Agenda Item AGENDA STAFF REPORT ASR Control 22-000938
MEETING DATE:	04/25/23
legal entity taking action:	Board of Supervisors
board of supervisors district(s):	2
SUBMITTING Agency/Department:	Health Care Agency (Approved)
Department contact person(s):	Annette Mugrditchian (714) 834-5026
	Veronica Kelley (714) 834-7024

Subject: Renewal of Contract for Early Childhood and Youth Mental Health Consultation

ceo CONCUR

County Counsel Review

Clerk of the Board

Pending Review

Approved Agreement to Form

Discussion

3 Votes Board Majority

Budgeted: N/A

Current Year Cost: N/A

Annual Cost: FY 2023-24 $2,300,000

Staffing Impact:

# of Positions:

Sole Source: No

Current Fiscal Year Revenue: N/A

Funding Source: State: 100% (Mental Health Services Act/Prop 63)	County Audit in last 3 years: No
Levine Act Review Completed: Yes

Prior Board Action: 5/24/2022 #18, 10/5/2021 #S14B, 8/10/2021 #11, 2/11/2020 #12

RECOMMENDED ACTION(S):

Approve Amendment No. 10 to renew the Contract with Charitable Ventures of Orange County for provision of Early Childhood and Youth Mental Health Consultation Services, for the term of July 1, 2023, through June 30, 2024, for an amount not to exceed $2,300,000, for revised cumulative contract total amount not to exceed $7,440,301.

Authorize the County Procurement Officer or Deputized designee to execute Amendment No. 10 to the Contract with Charitable Ventures of Orange County, as referenced in the Recommended Action above.

SUMMARY:

Approval of Amendment No. 10 to the Contract with Charitable Ventures of Orange County for Early Childhood and Youth Mental Health Consultation Services will help Orange County providers effectively manage the challenging behaviors exhibited by infants and pre-school children in early childhood settings and effectively manage the care of youth who are at clinical high risk of psychosis or who have experienced symptoms of psychosis.

BACKGROUND INFORMATION:

Your Honorable Board of Supervisors (Board) approved the Contract with Charitable Ventures of Orange County (Charitable Ventures) for provision of Early Childhood and Youth Mental Health Consultation (ECYMHC) Services. The Board also approved the Amendments listed in Table 1 below. All other Amendments with Charitable Ventures for ECYMHC Services were executed under Deputy Purchasing Agent delegated authority. Prior to contract expiration, the Health Care Agency (HCA) plans to issue a solicitation to continue services. The Orange County Preference Policy is not applicable to this Amendment.

Table 1: Prior Board Actions

Board Date	Contract/Amendment	Action	Term
February 11, 2020	Contract	Board Approved Contract with Charitable Ventures	March 15, 2020 – June 30, 2022
August 10, 2021	Amendment No. 3	Board Approved - Contract Increase and Target Population Expansion	July 28, 2021 – June 30, 2022
October 05, 2021	Amendment No. 4	Board Approved Contract Increase	September 29, 2021 – June 30, 2022
May 24, 2022	Amendment No. 7	Board Approved Term Renewal	July 1, 2022 – June 30, 2023

The proposed Amendment will allow services to continue for the term of July 1, 2023, through June 30, 2024, with an amount not to exceed $1 million for the scope of services targeting early childhood and education settings and $1.3 million for the scope of services targeting youth at risk of or experiencing early psychosis, their family members and mental health providers who serve these youth for a revised cumulative contract total amount not to exceed $7,440,301.

Scope of Services #1 Early Childhood and Education Settings

ECYMHC Services are designed to improve the mental health outcomes of young developing children, particularly those exhibiting challenging behaviors in early childhood and education (ECE) settings. These children are expelled at three times the rate of school children in kindergarten through grade 12. The services are intended to educate and build knowledge of early childhood providers throughout Orange County (OC) so that they are able to: 1) promote and support social and emotional development of young children in order to prevent challenging behaviors, 2) provide appropriate support for those children exhibiting ongoing challenging behaviors and 3) support the development of prosocial behaviors in young children.

ECYMHC Services include mental health consultation, training, education, coaching and support services to build capacity and increase the knowledge of early childcare providers. ECE providers are selected based on the following criteria: 1) Areas of the county with the highest vulnerability in social and emotional development based on the Early Development Index, a population-based measure of early child development, 2) ECE sites who have identified children with challenging behaviors and are at risk of expulsions and 3) ECE providers who may not have access to other state or federal funding.

However, ECYMHC Services are available to any provider in ECE settings such as licensed and licensed exempt childcare centers, family and faith-based childcare programs, ECE programs including non-state or non-federally funded and before-and-after school programs.

ECYMHC Services are provided by mental health consultants who have advanced training in mental health and/or early childhood development including expertise in all required evidence-based practices. ECYMHC Services are provided for a period of four to eight months, during which time a mental health consultant is paired with each ECE provider staff for practice-based individual coaching, training and feedback. Training is offered at ECE sites, community-based organizations, as well as online and will cover a variety of topics including trauma-informed practices, adverse childhood experiences, topics related to social and emotional skills development, challenging behaviors, screening and assessment and referral to community resources. When necessary, linkages to behavioral health services are made. Charitable Ventures conducts outreach to ECE providers, school districts, the Regional Center of Orange County and other organizations who intersect with ECE providers throughout OC.

Performance Outcomes

Program performance outcomes for the proposed Amendment will continue to measure the impact of services to increase the ability of ECE providers to manage challenging behaviors of children and promote prosocial behaviors. In FY 2021-22, 36 childcare sites were served, including 479 staff at these childcare sites with 2,416 children impacted by services. In addition, the program has served 26 childcare sites in FY 2022-23 through December. The program continues to conduct targeted outreach to ECE sites and is expected to make progress in these goals as increased access to childcare sites is provided. In 2022, two new partnerships were established: one with KinderCare which has 12 sites in Orange County and one with the YMCA. HCA staff continue to work with program staff in overcoming any barriers in meeting all contract goals.

Program performance outcomes for the proposed Amendment will be consistent with current year’s goals and will be measured by data collected through pre- and post-surveys, consultation logs and assessment tools. Outcome data for FY 2021-22, indicates that participants reported improvements in all areas measured, and the program has demonstrated success in achieving its overall goals (See Table 2 below). Because these outcomes are measured using a pre-test/post-test format the current year outcomes for FY 2022-23 are not available at this time.

Table 2: FY 2021-22 Performance Outcomes

Goals	Outcomes
ECE providers will report fewer children who engage in ongoing, persistent challenging behaviors.	46 percent of ECE providers reported fewer children with persistent challenging behaviors
Teachers will demonstrate an increase in knowledge of social-emotional development of children.	73 percent of teachers demonstrated an increase in knowledge of social-emotional development
Participating children will demonstrate an increase in pro-social behaviors.	83 percent of children demonstrated an increase in pro-social behaviors
Children will maintain good engagement in classroom tasks/activities while participating in the program.	100 percent of children maintained good engagement in classroom activities

Scope of Services #2 Youth at Risk of or Experiencing Early Psychosis

Services for mental health therapists and clinicians of youth at risk of or experiencing early psychosis, particularly HCA’s Orange County Center for Resiliency, Education and Wellness (OC CREW) Early Psychosis program, are intended to: 1) educate staff on best practices in the area of early psychosis spectrum conditions and 2) build their capacity to provide evidence-based mental and behavioral health support for youth experiencing symptoms and youth at risk of developing or experiencing an early psychosis spectrum condition. Services also include evidence-based screening, assessment, and consultation services directly to youth at clinical high risk and their family members, if needed. In addition to OC CREW staff, services will be available to other healthcare providers in the county including, but not limited to, licensed therapists, supervised unlicensed therapists, pediatricians, psychiatrists, social workers, school psychologists and counselors and other professionals who may work with or encounter youth at risk of developing psychosis symptoms.

Performance Outcomes

Early Psychosis program performance metrics for the proposed Amendment will be consistent with current year’s goals and will measure the feasibility and acceptance of the screening and assessment services provided to youth and their families, and of the consultation and training services for healthcare providers.

As early psychosis consultation services were first approved in October 2021, Charitable Ventures has primarily been focused on hiring and starting up program services, including identifying evidence-based screening and assessment measures, reviewing best practices, testing the electronic screening platform, and identifying and developing outreach strategies. Charitable Ventures launched its screening and assessment services for youth in January 2023 using a multi-pronged outreach campaign. Thus, youth screening, assessment and referral data, and family consultation data are not yet available. In anticipation of an increase in referrals to the OC CREW program following the imminent launch of the screening platform, Charitable Ventures has focused on providing training in current best practices and evidence-based approaches in early psychosis care to OC CREW and HCA behavioral health clinicians (see Table 3 & Table 4 below).

Although it was envisioned that OC CREW and other healthcare providers would seek case consultations, this service, while highly promoted, has been underutilized. However, since hiring a clinical Executive Director, Charitable Ventures is making steady progress on its outreach and training goals for healthcare providers and has its early psychosis consultation process in place, and is ready to begin youth screening and clinical assessments and family consultation. In January 2023, Charitable Ventures began promoting a primary screener through social media campaigns, outreach, and training events, with the intention of encouraging widespread screening for clinical high risk. Those youth identified as at higher risk for psychosis will be given a clinician led short screener and may be offered a full assessment. Youth who screen positive for a first episode of psychosis will be referred and linked to OCCREW. Any youth who screens positive for general mental health concerns will receive referrals to appropriate level of care.

Table 3: FY 2021-22 Units of Service

(Partial year, October 2021 - June 2022)

Outreach, Training and Case Consultation Activities

Annual Goal

Achieved

9 Months

Outreach and training sessions with community healthcare providers and other community organizations

Case consultations to healthcare providers

Table 4: FY 2022-23 Units of Service

(Partial year, July 2022 – December 2022)

Outreach, Training and Case Consultation Activities

Annual Goal

Achieved

6 Months

Outreach and training sessions with community healthcare providers and other community organizations

Case consultations to healthcare providers

*From August to November 2022, Charitable Ventures was without a clinical Executive Director and therefore unable to provide clinical consultations.

HCA anticipates progress towards achieving all goals in the next phase of implementation prior to the end of FY 2022-23 and is therefore requesting to continue these services in FY 2023-24 (see Table 5 below) when all phases will be provided in a coordinated effort to address the needs of youth at risk of or experiencing early psychosis.

Table 5: Contracted Service Levels

	Currently Estimated #s
a. Primary Screener -completed by youth or caregiver	300
b. Secondary Screener – clinician led	75
c-1. Full Assessment	45
c-2. Assessment Report w/Care Plan	45
c-3. Youth meeting criteria for an Early Spectrum Disorder	18
d. Referrals to community behavioral health services	75
e. Consultations provided to healthcare providers	45
f. Outreach and training sessions with healthcare providers.	25

The Contractor's performance has been confirmed as satisfactory. HCA has verified there are no concerns that must be addressed with respect to Contractor's ownership/name, litigation status or conflicts with County interests.

The proposed Amendment with Charitable Ventures for ECYMHC Services has no subcontractor. See Attachment B regarding Contract Summary Form.

HCA requests that the Board approve Amendment No. 10 to the Contract for provision of ECYMHC Services with Charitable Ventures as referenced in the Recommended Actions.

FINANCIAL IMPACT:

Appropriations for this Amendment will be included in Budget Control 042 FY 2023-24 Budget.

The Contract includes provisions allowing HCA to terminate the Contract, reduce the level of services, and/or renegotiate the levels of services provided, as necessary. This includes a notice that allows HCA adequate time to transition or terminate services to clients, if necessary.

STAFFING IMPACT:

N/A

ATTACHMENT(S):

Attachment A - Amendment No. 10 to Contract MA-042-20010886 for Early Childhood and Youth Mental Health Consultation Services with Charitable Ventures of Orange County
Attachment B - Contract Summary Form
Attachment C - Redline Version to Attachment A