Sonoma County Behavioral Health Board Meeting on Oct 21st

Short Summary of a presentation at the Sonoma County Behavioral Health Board meeting on 10/21/25

A review of California’s mental health data to address care disparities and improve community access.

Long Summary

The Board heard a presentation on mental health service disparities in California, using a CalMHSA data dashboard. The discussion highlighted challenges with data inconsistencies and access to care in Sonoma County, particularly for Asian, Pacific Islander, and native communities due to stigma and language barriers. The conversation also covered funding strategies, community outreach, and a call for more personal stories to better illustrate how individuals navigate the mental health system.

Data Analysis and Disparities

The California Mental Health Services Authority (CalMHSA) created a data dashboard to compare mental health measures across California’s 58 counties. According to 2023 data from the CalMHSA workbook, Sonoma County is performing poorly on the “access to care” measure. The data is based on claims submitted by the county to the state. Disparities in care were identified across different demographic groups and ethnicities. Data for small populations, such as Asian, Pacific Islander, Alaskan Native, and American Indian communities, is sometimes suppressed, making analysis difficult.

Access to Care Challenges

The county’s rate for access to care is below the statewide average, based on 2020-2021 data. Specific groups show very low service penetration rates: Alaskan Natives have a rate of 1.7%. Asian or Pacific Islanders have the lowest rate at 1%. Barriers to accessing care include: Cultural stigma around mental health treatment, especially within Asian Pacific Islander communities. Language barriers, such as a lack of Spanish-speaking staff at service locations.

Strategies and Funding

Best practices to support BIPOC communities are being implemented: Coordinated specialty care for individuals experiencing a first episode of psychosis. Community outreach events to inform residents about available services. Funding to address access to care goals will primarily come from: Behavioral health services and supports.

Full-service partnerships.

State-level funding from Prop 1 is allocated for workforce training and development, and the state is seeking local input on its use. A contractor provides support for staff in crisis situations, such as those on the mobile support team and at the crisis stabilization unit.

Patient Pathways

A request was made for more concrete examples of an individual’s journey through the mental health system. Three primary pathways for accessing care were outlined: Through an individual’s private insurance. By contacting the county’s access teams, which serve as the “front door” to services. It was suggested that a future meeting could feature individual stories to better illustrate how the system works on a personal level.

Short Summary of Sonoma County Behavioral Health Board Meeting on 10/21/25

The meeting began with a discussion about fixing communication issues.

Long Summary

Significant frustration was expressed regarding poor communication and the difficult onboarding process for new members. The group discussed proposals to improve orientation and to be more involved in vetting new recruits, highlighting a clear disconnect with the appointing authority.

Review of Progress

The Chair’s report was noted as being brief. The board reviewed current vacancies by district:

District 3: One vacancy. District 4: Two vacancies. District 5: Two vacancies.

Key Achievements

The board website has been updated. All new members and the latest minutes are now available on the website.

Challenges and Adjustments Needed

Significant frustration was expressed regarding the lack of communication and support for new board members. New members reported confusion over meeting schedules, specifically regarding a canceled August meeting that was then held. There have been difficulties with basic orientation, such as obtaining name tags and understanding procedures. A systemic issue was identified with the board’s inability to meet with prospective members before their appointment. The board feels this prevents them from setting clear expectations and providing a proper orientation. There is a conflict with a higher authority regarding the board’s role in the member appointment process, with the board feeling they are being excluded.

Action Items and Accountability for the Week Ahead

A member will contact ISD to correct a website error where a former co-chair is still listed. A motion was made and seconded to take formal action to address the board’s lack of involvement in the member appointment process. It was suggested that the group co-sign and send a letter to the County Board of Supervisors. The letter would advocate for the board’s involvement in recruiting and orienting prospective members.

Board Communication and Onboarding Issues

Board members expressed significant frustration over systemic communication failures. New members reported not receiving notifications for meetings, leading to confusion and missed sessions. Onboarding processes are lacking, with members struggling to get name tags or find sign-in sheets.

The board website had outdated information and was missing meeting minutes, though steps are being taken to resolve this with the IT department. A strong desire was voiced for the board to participate in the recruitment and orientation of new members to set expectations early. A consensus was reached to communicate again with the Board of Supervisors to assert their role in the appointment process, which is currently a point of contention.

Meeting Logistics and Technology

A discussion was held on whether to hold meetings in a consistent central location or rotate them through different geographical areas to engage local communities. Recurring technology failures, including issues with Wi-Fi and audio during the current meeting, highlighted the need for a reliable setup. A motion passed to adopt a hybrid approach: Meetings will be held at a consistent, central location with robust technology for a reliable Zoom presence. Presentations will be varied by geographical area to ensure all parts of the county are represented. The November meeting will be held at 1450 Neotomas, a location with superior audiovisual capabilities.

Vice-Chair Election

After a previously nominated candidate resigned, a new election was held for the Vice-Chair position. Alexandra and Angelina were nominated as candidates. Following a vote, Alexandra was officially elected as the new Vice-Chair.

Behavioral Health Services Act (BHSA) Overview

A presentation detailed the transition from the Mental Health Services Act (MHSA) to the Behavioral Health Services Act (BHSA). The key difference is that BHSA is broader, officially including substance use disorders alongside mental health. Under MHSA, funds could not be used to treat someone with only a substance use disorder. The BHSA prioritizes services for the most vulnerable individuals.

BHSA Program and Funding Allocation

Sonoma County expects to receive approximately $38 million in annual BHSA funds for the upcoming three-year plan. Funding is divided into several main categories:

Housing (30% / $11.4M): Half of these funds must be dedicated to serving the chronically homeless. Will be used for rental subsidies, vouchers, deposits, and utility bills.

Full-Service Partnerships (FSP) (35%):

Mandated programs for four age groups: children/youth, transitional-aged youth (18-25), adults, and older adults. Will continue specialty programs like Forensic Assertive Community Treatment (FACT).

Early Intervention & Prevention (51% of population-based funds):

Programs include the Youth Access Team, First Episode Psychosis treatment, Wraparound services for foster youth, and the Suicide Prevention Hotline.

The Integrated Plan

Counties are now required to submit a unified, three-year “integrated plan” for all behavioral health services. The Department of Healthcare Services (DHCS) has created a standardized template that all counties will use for this plan. The plan must account for all behavioral health funding streams, not just BHSA funds. It must address six state-mandated goals, including improving access to care and reducing homelessness, institutionalization, and justice involvement. Sonoma County has chosen to add suicide prevention as a seventh local goal due to higher-than-average rates in the area.

Measure O Meeting on August 20th

Short Summary of a meeting of the Measure O Oversight Committee on August 20th

County officials discussed severe funding cuts impacting behavioral health and homelessness services,highlighting critical financial challenges.

Long Summary

The conversation delved into the precarious financial state of Sonoma County’s behavioral health and homelessness services. You heard about federal Medicaid cuts, dwindling local funds, and the critical role of Measure O. Officials expressed nervousness about future reductions, the difficulty in predicting impacts, and the need for tough decisions, strategic partnerships, and community advocacy to maintain vital services amidst a “seismic shift” in healthcare funding.

Announcements

A $10 million Notice of Funding Availability (NOFA), titled “Behavioral Health and Homelessness Pathways to Sustainability,” has been released to support existing programs facing funding loss. The deadline for proposals is September 17th, with a pre-bid conference scheduled for the following day. Marc, the former board chair of NAMI, is recommended to fill the vacant “lived experience” seat. His appointment will go to the Board of Supervisors for official approval on September 3rd. A new ad hoc committee, including Supervisor Gore and Supervisor Coursey, has been established to oversee Measure O funding and enhance collaboration with partners. The county’s homeless services unit is undergoing a leadership transition, with a plan to reorganize the team under the behavioral health department.

Key Achievements

The Crisis Stabilization Unit (CSU) has successfully addressed staffing shortages and is now almost fully staffed and operational. A successful QPR (Question, Persuade, Refer) suicide prevention training was delivered to counselors at Analy High School, increasing their confidence in addressing suicidal ideation. The Crestwood Healing Center, a 16-bed psychiatric health facility, is running effectively and has become a significant asset, reducing reliance on private hospitals. Measure O currently funds 58.33 employees who are delivering essential mental health and crisis services across the county.

Challenges and Adjustments Needed

Financial Uncertainty: The most significant challenge is the looming fiscal crisis due to anticipated federal cuts to Medicaid/Medi-Cal, described as a “seismic shift” in healthcare funding. The county’s Realignment fund balance is dwindling, and the projected Measure O ending balance of $7.1 million is causing significant concern among leadership.

Project and Funding Gaps:

The planned mental health unit at the county jail is stalled because the allocated $39 million is insufficient for current construction costs, and the state has not allowed for plan lterations. Many homeless and housing providers are in urgent need of financial support to sustain their operations.

Strategic Adjustments:

A reorganization is planned to move the homelessness team into the behavioral health department to leverage Medi-Cal billing and improve service integration. A strategic pivot is underway for homeless services to focus on residents with higher behavioral health needs. An allocation adjustment for the $10 million NOFA may be requested to direct more funds toward struggling homeless and housing providers.

Action Items and Accountability for the Week Ahead

The team will continue developing a data-driven proposal for a second psychiatric health facility to further reduce costs associated with private hospital placements. The leadership will continue its monthly meetings with the new ad hoc committee to provide updates on. Measure O and align on strategic priorities, including the preference for transparent NOFA processes. A plan is being formulated to “take the show on the road” to proactively inform community groups, mayors, and councils about Measure O’s impact and the upcoming financial challenges. The search for an interim and permanent leader for the homeless services team is actively underway.

Behavioral Health Transformation Beginning

Among the New Year’s obligations mandated by the voters of California are the requirements placed on counties to transform its planning and delivery of mental health and substance use disorder services. New expectations are in place to conduct countywide research involving a wide range of stakeholders to develop integrated global spending plans for the use of all county revenues.

Bringing together dozens of individual program efforts, authorized and monitored from many different state and federal initiatives stretching back many decades, this new Behavioral Health Services Act (Behavioral Health Transformation) reforms behavioral health funding to prioritize services for people of all ages with the most significant mental health needs while adding the treatment of substance use disorder (SUD), expending housing interventions, and increasing the behavioral health workforce. It also enhances oversight, transparency, and accountability at the state and local levels.

The Behavioral Health Services Act builds on many strategies to meet community needs for culturally responsive services that improve health and reduce health disparities for all, including:

Reducing the silos for planning and service delivery.
Requiring stratified data and strategies for reducing health disparities in planning, services, and outcomes.
Advancing community-defined practices as a key strategy for reducing health disparities and increasing diverse community representation.

Sonoma County, through its Department of Health Services, will develop a Three-Year Integrated Plan, which must be developed in partnership with local stakeholders through a process that incudes meaningful stakeholder involvement in mental health and substance use disorder policy, program planning, and implementation, monitoring, workforce, quality improvement, health equity, evaluation, and budget allocations. Integrated Plans will include a demonstration of how the County will utilize various funds for behavioral health services to deliver high-quality, culturally responsive, and timely care along the continuum of services in the least restrictive setting from prevention and wellness in schools and other settings to community-based outpatient care, residential care, crisis care, acute care, and housing services and supports.

Three Local Funding Categories

Local behavioral health agencies are required to develop detailed plans for the use of BHSA funds in each of the following components, then submit those plans to the Behavioral Health Services Oversight and Accountability Commission (BHSOAC), and the CA Department of health Care Services (DHCS) for approval.

Housing Interventions
30% of local BHSA funding shall be dedicated to housing interventions for people living with serious mental illness/serious emotional disturbance and/or substance use disorder who are experiencing homelessness.
Funding can be used for thee full spectrum of housing services and supports, rental subsidies, operating subsidies, and non-federal share for Medi-Cal covered services, including clinically-enriched housing. Zit can also be used to further the California BHCONNECT.
Funding may also be used for capital development projects, subject to DHCS limits.
Full Service Partnerships
35% of the local assistance for Full Partnership (FSP) which should be optimized to leverage Medicaid as much as possible. FSPs include comprehensive and intensive care for people at any age with the most complex needs (also known as the “whatever it takes” model).
Behavioral Health Services and Supports (non-FSP) and Additional Components
35% for other services including Behavioral Health Services and Supports (non-FSP), Outreach & Engagement, Prevention and Early Intervention*, Capital Facilities and Technological Needs, Workforce Education and Training, and prudent reserve.

* A county shall utilize at least 51percent of Behavioral Health Services and Supports funding for early intervention programs and of that 51 percent, 51 percent must be allocated for early intervention programs to serve individuals who are 25 year of age and younger.

Behavioral Health Services Staffing Allocation Request to BOS on Dec 3rd

Recommended Action:

A) Adopt a personnel resolution amending the Department Allocation List of the Department of Health Services, adding 2.0 full-time equivalent Behavioral Health Clinician positions and 1.0 full-time equivalent Senior Client Support Specialist, effective December 3, 2024.

B) Adopt a Resolution authorizing budgetary adjustments to the fiscal year 2024-2025 adopted budget, increasing appropriations in the Department of Health Services by $468,207 to reflect revenue and expenditures associated with the requested position allocations.

(4/5th Vote Required)

Executive Summary:

As part of our response the California Department of Health Care Services’ Corrective Action Plan, Department of Health Services (DHS) management requests the addition of 2.0 full-time equivalent (FTE) Behavioral Health Clinician position allocations for the Behavioral Health Adult Access Team (not to be confused with ACCESS – Accessing Coordinated Care and Empowering Self Sufficiency – which is a separate program of the same name located in the Homelessness Services Division). These positions will provide Behavioral Health Assessments, case-management, and referrals for clients requesting services through the Access Team.

Additionally, the Youth and Family Services section of the Behavioral Health division within DHS is requesting approval from the Board to add 1.0 FTE Senior Client Support Specialist (SCSS) to staff the mandated Child and Family Team Meetings for youth who qualify for Intensive Care Coordination and Intensive Home-Based Services. These positions will leverage Medi-Cal Federal Financial Participation and Medi-Cal Administrative Activities, with approximately 50% matching funds provided by the Mental Health Services Act (MHSA).

Discussion:

Access Team – 2.0 FTE Behavioral Health Clinicians

The Behavioral Health Adult Access Team under the Adult Services unit is the first contact for clients requesting mental health services and are responsible for providing initial assessment and case-management services for clients requesting services with Behavioral Health. Access team assessors determine the level of need for mental health services, provide assessment, linkage, and information and referral for mental health services for children, youth, and adults. Clients qualify for different levels of care based upon these assessments.

The California Department of Health Care Services (DHCS) requires that the initial service appointment for new clients be offered within 10 business days of request. The current volume of requests has exceeded the existing capacity of the assessors and is resulting in timeliness issues, with some requestors waiting 6 weeks for their initial assessment. DHCS issued a Corrective Action Plan (CAP) on 4/26/23 regarding this issue during DHS’ last annual network certification; but despite adding additional 1.5 FTE of case-management coverage on the team in the Spring of 2024, the volume continues to exceed assessor capacity. DHCS issued a new CAP finding on 10/7/24, identifying timeliness to services as the leading issue.

Additionally, DHS has been approved to implement the Drug Medi-Cal Organized Delivery System (DMC-ODS) waiver starting in December. Based upon feedback from other bay-area counties, DHS anticipates an initial 50% increase in request volume that will taper off within the first quarter to an average of an ongoing 25% increase in request volume. Currently there are 5.0 Assessor FTEs on the Access Team, and 2.0 Senior Client Support Specialist FTE (to perform case-management). Each Assessor FTE can handle 20 new Assessments per month, plus a 30-member ongoing caseload. The current volume of inquiries is 200 per month, with 75% resulting in Assessment; and is anticipated to increase to an ongoing 175-200 Assessments needed per month after DMC-ODS. As such, DHS is requesting the addition of 2.0 FTE Behavioral Health Clinicians to improve the current wait time concerns, as well as in anticipation of the ongoing increase resulting from DMC-ODS.

This request is also responsive to the programmatic changes necessitated by the California Advancing and Innovating Medi-Cal (CalAIM) directives and the expansion of Substance Use Disorder Services through DMC-ODS.

Behavioral Health Clinicians perform duties which include, but are not limited to, the following: conduct comprehensive assessments to diagnose mental health conditions; develop treatment plans to authorize and guide specialty mental health services; provide emergency interventions in the field; provide a variety of case management and therapeutic support services to clients; may provide transportation, placement assistance, advocacy, and skills coaching for activities of daily living and other client support services; collaborate with other client-serving agencies to ensure the most supportive environment for each client; and perform related duties as required.

Youth and Family Services – 1.0 FTE Senior Client Support Specialist

Child and Family Teams (CFTs) within the Youth and Family Services section of the Behavioral Health division within DHS bring together loved ones and experts to support the child in reaching their potential and are dedicated to helping the family thrive. CFTs draw on a child’s and family’s strengths, experiences, knowledge, and network of support to create a plan for the safety, stability, and well-being of the children and family. The CFT process is intended to be inclusive of multiple formal support systems a family may need, as well as the informal, community, and natural supports that surround a family. CFTs are a required service for foster youth meeting the Katie A subclass, and for children who screen as qualifying for Intensive Care Coordination and Intensive Home-Based Services. These children are the higher needs children serviced by our system, many of whom are involved in multiple systems such as Behavioral Health, Child Welfare, or Juvenile Probation.

DHS is currently on a 2021 Corrective Action Plan with DHCS because the division is not facilitating any Child and Family Team Meetings for youth who qualify for Intensive Care Coordination and Intensive Home-Based Services.

These services are mandated by DHCS as part of the Mental Health Plan, and provide required and mandated Early and Periodic Screening, Diagnostic and Treatment services to youth. DHS has never had staff to provide this requirement. Youth and Family Services will need to provide approximately 1,600 CFTs per year. 1.0 FTE SCSS can provide approximately 350 CFTs per year.

There are not currently any staff available to provide these required and mandated services. Adding this 1.0 FTE SCSS will bring the total SCSS allocated to Youth and Family Services to 2.0 FTE (the second FTE is an underfill using an existing position) and will enable Youth and Family Services to begin providing the required services to children, including foster youth and youth on our Full Service Partnerships; the Family Advocacy, Stabilization and Support Team; and Transitional Age Youth. These 2.0 FTE SCSS will be able to provide close to half the required CFTs. DHS is planning to request addition staff next fiscal year to address the shortfall.