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HomeMy WebLinkAboutMINUTES - 12151998 - D2 ......_. . ......... ......... ......... ......... ......... ......... ......... .._..........._. _.....___.. .......... ......... ......... ......... ._....... ......... ...._.... ......... ........... ....... ......... THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on December 15, 1998 by the following vote: AYES: Supervisors Uilkema, Gerber, DeSaulnier, Canciamilla and Rogers NOES: None ABSENT: None ABS'T'AIN: None SUBJECT: ANNUAL PERFORMANCE REVIEW 1998 IT IS BY THE BOARD ORDERED that the annual report of the Contra Costa Health Services department is ACCEPTED. T hereby certify that the foregoing is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. ATTESTED: December 15, 1998 Phil Batchelor,Clerk of the Board of Superv' rs and County Administrator By Deputy ....................................................................................................................................................................................................................................................................................................................... individual, a coordinationplan is developed offered in the SOC consists of various mental that identifies the individual's desired results for health programs and services from the most his/her own life which the mental health restrictive, institutionally based services (e.g., delivery system can help him/her achieve. The hospitalization) to the least restrictive,commu- entire focus of the service delivery system is to nity-based services, (i.e.,early intervention and move away from institutional care and toward a prevention programs). These services are both community support service delivery system. county-operated and provided through con- tracts with community-based organizations. The Intensive Community Support Team pilot There are contracts for residential or hospital- project that was implemented in East County in based services and for less intensive community 1996 is growing in strength and has been very based services. successful in demonstrating a philosophical change in the way service delivery to the target The Children's Mental Health SOC does not population is conceptualized. This has served as stand alone. It is inextricably linked with other a catalyst for structural change in the delivery of public child-serving entities, i.e., schools, adult mental health services throughout the probation, social services, and health care County. This year, the intensive community providers. There is usually one or more of these support model was successfully implemented in other entities involved with each child and Central County and is underway in the West family mental health service. Interagency County Adult Clinic. Under this model, the collaboration is a necessary and important part clinics operate on a seven day a week, 24-hour a of service delivery.The goal is to provide one day coverage basis. This model prioritizes the seamless, coordinated and collaborative system provision of services necessary for clients to live for delivery of mental health services county- successfully in the community, thus avoiding wide. The SOC continues to be developed and, costly hospitalization and/or institutionaliza- when new elements are created, they are de- tion. signed to fill identified gaps in the SOC con- tinuum in order to reinforce the system's ability The target population and types of services to maintain children in their own home and provided currently are in response to Short community, or, in the event that a child is Doyle Medi-Cal Rehabilitation Option require- already in out-of-home placement, to enable ments, Medi-Cal Outpatient Consolidation such children to return to a less restrictive and, to some degree, other federal funding (i.e., environment. SAMESA). In addition to regular mental health services the following services are pro- Because the mandate of the state is for public vided either by County or contracted service mental health dollars to be expended for services providers: Day Treatment, Crisis Residential to seriously emotionally disturbed children, and Adult Residential,Vocational Development adolescents and.their families, and those indi- and Training, Housing Development and viduals and families that have the most urgent Training, Crisis Intervention and Stabilization, and Case Management Brokerage. needs, the SOC is heavily weighted toward serving that population. Children's Services. Children's Mental Health Mental Health Crisis Services. For all County Services has established a System of Care (SOC) residents, regardless of age or payor source, offering a continuum of services to meet the Crisis Services operates 24 hours a day,as an varied mental health needs of children, addles- outpatient, psychiatric emergency and crisis cents, and their families. The array of services service at CCRMC in Martinez,and 8:00 a.m.- 14 ............................... ...................... .................................... Jct—rs''-r& 5.00 p.m., .Monday through Friday at the West tion.These staff facilitate system-wide treatment County site,providing immediate access as a plans and advocate for case management for high mental health drop-in service and WB�I Code users of crisis and acute care facilities. 5150 evaluation and treatment center. For urgent, less emergent services, the Crisis and. As a 51501-designated service site, Crisis Services Assessment Team provides appointments for evalu- provides evaluation and treatment of consumers ation and treatment at the West County Crisis on 5150 holds requiring assessment,stabilization site,Concord Mental Health Clinic,and Pittsburg of symptoms,and referrals.Treatment choices may Mental Health Clinic. include admission for acute care,outpatient/fam- ily therapy, medication treatment, case manage- The Mental Health Advice Line located at the meat linkage,and.drug and alcohol programs. At CCRMC provides 24-hour advice and referrals CCRMC, 24-hour crisis stabilization treatment to Medi-Cal beneficiaries, uninsured and other is also available. callers. Medi-Cal beneficiaries are able to access the provider network and/or a Crisis and Assess- Drop-in evaluation and short-term treatment on ment Team appointmentthrough this line. an outpatient basis is provided for acute situational crisis related to bereavement, depression, acute- tinder Emergency Medical Treatment and Active traumatic stress disorder,brief psychotic reaction, Labor Act requirement(commonly known as"pa- and/or substance abuse. These clients may be at tient dumping„ under the COBRA or EMTA.LA. risk for hospitalization due to the severity of their laws), hospitals must screen and stabilize any in- symptoms. dividual who presents anywhere on hospital prop- erty, or en route via an 'ambulance, asking for Crisis Services also provides face-to-face consul- evaluation of a possible emergency medical con- tation, evaluation, and treatment recommenda- dition (including psychiatric emergencies and tions to requesting agencies for children and adult symptoms of substance abuse). Because some in- _ providers including group homes,shelters,medi- dividuals are screened as not appropriate for our cal clinics, and private practitioners and Critical mental health services, a jtriage log is kept with Incident Stress Debriefing and support to the com- the nature of the request, any disposition/refer- munity as requested for both natural and sudden ral, recommendations, and advice given. violent occurrences. Crisis Services provides phone consultation 24 Public Health hours a day to ether County-designated 5150 fa- The Public Health Division provides a range of cilities, emergency services, police departments clinical services and community outreach, nutri- and private practitioners regarding clients in their tion services and services for developmentally care and education, and training on W&I Code delayed children and adults, community wide 5150 issues to police and sheriff departments, prevention programs and health data collection emergency departments/medical facilities in Con- and assessment. tra Costa County, and mental health practitio- ners. Clinical services include Well Child and Primary Crisis Services provides Hospital Liaison staff for Care Pediatrics,Family Planning,SexuallyTrans- the monitoring of all adult psychiatric inpatient mitred Diseases,Tuberculosis Clinics,Immunize- admissions at CCRMC and contract hospitals as tion,and HIV Testing and Counseling. In addi- a result of Phase I Inpatient Medi-Cal Consolida- tion,there are mobile community clinical ser- vices for homeless people(Health Care for the 15 Homeless) and for those who do not present for and sexually transmitted diseases. care(Health on Wheels Mobile Clinic Van). The Home Health Agency provided over 31,929 A fundamental role of Public Health is to col- home visits in the last fiscal year and Public lect data and assess the health conditions and Health Nurses provided additional home visits needs of the community, and evaluate the effec- and case management for children and families. tiveness of public health and community activi- Public Health provides services in schools ties to improve the health of county residents. through the Dental Disease Prevention Program The Public Health Data and Evaluation staff and School-Based Public Health Clinics in Rich- work with CommunicableDisease Control, mond and Bay Point. Clinic services are sup- Clinic Services, Family,Maternal,and Child ported by the Public Health Laboratory,which Health, and the Community Wellness and Pre- also provides reference laboratory services for tu- vention Program to develop community health berculosis,parasites,and other communicable indicators and evaluate program effectiveness. diseases to non-Health Department providers throughout the county.Clinic services are Many of the our programs are state or federally complemented by Community Outreach Work- mandated with categorical funding attached to ers working in neighborhoods and with commu- them,which defines populations to be served nity groups to identify pregnant women, chit- and limits services to be provided. dren in need of health care,AIDS prevention, TB and STD follow-up and treatment,and Community Substance homeless outreach. Abuse Services Non-clinical direct services include Women, In- Community Substance Abuse Services (CSAS) advocates for alcohol and drug free communi- fants, and Childress (WIC) services which pro- vide monthly food vouchers to over 7,004 low- ties by promoting individual and family respon- income women and children,and Senior Nutri- sibility,hope, and self-sufficiency. tion Services which serves hot lunches to seniors Staff provide assessment for addiction severity at 19 sites throughout the county and provide Home Delivered Meals to homebound seniors and dual diagnosis, individual and groupcounseling,and an array of prevention service and people with AIDS. The George Miller for youth and families who are directly or Centers in Richmond and Concord provide indirectly affected by substance use or abuse. therapeutic services and education for develop- Primary prevention services are also provided to mentally disabled adultsandchildren, grassroots groups and local coalitions involved in changing alcohol and drug policies, norms Community-based prevention services are and conditions that impact community health implemented throughout the county in partner- and well being. ship with community-based organizations. Those services include AIDS prevention and CSAS operates and contracts for services education, tobacco control and cessation, co m- through a community-based continuum of care munity and domestic violence prevention, that stresses accountability and outcomes, is chronic disease control including nutrition edu- cation and active living projects, lead poisoning services comply with California State Standards prevention, and childhood injury prevention for Substance Abuse Treatment and Prevention programs. Communicable Disease Control fo- cuses on preventing the spread of communicable diseases in the community,especially tuberculosis 16 . . ............................................................................................................................................................................................ _... ........... ......... ......... .......... ...._....... ......._. ....................__..............__...... ...._....._.._...._. TREATMENT SERVICES substance abuse coalitions,grassroots organiza- Client Access to System of Care Services This tions and CSAS System of Care community- year CSAS developed the ACCESS Unit. This based prevention programs. unit is designed to screen clients and refer them The Community Partnership Forum Alliance- to the most appropriate treatment placement, CSAS provides staff assistance for an alliance of provide substance abuse information to the local prevention groups that work with the public, and make referral for prevention ser- Substance Abuse Advisory Board (SAAB) to vices. implement the Substance Abuse Action Plan. Detoxification.These services provide a residen- Treatment Clients'Children and Families-To tial setting for up to five days to support the ensure linkages among different modalities safe withdrawal from alcohol and/or drugs.To within CSAS's System of Care components and ensure continued care,CSAS requires linkages to ensure outreach to the children and families among the various treatment modalities to of clients,prevention services are provided at ollowing detoxification or residen- outpatient drug-free treatment programs, detox provide care f tial services. and residential programs. Services include Residential-Residential programs are 24 hours presentations, dissemination of information and a day, seven days a week social model environ- educational materials, education and support ments that require a minimum of 40 hours per groups, problem identification and referrals to week of counseling and/or structured therapeu- other System of Care service components. tic activities such as consciousness raising, twelve step groups,stress management, poly- SPECIAL SERVICES drug education, relapse prevention and plan- Criminal Justice-CSAS operates and contracts ning groups. for court, parole and probation mandated Outpatient Drug-Free Counseling. Our non- substance abuse treatment and intervention residential treatment programs provide indi- services,which include county-wide Driving vidual, group and family counseling, education Under the Influence, Drug Diversion (PC- and relapse prevention services.Treatment 1000), State(BASIN) and Federal Parolee/ includes assessment,development and imple- Probationers Programs, and Supervised Treat- mentation of individualized treatment and went and Recovery Services (STAR) in Rich- discharge plans, HIWAIDS and STD educa- mond. tion. Programs recommend participation in Driving Linder the Influence- CSAS operates AA, NA, SOS and other twelve step support three DUI sites in Antioch,Walnut Creek, and groups. CSAS operates three county drug-free Richmond and contracts with Bi-Bett and outpatient substance abuse treatment programs. Occupational Health Services, to provide First Offender and Multiple Offender services. DUI PREVENTION SERVICES services are a multifaceted statewide approach to The goals of prevention services are (1) to address the problem of alcohol and drug im- reduce alcohol and drug use and availability of paired drivers. those substances in the community, (2) to reduce alcohol and drug use among school-aged Supervised Treatment and Recovery[STAR] - youth; and (3) to increase the use of prevention rug Court Program-A collaborative effort activities that are research-based and outcome- between Contra Costa County,,Community driven. Substance Abuse Services Division,and Bay Superior Court funded by the US Department The Community Partnership-Community ofJustice,Office ofJustice Programs and the Partnership prevention services provide technical California Department ofAlcohol and Drug assistance,training,and resources to regional Programs. 17 .............. ........................ ....... ................................................................................................................... ...... .......... ............. .. ................................. Pregnant and Parenting Women-CSAS pro- dress the environmental components of health vides drug and alcohol abuse prevention, throughout the county. education,intervention and counseling inte- grated with perinatal health care for pregnant Retail Food Protection Po-agram is charged with and parenting women. In addition to alcohol assuring that purchased food is wholesome, and and other drug treatment,education about that it has been produced under conditions and pregnancy, parenting, health in general,self practices that are safe and sanitary. The pro esteem and life skills are provided. gram inspects over 4,000 restaurants, markets, bakeries, schools, vehicles, and caterers in the Contra Costa Health Plan County.The program also does routine and Contra Costa Health Plan (CCHP) is a county- complaint sanitation inspections for detention operated, state-licensed, federally qualified facilities,juvenile facilities,and massage parlors. Health Maintenance Organization (HMO). It utilizes Health Services Department programs Consumer 1),otection Program ensures that the for most of the health care provided to its County's food and water are safe and sanitary; members. These programs include services of public recreational and public swimming pools the Hospital and Health Centers, Public Health and spas are free of safety hazards and disease; (immunizations,CHDP services), Mental and that new and remodeled food and pool fa- Health and Substance Abuse services. cilities are constructed to assure compliance with appropriate laws and regulations. With CCHP uses community hospitals and providers over 1,500 public pools and spas, 160 small wa- for services not offered through our own Health ter systems, 260 construction plans submitted Services Department, (e.g., open-heart surgery) annually, 300 annual temporary food events, and as back-up for selected county services, and 240 mobile food preparation units, the (e.g., optometry). In addition, in emergencies, staff provide routine and complaint inspec- members may use community hospital emer- tions, plan check for proper design,ventilation, gency facilities.The Contra Costa Health Plan plumbing,and auxiliary structures,education, Local Initiative for Medi-Cal contracts with and event oversight to ensure compliance. The Health Services, as well as traditional Medi-Cal responsibility for recreational health (such as community providers for primary care and with pools and spas), retail food, as well as the mo- community specialists and hospitals. Kaiser bile and temporary food units are mandated to Health Plan is also a subcontractor for Medi- the county environmental health unit by state Cal. law. Either the county or the state Office of Drinking Water must provide the small water As a state-licensed, federally qualified HMO, system program. The county has been certified CCHP is subject to both federal and state as the Local Enforcement Agency for the small requirements for the level of benefits given to water program. Drinking water laws are estab- members. The state and federal governments lisped at the state level and must be equivalent impose additional benefit requirements for to or more stringent than federal water laws. AFDC,other Medi-Cal,and Medicare members. Land Use and Development Program safeguards EntAronmental and promotes the health and well being of the Health Program public through the application of environmental health principles to effective land use. Staff of Environmental Health provides administrative the program review some5 00 land use proposals support and oversight to programs which ad- 18 .............................. ............. _ __. ......... ......... ......... ......... ......... ......... ......... ......... ......._. ..........._..._... ....... ......... ............ ._.......................... ............ ............._............_... ......_... ........___. .......__........... -- annually;issue over 200 on-site wastewater dis- enforce all state and local laws and regulations posal system permits annually and inspect their pertaining to owners and operators of medical construction or abandonment;respond to com- waste generating facilities. The staff is respon- plaints about broken sewer laterals or mains and sible for permitting and inspecting sixty-seven failing septic systems;and monitor the activities permitted facilities and overseeing the activities of septic tanks and other vehicles for liquid dis- of 500 small generators of medical waste annually.. posal. The private well construction orabandon- ment program staff permit and inspect over The medical waste program has been designated 1500 individual water wells,soil borings and to enforce the Tattoo, Body Piercing, and Per- groundwater monitoring wells annually to ensure manent Cosmetic Standards and Regulations in they are properly constructed,maintained,and the county and eighteen incorporated cities. destroyed. State law mandates responsibility for The program will permit the facilities to operate these programs,and local ordinances used in the and permit individual practitioners to practice program must meet state minimum standards. their services.The program will enforce facility standards, proper standards of storage and dis- Solid and Medical Waste Management Program posal of medical waste, and protect the health of protects the health,safety and well-being of the the public, practitioners, and solid waste person- public and preserves and improves the quality of nel from exposure to harmful medical waste. the environment by assuring proper storage and disposal of solid waste. A local option program, .axle do"S Ma jS the Contra Costa County Local Enforcement Programs Agency(LEA)has been designated and certified by the California Integrated Waste Management As the State Certified Uniform Program Agency Board to enforce all state and local laws and (CUPA) for all of Contra;Costa County,staff of regulations pertaining to owners and operators the Hazardous Materials Programs provide over of solid waste facilities in the county and the sight, guidance, investigation and enforcement seventeen incorporated cities,except the city of of the laws involving the handling, storage and Pittsburg. Program activities include approving processing of hazardous materials in order to as- solid waste facilities'permits, monthly inspec- sure that the health and safety of the commu- tions of four landfills,two transfer stations, and nity is not jeopardized. one compost facility; monthly, quarterly, and annual inspections of fourteen closed, illegal Hazardous Waste Generator Program monitors and abandoned sites, three sludge spreading op- facilities to ensure safe and legal handling, stor- erations, and two soil remediation facilities. age, and:disposal of hazardous wastes. Busi- The Code Enforcement staff'investigates over nesses in Contra Costa County that generate 1,600 household trash and garbage complaints hazardous wastes are regulated by this program. annually and provides follow-up corrections. HSD conducts compliance inspections of these businesses every two years. The medical waste program protects the health of the public, health care facility personnel, and Underground Storage lank Program regulates landfill personnel from exposure to medical underground tanks which store hazardous mate- wastes containing potentially communicable rials which have the potential of leaking.These pathogenic organisms. This program is also a tanks must be registered,permitted,tested,and local option program, and the Contra Costa inspected.Contra Costa Health Services(CCHS) County LEA has been designated and certified issues permits and regulates these facilities to en- by the State Department of Health Services to sure that tanks are monitored for leaks to prevent 19 ...................................................................................................................................... soil and ground water contamination. In addi- Incident Response Program provides Emergency tion,staff review plans,perform on-site inspec- response staff on-call 24 hours a day to provide tions and issue permits for all new tank installa- technical assistance and oversight at locations of tions and tank removals. chemical spills, illegal drug labs, pipeline leaks and illegal dumping of hazardous wastes or chemicals.They provide identification of un - Hazardous Materials Release Response and In- ventory Program and Uniform Fire Code Article known substances, health hazardous wastes or 80.103(b)and(c)cover over 1,200 businesses chemicals. In addition, they initiate the com- in Contra Costa County, including major oil munity warning system developed to warn the refineries and chemical plants. This program, public in case of toxic spills, fires and other di- also referred to as the Business Plan Program, sasters. requires businesses to submit a plan and an in- ventory of hazardous materials stored on their Emergency Medical site with a map of their facility, showing the Services (EMS) storage location of hazardous materials and EMS provides overall direction, planning and emergency equipment. Facilities are inspected monitoring for the county's pre-hospital Emer- by Hazardous Materials personnel to ensure gency Medical Service system. The EMS compliance with regulations. system consists of fire,ambulance and related services which respond to 9-1-1 medical emer- Household Hazardous Waste Program provides gencics. A variety of agencies and organizations ongoing weekend collection events for both re- work together to provide persons who experi- cyclable and toxic household waste. These ence medical emergencies with a timely re- events are provided free to the public. In addi- sponse delivered in a professional and medically tion, the program provides information about appropriate manner. EMS providers include safe alternatives to many products which con- fire services, ground and air ambulance services, tain hazardous materials that may leach from public safety dispatch centers, law enforcement the landfill into the water supply. agencies and hospitals with their medical staffs. Supporting the direct service components are Risk Management and Prevention Program educational and training institutions,citizen seeks to prevent the accidental release of and medical advisory groups and various other "Acutely Hazardous Materials" (AHM) and to public and voluntary,organizations. prepare for public protection in the event of a release. Facilities are required to prepare de- EMS develops and administers service contracts tailed,step-by-step hazard analyses to identify with emergency ambulance providers to assure ways to prevent accidental releases of AHMs high quality, county-wide emergency ambu- and to develop Off-site Consequence Analyses lance coverage. The EMS Agency provides for emergency response planning. oversight of the county paramedic program and works with local hospitals to assure that re- Spill Prevention, Control and Countermeasure sources are available to care for patients arriving Program(SPCC)seeks to assure that the 218 by ambulance. Planning and monitoring services sites in Contra Costa that have above ground are provided by the EMS Agency for the special- storage tanks which store or transport bulk haz- ized trauma care system developed to assure that ardous materials have filed an SPCC plan with victims of automobile accidents and other major the State Water Resource Control Board. trauma receive the highest level of care. The EMS Agency coordinates the early defibrillation program providing heart attack victims access to 20 ............ 11 ......... ......... ......... ..... .... ........ .......................... ......... ......... .._...... ......... ......... ......... ................ _. ....... ._.......................................... rapid defibrillation by firefighter first responders who have been trainedand equipped with automatic defibrillator. Planning and prepared- ness for pre-hospital medical response to major incidents and disaster situations are coordinated by EMS staff. 21 Customer Pro i f e H,SD clients are defined in multiple ways. For some, we are the provider of last resort,for others the provider of choice, and still others, the only providerfor cerin unique services. Hospital & Health determined by various pieces of state and federal Ccwters legislation which govern the use of or access to funds. That legislation {enacted over many We offer services to all residents of Contra decades) has been modified by local choice, Costa County.The majority of our patients in- mostly fiscal. The local criteria for eligibility clude those who are on Medi-Cal,those who have become more restrictive as funding has - are not eligible for any type of federal, state, or become less available. private health plan,and the medically indigent receiving statutorily-required services under Sec- By legislative mandate,services are primarily tion 17000 of the Welfare and Institutions directed toward children and adolescents who Code of the State of California. We provide are identified as seriously emotionally disturbed'. care to many of the members of the Contra These are children and adolescents under age 18 Costa Health flan, including commercial mem- who have as their primary problem a clinically hers,County employees, and Medi-Cal eligible diagnosed mental disorder which results in persons mandated to choose a health plan un- behavior and functioning inappropriate to the der the state's.Medi-Cal Managed Care Pro- individual's age according to expected develop- gram. mental norms. Mental Health To be eligible for most mental health services, a Adu&Older Adult Program. Customers are child or adolescent must have a mental health adults who are functionally disabled and who diagnosis from the Diagnostic and Statistical are seriously and persistently mentally ill; older Manual of Mental Disorders(USM), and meet adults, 60 years and over,who require special- specific criteria of functional impairment. ized services due to functional impairment or ental significant changes in behavior related to a seri- t � h Crisis Services The customer is ous, persistent mental illness; and persons who generally an individual, family member(s) or are in severe crisis or are in danger of suicide, concerned person who is requiring some type of hospitalization or becoming seriously, persis- psychiatric intervention, including crisis coun- tently mentally ill. seling, medication, and psychiatric stabilization for psychiatric symptoms ranging from mild to Customers generally must be Medi-Cal recipi- severe. Clients may dropin, be referred by ents, or Medi-Cal eligible,or have no health another agency/practitioner, or placed on a care coverage or ability to pay for health care W&I Code 5150. coverage. Customers gain access to services through an individual service provider or crisis Public Health service, and go through a centralized assess The core Public Health programs of community mentlauthorization process. health assessment,communicable disease con- Children' Services. Eligibility for services to trot, and community-based prevention activities children in the public mental health system is such as tobacco control,AIDS prevention, com- munity and domestic violence prevention, and 23 ..................................................... ............................................................................................................... .......... ............................................................................ chronic disease control and prevention serve the HaZardouS Materials entire county population. Public Health Clinic Services target the Medi-Cal population, the Programs working uninsured, and the indigent papula- Hazardous Materials Programs serve the entire tion. Other programs focus on specialized community of Contra Costa County by over populations: Family, Maternal,and Child seeing the handling, processing and storing of Health on women and children, Senior Nutri- hazardous materials by business. Businesses and tion Project on all persons over 65, and the individuals handling hazardous materials are the Miller Centers on developmentally disabled more specific customers of our programs. adults and children. Emergency Medical Community Substance Services Abuse Services EMS services are designed to be available to county residents and to other who work or are In 1997-98 CSAS provided outpatient services to 2,936 clients,residential services to 624 cli- otherwise temporarily in the county in the event of a day-to-day emergency or disaster. Victims ents, and detoxification services to 3,089 clients. Of those clients, 69%were men/31%women. of sudden medical emergencies need the rapid Most CSAS patients were self-referred into response of trained emergency medical providers who can perform emergency treatment and an equal number of clients (34%) treatment, and provide transportation to an were treated for alcohol as for heroin use. ro p ap. Ipriate hospital. EMS dispatchers, fire first Contra Costa Health Plan responders, ambulance paramedics and EMTs, receiving hospital staff, training program CCHP seeks to serve the special needs of managers and ambulance companies and other vulnerable populations. It is available to Medi- EMS providers and emergency responders Cal and Medicare recipients, employees of require a well organized, professional EMS participating private and governmental employ- system as one component of the county's overall ers, and individual members of the general public. It takes part in special state programs emergency response system. including MRMIP for the medically uninsur- able, HIPC small business purchasing pool, AIM for the low-income pregnant women and their babies, and the recently established Health Families Program for low-income children. It currently serves over 50,000 adults and children. Environmental Health Our ultimate customers are the general popula- tion of and visitors to Contra Costa County who rely on appropriate inspection and regula- tory activities to protect their health. More spe- cific customers include the businesses and indi- viduals whose activities fall under our jurisdic- tion. 24 .............. ...... ............................................. ......._. ......... ......... ......... ......... _ ........ ........._...._......... ......... ......._. .._...... ......... ......... ......... ......... ..........._..... _. ........... ......... ......_.. *+�► Customer Relations6ips Each division has a unique blend of relationships with clients as evidenced in outreach and utilization. Programs vary in their ability to choose clients. Some programs have very specific eligibility requirements, while others are open to all who come for services. Hospital & patients' needs assessment survey. A post"Pa- Health Centers tients' Choice" implementation study con- ducted in the spring of 1997 showed increased The majority of our patients use our service be- patient satisfaction with access to short notice cause we are the health services of choice.With primary care. the advent of the states mandatory Medi-Cal Managed Care program in 1997, specified The division conducts ongoing inpatient satis- Medi-Cal eligibles choosing the Contra Costa faction surveys and annual outpatient satisfac- Health Plan may identify Contra Costa Re- tion surveys. For inpatient services,staff assist gional Medical Center and Contra Costa patients in completing a survey that focuses s on Health Centers as their health care provider. their care and stay at the hospital. We currently For indigents enrolled in Basic Adult Care,we receive an average of 400 surveys a month. are the only available option in the county. Similar patient satisfaction surveys arc con- ducted in the Ambulatory Care Health Centers annually to identify patients' concerns and to Patients are informed about our services ensure that operational interventions developed through a variety of formal and informal and implemented have been effective in the eyes'.... mechanisms. Formal mechanisms include mar- of the patients. Inpatient and outpatient satis-faction surveys are analyzed and incorporated posted in other county-wide departments, , into the divisions strategic plan. Appropriate through Social Services for patients who must operational interventions are_developed and choose a health plan under Medi-Cal Managed implemented to correct problems identified by Care, relationships with a host of county-wide our patients. community-based organizations,service organi- zations, religious organizations and numerous public guides to services. Informal mechanisms .Mental Health are primarily"ward of mouth." Persons enrolled Adult101derAdultProgram. With the program in CCHPare given orientation and marketing design discussed under the"Services Delivery materials which describe the services, hours of System" section,services are more available in operation, and points of contact. the community involving';natural support systems. Staff are spending most of their time Access to ambulatory care services has been im- out of the office in the community, becoming proved tremendously by the Patients' Choice more familiar with natural support possibilities, Program. Patients' Choice allows patients to building stronger relationships with local make same and next day appointments for pri- businesses and citizens, and becoming a part of mary care upon request. In 1995, patients community organizations that they can influ- identified improved access to short notice ap- ence on behalf of clients. Client satisfaction,'as pointments as their number one priority in a measured by standardized;satisfaction question- 25 ..__..... ....... ............._._.. _...... ......... ......... ......... ......... ......... ......... ......... ......... _..... .............._....... . ......... ......... ......... ._.... ._ r2 naires,will be administered regularly beginning Health Outreach Workers find clients in the as soon as the State Department of Mental communities,including IV-drug users with Health makes a decision about the format and AIDS, pregnant women and homeless persons. oversight of the performance outcomes process. Public Health services are brought to commu- nity settings through Health Care for the Children's Services.Target population children Homeless, Health on Wheels Mobile Clinic and youth are identified, screened, and referred Van, Home Health at various " ortals of en into the stem of Agency, and Public Health p Nursing. Public Health prevention programs care. Fees are charged using a statewide system are implemented through partnerships with and are based on ability to pay. A significant community-based organizations throughout the proportion of clients are on Medi-Cal and pay county. The Homeless Ombudsmen evaluates nothing for services. For court wards, the client satisfaction with homeless services primary portal is Juvenile Hall. For court county-wide. The Public and Environmental dependents, it is the Emergency Placement Health Advisory Board and community part- System (EPS),which is comprised of a number nerships provide feedback on community-based of emergency foster and group homes. For services. special education students, the portal of entry is initially the school, and secondarily screening by Community Substance Mental Health/Education Matrix staff. Other Abuse � SED youngsters may enter the system via one of es the three regional clinics, the Psychiatric Emer- Service Access The Access Unit began in.March gency Services Unit, or one of the local acute 1998. It is a centralized screening,placement inpatient units.Administration of a parent authorization and registration system connected satisfaction survey began this year as part of the to a central phone number.The Access Unit is statewide implementation of performance staffed by substance abuse counselors who outcome measures in Childress Mental Health provide information and referrals;conduct Services in California. alcohol or drug screening, make placement for needed services within 48 hours or sooner;set Mental Health Crisis Services.Anyone request- ' up intake and assessment appointments at the ing services is either evaluated and treated, and/ program site level, manage waiting lists; provide or is given recommendations and referrals to the care coordination and crisis counseling. appropriate service for care. Customers access services through telephone directories, hotlines, Service Fees-CSAS prevention services are free consumer publications, information and referral of charge;but clients are required to pay for line, advice nurses and other triage personnel in treatment services based on a standardized various hospitals and clinics, both private and method for determining ability to pay—a public, and through police departments and sliding fee scale to assess total household in- other public agencies. Crisis Services attempts to come. However, no client is denied services be included in all consumer publications, based on inability to pay. CSAS provides ongoing in-service training to raise awareness telephone directories, and agencies which do referral work, including networking data banks. among staff of the importance to pay attention to client's needs, particularly,mandated clients. .Public Health Public Health clients gain access to Public Criminal Justice Services intervention and Health services through the clinic and service treatment services are fee-for-service based an In addition, Public income and limited by regulations.The Federal sites throughout the county. 26 :.: .:.. ..... :::: t��l5-9ci✓ Probation Program funded by federal money is referred to out-of=-plan specialists if a Health the exception and BASN customers are required Center appointment is not available within time to pay only a portion of the cost of treatment. specified by providers. Additionally, CCHP has STAR customers fee-for-service is $1,260, taken steps to enhance its members' access to however, a significant number of customers are specialty services within the County's Health unemployed, underemployed or on aid, thus, Centers. fees are often reduced to encourage treatment compliance. Emergency,g , etlcal Ment Satrs�aaction- CSAS has established three SerWees customer satisfaction hot lines that are adver- EMS services are available county-wide. The tised in marketing and informational materials. EMS Agency plays a leading role with EMS One line is open to the general public and services coordination among EMS providers and: staffed.by Substance Abuse Advisory Board other emergency responders. Property owners members.The other two lines are dedicated to pay an annual assessment to CSA EM-1 to treatment clients and criminal justice clients. maintain availability of enhanced EMS services. Victims of sudden medical emergency pay for Last year the Substance Abuse Advisory Board emergency ambulance service; Medi-Cal, Medi- (SAAB) established a Client and Family Stand- care and private insurance cover the majority of ing Committee to ensure consumer input patients. Services are provided to all without regarding quality, culture, age and gender regard to ability to pay or insurance status. appropriate services. During the spring the Funding through CSA EM-1 is available to EMS Committee conducted a series of focus groups system participants for enhancements in the with former CSAS clients and their families and level of emergency medical services provided. is currently working on a report of findings. The EMS Agency relationship with some SAAB members have conducted site visits to customers is regulatory in nature at times. -- CSAS System of Care programs,are active Hospital interfacility transfers of emergency participants in the System of Care planning patients are monitored. The EMS Medical process and instrumental in the development of Director credentials and provides medical PIRA, the Partners in Recovery Alliance Project oversight for emergency response personnel. grant proposal recently funded by the Center The EMS Agency approves and monitors all for Substance Abuse Treatment. advanced life support provider programs and pre-hospital training programs operating within Contra CoStac Health plan the county. CCHP regularly surveys its members and conducted a member satisfaction survey this Increased efforts have been made by the EMS year. CCHP is also developing a patient satis- Agency to inform the public about EMS and 9- faction survey asking members to rate their 1-1 access through the Emergency Medical Care primary care providers. As CCHP also consid- Committee. These efforts include distribution ers its providers as customers,it will be conduct- of 9-1-1 brochures promoting the "Phone First" ing provider satisfaction studies of both staff campaign to schools, churches, clubs , industry providers and the new community provider and the public. network in 1998. The EMS Agency places a high priority on Accessibility to specialty care is a major focus of maintaining good customer relations through its attention for both customers and providers of day-to-day handling of customer inquires/ managed care. CCHP patients are routinely 27 .......'--- I .................................. ...................... ....................................................................... .............................................................................................. ...... ............ complaints and in annual evaluations of the ambulance services. Feedback is received anecdotally through participation in various groups and meetings and from public inquiries regarding ambulance services. No formal program to measure customer satisfaction has been undertaken. 28 ........... ............................ Section IV Performance, IYt.bicat Ys The approach to performance indicators is changing. Most used to,focus on the program/ systemlinstitutional measures of inputs--how many visits provided shots given,permits approved Some of those measures remain relevant, but we are moving toward identifying the outputs, or outcomes o,f'the activities,focusing on the effects on,�atientslclientslcustom- ers. This process is compkx. Each Division, especially those with multiple programs, is examining what should be measured In addition, many programs are directed by regula- tory agencies which specified the desired measures. For specific comparisons of data in FY 19.96.97 and .FY 19.97=.98, see ,Attachment C Hospital +& Mental Health Health Centers Adult/Ulder Aduk Program is planning for the addition of three adult measures, including a This division has developed multiple indicators consumer satisfaction measure, a behavior and and outcomes to monitor and improve quality symptom scale, and a qualify of life measure. and patient satisfaction. Some are determined. Currently, the Division is assessing different by regulatory agencies,such as the State Depart- technologies for the collection of data and the _ went of Health Services Licensing Division, ability to provide individual reports to clinicians and the Joint Commission of Accreditation of for treatment planning and aggregate reports to Healthcare Organizations. Examples include: supervisors for program planning. Implementa- * Average length of stay tion of the measures is expected in April 1999. • Patient satisfaction * Emergency Department utilization In addition to the focus on performance out- 0 Cost per patient per day comes,Mental Health is focusing its efforts on * Number of Ambulatory Care Visits per reducing state hospital bed.days, IMI)bed days, month by site acute hospital bed days, improving living * .Medical and:nursing staff quality assurance situations, improving educational activities, monitoring improving vocational status, and decreasing * QA monitoring by ancillary departments alcohol and other drug involvement. Signifi- cant progress has been made in increasing the availability of services in some of these areas (see 29 ..........................................................................................................................................................................................................................................................................-............ ............ below in Achievements). CBCLs have been received from caregivers of children in the system of care at intake. CbildrwWs Services.Realignment legislation On average, the scores on the major scales of requires that all counties report data on perfor- the measure hover near the clinical range mance measures adopted by the California (i.e. the top 2%) on behavioral problems. Mental Health Planning Council to the State Change scores from intake to six months Department of Mental Health. The Children indicate improvement in problem behaviors and Youth Performance Outcome System was particularly for youth whose parents indicate modeled after the evaluation system being 50 or more problems on the scale at intake. utilized by Systems of Care programs pursuant We are finding an average reduction of eight to AB 377 and AB 3015. This system is a problem behaviors from intake to the six multi-method approach which meets the month period. requirements of the legislation and provides the necessary data for measuring the established The Youth Self Report for Ages 11-18 outcomes. The outcomes being measured fall (YSR). Three hundred fifty-six YSRs have into two general categories: (1) system level been completed by youth in the system of measures and outcomes, and (2) consumer level care at intake. The data indicate a high measures and outcomes. Within the former, number of problems, again hovering near consumer placement (e.g., hospital, foster the clinical range on the scale. Overall, the home,etc.) and service (e.g., location of set- change scores indicate a reduction in behav- vices, type of contact, etc.) data is being col- for problems from intake to six months by lected. Consumer level data includes informa- roughly 4 points. The youth who reported tion about the consumer's functioning, compe- 50 or more problems on the scale at intake tence and impairment from the perspectives of reported 12 fewer problems after six the consumer, caregiver and clinician. Con- months. sumer level data also includes caregiver satisfac- tion.The core battery of survey instruments The Residential Living Environments Scale being used are: (ROLES). Data from the ROLES indicates that over two-thirds of the children in the • The Client Satisfaction Questionnaire system of care are either living at home or (CSQ8).Thus far we have received 271 are living in the home of a relative. Around completed questionnaires with an average 10 percent are living in a regular foster care score of 3.4 on a 4 point scale (4 W most setting, 3 percent are in a level 12-14 resi- satisfied). dcntial center and about 4 percent are living • The Child &Adolescent Functional Assess- in a group home. Less than 2 percent are ment Scale (CAFAS). Thus far we have either in state mental hospital or are inpa- collected 939 CAFAS at intake, with an tient in a medical hospital. average total score of 95, indicating a high level of functional impairment. The These instruments are standardized and have CAFAS data indicate a drop in the level of been tested as being valid and reliable. Their use functional impairment (i.e. improved will allow local programs to have comparative functioning) of about 15 points as measured data when competing with managed care firms by the CAFAS over roughly a 6-month for mental health services. In addition to fulfill- period. ing the legislative requiiements for monitoring • The Child Behavioral Checklist for Ages 4- outcomes, the performance outcome instru- 18 (CBCL). Five hundred sixty- three ments have become an integral part of the 30 ............................. clinical and client assessment and treatment- are also used to design a system of care that is planning process. responsive to limited resources,cost, and quality of services. The Mental Health Division has hired a Qual- ity Improvement Manager whose role is to Contra Costa Health Plan establish a comprehensive Quality Improve- CCHP regularly monitors utilization and ment Program for the Division and to lead the enrollment trends for each of its major groups development of a culture of continuous quality and reports results on a monthly basis to the improvement. Managed Care Commission and quarterly to the CCHPIBoard of Supervisors,joint Confer- Public Health ence Committee. Public Health evaluates performance by looking at community health indicators such as infant Environmental nt Health mortality, utilization of early prenatal care, and Annual Division Program Plans identify the to- tuberculosis rates. Clinical Services are evalu- tal workload of all programs and set activities ated by process measures including number of for each program. Individual staff members clients served, cost per unit service,and staff complete Annual Performance Evaluations that productivity measures. The Public Health Data include the identification;of activities they plan and Evaluation Unit has been charged with de- on accomplishing during the year. Standards veloping more targeted outcome evaluations of for the solid waste, medical waste, small water Public Health programs,especially Family, Ma- system and detention facilities are established by ternal,and Child Health programs and the the appropriate state agency and ongoing state county's programs serving people who are Local Enforcement Agency(LEA) certification homeless. is dependent on meeting the state standards. In the retail food and consumer protection pro- �' im?It?tnt Substancegrams, standards of service are based on state Abuse Services guidelines and local ordinances. CSAS developed thirteen major indicators to Hazardous Materials monitor the effectiveness of the Division's pre- vention efforts. CSAS focused most of its pre- Programs vention work on alcohol-related activities and The Division is responsible for implementing policy initiatives, and the performance indica- regulatory oversight of hazardous materials un- tors reflect these efforts. During FY 1997-98, der various State and County laws. Toward this CSAS providers and programs collected process end inspections, training, investigations, report- and outcome indicators. ing, and enforcement activities are tracked and documented. While the Divisions goal is to .Although performance indicators are only one protect the health of the community, perfor way to monitor how the system of care is oiler- mance is measured by the number of incidents ating research indicates that taking into consid- impacting or threatening community health eration acuity or severity of addiction, length of and safety. stay and discharge status are important indica- tors to track substance abuse treatment out- A statistical study, recently concluded for calen- comes. In a more indirect way, these indicators dar years 1989 through 1996, shows that for this period of time there were an average of five 31 ................................................................................................................................................ ................................... ............. ................................................................................................................. (5) major incidents per year with an annual range of between 2 and 9 incidents. No statisti- cally significant differences in the number of in- cidents affecting community health and safety was found. Emerge#" Medical Sert4ces Emergency Medical Services statistics are monitored in a number of areas: ambulance services and air ambulance services (response/ transportation times, and levels and quality of service provided); trauma care services (appro- priatc use of trauma center, trauma care); hospital resources (bed availability); and first responder defibrillation program (patient lives saved). Utilization statistics and trends, includ- ing number of ambulances dispatched, average response times, patients transported,patients receiving specialty trauma care, and defibrilla- tion saves are compiled for each area on a regular basis to evaluate performance and to identify any areas for increased attention. 32 ................................ .... Accompfis6ments Hospital & administered) systems, the Mental Health Division began operating as a Managed Care Health Centers Plan responsible for the administration and • Successful move into our new hospital, provision of all specialty,mental health services Contra Costa Regional Medical Center. to Medi-Cal beneficiaries who reside in Contra Costa County. This change significantly im- • CCRMC received a three year accredita- pacts the breadth of services offered to a broader tion from JCAHO. target population. The primary tasks in this area were the development of a contracted • provider network and the administrative and Full accreditation of cancer program, technical support mechanisms necessary to • Full accreditation for Family Practice Resi- manage it. dency Training Program. Adult,Services. During the last year,Adult • Continued success and improvement of"Pa- Services has discharged 12 consumers from bents' Choice Program." Same/next day ap- Napa State Hospital to lower levels of care. This pointment capacity increased from 11%of is the second year in a row that we have brought family practice appointments to 68%; re- a dozen individuals out of that level of care. duced the percentage of patients who do not This equates to a minimum of$120,400 per show up for their appointments; reduced person. Given that we have taken an average of Emergency Department Utilization. one individual a month out of the State Hospi- tal in the last.two years, this totals approxi • Implementation of computerized Carder En- mately$2.9 million. try system and Radiology Reporting through the MediTech system, improving In a collaborative effort with the Community efficiency and access to necessary medical Substance Abuse ServicesDivision,Mental information by staff via the computer. Health was one of the successful applicants for a federally funded grant to provide intensive case • Developed new format for the required management services to consumers who have Safety/Infection Control Review Training concurrent mental health and substance abuse that significantly reduces training costs. diagnoses. A program coordinator and staff were hired and services are now available to this Mental Health population in West County. Division-Wigle The primary accomplishment of the.Mental ChildlreWs Services. During 1998, Children's Health Division this year was the Implementa- Services implemented a 1 million expansion of tion of Phase II Outpatient Medi-Cal Consoli- EPSDT funded programs through contract dation on April 1, 1998. As a result of this agencies. New agencies include four school- consolidation of the extant Short-.Doyle(DMH based mental health programs; three augmented administered) and Fee-for-Service(DHS in-home intervention programs for preschool children and their families;expanded mental 33 ......... ......... ......... ......... ......... ....._... ......... ......... ......... ......... ......... ......... ......... ......... _....._ ...._.... _... .. ........... _._._... ......... V health services to Asian youth,and augmented their test results read. Approximately 16%of services to sexually abused/raped children and the people whose tests were PPD +. adolescents. • Updated the"Contra Costa Health Data'Web Ongoing training on the wraparound approach page (lJttP-*Ilwww-igc-orglcccdatthtm4, with to delivering services has occurred including a local data on HIV/AIDS, STDs, TB, other county-wide 3-day interagency conference for reportable diseases, Substance Abuse,Mater- staff from child-serving departments. Over 100 nal and Child Health, Heart Disease and child and family teams are now in place, provid- Stroke,Mortality Statistics,Chronic Diseases ing individualized team-based services. and Diabetes. Medi-Cal Managed Care has been imple- Maintained active surveillance for AIDS cases mented, including the creation of a mental in many hospitals in the county. health provider network with heavy emphasis on services to children, adolescents and their • Prepared and distributed Contra Costa family members. The Department of Social County's "HIV/AIDS Epidemiology Report" Service and Children's Mental Health are and"Tuberculosis Epidemiology Re od'. working collaboratively to provide a seamless system of care,including blending of funding Medical InterpreterslRefugee Health for meeting the mental health needs of depen Nine Medical Interpreters (Chinese, Farsi, dents and their families. Lao,Mien, Khmu,Russian, Vietnamese lan- guages) provided' services to clients of the Public Health Health Services Department in regularly C©11✓fMUIVIC4B7.E'1)ISEAS scheduled language-specific clinics (approxi- Public Health Epidemiology, mately 7,000 patient visits). Surveillance and Health I3atJx During the last fiscal year,the Refugee Health • Completed the "Young Domes'' Survey" in • which over 400 women,ages'18-29,living in Program has provided orientation, advocacy, the areas with the lowest income were visited health education grid health screening to close in 'their homes, interviewed, educated and to 100 refugees and asylees. These refugees came to Contra Costa from countries such as tested for HIV and syphilis. The incidence of HIV among these'young women in Con Russia,Vietnam, India, Bosnia, Croatia, and tra Costa was 1.0%, the highest in Northern Liberia. California. Two of the interpreters have earned a certifi- cate in Medical Interpreting through partici- Initiated the "Stop TB ASAI'" Program in which all households in areas of the county potion in a specialized training course. The with the highest incidence ofTuberculosis are remaining interpreters are also scheduled to visited,residents are educated about Tubercu- attend this training in the coming year. This losis and PPD skin testing offered. During training will enhance their ability to provide interpreter assistance to medical care provid- 1998 approximately 500 households, mostly in Nest Contra'Costa, have been visited by ers. two Disease Intervention Technicians who Tuberculosis Control tested approximately 300 people and gave educational information to all households vis- Conducted intensive review of all cases with ited. Of the people tested most (85%) got State Health Department to analyze cluster patterns and transmission of disease. 34 • Reviewed and revised data collection tools on of age). The system will ultimately include cases and their contacts to conform with Tar- immunizations for all children in Contra geted Case Management requirements. Costa. The goal,of course, is for all children to have all their immunizations on time. * Adopted new computer system,developed by . CDC to track all cases and contacts for data Health on Meek (HOW) • Provided mobile clinic services including pre- analysis and program.planning. ventive and urgent care to uninsured West Commun%able Disease Control Contra Costa residents three days a week. • Provided four training sessions for Social Ser- Added evening clinics three nights a month. vice on bloodborne pathogens transmission From July 1, 1997-lune 30, 1998,the HOW and control. van saw 954 individuals.Through the fund- ing from Kaiser-Richmond, HOW van pa- • Offered training on bice Control to all Public tients received medications free of charge— School Districts in Contra Costa. "Trained ten antibiotics, non-narcotic pain medications, personnel and PTA members from ten school topical treatments, vitamins, otic and oph- districts on lice detection, treatment-and pre- thalmic treatments,asthma medications,and vention. a variety of other pharmaceuticals. In addi- tion to urgent care, Health on Wheels pro- Immunization Assistance Pogram/4utreach vided 96 HIV tests, 180 TB tests, 46 STD • exams, 98 pregnancy tests, 28 clinical breast Worked with the Immunization Registry and community organizations to bring 400 tod- exams,468 child and 93 adult immunizations, dlers up to date on the basic series of child- as well as blood pressure, glucose and hemo- hoed immunizations, conducted ongoing globin testing. Staff also distributed free education to update physicians, schools, and condoms and a wide variety of health educa- day care providers about new immunization tion materials. In 1999, Health on Wheels requirements;began collaborating with WIC staff members look forward to operating in a and Head Start to raise immunization rates; new mobile clinic,which will be delivered in and conducted public awareness campaigns to late November. Funding for the new clinic increase knowledge in parents about the need was provided by Chevron Corporation,with:. - for timely immunizations. advocacy from the City of Richmond to irn- prove the health of West Contra Costa resi- • The program was awarded renewed funding dents. in 1998-99 to continue these efforts, and to _ work more closely,with CCHP to improve AIDS Program In collaboration with local community-based rates among private providers. organizations and advisory bodies, a county- Immunization Registry wide AIDS Awareness campaign was initiated • The Immunization Registry continued to ex- this year. The first phase of the campaign in- pand. In late 1998, the Registry will be op- eluded:the development and introduction of erational in all county clinics (CCCRMC, a logo(You Have the Pourer to Stop AIDS);the Contra Costa Health Centers, and Public development and dissemination of social mar- Health). Currently, over 74,000 people and keting materials; sponsorship of a variety of their immunizations are included. Over community-based "kick-off" events; and lo- 13,000 records are for children under the age cal mega coverage of the campaign. Phase two of five (about 20% of the county's 0-4 years of the campaign includes the development of 35 Spanish language materials, to be introduced We have designed and implemented a new in December for World AIDS Day. data collection system which will serve as the model for the Oakland Eligible Metropolitan • A mobile testing van was purchased and retro- Area(EMA). The new system, developed in fitted to expand the provision of HIV testing ACCESS software, has greatly improved our services to high risk clients in their communi- capacity to analyze service data and to more ties. The program has been well received by effectively and efficiently evaluate perfor- the community,with 16,548 outreach contacts mance. made,6,431 referrals for testing and 764 high- risk clients tested during the year. In June the AIDS Program received notifica- tion that the State Office of AIDS was split- The AIDS Program developed three new pro- ting a previously:shared (Alameda/Contra grams this year. Living Well faking Care of Costa} award for early intervention services Your Life, was successfully piloted in Rich- for women with HIV The project,developed mond and will move to Pittsburg later this collaboratively between community-based year. The series of informational workshops, organizations and rheAIDS Program,is sched- designed in collaboration with people with tiled to begin in East County in September. Contra Costa is now providing these services HIV to enhance client knowledge about HIV P g disease,and re-establish relationships with lo- through a newly developed resource/referral cal health centers and providers, was well re- program and ongoing medical care for this ceived by clients. The Volunteer HIVAnti- pulatian through CCRMC. body lest Counselor program was also success- fully piloted and will be offered again later C01tf11�LT1YI7YWELZ.IITESS d-PREVENTION this year. This program provides training and After a nationwide search, CW&PP hiredits n -" certification to individuals interested in vol- first director, CYdi,Sim Simpson, and began unteering services at the alternative test sites. working on a strategic planning process fo- cusing on program integration and enhanced The Medication Adherence program provides clients with home visits from an RN trained performance. in HIV medications so that clients can have a better understanding of their medications and The Healthy Neighborhoods Project(HNP) received the prestigious 1998 Award for Ex- develop methods to deal with complicated drug regimens. While it is too early to mea- cellence in Creating Healthy Communities sure the impact of this program, clients,phy- from the National Association of City and sicians and staff alike all speak highly of the County Health Officers. HNP received new program. funding to continue its unique, resident- driven approach to improving community • Following the May(97)closure of commu- health. Two grants from the California En- nity-based organization providing case man- dowment(totalling more than$450,000)pro- agement services,the AIDS Program success- viding HNP with an opportunity to recruit fully maintained full safety net services for the more than 80 residents in East and West former clients of the agency while nding was County to work as Neighborhood Health fu reorganized and the service put back out to Advocates. bid. All clients have since been transitioned from County case management back into com- • article titled"The HealthyNeighbor- munity-based organizations. hoods Project:A Local Health Department's 36 : ................. w .:.: Role in Catalyzing Community Develop • '' The Lead Poisoning Prevention Project mens,"was published in the professional (LPPP)identified 76 children with elevated journal Health Education and Behavior. blood lead levels. It was awarded a grant "Gender Differences in Homicide in Contra from the Environmental Protection Agency Costa County, California: 1982-1993," to expand outreach and education in the written by CW&PP's Data and.Evaluation African American and Laotian communities Unit,appeared in the American Journal of` in West Contra Costa and establish a Lead Preventive Medicine. Poisoning Prevention Consortium for community partners. In partnership with • CW&PP's Lead Safe Neighborhoods the City of Richmond, LPPP will begin trained residents in two neighborhoods to providing a public health presence in a$2.3 identify lead hazards and advocate for lead million HUD lead abatement project in poisoning prevention. Each neighborhood West County developed action plans to improve the quality of life of their neighborhoods. The * The Chronic Disease Framework was distrib- project also developed a how-to manual for uted to over 400 individuals and organ.ira- distribution statewide. tions. A slide show was developed and is available to present the.Framework to • More than 1,300 youth were recruited to community groups to encourage commu- participate in TIGHT—Tobacco Industry nity participation in chronic disease preven- Gets Hammered by Teens.They partici- tion. Pared in Board of supervisors' meetings, learned about tobacco industry targeting, In collaboration with the Contra Costa wrote letters and celebrated.the Board's rood Bank and the Food and Nutrition decision to move forward with a compre- Policy Consortium,CW&PP issued.Hun- hensive Tobacco-Free Youth Ordinance. ger. The Faces and.Facts,A Report on Food The Tobacco Prevention Project responded Security in Contra Costa County. The report to more than 400 inquiries and complaints described the results of a survey that found related to clean indoor air ordinances. 58,000 Contra Costans lack adequate food and provided recommendations for commu- • The Breast Cancer Partnership reached its nity solutions. goal of screening almost 1,500 women, a phenomenal increase of more than 210 • Working with seven local Iaw enforcement percent over last year! The Partnership agencies, the Childhood Injury Prevention received a grant from John Muir/Mt. Diablo Project took the lead in developing Cops Community Health Benefit Corporation to Caring for Centra Crista Children. The create a Patient Navigator Pilot Project and new group inspected 465 car seats for safety a grant from:the American Cancer Society and distributed 2,500posters on child to produce a calendar highlighting local passenger safety. African American breast cancer survivors. With a 400 member community partner- * By June, 1998,the Bicycle Head Injury ship,there are active Task.Groups in the Prevention Project had distributed more Asian,,African American,Lesbian, and than 6,100 helmets to low income children Latino communities. in Pittsburg,contributing to an increase in helmet use among elementary age children from 22 percent in 1994 to 72 percent in 1997. The Centers for Disease Control and 37 • Future of CHDP Planning Grant-State county with free access 24 hours a day,seven funding of $50,000 to convene a work days a week. group of CHDP representatives from across the state to develop a position/concept paper • The 25 member Homeless Continuum of regarding the future role of CHDP. Care Advisory Board was established and began the work of the continued develop- • Dental Sealants-:Funds and in-kind services mens and implementation of the Homeless were made available in order to place sealants Continuum ofCare Five Year Plan and the on the teeth of under and uninsured eligible continuum of care system of homeless and children. In targeted communities 171 housing services. Advisory Board member- children received 840 sealants. Estimated ship consists of consumers,advocates, value is over$45,000. citizens-at-large,service providers,faith community,business,service organizations, • Managed Care-CHDP has established an and City/County/Federal representatives. exceptional working relationship with CCHP via our liaison and through the collaborative • The 1997 HUD Homeless Assistance relationship of our PHN staff. An internal Consolidated Application for funding inter--program agreement was established representing the entire county was awarded which facilitates case management for certain $2 million in funding which maintained medical conditions reported on the CHDP existing,necessary programs and services for claim. This work is in support of the pri- people who are homeless. maty care providers. This model is the first of its kind in the state. • By increasing the Concord Shelter occupancy level to 95 beds(an increase of 35 beds)the • Re-establishment of the Children Dental emergency shelter'Winter Relief Program Health Foundation(CDHF)-Chir program provided 2,500 bed nights to over 150 assumed a pivotal leadership role in there- individuals during the harsh winter months establishment of the CDHF. This fund is of 1998. maintained by donations from local dentists, community organizations,and interested The new two-phase shelter program allowed individuals. The fund is used to provide for an increase in new intakes and resulted in dental services for children who are not an increased number of individuals served eligible for other sources of care. Approxi- through the shelter. The numbers of people mately 50 children benefitted from this served increased by approximately one-third program during FY 97/9$. over the previous year. HCyMEHEALTHAGENCY Through a partnership with Community • .Delivered 31,929 visits to 2,722 patients Services,the Homeless Hotline was able to during the last fiscal year. more than double the motel voucher pro- gram during the months of December • Contracted nursing services to Mental Health through February,providing shelter during Division,Social Services Department,AIDS the winter months to more families and Program,CCHP and other county programs. individuals in need. • Homeless Programs-The Homeless Hotline • The Homeless program has forged strong became a 1-800 number covering the entire relationships with the Department of Social 39 • Linked all CSAS sites to main server to open Cal programs along with 50,000 CCHP and close cases,input service data,and gener- members and 25,000fee-for-service patients ate service reports to each program. in Contra Costa Regional Medical Center (CCRMC). • Developed protocol and procedures for man- agement information system,to allow for star}- • In 1997, CCHP undertook an extensive dardized screening,assessment,client satisfac- campaign to increase immunization rates for tion and formalized internal linkages across the its members. The initial results were a continuum of care. statistically significant increase of 14 percent in immunization. • Developed and opened the Access Unit services in March 1998. From March to September, EnVi on%tgent l ealth 1998 3,416 clients were screened and triaged. The Division of Drinking Water, Depart- Of those, 234 have been screened out due to meat of Health Services,conducted an on- residence status,not meeting requirements for site program review of the Small Water detoxification,or being placed in a"tough love System Program and granted recertification list"because of repeated refusal to accept place- to the LFA.. ment while asking to be left in the waiting list. • Retail Food Program staff conducted sixteen Contra Costa Health Plan food handling courses for food facility • In the first full year of operating as the employees within the county,including six Medi-Cal Local Initiative, CCHP stabilized training seminars provided to employees of its Medi-Cal enrollment and maintained its local school districts. advantage over the Commercial plan in the Medi-Cal Two-Plan Model in our county. • The Medical Waste and Solid Waste Pro- Average monthly enrollment of Medi-Cal, gram staff`co-sponsored a Medical Waste Medicare and Commercial plan members Seminar for members of the business com- grew from 18,190 in 1986 to 45,729 cur- munity involved with handling and proper rently. Blue Cross of California succeeded disposal of medical waste. The Seminar was Foundation as the Commercial plan in June, also co-sponsored by Four hospitals within 1998 and CCHP continues to dead:the Contra Costa County.; There were over one Commercial plan in enrollment by a margin hundred attendees from both the public and of 9 to 1. private sectors. __ • CCHP was selected as the Healthy Families • With the passage ofAssembly Bill 59 in Community Provider Plan in Contra Costa January 1997,the LFA recently experienced a County,making it the most affordable plan hearing panel exercise involving an appeal in our county. from the City of Pittsburg on a decision * CCHP developed and installed a state-of- made by the LEA on an occurrence at Keller the-art case management computer system to Canyon Landfill. The hearing would have _ help it manage special populations,including been the first in Contra Costa County,and high risk OB patients. also required many staff hours and resources to create the-panel,and gather the informa- • The Advise Nurse program continues to tion to defend the LEA decision. The appeal expand. It now serves 75,000 eligibles in was subsequently withdrawn and the hearing the Solano, Sonoma, Napa and Placer Medi- was never conducted. 41 __ ...... ......... ......... ......... ......... ......... ......... ......... • The final draft of the septic system ordi- Supervisors in 1995. EMS areas being nance was completed and forwarded to addressed included system organization/ County Counsel for review management,staffingftraining,communica- tions,response/transportation,facilities/ • To better understand the status of the critical care,data collection/system evalua- aquifers, septic and water systems surveys tion,disaster medical response and public were conducted in Alhambra Valley, Orinda, information/education. Richmond,and San Pablo. • The EMS Agency maintains the"l-800- • Administrative hearings were conducted for GIVE-CPR" telephone number to make the owners/operators of 46 retail food available information regarding citizen CPR establishments and one small water system. training to the public. Pacific Bell has The hearings were conducted to provide the included this number in telephone books for owners with the opportunity to show cause all regions of the County. why.Environmental Health should not initiate suspension of their operating per- A multi casualty response by ambulances, mits for significant health code violations. public safety,hospitals, EMS and others Also, forty-four restaurants and retail provided coordination_and care for victims markets were ordered closed by Environ- of Concord Water World Slide collapse. mental Health staff for health code viola- One death and 32 injured were transported tions. to area hospitals. • Environmental Health moved to a new Funding was obtained from the State to office location. Along with the move, a new support the role of the Contra Costa telephone system was implemented,a new County Health Officer as the Regional filing system completed,and the computer Disaster Medical/Health Coordinator,for system upgraded. the Northern California Coastal Region. A Bay Area Disaster Medical Assistance Team Hazardous Materials was sponsored by Health Services and organized by the EMS Agency. • The HazMat Program is a Certified Uni- form Program Agency(CUPA) for all of Oversight and medical direction for the Contra Costa County.The Division Contin- EMS first responder defibrillation program ues to develop efforts to fulfill the legal and was provided. Under this program,all regulatory requirements of this program. firefighters county-wide are trained and equipped to use an automatic defibrillator to Emergency Medical provide electric shock to heart attack victims. Services During 1997,387 patients in cardiac arrest • were evaluated for treatment, 107 treated,23 A new Emergency Medical Care Committee "standing committee structure provided a saved for hospital admission and 13 dis- charged from the hospital. comprehensive evaluation of EMS system performance and made specific recommenda- A computerized system was initiated for tions for future action. This evaluation was • paramedics to use in patient care record based on standards identified in the County keeping. Data from this system will be used EMS System Plan approved by the Board of to evaluate paramedic performance. 42 ......... ......... ......... ......... .._...... _ ........ ............. ..._....... ......... ......... .._...... ......... ......... ......... ............... _. _.. ._........ ......... ......... ......... • Ambulance services under contract re- sponded to 52,143 emergency requests in 1997. Of these, 36,877 resulted in patient transport to a hospital emergency depart- ment. • All injured patients were evaluated using field trauma triage criteria established by the EMS Agency. Of those, 957 were trans- ported under County trauma protocols to a trauma center, usually the County-desig- nated John Muir Trauma Center. 43 Section V cf)aflenges & New Directions During the nextyear, we will be challenged to continue improving our health system while coping with an increasingly unstable pral base. Additional issues include coordination o,f'emerg-enry services and implementation of the Industrial Safety Ordinance. In terms ofpatient patient care, we will develap and evaluate ways to reduce unit casts of deliuering care, improve searnlessress of'servics and improve patient experience of services through increased staff development, improved flour, and improvement of physical plant. STARIMATION OF FUNDING Contra Costa Health Services,like all publically hospital systems,there is increasing concern that funded health systems,relies on a tenuous tangle DSH funding will be reduced.This funding is of funding based on state funded reimbursement essential to our operations;and our ability to and subsidies.Traditionally,Medi-Cal reim- provide services.This year we are looking at ways bursements are inadequate and state funding is to support efforts to eliminate the DSH hospital subject to changing legislative priorities.In administration fee imposed by the State.Ending addition to funding concerns,we continue to this state administrative fee would insure that the experience pressures of marketplace competition entire federal DSH payments would go to safety and increases in the number of uninsured.The net hospitals,thus increasing dollars for patient following is a thumbnail sketch of funding tee• Challenges we anticipate in the coming year: The federal government is changing its approach Low Medi-Cal Reimbursements. We look to cost-based reimbursement for Federally forward to a new administration in Sacramento Qualified Health Centers,which our system - which is more friendly to the health of vulner currently receives. deductions in FQHC could able populations.We hope that one of the require us to change the ways we currently immediate priorities will be an increase in the provide and pay for outpatient services. current Medi-Cal reimbursements.California ranks 46"in Medi-Cal(Medicaid)reimburse- Strengthening Access to Health Care through the mens nationwide. Increased reimbursement Medi-Cal Program.It is estimated.that 4000- levels are needed in order to peep up with health 6000 County residents are eligible for Medi-Cal care inflation throughout the state. but are not currently enrolled.Some have never been enrolled,some were previously enrolled and Changes in federal Payments. Contra Costa continue to be eligible but are no longer receiving Regional Medical Center receives Disproportion- benefits,and some are currently enrolled but are ate Share Hospital(DSH)reimbursement in danger of losing eligibility unless they reapply. provided to hospitals which treat adisproportion- In conjunction with Contra Costa Social Service, ate share of low income people including the we are developing mechanisms to ensure that all medically indigent and uninsured.Among public residents who are eligible are enrolled. The 45 __.. ......... ......... ......... ......... ......... ......... ......... ......... _........ ......... ......... ......... ......... ......... ......... ......... __... ..._... _ departments need to work together to build INDUSTRIAL SAFETY special efforts to make sure that those recipients ORDINANCE who lose cash assistance but remain eligible for The Board of Supervisors is considering adop- Medii Cal through Section 1931 (b)program tion of a>new Industrial.Safety Ordinance. As (Aid Cade 38)and Transitional Medi-Cal written,this ordinance will be the most far- continue to be enrolled.An estimated 10,500 reaching local ordinance in the nation governing people in this category are enrolledin CCHP businesses'use of hazardous materials. Our Their loss of Medi-Cal coverage could negatively current authority under the California Accidental impact the Health Plan by 10.1 million dollars Release Prevention program over certain safety per year.. issues at petrochemical refineries and other large handlers will be expanded to cover all processes Streamlining the Healthy Families Program. at those facilities.Our activities will include The Healthy Families Program is health insur- review of the facilities'safety plans which are ance for children whose families are below 200%n required under the ordinance;extensive on-site of poverty and not eligible for Medi-Cal.This audits;and public meetings on the plans.The state program has been fraught with difficulties ordinance also gives us authority to conduct since it began on July 1, 1998. Some of the safety and root cause analysis investigations and major problems(lengthy application,complex the right to enter a facility,examine documents, and limited eligibility,premiums,and co-pays) and interview employees after major chemical are being addressed at the state level.We look accidents or releases. forward to a state reconfiguration of the program in the coming year.Contra Costa Health Services Businesses covered by the Industrial Safety is in the process of coordinating the outreach and Ordinance will also be required to design a marketing on a local level as well as working Human Factors Program."Human actors"refers with community based organizations,health to the design of equipment,operations,proce- providers,and other county departments to dures and the work environment that are com enroll the estimated 4000 eligible children into patible with the capabilities,limitations,and the program as quickly as possible. needs of the workers. CCHS will be challenged to develop new guidance as this program is a EMERGENCY MEDICAL cutting-edge method to improve industrial SERVICES safety. Changes in the economics of health care and in health care delivery systems present our Emer- PROVIDER OF CHOICE FOR THE gency Medical Services Division with new MEDT-CAS POPULATION' challenges for serving those with medical emer- Medi-Cal patients have traditionally turned to gencies.Managed care with its demand for the County for their health care needs.Medi-Cal efficiency,has resulted in hospital mergers, Managed Care offers a choice to the Medi-Cal downsizing and closures,stretching the ewer- population of the local initiative(CCHP)or the gency and critical care resources of communities commercial plain(Blue Crass).While we have to deal with peak demand associated with retained a large number of our Medi-Cal pa- epidemics and disasters.In this environment, tients,we are working hard to continue to be EMS will need to develop collaborative strategies their provider of choice through the following involving local government and public and strategies: private health care systems to address community health and safety issues. Opening the New Hospital— Contra Costa Regional Medical Center. In January, 1998, 46 CCHS opened the Contra Costa Regional reimbursement for medical care services.Patients Medical Center,the newest hospital in the must enroll in the programs for which they are County.This 156 bed facility is equipped with eligible in order for us to be reimbursed.Both the latest seismic safety features and high-tech the research and our own experience has shown medical equipment.In addition,we have en- that many people do not enroll in available hanced our computer information network for programs unless they are reached on a person-to- easier registration and unproved availability of person basis. This issue is particularly challenging medical histories to facilitate rapid medical when the people to be enrolled are children. decisions.CCRMC will soon be celebrating its - first year of operation. While the staff has In order to educate and assist parents to enroll continued to work on a number of"post occu- their children into the health insurance benefits panty issues,"both patients and staff have for which they are eligible,we are developing a commented on how much easier it is to work customized,personalized education planlout- and take care of the patients in the new hospital. reach strategy. CCHS is the lead agency for a county-wide coalition to increase access to health In early Fall,artwork,including framed prints care for children. The coalition includes key and handmade quilts,were hungthroughout the community leaders and community organiza- hospital,adding warmth and personality to the tions in the development,implementation and previously bare hallways.The new Diagnostic evaluation of strategies to build comprehensive Imaging(Radiology)equipment has substantially access to health care by addressing barriers such as reduced our need to send patients elsewhere for lack of coordination among services as well as services previously not available.With the transportation,child care,language and diversity establishment of the Nuclear Medicine Service, issues. in conjunction with the Veterans Administration, patients no longer have to be transported to John EX " 41Nfi 'MODELS Muir or Mt.Diablo Medical Center for these COUNTY ORGANIZED services. We are confident that this facility is a IREALTIIr STSTEM(COIN) primary reason for those who choose us as their Legislation on the federal level to comprehen- provider. sively address the COHS issue by allowing _ Contra Costa to implement a county-organized Service Excellence. We are developing a long- health system has been stalled. We continue to term strategy to support an organization-wide look for variations of this model which would focus on service excellence. This effort will bring more Medi-Cal eligibles under managed include developing customer service strategies care and into our Contra Costa Health Plan,thus which involve employees in the innovation strengthening the public health care system. process and turn patients and employees into advocates for our system. Central to the initia- NE''ll'E'HEALTH CENTERS tive will be increased attention to soliciting and using patient and community input,and increas- Cater,for Health.The Center for Health, ing the cultural competency of the organization located in North Richmond,will open in Febru- to serve our diverse population. ary 1999 after five years of planning and con- struction.This facility will be unique in several COORDINATED OUTREACH respects.Through the Center for Health Advi- STRATEGIES FOR CHILDREN sory Board.,the community had considerable As noted above,our delivery system is over- input into the planning and construction of the whelmingly dependent on receiving third party Center.This health center will be a blend of 47 1.11.1.1.11.1........11..................................................................................................................... ................................................................................................................................... ............. ................ Public Health,S ubstancc Abuse, and Ambula- drainage im rovements will be made and the p tory Care services.Once funding is received,it first of the additional parking spaces will be will also contain an environmental and health added. education resource library for community use. PROP 10 IMPLEMENTATION Los Medanos Health Center. In July 1998, the Health Services is looking forward to participat- County signed a 20-year lease(extendable to 30 ing in the implementation of Prop 10. Services years)for the former Los Medanos Community to support positive early childhood development Hospital building in Pittsburg.This building are in short supply and do not reach all children will replace the over-crowded and deteriorating who could benefit from them. We will empha- facility at 550 School Street which currently size the importance of a broadly inclusive plan- houses the Pittsburg Health Center.Construc- ning process and advocate for strategies which tion drawings for the Los Medanos Health will integrate categorical interventions into Center will be completed in March 1999 with practical support for parents to teach their the goal of finishing construction by the end of children well. Health issues ofspecial concern 1999.The Los Medanos Health Center will for the prenatal and early childhood period contain a full range of medical and public health include early entry into comprehensive prenatal functions,including Urgent Care,as well as care with intense attention to smoking cessation health-related classroom space for Los Medanos during pregnancy;immunizations;anemia and Community College. lead screening-,and supporting-appropriate physical and psychological development. Home Martinez Master Plan. The department is visiting and peer support models will be impor- currently working with the County tant avenues to explore. Administrator's Office and an architectural firm to review and update a Master Plan for the Martinez Campus. The current recommenda- tion is to construct a three story medical office building for specialty services,allowing for the demolition of most of the old part of Merrithew Memorial Hospital. This approach will add approximately 300 parking spaces on the campus which are critically needed to serve patients. In addition,the previously approved plans for the new clinical lab budding are moving ahead. It is anticipated that asbestos abatement,demoli- tion of the old I and J wards, and construction of the new clinical lab will begin shortly after the new year. Once complete,the two story 15,000 square foot new clinical lab building will allow the department to move the Public Health Laboratory(currently located at 1111 Ward Street in Martinez) into the new lab building. On the former J ward site,paving,grading and 48 .............. ...................... Attachment A s x :: : r.::s < :.,r:,a i �/06 yy��''y� S:r' 1•_.. ;: `r.:' ..•`'.:i;:%:j'`�%r::.`::.,.y,'•, �y_�q Cc 40 OD w cc c CL LU fes. $ :{•i:•y?;+' i;+.}i:;isa};?:: LJ�/ Fa ,{ 1 F F n:..: % 1 w coCD UJ 0 rt•i-.:.K F F fi•.s''„ 'c.,,P,:+''.f`;h's:{;��,�:-'yfr��,tih;'�•,j:r'i.,��}Fr �%1�: v✓ ��f r CL : � .'� .'Fi1 s� ti:i;,;:y•'{-,-,,;•:•+:� ,'5',''Y..`^I''•;R; �f�F,.' 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Attachment B Co N to 00 ui A. 0 Cq N IN to In V� �j Ot N N cq 4N 0 0 0 Ct CL z z f.- 0 CD 0 < a. 0 IOU Cp co oo co z Ok Ilk co co LL 8 a Ct A actC Cf c%l u) co co co C11 or -or qr N A 61 r_ e LD 32 vu _ __ ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ...._... __.... ......_..... _ ......... ......... _ Ck ci m SO v 10 f. V "' a ti °° " " Attachment B a' y civ m � m rai M o v � Rr�i � w v N 0 QI Ci Of R m i•J iV M !�`}� N O m C ado CC allo � m d M a m cN- d aD R h d V 47 M N aD Q a+l b CV R` 01 M VY aD Y7 t6 MN fD dp . Hl 'Q 4 {j .. M O M tfi O N Q a7f C m C CIA N co N�,pp uRyry� (D Y 7MLS R N 47 <O W as aD W S w 04 R f- .+ fif R N d tf! �f aD SCI tN� 6s U y aMD R d ^ Vk s.M�- Ct N OND Of C N +� 4J ONi yy 2 N R O r M v' 6 M 01 1fi co W Rn , . to d OR9 v d b co 7 W o r ..... ti M d K1 � C CM•- M 0 N a0 �f lh R aD d I a0 MM .0f0 m hN UN1 a6D � d N - RLn ' j N toR cN W dpi u* a0 a0 t4 w M v W R d 4-9. M W r r W r r z z Q N V' f0 +n C5 t7 a0. M 4! w M W t5 N v0 m M o N ada P o D r M r (1) Cco co0)0) d co r- d CO cD Mt, o N r h- CRf MW !p (MV ado M M F- (,) } = N M M W as z > jy °' r Ce vii+ v m o tN S M 'fit at ti! aD w u7 �t7 N N Qo �tl M !V W C 9 N o M M ado PJ YM M W f0� r N 04 N H d d O b a7 d O LL b d c O W R R R 4%04 .... N aA CA d d aD CJ W P. a�b 1�fI Cl) N q t�DD M R N M O SG. rz tR M c, o d amp co co co d ac b N W- co M cLM co m W N N N CMi N (1 C!1 M r r y CD R r N d O O d R M M r � N. .. d8co O ad C N aac l7 �p f•� O o S � N O i7 M Om cD W iH r r o Q) p 9? to a a c ami o a _ _ :...... :........ w Ott ........................................................................................................................I...''I.....I..,....... .......... . ................................................................................................................................................................ Attachment C PERFORMANCE INDICATORS The following data compares FY 1996-97 and FY 1997-98, CONTRA COSTA REGIONAL MEDICAL CENTER AVERAGE GE DAIL Y CENSUS Fiscal Year 1996-97 Fiscal Year 1997-98 118 119 A VERA GE LENGTH OF STAY i DA YS) Fiscal Year 1996-97 Fiscal Year 1997-98 Medical Units 4.08 3.76 Psychiatric Units , 13.24 , _12.88 CONTRA COSTA HEALTH CENTERS A VERA GE MONTHLY 0 UTPA TiENT Puns CENTRAL COUNTY Fiscal Year 1996-97 Fiscal Year 1997-98 Martinez 5peci4!tr Clinics 3,549 3,500 Martinez Family Practice Clinic 3,929 4,110 Martinez Dental Clinic 312 304 Martinez IIE2!th Start 153 166 —Concord Older Adults 443 407 Concord Health Center 940 996 EAST COUNTY Fiscal Year 1996-97 Fiscal Year 1997-98 Bay Point Family Health Center* 168 1 226 Pittsburg>Health Center 4,376 4,645 PittsbM Dental Clinic 316 317 Piftsbwg Health Start 163 176 Antioch Health Center 279 374 Brentwood Health Center 828 779 East Coun Older Adults Clinic 167 136 Formerly named the Bay Point Wellness Center opened in 1997 . ...... ......... ......... ......... ......... ......... _ ..... . ......... ......... ......... ..... . ........ ....... ......... ......... ......... ......... ..- _...... _.. ... ._ . . __ _ Attachment C Performance Indicators 1:997-98 CONTRA COSTA HEALTHCENTERS'(continued) WEST CQLINTY Fiscal Year 1996-97 Fiscal Year 1997-98 Richmond Health Center 5,223 5,526 Richmond Dental Clinic 276 274 Richmond Healthy Start 194 170 West County bider Adult 238 254 Ing EMERGENCY Fiscal Year 1996-97' Fiscal Year 1997=98 DEPARTMENT AVERAGE VISITS PER MONTH 2,870 2,679 CONTRA COSTA HEALTH PLAN ENROLLMENT BYPAYOR May 1997 May 1998 .AFDC 40,787 35,149 Cross Over edi-Cal&Medicare 481 420 Other Medi-Cal 2,946 2,614 SeniorHealth- 479 466 Commercial Members 6,405 6,855 AEvL49PCIN.RN.Ci.BlHealth Families(begin 7-1-98 61 96 Basic Adult Care 4,887 4,326 ... r............ N.NN . ttt �.w . . ,., ......._. ......... ......... ......... ._..__.. . ._.... ......_....... ................. ......... ......... ......... .._...... ......... ......... ......... ......... ........__.. .._.. _.... __...._.. ......... ......... ......... 3r;L Attachment C Performance Indicators 1997-98 CONTRA COSTA COMMUNITY SUBSTANCE ABUSE SERVICES TYPE OF SERVICE' Fiscal Year 1996-97 Fiscal Year 1997-98 Outpatient Treatment 1,189 1,117 Outpatient Intensive 191 209 Residential Detoxification— Non-hospital 5,086 3,778 Residential Treatment 789 909 Methadone Detoxification 2,516 2,174 Methadone Maintenance 240 342 Primary Prevention 120,897 141,790 Secondary Prevention 1,591 2,400 [Driving Under Influence Program l 825 1.738 1 Individuals served __ _ __ .... _ _ .............. ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ._...... ... .._.. ......... . _ ....__... . .. ._. _.._. .. ...__ ........ �<a Attaelmwnt C Performance Indicators 1997-98 CONTRA COSTA MENTAL HEALTH A VL'R,4GE MONTMLYOUTPATIENT VISITS Fiscal Year 1996-97 .Fiscal Year 1997:98 MENTAL HEALThT' CLINICS Central CowAy 1,977 3,000 East County 2,157 2,655 West County 2,193 2,375 Fiscal Year 1996-97 Fiscal Year 1997-98 SPECIALTY CLINIC E Ward—Crisis 1,901 2,007 Specialty Children's Clinic 997 594 Day Treatment 3,945 4,564 Contracted Pro am 1,616 2,3,98 .Fiscal Year 1996-97 Fiscal Year 1997-98 BYPAYOR Medicare 1,418 1,546 Medi-Cal 9,246 11,043 Basic Adult Care 432 390 HMO 187 177 Private Pay 197 216 Private Insurance 530 793 Other 2,755 3,223 Attachment C Performance Indicators 19.9798 CONTRA COSTA PUBLIC HEALTH Mame Health Agency Fiscal Year 1996-97 Fiscal Year 1996-97 NURSING PRODUCTIVITY 5.61 5.29 Average#of Visits per.Day --per Nurse Fiscal Year 1996-97 Fiscal.Year 1997-98 A VERA GE NUMBER OF 2,793 2,994 CONTACTS PER MOATI�1 aif M"sta Senior,Nutrition Pia ram [MEALS SER VEDIPer month ...Fiscal Year 1996-97 .Fiscal Year 1997-98 --on e ate Moals 14,3'74 14,445 Home Delivered 13,128 13,35$ Home Delivered--AIDS 306 358 Guardian Care vela mentall Disabled 1,017 1,088 Public Nealth Clinic Services A VERA GE CLIENT Fiscal Year 1996-97 Fiscal Year 1997-98 ENCOUNTERS PER MONTH Child Health Screemn 258 321 Teenage E!Lo am TAP 153 20 Ile ee Pro atn 24 Fairdl Plannin STD 491 26 698 Women,Infants, and Children's Program(WIC) AVERAGE NUMBER OF VOUCHERS IS.S'ITRD►PE MONTII Fiscal Year 1996-97 Fiscal.Year.1997=98 16,236 15,744 ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ._.._. ... .. ... ........... __. . __..... . ................................. ......... ......... Attachment C Performance Indicators.1997--98 CONTRA COSTA ENVIRONMENTAL HEALTH ACTIVITY Fiscal Year 1996-97 Fiscal Year 1997-98 Com faints' 1 476 1 202 Solid Wastez 3,266 _ 3,495 Land Develo menti 6,191 5,099 Consumer Protectionz 18,155 18,482 Misc General Programs 50 62 ' Indicates number of responses to complaints which may or may not result in,a visit to site. Includes routine,,,follow-up, complaint inspections or investigations, consultation, license orpermit evaluation, direct abatement,and violation notices CONTRA COSTA HAZARDOUS MATERIALS PROGRAMS ACTIVITIES Fiscal Year 1996-97 Fiscal Year 199798 Notifications from Industry (cif a hazardous materials incident) 671 570 Complaints Received and Addressed 420 205 Number of Incidents Reported 213 167 Attachment C Performance Indicators 1.997-98 CONTRA COSTA. EMERGENCY MEDICAL SERVICES ACTIVITIES .Discal Year 1996-97 Fiscal Year 1997--98 Ambulance Services 46,890 52,143 Total Units Dis atched Air Ambulance Services 268 273 Patient Tran ort Trauma Services 842 957 Critical trauma patients transported First Responder Defibrillation Svs---- 35 23 "Field Saves"(patient admitted First Responder Defibrillation Svs--- 17 13 " System Saves"(patient discharged Interfacility Transfer Reviews 907 2,520 Cases Reviewed Vii ...........11............. ..................... PERSONNEL TABLE 1 Staffing Patterns-FTE's YTD YTD % Description JUNE 1998 JUNE 1997 Change Staff by Division: DETENTION 57.43 54.34 5.69% CONSERVATORSHIP 13.54 13.09 3.42% PUBLIC HEALTH 406.95 393.45 3.43% ENVIRONMENTAL HEALTH 74.60 73.30 1.77% CCS 49.76 48.90 1.76% SUBSTANCE ABUSE 75.90 71.14 6.69% MENTAL HEALTH 191.80 167.27 14.66% HOMELESS 1.21 0.72 67.59% FINANCE 167.74 161.99 3.55% HOSPITAL 708.63 697.29 1.63% IJP & CRISIS MENTAL HEALTH 121.99 115.29 5.81% CLINICS-AMBULATORY CARE 301.68 280.20 7.67410 CLINICS-OLDER ADULTS 7.55 7.85 -3.84% MEDICAL STAFF 180.98 176.46 2.56% DIRECTOR'S OFFICE 21.94 18.48 18.73% EMERGENCY MEDICAL SERVICES 7.09 5.84 21.39% Sub-total ENTERPRISE FUND 1 1,517.59 1,463.39 3.70% CONTRA COSTA HEALTH PLAN 75.20 65.41 14.96% Grand Total 2,463.96 2,351.02 4.80% Source: HSD Monthly FTE Reports ................................................................................................................................. ...................... .......... TABLE 2 HEALTH SERVICES DEPARTMENT SICK LEAVE USAGE FY 97/98 Value of Division Sick Leave Sick Leave Sick Leave Hours Used Hours Earned Used(2) CCRMC&Health Centers 96,453.00 116,399.00 $2,448,941.67 CCHP 3,012.00 3,851.00 70,691.64 Mental Health 12,345.00 14,313.00 298,996.90 Substance Abuse 5,145.00 5,343.00 91,478.10 Detention Facility 3,108.00 3,441.00 83,232.24 Public Health(1) 31,756.00 36.687.00 671,956.96 Homeless 14.00 88.00 273.00 Environmental Health 4,970.00 6.=.00 124.100.90 Total (1) Public Health includes Conservatorship and Calif.Children Services. (2) Based on average hourly rate excluding benefits. Source: County Payroll System Reports DA2663B and DA2663C c,%1231 vrd"79ft4jkW.wk4 ................................................. ................................. ARequest to Speak Form THREE ) MINUTE E 1 mpetttom: formand ' tin Ow box mw ft b dr+ rg " g Mune: LP AN Mdd Vinypy m 1peaung for :1 *ish to We&an Agenck Item �II�C "� ��il�Iirl/144111M�IIi�iW�Yw��MM11r1 I do not r��►to pipe& but leave for the Owd ID CO-WARM&M.44 .......................................................................................... . D.2 �1� wowAnnual CONTRA COSTA HEALTH SERVICES Performance Review 1998 CCHS Senior Scarff William B. Calker,MD Director Wendel Brunner,MD Director Contra Costa Public Health Milt Camhi Executive Director Contra Costa Health Plan Chuck Deutschman Director Contra Costa Community Substance Abuse Services Mary Foran Assistant to the Director Pat Godley Chief Financial Officer Julie Kelley Assistant for Program&Policy Frank Puglisi Executive Director Contra Costa Regional Medical Center Contra.Costa Health Centers Steven Tremain, mD Senior Medical Director Donna Wigand Director Contra Costa Mental Health Table Of Contents MissionStatement ........................................................................................ ..................... i OrganizationChart................................................................................................................ ii SECTION I' OrganizationStructure .................................................... .... ' ..................... 9 SECTION II Resources FinancialResources....................................................................................... ..................... 11 PersonnelResources...................................................................................... ..................... I 1 AffirmativeAction ........................................................................................ ..................... 11 SickLeave..................................................................................................... ..................... 11 StaffDevelopment........................................................................................ ' ..................... 12 Automation .................................................................................................. ..................... 12 SECTION III Service Delivery System Hospitalsand Health Centers ........................................................................ ..................... 13 MentalHealth ............................................................................................... . ..................... 13 PublicHealth................................................................................................. . ..................... 15 Community Substance Abuse Services........................................................... . .................... 16 ContraCosta Health Plan.............................................................................. ..................... 18 Environmental Health Program................ HazardousMaterials Programs....................................................................... .................... 19 EmergencyMedical Services .......................................................................... .................... 20 Custom" Profile Hospitaland Health Centers ......................................................................... .................... 23 MentalHealth ....................................................................................................................... 23 PublicHealth................................................................................................. .................... 23 Community Substance Abuse Services................................................................................... 24 ContraCosta Health Plan.............................................................................. .................... 24 EnvironmentalHealth .................................................................................. .................... 24 Hazardous Materials Program .............. EmergencyMedical Services .......................................................................... .................... 24 Customer Relationships Hospitaland Health Centers ......................................................................... .................... 25 MentalHealth ............................................................................................... .................... 25 PublicHealth...................................................................................................',...................... 26 ^~^__ -_-----------------------'___��--�--���� ^_ /0; ��� � Table of Contents � Continued Community Substance Abuse Services................................................................................... 26 ContraCosta Health Plan...................................................................................................... 27 EmergencyMedical Services -.....,...-..~~,........-.,~.-~^.......,..-.............,.-.-,....-...., 27 � Performance Indicators � � Hospital and Health Centers .......^-.,.,...-,~^..^.,._^..'.,^..^...^..-.-^_...,^..~..^.^`.._,. 29 � Mental Health ...,._-..^-...^.....^...^..^^~-^.^..,.....-...,~.^......,,^-..-..`^~,....^~.-.,.^-^ 29 � Public Health......................................................................................................................... 31 � Community Substance Abuse Services ................................................................................... 31 � Contra Costa Health Plan...................................................................................................... 31 � Environmental Health .^ ^.`..^.~..~.^.-..^.....^.....^.^...`..^-........~,....................., �l � ' HazardousMaterials ..--....-...^^--~....-........^^.-^..^.-'..-.^...`~.~...-,..^.....-...-... 31 EmergencyMedical Services .................................................................................................. 12 Accomplishments � pital and 7�ea\��(�eoteza .........,...~...^^^,^~~..-,..~^_,...`,,^..,.^,_~_,~~,.~^`~'~.,',~, 33 ' MentalHealth .,..-'..'^`'^`-~`'~-~-^^^'`^'-^-`~~--`^'~^^^-'^^^~`^~^`^^`~-~^^`~~^'~'^^~~'-^'``^-'^`'' 33 PublicHealth......................................................................................................................... 34 � Co Somac /��u����rv�c�o......-_.~..,....^~`.~~.~_....^.~....,.-.......,.....,40 ` � � o � �l &� ContraCosta Plan...................................................................................................... 41 Hazardous ���u{�� ^^`^..--~,.^,.,,'^^._,,^,^`,^_^_,,,,,.,.^^,,,'^__^,~,._^^_,,`,.,,,,'~. ` HuzucdmuaMarezbdm .......,....^^_..`^^.~~'..~^.^^....^.,^^^~.-.^~.,^_,..,,'^,^...^._,^.,.,,^^_.,,.^, 42 � 4,,,, � Medical Services .......,.~....-,....~..~^..~.-.....~.,...~,~_~.~_..^.~.._,.^,, ' ~E~~--O- . `�. ^° Challenges ��' =�. ^~.~~~ D~~ .~~~_~---_ � Challenges ..^...-..-,..,.'^^^^^'^.-^^^^^~^'-^.^^^`~''---~^^`''`^``^^^^`'-^'^~^~'^`~-^`'~^^^^~''^-^^'^`~~- ^. »m 47 Nemr��izect�xmu....~..^.~^^-'~~^~'~-^-~'^'~'~^^`~'^^^-``~^`^~`^'^^^`-''~-~'~^~^^`^`~~--^^`^`~-' -- � Begins After Page 48 Graph Attachment ^° � /\ttuchooent��.,.......--,...........-~~~.~^....-~......... C��r�oC^»oucy Suouu7 ./�^.�_ K�(��I� ��l4�09g � Aztucho�eotB.,'....'......,,'.^...,.'.,...^..~...^.,^.,......^,^,^.^,...,,.`.. ��u«q5un - ! oz�oc�� ......,.,^'.^^,.,-.'....'..,,`.....,,^..,.'......,......,','.... T�rf�z��mm��I�oicut�cx -__-_- Y� � Staffing Patterns Table l ....-....~-..~.~^'~'~-^^^^^^^`^^'~-^`~^~'^''`^~~^^~ ----`o ! Table 2............................................................................. Sick Leave Usage FY 1997-98 CONTRA COSTA HEALTH SERVICES Mission Statenwnt Contra Costa Health Services cares for and improves the health of all people in Contra Costa County with special attention to those who are most vulnerable to health problems and their conse- quences. Values We are an integrated system of health care services, community health improvement and environmental protection. + We emphasize quality of services and respect for all who use and work in our programs. + We anticipate community health needs and change to meet those needs. _ We work in partnership with our patients, cities and diverse com- munities, as well as other health, education and human service agencies. We encourage creative, ethical and tenacious leadership to imple- ment effective health policies and programs. i .......................................................................................................................................................................................... --T-- —T— LL LPJ Asia c9 9 Jim A ...... ------ ............ WIT to —T- 89 --r— Sig c ---T-- .......... Section I 0-roanizationaf structure The Health Services Department is made u o the allowin divisions: n f f g * Contra Costa Regional Medical Venter &Contra Costa.Health Centers • Contra Costa Mental Health • Contra Costa Public.Health * Contra Costa Community Substance Abuse Services * Contra Costa Health Plan • Contra Costa Environmental.Health • Contra Costa Hazardous Materials Programs • Contra Costa Emergency Medical Services • Finance * Personnel w Office of the Director The Office of the Director, Finance and Per- eral accounting, program reimbursement, and sonnel provide centralized administration and special projects and evaluation. policy direction for the operating divisions of the Department. Personnel provides assistance The Office of the Director also includes Depart- with recruitment,selection, classification, com- went-wide broad policy initiatives such as the pensation, benefits,employee health and em- Hazardous Materials Commission, Partners for ployee relations. It also assures adherence to the Health,Center for Health,',Diversity Services,Of- provisions of the county's own regulations in- Tice for Service Integration, Health Services cluding memoranda of understanding with the Ombudsman, Hazardous Materials Ombuds- employee organizations. man, and the Women's Advisory Committee. Finance manages all fiscal functions including We engage in numerous partnerships, through billing, contracts and grants, utilization review, contracts, coalitions, and joint efforts. Specific - payroll,data processing,budget,patient and gen- partnerships are described in the detailed sections which follow. 9 --hT Section 11 Resources Financial Resources ing(14.7%and 3.4%, respectively) due to ex- Contra Costa Health Services receives fiscal pansion of programs and changes from tempo- support through various funding mechanisms. rary or contract staff to permanent staff per The recommended budget for 1998-99 is agreement with Local One.The Homeless Pro- $381.3 million dollars, $354 million of which gram and.Office of the Director increased is net county cost (Attachment A). (67.6% and 18.7%) due to the conversion of employee contracts to permanent staff postions. Sources of funding include Medicare, Medi- Emergency Medical Services increased (21.4%) Cal, Private Pay/Insurance, Bond Revenues,To- due to program expansion and increased de- bacco Tax, SB855,VLF revenue, interest in- mand for services. come, Realignment monies (Hospital and Health Centers,CCHP);State CCS program A , t dve Action (Public Health); federal and state grants, client Contra Costa Health Services continues to fees (Public Health and Substance Abuse); make diversity a priority. Unlike years past,we Drug Medi-Cal, federal block grant,and state are unable to provide information regarding allocation (Substance Abuse); conservatorship workforce parity and ethnic distribution by lob fees (Conservator); property taxes (Emergency category.This information provided in the past Medical Services); Inspection Fees, Public by the County Affirmative Action Office is no Health Permits,Hazardous Waste Generator longer collected. Fees(Environmental Health/Hazardous Materi- als Program); Ryan)White funding(AIDS); State-Federal Medi-Cal Administrative Activi- The Department continues to have a full time ties/Targeted Case Management(Public Diversity Services Coordinator to carry out em- Health/Public Guardian), SAMSHA grant ployee Affirmative Action recruitment and funds, SSI/SSP (Mental Health); County Gen- monitoring and focus attention on creating a eral Funds(multiple programs.)These are sum- culturally competent workforce, one that is marized in Attachment B. well-prepared to serve our diverse patient and user population. Personnel Resources Sack Leave The overall level of staffing for Health Services Table 2 displays the amount of sick leave used by experienced a 4.8 % increase in 1998.Addi- each Division of the Department during fiscal year tions to staff this year(Table 1) included the 1997/98 as compared to the amount accrued. It Contra Crista Health Flan,which grew by ten is possible to use more sick leave in a year than employees due to continued expansion of the accrued because of the year to year carry-over of Plan. The Mental Health and Public Health sick leave. The average amount of sick leave use Divisions also experienced an increase in staff per FTE is 63.6 hours. The range by Division 11 .......................... .................................................................................................................................................................................................................................. tion System is well underway.Working with Su- varies from a low of 40 hours to a high of 73 perior Consultants,we plan on signing a con- hours in the 12 month period. However,the cur- tract with our preferred vendor by the end of rent reporting system does not allow us to distin- this year. guish between regular sick>leave and sick leave which is used up upon retirement. In addition, PHASE TWO OF THE DATA WARE_ these figures can not reveal situations where high HOUSE-With Phase One near completion, sick leave use is related to catastrophic illness as we now have expanded the data model to allow opposed to frequent short illnesses.Therefore,we for warehousing our complete CCRMC and have no explanation for the variations by Divi- Health Centers' Master Patient Index (MPI). sion. Medi-Cal eligibility is the next addition to the warehouse environment. Staff Development Performance evaluations are distributed to super- KEANE PATCOM (registration and billing sys- tem)-on a regular basis and required to be sub- tem)-version 7.4.6 was implemented last Octo- mitted in a timely fashion. All staff are encour- ber. aged during the annual evaluation process to iden- tify training needs and to develop a plan to meet CENTRAMAX ADVICE NURSE-System them. A system to register staff for the offerings was upgraded to a Year 2000 version in October, of the County Training Institute is in place. 1998 ANSOS NURSE SCHEDULING - System was Automation upgraded to a Year 2000 version in October, Information Systems technology plays a major role 1998. in supporting medical and administrative staff ac- tivities. With 23 multi-user computer systems, PROVIDER MASTER DATABASE AND AD- 1,750 personal computers and over 15,000 soft- MINISTRATIVE SUPPORT SYSTEM -A ware products throughout the Department, each centralized database, developed to include all Division has access to modern technology. CCRMC and HC plus CCHP Provider infor- There are five critical areas which our Informa- mation, is now online for selected staff.This tion Systems staff will be concentrating on this new in-house developed system will support year.These are Patient Care(e.g. the lab system), Surgery Privilege Verification and department- Regulatory(e.g.HEDIS Reporting),Policy(Men- wide credentialing. tal Health Managed Care,Healthy Families),Fis- cal (Billing and Payroll), and Year 2000 upgrades MEDIWARE SURGERY SYSTEM- Schedul- for all Divisions. 9 in component of this system went live in mid- In addition, we have developed an internal advi- November. sory group, System Network Advisory Group MEDITECH TRANSCRIPTION INTER- (SNAG),to disseminate information and provide FACES - The ADT interface from Meditech to feedback to Information System staff. EdiX is online while we continue to work on In 1997-98,CCHS Information Systems accom- the transcription upload to Meditech. plishments this year include: HOMELESS MEDICAL MANAGEMENT CCHP MCIS-An intensive work plan for SYSTEM -A replacement Year 2000 homeless implementing a new Managed Care Informa- system is now in beta-testing. 12 ........... ................................ Section III Customer Service Service De five-q S-pstem Contra Costa Health Services is responsible,for providing a continuum of health services to county residents, ranging from direct andprevention services for individuals to environ- mental and public health services that protect the well being of the entire community. CCHS works cooperatively with federal, state, regional and localprograms and theyprivate sector to assure comprehensive systems of health care and health protection. Hovil located in Richmond(primary,specialty, and Centers ancillary), Martinez(primary,specialty and an- & Health cillary), Bay Point(primary care), Pittsburg(pri- Early in 1998, we moved from Merrithew Me- wary, specialty,and ancillary), Brentwood(pri- morial Hospital to our new state-o, -the-art mary care),Antioch(primary care) and Concord Contra Costa Regional Medical Center (primary care). Specialized geriatric outpatient ("CCRMC). services are provided at the Older Adult Health Centers, located in Antioch (co-located with CCRMC is a general acute care teaching hospi- primary care health center),Concord(co-lo- tal providing a full range of diagnostic and sated with primary care health center) and El mealCerrito.The specialty care(provided at noted therapeutic services including emergency, me clinics) includes dental, rehabilitation, podiatry, cal,surgical, perinatal,pediatric and psychiatric infectious disease, pediatrics, eye, dermatology, services. Ancillary services include Diagnostic a orthopedics, urology, ENT, GYN and Hansen's Imaging,Clinical Laboratory, Pharmacy, Reb Disease.A new site, the Center for Health,will bilitation and Cardiopulmonary Care, We are open in North Richmond in early 1399. 7t will licensed to provide basic Emergency Care Ser- vices. In addition,a 24-hour Psychiatric Einer- combine primary care with special health im- gency Services Unit provides psychiatric evalua- boont programs for the surrounding neigh- borhoods, tion and treatment.The division is also respon- sible for the provision of health care to the adult and juvenile detention population. Mental Health Adult Pragram Services Mental health services A network of ten ambulatory care centers pro- for adults are designed to be responsive to the vide outpatient,specialty, and geriatric care ser- changing needs of individuals through a single vices.The primary and:specialty care centers are point of coordination and;integration. For each 13