Submittal to the Board of Supervisors County of Riverside, State of California Item: 3.28

Recommendations 26

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  ,u121 Aug2l Sep2l m21 Nov 21 Dec2l Jan22 Feb22 Mar22 Apr22 M.y22 lun22 Agency Requesting Crisis Services (B( A 2 P * S 1% City tmploye€ The majority of requests for MCMTs for crisis a5* county 8H/5UD Service came from Schools (45%) and x€pnd Hospitals (21%). 21r Otha. lt* llta RUHS-BH Eva luation 20 Mobile crisis Management Teams (MCMTI Demoeraohics MCMT teams served 589 individuals (476 individuals needing crisis services) during the zozl/2o22 hscal year. The demographics presented here is for all clients including those who received Crisis, Homeless Outreach, and MCMT Non-Crisis Outreach service, Gender of MCMT clients MCMT served more females Tranigender at6 (49%) than males (47%). tairh arx lndividuals identifying as Transgender accounted for 4% of all MCMT clients. 0a Age of MCMT clients OU.r dult 60+ 10t( Over a third (3a%) of MCMT AduhrGS9lr. clients were teens age 11to 15 years. Adults age 26 to ral lll,rtr 59 years accounted for 30% rti of clients served by MCMT teams. Ethnicity of MCMT clients Forty-four percent (440/"1 of MCMT clients were Hispanic/Latinx, 34% were lx White/Caucasian, and !3oA were Black/African ab<t/Alraar ADrt(,n 4* tltla American. A quarter of MCMT clients 125%l were reported as experiencing homelessness, while 2% of clients were Veterans. RUHS-BH Evaluation 27 Mobile Crisis Management Teams (MCMTI MCMTs divert individuals from an unnecessary inpatient admission wherever possible. The figure below provides the diversion rates for requests for crisis service. Homeless outreach and MCMT non-crisis outreach were excluded from these analyses. ln addition, requests in which the consumer refused services (5%, n = 13) were excluded from diversion rate calculations. lndividuals are considered diverted if they were diverted with a safety plan or were diverted to the MHUC. Percentage of Crisis Requests Diverted MCMTS was able to divert 57% of Crisis requests t{ot DY.n d l''a from an inpatient admission. Drvcncd 6?% Disposihon of Crisis Requests a{D The figure to 350 \ the left provides l@ the dispositions 2SO of MCMT Crisis 2@ requests. 150 112 r@ lndividuals 50 IJ I r l 5 either diverted 0 I with safety plan ll t . t fl a ty 6 b ? . L n t F M n H .d ( t r o c tr 5 d 1 . 5 b 0 v h a o d ld rr to .n o i. t r tE .d r Tr t . r .$ E {,o ra n n to r l t r i . . . d t t o o t .t t t lo yotu E n t t s ry ro or were tq.ubbd) MoD{. Ciid. Pq/,ch diverted to one T.rn the county's MHUCs- RUHS-BH Evaluation 22 Mobile Crisis Management Teams (MCMT) Linkaqe to Outpatient Services MCMTs provide referrals to outpatient services. RUHS-BH service data was used to examine service usage after contact with MCMTs. Clients were considered to be linked to outpatient services if they had an outpatient, substance use, or youth short-term residential program service record. lndividuals who were recorded as having private insurance were excluded from these analyses. Linkage to Outpatient Service Almost half (48%) of individuals served by MCMTs were linked to outpatient services nbrOhrn after contact with an ,73 Notlin*cdlo Linl.dllo MCMT team. Some Outpatl.nt Outpat!cnt individuals (39%) served s 30 !x 7 4 2 E 4 % 2 by MCMTS were already fllcClna participating in r09 outpatient services prior to their contact with MCMTS. EnBagement in Services The maiority (74%) of MCMT clients linked to outpatient services I to It Sa?vr(.. engaged in three or more 3l'l services. For clients with lcr rlra 3 or more services, the La 2 a f l f dE ta , r a ita * r, 15 to 3 ! {) r S x .rric.t average number of services was 31. tl o. i^orr Lrvlo Itx Readmission Rates for MCMT The table to the left provides the repeat Days to Readmission % crisis encounter rates at less than 15 days after first crisis contact and at 16 to 30 0 to 15 Days 3.34y" days after first contact with McMT teams. 16 to 30 Days o.98% 0 to 30 Days 4.32o/o RUHS-BH Eva IUation 23 Mental Health Urgent Cares (MHUC) Admissions The Crisis Support System of Care includes three regional Mental Health Urgent Care (MHUC) facilities (Riverside, Perris, and Palm Springs). lndividuals experiencing a mental health crisis can walk-in to an MHUC and receive individualized support 24 hours a day, 7 days a week. 5taffed by a competent, caring team, MHUCs provide a safe, supportive, recovery-oriented environment. The MHUC offers a variety of services such as assessment, peer support, psychiatric and medication support, recovery education, community coordination and follow-up. The MHUCS serve individuals 18 years and older with the Oesert and Mid-County MHUCs also serves adolescents 13 years and older. Requests for Service During the 202U2022 hscal year MHUCS had a total of 10,578 admissions (July 1, 2021June 30,2022],and served 5,909 unduplicated clients, The figure below provides the MHUC admission per month for each MHUC. MHUC Admissions 10,578 MHUC West 3,890 MHUC Mid-County 3,794 MHUC Desert 2,894 MHUC Admissions per Month 5@ 450 4@ 350 3m 250 2@ 150 lm I 50 o lul21 Aug 21 sep 21 Oct 21 Nov 21 Dec 2t lan22'Eeb22 Ma.22 Apt 22 May 22 r MHUC Wed 235 316 3ia 325 338 313 319 303 347 337 370 339 r rixuc uU-corntv 362 318 328 330 298 2s3 251 259 328 30s 345 407 MHUC Delen 207 237 2Q 232 211 245 258 229 2n 2fi 276 276 RUHS-BH Evaluation 24 Mental Health Urgent Cares (MHUC) Demoeraphics MHUC facilities served 5,909 individuals during the 2021l2022 fiscal year. Gender of MHUC Clients 1@16 All three regions served 90,6 more male than female 8016 clients. Gender was not 7 reported for 6 individuals. 6016 5(},6 4('( 3ota 8X 5a 20,4 47t, 42.}i 106 6$ Des€ rl Age of MHUC Clients 1@ra i wesr r Mid.Counw Oes€n Mid-County and Desert 90t6 a0'6 MHUCS serve clients 13 70x years and older, while the 5& 55'( West MHUC serves clients 50t6 4(t6 18 years and older. ,& Overall, the average age 70x f "*.o* of MHUC clients was 36 1(ra Fx ,* rl* tr (age was unknown for 3 096 clients). (13 yrs to !7yB) Ethnicity West Mid-County Desert Am. lndian/Alaska Native lo/o The MHUC Desert had the Asian/Pacific ls. r% t% Lo/o highest percentage of BIack/African Am. !4o/o 9o/o to% Hispanic/Latinx clients Hispanic/Latinx 32% 27% 39% l3e%1. Multi-racial 2% t% Lo/o Other/Unknown 27% 51% 7L% White/Caucasian 23% LGYo 38% RUHS-BH Evaluation 25 Mental Health Urgent Cares (MHUCI Lin kage to Outpatient Services The MHUCs assist consumers at discharge with linkage to outpatient services. Overall,25% of those served by MHUCs, were linked to outpatient mental hea lth/substa n ce use services. The figure below provides the percent of individuals linked to outpatient mental health/substance use services after an admission at one of the county's MHUCS. Some individuals (n = 103 or 7o/ol were placed in a County short term Crisis Residential program (CRT) following their MHUC admission. Percentage of MHUC Clients Linked to Outpatient Services t@16 90,6 M 7* w" 5(,6 Linkedto l-inked to tin*ed to oIutpatient Outpatient 4go Outpatient Services S€rviaes 5€rvices 3096 26% 24% 27% 2(Yo l0go 096 Mid.County Dese rt Re-admission rates for each of the three MHUCs are shown in the table below. percentages are discharges from the MHUC followed by another admission for the same client 15 days or less or 16 to 30 days after an MHUC admission. Recidivism rates for 15 days or less were highest for the Western MHUC (29%). Readmission Rates for MHUCs Days to Readmission West Mid-count! Desert 0 to 15 Oays 29% 74o/o 25% 16 to 30 Days 7% 6% 0 to 30 Days 36% 27% 3t% satisfaction data collected from Riverside and palm springs MHUcs show that overall, 96% of clients who received service during the zozl/2ozz fiscal year agreed or strongly agreed with the items on the satisfaction questionnaire. RUHS-BH Evalua6on 26 Crisis Residential Treatment (CRTI Crisis Residential Treatment facilities Located in each of the three county regions, Crisis Residential Treatment Facilities (CRT) provide enriched recovery based peer-to-peer support and interventions with the goal of stabilizing clients in acute crises in order to eliminate or shorten the need for inpatient hospitalization. Designed to provide a home-like service environment, the CRT has a living room set up with smaller activity/conversation areas, private interview rooms, a family/group room, eight (8) bedrooms, laundry and cooking facilities, and a separate garden area. lndividuals may stay at the facility for up to 14 days. Adm issions The CRT facilities had 1,044 admissions during the 2o2Ll2o22 Fiscal Year. The figure below provides the number of CRT admissions per month for each cRT for the 2o2L/20?2 fiscal year The Mid-County CRT began serving clients in August 2021. CRT Admissions 1,o44 West CRT (Lagos) 438 Mid-County CRT (Jackson House) 98 Desert CRT (lndio) 508 Number of CRT Admissions per Month r CRT Riv€Gide . CRT Mid{ounty CRT Oesen 60 50 40 45 'lS 38 36 17 37 37 30 33 3l 3/t 3a 31 20 10 I 6 t 8 6 9 6 8 0 lul21 Au821 Sep2t Oct 21 Nov21 Dec21 )an22 Feb 22 Mat 22 Apt 22 M'y 22 Jun22 27 RUHS-BH EValuation Crisis Residential Treatment (cRT) DemoRraph ics The CRT facilities served 725 individuals during the 2021/2022 fiscal year. Gender of CRT Clients 100% 9096 80% More males than 70x females were served by the CRT at each of 60% the three county 50% facilities. Gender was 4OYo i,hL Md. not reported for 5 M.b tox 30% 65X individua ls. 54X 2Wt 440/" t49a 1o% 29./. o% West CRT Mid-County CRT Desert CRT ABe of CRT Clients 1@X The majority of CRT 9(h 83% B3* clients were adults 80'6 l4% (age 26 to 59 years). 70r4 The average age of CRT 60'6 clients was 37 years 5(,6 40,6 3(}96 22% zalx 16% 16% 1016 l% 4% 03% ot6 we$ cRT CRT Mid{oirnty Dese n CRT I , lS lo 25 Fers 2610 59ye.rs 60yearsand older The Desert CRT served Ethnicity West CRT Mid-County CRT Desert CRT the highest percentage of Am. lndian/Alaska Native to/o Lo/o Hispanic/Latinx Asian/Pacific ls. 7% 1% clients (41%), while Black/African Am. L6% 76% t9% the Mid-County CRT Hispanic/Latinx 39% 26% 470/o served the highest Multi-racial 3% percentage of Unknown t5% t0% 8% White/Caucasian White/Caucasian 28% 43% 3L% clients (43%). RUHS-BH Evaluation 28 Crisis Residential Treatment (CRTI Linkage to Outpatient Services The CRTs assists consumers at discharge with linkage to outpatient services. The percentage of clients linked to outpatient services after admission to a CRT was highest at the Mid-County cRT (44%). Percentage of Clients Linked to Outpatient Services after a CRT admission l@x 9(,6 8()'6 7& 5(]9( 50'6 4W LMto 30'6 Llntcdto Ur*!dto Outpltit,rt (},tt tLar Outp.tlcnt 2ffi LrYlo Scrvlccs (x Scrvlcat wo 42% ao,a 09( Wen CRT Mid-County CRT Desert CRT Re-admissions rates to the CRTS are shown in the table below. Percentages are discharges from the CRT followed by another admission for the same client , 16 to 30 days, and 30 days or less. The West CRT had the highest rate of readmission for 30 days or less (2Oo/.1. Readmission Rates for CRTS West Days to Readmission Mid'County Desert 0 to 15 Days L5% 6/o 8o/o 16 to 30 Days 5% 6% 4% 0 to 30 Days 20% 72% !3o/o RUHS-BH Eva luation 29 Attachment E: Behavioral Health Department Response: Grand Jurv Response: Suicide: A Trasedv Affectinq All of US: Riverside Counw Data & Local Resources FINDINGS Finding 2: The Civil Grand Jury finds two observations during this investigation: 1. Desplte reasonable efforts to improve the deslgn of forms and to establlsh single points of contact, citizens still perceive intake forms as cumbersome; and 2. Citizens expect govemments to act proactively by initlating appropriate government services themselves, instead of relying on requests for servlces from users. Therefore, offering County residents the convenience of having multiple needs met in one physlcal location is a continuing need. Response: Agree ln response to the findings from the Civil Grand Jury, we concur with the observations presented. RUHS-Behavioral Health (RUHS-BH) has worked diligently to address the identified issues and enhance the service delivery experience for Riverside County residents. 1. Cumbersome lntake Forms: While we recognize concerns regarding the perceived cumbersome nalure of our intake forms, we have actively addressed these challenges. One of our significant responses was the establishment of lhe "Subcommittee for Standardization of lntake Paperwork." This team has been pivotal in refining our intake processes to be both user-friendly and comprehensive. Furthermore, with a keen eye on the diverse backgrounds of our consumers, we ensure forms are culturally sensitive, incorporating multiple languages and framing questions to respect cultural differences. ln our drive for efficiency, we introduced the "No Wrong Door" policy under lhe CalAlM initiative, ensuring consumers are guided appropriately regardless of their enlry point into our system. Additionally, we are consolidating multiple intake documents into a single comprehensive form to reduce redundancy. lt is worth noting that while we aim for streamlined processes, some forms, like lnformed Consent and HIPAA authorization, remain non-negotiable due to their legal and ethical imporlance. They are crilical in safeguarding consumers' rights, even if occasionally considered lengthy. Our initiatives underline our steadfast commitment to enhancing the consumer intake experience while mainlaining our high standards of service, legality, and ethics. 2. Proactlve Government Services: ln alignment with the Civil Grand Jury's recommendation for proactive governmental services, RUHS-BH has adopted the lntegrated Service Delivery (lSD) model, which provides residents with a unified,one- stop shop' experience. lSD, which represenls a significant shifl from a program-focused approach to a person-centered care model, aligns with the 'one-stop shop, strategy recommended by the civil Grand Jury. ISD exemplifies our dedication to addressing citizens' growing demands and our commitment to delivering integrated, efficient services to Riverside County residents. The Jurupa Valley Community Health Center is the ISD model's pilot site. Here, we have actualized the concept of a 'one-stop shop' service experience. This pilol involves multiple county departments - RUHS-BH, Public Health, lvledical Center and Community Health Centers; DPSS; First 5 Riversidei Office on Aging RCIT; and others - allowing us to tailor integration strategies to the unique needs of the communities served and evaluate their impacl on staff and service provision. Co-locating diverse Riverside Counly services eliminates redundancies in intake and assessment processes and collaboratively leverages resources across county deparlmenls. We are expanding this model to all remaining CHCs, prioritizing the nelit phase to ensure impact across the additional four Supervisorial districts. Using a phased approach will ensure a smooth rollout by learning from each stage. The ISD model is focused on crealing a user-friendly nelwork of services that address immediate needs while introducing various county resources. All our decisions, from service coordination to resource allocation, are data-driven to guarantee timely and relevant consumer assistance. Additionally, we are collaborating with other departments to pilot the ISD model outside CHC environments. Furthermore, the Enhanced Care Management (ECM) program under the CalAlM initiative embodies RUHS-BH's commitmenl to comprehensive care. The program caters to individuals with multifaceted medical and mental health needs across various settings - from homes and shelters lo community spaces. Recognizing the broad spectrum of health determinants, the ECM program emphasizes robusl community support in areas such as housing and medical nutrition. An integrated feedback mechanism ensures the model continually adapts to the community's dynamic needs. The Board of Supervisors and department leaders have committed signilicant financial and staff resources lo ensure the successful implementation of lSD. Further, an Oflice of Service lntegration was established lo guide the county-wide effort. Building on this momentum of foresight and strategic action, recognizing the need for proactive governmental services, and prioritizing our citizens'needs, the planned Mead Valley Wellness Village stands out as a model of excellence. Set to slart construction in eady 2024, the facility will showcase Riverside County's advanced approach to healthcare. The Wellness Village is strategically designed around the Behavioral Health Conlinuum of Care model and stands as a resolute answer to the region's critical health challenges The Wellness Village brings these citizen expectalions to life through a comprehensive range of services encompassing primary healthcare, behavioral healthcare, dentistry, mammograms, x-rays, and pharmacy services. At its core, the Village is built to eliminate patient wait times by centralizing healthcare services. This translates into the proactive government action citizens desire - efficient, timely, and comprehensive care without repeated service requests. ln this manner, the Wellness Village transcends being merely a healthcare facilityl it transforms into an all- encompassing campus dedicated to holistic well-being. This approach meels the ongoing need for streamlined solutions directly benefiting County residents. Key elements of the Wellness Village include: Residential Behavioral Health Programs: Within the Village campus, there will be provisions for a Substance Use Disorder Treatment Facility, Crisis Residential Treatment Facility, Adult Residential Facility (ARF), Mental Health Rehabilitation Center (MHRC), Children's Short Term Residential Trealment Program (STRTP), and a Children's Crisis Residential Program. Residential Facilities: Designed to foster a communal environment, individual and family apartments will cater to those facing behavioral health challenges (mental health and substance use disorders) who actively engage in treatmenl services via our outpatient program. Outpatient Behavioral Health Programs: The Village will extend outpatient services targeting mental health and substance use disorders. Additionally, the site will offer urgent menlal health care for children, adolescents, and adulls. Comprehensive primary physical health care services will also be accessible across all age groups. These services include: o Specialized and general health services o Tailored physical health services catering to specific populations o Denlistry, mammograms, X-rays, and an onsite pharmacy o lnclusion of a WIC office for nutritional supporl and education The Wellness Village will also undertake the following initiatives: Broadening avenues for healthcare and food accessibility Establishing an attractive workplace environment aimed al drawing top-tier talent and fostering community support Contributing to the local economy through activities in nearby businesses Forging partnerships with colleges and Workforce Development, enabling career mentorship and advancement opportunities RUHS'BH has undertaken proactive measures that align with citizens' expectations of governmenl-initiated services. lnitiatives like the lntegrated Service Delivery (lSD) model, including the 'No Wrong Door' policy under the CalAlM initiative, provide a unified experience and address the need for a central hub to caler to various needs. The forthcoming Mead Valley Wellness Village encapsulates this vision, strategically designed to offer a comprehensive range of services, including primary and behavioral healthcare, dentistry, mammograms, X-rays, and pharmacy services. By centralizing healthcare services and focusing on prompt, comprehensive care, the Wellness Village will not only meet bul surpasses the ongoing need for accessible, multi-service solutions, echoing the desire expressed by the Civil Grand Jury. Moreover, our ongoing effo(s to streamline intake processes, including the establishment of the "Subcommittee for Standardization of lntake Paperwork," showcase our commilment to addressing citizens' concerns while maintaining high standards of service, legality, and ethics. Finding 3: The Civil Grand Jury finds Riverside University Health System - Behavioral Health has significant partnerships with Riverside County agencies and communlty partners to serve the needs of County residents. Response to Finding: Agree; RUHS-BH in collaboration with Veterans' Services Prevention and Early lntervention (PEl)is a Mental Health Services Act (MHSA) component. A PEI plan is included in the annual MHSA planning process for each of the MHSA components- By design and community stakeholder direction, most PEI programs and services are contracted to community-based organizations that know their community best. PEI programs are intended to engage individuals before developing a serious mental illness or emotional disturbance or alleviate the need for additional or extended mental health treatment. A key element in reaching underserved, at-risk communities is offering programs where mental health services are not lraditionally given, such as schools, community centers, faith-based organizations, etc., and supporting local community-based organizations known and trusted by the community to deliver services. With this focus, Prevention and Early lntervention (PEl) has contracts with: Perris Valley Filipino Americ€n Association; lnland SoCal United Way 211+; Vision y Compromiso; Riverside-San Bernardino County lndian Health; Special Services for Groups; The Wylie Center: l\4Fl; California Family Life Center; The Latino Commission; Operation Safehouse; The Center; lnland Caregiver Resource Center; Jurupa Unified School Dislricl; Reach Out; Riverside Community Health Foundation; California Health Collaborative; Sigma Beta Xi; Family Health; and Support Network, among others. Furthermore, to ensure a holistic approach for our residents with heightened needs, our affiliations expand to inter-departmental partnerships, underscored by MOUs with RUHS-Public Health, the Ofiice on Aging, and Hemet Unifled School District. RUHS-BH also works in close collaboration with Riverside County Veterans' Services to ensure our veterans receive the support they need lo lead fulfilling lives post-service. The referral system from Veterans' services for behavioral health services is designed to be efficient, personalized, and responsive to the unique challenges veterans may face. Additionally, PEI is an originating chair{or the Suicide Prevention Coalition, a coalition of community and public service organizations to address multiple domains related to suicide prevention. Membership includes representatives from most county departments (including DPSS, Housing Authority, Youth Advisory Council, Office on Aging' and others), many community-based organizations, faith-based groups, and private-sector businesses. The partnerships of RUHS-BH are not confined to just these collaborations. our crisis Support System of Care (CSSOC) consistently witnesses interaction between multiple County and community agencies. The reach of our community Behavioral Assessment Teams (CBAT) and Mobile crisis-Response (MCR) is extensive, with entities ranging from the Riverside sheriffls Department, local fire departmenls, community shellers, faith-based organizations, and local businesses. ln conclusion, our commitment to the community is resolute and unwavering These parlnerships are more than just collaboralions; they are the connections binding our community, enabling us to offer timely and effective seNices- We remain committed to fortifying these relationships. Findlng 4: The Civll Grand Jury finds that 988, the newly estabtlshed Sutcide & Crisis Lifeline, diverts Riverside calls through the Los Angeles County call c6nter, Upon identifying as a Riverside resldent, the caller is referred to a secondary number. Though interpretatlon into over 240 languages and dlalects is marketed as available 247 wlth average time to be connected to an interprater within 17 seconds, this was not our experience when requesting interpretation. Response: Agree; RUHS-BH in collaboration with Veterans' Services A program of lnland SoCal United Way & 211+, the lnland SoCal Crisis and Suicide Helpline is available 2417 by calling 951686-HELP (4357). The service is a bilingual hotline staffed by highly trained and compassionate crisis counselors who are as diverse and representalive as the lnland SoCal Region. Counselors assist with emotional support, suicidality assessment and prevention, coping skills, and resource referrals and offer a warm hand-off for mental health services. Additionally, they provide help for a range of other mental health-related crises and experiences such as suicide loss survivor grief, abuse, domeslic violence, identity and relationships, and other sensitive topics. Helpline now also serves as the communities' front door to access the RUHS-BH Mobile Crisis Response teams. ln efforts to continue to strengthen Riverside County's Crisis System of Care and mirror lhe infrastructure of the 988 nelwork, Helpline statf/volunteers screen community members in crisis for the appropriateness of an in-person response from the RUHS-BH mobile crisis teams. The Helpline connecls communily members to the mobile crisis team dispatch cenler when indicated. ln FY22123, there were 5,331 calls to the Helpline. Of those calls, 3,398 were mental health- related, and 888 had suicidal content. There were also 174 warm translers from the Helpline to the RUHS-BH Mobile Crisis Response Team. The 988 system's structure and operations are centralized at the state level. while Riverside County cannot direclly change this system, it can advocate for such changes. The nearesl call center within lhe 988 network is Los Angeles through Didi Hirsch Mental Health services, which serves as the 988 center for seven southern california counties. Although Riverside county's Helpline applied to become a 988 call center, the application was paused during the transition to the 988 system. RUHS-BH leadership and the suicide Prevention coalition have been engaged with Didi Hirsch to promote the integration of the Helpline into the 988 network. The primary goal is establishing a localized call center in Riverside that effectively serves the county's residents. This would minimize the need for call transfers and enable more comprehensive oversight. Despite an initially positive dialogue, subsequent attempts to follow up with Didi Hirsch have noi resulted in any response or updales. Nevertheless, RUHs-BH remains committed to advocating for the inclusion of lhe Helpline in the 988 call center network. This integration would address call transfer challenges and I enhance language interpretation access. RUHS-BH is also cooperating with call center leadership to overcome the challenges and limitations posed by the 988 service. The locus is ensuring a seamless connection between Didi Hirsch and RUHS-BH mobile response units for callers in need. Strenglhening this collaboration remains of utmost importance lo RUHS. Finding 7: The Civil Grand Jury finds that a telephone behavioral health assessment could be an effeclive approach for identifying and managing behavioral heallh issues in older adults, perhaps paving the way for alternative ways to seeking and receiving mental health help among the homebound. Response: Partially Disagree Riverside University Health System - Behavioral Heatth (RUHS-BH) acknowledges the potential of telephone behavioral health assessment, as the Civil Grand Jury highlighted. lt is important to emphasize that a more robusl approach is needed when addressing risk factors for our Older Adult consumers. When concerns are raised about risk factors, we slrongly advocate for a comprehensive, in-person behavioral health screening and assessment to ensure a deeper understanding of the individual's situalion and needs. To provide lhe highest quality of care, we recommend conducting face-to'face assessments This could occur eilher in the consumer's environment, where they live or reside or within lhe welcoming and supportive environment of our Behavioral Health Wellness & Recovery clinics. This'in-person approach allows our skilled professionals to gain a holistic understanding of the individual's mental health, considering the nuances that may nol be fully captured through telephone assessments, Our commitment to the welFbeing of older adults compels us to explore every avenue that can enhance their mental health support. While telephone assessments have their merits, they are mosl effective when used with in-person assessments, especially when risk factors are a concern. This comprehensive approach is a teslament to our dedication lo Providing personalized, empathetic care that meets lhe unique needs of individuals. For homebound individuals who prefer remote assistance, RUHS-BH provides services and works with various agencies that cater to their needs and ensure access to mental health care and assistance: CARES Line (Community Access, Referral, Evaluation, and Support Line) 800' 499-3008: The CARES Line is a 24Il resource that serves as a lifeline for individuals seeking help. Trained staff can provide screening, information, and referrals for mental health ind substance use programs. The service ensures lhat individuals can reach out for support from the comfort of their homes whenever they need it. The compassionate and knowledgeable staff otfers assistance in English and Spanish, making it inclusive and accessible. lnland SoCal Crisis HelPline 951686'HELP (4357): The Crisis Helpline provides a confidential space for individuals experiencing emotional distress or crisis. Available around the clock, the Helpline is staffed by trained professionals ready to provide support, guidance, and resources. For those who may be homebound, the Helpline serves as a lifeline withoul the need to leave their residence. Prevention and Early lnlervention (PEl) Services: The PEI services offered by RUHS- BH are focused on preventing the development of mental health issues by reducing risk I factors and increasing protective faclors. These services include valuable resources such as free trainings, events, presentations, newsletters, and more. Homebound individuals can access these resources online, allowing them to stay informed and I empowered lo take proactive steps for their mental well-being. Additionally, RUHS-BH has specific programs like the Cognitive Behavioral Therapy (CBT) for Late-Life Depression, tailored for seniors aged 60 and over. These services are dispensed through community organizations, facilitating the service both in-house and at the participants' residences. Riverside Network of Care for Behavioral Health (https://riverside,networkofcare.org/): This resource seryes as a hub for seniors, veterans, individuals, families, and agencies seeking mental health information and resources- The online platform offers homebound individuals a wealth of information on local services, legislation, support options, and relevant news. Homeconnect (https://vrrww.rcdmh,org/Homeconnect): For individuals facing housing and homelessness challenges, HomeConnect ofiers vital assislance and resources. By providing a phone number for access, homebound individuals can connect with housing and homeless resources without a physical presence. TakemyHand Live Peer Chat (https://takemyhand.co/):This innovative technology solulion allows individuals to engage in real-time conversations about emotional wellness with trained peer operators. The Peer{o-Peer live chat interface provides a welcoming and inclusive environment for building resilience and coping strategies. With Certified Peer Support Specialists who understand emotional diflicullies and substance use challenges, the service is a valuable option for homebound individuals seeking support during difficult times. The designated chal hours offer consistent availability for connection. These options collectively demonslrate RUHS-BH's commilment to ensuring that even homebound individuals have access to various resources and support services for their mental well-being. The emphasis on telephone and online services underscores the organization,s dedication to reaching every corner of the community, regardless of mobility or location. ln our outpatient care provision, we integrate telephone assessments with in-person consullations. our process begins with a telephone evaluation to identify potential behavioral health concerns, followed by comprehensive in-person assessmenls conducted at our clinic, Recognizing the transportation challenges numerous older adults lace, we leverage our Community Service Assislance team, collaborate with health plan services, and engage community transporl agencies. This concerled effort ensures the accessibility of oui services, offering transporlation options thal facilitate ease of access. For example, in Fiscal year 2o2z- 2023 the western region older Adult lntegrated system of care clinic provided 50% of their services via telehealth, phone or as a lield service_ The Older Adults Full-Service Partnership (FSp) program, also known as the Specialty Multidisciplinary Aggressive Response Treatment (sMART) program, is designed to o:ffer specialized support to older adults grappling with severe and peisistent menial illness, particularly those who may not find tradilional outpatient treatment effeclive. This program - primarily focuses on individuals who are homeless, at risk of homelessness, or have experienced stays in care institutions. The SMART team is comprised of diverse experts, including psychiatrists, therapisls, nurses, and peer support specialists, to provide comprehensive care. A core component of this program involves pairing older adults with wellness guides who assist them in crafling recovery plans that emphasize healthier coping strategies for life's challenges. The program's offerings encompass individual and group therapies, case managemenl, assislance with substance abuse, nursing care, follow-up appointments with psychiatrists, peer support, family advocacy, and more. The SMART team goes beyond its internal resources by collaborating with various community organizations, housing programs, and agencies to ensure a holistic approach to care. Cultural sensitivity and empowerment of older adults to make their own decisions form a crucial foundation for building trust within this demographic. The success of the FSP program has been evident through its positive outcomes. Participants have experienced a reduction in arrests, mental health crises, physical health emergencies, instances of homelessness, and hospitalizations. Many have effeclively managed substance abuse, secured stable housing, and pursued goals like employmenl and independent living post-treatment. The program's expansion stralegy includes admitting more consumers annually and incorporating innovative practices like Mindfulness-Based Stress Reduction, Tai Chi, and Fit for Life. Technology is leveraged to enhance engagement and mental health services, offering features like appointment and medication reminders, daily check-ins, and goal tracking. Across the County the Older Adult Full-Service Partnership (FSP) program served 424 older adults. The results demonstrated noteworthy decreases in arrests, mental and physical health emergencies, and acute psychiatric hospitalizations. By improving connections lo primary services, integrated care was bolslered, and medical crises dropped. These FSP programs mirror the Western Region's initiative and cater to homeless or at.risk older adults with mental health challenges transitioning through various institutions. The multidisciplinary treatment teams include experls such as Behavioral Heallh Services supervisors, psychiatrists, clinical therapists, behavioral health specralists, nurses, peer support specialists, family advocates, and community service assistants. These programs encompass multiple cities and municipalities in the southern and mid-regions of the County. They are easily accessible through the Temecula Older Adult Wellness and Recovery Clinic's resource cenler, enhanced by technology-driven resources. The Mid-County Region FSP for older adults served 2'11 consumers. Simitarly, the Desert older Adult Full-service Pal1nership (FSP) is dedicated to supporting older adulls struggling with severe and persistent mental illness who might not respond well to traditional oUtpatient treatment. This program zeroes in on individuals who are homeless, at risk of homelessness or have been in care institutions. The Desert SMART team employs a flexible approach, collaborating with communily resources lo address a variety of needs. The program's integrated services are delivered through a multidisciplinary team, which includes Behavioral Health Services supervisors, psychiatrists, clinical therapists, behavioral health specialists, nurses, peer support specialists, family advocates, and community service assistants Given the challenging desert climate, collaborations for housing and re-engagement support hold critical importanie. Partnerships with housing programs like HHOPE have provided care and support to consumers in regional apartment complexes. The program emphasizes cultural sensitivity and consumer autonomy to establish and maintain trust in therapeutic relationships. consistently serving over 128 FSP consumers, the Desert FSP program has substantially reduced ariests, mental and physical health crises, acute hospitalizations, and notable progress in addressing subslance abuse. A signilicant achievement has been the decrease in emergency shelter stayior homelessness, with many individuals securing stable housing. ln line with other regional programs, the Desert FSP 3-Year Plan aspires to increase FSP consumers and services by 10% each year, necessitating statf increases, including clinical therapists, behavioral health specialists, and a peer support specialist, over the next three fiscal years The services offered include evaluations, medication checks, care planning, personalized therapy, peer support, specialized group therapy, family assistance, and home-based services through the regional Specialty Multidisciplinary Aggressive Response Treatmenl (SMART) teams. This comprehensive approach ensures the diverse needs of older adults are met and aligns effectively with the Grand Jury's recommendalions. The data outcomes from our Older Adult Full-Service Partnership Program poinl to substanlial improvements, underscoring our commitment and success. Hospitalizations decreased 39.40% in FY19l2O and 53.36% in FY21122. lnstances of mental health emergencies decreased 17.40% in FY19/20 and 24.52o/, in FY21l?2. Physical health emergencies declined 86.70% in FY19/20 and 93.70% in FY21tZ2. Linkage to primary care services increased 56.80% in FY19/20 and 68.50% in Fy21t2Z. These statistics underline our unwavering dedicatron to the older adults in Riverside County and validate our proactive response to the Grand Jury's suggestions. The alignment of our outcomes with the Grand Jury's findings underscores our commitment to delivering comprehensive, high-quality care. Our commitmenl to remote interventions and telephone-based services is a cornerslone of our strategy, illustrating our dedication to proaclive outreach, issue prevention, and early intervention. This commitment is clearly demonstrated through our establishment o{ mental health liaisons within the Ofiice on Aging. This initiative offers a comprehensive range of services, including depression screening, specialized Cognitive Behavioral Therapy (CBT) tailored for late-life depression, referrals, and consultations to address mental health concerns. ln fiscal year 2021 12022,lhe mental health liaisons conducted 102 outreach events at community meetings, resource centers, faith-based locations, senior centers, and by telephone. These efforts reached 3,638 individuals. These liaisons also provided CBT late life therapy directly to 27 participants, in addition to referring old adults to other PEI and clinic mental health services. This approach reflecls our commitment to meeting older adults where they are, regardless of their location or circumstances. Furthermore, the CareLinUHealthy IDEAS Program (ldenlifying Depression Empowering Aclivities for seniors) tackles a critical issue - depression among older adults who may be at risk of housing instability. Guided by the Healthy IDEAS model, which encompasses slreening, assessmenl, education, referral, and behavioral activation, we consistenfly provide vital support to help older adults maintain their overall well-being. This initiative, coupled with the Program lo Encourage Active and Rewarding Lives (pEARLS), is designed with flexibility in mind. we offer multiple options, from in-person iessions to zoom' meetings and telephone consultations, ensuring the broadest possible reach. pEARLS in FY21l22 sqeeaed 117 participants and direcfly served g3 older adults. Furthermore, many of the seryices were provided via zoom and phone. cognitive Behavioral rherapy for Late Liie Depression services are also provided through seveial pEl conlracted providers resulting in over 100 older adults receiving services in the most recent fiscal year. Many of these services included phone services. RUHS-BH remains steadfast in its commitment to addressing the mental health needs of older adults. We agree with the Civil Grand Jury's recognition of telephone behavioral health assessmenls and provide allernalive care delivery methods. We will continue to improve our services lo better serve our communily. Finding 8: The Civil Grand Jury finds that s€rvices to the LGBTQIA+ population exist in a patchwork fashion and mostly through non-profit agencies. A more visible and focused strategy at the County lsvcl is not apparent. Response: Partially Disagree PEI services are implemented through community-based organizations, which are typically staffed and managed by the identified service population who know the community best. We coordinate those providers as an overall strategy in the PEI plan. PEI has multiple programs that focus on the needs of the LGBTOIA+ community, dedicating resources lo outreach efforts tailored to this demographic. The Transilional Age Youth (TAY) Resiliency Program is a cenlral initiative targeting individuals aged 16-25. Historically, the program had distinct 'Stress and Your Mood" and 'Peer-to-Peer" services. But in light of experience and the data derived from its implemenlation, these were merged into the TAY Resiliency Project, enhancing coordination and communication. This reslructuring not only streamlines the services but also optimizes them, placing a heavy emphasis on supporting LGBTOIA+ youth. The pro.iecl caters to diverse mental health needs, from early interventions for depression to peerJed support groups. The data collected indicates that these interventions significantly bolster the mental well-being of the parlicipants. Additionally, there is a specific Cognitive Behavioral Therapy (CBT) for Late-Life Depression, catering to seniors aged 60 and above. This service is dispensed by community-based organizations, with an LGBTQIA+ dedicated entity offering the service bolh onsite and in participants' homes. Additionally, the PEI plan includes mental health promoters' programs lor underserved cullural communities, Promoters are specially trained members of the respeclive community contracted to develop culturally informed behavioral health presenlations and meet with community members to provide education and engagement. LGBTQIA+ is an identified communily within the mental health promoters program. RUHS-BH also contracts with Cultural Community Liaisons (CCL), who are members of lhe respective cultural community and serve as consultants on culturally informed outreach and care and as care access agents. RUHS-BH has 10 identified underserved or at-risk populations that have a ccL: African American; LatinxHispanic: Asian Pacific lslander; Native American; Middle Eastern/North African; Deaf and Hard of Hearing: Disabled; Military Veterans; Faith Based Communities: and LGBTQIA+. The LGBTQIA+ CCL has represenled RUHS-BH at LGBTOIA community events, directly engaging and educating the community, presented on LGBTQIA behavioral health at community meetings, and coordinated RUHS-BH sponsorship of LGBTQIA gatherings to welcome the community into RUHS-BH programs. Each ccL also chairs ils community advisory group and invites all interested parties to participate. Advisory groups provide feedback to the department on improving care in thek respective community. The advisory group for the LGBTQIA+ community is called Community Advisory on Gender and Sexuality lssues (CAGSI), which meets once per month. RUHS-BH requires annual cullural competency training for all employees. Training options include a series on providing care to clients that identify as transgender: Transgender 10'1, taught by peer employees with related lrans experience; Trans Care for the Generalist Clinician, led by a licensed clinician: and Developing Experlise in Working with Trans Clients, taught by a psychialrist with expertise in trans-related behavioral health care. A visible coordinated campaign to reach all Riverside County LGBTQIA+ communilies would require a cooperative effort among multiple county agencies, school districts, and local governments. Each has its perspective and degree of support for serving the LGBTQIA+ community, making a comprehensive plan more difficult to achieve. RECOMME NDATIONS Recommendation 2: The Civil Grand Jury recommends the Board of Supervisors focus on creating a more connected systems approach (inclusive of all County agencies) for County residents seeking resources. Consider implementation and enhancement of "one-stop shop" strategies from proven, evidence-based, government administration models by bringing together County services in one location that can beneflt all residents in accessing healthcare, transportation, referrals, and services. Response: lmplemented Riverside University Health System-Eehavioral Health (RUHS-BH) is committed to implementing the lntegrated Service Delivery (lSD) model in collaboration wilh the County of Riverside, aligning with the 'one-stop shop' strategy advised by the Grand Jury. This process, initiated in 2022, involves co{ocating various County services al one location to eliminate redundancies and leverage resources. The ISD model is being created and implemented. ISD is being implemenled at the Jurupa Valley Community Health Center in collaboration with multiple County deparlments. Financial and slaff resources have been allocaled for the successful ISD implementation, guided by the Office of Service lntegration and supported by RUHS and other County departments. ISD is set lo be elitended to the remaining CHCs, lollowed by implementation in non-CHC environments across the County. Our goal is to provide user- friendly, comprehensive services underpinned by data-driven decisions. This initiative redefines County-client engagement, focusing on holistic care and improved quality of life for Riverside County residenls. Background: lsD represents a significant shifl from a program-focused approach to a person-centered care model and aligns with the'one-stop shop'strategy the Civil Grand Jury recommends. Co- locating diverse Riverside county services eliminales redundancies in intake and assessment processes and leverages resources across County deparlments. The lsD model is being tested at the Jurupa valley community Health center (JVCHC). This pilot involves multiple county departments, encompassing RUHS-Behavioral Health, public Health, Medical cenler and community Health clinics, Dpss, First 5 Riverside county, otfice on Aging, Riverside County lnformation Technology, and others. This allows us lo tailor integration strategies lo the unique needs of the communities served and evaluate their impact on staff and service provision. The Board of Supervisors and department leaders have committed significant financial and staff resources lo ensure the successful implementation of lSD. An Office of Service lntegration was established to guide the County-wide etfort. To achieve broader outreach, the ISD model is sel to be extended to the remaining CHCs, followed by a pilot initiative in non-CHC environments across the County. Using lSD, we aim to establish a user-friendly network of services that meets immediate needs and introduces a wide range of County resources from the start of any service request. This model also emphasizes data-driven service placement and care coordinalion decisions to ensure consumers receive timely and appropriate assistance. The ISD initiative redefines how the County works and engages with clients, consumers, and residents. We are excited aboul its potential to provide more impactful community service, increase prevention and early intervention services, and deliver more holistic care. By partnering and implementing the ISD model with other County of Riverside deparlments, we are revolulionizing our service approach and aiming for a more integrated, holistic, efficient, and person-cenlered care system, ultimalely paving the way for an improved quality of life for Riverside County residents. Recommendation 3: The Civil Grand Jury recommends the Board of Supervisors to continue supporting and enhancing the implementation of model suicide prevention programs and strengthen existing programs that foster social emotional groMh, trauma' informed practices, continuity of care, and a continuum of crisis services across the County, Specifically, enhance applicable programs and services within Riverside County Suicide Prevention Coalition (to expand services), Housing Authority of the County of Riverside (to stabilize housing), Riverside County Office on Aging (to assist older adults), and the Youth Commission and its five Youth Advisory Councils (to advise the Board of Supervisors on youth suicide prevention). Response: lmplemented Riverside University Health System - Behavioral Health (RUHS-BH) has actively and wholeheartedly embraced the imperative to fortify Riverside County's suicide prevention programs. Upholding a dedication lo the welfare of our community, RUHS-BH has diligently worked to amplify model suicide prevention endeavors and bolster pre-€xisting initiatives that cultivate social-emotional growth, trauma-informed practices, seamless care continuity, and cOmprehensive Crisis ServiCes across the County. This responSe Underscores our Unwavering commitment to enhancing the efficacy and reach of programs within the Riverside county suicide Prevention coalition, the Housing Authority of the county of Riverside, the Riverside County Office on Aging, and the Youth Commission and its Youth Advisory Councils Our collective actions are a testament lo our pledge to nurture a more secure and supporlive environmenl for all residents. Here is a summary of the implemented action: Building Hope and Resiliency: A Collaborative Approach to Suicide Prevention in Riverside County is the Riverside County suicide prevention strategic plan. The plan, released in June 2020, was created through a data-driven process with community stakeholder feedback. The plan identilies goals and ob.iectives to address suicide in Riverside County and aligns with lhe California statewide strategic plan, Stnving for Zero. ln September 2020, the Riverside County Board of supervisors passed a resolulion adopting the strategic plan as a county-wide iniliative. The suicide Preventlon coalition was established in october 2o2o to bring the strategic plan to life. The Coalition is led in partnership by RUHS-BH (PEl) and public Health and includes eight sub-committees: Effective Messaging & Communications, Measuring & Sharing Outcomes, Upstream, Prevenlion-Trainings, Prevenlion-Engaging Schools, prevention-Higher Education, lntervention, and Poslvention. lnitiatives in place or in development include: Effective Messaging & Communications, chaired by the RUHS-BH Senior public lnformation Sp€cialist, hosts webinars/trainings to provide tips and tools for working with the news media. The trainings target Public lnformation/Communication Officers, individuals who might respond to a media interview (in response lo a suicide death or regarding suicide prevention). Training is also available for.iournalisls lo learn about suicide-safe reporting. The committee assists other sub-committees with a review of any developed material to ensure safe messaging. Measuring and Sharing Oulcomes is co-chaired by staff from RUHS-BH Research & Evaluation and RUHS-PH Epidemiology. The focus is developing up-lo{ate data briefs and providing requested data to sub-committees and other community members. Upslream, chaired by Office on Aging staff, addresses isolation, the most significant risk factor for suicide, The sub-committee focused its attention this year on addressing isolated older adults. They completed a survey and used the information to strategize activities to address identified needs. The focus for the next three years is to distribute a series of Kindness Kits to 1,000 homebound seniors, providing self-care items, brain game activities, information on available resources, and messages of hope and resiliency. Prevenlion, co-chaired by staff from RUHS-BH and RUHS-pH, offers trainings on slrategic outreach lo encourage more Riverside County residents to become trained helpers in suicide prevention. The focus for the nexl lhree years is to create brief video(s) promoting participation in suicide prevention gatekeeper trainings for those in high-risk groups and work with local businesses to share it. Trainings are available throughout the year and are accessible to anyone who lives and/or works in Riverside County. Prwenlion - Engaging schools (K-12), chaked by Riverside county office of Education staff, is working lo promote rhe standardization of policies across school districts to improve communicalion, collaboration, and consistency of suicide prevention, intervention, and postvention efforts. The focus for the nexl three years is to support school districts with implementing programs and strengthening existing programs that foster social-emotional growth, trauma-lnformed practices, and suicide prevention. . Prevenlion - Higher Education, co-chaired by the University of California, Riverside (UCR) and Moreno Valley College staff, focuses on implementing changes within the college system for the young adult population. This includes increased education and awareness regarding mental illness and suicide among college sludents and staff, assisting schools with implementing lrauma-informed practices, and promoting help- seeking behaviors among college youth. The focus for the next three years is 10 develop 3-5 minute "refresher" videos for stafi and faculty regarding suicide prevention that is accessible to all colleges/universities in Riverside County then create a campaign to share them and other suicide prevention-related information on campuses throughout the County. . lntervention, chaired by staff from RUHS-BH, developed a care transitions poster lor individuals discharged from inpatient hospitalization to encourage follow-up with outpatient services and educate their support system to assist with this. The focus for the next three years is to participate in the Mental Health Services Oversight and Accountability Commission (MHSOAC) Means Safety pilot program to promote firearm safety and increased access lo suicide prevention training for gun shop staff and members. Also, to reduce access to lethal means and thus increase the security of at' risk consumers and families, this sub-commitlee will begin a lirearm lock distribution pilot, starting with the RUHS - Medical Center. A successful pilot will set the stage for its expansion to other settings, incorporaling direct care providers from clinics and crisis teams. Additionally, this sub-committee will pilot training in Culturally Competent Suicidal lntervention and Care, focused initially on RUHS-BH senior clinical therapists, clinic supervisors, and lead crisis direct care staff. A successful pilot will inform expansion to other settings and disciplines. . Postvention, co-chaired by staff from NAMI Mt. San Jacinto and lnland SoCal Crisis Helpline, partnered with lhe Trauma lntervention Program (TlP) of Riverside County to develop LOSS (Local Outreach to Suicide Survivors) kits and enhance their current volunteer training with speciflc suicide poslvention lraining and response. The TIP I program has 41 trained and active volunleers available to respond in the community. Postvention has hosted webinars for survivors of suicide loss. The focus for the nexl three years is to recruil and train Survivors of Suicide Loss (SOSL) to become peer support facilitators and facilitators oJ American Foundation for Suicide Prevention's (AFSP) Healing Conversations. Addilionally, PEI will fund short-term Bereavement Counseling (6-8 sessions) for suicide loss survivors through community-based therapists. Recommendation 4: The Civil Grand Jury recommends Riverside University Health System - Behavioral Health to continue supporting the work of Riverside University BLhavioral Health Commission & Regional Advisory Board and its many Standing Committees (Adult System of Care Commlttee, Children's committee, crimlnal Justice Committee, iousing bommittee, Legislative Committee, Older Adult lntegrat6d System of Care Committee, and Veterans Committee). Consider behavioral health assessments among the aging via telephone in Riverside County as an effective approach for identifying and managing behavioral health issues in older adults and as an alternative way to seek and receive mental health help among the homebound. Response: lmplemented; ; RUHS-BH in collaboration with Velerans' Services Riverside University Health System-Behavioral Health (RUHS-BH) supports the Behavioral Health Commission, Advisory Boards, and Standing Commitlees. We value the recognition of telephone-based behavioral health assessments for older adults. While we use telephone assessments with risk analysis, in-person evaluations are crucial for better addressing risk factors. Therefore, we advocate for comprehensive facelo-face screenings al residences or our BH Wellness & Recovery clinics. This approach aligns with our dedication to innovative and inclusive care. We propose meeting consumers in settings that mirror their daily lives, enabling us to tailor interventions effectively. Our commitment remains steadfast in providing eftective, compassionate, holistic behavioral health care for Riverside County's older adults. We conlinuously refine our praclices to ensure the highest standard of support. Background: RUHS-BH recognizes the critical role the Behavioral Health Commission, Regional Advisory Boards and Standing Committees play in addressing the varied behavioral health needs of our County. Our support includes the following 1, Advisory Boards and Standing Committees: The Commifiees encompass areas such as Adult and Older Adult System of Care, Children's, Cnminal Justice, Housing, Legislative, and Veterans. The Commission entrusts a member to spearhead all Committees and Regional Boards. ln tandem, RUHS-BH provides clerical aid to record meetings. 2. Liaison Services: RUHS-BH sponsors an executive assistant to act as a direct link to the Commissjon. This liaison coordinates meetings, ensures compliance lraining, and sits on the Executive Committee, which lays the framework for forthcoming sessions. 3. Annual Board of Supervisors Report: Supporled by RUHS-BH, the Commission compiles and submits an annual report that encapsulates the endeavors of the BHC, Advisory Boards, and Standing Committees. 4. Events & lnitiatives: We promote events such as Mental Health Month and Recovery Happens. These initiatives bolster community outreach, aim to educate the public, and diminish the stigma associated wilh seeking help for suicide, mental health, and substance use challenges. Acknowledging the Grand Jury's suggestion regarding telephone services for older adults, RUHS-BH has formulated an approach prioritizing accessibility and comprehensive care. our process begins with a telephone screening and outreach, followed by scheduled in-person clinic visits for a thorough assessment. Recognizing potential barriers older adults face, we prioritize their convenience by offering transporlation assistance through our dedicated community service Assistance staff and team. Additionally, we collaborate with lheir healthcare plans (such as IEHP and Molina) and community-based transportation agencies, ensuring lransportation is not a banier to reaching our facilities. While we appreciate the potential of telephone assessments, we know that a more comprehensive strategy is essential, particularly when addressing risk faclors for older adult consumers. Hence, we wholeheartedly support a robust, in-person behavioral health screening and assessment process. This approach ensures accurale evaluations lailored to individual circumslances, whether conducted at consumers' homes or within our BH Wellness & Recovery clinics. Our commitmenl remains unwavering in providing effective and empathetic care to Riverside County's older adult population. Our RUHS-BH Older Adult lntegrated System of Care addresses senior residents' needs, focusing on their physical and emotional well-being. Services include: . Psychiatric Evalualions and Risk Assessments: Comprehensive evaluations to ascertain mental health conditions and risk assessments to detect potential self-harm or suicidal tendencies. Msdication Services: Continuous support and regular reviews ensure that the medication administered is effective and adjusted according to the evolving needs of the individual. lntegrated Care Planning: An interdisciplinary approach ensures seamless coordination between primary care physicians, mental health experts, and other community agencies. This includes focusing on recovery goals, addressing social determinants, assistance with housing, and linkage to essential services. lndividual Therapy and lntensive Case Management: Tailored therapy sessions and robusl case management ensure each person's specific needs are addressed. Peer Supporl Services: By engaging individuals who have lived experiences, we foster a supportave environment that aids in recovery. Specialized Group Therapy: Designed to combat the challenges of isolation, these sessions promote social inleraction and independent living. Family Advocacy and Caregiver Consultation: Recognizing the importance of lamilial support, we offer dedicated consultation services for caregivers and family members. Home.based and Field Services: Through our regional SMART teams, we reach out to those vulnerable to psychiatric hospitalization, homelessness, abuse, or those who might not receive services otherwise. S€rvice Locations: Our vast network spans eight strategic locations, from Riverside to lndio, ensuring ease of access for our residents. The RUHS-BH Older Adull lntegraled System of Care, through multiple clinics, has increased the number of older adults served by 37% over the lasl seven years from 3'217 lo 4'422-The growth to over 4,000 consumers is large compared to when the expansion of older adult service began when the number served was well below 2,000. Additionally, the services provided by our older Adult lntegrated system of care Full-service Partnership (FSP) Program served 424 ofthe higheshneed older adults in fiscal year 21-22. The intenslve servicesbf the Older Adult FulLservice Partnership (FSP) Program have resulted in tangible outcomes impacting consumers' lives. FSP Outcomes data for fiscal year 21-22 showed l . Psychiatric hospitalizalion decreased 53.36%. . Mental Heallh Emergency deparlment visits deqeased 24.52oh . Linkage lo primary care increased by 68% for those consumers without a primary care doctor when they began FSP services . Of those with a substance abuse problem, 51% were connecled to subslance abuse services. The data from our Older Adult lntegrated System of Care Full-SeNice Partnership (FSP) Program exhibits our commitment and success. Collectively, the data underscores our unwavering commitment to Riverside County's malure adults and illustrates tangible, positive outcomes. Our actions align with the Civil Grand Jury,s recommendations. Through sleadfast support of the Behavioral Health Commission, Regional Advisory Boards, and Standing Committees, along wilh comprehensive resources tailored for older adutts - including telephone assessments - RUHS-BH embodies a holistic approach to behavioral health care. While we are proud of these accomplishments, we recognize that excellence is a continuous journey. As such, we remain mmmitted to constan y striving for better, ensuring our methods and services evolve and adapt. We are driven by our responsibility lo enhance lhe lives of everyone in Riverside County, ensuring their diverse needs are met with unmatched care, diligence, and expertise. Recommendation 5: The Civil Grand Jury recommends Riverside University Health System - Behavioral Health continue evaluating crisis team services to identify gaps in service provision and potential funding sources. Response: lmplemented Riverside University Health System - Behavioral Health (RUHS-BH) has shown consistent and proactive dedication to enhancing and expanding crisis team services throughoul Riverside County. We have prioritized the need for thorough evaluations, ensuring thal potential gaps in service provision are addressed and bolstered by potential funding sources. our Mobile crisis Response Teams (MCRTs) have managed over 2,000 requests this past fiscal year, focusing on adults and youth, aiming to reduce law enforcemenl interactions and hospitalizations. Our Community Behavioral Assessment Teams (CBAT) have expanded wilh nine new unils, seamlessly integrating clinical therapy with law enforcement lo address mental health crises. coupled with the expansion of Mobile crisis Management Teams (MCMT) across several cilies and the introduction of the Community Assessment and Transport Team (CATT) pllot program, we've made notable strides in bridging service gaps, securing funding, and fortirying our commitment 10 Riverside Counly's mental and behavioral health needs. Here is a summary of the implemented action: Mobile Crisis Response Teams (MCRT): The Mobile crisis Response Teams (MCRTS), primarily comprised of a clinical rherapist ll or a Behavioral Health specialist paired with a Mental Health peer support Specialist, are central to our efforts in reviewing and refining our crisis services. They serve the three county regions with the core mission of minimizing unnecessary engagemenls with law enforcement and dicreasing unwar,anled inpatient hospitalizations. Since its inception, the MCRT has served individuals of all ages. However, in 2018, we collaborated with additional stakeholders, including schools, leading to a largeted expansion of services specifically for youth. Beyond crisis intervention, lhese teams also seamlessly connect individuals to outpatient and substance use services. lnFY 202112022, MCRTS addressed 2,090 requests, averaging 174 requests per month. Born from a need to support law enforcement during mental health emergencies, the MCRTS'role has since expanded. They now cater to myriad requests from hospital emergency departments, community agencies, group homes, and other community locations. Of these, 38% were from hospital emergency departments, while schools and lield requests each made up 28% of calls. To maintain transparency and efflciency, MCRTs utilize a web-based data system to chronicle each crisis encounter. The data not only quantifies their engagements but also aids in delermining consumers' demographics, referrals, and patterns of recurrent crises. This is then linked to the RUHS-BH electronic health record to track outpatient service utilization. Both CBATS and tvlCMTs follow a similar recording methodology. At the same time, Mental Health Urgent Cares (MHUCs) and Crisis Residential Treatment (CRT) usage data are sourced directly from the RUHS-BH electronic heallh record. ln December 2018, reiterating our commitment to adapt and improve, MCRTs broadened their scope to cater to youth under 21. This was primarily directed loward schools to reduce the need for law enforcemenl interactions. Consequently, many educational institutions, via their school resource officers, have partnered with MCRTs to ensure skeamlined crisis coordinalion. Our proactive approach wilh MCRTS is a testament lo our dedication to ensuring optimal service provision and addressing gaps. The consistent improvements and noleworthy performance of the MCRTs validate our unwavering commitment to the community as we continually slrive for service excellence. Community Behavioral Assessment Teams (CBAT): RUHS-BH has steadfastly committed to continuously evaluating and optimizing crisis team services. This dedication is evident through the strategic enhancement of the Community Behavioral Assessment Teams (CBAT), aiming to identify and address potential service gaps. CBATS, a unique collaboration between a RUHS-BH Clinical Therapist ll and a specially trained police officer, serve at the forefronl of our response to situations involving individuals grappling with a mental health crisis. Their primary goal is lo redirect lhese individuals to the most suitable community and behavioral health services, thus offering an alternative to traditional law enforcement interventions. On April 13,2021, backed bythe Board of Supervisors, as indicated in agenda item 3.32' RUHS-BH embarked on a significant initialive to expand its crisis response capacity. This etfori successfully integrated nine additional CBAT units, enhancing our capability to address behavioral health emergencies. This significant leap was realized through collaborative efforts with the Association of Riverside county chiefs of Police and sheriff (ARCCOPS) and the participation of local law enforcemenl bodies, including the Corona Police Department, Menifee Police Deparlment, Cathedral Cily Police Department, and Riverside Sheriffs Departmenl in areas such as Perris, Jurupa Valley, Cabazon, Hemet, Palm Desert, and Thermal. lt is worth mentioning that the teams based in Cabazon have developed a strong collaboration with the Beaumont Police Department, ensuring comprehensive service coverage in the Pass Area. This expansion of CBAT, in tandem with our olher proactive measures, unequivocally addresses the recommendation from the Civil Grand Jury. Riverside County reaffirms its unwavering dedication to fostering a safe and responsive community environment through continuous evaluation of our crisis teams, active collaborations and securing essential funding for enhancements. Moblle Crisis Management Teams (MGMT) MCMTs offer a comprehensive response and I wrap-around support system for individuals requiring ongoing behavioral health care, which encompasses both mental health and substance use treatment. Utilizing grant funds, we successfully expanded the N4CMT outreach. The program has forged new partnerships with cities, including Blythe, Corona, Hemet, lndio, Moreno Valley, Temecula, Banning, Menifee, and Riverside. Due to the high volumes of crisis needs identified, specific cities benefited from the addition of lwo teams, covering areas such as Coachella, Thermal, Mecca, North Shore, Norco, Eastvale, Temescal Canyon, Moreno Valley, Riverside, and Hemet Each MCMT unil comprises four multidisciplinary staff members: clinical therapists, peer support specialists, subslance use counselors, and a dedicated homeless and housing case manager. Every member underwent specialized training from crisis intervention and risk assessment to counseling and connecting individuals 1o residential trealmenl for mental health and substance use disorders. The teams'primary objective is to be responsive and person-cenlered, using recovery tools to prevent crises and divert individuals from unnecessary psychiatric hospitalizations when possible. These teams have become a vital immediate point of contact, otfering short-term treatment while guiding consumers toward longer-term treatment services. This hands-on approach is supplemented by the teams'ongoing involvement in community outreach activities and events, especially targeting people without housing and those needing assistance. ln partnership with cities, law enforcement agencies, community providers, and emergency responders, our vision is realized through a comprehensive, collective effort to cater to the diverse behavioral health needs of Riverside County. Community Assessment and Transport Team (CATT): ln line with our commitment lo meeting the Civil Grand Jury's recommendation of evaluating crisis team services and identifying gaps in service provision, we are proud to highlight the introduclion of our community Assessment and rransport Team (GATT). This initiative is a collaborative effort in partnership with American lvledical Response, lnc. This pilot program exemplifies our efforl to address service gaps and enhance care delivery to those grappling with mental health and substance use issues. The core objective of the CATT pilot program is to amplify the care we provide to Emergency Managemenl system palients confronting behavioral health and substance use complications. Through this innovative approach, we can bypass lraditional EMS system activations that oflen lead to emergency department visits. lnstead, individuals can be assessed directly onsite by a behavioral health clinician. Based on this comprehensive assessment, if deemed necessary, CATT will facilitale the transport of these individuals to an array of facilities best suited to their immediate needs. This includes mental health facilities, sobering centers, shelters, or any olher Riverside County Mental Health Crisis Services designated destination Lastly, it should be noted that RUHS-BH releases a Crisis Support System of Care Report each fiscal year to continue evalualing crisis team services with data and information. This report is attached (attachment A) for reference. Recommendation 6: Though Riverside County has expanded its trainer base for Frontline and Gatekeoper training (ASIST, SafeTalk, Mental Health First Aid, and Know the Signs) and established El Rotafolio as a Spanish version of SafeTalk, the Civil Grand Jury recommends Riverside University Health System-Behavioral Health to enhance training for RUHS social workers to look for and recognize slgns and symptoms of potential suicides during home visits and County detention center mental health program intake. Response: lmplemented; RUHS-BH in collaboration with Velerans' Services Riverside University Health System-Behavioral Health (RUHS-BH) acknowledges the Civil Grand Jury's recommendations regarding identifying potenlial suicides during home visits and within County delention center menlal health intakes. RUHS-BH has taken several steps to enhance training and oulreach. For instance, the Prevention and Early lntervention (PEl) program has trained nearly 10,000 individuals in mental health awareness and suicide prevention. While striving for conlinuous improvement, these trainings are held monthly, and residents can easily register through our website at httDs://www.ruhealth.orq /behavioral-health/pei-community-€ducatign or via the Suicide Prevention Coalition website at httos://www.rivcosoc.oroi oet-trained PEI extends beyond jusl offering prescheduled training sessions. Given the varied needs of our community, the initiative collaborates with county departments, including Veterans' Services, community-based organizations, faith groups, schools, March Air Reserve Base, and other entities to curate specialized training sessions, ensuring broad reach and effectiveness. Emphasizing lhe importance of staff training, RUHS-BH maintains a dedicated calendar focused on suicide pievention. This comprehensive training is mandated for all staff members, including those engaged in in-home visits, ensuring they can recognize and address potential suicide risks. Signilicant improvements in the Behavioral Health Detention program over the past year relarding detention facilities have been observed. The Behavior Health Acuily Level of Care Raling System has been rellned to resonale more wilh the acuity levels in outpatienl treatments By streamlining treatmenl services, RUHS-BH guarantees consistent care quality for inmates across difierenl mental health speclrums. Continuous Quality lmprovement and Suicide prevention subcommittee meetings involving integral department representatives aim to elevate behavioral health service delivery perpetually. Another vital step includes introducing intensive suicide prevention training for all delention facility staff interacting dkectly with inmates. Further enhancemenls have been made in protocols for non-emergency involuntary psychotropic medication, which now requires a court order, and in the Medication Assisted Treatment (MAT) program. Through comprehensive training programs, both generalized and specialized, dedicated outreach, conlinual slatf education, and enhancements in delention facilities, RUHS-BH is dedicated to meeting and exceeding lhe standards, ensuring the best possible care and support for the people we serve. Recommendatlon 7: The Clvil Grand Jury recommends the Board of Supervlsors and Riversldc County of Education partner to: 1. Collect more delin€ated Riverside County specific suicide data. 2. Continue to place more mental health care services in school and community settlngs. 3. Enhance partnerships between schools and County programs. 4, Be fully aware of the limitations of 988 as a resource until services are more operational, and work wlth the Los Angeles County call center to improve 988 servlce to Riverside Response: lmplemented ln response to the Civil Grand Jury's Recommendation, Riverside University Health System - Behavioral Health (RUHS-BH) affirms that all four parts of the recommendation have been successfully implemented. For the first recommendation regarding the collection of Riverside County-specific suicide data, we have collaborated with Riverside University Health System - Public Health (RUHS- PH). Together, our efforts have resulted in improved data collection methodologies, wilh RUHS- PH leading the charge by releasing eight critical suicide statistical reports and infographics thal are beneficial lo a wide range of stakeholders within our community. Addressing the second racommendation to bolster mental health care services in school and community setlings, our etforts have spanned numerous seclors within Riverside County. With the establishment of Prevention and Early lntervention (PEl) services and other partnerships, we have made mental health care support readily available within schools and other community venues. This has been enriched by various initiatives, including but not limited to strategic alliances with local school districts, RUHS's on-campus services, and the deployment oi mobile service units. As for the third recommendation emphasizing the enhancement of parlnerships between schools and county programs, we have made significant strides. lnitiatives such as lhe studenl Behavioral Health lncentive Program (sBHlp) and the collaborative system of care (cSoc) have cemented this partnership. we have also ensured that financial backing is in place to support these endeavors, evidenced by the secured funding for behavioral hLalth services at various school sites. The lnteragency symposium committee and the worKorce Education and Training Program are other nolable collaborations that bridge the gap between county programs and schools, ensuring a cohesive and integrated approach. Lastly, addressing the fourth recommendation concerning improving the 9gg service, our engagement with Didi Hirsch Mental Health services has been crucial. we advocate fervenfly for the Helpline's inclusion into lhe 988 network, aiming to create a Riverside-specific call center. while challenges have arisen, our dedication remains, with continuous collaborations to refine and optimize the 988 service for the residents of Riverside County, RUHS-BH is nol only in alignment with lhe Grand Jury's recommendations bul has taken substantive and proactive steps to ensure these recommendations are fully realized to benefit our community. Additional lnformation:
• R1
  lntroduction ofthe Suicide Prevention Plan: Staff from Prevention and Early lntervenlion (PEl) introduced the "Building Hope and Resiliency - A Collaborative Approach to Suicide Prevention in Riverside County" Plan. The plan was officially adopted by the Board of Supervisors a day earlier.
• R2
  The Civil Grand Jury recommends the Board of Supervisors focus on creating a more connected syslems approach (inclusive of all County agencies) for County residents seeking resources. Consider implementation and enhancement of "one-stop shop" strategies from proven, evidence-based, government administration models by bringing together County services in one location that can benefit all residenls in accessing healthcare, transportation, referrals, and services. Response: lmplemented The Riverside County Behavioral Health Commission (BHC) acknowledges and appreciates the recommendation of the Civil Grand Jury to focus on a more integrated systems approach for our county residents seeking resources. We concur that creating a'one-stop shop'strategy that consolidates County services in one location is a prudent and eflicient approach to better serve our residents. As an advisory body committed to ensuring citizen and professional input and involvement in all aspects of Department Services, the BHC's mandate includes reviewing and evaluating our community's mental health needs, services, facilities, and unique challenges. With our advancements toward an lntegrated Service Delivery (lSD) model, il's evident that Riverside County is making strides toward a holistic and person-centered care model, echoing the values the BHC upholds. An ISD pilot at Jurupa Valley Community Health Center, which merges services across RUHS- Behavioral Health, Public Heallh, Medical Center, DPSS, First 5 Riverside, Office on Aging, RCIT, and other departments, is a testament to the County's commitmenl to this goal. We are optimistic that the ISD model, emphasizing data-driven decisions and tailored integration strategies, will significantly enhance the service delivery experience for our residents. Given the importance and potential impact of the ISD model, the Behavioral Health Commission believes that our stakeholders and lhe public should be regularly informed and involved in its progress and oulcomes. Therefore, we have scheduled an ISD presentation/update at the November 1, 2023, BHC meeting. This presentation will serve as an opportunity {or lhe Commission and the public to be updated on the ongoing advancements, challenges, and successes of the ISD model. Furthermore, we will incorporate findings from the ISD developments into our annual report, as part of our mandate to inform the governing body on the needs and performance of the county's behavioral health system. This will ensure a consistent feedback loop and accountability mechanism as we work loward enhancing the county's servace delivery approach. We support and will continue to play an active role in the County's initiatives toward a more integrated service approach for the betterment of our community.
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  The Civil Grand Jury recommends the Board of Supervisors to continue supporting and enhancing the implemenlation of model suicide prevention programs and strengthen existing programs that foster social emotional growth, trauma-informed praclices, continuity of care, and a continuum of crisis services across the County. Specifically, enhance applicable programs and services within Riverside County Suicide prevention Coalition (to expand services), Housing Authority ofthe County of Riverside (to stabilize housing), Riverside County Office on Aging (to assist older adults), and the Youth Commission and its five Youth Advisory Councils (to advise the Board of Supervisors on youth suiclde prevention). Response: lmplemented ln response to the Civil Grand Jury's recommendation on suicide prevention and wellness in Riverside County, the Behavioral Health Commission (BHC) has been actively aligning our oversight and advisory roles with the community's needs. We have convened to discuss these topics extensively and are committed to ensuring lhey remain a focus in future deliberations. Summary of lmpl€mented Action in Response to Recommendation: We confirm our alignment with the Civil Grand Jury's recommendation, having already undertaken significant actions aligned with its objectives. The Behavioral Health Commission (BHC) has engaged in rigorous discussions during its meetings, with plans lo delve further into these topics in upcoming sessions. Past Meeting Highlights: Highlights from the 91112021 BHC Meeting on Suicide Prevention: 1. lntroduction ofthe Suicide Prevention Plan: Staff from Prevention and Early lntervenlion (PEl) introduced the "Building Hope and Resiliency - A Collaborative Approach to Suicide Prevention in Riverside County" Plan. The plan was officially adopted by the Board of Supervisors a day earlier. 2. Background of the Plan's Development: Ms. Brown detailed the evolution of lhe plan, mentioning notable milestones such as: o CDC's June 2018 report on "Preventing Suicide - A Technical Package of Policy, Programs, and Practices.' o Riverside County's participation in the Suicide Prevention Learning Collaborative in November 2018. c Partnership with various Riverside County institutions to develop a suicide risk assessmenl tool for schools in January 2019. o Riverside County Suicide Prevention Stakeholder meetings in July 2019. c Release and subsequent adoption of the "Building Hope and Resiliency' Plan in June and September 2020, respectively. 3. Plan Overview: PEI slaff elaborated on the plan's foundation, which integrates various national documents, local data, and feedback from Riverside County stakeholders. The plan emphasizes: o A suicidal crisis path model that encompasses upstream, prevention, intervention, and measures. o Three levels of inlervention: Universal, Selective, and lndicated. o Overarching strategic approaches like: . Building lnfrastructure and Support. . Effective Messaging and Communications. . Measudng and Sharing Outcomes. 4. Supporting Strategic Approaches: The Plan also incorporates additional strategic tactics specilic to each component of the suicidal crisis path, such as: o Upstream: Focusing on fostering healthy and connected communilies and promoting resiliency. c Prevention: Emphasizing the importance of training community groups and engaging with schools. o lntervention: Ensuring salely around means and integrating suicide prevention in health services. o Postvention: Offering coordinated responses following a suicide, supporting affected individuals, and recognizing the need for postvention efforts in Riverside CountY. 5. Coalition Recruitment: The PEI manager announced recruitment efforts for the Coalition and invited interested members to contribute towards actualizing the plan. 6. September Recognitions: The PEI manager mentioned the Board of Supervisors acknowledgment of September as National Recovery Month. PEI has initiated a virtual campaign focusing on suicide prevention and mental health, with events listed on the Up2Riverside landing page. The global communily will commemorate World Suicide Prevenlion Day on September'10 by lighting candles to remember lives losl to suicide. Highlights from the 91112021 BHC Meeting on Suicide Prevention: 1. Suicide Prevention Monlh Activities: The meeling covered various scheduled events, including Suicide Prevention Week, World Suicide Prevention Day, and the observance of National Recovery Month. 2. Meeting Theme: The central focus of the discussion was "Supportive Transitions - Reconnect, Re-enter, and Re-build." 3. Resource Distribution: Physical and virtual toolkits were disseminated to promote engagemenl, spread awareness, and offer preventive measures. 4. Pharmacist lnitiative: The commission revealed a new initiative to incorporale pharmacists in suicide prevention. 5. Coalition Updates: The Suicide Prevention Coalition, with the PEI manager as a co- leader, has held quarterly meetings since October 2020. 6. Sub-Committee Formations: Several sub-committees have been established within the Coalition to facilitate in-depth exploration of strategies and objectives. Highlights lrom 41612022 BHC Meeting on Suicide Prevention: 1. Subcommittee Overview: A comprehensive rundown was provided on the Suicide Prevenlion Coalition's sub-committee, particularly emphasizing their work related to postvention. 2. lntroduclion to "Suicidal Crisis Path": The attendees were introduced to the "suicidal crisis path' concept, complemented by an exposition of the multi-layered inlervention levels. 3. Addr6ssing Postventlon:The meeting spotlighted postvention response and -the supporl offered in the aflermath of a suicide. 4. Parlnership with TIP: The board declared ils collaboration with the Trauma lntervention Program (TlP), aiming to assist suicide loss survivors and provide immediate postuention services. 5. Other lnitiatives: Apart from the primary topics, the meeting delved inlo various ongoing initialives. These included webinars, training modules, and social media campaigns tailored for suicide prevention. Evolution of BHC's Strategy Through Discussions and Updates Our continuous deliberations, updates, and discussions in BHC's past meelings have been instrumental in shaping a comprehensive strategy for Riverside County. These focused engagements have steered us toward several crucial mileslones: . Our guiding principle, "Building Hope and Resiliency: A Collaborative Approach to Suicide Prevention in Riverside County," is based on data analysis and extensive feedback from community stakeholders. Aligned wilh the state's vision of "Striving for Zero," the Riverside County Board of Supervisors recognized and adopted this strategic plan in June 2020. This marked the genesis of the Suicide Prevention Coalition in October 2020. . ln collaboration with Riverside University Health System - Behavioral Health, the Suicide Prevention Coalition (SPC) has instituted eight specialized sub-commiftees under the Coalition. Each of these sub-committees hones in on specific aspects oI suicide prevention and mental health well-being: . Effective Messaging & Communicalions: This focuses on ensuring accurate 1 and safe communication regarding suicide prevention to the media and the public. 2. Measuring & Sharing Oulcomes: Coordinated by RUHS-BH Research & Evaluation experts and RUHS-PH Epidemiology, lhis committee ensures up-to- date data provision. 3. Upstream: With the Office on Aging at its helm, this sub-committee centers on addressing isolation, especially among older adults, by distributing Kindness Kits to homebound seniors. 4. Prevention (K-12 and Higher Education): Engaging with educational institutions, these sub-committees aim to standardize suicide prevention policies and practices. 5. lntervention: Chaired by RUSH-BH, we've initiated measures like Care Transitions poslers and programs to promote firearm safety among at-risk groups. 6. Postvention: ln collaboration with community organizations, we're focused on supporting survivors of suicide loss, providing essential resources and emotional care. The ongoing and planned initiatives mentioned above are tailored to fortify existing programs and introduce innovative measures that holistically address the mental health needs of our community. We are committed to evaluating the performance of these actions and ensuring community involvement at every stage, as required by our commission's mandales. We would also like to acknowledge the importance ol the Riverside County Suicide Prevenlion Coalition, the Housing Authority of the County of Riverside, the Riverside County Office on Aging, the Youth Commission, and its five Youth Advisory Councils. Their contributions and collaborations are invaluable in realizing our mission. The Riverside County Behavioral Health Commission (BHC) remains steadfasl in its dedication to assessing community needs, enhancing facilities, reviewing agreements, and providing guidance to Riverside University Health System - Behavioral Health while maintaining a transparent, ethical, and community-involved approach.
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  The Civil Grand Jury recommends Riverside University Health System - Behavioral Health to continue supporting the work of Riverside University Behavioral Health Commission & Regional Advisory Board and its many Standing Committees (Adult System of Care Committee, Chaldren's Committee, Criminal Justico Committee, Housing Committee, Legislative Committee, Older Adult lntegrated System of Care Committee, and Veterans Commitlee). Consider behavioral health assessments among the aging via telephone in Riverside County as an effective approach for identifying and managing behavioral health issues in older adults and as an alternative way to seek and receive mental health help among the homebound. Rasponse: lmplemented The Riverside County Behavioral Health Commission (BHC) acknowledges and embraces the recommendalion in the Grand Jury report. Our collaborative efforts wilh Riverside University Health System - Behavioral Health (RUHS-BH) reflect a shared dedication to ensuring the well- being of our community members. As an advisory body, the BHC works alongside RUHS-BH to engage citizens and proiessionals in shaping the direction of Deparlmenl Services, upholding the principles of inclusivity and innovation. RUHS-BH's commitment to supporting the multifaceted initiatives of the Behavioral Health Commission, Regional Advisory Boards, and various Standing Committees mirrors the BHC's mission to comprehensively address mental health needs, services, and challenges within the community. The endorsement of telephone-based behavioral health assessments for older adults underscores our joint efforts to find innovative ways lo caler to the needs of our aging population, especially those who are homebound. These telephonic assessments, backed by RUHS-BH, are essential to comprehensive in-person clinical visits, demonstrating our commitment to providing well-rounded care. The Older Adult lnlegrated System of Care, a product of our collaborative endeavors, exemplifies our dedication to enhancing the lives of older adults. This system, designed by RUHS-BH, encompasses a wide range of services that attend to the holistic well-being of older individuals. While we acknowledge the efficacy of telephone assessments with risk analysis, we wholeheartedly agree that a more robust approach is required when addressing risk factors. This entails conducting thorough in-person behavioral health screenings and assessments within the consumer's environment or the supportive context of our Behavioral Health Wellness & Recovery clinics. This hands-on approach allows our skilled professionals to capture nuanced aspects ofan individual's menlal health that may not be fully conveyed through telephonic interactions. Our pledge to elevate mental health support for older adults propels us to explore diverse avenues. While we recognize the value of telephone assessments. we concur that their potency is heightened when combined with in-person evaluations, particularly in cases involving risk faclors. This integrated approach underscores our dedication to delivering compassionate and personalized care that caters to the distinctive requirements of each person. Our commitment involves reviewing and assessing the evolving mental health needs of the community. The BHC remains dedicated as an advisory body to Riverside University Health System - Behavioral Health. Collaboratively with RUHS-BH, we focus on delivering care, support, and attention to all segments of our community, including our older adults.
• R5
  The Civil Grand Jury recommends Riverside University Health System - Behavioral Health continue evaluating crisis team services to identify gaps in service provision and potential funding sources. Response: lmplemented Recognizing the Civil Grand Jury's recommendation, the Riverside County Behavioral Health Commission (BHC) acknowledges Riverside University Health System - Behavioral Health (RUHS-BH) for its collaborative implementation. These aclions align with the BHC's mission and resolutely emphasize the commitment to cultivating ongoing enhancements in crisis team services. ln direcl response to lhis recommendation, RUHS-BH has showcased impressive strides in evaluating crisis team services and proactively addressing potential service gaps. Numerous notable examples spotlight the concrete outcomes that have materialized from this robust implementation: . Mobile Crisis Response Teams (MCRTs) Expansion and Outreach: RUHS-8H has 1 laken significant strides in expanding the MCRTs'scope to encompass youth up to 21 years old. This extension directly responds to community needs and emphasizes the commitment lo serve a broader range of individuals facing mental health crises. By l doing so, RUHS-BH bridges a critical gap in service provision and aligns with the BHC'S principle ol inclusive and comprehensive care. 2. Community Behavioral Assessment Teams (CBAT) Collaboration: The collaboration between RUHS-BH and local law enforcement agencies in expanding CBAT units showcases a collaborative ef{ort to provide a more holistic response to behavioral health emergencies. By integrating mental health professionals with specially trained police officers, this initiative exemplifies the spirit of partnership and underscores the imporlance ol a multidisciplinary approach in crisis intervention. 3. Community Assessment and Transport Team (CATT) Pilot Program: The introduction of the CATT pilot program, in parlnership with AMR (American Medical Response, lnc.), demonstrales a forward-thinking approach to crisis management. By directly assessing individuals on-site and facilitating appropriate transporlation to designated lacilities, RUHS-BH effectively streamlines the process and ensures limely access lo appropriate care. This initiative is a prime example of how innovalive solutions can address service gaps and enhance the overall experience for individuals in need 4. Mobile Crisis Management Teams (MCMT) Enhancements: The expansion of MCMT outreach, fueled by grant funds, is a testament to RUHS'BH's commitment to continuous improvement. By broadening the reach of MCMT units and strategically placing them in various cities, RUHS-BH ensures that individuals across Riverside County have access to immediate behavioral health care and support. This expansion meets lhe community's needs and reinforces RUHS-BH's dedication to proactive crisis intervention. These examples collectively highlight the dedication of RUHS-BH to implementing the recommendation by the Civil Grand Jury. By actively addressing gaps in service provision' collaborating with stakeholders, and optimizing crisis response strategies, RUHS-BH continues to set a precedent for excellence in mental and behavioral health services. The BHC supports these efforts and looks forward to further collaboration in ensuring the well-being of Riverside County's residents.
• R6
  Though Riverside County has expanded its trainer base for Frontline and Gatekeeper training (ASlST, SafeTalk, Mental Health First Aid, and Know the Signs) and established El Rotafolio as a Spanish version of SafeTalk, the Civil Grand Jury recommends Riverside University Health System.Behavioral Health to enhance training for RUHS social workers to look for and recognize signs and symptoms of potential suicldes during home visits and County delention center mental health program intake. Response: lmplemented ln line with the Behavioral Health Commission's (BHC) responsibility to ensure comprehensive community and professional input in RUHS-Behavioral Health Services, we recognize the critical importance of strengthening training for RUHS social workers. To address this, RUHS- Behavioral Health has implemented enhanced training measures, particularly emphasizing the identification of potential suicide signs during home visits and at the County detention center mental health program intake. Ensuring our behavioral health services remain current and effective, the BHC has been actively discussing, recommending, and being updated on maflers related to the Civil Grand Jury's recommendalion in our recent meetings. Recent BHC Meetings Addressing the Recommendation As parl of our commitment to keeping our behavioral health services currenl and effeclive, the BHC has been discussing and addressing the topics related to your recommendalion in our recenl meetings: On Aprll 6,2022, lhe BHC acknowledged Rlverside County's commendable efforts in expanding its trainer base for vital programs like ASIST, SafeTalk, Mental Health First Aid, and Know the Signs. The establishment of El Rotafolio, catering to our Spanish- speaking community, was also discussed, Furthermore, we underscored the importance of training for RUHS employees. On September 7, 2022. the BHC highlighted initiatives under the Mentat Heallh Services Act and our dedicated focus on suicide prevention within the community. The Suicide Prevention Coalition's subcommittee on poslvenlion etforls and its collaborations with the Trauma lnlervention Program (TlP) are among the measures emphasizing our commitment. RUHS-BH's lmplementation ol the Recommendalion Riverside University Health System-Behavioral Health (RUHS-BH) has proactively addressed items within the Civil Grand Jury's recommendations before the report. Among the measures implemented: Nearly 10,000 individuals have been lrained in mental health awareness and suicide prevention through the Prevention and Early lntervenlion (PEl)program. PEI ensures that trainings are accessible to all residents and collaborales with various I community enlities to offer specialized training sessions. RUHS-BH maintains a dedicated calendar for suicide prevention training, which is mandatory for all staff, including those who conducl home visits, to bolster their proficiency in identifying signs of potential suicides. Enhancements in the Behavioral Health Detention program have ensured a consistent quality of care for inmates. Continuous quality improvement meetings, specialized training for detention facility staff, refined protocols for non-emergency involuntary psychotropic medication, and the Medication Assisted Treatment (MAT) program are iusl a few of the strides taken to uphold our commitment to this crucial area. ln alignment with its roles, duties, and mission, the BHC takes the recommendation of the Civil Grand Jury seriously. We will continue to monitor, evaluate, and provide our insighls to the Board of Supervisors and Riverside University Health System - Behavioral Health concerning the mental health needs of our community. DPSS-0002800 County of Riverslde Depsrtment of Publlc Social Services Contracts Admlnlstratlon Unlt 10281 Kidd Stre€t Rlverslde, CA 92503 and Riverside County Riverside County lnteragency Child. Youth and Family Services Memorandum of Understanding t a 2 x RIVERSIDE COUNTY DEPARruENT OF PUBLIC SOC!qL SERTNCES 7tl5n1 ol 27 3.15 ocl 26:lr]2t DPSS-0002800 TABLE OF CONTENTS 1. DEFINITIONS 3 2 VISION 4 t 4 4. PURPOSE... 5 5. PRINCIPLES... 5 6. INTERAGENCYPROCESSES... 6 7. MUTUAL HOLD HARMLESS PROVISION... 12 8. INSURANCE ..12 9. TERM.................. 12 10. EARLY TERMINATION....,....,.... 12 ,I. .I CIVIL RIGHTS COMPLIANCE 13 12. WAIVER ........ 13 .13. AUTHORITY... 13 14. GOVERNING LAW AND VENUE.....,. 13 15, SEVERABILITY .......13 16. CONSTRUCTION AND CAPTIONS .......'t3 17. COMPLIANCE WTH LAW .......13 19. NOT|CES.................. .......14 19. ASSIGNMENT .14 20. ENTIRE AGREEMENT.......,.,,...,.. 14 21. MODIFICATION 14 22. SIGNED IN COUNTERPARTS .....14 23. ELECTRONIC SIGNATURES....,.,., .....14 List of Atlachments Attachmer l - List of System Partners Attachment ll - Drafl, Superior Court of the State of Califomia, Counly of Riverside, Juvenile Division, Blanket Order No. Addendum A - Califomia core Ptactice Model 7t15t21 Page2 ot 27 DPSS-0002800 This Memorandum of Understanding (MOU), de{ining the collaboralively shared deslgn, delivery and menagemenl of services to cfiildren, youth and families in Riverside County, is entered irt6 by and bet\,veen the followlng Partbs ("Syrtem partnerc'): Riverside County Oepartment of Public Social SeNices, Chiklren,s Services Divlsion (DPSSCSD) b. Riverside County Probation Department (RCP) o. Riverside University Health Systern - Behaviorat Heallh (RUHS-BH) d. lnland Counties Regional Center, lnc. d/b/a lnlsnd.Reglonal Center (lRC), a Calitornia non-profit corporation e. Riverslde County Office of Educstion (RCOE) f. Jwenlle Court, Superior Court of Califomia, Riverside County Hereinafier, lhe systBm Partners may'tie refened to tndivldually as a "partf , or collectively es the "Parties.'This Memorardum of understandhg shall superiede any prior Memoranduir of Understandlng. between the S)rstem partners, regarding delfuery of sha;ed services to children, youth and families. DEFINITIONS A. 'AB 2083' refec to Calfornla AsEembly Bill No. 2083, approved by the Govemor on September 27,2018, which aims to buitd on the Contini.rum of Cire Reform (CCR) implementation erfort by, among other things, developing a coordlnaled, timei, and trauma-informod, system-of-care approach for chlldren and youth in fosler care who heve experienced severe trauma. The bill requires each county to d€velop and implement a memorandum of under'standing, setting forth the roles and responsibf,ffies of agencies and olher entities thal serve children and youth in foster cari who have experienced severe trauma. B. 'Blankel Order No. 32" refers to the Superior Court of lhe Stete of CA, County of Riverside, Jwenlle Dlvlsion document, ou0ining lhe release and exchange of conlidential informalion among all partjes to thb MOU. ru parti€s shall ablde I tne Court-ordered Blanket Ordet and any approved amendmenis or revisions. C. "CFI' refsrs to Chitd and Famlly Team. D. 'CSD" reiers to DPSS Chlldren's Services Division. E. 'CSOC' refers to Colbborative Systems of Care. F. 'DPSS' and 'couNTr refer to the county of Riv€rside and its Deparlment of publc Social Services, which has adminisrative responstbitity for lhi6 MOU. DPSS and COUNTY are used interchangeably ln this MOU. . G. 'DPSS-CSD' reers to the Riverside County Department of public Social Services, Children's Services Divlsion. H. "ESStr refers to Every Student Succaeds Acl, which is a federaleducaton ad lbr K- 12 schools thet mendates educational equity tror Foster Students and schools. l. "FFA" reE s to FGter Family Agencies. 7115t21 DPSS4002800 J. 'ICPM' refers to lntegrated Core Practice Model K. 'IEAC' refers to lnteragency Executive Advisory Committee. L. 'lLf rebrs to lnteragency Leadership Team. M. 'lPC" refurs to lnteragency Placement Committee. N, 'lRC'refers to lnland Counties Regional Center, lnc. d/b/a lnland Regional Center O.''Katie A.' refers to lhe settlement agreement that requires the Counties to make systemic improvements to befter serve members of the class, and Federal Court that appolnls the Katle A Panel to mdnltor progress. P. 'MOLr refers to the terms and conditions, schedules, and attaohmentB included hereln. O. 'RCOE' refers to Riverskle County Omce of Education R. 'RCP' refers to the County of RlversHe and its Proballon Depertment S. 'RUHS-BH" refers to the County oI Riverside 8nd its Riverside University Health Sy6lem - Behavioral Health T. 'STRTP'refiers to Short Term Resldentlal Troatrnent Program. U. 'System Partners! rebrs to the parties listed in Attechmenl. I, individually and collectively, including thelr employees, agents, representativBs, subcontractors, and suppliers. 2 vtsloN Children, youth and families who are involved with child v.relfare, or are receiving foster care as dependents of the Riverside County Superior Court-Jwenlle Dlvislon, while in DPSS-CSD protective custody (Children's System of Care'), will receive timely, efieciive, collaborative seNices, consistent with the lntegrated Core Praclic€ Model (ICPM), which allow them to thrive in safe, permanEnt living situationE and that meet their sodal, emotional, cultural and behavioral needs. J. MISSION The Systern Partners will design, implement and maintain an integrated, trauma-focused system, with a shared framework that i8 information-driven, innovative, gnd reflec'tive of the ICPM. The system will d€liver servicss h a comprehenslve, culturally-responsive, eviJence-based/best prac-tica manner, regardless of whhh System Parlne/s door children and families enler. The System Partners will aclively seek to include foster youths' experiences and voices into County-lev€l collaborations and parlnerships thet manage or oversee the delivery of s€rvices affecling youth and families. The System Partners recognize that utilizing the ICPM for the sPeciflc PoPulalions addresled in this MoU ls tho lirst step to seNing a0 children and families with this model. 7t15t21 ol27 DPS$0002800 4. PURP E This M seeks to ensure that the Systems Partners' programs, praclic€s, and policies reflecl coordinated, integreted and efiedive dellvery of seryic€€ for children, youth, and , throughout lhe public program6. County-lovel System Partners have besn design by the Rfuerside County Board of SupeMsors to provide oversight and acco bility for certain stete and federally-fund€d programs end services, and to act as a coordlnaung councll and plannlng body, related to the programs and contained herein. The Syslem Parhers agree that consbtent interdepartmental and ragency badership ls essentialb successful planning and colleboratlon, on behalf of and families. The of this MOU is lo create an ongoing sbucture to address systemic baniers to provld lnteragency services. The System Partners intend to create a singlb seryice plan and ntain an adminisfative team with collaborative authority over the intenehted cNld welfare jWenile lustice, education, mental health and developrnental children's servlces. The Partners do not debgate their legal authority wlth respecl to any core func{on nor r of their agency; office, Department.or position. This MOU memodalizes the Syste Partnors' collaborative efforts, but it does not create any legal righb; it does not create 0r impose any legal obligations nor responsibillties on $e System PErtners; it does not inate, el&r, nor expand any duties or resporsibilities otherwise imposed or by lsw; it does not crsete any appeal rights, nor does lt allow for any cause of I action the event of purported breach of thb MOU. Th€ System Pa(ners each bear their clsts for participating in the system outlined in thls MOU, No System Partner is to pay ny money to any other System Partner for participeting in the system ot,tlined in this . However, the System Partners do fully plan to support the strudure and contained in thb MOU, and to provide a unified frarnework that will guide theh operati s and the activities, decisions, and direc-tion of each of their employees, ctildren, yorrth and family programming. 5. PRtNCt This M includes a mutual commltmer to and use of the California lnlegrated Core P Model (ICPM) for ChiHren, Youth and Families. System Partners agree to use the prin ples, velues, and praclice behaviors in their intersctions wjth youth and fumily, wilh on anothBr, with contraclors and Mth County partnera. The outllnes Ten Guiding Prac.tice Principles for Bervice delivery, dhich include the 1 fo key components: Family voice and choic€ Tearn-based Natural supports Collaboration and irdegration Community-based Culturally r€spedful lndividualized Strengths-bssed i Persistence i Outcomes-ba6ed 711 ol27 DPSS-0002800 The link, https://bil.lv/3mFvsp5. and the attached Addendum 'A', provide additbnal information on ths principles. INTERAGENCY PROCESSES The following elements are the primary and necessary components of comprahensive practices for the County of Riverside chlld and youth-serving System Parlners. System Partners' leaders will work together toward the best lnterest of chlldren and families, and lhe processes below support this work. The processes outline foundational efforts to affect lhe vision of the System Partners, building on mulual underslanding, best practices, and the tramework of the ICPM, while also complying with all legal mandates. Policies, protocols, and procedures will be developed, implemented, and reviewed as necessary, lo further the elements below. INTERAGENCY EXECUTIVE ADVISORY COMMITTEE (IEAC) The IEAC sels overall strategic direction for lhe lnteragency collaborative partnership. |EAC provides inpul and approves a two-year sirategic plan to guide the development of shared practice and policies, and to monitor and revise the plan as needed. To further a comprehensive and uniried County planning process, this plan may lncorporate, integrale, or expand upon, other existing interagency planning efforts. 'l-he IEAC meets al leasl one time per year to review and update the plan. Membership includes: Director, Riv€rside County Departmonl of Public Social S€rvices (DPSS-CSD), or designee . Riverside County Superior Court of California, Juvenile Eranch Presiding Judge, or designee . - Direclor, Riversidg Universlty Health System Behavioral Heatth (RUHS-BH) or designee . Chief Probation Ofricer, Riverside County Probation Department (RCP), or designee . Riverside County Superintendent o, Schools, Riverside County Otfice o, Education (RCOE), or dss(?nee . Exscutive Director, lnland Regional Center (lRC), or deslgnee . Olher System Partners' lesdership: as determined by the Committee . Parent and Youth representativas, as designated by the Comminee The IEAC gstiablishes co-chairs from the membershiP above that 6erve two- year staggered terms, with one new co-chair each year. B. INTERAGENCY LEAOERSHIP TEAM (ILT): The ILT oversees the implementation of the stret€gio plan approvsd by the IEAC and provides direc{ion and oversight to the lntstagency Placement 7115/121 I DPS$0002800 C0mmittee (lPC). Membership includes: . Assistant Dkector, Riverside County Department of Public . Social Services (DPSS-CSD), and/or designee Riverside County Superior Court of California, Juvenile Branch Judge/Commissioner, and/or designee . Deputy Dlrector, Children's and Tiansition Age Youth seruices Riversue Univorsity Health Syslem - Behavioral Health (RUHS- BH), and/or designee . Chief Deputy Probation Officer, Riverside County Probatlon Departmilnt, and/or designEe . Associate Superintendent of Sludent Programs and Services, Riverside County Office of Education (RCOE), and/or designee . Executive Director, lnland Rogional Center (lRC), and/or designee . Other'System Partners' leadership, as determined by the Committee The ILT establish€s co-chairs from the membership above that serve two-year staggered terms, rotaled among System Parlners or Departmenumembers, with one new co-chair each year. The ILT will meet quarlerly. The meeting forum preference is in-person, horrrever, other forums are acceptable (i.e. virtual meeting6), if necessary. The ILT will establish a consistent method of recording decisions and ideh fying responslble parties for following through on lhose decisions, sharing information, meeting notices, recordlng minutes, securing meeting venues, etc. l Whenever possible, ILT member System Partners and leadeB will seek consensus in decision-making. lf consensus cannot be reached, decisions may be mado by a simple majority vote of the total .number of authorized members of the lLT. Specific duties of the ILT members inctude: Manaoement. Administration and Service Deliverv: 1 offer interagency consultation. and coordination to support management and operation of the Riverside County lntegrated Children's Syslem of Care. Analyze opportunfties and projects and make recommendations to the IEAC. Provide recommendations and directions on impl8mentation of policies, procedures and programs included under this MOLI, Oversee the activities of all programs and seriices identified within the Collaborative Systems of Care (CSOC) Steerinq Committee. I 4 ldontify. and facilitate the development of any additional necessary 7t15n1 PageT ol 27 I DPSS-0002800 wdtten MOUS, and/or policies and procedures, for IEAC review and approval. Where these documents may also directly affect operations or obligations of any of the System Partners, those System Partners will a160 follow the procedures in place for approving such documents. 5. Ensure that all staff assigned to shared programming are provided with lhe necessary technical assistance, training, support and stBff resources to fulfill cetegorical mandates and implement the tCPM. This may indude, but is not limited to, esteblishing and impleminting competencles to gulde staff selection, tralning, coaching and psrtormance managemenl, lhat are conslslent with the ICPM. Ensure that System Partners' managers, supervisors, staff and contracled agencies provide services consislent with the shared Vision, Mission and Purpose and principles of this MOU and the ICPM. Policv Develooment. Coordination and Monitorino the Children's Collaborative Svstem df Care: 7 Make recommendations regarding submission, preparation and coordination of grant applications and grant deliverables. I Review and, as necessary, recommend program direction for applicable community parlnerG or providers- Gather and share annual reports on program issues, progress and outcomes. Discuss/approve requeEls from providers as appropriate to System Partners' rolss and oversight, e.9., CSD, RCP, and RUHS-BH will collaboratlvely review and approve Letters of Supporurequests from providers to become Short Term Residential Treatment Program (STRTP) providers, in a timely maoner. The ILT Administrator will serye as the designated communication authority when working on inter-county requests and correspondence. Participate on related coordinating councils, other advisory committees, and/or multi-disclpllnary teams that affect the System Partner processes or services and bring relevanl information to the lLT. Appoint and support staff to serve as liaisons to various shared projects, to ensure full continuum of care and linkages back to System Partner services. Monitor programs for general compliance with stafutory and regulatory requirement6 and provide guidanoe and technioal assistance to ensure program prac'tice is consistent with the values and principles of this interagency partnership. 12. Coordinate and develop additional agreements and/or MOUs, as necessary, to sssist in program coordination and problem solvlng. 7115n1 I DPSS-0002800 13, Work with communlty agencios lo d€velop and implement collaborative and integrated Elrategies, and to promote and utilize strengths_based, family-focused practice, on a systems-wide basis. 14- Consult wtth Riv€rslde County tribal representatives to develop .' processes for engaging and coordinating wlth the tribes, in the ongoing imptementation of the MOU. c INTERAG ENCY PLACEM ENT COMMITTEE (IPC) Sy8tem Partners managerG, or other qualified staff, will join y convene and adminisler the lPC, as required by stat€ mandateS - desiribing County lnleragency Placement Committees, and identified ln agreed-upon policy ani protocolr including appeals protocol. D SGREENING. ASSESSMENT AND ENTRY TO CARE In order to enhance unified service planning, System partners agree, to the full€st eltent allowed by law, to share nece-ssary and relevanl client-specific information, in order io conduct treatrnent, coo;dlnate care snd ensure the h'rghest quality care is available to youth and caregivers. E CHILD AND FAMILY TEAMING AND UNIFIED SERVICE PLANNING The System Partners recognize the Child and Family Team (CFT) as central to the implementation of Continuum of Care Reform anO the'lntejratd CJie .' a P c r h a l c e t v ic l e n g M p o o de s l i . t . i v E e n o g u a t g c e o m m e e n s t f a o n r d s y fu s l t l e p m a - r i t n n v e o rs lv h e ip il f w am ith il i l e h s e a C n F d T c i h s i ld c r r e iti n c ; a l l h i e n System Partners will work together to slrengthen systemic supports foi lhe CFT. ln order to maximize planning snd family engagement, System partners will provide a single, unified teaming process, for all youth in care. The System Partners will coordinate mental health care and educational services for youlh in the foster care system. Accordingly, System parfiers agree to implement policies cofiply with taws and/oiregulations requiring .to. such coordination, such as Katie A. or AB49O F SCHOOL STABILITY AND SCHOOL.OF.ORIGIN TRANSPORTATION PLAN Federar raw lEvery student succeeds Act (EssA)] requires that chird welfale agencies and schoor dlstricts deverop a Joint pran i6 ensure that transportation is available when it is in a studenfs beil tntdrest to remain in their school_of- origin after a change in placement. To comply with ESSA and improvo school stabilhy for students ln foster care, SJSPT Pa{tne1s agree to develop joint policiesiprocedures to ensure thatj dist cts and schoolE receive nolice within'one (1) dsy of any decision by the child welfare agencylo.change a sfuAent,s placein'ent (and, w'henever feaiible, DeTore lne ptac6ment change occurs); System partners work with lhe 6tudent,s educational rights holder to prompfly make the best interests determination; students have transportation to theh schools_of_or.rgin whlle best interests 7l15rz1 ol27 oPS$0002800 doterminations are pending and pending resolution ot eny dispute regarding school-of-origin rightsi and, if lt is determlned to be ln the stud€nt'B best interesl to remain in their school-of-origin, transportation is provided by the child welfare.agenoy (e.9. through caregiver reimbursement or publlc bus passos), bythe schooldistrict (e.9. by using or modifying an existing bus route), orjointly (e.9. by sharing the costs of transportation). G RECRUITIVIENT AND MANAGEMENT OF RESOURCE FAMILIES AND DELIVERY OF THERAPEUTIC FOSTER CARE System Partners will practice collaborative, unlform and consistent efforts, to recruit, tmin and support professional Regource Family car€giver6, in order to foster safe, permanent and healthy out-of-home placement when necessary. While CSD and RCP hsve legal obllgations and responsibilities to assure foster care capacity, RUHS - BH has parallel responsibility to assure adequate capacity for and oversight of Specialty Mental Health Services (SMHS), to support youth and their caregivers- System Partners agree to share n€cossary information and processes, as required and authorized by law, to support recrullment and retontion efforts. These include, but are not limited to; joint review of STRTP and Foster Family Agencies' (FFA) Program Statements and applications; joint investigation of complaints or grievances, as appropriate for each System Partner: ioint drafting and execution of contracts with providers; and, joint delivery of technical assistance and oversight. including on-sile reviews of programs and services. H OUALIW MANAGEMENT AND PROVIDER OVERSIGHT System Partners are committed to working together to back, monitor, evaluate and report on servioes supporling mutual clbnts, to meet reporting requirements, and inform evaluation of contraclors and vendors. t. TRAINING AND COACHING System Partners acknowledge that highly{rained, compelent staff, who understand and support each othe/s work, will help obtain better outcomes for children and families. System Partners agree to coordinate ioint training and coaching of stafi, so that they can better understand esch olhe/s roles, build relationships, and foster a collaborative approach in deliverlng seamless and integrated services. System Partners' representjalives may participate in developing and implementing training and coaching procssses for multiple partners. System Partflers willjointly plan and dellver training or in-service content thal is of value to their slafi, or other key partners. ILT members will use funding as flexibly as possible to facilitate the cross training and preperation of team members. 7115t21 ot 27 DPSS-0002800 ILT membeB also recognize their shared work with multiple oommunlty provider agencles, and the need for consHent communlcetlon, monltoring, snd support for ttEse providers. J. FIMNCIAL RESOURCES/MANAGEMENT The System Partne6 support eaqh o(her in puEuing tunding oppo(unities that strengthen the interagenc, service detrvery sysEm, including, but not limlt€d to, thos€ilhat maximize, blend, and/or leverage resources. System Partners wlll share information on these opportunitiea and wlll notify and consuft each othar, prior to applying br said tunding oppo(unfties. K. INFORMATION ANE DATA SHARING The System Partners agre€, as applicable, and to lhe tulbst extent allorved by law, to share necessary and relevanl client-specmc hbrmaton, h order to conducl treatment, coordinate care, and essure the highesl quellty seryice is avaihHe to youth and caregivers. Please reference the bllowing statues: (42 United States Code (U.S.C.) $ 671(a)(8XA); (a2 U.S.c. S 13e6(ax7); 42 c.F.R. S 421.302 (2009) as well as Califomia Welfare & lnstiMions Code g 4098, S 4096.1, S 4514, S 56m.3, S 10850, ands 18986.46. L CONFIDENTIiCLITY To lhe extent provided by Blenket Oder No. 32 (Attachment ll), slatute, or by a System Partne/s pollcles, the System Partners may share confidential informatiol with each other, in ord€r to ensure effeclive treafnent, coordinate care and to deliver quality services, pursuant to the requlrements of Welfare and lnstitutions Code section 16521 .6(a)(3). Confidential information shared under this MOU shall be subject to the continued conlidentiality requirements of the controlling statute or policy. Furlher, the System Partners agree that: 1 The System Partners shall provide for, and adhere to, lhe implemenlation and mainlenance of appropriate security protocols and procedutes, for the transfer and maintenance of confdential lnformation shared by the other System Partners. 2. Unless otherwise required by thi6 MOU or by Court order, the System Partners shall limit access and viewing of c-onfidential information to lndMduals who are neceBsary, to ensure complianco with the purpGes of this MOU. The Syslem Partnec shall p(escrib€ appropdate procedures for the timely destruc'tion or refum ofconfidenlial infonnation, once the purpo8e for whic+l lhe inrormation was released and exchanged has been salisfied, pursuant to Wetfare and lnstitulions Code sec-tion 16521,6(a)(3)(B). M DISPUTE RESOLUTION MECHANISM \Mrenever possible, ILT member System Partners and lesder8 wlll seek consensus in decbion-making. lf consensus cannot be reached, decisions may be made by a simple majority vote of the lotal number of authorized memberB of the ILT. 7t15t21 ol 27 DPSS-0002800 I Performance to Contlnue Durlng Dispute Performance oI this MOU 6hall continue during any necessary dispute proceeding, or any other dispute resolution mechanism, No payment due nor payable, by any Syslem Partner, shall b€ withheld due to a.pending dispute resolution, with exception to the extent that payment is the subjed of such dlspute. 7. MUTUAL HOLD HARMLESS PROVISION Each System Partner signing this MOU agrees lo hold harmless all other System Partners, including officers, employees, volunteers, and Egents, fom and against any.and all liability, loss, expensB, attorneys'fees, and/or claims for injury or damages, arising out of lhe performance of this MOU. The System Partners agree lo reasonably cooperate with each other in the investigallon and disposition ofthird-pafi liability claims, arising out of any servicos provided under lhis MOU. Absent of any conflic,ts of interest, it is the intention of the System Parlners to reasonably cooperate in the disposition of all 6uch claims. Such cooperation may indude joint investigation, defense and disposition of claims of third parties, arising from seruices performed under this MOU. The System Pdrtners agree lo promptly inform one another whenever an lncident report, claim or complalnt 16 liled, or whenever an lnvestigation is initialed conceming any seruic€ performed under this MOU. Each System Partnet may conduot its own investigation and engage its own munsel. Each of the Syslem Parlners hereby acknowledges that the System Parlners are lndependent contrac{ors and thet the reletlonship established among the System Parkrers, by this MOU, shall not constitute a partnership, joint venture nor agency. None of the System Parlners shall have the authority to make any statements, iepresentations nor commilments of any kind, nor take any actlon, which shall be blndlng on the other Parties hereto, without the prior written consent ofthe other Parti€s hereto, or Party hereto, as applicable, to do so. INSURANCE W'rthotd limiting or diminbhing each System Partner's obligation to hold harmless all other System Partners, each System Parlner, at its sole cost and expense, shall maintain or cause to be maintained, its own insurance coveraggs for workers' cornpensation, vehide liability, commercial general liabillty and cyber liability, for its own operations durir€ the term of this MOU. The lnsurance requirements contained in this MOU may be met with a program(s) of setf-insurance. I TERM Thh MOU shall remain in full force and effecl, ftom the date of signature, through December 31,2025, but may be terminated earlier, in accordance with the provisions of Section 10 of this MOU 10 EARLY TERMINATION This MOU may be terminated, without cause, upon thirty (30) days' Mitten notbe by any Party, or upon the mutual agreement of all Parties. The DPSS-o.SD Director, or designeo, is authorized to exercise DPSS-CSD'S rights, with respecl to any termination of this MOU, The Presiding Judge of lhe Juvenile Court for the Superior Court of Califomia, county of Riverside, or designee, is authorized to exercise the Preslding Judge's rlghts, with resPest to any termination of this MOU. The RUHS-BH Diredor, or designee, is authorized tq ' 7t15n1 ol27 DPSS-0002800 exercise RUHs-Blfs rights, with respect to any termination of this Mou. The RCp chief Probation Officer, ordesignee, is authorized toexerclse RCFS ,irhts, with respect to any termlnation of rhis MoU. The RcoE superintendent, or d6ignee, ts auirrorized to exereise RCOE's rights, with respect to any termination of ttris UOU. The IRC Executive Director, or designee, is authorized lo exercise IRC'S rights, with respect to any terminatlon of this MOU. 11. CIVIL RIGHTS COMPLIANCE system Partners shall ensure that the admlnishation of pubric assistance and Bocial seruce progrsms is nondiscriminatory. System pBrtners shall not dlscriminate in the provision of services, the allocation of behefits, employment of perBonnel, nor in the accommodation ln faclllties, on the basis of ethnic group identficatioir, color, race, religion, national origin, gender, age, se:ual orientation, physical or mer(al handlcai, in accodance with T,tle Vl of the Civit Righb Acl of 196i, 4Z U.S.C. Sec{on 2000d, and a[ other -per{nert rules and regurations promurgateo pursuant Gerato, and as otheMise provided by state law and regulations, as all riray noa exist, or be hereafler amended or changed. 12. WAIVER No walver_of any of the provisions of this Mou shall be efiective unrBss it b made in a . writing which refers to provbions so waived and which is executed by the parties. No course of dearing, nor delay or fairure ol a party in exerdsing any righiunder this MoU, shall affect any othei or tuture exercise of ihat ri-ght, nor any ixercisiof any otnJ rijrri. i Party shall not be precluded ftom exercising a rigiht by havirig partially exerJiseO tnairi'jtrt, nor by having previously abandoned or discontinuea steps,id enfor,:e that reht. 13. AUTHORITY 'Mou The signatureE of the parties.affixed to this affirm that they are duly authorized to commir and bind their respective party to the terms and conditioni set fortir inthd MbL,. 14. GOVERNING LAW AND VENUE This Mou,sha be govemed by the raws of the stste of carifomia. venue shafl be in Riverside County. 15. SE'ERABILTTY ' lf any portion of thrs Mou is decrared invarid, irbgar, or otherwise unenforc€abre by a coud of compet€nt jurisdic'tion, the remaining provisi;;s'shari"onunr", in fufl force end effect. 16, CONSTRUCTIONANDCAPTIONS since the Parties and/ortheir agents have par clpated fulry in th€ prepararion of this Mou, lhe hnguage of this Mou shalbe co_lstruid simpry, acmiding to'its iair.""nrng, noi for nor again't any. party. The captioni tt the vari-ous ;;A'id"ndd- ;;; 'triclly paragraphs are for conveniencer and ease of refurence only,6nd"r t O ic o t" n i, b t Oenne,'limit, augment, nor describe the scope, content, nor intent of this M-OU. 17. COMPLIANCE WTH LAW A[ P_arlies 6hall keep themserves tufly informed of and in compliance with all locar, state, and federar raws, rures, regurations, requirements and dir€ctives, relstive l" aa zob5 and rne purposes ofrhrs Mou, funding soufces and other govoming reguratory authorities that 7t15n1 I DPSS-0002800 impose dutles and regulations upon the Parties to this MOU, and which, in any manner, atfiBct the performance of their respective obllgatlons and/or duties, under this MOU. NOTICES All notices, claims, correspond€nce, and/or statements authorized. and/or required by this MOU, shall be deeined effedive five (5) businoss days after they are made in writing and deposited in the United States Postal Mall, eddressed as set forth ln ExnibftA. 19. ASSIGNMENT System Parlners shall not assign nor transEr any lnterest in this MOU without the prior Mitten consent ofallofthe Slslem Partners. Any attemptto assign ortransfer any interest, without the written consent of all of the System Partners, shan be deemed vcid and ol no force nor effec{, 20 ENTIRE AGREEMENT Thls MOU ls ths full and complete documenl describing seMces lo ba rendered by the Parties, including all covenants, conditions, and benefits, 21. MO DIFICATIO N Any alterations, varietions, modifications, or wafuers of provisions of tho MOU, unless specifically allowed ln the MOU, shall be valid only when they have been reduced to writing, duly signed and approved by th€ authorized representiativ8s of all Part'res, as an amendment to this MOU. Oral understandings, or'agroements that have not been incorporated herein, shall not be bhding on any ofthe Parties hereto. SIGNED IN COUNTERPARTS This MOU may be executed in any number of counterparts, each of which when exesuted shall constitute a duplicete original, but, all counterparts together shall constitute a single agreement. ELECTRONIC SIGNATURES Each party to this MOU agrees to tho use of electronic signatures, such as digital signatures, that meet the requirements of the California Uniform Electonlc Tran$ctions Act (fcuETA), at cal. cv. code $$ 1633.1 lo 1633.17), for executing this MoU. Tho parties further agree that the electronic signature(s) included herBin are intended to authenticate this writing and to have the same for@ and etfect as manual signatures. [Signature Pages Follow] I I I I I I 7t1snl ol 27 DPSS-0002800 Authorized a ignature lotthe County of Riverside J. a)-.-A.J Printed Name of Person a Karen Spiegel (r t o ! Ti e: I Cheir, Board of Superyisors F(E Date lt, < HO Recommended for Approval: F<UYJ Biverside County Department of public Social Services -.-/ <7^ , j.--r- Sayori Baldwin, Director Dare: seP 27,2021 Riverside University Health System - Behavioral Heallh Matthew Chang, Oireclor Date: 911312021 Riverside County Probation Department Ronald Miller ll, Chief Probation O41icer Date: Juvenile Court, Superior Court of California, Riverside County The Honorable Mark E. Petersen, presiding Judge Date: 7t15n.1 DPSS-0002800 Rfuerslde County Office ot Education Edwin Gomgz, Ed.D., Superintendent of Schools Date: lnland Counties Regional Center, lnc. Lavinia Johnson, Exec. Dir./Chief Execulive Offlcer Date: Approval as lo Form Gregory P. Priamos Counb/ Counsel 6tu&/to Sep 20, 2021 Esen Sainz Date SEned Deputy County Counsel Eric Stopher Date Signed Deputy County Counsel Approval as to Form Steven K. Beckett General Counsel & Director lnland Regional Center Dale Signed 7t15t21 .DPSS{002800 Authorized ignature for the County of Riverside: Printed Name of Person SignirE Karen Splegel TiUe: Chair, Board of Sup€rvisors Date Signed: I : Recommerded for Approvat l Rlverslde County Departmerit of Public Social Services I I Sayori Baldwin, Director Date: Riverside University Heatth System - Behavioral Heafth Matthew Chang, Director I Date: i ; Riverside County Probation Department //rW// ?om//L Ronald Miller ll, Chief Probation Oftcer Date: Aug 30, 2021 Juvenile Court, Superior Court of California, Riverside County Mdd E. P,larson The Honorable Mark E. PetersBn, presiding Judge Aus 30.2021 Dale: 7h5n1 of ?7 I DPSS-0002800 Riverside County Ofiice of Education Edwin Gom6z, Ed.D., Sup€rhtendent of Scfiools Date: lnland Counties Regional Center, lnc. UrAulvTohaoa, Lavinia Johnson, EIeo. Dr./Chlef Exdcutivo Ofiicer 4us26.202I Date: Approval as to Form Gregory P. Priamos County Counsel Esen Sainz Date Signed Deputy County Counsel es%,* Aug 30, 2021 E ic Slopher Date Signed Deputy County. Counsel Approval as to Form Steven K. Beckett I General Counsel DirBclor Inland Regional Center [tow E Eukb 4u826,202r Date Signed 7n5n1 ot 27 DPSS-0002800 Riverside of Education Edwin Gomez, Superintendent of Schools I Date: lnland Counties Regional Center, lnc Lavinia Johnson, Exec. Dir./Chief Executive Ofticer Date: Approval as to Form Gregory P. Priamos County Counsel Esen Sainz Dale Signed Deputy County Counsel Eric Stopher Date Signed Deputy County Counsel Approval as to Form Sleven K. Beckett General Counsel & Director lnland Regional Center Date Signed 7t15t21 DPSS-0002800 Attachment I - List of System Partners :Ne: '. r.l 1 Tho County of, Rlverslde, a polltical subdlvi3lon of the Stlto of Callfomla, on behalf of IE Iollowlng Departments: 4060 County Ckcle Orive Department of Public Social Se]vlce8, Chlldren,a Rlverside, CA 92503 Services Division @PSS) 4095 County Circle Drive Riverside Universlty Health Systerc-Behavioral Riverside, CA 92503 Health (RUHS-BH) Riverside County Pmbalion Departnent 3960 Orange Street I Riverside, CA 92501 2. Juvmile Court, Superior Court of California 4050 Main S'treet Riverside County Riverside, CA 92501 3. Riverside County Offce o, Education 3939 Thirteenth Sheet Riverside, CA 92501 4. lnland Counties Regionel Center, lnc. Physical Address: 1365 South Waterman Av€. San Bernardino, CA S24O&28O4 Mailing Addraes: P.O. Box 19037 San Elemardino, CA 9242}i9037 7115n1 . ot 27 DPS$0002800 Attachmenl ll . Draft I 2 3 4 s 6 't SI.,PERIOR COI,RT OF THE STATE OF CALIFORNIA E COTJNTY OF RTVERSIDE 9 ,LTVENILE DTVISION l0 u BLANKT]T ORDER NO. 32 \t ORDER FOR 'II-IE RELEASE AI{D l3 EXC}IANCE OF CONFIDENTIAL INFORMATION BETWEEN THE RTVERSIDE l4 COUNTY DEPARTMENT OF SOCI,AL SERVICES-CHILDREN'S SERVICES l5 DIVISION; RIVERSIDE COLNTY PROBATION DEPARTMENT, RTVERSIDE t6 UNNERSITY HEALTH SYSIEM- BEHAVIORAL HEALTH, TI{E RIVERSIDE l7 COT'NTY OFFICE OF EDUCATION INLAND COUNNES REGIONA! CENTE& INC. AND IE NECESSARY THIRD.PARTY CON,TMI'NITY PARTNERS TO FACILITATE A SYSTEM OF l9 CARE REQUIRED BY ASSEIV{BLY BILL 20E: 20 2t 22 Thc Cor*inuun ofCac Rrfq.E, initisrcd tn 2015 by and through Asscnbly BiU 403, (!,l rct ddhg 21 sestioo 16521.5 to thc Wclflrc !!d lnstitutioos Codc) is c1rrmtly bcing Glrthcr sspportcd by r 24 ORDER FOR T}IE RELEASE AND EXCHANOE OF CONFTDENNAL INFORMATION SET1IEEN THE R.IVERS'DE @UNTY DEPA.IiTMENI Of SOCIAL SERVIGS-qILDREN'S SERVICES DMSION: RIYERSIDE COUNTY 25 PROBATION DEPARTME}fI, ruVERSIDE I'NTVERSTTY HEALTH SYSTEM.BEITAVIORAL HETLTI! Tr{E 26 RIVESSIDE COUNTY OFFICE OF ED(rcAION, INLAND MT'NIIBS REGIO}IAL CENTE& TNq AND NECESSAX,Y T}NRDPARTY COMMIJMTY PARTNERS TO FACILTTATE A SYSTBM OF CARB REQUIRED BY ASSEMBLY BILL 2083 27 2t BLANKEI ORDER NO, 32 7t15n1 ol 27 DPSS-0002800 I syrtlm of csre for &Ililles e[gsgcd with c.hild rrtlfirc or fostcr carc. CouDty and local parocrs !!! Erodatrd to providc a coordiaarcd systcD of cqlc ro rvoid 86p6 in scrvicas End crEdc sfrblc bstcr 3 ptaccocnts. Thc s)strm of c8rc is to povide caoidimtad, timcty, cultunlty compelat! iotcgr8tld, 4 oomDulity-bss€d, shcn8th-brsed, individualiztd atld triuriiE iqforEcd scrvic.s to lddrlss systloic banicrs 5 to lhc tsaditional provision of iorcrlgcncy scrviccs. Tte Califomis Lcgistdur, by ad thrcugh th. ittrplemcutdion ofAslcErbly Bi[ 2083 (Chaprcr 8 I 5, 7 Stdut s of20l8), requires, in part, th8t Rivorsidc County devclop a mcrromodum of undcrstrrxling E outliDiug thc rolGs ard rcspoosibilitics oftbe agencics dcscriH 8s Syst m PartE s. The Rivcrsidc County 9 Dcpsrtncnt of Public Social Scrviocs-Ciildreo's Scrvic€s Divisiolr (DPSS4SD), Riveaidc County l0 hobatlon Dcparhant ECP), Rivcnidc Uoiv.rsity Health Sylr.m-Bdrsviord Hcahh (RUHS-BH), u Nvcaidc Couuty Officc of Educa(oa (RCOE) rDd Inhld Courtics Rcgional Ccntcr, Inc. d/b/a Inland t2 Regional Crotcr (IRC) (hcr.inaicr clllc4tivcly lef.rcd to as Sylt m Panocrs) h.ve nte[ld irto a Rivasidc l3 Coutrty htcragctrcy Child, Youth, and Frmily Ssryiccs Mcmorandur of Uld.rstsndirg (MOU), in l4 satisfaaion of this lcgislUion. Thc MOU, in parq supporrs tle structur. snd prDcess€s of cach Systrm 15. Par$cr. t6 The MOU slso rcquirls, io part, thsr confidc[tirl inforaatio[ atld drra bc ahared by and bctwern t? thE Systcm PartDcrs througi infonnalion ind ddr sharinS sgrccments to the extcnt pcnDided by fedenl and t8 ststc l8lds, This iocludcs informuion aod data shacd by particular tcaos or persons dcscribed and idcntificd I9 wilh lhc MOU. Thcsc tea0s or pDrsors includc an lntemgcngi E:rccutivc Advisory Comminee @AS), rn 20 Intcragcocy Lcrdclstiip Tcsrn (ILT), a Child lnd flmily Tcan (CF'I), s! htcE8.ocy placcmcnr Corunittcc 2l (IPC) and/or invcstcd &ird p[tics as defincd ad dcscribed withln Assembly Bill No.20t3, subscqucnt n legfulalion Ed tlc tcrms ofthc MOU. Invcsrcd lhird partics may includc, but &c lot limi&d to, individuals, 23 orgrnizations, agencic or eotiti6, wbo u! (l) st^,icc providcrs, or (2) 24 ORDER FOR T}IE REIXASE AI{D EXCHANOE OF COMIDE}TTIAL INFORMATION BETWEEN THE RIVERSIDE COUNTY DEPARTMENT OF SOCIAL SERVIC'ES.CHILDREN'S SERVICES DTVISION; RIVEnSIDE COUNTY 25 PROAANON DEPARTMENT, RIVSRSIDE I,,MVERSITY HEAI,TH SYSIEIVI'BEHAVIORAL HEALI]I, THE RIVERSIDE CII'NTY OFFICE OF EDUCATION, INLAI{D @I'NTIES RECIONAL CENTE& INC. AIIID NECESSARY 26 THIRDPARTY @MMUNITY PAiTNERS TO FACILIIATE A SYSTEM OT CARE REOI,NRED BY ASSBMBLY BILL mt1 27 BLANKET ORDER NO !2 28 7t15D1 Pege 19 ol 27 I DPSS-0002800 I mcmb""g of: loc4l cducational agencics, spccial cducation local plEn src&s, mrnagcd crre organizatioos plsccrient rgeaaiee, 8 child's fsmily, . fostcr youth advisory council, Indian tribes or cibsl orglDizsdols, 3 th. c.lifoEis stEtc Dcpartncut of Social scrvicas snd/or thc Rivi*idc superior coun-Juwoilc Division. Ilvestcd thid paties may bc, or may not bc, pt tics to tho MOU. Th€ ILT consisB of thc systqr pannds' l.adrrs, dcplrtmcnt heads or suporintcldents Bnd is the 6 goverairg rnd coordiutirg body. Tbc ILT *tablishcs lDd ovrrre* thc rxccrtion of thc MoU. Thc ILT 7 musl havo rcc.ss to, Bnd shrre, I furr child,s or youth,s mofidcntial informatiou to (l) guide staff, (2) 8 idcotis and resolvc coaf,idr, if aly, ad (3) lwcragc whct! tbcrc is s ,.reonobrc bcricfrhlr thc '.sourc.' 9 informrtioa is clcrrot to tbo child or youth. t0 Thc systcm Psrtners Eusr [Evr rccrss !o conEdcotirl inform*ion to sha* Bce'sary rod rdqvant u hformatioo in .roh c&!! in ryhich services must br plovidcd to coDduct trcatncnt, coordinarE csrc tnd to t2 dcliwr quallty scrviccs by and through case mtnagemelt and/or thc ctrorts.ofthc cFT ard tpc, lnvcsted l3 rhird prtics, oay be iacluded in rhc ILT activities or trcatnenr cec and plsrcmcot cfforts pr.vidcd for and t4 to r spccific,fos&r child. Tbc cslifortria lorcgrdcd corc pra.tic.€ Model gcpM) for childrcn youth and l5 Fr'iti.s ii a r*ourcc cr,tcd ir collsborrtion b€tweco thc c&lifortria Dcprtacnt ofHcalth csrc scrvices t6 and the california Dapsrtment of sosia.l scrviccs to providc practica.l guidaacc and dLlctiotr ro sysrcm t7 PEtDcrs asd Irvcsted Third Panies, whcrc applicrblc, in thc dclivcry oftimcly, cfcctive, aad i,tcgrdcd l8 scrviccs ro fostcr childrca. Thc tcPM is inte8rdld fu the Mou and h t,E provisim of scwices to fosrcr I9 childre!. Assembly Bill No. 2083 pcmits thc ILT to disolosc aod cxchalge cotrfidentier rnforoaliou rs 2l permitttd by fcdera.l law, Notwithstatrding, st!tutory disclosuc r6bictions prccludc DpSS-CSD Aom aa disstrdnating ccnEin hformarioD ualcss ruthorizcd by coun orde.. Spccifically, thc follorriog surutcs 23 precludc DPSSCSD tom disseoiaating informaioa dcsctibcd ia; 24 ORDER FOR TI{E RELEASE AND EXCHAN'GE OP CONFIDENIIAI IMORMATIOI.I BETWEEN THE RII€RSIDE 25 COI'NTY DEPARTMENT OF SOCTAL SERVICES-CHILDREN'S SERYICES DMSTON; RMRSIDE COlrNTy PROAATION DEPARTMENT. RIVERSIDE TJNT\E8SIT? HEALTH SYSITM.BE}IAVIORAL HEALTII, TIIE 26 FJVENSDE COTJNTY OFFTCE OF EDUCATION, INLAND MUNTTES REOIONALCEN'IE& INC. AND NECESSARY THIX.}PARTY COMMUNTTY PARINERS TO FACILITATE A SYSTEM OF CAREREQT,,IRTD BY ASSEMBLY BTLL 20E3 21 28 ALANKET ORDER NO. 32 7)15n1 ol 27 DPSS-0002800 . Cdifomla P.!ul Codc lcctionr I I167 lrd I I167.5 I . Califomia Wclfart srd ltlltitutbo! Codc scstioB 827, t28, t0!50, uld 16501, subdivision 2 (rX4) . Frmily Fdgrligna! Rights md Priv.cy Acl (20 US.C. 6l132e;3a c.F.R Pon 99, 15 mcadcd; 'FER.PA') 4 o Crlifomia Busincs and Proftsloor Codc ! 225t4 5 o Cdiforaia Civil Co& soctiotr I?9E29 6 r Crlifomia Mucrdoo Codc s.clioss 49073 ,49b76, 49076.5 U,d19076.7 7 e t Crliforoir Govcnrncot Codc arctioo 6250 . U.S.C. scdion 12329 aad 3rl C-F.R rcction 9931 9 . l0 RivcBidc Couoty Juvcnilc Blsok.t Ordcr 15. ll ' Ttc&foG, si.nc€ somc fcdcral ltw rnd Cdifomia larvs'may limit thc rclcase rnd cxctangc of colridrotial ioformatioq rcsolutioo ofthis conllict is ncccssrry by md thloogh rhis bhDkc{ ordcr. Good l3 callse supports thc rclcsse ud cxchuge ofconfidqtial inforerrion i! this cont xt siDcc I lirDitld lslcsss t4 of infon;ation about ! fosrcr child is in tbc child'r bcsr l crcsG whcrc multiplc ngstlsirs lrE involvcd in t5 Glcssing 8 fo3tcr child fc scnricts aodor plsorrDcat nccds. Thc purposc ofthis rclcosc 8od exchango is ia l5 rhc furthqrancc of Continuusl of Cu! Rcform rupporr.d by s systcm of carc for fo$!r childrctr. l7 Collaboruivc pfforts ir s rystcm of carc prcvides 8 coordinlrcd, timcly aad trruoa-informcd approlch to l8 fostlr cbildrc! b rddnss systcaic bqfticrs to ttc mditioml provisio! offutcragcncy scrriccs. Tbc Juvcsile l9 Court hcreby isru6 this bl.okct ordcr su&orizing 0re dlsclo:urc of ! juvenilo cssc file lrd/or co idqltial 20 infomaion ia compliaacc with Wclfrr! !!d Instit8iolr Codc s.ction 16521.6 srd in coordinuion wirh a 2l syrtcm of cs! prrscdbcd snd describcd by t[c MOU. Systcm Parh.rs .od iLcsred third prrties arc t', authorirld to rclcrsc tod o(chs.oge r fos&r child's confidcmirl ilformtion. Funhcr, lbe Syrtlm PrrrucB agrcc that: a 24 ORDER FOR THE RELBASE AND AXC}iANGE OT CONFIDENIAL INTUGT^-NON BETWEEN THE RTVERSDE cOlrNTY DEPARTMENT OF SOC1AL SERVICESCHILDREN'S SERVICES otustoN: RJVERJIDE COrrNTy 25 PROBATION DEPARTMENT, RIVERSIDE T'NIVERSITY HEALTH SYSTE}GBBHAVIORAI HE !TI{, TI'E RIVERSTDE COI'NTY OFFICE OF EDUCANON. INLA}.ID COI.,'NIIES REGIONAL CENN'R. INC. AND NECESSARY 26 THIR.}PARTY COMMUMTY PA.RTNERS TO FACILTTATE A SYSTEM OF CARE REQUIRED DY ASSETT,{BLY BILL m$ 27 DLANKET OR.DER NO- 32 2E 7t15n1 DPSS4002800 I . l. Thc SystcD PsnncB shlll pmvide for, rnd rdh6c ro, Uc implcrnr[tatioliod a mriotenarcc of lpprcpriatc $surity Folocols !!d proccdurcs for thc tronEfcr 8trd msintcn8flce 3 of coalidcntid infontration shartd by the oth6 System P!fincls 2. Unlcas othcrvlsc rEquircd by the MOU'or by coutt oidcr, thc Systcrn Psrtncn 5 shall limit rcccss rnd vicwing of confidantial information to iDdiyidurls who d! occcagary b 6 asurc compliracc with thc purporcs oftbc MOU aod 7 3. Thc Syseo Psllcn shallpnsoibc apiropriac proccdurts brthc rimcly dcstnraion t or rttum of confdcntial lafonnariou oncc 0rc purposc for which thc iaformaion wa: rclcascd cnd 9 cxchaagcd has bcca satirficd, pursu8trt to WclfrE md Institutions Codc rcclion 16521.6, 10 subdivkioa (a)(3)@). II Acccss, viewing, disorssioa aad/or u.sc ofany rccoldJ or confdcotid lnforoaion obuincd undor 12 this order ir solcly limitcd to u5r iD"coucrtion lld applicdioo of 0rc Rivcrsidc County Intcregcncy Child, l3 Youlh md Fsmily Scrviccs Meoorcsdum ofUndcistudilg rofcrcaccd r' 'MOtf and dcgcribld, in part, l4 abovc. C-onfidenticl idormrtiou relcarcd, cxohaagld or discu3scd wilhh tcams or committcca pursuant to l5 this Blanka Ordcr shsll lot be opoD to public iospcctior in 8oy instlsc!, Ttre coofdcntial infomltion l6 osiDtains its c.nfid.otis.l nst{.E in spit! oflhc rclcrsc aad disrgmbrtio[ pur5ut[t !o a systcm ofca!€, thc t7 tqrms ofthc MOU and thc actions of System Psrhcrs rnd invcaad tfiird pErlics. The Eco.ds aod iaformation IE disclosed under this ord6 shall not bc rrlc{scd to ary othcr cntity or individusl othc( thrn th! Synlm 19 Pgtocn or invcsted third partics dc.scribcd hcrch md within thc tarms ofthc MOU aDd shrll not be madc 20 my part of any other coutt filc thlt is opGD ro lhc public, The usc of rccords 8nd iDfornatioD obtained undcr 2t lhis ord€r ltr liEi&d to prDlrole r cootdinstcd syrtlm ofcaE to clildrco, youth and hmilics rugagcd ia child wclfsIr or to scrvc tlc occds ofRiwnidc County d.pa&nt childrco placcd i.u fostcr carc orly, uolcss 23 rulhorizcd by furthcr court ordcr or u allowcd by la*. Confdcrtiality of 24 ORDER FOR THE RELEASE A}ID E'(CI{ANGE OT C$NRDSNNAT D.IFORMANON BETWEEN THE RM.RIiIDE COT NTY DEPARTMENT OF soClAL SsRvIcEscHtr-DREN'S SERYICES DMSION: RIVBRS[DE COT NTY 25 PROEAION DEPARTMENT, RIVBRSIDE T'NTVEPSITY HEALTH SYSTEM.EEHAVTOR/qI HEALTII, I'I{E 26 RIVERSTDB COT'NTY OFFICE OF EDUCANON,INI.AND COT,NIIBS REOIONAL CENTE& TNC, AND NECESSARY TMf,,DPARTY COM}A'NITY PARN{ENS TO TACTUTATE A SYSTAM OF CARE REQ{,'IRED BY ASSEMBLY BILL 20t3 28 AI-ANKET ORDEN NO, 3? 7t15n1 ol27 I DPSS-0002800 I Subslaacc Usc Disordcr Palicnt Rccords, 42 CFR Psrt 2, snd thc Hllltt lDsunnce Porrsbilit, lnd Accounlability Act ofl996 (I{IPAA),45 CFR Palrs 150 & 164, can lot bc discloscd wittout wlittro conscDt 3 uulcss otbcrwisc providcd by law or rgul4ion. Tbc p,urposc oflhis order is to luthoriz, thc &lcasc ofinfonnrtior; rhis is not rn ordcr rcquiriry lbe rtle{se of iofornation. Thi! B latrkct frcI srrv6 to sllow for rcutine lslthcgrc/dcnhl crrc md infonnaion 6 shrrirg. TLis bl8lket ord.r oppli.s to cll childrcn in DPSrcSD protldtvE cusdy and is not . r.quircd 'l documeot mahtaiocd lo each child's juvcollc case 6lc. Datcd, 2021 ffi 9 Presiding Judgc ofthe ,uvcnilc Court l0 Riverside SupqiorCoufi t1 t2 l3 I4 l5 t6 IE 19 20 zl 22 23 u 6 ORDER FOR THE RELEASE AND EXCHA}iOE OT CONNDSNTIA, INFORMATION BETWEEN r}IE RIVEiS'DE ,< CoITNTY DEPARTMENT OF SOC{AL SERVICIJ-CHILDREN'S SERVICES DIVISION; RIYEnSIDE COUNTY PROBATION DSPARTMENI,. RIVERSTDE I'NTVERSITY HEALTII SYSTEM.BEHAVIORAL HEALTI1 THE RJVERSIDE CO(NTY OFFICE OP EDUCATION. INLA}ID COI.,NIIES REGIONAL CENTE& INC, AND NECESSARY 26 THIRT}PARTY COMMI.'NITY PARTNESS TO FACILTATE A SYSTEM OT CARE REQ{JIRED BY ASSEMDLY BILL 20t3 27 BLANKET ORDER NO. 32 28 7115n1 ol27 ' DPSS-0002800 AODENDUiN "A" Callfomla Core Practlce Modol The following excerpt is from the lntegrated califomia core practice Model. please refer to httos://bil.lvl3mFvSoS for additional informallon. Vlluea and Princlpler This lcPM is informed by nationally-re.cognized core values and principles and derived hrg€ly from research about how colaborative and integrated family services worr uest. rn-*6 g.rldgl1g:: wth the use of comptementary evidence-informed pratticee, suggest thai a ipecru. o, community-basod services and supports for chlldren, y - ouar, and tami6-s witr, or ai risk of, serious challenges, will improve the outcome of services. '1. Values Famlly--drrien end youth-guided: Famiry-driven and youthguided pracflces recognize that no one knows more abou the famflys story ino spLofic ne;ds rhan .' the famiry memb€rs themserves. The famiry membois can 6e"l oeicrite th"i hisi;r; culture, and preferences. They are the eiperts about themserves. consistent wifh the important developmental lask of personal lndividuation, the choices of a child or youth should be soticited .and resp€cted, whenev€r possible, durhg the ,o;e;4. \flhite addressing the needs end buitding on the strengths the d.,i6 ;t"'rG-;;i be the pJimary targer or purpose of interventions, services " m f ust focus onine neeoi of the wior6 famiry, with supports rhat empower families and enhance their abilitv to access intemal, natural, and community resouroes. \{hen family d;b"";" iil; own choices reflected in integrared service prans, even when irans reqrire andor youth precement outside their biorogicir famiry to ensure &fety, ptairs are " m "r o ,i r r J i likely to be sucoessful. communlty'based: The rocus of service and resources resid€ within an adaptive and supportive structure of systems, pro@sses, and relstionships, a tne Lr"i Servic€s and supporl shategies should take place ,n the most inclus " i o v m e, m re *i s it p y 6 nsiri, accessible, and reast restrictive settings, where safety, permanency, anl ramtty members' participation in communlty lib are maximizeo. cnitoren, vouth. ano tamitv members need access ro the same range of activities and famities, chirdren, and youth within theiriommunity, to supp"onrrt'rprJo"'nitimr-J"r iiti"r """.'t.ii#ii.il?i and development. culturally and rrnguBocrly competent] curture incrudes a broad range of tac-t"onrJs that shape,-identity, including, .but .reac*ring b6yond, raciil, 6*aer, tingurstic differences. rt rs criticar that membJrs of tne ieam oim " o f n n s n t i r c it , E ieipda tor diversity in Expression, opinion, and preference, especially as they come fogLther in teams ro make decisions. wordg and body ranguage.musi demonitrate an aiceotino and curious approach to understandini, tni ta-mif v, i"uroirg thiir-;d. G;;E strengths. rr is criticar that.communication meets tanguage and'iiteracy needs, with the use of .prain ranguage that everyone c€n understa-nd,-and rhe use 6f a hailhi;; or interpr€tsr, whenever language baniers exist. 7t15n1 ot 27 I DPS5{002800 A family's tradifions, values, and heritage are sourc€s of strength. Relatlonships with people and organtsations with whom they share a cuhural or spiritual identity can b6 essential sources of support. These resources are often "natural,, in that they potentially endure as sources of support atter formal services have ended. lt is lmportanl that the team embrace these organizations 8nd indivlduals, strengthening and nurturing positive conneotions, to assist the fEmlly members in achieving and malntaining positive change in their lives. 2. Tsn Gulding Practlce Principles Family voice and cholce, Each famlly member's perspective is intentionally etlctted and prioritized during all phases of the leaming and service process. The team strives to find options and choices for the plan that authentically reflect the family members' perspectiveE and preferences. Team-based: The team consists of individuals agreed upon by lhe family members and committed to the family, through intormal, formal, and community support and service relationships, At times, family members' choices about t€am membership may be shaped or llmlted by practicsl or legal consideratlons, hor,\,ever, the family should be supporled in making inform€d decisions about lvho should be part of the team. Ultimately, family members may choose not to participate in the process if they are unwilling to accept certain members. Natural supporG: The team sclively seeks and encourages full participation of members drawn from the famlly memberc'networks of interpersonal and ccimmunity relatiorchips. The plan reflects activities and interventions drawn on sources of natural support. These networks include friends, extended family, neighbors, coworkers, church members, and so on. Collaboration and lntegratlon: Team members woik cooperatively and share responsibility to joinlly develop, implement, monitor, and evaluate an integrated, collaborative plan- Thls principle recognizes that the team is more likely to be successtul in accomplishing its work when team members approach decisions in an open-minded manner and are prepared to listen to, and be influenced by, other team members. Members must be willing to provide lheir own perspectives, with a commitment to focus on strengrths and opportunities in addressing needs, and woft to ensure that others have opportunity to provide input and feel safe doing so. Each team member must be commitled to the team goals and{he integrated team plan. For professional team members, lnteractions are govemed by the goals in the plan and the decisions made by the team. This includes the use of resources controlled by individual members of the team. Vvhen legal mandates or other equirements constraln decisions, leam members must be willlng to work creatively and llexibly lo find ways to satisry mandates, while also working toward team goals. Communlty-based: The team will strive to implemenl service and support strategies that are accesslble and available, within the community where the family lives. Children, youth, and tamily members will receive Bupport so that they can access the same range of activities and environments as other families, childr6n, and youth within their communlty and that support their positive functioning and development. 7115t21 oI 27 DPSS{002800 Culturally respectful: The planning and service process demonstrates respect for, and builds upon the values, preferences (including language preferences), beliefs, culture and ldentity of the family members and lheir community or tribe. Culture is recognized as the wisdom, healing tradltions, and transmifted vatues that blnd people from one generation to another. Cultural humility requires actnowledgement that professional staff most often cannot meet all elements of culturel competence for all people served. Professionals must ensure lhat the service plan supports the achievement of goals for change and is integrated into the youth and familys cultures. Cultural humility and openness to loarning foster successful empowerment and better outcomes. lndlvldualized: The principle of family voice and choice lays the fouMation for indMdualization and ffexibility in building the plan. \Mtile formal services may provlde a portion of the help and support thst a family needs, plans and resources must be customized to the specifio needs of the lndividual child, yotth, and family memberc. Each element of the family's service plan must be built upon the unique ind specilic slrengths, needs, and interests of family members, including the assets and resources of their community and culture. Strengths.baeed: The service process and plan identry, build on, and enhance the capabilities, knowledge, skills, and assets of the child, youth, and family members, their tribe and mmmunity, and other team members. The team takes time io recognhe and validate the skllls, knowledge, insight, and strategies that the famity anOl[eir I team members have used lo meet the challenges they have encountered ln thelr lives, despite these strengths possibly having been inadequate in the past. This commitment to a Btrengths-based orientaflon intendE to highlight and support the achievement of outcomes, not through a focus on eliminating family membeis deficits, but rather through an effort lo utilize and increase their asset6. This begins with a uniform and singular use of the CANS assessment. Doing so validates, bui-lds on, and expands each family members' perspective (e.9., positive self-regard, self-efficacf , hope, optimism, and clarity ofvalues, purpose, and identity), their interpersonal asseis (e.9., social competence and social connectodness), and their expertise, skills, and knowledge. Persistence: The team does not give up on, nor blame or rej€c1 children, youth, nor their families. \Men faced with challenges or setbacks, the team conlinuei working toward meeting the needs of th€ youth and tamily and toward achieving the team,; goals. Undesirable behaviors, events, or outcomes, are not seen as evidence of youlh or family 'failure", but rather, are interpreted as indication that the plan should be revised to be more successful. in achieving the positive outcomes associated with the goals. At times, this requires team commitmenl to revise and implement a plan, even in the face of limited system capacity orresouroes. Outcomes-besed: The team ties the goals and strategies of the plan to observable or measurable lndicatorE of success, monitors progress conslstenl with those indicators, and revises the CANS and service plan accordingly. Thi6 princjple emphasizes that the team is accountable, to the family and all of the lpam members, to the.systems of care serving lhe children, youth, and famllles, and to ihe community. Ttacking progre66 toward outcomes and goals keeps the plan on lrack and indicates need for revision of strategies and interv'entions, as nocessary_ lt also helps the team 7t'16t21 26 ot 27 ,Page DPSS4002800 maintain hope, cohesion, and effectlveness, and allows the famity to recognke that things are indeed changing, and progress is being made. Historically, the ability to retain chitdren, youth, and family members in lreatrnent services lo complelion has been challenging. Children, youth, and families from vulnerable populations (e.9., children ot single parents, children living in poverty, minority lamilies) are reast likely to stay rn troatment. when asked aboui reaions f6i dropplng out, parents offen identiry stressors associated with getting to appointments, a sen3e that the treatment or service offered is inelevant to thek needs, oi L perceived lack of connection with the service provlder. while providers may hsve llttle control over a child and fsmily's daily life stressors or difficulties in accdssing care, they clearly have control over the relevance and opportunity to avold redundancy of services offered to families (supporting the principles of voice and choice and individualized), as w6ll as iheii enorts in relationship-building (also known as engagement). Within lhe CFT process, including a focus on the needs identm€d as highest priority by the child, youth, and famil! members themselves is a critical componenl of initial and suBtained engagemeni, during the service delivery process. An additional practical construct to thi8 approach is the realjty that a famlly,s complex needs have otten been recognked through servic€s directed by multiple and competlng service plans. Bringing service plan expectations and resources together, as well as following a shared CANS and a single and functionalstructured assessment process, will result in a simpllfl€d, coordinated plan that will greafly improve the prognosis of success and dramatically lower the stress on family members. 7t15n1 DHCS State of California-Health and Human Services Agency Department of Health Care Services IIC|{EL|..E BAASS GAVltl t/EWSot! OIRFCIOR 60rfRr'/oR December 20, 2021 Student Behavioral Health lncentive Program Objectives and Process ln accordance wilh State law (AB 133, Welfare & lnstitutions Code Section 5961.3), the Department of Health Care Services (DHCS) is directed to design and implement the Student Behavioral Health lncenlive Program (SBHIP). $389 million is designated over a three-year period (January 1 ,2022- December 3'1, 2024) for incentive payments to Medi-Cal managed care plans (MCPs) that mset predelined goals and metrics. SBHIP goals and metrics are associated with targeted interventions that increase access lo preventive, early intervention and behavioral health services by school-aftiliated behavioral health providers for children in public schools in Transitional-Kindergarten (TK)through grade 12. lncentive payments shall be used to supplemenl and not supplant existing payments to MCPs. ln addition to developing new collaborative initiatives, incentive payrnents shall be used to build on existing school- based partnerships between schools and applicable Medi-Cal plans, including Medi-Cal behavioral health delivery systems. Objective of Student Behavioral Health lncentive Payments . Break down silos and lmprove coordination of child and adolescent student behavioral health services through increased communication with schools, school afriliated programs, msnaged care providers, county behavioral health plans, and behavioral health providers. . lncrease the number of TK-l2 public school studenB enrolled ln Medi-Cal recslvlng behavloral hsallh tervlces through schools, school-affiliated providers, county behavioral health departments, and county offices of education. . lncrease non€pecialty services on or near school campuses. Objective of the SBHIP Workgroup ln accordance with lhe State law (AB '133: Welfare & lnstitutions Code Section 5961.3(b)), DHCS established a SBHIP Stakeholder Workgroup to develop the targeted interventions, goals, and metrics used to determine incentive payments to MCPs. The SBHIP Staksholder Workgroup has b6€n asked to assist DHCS in determining the design and approach to guide impl€mentation of SBHlp, in particular to: . Provide leedback and guidance on inlerventions, goals, and metrics. . Help identify activities that best target gaps, disparities, and inequities. . Provide leedback on incentive payment calculation and payment methodology Local Governmental Finsncing Division '1501 Capitol Avenue. MS 4603. P.O. Box 997436 Sacramento. CA 95899-7436 wwlv.dhcs.ca.oov The SBHIP Stakeholder Workgroup has representation from the Califomia Department of Education (CDE), MCPs, counly behavioral health departments, local educational agencies (LEAS), and other atfected stakeholders. Between Augusl 2021 and December 2021, there were multiple meetings to engage and collect feedback from stakeholders. DHCS to finalize by January 1,2022 Th6 SBHIP aftective date is Jenuary 1,2022. By that date, largeled inlerventions, metrics, goals, incentive payment calculation, and allocation methodology will be defined for the SBHIP. MCPs interested in participating in the SBHIP will need to submit a letler oI intent to OHCS. Targeted lnterventions: Aclivities that will increase access to preventive, early intervenlion and behavioral health services by school-afliliated behavioral heahh providets for TK-12 children in public schools. Goals: Oesired outcomss, locations, and/or populations to reach with each intervention or quality measure. Metrics: Specify the requirements, sleps, and measures lo assess achievement of selecled targeted interventions or quality measures. Allocalion Methodology: ldentifies the methodology used to allocale and dislribute incentives earned tor implemenling the selected targeled interventions and achieving specilied quality measures. SBHIP Duration and Sustainability SBHIP will follow three distinct phases; design, implementation, and posl-SBHlP. The design and implementation of SBHIP is structured with the intention to build infrastructure and r€lationships lhat extend beyond the three year incentive period. Devebp 5tructrrts to, Stakeholder gngEgem€nt and D.r6lop m!&ks, lntarr?nliorl8, Dci.rmlncpaymont structure lo imdemer{albrl (oversQht end 6ducstion and gp8b MCPB govomanc€) MCP assessmenvgap analysls MCPS design and impl€ment Continu€d Btekelbldsr t^,ilh lochnical assiotEncG lo inlew€ntions in coordinalion MCPS roceive psFnents bosed education support engagemont t!€tw6en with COE6, LEA6, County BH on metdcs echieved LEA3 and MCPS Departmentg, and BH providers Porl€BHIP (J6nus.y 2025 snd boFnd) stron B g H s tt n r i €n n d €d f l , n e o s n lr u b M c e t e n u d e r i € - f C ti i n a n g l s 6 c b t h o u o l d h o 6 l n s M ls o 8 d r€ i-Cal s O u e p p p a o l r l d o lm r M e on e M t d s i C , C P a s B M l . p C L a O €A ym s E S on , h l a C l v o o o r u n c 8 t d H y { r B 6 a e H c r t v 6 ic e lo s Ro c h o t u k n n ty . c h B o ip o H a s d a b in ' €t r E n l r s io e l n r n o n o g l M t 6 a C o d P M S c lo , o L 6 6 E rt A p g g , o r 6 l nd in 6d|oolB
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  MUTUAL HOLD HARMLESS PROVISION... 12
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  Coa(hell. I r32 Desert Hol Splings 9
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  outpatient services prior to their contact with MCMTS. EnBagement in Services The maiority (74%) of MCMT clients linked to outpatient services I to It Sa?vr(.. engaged in three or more 3l'l services. For clients with lcr rlra 3 or more services, the La 2 a f l f dE ta , r a ita * r, 15 to 3 ! {) r S x .rric.t average number of services was 31. tl o. i^orr Lrvlo Itx Readmission Rates for MCMT The table to the left provides the repeat Days to Readmission % crisis encounter rates at less than 15 days after first crisis contact and at 16 to 30 0 to 15 Days 3.34y" days after first contact with McMT teams. 16 to 30 Days o.98% 0 to 30 Days 4.32o/o RUHS-BH Eva IUation 23 Mental Health Urgent Cares (MHUC) Admissions The Crisis Support System of Care includes three regional Mental Health Urgent Care (MHUC) facilities (Riverside, Perris, and Palm Springs). lndividuals experiencing a mental health crisis can walk-in to an MHUC and receive individualized support 24 hours a day, 7 days a week. 5taffed by a competent, caring team, MHUCs provide a safe, supportive, recovery-oriented environment. The MHUC offers a variety of services such as assessment, peer support, psychiatric and medication support, recovery education, community coordination and follow-up. The MHUCS serve individuals 18 years and older with the Oesert and Mid-County MHUCs also serves adolescents 13 years and older. Requests for Service During the 202U2022 hscal year MHUCS had a total of 10,578 admissions (July 1, 2021June 30,2022],and served 5,909 unduplicated clients, The figure below provides the MHUC admission per month for each MHUC. MHUC Admissions 10,578 MHUC West 3,890 MHUC Mid-County 3,794 MHUC Desert 2,894 MHUC Admissions per Month 5@ 450 4@ 350 3m 250 2@ 150 lm I 50 o lul21 Aug 21 sep 21 Oct 21 Nov 21 Dec 2t lan22'Eeb22 Ma.22 Apt 22 May 22 r MHUC Wed 235 316 3ia 325 338 313 319 303 347 337 370 339 r rixuc uU-corntv 362 318 328 330 298 2s3 251 259 328 30s 345 407 MHUC Delen 207 237 2Q 232 211 245 258 229 2n 2fi 276 276 RUHS-BH Evaluation 24 Mental Health Urgent Cares (MHUC) Demoeraphics MHUC facilities served 5,909 individuals during the 2021l2022 fiscal year. Gender of MHUC Clients 1@16 All three regions served 90,6 more male than female 8016 clients. Gender was not 7 reported for 6 individuals. 6016 5(},6 4('( 3ota 8X 5a 20,4 47t, 42.}i 106 6$ Des€ rl Age of MHUC Clients 1@ra i wesr r Mid.Counw Oes€n Mid-County and Desert 90t6 a0'6 MHUCS serve clients 13 70x years and older, while the 5& 55'( West MHUC serves clients 50t6 4(t6 18 years and older. ,& Overall, the average age 70x f "*.o* of MHUC clients was 36 1(ra Fx ,* rl* tr (age was unknown for 3 096 clients). (13 yrs to !7yB) Ethnicity West Mid-County Desert Am. lndian/Alaska Native lo/o The MHUC Desert had the Asian/Pacific ls. r% t% Lo/o highest percentage of BIack/African Am. !4o/o 9o/o to% Hispanic/Latinx clients Hispanic/Latinx 32% 27% 39% l3e%1. Multi-racial 2% t% Lo/o Other/Unknown 27% 51% 7L% White/Caucasian 23% LGYo 38% RUHS-BH Evaluation 25 Mental Health Urgent Cares (MHUCI Lin kage to Outpatient Services The MHUCs assist consumers at discharge with linkage to outpatient services. Overall,25% of those served by MHUCs, were linked to outpatient mental hea lth/substa n ce use services. The figure below provides the percent of individuals linked to outpatient mental health/substance use services after an admission at one of the county's MHUCS. Some individuals (n = 103 or 7o/ol were placed in a County short term Crisis Residential program (CRT) following their MHUC admission. Percentage of MHUC Clients Linked to Outpatient Services t@16 90,6 M 7* w" 5(,6 Linkedto l-inked to tin*ed to oIutpatient Outpatient 4go Outpatient Services S€rviaes 5€rvices 3096 26% 24% 27% 2(Yo l0go 096 Mid.County Dese rt Re-admission rates for each of the three MHUCs are shown in the table below. percentages are discharges from the MHUC followed by another admission for the same client 15 days or less or 16 to 30 days after an MHUC admission. Recidivism rates for 15 days or less were highest for the Western MHUC (29%). Readmission Rates for MHUCs Days to Readmission West Mid-count! Desert 0 to 15 Oays 29% 74o/o 25% 16 to 30 Days 7% 6% 0 to 30 Days 36% 27% 3t% satisfaction data collected from Riverside and palm springs MHUcs show that overall, 96% of clients who received service during the zozl/2ozz fiscal year agreed or strongly agreed with the items on the satisfaction questionnaire. RUHS-BH Evalua6on 26 Crisis Residential Treatment (CRTI Crisis Residential Treatment facilities Located in each of the three county regions, Crisis Residential Treatment Facilities (CRT) provide enriched recovery based peer-to-peer support and interventions with the goal of stabilizing clients in acute crises in order to eliminate or shorten the need for inpatient hospitalization. Designed to provide a home-like service environment, the CRT has a living room set up with smaller activity/conversation areas, private interview rooms, a family/group room, eight (8) bedrooms, laundry and cooking facilities, and a separate garden area. lndividuals may stay at the facility for up to 14 days. Adm issions The CRT facilities had 1,044 admissions during the 2o2Ll2o22 Fiscal Year. The figure below provides the number of CRT admissions per month for each cRT for the 2o2L/20?2 fiscal year The Mid-County CRT began serving clients in August 2021. CRT Admissions 1,o44 West CRT (Lagos) 438 Mid-County CRT (Jackson House) 98 Desert CRT (lndio) 508 Number of CRT Admissions per Month r CRT Riv€Gide . CRT Mid{ounty CRT Oesen 60 50 40 45 'lS 38 36 17 37 37 30 33 3l 3/t 3a 31 20 10 I 6 t 8 6 9 6 8 0 lul21 Au821 Sep2t Oct 21 Nov21 Dec21 )an22 Feb 22 Mat 22 Apt 22 M'y 22 Jun22 27 RUHS-BH EValuation Crisis Residential Treatment (cRT) DemoRraph ics The CRT facilities served 725 individuals during the 2021/2022 fiscal year. Gender of CRT Clients 100% 9096 80% More males than 70x females were served by the CRT at each of 60% the three county 50% facilities. Gender was 4OYo i,hL Md. not reported for 5 M.b tox 30% 65X individua ls. 54X 2Wt 440/" t49a 1o% 29./. o% West CRT Mid-County CRT Desert CRT ABe of CRT Clients 1@X The majority of CRT 9(h 83% B3* clients were adults 80'6 l4% (age 26 to 59 years). 70r4 The average age of CRT 60'6 clients was 37 years 5(,6 40,6 3(}96 22% zalx 16% 16% 1016 l% 4% 03% ot6 we$ cRT CRT Mid{oirnty Dese n CRT I , lS lo 25 Fers 2610 59ye.rs 60yearsand older The Desert CRT served Ethnicity West CRT Mid-County CRT Desert CRT the highest percentage of Am. lndian/Alaska Native to/o Lo/o Hispanic/Latinx Asian/Pacific ls. 7% 1% clients (41%), while Black/African Am. L6% 76% t9% the Mid-County CRT Hispanic/Latinx 39% 26% 470/o served the highest Multi-racial 3% percentage of Unknown t5% t0% 8% White/Caucasian White/Caucasian 28% 43% 3L% clients (43%). RUHS-BH Evaluation 28 Crisis Residential Treatment (CRTI Linkage to Outpatient Services The CRTs assists consumers at discharge with linkage to outpatient services. The percentage of clients linked to outpatient services after admission to a CRT was highest at the Mid-County cRT (44%). Percentage of Clients Linked to Outpatient Services after a CRT admission l@x 9(,6 8()'6 7& 5(]9( 50'6 4W LMto 30'6 Llntcdto Ur*!dto Outpltit,rt (},tt tLar Outp.tlcnt 2ffi LrYlo Scrvlccs (x Scrvlcat wo 42% ao,a 09( Wen CRT Mid-County CRT Desert CRT Re-admissions rates to the CRTS are shown in the table below. Percentages are discharges from the CRT followed by another admission for the same client , 16 to 30 days, and 30 days or less. The West CRT had the highest rate of readmission for 30 days or less (2Oo/.1. Readmission Rates for CRTS West Days to Readmission Mid'County Desert 0 to 15 Days L5% 6/o 8o/o 16 to 30 Days 5% 6% 4% 0 to 30 Days 20% 72% !3o/o RUHS-BH Eva luation 29 Attachment E: Behavioral Health Department Response: Grand Jurv Response: Suicide: A Trasedv Affectinq All of US: Riverside Counw Data & Local Resources
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  Thousnd Pelms 0 lm 2m 3m 4U) 5m RUHS-BH Eva luation 6 Mobile Crisis Response Teams (MCRT) Goal 1: lncrease mobile crisis response to schools to avoid the need for law enforcement requests for crisis response to youth age 21 and younger and/or increase mobile crisis response to law enforcement, hospital emergency rooms, and community organizations for adults. MCRTS added teams in December 2018 to provide crisis service to youth age 21 and under at schools and other locations in an effort to decrease the need for law enforcement involvement. Most requests for MCRTS at schools were made by school resource officers as schools preferred to make requests for MCRTs through their school resource officers rather than allowing other school staff to directly request MCRTs. The figure below shows the number of school requests MCRTS received in each school district during the 2021-2072 Fiscal Year. Four request for crisis services were from colleges. Number of MCRTS requests received in each School District and County Region At\oRout/tft€o I11 N=590 cmou G(o uNrf [D ,URUPA UI,IIfItD ] MMETOVAUfYUNIf f,D -35 108 sTfiRs|DI COUNTY CHAiTER l.H@Ls l - t 16 8lvt8slDt Ul{rFfD va vtRm ulilrltD I29 tI€MII UNfITD Mtnrft uNrffD -I2a0E E54 MUSSIEIA VA!IfYUNIfltD -39 z NUVLW UNDN StHOOt Osrnf,r l7 PERRTS tttMt riataRY s.Hool D6lRrcT -Itt37 PEIRTSUr{IC HrcH rHOOt OISTTRCT 5 ilvtRgot cout{TY cHAaftR rtt@Ls r1 ut ROMOTANO UiIIFIED l2 SArl JACfiIOUtIIFfD rfMEcuu ur{frto BA Nll{6U lrf O t1 BTAUMOt{I UIIIIfO l2 I -tt46 coacHfl.lA uxrrEo D€S€RT SAT,I DS Ut{ IFITO PAIA' SPRITIGS UTIIFIEO 0 20 40 60 80 l(D 120 140 160 ls 20 -3s -8r RUHS-BH Eva luation 7 Mobile Crisis Response Teams (MCRTI Demographics MCRTS served 1,836 individuals during the 2027/2022 fiscal year. Most individuals spoke either English (91%) or Spanish (3%). Language was unknown for 6% of individuals. Five percent of individuals reported experiencing homelessness and 1% were Veterans. Gender of MCRTS Clients IranrSandcr ------ 1t6 M Not raporlad MCRTs served more females <1* (58%) than males (41%), with a1t 1% of individuals identifying as forn.L transgender. Gender for 2 sEr individuals was not reported. Age of MCRT Clients old.rAdr, (,rlldO.l0vrl N = 1,828 E Almost a third (31%) of clients Irra were Adults between the ages L.n U.l5Yn of 25 and 59 years of age. Age llx aitl was unknown for 8 clients. llY lClt trt ,rl Ethnicity of MCRT Clients Over a third (38%) of clients lx served were H is p a n ic/ Latin x. ttr RUHS-BH Evaluation 8 Mobile crisis Response Teams (MCRT| €gaLX Decrease inpatient psychiatric hospitalizahon through effective diversion. Diversion from an inpatient admission was measured using the disposition of the crisis contact. Contacts were diverted to home or to an alternative crisis support. Contacts in which the client was unable or unwilling to interact with MCRTs (5%, n = 131) or who had a disposition of "Other" lO.L%, n = 3) were excluded from the calculation of diversion rates. MCRTs were able to successfully divert over half (59%) of crisis contacts in the field. Non-crisis community supports included homeless shelters, emergency housing, and other social services. Diversion rates for MCRTS l{ot .ld ONt arta Diverted The majority (59%) of MCRT clients were diverted to home, to an county MHUc or to a cRT MCRT Contact Dispositions Prd xdclryxa rdnlBo I rs ols r H.raoY., votu,ir.rYhariJ.rb. I 53 H.id@ onsle Hdd I ,* oiv? ned io (m@mry slFon lxcfi<.id I 19 ul/erltd l! alt.fiE$/r crtr3 5!!9on . P..r (5r, w.Jl 1,. Oivlnld lo Alrdrt{l. (rH! luiDon- P..r(sU Mirt{dr y loo DiEn.d to ln.rDrhE cru.9Fon - P..r csu o.cn ls Dh,.n d ro AftrrrDrnr crlr.9rfpo.l . air lr (I.nt oiv.n.n lo lbir 1,036 5l5OholdtvTdt r.lrn .65 0 2@ a@ 6@ g@ l@0 12@ laoo - RUHS-BH Evaluation 9 Mobile Crisis Response Teams (MCRTI 5150 Lesal Hold Releases lndividuals can be placed on 5150 legal hold (involuntary evaluation hold), by law enforcement or hospitals, prior to the arrival of MCRTs. MCRTS can release an individual from a hold if the hold is not longer necessary. Two hundred ninety-two individuals were places on a 5150 hold prior to MCRTs arrival. MCRTs were able to discontinue the legal hold of 15% (n = 45) of individuals who were on a legal hold at the time of the teams arrival. 5150 Legal Holds and Discontinuances N=292 i Re.nained on 5150Le8al Hold r 5150te8al Hold D{onrinued 24' 8stt Goal 3: Reduce hospitalemergency room and inpatient psychiatric utilization Outpatient linkage should result in less need for subsequent inpatient admissions. lnpatient admissions that were not the result of the initial crisis contact (result of the 72 hour hold) were used in the calculation. Six percent (n = 111) of individuals had an inpatient admission of contact with MCRTS. Some individuals (n = 16) had more than one admission of MCRT contact. lnpatient Admissions N Had more than one inpatient admission 18 !o/o Had at least one inpatient admission 93 5o/o Total lnpatient Admissions 111 6% RUHS-BH Eva luation 10 Mobile Crisis Response Teams (MCRT) Ega!_!l: Increase access to alternative crisis services (i.e., outpatient mental health and substance abuse services). RUHS-BH service data was used to examine service usage after the initial crisis contact. Clients were considered to be linked to outpatient services if they had an outpatient mental health, substance use, or youth short-term residential treatment program service record. lndividuals who were recorded as being linked to a private provider and individuals havlng private insurance were not included in the analysis. Linked to outpatient Services Forty-one percent N = 632) of ind ividuals served by MCRTS were linked to outpatient services after LrlOl.rn contact with teams. Some 3ta individuals (n = 298) linked outprti.nt to outpatient services SaMcat lnl8 532 a lready had engaged in 59X 4ltn Palcr Cll.ni outpatient services prior to It be seen by MCRTS. Engagement in Services The majority (83%) of N=632 those linked to outpatient services 3to15 engaged in three or Sarvaces more services. Almost 32olo a third (32%) of MCRT Coiunucd at Ete.t d ll| 3 1,...t OnG d llora 16to 30 clients who were linked S \ a , rvlca S a rt t la * S€r 2 vi l c 9 e o s to services participated in 3 to 15 services. For 31 or l,lor. clients with 3 or more S.aYl6aa 30.r services, the average number of services was 39. RUHS-BH Evaluation 11 Mobile Crisis Response Teams (MCRT) Goal + lncrease access to alternative crisis services (i.e., outpatient mental health and substance abuse services) (cont.). The figure below provides the percentage of clients Iinked to outpatient services after contact with MCRTs for each fiscal year since the beginning of the Crisis program. MCRTs began serving clients in mid December 2014; therefore, the data for the 2014/2015 fiscal year is from December 18, 2014 throu8h June 30, 2015. lndividuals who were recorded as being linked to a private provider and individuals having private insurance were not included in the analysis. Outpatient Admission Trends rm% 900 8G6 7@h 6@6 506 41% 400/6 390k 42o/o 4SVo 430h 45o/o 41% 4Gh 3@i6 2@h 1O-o/E o% FY 14/1s FY 1s/16 Fr LqD Fy t7lL8 Fy 18/19 Fy 19i20 F,t 20121 Fy2Ll22 Goal 5: Reduce re-admissions to psychiatric emergency rooms or inpatient psychiatric hospitals. The table below provides the repeat crisis readmission rates at 15 days or less after first crisis contact and at 15 to 30 days after first crisis contact. Both have remained relatively low. Readmission Rates for MCRTS Days to Readmission % 0 to 15 Days 3.44o/o 16 to 30 Days t.43% 0 to 30 Days 4.87% RUHS-BH Eva luation 72 Mobile Crisis Response Teams (MCRTI Service referrals As part of crisis intervention, MCRTs provide individuals with referrals for various services each time teams have contact with a client. lndividuals can receive multiple referrals for different services. MCRTs provided 4,722 tefefialslo 1,835 individuals. Service Referrals
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  EARLY TERMINATION....,....,.... 12 ,I. .I CIVIL RIGHTS COMPLIANCE 13
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  CIVIL RIGHTS COMPLIANCE system Partners shall ensure that the admlnishation of pubric assistance and Bocial seruce progrsms is nondiscriminatory. System pBrtners shall not dlscriminate in the provision of services, the allocation of behefits, employment of perBonnel, nor in the accommodation ln faclllties, on the basis of ethnic group identficatioir, color, race, religion, national origin, gender, age, se:ual orientation, physical or mer(al handlcai, in accodance with T,tle Vl of the Civit Righb Acl of 196i, 4Z U.S.C. Sec{on 2000d, and a[ other -per{nert rules and regurations promurgateo pursuant Gerato, and as otheMise provided by state law and regulations, as all riray noa exist, or be hereafler amended or changed.
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  WAIVER ........ 13 .13. AUTHORITY... 13
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  AUTHORITY 'Mou The signatureE of the parties.affixed to this affirm that they are duly authorized to commir and bind their respective party to the terms and conditioni set fortir inthd MbL,.
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  GOVERNING LAW AND VENUE.....,. 13 15, SEVERABILITY .......13
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  SE'ERABILTTY ' lf any portion of thrs Mou is decrared invarid, irbgar, or otherwise unenforc€abre by a coud of compet€nt jurisdic'tion, the remaining provisi;;s'shari"onunr", in fufl force end effect. 16, CONSTRUCTIONANDCAPTIONS since the Parties and/ortheir agents have par clpated fulry in th€ prepararion of this Mou, lhe hnguage of this Mou shalbe co_lstruid simpry, acmiding to'its iair.""nrng, noi for nor again't any. party. The captioni tt the vari-ous ;;A'id"ndd- ;;; 'triclly paragraphs are for conveniencer and ease of refurence only,6nd"r t O ic o t" n i, b t Oenne,'limit, augment, nor describe the scope, content, nor intent of this M-OU.
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  CONSTRUCTION AND CAPTIONS .......'t3
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  COMPLIANCE WTH LAW .......13
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  NOT|CES.................. .......14
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  ENTIRE AGREEMENT.......,.,,...,.. 14
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  MO DIFICATIO N Any alterations, varietions, modifications, or wafuers of provisions of tho MOU, unless specifically allowed ln the MOU, shall be valid only when they have been reduced to writing, duly signed and approved by th€ authorized representiativ8s of all Part'res, as an amendment to this MOU. Oral understandings, or'agroements that have not been incorporated herein, shall not be bhding on any ofthe Parties hereto. SIGNED IN COUNTERPARTS This MOU may be executed in any number of counterparts, each of which when exesuted shall constitute a duplicete original, but, all counterparts together shall constitute a single agreement. ELECTRONIC SIGNATURES Each party to this MOU agrees to tho use of electronic signatures, such as digital signatures, that meet the requirements of the California Uniform Electonlc Tran$ctions Act (fcuETA), at cal. cv. code $$ 1633.1 lo 1633.17), for executing this MoU. Tho parties further agree that the electronic signature(s) included herBin are intended to authenticate this writing and to have the same for@ and etfect as manual signatures. [Signature Pages Follow] I I I I I I 7t1snl ol 27 DPSS-0002800 Authorized a ignature lotthe County of Riverside J. a)-.-A.J Printed Name of Person a Karen Spiegel (r t o ! Ti e: I Cheir, Board of Superyisors F(E Date lt, < HO Recommended for Approval: F<UYJ Biverside County Department of public Social Services -.-/ <7^ , j.--r- Sayori Baldwin, Director Dare: seP 27,2021 Riverside University Health System - Behavioral Heallh Matthew Chang, Oireclor Date: 911312021 Riverside County Probation Department Ronald Miller ll, Chief Probation O41icer Date: Juvenile Court, Superior Court of California, Riverside County The Honorable Mark E. Petersen, presiding Judge Date: 7t15n.1 DPSS-0002800 Rfuerslde County Office ot Education Edwin Gomgz, Ed.D., Superintendent of Schools Date: lnland Counties Regional Center, lnc. Lavinia Johnson, Exec. Dir./Chief Execulive Offlcer Date: Approval as lo Form Gregory P. Priamos Counb/ Counsel 6tu&/to Sep 20, 2021 Esen Sainz Date SEned Deputy County Counsel Eric Stopher Date Signed Deputy County Counsel Approval as to Form Steven K. Beckett General Counsel & Director lnland Regional Center Dale Signed 7t15t21 .DPSS{002800 Authorized ignature for the County of Riverside: Printed Name of Person SignirE Karen Splegel TiUe: Chair, Board of Sup€rvisors Date Signed: I : Recommerded for Approvat l Rlverslde County Departmerit of Public Social Services I I Sayori Baldwin, Director Date: Riverside University Heatth System - Behavioral Heafth Matthew Chang, Director I Date: i ; Riverside County Probation Department //rW// ?om//L Ronald Miller ll, Chief Probation Oftcer Date: Aug 30, 2021 Juvenile Court, Superior Court of California, Riverside County Mdd E. P,larson The Honorable Mark E. PetersBn, presiding Judge Aus 30.2021 Dale: 7h5n1 of ?7 I DPSS-0002800 Riverside County Ofiice of Education Edwin Gom6z, Ed.D., Sup€rhtendent of Scfiools Date: lnland Counties Regional Center, lnc. UrAulvTohaoa, Lavinia Johnson, EIeo. Dr./Chlef Exdcutivo Ofiicer 4us26.202I Date: Approval as to Form Gregory P. Priamos County Counsel Esen Sainz Date Signed Deputy County Counsel es%,* Aug 30, 2021 E ic Slopher Date Signed Deputy County. Counsel Approval as to Form Steven K. Beckett I General Counsel DirBclor Inland Regional Center [tow E Eukb 4u826,202r Date Signed 7n5n1 ot 27 DPSS-0002800 Riverside of Education Edwin Gomez, Superintendent of Schools I Date: lnland Counties Regional Center, lnc Lavinia Johnson, Exec. Dir./Chief Executive Ofticer Date: Approval as to Form Gregory P. Priamos County Counsel Esen Sainz Dale Signed Deputy County Counsel Eric Stopher Date Signed Deputy County Counsel Approval as to Form Sleven K. Beckett General Counsel & Director lnland Regional Center Date Signed 7t15t21 DPSS-0002800 Attachment I - List of System Partners :Ne: '. r.l 1 Tho County of, Rlverslde, a polltical subdlvi3lon of the Stlto of Callfomla, on behalf of IE Iollowlng Departments: 4060 County Ckcle Orive Department of Public Social Se]vlce8, Chlldren,a Rlverside, CA 92503 Services Division @PSS) 4095 County Circle Drive Riverside Universlty Health Systerc-Behavioral Riverside, CA 92503 Health (RUHS-BH) Riverside County Pmbalion Departnent 3960 Orange Street I Riverside, CA 92501
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  SIGNED IN COUNTERPARTS .....14
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  ELECTRONIC SIGNATURES....,.,., .....14 List of Atlachments Attachmer l - List of System Partners Attachment ll - Drafl, Superior Court of the State of Califomia, Counly of Riverside, Juvenile Division, Blanket Order No. Addendum A - Califomia core Ptactice Model 7t15t21 Page2 ot 27 DPSS-0002800 This Memorandum of Understanding (MOU), de{ining the collaboralively shared deslgn, delivery and menagemenl of services to cfiildren, youth and families in Riverside County, is entered irt6 by and bet\,veen the followlng Partbs ("Syrtem partnerc'): Riverside County Oepartment of Public Social SeNices, Chiklren,s Services Divlsion (DPSSCSD) b. Riverside County Probation Department (RCP) o. Riverside University Health Systern - Behaviorat Heallh (RUHS-BH) d. lnland Counties Regional Center, lnc. d/b/a lnlsnd.Reglonal Center (lRC), a Calitornia non-profit corporation e. Riverslde County Office of Educstion (RCOE) f. Jwenlle Court, Superior Court of Califomia, Riverside County Hereinafier, lhe systBm Partners may'tie refened to tndivldually as a "partf , or collectively es the "Parties.'This Memorardum of understandhg shall superiede any prior Memoranduir of Understandlng. between the S)rstem partners, regarding delfuery of sha;ed services to children, youth and families. DEFINITIONS A. 'AB 2083' refec to Calfornla AsEembly Bill No. 2083, approved by the Govemor on September 27,2018, which aims to buitd on the Contini.rum of Cire Reform (CCR) implementation erfort by, among other things, developing a coordlnaled, timei, and trauma-informod, system-of-care approach for chlldren and youth in fosler care who heve experienced severe trauma. The bill requires each county to d€velop and implement a memorandum of under'standing, setting forth the roles and responsibf,ffies of agencies and olher entities thal serve children and youth in foster cari who have experienced severe trauma. B. 'Blankel Order No. 32" refers to the Superior Court of lhe Stete of CA, County of Riverside, Jwenlle Dlvlsion document, ou0ining lhe release and exchange of conlidential informalion among all partjes to thb MOU. ru parti€s shall ablde I tne Court-ordered Blanket Ordet and any approved amendmenis or revisions. C. "CFI' refsrs to Chitd and Famlly Team. D. 'CSD" reiers to DPSS Chlldren's Services Division. E. 'CSOC' refers to Colbborative Systems of Care. F. 'DPSS' and 'couNTr refer to the county of Riv€rside and its Deparlment of publc Social Services, which has adminisrative responstbitity for lhi6 MOU. DPSS and COUNTY are used interchangeably ln this MOU. . G. 'DPSS-CSD' reers to the Riverside County Department of public Social Services, Children's Services Divlsion. H. "ESStr refers to Every Student Succaeds Acl, which is a federaleducaton ad lbr K- 12 schools thet mendates educational equity tror Foster Students and schools. l. "FFA" reE s to FGter Family Agencies. 7115t21 DPSS4002800 J. 'ICPM' refers to lntegrated Core Practice Model K. 'IEAC' refers to lnteragency Executive Advisory Committee. L. 'lLf rebrs to lnteragency Leadership Team. M. 'lPC" refurs to lnteragency Placement Committee. N, 'lRC'refers to lnland Counties Regional Center, lnc. d/b/a lnland Regional Center O.''Katie A.' refers to lhe settlement agreement that requires the Counties to make systemic improvements to befter serve members of the class, and Federal Court that appolnls the Katle A Panel to mdnltor progress. P. 'MOLr refers to the terms and conditions, schedules, and attaohmentB included hereln. O. 'RCOE' refers to Riverskle County Omce of Education R. 'RCP' refers to the County of RlversHe and its Proballon Depertment S. 'RUHS-BH" refers to the County oI Riverside 8nd its Riverside University Health Sy6lem - Behavioral Health T. 'STRTP'refiers to Short Term Resldentlal Troatrnent Program. U. 'System Partners! rebrs to the parties listed in Attechmenl. I, individually and collectively, including thelr employees, agents, representativBs, subcontractors, and suppliers. 2 vtsloN Children, youth and families who are involved with child v.relfare, or are receiving foster care as dependents of the Riverside County Superior Court-Jwenlle Dlvislon, while in DPSS-CSD protective custody (Children's System of Care'), will receive timely, efieciive, collaborative seNices, consistent with the lntegrated Core Praclic€ Model (ICPM), which allow them to thrive in safe, permanEnt living situationE and that meet their sodal, emotional, cultural and behavioral needs. J. MISSION The Systern Partners will design, implement and maintain an integrated, trauma-focused system, with a shared framework that i8 information-driven, innovative, gnd reflec'tive of the ICPM. The system will d€liver servicss h a comprehenslve, culturally-responsive, eviJence-based/best prac-tica manner, regardless of whhh System Parlne/s door children and families enler. The System Partners will aclively seek to include foster youths' experiences and voices into County-lev€l collaborations and parlnerships thet manage or oversee the delivery of s€rvices affecling youth and families. The System Partners recognize that utilizing the ICPM for the sPeciflc PoPulalions addresled in this MoU ls tho lirst step to seNing a0 children and families with this model. 7t15t21 ol27 DPS$0002800
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  San Ja(inlo l8 sun City 105 a8 !17 8.nnin8 --t11 432 Seaunont rl Cabaaon t) Calimesa rt8 C.rhedralCity t2
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  TAY Drop in Desert N = 4,722 TAY Drop in Mid-County 47 TAY Drop in West 42 MH Urgent Care 831 TGBTQ Suicide Prevention Line 661 Parent Partner Operation Safe House 187 NAMI 189 CREST Peer Crisis - ROCKY Follow-up - 176 | Emergency Housing Provided 11 -397 Family Advocates - 204 -257 Community MH Resources .27 Full Servire Partnership -r 56 Community Housing Support County Substance Abuse Program 747 Primary Care Physician 746 - County Outpatient - 0 200 400 600 800 1,000 -596 -569 RUHS-BH Eva luation 15 Community Behavioral Assessment Teams (CBAT) Communlty Behavioral Assessment Teams (CBAT) respond to law enforcement calls involving mental health issues in the community with the goal of diverting individuals experiencing mental health issues to community and behavioral health services. Teams consist of a specialist trained law enforcement officer, who provides safety and law enforcement expertise and an RUHS-BH Clinical Therapist ll, who assesses the client's behavior. Requests for Service During the 2021/2022 fiscal year, 16 CBAT teams responded to 2,843 requests (including calls for Homeless Outreach and Welfare Checks). CBAT Requests 2,443 Crisis 2,078 Homeless Outreach L70 Welfare Check 595 Avg. Number of CBAT Requests per Month All Types 237 Number of requests for CBAT teams per Month 7m 6m 5m 44o 445 4m iiiiiiilll 3m 2m 1m 0 ,uI21 Au821 Sep21 Oct 21 Nov2l Dec21 )an 22 Feb22 Mat 22 Apt22 May22 lur 22 RUHS-BH Evaluation L4 community Behavioral Assessment Teams (cBATl crisis R uests CBAT received 2,078 requests for Crisis Services durinB the 2021-2022 fiscal year. The mid-county region received the most requests for crisis service (n=1,448). The average number of calls per month for Crisis Services for CBAT was 173. CBAT Requests for Crisis Service 2,O78 West 559 Mid-County 1,448 Desert 7t Avg. Number of CBAT crisis Team Requests per Month t73 Number of requests for crisis Services ss 450 4m 350 3m 214 247 250 193 2O2 2m 1is8 l 167 1S2 ll 148 150 108 115 95 1m I I I I I 50 0 Jul21 Aug21 Sep21 Oct 21 Nov21 Dec21 .lan22 Feb 21 Mar 22 Ap.22 Mav 22 )!n22 15 RUHS-BH Evaluation Community Behavioral Assessment Teams (CaATl DemograDh ics CBATS served 2,393 individuals (1,792 individuals experiencing Crisis) during the 2021/2022 fiscal year. The demographics presented here isforall individuals regardless of type of request. Gender of CBAT clients Transgend€t 1t6 CBAT teams served more Fan'|.la 4* females (55%) than males (44%). Thirteen individuals (1%) Md. identifi ed as transgender. ssta Age of CBAT clients chtd {0ro lo) The majority of CBAT clients aL..Lar. 1t( (@.d Gaa.rl l54o/ol were adults, age 25 to 59 ,tt ,. llt to r5l yea rs. One-fifth of clients served by CBAT were TAY age l26ro59l 5t,t (16 to 25 yea rs). (ltlo Ztl 20x Ethnicity of CBAT clients Am lndi.n/Alaika Native 1t( Forty-four percent (44o/ol ol Whh.rr(.ucarlan Aii.n/P.(ifi( 1i?. CBAT clients were lslandcr edql^iL.t 2% White/Caucasian and 34% &n.lta,! were Hispanic/Latinx. A quarter of CBAT clients (25%) were Hl+&k/t rhr 3ax reportedas experiencing Multi homelessness, while 4% of 4% clients were Veterans. RUHS-BH Evaluation 16 Community Behavioral Assessment Teams (CBATI Whenever possible CBATS divert individuals from an unnecessary inpatient admission. The figures below provide the percentage diverted as well as ofthe disposition of CBAT crisis calls. Homeless outreach and welfare checks were excluded from these analyses. Additional, consumers who refused service ll8%, n = 375) or who were arr€sted (7% n = 117) were excluded from the analyses. lndividuals were considered diverted if they were diverted with a safety plan or were diverted to the MHUC. Percentage of Crisis Requests Diverted N = 1,586 CBAT was able to divert 45% of Crisis calls. Divened alot Olurbd as% ssi Disposition of Crasis Requests I vduntery ro ETs 23 Almost half (45%) N = 2,078 volunLry to Oese'l csu 2 of CBAT Crisis I requests were Tr.nspo(€d to M.dc.l[R 99 diverted to home Transooned to hpad.rt Psvch 13 or to an MHLlC. Transfened to olh€r Mobil€ CrisisT€.ln 7 Heldover on 51so hold 3 oi,,/ened to MHUC I 129 oiwrsion (Safety Ptan Established ) conirmer R€fused 5erutes 375 I Conrrrn€r Atrasted r17 S1s0Hold W.itten - 0 rco 2m 3m 4m sm 6m 70 8@ 9m 1mo -s87 RUHS-BH Evaluation 17 -711 Community Behavioral Assessment Teams (CBATI Linkaqe to Outpatient Services CBAT teams provide referralto outpatient services. RUHS-BH service data was used to examine service usage after contact with CBAT teams. Clients were considered to be linked to outpatient services if they had an outpatient, substanceuse, oryouth short-term residential program service record. lndividuals who were recorded as having private insurance were excluded from these analyses. Outpatient Linkage for CBAT clients Almost a quarter (24%) of ind ividuals served by CBAT teams were linked tl.rOh to outpatient services 299 ltor t trLd ro after contact with teams. OotDatlcm Some individuals t , m 6 9 r 58,1 149%, n = 2851served by l4'x. tlo.cl..i CBATS were already 25 participating in outpatient services prior to their contact with CBATS. Engagement in Services N=584 The ma.iority (79%) of cBAT clients linked to outpatient services engaged in three or 39% more services. For cdralru.dn f,If,rd h ta clients with 3 or more LEt Ouna* SrYlca ,JX 16 to tO lcwi.cr services, the average !5r number of services was at cr l/lor. 35. aS,{ Readmission Rates for CBATS The table to the left provides the Days to Readmission % recidivism rates at less than 15 days 0 to 15 Days s.00% after first crisis contact and at 16 to 30 days after first contact with cBATs. 16 to 30 Days 2.40% 0 to 30 Days 7 .40% RUHS-BH Evaluation 18 Mobile crisis Management Teams (MCMTI The Mobile crisis Management Team (MCMT) serves individuals who are at risk of a mental health crisis or who are frequently u6lize the crisis response system (e.g., emergency rooms or law enforcement) due to behavioral health needs. The MCMT teams consists of four staff members (Clinical Therapist, Behavioral Health Specialist ll, Behavioral Health Specialist lll, and Peer Support Specialist). Teams respond to requests from various entities in the county with the purpose of assessing and intervening with adults, children and youth experiencing a mental health crisis. MCMTs provide intensive case management after the initial crisis contact and continued engagement for linkage to ongoing outpatient care. ln addition, teams conduct intense, short-term, home-based case management and therapy, substance abuse services, linkage to residential services, and outreach to unengaged youth or adults who are at risk, homeless, or need services to prevent a mental heath crisis. Requests for Servic€ MCMT began service in August of 2021. During the 2O2U2022 fiscal year,4 MCMT teams responded to 643 requests (including calls for Homeless outreach and Non-Crisis Outreach) MCMT Requests 643 Crisis 509 Homeless outreach 57 Welfare Check 77 The fiBure below provides the number of request fro MCMT calls request per month for all calls (crisis, homeless outreach, Non-crisis outreach) for the 2021-2022 fiscal year. MCMTs received an average of 52 request per month. Number of Requests for MCMT teams per month 1iO N=543 120 1m 85 to 76 74 65 66 63 57 il56 l56 60 40 20 l - 0 Jul21 Aug21 Sep21 Oct 21 Nov21 Dec21 .lan22 Feb 2 2 Mat 22 Apt 22 MaY 22 !uo22 RUHS-BH Evaluation 19 Mobile Crisis Management Teams (MCMTI Crisis Reouests MCMT received 509 requests for Crisis services during the 2021-2022 fiscal year. The mid-county region received the most requests for crisis service (n= 238). The average number of calls per month for Crisis Services for MCMT was 42. MCMT Requests for Crisis Service 509 West 195 Mid-County 238 Desert 73 Number of Crisis Requests per Month 120 1m ao 12 63 60 55 56 56 48 39 li 4o 31 20 3 r 0 ,u121 Aug2l Sep2l m21 Nov 21 Dec2l Jan22 Feb22 Mar22 Apr22 M.y22 lun22 Agency Requesting Crisis Services (B( A 2 P * S 1% City tmploye€ The majority of requests for MCMTs for crisis a5* county 8H/5UD Service came from Schools (45%) and x€pnd Hospitals (21%). 21r Otha. lt* llta RUHS-BH Eva luation 20 Mobile crisis Management Teams (MCMTI Demoeraohics MCMT teams served 589 individuals (476 individuals needing crisis services) during the zozl/2o22 hscal year. The demographics presented here is for all clients including those who received Crisis, Homeless Outreach, and MCMT Non-Crisis Outreach service, Gender of MCMT clients MCMT served more females Tranigender at6 (49%) than males (47%). tairh arx lndividuals identifying as Transgender accounted for 4% of all MCMT clients. 0a Age of MCMT clients OU.r dult 60+ 10t( Over a third (3a%) of MCMT AduhrGS9lr. clients were teens age 11to 15 years. Adults age 26 to ral lll,rtr 59 years accounted for 30% rti of clients served by MCMT teams. Ethnicity of MCMT clients Forty-four percent (440/"1 of MCMT clients were Hispanic/Latinx, 34% were lx White/Caucasian, and !3oA were Black/African ab<t/Alraar ADrt(,n 4* tltla American. A quarter of MCMT clients 125%l were reported as experiencing homelessness, while 2% of clients were Veterans. RUHS-BH Evaluation 27 Mobile Crisis Management Teams (MCMTI MCMTs divert individuals from an unnecessary inpatient admission wherever possible. The figure below provides the diversion rates for requests for crisis service. Homeless outreach and MCMT non-crisis outreach were excluded from these analyses. ln addition, requests in which the consumer refused services (5%, n = 13) were excluded from diversion rate calculations. lndividuals are considered diverted if they were diverted with a safety plan or were diverted to the MHUC. Percentage of Crisis Requests Diverted MCMTS was able to divert 57% of Crisis requests t{ot DY.n d l''a from an inpatient admission. Drvcncd 6?% Disposihon of Crisis Requests a{D The figure to 350 \ the left provides l@ the dispositions 2SO of MCMT Crisis 2@ requests. 150 112 r@ lndividuals 50 IJ I r l 5 either diverted 0 I with safety plan ll t . t fl a ty 6 b ? . L n t F M n H .d ( t r o c tr 5 d 1 . 5 b 0 v h a o d ld rr to .n o i. t r tE .d r Tr t . r .$ E {,o ra n n to r l t r i . . . d t t o o t .t t t lo yotu E n t t s ry ro or were tq.ubbd) MoD{. Ciid. Pq/,ch diverted to one T.rn the county's MHUCs- RUHS-BH Evaluation 22 Mobile Crisis Management Teams (MCMT) Linkaqe to Outpatient Services MCMTs provide referrals to outpatient services. RUHS-BH service data was used to examine service usage after contact with MCMTs. Clients were considered to be linked to outpatient services if they had an outpatient, substance use, or youth short-term residential program service record. lndividuals who were recorded as having private insurance were excluded from these analyses. Linkage to Outpatient Service Almost half (48%) of individuals served by MCMTs were linked to outpatient services nbrOhrn after contact with an ,73 Notlin*cdlo Linl.dllo MCMT team. Some Outpatl.nt Outpat!cnt individuals (39%) served s 30 !x 7 4 2 E 4 % 2 by MCMTS were already fllcClna participating in