Riverside County Grand Jury
2022-2023
From the annual report
The consolidated year-end volume. The individual investigations it contains are listed separately below.
📑 Year-End Report
The full consolidated volume; individual reports are listed below.
Individual reports (9)
Findings & Recommendations
1 findings
F4:
The Civil Grand Jury finds that 988, the newly established Suicide & Crisis Lifeline, 38670 SKY CANYON DRIVE diverts Riverside calls through the Los Angeles County call center. Upon identifying as a SUITE 200 Riverside resident, the caller is referred to a secondary number. Though interpretation into over MURRIETA, CA 92563-2536 240 languages and dialects is marketed as available 24/7 with average time to be connected to an interpreter within 17 seconds, this was not our experience when requesting interpretation. (951) 249-8800 Response: The Riverside County Office of Education agrees with the finding. The Riverside County Suicide Prevention Coalition (SPC), an RCOE partner, is working on the
Additional Recommendations
4
Not linked to specific findings.
R1:
Collect more delineated Riverside County specific suicide data.
R2:
Continue to place more mental health care services in school and community settings.
R3:
Enhance partnerships between schools and County programs.
R4:
Be fully aware of the limitations of 988 as a resource until services are more operational, and work with the Los Angeles County call center to improve 988 service to Riverside County residents. Response: The Riverside County Office of Education agrees with the recommendation.
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Findings & Recommendations
8 findings
F1:
The Civil Grand Jury finds county-specific suicide data collection is deficient. Without local data, the extent of the problem is not clear and suicide prevention services and programs will not be appropriately designed.
Related Recommendations (1)
R1:
The Civil Grand Jury recommends the Board of Supervisors support more delineated county-specific suicide data collection through Riverside County Epidemiology Program Evaluation and its community partners. Based on Finding(s): F1 Financial Impact: Moderate Implementation Date: June 30, 2024 49 Validation of telephone-based behavioral assessments in aging services clients. Yeates, Conwell, Epub 2017 Sep 20 22
F2:
The Civil Grand Jury finds two observations during this investigation: (1) Despite reasonable efforts to improve the design of forms and to establish single points of contact, citizens still perceive intake forms as cumbersome; and (2) Citizens expect governments to act proactively by initiating appropriate government services themselves, instead of relying on requests for services from users. Therefore, offering County residents the convenience of having multiple needs met in one physical location is a continuing need. California Veterans Health Initiative to Combat Suicide and Address Mental Health 21
Related Recommendations (1)
R2:
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 benefit all residents in accessing healthcare, transportation, referrals, and services. Based on Finding(s): F1, F2, F3, F5, F6, F8 Financial Impact: Moderate Implementation Date: June 30, 2024
F3:
The Civil Grand Jury finds Riverside University Health System – Behavioral Health has significant partnerships with Riverside County agencies and community partners to serve the needs of County residents.
Related Recommendations (1)
R3:
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 growth, 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). Based on Finding(s): F3, F5, F6, F7, F8 Financial Impact: Minor Implementation Date: December 31, 2023
F4:
The Civil Grand Jury finds that 988, the newly established Suicide & Crisis Lifeline, diverts Riverside calls through the Los Angeles County call center. Upon identifying as a Riverside resident the caller is referred to a secondary number. Though interpretation into over 240 languages and dialects is marketed as available 24/7 with average time to be connected to an interpreter within 17 seconds, this was not our experience when requesting interpretation.
Related Recommendations (1)
R4:
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, Children’s Committee, Criminal Justice Committee, Housing Committee, Legislative Committee, Older Adult Integrated System of Care Committee, and Veteran’s 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. Based on Finding(s): F2, F3, F6, F7, F8 Financial Impact: Minimal Implementation Date: September 30, 2023
F5:
The Civil Grand Jury finds that the Riverside County Board of Supervisors Youth Commission and its five Youth Advisory Councils has the capacity through its relationship with schools and youth to advise the Board of Supervisors on youth suicide prevention.
Related Recommendations (1)
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. Based on Finding(s): F3 Financial Impact: Minor Implementation Date: March 31, 2024 23
F6:
The Civil Grand Jury finds that military veterans are currently served by a core committed team at the Riverside County Department of Veterans' Services. However, staffing and budgeting constraints have hampered the team’s capacity to connect veterans to the many resources available at State and Federal Veterans Administration.
Related Recommendations (1)
R6:
Though Riverside County has expanded its trainer base for Frontline and Gatekeeper training (ASIST50, 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 suicides during home visits and County detention center mental health program intake. Based on Finding(s): F2, F3, F6, F7, F8 Financial Impact: Minimal Implementation Date: March 31, 2024
F7:
The Civil Grand Jury finds that a telephone behavioral health assessment could be an effective approach for identifying and managing behavioral health issues in older adults, perhaps paving the way for alternative ways to seeking and receiving mental health help among the homebound.49
Related Recommendations (1)
R7:
The Civil Grand Jury recommends the Board of Supervisors and Riverside County of Education partner to: 1. Collect more delineated Riverside County specific suicide data. 2. Continue to place more mental health care services in school and community settings. 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 with the Los Angeles County call center to improve 988 service to Riverside County residents. Based on Finding(s): F1, F3, F4, F5, F8 Financial Impact: Moderate Implementation Date: September 30, 2023
F8:
The Civil Grand Jury finds that services to the LGBTQIA+ population exist in a patchwork fashion and mostly through non-profit agencies. A more visible and focused strategy at the County level is not apparent.
Additional Recommendations
1
Not linked to specific findings.
R19-24:
years of age. The latest CDC report also confirms ongoing and extreme distress among teens who identify as lesbian, gay, bisexual, or questioning. The report also found more than half (52%) of LGBTQIA+ students had recently experienced poor mental health, more than 1 in 5 (22%) attempted suicide in the past year, with particularly stark increases of harmful experiences among teen girls: • Nearly 1 in 3 (30%) seriously considered attempting suicide – up nearly 60% from a decade ago • 1 in 5 (18%) experienced sexual violence in the past year – up 20% since 2017, when CDC started monitoring this measure • More than 1 in 10 (14%) had been forced to have sex – up 27% since 2019 and the first increase since CDC began monitoring this measure • Compared to their counterparts, LGBTQIA+ youth and female youth reported greater levels of poor mental health; emotional abuse by a parent or caregiver; and having attempted suicide46 Palm Springs, Cathedral City, and Rancho Mirage are among the top 10 small cities in the nation with the most same sex households. Of that population, 65% have reported emotional and mental behavioral concerns in 2021. In the Inland Empire there are an estimated 27,000 transgender people and 82% have considered suicide in their lifetimes.47 45 From LGBT to LGBTQIA+: The evolving recognition of identity 46 New CDC data illuminate youth mental health threats during the COVID-19 pandemic 47 Community Health Needs Assessment Report, Desert Healthcare District and Foundation, September 2, 2021 19 In our investigation, services to the LGBTQIA+ population seem to be more robust in the Desert region of the County, or available via hotlines and websites. This network would be beneficial if it were replicated throughout the County. For a listing of County LGBTQIA+ suicide prevention and early intervention resources, refer to Appendix A8. Conclusion Given the data presented in this report, building life skills, such as coping and problem-solving skills, emotional regulation, conflict resolution, and critical thinking are important in protecting individuals from suicidal behaviors. Impulsiveness and aggressive behavior seem related to suicide. Furthermore, after one suicide attempt, another will likely follow within weeks, months or even up to two years. Currently, Riverside County suicide prevention services are attempting to meet the needs of this growing public health trend. • However, the dearth of county-specific data is a barrier to understanding the real impact of suicides and creates preventable challenges to service provision. Improving or expanding suicide prevention services does not guarantee that they will be used by the people most in need, nor increase the number of people who follow recommended referrals or treatment. • Accessibility is key. As a model for what works, it is recommended to enhance partnerships. It is paramount that counselors, social workers, health care providers, project managers, city council members, law enforcement, etc. come together and Riverside County’s Suicide Prevention Coalition have done just that, their first annual conference in October 2022, and quarterly meetings open to the public via zoom. • Gatekeeper training for teachers, coaches, clergy, emergency responders, primary and urgent care providers, and others in the community that have interactions with people who could be at risk for suicide, can lead to better and effective responses and guidance. • Suicides increase during economic recessions, so strengthening economic supports (i.e., unemployment, livable wages, medical benefits, housing, government subsidies, loan modifications, financial counselling) are vital. There are, nonetheless, reasons for optimism. • RUHS-BH continues to expand and enhance its 79 operational sites, 140 community based organizational sites, 100 school sites, and services to 60,000+ consumers per year. • In May 2022, California’s Governor announced $50 million for the establishment of the California Veterans Health Initiative (CVHI). The CVHI will deliver a comprehensive, coordinated statewide approach to ending veteran suicide by focusing on prevention, early intervention, and direct services to effectively combat the risk factors associated 20 with suicidal ideation. The CVHI will bolster awareness, outreach, and education efforts, as well as an increase capacity through coordinated support of the community-based systems of care. The Initiative consists of three main components, including: o Outreach and Education Campaign ($5 million). To address the risk factors associated with veteran suicide through an awareness campaign that educates veterans, stakeholders, partners, and the broader community on the knowledge, behaviors, and attitudes surrounding veteran suicide. The campaign will target prevention activities, and promote health and wellness. o Veteran Mental Health Support Network ($40 million). To expand access to mental healthcare for veterans and their families by supporting a network of veteran-specific mental health clinics throughout the state. Crisis intervention and treatment would be inclusive, equitable, and available to veterans regardless of age, period of service, type of service, discharge status, or disability rating. o Veteran Suicide Surveillance and Review Program ($5 million). To establish a multidisciplinary team of professionals and stakeholders focusing on the identification and collection of veteran specific suicide data. Additionally, the team will coordinate a statewide assessment of veteran’s mental health and provide recommendations on future prevention, intervention, and post- intervention strategies.48 • California’s Governor plans to build 1,200 small homes across the state for the homeless at a cost of $30 million (budget is inclusive of land, or rent of the land, construction, maintenance, etc.). Federal government requires cities to have shelter beds available before clearing out homeless encampments. FINDINGS F1: The Civil Grand Jury finds county-specific suicide data collection is deficient. Without local data, the extent of the problem is not clear and suicide prevention services and programs will not be appropriately designed. F2: The Civil Grand Jury finds two observations during this investigation: (1) Despite reasonable efforts to improve the design of forms and to establish single points of contact, citizens still perceive intake forms as cumbersome; and (2) Citizens expect governments to act proactively by initiating appropriate government services themselves, instead of relying on requests for services from users. Therefore, offering County residents the convenience of having multiple needs met in one physical location is a continuing need. California Veterans Health Initiative to Combat Suicide and Address Mental Health 21 F3: The Civil Grand Jury finds Riverside University Health System – Behavioral Health has significant partnerships with Riverside County agencies and community partners to serve the needs of County residents. F4: The Civil Grand Jury finds that 988, the newly established Suicide & Crisis Lifeline, diverts Riverside calls through the Los Angeles County call center. Upon identifying as a Riverside resident the caller is referred to a secondary number. Though interpretation into over 240 languages and dialects is marketed as available 24/7 with average time to be connected to an interpreter within 17 seconds, this was not our experience when requesting interpretation. F5: The Civil Grand Jury finds that the Riverside County Board of Supervisors Youth Commission and its five Youth Advisory Councils has the capacity through its relationship with schools and youth to advise the Board of Supervisors on youth suicide prevention. F6: The Civil Grand Jury finds that military veterans are currently served by a core committed team at the Riverside County Department of Veterans' Services. However, staffing and budgeting constraints have hampered the team’s capacity to connect veterans to the many resources available at State and Federal Veterans Administration. F7: The Civil Grand Jury finds that a telephone behavioral health assessment could be an effective approach for identifying and managing behavioral health issues in older adults, perhaps paving the way for alternative ways to seeking and receiving mental health help among the homebound.49 F8: The Civil Grand Jury finds that services to the LGBTQIA+ population exist in a patchwork fashion and mostly through non-profit agencies. A more visible and focused strategy at the County level is not apparent. RECOMMENDATIONS R1: The Civil Grand Jury recommends the Board of Supervisors support more delineated county-specific suicide data collection through Riverside County Epidemiology Program Evaluation and its community partners. Based on Finding(s): F1 Financial Impact: Moderate Implementation Date: June 30, 2024 49 Validation of telephone-based behavioral assessments in aging services clients. Yeates, Conwell, Epub 2017 Sep 20 22 R2: 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 benefit all residents in accessing healthcare, transportation, referrals, and services. Based on Finding(s): F1, F2, F3, F5, F6, F8 Financial Impact: Moderate Implementation Date: June 30, 2024 R3: 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 growth, 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). Based on Finding(s): F3, F5, F6, F7, F8 Financial Impact: Minor Implementation Date: December 31, 2023 R4: 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, Children’s Committee, Criminal Justice Committee, Housing Committee, Legislative Committee, Older Adult Integrated System of Care Committee, and Veteran’s 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. Based on Finding(s): F2, F3, F6, F7, F8 Financial Impact: Minimal Implementation Date: September 30, 2023 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. Based on Finding(s): F3 Financial Impact: Minor Implementation Date: March 31, 2024 23 R6: Though Riverside County has expanded its trainer base for Frontline and Gatekeeper training (ASIST50, 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 suicides during home visits and County detention center mental health program intake. Based on Finding(s): F2, F3, F6, F7, F8 Financial Impact: Minimal Implementation Date: March 31, 2024 R7: The Civil Grand Jury recommends the Board of Supervisors and Riverside County of Education partner to: 1. Collect more delineated Riverside County specific suicide data. 2. Continue to place more mental health care services in school and community settings. 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 with the Los Angeles County call center to improve 988 service to Riverside County residents. Based on Finding(s): F1, F3, F4, F5, F8 Financial Impact: Moderate Implementation Date: September 30, 2023 REQUIRED RESPONSES Pursuant to Penal Code §933(c) and §933.05, and Board of Supervisors policy A75, , F2, F3, F5, F6, F6, F7 R1, R2, R3, R6 • Housing Authority of the County of Riverside F2, F3 R2, R3, R4 • Riverside County Office on Aging F2, F3, F7 R2, R3, R4, R6 50 ASIST Suicide Prevention Training Program 24 • Riverside University Health System, Behavioral Health F2, F3, F4, F7, F8 R2, R3, R4, R5, R6, R7 • Riverside County Office of Education F4 R7 • Riverside County Department of Veterans' Services F2, F3, F4, F6 R2, R4, R6 • Riverside County Epidemiology Program Evaluation F1 R1 • Riverside University Health System, Behavioral Health Commission F2, F3, F7, F8 R2, R3, R4, R5, R6 Invited Responses • Desert AIDS Project (DAP) Health • Desert Healthcare District and Foundation
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Full Details →
Findings & Recommendations
8 findings
F1:
The Civil Grand Jury finds county-specific suicide data collection is deficient. Without local data, the extent of the problem is not clear and suicide prevention services and programs will not be appropriately designed.
Related Recommendations (1)
R1:
The Civil Grand Jury recommends the Board of Supervisors support more delineated county-specific suicide data collection through Riverside County Epidemiology Program Evaluation and its community partners. Based on Finding(s): F1 Financial Impact: Moderate Implementation Date: June 30, 2024 49 Validation of telephone-based behavioral assessments in aging services clients. Yeates, Conwell, Epub 2017 Sep 20 22
F2:
The Civil Grand Jury finds two observations during this investigation: (1) Despite reasonable efforts to improve the design of forms and to establish single points of contact, citizens still perceive intake forms as cumbersome; and (2) Citizens expect governments to act proactively by initiating appropriate government services themselves, instead of relying on requests for services from users. Therefore, offering County residents the convenience of having multiple needs met in one physical location is a continuing need. California Veterans Health Initiative to Combat Suicide and Address Mental Health 21
Related Recommendations (1)
R2:
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 benefit all residents in accessing healthcare, transportation, referrals, and services. Based on Finding(s): F1, F2, F3, F5, F6, F8 Financial Impact: Moderate Implementation Date: June 30, 2024
F3:
The Civil Grand Jury finds Riverside University Health System – Behavioral Health has significant partnerships with Riverside County agencies and community partners to serve the needs of County residents.
Related Recommendations (1)
R3:
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 growth, 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). Based on Finding(s): F3, F5, F6, F7, F8 Financial Impact: Minor Implementation Date: December 31, 2023
F4:
The Civil Grand Jury finds that 988, the newly established Suicide & Crisis Lifeline, diverts Riverside calls through the Los Angeles County call center. Upon identifying as a Riverside resident the caller is referred to a secondary number. Though interpretation into over 240 languages and dialects is marketed as available 24/7 with average time to be connected to an interpreter within 17 seconds, this was not our experience when requesting interpretation.
Related Recommendations (1)
R4:
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, Children’s Committee, Criminal Justice Committee, Housing Committee, Legislative Committee, Older Adult Integrated System of Care Committee, and Veteran’s 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. Based on Finding(s): F2, F3, F6, F7, F8 Financial Impact: Minimal Implementation Date: September 30, 2023
F5:
The Civil Grand Jury finds that the Riverside County Board of Supervisors Youth Commission and its five Youth Advisory Councils has the capacity through its relationship with schools and youth to advise the Board of Supervisors on youth suicide prevention.
Related Recommendations (1)
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. Based on Finding(s): F3 Financial Impact: Minor Implementation Date: March 31, 2024 23
F6:
The Civil Grand Jury finds that military veterans are currently served by a core committed team at the Riverside County Department of Veterans' Services. However, staffing and budgeting constraints have hampered the team’s capacity to connect veterans to the many resources available at State and Federal Veterans Administration.
Related Recommendations (1)
R6:
Though Riverside County has expanded its trainer base for Frontline and Gatekeeper training (ASIST50, 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 suicides during home visits and County detention center mental health program intake. Based on Finding(s): F2, F3, F6, F7, F8 Financial Impact: Minimal Implementation Date: March 31, 2024
F7:
The Civil Grand Jury finds that a telephone behavioral health assessment could be an effective approach for identifying and managing behavioral health issues in older adults, perhaps paving the way for alternative ways to seeking and receiving mental health help among the homebound.49
Related Recommendations (1)
R7:
The Civil Grand Jury recommends the Board of Supervisors and Riverside County of Education partner to: 1. Collect more delineated Riverside County specific suicide data. 2. Continue to place more mental health care services in school and community settings. 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 with the Los Angeles County call center to improve 988 service to Riverside County residents. Based on Finding(s): F1, F3, F4, F5, F8 Financial Impact: Moderate Implementation Date: September 30, 2023
F8:
The Civil Grand Jury finds that services to the LGBTQIA+ population exist in a patchwork fashion and mostly through non-profit agencies. A more visible and focused strategy at the County level is not apparent.
Additional Recommendations
1
Not linked to specific findings.
R19-24:
years of age. The latest CDC report also confirms ongoing and extreme distress among teens who identify as lesbian, gay, bisexual, or questioning. The report also found more than half (52%) of LGBTQIA+ students had recently experienced poor mental health, more than 1 in 5 (22%) attempted suicide in the past year, with particularly stark increases of harmful experiences among teen girls: • Nearly 1 in 3 (30%) seriously considered attempting suicide – up nearly 60% from a decade ago • 1 in 5 (18%) experienced sexual violence in the past year – up 20% since 2017, when CDC started monitoring this measure • More than 1 in 10 (14%) had been forced to have sex – up 27% since 2019 and the first increase since CDC began monitoring this measure • Compared to their counterparts, LGBTQIA+ youth and female youth reported greater levels of poor mental health; emotional abuse by a parent or caregiver; and having attempted suicide46 Palm Springs, Cathedral City, and Rancho Mirage are among the top 10 small cities in the nation with the most same sex households. Of that population, 65% have reported emotional and mental behavioral concerns in 2021. In the Inland Empire there are an estimated 27,000 transgender people and 82% have considered suicide in their lifetimes.47 45 From LGBT to LGBTQIA+: The evolving recognition of identity 46 New CDC data illuminate youth mental health threats during the COVID-19 pandemic 47 Community Health Needs Assessment Report, Desert Healthcare District and Foundation, September 2, 2021 19 In our investigation, services to the LGBTQIA+ population seem to be more robust in the Desert region of the County, or available via hotlines and websites. This network would be beneficial if it were replicated throughout the County. For a listing of County LGBTQIA+ suicide prevention and early intervention resources, refer to Appendix A8. Conclusion Given the data presented in this report, building life skills, such as coping and problem-solving skills, emotional regulation, conflict resolution, and critical thinking are important in protecting individuals from suicidal behaviors. Impulsiveness and aggressive behavior seem related to suicide. Furthermore, after one suicide attempt, another will likely follow within weeks, months or even up to two years. Currently, Riverside County suicide prevention services are attempting to meet the needs of this growing public health trend. • However, the dearth of county-specific data is a barrier to understanding the real impact of suicides and creates preventable challenges to service provision. Improving or expanding suicide prevention services does not guarantee that they will be used by the people most in need, nor increase the number of people who follow recommended referrals or treatment. • Accessibility is key. As a model for what works, it is recommended to enhance partnerships. It is paramount that counselors, social workers, health care providers, project managers, city council members, law enforcement, etc. come together and Riverside County’s Suicide Prevention Coalition have done just that, their first annual conference in October 2022, and quarterly meetings open to the public via zoom. • Gatekeeper training for teachers, coaches, clergy, emergency responders, primary and urgent care providers, and others in the community that have interactions with people who could be at risk for suicide, can lead to better and effective responses and guidance. • Suicides increase during economic recessions, so strengthening economic supports (i.e., unemployment, livable wages, medical benefits, housing, government subsidies, loan modifications, financial counselling) are vital. There are, nonetheless, reasons for optimism. • RUHS-BH continues to expand and enhance its 79 operational sites, 140 community based organizational sites, 100 school sites, and services to 60,000+ consumers per year. • In May 2022, California’s Governor announced $50 million for the establishment of the California Veterans Health Initiative (CVHI). The CVHI will deliver a comprehensive, coordinated statewide approach to ending veteran suicide by focusing on prevention, early intervention, and direct services to effectively combat the risk factors associated 20 with suicidal ideation. The CVHI will bolster awareness, outreach, and education efforts, as well as an increase capacity through coordinated support of the community-based systems of care. The Initiative consists of three main components, including: o Outreach and Education Campaign ($5 million). To address the risk factors associated with veteran suicide through an awareness campaign that educates veterans, stakeholders, partners, and the broader community on the knowledge, behaviors, and attitudes surrounding veteran suicide. The campaign will target prevention activities, and promote health and wellness. o Veteran Mental Health Support Network ($40 million). To expand access to mental healthcare for veterans and their families by supporting a network of veteran-specific mental health clinics throughout the state. Crisis intervention and treatment would be inclusive, equitable, and available to veterans regardless of age, period of service, type of service, discharge status, or disability rating. o Veteran Suicide Surveillance and Review Program ($5 million). To establish a multidisciplinary team of professionals and stakeholders focusing on the identification and collection of veteran specific suicide data. Additionally, the team will coordinate a statewide assessment of veteran’s mental health and provide recommendations on future prevention, intervention, and post- intervention strategies.48 • California’s Governor plans to build 1,200 small homes across the state for the homeless at a cost of $30 million (budget is inclusive of land, or rent of the land, construction, maintenance, etc.). Federal government requires cities to have shelter beds available before clearing out homeless encampments. FINDINGS F1: The Civil Grand Jury finds county-specific suicide data collection is deficient. Without local data, the extent of the problem is not clear and suicide prevention services and programs will not be appropriately designed. F2: The Civil Grand Jury finds two observations during this investigation: (1) Despite reasonable efforts to improve the design of forms and to establish single points of contact, citizens still perceive intake forms as cumbersome; and (2) Citizens expect governments to act proactively by initiating appropriate government services themselves, instead of relying on requests for services from users. Therefore, offering County residents the convenience of having multiple needs met in one physical location is a continuing need. California Veterans Health Initiative to Combat Suicide and Address Mental Health 21 F3: The Civil Grand Jury finds Riverside University Health System – Behavioral Health has significant partnerships with Riverside County agencies and community partners to serve the needs of County residents. F4: The Civil Grand Jury finds that 988, the newly established Suicide & Crisis Lifeline, diverts Riverside calls through the Los Angeles County call center. Upon identifying as a Riverside resident the caller is referred to a secondary number. Though interpretation into over 240 languages and dialects is marketed as available 24/7 with average time to be connected to an interpreter within 17 seconds, this was not our experience when requesting interpretation. F5: The Civil Grand Jury finds that the Riverside County Board of Supervisors Youth Commission and its five Youth Advisory Councils has the capacity through its relationship with schools and youth to advise the Board of Supervisors on youth suicide prevention. F6: The Civil Grand Jury finds that military veterans are currently served by a core committed team at the Riverside County Department of Veterans' Services. However, staffing and budgeting constraints have hampered the team’s capacity to connect veterans to the many resources available at State and Federal Veterans Administration. F7: The Civil Grand Jury finds that a telephone behavioral health assessment could be an effective approach for identifying and managing behavioral health issues in older adults, perhaps paving the way for alternative ways to seeking and receiving mental health help among the homebound.49 F8: The Civil Grand Jury finds that services to the LGBTQIA+ population exist in a patchwork fashion and mostly through non-profit agencies. A more visible and focused strategy at the County level is not apparent. RECOMMENDATIONS R1: The Civil Grand Jury recommends the Board of Supervisors support more delineated county-specific suicide data collection through Riverside County Epidemiology Program Evaluation and its community partners. Based on Finding(s): F1 Financial Impact: Moderate Implementation Date: June 30, 2024 49 Validation of telephone-based behavioral assessments in aging services clients. Yeates, Conwell, Epub 2017 Sep 20 22 R2: 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 benefit all residents in accessing healthcare, transportation, referrals, and services. Based on Finding(s): F1, F2, F3, F5, F6, F8 Financial Impact: Moderate Implementation Date: June 30, 2024 R3: 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 growth, 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). Based on Finding(s): F3, F5, F6, F7, F8 Financial Impact: Minor Implementation Date: December 31, 2023 R4: 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, Children’s Committee, Criminal Justice Committee, Housing Committee, Legislative Committee, Older Adult Integrated System of Care Committee, and Veteran’s 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. Based on Finding(s): F2, F3, F6, F7, F8 Financial Impact: Minimal Implementation Date: September 30, 2023 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. Based on Finding(s): F3 Financial Impact: Minor Implementation Date: March 31, 2024 23 R6: Though Riverside County has expanded its trainer base for Frontline and Gatekeeper training (ASIST50, 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 suicides during home visits and County detention center mental health program intake. Based on Finding(s): F2, F3, F6, F7, F8 Financial Impact: Minimal Implementation Date: March 31, 2024 R7: The Civil Grand Jury recommends the Board of Supervisors and Riverside County of Education partner to: 1. Collect more delineated Riverside County specific suicide data. 2. Continue to place more mental health care services in school and community settings. 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 with the Los Angeles County call center to improve 988 service to Riverside County residents. Based on Finding(s): F1, F3, F4, F5, F8 Financial Impact: Moderate Implementation Date: September 30, 2023 REQUIRED RESPONSES Pursuant to Penal Code §933(c) and §933.05, and Board of Supervisors policy A75, , F2, F3, F5, F6, F6, F7 R1, R2, R3, R6 • Housing Authority of the County of Riverside F2, F3 R2, R3, R4 • Riverside County Office on Aging F2, F3, F7 R2, R3, R4, R6 50 ASIST Suicide Prevention Training Program 24 • Riverside University Health System, Behavioral Health F2, F3, F4, F7, F8 R2, R3, R4, R5, R6, R7 • Riverside County Office of Education F4 R7 • Riverside County Department of Veterans' Services F2, F3, F4, F6 R2, R4, R6 • Riverside County Epidemiology Program Evaluation F1 R1 • Riverside University Health System, Behavioral Health Commission F2, F3, F7, F8 R2, R3, R4, R5, R6 Invited Responses • Desert AIDS Project (DAP) Health • Desert Healthcare District and Foundation
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Findings & Recommendations
4 findings
F1:
Patients remaining on ambulance gurneys experience extended delays prior to transfer of care. This is common at most hospital emergency departments in Riverside County.
Related Recommendations (1)
R1:
Riverside County Board of Supervisors to review, approve, and support programs, including telehealth and Safety-Net Ambulance Programs, throughout Riverside County to alleviate ambulance patient off load delays as recommended by EMS and Riverside County Fire Department. Finding 1, Finding 2, Finding 4 Financial impact: minimal to moderate, ~$200,000 per “fully stocked” Safety-Net Ambulance Program Time frame: by June 30, 2024
F2:
When ambulances and fire personnel experiencing ambulance patient offload delays (APOD), the dispatch system has fewer available ambulances and fire vehicles for response to 9-1-1 calls. This is a public safety issue.
Related Recommendations (1)
R2:
EMS to encourage and facilitate other hospitals in Riverside County to systematically work with REMSA to implement improvements similar to Riverside University Health Systems (RUHS) and other high-performing hospitals using “best practices”, to decrease APOD at the hospital emergency departments. Finding 1, Finding 3 16 Financial impact: minimal to moderate Time frame: by June 30, 2024
F3:
Riverside University Health System (RUHS), as well as other Riverside County high performing hospitals, have assessed and implemented improvements necessary for their hospital emergency department, specifically to reduce their time of APOD.
Related Recommendations (1)
R3:
As an interim solution, Riverside County Fire Department and AMR to utilize available personnel to relieve delayed fire and/or ambulance teams at the hospital emergency departments. The goal is for efficient transfer of care of the patient to the hospital emergency departments while releasing the emergency vehicles for the next 9-1- 1 call. Finding 1, Finding 2, Finding 3 Financial impact: minimal to moderate Time frame: by June 30, 2024
F4:
Many professional organizations, county departments, and state government have investigated and reported on the issues of APOD (delays over 30 minutes at a hospital emergency department prior to the transfer of care). These efforts, while commendable, have not resolved the delays at all Riverside County hospitals.
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Findings & Recommendations
2 findings
F7:
The Civil Grand Jury finds that a telephone behavioral health assessmenl could be an
F8:
The Civil Grand Jury finds that services to the LGBTQIA+ population exist in a
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Findings & Recommendations
5 findings
F1:
Partially disagree RUHS-Public Health (RUHS-PH) has a demonstrated history of using local data and community collaboration to guide the development of suicide prevention and other public health programs. RUHS-PH acknowledges the existence of data gaps and limitations, particularly in certain historically underserved populations such as LGBTQ+. To address data gaps and limitations, RUHS-PH is developing an action plan to enhance data collection in an effort to better prevent suicides in the County. The California Department of Public Health Office of Suicide Prevention recently awarded RUHS-PH 54.1 million for a two-year project for RUHS to address suicide reporting and response. The grant calls for, among other goals, enhanced suicide surveillance, expanding suicide risk screening in schools, community-level crisis response, and developing a suicide data dashboard to disseminate timely and actionable data to stakeholders in Riverside County, updated monthly. RUHS-PH will use this additional information to inform the design of existing and future services and programs. GRAND JURY
F2:
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
F3:
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.
F7:
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.
F8:
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
Additional Recommendations
5
Not linked to specific findings.
R2:
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.
R3:
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.
R4:
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.
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 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.
R6:
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: Response to
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F2:
The Civil Grand Jury finds lwo observations during this investigation:
F3:
The Civil Grand Jury finds Riverside University Health System - Behavioral Health
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