Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health and Recovery Services
Subject: Agreement with Felton Institute for Outpatient Mental Health Services and Aftercare Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Felton Institute for outpatient mental health services and aftercare services, for the term of June 1, 2025 through June 30, 2028, in an amount not to exceed $5,962,225.
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BACKGROUND:
Felton Institute (Felton) is the Bay Area's oldest, nonsectarian, nonprofit charitable social services provider. In collaboration with the University of California San Francisco, Felton delivers prevention and recovery services for early-onset psychosis.
Through its (re)MIND and Bringing Early Awareness and Management (BEAM) programs, Felton provides mental health services to youth and young adults in the Bay Area. (re)MIND is a coordinated specialty care model, an evidence-based monitored approach that targets individuals at high risk of experiencing a psychotic episode and individuals having had such experiences within the past five years. Felton also provides aftercare services for program graduates to support the maintenance of gains achieved in psychosis and early intervention treatment. BEAM provides early intervention for the treatment of bipolar spectrum disorders by intervening early with evidence-based, culturally competent assessment, diagnosis, and interventions. Both services teach the clients to manage their condition and move towards remission and recovery.
In 2011, under the San Mateo County Mental Health Services Act (MHSA) Prevention and Early Intervention Plan, which includes the prevention of early psychosis, Behavioral Health and Recovery Services (BHRS) conducted research on programs in the Bay Area that provided services deemed essential by community partners and BHRS staff. Such services include public education, outreach and engagement, a rigorous diagnostic process, cognitive behavioral therapy for early psychosis, algorithm-guided medication management, multifamily psycho-education groups, computer-based cognitive rehabilitation, education and employment support for clients, co-occurring treatment, and case management. The research found that Felton provided an approach aligned with BHRS's MHSA plan and that (re)MIND and BEAM were the only local programs successfully incorporating elements deemed essential by BHRS. As a result of the research and the continued need for early prevention of early psychosis services, BHRS has contracted with Felton (formerly Family Service Agency of San Francisco) since 2011.
DISCUSSION:
Felton continues to be a leader in providing evidence-based programs for early psychosis in San Mateo County and across the State of California.
As of 2023, Felton is the only provider in San Mateo County participating in the Early Psychosis Intervention Program in California designed to improve the quality of services and measure the impact of treatment. Also, Felton is the only community-based provider in the San Francisco Bay Area implementing the full continuum of early psychosis coordinated specialty care as defined by the National Institute of Mental Health and the Substance Abuse and Mental Health Services Administration. In addition, Felton is the only early psychosis provider in the San Francisco Bay Area and the only program in California offering services to those persons diagnosed with Bipolar and Mood Disorders with psychosis, along with aftercare services.
The County Procurement Department has preliminarily approved a waiver request to proceed to this Board for final approval of the waiver. Given the uniqueness of Felton’s provided services, BHRS is requesting that this Board waive the requirement for the Request for Proposals process and contract with Felton for the continuous service delivery of BEAM and (re)MIND in San Mateo County for the term of June 1, 2025 through June 30, 2028, in an amount not to exceed $5,962,225.
The resolution contains the County’s standard provisions allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
The County Attorney has reviewed and approved the agreement and resolution as to form.
BHRS provides a range of services to promote wellness and recovery and to support clients remaining in the lowest possible level of care. It is anticipated that 50% of clients will experience a decrease in the number of days hospitalized after starting the program.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Actual |
FY 2025-28 Projected |
|
Percentage of clients who experience a decrease in the number of days hospitalized after starting the program |
50% 15 clients |
50% 15 clients |
COMMUNITY IMPACT:
This agreement will positively impact the behavioral health of all residents between the ages of 14 and 35 years old who are experiencing their first psychotic episode regardless of insurance status. This agreement will impact clients from our marginalized communities who we understand experience a higher rate of disparities. By utilizing MHSA funding, marginalized communities - including unserved and underserved racial, ethnic, and cultural groups - will be provided with early intervention utilizing evidence-based treatments. Given this, continued MHSA funding will allow Felton to provide specialized early intervention services for psychosis to an unserved and underserved racial, ethnic, and cultural population.
FISCAL IMPACT:
The term of the agreement is June 1, 2025 through June 30, 2028. The amount of the agreement is not to exceed $5,962,225, for the three-year term. Funds in the amount of $2,050,567 are included in the BHRS FY 2025-26 Recommended Budget. Of that amount, $1,090,944 will be funded by MHSA, $596,000 by Medi-Cal Reimbursement, $132,534 by 2011 Realignment, $36,000 by Third-Party, and $195,089 by Net County Cost. Similar arrangements will be in place for FY 2026-27.
BHRS is changing the methodology used to pay contracted providers that are currently paid on a 1/12th, monthly advance. Specifically, BHRS is changing the payment methodology for most contracts to fee-for-service and payments will be made in arrears. Additionally, in previous fiscal years, BHRS was granted an exception to pay providers during the accounting “blackout period” in July and August. This exception will no longer be available.
To facilitate these changes, BHRS has agreed to one three-month pre-pay for July-September of FY 2025-26 to qualifying providers. This payment will be reconciled in November. This payment must be made in June 2025. However, to make this payment, an ATR is needed. One ATR for all the impacted contracts will be submitted on the May 22, 2025 Board agenda. There will be no pre-pays in subsequent fiscal years.