6-67 Program Locator County Health Heath Department Mental Health Administration Mental Health Youth Services Mental Health Adult Services Headline Measures 200 150 100 50 0 100% 80% 60% 40% 20% 0% Number of Out-of-Home Placements 163 160 154 160 160 02-03 03-04 04-05 05-06 06-07 Percent of Survey Respondents Who Agree or Strongly Agree They Are Satisfied with Services 02-03 03-04 04-05 05-06 06-07 Parents 94% 89% Youth 80% Data Development Measures Program staff are working on the development of a future Headline Measure that will monitor compliance with the AB 3632 mandate that all County mental health programs provide services as specified in each student s Individual Education Plan. AB 3632 services have been restructured in collaboration with the County Office of Education and local school districts. A Central Assessment Team (CAT) has been established to conduct all AB 3632 assessments. The goal of this team is to ensure adherence to timelines, provide consistent assessments, and facilitate timely access to services to both consumers and education staff. Following implementation of the CAT in September 2004, 101 referrals have been received. The new Headline Measure will track the average number of days from referral to completion of mandated assessments. Data are expected to be available by July 2005. Program Outcome Statement Mental Health Youth Services provides a wide range of child and family-focused mental health and therapeutic support services to children, adolescents, and their families in collaboration with caregivers, schools, other agencies, and the community in order to promote individual and family strengths, maintain youth in their homes and schools, and ensure mental health, well-being and safety for those youth and families served. The involvement of families and/ or caregivers at all levels of the system helps to achieve these outcomes. Services and Accomplishments Mental Health Youth Services contributes to the goals of the Shared Vision 2010 commitment to Ensure Basic Health and Safety for All by providing the support necessary to maintain youth in the community through comprehensive mental health services in County clinics, schools, Juvenile Hall, and clients homes; and by contracting with agencies and individual professionals to provide specialized mental health services that meet the needs of youth placed out-of-county. Youth Services has successfully collaborated for many years with partner agencies Juvenile Probation, the Human Services Agency (Child Welfare and Alcohol and Drug programs), Public Health, and schools to ensure effective collaboration in providing services to youth and their families. Program priorities include evaluating the effect of interventions on youths emotional well being and behavior, in successfully maintaining youth in the community, and avoiding group home level placements. The Canyon Oaks Youth Center (COYC) accepted its first youth placement in August 2003. The primary goal of COYC is to stabilize and return youth to the community or provide them with a lower level of care within the shortest possible time. COYC has served 29 youth and their families as of January 2005 with all youth being discharged at or prior to one year from admission. One of the main goals continues to be the return of youth placed out-of-county; during FY 2004-05 there were seven youth admitted to COYC from out-of- County placements. In addition, the Foster Care Group Home Provisional Rate Audit was successfully completed, which approved Rate Care Level 14 reimbursement, the highest State rate of reimbursement. The COYC evaluation outcomes for the first year of operation reflected a Parent Satisfaction rate of 96%.
6-68 The following are major accomplishments in the current year: Fully complied with new State Medicaid requirements for Day Treatment Services and Therapeutic Behavioral Services Established a Central Assessment Team for AB 3632 services Implemented an Evidence-Based Practice with Juvenile Justice population Story Behind Baseline Performance Headline Measure 1 monitors progress toward the important goal of decreasing the number of youth in out-of-home placements at the group home level, and maintaining these youth in the community with their parents and caregivers. This has required increased collaborative, intensive community-based services. The Wrap- Around Program, a collaborative model with funding from the State Department of Social Services, has been implemented for several years in partnership with Juvenile Probation and the Human Services Agency (HSA) to target up to 20 youth who are at risk of being placed in high level group homes. This program also provides intensive community-based services to ensure the successful transition of youth from group home level placements to their homes in the community. Funds that would have gone towards the cost of placement are instead being used to develop and implement individualized, strength-based, culturally-competent, and familyfocused plans to keep these youth in the community. This program has also been working collaboratively with the Girl s Juvenile Drug Court Expansion Program, a program targeting adolescent females who are wards of the court with substance abuse issues, most of whom also have significant mental health issues. These adolescents are all at risk of placement in group homes. Customer satisfaction is indicated in Headline Measure 2 by the percent of survey respondents (youth and parents) who agree or strongly agree that they are satisfied with services. The Statemandated tool for measuring satisfaction was changed in FY 2003-04 and results using the new tool show that parents have higher satisfaction with services received than do youth; however, this rate is projected to decrease in FY 2005-06 because of budget constraints. The two-year customer satisfaction target has been set at a Countywide standard for both parents and youth. In FY 2004-05, Mental Health Youth Services was one of seven counties selected by the California Institute of Mental Health to participate in a two-year Functional Family Therapy (FFT) development initiative. FFT is an Evidence-Based Practice that is family focused and strength-based. These home-based services are provided to youth ages 10 to 18 involved in the Juvenile Justice system. Services have been used effectively with diverse client populations and families in reducing recidivism. Implementation of FFT is part of a program redesign to increase the effectiveness of services provided to Juvenile Probation. Mental Health Youth Services has engaged in collaborative planning with Public Health and the Human Services Agency to develop a Partners for Safe and Healthy Children (PSHC) initiative that was approved by the Board of Supervisors on March 8, 2005. This program will provide comprehensive services to children ages 0-5 that are either dependents of the court or on voluntary status due to abuse and/or neglect, as well as their parents and/or caregivers. Gathering of information and initial training on the most effective Evidence-Based Practices in treating these youth and their families has been completed. Major challenges over the next two years will be: To implement new and expanded services through the resources provided by the Act to improve the Youth and Youth to Adult Systems of Care To provide AB 3632 services within funding and contractual agreements, contingent upon State and local budget and service mandates To redesign mental health services to youth involved with the Child Welfare or Juvenile Probation programs, in collaboration with Child Welfare Services and Juvenile Probation, in order to increase effectiveness and serve target populations within available resources To plan for optimal operation of COYC following approval of State DHSS administrative waiver To plan for transition to the new Youth Services Campus Program Priorities The Mental Health Youth Services program will meet performance targets by doing the following: Maintain Out-Of-Home Placements at 160 or Less Shorten the length of stay in group home placements through placement of Seriously Emotionally Disturbed (SED) youth at Canyon Oaks Expand the use of the Wrap Around Program as an alternative to placement or to shorten the length of stay for Juvenile Probation or Child Welfare involved youth Achieve an Overall Customer Satisfaction Rating of at least Centralize access processes and expand communication, increasing parent understanding of available services Sustain access to services through restructuring geographic access and language capabilities Maximize Third-Party Revenues Increase Medi-Cal, Healthy Families, and Healthy Kids health care insurance coverage for youth services through referrals and follow-up Maximize Efficiency and Cost Effectiveness of Services Evaluate the efficiency and cost effectiveness of FFT Evidence- Based Practice for high-risk youth Extend to contract service providers implementation and use of the CALOCUS assessment instrument as a tool for assessing appropriate levels and intensity of care Maximize parent/caregiver participation at all levels of the Youth System
6-69 Performance Measures Summary Table Performance Measures FY 2002-03 FY 2003-04 FY 2004-05 FY 2005-06 FY 2006-07 What/How Much We Do Number of clients served: - Intensive - Non-Intensive - Early Intervention (1) 784 1,408 459 711 1,451 452 637 1,322 359 720 1,800 360 720 1,800 400 Number of new clients: (2) - Intensive - Non-Intensive - Early Intervention 487 1,052 311 550 1,100 320 575 1,150 375 How Well We Do It (Quality) Percent of survey respondents who agree or strongly agree that they are satisfied with services received: (3) - Parents - Youth 94% 89% 80% Percent of survey respondents who agree or strongly agree that the client is better at handling daily life: - Parents - Youth 80% 83% 77% 71% 71% 72% Average number of days from receipt of parental consent to completion of AB 3632 mandated assessments (data development) Is Anyone Better Off? (Outcome) Average monthly census of out-of-home placements at the group home level Countywide by Mental Health, Probation, and Human Services Agency Average monthly census of out-of-home placements at the group home level by Mental Health Implementation of nationally recognized clinical Evidence-Based Practices 163 160 154 160 160 9 11 10 11 11 1 1 1 (1) The decrease beginning in FY 2004-05 is the result of a reduction in contracted services due to budget constraints. This data will increase with implementation of new services funded by the MHSA. s will be reevaluated following clarification of specific MHSA allocations. (2) New measure beginning in FY 2004-05. (3) Beginning in FY 2005-06 a Countywide standard of has been established for customer satisfaction.
6-70 Resource Allocation Summary 2003-04 2004-05 Revised 2004-05 Adopted 2005-06 Change 2005-06 Adopted 2006-07 Salary Resolution 142.0 143.0 141.0 153.0 12.0 153.0 Funded FTE 131.1 132.3 130.2 140.3 10.0 140.3 Total Requirements 14,488,220 15,588,982 17,629,224 20,052,761 2,423,537 20,051,341 Total Sources 11,239,444 12,424,499 14,618,677 15,533,606 914,929 15,593,172 Net County Cost 3,248,776 3,164,484 3,010,547 4,519,155 1,508,608 4,458,169 NCC Breakdown State EPSDT Match 145,000 145,000 145,000 COLAs for Providers 158,009 193,065 35,056 193,065 Mandated Services 1,763,425 2,650,000 886,575 2,650,000 Non-Mandated Services 944,113 1,531,090 586,977 1,470,104 Program Net County Cost The portion of this program s FY 2005-06 which is funded by the General Fund or Net County Cost (NCC) is $4,519,155 or 22.5% of Total Requirements. Of this amount, $4,074,904 or 96.6% is discretionary. This discretionary amount includes Mandated Services currently provided with no maintenance-of-effort or local match requirements, and Discretionary Services that include unfunded portions of Mental Health/Probation services at Hillcrest, Pre to Three program, Daly City Youth Health Center, Edgewood Child Abuse Program, and yearly contribution to the out-of-home placement fund collaborative. FY 2005-06 Program Funding Adjustments The following are significant changes from the FY 2004-05 Revised Budget to the FY 2005-06 : 1. Adjustments to Provide Current Level of Services Budget adjustments have been made to meet performance targets: inclusion of merit increases and negotiated labor increases; position adjustments that resulted in a net increase of one position with no overall change in Mental Health Division staffing total; increased facility rent expense; increased ISD charges associated with lease of additional PCs and allocation of ISD expense to budget units; increased independent contract expense for Child Psychiatrists; and reduction in Intrafund Transfers from the Human Services Agency for various Youth Services Programs. 367,553 1,145,735 461,052 0 1,239,234 1 2. Partners for Safe and Healthy Children (PSHC) Addition of five positions one Community Program Specialist II and four Psychiatric Social Worker IIs supports the program priority of achieving an overall customer satisfaction rating of at least by staffing the new PSHC program. This action reconciles to the Salary Ordinance Amendment (SOA) approved by the Board of Supervisors on March 29, 2005. The positions are fully offset by Medi-Cal, Supportive Therapeutic Options Program (STOP), Child Welfare System Improvement Plan (SIP), and grant funding. 299,607 549,345 (249,738) 0 0 5
3. Add Mental Health Program Specialist Addition of one Mental Health Program Specialist position contributes to the program priority of maintaining out-of-home placements at 160 or less by providing supervision of the 18 Residential Counselor IIs at Canyon Oaks who staff the facility on a 24/7 basis. The position will be fully funded by State Department of Social Services residential care rates, Medi-Cal, and Realignment. 6-71 89,937 89,937 0 0 0 1 4. Convert Extra Help Positions to Permanent Status Conversion of three Extra Help positions to permanent status supports meeting performance targets by addressing long-term workload needs and facilitates achievement of high customer satisfaction ratings. One Marriage and Family Therapist II position is added to Youth Services Case Management to provide individual and group therapeutic counseling and case management services to clients having basic and/or severe emotional, family, and/or social adjustment problems. Substance Abuse and Administration (SAMHSA) funding and a reduction in Extra Help expenditures will fully cover costs. In addition, 2.6 FTE Occupational Therapist II positions are added at the Therapeutic Day School to ensure maintenance of required staff-to-client ratios for operation as a Day Treatment Intensive Program under Medi-Cal. Positions will be fully funded through additional Medi-Cal claiming and reductions in Extra Help appropriation. 56,430 56,430 0 0 0 3 5. Delete Community Worker One vacant Community Worker II position is deleted. This adjustment offsets the conversion of an Extra Help position to permanent status in the Children s Health Initiative program within Health Administration. 0 (29,877) 0 0 (29,877) (1) 6. Youth Services Center One-time Start-up Costs One-time appropriations are being added for the Mental Health unit at the new Youth Services Center, which is scheduled to open in June 2006. Costs include purchase and installation of work stations, relocation of voice and data lines, moving expenses, startup training, and other one-time expenses. Funding from Non-Departmental Reserves will cover these costs. 0 299,251 0 0 299,251 0 7. Supervising Mental Health Clinician for Family Resource Centers Addition of one Supervising Mental Health Clinician-E supports the program priority of maximizing the efficiency and cost-effectiveness of services by providing clinical supervision for staff at Family Resource Centers throughout the County. This position is fully funded by the Human Services Agency. 0 96,731 (96,731) 0 0 1 8. Mental Health Program Specialist for Wraparound Program Addition of one Mental Health Program Specialist position supports the program priority of maintaining out-of-home placements at 160 or less by providing leadership for the Wraparound Program, a collaborative program with Child and Family Services and Juvenile Probation that provides intensive case management, treatment, and support services to Seriously Emotionally Disturbed (SED) youth involved in Juvenile Justice or Child Protective Services. The program will be expanded into a full partnership program with the implementation of the Mental
6-72 Health Services Act and this position will coordinate the expansion. The costs will be fully covered by Early and Periodic Screening, Detection, and Treatment (EPSDT), Medi-Cal, and collaborative out-of-home placement revenues, with no increase in Net County Cost. 20,150 81,252 (61,102) 0 0 1 9. Mental Health Program Specialist for Partnership for Safe and Healthy Children (PSHC) This adjustment supports meeting performance targets by addressing operational requirements. One Mental Health Program Specialist position is being added to provide clinical supervision and service coordination, including court documentation-related activities, for the Partners for Safe and Healthy Children (PSHC) program. The number of Child Protective Services (CPS) referrals and resulting caseload has increased significantly due to implementation of the Human Services Agency's "System Improvement Plan," and has required increased attention to the safety and treatment needs of high risk and vulnerable infants and children aged six years and under. The costs will be fully covered by Medi-Cal and Realignment revenues, with no increase in Net County Cost. 81,252 81,252 0 0 0 1 TOTAL FY 2005-06 PROGRAM FUNDING ADJUSTMENTS 914,929 2,370,056 53,481 0 1,508,608 12 FY 2006 07 Program Funding Adjustments The following are significant changes from the FY 2005-06 to the FY 2006-07 : 10. Adjustments to Provide Current Level of Services Budget adjustments have been made to meet performance targets: inclusion of merit increases, annualization of negotiated increases, and additional revenue from third party sources and claiming. 59,566 297,831 0 0 238,265 0 11. Youth Services Center One-time appropriations for program start-up have been eliminated. 0 (299,251) 0 0 (299,251) 0 TOTAL FY 2006-07 PROGRAM FUNDING ADJUSTMENTS 59,566 (1,420) 0 0 (60,986) 0