Veterans Affairs Commission - Regular Meeting

The compute computers are down.

You can hear us?

I can hear you guys just fine. Thank you.

Okay.

So I have this here.

Connected.

Yeah. Connected, but it's still having problems with the computer.

We're fine. I

we're the able to okay. So they are muted right now. Right? Mhmm. Okay. Let me just rename them. I'm unmuted. See. It's second meeting. I've already checked the school. You already checked them? They're unmuted. Okay. I need to remain. Okay.

Okay. I'm gonna convene the meeting. Okay. Good. We're gonna move forward. And before we do roll, we'll have Steph read the

Gonna test my mic first, and there we go. Alright. Before the roll call, I will announce that today's meeting is being recorded and will be posted on the board of supervisors website in conjunction with the meeting minutes. Commissioner Abram?

Present.

Commissioner Santiago? Here. Commissioner Clever? Here. Supervisor Ferrero?

Here.

Commissioner Santana? Here. Commissioner Smith? Here.

Very good. We'll nay we'll move on to the adoption of the agenda and approval of consent calendar. Are there any commissioner comments related to the agenda in this consent calendar? I have none. I see none. Therefore, we'll move on to public comment. Any public comment?

Lost place. One moment. None. So public comment is now being accepted on items on the consent calendar. Comments are limited to three minutes per person. Please voluntarily state your name for the record. One online participants who would like to make a comment, press the raise hand button. Phone participants, press 9. If you're in here in person, please raise your hand. We have one online.

Yeah. Amy Eldorado, you can unmute yourself and state your comment.

Okay. So I'm not sure if this pertains to the consent calendar or later. I mean, I'm not sure. But, so consent calendar is just, like, approving the minutes and all that, or is it for the whole agenda?

So items on the consent calendar, can be seen on the agenda itself. It is for the commission to recommend the approval of the meeting minutes as well as any action on the Alright.

I withdraw my time in for now. Thank you. Sorry.

Any other comments? We're we're set, Meredith.

I see none on-site and no more online.

Very good. So we'll now, bring this item to a vote.

I'll move for adoption of the, approval of the consent calendar.

You just

Commissioner Abram? Yes. Commissioner Santiago? Aye. Commissioner Clever? Aye. Supervisor Ferrero? Aye. Commissioner Santana? Aye. Commissioner Smith?

Aye. Very good. That we've approved the agenda and the consent calendar, and so we can move on now to public comments for items not on the agenda. Open forum, basically.

Public comments on any item not on the agenda is now being accepted. Comments are limited to three minutes per person. Please voluntarily state your name for the record. Online participants who would like to make a comment, press the raise hand button. Phone participants, press 9. If you're here in person, please raise your hand. And I do have one online from Naomi Eldorado. You can unmute yourself and state your comment.

Okay. Thank you. My name is Diane Rabinowitz, and I am the president of NAMI Eldorado County. And my statement has to do with avoidable tragedy. And I have, I'm making a statement, and there is a request attached to it.

And it has to do with the, mobile crisis calls. And this is in honor of Glen Reed for whom we are holding a memorial at the clubhouse tomorrow at noon. I noticed that the number of MCT calls dispatched is 36 out of 286 calls, which is 13%. So I questioned I had a question about the criteria by which it's decided that, to dispatch the team, the MCT, and I found a document online. Also, I was supplied this document by the director of behavioral health.

And, I found that there's a section on page five which asks whether the person in crisis is under the influence of any substances or alcohol. And when this when the call was made for MCT, this person was in the process of drinking himself into alcohol poisoning. I meant I specified that as the reason for my call, and I said that there was, there was, an incident a couple of months ago by which the person did poison himself. And because, we got him to the emergency room in time, he was saved. He was not put into the the crisis recovery center at that time, which is what our goal was.

But instead, we fortified our supports for him at the clubhouse with sponsors at AA. He was going to meetings. He was doing very well. He was helpful on the property here, and he relapsed. So, I was told by the dispatcher that he, that the the call the MCT would not be dispatched.

I was recommended to call 911, the sheriff department. I called them. They wouldn't help. So I took him to the the emergency room by myself. And because he wasn't mandated to be there, he walked, and he was found dead several days later, from alcohol poisoning.

So my request to you guys is behavioral health behavioral health department is that there be a review of how this criteria is applied and that, the the dispatchers pay a little bit more attention to the content of the request. If you if we are to strengthen the the connection between family members and, behavioral health, I think we need to, strengthen the belief, the validity, the belief coming from the dispatcher side in what the callers

Diane, I'm I'm sorry to interrupt. We are listening. Our timer did not show on our screen. I did keep time, and that has been three minutes.

Okay. Thank

you for your comment.

You've heard my request. I want a review of, you know, sort of a postmortem after the all the calls are made.

If you'd like to send any additional information

I will do that.

For staff, then we'll accept it. Thank you. Mhmm.

Alright. Any other open forum comments?

No comments online or on-site.

K. Moving along then. We're gonna go to our next agenda item. And the next agenda item number three is nominating committee to present the 2026 slate of officers for the behavioral health commission, election of chair, Westslope vice chair, South Lake Tahoe vice chair and secretary for 2026. Commission to receive review, discuss, and take action as appropriate. I'm gonna turn this over to our ad hoc member committee member, commissioner Santiago, to present the slate.

Thank you, mister chair. On behalf of the nominating committee, it is my honor to present the following nominees to serve as officers for the Behavioral Health Commission for 2026. Chair, Jim Abrams. Vice Chair, West Slope. We have two nominees, Deanna Santana and Steve Clavier.

Vice Chair, South Lake Tahoe, Norma Santiago. Secretary, Kieran Smith. Mister Chair, if there are no further nominations for Chair, Vice Chair, South Lake Tahoe, and secretary. I would move those nominees be duly elected to the offices for which they were, nominated by unanimous set consent. So at this time, I would ask if there are any further nominations from the floor for chair, vice chair, South Lake Tahoe, and secretary.

There being none

I'm sorry? Here.

Okay. There being none, I move that the nominees for chair, Jim Abram Vice chair Southlake Tahoe Norma Santiago and secretary, Karen Smith be duly elected by unanimous consent. I'll need a second.

I'll second.

Norma, I believe we will take the vote for the West Slope vice chair before we move and approve the slate as a whole.

Okay. Alright. Now moving on to the election of vice chair and, for West Slope. We have the two nominees, Deanna Santana and Steve Claver. I believe you guys were given a piece of paper to to indicate who you would vote for. Is that correct?

Correct. All commissioners have an envelope with a pen and a piece of paper to be able to write in your votes. Commissioner Santiago, if you have the ability to email us at bhadmin@edcgov.us, then we will be able to tell your vote.

Okay. Tell me again say that again for me, please?

Bhadmin@edcgov.us.

Bhadmin@edcgov.

And I can actually just go ahead and email you from that so then you can respond right back.

Okay. I will wait for your email.

Once you finish, you can, put your ballot in, and staff will collect it to count it.

I have yet to receive your email.

Oh, we put it back in the envelope. You need them all or just one?

Let me make sure it's sent.

There we go.

While staff count, we do feel that this is the appropriate time to bring this to, public comment before con continued commissioner discussion.

Okay. Public comment?

Comments are limited to three minutes per person. Please voluntarily state your name for the record. Online participants who would like to make a comment, press should press the raise hand button. Phone participants, press 9. If you're here in person, please raise your hand. I see none on-site and none online.

Very good. So, everybody, you've got all our envelopes, and do you have Norma's? Okay. So go ahead and tally them for us. And yes.

So on the ballots, we do have four to two to Deanna Santana.

So Deanna Thank you. Or

Deanna has been elected.

Elected. Very good. Thank you.

Thank you. So I would it's my pleasure then to, present for your consideration the following, officers for the following individuals, for the officers as officers for the Behavioral Health Commission in 2026. Chair will be Jim Abram, vice chair West Slope, Deanna Santana, vice chair, South Lake Tahoe, Norma Santiago, secretary, Kieran Smith.

Very good. So I guess this is there any further action on this item?

Yes. We will need a motion and a second for the commission to vote as a whole and move these the slate forward.

K. Somebody wanna make I'll move that.

Second. Commissioner Abram?

Yes.

Commissioner Santiago? Aye. Commissioner Clever?

Aye.

Commissioner or supervisor Ferrero? Aye. Commissioner Santana?

Aye.

Commissioner Smith?

Aye. Very good. Everyone.

Thank you, Norma, for handling this this item. Next item on our agenda is ad hoc committee for engagement with the Behavioral Health Service Act 2025 committee and plat process, CPP, to provide an update on the activities to date. So I wanna thank Meredith for providing some updated information to me. I'm gonna share that quickly. So there's different categories that the meetings, the CPP meetings are following.

And one is a stakeholder meetings, and that was those are specific current or interested collaborative partners. There's open forums, which are still which are available to networks of collaborative partners who chose to host. Then there's focus groups that are going to be occurring and have not yet occurred according to this information I received. There were three meetings that were stakeholder meetings, and the attendance for those three meetings was seven. There was eight open forum meetings, and the attendance for the open forum meetings were a 142.

There is still seven focus group to come in the month of December if everything proceeds as expected. I, myself, attended two meetings, and they were one before our commission meeting on the September 17, and I attended another one on October in October 2. And then I believe commissioner Cavare, you attended a couple?

I attended one. Yes.

One. Yes.

At the clubhouse.

At the clubhouse. So and then I believe commissioner Santiago attended one. Is that correct?

Yeah. That I attended the one before our last before the September 17 one is the one I attended.

I attended too.

You attend and

I attended too.

Okay. And commissioner Santana attended too. So the commission has been actively upholding their duty, which is to ensure stakeholder and citizen involvement in the CCP planning process. So it was interesting that the meetings that I attended, there was different groups of people with different areas of concerns and wondering what was going on. And I imagine every one of those meetings that's been held so far, different ideas and and concerns were expressed. So that's really all I got today an update that it looks like things are going along, and there's gonna be some more coming.

And the stakeholders that we do have listed, that all of this information will be in our integrated plan when we release it in the new calendar year, But we are still developing the full list of stakeholders. So when you have the count of of seven, that doesn't include meetings that are held by our executive team that are also in collaboration towards the future of behavioral health and how we document it in the integrated plan. So we're still gathering those details, because we have been meeting with, the different partners that are required by law, but also benefit our system of care as a whole.

Alright. Well, thank you for that additional information. I guess we should any other commission ask for any other commissioner comments?

I have a question, mister chair, if I may.

Yes.

Because my notes are so scribbly and I can't make heads or tails of what I wrote, can we kind of if can we please be provided a timeline with regards to these, you know, the the shareholder meetings, the open forums, the focus groups, and how that is integrated into everything that we are we are having to do in January and February?

So we we are focusing on what is required. You know, we we provided the ad hoc some information so then they can continue to work through their charge. The the information is still being gathered for the requirements in the integrated plan. So we are trying to navigate a new system, new information, and the process we are doing to to move forward with it. So we we will have more information coming in January ahead of the the first public release of the draft integrated plan, but we don't have any other information at this time.

We did provide a printed copy of a BHSA announcement with the focus groups, the Zoom links to attend virtually, and addresses to attend in person. And those will also be distributed on our website and to our current, distribution lists, including GovDelivery. If you're not already signed up to receive those, you can go online to do that or email bhadmin@edcgov.us.

And so the draft, the draft plan, you hope to have that, for public comment at the January, Meredith?

Either January, February so that we have ample time to be able to have that thirty day public comment prior to the intended March public hearing before this commission.

Thank you very much.

Very good. Any, public comment on this item?

Comments are limited to three minutes per person. Please voluntarily state your name for the record. Online participants who would like to make a comment should press the raise hand button. Phone participants, press 9. If you're here in person, please raise your hand. I see none on-site and none online.

Any further commission or comment? I see none. Therefore, we can move on to our next agenda item, which is agenda item number five, which is a presentation by the Eldorado County Behavioral Health Department staff and contracted providers on children, especially mental health services in Eldorado County, commissioned to receive review discussion, take action as appropriate, we can move forward with the presentation.

Alrighty. I'm gonna stay in my chair for this one.

Well,

this has been long awaited to have our providers here to do a little provider spotlight. So I'm just going to give a quick overview from the perspective of El Dorado County Behavioral Health about how we roll out and how we implement the requirements of children's specialty mental health services here in Eldorado County. And then we're going to give the floor each of our providers will have five minutes to come up and share their own presentation and talk about their specialty mental health services and the unique things that make each of our providers special. So I'm going to quickly go over what specialty mental health services are, who qualifies, how children in our community can access these services, how we provide them here in El Dorado County, and the role of our partner agencies, and what's next on the horizon for children's specialty mental health services. We talk about this a lot here, specialty mental health services.

So what exactly are specialty mental health services? So when we're looking at the continuum of services and level of intensity of care and need, we're really looking at the most severe needs for youth in our community. So these youth generally need more than just brief counseling. They're experiencing more than just what might be an acute stressor. They're having ongoing behavioral issues, emotional disturbance that's impacting their functioning in the home, in the school, in the community setting, with friends for something that's lasting an extended amount of time and hasn't been alleviated with more mild to moderate services.

This can also be the experience of trauma or complex trauma, family conflict, and crises that are, again, impacting their daily functioning. Within our services, we're really looking at the whole child approach and whole family approach. So these services are meant to really bring in a family and provide comprehensive services to help support the child and family in overcoming some of these challenges. The goal is really to help the children within our community integrate back into going to school, having hobbies, being with their family, and not have constant stressors due to mental health challenges. So who qualifies specifically for specialty mental health services?

Our youth that are age zero to 21, generally, we are looking at serving youth that have Medi Cal coverage. They are those who are experiencing significant emotional, behavioral, or psychiatric challenges. And there is a fast track into services for youth who are involved with child welfare or probation and those who are experiencing homelessness. So there are lots of different referral pathways into specialty mental health services, especially for youth. You know, our children are kind of out and about during the day at school, at sports, with church, school counselors.

So there's all kinds of different referral pathways. Most commonly, we do receive referrals directly from families. We also do receive referrals from our managed care partners. So sometimes a youth might be being seen at a managed care plan for more mild to moderate services, and sometimes their treating provider will elevate it to the specialty mental health service level and say they're really needing more intensive services to help stabilize them. We partner closely with child welfare, with probation, with school counselors.

We also do receive referrals from hospitals. So if a youth is placed in a psychiatric hospital, we receive direct referrals from those hospitals and also from our mobile crisis team. So the core set of services that are provided through outpatient specialty mental health services are individual and group therapy, individual and group rehabilitation, which is really looking at activities of daily living, so helping teach basic kind of functional skills for a child to go about or youth to go about their day, medication support services, case management, crisis intervention, and then two specialized services, which are called intensive home based services and intensive care coordination, which are reserved for some of our highest needs youth who touch on multiple different systems. And these services are meant to help really meet the child and family where they're at to help stabilize them. Then looking at residential placements, we have short term residential placement, STRTPs.

So Eldorado County Behavioral Health is responsible for arranging and paying for specialty mental health services when an Eldorado County youth is placed at an STRTP out of the county when and so probation and child welfare are able to place a youth at one of these higher levels of care if their care cannot be met in a home like setting. And so in those cases, we look to contract with other counties, behavioral health departments, or with the SCRTP themselves to ensure that our youth are receiving that high quality of care when they're placed outside of the county. And we have a contract with our in county SCRTP provider when youth are placed locally. And then just to briefly go over our network of care, we have all of our outpatient providers. They're here in our audience, and we'll get to hear from them soon.

So we have New Morning, Sierra Child and Family Services, Stanford Sierra, and Summit View. The primary providers of psychiatric medication support services is El Dorado County Behavioral Health. So our medical director, Doctor. Robert Price, provides the bulk of the medication services for our youth, and then Summit View also has, a staff psychiatrist to provide medication support to our youth. For acute crisis services, we have the El Dorado County mobile crisis team, which we've discussed.

Right? So they go out in the field. If there is a youth having a crisis, they'll go meet them in the field where they're at. We have a contract with a partner, Sierra Mental Wellness Group, who also provides mobile crisis services. And then we have El Dorado County behavioral health psychiatric emergency services staff who work in the emergency department of both Marshall and Barton Hospital to conduct 5,150 assessments when youth are brought in on a hold.

And then when a youth needs a higher level of acute care at an inpatient psychiatric location, we do need to use out of county inpatient hospitals because we do not have one in county that serves youth under the age of 18. The general funding sources are Medi Cal. So we have a contract with DHCS, the Department of Health Care Services, to provide these services. And then we send invoices and claims up to Medi Cal to receive reimbursement as at a state and federal match based on published rates from the Department of Health Care Services for to reimburse for the services. We also use realignment to cover the county match of those funds that are not covered by the Medi Cal drawdown.

And then we do utilize MHSA to fill in gaps for services like the full service partnership programming. And then looking ahead at specialty mental health services, there's lots of things coming down from the state in terms of programming that has never been so granularly defined for us in terms of how we have to provide services. So the state has a really large push for us to start really focusing on evidence based practices that they have ascertained are going to be the most beneficial for youth in the state. And so they have designated a few different evidence based practices that counties must start implementing and will become Medi Cal entitlements. So one of them is parent child interaction therapy.

There is multi systemic therapy, functional family therapy, and then high fidelity wraparound, which we're partnering very closely with our counterparts in child welfare and probation in order to come up with a really solid wraparound plan of how we're gonna work together to ensure that when a youth is stepping down from one of those residential programs that they're receiving a really high level of wraparound services to stabilize them in the home and also for other really high acuity youth that we want to prevent from going into a higher level of care, they're going to qualify for that high fidelity wraparound programming. And I'm happy that all of our providers out here are working on having these high fidelity programs. We're also going to be working with the Office of Education in order to ensure that our vendors can access the specialty mental health service clients that they're serving on campus during the school day. Specialty mental health services are dynamic in that they can be provided any time, any place. We're really trying to remove barriers to care and meet families where they're at, where behaviors are happening, and where we're going to get the most bang for our buck is meeting the kiddos where they're at.

And then we are also working on supporting and building out certified peers at our vendors. So a newer service that's allowed by the Department of Health Care Services are certified peer supports. And so those are folks with lived experience who've gone through a certification course, and they can help walk, whether they were a youth with lived experience or a family member with lived experience who might have had a child go through the same system, can really help partner with families and walk alongside them as they navigate their journey within specialty mental health services. So again, when we look ahead in the coming months and years, this is really our focus, is looking at how do we gain fidelity with these new programs, and how do we take advantage of these new opportunities to serve in really comprehensive ways through our specialty mental health services. So that is my little spiel about the basic overview of specialty mental health services.

Now, we're going to have each of our providers come up for their time to discuss what happens within each of their agencies. And I believe we're gonna hold questions until the end.

We are?

Well That was the plan.

The reason I'm asking you is is when you've given your presentation, things have come to mind. And once each Do wanna just cut to presentation happens.

We are able to adapt. Okay. We will hold public comments.

For it.

We will hold public comments until the end when all presentations

are complete. Comment to the end. But as we go through these presentations, I think it would be a good idea to be able to ask a couple of questions about each presentation. Otherwise, it's all gonna get

Jumbled.

In a big, muddy mess if we try to do it all at the same time. So my question

Yes.

Is on page 11 of your slide.

Mhmm.

And it is and I'm I'm wondering this statement. Support vendors being able to access their specialty mental health service clients on school campuses. How is that gonna occur? What how is that gonna work at the school?

So I'm not an expert in this. So it sounds like there needs to be agreements in place with different schools in order to have these vendors come on campus in order to protect privacy of the clients. And so because we are not the because Eldorado County Behavioral Health is not the one actually providing the services, we're just trying to support the conversations happening so that the vendors are able to to go to the schools and will be allowed on the campus to access seeing those kiddos on campus.

So who have you are the vendors already selected?

Oh, no. It's all of them.

All of them.

Yeah. So it would be all of the vendors that are able so they all have kids that go to Yeah. Every different school. Right? So it would be allowing them to be able to go to wherever whichever school their kiddo is at at the appropriate time and designated place.

Okay. I was just wondering how that that was my one and only question.

Got it.

Wondering how it was gonna work. Okay. Any other commissioner questions on this part of the presentation?

I do have one question. Could you enlighten us as to the number of out of county clients we may have?

Are you speaking about our kiddos that go out of county to an STRTP?

Yes, exactly.

Oh, I don't know off the top of my head, but I could get that number to you.

I'm just curious as to I know that the reason they're going out of county is we don't have it that that we don't have a space or a place for which to take care of them within the county, and I was just wondering how it how it is out of the count how much it is how much how many excuse me. I'm so sorry. I haven't

I hear you. I get I get what you're putting down, Norma.

Yeah. Okay.

I it's just nice to

have that information because I know that there's a cost associated with that for the department. And and so I just want to make sure as we start looking at our budgets in the future, how that impacts our overall budget.

So the cost for the behavioral health division is solely the cost of the specialty mental health services, which would not differ than wouldn't differ greatly than if they were in county receiving specialty mental health services. The bulk of the cost of having a youth placed at a higher level of care falls to the placing agency, whether that's child welfare or probation. In recent years, there have been a number of measures put in place to ensure that there are safeguards around placing youth in that higher level of care. So one of them is an interdisciplinary placement committee in which there are members of child welfare, probation, behavioral health, altar regional, office of education. We have folks from SARBoard there.

We have McKinney Vento. All talk about youth before they're even considered for a higher level of care. We're we're really trying to stabilize at home. We don't wanna send kiddos to a higher level of care unless it's really necessary. And then there was another intervention put in place to really have a second set of eyes before placing an agent can place, which is under Families First Prevention Services Act.

There is a person within behavioral health or multiple people who is called a qualified individual who has to take a number of trainings this is a clinician who has to do a number of trainings in order to conduct an assessment, a thorough assessment of the situation before they are approved to even look at placing at an SCRTP. So that that so there's a lot of safeguards in place. The numbers have dropped tremendously over time, but I can work with my partners in trying to get together a rough number. It's at any given point in time, it's less than 10. I it's probably five right now, if even.

And that's probably

very much. Thank you.

Kieran, I saw your hand up.

I was just curious. What's the difference between outpatient and inpatient services?

Oh, good question. So outpatient is if someone is, like, going to therapy one time a week. So you're you're still kinda living your life, going about doing things. Inpatient means generally that you're in a locked facility. So if someone is in acute crisis, so if they are gravely disabled, like they can't care for themselves or they are a danger to themselves or if they're a danger to others based on a mental health need, then they're gonna be placed at a higher level of care, like in a in a hospital where they're having twenty four seven monitoring, where they will be receiving intensive supports throughout a day, and they don't go home until they're no longer meeting criteria for that higher level of care. Awesome. Does that help explain

it? Yes.

Okay. And then also for the certified, so it says support building out certified peers at vendors on slide 11, and those are, like, people who have lived experience.

Correct.

Are those people who are related to the patient and are, like, getting that certification, or are they the clinician?

No. So it would be an employee of the agency. So it would be a person that's identified as having lived experience, and then they go through a certification course. We actually have a contract with an entity so that people can go through that. And the state of California actually put out a free path to do this because they're really seeing the value in having this. So it wouldn't be that my sister has lived experience, and she's going to become a peer and support me. It would be who's an employee of the agency who would then provide services.

Okay. Thank you. Mhmm.

Good question.

Any other questions from the commission? Very good. We can move on to our next presenter. Looks like that's New Morning.

So presenters, I will let you know we are gonna try to have the that countdown timer show on the screen. If it doesn't, we will hold up one hand at thirty seconds left and two hands when your time is complete. Thank you. Hi. I'm Carrie Thomas.

I'm Carrie Thomas. I'm director of administration for New Morning Youth and Family Services. Nice to be here. I'll tell you a little bit about New Morning. Since 1970, New Morning Youth and Family Services has been helping children, teens, and families in Eldorado County find safety, stability, and hope.

As a nonprofit organization, we provide counseling, crisis intervention, case management, and emergency shelter services to youth in need. Our dedicated team uses trauma informed care to help young people heal from abuse, neglect, and other challenges. This is our New Morning funding. So where it says state grants, that is our OES grants that we have for kiddos who've experienced any type of abuse or maltreatment. We have MHSA, which is our Latino outreach and our stigma reduction program.

We have fee for services, which is the Medi Cal program. So that's Straight Medi Cal, Anthem, and Mountain Valley. Those are the programs that or the managed health care plans that we provide services for. We have local grants such as EDOC, EDC, EDCO, and El Dorado Union High School District. And then our federal grants is for youth shelter.

Services provided by with provided with specialty mental health services. We offer, FSP traditional ICC and IHBS. That stands for intensive care coordinating and in home behavioral special services. Evidence based practices and certifications. Currently, we, utilize wraparound and motivational interviewing, wraparound working towards Certification and High Fidelity Wrap, PCIT, EMDR, and Motivational Interviewing.

Commission on Accreditation of Rehabilitation Facilities, CARF. We have been accredited since 2019 and currently through 2028. Specialized staff and roles, in addition to specialty mental health services and traditional, counseling services, we also have victim advocates. We have promotoras who help our Latino families, access resources in our community. We have family specialists who work with our kiddos who are specialty mental health service kids.

They help provide help attaining their goals that are set in place by the therapists. We also have youth behavioral specialists. Those are our YBS folks that work at the shelter to help our kiddos at the shelter. And then we have our clinical staff as well. Outcomes and impact.

So, our last fiscal year, we had 76 specialty mental health service clients. And then we have a success story here, it looks like. So at so we're gonna use the name John, which is a fictitious name. Shelter youth John had experienced significant housing instability leading to a stay at the Ashby House, which is our children's shelter the emergency youth shelter. During his stay, staff became concerned about his mental mental state and was provided specialty mental health services.

As he worked with his specialty mental health team, he began experiencing hallucinations. When it came clear that inpatient treatment was needed, the shelter team was concerned about safety and requested support from El Dorado County Behavioral Health Mobile Crisis Team to avoid a law enforcement response. The Mobile Crisis Team responded to the shelter to support our specialty mental health service team and coordinated transportation to the emergency room. John was admitted to an inpatient treatment to get the care that he needed. And that is it.

Good. Let me move on to the next presentation. Wonder if we got Sierra Child and Family.

Mister chair, I can't hear you.

Sierra Child and Family Services.

Mister chair?

Yes.

I had a question for New Morning. It's a quick one. I promise.

Oh, okay. Sorry. I guess I'll just leave my mic on all the time.

Yes.

Carrie?

Yes. I'm here.

Okay. Great. In your, your New Morning funding, you have MHSA at 19.2%, and you said that was, mostly for Latino outreach and Community stigma reduction. Yes. Yes. With the changes that are coming with BHSA, do you see some impact in being able to still provide those services?

That's what we're worried about, and that's why we are hosting a forum a focus group on the cultural aspect of this, the b h

BHSA integrated plan.

Thank you. So, yes, we are worried about that. We have a lot of clients in El Dorado County who utilize this program. We also partner with, South Lake Tahoe, with one of the agencies up there. So we do provide a lot of services.

And this is specifically for that demographic. Right?

Latino outreaches. Yes. Community stigma reduction, we have, that is our LGBTQ, support group. It's a youth led support group. We also have, community basketball.

Carrie, do you mind if I actually interrupt? Yes. So we are looking for this presentation to be focused on specialty mental health services. We know that our providers have a wide range of projects that they support, both funded by Eldorado County Behavioral Health and otherwise. So we want to do want to try to keep our our questions within that realm of specialty mental health services, and then we'll have other opportunities to have different discussions at a later date.

Okay. Thank

you. Well,

thank you. Thank you, Norma.

Thank you, Carrie. Thank you very much.

Now, mister Harwell.

Hi. I'm Barry Harwell, Sierra Child and Family Services. Sierra Child and Family Services was founded in 1988. We had, several programs during that time, which have all now been retired. Our mental health services began following the passage of s b one sixty three in 1997.

SB one sixty three started a program called the wraparound services. And in 2000, we approached El Dorado County Behavioral Health and said, hey. We'd like to explore starting a wraparound services program in El Dorado County. And after, some hemming and hawing, El Dorado County agreed to, contract with us to provide wraparound services, and we began a program, in partnership with El Dorado County, which evolved into the program we now provide. During that time, we went to, you know, develop that program with Eldorado County.

It was kind of a different time then. We went to a lot of conferences together, and we actually, because Eldorado County staff still had serve provided services at that time, we had lots of teams together. It was a really, interesting program back then, but those programs evolved. Currently, we provide foster care, adoptions, school based mental health pro programs, and especially mental health services. All of those programs interact together, so it's hard to separate out, especially mental health services from those programs because they're all integrated.

So I mentioned them here and as our overall agency overview. I was unaware this was a rigidly timed five minute program, so, I will just skip over all of these specialty mental health services. These are all in our contract. All programs, provide the same services. They are all in our and Justine already covered these.

They're all in our contracts. These are all standard specialty mental health services, for Medi Cal. Evidence based practices and certifications, we are certified by the, accredited by the Commission on Accreditation, COA. We have 42 clinicians practicing across three counties, including both slopes of Bellerada County. I didn't survey those 42 clinicians to see what, evidence based practices they are all, utilizing, but I think you'll find all four providers are use utilizing similar evidence based practices specific to El Dorado County contracts.

We do use motivational interviewing. We selected that mostly because of the countywide comprehensive prevention plan that we've been working on in with El Dorado County for the past two or three years. Deanna is shaking her head. She's been on that that work group. DBT, we have a contract with El Dorado County.

It's something that we use in all of our programs, and we have a contract specific to teach high school kids DBT skills. So thousands of kids over the past six years have been learning DBT skills, and we use that in our specialty mental health services program, of course. EDAPT is a coordinated specialty care, plan, program for first episode psychosis. We use that. It's integrated into our specialty mental health services plan and also into our first episode psychosis, contract that we use on with Eldorado County for, 14 24 year olds.

We also use the Incredible Youth parenting program. That's something that we, use to do parenting classes with our specialty mental health services clients. And then as all of us providers are are integrating, and Justine mentioned functional family therapy, multisystemic therapy, high fidelity wraparound, those are new, requirements coming down for for, specialty mental health services and FFPS. We are also integrating parents as teachers, and we're gonna be using that for some of our EDCOE programs and probably working that into our specialty mental health services as well. As far as outcomes and impact, I focus more about some of our overall impact in the community.

We've collaborated with Eldorado County Behavioral Health to create wraparound services in 2000. I think this was a huge step just in the history of our county to it moved community based services and community based organizations forward in the community. We were the first provider to actually, to contract out services in the county, and it created, you know, what became now the the focus. You know, county behavioral health does not provide services. It's all community based organizations. We introduced the cans to elder county behavioral health. We were the first organization to embrace the cans, and I does that mean two minutes or one minute, or what does that mean?

Now we're at thirteen seconds. We had a timeline established for the event. K. We had a timeline established for both the event.

Read the rest. We've done a lot, and that's it.

Thank you, Barry.

Are there any questions?

Wow. That was so fast. It's

Yeah. It's, I thought that five minutes was a general guideline. I didn't know it was a rigidly timed presentation. Usually, when we present to the commission, we get up and we have a presentation, and it's not it's not like public comment. It's a presentation of our but I guess tonight's different. Sorry about that commission. I should have

been I should have been more have any questions

at this question? What what is cans?

Think is the it's children adolescent needs and strengths battery.

Okay.

And we use it as we're assessing children. It's 62 questions that you ask, and it stress addresses needs and strengths of kids, and we use it for specialty mental health services.

Tool. Okay.

Yeah. Thank you. It's an assessment tool. So I got one And if if I may elaborate just a little bit more on that, Greg. I'm sorry. We, were the first organization in this county, and we we sent people to be trained. And then we trained all the behavioral health staff in the county on how to administer the cans. There was a certification process. And so when we brought it to the county, we talked to county behavioral health leadership, and we said, hey. We wanna use this tool. It wasn't required at that time. And so we partnered with behavioral health, and we said, we will train all of your staff. And so we trained all the there were, like, 50 people at that time. We trained all of the staff. We rented the fire hall. It was really a cool experience.

So Is this like a state, standard?

It is now. It wasn't at the time.

Okay.

It wasn't at the time. It was a new tool at the time. Thank you. Yeah.

I had a question on page I guess it's page four of your presentation. Yeah. Go ahead, Jim. Evidence evidence based practices and certification. So your evidence based practices, are these things that you foresee continuing in the in the future years?

Yes. Of course.

Okay. Yes, sir. Very good. Wanna just check.

Of the ones that we we listed there are are the new the the, functional family therapy, multisystemic therapy. Those are things that are being developed in California. There's a new, they're called centers for excellence that we will be working with. And throughout California, and Justine touched on this, every provider in the state has to become, kind of recertified, let's say, to use these. A a lot of people use functional family therapy. This is kind of like a California version of that. And so we have to go back to, to the drawing board a little bit, and and that's still a work in progress state one.

K. Well, thank you Yeah. For your presentation. I know it was quick. And

Yeah. I appreciate it. My apologies, for not being more prepared to fit all of that into five minutes.

That's alright. So we're moving on to the next presenter. Who do we have next?

Next is Summit View.

Summit View. Okay. Moving on to Summit View.

And and commission and presenters, will let you know. I do not intend to interrupt and stop the presentation. It is more of a guide to let you know the timing that we're trying to keep to for our agenda. Okay. Sasan? Yes. It is.

Okay. Hi. I'm Anna Gleason. I'm the CEO at Summit View at thirty one years there. This is Jess Schnetz, and she's our chief program officer.

So, in the interest of time, so our agency began in 1993 as a youth residential program and one nonpublic school classroom. Our current headquarters are in El Dorado Hills in the Business Park, and that also includes our nonpublic school site. We have a satellite office in Placerville, and we have currently 14 wellness centers on middle and elementary school campuses. Our youth residential program, is our in county short term residential therapeutic program, and we have, two houses, soon to be three. We have two group homes as well, and one of those will be switching over to another STRTP, which will give a total of 18 local county beds for STRTPs.

Nonpublic school, it we have three classrooms, including, a newly opened day student classroom for elementary age students, needing, restrictive, settings. We also have an adult residential program. Where am I? Okay. Services provided through specialty mental health. I think as, Barry did, I'll just skip through that slide. One more slide.

Am I our slide or your slide?

Are you our slide? Sorry.

I I am your slide, and your time is now showing. Thank you.

Oh, I thought you were gonna say my hard time is up. Okay.

Yeah. You're So, anyway, there there are the list, and we also do crisis intervention, as well, but I won't go into all those since, they've been expanded upon already. Our evidence based practices and certifications, our services are, we use an integrative approach to services. We primarily use DBT, CBT, motivational interviewing, and ACT. We have clinicians as well trained in EMDR and PC care, parent child care.

Our accreditations are our Council on Accreditation, which is now Social Current, so COA. And then we have our school accredited as well through the National Commission for the Accreditation of Special Education Services. Certifications would be California Department of Education, which oversees our nonpublic school. Looking toward the future, we're pursuing certification for high fidelity wrap, as well as TBS. We're planning to add, functional family therapy to our evidence based services.

And programmatically, we are looking into, Drugmedical organized delivery system, contract in addition to postvention services. We'll see how much we get through, but that is our, a bit of our focus right now. I also just quickly wanted to add an answer to what Norma asked about the STRTPs. Child welfare currently has, five youth in STRTPs. And then probation has not out of county. We have one of those. So four child welfare are placed out of county. One is in county with us, and then we have one probation in with us as well.

Okay. So pretty much the same gamut of staff. We are the one who has a psychiatrist as, Justine mentioned. Our learning coaches and mental health specialists, they are with us because we have the nonpublic school and the residential program. They are extra staff on-site who do skills coaching, crisis intervention as needed during the school day, during groups, and residents. K. Next slide. Here's some of our quick numbers here. See 77 youth enrolled, so that was from November 1 to now. For residential, hundred and twenty nine outpatient.

You can see the improvement on the scores there. But like Barry said, we're all required to use the cans and PSC 35. Forty seconds left. We have two success stories. So one is Quick. One is a outpatient client. He's a 20 year old who came from out of county, can move up with her boyfriend, had no job, no access to health care, couldn't drive, nothing, broke up with that boyfriend. Our case management team was able to get them connected to the clubhouse health care. They have a provider now. Good collaboration.

Time's up. Your turn. Twenty seconds.

So we have a residential success story from Eldorado County. So this is an Eldorado County probation youth, 17 year old female who was incarcerated at the JTC for over six months. Came to us following a very serious charge, had zero family or natural supports, when she came to us through her time with us, and she was behind in education. She is set to graduate, high school in December. She was reengaged with a father out of state.

She has, she's actually reunifying with her biological mother on the East Coast. I think what's most glaring about all of this for her is that when she came into us and having none of that in her life, we were able to use connection and relationship and, tapping into others that could help us in both locating but reengaging these family members. And she will be returning to her mom when she graduates in December. She has had almost zero incidents with us, since being with us. So, a huge success story for El Dorado County.

Alright. You did it.

Questions?

Any questions from the commission?

I just have one

I have a question.

Anna? Yes.

You were talking about your the homes that a home that you were adding, is it a group home or that short term residential therapeutic program home?

Sure. So, currently, we have two short term therapeutic residential programs as well as two group homes, different licensing regulations. We are taking one of our two group homes and moving it to a different license, which will be the STRTP that I referenced and Justine referenced earlier.

So we

have total of three STRTPs and one group home.

Wonderful. Congratulations on that.

Thank you. We'd love to have the the county youth back in county. So

K. And commissioner Colbert has one question.

It's it's just a semantic issue. Just when you you talk about residential treatment, is that outpatient? I mean, is that inpatient treatment?

So it was inter it's interesting that you asked that because many refer to it as inpatient. We're not a medical facility, so, it is twenty four seven residential treatment.

Well, that sounds like inpatient to me.

I mean, there there are aspects that are similar.

Sure.

Yeah. Alright. Thank you.

Yeah. You're welcome. Thank you.

Alright. Thank you, ladies. Appreciate your presentation. Really quickly before we move Sarah's backup, but Karen left. She had she had to go run another meeting.

Thank you. Noted. We are still at quorum.

Yeah. We'll have quorum.

All of our members. Thank you.

So, Sarah, come on up. We're happy to see you guys here tonight.

No. Good to see you again.

Alright. Do I need to we're good?

Okay. Alright. So I'm Sarah DeCorsi. I'm the executive director at Stanford Sierra Youth and Families. We actually just celebrated our hundred and twenty fifth anniversary. We merged together with Sierra Forever Families, in Sacramento County, and so between the two programs have a lot of history. So glad to be here. A little bit about us. So our mission is transforming lives by nurturing permanent connections and empowering families to solve challenges together so that every young person can thrive. We have a variety of, services that we provide, and we're in multiple counties.

We're obviously here in El Dorado, but we also have offices Sacramento County, Nevada County, Yolo County, and then also in, Napa and Solano. Very similar to a lot of our, people who've already presented here. Right? We do specialty mental health services. We've got traditional and FSP.

But in addition, we do TBS services, so that's gonna be our short term adjunct service. This is gonna be focusing on a specific behavior that's putting youth the most at risk of either moving to a higher level of care, whether that's hospitalization or perhaps an STRTP placement. And so that's an additional service that we provide, but we do a lot of the other services that, my other children's providers have already discussed. So I'll go ahead and skip through this guy. For our evidence based practices, we do PCIT, TFCBT, and high fidelity wraparound.

We also are COA certified. We also have the ability to do other EVP services that we do in some of our other counties, which include FFT, motivational interviewing, or just some of the other ones that we're not currently providing in El Dorado County but have the capacity to potentially do in the future. We also have clinicians facilitator specialists. We have those certified peers that Justine talked about earlier, those people with lived experience who have gone through the certification process with the state, and then also a TBS analyst. That's gonna be the person who's providing our TBS services.

Alright. So for the last fiscal year, we served a 181 kids with the average length of stay of two hundred and fifty days. I'm really excited to be able to spend some time talking about our success story with you. So we had a youth who was referred to our services. He had multiple police interactions due to just unsafe behaviors in the home. I think he lasted all of seventeen minutes in our intake before needing to take a break. While taking a break, the parents basically came forward and said, like, we believe out of home placement is the only thing that this kid needs. There's so many safety concerns. There's another sibling in the home. We just have no way of being able to function as a family, and we just need help.

And, ultimately, we're here just because this is the next step that we have to do in order for us to be able to get to out of placement. Right? So we sat down with this family. We're able to complete an intake, and really try to figure out how we can help support. This is a kid who got weekly therapy. He got skill building twice a week. They got a family partner to be able to help support them, but in addition, they also got those TBS services because of the multiple, police interactions and fifty one fifty holds this youth was placed on. We really, wrapped this family around with supports and services and really tried to help identify what the needs were. And in that, we really found that this was a family that really wanted to help support him. They did not want him out of their home.

They just were out of options and really just begging for help. Right? So with that, our team really helped support by identifying some triggers, identifying patterns, figuring out ways to be able to help support this youth. Initially, he was attending school forty five minutes a day because that's all he could stand. Right? Being able to help support that system and being able to work with the family. We were ultimately able to get to a place where he got a part time job. He was attending school full time, being able to help support the family. The family was able to get to a point where the family was doing, you know, interactions and vacations as a whole. Typically, what was happening beforehand was mom was taking one kiddo, dad was taking the other kiddo, and they were ships passing in the night not being able to see each other.

And, ultimately, when we sat down at graduation, getting to share a piece of pizza, we was really be able to highlight the great work that this youth was able to do and continue to do for this family. So thank you. Awesome.

Well, thank you very much for that. Commissioners, any questions? No. I wanna say what we actually, myself and another past commission member, we came and met with your your facility, and I was impressed with this actual facility and the work you do. And we did the report on what we just as involved. And Yeah. I thought we really appreciated you letting us speak with you then also. You know? Yeah. And thank you.

I don't see any questions here, so I guess thank you very much. Thank you. So I guess now we've completed all our providers. So any public comment?

Comments are limited to three minutes per person. Please voluntarily state your name for the record. Online participants who would like to make a comment should press the raise hand button. Phone participants, press 9. If you are here in person, please raise your hand.

I have none on-site and none online.

Any further, commissioner discussion? I hear none. See none. Okay. We're gonna move on to the next agenda item, item number six, review discussion questions of the behavioral health director's report.

So getting to that page. Anyone have any, questions, commissioners, on the monthly update?

I do.

Okay.

I'm looking at page 10 of 16 and prior twelve month period, Owl County hospitalizations. Am I reading that correctly that there was that big of an uptick on out of county hospitalizations in October?

Yeah. I'm seeing the same thing that you are, commissioner Santiago.

Is there any can you enlighten us as to what might be the cause of that? Because that's a purse that is a a pretty big jump.

Yeah. I I don't wanna misspeak or not give a complete answer, so I will take this back to my crisis team to understand if we just saw this trending up as a whole or what was going on here, and and we can get that information over to you all.

I'd appreciate it. Thank you. Mhmm.

Anyone else on the behavioral health update from the commission? I don't see anyone or any hands raised, so public comment?

Comments are limited to three minutes per person. Please voluntarily state your name for the record. Online participants who would like to make a comment, shift press the raise hand button. Phone participants, press 9. If you're joining here in person, please raise your hand. I have one online. Nami Eldorado, you may unmute yourself and and make your comment.

Oh, okay. Yeah. My question remains the same. If there are, over a 100 or over 200 calls, 280 something calls, how come there's only 37 dispatches? And, again, I'd like to request a closer look at, the ones that are denied, follow-up with the, you know, because eve even if there's not even if it's not, an emergency where it's a crisis, where it requires a fifty one fifty, at least if the mobile response team responds to a parent's cry for help with their loved one, that could be an introduction to engaging in services.

It doesn't have to necessarily result in a fifty one fifty, but it shows, that this community cares about people with serious mental illness. I'm talking about adults now. So, I just wanna reiterate my request that those calls are a little bit scrutinized to try and understand why the response rate is so low. And, if any of those calls are, like, duplicates or triplicates, people calling back again and again and refused, I mean, it's just a kind of a black box. You just don't understand.

You know, we don't the from the outside, you may understand what's going on, but from the outside, a person viewing it is just, you know, very confused. So a little bit more clarity about how that how that mobile crisis team works would be great. Thank you.

Diane, thanks for sharing. I know you and I had a chance to discuss this, and I think you bring up some good points. And we'll definitely take this back as a group and discuss some of these parts. One thing I do want to mention is that the calls to the crisis line, when someone is calling the crisis line, they're not necessarily requesting a mobile crisis response. The line itself is our general crisis line.

So people might be calling and aren't requesting a mobile response, or there might not be anything that warrants a mobile crisis response, and they're calling to talk to someone, which is what prior to inception of mobile crisis was what this line was for. So, again, the total number of calls is not necessarily the same number of people that were actually requesting a mobile crisis response, if that helps clarify the volume of calls any.

Mhmm. Yeah.

But is that the number people would call if they wanted to make a request?

Yes.

Is that the same number?

Yes.

Okay. Thank you.

Because I I thought the access line was the line to call for, you know, talking to a a a person who's skilled in responding to people in need, and I thought that the mobile crisis was a different call a different line. So I understand that a little bit better now. I appreciate you clarifying that. But still, I think, yeah, we need to look at how mobile crisis responds and what is the follow-up and so on and so forth.

Well, thank you, Diane, for your public comment.

I see no other comments on-site or online.

Alright. Any further commissioners discussion on the division's update? I see none. Therefore, we're going to move on. Any final comments from commissioner? I see none. Therefore, I'm gonna adjourn the meeting at 06:25. Thank you all for coming. Appreciate Have a good evening.

Our next meeting?

Yeah. And happy and happy Thanksgiving. Thanks, dear.

Commissioner Santiago, I did hear you. The next meeting is going to be discussed by the commission chairs. And if we do hold a December meeting or if we will see our next one in January, it will be posted on Legistar for the public to see.

Yeah. We're get we got a we got a planning planning meeting tomorrow afternoon, and we're gonna discuss how we move forward if it's December or January. And it will be posted at on Legistar when, that top proper time comes up. So thank you all. Have a good Thanksgiving.

Thank you. Happy Thanksgiving, everyone.