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Behavioral Health director overhauls spending, programs

Plumas County’s new Behavioral Health director rolled up his sleeves and is attempting to overhaul his budget and staffing positions — even if it means taking on the work of additional positions himself.

Director Tony Hobson was before the Board of Supervisors on Tuesday, Sept. 18, explaining that without some serious cuts and changes to the programs and budget he inherited just a short time ago — it will be in the red.

Besides struggling through his budget, trying to make ends meet and still provide services, Hobson is assuming the role of Alcohol and Other Drugs administrator, and taking the place of retired therapist Michael Gunter. Hobson will not fill those recently vacated positions at this time — except by himself.

What Hobson immediately grasped when he began to familiarize himself with his new program was his department was spending $5.5 million and he had only $4 million coming in. “There’s no way we can keep this up,” he told supervisors.

One solution, and not an easy one, was to streamline programs and to raise rates.

One place to begin was to look at the rates Behavior Health is charging its clients. Rates were set in 2007 and adjusted in 2013, and are out of alignment, Hobson told supervisors.

Not only will Hobson be raising rates to current levels, he’s ensuring that two of his major providers — Environmental Alternatives,  a foster care agency, and Plumas Rural Services mental health program for children — are able to also increase their rates.

By getting EA and PRS trained and connected with Behavioral Health’s Medi-Cal billing system, Hobson means that a greater part of the department’s deficient budget is being met, Hobson explained. This “should be enough to get us back to where we ought to be,” he said.

Closing Sierra House, a board and care program for residents with severe and persistent mental health concerns, is another expense off the books. The Plumas County Behavioral Health Commission voted to end that program in August. To continue that program would have meant additional expense in deferred maintenance that included everything from a leaking roof to ADA compliance issues.

He’s also had to withdraw financial support to other programs including PRS’s Community Connections.

While Hobson believes he’s off to a good start with managing this year’s Behavioral Health budget, there are still concerns within his programs that leave him scratching his head, he told supervisors.

According to a handout Hobson presented to supervisors, there are 74 approved positions in the department. There are actually four vacancies and 53 funded/allocated positions.

Hobson is also doing without a deputy director. Other non-funded positions include that of medical director, behavioral health quality assurance coordinator, AOD program clinician supervisor and a unit supervisor of nursing.

Supervisor Michael Sanchez asked if the state required a medical director for the program. Hobson responded that position would be covered under a special contract.

Hobson explained that Behavioral Health works with the schools and is working on meeting their needs. Like EA and PRS, he believes the schools must get on board with billing Medi-Cal.

Sanchez asked about the services the department provides to Feather River College. Hobson said he met with FRC President Kevin Trutna recently.

Mental health needs on campus are important. While students have medical insurance that meets their physical needs, they need assistance for mental health concerns. And from what Hobson said, he learned mental health needs are greater than physical health needs. He said he plans to keep the program in place. He just needs to figure out how to fund it.

Supervisor Sherrie Thrall asked if Hobson was keeping the wellness centers in Chester, Greenville and Portola in operation. Hobson explained that these operations are vital to the people outside Quincy. The centers are valuable places for intake services. He said that it just makes sense for people to travel a shorter distance to do routine processes than to require everyone from outlying areas to travel to Quincy.

Thrall agreed that the wellness centers are a viable solution. She added that other departments should learn about the realities in the cost of doing business.

As Hobson discussed his budget needs, Sanchez asked about behavioral health’s budget reserves.

Hobson said that his program would need to dip into reserves  this year. “Frankly we have the money,” he said.

Behavioral Health will need $1.2 million from its reserves, said Susan Scarlett, the county’s budget consultant. Thrall said the department has about $5.4 million in reserves.

Sanchez said he was concerned about not filling some positions. He said he’s concerned that people, including Hobson, would get burned out. Thrall agreed.

Hobson said some positions would be filled as funding comes available.

MHSA explained

It was just last September when then Behavioral Health Director Bob Brunson was before the Board of Supervisors with a $7.1 million program and expenditure plan that should have been good through 2020.

In reality, that plan didn’t last out the first year.

Although the plan probably looked good on paper and apparently supervisors liked what they heard — unanimously approving the plan — it was flawed.

Based on what Hobson revealed this September, the former director was creating new programs without tending to old business, namely updating the amount the program receives as reimbursement from insurance programs.

Brunson came up with 16 contracts with community agencies. These included a new program at FRC, the county’s three hospitals, EA and PRS, Plumas Crisis Intervention and Resource Center, mental health housing and other resources.

The smallest contract was for $51,696 for one of several agreements with PCSIRC. The largest was for $987,589 for one of PRS’s contracts with Behavioral Health.

AB 114 went into effect July 10, 2017, amending certain Welfare and Institution Code section related to MSHA funds.

On the consent agenda for the Board of Supervisors was Hobson’s MHSA Reversion Plan Update to the 2017-20 plan as required by AB 114. The bill also extended fund allocation expiration dates for small counties including Plumas from three to five years.

By July 1, 2017, Plumas was to receive more than $2.5 million and is to spend that amount by 2020.

Why services work at FRC

Plumas County Behavioral Health is putting services in immediate reach of Feather River College students, according to FRC President Kevin Trutna.

“The FRC Mental Health and Wellness Center depends upon the MHSA funding to provide the first-line campus triage service for FRC students,” Trutna said about the program that began last year.

Mental wellness is one of the top needs of college students today, Trutna explained. To prove his point, Trutna said that 145 different students used the on-campus services last year.

For 2016-17, FRC showed an enrollment of approximately 1,500 full-time students and approximately 2,600 part-time students.

Last year, 270 appointments were made on-campus for those students and 58 consultations with faculty/staff about student mental health issues.

Students sought intervention for mild to moderation issues such as depression, anxiety and substance use. They also needed more serious intervention for suicide prevention and group therapy sessions, Trutna said.

“In addition, three outreach events were held on campus that attracted 150, 25 and 225 students to each of the three events,” he said.

With Behavior Health services located just a stone’s throw away from the college, why are more centralized services required?

Historically FRC students do not seek external resources even when it’s located at such proximity to the campus, Trutna said.

Behavior Health isn’t prepared to absorb FRC’s population in need of mental health services, Trutna said. Initiating services on campus was a good use of Mental Health Services Act funding through Proposition 63 passed in 2004 and went into effect the following January.

Last year, Behavioral Health provided FRC with $557,032. Dr. Kelsie Foster was hired to form a specific program not only geared toward traditional mental health concerns, but with the student in mind. “In the first year of operations…Dr. Kelsie Foster has exceeded expectations in serving the well-being of students,” Trutna commented in a report about that program.

Services included then and now individual appointments, group sessions and consultations with faculty and staff concerning student issues and behavior.

Foster is continuing in her second year of services on campus. “Feather River College is advocating for continuing the use of MHSA funding to provide these needed services,” Trutna said.

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