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Approve a first contract amendment with Pacific Clinics for $145,086 for a total contract amount of $2,969,252 to expand community-based countywide mobile crisis services for the current period through June 30, 2024; and Delegate authority to the County Administrator to execute the amendment and any subsequent amendments, with County Counsel concurrence, up to an aggregate of $74,999
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Published Notice Required? Yes _____ No __X__
Public Hearing Required? Yes _____ No __X__
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services recommends that the Board of Supervisors approve a first contract amendment with Pacific Clinics for $145,086 for a total contract amount of $2,969,252 to expand community-based countywide mobile crisis services for the current period through June 30, 2024; and delegate authority to the County Administrator to execute the amendment and any subsequent amendments, with County Counsel concurrence, up to an aggregate of $74,999.
SUMMARY:
Solano County’s Mental Health Services Act Three-Year Plan FYs 2023/26 and the Suicide Prevention Strategic Plan 2021 support ongoing efforts to provide a comprehensive array of behavioral health services encompassing prevention, early intervention and treatment services along with the necessary infrastructure, technology and training elements to effectively support the mental health system. The Mental Health Services Act (MHSA) currently requires counties to provide countywide suicide prevention services and supports through the Prevention and Early Intervention (PEI) funding component. Community-based mobile crisis became a new benefit, or entitlement, under the Mental Health Plan as of January 2023.
On July 25, 2023, the Board of Supervisors approved a contract with Pacific Clinics for $2,824,166. This first amendment increases the contract by $145,086 for a total contract amount of $2,969,252 for FY2023/24 for the expansion of community-based mobile crisis intervention services to Solano County residents 24 hours a day, 7 days a week, 365 days a year as mandated by the State’s Department of Health Care Services (DHCS).
FINANCIAL IMPACT:
The Pacific Clinics community-based contract is funded with the Mental Health Services Act (MHSA) Prevention and Early Intervention (PEI) component as outlined in the MHSA Three-Year Plan FYs 2023/26. In addition to MHSA funding, Crisis Care Mobile Units (CCMU) grant funding will reimburse some contract expenses.
Appropriations for this contract are included in the Department’s FY2023/24 Working Budgets. There is no impact on the County General Fund.
DISCUSSION:
Pacific Clinics provides service to Solano County residents, both children and adults, who are acutely suicidal, homicidal, or gravely disabled. This service delivers community-based interventions instead of, or in conjunction with, law enforcement. The community-based mobile crisis teams are field-based and respond to community members where the crisis occurs; they work to engage, de-escalate, and resolve situations in the community, preventing unnecessary emergency department visits, crisis stabilization unit utilization, and law enforcement involvement.
May 2024 marks the third year of service of the community-based mobile crisis service since the Board approved the initial mobile crisis services pilot on February 9, 2021. During FY2021/22, the community-based mobile crisis team responded to 358 calls representing 306 unduplicated clients aged 8-95. Sixty percent (60%) of the 358 calls were stabilized in the community through clinical intervention, peer support, safety planning, and linkage to ongoing resources. The remainder of these individuals were placed on 5150 holds and provided appropriate crisis stabilization or inpatient hospitalization care to support their acute crisis needs.
During FY2022/23, the community-based mobile crisis program encountered staffing challenges and had to pause services on September 26, 2022. Between July 1 and September 26, 2022, the community-based mobile crisis team responded to 90 calls for 85 unduplicated clients ages 9-88. Solano County Behavioral Health and Pacific Clinics worked closely to address the staffing challenges, and successfully onboarded multiple teams to relaunch services. Discussions were also held with the City of Vallejo to clarify the role of its iHart program and establish protocols for County operated mobile crisis response in the City. Services were relaunched in May 2023. Between May 2023 through March 2024, the community-based mobile crisis team responded to 306 calls representing 267 unduplicated clients ages 8-93 years. Eighty percent (80%) of the 306 calls were provided with safety planning and linkages to other resources, while the rest (20%) of the clients were placed on 5150 holds.
Over the last year, a tiered relaunch has allowed the program to work with local law enforcement and community partners to support a 24 hours a day, 7 days per week, 365 days a year implementation, which began on April 15, 2024. On May 15, 2024, a mobile crisis community phone line operated by Pacific Clinics was launched (707-806-0866).
The recommended contract amendment will support the comprehensive onboarding of clinicians, structured salary with pay differentials, additional clinicians for dispatch and clinical consultation on weekends and overnight hours, infrastructure support to dispatch teams with on call clinicians to ensure coverage when a clinician is out or unable to work, equipment and vehicle costs, and costs of mandated training.
The contract amendment will support continuing these entitlement services in adherence to the California Department of Health Care Services (DHCS) Behavioral Health Information Notice (BHIN) 23-025 which requires Medi-Cal behavioral health delivery systems to establish or contract with providers to create qualifying mobile crisis teams.
ALTERNATIVES:
The Board may choose not to approve the Pacific Clinics contract amendment. This is not recommended as Pacific Clinics provides mobile crisis services, responding to community members experiencing a crisis where the crisis is occurring, thus reducing the use of hospital emergency departments, the crisis stabilization unit, inpatient facilities, law enforcement resources, and adherence to a statewide mandate.
OTHER AGENCY INVOLVEMENT:
The Solano County MHSA Three-Year Plan and annual updates are developed in collaboration with community members, which includes consumers, family members, county and community-based providers, law enforcement, local educational agencies, veterans, faith-based organizations, and the local Behavioral Health Advisory Board. The community and the MHSA Steering Committee continue to endorse funding community-based mobile crisis efforts. All law enforcement agencies and other community partners have been involved in the program development and implementation.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION