Contra Costa County Civil Grand Jury Report No. 1703

R1

The Board of Supervisors should consider identifying funds to add six psychiatrists at the three regional mental health clinics. Response: The recommendation requires further analysis. There are currently three funded psychiatrist positions that are vacant and the County is working to fill. Once those positions are filled, the County will continue assessing staffing needs and determine the number of additional positions needed. Furthermore, the County is currently in negotiations with Physicians’ and Dentists’ Organization of Contra Costa, which includes a review of benefits and wages for all represented classifications, including psychiatrists. Once an agreement is reached, more accurate salary and benefits figures will be available to identify the amount of funding needed for any additional positions.

R2

The Board of Supervisors should consider directing Human Resources to review the compensation packages for County psychiatrists to ensure their compensation packages are competitive compared to the private market. Response: The recommendation will not be implemented because it is not reasonable. The County is currently in negotiations with Physicians’ and Dentists’ Organization of Contra Costa; therefore, a review of benefits and wages for all represented classifications, including psychiatrists, is underway. The County cannot compete with the private market; therefore, comparing County compensation packages with other counties establishes more reasonable benchmarks. The issue of the County’s psychiatrist compensation packages is being addressed and will be known after negotiations are complete.

R3

The Board of Supervisors should consider directing BHS to redeploy therapists with a view to a more equitable ratio of children per therapist among the County’s three mental health clinics. Response: The recommendation has been implemented. Clinical staff are fairly and evenly distributed across the regional clinics with equitable ratios of children per therapist. Table A, included in the response to F7 shows the equitable distribution of psychiatrists across the County clinics. Our goal is to continue to deploy therapists with consideration to equity and the number of consumers presenting at the clinics for services.

R4

The Board of Supervisors should consider identifying funds to enable BHS to review and improve systems related to the real time availability of CBOs and individual private therapists for mental health service appointments. Response: The recommendation will not be implemented because it is not reasonable. The County is not aware of the existence of a real time tool to support the recommended effort. However, the County has processes in place to maintain current information on the availability of CBOs and individual private therapists. The Access Line regularly conducts test calls to CBOs and private therapists to ensure appointments are available. No referral is made to a CBO or private therapist unless they have an appointment available in the next ten (10) days.

R5

The Board of Supervisors should consider directing BHS to monitor and report on the wait times for mental health treatment for at-risk children. Response: The recommendation has been implemented. The Behavioral Health Division is required by regulation to monitor and report on the timeliness of mental health treatment for at- risk youth. During the last annual review, which was conducted in February of this year, the following data was presented to the External Quality Review Organization (State audit team): Timeline from initial request to clinical assessment appointment: County West Central East Wide Region Region Region Average length of time from first request 14.1 days 11.6 days 11.5 days 16.5 days for service to first clinical assessment MHP standard or goal 15 days 15 days 15 days 15 days Percent of appointments that meet this 63.8% 80.6% 81.0% 46.9% standard Range 1-48 days 1-47 days 1-43 days 5-48 days Timeline from initial request to first psychiatry appointment: County West Central East Wide Region Region Region Average length of time from first request for service to first psychiatry 12.0 days 11.2 days 3.1 days 20.5 days appointment MHP standard or goal 30 days 30 days 30 days 30 days Percent of appointments that meet this 100% 100% 100% 100% standard Range 1-30 days 1–26 days 1-9 days 12–30 days MH Children's Outpatient Clinics - Demographics by Age and Ethnicity Served vs Medi-Cal eligiblle population in FY 2016-2017 Basic demographic indicators for the Medi-Cal eligible population, served by the CCHSD MH vs county wide Children, open at MH Clinics for svcs CCC Medi-Cal Eligible Children Region # of Clients % of Total Region # of MC % of Total children Central 358 32.9% Central 25,284 22.8% East 418 38.4% East 49,741 44.8% West 312 28.7% West 36,024 32.4% Grand Total 1,088 100.0% Grand Total 111,049 100.0% Date Published : 8/3/2017 19:33; 1 of 7 MH Children's Outpatient Clinics - Demographics by Age and Ethnicity Served vs Medi-Cal eligiblle population in FY 2016-2017 Basic demographic indicators for the Medi-Cal eligible population, served by the CCHSD MH vs county wide Children, open at MH Clinics for svcs CCC Medi-Cal Eligible Children Region Age Group # of Clients % of Region Region Age Group # of MC % of Region Total children Total Central Age Group #1: 0-5 1 0.3% Central Age Group #1: 0-5 7,124 28.2% Age Group #2: 6-12 127 35.5% Age Group #2: 6-12 8,361 33.1% Age Group #3: 13-17 179 50.0% Age Group #3: 13-17 5,511 21.8% Age Group #4: 18-21 51 14.2% Age Group #4: 18-21 4,288 17.0% Total for Central 358 100.0% Total for Central 7,124 100.0% East Age Group #2: 6-12 136 32.5% East Age Group #1: 0-5 14,110 28.4% Age Group #3: 13-17 228 54.5% Age Group #2: 6-12 16,727 33.6% Age Group #4: 18-21 54 12.9% Age Group #3: 13-17 10,812 21.7% Total for East 418 100.0% Age Group #4: 18-21 8,092 16.3% West Age Group #1: 0-5 1 0.3% Total for East 14,110 100.0% Age Group #2: 6-12 112 35.9% West Age Group #1: 0-5 10,731 29.8% Age Group #3: 13-17 158 50.6% Age Group #2: 6-12 12,125 33.7% Age Group #4: 18-21 41 13.1% Age Group #3: 13-17 7,502 20.8% Total for West 312 100.0% Age Group #4: 18-21 5,666 15.7% Grand Total 1,088 N/A Total for West 10,731 100.0% Grand Total 111,049 100.0% Date Published : 8/3/2017 19:33; 2 of 7 MH Children's Outpatient Clinics - Demographics by Age and Ethnicity Served vs Medi-Cal eligiblle population in FY 2016-2017 Basic demographic indicators for the Medi-Cal eligible population, served by the CCHSD MH vs county wide Children, open at MH Clinics for svcs CCC Medi-Cal Eligible Children Region Ethnicity # of Clients % of Region Region Ethnicity # of MC % of Region Total children Total Central African-American 47 13.1% Central African American 1,040 4.1% Asian/Pacific Islander 13 3.6% Asian/Pacific Islander 3,771 14.9% Caucasian 164 45.8% Caucasian 5,840 23.1% Hispanic 120 33.5% Hispanic 9,029 35.7% Native American 3 0.8% Native American 69 0.3% Other Non White 10 2.8% Other Non White 4,764 18.8% Unknown 1 0.3% Unknown 771 3.0% Total for Central 358 100.0% Total for Central 1,040 100.0% East African-American 113 27.0% East African American 9,024 18.1% Asian/Pacific Islander 10 2.4% Asian/Pacific Islander 5,030 10.1% Caucasian 119 28.5% Caucasian 7,069 14.2% Hispanic 139 33.3% Hispanic 20,617 41.4% Native American 4 1.0% Native American 116 0.2% Other Non White 7 1.7% Other Non White 6,382 12.8% Unknown 26 6.2% Unknown 1,503 3.0% Total for East 418 100.0% Total for East 9,024 100.0% West African-American 93 29.8% West African American 6,099 16.9% Asian/Pacific Islander 12 3.8% Asian/Pacific Islander 5,035 14.0% Caucasian 60 19.2% Caucasian 1,925 5.3% Hispanic 127 40.7% Hispanic 17,456 48.5% Native American 4 1.3% Native American 50 0.1% Other Non White 1 0.3% Other Non White 4,414 12.3% Unknown 15 4.8% Unknown 1,045 2.9% Total for West 312 100.0% Total for West 6,099 100.0% Grand Total 1,088 N/A Grand Total 111,049 N/A Date Published : 8/3/2017 19:33; 3 of 7 MH Children's Outpatient Clinics - Demographics by Age and Ethnicity Served vs Medi-Cal eligiblle population in FY 2016-2017 Basic demographic indicators for the Medi-Cal eligible population, served by the CCHSD MH vs county wide Region # of Svcs % of Svcs Total Cost % of Cost in FY16-17 Central 13,266 39.6% $3,154,828 35.7% East 11,955 35.7% $3,300,070 37.3% West 8,264 24.7% $2,389,185 27.0% Grand Total 33,485 100.0% $8,844,083 100.0% Date Published : 8/3/2017 19:33; 4 of 7 MH Children's Outpatient Clinics - Demographics by Age and Ethnicity Served vs Medi-Cal eligiblle population in FY 2016-2017 Basic demographic indicators for the Medi-Cal eligible population, served by the CCHSD MH vs county wide Children, open at MH Clinics - all cases CCC Medi-Cal Eligible Children Region # of Clients % of Total Region # of MC % children Central 763 25.0% Central 25,284 22.8% East 983 32.2% East 49,741 44.8% West 1,305 42.8% West 36,024 32.4% Grand Total 3,051 100.0% Grand Total 111,049 100.0% Date Published : 8/3/2017 19:33; 5 of 7 MH Children's Outpatient Clinics - Demographics by Age and Ethnicity Served vs Medi-Cal eligiblle population in FY 2016-2017 Basic demographic indicators for the Medi-Cal eligible population, served by the CCHSD MH vs county wide Children, open at MH Clinics - all cases CCC Medi-Cal Eligible Children Region Age Group # of Clients % of Region Region Age Group # of MC % of Region Total children Total Central Age Group #1: 0-5 51 6.7% Central Age Group #1: 0-5 7,124 28.2% Age Group #2: 6-12 288 37.7% Age Group #2: 6-12 8,361 33.1% Age Group #3: 13-17 321 42.1% Age Group #3: 13-17 5,511 21.8% Age Group #4: 18-21 103 13.5% Age Group #4: 18-21 4,288 17.0% Total for Central 763 100.0% Total for Central 7,124 100.0% East Age Group #1: 0-5 70 7.1% East Age Group #1: 0-5 14,110 28.4% Age Group #2: 6-12 409 41.6% Age Group #2: 6-12 16,727 33.6% Age Group #3: 13-17 417 42.4% Age Group #3: 13-17 10,812 21.7% Age Group #4: 18-21 87 8.9% Age Group #4: 18-21 8,092 16.3% Total for East 983 100.0% Total for East 14,110 100.0% West Age Group #1: 0-5 151 11.6% West Age Group #1: 0-5 10,731 29.8% Age Group #2: 6-12 598 45.8% Age Group #2: 6-12 12,125 33.7% Age Group #3: 13-17 438 33.6% Age Group #3: 13-17 7,502 20.8% Age Group #4: 18-21 118 9.0% Age Group #4: 18-21 5,666 15.7% Total for West 1,305 100.0% Total for West 10,731 100.0% Grand Total 3,051 N/A Grand Total 111,049 100.0% Date Published : 8/3/2017 19:33; 6 of 7 MH Children's Outpatient Clinics - Demographics by Age and Ethnicity Served vs Medi-Cal eligiblle population in FY 2016-2017 Basic demographic indicators for the Medi-Cal eligible population, served by the CCHSD MH vs county wide Children, open at MH Clinics - all cases CCC Medi-Cal Eligible Children Region Ethnicity # of Clients % of Region Region Ethnicity # of MC % of Region Total children Total Central African-American 105 13.8% Central African American 1,040 4.1% Asian/Pacific Islander 20 2.6% Asian/Pacific Islander 3,771 14.9% Caucasian 304 39.8% Caucasian 5,840 23.1% Hispanic 302 39.6% Hispanic 9,029 35.7% Native American 8 1.0% Native American 69 0.3% Other Non White 18 2.4% Other Non White 4,764 18.8% Unknown 6 0.8% Unknown 771 3.0% Total for Central 763 100.0% Total for Central 1,040 100.0% East African-American 240 24.4% East African American 9,024 18.1% Asian/Pacific Islander 27 2.7% Asian/Pacific Islander 5,030 10.1% Caucasian 268 27.3% Caucasian 7,069 14.2% Hispanic 391 39.8% Hispanic 20,617 41.4% Native American 8 0.8% Native American 116 0.2% Other Non White 10 1.0% Other Non White 6,382 12.8% Unknown 39 4.0% Unknown 1,503 3.0% Total for East 983 100.0% Total for East 9,024 100.0% West African-American 372 28.5% West African American 6,099 16.9% Asian/Pacific Islander 35 2.7% Asian/Pacific Islander 5,035 14.0% Caucasian 169 13.0% Caucasian 1,925 5.3% Hispanic 666 51.0% Hispanic 17,456 48.5% Native American 10 0.8% Native American 50 0.1% Other Non White 22 1.7% Other Non White 4,414 12.3% Unknown 31 2.4% Unknown 1,045 2.9% Total for West 1,305 100.0% Total for West 6,099 100.0% Grand Total 3,051 N/A Grand Total 111,049 N/A Date Published : 8/3/2017 19:33; 7 of 7 MH Children's Outpatient Clinics - Demographics by Age and Ethnicity Served vs Medi-Cal eligiblle population in FY 2016-2017 Basic demographic indicators for the Medi-Cal eligible population, served by the CCHSD MH vs county wide Children, open at MH Clinics for svcs CCC Medi-Cal Eligible Children Region # of Clients % of Total Region # of MC % of Total children Central 358 32.9% Central 25,284 22.8% East 418 38.4% East 49,741 44.8% West 312 28.7% West 36,024 32.4% Grand Total 1,088 100.0% Grand Total 111,049 100.0% Date Published : 8/3/2017 19:34; 1 of 4 MH Children's Outpatient Clinics - Demographics by Age and Ethnicity Served vs Medi-Cal eligiblle population in FY 2016-2017 Basic demographic indicators for the Medi-Cal eligible population, served by the CCHSD MH vs county wide Children, open at MH Clinics for svcs CCC Medi-Cal Eligible Children Region Age Group # of Clients % of Region Region Age Group # of MC % of Region Total children Total Central Age Group #1: 0-5 1 0.3% Central Age Group #1: 0-5 7,124 28.2% Age Group #2: 6-12 127 35.5% Age Group #2: 6-12 8,361 33.1% Age Group #3: 13-17 179 50.0% Age Group #3: 13-17 5,511 21.8% Age Group #4: 18-21 51 14.2% Age Group #4: 18-21 4,288 17.0% Total for Central 358 100.0% Total for Central 7,124 100.0% East Age Group #2: 6-12 136 32.5% East Age Group #1: 0-5 14,110 28.4% Age Group #3: 13-17 228 54.5% Age Group #2: 6-12 16,727 33.6% Age Group #4: 18-21 54 12.9% Age Group #3: 13-17 10,812 21.7% Total for East 418 100.0% Age Group #4: 18-21 8,092 16.3% West Age Group #1: 0-5 1 0.3% Total for East 14,110 100.0% Age Group #2: 6-12 112 35.9% West Age Group #1: 0-5 10,731 29.8% Age Group #3: 13-17 158 50.6% Age Group #2: 6-12 12,125 33.7% Age Group #4: 18-21 41 13.1% Age Group #3: 13-17 7,502 20.8% Total for West 312 100.0% Age Group #4: 18-21 5,666 15.7% Grand Total 1,088 N/A Total for West 10,731 100.0% Grand Total 111,049 100.0% Date Published : 8/3/2017 19:34; 2 of 4 MH Children's Outpatient Clinics - Demographics by Age and Ethnicity Served vs Medi-Cal eligiblle population in FY 2016-2017 Basic demographic indicators for the Medi-Cal eligible population, served by the CCHSD MH vs county wide Children, open at MH Clinics for svcs CCC Medi-Cal Eligible Children Region Ethnicity # of Clients % of Region Region Ethnicity # of MC % of Region Total children Total Central African-American 47 13.1% Central African American 1,040 4.1% Asian/Pacific Islander 13 3.6% Asian/Pacific Islander 3,771 14.9% Caucasian 164 45.8% Caucasian 5,840 23.1% Hispanic 120 33.5% Hispanic 9,029 35.7% Native American 3 0.8% Native American 69 0.3% Other Non White 10 2.8% Other Non White 4,764 18.8% Unknown 1 0.3% Unknown 771 3.0% Total for Central 358 100.0% Total for Central 1,040 100.0% East African-American 113 27.0% East African American 9,024 18.1% Asian/Pacific Islander 10 2.4% Asian/Pacific Islander 5,030 10.1% Caucasian 119 28.5% Caucasian 7,069 14.2% Hispanic 139 33.3% Hispanic 20,617 41.4% Native American 4 1.0% Native American 116 0.2% Other Non White 7 1.7% Other Non White 6,382 12.8% Unknown 26 6.2% Unknown 1,503 3.0% Total for East 418 100.0% Total for East 9,024 100.0% West African-American 93 29.8% West African American 6,099 16.9% Asian/Pacific Islander 12 3.8% Asian/Pacific Islander 5,035 14.0% Caucasian 60 19.2% Caucasian 1,925 5.3% Hispanic 127 40.7% Hispanic 17,456 48.5% Native American 4 1.3% Native American 50 0.1% Other Non White 1 0.3% Other Non White 4,414 12.3% Unknown 15 4.8% Unknown 1,045 2.9% Total for West 312 100.0% Total for West 6,099 100.0% Grand Total 1,088 N/A Grand Total 111,049 N/A Date Published : 8/3/2017 19:34; 3 of 4 MH Children's Outpatient Clinics - Demographics by Age and Ethnicity Served vs Medi-Cal eligiblle population in FY 2016-2017 Basic demographic indicators for the Medi-Cal eligible population, served by the CCHSD MH vs county wide Region # of Svcs % of Svcs Total Cost % of Cost in FY16-17 Central 13,266 39.6% $3,154,828 35.7% East 11,955 35.7% $3,300,070 37.3% West 8,264 24.7% $2,389,185 27.0% Grand Total 33,485 100.0% $8,844,083 100.0% Date Published : 8/3/2017 19:34; 4 of 4 Contact: Jim Mellander Foreperson 925-608-2621 Contra Costa County Grand Jury Report 1703 Mental Health Services for At-Risk Children in Contra Costa County TO: County Board of Supervisors, Behavioral Health Services