UnGovr Transcript
iHow this transcript is madeUnGovr transcribes the official recording with automated speech-to-text, separates speakers by voice, and matches voices to the seated roster. Names and attributions are AI estimates and may contain errors.Verify any quote yourself: click anywhere in the transcript and the official video jumps to that exact moment, so you can check any quote against the recording.0:01 – 0:048 turns
Good morning, everybody. I'd like to welcome everybody to the April 22nd meeting of the Santa Barbara County Board of Supervisors. Mr. Allen can you get a roll call please?
Ms. Wolfe? Here. Ms. Farber? Here. Mr Adam? Here Mr. Calderon? Here Mr. Lavinino?
Indivisible with liberty and justice for all. All right,
hope everybody had a great Easter weekend and see if I can get an approval in the minutes for April 15th 2014. Moved and seconded. All those in favor? Aye. Any opposed? Passes unanimously. Takes us to our public comment period. Mr. Allen, do we have any speakers?
No request to speak.
No requests to speak from the public. Okay very good. We'll move on to our administrative agenda Do we have any, well you know what? Yeah. Do we have any people who would like to speak from the public on the administrative agenda?
Chairman Labnino and members of the board, we've no request to speak from the public. I have just two quick announcements. First all on item A5 from Alcohol Drug and Mental Health Services. This is regarding the agreement with Traditions Behavioral Health and I'd like to note that the department has requested that that item be withdrawn and not continued at this time. And they'll come back at an appropriate date that they'll set later on.
And second, on item A14 from Public Works. This is regarding easements for public utility purposes in the Goleta area in the 2nd district and Public Works has asked that this item be continued to your meeting on May 6th. And those are my changes.
Okay very good Mr. Allen. So before we go to the board why don't we take our resolutions first? So can I get a motion to approve items A1 through A3 please? Moved and seconded, all those in favor? Aye. None opposed, passes unanimously. Okay we'll take A1 I guess I'm resolution guy today so can I have Sandra Talamantes please come forward? Sandra is going to be recognized today for her very brief period here with the county of 34 years.
Wow, unbelievable and you're going to hear in the resolution that she's worked in some of the areas that she's been involved Exactly what we do here at the county and that's trying to help provide a safety net for those that have a hard time providing for themselves. And Sandra, we really appreciate all the time you've spent working in the community and We just hope that the next phase of your life is just as exciting as the last 34 years, hopefully more so. Mr. Allen can you please read the resolution?
0:04 – 0:073 turns
Chairman Lavinino, members of the board. This is item A1 it's a resolution recognizing Sandra Telemontes upon her 34 years of public service whereas Sandra has dedicated almost 34 years of her career to the residents of Santa Barbara County over 13 years with the Department of Social Services and 20 and a half years with the Public Health Department And whereas Sandra provided social service support to clients and programs that included aid to families with dependent children, Medi-Cal gain employment related services. In home support services program for the elderly, adult protective services, multi purpose senior service programs and maternal child adolescent in health program. And where as Sandra's provided quality care and commitment to client throughout her life span from high risk newborns to fragile elderly populations.
And whereas, Sandra has demonstrated the true quality of public health service and has consistently made a difference in the lives of her clients through preventative education and access to needed services. And whereas, Sandra has empowered and encouraged her clients towards self-sufficiency through patience and respect for all of her clients. And whereas, Sandra has demonstrated expertise, kindness and humility throughout her career.
And whereas, Sandra has acknowledged that she has learned valuable life lessons from her clients and continues to share those lessons with others on a daily basis. Now therefore it is hereby ordered and resolved that this Board of Supervisors of Santa Barbara County do hereby acknowledge Sandra Talamantes for her lifetime commitment to quality care to the citizens of Santa Barbara County pass and adopt it today.
Sandra, no you don't get to just walk away. You are required to say something actually.
All right. I've got it written down here. Good. Esteemed supervisors, I'd like to thank you for your acknowledgement of my 34 years of service to the residents of Santa Barbara County. 35 years ago when my husband and I relocated from Texas to California I had no idea that we would be staying here for this long, and I plan to stay here. Santa Barbara County is a great place to live, to raise a family, and to work.
I've enjoyed providing social service work for the people of our area. Throughout the years, I've had the support of supervisors and co-workers. And what I've learned from my years as a county employee is that it takes a team to accomplish the mission that each department develops. When everyone works together, the work always gets done well. Thank you once again and I'm honored and I wish all of you success in the future of our community.
0:07 – 0:126 turns
All right, A2 is a resolution proclaiming May 2014 as Military Appreciation Month in Santa Barbara County. I'd like to bring up Frank Campo the local veterans employment representative for the state of California with the Employment Development Department Workforce Services Branch. Frank you know I just want to publicly thank you for all the work that you've done for our veterans.
There's a lot of, big part of stand down for us and we try to provide a lot of services for our veterans. But without a job that's like the first thing that we need to take care of. So Frank's a great resource for us and a lot of our veterans that are out there looking for work. And while we're talking about appreciation for our veterans for everything they've done.
One of the things that we're really trying to concentrate is alerting our employers that veterans make outstanding employees. So I know you're going to have a few words to say about that, Mike if you could read the resolution please?
Chairman Labnino, members of the board. This is a resolution proclaiming May 2014 as Military Appreciation Month in Santa Barbara County. We're asked that people of our community have great appreciation and admiration for the many local men and women who served their country in the armed forces to protect and preserve the freedoms enjoyed by our community and by all Americans.
And whereas in war, international conflicts and peacekeeping missions men and women have been wounded, taken as prisoners and died in the line of duty. And whereas veterans possess a wide variety of valuable skill qualifications including experience, maturity, leadership and loyalty that make them ideal candidates for employment. And whereas, local veterans employment representatives, disabled veteran outreach program representatives and other employment development department staff are committed to ensuring that veterans receive the services and programs to which they are entitled. And promoting employer interest in hiring veterans.
Now therefore it be resolved and ordered that this board of supervisors in the county of Santa Barbara proclaims May 2014 as Military Appreciation Month in Santa Barbara County. And urges all local employers, organized labor, veterans organizations and other government leaders to support this worthy campaign to increase employment opportunities for the men and women who have faithfully served our nation in the military past and adopted today.
Thank you Chairman Lavinino. He whispered in my ear that veterans make good employees and Supervisor Carbajal said they also make good supervisors, so he
did
a good job for being a Marine. So I just want to thank him also for his service to our country and to our nation. Thank you to the board for this resolution. Not only do I work for EDD as a local veterans employment rep, I cover both Santa Barbara and St. Louis counties but I also serve on the Santa Barbara County Veterans Services Advisory Council representing Supervisor Adam from the 4th District and I'm also the chairman of the committee so we're also trying to do a lot more good stuff with our veterans. I just want to update the board since my last appearance here last year August of this past last year we hired another veterans rep to assist me. From January 2013 to August I was the only person covering both counties so I did get some additional reinforcements to kind of help me out.
He, Neoni Sonora is the Disabled Veterans Outreach Program Specialist he's working one-on-one with veterans that have barriers to employment and I'm working with employers trying to get those employers to hire those veterans So we've been very busy the last six months. There's been three job fairs in September and October, Santa Maria, Santa Barbara and Lompoc and then we just had one in Santa Barbara about a month ago when Supervisor Wolf was there to speak. We have one coming up next Friday May 1st in Lompoc and then On May 20th, we have a older worker job fair here in Santa Maria and then in June we're having another job fair in Santa Maria. So the economy is starting to rebound back and what we're seeing folks go back to work I believe the unemployment rate for Santa Barbara County is about 6.2% which is a little bit lower than what it's been the last four or five years of course the North County carries the burden of mostly unemployment rate but we're doing pretty good But as Supervisor Lavaniello said, I just want to encourage employers to hire veterans.
Most veterans or all veterans, most of them were 18-19 year old kids out of high school and didn't know what to do. They went to boot camp and they went through the training 90 to 120 days they learned a trade, a vocation. A lot of these men and women were in charge of multimillion dollar pieces equipment when they were 20 years old so they bring a good work ethic to the workforce They're a lot more mature than their civilian counterparts, so I encourage employers out there to just hire veterans. And again, I just want to thank you. I know we're a couple weeks early on the resolution but thank you.
All right. Thank you very much Frank Okay, our next resolution is A3. It will be if I could have Jim Talbot, the Executive Director of Smooth come forward. We will be adopting a resolution of commendation recognizing Smooth upon its 40 years of community service in Santa Barbara County and for those that don't know about Smooth what a great resource. Picks up the elderly, the disabled, takes them to their appointments.
I saw in the resolution 678,000 trips since the inception of SMOOTH. And for somebody that has an 84 year old mother-in-law living with them, I can tell you that there are a lot of medical trips associated with the elderly so what a great service and Mr. Allen could you please read the resolution?
0:12 – 0:183 turns
Chair Labnino, members of the board. This is a resolution recognizing SMOOTH for 40 years of community service. Whereas the first meeting of the Community Services of Santa Maria Valley Senior Citizens Transportation Committee was held on May 15th, 1974 and was attended by leaders from 15 community groups. And whereas, the name Santa Maria Organization of Transportation Helpers or SMOOTH was suggested by Judge John Goodmans and was approved by the group in August 22nd of 1974. And whereas, SMOOTH's first contract with the County of Santa Barbara was in 1977 to provide transportation services for elderly residents in unincorporated areas surrounding the city of Santa Maria.
And whereas, Smooth also operated contracts for the county in 1979 and 80 assisting consumers of the CETA employment program and providing on-the-job transportation for recipients of AFDC support. And whereas, Smooth entered into a contract in 1984 with the county to provide curb-to-curb transportation for residents of Santa Maria and the North County region to medical appointments in the Santa Barbara area.
And whereas that contract is now in its 30th year and it's administered by the County Public Health Department, and it continues to provide access to medical care not available in North County. In 2012 and 2013, the medical shuttle van provided over 1,800 passenger trips covering over 29,000 miles, in many cases to life-sustaining appointments. And whereas, Smooth was designated by the county in 1999 as the Consolidated Transportation Service Agency for the Santa Maria Valley and has subsequently provided over 678,000 passenger trips to seniors, the disabled and recipients of social services in the county.
Now therefore be it hereby ordered and resolved that the Board of Supervisors of the County of Santa Barbara commends and congratulates the Santa Maria Organization of Transportation Helpers or SMOOTH on its 40 years of community service in Santa Barbara County, and encourages all residents to join us in celebrating SMOOTH's positive contributions to our community. Passed and adopted today.
Chair Lavinino and Supervisors, thank you very much for this opportunity. I'm joined today by our Board Vice President Jeremy Moreno. I also have several of our board members and I took a quick scale of our board members present and we have over 45 years of volunteer service represented by Our six directors here today, very proud of that. Thank you very much for this proclamation.
I wanted to give a brief, very brief update to you on your investment in SMOOTH as your consolidated transportation service agency It's difficult to single out a single service to highlight with 40 years of service. But I'd like you to know that the trust that you put in SMOOTH by awarding it TDA and Measure A funding on an annual basis, we receive about $285,000 in TDA allocations on an annual basis. And I'd like you to know that the result of that $285,000, we leveraged that money with fee-for-service contracts, private foundation grants and community donations, and create over $1.1 million in transportation services for our region's seniors, disabled and social service programs. $285,000 in TDA Measure A.
1.1 million dollars in service I think you're getting a good bang for your buck and a good investment in smooth But we do thank you very much for this proclamation from our board of directors our staff management We thank you very much for this proclamation And your trust over 40 years, and we're looking forward to 40 more years of driving for this county Thank you very much All
right All right, our next item is could I please get Herman Parker to come to the podium please. Herman is the director of our community services department and Herman we are not going to grill you. Today's a sad day for us, as we always hate to lose an employee. Herman was hired in as our director of our community services department. He came in under very trying times. We had just consolidated the department.
I think we dropped a heavy load on him as far as dealing with some audit issues that we were dealing with at the time. Herman's represented the county very well, and Herman, we really wanted to recognize you today. We know you're leaving on to greener pastures but just wanted the board have an opportunity to thank you publicly. And I think we also have a little basket here for you, everything Santa Barbara so.
So I'll open it up to my board members. Herman, I just want to say for everything you've done for us, I think you've represented the county very well and we really appreciate the service that you've given our county. We just wish you and your family all the best moving forward. We'll just go down the line here, Supervisor Farr.
0:18 – 0:2216 turns
Thank you Mr. Chair. Herman I've already said goodbye to you but I just want to say publicly in front of everybody how much I've appreciated working with you. How I've always found you to be so caring and responsive. And certainly with the issues in my district, with the parks. Always a lot to talk about with Kachuma and Halama and the parks in Isla Vista. Of course also the whole side to do with housing and the community development block grants.
And so we're going to miss you. I certainly wish you well. It's definitely San Diego's gain and our loss, so best of luck.
Supervisor Carbajal.
Thank you, Mr Chair. Herman I know you came to our county when we were going through some serious challenges financially. We consolidated a number of departments and I think you did an extraordinary job in dealing with With that transition and that change for us. And it was a trying time, and I think you've persevered and provided extraordinary service to the residents of our county. Thank you very much for your service and good luck in your new horizons.
Supervisor Wolk?
Thank you Mr Chair and Herman yes we've been through a lot these past few years and I think through your leadership And the respect that you have gained from the community and the folks who work for you. We've seen some tremendous positive changes, and you've been there on the front lines. And I really do appreciate your service to the community. And just want to say that you are a great embodiment of a public servant, always responding in a very respectful way and listening to people And I will miss you and you are leaving your department in good hands, and we appreciate that. And best of luck to you and your family.
Well, I just want to echo everything that's been said already and remind you that you were one of the first department heads that I didn't know that called me up and told me that you had some problems and that you needed me to solve and put me to work. So I thank you for that and I thank you for all the good interactions that we've had in the last year or so, a year-and-a-half, and I wish you the best of luck
Mr. Chair, may
I?
This is a wow. First of all, I'd just like to thank the board so much for your kind words. It's truly been an honor to serve this community in the county of Santa Barbara. I've truly enjoyed it, learned a lot, grown. So I want to thank the board. I want to thank the CEO's office, Renee Ball, my staff at the Community Services Department, just a wonderful group of folks and I'm just so appreciative of the opportunity to be able to serve here.
And it's not cool for big guys like me to get emotional, so I'm going to stop now.
All right. So there was a late request from the Public to speak on A5, but A5 has been withdrawn so I'm hoping that individual if you still feel the need to speak on it.
They're going to speak on D3 now?
They're going to speak on D3 instead. Okay, perfect. All right, are there any items that my colleagues would like to pull?
821 Mr
Chair. 821. Supervisor Wolk?
A9 and A10.
Salute, Supervisor Cobb-Hollis 21. And so let's just take them in order then. Mr.
0:22 – 0:278 turns
Allen? Chairman Lavignino, members of the board, items A9 and A10. A9 is from planning and development. And it's to consider recommendations regarding the Pacific Coast Energy Company SEAP can number 94. This is an emergency permit. And then A10 is probation. And their recommendations are regarding an application to pursue 12th year allocation funding under the Juvenile Justice Crime Prevention Act.
Supervisor
Wolf. Thank you Mr. Chair I have a question of staff regarding this item, you know this is another emergency permit for a seepage can on a petroleum field and my question is the status in that In this report, we're basically stating that this is not a project pursuant to CEQA guidelines. Although we continue to have these seep cans and I know that there is another project coming before the county for another oil field project. And that perhaps these seep cans will be incorporated into that project But I just wanted to confirm that, because it just feels like we should have an environmental review on the cumulative impacts of these seep cans.
And we're not getting that. And I see Mr. Drude there. Thank you for being available to answer.
Yes, Mr. Chair, Supervisor Wolfe, we indeed are going to be processing the seep cans in an environmental review which we are about to embark upon. We're currently reviewing proposals to prepare that EIR for the Pacific Coast Energy Company's oil drilling and production plan. And a major portion of the focus of the EIR is going to be looking at past occurrences of seeps and what we can do to limit them.
For the future, and so as we embark upon that, that's going to be a main focus of that EIR. And that will be begun in probably a month and then we'll have public comments and hear people's views on this process as we move along through it and be bringing it back before decision maker for consideration with that discretionary permit in the near future.
Okay, that's very good. Thank you for that Mr. Drew. I appreciate it.
Perfect, well let's go to 810?
So I sit on the Juvenile Justice Coordinating Council, and I have since I've been a member of the Board of Supervisors. And I just want to commend all of the folks who sit on this council from the public defender that district attorney probation department ADMHS, it's an incredible group of folks. And I think that this report that we have in front of us is very reflective of the positive results that we have been seeing from county probation and all of the partners In that there is definitely a decrease in juvenile hall admissions.
We're seeing a decrease in number of violent offenses, daily population is being reduced but I also think it's important To highlight and to bring to folks attention that there still are issues that need to be addressed. One is the amount of drug use among our youth, the number of female offenders has not gone down in the same proportion as our male offenders.
And finally, and I've talked about this before the serious mental health issues that some of our juveniles are experiencing. So those three issues are being addressed in this report and again I just want to thank all of the folks who are involved in working with our kids. And we are seeing positive results, but again we're seeing some additional challenges. So I just wanted to bring that up to the board's attention that we're moving in a positive direction but we still have some issues that we need to work on. Thank you Mr. Chair.
Very good thank you Supervisor Wolf. Supervisor Carbajal? Mr. Allen did you read all of them or do we need to read 820?
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Chairman, members of the board. Item 820 is from Supervisor Lavagnino. It's regarding the approval of a contract with the Santa Maria Fair Park for the 2014 veteran stand down and then item 821 was pulled by Supervisor Carvajal from planning and development. It requests that the board set a hearing for May 6th to consider the appeal of the decision on the Historic Landmarks Advisory Commission to move changes to county landmark number 34. That's the Juarez-Hosmore Adobe in the first district.
Very good. On 820, I just wanted to pull it and publicly thank the Santa Maria Fair Park for once again hosting this year's stand down. The location, the way that the grounds are set up is just perfect for that event and without The Fair Park and especially the CEO, Dennis Pearson. Joe Bringle and Yvonne Beely being a big part of the stand down team in providing the location at a much reduced cost.
I'm not sure stand down would really happen it definitely would not be as effective as it is so I just wanted to publicly thank those individuals and the fair park. I know Dennis Pearson is on his way out he's retiring. And so here's the message out to the new CEO whoever you might be or prospective CEO. I would really appreciate it if you follow Dennis Pearson's lead. And so, and I also want to thank my board members for allowing us to move forward again this year. So that's all for 820, 821 is Supervisor Carbajal
Thank you, Mr. Chair. This is an appeal that's coming to the board dealing with the Juarez-Hosmer Adobe and I've asked council to examine if we could provide a facilitation opportunity between the parties here as we have done on other land use issues in the past. And I'd like to hear from Mr. Gazzone if that is feasible, oftentimes we can narrow the issues or resolve the appeals and I'm just wondering if that's something we could do?
Chair Leno and Supervisor Kerr-Paul. Yes, we have reached out to the landowner and the appellant. This appeal involves a mix of procedural and substantive issues. And we're going to see if we could sit down with them perhaps over a cup of coffee and maybe narrow a couple issues before this comes back to the board. And we reached out to the parties yesterday by voicemails and are probably going to be in contact with them today to move this along quickly.
0:29 – 0:367 turns
Great, thank you
very much. Okay, very good. Can I get a motion to approve the balance of the administrative agenda please? Moved and seconded. All those in favor? Aye. None opposed. Passes unanimously. Since we're on, it's just short time let's go ahead and move right into item number one. Mr. Allen.
Chairman Lavnino, members of the board. Item one is from the county executive office. It's a hearing to consider recommendations regarding the transient occupancy tax increase ballot measure for the November 2014 general election ballot.
Okay, very good. Mr. Buzanich? Good morning. Good morning members
of the board. Good morning chair. Before you today is a consideration of one of two options that you requested to be brought back for your consideration on increasing the transient occupancy tax putting a measure before the voters to increase the transient occupancies tax. Just to review a couple of the basics, that the transient occupancy tax, the TOT is a paid percentage of accommodation. Typically we think of it as a hotel room but may include other vacation rentals that is charged and paid for the privilege of occupying that said space.
Currently the county of Santa Barbara's transient occupancy tax rate is 10% of that charge. The city of Santa Barbara, Carpinteria, Goleta, Solvang and Buelton currently have a 12% TOT rate. And if your board were to choose to put an increase on the ballot for this November, the vote would be a county-wide vote but the measure would only apply to those properties in the unincorporated areas.
The proposed ordinance before you would increase the tax to either 12% or 12.5%, depending on if you select option one, 12%, or option two at 12.5%. The tax collection and administration of the tax would continue to be the same. It would be collected by the treasurer-tax collector and deposited by the auditor controller. It would continue to be a general tax for general government purposes, and it would be available to the board for annual appropriations.
The measure language in the resolution that is included in your option one and option two, is as follows. It says shall an ordinance to amend section 32-12 of the Santa Barbara County Code to increase the transient occupancy tax rate from 10% to 12%. Or again if you choose option 2, 12.5%, Upon transience, occupying defined hotels located only within the unincorporated areas of the county be adopted.
The revenue estimates in, I want to personally thank auditor controllers department for helping us to refine these numbers. But as you'll notice here with the proposed ordinance and resolution before you today we would look at a partial year collection during the 14-15 fiscal year. And we will look at a full collection of the new TOT rate in 15-16. And so you'll notice that in FY 14-15 beginning on January 1st, the tax would be collected at the new 12 or 12 and a half percent rate. And if you look at the third column there that says proposed 12% rate, Some odd, almost $700,000 difference between what would be collected in the latter half of the year versus the estimate in the first column of 10%. And if it was at 12%, it would be nearly $800,000.
If we look at then the first full year of collection, the variance becomes $1.5 million and an increase of 1.9 million roughly if you selected the 12.5% tax rate. The process before you today is the introduction of the ordinance, and your consideration of option one or option two of the 12 or 12.5% rate as requested by your board. The adoption of the ordinance will be bring back on the administrative agenda for May 6th. It would submit the ballot measures and the resolution directs the auditor to prepare a fiscal impact analysis, as well as council preparing the impartial legal analysis.
There would be a period to submit direct arguments in favor of the ordinance, which would be between July 14th and 23rd. Election day is November 4th and the new rate would be effective January 1st 2015. So before you today is a couple of recommended actions. You could select option one to place a 12% TOT rate on the November ballot by moving recommended actions A through E.
You can select option number two to place the 12.5% TOT rate on the November ballot by moving recommended actions F through J, and if you move actions E or J, you may appoint members to draft the arguments for future board consideration. With that concludes my remarks, if you have any questions I'm happy to answer them. Supervisor Farr then Supervisor Wolf?
Thank you, Mr. Chair. Mr. Buzan, it's just looking at the timeline here. If the board decides to go forward with this today and then you said it comes back on the admin agenda on May 6th, is right now only planning to meet twice in July, on the 1st and 8th? So if members of the board were going to be appointed to submit arguments in favor That would have to be done probably prior to July 14th, right? So would any of this need to come back to the board and be agendized for the full board prior to the boards break.
Chair Lavaniello, Supervisor Friar, the short answer is yes. You'd want to bring back that argument for board's consideration prior to that break. There does exist another possible option and perhaps council if you wanted to weigh in I saw you moving the microphone. Maybe you want to weigh in on that?
0:36 – 0:4313 turns
Chair Lavigno and Supervisors, so the board has really two choices. You could within either option when you have the choice of designating authorizing supervisors to draft the argument. You could also authorize them to sign on behalf of the board or you can bring it back for further discussion. So it's really a policy choice as to whether you want to bring the argument back after its drafted by one or more supervisors.
Okay, thank you. Well Mr. Chair I just wanted to get clarification on that because if this is something that needs to come back to us we want to make sure that's on the long range calendar in time.
Absolutely, thank you very much for that. Supervisor Wolf?
Thank you Mr. Chair. Mr. Bazonich, the way that the language is noted here it definitely does reflect a general tax with no specific allocation correct?
Chair and Supervisor Wolff, given that it's amending section 32-12 of the existing county code which does specify this as a general tax. The amendment would continue to be relevant to a special, pardon me, a general tax for the General Fund. That's correct?
The requirement for passage is 50% plus one.
Chair Lavinino, Supervisor Wolf, that's correct.
Okay,
very good. Do we have speakers from the public?
We have four requests to speak. We're going to start in Santa Barbara with Kathy Janenga Dykes and come back to Santa Maria for Mary Harris.
Good morning, Mr. Chair, members of the board. My name is Kathy Janega-Dykes. I'm CEO of Visit Santa Barbara and we are the tourism marketing agency for the South Coast. Today you're being asked to support an increase in the transient occupancy tax from 10% up to 12 or 12.5% in unincorporated areas. We support an increase that mirrors the TOT assessment in our incorporated areas, which is the 12%. And we also understand that this will bring much needed new revenues to the county. So while we support this increase in the TOT, TOT, we also urge you to look at new ways to continue to invest in our industry on an ongoing basis. Not specifically dedicating a certain percentage but looking at new ways to invest that will in turn bring new revenues community as well too.
And in fact, as a marketing agency we are responsible for tracking all of our specific programs so it is important for us and for you to know that the funding that you do give to us is spent wisely. In fact, we have impressive research and results to back up the statements. In fact, when Visit Santa Barbara doubled its marketing dollars really combining our county funding along with our city funding and our TBID funding with visits to our website increased 84% to 1.2 million. So why is this important? Because we know from our recent research that 50% of those people that travel to our website actually traveled to our destination. And we know specifically that between 9 and 10% are specifically influence from our organization. We're also able to report with certainty that Visit Santa Barbara marketing efforts directly increase lodging revenue here in the South Coast from $28 million to $44 million in only two years as well.
So our message is that if you invest in our tourism industry on an ongoing basis, You will easily see an increase in revenue from the county. And in fact, the ROI for our marketing efforts right now at Visit Santa Barbara is $10 for every dollar spent. So obviously that's a good investment. We also work really closely with our other tourism organizations throughout the county. You're going to be hearing from them shortly and in fact in the next couple of months you'll be hearing very shortly about a new program. That we will be working collaboratively to promote Sideways, a movie that was released in Santa Barbara about ten years ago and it's our ten year anniversary. So again we thank you for your ongoing support. We support the request to increase the transient occupancy tax to 12%.
And we look at ways to hopefully have you invest in our industry in the future. Thank you.
To be followed by Lana Hunter.
Hello, Chair Lavagnino, members of the Board of Supervisors and staff. My name is Mary Harrison. I'm Executive Director of Visit the San Ynez Valley, newly formed to join the forces of our 33 hotel members and the over 100 members of the former San Ynez Valley Visitors Association. At our board meeting on April 3rd, we discussed the initiative before you to raise the tourism occupancy tax in the unincorporated areas for Santa Barbara County up to 12%. The board felt that this move would create a level playing field among our 33 hotels. Nine of which are in the unincorporated areas of Santa Barbara County in the towns of Ballard, Los Alamos, Los Olivos and Santa Ynez. As you know, the cities of Solvang and Builton raised the TOT to 12% two years ago and there have been no problems with our visitors in accepting this increase.
Our visitors recognize the value and variety of lodging options in the beautiful San Ynez Valley, and they also appreciate the care taken by our cities and the county to maintain a wonderful environment for residents and visitors alike. And by paying TOT, our visitors are doing their share to maintain and enhance this environment through allocations for roads safety police and fire protection and so forth We would like to thank the supervisors for their continuing support of the tourism industry and to let you know that the destination marketing organizations of Santa Barbara County, such as with Kathy Janega-Dykes in her group at Visit Santa Barbara, cooperate fully and freely to make visiting our county the best possible experience it can be.
While we realize that you cannot promise increased tourism promotion funding if the TOT is raised in the unincorporated areas, we know that you are aware of the competitive nature of tourism promotion among destinations in California and throughout the country. We ask you to hear our requests for support with open minds and hearts. The hospitality industry gives back not only in TOT, but in sales and property tax and in the employment of a growing number of county residents.
Thank you for your attention and on behalf of Visit the San Ynez Valley Board of Directors I'm here to acknowledge your interest in asking the voters of Santa Barbara County To raise the TOT in the unincorporated areas of the county. Thank you very much.
0:44 – 0:528 turns
Thank you. Yes, my name is Lonnie Hunter, Chair Lavanino and members of the Board of Supervisors. I'm here today not to take a stand on what you should do on the TOT tax but to maybe share some thoughts on things that are very close to my heart. I am the founding chair and a member of the Economic Alliance of Northern Santa Barbara County. And that's a grassroots effort that was formed about three years ago to really educate people about possibility thinkings on the economy. So it's really about bringing jobs to our region and how could we Take a step back and maybe look from the stratosphere about how that might happen. And so I completely support the role of tourism, and the tourism industry providers in providing jobs and bringing people to our community.
But one of the things that I just want to plant a seed about maybe some creative thinking as you go forward in this process. For North County, I think you're all aware of this but Santa Maria still has an 11.3% unemployment rate as of February of this year. Lompoc is 12.7, Guadalupe is 12.3 and Los Alamos is 10.3 and we all know that it may be higher depending on how counts are done so we have economic issues in North County I'm also a local employer here and have been for 35 years And I own a property management company. And so one of the things that we see in the property management company is people coming in, they can't pay their rent because they don't have jobs or they're underemployed and that's a huge issue.
So I want to continue to have you keep your focus on what can you do for North County? So as you go forward looking at this TOT tax, I would encourage you to think about the possibility of how could maybe a portion of this money be used for economic development efforts. Now, of course, I would prefer that to be North County. That may not be realistic. But we really have got to figure out how do we get people into jobs that they can support their families. And how do we do it while we're keeping the quality of life that we also enjoy in this county? So I think personally now, not speaking from the Economic Alliance, I would support that tax increase and absolutely support the wine industry and In the work they're doing, in fact one of our new teams will be tourism and wine.
And we'll be tourism wind, the Economic Alliance has seven teams working on different issues. So we support that but take a step back and really engage in some possibility thinking as you go forward in this process and how could some of this money be used to help us create jobs and get this unemployment rate reduced? Thank you.
It's close enough. You're on a strict three minute clock, Mr. Armendariz.
Good morning, I'm Joe Armandariz representing Santa Barbara County Taxpayers Association. You all know how much I love new taxes so I just couldn't miss this opportunity to come down here and speak. Look, I understand very well that we have competing needs in our county. We have a need for more revenue. We have a need for economic development as articulated by Lenay. And so I just want to go on record as saying the Santa Barbara County Taxpayers Association, Santa Barbara County Technology and Industry Association is very receptive to what's being proposed here today. Particularly the taxpayers association because we do understand that To the extent that the county can generate more revenue and create a more robust muscular economy through economic development is a good thing.
A rising tide lifts all boats. I would caution my friends in the South County, and to a certain extent up here in the North County, to not so quickly foreclose on this idea of a 12.5% rate because It seems to me that a 12.5% rate, that would generate an additional nearly half a million dollars of revenue to the county is not insignificant. That's a fairly substantial amount of money to be allocated in productive uses.
We believe very strongly that there is a desperate need, indeed an urgent desperate need as pointed out by Lenay with respect to unemployment rates in the North County. That there is a very important role for county government to play. In terms of empowering families and empowering markets, empowering sectors through targeted economic development measures through via I should say a public private partnership. So I think that whether you're talking about a sales tax in the city of Santa Maria, a TOT tax in the county or in specific cities. There's nothing wrong with pointing out where general fund dollars go. And as we all know, general fund dollars go to public safety, general fund dollars go to roads, general fund dollars go to specific things and if general fund dollars can go to economic development, which it should.
Then it seems to me it's important that as you go out assuming that there is a favorable vote this morning. That when you go out and you talk about this issue to voters, you explain to them that this will empower county government to do productive things with general fund monies. And I believe that if you poll the average person today, they know intuitively that the biggest issue going on in America is jobs. It's the economy, it's economic prosperity upward mobility and so I believe you have a very receptive audience out there in the body politic that wants to see its government prioritize whether it's Measure M and prioritizing roads and facilities or it's prioritizing economic development. Public safety, public health, environmental services.
And so we strongly support what's being proposed here although I would suggest you lean more towards the 12.5%. Thank
you. Supervisor
Adam? If I could just ask you a clarifying question or two. Are you in favor of a special tax? that is committed to those efforts, or are you in favor of a general tax that just throws the money in and then it's a political decision how it gets spent?
If I were sitting in your chair, Supervisor Adams- That's why I'm asking you. I would argue-
Giving you an opportunity
to occupy the chair for a second. Let me live vicariously through you if I can. This wouldn't be the first time. That might be weird. I would argue strenuously, strenuously for a special tax frankly because I believe that the voters out there are receptive to the idea of county government doing productive things and I think that investing in economic vitality It's a mission, it's a vision for county government that I believe people are receptive to. Particularly in the North County as we heard the unemployment rates relative to the South County. But I also think even in the South County jobs are the number one priority for the American people from California to Vermont and that's just a fact. And so if I were sitting up there, I would encourage this board to consider a special tax and go out there and get that two-thirds vote to do it.
And make sure that those monies were invested strategically, tactically and carefully and productively. But I also recognize- In economic development? For economic development, I would obviously identify some of that for specific other uses including public works facilities, public safety. But I would definitely want language that includes economic development as part of any increase in the TOT. Okay. All right
0:52 – 0:574 turns
thank you. Bring it back to the board for discussion. Don't all press your buttons at once, Supervisor Farr.
I'll jump out here. Thank you Mr. Chair. Well, I'm very supportive of this. I was supportive of it when the board considered it the last time a couple of years ago. I thought it was interesting. Chair Lavin, you know when you said let's consider not just 12 but 12 and a half percent? And it is really telling here to see the increase in the money. And even in the short term, to have another $150,000 that's roughly what we heard during budget that the chambers were interested in for some economic development.
So for me, I'm prepared to go ahead and move forward and select option two. And I think that I would like you and Supervisor Carbajal to consider being the board's appointees And bring it back to the board by July 1st, just in case there's some tweaking that would need to be done. We could finish it on July 8th in time for the deadline.
Okay well since I don't see any other lights on I'll jump in as well. The reason why I'm leaning towards option two is for a number of reasons. One is we had an 8% TOT for 12 years, we've had a 10% TOT for 24 years. The last time we changed this was 1990. Now we did have to go back to the voters because of the technicality that we amended it without going out to the voters.
But it has been 24 years at this current rate. And so, I don't want to be coming back in another five years or ten years and trying to increase it. I think it's our chance to go out to the public. Well, I know we can't bind future boards and I don' really want to get into a special tax because of us. The two-thirds bar is hard to get over and It's really interesting because sitting here and we're hearing that people out there are receptive to new taxes, an increase in taxes.
That might very well be true. The two-thirds bar is a difficult one to get over. And I know a lot of people have passed TOT increases in the relatively Short past and been able to get over that two-thirds bar. And I know we can't bind future boards, and the language has to be very clear but I can speak for myself as one supervisor that I'd be very interested in tracking that difference between 12% and 12.5%, which could be anywhere between $200,000 to $400,000 or $500,000.
Obviously, we continue to have people come forward and ask us to invest in economic development. So it would be interesting to continue to track that and see where we could be part of the solution. The other thing is, we've lost money through the RNA through Goleta almost to the tune of a million and half dollars I think last year. TOT that we used to receive in. So while this does look like an influx of a million eight, we actually lost almost a million and half last year because we aren't receiving those TOT dollars anymore.
So I am hearing what's coming from our visitors and conventions bureaus where they indicate support as long as the money is spent wisely and Move towards economic development. I'd be happy to help write an argument in favor of this, and I would be in favor of option two. Supervisor Wolfe then Supervisor Carbajal then Supervisor Adam.
Thank you Mr. Chair. The issue of the 12 to 12 and a half percent. What I heard was support from Visit Santa Barbara for the 12% rate, and what I thought I heard from... I'm sorry is it Solvang? Visit San Ynez Valley was leveling the playing field. And I just don't know that And certainly the Taxpayers Association is willing to support the 12.5%. I'm assuming they would also support the 12%.
You know, I'm okay with either one but I really think that this is going to impact the lodging industry and from what we heard from them is that the 12% rate is the more appropriate rate. Of course I would like to see more money in our coffers, but more importantly I'd like to see this measure pass. And we're going to need the support from the lodging industry to get this passed and so I just throw that out there for consideration that maybe 12% is a more reasonable approach.
0:58 – 1:049 turns
Well, I'm going to bite. I'm not going to respond to that. I'll go to Supervisor Carbajal and then we'll go to Supervisor Adam.
Thank you. I certainly understand Supervisor Wolf's comments. I am greatly swayed by you Mr. Chairman and I'm greatly swayed by the Taxpayers Association. I rarely hear them talk so positively about taxes. And certainly, I think having the Taxpayers Association for, I don't want to say once. I think I might have heard them be positive one other time on taxes at least a couple of other times.
I think that expanding the pie In this fashion is an opportunity for us to also look at all the various needs that we have in our county. And certainly, I see tourism and economic development being part of that and exploring how we might be able Include those areas as the many areas that we could allocate such revenue to in the future. So, certainly I understand Supervisor Wolf's approach because I think it makes it a pretty slam dunk straightforward approach.
But I also agree with you, Mr. Chairman that this is an opportunity that will right size where we want to be with this tax and not meddle with it in future years. So I would be open to option number
two as well. Okay, Supervisor Adam?
Well, if we're going to listen to the taxpayers and if we want to eliminate in my opinion, the opposition from the hotel industry, we tell them where we're going to spend the money. And I don't have a problem necessarily with this tax either. I'm not a big fan of new taxes as everybody knows but um, and I don't care whether it's 12 or 12 and a half you know, It's pretty much the same thing. I mean, there's a little bit more money at twelve and a half and I don't think it's going to make a huge difference in terms of the electorate but I think what will make a huge difference in terms of the electorate perception of it is making a commitment to spend the money on economic development You know, if we tell people trust us, we'll just throw the money into the black hole of the general fund and then it could get spent anywhere.
And you know that's kind of my litmus test for whether this thing is good or not is whether we make a commitment to spending the money and tell people You know, here's how we're going to spend it and give them an opportunity to weigh in on whether they agree with that or not. Because I think you can sell a lot of taxes to people but you gotta make a commitment don't just tell them we want more money and we'll spend it how we see fit so if it was up to me I would propose a special tax And really make a commitment with the money. Okay, Supervisor Farr?
Thank you Mr. Chair. Well I did have a really good conversation with Mary Harris and Linda Johanson who owns a hotel in Solvang about this. And you heard Ms. Harris' comments here and they certainly reflect what I heard in our conversation. And that is that when people come to visit, if there's an extra 50 cents on their hotel bill it's not gonna mean anything to them.
I think that for the general public, I think the reason why so many all of them that put the increase of TOT on the ballot a couple years ago were successful is because people who live here realize By and large, this is not going to affect them. And this is a way that we can generate extra revenue that doesn't so directly impact the residents of the county.
So they're not really impacted. Visitors when you get your hotel bill, a couple extra dollars or in this case if it's between option one and option two is 50 cents is just insignificant. So, but I think obviously for us as we can see from the numbers a little bit multiplied a lot adds up to a whole lot of money. I think that in the same way when various sectors of the community came out to support the increase in the TOT in the cities and I know particularly for Solvang.
And then when it passed, you know that they did come back and say, you know We helped you pass this. And so now we want you To remember us and in our concerns and so I would fully expect that with the board But I am prepared to go forward with option two I think it's the it's the most appropriate one and I think it has a really good chance of passing at the ballot box Particularly if we're just trying to get too simple majority
Is that a motion or is there a motion?
Yeah. Okay, Mr. Chair I'll go ahead and move option two items F, G, H, I and J appointing yourself chair Lavagnino and supervisor Carbajal to draft the argument in favor and to bring it back by the July 1st meeting of the Board of Supervisors.
I'll second that.
Moved and seconded. Just before voting on the motion, I'd request that the clerk read in the title of the ordinance which is option two letter H.
1:04 – 1:1215 turns
Mr. Allen? Chairman Labonito, members of the board. I just want to reiterate exactly what's happening here on this item. First of all, the motion would approve Item A which is to receive the report B considering introduction of the ordinance amending section 3212 of Santa Barbara County Code to increase the TOT rate from the current level of 10% to 12.5%. This would be to read the title of the ordinance, which is an ordinance amending section 3212 of the code to increase the TOT to 12.5% and then waive further reading of the ordinance in full. This would also appoint supervisors Lavinino and Carbajal Draft on behalf of the board an argument for in favor of the TOT rate increase ballot measure and return to the board for consideration prior to July 23rd 2014 And then items d 1 2 & 3 would be set for the administrative agenda on May 6th for adoption
Actually, mr. Chair I think that he read option one and we're doing option two So most of it is the same except the key one is that a is different than F so I just want to make sure we're absolutely
clear on this. So all good, I think we're all going the same direction here but for the benefit of the public what we're looking at on the board agenda letter is options F through J including receiving and considering the report at F and working our way down And that also includes under option two item I, which is set a hearing for May 6th for the next phase of this. But in all other parts, I agree with what the clerk of the board read in and you have now read in the title of the ordinance also.
Supervisor Adam? Supervisor Carbajal first then supervisor Adam.
I just wanted to point out that, I think when this is a tax not for our county residents. And I say that for anybody who's watching or listening. This is for visitors that are coming to our area and staying in our hotels. An observation that I'd like to share is, I think when all of us go visit another place We rarely know or ask, what is the transient occupancy tax?
You just don't ask. You look at the bottom line rate and it's either one you can afford or want to pay or not. And then you decide to proceed where you want to make a reservation. And I think that's the same for people visiting Santa Barbara County. I think they're going to look at the overall rates and make a determination where they would like to stay. And again, this is a tax for visitors to our area who stay in hotels not Santa Barbara County residents for the most part. Certainly sometimes we have family that comes or visitors that are coming to see us but at the end of the day it's visitors to our area and Just restate that enough so that the public clearly understands it.
Supervisor Adam? Well, just because our residents aren't going to necessarily pay it and in fact we probably will because on numerous occasions I've stayed in Santa Barbara so we will some of us pay that. You know, I just am not going to be able to support the motion because we're not gonna call where the money is gonna go. And I think that we ought to give people the opportunity to weigh in on where we spend extra tax money instead of just throwing it into the general fund.
Supervisor, I'm gonna address that because you do raise a very interesting point and The problem that I have with if we, because I know in my own mind and obviously I don't always get what I want up here. Rarely but I think we're all interested in thinking that majority of these dollars would go to economic development and I sense that on the board. Right, we don't have it in writing and here's the problem I have with a special tax though.
I'm not going to be able to go out, now you have a campaign. You've got to get over the two-thirds bar. I think it's a pretty easy deal at 50% plus one. You go to two thirds all of a sudden now you have a campaign and I don't have the resources and we can't go out and speak. We can't really campaign for it and I don't want to put this thing on the ballot and have it fail and then You know, we jeopardize the entire amount of money that we were going to bring in. So I understand if your reluctance. I totally get it.
I got to go with what I think is is reasonable and I think this hasn't been increased in 24 years and I think that the board majority, I think all of us are thinking the same thing. If I thought some people were saying, hey, I want to put this into X or Y, I'd have a problem with that But I think everybody's committed to moving in the right direction. So, I know you want to respond to that.
Well no actually I don't. I just want to say that it has increased over the years because you got the same percentage as the hotel rooms increased And I'm not sure that, you know in 150 years will it be 98%? You know if you use that logic then it's got to go up every so many years. So the percentage stays the same but well yeah but the hotel rooms got more expensive so that's where you did get an increase So that's-. And
we've also lost throughout the time of the GLETA Revenue Neutrality Agreement. Yeah, sure. Supervisor Wolk?
Thank you Mr. Chair. Well I will be supporting this motion and I appreciate the discussion that we've had. You know I expressed my concerns about 12 versus 12.5%. You know, I want us to get this on the ballot and I'm fine with a 12.5%. But I do want to say that we have to be really straight with the voters and be really clear that this is a general tax and as much as whatever is being set up here, we are not making a commitment as to where this is going. And I respect Supervisor Adam for Wanting to be specific and taking that chance for the higher voter threshold.
But that's not what we're doing, we are not making a commitment. And if we want to make a commitment then we have to do what Supervisor Adam is asking us to do. So I'm happy to move forward with this item as it's proposed.
We have a motion and a second from Supervisor Carbajal, I believe? We'll take a roll call vote, Mr. Allen?
Ms. Wolff?
Aye.
Ms. Farr? Aye Mr. Adam? No. Mr. Carbajal? Aye Mr. Lavin, you know. Aye Passes 4-1
Okay our next item is not that long and then we have a couple of very long items so what we'll do is we'll still go to departmental item number two and then we'll take a break after that Mr. Allen
1:12 – 1:2215 turns
Chairman Labnino, members of the board, item two is from the county executive office. It's a hearing to receive and file additional information on estimated tax revenue impacts that may result from implementing a Prop 90 local option in Santa Barbara County.
Good
morning, Mr. Brzanich again. Chair Lavagnino, members of the board. As
a bit of background for you in consideration, in 1989 the county of Santa Barbara did consider implementing a Proposition 90 local option. In September of 2013, the board was provided an option to reevaluate whether or not they wanted to participate in the Prop 90 local option. And at that time of the hearing last September, the board directed the CEO staff to bring back this item with more information and notify all of the affected local agencies to elicit comments.
Staff has done that and this report is to fully inform your board about the results of that. Just as a reminder for you and for reminder for the public, we're really talking about two separate propositions here. Prop 60 which allowed for property tax relief for those people over the age of 55 to be able to transfer within their own county the base property value when purchasing a new home.
It's only allowed once, and that Prop 60 property tax relief needs to be filed within three years of the purchase. And it allows for intra-county transfers. Prop 90 came along later and it allows counties to accept the Prop 60 base value transfers between counties. If a local board of supervisor adopts a local option to accept those base value transfers, the amendment was made in November of 1989. I'm sorry for the dropped digit there.
And Santa Barbara County at this time does not accept base value transfers. Nine counties in the state of California do allow that. They're listed here, Ventura, Los Angeles, Orange, San Diego, Alameda, Santa Clara, San Mateo, El Dorado and recently Riverside County re-adopted their Prop 90 transfer local option provision under Proposition 90. With the help of the clerk recorder assessor's office, and I want to recognize Joe Holland for helping to provide this data. We asked some of those counties, a sample of those counties what their experience was in receiving and processing Prop 90 claims?
So in an annual basis, Santa Clara averaged 56 of Prop 90 claims with a average base value reduction of those 56 claims of just under $400,000. When you look at their total number of parcels which is over 475,000 and we reduced that for Santa Barbara County's number of parcels. That would equate to roughly 15 claims in Santa Barbara County during an annual, each year.
Ventura County had 72 claims. They were not able to provide us the data with their base value reduction unfortunately but when you equate the number of these claims it would average to about 37 a year in Santa Barbara County's total census of parcels. And in Alameda County, there were 54 claims with a $401,000 base value reduction. And when you extrapolate out the number of parcels in Santa Barbara County that would equate to 16.
And so we did some data using the 400 base value reduction, which is the average of the two data points that we had got from Santa Clara and Alameda. And we extrapolated out the number of claims for Santa Barbara County and we thought about 23 per year would be a possible number that we would have to consider here in Santa Barbara County. Using those numbers from the surveyed counties, it's estimated that $920,000 in Santa Barbara County property tax reduction over the next 10 years. So just under a million dollars because of the way our taxes are allocated approximately $550,000 of that would be reduced to schools.
184,000 would be reduced to cities and special districts. And about 184,000 would be reduced to the county. Per your board's direction last September our office solicited comment letters from the 62 tax receiving entities across the county. Nine of them responded. Eight were opposed and one came back taking a neutral position because of a relatively low amount of property taxes received by them. And we attach those to this board letter so you would have copies of those, and the public may review those.
It's also been six months since the county of Riverside re-implemented their Prop 90. And so with the help and the support from Riverside County's clerk recorder's office, assessor's office they were able to provide us with this data through the end of February. Through the end of February there were 18 Prop 90 claims were approved, 52 were still pending. Of those that were approved there were an average of $192,000 in base value reduction in Riverside County. If we prorated that out for Santa Barbara County it would be 43 applications.
I chose not to extrapolate out that price value into our other figures because of the real difference, I think in property values in Riverside County versus Santa Barbara County. But we could easily do that for you. Sorry, Supervisor Wolf?
Mr. Pisanich, so in this slide here, Are you extrapolating 43 applications for the county of Santa Barbara? So how does that tie into slide four? When you extrapolated 23 applications, which number should we be looking at?
Chair, Supervisor Wolff. I would say 43 is a really good way of looking at what an initial push and participation number would be at the outset of that. And I think it's indicative of a high workload that we would likely see when we initially implement if we were to implement a Prop 90 local option. But I think the Santa Clara, Alameda and Ventura numbers of applications are probably a good indicator of what the trend would be after 15 or 20 years of that implementation.
So I included this number particularly to think about what it would mean for our department staff to absorb that initial workload as we implemented Prop 90.
All right, then let's look at slide number five then. So you're basing those numbers on the 23, not the 43?
Supervisor, yes. That's correct.
So it in fact could be much greater if we were to use the 43. Chair,
Supervisor Wolff that would be correct if we used the 43. At this time, I just recommend it actually would be to receive and file the additional information on estimated tax revenue impacts that may result from implementing a Prop 90 local option in Santa Barbara County. And I'm available to answer any questions.
Any questions from the board? Supervisor Farr?
Thank you, Mr. Chair. You know I'm just kind of curious of the nine counties that participate in this can you could you do this more than once between counties?
Chair Levinino, Supervisor Farr, no. This is a one-time selection that you'd be able to make on taking this property value base value reduction credit
Okay, so there's a way that they track that. Because let's just say you started out in Riverside at a lower property value and then you went to Los Angeles and you got to keep it lower. And then you went from there to Alameda or Santa Clara. I mean the property values would keep going up and Depending on where you moved, being able to keep the very lowest property tax assessment that you had.
Chair Levin, you know Supervisor Farr, I'm not aware of what the mechanism would be to track those from between those nine participating local option counties or what we might be able to receive from them if a local resident participated in that. So-
1:22 – 1:2910 turns
Chairman Lavagnino, Supervisor Farr. The Prop 90s and Prop 60s they're tracked by the State Board of Equalization throughout the state and it's tracked by Social Security numbers so you only get it once. So you can't do it multiple
times a year. All right, that answers the question. Thank you very much. You
found your loophole but it was closed.
Somebody else's loophole. Somebody else had
already thought of that.
Chair Labanino and Supervisor Farr, I would agree with Mr. Holland with the seldom used caveat that if someone becomes severely and permanently disabled they may have another opportunity to take advantage of that otherwise one time opportunity. Okay,
thank you.
Okay, is this receive and file? A motion to receive and file. Or do we need one? I don't think there's any speakers. Okay, motion to receive and file. Moved and- Second it. Didn't know it was such a controversial item. All those in favor? Aye. None opposed? Okay, we're going to take a 15 minute break and we'll come back and tackle alcohol drug mental health.
Okay.
You. You. you you
1:32 – 1:381 turns
Hi. The. Yeah, we have evaluations. That's it. All right, we're going to come back to reconvene our meeting of the Board of Supervisors. We're going to go to departmental agenda item number three, Mr. Allen?
1:38 – 1:539 turns
Chairman Lavinino, members of the board. Item three is from Alcohol, Drug and Mental Health Services. It's a hearing to consider recommendations regarding the county of Santa Barbara alcohol drug and mental health services outpatient and inpatient system of care assessment. This is progress report one system change.
All right very good we'll go to Ms. Nisic.
Yes good morning and thank you Chairman Lavinino, members of the board. We are very happy to be here today to provide you with an overview on our progress to date on the alcohol drug mental health systems change effort. This effort began on May 21st when the board received the TriWest and Health Management Services report at that time you initiated and affirmed a structure and a strategy and a way forward to direct staff and our partners to address the issue identified Since that time we have established processes, systems and structures and we have taken key actions to effect change.
While much has been accomplished to lay a sound foundation, there is still much to do. To create a balanced integrated complexity capable welcoming culturally competent behavioral health system in the spirit of the systems change partnership we're going to have a unique presentation today you'll hear from staff our steering committee co-chair our partners peers and consumers Before I turn the presentation over to Dr. Wada, I'd be remiss to not recognize the hundreds of people that have been involved in this effort today. Specifically, I would like to take a moment to thank the steering committee members which is 35 individuals strong that have worked over the last nine months to help guide this process.
In addition, I'd like to acknowledge the work of the department specifically. They've worked diligently over the last many months to embrace this change process and have worked to reinvent our systems processes in the department as a whole. So with that, I would like to turn it over to Dr. Wada and our team to provide for the presentation.
Great, thank you Chair, members of the board. This next item is from Alcohol, Drug and Mental Health Services and it's a systems change progress report. I'd like to introduce our initial team of speakers as Ms. Nisic described we actually have A group of us that will be presenting this morning, so we'll be doing some rotating. But the starting lineup is to my left Michael Craft, Deputy Director over Clinical Operations. JT Turner, Executive Director over Phoenix House and Andrew Keller from TriWest Consultants.
I'd also like to echo Ms. Nishija's comments about thanking and recognizing everyone who has participated, and I certainly want to thank staff for all the work that they do. I know some are here in the audience behind us, some are listening, others are out in their offices and in the field and clinics and in the puff. But I really wanted to recognize them again for their hard work through the system change efforts but also just in their day-to-day operations and An exceptional job, and just a very talented and passionate group to work with. The next two items actually are from the Department of ADMHS and should really be viewed in tandem. So the first is described as an update on our systems change efforts to date, and it's focused on our internal and system-wide quality improvement activities based on the TriWest consultant report that was presented to you last summer.
As you will hear, we've made great progress with tangible improvements in a number of areas. Wait time for our first psychiatrist visit has improved. We were awarded new grants. Partner organizations have been reengaged. Our known fiscal liabilities have been addressed to a large degree. There's been some feeling that our internal culture is better. Yet there are other areas where change has been slow, and we're mindful of areas that still need greater attention. And we have remaining gaps. We have foundational and structural issues that will take time to resolve. The difference being however, that we are now addressing them openly and with the new sense of collaboration, inclusiveness, and accountability. You'll hear about these challenges as well.
This will then be followed by a presentation on our Mental Health Service Act plan update, where we'll discuss in greater detail our system plans going forward. And how all of the clinical program redesign efforts and program expansion recommendations fit into an overall strategy to make our behavioral health system more effective, efficient, and balanced. As Supervisor Carbajal has identified in the past, our presentations have been coming forward in pieces. The two presentations today will hopefully provide greater context and we'll be coming before your board again in June with a systems facility gap analysis and then again in the first quarter of fiscal year 14-15 for more comprehensive behavioral health system discussion.
Next slide. So we all recognize that our behavioral health system is vital to the health of our community and to public safety. As I said during the budget workshops, the work we do impacts all residents of the county but particularly some of the most vulnerable members of our society. We give them the opportunity to recover, to reach their fullest potential, to be there for their loved ones and to live meaningful lives. A federal construct called the Triple Aim provides our system change efforts with a very simple set of three broad goals. To improve the health of the population, to enhance the patient experience of care and to reduce or at least slow the increase in cost per capita.
So in improving the health of our population This has to do with how do we know that we're doing a good job. So I know Supervisor Adams asked during our budget workshop, what are our outcome measures to know that people are getting better? And that's a very valid question and something that we've built into our system change efforts. And we need to also enhance the experience of care. So is our system accessible? Is it culturally competent? What are the barriers to getting that care? Are transitions of care seamless such that people aren't lost or falling into gaps, or getting stuck in certain levels of care, or getting so frustrated that they stop coming in altogether? So that's our work and patient experience.
And then, reducing or at least slowing the increase in cost per capita. So if our system is efficient and balanced with people being seen at the right level with the most effective treatment it should actually improve on our cost per capita. If we excel in these three goals and in these three dimensions, then we'll know that our system provides good value. So in order to do that and for us to achieve our goals, we need a comprehensive system of care and recovery. So this slide developed by our medical director Dr. Oli Berenstain demonstrates the various components along the continuum of care.
So the ideal system has not just capacity at each level But within each level, the programs and services need to be functioning as effectively and efficiently as possible given the resources available to them. They need to be accessible, welcoming, able to address complex patients and their needs. They need to be culturally competent. The system also needs to be coordinated with seamless transitions from level to level as you go up along the continuum. And it needs to be appropriately balanced, so as you see down here at the most basic level we have our community and public health primary care providers education and outreach in the prevention components then we have clinics. Then we have more intensive services like our supported housing, assertive community treatment.
Then we have our crisis services so this can be crisis residential, crisis stabilization often with a housing component and at the very top we have the PUF or inpatient facilities that are often involuntary. And of course as you go up along the continuum there's increasing levels of need, increasing intensity of service and increasing levels of cost. And then you have step downs, IMDs or Institutions for Mental Disease and Boarding Care Facilities that provide housing as people come out of the PUF. So if you have gaps in any of these steps, or you don't have sufficient capacity, or they're not functioning well, then people fall to the next higher level. And so they're seen at a higher level of cost unnecessarily, and Get very expensive and out of balance.
And so as was highlighted in the Tri-West report, and also in an external quality review here in Santa Barbara just 222 of our high cost beneficiaries drove 35% of our claims. So that again is a very small number of people costing a lot of money in our system. That's true of any system but in comparison counties we're even far beyond that. Dr. Water, can you repeat that? I caught the last 35%. What percentage- 222 of our high cost beneficiaries drive 35.2% of the claims.
So again, that's true of any system. You'll have a small group of high utilizers but the average across the state is about 25% of the costs go towards those high beneficiaries and here in Santa Barbara County we're at 35%, so that's considerably higher than the norm. So again, our main goal, one of our main goals is to balance the system. So we have a client at the center. Again patients centered that's the way our system needs to be developed and then you have to have a balance between outpatient and inpatient.
The stronger you have your outpatient systems, the less demand and utilization you'll have on your inpatient. And then you have your prevention and early intervention and then crisis. And again we're trying to shift our resources and attention onto the prevention and early intervention and reduce the utilization on our crisis services. So the next slide demonstrates the basic phases of our five year system change efforts. So at the bottom down here, we have our most fundamental needs and that's to ensure that our foundations or core systems, policies, practices, structures and personnel are solidly in place. So we need to have the right people in the right positions. We need to develop standards, clear expectations and measures in order to strengthen our accountability.
Communication, responsiveness, trust clearly articulate our visions and values for the department and our systems of care and recovery. And only by starting to address some of these basic elements in our internal culture could we then advance to the next phase where we then look to secure partnerships and strengthen them. Then moving on to creating innovative programs and partnerships with increased service delivery to maximize and leverage opportunities. Then going on towards mastering that service delivery with confidence, achievement, and trust throughout the system. And then again getting to our vision of a fully integrated welcoming complexity capable culturally competent system of care recovery and services to all. So again, a lot of these are happening concurrently.
This is our vision but of course we're starting out trying to get to this vision so we've had to spend a lot of our initial time over this past year really working on these foundations and core systems. Supervisor Carbajal?
Thank you. I think today we're going to get a lot of really great information, and I'm really excited about it because of the opportunity that I think it presents for us. But I'm not an expert in organizational management or change but I have studied quite a bit in it. And all this framework that we're talking, that we're doing or moving into. We're going to succeed, we're going to adapt continuous process improvements. This structure once we achieve a lot of the changes that we are identifying they need to occur or will occur unless there's a culture change and a commitment to continuing this type of continuous discussion.
We're going to go back to a new system, and everything is going to deteriorate to maybe the old culture that we were trying to change. So I just want to ask you to keep in mind and to report back to us What is that systems change infrastructure? That you're going to continue to develop and to continue so that all this, it's a closed loop. It just continues to happen every year and we don't just get excited about our successes but rather we build on those successes and And not fall to the wayside, all that we've developed. So my biggest fear is that we go through a lot of energy, a lot of discussions, a lot of great input, a lot of great people working on this and unless it's self-sustaining, it's a waste of time. So I want to encourage you in some way if not today at our future hearing to let us know how you will continue this infrastructure of change agents.
A change structure that will give us some confidence that this was just not a one time investment in funds, but rather a real culture change.
Supervisor Carbajal through the chair, I think that's an excellent point. We're very mindful of that and through this entire process with the technical assistance of TriWest and Zia Partners we've really tried to instill throughout the department. And it's still a work in progress and culture change takes a long time but we really are emphasizing the continuous quality improvement aspects of systems change. You'll be hearing more about this throughout our presentation. We actually have a change agent that will be speaking and some of our partner entities as well. But it is something that is going to be a continual process and we have the structures in place to keep that going.
Supervisor Adam? I'm sorry, let's go to Supervisor Adam then Terry wants to comment on that as well.
Yeah I'm just hoping that at some point we're going to get to some more verbs here because I see a lot of adjectives. I don't see too many verbs you know I'd like to hear what the plan is and including actions. Terry?
Yes, yes Chair Lavinino and Supervisor Carbajal. In addition to Dr. Wada's comments one of the items before you today is to basically affirm the vision values and guidelines which is guiding that this steering committee process which is basically the foundation and philosophy on which all of this and all of the change in systems and all of the change that we're infecting is grounded upon and JT Turner will speak to that specifically at his portion of the presentation.
1:53 – 2:059 turns
All right, Dr. Water, let's continue. Great, thank you Chair. We can go ahead and
move on to the next slide. So systems change involves improvements in processes, practices design and implementation of a range of components within our behavioral health system and within the department. This is a basic structure that we have going forward. Of course, we have the Board of Supervisors at the top. We have the Statutory Mental Health Commission appointed by the Board of Supervisors that provides oversight for the department.
Advisory commission as well that's appointed by the Board of Supervisors. We have the consultants here providing assistance and recommendations through the CEO's office in the department. Here around the circle, we have all of our various action teams. The steering committee for crisis, we have cultural competency. We have peers, forensics and the children's system. And again, the entire systems change effort is being overseen under the guidance of the Behavioral Health Steering Committee which you had heard about and there's a roster attachment B in one of your handouts.
We then have change agents who you'll be hearing about later that are a mixture of both staff internally, community based organization partners. Family members, peers, consumers that are all part of the system and they've been trained in continuous quality improvement and are making changes throughout the system and are empowered to do so. Again, here's the theme of continuous quality improvement. We have internal departmental work groups and then we have a number of committees and everything that we're doing is guided by the values and visions of Mental Health Services Act and that were approved by the Behavioral Health Steering Committee. So again this is the basic structure that we have for systems change.
Next slide. So the general timeline, again this started back in 2012 when the Board of Supervisors authorized the CEO's office through TriWest to conduct a comprehensive assessment of the department and outpatient system. And I think that was a tremendous symbolic effort and action by the board of supervisors that demonstrated your clear investment and interest in the department to do better work and to improve the system generally. We then spent the beginning half of 2013 working with TriWest on the assessment. And they did an excellent job in reaching out to all the different stakeholders both internally and externally, and were really able to get buy-in and trust and produce their report back in May. We then spent the last half of 2013 implementing systems change, so we established a steering committee.
The action teams, we had a number of key hires to strengthen the organizational structure of the department. Now in 2014, we're starting to see some results. So we were awarded two major grants from the state to improve our crisis systems and now we're back before you with an update on all of our activities. And again, the presentation after this will provide additional detail on some of the changes going forward. So with that I am now going to be turning it over to Dr. Keller to give a quick recap of some of the major focus areas and findings from the report.
Sorry, doctor. You're going to have to move that closer to you. Yeah. Not really. Those things have to get really close. You want to press it up. Okay, there you go.
Good morning. Thank you Dr. Wada and- I'm glad I didn't say the
second time it was better because it was still off
so that would have looked really
bad.
Well good morning Chair Lavagnino, good morning members of the board. It's a pleasure to be back again today in this beautiful part of the world. It was about a year ago just a little bit under a year ago that I was here to share with you really some pretty hard findings. There were some hopeful trends, there was a lot of sound Financial change that I was able to report on, but there was really a pretty dire clinical situation in your community that we talked about and we shared with that. And I think you entrusted the community in a change process and we're here to talk about that. My role today is to really kind of remind you of what some of those findings were, speak to those. So in each section of the report I'm going to highlight where we were.
And then we've asked members of the change process Co-present together today where things are at, so you can get a sense of status from the community and not just from the department. Which I think in and of itself is an important change. A year ago it was the department up here saying we've had some difficult things to do and we had comments afterwards but remember this is of the community right now. We have a presentation to you on your community behavioral health system that really is shared and owned by community partners and not just the departments. So I think that's in and of itself a pretty important thing.
Supervisor Carbajal to your question, or the point rather you had made earlier about will this endure? I think being able to hear from people not just in the department will help attest to the chances for that. So I'd like to start with some systemic findings. That was, if you recall we thought it was very important to address the overarching system performance issues.
We described your system as reactive top down crisis driven a year ago and we're very pleased to be able to say that substantial progress has been made to establish a more collaborative plan full and partnership based system that's really founded on the strong financial controls Painfully established over the prior years and put in place and building now on that I think some very effective partnerships. If you recall, we described suboptimal performance at multiple levels. We described a culture that Supervisor Carbajal referred to earlier that really needed to change.
And central to that was a lack of the effective empowered partnerships that you really need if you're going to address the needs of people with complex needs. It can't just be there has to be housing, there has to be health all those parts have to be there. The other gap that we pointed out was the lack of an effectively organized clinical leadership, so you were really crippled on your management team because you just didn't have a full team in place. You had some vacancies that we'll talk about later. The other thing that we stressed was you had to fix these systemic issues first. We were very concerned. That if you just went after problems, you tried to fix things piecemeal. Tried to say okay well let's take this on or this on from the report that you were really going to risk not just failure but perpetuating and maybe even exacerbating the command and control culture that was really I think central to compromising your past efforts to improve in the clinical front.
So I have beside me here JT Turner, who's the co-chair of the CBO coalition. He is also the executive director of Phoenix of Santa Barbara. We also have Michael Kraft who is the assistant director for clinical operations now filling that critical leadership role that had been vacant for five years when I reported to you last year. So I'm gonna turn things over to them and they're gonna walk through each of the recommendations we made and give you a sense of the progress that's been accomplished in terms of that.
Michael?
Jerry Lavinino and members of the board, good morning. It is a deep pleasure to be here and as Andy indicated I'm occupying a seat that was vacant for five years. And when you consider that we are a clinical operation by definition, I think that was telling about the difficulties with structure. And so it is a great pleasure to be here in part speaking to you, I represent the staff and everybody who cares about the actual delivery of services. And so Supervisor Adam, to your point We recently met with a local systems expert who pointed out that it's as easy to create a bad system that will perpetuate itself, as it is to create a good system that will perpetuate itself. And I think that's advice well taken.
So our initial steps were focused on addressing the system issues. And by addressing the needs and the deficits in the systemic structure, our plan was and still is to then begin solving problems in a way that those problems will stay solved. So laying this foundation aligns all parts of this system and all participants and helps us as we work together then to tackle really difficult and complex issues. In many of the issues that were facing are not unique to this system of care they are widespread throughout the state So this approach had to be comprehensive. It meant that we needed to take an inventory and identify all elements of the system, all the participants, and we needed to clarify roles.
ADMHS has two primary roles. The first is that we are the mental health plan so we contract with the state and were required to do certain things. In addition, we are the largest provider of direct services in the county and so we have a dual role And there were times in the past where muddiness about the distinction between those roles created issues and so that was one of the distinctions that we drew right from the beginning.
We needed to be performance improvement driven, so that any action that we took I would like to begin by saying thank you to the Board of Supervisors. to be cost effective and the old style of mental health performance was rooted in delivery of service, volume of service rather than measurement of outcomes. And so that's one of the fundamental systemic shifts that we're making and we're going to share more about them a little bit.
So we're looking at clinical outcomes, the quality of life for the people that we serve. As well as metrics like the number of people seen, the length of treatment, the cost of services and identifying gaps within the system. This approach needed to be transformative. It could not be business as usual. It couldn't be done in the old style, otherwise we might solve specific problems but be creating problems that were unforeseen that we would have to deal with down the road.
So transformational in nature and then it needed to be community-wide so that every element of the system all of the pieces all of the partners were working together toward the same goal a goal that we define jointly consistent with some values that JT is going to share in just a moment So we've shifted the climate. And we went from a climate of closed control to a climate of openness and inclusion, where we share what it is that we're tackling, where we look at the very nature of the way that we conduct business. And so we had a variety of stakeholder events, regional meetings, wide solicitation of inputs, unprecedented level of surveys. And we openly acknowledge what our challenges are in a way that previously the department was not so quick to do.
We solicit feedback, we make course corrections along the way. For instance, we recently got some audit results that the state would like us to change the way that we're doing treatment plans. And so rather than respond in a reactive way, we shared those findings widely and we solicited input and we haven't come up with a solution yet but we're in process and we're very clearly defining the nature of the problem in a way that exceeds just the specific problem at hand.
And then finally, we're evaluating the organizational climate change as we go. So with every decision that we make, with every problem that we tackle, we're asking the fundamental question how does this action square with system transformation, the associated values and with our shared goals? And so I'd like to turn it over to JT who's going to share from the steering committee perspective.
2:05 – 2:162 turns
Good morning, Chair Lavagnino and members of the board. I'm glad to be here before you wearing two hats. One of my hats is co-chair of the steering committee on system change and in my other hat, I was going to bring hats but I didn't bring them. My other hat is co-chair of the CBO coalition, The Association of Behavioral Health County Contractors we formed last June.
On this slide you're looking at You see a photo of the big system change kickoff meeting held in Solvang last year. This was last June, actually hosted by ADMHS. This was held to inaugurate the start of transforming the behavioral health care culture in the county. The kickoff meeting involved a large number of people from all parts of the county who were given one basic message. This message was if you want to make this system better, you have to get involved.
Such as by joining the new team of change agents that Ken Minkoff and Chris Klein were mentoring. Or by being on an action team focusing on improving certain parts of the system, such as the Children's Services Action Team. Job number one was defined by TriWest consultant Andy Keller to my left. At the first meeting of the Steering Committee on System Change held last July, in Andy's words we needed to change the top-down culture at ADMHS which had over a number of years alienated its own staff, contractors and advocates in the community.
That job to move the old top-down culture to a culture of partnership, inclusion and transparency is at the heart of what the Steering Committee does at its monthly meetings led by the indomitable Terry Nisich. She would, by the way be a good person to have on the Oregon Trail if you were a pioneer We are in some ways on the Oregon Trail working to find the new land, the new culture of true partnership where advocates, family members, clients, staff providing services and administrators are all together on the wagon trail.
So what the steering committee did first was to assemble a diverse group of stakeholders from all parts of the county who cared a lot about how the mental health and addiction treatment system would evolve. What we needed next was a navigation system to make sure we were headed in the right direction. It took us a number of meetings hashing out the vision and guiding principles for the behavioral health system, and I want to tip my hat To Dr. Oli, who as my co-chair really helped with this process.
In November the steering committee adopted the vision and guiding principles which you are as a board asked to adopt as well. Actually can we go back to the previous slide? Thank you. Andy is enthusiastic. You will notice on this slide it says the steering committee borrowed from the values of the MHSA world, the values articulated in California's Mental Health Service Act. Are about system change. It's just that the county had never looked at how those could be applied to the whole system. The steering committee deliberately blends MHSA principles such as establishing a partnership culture with additional progressive principles, such as having a strength-based perspective when working with clients.
This means clients' deficits and disabilities are not the major focus of treatment, rather their abilities are what are built on to form their recovery. Next slide, please. So I want to highlight a couple of items on this page and one is accessibility. You see that's the top right side accessible. And accessibility is a value, which means we do whatever it takes if someone has a mental health need or needs treatment for addiction to make sure they receive services. The old way was to mostly serve those on Medi-Cal. The new way with MHSA providing the necessary gap funding is to serve all those who have a need for services. This is the quiet revolution.
Ken Minkoff is performing an important role as consultant, and one of his contributions has been to focus on the importance of having a welcoming culture. Also he has underscored the importance of our being complexity capable such as our ability to work with clients with a mental health condition such as bipolar disorder and an addiction. In closing, I'm going to put my hat on as co-chair of the CBO coalition.
When Cindy Burton, the CEO of PathPoint and I formed a catalyst to bring together all behavioral health county contractors for the first time to form an association called the CBO Coalition. And we did this last June. We had our first meeting last June. We wanted to make a positive contribution to systems change We have monthly meetings of the heads of contract agencies and quarterly invite Terry Nisich, Takashi, the two Michaels, that would be Kraft and Evans, and other execs from ADMHS to meet with us to work on evolving the system as partners.
This has been most productive, and Cecilia Rodriguez, CEO of Calm will talk more about this a bit later. We have a way to go. But we have made an excellent start and certainly need some ongoing if tapering consultation from Andy Keller and Ken Minkoff. They have been the muses for the work we have done on transformation, and I pay special tribute to them. I look forward to the evolution continuing, to new developments such as starting a housing action team which will focus on developing much needed additional housing and residential treatment beds.
Now I want to pick up on something that Supervisor Carbajal brought up earlier when Takashi was talking Which is, how do you keep up the elements of the transformation process and not slide back? That's a really key question. How do you not go back to the old dysfunctional ways? Well, the steering committee has a next step plan, next steps plan to keep up the momentum and will be an ongoing incubator of change and assess that decisions going forward abide by the vision and guiding principles we have in place.
The partnership culture is here. And we're working hard on improving services for clients and family members. I must say, I'm really glad to be part of this healthier evolving culture. Thank you.
Thank you. Mr. Craig? So Chair Lavinino and members of the board, so what are we doing systemically as we move forward? You've heard how we have reconfigured our culture and we've redefined what it is we're about and how we will do what we do. And central to that is this notion of value of care. And that is an organizing metric around which we are working our problem solving and our action teams along with the core purpose of access to care.
Access to care means both initial access, and access to the right level of service, and the right specialty of service throughout the system, and we're going to share more on that later. So value is our outcomes compared with our cost. And in order to move in that direction, the ADMHS executive team now is cohesive. We have six of us who meet regularly and representing clinical operations is me. In the medical specialty is Dr. Oli Berenson our Medical Director and he's an extremely solid partner in all that we're doing and has helped shape some of the language that the steering committee adopted. So you have a physician who's also a philosopher and understands how to bridge both Fiscally and administratively, we've got Michael Evans, the other Michael.
And he understands clinically what we're doing and really by training, he's an operations guy. So what this means is that we can draw from his strength in designing systems and solving problems that are fiscally sound. With compliance, we have our new member Celeste Anderson who understands the clinical nature of what we're doing and has helped shift the compliance function from being policing to being guiding and informing.
And then finally, the Office of Strategy Management. Suzanne Grimacy moved over from the clinical side and so in all of our strategic thinking she's able to represent the nuances of how clinical operations work. So even though we haven't focused on lost time as a specific metric, we didn't set out to do anything to change it. In the past year, we've seen a 9% drop and this is the sort of finding that is typical of systems that focus on value rather than just problem solving.
As you increase the quality of what you're doing, as you have specific outcomes and you reorient the whole system then you often find that you have positive changes in areas that you didn't specifically address. We're adopting the recovery model, which is a shift away from treatment to people as treatment with people. It's collaborative and it means that all the treatment decisions are determined in collaboration with whoever we're serving.
Based on their definition of the kind of life that they want. So it would be akin to in primary care if you went in and received a diagnosis of diabetes, your physician saying here are all the things you need to do and you need to be compliant with treatment as opposed to the question of what is the kind of life that you want? What matters to you? And then you lay out a road map for each individual person to help them create the life that they want.
Finally, the idea of value moves us away from being Medi-Cal focused. Medi-Cal reimburses us for the volume of services that we deliver regardless of whether those services are producing positive outcomes in people's lives. We are positioning ourselves as a system to focus on measurement of two major things. One is change in individual lives, and then the other is change that teams are producing. So which are effective? Which are not? And systemically what do we need to change to make the less effective teams more effective? And what that will do is it will ultimately position us in the long run for what we expect will be the demise of short-dual MediCal so that we will anticipate the changes that are necessary. So thank you.
2:16 – 2:339 turns
So the next thing we want to talk about are partnerships. And before I do that, I just want to point out too in terms of where we were before. These three jobs that these two gentlemen just described that they have JT's two jobs of co-chairing the steering committee that brings the community together. His other job co-chairing the CBO coalition that brings the CBOs together and helps organize them. And Michael's job organizing the clinical systems within ADMHS. None of these three jobs were being done when I spoke to you last. So just the fact that people are doing these jobs, let alone the fact that they're doing them well is a huge step forward as a system. The other piece is this, as I mentioned, the job that ADMHS has is a very big one.
Many people I think felt kind of overwhelmed when we looked at the results last time how will we possibly move forward and make improvements on this? And the critical part to that was we would have help. So to talk about that today further are people talking about three core partnerships that are essential to this change process and then we'll be moving into the clinical and other outcomes.
The first report is a peer report. Tina Wooten, the Consumer Empowerment Manager was going to be here today but she's ill and so what we're able to do is Mr. John Nibio, who's the co-chair of the Peer Action Team and who works with Family Care Network, one of ADMHS' CBO partners is able to be here to co-present on this. And I think this is really critical if you recall last time we talked there was a gap in the system between the clinical and the recovery people felt like, you know, recovery how do you fit that with a clinical mission? The clinicians were on one side people had a hard time even using the word clinical because they were afraid that we would lose recovery and so John can talk about where things are at now.
Thank you Chairman Romagnolo and Board of Supervisors for your leadership in bringing upon this change. As mentioned, Tina Co-Chair and Consumer Empowerment Manager is out ill today but we're here to carry on her leadership in the efforts of many peers and family members in our community. The idea of consumer and family participation in the mental health system is not new.
Both 2003 President New Freedom Commission Report on Mental Health and Prop 63, which was passed in 2004 made this a key component in system transformation. And I stand here today on behalf of all the great people I work with in the leadership in this room to say that we are part of a solution and not viewed as part of the problem in the past. And we've been received with open arms and working very hard with the leadership to make these changes. The peer action team is tracking some of the major barriers to advance recovery in Santa Barbara County, and making recommendations to the steering committee A peer committee of crisis action team is identified critical roles that consumers and family members and staff can play in a cost effective crisis management response.
Peers serving as change agents are actively working in the steering committee to advance wellness, recovery and resiliency. For example, the term system of care has now been changed to system of care and recovery which is one of those key systemic things that will sustain our values over time. Another example of the new spirit of collaboration is the formation of an exciting new support group titled Hearing Voices spearheaded by community leader Catherine Beltaran.
As a result, people directly impacted by the mental health systems are being listened to and they're finding their voices. They are now participating in the changes of our community wants and deserves. Although much work lies ahead, consumers, family members and advocates, ADMHS staff, partner agencies and the community at large provide an active participant in the process.
With your continued support together we ensure that our families and friends and neighbors with disabilities are offered pathways to wellness and recovery. And this is a very dedicated group of folks that's been well received and is working arm-in-arm with the leadership of this committee.
So the other key partnership that we're going to hear a report on now is the partnership between management and the folks doing the work. Clinicians both within ADMHS and across the community, and how that gap has been spanned. And we have here one of our change agents, Mr. Carlos Olsen who's a CARES clinician.
Good morning, Chair LaVanina, members of the board. My name is Carlos Olsen. I'm a therapist with ADMHS Cares in Santa Maria. Unlike before this is a new and exciting time for us that values inclusion and partnerships. Change agents are individuals who represent and are empowered to have a voice for department staff, community providers, peers, families, those we serve, and other community agencies.
Change agents like myself are passionate to advocate for designing and implementing a system of care that focuses and values continuous quality improvement, aimed at providing excellent services for people with complex issues. Anybody can be a change agent. Since the TriWest report, we have gathered monthly to work together and to partner with leadership to help transform our system.
As a group with the support and guidance of the consultants, we've provided recommendations to help design recovery centers that will meet the needs of people we serve including those previously underserved and unserved. We have also provided recommendations on how to engage clinical programs in systems change. We've received training and continuous quality improvement, and in providing welcoming recovery oriented services.
We're excited about the many opportunities to participate in systems change at various levels. Including in quality improvement action teams, work groups, department committees as well as efforts undertaken and individual programs within them and among them. Our input is encouraged, it's welcomed, it's valued, respected and it's incorporated in these efforts.
Department leadership has been visiting us throughout the county to communicate and collaborate with us addressing questions and concerns. I'd like to offer just some thoughts now from my fellow change agents regarding the system change process. I am grateful for the training for supervisors. I wish I would have had this years ago. I've been given so much useful information, had many questions answered and really enjoyed getting to know my colleagues.
I look forward to upcoming trainings and I'm grateful for all of the support. I'm feeling very hopeful and empowered in our new era of ADMHS. Another change agent says, I've worked for the department for 13 years and have been frustrated at the challenges we have faced. I am pleased to be a part of the current systems change process because it values principles such as mutual respect, dignity and empowering of those we serve and employees.
We're grateful as change agents for the support of the board, the CEO's office, our department's leadership and the consultants. Although much remains to be accomplished, the transformation of our system can and will be realized with continued support and collaboration with our stakeholders. Chairman Lavinino, members of the board thank you very much.
Thanks, Carlos. Carlos is up representing 147 change agents working across the county on this so it's a lot of folks behind him and that's the kind of thing I think Supervisor Carbajal that makes this something I'm hopeful is not going to go away anytime soon. The next person to talk about partnerships with other agencies is Miss Cecilia Rodriguez, Executive Director of CALM, to talk about how that's going.
Good morning, Supervisor Lavanino and supervisors. I'm here to give you a couple of examples of what it means when change happens where the rubber meets the road. When we formed the community-based organization coalition, the CBO Coalition last June, we weren't sure how that would be received. But it has been a wonderful change for us and it was a surprise frankly that the department was so open to input that we had.
We wanted to bring our ideas, our expertise of all the contractors To this change, which was transformational. And it was interesting that we met both adults and children. Some of us had never been in the room and met the other contractors before. So it was really wonderful for us to be together and also define that openness in the department. We participate, there's a CBO partner that participates in every action team.
And so we're part of this and right embedded with all the other partners. One thing I remember Andy describing that was a problem for us as the CBOs was what was called the quarterly scorecard where He came in and were, it was our quarterly trip to the woodshed is what it was. Replete with red lights and green lights and caution lights. And it felt really demoralizing and disrespectful frankly.
And that has changed, the department now we're working together towards a joint quarterly review. The same metrics are there, the accounting metrics are still there. We understand accountability, we want to be accountable but the process of that has profoundly changed and we're very grateful for that. We feel like partners. There's another example, the children's system of care.
There was a time maybe six to eight months ago when there were children that were on a wait list, the huge bottleneck. Children weren't coming through the doors and there were those of us on this other side, on the service provider side that weren't getting enough referrals where we were idle because we couldn't get people through the door fast enough so we worked together in an action team to resolve that bottleneck, to redeploy staff so that we could get those children assessed and to the right service that they needed. And it happened very quickly when we all worked together.
Finally let me tell you of something that's hot off the press that has happened because of this coalition. We've been approached by the Santa Barbara Foundation who wants to give significant funds to the coalition In order to prepare us and by association, the department for the changes that will be brought by the Affordable Care Act. We had someone come before us just a few weeks ago.
And so that's another benefit where the community and one of our community funders through the coalition will be able to benefit everyone. It's really wonderful when there's a partnership between the department and we welcome the change. We're very grateful for how things are being done now. And it's a profound difference, so thank you very much.
Well I think those examples that Cecilia used speak very well to how we built on the performance culture of the metrics, the sound metrics on the financial side but now they're being used in a different way rather than being said you must do this is now how can we do this together and we see solutions emerge as opposed to conflict. We're going to shift now, and I'm going to have JT's leaving. And we're going to have the other Michael, Michael Evans come up so that he and Michael Craft can really present as a management team which you may recall we didn't think you had a year ago. Now you have a management team functioning as a team. You had managers, you had executives but the team part we're here to show today.
And if you recall on the clinical side, many of these related to the systemic findings. There were many strengths or many good programs, many good clinicians but people were getting stuck just like Cecilia said we had people in need and people who had nobody to see on the same day. Insufficient access at multiple levels particular barriers related to race, ethnicity, language and Michael will be able to elaborate particularly on that, Michael Kraft. I can say Michael and you'll know one of them will do it.
And remember a lack of policies too. It wasn't just that we weren't making good decisions, we didn't have good guiding documents internally to tell us how do we make decisions? And the lack of integration and severe gaps for people with complex needs. So we have our Chief Financial Officer and our Assistant Director for Clinical Operations here to talk today about how they have partnered together as part of the executive team to begin to change clinical operations in the functions there.
Supervisor Carball has a question.
Thank you. It's not so much a question as an observation and a statement. When all this was being put together, all of us as supervisors gave a lot of suggestions and names of who we felt should be approached to be part of this effort. And I'm sure many of you in the audience Are part of the natural organic stakeholder outreach that we did. And I'm sure that it's also many of the folks that we up here identified and recommended.
There were three people in the audience that, in particular today, Dr. Casas, Patty Bliss and Cecilia, that I suggested would be essential to this effort. And the fact that all of them think this is a positive effort going forward, for me it's very insightful. Because I think there are three individuals that I have often times looked to in this particular area and they themselves are obviously believers that this is actually occurring, that we're making great strides and for me it means a lot so just want to thank you for including the folks that I include. There's other folks as well but there's three people here in the audience and I also wanted to add a reminder that as we move forward, we have this effort and everybody could be a change agent.
But after awhile, I think you need to be mindful of the fact that it becomes also an inadvertent closed effort of where are the change agents? And I think every supervisor at all levels in the department needs to have an open door policy. And unless you stress that to all your employees, you're not going to get their perception of how this whole change thing is affecting them who aren't considered the change agent.
Let them come in and tell every person, you know what? All this is great but see this thing? This is still problematic and you need to create a culture where they're coming in and they don't feel that their job is in jeopardy and that you truly value their input. Because if you see a lot of the same problems in the organization, from rank and file employees that aren't part of this effort.
This is all a special click and there are a lot of things that are happening but you're not going to really transform the organization the way you want to transform it. And I highly encourage you to create that culture where anyone can come to anybody who's part of this effort, especially the supervisors, and point to you some things Glaring, problematic issues.
And at the end of the day that's really what's going to I think achieve for us the true culture change that we want not just everybody who is involved so. And I say that because I stay in touch with a lot of those rank and file and there are still a lot of issues you need to resolve.
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So Chair Lavinino, members of the board and Supervisor Carbajal thank you for your suggestion participants. You can see that they are producing good effort and your comment about our inclusion of staff I think is a point very well made it's very insightful and I will give you my personal commitment to attend to that One of the responsibilities of my role is doing that and the way that the change effort has rolled out, the steering committee got going long before my position was filled. And so I stepped into my role in November and involving staff has been slightly stymied by the fact that we were down two regional managers. So we simply just had some organizational issues in terms of filling positions. Those regional managers are now in place, and we started a training with supervisors over the last two weeks.
So we took a full day to orient the supervisors to their role both in basic operations but also in system change. And so that will be an ongoing effort. So clinical operations, one of the major findings is that we had pockets of excellence throughout our system but we had silos. It was very difficult to navigate our system of care and so with our current structure with ADP, with the mental health side and also consumer empowerment all reporting to me We meet together weekly and so that's the first time in the department that that's ever occurred. So we're addressing those internal barriers while at the same time our primary effort has been focused on access to care and so we conducted an access survey, Dr. April Howard did then she has gone out to all clinical teams everywhere who are interested and the findings that come back have been consistent across the department that we need more staff and we need more clerical support But also, we need to centralize the access function and simplify the transfer process.
And I think the example that Cecilia gave is a wonderful example of how system change can work because we had a rigid rule that was not in a policy anywhere that CBO staff could not do initial assessments in the children's system. And so that was creating a bottleneck because we were downstaffed in one of the clinics yet we had unused capacity. So we took a look at the process and changed the rule.
We're focused on improved integration with our public health partners, and the SBIRT is an example of how we're moving that forward. And then the full integration of mental health and substance abuse treatment is one of the things we're going to talk about this afternoon. Our community partnerships with our application for the SB 82 grant, we've partnered with Cottage. And we're looking to partner with Marion to create a facility in the North County that would actually provide in-county psychiatric beds for youth.
Mr. Kraft? Yes. I think Supervisor Farr has the same question we all do. We hate to say we don't know something, but- I'm sorry.
But what is SBIRT? I'm sorry.
Yeah, so I know that we're running a little long and so I was trying to move quickly. So thank you for that. It's the Screening Brief Intervention and Referral to Treatment Tool. And it's in a-
Yeah, I knew that.
That's what I thought it was. You're the
only one who didn't know a
supervisor. All right, thank you for that. All right next
slide.
And referral to treatment. So it's an example of the screening that occurs in a primary care setting that can lead to specialized care and how do you integrate those services? All right, next slide please. Okay now we're ready. So TriWest also recommended that we develop specific work groups and there have been parallel but complementary efforts. The first is through the Steering Committee and the Constitution of Action Teams in those five specific areas and that process occurred as need was expressed within the system so that was not done in a top-down fashion it wasn't done through the executive leadership of the department but it was done in response to the community expressed need Each of these action teams is organized around the goal of improving access, and then each action team is empowered to define the specific changes that need to occur within their domain.
So you heard about the children's action team and attention to bottlenecks? The peers' action team came forward with the first request to the steering committee, and their request was that instead of making clinical decisions primarily based upon payer source, That we make clinical treatment decisions based on clinical need. I'm sorry, you're right. Thanks for the clarification.
Yeah, no, I appreciate that. So actually it was a cultural competency and diversity action team. The peers have come forward with a request for an expanded role for peers throughout the system, and that request was responded to with the identification of peer roles in the SB 82 grant. So out of a team of seven and a half within each region, two of those will be peers.
The change agents play a key role as you heard Carlos describe. And then, as I said earlier, we're training the team supervisors in the system change model and the CQI process, continuous quality improvement.
Supervisor Wolk?
Thank you Mr. Chair. I just want to make sure that I heard you correctly. Did you say that in the past treatment decisions were based upon ability to pay or whether or not someone had Medi-Cal?
Supervisor Wolf through the chair, yes. So if and we're going to go over this in detail with our MHSA presentation. So if you came into our system and were indigent meaning that you did not have any payer source then if you qualified for one of the MHSA specialty teams and your need was high enough in the adult system then you could access one of those teams like supported housing or act If you did not, then you would receive your care at the CARES Clinic so that all of our consumers who didn't have a payer source were treated at the CARES Clinic. So the decision about where you went for treatment was partly dependent not just on your clinical need but on your payer source.
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One person who's got a severe mental illness, one is indigent and one has Medi-Cal. So it sounds like the indigent person would go to CARES. Where would someone go if they had Medi-Cal? Would they have a psychiatrist that they would see?
So both would have a psychiatrist, so both would receive the basic services that are needed. So case work, psychiatry, psychotherapy. But if you were indigent, you would receive that at the CARES clinic which is not how it was initially designed. If you had Medi-Cal then you could go to the Foster Road Clinic or Calle Real and those teams were more robust and better equipped.
Well, that is just shocking to me. But thank you for sharing that and Boy, if that's one of the changes that we see, that's a really good thing. And as long as I have the microphone, I also want to say to Cecilia thank you for bringing up the other issue for the children's treatment and care. These two issues are so important. I love all of these charts and all the verbiage, and everything is very informative. But for me sometimes it's really good to just almost hear a case history or case story. So for instance, the gentleman, the clinician from CARES.
It would be good to hear, and if we have time where I can talk to him separately, but what is he actually doing different now with this system of change? How are we actually seeing the improvement for the consumer So as much as you can, as you move forward with your presentation touch on those things that are easily understandable and that we can actually see at the ground level the improvements.
Supervisor
Carball? Thank you for me out of this entire process improvement effort what was most Shocking to me was what I just heard and I heard that before this hearing that we were not going with What what was the most need and the best treatment approach but rather? Hey if you can pay or pay some You get ahead of The line for the better treatment than others, and I'm really really glad to hear That we've embraced a different philosophy. I think It's troubling to know that we certainly, I never really understood that we were doing that.
And I'm really grateful to the Culture Competence and Diversity Committee that this was something that they identified as an inequity that needed to be addressed in our system. It's always great, these efforts lead to identifying how we can improve and I'm really grateful for that.
Chair Labanino and this is responsible Supervisor Carbajal and Supervisor Wolfe. I think it's important to clarify that there was no policy, but I think that was the issue because there had not been a policy promulgated. This was something that just had arose, and I think we all took some time to realize. And I think if you had asked me a year ago, was this the policy? I would have said there were barriers around it, but it actually took a couple months in the work by the Cultural Competency Committee. And to get to your point, Supervisor Wolf about how that changes people's experience. We actually took folks from El Nuevo MNSR, the support group who had helped us identify a lot of the issues and we said would some of you who are in need of services be willing to step up and help us figure out how to get you services?
Show us what the barriers were and this was the first thing. The Latino Advisory Committee had previously pointed this out, but I think this really helped us get to the level of detail in individual people's lives about it wasn't just a matter of changing the policy. That was the first step, but then we had to actually deploy staff to make sure people understood that that wasn't a policy. Particularly if people had concerns around documentation or other barriers where they had severe needs that were getting served sometimes only in an emergency room. Working through that was critical and so you wouldn't have been able to do that without those folks at the table. It was very essential. And so now we have a policy, now we have leaders, now we have a rational framework that's actually being able to achieve the goals that you as supervisors get closer to that.
I mean, we now have it as a goal.
Thank you. And Chair Lavanino and members of the board, we also have a plan and that's the MHSA Plan Update. And Mr. Evans and I will be presenting this afternoon along with our partners exactly how we propose to do that. So
moving to the next slide, our next topic is metrics. We had a robust series of metrics that fiscal had been using and led to substantial fiscal improvement Yet, they were glaringly absent on the clinical side. And so we have moved to create a series of metrics that can be used by regional managers and team supervisors initially focusing on treatment plans and keeping those current.
Our time to psychiatrist is a relatively simple metric We're looking at our high utilizers, so who are those within the system who are consuming the most care and how effective is that? And then we begun the selection of individual outcome measures that will guide the level of care for each consumer. Through this effort, we've been able to drop the access to psychiatry time by 40% since the initial report.
It's a good start. We have a long, long way to go and it's an achievement that was done despite the fact that we have approximately six vacant psychiatrist positions. And so it's an example of process improvement.
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Supervisor Wolf?
You know, when I saw this in the report it still was shocking to me. That was one of the things that TriWest had pointed out and I think I commented back then about the wait times and you're obviously moving in the right direction What I think I heard you say is that we need to hire additional psychiatrists as one of the issues to remedy this situation. Is there anything else that needs to happen?
Supervisor Wolf through the chair. We also need to hire some additional clinicians because the way that the process works is there's an additional screening, there's a initial screening that happens that determines the need for access to psychiatry and so if we have inadequate clinicians in place then we're also delayed in getting access to psychiatry.
So if I could just ask another question and maybe Dr. Watta can help me with this because we both serve on the CENCAL board And now with the Medi-Cal expansion, there is additional psychological services that are available not just to single men but just the services are much more robust. I think we have contracted out with an individual provider who has a list of, I guess it's therapists that will provide those services. So how do the two systems, how are they coordinated with what is available through CENCAL? And maybe those are more minor behavioral issues compared to what ADMHS is able to offer.
Correct. Supervisor Wolf through the chair, you are correct. So what goes through CENCAL is what can generally be handled by the primary care system and then they have a network of providers through the Holman group I think that's who you're referring to. We've been working with CENCAL and the Holman Group for probably at least six months maybe longer than that closer to a year. On developing these protocols of how transitions happen, because you're absolutely correct. People may start out at a lower level of need and then escalate to a higher level transition to our system than have to go back. And so we have flow charts and systems in place to handle that. And in terms of your question about needing additional staff We have psychiatrist positions that are vacant, that we're working on.
But a lot of the other positions that we need are actually part of our budget expansion requests that were presented to you during budget workshops. And they're funded by primarily Affordable Care Act, by our grants that we've obtained so that they are there already.
Very good, thank you. Thank you.
Supervisor Farr?
Thank you, Mr. Chair. It is wonderful to see this improvement in the wait time but of course it is still too long. So I guess my question to you is that what is the goal that we're shooting for here? For how long between somebody needs to get in and they're actually seen? What does that performance measure and how does that compare to comparable counties to Santa Barbara?
Supervisor Farthuri, the chair. It's a wonderful detailed question. Thank you. So we are looking at a range of options for access to psychiatry and for those who are in crisis who need access immediately our goal is immediate access. And so one of the models that we're looking at is open access With the implementation of the SB 82 grants, we're going to be adding psychiatry to those teams so that we'll have psychiatry available 24-7 for crisis situations.
Currently, we don't make a distinction between the level of need and so one of the problems with this metric is that it doesn't allow us to categorize and have a process for determining how to access. So how we compare with other counties is at ranges. We are actually doing better than some and not as good as others. The range is anywhere from 10 days to where we started, which is in the 60's and 70's.
Okay, so that's ten working days? Yes. So two weeks? Yes. Okay, so if we could, we're going to get it to a system where people and children that are in absolute crisis they're seen right away but after the initial assessment if it looks like they don't need to continue in the crisis path then hopefully they could be seen within a two week period.
Supervisor Farr through the chair, absolutely. That is the goal is access to care as it's needed and as we're going to talk this afternoon of course one of the great benefits of that is that care delivered when it's needed even in a pre-crisis situation reduces the load on the back end of the system. In other words the use of the higher cost system and if we Don't provide that care quickly, then sometimes we force people to go to the ER and we create difficulties for partners. And it goes back to the triple aim that we're also creating a poor experience for our consumers.
Okay, well just Mr. Chair another follow up question I'm particularly interested in it for children so let's say something happens at school the school nurse is involved it's alerted and then there's a referral from the school so In that kind of a situation, because there's kind of an extra step in there. Is that still accounted for in trying to get some sort of an assessment right away and then a decision as to whether it is a crisis situation or whether we're looking at two or three weeks before our child could be seen?
Supervisor Farr through the chair, it's the same. So our intention is to do that with both children and adolescents and then adults as well. And as we're going to talk this afternoon, we'll be creating mobile crisis triage teams who can do pre-crisis work. And so they'll be able to go out into the field.
Okay great thank you
I have a question. Dr. Waters, so just so I get my head wrapped around this as well. So in your budget expansion that we went through in the workshop, does that get us to that two week turnaround? Or where does it get us?
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I don't think it's good news if no one's yet, okay. Yeah, I have great respect for Dr. Watt and so defer whenever I can. It will once the psychiatry positions are filled. So that's the crucial element at this point. Okay, that's
what I wanted to know. Thank you. Supervisor Carbajal? Despite this 20,000 foot effort in leading this restructuring, do we also have somebody who deals with the immediate challenges that need to be addressed? And the reason I say that is that I brought an issue dealing with carpentry and I know one of my constituents is probably going to say something in a while. And I know that's finally come to fruition, but it took three to four months to do something that I thought was relatively simple. But I'm not an expert and I'm just wondering if we have somebody at a high enough level that can take on these types of projects and deal with them effectively?
While we're working on this transformation. I know I sent Dr. Watt another item recently, I was at the task force on youth violence and gangs. And I was shocked to hear that in the South County, the Quetzal Academies which is the schools that deal with children who are high risk for maybe perhaps one of the many issues as mental illness. We didn't have the type of partnership.
With that school, that we really need to have. And actually I was there with Mr. Delfino from social services and this was being raised and we just looked at each other and I immediately called Dr. Wada but these are the types of things that I think You kind of wonder who's dealing with, while we're dealing to kind of do this restructuring. Who's dealing with some of the immediate things that need to be taken care of on a day-to-day basis that are issues that come up?
Dr. Wada?
Supervisor Carbajal through the chair. One of the challenges we have is that we're trying to implement all the systems change on top of our regular day-to-day operations, and so we do have challenges in terms of getting people to be assigned to special projects. We try to distribute that throughout our existing staff. Going forward, we've identified with all these changes and all these new grants that we are going to need more project managers to help guide us through that.
And we do need to strengthen the supervisory ranks, and so a part of our expansions over the last several months have been to improve that span of control and bring on more supervisors. So we're trying to address some of these issues but I think you're correct that when individual items come up they do need to be addressed in a more timely manner and we'll have to just distribute that amongst the staff that we currently have.
Thank you.
All right.
We had, we have both Michaels here and you may recall that our main recommend actually before I move on. I just want to point out the 40 to 45 days that things are at it's a tremendous improvement but and I know y'all pointed out that we need to go further on that. But I also want to point out that it's still really long time so this is good progress there's a sound The format now in place for you to make these improvements, but I think that particular statistic underscores why you don't only hear rosy things in between these meetings because it's still a pretty long time. So I know that was obvious, but I just want to underscore that. Because that's what consultants do, is we underscore obvious things.
So moving to the finance piece, you may recall that our main recommendation here was to don't lose your progress. Keep the strong financial controls that you had in place and build on them. And particularly look at expanding the management structure so that you had clinical leaders within and clinicians within as well as external partners working together on this. So it wasn't just we have a financial issue. Finance has to go fix it, so finance would actually have the operational partners internally and externally to get things done. So here to lead our discussion on that is our CFO Michael Evans.
Good morning to the chair and to the board. Next slide. So ADMHS continues to utilize the financial tools and systems that were established in 2009, in order to maximize revenue and to minimize cost report liabilities. So this was evident by the department ending fiscal year 12-13 without requesting additional general fund. But as I have stated on numerous occasions, the department has faced a structural funding imbalance for the last ten years which we face again in fiscal year 13-14.
But we are confident that going into fiscal year 14-15, the county will address this through the adoption of the 14- 15 budget development policies to establish an audit exception reserve of at least $1 million as well as TriWest's recommendation to establish an operating reserve. It was also noted in the Tri-West report that fiscal was driving the direction of the department. While fiscal is no longer steering the ship of ADMHS alone, we're now steering it with programs. So program staff develops the programs and services to be provided and fiscal figures out how to fund it while making sure we do so in a cost effective manner while also following all applicable rules and regulations.
The Tri-West report recommended that the county establish an IT task force to review the department's IT slash MIS capacity. The county did establish such a task force comprised of experts from different departments, The task force performed an assessment of ADMH's IT and MIS capacity, and then presented recommendations to the department to increase IT and MIS resources in order to develop and maintain adequate data systems. So that programs and fiscal staff can make data informed decisions in a timely manner.
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And so consistent with that shared leadership, our current Information Systems Steering Committee is co-chaired by one of our line clinical staff.
Supervisor Wolf?
Given that the auditor's office had been so intimately involved with some of the issues that we had in the past, are they still involved? Are they still one of your partners
Yes, through the chair and to the board. We have a regular scheduled meeting between ADMHS fiscal staff, auditor controller staff and the CEO staff that happens every other week.
Very good thank you.
So beginning this year, the department is using the MHSA plan update to drive the 14-15 recommended budget which you will hear in more detail in the next presentation. As part of the 14-15 recommended budget, the department formulated a funding hierarchy for the leveraging and best use of MHSA funds, realignment revenue grants and limited general fund contribution in order to maximize the use of our funding sources.
Our Revenue Management Team which was established in fiscal year 12-13 continues to maximize our revenue sources and reviews our revenue cycle on a continuous basis.
Supervisor Farr. Mr Chair, thank you. Mr Evans I just need some clarification here. So at the bottom of the, I think it was the previous slide said you had in a box extinguished or fully funded all liabilities through December 2013. Two slides before that, it says status that ADMHS finished 12-13 without requesting additional general fund. First time in many years and then as a budget development policy adding $1 million a year to the audit exception reserves so Maybe you could just kind of clarify all of that, because we certainly have put an enormous amount of money or booked an enormous amount of money for ADMHS. And so it would be good to know where we are in these different categories. So I'll just leave it at that and let you take it away.
Through the chair and to the board. So in December, we came to the board in which we updated the board on where we were at with all of our known and estimated cost report liabilities at that time. And we showed which ones were fully funded, and at that time we asked for I believe this was about $700,000 of additional funding to put into the audit reserve account in order to fully fund all the known liabilities that we had at that time.
We also showed that of the approximately, I believe it was about $18 million worth of liabilities that we had presented a year before. Half of those had actually been extinguished and so As of the end of calendar year 2013, all of the known liabilities that we know as far as cost report settlements and audits have either been extinguished or have been fully booked. And there are funds set aside in order to cover those.
Okay, actually let me just. So it was $18 million, $9 million was taken care of. $9 million is still there but what you're saying is that there's $9 million set aside to cover that if we need it? It's not booked.
Correct, I'm sorry to the chair and to the board. So all of the liabilities that we've known which go up through fiscal year 1011 have either been fully extinguished and paid off or they have been funds set aside in the audit exception reserve in order to fund them as they come up.
Okay, so going back to your 18 million take away 9 million with 9 million left. So we have 9 million in an audit reserve pot someplace? No. The CEO is shaking her head no, so maybe CEO Miyasato you could help me here.
Board members, I just had emailed Tom Alvarez and so I just want to confirm with Michael. We have an audit exception fund balance right now of $2.15 million. And that's the reserve fund that you created for the cost report settlement issues. In addition, you have your contingency fund balance, a different fund. And right now you have about $2.3 million and that's for different things that come up through the year. And of that amount we had thought that we would need more money for the PUF and so we had always thought if we need to draw money from that we would have fun in the contingency fund balance. But on a final note, I believe that the last two cost reports and Michael can talk about this filed with the state indicated the county was due refunds.
And so these may be between 1.5 and $2 million but we won't record that in our books until we get final confirmation.
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To the chair and to the board. And so at the time when we came in December, and we updated you on those fully known liability amounts. Since then, we have transferred a substantial amount of those funds into our operating budget. And so there's approximately $7 million that has been transferred into our operating budget. To actually pay and extinguish those known liabilities at that time.
And so I can get back to you on what the actual numbers are, but as of the end of December we have either extinguished all the known liabilities or we have fully funded them. I can tell you that much. I don't remember the exact numbers, but we can give you the exact numbers.
Okay so Mr. Evans said the seven million that then was transferred into your operating budget to take care of that, that was money that had been sitting in a reserve account? That had been booked previously out of general fund from earlier years?
Yes.
You know I think if we could get a one-page accounting of where we are Because I just have to say that when I see extinguished or fully funded all liabilities through December, that warms my heart. But then the previous page says that we're still putting a million dollars a year into an audit exception and so I just want to know, have a clearer sense of where we are because we have put an enormous amount of money into the department. And clearly this is a great report and we're working on improving in so many areas including the finances. But we have a desperate need for this general fund money in other areas as well. And so if things are going to straighten out to the point where we don't necessarily need to consider putting $1 million a year of general fund into an audit reserve, I'd like to know that too.
Thank
you Mr. Chairman. We're going to be around for a few more hours discussing this issue. So if Mr. Alvarez, I guess he's listening. If you could put that together and trail this, I mean trail that part of it to bring it back even if it's at the end of item four would be nice. Otherwise we can hear it later Mr. Gazzone.
Chair Leveny now and supervisors. I'll just note that as part of that we also currently have live litigation with the state on fiscal year 0607 and 0708 audits ADMHS Medi-Cal programs with about $6 million in disallowed costs, and that's part of the formula. And those litigation pieces go on literally for years so that's part of what you're asking about.
Okay, kind of forgot where we
were but I do want to just in comment before we close out the last piece note that Mike Geis, our consultant in the financial area had and this is particular to your question Supervisor Farr. Recommended that there be a routine reserve. Now, obviously you all have to make hard decisions about how you're going to use your funds but that is a typical practice in counties not when you know things but really truly for actual contingencies as opposed to having to use your contingency funds like you have historically to deal with things you knew were out there. Once you get caught up still having a reserve we actually recommended 5% of Medi-Cal contingencies would be the prudent thing so I just want to clarify that recommendation had been made and obviously you have many things to weigh.
On the administrative side, and I think this gets back to a point that several people made about you've got this big change process but who are the people actually doing the work? Who are the people actually responding like Supervisor Carbajal mentioned two issues that arise. One of the big gaps that we had talked about on the administrative side were that those positions were vacant. You had supervisors with a span of control, in many cases over 20 individuals which means basically you had no control. So our main recommendation in this area was to build on the financial and contract oversight processes, the mechanics that were there but to begin to fill the gaps in clinical administration.
Your five year vacancy in Mr. Craft's position, a very part time medical director not allowing sufficient need to deal with the administrative tasks that need medical oversight and numerous management and other vacancies as well as gaps in the utilization management system which is the management system you use to track those folks who have higher costs try to figure out whether there's alternative things to do. So our two members of the executive team, Michael Evans and Michael Kraft will continue to report on status there.
So all department administrative programs such as fiscal, IT, MIS facilities, medical records and quality assurance are now under the oversight of the Deputy Director of Administration in Finance slash CFO where we coordinate our efforts in order to support program staff.
3:09 – 3:146 turns
And so as part of this effort too, we have increased the number of supervisors that we have and we are adding them in phases reducing the span of control and promoting the system change effort. So next slide. So in addition, we have also through our reorganization split out the quality improvement function and move that under the Office of Strategy Management. So we are emphasizing the quality improvement and making that part of the culture.
And then focusing separately on quality assurance and utilization management.
Okay, so I am going to be going over these very quickly. So back in the last summer this was what we proposed as our transitional organizational chart. We've made some modifications since then. Next click. Next click. Administrative deputy at this position went away and these functions were redistributed through the rest of the deputies We established a chief of compliance per Tri-West recommendations that reports directly to the department director.
Some of the functions such as human resources, that went over to the business center model with downtown HR. The medical director was moved up to full time. The Clinical Operations Deputy, Mr. Kraft was brought on board. A number of programs consolidated under him to ensure integration so alcohol and drug, MHSA as well as clinical operations. We developed a new office of strategy management so instead of being reactionary we're now more forward thinking and that's coordinated in alignment with all of our values and visions and policies, communication et cetera.
The Chief Operating Officer, that position we had for the first six months. That was by plan. That position has been phased out so the functions that reported up there have now been redistributed again primarily to the CFO who's now a Deputy of Administration as well. And then we have the Director of Public Health and ADMHS and I believe the recommendation is to continue the departments as separate entities And having a recruitment for the director of ADMHS and going forward. So this is then that cleaned up chart with everything indicated, Office of Strategy Management, Medical Director, the combined CFO, Admin, Clinical Operations Deputy and you have the consultants over here, the Steering Committee and Mental Health Commission and Alcohol Drug Advisory Board.
Maybe this is to Ms. Nisic, what is the exact status of the recruitment for the ADMHS director?
Supervisor through the chair we are beginning that process right now in fact tomorrow Mrs. Nisic and I are meeting with most likely recruiter that would be working with to start framing that so we're starting that process basically tomorrow
So you know, this whole system of change I think some of you have talked about. You know it starts at the top and then Supervisor Carbajal talked about the morale of the department and this position is so incredibly important to the success of everything that has been going on. And so I'd like to know how this recruitment is being coordinated with system of change operation when we look at the recruitment materials. I know in the past, the Board of Supervisors has looked at the recruitment information to make sure that it meets our expectations.
Is that information being shared with a larger group? What's the process?
Yes, Chair Lavanino and Supervisor Wolfe in a variety of ways. First of all I should mention that the recommendation to hire the director is brought to you by both at the steering committee as a whole and the Mental Health Commission. We have discussed this in terms of the overall status of the department and next steps so that is basically a joint recommendation brought to you for consideration or was brought to the CEO for consideration and we're moving ahead on that.
Both the Steering Committee and the Mental Health Commission, as we have discussed with them, certainly we would suggest being involved as part of the stakeholder and outreach process. One of the key items that were in fact pointing to is part of the recruitment is what Mr. Turner referred to in terms of our guiding principles values and goals. It's been discussed on numerous occasions at the steering committee that these values, goals, and philosophies really shape the hiring of the individual.
So we really see that as being part of the overall recruitment plan. In addition to that, our potential recruiter, we have asked that individual to fully review the prior presentation to the board frankly back in May so she understands the magnitude of the issues And also reviewing this today to understand how the department's been transformed and looking at the unique qualities of a potential director in transforming a department. So, to answer your question very long way around yes we see the community of stakeholders being very much involved in this process.
3:15 – 3:202 turns
Chair Lavinino, members of the board. The last part we want to talk about is where we're at in terms of the compliance function. So joining us here is our Chief of Compliance Celeste Anderson and you'll notice that Michael Kraft is still sitting here because now rather than having one person that's responsible for both compliance and operations, we have split that so that we can actually have an independent compliance function which was one of the main recommendations we made. The others though, in addition to lack of independence was also the lack of joint ownership. That you can't just have a compliance person saying you gotta comply. You really have to have people owning that together and I thought it was wonderful that Michael said one of the main clinical things they're doing is trying to get treatment plans updated.
That's now thought about as a clinical issue as opposed to being thought about as a compliance issue because it is a clinical issue so I will let these folks talk about the status of that.
Good morning Chair Lavinino, members of the board. I come to you today as the new dedicated Chief of Compliance for ADMHS and I have really enjoyed my nine months in this role. I would describe to you as one of the core responsibilities of the function is to ensure that the department is in compliance with all federal state regulations statutes as well as with our contracts with the state Our contracts with the CBOs and our own policies and procedures. So that ranges from the Medicare and MediCal laws, our welfare and institution code governing mental health, alcohol and drug services. So it is a broad swath of responsibility.
Consistent with Supervisor Carbajal's comments however, the approach that the department has taken to ensure compliance Is to be inclusive and opening to all constituents because this is a job that I feel I can't do alone. So, I have reached out to the executive team, the auditor controller, risk management, our staff, our clients, our CBOs and ask them to help me in order to achieve the compliance with all of these requirements.
So as a cultural change, I'm hoping that that open door and that welcoming approach will make a difference. We'll make people aware that the idea is to solve the problems and to address the issues in a constructive way, as opposed to trying to attribute blame to any one person or any group. One of the primary responsibilities as recommended by Tri-West was to conduct a risk assessment. So that was one of the first objectives that we pursued through the compliance committee.
We engaged all managers to share information as to what they thought the greatest risks for the department were. And then through that committee we reviewed these risks and we chose the four top issues that we wanted to address this year. And as you see, access to service is one of those consistent with the comments that you've heard from my colleagues. It's a focus for all of us that are involved at the executive level.
Next slide. I also want to highlight that we approached the audit in a slightly different way as well, in order to ensure that everybody who's part of the system was involved. So we're thrilled to be able to report that on our administrative protocol, we had a 93% compliance rate. And as we closed our audit process, we invited our CBO partners to participate and hear the feedback from the auditors. This was something that had not been done before. So everybody was very clear that this wasn't just a message coming from ADMHS. It was a message from the state and something that we all needed to work on in partnership in order to continue to increase compliance throughout the system.
So I also want to highlight what is another special project for me, which has been launching our contract compliance effort. And as many of you are aware, I've worked with ADMHS contracts for years and years. And at this point, I get to assist on the other side. So the goal has been to have regular meetings with the CBO partners and talk about their contracts, talk about how it's working out, what isn't working Are the performance measures the right measures? Are there elements to the contract that need to be reconsidered, renegotiated the next time around. So this is something that had not been done before and something I had wanted to see done over the years so it's really exciting for me to be a part of this process and to continue to expand the working relationships that we have with the CBOs.
3:20 – 3:269 turns
If I could ask a question in looking at this how are you defining major clinical contracts under the revisions of scopes of work. What is a major clinical contract
So we're talking about really what the CBOs that partner with us in providing services. And so, in the past the scope of work was very regulatory. So the reference was to the state regulations in defining that scope of work and as you've heard before there wasn't a lot of negotiation in the contract process because Critical absence of the clinical director. And so at this point, working in tandem, the idea is to reshape those scopes of work. So ADP is working on this as well as on the mental health side and that there will be the give and take in creating those on a clinical focus not so much on a regulatory and or fiscal purpose.
Okay, well that sounds really great. But I'm still trying to decide, find out what is considered a major contract as opposed to not a major contract? Is it a
dollar value? Board contracts, I guess that's the
easiest answer. So over $100,000? Correct. So, let me give you an example of why I'm asking this. This happened right after I first came into office. We learned about a contract under $100,000 for somebody who was supposed to be working on alcohol issues in Isla Vista with the property owners. A contract that had been around for a number of years and kind of automatically renewed.
We had some questions about it, tried to get a copy of the contract. Tried to find out how the success rate had been over a number of years. There was nothing there or I never got it. So then what happened was that contract wasn't renewed but it really didn't get to the core of the issue which was who was minding the store so to speak? On these contracts that don't come to the board. Now I don't know whether the department has moved in the direction of not letting those contracts, so many that are under $100,000 but I have no sense of that or how many contracts there might be and And if you are then Who how does that? How did the minor contracts fit into this overall new system change because collectively if you're still, you know Letting quite a few of them.
That's still a significant amount of money and clearly we want to know whether they're fulfilling their purpose
Chair loving, you know supervisor far I know we do have a group that meets every other week that discusses these types of Contracts and projects that we're implementing, and we are talking about both the lower level contracts that we do on a purchase order as well as what would be bigger contracts. So there are systems in place right now to discuss the contracts.
It's also something that would be shared by the clinical programs as to why we have those contracts at all and what's needed. I agree right now, I think there are a lot of contracts that are, I mean we, I think this department has more contracts than probably any other contract both on the board level as well as on the purchase order level and I don't have a more specific answer on that other than I know that in working in current contracts, it goes through our program improvement meeting as a first step to talk about the need for the contract.
How to streamline these contracts and ideally not to have as many contracts to try to consolidate and be more outcome oriented in who we're contracting with. And I can also share this with Mr. Craft he may have something to add.
Supervisor Farr through the chair. Thank you, it's a wonderful question and the ADP group under John Doyle's leadership has taken to in partnership with the Drug Alcohol Advisory Board reviewing performance of all the providers and so the situation that you described is a situation that we should completely be able to prevent given the massive level of system change that we're going through. We're starting with the high-level contracts first and we're gonna work our way down but our intention is to review all contracts In addition, as Celeste was indicating, the previous focus in the contract language was about compliance. And we are adding a clinical component so that we will have clear programmatic description about where the contract, where that service fits in with the overall system and then how we're going to measure those outcomes.
So it's not just about compliance, it's about results.
Okay, thank you. Well I think I asked Dr. Wada about this issue the last time we were talking about it because I said well how could we find out about an individual contract and what the performance measures were and how they were doing? And he said well just ask but I think particularly because this department does let so many contracts that don't come to the board it would be good if you put together a list of all of those and who they were to and what the amounts are And as you go through this process, then they're coded that this is under ADP or this is under crisis or this is this. And this is how we see this fitting into this overall structure because I think that they can provide a really important element but because they're under $100,000 obviously we don't want them to get lost in the shuffle of all this obviously critically important compliance.
And again, on a dollar value they could be $90,000 but that's still a lot of money. Thank you Mr. Chair.
I hope you also understand that includes contractors on payroll, because that's, I remember that grant that she was talking about or that contract. And I know that sometimes we get very comfortable with contractors on payroll and you see their faces over and over again. The civil service doesn't really want that. It's for a specific year or project and we tend to use it as a different, we tend to really abuse that sometimes.
So it's really important to, I think also show those contractors on payroll and what metrics they're trying to achieve and for how long.
3:26 – 3:314 turns
Well the very last part is Dr. Wada talking about where we're going to go from here and Supervisor Lavanino, members of the board I just want to say in closing that you know we probably would have said something nice today no matter what but the thing we wrote into the report was chosen because we have consulted in many systems and the rapidity of change The commitment involvement in the system, the depth of change in a culture is one of the most effective we've ever experienced in this system. And I think these folks are to be commended for what they've underdone and not just the folks that have talked but you know dozens of people folks like Nancy Vasquez who's been critical for organizing things, Lyra Monroe others who and I mean there's many I'm not naming but many many people and I think they've exceeded I think what we would have expected to have happen in a year and I just want to be clear about that before Dr.
Water talks about where we're going next
Sure, so I'll go on to next steps and conclusion. So our next presentation will be on the Mental Health Services Act plan updates. And that will be later this afternoon where we talk a lot about our program redesign and some of the budget expansions that are included in our recommendations. That will then be going forward in the 2014-2015 budget approval process. So that's where we have a lot of our grants and other programmatic enhancements.
Of course, we'll be continuing with our system transformation implementation. We'll be coming back again in June for a presentation on our capital needs or facility needs. And then again in first quarter with a more comprehensive overall discussion on strategy and planning. And everything that we've been doing put together. Next slide, the system redesign of course with our general areas systemic clinical operations finance administration and compliance that you've heard today will continue progress in all of those areas. We've discussed the process to bring on a new director for the department and to keep the departments as stand alone entities separate from public health.
We have a big focus on the measurement of progress, looking at our clinical outcomes. We've developed in order to do this a very robust plan for evaluation. Our crisis system redesign again with facilities and housing supports are going to be critical. Access to services and driving those wait times to assessment and to psychiatrist appointment will still be working on that. And we want to ensure that we have a competent and strong workforce, so we will be working on recruitment and retention.
So those are the key next steps. And so the last slide again is our recommendations, and that is to receive and file the report, to adopt the system change vision values in guiding principles, and to direct us to return on June 17th with the facility needs presentation for our system of care. And that concludes our presentation, so thank you very much. Our last slide has our website, so for the general public we have a lot of information and updates on our website as well.
Supervisor Farth and Supervisor Adam?
Thank you Mr. Chair, Dr. Wada because I think that this well first of all I'm glad that one of the recommendations has to do with coming back for the capital and facility needs but to that end could you go back to this one of these very early slides here at the beginning? This little ladder, the stairs because I think that this gets to the facilities issue and I just want to make sure that we're going to get that information as well right there yeah So, some of these steps are county facilities. But then the supportive housing piece and then the stepping down to the board and care piece are really facilities out in the community. And I know that there's been a lot of discussion about the need for more of those facilities. And so they're integral to our plan here but they're not necessarily something that the county would be providing.
So I'm hoping that when you come back, that you will be talking about facility needs not just for the county's capital side. But how many more board and care facilities you think we need that would be adequate in support of housing? And also whether there is a way that the step down Goes back to more of a supportive housing rather than a board and care, and kind of the differences there between the two of them.
Because as we find opportunities out in the community or groups that want to provide those facilities, it'd be good to know more specifically how many and where in the county we need those to fill the gaps. Thank you Mr Chair.
3:31 – 3:3818 turns
Supervisor Farr through the chair, we'll be bringing that all back as part of that presentation. We'll have it separated regionally and where the gaps still exist and then progress that we're making towards filling some of those gaps so you're absolutely right this is not going to be restricted only to county projects.
And that's perfect. Thank you so much,
Supervisor Adam. OK, thank you, Dr. Wada and company. I think you've probably done a pretty good job here, but I'm still troubled by the metrics and the metrics are just inadequate to me. And I'm concerned that we're really only talking about the performance or efficiency oriented measures versus therapeutic effectiveness For instance, how does value of care measure success?
Wait time. It's a performance oriented measure and how do we define clinical success? And everybody's shaking their head but nobody's jumping to the mic to answer any of these things. I can just read it all if you like.
Supervisor Adam through the chair, it's a wonderful question. It's really at the heart of this whole change and so we didn't talk about it because it's just a level of detail that we didn't feel was appropriate for today But we've selected our first clinical outcome measure that we're likely to implement, which is the CANS. Now, we haven't implemented yet. It's an implementation that will require several steps including changes to our electronic health record.
But when I was talking earlier about the shift to the recovery model as opposed to sort of the Medi-Cal traditional model, that is at the heart of it because the outcome for every patient that we're serving, every person that we're serving is built right into their record And so those data then are available in their record and we're able to do analysis about any individual. For instance, a life event change or a change in medication and did their functioning improve or deteriorate?
In addition rather than having sterile clinical goals which we have historically tended to have which would be something like reduce the reported number of hallucinations by 10%. That it would be, those goals would be driven by what the consumer tells us are meaningful in their life. And so it's a fundamental shift.
Well and that gets me to my next question is do we have a definition of recovery?
We do. Recovery is when people return to the level of functioning that is meaningful to them. When they're able to engage in meaningful relationships and participate In the community and take their rightful place
Okay, do we know how many patients recover?
Currently we don't. We don't track in that way. We don't define in that way. But are you
going to start? Yes.
So we can tell you how many cases we close and even you can hear the language is different. We talk about cases as opposed to human beings.
Yeah, yeah. And I hear that and I see that and it's great but you know I want to have some way to measure the success of the program and there is financial success and then there is therapeutic success and if you're being financially successful I'm not sure there is much meaning in it without having therapeutic success. So what I really like to challenge you guys to do, and I know that you're having these multi-tiered management teams and lots of interaction with everybody top to bottom. Is to come back with at least two measurements that are trackable over time that quantify the success of the system for patients?
Because I think there's different ways to measure success, and maybe some of it is just semantics. But I'd like to cut through the clinical jargon stuff and really get it into language that regular people can understand. And demonstrate that therapeutic effectiveness rather than performance measures for the employees, and demonstrate the effectiveness on individual lives.
Supervisor Adam through the chair. Thank you very much and you have exactly captured our intention and In your reference to semantics in the beginning so much of it is about how we define and conceptualize even what we're doing So you you have really nailed the heart of it? Thank you
Thank You
supervisor to add that I think on behalf of the department I can certainly assure you will be coming back with far more than two measures in terms of our progress
well, you know I say too because I've been Talking to my staff here and trying to find some that we'd like to propose, and we can't come up with any. So it's hard you know I don't want to give anybody something that they can't do. You know I like to give achievable goals and I think You guys know it so well. And I think a lot of times, especially between the clinical community and the lay community we sort of talk past each other instead of really communicating and you know if you could come up with two guys it's going to be hard to come up with two I think that are really meaningful and show the effect that you're having on individuals lives That's gonna be a challenge I think So, I hope that we can come up with two real Real metrics and then track those over time Because I believe that what you guys Know that you're doing.
You know, I cannot know What you're doing? I will never know what you're doing and I will never understand it at any kind of a level that you guys are at And so what I'm trying to do is get something that I can tell people that understand as little of it as I do. That's going to make sense to them.
Supervisor Adam through the chair. A couple of metrics that we already are paying attention to how many human beings are we bringing back from a high level of care where they are out of the community back into the community and maintaining them close to their family and friends so that would be one simple very understandable measure another would be how many people Do we meet who are in crisis that we divert and provide care in the community rather than sending them to the hospital? So those would be two very simple and clear metrics or
even to jail
or to jail. Yeah, yes point well made
3:39 – 3:457 turns
Hey, let him it's a foresight of the apocalypse when you start getting applause in Santa Barbara
Thank you, Senator Barbara.
All right. Boy we have been here too long, you know? All right so I think we have 17 requests to speak. Is that the end of the presentation first off? Okay, 17 requests to speak it's 20-1. We start getting loopy about now, but we are going to hear public comment and get through this one. And so I'm gonna request from folks, and I know you've been here a long time, but I think most of us have a lot of the same things to say if we could limit our comments to two minutes instead of three so that we're not going exorbitantly long. So if we could go two minutes, and Jacqueline, if you could, Madam Clerk read the folks off.
Chair Lavinino, members of the board we are going to begin in Santa Barbara with Sarah Schofield to be followed by Wayne Mellinger.
Well, now I don't have time to set it up for two minutes. Good afternoon members of the board, Chair Lavanino. It's been my pleasure to serve on the Steering Committee and previously on the Behavioral Health Advisory Committee. I represented the hardworking direct service workers who are at the true core of ADMHS along with the people we serve. We civil service workers along with all of our partners which who I won't name but many of them CBOs, extra help etc., Meet with clients and implement any programs and outcome measures that are developed. We bill for services, keep chart notes etc., and assist with such a myriad of needs that I would use up all my time here just listing them. Just one is housing, just imagine having a caseload of 60 or more people and on any given day two or three or more can be facing eviction in this tight housing market.
Overall, many staff myself included do agree with the observation that there's an easing of tension in the department. And an increase in the visibility and leadership especially of Michael Kraft and Dr. Wada and openness in communication. Some have commented about feeling safer to make concerns known and have expressed relief at not having to undergo what they've referred to as the daily beating over meeting false productivity quotas.
Which were not based on historical hard data, but apparently pulled out of the air. When presentations are made now we appreciate that the numbers seem real and that with at least a stated emphasis on client service quality versus dollar amount. I haven't met any civil servants yet in my 13 years of county service who don't want our department to be financially secure.
We all want this and we have a hand in creating the programs we work and the programs work better. Since I'm running out of time here, I'll just say that we want to continue to be part of the collaborative effort working conditions and having a voice in how the actual work is done can make or break morale. And we continue to need well-resourced core services meaning reduction in caseload sizes and not just an extra help workforce.
We need to continue our collaboration without forgetting what that term well-resourced means. And we want to continue to be part of the effort to relieve our workload and be part of the process of change, including the implementation and creation of the programs that we're going to work in. Thank you.
19 seconds. Our next speaker is Wayne Mellinger to be followed by Chuck Hughes.
Honorable Board, my name is Wayne Mellinger and I am a local social justice advocate doing work with Clergy and Laity United for Economic Justice, CLU, the Central Coast Collaborative on Homelessness C3H and Families Act. I'm also a mental health consumer receiving treatment from our county's behavioral health system. Two years ago, I became homeless and was so depressed that I sought treatment at Cottage Hospital. While on the streets and suffering a severe mental health I found it nearly impossible to get services from our county's crisis clinic cares. For months, I suffered on the streets without treatment before I got someone to hear my pleas.
While I was on the streets, I witnessed hundreds of other people who were like me. Homeless, suffering severe mental health challenges and self-medicating because no treatment was available. We have a crisis in our county in which many, many people with mental health challenges suffer needlessly on the streets. I am here today to speak in favor of the ADMHS systems change. Doctors Ken Minkoff and Chris Klein have honed in on key changes that need to be made.
Our behavioral mental health system needs to welcome people with complex lives into trauma-informed systems of recovery, in which peer consumers play meaningful roles. I have been active in our systems change meetings and have greatly appreciated their openness to feedback from peer consumers. I have personally experienced some of the pockets of excellence that make up our mental health system. Please support the expansion of mental health services provided to people experiencing homelessness. Please consider the building of a residential treatment facility as advocated by Families Act and CLU. Thank you.
3:45 – 3:529 turns
Go ahead. I'd like to encourage folks to, do you have your clock down there? I'm not sure. Does the clock work there also? Okay just keep your eyes on the two minute clock please.
Check he is
Hello Chair and Board Members, my name is Chuck Hughes. And I came down to testify that system change has really made a great culture shift. In the past most decisions at the department was exclusive and just a few executives made decisions. It's a great culture shift and it really One case, well when it comes to one big change is the department's actually encouraging self-help and mutual support groups. Something in the past I don't know if they actually had a policy to discourage mutual support groups but it wasn't just the department, They steered consumers, their patients away from self-help groups. And now they're supporting it and encouraging it and a few self help groups have started since the system change started. And this department's been supportive of it.
One big reason why that's such a big thing for consumers is in the past you'd have to be at certain thresholds of need before you got any services. And if you weren't at that threshold, you have to get worse before you get services. And then after you've got services and you're functional, you'd come down and you would be on your own. You exit from the services, mental health service, and you'll be on your own to try to stay well.
With self-help groups it really makes a difference. Consumers can stay well on their own, and that's a great savings I think to the county. Thank you for listening to me.
Our next speaker is Angela Antenor to be followed by Amrita Salm.
Good afternoon, Chair Lavinino and board. Jeff Schaefer and I are going to go ahead and combine our comments so that we can save a little time. Wanted to thank you for making a priority the efforts that were happening in ADMHS to engage in transformation. It wasn't long ago we all remember how difficult the situation was in that people came to the board expressing concerns on a pretty regular basis.
Because of this process being led by your team, it's noticeable in the community that the community has been engaged in a respectful and real way. And has a functional way to express and share concerns and ideas. The level of trust of the county and ADMHS is on the rise. And while cultural change has taken awhile we believe this is the best option to make the improvements that are actually essential and needed.
The human costs at stake remain high, and we must continue to partner and coordinate our approaches together. ADMHS is working with C3H to try to coordinate and make sure that the services are done in a manner that is effective. So the amount of effort to create change needs to be committed to and affirmed because we're no way out of the woods yet. However, the indicators make us hopeful that ADMHS will continue to be an active partner for solutions in serving people living with mental illness and substance abuse issues.
The public financial cost to deal with the issues related to mental illness is also too high. For example, we've sometimes criminalized those people living with mental illness rather than having a strategy to more effectively intervene to serve those who need us. We will all benefit when we stop criminalizing mental illness. We also know that housing and supportive services for people living with mental illness or substance abuse issues is essential. And if coordinated well, it's not only cost effective but shows better and more sustainable outcomes.
C3H is counting on the continued partnership with ADMHS to move several of our joint initiatives forward. Our strong and focused partnership will be key in making a difference in the community including ending homelessness for some of the most vulnerable among us.
Yeah, I just wanted to support the system change and just let everyone know. First of all, I appreciate the Board of Supervisors in your work as well as ADMHS in your partnership. I have seen people on the ground over the past six months as I do regional work throughout the county beginning to work directly with people experiencing homelessness, some of our most chronic individuals and families. So I just wanted to appreciate already the changes happening and continue to encourage you to continue putting people with boots on the ground. Thank you very much.
Our next speaker is Amrita Som to be followed by Jan Winter.
Good afternoon, my name's Amrita Sam from Carpentaria. The proposed 2014-15 Mental Health Services Act is to quote adapt a behavioral health funding hierarchy that uses MHSA funds first and foremost to cover the costs associated with providing services to those that are unserved and underserved. The planning and implementation phase includes identifying these two populations, and then serving them appropriately. The county of Santa Barbara is well aware that there are several communities including Carpinteria that are both unserved and underserved.
Since August 2013, we have been promised a therapist to work in Carpinteria for a mere two days a week. Not sufficient to meet the needs but a start. The recent state funding of 8.3 million will provide services to the usual populations Santa Barbara, Lompoc and Santa Maria. This seems to be an unbroken record. What about the unserved and underserved populations? Do we exist or will we continue to be ignored?
Carpenterians hope that the continued inefficiency of AD and MHS will cease with and promises made will be fulfilled with the implementation of MHSA's plan. We look forward to all communities being served and provided adequate and improved mental health services and accessibility, thank you.
Our next speaker is Jan Winter to be followed by Steven DeLacy.
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I'm here representing 300 NAMI families and the Mental Wellness Center's Public Policy Committee. We are generally supportive of the plan, and certainly the principles and values that undergird it. And most certainly in the proposal to bring into better balance the expenditures at the front end of treatment, beginning with more timely access to first diagnosis and expanded crisis preventive services. So people can be stabilized before they need to go into inpatient care. We applaud the new focus on detailed measurement of patient outcomes. We applaud the very important shift to serving patients on the basis of their treatment needs rather than their reimbursement, but in one decision we are sorely disappointed. The decision confirmed at the Mental Health Commission meeting to postpone the request for approval of the contract with Traditions Behavioral Healthcare for additional psychiatrists.
That's one issue that's of surpassing concern to families. Timely access to a psychiatrist for getting medication prescribed, only a psychiatrist can do that and especially during crises upon discharge from hospital or from jail where the waits for meds can be far too long. Santa Barbara County clinics have been short five to seven psychiatrists for years, especially in North County. A fundamental goal of system reform has been timely access to treatment. Without more psychiatrists the gains in access can only come at the cost of less frequent patient contacts for clients already in the system.
Ann Eldridge and I were privileged to meet three psychiatrist applicants from traditions. Highly qualified young doctors, one with special credentialing in substance abuse treatment which many of our family members sorely need. I doubt if they will wait around for positions that may or may not be approved.
Next month- I'm
sorry but your time, your
two minutes are up. Thank you.
Thank you for this opportunity to speak to you.
Our next speaker is Steven DeLacy to be followed by David Hopkins.
Stephen DeLasse is on his way back, so please go forward.
Our next speaker is David Hopkins to be followed by Emily Allen
Dave is not here right now, so I've come up. Chair Lavagnino, board, my name is Emily Allen and I work at Legal Aid and with the Common Ground Santa Barbara County Volunteer Project. And volunteers have spent literally thousands of hours outreaching and surveying people experiencing homelessness. And not surprisingly they meet significant numbers of people with serious mental illness.
Personally, I started looking closely at the Alcohol, Drug and Mental Health Services Department back in 2007 when a licensed board and care was being shut down. Since then, I haven't stopped learning and watching and attending meetings and looking for solutions for these really critical issues. Right now, I will say that I feel very strong that the leadership at the county and the work of the department is really paying off.
So I'm certainly hopeful and the leveraging of resources like the Mental Health Service Act and the Medi-Cal expansion are very promising. So the county's investment in creating a better system of care, I think is really starting to pay off. The county though needs to continue to invest leadership and engage the community in this important issue. So I especially want to bring attention to the request for the specialty mental health services for people experiencing homelessness and increasing the number of shelter and board and care beds because there's We are going to return back here in Santa Maria with Dave Moore, to be followed by Richard Deddy.
Before I get the clock on me here, I want to say that you can't offer folks three minutes and have them prepare themselves along those lines then say you're interested in stakeholders and then pull a rug out from underneath them. That's a little hard to take they don't go together very well so if you really are interested in individual stakeholders you need to hear what they have to say thanks Carpentry is like Rodney Dangerfield in terms of mental health attention. You don't get no respect, and more infuriatingly it continues to get shortchanged on essential mental health services irrespective of the Mental Health Services Act mandating that counties report on specific communities that have been identified as facing significant disparities and then developing programs that address those disparities Carpinteria's local mental health services for adults and families are nearly non-existent.
And its youth services, according to the folks who deliver them were unfortunately initiated only after a local high schooler committed suicide. A reactive response to a serious situation which desperately needed a proactive intervention. One would hope that this historical lack of attention is attributable to inefficiency as opposed to indifference. But be that as it may, this is the county's opportunity to right the long-standing systemic oversights in the county's delivery or the lack thereof of appropriate mental health services to Carpinteria The fact that Carpentria's efforts to get a county therapist locally for two days a month began in August of 2013 and wasn't formally approved until April 16, 2014, nine months after the solution was promised suggests a level of disarray in the County's mental health system and beyond.
That is more than a little unsettling. If the contemplated county mental health restructuring fails to provide concrete, timely plans for addressing Carpinteria's mental healthcare needs. It's important to know that Carpinterians are a stubborn assertive bunch who has been noted or conversant with the Mental Health Services Act as well as the roles of patients rights advocates and quality assurance guidelines. And are more than comfortable reconnecting with contacts they've made at the state level if the need presents itself.
Carpentarians are also letter writers of some repute, be it the Coastal View, The Independent, The Santa Barbara News Press or the LA Times. While encouraged by ADMH's April 16th
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Sir, can I tell you something? Excuse me. You're actually speaking on the wrong item. We're on Item 3 right now and you're speaking on
Item 4. When I spoke to the people this morning when I came they pointed me to this particular place and said this is the time you should speak. They are the ones who signed me up for this.
Okay. You should be speaking on Item four and you'll be given a full three minutes on Item four. On Item three you had your chance to speak for two minutes and your time is up. Thank you.
Our next speaker is Richard Deddy to be followed by Tom Urbanski.
I wasn't really prepared to do this My son died there in 2010 after being there just three and a half hours. And during, afterwards I found out that PUF doesn't have any medical staff there after 6 o'clock at night. They do have a doctor on call. That doctor was called because my son was agitated and yelling and thrashing. And the doctor, Dr. Nicholson did call in or answered a page and he told them to give him an injection to calm him down.
Well, an hour-and-a-half later the nurses called and said it didn't take any effect and the doctor prescribed two more injections. Another hour-and a half went by they called the doctor again They gave him two more injections and a half an hour later he was found dead in his room. In a deposition with Dr. Nicholson, he was asked why he didn't go to the hospital. He says I don't have to it's not required.
Well then because there is a law that says anytime a patient receives an injection a doctor does have to examine them within an hour. A contract doctor was called in after the first injection and in his deposition he was asked How many times have you covered for this Dr. Nicholson? And he had been a contract doctor for four years in Santa Barbara County, and the fellow says over 100.
He says, does Dr. Nicholson ever come in? He says not that I know of. So I wonder if this situation has been changed. Do they have medical staff after six o'clock or is it still that way if the on-call doctor has more credibility what happened to Dr. Nicholson? You know, I'd like answers and really that's all I have time to say now. Thank you.
Our next speaker is Tom Urbanski to be followed by Jonathan Eman.
Good afternoon. Next door I talked to one of the consumers, I had a job like you guys up front and I walked up and saw one of the consumers and he said oh I had a problem I went to the hospital and I needed some help and they said well you can't do anything wrong unless you did something wrong so they took a chair and threw it through the window So I think what you're doing today is a long way from saving windows. But also, I dealt with the judges who did a terrific job on fighting dual problem of drinking and mental illness. And that went off pretty well. And then I ran into the Aristotle Alexander report which said we were sending a lot of our people out of this area, which was the worst thing we could do.
It was hard on the mentally ill and it was also hard on our bank account. We were losing money like crazy. Really happy to see what you're doing here today, and I think it was a great thing even though it was hard sitting through all this stuff. But I was impressed with the questions that were asked by the board members on my right and my left first of all.
How are you going to figure out all these other people that are doing things on different things that they have to finish off? You know, finding homes and all that. Because they get grants run out on you. And one of my left here who says how do we know if we're doing right? Good job. And I think you're doing fantastic. Take care.
Bye bye. Thank you Mr. Bansky.
Our next speaker is Jonathan Eman to be followed by James Rode.
Good afternoon. I'm Jonathan. I mean, I'm the team supervisor at the Kyrie L adult outpatient clinic. I've been there 10 years as a MFT and supervisor for last five years and I appreciate this opportunity to speak briefly on two issues The first is what I see as a tremendously positive change in culture at ADMHS. I supervise 18 people at the clinic when this process first started, four of my staff had been recruited to be involved in the systems change process. I now have nine members of the staff eagerly participating in some form or another in this process I think that reflects well on the optimism that's been created.
To the change by sharing one specific thing that's been going on, which is an example of the openness to innovation that is true now in our department. Recently a group on spirituality and faith communities has been formed and two years ago such a group wouldn't have ever even been imagined let alone supported and this group is Exploring the possibility of developing an ongoing collaboration between the county and households of faith and spiritually minded people. There's over 300 what we could call faith-based organizations in our county, most of those provide some level of care and support to people who are struggling not only physically or spiritually but often emotionally and psychologically. And I see this And those working with me on the community is a tremendous opportunity to leverage our outreach, especially to unserved and underserved populations.
There are so many communities that have an ethnic root to them that we were just excited about the chance to be able to penetrate into folks that are not open to reaching out to government traditionally. So thank you for
your time.
Our next speaker is James Road to be followed by Anne Marie Cameron.
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Chair Lavanino, members of the board, my name is James Road. I'm chair of the Mental Health Commission. I am on the Alcohol Drug Advisory Board and I also have the honor to serve on the Steering Committee. So I'm really kind of all over the place with this systems change and I'll get to that later in this today but my focus is always the people that I'm appointed to serve Next slide.
Supervisor Wolf, the same outrage that the system before was based on payment and ability to pay and not on need. That's just amazing to me but I'm glad to be part of the change that's taking place. I will see to it that is changed and we never go back to that old system. I also, because I'm on the Alcohol Drug Advisory Board and the Mental Health Commission, I love seeing the improved integration of mental health and substance abuse programs.
It's another thing that outrages me that has not been in place before but again, I'm just dealing with the now, the present and the future and that's all we can. That will be changed and I will see to it that does not go back to the way it was. I have been involved with the community-wide systems change from the very start. I was there when the change agents were organized, I have taken part in action teams and I'm also as I said on the steering committee.
What I love about this system's change is in the long run we're going to save money, we're going to save lives. It's going to make the community a better place to live in. These are goals that I am very passionate about And as always, it's my pleasure to have the opportunity to address this board. Thank you.
Mr. Chair, I just wanted to thank Jim for being here and to recognize and honor him for his work on both of these committees He really holds a special spot big on both the Mental Health Commission and on the Alcohol Drug Commission and can act as a liaison in between and Really does an outstanding job for the county and for the third district in particular? So thank you
Our next speaker is Anne-Marie Cameron to be followed by Patty Bliss.
Okay, hi. My name is Anne Marie Cameron. I'm the CEO of the Mental Wellness Center in Santa Barbara and despite my sunny disposition, I'm a cynic at heart and I have a good reason to be a cynic. I've worked in this community in the mental health behavioral system for over 25 years and for that length of time I've been an advocate and a service provider and have participated in no less than four attempts to transform our system But as we go through this process and as we started, I still bump into people in the community who say are they doing that again? Are they trying it again? And I'm here to tell you and to speak to the cynics that there are three main reasons that this time we have it and we're going to get it right.
The first reason is that there are hundreds of people, both old timers and cynics like myself as well as new partners, new people who've invested themselves in doing this work. When you talk about all the vision statements and the outcomes and all these things we're all invested in learning what it means and what the difference between promises and practice are.
The second reason is that the times are ripe for change with new resources, new money, new opportunities that allow us to make some big shifts. But the third reason is the most important reason and that reason is you and I'm talking to the board because you authorized, you started this process by asking for the report. You have helped the department with leadership that has made us all believe again that we can actually do this.
I plead with you to not let your foot off the gas, to not when this report is done to forget about this process but to ask us to come back regularly and to tell you where we are because the more you stand behind this, the more we stand to succeed. Thank you very much.
Hello, Chair Lovagnino and members of the Board of Supervisors. I'm Patty Bliss and I would say ditto to every single thing that Anna Maria said. I am one of the old timers who has been on many committees around this same topic and I have to say that this is the most open and inclusive challenging group of people to work with. I'm on the steering committee and was on the advisory committee suggesting that you get this started.
It is so encouraging to see everybody asked for their opinion, asked to participate, encouraged all along the way and that's something I think you should all be very proud That there are this many people in the county of Santa Barbara who care as much about the issue of mental illness and substance abuse. I just want to say finally that we're doing all of this work, all these efforts in order to provide excellent care to those people in our community who need support on the way to recovery. Thank you.
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Our final speaker is Stephen DeLacy back in Santa Barbara.
Thank you, my name is Stephen DeLasse and I am a brain injury survivor. I'm also a peer facilitator and advocate for those diagnosed with schizophrenia and their families. I am here today to support the needs of residential bed treatment program which is well long overdue. The time spent in jail incarceration creases and compounds the depth of mental despair and makes recovery all the more difficult to achieve.
I know through my own work with schizophrenia, safety and consistency in treatment is vital to recovery. Many of the homeless suffer from schizophrenia and we need a program and a place for treatment that is secure and safe. The effects of this residential treatment program will benefit not just the individuals but the entire Santa Barbara community. People with schizophrenia, which I'm particularly focused on. They can lead productive and rewarding lives with the help of this program and others similar to this.
Thank
you.
Thank you very much. That finishes out the public comment period. I'll bring it back to the board for discussion. Supervisor Wolf?
Well, this has been a long but extremely valuable presentation and I could just go on and thank everyone. Our staff, the CBOs, the consumers, you've all done an amazing job. I think one thing that Anne Marie said that really struck me is that we've gone from promise to practice and that was what I was trying to get out of something that I could hold onto You know, what is the actual practice that is different and? You've provided some examples and obviously those people who are out in the community Are seeing many more of those things and we've had time to talk about but again I just want to thank you. I want to thank TriWest because You know, I was a little cynical as you probably remember when we saw that You know, we were paying money for this report and I thought if this is one more report that goes on the shelf it's going to drive me crazy.
But there was an obvious need that we as a board obviously took it seriously, the community made sure that we knew how serious it was. And so as you went through the presentation and you actually highlighted the issues and then things that have been done, I mean it's very impressive for me to see that we are actually going back to that report and seeing something done.
And although I think that there's a few more things that we didn't touch on, for instance the jail issue, but that's gonna be another conversation. But we've definitely seen some improvements. The leadership from the executive staff, I must say from the comments made by the staff in the clinics is exceptional Because again, that's what I was saying before about it starts at the top. If you folks aren't open to listening and to making changes then it's not worth anything. And also being open and willing to have folks come to you in a safe environment which I think was demonstrated today not just by our staff but also the CBOs.
And I've been here seven years and I remember coming and there was just this Attention between our county staff and the CBOs. And it was one of those things that I think when we're all working toward the same common goal, how is that happening? Somehow you folks have broken that concrete wall, and I want to thank you Celeste. I think you probably had a lot to do with that but we're all working toward the same thing there needs to be and I really believe just from what I'm seeing in this room a lot of mutual respect and a lot of heartfelt Feelings that that we can do this together We cannot do it alone and there is such a need out there and we have to keep going and keeping our eye on the ball And so anyway, I know we're all probably ready for lunch.
We're gonna come back in here the other presentation But oh my gosh and to thank Terry you've been living this for Quite a few months. So thank you for your leadership as well. Thank you everybody
supervisor far
Thank you, Mr. Chair. Well besides all of the other metrics of success for this process that have been mentioned I just want to say from my perspective one of my major metrics of success is that I'm not hearing about ADMHS anymore. You know when I first came into office you know at first I heard about it from this part and then I heard about it from this part then I heard And after a while you go, maybe that much smoke means that there is some fire there.
But I'm not hearing about that anymore and I think that's because we had a great consultant report that really nailed the issues that I think everybody knew were out there whether they really wanted to talk about them or not. You formed this wonderful collaborative to bring everybody to the table and make it an important part of the team going forward, not just staff driven.
And we've heard that today, and as has already been said, it's that kind of teamwork that brings about the results that we all want. Clearly, we have a long way to go, and there's gonna be changes and questions. As we move forward, but this is really quite tremendous when we think about where we were a few years ago. So thank you all very much for everybody who's been involved with this.
Supervisor Carbajal? Thank you. I too want to add my congratulations to everyone who's worked on this, to bring us this far. Very encouraged and very excited about the promise that we hold with all the good work that's gone on but unlike Supervisor Farr, I have heard from a few constituents and you saw-you heard from two of them today and I think that issue could have been addressed and perhaps we wouldn't have had that input as we had it today, because a decision was made that the type of service that was requested by the community was feasible and doable. And it took probably six months to do something like that. Which is unacceptable.
And so not to be a wet blanket, but with much promise and encouragement I also must point out that we have our work cut out for us. And when communities come together and we make a determination that something is feasible, that we agree with them it's important we put our resources together and effectively see that through and Delay too long in losing the public's confidence, which I think we did with some of my constituents. So with that, I'm encouraged but again we're reminded we have a lot of work to do.
Very good. I'll make my, put my two cents in and then I'll let you. That's okay. She's hungry. I'll make it quick. I just wanted to say that sometimes I think it's interesting in this department that deals with recovery and those types of things and intervention is this Department needed one, you know. Since I was been elected it's been, it's hit rock bottom. I mean and I'm not really sure it could have gone much worse and so we all were up here and it's not new that you know I've heard people say now like Ann Marie said you guys are invested in this. I don't think it's new that we've been invested in it. We've just been struggling to figure out how to do it And the main thing that we did, I think is put in the right team. When you have the right leadership and you pointed to us but it's not us, it's we've got a team that starts at the top but it takes everybody.
And so the teams working on it and I think somebody talked about this already for me. It's how does this flow down to the front line employees and making sure that person that's actually doing It feels empowered and is part of this. And it's not just this group, it's everybody throughout the department. And it's always been a struggle for me in looking at this department between the clinician side that I don't understand at all and the financial side that is just always bad news. And so it's just been really difficult but, and I do want to caution us In the way these cost report settlements work is I don't want us to, we go through this report. We make all these changes. We're doing great and then we get hit with another cost report settlement that's from four or five years ago and then we all say well the public perception is it's not working your changes didn't work.
It's still costing us money. We have to remember that that's in the past so I'm encouraged about where we're going. Was very confident with the team that we put together, that we were going to get a great outcome. And there's two things that I think we still need to wrap up. One is and I know you guys are all going to kill me but Michael Evans had the, I think you have the numbers now that answers Supervisor Farr's question and then I have one last thing I want to get to.
Okay. We're just, I can hear everybody's stomach up here grumbling. Thank you. The liability page.
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Through the chair and to the board, what you see here is a schedule that we presented back in... So what you see here is a schedule that was presented as part of the board presentation back in December of 2013 regarding our currently known and estimated ADMHS liabilities. The first column shows when we originally came to the board back in May of 2012, that we started off with $19.4 million worth of liabilities.
And then you'll see that there were some adjustments made, there were some extinguishments. Some new liabilities added and then as of the end of September 2013 our liabilities were $9.5 million. And of that 9.5 million at that time 8.8 was fully funded we had $750,000 that weren't funded. And as part of that board hearing, we requested and you approved the funding of the remaining 750,000 so that all of the known and estimated liabilities at that time of $9.5 billion were funded.
Of that $9.5 million, $2.1 million of the funding is still remaining in the audit exception account. The balance has been transferred into the ADMHS Mental Health Fund in order to actually pay these liabilities that were previously booked.
Mr. Chair, thank you for this and now that I see this page I'm reminded of when we saw it before so I guess the budget principles That's asking us to put a million dollars a year into the audit account is being proactive because of the way that the audits and the cost settlements are reconciled and the length of time it takes to To get that accounting done
To the chair and to the board, that is correct. You'll see that the known liabilities were only through fiscal year 10-11. And though based on our preliminary cost reports middles for 11-12 and 12-13 we are expecting money back from the state instead of owing the state. We still have audits out there in the last audited year is fiscal year seven, eight. And so there are still audit exposures going back.
Okay, thank
you. Supervisor
Carball? We've discussed over recent months the need to better be more strategic in funding our roads, our infrastructure and I think what we're learning today and I know social services we have spent down quite a bit of a reserve That we used to have in social services as well. I think it's important, CEO Miyasato that we start looking at the type of reserves we need to have in our social service human safety net be it social services, be it mental health. That makes sense to have so that we're not constantly dipping into our strategic reserve but what is the best practice?
To be able to better operate and run these departments, and I think we need to do that in public health. Having been here a long time, I know we've spent down that reserve. Having been here a long time, I know we spent down that reserve in social services. Having been here a long time, we've never really established a reserve in mental health, and I think we need to start doing that. As rigorous as we're doing for all our other needs that we have. And I just want to stress that because I really look to you, CEO Miyasato, to give us what is the best practice operating reserves that we need to have?
Okay, very good. Do we have a motion? Okay, motion made and seconded. All those in favor? Aye. Any opposed? Passes unanimously. We're going to go to closed session. Mr. Gazzone can you please give us
4:27 – 5:422 turns
Chair Lavenino and Supervisors, your board is noticed for six items in closed session. Two existing litigation, the first County of Santa Barbara versus Civil Service Commission which is two cases 1440046 and 1466364 both dealing with Grady Williams. Second is Civil Attorneys Association versus County of Santa Barbara. You're noticed for one labor negotiations item, also dealing with Civil Attorneys Association of Santa Barbara County and three public employee performance evaluations. Social Services Director, Child Support Services Director and Public Health Director Slant ADMHS Director.
Wow let's see how that's going to go. We're going to take one hour break and we will be back for item four. you you you you Thank you. you you Hi. you you you you Yeah. Okay, we're going to get started. I'd like to reconvene this meeting of the Board of Supervisors. Item number four. Madam Clerk?
5:43 – 5:519 turns
Chair Lavinino and members of the board item number four is from Alcohol Drug and Mental Health Services it is a hearing to consider recommendations regarding the mental health services act plan update for fiscal year 2013-14 and 2014-15
Mr. Chair, just before we start I'll announce that there are no reportable actions from closed session.
Forgot about that again, sorry Mr. Gazzone. December I'm going to figure that out right before I leave. All right so we are going to Dr. Wada?
Yes. Chair Lavagnino, members of the board. Thank you very much. This next item is from Alcohol and Drug and Mental Health. It's an update on our Mental Health Services Act. And so in our prior presentation we talked about systems change and a number of activities that we've been doing over the last several months in response to the consultant report and recommendations. This next presentation is actually going to focus a little bit more going forward. So we'll be discussing how We are leveraging Mental Health Services Act funding, and actually incorporating its vision and guiding principles and values into the redesign of our programs. And programmatic expansions that were proposed as part of our budget recommendations. So we have again a team approach to this presentation, and I'm going to turn it over to Michael Kraft.
Chair Lavinino and members of the board, I'm happy to be back. And in a certain sense to continue what we started before lunch. And what we're going to talk about today specifically is a standalone item, but it's also a product of the system change that we talked about this morning. And that is the MHSA plan update for 13-14 and 14-15. And we decided to take a team approach in presenting again because this plan is the product of many, many, many participants. So to my right, we have Jim Rode who is the Mental Health Commission Chair and also a member of the ADP Advisory Board And to my left, Dr. Manny Casas who is co-chair of the Latino Advisory Committee, co-chair of the Cultural Competency and Diversity Action Team and is also a Mental Health Commissioner.
And then now I'd like to turn it over to our Division Chief over MHSA, Cuco Rodriguez.
Chair Lavanito, members of the board. Thank you. As you are probably aware, just the Mental Health Services Act or Prop 63 was approved in 2004 by the voters of California. And it essentially imposed a 1% tax on anyone making over $1 million in the state of California. The revenue generated from these programs was disseminated to counties throughout the state, and it also required each county to submit an annual plan update that needed to be posted for 30 days.
It also required approval from the Mental Health Commission and then final approval from the Board of Supervisors. One of the challenges presented to us, and opportunities during this update was that there were multiple activities going on within our county. One was obviously ACA, Things that we're talking about earlier, which were related to systems change. So one of the challenges presented to us with this plan update was to try to integrate and kind of coordinate all of these things together while still maintaining a lot of the requirements under MHSA.
So we use this as an opportunity to try to incorporate some of the structures that were created under systems change like the steering committee, the action teams. As well as working with the change agents to help develop this plan. So this is the first time in probably since the inception of MHSA That our process was very external as well. In the past, I think the department created its MHSA plans internally using primarily staff. This time around we've included all of these other different structures and make sure that they help develop the process.
I think JT talked a little bit about these in the previous presentation. These are the principles that were developed by the steering committee. One of the things that the steering committee did was to include the MHSA principles. As part of their overall kind of vision. So you'll notice that the bolded ones are the MHSA principles, I won't go over these. I think JT went over these but basically this is to illustrate kind of that integration of some of the requirements that we have under MHSA as well as in the steering committee.
Supervisor Carbajal.
Thank you. You know, I'm trying to look at all the materials that were provided to us and I'm hopeful that at some point in the near future you provide us with a flowchart that does a good job of showing us the entire mental health system and maybe that's one of the things you're going to do for us in the future because I am still trying to wrap my head around This specific funding and this specific effort, and how it fits into the whole scheme of things.
Whether it's just absorbed through augmentations, I'm just having for the life of me trouble understanding the entire system and how this fits into it or how this is a part of it. And if there was some kind of visual a matrix or flow chart that illustrated that, it would be very helpful because we're hearing this as two separate items. The item before and I still don't know how this fits into that item that we just heard.
Or is it separate or only certain components or what? That's why earlier, a few weeks ago, A full picture because having read the staff report and having looked at all this, I'm still completely bewildered as to how this truly fits into our entire department suite of services and programs or how it doesn't. For some reason, I don't fully get the full picture.
And I'm not sure that this presentation is going to do it, so I'm hopeful it does. But based on what I saw, I don't believe so. So I'll let you continue but just know that's my question about this item and the item we heard before.
So Supervisor Carbajal through the chair, that's exactly where we hope to go today. And the one piece that we're not going to focus on in this presentation is the inpatient system because MHSA cannot be used to fund inpatient care. So we will be talking about the interface between inpatient and outpatient but our focus today is primarily outpatient. And one of the things that was very clear to me in our conversation earlier this morning Is that there's still too much mystery in the nature of what we do and The distinction between the fiscal side and the clinical operational side is something that I would like to blur a little bit by making much more clear how we function operationally. So that's one of our goals for today.
Okay, again just to conclude, you know we have all these services and certain funding funds certain services. And then there's this funding that augments certain services. Again, I'm just trying to understand it but I'm not getting it.
5:51 – 6:083 turns
Okay, let's proceed.
Before I move on to the next slide, and Dr. Casas will be following up with a couple of other slides. In the previous presentation, this is something I really want to point out. These principles are very, very important or at least Stakeholders in the steering committee are taking these certainly very seriously. They've been in existence since the implementation of MHSA and the issue of services to uninsured populations has been raised in the past through the Latino Advisory Committee and other groups, and it wasn't until the development When the cultural competency action team pointed out that there was an inconsistency in the principles and the policies of the department, that they should be changed.
That it was really taken up by the steering committee so I do want to point that out because I think Supervisor Carbajal as you asked a critical question during the last report which was related to how do we maintain This kind of level of culture change. And I think certainly the steering committee and some of the action teams, particularly the cultural competency action team are very focused on ensuring that the decisions that the department makes are consistent with these principles.
Good afternoon, Chair Lombardino and the supervisors. It's really my pleasure to be here now I'm surrounded by a microphone here. But anyway I'm truly happy to be here for a variety of reasons First of all, I am very excited about the changes that are going on. And there is a need as it's apparent that we're gonna still continue to work on a lot of the things that we may not be able to answer today.
But my task today is actually to look at the process itself and help you understand what the process looks like. And it sort of is repetitious, so I'll try not to be repetitious. And I'm gonna try to highlight that which is unique to the MHSA in regards to getting input and so forth because that's what I think makes this whole process unique. And I say that from a historical perspective because I've been on this board for over 25 years on the commission, I should say.
For over 25 years, so when you're talking about you've seen it come up four or five times. I've seen it come up more than that believe me and I lived through the ups and downs of the ridiculousness of things some things that were done and some things that were in the right direction So when I had the opportunity to be involved and actually having Supervisor Carbajal throw my name in the hopper, I mean had he not done it, he'd probably be receiving calls from me every day. Why not me? Why not me because I've been involved for such a long time.
The other reason I get excited about it is I am a retired, I'm a professor emeritus from the university after 40 something years. And my whole area of expertise has been in the area of psychology and more specifically the provision of services to ethnic minority populations. And so much what is going on, I have written about, edited books about it, done research on it. So when I say I believe in it It's a life commitment, so I'm not here saying I'm here because I'm being paid by somebody or somebody has forced me to say these things. This is a commitment that I've demonstrated over the years. So when I say the things I say, I believe in them and I really encourage you Take a look at the whole picture and knowing that again that there are going to be areas that we need to address with greater specificity.
But, at least we're on the right track towards addressing them believe me I am very pleased that you've taken the time to actually Allow us to do this, because in the past this would not have been possible. Regardless of how much we, I or somebody else might have wanted to say why can't we do this and being told you can't versus first let's try it. And then we'll see. Let's try different alternative ways in order to accomplish this. So with that backing, I'd say that one of the things that...I'm just going to emphasize three areas that I think really are really important in regards to the process itself.
And the first one is that it's as planned and it has been implemented, is an open process that is being driven by the stakeholders. You can't believe how when I say that unless you are a stakeholder out in the community You can't really sense the excitement that you can see in people's faces when they think there is finally somebody listening. And they actually called a meeting and the people actually came to our, where we hold our support group meetings to get input. And in particular this is coming from underrepresented populations like the Latino population. When you have people Like Dr.
Wada, like Michael and like the consultants actually coming down to De La Vina to the clinic at night time and actually meeting with a support group to get input In order to make them the stakeholders a part of the process, you don't get a sense of the involvement there. You can hear it but all of a sudden you've got a room of 30 people who have never touched hands with Dr. Wada.
Right? So all of a sudden you have contact, you've made something real for them. When you say well how are we going to measure that? That's going to be hard to measure but believe me we got people on board that had never been on board before. All of a sudden they kept saying why are they coming here and why are they asking me what I want? Are they really gonna listen And so when we say hey, it's an open process and we're moving in that direction.
With that, Input that gives us, gives them ownership and credibility. Now you've heard this several times but I have to repeat it again and that is that this particular movement towards meeting a need rather than looking at the cost or admitting a need instead of seeing whether or not you have insurance was a big leap. And it actually started at one of these little small Latino advisory committee meetings with ten people there Who I would hear on a monthly basis because it's part of the MHSA process, is that this Latino Advisory Committee has to meet for input as part of getting the money.
And for years they were meeting, but they were meeting and being told this is what's happening. Almost like a show-and-tell project that was being sent in by the county and they sit there and they say yes, yes, yes just like you're saying to us you're not telling me enough. They would just sit there and say yes, yes and all of a sudden we're saying what is the problem here? Well one of the major problems that came out was Hey, when I go in there the first thing they look to see is if I have insurance.
And if I don't have insurance, I don't get any service or worse yet another way of looking at it is if you don't have insurance, it's more than likely and you're Latino and you don't have any kind of insurance including Medi-Cal The next thing that they think is, well they're going to think I'm here illegally. I'm undocumented so I can't seek out help because the flag is I don't have insurance. Anybody else would have insurance but I don't have it.
So these little things become intricate little important pinpoints and once you start removing them you've got participation and that's part of the process. The next thing is an increase in Increase the, well we were seeking to incorporate all stakeholders who wish to participate. Now this is important because until now there are certain groups that have been left out that we don't even talk about and we're seeing them at our meetings now.
And that's some of the African American population. I mean, in all the years I've been here it isn't until this year that I've actually seen African Americans come to a planning meeting and be invited. And they're coming in through the faith groups. We reached out to the faith group so those are our stakeholders. So we've increased the stakeholders who they are and we are getting diversity in there.
So we're moving in that area. The other thing is that we've become more comprehensive, extensive and made the process itself much more timely so that it's taking us much longer to actually get the work done. But it is the work of the community, and I would hope that it is the work of the community that we are seeking to serve. And so again if you take a look at the type of events that we hold, seems like it goes on forever.
Believe me driving up and down to one of these meetings and so forth there's element of love there because it takes a lot of time to make sure that we have Latinos represented there. And even though I'm not an elected individual, I attend as many of those because I'm possibly one of the few psychologists in the county that's Latino. And so I find myself being the source of help when I'm not the individual that should be doing it which only serves to gather more information to take it back to Dr. Wada. I'm part of this stakeholder and saying we don't have enough staff We don't often have Spanish speaking individuals. We don't have this, now it's not always a complaint but it's a matter that we're out there and so we have all these meetings that we try to cover to reach out in order to develop the plan, get input from the groups.
And I'm not going to go down that whole list you can see there is a lot of individuals who And it takes time because of the deadlines we have to meet. Now one of the issues that we've come across and that has also, we were able to accomplish is that for a long time, we were working with the MHSA budget separate from the overall budget. They weren't synchronized. So while we were working with the MHSA budget over here The other budget is going on over here. We'd finish our budget then we would have, you know, we'd finish our budgets in February or whatever but then we were already working behind time because we were already having to prepare for the next year so as a result of the commission stepping in and saying For this year let's start off, so let's synchronize the budgeting.
So it goes along with one budget so that we know what monies are available how we're going to use those moneys and its built into one process of which we are a part And that hadn't been done before, so we were running after or running ahead of and there was no synchronization. At least at this point now we can say this is what we got to work with, these are our finances and let's just put it on the table. That's where the Mental Health Commission comes in and starts making its rulings.
One of the mental health commission decided that for one thing, we were going to this year catch up and we were going to start working on the 14-15 budget. That meant we were still trying to finish up the actual budget for 13-14. So a decision was made, let's stop that budget. I mean we're still going to have a budget but we're not making any changes to the plan and we're not going to be asking for anymore money along these lines. What we're going to do is concentrate on the coming year when everything starts falling into place in regards to the evolution of the systems change and then moving it with the MHSA plan.
And so then we start the merging, which hopefully we'll explain to Supervisor Carbajal in a few minutes. See how some of that merging does take place. So basically those are the areas that we have really concentrated on that I feel really merit our attention. I've been mentioning the word stakeholders but again, I refer to them. They're there for you to see straightforward. We are reaching out to as many people as we possibly can.
In listening to some of the comments that were made, for example, Supervisor Wolff you said something about taking promises to practice and I think that gets us into going back to the process that I think Supervisor I want to say salute, but Supervisor Carbajal brought up relative to the fact that how do we have this buy-in? Well, we have a buy-in because as has been mentioned and I'll repeat again. This whole aspect of cost you know emphasizing The actual, the provision of services and not the cost has given us that aspect of involvement and of a promise that has impacted practice. That we didn't just come out tell these people tell us something and we're going to bring a change about. We actually brought a change about. And so that's a step in the right direction.
There was something else that was said Let's see here, with regards to Supervisor Carbajal when you said the continuity. I think I can guarantee that with those small groups at least with the Latino population that I work with directly most often. That they're not going to keep quiet next time they have a concern. Whether or not we accomplish what we would like to accomplish, that's another story. But I don't think we're going to sit and say well it's over and done with because you and I and many of us know that there's a lot of work to do.
And so I don think we're going to settle and say the sun has set. There's still work to be done, the sun is still up and we've got work to do. And so if anything I think the process itself is reflective of what we're doing in regards not just MHSA but also the whole systems change and it's one that I think needs to be encouraged and like I say I think it brought about some revolutionary changes at this point. We still have a ways to go And I hope to be around for a little bit longer to continue to serve and egg Supervisor Carpahal, anytime I can or anybody else of you. If I see that hey there's something that needs to be done and I'm still around like a squeaky wheel so You're going to hear it and so thank you very much for giving me the time and with that I give it over to I think Michael Thank you, Dr.
Casas.
6:08 – 6:135 turns
Some of the needs identified by the stakeholder process that Dr. Casas talked a little bit about, our stakeholders really pointed out that there were some various areas that we needed to focus on. One of the first areas that they identified was really improving our access for all populations and specifically addressing the issue of prioritization of treatment that's based on clinical need versus payer source.
In addition, some of the other system needs that were identified was that programs that were developed needed to have in mind the MHSA principles related to recovery models and inclusion, cultural competency, involvement of peers, integration. And again working with complex cases and clients. The other areas that were identified by stakeholders was that the programs that were being developed also needed to have a specialization. And along with that, we also needed to improve the way that we currently develop our assessments and provide access for clients.
So, Chair Lavagnino and members of the Board. I'd like to emphasize that by system-wide approaches what we're talking about is making changes throughout the whole system that make the whole system more efficient and then combining those with specialized services which we're going to talk about here in a few minutes. And so you've heard at length about the broad system wide principles in following the steering committee guidelines But we're making a transition now in the presentation to start to talk about in more detail, in a more pragmatic way.
What is it that we're going to do differently? So in the flood of words I want to make sure that doesn't get lost.
And what you see here is the stakeholders actually went in a little bit deeper and these are some of the areas That the stakeholders identified in terms of services and programs. And again, these specifically included programs for co-occurring populations. Again that would be our mental health and substance abuse clients which we've discussed a little bit. The recommendation that we look at a medical integration component which also included our geriatric population so these would be our clients who are also have physical needs as well as mental health needs.
Programs that address wellness and resiliency and recovery for children and adults. These are our personality disorder access to clients that are very difficult, and sometimes don't fit into traditional programs. In addition, although KDA is not funded by MSSA, it is included as part of our full spectrum of services. I think there was some discussion about working with the jails. So, one of the recommendations actually from the stakeholders was that we look at the development of a forensic team that is working with the courts and the jails to ensure that we're providing appropriate mental health services in working in conjunction with the courts. Again, we talked a little bit about improving our access and assessment services and really having it be a little more centralized.
There were also recommendations to improve our crisis system. So again, focus on pre-crisis services, we talked a little bit about that. Post discharge in terms of folks who are leaving the PUF and that would be through our newly funded triage teams. In addition, through MHSA what we are looking at is funding a crisis residential unit in South County. We have one in North, we'll have one on North and South. And also looking at the funding of a crisis stabilization unit and a new mobile crisis team in Lompoc which we haven't had. We've had mobile crisis in North and South but this will allow us an opportunity to also provide crisis services in Lompoc as well.
And then under the innovations component, two particular programs that we are also looking at. One would be a system wide training and what Michael pointed out which is again very specialized services. And then the final component is actually a component funded under innovations to work with young women who have been victims of Sexual trafficking here in Santa Barbara County. And again, that was I Think the last program
excuse me. Can you go back to that for a second supervisor far as a question?
Thank You mr Chair So I think you mentioned something we're talking about the forensic team about working with the courts So is that where we would include the juvenile hall and Los Prietas boys camp?
6:13 – 6:1921 turns
Supervisor Farr through the chair. The forensic team is focused on the adult system and currently the juvenile justice services are actually very well integrated in our system of care because they're part of our children's system of care, and so what we're looking at is how to bolster the adult system because that's where the great need is.
Okay, so you're happy with the way things are now with
Yes, we are.
With the children being-
We are and the innovative- At the camp in
Juvenile Hall.
I'm sorry.
Sorry. You know what I want to say? I'm getting tired here late in
the afternoon. It has been a flood of words and thank you for bearing with us. We are just a couple of slides away from the much needed flowchart and I think that will make some things clear. And what we have been trying to do with so many slides on different considerations is to frame for you all the different elements that we've been trying to take into account. And so that is everything from the system change principles, to ACA, the Affordable Care Act, to our normal operations, to the MHSA requirements and so we've been blending all those in And when you take all that input, look at who is it that's underserved or unserved. How do we reconfigure our system to reach them? And so this is a description of that.
And so in the juvenile justice system, we're looking at creating a new innovation program specifically to deal with the girls' needs and that would be on an outpatient basis. And we'll also have within the institution itself within Juvenile Hall, a girl's program. So we're actually expanding in juvenile justice as well.
Okay great thank you.
Supervisor Wolfe and Supervisor Carbajal.
Thank you for mentioning that. That was one of the things that was in the Juvenile Justice Coordinating Plan, speaking about the need for girls so it's good to see it up here. So I was interested in the forensic team because I think initially what you said is You could go into the jail and assess their system of care. But how can we do that if it's under Corizon?
So Supervisor Wolf through the chair. Exactly how operationally we can work more effectively with Corizon is not something that's been worked out yet. The forensic action team is still in a relatively early stage and within that domain, we also need to look at those who are declared incompetent to stand trial and how we reach them earlier in the process because if we can reach them before they're declared incompetent, we may prevent them from becoming a burden on the system in that way.
Well, I'm actually pleased to hear that you're looking into it. And I think the Tri-West report will give you some good guidelines because they did highlight Some issues and concerns, so I'm glad that there'll be some coordination in addressing those issues. Thank you.
Supervisor Carbajal? Thank you. Out of all those services right there are those wish lists? Are those things that we were doing before? Are those things we're going to implement now? What's current what's new out of those right there?
These, we'll get to the other slides. What we attempted to do and one of the things that the stakeholders had asked for was to ensure that our current funded MHSA programs not change at all. So really what you're seeing here, the majority of these are all for the most part newly funded MHSA programs. Are these wish lists or are these actual programs you're going to be implementing?
These, we're hoping are actual programs. I think as Michael pointed out some of the implementation details because we are doing this in a more collaborative way or still being worked out but for the most part this is what we're proposing in our upcoming plan update for 1450.
So if we come back a year from now you'll be able to tell me that all these programs are in place and some metrics of how we're doing. Is that
accurate or no? I'm sorry, Supervisor Carbajal through the chair yes. Yes to both of those and the MHSA plan update that will come back to you in June is connected with the budget expansions and Mr. Evans is going to walk us through those. The creation of any of these programs is not contingent upon the expansion so our intention is to do this as a transformation what the expansion will determine is how many people we can serve and how we'll serve them
Okay, the reason I was asking those questions is again, I'm trying to visualize what it is you're presenting here in terms of what already exists and what doesn't. I know we're going to get into the different systems, the adult, the crisis system, but you have a flow chart of how things will flow. But I don't see those programs specifically put in here This is the way the system is now, this is the way it's restructured.
This program exists here, it's also going to exist here in this capacity. This program doesn't exist over there but as one of the new programs and here's the way it fits in just sort I want to visualize the system, not just a flow chart but visualize the system of programs and services. What we have now, not only the new structure but the actual new services so that we can clearly see what we're getting that doesn't exist already now. And I think these do an attempt but it's far from being able Successfully achieve that For us to understand it fully and that's what I'm getting at
so chair and supervisor Thank you for that, and we'll clarify as we walk through that diagram And if it proves still to be inadequate then will provide a much more detailed flowchart
Great. Thank you
6:19 – 6:254 turns
And so we've touched on each of these items already, some of them at length and so we won't go through them. There are many considerations in how we've gone about doing this including caseload sizes, having balance between adults and childrens, partnering with the other county departments, the support staff that we need, the number of psychiatrists and so on.
This is our current system and we talked at length about its shortcomings, including the systemic shortcomings. And what you see here is that the inpatient element within our system of care is larger and out of proportion in part because the crisis and our prevention and early intervention and outreach services are disproportionately small. And so, go ahead.
In our transformed system, our focus is on balance and designing programs that will reach people quickly where they are and prevent them from rising to a higher level of care. So next slide. So this is our current system. And within the crisis system of care, we currently have no real pre-crisis support except for current persons in the system. So someone who's already being treated by a clinical team can get pre-crisis support. But for someone who's not already in treatment if they were to call and indicate that they're having a crisis Then unless that crisis reaches the level where actual hospitalization might be required, we have no service. So we have no capacity to go out and reach them where they are and try to help them deescalate.
So the mobile crisis teams that are currently in place, we have 13 staff who cover all three regions. And I'd like to point out too that when we talk about the regions, we tend to say Lompoc, Santa Maria and Santa Barbara in that we're sort of lumping and that within Santa Maria, we're talking about Cuyama and Guadalupe. In Lompoc, we're talking about The Valley.
And then in Santa Barbara also Carpinteria. And so it's a very large geographic region for such a small staff. And Goleta, thank you. And so the mobile crisis team goes out and they have one purpose in mind, which is to assess the crisis, determine the need for a hold and to get someone hospitalized if they need it. And if not as indicated by the dashed lines their linkage back into our outpatient system of care or the linkage after hospitalization back into the outpatient system is very weak.
That's a gap in our system The dash line to our crisis residential facility in the north also is an indication of difficulty because of the challenges that we face with this gap in service. That's an underutilized facility. And so, in our transformed system... So blending the funding from SB 82, the MHSA plan update and our current services what we envision is that We'll be able to provide pre-crisis services.
So the mobile crisis triage team is in addition to the system, and it will have three basic functions. The first is to reach those who are in a pre-crisis state. The second is to engage in discharge planning. And the third is to help people navigate our system. The SB 82 grant also allows us to expand the size of the mobile crisis teams and create a team in Lompoc so that that will become a stronger resource.
To create a crisis residential facility in South County, in Santa Barbara and also a crisis stabilization unit. Now the difference between those two is that a crisis stabilization unit is a 23-hour facility, meaning someone can come and stay for up to 23 hours. And in both of those we intend to have psychiatry available. In the current system, we have no psychiatrists attached to the crisis residential unit in the north.
And so that's a major gap. The mobile crisis team will be able to go out with the pre-crisis team, do what they do currently which is determine the need for a hold Facilitate the hospitalization if needed, and then the mobile crisis triage team will be able to pick up after discharge from the inpatient facility. Or if no hold is needed they'll be able to help navigate people through the system so that they can access care in their clinics.
Okay, so that was a lot to absorb.
Supervisor Wolff?
It was, but you know it's great to see that. So I do need to understand a little bit more the pre-crisis support piece because that would seem to be really important. Can you explain that a little bit more?
So Supervisor Wolf, through the chair. By pre-crisis what I mean is that if someone calls and for instance they are about to be evicted so they have a housing issue and based on that they're agitated and they're uncooperative but they're not threatening in a way where their life is in danger or they're endangering someone else we typically would not respond because it's not a psychiatric emergency that's putting them at risk for hospitalization So part of what I'm sure all of you have heard far too many times is that when people call in and they're requiring help, that there's an initial screening. And what they're told is we'll call us back when it gets more serious.
So this would address that need.
6:25 – 6:3428 turns
Where are these people housed? Right. What is the phone number if someone was to call them
So Supervisor through the chair, our intention is to have the same access phone number. So we'll have the same 24-7 number that is well known in the system and it will be routed to the appropriate region and that we're going to house the pre-crisis team along with the mobile crisis teams so those two teams will work in conjunction With the proposed expansion, we're looking at the facilities needs and so that's under analysis. But our intention in the North County for instance is to move the mobile crisis team out of the current CARES facility and house them on Foster Road. So they'll be on the same site as the Foster Road Clinic but they'll respond throughout the region.
And what about the CARES facility on De La Vena?
So that's one that I'm not sure at this point how we'll proceed with. And so it will be a similar planning north and south, so.
Are you saying it's possible that would be eliminated?
No, no I'm sorry. So in the next slide and supervisor through the chair forgive me for the confusion so in terms of where the pre-crisis team and the mobile crisis team would be housed in the south that is the facility I'm not sure about. We're not going to eliminate any facilities and in fact in the next slide we'll get into more detail about what will happen to the care site and the clinic site
And since we're talking about facilities and somewhat capital is this what we're going to be hearing back in the middle of June? Is that what that's gonna, we're gonna be talking in more detail about that.
Through the chair and to the board. So yes, so as we go through this system transformation part of that analysis is the capital needs assessment that will come back in June with. And so we'll be looking at how do we use our two current CARES facilities given that the CARES function of access and And assessment are going to go mobile. And so we're really having three sets of mobile teams that need a place to work out of, and at the same time, we're increasing the number of outpatient programs that we have. And so where we're looking at both for the care sites probably serving more as secondary adult clinic sites that these other programs operate out of. So, but that is part of the capital needs assessment that we're currently going through.
Thank
you. Supervisor
Carbone? Thank you. So the pre-crisis framework that you just discussed Michael in terms of the number that's gonna be implemented at the response what kind of timeline are we looking at there?
For the supervisor through the chair for the implementation We currently are in recruitment already and so given that the item has been approved by the board, we're in the recruitment. We've created a job descriptions. We've identified the basic functions and that's seven-and-a-half staff in each of the three regions with psychiatry associated.
And then once you have that, so when people call up and you have the 800 number, in order for us to get a sense of how well we're doing or We're responding to calls or not, are we going to have some kind of logging of calls where somebody calls? They had that housing crisis but we were able to address it. Because unless we're somehow logging those calls, we're not going to know how many calls we're getting, what the disposition is of those individuals. Going back to what Supervisor Adams said How are we deferring or detouring people from going more into crisis? So somehow there needs to be some kind of logging system, sort of a dispatch system that is able to, that were able to identify how many calls we're getting.
What kind of triage did we do on those individuals? What was the outcome? How many of them ended up going to crisis? How many didn't? I was hoping to hear, our timeline is assuming that all goes well and we hire these individuals. Our timeline is X but obviously you don't have a timeline. It sounds like a fluid process once we hire these people will be up and running but I was hoping we'd have a timeline so.
So supervisor through the chair, there will be logging associated with each of those teams and facilities. And so because it's grant based, there's a whole series of metrics that the grant actually requires. And so we'll be fulfilling all those in terms of the timeline. I'm just not sure exactly where we are. And so we do have a timeline. We have a team working on the implementation. I just am not clear
you want to give me a rough season spring summer winter
Yeah, we're looking at approximately three months to have the initial teams fully in place in all three regions. And so it's
ongoing. Okay and please forgive me for pressing you but I come from the school of unless we have a target date that target date will flow on to the next two or three years. So I always like us to think in terms of target dates if we don't meet them at least we had a target date But to kind of just let it flow means when we get to it, we'll get going.
So- Supervisor through the chair, it's not like that at all and I can understand and I appreciate your pressing because it actually is very important. We have a team that's dedicated to it with a manager who's committed. I just don't know the date. Thank you. Okay, let's go to the next slide. So this is our current outpatient adult system. So through access, there's a single phone line.
All the initial assessments are done in two sites, CARES North, CARE South and actually Lompoc does not have a unique CARES facility but it's done in the clinic. And then as we were talking earlier, the question of whether or not a consumer has Medi-Cal comes into play If the person meets our medical criteria for treatment and they have Medi-Cal, in the current system they go to the generic outpatient clinic.
If they don't then we ask the question about their level of needs. If their level of need is high enough to warrant an intensive program like supported housing or ACT and there's a slot open then that's where they go. If not, then they go back to CARES. And so CARES is currently functioning as an additional clinic within the adult system. By generic outpatient clinic, what we mean is that everyone who comes to the clinic receives a similar kind of care. So case work, psychotherapy individually or group counseling as needed and then psychiatry.
And so that's what the green oval of Medi-Cal Services indicates.
Excuse me I have a question.
How many
beds do we have in North County for cares? What's the size of the facility?
Chair, that's 12.
12? And what's the average give or take stay?
The average stay chair is approximately 10 days and people can stay up to 30 days.
Okay are we pressed for I guess what I'm trying to say is are we booting people out before they're ready to get back on their feet?
Chair, we are not. All right, thank you. Just to continue, it's actually a very astute question that there's a layered answer. We are not booting people out but the medical necessity for the facility for that level of care is very clear with the state and so the question of housing and where people go when they step down from that level of care is one of those analyses that will happen in the next year.
Well that's a $64 million question, right? I mean where do they go after they leave CARES.
Now if they have housing the where they go is not such a question because they come into our system of care so they get their treatment. For those who are homeless that's a different question.
Okay thank you.
6:34 – 6:4111 turns
So in our transformed system we'll currently have a single access line But the care site and the clinic will both become recovery centers. What do we mean by a recovery center? We mean that they will adhere to the principles of the recovery model, they'll also because their MHSA funded function consistently with the MHSA guidelines which are very different from the Medi-Cal guidelines.
The Medi Cal guidelines are very strict in terms of the medical necessity requirement and of course having Medi Cal. So the programs and services that will be available through each of those sites are initially the access and assessment. So we envision access and assessment as a centralized function, which gives the advantage that the access and assessment team can function in a standardized way across all three regions But can respond within each region to either site or even go out into the field to do that initial assessment.
So one of the places that we lose people is they call in, it takes a while for them to get in so there's a time gap and then by the time their intake appointment comes some of them don't show. And so we lose some people initially who need treatment. So this will help us to address that need while at the same time providing standardization. Supervisor Farr?
Thank you, Mr. Chair. So many people who need assistance have co-occurring disorders. So I'm just wondering whether you could speak to both how we're doing it now plus how we want to be doing it. It's going to address the need for detox, whether that's a drug and or alcohol addiction. Because ten days is long enough to kind of dry somebody out but it's not enough to break a cycle even 30 days really isn't enough. So I'm wondering how that piece is going to fit into the system and how that also is going to be a part of the capital needs. That's not necessarily funded by the county, but the need for more detox facilities in various parts of the county.
So here you can see that substance abuse treatment is blocked and is somewhat separate from our current system. And so, that was clearly schematically drawn that way because we still have a split system. With our revised system, with our transformed system we imagine co-occurring treatment teams. In fact we've designed co-occurring treatment teams that will be available in both sites along with separate substance abuse referrals as needed and so one of the things that we're looking at is The possibility of locating mental health practitioners with ADP providers or even having CBO providers provide that service so that we're co-occurring capable throughout.
So previously when we were talking about what is it that we need to do in a system wide basis, the co-occurring complexity capable is one of those elements so that wherever someone shows up in the system there are people there who are capable of dealing with both issues Now in terms of the detox needs, that's an ongoing need and I'm not sure where we are with that.
Well Mr. Chair thank you for that but let's not lose sight of that because I mean that's just a huge huge need and there are facilities where if you have plenty of money there's a lot of options But if you're middle class or even certainly low income, there are not a lot of options out there. And it's a huge need in a lot of ways. So I'm not saying that that's something that we can address but it's certainly something I want us to be mindful of and as we're looking at the facilities that we have in the county, I think that that's something that needs to be part of the discussion.
Supervisor through the chair, thank you. And part of what you're hearing when you hear me say I'm not sure is that this is a staging implementation and so what you are hearing here is a massive transformation and so some of the questions that you're raising are next step kind of questions and so it shows that you're really right in saying. So thank you Supervisor Carbajal.
Thank you. Michael, you have the co-occurring there in that circle? Would those be county staff? Would they be providers? Who's going to be there to assist in the assessment, the co occurring assessment in terms of a substance abuse issue?
So supervisor through the chair, the initial step is that we'll have county staff only simply logistically because that's the next step. And then we're looking at having each of those sites drug Medi-Cal certified so that we could have either county staff and or CBO staff within the county facilities providing that service. So, we're looking at both in both directions and again the idea is so that wherever people show up they can get the care that they need.
Okay,
thank
you.
Yes and so just moving around the oval. The next team is the medical integrated in geriatric and we're working on a better name. Our intention is that these are the people that we share with public health who have complex medical needs or who are aging and of course that's the largest cohort of adult population. And so currently we don't have any dedicated or specialized service for those who are facing that kind of complex challenge.
The next is the wellness, resiliency and recovery. And the focus again is the recovery model and because of the nature of this transformation we had to make sure that as we mapped all of our current clients into new programs that we abided by all the rules of MHSA. And one of those rules is no supplantation so you can't just use MHSA money to do what you always do.
So part of what that gives us the opportunity to do is to create newly designed programs using evidence-based practice models that we select in conjunction with our partners to address those that were currently treating. This also requires the caseload levels be at the appropriate level. So currently, we don't have specialized teams within the clinics who have smaller caseloads like in a dialectical behavioral therapy caseload typically it would be like 15.
Currently, we're sitting at about 80 to 90 in the adult system and so part of what this transformation will allow us to do is to vary the caseload size depending upon the type of treatment that's being provided And then the current MediCal services, and we show that just to emphasize that we're not losing anything. And then the mobile crisis teams that we've talked about.
6:41 – 6:471 turns
So as stated in the previous presentation, the MHSA plan update is the driver for the 14-15 recommended budget. The MHSA plan update moves the majority of the outpatient system into the MHSA fund. And so, the only outpatient programs that are not moved into the MHSA funds are those that were in existence in November 2004 when the Mental Health Services Act was approved by the voters. We've also developed a funding hierarchy that maximizes the department's revenue sources to fund our various systems of care and recovery.
So, and I'll just take you through this seven step funding hierarchy. So the first thing that we do is that the department first uses any grants or categorical funding that can only be applied to cover very specific costs. Next, so the department draws down as much Medi-Cal as our cost support for outpatient services, inpatient services, as well as administrative and quality assurance support.
Under number three, we then use our current year MHSA revenues to cover our non-MediCal costs. So MHSA revenues are used first and foremost to cover the cost of providing prevention, outpatient and crisis services to the unserved and the underserved which by definition tend to be those without MediCal and without the ability to pay for services. And it should be noted that MHSA revenues cannot pay for ADP costs or or for inpatient costs.
Under number four, any remaining current year MHSA revenue is then used towards the Medi-Cal match for again prevention outpatient and crisis services. Under number five we use our state realignment revenues are used to complete the Medi-Cal match for these services at which time our prevention outpatient and crisis services are then fully funded We then use our remaining state realignment revenues to cover the non-Medicale costs associated with our inpatient system, as well as our administrative and quality assurance non-Medical costs. And then number seven, the general fund is then used to cover any remaining non-medical costs.
Okay? So the goal of the 14-15 budget is to start balancing our systems as previously mentioned. Moving our outpatient system to the MHSA fund provides the department with the greatest funding flexibility by allowing us to use MHSA funds, grant funds, state realignment funds and the general fund revenues to cover the cost of providing prevention, outpatient and crisis services through programs that focus on specific populations with specific needs using culturally sensitive evidence-based practices without a restriction to a person's ability to pay.
So this results in a $24.6 million shift of cost and funding to the MHSA fund as part of the base budget without using any additional general fund revenues. The department is also requesting a 12.2 million dollar budget expansion in order to increase the size of the prevention early intervention system, increase and transform the outpatient system, increase the resources allocated to the crisis diversion And ultimately, reduce the size of the inpatient system.
So the following list is a list of our 14-15 budget expansion requests associated with the 14- 15 MHSA plan update. Each of these expansions is critical to balancing the resources available to each system and I'll briefly walk through each expansion request. So the first one is the crisis system expansion. It's a total of $5.8 million So what this does is it provides a third mobile crisis team for Lompoc, a second crisis residential facility in South County and the new crisis stabilization facility also in South County. All of which are partly grant funded.
Under the temporary housing expansion, this will double the number of boarded care and homeless beds that are currently funded by the department and allocated to persons with mental illness. The clinic transformation establishes new clinical teams to provide culturally sensitive evidence-based services to specific populations with specific desired outcomes.
The KDA excess costs, that expansion will provide mental health assessments and additional intensive services to children going through the foster care system. The homeless services will expand the amount of outreach, Direct services and coordination of care that's provided to the homeless population throughout the county. And the forensic services will do similar by expanding the amount of outreach, direct services and coordination of care to those involved with the criminal justice system.
The administrative support expansion, our budget expansion request replaces administrative support that was eliminated in prior years as well as adding IT, MIS and quality assurance support for our programs and services. And then the last one is the demand for clinic services. This is for additional extra help resources to address any pent up demand presented by the community as part of our system change.
6:47 – 6:5919 turns
Thank you Michael, Chair Lavagnino and members of the board. Good afternoon as we approach a short summary I am so excited to have this opportunity to share my feelings with you heart-to-heart and one of my concerns is as we're going through all these figures and facts I don't want you to miss the excitement that we were feeling as part of this team and i'm hoping you're feeling it also because it's uh it's a key component to what we're doing here It's not often we get an opportunity to change a system like this.
So along with that thought, I'm excited to be part of a total cultural change within the alcohol drug and mental health community. Like I said, that doesn't come up often in one's lifetime. And I want you to be sure to know that real changes are taking place now. This is not something that we're looking at five years from now they've already are taking place.
This is a subject that's come up before. I don't see any going back. We've gone too far already. I want this community to regain its voice That's important to me because I know what it's like to feel powerless, to stand up for oneself. My words carry the added responsibility of speaking for a community of people much larger than myself. This community is more inclusive now and more collaborative as we mentioned.
I am reminded of the clients we serve. That's what means the most to me. I'm reminded of the peers that we train I'm reminded of the family members who learned so much as they're going through the crisis with a loved one. I'm reminded of the staff who worked so hard to make these changes possible and not least, the community-based organizations who make the recovery that we talk about so real.
The brain is the ultimate mystery here and guess what? That is what we work with It's a real challenge. Part of our system change is the goal of recovery and self-respect. Now, a client can expect treatment based on need and not the ability to pay. Now a client will be heard. His voice will not be silent. I have watched stakeholders become change agents Or become part of one of five action teams.
And these groups ultimately report to the steering committee. These ideas are flowing freely and without fear, that's a huge change in itself right there in the culture. There is more inclusion of alcohol and other drug issues in the access process for the very first time. And the budget and the Mental Health Services Act budget are being presented together. That's unprecedented.
These changes are real and system-wide. Also, as Chair of the Mental Health Commission I want you to be sure to know That the Mental Health Commission has participated fully and was involved in every step of this systems change. And the commission supports this design and implement implementation conceptually. I want to finish with this thought all of us we are asking you to join with this vibrant community where real changes are taking place now, and that's our invitation to the board thank you.
Thank you. Does that wrap up the presentation? Or is there a summary?
There's a
summary.
Just a quick summary. So we do have some additional steps during this coming fiscal year, so we'll go through the annual plan update process. We're also allocating to the current Medi-Cal contracts on the mental health side 5% of MHSA funding so that each of the CBOs who are providing services will also be able to reach some non-Medi-Cal clients So refining the programs and then a more detailed analysis of who does what, where with whom. And by that I mean what is the role of CBOs, ADMHS in providing which services to which consumers in which locations? And so this is an initial step and of course it's the big transformational step and then the rest will be refinement from here. And so with that Dr. Wada
Sure, Chair Lavagnino, members of the board. I just want to summarize again that the recommended action is simply a receive and file at this point. We still have to go through a stakeholder process. We just wanted to get your input and then we come back in June for final approval of the Mental Health Systems Act plan update. And then one, just one final comment and that would be that with all these great new programs and redesigns and grants I think we do have to be mindful of realistic expectations. We do have them phasing in over a year assuming our budget is approved by your board in June But even then, that's a lot of people that we have to bring on board, that we have to train. We have to develop all the policies and standards and protocols of how all this is going to be coordinated together.
So I think really it's going to take, we'll have the metrics in place but the first year is going to more of a baseline. And then going forward, it's going to take years before we start to see the system really being balanced and some of that return on investment and decreased utilization of the high end. So I just wanted to make sure that was out there this is a multi-year process that we're going through. And then lastly, I just want to thank all the presenters for both for this presentation and earlier today, all the staff that have been involved, the stakeholders. Terry Mosnisch from the CEO's office has been providing great support and of course your board. Thank you very much.
Great. I see Supervisor Carbajal's light on, but I want to lead off with something and I don't want to embarrass you in any way, but Mr. Kraft how long have you been a Deputy Director?
Approximately, I'm sorry Chair Lavinino still learning protocol, approximately four months feels like four years.
Yeah.
Yes.
I have to say you know and I think this is only maybe the second time you've presented I think once down in Santa Barbara Your ability to answer questions and your ability to show your breadth of knowledge and depth of knowledge, it's really amazing. And I have always been, well since Dr. Water came aboard, I've always been really comfortable with our team.
On all sides, but you really add another gear in the cog. And I'm real excited about what I see us doing because a lot of this you can hear about hey, I think this is going to happen and we hope this happens. But if you just have a mouthpiece there that's just a person that doesn't really know all the details. I can tell you live in this department and you know this.
And it just gives me a comfortable feeling knowing that we have somebody that's got it. And I really appreciate that, so. And where were you before? You were-
Jerry and members of the board, I was in the department. So quick history, I worked at Santa Maria Children's at that clinic and then in the juvenile justice world. Became Regional Manager over Lompoc and then became Deputy. And Chair, I want you to know how deeply personally touched I am. I think that you can all tell how this is sort of mission level for me. It's life level and my family has been incredibly supportive.
Working lots and lots of hours so I'm deeply grateful to them and I'm absolutely determined So this is not pie in the sky. And I want you to know that and I know there are going to be bumps along the way, and I hate not having answers to questions. Thank you for being kind when I didn't know but
I
appreciate that.
Well they always show so thank you very much. Supervisor Carbajal?
I echo Supervisor Lavinino's comments. But now that we've come full circle with our hearing, you kind of understand why I was pressing you on timelines because what happens is we hear this and my expectation all of a sudden is a year from now, we're going to be able to look at those and find out what the metrics are. But Dr. Wada had the last word, and rightly so.
You have to manage our expectations and the public's expectations. And when you don't have timelines, you allow us to craft our timeline. Based on what I saw, I'm expecting implementation tomorrow or a year from now. I want to know how we're doing but Dr. Water brought us back to reality and that is why I press you for timelines because we need to know when do you hope to have what in place so If we're hitting our targets.
Because if we don't have those, six months go by and I'm frustrated because I just heard you six months ago and it's still not in place. So I always like to ground the good work we're doing with target timelines so that we understand and we have the same expectation of the speed we're marching to implement all these wonderful things that we're talking about.
Without the timelines, we're all on different pages. I thought we were doing that. What? It's taken us eight months to do it? So it just, it's really helpful. So I hope you understand that that's the reason I always press for timelines is that it just helps us all get on the same page and it helps Dr. Wada manage our expectations so- Yes supervisor through the chair
point very well made and I do understand that in the fact that you would press me tells me how much you care.
Supervisor Wolk
Thank you, Mr. Chair. During the last presentation I failed to thank Dr. Wada and I think you have really held all of this together and really done some magnificent work in something that's been so difficult. And I also want to thank the team. I think this was actually quite brilliant to bring in the whole MHSA funding piece and wrap it into the system of change. It always seemed like there was always this focus of keeping MHSA funding and programs separate from what the overall goal was in mental health, and I think that was mainly perhaps how the law was written and everyone wanted to make sure that they were following it correctly. But I do think that the way that you folks have crafted it By allowing some of that funding to go into this new reconstructed plan that makes so much sense, is a wonderful coming together of our funding source and the new program.
And so thank you for doing that. I'm very appreciative and I think this just really makes a lot of sense. You folks have been living it for months. For us up here We're trying to make sense of the charts and the lines and the graphs and everything, but you've done a really good job. And I want to thank you.
6:59 – 7:059 turns
Supervisor Wolf triggered something for me. Dr. Wada, for those that are watching in the public you've been hired to lead our public health department about four years ago and without extra pay you refuse to consider extra pay by this board. You have delved into one of the most Challenging, if not the most challenging department Santa Barbara County has had to deal with.
And you have taken on that responsibility with much grace and I know that you recently had another child in your family. And you're being pulled all over the place and it's not easy. You're probably stretched for time that you don't have, but I just want to express to you how grateful I am on behalf of all our constituents in our county government for you stepping up and doing the best you can and doing a great job in trying to manage the department you were hired for And now managing a department that's as big or bigger than your department in addition to your duties. So thank you so much for your willingness to take that on and your good work.
All right, with that we'll go to the public.
Chair Lavinino and members of the board, we have one request to speak on this item, and that is Dave Moore.
Three
minutes.
Thank you. Carpentry is like Rodney Dangerfield in terms of mental health attention, you don't get no respect and more infuriatingly it continues to get shortchanged on essential mental health services irrespective of the Mental Health Services Act mandating that counties report on specific communities that have been identified as facing significant disparities and then developing programs that address those disparities Carpentria's local mental health services for adults and families are nearly non-existent. And its youth services, according to the folks who deliver them were unfortunately initiated only after a local high schooler committed suicide. A reactive response to a serious situation. Which desperately needed a proactive intervention.
One would hope that this historical lack of attention is attributable to inefficiency, as opposed to indifference. But be that as it may, this is the county's opportunity to write the longstanding systemic oversights in the county's delivery or the lack thereof of appropriate mental health services to Carpinteria. The fact that Carpenter is efforts to get a county therapist locally for two days a month began in August of 2013 and wasn't formally approved until April 16, 2014.
Nine months after solution was promised suggests the level of disarray in the county's mental health system and beyond this more than a little unsettling If the contemplated county mental health restructuring fails to provide concrete, timely plans for addressing Carpinteria's mental healthcare needs it is important to know that Carpinterians are a stubborn assertive bunch who as has been noted are conversant with the Mental Health Services Act as well as the roles of patients' rights advocates and quality assurance guidelines.
And are more than comfortable reconnecting with contacts they've made at the state level if the need presents itself. Carpenterians are also letter writers of some repute, be it The Coastal View, The Independent, the Santa Barbara News Press or the LA Times. While encouraged by ADMH's April 16th staffing placement in Carpenteria we look forward to a brighter day in the very near future when Carpenteria receives a full complement of the mental health services its entitled to. Thanks.
Thank you. All right, with that I'll bring it back to the board. Supervisor Farr?
Thank you Mr. Chair well I would just like to echo the comments of my colleagues and their praise for Dr. Wada and all of the staff and community members that have been involved with this process and it really is nice to have had both of the presentations one right after another so we have a better understanding of how it all fits together Because having the money siloed has kind of siloed the programming, at least in my mind. And that doesn't need to happen and now isn't going to happen. After so many years that people have been involved with the ADMHS department at the county it was easy to get kind of cynical and say well yeah everybody wants to change but you know we're going to change well then nothing ever really changes.
But we can really feel the excitement, the enthusiasm by everybody. The fact that we have turned a corner here, it's a very significant turning point I think in the history of this department. And so, well we would like it to happen tomorrow and be done. We realize it's going to take a number of months and years to really see it fully implemented but I know that I'm going to look back on my time on the board and be very proud that I was a part of helping to push this forward. So thank you Mr. Chair.
Very good. Do we have a motion to receive in file? Moved and seconded all those in favor? Aye. None opposed passes unanimously. I think that's it. Okay, so we will adjourn and our next meeting is Tuesday May 6th in Santa Barbara. Thank you.
7:08 – 7:081 turns
I'm