Mentcil Health Department

SANTA CLARA

Dedicated to the Health

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VALLEY

of the Whole Community

HGALTH i HOSPfTAL SYSTEM

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MGNTAL HEALTH

Prepared by: Christopher Zubiaje^i^i^
Health Care Andlysfir

Mental Health Department
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Reviewed by: Martha Paine, Director of General

^

Jaime Lopez, Director Families & Children
Mental Health Department
April 19, 2001
TO;

Blanca Alvarado, Chairperson

Supervisor James T. Beall, Co-Chairperson
Children and Families Committee
FROM:

Nancy Pena, Ph.D., Director

Mental Health Department
SUBJECT:

Status Report on Implementation of the Mental Health Department
Community Treatment Facility(CTF)at 455 Silicon Valley Blvd.

RECOMMENDED ACTTON.S

1. Accept the Mental Health Department’s Status Report on the Community Treatment Facility
Implementation.

2. Direct the Mental Health Department to request Board of Supervisors approval to release
FYOl reserve accounts funds from BU 412 totaling $1,200,000(1C 4350, ESBJ 6001)to
$1,000,000(1C 4434, ESBJ 2329)and $200,000(IC 4434, ESBJ 2952)to offset one-time
contract and facility expenses in FYOl.

The Department of Mental Health is a division

of the Santa Clara Valley Health & Hospital System. Owned and operated by the County ot Santa Clara

\\IS2\USERS\GROUPSVMHEALTH\-TRANSM-n2001trans\01CTF Transmittal 4-2001(5) Revised.doc

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Children and Families Committee CTF Report - Page 2
April 19,2001

FISCAL IMPACT

There will be no fiscal impact on the County General Fund (CGF)as a result of these actions.
The FY 01 funds were reserved at the beginning of FY 01 in the Department’s budget for start-up
expense and program development. Largely due to the loss of anticipated state revenue (see
below), the $1.2 million 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 in FY 01.

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
funding. The fiscal impact to the Santa Clara County CTF project represented an approximate
loss of expected state offsets totaling $704,250 in FY 01 and approximately $1,080,000 in
aimualized state revenue.

For FY 02, the required county general fund support for Starlight will decrease as the start-up

phase of operations ends and the provider contract changes from a fixed cost to a fee-for-service
basis. The FY02 budget assumes that approximately $63,379 of the reserve funds will be needed
for the CTF next year, subject to final contract negotiations with counties. The remainder of the
reserve funds will be available for FY02 program development.
CONTRACT HISTORY

The County entered into its first contract this fiscal year, FYOl, with Starlight Adolescent
Center, Inc. to provide intensive locked residential treatment for severely emotionally disturbed
adolescents. The parent provider responded to a State Department of Mental Health Request for
Proposal on June 30, 1999 and was selected by the State to provide 36 regional beds (available to
Bay Area counties), with 24 beds allocated for Santa Clara County youth.

Given that this program is a regional program, the department will also be entering into inter
county agreements for use of regional beds. The department has completed negotiations with
Alameda County regarding its portion ofthe program and the contract language is being
reviewed by respective County Counsels. Solano County is paying for two beds on a fee-forservice basis and several other counties have indicated an interest in purchasing beds as well.

Contract negotiations with the provider for FY 02 included a review of current Santa Clara
County need and management of all out-of-county bed requests.
REASONS FOR RECOMMENDATION

The recommended actions will allow the Department to meet its contract obligations in FY 01

and continue operations in FY 02 of the State’s only Community Treatment Facility. This

program is aptly suited to meet the unique needs of children in the out-of-home system that need

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Children and Families Committee CTF Report - Page 3
April 19, 2001

contained mental health placements. Additionally, this service provides a demonstrated asset to
other
County agencies charged with placing adolescents from the Children’s Shelter and Juvenile
Hall.
BACKGROUND

In January 2000, a concept paper was prepared for the Board that outlined specific behavioral

health programs for youth that could be co-located in one facility. In May 2000, real property

at

455 Silicon Valley Blvd. was purchased with the intent to help meet the mental health and
substance abuse needs of youth in Santa Clara County by developing these behavioral health

programs. Potential programs are listed here; however, please see the original concept paper
formore detail. Programs are; 1)Integrated Assessment and 23-Hour Crisis Stabilization 2)

Cross-Agency Service Plan and Family Partnership, 3) Children’s Mental Health Crisis Team,4)

Crisis Residential Services, 5)Community Treatment Facility,6)Chemical Dependency

Residential Treatment, 7) On-site Pharmacy, and 8) On-site Educational Services.

The first programs to be implemented were the Community Treatment Facility(CTF)and their
companion programs, a Non-Public High School and an Intensive Day Treatment program

Admissions to Starlight Adolescent Center and CTF began in October 2000, and continue weekly

(see attached report). Due to unanticipated loss of state revenues and a slower than expected

ramping up of referrals, the Department is asking for approval to utilize the $1.2 million reserve

on a one-time basis in FY 01 to cover start-up and operating expenses for Starlight Adolescent
Center.

Since the development ofthese components at this site, preliminary inter-agency discussions

regarding the implementation of other programs has occurred. In assessing the current child and
adolescent behavioral health needs, additional service components have been identified that are
considered cntical. Specifically, there has been significant concern expressed at the lack of acute
inpatient and outpatient crisis services for children and adolescents. This service gap has been
identified as the most pressing priority for the next phase of program implementation. The
current lack of sufficient child and adolescent inpatient beds has become a concern for all bay
area counties. During the recent discussions with the Board, and the subsequent request for mid
year funding to address the problems in the adult continuum of residential treatment resources

the issue of children's inpatient need was raised. As beds have become scarce regionally, it has

become increasingly difficult to find hospital beds for county youth. Recently children have been

placed as far north as Vallejo and Sacramento, and as far south as Fresno. Most recently, no beds

were available, resulting in a significant number of overstay occurrences in EPS.

During budget meetings with the County Executive, the issue was raised again within the context
of discussions regarding future program implementation at the new Behavioral Health Center.
At the County Executive's request, the Department is developing cost scenarios for the
implementation of an inpatient resource for children. Given the need to establish an immediate

resource, the Department and Valley Medical Center administrations are recommending that
short- and long-term solutions be developed. These are presented in the attached report.

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Children and Families Committee CTF Report - Page 4
April 19,2001

CONSEQUENCES OF NEGATIVE ACTION

Failure to approve these actions increases the likelihood that the Community Treatment Facility
will not be able to continue operations and slows the development of key children's crisis
services that could potentially increase the need for more expensive out-of-county acute
psychiatric care.
STEPS FOLLOWING APPROVAL

Submit transmittal and recommendations to the next available Board meeting.
Cc;

Kim Roberts, Susan Murphy, Maryann Barry, Michael Meade, M.D., Jaime Lopez,
Mental Health Board and Mental Health Contractor’s Association

\\IS2\USERS\GROUPS\MHEALTH\-TRANSMT\2001trans\01CTF Transmittal 4-2001(5) Revised.doc

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Major Types of Axis 1
★ Psychiatric Diagnoses

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Emotional Disorders; e.g., Major Depressivgv
Disorder, Dysthymic Disorder, Depressive
Disorder Not Otherwise Specified, Bipolar,
Posttraumatic Stress Disorder

Behavioral Disorders: e.g.. Conduct

Disorder, Oppositional-Defiant Disorder
Intermittent Explosive Disorder, Impuse
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Control Disorder, ADHD

Psychotic Disorders: e.g.. Schizoaffective
Disorder

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Behavioral Disordersr^present in 16/21
-clients On76%::of STARLIGHT’S population

Psychotic Disorders; present in 1/21

clients or 5% of STARLIGHT’S population

6

STARLIGHT MODEL
LOCKED FACILITY

(CTF with psychiatric
stabilization & intensive
treatment)

INTENSIVE DAY
TREATMENT
PROGRAM

NUNPUBLIC SCHOOL

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' iPrelimlnaiy Data from

A STARLIGHT: Referral Difference^
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Probation ]DMH .
(n=5)
(n=4)

^ DSS
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age

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75%

92%

Average
GAF

% with
emotional

disorders

7