Inmate Healthcare (HLC)

As of September 1, 2020

The pending summarized recommendations listed below reflect the most current information and actions taken since the previous Board Study Session.  Summarized recommendations marked as complete have been updated for the March 10, 2020 Board Study Session.​​​

There are 146 recommendations in the category of Inmate Healthcare that are included in the Summarized Recommendations below. Of the 146 recommendations, 39 have been reviewed already as part of Suicide Prevention. The remaining 107 recommendations are summarized below.​

    Steps Taken: With the implementation of HealthLink, staff can identify medical and behavioral health issues during the booking process, provide appropriate intervention throughout an inmate’s incarceration period and when necessary, provide assistance upon an inmate’s release.

    Medication administration has always included identification checks and mouth checks.  Staff will ensure continuous adherence to this policy.

    Inmates receive a discharge summary (HealthLink report) that includes their care needs and medication(s).

    Medications for medical and behavioral health are monitored using lab testing as appropriate to determine levels as per the recommendation of the manufacturer and medical decision making.
    Voluntary versus involuntary medication use is reviewed on a case by cases basis and is dependent on review by a physician or psychiatrist.
    The list of medications has been completed and staff has been trained on the policies regarding Keep on Person medications.

    This Summarized Recommendation has been completed.

    Budget Status: The Board allocated $2.5 million as part of the FY 2016 Adopted Budget and $2.0 Million as part of the FY 2017 Adopted Budget for HealthLink to be implemented in Custody Health.

    County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Blue Ribbon Commission on Improving Custody Operations, Healthcare Gap Analysis – Wilcox, Mental Health Gap Analysis – Gage

    Responsible Department(s): Custody Health Services

    Master List Nos.: 46, 608, 610, 611, 619, 624, 625

    Review Date: FGOC reviewed on January 26, 2017.​

    Steps Taken: The services described in this Summarized Recommendation are available. 

    HealthLink tracks the number of appointments per dentist and the average number of dental clinic appointments by clinic and provider.  The information will be used to identify areas of need to minimize wait times.

    This Summarized Recommendation has been completed. 
    However, Custody Health will consider providing additional services when construction of the new Main Jail dental office is completed.  Construction is anticipated to begin in November 2018, with an anticipated completion date of September 2019. 
     

    Budget Status: The Board approved the following:

    • FY 2017 Adopted Budget: 1 Dentist position and 1 Dental Assistant position to support Dental Services in the Jail ($326,928).

    County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Blue Ribbon Commission on Improving Custody Operations, Dental Gap Analysis – Shulman

    Responsible Department(s): Custody Health Services

    Master List Nos.: 55, 548, 549, 550, 551, 553, 554, 556, 557, 560, 568

    Review Date: FGOC reviewed on January 26, 2017.

    Steps Taken: On December 15, 2015, the Board approved the creation of 12 Behavioral Health Teams and a Substance Use Treatment component in Custody Behavioral Health. On August 30, 2016, the Board approved the recommendations from the Jail Diversion and Behavioral Health Services Subcommittee.

    These actions have allowed for the following steps to have been taken:

    Substance Use Treatment Services (SUTS) Updates

    • There are 10 Behavioral Health (BH) Teams and the SUTS portion of the BH Team work began in November 2016. Ten staff are assigned to work in two teams: 5 staff are assigned to work with the Custody Health Services (CHS) BH Teams and the other 5 provide transitional planning and community placement of clients into behavioral health services. The teams are divided between the Main Jail and Elmwood.
    • The BHSD has secured 200 outpatient treatment slots serving approximately 800 clients annually and 50 Transitional Housing Unit (THU) beds serving 200 clients annually. 
    • The BHSD has secured 50 THU beds which are available to the inmates served. To date, 64 male and 40 female inmates have been referred for a THU bed.  
    • Since July 1, 2020 to December 31, 2020, the STEP program has received 39 referrals from CHS staff and have screened 39 individuals for treatment services. Seventeen individuals have been referred into treatment programs and 13 individuals have accessed Recovery Residence Programs.  Due to COVID-19, the STEP program has developed a protocol where clients can call the program collect to complete a screening, assessment and obtain a transition plan into the community.  The STEP program continues to meet clients upon release and provide them with taxi vouchers to their planned recovery residence, outpatient appointments and assist with obtaining the client’s medications.
    • Completion of the Muriel Wright redesign and implementation of 30 residential substance use treatment and respite beds and 15 co-occurring crisis residential beds. The Muriel Wright Center substance abuse residential program started receiving referrals on January 15, 2020, during which 11 clients have received an intake and of which 9 clients have been enrolled in treatment. The crisis residential co-occurring program is scheduled to complete its first client intake on February 24, 2020. The Muriel Wright Crisis Residential program served 66 unduplicated clients between July 1, 2020 through December 31, 2020.  Additionally, the Substance Use Residential program served a total of 36 unduplicated clients during the reporting period.

    Assessment Tools Update

    • The BHSD has developed and implemented a standardized, validated screening tool and assessment process: On December 5, 2017, the Behavioral Health Services Department (BHSD) provided an update on the development and implementation of a standardized, validated screening tool and assessment process with public safety partners, with the goal to divert individuals from jail into community services when appropriate. The Community Assessment Tool (CAT) has been developed and shared with law enforcement agencies. A workgroup comprised of BHSD leadership and justice partners was developed and has been meeting monthly to explore and discuss standardized, validated screening tools that could be used to facilitate the assessment process for justice involved individuals.  On December 11, 2020, the Probation Department presented on the Correctional Assessment and Intervention System (CAIS) and the Pretrial Services Department presented on the Risk Assessment they use, of which both serve as a risk and needs assessment tool that assists in determining supervision strategies and helps identify potential programs likely to increase client success rates.  The workgroup will continue to meet to identify and select screening tools that can be implemented across agencies.   The screening tool will be selected within two months.  The Implementation plan will occur within 6 months. During the 6 months, a communication plan will be developed, a training plan and a target start date. 

    Psychiatric Emergency Response Team (PERT) Update

    • The Psychiatric Emergency Response Team (PERT) program will consist of behavioral health clinicians who will accompany law enforcement officers from the Santa Clara County Sheriff’s Office, the San José Police Department, the Palo Alto Police Department, and the Morgan Hill Police Department to respond to behavioral health crisis calls. BHSD staff are actively working with law enforcement agencies to address requirements for clinical staff and are currently undergoing special recruitments for these roles. The Palo Alto Police Department has offered to assist with a specialized recruitment. Clinician interviews began on July 2020 and have continued as names have been received from the Employee Services Agency (ESA). Several candidates were interviewed between July and December 2020.  Thus far, one clinician has been hired and assigned to the Sheriff’s Office, with active recruitments ongoing. In an effort to support recruitment efforts, two meetings have been held with Palo Alto University to discuss opportunities for broadening recruitment efforts and creating a career pathway for students in PAU’s Masters and Doctoral programs to learn about PERT and Mobile Crisis Response Team (MCRT) work.  PAU has posted the PERT recruitment to their alumni network and future meetings will be scheduled to discuss student intern opportunities in the PERT and MCRT programs. 
      The beginning phase of collaborative training development took place from July through December 2020, which included gathering information for training clinicians, mental health peer support workers, officers, deputies, and dispatchers. The BHSD submitted an off-agenda memorandum with the formalized PERT training curriculum on January 22, 2021. Additionally, a Memorandum of Understanding (MOU) with the Sheriff’s Office, Police Department, and Santa Clara County will be established prior to the start of the program.

    Post-Custody Mental Health and Co-Occurring Outpatient Services Updates

    • Expand post-custody mental health and/or co-occurring outpatient services: The co-occurring program provides services to individuals that have both mental health and substance use issues. The program is community-based and designed to decrease the number of clients on the Jail Assessment Coordinator (JAC) and Community Awaiting Placement Supervision (CAPS) lists. The program is contracted to serve 40 clients annually. From July 1, 2020 through December 31, 2020, a total of 90 justice involved clients with co-occurring (mental health and substance use) conditions were served.
    • Increased Criminal Justice System (CJS) Full Service Partnership (FSP) capacity: The Full Service Partnership Program serves individuals who have three or more inpatient stays in the last 12 months and thus have higher-level mental health needs. From July 1, 2020 through December 31, 2020, the FSP programs served 470 criminal justice involved clients. Added housing flex funds for CJS FSP for clients referred to treatment services. These flex funds are available for individuals released from the JAC List and in need of housing assistance. In February 2017, BHSD amended existing provider agreements to add flex funds for 50 Criminal Justice FSP clients referred into treatment services. From July 1, 2020 through December 31, 2020, these funds have facilitated the housing of 70 clients released from custody. 
    • Despite the demand in FSP services, in FY 2021, the total contracted capacity for FSP services will be reduced by 35 slots resulting from budgetary cuts to AB109 FSP and CDCR programs. Five of these slots will be reduced from the AB109 FSP programs, while the elimination of CDCR FSP programs effective January 1, 2021 will result in a reduction of 30 additional slots.
    • Expand the 120-day Intensive Outpatient (IOP) Service Team: IOP provides intensive services for up to 120 days for individuals in need of less restrictive environment than hospitalization or residential care. The contracted capacity is 165 clients annually. In April 2017, the Criminal Justice Division expanded its services with the addition of the 120 day Intensive Outpatient Program (IOP), which provides 50 client slots. From July 1, 2020 through December 31, 2020, the IOP served 91 justice involved clients.
    • Develop one Behavioral Health Urgent Care Center as a drop-in center for law enforcement: The BHSD has assessed existing and new facilities for Urgent Care Drop-In services that are available 24/7 for law enforcement. The Department is currently exploring available options. Of note, the proposed Behavioral Health Acute Care Facility will include an adult 24/7 urgent care facility.  The Office of the County Executive and the BHSD are planning a new 24/7 Mental Health Triage Center (MHTC) on the Reentry Center campus to provide services to individuals that do not meet requirements for Emergency Psychiatric Services or need to be booked into custody. These services would also be available for the Mobile Crisis Response Teams and clients that are in court-ordered services. These services will triage and assess individuals for both mental health and co-occurring needs and connect them to the appropriate community services. The contract provider’s scope of work was modified to include admission for individuals experiencing a mental health crisis and/or under the influence of alcohol or other drugs. 
    • Add flex funds for Criminal Justice FSP for clients referred to treatment services: The Housing Flex Funds allow individuals that are being released from the JAC List and in need of housing assistance to access this funding. In February 2017, BHSD amended existing provider agreements to add flex funds for 50 Criminal Justice FSP clients referred into treatment services. Providers use this funding to assist clients in need of housing assistance. From July 1, 2019 through December 31, 2019, these funds have facilitated the housing of 22 clients released from custody.
    • Mission Street Sobering Center (MSSC): From July of 2020 through December of 2020, the MSSC had a total of 730 visits of which 465 were referred by the BHSD, 166 were referred by law enforcement partners, 93 were referred by emergency departments, 4 were referred by the Re-Entry Center, and 2 were referred from the Valley Homeless Healthcare Plan (VHHP) and VHHP Re-Entry Van. 
    • Establish a Permanent Supportive Housing (PSH) program: In February 2017, the Board approved the creation of a Permanent Supportive Housing (PSH) program to serve individuals being diverted from jail.  Permanent Supportive Housing (PSH) Services selected Community Solutions as the provider for intensive outpatient and PSH services and the BHSD amended their contract, which the Board approved on February 7, 2017. The PSH program provides outreach and supportive housing services to individuals being released from custody with a score of eight (8) or higher on the Vulnerability Index Service Prioritization Decision Assistance Tool (VI-SPDAT), which is used to determine homelessness and housing placements. Between July 1, 2020 and December 31, 2020, the PSH program was at capacity and served a total of 99 clients.  In addition to the PSH program with Community Solutions, the BHSD is currently working with Abode to develop a protocol in which a BHSD peer support worker will be responsible for coordinating linkage to Abode Services, including VI-SPDAT screenings and entries into HMIS with the goal of accessing long term, permanent housing for justice involved individuals.
    • Enhance Pretrial Mental Health Supervision Program with Superior Court: The Pretrial Services Officer (PSO) has been stationed at the Reentry Resource Center since the inception of the program in February 2017 and continues to facilitate interviews, releases, and supervision of eligible Pretrial CAPS clients. This position provides the CAPS team and Superior Court with status updates for those clients assigned to their supervision. Between July 1, 2020 and December 31, 2020, no clients have been released through CAPS to pretrial supervision but have rather been released directly into community-based treatment services.

    BHSD Staffing Updates

    • Add staff to Behavioral Health Services to assign Jail Diversion referrals for treatment placement of clients: In June 2017, the Criminal Justice Health Care Program Manager (HCPM) was hired. The HCPM actively manages the Jail Assessment Coordinator (JAC) and Community Awaiting Placement Supervision (CAPS) lists for the Behavioral Health Services Department. The BHSD has an HCPM position responsible for reviewing both the JAC and CAPS lists on a daily basis to determine placement recommendations; coordinating placements with Evans Lane Wellness and Recovery Center and the contract providers with criminal justice programs; facilitating client linkage to services and custody release; meeting on a bi-weekly basis with the CAPS Team to review client treatment recommendations and dispositions; assist providers with ongoing issues that would otherwise prevent the discharge of individuals on the JAC/CAPS list. Recently, the HCPM position was vacated in December of 2020, and the BHSD is currently in the process of hiring into this position.  In the interim, a Senior Mental Health Program Specialist is managing the JAC list and ensures that individuals being released from custody are linked to mental health and substance use treatment programs. Prior to vacating the position in December 2020, the HCPM managed and reported on the mental health and substance use treatment clients and coordinated care for 889 clients into mental health services from July 1, 2020.

    Budget Status: 

    • On September 13, 2016, the Board approved $4.8 million in funding for jail diversion efforts in FY 2017, along with an ongoing cost of $8.4 million.
    • On March 20, 2018, the Board approved an agreement with Telecare Corporation related to one-time funding in the amount of $1,172,538 for substance use residential treatment services and crisis residential services at the Muriel Wright facility.
    • In the FY 2019 Adopted Budget, the Board approved $317,622 in funding for 3 Custody Health Services positions to maintain services for inmates diagnosed with a serious mental illness in need of intensive post-custody services. These positions were previously funded through the Mentally Ill Offenders Crime Reduction grant.
    • Additionally, in the FY 2019 Adopted Budget, the Board approved $491,989 to augment the Electronic Monitoring Program (EMP) by adding 1 Pretrial Services Officer III position and allocating part of this on-going funding for equipment costs to support this Jail Diversion program.
    • As part of the FY 2020 Adopted Budget: 
      - Added a Director of System of Care position in the Behavioral Health Services Department to oversee the Jail Diversion and Justice Services system of care ($258,088). 
      - Ongoing funding in the amount of $440,000 for equipment costs to support Electronic Monitoring Program (EMP) in the Office of Pretrial Services. 
    • On June 23, 2020, the Board approved recommendations to move forward with an Electronic Monitoring Program with an ongoing maximum annual cost of $100,000 that includes satellite monitoring and remote tracking services.

    Source Report(s): Jail Diversion and Behavioral Health Subcommittee, Blue Ribbon Commission on Improving Custody Operations, Sheriff’s Jail Reform Plan, Mental Health Gap Analysis – Gage

    Responsible Department(s): Behavioral Health Services

    Master List Nos.: 45, 48-51, 129, 376-378, 626, 647-655

    Review Date: FGOC reviewed on January 26, 2017.

    Steps Taken: The Sheriff’s Office (SO) is working closely with CHS and HHS executive management staff and has established regular meeting sessions to improve the quality of care. Additionally, all Custody Bureau Captains attend Joint Operations Committee meetings every two weeks to work through challenges related to Classification, daily operations, and protocols. Mental Health staff is involved in de-escalation events. Discharges from Inpatient to Special Management and other units are coordinated through Classification, and, if necessary, with the Behavioral Health management. Lastly, CHS and Jail Facility Administrators continue to participate in quarterly Quality Improvement meetings to improve care practices.

    With the implementation of the Behavioral Health multi-disciplinary teams, collaboration between SO and CHS staff has increased. The Custody Health executive attends the SO Captains meeting so that all aspects of care of inmate patients can be addressed in both directions. This collaborative model continues to be refined.

    The Director of Custody Behavioral Health Services started work on July 30, 2018.  This position oversees all aspects of mental health services at both Main Jail and Elmwood Jail facilities.

    All Custody Health Staff wear a picture badge that identifies them as a Custody Health Services employee.  The badge also indicates their name and job title.

    On October 22, 2019, the Board approved a third amendment to an agreement with South Bay Emergency Physicians Medical Group, Inc., relating to providing physician staffing services that also includes expanding medical services hours in the custody setting to twenty-four (24) hours per day, seven (7) days per week. The custody staffing services section of the agreement is for a total amount of $3,752,406.

    Work is still ongoing by Custody Health Services leadership and the Office of the County Counsel to coordinate policy changes in support of inter-departmental collaboration.

    For the Sheriff’s Office, this summarized recommendation has been completed to the extent possible. Work is still ongoing by Custody Health Services.

     

    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.
    • 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 the teams noted above.
    • FY 2017 Adopted Budget: 6 Rehabilitation Officer positions and 1 Senior Management Analyst ($1.1 million) for programming and discharge planning.
    • January 23, 2018: Added new Director, Custody Behavioral Services Positions, in Custody Health Services to provide oversight of all Custody Health behavioral health staff and services.
    • 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 1 Administrative Assistant position and 1 Administrative Nurse II position ($351,137) to support Custody Behavioral Health services.
    • 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).
    • FY 2020 Adopted Budget:
      - Added one 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).
    • August 27, 2019: Adopted a salary ordinance adding one Chief Psychologist position to lead the Psychology Team in the planning, implementation, and evaluation of treatment modalities ($258,641).
    • October 22, 2019: Approved the Third Amendment to an Agreement with South Bay Emergency Physicians Medical Group, Inc, relating to physician staffing services that also includes expanding medical services hours in the custody setting to twenty-four (24) hours per day, seven (7) days per week ($3,752,406).
    • February 11, 2020: As part of the FY 2019-2020 Mid-Year Budget Review, the Board approved the transfer of one-time funds in the amount of $750,000 from the Reserve to Implement Jail Consent Decrees to Custody Health Services budget to fund the agreement with South Bay Emergency Physicians Medical Group, Inc.
    • FY 2021 Adopted Budget: 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).
    • FY 2021 Adopted Budget: 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).
    • FY 2021 Adopted Budget: Delete 1.0 FTE Rehabilitation Officer II position in the Inmate Screening Unit to screen inmates for in- and out-of-custody programs ($181,738).
    • FY 2021 Adopted Budget: Eliminate the ongoing Reserve to Implement Jail Consent Decrees to preserve certain position in the Department of Correction to implement components of the consent decree ($2,000,000) and to fund an agreement to provide continuous physician coverage in the jail facilities ($1,000,000).
    • FY 2021 Adopted Budget: Transfer 1.0 FTE Chief Psychologist position from the Santa Clara Valley medical Center to the Custody Health Services Department.

    • 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).
      FY 2021 Adopted Budget: Reduce ongoing funding of miscellaneous Services and Supplies by $205,894.

    • 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 3.0 FTE Rehabilitation Officer positions ($545,214).

    • February 9, 2021: As part of the Fiscal Year 2020-2021 Mid-Year Budget Review, the Board approved an increase in expenditure appropriations by $878,426 within the Custody Health Services budget to ensure around-the-clock medical services at the jails and increase expenditures appropriations for personnel to cover overtime in the Custody Health Services budget by $4.8 million.

    • February 9, 2021: The Board approved a salary ordinance deleting 1.0 FTE Director of Custody Behavioral Health Services and increasing the salary range for the Director of Custody Health and Custody Behavioral Health Services position by 7.7 percent.

    • 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 1.0 FTE Rehabilitation Officer II position related to the Voluntary Separation Incentive Program as part of the Fiscal Year 2020-2021 Mid-Year Budget Review ($206,474).

    • 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).

    Source Report(s): Sheriff’s Jail Reform Plan, Blue Ribbon Commission on Improving Custody Operations, Commission on the Status of Women, Civil Grand Jury, Mental Health Gap Analysis – Gage, Dental Gap Analysis – Shulman

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

    Master List Nos.: 103, 393, 529, 545, 547, 598-599, 614-615, 632-634

    Review Date: FGOC reviewed on January 26, 2017.​ 

    Steps Taken: Currently, white cards are available in all housing units 24/7 and collected by nurses on a daily basis from locked boxes. They also can also be submitted to any nurse during any point of contact.  When possible, inmates are triaged as the white cards are collected.  Otherwise, an assessment nurse performs the triage within 24 hours.  A triage system was developed for mental and physical needs.  All white cards are logged in HealthLink for guidance and review. 

    Custody Health Services (CHS) agrees that inmates should be provided with a mechanism to submit white cards at any time and is working with the Sheriff’s Office to either have locked boxes installed or provide a means to securely submit white cards using technology solutions. A study will be conducted to determine the feasibility of having inmates submit white cards directly to CHS through the use of secure technological means.

    The Refusal of Care form does include information regarding the consequences of refusing treatment and is available in English, Spanish and Vietnamese.  Providers also explain the consequences of refusing treatment.  In March 2018, it was revised to simplify the language and make it easier to understand. 

    In an effort to address inmate grievance issues and to provide better services, the Office of the Sheriff and Custody Health Services are working to pilot a new electronic Medical Request System at the Elmwood Women’s Facility. The plan is to have data within six months.  

    Budget Status: County Administration and the departments are evaluating to determine if additional resources are needed.

    Source Report(s): Dental Gap Analysis – Shulman, Healthcare Gap Analysis – Wilcox, Blue Ribbon Commission on Improving Custody Operations

    Responsible Department(s): Custody Health Services

    Master List Nos.: 30-31, 555, 583-584, 587-590, 595-597, 613

    Review Date: FGOC reviewed on January 26, 2017.​

    Steps Taken: CHS has implemented a two tier triage screening for booking. The initial screening (Tier 1) takes the client through a series of medical and behavioral health screening questions while obtaining baseline vital signs. Depending on the answers to the Tier 1 screening, clients that show an increased risk for medical or behavioral needs are then sent for further evaluation. This further evaluation is performed by a medical physician or mental health clinician. A triage set of criteria has been developed and implemented to determine acuity levels and appropriate next steps for both emergent, urgent and routine care. CHS staff completes all intake parameters.

    All nurses assigned to Intake Booking are given a one-week on-the-job training for Intake screenings and are paired with two experienced nurses. 

    This Summarized Recommendation is complete to the extent that Custody Health Services concurs with the recommendations.  CHS will continue to review the screening and assessment process on an ongoing basis to ensure that it reflects best practices.

    Budget Status: County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Healthcare Gap Analysis – Wilcox

    Responsible Department(s): Custody Health Services

    Master List Nos.: 574-575, 577-579

    Review Date: FGOC reviewed on January 26, 2017.​

    Steps Taken: The restraint policies have been reviewed, refined and implemented. The protocol for medical or behavioral restraints in the jail follow the same policy and procedures as VMC policy on physical and chemical restraints.

    This Summarized Recommendation has been completed.

    Budget Status: No additional resources are needed.

    Source Report(s): Mental Health Gap Analysis – Gage

    Responsible Department(s): Custody Health Services

    Master List Nos.: 627, 628, 629, 630

    Review Date: FGOC reviewed on January 26, 2017.​

    Steps Taken: The electronic medical record HealthLink system went live in May 2017. HealthLink is an integrated system that has the ability to update an administrative dashboard. Patients’ records on dental, medical and mental health are available in HealthLink. 

    With the implementation of HealthLink, caregivers are now able to securely and effectively view relevant patient information from all episodes of care to promote consistent patient care.  It also decreased paper documentation and replaced manual data tracking of information.

    Programming to capture metrics continue to be refined to accurately measure the effectiveness of healthcare delivery.

    A full time Quality Improvement (QI) manager for psychiatric/Mental Health services has been hired as of October, 2016 to be in charge of the quality management program of psychiatric and mental health for Adult Custody Health Services.

    Custody Health works closely with the Department of Correction to review critical incidents to determine if there were systematic issues that need to be addressed and, if necessary, make recommendations to reduce or eliminate the likelihood of future adverse events. 

    This Summarized Recommendation has been completed.

    Budget Status: The Board allocated $2.5 million as part of the FY 2016 Adopted Budget and $2.0 Million as part of the FY 2017 Adopted Budget for HealthLink to be implemented in Custody Health.

    County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Sheriff’s Jail Reform Plan, Blue Ribbon Commission on Improving Custody Operations, Mental Health Gap Analysis – Gage, Healthcare Gap Analysis – Wilcox

    Responsible Department(s): Custody Health Services

    Master List Nos.: 54, 56, 111, 571, 572, 591, 391, 392, 617, 622, 631, 635, 636

    Review Date: FGOC reviewed on January 26, 2017.​

    Steps Taken: Custody Health Services (CHS) has revised its triage guidelines regarding estimation of the time-sensitivity of an evaluation by an appropriate provider, in an appropriate setting, based on a patient’s dental, medical, and mental health conditions.

    All medical, mental health, dental, and medication history/records are documented in HealthLink to ensure that all CHS providers are aware of a patient/inmate’s needs.  

    CHS works with the DOC staff to ensure that inmates are made aware of their medical and dental appointments.  When necessary, CHS staff also explains the consequences of refusing treatment to encourage inmates to keep their appointment. To help remind inmates about their appointment and improve compliance rates, medical, dental, outpatient, and psychiatric appointments are being posted in inmate housing units one day prior to the scheduled appointment as of May 1, 2019.

    CHS is working on opening an optometry clinic at the Elmwood facility, and would work with the Sheriff’s Office to reduce the need to transport inmates to the Main Jail facility for optometry services.

    CHS will continue to monitor wait times for appointments and provide ongoing Quality Improvement reviews to ensure that inmates have timely access to healthcare.   

    ​The Sheriff's Office partially agrees to this recommendation, as some meal times vary for inmates in 8A-Acute Psych, SMI, etc. However, the facilities could not sustain the negative operational impacts that would result from a permanent change to the meal schedule. For example, court schedules, inmate hygiene, and out of cell activity/program time would suffer. To change the breakfast schedule would have an impact on weekly operations due to court schedules. Altering the lunch & dinner schedule would have an impact on out of cell activity/program time. The recommended changes also occur during shift change for deputies, so there will likely be an impact to staffing. This would also require a reorganization of food production services and an alteration to staff schedules and vendor deliveries.

    For the Sheriff’s Office, this summarized recommendation has been completed to the extent possible. Work is still ongoing by Custody Health Services.

    On October 22, 2019, the Board approved a third amendment to an agreement with South Bay Emergency Physicians Medical Group, Inc., relating to providing physician staffing services that also includes expanding medical services hours in the custody setting to twenty-four (24) hours per day, seven (7) days per week. The custody staffing services section of the agreement is for a total amount of $3,752,406.

    On December 10, 2019, the Board approved a referral requesting a plan and timeline for a Custody Health Services staffing study regarding provision of services in the County jails and recommendations for improving the medical and infirmary standards. Additionally, Custody Health Services, as part of the staffing study report, is conducting a benchmarking study of staffing levels for jails systems that are of similar size to the County of Santa Clara. The study should be completed by early Spring 2020 and a report will be submitted for the Board's consideration of the recommendations for the Budget Workshops in May 2020.

    Budget Status: The Board allocated $2.5 million as part of the FY 2016 Adopted Budget and $2.0 Million as part of the FY 2017 Adopted Budget for HealthLink to be implemented in Custody Health.

    As part of the FY 2020 Adopted Budget, the Board approved one part-time (0.5 FTE) Optometrist position to expand optometry services in the jail facilities ($96,663) and 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), and  added one Dietetic Technician  to effectively manage increased medical and religious diets ($101,426).

    As part of the Fiscal Year 2019-2020 Mid-Year Budget Review, the Board approved an ongoing cost increase of $1,381,406 in the budget allocation for overhead charges to the Custody Health Services budget for services provided by the Santa Clara Valley Medical Center Hospitals and Clinics.

    On October 22, 2019, the Board approved the Third Amendment to an Agreement with South Bay Emergency Physicians Medical Group, Inc, relating to physician staffing services that also includes expanding medical services hours in the custody setting to twenty-four (24) hours per day, seven (7) days per week. ($3,752,406). 

    As part of the FY 2019-2020 Mid-Year Budget Review, the Board approved the transfer of one-time funds in the amount of $750,000 from the Reserve to Implement Jail Consent Decrees to Custody Health Services budget to fund the agreement with South Bay Emergency Physicians Medical Group, Inc.

    As part of the FY 2021 Adopted Budget, the Board approved the following:

    • 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).

    • Elimination of the ongoing Reserve to Implement Jail Consent Decrees ($3,000,000).

    • Delete 3.0 FTE positions in the Food Services Unit: Baker, Dietetic Assistant, and Food Services worker ($313,696). The Food Services Unit will modify the staff schedule from 12 shifts to three shifts.

    • 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).

    • Delete 1.0 FTE Rehabilitation Officer II position in the Inmate Screening Unit to screen inmates for in- and out-of-custody programs ($181,738).

    • FY 2021 Adopted Budget: Delete 3.0 FTE Rehabilitation Officer positions ($545,214).

    • Transfer 1.0 FTE Chief Psychologist position from the Santa Clara Valley medical Center to the Custody Health Services Department.

    • Delete 2.0 FTE vacant Psychiatric Social Worker II position funded by Public Safety Realignment (AB109).

    • Delete 1.5 FTE Clinical Nurse positions.

    • Reduce ongoing funding of miscellaneous Services and Supplies by $205,894.

    • Reduce ongoing contract services funding supporting psychiatric 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

    As part of the Fiscal Year 2020-2021 Mid-Year Budget Review, the Board approved an increase in expenditure appropriations by $878,426 within the Custody Health Services budget to ensure around-the-clock medical services at the jails and increase expenditures appropriations for personnel to cover overtime in the Custody Health Services budget by $4.8 million.

    • February 9, 2021: Delete 1.0 FTE Rehabilitation Officer II position related to the Voluntary Separation Incentive Program as part of the Fiscal Year 2020-2021 Mid-Year Budget Review ($206,474).

    • February 9, 2021: Delete 4.5 FTE Psychiatric Social Worker II positions 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).

    Source Report(s): Sheriff’s Jail Reform Plan, Blue Ribbon Commission on Improving Custody Operations, Healthcare Gap Analysis – Wilcox, Human Relations Commission

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

    Master List Nos.: 112, 172, 329-331, 389-390, 395, 397, 607, 609, 612

    Review Date: FGOC reviewed on January 26, 2017.​

    Steps Taken: 

    The Sheriff's Office agrees with this recommendation and believes that group therapy will aid in the stability of the individual during incarceration and during re-entry into the community. 

    On September 26, 2017, the Board approved an amendment to the agreement with Traditions Psychology Group, Inc., which increased the maximum contract amount and extended the agreement for a 24-month period to expand the number of psychiatry hours in the Intake Booking area from 16 hours day, 7 days a week to 24 hours day, 7 days week.  The addition of psychiatrists to the Intake Booking area 24 hours day, 7 days a week will provide essential psychiatric resources to provide timely responses to those screened and triaged by nursing staff and mental health clinicians to need psychiatry services immediately.  The psychiatrists will provide psychiatric treatment to inmate patients with urgent mental health needs, such as those with suicidal thoughts and plans as well as to continue treatment for those who were taking psychotropic medications prior to incarceration.
     
    The Sheriff’s Office (SO) and Custody Health Services (CHS) agree with this recommendation.

    CHS has implemented a two-tier triage screening at Intake Booking.  The initial screening is conducted by a registered nurse who takes individuals through a series of standardized intake admission and screening questions while obtaining baseline vital signs.  Those assessed with a severe medical condition are sent to the hospital.  Those assessed to have an increased risk for medical or behavioral needs are referred to a medical or mental health physician or a mental health clinician for further evaluation.  Following the evaluation, a treatment plan and discharge planning are initiated based on standardized protocols.

    Both mental health and medical staff are available at Intake Booking twenty-four (24) hours a day, seven (7) days per week.  Staff includes registered nurses, mental health clinicians, and psychiatrists.  The psychiatrists provide timely responses to inmates with urgent mental health needs, such as those with suicidal thoughts and plans, and continue treatment for those who are taking psychotropic medications prior to incarceration.
     
    The CHS staff provides the Classification Unit (CU) staff with recommendations regarding housing.  During the intake and reassessment interview, the CU staff asks inmates if they need Mental Health services.  Since December 2016, the Mental Health staff has been conducting weekly visits to the restrictive housing areas to check for decompensation among the population. 

    The SO Programs Unit, CHS, and various contractors provide programs for inmates to participate in during their out-of-cell time.  CHS provides programs that are beneficial for inmates’ mental health and focus on rehabilitation efforts.

    The Supportive Transitional Empowerment Program (STEP) provides linkage to services and resources, case management, transportation, temporary housing/shelter, food, medical/dental resources, education, job/skills training, and other re-entry services with a goal to ensure a warm hand-off to the STEP team in the community.  STEP consists of a team of six (6) substance use counselors (4 in-custody and 2 community-based), a clinical Lead, and a Program Director who have been contracted to provide in-custody and post-custody substance use treatment services. 
    The in-custody STEP team provides inmates with substance use screening, treatment engagement, psycho-educational groups, and linkages to community services.  STEP also offers Living in Balance and Open to Change curriculums each week.

    CHS adheres to the California Lanterman-Petris-Short (LPS) Act standards and assesses patient eligibility for conservatorship when appropriate.  All CHS policies and procedures, including PREA, are continually reviewed and revised by Quality Improvement Managers to ensure that they reflect and are in compliance with the most up-to-date mandates and best practices. 

    CHS also developed a screening policy for suicide risk, implemented a suicide risk assessment tool, and conducts monthly meetings with the Custody staff to review critical incidents to determine if there are systematic issues that need to be addressed, and if necessary, makes recommendations to reduce or eliminate the likelihood of future adverse events.  Findings and/or recommendations may also be forwarded to the Suicide Prevention Committee for policy recommendations or implementation of recommendations when necessary.

    As part of the Administrative Management Policy, inmates that are placed in Administrative Management housing are immediately referred for a mental health screening that shall be completed within 72 hours of placement. Additionally, inmates who are identified as having an excludable diagnosis shall receive a minimum of 14 hours of out of cell time and also receive individual and/or group therapy sessions with Mental Health staff.

    On September 24, 2019, the Board approved the third amendment to an agreement with Traditions Psychology Group, Inc., relating to providing psychiatric physician services for County correctional facilities, increasing the maximum contract amount by $1,028,256. Additionally, on November 19, 2019, the Board approved the fourth amendment to the Traditions Psychology Group, Inc. agreement to increase the maximum contract amounty by $17,173,902 and extend the term through September 29, 2022.

    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.
    • 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 the teams noted above.
    • FY 2017 Adopted Budget: 6 Rehabilitation Officer positions and 1 Senior Management Analyst ($1.1 million) for programming and discharge planning.
    • FY 2018 Adopted Budget: Added new Psychiatrist position to provide on-site clinical oversight of behavioral health services, and Hospital Services Assistant position, 2 Clinical Nurse III positions, and one Staff Developer position to support jail reform efforts ($1.4 million).
    • January 23, 2018: Added new Director, Custody Behavioral Services Positions, in Custody Health Services to provide oversight of all Custody Health behavioral health staff and services.
    • May 1, 2018: An amendment to an agreement with NAMI Santa Clara County related to expanding Warmline/Help Desk services for Santa Clara County residents for a 12-month period through June 30, 2019 in the amount of $235,700.
    • FY 2019 Adopted Budget: Added 4 Clinical Nurse III positions ($791,976), 2 Sr. Psychologist positions ($494,908), and 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: Adjustment to the funding for the Custody Behavioral Health Teams by increase the Salaries and Benefits budget by $2.6 million. 
    • FY 2019 Adopted Budget: Added 8 Sheriff Correctional Deputy positions to be assigned as part of the Behavioral Health Team in the Multi Support Unit and 1 Sheriff Correctional Sergeant position to be assigned to oversee facility-wide out-of-cell time and restrictive housing for Main Jail administration ($1,454,527).
    • 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).
    • FY 2020 Adopted Budget:
      - Added one 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). 
    • August 27, 2019: Adopted a salary ordinance adding one Chief Psychologist position to lead the Psychology Team in the planning, implementation, and evaluation of treatment modalities ($258,641).
    • FY 2021 Adopted Budget: 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).
    • FY 2021 Adopted Budget: 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).
    • FY 2021 Adopted Budget: Delete 4.5 FTE Psychiatrist positions, which are difficult to fill and have been vacant for several years ($1,453,693).
    • FY 2021 Adopted Budget: Delete 4.0 FTE Psychologist positions, which are difficult to fill and have been vacant for several years ($846,826). Custody Health Services will modify the treatment programs and coverage to provide enhanced care for inmates.
    • FY 2021 Adopted Budget: Delete 1.0 FTE Rehabilitation Officer II position in the Inmate Screening Unit to screen inmates for in- and out-of-custody programs ($181,738).
    • FY 2021 Adopted Budget: Delete 3.0 FTE Rehabilitation Officer positions ($545,214).

    • FY 2021 Adopted Budget: Transfer 1.0 FTE Chief Psychologist position from the Santa Clara Valley medical Center to the Custody Health Services Department.

    • 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).

    • FY 2021 Adopted Budget: Reduce ongoing funding of miscellaneous Services and Supplies by $205,894.

    • FY 2021 Adopted Budget: Reduce ongoing Contract Services funding supporting psychiatric 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.

    • February 9, 2021: The Board approved a salary ordinance deleting 1.0 FTE Director of Custody Behavioral Health Services and increasing the salary range for the Director of Custody Health and Custody Behavioral Health Services position by 7.7 percent.

    • February 9, 2021: Delete 4.5 FTE Psychiatric Social Worker II position ($762,089) and 0.5 Staff Developer position ($116, 608) within Custody Health Services relating to the Voluntary Separation Incentive Program. 

    • February 9, 2021: Delete 1.0 FTE Rehabilitation Officer II position related to the Voluntary Separation Incentive Program as part of the Fiscal Year 2020-2021 Mid-Year Budget Review ($206, 474).

    • 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).

    Source Report(s): Sheriff’s Jail Reform Plan, Blue Ribbon Commission on Improving Custody Operations, Mental Health Gap Analysis – Gage, Zisser

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

    Master List Nos.: 44, 47, 52, 53, 101, 102, 123, 394, 396, 518, 616, 618, 620-621, 623

    Review Date: FGOC reviewed on January 26, 2017.

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