HomeMy WebLinkAboutBOARD STANDING COMMITTEES - 11132017 - FHS Agenda PktFAMILY & HUMAN SERVICES
COMMITTEE
November 13, 2017
10:30 A.M.
651 Pine Street, Room 101, Martinez
Supervisor John Gioia, Chair
Supervisor Candace Andersen, 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 accepting the report from the Employment and Human Services
Department on the use of technology for client services and directing staff to forward the
report to the Board of Supervisors for their information. (Kathy Gallagher, EHSD
Director; Michael Roetzer, EHSD Director of Administrative Services)
4.CONSIDER accepting the report from the Health Services Department on needle
exchange prevention as part of a comprehensive approach to reduce transmission of HIV
in Contra Costa County and directing staff to forward the report the Board of Supervisor
for their information. (Jessica Osorio, HIV/AIDS and STD Deputy Director)
5.CONSIDER accepting the annual report on the implementation of the Secondhand
Smoke Protections Ordinance, accepting the draft Smokefree Multi-unit Residences
Ordinance as recommended by the Health Services Department, and directing staff to
forward the draft ordinance to the Board of Supervisors for introduction and adoption.
(Daniel Peddycord, Public Health Director; Denice Dennis, Tobacco Prevention
Program Manager)
6.CONSIDER accepting the staff recommendations to carry forward twenty referrals and
eliminate one referral for the 2018 Family and Human Services Committee. (Enid
Mendoza, Senior Deputy County Administrator)
7.The next meeting will be scheduled for February 2018.
8.Adjourn
F&HS Agenda Packet Page 1
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
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
F&HS Agenda Packet Page 2
FAMILY AND HUMAN SERVICES COMMITTEE - Special
Meeting 3.
Meeting Date:11/13/2017
Subject:Report on the Impacts of Technology on Access to Public Benefits
Submitted For: FAMILY & HUMAN SERVICES COMMITTEE,
Department:County Administrator
Referral No.: 114
Referral Name: Impact of Technology on Access to Public Benefits
Presenter: Kathy Gallagher, EHSD Director; Michael
Roetzer, EHSD Administrative Services
Director
Contact: Enid Mendoza,
(925) 335-1039
Referral History:
On June 7, 2016, the Board of Supervisors approved the Employment and Human Services
Director's recommendation to refer oversight on the impacts of technology on access to public
benefits to the Family and Human Services Committee (F&HS), due to the department's
reworking of its business processes and development of technologies to make remote access of
public benefits more common for its clients. This became F&HS Referral No. 114.
This is the second report to F&HS on this referral.
Referral Update:
Please see the attached report from the Employment and Human Services Department with an
update on the Department's use of technology to support client services and staff efficiencies.
Recommendation(s)/Next Step(s):
ACCEPT the report from the Employment and Human Services Department on the use of
technology for client services and DIRECT staff to forward the report to the Board of Supervisors
for their information.
Fiscal Impact (if any):
There is no fiscal impact, the report is informational.
Attachments
Report on the Impacts of Technology
Impacts of Technology - Presentation Slides
F&HS Agenda Packet Page 3
1
40 Douglas Drive, Martinez, CA 94553 • 925.608.5000 • Fax (925) 313-1575 • www.ehsd.org
To: Family and Human Services Committee Date: November 13, 2017
From: Employment and Human Services Department
Subject: #114 Serving the Public Through Technology
The Employment and Human Services Department (EHSD) is pleased to again provide an update to the Family
and Human Services Committee (FHS) on the use of technology and our technology vision for the department.
We continue to offer an array of services and press forward with new applications of technology that support our
customers and staff.
STATE AND DEPARTMENT-WIDE SYSTEMS
EHSD uses multiple state mandated and managed systems to carry out its core functions:
Contra Costa County is one of 18 counties in the California Work Opportunity and Responsibility to Kids
Information Network (CalWIN) Consortium. CalWIN is an automated eligibility system that supports the
administration of public assistance programs including CalWORKs, CalFresh, Medi-Cal, General
Assistance, Foster Care and case management for Employment Services.
We also use the Child Welfare Services/Case Management System (CWS/CMS) to support child welfare
services.
The Medi-Cal Eligibility Data System (MEDS) is a data system for maintaining eligibility information for
public assistance programs including Medi-Cal.
Our In-Home Supportive Services (IHSS) is managed through the Case Management Information and
Payrolling System II (CMIPS II), a statewide database which supports and centrally processes payroll as
well as assisting with case management and reports.
Electronic Benefit Transfer (EBT) is a state debit card similar to an ATM card that is used to issue CalFresh
and cash aid benefits for CalWORKs and General Assistance. This system interfaces with CalWIN.
The newest statewide system is the California Health Eligibility, Enrollment, and Retention System
(CalHEERS), a business rules engine to determine eligibility for coverage under the Affordable Care Act
(ADA).
While not a state mandated system, EHSD is “paperless” for its public assistance program case records through
the use of a document imaging and management system called Compass Pilot. The use of this system allows
desktop and mobile access to case information and customer data for any EHSD staff with a need to access the
data.
M E M O R A N D U M
Kathy Gallagher, Director
F&HS Agenda Packet Page 4
Page 2
EHSD recently went “paperless” in our In-Home Supportive Services (IHSS) Program. All records of current
providers and those receiving IHSS services have been scanned into the Compass Pilot system and are now
maintained electronically. New documents and cases are immediately scanned and indexed into the system so
that they are available to all IHSS staff that needs them. This has also enhanced our ability to provide mobile
access for our Social Workers as they make mandated home visits. Our staff has on line access to case records
and is able to complete fillable forms on their mobile devices while they are in the home.
In addition to the state systems and systems for which EHSD has contracted, we also use our internal technology
staff to develop applications to assist staff to carry out our work more efficiently. As we will discuss in this report,
some of these in-house developed programs also greatly benefit our customers.
USING TECHNOLOGY IS SECOND NATURE IN EHSD
The EHSD has a long tradition of using technology to carry out its business. In 2005 the State rolled out CalWIN as
the electronic system to replace paper processes for our benefits programs. In that same year, EHSD opened its
first Call Center in Antioch and went paperless by contracting for an electronic records management system and
scanning our paper records into the system.
EHSD has major buildings throughout the County and our customers come from all areas of the County. The
ability for our workers to access customer records, quickly and accurately was a major factor in our drive to be
paperless. Using electronic records allows EHSD staff to access case records at any and all locations where the
customer is being served. We work to keep ahead of technology through the active participation of our senior
managers that meet to discuss and approve technology projects. We also have a technology strategic plan that
guides us in pursuing technology. Finally, we ask our customers what technology they would like to see that will
allow them to interact with us on their schedule from a location of their choice.
The use of technology fully supports the EHSD Vision, Mission and Values. The department’s long range
technology vision states: “EHSD technology is the leader in agile technology capabilities, interoperability and
information sharing for empowering customers, staff and partners to achieve a healthy, safe, secure and self-
sufficient community.” Our technology goals over the next 3-5 years focus on strategies that include:
Customer facing technology
Customer support using technology
Productivity enhancements
Pursuing innovation and ideas for internal and external customer service including processes for bringing
ideas forward
INITIATIVES UNDERWAY OR PLANNED
The California Department of Social Services (CDSS) just concluded a management evaluation of our CalFresh
program. The experienced state evaluators conduct these evaluations throughout the state and visit many social
services offices. The evaluation team visited three EHSD customer service offices to observe our processes in
real-time and to see what our customers experience. At the conclusion of their evaluation, and based on their
observations, they were extremely complimentary about the technology that is available to our customers. Our
customers are greeted by a Greeter asking how we can help them. If appropriate, they are referred to a kiosk to
get a ticket so they can gauge when they will be seen. We provide computer work stations that allow them to
apply for benefits, check their case status, print documents or scan documents. There is a copier in the event the
customer needs to make copies of documents. We have large monitors in the reception areas that provide
information and let the customers know when they will be seen. We also provide a self-scanning kiosk that
allows customers to scan their own documents, get a receipt and leave. There are also phones for the customers
to use to directly contact their worker for any issues about their benefits. The CDSS evaluators stated that they
F&HS Agenda Packet Page 5
Page 3
sometimes see one or two pieces of technology in a typical customer reception area but not the extent of
technology we deploy to directly serve customers.
We recently added a dedicated monitor in our interview areas that allows our customers to see documents that
apply to their case as they are filled out so they can verify the information as it is entered. The customers can
sign the documents electronically so they are complete without printing them. After the documents are
complete and signed, they are moved electronically into our document management system. This greatly speeds
benefits processing, ensures the accuracy of information and gets benefits to the customers faster.
As stated earlier, our staff works with multiple systems with the potential to need information from three
systems at the same time to fully assist our customers. Having the ability to display case information greatly
assists our workers to assist our customers. We identified specific workers, based on a business need, and
installed an additional monitor for their use. Having three monitors is a productivity enhancer and provides a
higher level of customer service.
We know from our customer surveys that about 95% of our customers have smart phones. Our customers have
told us that they want to be kept informed about appointments and other information about their cases. We
have been using text messages for our CalWORKs and CalFresh customers and we are looking at expanding the
use of text messages in other programs. We have nearly 26,000 customers that have opted-in to receive text
messages. We have moved to an “opt-out” process that will allow us to reach many more customers. Using text
messages greatly assists our customers with reminders and helps them continue to receive their benefits.
With our knowledge that our customers, along with most of the rest of us, rely heavily on smart devices for their
daily lives, we are currently piloting phone a charging station at one of our large offices to ensure our customers
have the capability to communicate with us. Reports are that the charging station is heavily used. If this pilot is
successful, we plan to add charging stations at all our major offices.
The Board of Supervisors fully supported the state legislation that allows Social Services agencies to donate
surplus personal computers to citizens in good standing in benefits programs. EHSD has an agreement with a
nonprofit organization to refurbish surplus computers and make the computers, along with an Internet
connection, training and support available to our customers. To date over 209 families have used this program
and we have an additional 65 families in the pipeline to receive a computer. We are taking steps to do additional
publicity for this program and expect to see increased activity. This program can be instrumental in helping low
income residents of Contra Costa County bridge the digital divide, help children with school work, help our
customers locate and apply for jobs, and get medical information. Our data collection shows that our customers
in West County have the lowest number of personal computers in their homes. We are working on an initiative
to reach out to our customers in West County about the availability of these personal computers and how to get
one.
My Benefits CalWIN (MyBCW) is a website that provides information on assistance programs, allows people to
apply for benefits, complete periodic reporting, find a social services office in their area, and for current
customers to check on their benefits from wherever they are and at any time. Access to MyBCW is also available
through the EHSD website. We are using text messages and other media to encourage customers not having a
MyBCW account to get one. This portal is a great convenience and timesaver for our customers and allows them
to avoid having to call or visit an office.
EHSD works closely with Health Services, the Food Bank and other community based organizations on their
efforts to use MyBCW to assist citizens to apply for benefits. These organizations provide additional portals that
allow for applications to be submitted from additional locations within the county.
F&HS Agenda Packet Page 6
Page 4
We have fully implemented our Workload Distribution Tool (WDT). When our customers interact with us, this
interaction frequently requires our workers to take actions or process documents. The WDT software allows us
to collect, distribute, and track workload in our major programs. This software allows workers and managers to
see and manage work more efficiently and effectively to meet processing timelines and provide data in near real
time. The WDT is a major step forward in customer service ensuring transactions are processed quickly and
efficiently and speeding up the granting or continuance of benefits.
We successfully completed the pilot of an initiative to allow our customers to complete their periodic
recertification interviews using video conferencing from an EHSD office. The pilot included English and Spanish
and a touch screen monitor for ease of use. Customers can easily sign documents right on the computer screen.
We are expanding this service to all our offices to allow our customers to video conference from anywhere
including their homes. We are also working with the contractor that provides translation services to offer
translation via video conferencing, including American Sign Language for our deaf, mute, and non-English
speaking customers.
We recently launched a pilot project of using our own bi-lingual Spanish speaking clerical staff to provide
interpretation services to our Spanish speaking customers. We have about 35 such staff and before we contact
an outside contractor, we locate one of our employees to interpret the interaction between the worker and
customer. This speeds up the interaction and provides a higher level of customer service because our staff is
familiar with the issues that are being discussed.
The State centralized the payroll process for our over 9,200 In-Home Supportive Services (IHSS) care providers.
However, we continue to field questions from our providers. We use an Interactive Voice Response (IVR) system
that provides virtual real time information on the status of their pay. The IVR allows care providers to obtain
information from any phone at any time.
The Community Services Bureau deployed the CLOUDS Interactive Texting (SMS) service to contact clients,
including automated SMS messages to families requesting absent child information, a Federal and State
requirement for Child Care programs. This unique system guarantees our child care program complies with this
mandate, whereas previously all parent contacts were manually done by staff.
The Community Services Bureau is currently testing/piloting the CLOUDS Mobile App for its Alternative Payments
Program clients and providers. This app will address client concerns regarding Case and Provider Reimbursement
Status, while also providing a direct, two way communication approaches between case managers, clients and
providers.
Among the benefits of this technology is the ability of clients and providers to utilize electronic forms and
attendance sheets as well as mobile scanning and drastically reducing the amount of time and labor, data entry
and time required by staff to efficiently manage their caseloads. Another benefit of Electronic Attendance sheets
is to allow the system to automate reimbursement calculations, according to child care contracts, and attendance
inconsistency notifications.
EHSD has a goal of being a data driven organization and having immediate access to data from the programs we
administer is critical. Our managers and supervisors need program performance information to facilitate decision
making and enhance our ability to provide superior customer service. We are currently working on two tracks to
provide quick access to information described collectively as Business Intelligence (BI). The two tracks include:
EHSD and Santa Clara County Social Services collaborated on a CSAC Merit Award winning project to
build on an in-house custom solution developed by Santa Clara. The collaboration gives EHSD access to
the information in EHSD’s systems of record (CalWIN, CMIPS II, CWS/CMS) quickly and easily without the
need to develop our own in-house BI or engage our Technology staff in designing custom reports. This is
F&HS Agenda Packet Page 7
Page 5
a highly successful collaboration that continues on. It allowed EHSD to gain data much quicker and at
less cost than would otherwise have been possible.
EHSD, through our participation in the CalWIN consortium, has partnered with other CalWIN counties to
support the CalWIN BI initiative. This system provides an additional opportunity to capture data on our
major benefits programs.
The data available in the BI systems provide our directors, managers and supervisors access to timely and
accurate information about who our clients are, e.g., where they live, demographics, case status, and trending
and forecasting, and overall program compliance. The programs supported include, IHSS, Medi-Cal, CalFresh,
General Assistance, CalWORKs and Child Welfare.
EHSD is updating and replacing a number of internal programs to assist with timekeeping, position management
and tracking, a personnel management data base, fiscal management and retrieval of policies, regulations and
reference materials.
Our department is committed to making effective use of technology to provide our customers with a good
experience and to assist our staff in carrying out their important work. We actively pursue new or better uses of
technology that have been proven to work. Based on feedback from our customers, we continue to work toward
providing multiple portals for our customers to apply for and receive benefits under the programs we administer
while substantially reducing the need to come into one of our offices.
F&HS Agenda Packet Page 8
Serving the
Public Through
Technology
F&HS Agenda Packet Page 9
STATEAND DEPARTMENT-
WIDE SYSTEMS
State Systems Drive Business Operations
Electronic Records Management
Call Centers
Workload Distribution Tool
Continued Recognition from State
Evaluators
F&HS Agenda Packet Page 10
Customer Experience
Greeter
Sign in Kiosk
Self-Scanning Kiosk
Customer PC with copier, scanner, printer
Information Monitor
Phones, Charging Stations
Electronic forms review and signature
F&HS Agenda Packet Page 11
Remote Services
MyBCW lets customers apply for benefits
or check on case 24/7 from smart
devices/PC
CSB interactive texting
IHSS Interactive Voice Response
Video Conferencing
→→
CUSTOMERVIDEOEHSD
F&HS Agenda Packet Page 12
Data and Technology
EHSD/Santa Clara award winning collaboration
Utilize more data to manage customer services,
community outreach
Technology streamlines staff and customer
experience
Continue customer surveys while adding high
tech enhancements
F&HS Agenda Packet Page 13
EHSD Technology Vision
Customer facing technology
Customer support using technology
Productivity enhancements
Pursuing innovation for internal and
external customer service
F&HS Agenda Packet Page 14
FAMILY AND HUMAN SERVICES COMMITTEE -
Special Meeting 4.
Meeting Date:11/13/2017
Subject:HIV Prevention / Needle Exchange Program Biannual Report
Submitted For: FAMILY & HUMAN SERVICES COMMITTEE,
Department:County Administrator
Referral No.: 61
Referral Name: HIV Prevention / Needle Exchange Program
Presenter: Jessica Osorio, HIV/AIDS and STD
Deputy Director
Contact: Enid Mendoza, (925)
335-1039
Referral History:
The HIV Prevention/Needle Exchange program was referred to the Family and Human Services
Committee (F&HS) in October 2002. The issue was discussed four times during 2003 and was
subsequently closed. The referral was then re-opened on January 4, 2005 for annual reports to
F&HS.
During the December 18, 2014 F&HS meeting, Health Services Department staff were directed to
begin reporting to F&HS bi-annually regarding Referral #61 - HIV Prevention/Needle Exchange
Program and to submit a report directly to the Board of Supervisor in the intervening years. On
December 14, 2015 F&HS received a report on the program and recognized the incidents of HIV
and AIDS has significantly decreased. Therefore, F&HS felt that a bi-annual report to the
Committee was sufficient. The Committee also advised staff to return to them at any time should
the exposure data significantly change.
Referral Update:
Please see the attached report for an update on needle exchange prevention and services.
Recommendation(s)/Next Step(s):
ACCEPT the Report from the Health Services Department on needle exchange prevention as part
of a comprehensive approach to reduce transmission of HIV in Contra Costa County and
DIRECT staff to forward the report to the Board of Supervisors for their information.
Fiscal Impact (if any):
There is no fiscal impact, the report is informational.
Attachments
F&HS Agenda Packet Page 15
Needle Exchange Report
F&HS Agenda Packet Page 16
RECOMMENDATIONS
1) Accept this report on needle exchange as part of the comprehensive prevention
program to reduce transmission of HIV in Contra Costa County.
2) Direct the Health Services Department to continue supporting and monitoring
needle exchange services.
SUMMARY
In 2006, the Contra Costa Board of Supervisors:
• Terminated the local State of Emergency first declared on December 14, 1999;
• Authorized the Health Services Department to administer a clean needle and
syringe exchange project pursuant to Health and Safety Code section 121349 et
seq; and
• Directed the Health Services Director to annually report to the Board on the
status of the clean needle and syringe exchange project.
This report satisfies State regulatory requirements to maintain needle exchange services
in Contra Costa.
As of December 2016, 2,614 individuals are living with HIV or AIDS in Contra Costa.
Between 2014 and 2016, the percentage of people living with HIV and identifying
injection drug use (IDU) as the mode of transmission has dropped from 10% of all
those living with HIV to 8%. While the percentage of those newly infected with HIV in
2016 identifying IDU as the mode of transmission increased marginally (2% in 2014 to
3% in 2016), the total numbers remain small (4 individuals newly diagnosed in 2016
attribute their infection to IDU).
Needle exchange services are provided under a contract with HIV Education and
Prevention Project of Alameda County (HEPPAC). The Health Department continues to
provide $54,000 in County General Funds annually to support the weekly operation of
needle exchange services in West and East County. While there has been a drop in the
number of individuals served, there has been an increase in referrals to health and
supportive services this past fiscal year.
Neither needle exchange nor legislative changes allowing pharmacies to dispense
syringes without a prescription have had any apparent negative effect on residents,
businesses or law enforcement in Contra Costa. The availability of needle exchange as
part of a comprehensive continuum of services for injection drug users continues to be
a necessary public health measure to reduce transmission of blood borne diseases in
Contra Costa.
F&HS Agenda Packet Page 17
BACKGROUND ON ACCESS TO CLEAN NEEDLES TO REDUCE TRANSMISSION
The California Department of Public Health (CDPH) reports that of the 128,415 people
living with HIV/AIDS in California in 2015, 13% identified their risk for HIV as injection
drug use (IDU).1 Further, the CDPH Office of Viral Hepatitis estimates that at least
60% of Hepatitis C Virus (HCV) infections in the state are associated with injection drug
use. Lack of access to new, sterile injection equipment is one of the primary risk factors
that may lead to sharing of hypodermic needles and syringes, which puts people who
inject drugs at high risk for HIV, HCV, and Hepatitis B infection.2
Needle exchange has been an essential component of Contra Costa’s strategy to reduce
the transmission of HIV attributed to Injection Drug Use (IDU) since 1999, when the
program operated under the Board’s declaration of a State of Emergency to authorize
needle exchange services. Health and Safety Code Section 121349.3 removed the
requirement for a Declaration of Emergency and current regulations now require only
that needle exchange information be provided at an open meeting of the authorizing
body every two years.
From 2005-2010, Contra Costa participated in a statewide Disease Prevention
Demonstration Project (DPDP) to assess the potential to reduce transmission of HIV by
increasing access to sterile needles and syringes. The project evaluation showed lower
injection-related risks among people who inject drugs in those counties with syringe
exchange programs. Additionally, evaluators of the pilot project found lower levels of
unsafe discard of used syringes, no increase in the rate of accidental needle-stick
injuries to law enforcement and no increase in rates of drug use or drug-related crime.3
As a result of the success of the DPDP, 2011 legislation expanded syringe access
through pharmacies throughout the state. Assembly Bill (AB) 1743 (Ting, Chapter 331,
Statutes of 2014) further expanded access in January 2015 by allowing customers to
purchase and possess an unlimited number of syringes. Participating pharmacies must
provide counseling and offer information on safe disposal.
REDUCING TRANSMISSION OF DISEASE
As of December 31, 2016 there were 2,614 individuals reported living with HIV or AIDS
(PLW H/A) in Contra Costa. Roughly 35.5% reside in Central County, 33.7% in West
County, and 30.7% in East County.4
1 https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/California%20HIV%20Surveillance%20Report%20-
%202015%20(Final%20Version%20Submitted%20for%20Approval).pdf
2 https://cchealth.org/aids/pdf/Legislation-and-Requirements.pdf 3 The full report of the evaluation can be accessed on the California Department of Public Health, Office of AIDS website
http://www.cdph.ca.gov/programs/Documents/SB1159StateReportFinal.pdf - 4 Data Use Agreement (DUA) Q2 2017
F&HS Agenda Packet Page 18
Chart 1: Distribution of all PLWHA by Region in Contra Costa as of 12/31/2016
Of all PLWH/A in Contra Costa, 343 individuals (13%) identify injection drug use or
injection drug use among men who have sex with other men as their mode of
transmission.5 The majority of those identifying injection drug use transmission are in
the West and Central areas of the county,
Chart 2: Distribution of all PLWHA Attributing Infection to Injection Drug Use in
Contra Costa by Region as of 12/31/2016
5 Data from 2016 Data Use Agreement (DUA) Data, Q2 2017.
14%
n=95
16%
n=116
14%
n=131
n=343
Central County
East County
West County
33.70%
35.50%
30.70%
West
Central
East
F&HS Agenda Packet Page 19
Chart 3: Mode of Transmission as Percentage of all PLWHA by Region in
Contra Costa in 2016
The number of new HIV infections occurring over the last 3 years (Chart 4) has
increased slightly, averaging 106 new HIV cases per year. A State change in residency
definitions in 2016, coupled with better clinical risk assessments and a move toward
more routine testing for HIV may be contributing factors to the modest increase in
numbers.
Chart 4: New HIV Infections by Year in Contra Costa County (2014—2016)
While West Contra Costa remains the region of the county most impacted by HIV, case
rates of new HIV infections are increasing in East Contra Costa (Chart 5). For that
reason, Needle Exchange services continue to be provided in West and East County.
64% 5% 9% 11% 10% 70% 5.30% 6% 9.60% 8.20% 56.5% 4.4% 8.8% 17.0% 12.0% 0%10%20%30%40%50%60%70%80%
West
Central
East
106
92
121
0
20
40
60
80
100
120
140
2014 2015 2016
F&HS Agenda Packet Page 20
Chart 5: Case Rates (Newly Identified HIV) per 100,000 residents by County
Region (2014-2016)
Most new cases of HIV (Chart 6) are men who have sex with other men (MSM).
Individuals with no identified risk or no risk reported (NIR/NRR), about 20% of the
cases, largely consist of women with partners of unknown status.
Chart 6: HIV Incidence by Mode of Exposure among Contra Costa Residents
Newly Identified with HIV Infection (2014-2016)
0
5
10
15
20
West Central East
16.2
6.2
10
13.7
5.4
9.3
15.3
6.6
12.2
2014
2015
2016
0 1 2 3 4 5 6 7 8
Men who Have Sex with Men (MSM)
Injection Drug Users (IDU) /MSM and IDU
Non-Injection Drug-Using Heterosexuals
Adult Other/ Adult Risk Not Reported or
Identified
2016
2015
2014
Rates per 100,000
F&HS Agenda Packet Page 21
HIV attributed to injection drug use continues to decline from 2005 and 2006, when
injection drug users comprised about 25% of all People Living with HIV in Contra
Costa.6 Statewide about 4.6% of adult males and 18.5% of adult females report
injection drug use as their primary risk, equating to 6.3% of adults living with HIV or
AIDS. Injection drug users who also report MSM activity account for about 8.1 percent
of those living with HIV or AIDS.7
MATERNAL TRANSMISSION
It often takes two or three months for an accurate diagnosis of HIV or AIDS in a
newborn, since a positive test at birth may reflect maternal antibodies and not HIV.
Children with HIV have usual childhood infections more often and more severely than
uninfected children, and can also be susceptible to the same opportunistic infections as
adults with HIV.
Of the 2,614 individuals living with HIV or AIDS in Contra Costa County, 19 are pediatric
cases: the majority are now adults and 3 are children 12 years of age or younger.
Identification and treatment of HIV positive women in prenatal care is nearly universal,
but we continue to encounter women who do not seek prenatal care prior to delivery.
In 2016, Contra Costa County had one new case of maternally- transmitted HIV. A
comprehensive case review completed by the CCRMC Safety and Performance
Improvement Committee found that while the woman accessed care quite late in
pregnancy, through multiple providers, and was inconsistent in her follow up, several
health care systems could have performed better to better to possibly prevent the tragic
outcome. Systems changes were proposed and there have been no new subsequent
maternal transmission cases reported. Mother and baby are both virally suppressed at
this time.
HEPATITIS C
Hepatitis C infection (HCV) is largely attributed to the use of contaminated needles.
Chronic HCV can lead to scarring of the liver, cirrhosis, liver failure and/or liver cancer.
Across California the number of chronic Hepatitis C carriers continues to be unreliable
due to variation in reporting capacities, changes in patient residences and the high
volume of duplicated positive lab tests. Consequently, in Contra Costa the Acute
Communicable Disease (ACD) program reviews only a fraction of the reports and only
follows extremely acute infections and those with a higher likelihood of yielding
opportunities for contact intervention and transmission interruption. There were 1,313
reports received by the ACD program in calendar year 2016. There may still be
reporting duplication in this subset since large de-duplication efforts still have to be
6 Contra Costa Public Health Division report, July 2006. http://cchealth.org/health-data/pdf/hiv_2006_07.pdf
7 HIV/AIDS Surveillance in California as of December 2015:
https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/California%20HIV%20Surveillance%20Report%20-
%202015%20(Final%20Version%20Submitted%20for%20Approval).pdf
F&HS Agenda Packet Page 22
completed by the State Health Department to compare previously reported cases across
jurisdictions and against historical reporting systems. The State is reviewing reporting
and recording processes and we will suspend analysis and inclusion of Hepatitis C data
in this report until the data is more accurate.
EXPOSURE IMPACT ON LAW ENFORCEMENT AND FIRST RESPONDERS
Occupational exposure to needle stick injuries (Chart 7) for first responders remains
low. The Communicable Disease Control Program has reviewed reports of exposures
and is in the process of transitioning responsibility for most first responder exposure
follow up back to the Occupational and Risk Management agencies of the respective
departments. Communicable Disease Control remains available for consult as
requested and printed materials are also available on our website at
http://cchealth.org/aids/syringe-exchange.php.
Two of 35 exposures reported in 2015 were needle stick contacts; five of 59 exposures
reported in 2016 were needle stick contacts; and zero of 25 exposures reported from
Jan-July 2017 were needle stick contacts.8 Public Health has received no reports of
subsequent HIV infection as a result of needle stick injury among law enforcement or
first responders.
Chart 7: Reported (Non-Medical) Needle Stick Exposures to First Responders
over Time
NEEDLE EXCHANGE SERVICES, FISCAL YEAR 16/17
All data below is supplied by the needle exchange contractor, HIV Education Prevention
Project of Alameda County (HEPPAC). HEPPAC has provided services since 2012.
Needle exchange services in the region rely on a combination of county general funds
and other funding secured by the contractor through foundations and other
8 Internal data provided by Contra Costa Health Department Communicable Disease Program, September 2017.
0
20
40
60
80
100
120
140
10/11 11/12 12/13 13/14 14/15 15/16 16/17
All Exposures
Needlestick
F&HS Agenda Packet Page 23
organizations. The budget funds portions of several staff salaries, including a needle
exchange worker, health promoter, program manager, clerk, and needle exchange
coordinator. The budget also funds supplies. Both service delivery and reporting
continue to improve.
In FY 16/17, HEPPAC noticed a drop in the client case load in West County. The
agency responded by searching for new West County sites, working with local “gate
keepers” to increase utilization by word of mouth to their IDU peers. HEPPAC also
continued the “roving” needle exchange services begun in the previous fiscal year since
that approach proved somewhat successful in increasing the number of individuals
served. Overall, the number of African Americans and Hispanics served through all
needle exchange sites dropped by 38% and 17% respectively compared to the previous
year. At the same time, the number of Whites served increased by 16% from the
previous year.
In East County, the situation is different: the Bay Point and Pittsburg sites yield the
highest volume of syringe exchanges in Contra Costa County. The average client at
East County sites is a Caucasian male between the ages of 40-49. The majority of the
Latino clients are served in the East County sites and the East County sites also have
identifed an increase in the number of participants reporting use of prescription opioid
pills, crushed and modified for injection. This trend is reflective of national trends and
may be a contributing factor in accidental overdose deaths.
HEPPAC also reports a significant increase in health and social services referrals from
871 referrals in the previous year to 941 referrals last year. This positive move is
attributed to HEPPAC’s stronger linkages to health care, substance use treatment, and
other resources.
Even though the total number of clients served has dropped this year, the number
served remains relatively consistent with the number served two years ago, with major
changes in the make-up of the clients being served (i.e. more White and Asian and
fewer African Americans and Latinos). One-for-one syringe exchange continues to be
the core operating principle of needle exchange, and individuals access services for
themselves or exchange on behalf of others. Of the 941 individuals (contacts) served in
the year, 556 (approx. 58%) were male, showing a slight increase in the number of
female clients served (up by 8%). A total of 89% of the contacts were in East County
and 11% in West County. The data reported by HEPPAC shows a continued shift
toward increasing utilization at the East Contra Costa sites. The agency is actively
seeking new sites in West County.
F&HS Agenda Packet Page 24
Table 1: Ethnicity Totals Over Time (Needle Exchange Program)
Ethnicity Totals Over Time
FY 14/15 FY 15/16 FY 16/17
African American 313 135 85
White 524 662 769
Latino/Hispanic 139 123 103
Native American 1 2 2
Asian/Pacific Islander 7 14 4
Other 3 3 1
Total 987 939 964
Individuals accessing needle exchange (Chart 8) for themserlves alone are reported as
“Contacts”: the number may contain duplicates.
Chart 8: Reported Individuals (Contacts) At Needle Exchange Services
Exchanging syringes for others is called a secondary exchange. Individuals who
exchange for others report the estimated number of individuals for whom they
exchange syringes, summarized in Chart 9 below. The overall volume of secondary
exchange was lower from the previous year by 10%. Because secondary exchangers
attend needle exchange more than once in a year their numbers are duplicated. The
number of clients they exchange for cannot be verified.
Chart 9: Secondary Exchanges at Needle Exchange Services
900
950
1000
FY 14/15 FY 15/16 FY 16/17
2025
2128
1898
FY 14/15 FY 15/16 FY 16/17Number F&HS Agenda Packet Page 25
Finally, as seen in Chart 10, the total number of syringes distributed over time
decreased approximately 15% from the previous year. The decrease is largely
attributed to the drop in secondary exchanges reported by those individuals who
exchange for others.
Chart 10: Reported Number of Syringes Distributed by Fiscal Year
Overall, the agency is performing well and will continue to provide services in both East
and West Contra Costa on a weekly basis. The Public Health program will continue to
monitor service delivery in West County to both assess why the volume of clients has
dropped off and determine if other steps are needed to increase performance.
ALCOHOL AND OTHER DRUG SERVICES
Admissions to AODS services (Chart 11) in Fiscal year 16-17 were up by 20% from the
previous year. The increased enrollment is attributed to several factors, including an
expansion of methadone treatment services due to increased admissions for opioid
abuse treatment and increased access due to the Affordable Care Act. Admissions are
not necessarily unduplicated individuals – one person may enter treatment multiple
times during the year depending on the availability of treatment slots. Indeed, 43% of
injection drug users reported 3 or more prior AODS treatment admissions.
Chart 11: All AODS Admissions and Opioid-Related Admissions
320,610 354,743 300,243
0
200000
400000
FY 14/15 FY 15/16 FY 16/17
Reported Number of Syringes Distributed by Fiscal
Year
1093 1249 1275 1531
0
1000
2000
3000
4000
5000
1314 1415 1516 1617
All Admissions
Opioid Admissions
Opioid classification
includes heroin,
oxycodone,
oxycontin, other
opiates / synthetics
F&HS Agenda Packet Page 26
Of the 3,954 admissions this past fiscal year, roughly 28% identified injection drug use
behavior (Chart 12). The proportion of injection drug users to the overall population in
AODS services has increased year to year over the last several years: FY 14/15 (18%);
FY 15/16 (25%), and FY 16/17 (28%).
Chart 12: Total Clients Served and IDUs as a Proportion of all AOD Services
As seen in Chart 13, the overall percentage of African Americans enrolled in services
has declined from 21% of those served in 2014/15 to 17% of those served in 2016/17.
The percentage of Hispanics enrolled in services has remained relatively steady at
roughly 20% of those served, and Whites comprise just over half the service enrollees.
Women remain roughly 34% of those served.
Chart 13: Enrollment in AODS Sites over Time by Primary Race/Ethnicity
Nearly 40% of those served in FY 16/17 (Chart 14) are new enrollees, and nearly 30%
of all IDUs served in the year had no prior AOD treatment admissions.
765 920 911 934 1152
0
1000
2000
3000
4000
5000
6000
FY 12/13 FY 13/14 FY 14/15 FY 15/16 FY 16/17
Total
Served
In FY 16/17 the Total N was 3,954. 1,152 IDUs were served.
1017 1043 827 709
2039
2614
1879 2071
825 978 832 967
0
500
1000
1500
2000
2500
3000
1314 1415 1516 1617
African Am White Hispanic
F&HS Agenda Packet Page 27
Chart 14: New Enrollees in AODS Services
Chart 15 shows that over the last three years, fewer enrollees reported being homeless
at the time of service initiation. In FY 2014/15, 34% of those served reported being
homeless, in FY2016/15 26%, and in FY 2016/17 21%.
Chart 15: Homeless Proportion of Enrollment in AOD Services
OTHER PREVENTION ACTIVITIES FOR INJECTION DRUG USE
Opioid Agonist Therapy
Current research out of Stanford explored the most effective and cost-effective ways to
combat HIV risk among injection drug users. As abuse of prescription opioids rises and
as more individuals inject drugs like heroin, the risk of increased blood borne illnesses
such as HIV and Hepatitis C also increases. Their investigation of HIV prevention
programs for injection drug users revealed that opioid agonist therapy (OAT) options,
most commonly methadone and buprenorphine maintenance therapies, are the most
cost effective. OAT options can also be highly effective in helping people stop injecting
3829 4054
4926
3730 3954
1460 1412 1956 1580 1549
0
2000
4000
6000
1213 1314 1415 1516 1617
Total Served new (never enrolled)
3829 4054
4926
3730 3954
1246 1398 1707
978 832
0
1000
2000
3000
4000
5000
6000
1213 1314 1415 1516 1617
Total Served
Homeless
F&HS Agenda Packet Page 28
drugs over time. They also found that combining prevention efforts such as needle-
syringe exchanges, OAT, Pre-Exposure Prophylaxis (PrEP), and prevention and testing
with high-risk negatives have higher rates of success than standalone interventions.9
Alameda & Contra Costa County Integrated HIV Prevention & Care Plan
Contra Costa County HIV/AIDS & STD program staff and Consortium members assisted
in the development of the regional 2017 - 2021 Alameda & Contra Costa County
Integrated HIV Prevention & Care Plan. The plan will be used to evaluate care and
prevention efforts in both counties. Key prevention components of the plan that focus
on injection drug users include:
1. By December 31, 2017, through a collaboration involving the Oakland
Transitional Grant Area (TGA) Collaborative Community Planning Council
(CCPC), the Contra Costa Consortium, and the two County health
departments, develop an End of AIDS Action Plan for the Oakland TGA
that outlines steps to implement a collaborative, multidisciplinary campaign to
end HIV in the two-county region, including ending new HIV infections,
ending HIV-related deaths, and ending HIV related stigma.
2. Continually collect and report data on new HIV diagnoses in the Oakland TGA,
including breakdowns by ethnicity, gender, transmission category, and age.
3. Conduct ongoing needs assessments to identify emerging issues related to
HIV infection and access to HIV education, testing, and other resources.
4. Deliver targeted, sustained, and evidence-based HIV prevention interventions
that are appropriate for high-risk populations.
5. Support the development of expanded, tailored HIV-related stigma reduction
campaigns in English and Spanish that are aimed at specific, high-risk
subpopulations and are developed in collaboration with consumers; that
address stigma related to HIV, homophobia, and HIV risk behaviors; that
incorporate cutting-edge social media approaches; and that contain sex-
positive messages.
6. Utilize targeted social marketing, media, mobilization and condom distribution
programs in English and Spanish to raise and sustain awareness of HIV risk.
7. Ensure widespread, accessible, and well-publicized syringe distribution and
syringe exchange services.
9 https://med.stanford.edu/news/all-news/2017/05/study-identifies-cost-effective-ways-to-combat-hiv-risk.html
F&HS Agenda Packet Page 29
The Integrated HIV Prevention & Care Plan targets the highest risk populations
including men who have sex with other men and injection drug users, for HIV
prevention and care services. Needle exchange remains an integral component of the
plan. In Contra Costa County, we anticipate continuing the use of County General
Funds for needle exchange services to support the downward trend in HIV infections
attributed to injection drug use. The current plan can be found on the Public Health
website at http://cchealth.org/aids.
New Data-to-Care Program
Data-to-Care is a new public health strategy that aims to use HIV and STD surveillance
data to identify HIV-diagnosed individuals and those at highest risk for HIV not in care,
link them to care, and support the HIV Care Continuum. In this reporting period, the
HIV/AIDS & STD Program began two new data-to-care interventions that prioritize high-
risk individuals: 1) targeted outreach to individuals who have been recently diagnosed
with an STD, including individuals who are co-infected with HIV and STDs, and 2) a PrEP
Navigation Program for Contra Costa residents. PrEP (pre-exposure prophylaxis) is the
use of anti-retroviral medication to prevent acquisition of HIV infection. It is used by
HIV uninfected persons who are at high risk of being exposed to HIV through sexual
contact or injection drug use. PrEP can reduce the risk for HIV infection by more than
92% if taken as prescribed. At present, the only medication with an FDA-approved
indication for PrEP is oral tenofovir disoproxil fumarate-emtricitabine (TDF-FTC), which is
available as a fixed-dose combination in a tablet called Truvada®. This medication is
also commonly used in the treatment of HIV. PrEP should be considered part of a
comprehensive prevention plan that includes adherence, risk reduction counseling, HIV
prevention education and provision of condoms. The data-to-care targeted outreach
intervention consists of generating line lists that are pulled from State and County
surveillance systems. These line lists are focused on three high-risk populations: MSMs
recently diagnosed with one or more STD, women of color (African American, Latinas,
Asian/Pacific Islander, and multiracial women) recently diagnosed with one or more STD,
and individuals co-infected with HIV and STD(s). Trained Disease Intervention
Technicians (DITs) call the individuals on the line lists and offer risk reduction services,
partner services, and, in the case of people who don’t have HIV, Pre Exposure
Prophylaxis (PrEP) navigation services. In this reporting period, DITs contacted a total
of 1,353 individuals and provided 283 risk reduction sessions with high-risk individuals.
OPIOID OVERDOSE
Opioids are medications that relieve pain. They reduce the intensity of pain signals
reaching the brain, diminishing the effects of a painful stimulus. Medications that fall
within this class include hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin,
Percocet), morphine (e.g., Kadian, Avinza), codeine, and related drugs. Hydrocodone
F&HS Agenda Packet Page 30
products are the most commonly prescribed for a variety of painful conditions, including
dental and injury-related pain. Morphine is often used before and after surgical
procedures to alleviate severe pain. Codeine, on the other hand, is often prescribed for
mild pain. In addition to their pain relieving properties, some of these drugs—codeine
and diphenoxylate (Lomotil) for example—can be used to relieve coughs or severe
diarrhea.
Heroin is an opioid drug that is synthesized from morphine. In 2012, about 669,000
Americans reported using heroin in the past year. The greatest increases in heroin use
are among individuals aged 18-25.10 Nearly 80% of Americans using heroin report
misusing prescription opiods first, and it is estimated that about 23% of individuals who
use heroin become dependent on it.11 Prescription opioid pain medications such as
Oxycontin and Vicodin can have effects similar to heroin when taken in doses or in ways
other than prescribed, and they are currently among the most commonly abused drugs
in the United States.
Approximately 60% of IDUs served in AOD programs identify Heroin as their primary
problem at admission.
The California Department of Health estimates there were 1,925 opioid related deaths
in 2016, most attributed to prescription pain medications either with or without alcohol
or other drugs. In Contra Costa County, there were 50 opioid overdose deaths in
2016.12 All regions of the county have experienced fatal overdoses, emergency
department visits, and hospitalizations due to opioid overdose.
Recognizing the life-saving effects of the opioid-overdose reversal drug naloxone,
Senate Bill (SB) 833 (Chapter 30, Statutes of 2016) established a new Naloxone Grant
Program within the California Department of Public Health (CDPH).13 The goal of the
program is to reduce fatal overdoses by increasing access to naloxone nasal spray
called Narcan.
The HIV/AIDS and STD Program is administering the Naloxone Grant Program by
distributing the county’s 1,642 State-allotted doses to local community agencies with
existing naloxone distribution systems and those working with individuals most likely to
experience or witness opioid overdoses. The agencies identified to receive Narcan
intranasal spray doses in Contra Costa County are Healthcare for the Homeless,
HEPPAC, New Leaf Treatment Center, and LifeLong Medical’s medication-assisted
treatment program.
10 https://www.drugabuse.gov/publications/research-reports/heroin/scope-heroin-use-in-united-states
11 http://www.drugabuse.gov/publications/drugfacts/heroin
12 https://pdop.shinyapps.io/ODdash_v1/
13 https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/SACB/Pages/NaloxoneGrantProgram.aspx
F&HS Agenda Packet Page 31
DISPOSAL
Contra Costa Environmental Health (CCEH) administers the Medical Waste Management
Program for Contra Costa County, and is the local enforcement and regulatory agency
for Medical Waste Generators. CCEH issues permits and registers generators of medical
waste, responds to complaints of abandoned medical waste on public property, and
implements the Medical Waste Management Act (Part 14, C. 1-11 of the California
Health and Safety Code). The agency web site maintains a list of frequently asked
questions (FAQs) on syringe and needle disposal, a list of disposal sites in Contra Costa,
a number of pamphlets describing the proper disposal of syringes and other medical
waste, as well as links to state and other resources. Additional information can be
found at http://www.calrecycle.ca.gov/FacIT/Facility/Search.aspx#MOVEHERE
NO. FACILITY NAME ADDRESS CITY
ZIP
CODE TELEPHONE
MATERIAL
CATEGORIES MATERIALS
1 Alamo Sheriff's
Substation
150 Alamo
Plaza, Suite C
Alamo 94507 (925) 837-
2902
Sharps or
Medications
Sharps (Home-
Generated)
2 City of Clayton 6000 Heritage
Trl
Clayton 94517 (800) 646-
1431
Sharps or
Medications
Sharps (Home-
Generated)
3 Danville Police
Station
510 La Gonda
Way
Danville 94526 (925) 314-
3700
Sharps or
Medications
Sharps (Home-
Generated)
4 Delta HHW
Collection Facility
(East County)
2550
Pittsburg
Antioch Hwy
Antioch 94509 (925) 756-
1990
Sharps or
Medications
Sharps (Home-
Generated)
5 El Cerrito Recycling
CTR
7501 Schmidt
Ln
El Cerrito 94530 (510) 215-
4350
Sharps or
Medications
Sharps (Home-
Generated)
6 Lafayette Fire
Station
3338 Mt
Diablo Blvd
Lafayette 94549 (925) 941-
3300
Sharps or
Medications
Sharps (Home-
Generated)
7 Moraga-Orinda fire
station
1280 Moraga
Way
Moraga 94556 (925) 258-
4599
Sharps or
Medications
Sharps (Home-
Generated)
8 Mountain View
Sanitation District
3800 Arthur
Rd
Martinez 94553 (925) 228-
5635
Sharps or
Medications
Sharps (Home-
Generated)
F&HS Agenda Packet Page 32
9 Orinda Police Station 22 Orinda
Way
Orinda 94523 (925) 254-
6820
Sharps or
Medications
Sharps (Home-
Generated)
10 Rossmoor Gateway
Building (For
Rossmoor residents
only)
1001 Golden
Rain Rd
Walnut
Creek
94595 (925) 906-
1801
Sharps or
Medications
Sharps (Home-
Generated)
11 San Ramon Valley
Fire District HQ
1500 Bollinger
Canyon Rd
San
Ramon
94583 (925) 838-
6600
Sharps or
Medications
Sharps (Home-
Generated)
12 Walnut Creek City
Hall
1666 North
Main St
Walnut
Creek
94596 (800) 750-
4096
Sharps or
Medications
Sharps (Home-
Generated)
13 Walnut Creek Fire
Station
1050 Walnut
Ave
Walnut
Creek
94598 (925) 941-
3300
Sharps or
Medications
Sharps (Home-
Generated)
14 West Contra Costa
County Hazardous
Waste Collection
Facility
101 Pittsburg
Ave
Richmond 94801 (888) 412-
9277
Sharps or
Medications
Sharps (Home-
Generated
The Public Health HIV/AIDS and STD program has received no complaints from law
enforcement, businesses, pharmacies, or community members regarding discarded
syringes this year.
CONCLUSIONS:
1. Access to clean needles has made a difference in Contra Costa and remains an
important component of the overall strategy to reduce transmission of blood borne
diseases.
2. Law enforcement exposure to potential blood borne pathogens via needle stick
injury has not increased with the implementation of needle exchange and pharmacy
sales. Materials for Law Enforcement to document potential exposure and request
assistance are available on the website.
3. The number of children under 12 years of age living with HIV or AIDS has
decreased and there is no evidence of increased maternal transmission of HIV to unborn
children.
F&HS Agenda Packet Page 33
Needle exchange is a critical component of Contra Costa’s HIV prevention strategy and
should remain in effect until further notice. Should the Committee desire, frequency of
presentations can be at two year intervals.
F&HS Agenda Packet Page 34
FAMILY AND HUMAN SERVICES COMMITTEE - Special
Meeting 5.
Meeting Date:11/13/2017
Subject:Proposed Secondhand Smoke Ordinance - Multi-unit Housing
Submitted For: FAMILY & HUMAN SERVICES COMMITTEE,
Department:County Administrator
Referral No.: 82
Referral Name: Secondhand Smoke Ordinance
Presenter: Daniel Peddycord, Public Health Director;
Denice Dennis, Tobacco Prevention Program
Manager
Contact: Enid Mendoza,
(925) 335-1039
Referral History:
The issue of secondhand smoke and the associated health implications was first referred to the
Family and Human Services Committee by the Board of Supervisors on March 1, 2006. Since
that time the Health Services Department has provided annual reports to update the Committee
and the Board of Supervisors on the problem and progress made to address it.
The Board of Supervisors adopted a comprehensive Secondhand Smoke Protections Ordinance in
2006 on the heels of the California Air Resources Board report which designated secondhand
smoke as a toxic air contaminant based on a review of the research linking secondhand smoke
with numerous adverse health effects. The Board strengthened these protections in October 2009,
October 2010 and April 2013 in response to community complaints regarding drifting smoke in
multi-unit housing and the need for additional policies to protect public health. On June 17, 2014
the Board of Supervisors adopted Ordinance 2014-06 which prohibits smoking on property owned
or leased by the County.
On April 13, 2015, the Family and Human Services Committee accepted the Health Services
Department's report on the implementation of the Secondhand Smoke Protections Ordinance and
directed staff to develop draft ordinance language that would create 100% smokefree multi-unit
housing for unincorporated communities and revise and strengthen the regulation of electronic
smoking devices under County ordinances.
On July 18, 2017, the Board adopted Ordinance No. 2017-01, which included electronic smoking
devices to the definition of "tobacco product" and established restrictions on the retail sales of
emerging tobacco products such as electronic smoking devices.
The Health Services Department has been working closely with County Counsel to draft
F&HS Agenda Packet Page 35
The Health Services Department has been working closely with County Counsel to draft
ordinance language to establish smokefree multi-unit housing policy for unincorporated
communities.
Referral Update:
Please see the attached:
- Report from the Health Services Department with an update on the implementation of the
Secondhand Smoke Protections Ordinance
- Draft Smokefree Multi-unit Residences Ordinance
- Redline version of the Secondhand Smoke and Tobacco Product Control Ordinance
- A Guide to Contra Costa County's Secondhand Smoke Protections Ordinance and For Property
Managers, Developers and Landlords in unincorporated Contra Costa brochures.
Recommendation(s)/Next Step(s):
ACCEPT the annual report from the Health Services Department on the implementation of the
Secondhand Smoke Protections Ordinance and DIRECT staff to forward the report to the Board of
Supervisors for their information.
ACCEPT the draft Smokefree Multi-unit Residences Ordinance as recommended by the Health
Services Department, and DIRECT staff to forward the draft ordinance to the Board of
Supervisors for introduction and adoption.
DIRECT staff to include an annual update on the implementation of the Smokefree Multi-unit
Residences Ordinance in their annual Secondhand Smoke Protections Ordinance report to the
Family and Human Services Committee.
Fiscal Impact (if any):
There is no fiscal impact, the recommended ordinance provisions would be implemented by the
Public Health Division's Tobacco Prevention Program and would be funded through the
program's current funding sources.
Attachments
Secondhand Smoke Protections Annual Report
Draft Smokefree Multi-Unit Housing Residences Ordinance
Draft Secondhand Smoke and Tobacco Control Ordinance with Smokefree Multi-Unit Housing Residences
Language - Redline
Secondhand Smoke Protections Brochures
F&HS Agenda Packet Page 36
• 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 Center and Health Centers •
WILLIAM B. WALKER, M.D.
HEALTH SERVICES DIRECTOR
DANIEL PEDDYCORD, RN,
MPA/HA
DIRECTOR OF PUBLIC HEALTH
C ONTRA C OSTA
P UBLIC H EALTH
597 CENTER AVENUE, SUITE 200
MARTINEZ, CALIFORNIA 94553
PH (925) 313-6712
FAX (925) 313-6721
WENDEL.BRUNNER@HSD.CCCOUNTY.US
To: Family and Human Services Committee, Contra Costa Board of Supervisors
From: Daniel Peddycord, RN, MPA/HA, Director, Public Health
Re: Annual Report on Implementation of Secondhand Smoke Protections Ordinance and Draft Smokefree
Multi-unit Residences Ordinance
Date: 11/13/17
Summary
At the April 2015 Family and Human Services Committee Meeting, Public Health presented its annual report on
implementation of the County’s Secondhand Smoke Ordinance and discussed challenges to protecting residents,
workers and visitors from secondhand smoke and electronic smoking devices. Of specific concern were issues for
residents living in multi-unit housing. The Committee directed staff to work with County Counsel to draft an
ordinance that would create 100% Smokefree Multi-unit housing for the unincorporated communities. The draft
ordinance, titled Smokefree Multi-Unit Residences, as well as the red-lined version of the relevant sections of
Chapter 445, are attached to this report for review and consideration. A brief report on implementing the current
ordinance is also presented.
Draft Ordinance Background
The Board of Supervisors adopted a comprehensive Secondhand Smoke Protections Ordinance in 2006. This
decision came on the heels of the California Air Resources Board report designating secondhand smoke as a toxic
air contaminant based on a review of the research linking secondhand smoke with numerous adverse health
effects. The vast majority of Contra Costans do not smoke, with data showing that 13.4% of residents in the
County do smoke. The Board strengthened the County’s secondhand smoke protections in October 2009,
October 2010, April 2013, June 2014 and July 2017 in response to community complaints regarding drifting smoke
and the need for additional policies to protect public health. These amendments to the county code included
expanding secondhand smoke protections to make all County-owned properties 100% smoke-free, and inclusion
of electronic smoking devices in the definition of “secondhand smoke.”
The majority of the 120 secondhand smoke complaints received by the Public Health Department’s Tobacco
Prevention Program over the last three years continue to be from multi-family housing residents, with 96
complaints regarding unit-to-unit and outside-to-unit drifting smoke. For residents of the unincorporated county,
staff follows up with landlords and property owners regarding compliance with the County’s current laws.
However, since the County’s ordinance does not include protections that address unit-to-unit drifting smoke,
many of these residents are still exposed to secondhand smoke in their homes.
In 2007, the World Health Organization issued policy recommendations on Protection from Exposure to Second-
Hand Tobacco Smoke, stating, "Scientific evidence has firmly established that there is no safe level of exposure to
second-hand tobacco smoke (SHS), a pollutant that causes serious illness in adults and children. There is also
indisputable evidence that implementing 100% smoke-free environments is the only effective way to protect the
population from the harmful effects of exposure to SHS."
WHO’s recommendation 1, in full, reads:
1. Remove the pollutant – tobacco smoke – by implementing 100% smoke-free environments.
This is the only effective strategy to reduce exposure to tobacco smoke to safe levels in indoor
environments and to provide an acceptable level of protection from the dangers of SHS
exposure. Ventilation and smoking areas, whether separately ventilated from non-smoking areas
or not, do not reduce exposure to a safe level of risk and are not recommended.
F&HS Agenda Packet Page 37
∎ Contra Costa Community Substance Abuse Services ∎ Contra Costa Emergency Medical Services ∎ Contra Costa Environmental Health ∎ Contra Costa Health Plan ∎
∎ Contra Costa Hazardous Materials Programs ∎ Contra Costa Mental Health ∎ Contra Costa Public Health ∎ Contra Costa Regional Medical Center ∎ Contra Costa Health Centers ∎
Air filtration companies agree that ventilation systems do not eliminate health risks caused by secondhand smoke,
and in 2015, the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) updated
its ventilation standards and re-confirmed its 2006 position that acceptable indoor air quality is based on an
environment that is completely free from secondhand tobacco smoke, secondhand marijuana smoke, and
emissions from electronic smoking devices.
Many communities in California have moved to address the issue of drifting secondhand smoke between units as
an air quality and health issue. At least 90 communities statewide, including 27 jurisdictions in the Bay Area, have
adopted 100% smokefree multi-unit housing laws, including Danville, El Cerrito, Richmond and Walnut Creek in
Contra Costa, and the Counties of Sonoma, San Mateo and Santa Clara. Unit-to-unit drifting smoke exposure
would be alleviated with a similar provision in the County’s ordinance.
Provisions of the Ordinance
The definition of “multi-unit residence” in the ordinance is unchanged and means a building containing two or
more dwelling units, including but not limited to apartments, condominiums, senior housing, nursing homes and
single room occupancy hotels.
The attached draft ordinance revises the County Code to:
Prohibit smoking in all dwelling units in multi-unit residences.
Require every new, renewed, or continued lease or other rental agreement for the occupancy of a dwelling
unit in a multi-unit residence to include terms that prohibit smoking in the dwelling unit.
Smoking would be permitted in a dwelling unit subject to a lease or other rental agreement that authorizes
smoking until the agreement is modified as required by the ordinance, and in a dwelling unit that is owner-
occupied until one year after the effective date of the ordinance. In order to provide outreach and education, and
to allow time for landlords to include the terms that prohibit smoking in every new, renewed, or continued lease or
other rental agreement, a one year implementation plan will be developed by staff, and all multi-unit housing
residences will be expected to be smoke-free one year from the effective date of the ordinance.
Implementation Considerations
If adopted, the Smokefree Multi-Unit Residences ordinance will be implemented through the Public Health
Department’s Tobacco Prevention Program. Compliance with the new smokefree multi-unit housing law will be
achieved through educational efforts with owners, property managers and residents of multi-unit housing, and
community groups. Educational efforts would include updating the County’s brochures on Secondhand Smoke
laws; an educational mailing to multi-unit housing managers, owners and associations; presentations to the
Municipal Advisory Committees and community groups; and collaborations with the California Apartment
Association to provide technical assistance to landlords in implementing the new law.
Outreach and education efforts to the community will include information on how to make a complaint about
drifting smoke in multi-unit residences, and an educational approach will be employed to address non-compliance.
This approach will include working with owners/managers to assure that requirements of owners/managers under
the ordinance are met, and providing technical assistance to owners/managers on compliance issues. If the
owner/manager has implemented the required lease terms and signage, staff will also correspond with the tenant
to educate the tenant on the law. The Tobacco Prevention Program has utilized a similar approach for addressing
violations of other multi-unit residence smoking restrictions under the County’s ordinance, such as no smoking in
common areas or near doors and windows of these buildings.
Implementation of the Smoke-free County Properties Provision and other Secondhand Smoke
Protections Ordinance Provisions over the Past Year
Smoke-Free County Campuses Provision:
Tobacco Prevention Program staff continues to take complaints about non-compliance with the County’s smoke-
free County Campuses law, and works with staff to address these complaints. A presentation was made to Risk
F&HS Agenda Packet Page 38
∎ Contra Costa Community Substance Abuse Services ∎ Contra Costa Emergency Medical Services ∎ Contra Costa Environmental Health ∎ Contra Costa Health Plan ∎
∎ Contra Costa Hazardous Materials Programs ∎ Contra Costa Mental Health ∎ Contra Costa Public Health ∎ Contra Costa Regional Medical Center ∎ Contra Costa Health Centers ∎
Management’s Countywide Safety Coordinators meeting in January 2017, and “Smokefree Contra Costa” paper
signage was updated and distributed for posting to the County Building Safety Coordinators at that presentation.
Tobacco Prevention Program staff continue to maintain the Contra Costa Smoke-Free Campus web pages on the
Health Services website (www.smokefreecc.org) This includes information on the ordinance and the “Frequently
Asked Questions” document for the public.
Other Ordinance Provisions and Addressing Complaints:
The Tobacco Prevention Program continues to educate the public and businesses on provisions of the ordinance
through community presentations, distributing educational brochures, responding to complaints and inquiries, and
incorporating materials into County business license materials. Additionally, the Tobacco Prevention Program
responds to drifting smoke complaints from residents throughout the County. Eight of these complaints over the
past year were related to either outdoor drifting smoke or business-related complaints. The other 33 complaints
received this year were regarding drifting smoke in multi-unit housing.
Recommendations
Staff recommends that the Family and Human Services Committee consider the draft Smokefree Multi-Unit
Housing Ordinance as part of today’s report, that the ordinance be brought forward from the Committee to the
full Board of Supervisors for consideration and that, if adopted by the full Board, staff update the Family and
Human Services Committee on implementation of the ordinance annually as part of its annual report on the
County’s Secondhand Smoke Protections Ordinance.
Attachments:
1. Ordinance No. 2017- ____ Draft Smokefree Multi-Unit Housing Residences
2. Ordinance (Smokefree Multi-Unit Housing Residences) Redline Version Draft
3. Brochures titled “A Guide to Contra Costa County’s Secondhand Smoke Protections Ordinance” and
“For Property Managers, Developers and Landlords in unincorporated Contra Costa.”
F&HS Agenda Packet Page 39
ORDINANCE NO. 2017-_____ DRAFT
SMOKEFREE MULTI-UNIT RESIDENCES
The Contra Costa County Board of Supervisors ordains as follows (omitting the parenthetical
footnotes from the official text of the enacted or amended provisions of the County Ordinance
Code):
SECTION I. SUMMARY. This ordinance amends Division 445 of the County Ordinance
Code to prohibit smoking in all dwelling units in any multi-unit residence and to require that the
prohibition be included in the terms of any new lease or rental agreement.
SECTION II. Section 445-4.004 of the County Ordinance Code is amended to read:
445-4.004 Prohibition of Smoking. Smoking is prohibited in the following places within the
unincorporated area of Contra Costa County:
(a) Enclosed places of employment.
(b) Enclosed public places.
(c) Service areas.
(d) All areas within twenty feet of doors, windows, air ducts, and ventilation systems of
enclosed places of employment, except while passing on the way to another destination.
(e) All areas within twenty feet of doors, windows, air ducts, and ventilation systems of
enclosed public places, except while passing on the way to another destination.
(f) The following outdoor areas:
(1) Outdoor dining areas at bars and restaurants.
(2) Outdoor lounges and outdoor dining areas at places of employment.
(3) Public trails and public parks.
(4) Public event venues.
(g) All multi-unit residence common areas, except that a landlord may designate a portion of
an outdoor common area as a smoking area. A designated smoking area of an outdoor
common area of a multi-unit residence must not overlap with any area where smoking is
ORDINANCE NO. 2017- _____ DRAFT
1
F&HS Agenda Packet Page 40
otherwise prohibited by local, state, or federal law; must be located at least twenty-five
feet in all directions from non-smoking areas; must not include areas used primarily by
children; must be no more than twenty-five percent of the total outdoor common area;
must have a clearly marked perimeter; and must be identified by conspicuous signs.
(h) All areas within twenty feet of doors, windows, air ducts, and ventilation systems of
multi-unit residences, except while passing on the way to another destination.
(i) All outdoor balconies, porches, decks, patios, and carports of multi-unit residences.
(j) All dwelling units in any multi-unit residence, except as otherwise provided in Section
445-4.006. (Ords. 2017- ___ § 2, 2010-10 § 3, 2006-66 § 5, 91-44 § 2).
SECTION III. Section 445-4.006 of the County Ordinance Code is amended to read:
445-4.006 Exceptions.
(a) Smoking is permitted at any location within the county unless otherwise prohibited by
this code or by state or federal law.
(b) Smoking is permitted in up to twenty percent of guest rooms in any hotel or motel, as
long as the hotel or motel permanently designates at least eighty percent of its guest
rooms as nonsmoking rooms, appropriately signs nonsmoking rooms, and permanently
removes ashtrays from these rooms. Smoking rooms shall be segregated from
nonsmoking rooms on separate floors, wings, or portions of either. Smoking rooms and
nonsmoking rooms shall not be interspersed. Nothing in this division requires a hotel or
motel to provide smoking rooms and the owner or operator of a hotel or motel may
choose to prohibit smoking throughout the property.
(c) If a dwelling unit in a multi-unit residence is subject to a lease or other rental agreement
and smoking is authorized under the lease or rental agreement, smoking is permitted in
the dwelling unit until the lease or rental agreement is modified to prohibit smoking in
accordance with Section 445-4.014.
(d) If a dwelling unit in a multi-unit residence is owner-occupied, smoking is permitted in the
owner-occupied dwelling unit until [date, one year after effective date of ordinance].
(Ords. 2017- ___ § 2, 2010-10 § 4, 2006-66 § 5, 91-44 § 2).
ORDINANCE NO. 2017- _____ DRAFT
2
F&HS Agenda Packet Page 41
SECTION IV. Section 445-4.014 of the County Ordinance Code is amended to read:
445-4.014 Required lease terms.
(a) Commencing [date, effective date of the ordinance], every lease and other rental
agreement for the occupancy of a dwelling unit in a multi-unit residence that is entered
into, renewed, or continued month-to-month must include the terms specified in
subsection (b) of this section on the earliest possible date allowed by law after providing
any required legal notice.
(b) Required Terms.
(1) A clause stating that smoking is prohibited in all dwelling units must be included
in the written agreements specified in subsection (a) of this section.
(2) A clause stating that it is a material breach of the lease or rental agreement to: (i)
violate any law regarding smoking while on the premises; (ii) smoke in any
dwelling unit; or (iii) smoke in any multi-unit residence common area where
smoking is prohibited, must be included in the written agreements specified in
subsection (a) of this section.
(c) The California Apartment Association’s Form 34.0, revised December 2016 and as
amended from time to time, may be used to comply with this section.
(d) A landlord’s failure to enforce any smoking regulation of a lease or rental agreement on
one or more occasions does not constitute a waiver of the lease or rental agreement
provisions required by this section and does not prevent future enforcement of the lease
or rental agreement provisions required by this section.
(e) A landlord is not liable under this chapter to any person for a tenant’s breach of smoking
regulations if:
(1) The landlord has fully complied with all provisions of this chapter; and
(2) Upon receiving a signed, written complaint regarding prohibited smoking, the
landlord provides a warning to the offending tenant, stating that the tenant may be
evicted if another complaint is received. Upon receiving a second signed, written
compliant against the offending tenant, the landlord may evict the tenant, but is
not liable for the failure to do so. (Ord. 2017- ___ § 4, 2010-10 § 5).
SECTION V. EFFECTIVE DATE. This ordinance becomes effective 30 days after passage,
and within 15 days after passage shall be published once with the names of supervisors voting for
ORDINANCE NO. 2017- _____ DRAFT
3
F&HS Agenda Packet Page 42
or against it in the Contra Costa Times, a newspaper published in this County.
PASSED on ___________________________, by the following vote:
AYES:
NOES:
ABSENT:
ABSTAIN:
ATTEST: DAVID J. TWA, _____________________________
Clerk of the Board of Supervisors Board Chair
and County Administrator
By: ______________________[SEAL]
Deputy
KCK:
H:\Client Matters\2017\HS\Multi-Unit Smokefree Ord Amend - draft6.wpd
ORDINANCE NO. 2017- _____ DRAFT
4
F&HS Agenda Packet Page 43
DRAFT
ORDINANCE NO. (Smokefree Multi-unit Residences) REDLINE VERSION DRAFT
1
Chapter 445-2
GENERAL PROVISIONS
445-2.002 Title.
This division is known as the secondhand smoke and tobacco product control ordinance of
Contra Costa County.
(Ords. 2006-66 § 4, 98-43 § 2, 91-44 § 2)
445-2.004 Purpose.
The purposes of this division are to protect the public health, safety and welfare against the
health hazards and harmful effects of the use of addictive tobacco products; and further to
maintain a balance between the desires of persons who smoke and the need of nonsmokers to
breathe smoke-free air, while recognizing that where these conflict, the need to breathe smoke-
free air shall have priority.
(Ords. 2006-66 § 4, 98-43 § 2, 91-44 § 2)
445-2.006 Definitions.
For the purposes of this division, the following words and phrases have the following meanings:
(a) "Characterizing flavor" means a distinguishable taste or aroma imparted by a tobacco
product or any byproduct produced by the tobacco product that is perceivable by an
ordinary consumer by either the sense of taste or smell, other than the taste or aroma of
tobacco. A "characterizing flavor" includes, but is not limited to, a taste or aroma relating
to a fruit, chocolate, vanilla, honey, candy, cocoa, dessert, alcoholic beverage, menthol,
mint, wintergreen, herb, or spice.
(b) "Cigar" means any roll of tobacco other than a cigarette wrapped entirely or in part in
tobacco or any substance containing tobacco and weighing more than three pounds per
thousand.
(c) "Constituent" means any ingredient, substance, chemical, or compound, other than
tobacco, water, or reconstituted tobacco sheet, that is added by the manufacturer to a
tobacco product during the processing, manufacture, or packing of the tobacco product.
(d) "Consumer" means a person who purchases a tobacco product for consumption and not
for sale to another.
(e) "Electronic smoking device" means an electronic device that can be used to deliver an
inhaled dose of nicotine, or other substances. An "electronic smoking device" includes a
device that is manufactured, distributed, marketed, or sold as an electronic cigarette, an
F&HS Agenda Packet Page 44
DRAFT
ORDINANCE NO. (Smokefree Multi-unit Residences) REDLINE VERSION DRAFT
2
electronic cigar, an electronic cigarillo, an electronic pipe, an electronic hookah, a vape
pen, or a vapor pen.
(f) "Enclosed" means all space between a floor and ceiling where the space is closed in on all
sides by solid walls or windows that extend from the floor to the ceiling. An enclosed
space may have openings for ingress and egress, such as doorways or passageways. An
enclosed space includes all areas within that space, such as hallways and areas screened
by partitions that do not extend to the ceiling or are not solid.
(g) "Flavored tobacco product" means any tobacco product, other than cigarettes as defined
by federal law, that contains a constituent that imparts a characterizing flavor. A tobacco
product whose labeling or packaging contains text or an image indicating that the product
imparts a characterizing flavor is presumed to be a flavored tobacco product.
(h) "Little cigar" means any roll of tobacco other than a cigarette wrapped entirely or in part
in tobacco or any substance containing tobacco and weighing no more than three pounds
per thousand. "Little cigar" includes, but is not limited to, any tobacco product known or
labeled as "small cigar" or "little cigar."
(i) "Package" or "packaging" means a pack, box, carton, or container of any kind, or any
wrapping, in which a tobacco product is sold or offered for sale to a consumer.
(j) "Menthol cigarettes" means cigarettes as defined by federal law, that have a characterizing
flavor of menthol, mint, or wintergreen, including cigarettes advertised, labeled, or
described by the manufacturer as possessing a menthol characterizing flavor.
(k) "Multi-unit residence" means a building that contains two or more dwelling units,
including but not limited to apartments, condominiums, senior citizen housing, nursing
homes, and single room occupancy hotels. A primary residence with an attached or
detached accessory dwelling unit permitted pursuant to Chapter 82-24 is not a multi-unit
residence for purposes of this division.
(l) "Multi-unit residence common area" means any indoor or outdoor area of a multi-unit
residence accessible to and usable by residents of different dwelling units, including but
not limited to halls, lobbies, laundry rooms, common cooking areas, stairwells, outdoor
eating areas, play areas, swimming pools, and carports.
(m) "Place of employment" means any area under the control of an employer, business, or
nonprofit entity that an employee, volunteer, or the public may have cause to enter in the
normal course of operations, regardless of the hours of operation. Places of employment
include, but are not limited to: indoor work areas; bars; restaurants; at least eighty percent
of the guest rooms in any hotel and motel; vehicles used for business purposes; taxis;
employee lounges and breakrooms; conference and banquet rooms; bingo and gaming
F&HS Agenda Packet Page 45
DRAFT
ORDINANCE NO. (Smokefree Multi-unit Residences) REDLINE VERSION DRAFT
3
facilities; long-term health care facilities; warehouses; retail or wholesale tobacco shops;
and private residences used as licensed child-care or health-care facilities when
employees, children or patients are present and during business hours. The places
specified in subdivisions (e)(1), (2), (6), and (7) of Labor Code section 6404.5 are places
of employment for the purposes of this division and are regulated as specified in this
division. The places specified in subdivisions (e)(3), (4), and (5) of Labor Code section
6404.5 are not places of employment for the purposes of this division.
(n) "Public place" means any area to which the public is invited or in which the public is
permitted. A private residence is not a public place.
(o) "Self-service display" means the open display or storage of tobacco products or tobacco
paraphernalia in a manner that is physically accessible in any way to the general public
without the assistance of the retailer or employee of the retailer. A vending machine is a
form of self-service display.
(p) "Service area" means any area designed to be or regularly used by one or more persons to
receive or wait to receive a service, enter a public place, or make a transaction, whether
or not the service involves the exchange of money. "Service areas" include but are not
limited to automatic teller machine waiting areas, bank teller windows, ticket lines, bus
stops and taxi stands.
(q) "Smoke" means the gases, particles, or vapors released into the air as a result of
combustion, electrical ignition, or vaporization when the apparent or usual purpose of the
combustion, electrical ignition, or vaporization is human inhalation of the byproducts,
except when the combusting or vaporizing material contains no tobacco or nicotine or
illegal substances, and the purpose of inhalation is solely olfactory, such as, for example,
smoke from incense. The term "smoke" includes, but is not limited to, tobacco smoke,
electronic smoking device vapors, marijuana smoke, and smoke from any illegal
substance.
(r) "Smoking" means inhaling, exhaling, burning, or carrying any lighted, heated, or ignited
cigar, cigarette, cigarillo, pipe, hookah, electronic smoking device, or any plant product
intended for human inhalation.
(s) "Tobacco paraphernalia" means any item designed or marketed for the consumption, use,
or preparation of tobacco products.
(t) "Tobacco product" means any of the following:
(1) Any product containing, made from, or derived from tobacco or nicotine that is
intended for human consumption, whether smoked, heated, chewed, absorbed,
dissolved, inhaled, snorted, sniffed, or ingested by any other means, including but
F&HS Agenda Packet Page 46
DRAFT
ORDINANCE NO. (Smokefree Multi-unit Residences) REDLINE VERSION DRAFT
4
not limited to cigarettes, cigars, little cigars, chewing tobacco, pipe tobacco, and
snuff.
(2) Any electronic smoking device.
(3) Any component, part, or accessory of a tobacco product, whether or not it is sold
separately.
(4) "Tobacco product" does not include any product that has been approved by the
United States Food and Drug Administration for sale as a tobacco cessation
product or for other therapeutic purposes where the product is marketed and sold
solely for that approved purpose.
(u) "Tobacco retailer" means any individual or entity who sells, offers for sale, or exchanges
or offers to exchange for any form of consideration, tobacco, tobacco products, or
tobacco paraphernalia. "Tobacco retailing" means the doing of any of these things. This
definition is without regard to the quantity of tobacco products or tobacco paraphernalia
sold, offered for sale, exchanged, or offered for exchange.
(Ord. No. 2017-01, § II, 7-18-17; Ord. No. 2013-10, § II, 4-9-13; Ord. No. 2010-10, § II, 10-12-
10; Ord. No. 2006-66 § 4; Ord. No. 98-43 § 2; Ord. No. 91-44 § 2)
Chapter 445-4
SECONDHAND SMOKE
445-4.002 County facilities.
(a) Smoking is prohibited in all buildings, vehicles, and other enclosed areas occupied by
county employees, owned or leased by the county, or otherwise operated by the county.
(b) Smoking is prohibited in all outdoor areas owned or leased by the county, including
parking lots, the grounds of the county's hospital and health clinics, and the grounds of all
other buildings owned or leased by the county.
(c) Smoking is prohibited on the grounds of the county's jails and county juvenile system
facilities to the extent allowed by law.
(Ords. 2014-06, § II, 6-17-14, 2006-66 § 5, 91-44 § 2)
445-4.004 Prohibition of smoking.
Smoking is prohibited in the following places within the unincorporated area of Contra Costa
County:
(a) Enclosed places of employment.
F&HS Agenda Packet Page 47
DRAFT
ORDINANCE NO. (Smokefree Multi-unit Residences) REDLINE VERSION DRAFT
5
(b) Enclosed public places.
(c) Service areas.
(d) All areas within twenty feet of doors, windows, air ducts and ventilation systems of
enclosed places of employment, except while passing on the way to another destination.
(e) All areas within twenty feet of doors, windows, air ducts and ventilation systems of
enclosed public places, except while passing on the way to another destination.
(f) The following outdoor areas:
(1) Outdoor dining areas at bars and restaurants.
(2) Outdoor lounges and outdoor dining areas at places of employment.
(3) Public trails and public parks.
(4) Public event venues.
(g) All multi-unit residence common areas, except that a landlord may designate a portion of
an outdoor common area as a smoking area. A designated smoking area of an outdoor
common area of a multi-unit residence must not overlap with any area where smoking is
otherwise prohibited by local, state, or federal law; must be located at least twenty-five
feet in all directions from non-smoking areas; must not include areas used primarily by
children; must be no more than twenty-five percent of the total outdoor common area;
must have a clearly marked perimeter; and must be identified by conspicuous signs.
(h) All areas within twenty feet of doors, windows, air ducts and ventilation systems of
multi-unit residences, except while passing on the way to another destination.
(i) All outdoor balconies, porches, decks, patios, and carports of multi-unit residences.
(j) All dwelling units in any new multi-unit residence, except as otherwise provided in
Section 445-4.006that receives a building permit on or after January 1, 2011.
(Ords. 2017- ___ § 2, 2010-10 § 3, 2006-66 § 5, 91-44 § 2).
(Ords. 2010-10, § III, 10-12-10 , 2006-66 § 5, 91-44 § 2)
445-4.006 Exceptions.
(a) Smoking is permitted at any location within the county unless otherwise prohibited by
this code or by state or federal law.
(b) Smoking is permitted in up to twenty percent of guest rooms in any hotel or motel, as
long as the hotel or motel permanently designates at least eighty percent of its guest
F&HS Agenda Packet Page 48
DRAFT
ORDINANCE NO. (Smokefree Multi-unit Residences) REDLINE VERSION DRAFT
6
rooms as nonsmoking rooms, appropriately signs nonsmoking rooms, and permanently
removes ashtrays from these rooms. Smoking rooms shall be segregated from
nonsmoking rooms on separate floors, wings or portions of either. Smoking rooms and
nonsmoking rooms shall not be interspersed. Nothing in this division requires a hotel or
motel to provide smoking rooms and the owner or operator of a hotel or motel may
choose to prohibit smoking throughout the property.
(c) If a dwelling unit in a multi-unit residence is subject to a lease or other rental agreement
and smoking is authorized under the lease or rental agreement, smoking is permitted in
the dwelling unit until the lease or rental agreement is modified to prohibit smoking in
accordance with Section 445-4.014.
(d) If a dwelling unit in a multi-unit residence is owner-occupied, smoking is permitted in the
owner-occupied dwelling unit until [date, one year after effective date of ordinance].
(Ords. 2017- ___ § 2, 2010-10 § 4, 2006-66 § 5, 91-44 § 2).
(Ords. 2010-10, § IV, 10-12-10, 2006-66 § 5, 91-44 § 2)
445-4.008 Posting requirements.
(a) "Smoking" or "No Smoking" signs, whichever are appropriate, with letters of not less
than one inch in height, or the international "No Smoking" symbol (consisting of a
pictorial representation of a burning cigarette enclosed in a red circle with a red bar
across it), shall be conspicuously posted in every building or other place where smoking
is regulated by this division by the owner, operator, manager or other person having
control of the building or other place.
(b) Every hotel or motel regulated by this division shall post at its entrance a sign clearly
stating that nonsmoking rooms are available, and every patron shall be asked as to his or
her preference.
(Ords. 2006-66 § 5, 91-44 § 2)
445-4.010 Ashtray placement.
No ashtray or other receptacle used for disposing of smoking materials may be placed at any
location where smoking is prohibited by this division or otherwise prohibited by law.
(Ord. No. 2009-26, § II, 10-20-09)
445-4.012 Disclosure of non-smoking residential units.
F&HS Agenda Packet Page 49
DRAFT
ORDINANCE NO. (Smokefree Multi-unit Residences) REDLINE VERSION DRAFT
7
In a multi-unit residence where units are rented or leased to tenants, the owner and manager of
the residence shall do all of the following:
(a) Maintain and keep on file at the premises: (1) a list of all designated non-smoking units at
the residence; and (2) a floor plan of the residence that identifies the location of all
designated non-smoking units, any units where smoking is permitted, and any designated
outdoor smoking areas.
(b) Disclose whether a policy for handling smoking complaints is in effect at the multi-unit
residence, and if so, the terms of that policy.
(c) Provide a copy of the list and floor plan, and a copy of any policy for addressing smoking
complaints in effect at a multi-unit residence, to each tenant along with every new lease
or rental agreement for the occupancy of a unit in a multi-unit residence.
(Ord. No. 2009-26, § III, 10-20-09)
445-4.014 Required lease terms.
(a) Commencing [date, effective date of the ordinance]January 1, 2011, every lease and other
rental agreement for the occupancy of a dwelling unit in a multi-unit residence that is
entered into, renewed, or continued month-to-month must include the terms specified in
subsection (b) of this section on the earliest possible date allowed by law after providing
any required legal notice.
(b) Required Terms.
(1) For any multi-unit residence where the landlord has designated separate smoking
and non-smoking dwelling units, a A clause stating that smoking is prohibited in
all dwelling units that have been designated as non-smoking units must be
included in the written agreements specified in subsection (a) of this section.
(2) For any multi-unit residence where the landlord has prohibited smoking in all
dwelling units, a clause stating that smoking is prohibited in all dwelling units
must be included in the written agreements specified in subsection (a) of this
section.
(3) For any new multi-unit residence that receives a building permit on or after
January 1, 2011, a clause stating that smoking is prohibited in all dwelling units
must be included in the written agreements specified in subsection (a) of this
section.
(2)(4) A clause stating that it is a material breach of the lease or rental agreement to: (i)
violate any law regarding smoking while on the premises; (ii) smoke in a non-
smokingany dwelling unit; or (iii) smoke in any multi-unit residence common
F&HS Agenda Packet Page 50
DRAFT
ORDINANCE NO. (Smokefree Multi-unit Residences) REDLINE VERSION DRAFT
8
area where smoking is prohibited, must be included in the written agreements
specified in subsection (a) of this section.
(c) The California Apartment Association's Form 34.0, revised January 2010 December 2016
and as amended from time to time, may be used to comply with this section.
(d) A landlord's failure to enforce any smoking regulation of a lease or agreement on one or
more occasions does not constitute a waiver of the lease or agreement provisions required
by this section and does not prevent future enforcement of the lease or agreement
provisions required by this section.
(e) A landlord is not liable under this chapter to any person for a tenant's breach of smoking
regulations if:
(1) The landlord has fully complied with all provisions of this chapter, and
(2) Upon receiving a signed written complaint regarding prohibited smoking, the
landlord provides a warning to the offending tenant, stating that the tenant may be
evicted if another complaint is received. Upon receiving a second signed, written
complaint against the offending tenant, the landlord may evict the tenant, but is
not liable for the failure to do so.
(Ord. 2017- ___ § 4, 2010-10 § 5).
(Ord. No. 2010-10, § V, 10-12-10)
Chapter 445-8
ENFORCEMENT
445-8.002 Compliance.
(a) A person may not smoke in any place where smoking is prohibited by this division.
(b) A person who owns, manages, operates or otherwise controls the use of any place where
smoking is prohibited by this division may not knowingly or intentionally permit
smoking in those places. For purposes of this subsection, a person has acted knowingly or
intentionally if he or she has not taken the following actions to prevent smoking by
another person: (1) requested that a person who is smoking refrain from smoking; and (2)
requested that a person who is smoking leave the place if the person refuses to stop
smoking after being asked to stop. This section does not require physically ejecting a
person from a place or taking steps to prevent smoking under circumstances that would
involve risk of physical harm.
(c) The presence or absence of the signs required by Section 445-4.008 is not a defense to
the violation of any other provision of this division.
(Ords. 2006-66 § 7, 91-44 § 2)
F&HS Agenda Packet Page 51
DRAFT
ORDINANCE NO. (Smokefree Multi-unit Residences) REDLINE VERSION DRAFT
9
(Ord. No. 2009-26, § IV, 10-20-09)
445-8.004 Remedies.
The county may seek compliance with this division by any remedy allowed under this code,
including but not limited to administrative fines (Chapter 14-12), infraction citations (Section 14-
8.008), and any other remedy allowed by law.
(Ords. 2006-66 § 7, 2003-01 § 4, 98-43 § 2, 91-44 § 2)
445-8.006 Initiation of enforcement.
Any person may initiate enforcement of this division by notifying the director of health services
or his or her designee of any violation.
(Ords. 2006-66 § 7, 91-44 § 2)
445-8.008 Liability.
For purposes of determining liability of persons, firms, corporations, or controlling franchises
with business operations in multiple locations, each individual business location shall be deemed
a separate entity.
(Ords. 2006-66 § 7, 2003-01 § 4, 98-43 § 2).
445-8.010 No retaliation.
No person shall retaliate against any employee or applicant for employment because the
employee or applicant exercises any rights afforded by this division.
(Ords. 2006-66 § 7, 91-44 § 2)
445-8.012 Other applicable laws.
This division shall not be interpreted or construed to permit smoking where it is otherwise
restricted by other applicable laws.
(Ords. 2006-66 § 7, 91-44 § 2)
F&HS Agenda Packet Page 52
F&HS Agenda Packet Page 53
F&HS Agenda Packet Page 54
F&HS Agenda Packet Page 55
F&HS Agenda Packet Page 56
FAMILY AND HUMAN SERVICES COMMITTEE -
Special Meeting 6.
Meeting Date:11/13/2017
Subject:2017 Family and Human Services Annual Report
Submitted For: FAMILY & HUMAN SERVICES COMMITTEE,
Department:County Administrator
Referral No.: N/A
Referral Name: N/A
Presenter: Enid Mendoza, Senior Deputy County
Administrator
Contact: Enid Mendoza, (925)
335-1039
Referral History:
At the end of each calendar year, the staff person to the Family and Human Services Committee
reports to the Committee on the activities during the year and makes recommendations regarding
the closure of referrals and the carryover of other referrals to the next year.
Referral Update:
Please see attached report on the 2017 Family and Human Services Committee activities.
Recommendation(s)/Next Step(s):
ACCEPT the staff recommendations to carry forward twenty referrals and eliminate one referral
for the 2018 Family and Human Services Committee.
Fiscal Impact (if any):
There is no fiscal impact, the report is informational.
Attachments
2017 Staff Report on F&HS Referrals
F&HS Agenda Packet Page 57
County of Contra Costa
OFFICE OF THE COUNTY ADMINISTRATOR
MEMORANDUM
DATE: November 13, 2017
TO: Family and Human Services Committee
Supervisor John Gioia, Chair
Supervisor Candace Andersen, Vice Chair
FROM: Enid Mendoza, Senior Deputy County Administrator
SUBJECT: 2017 YEAR-END REPORT ON FAMILY AND HUMAN SERVICES
COMMITTEE REFERRAL ITEMS
_________________________________________________________________________
RECOMMENDATION(S):
I. ACKNOWLEDGE that the Board of Supervisors carried over the following twenty-
four referrals from the 2016 Family and Human Services (F&HS) Committee to the
2017 F&HS referral calendar:
a. Referral #5 – Continuum of Care Plan for the Homeless/Healthcare for the
Homeless
b. Referral #20 – Public Service Portion of the CDBG
c. Referral #25 – Child Care Planning/Development Council Membership
d. Referral #44 – Challenges for EHSD (Continuum of Care Reform)
e. Referral #45 – Adult Protective Services and Challenges for Aged & Disabled
Populations
f. Referral #56 – East Bay Stand Downs for Homeless Veterans / Stand Down on
the Delta
g. Referral #61 – HIV Prevention/Needle Exchange Program
h. Referral #78 – Community Services Bureau/Head Start Oversight
i. Referral #81 – Local Child Care & Development Planning Council Activities
j. Referral #82 – Secondhand Smoke Ordinance
k. Referral #92 – Local Planning Council – Child Care Needs Assessment
l. Referral #93 – Youth Services Report (formerly Independent Living Skills
Program)
m. Referral #101 – FACT Committee At-Large Appointments
n. Referral #103 – SNAP/CalFresh (Food Stamp) Program
o. Referral #107 – Laura’s Law
p. Referral #108 – Call Center Oversight and the Health Care Reform Update
q. Referral #109 – Workforce Innovation and Opportunity Act
r. Referral #110 – Innovative Community Partnerships
F&HS Agenda Packet Page 58
Page 2 of 4
s. Referral #111 – Human Trafficking – Update on Commercial Sexual
Exploitation of Children and Update on the Family Justice
Center
t. Referral #112 – Policy Options to Protect Youth from Tobacco Influences in the
Retail Environment
u. Referral #113 – Built Environment and Health in All Policies
v. Referral #114 – Impacts of Technology on Access to Public Benefits
w. Referral #115 – Child and Teen Psychiatric Services
x. Referral #116 – Public Mental Health Care Systems
II. ACKNOWLEDGE that in 2017, F&HS received reports on the following twenty-
one referrals:
a. Referral #5 – Continuum of Care Plan for the Homeless/Healthcare for the
Homeless
b. Referral #20 – Public Service Portion of the CDBG
c. Referral #25 – Child Care Planning/Development Council Membership
d. Referral #44 – Challenges for EHSD (Continuum of Care Reform)
e. Referral #56 – East Bay Stand Downs for Homeless Veterans
f. Referral #61 – HIV Prevention/Needle Exchange Program
g. Referral #78 – Community Services Bureau/Head Start Oversight
h. Referral #81 – Local Child Care & Development Planning Council Activities
i. Referral #82 – Secondhand Smoke Ordinance
j. Referral #92 – Local Planning Council – Child Care Needs Assessment
k. Referral #93 – Youth Services Report (formerly Independent Living Skills
Program)
l. Referral #101 – FACT Committee At-Large Appointments
m. Referral #103 – SNAP/CalFresh (Food Stamp) Program
n. Referral #107 – Laura’s Law
o. Referral #108 – Call Center Oversight and the Health Care Reform Update
p. Referral #109 – Workforce Innovation and Opportunity Act
q. Referral #110 – Innovative Community Partnerships
r. Referral #112 – Policy Options to Protect Youth from Tobacco Influences in the
Retail Environment
s. Referral #114 – Impacts of Technology on Access to Public Benefits
t. Referral #115 – Child and Teen Psychiatric Services
u. Referral #116 – Public Mental Health Care Systems
III. ACKNOWLEDGE that F&HS did not receive the following three reports in 2017
for the indicated reason:
a. Referral #45 – Adult Protective Services and Challenges for Aged & Disabled
Populations – Due to staffing shortages and critical staff on leave,
the Employment and Human Services Department was unable to
prepare a report on this topic as scheduled for the September
meeting. The Department plans to report on this referral at the
beginning of 2018.
F&HS Agenda Packet Page 59
Page 3 of 4
b. Referral #111 – Human Trafficking – Update on Commercial Sexual
Exploitation of Children and Update on the Family Justice
Center – Due to scheduling conflicts, the Employment and
Human Services Department was not able to report on this
referral in November as scheduled. The Department plans to
report on this referral at the beginning of 2018.
c. Referral #113 – Built Environment and Health in All Policies – The Health
Services Department provided a second follow-up report on this referral in
September of 2016, which addressed the Board’s concerns that resulted in the
referral to F&HS. On February 14, 2017, the Department included the Built
Environment report in their annual report to the Board from the Planning
Integration for Community Health (PITCH). To prevent duplication, the
Department felt an additional report to F&HS was unnecessary and should be
eliminated in future years so that the Department can continue including this
topic in their annual PITCH report.
IV. ACCEPT the Health Services Department’s recommendation to eliminate Referral
#113 – Built Environment and Health in All Policies.
V. ACKNOWLEDGE that on July 18, 2017, the Board of Supervisors accepted the
final report on Referral #108 – Call Center Oversight and the Health Care Reform
Update and accepted the recommendations of the Employment and Human
Services Department and F&HS to eliminate this referral due to the cancellation of
the contract with state to provide Covered California Call Center services and the
elimination of the call center in Contra Costa County effective December 31, 2016.
VI. ACKNOWLEDGE that on October 30, 2017, F&HS received a report from the
Health Services Department on Referral #115 – Child and Teen Psychiatric
Services and Referral #116 – Public Mental Health Care System. Due to the
overlap of pending issues and questions related to both referrals, the Department
requested that the report be combined into one F&HS report to prevent duplication
and confusion. The Department’s report was accepted by F&HS and clearly
addressed the various issues in one report.
VII. ACCEPT the recommendation of the Health Services Department to consolidate
Referral #115 – Child and Teen Psychiatric Services and Referral #116 – Public
Mental Health Care System into one referral (Referral #116 – Public Mental Health
Care Systems) since they both relate to services provided by the County within the
public mental health care system. In the Department’s annual report, they will
include updates on the topic of psychiatric services to children and youth.
VIII. ACKNOWLEDGE that Referral #61 – HIV Prevention/Needle Exchange
Program is a biannual report to F&HS and that after today’s report to F&HS a
report will not be due to F&HS until 2019.
F&HS Agenda Packet Page 60
Page 4 of 4
IX. ACCEPT the recommendation to carry forward the following twenty referrals from
the 2017 Family and Human Services Committee to the 2018 Committee:
a. Referral #5 – Continuum of Care Plan for the Homeless/Healthcare for the
Homeless
b. Referral #20 – Public Service Portion of the CDBG
c. Referral #25 – Child Care Planning/Development Council Membership
d. Referral #44 – Challenges for EHSD (Continuum of Care Reform)
e. Referral #45 – Adult Protective Services and Challenges for Aged & Disabled
Populations
f. Referral #56 – East Bay Stand Downs for Homeless Veterans / Stand Down on
the Delta
g. Referral #78 – Community Services Bureau/Head Start Oversight
h. Referral #81 – Local Child Care & Development Planning Council Activities
i. Referral #82 – Secondhand Smoke Ordinance
j. Referral #92 – Local Planning Council – Child Care Needs Assessment
k. Referral #93 – Youth Services Report (formerly Independent Living Skills
Program)
l. Referral #101 – FACT Committee At-Large Appointments
m. Referral #103 – SNAP/CalFresh (Food Stamp) Program
n. Referral #107 – Laura’s Law
o. Referral #109 – Workforce Innovation and Opportunity Act
p. Referral #110 – Innovative Community Partnerships
q. Referral #111 – Human Trafficking – Update on Commercial Sexual
Exploitation of Children and Update on the Family Justice Center
r. Referral #112 – Policy Options to Protect Youth from Tobacco Influences in the
Retail Environment
s. Referral #114 – Impacts of Technology on Access to Public Benefits
t. Referral #116 – Public Mental Health Care System
X. DIRECT staff to forward the year-end report to the Board of Supervisors for their
information.
F&HS Agenda Packet Page 61