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HomeMy WebLinkAboutMINUTES - 10042011 - C.63PDF Return C.63 To: Board of Supervisors From: Family and Human Services Committee Date: October 4, 2011 Contra Costa County Subject:Annual Updates on the Continuum of Care Plan for the Homeless and the Healthcare for the Homeless APPROVE OTHER RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE Action of Board On: 10/04/2011 APPROVED AS RECOMMENDED OTHER Clerks Notes: VOTE OF SUPERVISORS AYE:John Gioia, District I Supervisor Gayle B. Uilkema, District II Supervisor Mary N. Piepho, District III Supervisor Karen Mitchoff, District IV Supervisor ABSENT:Federal D. Glover, District V Supervisor Contact:Dorothy Sansoe, 925-335-1009 I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. ATTESTED: October 4, 2011 David Twa, BY:June McHuen , Deputy RECOMMENDATION(S): ACCEPT the annual updates on the accomplishments and achievements of the Health Services Department's Continuum of Care Plan for the Homeless and the Health for Homeless as recommended by the Family and Human Services Committee. FISCAL IMPACT: None - report only. BACKGROUND: The Board of Supervisors referred to the Family and Human Services Committee the oversight of the Continuum of Care Plan for the Homeless and the Healthcare for the Homeless. The Health Services Department reports to the Family and Human Services Committee annually on the accomplishments and achievements of these efforts. BACKGROUND: (CONT'D) At their September 12 meeting, the Family and Human Services Committee reviewed the attached reports, accepted them, and requested that they be forwarded to the Board of Supervisors as information. CONSEQUENCE OF NEGATIVE ACTION: None. CHILDREN'S IMPACT STATEMENT: Not Applicable AgendaQuick©2005 - 2021 Destiny Software Inc., All Rights Reserved   5 1 CONTRA COSTA HEALTH SERVICES DEPARTMENT CONTRA COSTA COUNTY TO: Family and Human Services DATE: Sept. 12, 2011 Committee Members FROM: Rachael Birch, Project Director, Health Care for the Homeless SUBJECT: Health Care for the Homeless Annual Report Recommendations 1. Accept this report from the Health Services Department; and 2. Forward this report to the Board of Supervisors for acceptance; and 3. Direct staff to continue to report on an annual basis to the FHS Committee regarding progress and status of the Health Care for the Homeless Program and to submit an additional written report to the Board of Supervisors, at six-month intervals. Background Since 1990, the Health Care for the Homeless (HCH) Project has provided health care services to the homeless population through mobile clinics, as well as through the CCHS integrated ambulatory system of care, and the Departments of Mental Health and Alcohol and Other Drugs. Primary health care services provided by the HCH Mobile Team include routine physical assessments, basic treatment of primary health problems such as minor wounds and skin conditions, respiratory problems, TB screening, acute communicable disease screening, and coordination and referrals for follow up treatment of identified health care needs. A significant portion of the homeless patients seen in the mobile clinics have chronic diseases, including asthma, hypertension, diabetes, and mental health/substance abuse issues. The mobile team is comprised of a Medical Director, Family Nurse Practitioners, Nurses, Community Health Workers, Financial Counselor, Mental Health Specialist, and a Substance Abuse Counselor. Homeless patients who receive care on one of the mobile clinics are referred into one of the CCHS ambulatory care health centers for primary and specialty care, into County mental health and substance abuse services and to Contra Costa Regional Medical Center for emergency, inpatient hospital, outpatient surgeries, laboratory and radiology. There are currently four ambulatory care clinics, 2 located throughout the County, designated specifically for homeless patients to help them transition from the mobile clinic setting into the ambulatory care system. HCH staff members are present at each of these clinics. The HCH project also provides Public Health Nurses at each of the County shelters, providing comprehensive Targeted Case Management for homeless patients. During 2010, CCHS treated 16,055 homeless patients who generated 102,367 visits. This is an increase from 2009, when CCHS saw 15,094 homeless patients who generated 96,572 visits. The increase is likely due in part to the economic recession, which placed further demand on the safety-net system, including CCHS, and partly to the addition of three Community Practice Clinics in Concord, Antioch and San Pablo. Table 1 (below) indicates the Board of Supervisor’s District where homeless patients reside. If no residential zip code data are available, the zip code where a patient received care is used. Table 1: Percent of Homeless Patients by Supervisorial District, 2009 District 1- Supervisor Gioia 33% District 2- Supervisor Uilkema 20% District 3- Supervisor Piepho 2% District 4- Supervisor Bonilla 23% District 5- Supervisor Glover 22% The attached presentation contains additional demographic information on our HCH population. New Actions The following activities and updates have occurred since the last briefing to the Board of Supervisors on HCH activities: American Recovery and Reinvestment Act Funding In July 2009, the HCH Project received a Capital Improvement Project award to replace the Martinez Family Practice Site (Building 2 on the CCRMC Campus). This project will modernize the clinic and streamline clinic flow for maximum efficiency. The new unit will enhance the effectiveness and efficiency of providing clinical services to patients through reduced waiting times for clinic appointments at the Martinez site and throughout the CCHS system. A homeless-specific clinic will be offered at this site upon its opening. Funding for this project was calculated on a formula basis at $683,000. During the past year, CCHS devoted 3 time to meeting all conditions associated with the grant award prior to beginning construction, including extensive environmental assessments. The new clinic will have both medical and mental health components. Its design has been completed and is currently under review by the Department of Community Development. In December 2009, CCHS received $12 Million in ARRA funds for the construction of a new West County health center, to replace the Richmond Health Center. Construction is well under way on the 50,000 square foot, two story clinic. It will house a comprehensive array of outpatient medical services and support functions. The goal is to have the building achieve LEED certification for environmental quality. In May 2009, the HCH Project was awarded an additional $220,000 in stimulus funds to address the “Increased Demand for Services.” This amount of funding was calculated by a formula based on the number of homeless patients served by the HCH Program. This funding has been incorporated into our HCH base grant, increasing our annual amount to $958,795 Affordable Care Act In August 2011, the HCH Project received a New Access Point (NAP) grant from HRSA for $649,185 per year. The funding will help pay for a team of HCH staff to operate a homeless clinic in Concord, at 3024 Willow Pass Rd., Concord. This team will include one RN, one PHN, one Community Health Worker, one Medical Doctor, one Care Coordinator, one Mental Health Specialist, one Substance Abuse Specialist and one Registration Clerk. This funding will be incorporated into our HCH base grant, increasing the annual amount to $1,607,977. Integrated Primary Care Clinic in Concord The HCH Project will soon be opening an integrated primary care (IPC) clinic at Concord Mental Health. The proposed site will provide primary health care with specialty referral and coordination to adults with serious mental illness (and co- occurring substance abuse) and will be located at 1420 Willow Pass Road, Concord, CA. Referrals will initially come from enrolled consumers within Concord Mental Health, where it is estimated that at least 50% of the actively enrolled consumers do not have regular access to primary care and 70% are homeless. Homeless Respite Care and Shelter Clinic The HCH Project opened a licensed ambulatory care clinic at the Concord shelter in May 2011. The clinic serves homeless individuals staying at the Concord shelter and Respite, as well as all clients who meet the homeless 4 criteria. Open four days (20 hours) per week, the clinic includes an RN, FNP and Community Health Worker. The HCH Project continues to provide all medical and nursing care at the Philip Dorn Respite Center. Pro-Bono Dental Health Services for Homeless Clients The Homeless Consumer Advisory Board and HCH launched a partnership with a small group of private dental providers who provide services free of charge to homeless individuals who do not qualify for dental coverage through other programs. The Advisory Board has been a strong advocate about the need for this free service given a lack of affordable dental services, and we are very pleased that a pilot program will address some of this unmet need. A second client recently received free treatment and a complete set of dentures, at no cost, courtesy of the generous care from Dr. Alijanian, DDS, of Walnut Creek. A third client will soon begin receiving services from Dr. Michael Tobian. Dental services are essential to regaining employment and exiting homeless. Rentry Program for Individuals Exiting Incarceration The HCH Project continues to provide staff at the PACT (Probation and Community Together) meetings, providing parolees with assistance in entering our health care system. Kate Schwertscharf, HCH Public Health Nurse Program Manager, receives phone calls and referrals from the San Quentin Medical Project, Richmond Parole Office and the West County Detention Facility, assisting clients in accessing health services. New Medical Director The HCH’s Medical Director, Dr. Kate Colwell, retired after 24 years with CCHS. A new Medical Director, Dr. Nishant Shah, M.D., M.P.H. was identified from within the organization and was oriented by the previous, Dr. Kate Colwell. Summary This has been an exciting and busy time of growth and planning for the HCH program in CCHS. We expect that our next report will have significant updates on the milestones achieved for these new projects, while we also work hard to sustain the ongoing work of the mobile clinic team and homeless ambulatory care clinics. 5 Health Care for the HomelessContra Costa Health ServicesPresentation to the Family & Human Services Committee Contra Costa County Board of SupervisorsSept. 12th, 2011 Rachael BirchHCH Project DirectorKate Schwertscharf, PHNNurse Program Manager Who qualifies as “Homeless?”zAll homeless people in Contra Costa County•Lacking a fixed, regular, adequate nighttime residence•Primary nighttime residence in a shelter, welfare hotel, transitional housing•“Doubled-up” without name on a lease, couch surfing, etc. Funding for HCH ServiceszSection 330(h) Public Health Services ActHealth Care for the Homeless grant from the Federal Government (BPHC/HRSA) – approx. $1.6M per year. Funding ReceivedzIncreased Demand for Services (2009)- $112K per year – rolled into base Section 330 grant.zCapital Improvement Funds (2009) - $683K to replace Martinez bldg 2 with new modular unitz$12 Million award to rebuild Richmond Health Center (2009)zNew Access Point funding (2011) - $650K per year (Increasing base funding from $958K to $1.6 million per year) to open new homeless clinic in Concord. Number of Patients in 2010z16,055 unduplicated homeless patientsz102,367 visits: mobile clinics, ambulatory clinics, emergency department, mental health, substance abuse programs. Number of Patients in 2009 z15,094 unduplicated homeless patientsz96,572 visits: mobile clinics, ambulatory clinics, emergency department, mental health, substance abuse programs. How Patient Demand is Growing Over Time:z2008 vs. 2009:•22% increase in patients•17% increase in visitsz2009 vs. 2010:•6.4% increase in patients•6% increase in visits Why the increase?zExpanded ability to provide services through increased grant funding. -Increased access to care through new clinic openings.zEconomic situation creating increased demand HCH ServiceszMobile Clinic:•routine physical assessments•basic treatment of primary health problems such as minor wounds and skin conditions•treatment for respiratory problems•TB testing•acute communicable disease treatment•referrals for follow up in ambulatory/specialty care•substance abuse and mental health services 2 Mobile Clinic Teams,5 days a weekzAdult Emergency Shelters Concord & RichmondzCalli House (youth), RichmondzBay Area Rescue MissionzGRIP Souper Center & Family Shelter, RichmondzNeighborhood House of North RichmondzMonument Futures, ConcordzMonument CorridorzHome Depot : El CerritozMulti-Service Centers, Richmond, AntiochzAOD Treatment FacilitieszSt. Paul’s, Walnut CreekzAmbrose Community Center, BaypointzLove-A-Child, BaypointzMartinez Waterfront Ambulatory Care ClinicszOperate specialized homeless clinics in the Richmond, Concord and Antioch health centers & at Concord Respite Center for homeless patients •Bypasses waiting times for appointments•Bypass financial counseling process•Make the process more “user friendly” for homeless patients•Helps patients transition to mainstream health care delivery system Ambulatory Care, Specialty, & Hospital Services•4 ambulatory care clinics specifically for homeless patients in Richmond, Concord, Antioch•Family practice care•Specialty care•Outpatient surgery•Emergency Department•Inpatient care•Laboratory•Radiology•Pharmacy Mental Health ServiceszMental Health Treatment Specialist provides screenings, assessments, referrals into the Mental Health system for medication and treatment of clients in the shelters and at other mobile clinic sites Alcohol and Other Drug ServiceszSubstance Abuse Treatment Specialist provides screenings, referrals, and coordination of detox and recovery services specifically for homeless patients in shelters and other mobile clinic sites Patient Demographics 2010z50.5% malez49.5% femalez24% of homeless patients are completely uninsured, on no publicly-funded programz52% Medi-Cal; 2% Medi-CarezAll of our patients at 100% of the Federal Poverty Level and below. Race/Ethnicity in 2010Race HCH CountyWhite 36% 58.5%Latino/Hispanic 26% 24%Black/African American 23% 9%Asian/Pacific Islander 9.5% 15%American Indian/Alaskan Native 0.5% 0.58%Unknown 5% 2% Which Supervisor Districts were Patients from in 2010?I- Supervisor Gioia 33%II- Supervisor Uilkema 20%III- Supervisor Piepho 2%IV- Supervisor Mitchoff 23%V- Supervisor Glover 22%Total 100% Which Supervisor Districts were Patients from in 2008 & 2009?District 2008 2009I- Supervisor Gioia30% 31%II- Supervisor Uilkema13% 15%III- Supervisor Piepho6% 2%IV- Supervisor Bonilla19% 20%V- Supervisor Glover26% 31%Other5% 0% Strong Consumer InvolvementzActive consumer advisory board•Helped to create pro-bono dental services for homeless clients; third patient is receiving services and will receive a free set of dentures courtesy of Dr. Michael Tobian in Walnut Creek Changes & Updates – ClinicalzRespite Care program - HCH is pleased to continue our collaboration with the Behavioral Health and Homeless Program to provide higher level of medical care to medically fragile shelter clients.zConcord Shelter Clinic – HCH recently opened a licensed ambulatory care clinic located next to the Concord Shelter and Respite, open 20 hours per week.zTwo public health nurses are providing comprehensive medical case management at each adult shelter in the County. Changes & Updates - ClinicalzNew Medical Director, Dr. Nishant Shah – Staff physician. Changes & Updates - WCHC