HomeMy WebLinkAboutMINUTES - 03131990 - 1.38 To BOARD OF SUPERVISORS
FROM: Mark Finucane, Health Services Director Contra By: Elizabeth A. Spooner, Contracts Administrato ill
Costa
DATE: March 13, 1990 Co
SUBJECT: Approval for Federal Block Grant Renewal Application, oposalfor
Redirection of Block Grant Funds, and Addendum to Part A of the
Mental Health' Short-Doyle Annual Plan for FY 1989-90
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
A. Approve the attached Federal Block Grant Renewal Application
as an addendum to Part A of the Contra Costa County Short-Doyle
Annual Plan for Mental Health Services for FY 1989-90;
B. Approve the proposal specified in said Renewal Application for
the redirection of Federal Block Grant funds from existing
adult mental health service programs in West County to a new
West County Consolidated Adult Services Program starting April
16, 1990;
C. Assure compliance with Federal Requirements set forth as
Attachment II (Assurance of Compliance with Federal Require-
ments on Use of Allotments) in said Block Grant Renewal
Application; and
D. Authorize the Health Services Director or his designee (Stuart
McCullough) to submit said Block Grant Renewal Application to
the State Department of Mental Health.
II. FINANCIAL IMPACT:
This Federal Block Grant Renewal Application represents a prelimi-
nary plan for 'the receipt of a Federal Alcohol, Drug Abuse and
Mental Health Administration (ADAMHA) Block Grant Award amount of
$1, 474 , 186, which is a planning estimate for mental health services
in FY 1989-90.
This amount is the same allocation as last fiscal year and does not
contain any adjustments for cost-of-living increases. The
application instructions for FY 1989-90 require a redirection of
at least 41% of the award amount into new programs, pursuant to
P.L. 100-690. Since this redirection can be accomplished over a
two-year period, the Renewal Application contains a proposal to
redirect $155, 368 in Block Grant Funds to a new West County
Consolidated Adult Services Program, which is the portion redirect-
ed in FY 1989-9'0 based on an implementation of this new services
program starting April 16, 1990. On an annualized basis for FY
1990-91, a projected $739,772 (or 50. 2%) will be redirected into
the new West County Consolidated Adult Services Program.
CONTINUED ON ATTACHMENT: _ YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDA 10 OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE S :
ACTION OF BOARD ON MAR, I APPROVED AS RECOMMENDED >�_ OTHER
VOTE OF SUPERVISORS
1 HEREBY CERTIFY THAT THIS IS A TRUE
UNANIMOUS (ABSENT —L!! AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THEDATEDATE SHOWN.
CC: County Administrator ATTESTED MAR 13 1990,
Auditor-Controller PHIL BATCHELOR, CLERK OF THE BOARD OF
. Health Services SUPERVISORS AND COUNTY ADMINISTRATOR
M382/7-83 BY `' �� ,DEPUTY
FY 89-90 Federal Block Grant Renewal Application
and Addendum to Part A of the Short-Doyle Annual
Plan for Mental Health Services
Board Order Page '2
While adoption of this addendum to the Part A Plan does not
obligate the, County to make any expenditures, submission of
the Block Grant Renewal Application and approval by the State
are required "for the County to continue to receive Block Grant
funds from the State.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
The proposed,, redirection of $739,772 of the Federal Block
Grant into the new West County Consolidated Adult Services
Program, starting April 16, 1990, represents a major shift in
the system of mental health service delivery in West County.
The goal of this new program is to provide integrated client
services through improved multi-disciplinary assessments,
aggressive client planning and service coordination, and
tightly organized and focused service provision. Of the
$1,474, 186 grant amount, a projected $403 ,835 (or 27 .4%)
remains allocated for children's services. This Mental Health
Block Grant Program was formerly referred to as the West
County NIMH Community Mental Health Center (CMHC) Block Grant.
The FY 1989-90 Block Grant Renewal Application and proposal
for redirection of federal block grant funds was reviewed and
recommended for approval by the County' s Mental Health
Advisory Board at its meeting on February 22, 1990. (See MHAB
letter of recommendation included in the Renewal Application. )
In its recommendation, the MHAB also has commended the hard
work of the West County Mental Health Program staff in the
writing of this proposal.
This Block Grant Renewal Application represents an addendum
to Part A of the County's FY 1989-90 Short-Doyle Annual Plan
which the Board adopted on August 15, 1989.
Distribution by Health Services:
County Administrator
County Auditor",-Controller
Health Services Director
State Department of Mental Health
z
1-®38
1989/90
FEDERAL ADAMH BLOCK GRANT (FBG)
Renewal Application
and
Addendum to Part A of the
Short-Doyle Annual Plan
CONTRA COSTA COUNTY
ALCOHOL/DRUG ABUSE/MENTAL HEALTH DIVISION
595 Center Avenue, Suite 200
Martinez, CA 94553
(415) 646-4910 February 22, 1990
grant 5.2
89/90 FEDERAL BLOCK GRANT (FBG)
Contra Costa County
Renewal Application
Addendum to Part A of the Short-Doyle Annual Plan
TABLE OF CONTENTS
Subiect Page
Mental Health Advisory Board Review Letter i
A/DA/MH Block Grant RENEWAL APPLICATION
State Form - Attachment I
ASSURANCE OF COMPLIANCE WITH FEDERAL
REQUIREMENTS ON USE OF ALLOTMENTS
State Form - Attachment II
Block Grant PROGRAM BUDGET SUMMARY
State Form - Attachment III vi
NARRATIVE OF PLANT; 1
APPENDIX 6
Integrated Assessment Team - Figure 1 A-1
Client Coordinating Team - Figure 2 A-2
Objectives for New Program - Figure 3 A-3
Description of Programs not subject to
funding redirection - Attachment IV A-4
Program Budget - Attachment V A-13
grant 5.2
s� _L CONTRA COSTA COUNTY
MENTAL HEALTH ADVISORY BOARD
595 CENTER AVENUE,SUITE 200
n� �s MARTINEZ,CALIFORNIA 94553
Phone(415)646-4910
February 22 , 1990
Supervisor Nancy Fanden, Chair
Contra Costa County
Board of Supervisors
651 Pine Street '
Martinez , CA 945153
Dear Supervisor Fanden and Members of the Board:
The Contra Costa County Mental Health Advisory Board has reviewed
the Alcohol/Dru'g Abuse/Mental Health Block . Grant renewal
application and addendum to Part A of the annual Short-Doyle Plan
for FY 1989-90 and recommends approval and submission to the State
Department of Mental Health.
We would also like to commend the hard work of the West County
Mental Health Program staff in the writing of this proposal .
Sincerely,
Cynthia Miller
Chair
pr
cc: Phil Batchelor
Mark Finucane
Stuart McCullough
Robert Proctor
i
grant 5.2
A351 (6/88)
ATTACHMENT I
i
BLOCK GRANT PLANNING ESTIMATE
AND
RENEWAL APPLICATION
SFY 1989/90
COUNTY Contra Costa
FEDERAL BLOCK GRANT AWARD AMOUNT $ 1,474 , 186
PORTION REDIRECTED (PROJECTED AMOUNTS) $ 155,368*
The Mental Health Department of Contra Costa County hereby
requests continuation of the Federal Alcohol, Drug Abuse and
Mental Health Administration (ADAMHA) Block Grant. These
continuation funds will be used in accordance with Public Law
(PL) 100-690 and� as stated in the Assurance of Compliance with
Federal Requirements on Use of Allotments (Attachment II) .
This represents the SFY 1989/90 Planning Estimate for your
county. The same providers and/or programs that have been funded
with Federal ADAMHA Block Grant (FBG) in the past no longer are
required to be funded. Counties funded with FBG in SFY 1988/89
will receive thej, same amount of funds in SFY 1989/90 . Under the
terms of PL 100-690 these same FBG counties must redirect a
minimum of 41% of their funds to "New Programs" . However, those
counties that receive less than $100,000 of FBG in SFY 1989/90
are not requiredl! to redirect nor are programs in counties that
had been initially awarded FBG funds in SFY 1985/86 under PL 98-
509 . As redirection occurs, DMH Community Programs Operation
Branch liaison staff should be consulted to identify if the new
programs meet the federal definition of "New Programs . " The
changes must be consistent with the total county program effort
and must maintain/enhance the continuity of care for that county.
The Block Grant Planning Estimate is the total authorized gross
expenditure level of approved programs. These amounts are
subject to adjustment for a net reimbursable amount to the
county. The adjustments include but are not limited to Gramm-
Rudman-Hollings (!,Federal Deficit Reduction Act) adjustments,
prior year audit recoveries, federal legislative mandates
applicable to categorical funding, etc. The net amounts
reimbursable will be reflected on future allocations and/or
advance payments as the specific dollar amounts of adjustments
become known forieach county.
* Portion redirected in FY 1989-90, starting April 16, 1990.
A projected $739,772 (or 50.2%) is redirected on an annualized basis for FY 1990-91.
i
r '
County Mental Health Director
Stuart McCullough
grant 5.2
ATTACHMENT II
ASSURANCE_ OF COMPLIANCE WITH FEDERAL REQUIREMENTS ON
USE OF ALLOTMENTS
SEC. 1915. (a) Except as provided in subsections (b) and (c) , amounts paid to
a State under Section 1914 and amounts transferred by the State for use under
this part may be used for the State for --
E}}-p}aRA�p�,-e5�ah�#sb€A�;-ma�p�a�R;p�;-Eee��ipaE;R�;-aA�-eva�da��R�
pFejeets-€sF-€he-develepment-a€-meFe-a#€ee€#ve-pFeveRt4en -€Featment-and
�ebah#}}€a�#eR-aA�-aE�}r;�}es-fie-lea#-w#€a-a#Eebe�-aRe-��d�-andse-aAe
(2) grants to community mental health centers in accordance with Section
1916(c) and grants to community mental health centers for the provision
of the following services:
(A) Services for chronically mentally ill individuals, which include
identification of chronically mentally ill individuals and
assistance to such individuals in gaining access to essential
services through the assignment of case managers.
(B) Identification and assessment of severely mentally disturbed
children and adolescents and provision of appropriate services to
such individuals.
(C) Identification and assessment of mentally ill elderly individuals
and provision of appropriate services to such individuals.
(D) Services for identifiable populations which are currently
underserved in the State.
(E) Coordination of mental health and health care services provided
within health care centers.
Amounts provided for the activities referred to in the preceding sentence may
also be used for related planning, administration, and educational activities.
(b) A State may not use amounts paid to it under Section 1914 to --
(1) provide inpatient services in the case of amounts provided for
community mental health centers or provide inpatient hospital services
in the case of amounts provided for alcohol or drug abuse programs,
(2) make case payments to intended recipients of health services,
(3) purchase or improve land, purchase, construct, or permanently improve
(other than minor, remodeling) any building or other facility, or
purchase major medical equipment.
(4) satisfy any requirement for the expenditure of non-federal funds as a
condition for the receipt of federal funds, or
grant 5.2
• ASSURANCE OF COMPLIANCE
(5) provide financial assistance to any entity other than a public or
nonprofit private entity.
APPLICATION AND DESCRIPTION OF ACTIVITIES
SEC. 1916 (c)
(3) The State agrees to make grants to community mental health centers in
the State for the provision of comprehensive mental health services --
(A) Principally to individuals residing in a defined geographical area
(hereinafter in this section referred to as a 'mental health service
area' ) , with special attention to individuals who are chronically
mentally ill .
(B) Within the limits of its capacity, to any individual residing or
employed in its mental health service area regardless of ability to
pay for such services, current or past health condition, or any
other factor.
(C) Which are available and accessible promptly, as appropriate, and in
a manner which preserves human dignity and assures continuity and
high quality care.
(4) The State agrees to require that any community mental health center in
the State receiving a grant from the State under this part provide --
(Ay--outpatient services, including specialized outpatient services for
children, the elderly, individuals who are chronically mentally ill ,
and residents of its mental health service area who have been
discharged from inpatient treatment at a mental health facility.
(B) 24-hour-a-day emergency care services,
(C) day treatment or other partial hospitalization services "or
psychosocial rehabilitation services" ,
(D) screening for patients being considered for admission to State
mental health facilities to determine the appropriateness of such
admission, and
(E) consultation and education services.
NONDISCRIMINATION
SEC. 1919 (a)
(1) For the purpose of applying the prohibitions against discrimination on
the basis of age under the Age Discrimination Act of 1975, on the basis
of handicap under Section 504 of the Rehabilitation Act of 1973, on the
basis of sex under Title IX`of the Education Amendments of the 1972, or
on the basis of race, color, and national origin under Tiitle VI of the
Civil Rights Act of 1964, programs and activities funded in whole or in
part with funds made available under this part are considered. to be
programs and activities receiving federal financial assistance.
grant 5.2 iv
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ASSURANCE OF COMPLIANCE
(2) No person shall on the ground of sex or.religion be excluded from
participation in, be denied the benefits of, or be subject to
discrimination under, any program or activity funded in whole or in part
with funds made available under this part.
(b) Whenever the Secretary finds a State, or an entity that has received a
payment from allotment to a State under Section 1913, has failed to
comply with a provision of law referred to in subsection (a) (1) , with
subsection (a) (2) , or with an applicable regulation (including one
prescribed to carry out subsection (a) (2)) , the Secretary shall notify
the chief executive officer of the State and shall request him to secure
compliance. If within a reasonable period of time, not to exceed sixty
days, the chief executive officer fails or refuses to secure compliance,
the Secretary may --
(1) refer the.matter to Attorney General with a recommendation that an
appropriate civil action be instituted,
(2) exercise the powers and functions provided by the Title VI of the
Civil Rights Act of 1964, the Age Discrimination Act of 1915, or
Section 504 of the Rehabilitation Act of 1913, as may be applicable,
or
(3) take such other action as may be provided by law.
(c) When a matter it referred to the Attorney General pursuant to subsection
(b) (1) , or whenever he has reason to believe that a State or an entity
is engaged in a pattern or practice in violation of a provision of law
referred to in subsection (a) (1) or in violation of subsection (a) (2) ,
the Attorney General may bring a civil action in any appropriate
district court of the United States for such relief as may be
appropriate, including injunctive relief.
CRIMINAL PENALTY FOR FALSE STATEMENTS
SEC. 1920 Whoever --
(1) knowingly and willfully makes or causes to be made any false statement
or representation of a material fact in connection with the furnishing
of items or services for which payment may be made by a State from funds
allotted to the State under this part, or
(2) having knowledge of the occurrence of any event affecting his initial or
continued right to any such payment conceals or fails to disclose such
event with an intent fraudulently to secure such payment either in a
greater amount than is due or when no such payment is authorized,
shall be fined no more than $25,000 or imprisoned for not more than five
years, or both.
V
grant 5.2
State of California Department of Mental Health
Health and Welfare Agency Attachment III
?LOCK GRANT PROGRAM BUDGET SUMMARY
MH 1783 ( 5/89) ADDENDUM TO SHORT-DOYLE PLAN (PART A)
35/90 FISCAL YEAR SUBMISSION DATE: 2-22-90
07 COUNTY OF CONTRA COSTA
1 2 3
ALL PROGRAM TYPES 01-04
ITEMS CR/DC LESS:
(MH 1900 Non- BLOCK
Column 1) Block Grant GRANT
Salaries & Employee Benefits13-411 '412 $ 12425 0 985 609
Ooeratin Expenses 7 323 497 6,991.592 331 905
E ui ment 39,897 39,397500
Remodeling -0- -0- -0-
Count Overhead 386 533 48 932
Ne .Net Amount Ne . Net Rate 562'546 562,546 -0-
Actual Cost Fee for Service Con. 6,533,343 _ 6,016,201 517 1 2
Gross Program 28,306,160 26 422 072 1-1-884,088
LESS• Savings < -o- > < -o- > _0_
Ad usted Gross Pro ram 28,306,160 26 422.072 1 884.088
LESS: 1,550,242 1 1,5509242 1 -0-
Grants
Patients Fees 54-512 53,757 755
Patient Insurance 354,932 341,36917-,563
Medi-Cal/Fed. 7-585,676 7J49.570 236 106
Medi-Cal/Non-Ped. __0_ -0- -0-
Medicare 2 025'9381 976 856 49,082
Cons. Admin. -0- -0- -0-
Other 1.729- 166 1,618,770 110 39
Su of Residential Care -0- -0-
County Overmatch 5,740,240 5740240 - -
TOTAL REVENUES < 19,040,706 >< 18,630,804> (409.1902)
1 NET COST 99265,454 7,791,268 1,474,136
lIncludes the amount, reported on Line 1 (Net Cost) , Column 3
COMPLETION INSTRUCTIONS
I. GENERAL This form identifies the Block Grant State allocation proposed
usage for the budget year by gross and net costs. It also reconciles the
Block Grant to other CR/DC funding.
II. HEADING INSTRUCTIONS - Put in the two-digit State assigned county number
followed by the county name and date the form is completed.
=II . ITEM AND COLUMN INSTRUCTIONS - Refer to CR/DC Manual, Chapter III for line
items. Column 1 (CR/DC) is the sum of column 1 's MH 1900 from all program
types. Columns 2 and 3 are determined by county and may be prorated by the
most current comparable reports or a current representative sampling for
the year.
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grant 5.2
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III
NARRATIVE
Federal ADAMH Block Grant
Renewal Application and Addendum to Part A
Short-Doyle Annual Plan
I'
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grant 5.2
1989/90 FEDERAL ADAMHA BLOCK GRANT (FBG)
Renewal Application--Contra Costa County
NARRATIVE
a. ) A brief history of the proctram and services provided including
administrative events that impact.
The Federal Block Grant (prior to 7/82 CMHC grant) has, since
1980/81, funded a range of mental health services in West Contra
Costa County. FBG funded components included: a Psychiatric
Emergency Service, an Intensive Day Treatment program, adult and
children's outpatient clinics, case management program,
geriatric outreach program, and contracted services including
early intervention to high risk infants and mental health
counseling and outreach to the Spanish speaking population.
Programs approved in the initial CMHC application were never
fully operationalized due to declining federal funding thus
resulting in a functional disunity and isolation of program and
service functions. Currently the program receives $1,474, 186 of
which 50% or $739,772 will be redirected to "new programs" when
fully implemented. Continuing programs which are not subject to
funding redirection are described in APPENDIX, Attachment IV,
and will essentially be maintained as described in the 1988/89
Block Grant Application.
Programs proposed for Block Grant funding redirection in FY
89/90 are the Adult services in West county:
j
♦ 38th Street Clinic - Adult outpatient Services
♦ Broadway Clinic - Adult Outpatient Services
♦ West County Case Management Services
♦ Day Treatment Services (Intensive)
+ Psychiatric Emergency Services
These programs will be converted into a West County Consolidated
Adult Services Program (WESTCCASP) , composed of the following
components: an Integrated Assessment Team (IAT) which will act
as the single point of entry to adult services, a Client
coordinating Team (CCT) which will insure treatment/service
coordination, and a system of Service Groups (SG's) which will
provide direct client services.
The goal is to - provide integrated client services through
improved multidisciplinary assessments, aggressive client
planning and service coordination, and tightly organized and
focused service provision.
grant 5.2 2/22/90 -1-
Barriers to program/fiscal redirection in FY 89/90 -• Contra
Costa County faced with substantial budget reductions (due to
inadequate State COLA augmentations for health and mental health
services) along with the need to transition to a centrally
administered mental health system, eliminated the West County
Regional Mental Health Director Position. The resulting
reorganization has required extensive staff and management
effort to coalesce. The concepts and ideas represented. in this
document is a result of that unification. It is anticipated that
planning for implementation will require additional time with
the actual implementation beginning on April 16, 1990. The
funding and program redirection will be fully in place for FY
90/91.
b. ) Description of provider organization,—services, number of
recipients and service objectives
West County Consolidated Adult Services Program (WESTCCASP) will
primarily serve seriously mentally ill (SMI) adults who evidence
acute disorders and/or severely disabling disorders (including
those who are homeless or at risk of homelessness and those who
are dually diagnosed as substance abusers) . Secondarily
WESTCCASP will also attempt to serve the crisis and brief
therapy needs of West County residents who seek the services of
the mental health system and who have no other alternatives for
treatment. WESTCCASP will be made up of:
1. An Integrated Assessment Team (IAT) will be the centralized
point of entry to the Adult System. The IAT made up of a Mental
Health Treatment Specialist (MHTS) from the Crisis, Case
Management, and Adult Services Groups, along with a psychiatrist
and a backup MHTS from the Day Treatment Services Group, will
provide a prompt and appropriate response to all requests for
Adult Services. New community, agency, and hospital clients will
be referred to the IAT for two levels of assessment:
(a) assessment for appropriateness for public mental health
services (given resource restrictions and service system
priorities) and
(b) multi-disciplinary assessment including formulation of
initial intervention/service needs. (APPENDIX, Figure 1)
The following range of outcomes is expected:
■ Client needs are either better served elsewhere or are not
provided by our system. -Referral Out-
■ Client immediate needs are resolved by IAT. No additional
services are required.
■ Client immediately receives crisis services (includes 5150
grant 5.2 2/22/90 -2-
evaluation, medication evaluation, crisis intervention, etc. )
options may include referral out, hospitalization, and
immediate reassessment and follow-up by IAT.
N Client is assessed to need a service (or services) provided
by one of the SGs and a direct appointment is made for that
service, with a follow-up procedure to ensure linkage.
a Client is assessed to need services provided by two or more
SGs. A primary service will be determined and a direct
appointment made for the client. in addition, the primary
service provider will be requested to refer this case to the
CCT for further treatment/service planning. A follow-up
procedure will ensure linkage.
2. A Client Coordinatincr Team (CCT) will integrate treatment
and services for those clients whose needs are complex (such as
those requiring two or more service modalities) and those
clients who present special challenges to the service delivery
system. The CCT will normally be made up of assigned
representatives from each Service Group (SG) . When deemed
necessary representatives from other County and contract service
providers (hospital, probation, social services, residential,
day, vocational, housing, employment, rehabilitation,
Conservatorship, etc. ) will be invited to be a part of the
service coordination planning for client. The CCT will develop
a multidisciplinary, coordinated treatment/service plan,
facilitate implementation of these coordinated plans, and track
the follow-up on these plans. Management of this team will be
provided by a licensed Mental Health Program Supervisor along
with the direct and continued involvement of the West County
Medical Director. (APPENDIX, Figure 2)
3 . service Groups (SGIs) will be primary service providers:
• Service Group I-and 2 will provide individual, group, and
family therapy, as well as medication treatment services. Made
up of MHTS's who are licensed and designated as therapists and
psychiatrists who provide medication, treatment and
consultation services.
• Service Group 3 will provide evaluation, brokerage and support
services to the severely mentally ill (SMI) . Made up of MHTS Is
who are designated as case managers.'
'Current MediCal Case Management regulations (DMH 89-20)
preclude the same individual from providing both therapy and case
management services. This program will comply with current
regulations, however this is incongruent with a truly integrated
model of care. Contra Costa County will submit a waiver request as
soon as this is made possible by DMH regulations.
grant 5.2 2/22/90 -3-
■ Service Group 4 will provide intensive day treatment services.
Made up of a Clinical Nurse Specialist, MHTS 's designated as
day program specialists, psychiatrists who provide medication,
treatment and consultation services, and additional
specialized program staff.
■ Service Group 5 will provide crisis intervention services
including emergency medication. Made up of MHTS 's who are
designated as crisis specialists and psychiatrists who provide
medication, treatment and consultation services.
Implementation of the West County Consolidated Adult Services
Program (WESTCCASP) will require further refining of systems
designs to ensure that all implementation issues raised in
development have been addressed. Standardized forms will need
to be produced so that information gathered and coordinated
plans developed will be consistent and clear to all staff.
Training needs will have to be determined. The following
implementation process will be followed:
♦ March 9, 1990 - Written Implementation Plan submitted
for final approval.
♦ April 16, 1990 - First phase of implementation
♦ June 30, 1990 - Final phase of implementation
C) The evaluation method to be used to determine the effectiveness
of the program (services)
There will be at least three (3) major evaluation methodologies
used in determining the effectiveness of the program (services)
-both new and continuing programs.
1. A highly sophisticated on line computerized 1Kanagement
Information System (MIS) has been installed and implementation
is in progress which will allow detailed tracking of clients
through all service system venues. This MIS will produce
reports at regular intervals helping to ensure immediate
feedback to all service providers. The MIS computer will also
be used to provide inferential statistical analysis of the
quantitative data made available by this new system.
2. The Utilization Review/Quality Assurance Committee process
will provide ongoing analysis of the qualitative aspects of the
program.
3 . An on-site annual review providing descriptive analysis and
recommendations will be combined with information from the above
activities into one annual report to be submitted to the Local
Mental health Director on September 1, 1990/91/92 .
Finally, it is expected that we might use other evaluative
methods (such as a survey of client perceptions/client needs)
in order to more fully insure the effectiveness of our program.
grant 5. 2 2/22/90 -4-
Performance results of 88/89 FBG contract programs are reported
through the Final Contract Performance reports on file with the
County Mental Health Program. County operated program outcomes
have not been available during the. initial implementation of the
MIS. Detailed client outcomes and performance reporting will
be available for a portion of FY 89/90.
See objectives outlined in APPENDIX, Figure 3 . It is
anticipated that statistical outcome measures will be updated
for years 2 and 3 to more accurately reflect new programs and
improved statistics - client and staff data activity data -
with full operation of the new management information system.
d) Problems the .program is expecting to encounter
The proposed West County Consolidated Adult Services Program
(WESTCCASP) requires a restructuring of our system into an
integrated approach to services. As described in section b)
this includes ^requirement of a newly designed uniform intake and
assessment procedures, unified treatment/service planning, and
highly coordinated service provision. This will require
professionals to focus more on the systems aspects of service
delivery than has been required heretofore. Intensive
coordination will require a highly structured process of staff
communication which, in the past, has been difficult due to
staff schedules (many staff are part-time) , distance between
service sites, and slow/inconsistent delivery of written
materials. There are potential problems with adequate space
to house the IAT, clerical support to both IAT and CCT, and
safety and security for both staff and clients.
e) Proposed solutions or actions taken to address the problems
The above are real and significant concerns, however, we believe
that they can be managed and solved through the careful
development of an implementation plan, which will include
training and consultation in order to implement the programmatic
changes. While the transition will be difficult for staff and
managers, the process that has developed this proposal, and that
will develop the implementation plan, has been positive. This
will help to insure the success of the proposed changes.
f) Objectives and success standards in statistical terms for SFY
1989/90 and three-year goals with success standards
See objectives outlined in APPENDIX figure 3 . It is anticipated
that statistical outcome measures will be updated for years 2
and 3 to more accurately reflect new programs and improved
statistics - client and staff activity data - with full
operation of the new management information system (MIS) .
grant 5. 2 2/22/90 -5-
IIIA
APPENDIX
n
Integratedl,, Assessment Team - Figure 1 A-1
Client Coordinating Team - Figure 2 A-2
Objectives '; for new Program - Figure 3 A-3
Description of Programs not subject to
funding redirection - Attachment IV A-4
II
Program Budget - Attachment V A-13
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A-2
I,
t
Contra Costa County FIGURE 3
Federal Block Grant - ADAMH
FY 89/90
OBJECTIVES FOR NEW PROGRAM
i
Objective Fiscal Year
89/90 90/91 91/92
Integrated Assessment Team
1) Reduction/elimination of waiting list 20% 100% 100%
i
2) New West County inpatient clients
assessed by Integrated Assessment Team 100% 100% 100%
3) Clients presenting themselves will be
assessed and appropriately referred in or out 80% 100% 100%
b
Client Coordinatin1g Team
1) Compliance willlbe achieved with all
quality assurance guidelines 80% 100% 100%
I'
2) New clients referred to services
groups will conform to description of
target population 60% 80% 100%
3) Increase provisiion of brief therapy
and group modalities where clinically
appropriate j 10% 20% 20%
I'
4) Inpatient clients who are multi-
users of the system will be assessed by
the Client Coordinating Team for appro-
priate referral' 80% 100% 100%
1
grant 5.2
i
ATTACHMENT IV
Programs not subject to funding redirection
grant 5.2
1989/90 ATTACE�T IV
Continuing Programs
(Not subject to funding redirection)
The following contracted services will be provided under the Block
Grant during FY ] 989/90
1. DESARROLLO FAMILIAR, Inc.
Contractor provides outpatient mental health treatment services
(individual/family/group therapy and medication) primarily for, but
not limited to Spanish-speaking residents of Vest Contra Costa County.
In addition, CE&I/Advocacy Services are provided in order to strengthen
individuals' and communities' skills and abilities to cope with
stressful life situations before the onset of problems and to enhance
and/or expand agencies' and organizations' mental health knowledge
and skills. The agency serves approximately 1 ,000 clients per year.
Process Objectives
a. Follow-up of 75: of no show clients.
b. Expand services in areas of peripheral support : specific and
11
relevant education, parenting classes, AIDS education of 25: of
- Hipspanic population.
c. Increase search for corporate funds and donations to the amount
of $10,000.00.
Outcome Objectives:
a. Cointinuity of service will be increased by 25%, as evidenced by
less no shows.
b. A jgreater number of clients will be reached (25: more) through
expanded services.
c. Th'e agency will become less dependent upon federal funds by
increasing donation of foundation dollars.
2. EARLY ,CHILDHOOD MENTAL HEALTH PROGRAM
V Infant Outreach Services: Contractor provides a combination of
services assessment, treatment and consultation and training)
when problems are first identified, in order to interrupt or
prevent adverse interaction between parent and child which can
i result in emotional problems or complicate an original handicap.
Contractor provides services to infants and their families where
j there has been a past history of children with poor growth, unusual
sibling death, abuse or neglect or where marital , emotional and/or
financial crises exist which interfere with adequate parental
nurturing or inter-action with the child.
Process Objectives
a. To' provide no fewer than 1800 service units (to include 1600 units
of iirect client services and 200 units of consultation and training
seriices). To provide assessment and brief crisis intervention to
A- 4
grant 5.2
2. EARLY CHILDHOOD MENTAL HEALTH PROGRAM
� Process Objectives (cont'd)
l,w
a. no fewer than 65 families, treatment services to no fewer than
35 families , and consultation to no fewer than 90 professionals.
b. To provide psychosocial assessment of infant's social-emotional
development, maternal mental status, maternal-infant relationship,
and potential risk factors with one month of accepting each
family for service.
Outcome Objectives:
a. Thirty percent of families who receive ongoing services for six
months will show increased parent-child attachment as defined by
program criteria by the end of treatment as assessed by the client's
social worker.
b. Thirty percent of parents who receive ongoing services for six
months will improve their parenting skills as defined by program
criteria by the end of treatment, as assessed by the supervising
clinical social worker.
c. Fewer than 10t of families seen in ongoing treatment for :six months
will be referred to Child Protective Services for suspected child
abuse during the remainder of their time in treatment.
e Transitional Services: Contractor provides transitional services in
order to facilitate —the adjustment o€.children who finish Contractor's
Therapeutic Nursery School. Program (not funded by the County) into
normal nursery school programs or kindergarten classes , or other
appropriate settings, to reduce the stress associated with the
experience and demands of such new settings , and to help parents
and other caregivers maintain the child's previous , positive growth.
Transitional services include, but are not limited to,
1. ) consultation to the child's family and school , including home
and classroom visits, therapeutic assessments and referrals,
and
2.) classroom observation and placement.
The Infant Outreach and Transitional services provided approximately
2,000 units of service per year.
Process Objectives :
a. To provide no fewer than 280 service units (to include 265 units of
consultation services and 15 units of classroom observation and
placement services).
b. To offer, as a minimum, to each graduate of the Therapeutic Nursery
School and/or the graduate's family, at least three consultation/
parent education meetings; at least three consultation meetings for
the teacher; and information on appropriate community resources.
A -
grant 5.2
i
Process Objectives (cont'd)
c. To ,provide to teachers of no fewer than 90: of graduates of
t` Therapeutic Nursery School , information about the child 's develop-
mental history within one month of the child's entry into the
classroom and information about possible intervention modes within
two; months of child's entry into classroom
Outcome Objectives:
a. Seventy percent of children who can be contacted for this information
and�'who are enrolled in a regular school classroom upon graduation
from Therapeutic Nursery School will remain in a regular school
classroom at the end of nine months in the Transition Program,
1
b. Eighty percent of families who received services and who respond
to a written survey will indicate greater than average satisfaction
with service received on a Scale distributed. at the end of each
nine-twelve months of service.
c. Seventy five percent of all teachers and/or other school personnel
who received consultation services will indicate greater than average
sa ti�sfaction with service received on a Scale distributed at the
and of each nine-twelve months of service.
• Pre-school Mental Health Consultation Team(West) : To improve
functioning of presc-nool children who are at risk of becoming
emotionally disturbed and who are enrolled in W'-,y care centers or
day care homes or preschools in West Contra Costa County by providing
assessments of such children, consultation to parents and staffs of
facilities in which children are enrolled, brief counseling for
children and parents , and training for staffs of facilities on
methods and techniques for improving functioning of such children
in normal day care and preschool settings.
I]
Process Objectives :
a. Given sufficient staff resources , assess every preschool child in
West County who displays signs of emotional disturbance and who is
referred by teachers or care-givers in day care programs for children.
b. Given sufficient staff resources , provide program and case consultation
to preschool and day care staff in 'nest County in all instances where
such 'service is requested by preschool or day care programs.
c. Provide no fewer than 875 units of service.
Outcome Objectives:
a. On a Client Satisfaction Scale distributed in both East and nest
County the last quarter of contract year:
1. Eighty-five percent of responses from child care homes/centers
and preschools served will ind� -ate greater than average
satisfaction with services rece .ved.
grant 5.2 A - 6
Outcome Objectives (cont'd)
t a. 2. Eighty-five percent of responding teachers from day care homes/
centers or preschools who receive consultation will indicate
that the service was helpful in increasing their ability to
serve the child effectively,
b. On a brief questionnaire, eighty-five percent of other professionals
with whom staff collaborate on cases (either from agencies or as
individuals) will indicate greater than average satisfaction with
their contact with staff.
c. Sixty percent of parents served in fiscal year t qRa/gra will follow
through on referrals as reported by parents or providers.
3. YOUNG MEN'S CHRISTIAN ASSOCIATION OF WEST CONTRA COSTA
Contractor provides on-school site counseling/therapy services for
emotionally and behaviorally disturbed students in selected ;junior high
schools in the Richmond Unified School District. The mental health
services include assessing the needs of each referred student; (and the
student's family) , for mental health intervention; assessment services
include , but are not limited to classroom observation, face-to-fate
discussion with teachers, and face-to-face diagnostic interviews with
each student and/or members of the student's family. Specific treatment
plans are developed with progress reviewed at predetermined time periods .
Services prescribed by each student's treatment plan inc:::de, but are
not limited to, individual , group, and/or family therapy, therapeutic
recreation groups, and consultation with teachers and others. This
program provides approximately 2,036 units of service per year.
Process Objectives :
a. Contractor will maintain an in-school Mental Health Team in three
junior high schools in Richmond unified School District throughout
the Fiscal Year.
b. Contractor will assess 80 students and their families at these
schools for need for trental Health Services during Fiscal 'rear,
and will provide a minimum of 3,795 units of service as specified
in the contract.
Outcome Objectives : -
a. Seventy-five percent of all clients who remain in treatment the
length of time recommended by staff will achieve at least one of
their primary treatment goals.
b. In June j 989 , a survey of all clients (students and parents) at
the three schools will produce a highly favorable rating (4 or
5 on a I-5 scale) by 70: of the survey respondents relative to the
effectiveness of team interventions in helping the clients resolve
identified problems.
grant 5.2 A - 7
i
Outcome Objectives (cont'd)
i
{
C. In June ] g Rg a survey of school staff at the three schools who
have' been personally involved with referrals to the program will
Produce a favorable rating (4 or 5 on a 1-5 scale) , for team
intervention and/or consultation effectiveness by 65: of the
school staff surveyed.
4. RUBICON PROGRAMS, Inc.
t Administrative Services/West County Semi-Supervised Independent
ousi1'ngProgram: Contractor provides administrative services for
the County-operated West County Semi-Supervised Independent Housing
ProgrIam, a six-unit complex of two-bedroom apartments including a
community room office space located at 909-911 Virginia Avenue,
Richmond, California. Approximately 18-22 clients are served in
this program annually.
Process Objectives:
a. Living skill classes in the areas of cooking/nutrition, personal
management, and current events will be provided to all residents .
b. Rubicon will work closely with Nest County Follow-up/Case Management
to insure appropriate referrals.
Outcome Objectives:
a . Eighty percent of clients will be able to live in the community for
at least one year after graduation.
b. Sixty !'Percent of referrals will be clients previously residing in
board land care or half-way house residential settings.
•. Independent Living Outreach Program: Contractor provides the
?o1low1ling rehaoi itative non- di-Cal } outreach services for clients
with a mental disability which has impaired their ability to live
independently.
a. Comprehensive housing assistance to at least twenty-five (25) new
mentally disabled residents of West Contra Costa County. Contra ctAr
shall provide nine hundred (900) or more service units including :
1. Assessment of each client's housing needs ,
2. Identification of appropriate and affordable housing and
assistance for clients with said housing resources for the
purpose of referral and follow-up,
3. Certification of income and disability for application to the
`Section 8" program for the disabled administered by the
Contra Costa Housing Authority, which provides housing
subsidies to the disabled,
grant 5.2 A -8
•. Independent living Outreach Program (cont'd)
a. 4. Individualized instruction tailored to a client's specific
needs to maximize client's adjustment to independent living,
including instruction to money management, cooking, shopping,
nutrition, home care and maintenance, and independent living,
and,
S. Provision of supportive counseling, planning, goal setting
and problem solving to aid and support each client's community
adjustment.
b. Coordination and planning of services for mutual clientele with
Rubicon Homes, Transitional Apartments, Nyumba Chuki , Casa Cecilio
Chi and County Mental Health Services to include individual case
conferences as needed to- provide continuity to client services and
planning among the aforementioned service agencies.
c. Living skills training groups and scheduled recreational and social
activities.
d. Assistance and on-going case management services to clients receiving
housing services, including referrals and maintaining linkages to
the State Department of Rehabilitation, and additional vocational
training facilities, including Contra Costa College and the Disabled
Students Program.
Process Objectives:
a. Intake and Treatment plan development, including Tong term housing
placement of twenty-five new clients.
Outcome Objectives:
a. Eighty-five percent of these new clients will find and success-
fully remain in long terra independent-living situations.
A - 9
grant 5.2
The following County-ooerated services will be provided under the 3lock
Grant during FY 19$9/98.
1. WEST '!COUNTY GERIATRIC SERVICES
Geriatric outreach service provides consultation and evaluation of
older persons who have had significant changes in memory mood, behavior,
personality or function. Evaluations are provided to individuals in
home land skilled nursing facilities. Consultations are provided to
famiVies , individual and in group setting (support groups: Adult
Children of Aging Parents; Caregivers of Aging Relatives). Approximately
200 clients and their families are served annually.
Process Objectives:
a. In-home assessment by geriatric specialist within 72 hours of
750 of telephone referrals of persons 60 years and older.
b. Placement of 5 unduplicated clients (West County residents) , 60
years and over, in Garfield Geropsychiatric Hospital .
Outcome Objectives:
• a. Reduce utilization of I and J Wards by }lest County residents
60 years/over, by 100 days.
3� CHILDRENi AND ADOLESCENT SERVICES
The Children and Adolescent Services of the WCCMHC provides comprehen-
sive outpatient services at two locations to children aged 2 to 18 with
social , emotional and/or behavioral problems and their families.
Individualized treatment programs may include:
- Assessment and diagnosis
- individual/family/group psychotherapy
- play/activities therapy
- clrisis intervention
- consul Cation/referral
Through coordination with other service providers and schools, the
program is able to provide greater continuity of care for, children,
adolescents and their families. The service provides care to :;prox-
imazely 475 children and adolescents and their families.
Process Objectives:
a . Increase the percentage of clients seen in brief therapy
by IS:.
b. Provide follow-up care to at least 10: of the children and
their families after discharge.
Outcome Objectives :
a. Reduce the use of inpatient days for Kest County children
and adolescents by 30. during Ff 1 qRq j4n
b. Increase the total nu.nber of clients serve by 20:.
_� A - 10
4, COMMUNITY CLIENT/OUTREACS SERVICES
• Children Services: The goal of this program is to increase the
menta ea th of children and their families by providing consulta-
tion, education and training for parents, school staff and pertinent
human service-agencies. Activities include, but are not limited to,
the following:
- on-going parenting skills
- on-school site,consultation to families, teachers
and counselors regarding children with mental disabilities
- information and referral telephone services, education and
training for child-care providers.
Program Objectives:
a. Increase outreach to Richmond unified School District by 205,
i.e. , an additional 4 hrs./wk.
grant 5.2
ATTACHMENT V
Block Grant Program Budget
grant 5.2
ATTACIMENTI V
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