REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
December 17, 2024
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Revenue Agreement with the State of California Department of State Hospitals for the Diversion Opportunity for Outpatient Recovery Services Program
End
RECOMMENDATION(S)
Recommendation
1. Approve Revenue Agreement (State Agreement No. 24-79017-000), including non-standard terms, with the State of California Department of State Hospitals, for the Diversion Opportunity for Outpatient Recovery Services Program, in the amount of $24,874,000, for the contract period of July 1, 2024, through June 30, 2029.
2. Authorize the Chair of the Board of Supervisors, Assistant Executive Officer, or Director of the Department of Behavioral Health, to execute and submit the Revenue Agreement, any subsequent non-substantive amendments, or any other additional supplemental documentation, including compliance certifications, subject to review by County Counsel.
3. Direct the Director of the Department of Behavioral Health to transmit the Revenue Agreement, and any subsequent non-substantive amendments, to the Clerk of the Board of Supervisors within 30 days of execution.
(Presenter: Georgina Yoshioka, Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Promote the Countywide Vision.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). Revenue obtained from the Revenue Agreement (Agreement) with the State of California Department of State Hospitals (State) will offset the cost of providing Diversion Opportunity for Outpatient Recovery Services (DOORS). Adequate appropriation and revenue have been included in the Department of Behavioral Health (DBH) 2024-25 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
DBH is responsible for providing mental health and substance use disorder (SUD) services to county residents experiencing severe mental illness and/or SUD. An integral part of the service delivery system consists of effective alternatives to incarceration for individuals who are arrested and jailed in relation to their mental health illness and/or SUD.
DOORS allows individuals with a serious mental illness or co-occurring disorders (mental illness and a SUD) who have been found incompetent to stand trial (IST) to receive pre-trial diversion treatment in the community. DOORS was developed by DBH with the support of County Law and Justice Group partners, which include the County Superior Courts, Sheriff’s Department, Public Defender’s office, District Attorney’s office, and the Probation Department.
The funds from this Agreement will be utilized for the DOORS program, a unit within DBH’s Adult Justice Involved Programs (AJIP) established to provide diversion services. The program anticipates serving approximately 25 clients annually at an estimated cost of $124,840 per client. The DOORS population is determined by California State Welfare and Institution Code (WIC) 4361, Senate Bill 215, California Penal Code (PC) 1001.36, and California PC 1368/1370, which requires County courts to establish a pre-trial diversion program.
The DBH AJIP division began providing diversion services in 2018, for adults who have been charged with a felony or misdemeanor in the County and referred for community-based diversion or restoration of competency services for those deemed to be IST or likely to be found IST. These are individuals with a severe mental illness, such as schizophrenia, schizoaffective disorder, and/or bipolar disorder who can be treated in the community under the court’s supervision, as opposed to being treated in jails and/or state hospitals.
The DOORS program allows DBH to provide a pre-trial jail felony mental health diversion program for individuals charged with felony offenses in the county. Individuals with serious mental disorders who have been charged with certain felony crimes and found incompetent to stand trial qualify for diversion services pursuant to PC 1001.36 and WIC 4361. The DOORS program also allows DBH to provide clinically appropriate or evidence-based mental health treatment and wraparound services (services provided in addition to the mental health treatment necessary to allow the individual to successfully manage their mental health symptoms and successfully live in the community) across a continuum of care, as appropriate, to meet the individual needs of felony mental health diversion clients.
The Agreement contains non-standard County terms as follows:
1. The County does not have the right to terminate the Agreement, however the State may terminate the Agreement with 30 days’ notice to the County.
• Under the County standard contract, the County has the right to terminate the contract, for any reason, with 30-days written notice of termination without any obligation other than to pay amounts for services rendered and expenses reasonably incurred prior to the effective date of termination.
• Potential Impact: The County does not have the right to terminate the Agreement for convenience.
2. The County is required to indemnify, defend, and hold harmless the State against all claims arising out of the County’s performance under the Agreement and for any acts attributable to the County’s subcontractors, including contractors, suppliers and laborers.
• The County standard contract indemnity provision requires the contractor to indemnify, defend and hold the County harmless from third party claims arising out of the acts, errors or omissions of any person.
• Potential Impact: The State is not required to defend, indemnify, or hold the County harmless from any claims. If the County is sued for any claim, the County may be solely liable for the costs of defense and damages, which could exceed the total State amount.
3. The Agreement does not contain the standard County insurance requirements.
• Standard County policy requires inclusion of the standard County insurance requirements in contracts unless otherwise approved by the Risk Management Department.
• Potential Impact: The County is not aware of the insurance in place by the State and therefore cannot evaluate its adequacy in terms of providing protection to the County.
DBH recommends approval of the Agreement, including non-standard terms, because the Agreement funds DOORS related programs and services to county residents, which offers effective alternatives to incarceration for individuals who are arrested and jailed in relation to their mental health illness and/or SUD.
DBH is requesting retroactive approval of the Agreement from July 1, 2024 through June 30, 2029. DBH applied to the State on January 2, 2024 and received the Agreement on October 1, 2024. This is the first available Board meeting date after all necessary program, fiscal, and legal reviews. Approval of this item will approve the Agreement and authorize the execution and submission of the Agreement and any other additional supplemental documentation to the State for DBH to continue to provide services as part of the DOORS program.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health (Lisa Rivas-Ordaz, Contract Supervisor, 383-3940) on December 2, 2024; Risk Management (Gregory Ustaszewski, Staff Analyst, 386-9008) on December 9, 2024. County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on December 5, 2024; Finance (Paul Garcia, Administrative Analyst, 386-8392) on December 10, 2024, and; County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on December 10, 2024.