To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Add six (6) full-time positions and cancel one (1) full-time position in various classifications for the Behavioral Health Division in the Contra Costa Health Department
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
ADOPT Position Adjustment Resolution No. 26240 to add the following six (6) full-time positions:
• One (1) Administrative Services Assistant III (APTA) at salary plan and grade ZB5-1631 ($7,510 - $9,129)
• One (1) Substance Abuse Counselor (VHVC) at salary plan and grade TC5-1436 ($6,192 - $7,526)
• One (1) Mental Health Program Supervisor (VQHP) at salary plan and grade ZA5-1749 ($8,441 - $10,260)
• Two (2) Homeless Services Specialists (V9SD) at salary plan and grade ZB5-1404 ($5,999 - $7,291)
• One (1) Clerk-Senior Level (JWXC) at salary plan and grade 3RX-1033 ($4,434 - $5,662)
and cancel the following one (1) position:
• One (1) vacant Mental Health Clinical Specialist (VQSB) position #8761
for various programs in the Behavioral Health Division in the Health Services Department specified in Attachment A. (Represented)
Behavioral Health (0467): APPROVE Budget Amendment No. BDA-23-00309 authorizing FY 23-24 Reimbursement Government/Government (9951) appropriations in the amount of $732,942 and State Aid Realignment - Mental Health (9310) appropriations in the amount of $2,591 for salaries, benefits, and expenses in the Behavioral Health Division.
FISCAL IMPACT:
The Position Adjustment action has an annual salary and benefit cost of approximately $735,533. There is no Net County Cost as these positions will be fully funded through Mental Health Realignment funds, Mental Health Services Act (MHSA), State of California Behavioral Health Bridge Housing Program Funding and Community Care Expansion Program funds.
The Budget Amendment will result in increasing the appropriations to Reimbursement Government/Government Revenue code (9951) and State Aid Realignment - Mental Health (9310) appropriations in the amount of $735,533: Permanent Salaries (1011) by $457,988, F.I.C.A (1042) $21,232, Retirement Expense (1044) by $103,833, Employee Group Insurance (1060) by $89,507, Retiree Health Insurance (1061) by $56,812, Unemployment Insurance (1063) by $554, and Workers Compensation Insurance (1070) by $5,607 in the Behavioral Health Department.
BACKGROUND:
The Health Services Department is requesting these actions to support operational needs in various units:
1. The Quality Assurance/Utilization Review Unit is responsible for monitoring the effectiveness of the Mental Health Plan contract with the California Department of Health Care Services (DHCS) by providing oversight and review of clinics, organizations, and clinicians providing services to consumers in Contra Costa County. The Administrative Services Assistant III position being requested will work closely with the Mental Health Quality Improvement Coordinator to support the grievance and appeals system required by the Drug Medi-Cal Organized Delivery System and Mental Health Plan. Tasks include, but are not limited to, ensuring timely and adequate timeframes for issuing Notices of Adverse Benefit Determination, managing the Grievance and Appeals Log, submitting quarterly and annual reports to the DHCS, participating in audits from DHCS and other External Quality Review Organizations, and assisting the Mental Health Quality Improvement Committee with quality of care investigations, serious event reporting, and HIPAA incidents. The cost of the new position will be offset by the cancellation of one vacant Mental Health Clinical Specialist position, which has been vacant since February 18, 2020, and determined to no longer be needed.
2. The First Hope Program is an outpatient treatment program for young people and their families experiencing early symptoms of psychosis or a recent psychotic episode and provides intensive family-centered services to adolescents and young adults aged 12-30 showing early signs of psychosis. The program’s mission is to prevent the occurrence of an initial or subsequent psychotic episode and to reduce the secondary disability of those developing a psychotic disorder. The Substance Abuse Counselor position being requested is needed to address the significant levels of co-occurring substance use disorders that may be linked to symptoms of psychosis experienced by First Hope clients.
3. The Behavioral Health Housing Support Services Unit provide supportive services to severe and persistently mentally ill adults, children, and families by helping clients maintain their housing, providing linkage to needed services, providing transportation, and teaching coping skills and money management. The positions being requested are needed to implement the Behavioral Health Bridge Housing (BHBH) Program, a new program under the California Department of Health Care Services that provides funding across the state to operate bridge housing settings to address the immediate and sustainable housing needs of unhoused individuals who have serious behavioral health conditions, including a serious mental illness and/or a substance use disorder, that prevent them from accessing help and improving their housing situation. If the new positions are approved, the Mental Health (MH) Program Supervisor will oversee BHBH program staff, including clinical and non-clinical staff, work closely with community providers, author and manage Requests for Proposals, manage the program’s deliverables, and be the liaison between behavioral health and other departments to coordinate housing efforts. The Housing Services Specialists will provide housing navigation services, which may include conducting outreach to the homeless in the County, researching and recommending resolutions to homeless care issues and complaints, providing information and linkage to County health systems, assisting clients with obtaining short and long term housing, assisting consumers with navigating the County’s Coordinated Entry System (CES) for requesting housing assistance and collaborating with all providers within the CES, and developing housing plans with the clients that include educating them on daily living skills such as budgeting and financial management. The State of California BHBH Program Funding will be the funding source for the MH Program Supervisor and Housing Services Specialists. The Clerk-Senior Level being requested will provide administrative support to the BHBH Program and the Community Care Expansion (CCE) Program. The CCE Program funds the preservation of existing licensed residential and senior care facilities serving applicants and recipients of Supplemental Security Income/State Supplementary Payment or Cash Assistance Program for Immigrants, who are at risk of or experiencing homelessness. The funding for the Clerk-Senior Level will be 50% from BHBH Program Funding and 50% from CCE Program funds.
CONSEQUENCE OF NEGATIVE ACTION:
If this action is not approved, the Quality Assurance/Utilization Review Unit will continue to have insufficient staff to implement their quality management program to assess and improve the quality of care and services provided to mental health clients in the County by clinics or other health organizations. The First Hope Program will not have staff to provide substance counseling support, leaving clients at severe risk of relapsing into substance abuse which in turn increases their risk of future symptoms of psychosis or psychotic episodes. The Behavioral Health Housing Support Services Unit will not have staff to manage the implementation of the BHBH Program, provide housing navigation and support services to consumers at risk of or experiencing homelessness, or support clients though any housing obstacles or barriers, whether they be physical or administrative in nature, that they encounter. The Housing Support Services Unit will also not have sufficient administrative support to efficiently implement the BHBH Program and CCE Program.