County of San Luis Obispo Board of Supervisors Agenda Item Transmittal

R1

The County Health Agency’s Drug and Alcohol Services should resume its concentrated efforts to develop a residential detox service in the County to serve its Medi-Cal and less financially able citizens. This recommendation has been implemented. The County is currently participating in a planning effort in partnership with a community agency towards development of residential detox in the County. Additional efforts to develop the services and/or attract providers to meet the requirements for network adequacy within three years under the new Drug Medi-Cal Organized Delivery system will continue.

R2

The Board of Supervisors should direct the Sheriff and the Health Agency to evaluate the feasibility of and approach to repurposing vacated buildings within the County Jail’s honor farm as a residential detox service. A final report on the feasibility and if indicated the specific steps required to convert this housing to a substance-abuse residential and/or treatment facility should be completed by June 2018. This recommendation has not yet been implemented, but will be implemented. The Health Agency and the Sheriff will work together through the San Luis Obispo County Community Corrections Partnership (CCP) to evaluate the feasibility of and approach to repurposing vacant buildings in the County Jail’s Honor Farm as a residential detox facility. Because of the inter-agency nature of the services being evaluated, the CCP is the best venue for this evaluation. The CCP is a standing committee that, by statute, includes the following members:  Chief Probation Officer  Sheriff-Coroner  Chiefs of Police (a representative)  District Attorney  DA-Victim Witness (a representative)  Public Defender  Presiding Judge of the Superior Court (a representative)  Health Agency-Behavioral Health Department  Health Agency-Drug and Alcohol Division  County Administrative Office (a representative)  Community-Based Organizations (a representative) The Health Agency and the Sheriff will bring a report on the feasibility of converting this vacant space to the Board of Supervisors for further consideration by June 2018.

R3

The County Health Agency’s Drug and Alcohol Services should expand its County Jail programs, including individual and group counseling, to cover inmates who go through withdrawal protocols regardless of AB 109 status. This recommendation requires further analysis. The County will evaluate the needs for additional drug and alcohol treatment in the County Jail. The evaluation will include analyses of the inmates’ addiction status and treatment needs, treatment space requirements, and cost. The County will prepare this analysis , in advance of the development of the FY 2018-19 County budget.

R4

The County Jail should revise inmate classification and cell assignment to take into account the inmate’s substance abuse treatment needs and interest in such when determining cell placement. The recommendation requires further analysis. The Sheriff’s Office believes and agrees with the recommendation and this is done whenever possible, however, based on the configuration and classification of inmates, doing so could be very difficult to accomplish. The Sheriff’s Office agrees that placement of inmates could be possible, in some cases, with added programming space.

R5

The County Jail should house inmates interested and/or involved in drug and alcohol services in such a way as to create groups of addiction-treatment participants (e.g., units or pods) that allow for efficient delivery of treatment services; this includes separation from other inmates who interfere or disrupt treatment participation. The recommendation requires further analysis. The Sheriff’s Office agrees with the recommendation however, based on the configuration and classification of inmates, doing so could be very difficult to accomplish. The Sheriff’s Office agrees that this could be possible, in some cases, with the added programming space.

R6

The County Health Agency and Sheriff should integrate the functions of the jail’s medical and drug and alcohol service providers by locating their offices in close proximity and requiring coordinated care for inmates with substance use disorders. This recommendation has not yet been implemented, but will be implemented when the new medical facility and jail programming space is completed.

R7

The County Health Agency should pilot the usage of medication-assisted treatments, i.e., Buprenorphine and Naltrexone, with a select population of opioid and alcohol addicts at the County Jail. This recommendation requires further analysis. The Health Agency already continues medication assisted treatment in jail for inmates who enter the jail on Methadone treatment. The Health Agency also initiates methadone treatment for pregnant women for whom that protocol is indicated. The Health Agency is involved with a learning community through the California Healthcare Foundation to study the use of medically assisted treatment (MAT) in jails/prisons with the goal of developing a pilot for a sustainable plan for both the cost of staff and medications in jail. Health Agency staff will collaborate with Sheriff’s Office staff to ensure the development of appropriate operational processes. Health Agency staff will evaluate the need for increased staffing and/or other resources by the end of the calendar year.

R8

The Board of Supervisors should evaluate the Law Enforcement Assisted Diversion program or a similar pre-booking substance abuse diversion for County implementation as a means of motivating and engaging young adult arrestees who are assessed to be primarily substance abusers and not criminally oriented. A written evaluation by the County Administrative Officer should be reviewed at a meeting of Board of Supervisors by June 2018. This recommendation has not yet been implemented, but will be implemented. The Board of Supervisors will direct the San Luis Obispo County Community Corrections Partnership (CCP) to examine the Law Enforcement Assisted Diversion program or similar program to assess the feasibility and level of inter-agency support for such a program in San Luis Obispo County. Because of the inter-agency nature of the program model, the CCP is the best venue for this evaluation. The CCP will bring a report on the feasibility of this type of program to the Board of Supervisors for further consideration by June 2018. III. Recommended Responses from the Sheriff: Under Penal Code section 933, elected officials, including the Sheriff, must respond and may respond directly to the Presiding Judge and the Grand Jury, which the Sheriff has done. The Sheriff’s responses are provided below. A copy of the document transmitting the Sheriff’s responses is attached to this staff report.

R10

The County Health Agency should direct its Drug and Alcohol Services to work with the board of the homeless shelter to develop a plan for operationalizing two detox beds in the yet-to-be- built Homeless Services Center, which could entail the DAS providing onsite outpatient detox services if other treatment options are not viable. This plan is to be developed prior to the opening of the center or by June 2018. This recommendation has already been implemented. Health Agency staff members are already participating in a planning effort with the Homeless Services Center to develop a continuum of drug and alcohol treatment options, including detoxification, residential treatment, and outpatient levels of care. The development and completion of the plan is dependent on the timeline set by the Community Action Partnership of San Luis Obispo (CAP-SLO), owners of the Homeless Services Center under construction. II. Recommended Responses from the County Board of Supervisors: