HomeMy WebLinkAboutMINUTES - 12171985 - X.3 TO: BOARD OF SUPERVISORS
FROM; �./�Jl itra
Mark Finu.�c ne, Health Services Director �,
By: SLt McCullough, Assistant Health Services Director C(""""
DATE'. Decembers, 17, 1985 COU*
SUBJECT; program Proposal to the State Department of Mental Health for Services
to Mentally Disabled Homeless Residents of Contra Costa County
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
1 . Approve and authorize the Health Services Director or his designee to submit
to the State Department of Mental' Health the attached "Proposal for Services
to the Homeless Mentally Disabled of Contra Costa County," and;
2. Authorize the Health Services Director to fund the required ten percent
County Match from the approved 1985-86 Health Services Budget not to exceed
$56,350 for the annualized appropriation or a maximum of $30,000 for Fiscal
Year11985-86.
II. FINANCIAL IMPACT:
This proposal, if approved by the State Department of Mental Health, will pro-
vide an annualized increase in Short-Doyle funds of $507,091 for the provision
of services to homeless mentally disabled residents of the County. The County's
Short-Doyle allocation shall be augmented by $507,091 for fiscal year 1985-86
and for each subsequent fiscal year for the provision of these specific services
(State D.M.H: Allocation Worksheet attached for reference) . This will require a
ten percent Match totalling $56,350 on an annual basis and a projected Match
requirement of less than $30,000 for this Fiscal Year. There are sufficient
county dollars available to fund the required County Match within the approved
1985"86Health Services Budget.
III. REASON FOR RECOMMENDATION/BACKGROUND:
I
Contra Costa County's proposal for services to the homeless mentally disabled is
in response to a solicitation for program proposals by the State Department of
Mental Health. The State of California Budget Act of 1985 and Chapter 1286 of
the Statutes of 1985 (AB 2541 , Bronzan) specified $20 million to be used for
statewide services to chronically mentally disabled adults who are homeless or
at risklof becoming homeless. Contra Costa County's allocated share of this
appropriation, subject to State Department of Mental Health approval of the
program proposal, is $507,547 dollars.
This program proposal was submitted to the State Department of Mental Health
without the required Board of Supervisors' endorsement because the submission
timeline precluded this review and approval in advance of the State's November
22nd proposal deadline.
CONTINUED ON ATTACHMENT: _ YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
S1GNATURE(S1: v
ACTION OF BOARD ON V 4fULde4APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
UNANIMOUS (ABSENT s-- AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES. AND EN'T'ERED ON THE MINUTES OF THE BOARD
ABSENT ABSTAIN: OF SUPERVISOR ON THE DATE SHOWN.
cc: County Adminiustrator ATTESTED
Auditor-Controller PHIL BATCHELOR, CLERK OF THE BOARD OF
Health Services Director SUPERVISORS AND COUNTY ADMINISTRATOR
State Mental Health Department
via Health Services00
M382/7-83 BY DEPUTY
4
p
Board Order (page 2)
Program Proposal to the State Department of Mental Health for Services to
Mentally Disabled Homeless Residents of Contra Costa County
The Health Services Department proposes to implement a core network of ser-
vices for the homeless mentally disabled. . These services both directly
address community support needs of the target population and operate as
"clearing houses" for accessing and referral to additional resources which
cannot be provided by the program. Services will include:
o Multiservice Drop-In Centers, (three) , to be located in West,
Central and East County.
o Emer enc Shelter Program to be located in either Central or
East County, and accessible by public transportation to residents
of both regions.
The Multiservice Centers and the Emergency Shelter program would be
operated by non-profit community-based agaencies to be selected through a
competitive Request for Proposal process. Three 20/40 County mental health
staff positions will be established and assigned to the Multiservice Center
to provide counseling/case management services. In addition, a 20/40
County staff position will be established and assigned to. act as a resource
developer, fundraiser, and Countywide services liaison person.
IV. CONSEQUENCES OF NEGATIVE ACTION:
Failure to endorse this proposal and authorize funding of the required
County Match will result in the County's continued inability to provide
critically needed services to a vulnerable and seriously disabled popula-
tion. It is estimated that there are 3500 to 7000 mentally disabled resi-
dents of Contra Costa County who are homeless or at risk of becoming
homeless. Our existing mental health programs are unable to either provide
the types of specific services required by this population, or to engage in
the outreach activitiesnecessary to attract this population to more tradi-
tional services.
MF/SMc/GGB
Attachments
t _
s
a
PROPOSAL FOR SERVICES
to the
HOMELESS MENTALLY DISABLED
of
CONTRA COSTA COUNTY
SUBMITTED BY
Stuart McCullough
Assistant Director
Health Services Department
Alcohol/Drug Abuse/Mental Health Division
20 Allen Street
Martinez, CA 94553
(415) 372-4416
November 21, 1985
y
I. TARGET POPULATION
Estimate of Target Population.
We estimate that the number of Homeless Mentally Disabled (including those "at risk"
of being homeless) in Contra Costa County ranges from 3506 to 7160 individuals.
In an effort to quantify this population the following sources of data were
utilized: The 1980 census, a 1983 Contra Costa County Needs Assessment, records
from the County Department of Social Services, the Contra Costa County St.
Vincent De Paul Society, the Richmond Rescue Mission and the Alameda County
Emergency Response Network.
The target population estimate is derived from information provided by the above
agencies/sources and interpolated for Contra Costa County. The Agencies con-
sulted indicated that the incidence of mental disability within the total home-
less population is approximately 35%. This is supported by studies conducted
throughout the Nation which estimate that 30-40% of the homeless have some form
of mental disability.*
1980 census figures place the total number of Contra Costa County residents at
656,380. A recent study by the National Institute of Menta Health finds that 20%
of the population suffer from some form of mental disorder (n = 131 ,276). Popula-
tion projections based on this NIMH study and the 1983 Mental Health Needs Assess-
ment support an estimate that there are 10-15,000 severely and chronically mentally
disabled. adult residents of this County at any given point in time. The Contra Costa
County Department of Social Services reports 8,409 applications for general assis-
tance from 11-1-84 to 10-31-85. Of these applications, 5,009 (44%) were denied.
It is expected that a significant group of these individuals have a serious mental
disablity and have been unable to access local or Federal/State financial assistance.
U.S. Dept of Health and Human Services, "Alcohol, Drug Abuse And Mental Health
Problems Of The Homeless", 1983
"Listening To The Homeless", A Study of Homeless Mentally Ill Persons in
Milwaukee, April, 1985
Baxter, E and Hopper K., The New Mediancy: Homeless In New York City, Amer Jrnl
Of Orthopsychiatry, 1982, 52 (3) , 393-408
-1-
tsng these estimates and allowing for the high incidence of mental illness among
i persons living below the poverty line ,(69,077) and those who are unemployed, a
somewhat more precise estimate of the population can be derived. Factors placing
such persons at risk include poverty itself, unemployment/under-employment and
the strain of social stresses experienced by minorities, etc. We estimate the
number of Homeless Mentally Disabled to be from 3,506 to 7,160 persons in Contra
Costa County.
Annualized Estimate Of Number Of People To Be Served
We expect that approximately 1 ,000-1,500 individuals will utilize homeless ser-
vices during a year of program operation (eg. , from the point that all programs
are implemented). Annualized estimate of service contacts (duplicated count) is
43,840 based on projected service utilization by this population.
-2-
' 1
1
'• II: DESCRIPTION OF OUTREACH ACTIVITIES TO ESTABLISH INITIAL CON1fACT WITH THE
POPULATION TO BE SERVED.
Phase I: - Countywide Needs Assessment And Outreach
Throughout our process for planning and implementation of AB 2541 services, spe-
cial attention is given to outreach. In July 1985, as part of the initial
planning phase an Alcohol/Drug Abuse/Mental Health Division-wide task force was
formed. The purpose of this task force was to 1) ensure the early and continued
input of those most involved with the Homeless Mentally Disabled including poten-
tial service recipients, 2) identify who the Homeless Mentally Disabled are in
our County and where they are, and 3) design a continuum of services to meet the
needs of this population. The Homeless Mentally Disabled Task Force consists of
consumers, family members, Patients' Rights Advocates, mental health contractors,
Case Management staff, Criminal Jusice Mental Health staff, Conservatorship,
Crisis Services staff, Mental Health Advisory Board representative, etc. (See
Attachment A for Task Force membership)
The Task Force held a public meeting attended by a broad spectrum of individuals
and organizations. Testimony was given by the Social Services Department, men-
tal health service providers, consumers, the Mental Health Association, etc.
Members of the Task Force also visited agencies which currently provide services
to the homeless both within and out of the County.
On the basis of the above input and research, the Task Force developed a propo-
sal for services which outlined the philosophy, operating principles and a
continuum of services to address the needs of the Homeless Mentally Disabled.
This Task Force recommended core services to include three Multi-Service/Drop-in
Centers (a 'store-front' operation) as well as a temporary Shelter program to
serve two regions of the County which have no respite/shelter housing.
Phase II - Regional Planning/Outreach
Phase two of our planning is the establishment of Regional Committees. With
these committees we are broadening the focus of our work to include-additional
service providers and consumers within each geographic region. The purpose of
these Regional Committees is to develop the network of linkages/referrals which
are critical to the planning and implementation of a Multi-Service/Drop-in ser-
vice center for each area of the County.
-3-
1 t
+ Each Regional Committee is mandated to develop action plans for outreach to the
potentJ:al consumers of drop-in center services. Development of referral/linkage
networks is anticipated to occur over the. next few months as follows:
e Identify local agencies/services which may function as a supportive services
resource network. These referral resources are anticipated to assist in meeting
basic survival needs of clients such as meals, shelter, health care and direct
financial assistance which cannot be directly provided at the drop-in centers.
• Develop preliminary working agreements (to become Memoranda of Understanding)
with agencies re: referral/linkage support. These agreements will be formalized
between County, multi-service center provider and "linkage/referral" agencies per
State DMH requirement following the selection of the drop-in center provider(s).
e Develop strategy and timeline for outreach to local police departments, Social
Services offices, city officials, service clubs, chambers of commerce, etc. , who
must be informed and educated regarding proposed services.
e Develop protocol for referral of clients of multi-service center to County and
contract mental health services. Homeless services are not contingent on clients'
willingness to utilize existing mental health services, however, on a voluntary
basis 1these individuals may require linkage to case management, aftercare
(residential and day treatment) and outpatient programs.
• Continuing outreach to Homeless Mentally Disabled. How will consumers be
informed of services? How will these services be presented as useful, attractive
and non-threatening? How can current and former mental health consumers be
involved in outreach and public information activities?
Phase :LII - Direct Outreach To Target Population and Community
Phase 'three of our planning will begin upon receipt of the AB 2541 monies. At
that time we will hire consumers to survey (using a questionnaire) Homeless
Mentally Disabled individuals where they naturally congregate in order to: 1)
begin 'to develop trust with the target population; 2) elicit additional infor-
mation from the homeless themselves about what services are needed and how to
make them accessible and 3) continue process of outreach to the .target popula-
tion within each region of the County.
Outreach to the local community will also be a priority. Program implementation
must include community education regarding the needs of the homeless and program .
services in order to increase community acceptance. Community education and
outreach will be coordinated on a countywide basis by staff hired for project
start-up phase in conjunction with Regional Committees. (See Phase II above)
4-
III. A DESCRIPTION OF SERVICES NEEDED BY THE TARGET POPULATION
Homeless individuals need a wide range of health and human services including:
food, clothing, shelter, low-income housing, benefits assistance, legal aid,
social contact, counseling, medical attention, medication (medical and
• psychiatric) , and training (social skills, vocational, etc.) In addition Homeless
Mentally Disabled individuals need help with accessing or availing themselves of
services. Issues of trust, accessibility (location, type of agency, etc.) and
service! contingencies often act as barriers to the Homeless Mentally Disabled.
Within Contra Costa County there are few programs for the homeless. None of
these programs are designed specifically to serve the Homeless Mentally Disabled.
Limited resources that do exist, e.g. , Richmond Rescue Mission, food pantries,
local financial assistance (G.A.) are often inaccessible to the Homeless
Mentally Disabled because utilization of these resources requires more skill
and/or consistency and follow through than this population typically demonstrates.
In surveying the needs of the homeless in Contra Costa County the Homeless
Mentally Disabled Task Force took into consideration the fact that Contra Costa
County is a geographically large County with three distinct regions with distinct
needs and resources in each.
The West County region is composed of an ethnically diverse population in an
urban :setting. West County has a high rate of unemployment and Public Assistance
recipients. It is faced with many of the problems found in large urban centers.
It is a region with great needs and with some resources which are utilized by the
Homeless Mentally Disabled.
The Central County region is more suburban in character and ethnically more
homogeneous in population. This region of the County has very few resources to
offer the Homeless Mentally Disabled. The escalating cost of housing has almost
entirely eliminated single room occupancy hotels, board and care homes and other
low cost housing alternatives previously available to this target population.
This has resulted in an ever increasing number of homeless in what has been
perceived as a relatively affluent area.
The East County region is diverse including both rural farming communities and
industrial areas. However, the lower cost housing in this area has spurred rapid
-5-
growth of suburban communities surrounding run-down older cities. Redevelopment
in these areas is resulting in an overall increase in housing costs displacing
many individuals. This Region has very few resources available to the Homeless
Mentally Disabled and is isolated from the rest of the County due to inadequate
public transportation.
We are proposing the development 'of a core of services which shall both directly
address the needs of the Homeless Mentally Disabled and function as an orga-
nizing and a'ccess point for a range of additional services and resources
(both public and private sector.) Core services to be funded through the
current AB 2541 allocation shall include:
- Multi-Service/Drop-In Centers to be located in West, Central and East County
- Shelter/Short Term Housing to serve Central/East County
Multi-Service/Drop-in Centers - These regionally based centers will serve as a
point of access to link the Homeless Mentally Disabled (who do not utilize more
traditional outpatient or case management services) with vital human services.
The Homeless Mentally Disabled need a non-threatening environment to access ser-
vices such as medical screening, benefits advocacy and information and referral
for food, clothing and shelter. Drop-in or socialization center models have
proven to be an effective point of contact for this population.
Shelter Program - There is presently only one emergency shelter for the homeless
in Contra Costa County. This program, located in Richmond, is not easily
accessible to residents of the central and eastern areas of the County due to
transportation and geographic barriers. In addition, this existing shelter is
not designed to meet the needs of the Mentally Disabled Homeless population.
The establishment of a shelter program in Central or East County for the men-
tally disabled is proposed as an essential core service. Establishment of this
service was identified as a priority in the County's Mental Health Planning Task
Force Report of July 1985.
Referral/Resource Networks AB 2541 funding will support only a limited range of
services. In order to reduce and avoid service duplication, referral networks
are being developed within each region of the County. Each "Regional Network"
will develop a description of each provider agency (public and private) the ser-
vices it provides and the population that it serves. Inter-agency agreements
outlining referral procedures, follow-up and interagency coordination will be
-6-
developed. These agreements will facilitate referrals to a broad range of ser-
vices and establish mutual expectations for how clients will be served. The
development of community support will increase understanding and tolerance of
previously perceived 'difficult clients', and maximize access to resources (grant
monies, food/clothing donations, etc.) A referral network may look like this:
Salvation Army
Medical Clinic (clothing) Volunteers of America
(health care) (meals)
i
CENTER
Mental Health Clinic Social Security
(case management, medication (benefits)
psych evaluation for benefits)
Shelter
-7-
TV., PROPOSED SERVICES
Philosophy of the Homeless Mentally Disabled Program:
o That the program be attractive to and responsive to the needs of the popu-
lation it is intended to serve.
s That the program promote mutual self help and be voluntary (based on what
the client has identified as his/her needs.)
e That the program promote participation, on the part of the community and
clients in the program. This is to be done in a variety of ways (advisory
committees, volunteer program, etc.)
o That the services in the program are not contingent upon one another.
m That the emphasis of the program be on assisting clients in developing sup-
port systems and a more stable life. style.
The intent of this program is to meet the needs of the population (Homeless Men-
tally Disabled) as defined by the individual in cooperation with program staff,
with the goal of improving his/her living situation. One of the most effective
ways to help an individual improve his/her life is to support him/her in taking
more and more control over his/her life. Mutual self-help is integral to this
process and shall be supported in all program services.
Program Goals
e To provide needed advocacy making all available resources accessible to the
Homeless Mentally Disabled.
o To provide access to non-crisis medical care to this population which has "three
times the morbidity and mortality rates of their counterparts in the general
population" (American Psychiatric Association Task Force Report On The Homeless).
a Provide timely accessible and "attractive" services and resources which shall:
- reduce psychiatric hospitalization,
- decrease involvement with criminal justice system,
- reduce the battering often associated with living in an unhealthy environment,
- reduce social isolation, and
- increase access to housing and other essential resources.
Services Description
The following program description has been derived from the recommendations of the
Homeless Mentally Disabled Task Force. Many of the specific program components are
modeled after the program design of Berkeley Support Services, one of the "exemplary
programs" cited in "A Study Of The Issues and Characteristics Of The Homeless Popu-
lation In California", conducted by the Department of Housing and Community Devel-
i
,. opiAent with assistance from the State Department of Mental Health and State
Department of Social Services, April 1985. This proposal comprises a first phase
of service delivery based on the AB 2541 funding level. It is hoped hoped that a
more complete continuum of services can be built upon these core pro-grams through
leveraging of additional public and private funding and in-kind resources.
Core programs (Multi-Service Centers and Shelter) are to be operated by private
nonprofit community based agencies. Contract providers shall be selected through
a competitive (Request For Proposal) process on the basis of agency experience
r.
with these modes of services and agency experience/sensitivity to the target
population. Selected services such as medical screening and money managment
shall 'be provided by the County. In addition, several County staff positions,
Multi-Service Center Liaison and Resource Coordinator) are proposed to facilitate
linkages to existing mental health and human services and to coordinate addi-
tional resource development. Figure 2. "Proposed Services Organization" illus-
trates these County and contracted services and their interrelationships.
PROPOSED SERVICES ORGANIZATION
A/DA/MH Division Directo ----
--- Countywide Homeless
Ment. Disab. Adv Comm
[::Deputy Director ----j
Countywide Services
County-wide Resource
Advocate 20/40
Medical Screening
Money Management
EContract Provider Contract Provider Contract Provider
County Central County* East County*
rvice Center [Multi-Service Center Multi-Service Shelter
� Center Program
County Region Advisor County Regional Advisory County Regional Advisory
Liaison Committee Liaison Committee Liaison Committee
20/40 20/140 20/40
* The combined Multi-Service Center/Shelter will be located in either East or
Central County depending upon facility availablity
Figure 2
-9-
A. COUNTYWIDE SERVICES
The following countywide services are to be coordinated centrally and provided in
each region.
o Countywide Resource Coordinator
To coordinate among regional programsv' develop and advocate for additional
resources (including identification and solicitation of additional funding,
donations, etc....), and provide linkage to the countywide Homeless Task
Force. Network with inter-and intra-County service providers.
o Money Managemant to be provided at each Multi-Service Center on a voluntary
basis (major elements of money management program will be provided through the
computerized system utilized by the L.P.S. Conservatorship Unit).
o Medical screening and referral to be provided by a Nurse Practitioner at each
Multii-Service Center 2.5 hours per week. Additional on-site medical screening
may be provided by Family Practice Medical Residents.
B. MULTI-SERVICE CENTERS
We propose the development of Multi-Service Centers in each of the three
regions of the County. These Centers will function as a meeting place (drop-in
center), offer community support services and serve as a clearing house for
linkage to other available resources. The key program elements are:
Support Services
• Advocacy and Assistance in securing available Public Assistance, i.e.,
General Assistance, SSI, AFDC and Medi-Cal/Medicare
• Assistance in planning and securing housing both on a crisis and long term basis
• Money management services including budgeting, disbursement and assistance
with check cashing (service to be developed in compliance with State and County
requirements re: administration/handling of client funds)
• Social and vocational skills development through both on-site "classes", support
groups and referrals as appropriate
• On-site medical screening and referral (screening to be provided by licensed
nurse practitioners)
• Crisis intervention, case management and linkage to mental health services on
a voluntary basis
• Space and support for the growth and development of self-help groups
Practical Services
• Toilet and shower facilities
• Laundry facilities
• Mailing address to facilitate securing of funds
• Message/phone center
TABLE OF CONTENTS
EXECUTIVE SUMMARY
'I. Target Population 1
- Estimate of Target Population 1
- Annualized Estimate of Number of People To Be Served 2
II. Description of Outreach Activities To Establish Initial Contact
With The Population To Be Served 3
- Phase I - Countywide Needs Assessment and Outreach 3
- Phase IE - Regional Planning/Outreach 3
- Phase III - Direct Outreach To Target Population and Community 4
II.I. Description of Services needed By The Target Population 5
-Multi-Service Centers 6
- Shelter Program 6
- Referral/Resource Networks 6
IV„ Proposed Services 8
-Philosophy of the Homeless Mentally Disabled Program 8
! -Program Goals 8
-Services Description 8
-Proposed Services Organization g
A. Countywide Services 10
B;. Multi-Service Centers 10
.� Support Services 10
;: Practical Services 10
Staffing 11
Locations 11
C Homeless Shelter 12
.; Core Services 12
. Services to be Provided Through Co-located Multi-Service 12
Center
.Operating Principles 12
.Criteria for Admission 12
.Standards for Care 13
.Client Expectations 13
.Staffing 14
.Model 14
.Length of Stay 14
j A. Countywide Services 15
i B. Multi-Service Centers 15
C. Shelter - 15
! 16
V. Implementation of Proposed Services 17a
VI. Budget 18
Annual Budget 18 ,.
Startup Budget 19
EXECUTIVE SUMMARY
The plight of the Homeless Mentally Disabled population of Contra Costa County
is a grave concern to the citizens of this County, This concern was channeled
into constructive citizen involvement in July of 1985 with the establishment of
the Homeless Mentally Disabled Task Force. In anticipation of the passage of
AB 2541 the Task, Force both examined the needs of the Homeless Mentally Disabled
and began planning to meet those needs. This has recently led to the
establishment of a Countywide Homeless Task Force, under the auspices of Contra
Costa County!s Human Services Advisory Committee. The attached proposal is a
composite of the planning energies thus far expended. Every effort has been
made to include a broad range of interested citizens in this process including
the consumers themselves. It is our goal to provide the most critically needed,
cost effective and accessible services to the Homeless Mentally Disabled of this
County. Thefunding of the attached proposed programs will enable us to turn
this broad-bAsed involvement into a critical and viable service continuum.
The following services are proposed:
* Money Management
• Health Screening
• Inter-Regional Coordination and Promotion
e Regional Multi-Service Centers
• Shelter
o Information and referral including distribution of vouchers for housing,
mbals, food, transportation and referral to clothing closets.
o Refreshments (snacks)
o Clothing*
o Furniture exchange*
o Storage*
o Toiletries*
Staffing
It is our inte#ion to prepare a request for proposal to solicit competitive
bids for the provision of these services. Philosophically, it is our commitment
that staff be sensitive to the needs of this population. Consumers shall be
hired as core staff within each center. The staff should be generalists
interested in all aspects of the client's growth. The attached, Budget outlines
the specific staffing patterns. Please note proposed staff includes contracted
Multi-Service Center staff as well as a 20/40 County staff liaison to each
regional center. County liaison staff shall provide the following services as
requested/needed by the Center and/or program consumers:
- Assessment and Crisis Intervention;
- facilitate groups and/or skills classes;
- participate in the development of individual service plans (voluntary basis
to the client) -
- provide limited case management services;
- advocacy and liaison to other County and contracted services on behalf of
the Center and Individual clients.
Location
Within each region, location of the Center will take the following into consideration:
1. Accessibility to clients o Access to public transportation
o Centrally located to areas known to be popu-
lated by homeless persons
o Be a non-threatening location (not a hospital
and not in high crime areas)
2. Acces s to important services such as Social Security, Social Services,
food pantries, etc.
3. Community tolerance
4. Zoning, use permit requirements, etc.
50 Practical considerations: cost, available sites, etc.
optional services which are to be added as resources permit
C. HOMELESS SHELTER
A propose to contract for the operation of a Shelter program component in the
Central/East Region of the County where no alternative emergency housing resour-
ces are available to the Homeless Mentally Disabled. The Shelter will provide
the following services:
Core Services
o Beds
o Showers
o Evening meal
o Locked storage space
o Common living area
Services To Be Provided Through Co-Located Multi-Service Drop-In Center (See
N.A. above),
o Self-•help groups
o Counseling and referral services
Operating Principles
Privacy ha's been identified as a basic need for people and important for the
individuals to be served by this service. A balance has to be sought between
providing privacy and providing a safe environment.
A major goal, of the program is to attract the individuals most in need of the
services and to help them 'move-on' to a more stable living situation. A balance
must be sought between making the services comfortable and providing a transition-
al service. , There is a fine line between support and treatment. Extra care
must be taken to prevent the program from being seen as a treatment facility.
Consumer input and participation is a priority. A balance must be sought bet-
ween the need to have rules and structure and the program's ability to flexibly
respond to changing consumer needs and input.
Criteria For Admisssion
The individual entering the Shelter must:
o be screened and referred by the Multi-Service Center
o be without a home*
o not be a danger to self
o not be a danger to others
Home is defined here as a stable, safe living situation
-12-
0 not be so 'functionally disabled (from a mental or medical disability) that
he/she requires care and supervision to utilize facility
o be free from the incapacitating effects of drugs and alcohol
Standards For Care - The Shelter facility will meet Applicable State and local
requirements.
• A Shelter shall provide a clean, safe and healthy environment which is
consistent with conventional social services practices and which respects
individual needs and human dignity.
• A Shelter muses meet all local•government building standards and inspection
requirements, including handicapped access regulations.
• The physical lay-out of a Shelter shall provide living, kitchen and dining
facilities separate from sleeping areas, if such facilities are provided on
a congregate basis. The Shelter shall include provision of a lounge for
recreation or congregation. Telephone service for residents shall be pro-
vided separately from the office telephone in order to allow privacy.
• A Shelter!!s physical equipment shall be appropriate to meet the needs of
residents and to provide an attractive and pleasant atmosphere.
• The Shelter shall ensure an adequate supply of linen for each mattress provided
by the Shelter. Bed linens shall be changed with change of resident and, if
occupied continuously by one person, changed at least once a week. If the
Shelter provides only a bed, mat or cot, and residents are permitted to use
their own 'bedding, sleeping bag or bedroll, the Shelter shall implement routine
procedures for disinfecting the bed, mat or cot and its cover with each change
of resident.
• Residents shall not be locked in any portion of the Shelter.
• The physical condition of the Shelter's plant and equipment shall be maintained
on an ongoing basis.
• Every Shelter shall provide appropriate measures to safeguard and account
for personal articles of residents which are brought to the Shelter and any
cash entrusted to the care or control of the provider.
• In order to provide as much privacy as possible there should be no more
than 4 persons to a bedroom.
Client Expectations
• They will be encouraged to contribute something to the program -services
in- kind, goods, money.
• They will,be encouraged to help and support each other.
o. They'will,be expected to be actively involved in improving their living
situation. And working on tasks that have been identified by the client,
or the client and a staff person.
-13-
o These tasks will be part of the client's Service Plan.
One approach is to "label" clients according to program expectations and each
individual's level of participation. The differing expectations entail different
responsibilities on the part of the program.
Guests: Persons coming for the first time to the, program and unable or unwilling
to participate other than by being present are called guests. Guests -require
more effort on, the part of the program staff to make contact and develop trust.
r
Members: Persons who have become involved in the program and participate in the
program, contri-buting to it in the best way they are able are called members.
Program' staff are expected to encourage participation and to help members deve-
lop a Service Plan.
w
Assistants: ) Persons who are able and willing to help others and contribute by
helping to organize activities etc. , are called assistants. Program staff are
expected to support these efforts and offer any technical assistance needed as
defined by the group.
Staff: Persons who progress through the program and demonstrate the needed
skills are encouraged to apply for ,job openings in the program. Program staff
are expected to encourage and consider any qualified individual from the program
for any job openings.
Staffing (See Budget for specific proposed staffing)
o Staff composition shall be sensitive to and aware of needs of the popula-
tion to be served. Priority will be placed on hiring of mental health con-
sumers. .
o There should be no more than 20 clients to one staff person ratio in any one
location. ;"
Models
The Homeless Mentally Disabled Task Force has developed a statement of philo-
sophy which would guide all programs implemented to serve the Homeless Mentally .
Disabled.
Length of Stay
It is proposed that a 30-day average length of stay would provide adequate
respite and time to complete service plan goals.
_1$-
MODES OF SERVICE AND SERVICE FUNCTION
A. ' COUNTYWIDE SERVICES
Money Management (10-19)*Case Management
(60-69) Medication
Nurse Practitioner (70-79) Crisis Intervention
(20-29) Community Client Services
(10-19) Mental Health Promotion
Inter-Regional Service Coordinator (20-29) Community Client Services
B. MULTI SERVICE CENTERS
The broad range of services offered at the Multi-Service Centers will include
services in each of the following categories: (10-19) Mental Health Promotion
(20-29) Community Client Services
(40-49) Socialization Services
i
(30-39) Vocational Services
(10-19) Case Management
(70-79) Crisis Intervention
C. SHELTER
Shelter services are an essential element in service provision to the Homeless
Mentally Disabled. This service will initially be provided on a 16-hour a day
basis. The 'provision of this service fully meets the intent of AB 2541
(Bronzan). 'However, existing CR/DC service function codes do not specifically
describe or 'include the provision of Shelter services. Shelter Program voluntary
evening services may include modes of service also described under Multi-Service
Center -eg. , community client services, socialization and vocational services,
case management, crisis intervention, etc.. .
Y
I
i
F
4
*Service Function codes per State Department of Mental Health CR/DC Manual
-15-
V. IMPLEMENTATION OF PROPOSED SERVICES
As stated previously (Section IV) , Contra Costa County intends to contract with
one or more nonprofit community-based agencies for the provision of two
Multi-Service Drop-in Centers and one co-located Multi-Service Center/Shelter program.
Contract providers shall be selected through a competitive Request For Proposal
and selection process. Members of the Countywide Homeless Mentally Disabled Task
Force, including consumer representatives, will participate in a selection process
with Mental 'Health Administration. While provider selection is occurring, the
County will also recruit and hire a Project Manager who shall be responsible for
coordinating the implementation of both County and contract operated program ser-
vices. Successful program implementation requires that project implementation
staff be employed during the start-up phase. (Contra Costa County Mental Health
Services currently has no planning or program development staff due to prior
year budget 'reductions.) The Project Manager and his/her support staff will be
responsible for coordination of start-up activities among contract providers,
other County services and Departments and the communities in which the programs
are to be located. Such activities shall include:
o Coordination of community, and consumer (target population) outreach and education;
o Management of implementation scheduling and budget;
o Program location and facilities acquisition/lease;
o Securing of use permits, fire clearance and compliance with local ordinances;
o Monitoring of Contract Provider start-up activities and initial program opera-
tions to include renovation, equipment purchasing, staff hiring and training;
monitor and insure hiring of mental health consumers;
0 Start-up of Countywide programs (eg. , resource development, medical screening,
money management program requirements, etc..,)
o, Facilitation and coordination of Regional Homeless Committees activities in rela-
tion to- program provider start-up activities;
o Participation in selection/hiring of County staff/Program Liaisons.
It is anticipated that the Multi-Services Centers can be operational prior to the
close of the 1985-86 Fiscal Year--eg., May 1 is projected start-up date. The
start-up of;a Shelter facility will require a use permit and thus is not
projected for completion until August-September 1986. It is necessary to engage
-16-
in ongoing community education and consumer outreach activities during the imple-
men`lation phase if the programs are to be successfully opened and utilized by the
Homeless Mentally Disabled.
The following is an anticipated Implementation Schedule which details start-up
tasks and activities.
ti
i
r
I
I
i
f
r
r
i
4
i
`l
i
I
I
E
I
I
M
A
11
ro� i
t
}
i
� 1
f y
•i �
L
O
i O
CL
L �!
' 6 a
go
0 00 A
�+
I 0 r+
{ � Y p E
IL t q Y L J C a N7 S V 0
4 it fJ M b L 4 q 7 {
♦. c .L• .+
10. °s to a.
Op « 7 Q Y rt
6 L 6 » L Y 00 L O
G M 6 «
Ib L Y .00
a
6 .4 O « b C A a 06 go V N i H
Cl O q IS O
W L pmp
91
Z' Y Y it •0 L O 7 OS. a
Q O 6 CQ L Q Y m > m O a O a L b 4 i a6 O _
.Or6 G O 0 Y a a01 O 0 O b v 4 t q •+ O O C MN
..a L ary a m
0 !+
o} m v L b O L C C n C o a « e v « O O v
QS C O O q a J J E B O L .t J O C. AL1 L « O a a L O 6 J
O p M « A Y a Y L 7 O a $ OJ 4.0
C L b rw L" 0 OM V 7 L A
a a C L O O �C'+ O
O > Cf Oq.�tL O 6ga 11
O Y6 .0 L O ?�q 0 " = O .O L O O
p 6 a C .97 « A O
C = a ./ L .! or- L 0
aqao «.fGpYl aJLqqtVOi n s
\ J O O L .✓ O Y O L C q q
O 7 A E O 4 R4p. • b O tl Y J O O. G « O C « 5h O
Y .p1 L 7 O 0 S « O O C L aG Y 0 a a N 7 V « « O V 0 « « y O O O e aE0
tl L 0 q �f 4 v 7 O .� « L 6 O L L O O '4
O J 4 6 L L 1 6 0 O « w 6 • J > M O « 6 C « q +� 6 0 7 m j
vA q C d E a Y O O E m L• 00 m E O R L > O O I+
y oo oo L O pp 0 0 Z O « O p • « a O O p a a « 6 O b « L
O01 p <Q fi iII m G V Q /K •G ^ V > ` VC W N V O W O. t7 C 07 CC IAM
L , .. \ L \ Of \ G
'Z. Z
v > o o t. N u+ u+ « i An n m a An J u+ 1 1 _ J ut _ An 1 1 I r
« O 42, N. N m t0 N
N S ^ M- N +• a N ? fJ N T .L N 17' a 1{1 W N ? a S y, pr CO CA
.°. .i o 0, 0 0 o ai o 0 .0 o u o 0 0 0 0 0 0 au o 0 0 0 e. o o a o o 0 0 0
i
VI. -- BUDGET. - I
y e ANNUAL BUDGET
Central Services to be provided county-wide consist of.Money Management, Medical
Screening and an Inter-Regional Resource Developer.
Multi-Purpose Center - each Center is envisioned as having the same basic design and
staffing. However, we foresee greater diversity developing as each Center tailors
i'
this design to meet specific regional needs and to utilize available resources.
Shelter Budget - rerleetstShelter operating costs and staffing. This budget is
i' combined with Multi-Service Center (cc-located program) for the total operating
costs in either Central or Fast County. Shelter Budget is presented separately
at this point to provide clarity re: specific Shelter related Costs.
f
Program Component Detail of Estimated Expenditure Budget Total
COUNTYWIDE SERVICES
Money Management $10,000
Nursing Staff(Medical Screening) 7,000
L
Countywide Resource Coordinator 21,500
(20/40 County Staff) Sub-Total $38,500 $38,500 $38,500
MULTI-PURPOSE CENTERS
(Each region annualized)
I. Personnel
-County Liaison 20/40 FTE $14,000
-Contract Staff Salaries
40/40 Center Coordinator 18,500
40/40 Center Staff (may incl part-time help) 16,000
Contract Staff Benefits 8,625
Residents" Salaries 6.500
Sub-Total =63,625 $63,625
II. Operational
-Insurance 1,500
-Administrative Services 3,600
-Telephone 2,500
-Utilities 2,400
-Supplies 4,000
-Transportation 1,000
-Rent 10,46T
Sub-Total $25,467 $25,467
III. Indirect
-Administration (10$ of Contract Budget) 7,509 7,509
TOTAL COST PER MULTI-PURPOSE CENTER $96,601 3-SITES $289.803
SWELTER BUDGET
I. Personnel
40/40 Shelter Coordinator =18,000
40/40 Shelter Staff (3 a $16,000) 48,000
Temporary Staff 5,000
Maintenance 12,000
Benefits E 25% 19.500
Sub-Total $102,500 $102,500
II. Overhead
-Rente $40,5359
-Utilities 5,000
-Supplies 10,000
-Food 6,000
-Transportaion 2,000
-Insurance 2,500
-Rentals 6 Repairs 2,000
Sub-Total $60,035 60 035
III. Indirect
-Administrative (10$ of Budget) $16,253 $16,253
TOTAL $178,TSB
TOTAL ANNUALIZED $50T,091
eTo be adjusted onthe bases of actual facility lease costs when site is located
18-
r
Start-Up Budget FY 85-86
(Jan-June Expenditure Budget)
I. Implementation Staffing*
A. Project Manager (40140) $25,000
Assistant to Project Manager (40/40) 15,000
Clerical Support (20/40) 9,000
B. Operating Costs
- Supplies and Equipment 2,000
- Travel Reimbursement 1,500
$52,500 $ 52,000
II. Facilities Start-Up/Renovation
A. Multi-Service Center
Contract Program start-up staffing $20,000
Facility Renovation 20,000
Furniture 7,000
Appliances and Equipment 3,000
Lockers and Mail Boxes 2,000
Supplies(linens,food,service,mise suPp) 5,500
per site $57,000 3 sites $172,500
B. -Shelter
Program start-up staffing $ 15,000**
Facility Renovation 150,000
Furnishings 20,000
Appliances and Equipment 6,000
Supplies 5,000
Linens 1,500
$147,500 $197,500
III. Program Operation
A. Multi-Service Center(3 sites)(May-June) $46,554
(per site $15,518)
B. Countywide Support Services (May-June) 7,000
(money mgmt, resource devel, medic screen)
C. Training/Outreach
Benefits Advocacy Training 2,000
(for Contract do County Progr Staff)
I Mental Health Consumer Survey/Outreach 2,500
Misc. Training and Consultation 2,000
$60,054 $ 60,054
TOTAL START-UP BUDGET $482,554
* Includes fringe at 28$
** Shelter/Multi-Service Center contains start-up staffing totals $35,000
f
� Y '
o 'DIEPAR;ME'NT OF MENTAL HEALTH '
COMMUNITY MENTAL HEALTH SERVICES
1985-86 F.Y. ALLOCATION WORKSHEET
CONTRA COSTA
REVISION NUMBER 1
PROGRAM CURRENT ADJUSTMENT REVISED
ALLOCATION ALLOCATION
COMMUNITY SERVICES (INC. C.R.T.S.) $8,338,989 $0 $8,338,989
--------------------------------------- -------------- -------------- --------------
4% COST—OF—LIVING ADJUSTMENT $333,559 $0 $333,559
------------------------------------------ -------------- -------------- --------------
MDO(AB1229) 'INC. COLA (6 MONTHS FUNDING) —$62_468— -----------$0— —$62_468
----------------------------- ----- ----- ----
OMHSS OPT—OUT $0 $0 SO
------------------------------------------ -------------- -------------- --------------
EQUITY ADJUSTMENT $760,993 $0 $760,993
----- ------------------------ ----------- O— -------------- --------------
OTHER -MEN- S
TARGETTED SUPPLEMENTAL FUND (HOMELESS) $0 $507,547 $507,547
SUPPLEMENTAL RESIDENTIAL CARE SERVICES $0 $0 $0
TOTAL COMMUNITY SERVICES $9,496,009 $507,547 $10,003,556
PROGRAM DATA BY FUND SOURCES
4440-101-001(A) CRTS $1,004,760 $0 $1,004,760
------------------------------------------ -------------- -------------- --------------
4440-101-001(8) COMMUNITY SERVICES $8,491,249 $507,547 $8,998,796
TOTAL (FUND SOURCES $9,496,009 $507,547 $10,003,556
MEMO DATA
STATE HOSPITALS
GROSS $5,595,401 $0 $5,595,401
------------------------- --5-1,116-122 -----------$-- --5-1,116,122—
REVENUE
------------------------------------------ -------------- -------------- ----- --------
NET 'TOTAL $4,479,279 $0 $4,479,279
--------------------------- -------------- -------------- --------------
DAYS 35,220 0 35,220
OFFICE OF MENTAL HEALTH SERVICES
DIRECT $0 $0 $0
— ---------------------------- -------------- ----------- — --------------
PLACEMENT 50
$O
-- ----------- — -------------- --------------
TOTAL $0 $0
I CERTIFY THAT FUNDS ARE AVAILABLE IN ITEMS 4440-001-001, 4440-101-001 AND 4440-121-001
OF THE BUDGET ACT OF 1985 AND THAT THIS ACTION WILL NOT CREATE A DEFICIENCY.
PURPOSE AUGME�NyTATION FOR SERVICES TO THE HOMELESS
DATE
THOM S E. RIET2, DEPUTY D OR
DIVIS N OF ADMINISTRATI
DATE
EPARTMENT OF FlNANCE
Ii