r

(

Mental Health Department

SANTA CLARA
icated to the Health

645 South Bascom Avenue

San lose, California 95128

VAUjGY

oi the Whole Community

Tel (408)885-5770
Fax (408)885-5788

HeAim&HOSPITAL SYSTEM

D€RMITMeNTOF
MEI^AL HeALTH

Prepared by:

Soleng K. Tom M.D. gjT.
Medical Director
Teea Gilbert

Mental Health Program'SpecSist II

S II

Reviewed by: Nancy Pena,Deputy Director
Mental Health Department

vl

Martha Paine, Director of Genei

ind

Financial Services, SCVHHS^
Submitted by: Allan Rawland, Director
Mental Health Departmei

April 28, 1999
TO:

Board of Supervisors

FROM:

Robert Sillen, Executive DiTQCtaq~^
Santa Clara Valley Health and Hospital System

SUBJECT:

MENTAL HEALTH-APPROVAL OF FY1998-99 CONTRACT
AMENDMENT WITH ALLIANCE FOR COMMUNITY CARE TO

1)ADD NEW CUSTODY INTENSIVE ALTERNATIVES
PROGRAM, AND 2)AUGMENT EXISTING CRISIS
RESIDENTIAL PROGRAM
RECOMMENDED ACTION

1.

Approve the Department’s recommendation to award funding to Alliance for Community
Care for the provision ofthe Custody Intensive Alternatives Program.

2.

Authorize the Chairperson of the Board of Supervisors to execute the attached FY199899 amendment with Alliance for Community Care to implement the new Custody
Intensive Alternative Program and to expand the Crisis Residential Programs for the
period of May 1,1999, through June 30,1999.

ORIGlii

The Department of Mental Health is a division of the Santa Clara Valley Health & Hospital System. Owned and operated by the County of Santa Clara.
4041

G:\GROUPS\MHEALTH\-TRANSMT\99TRANS\99IAPCR2 April 28,1999

MAY 11 1999

(

(

MENTAL HEALTH-APPROVAL OF FY1998-99 CONTRACT AMENDMENT

April 28,1999
Page!

FISCAL IMPLICATIONS

This action will result in no impact on the General Fund. Funds for this contract amendment are
included in the approved Fiscal Year 1998-99 budget for the Department. This amendment adds
$526,498 to Alliance for Community Care’s FYl998-99 contract, increasing the maximiitii
financial obligation fi'om $14,257,871 to $14,784,369, ofwhich $133,527 is expected to be MediCal/Federal Financial Participation (FFP).

The following fiscal summary table describes the changes implemented by the proposed
amendment:

ALLIANCE

CURRENT

FOR

FY1998-99

COMMUNITY

CONTRACT

CARE

MAXIMUM

AMENDMENT AMOUNT

REVISED
FY1998-99

General Fund

Medi-Cal/FFP

CONTRACT
MAXIMUM

Custody

services $124,034

Intensive

$0

startup $134.750
Total $258,784

$76,445

$335,229

$2,871,135

$134,187

$57,082

$3,062,404

$11,386,736

$0

$0

$11,386,736

$14,257,871

$392,971

$133,527

$14,784,369

Alternatives

Crisis Residential

Other Programs
TOTAL

♦ Startup period is April 1,1999,through May 31,1999
CONTRACT HISTORY

Alliance for Community Care was formed in 1997 with the merger ofthree non-profit community
agencies: Community Companions,Miramonte Mental Health and Avenues to Mental Health,
who iog^er have niahy years of€»cpenehce providing ment^ heallb services. The Mental

Health Department has had an ongoing contract for more than ten years with the three agencies
which comprise the Alliance for Community Care organization.

On September 29,1998,the Board ofSupervisors directed the County Executive to provide a
comprehensive plan and protocol for program and contract monitoring and evaluation to include,
where possible and as appropriate, specific performance indicators(process and outcomes)which
will demonstrate the effectiveness ofdepartment programs and services at improving the well

being ofthe consumers we serve. The Mental H^th Department is planning to bring the plan for
the Board’s review in May.

The contract includes language implementing the Board’s Contracting Principles policy. This is a
Type n contract. Alliance for Community Care has submitted the required materials which are
deemed to be complete and are retained by the Mental Health Department.

A:\99IAPCR2 April 28,1999

{'
MENTAL HEALTH-APPROVAL OF FY 1998-99 CONTRACT AMENDMENT...

May 3,1999
Page 3

REASON FOR RECOMMENDATION

Board approval is requested to approve the Department’s recommendation to award contract

funds to this provider for the provision ofthe new Custody Intensive Alternatives Program.
The Board authorized this funding during the FY 1998-99 Coimty Budget process. An RFP
process was utilized and the Department concurs with the review panel’s recommendation to
award the program to this agency.

Approval is also requested to increase this provider’s current Crisis Residential Program to
implement another critical component ofthe Department’s FYl998-99 Redesign/Reinvestment
Plan. This action will provide additional alternatives to admission to acute care facilities, as well
as an alternative to lengthened hospital/Institute for Mental Disease(IMD)stay. It will increase
available service capacity from 44 beds to 50, and will increase crisis residential program staffing
to adequately manage the severity of mental illness symptoms ofclients referred to the program.
This proposal also includes funds to cover Medi-Cal revenue shortfalls due to significant changes
in Medi-Cal eligibility in the clients who utilize the program.

Board approval is requested to amend the current provider contract to include the two program
components described above.
BACKGROUND

Custody Intensive Alternatives Program

This program concept was developed through an interdepartmental and community planning
process to address the need to provide community based culturally competent services for
mentally ill adult individuals involved in the criminaljustice system. The program objective is
to offer treatment alternatives to incarceration and to decrease, over time,jail bed day use by
mentally ill individuals; and to decrease recidivism ofthese individuals into the criminal justice
system.

The Custody Intensive Alternative program has specific process and outcome measurements that
will be monitored by the Mental Health Department with regular oversight by the Jail Diversion
Task Force(composed ofrepresentatives from the County Executive Office, Mental Health
Department, Drug and Alcohol Program, Department of Corrections, Sheriff Department, Pretrial
Services, Public Defender, Courts, District Attorney, Mental Health Board, Alliance for the
Mentally 111(AMI),Probation Department,Public Guardian, and consumer and family
members).

The program includes three distinct intensive alternative services; the Intensive Community
Case Management Team will provide 24 hour/7 days per week case management, therapy,
medication monitoring, money management and integrated dual diagnosis treatment to mental
health and substance abuse clients; the Structured Day Program will operate five days per
week,including one weekend day, to develop social skills and daily living skills for integrated
dual diagnosis clients; and the Transitional Residential Program will include eight dedicated
beds to be occupied by individuals over a 6-9 month period, which will hopefully decrease, over
time, the jail bed day use by mentally ill clients. When completely operational, the Intensive
G:\GROUPS\MHEALTH\-TRANSMT\99TRANS\99IAPCR2. April 28, 1999

/

r

MENTAL HEALTH-APPROVAL OF FY 1998-99 CONTRACT AMENDMENT...
April 28,1999
Page 5

utilization by reinvesting existing financial resources in a continuum of community-based
residential, case management and treatment services.

The program specific outcome measures for this two- month contract modification are:
1.

Establish a new baseline for average length of stay.

2.

Establish a new baseline for% admitted from an institution compared to % discharged to
the community.

3.

Establish a new baseline for% successfully diverted from hospitalization (i.e., community
admit, community discharge).

The Department plans to use the data gathered from the last two months ofthis fiscal year to
assist in setting the performance expectations for the same serrices for the next fiscal year.
Crisis residential contracts are monitored monthly regarding units ofservice provided versus units
ofservice contracted. Programs are monitored every she months regarding appropriateness of
clients served based on contracted agreement and Mental Health Rehabilitation Option
requirements

Alliance for Community Care is the only provider that has a contract with the Department to
provide crisis residential services in Santa Clara County. In accordance with the community
plarming process recommendations to expand this service component through the existing
provider, on December 18,1998, Alliance was contacted requested to submit a proposal as the
sole source provider. On January 22,1999 and March 1,1999 the Department met with Alliance

to review the proposal,and we have determined the new program will meet the goals set forth by
the Redesign^einvestment Plan.
CONSEQUENCES OF NEGATIVE ACTION

Failure to approve this action will prevent the Mental Health Department from implementing the
Custody Intensive Alternatives Program which offers alternative treatment programs to mentally
ill criminal justice clients and from offering a short term crisis residential services as an alternative
oflower level ofcare for State Hospital and IMD services.
STEPS FOLLOWING APPROVAT.

Clerk ofthe Board:

cc:

Return two conformed copies ofthe contract amendment and
transmittal to the Mental Health Department via SCVHHS.

K. Roberts, M. Hiland, Mental Health Board, J. Doyle(Contractor’s Association)

A:\99IAPCR2 April 28,1999

f

THIRD AMENDMENT TO AGREEMENT FOR MENTAL HEALTH SERVICES,
DATED JUNE 24,1998, BETWEEN COUNTY OF SANTA CLARA AND
ALLIANCE FOR COMMUNITY CARE

This is the Third AMENDMENT to the Agreement for Mental Health Services between the County
ofSanta Clara(COUNTY)and Alliance For Community Care(PROVIDER), dated June 24,1998,
and recently amended on April 27, 1999(Second Amendment). The purpose ofthis Amendment is
to: increase the County’s maximum financial obligation under the Agreement for Fiscal Year 1998-99;
add additional services(Custody Intensive Alternatives Program, Crisis Residential Services)to the
scope ofwork; and add the attached Exhibits A,B,and B-1 which are incorporated by this reference.
IT IS AGREED:
1.

Exhibit A; For Fiscal Year 1998-99, the attached Exhibit A for the Custody Intensive
Alternatives Program: Reporting Unit Grouping(RUG)#1 (Reporting Unit(RU)83146),
RUG #3 (RU 83624), RUG #7(RU 83894); and the attached Exhibit A for the Crisis

Residential Services: RUG #2(RU 43021, 83211, 83011, and 83221) are added to the
Agreement. The attached Exhibit A for the Crisis Residential Program replaces the existing
Exhibit A for such services. Provider agrees to supply the services described in the attached
Exhibits A,in addition to the services set forth in the Agreement dated June 24, 1998, and
subsequently amended.
2.

Exhibit B; The attached Exhibit B Summary Page replaces the Exhibit B Summary Page
which is attached to the Agreement dated June 24, 1998, and subsequent amendments. The
attached Exhibit B and B-1-Estimate of Program Financial Data for Custody Intensive
Alternatives Program is added to the existing Exhibit B. The attached Exhibit B for Crisis

Residential Program replaces the existing Exhibit B for said program.
3.

OBLIGATION OF PROVIDER: The following is added to subparagraph 1.1 Services and
Standards in the Agreement dated June 24, 1998, as amended:

“Provider shall provide Custody Intensive Alternatives Program Services fi-om May 1, 1999,
through June 30,1999. For Fiscal Year 1998-99, County shall pay Provider up to $134,750
for start-up costs incurred after April 1,1999,for the line items identified in Exhibit B-1. The

Provider shall be paid in accordance with the budget in Exhibit B-1. Transfer ofexpenditure
amounts less than 15% among the line items in Exhibit B-1 is permitted; larger transfer
amounts shall require written approval from the Department Director. Purchases made after
May 30, 1999, shall not be compensated.”
4.

COMPENSATION AND BILLINGS: The following is added as subparagraph 2.8.2 in
section 2.8 on Provider Claims for Compensation in the Agreement dated June 24, 1998, as
amended :

“(a) For start-up costs incurred in support of the services for the Custody Intensive
Alternatives Program described in the attached Exhibit A, Reporting Unit Grouping(RUG)
#1 (Reporting Unit(RU)83146), RUG #3(RU 83624), and RUG #7(RU 83894), Provider
shall be reimbursed in accordance with the line items identified in Exhibit B-1. Provider shall

complete an invoice no more than once a month using the format attached to Exhibit B-1 and
return the invoice to the Department to obtain reimbursement.
A:\AMD3ALL.WPD April 20,1999

Page 1

MAY 11 1999

r

(b)

Except as may be otherwise provided in the Agreement, Provider shall furnish and be

responsible for all supplies, furniture, telephones, and equipment necessary for the
performance of this Agreement.

(c)
All personal property, supplies and equipment purchased in full or in part from
payments received under this Agreement and listed on Exhibit B-1 shall become the property
of County, unless otherwise agreed in writing by Provider and Director,

(d)
All personal property, supplies and equipment purchased by Provider in whole or in
part under this Agreement and listed on Exhibit B-1 shall be so identified and marked by
Provider. Provider shall maintain a separate detailed list identifying all such items, together
with the name and address of seller, total cost, and the amount of payment requested, and
shall make such list available to the Director upon request.
Upon termination of this Agreement, Provider shall immediately return all personal
property, supplies and equipment purchased in whole or in part with County funds and listed
on Exhibit B-1 to County, except as may be specified and approved by the Director.

(e)

(f)

Provider shall prepare and submit an annual inventory of all personal property,
equipment, and supplies purchased in whole or in part with County funds and listed on Exhibit
B-1 pursuant to this and previous mental health services Agreements with County. This
inventory shall be provided to County in conjunction with the Annual Fiscal Report.
Donated personal property, including supplies and equipment, shall become the
property ofProvider or such other person or entity specified by donor. Provider shall keep

(g)

accurate records of all such donations, as well as any donations of services. Such records
shall include the identification ofthe donors and an estimate of value. Such records shall be

made available to Director upon written request.

G:\MHEAL’raSHRTDYL\SDLBLR\FY99\AlvID3ALL.WPD April 20,1999

Page 2

(

All other terms and conditions of the Agreement dated June 24, 1998, and amended twice, shall
remain in full force and effect, except to the extent that such terms and conditions may be inconsistent
with the terms and conditions ofthis Amendment.

WITNESS WHEREOF,the parties have executed this Amendment as ofthe date below.
COUNTY

PROVIDER

MAY 11 1999
Date:

Date:

CHAIRPERSON,BOARD OF SUPERVISORS

PETE McHU^

EXECUTI^ DIRECTOR

ALLIAEJ)^FOR COMME

Attest:

PHYl^ A.PEREZ,CLERK
boaM)of supervisors

Approve as to Form and Legality:

DEPUTY COl

COUNSEL

DATE

G;\MHEALTH\SHRTDYL\SDLBLR\FY99\AMD3ALL.WPD April 20,1999

Page 3

TC.

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2nd Modification

March 4, 1999

Exhibit A: Reporting Unit Grouping U2
FY 1998-99

Provider Name: Alliance for Community

Address:

Care

438 N. White Road

San Jose, CA 95127

Reporting Unit #: 83211

Telephone:(408)261-7135; x219

Contact Person: Vonza Thompson
Program Title:

QoveiayZeller Center

Program Address:

436 N. White Road

Telephone:(408)259-0760

San Jose, CA 95127

Program Types:

Crisis Residential

DESCRIPTION OF SERVICES/INTENT & GOALvS:
A1.

System-Wide Program Intent and Goals;
1.

To provide diversion of individuals from admission to psychiatric
hospitalization;

2.

To enable individuals to be discharged earlier than would otherwise
be possible from BAP;

3.

To assist individuals return to the community from IMDs.

A2.

Additional Provider Specific Program Intent and Goals: None

B.

Description of Services and Treatment Methods:

Adult crisis residential services provide therapeutic services in a 24-hour

residential treatment program as an alternative to hospitalization or
institutionalization for individuals who do not present medical complications
requiring nursing care as they are assisted in the stabilization of acute

psychiatric symptoms. Individuals in crisis residential settings are supported
in their efforts to restore, maintain and apply methods which eliminate or
manage psychiatric symptoms, develop interpersonal and independent living
1

(

skills, and access community support systems. These programs are
provided consistent with Title 19, Community Care Licensing. State
Department of Mental Health Social Rehabilitation certificates and MediCal
Rehabilitation Option regulations. This is a structured all-inclusive program
with services available seven days a week. Service activities include
assessment, evaluation, plan development, rehabilitation, collateral and

crisis intervention. Services will be provided based on individuals assessed
needs.

The Crisis Residential programs. SubAcute Residential Treatment(SART);
Goveia/Zeller, Litteral House and Casa San Antonio share services of staff

specifically charged with assisting individuals discharge effectively from the
programs. These staff assist any ongoing Service Provider (e.g.. Service
Team)if the individual is open to another service. They research and initiate
actions and help the individual secure benefits and housing. They provide
the individual, family and Service Provider, as appropriate, with guidance in
following through with lengthy benefits procedures. They are available for
post-discharge consultation to help stabilize housing.
Clients must be ambulatory and free of communicable disease.
II.

POPULATION SERVED
1.

2.

ACTIVE CASELOAD AND
LENGTH OF SERVICE

Target

a. Active Caseload:

14

b. Length of Service:

20 days

c. Annualized Capacity:

252

ETHNIC PROFILE

Target %

White

72

Hispanic

11

Asian

7

African-American
American Indian

8

Other

1

1

2

I

3.

AGE

Target %

0-17

0

18-59

96

60+

4

This service is also available to clients who are open to the Older Adult
or
Division and authorized to this service level by OA Division Director ..

designee with these limitations: 1) no more than two individuals may be
served at any one time in any of ALLIANCE crisis residential programs; 2)

the Older Adult Division and ALLIANCE must agree that the service is
appropriate and the individual can be effectively and safely served in the
program at the time of referral; 3) the 0|der Adult Division assumes
responsibility for transportation to off-site planned appointments and out
placement. All emergency appointments are the responsibility of ALLIANCE.
4.

5.

SERVICE REGION

Target %

North

5

South

0

East

85

West

10

Other

0

DIAGNOSTIC SPECTRUM/INCLUSIONARY CRITERIA

Crisis residential program will provide services to seriously mentally ill
clients whose level of functioning, symptoms, and psychiatric history
necessitate service intervention in order to maintain clients in community
settings to help clients achieve agreed upon desired outcomes and achieve
a sense of their own power and ability to positively influence their own lives.

The diagnostic spectrum includes schizophrenia and other psychotic
disorders, major depression, major affective disorders, post-traumatic stress

disorder, and the dual diagnosed (mental health, developmental disability or
drug and alcohol related diagnosis).

All clients must have an Axis I (DSMIV) diagnosis (majority of clients

diagnosed as having schizophrenia, schizoaffective disorder, major
depression or bipolar disorder).

3

f

III- PROGRAM PERFORMANCE STANDARnR
A.

Referrals;

This service typically admits individuals referred by a Service Team.

Inpatient Unit , ACCESS or other County designated referral services
Program provides 24-hour admissions for all ALLIANCE crisis residential
programs.

Priority access to available space will be given EPS and then to other
referral sources including Inpatient or Authorization Units and Service

Teams.

The service will admit onlyThose individuals who meet the criteria for this
service type established by the Department of Mental Health certification
standards ancT the Department of Social Services licensing standards.

ALLIANCE reserves the right to refuse admission of an individual who, in the

opinion of ALLIANCE cannot be safely or effectively served.

Individuals accepted into this program must have a history of frequent recent

use of 24-hour acute, IMD, ACCESS or EPS services and be able to benefit

from this level of service to increase their level of functioning and to address

the defidencies in functioning that affect their ability to maintain community

In specific instances the County may request services for an individual who

does not have one of the identified diagnoses or a significant history of use
of Intensive Services, but who is currently requiring a significant level of
services from ACCESS. EPS or BAP. The provider shall review these

referrals on a case by case basis and accept such referrals if. in good faith
provider determines service could be effective.

Alliances’ ability to achieve the target established in Section II is directly

related to the level and type of referrals received from County Mental Health.
The Agency will not be held to these targets if the referral pattern from
County Mental Health Division vary significantly from the proposed service
populations targets, particularly as they relate to ethnic and racial
populations and severity levels.
B.

Assessments:

This program is certified as a short-term crisis residential program by the
State Department of Mental Health. Consistent with Section 532 of Title 9,
California Code of Regulations, Individuals admitted to Crisis Residential

Treatment Services must receive a mental health and medical assessment
including a screening for medical complications which may contribute to
his/her disability, within three days prior to or after admission.

C.

Hours of Operation:
1.

System-Wide Requirements:

Crisis residential services are provided 24 hours per day, seven days

per week.
2.

Specific Hours of Operation Plan:

This seivfce is in operation 24 hours per day, seven days per week.
In addition to on site staff there is 24 hour on call professional and
psychiatric staff. Changes to this plan shall be submitted to the
Division Director for approval prior to implementation.
D.

Service Intensity:

All services will be provided in accordance with rehabilitation services
coordinated care requirements. Service activities include assessment

Evaluation, Plan Development, Rehabilitation and Collateral. The prograrri
focus is on the client's recovery from the acute phase of mental illness
achievement of improved functional mental health and development of the
life management skills and necessary financial, social and mental health

support required for stable community living. As most of these clients suffer

from persistent mental illness with recurrent acute crisis, particular attention
IS given to identifying each client's precursors to hospitalization in order to
prevent or decrease future hospitalizations.

The treatment staff at the residential treatment site will work collaboratively
with the Mental Health System Service Teams that coordinate services for

individuals to utilize this service to improve the individual’s community
functioning. Both this service provider and the Mental Health System
Service Team will assist each individual to transition from this intensive
soon as he/she has the stability necessary to function adequately

service as

in a lesser level of care.
E.

Discharge:

This service is time limited by regulation to three months. Any length of stay
beyond one month requires justification documented in the clinical chart.
5

This service is targeted to enable individuals to progress towards a less
restrictive level of care.

The provider may discharge any individual if Provider determines that he or
she cannot be safely served by the program and/or if the individual
represents a danger to other individuals receiving program services If

Provider determines that services provided at the residential site are not
effective in meeting the goals agreed upon for this service, Provider will
confer with the individual’s Service Team to revise service goals or to
effectuate discharge.

Residents may also be discharged for the following reasons;(1) death of
resident;(2) upon refusal of resident to comply with the treatment program(3) tipon resident’s unilateral decision to leave the facility (4) whenever
continued service would violate Title 9 or Title 22 regulations for this service

type.
F.

Administrative Participation;

A suitable representative of the Agency shall attend regularly scheduled
meetings, training sessions, seminars or other meetings as scheduled by the

Director of Mental Health or his/her designee. This includes monthly
Adult/Older Adult System of Care meeting.
IV.

STAFFING REQUIREMFNTS
A.

Minimum Staffing Requirements;

Staffing shall be provided at least at the minimum licensing requirements as

set forth in Title IX, Title XIX, Title XXII and MediCal regulations where
applicable.

B.

Additional Staffing Expectations;

In addition to the above licensing requirements. Program staff is expected

to possess and be trained in the following background and skills;
*

principles of psychosocial rehabilitation
crisis management

6

(

c.

f

Projected Staff Listing;
No. of FTE

Type of
License/Cert.

Language Capability/
Certified Cultural

Competency
1.25

Admin. Assistant 11

.025

Nurse

1.0

Program Manager,

African-American

MHRS
4.0

Clinical Services

African-American (1)

Specialist, MHRS
9.5

Mental Health Workers
II, BA

Filipino (2), African-American
(3), Spanish (.6)

1.0

Clinician, MFCC
Operations Assistant II

Vacant (.5); Spanish (1.0)

.17

Operations Manager

Spanish

.3

Psychiatrist

East Indian

1.5

a:gvzl8321.1
3/4/99

7

2nd Modification
March 4, I999

Exhibit A; Reporting Unit Grouping UJ
FY 1998-99

Provider Name: Alliance for Community
Care

Address: 438 N. White Road
San Jose, CA 95127

Reporting Unit #: 43021

Contact Person: Vonza Thompson

Telephone:(408)261-7135; x219

Program Title: SubAcute Residential Treatment(SART)

Program Address: 578 N. Mathilda Avenue Telephone:(408)746-3919
Sunnyvale, CA 94086
Program Types: Crisis Residential
ASCRIPTION OF SERVICFS/INTFNT/t nnAi cA1.

System-Wide Program Intent and Goals;
1.

To provide diversion of individuals from admission to psychiatric

hospitalization;

2.

To enable individuals to be discharged earlier than would otherwise

3.

To assist individuals return to the community from IMDs.

be possible from BAP;

A2.

Additional Provider Specific Program Intent and Goals; None

B.

Description of Services and Treatment Methodsor

1

access

Programs are provided

consistent with Titte 19*^ Commun«\^Car
intervention. Services will be
needs.

rehabilitation,
collateral
•_! j

assessment.
crisis

provided based on individuals assessed

SSrUBr^tan'dc“A'nTotr h
the individual, family and
“
Prol ®

following through with lenothv bpnpfifc ’ ^PP'’°P'''3t®. with guidance in

post.disLrgetSS?o XllahT^rsing"''^^

Clienis must be ambulatory and free of communicable disease.
POPULATION .gPRupp
1.

active caseload ANn
LENGTH OF SERVICF

Target %

Active Caseload:
Length of Service:

15

40-45 days

Annualized Capacity:
2.

114

ETHNIC PROFII F

Target %
White
75

Hispanic

10

Asian

5

African-American
American Indian

10
0

Other

0

2

(

3.

AGE

Target %
0-17
0

18-59

96

60+

4

Division and ALLIANCE must agree that

Adult

HF=
responsibility of

4.

SERVICE REGION!

Target%
North
South

30
6

East

50

West

14

Other

0

diagnostic SPECTRUM/INCLUSIONARY CRITFpia

iiP&misSi
=?^3=~-=.-=
3

EBOSBAMPERFORMANnF STAMnAono.
A.

Referrals;

Unit E^^'^SeSS of

®

S™nl1rngfnT:t:nr''or Authorization Units and Service
A x._ .

other

Teams.

standards and he

0^00

“rtification

Alliance reserves the riXo rfr,! r'

standards':

opinion of Alliahce, cannot be safely orSveltrefteT''""''
recent

of intensive Services btt v^tol Sen,IIn ^

services from EPS ACCESS or rap n ''“"''og a significant level of

referrals on a case bV^se ba!is
'’r"'®''
provider determines service could be effeSlte
pattern from the Mental Health Dpnartrll ?
B.

'^ese

targets if the referral

Assessments:

sLrS=~?SS~H«

Treatment Services must receive a mental health and medical assessment
c.

Hours of Operation;
1.

System-Wide Requirements:
Crisis residential services
per week.

2.

are provided 24 hours per day. seven days

Specific Hours of Operation Plan;

24 hours per day, seven days per week

In addmon to on site staff there is 24 hour on call professional and
psychiatric staff. Changes to this plan shall be submitted to the

Division Director for approval prior to implementation
D.

Service Inlensity:

iiisiiipsss
achievement of improved functional mental health'S^d Lvetoimim ofThe
IS

functioning Both the Cri^s ReXlral'Sirge
necessary to function adequately in a lesser level of care.
E.

^

Discharge;

This service is time limited by regulation
. to three months. Any length of stay
requiresjustification documented in the client chart. This

beyond one month

5

LT''?

individuals to progress towards a less

restrictive level of care.

in:
s
bv m?'
represents a danger to other inJLidi

'’®
individual

or

Provider determines

^^rvices. If

effective in meeting the qoals anrppH nr. f

®it® are not

confer with the individual’s Service Teaeto^reviL^^'^'^’
^ ° revise service goals or to

effectuate discharge.

r«&"'?efu"salTeS?o

<^>program;
''®®'h ®f
treatment
(3) upon resident's unilateral decision^Tave'IS**.*
»minued senrice would violate Title 9 or Title 22 regulSo'r'mr"®''"’
service

F.

Administrative Participation;

leC

®«®®'^ ^®9-'-'y scheduled

Director of MTotal HTaUh

Aduigoider Adult Systenl of Care meetinrs'®"®^'
IV.

'he

STAFFING REQUIRFMFMtq
A.

Minimum Staffing Requirements:
as

applicable.
B.

’

Additional Staffing Expectations;

^

principles of psychosocial rehabilitation,
crisis management

6

regulations, where

I

{

c.

Projected Staff Listing:
No. of FTE

Type of
License/Cert.

Language Capability/
Certified Cultural

Competency
1.25

Admin. Assistant ii

.025

Nurse

1.0

Program Manager,
MHRS

4.0
9.5

Clinical Services
Specialist, MHRS

Mental Health Workers
II, BA

Spanish (1)

Japanese-American (1)
Filipino (2), African-American
(3), Spanish (.8)

1.0

Cjiolcian, MFCC

1.5

Operations Assistant Ii

Vacant

Operations Manager

Spanish
East Indian

.17
.3

Psychiatrist

a:sart4302.1
3/4/99

7

2nd Modification
March 4, 1999

Exhibit A; Reporting Unit Grouping
FY 1998-99

Provider Name: Alliance for Community
Care

Address: 438 N. White Road
San Jose, CA 95127

Reporting Unit #: 83221

Contact Person: Vonza Thompson

Telephone:(408)261-7135; x219

Program Title: Casa San Antonio

Program Address: 20tS. 13th Street
San Jose, CA 95112

Telephone:(408)297-0929

Program Types: Crisis Residential
description of SERVICES/INTENT;^ nr>Ai cA1.

System-Wide Program Intent and Goals;
1.
2.
3.

To provide diversion of Individuals from admission to psychiatric
hospitalization;

To enable individuals lo be discharged earlier than would otherwise
be possible from BAP;

To assist individuals in their return to the community from IMDs.

A2.

Additional Provider SpecWc Program Intent and Goals; None

B.

Description of Services and Treatment Methods'
or

1

r

independent living skills and annes

interpersonal and

progrLs are prZS'^p 4'^“^^;:";9"coZ'’°7 T^T

BESHrlT
SSSS-S
with services available seven dl^L a w/ir Se™-^"‘'"1“^'''®
and

=rss£7ir~^
Sve'iSiteruttelLtHZe ani

(SART)-

Irnlan^S;rr^:°^;j°“^
the individual, family and S^ce Prnler f

following through with lenqthv benefits nr ^PP^P^®*®’ with guidance i..
in

pcst-discharge®consu;L^trrh:rsSbX^^^^^^^^

II.

POPULATION .qFRX/Pn
1.

active CASFl nzin AMp
LENGTH OF .SFRVirg

Active Caseload:
Length of Service:

9

20 days

Annualized Capacity:
2.

126

ETHNIC PROFll F

Target %
White
62

Hispanic

15

Asian

10

African-American
American Indian

10
1

Other

2

2

(

3.

AGE

Target %
0-17
0

18-59

100

60+

0

This service is limited by Community Care Licensino regulation to serving

individuals who are 18 to 59 years of age.
4.

^

SERVICE REGIONi

Target%
North
10

South
East
West

2
77
11

Other

0

DI^NOSTIC SPECTRIiM/iNCLUSir>MAPY CRITERIA
Crisis residential

clients whose leverS^fUnctionim'^Imo^^

seriously mentally III

necessitate service intervention in orde^r tojnamtain
mafntein clients in community

settings to help clients achieve anrooH

psychotic

post-traumatic stress

developmental disability or

drug and alcohol related diagnosis).

depression or bipolar disorder).^

'

disorder, major

EBQGRAM performance STANnAPncA.

Referrals;

This service typically admits individuals referred hv =>

Sn.rottifb^on&
programs.
3

•

-r

^ alliance crisis residential

r

^r- A .u •

- Other

or Authorization Units and Service

Teams.

T.
'hstandards and the Department of^rtni^TL”^ Mental Health certification

alliance reserves the riqhZifl®°H^

"“"='"9 ^'^"dards.

opinion of ALLIANCE, cannot be safely or effectively seVUV^"'^''
Vse oVS^raTe
^
'-''-nt recent

from this level of ser^i ™ToSe

to benefit

level offunctioning and to address the

t^e'r

their ability to martain ^mln“y nfe

^^^dt

d"o:rnofhiro:?:f7h;id°eS^^^^^^

of Intensive SerViSs but wVo H V ST h

who

of use
^ significant historylevel

of
services from EPS ACCESS or BAP d,^^®9t"r'og a Significant these
referrals on a case by «se basis and a^c.!T T'f' ^^'''^w

provider determines service could te effeSire

iHl=5:ss-“=
•

population targets.

e.

-r-

pattern from

vary significantly from the proposed service

Assessments:

This program is certified

Treatment Services must receive a mentafh

Residential

=r.;sars.=~s==
C.

Hours of Operation;
1.

System-Wide Requirements:
Crisis residential
per week.

services are provided 24 hours per day, seven days
4

i.

2.

D.

Specific Hours of Operation Plan-

Service Intensity;

trrs™rrESfT
support required for stable community Xing aL moXofthelT'f "
from
persistent mental illness with reatrrentacutex .“siX Particular
oartLlarau
attention
IS given to identifvina eanh riitinfc

prevent or-qec^eX^lfum htpIXS^"

^thtSSafHeaimlyXternS^rti^^^^^^^
and the Mental Health System SeXiS

transition from this intensfe serCITas

*0

's hlXlT

Provider

necessary to function adequately in a lesser level ofire
E.

Discharge:

ifs;===i:=:=
"
b^sl^S bv''',h

or

J^ntaued service would violate Title 9or Title 22 regulations'fL this ser^ii'
F.

Administrative Participation:

Adult/Older Adult SyLm of Care
IV.

staffing REQUIRFMFMT.q
A.

Minimum Staffrng Requirements:

sss'itTS“xrrS:^"Krs£ri.
as

B.

Additional Staffing Expectations:

*

principles of psychosocial rehabilitation
crisis management

C.

Projected Staff Listing:
No, of FTE

Type of
License/Cert.

Language Capability/
Certified Cultural

Competency
1.0

Program Manager, MHRS

1.25

Admin. Assistant II

.025

Nurse

4.0

Clinical Services

7.5

Mental Health Worker
II. AA

.5

1.5

Clinician, LMFCC
Operations Assistant II
6

African American (3)
Vacant

No. of FTE

Type of
LIcense/Cert.

Language Capability/
Certified Cultural

Competency
.16

.176

Operations Manager
Psychiatrist

a:casa8322.1
3/4/99

7

Spanish

/"

c

2nd Modification
March 4, 1999

JExhibit A; Reporting Unit Grouping #2
FY 1998-99

Provider Name: Alliance for Community
Care

Address: 438 N. White Road
San Jose, CA 95127

Reporting Unit #: 83011

Contact Person: Vonza Thompson

Telephone:(408)261-7135; x219

Program Title: Litteral House

Program Address: 96 S. 14th Street
San Jose, CA 95112

Program Types:
I.

Telephone:(408)998-3293

Crisis Residential

description of SERVICES/INTENT & GOAi SA1.

System-Wide Program Intent and Goals:
1.

To provide diversion of individuals from admission
hospitalization;

2.

to psychiatric

To enable individuals to be discharged earlier than would otherwise
be possible from BAP;

3.

To assist individuals in their return to the community from IMDs.

A2.

Additional Provider Specific Program Intent and Goals; None

B.

Description of Services and Treatment Methods;

Adult crisis residential services provide therapeutic services in a 24-hour
residentia treatment program as an alternative to hospitalizalL
inst tutionalization for individuals who do not present medical complications
or

'''

stabilization of acute

f Individuals
residential
settings are supported
in their efforts to restore,
maintainin crisis
and apply
methods
which eliminate or
1

I

Stmf
'n'®n=®^»nal
andnmAromo
independent
living skills, and access community support systems
Thncp

«=rss„'sss=„r=s.r£s

g|s?r,s'=?sssr.t;n.“ia
the

r
-““a^“'SSS
followinXougrw^^
post-discharge consultation to help stabilize housing

available for

Clients must be ambulatory and free of communicable disease.
POPULATION SERVFD
1.

ACTIVE CASELOAD AND
LENGTH OF SERVICE

Target

a. Active Caseload:

12

b. Length of Service:

20 days

c. Annualized Capacity:
2.

134

ETHNIC PRQFILF

Target%
White
67

Hispanic

14

Asian
8

African-American
American Indian

10
1

Other

0

2

/

3.

AGE

Target %
0-17
0

18-59
100

60+

0

This service is limited by Community Care Licensing regulation to serving

individuals who are 18 to 59 years of age.
4.

.SERVICE REGION

Target %
North
South

20
5

East

60

West

15

Other

0

diagnostic SPECTRUM/lMCLUSinMARV PPITCD..
services to seriously menially ill

The

^

rr

i"«®ence their ot^Tes

rd^umrrs
or

Zanc^lri

diagnosis (majority of clients

as having schizophrenia, schizoaffective disorder

depression or bipolar disorder).

'

major

program performance STANDARDS
A.

Referrals;

This service typically admits individuals referred by a Service Team

Inp^ent Unit ACCESS or other County designated refemal se^feS Zelter

Sr;SSp^r““
3

community?^:

(

TeZt

*° available space will be given lo EPS and then to other

A'^'ho^^ation Units and Serlte

The service will admit only those individuals who meet the criteria for this
standards and the Department of Social Services licensinq stanS^

l^idividJa “wbrnT'*''

admission of

an

individual, who in the opinion of Alliance for Community Care cannot be
safely or effectively served.
P''°9^3m must have a history of frequent recent

^evefnf
^e able to beneffl
"
fr
leve of service to stabilize psychiatric symptoms,
increase their level of

functioning
and to address the deficiencies in functioning thScUhei
ability to maintain community life.

request services for an individual who

does not have one of the identified diagnoses or a significant history of use
^

provider shall review these referrals on a

case by case basis and accept such referrals if. in good faith’ ^provider
determines service could be effective.
'^® ‘^'■9®' established in Section II is directly

relat^ lo the level and type of referrals received by County Mental Health^
The Agen^ will not be held to these targets if the refemalpaWern varies

significantly from the proposed service population targets
B.

Assessments:

This program is certified as a short-term crisis residential program by the
State Department of Mental Health. Consistent with Section 532 of Tito 9

California Code of Regulations, Individuals admitted to Crisis

Treatment Services must

^

Residential

and medical assessment

me uding a sCTeening for medical complications which may contribute to

his/her disability, within three days prior to or after admission.

4

c.

Hours of Operation:
1.

System-Wide Requirements;
Crisis residential services
per week.

2.

are provided 24 hours per day, seven days

Specific Hours of Operation Plan;

operation 24 hours per day. seven days per week

In addition to on site staff there is 24 hour on call professional and

psychiatric staff. Changes to this plan shall be submitted to the
Division Director for approval prior to implementation.
D.

Service Intensity:

^ordrJ!?d
o'"*" requirements. accordance
with rehabilitation
services
coordinated care
Service activities
include
Assessment

Evaluation. Plan Development, Rehabilitation and Collateral The program
focus IS on the client's recovery from the acute phase of mentarillnes^
achievement of improved functional mental health and development of the
life management skills and necessary financial, social and mental health
from^r'T'T"^
' ' ‘■ng- As most of these clients suffer
from persistent
mental
illness
with
X
.
recurrent acute crisis, particular attention
nrpvin?
to Identifying each client's precursors to hospitalization in order to
prevent or decrease future hospitalizations.
IS

residential treatment site will work collaborativelv/

n
u®"""
Teams. Both this se“i“ wt
transhion Ifromt fh";"^^^[’Sive service as soon as he/she has individual
to
the stability

necessary to function adequately in a lesser level of care.
E.

^

Discharge;

''T

regulation. Any length of stay

clinical chai/

Thfs ifr,
requires
justification
documented in the
This
service is targeted
to enable
individuals
to progress towards

restrictive level of care.

a less

■me provider may discharge any individual if Provider determines that he or

she cannot be
j safely served by the program and/or if the individual

represents a danger to other individuals receiving program services If

Provider determines that services provided at the residentSi slte ^e nc;[
5

reasons; (1) death of

service would violate Title 9 or Title 22 regulations for this ser^^e
F.

IV.

Administrative Participation;

STAFFING REQUIREMFNTS
A.

Minimum Staffing Requirements;
as

B.

Additional Staffing Expectations;

In addition to the above licensing requirements, Program staff is expected

to possess and be trained in the following background and skills
knowledge and skills in the principles of psychosocial rehabilitation.
C.

Projected Staff Listing;
No. of FTE

Type of
License/Cert.

Language Capability/
Certified Cultural

Competency
1.0

Program Manager, MHRS

1.25

Admin. Assistant il

.025

Nurse

4.0

Clinical Services

6

c

No. of FTE

Type of
License/Cert.

Language Capability/
Certified Cultural

Competency
7.5

Mental Health Worker
II, AA

1.5

Spanish (2), Vietnamese (1)

Operations Assistant II

.16

Operations Manager

.175

Psychiatrist

a;lttt8301.1
3/4/99

7

Spanish

(

Exhibit A: Reporting Unit Grouninr] a 7
FY 1998-99

Provider Name: Alliance for Community
Care

Address: 438 N. White Road
San Jose, CA 95127

Reporting Unit #: 83894

Contact Person: Vonza Thompson

Telephone:(408)261-7135

Program Title: Alliance - Alameda - lAP Day Rehabilitation
Program Address: 2001 The Alameda
San Jose, CA 95126

Program Type: Day Rehabilitative
I.

Telephone:(408)261-7777

- Full Day Program (Adult & Older Adult)

ASCRIPTION OF SERVICE/INTENT/innAi q
A1.

Program Intent and Goals;

m Th^ WP^H
'he Intensive Alternative Program
tnisdemeanant and non-serious
te purpose
pumie ISs to divert appropriately
P^Vehiatric diagnosis
of major
mental
illness,
identified
inmates
from
thp
criminal/correctional system into the mental health system, where supervised

S^nv offindJf

community services can more effectively treat mental illness
A.2

Additional Provider Specific Program Intent and Goals;

The lAP Day Rehabilitation program is designed to serve clients who

flSTl

(ICCMT)and who need this

are

Management Treatment Team

service to develop the skills and resources to

live in the community and to avoid legal problems.
Alliance will provide the following information;

The number of individuals who have been diverted from incarceration.

1

f

The number of individuals who received alcohol and substance abuse
services from this service or to whom these services are arranged

assessed to be in need of thLe

•

Utilization management, including age, ethnicity, language and

culture of clients served.

•

The number of individuals who “failed” and a summary of the reasons.

The length of time between referral and the time client begins service.

average and range.
•

^

Length of stay.

Number and types of units of service provided by the program.
B.

Description of Services and Treatment Methods;

rehabilitation services are organized and structured full day programs

^^rtrnT^rf
^
Coordinated Services guidelines.

'"'^'''W^als operating under the

lAP Day Rehabilitation services are intended to serve individuals who

require assistance to learn the skills and develop the supports to
effectively in the community and not commit violations of the law.

Servi^s will include, but are not limited to. Assessment, Evaluation Plan

velopment Psychotherapy, Rehabilitation and Collateral to meet

stabilthf n

health
developing financial, social and
mental
reduce need for

hospitL^izatio^^^^® community tenure and significantly

POPULATION SERVFnA.

ACTIVE CASELOAD ANin
LENGTH OF SERVICE

Active Caseload:
Length of Service:

3-4 months

Total Clients ServedA^ear:

60

15

2

t

B.

ETHNIC PRQFII F

Target %

White

50

Hispanic

16

Asian

9

Black

C.

25

American Indian

1

Other or Missing

2

AGE

Target %

0-17

0

18-59

59

60+
D.

1

SERVICE REGION

Target %

North

15

South

8

East

60

West
E.

17

DIAGNOSTIC SPFCTRUM/INCLllSiONARY rpiTPPiA
seriously menially ill clients whose

level of functioning, symptoms, and psychiatric history necessitate service
intervention in order to maintain clients in community settings and in order
to help clients to achieve agreed upon desired outcomes and to achieve a

sense of their own power and ability to positively influence their own lives

The diagnostic spectrum includes schizophrenia and other psychotic

disorders, majOT depression, major affective disorders, post-traumatic stress
disorder and the dual diagnosed (mental health, developmental disability
or

drug and alcohol related diagnosis).
PERFORMANCE STANnARn.q
A.

Referrals:

The Day Rehabilitation program will accept clients referred jointly bv the
Discharge Planner and ICCMT . Admission will require Coordination Plan

approval for this planned service from the ICCMT.

3

I

B.

Assessments;

wniplete an assessment for each client that

;rp::t:";^ornS“^
Provider will assess all clients at intake, using the Functional Assessment
Scale. Additionally, clients will be re-assessed
at discharge and/or at six
month intervals, as applicable.
C.

hours of OPERATiriM
1.

System-Wide Requirements:

( )hours of structured programming every day program operates.
2.

Specific Hours of Operation Plan:

Monday through Saturday: 1:00 p.m. through 6:00 p.m.
Changes to this plan shall be submitted to the Division Director for

approval prior to implementation.
D.

Service Intensity:

and

cSraf^Tre'cmn^^mT"'’
D®''®l®Pnient,
,^nr^
program will focus on the
individual’sRehabilitation
development of
LkHk

functional mental health and development of the life management

skills and necessary finandal, social and mental health support required for

stable community living.

collaboratively with the lAP

Discharge Planner, ICCMT and Transitional Residential Servfca

4

E.

Discharge:

™s^rvice is time limited by intent. Staff will work collaboratively with the

ICCMT to discharge individuals appropriately.
F.

Administrative Participation:

A suitable representative of the Agency shall attend regularly scheduled

meetings, training sessions, seminars or other meetings as scheduled bv the
Director of Mental Health or his/her designee This includes monthly
Adult/Older Adult System of Care meetings.
IV.

STAFFING REQUIREMFNT.9
A.

Minimum Staffing Levels:

Staffing shall be provided at least at the minimum licensing requirements as

set forth in Title IX, Title XIX, Title XXII and MediCal regulations where
applicable or at such higher level as necessary for some programs.

B.

Additional Staffing Expectations:

In addition to the above licensing requirements. Program staff is expected

to possess and be trained in the following background and skills:

^

knowledge and skills in the principles of psychosocial rehabilitation-

paraprofessional staff are expected to be trained and receive from the

Departments Quality Improvement Division paraprofessional

certification within the first six months of employment.
C.

Projected Staff Listing:

No. of FTE

Type of

Language Capability

License/Cert.
.333
.50

Certified Cultural Competency

lAP Manager

Asst Program Manager

2.0

Clinical Services

2.0

Specialist. MHRS
Mental Health Worker II

.5

Admin Asst 11

2.0

Mental Health Worker I
a;dayrehab.iap
3/12/99
5

Exhibit A: Reporting Unit Grouping
FY 1998-99

Provider Name: Alliance for Community

Address: 438 N. White Road

Care

San Jose, CA 95127

Reporting Unit #: 83624

Contact Person: Vonza Thompson

Telephone:(408)261-7135, x219

Program Title: lAP Transitional Residential(TR)
Program Address: 230 N. Morrison Street
San Jose, CA 95126

Program Types: Adult Transitional Residential
I.

DESCRIPTION OF SERVICES/INTFNT & GOAI .S
A1.

System-Wide Program Intent and Goals;

^is se^ice is one of five components of the Intensive Alternative Program

(lAP). The lAP was developed for specified misdemeanant and non-serious
felon offenders who carry a psychiatric diagnosis of major mental illness [Its
purpose IS to divert appropriately identified inmates from the

criminal/correctional system into the mental health system, where supervised

community services can more effectively treat mental illness.
A2.

Additional Provider Specific Program Intent and Goals
1.

The lAP TR program is designed to serve clients who are open to the

l/^ Intensive Community Case Management Treatment Team

(ICCMT) and who need this service to develop the skills and
resources to live in the community and to avoid legal problems
2.

The TR program will participate in evaluation activities as part of the
lAP. Alliance will provide the following information:

The number of individuals who have been diverted from
incarceration.
1

i

The increase in level of functioning as measured by the
Functional Assessment Scale (FAS).
The number of individuals who received alcohol and
substance abuse services compared to the number who were
assessed to need these services.

Utilization management, including age, ethnicity, language and

culture of clients served.

The number of individuals who have “failed” and a summary of

the reasons.

The length of time between referral and admission to service.
average and range.

Length of stay.

•
B.

Number and types of units of service provided by the program.

Description of Services and Treatment Methods:

The TR program provides rehabilitation services in a non-institutional
residential setting where individuals are supported in their efforts to restore,
maintain and apply interpersonal and independent living skills and access
community support systems. Within the therapeutic community there are a
range of activities and services for individuals who would be at risk of return

to incarceration if they were not in the residential treatment program. The
program operates in compliance with Title 19. Title 22 and the MediCal
Rehabilitation Option.

Clients must be ambulatory and free of communicable disease.
POPULATION SERVED
1.

ACTIVE CASELOAD AND
LENGTH OF SERVICE

Target

a. Active Caseload:

8

b. Length of Service:

6-9 months

c. Annualized Capacity:

16

2

2.

ETHNIC PRQFII F

Target %

White

50

Hispanic

16

Asian

9

African-American
American Indian

25
0

Other
3.

0

AGE

Target %

0-17

0

18-59

94

60+
4.

6

SERVICE RFGinN

Target %

North

10

South

10

East

65

West

15

'
Because this service is very specialized it is “county-wide”. The percent
served from each region reflects the historical referral patterns.
5.

DIAGNOSTIC SPECTRUM/INCLUSIQNARY f^PiTPPiA

Adult residential program will provide services to seriously mentally ill clients
whose level of functioning, symptoms, and psychiatric history necessitate
se^ice intervention in order to maintain clients in community settings and in

order to help clients to achieve agreed upon desired outcomes and to

achieve a sense of their own power and ability to positively influence their
own lives. The diagnostic spectrum includes schizophrenia and other
psychotic disorders, major depression, major affective disorders posttraumatic stress disorder, and the dual diagnosed (mental health.
developmental disability or drug and alcohol related diagnosis).

All clients must have an Axis I (DSMIV) diagnosis (majority of clients

diagnosed as having schizophrenia, schizoaffective disorder major

depression or bipolar disorder).

3

c
III. PROGRAM PERFORMANCE STANDARDS:
A.

Referrals;

The TR program will accept clients referred jointly by the Discharge Planner
and ICCMT. Admission will require Coordination Plan approval for this
planned service from the ICCMT.

Alliance’s ability to achieve the targets established in Section II is dependent
on the level and type of referrals received from the lAP Discharge Planner.
The agency will not be held to these targets if the referral pattern from the
Discharge Planner varies significantly from the proposed service population,
particularly in relation to ethnic and racial characteristics of referrals.
B.

Assessments:

This program is certified as an adult transitional residential program by the
State Department of Mental Health. Consistent with Section 532 of Title 9,
California Code of Regulations. Individuals admitted to Adult Residential

Services must receive a mental health and medical assessment, including
a screening for medical complications which may contribute to his/her

disability, within 30 days prior to or after admission. The TR program do the
required medical and mental health assessments.
C.

Hours of Operation:
1.

System-Wide Requirements:

Adult residential services are provided 24 hours per day, seven days
per week.
2.

Specific Hours of Operation Plan:

This service is in operation 24 hours per day, seven days per week.
In addition to on site staff there is 24 hour on call professional staff.
Changes to this plan shall be submitted to the Division Director for
approval prior to implementation.
D.

Service Intensity:

Service activities include Assessment, Evaluation, Plan Development,
Rehabilitation and Collateral. The program will focus on the individual’s

development of improved functional mental health and development of the
life management skills and necessary financial, social and mental health
support required for stable community living.
4

(

TR staff will work collaboratively with the lAP Discharge Planner, ICCMT and
Day Services.
E.

Discharge;

This service is time limited by regulation and by intent. Staff will work

collaboratively with the ICCMT to discharge individuals appropriately.
If Provider determines that services provided at the residential site are not
effective in meeting the goals agreed upon for this service, Provider will

confer with the individual’s Service Team to revise service goals or to
effectuate discharge.

ALLIANCE may discharge any individual if it determines that they cannot be
safely served by the program in compliance with Title 9, and Title 22.
Examples of Title 9 and 22 violations are;

•

If client is verbally or physically threatening to staff, other clients or
property.

•

If client is found with drugs or alcohol in the program.

•

If client returns to the program under the influence and client’s
behavior is problematic.

•

If client is found possessing weapons at the program.

•

If client violates the conditions of his/her parole, probation or SORP.

If any individual has to be discharged based on violations regarding Title 9,
or Title 22 regulations, the Discharge Planner, the appropriate other criminal
justice agency staff responsible for individuals care will be contacted

assuming that these individual’s are available seven (7) days a week; 24hours a day.

Residents may also be discharged for the following reasons;(1) death of
resident; (2) upon refusal of resident to comply with the service plan; (3)
upon resident’s unilateral decision to leave the facility; (4) whenever

continued service would violate Title 9. 19 or Title 22 regulations for this type
of service.

5

F.

Administrative Participation:

A suitable representative of the Agency shall attend regularly scheduled
meetings, training sessions, seminars or other meetings as scheduled by the
Director of Mental Health or his/her designee. This includes monthly
Adult/Older Adult System of Care meetings.
IV.

STAFFING REQUIREMENTS
A.

Minimum Staffing Requirements:

Staffing shall be provided at least at the minimum licensing requirements as
set forth in Title IX, Title XIX, Title XXII and MediCal regulations, where
applicable.
B.

Additional Staffing Expectations:

In addition to the above licensing requirements. Program staff is expected
to possess and be trained in the following background and skills:
principles of psychosocial rehabilitation;
substance abuse treatment

C.

Projected Staff Listing:
No. of FTE

Type of

Language Capability/

License/Cert.

Certified Cultural

Competency
.333
.5

lAP Manager
Asst Program Manager, MHRS

1.0

Clinical Services

2.0

M.H. Worker 11

.5

Operations Asst 11
Psychiatrist

Specialist, MHRS

.25

artmsresi.iap
3/18/99

6

Exhibit A: Reporting Unit Grouping
FY 1998-99

Provider Name: Alliance for Community
Care

Reporting Unit #: 83146

Address: 438 N. White Road
San Jose, CA 95127

Telephone:(408)261-7135, x219

Contact Person: Vonza Thompson

Program Title: Intensive Community

Program Type: Adult Service Team

Case Management Treatment
Team (ICCMT)

Program Address: 2001 The Alameda

Telephone:(408)261-7777
On-Call: 1 (800)550-6121

San Jose, CA 95126

DESCRIPTION OF SERVICES/INTENT AND GOAI SA1.

System-Wide Program Intent and Goals;

^is semce IS one of five components of the Intensive Alternative Program

(lAP). The lAP was developed for specified misdemeanant and non-serious
felony offenders who carry a psychiatric diagnosis of major mental illness
Its purpose is to divert appropriately identified inmates from the

criminal/correctional system into the mental health system, where
appropriate supervised community services can more effectively ireat mental
A2.

Additional Provider Specific Program Intent and Goals;
1.

The lAP ICCMT program is designed to serve clients who are referred

by the lAP Discharge Planner and who need this service to develop

the skills and resources to live in the community and to avoid leqal
problems.

2.

^

■me ICCMT program will participate in evaluation activities as part of

the lAP. Alliance will provide the following information;

1

(

(,

The number of individuals who have been diverted from
incarceration.

The increase in level of functioning as measured by the
Functional Assessment Scale (FAS).
The number of individuals who received alcohol and
substance abuse services from this services or to whom

these services are arranged by this program compared to the
number who were assessed to be in need of these services.

Utilization management, including age, ethnicity, language and
culture of clients served.

The number of individuals who “failed” and a summary of the
reasons.

•

The length of time between referral and the time client begins
service, average and range.

B.

•

Length of stay.

•

Number and types of units of service provided by the program.

Desaiption of Services and Treatment Methods:

The ICCMT program provides outpatient mental health services within the

requirements of the MediCal Rehabilitation Option. Available treatment

methods include crisis intervention, individual, group, collateral and family
services, assessments, evaluations, medication support services,

rehabilitation services, case management/brokerage services and money
management.

POPULATION SERVED:
A.

Active Caseload and

Target

Length of Service
Active Caseload:

100

Length of Service:

6-9 months

Total Clients ServedA^ear:

200

2

r

r

B.

C.

D.

Ethnic Profile

Target %

White

50

Hispanic

16

Asian

9

African-American
American Indian

25
0

Other or Missing

0

Age

Target %

0-17

0

18-59

98

60+

2

Service Region

Target %

North}
South}
East}
West}

See below

Alliance for Community Care is responsive to individuals’ mental health
needs 24 hours daily as needed independent on where and how consumers

live in the community. Service Teams will follow individuals across regional

boundaries, County-wide as needed, consistent with individual choice. The
focus of service delivery, however, will be the East and Downtown areas of
Santa Clara County.
E.

Diagnostic Spectrum/Inclusionarv Criteria

ICCMT will provide services to seriously mentally ill clients whose level of
functioning, symptoms, and psychiatric history necessitate service

intervention in order to maintain clients in community settings, to help clients

to achieve agreed upon desired outcomes and to achieve a sense of their

own power and ability to positively influence their own lives. The diagnostic
spectrum includes schizophrenia and other psychotic disorders, major
depression, major affective disorders, post-traumatic stress disorder, and the
dual diagnosed (mental health, developmental disability or drug and alcohol
related diagnosis).

3

PROGRAM PERFORMANCE STANDARDS:
A.

Referrals;

The ICCMT program will accept clients who meet the requirements of the
lAP target population and agree to receive lAP services and are referred by
the Discharge Planner

Alliance’s ability to achieve the targets established in Section II is dependent
on the level and type of referrals received from the lAP Discharge Planner.
The agency will not be held to these targets If the referral pattern from the
Discharge Planner varies significantly from the proposed service population,
particularly in relation to ethnic and racial characteristics of referrals.
B.

Assessments:

ICCMT will do an initial assessment of each client referred by the County
Discharge Planner.

Provider will assess all clients at intake using the Functional Assessment
Scale. Additionally, clients will be reassessed at discharge and/or at six
month intervals, as applicable.
C.

Hours of Operation:

System-wide Standard: The ICCMT is expected to provide 24-hour services
to meet the needs of each individual assigned to the Service Team.
D.

Service Intensity;
The program will focus on the individual’s development of improved
functional mental health and development of the life management skills and

necessary financial, social and mental health support required for stable
community living. Services will be provided in various locations in the
community. When an individual is assessed to need additional services
he/she will be assessed for admission to the lAP Transitional or Day Service.
E.

Discharge;

This service is intended to provide services from about six to nine months.

ICCMT staff will work collaboratively with the justice system, client, other
mental health services and drug and alcohol services to effectively transfer
the individual to less intensive services for continued treatment and support.
4

F.

Administrative Participation;

A suitable representative of the Agency shall attend regularly scheduled
meetings, training sessions, seminars or other meetings as scheduled by the
Director of Mental Health or his/her designee. This includes monthly
Adult/Older Adult System of Care meetings.
IV.

STAFFING:
A.

Minimum Staffing Requirements:

Staffing shall be provided at least at the minimum licensing requirements as
set forth in Title IX, Title XIX, Title XXII and MediCal regulations where
applicable or at such higher level as necessary for some programs.
B.

Additional Staffing Expectations;

In addition to the above licensing requirements. Program staff is expected
to possess and be trained in the following background and skills:

knowledge and skills in the principles of psychosocial rehabilitation;
paraprofessional staff are expected to be trained and receive from the

Department’s Quality Improvement Division paraprofessional
certification within the first six months of employment;
capability of addressing the diverse clients’ levels of acculturation and
biculturality;

*

capability of language and cultural competency;
knowledge of multicultural experience;

knowledge of the local community resources available to the client

population, including networking with ethnic community resources to
meet the specific needs of the consumer;

Capability of strong collaboration/coordination with local providers of
health and human services in the community.
C.

Projected Staff Listing:

No. Of FTE

Type of

Language Capability/Certified
Cultural Competency

License/Cert.
.333

lAP Manager

1.0

Clinician II

5.0

Clinical Services Spec

1.0

Mental Health Worker I

5

No. Of FTE

Type of

Language Capabitity/Certified
Cultural Competency

LIcense/Cert.
1.0

Administrative Asst II

.50

M.D.

a:iccmt
3/12/99

6

EXHIBIT B

" yVIARY PAGE

FISCAL YEAR 99

July 1,199a>June30,1999

AGENCY NAME:ALLIANCE FOR COMMUNITY CARE

REPORTING UNIT GROUP# 1 ADULT SERVICE TEAM

mI1!I

^

residential

* 3 ADULT TRANSITIONAL RESIDENTIAL

REPORTING SnS GROUP# ^ ADULT DAY REHABIUTATIVEnNTENSIVE
®«"«c«*-R9*klentlaUHouslnfl

Modification 1;

12/18«8

Modification 2;
Modifications
Modification 4

01/25/99
QQl22m

04/28/99

REPORTING UNIT GROUP#19 RESIDENTIAL CARE FACILITY
DIVISION: ADULT

;dei

lurJ2rnfJ-j?rrl^ir».^

Share Only -51,47% of Total Medical Program uoatai

$5,300,809
$2,137,105
$4,997,561
11:

,475

REPORTING UNIT GROUP#10 OLDER ADULT SERVICE TEAM
DIVISION: OLDER ADULT

-.

maximum HNANCIAl

r
snare only » 51,47% of Total Medical Program

Tmz—
$571,458
$137,227

$538,816

REPORTING UNIT GROUP# 14 F4C RESIDENTIAL DAY/
DIVISION: FAMILY AND CHILDREN’S

HNANdlAL 6BUgAII6N

—r

T5TAL
$566,888

IpsDTSWE^DS I^TCHing amount(In^^M^e RealiflnfLt and State Sfik rfM^diZiiy

$0
$466,642

$67,863

MAXIMUM FINANCIAL OBLIGATION
TOTAL AGENCY

mT^COnc^Uilurn^^^^

Share Only -51,47% of Total Medi-Cal Program

$6,439,155
$2,274,332
$6,003,019
.863

y^MUM FINANCIAL OBLIGATION

Modificadon 3,Co^amendment to add Custody Intensive Alternatives Programs, Start date of programs 05A)1/99 $ 134.750 start up costs included inii summary.

.. ,„ „ ^ StartuppenodApril 1.1999-May30.1999,

Modification 4: Budget Augmentation to increase Crisis Residential Program by6 beds effective May 1 1999

ALUANCE.WK4
04/29/99

EXHIBIT B - ESTIMATE OF PROGRAM FINANCIAL DATA
REPORTING UNIT GROUPING;#1 ADULT SERVICE TEAMS
AGENCY NAME: ALLIANCE FOR COMMUNITY CARE
MODE/

SERVICE
FUNCTION
NAME

REPORTING SERVICE
UNIT
FUNCTION

15:01-09 Case Managemant Brokerage

FISCAL YEAR 99

SUBMISSION DATE:

04/29/99

July1, 199&Uune30,1999

RATE

PROGRAM
NAME

UNITS OF
SERVICE

PER
UNIT

MEDICAL
FFP

BASE
COUNTY

REVENUES
OTHER THAN

CONTRIBUTION

FED/ST/CNTY

TOTAL
PROGRAM
COSTS

ICCMT/IAP

Short-Doyle MediCal/ County match

13.184
1

Unsponsofed
Total Brokerage

684

$1.50
$1.50

13,868

$10,195
$10,195
1

$9,582
$1,026
1
$10,608

$0

$19,777
1
$1.

$0

$201

$41,568
$2,157

Mental Health Services
15:30-59

Short-Doyle MediCal/ County match

23.753
1

Unsponsored

1,233

Total Mental Health Services

15:60-69 Medication Support
~
Short-Doyle MediCal/ County match

24,986

6,997
363

Total Medication Su
15:70-79 Crisis Intervention

$3.57
$3.57

7,360

$20,140
$2,157

$0

121,428

122,297

iO

$12,877

$12,102
$1,296

$0

112,877

i13,398

$24,979
$1,296
$26,275

$644

$0

1844

$794
$85
$879

$0

$11
$85
$1.723

$45,344

$47,182
i

$0

$92,526
i

ICCMT/IAP

Short-Doyle MediCal/ County ma^

819

Unsponsored
Total

$21,428
I

ICCMT/IAP

Unsponsored
1146

$1.75
$1.75

42
861

Intervention
TOTAL ESTIMATE

$2.00
$2.00

47.075
1

Program start date 05/01/99

als

MAXIMUM FINANCIAL OBUGATION

FEDERAL MEDI-CAL AMOUNT (Federal Share Only = 51.55% of Total Program Costs)
AMOUNT (County General FundXUnsponsofBd Share Only = 100% ^Totah

ALLIANCE.WK4
04/29/99

)

TOTAL

$45,344
$4,564
1
$42,618
1
$92.526

Index 4390

EXHIBIT B

JIMATE OF PROGRAM FINANCIAL DATA

REPORTING .WIT GROUP# 3 ADULT TRANSITIONAL RESIDENTIAL

)FISCAL YEAR 99

MODE/

REPORTING SERVICE
UNIT
FUNCTION
!4

05;i

SERVICE
FUNCTION
NAME

RATE

PROGRAM
NAME

SUBMISSION DA

>03^22/99

July 1,1998-June30,1999

AGENCY NAME: ALLIANCE FOR COMMUNITY CARE

UNITS OF
SERVICE

PER
UNIT

MEDICAL
FFP

BASE
COUNTY

REVENUES

TOTAL

OTHER THAN

CONTRIBUTION

FED/ST/CNTY

PROGRAM
COSTS

Transitional Residential
Shoft-Doyte MediCal/ County nrwrt57

237

$113.89

Unsponsored
Total Transitional Residential

217
454

$113.89

TOTAL ESTIMATE

454

$13,939

$13,100
I
$24,664

$0
$0

$13.939

$27,039
1
$24,664
I

$37.784

is.

$51.703

$13,939
t

$37,764

i£

$51,703

Program start date 05/01/99

als

$13,939
$24,664
$13,100
1
$51,703

ALLIANCE.WK4

04/29/99

Index 4390

EXHIBIT B - ESTIMATE OF PROGRAM FINANCIAL DATA
REPORTING UNIT GROUPING;« 7lAP DAY REHABILITATION
AGENCY NAME: ALLIANCE FOR COMMUNITY CARE
MODE/

SERVICE
FUNCTION
NAME

REPORTIN SERVICE
UNIT
FUNCTION
05:65

FISCAL YEAR 99

PROGRAM
NAME

IIAP Day Rehabilitation

SUBMISSION DATE:

03/22/99

July 1,1998-Jun«30,1999

UNITS OF
SERVICE

RATE

MEDICAL

PER
UNIT

FFP

BASE
COUNTY

CONTRIBUTION

REVENUES
OTHER THAN
FED/ST/CNTY

TOTAL
PROGRAM
COSTS

Ray Rehab/CT*

Short-Doyle MediCal/ County match

342

Unaponsored
Total lAP Day Rehabilitation

579

TOTAL ESTIMATE

$97.22
$97.22

579

$17.162

$17,162

$16,130
$22,956

$39,088

$0
$0

$33.292
$22.958
$56.250

$56,250

Program atart data 05/01/99

Maximum t^iNA^^dlAL 6&U6ATI6fj

FEDERAL MEDI-CAL AMOUNT (Federal Share Only = 51.55% of Total Madj-CafP
UNSPONSORED AMOUNT

General Fund)(Unaponaored Sham

COUNTY GENERAL FUND MATCHING AMOUNT(Indudea State Reali

MAXIMUM FINANCIAL OBLIGATION

v

uoea oiate rceait

iram Costs)
= 100% of Total)
MTt and State Share of I ledi-Cal'

TSTal
$17,162
$22,958
$16,130
$56,250

Index 4390

ALLIANCE.WK4
04/29/99

)

I

EXHIBIT B.E
RTE OF PROGRAM FINANCIAL DATA
REPORTING L GROUP HI 2 ADULT CRISIS RESIDENTIAL
AGENCY NAME: ALLIANCE FOR COMMUNITY CARE
MODE/

REPORTING
UNIT

SERVICE
FUNCTION
NAME

SERVICE
FUNCTION

I

PROGRAM
NAME

UNITS OF
SERVICE

FISCAL YEAR 99

SUBMISSION DATE:

July 1.1998-June 30, 1999

1)5/08/98

MODIFICATION #4 DATE:

04/28/99

RATE
PER
UNIT

MEDICAL

BASE

FFP

COUNTY

CONTRIBUTION

REVENUES
OTHER THAN
FED/ST/CNTY

TOTAL

PROGRAM
COSTS

Adult Crisis Residential

Short-Doyto MedICal/ County match

3,534
1

Unsponsored

504
4.038

TotalSART

wr

Adult Crisis Residential

3,144

Unsponsored

895

Total Govela
05:45

Adult Crisis Residential

5384,576

lEKSai

5112,950
5497,626

50
50

JO

5792,451
5112,950
5906.401

Adult Crisis ResidentiaT

,840

5342,114
5200,584

50
50

5642.698

JO

5704,954
5200,584
5906.638

Utteral House

2.482
I

Unsponsored
Total LIttefal House

Short-Doyle MediCal/ County match
Unsponsored

5224.21
5224.21

4,039

Short-Doyle MediCal/ County match

Total Casa San Antonio

5407,875

~~

Short-Doyle MedICal/ County match

83011

5224.21
5224.21

681

5224.21
5224.21

5284,136

’,907

5152,614

50

5420.621

JO

5152,614
5704.667

5211.082

5199,023
5136,703

50
50

5136.703

5211.082

5336,726

JOin

3,143
1
Casa San Antonio
1.829
i
610
2,439

5224.21
5224.21

5410.105

JO

Modification 4: Budget Augmentation to increase by 6 beds and increase rates(5180 to 5224)efrectivo May 1,1999(Total Program Costs Increase from 52,871,135

to 53.062,404).

csm

MAXIMUM Financial

—% of Total Medl-Cal Pr^ram Costs)

UNSPONSORED AMOUNTL(County General FundlfUnsponaored Share Only - 100% of Toteh '

TSTaT
51,265,933
5602.851

51,193,620
53.062.404

ALLIANCE.WK4
04/29/99

Index 4390

I I I

Attachment B-1

Custody Intensive Alternatives Program

Intensive Community Case Management Team(RUG #1)

Alliance for Community Care

^dget:
One Time Start-Up Costs(April 1,1999 - May 30’
FY1998-99
Operating Expenses:

7 Workstations/chairs @ $3,000

Costs

$21,000

Telephone system expansion;
8 phone lines @ $50
8 phones @ $100
8 port station card
Labor

Subtotal

$400
$800
$100
$200

$1,500

Information system expansion:
Data cabling
5 computers @ $1,700
1 printer @$1,500
Subtotal

Carpeting - 242 sq. yds. @ $15

$5,000
$8,500
11.500
$15,000
$4,000

Training:
Family Education Foundation

5 days"START @ $1,000
Community Solutions

1 day (Violence Prevention)
Health Realization
Subtotal

$5,000

$1,000
$1.600

$7,600

TOTAL OPERATING EXPENSES

$49,100

TOTAL START-UP COSTS

$49,100

ALLIANCE.WK4

04/29/99

Attachment B-1

Custody Intensive Alternatives Program
Structured Day Services Program(RUG #7)

^Alliance for Community Care Proposal

m9lW^99

Start-Up Costs (April 1,1999 - May 30, 1999)

Operating Expenses;

6 work stations @ $2,400

Telephone system expansion:
5 phone lines @ $50 per line
5 phones at $100 each
8 port station card
Labor

Subtotal

Cost

$14,400

$250
$500
$100
$200

$1,050

Information System expansion:
Data cabling
5 Computers @ $1,700
1 Printer© $1,500
Subtotal

$5,000
$8,500
$1500
$15,000

"raining;

. amily Education Foundation*
5 days @ $1,000

Community Solutions -1 day
(VIOLENCE PREVENTION)
Health Realization
Subtotal

$5,000
$1,000
il.600

$7,600

Carpeting

$15/SQ. YD. X 242 YARDS

$4,000

Activity chairs/tables

$1,000

TOTAL OPERATING EXPENSES

$43,050

TOTAL START-UP COSTS

$43,050

ALLIANCE.WK4

04/29/99

r
Attachment B-1

Custody Intensive Alternatives Program

Transitional Residential Program(RUG #3)
Alliance for Community Care Proposal

Budget: One Time Start-Up Costs (April 1,1999 - May 30.1999)
’

FY1998-99

Operating Expenses:

Licensing required:
Basement ceiiing
Exterior stairway repair

interior step/doorway repair
Subtotai

Costs

$5,000
$2,000
$2.000

$9,000

Teiephone system replacement

w/required intercom capability
and desired voicemail system

$20,000

Furnishings meeting licensing
requirements - for six:

beds/nightstands/lamps etc.
at $1,000 per person

$6,000

Training:
Family Education Foundation*
5 days @ $1,000

$5,000

Community solutions -1 day
(VIOLENCE PREVENTION)
Health Realization
Subtotal

$1,000
$1.600

$7,600

TOTAL OPERATING EXPENSES

$42,600

TOTAL START-UP COSTS

$42,600

ALLIANCE.WK4

04/29/99

('

(

Attachment to B-1

Alliance for Community Care
Invoice

Agency Name: Alliance for Community Care
Billing Address: 438 N. White Road,San Jose, CA 95126
Program Name: Custody Intensive Alternatives Program
Type of Invoice: Monthly

A.

Operating Expenses:

Amount:

1.

Workstations/chairs

2.

3.

Phone lines
Phones

4.

Port station card

5.

Labor-phone system

6.

Data cabling
Computers

7.
8.

Printer

9.

Carpeting
Training-”START"

10.
11.

Training-Violence Prevention

12.

Training-Health Realization

13.

14.

Licensing (Building Structure)
Furnishing

Subtotal Operating Expenses

B.

Total Invoice:

C.

Time Period Covered By This Invoice:

Authorized Signature
Note:

Date

Santa Clara County holds the right to audit contractor’s files to ensure the accountability
of charges. Agency must attach receipts to invoice.
Please submit invoice to:

Department of Mental Health
Attn: F&C

645 S. Bascom Ave., San Jose, CA 95128