Tag: health

Sonoma County’s HealthCare Crossroads

Short Summary

A forum on the major threats facing healthcare access for the Latino community in Sonoma County was held on November 14th.

Long Summary

At the Los Cien Health Care Forum, where leaders discussed dire threats to community healthcare. Keynote speaker Francisco J. Silva detailed how federal policies like HR 1 and a state ballot initiative could devastate Medi-Cal and community clinics, disproportionately impacting Latino families. A panel of local health leaders reinforced the urgency, discussing the local impact of these cuts, the rise in uninsured patients, and the strain on services. The core message was a call for unified community action to protect the healthcare safety net.

Membership and Business Support

A membership program has been relaunched after being closed for reimagining. A dedicated email about membership will be sent, including a link to join online. A new non-profit and business directory is being developed to provide a trusted list of services. There is a focus on creating programs to support business owners and professionals inclusively, rather than forming a formal business chamber.

Los Cien Health Care Forum

The event began with a welcome by Herman G. Hernandez, Executive Director of Los Cien. Acknowledgments were given to partners, including the Luther Burbank Center, and the design team volunteers. The BRIDGE alumni program (Building Representation, Inclusion, Diversity, and Governance Excellence) was recognized. A tribute was paid to Rick Nolan, the retired CEO of the Luther Burbank Center, for his decade-long partnership and support of the Latinx community.

Keynote on Threats to California Healthcare

Keynote speaker Francisco J. Silva, CEO of the California Primary Care Association, discussed major challenges facing healthcare.

Impact on Latino Communities:

Cuts to Medi-Cal and community health centers are direct cuts to the Latino community, as they form the largest group of enrollees and patients.

Federal HR 1 Impacts:

This federal law represents a significant rollback of Medicaid access. It imposes work requirements and frequent eligibility hurdles. Nationally, it could cut $1 trillion from Medicaid and strip $32 billion from community health centers. In California, it is estimated that 1-3 million people could lose Medi-Cal coverage.

State-Level Cuts:

State proposals aim to limit Medi-Cal for undocumented immigrants by freezing enrollment and introducing a $30 monthly premium. These changes threaten the “Health Care for All” progress made in the state.SEIU UHHW Ballot Initiative. A statewide ballot initiative filed by SEIU UHHW is described as the “most dangerous attack on community health centers in California history.” An independent analysis projects the initiative would: Divert $1.7 billion from patient care into penalties; Push a majority of clinics into financial deficit, with 47% at risk of closure; Force cuts to enabling services like translation, transportation, and community health worker programs. The public is urged to read petitions carefully and understand that this measure could cripple the healthcare safety net.

Local Impact in Sonoma County

One in three residents of Sonoma County (approximately 140,000 people) is on Medi-Cal. Proposed policy changes will double the county’s administrative workload for recertifications while simultaneously cutting its caseload-based funding. The cost of uncompensated care will financially impact everyone, from private employers to public services. Safety-net providers are already seeing an increase in patients, with the Jewish Community Free Clinic reporting a 25% rise in the last 60 days. There is a growing level of fear among patients, with some rationing visits or hesitating to seek care due to immigration concerns.

Community Collaboration and Response

Sonoma County’s healthcare leaders are working together to create solutions for the impending crisis. The community is advised to seek information from trusted sources like 211, OpenDoorsSC.com, and local health organizations to combat misinformation. Health centers affirmed that they do not ask for or share patient immigration status with government agencies. Partnerships are key, with organizations like Kaiser Permanente investing in community health grants and housing projects based on shared needs assessments.

Behavioral Health Crisis

The panel highlighted a severe and worsening crisis in behavioral and mental health. There is a critical shortage of services, clinicians, beds, and facilities for all populations, not just those on Medi-Cal. The county’s behavioral health system currently has a waitlist of over 500 people for its high-need services. This crisis existed before the current policy threats and is expected to be exacerbated by them.

Call to Action

Leaders emphasized that local action is critical, as federal and state support is no longer reliable. The community is called to get involved, advocate, and hold legislators accountable. Local control over funding through measures like Measure O is crucial for sustaining services. Training future healthcare professionals within the community is a key strategy, as many tend to stay and practice where they train.

Sonoma DHS Homeless Revamping Workshop, Oct 23rd

Short Summary

You participated in a feedback session on the county’s new vision for homeless services.

Long Summary

The meeting was called by the Department of Health Services feedback session where new leadership, Nolan Sullivan and Desirae

Olstrom, unveiled a revamped strategy to address homelessness. They proposed a “funnel” system using county facilities to support individuals with high-acuity behavioral health needs. The majority of the meeting was dedicated to gathering your and other partners’ feedback on this new model, identifying systemic gaps, and discussing the need for better collaboration, data transparency, and a unified system of care.

The problem

The Department of Health Services is revamping its homeless services team and seeking feedback on a new vision to improve partnerships and service delivery. The county aims to address its historically siloed approach and open up its resources and processes for better collaboration. The primary focus of the new vision is the segment of the homeless population with high-acuity behavioral health and substance use needs, which is estimated to be 5-10% of the total 1,900 homeless residents. This group is often difficult to serve in traditional programs and can destabilize properties.

Themes discussion

A new “funnel” system was proposed by the county to create a continuum of care for high-acuity individuals. The pathway would move clients through a series of facilities with increasing levels of independence: 

  • Eliza’s Village: The entry point for stabilization.
  • Arrowwood: Single occupancy rooms with more services. 
  • Mickey Zane: Individual apartments to prepare for independent living.

The end goal is to graduate individuals back into the Coordinated Entry (CE) system for Permanent Supportive Housing (PSH).

A major concern raised was the large population that the county’s proposed funnel would not serve, leaving approximately 1,500 individuals for partner agencies to handle. This includes specific hard-to-house groups, such as arson (219) and sex offense (290) registrants, who are often screened out of existing housing options. The need for a single, unified system of care was a recurring theme, emphasizing the need to break down silos between county departments (e.g., Homelessness and Behavioral Health) and external partners. Data transparency and system functionality were highlighted as critical for building trust and enabling effective

collaboration. The current HMIS system is considered limited in its reporting capabilities. Resource constraints and funding limitations for the county, cities, and non-profit providers were an underlying issue throughout the discussion.

Specific ideas

Integrate county behavioral health staff directly with partner agencies and on-site at facilities. This “in-person handoff” is seen as extremely beneficial for navigating clients into services. 

  • Develop a centralized and transparent referral system for providers. This would allow agencies to submit referrals for high-needs clients and track their status. 
  • Provide a higher level of ongoing support for clients once they are in PSH. An Assertive Community Treatment (ACT) model was suggested for individuals who continue to need intensive services after being housed. 
  • Address the challenge of individuals who refuse services or are too ill to engage with support systems. 
  • Streamline the contracting and RFP process to reduce administrative burden. Suggestions included creating multi-year contracts and consolidating various city and county RFPs into a single cycle.

Future directions

  • The county should take on a lead role as a convener to bring together all stakeholders, including shelter providers, tribal entities, and cities, to address system-wide issues. 
  • One immediate project suggested was creating a coordinated emergency weather response plan. 
  • The group should develop a unified advocacy message to state legislators regarding restrictive funding and unfunded mandates.
  • A formal “gap analysis” is needed to inventory all existing services and providers in the county to identify where deficiencies lie.
  • The county will continue to refine its “funnel” model while considering the feedback on excluded populations and operational challenges, such as the remote location of Eliza’s Village. 
  • The county acknowledged the need to improve internal policies, noting they recently implemented a six-month time limit at facilities like Eliza’s Village to ensure client progression.

Measure I Citizens Advisory Council Meeting, Oct 23rd

Short Summary

The group refined and approved funding strategies for early childhood and community health initiatives.  It finalized early childhood support strategies, focusing on community-based care and inclusive language, ending with personal reflections.

Long Summary

The advisory council made final adjustments to strategic language for early childhood funding.  The group meticulously refined the language for early childhood funding strategies, deciding to prioritize local ‘place-based’ organizations and add ‘play-based’ approaches to mental health. It also discussed including license-exempt centers in future compensation models and creating a flexible scholarship model. The discussion emphasized supporting local providers and ensuring service availability before expanding screening.The session concluded with a successful vote to approve the amended strategies and 

reflections on the work’s impact and importance for the community.  The group expressed heartfelt reflections from members on the collaborative process, the importance of the work, and a shared 

sense of accomplishment and gratitude.

Members expressed humility, gratitude, and respect for the collaborative process and the work of early childhood educators.  The group acknowledged the significance of having funding and a community-driven process to support families, which is not a given everywhere.  Appreciation was extended to the staff for preparing materials that enabled detailed and productive conversations.

Review of Progress

The team met to finalize the language and allocations for several key strategies before a formal vote. The team reviewed and finalized funding strategies for a five-year plan, marking a significant milestone from the initial idea phase to an approved plan.  The discussion’s goal was to ensure the intent of the strategies was clearly captured, particularly for the development of future Requests for Proposals (RFPs).  Participants reflected on the progress made, from initial concepts to a voted-upon five-year plan, acknowledging it as a significant accomplishment for the county’s early childhood and health initiatives. Discussion centered on refining the language of the strategies to ensure the intent is clear for the Request for Proposals (RFP) process.  The overall progress was framed as a major accomplishment in supporting the county’s children and families, even while acknowledging that the funding is a “drop in the bucket” compared to the total need.

Key Achievements

The group successfully reached a consensus on several complex language changes after detailed discussion. The council successfully voted on and approved the proposed strategies and allocations with a series of amendments. A motion was passed to approve the strategic plan with all discussed amendments, marking a major milestone, to implement specific language changes across several strategies, finalizing the framework for future funding.

Challenges and Adjustments Needed

Provider Eligibility and Prioritization

A concern was raised about large, external organizations applying for funds instead of local providers who know the community.

It was suggested to explicitly call out both “new and existing service providers” to expand the field while prioritizing local expertise.

Broadening Strategy Language

The term “Family Resource Center” was deemed too restrictive. Several strategic adjustments were made to proposal language to ensure clarity and inclusivity:   Also included was the broader “place-based locations in neighborhoods” to include a wider range of trusted community organizations. The “sliding scale” language for family scholarships was questioned for not accounting for family expenses beyond income. The group moved toward the idea of “developing a model” to allow for more flexibility.

Clarifying Service Types

To ensure mental health services are not purely clinical, language was added to strategy 1A. The phrase “which could include play-based” was inserted after “mental health services” to emphasize the importance of play without being overly prescriptive.The group discussed the need to expand service capacity in tandem with developmental screenings to avoid causing anxiety for families whose children are identified as needing support.There was concern that increasing developmental screenings could cause family anxiety if corresponding intervention services are not available.

Compensation Model for ECE Providers

It was discussed whether legally license-exempt centers “will be considered” when the compensation model is determined, acknowledging the complexity of their full inclusion. The group debated whether legally licensed exempt centers should be “included” or “considered” for the new compensation model. The final decision was to use the language “will be considered when the compensation model is determined” to ensure they are part of the conversation without making a premature commitment.  A future process will be initiated to design the ECE compensation system, which will consider legally licensed exempt centers.

Several strategic adjustments were made to proposal language to ensure clarity and inclusivity: Added the phrase “which could include play-based” to the mental health services strategy to emphasize the importance of play without being overly prescriptive. Removed specific examples like “family literacy programs” to make the strategy for non-traditional early learning programs more general. 

Action Items and Accountability for the Week Ahead

Finalize Strategy 1A Language

Add “which could include play-based” after “mental health services” and before “and nutritional supports.”

Correct Strategy 2A Language

Add the word “and” to correct a grammatical error in the phrase “mobile and pop up clinical.”

Update ECE Strategy 1B

Remove specific program names to broaden the scope, changing the wording to “Invest in and elevate non-traditional early learning programs.”

Implement Approved Changes

Staff is accountable for incorporating all approved amendments into the official strategy documents that will guide the development of RFPs.

California Behavioral Health Planning Council Meeting on June 19, 2025, Housing and Homelessness Committee

Item #2 California Interagency Council on Homelessness (Cal ICH) Action Plan for 2025 – 2027 

Cody Zeger, Director of Statewide Policy at the California Interagency Council on Homelessness (Cal ICH), presented an overview of their 2025-2027 Statewide Action Plan to prevent and end homelessness. Cody began with a brief introduction to Cal ICH, which is responsible for overseeing the implementation of Housing First policies, guidelines, and regulations supported by an advisory committee and a lived-experience advisory board. 

Initially launched in 2020, Cal ICH’s Action Plan aims to coordinate state efforts to address homelessness with a vision of building an equitable and just California where homelessness is rare, brief, and a one-time experience. The 2025-2027 Action Plan focuses on the following five key goals: 

• Help more people leave unsheltered homelessness. 

• Help more people move into housing. 

• Ensure people do not experience homelessness again. 

• Prevent more people from experiencing homelessness. 

• Create more housing. 

Cody also presented the plan’s three-year targets: 

• Move 70% of unsheltered individuals into shelters. 

• Place 60% into permanent housing. 

• Create 1.5 million new housing units with 710,000 designated for low-income residents. 

He described key strategies to meet these goals such as interagency coordination, strategic investments, and equity-centered frameworks to address systemic barriers. Cody highlighted core principles that guide the plan, such as prioritizing racial equity, adopting trauma-informed approaches, and elevating the voices of those with lived experience of homelessness. 

Cody concluded his presentation and opened the floor for questions from committee members. Key topics included: 

• A committee member inquired about the size of the lived experience advisory board. Cody shared that Cal-ICH reduced its membership from 30 to approximately 25 members. Each member serves a two-year term. He explained that the board provides subject matter expertise, reviews key documents, and offers recommendations to Cal ICH members before key decisions. 

• A committee member raised concerns about the proposed 44% federal cuts to the U.S. Department of Housing and Urban Development (HUD), particularly their impact on project-based and tenant-based rental assistance. Cody acknowledged the risk, noting that 15,000 emergency housing vouchers are slated to expire. 

• A committee member asked how the number of homeless individuals aligns with the projected housing units. Cody explained that the 2.5 million planned units, including 1.5 million by 2027 and 710,000 reserved for low-income residents, are part of a broader housing strategy and not specifically designated for the homeless population. 

• A committee member asked how racial equity is reflected in the plan’s goals and data analysis. Cody emphasized Cal ICH’s commitment to disaggregating targets by race, ethnicity, and gender to ensure a more inclusive and equitable approach. 

• When asked about Cal ICH’s leverage in advancing the Action Plan, Cody described their statutory authority and stressed the importance of cross-agency relationships. He noted that their influence stems from formal power and their ability to communicate and coordinate across state departments. 

Public Comment: 

Paula, a member of the public, inquired about current data reflecting progress toward the plan’s three-year goal of a 42% increase in housing placements. Cody directed her to Cal ICH’s website, where quarterly updates provide the latest information. He noted that the most recent data covers the calendar year 2024. 

Barbara Wilson from Los Angeles County raised a question about tracking individuals moving from hospital settings to residential facilities, particularly those with psychosis. She was concerned about how these transitions are captured and whether individuals lose housing access once in licensed facilities. 

Council Member John Black emphasized the importance of early intervention, proposing the use of peer support workers to help individuals who are newly experiencing homelessness before their situation worsens. 

Item #3 Perspectives on Recovery Housing Panel Discussion 

Over the past two quarterly meetings, the Housing and Homelessness Committee engaged in discussions about recovery housing and the Housing First model. The discussions focused on their roles within behavioral health services and highlighted key challenges and best practices. This panel built on those discussions and provided first-hand insights to inform the Committee’s work further. 

The panel featured three distinguished speakers with lived experiences of addiction and homelessness: 

• Elizabeth Colorado, Advocate for the Unhoused Community 

• Claudine Sipili, Lived Experience & Innovation Director, Destination Home 

• Anna Kokanyan, Director of Admissions & Program Director, Conquer Recovery Centers 

Each panelist shared their personal story of how recovery housing played a pivotal role in their journey to stability and long-term recovery. They addressed the barriers often faced during transitions from homelessness and addiction to stable housing, including financial hardship, limited guidance, and systemic obstacles. Their experiences highlighted the need for compassionate, structured environments that foster connection and provide resources without rigid requirements. 

The panelists called for more flexible, trauma-informed approaches that prioritize human dignity, autonomy, and choice. Claudine emphasized the need to advocate for policies that center racial equity and incorporate lived expertise. She also stressed that recovery housing should remain voluntary and not a requirement. Anna emphasized the need to validate individuals’ feelings and provide care in safe and supportive settings. Elizabeth highlighted the need to meet people where they are and guide them through both recovery and permanent housing pathways. 

The panelists expressed their gratitude for the opportunity to share their experiences. The discussion concluded with a Questions-and-Answers session with committee members. Key topics included: 

• A committee member asked Anna about the duration of her program at Conquer Recovery Centers and why participants travel from out of town. Anna explained that many public facilities have waitlists of six to nine months. Her program, which accepts private insurance, provides more immediate access to treatment. 

• A committee member celebrated Anna’s recent acceptance into a college program and shared heartfelt reflections on her journey. They emphasized the value of lived experience, resilience, and personal growth. 

• Another member raised concerns about the decision to offer housing before addressing mental health and substance use needs. The panelists acknowledged the diverse perspectives on the Housing First model and emphasized that services must reflect individual needs and allow each person to guide their own recovery. 

• When asked how they remain strong and grounded in their work, the panelists shared personal wellness practices. Anna spoke about the importance of caring for the mind, body, and spirit through exercise, prayer, meditation, a healthy diet, and therapy. Claudine described her connection with nature through off-road travel as a source of peace, reflection, and spiritual strength. Elizabeth emphasized simple acts of kindness to give back and stay rooted in empathy and purpose. 

• A committee member offered encouragement and shared a personal story about how they helped an individual regain custody of her children. The story affirmed the power of persistence, compassion, and hope. 

Public Comment: 

Barbara Wilson expressed appreciation for the panel discussion and proposed the creation of a safe healing space for individuals with behavioral health challenges. She shared that, in her experience, every unhoused person she had worked with could successfully maintain housing. Barbara also raised concerns about the Housing First model, noting that some individuals struggle with its structure and may feel like failures when they must return to more supported environments. Additionally, she questioned defining success solely in terms of paid employment, emphasizing that mental health conditions can impact a person’s ability to work. 

Anna, a college student, shared how impactful it was to hear directly from individuals with lived experience. While she studied incarceration and homelessness in her coursework, she said the personal stories gave her a deeper and more meaningful understanding of the issues. 

A committee member highlighted the challenges of treating individuals who use substances. She acknowledged the value of harm reduction but emphasized that trauma work remains difficult when a person remains under the influence. 

Item #4 Cal ICH and Recovery Housing Panel Debrief Discussion 

The Committee debriefed on the information presented by Cody Zeger from the California Interagency Council on Homelessness (Cal ICH) and the panelists from the Recovery Housing Panel. Committee members also discussed potential next steps. 

A committee member expressed deep appreciation for the lived expertise shared by the panelists. She emphasized the value of hearing from individuals who have experienced addiction and homelessness, are now in recovery, and are helping others through successful programs. She encouraged the inclusion of similar presentations in future meetings. Another committee member outlined the following follow-up items in response to the presentation from the California Interagency Council on Homelessness (Cal ICH): 

• Federal Housing Voucher Concerns: Urged follow-up with Cal ICH about federal funding cuts and reduced availability of rental vouchers. She noted that the presentation addressed only Homeless Prevention vouchers, which make up a small portion of the total supply. In Monterey County, she reported that no new Tenant-Based Vouchers appear available, and Project-Based Vouchers remain unavailable, which has stalled progress for individuals on waitlists. 

• Support for Undocumented Populations: Requested information on Cal ICH’s strategy to support undocumented individuals. The committee member shared that 13.5% of her county’s population are undocumented and many in this group experience homelessness. She shared that local shelters have reached capacity and often house undocumented families for extended periods, which forces others in need of emergency shelter to go without. She urged the Committee to seek state-level guidance and data on this growing concern. 

The committee member raised concerns about the long-term effectiveness of six-month rapid rehousing programs. She explained that individuals with serious mental illness who are unemployed often do not meet eligibility requirements for these short-term services. Even among those who do qualify, many are unable to sustain rent payments once the assistance ends. In one local case, 90% of participants became homeless again after the six-month support period. She questioned whether this approach offers a sustainable solution. 

A committee member added that shelters should function as gateways to permanent housing, not long-term temporary accommodations. While acknowledging the value of recovery housing, he stressed that it is just one piece of a broader housing continuum that requires support. 

Another committee member emphasized the importance of homelessness prevention. She referenced research from the University of California, San Francisco, showing that many people become homeless after missing a single rent or mortgage payment. She questioned why state and national investments remain focused on rehousing rather than proactively preventing housing loss. She also acknowledged the efforts of one panelist whose organization is working effectively in the prevention space. 

A committee member described the current moment as a pivotal opportunity to advance the Committee’s advocacy efforts. He noted that, although the presenter outlined several strategic goals, homelessness prevention remained undefined. He emphasized the value this Committee brings, as members provide firsthand insight into effective prevention strategies. The committee member added that the collective effort of this Committee could help influence broader policy decisions and bring hope to individuals at risk of homelessness. 

Public Comment: 

Barbara Wilson expressed appreciation for the Committee’s longstanding work, recalling her early involvement when she raised concerns about the closure of licensed adult residential facilities due to low reimbursement rates. She also highlighted the gap in oversight for sober living homes, which are unlicensed and therefore not subject to consistent standards. Barbara noted she has been in dialogue with her county’s Sober Living Council and referenced similar efforts in Santa Clara County to establish operational guidelines for these homes. 

She emphasized the lack of communication between systems and that many individuals’ experiencing homelessness are unaware of licensed residential options. In contrast, mental health providers often lack insight into the realities of homelessness. Barbara stressed the urgency to break down these silos, particularly due to recent resistance from the substance use community during a Los Angeles County town hall meeting, where concerns were raised about merging mental health and substance use systems. 

Action/Resolution 

Committee staff will follow up with the questions to the California Interagency Council on Homelessness (Cal ICH). 

Responsible for Action-Due Date 

Simon Vue – April 2025 

Item #5 Proposition 1 Update 

Council staff, Simon Vue, shared an update on Proposition 1 Bond Behavioral Health Continuum Infrastructure Program (BHCIP) Round 1: Launch Ready. 

On May 12, 2025, the Department of Health Care Services (DHCS) announced Proposition 1 BHCIP Round 1: Launch Ready awards. Eligible organizations applied for funding to construct, acquire, and rehabilitate properties for behavioral health services for Medi-Cal members. The Department awarded 124 projects across 214 behavioral health facilities in California to support: 

• 5,077 new residential/inpatient treatment beds for mental health and substance use disorders. 

• 21,882 new outpatient treatment slots. 

Additionally, the Department is preparing to launch BHCIP Round 2: Unmet Needs in May 2025, which will provide up to $1 billion in competitive funding awards. 

This funding is a vital part of the Department’s Behavioral Health Transformation efforts, which aim to strengthen California’s approach to providing services for mental health and substance use disorders by focusing on community-based care and support. Although the Behavioral Health Continuum Infrastructure Program (BHCIP) is not part of Proposition 1, the measure allocates up to $4.4 billion through the Behavioral Health Infrastructure Bond Act (BHIBA), which establishes the program as a key vehicle to expand California’s behavioral health infrastructure. This funding supports the development of treatment facilities, including residential care settings and supportive housing. The Department distributes these funds through competitive grants, focusing on community-based services and regional projects. 

Action/Resolution 

Staff will continue to monitor for the May updates regarding the Bond Behavioral Health Continuum Infrastructure Program Round 2: Unmet Needs. 

Responsible for Action-Due Date 

Simon Vue – May 2025 

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.

Upcoming Public Actions

On Tuesday (tomorrow), the Board of Supervisors will be acting on two Consent Agenda items which have the ability to expand service and housing for residents served by the County:

  • (Item #9) Bond Behavioral Health Continuum Infrastructure Program Round-1 Grant Application Resolution Update.  Adopt a Resolution to replace Resolution 24-0519 authorizing the Director of Health Services, or designee, to apply to the California Department of Health Care Services’ Behavioral Health Continuum Infrastructure Program Round 1 (BHCIP 2024) Launch Ready Program Request for Applications, increasing the application amount by $10,202,227.50 for a new not-to-exceed amount of $67,702,227.50 for the construction of four Mental Health Rehabilitation Centers and one Adult Residential Substance Use Disorder Treatment Facility.
  • (Item #11) New positions to support California Advancing and Innovating Medi-Cal (CalAIM). A) Adopt a Resolution amending the Sheriff’s Office Department Allocation List to add 1.0 Full Time Equivalent (FTE) Administrative Aide, effective February 4, 2025, to support the mandated California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved Initiative. B) Adopt a Resolution amending the Department of Health Services Department Allocation List to add 2.0 Full Time Equivalent (FTE) Senior Client Support Specialists, effective February 4, 2025, to support the mandated California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved Initiative. 
    • In 2023, California became the first state in the nation approved to offer a targeted set of Medicaid services to youth and adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release with the goal of addressing the unique and considerable health care needs of justice-involved individuals, improving health outcomes, delivering care more efficiently, and advancing health equity across the state.
    • Through a federal Medicaid 1115 demonstration waiver approved by the Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) has partnered with state agencies, counties, and community-based organizations to establish an expanded system for providing enhanced care. Implementation of the mandated expansion in services, called California Advancing and Innovating Medi-Cal, or CalAIM, involves establishing a reentry process that provides incarcerated adults with the physical and mental health services they need before release, and connecting them to appropriate service providers for care upon reentry to the community. 
    • Eligible inmates will receive services up to 90 days before their release to stabilize their behavioral health conditions and establish a plan for their community-based care. The Sheriff’s Office intends to go-live with the provision of enhanced services in January 2026.  The deadline to go live is September 30, 2026. 

On Wednesday, there are three meetings that are central to the work of providing direction to County and community services for homeless, mentally-ill, and addicted residents in Sonoma County. 

  • Behavioral Health Board Executive Committee, 10:30am, 2227 Challenger Way, Room 201.  Planning meeting for the Full BHB meeting on Feb 18th. 
  • MHSA Program Steering Committee, 1-3pm, 2227 Challenger Way, Galaxy Room (next to Room 201)
  • Measure O Oversight Committee, 4-5:30pm, 1450 Neotomas Ave, Suite 200. Quarterly meeting to review finances and progress on programs funded.

On January 28th, the Santa Rosa City Council considered, and then delayed approval of a an application to the State of California Department of Housing and Community Development’s HomeKey+ Grant Program for the City to be a co-applicant with Burbank Housing Development and Caritas Homes Phase II LLC in an amount not to exceed $13.95 million.  The grant is for the development of permanent supportive housing for individuals or households with an individual who is homeless, chronically homeless, or at risk of homelessness and who are also living with a behavioral health challenge. Caritas Homes Phase II, the final stage of the Caritas Village project located in downtown Santa Rosa will add 30 new affordable apartments reserved for homeless individuals referred through the Sonoma County Coordinated Entry system, meets the eligibility criteria for HomeKey+ funding.  The item was pulled from the City Council agenda, and will be rescheduled at a later date.

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.

  1. Housing Interventions
  2. 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.
  3. 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.
  4. Funding may also be used for capital development projects, subject to DHCS limits.
  5. Full Service Partnerships
  6.  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).
  7. Behavioral Health Services and Supports (non-FSP) and Additional Components
  8. 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.

Homeless America – Pepperdine University

On Tuesday, March 26, 2024 The Pepperdine School of Public Policy hosted “Homeless America: Creative and Compassionate Responses to a Cross-Sector Challenge” conference in downtown Los Angeles. Before COVID struck the United States in early 2020, California governor, Gavin Newsom, gave his annual “State of the State Address”, which was focused on addressing the burgeoning homelessness crisis in the state. As the impact of the virus has receded, the issue of homelessness has returned to center stage. A recent survey of Californians by the Public Policy Institute of California found that a full 89% of those questioned view homelessness as either a “Big Problem” or “Somewhat of a Problem”. The issue of homelessness draws so many policy domains from housing to mental health services and public safety. It’s also a true “cross sector” challenge, requiring engagement by the government, nonprofit, and business sectors. Through an afternoon of panels and keynotes, we explored how the public sector and nonprofit leaders are taking a variety of approaches to respond to this crisis. Keynote Address:

PANEL 1: The Role for Government MODERATOR

  • Rick Cole , Adjunct Faculty, PepperdineSchool of PublicPolicy and Chief Deputy Controller ,City of Los Angeles

PANELISTS

  • Kevin Faulconer, Visiting Professor of Community Leadership and Government Innovation, Pepperdine School of Public Policy
  • Elizabeth Mitchell, Partner, Umhofer, Mitchell & King, LLP
  • Brandon Young, Partner, Manatt, Phelps & Phillips

Keynote Address

PANEL 2: The Role for Nonprofits MODERATOR

  • Soledad Ursua, Board Member, Venice Neighborhood Council

PANELISTS

  • Matthew Dildine (JD ’08, MPP ’08, 04), Chief Executive Officer, Fresno Mission
  • Jim Palmer, Chief Executive Officer, TrueSight Solutions
  • Brian Ulf, Chief Executive Officer, SHARE!

CLOSING REFLECTIONS SPEAKERS:

  • Byron Johnson, Distinguished Visiting Professor of Religious Studies and the Common Good,

Pepperdine Schoolof PublicPolicy

  • Robert Marbut, Professor, Northwest Vista College
  • Pete Peterson, Dean, Braun Family Dean’s Chair, Pepperdine School of Public Policy