Agenda

1.

Introductions

Chair Andersen convened the meeting at 10:32 a.m. and invited attendees to introduce themselves.

2.

Public comment on any item under the jurisdiction of the Committee and not on this agenda (speakers may be limited to three minutes).

No one offered testimony during the public comment period.

3.

RECEIVE and APPROVE the draft Record of Action for the July 29, 2019 Family & Human Services Committee meeting.

The Record of Action for the July 29, 2019 meeting was approved as presented.

AYE:	Chair Candace Andersen, Vice Chair John Gioia
Passed

Attachments:

Draft FHS Record of Action for July 29, 2019

4.

ACCEPT the joint update report from Behavioral Health Services and the Mental Health Commission on the public mental health care system, child and teen psychiatric services.

Behavioral Health Director Suzanne Tavano summarized the staff report, advising that under Managed Care, the County must meet certain State compliance standards. She reported that the County has met the standards for the required number of providers but fell slightly short of the standard for timeliness in consultations and medication. She noted that there had been incremental improvement, with non-psychiatry wait times meeting the 10-day standard and psychiatry wait times close to meeting the 15-day standard. She highlighted the expansion of tele-psychiatry as one of the strategies used by the department to reduce wait times.

Suzanne discussed how the department has analyzed the flow of people through the behavioral health system and determined that housing is a serious bottleneck and should be the focus of current attention. Behavioral Health works closely with the County's Homeless (H3) program to smooth the transition of people from hospital to locked facility to community housing settings. She noted that funding and regulatory silos hinder these efforts. She observed that the lack of adequate step-down programs result in lengthier hospital stays than are strictly necessary.

Vice Chair Gioia noted that H3 has been working with the City of San Pablo to leverage HUD funding to construct 60-70 units of housing with supportive services in San Pablo. He praised the City of San Pablo for its strong collaboration with the County on the housing project, a library, a fire station, a WIC (Women, Infants and Children) site, and the West County Health Center.

Suzanne commented that the County's open-door policy to psychiatric emergency services (PES) is generous when compared to other counties, noting that the majority of counties do not have crisis stabilization units (CSUs) as does Contra Costa County. She noted that the average daily population at PES is 40, which is a challenge in that limited space. She remarked on the push and pull between PES beds and hospital beds, and the way cost reimbursement influences that relationship.

She reported visiting adult and children CSUs and thought that the Willow Rock CSU (Alameda Co.) might be a good model to implement in this county if separate space for a children's facility could be identified. She noted how traumatizing it can be for a child to witness a W&I 5150 (psychiatric emergency) event.

She concluded by stating that the County and its community contractors struggle to find qualified providers due to lack of competitive salaries.

Barbara Serwin spoke on behalf of the Mental Health Commission, praising the new Behavioral Health leadership and their fresh approach to solving old problems. She appreciates the division of responsibilities among the new leadership. She is of the opinion that PES redesign should be the priority, citing the findings in a 2019 grand jury report. She reported that the MH Commission will reach out to community partners to collate best practice concepts and bring those to the FHS Committee for consideration.

Douglas Dunn provided a handout (attached) that discusses the impacts of a shortage of step-down programs and housing for persons discharged from locked facilities. He claimed that the County's locked facility budget was balanced only by a temporary savings in other programs. He recommended that the County support the repeal of the Medi-Cal reimbursement exclusion.

Chair Andersen was not present during the testimony of the following public speakers, who each spoke about the need of community-based mental health services providers for additional funding, and their struggles to maintain staffing and services with uncompetitive salaries: Dan Geiger, Rich Wengal, David Bergeson, Susanna Marshland, Leticia Galyean, Antoinette Harris, Pete Caldwell, and Jay Berlin.

Vice Chair Gioia assured the speakers that the Board of Supervisors is aware of their predicament and, earlier this year, authorized the formation of a work group to study the problem. He advised that Health Services Director Anna Roth will contact the agencies soon. He observed that Contra Costa County has a lower tax base than neighboring counties and also lacks a local sales tax that many other counties enjoy. He advised that the Board's Finance Committee is studying a proposal for a local sales tax initiative and, should it be pursued, will need the help of community partners to raise awareness of the need.

Suzanne added that HSD has already begun gathering salary data from the County's community contractors and has also engaged an outside consultant to assist with the study effort.

Leslie May suggested that the community partners recruit at college campuses.

The Committee accepted the report and directed staff to forward it to the Board of Supervisors on Consent for their information. The Committee directed HSD to report back in one year.

AYE:	Chair Candace Andersen, Vice Chair John Gioia
Passed

Attachments:

Joint Behavioral Health Services and Mental Health Commission Status Report

Public Comment_Douglas Dunn

5.

ACCEPT status report on the Employment and Human Services Department's providing an update on CalFresh and the department's implementation of the CalFresh benefits expansion.

Kathy Gallagher and Rebecca Darnell presented the CalFresh annual update and SSI expansion reports. Kathy reported that CalFresh applications are beginning to level off at about 2,700 per month as compared to 2,200 per month prior to the SSI expansion.

Kathy also advised that effective September 1, the current waiver for Contra Costa County from the Able Bodied Adults Without Dependents (ABAWD) 90-day limit for CalFresh benefits was terminated. The termination of this waiver is somewhat mitigated by individual exemptions that are allotted to each state based on annual caseload. The County has adopted the State's criteria for granting the exemptions and has elected to approve exemptions for all individuals who have exhausted their 90-days of benefits. The exemptions will maintain benefits for these individuals until April 2020 or until such time that employment is found for them.

Rebecca reported that the Food Bank and other community organizations such as Opportunity Junction have partnered with EHSD to assist clients in navigating the application process to receive new or expanded benefits or ABAWD exemptions.

Caitlyn Sly alleged that EHSD was unwisely discouraging clients from using the "Get CalFresh.org" website to apply for benefits.

Mariana Moore commented that EHSD should not celebrate the leveling off of new CalFresh applications. She stated that the significant unmet need warrants further outreach. She requested data from EHSD on the number of recipients who qualified for only a $15 benefit vs. those who qualified for more once the Medi-Cal exemption was verified. She felt that telegraphing a low expectation for additional benefits had discouraged participation.

Colleen Kauth complained that EHSD had not responded to her letter sent in June/July, to which Kathy Gallagher responded that she was in consultation with County Counsel. Ms. Kauth stated that while 90% compliance is the threshold to avoid DHS fines, 100% compliance is required by law.

Vice Chair Gioia wrapped up the discussion by asking EHSD to provide better estimates of potential benefits to people to encourage greater participation.

The Committee accepted the report and Vice Chair Gioia asked that the Bay Area Legal Aid's concerns be referred for discussion by the Board in its next closed session. He also directed EHSD to report back to the Committee in November with a written outreach plan involving community partners and with a current staffing model and proposed staffing model should there be new federal funding allocations.

AYE:	Chair Candace Andersen, Vice Chair John Gioia
Passed

Attachments:

EHSD CalFresh Report

EHSD CalFresh Expansion Report

EHSD Supplement to CalFresh Report

EHSD Supplement to CalFresh Report_Statewide Data

CalFresh News Article

Public Comment_Multi-Faith Action Coalition

6.

The October 28, 2019 meeting of the Family and Human Services Committee has been canceled. A special meeting has been scheduled for October 7, 2019 at 1:00 p.m. in Room B001, County Finance Building, 625 Court Street, Martinez.

7.

Adjourn

Vice Chair Gioia adjourned the meeting at 12:25 p.m.