Health Services >- $111,809. Purpose >- $84,739 >- ($318,645) >- $52,511 >- $330,072. Major Budget Changes >- $123,082 >- $42,752 >- $53,300

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Frederick Hawkins
5 years ago
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1 Kenneth B. Cohen, Health Care Services Director Mental Health & Increase/ Substance Abuse Fund Actual Approved Requested Recommended (Decrease) Expenditures Salaries & Benefits $5,537,127 $6,973,501 $7,222,097 $7,222,097 $248,596 Services & Supplies 8,681,393 9,115,924 9,325,382 9,325, ,458 Fixed Assets 0 149,100 51,150 51,150 (97,950) Total Expenditures $14,218,521 $16,238,525 $16,598,629 $16,598,629 $360,104 Expenditure Reimbursements (1,692,396) (1,751,462) (1,645,472) (1,645,4 72) 105,990 Total Appropriations $12,526,125 $14,487,063 $14,953,157 $14,953,157 $466,094 Earned Revenues By Source Fines/F OIfeitures/Pe na Ities $210,000 $210,000 $325,000 $325,000 $115,000 Interest/Rents Aidji-om Other Governments 8,100,514 9,311,078 9,207,432 9,207,432 (103,646) Charges for Services 4,228,695 3,549,810 3,969,550 3,969, ,740 Miscellaneous Revenues 400, , , ,400 35,000 Operating Transfers In 0 500, , ,000 0 Fund Balance (967,907) Total Revenues $11,971,850 $13,932,788 $14,398,882 $14,398,882 $466,094 Net County Cost $554,275 $554,275 $554,275 $554,275 $0 Allocated Positions Temporary (Full-Time Equivalent) Total Staffing Purpose Although counties are not required by law to provide substance abuse prevention and treatment services, if a county chooses to provide such services, various State and federal regulations control its operation. State law mandates a 10% county match of State-provided funds. Federal law mandates that 20% of the federal funds be spent for prevention, 10% for perinatal services, and 5% for pre and post counseling for injection drug users. Major Budget Changes Salaries & Employee >- $42,752 >- $275,430 Benefits Negotiated salary and benefits adjustments. Add four positions. >- $111,809 >- $84,739 >- ($318,645) >- $52,511 Services >- $330,072 >- $123,082 >- $53,300 & Supplies Transfer a Substance Abuse Supervisor from Mental Health Services (MHS). Transfer a Substance Abuse Counselor from Alcohol/Drug Alternative Program (ADAP). Transfer four positions to MHS. Increase in extra-help. Increase in Methadone maintenance providers and treatment services. Increase in Behavioral Health and Health Care Services Administration costs. Increase in professional services for data analysis consultants. F-13

2 ~ ($157,841) ~ ($79,090) ~ ($40,472) Fixed Assets ~ $35,000 ~ $9,900 ~ $4,500 ~ $1,750 Expenditure ~ ($105,990) Revenues ~ $300,797 ~ $142,689 Decrease in rent and facility-related costs. Decrease in Workers' Compensation and Casualty Insurance costs. Cost Allocation Passenger van. Reimbursements Plan adjustment. Commercial refrigerators (2). Commercial stove. Breathalyzer/Calibration kit. Decrease in reimbursement from MHS and Human Services Agency (HSA) for substance abuse counseling and treatment. Increase in State Medi-Cal and federal Drug Medi-Cal revenue. Increase in federal block grant funding. ~ $132,643 Increase in court-ordered and patient fees. ~ $100,000 Increase in drunk driving fine transfers from Statham Trust. ~ $81,482 Increase in Substance Abuse and Mental Administration Drug Court funding. ~ $35,000 Increase in contract outpatient services. ~ ($327,817) Decrease in State-grant funding. Program Discussion The proposed Substance (SAS) budget totals $16,598,629 which is an increase of $360,104 from The increase is primarily due to the addition of two positions and additional Drug Medi- Cal pass through to providers within the County. In , the State Budget Act realigned several programs and the revenue to support those programs. As a result, Drug Medi-Cal treatment providers who were reimbursed by the State are now reimbursed through the County utilizing realigned State sales tax revenue. The recommended positions: budget adds a net of two Workload Data Actual Est./Act. Projected Prevention Activities Schools Contacted Students Contacted 4,825 3,898 4,655 5,000 5,000 Organizations Contacted Individuals Contacted ,500 1,500 Treatment Services Recovery House-Admissions RecovelY House-Client Days 13,608 12,438 12,447 13,338 13,717 Family Ties-Admissions Family Ties-Client Days 9,200 9,093 9,731 9,940 10,385 Centra/Intake Referrals 1,793 1,560 1,336 1,575 1,732 Chemical Dependency Counseling Center Intakes F-14

4040600000-Substance ~ Add two Substance Abuse (SA) Program Supervisors, a Mental Health Clinician, and a SA Counselor. ~ Transfer three SA Counselors and an Office Assistant to MHS.

3 Substance ~ Add two Substance Abuse (SA) Program Supervisors, a Mental Health Clinician, and a SA Counselor. ~ Transfer three SA Counselors and an Office Assistant to MHS. ~ Transfer a SAS Coordinator from MHS. ~ Transfer a SA Counselor from ADAP. The recommended budget adds four positions to provide supervision for Recovery House and Family Ties as well as counseling services for the Intensive Outpatient Program and Chemical Dependency Counseling Center. The position transferred from ADAP will be funded by the Substance Abuse Prevention and Treatment (SAPT) Block grant. The four positions transferring to MHS are currently funded by MHSA programs. Residential Treatment Recovery House and Family Ties receive referrals from Probation, Parole, Child Protective Services, MHS, and the general public. Recovery House is licensed for men and women. Family Ties is a perinatal program for women and their children. Both residential programs provide treatment and transitional services, and collaborate with other agencies. Lack of clarity on State regulations regarding implementation for Drug Medi-Cal reimbursement for residential programs has created difficulties with planning and early implementation of Drug Medi-Cal reimbursable services. However, SAS is exploring residential options in relation to Drug Medi-Cal reimbursement and may request a budget amendment if significant increases in reimbursement could be programed and implemented during Family Ties has had fewer admissions to date than last year, but longer lengths of stay. Family Ties is a six-month program. Reasons for longer lengths of stay include more clients completing the program, and some clients can receive up to 30-day extension for relapse concerns, early postpartum, reuniting with children, medical complications, or transitional housing issues. The recommended budget anticipates restoring SAPT Block grant funds after the sequestration reduction to the Federal Fiscal Year (FFY) 2013 award. The State Department of Health Care Services recent distribution of SAPT 2014 award is projecting to be at FFY 2012 award level of $142,689. Outpatient Treatment Programs Central Intake accepts walk-in referrals on weekdays. The Chemical Dependency Counseling Center (CDCC) serves adults, youth, and pregnant or parenting women (perinatal). The CDCC perinatal component has experienced a slight decrease in referrals from Dependency Drug Court and/or Child Protective Services for pregnant subst,!nce abusing women. In previous years, these two agencies included a payment agreement with the referral document. Now the majority of clients are responsible for covering the cost of treatment services, possibly through use of Drug Medi-Cal. The screening and assessment process identifies the level of treatment the pregnant female may need taking into consideration other family dynamics such as older children or caring for other family members. Taking these other issues into account, some women are referred to outpatient services but if a more intensive level of treatment is necessary, a referral to residential treatment is given. CDCC is moving towards reinstatement of the Intensive Outpatient Program (lop) at CDCC. This would be a Drug Medi-Cal reimbursable program and would enhance the continuum of care between less intensive outpatient groups and residential treatment. lop was previously provided, but put on hold due to program cutbacks and reduced staffing. The reinstatement of lop is estimated to generate an additional $145,000 in Drug Medi-Cal funding. California Work Opportunity & Responsibility to Kids (CaIWORKs) Program The San Joaquin County CalWORKs Behavioral Wellness Clinic continues to provide substance abuse services to Cal WORKs clients who are experiencing symptoms of drug and alcohol abuse, which negatively impact their ability to obtain and retain employment. The Substance Abuse Counselors provide assessment, testing, educational, and treatment opportunities to this population. The Substance Abuse Counselors work closely with the clinic's Mental Health Clinicians to provide group therapy. Two Seeking Safety groups continue to be offered to Cal WORKs clients who are assessed as able to benefit from this particular group. Developing further opportunities for serving those with co-occurring disorders are a focus in this integrated system of service delivery. The SAS Counselors assist HSA Case Managers with home visits and provide assessments and referrals to inpatient and outpatient substance abuse treatment programs. The SAS Counselors are out-stationed a few days a week at various EI Concilio sites and the Lao Khmu site. In addition, a SAS Counselor provides drug testing and referral services for the HSA Dependency Drug Court. F-15

Prevention Services Prevention Services offers the following programs and services, which are targeted towards substance abuse prevention and mental health awareness: ~ Alcohol and Kids Don't Mb: -

4 Prevention Services Prevention Services offers the following programs and services, which are targeted towards substance abuse prevention and mental health awareness: ~ Alcohol and Kids Don't Mb: - This communitybased education program is a five session, one and one half to two hours each session, program that provides education about and stresses the importance of not drinking during pregnancy and while raising children. ~ Project Towards No Drug Abuse (TND) - This 12 session interactive classroom-based substance abuse prevention program is designed for senior high school students and each session is one hour. Project TND focuses on three factors that predict tobacco, alcohol, and other drug use, violence-related behaviors, and other problem behaviors among youth including motivational factors, skills, and decisionmaking. ~ Project ALERT - Project ALERT is a substance abuse prevention program designed for seventh and eighth graders. This program is delivered in 14 sessions. The core curriculum (seventh graders - lessons I through II) stresses motivating non-use, identifying pressures to use drugs, learning to resist those pressures, practicing resistance skills, a review of the key concepts, inhalant abuse, and smoking cessation. The booster lessons (eighth graders - lessons I through 3) are designed to build on the core curriculum by covering motivating resistance to drugs, practice resisting internal and external pressures to use drugs, and benefits of resisting drugs. Activities, audiovisual materials, handouts, and student homework assignments are part of the curriculum. ~ Too Good/or Drugs (TGFD) - TGFD is a schoolbased prevention program for kindergarten through eighth grade that builds on students resiliency by teaching them how to be socially competent and autonomous problem solvers. ~ Speaker's Bureau/Health Fairs - Prevention Services staff sets up booths at local health fairs and events to provide information to the community on substance abuse prevention, specific drugs and their effects, and mental health awareness. Staff is also available to speak at public engagements and to classes. Presentations can be tailored to meet specific needs and requests of a certain audience. ~ Friday Night Live (FNL)/C1ub Live (CL) - The San Joaquin Friday Night Live Partnership is made up of 15 high school chapters and 11 primary school chapters (sixth through eighth grade). FNL chapters consist of high school-age youth working in partnership with adults. CL consists of middle school-age youth working in partnership with adults. ~ Students in Prevention (SIP) - The SIP program began in 1979 as a peer-to-peer alcohol prevention program. Its main focus was to prevent alcohol use by teenagers as many high schools were reporting alcohol-related incidents. Approximately 50 high school students are employed each year representing 22 high schools. Each SIP student provides a minimum of one monthly classroom presentation in local grammar schools. ~ SIP Transitional Age Youth (STAY) - This project began in 2011 as an extension of the SIP program. The objective was to have college-age young adults serve as peer educators on the topic of substance use prevention and mental health awareness. ~ Yellow Ribbon (YR) - This is a suicide prevention program offered to participating high schools. Participating high schools identify a group of students who will receive YR training. The STAY team trains these students and the students in tum provide YR presentations to their campus population. Further, the high schools identify adults on their campuses who will serve as "gatekeepers". Gatekeepers are trained by the STAY team as well and serve as extra support when students conduct presentations on their respective campuses. ~ Red Ribbon Celebration - San Joaquin County began celebrating Red Ribbon in the 1990s and today prevention staff provides local school districts with support through drug-free activities for youth and their families. School districts are encouraged to purchase drug-free wristbands and promote Red Ribbon activities on their school campuses (i.e. door decorating contests, poster contests, dress-up days, rallies, and assemblies). Prevention Services offers support by providing guest speakers for school assemblies and arranging for Red Ribbon Week activities. Previous activities have included a health fair, family nights (University of the Pacific sports event or bowling at Pacific Avenue Bowl), movie night, and a skate party Realignment As a result of the 20 II Realignment, counties are now responsible to pay Drug Medi-Cal treatment providers, including service utilization monitoring and claim processing, with the realigned State sales tax revenue. In , SAS entered into Drug Medi-Cal contracts with F-16

5 providers that were previously managed by the State. Most of the Drug Medi-Cal contracts are with providers of Narcotic Treatment Programs (NTP), the most costly of the Drug Medi-Cal services. The Governor's proposed budget for includes reference to a State Plan amendment that could make adjustments to the current fee-for-service Drug ~edi-cal program. This is key as the fee-for-service model allows for little to no management of service costs relative to budget. A State Plan amendment could facilitate development of a model inclusive of managed care tools for balancing service costs with available resources. The recommended budget includes an increase of $300,797 in NTP Drug Medi-Cal contracts of $6.3 million. F-17

City of Berkeley CSS Plan Revised Budget Narratives. Full Service Partnership Integrated Services Expansion for TAY, Adults and Older Adults

City of Berkeley CSS Plan Revised Budget Narratives The additional funds provided by the CSS expansion have been added into the previously approved 07/08 budgets. What follows are the revised budget narratives