San Luis Obispo County has increased contracts addressing social ills, from eating disorders of teenagers to mental health counseling and parenting classes.
County Supervisors approved a new contract with Central Coast Treatment Center to provide eating disorder services to “high risk youth,” and not to exceed $702,000. The contract expires next June.
“Behavioral Health,” reads a report, “operating under the Health Agency, is mandated by the State of California to provide Eating Disorder [ED] treatment services to eligible Medi-Cal beneficiaries throughout the County. Behavioral Health does not have staff on hand to provide outpatient treatment for these services and does not operate a facility that provides residential treatment services.”
According to the Health Department eating disorders are common. “At least 30 million individuals of all ages, gender identifications, sexual orientations, and races/ethnicities,” the report said, “suffer from EDs in the United States. Research indicates there has been a 30% jump in eating disorder-related hospital admissions among females ages 12-18 during the Covid-19 Pandemic. County Behavioral Health staff have received an increasing flow of client referrals with serious EDs and assessed a higher demand for a range of ED treatment modalities, including assessment, Intensive Outpatient Treatment [IOT], Partial Hospitalization Program (PHP), and residential treatment. In prior years, Behavioral Health received on average one or two of these referrals for treatment annually. “
The report said in Fiscal Year 2022-23, they got or completed 43 referrals “for clients who need immediate, life sustaining treatment.”
Back in September 2021, the Supervisors signed the first 1-year contract with the Treatment Center for $540,000 and extended the contract in August 2021 at the increased rate of $675,000.
This second amendment to the original contract was allowed by the original terms and according to the report, at a 25% increase is in keeping with increases made to other contracts.
But because it’s over 25% of the original contract amount, it had to go to Supervisors and not just be automatically approved by the Health Agency Director.
The agency feels this is an important service. “To address the emerging increased need for ED services most effectively, contracts with facilities like Central Coast Treatment Center are necessary. Providing these services will help prevent re-hospitalization and higher system costs for clients with co-occurring ED and mental health, physical health, and/or substance use disorders issues. “
Post Jail Services
The Supervisors also gave permission for the Health Agency Director to accept a $1.14 million grant from the “Providing Access and Transferring Health” or PATH grant program aimed to “provide operational and supportive services for justice involved individuals transitioning out of incarceration to behavioral health treatment or supportive housing.”
The funding comes from State Assembly Bill 133 (AB 133) passed in 2021 that requires jails to help referrals to the County’s specialty mental health services, Drug Medi-Cal, the Drug Medi-Cal Organized Delivery System and/or “Medi-Cal Managed Care Plan [MCP] for incarcerated individuals who received behavioral health services while incarcerated, to allow for the continuation of behavioral health treatment. These agencies have not been able to bill Medi-Cal for any services prior to client’s release from correctional custody.”
This past January, the Federal Government rectified that discrepancy and opened up these types of services to Medicaid funding, starting 90 days before a prisoner’s release date.
“Through a Federal Medicaid 1115 demonstration waiver,” the report explained, “counties will create community re-entry processes to assist people leaving incarceration in connecting to community-based services. Pre-release services will provide care management and include physical and behavioral health community connections. For people receiving these services, a care manager will be assigned to establish a relationship with the individual, understand their health needs, and coordinate services.”
The County Sheriff’s Department, working on this program with the Health Agency, has already gotten one of these PATH grants that it used on “planning for the implementation of this re-entry initiative.”
This latest grant will get the County to the point of readiness to start the program by 2026, when the $1.14M grant runs out.
To that end, the item Supervisors approved on Sept. 12 the hiring of an Administrative Services Officer (ASO), a Behavioral Health Clinician (BHC), and a Behavioral Health Specialist (BHS), on limited term contracts to work on this program.
They also budgeted an additional $270,000 of State Health Aid Program monies. This money breaks down as $239,000 for salaries and benefits, and $31,000 in services and supplies covering just this fiscal year.
The PATH grants are to fund: “training, technical assistance, and planning to support behavioral health in-reach at the San Luis Obispo County jail; and, recruitment, hiring, onboarding, and supporting staff salaries for personnel supporting BHD in-reach services and linkages as mandated by AB133 and the Medi-Cal initiative.”
The ASO position, the report said, will provide “coordination between agencies, data collection and support to the re-entry team.”
The BHC and BHS positions, “will focus solely on providing both in-custody and out-of-custody transitional services for incarcerated individuals requesting BH support including case management, intake, screening, assessment, counseling, transportation assistance, coordination with BH programs/levels of care, housing support, and re-entry group services.”
Also, when the grant monies run out in 2026, the County plans to make these temp jobs permanent under the “California Advancing and Innovating Medi-Cal [CalAIM] initiatives that will allow the funding for the positions to be fully offset by Medi-Cal reimbursement in the future.”
The three-person team is being called the “Behavioral Health Path Team,” according to the report, working only with juveniles in this program.
“This team will move between the County Jail and County BHD campuses,” the report explained, “and will increase coverage, continuity of care, and appropriate placement. Services will include access to services prior to release, assessments for appropriate placement and identifying placements. These services will improve transitions into the community upon release from jail custody.”
Boost to Family Strengthening
The Center for Family Strengthening also got a significant bump in its County allocations, as Supervisors were asked to approve increasing that contract more than 25% to a maximum of $396,000 for the current fiscal year, which started July 1.
“The Center for Family Strengthening [CFS], formerly known as the San Luis Obispo Child Abuse Prevention Council,” the County report said, “provides a range of support services, including the “Family Education, Training and Support” [FETS] programs.”
The contract is part of the County Health Agency’s contracts with community organizations, “to provide consumer services, mental health and substance use prevention and early intervention programming, including those implemented through the Mental Health Services Act [MHSA].”
CFS operates the County’s FETS Program, the report said, which, “serves parents and families of youth at-risk for mental health issues in San Luis Obispo County. The program provides a multi-level approach to reducing risk factors and increasing protective factors for all parents and caregivers raising children. These services include coordination of parenting resources, parent education classes, and parent coaching services.”
Over the past 3 years the contract has been in place, the County said there has been a big increase in demand, especially from Spanish-speaking people.
“This can be attributed to outreach efforts and building an online community of over 100 Spanish speaking parents,” the report said, “many of which have shown interest in coaching and education services. Output for the program has consistently delivered above estimated units for parents and families receiving coaching services and education classes.”
With the influx of millions of people across the U.S. Southern Border over the past 3 years, it could probably be expected that demand for these types of services will continue to increase, along with the numbers of Spanish-speaking clients, though the recent influx of immigrants have been reported to have come from some 140 different countries, and no doubt speak a wide variety of native languages.
That’s why the County’s request for more personnel includes bilingual staff. “The contracted program is requesting funds to expand capacity by adding a 1.00 FTE [full time equivalent] bicultural and multilingual specialist, along with administrative support, to their staff to appropriately serve the culturally diverse communities presenting the highest demand for coaching and education services.”
In the current budget, CFS’ contract was set at $295,000 and the amendment just approved increases that by $101,000, an amount the Supervisors added to the FETS Program budget. The County’s advisory committee on such matters, the so-called Mental Health Advisory Committee, had already recommended Supervisors bump up CFS’ contract.
How does this nearly $400,000 break down? According to a chart in the report, $156,000 is for family education, training and support; $101,000 for the same use as a 1-time allocation; and $138,000 for “Promotores” or “interpretation services.”