Score: +2 (2/3/0)

Contra Costa County Grand Jury • 2022-2023

A Report by the 2022-2023 Contra Costa County Civil Grand Jury

Published: April 21, 2023 33 pages

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⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.

⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.

Findings and Recommendations 17 findings

F1 Page 7

Prior to the Covid-19 pandemic, tele-mental health and audio-only services available through BHS were a small portion of the outpatient services provided (7% in 2018; 8% in 2019). RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent disagrees partially with this finding. An explanation was given.

No recommendations for this finding

F2 Page 7

During the Covid-19 pandemic, BHS did not offer training to prepare clinicians or clients for effective and confidential use of tele-mental health services. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent disagrees wholly with this finding. An explanation was given.

Related Recommendations (2)

Page 10

Develop a training program for BHS clinicians, network providers, and support staff to facilitate the use of tele-mental health. RESPONDENT RESPONSE TO RECOMMENDATION Contra Costa County Board of Supervisors The recommendation requires further analysis. An explanation was given. Due: June 30, 2022 Analysis Complete? Unknown

Page 10

Develop a training program for clients to facilitate and provide support for the use of tele-mental health. RESPONDENT RESPONSE TO RECOMMENDATION Contra Costa County Board of Supervisors Respondent agrees with the recommendation. A summary was provided.

F3 Page 7

During the Covid-19 pandemic, BHS tele-mental health services continue to be underutilized. While audio-only increased to 52% of all outpatient services, tele-mental health was 18% of outpatient services delivered RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent disagrees partially with this finding. An explanation was given.

No recommendations for this finding

F4 Page 7

At the outset of the Covid-19 pandemic, tele-mental health and audio-only services decreased the number of missed appointments. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent agrees with the finding.

No recommendations for this finding

F5 Page 7

Tele-mental health services are appropriate for clients who are more stable, verbal and insightful. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent agrees with the finding.

No recommendations for this finding

F6 Page 8

Tele-mental health services are appropriate to use with clients displaying symptoms of anxiety and depression. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent agrees with the finding.

No recommendations for this finding

F7 Page 8

The greater use of audio-only services has the limitation of not offering visual cues, which provide clinicians with important clinical information. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent agrees with the finding.

No recommendations for this finding

F8 Page 8

Tele-mental health services are not appropriate fora. Homeless populationsb. Patients presenting with chronic schizophrenia with a limited capacity to manage the tasks of daily lifec. Patients prescribed controlled substances or injectable medication. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent disagrees partially with this finding. An explanation was given.

No recommendations for this finding

F9 Page 8

BHS has not incorporated tele-mental health into a comprehensive service delivery model to offer a broad range of opportunities for underserved populations to receive mental health services. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent disagrees wholly with this finding. An explanation was given.

Related Recommendations (2)

Page 9

Develop a hybrid plan to integrate tele-mental health services with in-person services in their clinics. RESPONDENT RESPONSE TO RECOMMENDATION Contra Costa County Board of Supervisors Respondent agrees with the recommendation. A summary was provided.

Page 10

Coordinate with network provider groups to integrate tele-mental health services with in-person services. RESPONDENT RESPONSE TO RECOMMENDATION Contra Costa County Board of Supervisors Respondent agrees with the recommendation. A summary was provided.

F10 Page 8

Access to outpatient mental health services in Contra Costa County suffers from difficulties with transportation to clinics, long wait times for appointments, and insufficient availability of after-hours appointments. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent disagrees partially with this finding. An explanation was given.

No recommendations for this finding

F11 Page 8

BHS has a limited number of clinicians who can provide culturally and linguistically sensitive services to diverse minority groups. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent disagrees wholly with this finding. An explanation was given.

No recommendations for this finding

F12 Page 8

Increasing access to mental health services is a priority for Contra Costa County BHS. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent agrees with the finding.

No recommendations for this finding

F13 Page 9

The FCC reported 99.2% of Contra Costa County residents have access to internet broadband for greater use of tele-mental health services. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent disagrees wholly with this finding. An explanation was given.

No recommendations for this finding

F14 Page 9

BHS has not followed the directives of the California Telehealth Advancement Act of 2011 to develop telehealth services to better meet the needs of underserved populations in the community. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent disagrees wholly with this finding. An explanation was given.

No recommendations for this finding

F15 Page 9

The Congressional Consolidated Appropriations Act of 2021 expands Medicare services to allow tele-mental health services to be integrated with in-person sessions, and to be received by beneficiaries in their home without geographic limitations. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent agrees with the finding.

No recommendations for this finding

F16 Page 9

BHS lacks an adequate electronic data system to evaluate the efficacy of outpatient mental health services provided. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent disagrees partially with this finding. An explanation was given.

Related Recommendations (6)

Page 10

Collect outcome data from BHS providers and programs to provide feedback to improve mental health services delivered to the community. RESPONDENT RESPONSE TO RECOMMENDATION Contra Costa County Board of Supervisors Respondent agrees with the recommendation. A summary was provided.

Page 10

Increase the use of MyChart health care information system to make clinical information accessible to clients and providers. RESPONDENT RESPONSE TO RECOMMENDATION Contra Costa County Board of Supervisors Respondent agrees with the recommendation. A summary was provided.

Page 11

Modernize the electronic data collection capabilities of the quality management program to provide meaningful information about mental health services. RESPONDENT RESPONSE TO RECOMMENDATION Contra Costa County Board of Supervisors The recommendation requires further analysis. An explanation was given. Due: June 30, 2022 Analysis Complete? Unknown

Page 11

Develop appropriate clinical metrics to evaluate outcomes that improve the effectiveness of mental health services provided. RESPONDENT RESPONSE TO RECOMMENDATION Contra Costa County Board of Supervisors Respondent agrees with the recommendation. A summary was provided.

R10

Page 11

Seek grants and MHSA funding to upgrade the technological resources of the quality management program. RESPONDENT RESPONSE TO RECOMMENDATION Contra Costa County Board of Supervisors Respondent agrees with the recommendation. A summary was provided.

R11

Page 11

Allocate funds for BHS to upgrade its quality management program. RESPONDENT RESPONSE TO RECOMMENDATION Contra Costa County Board of Supervisors The recommendation will not be implemented because it is not warranted. An explanation was given. Summary of Responses

F17 Page 9

BHS does not collect clinical data from network providers, which limits accountability for the outpatient mental health services provided to county residents. RESPONDENT RESPONSE Contra Costa County Board of Supervisors Respondent disagrees partially with this finding. An explanation was given.

Related Recommendations (1)

Page 10

Collect outcome data from network providers to provide feedback to improve mental health services delivered to the community. RESPONDENT RESPONSE TO RECOMMENDATION Contra Costa County Board of Supervisors The recommendation has not yet been implemented but will be implemented in the future. By: July 1, 2022. Implemented? Unknown

Agency Responses 2

Government agencies' official responses to this report's findings and recommendations. Click on a response to see the structured breakdown.

Board of Supervisors

September 22, 2023 • 11 pages • 3 responses • Score: +1 (+1, 1, 0) View Details ▾

PDF

3 responses to findings and recommendations

Response: Implemented

Score: 0

, the County prepares an Annual Progress Report (APR) on the jurisdiction's status and progress in implementing its housing element using forms and definitions adopted by the California Department of Housing and Community Development (HCD). The County's reports are available on the County website. HCD compiles and showcases all APRs through its interactive digital data dashboard with downloadable data sets. In addition, the County plans to create a comprehensive webbased tool to report on the status of actions related to its adopted Housing Element as well as its in-progress comprehensive Gene...

Response: Agree Score: +1

for detailed RHNA targets from previous Housing Element cycles. Recommendations 1. Each city and the County should consider assigning a staff position with clear leadership, ownership and accountability to achieve allocated RHNA targets. The individual in this position would be responsible for establishing and promoting an operational plan to achieve the RHNA goals set forth in the housing element plan. <b>Response</b>: The recommendation has been implemented to the extent of the County's responsibilities. California's Housing Element Law acknowledges that, in order for the private market to ...

Response: Unknown Score: 0

, the County focused not only on the feasibility of development but also on locations that are well-positioned to provide a range of other benefits to future residents. For sites where existing zoning is not adequate to realize otherwise feasible housing potential, the County will be rezoning the sites to allow the project density and remove development obstacles. 7. Each city and the County should consider reviewing their zoning policies to identify restrictive zoning policies unique to their jurisdiction that impede AH projects and consider making zoning changes in light of that review that ...

Board of Supervisors

August 08, 2023 • 8 pages • 3 responses • Score: +1 (+1, 2, 0) View Details ▾

PDF

3 responses to findings and recommendations

Response: Will Implement

Scheduled: within 90 days Score: +1

The recommendation will be implemented by October 31, 2023. 2. We recommend that the DCD establish a well-publicized deadline for all agricultural contract applications (e.g., October 1), process all agricultural contracts together and preschedule a standing item on the planning commission's agenda (if required) and the board of supervisor's agenda in late November or early December, with contract approval on or before December 31 of the same year, striving to approve agricultural contracts within 90 days. Response: The recommendation will not be implemented because it is not reasonable or war...

Response: Implemented

Score: 0

pertaining to the recommended approval interval target. 7. We recommend that the DCD review and adhere to their stated goal that calls and emails from applicants be returned within two business days. Response: The recommendation has been implemented. 8. We recommend that the DCD implement an escalation process for agricultural contracts so that the applicant can request management intervention if key milestones and deadlines are in jeopardy of being missed. Response: The recommendation has been implemented. DCD has had and will maintain the ability for applicants to escalate concerns to manage...

F15

Response: Disagree Partially Score: 0

The respondent partially disagrees with the finding. Respondent acknowledges instances of staff not responding to inquiries in a timely manner, but it is not typical. 8. When applicant email inquiries are responded to, they often provide a progress status that fails to materialize and/or is overly optimistic. Response: The respondent partially disagrees with the finding. Upon request for a time estimate, planners endeavor to provide accurate estimates given the present circumstances. Respondent acknowledges estimates were sometimes provided that, in hindsight, were optimistic. However, there a...