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Approve a fifth contract amendment with Bay Area Community Services (BACS) for $660,642 for a total amount of $3,203,328 effective May 2, 2017 through June 30, 2017 to provide crisis aftercare services, urgent respite housing, and transitional housing services; and Authorize the County Administrator to execute the amendment
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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 approve a fifth contract amendment with Bay Area Community Services (BACS) for $660,642 for a total amount of $3,203,328 effective May 2, 2017 through June 30, 2017 to provide crisis aftercare services, urgent respite housing, and transitional housing services; and Authorize the County Administrator to execute the amendment
SUMMARY:
In November 2004, California voters passed Proposition 63-also referred to as the Mental Health Services Act (MHSA)-which imposes a one percent income tax on personal income in excess of $1 million to provide funding to support County mental health programs. There are five funding streams of MHSA: Prevention and Early Intervention (PEI); Community Services & Supports (CSS), Innovation (INN); Workforce Education and Training (WET); and Capital Facilities and Technological Needs (CFTN). MHSA programs address a broad continuum of prevention, early intervention, and direct services along with the necessary infrastructure, technology and training elements to effectively support the mental health system. Counties administer the MHSA programs, and are required to create and implement, with the local community, three-year integrated plans.
On January 24, 2017, the Board of Supervisors approved the Mental Health Services Act (MHSA) FY2016/17 Annual Update and the Three Year Integrated Plan for Fiscal Years 2017/18 through 2019/20.
BACS provides the CSS Relapse Prevention and Crisis Aftercare program for adults with serious mental illness who have recently experienced a crisis and have been discharged from an inpatient facility or the crisis stabilization unit. The program includes case management, brief treatment, peer support and respite housing services and is now being expanded to increase the urgent respite component and to include transitional housing services for individuals with serious mental illness at risk of hospitalization. In FY2015/16, the existing program served 120 unduplicated clients and assisted in reducing inpatient hospitalizations by 22.6% and achieving a 12% recidivism rate (total number of clients readmitted to an inpatient facility within 30 days of discharge). Through March 30, 2017, BACS has served 123 unduplicated clients and has assisted in maintaining a 12% recidivism rate.
The expanded urgent respite housing will be used for consumers who would benefit from 24/7 monitoring and support but that do not qualify for a Crisis Residential Treatment program or placement in an inpatient setting following presentation to the Crisis Stabilization Unit. A program supervisor and peer counselor will provide on-site support and case management to individuals accessing the urgent respite and transitional housing services. Both the respite and transitional housing components will help to prevent homelessness for individuals with serious mental illness and are expected to also reduce recidivism and re-hospitalization. The transitional housing units will primarily be used for consumers who are stepping down from inpatient facilities and/or are considered to be harder to house. Additional funds are necessary to ensure the facility is ready for mental health consumers to begin to reside in the transitional housing units which will include start-up furnishings and necessary renovations to ensure units are livable.
Due to a shortage of shelter beds in Fairfield, the BACS Fairfield respite location has been utilized to provide urgent short-term respite housing including on-site peer support and case management services for seriously mentally ill adult consumers. In order to support a higher volume of mental health consumers in need of urgent respite housing, a large portion of the aftercare contract funds were utilized. In FY2015/16, BACS provided respite housing for 131 unduplicated individuals; from July 1, 2016 through March 30, 2017, BACS has provided respite housing for 208 unduplicated individuals. This unintended overutilization has exhausted the current aftercare contract and an amendment is needed to continue services through the end of the fiscal year. The Department is requesting an increase to the contract to continue to provide the direct aftercare mental health services through June 30, 2017 and to initiate the transitional housing component.
FINANCIAL IMPACT:
The recommended contract amendment for BACS is included in the Department’s FY2016/17 Approved Budget and is fully funded by MHSA revenue. There is no additional impact to the County General Fund.
DISCUSSION:
BACS Aftercare program provides peer recovery supports, multidisciplinary coordination, case management, direct mental health services, medication management and respite housing.
On September 27, 2016, the Board of Supervisors approved a California Housing Finance Authority contribution agreement with Bay Area Community Services to purchase a property at 345 Travis Blvd in Fairfield to provide transitional housing services with supportive care to individuals with serious mental illness. The property is comprised of two buildings: the front structure is a single family home utilized for the Respite program which provides consumers up to three days of housing and case management to link consumers to necessary services; and the back structure is a seven unit apartment complex with 2 bedrooms in each unit, which will be used to house up to fourteen consumers, two consumers per unit for six to twelve months while more permanent housing options are secured. The City of Fairfield has agreed to supply site-based Housing and Urban Development (HUD) vouchers for each of the seven transitional housing units which will be used to augment consumers’ rent and support the physical plant. Consumers will receive case management needed to live independently. Part of the additional funding will allow for on-site peer counselors to ensure that consumers in respite and transitional housing units have ready access to timely peer intervention and linkage to services thus decreasing recidivism and re-hospitalization. The additional funding will also provide meals for Respite clients three times a day and one meal for transitional housing clients.
With the expansion of the Aftercare contract to include respite services and transitional housing, the contract will be separated to three different contracts beginning fiscal year 2017/18. This split will allow the Department to better track utilization of the programs, performance outcomes and the corresponding funding. The Division monitors outcomes including the key measures of the total number of inpatient hospitalizations per fiscal year, the total number of clients who are readmitted to an inpatient facility within 30 days of discharge to the community, and the number of clients who receive a follow up psychiatry appointment within 30 days of discharge which directly impacts recidivism rates.
This is the fifth amendment for Bay Area Community Services. The first amendment was on June 23, 2015 which increased the contract by $742,683 with a new contract amount of $2,542,686. The second amendment, which was dated February 23, 2016, was an amendment to the scope of work. On June 30, 2016, the third amendment adjusted the budget to include a Repair and Maintenance line item but did not modify the contract amount. On February 6, 2017, the fourth amendment adjusted the budget again but did not modify the total contract amount.
ALTERNATIVES:
The Board may choose not to approve the proposed amendment. However, this is not recommended as it would limit peer support for individuals served through the BACS Aftercare program who are at high risk for re-hospitalization and prevent the usage of a housing facility for seriously mentally ill consumers who are homeless or at risk of homelessness.
OTHER AGENCY INVOLVEMENT:
The operation of the Relapse Prevention and Crisis Aftercare Program which includes, respite and transitional housing was approved by community stakeholders as reflected in in the recently approved MHSA Annual Update FY 2016/17 and the Three-Year Integrated Plan FY 2017/18 through 2019/20.
The City of Fairfield has agreed to supply site-based Housing and Urban Development (HUD) vouchers for each of the seven transitional housing units which will be used to augment consumers’ rent and support the physical plant. Solano County Behavioral Health will be funding the direct services provided by BACS to include peer support, case management, and general housing support.
County Counsel has reviewed the contract for legal sufficiency.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION