Connie Moreno-peraza, Msw, Lcsw Behavioral Health Director August 22, 2024 Honorable Michael Jurkovich, Presiding Judge

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The MCGJ recommends that MBHS submit a recruitment and retention plan that includes salary increases and incentives to the Board of Supervisors of the MCGJ report posting, addressing the long-standing staffing shortage. The recommendation has been partially implemented but will be fully implemented in the future. MCDBHS will develop a retention plan of the MCGJ report posting. Additional details regarding ongoing efforts in this area are included below, since various efforts have been launched within the last couple of years to address and improve these continued challenges. 1. MCDBHS sends out recruitments and job flyers to licensed/non licensed providers in the general areas encouraging them to apply for vacant positions through the County website. MCDBHS is actively working with the Madera County Human Resources Department in the development of new and innovative recruitment strategies as a means of filling current vacancies. This includes outreach to local Colleges and Universities, as well as participating in Community Job Fairs and other community events. 2. MCDBHS has implemented an Internship Program which is available to existing staff and outside individuals who are currently enrolled in a master's level program. MCDBHS continues to expand its Partnerships with Local and Out of County Universities. The Internship Program provides a full continuum of training and education with the emphasis of preparing them for an entry level Clinical Position. The program has been successful in that a number of those who completed their internships were eligible to apply for vacant MCDBHS positions. As an additional Behavioral Health Services P O Box 1288 Madera, CA 93639 • 559.395.0451 • MadCoServices.com • maderacounty.com CONNIE MORENO-PERAZA, MSW, LCSW PARA Behavioral Health Director retention strategy, internships have been made available for existing MCDBHS staff, which has resulted in staff being able to compete, advance and promote within the Department. With the development and implementation of new Programs specific to CalAIM, MCDBHS has experienced the return of former staff who indicated their interest and appreciation for new opportunities to advance. 3. Incentive pay has been established for staff who need to travel daily to our rural, mountain area, clinic as part of their assignment. 4. Posting of new recruitments for hard to fill positions is continuous to allow for ongoing recruitments versus time limited. 5. MCDBHS established a new Staff Activities Committee (SAC), promoted and supported by BHS director, for the past few months to plan and carry out fun activities at each of our clinic sites on the First Friday of each month, "1st Fun Fridays". Some of the activities in past and planned for the future include: 01/05/2024 - Concha and Wellness Café 02/02/2024 - Superbowl Potluck 03/01/2024- Sprint into Action Wear Floral Print 04/05/2024 - Share your Favorite Snack w/Coworkers 05/10/2024 - Cinco de Mayo Potluck 06/07/2024 - Annual Donut Day, Swap donuts 07/05/2024 - Summer Potluck 08/02/2024 - Back to School Gear Day - Wear your school of choice attire 09/06/2024 - Sports Jersey Day 10/04/2024 - Halloween Door Decorating Contest 11/01/2024 - Let's get Flannel with it! Wear your flannel. 12/06/2024 - Staff Appreciation Lucheon. The SAC also has monthly fundraisers that goes towards the annual staff appreciation luncheon at the end of calendar year. They sell items such as popcorn grams and aguas frescas. We have and will continue to raffle different types of baskets filled with items for different uses. 6. Efforts were made to alleviate stressors and boost morale in relation to caseloads. The Directors' Leadership Team has carried out discussions on how to address the high caseload numbers. Although many factors can contribute to high caseloads, one that MCDBHS quickly identified and has taken action to correct are those cases where client contact has not occurred in more than 2 months. Although these do not account for all high caseloads, they will provide MCDBHS providers with a more accurate caseload count of active clients. In late July, the Quality Behavioral Health Services P O Box 1288 Madera, CA 93639 • 559.395.0451 • MadCoServices.com • maderacounty.com DERA CONNIE MORENO-PERAZA, MSW, LCSW Behavioral Health Director

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The MCGJ recommends that MBHS update its Workforce Training Policy to expand the number of professional development training sessions and certifications available to employees, with costs incurred by MBHS of the MCGJ report posting. The recommendation has not yet been fully implemented. MCDBHS will update its Workforce Training Policy of the MCGJ report posting. Additional details regarding ongoing efforts in this area are included below. Training our providers and staff is vital to our operations. For this reason, MCDBHS is in the process of identifying a Training Coordinator. This will assist our training planning and coordination efforts throughout our clinic sites. The Training Coordinator will be responsible for the coordination and development of an annual training plan. The Training Plan is to include training all areas of MCDBHS (Clinical, Administrative, Fiscal in addition to other areas in need of training support). This position will come with a clinical background to ensure our clinical staff are heard and necessary trainings are scheduled. In March 2024, MCDBHS conducted a training survey to determine which trainings were in demand for both our clinical and administrative teams. This information will be utilized to guide the efforts of our Training Coordinator once established. During the onboarding process, new providers are required to complete the Documentation Training in addition to MCDBHS specific policies and procedures. This is followed by a one-on-one Electronic Health Record (EHR) Training to ensure effective navigation and clinical document completion. Ongoing training and support are thereafter provided by direct supervisor and division manager as needed. MCDBHS, as required, incurs the cost of our annual HIPAA/Law & Ethics Training for which providers received 6 Continuing Education (CE) units. Although this training Behavioral Health Services P O Box 1288 Madera, CA 93639 • 559.395.0451 • MadCoServices.com • maderacounty.com CONNIE MORENO-PERAZA, MSW, LCSW OERAPopulari Behavioral Health Director Assurance Division, along with clinical lead staff, spearheaded this effort by running reports to best identify which cases could be closed and under what circumstances. The pilot included a total of 100 charts from April 2024 to present, with a total of over 50 being sent a Notice of Adverse Benefit Determination (NOABD) which provides a 10-day window to engage back in services, if no contact is made, client is discharged. MCDBHS has aligned with the state's provider to client ratios as indicated in BHIN 24-020 and has revised its sustainability standard from 70% to 60% as per the same BHIN. The goal of these efforts is twofold: to provide more accurate active caseloads for each provider and to provide a more attainable sustainability standard, while remaining in compliance with state regulation. 7. MCDBHS has also partnered with the Health Resources and Services Administration (HRSA) for many years which as noted on their website has assisted "Nearly 22,000 health care providers through loan repayment and scholarship programs". MCDBHS ensures open application periods are communicated promptly to our providers and follows up with certifying each of the applicants so they can be considered for loan repayment funds. Each year we have between 1-3 providers who commit to remain in employment with MCDBHS for a minimum of 2 years to qualify to receive loan repayment funds which is a huge incentive for both the provider and MCDBHS. 8. The Central Regional Partnership through the Mental Health Services Act Workforce Education and Training (WET) program has developed a Retention Program (RP) opportunity. Madera County, in collaboration with other counties in the region, has partnered with the California Mental Health Services Authority (CalMHSA) to make this funding available to the county Public Mental Health System workforce. It will award up to $2,265 to qualified workers within the Region's Behavioral Health care that commit to a 12-month service obligation in a recognized hard-to-fill or hard-to-retain position. Through this program, the Regional Partnership seeks to support its qualified providers that service the most underserved populations within the county and work in the most hard- to-retain positions. 9. During the review process of MCBHS by the Madera County Grand Jury, Madera County labor unions and human resources department were in the process of negotiations as a result of the new classification and compensation study. Since then, staff have been provided with salary increases based on the analysis completed by Koff and Associates and agreed upon labor negotiations. Behavioral Health Services P O Box 1288 Madera, CA 93639 • 559.395.0451 • MadCoServices.com • maderacounty.com CONNIE MORENO-PERAZA, MSW, LCSW Behavioral Health Director is required every two years, MCDBHS understands regulation is everchanging and seeks to keep its employees as up to date as possible in this regard. Early in 2024, MCDBHS rolled out a Narcan/Naloxone training for all staff. This is a voluntary training, however, offered at time of onboarding to ensure our staff is appropriately trained to administer Narcan whenever necessary. MCDBHS is also a Narcan/Naloxone distribution point, all clinics keep Narcan kits on hand for distribution to the public upon request. The Prevention, Outreach, and Community Engagement Team is leading the efforts to train partner and community agencies as well as the public in the administration of Narcan to better prepare the community as a whole to save lives The Prevention, Outreach, and Community Engagement Team received free Core Competencies for Prevention training upon being hired. The team also received training to become certified "train the trainers" for Mental Health First Aid and Applied Suicide Intervention Skills Training to become certified to provide the training in the community. MCDBHS partnered with The Change Companies to provide ASAM training to all providers, Mental Health (MH) as well as Substance Use Disorder (SUD) providers. MCDBHS incurs all costs for this 3-module training, granting a total of 13 CEs to each provider. MCDBHS also incurs all costs related to license renewal for our many providers. Although, it is usual that counties will require providers to pay then be reimbursed, MCDBHS has opted to incur the cost upfront to minimize disruption in the daily activities of our providers.

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The MCGJ recommends that MBHS add Spanish-language media outlets to their outreach efforts to the Hispanic/Latino community of the MCGJ report posting. The recommendation has been partially implemented but will be fully implemented in the future. MCDBHS will strategize and identify the most appropriate Spanish- Behavioral Health Services P O Box 1288 Madera, CA 93639 • 559.395.0451 • MadCoServices.com • maderacounty.com CONNIE MORENO-PERAZA, MSW, LCSW P Je RA Behavioral Health Director language media outlets to outreach the Hispanic/Latino community of the MCGJ report posting. Additional details regarding ongoing efforts in this area are included below. MCDBHS is committed to culturally and linguistically competent services that are embedded throughout the entire system of care. MCDBHS understands and acknowledges how cultures, values, beliefs, life experiences, and perspectives impact client's decision-making that influence their overall health and well-being. MCDBHS goal is to provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs. MCDBHS developed strategies designed to address: 1. Governance, leadership, and workforce, 2. Communication and Language Assistance, and 3. Engagement, Continuous Improvement, and Accountability. Under Communication and Language Assistance, we identified specific goals to target the Hispanic/Latino population; Goal 3. Focus on increasing our penetration rates for the Hispanic/Latino population by increasing our online/social media presence; Goal 4. Increase engagement for all BHS clients through an online/social media platform to help reduce stigma; and Goal 7. Focus on community partnerships that are beneficial for our clients to help evaluate policies and practices that ensure cultural and linguistic appropriateness. MCDBHS established a Marketing and Media Committee to provide direction on the overall comprehensive marketing and communications strategies for the department. BHS Marketing and Media Committee developed branding guidelines and resources to ensure materials developed are culturally and linguistically appropriate for the community. The BHS Marketing and Media Committee ensure materials developed are in line with the department's mission. For FY2023-2024, MCDBHS strived to increase engagement via social media completing a total of 283 posts. On a monthly basis BHS prevention staff develop bilingual educational social media post for Facebook and X (Twitter). BHS is currently working with OutFront Media Group to launch several bilingual billboards to be displayed throughout Madera County. In May 2024, we had the opportunity to work with iHeart Media to promote our youth summit via radio broadcast (La Preciosa, B95, and Soft Rock 98.9), digital media using geofencing, and used Madera Unified School District digital platform, Peach Jar to reach all Behavioral Health Services P O Box 1288 Madera, CA 93639 • 559.395.0451 • MadCoServices.com • maderacounty.com CONNIE MORENO-PERAZA, MSW, LCSW DERA Behavioral Health Director parents and students attending Madera Unified School District. We are currently exploring social media boost of our educational post, Peach Jar to share flyers and information for parents, and preparation for a strategic planning session with partners and community members to help the prevention team develop a comprehensive communication plan. The communication plan will be used to guide the development of social media campaigns using print media, earn media, social media, and digital media targeting the Hispanic/Latino Community. Other outreach efforts conducted in-person to reach and engage the Hispanic Latino community include: Participation in Youth Specific Efforts: collaborated with local schools 37 instances to provide a presentation, workshop, and/or participated in outreach events during student's lunch. 2. Parent Specific Efforts: collaborated 29 instances with local schools and organizations that serve parents of students attending local Madera County schools. 3. County-wide Efforts: collaborated with organizations throughout Madera County to disseminate information, reaching 10,693 community members. 4. Establishing partnerships with organizations that served the monolingual Spanish speaking communities including Madera Coalition for Community Justice, City of Madera Park and Recreational Services, and their Senior Services. 5. In September of 2024, BHS will be launching educational workshops to help educate the community about mental health illness. These workshops will be conducted in Spanish and English. The purpose of these workshops is to help reduce stigma surrounding mental health that prevents individuals from seeking services, primarily focusing on the Hispanic Latino Community. 6. BHS partnered with other organizations to increase outreach efforts targeting the Hispanic Latino community by conducting outreach at Farmer's Markets, Madera Flea Market, and reaching out to organizations that work with the Oaxacan community.

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The MCGJ recommends that MBHS consult with a professional of the MCGJ report posting to improve the interior of the treatment areas and create a more therapeutic environment. Behavioral Health Services P O Box 1288 Madera, CA 93639 • 559.395.0451 • MadCoServices.com • maderacounty.com CONNIE MORENO-PERAZA, MSW, LCSW PARA Behavioral Health Director The recommendation has been partially implemented but will be fully implemented in the future depending on available funding sources and depending on state and local budgets. MCDBHS will seek consultation with County Administration on available resources to develop a cost effective, well thought out, phased in facilities plan to improve the interior of the treatment areas, with staff and client input, of the MCGJ report posting. Additional details regarding ongoing efforts in this area are included below. As it relates to client and family needs, MCDBHS relocated its Children's Services to its own separate office site. The name "Children, Youth and Family Recovery Center" (CYFRC) came about as result of staff input and feedback. CYFRC is a full-service Children's Site; in that, it provides Mental Health, Substance Abuse Disorder and Medication Services. The Children's Team (Clinical Providers, Administrative Staff and Supervisors) worked together in identifying the décor that would serve to be a more welcoming, warm, child/family environment while taking into consideration the importance of cultural diversity, equity and inclusion. Chowchilla Recovery Center has created a welcoming environment by dedicating a small area for children inclusive of a library and child size furniture. This is something we will consider replicating at our other locations. At our main location, known as "7th Street", the intake rooms are being reassessed to incorporate a more welcoming feel for the public. The dedicated office for the officer of the day office has already been decorated to include greenery and artwork for a more soothing and welcoming environment. In conference rooms and other specific locations throughout the clinic, client's therapeutic artwork has been put on display which has been quite welcomed by staff and the public alike. The halls and waiting areas have smart TV's playing soft, soothing music to create a relaxing atmosphere. Last, one conference room has been upgraded with new tables and chairs. A wall of the front reception office was painted with a warm color blue and it has bilingual signage on for "Welcome-Bienvenidos" to ensure our Spanish speaking clientele feel welcome in their own language. The others will continue to be upgraded as soon as the FY2024-2025 Budget is approved by the Board of Supervisors in September 2024. MCDBHS will continue to make efforts to improve the feel of our clinic sites by incorporating greenery and assessing the feasibility of painting walls for a more welcoming feel. Behavioral Health Services P O Box 1288 Madera, CA 93639 • 559.395.0451 • MadCoServices.com • maderacounty.com CONNIE MORENO-PERAZA, MSW, LCSW Behavioral Health Director

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The MCGJ recommends that MBHS coordinate press releases, local news coverage, and social media campaigns to highlight the C.A.R.E.S. team and their services of the MCGJ report posting. The recommendation has not yet been implemented but will be fully implemented during FY2024-2025. MCDBHS will research the best avenues for the coordination of press releases, local news coverage, and social media campaigns for C.A.R.E.S. team and its services, in coordination with the CAO Public Information Team (PIT) of the MCGJ report posting. Additional details regarding ongoing efforts in this area are included below. The Prevention, Outreach, and Community Engagement Services focuses on education and support of individuals and communities to prevent the use and misuse of drugs and the development of substance use disorders; promotes the prevention and treatment of mental health disorders; conducts community outreach efforts to increase awareness of early signs of addiction and mental illness to enhance the wellbeing of individuals, families, and the community. Prevention services include CARES outreach services, which include education outreach aimed to educate and inform the community about our mobile crisis and non-crisis services through educational presentations and community engagement efforts. Community outreach efforts include tabling services at local events to increase awareness of our mobile crisis services, build rapport and partnerships with the community, and provide FREE marketing materials to promote our CARES services. For FY2023-2024, MCDBHS held or attended a total of 165 outreach events where CARES information reached a total of 6,372 community members. The outreach team also shared CARES information during 28 presentations throughout Madera County and established 61 partnerships with community organizations, business, and schools who were provided CARES marketing materials (posters, flyers, and business cards) to share with clients and customers. During this same period a total Behavioral Health Services P O Box 1288 Madera, CA 93639 • 559.395.0451 • MadCoServices.com • maderacounty.com CONNIE MORENO-PERAZA, MSW, LCSW E PARTIE WITH Behavioral Health Director of 283 educational social media posts that included the Centralized Access and Crisis Line and CARES information were completed. Currently, MCDBHS has a purchasing agent agreement (PAA) with OutFront Media to develop graphics and establish billboards that include our CARES information in two locations within the City of Madera, we are also opting into a poster rotation program that will feature our billboards in various locations that include the City of Chowchilla and rural areas of Madera County. We are also inquiring about print media, digital media, and radio broadcasting via iHeart Radio.

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The MCGJ recommends that MBHS implement an internal program to support the well-being and mental health of its employees of the MCGJ report posting. The recommendation has been partially implemented but will be fully implemented in in the next two years. MCDBHS will strategize and identify further improvements for the well-being and mental health of its employees of the MCGJ report posting. Additional details regarding ongoing efforts in this area are included below. MCDBHS has conducted various efforts to support the health and well-being of its staff. These became much more urgent and focused during the COVID-19 pandemic which saw our agency adapting to the immediate needs such as preventive measures and flexibility in schedules to work-from-home. During this time, MCDBHS leverage CredibleMind and its Live Well Madera County webpage to provide local resources to our staff. A survey to gauge burnout was launched in the early months of COVID so staff could determine when they needed to step away and regroup. Since then, additional efforts have been launched for the health and wellness of our staff, some of these are: 1. Implementation of a Wellness Room, which staff can use during their breaks throughout the working day to decompress, destress, relax, and/or do Behavioral Health Services P O Box 1288 Madera, CA 93639 • 559.395.0451 • MadCoServices.com • maderacounty.com DERA CONNIE MORENO-PERAZA, MSW, LCSW Behavioral Health Director mindfulness activities. This room was furnished with a therapeutic chair, cushions, soft lighting, soothing sounds machine and create an overall peaceful space. This Wellness Room is also conducive and arranged as a private "Lactation Room" for employees who need to use it after giving birth and returning to work. 2. Wellness Wednesday was established. This is an internal department email sent to all staff providing tips, recommendations, and facts related to mental health and wellness as well as additional resources staff can reference to support their health and wellbeing. 3. Monitors have been installed in lobby and other general areas set to play soothing music and encourage mindfulness. 4. The SAC also helps in the well-being of staff by creating and participating in fun monthly activities for all staff members to take part in. 5. "1st Fun Friday" has continued to promote a relaxed, fun, stress free work environment. 6. "Friday Jean's Day" has continued as well, and signage is posted in our facilities to inform the public of this relaxed attire at work. 7. COVID temperature scanners and preventative materials such as masks, hand sanitizers continue to be readily available throughout our clinics, notification of infections are sent to all staff as applicable to safeguard the health and wellbeing of our clients and staff. 8. A partnership with CredibleMind and the creation of the https://madera.crediblemind.com/ website a few years ago, provides our staff with resources for all around well-being through literature and podcasts on many topics as well as assessments to monitor one's own well-being and suggesting resources to provide relief. In addition, a WellScreen tool is being considered for implementation which promises to contribute to the County's expansion in access to local and self-help behavioral health resources, improved access for youth and acute mental health candidates and lower overall behavioral health service costs through improved triage efficiency.