HomeMy WebLinkAboutBOARD STANDING COMMITTEES - 10072019 - FHS Cte Agenda Pkt
FAMILY & HUMAN SERVICES
COMMITTEE
SPECIAL MEETING
October 7, 2019
Note changed time: 1:00 P.M.
Note changed location: 625 Court St., Room B001, Martinez
Supervisor Candace Andersen, Chair
Supervisor John Gioia, 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. RECEIVE and APPROVE the draft Record of Action for the September 23, 2019
Family & Human Services Committee meeting. (Julie DiMaggio Enea, County
Administrator's Office)
4. RECOMMEND to the Board of Supervisors the appointment of Y'Anad Burrell to the
At Large 1 seat on the Arts and Culture Commission of Contra Costa County to a term
expiring June 30, 2023, as recommended by the Commission. (Julia Taylor, County
Administrator's Office)
5. RECOMMEND to the Board of Supervisors the appointment of Kathie Thompson to
At Large #3 seat, and Gerald Richards to At Large #9 seat, with terms expiring
September 30, 2021, on the Advisory Council on Aging, as recommended by the
Council. (Anthony Macias, Employment and Human Services Department)
6. CONSIDER accepting a status update from the Public Health Division of the Health
Services Department on the implementation of the Secondhand Smoke Protections
Ordinance and directing staff to report back to the Family and Human Services
Committee meeting in 2020. (Daniel Peddycord, Public Health Director)
7. CONSIDER accepting report on the on the implementation of the tobacco retailer
licensing and businesses zoning ordinances. (Daniel Peddycord, Public Health
Director)
8. CONSIDER accepting the Annual Report of the Assisted Outpatient Treatment
Program for the period January 1 through December 31, 2018. (Warren Hayes, Health
Services - Mental Health Program Chief)
9.The November 25, 2019 meeting of the Family and Human Services Committee has
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9.The November 25, 2019 meeting of the Family and Human Services Committee has
been canceled due to the Thanksgiving holidays. A special meeting has been scheduled
for Wednesday, November 13, 2019 at 10:30 a.m.
10.Adjourn
The Family & Human Services Committee will provide reasonable accommodations for persons
with disabilities planning to attend Family & Human Services Committee meetings. Contact the
staff person listed below at least 72 hours before the meeting.
Any disclosable public records related to an open session item on a regular meeting agenda and
distributed by the County to a majority of members of the Family & Human Services Committee
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:
Julie DiMaggio Enea, Interim Committee Staff
Phone (925) 335-1077, Fax (925) 646-1353
julie.enea@cao.cccounty.us
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FAMILY AND HUMAN SERVICES
COMMITTEE 3.
Meeting Date:10/07/2019
Subject:RECORD OF ACTION FOR THE SEPTEMBER 23, 2019 FHS
MEETING
Submitted For: David Twa, County Administrator
Department:County Administrator
Referral No.: N/A
Referral Name: N/A
Presenter: Julie DiMaggio Enea Contact: Julie DiMaggio Enea (925)
335-1077
Referral History:
County Ordinance requires that each County body keep a record of its meetings. Though the
record need not be verbatim, it must accurately reflect the agenda and the decisions made in the
meeting.
Referral Update:
Attached is the draft Record of Action for the September 23, 2019 Family & Human Services
Committee meeting.
Recommendation(s)/Next Step(s):
RECEIVE and APPROVE the draft Record of Action for the September 23, 2019 Family &
Human Services Committee meeting.
Fiscal Impact (if any):
None.
Attachments
Draft FHS Record of Action for Septemver 23, 2019
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FAMILY AND HUMAN SERVICES
COMMITTEE
RECORD OF ACTION FOR
SEPTEMBER 23, 2019
Supervisor Candace Andersen, Chair
Supervisor John Gioia, Vice Chair
Present: Chair Candace Andersen
Vice Chair John Gioia
Staff Present:Julie DiMaggio Enea, Sr. Deputy County Administrator
Attendees:Rebecca Darnell, EHSD; Warren Hayes, HSD Behavioral Health Services; Leslie May, MH
Commission; Colleen Kauth, Bay Area Legal Aid; Luis Tenorio, Bay Area Legal Aid; Suzanne
Tavano, HSD Behavioral Health Services; Carolyn Foudy, EHSD; Colleen Isenberg, District
IV Supervisor's Office; Douglas Dunn, MH Commission; Kathi McLaughlin, CPAW; Kathy
Gallagher, EHS Director; Rich Wengal, Youth Homes; David Bergesen, COFY, Inc.; Susanna
Marshland, Fred Finch Youth Center; Leticia Galyean, Seneca Family of Agencies; Antionette
Harris, Uplift Family Services; David Geiger, Human Services Alliance of CCC; Jay Berlin,
Alternative Family Services; Pete Caldwekk, We Care Services; Jill Ray, BOS District II
Representative; Barbara Serwin, MH Commission; Mariana Moore, Ensuring Opportunity;
Tracy Murray, EHSD
1.Introductions
Chair Andersen convened the meeting at 10:32 a.m. and invited attendees to
introduce themselves.
2.Public comment on any item under the jurisdiction of the Committee and not on this
agenda (speakers may be limited to three minutes).
No one offered testimony during the public comment period.
3.RECEIVE and APPROVE the draft Record of Action for the July 29, 2019 Family &
Human Services Committee meeting.
The Record of Action for the July 29, 2019 meeting was approved as presented.
AYE: Chair Candace Andersen, Vice Chair John Gioia
Passed
4.ACCEPT the joint update report from Behavioral Health Services and the Mental Health
Commission on the public mental health care system, child and teen psychiatric services.
DRAFT
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Behavioral Health Director Suzanne Tavano summarized the staff report, advising
that under Managed Care, the County must meet certain State compliance
standards. She reported that the County has met the standards for the required
number of providers but fell slightly short of the standard for timeliness in
consultations and medication. She noted that there had been incremental
improvement, with non-psychiatry wait times meeting the 10-day standard and
psychiatry wait times close to meeting the 15-day standard. She highlighted the
expansion of tele-psychiatry as one of the strategies used by the department to
reduce wait times.
Suzanne discussed how the department has analyzed the flow of people through the
behavioral health system and determined that housing is a serious bottleneck and
should be the focus of current attention. Behavioral Health works closely with the
County's Homeless (H3) program to smooth the transition of people from hospital to
locked facility to community housing settings. She noted that funding and regulatory
silos hinder these efforts. She observed that the lack of adequate step-down
programs result in lengthier hospital stays than are strictly necessary.
Vice Chair Gioia noted that H3 has been working with the City of San Pablo to
leverage HUD funding to construct 60-70 units of housing with supportive services
in San Pablo. He praised the City of San Pablo for its strong collaboration with the
County on the housing project, a library, a fire station, a WIC (Women, Infants and
Children) site, and the West County Health Center.
Suzanne commented that the County's open-door policy to psychiatric emergency
services (PES) is generous when compared to other counties, noting that the
majority of counties do not have crisis stabilization units (CSUs) as does Contra
Costa County. She noted that the average daily population at PES is 40, which is a
challenge in that limited space. She remarked on the push and pull between PES
beds and hospital beds, and the way cost reimbursement influences that relationship.
She reported visiting adult and children CSUs and thought that the Willow Rock
CSU (Alameda Co.) might be a good model to implement in this county if separate
space for a children's facility could be identified. She noted how traumatizing it can
be for a child to witness a W&I 5150 (psychiatric emergency) event.
She concluded by stating that the County and its community contractors struggle to
find qualified providers due to lack of competitive salaries.
Barbara Serwin spoke on behalf of the Mental Health Commission, praising the
new Behavioral Health leadership and their fresh approach to solving old problems.
She appreciates the division of responsibilities among the new leadership. She is of
the opinion that PES redesign should be the priority, citing the findings in a 2019
grand jury report. She reported that the MH Commission will reach out to
community partners to collate best practice concepts and bring those to the FHS
Committee for consideration.
Douglas Dunn provided a handout (attached) that discusses the impacts of a
shortage of step-down programs and housing for persons discharged from locked
facilities. He claimed that the County's locked facility budget was balanced only by a
DRAFT
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temporary savings in other programs. He recommended that the County support the
repeal of the Medi-Cal reimbursement exclusion.
Chair Andersen was not present during the testimony of the following public
speakers, who each spoke about the need of community-based mental health
services providers for additional funding, and their struggles to maintain staffing
and services with uncompetitive salaries: Dan Geiger, Rich Wengal, David
Bergeson, Susanna Marshland, Leticia Galyean, Antoinette Harris, Pete Caldwell,
and Jay Berlin.
Vice Chair Gioia assured the speakers that the Board of Supervisors is aware of
their predicament and, earlier this year, authorized the formation of a work group to
study the problem. He advised that Health Services Director Anna Roth will contact
the agencies soon. He observed that Contra Costa County has a lower tax base than
neighboring counties and also lacks a local sales tax that many other counties enjoy.
He advised that the Board's Finance Committee is studying a proposal for a local
sales tax initiative and, should it be pursued, will need the help of community
partners to raise awareness of the need.
Suzanne added that HSD has already begun gathering salary data from the County's
community contractors and has also engaged an outside consultant to assist with the
study effort.
Leslie May suggested that the community partners recruit at college campuses.
The Committee accepted the report and directed staff to forward it to the Board of
Supervisors on Consent for their information. The Committee directed HSD to
report back in one year.
AYE: Chair Candace Andersen, Vice Chair John Gioia
Passed
5.ACCEPT status report on the Employment and Human Services Department's providing
an update on CalFresh and the department's implementation of the CalFresh benefits
expansion.
Kathy Gallagher and Rebecca Darnell presented the CalFresh annual update and
SSI expansion reports. Kathy reported that CalFresh applications are beginning to
level off at about 2,700 per month as compared to 2,200 per month prior to the SSI
expansion.
Kathy also advised that effective September 1, the current waiver for Contra Costa
County from the Able Bodied Adults Without Dependents (ABAWD) 90-day limit for
CalFresh benefits was terminated. The termination of this waiver is somewhat
mitigated by individual exemptions that are allotted to each state based on annual
caseload. The County has adopted the State's criteria for granting the exemptions
and has elected to approve exemptions for all individuals who have exhausted their
90-days of benefits. The exemptions will maintain benefits for these individuals until
April 2020 or until such time that employment is found for them.
DRAFT
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Rebecca reported that the Food Bank and other community organizations such as
Opportunity Junction have partnered with EHSD to assist clients in navigating the
application process to receive new or expanded benefits or ABAWD exemptions.
Caitlyn Sly alleged that EHSD was unwisely discouraging clients from using the
"Get CalFresh.org" website to apply for benefits.
Mariana Moore commented that EHSD should not celebrate the leveling off of new
CalFresh applications. She stated that the significant unmet need warrants further
outreach. She requested data from EHSD on the number of recipients who qualified
for only a $15 benefit vs. those who qualified for more once the Medi-Cal exemption
was verified. She felt that telegraphing a low expectation for additional benefits had
discouraged participation.
Colleen Kauth complained that EHSD had not responded to her letter sent in
June/July, to which Kathy Gallagher responded that she was in consultation with
County Counsel. Ms. Kauth stated that while 90% compliance is the threshold to
avoid DHS fines, 100% compliance is required by law.
Vice Chair Gioia wrapped up the discussion by asking EHSD to provide better
estimates of potential benefits to people to encourage greater participation.
The Committee accepted the report and Vice Chair Gioia asked that the Bay Area
Legal Aid's concerns be referred for discussion by the Board in its next closed
session. He also directed EHSD to report back to the Committee in November with a
written outreach plan involving community partners and with a current staffing
model and proposed staffing model should there be new federal funding allocations.
AYE: Chair Candace Andersen, Vice Chair John Gioia
Passed
6.The October 28, 2019 meeting of the Family and Human Services Committee has been
canceled. A special meeting has been scheduled for October 7, 2019 at 1:00 p.m. in
Room B001, County Finance Building, 625 Court Street, Martinez.
7.Adjourn
Vice Chair Gioia adjourned the meeting at 12:25 p.m.
For Additional Information Contact:
Julie DiMaggio Enea, Interim Committee Staff
Phone (925) 335-1077, Fax (925) 646-1353
julie.enea@cao.cccounty.us
DRAFT
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FAMILY AND HUMAN SERVICES COMMITTEE 4.
Meeting Date:10/07/2019
Subject:Appointment to the Arts and Culture Commission
Submitted For: David Twa, County Administrator
Department:County Administrator
Referral No.: N/A
Referral Name: N/A
Presenter: Julia Taylor Contact: Julia Taylor, 925.335.1043
Referral History:
On December 6, 2011 the Board of Supervisors (BOS) adopted Resolution No. 2011/497
adopting policy governing appointments to boards, committees, and commissions that are
advisory to the BOS. Included in this resolution was the requirement that applications for at
large/countywide seats be reviewed by a Board of Supervisors committee.
Referral Update:
The Arts and Culture Commission advises the Board of Supervisors in matters and issues relevant
to Arts and Culture, to advance the arts in a way that promotes communication, education,
appreciation and collaboration throughout Contra Costa County; to preserve, celebrate, and share
the arts and culture of the many diverse ethnic groups who live in Contra Costa County; to create
partnerships with business and government; to increase communications and understanding
between all citizens through art. Most importantly, the Commission will promote arts and culture
as a vital element in the quality of life for all of the citizens of Contra Costa County.
The Arts and Culture Commission (AC5) is composed by one representative from each of the five
supervisorial districts, four at-large representatives and one alternate, for a total of ten seats.
Appointments are for a four-year period with terms expiring on June 30 of alternating odd
numbered years. The current roster is listed in the attached memo. There are currently no vacant
seats. At their July meeting, AC5 voted to nominate Y'Anad Burrell to the At Large 1 seat, for
which the term expired on June 30, 2019.
Recommendation(s)/Next Step(s):
RECOMMEND to the Board of Supervisors the appointment of Y'Anad Burrell to the At Large 1
seat on the Arts and Culture Commission of Contra Costa County (AC5) to a term expiring June
30, 2023, as recommended by AC5.
Attachments
Y. Burrell Appointment Memo 8
Y. Burrell Appointment Memo
Y. Burrell Application
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ARTS AND CULTURE COMMISSION OF CONTRA COSTA COUNTY
651 PINE STREET, 10TH FLOOR, MARTINEZ, CA 94553
STAFF@AC5.CCCOUNTY.US (925) 646-2278 AC5.ORG
July 25, 2019
Family and Human Services Committee
Appointment Recommendation for Arts and Culture Commission of Contra Costa County
Please consider the appointment of:
Ms. Y’Anad Burrell Richmond, District 1 Al-Large #1 Seat
This appointment will fill the Al-Large #1 Seat
Current Commission Seats:
Commissioner Silvia Ledezma Richmond, District I
Commissioner Beverly Kumar Danville, District II
Commissioner Petural Shelton Danville, District III
Commissioner Elizabeth Wood Concord, District IV
Commissioner Teresa Snook O’Riva Rodeo, District V
Commissioner Y”Anad Burrell Richmond, At-Large I
Commissioner LaMar Anderson Concord, At-Large II
Commissioner Joan D'Onofrio Concord, At-Large III
Commissioner Lanita Mims Antioch, At-Large IV
Commissioner Pearl Parmelee Cabrera Alternate
After reviewing five applications and careful consideration of issues relevant to Arts and Culture
in Contra Costa County, including advancing the arts in a way that fosters creatively within the
community and celebrates our diverse cultural expression, the Commission recommends Y’Anad
Burrell to fill the At-Large #1 Seat.
Working with the current AC5 Commissioners, this new Commissioner will promote the Arts and
culture as a vital element in the quality of life for all of the citizens of Contra Costa County.
Recruitment efforts including two months of posting on the CCTV Bulletin board, news releases
sent to many news outlets, posting on Supervisors newsletter, emails sent on Constant Contact
and posting on the AC5 website.
Also considered were applications from Carolyn Considine , Lafayette; Ben Miyaji, Pittsburg;
Martha Newman, Kensington and Charmion Patton, Richmond.
Sincerely,
Roger Renn, AC5 Managing Director
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Please return completed applications to:
Clerk of the Board of Supervisors
651 Pine St., Room 106
Martinez, CA 94553
or email to: ClerkofTheBoard@cob.cccounty.us
First Name Last Name
Home Address - Street City Zip Code
Phone (best number to reach you)Email
Resident of Supervisorial District:
EDUCATION Check appropriate box if you possess one of the following:
High School Diploma CA High School Proficiency Certificate G.E.D. Certificate
Course of Study/Major Degree Awarded
Yes No
Yes No
Yes No
Other Training Completed:
Board, Committee or Commission Name Seat Name
Have you ever attended a meeting of the advisory board for which you are applying?
No Yes If yes, how many?
Please explain why you would like to serve on this particular board, committee, or commission.
Describe your qualifications for this appointment. (NOTE: you may also include a copy of
your resume with this application)
I am including my resume with this application:
Please check one: Yes No
I would like to be considered for appointment to other advisory bodies for which I may be qualified.
Please check one: Yes No
Contra
Costa
County
BOARDS, COMMITTEES, AND COMMISSIONS APPLICATION
Colleges or Universities Attended
THIS FORM IS A PUBLIC DOCUMENT
Y'ANAD BURRELL
RICHMOND
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SAN FRANCISCO STATE UNIVERSITY ACCOUNTING
GOLDEN GATE UNIVERSITY PUBLIC ADMINISTRATION
GOLDEN GATE UNIVERSITY HEALTHCARE MANAGEMENT
PARALEGAL CERTIFICATE, FUNDRAISING CERTIFICATE
ARTS & CULTURE COMMISSION CONTRA COSTA COUNTY AT-LARGE
Served for 7 years as AC5 Commissioner
I have served on this commission for the last 7 years and would like to continue that endeavor. At our June 3rd Commission meeting I was voted in as Chair of the Commission and
very honored for the opportunity.
I joined this commission out of my passion and interest for diversity, inclusion and equity in the arts sector. Here is a partial list of my activities over the years: (1) Introducing the Art of
Living Black to AC5 where the group now participates regularly in Art Passage event; (2) represented AC5 on Create CA Committees; (3) participated as a Judge on several youth art
competitions in the county; (4) Participated as a grant reviewer with the California Arts Council; (5) I Chair the AC5 Communications Committee and co-lead the rebranding of the AC5
logo; and (6) we are currently in the process of developing a plan to develop a new county-wide Cultural Plan, as the last one was done over 15 years ago.
I have more than 15 years in the arts and culture spaces from producing art/fashion events to
being an advocate for diversity in the arts. I served for 7 years on the Leadership Vanguard
Committee for the Museum of the African Diaspora (MoAD) in San Francisco as well.
Print Form
✔
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Are you currently or have you ever been appointed to a Contra Costa County advisory board?
Please check one: Yes No
List any volunteer and community experience, including any boards on which you have served.
Do you have a familial relationship with a member of the Board of Supervisors? (Please refer to
the relationships listed below or Resolution no. 2011/55)
Please check one: Yes No
If Yes, please identify the nature of the relationship:
Do you have any financial relationships with the county, such as grants, contracts, or
other economic relationships?
Please check one: Yes No
If Yes, please identify the nature of the relationship:
Signed: Date:
Submit this application to: Clerk of the Board of Supervisors
651 Pine St., Room 106
Martinez, CA 94553
6. Some boards, committees, or commissions may assign members to subcommittees or work groups which may require an additional
commitment of time.
5. Meeting dates and times are subject to change and may occur up to two (2) days per month.
7. As indicated in Board Resolution 2011/55, a person will not be eligible for appointment if he/she is related to a Board of Supervisors member in
any of the following relationships: mother, father, son, daughter, brother, sister, grandmother, grandfather, grandson, granddaughter, great-
grandfather, great-grandmother, aunt, uncle, nephew, niece, great-grandson, great-granddaughter, first-cousin, husband, wife, father-in-law,
mother-in-law, daughter-in-law, stepson, stepdaughter, sister-in-law, brother-in-law, spouse's grandmother, spouse's grandfather, spouse's
granddaughter, and spouses' grandson, registered domestic partner, relatives of a registered domestic partner as listed above.
8. A person will not be eligible to serve if the person shares a financial interest as defined in Government Code §87103 with a Board of Supervisors
Member.
Important Information
1. This application and any attachments you provide to it is a public document and is subject to the California Public Records Act (CA Government
Code §6250-6270).
2. All members of appointed bodies are required to take the advisory body training provided by Contra Costa County.
3. Members of certain boards, commissions, and committees may be required to: 1) file a Statement of Economic Interest Form also known as a
Form 700, and 2) complete the State Ethics Training Course as required by AB 1234.
4. Meetings may be held in various locations and some locations may not be accessible by public transportation.
I CERTIFY that the statements made by me in this application are true, complete, and correct to the best of my
knowledge and belief, and are made in good faith. I acknowledge and understand that all information in this
application is publicly accessible. I understand and agree that misstatements and/or ommissions of material fact may
cause forfeiture of my rights to serve on a board, committee, or commission in Contra Costa County.
Questions about this application? Contact the Clerk of the Board at (925) 335-1900 or by email at
ClerkofTheBoard@cob.cccounty.us
THIS FORM IS A PUBLIC DOCUMENT
Healthy Richmond, Access to Quality Healthcare Committee
Board Member, PEERS (Community Mental Health)
PRSA National, Diversity & Inclusion Committee (Public Relations Society of America)
Past Vice President/SF Bay Area | California Diversity Council
Past President, Public Relations Society of America (PRSA), SF Chapter (2016)
Former Vanguard Advisory Council Member, Museum of the African Diaspora (2010 – 2017)
Y'Anad Burrell 6/10/19
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FAMILY AND HUMAN SERVICES
COMMITTEE 5.
Meeting Date:10/07/2019
Subject:Appointment to the Advisory Council on Aging
Submitted For: Kathy Gallagher, Employment & Human Services Director
Department:Employment & Human Services
Referral No.: N/A
Referral Name: N/A
Presenter: Anthony Macias Contact: Anthony Macias,
925.602.4175
Referral History:
On December 6, 2011 the Board of Supervisors adopted Resolution No. 2011/497 adopting policy
governing appointments to boards, committees, and commissions that are advisory to the Board of
Supervisors. Included in this resolution was a requirement that applications for at
large/countywide seats be reviewed by a Board of Supervisors committee.
The Advisory Council on Aging provides a means for county-wide planning, cooperation and
coordination for individuals and groups interested in improving and developing services and
opportunities for the older residents of this County. The Council provides leadership and
advocacy on behalf of older persons and serves as a channel of communication and information
on aging.
The Advisory Council on Aging consists of 40 members serving 2 year staggered terms, each
ending on September 30. The Council consists of representatives of the target population and the
general public, including older low-income and military persons; at least one-half of the
membership must be made up of actual consumers of services under the Area Plan. The Council
includes: 19 representatives recommended from each Local Committee on Aging, 1
representative from the Nutrition Project Council, 1 Retired Senior Volunteer Program, and 19
Members at-Large.
Referral Update:
There are currently 29 seats filled on the Advisory Council on Aging and 11 vacancies. These
vacant seats include: Local Committee Oakley, Local Committee San Pablo, Local Committee
Lafayette, Local Committee Moraga, Local Committee San Ramon, Local Committee Martinez,
Local Committee Pinole, Local Committee Pittsburg, and Member-At-Large seats 3, 8, and 9.
This recommended appointment will bring the membership to 31, leaving 9 seats vacant.
Recommendation(s)/Next Step(s):
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RECOMMEND to the Board of Supervisors the appointment of Kathie Thompson to At Large #3
seat, and Gerald Richards to At Large #9 seat, with terms expiring September 30, 2021, on the
Advisory Council on Aging, as recommended by the Council.
Fiscal Impact (if any):
There is no fiscal impact.
Attachments
K. Thompson Application
K. Thompson Appointment Memo
G. Richards Application
G. Richards Appointment Memo
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Kathy Gallagher, Director
40 Douglas Dr., Martinez, CA 94553 Phone: (925) 313-1579 Fax: (925) 313-1575 www.cccounty.us/ehsd .
MEMORANDUM
DATE: 06/27/2019
T O: Family and Human Services Committee
CC: Tracy Murray, Deputy Director, Aging and Adult Services
FROM : Anthony Macias, Staff Representative for the Advisory Council on Aging
SUBJECT: Advisory Council on Aging – Appointment Requested
The Contra Costa Area Agency on Aging (AAA) recommends for immediate appointment to the
Contra Costa Advisory Council on Aging (ACOA) the following applicant: Ms. Kathie Thompson
for Member at Large (MAL) Seat # 3. The MAL #3 seat is undesignated and has remained vacant
since 03/26/2019, with term ending 9/30/2019.
Recruitment has been handled by both the Area Agency on Aging, the ACOA and the Clerk of the
Board using CCTV. AAA staff has encouraged interested individuals including minorities to apply
through announcements provided at the Senior Coalition meetings and at the regular monthly
meetings of the ACOA. The Contra Costa County EHSD website contains dedicated web content
where interested members of the public are encouraged to apply and provided an application with
instructions on whom to contact for ACOA related inquiries, including application procedure.
Ms. Thompson submitted an application for ACOA membership dated 06/13/2018 that is provided as
a separate attachment. An interview with Ms. Thompson and the ACOA Membership Committee
was held on 08/15/2018. Ms. Thompson was then selected to be placed on the wait list for the next
available opening of an MAL seat. When MAL#3 seat was vacated on 04/09/2019, Ms. Thompson
was recommended to the ACOA Executive Committee for approval to fill this seat. At the 06/5/2019
Executive Committee meeting. Ms. Thompson was approved unanimously by this committee to fill
MAL#3 seat. The members of the ACOA voted unanimously to approve Ms. Tobey’s appointment
recommendation at their 06/17/2019 meeting.
Thank You
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Kathy Gallagher, Director
40 Douglas Dr., Martinez, CA 94553 Phone: (925) 313-1579 Fax: (925) 313-1575 www.cccounty.us/ehsd .
MEMORANDUM
DATE: 09/05/2019
T O: Family and Human Services Committee
CC: Tracy Murray, Director Aging and Adult Services
FROM : Anthony Macias, Staff Representative for the Advisory Council on Aging
SUBJECT: Advisory Council on Aging – Appointment Requested
The Contra Costa Area Agency on Aging (AAA) recommends for immediate appointment to the
Contra Costa Advisory Council on Aging (ACOA) the following applicant: Mr. Gerald Richards for
Member at Large Seat # 9. The MAL #9 seat is undesignated and has remained vacant since May 15,
2019.
Recruitment has been handled by both the Area Agency on Aging, the ACOA and the Clerk of the
Board using CCTV. AAA staff has encouraged interested individuals including minorities to apply
through announcements provided at the Senior Coalition meetings and at the regular monthly
meetings of the ACOA. The Contra Costa County EHSD website contains dedicated web content
where interested members of the public are encouraged to apply and are provided an application with
instructions on whom to contact for ACOA related inquiries, including application procedure.
Mr. Richards was a prior member of the ACOA. A re-interview was determined to be unnecessary to
fill MAL #9 on the ACOA with term ending 9/30/2021. Mr. Richards submitted an application for
ACOA membership dated 03/26/2019 that is provided as a separate attachment. At the time of his
ACOA Membership Committee selection to fill one of the At Large vacancies there were no other
applicants; the ACOA voted to approve Mr. Richards’s appointment recommendation at their
08/21/19 meeting.
Thank You
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FAMILY AND HUMAN SERVICES
COMMITTEE 6.
Meeting Date:10/07/2019
Subject:Secondhand Smoke Ordinance
Submitted For: Anna Roth, Health Services Director
Department:Health Services
Referral No.: FHS #82
Referral Name: Secondhand Smoke Ordinance
Presenter: Daniel Peddycord, Public Health
Director
Contact: Jen Grand-Lejano (925)
313-6216
Referral History:
At the November 13, 2017 Family and Human Services Committee meeting, Public Health
presented its annual report on the implementation of the County’s Secondhand Smoke ordinance
with a recommendation that the Committee consider a proposed ordinance to strengthen the
current smoking protections to prohibit smoking inside dwelling units of multi-unit housing,
including condos and townhomes. The Committee accepted the report and recommendations,
requested that language be added to extend smoking restrictions to guest rooms of hotels and
motels, and directed staff to forward those recommendations to the Board of Supervisors for
discussion and approval.
The ordinance, titled Smoke-free Multi Unit Residences, was adopted by the Board of Supervisors
on March 13, 2018 with implementation to begin for new and renewing leases on July 1, 2018,
and for continuing leases and owner-occupied units on July 1, 2019. At the request of the Board
of Supervisors, Contra Costa Public Health staff provided reports in March 2018 on preliminary
implementation of the ordinances with a follow up report to the Family and Human Services
Committee being made in October of 2018, at which FHS asked Public Health staff to send a
letter to each City Manager inviting them to model their own city ordinances after the County's
ordinance.
Referral Update:
Please see the attached report from the Public Health Division of the Health Services Department
with an update, since the October 2018 report, on the implementation of the Secondhand Smoke
Protections Ordinance.
23
Recommendation(s)/Next Step(s):
ACCEPT the annual report from the Public Health Division of 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.
DIRECT staff to provide updates on implementation of the ordinance as part of staff’s annual
report on the County’s Tobacco Retail Licensing Ordinance.
Fiscal Impact (if any):
There is no fiscal impact.
Attachments
Annual Report on Implementation of Secondhand Smoke Protections Ordinance
Letter to Landlords re Smokefree MUH
Letter Accompanying Actual License
24
• 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 •
ANNA M. ROTH, RN, MS, MPH
HEALTH SERVICES DIRECTOR
DANIEL PEDDYCORD, RN, MPA/HA
DIRECTOR OF PUBLIC HEALTH
C ONTRA C OSTA
P U BLIC H EALTH
597 CENTER AVENUE, SUITE 200
MARTINEZ, CALIFORNIA 94553
PH (925) 313-6712
FAX (925) 313-6721
DANIEL.PEDDYCORD@HSD.CCCOUNTY .US
To : Family and Human Services Committee, Contra Costa Board of Supervisors
From: Daniel Peddycord, RN, MPA/HA, Director, Public Health
Re: Annual Report on Implementation of Secondhand Smoke Protections Ordinance
Date: 10/07/19
I. Summary
The Smoke-free Multi Unit Residences ordinance was adopted by the Board of Supervisors on March 13,
2018 with implementation to begin for new and renewing leases on July 1, 2018, and for continuing
leases and owner-occupied units on July 1, 2019. A brief report specific to implementation of the new
Smoke-free Multi-Unit Residences ordinance is presented, including information on the continued
implementation of the broader Smoke-free Secondhand Protections Ordinance.
II. Secondhand Smoke Ordinance Background
The Board continues to respond to community needs by strengthening the County’s secondhand smoke
protections in October 2009, October 2010, April 2013, June 2014, July 2017, and March 2018.
Additional policies have been adopted to address community complaints regarding drifting smoke within
multiunit housing within county limits. These amendments to the county code included expanding
secondhand smoke protections to make all County-owned properties 100% smoke-free, inclusion of
electronic smoking devices in the definition of “secondhand smoke”, and 100% smoke -free multi-unit
housing including condos, townhomes, and guest rooms of hotels and motels.
III. Implementation of Smoke-free Multi-Unit Housing Residences since the October 2018
report to Board of Supervisors
The Smokefree Multi-Unit Residences ordinance is implemented through the Public Health
Department’s Tobacco Prevention Program (TPP).
The Public Health staff worked with the Business License Office to include information about the newly
adopted smoke-free multi-unit residence ordinance in the annual mailing to all business owners. In May
2019, the Business License Office mailed annual business renewal reminder letters and the County’s
Secondhand Smoke Protections brochure to all owners of multi-unit residences of 4 or more dwelling
units who currently have a Contra Costa business license. The mailing directed owners to the TPP
Secondhand Smoke website to highlight the laws and provide resources to landlords, including signage
and template language to add to their lease agreements. Since the County’s secondhand smoke
protections defines multi-unit housing as a dwelling with 2 or more units, Public Heath staff also sent
notification letters to all multi-unit housing owners who own 2 or more units. The mailing directed
owners to the TPP Secondhand Smoke website to highlight the newly adopted laws, resources they can
use, and an electronic form that verifies their compliance to the ordinance. This compliance form allows
Public Health staff to streamline the correspondence with landlords to ensure that all multi-unit owners
and property managers have received information about the new laws and implemented new
requirements such as updating all leases to include required smoke-free language and meeting required
signage posting requirements.
25
∎ 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 ∎
Of the 5,028 educational letters sent to multiunit housing landlords and managers, we received 487
responses to the policy verification survey. The data was collected through an online form and exported
into an Excel spreadsheet for analysis. Almost all of the respondents (97%) reported being compliant with
the following component: disclosing the policy for handling smoking complaints in effect at the multi-unit
housing residence and providing a copy of that policy to each tenant along with every new lease or rental
agreement for the occupancy of a unit in a multi-unit housing residence. Of the 15 respondents (3%) who
reported not being in compliance, most of them explained that they owned units that they lived in or said
that this policy should be the responsibility of the Home Owners Association (HOA).
Public Health staff created an online link for the public to report secondhand smoke complaints and
request information. This link is available on the TPP Secondhand Smoke website to facilitate a more
streamlined complaint process, and standardize information received through complaints, such as the
location within the unincorporated areas of the County and the type of smoke reported (e.g., cannabis,
vape, or combustible tobacco).
Lastly, Public Health staff conducted outreach and education efforts to the community that included a
social media campaign to raise awareness about the health risks of secondhand smoke, the policies in
place to protect residents, and how to make a complaint about drifting smoke in multi-unit residences.
IV. Enforcement of Smoke-free Multi-Unit Housing Residences
With a focus on providing education to residents, landlords, owners, property managers and operates,
Public Health staff prioritizes compliance over punishment for violations. However, in the instances
where enforcement is needed, Public Health staff has established a uniformed process for the smoke-free
multi-unit residence ordinance. The following steps have been developed by Public Health staff in
partnership with Contra Costa County Counsel.
1. Staff will document secondhand smoke complaint and verify jurisdiction within the
unincorporated areas of county limits.
2. Staff will communicate with property owners via phone and informal email letter to
landlord/tenant in violation making them aware of the compliant and what is needed to be
compliant.
3. Staff will grant a 30-day period to the property owner to make arrangements in order to be in
compliance.
4. Staff will conduct visits to review and determine if issues concerning signage, lease addendum, or
other complaints on smoking within the property have been addressed and the property is in
compliant.
5. Should there be times if the issue persists without prior communication for delay, staff will
administer formal notice of violation letter in the mail.
6. Should there be continued non-compliance; the staff will issue formal infraction citation(s) with
invoice with associated fine amount until the property remedies smoking violations.
7. Staff will determine if violations are addressed and property is in compliance.
V. Next Steps for Compliance
Public Health staff with members of the Tobacco Prevention Coalition will be conducting "no smoking"
signage observations in November 2019. The observations will be for the most common size multi-unit
residence buildings in two of the largest low-income communities within the unincorporated Contra
Costa County, Bay Point and El Sobrante. Public Health staff will determine and the compliance through
26
∎ 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 ∎
observations of smoke-free signage and presence (or lack thereof) of ashtrays within several buildings.
Each property observed will be documented with photo documentation, survey results, letters to
landlords, tenants, and compliance violations.
Public Health staff will continue to implement an educational approach to address any non-compliance,
including working with owners/managers to assure that requirements of owners/managers under the
ordinance are met, and providing technical assistance. 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.
V. Technical Assistance to Contra Costa Cities
Public Health Staff responds to drifting smoke complaints from residents throughout the County.
Outside of the Unincorporated County, the majority of secondhand smoke complaints received are from
Concord, Walnut Creek, and Martinez. Staff continues to provide resources and information to public
who file complaints, as well as forward the complaint to the appropriate contact in those cities when
possible.
Staff continue to respond to requests from Contra Costa cities and have provided technical assistance to
the cities of San Pablo, Hercules, Clayton, Concord, Antioch, and Pittsburg which have considered
similar smoke-free multi-unit housing policies for their jurisdictions based on the model provided by the
County.
In April 2019, Tobacco Prevention Program disseminated a Request for Proposal for community-based
organizations to work with communities in Pittsburg, Antioch to educate the community about smoke-
free multi-unit housing. Two agencies have been identified: Bay Area Community Resources and
Community Health for Asians and execution of their projects will begin in Fall of 2019.
VI. Recommendations
Staff recommends that the Family and Human Services Committee accept the report and direct staff to
continue to provide updates on implementation of the ordinance as part of staff’s annual report on the
County’s Secondhand Smoke Protections Ordinance.
27
• Contra Costa Behavioral Health Services • Contra Costa Emergency Medical Services • Contra Costa Environmental Health •
• Contra Costa Hazardous Materials • Contra Costa Health Plan • Contra Costa Public Health • Contra Costa Regional Medical Ce nter and Health Centers •
ANNA M. ROTH, RN, MS, MPH
H EALTH SERVICES D IRECTOR
D AN PEDDYCORD , RN, MPA/HA
D IRECTOR OF PUBLIC H EALTH
CONTRA COSTA
PUBLIC HEALTH
COMMUNITY WELLNESS AND
PREVENTION PROGRAM
597 Center Avenue, Suite 1 10
Martinez, California 94553
Ph 925 -313-6214
Fax 925 -313-6840
RACTION REQUIRED: Contra Costa Smoke-free Multi-Unit Housing Law Effective July 1, 2019
*Single Family Homes Not Included*
LAMBAKIS JUSTIN TY
1423 MARLIN PL
DISCOVERY BAY CA 94505 June 1, 2019
Dear Contra Costa County Multi-Unit Housing Owner:
Please be informed that Multi-unit Housing in Unincorporated Contra Costa County is required to be
100% smoke-free effective July 1, 2019, including all owner-occupied units . The Contra Costa
County Secondhand Smoke Protections Ordinance as amended in March 2018 prohibits smoking in
multi-unit residence dwellings including apartments, condominiums, townhomes, and any multi-unit
housing residence with two or more dwelling units . “Smoking”, includes use of tobacco products,
electronic smoking devices (e.g., electronic cigarettes, vape pens, Juuls), and marijuana.
This ordinance applies to the unincorporated areas of Contra Costa.
Our records show that you are the owner of the multi-unit housing residence located at 1423
MARLIN PL, Discovery Bay, 94505 that is impacted by the new law. Please note that if that
residence is in fact a single family home and not a multi-unit housing residence, it is not included in
this law.
Smoking is prohibited in the following areas of all multi-unit housing residences with 2 or
more units in the unincorporated county:
In 100% of all units of new and existing multi-unit housing residences
Within 20 feet of doors, operable windows, air ducts, and ventilation systems of multi-unit
housing units
In common indoor and outdoor areas (e.g. laundry room, swimming pool)
On all balconies, patios, decks and carports of multi-unit housing residences
What Owners, Operators or Managers Must Do:
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 that smoking
is prohibited in all dwelling units effective July 1, 2019.
ACTION REQUIRED BY JUNE 30, 2019
Owners, Operators or Managers are required by law to comply with
the provisions listed below and to contact Contra Costa County
staff to confirm that they are compliant. Complete the required
information vis this link: tinyurl.com/CountySmokefreeMUH
28
∎ 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 ∎
Disclose the policy for handling smoking complaints in effect at the multi-unit housing residence
and provide a copy of that policy to each tenant along with every new lease or rental agreement
for the occupancy of a unit in a multi-unit housing residence.
Post “No Smoking” signs with letters of not less than one inch in height, or the
international “No Smoking” symbol (consisting of a burning cigarette in a red circle
with a red bar across it, see example to the right), visibly on the exterior of every
building or other place where smoking is regulated. While not required by law, it may
be helpful to add information to signage indicating that the use of electronic
cigarettes is also prohibited in smoke-free areas . It is not required to post “no
smoking” signage inside or on the doorway of any dwelling unit in a multi-unit residence.
Do not allow ashtrays or other receptacles for disposing of smoking material where
smoking is prohibited.
Do not allow smoking in smoking prohibited areas.
Owners, Operators or Managers who fail to comply with the ordinance may face administrative fines
of $100 for the first violation, $200 for the second violation within a year and $500 for each additional
violation within a year. Owners, Operators or Managers who fail to comply with this ordinance may be
subject to other legal claims by tenants.
A full copy of the law, signage, sample lease addendum and other Owner, Operator or Manager
resources, as well as information about the harmful effects of secondhand smoke exposure are
available through the Contra Costa Health Services Tobacco Prevention Project ’s website at
http://cchealth.org/tobacco/secondhand-smoke/. Information about quitting smoking is available by
calling the California Smoker’s Helpline at 1-800-NO -BUTTS or https://www.nobutts.org/
We look forward to working with you to create a healthy smoke-free environment in compliance with
this law.
Sincerely,
Jen Grand-Lejano, MS
Tobacco Prevention Program
Contra Costa Health Services
29
• Contra Costa Behavioral Health Services • Contra Costa Emergency Medical Services • Contra Costa Environmental Health •
• Contra Costa Hazardous Materials • Contra Costa Health Plan • Contra Costa Public Health • Contra Costa Regional Medical Ce nter and Health Centers •
ANNA M. ROTH, RN, MS. MPH
H EALTH SERVICES D IRECTOR
D AN PEDDYCORD , RN, MPA/HA
D IRECTOR OF PUBLIC H EALTH
CONTRA COSTA
PUBLIC HEALTH
COMMUNITY WELLNESS AND
PREVENTION PROGRAM
597 Center Avenue, Suite 110
Martinez, California 94553
Ph 925 -313-6 214
Fax 925 -313-6840
- OVER -
NEW Requirements for Contra Costa County Secondhand Smoke Protections Law
May 1, 2019
Dear Contra Costa County Business Owners, Managers and Landlords:
Please be informed that The Contra Costa County Secondhand Smoke Protections Ordinance was
amended in March 2018 to prohibit smoking in multi-unit residence dwellings including
condominiums and townhomes , and hotels and motels including all guest rooms . All units and
leases must be in compliance no later than July 1, 2019. “Smoking”, includes use of tobacco
products, electronic smoking devices (like electronic cigarettes), and marijuana. This ordinance
applies to the unincorporated areas of Contra Costa.
Where smoking is prohibited in the unincorporated areas of Contra Costa County:
Within 20 feet of doors, operable windows, air ducts, and ventilation systems of any enclosed
place of employment and enclosed places open to the public
In outdoor dining areas, restaurants, and outdoor lounges (including dining areas at places of
employment)
In public parks and on public trails
In service areas (such as ATM lines, ticket lines, and bus stops)
At public events
In any indoor workplace or indoor area open to the public, including tobacco shops and owner or
volunteer operated businesses
Any County-owned or leased building
Smoking is also prohibited in the following areas of all multi-unit housing residences with 2
or more units in the unincorporated county:
Within 20 feet of doors, operable windows, air ducts, and ventilation systems of multi-unit
housing units
In common indoor and outdoor areas (e.g. laundry room, swimming pool)
On all balconies, patios, decks and carports of multi-unit housing residences
In 100% of all units of new and existing multi-unit housing residences
In addition, landlords of multi-unit housing with 2 or more units in the unincorporated county
must:
Disclose the policy for handling smoking complaints in effect at the multi-unit housing residence,
and provide a copy of that policy to each tenant along with every new lease or rental agreement
for the occupancy of a unit in a multi-unit housing residence.
30
∎ 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 ∎
What Owners, Operators or Managers Must Do:
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 that smoking
is prohibited in all dwelling units starting July 1, 2018
Post “No Smoking” signs with letters of not less than one inch in height, or the
international “No Smoking” symbol (consisting of a burning cigarette in a red circle
with a red bar across it, see example to the right), visibly on the exterior of every
building or other place where smoking is regulated. While not required by law, it may
be helpful to add information to signage indicating that the use of electronic
cigarettes is also prohibited in smoke-free areas . It is not required to post “no
smoking” signage inside or on the doorway of any dwelling unit in a multi-unit residence
Do not allow ashtrays or other receptacles for disposing of smoking material where
smoking is prohibited
Do not knowingly allow smoking in smoking prohibited areas
Landlords and owners who fail to comply with the ordinance may face administrative fines of $100
for the first violation, $200 for the second violation within a year and $500 for each additional
violation within a year. Landlords who fail to comply with this ordinance may be subject to other legal
claims by tenants.
A full copy of the law, signage, sample lease addendum and other landlord resources, as well as
information about the harmful effects of secondhand smoke exposure are available through the
Contra Costa Health Services Tobacco Prevention Project’s website at
http://cchealth.org/tobacco/secondhand-smoke/ or by calling 925-313-6214. Information about quitting
smoking is available by calling the California Smoker’s Helpline at 1-800-NO -BUTTS or
https://www.nobutts.org/
We look forward to working with you to create a healthy smoke-free environment in compliance with
this law.
Sincerely,
Dan Peddycord, RN, MPA/HA
Director of Public Health
Contra Costa Health Services
31
FAMILY AND HUMAN SERVICES
COMMITTEE 7.
Meeting Date:10/07/2019
Subject:Policy Options to Protect Youth from Tobacco Influences in the Retail
Environment
Submitted For: Anna Roth, Health Services Director
Department:Health Services
Referral No.: FHS #112
Referral Name: Policy Options to Protect Youth from Tobacco Influences in the Retail
Environment
Presenter: Dan Peddycord Contact: Jen Grand-Lejano (925)
313-6216
Referral History:
The Board of Supervisors approved two tobacco control ordinances in July 2017 to protect youth
from tobacco influences in the retail environment: a zoning ordinance and a tobacco retailer
licensing ordinance. Of particular concern were the marketing and availability of youth-friendly
flavored tobacco products, small pack sizes of cigars and cigarillos, and density and location of
tobacco retailers, since these contribute largely to youth exposure to tobacco influences and
tobacco use. The tobacco retailer licensing ordinance required extensive preparation for
implementation, and tobacco retailers were required to be compliant with the new provisions by
January 1, 2018. Contra Costa Public Health staff provided a report to the Board of Supervisors in
March 2018 on preliminary implementation efforts.
Referral Update:
Please see the attached report from the Public Health Director on the implementation of the
tobacco retailer licensing and businesses zoning ordinances.
Recommendation(s)/Next Step(s):
ACCEPT report on the on the implementation of the tobacco retailer licensing and businesses
zoning ordinances.
DIRECT staff to continue to provide updates on implementation of the ordinances as part of
staff’s annual report on the County’s Secondhand Smoke Protections Ordinance.
Fiscal Impact (if any):
There is no fiscal impact.
32
Attachments
Annual Report on Implementation of Tobacco Retail Licensing Ordinances
Letter Accompanying Renewal Notice
33
• 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 •
ANNA M. ROTH, RN, MS, MPH
HEALTH SERVICES DIRECTOR
DANIEL PEDDYCORD, RN, MPA/HA
DIRECTOR OF PUBLIC HEALTH
C ONTRA C OSTA
P U BLIC H EALTH
597 CENTER AVENUE, SUITE 200
MARTINEZ , CALIFORNIA 94553
PH (925) 313-6712
FAX (925) 313-6721
DANIEL.PEDDYCORD@HSD.CCCOUNTY .US
To: Family and Human Services Committee, Contra Costa Board of Supervisors
From: Daniel Peddycord, RN, MPA/HA, Director, Public Health
Re: Annual Report on Implementation of Tobacco Retail Licensing Ordinances
Date: 10/7/19
I. Summary
In July 2017, the Board of Supervisors adopted two tobacco control ordinances to protect youth from
tobacco influences in the retail environment. The first being a zoning ordinance and the second a retailer
licensing ordinance. The goal of these ordinances is to regulate the marketing and availability of youth-
friendly flavored tobacco products, small pack sizes of cigars and cigarillos, and density and location of
tobacco retailers, as these contribute largely to youth exposure to tobacco influences and tobacco use. The
tobacco retailer licensing ordinance required tobacco retailers to be compliant by January 1, 2018. At the
request of the Board of Supervisors, Contra Costa Public Health staff provided reports in March 2018 on
preliminary implementation of the ordinances with a follow up report to the Family and Human Services
Committee being made in October of 2018. This report is a brief overview of implementation activities
that have taken place since October 2018, as well as next steps.
II. Ordinance Provisions
Zoning Ordinance 2017-10 Tobacco Retailer Businesses (effective 8/11/17) states:
a) New retailers operating within 1000 feet of schools, parks, playgrounds and libraries are prohibited
from selling tobacco products. Existing tobacco retailing businesses operating within 1000 feet of
these areas are nonconforming uses. A nonconforming use will be allowed to continue operating
under the ordinance.
b) New retailers within 500 feet of tobacco retailers are prohibited from selling tobacco products.
Existing tobacco retailing businesses operating within 500 feet of another tobacco retailer will
be come nonconforming uses. A nonconforming use will be allowed to continue operating under the
ordinance.
c) No new “Significant Tobacco Retailers”, including vape shops, hookah bars or smoke shops are
allowed. A “Significant Tobacco Retailer” is defined as ha ving more than 20% of retail sales space
dedicated to tobacco retailing use.
Licensing Ordinance 2017-01 Tobacco Product and Retail Sales Control (effective 1/1/18) states:
a) The definition of “tobacco products” and “smoke” includes all electronic smoking d evices and
liquids, including all electronic devices that could be used to deliver a dose of nicotine or other
substances.
b) The sale of flavored tobacco products, including menthol cigarettes, is prohibited within 1,000 feet of
schools, parks, playgrounds, and libraries.
c) The sale of cigars, including little cigars and cigarillos, is prohibited in pack sizes under ten (10).
Premium cigars that sell for $5.00 (including taxes and fees) or more are exempt from this provision.
d) No tobacco retailer’s license wi ll be issued that authorizes tobacco retailing in a pharmacy.
e) Compliance with state and local storefront signage and drug paraphernalia sales laws is required in
order to maintain a Contra Costa Tobacco Retailer License.
34
∎ 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 ∎
f) Tobacco retailers are required to check identification (ID) of customers who appear younger than 27
years of age.
g) The number of retailers that can sell tobacco products is “capped” at current number (92) of licenses
issued by the County. (effective 8/17/17)
Condition of License Suspension if a Violation of the Law Occurs:
h) Tobacco retailers who have their license suspended due to violations of the law are required to remove
tobacco advertising during license suspension periods.
i) The time period reviewed for prior violations of the license (the “look-back” period) is expanded from
24 months (2 years) to 60 months (5 years) when considering the length of time for a license suspension
for retailers found to be in violation of the law.
Retailers found to be in violation of the law can be fined up to $500 for each day that they are in violation,
per County Code 14-12.006, “Administrative fines,” and may face suspension or revocation of their
tobacco retailer license.
III. Implementation
A. Implementation efforts from October 2018 report to the Board of Supervisors
The Public Health staff worked with the Business License Office to include information about
tobacco retail ordinance and resources in the annual mailing to all business owners. In May
2019, the Business License Office mailed the annual business renewal reminder letters to all 88
unincorporated tobacco retailers, who also received a flyer on compliance with Ordinance
2017-10 Tobacco Retailer Businesses and Ordinance 2017-01 Tobacco Product and Retail Sales
Control.
The Tobacco Retailer Businesses zoning ordinance prohibits new tobacco retailers from
locating within 1,000 feet of schools, parks, playgrounds and libraries, and within 500 feet of
another tobacco retailer. The Public Health and Department of Conservation and
Development staff developed a protocol for license approval in August 2017 which remains in
place. As needed, Public Health Staff provide technical assistance to Department of
Conservation and Development front line staff that interacts with tobacco retailers requesting
zoning verification.
Public Health staff in partnership with a team of 15 adults from the following agencies: Contra
Costa County Office of Education; Tobacco Use Prevention Education (TUPE); Contra Costa
County Health Services’ Alcohol and Other Drugs Prevention Program and Nutrition and
Physical Activity Promotion Program; and Bay Area Community Resources to conduct the
Statewide Health Stores for a Healthy Community survey. Over 380 stores were surveyed, and
the findings will provide information about the marketing of tobacco products that are
attractive and affordable to youth and include measures to make tobacco products easily
accessible through store discounts and online coupons. Surveys will be sent to the California
Department of Public Health’s California Tobacco Control Prevention Program to be analyzed
and the findings will be shared with Public Health. Public Health will utilize this data when
conducting compliance checks in early 2020.
35
∎ 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 ∎
B. Next Steps for Increased Compliance
In 2018, Public Health staff provided technical assistance to the Sheriff’s Office on applying for
and funds from the California Department of Justice to combat youth use of and access to tobacco
products and enforce the tobacco sales to minors. The Sheriff’s Department was awarded these
funds and Public Health staff will continue to work with the Sheriff’s Office to conduct tobacco
retail compliance inspections, including youth decoy and shoulder tap operations for enforcement
of sales to minors.
The Public Health staff also applied for and was awarded funding ($838,379.00) offe red by the
California Department of Justice to fund local tobacco enforcement activities complementary to
those enforcement activities charged to the Sheriff’s Office from November 2018 through June
2021. As a designated enforcement agency for tobacco retailer licensing laws, Public Health staff
will conduct tobacco retail compliance inspections in partnership with the Sheriff’s Department,
provide retailer educations sessions, and conduct outreach and education to K-12 schools, colleges,
and youth-serving organizations to combat youth and young adult tobacco use including vaping.
Through the new funding from the California Department of Justice, Public Health will:
1. Conduct enforcement activities with licensed tobacco retailers which include updating protocols
for conducting compliance inspections with local retailers; developing a list of tobacco retailers
to target enforcement actions based on data from the California Department of Ta x and Fee
Administration and the local Business License Office; conduct 100 tobacco retail compliance
inspections; cite violations of tobacco retail laws and conduct follow-up inspections.
2. Conduct tobacco retailer education classes on an annual basis with emphasis on tobacco laws
meant to reduce youth tobacco influence.
3. Maintain tobacco retailer information and complaint hub (i.e., hotline and website) to provide
technical assistance to tobacco retailers as well as the general public about tobacco retail issues
and accept reports of any violations of local tobacco retail laws.
The capacity of both the Sherriff’s Department and Public Health to respond to planned activities
leading to the completion of tobacco retailer compliance inspections, including youth decoy and
shoulder tap operations have been significa ntly impacted as staff at the Sherriff’s Department have
been reassigned, and Public Health has encountered challenges in hiring staff for this new funding
source. The above activities continue to be a priority and activities are expected to begin early
2020.
C. Technical Assistance to Contra Costa Cities
On June 8, 2018, Public Health staff conducted a presentation about local tobacco retail
implementation efforts at the Contra Costa Mayors Conference and offered technical assistance to
Contra Costa cities that were interested in considering similar laws. As a result of this presentation
several cities have requested and have been provided with technical assistance from Public Health
staff (i.e., Concord, San Ramon, Danville, and Antioch). Within the past year, the following cities
have adopted tobacco retail control policies utilizing the Contra Costa County ordinance as a
model:
36
∎ 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 ∎
City Policy Description Date adopted/
Date effective
San Pablo Prohibits sale of all flavored tobacco products,
including menthol within city limits
Dec 2018/
Mar 2019
Lafayette Prohibits sale of all flavored tobacco products,
including menthol within city limits
May 2019/
Aug 2019
Richmond Prohibits sale of all flavored tobacco products,
including menthol within city limits
July 2018/
Sept 2019
Oakley Future Tobacco Retailers businesses would be
prohibited from being located within 500 feet of
existing tobacco retailers or 1,000 feet of youth -
sensitive areas: parks, playgrounds, libraries, schools
and bus stops servicing schools. Retailers already
inside that 1,000 -foot buffer are exempt.
TRL with a high cap of number of tobacco retailer
licenses (25)
Dec 2018/
Jan 2019
In April 2019, Tobacco Prevention Program disseminated a Request for Proposal for community-based
organizations to work with communities in Pittsburg and Antioch to educate the community on the
importance and benefits of protective tobacco measures to reduce the influence and use of tobacco and
tobacco products in environments that are youth sensitive. Two agencies have been identified: Bay Area
Community Resources and Community Health for Asians and execution of their projects will begin in Fall
of 2019.
In August and September 2019, Tobacco Program staff, the Health Officer and Public Health Director
provided technical assistance and public testimony to the City of Richmond related to the development
and subsequent adoption of policy to suspend the sale of vaping products. This action was taken in the
wake of growing national concerns related to the incidents of severe pulmonary illness triggered by the use
of vaping products.
In addition, Public Health staff has been instructed by the Board of Supervisors to develop a proposed
vaping sales moratorium for consideration in response to the epidemic of teen vaping and the incidence
of severe pulmonary illness related to the use of vaping products. As of September 27 th, the Centers for
Disease Prevention and Control (CDC) reports over 800 cases across 46 states and 12 deaths. In California
there have been 90 cases reported and 2 deaths, as of September 24 th, 2019. Public Health staff is currently
working in partnership with Contra Costa County Coun sel to draft language for the proposed ordinance
that is tentatively scheduled to be presented to the Board of Supervisors in late October or early November
2019.
D. Technical Assistance to Nationwide Tobacco Control
Public Health staff was selected by the National Association of Attorneys General (NAAG) to present at
their 2019 Tobacco Policy and Responsible Retailing Conference in Tampa, Florida in May 2019. Staff was
invited to provide best practices on the successful implementation of local tobacco retailer licensing laws.
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 ∎
III. Recommendations:
Staff recommends that the Family and Human Services Committee accept the report and direct staff to
continue to provide updates on implementation of the ordinance as part of staff’s annual report on the
County’s Tobacco Retail Licensing Ordinance.
38
• 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 •
ANNA M. R OTH , RN, MS , MPH
HEALTH S ERVICES D IRECTOR
DAN PEDDYCORD, RN, MPA/HA
DIRECTOR OF PUBLIC HEALTH
CONTRA COSTA
PUBLIC HEALTH
COMMUNITY WELLNESS AND
PREVENTION PROGRAM
597 Center Avenue, Suite 110
Martinez, California 94553
Ph 925 -313-6214
Fax 925 -313-6840
If a retailer sells tobacco products in Unincorporated Contra Costa without a valid or current
license, then the retailer can be cited and/or fined. If a Contra Costa tobacco retailer
violates any federal, state, or local tobacco control law, their license may be suspended.
Date: May 1, 2019
To: All Contra Costa Tobacco and Electronic Cigarette Retailers in the Unincorporated Areas
From: Dan Peddycord, RN, MPA/HA, Public Health Director
Subject: New Tobacco Retailer’s License Requirements
As a reminder, all retailers selling tobacco products, including electronic smoking devices such as electronic cigarettes,
vapor pens, e-hookah and refill cartridges, in the unincorporated areas of Contra Costa County must obtain a County
Tobacco Retailer’s L icense each year when they apply for or renew their Contra Costa County business license. The
County tobacco retailer’s license for July 1, 2019 through June 30, 2020 is distributed by the Tax Collector’s Office
and costs $287.00 annually. Each retail location in Unincorporated Contra Costa must have its own County tobacco
retailer’s license.
If you sell tobacco products from a fixed location, you must check off the box on the Business License Renewal
Application to indicate that you wish to sell tobacco products at this location and include the $287.00 tobacco license
fee with your business license renewal fee.
Please note the following:
Distributors of tobacco products do not need to obtain a tobacco retailer’s license.
Businesses that sell tobacco products from vehicles or on foot are not eligible for a tobacco retailer’s license
and cannot sell tobacco products, including electronic cigarettes, in the unincorporated areas of the County.
County Ordinance Chapter 445-6 prohibits tobacco vending machines. Businesses that operate vending
machines must remove their vending machines. They can sell tobacco products only by means of employee
assistance.
Tobacco Control Laws that effect unincorporated areas of Contra Costa include, but are not limited to:
Recently revised County Ordinance Code Chapter 445 (Secondhand Smoke and Tobacco Products
Ordinance)
o No sale of flavored tobacco products within 1000 feet of a school, park, playground, or library
o No sale of cigars in a package of few er than 10 cigars. Cigars priced at $5 or more per cigar,
including taxes and fees, are exempt
o No sale of any tobacco products at a business that has a pharmacy
o Number of County tobacco retailer licenses capped at 90. Timely renewal of County tobacco
retailer licenses before July 1, 2019 is important to avoid any issues with maintaining the license
PC308(a) and STAKE Act (sales of any tobacco product to minors under 21)
In addition to the County license, tobacco retailers are also required to possess a license from the California
Department of Fee and Tax Administration. Failure to obtain and maintain this license can result in a fine of $5,000,
or up to one year imprisonment in the county jail, or both the fine and imprisonment (Business and Professions Code
sections 22972 (a), 22980.1 (h) and 22981). You may register or renew your registration online by going to
https://www.cdtfa.ca.gov/services/#Register-Renewals
For any questions, please visit our website at http://cchealth.org/tobacco/retailers.php or call the Tobacco
Prevention Project of the Public Health Division at 925-313-6216. Thank you for your efforts in reducing tobacco
access to youth and upholding all tobacco laws.
39
FAMILY AND HUMAN SERVICES COMMITTEE 8.
Meeting Date:10/07/2019
Subject:Annual Report to the California Department of Health Care Services on Contra
Costa’s Assisted Outpatient Treatment Program
Submitted For: Anna Roth, Health Services Director
Department:Health Services
Referral No.: FHS #107
Referral Name: Laura's Law
Presenter: Warren Hayes, L.M.F.T. , Mental Health
Program Chief
Contact: Warren Hayes (925)
957-2616
Referral History:
The Assisted Outpatient Treatment Demonstration Project Act (AB 1421), known as Laura’s
Law, was signed into California law in 2002 and was authorized until January 1, 2017. Laura’s
Law is named after a 19 year-old woman who worked at a Nevada County mental health clinic.
She was one of three individuals who died after a shooting by a psychotic individual who had not
engaged in treatment.
AB 1421 allows court-ordered intensive outpatient treatment called Assisted Outpatient Treatment
(AOT) for a clearly defined set of individuals that must meet specific criteria. AB 1421 also
specifies which individuals may request the County Mental Health Director to file a petition with
the superior court for a hearing to determine if a person should be court-ordered to receive the
services specified under the law. The County Mental Health Director or his licensed designee is
required to perform a clinical investigation and, if the request is confirmed, file a petition to the
court for AOT.
If the court finds that the individual meets the statutory criteria, the recipient will be provided
intensive community treatment services and supervision by a multidisciplinary team of mental
health professionals with staff-to-client rations of not more that 1 to 10. Treatment is to be
client-directed and employ psychosocial rehabilitation and recovery principles. The law specifies
various rights of the recipient as well as due process hearing rights.
If a person refuses treatment under AOT, treatment cannot be forced. The court orders a meeting
with the treatment team to gain cooperation and can authorize a 72-hour hospitalization to gain
cooperation. A Laura’s Law petition does not allow for involuntary medication.
AB 1421 requires that a county Board of Supervisors adopt Laura’s Law by resolution to
40
AB 1421 requires that a county Board of Supervisors adopt Laura’s Law by resolution to
authorize the legislation within that county. AB 1421 also requires the Board of Supervisors to
make a finding that no voluntary mental health program serving adults or children would be
reduced as a result of implementation.
At its June 3, 2013 meeting, the Legislation Committee requested that this matter be referred to
the Family and Human Services Committee (FHS) for consideration of whether to develop a
program in the Behavioral Health Division of the Health Services Department that would
implement assisted outpatient treatment options here in Contra Costa County. On July 9, 2013,
the Board of Supervisors referred the matter to FHS for consideration. FHS received reports on
the implementation of Laura's Law on October 16, 2013 and March 10, 2014, and on February 3,
2015, the Board of Supervisors adopted Resolution No. 2015/9 to direct the implementation of
Assisted Outpatient Treatment (Laura’s Law) for a three-year period and directed the Health
Services Department (HSD) to develop a program design with stakeholder participation. The
Board further authorized the Health Services Director to execute a contract with Resource
Development Associates, Inc. to provide consultation and technical assistance with regard to the
evaluation of the County’s Assisted Outpatient Treatment (AOT) Program for persons with
serious mental illness who demonstrate resistance to voluntarily participating in behavioral health
treatment.
On February 3, 2015 the Contra Costa Board of Supervisors adopted Resolution No. 2015/9 to
direct the implementation of Assisted Outpatient Treatment (Laura’s Law) for a three year period
and directed the Health Services Department (HSD) to develop a program design with stakeholder
participation. The Board further authorized the Health Services Director to execute a contract with
Resource Development Associates, Inc. to provide consultation and technical assistance with
regard to the evaluation of the County’s Assisted Outpatient Treatment (AOT) Program for
persons with serious mental illness who demonstrate resistance to voluntarily participating in
behavioral health treatment.
On September 25, 2017 the Family and Human Services Committee received and discussed the
AOT Program reports for fiscal year 2016-17 as provided by the Health Service Department and
Resource Development Associates. Contra Costa Behavioral Health Services was directed to
coordinate with the Health, Housing and Homeless Services Division and develop a plan to
maximize enrollment in Assertive Community Treatment (ACT) of persons who are eligible for
the AOT Program and are homeless or at risk of homelessness. Mental Health Systems is the
contract agency providing Assertive Community Treatment to fidelity.
On October 17, 2017 the Board of Supervisors accepted the Plan for Maximum Enrollment of
Persons Eligible for the AOT Program, as well as the July, 2016 through June 30, 2017 evaluation
report from Resource Development Associates.
On December 3, 2018 the Family and Human Services Committee accepted the Behavioral
Health Services Cumulative Evaluation Report on Contra Costa’s Assisted Outpatient Treatment
Program and recommended to the Board of Supervisors (and was subsequently adopted) that the
AOT Program be extended beyond its three year pilot period and incorporated as part of
Behavioral Health Services’ ongoing service delivery.
Referral Update:
On April 26, 2019 the annual report for the California Department of Health Care Services
41
On April 26, 2019 the annual report for the California Department of Health Care Services
(reporting period: January 1 – December 31, 2018) was presented and discussed at the AOT
Workgroup Meeting. Community members were in attendance and had the opportunity to
question and comment upon the report results, as well as receive an update from Behavioral
Health, the contract service provider, Mental Health Systems, and representatives of the court and
public defender’s office.
The report’s Summary of Findings highlighted the following:
A high degree of collaboration exists between CCBHS and Mental Health Systems to
identify and engage eligible consumers in Assertive Community Treatment (ACT) services.
The County’s AOT program connected the majority of referred individuals to the appropriate
level of mental health services, including ACT.
A majority of consumers experienced benefits from participating in the program.
The implementation of the new health care billing system (ShareCare) caused limitations on
the availability of quality of service data.
For the 2018 calendar year the program received 174 referrals, with an active caseload of 75
individuals enrolled in ACT (target maximum enrollment is 75). At the end of the year an
additional 11 persons were deemed eligible and still receiving outreach and engagement services
prior to enrollment for treatment. three persons were involved with the court system and either
voluntarily participated in treatment or participated via court order. Three individuals had
sufficiently recovered to enable stepping down to a lower level of mental health care. Mental
Health Systems, the ACT provider, has 13 formerly homeless clients housed via master leasing
arrangements in either shared and scattered site housing.
Recommendation(s)/Next Step(s):
ACCEPT the Annual Report of the Assisted Outpatient Treatment Program for the period January
1 through December 31, 2018.
Fiscal Impact (if any):
None, as funds are authorized and budgeted for the AOT Program for the balance of FY 2019/20,
and MHSA revenue is expected to sustain the CCBHS portion of the program costs.
Attachments
Contra Costa County Assisted Outpatient Treatment (AOT) 2018 Annual Report for the California Department of
Health Care Services
42
Contra Costa County Assisted Outpatient
Treatment (AOT)
Annual Report for the California Department of Health Care Services
Reporting Period: January 1 - December 31, 2018
43
Contra Costa County Behavioral Health Services
Assisted Outpatient Treatment Program: January 1 – December 31, 2018 DHCS Report
March 28, 2019 | 1
Table of Contents
Introduction ............................................................................................................................................ 4
Background Information ...................................................................................................................... 4
Contra Costa County’s AOT Program Model ......................................................................................... 4
Organization of the Report .................................................................................................................. 6
Methodology .......................................................................................................................................... 7
Data Measures and Sources ................................................................................................................. 7
Data Analysis ....................................................................................................................................... 9
Limitations and Considerations .......................................................................................................... 10
Findings ................................................................................................................................................ 11
Pre-ACT Enrollment Findings ............................................................................................................. 11
ACT Enrollment Findings .................................................................................................................... 15
Summary of Findings ............................................................................................................................ 25
Appendices ........................................................................................................................................... 27
44
Contra Costa County Behavioral Health Services
Assisted Outpatient Treatment Program: January 1 – December 31, 2018 DHCS Report
March 28, 2019 | 2
Table of Figures
Figure 1. Contra Costa County AOT Program Stages ................................................................................. 5
Figure 2. MHS Outreach and Engagement Attempts (N = 906) ............................................................... 14
Figure 3. Referral to ACT Enrollment Summary ...................................................................................... 15
Figure 4. Primary Diagnosis (N = 85) ...................................................................................................... 16
Figure 5. Employment 12 months .......................................................................................................... 17
Figure 6. Employment at........................................................................................................................ 17
Figure 7. Intensity of ACT Contacts per Week ........................................................................................ 19
Figure 8. Frequency of ACT Contacts per Week ...................................................................................... 19
Figure 9. Consumers’ Housing Status before and during ACT ................................................................. 21
45
Contra Costa County Behavioral Health Services
Assisted Outpatient Treatment Program: January 1 – December 31, 2018 DHCS Report
March 28, 2019 | 3
Table of Tables
Table 1. Data Sources and Elements ........................................................................................................ 7
Table 2. DHCS Reporting Requirements and Corresponding Data Sources ................................................ 8
Table 3. Summary of Requestor Type (N = 201) ..................................................................................... 11
Table 4. Outcome of CCBHS Investigations for Consumers Referred in 2018 (N = 201) ........................... 12
Table 5. MHS Service Summary (N = 114) .............................................................................................. 13
Table 6. AOT Consumer Demographics (N = 85) ..................................................................................... 16
Table 7. Sources of Financial Support for ACT Consumers (N = 83) ......................................................... 17
Table 8. ACT Service Engagement (N = 65) ............................................................................................. 18
Table 9. Consumers’ Crisis Episodes before and during ACT ................................................................... 19
Table 10. Consumers’ Psychiatric Hospitalizations before and during ACT ............................................. 20
Table 11. Consumers’ Bookings before and during ACT .......................................................................... 20
Table 12. Self Sufficiency Matrix Scores ................................................................................................. 22
46
Contra Costa County Behavioral Health Services
Assisted Outpatient Treatment Program: January 1 – December 31, 2018 DHCS Report
March 28, 2019 | 4
Introduction
Background Information
In 2002, the California legislature passed Assembly Bill (AB) 1421 (also known as “Laura’s Law”), which
authorized the provision of Assisted Outpatient Treatment (AOT) in counties that adopt a resolution for
its implementation. AOT is designed to interrupt the repetitive cycle of hospitalization, incarceration, and
homelessness for people with serious mental illness who have been unable and/or unwilling to engage in
voluntary services. AOT uses an expanded referral and outreach process that may include civil court
involvement, whereby a judge may order participation in outpatient treatment. The California Welfare
and Institutions Code1 defines the target population, intended goals, and specific suite of services required
to be available for AOT consumers in California (see Appendix I).
On February 3, 2015, the Contra Costa County Board of Supervisors adopted a resolution to authorize the
implementation of AOT. Currently, Contra Costa County Behavioral Health Services (CCBHS) provides
behavioral health services to AOT consumers through an Assertive Community Treatment (ACT) team
operated by Mental Health Systems (MHS), a contracted provider organization. Contra Costa’s AOT
program represents a collaborative partnership between CCBHS, the Superior Court, County Counsel, the
Public Defender, and MHS. Community mental health stakeholders and advocates have remained
involved in providing feedback and supporting the program to meet its intended objectives. The County’s
AOT program became operational on February 1, 2016 and accepted its first consumer in March 2016.
ACT is an evidence-based service delivery model for people with serious mental illness who are at-risk of
or would otherwise be served in institutional settings or experience homelessness. ACT has the strongest
evidence base of any mental health practice for people with serious mental illness and, when
implemented to fidelity, ACT produces reliable results for consumers. Such results include decreased
negative outcomes (e.g., hospitalization, incarceration, and homel essness) and improved psychosocial
outcomes (e.g., improved life skills and increased involvement in meaningful activities).
Contra Costa County’s AOT Program Model
Contra Costa County has designed an AOT program model that responds to the needs of its communities
and exceeds the requirements set forth in the legislation. The Contra Costa County AOT program includes
a Care Team comprised of CCBHS Forensic Mental Health (FMH) and MHS staff. Figure 1 below depicts
the County’s AOT program stages from pre-enrollment (Referral and Investigation; Outreach and
Engagement) through enrollment.
1 Welfare and Institutions Code, Section 5346
47
Contra Costa County Behavioral Health Services
Assisted Outpatient Treatment Program: January 1 – December 31, 2018 DHCS Report
March 28, 2019 | 5
Figure 1. Contra Costa County AOT Program Stages
AOT Process
As originally designed, the first stage of engagement with Contra Costa County’s AOT program is through
a telephone call referral whereby any “qualified requestor” can make an AOT referral.2 Since October
2017, the County has also conducted frequent outreach meetings with the Martinez Detention Center,
the Psychiatric Inpatient Unit at Contra Costa Regional Medical Center (4C), and Contra Costa County
Health, Housing, and Homeless Services (H3) in order to identify additional potentially eligible consumers
to be referred. Within five business days, a CCBHS mental health clinician connects with the requestor to
gather additional information on the referral and then reaches out to the referred individual to begin
determining if they meet AOT eligibility criteria (see Appendix I).
If the person initially appears to meet eligibility criteria, a CCBHS investigator from the FMH s taff facilitates
a face-to-face meeting with the consumer and/or support networks to gather information; attempts to
engage the consumer; and develops an initial care plan. If the consumer continues to meet all nine
eligibility criteria, FMH investigators share the consumer’s information with the MHS team. MHS then
conducts outreach and engagement activities with the consumer to encourage their participation in ACT.
If at any time the consumer accepts voluntary services and continues to meet eligibility cri teria MHS
begins the ACT enrollment process. If the person does not meet all nine AOT eligibility criteria but is in
need of mental health services, FMH staff work to connect them to the appropriate type and level of
behavioral health services. Such service linkages include connections to:
❖ FSPs;
❖ Clinical case management and/or medication management;
❖ Private providers or Kaiser;
❖ Medical care; and
❖ Alcohol and other drug services.
2 Qualified requestors include: An adult who lives with the individual; Parent, spouse, adult sibling, or adult child of the individual;
Director of an institution or facility where the individual resides; Director of the hospital where the person is hospit alized; Treating
or supervising mental health provider; Probation, parole, or peace officer.
CCBHS FMH
receives
referral and
conducts
investigation,
then refers to
MHS or other
mental health
services
Referral and
Investigation
MHS provides
outreach and
engagement
to AOT eligible
individuals
Outreach
and
Engagement
Consumers
enroll in ACT
voluntarily or
via court
agreement
ACT Team
Enrollment
48
Contra Costa County Behavioral Health Services
Assisted Outpatient Treatment Program: January 1 – December 31, 2018 DHCS Report
March 28, 2019 | 6
However, if after a period of outreach and engagement, the consumer does not accept voluntary services
and continues to meet eligibility criteria, the County mental health director or designee may choose to
complete a declaration and request that County Counsel file a petition with the court. Utilizing a
collaborative court model that combines judicial supervision with community mental health treatment
and other support services, Contra Costa County then holds one to two court hearings. At the first hearing,
the consumer has the option to enter into a voluntary settlement agreement with the court to participate
in AOT.
If the consumer continues to refuse AOT and is unwilling to enter into a voluntary settlement agreement,
then he/she may be court ordered into AOT for a period of no longer than six months at the second court
hearing. After six months, if the judge deems that the person continues to meet AOT criteria, they may
authorize an additional six-month period of mandated participation. Consumers may also choose to
voluntarily continue with services. At every stage of this process, CCBHS’ FMH and MHS staff continue to
offer the individual opportunities to engage voluntarily in services. Conversely, the AOT Care Team may
recommend a 72-hour 5150 hold if the consumer meets existing criteria and is resistant to services.
Organization of the Report
The following report of Contra Costa County’s AOT program implementation and outcomes is broken into
four sections, highlighted below:
❖ Methodology
❖ Pre-ACT Enrollment Findings
❖ ACT Enrollment Findings
❖ Summary of Findings
The Methodology section provides a brief description of the data sources and analysis techniques used to
address the required DHCS outcomes. This is followed by a discussion of findings from our evaluation of
Contra Costa County’s processes for AOT referral, investigation, and outreach and engagement in the Pre-
ACT Enrollment Findings section. The ACT Enrollment Findings section then describes the consumer profile
in Contra Costa County, as well as consumers’ service engagement and outcomes during ACT enrollment.
Finally, the Summary of Findings section highlights key findings from the County’s AOT implementation
during the 2018 calendar year.
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March 28, 2019 | 7
Methodology
RDA worked closely with CCBHS and MHS to assess the implementation of the County’s AOT program, as
well as the extent to which individuals receiving AOT services during 2018 experienced decreases in
hospitalization, incarceration, and homelessness, and improvements in psychosocial outcomes such as
social functioning and independent living skills. This evaluation is intended to meet regulatory DHCS
requirements. In order to report on these requirements for consumers receiving AOT services during
2018, the following consumers were included in the analysis:
❖ Evaluation Period: January 1, 2018 through December 31, 2018
❖ Consumers Included: Any consumer who was referred to FMH, found to be AOT eligible, and
received ACT services during the evaluation period
❖ Consumers Excluded: Any consumer who was referred to FMH and closed to the AOT process
before the end of the evaluation period
This report includes findings for all consumers in Contra Costa County’s AOT program, followed by findings
for court-involved AOT consumers only. As previously stated, this version of the report contains protected
health information (PHI) and should not be distributed publicly.
Data Measures and Sources
RDA worked with CCBHS and MHS staff to obtain the data necessary to address the DHCS reporting
requirements for the 2018 calendar year from several data sources. Table 1 presents the County
departments or agencies that provided data for this evaluation, as well as the data sources and elements
captured by each data source. Appendix II provides additional information on each data source.
Table 1. Data Sources and Elements
County Department/Agency Data Source Data Element
Contra Costa County
Behavioral Health Care
Services
CCBHS FMH AOT Request Log • Individuals referred
• Qualified requestor information
CCBHS FMH AOT Investigation
Tracking Log
• CCBHS investigation attempts
Contra Costa County PSP and
ShareCare Billing Systems
• Behavioral health service
episodes and encounters,
including hospitalizations and
crisis episodes
• Consumer diagnoses and
demographics
Mental Health Systems MHS Outreach and
Engagement Log
• Outreach and engagement
encounters
50
Contra Costa County Behavioral Health Services
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March 28, 2019 | 8
County Department/Agency Data Source Data Element
FSP Forms in Microsoft Access
Database
• Residential status, including
homelessness
• Employment
• Education
• Financial support
MHS Outcomes Spreadsheet
• Social Functioning
• Independent Living
• Recovery
Contra Costa County
Sheriff’s Office
Sheriff’s Office Jail
Management System
• Booking and release dates
• Booking offense
In order to ensure the reporting process met the requirements stated in Section 5348 of the Welfare and
Institutions Code, RDA mapped the data source onto each reporting requirement (see Table 2).
Table 2. DHCS Reporting Requirements and Corresponding Data Sources
DHCS Reporting Requirement Data Source
The number of persons served by the program Contra Costa PSP and ShareCare
Billing Systems
The extent to which enforcement mechanisms are used by
the program, when applicable
CCBHS Care Team (FMH and ACT
teams) Communications
The number of persons in the program who maintain
contact with the treatment system
Contra Costa PSP and ShareCare
Billing Systems
Adherence/engagement to prescribed treatment by persons
in the program
Contra Costa PSP and ShareCare
Billing Systems
Substance abuse by persons in the program Contra Costa PSP and ShareCare
Billing Systems, and
CCBHS Care Team Communications
Type, intensity, and frequency of treatment of persons in
the program
Contra Costa PSP and ShareCare
Billing Systems
The days of hospitalization of persons in the program that
have been reduced or avoided
Contra Costa PSP and ShareCare
Billing Systems
The number of persons in the program with contacts with
local law enforcement, and the extent to which local and
state incarceration of persons in the program has been
reduced or avoided
Contra Costa County Sheriff’s Office
Jail Management System
The number of persons in the program able to maintain
housing
FSP Partnership Assessment Form
(PAF) and Key Event Tracking (KET)
The number of persons in the program participating in
employment services programs, including competitive
employment
FSP PAF and KET and Care
Communications
Social functioning of persons in the program Self Sufficiency Matrix (SSM)
Skills in independent living of persons in the program Self Sufficiency Matrix (SSM)
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Contra Costa County Behavioral Health Services
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March 28, 2019 | 9
DHCS Reporting Requirement Data Source
Victimization of persons in the program MacArthur Abbreviated Community
Violence Instrument
Violent behavior of persons in the program MacArthur Abbreviated Community
Violence Instrument
Satisfaction with program services both by those receiving
them and by their families, when relevant
MHS Consumer Satisfaction Surveys
Data Analysis
Throughout the data analysis process, RDA collaborated with CCBHS and MHS staff to vet analytic
decisions and findings. RDA matched clients across the disparate data sources described above and used
descriptive statistics (e.g., frequencies, mean, and medi an) for all analyses, including pre- and post-
enrollment outcome analyses. As the Contra Costa County’s AOT program has been active since February
2016, some consumers have had the opportunity to engage in the program, close, and re-enroll. In order
to accurately capture the variation in their experiences, RDA made the following analytic choices
regarding consumers with multiple enrollments:
❖ Service Participation: Consumers’ multiple enrollments were treated as unique enrollments to
determine the intensity and frequency of their service experiences.
❖ Consumer Outcomes: The date of consumers’ first ACT enrollment was used to distinguish pre-
and post-enrollment consumer outcomes for individuals with multiple enrollments. This means
that for all consumers, outcomes (e.g., hospitalization) that occurred after a first enrollment were
treated as post-enrollment outcomes.
In order to compare pre- and post-enrollment outcomes (i.e., hospitalizations, crisis episodes, and
criminal justice involvement), RDA analyzed the rate (per 180 days) at which consumers experienced
hospitalization, crisis, and incarceration outcomes prior to and after enrolling in ACT. To calculate rates of
occurrence in the three years prior to a consumer’s enrollment, RDA identified the oldest hospitalization,
crisis, and jail bookings for that consumer that took place within three years of their program enrollment
date. Starting with this first date of occurrence, the number of pre-enrollment days were determined and
used to standardize the rate of occurrence prior to AOT enrollment (per 180 days). During enrollment, the
rate of occurrence was determined by the number of days a consumer was enrolled in the ACT program.
RDA did not conduct this standardization with any self-reported data. Additionally, when conducting the
service participation analyses, RDA removed consumers who had less than 30 days of enrollment data.
These consumers were included in consumer outcomes analyses.
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March 28, 2019 | 10
Limitations and Considerations
As is the case with all “real-world” evaluations, there are important limitations to consider when reading
this report. One important limitation is that Contra Costa County implemented a new billing system during
2018, shifting from the PSP billing system to ShareCare on July 1, 2018. According to data RDA received
from the PSP and ShareCare systems, there were substantially fewer MHS encounters per consumer after
July 1 compared to the first half of the year. However, it is unclear whether these differences demonstrate
true differences in the number of encounters consumers experienced, if data from ShareCare
underestimated consumer encounters due to issues with data entry or data extraction from the new
system, or whether it is a combination of both. Contra Costa County will look further into this issue for
the 2020 report to DHCS; however, data on service intensity, frequency, type, and adherence should be
interpreted cautiously in this report.
Another consideration is that only 85 consumers participated in the AOT treatment program during 2018.
While this number is in alignment with the County’s expectations for program participation, the relatively
few individuals enrolled in 2018 can lead to significant shifts in the data based on the experiences of
relatively few individuals. This is particularly true when assessing the proportion of individuals who
experienced crisis, hospitalization, and criminal justice involvement. Thus, findings should be interpreted
with caution.
It is also important to note that there is more data available for the longer pre -enrollment periods
compared to the shorter post-enrollment periods. Therefore, ACT consumers had greater opportunities
to experience various outcomes prior to program enrollment than after program enrollment. To account
for differences in the pre- and post-time periods, RDA standardized outcomes measures to rates per 180
days for all data that were not self-reported. Nevertheless, because most consumers spent less time in
ACT than in the pre-enrollment period, there is less opportunity for them to experience outcomes such as
hospitalization, arrest, and/or incarceration during their ACT participation period. As a result, these
outcomes may be underestimated if a large number of consumers experienced zero negative outcomes
during shorter periods while they were enrolled in ACT. On the other hand, if consumers experienced a
number of negative outcomes for lengthy periods during their ACT enrollment period, these estimations
may be overestimated.
Lastly, for the assessment of housing and employment outcomes for ACT consumers relied on self-
reported data. Self-reported data often have reliability and validity issues, as consumers may not be able
to recall experiences or be willing to share them for fear of stigmatization or negative consequences. This
limitation is primarily a concern for measuring consumers’ pre-enrollment experiences. MHS staff did
closely track changes in consumers’ housing and employment statuses while they were enrolled in ACT.
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Findings
Pre-ACT Enrollment Findings
In 2018, Contra Costa County received 201 referrals to AOT for 174 unique individuals.3 Approximately
two-thirds of those consumers were either still under investigation or were connected to mental health
services. The following sections report on Contra Costa County’s processes for AOT referral, investigation,
and outreach and engagement, and highlight key findings across each area.
Referral for AOT
The majority of AOT referrals (55%) continue to come from consumers’ family members.
As Table 3 demonstrates, almost 95% of all referrals to AOT were made by family members, mental health
providers, or law enforcement officials. Family members made over half (55%) of the 201 referrals to AOT,
while mental health providers and law enforcement officials made 29% and 11% of referrals to AOT,
respectively. An additional 5% of referrals came from a director of a hospital, another adult that lives with
the individual, an unknown requestor, or an unqualified requestor.
Table 3. Summary of Requestor Type (N = 201)
Requestor Percent of Total Referrals (N = 201)
Parent, spouse, adult sibling, or adult child 55% (n = 111)
Treating or supervising mental health provider 29% (n = 58)
Probation, parole, or peace officer 11% (n = 22)
Director of hospital where individual is hospitalized 2% (n = 4)
Not a qualified requestor 1% (n = 2)
Adult who lives with individual 1% (n = 2)
Other/Unknown 1% (n = 2)
Care Team
Contra Costa County’s Care Team consists of CCBHS’ FMH and MHS staff. CCBHS FMH receives all AOT
referrals and conducts an investigation for each individual referred in order to determine AOT eligibility
(see Appendix I. AOT Eligibility Requirements). CCBHS FMH refers AOT-eligible consumers to MHS staff,
who conduct outreach and engagement to enroll consumers in ACT services.
3 In 2018, FMH experienced a fire that compromised some data. Data that FMH sent to RDA indicates there were 201 request
calls for AOT received in 2018. However, data from MHS’ Outreach and Engagement log shows an additional 10 consumers who
received an AOT referral and received Outreach and Engagement in 2018 that are unaccounted for in the FMH data.
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After CCBHS receives an AOT referral, the FMH team conducts an investigation to determine if the
individual meets the eligibility criteria for the AOT program. In addition to consulting prior hospitalization
and mental health treatment records for the individual and gathering information from the qualified
requestor, the FMH investigation team also attempts to make contact with the referred individual in the
field.
Approximately 31% (n = 63) of consumers were identified as eligible for AOT and referred to
MHS for outreach and engagement.
As shown in Table 4, FMH received and investigated 201 referrals for AOT in 2018. Of those referrals,
approximately one-third (31%, n = 63) were referred to MHS for outreach and engagement and potential
enrollment in ACT. FMH connected or re-connected 33 (16%) consumers to a mental health provider,
while 40 (20%) consumers were still under investigation at the end of the year.
Table 4. Outcome of CCBHS Investigations for Consumers Referred in 2018 (N = 201)
Investigation Outcome Referred
Consumers
% of Referred
Consumers
Referred to MHS 63 31%
Engaged or Re-Engaged with a Provider 33 16%
Investigated and Closed 65 32%
Ongoing Investigation 40 20%
Approximately one-third of individuals (32%, n = 65) referred to AOT were investigated and closed. Of
those 65 consumers determined to be ineligible, the majority either did not meet all nine eligibility
requirements (34%, n = 22) or were unable to be located (37%, n = 24). The remaining 19 consumers (29%)
were closed for one of the following reasons:
❖ They were unable to be assessed for eligibility (i.e., moved out of County, extended incarceration,
or extended hospitalization);
❖ The qualified requestor withdrew the referral; or
❖ The qualified requestor could not be reached.
CCBHS FMH worked to connect individuals who were ineligible for AOT to the appropriate level of mental
health treatment and also provided resources and education for family members of these individuals.
The County’s investigation team was persistent in their efforts to locate consumers, determine
consumers’ eligibility for AOT, and connect eligible consumers to MHS.
In order to capture the complete efforts of the FMH team, RDA included all investigation data for
consumers who were under investigation in 2018; so if a consumer’s eligibility investigation began in late
2017 and carried over into 2018, RDA included all of that consumer’s investigation data. On average,
CCBHS FMH’s investigation team made six contact attempts to reach each individual referred to AOT. The
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investigation team worked to meet consumers “where they’re at,” as evidenced by the variety of locations
where investigation contacts occurred. Investigation teams attempted to connect with consumers in the
field 17% of the time. They also met consumers at inpatient or licensed care (9%) and c orrectional (4%)
facilities, as well as consumers’ homes (7%). Just over half (56%) of investigation encounters occurred
either over the phone or in a County office. One-fourth of these phone or office contacts represent the
initial two contact attempts made by the FMH investigation team.
If the CCBHS FMH team determines that a consumer is eligible for AOT, the consumer is connected with
MHS. The MHS team then conducts outreach and engagement activities with those individuals and their
family to engage the individual in AOT services. As per the County’s AOT program design, MHS is charged
with providing opportunities for the consumer to participate on a voluntary basis. If, after a period of
outreach and engagement, the person remains unable and/or unwilling to voluntary enroll in ACT and
continues to meet AOT eligibility criteria, MHS may refer the individual back to FMH to file a petition to
compel court ordered participation.
MHS’ diverse team provided intensive outreach and engagement to consumers in a variety of
settings.
During 2018, MHS served 114 consumers in some capacity, either providing outreach and engagement or
ACT services. While some consumers only received outreach and engagement services in 2018, others
were also enrolled in ACT at some point during the year. As shown in Table 5, 73 consumers received
outreach and engagement services in 2018.4 Of those who received outreach and engagement services in
2018, 44 enrolled in ACT. Another 41 consumers received outreach and engagement prior to 2018 and
were ACT-enrolled during 2018.
In order to capture the total effort of MHS’s team, RDA included all outreach and engagement efforts for
ACT-enrolled consumers who were enrolled in 2018 in the following analyses. In other words, for all
consumers who were part of the ACT program in 2018 but received outreach and engagement services in
2017 or 2016, RDA included their outreach and engagement data. As shown in Table 5, 44 of the 73 (60%)
consumers who received outreach and engagement during this time period subsequently enrolled in ACT
services, and an additional 11 consumers (15%) were still in the outreach and engagement process as of
December 31, 2018.
Table 5. MHS Service Summary (N = 114)
4 MHS data indicates that 73 consumers received outreach in 2018, which is ten additional consumers than indicated in the FMH
data.
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Consumer Status Number of
Consumers
% of
Consumers
Received Outreach in 2018 73 64%
Outreach is Ongoing 11
Outreach Closed 18
Enrolled in ACT 44
Received Outreach in 2016/17; ACT services in 2018 41 36%
MHS provided outreach and engagement services
to consumers and their support networks. MHS
made 906 outreach attempts with the consumers
either enrolled in AOT or referred to MHS for AOT
in 2018. The ACT team conducted the majority
(65%) of its consumer outreach attempts in-
person. Just under one-quarter (21%) of their
outreach efforts were with consumers’ family
members or other community service providers
(see Figure 2).
MHS relies on a diverse multidisciplinary team to
conduct outreach and engagement. Just over half
(52%) of outreach attempts were by a peer partner, while one in five outreach attempts were made by
the ACT team leader (19%). A family partner, alcohol and drug specialist, clinician, nurse, psychiatrist, or
team supervisor also made outreach attempts during the evaluation period. As with the County’s
investigation team, MHS persisted in their efforts to meet consumers “where they’re at.” One in five
attempts (20%) occurred in the community, while about one in four (24%) attempts occurred at a
consumer’s home. The ACT team also attempted to connect with consumers at a hospital or crisis
stabilization facility, other community service provider locations, and criminal justice sites, such as jail,
police stations, and the courthouse.
The average length of time from AOT referral to enrollment i s 119 days, and most consumers
(80%, n = 68) enrolled in ACT voluntarily.
Contra Costa County designed an AOT program model that sought to engage and enroll consumers in ACT
within 120 days of referral. Collectively, it took the Care Team approximately 119 days to conduct
investigation, outreach and engagement, and enrollment of consumers in AOT in 2018. Figure 3
summarizes the outcomes of all referrals to AOT following the Care Team’s investigation, outreach, and
engagement efforts. At the end of 2018, 85 consumers were enrolled in ACT. Of those 85 consumers, 20%
(n = 17) enrolled with court involvement and the remaining consumers enrolled voluntarily.
Figure 2. MHS Outreach and Engagement
Attempts (N = 906)
Collateral
21%
In-Person
Unsuccessful
14%
In-person
Successful
51%
Phone/Email
14%
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Figure 3. Referral to ACT Enrollment Summary5
ACT Enrollment Findings
The ACT team served 114 unique consumers in 2018, either by outreach and engagement, or enrollment
in ACT. The following section provides information on the profile of enrolled consumers as well as service
engagement and consumer outcomes during enrollment.
Consumer Profile
Contra Costa County is reaching the identified target population.
As shown in Table 6, 41% of all consumers enrolled in ACT services during 2018 were female. The majority
of consumers identified as White/Caucasian (53%, n = 45), while 19% (n = 16) identified as Black/African
American and 13% (n = 11) identified as Hispanic. An additional 12% (n = 10) of consumers identified as
some “Other” race and 4% (n = 3) did not report their race/ethnicity. The majority of consumers (64%, n
= 54) were between the ages of 26 and 49 years old.
5 As noted previously, in 2018 FMH experienced a fire that compromised some data. Data FMH sent to RDA indicates there were
201 request calls for AOT received in 2018. However, data from MHS’ Outreach and Engagement log shows an additional 10
consumers who received an AOT referral and received Outreach and Engagement in 2018 that are unaccounted for in the FMH
data.
Consumers
referred to AOT in
2018
N = 201
FMH intervention,
not referred to
MHS
n = 138
Investigation ongoing
n = 40
Engaged or re-engaged
with provider
n = 33
Investigated and closed
n = 65
Referred to MHS
n = 114*
*41 were referred
or already enrolled
in ACT before 2018
Did not enroll in ACT
n = 29
Ongoing Outreach
n = 11
Closed
n = 18
Enrolled in ACT
n = 85
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8%, 7
28%, 24
64%, 54
Other, including Mood Disorder, or
Unspecified
Bipolar Disorder
Psychotic Disorder, including schizophrenia
and schizoaffective disorders
0 10 20 30 40 50 60
Table 6. AOT Consumer Demographics (N = 85)
Category Percent of
Consumers
Number of
Consumers
Gender
Female 41% 35
Male 59% 50
Race/Ethnicity
White 53% 45
Black/African American 19% 16
Hispanic or Latino 13% 11
Other 12% 10
Unknown/Not reported 4% 3
Age
18 – 25 21% 18
26 – 49 64% 54
50+ 15% 13
Consumers enrolled in ACT are reflective of the intended AOT population of individuals with serious
mental illness (see Figure 4). The majority of consumers (64%, n = 54) had a primary diagnosis of a
psychotic disorder, including schizophrenia and schiz oaffective disorders. Another 28% (n = 24) had a
primary diagnosis of bipolar disorder. Furthermore, 68% (n = 58) of consumers had a co-occurring
substance use disorder.
Figure 4. Primary Diagnosis (N = 85)
Partnership Assessment Form (PAF) data were available for 83 ACT consumers. Of those 83 consumers,
74% (n = 72) were unemployed at some point in the 12 months prior to enrolling in ACT (see Figure 5). As
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shown in Figure 6, 81% (n = 67) of the consumers with available data were unemployed when they were
enrolled in ACT services.
Figure 5. Employment 12 months
before ACT (N = 83)
Figure 6. Employment at
ACT Enrollment (N = 83)
Financial support data were available for 83 consumers. Table 7 depicts the different sources of financial
support and income for consumers in the 12 months prior to enrollment, as well as at the time of
enrollment. The “Other” category includes retirement/Social Security income, tribal benefits, wages or
savings, housing subsidy, and food stamps. The majority of consumers received Supplemental Security
Income/State Supplementary Payment (SSI/SSP) or Social Security Disability Income prior to (59%) and at
the time of (55%) enrollment. Approximately 13% of consumers reported having no financial support or
income prior to enrollment, while 16% of consumers reported having no financial support at the time of
enrollment.
Table 7. Sources of Financial Support for ACT Consumers (N = 83)6
Source of Financial Support Received in the 12 Months
Prior to Enrollment
Receiving at Enrollment
Supplemental Security or Disability Income 59% 55%
Support from family or friends 23% 23%
Other 4% 2%
No Financial Support 13% 16%
Unknown 7% 8%
Service Participation
The following sections describe the type, intensity, and frequency of service participation, as well as
adherence to treatment. Of the consumers enrolled in ACT during 2018, four were enrolled for less than
one month, and 16 consumers had no MHS encounter data available to determine service participation.
Therefore, the following analyses include service data for 65 out of 85 consumers who received MHS
services in 2018.
6 Total percentages are greater than 100 because some consumers had more than one source of support.
Unknown, 7%
Unemployed, 87%
Some Employment, 6%Unknown, 19%
Unemployed, 81%
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It is important to note that Contra Costa County implemented a new billing system during 2018, shifti ng
from the PSP billing system to ShareCare on July 1, 2018. According to data RDA received from the PSP
and ShareCare systems, there were substantially fewer MHS encounters per consumer after July 1
compared to the first half of the year. However, it is unclear whether these differences demonstrate true
differences in the number of encounters consumers experienced, if data from ShareCare underestimated
consumer encounters due to issues with data entry or data extraction from the new system, or whether
it is a combination of both. Contra Costa County will look further into this issue for the 2020 report to
DHCS; however, data on service intensity, frequency, type, and adherence should be interpreted
cautiously in this report.
The multidisciplinary ACT team provides wrap-around behavioral health services to consumers.
ACT consumers in Contra Costa County received services from a multidisciplinary ACT team who provide
wrap-around behavioral health services. When implemented to fidelity, ACT produces reliable results
including decreased negative outcomes, (e.g., hospitalization, incarceration, and homelessness) and
improved psychosocial outcomes. In 2018, consumers were enrolled and receiving ACT services for an
average of 437 days. On average, they received two in-person service encounters per week for a total
average of two hours of in-person services per week (see Table 8).
Table 8. ACT Service Engagement (N = 65)
Average Range
Length of ACT Enrollment 437 days 52 – 1014 days
Frequency of ACT Service Encounters 2 face-to-face contacts per
week
<1 to 10 face-to-face contacts
per week
Intensity of ACT Services 2 hours of face-to-face
contact per week
<1 – 9 hours of face-to-face
contact per week
Approximately one-third of consumers were adherent with ACT services.
Using the ACT fidelity guidelines as a reference, consumers were considered “treatment adherent” if they
received at least one hour of face-to-face engagement with their ACT team at least two times per week.
Twenty-three of 65 consumers included in the service analysis (35%) met this standard of adherence (see
Figure 7 and Figure 8).7 However, as noted above, these findings should be interpreted cautiously, because
it is unclear whether the PSP and ShareCare billing data that RDA received to track MHS service
participation reflects true service participation or whether service participation is underestimated due to
errors in data entry or extraction from the new ShareCare system.
7 15 consumers met the standard for intensity but not frequency of service.
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Figure 7. Intensity of ACT Contacts per Week
Figure 8. Frequency of ACT Contacts per Week
ACT Consumer Outcomes
The following sections provide a summary of consumers’ experiences with psychiatric hospitalizations,
crisis episodes, criminal justice involvement, and homelessness before and during ACT enrollment. When
appropriate, these outcomes are standardized to rates per 180 days in order to account for variance in
length of enrollment and pre-enrollment data. All 85 consumers served during 2018 were included in the
following outcomes analyses. To calculate rates of occurrence in the three years prior to a consumer’s
enrollment, RDA identified the oldest hospitalization, crisis, and jail bookings for that consumer that took
place within three years of their program enrollment date. Starting with this first date of occurrence, the
number of pre-enrollment days were determined and used to standardize the rate of occurrence prior to
AOT enrollment (per 180 days). During enrollment, the rate of occurrence was determined by the number
of days a consumer was enrolled in the ACT program.
The County’s PSP Billing System was used to identify consumers’ hospital and crisis episodes in the 36
months prior to and during AOT enrollment through June 30, 2018. The County’s new billing system,
ShareCare, was used to identify consumers’ hospital and crisis episodes from July through December,
2018.
The number of consumers experiencing crisis episodes and psychiatric hospitalization
decreased during ACT.
The number of consumers experiencing a crisis episode decreased during ACT, as did the rate of their
crisis experiences. Almost all consumers (94%, n = 80) experienced at least one crisis episode in the three
years before ACT with episodes lasting an average of just over one day. Fewer consumers had a crisis
episode during ACT (48%, n = 41). Among those who did have crisis episodes, they experienced
approximately three episodes every six months both prior to and during ACT participation. The average
length of crisis episodes remained steady prior to and during ACT enrollment (see Table 9).
Table 9. Consumers’ Crisis Episodes before and during ACT
40%, 26
20%, 13
40%, 26
0
4
8
12
16
20
24
28
<1 hour per week 1 hour per week 2 or more hours
per week
43%, 28
20%, 13
37%, 24
0
4
8
12
16
20
24
28
32
<1 contact per
week
1 contact per
week
2 or more
contacts per week
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Crisis Episodes
Before ACT enrollment During ACT enrollment
Number of Consumers (N = 85) n = 80 n = 41
Number of Crisis Episodes 2.8 episodes per 180 days 3.1 episodes per 180 days
Average Length of Stay 1.2 days 1.2 days
Similar to those experiencing crisis episodes, the number of consumers who experienced a psychiatric
hospitalization decreased during ACT. Approximately 53% (n = 45) of consumers were hospitalized in the
36 months before ACT, compared to 18% of consumers (n = 15) who experienced a hospitalization during
ACT. Those with at least one hospitalization before ACT experienced approximately 1.1 hospitalizations
every 180 days, lasting an average of 13.7 days each. Consumers were hospitalized fewer times (0.8
hospitalizations per 180 days) while enrolled in ACT, and the average hospitalization lengths were similar
prior to (13.7 days) and while enrolled (15.8 days) in ACT (see
Table 10).
Table 10. Consumers’ Psychiatric Hospitalizations before and during ACT
Psychiatric Hospitalizations
Before ACT enrollment During ACT enrollment
Number of Consumers (N = 85) n = 45 n = 15
Number of Hospitalizations 1.1 hospitalizations per 180 days 0.8 hospitalization per 180 days
Average Length of Stay 13.7 days 15.8 days
This section describes consumers’ criminal justice system involvement utilizing data from the Sheriff’s
Office to assess the number and the average lengths of jail bookings for each consumer in the 36 months
prior to and during ACT enrollment.
The number of consumers incarcerated in County jails decreased during ACT.
Over half of ACT consumers (54%, n = 46) were arrested and booked into County jail at least once in the
three years prior to ACT enrollment. On average, prior to ACT enrollment, they were arrested and booked
into County jail approximately two times per 180 days and were in jail for an average of 23.8 days. During
ACT participation, however, just over one-quarter of consumers (26%, n = 22) were arrested and booked
into County jail. Among these individuals, on average, they were arrested and booked at slightly higher
rates per 180 days during ACT enrollment, and the average length of their incarcerations following an
arrest increased slightly as well, from 23.8 to 28.5 days (see Table 11).
Table 11. Consumers’ Bookings before and during ACT
Bookings and Incarcerations
Before ACT enrollment During ACT enrollment
Number of Consumers (N = 85) n = 46 n = 22
Number of Bookings 2 bookings per 180 days 2.5 bookings per 180 days
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Average Length of Incarceration 23.8 days 28.5 days
Over 80% of consumers were in stable housing at the conclusion of the evaluation period.
At enrollment, 61% of consumers were in stable housing. RDA compared consumers’ baseline housing
status to their last known residence in 2018 to explore changes in consumers’ housing status during ACT
enrollment. Housing information was taken from consumers’ Partnership Assessment Form (PAF) at
intake and the subsequent Key Event Tracking (KET) form that were used to note changes in a consumer’s
status. This analysis contains information from 52 consumers due to limited data availability.9 As shown
in Figure 9, 79% (n = 41) of consumers had stable housing at the end of their ACT enrollment or the
reporting period. The remaining 21% (n = 11) of consumers either lost their housing while in ACT or never
had nor gained stable housing.
Figure 9. Consumers’ Housing Status before and during ACT
ACT enrollment provides consumers with support for their employment and education.
All ACT consumers have access to vocational services provided by the ACT team. However, during the
evaluation period, less than one-quarter of ACT consumers (n = 18) accessed these services through ACT.
Employment services included: support developing résumés, searching for job openings, preparing for
interviews, and submitting applications. The ACT team also worked with consumers to identify their
vocational goals and discuss how employment can lead to independent living for consumers. The number
of consumers with some form of employment (either part- or full-time, or volunteer work) increased
during ACT. While no consumers had employment at enrollment, four consumers held competitive
employment at some point during ACT in 2018. An additional five ACT consumers attended school or
completed a degree in 2018.
8 RDA used the Department of Housing and Urban Development (HUD) definition of stable housing to determine which categories
from the FSP PAF and KET forms should be considered “housed.”
9 Two consumers were missing a PAF and were not included in this analysis. An additional 23 consumers who were enrolled for
more than two-months and did not have a KET were also excluded. Eight consumers housing status was unknown.
Consumers who obtained or
maintained housing
•79% of consumers were not housed
before ACT but obtained housing while
enrolled or were housed before ACT and
continued to maintain housing while
enrolled
Consumers who were not
stably housed
•21% of consumers were not housed
before or during ACT enrollment or were
housed before ACT but did not maintain
housing during ACT
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When implemented to fidelity, ACT programs can enhance consumers’ abilities to function independently
and participate in activities of daily living. Throughout consumers’ enrollment in ACT, the MHS team
administered the Self Sufficiency Matrix (SSM) to assess consumers’ social functioning and independent
living on a quarterly basis. The SSM consists of 18 domains scored on a scale of one (“in crisis”) to five
(“thriving”).
ACT consumers experienced slight increases in their self-sufficiency while enrolled in ACT.
The MHS team assessed consumers at intake, every 90 days, and upon discharge. Intake data were
available for 48 consumers enrolled in ACT during 2018, 34 of whom also had at least one reassessment.
Table 12 reports the average scores for consumers at intake, as well as at 3, 6, 12, and 18 months after
enrollment.10
Table 12. Self Sufficiency Matrix Scores
Domain
Intake
Average
Score
3-month
Average
Score
6-month
Average
Score
12-month
Average
Score
18-month
Average
Score
Housing 3.08 3.35 3 3 3.63
Employment 1.08 1.12 1.16 1.36 1.43
Income 1.79 2.24 1.97 2.73 2.25
Food 2.65 2.85 2.72 2.8 3.25
Child Care 4.5 4 4 4 3
Children's Education 4.75 5 5 5 5
Adult Education 3.6 3.21 3.41 3 3.25
Health Care Coverage 4.02 4.38 3.88 3.36 3.63
Life Skills 3 3.47 3.47 3.09 3.63
Family/Social Relations 2.56 3.94 2.78 2.82 2.5
Mobility 2.73 3.03 3.09 3.36 2.38
Community Involvement 2.42 3.12 2.44 3.27 2.38
Parenting Skills 3 2.6 3.67 1.67 4
Legal 3.74 3.94 4.17 3.64 4.57
Mental Health 2.15 2.15 2.25 2.91 2.38
Substance Abuse 3.17 3.15 3.25 3.27 4.13
Safety 3.73 4.06 3.94 3.64 4.38
Disabilities 2.52 2.47 2.6 3 2.88
Total Score 43.44 47.82 44.75 45.73 49.63
n=48 n=34 n=31 n=10 n=7
10 “n/a” indicates where no scores were given for SSM domains
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Consumers’ average scores across domains at each SSM administration were higher than the average
scores at intake.
Consumers who meet the eligibility requirements for AOT often have perpetrated violence towards others
and/or experienced violence and victimization. The team administered the MacArthur Abbreviated
Community Violence Instrument (MacArthur tool) at intake, every 180 days, and at discharge to
determine if consumers were either perpetrators of violence and/or victims of violence. The assessment
asks consumers about the following types of violence:
❖ Throwing things at someone
❖ Pushing, grabbing, or shoving someone
❖ Slapping someone
❖ Kicking, biting, or choking someone
❖ Hitting someone with a fist or object, or beating someone up
❖ Forcing someone to have sex against their will
❖ Threatening someone with a gun, knife, or other lethal weapon
❖ Using a knife on or firing a gun at someone
Consumers were asked if they had either perpetrated and/or been victims of each type of violence in the
prior month.
Few ACT consumers perpetrated violence towards others and/or experience victimization.
The MacArthur tool includes 17 questions that assess the frequency of violence, victimization or
perpetration of assaultive behavior by consumers during the last month. Victimization and violent
behaviors include behaviors that cause physical or emotional harm to themselves or others. These
behaviors can range from verbal abuse to physical harm to self, others, or property.
MHS administered the MacArthur Tool with 48 ACT clients during 2018. The majority of ACT clients at
baseline reported that they had not been victimized nor perpetrated violence towards someone in the
month prior to enrollment. No consumers (n = 28) reported being victimized or perpetrating violence in
the prior month for MacArthur assessments taken between three and twenty-four months after ACT
enrollment. However, given the sensitive nature of these questions and that very few individuals reporting
experiencing either activity during both time points, these results are likely an underrepresentation of
these outcomes and should be interpreted with caution.
Understanding both consumers’ satisfaction with ACT services is an important way to ensure ACT services
are meeting the needs and expectations of the individuals the program serves. MHS’ client satisfaction
survey tool was used to assess consumer satisfaction with ACT services.
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Overall, ACT consumers are very satisfied with ACT services and consumers’ recovery while
enrolled in ACT.
In 2018, MHS collected program satisfaction surveys from 42 consumers. Clients were asked to rate their
overall satisfaction with the services they received from MHS on a scale of 1 to 5, 5 being the most positive.
Forty-one consumers responded to this question with an average score of 4.7.
MHS connected consumers with many resources and supported them in acquiring assistance for their
everyday needs. The greatest number of consumers noted that MHS helped them with the following
resources:
❖ Housing (n = 25)
❖ Transportation (n = 28)
❖ Counseling (n = 30)
❖ Medication Support (n = 30)
No AOT enforcement mechanisms were used during 2018.
The primary enforcement mechanism occurs when AOT consumers (e.g., consumers who have a voluntary
settlement agreement or AOT court order) refuse to engage and a judge orders the consumer to meet
with the treatment team or issues a mental health evaluation order at a designated facility for a consumer
who does not meet 5150 criteria established in the Welfare and Institutions Code. These enforcement
mechanisms were not used in 2018 in Contra Costa County’s AOT program.
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Summary of Finding s
This 2018 report to California’s DHCS was written in recognition of the collaborative efforts of those
involved in the implementation of the AOT program in Contra Costa County. The following discussion
summarizes implementation activities and consumer accomplishments during 2018.
CCBHS FMH and MHS collaborate to identify and engage eligible consumers in ACT services.
After almost three years of implementation, FMH and MHS have made important strides in their
collaborative efforts to effectively and efficiently identify and engage eligible AOT consumers. Both teams
are persistent in their efforts to work with consumers who may be difficult to find and engage by nature
of their diagnoses and co-occurring substance use disorders. The FMH and MHS teams meet consumers
in a variety of locations and use cultural and age-specific approaches to engage both consumers and their
support networks.
CCBHS FMH and MHS have a demonstrated commitment to this program and making data -driven
improvements. They regularly assess ways to improve their collaboration in service of consumer needs.
In 2018, FMH and MHS began joint case reviews on a monthly basis of every referred consumer who has
not yet enrolled in the program to determine if and when court involvement should take place in order to
ensure that consumers who require court involvement to participate are promptly identified.
Furthermore, both FMH and MHS have strong and positive working relationships with the Contra Costa
County Court system, which enables all parties to ensure consumers who are eligible for AOT services to
receive the support they need.
The County’s AOT program connected a majority (59%) of referred individuals to the
appropriate level of mental health services, including ACT.
In 2018, the County received 201 referrals for AOT. At the conclusion of the year, 20% (n = 40) were still
being investigated for AOT eligibility. Of those referrals that were closed, 33 were ineligible for AOT but
connected to another provider, that they worked with in the past or a new mental health provider. This
indicates that the AOT program in Contra Costa County also provides opportunities for consumers who
are not eligible for AOT to access mental health services. Forty-four of the consumers referred to MHS in
2018 for outreach and engagement services were ultimately enrolled in ACT and 11 consumers were still
receiving outreach and engagement at the end of the evaluation period. In 2018, less than a third of
consumers were closed without connection to services; the majority of those who were closed either did
not meet all of the nine AOT eligibility criteria, could not be located, or the qualified requestor was
unavailable or withdrew the request.
Data limitations mostly stemming from the implementation of a new health care billing system
(ShareCare) during 2018 impacted the quality of service data available for this report.
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According to the data that RDA received from the PSP and ShareCare billing systems, there were
substantially fewer MHS encounters per consumer during the second half of 2018 compared to the first
half of the year. However, it is unclear whether these differences demonstrate true differences in the
number of encounters consumers experienced, if data from ShareCare underestimated consumer
encounters due to issues with data entry or data extraction from the new system, or whether it is a
combination of both. From RDA’s perspective, whenever new data systems are being implemented across
large service agencies, it is natural for there to be data-related issues for both inputting and extraction.
Contra Costa County will look further into this issue for the 2020 report to DHCS.
The majority of ACT consumers experienced benefits from participating in the AOT treatment
program.
Consumers experienced a range of benefits from their participation in ACT. For the following outcomes,
fewer consumers experienced these negative outcomes during their ACT enrollment compared to the
years prior to their ACT enrollment:
❖ Crisis episodes,
❖ Psychiatric hospitalizations,
❖ Arrests and incarcerations,
❖ Homelessness,
❖ Victimization, and
❖ Violence towards others.
Additionally, ACT consumers’ average total scores on their Self-Sufficiency Matrix (SSM) reassessments
were higher than their average scores at intake, suggesting that consumers are improving in their social
functioning and independent living skills through program participation. Lastly, consumers expressed
satisfaction with ACT services while enrolled in ACT. In survey responses, consumers rated their level of
satisfaction very high (4.7 on average on a scale of 1 - 5). In particular, ACT consumers noted that MHS
helped them with housing (n = 25), transportation (n = 28), counseling (n = 30), and medication support
(n = 30).
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Appendices
Appendix I. AOT Eligibility Requirements11
In order to be eligible, the person must be referred by a qualified requestor and meet the defined criteria:
❖ The person is 18 years of age or older.
❖ The person is suffering from a mental illness.
❖ There has been a clinical determination that the person is unlikely to survive safely in the
community without supervision.
❖ The person has a history of lack of compliance with treatment for his or her mental illness, in that
at least one of the following is true:
a. At least 2 hospitalizations within the last 36 months, including mental health services in a
forensic environment.
b. One or more acts of serious and violent behavior toward himself or herself or another, or
threats, or attempts to cause serious physical harm to himself or herself or another within
the last 48 months.
❖ The person has been offered an opportunity to participate in a treatment plan by the director of
the local mental health department, or his or her designee, provided the treatment plan includes
all of the services described in Section 5348, and the person continues to fail to engage in
treatment.
❖ The person's condition is substantially deteriorating.
❖ Participation in the assisted outpatient treatment program would be the least restrictive
placement necessary to ensure the person's recovery and stability.
❖ In view of the person's treatment history and current behavior, the person is in need of assisted
outpatient treatment in order to prevent a relapse or deterioration that would be likely to result
in grave disability or serious harm to himself or herself, or to others, as defined in Section 5150.
❖ It is likely that the person will benefit from assisted outpatient treatment.
11 Welfare and Institutions Code, Section 5346
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Appendix II. Description of Evaluation Data Sources
CCBHS AOT Request Log: This spreadsheet includes the date of each AOT referral, as well as the
demographic characteristics of each individual referred to AOT and the disposition of each r eferral upon
CCBHS’ last contact with the individual referred (e.g., unqualified requestor, open AOT investigation,
voluntarily accept MHS services, court-involved MHS participation). These data were used to identify the
total number of referrals to the County’s AOT program during.
CCBHS Blue Notes: CCBHS staff converted the Blue Notes (i.e., field notes from successful outreach
events) into a spreadsheet tracking the date, location, and length of each CCBHS Investigation Team
outreach encounter. These data were used to assess the average frequency and length (i.e., days and
encounters) of investigation attempts provided by the CCBHS Investigation Team per referral.
MHS Outreach and Engagement Log: This spreadsheet tracks the date and outcome of each MHS
outreach encounter, including information on who provided outreach (e.g., family partner, peer partner,
clinician) to whom (consumer or collateral contact such as friend, family, or physician), and the location
and length of each outreach encounter. Data from this source were used to calculate the average number
of outreach encounters the MHS team provided each consumer, as well as the average length of each
outreach encounter, the location (e.g., community, secure setting, telephone) of outreach attempts, and
the average number of days of outreach provided for reach referral.
Contra Costa County PSP and ShareCare Billing Systems: These data track all services provided to ACT
participants, as well as diagnoses. PSP and ShareCare service claims data were used to identify the clinical
diagnoses of ACT participants at enrollment, as well as the types of services consumers received pre- and
during-ACT enrollment (e.g., outpatient, inpatient, residential, and crises), the average frequency with
which consumers received ACT FSP services, and the average duration of each service encounter.
FSP Partnership Assessment Form (PAF), Key Event Tracking (KET), and Quarterly Assessment Form
(3M): Though the PAF, KET, and 3M are entered into the Data Collection and Reporting (DCR) system, data
queries were unreliable and inconsistent; therefore, MHS staff entered PAF, KET, and 3M data manually
into a Microsoft Access database. These data were used in this report to generate consumer profile
measures and self-reported changes in outcome measures such as homelessness before and during ACT.
MHS Outcomes Files: These files include assessment data for a number of clinical assessments MHS
conducts on ACT participants. For the purposes of this evaluation, the Self Sufficiency Matrix (SSM) was
used to assess consumers’ social functioning and independent living. Future reports will include findings
from the MacArthur Abbreviated Community Violence Instrument to address consumers’ experiences of
victimization and violence.
Contra Costa County Sheriff’s Office Jail Management System: Data from this system included
consumers’ booking offenses, dates, and release dates for the three years prior to ACT-enrollment and
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the time following ACT enrollment through the end of 2018. They were used to examine consumers’
arrests and jail stays before and during ACT.
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