Response to the Santa Clara County Civil Grand Jury Final Report Falling

The Civil Grand Jury commends DFCS and BHSD for producing a complete continuum of care plan for high-acuity youth that addresses the establishment of E-STRTPs within the County, enhances TrSCF staffing, and adds more ISFC+ homes. Response to Finding 1 The County agrees with this finding.

The County has underperformed in delivering a complete continuum of care for high-acuity youth. Board of Supervisors: Sylvia Arenas, Betty Duong, Otto Lee, Susan Ellenberg, Margaret Abe-Koga County Executive: James R. Williams Adopted: 08/26/2025 Re: Response to the Santa Clara County Civil Grand Jury Final Report Falling Through the Cracks: Failing Santa Clara County’s High-Needs Youth August 26, 2025 Response to Finding 2a The County partially agrees with this finding. Well before the State enacted Assembly Bill 403 in 2015 and began implementing the Continuum of Care Reform (CCR) initiative in 2017, the County had begun moving away from congregate care including through closure of the Children’s Shelter in 2009. Over the last 16 years, the County has worked to establish a robust continuum of temporary and permanent placement options that meets the requirements and goals of CCR, as described in detail in the November 5, 2024 and February 25, 2025 reports to the Board of Supervisors (“Board”), an Off-Agenda Report to the Board sent on May 30, 2024, and responses to Finding 2b below. From Welcoming Centers, Resource Family Approval (RFA) Homes, Intensive Services Foster Care (ISFC) Homes, ISFC+ Homes, Transitional Residential Shelter Care Facilities (TrSCFs), and now the development of in- county Enhanced Short-Term Residential Therapeutic Programs (E-STRTPs), the County has strived to address the temporary and permanent placement needs of all children and youth who must live apart from their biological parents. The County’s continuum of care serves between 500 and 600 youth at any given time, and the current continuum of care meets the needs of most youth, including those with the most significant medical or behavioral health challenges. There are, however, significant opportunities to continue to grow and improve the County’s continuum of care, and to better address some of the key challenges the County has encountered in trying to meet the diverse and complex needs of our highest acuity youth. In reports to the Board, County Administration has noted that additional resources and/or strategies are needed to address the unmet needs of the approximately 12 to 16 youth in the County’s care with highest needs per year, for whom identifying viable placement options is more challenging. As acknowledged in the Civil Grand Jury’s report, most systems of care statewide and nationally have also experienced challenges in finding sufficient family-based placements for older youth, especially those with significant mental health needs, behavioral health challenges, and/or medical needs. To address these challenges, the County adopted and is implementing a multi-pronged strategy including expanding the number of ISCF+ homes, Re: Response to the Santa Clara County Civil Grand Jury Final Report Falling Through the Cracks: Failing Santa Clara County’s High-Needs Youth August 26, 2025 increasing and improving services at the County-operated TrSCFs, and establishing four E-STRTPs.

The current plan was only produced following a referral from the Board after years of failing to provide an in-county STRTP. Response to Finding 2b The County partially agrees with this finding. Over the last 10 years, the County developed and has continuously worked to improve a continuum of care for all foster youth, including those with the highest needs. The Board’s referral was the impetus for exploring a County-operated E-STRTP rather than solely seeking non-profit organizations that were willing to open an E-STRTP in our county. The overall plan, however, builds on departments’ previous experiences and includes other critical strategies including expansion of ISFC+ Homes and improvements to TrSCFs.

Because no one person has the responsibility and authority for the delivery of a continuum of care for high-acuity youth, there is no singular sense of urgency or coordinated priorities across departments to deliver solutions. Response to Finding 3 The County disagrees with this finding. First, the finding implies that County Departments have not urgently prioritized or taken responsibility for improving the continuum of care for high- acuity youth. The County’s recent and previous reports detailed the ways in which County Departments have worked to solve the complex challenges arising from Continuum of Care Reform. In addition to working together on the current plan, the Department of Family and Children’s Services (DFCS), the Behavioral Health Services Department (BHSD), and the Probation Department have been Re: Response to the Santa Clara County Civil Grand Jury Final Report Falling Through the Cracks: Failing Santa Clara County’s High-Needs Youth August 26, 2025 and continue to work closely on many other related projects, such as when these Departments jointly staffed and addressed challenges with the continuum of care’s Receiving, Assessment, and Intake Center in 2019. Second, given the critical role of each of these three departments in meeting the needs of high-acuity youth, sustained improvement relies on the continued leadership of and collaboration between County Departments and non-County agencies. High-acuity youth have complex needs and can have varying levels of interactions with County Departments and other public agencies that are part of the child welfare, juvenile justice, public mental health, and other systems of care. Each of these County departments and non-County agencies carries expertise with specialized staff and clinical providers to address the unique needs of each high-acuity youth in accordance with different bodies of Federal and State regulations, to ensure services provided by each of these departments and agencies are effective and adhere to best practices. Third, for the last several years, significant centralized support and oversight for these efforts has been provided by the Office of the County Executive.

There is no solution in the February 2025 plan to address the high cost of housing in the short term for existing ISFC+ families who are not in hosted homes. Re: Response to the Santa Clara County Civil Grand Jury Final Report Falling Through the Cracks: Failing Santa Clara County’s High-Needs Youth August 26, 2025 Response to Finding 4 The County partially agrees with this finding. Reducing the burdens associated with the high cost of housing in our region is an important tool to address barriers in recruiting and retaining ISFC+ Home caregivers. The County’s reports identified several ways that the County will take steps to address this challenge including by helping Foster Family Agencies (FFAs)— the agencies responsible for recruiting, training, retaining, and supporting caregivers, including ISFC+ Home caregivers—purchase or lease homes, make County-owned residences available for long-term use, and increase housing stipends and/or other payments to caregivers. Each caregiver’s situation is different, however, and DFCS is working with FFAs and individual caregivers to determine the solutions that would work for them. Finally, while the high cost of housing is a significant and common barrier, it is not the only challenge faced by current and potential ISFC+ Home caregivers. DFCS is actively working with FFAs and caregivers to overcome all obstacles to increasing the availability of ISFC+ Homes. Currently, two of the three FFAs (i.e., Seneca Family of Agencies and Pacific Clinics) offer agency-sponsored homes. For caregivers who do not use agency-sponsored homes, a higher stipend is provided to cover rent or monthly expenses. Work with the ISFC+ Workgroup has revealed that a mixed approach is ideal since every potential caregiver’s situation is different. For example, agency-sponsored housing may work best for some caregivers, but for others, using their own home is a better choice. The ISFC+ Workgroup continues to assess the needs of its providers, but thus far, the largest barrier does not seem to be housing. Instead, the biggest challenge has been finding the right individuals dedicated and willing to work with this population as a 24/7 caregiver. DFCS is working with the Facilities and Fleet Department to assess the option of a County-owned/leased home to encourage additional caregivers to come forward. In addition, DFCS is working on State and Federal funding applications that could potentially help cover costs for housing. Applications are expected to be submitted by fall 2025. Re: Response to the Santa Clara County Civil Grand Jury Final Report Falling Through the Cracks: Failing Santa Clara County’s High-Needs Youth August 26, 2025 The DFCS recruitment team is also continually assessing the abilities of potential caregivers interested in providing care for high-acuity youth. This team shares materials, valuable information, and joint marketing campaigns, and works with County partners/providers to recruit qualifying caregivers.

For many years, the County experienced significant challenges with its TrSCFs, formerly known as “scattered sites.” The plan does not include a timeline for the County to add at least one staff member at each TrSCF with additional training and experience managing complex behaviors of the youth in these homes. Response to Finding 5 The County partially agrees with this finding. The County agrees with the need to add staff with clinical expertise at the TrSCF sites, which is reflected in the continuum of care plan and is in the process of being implemented. The County does not agree that staff must be County staff, as contracting with an experienced provider for experienced clinical staff at these sites would also meet this need. Re: Response to the Santa Clara County Civil Grand Jury Final Report Falling Through the Cracks: Failing Santa Clara County’s High-Needs Youth August 26, 2025

The County’s past experience demonstrates it needs more than one contractor providing E-STRTPs. Having multiple providers is a critical component of the plan to provide E-STRTPs. Response to Finding 6a The County agrees with this finding. The County agrees that multiple providers are needed to run E-STRTPs in the county, which is why the County’s continuum of care plan incorporates both a County-operated E-STRTP and at least one Community-Based Organization (CBO)-operated E-STRTP. While CBO-operated E-STRTPs would be less expensive and potentially more quickly established than a County-operated E-STRTP, taking a two- pronged approach enables the County to develop the expertise needed to establish and operate an E-STRTP. This will also enable the County to assume operations of a CBO-operated E-STRTP if the CBO is suddenly unable to continue operations. Even for the CBO-operated E-STRTPs, the County aims to either own the property, be the lessee, or have the right of first refusal to acquire or lease the property. This approach ensures that the County could transition the operation of the E-STRTP to a different CBO or County staff if the current provider was unable or unwilling to operate the program. Given the Board’s direction, the County is focused on working with a CBO for one or more E-STRTPs and establishing at least one County-operated STRTP. Staff will monitor implementation, utilization, and effectiveness to determine if additional CBO-operated E-STRTPs are necessary. Re: Response to the Santa Clara County Civil Grand Jury Final Report Falling Through the Cracks: Failing Santa Clara County’s High-Needs Youth August 26, 2025

The County’s timeline for establishing its own E-STRTP is significantly longer when compared to a CBO. Response to Finding 6b The County agrees with this finding.

The establishment of the County-based E-STRTP requires multi-year funding from the County. Response to Finding 7 The County agrees with this finding.

The County does not know the total cost of the continuum of care across multiple departments for high-acuity youth and therefore cannot determine how effectively taxpayer dollars are being spent. Response to Finding 8 The County disagrees with this finding. The County has not compiled County-wide costs associated with all services utilized by high-acuity youth because doing so would require collecting detailed and highly confidential health, child welfare, and juvenile justice records for individual youth served by many County departments and contracted service providers; such an analysis would be extremely time and labor intensive, highly dependent on how the term Re: Response to the Santa Clara County Civil Grand Jury Final Report Falling Through the Cracks: Failing Santa Clara County’s High-Needs Youth August 26, 2025 “high acuity youth” was defined as there is no standard definition; and most importantly, is not needed to advance the goal of improving services for these youth as the County has consistently been willing to invest whatever resources are needed to meet these children’s needs. Further, it is well established that the best option for high-acuity youth is permanent placement in a family-based setting. When such options are not available, the County is committed to providing a range of temporary or short-term placement options, until more permanent and/or family-based settings do become available. Moreover, the County’s focus and efforts must remain devoted to implementing the proposed plan to provide better access to these placements as quickly as possible.