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Glossary of Acronyms, Abbreviations, and other Terms (in alphabetical order):
Contra Costa County has a policy of making limited use of acronyms, abbreviations, and industry-specific language in its
Board of Supervisors meetings and written materials. Following is a list of commonly used language that may appear in
oral presentations and written materials associated with Board meetings:
AB Assembly Bill
ABAG Association of Bay Area Governments
ACA Assembly Constitutional Amendment
ADA Americans with Disabilities Act of 1990
AFSCME American Federation of State County and Municipal
Employees
AICP American Institute of Certified Planners
AIDS Acquired Immunodeficiency Syndrome
ALUC Airport Land Use Commission
AOD Alcohol and Other Drugs
BAAQMD Bay Area Air Quality Management District
BART Bay Area Rapid Transit District
BCDC Bay Conservation & Development Commission
BGO Better Government Ordinance
BOS Board of Supervisors
CALTRANS California Department of Transportation
CalWIN California Works Information Network
CalWORKS California Work Opportunity and Responsibility
to Kids
CAER Community Awareness Emergency Response
CAO County Administrative Officer or Office
CCHP Contra Costa Health Plan
CCTA Contra Costa Transportation Authority
CDBG Community Development Block Grant
CEQA California Environmental Quality Act
CIO Chief Information Officer
COLA Cost of living adjustment
ConFire Contra Costa Consolidated Fire District
CPA Certified Public Accountant
CPI Consumer Price Index
CSA County Service Area
CSAC California State Association of Counties
CTC California Transportation Commission
dba doing business as
EBMUD East Bay Municipal Utility District
EIR Environmental Impact Report
EIS Environmental Impact Statement
EMCC Emergency Medical Care Committee
EMS Emergency Medical Services
EPSDT State Early Periodic Screening, Diagnosis and
treatment Program (Mental Health)
et al. et ali (and others)
FAA Federal Aviation Administration
FEMA Federal Emergency Management Agency
F&HS Family and Human Services Committee
First 5 First Five Children and Families Commission
(Proposition 10)
FTE Full Time Equivalent
FY Fiscal Year
GHAD Geologic Hazard Abatement District
GIS Geographic Information System
HCD (State Dept of) Housing & Community Development
HHS Department of Health and Human Services
HIPAA Health Insurance Portability and Accountability Act
HIV Human Immunodeficiency Syndrome
HOV High Occupancy Vehicle
HR Human Resources
HUD United States Department of Housing and Urban
Development
Inc. Incorporated
IOC Internal Operations Committee
ISO Industrial Safety Ordinance
JPA Joint (exercise of) Powers Authority or Agreement
Lamorinda Lafayette-Moraga-Orinda Area
LAFCo Local Agency Formation Commission
LLC Limited Liability Company
LLP Limited Liability Partnership
Local 1 Public Employees Union Local 1
LVN Licensed Vocational Nurse
MAC Municipal Advisory Council
MBE Minority Business Enterprise
M.D. Medical Doctor
M.F.T. Marriage and Family Therapist
MIS Management Information System
MOE Maintenance of Effort
MOU Memorandum of Understanding
MTC Metropolitan Transportation Commission
NACo National Association of Counties
OB-GYN Obstetrics and Gynecology
O.D. Doctor of Optometry
OES-EOC Office of Emergency Services-Emergency
Operations Center
OSHA Occupational Safety and Health Administration
Psy.D. Doctor of Psychology
RDA Redevelopment Agency
RFI Request For Information
RFP Request For Proposal
RFQ Request For Qualifications
RN Registered Nurse
SB Senate Bill
SBE Small Business Enterprise
SWAT Southwest Area Transportation Committee
TRANSPAC Transportation Partnership & Cooperation (Central)
TRANSPLAN Transportation Planning Committee (East County)
TRE or TTE Trustee
TWIC Transportation, Water and Infrastructure Committee
VA Department of Veterans Affairs
vs. versus (against)
WAN Wide Area Network
WBE Women Business Enterprise
WCCTAC West Contra Costa Transportation Advisory
Committee
__________________________________________________________________________________________________________________
Schedule of Upcoming BOS Meetings
To be determined
2
z Contra Costa Alcohol and Other Drugs Services z Contra Costa Emergency Medical Services z Contra Costa Environmental Health z Contra Costa Health Plan z
z Contra Costa Hazardous Materials Programs z Contra Costa Mental Health z Contra Costa Public Health z Contra Costa Regional Medical Center z Contra Costa Health Centers z
William B. Walker, M.D. CONTRA COSTA
HEALTH SERVICES DIRECTOR MENTAL HEALTH
DONNA M. WIGAND, L.C.S.W. CHILDREN’S SYSTEM OF CARE
MENTAL HEALTH DIRECTOR VERN L. WALLACE, L.M.F.T
CHILDREN’S PROGRAM CHIEF
1340 Arnold Drive, Suite 200
Martinez, CA 94553
Phone: (925) 957-5126
Fax: (925) 957-5156
Memorandum – Executive Brief
To: Family and Human Services Committee
From: Donna Wigand
Mental Health Director
By: Vern Wallace
Child and Adolescent Program Chief
Date: December 6, 2010
Re: Update and Sustainability of the Seneca Residential Program (C5 Residential).
SUBJECT:
Update to the Family and Human Services Committee regarding the Seneca
C-5 Program
RECOMMENDATION:
Request the Family and Human Services Committee accept this report on the C-5 program operated by
Seneca Center.
FISCAL IMPACT:
Cost Neutral. The cost of the program remains the same on a cost per child basis. As a result of the
changes at the state level the program going forward will only be able to accept MediCal youngsters.
However, the daily cost per child exceeds all current reimbursements and the provider is working to
reduce this cost to the lowest possible level. Previously this money, referred to as “match,” was claimed
to the SB 90 mandate claim from the AB3632 program, and was available for cost reimbursement.
However, in order to maintain a youth in this placement the additional daily dollars will have to be funded
from some other source or the cost will have to be reduced in some way.
As a result, we are proposing to reduce the daily Contra Costa enrollment in the program to eight
MediCal youngsters. A daily “patch “ of county dollars will be required in order to continue to sustain the
placements for these very troubled youngsters. Overall costs will be reduced. In addition to the eight
Contra Costa youth the vendor will offer eight beds to surrounding counties at a slightly higher daily rate.
Additionally, other counties will be charged a user fee of $125.00 per day to offset the Contra Costa Day
rate and patch. However, the program may still be underfunded and could require some county
contribution of funds in order to be sustainable. Without this program Contra Costa will be forced to place
youngsters at great distance from their home, with some out-of-state, and with greater emotional cost to
the families.
.
3
z Contra Costa Alcohol and Other Drugs Services z Contra Costa Emergency Medical Services z Contra Costa Environmental Health z Contra Costa Health Plan z
z Contra Costa Hazardous Materials Programs z Contra Costa Mental Health z Contra Costa Public Health z Contra Costa Regional Medical Center z Contra Costa Health Centers z
BACKGROUND:
The Health Services Department, Mental Health Division, has been providing services to children at the
Oak Grove facility in Concord through a contract with Seneca since 1999. Mental Health, along with its
interagency System of Care partners, has fought to maintain services at the facility. Current changes in
the state budget and the availability of additional funding sources once again challenge the sustainability
of the program... This program includes step down, or community re-entry programming, Intensive
treatment foster care, and a number of best practice models of service delivery. It will continue to
enhance the current children’s system of care and maintain Contra Costa as one of the leading providers
of Children’s mental health services in the nation. Not sustaining this program could lead to greater cost
to the County and families of Contra Costa.
CURRENT
Today there are 15 Contra Costa youngsters at the C5 program. Most of these youngsters will require
intense mental health services and out of home placement. Some will go home, but some will live a life
in care, with many remaining in the Mental Health Adult System of Care.
4
Page 1 of 5
M E M O R A N D U M
DATE: December 6, 2010
TO: Family and Human Services Committee
Supervisor Gayle B. Uilkema, District II, Chair
Supervisor Federal D. Glover, District V, Vice Chair
FROM: Ruth Fernández, LPC Coordinator/Manager, Educational Services
SUBJECT: Local Planning Council for Child Care and Development – Council Activities-Referral #81
CC: Contra Costa County Office of Education
Dr. Joseph A. Ovick, Contra Costa County Superintendent of Schools
Dr. Pam Comfort, Associate Superintendent, Educational Services
RECOMMENDATION(S):
ACCEPT the below written report of activities, key accomplishments and challenges during fiscal year
2010-2011 for the Local Planning Council for Child Care and Development (LPC) as they relate to the
implementation of the Comprehensive Countywide Child Care Plan 2008-2011 in the following goal
areas: 1) Promoting access to quality child care, 2) Develop and nurture a trained workforce, 3) Foster and
promote coordination and collaboration with the community, 4) Advise sponsoring entities on local issues
and priorities in child care and development.
KEY PLANNING COUNCIL ACCOMPLISHMENTS:
• Convened over 15 local subsidized early care and education programs to coordinate and advocate for the
retention of subsidized funding serving low income children throughout the County.
• Developed, implemented, and administered a countywide professional development program for
individuals working in subsidized programs in Contra Costa County.
• Served as a public and inclusive coordinating and planning mechanism for the diverse field of early care
and education in the County.
• Created and published educational resources in English and Spanish for child care providers and parents
of young children.
• Sponsored a seminar for City Planning Department staff to provide technical information and supportive
child care language that would inform the development of municipal General Plans and Housing Elements
Reports.
• Developed user-friendly resources on professional development resources, events, and higher education
degree programs.
• Attended city council meetings, First Five commission meetings and other planning commission meetings
throughout the County in support child care services.
• Successfully completed Annual Self-Evaluation and Compliance Report as required by the California
Department of Education.
CHALLENGES:
• 50% reduction in annual state funding allocation for the Local Planning Council.
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Page 2 of 5
• 25% reduction in annual state funding allocation for the AB212 Professional Development Program Staff
Retention activities.
• Reduction of staffing infrastructure for the implementation of LPC projects and activities.
• Unfilled LPC membership categories.
ACTIVITIES IDENTIFIED FOR REPORTING PERIOD
(July 2010 – June 2011)
GOAL 1: PROMOTE ACCESS TO QUALITY CHILD CARE
Strategies Activities Objectives
Cross-agencies
collaboration &
partnerships
Convene quarterly county-wide
State-funded Program
Administrators Meetings.
Meetings are held at the County
Office of Education from
2-4 p.m.
• Promote cross-agency conversations that will
promote: collective problem solving, resource cross-
pollination, shared best practices.
• Leverage existing resources to explore new
partnerships and collaboration opportunities.
• Serve as a source of information regarding the needs,
challenges, and opportunities for State-funded/Title
V Child Development Programs.
• Provide a forum for dialogue, new connections and
relationships among child care services agencies
including Head Start, Early Start, Early Head Start,
School Districts, Non-profit agencies and State-
Preschool Programs.
Participate in cross agency
collaborative for First Five’s
Preschool Makes a Difference
Program (PMD)
• Serve as a liaison for the development of new
relationships between school districts and other
community agencies.
• Support the implementation of quality standards
identified by PMD and best practices for
professional development and curriculum in child
development programs including family child care,
state-funded programs, federally funded programs,
private, and exempt providers.
LPC Coordinator participates
in the Healthy and Active
Before Five Leadership
Council Meetings, events, and
activities.
Promote the implementation and enforcement of
healthy food and beverage environment policies in
child care programs and in all LPC meetings and
events.
On-going collaborative
meetings with Head Start
programs and the Community
Services Bureau
• Leverage existing resources for staff professional
development and growth.
• Coordinate efforts to support the early care and
education workforce to achieve the completion of
degrees within the established federal timeline (AA,
6
Page 3 of 5
BA, MA)
• Share resources and pilot new initiatives that
promote innovation and creativity
Implement new
regulations from the
California
Department of
Education (CDE)
Voluntary Temporary
Transfer of Funds (VTTF)
• Continue to monitor the process established by the
California Education Code (EC) Section 8275.5
known as the Voluntary, Temporary Transfer of
Funds.
• Ensure all child care and development funds appropria
by CDE are fully utilized within the fiscal year (FY).
• Assist and facilitate the local process in the
voluntary transfer of Child Development Division
(CDD) contract funds between CDD funded
agencies in Contra Costa County.
• The LPC Coordinator continues to inform Contra
Costa CDD funded agencies about resources and
information released by the state’s Child
Development Division. As defined by the state
CDD contractors will have an opportunity to request
transfer of funds for FY 2009-10 from November 1-
15 and May 1-15. Requests must be submitted to
the LPC during these periods.
Develop local priorities for
new state child care and
preschool funds
Priorities are determined and approved by the Local
Planning Council, Board of Supervisors and County
Superintendent of Schools and are submitted to the
CDD by May 30th of each calendar year.
GOAL 2: DEVELOP AND NURTURE A TRAINED WORKFORCE
AB 212 Professional
Development
Program (PDP)
Provide advising and
professional growth counseling
services
• Coach and mentor staff members at state-funded
child care programs for continued professional
development and educational achievement
• Connect staff members with local, regional, and
state-wide educational and professional development
resources such as conferences, seminars, trainings,
certificate programs and higher education degree
programs and institutions.
Provide stipends as incentives
for continued professional
growth and educational
advancement
• Participants are required to complete a minimum of
3 college units for degree or child development
permit applicable courses.
• Develop a professional development plan for quality
improvement based on their classroom observations
and indicators as indicated in the children’s desired
results developmental profiles
• Implement the approved professional development
7
Page 4 of 5
activities in their plan and write a reflective essay of
their learning
• Promote the retention of qualified staff at State-
funded Child Development Programs
Increase the teacher’s
knowledge, skills, and
strategies for achieving better
outcomes for children, while
continuing education and
professional development.
• Promote teacher’s reflective practices in the
classroom
• Foster peer coaching and classroom observation
• Support the use of self-assessment tools and inter
reliable quality evaluation tools
AB212 Center-
Based Team
Professional
Development
Grants
Identify eligible and interested
state funded programs to
successfully implement a team
professional development plan
(grants up to $5,000)
The Center-Based Team Professional Development
Grant is designed to foster:
Peer learning: through the creation of small peer
learning groups or discussion groups.
Communication: to identify areas of staff expertise
and areas for staff growth.
Mutual Cooperation: to promote sharing of
professional knowledge, to put knowledge gained from
professional development opportunities into practice in
the classroom, and to support team-based approaches to
program improvement.
Professional Development: in areas that have been
identified by the staff team at the site.
Personal Growth and Emotional Support for Staff:
to support the retention of a stable and skilled
workforce.
GOAL 3: FOSTER & PROMOTE COLLABORATION AND COORDINATION WITH THE CHILD
CARE COMMUNITY
Parent Education
Campaign
Create a Road Map to
Kindergarten Guide for
parents with children age 0-5
Provide families with a navigation tool that will guide
them to better prepare their children to enter
Kindergarten by reinforcing key school readiness skills
children need to successfully transition into a more
structured academic learning environment. The Road
Map also includes relevant information about
kindergarten information requirements and tips for
parents to become partners with their child’s teacher
and school.
Develop marketing tools that link
families with 211 telephone
services specifically to access
school district information
when preparing to register
their children in kindergarten
Collaborate with the County Office of Education, the
211 Database/services and the Community Services
Bureau to create and disseminate relevant information
with community agencies, pediatric clinics, parent
education programs, and other family resource centers.
GOAL 4: ADVISE SPONSORING ENTITIES ON LOCAL ISSUES AND PRIORITIES IN CHILD CARE
AND DEVELOPMENT
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Build rapport with
LPC appointing
bodies and other
local government
officials
Implement Contra Costa
County Comprehensive
Countywide Child Care Plan
2008-2011
• Provide bi-annual reports to the Family and Human
Services Committee of the Board of Supervisors
pertaining to LPC activities, challenges, and
strategic planning.
• Mobilize public and private resources to address
identified local child care needs
Plan, organize and implement
the 7th Annual Young
Children’s Issues Forum ~2011
Provide a forum for open dialogue and information
sharing between legislators, local officials and the
community regarding current children’s issues.
9
10
County of Contra Costa
OFFICE OF THE COUNTY ADMINISTRATOR
MEMORANDUM
DATE: December 1, 2010
TO: Family and Human Services Committee
Supervisor Gayle B. Uilkema, Chair
Supervisor Federal D. Glover, Vice Chair
FROM: Dorothy Sansoe, Staff
Sr. Deputy County Administrator
SUBJECT: Referral #61 – HIV Prevention/Needle Exchange
Recommended Action:
ACCEPT the attached report and any public comment; DIRECT the Health Services
Department to continue supporting and monitoring needle exchange services and
reporting annually as required by law; and DIRECT staff to forward the report and
comments by the Committee to the Board of Supervisors.
Background:
The Health Services Department, Public Health Division provides an annual report to the
Family and Human Services Committee on the status of HIV Prevention and Needle
Exchange Services in our community. Attached is the 2010 report.
Attachments
11
12
Contra Costa Health Services
Needle Exchange Update Report to Family & Human Services Committee
November 2010
- 1 -
RECOMMENDATIONS
1) Accept this report on needle exchange as part of the comprehensive HIV
Prevention Program.
2) Direct the Health Services Department to continue supporting and monitoring
needle exchange services and reporting annually as required by law.
SUMMARY
This report satisfies State legislation requirements to maintain needle exchange services
in Contra Costa without a declaration of a State of Emergency.
Legislative changes occurring since the last report include 1) Issuance of federal
guidance on the use of select federal funding for needle exchange services and
2) Extension through 2018 the state law allowing registered pharmacies to sell small
numbers of syringes to adults without a prescription.
County general funds to support the operation of Needle Exchange services were
further reduced this year to $49,000, and one time state funding in the amount of
$10,000 was added to the contract in accordance with guidance issued to the State
Office of AIDS by the Center for Disease Control (CDC). Condoms and Health Education
materials continue to be provided by the AIDS Program as available.
The percentage of new HIV AIDS infections attributed to IDU is increasing among men
but stable among women. Reported cases of Hepatitis C and the number of infants
with antibodies to HIV present at birth have decreased since the State of Emergency
was first formally declared in 1999.
Household generated sharps waste are not allowing in the regular household waste
stream. In addition to State-approved mail-back services, four facilities in Contra Costa
accept properly containerized, home-generated sharps waste. Other larger medical
providers continue to explore disposal options. A list of Frequently Asked Questions
(FAQs) about syringe disposal, as well as local disposal options, is available on the
county website at http://cchealth.org/groups/eh/faqs/faqs_medical.php
The availability of needle exchange as part of a comprehensive continuum of services
for injection drug users is a necessary Public Health measure to reduce transmission of
blood borne diseases and should remain available in Contra Costa County.
13
Contra Costa Health Services
Needle Exchange Update Report to Family & Human Services Committee
November 2010
- 2 -
BACKGROUND
Syringe exchange programs (SEPs) have been operating in California since the 1980s. In 2000,
legislation went into effect (Assembly Bill [AB] 136 (Mazzoni, Chapter 762, Statutes of 1999)
which authorized the establishment of SEPs in counties or cities that declared a local state of
emergency. In 2005, Governor Arnold Schwarzenegger signed AB 547 (Berg, Chapter 692,
Statutes of 2005) which simplified the process for local authorization of SEPs by replacing the
continuous declaration of a local state of emergency with an annual report.
In 1999 the Contra Costa Board of Supervisors endorsed needle exchange as a component of a
comprehensive HIV risk reduction strategy to reduce the transmission of HIV and other blood
borne diseases attributed to injection drug use. On January 10, 2006, the Contra Costa Board
of Supervisors:
TERMINATED the local State of Emergency first declared on December 14, 1999;
AUTHORIZED the Health Services Department to administer a clean needle and syringe
exchange project pursuant to Health and Safety Code section 121349 et seq; and
DIRECTED the Health Services Director to annually report to the Board on the status of
the clean needle and syringe exchange project, with a focus on reducing transmission
among women to their unborn children, reducing HIV and Hepatitis C transmission,
ensuring access to treatment services, and not increasing risk to law enforcement.
FEDERAL CHANGES OCCURING THIS YEAR
In December 2009, President Barack Obama signed the Consolidated Appropriations Act of
2010, which began the process of lifting the 1988 ban on the use of specific Federal funds for
syringe exchange programs. On July 7, 2010, the U.S. Department of Health and Human
Services issued guidance on the use of funds for federal fiscal year (FY) 2010, and additional
guidance was issued by both the Centers for Disease Control (CDC) and the Substance Abuse
and Mental Health Services Administration (SAMHSA). The CDC guidance is relevant to Contra
Costa and applies to FY 2010/2011.
The CDC guidance is directed to state health department grantees on the use of Federal FY
2010 funds only. It allows state health departments and their grantees the flexibility to
reallocate their current federal funding. This guidance does not apply to any available state
prevention funding. In October 2010, the State of California distributed a small amount of one-
time only funding to the most impacted local health jurisdictions. Contra Costa received
approximately $35,000 in one time funding to be expended by December 31, 2010. Of this
amount, $10,000 was placed in FY 10/11 needle exchange services.
REDUCING TRANSMISSION OF DISEASE
HIV and AIDS Data
As of December 31 2009, 1,816 individuals were living with AIDS or HIV in Contra Costa. The
distribution has not changed significantly since the last report: approximately 81% are male
and 19% are female. African Americans are 30% of those with HIV or AIDS, Whites are about
47% and Hispanics have increased to nearly 19% of the caseload. Nearly 59% of all
transmission is among men who have sex with other men (MSM). Injection drug use is
14
Contra Costa Health Services
Needle Exchange Update Report to Family & Human Services Committee
November 2010
- 3 -
attributed to nearly 19% of all cases and heterosexual contact in Contra Costa is responsible for
approximately 13% of cases, occurring largely in females. After several years of a steady
decline in the number of new infections attributed to IDU, there is resurgence among men
attributing their infection to injecting drugs. This may correlate with an increase noted in
younger MSM who are also injecting drugs.
Other Data
The number of Chronic Hepatitis C carriers continues to decline from the high of 1400 cases
reported in 1999 to 610 cases reported in FY 2009. Greater community knowledge and
awareness of Hepatitis C, more wide-spread use of approved confirmatory lab tests, changes in
reporting, and delayed diagnosis may all influence reporting.
15
Contra Costa Health Services
Needle Exchange Update Report to Family & Human Services Committee
November 2010
- 4 -
As of August 2009, 130 Contra Costa infants have tested positive for antibodies at birth1. This
number reflects a downward trend, and most infants testing positive for antibodies at birth
revert to negative status by two years of age. Funding for the Stanford research project
providing this data was eliminated with the state budget cuts last year. Currently, Contra Costa
has 10 children 0-13 years of age living with HIV.
Exposure Impact on Law Enforcement and First Responders
The Public Health Division provides assistance to law enforcement and first responders
potentially exposed to a communicable disease during the course of their work. The number of
needlestick exposures compared to all exposures (blood, saliva, cuts, bites, flu, etc.) reported
among all responders remains small, with 2 needlestick injuries reported between July 1 2009
and June 30 2010. Both these injuries were sustained by first responders at accident scenes.
A brochure for law enforcement and all forms needed to request Public Health assistance in the
event of an exposure are available on our website at www.cchealth.org/groups/aids.
ACCESS TO CARE AND TREATMENT
Many needle exchange services in the Bay Area have been reduced or eliminated following the
2009 budget cuts, and in most neighboring jurisdictions needle exchange services rely primarily
on other funding secured by community based organizations. Due to time and staff constraints
we are not able to analyze remaining services outside Contra Costa.
Community Health Empowerment (CHE) Progress Report
Greater Richmond Interfaith Program (GRIP) remains the fiscal agent for Needle Exchange
services provided in Contra Costa by CHE. The FY 0910 portion of the budget from county
general funds was $54,000. In 10/11, the county portion of the budget is $49,000, with
$10,000 in State / CDC pass through funds. CHE also receives modest amounts from private
funders. The budget supports limited Program Director time, exchange staff stipends, grant
writer services, supplies and some operating expenses including a drug overdose prevention
1 Stanford University. School of Medicine, CA Pediatric HIV Surveillance Data as of August 2009.
16
Contra Costa Health Services
Needle Exchange Update Report to Family & Human Services Committee
November 2010
- 5 -
project situated in Baypoint. A limited number of condoms and health education materials are
available to CHE through the Public Health Division.
Earlier this calendar year, CHE partnered with the Public Health Clinics mobile van team to pilot
a Drug Overdose prevention project, providing education and medications to reduce deaths due
to overdose. We are currently evaluating this service and looking at ways to encourage people
attending the syringe exchange to also access the services on the van.
CHE continues to operate and report activities from 4 exchange sites (Richmond, North
Richmond, Pittsburg, and Bay Point). The agency has maintained relatively stable operations
this year and services have been provided at least twice monthly in each end of the county as
stipulated in the contract. CHE has collaborated with the county to provide outreach and
information on H1N1 and Hepatitis vaccination services in the county, informed participants of
the availability of HIV testing and AODS treatment services, educated participants on wound
care and prevention of abscesses, and provided referrals for other services. They have also
established a new service this year targeting young people 15-19 years of age: in collaboration
with the church site in Baypoint, CHE offers a meal, clothing, and education to youth attending
the syringe exchange site. The agency reports that several young people have begun to use
the service and they expect more to show up as information about the service becomes more
widely known.
CHE reports that law enforcement continue to demonstrate intolerance for the program,
confiscating syringes and supplies from needle exchange participants. CHE does provide clients
with a letter indicating that they are participants in a Board – certified program, but law
enforcement has not shown much interest in supporting harm reduction.
CHE provides the following information on needle exchange for FY 09/10. Participants are
predominantly White (53%), African American (36%), and Hispanic (11%). Women are 39% of
those served. One for one syringe exchange is done. Some individuals bring in syringes to
exchange for others, called a secondary exchange, reflected as “Number of Individuals
Reported to be Reached by Needle Exchange Services”, below. “Contacts” refers to the
number of individuals accessing the sites – the figures are not an unduplicated count.
17
Contra Costa Health Services
Needle Exchange Update Report to Family & Human Services Committee
November 2010
- 6 -
The last quarter of FY 0910 and the first quarter of the new fiscal year 10/11 show an increase
in the number of syringes distributed and it is anticipated that the overall number will increase
in the current fiscal year.
Alcohol and Other Drug Services (AODS)
Last fiscal year AODS treatment sites reported 4,664 encounters. Demographics have not
changed substantially over time: women are more than 1/3 of enrollees and injection drug
users about 1/5 of enrollees. The reported number of clients served who have not previously
enrolled in AODS services is up from approximately 6% in 0708 to 39% in 0910.
18
Contra Costa Health Services
Needle Exchange Update Report to Family & Human Services Committee
November 2010
- 7 -
Roughly 1/3 of all enrollees indicated that they were homeless at entry into the AODS program.
HIV Education and HIV rapid testing are offered at AODS residential and detox centers
throughout Contra Costa. In FY 0910, 479 individuals received HIV education services and 348
completed HIV testing. This is a drop of about 25% from the previous years due to FY 0910
AIDS Program budget cuts. The AIDS Program also offers Hepatitis C testing to individuals who
are injection drug users. This year we also initiated HIV and STD testing for youth at selected
AODS centers with higher numbers of youth, including the Orrin Allen facility.
Pharmacy Syringe Sale
On September 30, 2010 Assembly Bill (AB) 1701 was signed into law, extending until 2018 the
current program which allows pharmacy sale of syringes without a prescription in any city or
county that authorizes a Disease Prevention Demonstration Project (DPDP). AB 1701 leaves
authorization and implementation of DPDP to individual local health jurisdictions, and neither
requires nor provides funding for state oversight of its execution
19
Contra Costa Health Services
Needle Exchange Update Report to Family & Human Services Committee
November 2010
- 8 -
DPDP was established in 2005 when Senate Bill (SB) 1159 (Vasconcellos, Statutes of 2004,
Chapter 608) established a pilot program to allow California pharmacies, when authorized by a
local government, to sell up to ten syringes without a prescription to an adult. Participating
local health departments must register interested pharmacies and provide them with
appropriate educational materials; participating pharmacies are required to provide specified
information to their customers, store syringes securely, and provide for syringe disposal through
any one of a number of methods, including sale of personal sharps containers. Contra Costa
was the first county in California to register pharmacies to participate in this program in January
2005.
Walgreen’s and Rite Aid pharmacy chains are the predominant pharmacies registered to provide
DPDP services in Contra Costa. An annual telephone survey of registered pharmacies has found
no complaints or major concerns voiced. A 10 pack of syringes costs consumers between $2.50
and $3.40. Some stores offer onsite disposal but most refer to other county resources for
disposal. Of the 35 respondents in 2009, 74% indicated they serve more than one individual
per week: of this number, 23% serve 6 or more individuals per week. Information for
pharmacies is posted on our website, http://www.cchealth.org/groups/aids/pharmacy.php.
COMMUNITY CONCERNS
As of September 2008, SB 1305 made it illegal to dispose of needles and syringes in the solid
waste stream. No complaints of discarded needles have been received by the AIDS Program
during the year. Environmental Health maintains a list of frequently asked questions on
syringe disposal, a list of disposal sites in Contra Costa, and links to state sanctioned mail back
services. More information is at http://www.cchealth.org/groups/eh/faqs/faqs_medical.php
West County residents
only
East County residents only
All Contra Costa County
residents
Household hazardous waste
facility
101 Pittsburg Ave.
Richmond, CA 94801
1-888-412-9277
Delta Household Hazardous
Waste Collection Facility
2550 Pittsburg/Antioch
Highway
Antioch, CA 94509
925-756-1990
Sutter Regional Medical
Foundation
4053 Lone Tree Way
Antioch, CA 94509
925-756-3400
John Muir Pharmacy
1220 Rossmoor Parkway
Walnut Creek, CA 94598
20
Contra Costa Health Services
Needle Exchange Update Report to Family & Human Services Committee
November 2010
- 9 -
OTHER PREVENTION ACTIVITIES FOR INJECTION DRUG USE
Funding for HIV prevention services was substantially reduced last year and all prevention
subcontracts eliminated save for needle exchange. Prevention remains a core component of
the Public Health Department, and needle exchange services are included in the 5 year HIV
prevention plan as one component to reduce transmission of HIV and AIDS among injection
drug users in Contra Costa. In addition to needle exchange, other remaining prevention
activities include:
An AIDS and Homeless collaborative continues to support homeless service providers in
HIV risk recognition, HIV testing, referrals and other activities.
A “Prevention with Positives” program supports HIV positive clients by building
prevention skills and developing incremental behavior change plans.
The Health Department continues to provide anonymous partner notification assistance.
Community based agencies contracted to provide HIV Care services have been trained in
risk reduction and partner notification processes.
The AIDS Program continues to provide testing services at a limited number of
community sites and in Alcohol and Other Drugs Services programs. Nearly all HIV
testing provided by the AIDS Program uses HIV rapid test, providing preliminary results
in 20 minutes. All those with preliminary positive test results are given an immediate
confirmation test
Preliminary positive clients are provided referrals for treatment, assistance in notifying
potentially infected partners, and assistance in making medical appointments. We are
exploring options to directly make appointments with an HIV specialist to review the
results of the confirmation test as a method to improve early access to care and
medications as a method to reduce transmission in the community.
Training is offered as available to increase community capacity to provide prevention
services in Contra Costa.
CONCLUSIONS:
1. Access to clean needles through needle exchange and pharmacy syringe services
remains a necessary Public Health measure to reduce transmission of blood borne
diseases. While overall infections attributed to injection drug use have declined over time,
over the last 3 years there has been an increase in the number of new cases of HIV / AIDS
among men attributed to injection drug use. The availability of needle exchange and
pharmacy syringe sales is necessary to control this trend.
2. Reported local law enforcement exposure to potential blood borne pathogens via
needle stick injury has not increased since needle exchange and pharmacy sales
have been implemented. Materials for Law Enforcement to document potential exposure
and request assistance are available on the website.
3. The contract for needle exchange services remains an important HIV prevention
service component and should remain in effect so long as the service is provided.
The service is a necessary component of the long-term strategy to reduce transmission of HIV
and Hepatitis.
21
22
Needle Exchange Update November 2010Prepared for the Contra Costa Board of Supervisors by Contra Costa Health Department23
NEEDLE EXCHANGEIn 1999, the Contra Costa Board of Supervisors endorsed a State of Emergency with respect to HIV and AIDS to allow for the provision of needle exchange services. A major interest was to reduce transmission in women and to their unborn children. Since 2006, a State of Emergency declaration is not needed if an annual update on activities is provided and public comment is invited.24
HIV/AIDS in Contra Costa CountyAs of December 31 2009, 1,816 individuals were living with AIDS or HIV in Contra Costa. Approximately 81% are male and 19% are female. African Americans are 30% of those living with HIV or AIDS, Whites 47% and Hispanics have increased to nearly 19%. The predominant transmission among those living with HIV or AIDS remains men who have sex with other men (MSM).Contra Costa Epidemiology, Surveillance & Health Data (ESHD)25
Changes In LegislationFederal law now allows use of selected federal funds for syringe exchange in limited circumstances. CDC guidance issued to the State Office of AIDS includes authorization for use of some CDC pass-through funds for this purpose. SB 1159 was extended through 2018, allowing registered pharmacies to sell syringes without a prescription. 26
HIV/AIDS Attributed to Injection Drug Use (IDU)212234181910111014199691099366405101520253035402000 2001 2002 2003 2004 2005 2006 2007 2008 2009Year of DiagnosisHIV AIDS Diagnoses Among Injection Drug Users (IDU) in Contra Costa County 2000 - 2009Male IDUFemale IDU27
Infants Testing Positive for HIV Antibodies at Birth Over Time(total n=130)Stanford University School of Medicine, CA Pediatric HIV Surveillance Data as of August 2009051015202530354045Infants Testing Positive for HIV Antibodies At Birth28
Reported Chronic Hepatitis C Cases0200400600800100012001400160029
Law Enforcement and First Responder Exposures0204060801001202004/05 2005/06 2006/07 2007/08 2008/09 2009/10All ExposuresNeedlestick30
Funding for Needle ExchangeCurrent (10/11)contract for $59,000 includes $10,000 in one-time only funds from the State. Offer condoms and other risk reduction materials as availableAgency continues to seek and receive small sums of other private funding to support operations31
Contacts at Needle Exchange Sites050010001500200025003000350004050506060707080809091032
Number of Syringes Distributed0500001000001500002000002500003000003500004000000405 0506 0607 0708 0809 091033
Secondary Exchanges Reported01000200030004000500060007000800004050506060707080809091034
AODS Service Enrollment35
Other Prevention Strategies to Reduce Transmission of HIV in IDUsAnonymous Partner notification and counseling servicesPrevention with positives programHomeless collaborativeHIV testing services in community and in Alcohol and Other Drugs Services programs. Pharmacy syringe sales (State DPDP)in two chains and a few other stores.36
Syringe Disposal OptionsWest CountyHousehold Hazardous Waste facility101 Pittsburg Ave., Richmond, CA 94801 1-888-412-9277East CountyDelta Household Hazardous Waste Collection Facility2550 Pittsburg/Antioch Highway, Antioch, CA 94509 925-756-1990All Contra Costa County residentsSutter Regional Medical Foundation4053 Lone Tree Way, Antioch, CA 94509 925-756-3400John Muir Pharmacy1220 Rossmoor Pkwy, Walnut Creek, CA 9459837
CONCLUSIONS1. Access to clean needles through needle exchange and pharmacy syringe services remains a necessary Public Health measure to reduce transmission of blood borne diseases. While overall infections attributed to injection drug use have declined over time, over the last 3 years there has been an increase in the number of new cases of HIV / AIDS attributed to injection drug use among men. The availability of needle exchange and pharmacy syringe sales is necessary to control this trend. 2. Reported local law enforcement exposure to potential blood borne pathogens via needle stick injury has not increased since needle exchange and pharmacy sales have been implemented. Materials for Law Enforcement to document potential exposure and request assistance are available on the website. 3. The contract for needle exchange services remains an important HIV prevention service component and should remain in effect so long as the service is provided. The service is a necessary component to reduce transmission of HIV and Hepatitis.38
County of Contra Costa
OFFICE OF THE COUNTY ADMINISTRATOR
MEMORANDUM
DATE: December 1, 2010
TO: Family and Human Services Committee
Supervisor Gayle B. Uilkema, Chair
Supervisor Federal D. Glover, Vice Chair
FROM: Dorothy Sansoe, Staff
Sr. Deputy County Administrator
SUBJECT: Referral #45 – Elder Abuse
Recommended Action:
ACCEPT the attached report and any public comment. ACKNOWLEDGE that the
fastest growing segment of the population in Contra Costa County is the 85+ age group;
DIRECT staff to complete a fiscal analysis to determine long term funding availability
and, if appropriate, forward a request for four additional positions to County
Administrator for review, processing through the Human Resources Department, and
submission to the Board of Supervisors for approval.
Background:
The Employment and Human Services Department, Aging and Adult Services Division
provides an annual report to the Family and Human Services Committee on the status of
services to the elderly in our community. Attached is the 2010 report.
This report outlines the difficulties faced by the program since the implementation of
staff reductions and the growth in the elderly population. The Department is
recommending the addition of staff to the Adult Protective Services program. The
addition of four social worker positions is estimated to cost a total of $488,300 of which
approximately $122,705 is County General Fund. The balance of the cost is covered by
State and federal funds. The Department believes that there is sufficient current year
savings within the Adult and Aging Services Division to provide the funding needed for
these positions.
39
40
Page 1 of 16
Report to the Family and Human Services Commission, December 2010
Submitted by John Cottrell, Director, Aging and Adult Services
“SKATING ON THIN ICE”
Adult Protective Services (APS) is part of a continuum of programs provided by
the Aging and Adult Services Bureau (A&AS) of Employment & Human Services
Department (EHSD) which all seek to promote maximum independent
functioning for elders and adults with disabilities, assisting clients to avoid
unnecessary or inappropriate institutional care. Many of the supports that have
been available to Adult Protective Services for over a decade have since been
dismantled due to the current economic meltdown and resulting cuts to programs
at the State and County level. Since December of 2008 when APS lost 75% of its
staffing (reduced from 17 social casework specialists to 6 and from three
supervisors to one), Adult Protective Services staff in Contra Costa County
continue to carry some of the highest caseloads in the State. The State average
for an Adult Protective Services worker caseload is approximately 17-21 cases
per month. Our social casework specialists carry on the average of 65 cases a
month.
Adult Protective Services is defined as an emergency response program. The
program is primarily State Funded. Though there is currently national advocacy
for Federal funding for this program, it is still in the distant future. Given the
complexity of the reports of abuse that are received by APS, it is unusual that a
case will be opened and shut quickly. This is evidenced by the fact that each
month, approximately 300 plus cases are carried over. Most of the situations that
are reported to APS are not quickly resolved. Most of the reports that APS
receives requires intervention in order to prevent an emergent response. In
addition to the already reported cases of elder abuse, National research studies
indicate that as much as 84% of elder and dependent adult abuse and neglect
goes unreported. Findings indicate that the reasons for this are consistent with
the reasons for not reporting in other domestic violence/abuse situations: fear of
retaliation and increased abuse/harm to the victim, fear of abandonment, lack of
trust of law enforcement or other authority to provide adequate protection.
18 to 21 new referrals are received in Contra Costa APS every day. That means
each APS Social Casework Specialist receives on the average 18 referrals each
month on top of the existing caseload they already carry. When a staff member is
on vacation or ill, this then increases the load for this small one-unit staff. The
Statewide recommended caseload for an APS social worker is no more than 11
new referrals a month and a caseload of no more than 25 cases. In Contra
Costa, Social Casework Specialists receive on the average 18 new cases a
month and currently carry an average caseload of 65 cases each.
41
Page 2 of 16
In addition to the staff cuts to the APS program, two important resources were
taken from the APS program in December of 2008: that of the nurse and mental
health specialist assigned to the APS program.
Prior to January of 2009, the Health Services Department assigned a nurse and
a mental health specialist from the older adult Mental Health program to the Adult
Protective Services unit. This proved to be essential in dealing with the more
severe of the self-neglect cases in which dementia or other forms of organic
brain disease affected the identified ‘alleged victim’. These tend to be some of
the more serious situations and often require speedy medical intervention.
Having a nurse on staff that could assist the APS staff dramatically increased the
ability of APS to put either an emergency response plan or a care management
plan in place expeditiously. Additionally, as most reports of adult abuse involve a
perpetrator that is known to the victim (often times a family member), having a
mental health specialist who had 5150 (involuntary hold) privileges was
extremely helpful for elders or dependent adults who either were having a mental
health crisis or who were faced with complicated and often conflicting emotional
issues related to abuse and neglect. The mental health specialist worked with the
APS worker in creating a safety and service plan for the elder or dependent
adult.
Current staffing
Currently, there is one APS supervisor and seven permanent APS social
casework specialists. The unit has two clerks. The three Information and
Assistance (I&A) social workers support the APS unit by handling the APS intake
as well as I&A calls. The I&A supervisor also helps with APS Intake on high
volume call days.
As mentioned above with the APS staff, if any of the I&A staff are ill or on
vacation, the burden falls to the remaining staff. Currently, there are two staff
assigned to each part of the county and one APS worker that is a floater that
assists in the part of the county where there are the most referrals in any given
time period.
Types of Referrals
APS receives reports on all types abuse and neglect of elders and dependent
adults. APS continues to work closely with law enforcement, the District Attorney,
the Health Services Department, hospital social workers, the Conservators’
office, and community based providers on finding resolution for very complex
situations.
Many of the reports of abuse involve caretakers who are often, but not always,
family members. Sorting out the facts in many of these cases takes a great deal
42
Page 3 of 16
of skill, patience, and time. Many reports are multi-faceted in that there are
allegations of intimidation, physical abuse, neglect, and as we see increasingly,
financial abuse.
Referrals come from all sources: law enforcement, hospitals, social workers from
Regional Centers and other rehabilitation centers, family members, concerned
neighbors, and from individuals themselves seeking help and protection.
Many of the referrals that APS continues to receive are those of self-neglect.
These are some of the most difficult to resolve because in many cases, the
person who is self-neglecting may also be refusing services. That person may
also have Alzheimer’s or other form of dementia that reduces their capacity to
actually make an informed decision about accepting services or not.
From September 1, 2009 through August of 2010, the APS unit opened 1,533
cases. Each case that is opened may have one or more allegations of abuse or
neglect. Of the cases opened in this time period, only 43 cases had been active
in APS before. During this period, there were 621 reports of financial abuse, 436
reports of caregiver neglect, 184 reports of assault and battery, and 983 reports
of self-neglect in which there were identified serious health and safety hazards.
The supervisor for APS also has the added burden of appropriately assessing
out cases that may not rise to the level of needing an investigation but are in
need of services.
The Information and Assistance (I&A) staff in addition to handling the intake for
all of the APS cases also provides information and referrals to help link
individuals to the appropriate agency or service provider. From September 1,
2009 through August 31, 2010, I&A workers received 10,128 calls for that year
and which equates to an average of 844 calls a month. Those calls include the
complicated and time consuming APS intake calls.
At the end of this report the Commission will read through A Month in APS.
These are brief descriptions of the referrals that resulted in open cases for that
time period (147 new cases as described below that resulted in 21 new cases for
each social worker.) Having a real look at what the seven APS workers deal with
on a day to day basis is essential in understanding the critical need now to
increase the staffing and capacity of Adult Protective Services.
Response Time
The types of in-person responses are as follows: immediate, 24 hour, three-day,
ten-day and “NIFFI” (non face-to-face.) APS has very few immediate or 24 hour
response referrals. Most of the referrals that are received are assigned a 10 day
response time. Generally, staff have been able in the past to make the first
attempt to see what is termed the ‘alleged victim’ (AV) within that time frame.
However, now with increased caseloads social casework specialists are
43
Page 4 of 16
increasingly unable to meet those timeframes. Generally, because in many
cases, the abuser lives in the home, APS must go out cold without phoning
ahead. This sometimes necessitates multiple visits unless the APS investigator
knows that a person is home alone or is at a place where they can be safely
interviewed without the threat of later retaliation by a suspected abuser. This
reality, combined with over burdened caseloads, contributes to the very real
possibility that we may not be able to get there in time. APS does respond
immediately or within 24 hours on high risk referrals involving physical abuse or
neglect where there is risk of injury or where physical health and safety is in
jeopardy. The APS unit relies on law enforcement assistance in the more
dangerous and volatile situations.
Additionally, now that the State has shut down the Linkages Program and
reduced the Multipurpose Senior Services Program (both programs designed as
case management programs for at risk elders and dependent adults), it is
extremely difficult to find resources that help ensure the health and safety of the
alleged victim of abuse.
Length of time cases are open:
In general, APS cases in this county are open an average of four to six months.
This is twice as long as in most other neighboring counties as our staffing is
significantly less than our neighbors.
COUNTY COMPARISON: POPULATION AND APS STAFFING
COUNTY
POPULATION (as of 2008)
Bay Area Counties with like
demographics
(As of December
2010)
STAFFING LEVEL
(Line Staff)
ALAMEDA Pop: 1, 474,368 2 supervisors
17 social workers
SANTA CLARA Pop: 1,682,585 3 supervisors
29 social workers
SAN FRANCISCO Pop: 815,358 7 supervisors
37 APS social workers
CONTRA COSTA Pop: 1,051,677 1 supervisor
7 social workers
44
Page 5 of 16
Future Planning
Given our current staffing and in order to prepare for what is coming, the Baby
Boomers (those born between 1946 and 1964), we need to increase the staff in
this one-unit program. We currently do not have enough staff and resources to
meet the current demand of referrals that are coming through the door and over
the phone and fax lines let alone have the capacity to handle future needs.
According to the last U.S. Census, almost 11% of the 36 million residents in
California are 65 or older. Its most recent estimate is that Contra Costa County
residents over age 54 constitute 11.5% of the county's population, or about
118,000 individuals.
The fastest growing segment of the population in Contra Costa County is the 85+
age group. Over the next 10 years, this group is predicted to skyrocket by 55%.
The 65+ age group is expected to increase by 37%.
Volunteer Care Coordination
Two initiatives, one new and one a past practice, are also being developed. The
past practice of Multi-Disciplinary Teams (MDT) is being renewed to enhance our
ability to communicate between community partners to help facilitate difficult and
complex cases. Teams will consist of representatives from Adult Protective
Services (APS), In Home Supportive Services (IHSS), Public Authority (PA),
Health Services (HSD), Information and Assistance (I&A), Multipurpose Senior
Services Program (MSSP), Conservatorship representatives, etc. on a case-by-
case as needed basis. Due to drastic reductions in staffing in 2008/2009, MDTs
became a secondary practice. It has become apparent that regardless of
staffing, MDTs are needed and will be even more critical in future.
The development of a new initiative for volunteer care management and case
coordination is also underway. A crack in the foundation of providing timely and
efficient social services to the community is the lack of a solid care
management/care coordination program. Aging & Adult Services is developing a
volunteer program that can provide this type of service to the community’s aged
and adult disabled residents regardless of income. Those who are low income
can receive the service at no cost. Middle income participants can receive the
service based upon their ability to pay (sliding scale.) Those with higher incomes
will be afforded the opportunity to pay full price for the service. Services for the
middle income group will be subsidized by donations, grants and the higher
income bracket participants.
Given these stark facts, as stated above, and even with the new initiatives, we
recognize that Contra Costa will need to staff up to handle ever increasing
caseloads. One unit to handle all of the APS referrals is clearly not enough today
and it won’t be enough tomorrow. We are definitely skating on thin ice.
45
Page 6 of 16
RECOMMENDATIONS
Increasing the level of APS staffing is critical at this time to address the current
workload and to assure to the residents of Contra Costa County that our county
is following our State’s mandate to “establish and support” our APS program and
is taking steps to protect our most vulnerable at risk population now and in the
future.
The chart below indicates the total annual salary and benefits (and county costs)
required to add Social Casework Specialist to APS.
FTEs
Class
Code
Salary
3rd Step
Benefits
74%
Total
Annual
S&B
Total
County
Cost
Social Casework
Specialist II
1 XOVB $70,158 $51,917 $122,075 $30,519
Social Casework
Specialist II
2 XOVB $140,316 $103,834 $244,150 $61,037
Social Casework
Specialist II
3 XOVB $210,474 $155,741 $366,225 $91,556
Social Casework
Specialist II
4 XOVB $280,632 $207,668 $488,300 $122,075
46
Page 7 of 16
Appendix
Summary Case by Case Account
August 2010
A month in the life of
Adult Protective Services
Of Contra Costa County
147 reports of abuse and neglect
(see pgs. 7-15)
Types of abuse: Referral Sources:
Financial Abuse: 49 Healthcare Provider: 38
Self Neglect: 32 Supportive Services 27
Neglect: 30 Family Member 27
Assault/Battery: 19 Financial Institution 22
Under/Over Medication: 6 Acquaintance 13
Other: 4
Isolation: 3
Constraint/Deprivation 2
Abandonment: 1
# of Males: 42
# of females: 103
Dependent Adult 30
Elder 117
Over 85 33
47
Page 8 of 16
AUGUST 2010: A MONTH IN THE LIFE OF ADULT PROTECTIVE SERVICES
Abuse Type Summary of Allegations Male
Female
Dep.
Adult
Elder
Over
85
Referral
Source
Assault/ Battery Ex caregiver struck victim and reporting party in a group
home.
X X Regional
Center Staff
Assault/ Battery Reports of repeated abuse from 95 year old father. Not
allowing developmentally disabled daughter medical
treatment.
X X Medical
Social
Worker
Financial
Abuse
Paid caregivers having victim withdraw funds from her
account for them.
X X X Bank
Employee
Assault /
Battery
Victim sent to ER from dog bite. Dog belongs to
daughter who let the dog attack her. Daughter reported
to be abusive in other ways.
X
X Medical
Social Worker
Neglect and
Financial
Abuse
Victim is being neglected by live-in relative, not fed or
bathed regularly, home unkempt. Money is taken from
victim’s room.
X X Friend
Neglect Victim living in a closed down restaurant, no utilities.
Abuser threatened to throw him out on the street if he
complains.
X X Concerned
Citizen
Psychological
Abuse
Mother belligerent and threatens developmentally
disabled daughter, may have taken jewelry from her.
X Attorney
Financial
Abuse,
Constraint
Deprivation
Confused elder being taken advantage of by several
homeless people whom she has let into her home.
Using her car, not letting her get out of house, taking
money. Eating her food.
X X Doctor
Neglect 88 year old admitted to hospital. Will be transferred to
SNF. Husband unable to provide care, disabled himself.
X X X Medical
Social worker
Neglect
Self Neglect
Elderly couple becoming unable to care for themselves.
Very forgetful, but refusing supportive services.
X X X X Home Health
Staff
Financial
Abuse
Customer giving large sums of money to grandson to
invest in E Trade. Over $50,000 given so far. She only
has $12,000 left.
X X X Bank
Manager
Assault
Neglect, Over/
Under
medication
Elder allowed homeless “friend” into home. Has become
frightened of her. Abuser chased maid with a broom.
Medications were taken.
X X X Social Worker
Financial
Abuse
Adult son depleted account of $30,000. Accused of
setting up joint account fraudulently. Also has mother’s
car, refuses to return it.
X X Friend
Financial
Abuse
Adult daughter writing checks from mother’s account
without mother’s knowledge or consent.
X X X Bank
Employee
Financial
Abuse
A developmentally disabled adult’s mother accused of
using his money for herself. Grandmother’s house is in
foreclosure.
X X Sheltered
Workshop
Employee
48
Page 9 of 16
Abuse
Type
Summary of Allegations Male
Female
Dep.
Adult
Elder
Over
85
Referral
Source
Financial
Abuse
Victim often runs out of funds before end of the month.
IHSS provider accused of taking advantage of her
financially.
X X VA Clinic
Staff
Financial
Abuse
Sister has POA and DPOA over victim Recently moved
into the home after losing her job. Accused said to drink
excessively, is not paying bills, stealing money.
X X X Grandson
Financial
Abuse
Victim is deaf. Daughter who has POA refinanced her
home loan from conventional to jumbo. Increasing
mortgage $1,000 a month. Victim cannot afford this
amount.
X X Bank
Manager
Under/
Over
Medication
Male friend living in home said to steal prescription pain
killers to sell.
X X Case
Manager
Other Victim lives with mentally ill daughter, who is
decompensating, becomes verbally abusive. Mother
wants her to leave.
X X Daughter
Under/Over
Medication
Victim has pancreatic cancer and takes oxycontin.
Friends are stealing money and meds.
X X Self
Financial
Abuse
Call to bank, person in the background heard to yell at
elder, trying to get him to give out account information.
Another person, woman, maybe trying to get POA.
X X Bank
Employee
Financial
Abuse
Neglect
Victim reports IHSS caregiver, ex husband, not
providing good care and taking her money. She has no
other family and does not want to live in a SNF. Hospital
d/c’d her back home to his care.
X X Medical
Social Worker
Other 15 year old grandson living in home. Verbally abusive.
Suspected drug use and dealing going on.
X X CFS Social
Worker
Isolation 20 year old with mild retardation and Aspergers is now
staying with boyfriend’s family. Her parents afraid the
boyfriend’s family may move her out of state.
X X Father
Self Neglect Victim has become hoarder. Especially with food, which
was rotting in her house. House itself may be in code
violation. Only relative lives in Nevada.
X X Relative
Neglect /
Financial
Abuse
Victim conserved. Lives alone. Very confused. Unable to
provide for his basic needs and conservator appears to
not be providing needed supports or supervision.
X X X Social Worker
Neglect /
Financial
Abuse
Elder lives with son, suspected drug user. She Is left
alone. Found soiled with no electricity in home, food
rotting, bills have not been paid.
X X X Social Worker
49
Page 10 of 16
Abuse Type Summary of Allegations Male
Female
Dep.
Adult
Elder
Over
85
Referral
Source
Neglect Paid provider left developmentally disabled client alone
in a locked car while she ran an errand. Client became
afraid and started yelling for help.
X X Police Officer
Assault Battery Victim being discharged from hospital when wife began
yelling that she couldn’t take it anymore. Victim reported
that wife yells and is physically abusive to him at home.
X X Nurse
Self Neglect Developmentally disabled man lived with his mother
who just died. No one else known to be at home to give
him care. Phone appears disconnected.
X X Family
Member
Self Neglect Brain damaged adult daughter lived with father who has
just died. Prior multiple calls to 911 as daughter fell a lot.
She called today and has been admitted to hospital.
X X Fire Fighter
Financial abuse
Isolation
Grandson living with victim. Taking advantage of POA.
Has taken her car and furniture, Is verbally abusive.
Victim fearful and wants grandson to leave her home.
Victim has left her home and is staying with sister.
X X X Sibling
Self Neglect Demented woman lives alone. Becoming less able to
provide for herself. Rotting food. Bathroom may not be
functional. Being taken advantage by home repair
workers. Reports two burglaries.
X X X Police Officer
Verbal Abuse Developmentally Disabled man attends day program.
Mother had to pick him up and began yelling at him and
staff. Victim cowered and appeared frightened by
mother.
X X Day Program
Staff
Financial
Abuse
Neglect
Dependent Adult living with nieces who has taken her
social security checks and doesn’t give victim any
pending money. Niece’s boyfriend is IHSS provider, but
not giving any care.
X X Friend
Financial
Abuse
Neglect
Elderly disabled and confused woman lives with
disabled son, who she can no longer help care for. No
care being provided for either. A “bookkeeper “ may be
stealing money and threatening elder as she is afraid to
fire her.
X X X X Friend
Neglect
Financial
Abuse
Man with brain injury and alcohol abuse in hospital from
fall. Wife accused of providing no care an also being
alcoholic. Brother is trying to get POA and get victim into
rehab.
X X Brother
Financial
Abuse
Elderly confused woman living with son who is emptying
her bank account, to pay for gambling debts. Son does
not contribute to any housing or food expenses, yet
does have a small income.
X X Daughter
Financial
Abuse
Neglect
Dependent adult not being cared for by live in IHSS
worker, who coerces her into signing fraudulent
timecards. He is also verbally abusive. Woman wants
him to leave, but doesn’t know how to go about this.
X X Friend
Financial
Abuse
Suspected check forgery of $3,600 from elder’s account
(signature did not match).
X X Bank
Employee
50
Page 11 of 16
Abuse Type Summary of Allegations Male
Female
Dep.
Adult
Elder
Over
85
Referral
Source
Self Neglect Elderly physically disabled woman recently in
hospitalized due to falls. Becoming unsafe at home and
less able to provider for her own needs. No family.
X X Discharge
Planner
Financial
Abuse
Money manager is being accused of quoting one price
and charging much more to her client without providing
additional services. Also got POA and has become
beneficiary of client’s life insurance.
X X Facility
Service
Coordinator
Neglect / Fraud Demented elder being left alone by IHSS caregiver and
not providing care when in the home. Naps, watches
television.
X X Nephew
Financial
Abuse
Son previously abused his demented mother’s trust by
withdrawing several thousand dollars unauthorized.
Trust was revoked. Son s now threatening his mother in
order to get back on the trust and may be working with
an accomplice in an investment firm.
X X X Attorney
Neglect Dependent Adult is unsafe alone, has set fire to apt.
once. Has not paid rent. Is being evicted. Live-in son
does not provide adequate care. They cannot make
budget last, run out of food each month.
X X Friend
Neglect /
Financial
Abuse
Terminally ill elderly man is being neglected by live-in
girlfriend. Not given his meds properly, causing much
pain. Cancer has spread to brain; he is not competent to
make decisions. GF took him to lawyer got him to turn
over his finances. Son lives out of state.
X X Niece
Constraint
Deprivation
Assault
Woman with MS told her therapist she being physically
and verbally abused by her mother and boyfriend with
whom she lives. Says boyfriend is abusive when he is
on drugs.
X X Therapist
Self Neglect Elderly neighbor living alone becoming demented and
has been found wandering outside her house at night,
yelling. One son lives out of the area and the other is
estranged
X X X Neighbor
Neglect Developmentally disabled man came to day program
with empty water bottles and a note from mother saying
they were out of drinking water. There have been
previous similar issues with food shortages.
X X Teacher
Abandonment 80 year old woman, ill with cancer, dependent on
husband for care. Husband has left. He has done this
before. He has financial control. She is low on food. No
other family.
X Self
Assault/
Battery
Elderly demented woman. Came to day program with
bruising on her upper arm. Daughter is her only
caregiver.
X X Day Program
Staff
Self Neglect 95 year old in independent senior housing becoming
less able to care for herself. Must be reminded to pay
rent. No food in refrigerator. Asks for money from others
in complex.
X X X Apartment
Manager
Assault/
Battery
Elderly woman’s daughter in jail for elder abuse, now
daughter’s boyfriend comes over, breaks in to steal.
Stole a gun and threatened to kill the elder if she
pressed charges.
X X Self
51
Page 12 of 16
Abuse Type Summary of Allegations Male
Female
Dep.
Adult
Elder
Over
85
Referral
Source
Assault /
Battery
Older woman beaten up by long time boyfriend X X Self
Neglect Partially paralyzed man dependent on others for
personal care and food is not getting these services
from his IHSS caregiver girlfriend.
X X Neighbor
Self Neglect 78 year old mentally ill person lives alone, has recently
lost 20 -25 pounds. Frequent calls to police reporting
break-ins that have not occurred.
X X Landlord
Financial
Abuse
Elderly woman fell at home alone. Neighbors notices
papers stacking up and found her. She was sent to
hospital where she reported that her housemate renter
is pilfering her money.
X X Medical
Social Worker
Self Neglect Elderly mentally ill woman becoming unsafe living alone
in her condo. Refuses necessary medical treatment.
Estranged from children.
X X X Son
Under/Over
medication
Isolation
Post stroke woman living with husband who cannot
provide adequate care, but he refuses help and will not
allow their daughter access to her mother even over the
phone
X X Daughter
Other Disabled woman caught in family dispute with adult
children who interfere with the IHSS worker trying to
provide care.
X X Self
Self Neglect 86 year old blind woman, with mild dementia still living
alone. Needs in home assistance or placement in
assisted living, but is very resistant. Low income, but too
high to qualify for IHSS.
X X X Case
Manager
Self Neglect Woman living in senior housing may be at risk as she
does not follow medical regime and is resistant to
outside help or considering going to assisted living.
Does not always have enough to eat.
X X Social Worker
Self Neglect Elderly woman becoming less able to meet her finances.
Unclear as to why.
X X Community
Services
Employee
Under/Over
Medication
Disabled woman says housemate is stealing her pain
medications.
X Social Worker
Self Neglect 86 year old lost his house, now living with friend. He is
at risk medically and is non compliant. Appears
confused. Friend can no longer handle him living with
her. No family to be found.
X X X Friend
Neglect Person with DPOA for 84 year old demented elder not
making rent payments for her.
X X X Medical
Social Wkr
Neglect / Self
Neglect
Wheelchair bound reclusive elder, unkempt, sores on
legs. Smells of urine. Stench throughout house. Meals
on Wheels being discontinued due to health risk to
volunteer
X X Meals on
Wheels Staff
Isolation Sister living with and caring for mentally ill brother will
not allow another sister or a mental health worker
access to see the brother.
X X Case
Manager
Self Neglect 92 year old becoming unsafe at her home. Lives alone.
Fell and admitted to hospital. Refuses to admit she
cannot care for herself.
X X X Home Health
Employee
52
Page 13 of 16
Abuse Type Summary of Allegations Male
Female
Dep.
Adult
Elder
Over
85
Referral
Source
Neglect / Self
Neglect
Elderly disabled husband unable to care for 80 year old
wife with severe dementia. Left her in bed for days at a
time. Family minimally involved. Wife admitted to
hospital.
X X X Medical
Social Worker
Self Neglect Mentally ill wheelchair bound woman, barely managing
living alone in two story condo. Has to crawl upstairs to
access kitchen. Taken to ER with burns. Resistant to
assistance.
X X Medical
Social Worker
Neglect 96 year old living with daughter who is his caregiver but
disabled herself and may not be able to provide
adequate care. Elder does not qualify for IHSS, but is
low income.
X X X Firefighter
Neglect 78 year old demented woman neglected by adult
substance abusing children, who also threaten current
paid caregiver.
X X In Home Care
Nurse
Self Neglect Elderly man found by police in apartment living in
squalor, no food, smelling of urine. Was 5150’d to
hospital as gravely ill and is terminally ill.
X X Police Officer
Self Neglect Blind 89 year old woman living in independent senior
housing, becoming less able to live on her own and is
becoming very frightened.
X X X Medical
Social Worker
Financial
Abuse
Verbal Abuse
Ex caregvier harassing confused disoriented 80 year old
she used to work for and was fired.
X X Friend
Financial
Abuse
Confused elder came to bank and made an unusually
large withdrawal, could not explain what it was for. A
paid caregiver is suspected.
X X X Bank
Employee
Financial
Abuse
Confused elder had been victim of several scams, lost
approx. $20,000. Also two sons suspected of having
mother secretly send them money. One son hasn’t
worked in 30 years.
X X X Daughter
Financial
Abuse
Confused elder believes his daughter who has POA has
had his condo refinanced without his consent. He also
has a long time companion whom he has given large
sums of money to to help her pay off debts.
X X Money
Manager
Neglect Abuse 87 year old demented woman lives at home with
husband who also is disabled. They have caregivers
during the day, but not at night. Reporter concerned that
woman may not be safe at night.
X X X Church
Employee
Financial
Abuse
94 year old with no family recently befriended by
someone living in Reno who has convinced him to
change his will, that would leave his condo to charity,
and give the condo to new friend’s organization in
Nevada.
X X X Anonymous
Assault /
Battery
Financial
Abuse
Woman’s daughter demands money and has stolen it
from mother’s purse. Verbally abusive and has shoved
and hit mother so she fell to the floor and was sent to
ER with abrasions.
X X Medical
Social Worker
Financial
Abuse
Person representing himself as an employee of a
disabled man has come into bank cashing several large
checks totaling up to approx. $7,000. Bank unable to
contact account holder.
X X Bank
Employee
53
Page 14 of 16
Abuse Type Summary of Allegations Male
Female
Dep.
Adult
Elder
Over
85
Referral
Source
Financial
Abuse
Woman’s adult child stealing checks and forging her
name to cash them. Woman is now overdrawn on her
account. Woman is very upset but will not say which
child is doing this.
X X Bank
Employee
Financial
Abuse
Elderly woman had a shared account with a boyfriend.
Just hours after his passing the elder and a niece came
into the bank and withdrew $17,000. Elderly woman
appeared “out of it” After a few days they took out
$127,000. Niece moved in with woman and opened a
joint account with her.
X X Bank
Manager
Financial
Abuse
Confused 90 year old being scammed by worker who
keeps charging money for a bathroom remodel that has
been going on for over a year. Also several thousands
of dollars of unauthorized credit card charges and
withdrawals.
X X X Bank
Employee
Assault /
Battery
Adult substance abusing son was living in the home and
has become verbally and physically abuse of mother.
Restraining order being sought.
X X Police
Self Neglect Elderly man living alone and becoming unsafe. Cooks
from a hot plate in his bedroom. Very unsteady on feet.
Resistant to any assistance.
X X Daughter
Neglect Elderly man with advanced dementia keeps being
admitted into hospital due to inadequate care from wife
who also may have beginning Alzheimer’s. Wife refuses
any in-home help.
X X X Nurse
Neglect Elderly man found wandering near BART station, very
confused, gave two addresses, one of which was a drug
house. No food in the house, 5150’d to hospital.
X X BART
Employee
Neglect 80 year old demented man drove several miles away
from home, then tried to walk back home barefoot. Feet
severely burned and he was hospitalized. Wife unable
to care for him.
X X Medical
Social Worker
Financial
Abuse
Second report of elderly woman being brought into bank
by paid caregivers to cash checks made out to them, not
the caregiving agency that she is also paying.
X X X Bank
Employee
Self Neglect Woman found lying in own excrement in her apt.
Residence had foul order from both human and animal
urine and excrement, multiple cockroaches seen.
X X X EMT
Self Neglect Elderly woman living in boarding house room, is a
hoarder and unable or unwilling to clean herself. Other
residents complaining of her odor.
X X Landlord
Neglect
Financial
Abuse
Disabled woman living with daughter who is neglecting
her, not helping her bathe regularly, sporadically
providing meals, letting her meds run out, using her
mother’s money for herself.
X X Medical
Social Worker
Verbal Abuse Domestic Violence report for couple married over 50
years
X X Medical
Social Worker
Financial
Abuse
Elderly man believed to be a victim of a sweetheart
scam of several thousand dollars perpetrated by a
caregiver.
X X X Bank
Employee
54
Page 15 of 16
Abuse Type Summary of Allegations Male
Female
Dep.
Adult
Elder
Over
85
Referral
Source
Financial
Abuse
79 year old disabled man cheated out of $12,000 by
IHSS provider.
X X Friend
Financial 77 year old woman believed to be victim of check
forgery.
X X Bank
Employee
Self Neglect Elderly woman becoming unsafe living alone due to
frequent falls. Refuses services or offers to live with
adult children.
X X Neighbor
Neglect
Financial
Abuse
Nephew moved in with aunt when her sister died.
Claims he is trying to save home from foreclosure,
Works full time and cannot provided adequate care for
aunt.
X X Niece
Assault /
Battery
Elderly couple’s grandson is living with them and is
verbally abusive and threatening to them. They have
been advised by police to get a restraining order.
X X X Son
Self Neglect Morbidly obese confused woman (300+ lbs) making
frequent 911 calls due to falls. Apt is a fire hazard.
Needs to move to a SNF, but refuses.
X X Fire Dept
Staff
Neglect
Financial
Abuse
An 82 year old woman lives with daughter who is
accused of taking her SSI checks and spending them on
herself and not providing mother enough food. Now an
elderly friend is staying with them and says the same
thing is happening to him.
X X X Mosque
Member
Assault/ Battery Elderly parents been verbally and physically abused by
44 year old daughter who moved back in with them after
a divorce. Couple is obtaining restraining order.
X X X Daughter in
law
Financial
Abuse
Elderly man befriended by a man, who moved into his
house and opened joint accounts with him then depleted
accounts of thousands of dollars.
X X Self
Assault/ Battery Autistic man becomes abusive to father’s live-in
girlfriend who hits and kicks back at him.
X X Therapist
Financial
Abuse
Granddaughter was staying temporarily with
grandmother and stole a check and deposited into her
own account.
X X Bank
Employee
Assault/ Battery Disabled woman’s husband physically and verbally
abusive to her. Victim showed signs of bruising.
X X Medical
Social Worker
Neglect
Under/Over
Medication
Elderly woman’s daughter, who is her caregiver, is
accused of stealing her pain meds and not providing
adequate care.
Grand-
daughter
Self Neglect Mentally ill man not providing himself with adequate
nutrition and too paranoid to take advantage of normal
nutrition resources, such as meals on wheels, food
banks.
X X VA therapist
Verbal Abuse 76 year old woman living with brother and his friend.
Friend is verbally abusive and threatening to woman.
X X Doctor
Neglect Seriously ill 81 year old found in poor condition by her
sister. The caregiver was outside, unaware of or
concerned about the woman’s condition. The sister
called 911.
X X Medical
Social Worker
55
Page 16 of 16
Abuse Type Summary of Allegations Male
Female
Dep.
Adult
Elder
Over
85
Referral
Source
Self Neglect Elderly demented woman may be cutting herself in
suicide attempts.
X X IHSS Worker
Neglect Developmentally disabled man came to day program
with bandages over an abdomen wound. He lives with
his grandmother who may have dementia. Neither
could explain wound.
X X Regional
Center Staff
Financial
Abuse
Niece and husband accused of financially exploiting
aunt, whom they have lived with for 3 years.
X XX Sister
Battery/Assault
Financial
Abuse
Demented woman has adult son, his girlfriend and her
son living with her. They are her caregivers, pay no
rent. Not providing care needed. He is suspected meth
user. He has reportedly slapped her and may be
stealing from her.
X X Sister
Assault/Battery
Self Neglect
Elderly man allowing a substance abusing son to
continue living on his property. Son has hit father. Both
have threatened to kill one another. Father refuses to
call police, to seek restraining order or live with any of
his other children.
X X Son
Financial
Abuse
80 year old grandmother suspects grandson has taken
and used her ATM for charges over $1,000.
X X Bank
Employee
Neglect
Financial
Abuse
Disabled 81 year old who uses a wheelchair, lives with
adoptive son who leaves her alone for days at a time.
She gives him money for food, but he doesn’t buy food.
He is suspected of using drugs. Tore her phone out of
the socket.
X X Brother In
Law
Self Neglect 80 year old confused man being evicted due to an
acquaintance causing a disturbance at apt. Did not
respond to eviction notice.
X X Friend
Neglect 84 year old woman with multiple disabilities living in
subsidized housing that has no heat and cockroaches
present
X X Medical
Social Worker
Assault/ Battery 81 year old man being hit by younger family members
he is currently living with. They allegedly take his money
to buy and use drugs.
X X Landlord
Neglect
Self Neglect
80 year old man is cared by wife who is wheelchair
bound and appears confused herself. House unkempt,
not making doctor appts, questionable if meals are
being served regularly. Couple have no supports in
place such as home care services
X X X Case
Manager
Neglect 94 year old woman with dementia, left in bed all day,
covered with sores, feces, wet with urine. Lives with
son who is primary caregiver, but works during the day.
X X X Hospice
Nurse
Financial
Abuse
Son making fraudulent charges on mother’s ATM
without her knowledge.
X X X Bank
Employee
Self Neglect Very disabled elder unable to care for herself, but is so
abusive to IHSS caregivers they quit. High risk for SNF
placement.
X X IHSS
caregiver
Neglect Confused disabled elder receiving poor care from
daughter who is a substance abuser.
X X Relative
56
Adult Protective Services2010 Report to the Family and Human Services Committee of the Contra Costa CountyBoard of Supervisors57
INTRODUCTIONThe last report on Adult Protective Services to the Family and Human Services Committee was in 2009.58
ApproachThe main strategy of the APS program is to make available to the at-risk individual a variety of health and social programs to ameliorate or eliminate the risk of abuse, neglect, or exploitation.Due to the closure of case management programs (e.g. Linkages) and continued erosion of the safety net for elders and dependent adults in this most recent economic downturn, the likelihood of premature institutionalization and repeated reports of abuse coming into the program is increased.59
ResponsibilityAPS is the public’s first responder to allegations of abuse and neglect against dependent adults and the elderly.60
StaffingThis year is the second year of operation for APS following severe staffing reductions and an overall environment of fewer county and community based resources to draw upon.61
CaseloadsAPS practitioners statewide generally have agreed that the best practice caseload is to receive 15 new abuse reports and to carry over another ten from the previous month for atotal of 25 cases per month. 62
CaseloadThe current caseload for an APS Social Casework Specialist in Contra Costa County is 65. Each caseworker receives on the average of 18-21 new cases a month.63
Caseloads2004 to presentYear Caseload size/per APS worker200423.75200531.8200635200737200844.7320096420106564
CaseloadsIn the first half of 2002, APS had 18 social casework specialists, a mental health clinical specialist and two public health nurses.In the second half of 2002, it lost a unit’s worth of staff.December of 2008, experienced a 75% reduction.Today, there is one supervisor and seven social casework specialists.65
Staffing: County ComparisonContra Costa County has the third largest population of the Bay Area Counties. Population by County (2008-2009):Alameda 1,474,368Santa Clara 1,682,585San Francisco 815,358Contra Costa 1,015,67766
COUNTYBay Area Counties with like demographicsPOPULATION(as of 2008)(As of December 2010)STAFFING LEVEL(Line Staff)ALAMEDAPop: 1, 474,3682 supervisors17 social workersSANTA CLARAPop: 1,682,5853 supervisors29 social workersSAN FRANCISCOPop: 815,3587 supervisors37 APS social workersCONTRA COSTAPop: 1,051,6771 supervisor7 social workers67
Caseload ImpactBetween September 1, 2009 and August 31, 2010, 1533 new APS cases were opened. Only 43 of those had ever been opened before in Adult Protective Services.68
Reports of Abuse Perpetrated by Others Received between 9/1/09 and 8/31/1069
Reports Made to APSof Self-NeglectSeptember 1, 2009 through August 31, 2010 in Contra Costa County70
Caseload PressureWhile the plan last year was to utilize “NIFFI” (Non faceto face investigation) as a way to ‘manage’ the self-neglect referrals, we have found that most of thesereferrals are too high risk to assign as a “NIFFI”.While we do cross report to law enforcement in financial abuse cases, law enforcement is also understaffed to investigate and gather information for the District Attorney’s Office.The senior community is becoming more aware of financial exploitation and reports of financial abuse from financial institutions have increased significantly as demonstrated this past year.71
Grand Jury FindingsGrand Jury FindingsWe will reiterate the Grand Jury finding that the primary target for financial abuse in Contra Costa County is elderly individual. Caseload statistics from this past year show this to be true.a consortium of community-based organizations, elder advocates and a member of the AAA’s Advisory Council on Aging have formed CASE = Communities Against Senior ExploitationCASE is a public awareness campaign with a speaker’s bureau to speak to senior groups and the general public about elder financial abuse72
•Restore essential staff positions, such as the Public Health Nurse, the Mental Health Specialist and at least four of the social workers to APS that were lost as of January 1, 2009.Recall Last year’s Grand Jury Recommendation73
Who’s coming to APS?The Baby BoomersGiven our current staffing, APS is not prepared for what is coming: the Baby Boomers. As we have illustrated, we barely have enough staff and resources to meet the current demand let alone this exponential increase in our aging population.In recent estimates, Contra Costa County residents over age 54 constitute 11.5% of the county's population, or about 118,000 individuals. The fastest growing segment of the population in Contra Costa County is the 85+ age group. Over the next 10 years, this group is predicted to skyrocket by 55%. The 65+ age group is expected to increase by 37%.74
Volunteer Care Assessmentand Care ManagementTwo initiatives, one new and one a past practice are also being developed. 1. Past practice of Multi-Disciplinary Teams (MDT) is being renewed.2. Volunteer Care Assessment and Care Coordination is being developed.75
Multi-Disciplinary Teams (MDT)Will consist of representatives from:Adult Protective ServicesIn Home Supportive ServicesIHSS Public AuthorityHealth Services DepartmentInformation & Assistance (I&A)Multi Purpose Senior Services ProgramConservatorshipRepresentatives to be used on a case-by-case “as needed” basis76
Volunteer Care Assessment and Care CoordinationVolunteer based service provided to CCC aged and adult disabled residents, regardless of income.Low income clients served at no cost.Middle income participants pay according to their ability to do so (sliding scale.)Those with higher incomes pay the full price (which will help offset costs of the low income consumers.)Grants, and donations will also supplement the costs for the Program.77
ConclusionW&I Code 15750 states, “each county welfare department shall establish and support a system of protective services to elderly and dependent adults who may be subjected to neglect, abuse, or exploitation or who are unable to protect their own interests”.78
Annual Salary, Benefits and County Costs to Add Social Casework Specialist IIs to APSFTEsClassCodeSalary3rdStepBenefits74%Total Annual S&BTotal County CostSocial Casework Specialist II1 XOVB $70,158 $51,917 $122,075 $30,519Social Casework Specialist II2 XOVB $140,316 $103,834 $244,150 $61,037Social Casework Specialist II3 XOVB $210,474 $155,741 $366,225 $91,556Social Casework Specialist II4 XOVB $280,632 $207,668 $488,300 $122,07579
John B. CottrellDirector, Aging & Adult ServicesEmployment & Human Services40 Douglas Dr., Martinez(925) 313-1605jcottrell@ehsd.cccounty.us80
County of Contra Costa
OFFICE OF THE COUNTY ADMINISTRATOR
MEMORANDUM
DATE: December 6, 2010
TO: Family and Human Services Committee
Supervisor Gayle B. Uilkema, Chair
Supervisor Federal D. Glover, Vice Chair
FROM: Dorothy Sansoe, Staff
Sr. Deputy County Administrator
SUBJECT: 2010 YEAR-END REPORT ON REFERRAL ITEMS
RECOMMENDATION(S):
I. ACKNOWLEDGE that the Board of Supervisors referred one new item to the Family and
Human Services Committee (FHS) for their review and consideration during the 2010
calendar year in addition to the referrals carried over from the prior year.
II. ACCEPT the recommendation to carry forward the following seventeen referrals from the
2010 Family and Human Services Committee to the 2011 Committee:
a) Referral #1 – Child Care Affordability Fund
b) Referral #2 – Oversight of the Service Integration Team
c) Referral #5 – Continuum of Care Plan for the Homeless/Healthcare for the Homeless
d) Referral #20 – Public Service Portion of the CDBG
e) Referral #25 – Child Care Planning/Development Council Membership
f) Referral #44 – Challenges for EHS
g) Referral #45 – Elder Abuse
h) Referral #56 – East Bay Stand Down for Homeless Veterans (Bi-annual)
i) Referral #61 – HIV Prevention/Needle Exchange Program
j) Referral #78 – Community Services Bureau/Head Start Oversight
k) Referral #81 – Local Child Care & Development Planning Council Activities
l) Referral #82 – Secondhand Smoke Ordinance
m) Referral #92 – Local Planning Council – Child Care Needs Assessment
n) Referral #93 – Independent Living Skills Program
o) Referral #95 – Child Welfare Improvement Plan Annual Update
p) Referral #100 – Child Poverty
q) Referral #101 – FACT Committee At-Large Appointments
III. ACCEPT the recommendation to close the following seven referrals:
a) Referral #11 – Oversight of the Work of the Policy Forum
b) Referral #58 – County Wide Youth
c) Referral #94 – Children’s Treatment
81
Page 2 of 2
d) Referral #96 – Fee for Service Child Care
e) Referral #98 – Mental Health Pavilion
f) Referral #99 – Closure of the Chris Adams Girls Home
g) Referral #102 – Work of the Consolidated Planning Advisory Workgroup
BACKGROUND/REASONS FOR RECOMMENDATION(S):
Between January and December 2010, the Board of Supervisors referred one new item to the
Family and Human Services Committee (FHS) in addition to referrals carried forward from the
2010 year. The FHS Committee heard twenty-four separate reports on twenty two different
referrals.
The following items should be closed out as noted:
h) Referral #11 – Oversight of the Work of the Policy Forum – The Policy Forum has not
met in approximately two years due to budget reductions among the participating entities
and resulting time constraints.
i) Referral #58 – County Wide Youth Commission – The Board of Supervisors sunset the
Commission on June 8, 2010.
j) Referral #94 – Children’s Treatment Oversight – The FHS has been monitoring changes
to services at the Seneca treatment facility proposed in 2007. All changes have been
implemented and continued oversight is no longer necessary.
k) Referral #96 – Fee for Service Child Care – The addition of child care services to the
County Head Start program has been monitored by FHS since October 2007. The
program is up and running smoothly. Continued oversight separate from referral
numbers 44 and 78 is no longer needed.
l) Referral #98 – Mental Health Pavilion – A Review of Services to Be Provided – The FHS
reviewed the potential services to be offered at a proposed new mental health pavilion.
The Committee referred the recommendations to the full Board for review.
m) Referral #99 – Closure of the Chris Adams Girls Home – This program was eliminated
during the 2009 budget reductions. The FHS Committee monitored the process used
during to closing of the facility to ensure that all children were appropriately placed in
other services. This process is now complete.
n) Referral #102 – Work of the Consolidated Planning Advisory Workgroup – This referral
was made at the request of the Internal Operations Committee. FHS reviewed the
activities of the workgroup, including allocations of funding. The issues referred have
been addressed.
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