Behavioral Health Board - Regular Meeting

doing digital stories in the past. Yeah, I know. I'm not supposed to share your story and we're kind of required to do a course of our grants. So, I'm planning to go through that training at some point, but the hard thing is right now and I'm just still transition at some point. I don't know how similar it is. the same uh whatever you want to do with eventually I'm going to go to a schedule where you want to go next Friday are you do you want to do a picture. Margaret, he's just taking them real quick. Go, Kelly. Go. Where did the back wall there? He's doing it. Okay. My hair look okay. I know. It's like there go right against the wall. Awesome. comparison.

Okay, that'd be great. Absolutely. I'll be my like my photo dress. You're after Bob. You're after Oh, I was on the Hello. How are you? Good. How are you? to do some things in very much field. All right. I'm terrible at checking here personally. Great. Okay, we are about to start this meeting. Did you get your photo taken? Thank you very much. Call this meeting to order at 12:17. Welcome to the monthly behavioral health board meeting. We are the advisory board for the board of supervisors. We hold this meeting on the fourth Thursday of each month and it runs from 12:15 to 2:15. We meet in person at 507 F Street in Eureka. This is a public meeting and everyone is invited to attend. Members of the public may participate. The minutes in the agenda can be found

by searching online Humble County Behavioral Health Board. We provide time for public comments early on in the agenda. Public comments need to be limited to three minutes and pertain to matters related to behavioral health. We ask that you make your comment in a respectful manner. Please note this meeting is being recorded and if you have any questions contact myself, Flora Montana or any of the behavioral health board members. And with that, Joe, if you will the roll call. Sean Ber here. Eight story here. Here Johnson here. Bernie Fry present. Alex here. We have a quum. We have a quorum. Very good. Thank you all. We will go around and introduce staff. Starting in this room with deputy director, deputy director. Go ahead and just introduce district finance act director. Do you want to introduce yourself? So sorry. Laurel Johnson, Department of Health and Human Services. I'm an analyst in DHS. Joe McMass, executive secretary, health and human services director.

All right, we'll go to online. Just popcorn to the few of you. Hi, Sharon Wolf, DHHS legislative analyst. Very nice to be with you. And I will popcorn over to Sonia. Hi everyone. Sonia Lovey Boy, she her pronouns. I'm a senior program manager now with Children's Behavioral Health um representing several different programs and children, but also still supporting and supervising the Humble County Transition Collaboration. And now I'll pass to Chelsea. Hello everyone. Kelsey Rei, they them pronouns youth organizer with the Humbult County Transition Age Youth Collaborations. All the folks online. Oh, let's go to Genevie. Hello, I'm Jenny Stfield. I'm interning for Natalie Aoyo. Um, Melissa Hello. Is this working? Hi everyone. I am Melissa Nelson, patient navigator here at Aegis. Awesome. All right. I think that's everyone. Are there any adjustments to the agenda? Seeing hearing none, we will move on to public comments. Are there any public comments? And um moving on then to action items. We need to approve the minutes from 522. So move. All right. All in favor of approving the minutes. Say I opposed. Bam. Minutes approved. Wow, look how fast we got to you, Jack. Awesome. And now the presentation we've all been

waiting for from Jack Brazil. Uh yeah, so I am uh going to present today on our adult system of care. This is our adult outpatient uh program that we have here with County Behavioral Health. And we're gonna run through those programs. And I'm going to do it in uh kind of a using a a what we call a vignette, right? Or an example so we can kind of see how it might look for somebody entering our system. Okay. Uh is it this time? Yeah. What's this? Okay. So, um first thing we'll do is just kind of go through the programs that we're going to look at today. uh same day service, the access program, the outpatient hope center, arrest program, uh our CCT program, our regional program, and then older adults. I'll go through those acronyms as we all next slide. All right, so the first thing we're going to do is meet Sam. Sam is a 22-year-old male who is experiencing elevated mood, difficulty sleeping, pulsive behaviors, and irritability. Parents are worried for him as he has not slept in three days and is becoming increasingly agitated when they try to engage with him on a solution.

So Sam's parents then take him to same day service. Next slide. Uh so they take him to 720 Wood Street where he was able to meet with a clinician in the same day service program within an hour. The clinician performs a crisis risk assessment to determine if Sam needs to go to a psychiatric facility. At this time Sam was not vocalizing any safety issues but did admit he was scared that he could not go to sleep. He admitted to past episodes of depression where he struggles to get out of bed, is mostly worried that he will become depressed again. The clinician was able to work with the client on some coping skills and provide resources for education on the symptoms of bipolar. Sam was willing to sign an ROI for his parents and together with the clinician, they developed a safety and afterare plan. the clinician was able to get him set up with an appointment with the access program to initiate ongoing mental health treatment. Next slide. So here we see Sam at the same day service getting evaluation by a clinician. Uh at same day services we do risk assessments and 5150 evaluations. Uh we screen for the necessity of ongoing services and we offer some brief therapy and some case management. Next slide. All right. Here we are in access. So Sam came in at his scheduled time and met with a mental health clinician for his adult assessment. This is a medical required assessment that allows us to determine treatment needs and ensure Sam is meeting medical necessity for county services. Sam was given a diagnosis of bipolar and based on his difficulty and his relationship with the parents uh that

puts his housing in jeopardy, Sam does indeed meet criteria for county behavioral health services. Sam is given an appointment with the psychiatrist for the following week and encouraged to come back to access if his condition persists or worsens. So at Access is where we do our uh our behavioral health assessment. We determine the eligibility for services. Uh we do some treatment planning and get following appointments and some brief therapy and case management. So in access this is where we would really determine you know this criteria medical necessity right and a lot of people are kind of familiar with that in the sense sometimes folks will come to county and then refer them back to partnership or to um uh services in the community as opposed to getting services in house and medical necessity is really based upon severity what we said functional impairments right so where in the relation relationships, occupation, housing, your ability to access access food, clothing, shelter. So those things would need to be impaired in addition to uh the need for that mental health diagnosis. All right, next slide. All right, so um in addition to psychiatry, uh Sam is now getting adult outpatient services. He's referred for therapy and some case management with the adult outpatient program. Uh Sam identifies the goal of wanting to get his own housing and move out from his parents' home. His case manager works to link him to available housing resources in Humble County. His case manager also finds him a primary care physician and ensures he makes his appointments to his psychiatrist and any other necessary medical appointments. His therapist uh has identified some past trauma with Sam that causes him distress at times. They work together to

develop strategies to move through these traumatic experiences to where they no longer impact his mood and function. Over the course of time, Sam's case manager was able to work to get him into a local supported housing downtown Eureka. Sam is thrilled and reports feeling genuinely happy for the first time in many years. So, I know it's kind of in the the purple there, but so at adult outpatient, uh we do individual therapy, case management, group therapy, and then individual rehab. Individual rehab is done by some of our pair of professionals, our case managers, and it's really kind of focusing on specific symptoms. um like hey let's work on your uh your your sadness today or let's work on hopelessness or let's work on or anger management skills right so um behaves very specific to a particular mental health argument okay next slide please the resident engagement and support team rest all right given that Sam is new to housing as case management is transferred to the resident engagement and support team or rest. The rest program specializes in ensuring the success of recently housed individuals, especially those coming from homelessness. Sam meets with his case manager who continues the good work from his adult uh his rest case manager who continues the good work from his adult outpatient case manager. The rest case manager also ensures Sam is able to perform task of daily living and is knowledgeable in resources to get the new apartment furnishings and housing accessories needed for success. one of uh real quick on that just so not all the time would we necessarily transfer somebody who's got a case manager to a rest case manager just

because they're housed but just for the purposes of this uh uh PowerPoint and highlighting what the rest team does. But um rest is really part of our innovation funding that we got a few years back. Um and it follows a lot of housing first principles. Um and they do a lot of work in our supported housing units throughout uh Humble County. So the main ones here at Bay View and ABC here have down Rio. So our race case managers work really closely with those uh those facilities. Um uh so uh after uh Sam is housed, he meets his neighbor and they become friends and Sam uh uh and this neighbor asks if he's ever been to the peerrun hope center. Sam admits to some social anxiety, but with the encouragement of his neighbor and case manager, Sam decides to attend the hope center. Next slide. Sam is nervous and apprehensive. It's his first day at the Hope Center. Upon entering, he hears some groovy music being played that reminds him of his childhood. He peeps inside and the DJ playing music and people smiling and laughing, sipping coffee. Sam has come on Wednesday's music class for one of our outpatient case manager TJs. While participants pick the music, Sam meets many new friends at the Hope Center and is introduced to all the peer support staff. Through the week, Sam participates in many other classes and activities such as meditation and mindfulness class and book club. He even joins even joins the May's mental health awareness walk to the courthouse to bring awareness to the community that

recovery is possible. Next slide. So there's Sam in his bright green shirt uh on the information this mental health awareness. Great as AI could do. So uh the hope center is peer-led. All staff have lived experience with mental health and our substance abuse as well as other life challenges. activities include recovery education classes, folks like wellness and recovery. Community building activities are also offered at the hope center. So I'm hopeable most folks are aware in the hope center but that is uh they are located at 720 in the campus there. It is peer run. All of the folks that work there, all the staff that we have identify as those with lived experience and um they provide a number of different groups and classes and one-on-one opportunities um and really this chance to promote recovery through lived experience. Um and it's a pretty great place at all. Really like it. So that is the hope center. Uh, next slide. Sam reaches a period of his life of high functioning and good stabil and good stability. Unfortunately, things in life do not stay static. Sam received a phone call one day from his parents that his family dog had passed away. Despite the high level of support from his case manager, therapist, hope center friends, and housing community, this news devastates Sam, and he soon forgets to take his medication and withdraws from social activities, including missing his psychiatry room. Sam ends up in simp after being found wandering the streets

of Eureka with no ability to communicate who he was or how he would access food and shelter. Next slide. Sam is stabilized by the wonderful and hardworking treatment team of supervisors. In anticipation of his discharge, he is linked with a comprehensive community treatment program CCT. This program uh designates Sam as a full service partner and assigns him a case manager and a clinician. case manager and clinician meet with him and coordinate daily check-ins and identify areas. He's also giving nursing support which involves a nurse coming to fill his pillocks for him once a week and discuss any issues of medications he Sam is also introduced to a CCT peer support specialist who like the peers at the hope center provides hope for him in his recovery journey by talking about his pulmon experience. Sam's CCT case manager ensures that he makes all of his appointments and has a whatever it takes approach to ensure stability and recovery. Sam continues to attend classes at the Hope Center and also attends a men's saking safety safety group with the adult outpatient program. So CCT is one of our programs that uh you know really important in terms of our behavioral health service act funding um that we have uh what they call a full service partner program FSP. Um, and this is really, um, you know, working with individuals with severe and persistent mental illness to help them, you know, uh, stay out of the hospital, stay out of jail, stay out of emergency rooms, stay out of placements. Um, and so that's where we kind of have this monitor, you know, whatever it takes, right? So, we'll do a lot of different things for folks that are FSPs, uh, you know, including, you know,

making sure that they have, uh, we paid for like tuition for them before. We've done, uh, paid for certain programmings, programs for them to go to, gotten them bicycles to get back and forth to appointments. Um, done a number of things to really help promote their recovery. And um uh CCT um you know works very much as a team very collaborative approach to uh you know working with folks clinician case manager nurse um and therapist. Um again the one thing I would say here just as a sort of clinical um clinical understanding too is you know this is happening really quickly and Sam had a therapist and a case manager again we wouldn't necessarily you know disrupt the his treatment team because he stepped down from SV necessarily but just for the purpose of illustrating this sure we see the different programs we have and how people enter them a lot of times times the folks from CCT are stepping down from simp um and and that's where CCT doing their purpose. All right, next slide. So Sam works with uh CCT for over a year with great success. He has been the most stable he has ever been and feeling positive about his future. His parents made a move to Will Creek and Sam decided he wanted to be closer to them. His CCT case manager works with him to find housing in the area. Sam's care is then transferred to regional services. He is introduced to a new case manager that travels out to Willow Creek every week. He also meets in person with his new clinician and gets his psychiatry

services through teleaalth. Uh both uh his therapy and his psychiatry happen at a local office for right now. Um and Sam also got a new puppy at his home to keep him company. Okay. Uh next slide. Uh so just a list here of some regional services. So services offered to consumers at outline communities. So it's basically kind of adult outpatient here in Eureka but we go out to uh the uh the place uh places will creek Fortuna and Rio and we offer all of those wonderful things and SUD services. So, one of the things we have in that program that we don't in CCT or in our other programs, a substance use counselor that goes along substance use treatment oneon one and then they do some groups sometimes if they get enough folks together. Uh, so we have those SUD and we collaborate with our local community out there pretty well. Um and Kelly probably know she put most of that groundwork for the collaboration. So uh okay next slide older adults. All right. So fast forward here is 71 July 1st 2065. Former deputy director of behavioral health Jack Brazil is now an elected member of the board of supervisors at Bridge Beyond Measure. [Laughter]

Sam is now 62 years old. He has lived a good life and will create helping foster abandoned dogs along with his partner. At one point some years ago, Sam was transferred from behavioral health to primary care for his ongoing medication needs. no longer requiring the specialized services of behavioral health. Eventually, Sam suffers from numerous health problems requiring travel to Eureka and recognize it is better for him to be closer to those services. During the move, Sam forgets to take his medication and has a period of not sleeping and ended up at the Humble County state-of-the-art triage center in the Mad River Hospital complex. It's been in operation for many years. Um from there he is uh re-referred to county behavioral health and agrees to get services in the older adult uh program. In this program he sees a psychiatrist and a nurse on a regular basis sometimes in his home. He also has a case manager who's familiar in navigating the local medical system and can provide specialized support and referrals to meet Sam's changing need including IHSS. He also has a clinician who works with him on his anxiety of growing older. Next slide. So uh our older adult program is another uh BHSA behaval service act funded program. Um and this is designed for clients 60 and above with comorbid uh physical health care and adult protective services involvement or learning concerns. there there's some gray in that but generally it is going to be our folks that are you know 60 and above have you know the diagnosis of mental illness and then there is some fear or some concern that APS might get involved

with their care unless we really act and and help do some preventative work and so that's really kind of the criteria we look for um they do intensive case management or older adults case managers have smaller case loads uh on-site and in-person psychiatric appointment. So, right now, our nurse and doctor will go to the person's home if that's what they sort of best for the client. Um, they've done that. They go to uh some of the let's say they go to some of the assisted living facilities too and we'll meet folks there as well. Uh, and so nursing case management, our nurse there, Deb is our excellence and that field. Um, and we offer therapy and support. We have a couple clinician and a half that's kind of assigned to this case. Um, so that's that's who they work with. Um, and as I mentioned, coordination with physical care and APS and IHSS. So the older adults program itself actually sits in the APS IHSS office there on. Uh, so yeah. So that's older adults. Uh, excuse me. So, even though he became rich, he would still qualify for that program. Oh, Sam didn't become rich. This this former deputy director of Oh, I see. I see. Sorry, I thought it was funny. Manifesting. Yeah. Okay, next slide. So that's uh that's the programs and I'm happy to take any questions about those programs. Yes. I mean, okay, that is a really good question, Marie. Just wondering um is there any

eligibility for older adults that are going to be on just like income requirement or uh no just yeah usually their behavioral health clients um and what have just those those couple of requirements of being 16 plus having that mental illness diagnosis and then you know there certainly there are folks who are in our regular adult outpatient program that are 60 plus, have a mental illness, but they're not referred to older adults. The older adults is really for those folks who maybe there's some kind of real tricky comorbid physical health thing. But most of the time it is that we're concerned that they're going to lose their housing or they're going to end up in a hospital or APS is going to need to take control over things. And so, um, we kind of look for those more severe cases like that. Yes. When does the innovation funding and the rest? It's coming up, isn't it? Yeah. My question. Oh, sorry. Veron no that was anyway. Yeah. So that the the innovation funding which you know Oliver is not here but I think the the rules on that are going to change a little bit to where I'm not sure how much programming or money we're even getting anymore but you know in in this sort of initial u program outline you know for these programs you have to we had to go to Sacramento well we didn't have to go but we zoomed to Sacramento and you know had to present this innovation program got the funding it's very time limited five

years so I would I would think within a year or so having said that my thought is that BHSA is really focused in on you know housing right and everything that goes with that including supports and so I would imagine that a lot of the work that REST does qualifies already for you know that type of the the the transition right so um they were just continue what they're doing. And yeah, and just to kind of echo that on that thought, Jack, yes, you're 100% right that rest would definitely appear to fit within the housing uh bucket of BHSA. So, we are having some very early discussions around how all of that can be restructured to fit within BHSA. But it does seem that in that that rest would be a good fit. Yeah. I one one other thing just to add to that it's in addition to BHSA we also have some of these services are now being funded by Cal AIM as another funding source so that funding will get braided um so I just want to put it out it is not strictly BHSA for some of these services uh we do have some other funding sources we're waiting to see you know how things change of course going forward but CalaMain will al also offer the full service partnership services to clients. So we do have other funding and a lot of our services like CCT or older adults regional we're billing medical to for the the service. So whatever medical doesn't cover then we say that you have other questions. No, I'm not familiar with the presentation, so I don't have a problem with that. Sorry. How many clients in the older

adults program, Jack? Do you know? There's probably around 50 or so clients in the older adults, some with varying degrees of services, right? So, some might be med support only. They just see Dr. Um but uh some of them get those services. Are they followed into um residential places if they haven't have to go to places like Timber Ridge or other kind of Yeah, they would be. Yeah, as long as they have that for psychiatry and that's they're asking for Dr. Zmers to continue, they would see folks in Timber Bay. Is there a limit people their capacity? Yeah, you know that not a not a black or white limit. You know, we get referrals to the program and the the nurse and supervisor depth and supervisor Mark will kind of the referrals and see, you know, where they could accommodate, you know, a person. If they're meeting, they'll try and bid them. They'll try and get them So, but they like to keep it around that general area. Great presentation. Thank you. Yeah, thank you. That's uh I will admit that I spent some county time AI device together. The next one coming up. Oh, I like kitties. I like cats. Is there any questions um online? Anybody? Would would you please Joe send that

PowerPoint out? That's a keeper. It's a good one. Thanks. We can click out of it. Thank you very much, Jack. You're welcome. So the other thing I'll say just real quick too in terms of my purview and programs right there is that adult system of care that's with behavioral health and then there's a couple other programs APS and IHSS public guardians office and the vets office. So those are all things that are within adult system here with behavioral health. I think we're going to do a presentation soon on public guardian program. So you guys will hear about that. Um but just kind of the way we work at APS and IHSS the veterans is also adults. Great. All righty. Communications is the time when behavioral health board members can share, ask questions, communicate. Oh, I'll start over with Vernon because I'd love to start with Vernon. Okay. Next, we'll go to Kings. Uh Vernon and I were just talking about the brave faces training that Vernon gratefully brought to our community. When was that? The last weekend the 31st, right? And so um it was a I didn't get to participate because I was overwhelmed with the transition in life, but um it I heard really great things about it. So it's a training to teach folks with lived experience how to tell their stories in an effective way to break stigma. And so I know Vernon's really passionate about figuring out how to be able to do that better on an ongoing basis. and breaking up. Uh I don't know if you want to speak

more to what your vision of that would be. Well, I I'm wanting to people with lived experience to tell a story that ends up in a meaningful message to change the way that people are looked at and talked about with mental illness and slack homelessness. And I really believe in this implementation out of out of ready. I went through it about 10 years ago. Um, and it really changed my life in a lot of ways. Uh, the way that I looked at others and the way I looked at myself and my mental, but I'm hoping to be able to implement something similar to that here. um just uh just keep it in your thoughts. Um hopefully we can move forward from from this point forward. So on my from my perspective as a NAMI board member, they also have a training uh that's called share your story with the walkers. So it's specific to CIT. And so it's a requirement of a grant that we hold for to fund uh CIT related stuff. And so I I think mommy will would be happy to partner with Vernon and anybody else that's interested in kind of bringing that to our community. Um and it's it's part of our CIT trainings locally to have lived experience panels. So that would be a great way for us to funnel people into you know doing sharing their stories there. There's also other events in the community where that can be effective. So, um, once I have a little more bandwidth, I'll I'll work with Vernon on that, but if anybody else is interested, please tell

you. Um, yeah. Um, so in thinking about the recovery happens event that's happening in September, I may touch um I think I've already told you that Brendon and I are going to share a table to represent the behavioral health board, but I got a hold of Deanna Bay and she's going to give us some um county program information. But one thing that struck me too and uh probably I should talk to you too dette a little bit about that is that at that event there are always tables from various programs that do substance use disorder services but really not all services are able to be you know have a table. It's you know time and space and all that. So, I was thinking of asking if it would be a good idea to um have the ones that can't table send to either Deanna or to you, Dette, um a uh you know, a a blurb about their program and what kind of SUD services they do so that when people go around and collect things, they really get a more comprehensive picture than just whoever happens to be a link. So, um I'd be happy to help head that up, but uh probably it shouldn't be funneled to either recover. Yeah, that'd be good. Thank you. That's all right. Ra um just uh let's see, communications. Um getting ready getting excited for the SUD conference in um Long Beach. That's August 19th. the 21st. Um, and if you

haven't already, I would uh suggest registering. Um, and the hotels are still available in the block, but they're going quickly. So, if you haven't l got your room, I would suggest doing it um soon. Looking forward to it. Um, I think that's it for communication. The rest we can talk about the SOD. Thanks. Thanks, Bob. Hi everybody. Um got a standown coming up here at the end of September and uh nation scientist received a PBHI grant for global refurbishment uh which and staff become clinician and two other case manager and peer support staff with that grant. So that enables us to go up into the Nether regions. It's got a Starlink up link and so that van is completely capable of doing uh all kind of telecommunications, tele health, uh all that. And it's um we're busy establishing routing um to go up into these places that have been underserved, not served at all. now with some way to be able to provide full service to the popular a better veteran population add to that a little bit. Yeah. So CBI is dotted program and so so far we hired one clinician and the other two clinicians will hopefully start um posted next week that support and outreach specialist and MSU he's talking about for tele health and it will good for 12 weeks or 12

sessions of clinical counseling. So, is it up and running now? Well, we have the MSU, we have the clinician. We're just going to hire the outreach person for support. Still a few weeks. Yeah. So, the MSU is front end, but I mean our far link isn't quite up and running yet. So, we're still um hopefully in the more than July. Okay. Beautiful. Uh mobile service. Well, so big old van you'll see driving around has find us on it. Needs to come to the service fair. Yeah. And we'll be there for How long is the grant been for? It's a three-year grant. That's great. Nice. Awesome. Partnership. Sean, you have nothing. You don't want to talk about how we've been interviewing some of the people. I know just in a little update. So, of the five people that we have to fill the three seats that are still Yeah. We have every two of the executive committees every two week. So hopefully next Alex today so please don't hesitate to interrupt if you need to slow down or be louder. Um so during a meeting of the resilient power across the behavioral health committee of writing advocacy board um some bills came to my attention that may impact mental health services

in the county um in particular SB67 which makes the easier SB25 which include biper one conditions um that would be care act uh requirements so someone can compile to engage in court uh that we're lung there's also SP 331 which includes um alcoholism under the definition of disabled um SB820 which would that um inmates um in prisons may be given antisycotic medications without consent based on 72 hours psychiatric holds that also includes text I think I'll post that one or the other I mentioned but uh stating text saying that um people who um have been indicted misdemeanors would also be able to be given medications and things of that nature without the consent. Um and then ABS6 which would exempt ER doctors from liability permit them to write whole situations. Um a youth advocacy bar has generally not supported some of these bills um because um of lived experience experienced farm from these sort of shifts towards more tariffs to mental health. Um many of us on the board myself included have been medicated without our consent. uh I've had personal experience, not myself, but uh other folks have had personal experience like interacting with folks in the conservatorships. So all that's to say is I'm not an expert in these but um just thinking about how stretched our county resources already are hearing a talk in this room about the impact of conservatorships. Um, if I'm concerned about the impact of those bills, I'm wondering if there's room for us to discuss further or to recommend that the board supervisors be. Joe, did you hear all of the bills that

Alex noted? because if you didn't, I would love for Alex to provide those bill numbers to Sharon and to you so that you can put it in the notes so that um so that Sharon and Nancy can take a look. I wouldn't mind us coming back and speaking about them more if you wanted. I don't know how you agendize things. Maybe that would be the exact Yeah, we can put it on the agenda the executive um future items. And thank you for looking at all of those, Alex. That's also Thank you. Sharon. Oh, Sharon. Hi. Thank you so much. And Alex, that's terrific. Thank you so much for those bill numbers. Um, I recognize a number of them. We are watching them closely. One thing I wanted to offer and it's at at the will of the board of course. Vernon and I have spoken in the past about an ad hoc committee or some some people that are interested in discussing some of these bills. Um, and then the behavioral health board could choose to take a position. And what you are doing essentially is you are choosing a position on a particular bill that you then recommend to the board of supervisors that they take this position and why. And that's and we can assist you with that. Nancy Stark and I can assist you with that process. Um but if it's the will of the board, we can certainly set up an ad hoc meeting to discuss these bills. Um Vernon had another bill that I'm blanking on the number, but we can wrap up some of these others um and do it as a group and come back or whatever you choose, but we certainly are thankful that you are looking at these bills and love to get

your input on them. Thank you. Thank you. Yes, Vernon. Um I'm glad that that that was ad hoc committee was mentioned. I just got Raphael's uh information. We will be making for the next executive committee uh a request to start an ad. Okay. Do you still have the form? I still have a Okay, great. That would be a wonderful do. Yay. Thank you. I'll add all that in favor of being part of that to discuss uh a couple more things as well. acknowledging that I don't know if you organized the issues we see where the L brought these bills to my attention to our attention is a group of us keep an eye on them. Um also y'all might be interested in looking at AB 255 um about supportive recovery residence programs. It would add text to the bill revising it before it said that folks may not be evicted from um recovery programs for relapse. the text like now automatic eviction last Thank you. Thank you. I know it's not like an item on here for discussion right now, but I do think that ad hoc uh process sounds really good and it would be really helpful in future years to do it like pretty like it's it's sort of late in the legislative process right now. Um, and a little bit I I I got a little bit of a cool response from um some some of our legislator staff at like making some comments this week about bills. They're

like, "It's kind of late for us to um to amend." Um, so, so it's just it was helpful for me to realize that like when it's hard to, you know, because now some of these bills have been amended two, three, four times. Um, but they're feeling like their chances to amend them are very slim now. So, it's hard to kind of find that exact ideal time when it's close to they're still willing to receive that input. Um, I just got the feedback that it was late for the things I was asking about. So, um, so it does definitely feel like a like May is sort of the like ideal time to like weigh in if you're seeing changes. So, I just thought that was helpful. Um, we passed our budget this week. Um, and let's see what else. Um definitely keeping an eye on the um the budget because the yesterday or Tuesday the um they reached an agreement on a spending plan for the state budget I should say. Um and so some of the implications of that are starting to roll out. Um I think one of the big ones was that uh formally the HAB program the Can you help me with what that stands for? Housing assistance program. Yeah. Okay. That program was like formally not included but then now it's being included in the trailer bill. Um, so TBD on that and then there were a number of programs that were uh where funding was initially proposed to be taken away and then looks like it's been returned for like the home safe housing disability advocacy a couple other programs and some behavioral health one-time funding for Prop 36 which is great but also

scary because yeah so there was a lot around that I'm sure um their team are tracking that probably more closely than I am, but um it's just interesting to see kind of what that is like. That isn't final yet, but it looks like there's a general agreement on that spending plan. So, um we're closer to knowing what the state funding picture is going to be, which I think is going to be really important. And um beyond that, um I I didn't have a ton to bring today. I uh yeah, I know it was a big hurdle to get to the point of uh having a budget for the county that we could pass that people could live with. And it's not I know it's not easy right now. Um so, um I'm conscious of that and keep showing up. Do you have communication? Um, all I will say is I sent an email out to everybody and need a short little two to three sentence bio. Got your photos taken. I'm going to take yours after we or you or you can send me one. But um for the annual report, we're going to have our faces to the community. So, Yes. And that's all I have right now. So, we'll move on to reports. We have director Beck with us. Yeah. Thank you. Um, I would like to mention that Crossroads

just celebrated their 50 years and um, we recognized them at the board of supervisors meeting on Tuesday. So, that was really wonderful. Thank you, Natalie. Um, for your kind words for them. um West and his team has just worked really hard um recently to just keep up the good work that Crossroads has been doing. So, I'm really happy about that. Um because they they do get to have a new program in Henderson Center. I think you've all heard about that, but and maybe you maybe you're going to talk about that a little bit. I don't know. Um, but good work happening there. I'm really pleased with that. Uh, we uh we were recently I was looking for Nancy. I'm not sure if Nancy is on or not. So, I'm just gonna speak for her. Um, we talked with Nora from Senator McGuire's office. they're doing last minute um uh discussions around one-time funding and um Sorrel Leaf was one that came up and then also the um Mad River Crisis Triage Center if they were short on funding. So, we actually did put a plug in for um funding for Mad River and for Sorrell Leaf. uh Thor Lee contacted uh I think Supervisor Bone and also um Senator Wuire's office around um asking for additional funding and really Nora had referred him to uh Supervisor Bone because it um the funding has to come through the county for um distribution.

So, um that we we may get additional dollars there um through the budget. Um, as Natalie talked about the state budget, you know, we received the May revised information around the state budget and it was really long and um really put us all in made us very nervous about what next steps were going to be even because we we're already reducing FTEES and and our budgets are in a way that that we can't really um think of decreasing any other services. But um so they were really awful and um some of the funding has come back um through their the states process. So it it makes us be happy that there's like going to be additional funding, but it's still bad. Like I was talking with Nancy about it this morning. It's still awful because it's still taking away funding from us, but um but it's better than it was. So, that is good news. um we'll have a state budget approved and then we'll wait to see what happens with the federal budget and then I think that the state will then go back into session to do additional changes um be- because they'll have to based on the federal uh cuts that that we may receive. The hardest part for us in DHS is it's not only DHS services being impacted, but there's so many other services in the community that are being impacted, too, that it's just going to really hurt our community members. We've

built a a really nice system. I feel like we've built a really nice system with our partners to provide every service imaginable to all all people in our community and this is really pulling back all all sorts of things that we worked so hard to to implement. So, um, so much work and just adding the work requirements to federal on the federal side, just adding the work requirements back is going to add so much work to our eligibility and benefit staff because right now they're doing annual um, uh, red determinations. And um and now we'll probably have semianual uh and then all of the ver income verification stuff is going it's just going to be so hard. We're going to lose a lot of folks um through that process. I know um and it'll just it'll end up impacting our health care systems. So um and we're doing everything possible. staff are really looking at all ways that we can um prevent the impacts in the community as much as possible. We've had some very good conversations with our healthc care CEOs about what we can possibly do together to to minimize our systems. So, um I wish I had better news than that. Um, we we've talked about Prop One before. So, we got Prop One. I can't even say enough how wonderful it is that we have we got the prop one for

seer virus but also in our community there's there was another I don't even remember much there's there's like a hundred million dollars almost to our community for services um our native our our tribes got a number of grant prop one grants in addition to uh the 43.5 million that we received for summer virus. So really wonderful stuff and that's all. Thank you. I'll just plug a few for Emmy and then I have a few for my programs. Um we're still uh working on our strategic planning and our racial equity plan and we're working on aligning those um all of that work together. So that's uh continuing. We um across the department we're really focusing our efforts on increasing our direct services uh percentage. So, there's been a lot of work going into that to help improve our budget and uh cash flow and behavioral health. So, we're making progress on that as well to meet our targets. Um I'm not sure if everybody is aware, but uh Kaylee Emory, our children's behavioral health director, um resigned and her last day was yesterday. So, we're pretty sad about that. But Martin Stefon is stepping in as interim for Children's to help out. So, so that's been good. Um, having Martin step into that. Um, and also coming into this cont end of this fiscal year, our contract

completions uh were 100% for behavioral health for this contract go around, which was really good. But it's a huge effort with all of our analysts and programs that are involved in getting those contracts uh completed on time especially um given that we have them in a new system now in laser fish. So it's a little bit uh the process is different but our staff did an amazing job there. Also we have a new patients rights advocate working for health. Her name is Carla Plata Torres. So, um, we would like to give a big thanks to Betty Garfield for filling in for the last year as our patients rights advocate. So, she did an amazing job uh there and we really appreciate her and we're looking forward to Carla standing up uh and uh taking on that role moving forward. Um, so for my programs, uh, QY has been really busy lately. We've had a lot of as as as always, but it seems like now a little bit more so. We've had several audits and uh, surprise visits. Uh, one from um, California Department of Public Health uh, the investigating some allegations um, on SV. All were unfounded. Um and uh also we do have a corrective action plan on that related to our completing of our clinical documentation for staff that are no longer with the county. So we're working on a plan or correction there with uh with CDPH. And we also have a couple other upcoming audits with department of healthc care

services. One is SB's uh site reertification. as a anticipated review that we have with DHCS as well uh as a couple other projects related to our network adequacy and our timely um access to services. So, we're working with DHCS on a couple of those um aspects of the work that we're doing with them, but it's a DHDS has really expanded their personnel over the last during the pandemic and and now they're kind of into their roles now. So, it's a lot more active engagement with counties. So, we're really feeling that now with uh DHCS. Um, shifting gears on that, uh, our Mist team is is 24/7 since, uh, the beginning of the month. So, that's been going uh, smoothly. Uh, and nothing new to report there. That's been going really well. I'm actually pretty pleased with how things have been operating here, but also we have um, the SB43 workg groupoup exterior committee is still uh, uh, happening monthly. I had to cancel last uh month's meeting due to that surprise um review by CDPH, but we're on track for uh this coming month's meeting. And the state just released some more information around LPS designated facilities and some interimm regulations related to SP43. Um, this is kind of the outline of things that current designated facilities would need to do in order to become a SB43 SUV designated facility.

Oh, so uh there are asking for comments on those until um next week I believe. So, uh, we're reviewing that, uh, those regular term regulations now that hopefully will provide some feedback, but those are really interesting, but raised some interesting questions about what that might look like for facilities like center or uh or Crestwoods, MHRC, for instance. So, um, so yeah, that's it. Uh, that's it for me. Would that include like our crisis residential and that kind of placement also or are we just talking about lock facilities? Yeah, we're just talking about lock facilities as a you know for and this is to capture those folks with severe substance use disorder. Yeah. Um detainments for treatment. That's really I'm I'm just really happy to hear that there's going to be somewhere for folks to go because at this point there hasn't been. So if there's a way to I and I don't know how the dual I we we already treat dual diagnosis but and and this is going to be so much different. I'm I'm glad they're trying to put figure out something. That's true. And the the typical things are that they want in place for these designated facilities are uh MAT protocols uh you know in place and what to do with regards to induction and uh or maintenance uh or continuence. Uh those types of um policies and procedures uh need to be in place. Uh so they're

also looking at a 18-month window for programs to apply um for that designation. That would start January 1st when we implement. So 18 months from there we wanted to do that first providers for instance we'd have 18 months to apply for that designation or but you're looking at how if you have more SUV people in than you have less yeah I mean right and you know the crazy yes especially when our current um bed utilization for LTDS population on separ still is hovering almost 60% of of bed availability. So it's still yeah it would definitely uh impact it's going to impact our system. Sure. Kelly, may I ask a question? Of course. I was curious if you have any stats on call volume for miss and like hours and things like that. I mean, just I know you may not have like I don't have specifics, but it's been uh it's been quiet. It's Yeah, just say a Q word. It's uh Well, I've been in crisis long enough and I've said that plenty of times and everything's been okay. So, I think we're uh But that's now it's going to get me. Yeah. Uh yeah, P volume has been um manageable. Good. But uh nothing. In fact, it's been lower than traditionally. I think people know. So, well, we're not out, uh, you know, doing public service announcements and getting ad space uh on billboards or anything uh because we're still under staff. So, the

team of four, including myself, uh is holding it down. So, yeah. Are you dispatching through the crisis? Okay, I'll spread the word for you. Well, I mean the important part is that if people are in crisis, you know, uh then there's another option. Yeah. On that last matter of being designated for SUD stuff too. Is that is that something that all these kind of agencies have to do or just if they want to be designated that way? Right. Just if they want to be designated in that way. It's not a requirement for us. Uh but you know, keep in mind we're in the north state here where there's no other options um you know around our uh in the north state as far as alternatives. I think you know that's been clear in our our workg groupoup steering committee is that we're that gap is still there right and is the county mandated to adopt it at some point? Yeah. So, you don't have a place for them to go, right? The what I'm hearing uh from the director's association work group that I'm in around SP43, the um the a lot of counties um have a very limited number of those designated holds placed. True for us. We're special. Well, I mean, look at the number of conservies we have compared to the other county. I just I do think that there's still a lot of question around

severe substance use diagnosis and how how long we can hold someone after they're clear, right? like what do we do with folks? How how do we hold folks that are not experiencing substance use? Right. Right. Psychosis at this point and want to go back to doing their every that's where the MAT comes in. I think it I I think just having that um outgoing service available is going to be really important. Being able to get into residential treatment directly to get into treatment. Yeah. Well, maybe crossroads expand the or crossroads. Yeah. Maybe there will there will be more residential beds. there's going to be a big gap. So there'll be a lot of purpose. One thing that we talked about in the SP steering committee work group is um establishing clear protocols to these linkages to handoffs uh to uh you know to crossroads or to to Egypt or you know to what we have or to waterfront um and make making sure that everybody's aware of that and knows um how we can make those transition for those that it's appropriate for that fit emergency departments. So that's one thing we had talked about last last November meeting. So I think a lot of the work is going to be focused on that uh in the committee moving forward. So yeah, it's it'll be good uh continuing to have these meetings, collaborating as a as a a community around how we're going to approach this

to meet the needs of of our community. That just made me think. Um, and don't let me forget about this, Paul, but the opioid settlement funding committee approved some funding for a position that will be designated to assist with that referral to a partnership for that bottleneck that we're experiencing currently when to get people the services when when it's needed. It seems like we have a such a delay that it causes people to decide to go about their business instead of getting treatment because it there's such a delay. So, um I think that that could be helpful for SB43 implementation also to make sure that we're because that that was my main ask was just making sure that we're doing something around that bottleneck. It's right now it's pretty bad. That's the biggest complaint that I hear is people can't get into services. Huge huge problem. the session with the week. Thank you. You have anything yet? Uh I don't think not too much beyond what I covered. I I maybe I mentioned this at the exec board meeting, but uh we've done talk about over here is our efforts with Calpaly Humboldt and our intern program there. Um we we're starting to do interviews now for students that have their number and for the best this last year. It's been a really it's really grown this partnership that we have with them and now we're hitting even um counseling psych students uh as well which never

seemed to happen. So we get our those on the LCSW track, those on the LMFT track uh they're they're interning with us and carrying around and applying for our jobs and so few interviews come out and wonderful. It's been a good good deal for us to question. Yay. It's great. Good news. Even though that part of that program is I have to move out of my office so that I can take that. It's all right for the great Oh. All right. Um but I digress. The SUD committee update. Do you have any? So I'm trying it up. So this uh past uh meeting um the committee brought up uh the Noah initiative for Humble County and there's a Dr. Sarah Devito medical director of partnership that's planning on doing a presentation on nitrous oxide which is really exciting. Um uh the board of supervisors voted unanimously in favor of the bill that to ban sales. Um you are stepping on top. Um anyways uh sorry um the international that's actually here international uh overdose awareness day for preparation um planning is going it's August 30th tacos donated from Alves August 31st August 31st I was thinking of my birthday my birthday Um there's a a new detox project on East Creek coming soon. Um we're pretty exciting. I'll let uh I'll talk more

about that. I wanted to talk a little bit a discussion we had in um in this meeting. Um so there's a lot of sober living beds empty right now. Um and uh and in our meeting was it was kind of discussed that um it's because a new life discovered and so um I wanted to share something that uh I think that a lot of people um aren't like a lot of people are being referred to sober living and there's a couple of them that charge more than general relief based. Yeah. Um and so one of them is actually asking for a $500 deposit even though probation or anyway so um so what's and then you know people have to pay that back um at some point when they get a job generally you have to pay back anyways um I just want to share that um I I did talk to um to is there Na at the um county about how we need to let these people know um on both sides that if we're if we're accepting general relief people can't work on it. I mean, they can work, but they, you know, yeah, expect somebody on general relief to pay 500 when they only can have 300 or whatever relief. Um, and so it kind of puts people in a bind to get caught up in a wreck. The other thing is uh the programs that actually offer food with their um with like food life they off they get three

meals a day well immediately their food stamps get discontinued. Um so like I think it's important that if we work with with people we are going to pause this meeting right