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Extracted from Consolidated Report
This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.
Santa Cruz County Grand Jury
• 2024-2025
Santa Cruz County Civil Grand Jury Rainbow the Reports
⚠️ 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 7 findings
F1
Page 129
Data: The Health Services Agency has not developed and deployed analytic, data-driven reports to address the financial challenges in managing the Behavioral Health and Substance Use Disorder services, despite
F2
Page 130
Administrative: The Jury finds that many programs, such as the Focus Intervention Team, Integrated Housing And Recovery Team, 24/7 Mobile Crisis Response Team, and Enhanced Care Management, provide critical services to High-Cost Beneficiaries. Although they have overlapping goals there is little to no coordination for tracking clients that receive services from one or more of these programs. The lack of coordination leads to higher costs in an era of shrinking resources.
F3
Page 130
Clinical: Santa Cruz County does not have a Level of Care Tool to track and manage High-Cost Beneficiaries. The Central California Alliance for Health does have a Level of Care Tool to track and manage High-Cost Beneficiaries. The parties are partners in the delivery of services and their resources could be leveraged to create a unified Level of Care tool.
F4
Page 130
Administrative: Santa Cruz County programs and resources for High-Cost Beneficiaries, and all Health Services Agency behavioral health and substance use disorder services, are siloed and fragmented across HSA departments and contract providers. For example, clinical, financial, and operational benchmarks are not being used to report the cost of services and track patient acuity. As new programs are being developed, the financial, operational, and administrative targets are not established in advance or integrated into operations. County and Alliance collaboration and coordination can pave the way to overcome fragmentation.
F5
Page 130
Data, Clinical & Administrative: The Central California Alliance for Health (Alliance) has substantial financial reserves, and Santa Cruz County has seats on the governing board of the Alliance. Clinical, financial and operational collaboration between these agencies, who are both insurers and providers, needs to be better coordinated and integrated at all levels to improve treatment and outcomes for all clients.
F6
Page 130
Administrative: The Jury finds that the Serving Communities Health Information Organization and the Mental Health Advisory Board partnerships with Santa Cruz County could be better leveraged to have greater impact on Behavioral Health. Failure to leverage these partnerships results in missed opportunities to coordinate programs and services.
F7
Page 130
Compassion: Throughout the Grand Jury investigation, the Jury found that the staff and leadership of the Health Services Agency, Santa Cruz County Sheriff’s Office, and the Central California Alliance for Health are compassionate in the treatment of people experiencing behavioral health or substance use disorder. Patients are treated with dignity and respect, despite sometimes difficult conditions. High-Cost Beneficiaries published June 26, 2025 2024-2025 Consolidated Final Report 125
Recommendations 8
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R1Page 131Administrative Integration. The Board of Supervisors recently adopted Operational Plan #91 which calls for establishing a financial plan for the County behavioral Health system by December 31, 2025. Given the urgency of reduced funding, the Santa Cruz County Health Services Agency should provide a monthly progress report beginning August 1, 2025 to the Santa Cruz County Board of Supervisors on Operational Plan #91.
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R2Page 131Ongoing External Reporting. Given the urgency of diminishing funding, the Santa Cruz County Health Services Agency should publish a monthly report on its public website no later than October 1, 2025. The website should summarize patient volumes, cost benchmarks, quality benchmarks, provider productivity, number of patients being tracked for high utilization, and number of patients enrolled in Enhanced Care Management (through the Alliance). An appropriate subset of reports specific to Behavioral Health and Substance Use Disorder should be provided to the Mental Health Advisory Board beginning October 1, 2025.
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R3Page 131Ongoing External Reporting: In order to leverage their partnership with the Mental Health Advisory Board (MHAB) and raise public awareness around Behavioral Health in Santa Cruz County, the Health Services Agency and the Central California Alliance for Health should jointly report to the MHAB. Their reporting should occur at least bi-annually starting no later than June 30, 2026. Their report should discuss their collaborative efforts towards implementing a LoC tool, their progress towards developing value-based financing and should include Year-to-Date statistics on HCBs.
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R4Page 131Ongoing External Reporting: At least bi-annually beginning no later than September 30, 2025, Health Services Agency (HSA) and the Central California Alliance for Health (Alliance) should meet jointly with Serving Communities Health Information Organization (SCHIO). The meeting agenda should include a review of the data HSA and the Alliance submit to SCHIO and the SCHIO data and reporting features that HSA and the Alliance use. The goal is to leverage their partnership and better integrate the dissemination of accurate information to health care professionals and law enforcement about the treatment and needs of their clients. The outcome of the meeting should be reported to the Mental Health Advisory Board.
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R5Page 131Clinical Integration. Annually, beginning January 1, 2026, the Santa Cruz County Health Services Agency and the Central California Alliance for Health should review, align, and jointly publish their aligned clinical and program delivery methods and goals for all levels of Behavioral Health and Substance Use Disorder patients.
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R6Page 131Administrative, Financial & Clinical. By July 1, 2026, the Santa Cruz Health Services Agency and the Central California Alliance for Health should have a shared database and shared criteria for identifying potential High-Cost High-Cost Beneficiaries published June 26, 2025 126 Santa Cruz County Civil Grand Jury Beneficiaries. This Level of Care tool should track costs, services, and outcomes for not only Behavioral Health and Substance Use Disorder High-Cost Beneficiaries, but for all clients. The following California Health Care Foundation brief provides a starting point for building a more integrated system of care over the long term: Better Integrate Physical and Behavioral Health Care.
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R7Page 132Administrative Integration. The Santa Cruz County Health Services Agency and the Central California Alliance for Health should develop a seamless administrative process that uses standardized and shared data, reports and goals. No later than December 31, 2026, a report shall be submitted to the respective governing boards outlining the processes established to integrate network management, provider payment, and data collection and reporting.
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R8Page 132Financial Integration. On or before July 1, 2027, the County Health Services Agency and the Central California Alliance for Health should report to their respective governing boards the steps they have taken towards financial integration of all behavioral health services and substance use services using a value based financing process. Braiding Medicaid Funds described in the August 2024 Brief from the California Health Care Foundation provides a framework for achieving this necessary integration.
Conclusions 6
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CL1The grand jury’s legal obligation to inquire into the condition and management of each local detention facility within the county was fulfilled by touring the facilities, making general inquiries to the staff, and reviewing recent regulatory reports. vi Santa Cruz County Civil Grand Jury 2024–2025 SANTA CRUZ COUNTY CIVIL GRAND JURY Photo Credits: Cover picture by Shmuel Thaler / Santa Cruz Sentinel, Picture of Jurors is a personal photo. 2024-2025 Consolidated Final Report 1 “Climate Action” Demands Outreach . County staff alone cannot meet our County’s climate goals. Summary Santa Cruz County, like all other counties in California, was tasked with specific climate action goals by the State of California legislature in 2016 (Senate Bill 32) and again in 2022 (Assembly Bill 1279). The County has responded with proposed written actions that will advance the stated climate goals. But making a meaningful dent in those goals requires citizen cooperation. The County has conducted minimal to no outreach to the community and has failed to achieve widespread citizen engagement in the effort to mitigate climate change, specifically in reducing the production of greenhouse gases (GHG) caused by vehicle emissions. It is crucial to have increased citizen involvement in implementing climate action goals for the benefit of all. The Santa Cruz Grand Jury (the Jury) encourages the County’s Office of Response, Recovery & Resilience (OR3) to engage with the citizens of Santa Cruz County to increase the community’s understanding of the goals and gain the community’s cooperation in reducing GHG’s so that the County can achieve the larger goals established by the State of California. Climate Action Demands Outreach published June 2, 2025 Page 1 of 14 2 Santa Cruz County Civil Grand Jury Table of Contents Background 3 Scope and Methodology 4 Investigation 5 Storymap Website Created for Public Use 5 Other Public Information Sources 6 Reaching out to John Q. Public 8 Conclusion 8 Findings 9 Recommendations 10 Required Responses 10 Invited Responses 10 Definitions 11 Sources 11 References 11 Websites 13 Site Visits 14 Climate Action Demands Outreach published June 2, 2025 Page 2 of 14 2024-2025 Consolidated Final Report 3
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CL2“Everybody knows” drunk driving is dangerous, yet we still mount campaigns to raise awareness. “Everybody knows” that wood houses burn down in fires, yet fire departments still develop websites about fire-wise landscaping. And “everybody knows” that gasoline-fueled cars emit pollutants. Unfortunately, to date, the County has no public campaign to directly address this largest pollutant source in the county. Passenger vehicle use is the largest single polluter shown in the CAAP. The goal given by the State of California to the County covers all emissions. Yet the Jury was told that Outreach was not the County’s job.[3] [5] As currently assigned, the responsibility for achieving CAAP goals rests with the County OR3. Climate Action Demands Outreach published June 2, 2025 Page 8 of 14 2024-2025 Consolidated Final Report 9 The County has admitted that it cannot meet its state-mandated climate emission reduction goals without the cooperation of the community at large. Since climate change represents an existential threat to all citizens, the Santa Cruz County Grand Jury urges the County to reprioritize climate Outreach.
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CL3We have evaluated the outstanding progress made by our local government towards improving operations. When the agencies accept the recommendations, follow through and meet their expressed commitments, our community benefits from increased government transparency and accountability. 2025 Findings, Recommendations, and Commendations
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CL4The Santa Cruz County Grand Jury believes that the public and the professionals, both private and on staff, will benefit from a more customer-focused and efficient process for obtaining building permits. With that objective in mind, the 2024-2025 Santa Cruz County Grand Jury respectfully submits the following findings and recommendations.
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CL5The main function of California’s Civil Grand Juries is to promote transparency and accountability within departments and agencies of local government. The following recommendations from the Santa Cruz County Grand Jury will help the Watsonville Police Department more effectively and efficiently engage with the people of Watsonville. This will reduce trauma for those cited for minor infractions and the other community members involved and will also improve relations with the community. Ongoing and straightforward communication between officers and the people they serve leads to officers being seen as positive role models and prevents crime. Handcuffing and Transport published June 18, 2025 Page 9 of 17 72 Santa Cruz County Civil Grand Jury
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CL6Human trafficking does occur in Santa Cruz County, but goes largely unrecognized and unreported. Lack of data regarding human trafficking activity, lack of collaboration among stakeholders, insufficient training, and lack of compliance with state and local laws leave us in the dark as to the prevalence of human trafficking. As a result, the issue is not being adequately addressed, and the trafficking problem will continue unabated and possibly increase, unless proactive measures are taken. The Jury is hopeful that recommendations in this report to address the scourge of human trafficking in our community will be seriously considered and adopted. Reducing Human Trafficking published June 30, 2025 Page 18 of 28 98 Santa Cruz County Civil Grand Jury
Commendations 2
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CM1C1. The Santa Cruz County Civil Grand Jury commends our County CISO for regularly attending the semi-annual conference of CCISDA (California County Information Services Directors Association). The frequent exchange of information and the comparison of experiences between counties is very helpful. In addition to leading the Consortium, the CISO also now leads an internal group involving IT, the Sheriff’s office, District Attorney, Human Services, and other offices as needed. C2. The City of Santa Cruz remains committed to strengthening its cybersecurity resilience framework and continuously improving its workforce strategies and response capabilities. The Santa Cruz County Civil Grand Jury commends the City of Santa Cruz for protecting the community by prioritizing its Information Technology Department including hiring a Cybersecurity IT Manager. We also commend the City of Santa Cruz for successfully creating a comprehensive Cybersecurity Plan. C3. The Santa Cruz County Civil Grand Jury commends the City of Scotts Valley for protecting the local community by hiring a local Scotts Valley firm for administering its Cybersecurity framework and response capabilities. Honoring Commitments published June 17, 2025 Page 17 of 24 32 Santa Cruz County Civil Grand Jury C4. The Santa Cruz County Civil Grand Jury commends the Sheriff's Office for the services provided to the women at Blaine Street since reopening in 2023. Blaine Street is the minimum security women’s facility in Santa Cruz. Earning the privilege to move from the Main Jail to Blaine Street gives the women a sense of self-worth and pride in their accomplishments. They are appreciative of the vast services offered at Blaine Street and take advantage of these programs to better themselves. The evidence of support for one another as women is a result of the incredible staff, and the programs and services offered. C5. The Santa Cruz Civil Grand Jury commends the Sheriff’s Office for recognizing the need for a dedicated dental clinic and dental services at the Rountree facility location. The benefits are indeed significant for all involved. C6. The Santa Cruz County Civil Grand Jury commends the Public Defender’s Office for providing funding for holistic care. C7. The Santa Cruz County Grand Jury commends the Santa Cruz County’s Behavioral Health Division for effectively improving access to care, and promoting the mental well-being of our community. C8. The Santa Cruz County Civil Grand Jury commends County Behavioral Health for providing 24/7/365 mobile crisis response services. Also notable, as part of the Crisis Now Innovation Project, Behavioral Health is conducting ongoing evaluation of current services. The goal is to identify gaps in the crisis continuum of care and develop recommendations to address those gaps.
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CM2C1. The Santa Cruz County Grand Jury believes that the management of the Watsonville Police Department is truly concerned about the safety of everyone in Watsonville. This is demonstrated by their desire to protect the vulnerable from harm and treat everyone with respect. (F6) Handcuffing and Transport published June 18, 2025 Page 11 of 17 74 Santa Cruz County Civil Grand Jury