City of Alexandria, Virginia
________________
MEMORANDUM
DATE: JUNE 16, 2021
TO: THE HONORABLE MAYOR AND MEMBERS OF CITY COUNCIL
FROM: MARK B. JINKS, CITY MANAGER /s/
DOCKET TITLE:
TITLE
Consideration of the Release of $789,909 from FY 2022 Contingent Reserves for Mental Health Resources, Teen Wellness, and Behavior Health Support for School Age Children.
BODY
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ISSUE: Consideration of the release of $789,909 from FY 2022 Contingent Reserves for Mental Health Resources, Teen Wellness, and Behavioral Health Support for School Aged Children.
RECOMMENDATION: That City Council allocate $789,909 held in FY 2022 General Fund contingent reserves to enable the distribution of funding to department budgets for the Court Service Unit ($101,000), Department of Community and Human Services (DCHS)($566,909), and Alexandria Health Department ($122,000).
BACKGROUND: During the FY 2022 budget’s final Add/Delete work session, City Council reallocated $789,909 from the Police Department budget for School Resource Officers (SROs) to contingent reserves. City Council directed staff to present a proposal, with input from ACPS, to City Council for use of the funding for mental health resources for school aged children, the Teen Wellness Center, an additional Behavioral Health Specialist for the Alexandria Crisis Intervention and Co-responding Program (ACORP) pilot program, or other similar needs identified by staff.
City staff held a series of discussions and consulted with ACPS staff, to identify the greatest areas of need for school aged children across the City. The parameters for the discussions and strategies were that the funding should address the following areas of need:
• Align with mental health, teen wellness, and behavioral health support needs for school- aged children;
• Alleviate capacity limitations and reduce the number of students on waitlists for services; and
• Anticipate increased student support needs as students return to in-person learning.
DISCUSSION: The following City Departments interact the most with ACPS’ school aged children. The mental health, teen wellness, and behavioral health support services provided by these departments are listed below as well as their current waitlist and capacity limits.
DCHS’ Child and Family Behavioral Health Services (CFBHS): Prior to the pandemic (2019 to 2020) DCHS’ CFBHS Division was staffed with 4.40 FTEs who were allocated as follows:
• Alexandria City High School Main Campus: Two Senior Therapists (1 English Speaking, 1 Spanish Speaking) providing 80 hours total per week at school (approximately 40 client caseload).
• Alexandria City High School - Minnie Howard Campus: One Senior Therapist (English speaking) providing a total of 16 hours for service (approximately 10 client caseload);
• Hammond Middle School: Two Senior Therapists (1 English Speaking, 1 Spanish Speaking) providing a total of 64 hours of service at the school (approximately 30 client caseload); and
• George Washington Middle School: One Senior Therapist (English speaking) providing 16 hours of service at the school (approximately 10 client caseload).
DCHS’ CFBHS has a current wait list of eleven (11) school age youth, the majority with Spanish speaking parents who are recommended to have a bilingual therapist. Over the course of a year, wait list times vary due to prioritization and triage of severity of symptoms as well as vacancies within CFBHS. Historically, the school-based waitlists are as follows (by January/March of the school year):
• Alexandria City High School Main Campus: 25 to 30 students on the English-speaking waitlist, 20 to 25 students on the Spanish speaking waitlist;
• Alexandria City High School Minnie Howard campus: 5 to 10 students on a waitlist;
• Hammond Middle School: 5 to 10 students on the English-speaking waitlist and 5 to 10 students on the Spanish speaking waitlist; and
• GW Middle School: Little to no waitlist due to a variety of factors, including less exclusive need for school-based services and language limitations.
Each year ACPS Student Support Services requests that CFBHS provides more clinicians in schools than DCHS has capacity to provide. If CFBHS had more capacity, this program would provide considerably more outreach, group therapy, and consultation. Furthermore, City staff anticipates from all studies showing an increase in mental health symptoms within school age youth that there will be a three-fold (3x) increase the number of referrals historically received during the school year, particularly as students adjust to in-person learning.
Court Service Unit: The CSU has on staff two Senior Therapists who receive referrals from judges, intake and probation officers and provide therapy to youth and families, biopsychosocial evaluations, juvenile sex offender evaluation and treatment, custody evaluation/home studies, and parenting classes for those in custody disputes. The program communicates with the Court to maintain an appropriate number of cases and, in so doing, does not maintain a wait list. Therapists staff each referral and determine an appropriate service provider based on insurance and capacity. If services cannot be provided in-house and the client is eligible for services with DCHS, then referrals are made. When Senior Therapist caseloads are full, a memo is sent to the judges, who then avoid making referrals for services not available outside the CSU (i.e., custody evaluations/home studies, until therapists have the capacity).
The CSU currently funds two Counselors through the Intervention Prevention and Education (IPE) program who provide Therapeutic Case Management for youth who are at risk of gang involvement; including family reunification, acculturation, and community resources. Some youth are gang involved while many exhibit risk factors such as, substance abuse, crime, teen pregnancy, and poor school performance. The waitlist for the program during the current fiscal year is not representative of the average waiting time and waitlist since the IPE program has shifted service delivery due to the COVID-19 pandemic. During previous years, an average wait time for a case to be assigned was as follows:
• In 2019 there were 17 students on the waiting lists at a given time with an average waiting time of 38 days; and
• In 2020 there were 30 students on the waiting lists at a given time with an average waiting time of 31 days.
Alexandria Health Department: AHD staffs and operates the Teen Wellness Center (TWC) within Alexandria City High School. The Teen Wellness Center is a medical clinic that provides health services to any teen living in the City of Alexandria. The clinic is open year-round and provides a variety of health and confidential services to teens between the ages of twelve and nineteen. There are no TWC providers based at the Minnie Howard campus. All youth needing services are referred to DCHS mental health staff.
Proposal: The recommendations for reallocating the $789,909 are listed below. The proposals selected by staff where those that would best alleviate current capacity limitations and reduce the number of ACPS students on waitlists for mental health services as well as anticipate increased student support needs as students return to in-person learning.
• Court Services Unit
o Alexandria Mentoring Partnership Coordinator (+1.0 FTE) to ensure that every child has caring adult role models. This proposal is in alignment with the Children and Youth Master Plan and would support evidence-based practices among mentoring programs, support development of new mentor programs, and establishment of a Mentoring Institute, whereby caring adults in Alexandria will be trained in mental health first aid, building assets, youth development, drug and alcohol and child abuse prevention. (+$101,000)
• Alexandria Health Department
o Public Health Nurse II (+1.0 FTE) will be located at the Minnie Howard Campus, provide a limited number of health services there, and act as a bridge to mental health practitioners and the full range of TWC services. The nurse will primarily focus on following up with students on recommendations made by AHD and DCHS healthcare providers. This type of follow up is key to enacting change in sleep patterns, diet, exercise, self-care, and high-risk behaviors that affect both mental and physical health. (+$122,000)
• DCHS
o Therapist Supervisor (+1.0 FTE) to support staffing/supervisory needs in CFBHS, coordination opportunities, and dedicated system support for ACPS. This therapist supervisor would develop a coordinated effort with the Youth Development program to provide services through the continuum of care (Prevention, Early Intervention, Treatment, and Crisis response), meeting increasing school community demands. (+$122,422)
o Senior Therapist (Licensed Mental Health Professionals) (+2.0 FTE) will provide individual, family, and group therapy for school-based youth, consultation, and crisis response. (+$117,199 x 2.0 FTE).
o Human Services Specialist II (Qualified Mental Health Professionals) (+1.0 FTE) would provide support for family outreach and engagement and prevention/early intervention activities. There will be a focus on building on/collaborating with ACPS restorative justice and equity efforts, closing the disparity gap, and meeting global youth needs within the school setting. (+$98,654)
Licensed Senior Therapist (+1.0 FTE) who serves as an Emergency Services (ES) generalist who would focus on mobile crisis and outreach and engagement work. This would include the schools when needed and in other settings. Depending on the type of situation the therapist is called to, some calls would get responded to with a Police Officer, others would not. This ES therapist would be scheduled during the day to respond to any potential increase in school referrals. (+$111,435)
It should be noted that an additional ACORP position was not recommended because the primary intent of this allocation was to focus on directly serving school aged youth.
FISCAL IMPACT: The $789,909 is currently held in FY 2022 general fund contingent reserve for this purpose and therefore there will be no additional impact to the City’s operating budget. Authorization by City Council will increase Department General Fund budgets by the amounts and FTEs listed in the table below. City Council approval of this proposed planned will allow staff to recruit the proposed seven additional staff and hire prior to the start of the upcoming school year.
|
DCHS |
• 1.0 School Services Therapist Supervisor • 2.0 Senior Therapists LMHP • 1.0 Human Services Specialist II QMHP • 1.0 Licensed Senior Therapist Emergency Services |
$566,909 |
|
Health |
• 1.0 Public Health Nurse II |
$122,000 |
|
Court Services |
• 1.0 Alexandria Mentoring Partnership Coordinator |
$101,000 |
|
Total |
$789,909 |
STAFF:
Debra Collins, Deputy City Manager
Mike Mackey, Director, Court Service Unit
Kate Garvey, Director, Department of Community and Human Services
Dr. Anne Gaddy, MD, MPH, Acting Director, Alexandria Health Department
Morgan Routt, Director, Management and Budget
Meghan McGrane, Budget Analyst, Office of Management and Budget