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Home My WebLink AboutMINUTES - 03011994 - 1.51 TO: BOARD OF SUPERVISORS FROM: Mark Finucane, Health Services Director Uu Contra By: Elizabeth A. Spooner, Contracts Administrator COSta DATE: February 17, 1994 . @County SUBJECT: Approve Submission of Federal SAMHSA Grant Renewal Application for Mental Health Services during Fiscal Year 1993-94 SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION I. RECOMMENDED ACTION: A. Approve and authorize the Health Services Director, or his designee (Lorna Bastian) to submit the Federal SAMHSA Grant Renewal Application to the State Department of Mental Health, for $1,475,000 in Federal SAMHSA Grant Funds, and $121,029 in AB 2476/SB 463 Augmentation Funds (for a total of $1,596,029) , for the period from July 1, 1993 through June 30, 1994, to continue Federal Grant-funded mental health services. B. Authorize the Health Services Director, or his designee (Lorna Bastian) to execute, on behalf of the County, the following application documents: Initial Allocation Worksheet; Assurance of Compliance; Certifications (regarding lobbying, salary rate cap and drug free work environment) ; and Grant Planning Estimate. C. Authorize the Health Services Director, or his designee (Lorna Bastian) , 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 Renewal Application describes service program changes which are necessary for the County to remain eligible to continue to receive this $1,596,029 Federal Grant Allocation, and presents a plan and detailed provider budgets for use of these funds, including new expenditures to utilize the $121,029 in AB 2476/SB 463 Augmentation Funds. No County matching funds are required. III. REASONS FOR RECOMMENDATIONS/BACKGROUND: This FY 1993-94 SAMHSA Grant Renewal Application was reviewed and recommended for approval by the County's Mental Health Advisory Commission at its' meeting on January 25, 1994. This year's Federal "Substance Abuse and Mental Health Services Administration" (SAMHSA) Grant Program completes the implementation of program changes begun last year to fully utilize the Federal Grant funds for integrated systems of care to serve the target populations of seriously and persistently mentally ill (SPMI) adults and seriously emotionally disturbed (SED) children and youth. CONTINUED ON ATTACHMENT: X- YES SIGNATURE: , RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMME A ON OF BOARD C MMITTEE APPROVE OTHER SIGNATURE(S) 1 ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS UNANIMOUS (ABSENT ) 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 SUPERVISORS ON THE DATE SHOWN. Contact: Lorna Bastian (313-6411) cc: Health Services (Contracts) ATTESTED _ Auditor—Controller (Claims) Phil Batchelor, Clerk of he Board of State Dept. of Mental Health SupenlisQ vdCQ1WtyAdMin&aW Mee2/7-ee BY -A, &ALA..( DEPUTY r � FY 1993-94 SAMHSA Grant Board Order Page 2 The new AB 2476/SB 463 Augmentation Funds will permit the creation of some new service staff positions and the purchase of needed technical assistance, training, and evaluation services. 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 1993-94. In order to meet the deadline for submission, the document has been forwarded to the State, but subject to Board approval. Three sealed copies of the Board Order authorizing submission of the application should be returned to the Contracts and Grants Unit. 29 - 472 - 2 CONTRA COSTA COUNTY SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) BLOCK GRANT RENEWAL APPLICATION FOR STATE FISCAL YEAR 1993-94 CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT MENTAL HEALTH DIVISION 595 CENTER AVENUE, SUITE 200 MARTINEZ, CA 94553 i (12/93) CONTRA COSTA COUNTY SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) BLOCK GRANT RENEWAL APPLICATION FOR STATE FISCAL YEAR 1993-94 TABLE OF CONTENTS SAMHSA .Block Grant Allocation Worksheet Enclosure I Program Narrative Description Enclosure II Assurance of Compliance with Public Law 102-321 Requirements on Use of Allotments Enclosure III Certifications Enclosure IV Block Grant Program Budget Summary (MH 1783) Enclosure V Federal Grant Detailed Provider .Budget(s) MH 1779 Enclosure VI SAMHSA Block Grant Planning Estimate Enclosure VII ' ENCLOSURE I State of California Health and Welfare Agency Department of Mental Health SAMHSA BLOCK GRANT ALLOCATION WORKSHEET MH 1772A (7/93) STATE FISCAL YEAR 1993/94 FEDERAL CATALOG NO. 93 . 958 COUNTY Contra Costa REVISION NUMBER 00 The State Department of Mental Health (D:MH) , under provisions of 42 United States Code, Sections 300x et. seq. , as it read on January 1, 1992, and as amended by P.L. 102-321, and the State Budget Act of 1993 (Chapter 55, Statutes of 1993) , is authorized to allocate the mental health portion of the Federal Substance Abuse and Mental Health Services Administration (SAMHSA) Block Grant funds to counties for State Fiscal Year (SFY) 1993/94 . These funds should be used to begin new programs or expand existing programs . 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 recoveries , retained unexpended amounts, etc. Your allocation is identified below. I . GROSS EXPENDITURE LEVEL A. SAMHSA Block Grant Funding Base $ 1,475,000 B. AB 2476 Augmentation $ 54, 070 C. SB 463 Augmentation $ 66 , 959 D. Total Authorized Gross Expenditure Level $ 1,596 029 II . REIMBURSEMENT ADJUSTMENT(S) A. < > B. C. Total Adjustments <$ > III . NET ALLOCATION REIMBURSABLE $ 1,596 , 029 PURPOSE: Initial Allocation DATE: September 3, 1993 I, the undersigned, have accepted the Federal SAMHSA Block Grant funds for 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. County Mental Health Director Date ENCLOSURE II 3 . 0 INTRODUCTION In Fiscal Year 1993-94, the SAMHSA Block Grant funds will be used to support three major program areas: the seriously mentally ill (SMI) adults, older adults and seriously emotionally disturbed (SED) children and adolescents. In each program area under Statement of Purpose, service integration is discussed as it specifically relates to that program area. However, at the Health Services Department level, there is an ongoing effort to integrate services on a very broad scale. An Office for Service Integration was established in November 1991. Mental Health staff serve on the committees formed under this office. Additionally, under the leadership of the Board of Supervisors and the County Administrator, the County has made a commitment to innovative approaches to integrating services. This began with the Youth Services Board and more recently with the Expanded Youth Services Board (see Section 3 .3 Statement of Purpose) . Departments involved in this effort include Health Services (Medical Care, Mental Health, Substance Abuse, Public Health) , Social Service and Community Services, in addition to the County Office of Education. These critical developments at the County level will affect the way the Mental Health Division is able to integrate programs and will change interdepartmental relationships significantly. In summary, implementation of the principles of integrated systems of care, pursuant to the State Plan, PL 99-660, PL 102- 321 and AB 1288 are underway at several levels in the system. The results will be unfolding over the next few years and will be described in future SAMHSA renewal applications as they relate to the mental health system of care. Crucial to providing an effective and efficient integrated service delivery approach is ongoing training of staff and evaluation of services to ensure that the system of care is being responsive to the changing needs of individuals in the target population. This fiscal year a small amount of funding will be dedicated to a staff trainer and a SAMHSA project evaluator who will develop outcome measures and an evaluation protocol. 1 3 . 1 PROGRAM DESCRIPTION: SERVICES FOR SERIOUSLY MENTALLY ILL ADULTS A. STATEMENT OF PURPOSE In Fiscal Year 1992-93 our community-based mental health system shifted its target population focus to serving seriously mentally ill (SMI) individuals with a specific, intensive focus on individuals who are considered "high users" of our system's mental health services. With a shift in our target population in the past ,'year, our goal for Fiscal Year 1993-94 is to further develop a community support model of service delivery providing the most intense level of services to individuals with the highest degree of functional impairment who are at risk of costly, often unnecessary, hospitalization or institutionalization. Concurrently, it is our , goal to return to a lower level of care those SMI 'individuals who are institutionalized. In keeping with the principles of the State Plan, PL 99-660, PL 102-321 and AB 1288, services will be delivered in a framework of an integrated system of care designed to include all major mental health providers within the current system--county and contract programs--and other county services such as Conservatorship, Substance Abuse, forensic and inpatient services. Commencing in the third quarter of Fiscal Year 1993- 94, adult services will begin implementation of Coordinated Services, which will provide a new structure to ensure better coordination and integration of services to SMI adults. B. OBJECTIVES (1) Decrease the adult census at Napa State Hospital by 10 beds (Baseline: N=57) with the transfer of individuals to a regional neuro-behavioral facility (by March 15, 1994) . (2) Develop a subacute intensive treatment capacity of 10 beds as a treatment alternative to acute psychiatric hospitalization (by October 1, 1993) . (3) Beginning July 1,1993, the Bed ][review Committee will meet on a weekly basis, reviewing the status of individuals currently residing in an IMD with the intent, upon stabilization, of discharging individuals to a lower level of care. (4) Completion of a four-page comprehensive assessment on all individuals (N=100) who dare residing at Napa State Hospital and contracted locked psychiatric skilled nursing facilities (IMDs) (by March 15, 1994) . 2 (5) Add another daily tier of partial hospital services, thereby increasing the number of daily participants by 40o by December 1993 . (Baseline: N=20 ADA) (6) Increase overall case management staff from 10 to 15 FTE, thereby increasing the system's case management caseload from 400 to 550 SMI individuals (by June 30, 1994) . (7) As a result of a more intensive case management approach, at least 20 of the 40 individuals transitioned from IMDs to the community will remain in the community for a period of three months or longer (between July 1, 1993 and June 30, 1994) . (8) Contract with Mental Health Consumer Concerns to develop a six-month training program for consumers, whose goal is to secure volunteer or paid staff positions in County Mental Health programs and/or County funded contract mental health programs (January 1, 1994 through June 30, 1994) . (9) Commence hiring four part-time consumer staff persons as "Community Support Workers" to work in County Mental Health programs (by July 1, 1994) . (10) Contract with a housing consultant (by November 15, 1993) to: • Evaluate the Housing for Independent People (HIP) housing programs that currently exist to determine what changes in licensure and programming are needed to better serve Contra Costa County's SMI adults (November 15, 1993 through June 30, 1994) . • Explore funding and program possibilities for housing development for Contra Costa County's SMI adult population (November 15, 1993 through June 30, 1994) . C. PROGRAM DESCRIPTION • Target Population The adult system of care target population includes SMI adults 18 and over who are functionally disabled. Special consideration is given to homeless SMI clients. Pursuant to Section 1912 (c) of the Public Mental Health Services Act, as amended by Public Law 102-321, "adults with a serious mental illness" are persons: ..a 3 - age 18 and over - who currently or at any time during the past year - have had a diagnosable mental, behavioral, or emotional disorder of sufficient durationto meet diagnostic criteria specified within DSM-III-R - that has resulted in functional impairment which subse- quently interferes with or limits one or more major life activities. These disorders include any mental disorders (including those of biological etiology) listed in DSM-III-R or their ICD-9-CM equivalent (and subsequent revisions) with the exception of DSM- III-R "V" Codes, substance use disorders, and developmental disorders, which are excluded unless they co-occur !with another diagnosable serious mental illness. All of these disorders have episodic, recurrent, or persistent features; however, they vary in terms of severity and disabling effects. Functional impairment is defined as difficulties that substantially interfere with or limit role functioning in one or more major life activities, including basic daily living skills (e.g. , eating, bathing, dressing) ; instrumental living skills (e.g. , maintaining a household, managing money, getting around the community, taking prescribed medication) ; and functioning in social, family, and vocational/education contexts. Adults who would have met functional impairment criteria during the referenced year without the benefit of treatment or other support services are considered to have serious mental illnesses. • Services -Offered (1) Mental Health Services in West, Central and East County Mental health services to SMI adults in a clinic or community setting (includes client's residence, a park, restaurant, etc. ) : case management/brokerage (linkage, placement and plan development) , collateral, assessment, individual, group, medication support, and crisis intervention. (2) Partial Hospitalization Partial hospital services are offered to SMI adults five days a week with two distinct program levels; the morning program serves a less acute SMI population, while the afternoon program is targeted to individuals in crisis and/or at risk of immediate hospitalization. Services offered at both program tiers include: 4 - Medication monitoring - Psychiatric evaluation and diagnosis - Crisis intervention - Individual and family therapy - Peer support - Expressive arts therapy - Skill building groups. (3) Assessment/Monitoring of SMI Clients Residing in Institutions/Facilities The SAMHSA grant will fund 1. 0 FTE Clinical Nurse Specialist and/or Mental Health Clinical Specialist to provide assessment and .ongoing monitoring and case management services to individuals residing in Napa State Hospital and the IMDs; attend monthly and quarterly treatment meetings at each facility; minimum once a month face-to-face contact with each individual and written summary of individual's status; participate in discharge planning efforts by presenting information for discharge to the Bed Review Committee; and facilitate linkage with conservators and outpatient case management assignment upon discharge. (4) Training of Community Support Worker staff Contra Costa County Mental Health Division will develop a contract with Mental Health Consumer Concerns to establish a training program for consumers interested in securing volunteer and/or paid positions in County or contract mental health programs. The training program will include content as follows. (a) Group Training Sessions - Peer Counseling--active listening, goal setting, , needs assessment, client's expressed needs - Information and Referral--community resources - Benefits Advocacy--effective use of resources - Living Skills Training and Housing Counseling The Mental Health Service System Completing Paper Work, Case Histories and Case Records - Ethics and Confiaentiality - Working relationships; working with professional providers and other colleagues 5 Other training topics specific to region, job duties and specific CSW needs (b) On-the-Job Training - Shadowing; participation in staff meetings and case conferences. - Begin assisting co-workers with specific client services. Next fiscal year four part-time Community Support staff will be hired as part of the Contra Costa County Mental Health Division's movement toward the creation of a client-driven system and the provision of integrated services which are planned, implemented, and evaluated by teams of clients, families and providers. (5) Housing for SMI Adults (a) A housing consultant will be hired to evaluate the existing housing programs in Concord and Pittsburg operated by Housing for Independent People, Inc. , specifically the possibility of changing licensure of a six-bed independent home to a board and care facility with greater capacity; the potential of establishing a social rehab program/facility will also be explored. The intent of this effort is to maximize our housing resources to best meet the needs of our target population. Funding opportunities will also be explored to develop, and thus increase, the overall supply of community-based housing alternatives for the SMI adult population. (b) Contract with Housing for Independent People, Inc. , to operate Semi-Supervised Living Residential Treatment Programs for SMI adults at two locations: Santa Fe in Pittsburg and Clayton Way in Concord. This supportive housing program provides affordable housing for SMI adults who, for the most part, have never maintained a successful living arrangement. • Cultural Competence A recently formed Ethnic Services Committee will be addressing the service needs of our various ethnic populations and assuring that our services are culturally and :linguistically relevant and that staff is culturally competent. The mission statement for the committee is: 6 The aims of the Ethnic Services Committee include: the identification of current and future mental health service needs of the racial/ethnic populations within the community of Contra Costa County; the development of recommendations to the Mental Health Administration about the provision of linguistically and culturally appropriate treatment, interventions, and services; the identification of long- term solutions that address the retention and recruitment of bilingual and bicultural staff for all service components; and the review and analysis of service utilization in order to ensure equitable access to available mental health services for all persons regardless of race or ethnic group identification. D. STAFFING Mental Health Services' West Central East 1.0 Program Supv. *1. 0 Program Supv. 1. 0 Program Supv. (LCSW) (MFCC) (MFCC) . 1. 0 LCSW *2.0 LCSW *3 . 0 LCSW 3 . 0 MH Specialist 4. 0 MH Specialist *3 . 0 MH Specialist 2. 0 Sr. MH Worker *2.5 MD 2 . 5 MD 2 .5 MD 2. 0 Clerk *2. 0 Clerk 2 . 0 Clerk Assessment/Monitoring - Partial Hospital Institutions/Facilities *1. 0 Program Supv. (LCSW) 1. 0 Clinical Nurse Specialist/ 2 . 0 LCSW Mental Health Clinical 1. 0 MFCC Specialist 2 . 0 Sr. MH Worker *1.0 MH Activity Specialist .5 RN .8 MD 1. 0 Clerk *Bilingual (Hispanic) capability E. PEER REVIEW Julie Peck, Adult/Older Adult Program Chief, will participate as a member of the State Department of Mental Health Review Team in order to meet the annual peer review requirement. 7 F. IMPLEMENTATION PLAN Please refer to Section B (Objectives) where specific timelines for implementation are delineated for each objective. G. DOCUMENTATION DESCRIPTION • Objective No. 1 - Monthly census report for Napa State Hospital. - Written evaluations of Napa State Hospital patients to be transferred. • Objective No. 2 Review dates and progress of Contra Costa County admissions to three contract subacute facilities as docu- mented in weekly Bed Review Committee meeting minutes. • Objective No. 3 - Review written, weekly minutes of Bed Review Committee. • Objective No. 4 - Review of four-page assessment on each Contra Costa County resident institutionalized at Napa State Hospital, the contract subacute program(s) , and the contracted IMD beds. • Objective No. 5 - Review PSP average daily attendance reports for Partial Hospital Program. • Objective No. 6 - Review Personnel Information Report #3 to confirm addi- tional staff in case management by region. • Objective No. 7 - Review charts in each region of individuals discharged from IMDs and transitioned to case management. • Objective No. 8 Review contract and service plan for Mental Health Consumer Concerns. ReZiew formal training/course outline. 8 • Objective No. 9 - Develop written position duty statement, develop recruit- ment materials used to hire part-time Community Support Worker staff. • Objective No. 10 - Review contract to hire housing consultant. Review service plan and all written reports submitted by housing consultant. 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 also provides inferential statistical analysis of the quantitative data made available by this system. As part of a monthly MIS Committee meeting, problems and/or barriers and correction plan(s) will be discussed, and the Program Chief will implement correction plans and monitor results. (2) The Utilization Review/Quality Improvement Committee process provides ongoing analysis of the qualitative aspects of the program. The Adult/Older Adult Program Chief will monitor, correct and resolve identified problems in her respective program areas. A system of care including a full spectrum of support services such as housing, employment, education and peer support are all essential to maintaining individuals with a severe mental illness within their communities. Obviously, lack of these services create barriers to individuals living successful lives in the community. The greatest barrier identified for this fiscal year is the lack of appropriate residential programs and other housing in order to move SMI adults from institutional settings to lower levels of residential care and other housing alternatives. 'In anticipation of this barrier this fiscal year, a housing developer/consultant was contracted to explore funding and 9 program possibilities for housing (see Program Description Section (5) , p. 6) . As an ongoing process the Adult/Older Adult Program Chief and Mental Health Director are actively developing alternatives to higher levels of care. Additionally, in the last quarter of Fiscal Year 1993-94, a broad-spectrum planning process will refine a community-based system of care, which may result in "the redirection of resources and/or programmatic changes to more fully meet the needs of seriously mentally ill individuals. 10 3 .2 PROGRAM DESCRIPTION: GERIATRIC OUTREACH PROGRAM A. STATEMENT OF PURPOSE The Geriatric Outreach Program serves persons who are experiencing multiple changes in their lives that influence their ability to remain living independently in the community. The overall goal is to assist seriously mentally ill/functionally impaired older adults to remain in the community by increasing their accessibility to mental health, health and other community services available to persons 60 years and older. The Geriatric Outreach Program meets the SAMHSA guidelines not only by the population it serves, but also because the Geriatric Services Program has an integrated service delivery approach. • Outreach • Older Adult Clinics (E1 Cerrito, Concord and Antioch) • Geriatric Med-Psych Inpatient Unit * Subacute SNF (contract beds) Staff in the four service areas often refer older adults to services. needed; for example, Outreach staff ref er. older adults to the Older Adult Clinics or the Geriatric Med-Psych Unit. Clinic staff often refer older adults to Outreach for in-home evaluations, for groups, or other needed services that have been identified. The subacute program staff may refer older adults to the clinics, inpatient or Outreach. Older adults may move back and forth along the continuum of care depending on the level of services needed at any given point in time. Older adults who receive services from the Geriatric Services Program have an identified care manager who monitors and coordinates the services needed by the individual. The care manager may be the individual's physician, psychiatrist, or outreach geriatric specialist. To ensure continuity of care and good coordination among the Geriatric Services Program staff, there are team meetings held twice monthly (six hours total) and physicians, psychiatrists, social workers, and nurses attend to discuss cases. B. PROGRAM OBJECTIVES (1) Provide in-home assessments by geriatric specialist within 72 hours of 75% of. telephone referrals of Contra Costa County residents aged 60 years and over. (2) Increase by 20% the number of outreach follow-up and moni- toring referrals in Westi County, .Central County and East County of persons 60 years and over as a result of stronger linkage and coordination with the .3 Older Adult Clinics in the respective geographic regions. 11 (3) A minimum of ' 10% of service units (approximately 2, 000 units) provided annually by geriatric outreach staff will be dedicated to community education and information regarding aging and mental health issues. (Unit of service 15 minutes. ) C. PROGRAM DESCRIPTION The Contra Costa Geriatric Services Program provides, to persons 60 years and older, community-based services that include out- reach, crisis intervention, in-home functional assessments, supportive counseling, information and referral and short-term monitoring. Community education and graining and support groups are also offered to elders, family members and caregivers. Outreach services are targeted to seriously mentally ill/ functionally impaired residents, 60 years and older, who are experiencing significant changes in behavior, memory, mood or function as a result of their mental health problem. Services are designed to meet the seriously mentally ill/ functionally impaired older adult's needs and assist 'in identifying and using a system of integrated services that provides a continuum of care for Contra Costa County residents, aged 60 years and over, who are identified by at least one of the following characteristics: • Psychiatric disorders. • Discernible impairment in cognition, behavior and/or functional status. • Significant changes in behavior, memory, cognition, mood or function. • Frail and at risk of hospitalization and/or institutionalization. • Difficulty managing his/her environment. • Multi-system problems. Outreach services encompass the following activities: • In-home assessment by a geriatric specialist of an older person who, due to serious mental health problems, is having difficulty managing in their environment. The specialist will identify the presenting prQblems and will develop a plan that often includes identifying lavailable options, mobilizing the support network, coordinating needed resources, and monitoring the situation over time. 12 • Crisis evaluation/intervention of elders in the community. Involuntary hospitalization as appropriate. • Supportive counseling to older individuals and their families. • Advocacy on behalf of the elder. • Psychiatric consultation to skilled nursing facilities. • Provision of education and training to community agency groups and organizations. • Support groups: - for men and women 60 years and over (weekly in Central County) ; - for older men who are caregivers (twice monthly in Central County) ; - for spouses/caregivers of older adults suffering from dementia (monthly in West County) ; - for caregivers of aging parents/relatives (weekly in evening in West County) ; and - for caregivers of elders (weekly in East County) . The Outreach Program receives referrals from the Health Services Department providers and from the community - family members, neighbors, friends - and from hospitals, health care providers, social service agencies, and aging network agencies. D. STAFFING West County Geriatric Outreach 0. 2 FTE Program Manager 1. 0 FTE MSW 1.0 FTE R.N. Central/East County Geriatric Outreach 0. 3 FTE Program Manager 3 . 0 FTE LCSW `i 13 E. DESIGNATED PEER REVIEW REPRESENTA^.FIVE Julie Peck, Adult/Older Adult Program Chief, is designated as the peer review representative who will participate as a member of the State Department of Mental Health Review Team to assess the quality, appropriateness, and efficiency of treatment services provided. F. IMPLEMENTATION PLAN The program described above was fully implemented at the end of Fiscal Year 1992-93 . G. DOCUMENTATION DESCRIPTION Documentation of outreach contacts will include a DSM-III-R diagnosis and level of functional impairment. Julie Peck, Adult/Older Adult Program Chief, is responsible for ensuring that program documentation requirements are met. • Objective No. 1 - Each staff person has a written job description, outlining his/her job responsibilities, as well as his/her schedule. - Each staff person completes, on a daily basis, activity sheets listing every client contact that is direct or indirect and the amount of time spent on each interaction. All collateral phone calls are also listed on the daily activity sheet as well as meetings attended. • Objective No. 2 A referral log is filled out each time a new referral comes in and, at the end of each month, information from the .log is compiled. - Weekly reports, identifying number of patients seen by provider, number of missed appointments, number of home visits, etc. , is completed for each clinic. • Objective No. 3 - Each staff person's activity sheet, plus flyers, brochures, and announcements. All reports are compiled on a monthly basis for purposes of comparison between months in current year as well as past years. An annual report is completecr identifying referrals or units or service per provider or staff person. 14 H. PROGRAM EVALUATION PLAN Peer evaluation of program activities occurs once monthly at all- staff meetings where cases are discussed and problem-solved. Clinical team meetings at clinic sites to enhance communication between outreach and clinic staff occur once monthly. Weekly supervision of outreach staff is provided by Adult/Older Adult Program Chief. ;a 15 3 .3 PROGRAMDESCRIPTION: PROGRAM FOR SERIOUSLY EMOTIONALLY- DISTURBED CHILDREN AND ADOLESCENTS A. STATEMENT OF .PURPOSE The purpose of Contra Costa County's program for seriously emotionally disturbed (SED) children and adolescents is to enable a child/adolescent to remain at home or in the least restrictive alternative placement, and to assist them as students to function better in the academic setting. Because SED children and adolescents and their families typically require more than one service, and services from more than one agency, insuring effective responses to the multiple needs of each child demands effective coordination of the various parts of the; service delivery system. The SAMHSA funded services for SED children and adolescents, along with the other component parts of services for children in Contra Costa County, participate in an interagency system of care. The Youth Services Board (YSB) ,, established by the Board of Supervisors in 1978, is the County's Interagency Policy and Planning Council (IPPC) concerned with seriously emotionally disturbed youth. The YSB is the core of an interagency network that provides both the structure and process for (1) interagency collaboration at the system level, i.e. , joint planning, joint funding, joint administration; and (2) integrated service delivery at the child/family level. YSB membership includes the department: heads of Health Services, Community Services, Probation, and Social Service, the Mental Health Director, the County Superintendent of Schools, .the Juvenile Court Judge and the County Administrator as Chairperson. It meets monthly or as often as needed. The Expanded Youth Services Board--composed of YSB members, agency middle managers, representatives of community-based organizations. and child advocates/parents--meets at least quarterly to provide a forum for discussion of interagency system issues and single/dual public agency plans and projects. B. OBJECTIVES (1) Reduce the average number of SED children and adolescents, placed pursuant to educational difficulties, in out-of-home placements by 1.5 per month in Fiscal Year 1993-94. (Baseline: Median = 42 .5 per month; Mean = 42 .75 per month. ) (2) Demonstrate achievement of or progress toward client mile- stones (i.e. , improved school behavior, better attendance, return to regular classroom or less restrictive setting) 'as documented in chart notes. 16 (3) Develop a client satisfaction survey form and description of a proposed survey process by July 1994, to be given to a sampling of clients in Fiscal Year 1994-95. (4) Design and implement an internship training program in order to maximize service delivery to SED children and adolescents who are receiving services because of educational difficulties (July 1993 - June 1994) . C. PROGRAM DESCRIPTION The target population identified to receive services are those children (pursuant to Section 1912 (c) of the Public Health Services Act, as amended by Public Law 102-321) "with a serious emotional disturbance" as described below: - from birth up to age 18 - who currently or at any time during the past year, - have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within DSM-III-R, - that resulted in functional impairment which substantially interferes with or limits the child's role or functioning in family, school, or community activities. They also meet one the following criteria: Dependents or wards of the court under Section 300 or 602; Special education students receiving services under Chapter 26.5; Children receiving mental health services in a psychiatric hospital or residential treatment program; and - Children receiving day treatment, crisis services or other intensive public-sector services and who are at risk of out-of-home placement. The following services for SED children and adolescents will be funded by SAMHSA. (1) Program for Seriously Emotionally Disturbed Children and Adolescents with Educational Difficulties Services to special education students are provided by a centralized program offering..'a range of services includingg-e assessments, medication manament, individual, family and group therapy, and case management for students in day treatment or, residential treatment programs. 17 Family therapy offers parents and children an opportunity to work together to make changes that are interfering with the child's school functioning. Sessions with a licensed clinician are scheduled on a regular basis. This approach is frequently the treatment of choice, in that parent participation is a key factor in the educational success of the student. Group .therapy may be offered as either the primary service or an adjunct and may be recommended for the: student and/or parents. Child and adolescent groups meet either at school sites or at a central location. This format encourages students to exchange ideas and share feelings under the guidance of an experienced therapist. For adolescents, feedback from peers can be extremely influential and helpful, and for younger children the inter- actional nteractional skills developed may lead to improved school functioning. Parent support and education groups offer a forum for problem solving as well as a more structured presentation of effective parenting approaches. Group sessions are generally held weekly. When family or group therapy do not seem sufficient or appropriate, individual therapy for the child or adolescent may be recommended. The focus, intensity, frequency, and duration of the therapy are determined by the student's ability to make use of and benefit from this treatment approach. Some work is more talking and perhaps more directive; other work is more open- ended and organized around a play format. In addition, parents usually meet with their child's therapist on a regular basis. Consultation may be recommended either as an adjunct to out- patient therapy or as a separate service in order to deal with specific problems, issues, or questions. Consultations may be directed to the family and/or the school. The goal is to develop and implement a series of brief interventions to facilitate the student's school functioning and academic performance. Case management is generally recommended for all qualifying students. It is provided to ensure that all available services are in place and coordinated to meet the needs of the student and to support the family. For students who are receiving direct mental health services through day treatment or residential treatment programs, case management is the primary service provided by County Mental Health staff. It focuses on transi- tioning the student into and out of the day or residential treatment program and monitors the progress of the .student during their tenure in the program. For students receiving outpatient psychotherapy, some case management is typically provided by the assigned therapist. She helps the student and family access other necessary community resources and helps the various agencies to coordinate their efforts on behalf of the family. ' 18 With part of the new SAMSA augmentation, one FTE position will be added to this program in January 1994. This position will be a full-time Family Intervention Specialist who will provide community-based and home-based services with the families of SED children and adolescents: The Family Intervention Specialist will. intervene directly with these families on an ongoing basis to help break the cycle of escalation to crisis. She/he will also provide case management services to link these families with additional support .services in the community. The integrated and individualized service plan (ISP) provides for a process of plan development and implementation that is both child-centered and family-focused and considers the ethnicity and cultural background of the family in the planning and delivery of services. The ISP is individually created and designed to meet the particular needs of the child and his/her family. It seeks to facilitate the development of age-appropriate behavior in the child, to provide a safe environment for this process to occur in, to support and enhance the integrity of the family unit by emphasizing and facilitating family participation, as well as participation by extended family and community support people. Finally, the ISP process identifies and builds upon family and community strengths and resources. It recognizes that SED children and adolescents need to be living with their families or, when that is not possible, in the least restrictive alternative setting. It places top priority on what services the child and family need in order for the child to remain at home or to return home and recognizes that a family-centered approach is most consistent with the values of ethnically diverse groups. (2) Assessment/Monitoring of SED Children and Adolescents in Institutional/Residential Settings .5 FTE Residential, State Hospital and Subacute Case Manager based in the Mental Health Youth Interagency Assessment and Consultation Team (YIACT) . This position will monitor, gate keep, and establish and maintain linkages for the State Hospital, La Cheim Residential, Seneca Residential and Willowcreek 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 Children and Adolescent Services Program Chief, and monitored by this case manager. .5 FTE Psychologist/MFCC, also based in the YIACT program, will provide assessment and testing services for children and adolescents referred by the Social Service Department, in order to determine SED status and appropriate placement; consultation/ screening for the Social Service Department. 19 (3) Residential Treatment Centers for SED Children and Adolescents La Chdim Residential Treatment Center:; provide two six-bed facilities with a 24-hour structured residential treatment program for severely disturbed children. Browning' House and Stanley House serve youngsters aged 12 to 18 years old. Both serve Contra Costa residents only. Intensive individual, group and family therapy services are offered along with a specialized educational program. D. STAFFING SED Children and Adolescents in School_ 1. 0 Program Supervisor (MFCC) .8 Ph.D. 3 . 35 LCSW 6.8 MFCC 1. 0 Family Intervention Specialist .4 MD 1.8 Clerk YIACT .5 LCSW/MFCC .5 Ph.D. /MFCC La Cheim Contract service provider E. DESIGNATED PEER REVIEW REPRESENTATIVE The Children and Adolescent Services Program Chief, or her designee, will participate as a member, of the State Department of Mental Health Review Team to meet the annual peer review require- ment. F. IMPLEMENTATION PLAN Please refer to Section B (Objectives) where specific timelines for implementation are delineated. G. DOCUMENTATION DESCRIPTION • Objective No. 1 - Review placement tracking log. 20 • Objective No. 2 - Review a 10% sample of SED children and adolescent charts which will include a five axis DSM-III-R diagnosis, commu- nity functioning evaluation, service plans, and chart notes documenting achievement or progress toward client milestones. • Objective No. 3 Review Client Satisfaction Form and proposed survey process outline. • Objective No. 4 Review training guidelines, schedule of trainings, number of internships and service units provided. 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 also provides inferential statistical analysis of the quantitative data made available by this system. As part of a monthly MIS Committee meeting, problems and/or barriers and correction plan(s) will be discussed, and the Program Chief will implement correction plans and monitor results. (2) The Utilization Review/Quality Improvement Committee process provides ongoing analysis of the qualitative aspects of the program. The Children and Adolescent Services Program Chief will monitor, correct and resolve identified problems within the program area. ..a 21 ENCLOSURE III ASSURANCE OF COMPLIANCE WITH PUBLIC LAW 102-321 REQUIREMENTS ON USE OF ALLOTMENTS Section 1911(b) PURPOSE OF GRANTS t (b) Purpose of Grants - A funding agreement for a grant under subsection (a) is that, subject to Section 1916, the State involved will expend the grant only for the purpose of-- (b) (1) carrying out the plan submitted under section 1912(a) by the State for the fiscal year involved; (b) (2) evaluating programs and services carried out under the plan; and, (b) (3) planning, administration, and educational activities related to providing services under the plan. Section 1912 STATE PLAN FOR COMPREHENSIVE COMMUNITY MENTAL HEALTH SERVICES FOR CERTAIN INDIVIDUALS (a) In General - The Secretary may make a grant under section 1911 only if-- (a)-(1) the state involved submits to the Secretary a plan for providing comprehensive community mental health services to adults ,with a serious mental illness and to children with a serious emotional disturbance; (a) (2) the plan meets the criteria specified in subsection (b) ; and, (a) (3) the plan is approved by the Secretary. Section 1913(c) CRITERIA FOR MENTAL HEALTH CENTERS (c) Criteria for Mental Health Centers - The criteria referred to in subsection (b) (2) regarding community mental health centers are as follows-- (c) (1) With respect to mental health services, the centers provide services as follows; (c) (1) (A) Services principally to individuals residing in a defined geographic area (hereafter in this subsection referred to: as a"service area") ; (c) (1) (B) Outpatient services, including specialized outpatient services for children, the elderly, individuals with a serious mental illness, and residents of the service areas of the centers who have been discharged from inpatient treatment at a mental, health facility; i (c) (1) (C) 24-hour-a-day emergency care services. (c) (1) (D) Day treatment or other partial hospitalization', services, or psychosocial rehabilitation services. ENCLOSURE III Page 2 (c) (1) (E) screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission; (c) (2) The mental health services of the centers are provided, within the limits of the capacities of the centers, to any individual residing or employed within the service area of the center regardless of ability to pay for such services; (c) (3) The mental health services of the centers are available and accessible promptly, as appropriate and in a manner which preserves human dignity and assures continuity and high quality care; Section 1916 RESTRICTIONS ON USE OF PAYMENTS (a) In General - A funding agreement for a grant under Section 1911 is that the State involved will not expend the grant-- (a) (1) to provide inpatient services; (a) (2) to make cash payments to intended recipients of health services; (a) (3) to purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling) any building or other facility, or purchase major medical equipment; (a) (4) to satisfy any requirement for the expenditure of non-federal funds as a condition for the receipt of federal funds; or (a) (5) to provide financial assistance to any entity other than a public or nonprofit private entity. (b) Limitation on Administrative Expenses - A funding agreement for a grant under section 1911 is that the State involved will not expend more than five percent of the grant for administrative expenses with respect to the grant. Counties have a ten percent administrative cap (see MH 1779) . Section 1946 PROHIBITIONS REGARDING RECEIPT OF FUNDS (a) Establishment. (a) (1) Certain false statements and representation. - A person shall not knowingly and willfully make or cause to be made any false statement or representation of a material fact in connection .with the furnishing of items or services for which payments may be made by a State from a grant made to the State under Section 1911 or 1921. ENCLOSURE III Page 3 (a) (2) Concealing or failing to disclose certain events - A person with knowledge of the occurrence of any event affecting the initial or - continued right of the person to receive any payments from a grant made to a State under Section 1911 or 1921 shall not conceal or fail to disclose any such event with an intent fraudulently to secure such payment either in a greater amount than is due or when no such amount is due. (b) Criminal Penalty for Violation of Prohibition - Any person who violates any prohibition established in subsection (a) shall for each violation be fined in accordance with Title 18, United States Code, or imprisoned for not more than five years, or both. Section 1947 NONDISCRIMINATION (a) In General . (a) (1) Rule of construction regarding certain civil rights laws - 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 of race, color, or 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 Section 1911 or 1921 shall be considered to be programs and activities receiving Federal financial assistance. (a) (2) Prohibition - No person shall on the ground of sex (including, in the case of a woman, on the ground that the woman is pregnant) , or on the ground of religion, be excluded from participation in, be denied the- benefits of, or be subjected to discrimination under, any program or activity funded in whole or in part with funds made available under Section 1911 or 1921. (b) Enforcement. (b) (1) Referrals to attorney general after notice - Whenever the Secretary funds that a State, or an entity that has received a payment pursuant to Section 1911 or 1921, has failed to comply with a provision of law referred to in subsection (a) (1) , with subsection (a) (2) , or with an ap licable regulation (including one prescribed to carry out subsection (a�(2) , the Secretary shall notify the chief executive officer of the State and shall request the chief executive officer to secure compliance. If withina reasonable period of time, not to exceed 60. days, the chief executive officer fails or refuses to secure compliance, the Secretary may-- (b) (1) (A) refer the matter to the Attorney General with a recommendation that an appropriate civil actian be instituted; (b) (1) (8) exercise the powers and functions provided by the Age Discrimination Act of 1975, Section 504 of the Rehabilitation Act of 1973, Title IX of the Education Amendment of 1972, or Title VI of the Civil Rights Act of 1964, as may be applicable; or ENCLOSURE III Page 4 (b) (1) (C) take such other actions as may be authorized by law. (b) (2) Authority, of Attorney General - When a matter is referred to the Attorney General pursuant to paragraph (a) (1) (A) , or whenever the Attorney General 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. � IP7, ignature of Official Authorized Date to Sign Application i ENCLOSURE IV 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 or will be paid to any person for 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 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 subawards at all tiers ( including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a 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 willbeused to pay an individual salary at a rate in excess of $125,000 per year, not including benefits . 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 Mental Health Block Grant funds. ..i Signature of Official Authorized Date to Sign Application MH783041 State of California Department of Mental Health SAMHSA GRANT ENCLOSURE V FEDERAL GRANT DETAILED BUDGET SUMMARY MH 1783 REV(4/93) Fiscal Year 1993 — 94 Submission Date: 10-22-93 County CONTRA COSTA County Number: 07 ct C2 TOTAL FEDERAL GRANT ITEMS MENTAL HEALTH BUDGET BUDGET REQUEST 1 Salaries and Employee Benefits 15,463,009 1,113,369 2 O eratin Ex enses 8,429,690 630,139 3 Equipment 4 Remodeling 5 County Overhead 361,006 4,615 6 Ne otiated Net Amt./Negotiated Rate 10,209,462 40,000 7 Actual Cost/Fee for service contract 6,987,292 78,493 8 Gross Program (SUM LINES 1 THRU LINE 7) 41,450,459 1,866,616 9 LESS: Savings 101 Adjusted Gross Program(LINE 8 — LINE 9) 41,450,459 1,866,616 12 LESS REVENUE: 14 PATH Grant 93,399 15 SAMHSA Grant 1.596,029 `>'<> 16 Other Grants 17 Patient Fees 384,714 18 Medi—Cal/Fed 5,886,339 19 Medi—Cal/Non—Fed 0 Medicare 1,938,611 1 Conservator Admin. Fee 2 Other 15,331,210 270,587 3 4 TOTAL REVENUES (SUM LINES 13 THRU 23) 25,230,302 270,587 261 SAMHSA GRANT PROG. COST Line 10— Line24KERMEMM 1,596,029 8 GROSS P GM LESS REVENUE LINE 10 — LINE 24 16.220 157 COMPLETION INSTRUCTION I. GENERAL — This form identifies the most recent Federal Grant allocated to the county by the State DMH for use for the budget year as summarized by the gross and net amounts and may be supported by the Federal Grant Detailed Provider Budget(s). It reconciles the Federal Grant to other funding sources. 11. HEADING INSTRUCTIONS — Enter the State Fiscal Year, the two—digit State CR/DC assigned county number and the date the form is submitted. III. ITEM AND COLUMN INSTRUCTIONS — Column 1 must be equal to the entire local mental health program budget including all fudning sources. Column 2 must be equal to the sum of the MH 1779's (Federal Grant Detailed Provider Budget). Column 2, Line 26, should equal the amount of the county's grant allocation. ENCLOSURE VI Federal Grant Detailed Provider Budget(s) : Form MH 1779 TABLE OF CONTENTS Prov. # Provider Name 0 701 West County Adult Mental Health Services (Community Support Team) 0 702 East County Adult Mental Health Services (Community Support Team) 0 721 Central County Adult Mental Health Services (Community Support Team) 0 778 West County Adult Partial Hospital Program (Intensive Day Treatment) 07AE West. County Geriatrics Outreach Program 0 771 Central/East County Geriatrics Outreach Program 0 786 AB3632 Special Educ. Pupil SED Childrens Comm. Support Team 0 711 YIACT — SED Child Assessment/Institutional Placement Case Management Services 0 783 La Cheim Residential Treatment Centers, Inc. - Contract (Childrens Resid. Care) 0 7AK Housing for Independent People, Inc. — Contract (Concord Adult Resid. Care) 0 7AL Housing for Independent People, Inc. — Contract (Pittsburg Adult Resid. Care) 0 799 Mental Health Administration — State Hospital/IMD Case Management 0 784 MH Consumer Concerns, Inc. — Contract (Consumer/Comm. Support Worker Project) 0 799 MH Admin. — Consultant/Contractor (Housing Development Project) 0 799 MH Admin. — Consultants/Contractors (Staff Trainer/SAMHSA Proj. Outcome Evaluation) M77993J1 State of California Health and Welfare Agency Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 10-22-93 MH 1779 REV(9193) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA COUNTY CONTACT: Tars Ching TELEPHONE NUMBER: (510) 370 — 5058 PROVIDER NAME: WEST CO.ADULT MH SVCS PROGRAM TITLE: Community Support Team PROVIDER ADDRESS: 38th and Bissell,Richmond PROVIDER NUMBER: 0701 MODE/COST CENTERS: 15/01-79 all inclusive 1 2. , 3 STAFF Last Request New Title of Position Approved or Approved List by name of position and FTE) Budget Chane Budget 1 M. D.s 0.18 FTE 23,016 21 R. N.s FTE j 3 Program Supv. 0.09 FTE 6,582 j 4 MH Clin Spec 0.21 FTE 13,213 S,Cfin Psychologist FTE 1 6 MH Worker/Case Mgr. 0.16 FTE 8,125 7 MH Activity Spec FTE 8 Clerks 0.39 FTE _ 19,112 j 91 101 12 TOTAL STAFF EXPENSES (sum lines 1 thru 10) 70,048 14 Consultant Costs (itemize): 15 Outside Medical Services 263 j 16 Contracted Services 383 171 18 1 Equipment (Where feasible lease or rent) (itemize): 19 Maintenance of Equipment 15 20 Rent of Equipment 12 21 221 23 Supplies (Itemize): 24 I Office Expense 1 114 251 Communications 302 261 Rentals/leases—Building 1,803 27 Household&Medical Supplies 124 28 1 Travel — Per Diem,Mileage,&Vehicle Rental/Lease 99 29 —Client Transportation&Vehicle Rental/Lease 30 31 �Al r Expenses (Itemize): 32 cated Indirect Operations Overhead Costs 4.884 33 34 35 36 38 i 39 COUNTY.ADMINISTRATIVE COSTS (Instructions on back) 7,801 41 NET PROGRAM EXPENSES sum lines 12 thru 39 85,848 43 REVENUES : Regular 7,451 45 Short—Doyle&other Govt funding sources 17,385 47 TOTAL REVENUES 24,835 49 GROSS COST OF PROGRAM sum lines 41 and 4 110,683 DMH APPROVAL BY: TELEPHONE: DATE: M77993N1 State of California Health and Welfare Agency Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 10-22-93 MH 1779 REV(9/93) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA COUNTY CONTACT: Tars Ching TELEPHONE NUMBER: (510) 370 —5058 PROVIDER NAME: EAST CO.ADULT MH SVCS PROGRAM TITLE: Community Support Team PROVIDER ADDRESS: 550 School St,Pittsburg PROVIDER NUMBER: 0702 MODE/COST CENTERS: 15/01—79 all inclusive 1 2 3 STAFF Last Request New Title of Position Approved or Approved List by name of position and FTE) Budget Change Budget 1 IM. D.s 0.35 FTE 44,749 21R. N.s FTE 31 Program Supv. 0.11 FTE 8,337 4 MH Clin Spec 0.15 FTE 9,590 5 Clin Psychologist FTE 6 MH Worker/Case Mgr. 0.19 FTE 10,145 7 MH Activity Spec FTE 8 Clerks 0.83 FTE 33,456 9� 10j 12,TOTAL STAFF EXPENSES (sum lines 1 thru 10) 106,277 14 Consultant Costs (Itemize): 15 Outside Medical Services 802 16 Contracted Services 1,985 171 18 Equipment (Where feasible lease or rent) Itemize): 19 Maintenance of Equipment 353 20 Rent of Equipment 761 21 22 23 1 Supplies (Itemize): 24 Office Expense 2,052 251 Communications 2,516 1261 Rentals/leases—Building 4,439 27 Household&Medical Supplies 2,557 28 Travel — Per Diem,Mileage,&Vehicle Rental/Lease 2,091 29 — Client Transportation&Vehicle Rental/Lease 30 31 Other Expenses (itemize): 32 Allocated Indirect Operations Overhead Costs 9,626 33 34 35 36 38 39 COUNTY ADMINISTRATIVE COSTS (Instructions on back) 13,343, 41 NET PROGRAM EXPENSES sum lines 12 thru 39 146,802 43 REVENUES : Regular 10,634 45 Short—Doyle&other Govt funding sources 24,812 47 TOTAL REVENUES 35,446 49 GROSS COST OF PROGRAM sum lines 41 and 4 182,248 DMH APPROVAL BY: TELEPHONE: DATE: M7799301 -State of California Health and Welfare Agency Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 10-22-93 MH 1779 REV(9/93) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA COUNTY CONTACT: Tars Ching TELEPHONE NUMBER: (510) 370 —5058 PROVIDER NAME: CENTRAL CO.ADULT MH SVCS PROGRAM TITLE: Community Support Team PROVIDER ADDRESS: 2025 Port Chicago Highway,Concord PROVIDER NUMBER: 0721 MODE/COST CENTERS: 15/01-79 all inclusive 1 2 3 STAFF Last Request New Title of Position Approved or Approved List by name of position and FT Budget Change Bud et 1 M. D.s 0.46 FTE 58,408 2 R. N.s FTE 3 Program Supv. 0.13 FTE 9,639 4 MH Clin Spec 0.17 FTE 10,933 5 Clin Psychologist FTE 6 MH Worker/Case Mgr. 0.33 FTE 17,173 7 MH Activity Spec FTE 8 FClerks 0.43 FTE 17,343 9 10 12;TOTAL STAFF EXPENSES (sum lines 1 thru 10) 113,496 14 Consultant Costs (Itemize): 15 Outside Medical Services 948 16 Contracted Services 1,400 17 18 1 Equipment (Where feasible lease or rent) (itemize): i9l Maintenance of Equipment 49 20 Rent of Equipment 632 21 221 23 1 Supplies (Itemize): 24 Office Expense 777 25 Communications 1,001 I 26 Rentals/leases—Building 9,903 27 Household&Medical Supplies 1,184 28 Travel — Per Diem,Mileage,&Vehicle Rental/Lease 684 29 — Client Transportation&Vehicle Rental/Lease 30 31 Other Expenses (Itemize): 32 Allocated Indirect Operations Overhead Costs 7,950 33 34 35 36 38 39 COUNTY ADMINISTRATIVE COSTS (Instructions on back) 13,806 41 NET PROGRAM EXPENSES sum lines 12 thru 39 151,830 43 REVENUES : Regular 11,445 45 Short—Doyle&other Govt funding sources 26,705 47 TOTAL REVENUES 38,150 49GROSS COST OF PROGRAM sum lines 41 and 4 189,980 DMH APPROVAL BY: TELEPHONE: DATE: M77993 K1 State of California Health and Welfare Agency " Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 10-22-93 MH 1779 REV(9/93) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA COUNTY CONTACT: Tars Ching TELEPHONE NUMBER: (510) 370 — 5058 PROVIDER NAME: WEST CO.PARTIAL HOSPITALIZATION PROGRAM TITLE: Adult Intensive Day Trtmt PROVIDER ADDRESS: 256 — 24th St, Richmond PROVIDER NUMBER: 0778 MODE/COST CENTERS: 10/81—85 1 2 3 STAFF Last Request New Title of Position Approved or Approved List by name of position and FTE) Budget Chane Budget 1 M. D.s 0.09 FTE 11,591 2 R. N.s 0.10 FTE 7,180 3 Program Supv. 0.09 FTE 6,572 4 MH Clin Spec 0.53 FTE 33,344 5 Clin Psychologist FTE 6 MH Worker/Case Mgr. 0.34 FTE 17,766 7 MH Activity Spec 0.20 FTE 9,737 j 8 Clerks 0.29 FTE 11,481 9 � t 10 12 TOTAL STAFF EXPENSES (sum lines 1 thru 10) 97.671. j 14 Consultant Costs (Itemize): 15 Outside Medical Services 16 Contracted Services 375 17 18 Equipment (Where feasible lease or rent) (itemize): 19 Maintenance of Equipment 364 20 Rent of Equipment 143 21 22 23 1 Supplies (Itemize): I 241 Office Expense I 1,315 25 Communications 584 26 Rentals/leases—Building 10,927 27 Household&Medical Supplies 2,495 28 Travel — Per Diem,Mileage.&Vehicle Rental/Lease 942 29 —Client Transportation&Vehicle Rental/Lease 30 311 Other Expenses (Itemize): 321 Allocated Indirect Operations Overhead Costs 11,315 33 34 35 36 38 39 COUNTY ADMINISTRATIVE COSTS (Instructions on back) 12.61.5 41 1 NET PROGRAM EXPENSES sum lines 12 thru 39 138,746 43 REVENUES : Regular 8,444 45 Short—Doyle&other Govt funding sources 19,702 47 TOTAL REVENUES 28,146 49 GROSS COST OF PROGRAM sum lines 41 and 4 166,892 DMH APPROVAL BY: TELEPHONE: DATE: M77093L1 State of California Health and Welfare Agency Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 10-22-93 MH 1779 REV(9/93) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA. COUNTY CONTACT: Tars Ching TELEPHONE NUMBER: (510) 370 — 5058 PROVIDER NAME:. WEST CO.GERIATRICS OUTREACH PROGRAM TITLE: Geriatrics Outreach PROVIDER ADDRESS: 11720 San Pablo Ave., #C, EI Cerrito PROVIDER NUMBER: 07AE MOD E/COSTCENTERS: 45/20 1 2 3 STAFF Last Request New Title of Position Approved or Approved List by name of position and Budget Change Budget 1 M. D.s FTE 21R. N.s 0.91 FTE 62,881 3 Program Supv. 0.09 FTE 6,500 4 MH Olin Spec FTE 5 Clin Psychologist FTE 6 MH Worker/Case Mgr. 0.95 FTE 54,004 7 MH Activity Spec FTE 8 Clerks FTE 91 101 12 TOTAL STAFF EXPENSES (sum lines 1 thru 10) 123,385 14 Consultant Costs (Itemize): 15 Outside Medical Services 16 Contracted Services 9,719 17 18 1 Equipment (Where feasible lease or rent) Itemize): 19 Maintenance of Equipment 20 Rent of Equipment 21 22 23 1 Supplies (Itemize): 241 Office Expense 295 251 Communications 543 26 Rentals4eases—Building 271 Household&Medical Supplies 28 Travel — Per Diem,Mileage,&Vehicle Rental/Lease 2,200 29 — Client Transportation&Vehicle Rental/Lease 30 31 Other Expenses (Itemize): 32 Allocated Indirect Operations Overhead Costs 33 34 35 36 38 39 COUNTY ADMINISTRATIVE COSTS (instructions on back) 13,614 41 NET PROGRAM EXPENSES sum lines 12 thru 39 149,756 43 REVENUES : Regular 45 Short—Doyle&other Govt funding sources 10,000 47 ITOTAL REVENUES 10,000 49 GROSS COST OF PROGRAM sum lines 41 and 4 159,756 DMH APPROVAL BY: TELEPHONE: DATE: M77993M1 State of California Health and Welfare Agency` Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 10-22-93 MH 1779 REV(9/93) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA COUNTY CONTACT: . Tars Ching TELEPHONE NUMBER: (510) 370 —5058 PROVIDER NAME: CENTRAL/EAST GERIATRICS PROGRAM TITLE: Geriatrics Outreach PROVIDER ADDRESS: 595 Center Ave.. #200, Martinez PROVIDER NUMBER: 0771 MODIE/COSTCENTERS: 45/20 t 2 3 STAFF Last Request New Title of Position Approved or Approved (List by name of position and FTE) Budget Chane Budget 1IM. D.s FTE 21R. N.s FTE 3 Program Supv. 0.11 FTE 8,000 4 MH C1in Spec 1.98 FTE 124,416 5 Clin Psychologist FTE 6 MH Worker/Case Mgr. FTE 7 MH Activity Spec FTE 8 Clerks 0.25 FTE 10,000 9� 101 12(TOTAL STAFF EXPENSES (sum lines 1 thru 10) 1 142,416 14 Consultant Costs (Itemize): 15 FOutside Medical Services 16 1 Contracted Services 3,859 171 18 Equipment (Where feasible lease or rent) (itemize): 19 Maintenance of Equipment 20 Rent of Equipment 21 22) 23`Supplies (Itemize): 24 1 Office Expense 428 251 Communications 2,559 261 Rentals4eases—Building 27 Household&Medical Supplies 24 28 Travel — Per Diem,Mileage, &Vehicle Rental/lease 3,458 29 — Client Transportation&Vehicle Rental/Lease 30 '31 Other Expenses (Itemize): 32 Allocated Indirect Operations Overhead Costs 33 34 35 _ 36 38 39 COUNTY ADMINISTRATIVE COSTS (Instructions on back) 15,274 41 NET PROGRAM EXPENSES sum lines 12 thru 39 168,018 43 REVENUES : Regular 45 Short—Doyle&other Govt funding sources 15,000 47 TOTAL REVENUES 15,000 49 GROSS COST OF PROGRAM sum lines 41 and 4 183,018 DMH APPROVAL BY: TELEPHONE: DATE: M77993A1' State'of(>alifornia Health and Welfare Agency Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 10-22-93 MH 1779 REV(9/93) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA COUNTY CONTACT: Tars Ching TELEPHONE NUMBER: (510) 370 — 5058 PROVIDER NAME: A63632 SEP Child Svcs PROGRAM TITLE: SEP/SED Child Prog. PROVIDER ADDRESS: 2425 Bisso Lane, #280,Concord PROVIDER NUMBER: 0786 MODE/COST CENTERS: 15/01—79 all inclusive 1 2 3 STAFF Last Request New Title of Position Approved or Approved List by name of position and FTE) Budget Change Budget 1 M. D.s 0.20 FTE 25,663 21 R. N.s FTE 3 1Program Supv. 0.30 FTE 22.205 4 1 MH Clin Spec 3.40 FTE 204,000 5 1 Clin Psychologist 0.30 FTE 20,736 6(MH Worker/Case Mgr. FTE 7 MH Activity Spec FTE 8 1 Clerks 0.60 FTE _ 23,472 9 1 MH Clin Spec 0.50 FTE(*) 30,000 10 (*) = 1.0 FTE for 6 months (new SAMHSA position) 12 TOTAL STAFF EXPENSES (sum lines 1 thru 10) 326.076 14 Consultant Costs (Itemize): 15 Outside Medical Services 16 Contracted Services (per attached) 17 18 Equipment (Where feasible lease or rent) (itemize): 19 Maintenance of Equipment 20 Rent of Equipment 21 22 231Supplies (Itemize): 241 Office Expense (incl.desk &chair for new SAMHSA position) 5,000 251 Communications 3,000 261 Rentals/leases—Building 24,155 271 Household&Medical Supplies 28 Travel — Per Diem,Mileage,&Vehicle Rental/Lease 5,000 29 —Client Transportation&Vehicle Rental/Lease 30 31 Other Expenses (Itemize): 32 33 Ancillary cost overhead 15,000 34 35 36 38 `a 39 COUNTY ADMINISTRATIVE COSTS (instructions on back) 42,026 41 NET PROGRAM EXPENSES sum lines 12 thru 39 420,257 43 REVENUES : Regular 5,000 45 Short—Doyle&other Govt funding sources 5,000 47 TOTAL REVENUES 10,000 49 GROSS COST OF PROGRAM sum lines 41 and 4 430,257 DMH APPROVAL BY: TELEPHONE: DATE: M7799381 State of California Health and Welfare Agency Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 10-22-93 MH 1779 REV(9/93) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA COUNTY CONTACT: Tars Ching TELEPHONE NUMBER: (510) 370 —5058 PROVIDER NAME: YIACT PROGRAM TITLE: Assessments/Inst CM Svcs PROVIDER ADDRESS: 2425 Sisso Lane#235.Concord PROVIDER NUMBER: 0711 MOD E/COST CENTERS: 45/20 and 15/01-32 1 2 3 STAFF Last Request New Title of Position Approved or Approved (List by name of position and FTE) Budget Change Budget 1 M. D.s FTE 2 R. N.s FTE 3 Program Supv. FTE 4 MH Clin Spec 0.50 FTE 30,000 5 Clin Psychologist 0.50 FTE 31,000 6 1 MH Worker/Case Mgr. FTE 7 MH Activity Spec FTE j 8 1 Clerks FTE _ I 91 10 12 TOTAL STAFF EXPENSES (sum lines 1 thru 10) 61,000 14 Consultant Costs (itemize): 15 Outside Medical Services 16 Contracted Services (per attached) 17 I 18 Equipment (Where feasible lease or rent) Itemize): 19 Maintenance of Equipment 20 Rent of Equipment 21 22 23 Supplies (Itemize): 24 Office Expense 25 Communications 26 Rentals leases—Building 27 Household&Medical Supplies 28 Travel — Per Diem,Mileage,&Vehicle Rental/Lease 2,000 29 — Client Transportation&Vehicle Rental/Lease 30 311 Other Expenses (Itemize): 321 Allocated Indirect Operations Overhead Costs 33 34 35 36 38 39 COUNTY ADMINISTRATIVE COSTS (Instructions on back) 7,006 41 NET PROGRAM EXPENSES sum lines 12 thru 39 70,000 43 REVENUES : Regular 45 Short—Doyle&other Govt funding sources 47 TOTAL REVENUES 49 GROSS COST OF PROGRAM sum lines 41 and 4 70,000 DMH APPROVAL BY: TELEPHONE: DATE: M71993C1 ' State of California Health and Welfare Agency Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 10-22-93 MH 1779 REV(9/93) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA COUNTY CONTACT: Tars Ching ' TELEPHONE NUMBER: (510) 370 — 5058 PROVIDER NAME: La Cheim Resid,Trtmt Ctrs,Inc. PROGRAM TITLE: SED Child Resid,Trtmt PROVIDER ADDRESS: 5860 McBryde,Richmond/1025 Balmore Ct, El Sobrante PROVIDER NUMBER: 0783 MOD E/COST CENTERS: 05/60 1 2 3 STAFF Last Request New Title of Position Approved or Approved List by name of position and FTE) Budget Change Budget 1 IM. D.s FTE 21 R. N.s FTE j 3 1 Program Supv. FTE 4 1 MH Clin Spec FTE 5 1 MH Clin Psychlgst FTE 6 MH Worker/Case Mgr. FTE 7 MH Activity Spec FTE 8 Clerks FTE ._ 91 10i 12 TOTAL STAFF EXPENSES sum lines 1 thru 10) 14 Consultant Costs (Itemize): 15 Outside Medical Services 16 Contracted Services (per attached) 17 18 1 Equipment (Where feasible lease or rent) (itemize): 19 Maintenance of Equipment 20 Rent of Equipment 21 22 23 Supplies (Itemize): j 24 I Office Expense I 25 Communications 261 Rentals/leases—Building 27 Household&Medical Supplies 28 Travel — Per Diem,Mileage,&Vehicle Renta!/Lease 1 29 — Client Transportation&Vehicle Rental/Lease 30 31 1 Other Expenses (itemize): 321 La Cheim Residential Treatment Centers,Inc.Contract 24-351 40,000 33 to provide residential treatment for SED children and youth in 34 2 group homes (net negotiated rates) 35 36 38 a 39 COUNTY ADMINISTRATIVE COSTS (Instructions on back) 41 NET PROGRAM EXPENSES sum lines 12#!T_2j9_ 40,000 43 REVENUES: Regular 45 Short—Doyle&other Govt funding sources 47 TOTAL REVENUES 49 1 GROSS COST OF PROGRAM sum lines 41 and 4 40,000 DMH APPROVAL BY: TELEPHONE: DATE: M77993D 1 State of California Health and Welfare Agency Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 10-22-93 MH 1779 REV(9/93) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA COUNTY CONTACT: Tars Ching TELEPHONE NUMBER: (510) 370 —5058 PROVIDER NAME: HIP, Inc. PROGRAM TITLE: Adult Transitional Housing PROVIDER ADDRESS: 859 Clayton Way,Concord PROVIDER NUMBER: 07AK MODE'1COST CENTERS: 05/80 1 2 3 STAFF Last Request New Tide of Position Approved or Approved List by name of position and Budget Chane Budget 1 IM. D.s FTE 2 R. N.s FTE 3 Program Supv. FTE 4 MH Clin Spec FTE 5 MH Clin Psychlgst FTE 6 MH Worker/Case Mgr. FTE { 7 MH Activity Spec FTE 8 i Clerks FTE 91 10 12 TOTAL STAFF EXPENSES (sum lines 1 thru 10) 14 I Consultant Costs (Itemize): 15.1 Outside Medical Services 16 Contracted Services (per attached) 17 18 Equipment (Where feasible lease or rent) (itemize): I 19 Maintenance of Equipment 20 Rent of Equipment 21 221 23 1 Supplies (Itemize): 24 1 Office Expense j 251 Communications 26 1 Rentals leases—Building 271 Household&Medical Supplies 28 Travel — Per Diem,Mileage,&Vehicle Rental/Lease 29 — Client Transportation&Vehicle Rental/Lease 30 31 Other Expenses (Itemize): 32 Housing for Independent People, Inc.Contract#24-522 25,000 33 34 35 36 38 39 COUNTY ADMINISTRATIVE COSTS (Instructions on back) 41 NET PROGRAM EXPENSES sum lines 12 thru 39 25,000 43 REVENUES : Regular 38,765 45 Short-Doyle&other Govt funding sources 13,170 47 TOTAL REVENUES 51,935 49 GROSS COST OF PROGRAM sum lines 41 and 4 76,935 DMH APPROVAL BY TELEPHONE: DATE: M77993E1 Stade of California Health and Welfare Agency Depar"ent of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 10-22-93 MH 1779 REV(9/93) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA COUNTY CONTACT: Tars Ching TELEPHONE NUMBER: (510) 370 —5058 PROVIDER NAME: HIP, Inc. PROGRAM TITLE: Adult Transitional Housing PROVIDER ADDRESS: 405 East Santa Fe, Pittsburg PROVIDER NUMBER: 07AL MODE/COST CENTERS: 05/80 1 2 3 STAFF Last Request New Title of Position Approved or Approved List by name of position and FTE) Budget Change Budget 11 M. D.s FTE 21 R. Ks FTE 3 1 Program Supv. FTE 4 MH Clin Spec FTE 5 MH Clin Psychlgst FTE 6(MH Worker/Case Mgr. FTE 71 MH Activity Spec FTE 81Clerks FTE _ 91 I 101 12 TOTAL STAFF EXPENSES (sum lines 1 thru 10) 14 1 Consultant Costs (Itemize): 15 1 Outside Medical Services 1 i 16 Contracted Services (per attached) 1 171 18 1 Equipment (Where feasible lease or rent) (itemize): 191 Maintenance of Equipment 201 Rent of Equipment 211 22 23 1 Supplies (Itemize): 24 1 Office Expense 251 Communications 26 Rentals leases—Building I 27 1 Household&Medical Supplies 28 Travel — Per Diem,Mileage,&Vehicle Rental/Lease 29 — Client Transportation&Vehicle Rental/Lease 30 31 1 Other Expenses (Itemize): 321 Housing for Independent People,Inc.Contract#24-522 25,000 33 34 35 36 38 i 39 COUNTY ADMINISTRATIVE COSTS (instructions on back) 41 NET PROGRAM EXPENSES sum lines 12 thru 39 25,000 43 REVENUES : Regular 49,010 45 Short—Doyle&other Govt funding sources 8,065 47 TOTAL REVENUES 57,075 49 GROSS COST OF PROGRAM sum lines 41 and 4 82,075 DMH APPROVAL BY: TELEPHONE DATE: M77993FI State of California Health and Welfare Agency Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 10-22-93 MH 1779 REV(9/93) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA COUNTY CONTACT: Tars Ching , TELEPHONE NUMBER: (510) 370 —5058 PROVIDER NAME: MH Administration PROGRAM TITLE Adult Napa/IMD CM PROVIDER ADDRESS: 595 Center Ave., Ste.200,Martinez PROVIDER NUMBER: 0799 MOD EICOST CENTERS: 15/01-03 1 2 3 STAFF Last Request New Title of Position Approved or Approved List by name of position and FT Budget Chane Bud et 1 IM. D.s FTE 21R. N.s 0.50 FTE 43,000 3 Program Supv. FTE 4 MH Clin Spec 0.50 FTE 30,000 5 MH Clin Psychlgst FTE 6 MH Worker/Case Mgr. FTE 7 MH Activity Spec FTE 8 I Clerks FTE 91 101 I 12 TOTAL STAFF EXPENSES (sum lines 1 thru 10) 73,000 1 14 I Consultant Costs (Itemize): 15 1 Outside Medical Services 16 Contracted Services (per attached) 171 18 1 Equipment (Where feasible lease or rent) (iternize):- 191 Maintenance of Equipment 20 Rent Ref Equipment 21 221 23 Supplies (Itemize): 24 1 Office Expense 251 Communications 1 261 Rentals leases—Building 271 Household&Medical Supplies 28 1 Travel — Per Diem,Mileage,&Vehicle Rental/Lease 2,600 29 — Client Transportation&Vehicle Rental/Lease 30 31 Other Expenses (Itemize): 32 Allocated Indirect Operations Overhead Costs 33 34 35 36 38 0 39 COUNTY ADMINISTRATIVE COSTS (Instructions on back) 8,400 41 NET PROGRAM EXPENSES sum lines 12 thru 39 0 84,000 0 43 REVENUES : Regular 45 Short—Doyle&other Govt funding sources 47 TOTAL REVENUES 0 0 0 49 1 GROSS COST OF PROGRAM sum lines 41 and 4 0 84,0001 0 DMH APPROVAL BY: TELEPHONE: DATE: M77993G1 State'of(;alifornia Health and Welfare Agency Department of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SU13MOSION DATE: 10-22-93 MH 1779 REV(9/93) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA COUNTY CONTACT: Tars Ching TELEPHONE NUMBER: (510) 370 — 5058 PROVIDER NAME: MH Consumer Concerns,Inc. PROGRAM TITLE: Community Support Worker Proj. PROVIDER ADDRESS: 714 Alhambra Ave., Martinez PROVIDER NUMBER: 0784 MODE/COST CENTERS: 15/01-02-03-10-31-32-33 1 2 3 STAFF Last Request New Title of Position Approved or Approved List by name of position and FTE) Budget Change Budget 1 M. D.s FTE 21R. N.s FTE 3 1 Program Supv. FTE 4 MH Clin Spec FTE 5 MH Clin Psychlgst FTE 6 MH Worker/Case Mgr. FTE 7 MH Activity Spec FTE 8 Clerks FTE - 91 10 12 1 TOTAL STAFF EXPENSES (sum lines 1 thru 10) 14 Consultant Costs (Itemize): 151 Outside Medical Services 161 Contracted Services (per attached) 17 18 Equipment (Where feasible lease or rent) (itemize): 19 Maintenance of Equipment 20 Rent of Equipment 21 22 23 Supplies (Itemize): 24 Office Expense 25 Communications 26 Rentals/leases—Building 27 Household&Medical Supplies 28 Travel — Per Diem,Mileage,&Vehicle Rental/Lease 29 — Client Transportation&Vehicle Rental/Lease 30 311 Other Expenses (Itemize): 32 Pending Contract to train community support teams and consumer/ 33 community support workers(incl.on—the—job training). 30,000 34 35 36 38 39 COUNTY ADMINISTRATIVE COSTS (instructions on back) 41 NET PROGRAM EXPENSES sum lines 12 thru 39 30,000 43 REVENUES : Regular 45 Short—Doyle&other Govt funding sources 47 TOTAL REVENUES 49 GROSS COST OF PROGRAM sum lines 41 and 4 30,000 DMH APPROVAL BY: TELEPHONE: DATE: M779g3H1 State of California Health and Welfare Agency Departnient of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 10-22-93 MH 1779 REV(9/93) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA COUNTY CONTACT: Tars Ching TELEPHONE NUMBER: (510) 370 - 5058 PROVIDER NAME: MH Administration PROGRAM TITLE: Housing Development Project PROVIDER ADDRESS: 595 Center Ave., Ste.200,Martinez PROVIDER NUMBER: 0799 MODE/COST CENTERS: 00/20(Admin) 1 2 3 STAFF Last Request New Title of Position Approved' or Approved List by name of position and,FTE) Budget Change Budget 1 M. D.s FTE 2 R. N.s FTE 3 Program Supv. FTE 4 MH Clin Spec FTE 5 MH C1in Psychlgst FTE 6 1 MH Worker/Case Mgr. FTE 7 MH Activity Spec FTE 81 Clerks FTE _ 9 101 12 TOTAL STAFF EXPENSES (sum lines 1 thru 10) 14 Consultant Costs (itemize): 15 1 Outside Medical Services 16 Contracted Services (per attached) i 171 Housing Developer Contract#24-686 24,000 18 Equipment (Where feasible lease or rent) (itemize): 19 Maintenance of Equipment 20 Rent of Equipment 21 22 23 Supplies (Itemize): 24 Office Expense j 25 Communications 26 Rentals/leases-Building 27 Household&Medical Supplies 28 Travel - Per Diem,Mileage, &Vehicle Rental/Lease 1 29 - Client Transportation&Vehicle Rental/Lease 30 31 Other Expenses (Itemize): 32 Allocated Indirect Operations Overhead Costs 33 34 35 36 38 a 39 COUNTY ADMINISTRATIVE COSTS Qnstructions on back) 41 NET PROGRAM.EXPENSES sum lines 12 thru 39 24,000 43 REVENUES : Regular 45 Short-Doyle&other Govt funding sources 47 TOTAL REVENUES 49 GROSS COST OF PROGRAM sum lines 41 and 4 24,000 DMH APPROVAL BY: TELEPHONE: DATE: 0799311 Stat§of California Health and Welfare Agency De wtinent of Mental Health SAMHSA GRANT FEDERAL GRANT DETAILED PROVIDER BUDGET SUBMISSION DATE: 10-22-93 MH 1779 REV(9M3) FISCAL YEAR: 1993-94 COUNTY: CONTRA COSTA COUNTY CONTACT: Tars Ching % TELEPHONE NUMBER: (510) 370 — 5058 PROVIDER NAME: MH Administration PROGRAM TITLE: SAMHSA Evaluation/Training PROVIDER ADDRESS: 595 Center Ave.. Ste.200,Martinez PROVIDER NUMBER: 0799 MODE/COST CENTERS: 00/20(Admin) 1 2 3 STAFF Last Request New Title of Position Approved or Approved List by name of position and Budget Chane Budget 1IM. D.s FTE I 21 R. N.s FTE 3 j Program Supv. FTE 4 1 MH Clin Spec FTE 5 MH Clin Psychigst FTE 6 MH Worker/Case Mgr. FTE 7 1 MH Activity Spec FTE 8 1 Clerks FTE 91 i 101 12!TOTAL STAFF EXPENSES (sum lines 1 thru 10) i 14 1 Consultant Costs (Itemize): 15 1 Outside Medical Services 161 Consultant Contracts to design SAMHSA Project evaluation/outcome measures and 212721 36,772 17 to train staff 18 Equipment (Where feasible lease or rent) (itemize): 19 Maintenance of Equipment 20 Rent of Equipment 21 221 23 1 Supplies (Itemize): 241 Office Expense 1251 Communications 261 Rentals leases—Building 271 Household&Medical Supplies 28 1 Travel — Per Diem,Mileage,&Vehicle Rental/Lease 29 —Client Transportation&Vehicle Rental/Lease 30 311 Other Expenses (Itemize): 321 Allocated Indirect Operations Overhead Costs [33 � 341 35 I � I 8Q .i 339 COUNTY ADMINISTRATIVE COSTS (Instructions on back) 41 NET PROGRAM EXPENSES sum lines 12 thru 39 2,2721 36,772 43 REVENUES : Regular 45 Short—Doyle&other Govt funding sources 47 TOTAL REVENUES 49 GROSS COST OF PROGRAM sum lines 41 and 4 2.2721 36,772 DMH APPROVAL BY: TELEPHONE: DATE: ENCLOSURE VII SUBSTANCE ABUSE, MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) BLOCK GRANT ' SFY 1993/94 PLANNING ESTIMATE COUNTY Contra Costa ISSUE DATE: :April 14 , 1993 FEDERAL SAMHSA BLOCK GRANT PLANNING ESTIMATE Base Allocation $ 1,475,000 AB 2476 Augmentation $ 54, 070 Total $ 1,529,070 The Department of Mental Health for Contra Costa County hereby requests continuation of the Substance Abuse, Mental Health Services Administration (SAMHSA) Block Grant. These funds will be used in accordance with 42 U.S.C.A. , Sections 300x through 300x-13 , as it read on January 1, 1992, and amended by Public Law (PL) 102-321, and will be used as stated in the enclosed y Assurance of Compliance with Federal Requirements on Use of Allotments, and the Certification Statements . The amount is the total authorized gross expenditure level of approved programs for SFY 1993/94 . This amount is subject to adjustments for a net reimbursable amount to the county. The adjustments include, but are not limited to, Gramm-Rudmann- Hollings (Federal Deficit Reduction- Act) reductions, prior year audit recoveries, federal legislative mandates applicable to categorical funding, augmentation, etc . The net amount reimbursable will be reflected on future allocations and/or advance payments as the Specific dollar amounts of adjustments become known for each county. The county should use this amount for planning purposes and to build the county' s SFY 1993/94 base budget for SAMHSA Block Grant funded mental health programs . County Mental Health Director Date