HomeMy WebLinkAbout2019-06-18; City Council; ; Letter of Support for the County of San Diego FY 2019-20 Behavioral Health Services Division Budget(i) CITY COUNCIL
Staff Report
Meeting Date: June 18, 2019
To:
From:
Staff Contact:
Mayor and City Council
Scott Chadwick, City Manager
Jason Haber, Assistant to the City Manager
jason.haber@carlsbadca.gov or 760-434-2958
CAReview ~
Subject: Letter of Support for the County of San Diego FY 2019-20 Behavioral
Health Services Division Budget
Recommended Action
Authorize the Mayor to execute a letter in support of the county's proposed FY 2019-20
Behavioral Health Services Division budget.
Executive Summary
This report presents for City Council approval, a letter in support of the county's proposed FY
2019-20 Behavioral Health Services Division budget (Exhibit 1), as directed by the City Council at
the May 14, 2019, City Council meeting.
Discussion
The mission of the County of San Diego Behavioral Health Services Division is to make people's
lives healthier, safer and self-sufficient by delivering essential services in San Diego County.
The Behavioral Health Services Division Operational Plan and Budget Information, excerpted
from the County of San Diego CAO Recommended Operational Plan Fiscal Years 2019-2020 &
2020-2021 Presented to the Board of Supervisors on June 10, 2019 (Exhibit 2), provides a
detailed discussion of the division's services, accomplishments and objectives, as well as the
recommended budget changes for FY 2019-20 and FY 2020-21.
The county's recommended budget and operational changes include, but are not limited to, the
following:
Mental Health and Substance Use Disorder Services
• , Adding $50.3 million to Behavioral Health Services (BHS), bringing the annual budget to
$708.5 million for mental health and substance use disorder services, with emphasis on
crisis stabilization efforts and expanding the continuum of care, including:
o $25.3 million for enhanced mental health outpatient walk-in services, Assertive
Community Treatment services and 70 Psychiatric Emergency Response Teams
June 18, 2019 Item #7 Page 1 of 13
o 177 new mental health beds for various levels of need within the mental health
system
o 123 new positions in BHS including to County Psychiatric Hospital to address in-
patient capacity, new programs, and assisting contract partners in service
delivery.
Housing, Homeless and Eligibility Services
• $12.4 million for housing efforts for homeless families, disabled individuals, and
affordable housing projects.
• $17.2 million in the No Place Like Home program to create supportive housing for
persons experiencing or at risk of homelessness who need mental health services.
• Double the Innovative Housing Trust Fund by adding $25 million to boost the region's
inventory of affordable housing units. The full $SO million trust fund could result in as
many as 1,800 affordable units.
• Develop 700+ affordable housing units on excess County property.
• Over $225 million for homeless-related services.
• Over 1 million individuals assisted in achieving health insurance, food assistance and
cash aid.
Fiscal Analysis
No city funding is being requested at this time.
Next Steps
Should the City Council authorize a letter in support of the county's proposed FY 2019-20
Behavioral Health Services Division budget, such letter will be signed by the Mayor and
submitted to the County Board of Supervisors prior to the June 19, 2019, 5 p.m. deadline.
Environmental Evaluation (CEQA)
Authorizing a letter of support does not qualify as a "project" under the California
Environmental Quality Act (CEQA) per State CEQA Guidelines Section 15378, as it does not
result in a direct or reasonably foreseeable indirect physical change in the environment.
Public Notification
This item was noticed in accordance with the Ralph M . Brown Act and was available for public
viewing and review at least 72 hours prior to scheduled meeting date.
Exhibits
1. Letter in support ofthe county's proposed FY 2019-20 Behavioral Health Services Division
budget
2. Behavioral Health Services Division Ope rational Plan and Budget Information excerpted
from the County of San Diego CAO Recommended Operationa l Plan Fiscal Years 2019-2020
& 2020-2021 Presented to the Board of Supervisors on June 10, 2019
June 18, 2019 Item #7 Page 2 of 13
June 19, 2019
County of San Diego Board of Supervisors
1600 Pacific Highway, Room 402
San Diego, California 92101
Dear Members of the County Board of Supervisors:
C cityof
Carlsbad
I respectfully write to express the City of Carlsbad's support for the county's proposed FY
2019-20 Behavioral Health Services Division budget, especially as it relates to serving the critical
needs of North County communities.
The city appreciates and supports the county's efforts to address the needs of people with
mental health or substance use disorders, and those experiencing homelessness or at risk of
homelessness throughout the county. We believe that the proposed infusion of new funding will
significantly enhance the division's ability to fulfill its mission to make people's lives healthier, safer
and self-sufficient by delivering essential services in San Diego County.
The city has adopted a Homeless Response Plan that identifies the need for regional partnerships
and additional resources to address the broad range of circumstances affecting homelessness in
Carlsbad and throughout North San Diego County. Therefore, we strongly support the county,
other public agencies and local service providers that serve our residents in their efforts to
identify and secure essential services and help meet the critical need for behavioral/mental health
and addiction recovery programs.
As such, the City of Carlsbad wholeheartedly supports and encourages your approval of the proposed FY
2019-20 Behavioral Health Services Division budget.
Sincerely,
Matt Hall
Mayor
cc: Members of the City Council
Scott Chadwick, City Manager
Celia Brewer, City Attorney
City of Carlsbad City Council
City Hall 1200 Carlsbad Village Drive I Carlsbad, CA 92008 I 760-434-2820
June 18, 2019 Item #7 Page 3 of 13
al th Services
Mission Statement
To make people's lives healthier, safer and self-sufficient by
delivering essential services in San Diego County.
Department Description
Behavioral Health Services (BHS) provides mental health and
substance use disorder services to over 80,000 San Diego
County residents of all ages, which includes the expanded
capacity resulting from the implementation of the Drug Medi-
Cal Delivery Organized System (DMC-ODS). Services are
provided through 10 county operated programs, over 300
contracts and 800 individual fee-for-service providers.
BHS offers services across the lifespan through coordinated
systems of care. Inpatient health services are provided through
the San Diego County Psychiatric Hospital (SDCPH} and
Edgemoor, a Distinct Part Skilled Nursing Facility (DP-SNF).
BHS delivers services, in alignment with the priorities presented
in the HHSA Ten Year Roadmap for Behavioral Health Services,
to address the most serious behavioral health issues affecting
San Diego County residents. Services include, but are not limited
to, (the list below with numbers reflecting the end of Fiscal Year
2017-18):
♦ Access and Crisis Line-answer over 56,000 calls annually by
licensed clinical staff to provide crisis intervention and refer-
rals;
♦ Collaborative Courts-provide over 400 individuals court
directed substance use disorder and mental health treatment
services in lieu of prison time;
♦ Crisis Residential Services-provide mental health services
to over 2,800 adults who are experiencing a crisis and require
inpatient treatment;
♦ Crisis Stabilization Units (CSUs)-provide, short-term (less
than 24 hours) psychiatric emergency services for over 6,700
youth and adults through four 24/7 facilities;
♦ Friday Night Live Partnership-engage youth in alcohol and
drug prevention activities throughout 51 middle and high
school campuses countywide;
♦ Full Service Partnership (FSP) Programs-embrace a "what-
ever it takes" approach to treatment serving approximately
14,000 residents with a serious mental illness including those
who were homeless (or at-risk of homelessness) with linkages
to housing and employment services;
Exhibit 2
•••
♦ In-Home Outreach Team (IHOT) and Assisted Outpatient
Treatment (AOT)-offer services for people with a mental ill-
ness who are resistant to treatment in accordance with
Laura's Law; IHOT/AOT receives over 900 referrals with nearly
600 individuals accepted into the programs;
♦ Pathways to Well Being-supports the provision of Intensive
Care Coordination (ICC), Intensive Home-Based Services
(IHBS) and the development of the Child and Family Team
(CFT) for over 800 youth involved in Child Welfare Services, as
well as for youth receiving services in mental health treat,
ment programs who have multi-system involvement (Proba-
tion, Education, Regional Centers, etc.);
♦ Prevention and Early Intervention (PEI) Programs-support
mental health awareness, reduce stigma and discrimination
against individuals with mental illness and increase aware-
ness of suicide prevention;
♦ Psychiatric Emergency Response Teams (PERT)-pair a clini-
cian with law enforcement responding to 911 calls for individ-
uals who may be experiencing a mental health crisis, with the
goal of a more compassionate and effective handling of inci-
dents -in Fiscal Year (FY) 2018-19, the number of teams grew
from 50 to 70; In addition, PERT/EMS provides outreach and
engagement to high utilizers of the 911 EMS system. Similar
to the Crisis Assistance Helping Out On The Streets
(CAHOOTS) program, PERT/EMS responds to 911 EMS calls by
high utilizers with the goal of linking individuals to ongoing
services and decreasing the frequency of 911 calls and emer-
gency department transports;
♦ Regional Substance Use Disorder (SUD) Prevention Pro-
grams-utilize environmental prevention strategies and
media advocacy to work with community groups (including
youth) to change conditions that contribute to SUD-related
problems;
♦ Recovery Centers (RCs)-offer outpatient SUD treatment and
recovery services to over 4,000 individuals, which includes
specialized programming for pregnant and parenting moth-
0 HEALTH AND HUMAN SERVICES AGENCY CAO RECOMMENDED OPERATIONAL PLAN FISCAL YEARS 2019-20 AND 2020-21 233
June 18, 2019 Item #7 Page 4 of 13
■■ BEHAVIORAL HEALTH SERVICES
ers; services support participants who may have co-occurring
mental health treatment needs, as well as provide service
connections to support the individual's recovery;
♦ School-Based Mental Health Services-offer outpatient
mental health treatment in over 400 designated schools
throughout the County; services are known as Schoolink;
♦ Teen Recovery Centers (TRCs)-offer outpatient substance
use disorder treatment services to over 900 youth ages 12-17
through regionally based clinic locations and over 25 school-
based facilities; and
♦ Wraparound Programs-provide individualized and intensive
case management services to over 550 children and youth
with complex behavioral health service needs.
♦ Acute Inpatient Hospitalization Services-provide 24/7 care
and help patients of all ages deal with a mental health crisis,
become stabilized, and move ahead to a less restrictive level
of care. In Fiscal Year 2019-20, services in this category
include 82 beds at the San Diego County Psychiatric Hospital
and an additional 579 beds through contracted providers.
♦ Adult Residential Facilities-provide services in a home-like
residential facility to individuals with mental illness. who
require psychiatric treatment and psycho/social rehabilitative
services, with an estimated 37 beds serving clients in Fiscal
Year 2019-20.
♦ Long-Term Residential Care-include services in the follow-
ing settings: Institutions for Mental Disease (Mental Health
Rehabilitations Center, SNF/Special Treatment Programs),
Skilled Nursing Facilities (SNF) and Board and Care Facilities,
with an estimated 687 beds serving clients in Fiscal Year
2019-20.
♦ Edgemoor Distinct Part Skilled Nursing Facility-has a maxi-
mum bed capacity of 192 and provides 24-hour, long-term
skilled nursing care for individuals having complex medical
needs who require specialized interventions from highly
trained staff.
In addition to the services above, BHS participates in a number
of key initiatives, including but not limited to:
♦ Project One For All (POFA)-houses and treats over 900 indi-
vi_duals experiencing serious mental illness and homelessness
through comprehensive wraparound services paired with
housing. BHS provides outreach and engagement, treatment
and permanent supportive housing through its FSP Assertive
Community Treatment (ACT) programs;
♦ It's Up to Us-informs the public through a media campaign
to eliminate mental health stigma and prevent suicide, and
♦ Drug Medi-Cal Organized Delivery System (DMC-ODS)
Implementation-expands overall system capacity for treat-
ment of substance use disorders, which provides new and
enhanced services for our customers such as withdrawal
management, expanded case management, post-treatment
recovery servic.es, residential treatment; physician consulta-
tion and medication assisted treatment services. This trans-
formative blend of new and expanded services provide a full
continuum of integrated services based on their medical
needs throughout the recovery process, and is expected to
increase the number of people the County can serve by 30%
over a three-year period. Implementation began July 1, 2018.
In order to deliver these critical services, BHS has 987.50 staff
years, including medical professionals, and a budget of $708.5
mi/lion that includes payments made to care providers.
Strategic lniti_ative Legend
Q ® @ ®
BBH LS SE/T OE
0 -Audacious Vision
• -Enterprise Wide Goal
■ -Department Objective
For more information on alignment to the Strategic Initiatives,
Contributing Departments and External Partners, refer to· the
Group Description section within the Health and Human and
Services Agency Summary. Text that is followed by EWG
nomenclature indicates coordination with at least one other
department.
2018-19 Anticipated Accomplishments
Q Building Better Health
• Promote the implementation of a service delivery system
that is sensitive to individuals' needs
■ Linked 45% (54 of 120) of participants identified as Poten-
tial Laura's Law (PLL) candidates to services via In-Home
Outreach Team (IHOT) or via voluntary Assisted Outpatient
Treatment (AOT) program thus successfully diverting them
from court-ordered treatment.
■ Ensured 90% (1,350 of 1,500) of individuals who were
admitted to the San Diego Psychiatric Hospital (SDCPH),
were not readmitted within 30 days of discharge, demon-
strating accountability and commitment to outstanding
patient care.
■ Diverted 65% (3,575 of 5,500) of residents (of all ages) who
received crisis stabilization services from inpatient hospi-
talization. Crisis stabilization units provide 24/7, short-term
services (less than 24 hours) to individuals who are experi-
encing a psychiatric emergency.
■ Ensured 53% (451 of 850) of Full-Service Partnership/
Assertive Community Treatment (FSP/ACT) participants,
with a history of inpatient and emergency services use,
demonstrated a decrease in the use of these critical and
costly services, this measure includes individuals receiving
services under Project One For All. FSP/ACT services are the
highest level of outpatient care serving homeless individu-
234 CAO RECOMMENDED OPERATIONAL PLAN FISCAL YEARS 2019-20 AND 2020-21 HEAL TH AND HUMAN SERVICES AGENCY (I)
June 18, 2019 Item #7 Page 5 of 13
als (or at risk of homelessness) with a "whatever it takes,
24/7" approach to treatment which includes housing and
employment services.
■ Diverted 82% (1,722 of 2,100) of individuals who com-
pleted mental health treatment while residing in crisis resi-
dential beds from being readmitted to a crisis residential
program or hospital within 30 days of discharge, which
supports an individual's successful integration into the
community.
■ Ensured 95% (855 of 900) of adolescents had an appoint-
ment at a Substance Use Disorder (SUD) outpatient pro-
gram within 10 business days of requesting services.
■ Launched Schoolink, a rebranding of the behavioral health
services provided at schools that share successful strate-
gies for linking students to services. It also provides
resources for staff and providers on available services,
referral processes, roles and responsibilities, and best prac-
tices for outreach and communication.
@ Living Safely
• Plan, build and maintain safe communities to improve the
quality of life for all residents
□ Diverted 50% (3,950 of 7,900) of adults from psychiatric
hospitalization or incarceration through crisis intervention
services provided by the Psychiatric Emergency Response
Team (PERT). The PERT model pairs a clinician with law
enforcement to ensure appropriate response, which
includes linkages to needed services for individuals who
may be experiencing a mental health crisis. (LS2)
• Fully implement a balanced-approach model that reduces
crime by holding offenders accountable while providing them
access to rehabilitation
■ Ensured 98% (98 of 100) of clients who complete Drug and
Re-entry court program treatment had no new criminal
activity resulting in a conviction while enrolled in the pro-
gram.
@ Sustainable Environments/Thriving
• Create and promote diverse opportunities for residents to
exercise their right to be civically engaged and finding solu-
tions to current and future challenges
□ Provided training to 35,000 community members
countywide and enhanced community recognition of
suicide warning signs and mental health crises so they can
refer those at risk to available resources. These trainings
empowered community members to help connect others
to needed services and lessen the likelihood of negative
outcomes. (SE/T6)
BEHAVIORAL HEALTH SERVICES ■■
@ Operational Excellence
• Provide modern infrastructure, innovative technology and
appropriate resources to ensure superior service delivery to
our customers
□ Edgemoor Distinct Part Skilled Nursing Facility maintained
5 of 5 stars on the Centers for Medicare and Medicaid
Services (CMS) Rating System. The CMS Five-Star Quality
Rating System is a tool to help consumers select and
compare skilled nursing care centers using standards that
push the difficultly of achieving top tier performance.
Maintaining five stars ensured Edgemoor will remain in the
top 10% of skilled nursing facilities in California. (OE4)
■ Edgemoor Distinct Part Skilled Nursing Facility submitted
an application for the Malcom Baldrige National Quality
Award, the highest level of national recognition for perfor-
mance excellence and was one of 12 entities nationwide to
earn a prestigious site visit. While Edgemoor did not
receive the award this year, earning a place in the competi-
t ion demonstrated their commitment to service delivery
excellence.
■ Enhanced continuity of services for customers of all ages
exiting residential SUD treatment and throughout their
recovery process by collecting baseline data for customers
admitted to outpatient treatment within 10 days, as
required by the State. These efforts demonstrated an align-
ment of resources to increase care coordination as part of
the Drug Medi-Cal Organized Delivery System (DMC-ODS)
implementation and a commitment to improve outcomes
by supporting relapse prevention.
• Strengthen our customer service culture to ensure a positive
customer experience
■ Answered 95% (50,350 of 53,000) of calls to the Access and
Crisis Line (ACL) within an average of 60 seconds and pro-
vided timely access to for individuals seeking behavioral
health services.
• Pursue policy and program change for healthy, safe and thriv-
ing environments to positively impact residents
■ Reported accomplishments in alignment with the Visions
and Strategies outlined in the HHSA Ten Year Roadmap for
Behavioral Health Services from within the County, as well
as the achievements from community partners and stake-
holders groups.
■ Released the Suicide Prevention Action Plan Update 2018
to advance the community conversation on specific steps
everyone can take to reduce suicide. The Action Plan Stra-
tegic Framework was designed to bring together multi-sys-
tems of advocates, service providers, community members
and schools so they can advocate for those struggling with
mental health challenges.
(ll HEALTH AND HUMAN SERVICES AGENCY CAO RECOMMENDED OPERATIONAL PLAN FISCAL YEARS 2019-20 AND 2020-21 235
June 18, 2019 Item #7 Page 6 of 13
■■■ BEHAVIORAL HEALTH SERVICES
■ Unveiled "Stop Firearm Suicide SD," a new suicide preven-
tion educational campaign with a focus on reducing access
to guns for persons with suicidal ideation.
2019-21 Objectives
Q Building Better Health
• Promote the implementation of a service delivery system
that is sensitive to individuals1 needs
■ Link 45% (59 of 130) of participants identified as Potential
Laura's Law (PLL) candidates to services via In-Home Out-
reach Team (IHOT) or via Assisted Outpatient Treatment
(AOT) program thus successfully diverting them from court-
ordered treatment.
■ Ensure 90% (1,350 of 1,500) of individuals who are admit-
ted to the San Diego Psychiatric Hospital (SDCPH), are not
readmitted within 30 days of discharge, demonstrating
accountability and commitment to outstanding patient
care.
■ Divert 70% (4,410 of 6,300) of residents (of all ages) who
receive crisis stabilization services from inpatient hospital-
ization. Crisis stabilization units provide 24/7, short-term
services (less than 24 hours) to individuals experiencing a
psychiatric emergency.
■ Ensure 50% (600 of 1,200) of Full-Service Partnership/
Assertive Community Treatment (FSP/ACT) program partic-
ipants with a history of inpatient and emergency services
use, demonstrate a decrease iri the use of these critical and
costly services, this measure includes individuals served
under Project One For All. FSP/ACT services are the highest
level of outpatient care serving homeless individuals (or at
risk of homelessness) with a "whatever it takes, 24/7"
approach to treatment which includes housing and
employment services.
■ Divert 85% (2,295 of 2,700) of individuals who complete
mental health treatment while residing in crisis residential
beds from being readmitted to a crisis residential program
or hospital within 30 days of discharge, which supports an
individual's successful integration into the community.
■ Ensure 100% (900 of 900) of adolescents have an appoint-
ment at a Substance Use Disorder (SUD) outpatient pro-
gram within 10 business days of requesting services, as
required by the Centers for Medicare and Medicaid Ser-
vices.
■ Address the needs across the continuum of care for those
with behavioral health conditions, through enhanced data
analytics, improved care coordination, the establishment
of a regionally distributed and community located behav-
ioral healthcare hubs that will include a focus on crisis sta-
bilization, long-term residential care and prevention
activities.
® Living Safely
• Plan, build and maintain safe communities to improve the
quality of life for all residents
■ Divert 50% (5,500 of 11,000) of individuals of all ages from
psychiatric hospitalization or incarceration through crisis
intervention services provided by the Psychiatric Emer-
gency Response Team (PERT), which include linkages to
appropriate services. The PERT model pairs a clinician with
law enforcement to ensure appropriate response to an
individual who may be experiencing a mental health crisis.
To strengthen the continuum of care and provide alterna-
tives to emergency rooms or jails, Mental Health Crisis Sta-
bilization centers will be created regionally to provide
immediate access to behavioral health services for individ-
uals in need.
• Fully implement a balanced-approach model that reduces
crime by holding offenders accountable while providing them
access to rehabilitation
■ Ensure 95% (95 of 100) of clients who complete Drug and
Re-entry court program treatment will have no new crimi-
. nal activity resulting in a conviction while enrolled in the
program.
@ Sustainable Environments/Thriving
• Create and promote diverse opportunities for residents to
exercise their right to be civically engaged and finding solu-
tions to current and future challenges
■ Provide training to 35,000 community members county-
wide to enhance community recognition of suicide warning
signs and mental health crises so they can refer those at
risk to available resources. These trainings empower com-
munity members to be able to help connect others to
needed services and lessen the likelihood of negative out-
comes.
@ Operational Excellence
• Provide modern infrastructure, innovative technology and
appropriate resources to ensure superior service delivery to
our customers
■ Edgemoor Distinct Part Skilled Nursing Facility will main-
tain 5 of 5 stars on the Centers for Medicare and Medicaid
Services (CMS) Rating System. The CMS Five-Star Quality
Rating System is a tool to help consumers select and com-
pare skilled nursing care centers using standards that push
the difficultly of achieving top tier performance. Maintain-
ing five stars ensures Edgemoor will remain in the top 10%
of skilled nursing facilities in California.
■ Track and analyze the Third Next Available Appointment
(TNAA) in accordance with nationally recognized measures
to establish a baseline for offering timely appointments for
clients seeking Substance Use Disorder treatment. TNAA is
236 CAO RECOMMENDED OPERATIONAL PLAN FISCAL YEARS 2019-20 AND 2020-21 HEAL TH AND HUMAN SERVICES AGENCY ~
June 18, 2019 Item #7 Page 7 of 13
an industry standard that most closely reflects a program's
true access time as the first and second next available
appointments might be due to client cancellation or other
event that is not predictable or reliable.
■ Answer 95% (50,350 of 53,000) of calls to the Access and
Crisis Line (ACL) within 60 seconds to provide timely access
to for individuals seeking behavioral health services.
• Pursue policy and program change for healthy, safe and thriv-
ing environments to positively impact residents
■ Annually report accomplishments in alignment with the
Visions and Strategies outlined in the HHSA Ten Year Road-
map for Behavioral Health Services from within the County,
as well as the achievements from community partners and
stakeholders groups.
BEHAVIORAL HEALTH SERVICES ■■
Related Li nks
For information about mental illness, how to recognize symp-
toms, use local resources and access assistance, go to:
♦ www.Up2SD.org
For information about the Network of Care for Behavioral
Health, go to:
♦ www.SanDiego.NetworkOfCare.org
For additional information on the programs offered by the
Health and Human Services Agency, refer to the website:
♦ www.sandiegocounty.gov/hhsa
HEALTH AND HUMAN SERVICES AGENCY CAO RECOMMENDED OPERATIONAL PLAN FISCAL YEARS 2019-20 AND 2020-21 237
June 18, 2019 Item #7 Page 8 of 13
•• BEHAVIORAL HEALTH SERVICES
Performance 2017-18 2018-19 2018-19 2019-20 2020-21
Measures Actuals Adopted Estimated Recommended Recommended Actuals
Q Clinical Improvement in Children 89% N/A and Youth Who Complete Mental of 9,322 N/A N/A N/A
Health Treatment 1
PLL Candidates Successfully Linked . 50% 45% 45% 45% 45%
to Services4 of 278 of 120 of120 of 130 of130
SDCPH patients not readmitted 92% 85% 90% 90% 90%
within 30 days4· s of 1,460 of 1,500 of 1,500 of 1,500 of 1,500
CSU Patients Diverted From 62% 60% 65% 70% 70%
Psychiatric Hospitalization4• s of 6,570 of 5,500 of 5,500 of 6,300 of 6,300
FSP/ACT participants who 59% 50% 53% 50% 50% decreased use of inpatient and of 1,224 of850 of 850 of 1,200 of 1,200 emergency services4• s
Individuals not readmitted to a 82% 85% 82% 85% 85% crisis residential program and/or of 3,002 of 2,100 of 2,100 of 2,700 of 2,700 hospital within 30 days4• s
Adolescents receiving timely 100% 90% 95% 100% 100%
access to SUD treatments of 978 of900 of900 of900 of900
® PERT Interventions not resultini in 45% 50% 50% 50% 50%
hospitalization or Incarceration of 9,675 of 7,900 of 7,900 of 11,000 of 11,000
Drug and Re-entry court
participants who did not have 100% 95% 98% 95% 95% criminal activity resulting in a of 184 of 100 of 100 of 100 of 100 conviction while enrolled in the
programs
@ Community members receiving
suicide prevention training4• s 38,414 30,000 35,000 35,000 35,000
@ Edgemoor CMS Rating System2 N/A 5 5 5 5
Edgemoor Patients with Complex 83% Needs Not Readmitted to Hospital of24 N/A N/A N/A N/A
within 30 Days3
Access and Crisis Line answered 95% 95% 95% 95% 95%
within an average of 60 seconds s of 56,671 of 53,000 of 53,000 of 53,000 of 53,000
BHS Employees who Complete 100% N/A N/A N/A N/A Cultural Competency Training3 of 864
Table Notes
1 Measure deleted in Fiscal Year 2018-19 as tool to measure clinical improvement is being replaced.
2 New measure added in Fiscal Year 2018-19 to demonstrate the above average performance efforts in the County's
skilled nursing facility. Centers for Medicare & Medicaid Services (CMS) created the Five-Star Quality Rating System to
help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas of
concern. The CMS quality rating system gives each nursing home a rating of between 1 and 5 stars. Nursing homes with
5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality
much below average.
3 Measure deleted in Fiscal Year 2018-19 to demonstrate better alignment of resources.
238 CAO RECOMMENDED OPERATIONAL PLAN FISCAL YEARS 2019-20 AND 2020-21 HEALTH AND HUMAN SERVICES AGENCY 0
June 18, 2019 Item #7 Page 9 of 13
BEHAVIORAL HEALTH SERVICES ■■
4 BHS provides mental health and substance use disorder services to San Diego County residents based on need and can
only estimate the number expected to be served due to the inability to project the exact demand for behavioral health
services each year.
5 Final Fiscal Year 2017-18 Actuals updated following the publication of Fiscal Year 2018-20 Adopted Op Plan.
Recommended Budget Changes and
Operational Impact: 2018-19 to 2019-20
Behavioral Health Services (BHS) has an overall increase of $50.3
million. The majority of the increase is related to the enhance-
ment of services across all levels of care, the modernization of
BHS Information Technology (IT) systems, and investments in our
system of care workforce.
BHS is expanding offered services throughout the County to
address the recognized on-going need for mental health and
substance use disorder services. Increased services include the
addition of 177 beds across various levels of acuity/need within
the mental health system of care, enhanced outpatient walk-in
clinic services, increased prevention programs, targeted pro-
grams for seniors, and increased services for veterans. BHS also
continues to invest in developing and maintaining a robust and
first-class workforce, with both County employees and its con-
tracted service providers. These efforts include contract
enhancements to increase investments in our system of care
workforce and hiring County staff to administer and monitor
contracted services.
In addition, modernizing BHS' IT system is critical to its ability to
provide and deliver optimum services to clients. This effort will
enhance BHS' ability to exchange health information electroni-
cally, resulting in the provision of higher quality care for patients
and better managed care and health care outcomes. The IT sys-
tems will support the San Diego County Psychiatric Hospital
(SDCPH), outpatient services, and Edgemoor Distinct Part Skilled
Nursing Facility (DP-SNF).
Staffing
Increase of 123.50 staff years
♦ Increase of 57.00 staff years, including the transfer of 2.00
staff years from the Public Safety Group for the Edgemoor
Distinct Part Skilled Nursing Facility (DP SNF) to improve effi-
ciency and quality of care. The majority of the positions (45
total staff years) will improve staffing consistency by replac-
ing shifts currently filled by registry staff or overtime staff,
while the remaining positions (12 total staf years) will
address the implementation of 12-hour nursing shifts to sup-
port improved quality of care and nursing recruitment and
retention.
♦ Increase of 54.00 staff years to SDCPH to address increased
inpatient bed capacity. The increased staffing is required to
support the necessary direct patient care and administrative
support to care for an increased patient population and will
also help to address shifts currently filled by registry staff and
overtime staff.
♦ Increase of 8.50 staff years in BHS administration to augment
program monitoring activities and to develop a population
health and analytics function within BHS.
♦ Increase of 4.00 staff years to support the implementation
and ongoing management of No Place Like Home to create
affordable housing for MHSA-eligible clients as approved by
the Board of Supervisors on February 12, 2019.
♦ Additionally, staff transferred among related programs within
BHS to manage operational needs.
Expenditures
Net increase of $50.3 million
♦ Salaries & Benefits-increase of $11.2 million due to the
addition of 123.50 staff years noted above, required retire-
ment contributions, and negotiated labor agreements.
♦ Services & Supplies-net increase of $39.1 million.
❖ Increase of $17.7 million to expand mental health services,
including enhanced outpatient walk-in services, Assertive
Community Treatment (ACT) services, and bio-
psychological rehabilitation services. In addition, cost of
doing business adjustments are included for existing
contracted services due for re-procurement.
❖ Increase of $12.5 million in long-term care services
• Adding 38 contracted Institute of Mental Disease (IMD)
beds in the community.
• Adding 24 contracted IMD beds located at SDCPH
through new procurement
• Adding 8 shelter beds for transition youth
• Adding 4 contracted beds at Skilled Nursing Facilities
• Adding 3 contracted beds at Residential Board & Care
facilities
• Adding 100 Augmented Service Provider (ASP) beds in
the community .
• Increasing rates for SDCPH contracted psychiatrists
❖ Net Increase of $6.S million for primarily one-time costs to
modernize electronic health records at BHS, SDCPH and
Edge moor.
0 HEALTH AND HUMAN SERVICES AGENCY CAO RECOMMENDED OPERATIONAL PLAN FISCAL YEARS 2019-20 AND 2020-21 239
June 18, 2019 Item #7 Page 10 of 13
■■ BEHAVIORAL HEALTH SERVICES
+ Increase of $3 .2 million to cover the expansion of PERT
teams during Fiscal Year 2018-19 (bringing the total to 70
teams), pre-acute crisis stabilization services, and veteran
call center crisis services.
❖ Increase of $3.2 million to allow for additional investments
to enhance the overall system of care for mental health
and substance use disorder services.
❖ Increase of $1.2 million to enhance contracted prevention
services.
❖ Decrease of $5.2 million for an anticipated reduction in
contracted temporary staffing help due to increased added
staff years.
Revenues
Net increase of $50.3 million
♦ Intergovernmental Revenue-net increase of $43.3 million.
+ Increase of $18.8 million in Short-Doyle Medi-Cal revenue
to align with increased rates, units of service, and
additional SDMC eligible costs.
❖ Increase of $18.2 million in MHSA revenue due to
increased MHSA eligible costs.
❖ Increase of $5.S million in Realignment revenue to support
Salaries & Benefits and enhanced contracted services
based on projected statewide sales tax receipts and vehicle
license fees dedicated to Health and Human Services
program costs.
+ Increase of $0.8 million in funding to compensate for
training, certification and oversight costs associated with
new State mandated mental health outcome measurement
reporting.
♦ Charges for Current Services-increase of $1.2 million
❖ Increase of $1.2 million for revenue in the Edgemoor DP
SNF primarily due to an increase in the Medi-Cal daily bed
rate.
♦ Miscellaneous Revenues-decrease of $0.6 million.
.o, Decrease of $0.5 million for a contracted expense that is
now located in Child Welfare Services.
+ Decrease of $0.1 million in Edgemoor DP SNF to align with
expected share of cost revenue.
♦ General Purpose Revenue -Increase of $6.4 million.
❖ Increase of $6.0 million to support expansion of San Diego
County Psychiatric hospital.
+ Increase of $0.4 million to fund two positions transferred
from Public Safety Group to support services with
Edgemoor hospital.
Recommended Budget Changes and
Operational Impact: 2019-20 to 2020-21
Net decrease of $6.2 million is the result of a decrease of $11.1
million in Services & Supplies associated with one time costs off-
set by an increase of $4.9 million in Salaries & Benefits due to
negotiated labor agreements.
240 CAO RECOMMENDED OPERATIONAL PLAN FISCAL YEARS 2019-20 AND 2020-21 HEALTH AND HUMAN SERVICES AGENCY 0
June 18, 2019 Item #7 Page 11 of 13
BEHAVIORAL HEALTH SERVICES ••
Staffing by Program
Fiscal Year Fiscal Year Fiscal Year Fiscal Year '
2017-18 2018-19 2019-20 % 2020-21
Adopted ' Adopted Recommended Change Recommended
Budget Budget Budget Budget
' 55.oo I I Alcohol and Qther Drug Services 28.00 i 56.00 (1.8) 55.00 !
Mental Health Services 235.oo l 191.00 195.50 I 2.4 195.50
I
Inpatient Health Services 471.00 , 471.00 583.00 23.8 583.00
Behavioral Health Svcs I 154.oo I Administration 89.oo l 146.00 5.5 154.00
I
Total 823.00 864.00 987.50 14.3 987.50
Budget by Program
Fiscal Year Fiscal Year Fiscal Year Fiscal Year
2017-18 2018-19 2019-20 % 2020-21
Adopted Adopted Recommended Change Recommended
Budget Budget Budget Budget
Alcohol and Other Drug Services I$ 67,661,442 1 $ 185,142,425 $ 186,138,067 0.5 1$ 184,262,023 I I Mental Health Services 371,394,999 372,029,897 408,211,983 1 9.7 403,548,694
Inpatient Health Services 76,820,188 79,201,587 89,362,095 1 12.8 89,802,617
Behavioral Health Svcs 13,221,463 21,801,641 24,774,848 1 13.6 24,714,930 Administration I I )
Total $ 529,098,092 $ 658,175,550 $ 708,486,993 7.6 $ 702,328,264
Budget by Categories of Expenditures
Fiscal Year Fiscal Year Fiscal Year Fiscal Year
2017-18 2018-19 2019-20 % 2020-21
Adopted Adopted Recommended Change Recommended
Budget Budget Budget Budget
Salaries & Benefits $ 90,569,701 1 $ 99,925,275 $ 111,138,599 11.2 $ 116,026,935
I
Services & Supplies I 442,924,060 I 567,541,274 606,620,893 , 6.9 595,573,828
' Other Charges 4,909,686 1 20,000 20,000 ; 0.0 20,000
Capital Assets Equipment 168,000 I 168,000 186,500 11.0 186,500
I I
Expenditure Transfer & ' (9,473,355) i (9,478,999) (9,478,999) ' 0.0 (9,478,999) Reimbursements I I
Total $ 529,098,092 $ 658,175,550 $ 708,486,993 7.6 $ 702,328,264
HEALTH AND HUMAN SERVICES AGENCY CAO RECOMMENDED OPERATIONAL PLAN FISCAL YEARS 2019-20 AND 2020-21 241
June 18, 2019 Item #7 Page 12 of 13
•• BEHAVIORAL HEALTH SERVICES
Budget by Categories of Revenues
Fiscal Year Fiscal Year Fiscal Year Fiscal Year
2017-18 2018-19 2019-20 % 2020-21
Adopted Adopted Recommended Change Recommended
Budget Budget Budget Budget
Intergovernmental Revenues $ 472,554,608 $ 572,859,066 $ 616,175,856 7.6 $ 608,700,234
Charges For Current Services 42,895,718 43,854,744 45,040,047 2.7 46,345,802
Miscellaneous Revenues 1,749,624 1,863,598 1,239,578 (33.5) 1,239,578
Other Financing Sources 4,400,000 4,400,000 4,400,000 0.0 4,400,000
General Purpose Revenue 7,498,142 35,198,142 41,631,512 18.3 41,642,650 Allocation
Total $ 529,098,092 $ 658,175,550 $ 708,486,993 7.6 $ 702,328,264
242 CAO RECOMMENDED OPERATIONAL PLAN FISCAL YEARS 2019-20 AND 2020-21 HEAL TH AND HUMAN SERVICES AGENCY 0
June 18, 2019 Item #7 Page 13 of 13