Custody Hiring, Staffing, and Training (HST)

Steps Taken: The Sheriff’s Office agrees with these recommendations. Some positions have been added to Internal Affairs, Grievances, and PREA. However, the Sheriff’s Office is currently utilizing overtime for many staffing needs such as Classification and Multi- Support Deputies for the behavioral health teams. The Sheriff’s Office is aggressively recruiting new deputies to fill vacancies and running continuous academies. The Sheriff’s Office will prioritize staffing needs and identify critical areas to request positions at mid- year and through the budget process.

Custody Health Services (CHS) has an existing Crisis Response Team available 24/7 to respond to both urgent and non-urgent referrals from staff, including making acute psychiatric placement for patients when necessary.  CHS also has 10 multi-disciplinary Behavioral Health Teams (BHT) that provide crisis intervention, psychiatric assessment, medication management, individual/group therapy, case management, and discharge planning.  Staff continues to monitor service level needs to determine if the number of BHTs should be increased.  CHS also works closely with the Department of Correction to review critical incidents to determine if system improvements can be made. 

The CHS component of this Summarized Recommendation has been completed.  However, CHS will continue to monitor services to adapt to the evolving needs of inmates through ongoing Multi-Disciplinary Treatment Plan meetings.     

The Sheriff’s Office indicates they have a continued need for additional staffing to implement this recommendation. Additional staffing needs will be reviewed as part of the staffing study.

In April 2019, an expert consultant team began work on a staffing study of the jail and law enforcement operations to help inform the budget process, short-term and long-range strategies, and future Board actions. The Custody Division’s portion of the staffing study being conducted by CGL, an outside consultant. Since 2019 and 2020 when CGL was conducting their analysis and preparing the staffing study, much has changed due to COVID-19. As such, the work papers did not provide the analysis required to assist the Board with budgetary and staffing level decisions. The Board was notified that Administration was recommending a new competitive solicitation process. In September 2021, a Request for Information (RFI) was issued to engage experts in an analysis of current staffing studies in a correctional setting and the recommended approach for ensuring the analysis has the flexibility to respond to a changing criminal justice landscape. A draft preliminary report is expected to be presented by County Administration during the October 2021 meeting of the Finance and Government Operations Committee.

For FY 2023, the Board approved 5.0 FTE Clinical Nurses and 5.0 FTE Marriage and Family Therapist positions to establish Crisis Intervention Teams (CIT) in partnership with 5.0 FTE Sheriff’s Office Custody Bureau personnel that were part of the March 2022 Board approval of additional Correctional Deputy positions related to the Chavez and Cole Consent Decree Remedial Plan.  The CIT model is a model supported by the National Institute of Corrections and addresses patient crisis through a multidisciplinary approach, rooted in best practices, that in turn leads to better patient outcomes, wellness, and interactions with CHS and Sheriff’s personnel.

For FY 2023, the Board approved one-time funds in contracted services to help design a Behavior Change Model to integrate at all levels of care. The Behavior Change Model will be based on behavior change principles and use evidence-informed and evidence-based programs and practices to ensure all staff understand a behavioral approach to change and share a common language that patients as well as other staff will understand. Through these changes, a behavior change plan will be shared with all Sheriff’s Office’ Custody Bureau staff and other disciplines, such as medical providers, to improve collaboration for care.

For the Crisis Intervention Team (CIT), the Clinical Nurse and Marriage and Family Therapist positions are in various stages of posting and hiring with expected placements by summer 2023. CHS and the Sheriff’s Office Custody Bureau have begun planning meetings to begin development of policies, procedures, education, training, implementation, and operationalization of the CITs for both adult jails with a proposed soft launch in summer 2023. CHS has scheduled a series of collaborative meetings for consultation with the California Correctional Healthcare Services (CCHCS) Mental Health colleagues who have implemented CITs across the California Prisons to include key performance indicators (KPIs) and outcome measures. 

For the Behavior Change Model, CHS is currently researching existing programs and practices including potential vendors that have subject matter expertise in working in correctional settings. A Request for Statement of Qualifications (RFSQ) is expected in spring with contracted services planned for summer/fall. The model that CHS is considering is the Moral Reconation Therapy (MRT) Model designed for carceral settings.  

Custody Health has been granted two Peer Support Worker codes in FY 2024 in enhancing patient care and support within the facility. Peer Support Workers play a crucial role in fostering a supportive and understanding environment, as they have personal experience with mental health challenges and the criminal justice system. Their unique perspective allows them to connect with patients on a deeper level and provide empathetic, non-judgmental support. 

Due to necessary CHS staff restructuring and County-wide deletions of vacant positions to address a structural deficit, the Crisis Intervention Team (CIT) Clinical Registered Nurse and Marriage and Family Therapist positions have been eliminated for FY 2024 placing the CIT program on permanent hold.

For FY 2024, 6.6 FTE Clinical Registered Nurse (RN) positions were repurposed to 13.0 FTE Licensed Vocational Nurse (LVNs) positions to complement and enhance delivery of healthcare for patients enabling LVNs to relieve RNs of certain clinical and ancillary duties enabling RNs to provide greater patient care within their higher-level scope of practice. The LVN/RN partnership will improve efficiencies in providing care. 

For FY 2024, Custody Health Services secured a 1.0 FTE Licensed Clinical Supervisor for Psychiatric Social Workers to assist with increasing patient care hours and provide opportunities for Psychiatric Social Workers to work towards credentialing and licensing.

For FY 2024, Custody Health Services secured a 1.0 FTE Medical Social Worker II and 2.0 FTE Rehabilitation Counselor positions to further augment the Medication Assisted Treatment (MAT) Program 
for opioid and substance use disorder treatment.

For FY 2024, Custody Health Services repurposed a 1.0 FTE Infection Control Nurse and 1.0 FTE Medical Laboratory Technician from 2.0 FTE clinical nurse positions to augment the communicable disease 
prevention and treatment program for enhanced patient services and education.

For FY 2024, Custody Health Services increased the 0.5 FTE Optometrist position to 1.0 FTE in order to augment ophthalmology services.

For FY 2024, Custody Health Services added a 1.0 FTE Office Management Coordinator position by repurposing and cost saving a 1.0 FTE Psychiatric Social Worker position to augment ancillary and 
operational support for overall patient services.

For FY 2024, Custody Health Services eliminated 9.3 FTE vacant positions (2.0 FTE Medical Unit Clerk; 3.0 FTE Clinical Nurse III; and 4.3 FTE Psychiatric Social Worker II) as part of a County-wide effort to 
address the structural deficit. 

For staffing coverage, Custody Health Services is hiring extra help/per diem Registered Nurses/Licensed Vocational Nurses to help fill various shifts for 24/7 operations.

Custody Health Services Administration is reviewing current staffing care models to address potential gaps in both the short term and long term. 

Budget Status: The Board approved the following:

• December 2015: 59 positions in Custody Health Services to provide multi-disciplinary healthcare staff and support staff ($16.6 million) for mentally ill inmates for behavioral health services during incarceration and re-integration into the community.
• February 2016: 1 Sheriff’s Sergeant for the Internal Affairs Unit ($229,610).
• FY 2017 Adopted Budget: 1 Psychiatric Social Worker II position ($185,697) for night shift mental health staffing.
• FY 2017 Adopted Budget: 2 Sheriff’s Sergeant positions and 1 Management Analyst position to the Internal Affairs Unit ($591,854).
• FY 2017 Adopted Budget: 1 Sheriff’s Correctional Lieutenant position and 2 Management Analyst positions ($502,408) to track, investigate, and respond to grievances.
• FY 2016 Adopted Budget: 1 Sheriff’s Correctional Sergeant position and 1 Sheriff’s Correctional Deputy position ($314,500) were added for the Professional Compliance unit.
• November 2015: Also for the Professional Compliance Unit, 1 Sheriff’s Correctional Lieutenant, 1 Sheriff’s Correctional Sergeant, and 2 Sheriff’s Correctional Deputy positions were added ($741,000)
• FY 2017 Adopted Budget: 5 Sheriff’s Correctional Deputy positions and 1 Clerk position ($827,539) were added to the Office of Operational Standards and Inspection Unit to support policy and compliance work.
• FY 2017 Adopted Budget: 10 Sheriff’s Correctional Deputy positions and 1 Sheriff’s Correctional Sergeant position ($1.6 million) were added as Multi Support Deputies to support behavioral health teams.
• November 2015: 1 Sheriff’s Correctional Lieutenant position and 1 Sheriff’s Correctional Sergeant position ($454,834) to provide additional supervisory staffing to the Classification Unit
• FY 2017 Adopted Budget: 1 Sheriff’s Correctional Captain position ($290,402) and one of the responsibilities of this position was the new classification system.
• November 2015: $420,000 in ongoing funding for another correctional cadet academy.
• FY 2018 Adopted Budget: 2 Senior Management Analyst positions ($338,062) to conduct audits, provide quality assurance of grievance responses, identify trends, and produce training materials regarding grievances.
• FY 2019 Adopted Budget: Approved an adjustment to the funding for the Custody Behavioral Health Teams by increasing the Salaries and Benefits budget by $2.6 million.
• FY 2019 Adopted Budget: Added 4 Clinical Nurse III positions ($791,976), 1 Administrative Assistant position, and 1 Administrative Nurse II position ($351,137) to assist with providing comprehensive ambulatory medical, mental health, and pharmacy services to inmates at the Main Jail and Elmwood facilities.
• FY 2019 Adopted Budget: Added 18 Sheriff Correctional Deputy positions and 2 Sheriff Correctional Sergeant positions for various custody needs, including assisting the multidisciplinary teams to address the needs of mentally ill inmates and inmate movement for healthcare appointments ($3,225,870).
• February 12, 2019:  Funded 2.6 Clinical Nurse III positions in the Main Jail (1.3 FTE) and Elmwood (1.3 FTE) Medical Services unit for the Custody Health Services Department to meet the increased demands for care, backfill for nursing staff attending trainings or taking time off, meet other needs ($595,788).
• February 26, 2019: Added $8,155,362 from the Special Programs Labor Reserve to the Sheriff’s Department of Correction Contract ($5,000,000 ongoing) and Custody Health Services ($3,155,362 one-time) budgets relating to augmentation of salaries and benefits for use of overtime and extra help.
• June 4, 2019: Approved funding in the amount of $7,750,000 for the Sheriff’s Office to cover increased jail operations costs. 
• FY 2020 Adopted Budget: 
  - Added a Quality Improvement Coordinator position and 2 part-time (0.5 FTE) Health Care Program Analyst Associate positions to conduct quality assurance and improvement reviews, monitor processes, and conduct studies in various areas, including compliance with the ADA for the Custody Health Services Department ($319,075).   Added a Quality Improvement Coordinator position and 2 part-time (0.5 FTE) Health Care Program Analyst Associate positions to conduct quality assurance and improvement reviews, monitor processes, and conduct studies in various areas, including compliance with the ADA for the Custody Health Services Department ($319,075). 
  - Added 3 Assistant Nurse Manager positions to ensure coverage on every shift at the Main Jail facility on the acute psychiatric unit 8A ($662,704).
  - Added one Quality Improvement Coordinator position that will provide training on mental health focused topics ($155,605).
  - Funded 3.5 Medical Unit Clerk positions to support the Intake Booking area to ensure proper and timely processing and scheduling of dental, medical, and behavioral health appointments ($341,680).  
  - Added one part-time (0.5 FTE) Optometrist position to expand optometry services in custody.
• FY 2020 Adopted Budget: Added one Law Enforcement Clerk position in the Grievance Unit to assist with the process to provide timely responses ($96,598).
• As part of the FY 2021 Adopted Budget, the Board approved the following:
  • Add 1.0 FTE Medical Unit Clerk position to support the Custody Health Services Department’s discharge process, review release prescription orders, and issue vouchers for transportation resources ($109,925).
  • Funding for the Space Feasibility Study of the Main Jail North booking area, along with exam rooms adjacent to booking to allow for a more efficient booking process ($225,000).
  • Delete 1.0 FTE Law Enforcement Clerk position in the Administration Booking Unit ($104,150).
  • Delete 8.0 FTE vacant Sheriff’s Correctional deputy positions in the jail ($1,572,136).
  • Reduce overtime in jail operations ($1,131,981). The Sheriff’s Office implemented operational changes to reduce the need for overtime.
  • FY 2021 Adopted Budget: Delete 2.0 FTE vacant Sheriff Correctional Deputy positions that are funded by Public Safety Realignment (AB109).
  • FY 2021 Adopted Budget: Delete 37.0 FTE Correctional Deputy positions and 1.0 FTE Sheriff’s Correctional Sergeant Position ($7,363,913)
  • FY 2021 Adopted Budget: Reduce ongoing contract services funding supporting psychiatrist services by $1,209,844. This action will limit the contractor’s ability to provide critical services in Intake Booking and the Acute Inpatient Psychiatric Unit.
  • FY 2021 Adopted Budget: Delete 2.0 FTE vacant Psychiatric Social Worker II positions funded by Public Safety Realignment (AB109).
  • FY 2021 Adopted Budget: Delete 1.5 FTE Clinical Nurse positions (($386,265).
• February 9, 2021: Delete 4.5 FTE Psychiatric Social Worker II position within Custody Health Services relating to the Voluntary Separation Incentive Program ($762,089).
• February 9, 2021: Delete 0.8 FTE Psychiatric Social Worker II position within Custody Health Services as part of the Fiscal Year 2020-2021 Mid-Year Budget Review ($135,482).
• March 23, 2021: Add 1.0 FTE Health Care Service Line Director position, 1.0 FTE Medical Social Worker position, Add 2.0 FTE Psychiatric Technician positions, 4.0 FTE Medical Assistant positions for Main Jail, 9.0 FTE Medical Assistant positions for Elmwood, 6.0 FTE Medical Unit Clerk positions, 1.0 FTE Management Analyst position, 4.0 FTE Janitor positions, 1.0 FTE Infection Control Nurse position, 1.0 FTE Health Care Program Analyst II position, 1.0 FTE Sr. Mental Health Program Specialist position, and 2.0 FTE Business Intelligence Analyst positions to meet the Consent Decree’s mandate to provide adequate integrated medical care to incarcerated patients as measured through access to care and population health quality indicators and evidenced-based clinical practices that mitigate risk and reduce patient harm, morbidity, and mortality.
• FY 2022 Adopted Budget: Add funding for 20 existing Cadet positions for Correctional Academy ($2,537,480).
• FY 2022 Adopted Budget: Add 1.0 FTE Chief of Quality Management position, 1.0 FTE Chief of Mental Health Position, 2.0 FE licensed Vocational Nurse positions, 2.0 FTE Administrative Assistant positions, 4.0 FTE Medical Unit Clerk positions, 2.0 FTE Management Analyst positions, and 1.0 FTE Community Worker positions as part of the phase two of Custody Health Services’ restructure to meet the requirements of the federal consent decrees ($1,945,598).
• February 8, 2022: As part of the Fiscal Year 2021-2022 Mid-Year Budget Review, the Board approved an increase in expenditure appropriations by $3,564,258 within the Sheriff’s Office budget relating to increased costs in overtime to maintain essential services throughout the jail operations.
• March 8, 2022: Add 43.0 FTE Correctional Deputy positions related to the Chavez and Cole Consent Decree Remedial Plans to work directly with the Custody Health Services Behavioral Health Teams to provide acute or seriously mentally ill, intellectually disabled, and cognitive disability inmates with assisted daily living services, escorts, access to care, and constant and direct supervision of mental health structured programming and out-of-cell time ($750,224). 
• FY 2023 Adopted Budget: Add 5.0 FTE Clinical Nurse I positions and 5.0 FTE Licensed Masters Level Clinician II positions to establish Crisis Intervention Teams in partnership with Sheriff’s Office Custody Bureau who will assign 5 Multi-Support Deputies (MSD) ($1,328,733).
• FY 2023 Adopted Budget: Approved one-time funding for contracted services to help design a Behavioral Change Model ($500,000).
• FY 2023 Adopted Budget: Approved ongoing funding in the amount of $534,504 for 1.5 FTE Pharmacist Specialist and 1.0 FTE Pharmacy Technician position to increase medication dispensing volumes and ensure patients receive medication while in custody.
• February 7, 2023: As part of the Fiscal Year 2022-2023 Mid-Year Budget Review, the Board approved a one-time increase of $4.1 million for expenditure appropriations in the Department of Correction – Sheriff Contract Budget Unit related to increased costs in overtime to maintain essential services throughout the jail operations.
• FY 24 Budget: Add 2.0 FTE Mental Health Peer Support Workers for in reach services; Add 13.0 LVN positions and delete 6.6 RN positions; Add 1.0 FTE Licensed Clinical Supervisor; Add 1.0 FTE Medical Social Worker II and 2.0 FTE Rehabilitation Counselors; Add 1.0 FTE Infection Control Nurse, 1.0 FTE Medical Laboratory Technician, and delete 2.0 FTE Clinical Nurse positions; Add 1.0 FTE Optometrist and delete 0.5 FTE Optometrist; Add 1.0 FTE Office Management Coordinator and delete 1.0 FTE Psychiatric Social Worker position; Delete 9.3 FTE vacant positions (2.0 Medical Unit Clerks; 3.0 Clinical Nurse III; 4.3 Psychiatric Social Worker II). 

Source Report(s): Sheriff’s Jail Reform Plan, Civil Grand Jury, Department of Justice, Blue Ribbon Commission on Improving Custody Operations, Emblidge Report, Zisser

Responsible Dept(s): Sheriff’s Office, Custody Health Services

Master List Nos.: 107, 117, 157-158, 202, 440-446, 506, 509, 519, 531-532

Review Date: FGOC reviewed on December 19, 2016.​