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BOARD OF SUPERVISORS

BOARD OF SUPERVISORSMay 21, 2013

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BodyBoard of Supervisors
MeetingRegular Meeting
Date📅 May 21, 2013

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Meeting Summary

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At a glance

Mental Health Month Resolution

  • Supervisor Lavinino sponsored a resolution proclaiming May 2013 as Mental Health Month to combat stigma.
  • James Road, Chair of the Mental Health Commission, accepted the resolution on behalf of clients and families.
  • The board adopted the resolution.

Mormon Helping Hands Resolution

  • Supervisor Lavinino sponsored a resolution recognizing the "Mormon Helping Hands" initiative for volunteer work and food drives.
  • Darren Halstein, Stake President for the Santa Maria Stake, accepted the resolution.
  • The board adopted the resolution.

Tax and Revenue Anticipation Note (TAN) Short-Term Financing Program

  • Treasurer-Tax Collector Henry Hagan presented the annual TAN program to address seasonal cash flow gaps.
  • The proposed issuance is tax-exempt with a 12-month maturity, sized at $40 million with a not-to-exceed amount of $60 million.
  • Anticipated interest is approximately 25-30 basis points, with pricing expected around June 4.
  • The board approved the item.

Benefit Assessments for County Service Areas 3 and 31 and North County Lighting District

  • Public Works staff presented recommendations for benefit assessments for CSA 3 (Goleta Valley) and CSA 31 (Isla Vista).
  • No changes to base assessments are proposed for FY 2013-14 for either CSA, with healthy fund balances noted.
  • A zero assessment is proposed for the North County Lighting District due to a healthy fund balance.
  • The board approved the item.

Anderson Conservation Easement Resolution of Necessity

  • General Services staff requested a Resolution of Necessity to use eminent domain to secure clear title to a 16-acre conservation easement.
  • The easement was acquired to satisfy a settlement with the U.S. Fish and Wildlife Service regarding California tiger salamanders.
  • A pending foreclosure sale risks extinguishing the easement, with a deadline to transfer it to a conservation organization on September 10, 2013.
  • The board approved proceeding with staff's recommendation on the condition that a future hearing be scheduled to present full facts regarding the original incidents.

FY 2013-14 Public Safety Realignment Act Plan (AB 109)

  • Chief Probation Officer Beverly Taylor and Chief Deputy of Jail Operations Laz Salinas presented the operational plan for AB 109.
  • The plan covers Post-Community Supervision and Post-Sentence Supervision offenders, with 80% having substance abuse needs.
  • The county’s success rate for PRCS offenders is 82%, higher than the state average of 65%.
  • The board approved the item.

Alcohol, Drug and Mental Health Services (ADMHS) System of Care Assessment

  • Staff presented findings from board-authorized assessments of the ADMHS outpatient and inpatient systems of care and business practices.
  • Key systemic issues include a lack of coordination among clinical programs, damaged partnerships, and organizational atrophy in clinical leadership.
  • The Assistant Director of Clinical Operations position has been vacant for five years, leaving 80% of the organization without an official representative on the executive team.
  • Staff recommended a fundamental commitment to clinical services, a transitional structure involving partners for a six-month period, and a shift in culture from a crisis-driven, financially focused approach to one prioritizing clinical quality and access.

Full summary

Opening and Administrative Items

  • Approval of Minutes (May 14): A motion was made and seconded to approve the minutes of May 14. The motion passed unanimously.
  • Public Comment: One speaker addressed the board regarding funding for the University of California Cooperative Extension and 4-H programs, citing statistics on youth involvement and juvenile crime rates in Santa Barbara County. The speaker urged the board to maintain funding for the UC Cooperative Extension as an ongoing line item rather than a one-time funding item.
  • Administrative Calendar: Supervisor Wolff requested to pull Item A14 (Responsible Pet Ownership Program) to commend the Director of Animal Services and staff for their work on the program. No formal vote was taken on this specific item at that time. A motion was made and seconded to approve the entire administrative calendar. The motion passed unanimously.
  • Announcements: The Clerk announced that construction at the Better Avia Government Center in Santa Maria is on track to allow the board to return to the Joe Centeno County Government Building by July 9, 2013. Remote video testimony equipment will move back to the Joe Centeno building starting with the June 4 meeting. The board observed a moment of silence for victims of the tornadoes in Oklahoma.

Resolutions

  • Item A1 (Mental Health Month Resolution): Supervisor Lavinino sponsored a resolution proclaiming May 2013 as Mental Health Month to combat stigma associated with mental illness. James Road, Chair of the Mental Health Commission, accepted the resolution on behalf of clients and family members. Supervisor Farr thanked Mr. Road for his service. The resolution was adopted.
  • Item A2 (Mormon Helping Hands Resolution): Supervisor Lavinino sponsored a resolution recognizing the "Mormon Helping Hands" initiative by The Church of Jesus Christ of Latter-day Saints for their volunteer work and food drives benefiting local food banks and shelters. Darren Halstein, Stake President for the Santa Maria Stake, accepted the resolution. The resolution was adopted.

Departmental Agenda

  • Item 1: Tax and Revenue Anticipation Note (TAN) Short-Term Financing Program (FY 2013-14)
  • Discussion: Treasurer-Tax Collector Henry Hagan presented the annual TAN program, a collaboration between the Treasurer, Auditor-Controller, County Counsel, and CEO’s office. The program addresses seasonal cash flow gaps due to property tax revenue timing. The proposed issuance is tax-exempt with a 12-month maturity, sized at $40 million (with a not-to-exceed amount of $60 million). Anticipated interest is approximately 25-30 basis points. Pricing is expected around June 4.
  • Decision: A motion was made and seconded to approve the item. The motion passed unanimously.
  • Item 2: Benefit Assessments for County Service Areas 3 and 31 and North County Lighting District (FY 2013-14)
  • Discussion: Public Works staff presented recommendations for benefit assessments.
  • CSA 3 (Goleta Valley): Created in 1963 for street lighting and park maintenance. The base assessment is $24 per parcel per month. No change is proposed for FY 2013-14. The fund balance is $255,866. Supervisor Wolff noted that funds previously directed to parks were moved back to CSA 3, allowing for deferred maintenance and equipment purchases specific to the district.
  • CSA 31 (Isla Vista): Created in 1963 for street lighting. The base assessment is $12.93 per parcel per month. No change is proposed. The fund balance is $183,000, improved by the return of property taxes from the IVRDA dissolution.
  • North County Lighting District: Created in 1994. A zero assessment is proposed for FY 2013-14 due to a healthy fund balance.
  • Decision: A motion was made and seconded to approve the item. The motion passed unanimously.
  • Item 3: Anderson Conservation Easement Resolution of Necessity
  • Discussion: General Services staff presented a request to adopt a Resolution of Necessity to use eminent domain to obtain clear title to a 16-acre conservation easement on the Anderson property in the La Purisima foothills. The easement was acquired for $240,000 to satisfy a Conditional Settlement Agreement with the U.S. Fish and Wildlife Service regarding alleged "takes" of California tiger salamanders. The landowner failed to clear title due to mortgage liens, and a foreclosure sale is pending, which would extinguish the easement. The deadline to transfer the easement to an approved conservation organization is September 10, 2013.
  • Public Hearing: The Chair called a public hearing.
  • Sonia Duzhnevska (Property Owner) expressed support for retaining the easement but opposed condemnation, arguing it would reduce property value and create negative public perception of government cooperation. She noted her bankruptcy trustee had abandoned the ranch from the estate.
  • Samuel Sweet (UCSB) urged the board to preserve the easement, noting it was approved by Fish and Wildlife as a valid mitigation measure. He expressed concern that condemnation could negatively impact agricultural properties elsewhere.
  • Bill Georgie (Santa Barbara County Cattlemen’s Association) requested a continuance to study the issue. He raised concerns about lack of notification to neighbors, potential impacts on agricultural operations, and the justification for selecting this specific parcel over other offered lands. He questioned the "take" findings and the necessity of eminent domain.
  • Board Discussion: Supervisors discussed the timeline, the risk of foreclosure extinguishing the easement, and the potential consequences of violating the settlement agreement (loss of future take permits). Supervisor Adam requested a full disclosure of the facts leading to the settlement. Supervisor Lavinino questioned the title search process and the finding that no other land was available. Staff explained that the settlement agreement has been extended eight times and that delaying the decision risks missing the September 10 deadline and potentially paying for the easement twice if foreclosure proceeds.
  • Decision: Supervisor Adam moved to proceed with staff's recommendation on the condition that a future hearing be scheduled to provide a full presentation of the facts regarding the original incidents. The motion was seconded. The motion passed unanimously.
  • Item 4: FY 2013-14 Public Safety Realignment Act Plan (AB 109)
  • Discussion: Chief Probation Officer Beverly Taylor and Chief Deputy of Jail Operations Laz Salinas presented the operational plan for AB 109 (Public Safety Realignment).
  • Probation: The plan covers two populations: Post-Community Supervision (PRCS) offenders (released from state prison) and Post-Sentence Supervision (PSS) offenders (sentenced to local jail). As of April 2013, there are 329 PRCS and 143 PSS offenders under supervision. 80% have substance abuse needs. The county’s success rate for PRCS offenders (82% completed supervision without new felony conviction) is higher than the state average (65% success) and CDCR’s reported failure rate.
  • Sheriff: The Sheriff’s Office has received 352 individuals sentenced under AB 109. Straight jail sentences are decreasing in favor of split sentences (jail time plus probation), which Salinas attributed to judges recognizing the benefits of re-entry programs. Electronic monitoring usage has increased significantly.
  • Electronic Monitoring Violations: Sheriff’s Office staff reported that since inception, 81 individuals have been released on electronic monitoring or alternative sentencing under AB 109. Seven individuals (approximately 14%) have violated conditions, with one instance identified as a felony escape due to cutting a bracelet. Staff noted that risk assessments are conducted prior to transfer to determine supervision levels.
  • Population Projections: Staff reported that the average daily population of AB 109 inmates in county jail facilities or on electronic monitoring in 2012 was 145. This represents a 14% increase over the original state projection of 127 inmates. Staff stated they intend to use 145 as the new benchmark for measuring AB 109 impact.
  • Funding: The Community Corrections Planning Team (CCP) plan is funded with approximately $10 million, consisting of the fiscal year 13-14 allocation (just under $9.5 million) and approximately $640,000 in unspent prior-year allocations. Staff noted a reduction in reliance on one-time funding compared to previous years.
  • Future State Funding: The Board inquired about future state funding levels. Staff indicated that allocation formulas for fiscal years 13-14 and 14-15 are established. A committee is currently working on adjusting percentages for years following 14-15, with proposals expected to be submitted to the Department of Finance in late summer or early fall. Staff anticipated that funding for fiscal year 14-15 would be at least $10 million, potentially higher due to growth above baseline allocations.
  • Fund Allocation: The plan allocates approximately 35% to sheriff custody and alternatives, 33% to probation case management, 29.3% to treatment services, and over 3% to local law enforcement collaboration and evaluation.
  • Evaluation and Treatment: Staff described a collaboration with UCSB to evaluate program outcomes, including recidivism and rebooking rates, with a report expected by the end of the summer. The Board requested that future reports include detailed elaboration on treatment services, providers, and costs.
  • Challenges: Staff identified three pressing challenges:
  • 1. Treatment needs for pre- and post-release inmates, requiring enhanced programs and funding. 2. Uncertainty regarding the potential release of approximately 9,000 additional prisoners from state prison following a Ninth Circuit decision, with an estimated 1% (approximately 90 individuals) potentially returning to Santa Barbara County. 3. Adequate jail space, as the facility is operating at or near its court-ordered cap.
  • Sober Living and Detox: The Board inquired about efforts to secure sober living and detox beds given the high need. Staff stated they are increasing sober living bed allocations in North and South County, working with the C3H coalition to increase residential options, and utilizing local detox facilities for male and female offenders.
  • Recidivism Rates: The Board discussed recidivism statistics. Staff clarified that the statewide felony conviction rate for those on probation supervision is 35%, while Santa Barbara County’s rate is 18% (based on a 15-month period).
  • Jail Census: Staff reported that the total jail population hovers slightly over 1,000, with approximately 660 in the main jail and 220 in the medium-security facility. AB 109 inmates constitute a portion of this total.
  • Public Comment: A representative for Families Act spoke in support of increasing budget allocation toward rehabilitation, including residential treatment, detox housing, and employment services. The speaker emphasized the distinction between supervision, incarceration, and true rehabilitation, urging the CCP to collaborate with the behavioral health system to address the needs of individuals with mental health and substance use disorders.
  • Decision: A motion was made and seconded to approve the item. The motion passed unanimously.
  • Item 5: Alcohol, Drug and Mental Health Services (ADMHS) System of Care Assessment
  • Discussion: Staff presented findings from board-authorized assessments of the ADMHS outpatient and inpatient systems of care and business practices. The assessments were conducted by Health Management Associates (HMA) for the inpatient system and TriWest Associates for the outpatient system and business practices. The process involved over 400 independent contacts with stakeholders, including the Latino Advisory Committee, NAMI, and community-based organizations.
  • Systemic Findings:
  • Staff noted that while there are many excellent programs and pockets of excellence, overall organizational functioning has suffered, with performance declining in recent years.
  • Key systemic issues include a lack of coordination among clinical programs (e.g., forensic liaison, competency restoration), damaged partnerships with other county agencies and providers, and organizational atrophy in clinical leadership.
  • Staff highlighted that the Assistant Director of Clinical Operations position has been vacant for five years, leaving 80% of the organization without an official representative on the executive team.
  • Staff recommended a fundamental commitment to clinical services, a transitional structure involving partners (county agencies, homeless services, CBOs, hospitals, foundations) for a six-month period, and a shift in culture from a crisis-driven, financially focused approach to one prioritizing clinical quality and access.
  • Clinical Operations Findings:
  • Staff identified transitions between programs (e.g., inpatient to outpatient, hospital to outpatient) as a major area of concern due to a lack of standardized policies.
  • Staff reported that 222 Medi-Cal beneficiaries (5% of those served) drive $10 million in annual costs, representing 35% of Medi-Cal spending. This is higher than the 25% average in other California counties.
  • Access to care has decreased over time. Medi-Cal penetration has dropped by 22% in the last five years.
  • Average wait times for psychiatry services are 66 days for adults and 73 days for children. The standard of seeing a provider within 10 days is met only about 40% of the time.
  • Staff noted a lack of clinical policies to prioritize urgent cases, such as those coming from AB 109, hospitals, or jails.
  • Staff identified barriers to integrating drug and alcohol programs with mental health services, including a lack of managerial coordination and a part-time medical director.
  • Staff noted that despite hiring 15% more bilingual staff, there are still insufficient bicultural delivery capabilities and disincentives for providing interpretation services.
  • Financial Findings:
  • Staff stated that the county has established sound financial processes and budgeting.
  • Staff noted that the county relies heavily on Medi-Cal revenue, which is a complex funding stream requiring dedicated resources for compliance.
  • Staff indicated that the Affordable Care Act may increase revenue but also requires the department to develop competencies for private insurance and estimate pent-up demand.
  • Board Inquiries:
  • The Board inquired about wait times compared to other counties. Staff stated that comparative data exists but was not included in the report and could be provided.
  • The Board inquired about the integration of drug and alcohol and mental health services. Staff confirmed that integration is lacking and requires managerial attention and cultural change.
  • The Board inquired about the financial soundness of ADMHS. Staff affirmed that financial processes are sound but emphasized the need to manage the risk associated with Medi-Cal reliance.
  • Financial Management, Budgeting, and Administrative Recommendations:
  • The consultant presented findings regarding the department’s financial processes, noting that the current financial mechanism is rigorous and sound, with checks and balances in place. However, it was noted that the finance department lacks sufficient input from clinical managers, particularly regarding the Affordable Care Act (ACA) and the AB 109 program. The consultant recommended that clinical managers be empowered to provide input on budgeting and planning to ensure clinical needs are integrated with financial strategies.
  • Specific financial recommendations included:
  • Reserves: Reestablishing reserves, with a suggested range of 5% to 10% of the federal participation portion of Medi-Cal, to prepare for potential findings and irregularities.
  • Productivity Metrics: Reducing the emphasis on the "clinic model" productivity report as the sole metric for performance evaluation. The consultant advised increasing focus on other metrics, such as timeliness of care (e.g., seeing patients within 10 days) and the number of people served, rather than just direct units.
  • Budgeting Process: Shifting the budgeting process to be more forward-looking, incorporating new opportunities and changes in the county and state, rather than focusing solely on maintaining current operations.
  • Supervisor Farr inquired about the proposed reduction of 16 FTEs in the upcoming budget and how it aligns with the consultant’s findings. Dr. Wada explained that the budget was prepared before the consultant’s findings were available, resulting in a "status quo" budget. The 16 FTE reduction is primarily due to the Juvenile Justice Mental Health Services Program through probation and other efficiencies. The department stated that it is not requesting additional funding beyond what is in the proposed budget and aims to implement recommendations within existing resources.
  • The consultant outlined administrative recommendations to address clinical leadership gaps:
  • Clinical Leadership: Filling the vacant top clinical manager position with a clinician who has 5–10 years of senior management experience and expertise in both mental health and substance abuse.
  • Span of Control: Addressing the high number of direct reports for clinic supervisors (12–25), which is considered too high for effective management.
  • Utilization Management: Improving the utilization management program, which is currently understaffed and relies on manual case reviews rather than data-driven outlier analysis.
  • Medical Director: Creating a full-time Medical Director position (90% FTE) to focus on clinical policy, distinct from administrative duties.
  • Assistant Medical Directors: Designating existing physicians as Assistant Medical Directors for specific populations (children, geriatric, addictions) to oversee clinical policy development for those areas, without adding new positions.
  • Organizational Structure: Repurposing the Assistant Director of Mental Health role to an Assistant Director for Clinical Operations, overseeing both mental health and substance use services.
  • Supervisor Farr asked for clarification on the qualifications for these roles. The consultant confirmed that the top clinical manager must be a clinician with management experience, while Assistant Medical Directors would be physicians responsible for policy, supported by non-physician managers for implementation. Supervisor Carbajal noted that while avoiding new positions is preferred, necessary positions should be added if required to fix the department.
  • Compliance and Contract Oversight:
  • The consultant discussed compliance challenges exacerbated by the Affordable Care Act, noting increased risks for federal and state fund repayment. Key findings and recommendations included:
  • Independence: The current compliance officer has operational responsibilities, creating a conflict of interest. The consultant recommended a full-time, independent compliance officer with no operational duties.
  • Risk Assessment: Current risk assessments are limited in scope and not routinely repeated. The consultant recommended a more comprehensive, integrated risk assessment process involving multiple staff members, prioritizing risks such as HIPAA disclosures versus treatment plan updates.
  • Auditing: Claims billing audits are currently confounded with other reviews. The consultant recommended separating claims billing audits to improve efficiency.
  • Training: Current training materials focus too much on prohibitions rather than guidance on compliance. The consultant recommended developing clear policies and guidance for clinicians, ensuring training is not penalized in performance metrics, and providing explicit organizational endorsement of training.
  • Contractor Engagement: While contract rigor has improved, the relationship with Community-Based Organizations (CBOs) is described as atrophied. The consultant recommended more collaborative planning and engagement with contractors to optimize services and innovation, rather than relying solely on strict contractual enforcement.
  • Inpatient Psychiatric Facility (PUF) and HMA Peer Review:
  • The department presented findings from a peer review conducted by HMA (Hospital Management Associates) regarding the inpatient Psychiatric Unit (PUF). The review covered inpatient capacity, utilization, operations, access, intake, discharge, compliance, and service gaps.
  • Key points included:
  • Cost and Model: The "SuperPUF" model has salaries and benefits 33–45% higher than comparable services. The freestanding PUF model is limited by licensure to 16 beds and cannot provide medical detox or care for complex medical comorbidities (e.g., diabetes, COPD), limiting its ability to address the whole person.
  • Operational Issues: Findings included delays in care, lack of collaboration with community hospitals (Cottage and Marion), and the use of a homegrown acuity tool lacking research backing.
  • Correctional System: The report highlighted concerning conditions for individuals with 5150 holds at the county jail, including solitary confinement. The department noted that the Sheriff’s Department and Corizon (jail mental health provider) are working to address these issues, including potential enhancements to the Corizon contract for 5150 evaluations and incompetency to stand trial hearings. Supervisor Wolf suggested the Board look at the current Corizon contract to address these concerns immediately rather than waiting for a new contract.
  • Recommendation: The consultant recommended against making an immediate decision to retain or replace the PUF. Instead, they proposed a Request for Information (RFI) to gather data on alternative inpatient care options, including potential partnerships with hospitals or private providers. This would allow for a comprehensive cost-benefit analysis. The consultant noted that if an inpatient hospital option is viable and can address whole-person care, it may be preferable to the current PUF model.
  • Supervisor Wolf asked if the HMA report’s findings on jail conditions were addressed with Corizon. The department confirmed that the Sheriff’s Department reviewed the recommendations and that enhancements to the Corizon contract are being considered.
  • Implementation Plan and Organizational Structure:
  • Dr. Wada presented the proposed next steps for implementing the consultant’s recommendations. The plan includes:
  • Shared Leadership: Retaining the current shared leadership structure (Dr. Wada overseeing both Public Health and ADMHS) for at least six months. This is not a recommendation for merger; the departments will remain separate.
  • Chief Operating Officer (COO) of Systems Change: Creating a new, temporary position (6 months to 1 year) funded through salary savings. This role would focus on driving the implementation of the consultant’s recommendations, facilitating change, and coordinating efforts.
  • Advisory and Work Groups: Repurposing the CEO Advisory Committee for ongoing high-level guidance and accountability. The TIGER team (county staff) would be folded into focus area leads. Design teams or action teams, composed of frontline staff, managers, psychiatrists, and CBO representatives, would be established to drive specific actions.
  • Consultant Retention: Retaining TriWest and Zia Partners for a $100,000 contract to provide technical assistance and coaching during the transitional period.
  • RFI for PUF: Developing an RFI for inpatient psychiatric services in consultation with the CEO Advisory Committee.
  • The proposed organizational structure changes include:
  • Compliance: Establishing a standalone compliance program reporting directly to the Director, funded through salary savings.
  • Administrative Deputy: Reorganizing the Administrative Deputy position. Functions currently under this role would be distributed to other areas (e.g., IT/billing to CFO, Compliance to Director, Utilization Management/Quality Assurance to Medical Director).
  • Clinical Operations Deputy: Creating a new Clinical Operations Deputy position, funded by the reorganization of the Administrative Deputy role. This position would oversee clinical and program services, including MHSA and Alcohol and Drug programs.
  • Supervisor Farr asked for clarification on whether this is an implementation or transition plan and expressed concern about the implications of Dr. Wada’s dual role for Public Health. The department clarified that this is an implementation phase, but the department remains in transition. The shared leadership structure is proposed for six months, after which the Board would assess progress and decide on the future leadership structure (e.g., separate director, deputy, or continued shared leadership).
  • Supervisor Wolf questioned why the COO position is temporary rather than a permanent ADMHS Director position. The department explained that the COO role is specifically designed to drive the immediate implementation of the consultant’s recommendations, which requires a specific set of skills. The permanent leadership structure (Director or Deputy) should be determined after the initial changes are implemented, as the job requirements may change. Additionally, recruiting for a permanent director would take approximately six months, delaying the start of implementation.
  • Supervisor Wolf asked about the cost of the RFI. The department stated that the RFI would be developed in-house by staff with assistance from the CEO Advisory Committee and consultation with TriWest, with no direct cost to the county for the RFI development itself.
  • Consultant Report and Recommendations (Continuation):
  • Staff presented the final slides of the TriWest/Zia Partners consultant report, detailing the proposed implementation structure. Key points included:
  • Consultant Retention: A proposal to retain TriWest and Zia Partners as consultants during the implementation phase.
  • Organizational Structure: A proposal to reinstate a full-time medical director position, which is incorporated into the proposed 2013-2014 budget. The presentation outlined a span of supervision for the director and a restructured contracts function reporting to the CFO with a tie-in to clinical operations.
  • Implementation Process: The presentation described an "upside-down" organizational structure where action/design teams (focused on areas like ACA compliance, crisis systems, and clinical operations) drive the effort, reporting to a Systems Change lead (COO) and ultimately to the CEO Advisory Committee.
  • Continuum of Care: An example workflow was shown illustrating the continuum of care from prevention/primary care to acute crisis (PUF/IMD), highlighting current gaps in smooth transitions between levels of care.
  • Summary of Recommendations: Staff listed five specific recommendations for Board action:
  • 1. Receive the report regarding the analysis of outpatient and inpatient systems of care. 2. Direct staff to implement formal structure and processes for systems change as determined by the Board. 3. Direct staff to return on June 4th with a contract for TriWest/Zia Partners support in the amount of $100,000, beginning July 1st. 4. Direct staff to prepare requests for information (RFI) to request further data on the provision of psychiatric inpatient care. 5. Determine that these activities are exempt from CEQA.
  • Public Comment: Twenty speakers addressed the Board. Comments generally focused on the following themes:
  • Support for the Report: Several speakers, including representatives from the Mental Health Commission, NAMI, CALM, and the Legal Aid Foundation, expressed support for the consultant report, citing it as a necessary step to address long-standing issues and improve the system.
  • Leadership and Management: Multiple speakers emphasized the need for strong, accountable leadership and a permanent director for ADMHS, expressing concern that relying on consultants without internal management capacity was insufficient. Some urged the Board to prioritize hiring a director over or alongside the consultant engagement.
  • Inpatient Care and Beds: Several speakers, including representatives from Cottage Health, NAMI, and individual consumers/families, highlighted the critical shortage of residential treatment beds and inpatient capacity. They warned against the trend of using jails for mental health crises and urged the Board to invest in community-based residential treatment and ensure inpatient care is available locally.
  • Stakeholder Involvement: Speakers from consumer/family advocacy groups (NAMI, Mental Health Commission) and CBOs stressed the importance of including consumers, families, and community-based organizations in the implementation teams (TIGER team) and decision-making processes.
  • Cultural and Linguistic Competence: A speaker representing the Latino Advisory Committee highlighted the need for culturally and linguistically appropriate services, the importance of translators, and the need to legitimize the department’s diversity plan.
  • Transparency and Accountability: Several speakers called for greater transparency, accountability measures, and a formal mechanism for public feedback/complaints regarding service quality.
  • Consultant Costs: One speaker representing a labor union questioned the cost-effectiveness of hiring consultants, suggesting that internal staff could perform similar functions, and expressed concern about the volume of consulting contracts.
  • Other Comments: One speaker discussed the Social Security Act and alleged illegal seizures of property from disabled individuals, though this was not directly related to the ADMHS report. Another speaker expressed support for the report but requested that the Board consider the impact on the Latino community and ensure their voice is included.
  • Board Deliberation:
  • Chair Carbajal expressed support for the report and the recommendations. Stated openness to moving forward with the report’s recommendations but emphasized the need to consider the option of recruiting a permanent director sooner rather than later. Noted that the Board should have the option to move forward with director recruitment when the item returns in six months.
  • Supervisor Farley requested that staff return on June 4th with a complete organizational chart (existing and proposed), including details on the 16 FTEs in the proposed budget, budget shifts, and any unbudgeted costs. Emphasized the need for continued input from clients, CBOs, and frontline staff. Called for an overall assessment and mapping of the county’s continuum of care, including partnerships with CBOs and identification of gaps (e.g., detox beds, supportive housing). Expressed support for the Marion Hospital partnership to address bed shortages.
  • Supervisor Lavagnino agreed with Supervisor Farley’s points. Praised the consultant report for providing concrete "marching orders." Supported the need for a public feedback portal. Highlighted the progress being made with Marion Hospital to increase bed capacity.
  • Supervisor Wolf asked for clarification on the consultant entity (TriWest vs. Zia Partners), which staff confirmed as a joint effort. Expressed support for the report and the $100,000 consultant contract. Raised concerns about Recommendation D (the RFI for psychiatric inpatient care), stating she was not ready to move forward with the RFI without better understanding of the current PUF (Psychiatric Unit Facility) and input from the new medical director. Suggested directing staff to request further data on inpatient care provision first, with the RFI as a potential later option.
  • Staff explained that the RFI is a structured way to gather information on options for inpatient care, allowing the Board to make an informed decision on whether to continue with the PUF model or explore other options. They noted that the PUF is a freestanding psych facility and that the RFI would allow for a systematic evaluation of alternatives.
  • Staff Recommendations and Next Steps:
  • Members discussed the timing and scope of upcoming actions regarding Request for Information (RFI) processes and potential presentations by Dr. Long. Supervisor Farley proposed conducting the RFI and the presentation simultaneously to ensure progress without committing to a specific vendor. Unidentified Speaker 5 raised concerns about the staff time required for such actions. Alicia Hood, representing staff, recommended proceeding with both actions concurrently, noting that the additional staff time required was relatively minor and that providing comprehensive information from consultants and staff would aid in decision-making. Hood suggested that the report be delivered by Dr. Wada, with the medical director included in the discussion to provide context on the current status of PUFF.
  • Supervisor Adam expressed reservations about the organizational strategy but emphasized the need for a permanent management strategy with clear expectations and accountability mechanisms to evaluate success.
  • Decision: Supervisor Farr moved to adopt staff’s recommended actions A through E, incorporating a request to return on the 4th with information regarding the organizational chart, as well as Supervisor Wolf’s additional request. The motion was seconded. The motion passed unanimously.