Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health, and Recovery Services
Subject: Agreement with Alternative Family Services, Inc. for Specialty Mental Health Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Alternative Family Services, Inc. to provide Specialty Mental Health Services, for the term of March 1, 2024, through June 30, 2026, in an amount not to exceed $2,463,000.
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BACKGROUND:
In 2013, as a result of Katie A v. Bonta lawsuit settlement agreement with the Department of Health Care Services (DHCS), DHCS agreed to take a series of actions that transformed the way California children and youth who are in foster care or who are at imminent risk of foster care placement, receive access to mental health services. The settlement specifically changed the way a defined group of children and youth with the most intensive needs, referred to as “Katie A. subclass members”, involved with the Department of Children and Family Services (DCFS), are assessed for mental health services. It introduced three covered Specialty Mental Health Services (SMHS) for qualifying Medi-Cal beneficiaries under the age of 21. These three covered services are Intensive Care Coordination (ICC), In-Home Based Services (IHBS), and Therapeutic Foster Care Services (TFC).
In 2017, DHCS expanded ICC, IHBS, and TFC to all Medi-Cal-eligible clients under the age of 21, not just those involved with DCFS. In response, county mental health departments were required to expand services to all funded programs. To meet the DHCS requirement and provide appropriate services to eligible Medi-Cal beneficiaries, in April 2023, San Mateo County Health Behavioral Health and Recovery Services (BHRS) released a Request for Proposals, seeking proposals from qualified providers to provide SMHS, including IHBS, ICC, and TFC.
In October 2023, Alternative Family Services, Inc. (AFS) was elevated to provide these services. AFS is a private, non-profit community services agency that has been providing community-based behavioral health services since 2004. AFS currently provides SMHS in other Bay Area counties, including Alameda, Contra Costa, San Francisco, and Sonoma.
DISCUSSION:
SMHS includes TFC, IHBS, and ICC, and this range of vital programs is tailored to meet the diverse needs of children, youth, and families. Such services are more intensive and an adjunct to outpatient mental health services, encompassing community engagement, physical and mental health support, and crucial social assistance. SMHS incorporate trauma informed practices, recognizing and addressing the complex effects of trauma on the child/youths’ well-being.
Among the SMHS provided by AFS, TFC services are a short-term, intensive, highly coordinated, trauma-informed, and individualized SMHS. Qualifying children and youth clients with complex emotional and behavioral needs are placed with trained, intensely supervised, and supported TFC parents. AFS is responsible for ensuring the TFC parent meets the required qualifications to participate. The TFC parent and AFS will provide crisis intervention services as needed if a mental health crisis occurs within the home.
AFS will also provide ICC for eligible children and youth. ICC is a targeted case management service that facilitates assessment of care planning for, and coordination of services to beneficiaries under age 21 who are eligible for the full scope of Medi-Cal services and who meet medical necessity criteria for this service. ICC service components include assessment, service planning and implementation, monitoring, and transition support.
AFS will also provide IHBS, which are individualized, strength-based interventions designed to correct or ameliorate mental health conditions that interfere with a beneficiary’s functioning. IHBS help the child or youth build skills necessary for successful functioning in the home and community, as well as improving the family’s ability to help the child or youth successfully function in the home and community. IHBS are provided according to an individualized treatment plan developed by the Child and Family Teams (CFTs), in accordance with the Integrated Care Management Program, and in coordination with the family’s overall service plan.
Finally, SMHS includes the establishment of CFTs to be facilitated by AFS, as a collaborative relationship among a child, their family, and involved child-serving systems. The CFT works with the involved family towards a shared vision, allows for direct communication among team members, and positively impacts decision-making.
The resolution contains the County’s standard provision allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
The agreement and resolution have been reviewed and approved by the County Attorney as to form. This agreement is late due to lengthy negotiations between BHRS and AFS.
It is anticipated that 80 unduplicated clients will receive SMHS support services.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-26 Projected |
|
Number of unduplicated clients that receive SMHS support services |
80 unduplicated clients |
80 unduplicated clients |
FISCAL IMPACT:
The term of the agreement is March 1 ,2024 through June 30, 2026. The amount of the agreement is not to exceed $2,463,000 for the 28-month term. Of the agreement amount, $300,000 is included in the BHRS FY 2023-24 Adopted Budget. Of that amount, 50% will be funded by 2011 Realignment and 50% by Medi-Cal reimbursement. There is no Net County Cost. Similar arrangements will be in place for subsequent years.