2010-2011 Santa Clara County Civil Grand Jury Report Mental Health Support at Youth Ranches

Conclusions 4

• CL1 Page 9
  Various mental health providers demonstrate a lack of coordination and communication, which compromises the effective delivery of those services.
• CL2 Page 9
  Communication among individual professionals about mental health needs is limited and inefficient and is exacerbated because separate records, such as medical charts and progress notes, are maintained. 9
• CL3 Page 10
  Metrics are available but are not used to evaluate whether mental health needs are being met, whether needs are increasing, or whether the various CBO providers are being used in the most efficient manner.
• CL4 Page 8
  The Grand Jury was impressed with the dedication and commitment of the Probation counselors and therapists interviewed. All seemed to be sincerely interested in the well- being of their clients. While Probation staff at the Ranches are satisfied with the individual mental health therapists provided by CBOs, the lack of coordination of their services handicaps Probation’s efforts to provide the best services possible to their clients. Further, the practice of each agency maintaining its own separate records, such as medical charts and progress notes, hampers the continuity of health care and the coordination of appropriate treatment for clients. It also appears that since mental health therapists are not assigned to specific pods as the Probation counselors are, the provision of mental health services is moving in the opposite direction from that recommended in the Huskey Report, which advised a pod approach to all staff (Probation and counselors/therapists) assignments to achieve continuity of treatment. In addition, there is significant risk of burnout, given the administrative decision to assign just a single therapist to each Ranch facility. By more closely aligning Ranch therapists to the CMH therapists assigned to Juvenile Hall, all therapists could provide back-up and extra help as needed at any SCC juvenile facility, which could alleviate burnout. 8 A wide range of providers offer services to the Ranches. With so many players, communication will continue to be a challenge. Ranch management must continue to assess the communication needs of the various groups and ensure, at minimum, that client information is collected in one file and shared with all treatment providers. The Grand Jury applauds the effort by CMH and CHS to institute quarterly communication meetings with the CBOs beginning in the first quarter of 2011, and encourages Probation and DADS to participate in those meetings. Findings and Recommendations Finding 1 Various mental health providers demonstrate a lack of coordination and communication, which compromises the effective delivery of those services. Recommendation 1a Santa Clara Valley Health & Hospital System (SCVHHS) should continue to move toward ensuring that all therapists, whether employed by CMH or a CBO, are certified to provide counseling for “co-occurring disorders.” Furthermore, SCVHHS should pursue efforts to dismantle bureaucratic and contractual barriers to providing single-point (one counselor to one client) counseling. Recommendation 1b Probation, CMH, and DADS should designate one person to be responsible for coordinating mental health treatment for each client. Recommendation 1c Probation leadership at the Ranches should evaluate communication systems currently in use by providers at each of the facilities, and they should work to ensure that open communication and file-sharing programs are put into place. In addition, the frequency of site-wide team meetings or other programs should be increased in order to ensure that various team members know one another and are familiar with the treatment programs for all minors under their care. Finding 2 Communication among individual professionals about mental health needs is limited and inefficient and is exacerbated because separate records, such as medical charts and progress notes, are maintained. 9 Recommendation 2 Santa Clara Valley Health & Hospital System should institute one chart or one recordkeeping system, such as the UNICARE system already in place, and require its use by CMH, Custody Health Services, DADS, and the relevant CBOs. Finding 3 Metrics are available but are not used to evaluate whether mental health needs are being met, whether needs are increasing, or whether the various CBO providers are being used in the most efficient manner. Recommendation 3a Probation and CMH should agree on benchmarks to identify which minors in custody should receive mental health or social services counseling. Recommendation 3b Probation and CMH should agree on which metrics are necessary to plan staffing needs, and review those metrics at regular communication meetings. 10 APPENDIX A Table of Acronyms and Abbreviations CBO Community-based Organization Custody Health Services, a Department within Santa Clara Valley CHS Health & Hospital System County Mental Health, a Department within Santa Clara Valley CMH Health & Hospital System The Department of Alcohol and Drug Services, a Department DADS within Santa Clara Valley Health & Hospital System ERP Enhanced Ranch Program A 106-page report entitled “Implementing a Trauma-Informed Mental Health and Juvenile Probation System”, presented to Santa Huskey Report Clara County Mental Health Department and the Juvenile Probation Department, October 31, 2008. Submitted by Huskey & Associates MDT Multi-Disciplinary Team Probation Santa Clara County Probation Department SCC Santa Clara County SCVHHS Santa Clara Valley Health & Hospital System William F. James Boys’ Ranch and Muriel Wright Residential The Ranches Center 11 APPENDIX B Bibliography Agreement between the County of Santa Clara and Community Solutions for the Provision of Mental Health Services for Fiscal Year 2008-2009, and Amendments through 2010. Exhibit A1, Amendment to Agreement between the County of Santa Clara and Starlight Community Services for MHSA JPD Aftercare and JPD Ranch Mental Health. July 1, 2010. Healthy Returns Initiative, website: http://www.healthyreturnsinitiative.org/index.html Huskey, B. & Associates, Implementing a Trauma-Informed Mental Health and Juvenile Probation System, presented to Santa Clara County Mental Health Department and the Juvenile Probation Department, October 31, 2008. Juvenile Justice Commission, County of Santa Clara, Inspection Report Muriel Wright Residential Center, June 2009. Juvenile Justice Commission, County of Santa Clara, Inspection Report Muriel Wright Residential Center, June 2010. Juvenile Justice Commission, County of Santa Clara, Inspection Report James Boys Ranch. January 2009. Juvenile Justice Commission, County of Santa Clara, Inspection Report William F. James Boys’ Ranch. May 2010. County Contract with Starlight for services to William F. James Boys’ Ranch. County Contract and related amendments with Community Solutions for services to Muriel Wright Residential Center. Superior Court of California, County of Santa Clara Juvenile Division, Standing Order for Multi- Disciplinary Sharing of Health Information for Children in Juvenile Facilities. Filed August 13, 2009. Santa Clara County Probation Department, Juvenile Detention Services website: http://www.sccgov.org/portal/site/probation/agencychp?path=%2Fv7%2FProbation%20Departm ent%20(DEP)%2FJuvenile%20Detention%20Services 12 APPENDIX C 2009 Standing Order 13 14 15 16 This report was PASSED and ADOPTED with a concurrence of at least 12 grand jurors on this 12th day of May, 2011. Helene I. Popenhager Foreperson Gerard Roney Foreperson pro tem Kathryn Janoff Secretary 17

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