The County is tracking 13 performance measures related to prevention and early intervention for children at-risk of abuse, trauma or mental illness. For updates and to track our progress, visit our Performance Dashboard.
Important note: The following recommendation was approved by the Board of Supervisors on July 9, 2013.
To: Honorable Board of Supervisors
From: John L. Maltbie, County Manager
Subject: Measure A Report Back: Prevention and Early Intervention for Children At- Risk of Abuse, Trauma, or Mental Illness
RECOMMENDATION:
Direct staff to budget $3,989,139 in the FY 2013-14 budget and $5,325,874 in the FY 2014-15 budget to improve collaboration between County services and schools in order to prevent mental illness, emotional disturbance and substance use among children and youth, intervene early, and avert crises.
BACKGROUND:
San Mateo County has a long history of strong inter-agency collaboration between the San Mateo County Health-Behavioral Health and Recovery Services, Probation, Human Services Agency-Children and Family Services (HSA-CFS) and schools and districts focusing on children and youth at risk of adverse psychological, health and social outcomes and their families. The strength of these efforts has been primarily directed toward students in special education with serious emotional problems and with students at seven schools served via family resource centers. This collaboration has resulted in one of the lowest out of home placement rates in the state, innovative programs such as Pre to 3 and Partners for Safe and Healthy Children and the coordination of services at the Youth Services Center. The joint planning and coordination between the agencies occurs through the Children and Youth System of Care (CYSOC) committee structure.
Among the CYSOC partners significant resources are devoted to the early identification, intervention and treatment of children and families with the highest risks and needs in the County. Although substantial resources are dedicated to school age children and their families, there is more we could do to prevent the problems of untreated mental illness, emotional disturbance and substance use that result in school failure, broken families, and criminal justice involvement. There are few resources for children and youth who stand at the precipice of, but have not yet fallen into, special education, the Child Welfare System, or criminal activity. The schools and the County have not been organized to address the behavioral health and social support needs of students who are developing problems but flying just beneath the radar.
Members of the Board of Supervisors and many others participating in the initial hearings on Measure A commented on the importance of prevention, early intervention and treatment of mental health problems among children and youth. This strong advocacy was in part a reaction to the tragedy that occurred at Sandy Hook elementary school and the desire to do everything possible to prevent such incidents in San Mateo County. In March, the County Manager asked CYSOC to address this issue. CYSOC included the County Office of Education and the Sheriff’s Office in the development of these recommendations.
DISCUSSION:
The Children and Youth System of Care (CYSOC) committee consisting of BHRS, HSA, Probation and now the County Office of Education is proposing to build on our strong partnership and take our collaborative efforts to the next level by expanding our prevention, early intervention and treatment capacity to ensure that children and youth in San Mateo County have the best opportunity to be successful in school and achieve optimal mental health. We have taken a systems approach representing a new way of doing business by establishing more formal linkages between county services and our education partners in the planning, implementation and evaluation of these services. In consideration of these recommendations CYSCO has proposed evidenced based and/or promising practices and identified financial leveraging through federal and education funds.
As a planning framework for discussing and evaluating the recommendations, CYSOC adopted the School Mental Health and Response to Intervention framework that focuses on: what should be available to all students (primary prevention), what will some students need (early intervention), and what will a few students need (treatment). In addition, an initial meeting was held with the School/Behavioral Health Task Force as follow up from the School Safety Summit in April. Below are CYSOC’s recommendations for prevention, early interventions and treatment. All of these recommendations were vetted with the School Safety Summit’s Mental Health Supports for Schools Task Force. The future focus of the task force will be to implement the approved recommendations and to improve the collaboration and communication between schools, districts and the County.
For prevention, CYSOC recommends:
• Parenting Project to provide intensive parent training and support for addressing emotional health and other problems that come up for parents of adolescents
• Youth Mental Health First Aid to assist school personnel in early identification and intervention
• HSA-CFS Supportive Hotline with StarVista to provide easy access to services
• Family Resource Center Expansion to broaden access to future early intervention and family supports referred by school personnel
• School, Police and Community Collaborative-East Palo Alto
• County Office of Education (COE) Coordinator/Liaisons to connect school-based family needs to the appropriate County services
For early intervention, CYSOC recommends:
• Pre-3/Partners enhancement to meet the demand for services to more young mothers many of whom are vulnerable and have serious mental health challenges
• Early Onset Bi-Polar Intervention to allow students with bi-polar disorder to remain in school and avoid serious disruptions to them and the schools
For treatment, CYSOC recommends:
• Trauma Related Interventions to expand capacity to meet the needs of children and youth with serious trauma experiences
• Psychiatric Emergency Case Management to provide immediate support to children, youth and families experiencing a serious mental health crisis
• Residential Substance Use Treatment to prevent youth from entering the juvenile justice or child welfare systems due to their substance use
• Expansion of Outpatient Mental Health and Substance Use Treatment Services to provide better access to services for students who are experiencing problems but are not seriously emotionally disturbed
To deliver these recommended services and to strengthen the collaboration between BHRS, HSA, Probation and Education, we are recommending that Measure A partially fund a School/CYSOC Coordinator through the County Office of Education and six part- time regional liaisons. The county-wide coordinator would attend CYSOC meetings, coordinate with school district administrative teams in the planning and implementation of the recommendations, secure school funding, and participate in evaluation of the efforts. The stipend liaisons would work with the appropriate BHRS community services area manager and the HSA-CFS manager to facilitate service delivery at the local school level. Furthermore, CYSOC is considering adopting the Field Crisis Team model, currently used by law enforcement, BHRS and others to collaborate on adults with complex conditions, for children and youth. To ensure that the Measure A funded programs meet the desired outcomes, CYSOC will assume responsibility for monitoring ongoing progress, developing and implementing course corrections, and reporting to the CMO.
Performance Measure(s):
|
Measure |
FY 2013-14 Projected |
FY 2014-15 Projected |
|
Number of truancy, suspensions and expulsion |
Data development |
Data development |
|
Knowledge about and recognition of mental health problems by school personnel and student peers |
Data development |
Data development |
|
Number of hotline calls referred to and receiving services |
Data development |
Data development |
|
Measure |
FY 2013-14 Projected |
FY 2014-15 Projected |
|
Percentage of school personnel referring students with emotional issues |
Data development |
Data development |
|
Percent of students exhibiting positive student behaviors |
Data development |
Data development |
|
Number of families on waitlist for Pre to 3 services |
50 |
20 |
|
Number of referrals from WIC to home visiting programs for identified high risk parent |
4 |
40 |
|
Number of youth ages 15-29 screened, assessed, and treated for bipolar disorder |
0 |
15 |
|
Percent of youth receiving hospitalization for behavioral health conditions |
Data development |
Data development |
|
Percent of transitional age youth who receive at least 1 clinical follow up within 7 days after leaving Psychiatric Emergency Services |
Data development |
Data development |
|
Number of youth successfully completing treatment |
Data development |
Data development |
|
Percent of students that receive timely outpatient behavioral health services |
Data development |
Data development |
|
Percent of school districts that are being supported in meeting the behavioral health needs of students |
Data development |
Data development |
FISCAL IMPACT:
It is recommended that $3,989,139 in Measure A funds be appropriated for the FY 2013-14 budget and $5,325,874 of Measure A funds be appropriated for the FY 2014- 15 budget. The San Mateo Health and the Human Services Agency are able to leverage funds from state and federal sources in the amount of $1,239,924 in FY 2013-14 and
$1,653,232 in FY 2014-15. The County Office of Education is providing matching funds in the amount of $56,250 in FY 2013-14 and $75,000 in FY 2014-15. Attached is a detailed breakout of the costs of each individual proposal and the funding source.
MEASURE A FUNDS RECOMMENDED IN THIS REPORT:
|
Proposal |
FY 2013/14 |
FY 2014/15 |
|
Prevention and Early Intervention |
$3,989,139 |
$5,325,874 |
Attachment I
|
Proposal |
Agency |
FY 2013-14 Measure A Funds |
Other Funds |
FY 2014-15 Measure A Funds |
Other Funds |
|
Parenting Project |
BHRS |
$30,000 |
0 |
$40,000 |
0 |
|
Youth Mental Health First Aid |
BHRS |
$242,871 |
0 |
$323,828 |
0 |
|
HSA-CFS Supportive Hotline |
HSA |
$430,500 |
0 |
$591,220 |
0 |
|
Family Resource Center Expansion |
HSA |
$840,427 |
$452,538 |
$1,120,569 |
$603,383 |
|
School, Police and Community Collaborative- East Palo Alto |
BHRS |
$82,500 |
0 |
$110,000 |
0 |
|
Pre-3/Partners |
BHRS |
$217,629 |
$172,370 |
$290,173 |
$229,827 |
|
Enhancement |
|
|
|
|
|
|
Family |
$405,059 |
$135,020 |
$540,079 |
$180,027 |
|
|
Health |
|||||
|
Early Onset Bi-Polar Intervention |
BHRS |
$297,549 |
$2,450 |
$396,733 |
$,3,267 |
|
Trauma Related Interventions |
BHRS |
$438,900 |
$37,500 |
$575,000 |
$50,000 |
|
Psychiatric Emergency Case Management |
BHRS |
$184,329 |
$108,171 |
$245,772 |
$144,228 |
|
Residential Substance Use Treatment |
BHRS |
$225,000 |
$56,250 |
$300,000 |
$75,000 |
|
Expansion of Outpatient Behavioral Health Services |
BHRS |
$493,125 |
$275,625 |
$657,500 |
$367,500 |
|
Proposal |
Agency |
FY 2013-14 Measure A Funds |
Other Funds |
FY 2014-15 Measure A Funds |
Other Funds |
|
Coordination between schools and County: COE Director and Liaisons |
County Office of Education |
$101,250 |
$56,250 |
$135,000 |
$75,000 |
|
Sub-Total Measure A |
|
$3,989,139 |
|
$5,325,874 |
|
|
Sub Total Other Funds |
|
|
$1,296,174 |
|
$1,728,232 |
|
Total FY 2013-14 $5,285,313 |
Total FY 2014-15 $7,054,106 |
Important note: This is a copy of the official report -- item 3C on the Board's agenda.