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Health and Human Services Agency (HHSA) recommending the Board:
1) Make findings that the provision of County-wide Dialectical Behavior Therapy (DBT) and Transitional Age Youth First Episode Psychosis (FEP) services in accordance with Community Mental Health Services Block Grant requirements provided by Sierra Child & Family Services, Inc. (Sierra) are in the public's best interest and that there are specialty skills, qualifications, and equipment not expressly identified in County classifications involved in the performance of the work in accordance with El Dorado County Ordinance Code, Chapter 3.13.030(B), El Dorado County Charter, Section 210(b)(6);
2) Approve and authorize the Chair to execute the competitively procured Agreement for Services 9074 with Sierra for provision of DBT and FEP services for the retroactive term of August 1, 2024, through June 30, 2026, with the option to extend for one additional year through June 30, 2027, and a maximum obligation of $960,408 regardless of the term extension;
3) Authorize the Purchasing Agent to execute amendments relating to Agreement 9074, contingent upon approval by County Counsel and Risk Management, which do not increase the maximum obligation or term of the Agreement; and
4) Authorize the HHSA Director, or the Chief Assistant Director, to execute programmatic, administrative, and fiscal documents relating to Agreement 9074.
FUNDING: 100% Federal Mental Health Services Block Grant.
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DISCUSSION / BACKGROUND:
Since 1997, Mental Health Services Block Grant (MHBG) funds have been used in collaboration with other public and private organizations such as the HHSA Social Services programs and the El Dorado County Office of Education to address the needs of children/adolescents with serious emotional disturbance.
MHBG is comprised of funds to: 1) support the County in carrying out plans for providing comprehensive community mental health services to adults (age 18 and over) with serious mental illnesses, and to children (under age 18) with serious emotional disturbances; 2) provide treatment to patients diagnosed with dual disorders (psychiatric disorders along with alcohol and other drug use disorders); and 3) provide treatment to adolescents and young adults who experience psychotic symptoms or a psychotic episode for the first time.
Since Fiscal Year (FY) 2014-15, HHSA has dedicated MHBG funding to provide DBT and FEP services in El Dorado County high schools. DBT is an evidence-based psychotherapy approach used to treat many conditions, based on mindfulness skills, distress tolerance skills, and emotional regulation. FEP refers to the initial symptoms of psychosis, and when a client is connected quickly with the right treatment services, the services can be life-changing and can radically alter the person's future.
HHSA is a recipient of MHGB funds via the Substance Abuse and Mental Health Services Agency (SAMHSA) and the Department of Health Care Services (DHCS). MHBG funds must be spent in accordance with Public Law (PL) 102321 (Block Grants to States Regarding Mental Health & Substance Abuse) and PL 106-310 (Children's Health Act of 2000). The HHSA MHBG award for FY 2024-25 and FY 2025-26 is $437,347 per year, for a total award of $874,694.
In December 2019, HHSA worked with County Procurements and Contracts Division to process Request for Proposal (RFP) 20-918-029 for DBT and Transitional Age Youth FEP services on the West Slope of El Dorado County, which resulted in a single proposal from Sierra. As a result, Sierra was awarded the RFP by the County Board of Supervisors (Board), and Agreement 4342 was executed with Sierra for a one-year term (Legistar File 19-1461) to coincide with the MHBG FY funding HHSA was awarded. Thereafter, Agreements 5012 and 5417 (Legistar Files: 20-0908 and 21-0002), each for one-year terms and 6989 (Legistar File: 23-0186) for a two-year term, were approved by the Board and executed with Sierra to coincide with the MHBG funding awarded to HHSA.
Consistent with national trends, El Dorado County continues to experience an increase in the population of seriously emotionally disturbed children and adolescents. A number of these youth engage in risky behaviors such as self-harm, use of mood/mind altering substances and suicidal behaviors. These youth often experience family, relational issues, and school difficulties. The success of Sierra’s DBT and FEP programs on community high school campuses has been supported by collaboration between Sierra and local area schools, resulting in a dedicated space in the high schools for Sierra to conduct mental health screenings and services to ensure easy access for eligible children and youth.
On March 17, 2024, on behalf of HHSA, the Chief Administrative Office (CAO) Procurement and Contracts (P&C) Division, released Request for Qualifications (RFQ) 24-0047, to solicit responses for the operation of DBT and FEP services on the West Slope in accordance with MHBG requirements. A single response was received by Sierra which met the RFQ requirements and was deemed qualified to perform DBT and FEP services by the evaluation panel. On May 29, 2024, CAO P&C posted the RFQ’s resulting Qualified List, determining that Sierra was deemed qualified to provide DBT and FEP services in the County. Subsequently, HHSA staff began developing Agreement 9074 with Sierra for the DBT and FEP services.
HHSA Behavioral Health Division (BHD) staff anticipated the MBHG application process to begin in May 2024 as it had been released in previous years, however the application for FY 2024-2026 funding was not sent by DHCS until June 14, 2024. HHSA BHD submitted its application on June 28, 2024. The funding was awarded to HHSA on August 7, 2024, and was accepted by the HHSA Director per Board delegation provided via Resolution 093-2022 (Legistar File: 22-0813). In the interim, Sierra Agreement 6989 was amended to extend for the maximum of one month per Board Policy C-17, 3.4(6) which allows the most recent awarded contract to be extended for an interim time to allow for services that are needed pending a competitive solicitation award (Legistar File: 24-0715). As a result of that extension, Agreement 6989 expired on July 31, 2024, aligning with the end date of the FY 2023-24 MHBG funding.
After changes in distribution of MHBG funding over the past few years, counties are not guaranteed an allocation, therefore BHD did not move forward with the pending service contract until receipt of the County posted RFQ Award Notice. Due to the complicated nature of the contract the approval of Counsel involved numerous edits that significantly delayed the process as all parties involved had to approve. This led to a longer than usual turnaround from the date the contract was started to the date it is coming to the Board. Having already established space in the high schools to provide the services and recognizing the importance of the provision of the services to the youth in the community, Sierra continued to provide the DBT and FEP services and is still providing the services today. Therefore, HHSA requests the Board approve Agreement for Services 9074 with Sierra for a retroactive term of August 01, 2024, through June 30, 2026, to coincide with the end date of the FY 2025-26 MHBG funding and to allow for the payment of the continued services.
ALTERNATIVES:
Should the Board decline to approve this recommendation, HHSA will be out-of-compliance with the FY 2024-26 MHBG plan and application, which indicates that these services will be contracted out due to the specialized skills needed to provide said services.
PRIOR BOARD ACTION:
1) 01/14/20, 19-1461, HHSA DBT & FEP RFP Award to Sierra Child & Family, 4342
2) 09/01/20, 20-0908, HHSA Sierra Child & Family Svcs, 5012
3) 06/29/21, 21-0002, HHSA Sierra Child & Family Svcs Agmt 5417
4) 06/21/22, 22-0813, HHSA BH Director Signing Authority, Resolution FY 22/23
5) 03/14/24, 23-0186, HHSA Sierra Child & Family Services DBT-FEP Agreement 6989
6) 06/25/24, 24-0715, HHSA Sierra Child & Family Services Agreement 6989 Amendment I
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel, Human Resources, Risk Management, and Procurement and Contracts.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no General Fund Cost associated with this agenda item. Sufficient appropriations were included in the FY 2024-25 Budget and will be included in future budgets for the term of the Agreement.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Clerk of the Board to obtain signature of Chair on one original Agreement for Services 9074.
STRATEGIC PLAN COMPONENT:
N/A
CONTACT
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency