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HomeMy WebLinkAboutMINUTES - 02152005 - C66 t i FHS #68Contra Costa TO: BOARD OF SUPERVISORS �; --------� ► FROM: Family and Human Services Commitee County Fav DATE: February 15, 2005 , SUBJECT: CCFuture Fund SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION Recommendations: 1. ACCEPT the report from the Assistant County Administrator on the CCFuture Fund, as recommended by the Family and Human Services Committee. 2. DIRECT that the Contractor's Alliance be notified prior to any discussions or allocations of funds from the CCFuture Fund. Fiscal Impact: Funding from the Transient Occupancy Tax (TOT) from the Renaissance Hotel is dedicated to the CCFuture Fund. Allocations from this fund were approved during the 2004/2005 budget approval process. Background: At its January 11, 2005 meeting, the Board of Supervisors requested that the Family and Human Services Committee review the process which resulted in allocation of CCFuture Funds to the Children's Mental Health System of Care to avoid reduction of County staff in the wraparound program. The attached report responds to that request and presents proposed program descriptions, budgets and evaluation plans for the Children's System of Care program. CONTINUED ON ATTACHMENT: X YES SIGNA RE: `- RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): 4 FE ERAL GLOVER MARK DeSAULNIER ACTION OF BOARD ON A29JAPPROVE AS RECOMMENDED 2Q OT44ER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AND ENTERED ON THE MINUTES OF THE BOARD AYES: NOES: OF SUPERVISORS ON THE DATE SHOWN. ABSENT: ABSTAIN: ATTESTED JOFTN S EETEN,CLE F THE BOARD OF Contact Person: Dorothy Sansoe(5-1009) SUPERVISORS AND OOUNTY ADMINISTRATOR CC: CAO EHSD BY: DEPUTY County of Contra Costa OFFICE OF THE COUNTY ADMINISTRATOR MEMORANDUM DATE: February 7, 2005 TO Family and Human Services Committee Supervisor Federal D. Glover, Chair Supervisor Mark DeSaulnier,Member FROM: Sara Hoffman S� Assistant County Administrator SUBJECT: CCFUTURE FUND—REFERRAL#68 Recommendation: ACCEPT the report on the allocation process of CCFuture Funds to Children's Mental Health System of Care. Background/Reasons for Recommendation At its January 11, 2005 meeting, the Board of Supervisors requested the Family and Human Services Committee to review the process which resulted in the allocation of CCFuture Funds to the Children's Mental Health System of Care to avoid the reduction of County staff in the wraparound program. This referral was made in response to a query by Liz Callahan, Director, Contractors' Alliance, questioning why funds were not distributed to Children's Mental Health contractors. Staff received the impression that Children's Mental Health contracts had been cut during the budget process and that there was a perceived equity issue. In January 2004, the Board of Supervisors created the CCFuture Fund and earmarked the Fund for prevention programs serving children and families in Contra Costa County. The mission of the fund is to: . invest in programs and seruices that are results-based family-oriented, collaborative, and available at critical points in the lives of children and families, thereby i�aiprol'171g fCIlfi17I1'f 11IC11011771g C711Gl�1'eG�t(C111g llle I91gI1 COSTS Of LIe�Je1lGTel7C1�. i r • In addition, the Board approved criteria for selecting programs for CCFuture grants and program evaluation requirements. The CDBG program was designated grant administrator. The original intent was to develop the first grant cycle in fall of 2004 with the first allocations effective July 1, 2005. However, at its August 11, 2004 meeting, the Board concluded that it would be counterproductive to initiate a grant process for new programs while important existing programs were being substantially reduced or eliminated in order to balance the County's budget. Targeting the Children's Mental Health program and Zero Tolerance for Domestic Violence Initiative for CCFuture Funds for the next two years made sense, since they: ➢ built upon existing County investments in supporting effective programs for children and families; ➢ already incorporated the CCFuture criteria into day-today operations; and ➢ could demonstrate program accountability for improved client outcomes. Children's Mental Health System of Care Overall, Children's Mental Health lost $4.2 million in the budget process, including $3.2 million net county cost and $1 million of matching revenue. The $675,000/year allocation from the CCFuture Fund was targeted to restore the System of Care wrap-around program(see attached proposal). The System of Care wrap-around program has been one of two model programs that have participated in the CCFuture pilot since inception. With funding support from the S. H. Cowell Foundation and Stuart Foundation, we were able to procure and implement program performance software that tracks individual client results and enables the department to assess the effectiveness of this program in diverting youth from expensive, high level out-of-home placements (see attached June 16, 2003 report). In addition, Children's Mental Health has assumed responsibility for the other portion of the CCFuture construct, the Data Archive which is designed to link data from multiple sources into an anonymous data base that can track the cumulative impact of individual interventions upon the health and well-being of children and families within specific p neighborhoods and communities. Targeting CCFuture Funds The CCFuture Fund was way the County established as a mechanism to change the y allocates funds, to be more businesslike and accountable for results. Contra Costa County has invested considerable institutional and organizational time, energy and resources into developing the System of Care wrap-around program. Budget reductions that had been approved by the Board for FY 04-05 would have basically 2 r r meant its demise, resulting in increased expensive out-of-home placements and continued tragedy in the lives of the young people who would not have received their services. According to Children's Mental Health, budget reductions did not affect the Children's Mental Health contractors in the same way. No contract payment limits were reduced; rather the funding source was shifted from County general fund dollars to federal and state sources, i.e., Medi-Cal reimbursement. This meant that the contractors needed to serve more Medi-Cal eligible clients and meet those Medi-Cal requirements. According to mental health staff, a recent review of the utilization rate among the contractors indicates that they are on-track with the previous year, prior to the shift in funding sources. Vern Wallace, Chief of Children's Mental Health, will be available to answer Committee questions concerning this issue. cc: Vern Wallace, Chief, Children's Mental Health Liz Callahan, Contractor's Alliance 3 • Report to Family and Human Services Committee Contra Costa County Board of Supervisors June 16, 2003 i r Children"s System of Care. Preliminary Analysis Contra Costa County Children`s Mental Health Research and Evaluation overview of Project ■An enrollee based project ■ Six months pre-enrollment compared to six month follow-up period (1 July 2002 through 31 Dec 2002) a Enrollment date determined by County ■ Data due 31 Jan 2003 Demographic Information - ■ 130 clients — ■ Primarily reale —Somewhat skewed — because of 36 male Summit Center residents a Ethnicity of clients dose to county .r averages of 200°ro _ poverty level 1 j Demographic Information ■ DO/*betw"m a--5 • 26%between 6-11 • 35%between 12-15 ■ 396 between 16-18 ■ 0%over 18 Diagnostic Information • Thirty-nine different DSM-IV diagnoses listed i4 asmy:as 331'.•A'DaYacas ■ Mood Disorders —BP=15 _ - - MDD=11 — DD NOS=13 -- - Dysthymia=5 _.:_ • Summit Center data with a high%of Conduct Disorder History of Problems - ■ Over 50%of enrollees have a history of psychiatric hospitalization ■ 38%of the sample have been detained in Juvenile Hall 2 1 r History of Problems .s.-.-.._....�_ n 47%of enrollees have been placed outside of the home a The most common E__ problem reported is a history of pool` school attendance —Nearly 3A of enrollees Interagency Involvement a Probation —Pre-enrollment=39%(so clients) —Follow-up=29%(38 clients) ■ Special Education —Pre-enrollment=68%(88 clients) —Follow-up=69%(90 clients) ■ Child and Family Services —Pre-enrollment=35%(46 clients) —Follow-up=18%(23 clients) Changes In 3uvenile Hall Detention ■ using paired t-test analysis,t/(1,129)_ 6.0,p<0.001 Grp ir..ue�nisfs ■ There was a _s, statistically significant decrease in 3uvenile •_' n....-'; Hall Detention , comparing System of <w.s.rr Pry Care pre-enrollment data to follow-up data 3 Changes in Ranch Placement ■ Using paired t-test analysis, t(1,�z9)=2.2,p<0.03 Nabasor,P*mYwamEdw 4onch ! There were 5 Clients who averaged 46 days el placement during the pre- ensallment penfld,M none in the#ftw-up ■ There was a statistically significaen�t decrease in li�placements T.�. cornpariqg..System of Care ro&nent Mata to %v p data Changes in Group Home Placement Days a Using paired t-test analysis,t(11129)_ 2.16,p<0.03 OIaNG t:•.1}:ii.t'_•:P+Za1Cin: ■ There was a statistically significant777 i decrease in days spent in high lever Group Homes comparing System of Care pre- enrollment data to foilow-tip data Changes In GroupHome Placement Days • Using paired t-test analysis.. ti(1,129) ChiCiBk in�alYfl+Q fl4K4 d;.5 kP.aae KtC+ti 1.2/l,p=0.22 =. - a There was a non- significant increase in days Spent in lower level Group Homes comparing System of Care pre-enrollment data to follow-up data 4 � r Changes in Foster Family Agency Placements ■ using paired t-test analysis,t(1,129)_ 2.52 <0.02 _ 1 p :corer Frr•:�y::�n�P:�aeea�era • There was a statistically significant �} g .- decrease in days spent in FFA comparing System of Care pre- enrollment data to follow-up data Changes in 'aOtherff L . Arrangements a In Contra Costa County, Summit Center is coded as OM*4 I,sl'rrxre C*m-c4 P:w m= an"other"living arrangement 27 a Using paired t-test analysis, t(1,129;_-23,p<0.02 a There was a stat sticafy significant increase in •,. ::_, "other"placements-this is explained by clients entry in Summit Center for Treatment Additional Analysis of Living Arrangements ■ Comparing- the- pre- enrollment period to the foilow-up,there were no significant changes in the following living arrangements: - Home 1 -unship -Foster Home - Shelter - Homeless 5 Changes in ch iatric ,. Hospitalization ■ Using paired t-test analysis,t(1x129)= 3.55 p<0.001 ....I. . Pay"&V ie ramp carat or r There was a statistically significant .. decrease in Psychiatric Hospitalization F1 '..P-'." C!:•-. comparing System of y 1 1 VIII Care pre.-er ohment data to follow-up data Changes in Day Treatment . Using paired t-test analysis,t/{(1,129)= 2.69,p<O.OQ8 ■ There was a statistically significant ri''" ski.' u•-s•. * 1 w decrease in Day - - Treatment comparing System of Care pre- _ _: .atssasa'_=rs.. enrollment data to follow-up data Changesin outpatient Service : using paired It-test ww.*!�Vs, t;1,129) -2.97,p<0.004 a There 4vere significant increases in outpatient minutes comparing System of Care pre-enroPment data to folbw-up data ■ This is further evidence of services being given ......,.�°. in the least restrictive setting Changes in Estimated Dental Health Costs a Es fru ted Medi-Cal Costs Non- decreased$371,636 Med-t-Caj Medi—Cal comparing pre-enrolment Costs costs .rel versus folow-up ■ Estimated non-Medi-Cal Service Change Change Costs decreased 6112,376 t-n. -321,89 -19SA33 comparing pre-enrollment pay, -x,300 -94,128 Oit�.l versus f ow-up t�t e Overall,estirnated mental ou"ti +180,033 +18CAM health costs decreased Iit ■ 1�1�.1�1 .I� $484,012 comparing,pre- —1 1-371,636 -112,376 enrollment versus fbilow-up FunctionalChanges School Attendance 1 a Using pained t-test analysis,t(1,129)= 12.85,p<0.001 — Zero through four scale �"°�'�'s �m. r . —Zero=never attends - - Four=aWays attends ` ■ There was a statistically significant Increase in school attendance comparing` ` System of Care pre- ;� enrollment data to follow-up data FunctionalChanges Recidivism-Felonies ■ Using paired t-test analysis,t(1,129)= 4.60,p<0.001 a There was a g: statistically significant decrease in the number of felonies reported comparing System of Care pre- enrollment data to follow-up data 7 Functional Changes Rec dnm*sm-Misdemeanom a Using paired t-test analysis,t(1,129)= 5.80,p<0=001 ■ There was a statisticallysignificant i_ --- decreasein■Yr■to f 557_ I�q�Fll�■ number of s.-.. misdemeanors reported comparing System of Care pre- enrollment data to fallow-up data - •-"' Conclusions of Farm Preliminary Analysis a�ll�a■.air Ia1 • We are serving an ethnically diverse population of those most in need ■ Comparing six months pre-enrollment in CSOC to the period July--Dec 2002: - There is a moverrant tm-ards less restrictive ii Ang arranger-wits -The change in lMng arrangements results in cost sm ings - There is an fficrease in outpatient services and a corresponding decrease in hospitalization and day treatment - The change in mental health usage patterns results in cost savings — School attendance increases — Fewer felonies and misdemeanors are committed Future Puns w Continued data analysis — Compare with State and ` Bay area data-v-.tm _ appropriate }' • Deterrvne potentia.1 cost savings - GweW Agency sawngs •=ecce-a: •State Assist kith Social Marketing 1 • Disseninate results throughout County to hdp energize staff an+d coctsc�rnersl Contra Costa System of Care Proposalfor Contra Costa Futures Grant Overview Contra Costa County, located in the San Francisco Bay area, is the ninth most populous county in California, with close to one million residents spread across 730 square miles. At least 50 different lanes are spoken and 100 countries represented. Children and youth account for approximately 27 percent of the County's population. The number of children and youth has increased from almost 212,000 in 1990 to over 237,00 in 1997. Despite overall measures of economic well being, there are areas of extreme poverty in the county. Between 1980 and 1990 54,000 residents (including 22,000 children) were living in poverty. This poverty manifests itself too often in higher rates of illegal substance abuse, homicide, school dropout, and child abuse and neglect. Mental health workers in west County, for example,report an enormous need for grief and loss work. Tareet Population The population served by the System of Care Program are Contra Costa County residents less than 22 years of age who have at least one DSM-IV diagnosis, and who are in out of home placement as a result of a mental health condition or who are at imminent risk of out-of home placement. These clients will receive a full wrap-around assessment, a child and family team,intensive case management, and individualized and tailored care. Services and Resources Contra Costa County Children's Mental Health System of Care provides a wide range of mental health prevention, consultation and treatment services to children,youth, and their families. These services include Crisis Intervention; Institutionally-Based Care; Community Treatment; and Intensive Wraparound Program. The current array of services have incorporated key core values--child centered, community-based, and family-focused—into every aspect of service delivery. At the core of the service array is the Wraparound Program (See attached Fact Sheet) an intensive intervention program for the most at-risk families. The Wraparound model employs a plug process m which a family and a skilled team facilitator bring together the important people in the family's life -- friends, relatives and professionals – in a series of organized team meetings in order to address the family's needs and to create specific strategies to meet those needs. The clinician may also provide home-based family therapy if the family requests them. Wraparound focuses on the strengths, skills, and talents of the family and other team members. It pays attention to the family's /A//-3/0`t cultural preferences,values and traditions. It creates services and solutions tailored to the specific needs of the family. Proposal This proposal to Contra Costa Futures is for the funding of sixteen FTE's to provide Wraparound and outpatient mental health services to the population described above. This will serve as a continuation of a greatly valued relationship between Contra Costa Children's Mental Health and Contra Costa Futures beginning with the earlier efforts to develop a common data base and now culminating in the ability to look at the impact of all service delivered under Wraparound related to the frequency, intensity and duration of service episode and positive outcomes for the child and family. Policy and Governance The System of Care Planning and Policy Council provides oversight for the System of Care, helping to support accountability. Parent representatives and first-line administrators from public agencies have assembled to engage in the highly coordinated activities of setting and monitoring system-wide outcomes, evaluation, quality assurance, and resource development. Evaluation This project will utilize a time-series cohort design to track the effectiveness of the Children's System of Care treatment. The first cohort will consist of children entering the system of care between July Is'2004 and December 30 2004. The second cohort will consist of children entering care between January l"2005 and June 3& 2005, and the final cohort period will start July 1't 2005 and end December 31"2005. Cohorts 1 and 2 will receive a baseline assessment,and a 6 and 12 month follow-up assessment. Cohort 3 will only receive a baseline and a six month follow-up because of the 2 year time limit of the grant. Assessment Overview: The child(if age 11 or older)and the parent/caregiver will undergo an extensive (approximately 2.5 hours)interview utilizing structured questioning as well as psychometrically validated surveys. Other methods of obtaining information needed for the evaluation include querying the Mental Health PSP database for mental health usage and billing information,treatment provider information, and diagnostic information. Information regarding out of home placements will be gathered from the Child welfare CWS/CMS database. Measures: Clinical (i.e., symptomatology) and functional (e.g.,how is the child doing in school?) measures will consist of the following: 1)Behavioral and Emotional Rating Scale (BERS),2)Caregiver Strain Questionnaire(CGSQ), 3)Child and Adolescent Functional Assessment Scale(CAFAS),,4)Child Behavior Checklist(CBCL), 5)Delinquency Survey(DS), 6)Education Questionnaire(EQ), 7)Family Assessment Device—General Functioning Scale(FAD-GFS),, 8)Family Resource Scale(FRS),9)Family Satisfaction Questionnaire(FSQ-A), 10) Substance Use Survey(SUS—AB), 11)Youth Satisfaction Questionnaire(YSQ-A), 12)Youth Self Report(YSR). Analytic Overview: Clinical and Functional: The scores on the follow-up measures will be singularly compared to the baseline scores (typically using multiple linear regression)as well compared in a grouped fashion using a repeated measures analysis. Planned covariates include client age,ethnicity,and severity of mental illness. In addition,the different cohorts will be compared to determine if there was evidence of an improving or maturing system resulting in better outcomes for children and families. It should also be noted that specific attention will be paid to changes in school performance and juvenile justice recidivism. Fiscal: Changes in living arrangements(e.g.,moving from a group home back to the family home)will be examined in order to determine cost avoidance at the county and state/federal level. Costs for living arrangements for the year prior to entry into the system of care will be determined and will act as the baseline for this measurement. Changes in mental health usage patterns will be analyzed in order to examine cost avoidance. Medi-Cal eligibility will also be considered in order to determine costs avoided at the county and state/federal level.Mental health for the year prior to entry into the system of care will be determined and will act as the baseline for this measurement. Treatment Provider: The total number of clients(as well as those in this project)that each provider is carrying will be determined. This will be compared to average caseloads in the previous year in order to measure changes in productivity. The provider's total billable services will also be examined in order to determine productivity. In addition,the average length of time between client visits will be analyzed. The number of clients(enrolled in this project)for each provider that show treatment gains,drop out of treatment, exhibit worsening of symptoms and functioning or show no change in outcome measures will be reported. Summary In summary,funding from the Contra Costa Futures grant would provide Contra Costa Children's System of Care with sixteen FTE's to continue serving youth with Wraparound Services. These services would reduce out-of-home placement, hospitalizations,involvement with the Juvenile Justice system and would increase school attendance and participation. These services are strength-based,family and child centered within a community,home, and school context. Outcome data would be collected and submitted to California Futures in quarterly reports. © dp a fi r VOA w "It M .• 0 d Al H � � V � W p .�• .� W � w 0 oa H — • 4 Q e3txai' � �, " � 01 r. �, •er 'er TS 00 VA W V wVAN& C4- vi jo SOO wa PA. 41 1p p.► ''off ,o epi IPA o � a