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HomeMy WebLinkAboutBOARD STANDING COMMITTEES - 09122011 - FHS Cte Agenda Pkt FAMILY AND HUMAN SERVICES COMMITTEE September 12, 2011 11:00 A.M. 651 Pine Street, Room 108, Martinez Supervisor Gayle B. Uilkema, District II, Chair Supervisor Federal D. Glover, District V, Vice Chair Agenda Items: Items may be taken out of order based on the business of the day and preference of the Committee 1. Introductions 2. Public comment on any item under the jurisdiction of the Committee and not on this agenda (speakers may be limited to three minutes). DISCUSSION 3. Referral #101 – Approve Appointments to the Family and Children’s Trust (FACT) Advisory Committee (Presenter: Rhonda Smith, EHSD) 4. Referral #2 – Annual update on Oversight of the Service Integration Program (Presenter: Paul Buddenhagen, EHSD) 5. Referral #5 – Annual updates on the Continuum of Care Plan for the Homeless (Presenter: Lavonna Martin) and Healthcare for the Homeless (Presenter: Rachael Birch The next meeting of the Family and Human Services Committee is scheduled for October 10, 2011 at 11:00 a.m. ☺ The Family and Human Services Committee will provide reasonable accommodations for persons with disabilities planning to attend Committee meetings. Contact the staff person listed below at least 72 hours before the meeting.  Any disclosable public records related to an open session item on a regular meeting agenda and distributed by the County to a majority of members of the Family and Human Services Committee less than 96 hours prior to that meeting are available for public inspection at 651 Pine Street, 10th floor, during normal business hours.  Public comment may be submitted via electronic mail on agenda items at least one full work day prior to the published meeting time. For Additional Information Contact: Dorothy Sansoe, Committee Staff Phone (925) 335-1009, Fax (925) 646-1353 dsans@cao.cccounty.us 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 Sept 13 Sept 20 Sept 27 1 Joe Valentine, Director 40 Douglas Dr., Martinez, CA 94553 Phone: (925) 313-1579 Fax: (925) 313-1575 www.cccounty.us/ehsd MEMORANDUM DATE:September 12, 2011 TO: Family &Human Services Committee Supervisor Federal D. Glover, District V, Chair Supervisor Gayle B. Uilkema, District II, Vice-Chair cc:Dorothy Sansoe FROM:Joe Valentine, EHSD Director Paul Buddenhagen, Program Manager, Service Integration Program SUBJECT:Report on the Contra Costa County Service Integration Program RREECCOOMMMMEENNDDAATTIIOONN ACCEPT the attached report on the activities and achievements of the Contra Costa County Service Integration Program. EEXXEECCUUTTIIVVEE SSUUMMMMAARRYY Established in 1994, the Contra Costa County Service Integration Program co-locates County and non-profit agency service providers and community residents in neighborhood-based centers to provide accessible, coordinated public services tailored to meet the specific needs and goals of low- income families, while also engaging families in resident-driven efforts to revitalize their communities. The success of this program’s Service Integration Team (SIT) model stems from the synergistic relationship between its two key program components: (1) integrated case management services and (2) neighborhood-building activities. This year the Service Integration Program has had two major changes. The first is that the SIT budget was eliminated and the second is that the SIT Program Manager position was combined with the East Bay Works One Stop Administrator position. These changes have made operating SIT more challenging but also created a pathway to enhanced integration of the One Stops and SIT. The Service Integration Program is widely recognized as a leader in the development of successful strategies that improve outcomes for low-income children, youth and families. Key Service Integration innovations include: Developing new paradigms of inter-agency collaboration and creating necessary tools to support this work, including cross-agency information-sharing protocols, an integrated case management system and an effective family conferencing model. 2 Redefining County-community partnerships to help fundamentally shift the way in which our public agencies work with residents of low-income communities. Launching new initiatives and strategies, such as free tax preparation services (Volunteer Income Tax Assistance), community career centers, employment-focused service delivery, County--Schools projects, the Supporting Fathers Involvement Program, SparkPoint and others Serving as a local model of public sector “systems change”by implementing performance-based results and new strategies for leveraging public and private investments. The success of the Service Integration model is evident in the measurable improvements achieved in the lives of the children, families and communities it serves. Recent examples of Service Integration Program outcome measures include: For the 2011 tax season SIT’s Bay Point Works’ staff prepared and filed 271 tax returns – more than any other site in the County --saving low-income community residents more than $27,000 in filing fees, while helping put more than $428,000 in federal tax refunds back in the pockets of working poor Bay Point residents (and circulating in the local economy). Significantly, $154,056 in Earned Income Tax Credit and $141,943 were returned to families for whom Bay Point Works SIT staff prepared and filed taxes. EITC is the single most effective government program in lifting people out of poverty and Bay Point SIT has helped many people in the community claim a Federal benefit that helps them escape poverty. North Richmond SIT completed work on the first phase of the Supporting Father Involvement Program which culminated in researchers from Yale University, Smith College and UC Berkeley publishing a groundbreaking study on the importance of including fathers in social services work in the Journal of Marriage and Family. This research and intervention represents the first randomized, controlled clinical trial focused on father involvement in low income families.You can read the full study here: http://www.supportingfatherinvolvement.org/jmf-2009-article.pdf More than 200 families in the child welfare system statewide (43 in Contra Costa County) participated in 32 hours of group sessions with ongoing case management support and the research confirms that when fathers become more involved in parenting --and in working with mothers as co-parents and partners --the result is healthier families and healthier children.Parents experience reduced stress and anxiety,more relationship satisfaction, and children are less hyperactive and aggressive. Based on SFI’s demonstrated success, last month the Service Integration Program applied for a $2.4 million 3 year federal grant that combines the best of Supporting Father Involvement with SparkPoint. 3 In partnership with Helms Middle School in San Pablo, SIT’s Helms Involving Parents program last year helped make significant reductions in absenteeism, suspensions, and bullying. At the same time through the SIT created coffee club, parent involvement was dramatically increased. These changes resulted in a calmer school with more ADA revenue and parent volunteers. Based on this success we have been able to raise money to continue the expanded Nystrom Involving Parents program. Due to the effectiveness of this model, the Service Integration Program has received local, state and national awards; has been the subject of articles and research studies; and frequently is represented by Service Integration staff at conferences as a “best practice” model. The Service Integration Program has been successful in leveraging its positive outcomes to raise money for new innovative programs that benefit Contra Costa’s most impoverished families. The chart below contrasts SIT’s private revenue with net county cost during the past ten years. SIT Revenue 2000/01 –2011/12 NCC VS Non County $- $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000 $800,000 $900,000 2000/01 2002/03 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011-12 Net County Cost Revenue 4 Like public agencies across the nation, Contra Costa County is also severely impacted by the ongoing recession. This year for the first time since its creation, the Service Integration Program budget has been eliminated. Staff assigned to SIT draw revenue from their respective departments and nonprofit agencies but SIT has no budget for programs. As you can see in the chart above all resources dedicated to SIT are raised by SIT staff from private and public grants. BBAACCKKGGRROOUUNNDD Established in 1994, the Service Integration Program is a multi-disciplinary collaboration of three Contra Costa County departments (Employment & Human Services, Health Services and Probation), two school districts, community-based organizations (CBOs) and neighborhood residents. The Service Integration Program’s two Family Service Centers were designed to take an innovative approach to working with families that historically have posed some of the greatest challenges to service providers: families involved in two or more county systems who live in the County’s most economically disadvantaged communities. This unique model co-locates County and non-profit agency service providers and community residents in neighborhood-based centers to provide accessible, coordinated public services tailored to meet the specific needs and goals of low-income families, while also engaging families in resident-driven efforts to revitalize their communities. The success of the Service Integration Program model stems from the synergistic relationship between its two key program components: (1) integrated case management services and (2) neighborhood-building activities. The integrated case management services component places cross- disciplinary Service Integration Teams comprised of Substance Abuse and Mental Health Counselors, Employment Specialists, Probation Officers, School Family Resource Workers, Social Workers and other specialists in Family Service Centers located in Bay Point and North Richmond. Based on the premise that the challenges facing low-income families and communities are inter- related, these teams embrace a holistic approach. The teams focus on the whole family unit, rather than just the individual, and build upon family strengths to provide services driven by and customized to each family’s unique circumstances. In addition to providing families with more personalized services in the communities where they live, this multi-disciplinary approach produces a comprehensive, consistent strategy for each family, reducing conflicting expectations and demands made by different programs. The Service Integration Program’s two neighborhood-building projects, Bay Point Works (BPW) and the North Richmond Empowerment Collaborative (NREC), were born out of the recognition that an integrated team of county and community-based organization staff was a necessary, but not sufficient mechanism for addressing the full range of challenges facing the communities of Bay Point and North Richmond/San Pablo. BPW and NREC were designed to harness the talents and skills of neighborhood residents in the process of revitalizing their communities. This strategy has galvanized the creation of highly innovative and successful programs (designed specifically by and for community members) that support and build upon local cultures and traditions and fill critical gaps in the formal service delivery system. Perhaps most important of all, the neighborhood-building 5 projects have expanded the long-term capacity of the Bay Point and North Richmond/San Pablo communities by developing the skills of numerous neighborhood residents and providing opportunities for them to give back to their communities and build stronger connections in the neighborhoods where they live. BPW’s community-building efforts started with the establishment of the Bay Point Community Career Center in May 1998 and have expanded steadily from there. Every year since, BPW has strengthened its services and, in turn, helped more and more Bay Point residents get jobs, keep jobs and move up the job ladder. In recent years, BPW has offered a number of supportive services that go well beyond the traditional employment services package, such as free income tax preparation for low-income Bay Point workers to help them capture the benefits of the Earned Income Tax Credit (EITC) and free structured activities for the young children of “working poor” parents during school holidays. NREC’s community-building activities also initially focused on boosting neighborhood employment. Early successes included reinstituting night bus services in North Richmond, creating several in- home family day care centers and establishing the North Richmond Community Career Resource Center, which continues to serve neighborhood residents after having been spun off to a CBO in 2000. After making a number of strides in the area of employment, NREC decided to take on an issue of great importance to neighborhood residents: low levels of student success and parental involvement at Verde Elementary School. This focus resulted in the establishment of NREC’s Verde Involving Parents (VIP) Program, which has played a critical role in initiating and sustaining the renaissance of Verde Elementary School over the past seven years. With private foundation support, the VIP program was recently expanded to Helms Middle School, which is where kids leaving Verde go to continue their education. This report to the Family and Human Services Committee of the Board of Supervisors summarizes some of the Service Integration Program’s key innovations and contributions to improving the wellbeing of Contra Costa children, families and communities over the past 15 years. SSEERRVVIICCEE IINNTTEEGGRRAATTIIOONN PPRROOGGRRAAMM AASS AA LLEEAADDEERR IINN ““BBEESSTT PPRRAACCTTIICCEESS”” Since its inception over a decade ago, the Service Integration Program has emerged as a leader in the development of successful strategies that improve outcomes for low-income children, youth and families. The Service Integration Program reaches far beyond the traditional “agency service provider” model by involving low-income residents as integral partners in the process of addressing the needs and aspirations of the neighborhoods where they live. This small, inter-agency program draws down flexible funding from private foundations and outside contracts to complement more traditional federal, state and county funding streams. As a result, Service Integration has managed to maintain a flexibility and inventiveness unusual to public sector agencies. SIT has launched programmatic, fiscal and organizational innovations that have laid the foundations for the development of more effective and efficient services to children, families and communities countywide. 6 Due to the effectiveness of the Service Integration model, Contra Costa County has received local, statewide and national recognition and has been the subject of research papers and studies, including: North Richmond Gets Its Buses Back: How a Poor Community and an Urban Transit Agency Struck Up a Partnership (Institute of Governmental Studies Press, University of California, Berkeley, 1999), which focuses on NREC’s successful strategy for partnering with A.C. Transit to bring night-time bus service back to North Richmond; and A Case Study on North Richmond (Abt Associates, on behalf of the Ford Foundation, 2004), which highlights the VIP Program as a successful model of school-community revitalization. The latter study credits VIP as being “largely responsible for the major improvements in school attendance, parent involvement and student behavior that have taken place at Verde…” THree years ago the National Center for Children in Poverty at Columbia University highlighted SIT’s VIP program as a best practice intervention in their report,Present, Engaged, and Accounted for: The Critical Importance of Addressing Chronic Absenteeism in the Early Grades Some of the Service Integration Program’s major areas of innovation are summarized below: Inter-Agency Collaboration:Service Integration has been at the vanguard of Contra Costa’s efforts to develop effective models of collaboration and cross-program and - agency partnerships, paving the way for greater collaboration countywide. Service Integration has developed new organizational structures to support this collaboration at the management oversight level (e.g., the inter-agency Service Integration Executive Oversight Committee), as well as at the frontline service delivery level (e.g., multi- disciplinary teams). The infrastructure and tools established through Service Integration’s partnership model and the relationships that have formed as a result have laid the groundwork for and facilitated the success of many other inter-agency initiatives. County-Community Partnerships:Service Integration has redefined relationships between public agencies and residents of low-income neighborhoods while developing a viable model for bridging the all too common gap between agency “service providers” and the communities they serve. In 1997, in the wake of Federal Welfare Reform, each of the SIT sites engaged neighborhood residents in planning efforts to determine how these communities could succeed in this new policy environment. These efforts resulted in the establishment of two innovative community-building projects, Bay Point Works and the North Richmond Empowerment Collaboration. Last year we surveyed Bay Point residents to find out how we could better help them into economic stability. The results of this survey will lead the way in our effort to partner with community based nonprofit organizations. Cross-Agency Information-Sharing:Working together, key Service Integration partner agencies (i.e., EHSD, CCHS, Probation, CAO) and County Counsel developed Contra Costa’s first informed consent agreement for integrated services in 1994. This confidentiality release gives permission for Service Integration staff from participating agencies to share information to better serve families. This “Agreement to Participate” form served as a model for more recent integrated services programs, such as the mental health “Spirit of Caring” Initiative, and contributed to the establishment of the Service Integration Program as Contra Costa’s first official “Multi-Disciplinary Children’s Services Team”. 7 Outcomes/Performance-Based Accountability:Service Integration spearheaded Contra Costa County’s early efforts to implement performance-based accountability. In the early-and mid-1990’s, the inter-agency Service Integration Management Team developed a set of meaningful outcomes that could be used to evaluate the success of the Service Integration Program by concretely measuring the program’s impact on the lives of children and families. Service Integration staff has diligently tracked these program results since 1996. Service Integration’s novel approach led to wider adoption of outcome measures by other County programs and laid the groundwork for the 1997 establishment of Contra Costa’s Children and Families Report Card. Leveraging Public and Private Investments:Service Integration has designed its fiscal strategy around encouraging private foundations and other funders who do not typically support county ventures to invest in innovation in the public sector. SIT currently has commitments of more than $700,000 from private and public sources to fund a variety of family support projects through June 2012. Through its strong track record of capturing measurable results, promoting public-private partnerships and engaging community residents in the process of bettering their neighborhoods and their lives, Service Integration has helped to convince many new funding partners that investments in the public sector can galvanize sustainable individual, family, neighborhood and systems change. Holistic, Integrated Case Management System:The Service Integration Program pioneered the County’s first integrated case management process. Focusing on the whole family unit, rather than just the individual, this process allows SIT staff to build upon family strengths and provide services driven by and tailored to each family’s unique needs. Service Integration created the Family Assessment Record to support the development of comprehensive plans for addressing issues in a range of interdependent life domains, such as child care, child and adult health, transportation, school, employment and other social supports. First developed in 1995, this tool and the SIT case management process as a whole have been refined over the years to support continuous improvement and better integration of Service Integration services. SIT staff, funded by a generous grant from the S.H. Cowell Foundation is nearing the end of a 2 year project to re-evaluate the case management model and make updates. One of the interesting findings is that in order to truly strengthen individuals and families we also have to strengthen the communities in which they live. We are embarking on a community development/organizing model in Bay Point and will report progress next year. Family Conferencing:The Service Integration Program’s “Family Conferencing” model brought a new way of doing business to Contra Costa County. Service Integration began conducting inter-agency case conferences with client families in the mid-1990s. The success of our family conferencing model helped open the doors for similar family- focused models in Contra Costa, such as “Wraparound” in Children’s Mental Health and “Team Decision Making” in Children and Family Services. 8 Employment-Focused Service Delivery:In 1995, prior to the passage of Welfare Reform, Service Integration was the first County program to implement an employment- focused service delivery model. The Service Integration model transitioned “eligibility workers” into “employment case managers” and tapped into the resources of all disciplines to move welfare recipients into the workforce. Due to the effectiveness of this model, the Service Integration Program was invited to co-develop EHSD’s redesign plan for restructuring its eligibility determination function into an employment-focused service delivery strategy. Free Tax Preparation Services (Volunteer Income Tax Assistance):In 2003, the Service Integration Program piloted the Volunteer Income Tax Assistance (VITA) free tax preparation model at the Bay Point and North Richmond SIT sites. Based on the success of this pilot, Service Integration played a lead role, along with a number of other partner agencies, in launching a countywide VITA campaign in 2004:Earn It! Keep It! Save It! Contra Costa. This year, the Bay Point Works VITA site filed more tax returns than any of the County’s thirteen VITA sites. Community Career Centers:In May 1998, Bay Point SIT’s BPW project established the Bay Point Community Career Center, a forerunner to the County’s One-Stop Career Center system. In January 2000, NREC established a second Community Career Center in North Richmond. The Career Centers introduced community-based employment resources delivered via a neighbor-helping-neighbor model to the communities of Bay Point and North Richmond. The Bay Point Community Career Center continues to be a heavily utilized hub in the community; 7,563 people have enrolled as members of the Career Center since it opened in 1998! Verde Involving Parents (VIP):Service Integration’s VIP Program, established in February 2001, has reaped impressive results. VIP is a team effort of parents, students, teachers and county agencies and non-profit organization staff who live and work in North Richmond. Their goal: get our children to school –every day, on time and ready to learn. Due to the dramatic impact of VIP on student attendance and parent involvement at Verde Elementary School, the West Contra Costa Unified School District (WCCUSD) invested $125,000 in the VIP Program during the 03/04 and 04/05 school years. During the first half of 2004, at the request of WCCUSD Superintendent Dr. Gloria Johnston, the VIP staff and managers met with principals and staff from four low-performing elementary schools to offer technical assistance and training on the VIP school improvement model. In summer 2004, the VIP Program presented the WCCUSD with a Training Handbook to support its VIP replication efforts. In the last year SIT has expanded by working with parents, teachers and administrators at Nystrom Elementary School and Helms Middle School to implement the “involving parents’ model at those two schools. Supporting Father Involvement (SFI):We are pleased to offer an evidence based program that improves families’ lives to Contra Costa County. Service Integration’s North Richmond family service center is one of five sites statewide to provide the SFI program. For the next three years, SFI will be working with families in the child welfare system to reconnect fathers with their families and increase protective factors so that they stay healthy. 9 MMoovviinngg FFoorrwwaarrdd::SSIITT AAss aa MMooddeell ffoorr CChhaannggee ––SSppaarrkkPPooiinntt One of the Service Integration Program’s strengths is its flexibility to respond to local, community need in a collaborative, public-private, outcomes focused way. This dexterity has allowed SIT to pilot many new ideas that were then replicated in other locations. Not in decades has the economic landscape been as rocky and challenging as it is now. Unemployment rates are at 25 year highs, obesity is more prevalent than ever, school test scores are falling and budgets have cratered. How health and human services agencies respond to this crisis to remake the social safety net will be a serious challenge. The Service Integration Program is taking up this challenge by working closely with local residents, county departments, nonprofit agencies, schools, community colleges, private foundations, and businesses to rethink and reorganize a fractured and wobbling safety net system. Creating a new system that builds collaborative goals and brings leveraged resources to bear on the problems of poverty is our current focus. This focus and thinking has led us to SparkPoint, a novel antipoverty approach that is taking shape in Richmond and Bay Point. In Bay Point, a group of nonprofit, funder and government leaders are helping to transform the existing service integration family resource center into a SparkPoint center. We are building on years of community based services to transition our focus from general family support to specific economic support. The SparkPoint center opened to the public in June 2011 and focuses on helping low-income people from East County become economically stable. Four specific outcomes we are measuring over three years: Reducing Debt to no more than 40% of take home pay Improving Credit Scores to 650 and above Increasing income through getting a job Increasing assets by amassing at least one month of liquid savings We have raised more than $250,000 from private foundations in support of the Bay Point SparkPoint Center with a goal of helping 250 East County residents thrive financially.     5 1 CONTRA COSTA HEALTH SERVICES DEPARTMENT CONTRA COSTA COUNTY TO: Family and Human Services DATE: Sept. 12, 2011 Committee Members FROM: Rachael Birch, Project Director, Health Care for the Homeless SUBJECT: Health Care for the Homeless Annual Report Recommendations 1. Accept this report from the Health Services Department; and 2. Forward this report to the Board of Supervisors for acceptance; and 3. Direct staff to continue to report on an annual basis to the FHS Committee regarding progress and status of the Health Care for the Homeless Program and to submit an additional written report to the Board of Supervisors, at six-month intervals. Background Since 1990, the Health Care for the Homeless (HCH) Project has provided health care services to the homeless population through mobile clinics, as well as through the CCHS integrated ambulatory system of care, and the Departments of Mental Health and Alcohol and Other Drugs. Primary health care services provided by the HCH Mobile Team include routine physical assessments, basic treatment of primary health problems such as minor wounds and skin conditions, respiratory problems, TB screening, acute communicable disease screening, and coordination and referrals for follow up treatment of identified health care needs. A significant portion of the homeless patients seen in the mobile clinics have chronic diseases, including asthma, hypertension, diabetes, and mental health/substance abuse issues. The mobile team is comprised of a Medical Director, Family Nurse Practitioners, Nurses, Community Health Workers, Financial Counselor, Mental Health Specialist, and a Substance Abuse Counselor. Homeless patients who receive care on one of the mobile clinics are referred into one of the CCHS ambulatory care health centers for primary and specialty care, into County mental health and substance abuse services and to Contra Costa Regional Medical Center for emergency, inpatient hospital, outpatient surgeries, laboratory and radiology. There are currently four ambulatory care clinics, 2 located throughout the County, designated specifically for homeless patients to help them transition from the mobile clinic setting into the ambulatory care system. HCH staff members are present at each of these clinics. The HCH project also provides Public Health Nurses at each of the County shelters, providing comprehensive Targeted Case Management for homeless patients. During 2010, CCHS treated 16,055 homeless patients who generated 102,367 visits. This is an increase from 2009, when CCHS saw 15,094 homeless patients who generated 96,572 visits. The increase is likely due in part to the economic recession, which placed further demand on the safety-net system, including CCHS, and partly to the addition of three Community Practice Clinics in Concord, Antioch and San Pablo. Table 1 (below) indicates the Board of Supervisor’s District where homeless patients reside. If no residential zip code data are available, the zip code where a patient received care is used. Table 1: Percent of Homeless Patients by Supervisorial District, 2009 District 1- Supervisor Gioia 33% District 2- Supervisor Uilkema 20% District 3- Supervisor Piepho 2% District 4- Supervisor Bonilla 23% District 5- Supervisor Glover 22% The attached presentation contains additional demographic information on our HCH population. New Actions The following activities and updates have occurred since the last briefing to the Board of Supervisors on HCH activities: American Recovery and Reinvestment Act Funding In July 2009, the HCH Project received a Capital Improvement Project award to replace the Martinez Family Practice Site (Building 2 on the CCRMC Campus). This project will modernize the clinic and streamline clinic flow for maximum efficiency. The new unit will enhance the effectiveness and efficiency of providing clinical services to patients through reduced waiting times for clinic appointments at the Martinez site and throughout the CCHS system. A homeless-specific clinic will be offered at this site upon its opening. Funding for this project was calculated on a formula basis at $683,000. During the past year, CCHS devoted 3 time to meeting all conditions associated with the grant award prior to beginning construction, including extensive environmental assessments. The new clinic will have both medical and mental health components. Its design has been completed and is currently under review by the Department of Community Development. In December 2009, CCHS received $12 Million in ARRA funds for the construction of a new West County health center, to replace the Richmond Health Center. Construction is well under way on the 50,000 square foot, two story clinic. It will house a comprehensive array of outpatient medical services and support functions. The goal is to have the building achieve LEED certification for environmental quality. In May 2009, the HCH Project was awarded an additional $220,000 in stimulus funds to address the “Increased Demand for Services.” This amount of funding was calculated by a formula based on the number of homeless patients served by the HCH Program. This funding has been incorporated into our HCH base grant, increasing our annual amount to $958,795 Affordable Care Act In August 2011, the HCH Project received a New Access Point (NAP) grant from HRSA for $649,185 per year. The funding will help pay for a team of HCH staff to operate a homeless clinic in Concord, at 3024 Willow Pass Rd., Concord. This team will include one RN, one PHN, one Community Health Worker, one Medical Doctor, one Care Coordinator, one Mental Health Specialist, one Substance Abuse Specialist and one Registration Clerk. This funding will be incorporated into our HCH base grant, increasing the annual amount to $1,607,977. Integrated Primary Care Clinic in Concord The HCH Project will soon be opening an integrated primary care (IPC) clinic at Concord Mental Health. The proposed site will provide primary health care with specialty referral and coordination to adults with serious mental illness (and co- occurring substance abuse) and will be located at 1420 Willow Pass Road, Concord, CA. Referrals will initially come from enrolled consumers within Concord Mental Health, where it is estimated that at least 50% of the actively enrolled consumers do not have regular access to primary care and 70% are homeless. Homeless Respite Care and Shelter Clinic The HCH Project opened a licensed ambulatory care clinic at the Concord shelter in May 2011. The clinic serves homeless individuals staying at the Concord shelter and Respite, as well as all clients who meet the homeless 4 criteria. Open four days (20 hours) per week, the clinic includes an RN, FNP and Community Health Worker. The HCH Project continues to provide all medical and nursing care at the Philip Dorn Respite Center. Pro-Bono Dental Health Services for Homeless Clients The Homeless Consumer Advisory Board and HCH launched a partnership with a small group of private dental providers who provide services free of charge to homeless individuals who do not qualify for dental coverage through other programs. The Advisory Board has been a strong advocate about the need for this free service given a lack of affordable dental services, and we are very pleased that a pilot program will address some of this unmet need. A second client recently received free treatment and a complete set of dentures, at no cost, courtesy of the generous care from Dr. Alijanian, DDS, of Walnut Creek. A third client will soon begin receiving services from Dr. Michael Tobian. Dental services are essential to regaining employment and exiting homeless. Rentry Program for Individuals Exiting Incarceration The HCH Project continues to provide staff at the PACT (Probation and Community Together) meetings, providing parolees with assistance in entering our health care system. Kate Schwertscharf, HCH Public Health Nurse Program Manager, receives phone calls and referrals from the San Quentin Medical Project, Richmond Parole Office and the West County Detention Facility, assisting clients in accessing health services. New Medical Director The HCH’s Medical Director, Dr. Kate Colwell, retired after 24 years with CCHS. A new Medical Director, Dr. Nishant Shah, M.D., M.P.H. was identified from within the organization and was oriented by the previous, Dr. Kate Colwell. Summary This has been an exciting and busy time of growth and planning for the HCH program in CCHS. We expect that our next report will have significant updates on the milestones achieved for these new projects, while we also work hard to sustain the ongoing work of the mobile clinic team and homeless ambulatory care clinics. 5 Health Care for the HomelessContra Costa Health ServicesPresentation to the Family & Human Services Committee Contra Costa County Board of SupervisorsSept. 12th, 2011 Rachael BirchHCH Project DirectorKate Schwertscharf, PHNNurse Program Manager Who qualifies as “Homeless?”zAll homeless people in Contra Costa County•Lacking a fixed, regular, adequate nighttime residence•Primary nighttime residence in a shelter, welfare hotel, transitional housing•“Doubled-up” without name on a lease, couch surfing, etc. Funding for HCH ServiceszSection 330(h) Public Health Services ActHealth Care for the Homeless grant from the Federal Government (BPHC/HRSA) – approx. $1.6M per year. Funding ReceivedzIncreased Demand for Services (2009)- $112K per year – rolled into base Section 330 grant.zCapital Improvement Funds (2009) - $683K to replace Martinez bldg 2 with new modular unitz$12 Million award to rebuild Richmond Health Center (2009)zNew Access Point funding (2011) - $650K per year (Increasing base funding from $958K to $1.6 million per year) to open new homeless clinic in Concord. Number of Patients in 2010z16,055 unduplicated homeless patientsz102,367 visits: mobile clinics, ambulatory clinics, emergency department, mental health, substance abuse programs. Number of Patients in 2009 z15,094 unduplicated homeless patientsz96,572 visits: mobile clinics, ambulatory clinics, emergency department, mental health, substance abuse programs. How Patient Demand is Growing Over Time:z2008 vs. 2009:•22% increase in patients•17% increase in visitsz2009 vs. 2010:•6.4% increase in patients•6% increase in visits Why the increase?zExpanded ability to provide services through increased grant funding. -Increased access to care through new clinic openings.zEconomic situation creating increased demand HCH ServiceszMobile Clinic:•routine physical assessments•basic treatment of primary health problems such as minor wounds and skin conditions•treatment for respiratory problems•TB testing•acute communicable disease treatment•referrals for follow up in ambulatory/specialty care•substance abuse and mental health services 2 Mobile Clinic Teams,5 days a weekzAdult Emergency Shelters Concord & RichmondzCalli House (youth), RichmondzBay Area Rescue MissionzGRIP Souper Center & Family Shelter, RichmondzNeighborhood House of North RichmondzMonument Futures, ConcordzMonument CorridorzHome Depot : El CerritozMulti-Service Centers, Richmond, AntiochzAOD Treatment FacilitieszSt. Paul’s, Walnut CreekzAmbrose Community Center, BaypointzLove-A-Child, BaypointzMartinez Waterfront Ambulatory Care ClinicszOperate specialized homeless clinics in the Richmond, Concord and Antioch health centers & at Concord Respite Center for homeless patients •Bypasses waiting times for appointments•Bypass financial counseling process•Make the process more “user friendly” for homeless patients•Helps patients transition to mainstream health care delivery system Ambulatory Care, Specialty, & Hospital Services•4 ambulatory care clinics specifically for homeless patients in Richmond, Concord, Antioch•Family practice care•Specialty care•Outpatient surgery•Emergency Department•Inpatient care•Laboratory•Radiology•Pharmacy Mental Health ServiceszMental Health Treatment Specialist provides screenings, assessments, referrals into the Mental Health system for medication and treatment of clients in the shelters and at other mobile clinic sites Alcohol and Other Drug ServiceszSubstance Abuse Treatment Specialist provides screenings, referrals, and coordination of detox and recovery services specifically for homeless patients in shelters and other mobile clinic sites Patient Demographics 2010z50.5% malez49.5% femalez24% of homeless patients are completely uninsured, on no publicly-funded programz52% Medi-Cal; 2% Medi-CarezAll of our patients at 100% of the Federal Poverty Level and below. Race/Ethnicity in 2010Race HCH CountyWhite 36% 58.5%Latino/Hispanic 26% 24%Black/African American 23% 9%Asian/Pacific Islander 9.5% 15%American Indian/Alaskan Native 0.5% 0.58%Unknown 5% 2% Which Supervisor Districts were Patients from in 2010?I- Supervisor Gioia 33%II- Supervisor Uilkema 20%III- Supervisor Piepho 2%IV- Supervisor Mitchoff 23%V- Supervisor Glover 22%Total 100% Which Supervisor Districts were Patients from in 2008 & 2009?District 2008 2009I- Supervisor Gioia30% 31%II- Supervisor Uilkema13% 15%III- Supervisor Piepho6% 2%IV- Supervisor Bonilla19% 20%V- Supervisor Glover26% 31%Other5% 0% Strong Consumer InvolvementzActive consumer advisory board•Helped to create pro-bono dental services for homeless clients; third patient is receiving services and will receive a free set of dentures courtesy of Dr. Michael Tobian in Walnut Creek Changes & Updates – ClinicalzRespite Care program - HCH is pleased to continue our collaboration with the Behavioral Health and Homeless Program to provide higher level of medical care to medically fragile shelter clients.zConcord Shelter Clinic – HCH recently opened a licensed ambulatory care clinic located next to the Concord Shelter and Respite, open 20 hours per week.zTwo public health nurses are providing comprehensive medical case management at each adult shelter in the County. Changes & Updates - ClinicalzNew Medical Director, Dr. Nishant Shah – Staff physician. Changes & Updates - WCHC