Score: +3
(10/32/7)
Contra Costa County Grand Jury
• 2020-2021
Contact: Samil Beret Foreperson
Published: November 19, 2021
10 pages
⚠️ 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 11 findings
F1
County IT Departments are chronically understaffed.
Related Recommendations (1)
R1
The Board of Supervisors direct the County Chief Information Officer by December 2022 to create a talent pool within DoIT that includes cyber security experts to relieve chronic staffing shortages in all IT departments.
F2
Obsolete equipment poses a vulnerability threat to County IT security.
Related Recommendations (1)
R7
The Board of Supervisors direct the County Administrator by December 2022 to have all County departments identify and replace obsolete IT hardware. The Board of Supervisors direct the County Administrator by June 2022 to
F3
Some County IT departments do not have time to conduct software and hardware updates, and vulnerability scans which are critical for cyber security because of understaffing.
Related Recommendations (3)
R3
The Board of Supervisors direct the County Administrator by June 2022 to require the installation of software on all County computers that can scan for threats and viruses on any device attached to them.
R4
The Board of Supervisors direct the County Administrator by June 2022 to authorize DoIT to require system vulnerability testing on all County computer systems.
R6
The Board of Supervisors direct the County Administrator by June 2022 to have DoIT ensure mandatory updates are performed on all systems for all software applications.
F4
Some County departments with small IT staffs do not have specialized cyber secu- rity personnel.
No recommendations for this finding
F5
Cyber security training is performed on an inconsistent basis in some County de- partments.
Related Recommendations (1)
R5
The Board of Supervisors direct the County Administrator by June 2022 to require all county employees to complete annual cyber security awareness training.
F6
County employees and contractors use personal storage devices (e.g., flash drives) on County computers.
Related Recommendations (1)
R2
The Board of Supervisors direct the County Administrator by June 2022 to require all IT departments to forbid use of personal devices on and with County computers (e.g., personal thumb drives).
F7
The use of personal devices makes County computers vulnerable to denial of ser- vice, data breaches or other cyber-attacks.
Related Recommendations (1)
R2
The Board of Supervisors direct the County Administrator by June 2022 to require all IT departments to forbid use of personal devices on and with County computers (e.g., personal thumb drives).
F8
IT expenditures and budgets in County departments are not transparently reported so it is difficult to identify redundant and duplicative IT expenditures.
Related Recommendations (1)
R8
require County departments to identify their planned IT spending in their overall budgets for transparency.
F9
Decentralized IT structures increase vulnerability to cyber-attacks.
No recommendations for this finding
F10
The County’s IT structure is decentralized.
No recommendations for this finding
F11
Based on interviews, Contra Costa County is at a disadvantage to hire IT staff with cyber security expertise due to increased compensation and perks offered by some private enterprises.
No recommendations for this finding
Agency Responses 4
Government agencies' official responses to this report's findings and recommendations. Click on a response to see the structured breakdown.
▶
Board of Supervisors
March 07, 2022
•
18 pages
• 15 responses
•
Score: +4
(+7, 5, -3)
View Details ▾
15 responses to findings and recommendations
F1
County IT Departments are chronically understaffed.
Response: Agree
Score: +1
There is a need for improved animal services throughout the County. Response: Agree. The County plans to implement a new service agreement with the cities in Fiscal Year 2022/23. The County anticipates that under the new city agreements, there will be a greater level of service throughout the County.
R1
The Board of Supervisors direct the County Chief Information Officer by December 2022 to create a talent pool within DoIT that includes cyber security experts to relieve chronic staffing shortages in all IT departments.
Response: Will Implement
Due: December 2022
Scheduled: Fiscal Year 2022/23
Score: +1
There is a need for improved animal services throughout the County. Response: Agree. The County plans to implement a new service agreement with the cities in Fiscal Year 2022/23. The County anticipates that under the new city agreements, there will be a greater level of service throughout the County.
R3
The Board of Supervisors direct the County Administrator by June 2022 to require the installation of software on all County computers that can scan for threats and viruses on any device attached to them.
Response: Will Not Implement
Due: June 2022
Scheduled: Fiscal Year 2022/23
Score: -1
The recommendation will not be implemented because it is not warranted or is not reasonable. Additional funding will not be provided because funding for other mandated services takes precedence over funding of discretionary services.
R4.
CCAS explore embedding Animal Control Officers at selected police stations to expand services, such as wildlife retrieval, throughout the county. Response: The recommendation will not be implemented because it is not warranted or is not reasonable. Based on the cost and logistical complexities, it is not feasible to implement this. Additionally, it would be ...
R4
The Board of Supervisors direct the County Administrator by June 2022 to authorize DoIT to require system vulnerability testing on all County computer systems.
Response: Will Not Implement
Due: June 2022
Scheduled: Fiscal Year 2022/23
Score: -1
The recommendation will not be implemented because it is not warranted or is not reasonable. Based on the cost and logistical complexities, it is not feasible to implement this. Additionally, it would be Page <b>2</b> of <b>4</b>
difficult to identify appropriate locations for facilities to house animals and provide adequate veterinary care. The department cannot function without a multidisciplinary facility (e.g., field services, husbandry, medical care, animal enrichment programs, etc.).
R5.
CCAS engage a consulting firm to obtain guidance on the possible redistribution of animal services...
F5
Cyber security training is performed on an inconsistent basis in some County de- partments.
Response: Disagree Partially
Score: 0
Agree. Based on a 2021 survey provided to the County's 18 contracted cities and the standard customer service surveys provided to patrons of Contra Costa Animal Services (CCAS), there is a need for increased community outreach and education about all services provided.
F6.
Funding reductions to the CCAS budget have hindered live wildlife retrieval and rescue. Response: Partially disagree. The retrieval and rescue of wildlife is not a locally mandated service, nor is local funding provided by the State for this function. Although the County provided this service in the past, the service has b...
R5
The Board of Supervisors direct the County Administrator by June 2022 to require all county employees to complete annual cyber security awareness training.
Response: Will Not Implement
Due: June 2022
Scheduled: Fiscal Year 2022/23
Score: -1
The recommendation will not be implemented because it is not warranted or is not reasonable. The County completed a consulting engagement within the last 5 years with findings that supported the County's current efforts, including the needed rate increases to cities.
R6.
CCAS pursue a Memorandum of Understanding with ARF to coordinate resource "sharing". Response: The recommendation requires further analysis. By June 2022, the County will evaluate if such an arrangement would be mutually beneficial. Partnerships may affect the County's limited resources and impact existing operations. It sho...
F6
County employees and contractors use personal storage devices (e.g., flash drives) on County computers.
Response: Disagree Partially
Score: 0
Partially disagree. The retrieval and rescue of wildlife is not a locally mandated service, nor is local funding provided by the State for this function. Although the County provided this service in the past, the service has been discontinued as it placed undue stress on mandated services. As retrieval and rescue of live wildlife falls under the jurisdiction of the California Department of Fish and Wildlife, the County is unable to speak to the State's ability to provide this service.
F7.
A satisfaction survey of the 18 CCAS-contracted cities revealed 40% satisfied, 40% somewhat satisfied, a...
R6
The Board of Supervisors direct the County Administrator by June 2022 to have DoIT ensure mandatory updates are performed on all systems for all software applications.
Response: Requires Analysis
Due: June 2022
Scheduled: Fiscal Year 2022/23
Score: 0
The recommendation requires further analysis. By June 2022, the County will evaluate if such an arrangement would be mutually beneficial.
R8.
CCAS pursue a Memorandum of Understanding with East Bay SPCA to coordinate resource sharing. Response: The recommendation requires further analysis. By June 2022. the County will evaluate if such an arrangement would be mutually beneficial.
R9.
CCAS management and City Managers pursue customization of the Animal Services contracts to include basic service plus extended services for an additional fee. Response: The recommendation will not be implement...
F7
The use of personal devices makes County computers vulnerable to denial of ser- vice, data breaches or other cyber-attacks.
Response: Agree
Score: +1
Agree.
F8.
All CCAS contracts with municipalities provide identical services at the same cost per capita. Response: Agree.
F9.
Additional vaccination and spay and neuter clinics would reduce the number of homeless and surrendered animals in the shelters. Response: Agree.
F10.
There are private animal shelter facilities, The Milo Foundation and ARF, in the western and central parts of the County, respectively. Response: Agree.
F11.
A private animal shelter in Alameda County, East Bay SPCA, is located near the southern part of Contra Costa County. Response: Agree. It should be noted the ...
R7
The Board of Supervisors direct the County Administrator by December 2022 to have all County departments identify and replace obsolete IT hardware. The Board of Supervisors direct the County Administrator by June 2022 to
Response: Requires Analysis
Due: December 2022
Scheduled: Fiscal Year 2022/23
Score: 0
The recommendation requires further analysis. By June 2022, the County will evaluate if such an arrangement would be mutually beneficial.
R8.
CCAS pursue a Memorandum of Understanding with East Bay SPCA to coordinate resource sharing. Response: The recommendation requires further analysis. By June 2022. the County will evaluate if such an arrangement would be mutually beneficial.
R9.
CCAS management and City Managers pursue customization of the Animal Services contracts to include basic service plus extended services for an additional fee. Response: The recommendation will not be implement...
F8
IT expenditures and budgets in County departments are not transparently reported so it is difficult to identify redundant and duplicative IT expenditures.
Response: Agree
Score: +1
Agree.
F9.
Additional vaccination and spay and neuter clinics would reduce the number of homeless and surrendered animals in the shelters. Response: Agree.
F10.
There are private animal shelter facilities, The Milo Foundation and ARF, in the western and central parts of the County, respectively. Response: Agree.
F11.
A private animal shelter in Alameda County, East Bay SPCA, is located near the southern part of Contra Costa County. Response: Agree. It should be noted the EBSPCA serves Alameda and Contra Costa Counties.
F12.
Measure X funding has not been allocated for CCAS operations. ...
R8
require County departments to identify their planned IT spending in their overall budgets for transparency.
Response: Requires Analysis
Scheduled: Fiscal Year 2022/23
Score: 0
The recommendation requires further analysis. By June 2022. the County will evaluate if such an arrangement would be mutually beneficial.
R9.
CCAS management and City Managers pursue customization of the Animal Services contracts to include basic service plus extended services for an additional fee. Response: The recommendation will not be implemented because it is not warranted or is not reasonable. The County is developing animal services agreement with our contract cities that will provide improved services. We disagree that individual cities should be able to contract for services that a...
F9
Decentralized IT structures increase vulnerability to cyber-attacks.
Response: Agree
Score: +1
Agree.
F10.
There are private animal shelter facilities, The Milo Foundation and ARF, in the western and central parts of the County, respectively. Response: Agree.
F11.
A private animal shelter in Alameda County, East Bay SPCA, is located near the southern part of Contra Costa County. Response: Agree. It should be noted the EBSPCA serves Alameda and Contra Costa Counties.
F12.
Measure X funding has not been allocated for CCAS operations. Response: Agree. RECOMMENDATIONS - California Penal Code Section 933.05(b) requires a response to the designated recommendations of the Grand Jury.
R3...
F10
The County’s IT structure is decentralized.
Response: Agree
Score: +1
Agree.
F11.
A private animal shelter in Alameda County, East Bay SPCA, is located near the southern part of Contra Costa County. Response: Agree. It should be noted the EBSPCA serves Alameda and Contra Costa Counties.
F12.
Measure X funding has not been allocated for CCAS operations. Response: Agree. RECOMMENDATIONS - California Penal Code Section 933.05(b) requires a response to the designated recommendations of the Grand Jury.
R3.
The County Board of Supervisors allocate additional funding to provide outreach to educate residents about available CCAS services. Response: The recommendat...
F11
Based on interviews, Contra Costa County is at a disadvantage to hire IT staff with cyber security expertise due to increased compensation and perks offered by some private enterprises.
Response: Agree
Score: +1
Agree. It should be noted the EBSPCA serves Alameda and Contra Costa Counties.
F12.
Measure X funding has not been allocated for CCAS operations. Response: Agree. RECOMMENDATIONS - California Penal Code Section 933.05(b) requires a response to the designated recommendations of the Grand Jury.
R3.
The County Board of Supervisors allocate additional funding to provide outreach to educate residents about available CCAS services. Response: The recommendation will not be implemented because it is not warranted or is not reasonable. Additional funding will not be provided because funding for oth...
▶
Board of Supervisors
February 08, 2022
•
8 pages
• 15 responses
•
Score: -1
(+2, 10, -3)
View Details ▾
15 responses to findings and recommendations
F1
County IT Departments are chronically understaffed.
Response: Disagree Partially
Score: 0
Respondent agrees with the finding. F2. Law enforcement response to mental health calls reduce resources needed for serious crimes. Response: Respondent agrees with the finding. F3. Successful pilot programs in other states have earned voter funding support for program expansion. Response: Respondent agrees with the finding. F4. Community trust in mental health crisis response teams can only be developed over time. Response: Respondent agrees with the finding. F5. Educating the community about mental health crisis response teams is essential for their acceptance and use.
Response: Respondent ...
R1
The Board of Supervisors direct the County Chief Information Officer by December 2022 to create a talent pool within DoIT that includes cyber security experts to relieve chronic staffing shortages in all IT departments.
Response: Implemented
Score: 0
The recommendation has been implemented. In November 2021, the Board approved funding for expansion of the existing Community Crisis Initiative through Measure X allocations. The Board approved the Health Services Department Behavioral Health Services proposal for a total of $5M one-time funding to support the redesign of County property to serve as the Crisis Hub and $20M in funds for staffing and ongoing operational expenses. The funding supports expansion of the existing MCRT program to include a pilot project. R2. By June 30, 2022, the Board of Supervisors direct DHS to cooperate with the ...
F2
Obsolete equipment poses a vulnerability threat to County IT security.
Response: Disagree Partially
Score: 0
Respondent agrees with the finding. F3. Successful pilot programs in other states have earned voter funding support for program expansion. Response: Respondent agrees with the finding. F4. Community trust in mental health crisis response teams can only be developed over time. Response: Respondent agrees with the finding. F5. Educating the community about mental health crisis response teams is essential for their acceptance and use.
Response: Respondent agrees with the finding. F6. DHS efforts to educate the community about MCRT services have been ineffective and need improvement. Response: Re...
R2
The Board of Supervisors direct the County Administrator by June 2022 to require all IT departments to forbid use of personal devices on and with County computers (e.g., personal thumb drives).
Response: Implemented
Score: 0
The recommendation has been implemented. The County's Health Services Department Behavioral Health Services staff have cooperated with the City of Antioch in support of the city's proposed pilot project and collaborative efforts with the City of Antioch will continue. County staff met twice with representatives from Urban Strategies recently as part of the City of Antioch's proposed pilot development. R5. By June 30, 2022, the Board of Supervisors direct DHS to establish a joint team including representation from community partners for administration of the pilot project. Response: The recomme...
F3
Some County IT departments do not have time to conduct software and hardware updates, and vulnerability scans which are critical for cyber security because of understaffing.
Response: Disagree Partially
Score: 0
Respondent agrees with the finding. F4. Community trust in mental health crisis response teams can only be developed over time. Response: Respondent agrees with the finding. F5. Educating the community about mental health crisis response teams is essential for their acceptance and use.
Response: Respondent agrees with the finding. F6. DHS efforts to educate the community about MCRT services have been ineffective and need improvement. Response: Respondent disagrees partially with this finding. The County Health Services Department has made significant efforts to effectively educate the communi...
F4
Some County departments with small IT staffs do not have specialized cyber secu- rity personnel.
Response: Disagree Partially
Score: 0
Respondent agrees with the finding. F5. Educating the community about mental health crisis response teams is essential for their acceptance and use.
Response: Respondent agrees with the finding. F6. DHS efforts to educate the community about MCRT services have been ineffective and need improvement. Response: Respondent disagrees partially with this finding. The County Health Services Department has made significant efforts to effectively educate the community about the mobile crisis response initiative, a component of the larger A3 Mobile Crisis Initiative. These efforts have included produci...
F5
Cyber security training is performed on an inconsistent basis in some County de- partments.
Response: Disagree Partially
Score: 0
Respondent agrees with the finding. F6. DHS efforts to educate the community about MCRT services have been ineffective and need improvement. Response: Respondent disagrees partially with this finding. The County Health Services Department has made significant efforts to effectively educate the community about the mobile crisis response initiative, a component of the larger A3 Mobile Crisis Initiative. These efforts have included producing outreach materials, participating at local public meetings, promoting access to information online, and creating online communications and engagement opportu...
R5
The Board of Supervisors direct the County Administrator by June 2022 to require all county employees to complete annual cyber security awareness training.
Response: Will Not Implement
Score: -1
The recommendation will not be implemented because it is not warranted or is not reasonable. Community Partners have been integral to the development and success of the A3 initiative from its conception and will continue to be throughout its implementation. The administration of the current County pilot, however, is primarily managed by the County's Health Services Department's Behavioral Health Division. Community partners play advisory and subject matter expert roles, but there is no plan to have community partners administer the program. Community partners include: Those with lived experien...
F6
County employees and contractors use personal storage devices (e.g., flash drives) on County computers.
Response: Disagree Partially
Score: 0
Respondent disagrees partially with this finding. The County Health Services Department has made significant efforts to effectively educate the community about the mobile crisis response initiative, a component of the larger A3 Mobile Crisis Initiative. These efforts have included producing outreach materials, participating at local public meetings, promoting access to information online, and creating online communications and engagement opportunities for the public. Community education can always be improved upon. The following are examples of these efforts to date: In November 2020, the Heal...
R6
The Board of Supervisors direct the County Administrator by June 2022 to have DoIT ensure mandatory updates are performed on all systems for all software applications.
Response: Will Not Implement
Score: -1
The recommendation will not be implemented because it is not warranted or is not reasonable. The County's current A3 Initiative is a County-wide initiative that will expand based on internal capacity and partnership with individual cities. There has been a substantial level of community education (as outlined in F6), including the Antioch community. The County's A3 team welcomes community education partnership with the City of Antioch if conditions allow. This
4 recommendation will be discussed in ongoing meetings between the City of Antioch and the County. R7. By December 31, 2022, the Antio...
F7
The use of personal devices makes County computers vulnerable to denial of ser- vice, data breaches or other cyber-attacks.
Response: Disagree Partially
Score: 0
Respondent agrees with the finding. F8. California funding grants, including AB-118, are available for pilot program
. creation and continuing operations. Response: Respondent disagrees partially with this finding. To date, there have not been any funding opportunities under AB-118. However, the County has applied for available pilot program creation and continuing operations funding from a variety of other sources, including American Rescue Plan Act (ARPA) and Coronavirus Response and Relief Supplemental Appropriation ACT (CASSRA), Federal Block Grants, and the California Department of Healt...
R7
The Board of Supervisors direct the County Administrator by December 2022 to have all County departments identify and replace obsolete IT hardware. The Board of Supervisors direct the County Administrator by June 2022 to
Response: Will Not Implement
Score: -1
The recommendation will not be implemented because it is not warranted or is not reasonable. The County Board of Supervisors is not the governing body over the Antioch Police Department, nor its 911 dispatchers, and respectfully defers this recommendation to the City of Antioch for response. R8. By September 30, 2022, DHS apply for all available state, county, and private grants (e.g., AB-118), as well as money available through Measure X, as a source of funding. <u>Response</u>: The recommendation has been implemented. The County has applied for and secured funding from a variety of sources, ...
F8
IT expenditures and budgets in County departments are not transparently reported so it is difficult to identify redundant and duplicative IT expenditures.
Response: Disagree Partially
Score: 0
Respondent disagrees partially with this finding. To date, there have not been any funding opportunities under AB-118. However, the County has applied for available pilot program creation and continuing operations funding from a variety of other sources, including American Rescue Plan Act (ARPA) and Coronavirus Response and Relief Supplemental Appropriation ACT (CASSRA), Federal Block Grants, and the California Department of Health Care Services (DHCS) Crisis Care Mobile Units (CCMU) Program. F9. The current MCRT program does not provide standardized responses within the County due to limited ...
F9
Decentralized IT structures increase vulnerability to cyber-attacks.
Response: Agree
Score: +1
Respondent agrees with the finding. F10. The City of Antioch is a suitable community to serve as a pilot city for the MCRT expansion program. Response: Respondent agrees with the finding. <b>RECOMMENDATIONS</b> - California Penal Code Section 933.05(b) requires a response to the designated recommendations of the Grand Jury. RESPONSES TO RECOMENDATIONS: The Grand Jury recommends that R1. By June 30, 2022, the Board of Supervisors approve funding for the expansion of the existing DHS/MCRT program to include a pilot project. Response: The recommendation has been implemented. In November 2021, the...
F10
The County’s IT structure is decentralized.
Response: Agree
Score: +1
Respondent agrees with the finding. <b>RECOMMENDATIONS</b> - California Penal Code Section 933.05(b) requires a response to the designated recommendations of the Grand Jury. RESPONSES TO RECOMENDATIONS: The Grand Jury recommends that R1. By June 30, 2022, the Board of Supervisors approve funding for the expansion of the existing DHS/MCRT program to include a pilot project. Response: The recommendation has been implemented. In November 2021, the Board approved funding for expansion of the existing Community Crisis Initiative through Measure X allocations. The Board approved the Health Services ...
▶
Board of Supervisors
February 08, 2022
•
6 pages
• 1 response
•
Score: 0
(+0, 1, 0)
View Details ▾
1 response to findings and recommendations
F6
County employees and contractors use personal storage devices (e.g., flash drives) on County computers.
Response: Disagree Partially
Score: 0
. County employees and contractors use personal storage devices (e.g., flash drives) on County computers. F6 response. The respondent partially agrees with the finding. Some County departments currently have technical controls which prohibit the use of personal storage devices on County computers. F7. The use of personal devices makes County computers vulnerable to denial of service, data breaches or other cyber-attacks. F7 response. The respondent agrees with the finding. The industry is, however, moving in a direction where use of personal devices for some work functions is more common, and ...
▶
Board of Supervisors
March 17, 2020
•
75 pages
• 19 responses
•
Score: 0
(+1, 16, -1)
View Details ▾
19 responses to findings and recommendations
F1
County IT Departments are chronically understaffed.
Response: Disagree Partially
Score: 0
Respondent disagrees wholly with this finding. The use of telehealth has been the subject of Behavioral Health Services (BHS) staff meetings and BHS has provided a variety of materials and training for both clinicians and clients promoting the effective use of tele-mental health services during the COVID-19 pandemic, including a 14-page telehealth user guide for staff (Attachment A). The user guide includes procedures for identity verification, instructions for using multiple devices (e.g., phone, tablet, computer), instructions to assist patients, and how to use interpreters while using teleh...
R1
The Board of Supervisors direct the County Chief Information Officer by December 2022 to create a talent pool within DoIT that includes cyber security experts to relieve chronic staffing shortages in all IT departments.
Response: Implemented
Score: 0
The recommendation has been implemented. BHS is currently a hybrid plan that integrates tele-mental health services with in-person services in the clinics. The data shown in the chart provided in response to
F2
Obsolete equipment poses a vulnerability threat to County IT security.
Response: Disagree Partially
Score: 0
Respondent disagrees wholly with this finding. The use of telehealth has been the subject of Behavioral Health Services (BHS) staff meetings and BHS has provided a variety of materials and training for both clinicians and clients promoting the effective use of tele-mental health services during the COVID-19 pandemic, including a 14-page telehealth user guide for staff (Attachment A). The user guide includes procedures for identity verification, instructions for using multiple devices (e.g., phone, tablet, computer), instructions to assist patients, and how to use interpreters while using teleh...
R2
The Board of Supervisors direct the County Administrator by June 2022 to require all IT departments to forbid use of personal devices on and with County computers (e.g., personal thumb drives).
Response: Implemented
Due: June 2022
Scheduled: Fiscal Year 2022-23
Score: 0
The recommendation has been implemented. Network providers are part of the Mental Health Plan (MHP) and were provided the same advice going forward about client choice, implementation of tele-mental health services, training documents, and ongoing updates from DHCS. The Mental Health Division holds a semimonthly Contract Provider meeting where updates are provided. R3. Develop a training program for BHS clinicians, network providers, and support staff to facilitate the use of tele-mental health. Response: The recommendation requires further analysis. As mentioned above, considerable efforts to...
F3
Some County IT departments do not have time to conduct software and hardware updates, and vulnerability scans which are critical for cyber security because of understaffing.
Response: Unknown
Score: 0
, indicates that as of September 2021, almost one-half of services were delivered via either telehealth or audioonly. The number of in-person versus tele-mental health services is largely driven by client choice and BHS adapts services based on that choice and professional judgment for optimal patient outcomes. The BHS hybrid plan is coupled with the Telehealth Act of 2011 and COVIDrelated telehealth Information Notices from DHCS highlighted above, and is outlined in the BHS memo to providers issued in March 2020, and included with Attachment A. R2. Coordinate with network provider groups to i...
R3
The Board of Supervisors direct the County Administrator by June 2022 to require the installation of software on all County computers that can scan for threats and viruses on any device attached to them.
Response: Requires Analysis
Due: June 2022
Scheduled: Fiscal Year 2022-23
Score: 0
The recommendation requires further analysis. As mentioned above, considerable efforts to facilitate the use of tele-medicine for all staff types have occurred. These include hardware accommodation (e.g., webcams, microphones, laptops), written training guides on the technology, usage protocols, interpreter services when using tele-mental health, use of all types of devices (e.g., smartphone, tablet, computer) when using tele-mental health, and patient educational materials for using videoconferencing. Tele-mental health for consumers can be used more effectively by fleshing out a more robust ...
F4
Some County departments with small IT staffs do not have specialized cyber secu- rity personnel.
Response: Disagree Partially
Score: 0
Respondent agrees with the finding. F5. Tele-mental health services are appropriate for clients who are more stable, verbal and insightful. Response: Respondent agrees with the finding. F6. Tele-mental health services are appropriate to use with clients displaying symptoms of anxiety and depression. Response: Respondent agrees with the finding.
F7. The greater use of audio-only services has the limitation of not offering visual cues, which provide clinicians with important clinical information. Response: Respondent agrees with the finding. F8. Tele-mental health services are not appropriate f...
R4
The Board of Supervisors direct the County Administrator by June 2022 to authorize DoIT to require system vulnerability testing on all County computer systems.
Response: Implemented
Due: June 2022
Scheduled: Fiscal Year 2022-23
Score: 0
The recommendation has been implemented. Clinicians have been trained to assist clients to facilitate and provide support for the use of telemental health. Patient training material and implementation guides are available in both English and the BHS threshold language of Spanish. R5. Collect outcome data from BHS providers and programs to provide feedback to improve mental health services delivered to the community. Response: The recommendation has been implemented. Contra Costa BHS collects outcome data for the County's BHS clinic providers and programs and has numerous reports that analyze t...
F5
Cyber security training is performed on an inconsistent basis in some County de- partments.
Response: Disagree Partially
Score: 0
Respondent agrees with the finding. F6. Tele-mental health services are appropriate to use with clients displaying symptoms of anxiety and depression. Response: Respondent agrees with the finding.
F7. The greater use of audio-only services has the limitation of not offering visual cues, which provide clinicians with important clinical information. Response: Respondent agrees with the finding. F8. Tele-mental health services are not appropriate for a. Homeless populations b. Patients presenting with chronic schizophrenia with a limited capacity to manage the tasks of daily life c. Patients pre...
R5
The Board of Supervisors direct the County Administrator by June 2022 to require all county employees to complete annual cyber security awareness training.
Response: Implemented
Due: June 2022
Scheduled: Fiscal Year 2022-23
Score: 0
The recommendation has been implemented. Contra Costa BHS collects outcome data for the County's BHS clinic providers and programs and has numerous reports that analyze the data, including benchmarks when available (for example Children's Adolescent Needs and Strengths (CANS), client satisfaction, PHQ9 for depression, GAD 7 for anxiety, & HEDIS medication monitoring measure reports). In addition, Contra Costa BHS is in the process of establishing an evidence-based practices, outcomes data dashboard to include CANS data available to all clinicians and inform practice. Quality Management will be...
F6
County employees and contractors use personal storage devices (e.g., flash drives) on County computers.
Response: Disagree Partially
Score: 0
Respondent agrees with the finding.
F7. The greater use of audio-only services has the limitation of not offering visual cues, which provide clinicians with important clinical information. Response: Respondent agrees with the finding. F8. Tele-mental health services are not appropriate for a. Homeless populations b. Patients presenting with chronic schizophrenia with a limited capacity to manage the tasks of daily life c. Patients prescribed controlled substances or injectable medication. Response: Respondent disagrees partially with this finding. There could be instances where engagement wit...
R6
The Board of Supervisors direct the County Administrator by June 2022 to have DoIT ensure mandatory updates are performed on all systems for all software applications.
Response: Will Implement
Due: June 2022
Scheduled: Fiscal Year 2022-23
Score: +1
The recommendation has not yet been implemented, but will be implemented in the future. Contra Costa BHS has begun updating all fee-for-service contract templates with network providers. The contract template revision will include contractor obligations to provide additional outcome measures that will be collected on an annual basis starting with Fiscal Year 2022-23. The revised contract templates will be fully implemented for all necessary network providers effective July 1, 2022. R7. Increase the use of MyChart health care information system to make clinical information accessible to clients...
F7
The use of personal devices makes County computers vulnerable to denial of ser- vice, data breaches or other cyber-attacks.
Response: Disagree Partially
Score: 0
Respondent agrees with the finding. F8. Tele-mental health services are not appropriate for a. Homeless populations b. Patients presenting with chronic schizophrenia with a limited capacity to manage the tasks of daily life c. Patients prescribed controlled substances or injectable medication. Response: Respondent disagrees partially with this finding. There could be instances where engagement with homeless populations is more accessible using telehealth or audio-only modalities. In-person services can sometimes be disadvantageous to clients due to logistical barriers such as transportation or...
R7
The Board of Supervisors direct the County Administrator by December 2022 to have all County departments identify and replace obsolete IT hardware. The Board of Supervisors direct the County Administrator by June 2022 to
Response: Implemented
Score: 0
The recommendation has been implemented. Currently, more than 50% of adults have a MyChart account. The use of MyChart has been well-received by clients, and utilization is growing. Clients using MyChart have full access to their medical record. BHS is also increasing the functionality within MyChart to include esigning forms and other functionality.
R8. Modernize the electronic data collection capabilities of the quality management program to provide meaningful information about mental health services. Response: The recommendation requires further analysis. BHS is currently undergoing a syst...
F8
IT expenditures and budgets in County departments are not transparently reported so it is difficult to identify redundant and duplicative IT expenditures.
Response: Disagree Partially
Score: 0
Respondent disagrees partially with this finding. There could be instances where engagement with homeless populations is more accessible using telehealth or audio-only modalities. In-person services can sometimes be disadvantageous to clients due to logistical barriers such as transportation or timing. In these cases, engagement with clients via telehealth can be the preferred modality, perhaps as an adjunct to in-person services. On the other hand, telehealth and audio-only is likely to be ineffective with patients described in b and c above. In-person service is required for clients who are ...
R8
require County departments to identify their planned IT spending in their overall budgets for transparency.
Response: Requires Analysis
Score: 0
The recommendation requires further analysis. BHS is currently undergoing a systems gap analysis to develop a technology strategy aligned with the direction of healthcare changes. There are major changes underway for major issues such as payment reform, documentation changes, outcome measures, and a long-term goal of value-based care. Integration with Primary Health and within BHS between Mental Health services and Substance Use services is part of the overall landscape of Behavioral Health Plans across California. As mentioned above, BHS currently uses two separate systems, one for clinical d...
F9
Decentralized IT structures increase vulnerability to cyber-attacks.
Response: Disagree Partially
Score: 0
, BHS has a full array of services available to meet the needs of the underserved in the community. The Telehealth Advancement Act of 2011 and several Notices from DHCS (Behavioral Health Information Notice No: 21-047; Behavioral Health Information Notice No: 21-047), have removed telehealth barriers and ensured parity between in-person services and tele-mental health services. BHS has fully embraced tele-mental health. Evidence of the commitment of BHS to tele-mental health is evident in the memo sent to BHS staff and contract providers on March 20, 2020: "Guidance Regarding Provision of Serv...
F10
The County’s IT structure is decentralized.
Response: Disagree Partially
Score: 0
Respondent disagrees partially with this finding.
Transportation issues have been long-standing challenges for mental health clients. Contra Costa is a large county and access to public transportation is a common issue. To address this challenge BHS has been involved in the "Barriers to Transportation Project," hiring two Community Support Workers as Commute Navigation Specialists (CNS) in March 2017. The program is a systematic approach to developing effective family and peer-driven transportation navigation support to the entire mental health system of care. Regarding long wait times, BHS i...
F11
Based on interviews, Contra Costa County is at a disadvantage to hire IT staff with cyber security expertise due to increased compensation and perks offered by some private enterprises.
Response: Disagree
Score: -1
Respondent disagrees wholly with this finding. BHS has devoted considerable resources into ensuring the diversity of clinicians to provide culturally and linguistically sensitive services to diverse minority groups. An in-house Ethnic Services Manager/ Ethnic Services Coordinator who helps ensure that the workforce has the background and training to work with diverse groups and develops the Cultural Humility Workplan, a living document with clear focus areas and goals. Additional resources include an ongoing training plan, differential pay for bilingual staff, and a Language Line with Health C...