Homeless Youth, Sonoma County In Dubious First Place

Because the County lacks a Medi-Cal residential rehabilitation facility for young people with substance abuse disorders, homeless young people who need such treatment are at particular disadvantage. Response: The Department of Health Services wholly disagrees with this finding. We disagree with this finding. Sonoma County’s Medi-Cal residential treatment facilities serve young people, 18 years and older, with substance abuse disorders (SUD). There are no residential treatment facilities specifically dedicated to young people. While it would be a benefit to develop specialized SUD services for Transition Age Youth (TAY), particularly those who are homeless, it’s unclear that residential treatment would be the preferred modality. Research finds, and local experience supports, that congregate care for this population, which often includes youth with complex needs and challenges experience challenges in such settings. Congregate care mixes youth who have different levels of risk and maladaptive behavior. The result is that lower risk youth adopt the problematic behaviors of higher risk youth. Services that are family and community-based (i.e. not institutional), have the strongest outcomes for youth with SUD and criminal behavior.

The same substance abuse treatment protocols are being used for youth and adults even though research shows that young people need treatments designed for their particular age and needs. Response: The Department of Health Services wholly disagrees with this finding. DHS provides services tailored to young people up to the age of 18. The SUD curriculum for youth in custody in Juvenile Hall is an evidence-based curriculum specifically designed for this age group. Similarly, the Drug Abuse Alternatives Center (DAAC) utilizes an evidence-based curriculum for youth in its outpatient services. DHS SUD residential programs serve young adults 18 – 25 yrs. While they do not have general programming specific to young adults, all assessments are individualized, taking into account each client’s developmental needs.

The availability of outpatient mental health service provider appointments that accept Medi- Cal payments is inadequate to serve the number of youths requiring such services; more options are needed for therapeutic resources for children and young adults. Response: The Department of Health Services disagrees partially with this finding. The Sonoma County DHS Mental Health Plan (MHP) has met all California Department of Health Care Services (DHCS) network adequacy requirements; however, the totality of community needs for child and young adult mental health services exceeds available resources, as is the case throughout California. DHS agrees that expansion of youth outpatient services would be valuable. It is a priority of the County to increase mental health resources for youth should additional funding be made available. In November 2020, DHS will know whether or not the Sonoma County Local Mental Health, Addiction and Homeless Services Measure Transactions and Use Tax has passed. This 1/4 cent tax will provide a sustained funding source that will, among other things, support the expansion of the substance use disorder service system. This expansion will be supported by a planning process to be determined, that would include the design of TAY SUD services. In addition, if the measure is passed, the County will be able to contract with providers to deliver Crisis Assessment, Prevention & Education (CAPE) programs and also partner with the Junior College to support programming for TAY.

The County needs a short-term mental health facility that accepts Medi-Cal payments and serves young people. Response: The Department of Health Services wholly disagrees with this finding. “Short-term mental health facility” is a very general term and we are uncertain as to the type of facility the Grand Jury references. Sonoma County DHS short-term mental health facilities, the Crisis Stabilization Unit (CSU), Crisis Residential Treatment (CRT) and transitional housing programs serve TAY, including those who are homeless. The County is also in the process of developing its own 16-bed Psychiatric Health Facility (PHF), and expects to begin operation by 2021, that can also serve this population. It is unclear that congregate settings specifically for this population would be beneficial or feasible. Research finds that placing youth, with varying degrees of maladaptive behavior, together has negative consequences. Youth with lower levels of risk decompensate further under the influence of peers with more serious disturbance. Indeed, California Department of Social Services (CDSS) policy under Continuum of Care Reform (CCR) is to reduce or eliminate the use of residential care for children and youth. Family and community-based services, such as family therapies and wrap around services for youth in permanent supportive housing hold more promise for effective outcomes.

The majority of the County’s efforts related to the homeless youth population focus on providing programs and services to young people already living on the streets, rather than programs to prevent homelessness in the first place. Response: The Department of Health Services disagrees partially with this finding. The Department of Health Services (DHS) and Community Development Commission (CDC) recognize the importance of providing services to prevent homelessness, however, we have found that the most effective results for housing are spending dollars on rapid rehousing for youth homelessness. Additionally, the National Alliance to End Homelessness (NAEH) identifies diversion as the best method of reducing homelessness in communities. They indicate there are very few evidence based predictors of homelessness and therefore a comprehensive diversion program is the best way of ensuring reduced entries to shelter or services (https://endhomelessness.org/use-esg-cv-to-help-those-currently-experiencing-homelessness- first-prevention-as-a-back-up-strategy/). Unfortunately, funding for TAY housing programs and services has gone down in Fiscal Year 2020- 2021 due a decrease in State funding from $11.5 million in Homeless Emergency Aid Program (HEAP) funds to $6.7 million in Homeless Housing Assistance and Prevention funding. The CDC is committed to programs that are youth-centered, youth-informed, and grounded in permanent housing solutions with trauma informed care and is recommending establishing a Youth Action Board (YAB) in 20-21. DHS does not agree that behavioral health services are focused on individuals who are homeless. Mental health services are available and utilized by young adults who are at-risk of homelessness, but are not homeless. Reducing transition to homelessness is one of the primary targets of DHS’ Full Service Partnership and outpatient service programs.