A
SANTA CLARA

Bip c
Department
8^8 South Bascom Avenue, Suite 200
San )ose, California 95128

VALLGY

Tel 14081 885-5770
Fax 14081 885-5788
Fax (408)885-5789

Dedicated to the Health

of the Whole Community

FteAUH t HOSPFTAL SYSTEM

DCPARTTVieNT OF
M6NTAL HGALTVI

Status Report - Starlight Adolescent Center,Inc.
Community Treatment Facility(CTF)
April 11,2001

The following report provides an update on the status ofthe new intensive residential treatment

program for adolescents, Starlight Adolescent Center, Inc., and planning for additional

program components at the new county facility located at 455 Silicon Valley Blvd The

Coi^umty Treatment Facility(CTF)is the first ofseveral behavioral health programs to be
implemented at the new facility. This regional program provides sub-acute-planned residential
placements for adolescents experiencing serious emotional,mental health problems and accepts

referrals from the Department of Family and Children Services(DFCS\ the Juvenile Probation
Department(JPD)and Mental Health.

The report covers three general areas: 1)Starlight CTF program status, 2) budget and fhnding

issues, and 3)planmng for additional programs at the new facility.
Starlight CTF Program Status

The program began admissions in October 2000 and has admitted 26 adolescents as of April 5

2001. Admission have been slower than planned(32 budgeted vs. 26 actual), however the

department anticipates reaching a total census oftwenty-seven admissions in the next several
weeks and should be at budgeted capacity by the start ofFY 02. Three youth have been

discharged. The census includes the following:
Santa Clara County Youth

Other County Youth

Probation

5

DFCS

7

Alameda Co.
Solano Co.

Mental Health

3

Total

15

7

1
8

The department has been working with Probation and DFCS staffto ensure that all potential

placements from Juvenile Hall and the Children’s Shelter have been identified. There
currently four new assessments for admission approved and two pending referrals for
assessment. Referring agencies continue to assess and refer new cases through the Resource
and Intensive Services Committee(RISC) weekly inter-agency review process. The Committee
has done an excellent job in making sure that only those referrals meeting state criteria for this
are

level of intensive treatment are referred to Starlight for admission. To date Starlight has turned
down only one referral, which was an out-of-county male on probation with a history of violent
The Dcp.irtmcnl of Mental Hcallfi is a division of iFie Santa Clara Valley FHealth & Hospital Sysl

em.

Owned and operated Iry the County of Santa Clara

CTF Status Report - 4/11/01
Page 2

gang behavior. Over 150 manuals outlining guidelines for referral and admission have been
produced and distributed to partner agencies and counties.

DFCS Social Services Agency Involvement. The DFCS Placement Manager at the Social
Services Agency has indicated that all the adolescents who are at the Children Shelter and
awaiting placement have been reviewed for possible referral to Starlight. Many of them do not

qualify for CTF level of treatment and are referred elsewhere such as the new Matrix Program at
Eastfield Ming Quong. DFCS believes that all the children with severe psychiatric issues that
were at the Shelter have been appropriately placed. The Children Shelter staff will continue to
assess new admits to determine appropriateness for Starlight’s level of care and referral to RISC.
Juvenile Probation Involvement. The Probation Department Manager responsible for
placements has expressed satisfaction with the level of service and availability oTthe program as
a positive alternative for minors with serious mental health problems. At this time, there are no
referrals for other JPD minors to be referred to Starlight. Their representative on the RISC
committee agrees that RISC is doing an excellent job reviewing and referring appropriate cases
to Starlight.

-

Other County Contracts- The department has completed negotiations with Alameda County

regarding its use of regional beds and the contract language is being reviewed by respective
County Covmsels. Solano County is paying for one bed on a fee-for-service basis. Several other

counties have indicated an interest in purchasing beds as well. It is interesting to note that to
date only Los Angeles County has been able to make any progress towards opening its CTF,
which will also be operated by the same provider as Santa Clara County. No other counties have
been able to move their projects forward, citing costs and regulatory constraints as the reasons.
In addition, the only Northern California provider has withdrawn their request to be a provider
leaving only one other potential provider in San Francisco and Solano counties. Consequently,
Santa Clara County has received many inquiries from other counties regarding possible contracts
for CTF beds. Ctirrently Alameda County has requested ten(10)beds for FY02,leaving another
two(2)available for other bay area cotinties.

Contract negotiations with the Santa Clara County provider for FY 02 occurred in early April
2001 and included a review ofcurrent Santa Clara Coimty need and management of all out-of
county bed requests. The contract, which for this year is a fixed-cost contract, will revert to a
standard net negotiated rate or state Medi-Cal allowed rate contract for FY 02.
Budget and Funding Issues

FYOl Budget Projections. FYOl year-to-date budget estimates were prepared by SCVHHS
Finance Staff and forwarded to OBA detailing the service utilization, revenues and expense
projections through 12/31/00. Largely because of the loss of anticipated state revenue (see
below),$1.2 million currently reserved for further facility and program development at this
site is needed on a one-time basis in FY 01 to cover start-up and operating expenses for
Starlight Adolescent Center. SCVHHS Finance and OBA staff have reviewed Starlight
Adolescent Center’s FY 01 year-to-date and projected actual expenses, earned revenues and
required county general fund contribution to verify the need for the $1.2 million reserve funds.

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CTF Status Report - 4/11/01
Page 3

The mental health fixed-cost contract for FY 01 services includes general maintenance,janitorial
and landscaping costs in its agreement with Starlight, considerably reducing the ongoing
maintenance responsibilities of the facility for GSA-Building Operations. The Department also
assisted GSA-Property Management in crafting a lease for approximately 52% of the facility
(26,516 square feet) which will return $ 411,585 in rental income in FY 01 and an estimated

rental income of$ 510, 459 in FY 02. Further program development at the facility is estimated
to generate a proportionate amount of additional fair market rent for the County from the
remaining 24,113 sq. ft. left to be allocated.

State Funding Issues. In the State’s FY 01 budget, the legislature had appropriated
approximately $2500/month per CTF bed to help assist host counties in the development and
deployment of this sub-acute resource for their regions. Unfortunately, citing the fact that no

community treatment facilities were developed at the time the state budget was being approved.

Governor Davis vetoed this ftmding. The fiscal impact to the Santa Clara County CTF project'

represented an approximate loss ofexpected state offsets totaling $704,250 in FY 01 and
approximately $1,080,000 in annualized state revenue.

The Department continues to provide regular program updates to the state agencies providing
licensing and certification ofthe CTF, and has subsequently sent annualized expense and
revenue estimates to the State Department of Mental Health(DMH)to augment their request for
additional CTF ftmding. Specific Health Care Financing Administration(HCFA)guidelines
make the possibility of a new “CTF Rate” unlikely for the next few years. DMH is
recommending that the Governor approve an interim rate adjustment for providers until then.

Our FY02 budget planning with the provider does not include any assumptions of state funding
at this time.

FY 02 CTF Budget. For FY 02,the required county general fimd support for Starlight will
decrease as the start-up phase ofoperations ends and the provider contract changes from a fixed
cost to a fee-for-service basis. The current FY 02 projected budget requirements are as follows:
Expense and Revenues For Fiscal Year 2001-02: Starlight Adolescent Center
Total Expense
Total Other Revenue(AFDC,ffp,epsdT)
Net Coimty Cost Required
Current County Cost Budgeted
Netted Additional from Reserve

Remaining Reserve for New Programs

$ 7,529,000
$6,105,510
$ 948,993
$ 885,614
$
63,379
$ 1,136,621

The above budget assumes that $63,379 of the reserve funds will be needed for the CTF next

year. However, it is possible that this amount could change since contract negotiations with other
counties for use of the program continue. This leaves an estimated $1.1 million remaining from
the reserve available in FY02 for the development and implementation of other programs.

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CTF Status Report -4/11/01
Page 4
Additional Program Implementation & Planning

The following describes the status of additional program development at the facility. Some
components have been implemented this fiscal year and others are being proposed for FY 02.
♦ Implemented Program Components

The Resource and Intensive Services Committee(RISC)- This committee has been located

with additional staff at the facility and meets weekly to review all residential and wraparound
referrals (estimated 250 youth capacity). The Mental Health Department requested and received

DMH approval to use its System of Care allocation to fund a full-time position to participate in
this interagency placement review. Co-location of staff serving the out-of-home youth population
has improved coordination and linkages across the behavioral health continuum. Currently two
(2)DFCS staffs are using administrative space at the facility, and plans are in place for an
additional four(4)DFCS Staff.

Mental Health Hospital Liaison - The Department has stationed its children’s Hospital Liaison
at the facility to assist in coordination with the CTF and RISC. This role includes care

management and aftercare linkage of children and adolescents in private hospitals and
coordination with EPS.

♦ Planned Programs for FY 02

AB3632 Assessment & Case Management. The Mental Health Department plans to move its
Intensive Case Management Team to the facility this fiscal year. These four case managers are
responsible for Special Education youth and adolescents that are residing in out-of-home
placements, including those placed in the CTF. Co-location at the facility will improve
coordination and prepare for centralization of AB3632 assessments and case management
functions. The department has seen a steady rise in the number of AB3632(Special Education,
Seriously Emotionally Disturbed)assessments received fi^om 32 School districts across the

county. In part, this increase can been seen as the successful result of outreach to the juvenile
justice and foster care population to inform them oftheir educational rights under the law. As
part ofthe FY 02 budget process,the Dqiartment is proposing to use State Mandated Cost
reimbursements(SB90)to expand and centralize two important functions required by Chapter
26.5 (Section 7570 of Division 7 of Title 1 ofthe Government Code). This proposed expansion
ofservices to children and families with mental health and special education needs will add
additional staff(1.0 FTE Mental Health Program Specialist 0,4.0 FTE Psychiatric Social
Workers and 1.0 FTE Advanced Clerk Typist)to expand intensive case management and
assessment services. A total often(10) Mental Health Department staff will be located at the
facility.
♦ Proposed Options for Remaining Space

The original Behavioral Health Center Concept Paper proposed two(2) additional youth
residential programs, one for the treatment of dual diagnosed youth (mental health and substance
abuse)and another for crisis residential. After discussion with DADS,Social Services and JPD,
the greatest needs appear to be for short-term acute treatment.

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CTF Status Report - 4/11/01
Page 5

Over the past three years there has been a dramatic reduction in the number of psychiatric

inpatient hospital beds for children and adolescents. Three hospitals serving youth in the bay
(Belmont Hills, Charter, and Walnut Creek Hospitals) have closed resulting in the loss of
over 200 beds, of which one-third were for children and adolescents. Consequently, Santa Clara
County has no acute inpatient beds for youth under age eighteen within the County and those
area

regional beds that are available are always in extremely high demand.

In the past year, those youth needing psychiatric hospitalization have gone to Fremont Hospital

in Fremont, Mills Peninsula Hospital in Burlingame, Mt. Diablo Hospital in Concord, California
Specialty Hospital in Vallejo, Sutter and Sierra Vista Hospitals in Sacramento and to Fresno
when all beds are filled. This creates a less than ideal situation for patient care as families are

often unable to travel these long distances to visit with their children and to participate in
treatment and discharge planning.

The need for hospital beds for youth continues despite the implementation of new programs for
seriously disturbed youth, as short term acute care is necessary in certain situations (e.g, suicide
attempts and other psychiatric emergencies) as opposed to the need for long'term treatment

programs. The average length of stay for child and adolescent inpatient care is currently nine(9)
days.

The bed capacity need for short-term acute inpatient care for private and public fimded child and

adolescents patients for Santa Clara County is estimated to be 15-20 beds. It is important to note
that the County Emergency Psychiatric Service(EPS)as the designated evaluation site for the

coimty, often facilitates hospital admission of privately insured child and adolescent patients to
private hospitals. Thus, while the hospital care ofthese youth is not the financial responsibility
ofthe coimty,the facilitation oftimely admission to private hospitals is our responsibility.
A recent telephone survey of bay area mental health directors and Kaiser indicates there is a
general shortage ofpsychiatric inpatient beds, and many counties indicate they often have to call

virtually every psychiatric hospital in the state looking for hospital beds for their youth. In the
past two months,the Santa Clara County public fimded youth inpatient census has peaked to as
high as ten (10). The average census as ofthe end of March 2001 was seven. With the increased

hospitalizations of youth has also come a delay in finding hospital beds as the Department
competes with other bay area counties and v^fii Kaiser. When beds are not immediately
available, youth must wait in EPS with adults who are being evaluated for treatment. If the
youth are not hospitalized within the 24-hour timefimne,they have been temporarily moved to
the Pediatric Unit ofthe hospital to wait for a psychiatric placement. This is not an acceptable
situation and more appropriate solutions need to be put into place immediately.
There is an estimated acute hospital need of 7-8 beds for public Santa Clara County youth. The
County Executive has requested that the Department provide cost estimates for implementation
of a child and adolescent inpatient program. Several program options are currently being
reviewed that include contracting two models of acute care or developing a county-run program
at the new facility. Preliminary estimates are that several options are possible and could be
funded through existing funding, utilizing the Behavioral Health Center reserve funds and funds
budgeted for contracted youth inpatient services in FY02.

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CTF Status Report - 4/11/01
Page 6

Mental Health Department and VMC administrations are recommending that further analysis is
made of the various options, and that short- and long-term solutions to the children's acute
inpatient problem be implemented:

♦ The short-term solution is to establish a contract immediately for 7-8 inpatient beds with
Fremont Hospital through the end of FY02, utilizing current inpatient contract funds for the
remainder of FTOl; and Behavioral Health Center reserve and approximately $600,000 in
FY02 existing children's hospital budget for FY02.

♦ The long-term solution is to initiate planning over the course of next year(FY02)for a child
and adolescent inpatient program which could be implemented in FY03.

This plan will address the immediate need while allowing time for the Mental Health Department
and Valley Medical Center to adequately plan a new program. It is estimated that the new

program would utilize the Behavioral Health Center reserve and inpatient-contract budget in
FY03.

As the county continues to grow in its population, the nqed for acute psychiatric services will

also continue to grow. With an estimated 400,000 -500,000 children in this county, having an
in-county provider will allow for more effective, culturally proficient and better coordinated
services involving the Children’s System of Care providers.
Summary and Recommended Next Steps

■

The CTF Starlight Program has been implemented and county departmental staffs are pleased
that the program is meeting the original intent. This program is occupying two 20-bed
residential wings, and administrative space for the private school and the day treatment
program.

■

Administrative and case management staffs with responsibilities in the area ofplacement and
resource coordination from Mental Health, SSA,and Probation have been co-located at the

facility. These staff work together to insure appropriate oversight ofintensive out-of-home
service coordination among departments.

■

There are currently two 20-bed wings available for new programs. It is recommended that
one ofthe wings be considered for a 16-20 bed acute care residential program for children
and adolescents.

■

It is recommended that rather than attempting to put a third residential program in place in
the near futui e, that the remaining wing be utilized for an outpatient interagency assessment
and crisis intervention service. This would be put in place through redirection of county staff
(Mental Health, DADS,JPD, SSA, and Health) and with space available for the EMQ
Mobile Crisis Service. The outpatient service would be utilized for youth and families in
crisis and will provide an alternative to EPS for those youth that do not need the locked EPS

setting. Many child and adolescent crises could be diverted from acute hospitalization by
providing intensive family counseling and crisis intervention services. These types of service

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CTF Status Report - 4/11/01
Page 7

are the key function of the EMQ Mobile Crisis Service. With space at the new site, EMQ
would have the opportunity to offer neutral clinic space for evaluations and follow-up
treatment in collaboration with county staff In addition, the new interagency assessment

team could provide comprehensive assessments and placement recommendations for youth
considered at-risk by the Court or other county child-serving agencies.

7