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.0:03 – 0:0714 turns
Good morning and welcome to this October 11th, 2022 meeting of the Santa Barbara County Board of Supervisors here in the Santa Maria hearing room. Madam Clerk, will you please call the roll?
Roll call, called by Clerk of the Board
Show transcript
And
the next item of business is approval of the October 4th, 2022 meeting minutes. May I have a motion?
So moved.
Second. And any discussion? All in favor say aye. Aye. Any opposed pass unanimously. CEO Miyasato
No report this morning chair
and Madam Clerk any announcements
Chair Hartman and members of the board, I do have a couple quick announcements this morning. We posted an addendum to today's agenda on Friday October 7th amending the departmental agenda. The departmental agenda was amended to include an additional agenda item from the Behavioral Wellness Department regarding an update on CareCorps. This amendment was posted online and has been made available to the board and the public Lastly, I would like to remind the public who are participating in our meeting of today's board's updated methods of public participation.
For the Board of Supervisors' methods of public participation and to provide public comment during general public comment on an item on the board's agenda please see page two of the agenda. Members of the public can attend meetings in person both in the Santa Barbara Board Hearing Room Chambers as well as the Santa Maria-Borne Hearing Room Chambers. Please note the board is following all local and state guidelines and are no longer requiring face coverings indoors If you attend the board meeting in person, you will no longer be required to wear face coverings. But please be advised that the Public Health Department is still strongly encouraging all county staff and members of the public to mask and socially distance themselves in crowded areas.
I would also like to remind the public that if you require any special accommodations, please contact the Clerk of the Board's Office to make that request, preferably the Friday prior to the board meeting. Individuals that would like to provide verbal public comment virtually may do so via Zoom by registering in advance via the link available on page 2. After registering, you will receive a confirmation email containing important information about joining the virtual meeting.
Once the chair has announced the item you want to comment on, please join the meeting with the information provided in the registration confirmation email. You will be placed on mute until it is your turn to speak. The clerk will call you by name when removed from you, you'll hear notification that your line has been unmuted. If you're using a touchtone phone, you may need to press star six to unmute yourself Each person may address the board for up to three minutes at the discretion of the chair. If you have any questions, please contact the clerk of the Board's office at 805-568-2240. That concludes my announcements for today.
Thank you Madam Clerk. Turning to our administrative agenda. Board members would you like to pull any items? I have Supervisor Nelson A9 and A18. That's
correct.
Any others? And Madam Clerk, Members of the Public Chair Hartman
and members of the board, we also had a request to pull administrative item 17.
Okay would you read A9 into the record
please? Chair Hartman and members of the board, Administrative Item 9 is from the County Executive Office. It is to consider recommendations regarding the circumstances of the existing state of emergency.
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Supervisor Nelson?
Yes I was just hoping for a roll call vote.
All right, Supervisor Levinita.
I'm going to be 17
second
second
and a roll call vote. Madam Clerk.
Oh, oh, I'm moving a nine and 17 later, but not for now. And as of the second or the motion,
I understand.
Roll-call vote Passed 3–1
Show transcript
Motion passes 4 to 1
and would you read a 17 into the record please
Chair Hartman and members of the board, Administrative Item 17 is from the Public Works Department. It is to consider recommendations regarding a cooperative agreement and construction of Measure A safe routes to school and bicycle and pedestrian projects. This project is located within the first second and third districts and it also requires a forfeits vote.
And I gather this was pulled by a member of the public?
Chair Hartman and members of the board, we have Scott Wenz in Santa Barbara. Mr. Wenz?
Madam chair, members of the board, Scott Wenz representing Cars are Basic. I'd like to open this comment stating that Cars are Basic has never In the twenty five year history taking one penny of taxpayer money. We find this item to be disingenuous because the safe routes to school program that it says they want to the bicycle coalition slash coast whatever name they're coming under these days has in fact failed.
In 2016 Supervisor Williams and Supervisor Hart were at the Santa Barbara City Council meeting where the Bicycle Coalition had to admit examination that their Safe Routes to School program had not succeeded. That means the Safe Routes to School program for the Bicycle Coalition has not worked since 2011. We have challenged the Safe Routes to School program by the Bicycle Coalition for many times, and we're getting sick and tired of watching them come up and asking with a tin cup in their hand please give us money.
If Supervisor Williams will remember, he gave the Bicycle Coalition $386,000. The City of Goleta last year gave the Bicycle Coalition $20,000 and the City of Bilton gave them $10,000 add it all up folks you're getting close to half a million dollars for an organization that has rental property in Santa Barbara has its own income And it's amazing that they have even had the guts to come before any government agency for public money.
They haven't been able to prove their program works. If the Bicycle Coalition's basic concept of transportation planning had worked, what's called Death Valley, called this downtown Santa Barbara would've worked. The city of Santa Barbara has then in 2016 25 miles of interconnected bike modal-modal paths. Today they have well over 50 miles of interconnected bike and multi-modal paths that include routes to schools. It has not worked, therefore money for this program is absolutely unnecessary. They have their own income and the Bicycle Coalition is being used in violation of their 501c3 standing as a PAC.
Make absolutely no mistake about it. When the Bicycle Coalition comes to you and says they want money, they also turn around and say oh by the way those of you that support us will be more than happy to make sure our memberships know. And that's a PAC. This is not a good program this is continuation of a slush fund we recommend against it.
Thank You Mr. Williams. Turning to item A18 Madam Clerk would you read that into the record please?
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Chair Hartman and members of the board, Administrative 18 is from the Sheriff Coroner's Office. It is to consider recommendations regarding a second amendment to the Contract Law Enforcement Services Agreement between the County of Santa Barbara and the cities of Buellton, Carpinteria, Goleta, and Solvang. This item requires a forfeit vote. Supervisor
Nielsen. Yes, thank you Chair Hartman. I'm just highlighting this item. I plan on moving it forward currently but I just wanted to is the first time we've had this before us in open session and this is a contract that we have between our Sheriff's Department and our contract cities and while it's important to continue how those partnerships with those cities for The safety of the community as a whole. These contracts are troubling to me, we fully staff these positions as well as the CRDs and other important law enforcement roles in these cities meanwhile that we have many many shifts in the unincorporated area that go unfilled and so this is a frustrating thing for me as a supervisor and as someone who represents a large portion of the unincorporated area The other thing that's frustrating about this is that we are actually subsidizing these cities with these contracts and that's troubling as well.
These are cities with large sales tax bases, and you know there are unmet needs elsewhere in the county. Our Prop 172 dollars are given to counties for specifically county-related public safety concerns. We have a lot of...we touch public safety in a way that cities do not And these funds need to be husband as best as possible so that we can meet the challenging needs that we have. That said, hopefully in the future some of these problems will be resolved and we'll be able to address that. I also know that we have an item coming before us Thank you, Mr. Chair and members of the board.
If we are going to fund these programs or these positions for cities, that they are fully compensated back to the county. Unincorporated residents or the county as a whole shouldn't be subsidizing these cities. Law enforcement is expensive And that's one of the reasons why these cities come turn to the county to help fulfill that need. And so it really should be on the back of the entire organization. And so, you know, I would definitely pause in the future when the next contract comes back if it isn't a cost neutral fee for services. Thank you.
Thank you, Supervisor Nelson for raising that. So you don't need a separate vote. So we're ready for the balance of the administrative agenda. May I have motion?
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So moved.
Second. All in favor say aye. Aye. Any opposed? Passes unanimously. Madam Clerk, turning to our first resolution would you read item number 25 into the record please
Chair Hartman and members of the board. Administrative item 25 is sponsored by Supervisor Williams and Supervisor Hartman. It is to adopt a resolution proclaiming the second Monday of October 2022 as Indigenous Peoples Day in Santa Barbara County. Joining us via Zoom, we have Reginald Pagolin, Eleanor Fishburn, and Matthew Bistuso. I will now read the resolution into the record.
Whereas Indigenous Peoples Day is a holiday that celebrates and honors the diverse Native and Indigenous peoples of the Americas, commemorates their histories and cultures, emphasizes the fact that discovery does not mean ownership, and was first recognized by Santa Barbara County Board of Supervisors in 2018. And whereas the Chumash people have resided in the lands that span over 7,000 square miles between Topanga, Ragged Point, San Luis Obispo, Fresno, Bakersfield and the Channel Islands for over 15,000 years with their population once numbered at 20,000.
And whereas the early Chumash were hunters, gatherers and fishermen who utilized the abundant natural resources of the land for food clothing medicine and shelter causing the Chumash culture to be considered one of the most unique and advanced on the continent. And whereas after the arrival of the Spanish settlers in 1769 five missions were established in Chumasha territory and the Chumash population was greatly diminished Due largely to the introduction of European diseases and enslavement, dwindling to just 2,788 by 1831. And whereas in 1824 the Chumash organized the largest resistance to occur during the Spanish and Mexican periods In California, leading to a revolt at three missions in Santa Barbara County. San Ines, La Prisima and Santa Barbara against the long hours of forced labor and demanding the equal treatment promised by both Spanish and Mexican governments.
And whereas all native and indigenous peoples of the America are extraordinarily resilient people who have successfully fought to keep their culture and traditions alive Whether they have been able to remain on their native lands or not. And locally we see this with the Sandinas Band of Chumash Indians, the Coastal Band of Chumash Nation, the Barbaranyo and Venturanyo Bands of Mission Indians, the Barbaranyo-Chumash Tribal Council, the Barbaranyo Band of Chumash Indians And many other Chumash bands, clans, their families who live on yet are restricted access to their lands and all other native and indigenous people who have been forced off their native lands. And now they're in Santa Barbara County.
And whereas the county of Santa Barbara recognizes the past and ongoing contributions of all native and indigenous peoples of the Americas that you match people in our county. And values the Chumash Nation and people as partners in governance, and encourages the education of all residents in the rich culture that has existed on these lands for time immemorial.
Now therefore be it hereby ordered and resolved that this Board of Supervisors hereby adopt this resolution to recognize the second Monday of October as Indigenous Peoples Day in the County of Santa Barbara passed and adopted today.
Good morning and thank you Supervisors for recognizing Native American Day. History, yes absolutely it's long overdue just recently had an interview with some folks from NBC and a group of Native people doing reports about the mission system, of all things. Just so happens that as part of this proclamation I appreciate the recognition of the Battle of the 1824 in the Chumash but it probably started out long before that and as I went through my interview we started recapping a lot of things about history itself and being one of the only Ethnic groups identified within the Declaration of Independence as merciless Indian savages.
So I think about that and where we go, how far we get what we're going to do. I think back to the history that was just before I was born in 1950 you could actually write to South Dakota and buy an Indian child for $100 less than a price of a piece of cattle so we've come a long way We're still got a long way to go. We're striving right now to put education, Native American education in the school systems.
Acknowledge in your resolution talking about people well I'm one of our last canoe builders so I apply mathematics and science to that. The mathematics being the simple design and the width of your hand as a measuring instrument And it didn't talk about advanced mathematics and water displacement of how much water is displaced when you place a canoe. So mathematics, chemistry and science has always been part of our culture.
It just has to be acknowledged. I think I used the phrase academic privilege as an aspect where we're battling why we're not recognized why our collections are in museums at universities so we've still got a long battle to go The no this is mine for research, whereas. You're holding on to something that's sacred to us. You're holding onto sacred objects. You part of our culture? Why should it be yours? I mean even today I think you can go down to the Maritime Museum in Santa Barbara and as much as they've contributed, it was interesting to have a discussion with the director just a snippet of the Maritime Museum and he said yes, and we had one of the two moles Just like I said, I know I built it.
So it was kind of like that academic privilege is coming through something that I've built even today. So in this resolution, I want to say thank you from the tribe still a lot of history to correct still a lot of future to build. So I want to thank you very much.
Thank you for being here with us. Thank you. Madam Clerk, we have some participants on Zoom. Ms. Fishburne I believe?
0:22 – 0:276 turns
Yes good morning.
Thank you.
County Board of Supervisors. Okay good morning County Board of Supervisors and Thank you for this, for recognizing Indigenous Peoples' Day. For me, Indigenous Peoples' Day is every day as we continue to bring back our culture, as we continue to express our needs and our wants. We are the stewards of the land and protectors of our Chumash cultures We educate through sustaining and perpetuating the culture and spiritual practices of our people.
You know, over the span of hundreds and thousands of years, our Barbareño Chumash ancestors were born lived and died on our ancestral homelands in present day Galita and Santa Barbara. We honor their memory, even as we honor this land as sacred. It is from our ancestors that we have gained the wisdom of the culture, historical and spiritual value of this land. We know that the spirits of our ancestors are still here and alive within us forever connected to this land that they loved I just look forward to this as the start of a building of relationships throughout the years so that we're not just called upon on one special day to be acknowledged.
We want to collaborate, we wanna work with, we wanna share our wisdom and our knowledge that has been passed on. Thank you all for recognizing the Chumash of this land today. The Barbaranio Band of Chumash Indians thanks you and we look forward to developing relationships with the county, city and anybody else who's willing to bring us to the table and sit down and have a conversation. Thank you.
Thank you Ms. Fishburne for being with us. Supervisor Williams?
Well, first of all, I want to thank the Bob Ranio Band of Chumash Indians Chair Eleanor Fishburne for joining us on Zoom and for the Coastal Band of Chumash Indians Mia Lopez for helping us with this resolution, helping us draft the resolution. And Reginald for being here in person. Thank you. As Eleanor said, For some of us, Native American Day is every day.
You know my children you know their great grandmother was forbidden from speaking her language ironically at the same time that that same language Navajo was helping us win The war in the Pacific, she would be beaten for using it. Right? So I feel like not only are these days important for telling our stories which I try to tell my girls every story time but also On confronting our own inconsistencies, our own hypocrisies of our history because that's how we build a better community. That's how we build a stronger community is and one that has truth confronts truth in the past.
Sees the gap between our aspirations and our past reality, and strives to close that gap so that we can meet the aspirations of what this nation should be like. So I thank you all for being here. Thank you for the celebration. And it's meaningful to me, and I know many others that we commemorate this day.
And I just wanted to add, I serve on the Fire Safe Council and there it's very interesting because we're consulting Chumash people about the history of fire and how they manage fire. We have the belief that we have lots to learn because Our understanding is that they lived successfully with fire and managed it in the landscape. So we're working with you to recover this history because it'll benefit all of us, so we're very appreciative.
Thank you again. Madam Clerk turning to item number 26.
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Chair Hartman and members of the board, administrative item number 26 is sponsored by Supervisor Lavanino. It is to adopt a resolution proclaiming the month of October 2022 as Italian Heritage Month in Santa Barbara County. Joining us here in person we have Alfonso Curti and Larry Lavanino. If you will please join us at the podium I will now read the resolution into the record Whereas in the five centuries since the first Italian explorers set sail across the Atlantic Ocean, countless individuals have followed the course they chartered to seek a new and better life in America.
And whereas since that time generation of Italian-Americans have helped shaped our society and steered the course of our history. And whereas during Italian American Heritage Month we recognize the rich heritage of Americans of Italian descent and celebrate their immeasurable contributions to our nation And whereas, it is important to remember that like most other immigrant populations many of the new arrivals from Italy face racial and religious bigotry. During one incident in New Orleans 19 Italians were lynched by a mob of 10 000 people and whereas during World War II even though many Italian Americans served on the front lines heroically Defending their new country, many others were labeled as aliens forced from their homes and sent to internment camps.
And whereas Italian-Americans persevered with hope and hard work to reach their own American dream and help build this great country. Today the legacy that these intrepid immigrants is found in millions of American men women and children who have drawn on the courage of their forefather to lead in every facet of American society from the arts and entertainment, to politics finance and organized labor. And whereas we honor the long history and vast contributions of Italian Americans Let us recommit to extending the promise of the American future to future generations. Now, therefore be it and it is hereby ordered and resolved that this Board of Supervisors proclaims the 11th day of October 2022 as American Heritage Month in Santa Barbara County and extends congratulations and best wishes to all those of Italian descent passed and adopted today.
Thank you, Madam Chair. Members of the board, actually Alfonso is more Italian than I am. He's, I guess first generation and I'm fourth generation and Supervisor Lavinino is fifth generation of our family to live here in United States. On behalf of all the Italian and Swiss-Italian families that settled here in Santa Maria, I want to thank this Board of Supervisors for recognizing our place in the history of this great country.
Like many other immigrants my great grandfather Augusto came to this country with very little. He was so poor on his journey to the new world, he had to walk across the Isthmus of Panama because he didn't have enough money to pay to sail around the Cape. Like so many others, he came to California on a quest for gold. Today I wear a ring that has been passed down through my family that was made from the very gold Augusto discovered.
Newly arrived Italians stuck together And it just so happened that the founder of the Bank of Italy, A.P. Giannini was a personal friend to my grandmother Maria. They were both Genovese. One day over a plate of raviolis he asked my father what his career plans were. Dad was on his way to Stanford to become a lawyer but A. P. convinced him to come and work for him in his new bank.
In 1935, Dad was sent from San Francisco to check on a new branch in a small town named Santa Maria. What was supposed to be a six-month stay turned into a lifelong love affair with the city. He worked for 42 years for the Bank of America, formerly the Bank of Italy. I'm not so sure why so many Italians settled in the Santa Maria Valley. Maybe the Mediterranean climate reminded them of home.
Farini, Rigetti, Moretti, Manetti, Monaghetti, Diani, Carrari, Lanini, Brunello. The list goes on and on. Italians and Swiss Italian families who helped make Santa Maria a great place to live. On behalf of all of them thank you or should I say mille grazie. Ciao!
Good morning everyone. I'm not much of a speecher, but I want to say something over here. I want to thank the people that they came to United States from Italy and Europe before me. Unfortunately, fortunately I should say, I came with Alitalia with one plane, one ticket and I came to Solvang. I've been over 25 years and the overwhelming welcoming from the people in the town from Santa Maria to Solvang Very grateful to be in my family, my brothers. They're here today and so that is my speech for today. So thank you again. Thank you
so
much. We still believe in the American dream. We still do keep working hard. Thank you
Supervisor Levinino.
Thank you, Madam Chair. First, I want to thank you for encouraging board members to look into their own heritages and to honor those in their districts . And it was helpful because going looking into this resolution and studying about this did get me to ask questions more about I didn't know the story about Augusto traveling across the isthmus of Panama , which by the way, I checked out at 30 miles.
So We were talking about that's the middle mile back in the day, right? Like on the trip. So you know and I didn't also know that the ring that my father wears it was from Augusto so I got to learn some things and Alfonso just a I think he embodies kind of what the story of the immigrant is in this country as somebody that comes here relies on The rest of us looks to the rest of us for acceptance, works hard runs an awesome business very successful and then turns around and gives back to the community.
That's the immigrant story so great day today. Thank you
so much. We really appreciate it. I think we all learned a great deal about the Italian contribution to our culture and going from indigenous Chumash people to Italian people, we have such a wealth of cultural traditions that we all can learn from and share in value. So thank you for being with us. And Supervisor Lavanino, it's kind of Lavanino day
0:34 – 0:384 turns
here. It is Lavanino Day here. So I just wanted to highlight October 15th Saturday is the 10th annual Veterans Stand Down. First off, I want to thank all the county employees who have volunteered and continue to volunteer. They are the backbone of stand down a lot of county employees Show up and to support our veterans. But for any veteran that's out there, or if you know a veteran whether or not they're in need or they've just served our country would really like to get him to the Santa Maria Fair Park this Saturday from 9 to 1 everything for those that are in need it's everything from getting a shower and a haircut new clothes we have on site assessments for mental health You can bring your pet. We will take care of your pets, get you pet food, we'll groom your pet, we'll chip your pet.
If you bring your kids, we will groom them and chip them as well but we don't really recommend that as much. But we also have crisis counseling, healthcare screenings, employment assistance just about any service you can imagine is provided as long as well as a barbecue dinner and a breakfast Also courtesy of the Chumash this year, they're providing transportation all the way from San Luis Obispo to Carpinteria. So there is a set time to pick up a bus. Those times are listed on sbcountystanddown.com And so I encourage everybody to go there, figure out we'll bring you and take you home.
And also just wanted to let folks know if there's if you feel like you want to help, there's a way to do that. You just go on SP County stand down dot com. There's a link to Wal-Mart. Just click on that link and it's basically like being in a wedding registry. There's things that we still need. Just click on those items. Give us your credit card. You don't have to go to Walmart. You don't have to deliver the items they're delivered right to the fair park And so I want to thank everybody for that. There is a collection tomorrow at the Santa Maria Fair Park, if you have new clothes that you'd like to donate October 12th from twelve to two at the Santa Maria Fair Park. And I also want to give a shout out to the stand down coordinator for my office, Sandy Agalos, who makes this all happen three four six eighty four hundred.
If you have any questions, you can talk to her eight oh five three four six eighty four hundred. I think that's it. Thank you.
This is the 10th anniversary, right?
10th anniversary modeled after San Diego. And the reason why we're doing it is because I was watching 60 Minutes one time and they were highlighting that one in San Diego. And what got me was they were interviewing the organizer and the 60 minutes correspondent said, We don't expect you can change somebody's life in one day, do you? And the guy said, Yeah, I think we can.
And that got me to thinking if you reconnect a homeless veteran or somebody that's struggling back into the community on that day, provide them all the follow up. We can change somebody's life. So that's what we exactly intend to do on Saturday and we've been successful in doing in the past. So again, thank you to all the volunteers
and thank you for leading such a legacy. All right, general public comment. Madam Clerk how many speakers do we have? Chair Hartman and
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members of the board we have 10 requests to speak for general public comment. Okay we will start here with Billy Galanders to be followed by Chuck Williams
Good morning, my name is Philip Gallanders and I am a member of the New California State. And I'm here to read the Declaration of Constitutional Default. The state of California is in constitutional default and does not have constitutional standing as a member state in the Union of States called the United States of America. We the people, as citizens of the United States living in California are following the process of West Virginia that successfully restored the Virginia state government after the Wheeling Conventions of 1861.
Congress admitted California into the compact of statehood within the United States of America in 1850 Because the California 1849 Constitution ratified for consideration guaranteed a Republican form of government. The United States, the violation of the United States Constitution Article 4 Section 4 Clause 1. The United States shall guarantee to every state in this union a Republican form of government.
Today California is a state in free fall at all levels This free fall has been orchestrated over the last 170 years by socialists and communists, and we're now nearing the end of their plan that clearly demonstrates a design to reduce United States citizens living in California under absolute despotism. Today this plan has eliminated the three branches of government, independent branches.
Created a mono-party legislature which has established enabled and empowered the rise of a pusillanimous governor dictator. This pusillanimous governor whose character is thus marked by every act which may define a tyrant is unfit to be the elected governor of a free people Likewise, elected appointed and regional officials of the state of California whose character is thus marked by every act which may define a tyrant are unfit to be the elected appointed and regional officials of a free people.
California elections have been corrupt for decades The State of California government officials have established secret election schemes within counties and school districts with the intent to embrace the plan of an authoritarian form of government. Their aim is to eliminate the state of California citizens Republican form of government. An unconstitutional administrative state now exists in California in direct violation of the September 9, 1850 compact with the United States of America.
Thank you.
Thank you. I'd just like to add for the record that I have absolute confidence in our county elections. It's been gone up to the Supreme Court even, an appeal and found that it's absolutely correct in how they do things so I have absolute confidence in our Elections Department
You're one of few. I'm Seth Williams, Old Town Orchid and I support New California State violation of United States Constitution Oracle 4 Section 4 Clause 2 and shall protect each of them against invasion. The State of California has failed to prevent the massive invasion of illegal foreign nationals, which is indirect violation of the Constitution of the United States Article 4 Section 4 that guarantees protection from invasion. To be sure state and local government officials are actively engaged In the trafficking of human flesh, slavery with vicious criminal cartels who are trafficking hundreds of thousands of illegal foreign nationals across the border. Repealing, reaping billions of dollars each year. This is openly promoted by the state government officials and members of the state legislature who approve legislation encouraging what is now multi-billion dollar slave industry.
The on the ground violence and lawlessness all along the southern border of the United States caused by cartels and gangs is extensive, well documented, and persistent. It satisfies the definition of actually invaded and invasion under the Constitution of the United States. Violation of the United States Constitution Article 4, Section 4, Clause 3 and the application of the legislature or of the executive when a legislature cannot be convened against domestic violence The State of California has failed to prevent the harm and domestic violence increased by the above stated invasion. which is in direct violation of the Constitution of the United States, Article 4, Section 4 that guarantees protection from domestic violence. Yet the legislature passes laws that openly commit and encourage acts of violence and lawlessness.
The peaceful and honest government opens the prisons releasing vicious criminals out into the streets who murder, rape, and steal. Acts of insurrection. The government of California, the current socialist governor dictator and model party system along with local officials are following a coordinated design with the intent to actively engage in acts of insurrection against the U.S. Constitution.
Acts of secession. The California government, in conjunction with the socialist state executive instituted wherever the current socialist dictator has usurped power, has actively engaged in acts of succession and have created a rate of terror by the United States citizens living in California with the intent to secede from the United States of America to thus destroy the very Union states which secures our liberty and freedom. Thank you guys.
Thank you. Madam Clerk.
Next
we'll have Susan Hudspeth to be followed by Ravi Levi.
0:44 – 0:518 turns
Good morning. This is a
continuation of what Mr. Williams just read, abdication of authority betrayal by the sitting pusillanimous socialist governor dictator Gavin Newsom of California. The Monoparty Legislature and local elected officials is evidence of abdication of their responsibilities of authority and sovereignty. Over the citizens of the United States living in the state of California.
Actions, a restored government of California consistent with the compact of 1850 with the Congress will be established and will consist of a Republican form of government with an executive branch, a judicial branch, and a bicameral legislative branch. New California State is a new state in development forming from the state of California. New California State is exercising its God-given rights as declared in the 1776 United States Declaration of Independence and as ratified in the 1789 United States Constitution under Article 4, Sections 3 and 4 New California is the making of a new state just like 50 other states have been formed to make a union of states, the United States of America.
Blessed is the nation whose
God is the Lord. Psalm 32 12 We came here today not just to read this
declaration. This is an introduction to you of a movement that was established and declared independence on January 15, 2018. We have read over 190 grievances of complaint in public square advising the public of criminal action. Of the current mono party government and now based on executive action for the last 1,000 days is proclaimed a dictatorship. We the people have purpose to stop the reign of a dictatorial power through the peaceable means of establishing a true Republican form of government called the state of New California, providing the citizens with a representative form of government as the founding fathers had originally intended.
Ladies and gentlemen of the board Thank you for the opportunity to address this body. This is not the final address you were will hear from us. Thank you.
Thank you.
Next we
have Revy Levi to be followed by Lori Lee.
On a completely different topic. Good morning Board of Supervisors, CEO, Miyasato and County staff. My name is Revy Levy, I work as an organizer with SEIU 721 and I represent our SEIU 721 members, your employees. I'm here today to highlight the letter, a letter that was addressed to all of you regarding the comments made by the Director of Social Services Mr. Daniel Nielsen on April 11th 2022.
We have yet to receive a response from anyone in the county and would like to put this on the record as you all aware our SEIU 721 members have been working non-stop since the COVID health crisis broke out and member continue to do more with less We were shocked when we heard Mr. Nielsen addressing the board, when asked why 30% of our workers were leaving the county within the first five years in the department.
And Nielsen's response was that many of them were young women who are living to have children. He seems to be suggesting that young women leave their jobs more frequently due to youth immaturity and not knowing what they have gotten themselves into. What he doesn't tell you is that they have a change of heart and mind due to making a calculated, well-reasoned choice to improve their financial situation.
He goes on to speak about advancement in context of college attainment not in reference to actual career paths within the department. The letter also emphasized that this reflected the criticism formally raised by some of our SEIU 721 chapter board members, your employees who stated quote advancement seems to be contingent upon college attainment end quote which may be a meaningful milestone for someone individually but this is an entirely separate issue from career investments.
Young women make rational decisions and the 30% attrition rate is relevant to office culture, their lack of career advancement and their relatively low wages. There is some truth in this mention of children but that applies to all employees both men and women. All employees want to have good benefits for themselves and their family members, yet when they have insufficient benefit you cannot expect to retain people without providing parental leave and sufficient income to afford child care. Parents do not simply leave because it's difficult to work in social services after having children.
After having children, our SEIU 721 members also identified barriers to promotion as a big reason workers leave the county. In fact we submitted information requests asking how many workers were promoted without having a degree and the response was that they don't have that information. We are still waiting for a response to this letter that our regional director sent you. You will be hearing from some of our members themselves, but I hope that in the future you check the facts and you question the true reason why your members, sorry, why our members, your employees are leaving their county jobs. Thank you for your time.
0:51 – 0:588 turns
And I would ask you not to clap. If you agree with something, do it quietly. Thank you and Madam Clerk.
Lori Lee to be followed by Yuri Gomez. Good morning.
Hi, my name is Lori Lee and I'm a social worker for Child Welfare Services. I've worked for Santa Barbara County for 18 years. Thank you for the opportunity to speak to you today. A social worker is a helping person. A social worker puts their heart and soul into their jobs with only goal of being to help those in need. Like it's always said, you definitely don't go into the field of social work for the money. And we all understand that when taking on this calling. Social workers in Santa Barbara County do this job because they love the profession They want to help families, especially children. They want to make sure that children are safe and can remain with or return to their families. This is our goal in a nutshell. Social work in Santa Barbara County has evolved in the past 5-10 years to the point of social workers doing 10-15% social work and the rest is extra paperwork and requirements.
Federal and state guidelines have changed in the past 5 to 10 years, which are guidelines that have been put into place to ensure more safety equity and support are given to families that need these services. We understand these additional requirements and agree that they make for the best outcomes for our families. However, these additional requirements have put a huge burden on social workers And Santa Barbara County has not changed with the times. Social workers are not only required to meet with children, parents, families and foster parents each month but also to be legal experts, court report writers, clerical specialists, visitation supervisors and investigators all while carrying the same caseload as in years past.
A person who could carry 25 cases 10 years ago did the same amount of work that a social worker can do with 5 to 10 cases today, but the caseloads have remained the same. The legal mandates are crazy and if you read some of the court reports, you would think with all of the legal citations that a lawyer had written them. Those are the requirements and we are glad to do these things to ensure for the safety of children in Santa Barbara County.
Some have said the reason for so much attrition in child welfare is because of the nature of the work. While being a social worker in this field, you see a tremendous amount of sad and alarming situations. This is not the reason for such a high turnover. The reason is due to the amount of work expected and not having enough time in the day, week or month to complete all of the required tasks. Workers are working 5, 10, 15, 20 hours of overtime per week. While this may sound like a great way to earn money it leads to severe burnout over time. Workers want overtime to be the exception not the norm. In Santa Barbara County, we do not have dedicated after hours staff. So workers who've been working all day are then required to be on call at night and then be back to the office for their regular shift the next day.
They have to do this in an average of every two to three weeks sometimes multiple days in a row. Even law enforcement doesn't have their staff work or shift and then another and then another back-to-back ship. Workers burn out and then they're leaving the agency at alarming rates. Something needs to be done. Higher wages, lower caseloads or caps on difficult caseloads more clerical staff and opportunities for informal affordable insurance are just a start but it would be a great start to keep those talented professionals within Santa Barbara County.
Thank you.
Thank you.
Gary Gomez to be followed by Megan Salzas
Good morning, my name is Yuri Gomez and I'm a supervisor in the Department of Social Services Child Welfare Services. I will I have been with the department for approximately 12 years and I'm here today to support our my colleagues in our department. We work with vulnerable populations you on April 11th praised the work that was done by our department however we believe that the reasons For why our workers are leaving at such high rates were simplified.
We do have young workers we have majority women employees. However, they do have children and they have to prioritize their families. And sometimes they leave the department not because they're tired of the work, not because they can no longer do the work. It is hard work and we continue to do it day after day. During the pandemic, we were not closed one day. We were open 365 days 24-7 Workers who have children, they move on to other jobs because they offer better health benefits.
Our workforce last year when we were negotiating our contract, we talked about how many people within our department were able to afford healthcare and we discovered that out of the over 500 employees with social services about 19 of those employees were able Take advantage of the family plan. Through negotiations, we were able to receive $25 to help with the plus one family plan. $25 per pay period.
So I'm here today not only to clarify the reasons why people are leaving, but also to ask you to keep that in mind as we come forward in the next year and two years and talk about the real reasons why we need to improve our benefit plans. Lori Lee mentioned the after hours services that we provide for Child Protective Services and Adult Protective Services.
Our after hours structure is really working as a night shift, it's not an on-call service as other departments have like Public Works where they go and fix plumbing that broke overnight. This shifts are busy Every night, nonstop calls going out. And like Lori mentioned, people are tired. They want to go home and rest. They want to go home and spend time with their families. And that's not possible with what we currently have. So we're really pleading that you take this into consideration and then that you make the changes needed for us to retain our workers.
Thank you.
Thank you. Megan Salas followed by Jones
0:58 – 1:047 turns
Hi, my name is Megan Salas and I'm an eligibility worker. I carry more caseworkers than any eligibility worker could handle but I am experienced and committed to my job and to our community. And when my coworkers leave for a better work situation we all have to do more with less. It's really affecting everybody in my whole office it really affects us all every day and I can see the morale just going down thank you for your time.
Thank you Jones to be followed by Benjamin Beach.
Good morning, my name is Shakara Jones I have been with Child Welfare Services for a year and eight months as I address the Board of Supervisors I have a question for you all when was your last time? When was your last time when you were a frontline worker? When was your last time when you spoke to a frontline worker When was the last time you worked a nine hour shift and then work after hours, a total of 24 hours?
When was the last time you went to a hospital and saw a baby with withdrawal symptoms because of the poor choices of a caregiver. When was the last time when you waited several hours for law enforcement to respond to a home because of safety concerns? When was the last time you lost sleep because of the decision you made out in the field, knowing the ramifications of the decision and how it would impact a family forever?
I know when the last time was for me. And the people behind me know as well. My colleagues and I serve our communities with everything we have, and then some. The statement that was made by Ms. O'Neilson was offensive, sexist, and a spit in the face of the work that mothers and fathers have achieved in this line of work. As an expecting mother, my baby, my pregnancy is not the reason for low retention rates. Low retention is due to lack of resources, high caseloads, low staff members, the overwhelming stress that the job entails, and the list goes on.
But before I close, one more question. When was the last time you did this work? Thank you. Thank you.
Benjamin Beach to be followed by our final speaker Jasmine Mara. It's
a tough act to follow. My name is Benjamin Beach, and I'm a social worker with County Holistic Defense. The pandemic has created more and more difficult home situations as families are pulled together often experiencing hardship pulling resources often sharing rent. And I often serve family members who are both victims and identified as offenders in cases, as family members bounce between hospitals and jails experiencing psychiatric and behavioral health crises.
I do my job to uplift our communities, to protect and promote public health safety and welfare. And I stand in solidarity With the social workers you've heard from today. Social workers do not. Leave jobs due to. Pregnancy, for example, social workers leave jobs for rational reasons. Particularly pay and benefits. And also office environment on reasonable expectations and.
inability for advancement. Thank you,
thank you and now for our final speaker Jasmine Mara
Good morning my name is Jasmine and I'm a child social worker with Child Welfare Services I have been with the county since December of 2014, where I have worked as an eligibility worker and now as a social worker with child welfare. In my work, I see the most unimaginable things happen to children on a daily basis, and I'm still here to support the children in our community.
To expand on what the rest of my colleagues have mentioned about after hours, I want to give you an idea of what that's like. When you get the phone for after hours, as soon as your shift is over, you are walking on eggshells for the rest of the night up until the early hours of the morning. You are waiting for that phone to go off and when that phone does it is very possible you will spend hours in a hospital. It's possible you'll spend hours in Office of Law Enforcement in someone's home who you've never been in and you don't know what's around the corner.
Sometimes law enforcement's there with you sometimes they have to leave you for another crisis To do that job and then to have to go home. If you can only imagine staying up all night, up until two or three in the morning and then going trying to sleep only to wake up for example myself at five in the morning to get my own child ready for school together to the next day and then to manage a full caseload where I have all of the children who's Needs are always pressing to support the resource homes, to support the providers, to connect to services.
It is a lot and then to have it with short staff, it makes it harder because not only am I taking on my needs, the children's needs, the provider's needs but those of the rest of my colleagues as well. We shouldn't be having to depend on new staff to train new staff For retention rates, it's not because we get pregnant. It is not because we are following our partner's careers. I speak hopefully not only for myself but I love the job that I do. I come back every day because of the love that I have for my job.
Thank you. Thank you.
1:04 – 1:1814 turns
Madam Chair, that was our final speaker for public comment.
Supervisor Williams?
Well, I just wanted to say that this board has deep respect for the amount of work, the stress, the danger that social workers in this institution face. And we are committed to addressing retention issues throughout the institution. We have a lot of departments and places where that is an issue. I especially want to say that we want to make sure that this institution is a place where young women are welcome, where mothers are welcome and where fathers who intend to be equal partners in raising children are welcome.
So we hear you
And I just wanted to add, I thank you so much for being here today and explaining what the pressures you're experiencing are. And I learned a great deal and I know to be here on top of everything else that you're dealing with is a real commitment. You are the frontline and our children are our future and you have one of the hardest jobs most emotionally demanding and now we have a fuller appreciation. So thank you again for being here.
And with that, Madam Clerk, we're turning to departmental item number one.
Chair Hartman and members of the board, departmental item number one is from the Social Services Department and the County Executive Office. It is a hearing to consider recommendations regarding the KPMG operational performance review of Santa Barbara County's Department of Social Services.
Supervisors, I'm gonna kick this off and we're gonna first get the PowerPoint up. One second. First of all, I do want to address the public comment. And I hope you do stay for this item and there's a report that KPMG did. We're doing reports in all our departments to improve our effectiveness and our efficiency but it also means how can we streamline things so there is more manageable caseloads for our employees? They actually talk about things that we could do to help employee retention So it's a large report.
We'll be just highlighting some of the aspects of it, but I also wanna just recognize the department and I think we're having problems pulling up the PowerPoint, but DSS is our largest department of all our employees. It's 15% in the entire county's budget and it's largely state funded with mandated programs and that puts pressure on the department But I want to thank DSS for being open to the recommendations from KPMG and working through them.
In some, the departments already underway are doing things in alignment and somewhere saying there could be there we could be doing more. But it starts with the first step for everybody. And I just wanna tell you that, there's a lot of frustration especially now in the economy that we're in. Like you said, there's a lotta state regulations out there, it puts demands and the board is committed to figure out the best solutions and balancing all those.
But I do wanna just commend the department for putting one foot in front of the other, doing all the things that they were doing and the requirements they have to meet. And today is just talking about what can we do better? And did we get the report up? Let's just see if we can get, there we go. So next slide please. So today as you know supervisors, we've been doing presentations.
Oh. Can we someone turn, thank you. There we go, thank you.
We've been doing presentations so today this is another presentation by KPMG. We are doing these operational and performance reviews and again In the context of Renew22, as you see that we've done three years of reports and trying to hit all our departments. We did nine in the first year, we did three this second year and now we're doing eight in this third year and the number of reports varied by the complexity of the departments. And so as you see, we're still in the process and in this third year we have more to do. Next slide.
And so as you recall What we ask KPMG to do is compare, look at best practices. Highlight where their improvements could be made and I just want to emphasize this is not a financial audit. KPMG does have an auditing business but this is their management side of the consulting business to look at how we can do better even though it's not an audit and it's not a budget cutting exercise. We hope the recommendations will result in savings and efficiencies for the department Areas of focus were selected by the County Executive Office, received input from board members and working with the department.
And again it relies on the departments cooperation and collaboration in getting the right data. Next slide. And so as I said social services as we know is our largest department even larger than the Sheriff's Department. And again it's 15% of our total countywide spend. And today well I'm going to hand it off next slide The folks who've been working with us in the KPMG, Kiva Thornton, the managing director and Lauren Coble-Levitt who is our manager in charge of this engagement. So they're going to go through a high level of the recommendations that they're presenting again there's a report attached to the board agenda letter they're not going to go through all the recommendations but then we will have the department talk about their implementation plan thank you I'm sorry, we have Bill Zizek as well on online on Zoom.
Yes.
Hi, Bill. Yes.
Hi. Good morning. Thank you CEO Miyasato and good morning Chair Hartman, members of the board is, uh, as you know, my name is Bill Zizek. I'm the KPMG practice leader for our government strategy and operations team. Um, as the CEO indicated in the chamber with you today is Kiva Thornton your engagement leader and Lauren Koval Levitt our delivery manager It is our pleasure to be here with you today to provide you with an overview of our recommendations for both social services and the behavioral wellness departmental reviews, which represent our 11th and 12th departmental presentations to your board. And just to echo some of the comments made we recognize that the Members of these departments have been and increasingly are acting as first responders in our communities given the increasing trends of crisis, substance abuse and violence across the country.
Kiva and Lauren will take you through our highlights and recommendations and we'll be happy to answer any questions you may have thereafter. So Kiva and Lauren I'll hand it over to you.
Great, thank you Bill. So on the screen at the moment you can see our project timeline with review of the social services department beginning in August 2021 and concluding in February 2022. We are currently nearing the conclusion of the public health department review around the midpoint of the review with county council and just beginning our review with Public Works.
Briefly on our methodology, we begin every department review by engaging with staff in interviews and focus groups. We analyze available data on department operations and utilize benchmark and leading practices to identify themes and opportunities to enhance the operations of the department. As with all departments, we hold a midpoint update to department leadership and the CEO team on emerging themes to help ensure alignment with our findings and share working drafts of our preliminary report to be validated, commented on and accepted by department leadership and the CEO team.
As with all our reports, we'll begin with our commendations. To start with the department has recently leveraged the newly deployed CalWIN Business Intelligence Data Warehouse to explore opportunities to track program performance data in a more efficient and effective way to understand their operations Furthermore, in an effort to standardize training and development opportunities, economic assistance and employment services developed a specific training cohort for eligibility workers which will allow the eligibility workers to begin serving clients at an earlier stage.
We'd also like to commend the department on their deep and demonstrated commitment to client service delivery. The department has maintained and enhanced virtual opportunities or operations during unprecedented circumstances within the last year due to the COVID-19 pandemic. Moving forward from our commendations, you may recognize this maturity model from our past presentations. The model looks at key elements of the department operations and the purple boxes indicate where departments' operations are currently and the gold boxes illustrate where we believe the department can work towards.
We've pulled out the two most important elements for the social services department, which are service delivery model and data and reporting. Looking at the top line for the service delivery model currently the caseload and utilization targets are not formalized or regularly analyzed against performance to understand staff workload and caseloads. This also ties to the bottom line of data and reporting where data analysis require significant institutional knowledge with little written guidance on process and reporting mechanisms.
From our review and the recommendations that we provide, we believe the Social Services Department can get to a place where established processes for data tracking and analysis will assist with the creation of enhanced caseloads schedules and staff utilization to help manage operations As Bill mentioned, we're not going to go through every recommendation in our over 100 page report. However there are three main areas of recommendations that we would like to highlight today for your consideration and the first being workload and demand management at the second being client service delivery and the third being performance management so I'll pass over to Lauren to cover our key recommendations and we're happy to answer any questions towards the end.
Thank you
Keeva There's opportunity for the department to perform an activity based and demand driven workload analysis across the protective services division. To allow the Department of develop optimal caseload ranges during our analysis, it was found that there were significant differences in caseloads. For example, during fiscal year 20 to 21, the largest average monthly adult protective Services caseload was 130% higher than the smallest average monthly caseload per staff member.
While there is an understanding that caseloads may vary due to complexity, the caseload variation experienced is high. This workload-based analysis will help ensure a more balanced caseload across staff as well as help ensure enhanced client service delivery.
Moving on to our next recommendation High utilizers are clients who have a high need for programs offered by the Social Services Department as well as other county services. These clients have extensive and complex needs that often have difficulty navigating various pathways to receiving care across multiple departments, programs and systems. There's opportunity for the department to conduct an analysis of these high utilizers across specifically social services programs.
This will allow the department to formally identify these clients with multifaceted names, evaluate any gaps in current service offerings, proactively address these identified gaps and provide additional support in navigating these services. Since this report, there's been significant progress made on this recommendation as well as the allocation of Health and Human Services funding which the department can expand on during their implementation plan.
Moving on to our last recommendation for presentation here today. In addition to the data already collected by the department, the Department should consider adopting additional measures that specifically focus on program outcomes and performance to allow the Department to enhance its ability to measure and tailor program effectiveness for the benefit of the customer experience and enhanced client service delivery.
These performance measures coupled with outcome measures discussed previously will serve to improve client related outcomes and facilitate consistent achievement of program goals and overall program effectiveness and efficiency. It will also enhance accountability among staff, drive performance and allow the department to increase the effectiveness of demand management To summarize, some of the key takeaways from the social services recommendations are one to expand demand-driven deployment across the department as well as leverage existing data to improve performance monitoring and encourage continuous improvement.
1:18 – 1:3310 turns
I'd just like to thank the director of the Social Services Department, his leadership team and all the staff who participated in the review as well as the CEO and her team for their high degree of engagement throughout the review. It was a privilege to work with you all again.
Thank you. And that concludes your presentation?
The department will now provide their response and then we can take any questions afterwards.
Mr. Nielsen
Good morning Chair Hartman and Supervisors. Over the course of the next nine slides and 11 minutes, I will be highlighting the department's plans as a result of KPMG's recommendations. Each slide covers one of the nine areas of focus in the KPMG report and contains each of the recommendations related to that area of focus. We patterned our presentation for you today in the same general format as the department's response to the KPMGs review and implementation timeline document that you have in your documents.
We had four recommendations in the area of client service delivery. KPMG's recommendations in this area were about knowing who our highest needs clients are and making sure that they get the help they need, utilizing technology as much as possible to increase client access Regularly evaluating our local programs with the general relief program identified in particular and making sure that the shifts we offer to employees maximize our effectiveness in reaching our clients.
We currently utilize a no wrong door policy and a horizontal integration practice, to make sure our clients that are in need of more than one of our services are identified and linked to those additional services within the department. While we will be looking, we will be continuing to look for opportunities to identify and serve those with multiple needs. We look forward to the development of a process for the assessment and servicing of clients on a cross-departmental basis that is underway within the Health and Human Services Departments in which we anticipate will be in action in the next fiscal year.
We have a long history of attempting to utilize technology for the benefit of client access, with the effort to utilize kiosks in our lobbies several years ago and our more recent octopus innovation which we have highlighted to your board on several occasions. Once we transition from our current CalWIN system to CALSAS in April of 2023 We will be assessing during the 23-24 fiscal year to see if any modifications or augmentations to that system are needed to maximize client access.
The KPMG report highlighted that our locally funded general relief program has not been evaluated recently, and we will be working with the CO's office during the remainder of this year to best determine how to conduct that evaluation and will be bringing any proposals resulting from that evaluation to your board during the 23 24 fiscal year. While we currently offer 980 shifts as well as significant individual flexibility to staff in child welfare and adult services, which maximize each worker's ability to have a schedule week by week that allows for them to see their clients at times that work best for those clients.
KPMG feels this matter should be further studied and we have agreed to further evaluate our practices in coming months. We had four recommendations in the area of application and case management. It's not
working? You had one job. It's not progressed. Is there a clicker? There we go. My
apologies, we had four recommendations in the area of application and case management. While the department makes ongoing efforts to improve communication of expectations to staff across a multitude of units located in multiple buildings, there is always the need to assess the effectiveness of current practice and improve. One of the ways we improve is to provide tools which cause consistent practice across workers with examples of that being our task management tool which we implemented in intake units in June and our new document imaging system which we are implementing in December.
We have been in the process of expanding and improved organizational model within the Economic Assistance and Employment Services Division. And as of June, we have moved all of our regional offices to the use of multi-program intake units to strengthen the lead worker model. We have historically utilized specialized units within the Benefit Services Center to the extent that staffing and caseload ratios allow and agree that these are valuable for certain subsets of our population.
We intend to continue reviewing this model on a frequent and no greater than annual basis to make sure that we are maximizing our impact by where we choose to have our specialized units focused. As we prepare for Caltrans implementation in April 23, we have been further evaluating our triaging methods and task prioritization at the Benefit Service Center. And after implementation will assess for any disconnects between the system and our desired outcomes, and will then act to address those gaps.
We had two recommendations in the area of workload and demand management. DSS agrees that an ongoing assessment of workload and who is available to do that work appropriately within various classifications, is essential to make sure that the impact of each staff person is maximized given their various skill sets. The managers and supervisors analyze workload and staffing data at a macro level to make sure that the staffing levels by classification and the staffing mix per building is maximized within the constraints of resources.
We have developed and utilized tools such as our equalizer tool in the economic assistance area to have workloads spread evenly across all available staff in our various offices. The managers and supervisors also make assessments on a daily and weekly basis at a micro level, to adjust staff assignments and to take into account current planned vacancies and current leaves of absence In addition to unexpected sick leave and crisis situations that arise with our clients that take large amounts of time to resolve.
Our new CALSAS system, which launches in April of 23 will include an integrated scheduling component. And after that is fully operational we will assess if anything further is needed related to the scheduling of our eligibility staff to include the staff at the Benefit Service Center. We had three recommendations in the area of data performance and outcome The department already has a significant number of outcome-based and performance measures that we utilize, in addition to the many state and federal measures we are required to track and perform to.
And examples of those are listed on page six of our report. In addition to the ongoing creation and refinement of our internal measurements, measurement tools and reports. We will be working collaboratively with the other Health and Human Services Departments to develop additional measures where appropriate to assess the outcomes of our mutual clients across departments.
And we will be refining our reporting metrics as part of the next budget cycle. The department is excited about the opportunity to collaborate with the county's chief data officer and will be identifying the staff appropriate for that collaboration as part of the next budget cycle. We had two recommendations in the area of administrative services. The county is implementing an Enterprise Resource Planning System, or ERP that will include an integrated leave management component for use by all county departments. This will allow social services to give up its very labor intensive tracking system.
Our current system works and allows us to be successful in staying on top of leaves but requires a great deal of effort. We expect the ERP human resource module to go live in March of 2024 With the ERP financial module expected to go live in the first quarter of the next fiscal year, we anticipate having a significantly more robust financial tracking and reporting tool which will provide us with additional information and aid us in having more streamlined reporting processes.
In the area of learning and development, we have three recommendations. Currently administrative office professionals in collaboration with their supervisors select at least one class each year that is documented in their individual development plan. We intend to enhance the current training we provide to our administrative office professionals and will be assessing over the next eight months what that additional training should look like and we will implement the new training by July of 2023.
Two months ago, we completed our first round of cross-training across district offices for economic assistance and employment services as recommended in section 6.2 and we will continue this effort on an ongoing basis. We piloted our first Adult Protective Services induction training beginning in August. Adult Protective Service leadership is continuing to work with staff development to evaluate and refine the model.
In the area of succession planning KPMG had two recommendations The annual training our staff receives is addressed in their annual performance evaluations, even though it is not part of the format and the templates used. Moving forward we plan to use the countywide learning management system that will be a component of the County ERP to better establish track and evaluate the training our staff participate in.
In 2021, we reduced the amount of time eligibility workers spent in induction training from six months to four months on a pilot basis. The pilot was successful and we are now using that model which allows us to train three classes per year instead of two increasing the number of new eligibility workers available to start work from approximately 40 per year to 60.
In the area of technology, we had three recommendations In regard to Recommendation 8.1, the Department believes the coordinated entry system planned for development within the Health and Human Services Functional Group along with the development of the Health and Human Services Dashboard currently underway will provide an opportunity to see our clients more holistically from a data perspective. And we are participating fully with the CEO's Office and other departments in the creation of the dashboard which will be functional in the current fiscal year and the coordinated entry system which will be operational in the next budget year.
In regard to recommendation 8.2, the department agrees that a service level agreement would be helpful though we do currently meet with Central ICT on a quarterly basis. We have initiated discussion and are currently working on a draft service level agreement. We agree that mobile access for Adult Protective Service and Child Welfare staff, while they are working in the field would be beneficial. And we have ordered new docking stations for all of our social work staff that will enable them to easily transition from office to field. And we will have procedures for enabling mobile access by the end of the year.
Finally, on slide nine in the area of interagency collaboration of county services. We had two recommendations related to the use of analysis technology collaboration and communication to maximize our impacts on the clients we serve. The department is working with the CO's office and other health and human service departments to develop technology to support the assessment referral tracking and support of clients across county departments as we work to quickly identify needs and get clients connected with the interventions they need.
While much interdepartmental communication currently occurs, the Healthy Human Services Dashboard and the Coordinated Entry System previously mentioned will strengthen our knowledge of our clients and our ability to work across departments and better intervene with our clients in a holistic manner. And that concludes my comments.
Thank you very much Director Nielsen. So that brings it back to the Board for questions. Supervisor Williams?
So, you know, and I'm trying to synthesize a little bit of what I've heard. And feel free to sort of correct me that there seems to be some from the KPMG report, some acknowledgement that there may be workload issues. But it's unclear to me from the recommendations and from the response whether That data-driven solutions will address that in its entirety or whether there is, in KPMG's opinion or in the department's position, opinion of whether there's sufficient staffing or not to take care of that
issue. Supervisor Williams to the chair so you hit the nail on the head. So, the process came PMG recommends is useful and but it becomes more useful the more fully we're staffed to where we have the people in place to be able to do the work. Currently in Child Welfare Services, we have 14 vacancies amongst the social workers so a 19% vacancy rate and so assessing who is doing what where and who could be right I mean that helps and that happens already kind of on a flow basis to make sure we have the resources we do have in the most critical positions, dealing with front end work, dealing with other things that are deemed more critical than others.
But to be able to masterfully plan organizationally in the way envisioned will have to be something that fully occurs once the staffing levels are much closer to being 100%. It doesn't have to be 100%, but a lot closer.
1:33 – 1:3911 turns
Supervisor Nielsen?
Yes, thank you Chair Hartman. You know I'm concerned about the staffing as well it sounds very similar to what we have got going on with the Sheriff's Department that were at crisis level and the existing staff is um you know overwhelmed by um the issues that we're facing. What are we doing this is actually for Mr. Nielson but what are we doing what other what other uh strategies might we use to ramp up that hiring so that we can see relief sooner than later
Supervisor Nielsen through the chair, so I'll ask Deputy Director Krueger to pipe in with more specifics. I'll just start off with years ago we started making our recruitments to be continuous recruitment so that we had applicants on a flow basis We, you know try to do we I'm not sure where the status of the day in the life of video is related to child welfare or adult protective services.
But we have departmentally efforts being made to try to attract Applicants but at the same time educate them about what they're applying for so they have a greater sense and are able to ask questions or discern greater, you know before they come. But if Deputy Director Krueger would want to more fully answer your question
Thank you. Yes, we've made a lot of efforts to work with our HR department to look at our recruitment process to remove any barriers as Director Nielsen has stated we do have a continuous recruitment for our master's level practitioners and we have increased the number of social worker Our bachelor's level recruitment that we do every year in an effort to make sure that we have a constant fresh list to hire from.
We've recently started doing some incentives for our master's level staff, which we previously hadn't done in our department to attract people and in terms of like relocation incentives and so forth And we do have done some extensive retooling of our interview process in terms of trying to provide more information early on about what the job entails, to make sure people are fully informed.
In terms of like day in the life and our interactive interview process. So, and we're continuing to look at what we can do to increase the number of people that were able to hire. As Daniel said we do have 14 vacancies currently year to date we've had 14 people leave, we've had 10 people on boarded and seven internal promotions. We have two days of interviews this week where we're going to be trying to hire as many people as we possibly can.
And, as Daniel mentioned, the overhire in anticipation of having a full training class so we can get as many people out into units as soon as possible.
Thank you Ms. Kruger and I guess the other follow-up question to that is it's not a funding mechanism? We have state funding to fill those positions fully?
Supervisor Nielsen through the Chair, we have the funding to fill those positions It's just one thing that Deputy Director Krueger did not mention that we do. That doesn't help increasing the numbers, but it helps in terms of increasing the proficiency of our staff is that we support staff going through the Title IV-E program which are workers that are working for us and at the same time working on their master's degree um and we usually have several each year that are doing that unfortunately this past spring We lost, I think two of them shortly after graduation to other places that were able to offer a higher salary. But we do support that as a way of growing our own.
Got a couple more
questions. So just so I could better understand what's the mix of those open positions on the masters levels and the bachelors level social workers? That where we have openings for?
Yes, Supervisor Nelson to the chair. I believe currently we have nine masters level vacancies and five social worker were able to fill the social worker typically a lot more easily. There's a statewide shortage of masters level practitioners there's a the MSW programs are not putting out enough for the counties so there's constant you know shortage of masters level staff throughout the state and counties are Competitively trying to attract them to their counties. So it's something that we do struggle with
and a point of interest for you on that particular topic We recently discovered we have regular interactions with the schools that produce social workers to give them feedback about Like how they ought to tailor their programs and things like that, and we recently had a conversation with a school that had several people drop out of their beginning class and decide not to attend. And the question was asked, well are you using your waiting list to backfill? And they said no it's too late. The school started a week ago and then I asked the question of well doesn't that affect your funding? And the answer was no it doesn't. So there's problems in the system in terms of impetus for some of the players to maximize what their role is too.
Sounds like an over enrollment is necessary. I guess, you know, I don't want to just focus on social workers and we obviously have eligibility worker issues as well. And what are we doing on the hiring side there to meet those needs?
Deputy Director Maria Gardner will take that.
1:39 – 1:5515 turns
Thank you, Supervisor, through the chair, Director Nielsen mentioned a strategy that we have recently adopted We piloted it in 2021 and we are now on our fourth hiring cycle, which is to shorten our induction training. It is a mix of hands-on and theory from day one now where before there was a bit of classroom training and then some hands-on and more classroom and hands-on. And so we're able to consolidate the calendar and staff is now receiving the same amount of classroom training and the same amount of hands on training just in a different mix eliminating some You know, late starts or early finishing of the content for the day where there was just some extra time. Obviously we made good use of that time for practicum but we were able to squish the calendar into a four-month classroom timeframe which allows us to hire three classes a year instead of just two so we increased our onboarding by 50% with that strategy And where we are right now is we currently have staff in three different areas being trained.
We did an overhire strategy because of the CALSAS implementation that's coming up in April, so for a moment we will not have our three classes per year We're going to do our best to catch up, but there will be a moment where instead of onboarding at a four-month cycle it'll be about a five or six month cycle because we have to train our existing staff in the new system and we can't be doing both at the same time. But we are in earnest planning for that next class so we always have it in the queue And we're working really efficiently with our HR staff and our supervisors and managers to be able to do those hiring panels efficiently, and onboard staff.
Well thank you. You know staffing is critical. It's a problem across all departments but specifically here in so I think all eyes are there and energy is you know Will deserve to be put in these places, especially when there's funding already available. So those dollars are there and they're going unspent because and just really taxing the men and women that are in this room here that have come to speak to us so it's really important I think it's critical for the organization and specifically this department
Ms. Thornton, did you have anything you wanted to add or you're just available? Available for questions.
Okay, CEO Ms. Sapo. I just wanted to point out there is a whole section on their part on staff workload and utilization. And so I want to ask Ms. Thornton is there anything else that we should be aware of because the question was what's the right amount of staffing and obviously folks in the field say hey we have enormous caseloads and we need some help and there's some vacancies But as you know, KPMG never recommends more staffing where they first understand what your staffing patterns are and where there is a gap. Where there is more help needed. So I just wanted to ask you could you elaborate on that for us?
Yep, that's absolutely correct CEO Miyasato. We try to follow the data in all of our recommendations so we conducted interviews and focus groups with the staff but when we looked at the data we did see a disparity in caseload and workload across staff which would lead us to believe that there are enhanced mechanisms to try to distribute that workload equitably and in parity across caseworkers I would also say that we recommend the data So that the department can at a more granular level understand what that workload is. It was mentioned earlier today, the additional regulations and requirements so it's not just time and feel its administrative time it is travel time we've made some recommendations around technology enhancements to try to ease some of that burden but we would recommend enhanced kind of data tracking reporting to really understand the full workload Usually caseload doesn't always equal workload in terms of the time you need to be spent on the case, depending on the complexity of the case as well.
So our recommendation and to your point advisor Williams is a first step in trying to understand the workload of the staff within the department at a more granular level So that you can then develop what we call optimal caseloads per caseworker, per eligibility worker to make sure that the work that they are being asked to do is in line with what they can do in that day and in that shift.
Supervisor Hart?
I just like to connect some things. And I think that the presentation today, the testimony from folks who are doing the work shows how hard this is to do and how difficult it is to put the pieces together so that it works for the clients that we're serving, the community, the folks who are doing the work. And I know that the point that Supervisor Nelson was making to that, you know we're having a staffing issue as an organization not just in this department but in the Sheriff's Department and others. It kind of makes me want to look a little deeper into that not just with these two departments but you know where are we in terms of being able to backfill positions across the organization because it's speaking to a much larger issue um just Anecdotally, I was shopping at a local grocery store a little while ago and the checker was actually somebody who lives in the San Fernando Valley who is being brought up to serve as a checker in a grocery store.
And the grocery store was putting her up in a hotel and paying her overtime in order to cover shifts. So there's a crisis in our community. It's related to housing costs which have with gas prices just exploded as one of the highest inflationary elements in our economy And folks are feeling the pinch in a really serious hard way. And it's just making it very difficult for every employer, public or private sector to get people to be able to make a living and stay in our community. And we're fighting against that tide too. And I know that if you peel this back far enough, that's probably the biggest source of stress for people and making choices about where they work and how much they get compensated and what it means for their lives. So these are really big issues.
Supervisor Labanino.
Thank you, Madam Chair. Yeah, just to piggyback on that a little bit. I'm also just excited that we're actually doing this because if you think about it before Renew 22 and before the KPMG reports basically all we did what we had always done departments did make improvements along the way and try to keep up and do what they were doing but This is. Can you all hear that? I got like, yeah.
Stadium Yeah. I'm going to sing the national anthem next, but. I mean, I feel good that I think input from frontline workers is very important and to answer one of the questions is when's the last time almost every day talking to a front line worker and almost I've actually ridden with With social workers before. I was amazed, I mean I could not believe. The houses you guys were walking into that I was like, are you sure we're supposed to be going in here? We don't have backup coming or knocking on doors in neighborhoods that would give me a little bit of pause walking in there by myself. I was with an older female and she's just doing her job and it was very impressive but what I wanna convey to you is that this is the CEO of the county Five board members, we're trying to tackle this.
We hear you, we understand, we're trying to make improvements and what's really impressive to me is that I think more so than any of the other KPMG reports that I saw maybe because it's the size of the department there's 25 recommendations and not one of them As Department of Social Services came back and said, we don't want to do that or we don't think that's important on every single item. It's like, hey, we're either working on that. We're going to implement it soon. We understand that's a problem and we need to take a look at that.
But I think there's some synergy here. You guys might not feel it, but I do. And we are bumping our heads against this whole workforce that seems to be invisible out there You know, for one reason or another we're having a hard time attracting people. And I know most people would say it's because of benefits and pay but we're also under the constraint of being able to...
We also have the other side of us that is trying to keep the lights on and keep the roads paved and keep people safe and all those types of things so it's a balancing act And like I said, you know you're talking about a department 760 positions. That's larger than probably a lot of counties. You know that one department so I went back and I found this since my dad was here today.
He gave me this, this is the 1974-75 budget for the Board of Supervisors. It's in this little pamphlet but you know what the biggest expenditure was back then? Social services! That's that's the job that we're here to do is take care of people. That's why the county exists. That's why we all have our jobs because we're the social safety net it's the job you guys do and I know with your management trying to do the best you can I also understand and I want to acknowledge the training that's involved. I could not believe the onerous state, well, I could but it was actually difficult to watch you know the state and federal regulations that are piled on top of some of our just frontline workers eligibility workers having to make decisions.
And I'm glad we addressed some of that and so those are my comments.
Supervisor Williams?
Well, I just want to underscore what I thought was a really important point that Steve made. It's that you know institutions that want to get better create introspection and think about whether they're doing things correctly or the best way they could possibly do it. And we've had departments who get a KPMG review and Are resistant to a lot of the recommendations. I will not name them by names but social services, I think due their credit is going okay yeah we need to do that and I think that should give frontline workers some hope that issues can be addressed I also think that we're in a brave new world and we could use more input from you as to what things to accentuate.
Wages have always been the dominant thing in all our collective bargaining discussions, always. And you know I've been in these with the city long before I ever was at the county and was going why isn't health benefits a bigger issue that we talk about? And so I really appreciated the speaker who talked about that issue because Just speaking for myself, because of the functionality of putting money towards benefits I'd rather part with $1.05 health benefits than just part with a dollar towards wages or maybe even a little higher.
To me, I hope it's something that both the union and the county accentuate in our further discussions. But I also think we should be talking about other things because I mean it when I say that mothers and fathers should feel welcome. It may be that what the county needs to do And we have been talking about this with the master plan, Chi Real Master Plan is have our own child care operation. That may be one of the things that we have to think about in the long run to be able to make it possible for parents to do their job well but also have you know their kids prioritized.
CEO
Miyasako. So I just wanted to remind the board of some of the positive benefits you did take in those last negotiations and to also our employees because i do want to thank our unions for pushing it, and that was for health benefits so as you know we cover the lowest cost EPO plan so we employee only coverage but what you agreed to And really, again that the unions actually pushed for and they got was that we were increasing our health coverage. And so what it means is that for the next plan year this 2023 plan year It's the same for employee only employee plus one. It is only 25 twice monthly, but employee plus family because that's what we do want to encourage your families is $155 in addition to help coverage and next year 2024 plan those numbers double So your board did demonstrate that you know that there was an issue with health benefits And we did hear you so I just want to let you know that so for the 20 tour 2024 plan year It goes to $310 twice monthly for employee plus family.
And we're continuing to work on our benefits, so thank you.
I just want to say I'm counting the days till that too because of, you know, we receive the same benefits as the General Bargaining Unit and it's a big deal.
And I have heard our CEO say over and over again that this is the thing that keeps her up at night, how to provide family health benefits for our employees. So it is top of mind. I had a couple of questions but I think first an observation some of the testimony we heard today about what your job is like as eligibility workers and social workers Was really heart-wrenching and then we're talking in terms of kind of abstractions process and technology. And yet I think there really is a connection in how we can make the job Easier, smoother more satisfying.
I hear in many professionals across the board that people got into a field to do a certain job and they really have a heart for that job and That was certainly clear in the testimony we heard today And yet so much of their time is spent doing the paperwork And I think some of the technology that we're developing is to get at that and to free up more time, to do the more satisfying and really the very significant work. But if we don't have the reporting requirements met then we don''t get reimbursed and so it's kind of a trick. We've talked a fair bit about the issues today of recruitment.
know a little bit more about retention. And when I heard a bit about the opportunity for more education, but I think you know the kind of support for employees whether it be ways that they can support each other that they feel support from the institution as well as Career development and individual guidance on what opportunities are either in Department of Social Services or perhaps as we heard with the public defender, that you feel there's a growth opportunity. So I wonder if somebody could take that for
1:55 – 2:0110 turns
me? I would be happy to take that Chair Hartman. And the summary statement is I could list probably 30 to 45 specific things in the department that happen related to retention. Some big, some small from simple things like the deputy director or the director showing up at new employee orientation to welcome the new staff. I attend all the new social worker when they first are hired to have a meeting with the social worker managers and the director Welcome and to share stories about our experience. I have a background in child welfare myself, so we share stories to make those connections.
We have more formally, we have a leadership development program that our staff run in conjunction with our staff, our managers and supervisors and line staff run in conjunction with our staff development staff To expose staff to different developmental opportunities related to interviewing and resume writing and other workshops that we have over the course of several months for them to polish their skills and their ability to present themselves.
We have a very healthy tuition reimbursement program that we began several years ago as a pilot and then converted into just an ongoing reality.
And how many people are taking advantage of that?
I don't have my HR director here with me today but quite a few based upon the number of staff that i have encountered over the past year, year and a half We had it, I know the amount because we, maybe Rachel's looking. I think but we have it budgeted at $50,000 a year and I think this last fiscal year we increased it to maybe 60 to make sure that everybody that applied that had a qualifying circumstance but it's very healthy in terms of if a person slowly works on getting their degree they could potentially get their entire Associate or bachelors degree fully reimbursed depending if they keep their classes per year down to the amount that's reimbursable in terms of total dollar amount. We have we have things you know small, you know our diversity equity and inclusion work is very much a component of staff retention I believe in terms of having people Um, feel heard and feel included and see where they fit.
We have Deputy Director Krueger in Child Welfare has you know each branch kind of does their own individual things that speak to the nature of the work Um, being done. I think I mentioned at a board hearing several weeks ago that we have a mandated process in place now where when the individual meetings happen between a supervisor and a line worker they're expected to cover...
What's the phrase that we did? The what? Yeah, engagement and engagement process. We took the county's concept of like an annual stay interview and said well that doesn't really work for us and that's not the type of relationships we have with our staff so we met with staff development at the county level and our executives and created The managers created engagement discussions, which the supervisors have guidance to utilize components of during each of their individual meetings with our staff each month. To have that sort of like supportive you know what do you need and how's things going for your sorts of discussions and what can we do for you on a more regular basis rather than just annually? So that's just a few of the things but it's truly a list that is in the dozens long
Okay, well thank you for that. Another question and this is to Kiva, Ms. Thornton we have many reporting requirements from the state and you're suggesting additional outcome measures that are I guess a report card to the community could you elaborate on them a little bit?
Yes, absolutely and I do want to mention that I'm not here today but we do have a qualified social worker on our staff who is part of as a subject matter professional. Her name is Vivian Damien and she worked with us with the report so we get that kind of first-hand experience to make sure that our recommendations meet those requirements and understand in the environment with this staff working While the regulatory requirements do report on performance in line with the program requirements and the funding requirements, the additional metrics that we're suggesting is are your programs effective in helping citizens and meeting the mission of what they are set out to do. So are you improving the safety of the community? Are you improving the health of the community?
So while there are additional reporting requirements I think really what we're trying to get at Is the funding and is the program effective in delivering what it is required to do? And if not, by measuring that you can make tweaks and adjustments along the way and address it in a real time basis. But really we want to make sure that the mission and the vision of the department and the work that the staff is doing on a day-to-day basis really impacts and has the right impact on the communities.
So can you elaborate in a specific example
There are numbers listed in the report. I don't have it offhand but for example how many Children have been permanently placed in housing over the last number of years. How many people come back into the system? How many people have been using your programs for 5, 10 plus years and if they are then maybe that's not a solution to the challenge that they're facing there needs to be another strategy that is kind of deployed to those cohorts. Tying into our recommendation around high utilizers High utilizers within the social services department but also high utilizers in the county in general looking at public health, behavioral health, homeless, criminal justice system. You know people that have maybe been in the system for a long time or are utilizing not just all of the social services programs but programs across the county and by identifying those individuals are there strategies that you can apply to the cohorts to actually get them the outcomes that they need versus them staying in the system for a long time?
That is very helpful. Thank you.
You're
welcome. Madam Clerk, any public comment?
2:01 – 2:027 turns
Chair Hartman and members of the board we have no request to speak on this item.
Any final things from members of the board? Well, I did want to add one thing and that is that I know Director Nielsen has a heart for this work. And I appreciate all that you and your team do on a day-in day-out basis. Now you're doing health and social services so it's quite a stretch and we really appreciate all that you do.
Thank you, Chair Hartman and my public health staff who are watching today to learn for what they need to do when they come here in a month or two would not be happy with me if I failed to mention that public health currently has a 20% vacancy rate as well. So all of you are correct in terms of this being a global issue.
And the pressure it puts on the people who are here doing the work. And so we all need to be recruiters for the county. Thank you. I need a motion for staff recommendation to receive and file.
So moved,
seconded. Okay and all in favor say aye. Aye. Any opposed? Passes unanimously and let's take just a five minute break, a real short break we'll be
back
2:15 – 2:4010 turns
Welcome back. After a short break, we're reconvening the October 11th 2022 meeting of the Santa Barbara County Board of Supervisors. We're on departmental item number two. Madam Clerk, would you read that into the record please?
Chair Hartman and members of the board, departmental item number two is from the Behavioral Wellness Department and the County Executive Office. It is a hearing to consider recommendation regarding KPMG's operational performance review of the Santa Barbara County Department of Behavioral Wellness.
CEO Miyasato?
Thank you chair Hartman Board Members this is the second KPMG report we're going to be going over today and this is on the Department And I'm going to just, I'm going to skip through these slides. It's the same intro slides that we heard earlier about the context and where we are. But if you go down to the next slide, let's see organizational over here it is district manager board. This department has 404 employees in $146 million budget and I'm going to hand it over to Kiva.
Great, thank you CEO Miyasato. And good afternoon again to the board. Depicted on this screen is again our project timeline as we mentioned previously and we conducted the behavioral wellness department review beginning in April of 2021 and concluded in January of 2022. We are again finishing our public health review where at the midpoint for our county council review and we're just commencing our review with Public Works.
I know we've just seen these slides, so I'll go through it at a high level but again our methodology always starts with interviews and focus groups with the staff level to really understand the true operations of the department. We use available data to analyze department performance and program operations. We utilize benchmarks and leading practices to identify themes and opportunities. And we have a very collaborative process with the department and the CEO team to analyze our findings at the midpoint, to review and validate our recommendations towards the end before we finalize the report and present it to the board.
As with all our reviews, I'd like to start with the commendations for the Behavioral Wellness Department. To start the department has begun a multi-year systems change initiative with the overall goal of enhancing access to client services. Key outcomes from this initiative included the integration of the mental health and alcohol and drug services to streamline and deliver more coordinated care to clients as well as reforming the documentation processes to enhance compliance.
Furthermore, to maximize client service delivery to county residents the department has implemented processes for tracking staff utilization including a Tableau dashboard. This also includes the formation of our Utilization Committee as well which serves as a collaborative problem-solving forum with the aim of increasing department wide utilization thereby working to increase the number of county residents with access to behavioral health care.
We'd also like to commend the department on their expanded use of telemedicine The department worked to safely maintain client service delivery during the COVID-19 pandemic by expanding telemedicine services and capabilities to increase access to care. As we mentioned previously, this is our maturity model and we've again pulled out two of the key elements that we think are most important for behavioral wellness service delivery model and data and reporting Looking at the top line for service delivery model, the utilization targets in the department are not formalized or consistently monitored and communicated to staff on a regular basis.
To help ensure commitment to achieving those targets which ties into the bottom line of data and reporting where data is recorded and reviewed and updated but the communication and flow down to staff is on an inconsistent basis We believe that through our recommendations, the Behavioral Wellness Department can get to a place where the utilization targets are formalized and that data can be clearly communicated and disseminated through the department to improve and enhance client service delivery.
So again, we won't go through every recommendation in the report but we're happy to answer questions on any of the recommendations. There are three areas of recommendations we'd like to highlight today for your consideration which is financial management, staffing service delivery and utilisation management so I'll pass to Lauren now who can go through the recommendations in more detail
Thank you, Kiva. Thank you Board of Supervisors. Our first recommendation here is on a CalAIM readiness assessment. As we all know, CalAIM proposes a number of reforms to improve service delivery for county behavioral health services. The area with the most significant implications for the department operations is in the area of Medi-Cal financing as the state will transition away from a cost reimbursement approach.
The department's current approach to cost reimbursement does not monitor outcomes or take approaches to increase productivity as well as effectiveness. We recommend initiating a departmental CalAIM readiness assessment to help ensure operational and fiscal alignment in conjunction with countywide efforts to prepare for this transition. Examples of how this assessment could be achieved include analysis of utilization which will need to be achieved under these reforms, the number of appointments to be booked per year, per day, per week.
The level of no-shows targeted as well as the number of staff and staff mix required to provide the required services of the department This will assist the department in identifying strategies to maximize reimbursement and ensure the department financial position is not adversely affected by CalAIM reforms. Since this report, there has been a significant progress made through the allocation of HHS funding which the department can expand on shortly.
Moving on to our second recommendation that we're highlighting today The Act is an evidence-based program which aims to provide mental health care to individuals with acute mental illness. Across the three ACT programs within the county, the department served an average of 89 clients per program per month, which is below the recommended 100 clients. The majority of clients also received less than the recommended minimum of eight interactions per month.
Because the three programs are operating below the Act's standards of care, there is opportunity to evaluate alternative programs to better tailor service delivery to meet the needs of the target population for these programs. And then thirdly, staff utilization is a key metric for behavioral health providers to understand workload, to maximize service delivery to clients and to manage staff performance and productivity It is important to note that the department does not currently have formal targets for staff utilization, but have considered a blanket 60% utilization target for all staff.
Based on our analysis during this review, the weighted average utilization for fiscal year 2020-2021 was 46%. Given the wide ranging services provided by the department, which vary by position in terms of the provision of direct client service. It is necessary to have role based targets, which will allow for a more tailored approach to utilization management as compared compared excuse me to the blanket department wide target currently utilized.
Please keep that is OK. Secondly, we looked at unaccounted for time as well in utilization and we do recommend a system process for coding this time within the EHR or Timecode System to better understand how this time is spent which directly relates back to the utilization targets. So to summarize Key takeaways, again from the Behavioral Wellness Department are something that we see as a common theme throughout our KPMG reports. And that's to leverage the existing data within the department to improve performance monitoring and encourage continuous improvement. And then specifically for behavioral wellness, to expand processes for tracking the cost of services delivered by the department in regards to counting.
We'd just like to close by once again thanking the director of the department and all the staff within the department who participated in the review, as well as CEO and her team for their high degree of engagement throughout the review.
Thank you. Thank you,
Director Navarro. There we go. Good morning. Morning
CEO Miyasato, Chair Hartman, Governing Board and staff. Thank you this morning I want to start off by saying thank you to KPMG for a wonderful report as highlighted in their timeline. This report actually began and was virtually completed before I began my tenure here at BWEL, and have to say that before I got the final report had already started to identify some of the similar recommendations that KPMG brought brought forward, so it was great to get the report and to read it and to feel that myself as a newbie on the team was right in alignment with what KPMG was bringing forward to us as areas of improvement. So all right I have someone to move my slides from me so there we go. Okay, so I just want to highlight that in our report there were five areas of focus that came out clearly.
They looked at our mental health outpatient community and psychiatric health facility direct services clients. I'm missing a word here in number two but it was more of a program systems review looking at all of our programs and how they fit into our system of care the homeless delivery and assistance integration of all those programs are contracting processes And recruiting and retention, again staff service and delivery is very important.
Oops wrong way here we go so the areas of recommendation we have 19 recommendations that I will be reviewing today there were in seven categories and each of the slides will identify Two or more of these goals, excuse me areas of recommendation. We're going to start with the system of care strategy and performance so there are many reviews comprehensive reviews about community assessment and what's needed throughout the county done by different departments but really there has not been one that's comprehensive to just behavioral wellness We do agree that there needs to be a comprehensive needs assessment. That is a priority for us and really building on the community survey from ARPA that was conducted by Be Well early on and now has resulted in some new programming, we're going to build on that comprehensive needs assessment and actually marry it with the Mental Health Service Act annual Review, which is a comprehensive convening of stakeholders from a variety of sectors in the private and public sector in our county.
And by using surveys staff surveys and focus groups and other Conversations with clients and staff really to identify what are the gaps in needs and services within our community for that system of care. In addition to that, we're also going to be conducting a performance review at something speaking to what KPMG was just reporting and understanding what are some primary outcomes of the programs that we serve identifying what those can be? And how are we meeting those in our comprehensive performance review which will begin It's really great timing because this is the year that we begin our new three-year plan for the Mental Health Service Act. But of course, Mental Health Service Act funding cannot really be planned for without a full comprehensive review of the entire system's needs as well as the performance of all the programs within those.
So that's what we're working on this year and by June of 2023 By April, excuse me, when it's time to post the report for 30-day review we will have conducted both the needs assessment and the performance review. And planned for our programming and funding for the next three years out through fiscal year 25-26. Our next area of recommendation was to conduct analysis of high utilizers of county BWELL services to identify the highest needs population.
And right now at the time of the report, B-Well did not have a consistent way to identify those high utilizers across our systems. So beginning in the spring it was the management of quality care management team, the IT team, alcohol and drug program team and clinical services began to identify data points that indicate to them that these are high utilizers.
hospitalizations, reopening reassessment of cases, length of care in cases, homelessness things like that. Ongoing now they're going to be putting these data points into a monthly report beginning in January 2023 and we will use that report I think in speaking to KPMG's recommendations about the use of data the data we have a lot of data points in Be Well And per these recommendations, we'll be bringing them together in a way that helps us to drive data decision making.
That is actually the priority goal this year under our employee performance reviews. It's the department wide goal that we bring training and understanding to our staff about all the data points that we have and how to use data to really drive decisions effectively for our department in terms of programming and gaps. There are some other areas that I'd like to highlight in High Utilizers which we'll get to a little later when we talk about interagency collaboration.
A second area of focus in the recommendations was around financial management and, in particular, around the grant funding that BWELL receives. So as you all are aware, BWELL has been very effective In securing grants over the last few years. And in fact, at the time of this report there were up to 20 I think 24 grants at that time with three on deck to be added to the system.
However, at the time of this report it was really clear that we did not have a clear utilization plan for grants and or tracking of those. So in shortly after the beginning of the KPMG report, a grants contract coordinator was hired and she began to support the various grants, placing them in a dashboard and helping to coordinate utilize and convene appropriate staff to begin to review the ethics track, the efficacy and utilization of those grants.
Beginning in fall of 2022, we have recently hired a new fiscal staff member that will be the partner to the Grants Coordinator to really help us track that utilization of the existing grant projects including what do we need to spend on a monthly basis to stay on target? How are we spending and how are we doing in the outcomes that are required by those grants.
This process will ensure that the system is really prepared To meet the grants effectively. Another piece that the Grants Coordinator is working on is creating forms on the front end so that when we do apply for grants, there's a comprehensive recording of the staffing required to meet that grant and that is all tracked in the dashboard at this point in time those things were handled by different staff and not one central person. So we're bringing that all together now And that is increasing the efficiency and efficacy in utilization.
Another outcome of this transition based on the recommendation was that we realized that we needed to have a more progressive but realistic approach to grants, that grants really needed to be done in conjunction with the first recommendation which is a comprehensive needs assessment of our system and of our community. That grants really needed to be strategically and intentionally sought after. And so again, the Grants Coordinator and the Fiscal Team are working on putting together that system for us to track the performance and utilization.
The third recommendation in fiscal management is commencing the departmental CalAIM readiness assessment. We know that CalAIM Is here and beginning in the spring of 2022. The Department of Health Care Services offered what is called the Behavioral Health Quality Improvement Plan program. Bewell's plan was accepted in April of 2022, and by meeting various targets between now September 30th 2023 through to 2022 through to September 2023 we will receive financial incentives to be ready for Cal AIM. The most recent deliverables were around policies and identifying trainings for staff to onboard new protocols and processes for CalAIM.
And the next deliverables will be around the financial management and utilization of staff, and preparing for payment reform. Once we meet those deliverables, then we are able to receive those incentives to further help us build the system in terms of getting ready for CalAIM. Again a big part of CalAIM is the data-driven decision making really helping staff to understand the data points we are collecting as required by CalAIM how to effectively use those to make decisions and what do they mean collectively as part of a system not just as independent data points In beginning in spring of 2022, BUL submitted cost surveys to DHCS for mental health services plan and DMCODS in preparation for looking at the statewide cost reimbursements for CALI.
We continue to and we'll discuss in the next round of recommendations around staff utilization. The cost of services within our system per program, per service in order to prepare us to be ready for what may be the final reimbursement dollars from the Department of Health Care Services in response to CalAIM. Serendipitously and kind of coinciding with this report and its recommendation for us to look at utilization roles, CalAIM is also looking to finance in payment reform based on staff utilization roles. So those two are coinciding.
I also want to say that in terms of CalAIM readiness, in conjunction with the CEO office, B-Well is developing short, medium and long term one to five year goals and transition plan for CalAIM implementation in coordination with the other departments that will be impacted by CalAim including Department of Social Services and Public Health. So in that meeting we're also looking at data integration And data sharing practices and initiatives across all health and human services programs in the county.
All right, now getting to the recommendation of utilization management focusing on staff utilization. We agree with the recommendation that we need to develop the role specific utilization targets to implement leading practices and enhance staff utilization. Beginning in October 2021, the IT and quality care management and clinical teams put together a protocol using Tableau to starting with five staff at a time adding five each month for two week period using Smartsheet and Tableau that helps people to track their time and identify what they were doing with different clients in their respective roles. Whether that be a therapist or case manager or a recovery assistant Currently, it's been a year now and the department is refining that tool as we look to see where we have some gaps in terms of infrastructure and helping to support staff to do direct service more effectively by providing infrastructure in other parts of the system.
And we'll talk about that in a minute. We also are focusing now beginning in fall 2022 through to January 23 on training our staff and supervisors on how to help them in regular meetings with staff, to track utilization and to help staff focus on the most relevant duties to the tasks they are assigned. And making sure that people stay within those lanes for cost efficiency and performance efficiency.
The next part of the utilization management, of course, is to make sure that we have data systems that are enhancing the reporting accuracy of our staff. in their data as well as how they're tracking their systems. We partially agree with that and that recommendation, it's certainly true that we need systems to track the staff utilization but more importantly we need to have training for staff supervisors management and staff across the board to understand what are the expectations of the system of our mission as BWEL And within their respective parts of the system, what the expectations are for their roles. So understanding that for a therapist providing transportation on a weekly basis may not be what is primary to their role and really helping staff and managers to track those challenges that they may have.
Of course all going back to the understaffing that we are having in the department so. All right. And the third goal in the utilization management is to develop a strategy and timeline related to our electronic health record, of course. Our electronic health record is where we will look to really create one stop shop with the effective data reports that we need for CalAIME for our own ability to track performance and utilization and remain high in efficiency and performance the clients that we serve. Our current EHR, of course is the legacy system clinicians gateway and share care. That foundational technology is very outdated. We're unable to meet the requirements of CalAIM such as interoperability and really unable to do multi-user tracking for clients who are the high utilizers.
So in beginning in summer 2022 Be Well joined a statewide initiative with other counties to adopt a statewide standardized EHR electronic health record. That is the goal of Calium by 2027, to be able to have all electronic health record systems across the state be able to communicate with one another and track data across our state understanding that when people move from one region to another they should be able receive the same level of care that they receive Have their electronic health record immediately transferred with them. So behavioral wellness is coordinating, is going to be joining a project that's being coordinated by the California Mental Health Services Authority, CALMESA.
And we anticipate the initial deployment of the new standardized electronic health record will be in place by the end of June 2023. And that will take us about two years post that time to fully implement the electronic health record throughout our system. Again, currently IT in B-Well has a variety of data analytics and systems that they're operating and having those communicate And teaching staff how to make sure that they've checked all these various data points is sometimes cumbersome and not cost effective. So we look forward to having a new EHR that allows us to put that
2:40 – 2:588 turns
all in one place. All
righty, so recommendation the next set of recommendations is around staffing and service delivery. All right, so this brings us to the third recommendation that was discussed by KPMG just a minute ago which is around looking at the ACT programs. ACT is for Assertive Community Treatment. It is a very prescribed evidence-based practice for working with those most severely impacted by severe and persistent mental illness and all of the consequential issues that happen with that. such as homelessness, lack of community support, lack of family support. We currently have three ACT teams operating and as noted by KPMG they are not as efficient as some other programs which are more flexible so in the KPMG report you will see them allude to this FACT model the Flexible Assertive Community Treatment but in California we have what is called full service partnership and in fact in our system of care It's mandated by the MHSA programming that you have ACT-level or full service partnership level programs.
Due to our staffing shortages, we are looking to convert this year as we meet with the MHSA stakeholders to really move to a systemwide full service partnership model that will allow for the flexibility of staffing and meeting the needs and be more responsive to these high utilizer clients so that maybe So that the goal is that we get to that minimum of 100 per month, per program as well as a minimum of eight sessions per month for staff. I mean per client with not having to have this evidence based practice it's very strict that you have to see a therapist this many times or case manager full service partnership is much more flexible.
We began with conversations with our ACT and Full Service Partnership community leaders, the leaders in our CBOs and within our own system. In the spring of 2022 we talked about this transformation all are very on board. Beginning next month we will have our first discussions around how to move that transformation system-wide consistency in training staffing as well as performance measures and outcomes across the full range The county from south to north and west and east.
In
that.
Going back to this in the review of the ACT program and FSP, I do want to highlight that we will be doing a complete overhaul of the criteria and referral system so that we make it more specific to these programs and have a much more efficient and quick access flow into those higher level programs than we have now. And so that will be completed all by July of 2023.
We really want to look at, number two the recommendation is now to really look at the Justice Involved Services programs. In the report you'll see them highlighted as forensic programs but I just want to say that in beginning this overhaul and realignment of justice involved services with increasing Funding and focus by CalAIM. We've moved to the more philosophically and funding correct label of justice-involved services programs.
Again, forensic has stigma. And when we look at what we're talking about, we're talking about persons who are inappropriately averted into law enforcement and jail because we have not had the right systems to serve them in behavioral health for so long. So we are looking to really work with Justice Involved Services programs throughout our county. Myself and John Doyle are doing shadowing with the programs to really understand where some of the inefficiencies are happening in terms of staffing, staff reporting and referral out to the other treatment programs.
And we began that just this month, and we will be utilizing a time study with the Justice Involved Services staff Is similar to the one back in recommendation 3.1 that will be completed by January, to really help us look at what is the correct staffing for the increasing number of folks who are being referred into our system as a result of recent legislation such as SB317 and of course in preparation for care court.
Across all of these service staffing and service delivery recommendations, a real focus on identifying clear performance measures that we can track. That we can at the hit of a button in our new EHR will be able to help us keep track of how well we're doing and modify staffing and service delivery is a key component of all these recommendations. Next, we're going to get to some of the staffing recruitment and retention issues here in recommendations 4.3 and 4.4.
And I'm happy to say that they've been completed at least the first one here in collaborating with county HR. Thank you to the Board of Supervisors and for County HR if you're listening, for all your diligence and hard work to get us this goal here where we now have a review. We have now pay differentials for our psychiatric health facility Crisis Stabilization Unit staff and we are now adopting a team-based model of care as well to increase efficiency there in the PUF. That was completed, the salary issues were finished in August of 2022. The team based program began in July of 2022 and we're doing cohorts of staff throughout the psychiatric health facility and that full expansion will be done by July 2023 And the next recommendation was to collaboratively engage with our own internal HR team in B-Well to establish a policy for managing sick time.
I think the reality is of course that we know that when people get sick, people get sick and they need to take time when they're ill but what we have not been able to really track effectively is having a policy around that and having a policy around how What staff needs to track in terms of when someone goes out on sick leave, how long they're out on sick leave. What does that mean for staffing and really helping management to look at that? And also helping staff and helping to identify trends in sick leave by having a policy then and also being able to track that more effectively we can look at trends and really seek to identify what are some of the protocols that we need to have in place to reduce that sick leave. And we're working on that currently And that should be completed by January 2023.
But as stated, again we're not trying to in any way impact the right of staff to take their sick leave when they are feeling ill and when they need to do so. But there may be instances when taking vacation days is more appropriate than taking
sick days. All right. Now we're going to talk about
succession planning here. So we really want to talk about it says succession planning but it's also about recruitment right? It's also about making sure we get people coming in a good flow through the system so 5-1 was to collaborate with county HR to review their human resource processes that as well as our own and to make sure that we are speeding recruitment and timelines and we're not getting caught up somewhere and creating Unnecessary delays and inefficiencies. We met in May of 2022, myself and our Be Well HR manager, interim manager Jeffrey Mariano, and we identified five key areas that we thought we could gain some efficiency. And we're really happy to report and so thankful to County HR that they met us on those.
They began to immediately work with us to eliminate those administrative barriers One resulting improvement was they granted us additional permissions to the hiring managers of B-Well. To identify, to input requisitions, identify new lists and bring those into our system more quickly. They allowed us to have our applicants be reviewed and selected directly by our B-Well staff And they helped us to clarify the roles and responsibilities at each stage of the requisition process, something that we were confused about as were their staff in many instances. And finally, they granted us a 72-hour turnaround time for County HR to approve our requisitions. We are waiting sometimes up to three and four weeks for those And we created some efficiencies and now we have a very good flow.
We still have about a 29% departmental vacancy rate, but that's not related to any hangups here so I'm glad to say that and thanks again to County HR for their partnership. The next goal around succession planning is developing a proactive strategy to enhance succession planning. I didn't identify any ideas for that, but early on in the process of early on in my tenure coming to be well it was really clear that we have a lot of staff at the direct line level who have a lot of great ideas and are dying to be heard about ideas they have to create efficiencies.
I'm really excited to report that many times when they bring those forward to us, they're really in alignment with things in our KPMG report. It's pretty exciting. So what we have developed is a new collaboration that actually we have our first meeting next month-next week beginning in August. We asked all of the programs throughout the system including fiscal contracts HR all of them To have the direct staff, not management select a representative from their program to meet quarterly with the executive team. To bring forward ideas concerns and comments about how to better improve the overall organizational Functioning of be well, so this group they haven't picked a name for themselves They said they'll have one by the time we meet next Thursday.
This is a group of now 19 Staff who were brought together and Suzanne grimacee our public information officer provided them with a training on leadership About how to be a leader but also how to plan an agenda facilitate a meeting they're taking the lead They will meet, they convene themselves the week before they meet with us. They bring together their ideas. They are part of their agenda in their departmental staff meetings each month soliciting information from their peers around I'm going to go ahead and open it up for questions.
The programs will have an opportunity to select a new representative, and in that way we really hope to bring the two values that we are uplifting in our department this year. It started with our all staff last month of identity and belonging because again we know that the money is not all that people care about right now they do care about feeling like they're in a place where they're heard And that they are, they're a part of something bigger than themselves. So this is one way for us to do that and we really think that it will create future leaders within our department as well as hopefully the word gets out and it also creates I tell two friends and I tell two friends what what a great place it is to work and we get more recruitment in as another outcome.
It sounds very much in the spirit of Renew 2022. Yes,
it is. All right. So now some of the other another recommendation was around our contracts processes. So when KPMG met with our teams and really talked to staff, there's a lot of confusion and people really concerned about the inefficiencies and the delays in contracting with certain partners in our system. So the first recommendation was that we engage with county council to increase specificity of expectation around turnaround time, scope of review for efficiency.
And I'm happy to report that County Council Rachel Van Molen and myself met, I don't know how many months it's been now maybe four or five months back and we agreed that B-Well really should be on the same process and protocol of contract review that other county departments are. And so we made that happen, and what that did is that brought us less people coming to our County Council with I need this, I need this, here's a new contract for you to review it in this way now there's no longer a prioritization that changes week-to-week It is first in, first out and it is leadership. It is two or three of us from leadership meeting weekly with or bi-weekly as needed with our county council to review contract items and get things docketed.
So I think it's working well so far. I know that I have a follow up meeting in the next couple of weeks with Rachel to see how things are going. The second recommendation was that we implement an electronic contract management system to better coordinate workflows and streamline the contract review and approval process. We are working on that currently, the timeline...we're really hoping to develop an internal contracting process through an updated written policy and procedure identifying other workflows to clearly define the roles and responsibilities Of contracts purchase orders and staff requesting those in order to meet the needs of this goal as well as fiscal management goal that we talked about earlier.
And staff utilization, looking at how they're spending their time and what they're spending their time on. We've actually added staffing in our system this year. We've added some contract monitors. We've added a fiscal staff that will really focus on these goals. And so in contract management we do have a fiscal staff who will be taking the lead on managing this system.
All right, we also look forward of course to the ERP project and seeing what efficiencies we can gain there from those systems. The final area of focus was interagency collaboration. Certainly, B-Well has a lot of that going on from working with not only our CBO partners but of course with our justice law enforcement justice involved programs public defender probation DSS and public health as well as community services. The first recommendation though was really focused on enhancing our collaboration regarding homeless outreach efforts within the community And really looking to partner more closely with Community Services Department to streamline and enhance that service delivery.
Be Well provides key staffing for the current multidisciplinary team for homeless encampment response in partnership with CSD, and we actually have new funds that came through in July 1 from ARPA and we are enhancing That staffing to have a wider reach in the encampment response over the next year and through 2024. One other way that we are looking to enhance the collaboration is BeWell has submitted, excuse me, an innovation plan for approval by the Mental Health Services Oversight and Accountability Commission. We're awaiting final approval on that. And what we're looking to do there is with our innovations dollars at MHSA create a housing division That will collaborate with other county agencies to provide staff specifically targeting the retention of persons in housing.
And so this will be staff that will be likely peers, providing peer support as well as case management and this will fill a gap that is being increasingly identified by the Be Well staff and Community Services Department. That they're doing a great job of doing the outreach bringing people into the system But once people get housed, we don't have that next level of care to keep people housed. And so we're having some unwelcome signs of high turnover early on when people are housed and this program is looking to address that gap. Certainly if that plan doesn't go through for whatever reason, we are prepared and be well to modify that and use some of our current funds not as In the meantime, be well is building on the effectiveness of course we are part of the Homeless Interagency Public Council of County Directors meeting that's held monthly.
And where myself and the other directors for the departments working in homelessness meet, and talk about making sure that we're ensuring collaboration and tracking clients' experience with homelessness throughout the county and identifying services that are needed and in what regions.
2:58 – 3:1322 turns
All right.
Our next interagency collaboration goal is to strengthen and expand partnerships with criminal justice agencies and connect eligible Justice Involved residents to behavioral health services. So we are, there's a variety of ways that we are looking to do that. There's lots of opportunities in the Stepping Up steering committee, which is a collaboration of law enforcement and behavioral wellness community. We're looking we have some funding through the Community Corrections Partnership to We are working with them, they're actually hiring a discharge coordinator to increase collaboration between the partners in the Stepping Up Committee as well as in the CCP. This is a more direct handoff from people being discharged from jail into behavioral health and other public health and other systems.
And we have a new collaborative with Be Well and the Public Defender's Office as we work to divert individuals as a result of Senate Bill 317, which eliminates misdemeanor ISTs. So we have staff that are meeting weekly and working on diversion there. We are identifying currently looking at what are the housing options and delays that we have in our system So we're working on a protocol, excuse me, on a data collection and we will be creating a dashboard of real-time housing options for those who are coming out of the Justice Involved system.
And to see where the beds are available and how to connect them more readily and easily into the system so that they don't end up back on the street and reincarcerated. It's really anticipated that these care coordination and case management services that we're talking about will not only be employed for, not only the high utilizers but other clients with complex needs in our systems.
We're working with the Sheriff's Department to explore the human resource needs and being able to do more in reach one of the CalAIM initiatives is to do more in reach sooner into the jails before people get discharged so we're looking and also working with CENCAL to maybe identify some enhanced case management dollars that we may be able to utilize in that collaboration moving forward. All right, and of course the recent legislation establishing CareCourt throughout the state since January 2025 as a deadline for us to have our county and judicial systems coordinating and fully aligning for persons diagnosed with psychotic disorders So that we can wrap them up quickly in treatment and help them to get on their journey to recovery much sooner.
Minimizing the long-term impacts to both our behavioral health, public health systems as well as keeping folks out of jail. Finally the last recommendation was to conduct CalAIM reform planning to increase integration between CENTCAL and complementary county departments. Be well began in April 2020, no excuse me. Yes, in the spring. That's right in the spring. It is a spring I was looking at the wrong date sorry.
BWELL has bi-monthly meetings with County Behavioral Health, County Public Health to work on coordination and integration of care. The purpose of that meeting is to provide a forum for the BWELL practitioners and public health behavioral health specialists to work together to achieve integrated client care goals. And we've been very successful thus far The goals include the data sharing agreements, policies about no wrong door and actually sharing information within each other's electronic health records.
And this is both for mental health and the drug Medi-Cal ODS services. And that's been really effective, and we're expanding that. We're also meeting with CENCAL regularly to discuss ways that we can utilize some of the incentives as well as funding opportunities that they are being granted by the state as part of the implementation of CalAIM. All right. And then finally, of course, as noted earlier, BWEL has staff from IT From quality care management and the executive team participating in those monthly countywide meetings being led by the CEO's office on county planning. So that is another way that we are preparing for the reform.
And that is my implementation report, so I'll now take any questions.
Thanks again. It's a lot to assimilate. How long have you been here Director Navarro?
It'll be 10 months on Thursday.
Extraordinary Supervisor Hart.
Well, you're doing a fabulous job and we're lucky to have you. And thank you for such a comprehensive report. The thing I just appreciate your enthusiasm for embracing the report. I think it just shows your leadership style that you want to get under the hood and figure out what needs tinkering and fixing. And I particularly appreciate that you and Mr. Doyle are both going to be personally shadowing the justice involved staff in the programs to see how you can take those things next level. That's there's a great opportunity there and knowing that your hands are on The wheel makes me very confident of success.
Thank you, and I just want to say that John Doyle is already shadowing crisis he's been following he's been going out with crisis on calls for the last two weeks so yeah he's really enjoying that very much because we can't help them and make decisions you know about future until we know exactly what they're doing so he's he's on it
other questions And to KPMG or Supervisor Nelson.
Yes, thank you Chairman I guess my question is just you know I saw what the integration with other agencies in 7.2 talk about co-response and you know we have this debate about crisis response versus co-response and making sure that you know that's fully Established, you know it's been a priority of this board. We've seen presentations that have shown us that it's quite effective in keeping people arrested and getting treatment sooner.
Any further thoughts about that moving forward?
Yeah, well we're actually in the process of putting together a budget. The CCP is providing funding to Sheriff and Be Well to create a new team that will cover Santa Maria and Wampoag so we are presenting that I think by the 26th to go to the next meeting for approval and we are also focused on creating filling out our entire mobile response system in Be Well because there's a range needs out there in our community, as identified by folks who call in and are very clear that they're afraid to have law enforcement come just because of their family's history or whatever they're worried about going through. So we are really working to expand a full range of mobile crisis response that will of course always include co-response teams.
with the Sheriff's Department.
Great, thank you. You know obviously we can't have co-response 24 hours a day it is not going to work and as far as allocating resources doesn't make sense so those do really tie together and I'm really excited about seeing where that goes. Thank you
Supervisor Hart? Yeah, I just had one quick question for Ms. Thornton. The vacancy problem is persistent and in all the presentations and you sit in a unique place to look beyond Santa Barbara County at other government agencies what can you tell us about that?
I think that it's not a unique problem, we're seeing it across the nation. We work with LA County, Hamilton County and Indiana. We work with Lafayette, Louisiana they're all experiencing the same vacancies. I think that is why we try to look at our reviews through that data lens and the technology lens so is there a way to improve Your data reporting, do you get better insight into where the challenges are?
Can you improve your processes through automation or through use of technology to release the burden of some of those administrative or manual tasks on your staff to release capacity. I don't think that there is a quick fix or a silver bullet from what we've seen across our other clients but I think implementing some of the enhancements that we recommend and looking at kind of looking at your operation through that lens can help alleviate some of the challenges in the short term.
Thank you.
I had a couple of questions. The first, though, is an observation about the 25 grants and three more in the door coming in the door and how you've got to handle on that and how important it is not just to be opportunistic but to be strategic in grants going for grants and grant administration and management I realize there's something I don't understand and probably should. And that is, what is the difference in billing between CalAIM and what we do now?
How do we expect billing to change?
Okay so right now how we bill is we get, there's a cost per minute rate for various services whether it's individual therapy or group therapy or psychiatric service or an intake And those have a cost per minute attached to them. And when we, and the cost per minute is based on our costs. So a whole program includes not only the people that provide the service it involves the AOPs that support them, the fiscal people that support them some of the leadership that supports them. And so all of that gets put together and says okay this program costs X amount of dollars. And this is how much we, so this is the cost per minute Based on how much we spend for our services. And so that's what we bill and that's what we are reimbursed at, at that rate.
What's going to happen with payment reform is the state is setting rates for what they based on an analysis they've been doing since the spring. They have been taking the cost reports and the cost per minutes from every county in the state and they're dividing them by Urban counties, large counties, medium counties, small counties, frontier counties. And really trying to find what is the sweet spot number that is the right number to charge for service. Tailored
to
each of those kinds of things. Is it urban? Is it frontier? Is it large, medium or small? And so they are going to reimburse us At a set dollar amount. So if you're going to do 45 minutes of therapy and it's provided by a licensed therapist, you're going to get paid X amount of dollars for that. That's it. If you're providing psychiatric service 30 minutes from an MD this is how much we will reimburse that what the Risk is, as we've talked about previously, is that our cost per minute if it's higher. It could be that this rate that they figured out is more in the middle and that may turn out to be lower than what we're used to receiving.
However, the state is committed to making sure that they actually overfund On the dollar amounts, at least for the first few years as we all learn to adjust our systems to the performance moving towards that performance based outcome measure of 2027. Because they're really looking to then fund us based on our performance measures by 2027 so we will have these services that we provide and each year we will have to turn in reports about how many people we served and how well did they do?
Right. How well did they do? So will this
lessen the reporting burden over time? It
will lessen the reporting burden and it will lessen the audit burden. So right now, the way we're paid is an assumption that everything we're paying for, we're doing it right and we're getting and everything all the paperwork is correct. And so what happens is somewhere between five and seven years out when they catch up The state comes back and says let's go back to 2015 and look at everything. Did you have all your documentation in a row? Oh wait a minute, it looks like 2% or 5% or 10% of what you did was not up to par so we're going to take back right now this X amount of dollars, 10% from that fiscal year. In the new scheme of things because it's a set rate there is no auditing on the backend. What you get paid is what you get paid. So the audit risk is removed.
Cost reporting Is removed. What then is more highlighted is who's doing how many services are you doing? How many people are you serving? Is your system efficient in caring for your county and what are the performance measures and outcomes to demonstrate that?
Thank you, that's very helpful. So I've had some people from your department come to me saying that a lot of people or more than they'd like to see are hired locum? They're not brought on as county employees, they're hired as consultants, I guess and I wonder if you could speak to that
Yes, in particular that's in our medical field with our psychiatrists and our nursing staff. It is very hard to find that higher level professional who's used to making well over a certain amount of money and that goes a long way in other counties where the housing costs are not so exorbitant. And so what happens is we have a hard time recruiting people to come and stay and be permanent employees in Santa Barbara County They would rather work for locum tenen, which actually pays more. It doesn't get benefits but it actually pays more and they can go from different departments or healthcare organizations to organizations as needed.
And so it's really about again, it's the cost of living. talked about that earlier with Department of Social Services. I have to say, and I commend Dr. Oli however on being a really compassionate and excellent psychiatrist. He cares about the people that we work with and that translates to people when he's meeting with them to hire them. And so we actually have a doctor that was hired through Locum Tenens a few months ago who has made it Cleared us and said she wants to be permanent. So she'll be converting to permanent We have another doctor who was never located in this state before Even though he had family in Santa Maria four years ago when he was hired He did not he said I can't come live there It's too he made the decision to come and he just moved to California a couple of months ago So because he wants to stay with the department, he believes in the mission and he believes in working under dr.
Oli
3:14 – 3:1614 turns
And well, that's good to hear. Great for Dr. Oling. So the billing that you described how would it be affected?
Well, it won't be affected by who provides the services. You know, it'll still be that if you have a psychiatric nurse practitioner who is providing a service, it will be X amount of dollars for her 30 minute session or her 45 minute session Session where the costs come in, of course is that whatever reimbursement rate we're getting. We are paying the locums tenants higher than we do pay permanent and so We're in the middle of negotiations and doctors, we're hoping to help doctors to feel more comfortable about the benefits that we offer here in B-Well, in the county at large. And to really focus on... That is our intention, is to focus on recruiting and retaining civil service doctors and nurses within our system.
Okay well thank you. Any other questions? Public comment Madam Clerk?
Chair Hartman and members of the board, we have one request to speak on this item. That individual was previously logged into Zoom but has now left the meeting. We have no further requests to speak.
All right, bringing it back to the board I think just need a motion to receive and file.
I'll
make that motion. Second?
All in favor say aye. Aye. Any opposed passes unanimously. Madam Clerk number three would you read that into the record?
Chair Hartman and members of the board, departmental item number three is from the Behavioral Wellness Department. It is a hearing to consider recommendations regarding the Community Assistance Recovery and Empowerment Court update.
All
right.
OK, thank you. Hello, everyone. So I think this is a good segue. Oh, are we starting?
Please.
OK. Yeah, let's all right. So this is a great segue from the last report I just gave because we're now going to jump into the care court legislation update All right, so this is a Senate Bill 1338 established by Umberg out of Orange County. He's the lead author on this and this was signed into legislation at the end of last month by the governor. It is called the Community Assistance Recovery and Empowerment Act or CARE.
And we know that it establishes something called care courts. This is actually the realization of Governor Brown's commitment. He's been talking about that all this year, and actually when I went back and
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researched...
Oh my gosh! I put brown in there! How did that get in there? So sorry. It
was around for a long time, and there were two of them.
For a long time. That is so funny. Well actually This is, sorry Governor Newsom. I hope he's not watching. I
hope
he's not watching. All right we're going to get off this slide really good but anyway Care Court was first discussed oh man it's been a long week okay so care court was first discussed back in 2015 about really how do we help people who are the most disabled by their mental illness get the care they need and thought to be languishing on the streets In particular, many of who are homeless and who are also deteriorating medically.
So here we are now in 2022 this is a new civil court that receives and manages petitions for participation. Of individuals who are identified by either their family members. It can be a roommate, it can be a health professional, it can be any first responder. A public guardians office or some of the individuals who can refer people who they think are experiencing a psychotic disorder to the care of a care court which would allow them to be placed in a court ordered treatment program.
The court is going to convene no less than if someone is accepted and agrees to participate. People will meet every 60 days with the residing judge, somebody called a supporter, and their treatment team to review their progress in treatment. Under the CARE Court, the civil court of the county is required to provide counsel to all referred individuals who are referred in not And we're talking just referred, not necessarily participants yet.
And is this public defender or county council?
Public defender. I'm sorry, public defender unless they retain their own counsel and under care court County behavioral health is responsible for all the mental health care. We are required to do the initial assessments for participation And if identified as eligible, County Behavioral Health is required to do the ongoing treatment for the duration of participation regardless of someone's insurance status.
The court is also required to hire supporters and their role is to assist respondents participants to navigate the court and the mental health system. They're there to act as a support to the respondent but also to help them in the decision making for their services and care. Who's eligible for CareCourt? It's really important to say out loud, there's been a lot of people talking about well this is just the way that the legislature or the governor is looking to address homelessness but CareCourt is not for everyone experiencing homelessness or mental illness it's a very narrow group of individuals these are persons who have schizophrenia spectrum or some other diagnosable psychotic disorder And in addition to that, they must meet other criteria as identified by the law.
It's not as restrictive however, as Laura's Law. So this is very it's similar and an expansion if you will of Laura's Law specifically persons in Laura's law they need to have some history maybe of law enforcement experiences, some long-term mental health service crisis needs but in care court a person need only have up to six months of outpatient mental health treatment and need not have any other crises or experience with law enforcement to be referred.
And again, while most eligible individuals will likely be Medi-Cal recipients the type of insurance is not a qualifying consideration and County Behavioral Health will be responsible to serve and treat them. Once a petition is brought forward to the court and the judge Decides that it is a valid petition. There will be an assessment for final qualification and that assessment has to occur within 14 days of the court's receipt of the petition.
At the end of that, 14 days. Someone will be deemed either qualified or not qualified. If they are deemed qualified, there's another 14 days that the treatment team then from Be Well has to along with the supporter and the respondent come up with an agreement participation for the full assessment and clinical evaluation for a care plan agreement. If someone agrees to be a part of this care plan and says OK I will take this care, Meet with you for a year. The first progress hearing will occur 60 days after that and every 60 days for up to one year.
At the end of one year, that participant either graduates or if it appears that they are still needing more time, they can be extended up to 1 more year in treatment with behavioral wellness. A lack of compliance with the plan, however, may result in court-ordered and further assessment which could lead to court ordered medication. But I want to be really clear and I think this education information is important. Medication cannot be forced.
And the legislation is very clear about that it can be court ordered but will never be forced And then an ongoing lack of compliance either at the one-year mark or at the end of the two years could result in further evaluation for public, for guardianship under LPS conservatorship.
And right there if I may ask what powers does a guardian have?
So the Public Guardian's Office under LPS Conservatorship has full medical...
so that they can demand that somebody take medication?
They will yes they will put the person into long term treatment and care And that the person be put on medication and care. Yes. As we know, housing is a major care court consideration without stable and safe place for people to live recovery is just not sustainable. So respondents served by care court will need a diverse range of housing right from the interim housing clinically enhanced kind of shelter housing with clinical programming or bridge housing Licensed adult senior care facilities, supportive housing or support to be home with family and friends.
Care court legislation talks a lot about the $14 billion or billions of dollars of housing investment but I want to be really clear that the care court legislation states very clearly that it's relying on $14 billion that has already been given over to counties in the past two years. And those major investments are under MHSA through the No Place Like Home project, Project Roomkey and DHCS among some other identified housing. I did attach the full legislation, the final draft to your report and if you go through there it outlines all of the housing programs at the state that CareCourt is expecting counties will leverage.
There's also specific counting behavioral health clinical programming under MHSA. And that is why, again kind of in alignment with the KPMG report it Specifically calls out in the CARE Act that full service partnerships are expected to be the primary service delivered service program offered to people in care court. And that if a county doesn't place, if a County Behavioral Health doesn't place them in an FSP we must write a report as to why and what are the barriers of that in our county? So one of the reasons for that, of course, is that under full service partnerships in California under MHSA there are dollars attached for some housing assistance funds. And there's an expectation that we as County Behavioral Health will be using those for these recipients.
So the implementation starts started already for the first eight county cohorts Frontier County Glen Orange County, Riverside, San Diego, Stanislaus and Tuolumne as well as the city and county of San Francisco. The remaining counties, that's us, are to commence no later. We can start sooner but no later than December 1st 2024. There is a possibility to extend however if your county experiences some crisis of some sort. It doesn't give what those crises it doesn't say if it has to be a natural disaster or not but There will be an extension of up to 2025 if needed. There will be no provision for opting out, this is different than Laura's law. Laura's law has that opt-out provision there is no provision for opting out of CareCourt and county's not in compliance with CareCourt for whatever particular reason that may be.
Maybe your county does not have the full range of options of housing that are required to be offered maybe your behavioral wellness Program is not meeting the deadlines. Maybe the court supporters are not fully staffed, et cetera, et cetera. The fines can be up to $1,000 a day with a maximum of $25,000 per year per respondent in the program. So how CareCourt is funded? Because this is a very big ticket item and I'll talk about our Assumptions around numbers in a minute, but the existing funding sources for the care related services for the behavioral health part. There's no new money coming in at this point Specifically, but I'll talk about that in a minute. But they're expecting that we are going to be using our already MHSA and realignment funds and programs as the primary resource for the for our staff and the services again most respondents will be in Medi-Cal Will or they'll be eligible so we will be able to leverage federal dollars there and Thankfully, the language is very clear in the CARE Act now that health plans private or managed care plans for Medi-Cal will be required to reimburse county behavioral health for the costs.
So that's great funding for additional counsel public defender's office court supporters and technical assistance for the court system to set up this civil court are available and will be provided Now, bottom bullet point relates to the first one in that additional funds to support costs and care court success will be identified. via discussions with DHCS. So in the legislation, it calls out that Department of Healthcare Services is required to meet individually with each of the remaining second cohort counties between now and 2024 to identify if there are any costs and funding that we need to make sure that we are successful because again, it is a mandate and the state is looking to help us to be successful as possible and not end up with fines.
So the work ahead now, actually before I get to that one let me just give you some numbers. At the state level and California Behavioral Health Directors Association we really started thinking about what could this number be of persons who could get referred to care court let's say in the first year of operation? So when we look at identifying that they were probably looking at folks who are likely unhoused, we look at our point-in-time count number so for us in Santa Barbara it's around 1900 We know that, and again this is psychotic disorders not substance use psychosis but psychotic mental health disorder spectrum. We're talking about roughly one in three people 30-33% of persons who are unhoused have those diagnoses and you think okay so of those folks so what is that number for us in Santa Barbara?
And I'm sorry I think it's about uh and then we look at the fraction of those that are actually going to participate And I think we come up with somewhere between 117 and 143 a year is what we think will be referred. Because in our system here in B-Well, from our data we know that roughly 20 to 22 percent Of the people we serve have a psychotic disorder. So if we think about 30% of persons that are unhoused, have a mental illness 22 to 20 to 22 percent of those have a psychotic disorder. It's roughly around 117 140 people a year that are on house in Santa Barbara County that could qualify for care court.
And when we look at those numbers for funding, it's pretty exorbitant. It's about an additional 16 staff a year, including direct staff and all the support that goes with it. It's about a five million dollar a year program, just about 4.6 I think.
Is that be well staff or is that public defender? Public
Defender Staff. I'll give you those numbers as well.
So so the five million in this 16 is just Be Well?
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Because you have to have the right staffing ratio. Again, these are folks that are pretty severely disabled by their mental illness so we want to make sure that we have the right staffing ratios of no more than usually 1-12. 1-10 is a best practice but working from a 1- 12 is also Noted. And when we look at the numbers for this is information that care court cost estimates that were provided to CEO Miyasato back in the start of this discussion, it's roughly about sorry 800 Public Defender's Office at roughly $830,000 a year additional cost. County Council $480,000 there will be some cost to County Council and the Public Guardians Office an additional $200,000 per year.
And then Behavioral Health so we're total of just under seven million dollars a year to onboard this program understanding that on the behavioral health side If everyone had Medi-Cal, we would be leveraging about 50 cents on the dollar of that. And there may be of course respondents who are in private care plans and managed care plans. But if you think about that ongoing, if you have people coming in one year it can build pretty quickly so what are we doing now to get ready because 2024 is going to be here before we know it? So we know that planning and preparation is key. So the Santa Barbara County Departments that are involved, of course in executing and effectively implementing CareCourt are BWELL, the Public Defender, Probation, the Public Guardian's Office.
So we've begun meeting with the CEO's office to talk about what do we need to do? And we're each focusing independently but also collectively on this target population. So in my own system of care, of course as you know from the recent budget Amendments, I added some staff to our AOT program which is Laura's Law. Adding staff looking and realigning staff in our outreach programs. Looking again as we look at staff utilization kind of going back to KPMG it all fits in together.
Do we need as many therapist positions as we have identified? And they're sitting vacant. Might we convert those to some of these peer positions in case management positions in the adult system? Because those are the types of services that this population needs more immediately, so really looking to convert positions for more effective staff utilization. That's what we're doing and be well and I know that across with public defenders office probation and Public Guardian were increasing our communication pathways. We're looking at protocols and procedures for easy referral and assistance.
We're also assessing not only our staffing, but we're assessing our training because there's a lot of training that will be needed for our staff with this particular population including best practices like motivational interviewing and things like that. We are also looking to other counties such as Stanislaus County and some others who have already implemented similar projects prior to CareCourt about fortifying the collaborations between Justice services, law enforcement and behavioral health.
And we really want to establish good communication pathways, really easy flow. I think the other part of it is the work ahead is about stakeholder communication. It's about really educating the public about what CareCourt means and drilling down on that for them, same way I think we've done for Laura's Law since it was implemented. We want to educate and inform the community about CareCourt but we also want to meet with them ahead of our implementation and planning because we need to really hear from them what are some of the current challenges and gaps that they're having? This is the group, you know these stakeholders many of them who want to meet with us and who will be attending these meetings are likely people who will refer into Care Court.
So it'll be important to educate to them about what is and what's not available and hear from them what are the barriers that they have currently so that we can prepare prepared to ameliorate them as best as possible. And then finally really the work ahead in our county is to develop a broad range of housing options Including permanent, affordable, sustainable housing solutions for transition following this one to two year care court process.
We can do the transition housing, we can do shelter housing for a year but people have to go somewhere after that so it's really about developing this broad range of housing and that's what Care Court calls out is they're not saying we have to pay for it and they're not saying that we have to mandate it they're saying that our counties have to demonstrate That we have a broad range of housing options.
And that's my update.
Supervisor Williams?
Well, I have an actual question but of course that got to mind the fact that we still have the challenge very few private folks being willing to take Section 8 vouchers right and the continuum of getting these folks better housing is severely limited If the public, if the only capacity is in the public sector. So just if in case there's somebody who has rental housing that is watching.
That's got it we got to talk about that right because people want solutions to this, but solutions usually mean folks working together to create headway. My question was more along the lines of, you know, you've monitored this closer than I have but this is a new change. Usually new changes in the way a system that's made that's mandated by the state often goes through changes in the legislature in their first few years You know, if you had designed it what would you have done differently?
Because one of us may have to vote on those changes in the coming years. So I don't know which one but one of us sitting here might have to so yeah.
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I think I would have really been more realistic about the impact to the behavioral health system in California, especially coming off of a pandemic. I think that we only have a limited amount of funds and when we look at the potential impact to our systems with this population Especially folks being mandated. What we've seen in Laura's law is it's effective when we get people, when we get people into front of a judge and we offer volunteer services they say yes or even the threat of court they say yes and they come into the system more quickly so we're really going to have a growth in our system but to what cost in MHSA right? I only have a certain amount of funds to share between my children's system of care and my adult system of care. So that is one of the things that you referenced earlier, something that keeps CEO Miyasato up at night.
That's one of the things I think about for the future is how do we balance that? So I'm hoping and you said as legislation changes in the first few years of new legislation, I'm really hoping that our cohort counties and I have no doubt they will what DHCS will see in working with them it's like oh Oh yeah, you got to pay for it. So I'm hoping that what we'll find is that we can increase the likelihood that there will be funding to the behavioral health side of the system in this and I think I would have included the private sector more broadly in the legislation I do think that even in our own county, when you look at who might be referred for this it's not just going to be people who are unhoused that are eligible for Medi-Cal. It may be that young adult Who is in the throngs of their first psychotic episode and the family just doesn't know how to help them and work with them.
And they are insured, they're under 26, they have insurance. And if we had some maybe partnering and leveraging of some of the private dollars actually coming into the system versus after the fact that might have helped. And then again looking at the housing piece and understanding realistically what that means for counties especially counties like ours.
Supervisor Nelson.
Yes, thank you Chair Herman. So if somebody doesn't take treatment then they could be referred to the guardian or given a guardian? They
could and I think that's the piece that I want to educate the community and the public on around CareCourt when you look at that if somebody walks away from CareCourt they walk away from CareCourt. If we're given an evaluation of somebody's resistant to treatment we know Again, the research is very clear. At least half people with an untreated psychotic disorder have a symptom called anosognosia which impacts the brain and impairs them from having self-awareness. So we often say oh they're in denial or noncompliant but really in reality they don't know that they're sick it's a similar symptom that happens sometimes to stroke victims. And so when that happens They, okay they get referred for a guardianship referral. They may not meet the qualifications for guardianship and if they don't they can just walk away.
Can you walk me through that? So what would prevent them from being able to get a guardianship?
Well I think that when you are assessing for conservatorship there are certain criteria that someone must need to meet like unable to feed themselves or unable to take care of medical needs that they may have or unable to nutritionally or physically care for themselves and that they, or to handle realistically handle life and decisions day-to-day decisions. There are many folks who have psychotic disorders that can do those things that will not qualify. And we're seeing that already now in our you know some of our programs like Senate Bill 317. We have more people being referred for that evaluation and unfortunately not qualifying Even though they are having issues in the community and people are feeling like they're at risk in their community, they don't meet the standard.
Because again LPS conservatorship is about protecting someone's civil rights at the same time evaluating whether it's better for them to have those handled by someone else. It's not a straight line, I guess is what I'm saying.
Yes, it sounds very counterintuitive that somebody not willing to accept treatment for serious mental health would not qualify for that. My next question was we're thinking maybe about 125 users of this annually and I guess there's a vision that it's a new cohort every Every year that comes through this or is it kind of just there's 125 people in the system. They might have they might be multiple years within care court is what's what's that exactly look like?
Right so that's what I'm talking, so it could it's one year is the initial care court treatment but they can be extended up to two years. So even if you had half of the people extended a second year you're already at 200 Folks in the second year, you treated 125 in the first year already up almost at 200 in the second year. So I think that is a concern. The other piece of it is and there's a cost that I didn't even talk about and I'm sorry that I was remiss and thank you for letting me circle back to it when these people get if they're these people sorry that's a terrible way to say that I apologize when respondents who are participants in care court are identified for conservatorship And they are placed in long-term care.
That's on the dime of behavioral health. And we currently, in this past year paid I wanna say if I look at my data it was about $9 million in costs for people on conservatorship. And so every year we're adding to that roster exponentially that's a huge cost to counties.
At the same time, we keep hearing about prevention and dealing with an acute issue can save us in the long run on some cost aversion. Whether it's with our criminal justice system or public health system or just our quality of life for our communities. So I guess that's the balance that we're gonna need to find moving forward. And I'll just end my questions by saying I'm cautiously optimistic what we've been doing As a state and as a society hasn't really been working at this point. So I don't know if care court is the ultimate solution, but we have to do something different if we would hope to address these problems.
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CEO Miss Otto
and chair board members. You know CSAC has been very engaged in this getting up to the legislation, the CEOs my organization have and again I think as Supervisor Nelson said everyone appreciates the intent but the one thing that the CEOs are very frustrated about and what Ms. Navarro talked about is on the housing money That the governor of the state has said, counties use the MHSA money we've already given you that we've already allocated or that we have programs for. So that's going to be difficult decisions ahead about who gets the housing and for what category because it's sort of like the respondents here get to jump the line because it's an important priority but that means there are others who may not get the housing we would have otherwise wanted to provide.
Well a note of caution. A lot ahead. I don't see any other lights up here any public comment? Chair Hartman and members
of the board we do have one request to speak. We'll go to Zoom with Susan Sindelar. Give me just a second and I'll unmute you. Susan.
Yes can you hear me. We can. Thank you. My name is Susan Sindelar, I am a resident of Santa Barbara County. I live on the Mesa. I have a family member who does have a psychotic disorder and I have been following the care court legislation since it was proposed in the state assembly and had been participating in some of the processes to try to amend I'd like to address a couple of the questions and comments that the Board of Supervisors have already made.
Supervisor Nelson was absolutely correct, there was a lot of intent behind this to try to do something different because something different does need to be done. Care Corps is the way for An innovative program to be developed, but in hearing from the department head Department chair Navarro that. The goal is to essentially model this similar to the AOT program. That's not exactly what care court was designed to be. It was designed essentially as a way to try to address the homelessness problem. And as he and as the CEO indicated, there is no funding.
This was brought up to the governor. This was brought up to the senators. This was brought up during all of the hearings. And essentially what all of the legislators wanted to have done was counties to re-evaluate how their mental health programs and their mental health departments are operating, to better meet the needs of the seriously mentally ill or the disabled members of their community who as a result of these mental illnesses are not able to be as functional as other members of society.
One of the concerns that I think the Board of Supervisors should continue to monitor is exactly how and where the funding is going to be going within these programs. Many people who do have psychotic disorders, have a psychotic disorder that's a result of a substance use induced psychotic. They have substance use induced psychotic episodes and that psychosis can last for years but under the current disintegrative system of care that the county mental health program has right now, County Mental Department of Behavioral Wellness Those members are funneled directly into the contract based alcohol drug program rather than having the integrated care that other counties do have by having a combined co-occurring disease or co-occurring disorder.
Program facilities, any kind of additional coordination of care. And without that I think that the supervisor's concerns that this is just good intent without any actual follow through or any other changes will happen. Governor Newsom did do this so that we would have a change and I really hope that this county looks closely at the budgets and looks closely at the way that this is implemented to make sure that there will be a change.
Thank you for your time.
Thank you for yours Supervisor Nelson
Yes. Thank you, Chairman. I think that there was some good comments there that yes, I would love for you to respond to. I saw your head nodding during that public comment. Could you share? Yeah,
I appreciate I appreciate her calling in and I appreciate the comments and. And actually, I understand that this is meant to be different than AOT, and I'm sorry if my comments alluded to the fact that I thought it was an expansion, but it is it's actually goes beyond and it does more Barbara County Board of Supervisors meeting And that's how that happens. And so definitely we'll be looking at our program, so I appreciate the comments. That is part of the work ahead and this year we talked in the KPMG assessing our programs. Do we have the right programs for this community's needs?
And are we putting our funding in the right bucket? So we are looking at that yes.
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With CalAME and with the Care Court and with everything, KPMG reports and post-COVID you have a lot on your plate. And we're here to support you. No other public comments? I guess we're ready for a motion to receive and file.
Yes, I'll make that
motion.
Second.
All in favor say aye. Aye. Any opposed? So passes unanimously. We are adjourned until October 18th
in Santa Barbara