San Francisco County Grand Jury
• 2019-2020
• Agency Response
Response to 2019-2020 Civil Grand Jury Report, Strengthen Our Behavioral Health Services
⚠️ 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 8 findings
F1
High staff vacancy rates inhibit the ability to care for individuals with mental illness DPH Agree and substance abuse disorders. HRD
Related Recommendations (1)
R1
By March 2021, re-evaluate the hiring process for ICM’s in light of the success of the DPH Will be implemented DPH-HR and BHS are partnering on a batch hiring of 40 FTE 2930, Behavioral Health expedited strategy for hiring registered nurses executed in March 2020. Leverage it HRD Clinicians. The ETA for these hires is January 2021. to inform a redesign of existing policy. DPH and HRD are also collaborating to reexamine the hiring process for licensed clinicians with a goal of streamlining the process, e.g., criteria, testing.
F2
The shortage of Intensive Case Managers is chronic. DPH Agree HRD
Related Recommendations (1)
R2
By June 2021, fill 50% of ICM vacancies in 21 days or less. DPH Will not be implemented BHS is working to hire the 2 vacant civil service clinicians as part of the 2930 batch HRD hiring. The majority of ICM programs are operated by CBOs. Of the 231 FTE direct service ICM staff (clinicians, health workers, psychiatrists) funded by BHS, only 51 FTE are DPH staff. It is currently not possible to hire permanent civil service positions in 21 days. There are several steps in the Civil Service hiring process which include a Form III submission, position approval, reassignment/posting, selection process, request to hire submission, and onboarding process. The fastest hiring time projection from DPH HR is 120 days. The current average for BHS hires is about one year from when the position is identified as needed and entered into our system to the start date of the position. We are working to improve this time.
F3
Lengthy and inefficient hiring protocols are contributing to a shortage of Intensive DPH Disagree, partially Intensive Case Management (ICM) is one level of care provided by Behavioral Health Services Case Managers. HRD (BHS). BHS currently has the capacity to serve 1,200 clients in our ICM programs while thousands of clients are served by outpatient behavioral health clinics. The majority of ICM programs are operated by Community Based Organizations (CBOs). Of the 231 full-time equivalency (FTE) direct service ICM staff (clinicians, health workers, psychiatrists) funded by BHS, only 51 FTE are DPH staff. The balance are employed by CBOs. BHS understands that vacancy rates for civil service programs is a result of delayed hiring where the CBO vacancy rate are due to the relatively low salary CBOs are able to offer. BHS is currently partnering with DPH-HR to do a mass hiring of civil service Behavioral Health Clinicians with a goal of hiring approximately 40 new clinicians.
Related Recommendations (1)
R3
By March 2021, engage the Budget and Legislative Analyst or other external DPH Will not be implemented DPH reclassified the Director of Behavioral Health position in June 2020 to reflect the consultancy to examine the policy and practice of executive placement and HRD complexity of work and reporting structure. compensation for the Director of Behavioral Health.
F4
The position of Director of Behavioral Health has been filled with five different DPH Agree individuals in five years.
Related Recommendations (1)
R4
By September 2021, in light of the study findings, redesign and realign the position DPH Has been implemented DPH has changed the reporting structure of the Director of Behavioral Health to report of BHS in the organizational structure as a direct report to the Director of Health. directly to the Director of San Francisco Health Network and the Director of Health.
F5
BHS’ scale of operation in terms of staff count, budget size, and public impact are DPH Disagree, partially BHS’s reporting position in the Ambulatory Care division of DPH has historically supported not reflected in its deeply nested reporting position in DPH. integration of behavioral health services in all areas of ambulatory care. Additionally, BHS is not larger in scale than other ambulatory care services in terms of civil services employees, number of people served, and the health impact on the population of San Francisco. BHS is moving from being one of five sections within the Ambulatory Care division of the San Francisco Health Network (SHFN) to being a new division of the SFHN. The new Director will report directly to Grant Colfax (Director of Public Health) and Roland Pickens (Director of San Francisco Health Network). This change is because BHS is both a health plan and set of direct client services, and as such has complex and large contracting and budgetary elements, and scope of work, which distinguish it from the rest of Ambulatory Care.
Related Recommendations (1)
R5
By September 2021, ensure discipline surrounding regular document and event DPH Will be implemented BHS has plans to revamp the BHS website. The workplan for this project involves making the reporting to ensure timely, accurate web access. website more effective in helping clients access care and to increase access to information about our system including program data and system outcomes. BHS will incorporate this goal into the design and maintenance plan for the website.
F6
Regularly published DPH reports are not consistently published on the department DPH Disagree, partially BHS publishes many reports on the Department of Public Health website. BHS also has plans to web site. revamp the BHS website to make it more effective in helping clients access care and to increase access to information about our system including program data and system outcomes. Currently, many reports regarding Behavioral Health client satisfaction surveys and quality improvement work are published here: https://www.sfdph.org/dph/comupg/oservices/mentalHlth/CBHS/default.asp
Related Recommendations (1)
R6
By September 2021, provide local site directories for public notice DPH Will be implemented BHS and DPH will incorporate this goal into the design and maintenance plan for the website.
F7
DPH Headquarters at 101 Grove St. provides no public directory of offices and DPH Agree services.
Related Recommendations (1)
R7
By September 2021, publish direct contact information of offices and service DPH Will be implemented BHS and DPH will incorporate this goal into the design and maintenance plan for the website. personnel to enhance public access to DPH services. 2
F8
DPH website provides no public directory of DPH Agree phone numbers. Strengthen Our Behavioral Health Services FY 2019-20 Civil Grand Jury Report Response Response Text Has been implemented Summary regarding implemented action Respondent # Recommendation Will be implemented Timeframe for implementation Assigned by CGJ Require further analysis Explain scope and parameter of analysis, timeframe (should not exceed 6-months) Will not be implemented Explain thereof
No recommendations for this finding