REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
August 4, 2026
FROM
JOSHUA DUGAS, Acting Director, Department of Behavioral Health
SUBJECT
Title
Amendment to Contract with Victor Community Support Services for Therapeutic Behavioral Services
End
RECOMMENDATION(S)
Recommendation
Approve Amendment No. 4 to Contract No. 21-474, with Victor Community Support Services, Inc., for the provision of Therapeutic Behavioral Services, increasing the total contract amount by $221,000, from $11,050,000 to $11,271,000, with no change to the contract period of July 1, 2021, through December 31, 2026.
(Presenter: Joshua Dugas, Acting Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Promote and Fulfill 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). The increase of $221,000 for Therapeutic Behavioral Services (TBS) will be funded by Medi-Cal Federal Financial Participation and 2011 Realignment. The recommended contract increase of $221,000 is needed due to higher costs per client under California Advancing and Innovating Medi-Cal (CalAIM) initiatives for clients receiving TBS. Adequate appropriation and revenue have been included in the Department of Behavioral Health’s (DBH) 2026-27 budget.
BACKGROUND INFORMATION
DBH is responsible for providing mental health and substance use disorder (SUD) services to San Bernardino County residents experiencing severe mental illness and/or SUD. Since 2005, TBS has been offered through contracted providers as a supplemental Specialty Mental Health Service (SMHS) under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit.
TBS are short-term, individualized, one-to-one outpatient services for beneficiaries up to the age of 21 years. TBS support children, youth, and transitional-aged youth with serious emotional challenges who are experiencing a crisis or significant life transition and require targeted assistance to achieve goals in their individualized treatment plans. These services provide additional support for beneficiaries whose behavioral or emotional symptoms place them at risk.
More than half of TBS participants experience a reduced need for higher levels of care or repeat hospitalizations along with improved school functioning, behavior, and overall stability. In addition, TBS assists participants and their families, caregivers, foster parents, residential staff, and school personnel with effective strategies to manage challenging behaviors, build positive skills, and maintain progress in the least restrictive environment.
The implementation of a Fee-for-Service (FFS) rate structure occurred through the CalAIM initiative. Prior to January 2026, DBH operated the Victor Community Support Services (VCSS) contract as a cost reimbursement contract. Under the Fee-for-Service reimbursement methodology, providers are reimbursed based on services delivered, which may exceed prior cost reimbursement levels. VCSS has successfully implemented the CalAIM FFS requirements for EPSDT Medi-Cal SMHS. Since January 2026 service expenditures have exceeded the prorated monthly contract amount (1/12th of the annual contract) by an average of 12.4% per month, with a range of 8.5% to 18.7% on any given month, demonstrating the need for additional funding to meet service demand. The proposed amendment to the TBS contract with VCSS will increase available funding to support the anticipated provision of SMHS in accordance with the CalAIM FFS standards.
In 2024-25, TBS achieved the following outcomes:
• 292 unduplicated clients served
• Average cost of $16,330 per client
Upon approval of the recommended contract amendment, DBH anticipates:
• Serving approximately 305 unduplicated clients over the contract term
• Maintaining an average cost of $17,609 per client
On June 22, 2021 (Item No. 26), as a result of a formal procurement, the Board of Supervisors (Board) approved Contract No. 21-474 with VCSS in the amount of $6,175,000 for the provision of TBS, for the period of July 1, 2021 through March 31, 2026.
On March 26, 2024 (Item No. 25), the Board approved Amendment No. 1 to Contract No. 21-474, effective December 1, 2023, with VCSS for the provision of TBS increasing the total amount by $2,925,000, from $6,175,000 to $9,100,000, and updating standard contract language, with no change to the total contract period of July 1, 2021 to March 31, 2026. This change was a result of MHS ending their contract with DBH effective December 31, 2023, so these services were transitioned to VCSS.
On December 16, 2025 (Item No. 29), the Board approved contract amendment templates to update the provisional payment language in contracts with providers of specialty mental health and/or substance use disorder and recovery services. Item No. 29 also authorized the department’s Assistant Executive Officer, Deputy Executive Officer, or Director to execute this amendment (including non-substantive changes) using the approved amendment templates.
On March 10, 2026 (Item No. 16), the Board approved Amendment No. 2 to Contract No. 21-474, increasing the total contract amount by $1,950,000 from $9,100,000 to $11,050,000 and extending the contract term by an additional nine months, for the total contract period of July 1, 2021 through December 31, 2026.
On June 30, 2026, Amendment No. 3 to Contract No. 21-474 with VCSS was amended to update the provisional payment language pursuant to the Board approved template in the contract via Delegated Authority.
Performance measures for VCSS and their implementation of TBS youth demonstrate that they typically provided a service every two to three days for an average time period of 100 to 125 days, with 20 hours of services provided in the first several months then gradually adjusting down to approximately 10 hours per month. Outcome measures indicate that 77.8% of all recipients of TBS from VCSS show an improvement on an identified concern. Examples of the outcome areas evaluated and the percentage of clients who demonstrated improvement are summarized in the table below.
|
Area of Concern |
Clients with Identified Need (%) |
Clients with Noted Improvement (%) |
|
School Behavior |
80% |
73% |
|
School Achievement |
63% |
60% |
|
School Attendance |
32% |
61% |
|
Oppositional |
83% |
48% |
|
Anger Control |
91% |
50% |
PROCUREMENT
N/A
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health (Marianna Martinez, Administrative Supervisor II, 383-3940) on July 7, 2026; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on July 15, 2026; and County Finance and Administration (Iliana Rodriguez, Administrative Analyst, 386-8392) on July 17, 2026.