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HomeMy WebLinkAboutMINUTES - 03091993 - 1.31 1 -31 1I�` TO: BOARD OF SUPERVISORS V FROM: Mark Finucane, -Health Services Director Contra By: Elizabeth A. Spooner, Contracts Administrator Costa DATE: February 25, 1993 County SU BJECT:Approve Submission of Federal SAMHSA Grant Revision and AB 2476 ADAMHA Grant Program Application (#29-472-1) for FY 1992-93 SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION I. RECOMMENDED ACTION: A. Approve and authorize the Health Services Director, or his designee (Mental Health Division Director) to submit the Federal SAMHSA Grant Revision and AB 2476 ADAMHA Grant Program Application to the State Department of Mental Health, for $1,475,000 in Federal SAMHSA.Grant Funds, and $54,070 in Federal ADAMHA AB 2476 (one-time-only) Grant Funds for the period from July 1, 1992 through June 30, 1993. B. Authorize the Health Services Director, or his designee (Mental Health Division Director) to execute, on behalf of the County, the following application documents: Initial Allocation Worksheet; Assurance of Compliance; and Certifications (regarding lobbying, salary rate cap and drug free work environment) . C. Authorize the Health Services Director, or his designee (Mental Health Division Director) , to make minor changes in said Application as may be requested by the State to maintain compliance with State and Federal requirements. II. FINANCIAL IMPACT: The SAMHSA Grant Revision and AB 2476 ADAMHA Grant Program Application describe service program changes which are necessary for the County to remain eligible to continue to receive this $1,476,000 Federal Grant Allocation, and presents a plan and detailed provider budgets for use of $54,070 in one-time-only Federal AB 2476 Grant Funds. No County matching funds are required. III. REASONS FOR RECOMMENDATIONS/BACKGROUND: This FY 1992-93 SAMHSA Grant Revision and AB 2476 Grant Application was reviewed and recommended for approval by the County's Mental Health Advisory Board at its meeting on December 17, 1992. The Federal SAMHSA Block Grant Renewal Application, approved by the Board of Supervisors on December 8, 1992, described a continuation of the County's long- standing West County Community Mental Health Center (CMHC) Federal Block Grant Program. However, the new Federal "Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) Reorganization Act" which establishes the new "Substance Abuse and Mental Health Services Administration" (SAMHSA) Grant Program requires that these Federal Grant Funds now be used for integrated systems of care for target populations of seriously and persistently mentally ill (SPMI) adults and seriously emotionally disturbed (SED) children and youth. Fiscal Year 1992-93 is a year in which existing grant programs may transition from the d ADAMHA grant CONTINUED ON ATTACHMENT:—X— YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMEATI N OF BOARD C MITTEE APPROVE OTHER SIGNATURE(S) ACTION OF BOARD ON APPROVED AS RECOMMENDED 7L OTHER VOTE OF SUPERVISORS UNANIMQUS (AMSENT ) I HEREBY CERTIFY THAT THIS IS A TRUE AYES:- NOES: AND CORRECT COPY OF AN ACTION TAKEN ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISOR=THEE SHOWN. Contact: Lorna Bastian (313-6411) CC: Health Services (Contracts) ATTESTED Auditor-Controller (Claims) Phil Batchelor, Clerk of the Board of State Dept. of Mental Health $upefvW166dG=tyAdminiSkdW M382/7-83 BY — DEPUTY SAMHSA/AB 2476 ADAMHA Grants Board Order Page 2 requirements and may make program changes in order to fully implement the new SAMHSA requirements by July 1, 1993. The SAMHSA Grant Revision and AB 2476 ADAMHA Grant Program Application describes how the County will shift the Federal Grant Funds from the West County CMHC Program into County-wide integrated systems-of-care for adults and children. The one-time-only AB 2476 Federal Grant Funds will permit the purchase of start-up equipment and start-up services which are necessary to accomplish the SAMHSA goals. While approval of this document does not obligate the County to make any expenditures, submission and approval by the State are required in order for the County to receive these Federal Grant Funds from the State in FY 1992-93. In order to meet the deadline for submission, the document has been forwarded to the State, but subject to Board approval. Five certified copies of the Board Order authorizing submission of the application should be returned to the Contracts and Grants Unit. 1 -31 "N CONTRA COSTA COUNTY FEDERAL SAMHSA GRANT REVISION , AND AB 2476 ADAMHA GRANT PROGRAM APPLICATION FOR FY 1992-1993 CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT MENTAL HEALTH DIVISION 595 CENTER AVENUE, SUITE 200 MARTINEZ, CA 94553 CONTRA COSTA COUNTY FEDERAL SAMHSA GRANT REVISION AND AB 2476 ADAMHA GRANT PROGRAM APPLICATION FOR FY 1992-1993 TABLE OF CONTENTS SAMHSA/ADAMHA Block Grant Allocation Worksheet Enclosure I Mental Health Advisory Board Approval Letter Enclosure II Program Narrative Description Enclosure III Attachment A: Organizational Chart Attachment B: Mental Health Overview and Philosophy Attachment C: Case Management Program Target Population Attachment D: Characteristics of "High Users" Assurance of Compliance with Federal Requirements Enclosure IV on Use of Allotments Certifications Enclosure V Detailed Provider Budgets (MH 1779) Enclosure VI 1. Adult Intensive Case Management Unit (and Equipment List) 2. Intensive Family Preservation Mental Health Project (and Families First Contract Budget) 3 . Mental Health Administration (Office of Children Services Program Chief) 4. YIACT Case Management l ENCLOSURE I State of California Health and Welfare Agency Department of Mental Health ShMIiSA/ADAMHA BLOCK GRANT ALLOCATION WORKSHEET MH 1772A (6/92) STATE FISCAL YEAR 1992/93 FEDERAL CATALOG NO. 93.992 COUNTY Contra Costa REVISION NUMBER 00 The State Department of Mental Health (DMH) , under provisions of 42 United States Code, Sections 300x et. seq. , as it read on January 1, 1992, and as amended by F.L. 102-321,, and the State Budget Act of 1992 (Chapter 587, Statutes 1992) , is authorized to allocate the mental health portion of the Federal Substance Abuse and Mental Health Services Administration (SAbMSA)/Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) Block Grant funds to. counties for State Fiscal Year (SFY) 1992/93. Your Initial Allocation is identified below. The "SAMHSA Block Grant Funding Base' below is the amount included in the resource base for your county. "Adjustment(s) " to this base may be permanent or on a one-time basis as indicated. Please note that these allocation amounts are subject to further adjustments, as amounts are identified, which include, but are not limited to, Gramm-Rudman reductions, prior years ' audit reco e-ies, retained unexpended amounts, etc. The AB 2476 augmentation is a one-time only amount that will not become a part of your resource base. These funds cannot be used to supplant existing programs but can to used to begin new programs or expand existing programs . I . GROSS EXPENDITURE LEVEL A. SAMHSA Block Grant Funding Base $ 1,475,000 B. AB 2476 FUNDS - ONE-TIME ON'11Y $ 54,070 C. $ D. Total Authorized Gross Expenditure Level $ 1,529,070 II. REIMBURSEMENT ADJUSTMENT(S) A. < > B. C. Total Adjustments <$ > III. NET ALLOCATION REIMBURSABLE $ 1,529,070 +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ PURPOSE: Initial Allocation DATE: September 29, 1992 I, the undersigned, have accepted the Federal SAMHSA Block Grant funds fpr the county under those conditions established by governing federal and state laws, policies, regulations, and guidelines as well as the specific conditions included in the County Application. 11-24-92 County Mental Health Director Date ENCLOSURE II CONTRA COSTA COUNTY MENTAL HEALTH ADVISORY BOARD 595 CENTER AVENUE,SUITE 200 MARTINEZ,CALIFORNIA 94553-4639 O: •:i;�i:n�' ,, 14 Phone(510)313-6414 SpA-COUIz'� January 20, 1993 Supervisor Tom Torlakson, Chair Contra Costa County Board of Supervisors 651 Pine Street Martinez, CA 94553 Dear Supervisor Torlakson and Members of the Board: The Contra Costa County Mental Health Board has reviewed the Substance Abuse/Mental Health Services Administration Grant Revision for Fiscal Year 1992-93 and AB 2476 Alcohol/Drug Abuse/Mental Health Grant Program Application and recommended approval and submission to the State Department of Mental Health on December 17, 1992 . Sincerely, Cynthia Miller Chair pr cc: Phil Batchelor Mark Finucane Pat Roach A351 (10/91) ENCLOSURE III FEDERAL FY 1992-93 SAMHSA GRANT REVISION AND AB 2476 ADAMHA GRANT PROGRAM APPLICATION CONTRA COSTA COUNTY MENTAL HEALTH PROGRAM NARRATIVE DESCRIPTION A. STATEMENT OF PURPOSE The following narrative reflects the principles on which the FY 1992-93 SAMHSA Grant is being implemented. During the past year, Contra Costa County Mental Health has been redesigning and changing its system to align with Federal and State mandates and with the client driven and integrated service philosophy. Grant funds support elements of a total program moving toward a fully inte- grated system of care. The new AB 2476 SAMHSA Program description for adults is on page nine (9) and the children's is on page thirteen (13) . Contra Costa County Mental Health will provide integrated services through a community-based system of care to targeted populations of children, adults, and older adults in accordance with Public Law 99-660, and consistent with the mission, goals and objectives of the Mental Health Division, State Comprehensive Mental Health Services Plan of 1986, the AB 904 California Mental Health Master Plan, and AB 1288 Mental Health Realignment Legislation. In the past year, this philosophy has been integrated into the mission, goals, and objectives of the organization. Services will strive to meet the needs of the target population and bring the services to that group. Mental health workers will assist clients in identifying and using the integrated system of care which includes mental health and other community services. Clients will be assisted in "developing the skills and acquiring the supports and resources they need to succeed where they choose to live, learn, and/or work; maintain responsibility, to the greatest extent possible, for setting their own goals, directing their own lives, and acting responsibly as members of the commu- nity" (CA Mental Health Master Plan) . Programs will focus on strengthening skills, and developing environmental supports to sustain clients in the community. The system of care acknowledges and incorporates the importance of culture, language and the value of cultural diversity. Services are adapted to meet cultural diversity and culturally unique needs. To the extent possible, mental health staff represent the culture and language diversity of the County. 1 B. OBJECTIVES Specific program objectives for adult and children services are described in I. SYSTEMS OF CARE DESCRIPTION. Based on Public Law 99-660, Contra Costa Mental Health will meet the following six major objectives: • To assist persons with mental disabilities to function as independently as possible; • To provide mental health services to the following priority target populations: seriously emotionally disturbed (SED) children and youth; seriously mentally ill (SMI) adults and older adults; and homeless mentally ill; • To provide integrated services for priority target populations within systems of care that are client-centered, culturally competent, and fully accountable; • To encourage and foster the development of innovative and creative approaches that are based on successful program models, to serve the target population; • To advocate for the seriously mentally ill and to monitor, review, and evaluate mental health services in Contra Costa County; • To provide comprehensive mental health rehabilitation services that promote long-term mental health gains as outcomes; and • To provide ease of movement between the components of the Mental Health system of care, i.e. , from inpatient to case management, from child services to adult, and adult to older adult services. C. PROGRAM DESCRIPTION 1. Target Population The target populations for adults and children are described in I. SYSTEMS OF CARE DESCRIPTION. 2 . Services Offered Contra Costa County Mental Health's integrated services system includes the following components provided directly and by commu- nity-based organizations to adults and children who meet the target population criteria as described in I. SYSTEMS OF CARE DESCRIPTION: • Inpatient services provided through contract with local psychi- atric hospitals. 2 • Outpatient and outreach services (including specialized services for children and the elderly) , case management, and medication monitoring which are specialized to meet the needs of individuals who are seriously mentally ill, and residents of the mental health service area who have been discharged from inpatient treatment, IMDs, and County-operated inpatient units; • Emergency care services available 24-hours a day in a hospital and 8-hours a day in a psychiatric health facility and crisis intervention services; • Screening for appropriateness of patients being considered for State hospital and IMD admissions; • Intensive day treatment, partial hospital services, and voca- tional programs; • Consultation and education services; • Supported housing, crisis residential, and augmented board and care services; and • Advocacy and self-help promotion. For the adult and children program descriptions, refer to I. SYSTEMS OF CARE DESCRIPTION. 3. Methods for Delivering Culturally Appropriate services Mental Health's system of care integrates cultural competence into all aspects of policy, planning, service delivery, and evaluation. Mental Health will acknowledge and incorporate the importance of culture and language, the value of cultural diversity, and the adaptation of services to meet culturally unique needs. All services will: • Maintain, as a goal, levels of bicultural and bilingual capacity (staff and/or community-based organizations) that is at least proportionate to the specific demographics of the various ethnic populations within this region; • Ensure access and utilization through program components that are easily identifiable to clients and the community; and • Ensure access to programs and services that incorporate non- Western health and healing practices, and take into account ways that mental illness is conceptualized by various ethnic/cultural communities. 4 . Type of Setting Services which are part of the FBG are offered as part of a system 3 of integrated services for mental health clients in a variety of locations throughout Contra Costa County including outpatient programs, community-based outpatient programs, medical clinics, emergency care services, homeless programs, board and care homes, client homes, schools, juvenile detention facility, partial hospital program, day treatment programs, vocational programs, parks, and inpatient units. 5. Planned Community Outreach a) Adult System of Care To successfully work with the SMI target population requires outreach including, occasionally, assertive outreach. Case managers provide outreach necessary as part of the treatment, whenever necessary, to successfully engage with individual clients in the treatment process within his/her natural environment. b) Children's System of Care To successfully work with the SED/target population necessitates outreach to schools, Juvenile Hall, client homes, inpatient units, and day treatment programs. Also required is interagency work with Probation, Social Service, and Education which includes coordination of system's services and individual client specific coordination. D. STAFFING Please refer to the detailed description of staffing under I. SYSTEMS OF CARE DESCRIPTION, Adult System of Care 1. , e. Staffing and Children's System of Care 2. , d. Staffing. (Also, please refer to ATTACHMENT A, Mental Health Division Organizational Chart. ) E. DESIGNATED PEER REVIEW REPRESENTATIVE Max Cowsert, Adult Services Program Chief, is designated as the Peer Review Representative and will participate as a member of the State DMH Review team to meet annual peer review requirements. F. IMPLEMENTATION PLAN Please refer to the detailed implementation plan under I. SYSTEM OF CARE DESCRIPTION, Adult System of Care 1. , f. Implementation Plan and Children's System of Care 2. , e. Implementation Plan. 4 G. DOCUMENTATION DESCRIPTION Client documentation is maintained on the standard Medical Review format, and system's data is managed at the Chief level incorpo- rating all elements of Utilization Review. The Adult and Children Services Program Chiefs monitor the quality and flow of documentation along with the Quality Assurance Coordinator for community-based programs. The Children Program Chief performs this function for children contract services as does the Community Programs Director for adult contract services. H. PROGRAM EVALUATION PLAN Contra Costa County Mental Health proposes an outcome oriented evaluation plan which will match the programs outlined in this grant. The following two primary evaluation methodologies have been used in the past and will be used in this plan to determine the effec- tiveness of services: 1) A sophisticated on-line computerized Management Information System (MIS) allows detailed tracking of clients through all systems of care components. This MIS produces reports at regular intervals helping to ensure immediate feedback to all service providers. The MIS computer also provides inferential statistical analysis of the quantitative data made available by this system. As part of the monthly MIS Committee meeting, problems and/or barriers and correction plan(s) will be discussed, and the Program Chiefs will implement correction plans and monitor results. 2) The Utilization Review/Quality Assurance Committee process provides ongoing analysis of the qualitative aspects of the program. In addition, performance results of FY 1992-93 FBG community-based organizations will be reported through the Final Contract Performance reports and will be on file with the County Mental Health Program. County-operated program outcomes are also avail- able. The Adult and Children Program Chiefs monitor, correct, and resolve identified problems within County-operated programs. The Children Program Chief performs this function for Children's community-based organizations, and the Community Programs Director for adult community-based organizations. The Geriatrics Program Chief performs this function for the County-operated geriatrics outreach program. 5 I. SYSTEMS OF CARE DESCRIPTION 1. ADULT SYSTEM OF CARE a. Target Population The ADULT SYSTEM OF CARE target population includes seriously mentally ill (SMI) adults 18 and up who are functionally disabled. Special consideration is given to homeless SMI clients. (A small number of clients are 65 and older. Contra Costa County has an Older Adult geriatric medical/psychiatric program which provides services to those who exhibit brain damage due to aging. ) This population includes persons with schizophrenia or other psychoses, severe depression, manic-depressive disorder, or other types of disorders that may lead to chronic disability or institu- tional care or confinement. SMI persons typically have functional limitations in major life activities, and require treatment and services over an extended time--sometimes throughout a lifetime. These individuals have an extensive history of contact with mental health, have had positive and/or negative experiences with the mental health system, may have developed a mistrust for the system and the myriad of professionals with whom he/she has worked, may have a drug and/or alcohol problem, may reject traditional mental health services and prefer to use jail and medical services, and may have resided at multiple addresses. (Please refer to ATTACHMENT C, Contra Costa County Mental Health Case Management Program, Target Population, Philosophy, and Values. ) b. Services Offered Services are designed to meet the SMI client's needs and assist in identifying and using a system of integrated services to enhance quality of life. Services are delivered to the client where he/she lives, learns, works, or plays. Case managers, through service coordination, will provide outreach to the target population to engage with them and assist them in making choices about housing, social relationships, leisure activities, and in clarifying and focusing on the steps necessary to use the system. Contra Costa's organized community-based system of care utilizes case managers to coordinate, assess, plan, link, monitor, advocate, and facilitate within the integrated services system with and for the target population clients. These integrated services are part of the larger Contra Costa County Adult System Of Care which interfaces with the following: other service providers (Health, Conservatorship, Jail, Drug and Alcohol) ; other County-operated services (inpatient, forensic, emergency) ; and contracted services (residential, crisis, housing, advocacy,• self-help) . 6 c. NEW SAMHSA INTEGRATED SERVICE PROGRAMS FOR SMI ADULTS SAMHSA funds are earmarked for the programs described in this section. During the past year Contra Costa County Mental Health has been moving toward a fully integrated system of care for the SMI client. SAMHSA funding will be used to develop a new centrally supervised, intensive, case management program which will focus on the highest priority clients or "high users" within the target population. As a sub-group, clients are defined as "high users" by consequences of disability, have drug and/or alcohol problems, and have been excluded from mental health programs because of extreme behaviors. This project will focus exclusively on this group. The larger SMI population will not receive services through this -program. The new program will provide a highly specialized, 24-hour per day, 7 day per week program for one hundred (100) SMI clients. The clients have been identified by the County through client inpatient and crisis services use rates. The "high users" are at-risk of or have been admitted repeatedly to a psychiatric hospital, require an intensive system of services to avoid or reduce the risk and/or incidence of hospitalization, have frequent contact with crisis services, have psychotic illnesses that are severe in degree and persistent in duration, and often have unattended serious and/or persistent medical problems, often aggravated by substance abuse and/or alcohol. (Please refer to Attachment D, Characteristics of High Users. ) 6. 0 FTE Case Managers, who are currently located in regional sites and have operated as part of a regional system, will become a centralized resource dedicated to the SMI population. A new supervisory position will be created to implement the centraliza- tion, manage the day-to-day program operations, and develop and supervise the clinical program. 1. 0 FTE Case Manager Aides (2 part-time staff) will be added to assist case managers in providing services in the field such as transportation, assisting with medical and mental health services, assisting with housing and personal care matters, and linking clients to self- help "sponsors" and groups. 1. 5 FTE Family Nurse Practitioners will be added to provide medical case management and a bridge between psychiatric and medical services•. Fifty (50) "high user" clients will be assigned to the Family Nurse Practitioners for primary health care including the following elements: identify the health status of individuals by taking thorough histories; perform and/or assure physical examinations and appropriate diagnostic and screening tests; assure simple gynecological diagnoses and provide simple treatments for 7 these conditions; provide supportive counseling, guidance and instruction in the areas of personal hygiene and family planning; make home visits to assess medication problems and health status and provide care as needed; and coordinate with the case manager for non-medical follow-up. 0.5 FTE Clinical Nurse Specialist - Psychiatric nurse will be added to provide adjunct psychological/educational activities which encompass the following: assist with diagnosis and treatment; participate in case conferences with case managers and other mental' health treatment staff; provide group therapy; provide information to clients and families on symptom management; provide education on medications and medication related matters; and administer medications, as needed. In October 1991, training geared toward this change began. In order to more effectively deliver services to the target popula- tion, case managers have participated in a series of trainings related to the transition to serving a targeted population using Community Support Model methodology. A committee of case managers = designed a new service plan, evaluation, and case notes forms and a companion training manual with input from the State Department of Mental Health Technical Assistance staff to ensure that it met utilization review requirements. A comprehensive assessment form is being developed, and a November 1992 implementation training is scheduled for case managers on the use of the forms. Case managers will coordinate integrated service delivery through accessing the use of medication monitoring services, outpatient services (brief and/or group therapy) , and will coordinate and link with residential services through residential case managers who provide similar services to SB 155 (provides supplemental rates for clients requiring a higher level of care) clients. Case managers will actively intervene to assist clients and enlist participation in treatment delivered in the natural environment. As part of the service integration effort in designing a cohesive and comprehensive system of care, the Community Programs Director will work with the Directors of community-based organizations which are part of the County system to redesign programs to serve this defined "high user" high priority population. Contracts with these groups will be renegotiated to reflect this new target population and services. All mental health clients in West County with a medical record number will have access to an Advice Nurse beginning in January 1993 as a part of the expansion of this service within the Health Services Department's system of care. Other areas of the County will be phased in during the year. All Mental Health clients will have access to the Advice Nurse by the end of the fiscal year. 8 d. NEW AB 2476 SAMHSA PROGRAM FOR ADULTS The one-time-only AB 2476 funding will be used to support the expenses incurred in providing countywide community-based services to the 100 project clients. Services will be delivered by the new SAMHSA program staff, 6 case managers, .2 case management aides, and 3 nurses, outside of the traditional office setting. Equipment plays a vital part in accomplishing the SAMHSA goals. A fax machine, 4 file cabinets, and 2 computers, printers and software will be purchased to assist with the required State performance outcome reports, MIS data reports, and automated word- processing for assessing clients and preparing individual service plans. Paging equipment for 11. 5 FTE positions will be leased. A consultant, knowledgeable in the Community Support Program (CSP) model, will work up to 40 hours during the transition from 1-1-93 to 6-30-93 , to provide implementation assistance and training to current case managers and new program staff. Since other system staff are integral to coordinated service delivery for SMI clients, CSP training will also be provided for inpatient, outpatient and community-based program staff. e. Staffing The following staff will comprise the centralized, intensive program for "high user" clients: • 1 FTE Supervisor/Team Leader; • 6 FTE Case Managers (1 licensed case manager and 5 unlicensed case managers) ; • 1 FTE Case Manager Aide (to be hired after 7-1-93) ; • . 5 FTE Clinical Nurse Specialist - Psychiatric; • 1. 5 FTE Family Nurse Practitioners; • .25 Psychiatrist; • 2 FTE Senior Level Clerks (reporting and utilization review) ; • .75 FTE Adult Program Chief; and • Consultant - 40 hours 1-1-93 to 6-30-93 (technical assistance in implementation and training) . f. Implementation Plan During the transition period of 1-1-93 to 6-30-93 from the ADAMHA Block Grant to the SAMHSA Block Grant, implementation and training will occur. Effective 6-30-93, FBG funding will no longer be directed toward the currently funded programs which include: Desarrollo/Familial Unitas Outpatient Program; Rubicon Independent Living Outreach Program; West County Geriatrics Outreach Service Program; and West County Consolidated Adult Services Program, including outpatient, case management, partial hospital, and crisis service. 9 Effective 7-1-93, all SAMHSA funding will be directed to the new program. The following outlines the implementation plan for the new SAMHSA program which will begin on 7-1-93: • Create Supervisor/Team Leader position - 3-1-93; • Advertise for Supervisor/Team Leader position - 3-15-93; • Interview and hire Supervisor/Team Leader position - 3-29-93; • Request volunteers from case management staff - 4-1-93; • Supervisor/Team Leader begins working and receives orienta- tion - week of 4-22-93 and 5-1-93; • Interview and select the case managers - week of 6-8-93; • Advertise for Family Nurse Practitioner and Psychiatric Nurse Clinician - 4-8-93; • Interview and hire staff - week of 5-1-93; • Train new staff - 6-5-93 ; and • Program begins - 7-1-93. g. Goals The following reflect the goals on which the adult system of care portion of the FY 1992-93 Block Grant is being implemented: • Client Strengths - Client strengths will be used as the focal point in writing the service plan for 100% of the clients assessed by case managers. • community setting - 100% of the case managed clients will receive services where he/she lives, learns, works, or plays. - The least restrictive setting will be selected for 100% of the clients served. - In selection of services, client choice will be honored in 90% of the cases, within the parameters of limited resources. • Barriers - Environmental and client centered barriers will be identified in 100% of the service plans written. 10 • Coordination - The Mental Health Division will establish service interface agreements with the Health Services Department for the formal integration of access to general care services, and with other agencies outside the Division. (This includes the transition from child to adult.) - Formal agreements will be established with Conservatorship Services to coordinate .clinical care and facilitate the movement of clients into and out of the State hospital and IMDs. • - Formalized working relationships will be established between the County inpatient units and case management services to enhance service coordination. - Assess services offered by community-based organizations and recommend program changes to maximize the provision of services to the target population. 2 . CHILDREN'S SYSTEM OF CARE a. Target Population The CHILDREN'S SYSTEM OF CARE target population includes seriously emotionally disturbed children and adolescents under age 18, with active consideration given to the needs of families of the target population. This population includes persons with psychotic symptoms, suicidal risk, risk of violence in which the individual has recently caused or is likely to cause injury to persons or significant damage to property, or is at-risk of being removed from home or has already been removed. b. Services Offered Contra Costa County Children's Services provides comprehensive services to children aged 0 through 17 with social, emotional, and/or behavioral problems and their families. To provide continuity of care for children and families, integrated services are delivered as part of the Contra Costa County's interagency system of care which interfaces with Probation, Social Service, Health Services, Education and community-based organizations (residential services, inpatient services, day services) . As part of the service integration effort in designing a cohesive and comprehensive system of care, the Chief of Children's Mental 11 Health will work with the community-based organizations to redesign programs to work within the interagency arrangement. c. NEW INTEGRATED SERVICE PROGRAMS FOR SED CHILDREN During the past year, Contra Costa County Mental Health has been moving toward a fully integrated system of care for the SED child. The program will focus on the following: children and families requiring a comprehensive system of services to avoid or reduce the risk of residential placement or hospitalization; children who currently reside in out-of-home placement; children who have frequent contact with services within the interagency arena; children who are in transition to adult services; or children who have emotional disabilities that are severe in degree. These clients are identified through interagency collaboration based on multi-systems involvement. The following outlines the changes which will coordinate and provide comprehensive services to SED children and families. 1) Interagency Partnership Because children have multi-system involvement, an interagency partnership will be formed to enhance the coordination of resi- dential, subacute, and hospital placement for children. To accomplish this goal a Mental Health Case Management Forum, chaired by the Mental Health Children's Chief, will be formed to coordinate out-of-home placement activities with Social Service and Probation for children placed at the highest State established Residential Care Levels (RCL) (Level 13 or 14) . The Forum will address intra-division and inter-department linkages and case management matters, utilization review regulations, movement of children from State and local hospitals and residential placements, systems coordination of clients, and client specific issues. 2) Program a) Part 1. Children's Case Management Program: A centrally coordinated Children's Case Management Service will utilize case managers to coordinate the movement of children in and out of out-of-home placement and review children identified as being at-risk. To create this program, staff are being reassigned to the centrally coordinated program. Regionally-based case managers will join the existing Mental Health Youth Interagency Assessment and Consultation Team (YIACT) to create a children's system of care which will provide integrated services to children countywide. The team will assume responsibility for children placed in Napa State Hospital, community-based psychiatric hospitals, subacute facility, 12 and SNFs. The team will be responsible for Probation, Social Service, and Regional Center's SED/target population children placed in any of the above settings. Staff representing these children will participate in the Mental Health Case Management Forum. (Please refer to c) Part 3 . Case Management Coordinating Meetings. ) This program will have several components which are outlined as follows: • Residential, State Hospital and Subacute Case Manager (1.0 FTE) : will monitor, gate-keep, and establish and maintain linkages for the State Hospital, La Cheim Residential, and Seneca Residential placements. All Social Service, Probation, and Regional Center placements into these residential/hospital services will be screened by this case manager, approved by the Chief of Children's Mental Health, and monitored by this case manager. • The Acute and Family Preservation Case Manager (1.0 FTE) : will monitor, gate-keep, and oversee the approximately 260 yearly admissions and discharges for the seven community-based acute hospitals. All placements into the Family Preservation program will be screened and monitored by this case manager. • The Regional Case Managers (1.5 FTE) : will link to the children being discharged from the State Hospital, ensure that linkages are being made for medication, psychiatric consultation, follow-up on children seen by crisis services, and provide services to at-risk children referred by Mental Health outpatient programs. • Other staff in the program include the following: 1. 5 FTE psychologists will provide testing for Social Service children; 1.25 FTE case managers will be stationed at Juvenile Hall; 1.0 FTE case manager will provide on-site and aftercare services at Byron Boys' Ranch, and crisis and counseling services at the County shelter for dependents; .50 FTE psychiatrist; .20 FTE Medical Director; and .25 Supervisor. b) Part 2 . NEW AB 2476 SAMHSA PROGRAM FOR CHILDREN To support the new SAMHSA program for children, the new one-time- only AB 2476 funding will be utilized to establish the core of a computerized tracking network within Mental Health to enable the centrally coordinated case management system to function optimally within Mental Health and to establish linkage to the interagency network with County Probation and Social Service Departments. The two computers and companion equipment, printers and software will be purchased with one located at YIACT, the core for central coordinatjon, and the other located in the Children Services Program Chief's office to be dedicated to SAMHSA activities. Mental Health will contract with a community-based organization to staff (1. 0 FTE or 2 - . 5 FTE) and supervise a Family Preservation 13 program for SED children and families. Those eligible for Family Preservation services are children who are identified as being at- risk of acute hospitalization or those who can be discharged early, but require intense support to maintain the placement with his/her family. Two workers are necessary due to the geographic constraints of the County. Referrals will be screened and monitored by the Acute Hospital and Family Preservation Case Manager. The AB 2476 funding will be used to fund $27, 000 of the initial $34, 259 contract. Following the 1992-93 transition year, this contract will be funded under SAMHSA Grant funds. c) Part 3. Case Management Coordinating Meetings: To provide comprehensive, timely intervention and coordinated movement of children within Mental Health and within the intera- gency arena, the following three coordinating groups are necessary: Case Management Forum: • The Case Management Forum, chaired by the Chief of Children's Mental Health, will meet by-monthly, or more often if necessary, to , review and discuss the system's issues related to case management services and Mental Health's SED children. The meeting's content will include a review of the interactions within the interagency systems, problems regarding utilization review and case management services, and problem solving about difficult children. Social Service, Probation, and Regional Center representatives will participate in discussion about linkages and specific children. All Residential Care Level 13 and 14 referrals will be reviewed and approved by Mental Health in the Case Management Forum. State law requires that Mental Health evaluate and approve all children admissions to RCL 13 and 14 . Additionally, the Case Management Forum will review all children being considered for placement at Napa State Hospital. Inpatient Placement/Discharge Meeting: • The Chief of Children's Mental Health will chair a monthly Children's Inpatient meeting to discuss all the issues related to hospitals and hospitalized children, including children placed in the two free beds at Walnut Creek Hospital. Residential/Day Treatment Placement/Discharge Meeting: • The Chief of Children's Mental Health will chair two monthly meetings on the two community-based residential/day treatment programs. The meeting will combine discussion on residential/day treatment placements and on children who will transition from residential/day treatment to day treatment only. 14 d) Part 4. Future Program Plans: All programs described will be case managed by the core case management unit and its component parts described as the center piece of this plan. Future plans include phase-in of the following programs: • A subacute treatment program is being developed jointly with Alameda County Mental Health which is scheduled to receive referrals in 12-93. • Individualized Residential Treatment (IRT) will be used as a step-down residential program for children placed in the State Hospital or RCL 13 and 14 who are not ready to return home. (IRT definition: 2.0 FTE trained, supervised, agency supported, treat- ment family-based foster parents who deliver agency-led, goal and team-oriented treatment for children and families. ) • Crisis IRT will be used as an alternative to acute hospi- talization when Family Preservation is not appropriate. • School-based intensive day treatment programs for SED wards, dependents, and non-3632 children and youth will be used as a diversion from and/or early exit from out-of-home placement (residential, subacute, or hospital) . The school-based intensive day treatment program will be phased-in throughout the County as demand warrants. Additionally, Family Preservation services will be phased-in as needed to compliment and support services delivered in the day treatment system. Although SAMHSA funding is not being allocated to AB 3632 funded services, 3632 Program Case Managers will link to the described structure for planning when AB 3632/SED children are hospitalized in an acute hospital or State hospital. 3) Mental Health's Role The following services will be provided to children and to families, as needed: • Through County-operated services, case managers will provide consultation, group, individual, and family transitional services; • Through community-based organizations, acute care beds, treatment, and consultation will be provided; • In long-term care at Napa State Hospital, the La Cheim Residential Napa Diversion program, or Seneca Residential program, case management will be provided to aid in reducing length of stay through treatment and reunification planning; and 15 • Psychological assessment, consultation and recommendations regarding specific mental health problems (treatment interventions, appropriate placement options, and reunification planning) . Children's problems differ from adults' due to physical, cognitive, social, and emotional growth, and because, in most instances, they are dependent within a family structure. For the children who are at-risk of or are in out-of-home placement, psychiatric, psychological, and psychosocial assessment, treatment and crisis management are coordinated by the case manager. Families are provided similar services, as needed. d. Staffing The following staff will comprise the centrally coordinated team: • 3. 5 FTE Case Managers (1.0 Residential, State Hospital and Subacute Case Manager, 1.0 Acute and Family Preservation Case Manager, 1.5 Regional Case Managers) ; • 1.25 FTE Case Managers (stationed at Juvenile Hall) ; • 1. 0 FTE Case Manager (stationed at the Byron Boys' Ranch and the County shelter for dependents) ; • . 25 Chief of Children's Mental Health (centralized coordinator role) ; • 1. 0 FTE Children's Program Supervisor; • .25 Regional Supervisor; • .50 contract Psychiatrist; and • . 20 Medical Director. e. Implementation Plan The transition from the ADAMHA Block Grant program to the new SAMHSA Block Grant program has begun. Effective 1-1-93, FBG funding will no longer be directed toward the currently funded programs which include the following: West County Child/Adolescent Outreach Program; West . County Child/Adolescent Outpatient Clinic; Early Childhood Mental Health Program/Infant-Transition Service; Early Childhood Mental Health Program/Preschool Team-West; and YMCA/ Junior High School Outreach Program. The following outlines the implementation plan for the SAMHSA program which will begin on 1-1-93 : 16 • Residential, State Hospital, and Subacute Case Manager, Acute and Family Preservation Case Manager, and Supervisor - 1-1-93; • Family Preservation contract scheduled for implementation - 1-1-93; • Case Management Coordination meeting to begin - 1-1-93; • Subacute facility scheduled to open - 6-1-94; • Individualized and Crisis IRT scheduled for a 1994 implementa- tion; and • School-based intensive day treatment program scheduled for a 1994 implementation. f. Goals The following reflects the goals on which the Children's System of Care portion of the FY 1992-93 Block Grant are being implemented: • Interagency Partnership - Form an interagency placement team for children in part- nership with Social Service and Probation to coordinate out-of-home placement for children. - As part of the above partnership, develop alternatives to State hospital placement, i.e. , subacute facility. - Participation in the planning efforts of the Youth Services Board, an interagency group composed of the Mental Health Director, Health Services Director, Social Service Director, County Probation Officer, County Superintendent of Schools, Juvenile Court Judge, Community Services Director, and County Administrator. - Participate with Department of Education in the school-based Primary Intervention Programs. - Participate in the Perinatal Task Force. • Support for Families - Services appropriate to the family's needs will be delivered to 100% of the families whose children are in placement. - In 70% of the cases where Family Preservation services are provided to children and families, the child will be maintained within the family structure for six (6) months after termination of intensive services, and in 60% of the 17 cases, for one (1) year after intensive services are terminated. • Transitional Services In 100% of the cases referred to the adult system of care, referral will be made three (3) months prior to the client's eighteenth birthday (applies to those who meet the definition of the adult target population) . 18 E - « §s! ■ § k 92 s ■ � �BJ to ` �� ; ■ \� § 96 � k § - ;§ ; .( - . e■ ;! as ;! § - ` Cw Bk P § i k z §o © / § �- B �§ _ ask k- _ 44 . - �� I; !. �gK !Q �B ; LU -J f ! / fM Lu � Mw a = , F- "Ou 2� � �� . U_ 00 _B .§ 52 as k ' == 11c ■s k� -§� - IC § k§ §o § - §! � � �! §■ k� �§ � . § j \{ }k /S =e _! � ATTA0161ENT B CONTRA COSTA COUNTY MENTAL HEALTH DIVISION OVERVIEW AND PHILOSOPHY TARGZT POPULATION: Contra Costa County Mental Health will provide services to targeted populations in accordance with Public Law 99-660, State Comprehensive Mental Health Services Plan of 1986, the AB 904 California Mental Health Master Plan and AB 128S. -Mental Health Realignment Legislation. The targeted populations are described in the following three groups: *Seriously emotionally disturbed children and adolescents under age 18, with active consideration given to the needs of families of the target populations; *Seriously and persistently mentally ill (SPM=) adults who are functionally disabled; solder adults, 60 years and over, who require specialized services due to functional impairment or significant changes in behavior related to a serious, persistent mental illness or a dementia. PHILOSOPHY AND V Lti S: Services will strive to meet the needs of clients. Mental health workers will assist clients in identifying and using the spectrum of mental health and community services. Clients will also be assisted in "developing the skills and acquiring the supports and resources they need to succeed where they choose to live, learn, and/or work; to maintain responsibility, to the greatest extent possible, for setting their own goals, directing their own lives, and acting responsibly as members of the community" (CA Mental Health Master Plan) . Programs will focus on strengthening skills, and developing environmental supports to sustain clients in the community. The system of care will acknowledge and incorporate the importance of culture and language, the value of cultural diversity, and the adaptation of services to meet culturally unique needs. CL.T=-DIRECTED SsRVI CES: Based on client strengths and functional and/or organic disabilities, realistic goals will be set by the client and mental health worker, in consultation with family and/or �- significant others. Family and community supports will be ` identified to assist in meeting goals. Service decisions will be made by the client in consultation with the mental health worker who will assist the client in making choices about living environments, social relationships, leisure activities and housing. CONTRA COSTA COUNTY MENTAL HEALTH DIVISION OVERVIEW AND PHILOSOPHY March, 1992 Page 2 For children, realistic goals will be set by mental health staff in concert with the child, his/her family, and in collaboration with other child-serving agencies; e.g. , the schools, probation, social services, etc. The Mental Health Division will design services that enhance the quality of life, promote client empowerment, encourage clients' achievement of potentials, and respond to clients .of varied ethnic and cultural origin. 1w_=WTAL H?ALTH GOALS: For adult clients, the Mental Health Division will strive to measurably reduce use of hospitals, XMD facilities, jail and crisis services; increase length of community tenure; increase paid and unpaid employment; increase stability in housing; increase use of nationally recognized intervention methods; increase symptom management and medication education (pseudo- educational interventions) ; develop additional service system components; e.g. , respite for care givers, supported housing and supported employment; and strive to respond to, and meet, the culturally unique needs of the ethnically and culturally diverse client population. For children and adolescents, the Mental Health Division will provide high quality family-focused clinical services to an ethnically and culturally diverse population of children, adolescents and families throughout the county. Staff will consult with, collaborate with, and participate in interagency services and planning with the County departments legally responsible for the education, care, and custody of children (including care-giving county facilities) as well as with community agencies serving targeted population groups. Children's services will strive to design programs and provide treatment and case management services which: (1) maintain children in the least-restrictive environment; (2) build on family strengths to prevent acute hospitalization and/or reduce the length of hospital stay; (3) divert youngsters from residential treatment, juvenile hall, and crisis services; and (4) aim to increase the child and family's ability to function within the home and in the community. �- a� ATTACHMENT C CONTRA COSTA COUNTY MENTAL HEALTH CASE MANAGEMENT PROGRAM TARGET POPULATION, PHILOSOPHY, AND VALUES TARGET POPULATION Included in the target population for case management services are persons ages 18 to 65 with severe and persistent mental illness such as schizophrenia or other psychoses, severe depression, manic- depressive disorder, or other types of disorders that may lead to chronic disability. Severe .and persistently mentally ill persons typically have functional limitations in major life activities, and require treatment and services over an extended time--sometimes throughout a lifetime. These individuals have an extensive history of contact with the mental health services system. PHILOSOPHY AND VALUES Services are designed to meet the needs of clients with serious and persistent mental illness and assist in identifying and using a spectrum of mental health services to enhance quality of life. Case managers will assist the client in "developing the skills and acquire the supports and resources needed to succeed where they choose to live, learn and work; to maintain responsibility, to the greatest extent possible, for setting their own goals, directing their own lives, and acting responsibly as members of the community" (CA Mental Health Master Plan) . Case management and other mental health services will focus on strengthening skills, developing the environmental supports necessary to sustain clients in the community, and be culturally and linguistically relevant. •MENTAL HEALTH'S GOALS: The Mental Health Division will strive to measurably reduce use of hospitals, jails, and crisis services; increase length of community tenure; increase paid and unpaid employment; increase stability in housing; increase use of a variety of intervention techniques; increase symptom management and related education; and develop additional service system components; (e.g. , respite services for care givers, supported housing and supported employment) . •CLIENT-DIRECTED SERVICES: Service decisions will be made by the client in consultation with the case manager. Knowledge of the service system will assist the client in making choices about living environments, social relationships, leisure activities, housing, and in clarifying and focusing on the steps necessary to use the system. Mental Health will gear services to enhance the quality of life, promote client empowerment, and encourage attainment of potentials. CONTRA COSTA COUNTY MENTAL HEALTH CASE MANAGEMENT PROGRAM TARGET POPULATION, PHILOSOPHY, AND VALUES March, 1992 Page 2 •METHOD OP SER710E DzTZV RY: Based on strengths and functional disabilities, realistic goals will be set by the client and case manager with family and community supports being identified to assist in meeting goals.. Education will developing successful community living skills and techniques for symptom and medication management. As case managers challenge themselves to work with SPMI clients in developing additional capacities for choice, perspectives of client capabilities will increase. CASE MANAGZR IS ROLE: The case manager facilitates the provision of community-based care and treatment. Case Management is a recognized therapeutic modality. Training will enhance methods used by case managers, foster staff ' empowerment, and provide the skills necessary for meeting achievable outcomes. Case managers will work in Community Living Support Teams, focus on client strengths, set achievable goals with clients while utilizing individual team members, skills. The list of comprehensive services includes: assertive outreach, use of community resources, provision of support and education, retaining responsibility for clients, and working with family or significant others. All team members, including the physician, are expected to perform case management functions. There is a formal designation of "Case Manager" for staff members whose primary responsibilities are case management related. The team makes all decisions on: allocation of resources, allocation of time, duration and frequency of services, and outcome measures. Case Managers will provide the following: *Assessment: Determine an individual's current and potential strengths, weaknesses, and needs. •Planninca: Develop a specific individual service plan, with provisions for day, evening, and night, weekend and holiday linkages to needed activities. *Lipkin= Referring or transferring individuals to all required services in the formal and informal caregiving systems. f eMcnitorinc: Continuous evaluation of client progress. _ CONTRA COSTA COUNTY MENTAL HEALTH CASE MANAGEMENT PROGRAM TARGET POPULATION, PHILOSOPHY, AND VALUES March, 1992 Page 3 •Advocacv: Interceding on behalf of an individual to assure equity both in the specific case and for any large group or class to which the client might belong. The case manager is an advocate for the client in achieving the highest level of functioning possible in the least restrictive environment. *Facilitator: Foster client-directed services which promote the highest level of functioning in the ' least-restrictive environment. •Surervisor's Role: The supervisor will ensure that the system's work is focused on the client, ensure timely client flow, coordinate linkages between programs, monitor caseload goals, and ensure that specialized caseload needs are addressed. The supervisor will perform the following functions: •Team Leader: Direct, supervise and coordinate the activities of the team. *Teacher: Provide clinical supervision for each case; define functional disability and identify and assess client strengths; lead in the development and maintenance of summon systems critical to client stability in the community; assure clarity of Mental Health's vision for Case Management Services; and provide a framework for staff to work within. •Advocate: Recognize and act in accordance with the concept that people with mental illness have the ability to live, learn, and work; assure the right to receive culturally relevant services; maintain an understanding of bureaucracies and methods to negotiate them; champion quality services based on case manager/client input; identify services needed; and promote program development. *Role Model: Exhibit a willingness and commitment to work with the target population; illustrate the ability to take risks; demonstrate creativity, innovation and leadership in the development of services within existing resources; provide modeling for working in the community; and display an ability to build on staff's strengths. ' ATTAC ENr D CONTRA COSTA COUNTY MENTAL HEALTH CHARACTERISTICS OF THE "HIGH USERS' OF MENTAL HEALTH SERVICES BEHAVIORS: o Frighten people o Threaten people o Experience rejection o Intrusive o Make loud noises o On occasion are a safety threat (create the feeling of such) o Threats of violence o Verbally abusive o Suicidal and self destructive behavior o Homicidal o Use drugs and/or alcohol o Transient o "Burn out" family, friends, case managers, etc.. o Looking for attention MENTAL HEALTH HISTORY: o Reject traditional mental health services o Use criminal justice system (many prefer) o "High users" of medical services o Some require daily contact with case manager o "High users" need and search for a "container" , i. e. , inpa- tient, jail, crisis, medical, etc. Needing and looking for rest, familiarity, and acceptance. o Mixing drugs and/or alcohol and medications o Contact(s) with police o Problems maintaining housing o Problems maintaining stability o Frequently on the verge of decompensation o Loss of trust in the system because of its intrusive nature o Frequently misdiagnosis o Multiple diagnosis EFFECTS OF MENTAL ILLNESS: o Burned bridges with programs/services o Not interested in traditional mental health services o Problems with symptom management o Difficulty adhering to medication regime outside institutional setting o Loss of contact with families o Lack of a social network o Poor social skills o Alcohol and drug use is socially acceptable and a network of people is connected with its use. Many live in or near neighbor- hoods which contribute to the problem o Manipulate the system - individual staff and services o Feel out-of-control o Feel alone and abandon o Problems with boundaries o Illness may last for a lifetime o Interrupts adult development o Why me? Why do I have this illness? o Mental illness is an enduring disability o Economic dependence o What does it mean to be a man/woman and have this illness? o Investment in abstract ideas o Difficulty coping with stress and failure o Fragmented life SERVICES NEEDED: o Drop-in services o Self-help o Alumni groups o Symptom management groups o Medication education groups o Intensive case management with outreach capability o Mobile services, composed of case manager, doctor, and occa- sionally police o Alternatives housing options o Coordinated treatment plan which includes all players in its development. Staff work from a unified front. o Residential and non-residential drug and/or alcohol treatment o Money management o Programs that tolerate unusual behavior o Stable and consistent relationship(s) with a set of staff o Programs that create a feeling of client ownership o Assist clients' in finding a purpose in life Notes from Case Management Training DF/8-21-92 • ENCLOSURE IV ASSURANCE OF COMPLIANCE WITH FEDERAL REQUIREMENTS ON USE OF AIJATMENTS SEC. 1915. (a) Except as provided in subsection (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 by the state for 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 seriously and persistently mentally ill individuals, which include identification of, and assistance to, such individuals in gaining access to essential services through the assignment of case managers; (B) identification and assessment of seriously emotionally 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; and, (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 in 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 cash 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 (5) provide financial assistance to any entity other than a public or nonprofit private entity. ENCLOSURE IV Page 2 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 are") , with special attention to individuals who are seriously and persistently mentally ill; (B) within the limits of its capacity, to any individual residing or employed in its mental health services area regardless of ability to pay for such services, current or past health condition, or any other factor; and, (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 -- (A) outpatient service, 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 service"; (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 1972, or on the basis or race, color, and national origin under Title 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. ENCLOSURE IV Page 3 (2) No person shall on the grounds 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 a 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 60 days, the chief executive officer fails or refuses to secure compliance, the Secretary may -- (1) refer the matter to the Attorney General with a recommendation that an appropriate civil action be instituted; (2) exercise the powers and functions provided by Title VI of the Civil Rights Act of 1964, the Age Discrimination Act of 1975, or Section 504 of the Rehabilitation Act of 1973, as may be applicable; or (3) take such other action as may be provided by law. (c) When a matter is 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. ti 11-24-92 Signature of Official Authorized Date to Sign Application . ENCLOSURE V CERTIFICATIONS CERTIFICATION REGARDING LOBBYING 1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract; the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal , amendment, or modification of any federal contract, grant, loan, or cooperative agreement. 2) If any funds other than federal appropriated funds have been paid of will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, and officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL "Disclosure Form to Report Lobbying", in accordance with its instructions. 3) The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. . This certification isa material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 for each such failure. SALARY RATE CAP The undersigned certifies that no grant funds will be used to pay any salaries . . at . a . rate .in excess of $125,000 per year. DRUG FREE WORK ENVIRONMENT The undersigned certifies that reasonable efforts are made to maintain a drug- free work place in all programs supported by the SAMHSA Formula Grant funds. 11-24-92 Signature of Official Authorized Date to Sign Application zrt�Luauxt; VI State of California AB 2476 - ADULT PROGRAM Health ands el are Agency Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 11-24-92 MN 1779 REv(10/92) CONTRA COSTA FISCAL YEAR: 1992-93 COUNTY: COUNTY CONTACT: Bob Proctor TELEPNONE NUMBER: (5 10) 370-5013 PROVIDER NAME: Central Adult Intensive Case Mgmt. Unit (County Cost Center 5959) PROVIDER ADDRESS: 2025 Port Chicago Highway, Concord, CA 94520 PROVIDER NUMBER: 07-072 1 MODE/COST CENTERS: 50/11 and 60/61 •........saaaaasaa-aaaaaaaaasaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa-aaaaaaaaa-aaaaaaaaaaaaaaaaaaaaaaa 1 2 3 ............-••-------------------------------------- ............... ............... ............... STAFF Last Request New Title of Position Aproved or Approved (list by name of position and FTE) ludget Change Budget .•--•----•-•---------------------------------------- --•--••-----•- -------a--•-- --••----••--_ 1 2 3 4 5 6 7 8 9 10 11 ----------------------------------------------------- ----•--------• -•--•--------- •------------ 12 TOTAL STAFF EXPENSES(sum lines 1 thru10) 13 ..................................................... ........aaaaaaa aaaaaaaaaa.aaa. ............... 14 Consultant Costs (Itemize): $ 1,700 16 assistance/staff trainillg for new Comm. 17 18 Equipment ere easy c ease or ren ew zed : 19 Purchase start-up equipment to support $14,034 20 21 Case Man ement Unit. see attached eauio. 22 23 Su pp ies emize) : 24 25 26 27 28 Travel 29 30 erxpenses emize : 31 Rent leaspae ink beepers for four staff $ 100 32 --( ay June 33 ;4 35 36 37 -----------------...---.--------------•------------- --------------- --------------- --- ------------- 38 TOTAL PROVIDEREXPERSES (sum lines 12 thru 36) $15,834 39 aaaaaaaaaa aaa...:..a■aaaaaaaasaaaa-asa-aasa�aaaaaaa aa-aaaaaaaaaaaa ..............• -aaaaaaaaaaaaaa 40 REVENUES: Regular 41 -0- 42 or oy e A other Govt tunding sources —0- 43 - •.... •-•----•-••-•-----•--•--••••••-----••--••• ••-•-•--••--- ............... ....... 44 TOTAL REVENUES -0- 45 •aaaaa■sasaa-aaaaaaa-aaaaaaaa-aaaaaaaaaaaaasaaaasaaaa .............s, aaaaaaaaaaaaaaa saaaa-aaaaaaaaa 46 NET REQUESTED FOR PROVIDER $15,834 41 ..................................................... ............... ...aaaa........ ..............a 48 COUNTY ADMINISTRATIVE COSTS (INSTRUCTIONS ON BACK) -0- 49 30 TOTAL COSTS FUNDED- FROM- GRANT(sum lines 46 and 48)• •-� $15,834 •-•- •--•- waa.a.aaaasaaaea■aaaaaaaaaaaaaaMaaaaa.aaaaa.asaaaaaaamasaaaaaaaaaaasaaaaaaaa aaaaaaaaaaaaaaaaaaaaaasaa DMH APPROVAL BY: TELEPHON:: DATL: ENCLOSURE oI Page 2 , COMPLETION INSTRUCTIONS FOR FEDERAL GRANT DETAILED PROVIDER BUDGET - MH 1779 (REV.10/92) 1. READING INSTRUCTIONS: Complete all items. It. FORM INSTRUCTIONS: A. COLUMN INSTRUCTIONS 1. Last Approved Budget- Enter in this column all and only those figures pertaining to the final APPROVED budget for the last fiscal year in which this program was operational. 2. Request or Change - Enter in this column onli those figures =hat are different than figures in the last APPROVED BUDGET column or those figures for a completely new program. 3. New Proposed Budget- Enter in this column the sum of colOmns 1 and 2 adjusting for negative numbers as necessary. I. LINE INSTRUCTIONS. 1 - 8: Staff- Enter position TITLE, FULL TIME EQUIVALENTFTE) percentage, and the salaries plus benefits applicable to the i entified FTE. 12: TOTAL STAFF EXPENSES- SUM lines 1 thru 10. 14 - 17: CONSULTANT COSTS. ENTER consultant title, subject. and the maximum cost of the contracts. 18 - 22: EQUIPMENT - REFER to CR/DC manual which specifies limit on equipment. Equipment is capitalized when each item purchased is over $10,000 23 - 27: SUPPLIES Identify office, printing, products involved in selling or for therapeutic purposes, etc. 28 - 29: TRAVEL • Total cost of Per diem and mileage reimbursements 30 - 36: OTHER EXPENSES - CR/DC defined operating expenses and any other expenses that are extraordinary and not in any other category. (DO NOT ENTER ADMINISTRATIVE EXPENSES IN THIS CATEGORY) 38: TOTAL PROVIDER EXPENSES - Enter on this line the sum of lines 12 thru 36. 40: Regular - Includes patient fees, patient insurance, other grants, Medicare , 42: Short-Doyle and Other Governmental Funding Sources - For mixed funding, enter: 1) DMH pass through of Federal and State, or private grants or, 2) Short-Doyle funds generally consisting of State and county 6eneral funds. 44: Total Revenues - sum of lines 40 - 42. 46: Net Requested for Provider - Subtract line 44 from line 38. 48: COUNTY ADMINISTRATIVE COSTS - This amount includes Contract Admin. costs, and/or County Overhead and/or the Distribution of Admin. Support i Research i Evaluation The County is limited to 10% of the TOTAL GRANT ALLOCATION for the TOTAL :. Administrative Costs. 9: TOTAL COSTS FUNDED FROM GRANT Enter here the sum of lines 46 and 48. C. APPROVAL OF BUDGET. UPON RECEIPT of the budget for each pDrovider DMH WILL REVIEW, APPROVE AND RETURN TO THE COUNTY A COPY OF THE ADPROVED BUDGET. ' 1 CONTRA COSTA COUNTY BUDGET FORM MH 1779 AB2476 ONE-TIME-ONLY FEDERAL ADAMHA BLOCK GRANT APPLICATION: FY 92-93 ATTACHMENT TO PAGE 1 PROVIDER #07-0721: New Centralized Adult Intensive Case Management Unit DETAILED PROVIDER BUDGET (MH 1779) EQUIPMENT LIST for County Cost Center 5959: Purchase start-up equipment necessary to support the new ,SAMHSA Grant program COST TOTAL AB2476 QUANTITY DESCRIPTION PER ITEM GRANT COST -------- ------------------------- -------- ------------- Personal Computer Workstation: 2 IBM Compatable PC $1, 500 $3, 000 2 Modem 300 600 2 Mice 139 278 2 Surge Protector 90 180 2 Cables 50 100 2 Software Programs ** 850 1,700 2 Laser Printer 11500 3, 000 2 Laser Cartridges 200 400 2 Workstation table & chair 700 1,400 ------------- 10, 658 4 File Cabinets 400 1, 600 1 Plain paper FAX machine 1, 520 1,520 2 Boxes of FAX paper 128 256 ------------- TOTAL AB2476 EQUIPMENT PURCHASE $14, 034 ** DOS, word processing, spreadsheet/data base, desktop software NOTE: This equipment will be appropriately inventoried to remain the property of the Grantor and will be returned to the Grantor following the end of the Federal Mental Health Grant period, in accordance with Fed. grant regulations. ENCLOSURE VI State of California AB 2476 — CHILDREI�I PROGRAM Nealth andgWelfare Agency Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 11-24-92 MH 1779 REY(10/92) CONTRA COSTA FISCAL YEAR: 1992-93 COUNTY: COUNTY CONTACT: Bob Proctor TELEPHONE NUMBER: (510) 370-5013 PROVIDER NAME: Families First, Inc./Intensive Family Preservation Mental Health Project PROVIDER ADDRESS: 180 East Leland, Pittsburg, CA 94565 PROVIDER NUMBER: ** MODE/COST CENTERS: 15/10-30-40-50-70 ** new/pending Outpatient Treatment ffffffffffffSamoan games ago seems fffff f fff!!f\ff■!f!\ff■fffffffffffffffff"same !!!!llff tfl.ff 1 2 3 ----•----• ----_••---•-•---•-•-••-•------•------- ............... ............... -••- --•-••- STAFF Last Request -New Title of Position Appproved or Appproved (List by name of position and FTE) tudget Change `udget •--_-•----• ........................................ ... -----.-.•.--- --•---•---•-- 1 2 3 4 S 6 7 8 9 10 11 ----------------------------------------------------- --------•--•- --------------- ----------•-- 12 TOTAL STAFF EXPENSES(sum lines 1 thru10) 13 ..................................................... ............... ............... ............... 14 Consultant Costs (Itemize): 15 16 17 18 Equipment ere feasible lease or ren emize) : 19 20 21 22 23 Supplies emizej : 24 25 26 27 28 Travel 29 30 other Expenses (Itemize): 31 Initial contract (pending) with County to $34,259 32 _ � rva,Ti 33 m 34 budget) 35 36 31 -----------------—-—-----------------............ •-•••••-•---• -•- •--•--•-- ---•---•---•- 38 TOTAL PROVIDER EXPERSES (sum lines 12 thru 36) 39f/fffffffff!■f!flfflfff■■fffffffffffff•\!/ff.i...l..! lffff.fff■1f!!! ffffffff!\\ffff fffflf ff if fffff 40 REVENUES: Regular 41 —0- 42 Short-Doyle I other 6ovt funding sources $ 7,259 43 - NUE ------•--•--- --••-•-------. ----_ ----- 45 TOTAL REVENUES � 7,259 •/!!llff ilk\ff lffffff!lfffflf lffffffflf!!!!f!!!ff!!.! (fffff fffff elft f! ■11!!\!!!\!■ ffffflffffffff■ 46 NET REQUESTED FOR PROVIDER $27,000 47 ff!\\ff!*!!■ffflf!!flfflff■f lff lfflffffffff\!lffffft! ffffftfffff lfff !fffff lffflffff ■!f!flfflfffflf 48 COUNTY ADMINISTRATIVE COSTS (INSTRUCTIONS ON BACK) —0— 30 TOTAL COSTS49 -FUNDED FROM-GRANT(sum lines-46-and-48)--. ............... --$27,000..... ............... DMH APPROVAL BY: TELEPHON:: DATE: ENCLOSURE oI Page 2 COMPLETION INSTRUCTIONS FOR FEDERAL GRANT DETAILED PROVIDER BUDGET - MH 1779 (REV.10/92) I. HEADING INSTRUCTIONS: Complete all items. I1. FORM INSTRUCTIONS: A. COLUMN INSTRUCTIONS 1. Last Approved Budget- Enter in this column all and only those figures pertaining to the final APPROVED budget for the last fiscal year in which this program was operational. 2. Request or Change - Enter in this column only those figures that are different than figures in the last APPROVED BUDGET column or those figures for a completely new program. 3. New Proposed Budget- Enter in this column the sum of columns I and 2 adjusting for negative numbers as necessary. B. LINE INSTRUCTIONS. 1 - 8: Staff- Enter position TITLE, FULL TIME EQUIVALENT (FTE) percentage, and the salaries plus benefits applicable to the identified FTE. 12: TOTAL STAFF EXPENSES- SUM lines 1 thru 10. 14 - 17: CONSULTANT COSTS. ENTER consultant title, subject, and the maximum cost of the contracts. 18 - 22: EQUIPMENT - REFER to CR/DC manual which specifies limit on equipment. Equipment is capitalized when each item purchased is over $10,000 23 - 27: SUPPLIES Identify office, printing, products involved in selling or for therapeutic purposes, etc. 28 - 29: TRAVEL - Total cost of Per diem and mileage reimbursements 30 - 36:• OTHER EXPENSES - CR/DC defined operating expenses and any other expPenses that are extraordinary and not in any other category. (D0 NOT ENTER ADMINISTRATIVE EXPENSES IN THIS CATEGORY) 38: TOTAL PROVIDER EXPENSES - Enter on this line the sum of lines 12 thru 36. 40: Regular - Includes patient fees, patient insurance, other grants, Nedicare 42: Short-Doyle and Other Governmental Funding Sources - For mixed funding, enter: 1) DMH pass through of Federal and State, or private grants or, 2) Short-Doyle funds generally consisting of State and county General Funds. 44: Total Revenues - sum of lines 40 - 42. 46: Net Requested for Provider - Subtract line 44 from line 38. 48: COUNTY ADMINISTRATIVE COSTS - This amount includes Contract Admin. costs, and/or County Overhead and/or the Distribution of Admin. Support i Research i Evaluation costs. The County is limited to 10% of the TOTAL GRANT ALLOCATION for the TOTAL ' Administrative Costs. = 9: TOTAL COSTS FUNDED FROM GRANT - Enter here the sum of lines 46 and 48. C. APPROVAL OF BUDGET. UPON RECEIPT of the budget for each provider DMH WILL REVIEW, APPROVE AND RETURN TO THE COUNTY A COPY OF THE APPROVED BUDGET. r FAMILIES FIRST, INC. - FAMILY PRESERVATION PROJECT BUDGET OF ESTIMATED PROGRAM EXPENDITURES ----------------------------------------- NUMBER 24- -------------- A. GROSS PROGRAM BUDGETS FISCAL YEAR AMOUNTS ------------------------ 1. COST CATEGORIES FY 92-93 FY 93-94 (1/93-6/93) (7/93-6/94) a. PERSONNEL SALARIES AND BENEFITS: ----------- ----------- (DIRECT COSTS) (1) Associate Executive Director* $ 1,294 2,587 (2) Program Supervisor 2,780 5,560 (3) Therapists 16,750 33,500 (4) Secretarial Staff 791 1,682 (5) Fringe Benefits 5,620 11,265 (6) SUBTOTAL AMOUNT $ 27,235 $ 54,594 b. OPERATING EXPENSES (DIRECT COSTS) : (1) Accounting $ 0 $ 0 (2) Office Supplies/Postage** 55 110 (3) Telephone 440 880 (4) Mileage 1,266 2,532 (5) Conference & Training 58 115 (6.) Printing 23 45 (7) Recruitment 114 227 (8) Office Lease 545 1, 090 (9) Utilities 138 276 (10) Building Maintenance & Supplies** 55 109 (11) Equipment Lease 64 127 (12) Emergency Family Financial Assistance 2,250 4 ,500 ---------- ---------- (13) SUBTOTAL AMOUNT $ 5,008 $ 10, 011 c. INDIRECT COSTS (SUBTOTAL AMOUNT) *** 2, 016 4, 032 2. TOTAL GROSS ALLOWABLE PROGRAM COST $ 34,259 $ 68,637 B. LESS PROJECTED NON-COUNTY PROGRAM REVENUES "'(To be collected and provided by Contractor) 1. Client Fees and Insurance $ -0- -0- 2. Grants and Subventions -0- -0- 3. Donations -0- -0- 4. Other (Specify: ) -0- -0- ----------- ----------- 5. TOTAL PROJECTED NON-COUNTY PROGRAM REVENUE ( -0- ) ( -0- ) C. NET ALLOWABLE FISCAL YEAR COST (Fiscal $ 34 ,259 $ 68,637 Year Payment Limits) ***Includes liability insurance INITIALS: CO. DEPT. CONTRACTOR -1- EXULOSURE VI AB 2476 - CHILDREN PROGRAM (Page 3 of 4) tate of California Nealth and Welfare Agency Department of Mental Wealth SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 11-24-92 MH 1779 REV(10/92) 1992-93 COUNTY: CONTRA COSTA FISCAL YEAR: COUNTY CONTACT: Bob Proctor TELEPHONE NUMBER: (5 10) 370-5013 PROVIDER NAME: Mental Health Administration (Office of Children Services Program Chief) PROVIDER ADDRESS: 595 Center Ave., Suite 200, Martinez, CA 94553 PROVIDER NUMBER: 07-0799 MODE/COST CENTERS: 00/20 (Admin.) ............send...........gone season................................meatus asa......ssa............... 1 2 3 .................................................. ............ ............... - ............. STAFF Last Request New Title of Position Appproved or proved (List by name of position and FTE) `udget Change udget ....----•-- ...................................... __..__-_.-- .. .............. ....... 1 2 3 4 5 6 7 8 9 10 11 ----------------------------------------------------- ----•-•--•--•- -------------- ------------- 12 TOTAL STAFF EXPENSES(sum lines 1 thru 10) 13 ..................................................... ............... ............... ............... 14 Consultant Costs (Itemize): 15 16 17 18 Equipment jWhere feasible lease or ren emizel : 19 Purchas 1 PC system: including printer. $5,368 20 so twat and workstation turniture. 21 County Cost Center 5946 22 23 Supplies (itemize) : 24 25 26 27 28 Travel 29 30 Other Expenses emize : 31 32 33 34 35 36 31 ft.. ..............._._._...--...._-------•------•-- ............... .... ...... -------- 38 TOTAL PROVIDER EXPERSES (sum lines 12 thru 36) $5,368 39 .............................................bassoons ............... ............... ..........s.... 40 REVENUES:41 Regua,ar -0- 42 Short-Doyle other Govt funding sources _0_ 43 .. ........................•---•---•-......._--..-- --•---•...--- ---- •..------ ._--• ..... 44 TOTAL REVENUES _0- ' 45 ..................................................... ............... ............... ............... 46 NET REQUESTED FOR PROVIDER $5,368 47 •.aa.....a...s.■...■a.s...a.......aaaaa.a....a..saass ......aa......■ ■..a..aa....... ............... 48 COUNTY ADMINISTRATIVE COSTS (INSTRUCTIONS ON BACK) -0- 49 ----------'-•-----------••--- ---- ---------------- -------..---- ----------_--- ---------------- 50 TOTAL COSTS FUNDED FROM GRANT(sum lines 46 and 48) ....................................................................... $5 X368...........:.......... DMH APPROVAL BY: TELEPHONE: DATt: ENCLOSURE VI Page 2 " COMPLETION INSTRUCTIONS FOR FEDERAL GRANT DETAILED PROVIDER BUDGET - MN 1779 (REV.10/92) I. HEADING INSTRUCTIONS: Complete all items. II. FORM INSTRUCTIONS: A. COLUMN INSTRUCTIONS 1. Last Approved Budget- Enter in this column all and only those figures pertaining to the final APPROVED budget for the last fiscal year in which this program was operational. 2. Request or Change - Enter in this column onlythose figures that are different than figures in the last APPROVED UDGET column or those figures for a completely new program. 3. New Proposed Budget- Enter in this column the sum of columns I and 2 adjusting for negative numbers as necessary. B. LINE INSTRUCTIONS. 1 - 8: Staff- Enter position TITLE, FULL TIME EQUIVALENT (FTE) percentage, and the salaries plus benefits applicable to the identified FTE. 12: TOTAL STAFF EXPENSES- SUM lines 1 thru 10. 14 - 17: CONSULTANT COSTS. ENTER consultant title, subject, and the maximum cost of the contracts. 18 - 22: EQUIPMENT - REFER to CR/DC manual which specifies limit on equipment. Equipment is capitalized when each item purchased is over $10,000 23 - 27: SUPPLIES Identify office, printing, products involved in selling or for therapeutic purposes, etc. 28 - 29: TRAVEL - Total cost of Per diem and mileage reimbursements 30 - 36.:. OTHER.EXPENSES - CR/DC defined operating expenses and any other exppenses that are extraordinary and not in any other category. (DO NOT ENTER ADMINISTRATIVE EXPENSES IN THIS CATEGORY) 38: TOTAL PROVIDER EXPENSES - Enter on this line the sum of lines 12 thru 36. 40: Regular - Includes patient fees, patient insurance, other grants, Medicare 42: Short-Doyle and Other Governmental Funding Sources - For mixed funding, enter: 1) DMH Passthrough of Federal and State, or private. grants or, 2) Short-Doyle funds generally consisting of State and county General Funds. 44: Total Revenues - sum of lines 40 - 42. 46: Net Requested for Provider - Subtract line 44 from line 38. 48: COUNTY ADMINISTRATIVE COSTS - This amount includes Contract Admin. costs, and/or County Overhead and/or the Distribution of Admin. Support i Research i Evaluation costs. The County is limited to 104 of the TOTAL GRANT ALLOCATION for the TOTAL :. Administrative Costs. 9: TOTAL COSTS FUNDED FROM GRANT - Enter here the sum of lines 46 and 48. C. APPROVAL OF BUDGET. UPON RECEIPT of the budget for each provider DMH WILL REVIEW, APPROVE AND RETURN TO THE COUNTY A COPY OF THE ADPROVED BUDGET. LNULUSURE VI • (Page 4 of 4) ' hate of California AB 2476 - CHILDREN PROGRAM Health and Welfare Agency Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 11-24-92 MH 1779 REV(10/92) 1992-93 COUNTY: CCNTRA COSTA FISCAL YEAR COUNTY CONTACT: Bob Proctor TELEPHONE HUMBER: (510) 370-5013 PROVIDER NAME: YIACT Case Management PROVIDER ADDRESS: 2425 Bisso Lane, Suite 235, Concord, CA 94520 PROVIDER NUMBER: 07-0711 NODE/COST CENTERS: 50/10 .aa.rima,aaaa.asanwaaa■aaaaaa anus ago sa.aa.aaaaaa.aa.a.aaa.aa..asaa...as..asses....................was 1 2 3 STAFF •Last Request -New Title of Position Approved or Approved (List by name of Position and FTE) Budget Change Budget .................................................. -----•---••-•- ............. •-•.---...•-- 1 2 3 4 S 6 7 8 9 10 11 ----------------------------------------------------- --a--•------- ------------- ----------•-- 12 TOTAL STAFF EXPENSES(sum lines 1 thru10) 13 ..................................................... ............... ............... ............... 15 Consultant Costs (Itemize): 16 17 18 Equipment ere teasibie lease or ren emize) : 19 Purchase L PC system: include printer, $5,868 20 21 Countv Cost Center 59 22 23 Supplies (itemize) : 24 25 26 27 28 Iravel 29 30 Uther Expenses (itemize): 31 32 33 34 35 36 31 ----------------------------•-----•--------------- •----•------•- ------—- ---•- ---•-•------- 38 TOTAL PROVIDER EXPE1tSES (sum lines 12 thru 36) $5,868 39aaaaaaaasaaaawa.aaa.a.aaaaa.a.a.a.a.aaaaaaaaabaaaaaaa aaaaaamaaaaaaaa aaaa.a.aa.aa... ....aaaaa.aaaa■ 40 REVENUES: Regular 41 -0- 42 ort- oy e I other r6ovt funding sources -0- 43 ----------------------------------------------------- ------------- --•------••-- ------- 44 TOTAL REVENUES -0- ' 45a...aa.a.a.a.w...a..a...........................a.... .............a. aaaaaaaaa.aaaa. ............... 46 NET REQUESTED FOR PROVIDER $5,868 47 asaaaaaaaaaaawaa.aaasaaaaaaaaaaaaaaasaaaaaaaaaaaaaaa■ aaaaaaaaaaaaaa■ ■aaaaaaaaa.asaa aaasaaaaaaaaaaa 48 COUNTY ADMINISTRATIVE COSTS (INSTRUCTIONS ON BACK) -0- 50 TOTAL COSTS FUNDED FROM GRANT(sum lines•46 and 48) --- $5,868 •- - •• - .aaaawaaaaamap seems a.a.aaaaaaaawaaaaaaaaaaaa■aaaasaasense asee sauna aaaaaa mass Mae museums aaaaaaaaaaaaaaa DMH APPROVAL BY: TELEPHON.: DATE: ENCLOSURE 9I Page 2 COMPLETION INSTRUCTIONS FOR FEDERAL GRANT DETAILED PROVIDER BUDGET - MH 1779 (REV.10/92) I. HEADING INSTRUCTIONS: Complete all items. Il. FORM INSTRUCTIONS: A. COLUMN INSTRUCTIONS 1. Last Approved Budget- Enter in this column all and only those figures pertaining to the final APPROVED budget for the last fiscal year in which this program was operational. 2. Request or Change - Enter in this column only those figures that are different than figures in the last APPROVED BUDGET column or those figures for a completely new program. 3. New Proposed Budget- Enter in this.-colicin the sum of columns 1 and 2 adjusting for negative numbers'as necessary. B. LINE INSTRUCTIONS. 1 - d: Staff- Enter position TITLE, FULL TIME EQUIVALENT (FTE) percentage, and the salaries plus benefits applicable to the identified FTE. 12: TOTAL STAFF EXPENSES- SUM lines 1 thru 10. 14 - 17: CONSULTANT COSTS. ENTER consultant title, subject, and the maximum cost of the contracts. 18 - 22: EQUIPMENT - REFER to CR/DC manual which specifies limit on equipment. Equipment is capitalized when each item purchased is over $10,000 23 - 27: SUPPLIES Identify office, printing, products involved In selling or for therapeutic purposes, etc. 28 - 29: TRAVEL - Total cost of Per diem and mileage reimbursements 30 - 36: OTHER EXPENSES - CR/DC defined operating expenses and any other exppenses that are extraordinary and not in any other category. (DO NOT ENTER ADMINISTRATIVE EXPENSES IN THIS CATEGORY) 38: TOTAL PROVIDER EXPENSES - Enter on this line the sum of lines 12 thru 36. 40: Regular - Includes patient fees, patient insurance, other grants, Nedicare , 42: Short-Doyle and Other Governmental Funding Sources - For mixed funding, enter: 1) DMH pass through of Federal and State, or private grants or, 2) Short-Doyle funds generally consisting of State and county General Funds. 44: Total Revenues - sum of lines 40 - 42. 46: Net Requested for Provider - Subtract line 44 from line 38. 48: COUNTY ADMINISTRATIVE COSTS - This amount includes Contract Admin. costs, and/or County Overhead and/or the Distribution of Admin. Support i Research i Evaluation costs. The County is limited to 10% of the TOTAL GRANT ALLOCATION for the TOTAL Administrative Costs. =�9: TOTAL COSTS FUNDED FROM GRANT - Enter here the sum of lines 46 and 48. C. APPROVAL OF BUDGET. UPON RECEIPT of the budget for each provider DMH WILL REVIEY, APPROVE AND RETURN TO THE COUNTY A COPY OF THE APPROVED BUDGET.