Trinity County Grand Jury • 2003-2004

File Jun - 2004 Superior Court of California )1q County of Trinity By: Donna Regnani, Deputy Clerk Trinity County Grand*

Published: May 10, 2004 24 pages
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Findings and Recommendations 5 findings

F1
Quality Review: The Medi-cal review was reviewed for compliance and areas of concern. In was found that the Medi-Cal review process is primarily concerned with the adequacy of paper work to meet requirements of that state agency. There has been significant improvement in the Behavioral Health's compliance with the requirements since the last Grand Jury assessment of this department. Following the previous investigation of this department by the grand jury, the Board of Supervisors agreed to form a committee to oversee the Kings View Behavioral Health Program and determine the quality of its services to clients. This has not occurred. Instead, they decided to rely on the review by Medi-Cal. There is a process whereby clients and/or other citizens can express concerns, complaints (or exceeded expectations) with the department. At present, there is no formal or semi-formal system for determining general client satisfaction or specific improvement as a direct result of services. Administrators stated that they believe that clients are free to complain or to disagree about services offered and that the program is a good one for their clients. The results of the survey conducted by the Grand Jury demonstrate dramatic improvement in personnel satisfaction. Since a significant number of the responding employees are not those present at the time of the last grand jury, it is not clear if the present personnel better fit the needs of the administration, or if there have been changes in management style. In the previous grand jury investigation, advisory board members reported being frustrated by lack of input into department programs. -32−
Related Recommendations (1)
R1
The Behavioral Health Department is to be congratulated on improved compliance with Medi-Cal regulations. Since Medi-Cal is the primary funding source for this department, it is imperative to strive for maximum compliance. However, much of the concern in the previous grand jury investigation of this department, as managed by Kings View, concerned client and personnel dissatisfaction. This department is also to be congratulated on improved job satisfaction as expressed by the responding personnel. While an established method to receive and log active complaints is in place, a method of surveying client opinion as to services and outcome of prescribed treatment is strongly recommended. The low incidence of client representation on the advisory board for this department is of concern, as it may indicate a disconnection between clients and the professional staff. It is recommended that every effort be made to increase client (present or former) willingness to be members of this board in order to affect policies that may be made. The state mandated percentage of user representation should be the minimum on the board, and the present user representation is well below this required number. It is also recommended that the Advisory Board be supported and encouraged to take an active role in ongoing development and review of policies for the department.
F2
Video conferencing: The use of video-conferencing between clients and psychiatrists is provided to enable clients to have direct interactions with a psychiatrist for some counseling and for prescription and follow up when psychotropic medication is indicated. There is not a psychiatrist available in Trinity County and the cost of providing these services through an on site person, who would need to be paid for travel time and accommodations is prohibitive. Recruitment of an on site psychiatrist is almost impossible given the amount of money available for this service. Costs are reduced by using teleconferencing. More than one psychiatrist provides the service, thus permitting clients some flexibility in scheduling and the opportunity to change professionals if the client wishes. Teleconferencing is provided in a secure room with two-way visual and verbal content. Members of this committee observed the process (without a client present) and spoke with one of the psychiatrists. The deputy directors stated that they consider this to be an excellent system for providing services with maximum flexibility for clients. They reported high client satisfaction. Because of confidentiality constraints, clients were not interviewed concerning their experiences with this type of service; staff reported that complaints about this system were minimal. A member of this committee, who is a retired psychologist, stated that he believes this system, as it functions, is excellent.
Related Recommendations (1)
R2
The Behavioral Health Department is to be commended for their effort to provide psychiatric services within the county in spite of financial and distance constraints. Again, the development of a method to assure accuracy in assessing client responses to the service is recommended.
F3
Selection of a new executive director: Initial posting of the position and interviewing of candidates are conducted by Kings View outside of Trinity County. After a selection is made, the successful applicant is interviewed by Brian Muir, and if he has no objection, the person is hired. The deputy directors and the advisory board have no formal place in this recruitment process. The deputy directors assured the grand jury committee members that they had full confidence that they would approve of the person if Mr. Muir approved of the selection.
Related Recommendations (1)
R3
Kings View may never send for approval any but their ideal candidate for this sensitive position, and Mr. Muir may always be correct in his analysis of the candidate, but it would seem at least courteous to allow the deputy directors and advisory board to speak with the person before confirming his or her appointment. It is recommended that the advisory board (with its consumer representatives) and the deputy directors be formally given opportunities to ask questions they consider important as part of the selection process.
F4
Interactions with staff members at the juvenile facility: The need for client confidentiality is clear; counselors should not discuss privileged information with facility staff, and there have been no complaints presented to the grand jury in this area. Couched among statements of respect for counseling services provided in the juvenile facility there was a noted lack of respect for sessions consisting of "playing"—a board game, for instance. Possible rationale for the use of board games and other devices in gaining or maintaining rapport with clients was suggested and defended by directors when this concern was reported to them during the meeting before this report was prepared.
Related Recommendations (1)
R4
The need for rapport, especially with young clients, is not in question in this report. Some level of rapport with facility staff is also important for maximum benefit of counseling and for facility staff support of goals. Some statement to facility staff of the rationale for use of nonstandard materials or techniques in a specific case is recommended if this can be done without violating client confidentiality.
F5
Quandary in Crisis Intervention with person's on parole: After 5:00 P.M., crisis calls are routed through 911 to the sheriff's department. Suicide calls are routed to the sheriff's department as well as to Behavioral Health, in order that the individual's safety can be assured. At the hospital, a determination is made whether-or-not there is a serious risk to the safety of that person or others. A procedure, known as "51-50," may be employed to place the individual under involuntary commitment for up to 72 hours if it is determined that the person is a danger to himself or herself or to others. The quandary is when a person is on parole after being convicted of a crime related to substance abuse and who also has a history of severe depression. If the individual becomes suicidal when under the influence of a substance, and his or her parole is conditional on not using that substance; if the person calls the crisis line, he or she will be remanded to jail for the remainder of his sentence. If he or she does not call, suicide may result. This situation occurs more frequently than most of us would imagine. The Behavioral Health Department is not paid for time spent by counselors working with their clients if the client is in jail. It is the department's policy to continue seeing clients while they are in jail if they are already in the program.
Related Recommendations (1)
R5
The Health and Human Services Committee of the grand jury supports the Behavioral Health Department's policy of maintaining continuity of treatment for incarcerated clients as the client's best chance to improve. Beyond frequent reminders to consumers with this risk and recommendation of use of earlier use of the crisis line rather than substance abuse the grand jury has no recommendation or solution for this quandary. CONCLUSION: The Behavioral Health Department has made improvements in many areas since the previous grand jury investigation. There is continued need for better client representation on the advisory board for this department, and a clearer avenue for input by the advisory board into the department's policies and in the selection process for a new executive director. A system for monitoring and acting on client recommendations for changes within the department has also been recommended. -35- The original pilot program method of service was optimal, but very expensive. In the climate of shrinking budgets and increasing, frequently changing requirements from state agencies and mandated methods of treatment under these programs, such programs are no longer possible, except citizens with sufficient high level insurance to pursue treatment privately. The staff is dedicated to providing the best possible service to clients and to interacting effectively with other agencies to provide a wide range of cooperative programs to benefit clients. They are commended for their efforts. RESPONSES REQUIRED:

Conclusions 4

No Responses Found 2

Government entities assigned to respond to this report. No response documents have been linked in our database.

County of Trinity Agency
Trinity County Board of Supervisors Elected County Office

* This report's PDF did not contain easily extractable text and required Optical Character Recognition (OCR) for analysis. There may be minor errors in the extracted findings and recommendations due to OCR limitations with scanned documents.