HomeMy WebLinkAboutBOARD STANDING COMMITTEES - 09122016 - FHS Cte Agenda Pkt
FAMILY & HUMAN SERVICES
COMMITTEE
September 12, 2016
1:00 P.M.
651 Pine Street, Room 101, Martinez
Supervisor Candace Andersen, Chair
Supervisor Federal D. Glover, 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).
3. CONSIDER recommending to the Board of Supervisors the appointments of Beth Mora
and Lanita Mims to at-large seats on the Contra Costa Commission for Women.
4. CONSIDER accepting the report from the Health Services Department on the
implementation of Laura's Law (Assisted Outpatient Treatment program), and forward it
to the Board of Supervisors for approval. (Warren Hayes, MHSA Program Manager)
5. CONSIDER accepting the report from the Health Services Department on the Built
Environment Program and Health in All Policies, and forward it to the Board of
Supervisors for their information. (Daniel Peddycord and Tracey Rattray, Health
Services Department)
6. CONSIDER accepting the report from the Employment and Human Services
Department on foster care Continuum of Care Reform, and forward it to the Board of
Supervisors for their information. (Kathy Gallagher, Employment and Human Services
Director)
7.The next meeting is currently scheduled for October 10, 2016.
8.Adjourn
The Family & Human Services Committee will provide reasonable accommodations for persons
with disabilities planning to attend Family & Human Services 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 & Human Services Committee
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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:
Enid Mendoza, Committee Staff
Phone (925) 335-1039, Fax (925) 646-1353
enid.mendoza@cao.cccounty.us
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FAMILY AND HUMAN SERVICES
COMMITTEE 3.
Meeting Date:09/12/2016
Subject:Reappointments to the Contra Costa Commission for Women
Submitted For: FAMILY & HUMAN SERVICES COMMITTEE,
Department:County Administrator
Referral No.: N/A
Referral Name: Appointment to Advisory Bodies
Presenter: Enid Mendoza Contact: Enid Mendoza, (925)
335-1039
Referral History:
On December 6, 2011 the Board of Supervisors adopted Resolution No. 2011/497 adopting policy
governing appointments to boards, committees, and commissions that are advisory to the Board of
Supervisors. Included in this resolution was the requirement that applications for at
large/countywide seats be reviewed by a Board of Supervisors sub-committee.
Referral Update:
The Contra Costa Commission for Women has submitted the attached requests for appointments
to seats on the Commission. The Commission reviewed the applications and interviewed the
candidates and recommends the appointments.
Recommendation(s)/Next Step(s):
RECOMMEND to the Board of Supervisors the following appointments to the Contra Costa
Commission for Women:
Beth Mora, resident of Danville, to the At-Large Seat 11 with a term expiring February 28, 2018,
and
Lanita Mims, resident of Oakley, to the At-Large Seat 10 with a term expiring February 28, 2018.
Fiscal Impact (if any):
No fiscal impact.
Attachments
Beth Mora Application
Lanita Mims Application
3
4
5
6
7
8
9
10
11
12
13
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FAMILY AND HUMAN SERVICES COMMITTEE 4.
Meeting Date:09/12/2016
Subject:Referral No. 107 Laura's Law - Assisted Outpatient Treatment
Submitted For: FAMILY & HUMAN SERVICES COMMITTEE,
Department:County Administrator
Referral No.: 107
Referral Name: Laura's Law
Presenter: Warren Hayes, MHSA Program
Manager
Contact: Enid Mendoza, (925)
335-1039
Referral History:
The Assisted Outpatient Treatment Demonstration Project Act (AB 1421), known as Laura’s
Law, was signed into California law in 2002 and is authorized until January 1, 2017. Laura’s Law
is named after a 19 year old woman working at a Nevada County mental health clinic. She was
one of three individuals who died after a shooting by a psychotic individual who had not engaged
in treatment.
AB 1421 allows court-ordered intensive outpatient treatment called Assisted Outpatient Treatment
(AOT) for a clearly defined set of individuals. In order to be eligible for AOT an individual must
meet the following criteria:
• Must be 18 years or older
• Must be suffering from a SMI (W&I 5600.3)
• Unable to survive safely in community without supervision
• History of lack of compliance with treatment, evidenced by either:
– Hospitalized/incarcerated 2 or more times in last 36 months in forensic or MH unit of State or
local correction facility due to mental illness
– Demonstrated violent behavior towards self or others in the last 48 months
• Offered and refused treatment on a voluntary basis
• Condition must be deteriorating
• Assisted Outpatient Treatment (AOT) is considered the least restrictive treatment
• AOT is needed to prevent relapse or further deterioration
• Will benefit from AOT
AB 1421 specifies that any of the following -- an adult with whom the person resides; a parent,
spouse, sibling or child of person (18 or older); the director/designee of the mental health
treatment facility or residential facility where the person is/was receiving treatment; a licensed
mental health treatment provider; or a law enforcement officer (including probation/parole) – may
request the County Mental Health Director to file a petition with the superior court for a hearing
15
to determine if the person should be court ordered to receive the services specified under the law.
The County Mental Health Director or his licensed designee is required to perform a clinical
investigation, and if the request is confirmed, to file a petition to the Court for AOT.
If the court finds that the individual meets the statutory criteria, the recipient will be provided
intensive community treatment services and supervision by a multidisciplinary team of mental
health professionals with staff-to-client rations of not more that 1 to 10. Treatment is to be
client-directed and employ psychosocial rehabilitation and recovery principles. The law specifies
various rights of the person who is subject of a Laura’s Law petition as well as due process
hearing rights.
If a person refuses treatment under AOT, treatment cannot be forced. The Court orders meeting
with the treatment team to gain cooperation and can authorize a 72 hour hospitalization to gain
cooperation. A Laura’s Law petition does not allow for involuntary medication.
AB 1421 requires that a county Board of Supervisors adopt Laura’s Law by resolution to
authorize the legislation within that county. AB 1421 also requires the Board of Supervisors to
make a finding that no voluntary mental health program serving adults or children would be
reduced as a result of implementation. A lack of funding and ongoing controversy over forcing
individuals with mental illness into treatment has led most counties to decide against enacting.
Nevada County was the first to adopt Laura's Law. In addition to Nevada and Contra Costa, El
Dorado, Kern, Los Angeles, Mendocino, Orange, Placer, San Diego, San Francisco, San Mateo,
Santa Barbara, Shasta, and Yolo counties have implemented a Laura's Law pilot program.
At its June 3, 2013 meeting, the Legislation Committee requested that this matter be referred to
Family and Human Services Committee (FHS) for consideration of whether to develop a program
in the Behavioral Health Division of the Health Services Department that would implement
assisted outpatient treatment options here in Contra Costa County.
On July 9, 2013, the Board of Supervisors referred the matter to FHS for consideration.
On January 6, 2015 and January 5, 2016, the Board of Supervisors accepted the staff
recommendation to carry forward FHS Referral #107 Laura's Law to the 2016 FHS Committee.
Referral Update:
On March 10, 2014, FHS accepted the report and recommendations from the Health Services
Department to pilot an Assisted Outpatient Treatment Program.
On October 7, 2014, the Board of Supervisors considered the report from the Health Services
Assisted Outpatient Treatment (AOT) Workgroup. The Board expressed its intention to
implement an involuntary assisted outpatient treatment program, and instructed the County
Administrator’s Office and Health Services Department to provide additional information at a
later Board meeting to ensure no voluntary programs would be reduced as a result of
implementing Laura’s Law.
On February 3, 2015, the Board of Supervisors adopted the recommendations of the Health
Services Department for a program to be developed with stakeholder participation. Additionally,
the Board directed staff to return to the Board for final approval of the program once funding for
the program implementation had been built into the budget.
16
On December 15, 2015, the Health Services Department provided the Board of Supervisors with
an update on the progress of the Assisted Outpatient Treatment Program. The Board approved the
department's recommendation to continue with the program's implementation using $2.25 million
per year of Mental Health Services Act funding, which would not impact the County's General
Fund or reduce the existing voluntary mental health program services. The Board asked that the
department return with an update after six months of the full implementation.
Recommendation(s)/Next Step(s):
ACCEPT the report from the Health Services Department on the implementation of the County's
Assisted Outpatient Treatment Program, as authorized by the Board of Supervisors and AB 1421
(Laura's Law), and forward the report to the Board of Supervisor for approval.
Fiscal Impact (if any):
Mental Health Services Act funding to support the program is contained within the Health
Services Department budget. There is no impact to the County General Fund.
Attachments
AOT Report Feb - Jul 2016
AOT Brochure - Attachment 1
AOT Brochure - Attachment 2
AOT Brochure - Attachment 3
AOT Data Report - Attachment 4
17
18
Contra Costa Behavioral Health Services Interim Report
Assisted Outpatient Treatment Program - Period Covered: February – July 2016
The Contra Costa County (County) Board of Supervisors (BOS) has authorized the program
design and budget to implement Assisted Outpatient Treatment (AOT), and has requested an
interim report after six months of operation.
AOT is civil court ordered treatment for persons with serious and persistent mental illness who
demonstrate resistance to participating in services. The program design incorporated
stakeholder input through a series of workgroup meetings, and consists of a partnership
between, 1) the County’s court system to adjudicate petitions for mandating mental health
treatment, 2) Contra Costa Behavioral Health Services (CCBHS) staff to determine eligibility,
ensure mental health care is provided, and initiate petitions, as appropriate, and, 3) a
community based organization, Mental Health Systems’ ACTiOn Team (MHS) to provide
outreach, engagement and Assertive Community Treatment (ACT) level of care to individuals
referred by CCBHS.
The program officially started on February 1, 2016 by opening a web site with a dedicated
telephone line for referrals, and informing the community with promotional materials and
approximately fifteen presentations to NAMI – Contra Costa, law enforcement agencies, and
service providers that staff were hired, trained, and open for business. (Attachments 1,2,3)
Through the end of July, CCBHS has processed 101 qualified referral requests; 62 of the
requests coming from family members, 16 from law enforcement, 16 from mental health
service providers, and 7 from other sources. Geographical breakdown roughly approximates
the respective populations of East, Central and West Contra Costa County. The rate of requests
has been gradually increasing, with 26 of the requests still in the investigatory process. The
length of time to determine AOT eligibility has ranged from a minimum of two weeks for cases
currently open to CCBHS, to more than six weeks when information has to be obtained
elsewhere. Of the 75 cases where a disposition has been established, 13 have been referred to
MHS for outreach and engagement, 16 are receiving ACT services, and 3 petitions have been
recently filed and are awaiting a first court appearance. 39 individuals were deemed not to be
eligible, with 16 of these individuals connected to other appropriate mental health services, and
one individual incarcerated. (Attachment 4)
The litigation, or court function of AOT, is new and in its early stages. A total of six court
petitions have been filed, with three cases resulting in a settlement agreement where the
individual is voluntarily participating in services, and three petitions have been recently been
filed. The number of petitions filed appear to be low, as CCBHS and MHS staff appear to be
successful in connecting individuals, whether eligible for AOT or not, to either the Adult Mental
Health System of Care, or to Mental Health Systems’ ACTiOn Team, depending upon the acuity
level of their illness. For those AOT petitions that have gone to court, CCBHS staff, County
Counsel, the Public Defender’s Office and Superior Court staff have communicated and worked
well together to benefit and complement the AOT program.
19
The above data reflects a start-up pattern consistent with other large counties who have
implemented AOT; namely, program numbers start slow, accelerate at about the six month
period, and then plateau. Also consistent is low court involvement, with the preponderance of
referred individuals accepting mental health treatment.
CCBHS staff have worked hard to adapt to the role of expeditiously responding to referral
requests, determining eligibility, and ensuring connection to the appropriate next steps;
whether referral to MHS for outreach and engagement, engaging the court process, or ensuring
individuals receive the right type of care, whether they are eligible for AOT or not. Staff report
an increase over time in the quality of information and support supplied by qualified
requestors. This is resulting in a greater rate of appropriate referrals that exhibit acute clinical
need. Reported challenges include managing confidentiality while serving court summons to a
service user in a treatment setting, adapting the original program design to day-to-day
operations, and establishing a computerized data management system specific to AOT.
Mental Health Systems has achieved full staffing capacity to field a multi-disciplinary mobile
team consisting of mental health clinicians, psychiatry, nursing, vocational and housing support,
and peer and family partner providers. They have established a master-leased property that
has the capacity to safely house up to seven non-crisis clients. Staff have undergone extensive
trainings in the ACT model of treatment and various evidence based practices, such as various
assessment tools and Motivational Interviewing. The ACTiOn Team has partnered with Contra
Costa NAMI to develop supportive and collaborative relationships, and has provided a three
part training series to assist family members have a better understanding of ethical, legal and
cultural practices of care providers. Two written testimonials from family members have been
received that attest to both the effectiveness of the care provided, as well as the support they
have received during the process. Reported challenges include clarifying CCBHS’s role as it
affects day-to-day clinical care decision-making by the MHS ACTiOn Team, introducing the ACT
model of care to this County, and housing clients who are not yet ready to safely maintain
themselves in housing that is available.
In March of this year Resource Development Associates (RDA) was authorized to provide an
independent quantitative and qualitative evaluation of Contra Costa’s AOT Program, and to
report on the program’s programmatic and cost effectiveness. Since then RDA, CCBHS and
MHS staff have together identified the data sources, methodology and time line to gather,
analyze and report on the research questions of 1) how faithful are ACT services provided to
the ACT model, 2) what are the outcomes for people who participate in AOT, 3) what are
differences between people who voluntarily participate in AOT versus those who are court
ordered, and 4) what are the differences between those who participate in AOT versus those
who participate in the County’s Full Service Partnership Programs. Recent and planned
activities include a site visit to MHS by RDA in August that utilizes the Dartmouth University ACT
Fidelity scale, collection of agreed upon data by RDA in September, analysis with participating
partners in October, and a full report with data generated in November to CCBHS, the Mental
Health Commission, and the Board of Supervisor’s Family and Human Services Committee.
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Assisted
Outpatient
Treatment
Qualified
Requesters
1430 Willow Pass Road, Suite 100
Concord, CA 94553
925-957-5201
cchealth.org/bhs
You Should Know
Information you provide as a referring
person, such as your identity and personal
information, may not be held as confidential
and could become part of a court record.
As a qualified requesting party you will be
expected to participate, and the process
may require a substantial amount of your
time and effort. The AOT program works
within the parameters of medical privacy
laws to safeguard protected information.
Client information and outcomes may not
be shared with qualified requesting parties
without informed written consent.
In Crisis?
If you are experiencing a life-threaten-
ing emergency, call 911 immediately.
To speak with a trained crisis counselor
about a mental health concern, call
1-888-678-7277
day or night
The AOT Program does not provide mental
health crisis services to the general public.
For more information about the AOT Program,
visit chealth.org/mentalhealth/lauras-law.php21
How to Request Services
Contra Costa Behavioral Health
provides assisted outpatient treatment
(AOT) for persons experiencing
mental illness who meet the criteria
of 2002 California Assembly Bill 1421,
also known as Laura’s Law.
18 or older with a mental illness
Mental health condition worsening
Unlikely to be safe in the
community without supervision
Needs the program to prevent
serious harm to themselves or
others
Has not engaged in offered
treatment
History of resisting mental health
treatment, and
Hospitalized due to mental illness
2 times in the last 36 months, OR
1 or more acts of violence toward
themselves or others in the last
48 months
Program participation would be the
least restrictive option to ensure
recovery and stability
Likely to benefit from participating
If you know someone who meets
ALL these criteria, you can request
AOT services from Contra Costa
County if you are over 18 and are a:
Probation or police officer
Parent, spouse, child or member
of the person’s household
Mental health clinician serving
the person
Director of a facility where
the person is hospitalized or
receiving mental health care
To request AOT services, call
1-844-422-2268.
Making a Request
A clinician will return your call during
business hours. Please be ready to
share details and provide examples
supporting your request.
Your information helps Behavioral Health
Services (BHS) determine if AOT is
appropriate for the person.
Documentation such as prescriptions,
hospital papers or other medical records
will aid the process. Information about
how to locate or contact the person also
helps.
What to Expect
If BHS determines AOT is an appropriate
legal option to pursue, mental health
outreach workers will try to contact the
person and connect them to services,
potentially several times. Voluntary
participation is always the goal.
The clinician may also contact you again
for follow-up information.
BHS will refer the person to appropriate
services within the Mental Health
System.
When a person who needs AOT will not participate, BHS petitions a
Contra Costa Superior Court judge for a private civil hearing. After the
hearing, the judge may require them to participate.22
Assisted
Outpatient
Treatment
For
Clients
1340 Arnold Drive, Suite 200
Martinez, CA 94553
925-957-5201
cchealth.org/bhs
You Should Know
The AOT Program does not provide
mental health crisis services. If you are
experiencing a life-threatening emergency,
call 911 immediately.
In Crisis?
If you are experiencing a life-threatening
emergency, call 911 immediately.
To speak with a trained crisis counselor
about a mental health concern, call 1-888-678-7277 day or night
The AOT Program does not provide mental
health crisis services to the general public.
For more information about the AOT Program,
visit chealth.org/mentalhealth/lauras-law.php
23
How does it work?
What is Assisted Outpatient
Treatment?
Assisted Outpatient Treatment (AOT) is a team-
based support service to help you feel better and
stay safe. A supportive team helps you identify
your needs, helps create a plan for getting those
needs met, and supports you each step of the way.
Who gets AOT?
We offer AOT to people who have had serious things
happen, such as going to Psychiatric Emergency
Services, having a problem with the police or who
may just feel unsafe in the community. We only
offer AOT if we think it can help.
What are the benefits of AOT?
NOBODY wants police, hospitals or courts in your
life. People who participate in AOT are much
less likely to have that kind of problem again.
Also, people who participate in AOT are treated
with respect and make their own choices. While
receiving services, you still live at home and go
where you want. Or, if you need a home, AOT can
work with you to find one.
People who participate in AOT work
with a team of professionals to make
a treatment plan just for them. Plans
address things that can get in the way
of staying safe and healthy. Services
can include:
Help with medication
Access to primary health care
Substance abuse counseling
Mental health treatment
Help with health benefits
Access to supportive housing
programs
Job training
Peer support for you and your
family
Why have I been contacted
about AOT?
Someone recommended that this program might
be helpful to you. Trained support staff from
Contra Costa Behavioral Health will work with
you to decide if AOT is a good fit, or if some other
service might be better for you.
Do I have to pay?
This program is funded through a combination of
the county’s General Fund and the Mental Health
Services Act. All eligible people will be served
regardless of their ability to pay.
What about my privacy?
AOT is confidential. Not even the person who
recommended you will know if you join the program
or any other details about your treatment, unless
you tell someone. You have the opportunity to
include others in your plan if you choose.
What if I do not want help?
AOT works best for people who are willing to
participate. A few of our clients are placed in the
program after a court hearing, because a judge
decides it is very important for them to participate.
The AOT team is mobile and offers flexible hours that make
connecting more convenient for you.24
Assisted
Outpatient
Treatment
Program
Overview
1430 Willow Pass Road, Suite 100
Concord, CA 94553
925-957-5201
cchealth.org/bhs
The Court’s Role
The goal is for eligible individuals
to voluntarily participate in the AOT
Program. However, in cases where a
referred individual will not do so, they will
be summoned to a private civil hearing in
Contra Costa Superior Court.
In this situation, BHS files a petition with
the court, and a judge holds a hearing
that includes the referred individual and
their legal representation, provided by
the Public Defender’s office. After the
hearing, the judge may order the referred
individual to participate in AOT.
In Crisis?
If you are experiencing a
life-threatening emergency,
call 911 immediately.
To speak with a trained crisis counselor
about a mental health concern, call
1-888-678-7277
day or night
For more information about the AOT Program,
visit cchealth.org/mentalhealth/lauras-law.php
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What AOT does
Assisted Outpatient Treatment (AOT) is for
people with severe and persistent mental
illness, who need treatment to prevent
them from getting worse, may pose a risk
to themselves or others, and who usually
decline care or struggle to stay or enroll in
treatment.
For these individuals, Contra Costa
County has adopted Laura’s Law,
which allows counties to use the civil
court system to supervise care.
The court process is only used
after every effort has been made
to encourage individuals who need
treatment to voluntarily participate.
The AOT program is a partnership
between Contra Costa Behavioral
Health Services (BHS), the Superior
Court, the Public Defender’s Office
and Mental Health Systems, a
nonprofit service provider.
Eligible individuals benefit from a
24-hour team response that can
include treatment, medication,
access to primary health care,
substance abuse counseling,
counseling regarding benefits
and other resources, access to
supportive housing services,
vocational rehabilitation, and peer
and family member support.
Participants are either referred to
the program by the court or join
voluntarily. Those who do not meet
all AOT eligibility requirements
are connected with appropriate
behavioral health services.
When a person who needs AOT will not participate, BHS petitions a
Contra Costa Superior Court judge for a private civil hearing. After the
hearing, the judge may require them to participate.
Who is eligible for AOT
An adult with mental illness may qualify for
the AOT program if their mental health is
getting worse, they are unlikely to be safe
in the community without supervision,
and they have a recent history of
hospitalization or violence related to their
mental health.
The program is intended for those who
have previously declined or not engaged
in offered treatment.
For more information about who
qualifies for AOT and who can request
an AOT screening, visit cchealth.org/
mentalhealth/lauras-law.php
How AOT works
A Care Team responds to qualified
requests for AOT screening and supports
those involved, encourages participation in
appropriate mental health care, provides
links to services and engages the person
in the least restrictive care needed.
Eligible individuals receive Assertive
Community Treatment, a nationally
recognized, evidence-based practice.
The ACT team is led by a licensed mental
health clinician and works with clients to
implement individualized treatment plans.26
Assisted Outpatient Treatment Program Data – FEB through JUL 2016 ATTACHMENT 4
Number Percentage County
Demographic
Percentage
Gender Male 59 58 49
Female 42 42 51
Total 101
Region West 28 28 24
Central 46 45 50
East 27 27 26
Total 101
Type of
Qualified
Requestor
Family Members 62 61
Law
Enforcement
16 16
Service Providers 16 16
Other 7 7
Total 101
Outcomes Case opened -
determining AOT
eligibility
26
Referred to MHS
for outreach and
engagement
13
Volunteered for
ACT Services
16
Court Involved
petition pending
3
Connected to
other mental
health services
16
Not eligible for
AOT
26
Incarcerated 1
Total 101
27
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FAMILY AND HUMAN SERVICES COMMITTEE 5.
Meeting Date:09/12/2016
Subject:Referral No. 113 Built Environment and Health in All Policies
Submitted For: FAMILY & HUMAN SERVICES COMMITTEE,
Department:County Administrator
Referral No.: 113
Referral Name: Built Environment and Health in All Policies
Presenter: Daniel Peddycord, Public Health Director; Tracey
Rattray, Community Wellness and Prevention
Program Director
Contact: Enid Mendoza,
(925) 335-1039
Referral History:
The Board of Supervisors referred consideration of the Built Environment Program and Health in
All Policies to the Family and Human Services Committee on May 12, 2015.
On July 20, 2015, the Family and Human Services Committee received a report from the Health
Services Department on this topic, including an update on the Planning and Integration Team for
Community Health (PITCH).
On October 20, 2015, the Board of Supervisors accepted the department's report on Health In All
Policies and the Built Environment Program as recommended by FHS.
On January 5, 2016, the Board of Supervisors accepted the staff recommendation to carry forward
FHS Referral #113 Built Environment Program and Health in All Policies to the 2016 FHS
Committee.
Referral Update:
Please see the attached report for the update on the Built Environment Program and Health in all
Policies.
Recommendation(s)/Next Step(s):
ACCEPT the report from the Health Services Department on Built Environment Program and
Health in All Policies, and forward it to the Board of Supervisors for their information.
Fiscal Impact (if any):
No fiscal impact.
Attachments
29
Attachments
Built Environment Program and Health in All Policies Report
30
• Contra Costa Behavioral Health Services • Contra Costa Emergency Medical Services • Contra Costa Environmental Health •
• Contra Costa Hazardous Materials • Contra Costa Health Plan • Contra Costa Public Health • Contra Costa Regional Medical Ce nter and Health Centers •
W ILLIAM B. W ALKER, M.D.
HEALTH SERVICES DIRECTOR
DAN PEDDYCORD, RN, MPA/HA
DIRECTOR OF PUBLIC HEALTH
Contra Costa
Public Health
597 Center Avenue, Suite 200
Martinez, California 94553
Ph 925-313-6712
Fax 925-313-6721
DANIEL.PEDDYCORD@HSD.CCCOUNTY.US
To: Family and Human Services Committee, Contra Costa Board of Supervisors
From: Daniel Peddycord, Public Health Director
Re: Update on Community Wellness and Prevention Program Activities
Date: September 12, 2016
Background:
During the budget hearings of May 12, 2015 the Board of Supervisors referred consideration of the Built
Environment Program and Health in All Policies to the Family and Human Services Committee. Specifically,
some members of the Board expressed interest in assuring that policy work and policy advocacy occurring
within the Community Wellness and Prevention Program (CWPP) was consistent and in-step with the policy
positions adopted and endorsed by the Board of Supervisors. Board members asked that CWPP not be out
ahead of the Board on policy and that their community advocacy work be cognizant of this sensitivity. The
concern expressed was that coalition building for policy advocacy could lead to CWPP program staff actively
promoting policy positions that the Board had yet to consider, bringing to question the appropriateness of
mobilizing coalitions for this purpose.
On July 20th, 2015 CWPP presented a report on the Built Environment (BE) and Health in All Policies (HIAP) ,
to the Family and Human Service Committee as requested. A report on the Planning and Integration Team
for Community Health (PITCH) was also presented at this meeting. In parallel these reports were also
forwarded through the Finance Committee on September 15th, 2015. Subsequently, these reports were
forwarded to the full Board of Supervisors for consideration on October 20th, 2015. The report on BE and
HIAP, was presented as an on-agenda item with subsequent discussion. Representatives from the City of
San Pablo, the City of Concord and Healthy & Active Before 5 spoke during the presentation on behalf of the
benefits of working with the Community Wellness and Prevention Program, as an extension of the Public
Health Division. The report highlighted funding grants, in the millions of dollars, and technical assistance that
Public Health staff had contributed to the cities being able to receive. In this way, it was noted that the
Public Health Division serves and advises on the Public Health needs for all cities in the County as well as the
unincorporated jurisdiction of the County itself.
This report is intended to be a follow up to the subsequent reports and to summarize the actions taken by
the Public Health Division to address the interest expressed by Board.
31
2
Built Environment:
To help address concerns connected with work that CWPP is doing related to the built environment, land use
and transportation planning, the Public Health Division (PHD) has clarified that CWPP does not have a formal
program called “Built Environment”. CWPP recognized that its web site page related to the built
environment was causing some confusion and may have contributed to the perception that coalition building
and community mobilizing may be in conflict with Board policy or practice. As such the web-site has been
revised, the Built Environment page removed and the program activity is described under the banner of
“Healthy Communities”. PHD leadership has worked with CWPP program staff and management on
awareness of board policy and being sensitive to policy and programmatic work that touches upon the built
environment and land use planning. Keeping Board Offices informed of regional work being done in specific
supervisorial districts has also been emphasized as a key means to help assure alignment with board policy
and board member interest. CWPP also recognizes that the Department of Conservation and Development
(DCD) and parallel Departments within City jurisdictions are the lead agencies on local land use and planning.
To advance an interest in creating Healthy Communities, CWPP works with staff and leaders within the
County and City jurisdictions to advise on policy, organizational change and programmatic activity to advance
the health of communities. These activities typically related to Safe Routes to Schools, Complete Streets and
promoting increased physical activity and healthy nutrition. The Public Health Division recognizes these
critical strategies to help address the epidemics and cost associated with obesity and diabetes.
CWPP’s work in Concord has been communicated to the office of District IV, work connected to the Healthy
and Livable Pittsburg Collaborative has been communicated to the Office of District V, and work being done
in Richmond and San Pablo has been communicated to the Office of District I. Currently CWPP is in
communication with all District offices regarding research for the Let’s Move campaign.
Examples of work related to the unincorporated area of the County
Through the Planning and Integration Team for Community Health (PITCH), in May 2015, CWPP staff
partnered with Public Works for the Active Transportation Program (ATP) Cycle 2 grant program CWPP.
CWPP staff wrote public health sections of two grants for unincorporated Bay Point. The two projects
included closing sidewalk gaps on Pacifica Ave. ($600,000) and a reconfiguration of Bailey Rd/SR 4
interchange to make it safer for cyclists and pedestrians ($4,160,000). These projects were awarded funding
from ATP and included funding for CWPP staff to compliment the street improvement projects with Safe
Routes to School education focused on students at Bay Point schools and with safe driving education
components for commuters driving to and parking at the BART station. Subsequently CWPP partnered with
Public Works on three grant applications for ATP Cycle 3 grant program for street improvements in
unincorporated Walnut Creek, El Sobrante, and Vine Hill. We are awaiting a response from ATP about
whether these grants will be funded.
Examples of Work with Cities
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The City of Concord contracted with CWPP to provide community education, outreach and guidance in the
development of their citywide Bicycle, Pedestrian, and Safe Routes to Transit Plan. This plan, which goes to
Concord City Council in September, 2016, establishes standards for the city, describes a complete bicycle and
pedestrian infrastructure network, prioritizes projects, and will position the city to be more competitive for
receiving grant funding such as ATP and One Bay Area Grant (OBAG) funds.
In addition, CWPP staff are working with staff from the City of San Pablo on several initiatives. CWPP staff are
serving on the Technical Advisory Committee for San Pablo’s Bicycle and Pedestrian Master Plan,
contributing a health-promotion and injury-prevention perspective to the plan. CWPP staff will assist the city
with public outreach, consideration of community input, and recommendations on drafts of the plan. This
plan will position San Pablo to be more competitive for receiving grant funding such as ATP and OBAG funds.
Through the San Pablo Childhood Obesity Prevention Taskforce, CWPP staff responded to the City Council’s
request for input regarding city support for childhood obesity prevention. This resulted in the city allocating
$50,000 to support physical activity programs, new water stations and salad bars in schools. We have also
been working with San Pablo staff to have new park space considered in the options for the development of
the Plaza San Pablo Site. Leaders from the city of San Pablo have noted a need for and have established a
priority to create additional park space for its residents.
CWPP provided community educational workshops and led community outreach to develop a vision for
Rumrill Blvd/13th St in San Pablo/Richmond. The community meetings solicited input from the community
and a design was developed that included a protected walking and bicycling path along the length of much of
the corridor. This information was included in San Pablo’s application to ATP which was awarded $4,310,000
from the regional funds, overseen by the Metropolitan Transportation Commission, in November 2015.
In support of the Healthy and Livable Pittsburg Collaborative, CWPP assisted the City of Pittsburg in writing
an ATP grant to fund a $300,000 Bicycle, Pedestrian, and Safe Routes to School Master Plan. We are waiting
to hear if the grant will receive funding. If the grant is received, the two year planning process will result in a
plan that incorporates community input into the Master Plan and will position Pittsburg to be more
competitive for receiving grant funding such as ATP and OBAG funds.
The amount of fiscal resources, related to advancing health in the built environment, that CWPP has worked
with civic and community partners to achieve is considerable. Since the previous report on CWPP’s work on
the built environment, CWPP staff has assisted in bringing an additional $9,070,000 into the county. When
combined with the $9,865,000 summarized in the previous report, to date, CWPP has assisted in bringing
$18,935,000 into Contra Costa County unincorporated areas and cities for health promoting transportation
projects.
Health in All Policies
As noted in the report of July 20, 2015, Health in All Policies (HIAP) is a concept that recognizes that our
health, and to a great extent our health behaviors, are strongly influenced and shaped by the built
environment, as well as by organizational practices and policies in the places where we live, work, learn and
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play. As such, the concept of HIAP encourages us to give consideration to the health implications, as well as
opportunities, to improve and protect our health in virtually every public and organizational policy decision
that we make.
To help assure that CWPP staff were acting in concert with the interest and concerns of the Board of
Supervisors, the Public Health Division sought to better align the work that CWPP is doing in the arena of
policy and organizational change with the County’s annual State Legislative Platform. Specifically the PHD
asked the Board to support funding and policy aimed at population-based chronic disease prevention efforts
to advance a policy, systems and organizational-change approach to addressing the underlying
environmental factors and conditions that influence health and health behaviors. Additionally the PHD asked
the Board to support efforts to advance a HIAP approach to work across the County. Lastly, the PHD asked
the Board to consider supporting ongoing study of the health impacts of global and regional climate change
and to support ongoing countywide mitigation efforts. All three of these recommendations were endorsed
by the Board of Supervisors and added to the 2016 State Legislative Platform. In addition, as CWPP or any
Public Health staff are asked to address a specific state or national policy, the Public Health Division is
working with the CAO’s office to affirm the County’s Official position and to assure that staff comments and
actions are consistent with that of the Board.
Examples of work with County, Cities and Community Partners:
Tobacco Prevention Policies: The Public Health Director (PHD) and CWPP staff recently presented fifteen
tobacco control and prevention policy options to reduce youth access to tobacco to the Board of Supervisors.
The Board endorsed all of the recommendations and directed the Public Health Division to return with a
revised County Ordinance for further consideration. The PHD plans to present this to the full Board in the fall
of 2016. In addition, the Board of Supervisors endorsed Prop 56 a "Cigarette Tax to Fund Healthcare, Tobacco
Use Prevention, Research, and Law Enforcement Initiative Constitutional Amendment and Statute." These
examples serve as an illustration of the Board’s long standing support for protecting youth from exposure to
tobacco products, noting that over 90% of all adult smokers were introduced to tobacco use as minors.
CWPP staff connected with Tobacco Prevention will be working with City leaders and staff to promote
consideration of policies to advance tobacco prevention.
Promoting Physical Activity: CWPP and community partners, including Monument Impact, First 5 Contra
Costa, and the Central County Regional Group, developed and administered surveys of park conditions in the
City of Concord. The results were reviewed together with community partners and a series of recommended
improvements were developed. The team then presented these recommendations to the Concord Parks,
Recreation, and Open Space Commission and City Council. In response, the City of Concord allocated
$945,000 in park renovations to Ellis Lake and Meadow Homes Parks (the two priority parks from the
assessment), including new bathrooms, new play structures, upgraded walkways, improved lighting, and
improved shading. Sources of this funding included East Bay Regional Measure WW and City of Concord
Measure Q funding.
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CWPP staff in partnership with Monument Impact, First 5 Contra Costa, Central County Regional Group,
Healthy and Active Before 5, County Connection and the City of Concord, led a walk audit of Detroit Ave,
which resulted in a successful OBAG application for $2,200,000 (noted in CWPP’s previous report), which
paid for bicycle lanes, sidewalk gap closures, improved intersections, and improve transit stops. Construction
was completed in 2016.
CWPP was requested by a parent group at Cambridge Elementary in Concord to host a walk audit to assess
walking conditions around the school. CWPP performed the walk audit in November 2015, which District IV
staff attended. Follow up meetings with parents, school staff, and Concord Police Department helped refine
the parents’ vision and created priorities, which were shared with city transportation staff. City staff is
investigating funding opportunities for improvements.
Another example is CWPP’s technical and research assistance to support First 5 Contra Costa and the West
County Regional Group, working in close collaboration with the City of San Pablo, for park improvements,
identifying funding sources for parks, and identifying locations in the city for new park space.
CWPP continues to provide staff support for the Healthy and Livable Pittsburg Collaborative (HLPC) which
includes staffing meetings, administering the project, and grant writing assistance to community agencies
that are working to promote healthy eating and active living in the city. HLPC partners, which include staff
from the City of Pittsburg and District V Supervisor’s office, are particularly interested in exploring improving
food access, park improvements, promoting walking and cycling, establishing community gardens and
working with the city on their efforts to create safer streets.
In addition, CWPP staff are providing technical assistance to all jurisdictions in the County who are interested
in the Obama Administration’s Let’s Move Campaign.
In Summary:
While CWPP continues to work in the arena of policy, systems and organizational change, it does so with a
better appreciation for assuring that its work is consistent with and informed by the policy interest and
official position of the Board of Supervisors. In parallel, while CWPP continues to participate on various
committees and collations it does so with respect for and intention to be consistent and in-step with board
policy. Even if the request is generated by a City, School, Parks District or a community group, CWPP
appreciates that policy makers are elected to consider and adopt policy and to represent the public’s or
organizational interest, and that as public employees we must be sensitive to and respectful of this process.
Finally, CWPP appreciates that it’s role is not to self-generate community coalitions to advance its
programmatic interest but rather to participate, offering technical assistance, and/or as formally endorsed by
the Board of Supervisors.
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FAMILY AND HUMAN SERVICES COMMITTEE 6.
Meeting Date:09/12/2016
Subject:Rerferral No. 44 Challenges for EHSD - Continuum of Care: Foster Care
Submitted For: FAMILY & HUMAN SERVICES COMMITTEE,
Department:County Administrator
Referral No.: 44
Referral Name: Challenges for EHSD - Continuum of Care Reform
Presenter: Kathy Gallagher, Employment and Human
Services Director
Contact: Enid Mendoza, (925)
335-1039
Referral History:
This referral to the Family and Human Services Committee (FHS) was originally made by the
Board of Supervisors on April 25, 2000. Another referral, number 19, on Welfare Reform was
referred on January 21, 1997. On January 1, 2005, the Board of Supervisors combined these two
referrals so that the Department could provide updates on various aspects of their programs as the
need arose. Since that time, the Family and Human Services Committee has received annual
updates from the Employment and Human Services Department on a variety of issues impacting
the Department.
On January 5, 2016, the Board approved the staff recommendation to carry forward this referral to
the 2016 FHS. On June 7, 2016, the Board approved the recommendation of the Employment and
Human Services Director to eliminate the "Office of the Future" component of the referral and
expand the referral to include a report on the Continuum of Care (Foster Care) topic.
Referral Update:
Please see the attached report from the Employment and Human Services Department.
Recommendation(s)/Next Step(s):
ACCEPT the report from the Employment and Human Services Department on the foster care
Continuum of Care Reform and forward it to the Board of Supervisors for their information.
Fiscal Impact (if any):
No fiscal impact.
Attachments
Continuum of Care - Foster Care Presentation
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CALIFORNIA’SCHILDWELFARECONTINUUM OFCAREREFORM(CCR)OVERVIEWSEPTEMBER12, 201639
A comprehensive framework that supports children, youth and families across placement settings in achieving permanency.CCR includes:oIncreased engagement with children, youth and familiesoIncreased capacity for home‐based family careoLimited use of group home careoChanges in rates, training, accreditation, mental health services and accountability & performanceWHAT IS THECONTINUUM OFCAREREFORM?40
BACKGROUNDLegislatively mandated by AB 403Builds on previous reform effortsProvides the statutory and policy framework to promote services and supports provided to the child or youth41
VISIONAll children live with a committed, permanent and nurturing family Individualized and coordinated services and supports Focus on permanent family and preparation for successful adulthoodGroup Home care, when needed, is a short‐term, high quality, intensive intervention that is just one part of a continuum of care available for children, youth and young adults42
Group HomeShort Term Residential Treatment Program (STRTP)Children who cannot be safely placed in a family can receive short‐term, residential care with specific care plans and intensive therapeutic interventions and services to support their transition to a family.THEPARADIGMSHIFT43
Resource FamilyRelative CaregiverFoster Family Adoptive FamilyResource Family Approval (RFA):•A new process for licensing foster homes and approving relatives•Single, unified RFA process that will be used for all caregiver families: Kin, Non Related Extended Family Members (NREFM), licensed foster families, and FFA foster familiesFoster Families/Relatives Resource Families44
RESOURCEFAMILYAPPROVAL(RFA) PROCESSHighlights of new RFA process effective 01/01/17:•More comprehensive in‐depth background checks and training requirements for all caregiver families, including a psychosocial assessment•Once approved, families do not need an adoption home study to adopt a child in their care•Existing homes to be transitioned to RFA homes over the next two years45
INCREASEDENGAGEMENTChild & Family Team(CFT)Up‐front and continuing assessment that includes youth, family and others that are deemed important to the youth and family to provide input on the supports, services, and placement needed by the youth and family46
CORESERVICESShort Term Residential Treatment Programs (STRTP) and Foster Family Agencies (FFA) must make available core services:Access to specialty mental health services Transitional support services for placement changes, permanency, aftercareEducation, physical, behavioral and mental health supportsActivities to support youth achieving a successful adulthoodServices to achieve permanency & maintain/establish family connectionsActive efforts for Indian Child Welfare Act (ICWA) ‐Eligible children47
OVERSIGHT& ACCOUNTABILITYNational Accreditation of STRTPs and FFAsCross Departmental Oversight FrameworkEvaluate provider performance along common domains developed by the StateYouth, caregiver and stakeholder satisfaction surveysPublic transparency of provider performance48
NEWPROVIDERRATESTRUCTUREOne rate for Short‐Term Residential Therapeutic Program settingsA tiered rate structure for Home Based Family Care based on the level of care to be provided by Resource FamiliesNew rates begins 1/1/1749
IMPLICATIONS FORCONTRACOSTACOUNTYContra Costa County has 107 dependent children in Group Home placements (approximately 10%) placed throughout 50 different group homes Currently there are approximately 260 licensed homes and 250 approved relative homesCCC will need additional Resource Family Homes able and willing to take children stepping down from Group Homes (STRTPs) 50
CONTRACOSTACOUNTYPLACEMENTSSILP6%Foster Family Home16%Relative/NREFM27%Foster Family Agency28%Group Home9%Guardian Home (voluntary)13%Guardian Home (dependent)1%Group Homes and FFA’s will require National Accreditation and Group Homes will convert to STRTPs43% of placements will convert (over 2 years) to Resource Family Homes51
CHALLENGES AHEAD FORCCCMental Health Services CollaborationIncreased expectations of services with insufficient fundingRecruiting Foster Families Increase community awareness of need for caregivers and the specific needs of our youthIncreased training needed for caregiversBased on high needs youth who will be transitioning to home based carePayment RatesRestructured rates need to sufficiently account for higher, more intensive levels of services provided by caregivers52
THEWORKSubmitted CCC’s Resource Family ApprovalImplementation plan to CDSSBegun reviewing all youth in Group Home Care to assess the service and support needs to move to a Resource Family PlacementCreated a CCR Leadership Team consisting of EHSD Agency Director, Behavioral Health Director, and Chief Probation Officer and Chief Assistant CAOInitiated Work Groups comprised of staff from CWS, BH, and Probation to focus on the implementation strategies for:‐Child & Family Teams‐Resource Family Approval‐Group Home/Foster Family Agencies/ Behavioral Health‐Training‐Communication‐DataEHSD has…Created a Steering Committee consisting of the CFS Director, Children’s Behavioral Health Manager, Probation Manager, Parent Partner, and Youth Partner53
VisionLegislationPolicySystem ChangesPractice ChangesThis will require:•Cross department collaboration (CFS, Behavioral Health, Probation) •Up front investments•Increase communication with community members regarding needs for quality Resource Families•Time to build capacity at the local level to support children & youth in home based careIT’SAPROCESS…54
LOOKINGAHEAD“The goal for all children in foster care is normalcy in development while establishing permanent life‐long family relationships. Therefore, children should not remain in a group living environment for long periods of time”“All children deserve to live with a committed, nurturing, and permanent family that prepares youth for a successful transition into adulthood.”55
QUESTIONS ANDANSWERS56