TO: Board of Supervisors
FROM: Steve Lederer, Director of Public Works
REPORT BY: Daniel Basore, Engineering Supervisor
SUBJECT: Project creation, budget amendment, and agreement for the “Crisis Stabilization Unit (CSU) - Children’s Services Expansion Project” PW 24-15
RECOMMENDATION
title
Approve and authorize creation of Capital Improvement Project 24027 for the “Crisis Stabilization Unit (CSU) - Children’s Services Expansion” PW 24-15, approve a Budget Amendment, and approve and authorize Agreement No. 240326B with TLCD Architecture for a maximum of $466,286 for design and construction administration services. (Fiscal Impact: $800,000 Expense; HHSA Fund; Not Budgeted; Discretionary)
[4/5 vote required]
body
BACKGROUND
The Department of Health Care Services (DHCS) was authorized through Welfare and Institutions Code Sections 5960-5960.45 to establish the Behavioral Health Continuum Infrastructure Program (BHCIP) with $2.2 billion to construct, acquire, and rehabilitate real estate assets or to invest in needed mobile crisis infrastructure to expand the community continuum of behavioral health treatment resources. DHCS is releasing BHCIP grant funds through six rounds that target various gaps in the state’s behavioral health facility infrastructure.
BHCIP aims to reduce homelessness, incarceration, unnecessary hospitalizations, and inpatient days and improve outcomes for people with behavioral health conditions by expanding access to community-based treatment. BHCIP proposes to invest in the expansion of beds, units, or rooms by building new behavioral health continuum infrastructure and expanding capacity. These resources would expand the continuum of services by increasing capacity for short-term crisis stabilization, acute and sub-acute care, crisis residential, community-based mental health residential treatment, substance use disorder residential treatment, peer respite, mobile crisis, community and outpatient behavioral health services, and other clinically enriched longer-term treatment and rehabilitation opportunities for individuals with behavioral health disorders, in the least restrictive and least costly setting.
AHP released “Round 5: Crisis and Behavioral Health Continuum” with a due date of applications by February 13, 2023. HHSA applied for the funds after extensive exploration and data collection on current community crisis needs, including children’s mental health needs related to the pandemic. The children’s expansion will provide crisis psychiatric assessment and crisis stabilization services for youth in Napa County. The services include medication assessment and administration, comprehensive care coordination, safety/discharge planning, and when necessary, facilitation of admission to psychiatric inpatient services. The service expansion will increase the current bed count from two in the current Crisis Stabilization Unit (CSU) to four in a separate area, created as a children’s specific treatment milieu focused on providing trauma informed, client-focused and culturally/linguistically appropriate services geared toward wellness and recovery.
By supporting an expansion of doubling the beds for children, we increase capacity not only within the crisis stabilization unit but also supporting the local emergency department. The two children’s beds in operation in the current CSU will be converted to adult beds. None of the BHCIP funding will be used in that transition to adult beds. The increase to four beds also supports the larger community mission to keep children in their communities and in home settings. Without local capacity, children are sent to out of county inpatient psychiatric hospital beds, which create costly barriers for family especially costs including childcare coverage for other children and transportation costs to out of county hospitals. The expansion of a children’s crisis CSU promotes the value in providing children and family specific services, creating a calm and safe therapeutic setting and providing an opportunity for children to have more choice and voice in a separate clinical setting.
On July 25, 2023, the Board adopted a resolution authorizing the Director of HHSA to execute all required documents to participate in the BHCIP program, including but not limited to the Program Funding Agreement (PFA), Declaration of Restrictions and Performance Deed of Trust accepting $3,329,955 in deliverable based revenue from the California Department of Health Care Services (DHCS) through its contractor, Advocates for Human Potential (AHP).
The item before the Board today will establish the associated capital improvement project, execute a professional service agreement (PSA) to support the project and a budget amendment necessary to fund the PSA, staff time, and required cash match contribution of $277,964 to the grant fund. TLCD was included in the design team for the associated grant due to their extensive knowledge as the designer of the CSU facility.
Requested Actions:
1. Approve a Budget Amendment for the following (4/5 vote requires):
a. Increase Transfers Out appropriations by $800,000 in HHSA-Agency Administration (2000, 2001000, Account 56100) offset by use of its available fund balance to transfer to Capital Improvement Project 24027; and
b. Creation of a new Capital Improvement Project 24027 for the “Crisis Stabilization Unit (CSU) - Children’s Services Expansion” PW 24-15, State Project UUID: B5_497_CrisisStabNapa and increase appropriation Construction Services by $800,000 (Fund 3000, Sub-Division 3000504, Project 24027, Account 52360) offset by a transfer-in revenue from HHSA-Agency Administration.
2. Approval and authorization of Agreement No. 240326B with TLCD Architecture for $466,286 for design and construction administrations services.
FISCAL & STRATEGIC PLAN IMPACT
|
Is there a Fiscal Impact? |
Yes |
|
Is it currently budgeted? |
No |
|
Is it Mandatory or Discretionary? |
Discretionary |
|
Discretionary Justification: |
Today’s actions are necessary to fulfill the cash match obligation of the State grant funding requirements as well as establish and budget a CIP and execute a PSA to support the design and construction of the project. |
|
Is the general fund affected? |
No |
|
Future fiscal impact: |
Staff will return to the Board at a later date to request additional funds to fund construction. |
|
Consequences if not approved: |
HHSA’s Behavioral Health division would be unable to make use of funds to support critical services |
|
Additional Information |
The grant fund is a deliverable based program funding agreement and the County will be reimbursed by the State up to a not to exceed amount of $3,329,955. The County must participate a minimum $277, 964 cash match at the start of the project that will not be reimbursed. |
ENVIRONMENTAL IMPACT
ENVIRONMENTAL DETERMINATION: The proposed action is not a project as defined by 14 California Code of Regulations 15378 (State CEQA Guidelines) and therefore CEQA is not applicable.