Recording in progress.

All right.

So good morning, everyone.

You started with a joint meeting of uh the health committee and public protection committee.

Clerk take the role.

Supervisor Town.

Present.

Supervisor Miley.

Here.

Supervisor Marquez, excuse.

Right.

Any instructions we need to provide?

No.

Okay.

Right.

So we have one agenda item this morning.

And it's an informational item.

Okay, first, yes, last, a progress update.

Good morning, Chair Miley, Supervisor Tam.

Thank you.

It's a pleasure to be here today.

What you have, my name is Dr.

Karen Tribble.

I'm the behavioral health director of Alameda County, and I am pleased to be here representing first our department, but also a system effort.

So today's item is the Alameda County Care First Jails Last Progress update that your board has asked to have an update.

And I acknowledge that there is so much more than our department.

There are many different stakeholders and colleagues involved in this, and I've been asked to start the process just to lay the groundwork in context before we begin.

Next slide, please.

As you know, your board unanimously approved the resolution to begin this process to describe Alameda as a care first jail's last county.

And it actually stands on the back of many of the efforts and your advocacy over the last several years.

The Care for Shields has process ultimately created a task force that developed 58 recommendations that came before your board in August of 2024.

And as you know, you delegated the county's mental health advisory board to monitor the implementation and track as well as support the efforts through all of the departments and also directed our board, our department to conduct a cost analysis, funding resources, and work to support the integrated county plan once that work is underway.

Next slide.

So the next couple of slides is just an overview.

I'll do that briefly before I hand it over to our other colleagues.

Next slide, please.

So the context to this is again to highlight some of the intersectional elements, some of the other initiatives that are currently occurring, and some of the community stakeholders and advocates that have been fundamental in support and follow through for your leadership and the work that's been occurring to date.

Next slide.

Essentially, essentially a gaps analysis of what all of the system looks like.

Alameda County is unique in that it created two additional areas of focus.

So aside from the typical six, where you have zero to six in terms of the strategies and the sequential areas, it added intervention and support and earlier intervention, which we'll go through now.

Next slide.

So the two models that Alameda County added and believe that it would be important to do based on those hundred stakeholder meetings was to include prevention as an intercept negative two and early intervention, which is intercept negative one.

And again, that is slightly different than the evidence as evidence-based model because those that convened at that time, many of us who participated believe that Alameda County wanted to be ahead of some of the issues and not only provide throughput but also path forward to decrease the number of individuals that are just as involved or that need support through the system.

And so as you can see, beside those two community services, law enforcement, the initial court hearings, detention, jails, courts, re-entry, and community corrections.

And again, that's intercept five.

So the highest being five, the lowest at the time that was developed in the model was negative two.

So ultimately, that map helped to launch more strategies that the county engaged in to move things forward.

Next slide, please.

And following that, in early 2018, your board also approved the development of the Justice Involvemental Health Task Force, many of which uh some of the members of the community as well as uh the counties are involved today and are present, and that interdisciplinary team was involved to help make a recommendation to policymakers, yourselves around what would truly help to improve the system right resources and individuals.

And so that Justice Mental Health Task Force also identified some recommendations that also included county and statewide coordination.

So that also served as the basis for which uh some of the efforts continued through today.

Next slide.

Um as you know, there was also um a lot of activity in the behavior health space, and as you recall, you your board also directed in May of 2020 the forensics plan that was created and developed by our department, which synthesized some of the work that you saw before, the advocacy, the feedback, the direction your board had provided us, and then also synthesize the recommendations from Justice Mental Health, excuse me, the Justice Involved Task Force.

And so that created and yielded a plan that the department used to chart its efforts specifically.

As you also know, uh former Chief Wendy Still from probation was also charged by our former board leadership to develop and spearhead the Alameda County Reimagine Justice Initiative, which you're also familiar with.

So again, all of these are intersections and develop developed a lot of opportunity for interagency planning and so forth.

And that particular work also included more to specific recommendations regarding data sharing and what the county could actually do to support the system-wide effort.

And finally, uh locally in Oakland, there was a specific call for a youth justice report, which was commissioned and completed in 2023.

So that work also contributed to some of the work, although most of what you see here focused on adults, but again, it did fit with the county's earlier intervention and prevention type of approach, starting early.

Next slide.

So there are so many concrete deliverables and outputs that occurred as a result of your direction, the work, the interagency uh planning and everything that has uh created the system to date, including the creation of navigation centers system-wide, um, both sponsored by many different types of departments, but those exist today.

The expansion of services, increased interagency coordination, capital expansion and facility projects, and some of which you'll hear today from various departments and agencies, and at the end of the day, increased quality and results-based accountability.

So our hope today is that as we provide an update regarding the recommendations made by the Care First Care Just Task Force, that the broader panacea and the work and their advocacy and efforts have actually yielded some programming changes even to date.

So with that, next slide.

So the African American Wellness, how does we call it or here resource center?

So GSA has the request to award the design build entity contract.

It is posted on tomorrow's board agenda for award for construction.

And the African American Wellness Council will present to the health committee in November.

Do you want us to uh ask questions as we go along or when we completely finish?

Well, ask questions as we go along, or when you completely finish all of this.

You can ask questions if you'd like.

Okay.

So just a quick question on the African American Wellness Hub.

It's coming to us tomorrow for the building, but um just a few questions.

In the meantime, how are the the clients or some of the patients?

How are their needs being met?

And then I know there was a lot of community feedback about having family members and people with lived experience as part of that council, to um make sure that we have the adequate services at the wellness center.

Do you know where that's at?

Thank you.

Yes, I'm happy to answer that.

Uh so since the initial conceptualization of the hub, uh, our department has funded several different projects, one as centers, also a training and other initiatives, and some of that work is uh through I don't want to call out well, Black Men Speak, there are different projects that are working, as well as uh setting up and creating training pathways to actually train from the highest level psychiatric practitioners to how to treat appropriately culturally appropriate to case management and outreach workers.

So those programs have um have been co-created and continue.

Um, and then you asked about the family member uh process.

The hope is that on the wellness advisory uh committee that they will also be able to be uh infused and have uh support.

So the goal ultimately within the services is to move and transition the services that are already created, work with other agency partners, public health, uh social services, once the building is actually complete to have that stationed, and then build on the work that's already been uh completed.

But those are actually ongoing now and have continued uh now for about three years.

Okay, um, I'm sorry, did you did you cite the specific locations where some of the clients are getting services?

So right now, some of the services they're they're countywide programs, so most of them are concentrated in um Oakland, Hayward, some work in South County.

Uh for example, FERC and NAMI and other places are out in South County, and the training and such, many of which are virtual.

So those occur across uh sites.

Okay.

Uh the training of the actual providers beside the psychiatric providers that occurs for many different um organizations and is spearheaded through some of our psychological organizations that are testing that.

So that has actually Oakland and the unincorporated, so many different areas are covered there.

Different sites that are existing now, but there is no actually building quite yet.

So it's we've looked at it as an interim, the interim hub.

So those things are occurring at pre-existing locations within organizations and or virtual.

Okay, thank you.

Oh, thank you.

And I almost forgot, and there's intern programming already underway as well and training.

Good morning, supervisors, Captain Oscar Perez.

Uh my assignment's at Santa Rita Jail.

Um regards to safe landing at the San Rita lobby.

We've worked with our partners here at GSA and removing a large bench that was in the middle of the lobby area, and we are designating that area right there for roots, our partners at roots, and we've also re-keyed a large closet area, which is within 10 feet of that area, so they can put all their personal belongings.

That area right there is prime real estate at Santa Rita jail.

Um we also believe that individuals that are being released are best, they they are best suited to receive services right there in that lobby area.

100% of the individuals being released will have to pass through that area.

So we believe having that space right there it would best suit all partners involved.

Um we also would provide them with a space directly outside of the doors if they needed some space for some confidential seating.

When will the space be operational?

Because you know, it seems like we've been hearing about this for quite a while.

And I know I talked to Dr.

Noha monthly, and it just seems like this has been taking forever.

And I know that's not a roots' preference, but they're willing to give it a try to see how it works.

So when will this become operational?

Yes, I actually spoke with the supervisor last Thursday of Roots, and we are gonna try they are gonna put some desks inside the lobby as a trial period to see how this works out.

Okay, and then what about the um transportation contract?

We're currently having conversations with our partners at probation for a future RFP.

Because, you know, before um Roots was providing transportation, you know, the folks who were released would just wander around Dublin and we don't want that to occur.

I think we've corrected that problem.

We want to get people, you know, give them transportation so they can get back to wherever they need to go.

A lot of them are coming back here to Oakland, so we want to continue that transportation as well.

So we're those conversations right now are being had for that future, okay.

Just a quick question.

Uh on I know uh Dr.

Avalada's really a strong advocate on pre-release and re-entry planning.

Do you know uh whether we um would have access to the Cal Aim funding uh to help with some of this effort with uh especially the safe landing project?

I don't know.

I'd have to get back to you on that.

Okay.

Thank you.

What I can share about the Caling planning is that uh that planning is still underway and it's not expected to go live until July of uh 2026.

Um so you know, there's a lot of work to do in between then, but as the sheriff's office indicated, um there may be space for that, but it's a while away.

Good morning, everyone.

I apologize for my chartiness.

Um, with respect to the safe landing project um managed by Roots, is there going to be any coordination with the recently open diversion and triage center in Pleasanton managed by Horizon?

Do we know if there's no if there's a representative here from Roots or if we know if there's been any discussion about collab collaborating with respect to those efforts?

Thank you, Supervisor DeMarquez for the question.

Uh, the answer is yes, we hope so.

Uh, we understand that there is transportation and other things that are being worked through with the sheriff's office, um, but um our plan through the horizon and that program is to have it available for them.

From what I've heard, they've already had opportunity to work with those that are on the ground already as a potential resource and uh law enforcement has already utilized that service and support.

So we're hoping, will it be more?

Thank you.

Welcome back, Dr.

Triple.

Thank you.

Long overdue.

I apologize.

I should have been tracking.

Um so this recommendation that came from the um justice, uh excuse me, Care Force Jails last recommendations was around the um several questions at our mental health board and the and the the just the uh task force subcommittee ad hoc committee talked about.

And so some of those questions relate to what you see here.

So the first thing is where we are in terms of planning.

Um, there were many different questions and recommendations to use a particular provider and expand that provider.

So what has later been uh clarified uh to our uh community is as this is uh something that is part of behavioral services act program, and that it is not specific to one particular provider.

We hope to continue to support certainly all of the efforts, and we have already opted in to doing first uh episode early psychosis.

One thing is interesting is that it is a part of the BHSA requirements, and and the Department of Healthcare Services is requiring that there be uh modalities and standard practices and elements that uh will track fidelity.

So that is something we've already been doing Fidelity reviews internally on our own, and the state will be evaluating every county as we're implementing, because it is part of BHSA requirements, and that is effective July 1st.

So that program and anything we do in the future, whether there is additional or more different procurement processes will incorporate that.

The other piece that I'll acknowledge that is that the way that we have been approaching can now really consider individuals uh younger, obviously in the spectrum, but what the state is now evaluating is whether it can be used lifelong.

We're not as looking at it as, for example, a person who's 80 years old having a first episode or six years old because there's likely other organic and other factors at play, and we think that the outcomes that we've seen already are best focusing on earlier intervention, early first episode, our youth and maybe our older transitional age youth if possible.

But those are some of the work that we're doing.

So just reaffirming uh we had already committed to this process and will continue to do that work.

The other questions and related to the recommendations that you heard from our mental health board as well as the ad hoc committee was around the psychiatric beds, and the question and recommendation was that a gap analysis be completed.

So, this response that you can see on this is we have provided all of the reports and the elements of our studies to help us to contribute to where we saw the gaps, and so these are highlighting some of those.

I'll unpack them specifically and provide more concrete updates.

The state itself supported the a statewide analysis of what was missing or not, and essentially the report for the RAND study, whether one agreed or not with the context, is that there would be a delta, a lack of available beds by 2026, about 2.1%.

So that's what they believe.

They did not specifically look at Alameda.

So instead, what we did is we produced and provided to our mental health advisory committee and the task force ad hoc committee were around what we first started.

Our baseline was in 2015, which is our crisis services report.

We also provided reports relative to the development of our um the public FSP as well as the crisis reports that are posted on our website that we've also done.

And we also had a plethora of data available to us.

We had our information relative to psychiatric hospital 5150s, where they're occurring.

We also had the data before and after we've implemented expansion of creating facilities that could be receiving centered.

So we were really flush with data to that end.

We increased by significant numbers, which I'll show you on the on the next slide, please.

So based on the results, and I should acknowledge that we are we are very adept at evaluating our progress consistently.

So we will be continuing, particularly as it yields potential changes in January of 2026 when SB 43 begins.

Again, that changes the law for who can be 5150.

But to date, we um have added 83 locked subacute beds, they're under construction, 20 locked acute geriatric psychiatric beds, as well as locked medical psychiatric beds.

So that it well exceeds beyond the gap that the state believed that the Bay Area would have, and as a breakdown for us, um, we started that process at about 6% increase locally by adding an additional 18 beds at Villa Fairmont, and that occurred and started in about uh 2020 through 2023.

And that was a change because uh we had previously our pride leadership had um enabled private insurance to hold at least 18 beds at Villa Fairmont, so we purchased those back.

So we started that process, so that increase is already in inclusive, and that's about a six percent increase just with Alameda County alone.

It certainly does not include what other counties are or are not doing, but that's where we started.

Um if you look at the next slide.

Oh, I'm sorry, um, I will go back to our slide.

I apologize.

I think it's in um previous slides, but was specifically what that looks like is um we are now at about mid 200s between uh high 200s, 250 to 270 acute uh locked just subacute beds in our facility, and by 2029, we anticipate that additional 83 beds will be added.

So besides the six percent that we've already increased, that will give us a subtotal here locally of about a 30% increase.

So again, that far exceeds what the state believed the delta would be for Bay Area.

We are again there's no way that uh our progress will contribute to that.

And in fact, Alameda County will be likely because most Bay Aries do not have their own locked MHRC, will be a resource.

Um, and again, um that is us alone is an increase about 30 percent.

Thank you, Dr.

Trivel.

Yes, so um, so we won't have these 83 beds available until 2029.

No, we already have 18 that are available right now, and we're adding an additional 83 of the subacute and then 40 more that are available over the next um four to five years.

Okay, so we've got 18 now, 83 will be available when uh between by 2029.

So uh actually 83 plus 40.

83 plus 40 by 2029, correct.

So uh so are they coming online at different times?

Yes.

So it's not like 83 plus 40 will become available in 2029, they're coming on a cascading absolutely, yes.

And with different partners, Alameda Health System, with uh telecare and other partners, yes.

Okay, and then it's great we're we're exceeding the 2.1% threshold, but do you think that threshold will increase by 2029?

I mean, this is will we see the results that will diminish the need, or will we or will we see increased need?

So 2029.

That's a good question.

I I will say again, the 2.1% delta that the state expected would be was Bay Area, right?

And I believe uh there's a strong possibility that the entire Bay Area will need more of those beds, but again, locally for us, we have already started that work based on the analyses we had done.

So we've just locally increased right now six percent with an additional um 30 percent coming online.

So I think we will be solid.

The only thing that um is a huge factor that I have to acknowledge is with the shift from BHSA to focusing on more severely ill and the way that the other services will not be part of our system, we may see an increase in need, um, and unintended changes based on some of the legislative processes as well as SB 43.

So right now it appears will be way um overly resourced and likely uh other counties will look to Alameda to subcontract if possible.

We we want to hoard them locally first, um, but I can't predict based on those two factors BHSA transition as well as SB 43.

I'm not sure what that will do.

The data is still out, so we'll be doing additional gaps analyses once those processes happen.

Okay, because I know I'm gonna talk some more questions about that later on, the prevention piece and the other strategies, uh but let me but go to my colleagues on this particular item.

Anybody have any other questions?

Uh let me just follow up on um Supervisor Miley's question.

When we took back the beds from Villa Fairmont, uh Kaiser was obviously very concerned.

Yes.

And um, so you're saying that we we have we're over-resourced and we have adequate, but it sounds like um for them, they were kind of depending on those beds.

So where would they find those treatment beds that are needed?

They had already built another facility that is for Kaiser only patients in Alameda County.

And they also had typically count our most Kaisers don't have locked resources.

They utilize relationships with counties.

And so, but they did build a facility within Alameda County.

And they also had, I believe it took us about a year to transition.

And so all of those individuals are supported and placed in our neighboring partners or wherever count uh the private insurance, which is Kaiser can do.

So you're absolutely right.

Kaiser benefited from when we sold, or allowed our partner to have them, and based on our nerd, we'd increased and we have need of those, and they're being utilized today based on what we were seeing, the trends.

If someone is held on the 5150, is it likely that they would go to John George?

Or just does it depend?

It depends.

We have a number of uh what we call them uh receiving centers in the county.

For the most part, as a county um safety net, we utilize John George for the most part.

Um obviously if they're young and they're 5585, they go to Willow Rock for as a county.

Okay, and then um in terms of next steps, if they require a higher level of care, how is that care and coordination managed?

Is it Alameda Health Systems responsibility or ours?

I'm just trying to understand that the relationship.

And then um, who are you contacting in terms of placement?

Is there like a registry?

Just want to have a better understanding of the system.

Great question.

Uh so over the last several years we've become more integrated with AHS.

So obviously, we uh when I say we, the county through our department funds those beds.

Alameda Health System has also increased their own internal care coordinators and social workers at John George.

We have staff and critical care managers actually stationed at John George, and we've also created a number of programs that are designed for them to actually be able to direct admin to that program.

So there that starts first.

We also created an alert uh about three years ago that appears on any provider.

So whenever their uh adult person is um hospitalized, if they're a case manager or psychiatrist, they can have an alert.

They'll see first thing uh when they open their screen and alert that that person has been hospitalized, and so we've also created a pathway over the last three years for Alameda Health System to be able to look and see who is assigned and where, and so that's how some of that cross-coordination comes.

So they can actually again see who their care manager is, see who their program is, they can even see their last diagnosis and they can see um when they've last been treated.

So that's some of the work we've been working on last few years.

And what's that database that system?

They can look through uh the the archaic one was in CIS, but Clinicians Gateway allows you to see that in the background.

Thank you.

You're welcome.

Thank you.

And I will defer to our colleagues.

Thank you.

So I'm here um today to talk to you about area 5A, also be available to answer questions about 5C.

Um, under the leadership of our district attorney, Ursula Jones Dixon, I've been tasked with um bringing CARES Navigation Center back to health and life, and I want to start today talking with you about this program.

So, as I'm sure you're aware, it was the first precharging mental health and substance use disorder diversion program in Alameda County and in the state of California.

This model did not exist before we built it.

It came into existence as a collaborative program with partnership with Behavioral Health.

We looked at programs not just within our state but across the country, visiting programs down south back east, looking at best practices.

We then brought what we learned back to Alameda County, looked at our needs as a part of the strategic intercept map process, the justice-involved mental health process, and we wrote a grant in 2019, which was successful for the navigation center.

It was planned to open in the spring of 2020, but we all know what happened in the spring of 2020.

We found an astounding partner at that time, La Familia.

They stuck with us through the trials and tribulations of having to redesign this program for the pandemic, and we were doors open in the spring of 2021.

When we opened it involved intensive engagement with law enforcement partners, we had a committee of police officers that we collaborated with in order to develop this model.

There was a hiatus of sorts where the program went through a great deal of flux where there was essentially no referrals or very few referrals over the course of two years.

My first day back in the office was March 3rd of this year.

And at the time that I'd arrived in that first quarter, we I lived by quarters because this is a hundred percent grant funded program at this time.

We had zero referrals in that first quarter.

In the second quarter, when I returned, our referrals went up to approximately seven.

We doubled that number in the third quarter, and we're in the process of expanding to a second facility in the south part of the county.

And we've we have a new community-based partner for the existing facility.

There's a picture up there of the exterior of the facility and the interior.

They're called the Uncuffed Project, and they're a new community-based partner for Alameda County, and I inherited that CBO partner for the expansion.

I'm hoping to return to working with La Familia because they have the bones that we need to rapidly build out the expansion.

They still have the mobile team that we work to develop together.

They have a database, a case management system that included the CARES Navigation Center model because we were partnering as they built it out.

They also retain the staff, some of the staff and institutional knowledge from the original build out, and so we're hoping to work with La Familia to build out the new location as it will expedite the doors open on that second facility and location that we're hoping will service South County, so Hayward, Castro Valley, that type of area.

So the program has come a long way since we've returned, with us working intensively with law enforcement officers, rebuilding trust and channels of communication with our police partners so that they will bring individuals into the navigation center.

As you all are aware, if an individual accepts the risk reduction plan, then we decline to charge the criminal case that brought them into the navigation center.

Many of the individuals brought to the navigation center also have other pending cases in the county.

We will take a look at those cases to assess whether they are appropriate for referral into collaborative courts as an additional incentive to help engage individuals with the work at the navigation center.

So we have this new location that really is servicing North County that's at 334 25 Market Street.

We've done high degree of work with our police partners.

When we first came into the Navigation Center, if you can believe this, they did not have any furniture for people to sit on.

They were using folding metal chairs when I got there.

We found resources within the grant to actually buy those recliners that are pictured in the photograph above, so that there would actually be true respite, seating, and comfortable accommodations for clients when they were brought into the navigation center.

And we had to engage in intensive training with our CBO partner because they were not clear on what the model was and the design and how to engage with the clients.

And so we've been able to significantly increase our referrals in the time that we've been back, and we hope to see more improvement in the coming weeks and months.

And again, as I've mentioned, we're in the process of working through our expansion.

Now I want to touch on a couple of other areas that are related to slide 5A and the topic 5C that the Mental Health Advisory Board asked us to comment on, which is our collaborative court programs.

As I mentioned in my introduction, I also supervise and oversee the collaborative courts work for the district attorney's office.

And so I just want to give a little bit of background to place collaborative courts in context because people throw the term around but don't really think about what it means.

So Alameda County was a pioneering department and jurisdiction in the area of collaborative courts.

We had one of the very first collaborative court or treatment courts in the country.

It was a drug court that started in about 1990 1991.

We helped to develop the best practices for what is a collaborative or treatment court.

Many of those best practices, after a lot of research and study, have been codified into manuals that you can find on the Bureau of Justice Assistance website, which is a federal website.

The model was expanded beyond drug courts to encompass other treatment like behavioral health veterans courts that all grew from that initial pioneering project that was a drug court.

These are it's a data-driven approach.

And if you engage in what we call in this work fidelity to model, meaning you do the things that have been researched and shown as successful, then you can reduce recidivism and reintegrate individuals into the community.

So we have historically had the most collaborative courts of any county in the state of California.

That's just been the way that it was.

We pioneered the model and then we expanded to these other types of collaborative courts at a rapid pace in order to reintegrate individuals into the community when it was safe and appropriate.

In recent years, there have been massive legislative changes, and you're going to hear from other partners who will talk to you about the collaborative courts and the numbers.

And these changes have resulted in other courts forming as a result of the legislation.

An example being mental health diversion, Penal Code Section 100136.

The formation of that court has essentially led to the cannibalization of the longstanding treatment courts that work towards fidelity to model and best practices and what is a treatment court.

So when you think about a collaborative court, we call it collaborative because every partner, the public defender, the DA, the judge, the treatment provider, has an equal say in the court, whether someone comes in, whether someone should be excluded from the court.

There's sanctions and incentives that are well established.

There's all these factors and variables that form the model.

These newly formed courts have zero model.

There are no, there's no collaboration, it's highly litigious.

There's it's a completely different structure.

And so because there's no case management, there's no collaboration, and there's no model, a number of individuals have elected to track down the 100136 court track as opposed to the long-standing treatment courts that have existed before.

That's one example, but there are numerous statutory changes that have impacted the collaborative courts and whether individuals matriculate into the collaborative courts.

In addition, we now have, you know, folks who are getting site released out of the jail.

There's not a lot of incentive if folks know that they're not going to have any custody time on a case for them to elect treatment, which could be longer than if they just dispose of their case.

Probation on misdemeanors used to be three years, it's only one year.

Probation on felonies used to be five years, it's only two years.

As these things have changed in recent years in the law, it's reduced the incentives for individuals to elect treatment over just resolving their case.

And so that's impacted our treatment courts.

And so I just wanted to put that into context as you're thinking about the numbers and treatment courts as you're hearing and learning about whether they're up or down.

There have been a lot of legislative changes that have impacted the viability and suitability of our collaborative court programming and models.

Lastly, I just want to update you all on our data.

One of the key pieces that our partners wanted to hear about, the mental health advisory board is the status of data.

So when I left the office in December of 2022, there was no data and analytics division.

Now there is a data and analytics division that is developed in recent times and under the leadership of our current district attorney, Ursula Jones Dixon, we're expanding that division, adding staff in order to improve our data work.

One of the challenges, and I think this is important for folks to understand is we have a native system, which means it was built here in Alameda County, and it is a case management system.

It was not designed to provide data reports to the community.

So we have to employ skilled data analysts who can write code in order to draw out the data that's being requested by our partners, and under Ursula Jones Dixon's leadership, that's exactly what we're doing.

We're bringing on data analysts who are able to write the necessary code, and so right now we're in that building process, and we hope to be able to continue to collaborate with the Office of Collaborative Court Services with our partners in probation and the Sheriff's Department to build a robust, reliable and accurate data reporting system for our county in this space.

And so that's also moving rapidly.

We've already expanded the team since I returned and added an individual focused on collaborative courts data, but there's additional expansion that's planned for the future.

So I will end on that update on our progress with data.

Thank you.

Thank you.

Thank you for the presentation.

Yes, thank you.

Um I really appreciate the updates with respect to having a data analytics division that's going to be key moving forward.

Can you highlight, and I don't know if you could disclose this yet, but do you know the location specifically for the second CARES navigation site?

We do not, we're working on it.

Okay.

And what's your timeline?

Is the goal to have that open in the next six months, nine months?

Do you have an estimate?

So part of why I'm going with the partner I'm going with is to speed it up.

So we're shooting for January.

Great.

I will just flag on the record.

I'm really happy that Alameda County has been successful in securing Prop $1.

But if you look at that, a substantial number of that funding and services and programming is coming to the city of Hayward specifically.

That is a lot for one community to absorb.

The community is open and willing to receive the services.

I'm just going to respectfully ask that we coordinate.

So we've had meetings with City of Hayward staff, Behavior Health Services, plan to have meetings in the future with BACs, but there's just significant programming coming to the Regis Village as well as St.

Rose Hospital.

So we want to make sure we're in constant communication with leadership, local leaders as well as law enforcement, just so we could have clear communication, and and I'm I am going to flag contracts are going to be key with respect to like security.

Like what we say we're doing in a contract has to be done.

So I'm not saying it hasn't, I'm just putting it out there as the supervisor that represents Hayward.

It's really important to me that we do this right.

I don't expect us to live in a bubble.

There are going to be incidents, things are going to happen.

That's just life.

It's going to happen in any community, but I do want us to be proactive and have lines of communication so we can mitigate some of those challenges.

And thank you for that, Supervisor.

I just want to comment that one of the cornerstones of the program and the training we give to law enforcement is that we're not interested in them bringing their problems to a city where they weren't before.

It's a part of the training.

Knock on wood.

Basically, this was piloted or built out in Oakland, and we've been able to say that clients coming into the community have not created a requirement, for instance, for OPD to come back out and have to address an issue.

It's a part of the model, so I hear you loud and clear in terms of the location and the need to make sure that we're not pushing more problems out into a community.

Thank you.

Thank you.

Thank you for that update.

I am so pleased that you know, under your leadership, we're getting the referrals where we have the partnerships with law enforcement to get them because the one navigation center and Fruitville, I think they closed, and I I don't even know what ever happened to the funding.

They kept saying it wasn't enough funding, but they weren't getting referral.

So in terms of like you talked about the grant funding and the sustainability of that program, which is really important to make sure that we we have the operational, not just the capital part.

How do you see that panning out?

So to be clear, um, especially the original location was extremely underfunded.

La Familia, because they're a dynamic group, leveraged other pieces of their organization.

They wrote companion grants, which we partnered with them on to fill the needs gap with the original navigation center.

Those same struggles continue to exist.

And so we've had to be creative and innovative in terms of meeting the need.

Um, and that's a part of the conversation that I'm having again with La Familia for the expansion piece.

Back um, I want to say it was spring of 2022.

I came to the Board of Supervisors about the funding piece, and there was actually a board letter committing finding nine million dollars to fund CARES Navigation Center and the expansion because we did not have grant funding at the time.

Obviously, there was a lot of change that occurred.

Um, there was the application for and the acquisition of additional grant funding that will bridge us until 2028, um, but we're definitely gonna be coming to the board to the county, talking about funding a revenue new streams for at that time, what will be two up and running facilities for the CARES Navigation Center, and it's always a fight to find the dollars.

Also, we had a lot of collaboration with our other partners.

Behavioral health had written us into the mental service, Mental health Service act for a small amount of funding for the original because it was so underfunded for the original um facility.

And so there were places that we went to and talking in partnership, and so it's a way that we can highlight for you that um part of the drive of this work and care first jails last was to get our departments working together more closely, and it's absolutely done that.

I'm definitely talking to Dr.

Tribble and Juan Taizan, who was a part of this process.

They built out an entire forensic division, and so that's constant communication.

The team over at the Sheriff's Department probation because we're trying to fill these holes and meet the treatment need, but the budget issue will be huge, and you'll probably be hearing from me in early 2027 about what's going to happen because the grant funds are drying up.

We were looking at federal grants, but because of, as you know, some of the immigration requirements, they're not suitable for our jurisdiction.

And so we're definitely going to have some challenges as we look forward for revenue streams into you know 28 and beyond.

Thank you for that.

Um that's a good point in terms of not qualifying because of the immigration uh status issues.

Yeah, I just want to say thanks for the uh the presentation.

Very thorough.

You you presented some things that I wasn't aware of, uh, which is very helpful.

And um I'm just really pleased because you've been back on board since March.

I've been back since March, March 3rd of this year.

Of this year.

I'm just very thankful that we have you back in the position because you know, you're you know your stuff.

Thank you.

We need to have good people who know their stuff, making things happen.

And I'm very appreciative that we have um uh Ursa Jones Dixon as our as our DA, and I'm confident that whatever um direction you need to make this work, you're gonna make it work, and we're we're here to support that.

So uh thanks for this um overview because like Supervisor Dan mentioned, you know, I didn't know what happened to the Frufail uh CARES Navigation Center.

Um it's just kind of been a disconnect.

So it's good to have have you back and working with everyone to drive this piece of the agenda.

So thanks.

Thank you.

Can I I also want to publicly thank you?

I should have started with that.

Sorry.

Want to thank you for the tremendous work and for sharing the historical context as well.

Thank you.

Thank you.

Good morning.

I'm Judge Della Piana.

I have the current assignment to handle most of the mental health courts for Alameda County, and I am here primarily to answer any questions that you all might have.

Um, as a representative of the court, I think uh my able colleagues from the district attorneys and the public defender's office as well as Almita County Behavioral Health and the collaborative courts uh will have the most uh information for you.

And as the assigned judge, I am the person who sees has the bird's eye view of all of the different mental health uh diversion courts or mental health related courts.

So I prepared this slide um with estimates from our best data, which as you heard, we're working on improving.

Um I did want to highlight what LD Lewis shared, which is there has been this significant shift to cases heard through mental health diversion because of the changes in the statute, and uh we do not have, unlike every other court where we are providing treatment uh as a mechanism to get some relief in one's case, criminal case.

We do not have any assigned clinical staff, even though, as you can see, it is both now, and this is a recent change, it is both now the um court with the biggest number of people coming in, uh, and it is a court where there are very, as the legislature has had us uh consider very serious felonies, uh violent felonies in this court.

So I just wanted to highlight that for you all.

It's a relatively new development, and I would say the lack of clinical staff is something that this body as well as all of the rest of us should be paying close attention to.

So happy to answer any questions as insofar as I can in my ethical capacity, but uh very happy to be here and grateful for this uh body paying attention to these important issues.

Any questions before I jump in?

Um I do have a couple clarifying questions.

Thank you, Judge, for being here, and good morning.

Um, don't expect you to have an answer for this.

It might be a team effort, but since we don't currently have uh clinical staff, obviously that is a barrier, and that what I'm understanding is the filings are really high in this court, which is good because we want to keep people out of Santa Rita jail, get them into treatment.

That is our goal.

Um are there any existing grants?

Um, is there funding that we're not tapping into that?

Uh the Judicial Council, as well as our behavioral health services might be aware of.

I'm not aware of any grants through judicial counsel.

The statute did not come with assigned funding.

Um, and the broader question might be a good one for others uh who are more in grant in other grant spaces.

Okay.

Um other than staffing challenges, is there anything else that you could recommend to us that we should be mindful of or considering as we continue to advance this work?

I think in the diversion courts, that's a significant, that's the most significant one.

Um as we get more granular, there are always things that we can improve.

There are, of course, the effects that not having assigned clinical staff have on the length of time someone spends in custody, the quality of the treatment plan we get, the likelihood of success uh in the program overall.

And I think that's why I wanted to focus and really highlight that particular issue, emergent issue.

Thank you.

Yeah, thank you.

Okay, so I'll go.

So thank you, your honor.

So yeah, I wanted to further go down that road with you.

So the fact that you don't have clinicians, um, what's the impact of that?

So uh I um Ms.

Regular from the Public Defender's Office, could talk more about what uh it's primarily what's happening without clinicians, is primarily defense attorneys finding through various paths, clinical resources, many of which are county resources, but um my sense is that it takes quite a bit of time in order for a defense an individual defense attorney to make those connections, find someone who can do an evaluation, find someone who can do a treatment plan.

I know the defense bar has been working to attempt to do that better and better, but the reality is that every other, as you as you know, every other court we have has clinical staff assigned to the court, which means that there's someone to do an assessment.

There's someone to evaluate whether this person is appropriate for treatment court or not, whether they're likely to succeed, whether they're interested in it, what their diagnoses are, um, what the correct treatment plan is.

I'm not obviously not a clinician and and couldn't guess.

I as the court rely heavily on clinical staff, and when we're short of that, um it changes what's possible, it changes the amount of time that someone spends in custody before they go to treatment.

It changes the outcomes, and and I do want to emphasize there's also a significant impact on victims.

Um I'm I'm having multiple court dates in mental health diversion when people who have been affected by a crime are coming to each of those court dates, wanting to say their piece, wanting to have a decision, know what's happening in the case.

Um I think that's a negative impact as well.

So those are just a few, again, my partners could say more about the ways in which the lack of clinical resources has affected uh this particular new burgeoning court.

And it's 220 current participants, uh 170 felonies and 50 pending.

Um can you just give me a sense of what the time frame of this is?

How long between the referral to mental health diversion and getting into treatment?

Is this for the calendar year?

Fiscal, you know, what what's just a point in time number.

Okay, okay.

Um, so that's uh I talked to the judge who had this assignment just prior to me, and she thought that was an estimate that is around accurate for the course of this year, and it has been building over the course of the past two years.

I see.

And then in your um opinion, how many clinicians do you think you need?

Um I can you can see how many clinicians we have for the other courts and the and the numbers there.

I I don't want to speak for the folks who would provide these resources, Alameda County Behavioral Health or the Office of Collaborative Courts, those are the two entities that we work with.

Um I think they'd be better suited to make an estimate, but um I think the other numbers provide a guideline.

Okay, so uh I'm seeing four for drug court, I'm seeing four for family treatment, and that's less than a hundred participants, so we're talking maybe eight, and we're talking felonies too.

So, um, I will say, going from as you all well know, uh when you have zero any increase is beneficial, right?

So I just I don't want this body to be daunted by uh the high volume uh but yes, I think I think you're on the right track.

So what's what what's the cost of a clinician?

Now, if you can't answer that, maybe somebody else can.

What's the cost of a of one clinician?

I don't know the answer to that, but I think Alameda County behavioral health will.

All right, so yeah, if somebody can come and help.

Sorry, I know that we have people already.

You've cued me up.

I appreciate that.

Um, so you so to your question, it depends, but anywhere between um about 200,000.

And so at the end of the day, um, as was mentioned, uh, the courts have already reached out to us, and though while we can't control legislation, we've already been thinking about since we have a whole system of care forensic diversion and re-entry, one ties and we're looking at is there a way, a path forward for us to combine the resources and and additionally support the mental health diversion now.

So again, we can't control the legislation, but we've been strategically thinking internally what we can do.

Because again, these are all of our joint uh clients.

Because before today, before L D mentioned what she mentioned about the diversion courts and now the mental health and the change in the law, and now hearing this, you know, wasn't you know, just wasn't registering with me, but now I think this is a serious concern.

Yes, it is, and that it is it's complicated whenever the new legislation, we've seen several keep coming out uh very rapidly without the funding.

But at the end of the day, we're trying to look at what can we buttress now, what can we utilize, we where do we have existing staff?

And so um Director Tizan and uh James Wagner, they've been talking and we've been looking at what are the available resources that we could support with.

Well, I really would like for um behavior health to come back with us, you know, to the to the committee.

I joint committee.

Any other questions call me up?

I'll be here, but I I do just want to say I'm so grateful as uh someone who has a very specific role in this whole process to have such excellent partners across the board.

We really are lucky in Alameda County.

Yes.

So I think it's gonna be important to come back to this joint committee with um some indication of how we can address this this problem of um the lack of uh clinicians and funding.

Because you know, maybe we can't get to eight.

Maybe we can get to four.

But the point is not having any based on the seriousness of this.

Is it, you know, it's a it's a both public safety issue uh that we need to try to address.

We agree, absolutely.

And I think we would probably do so obviously with our partners together, as we've been working on for sure, absolutely.

Yes, go ahead.

Good morning.

My name is Stephanie Regular.

I'm an assistant public defender and I supervise our mental health unit.

So I did want to alert um to funding that is currently available for diversion, and that's specifically for mental health diversion.

In this county, we refer to it as DSH diversion.

So those are the individuals who have been found incompetent to stand trial and prior to commitment to the state hospital, or excuse me, admission to the state hospital.

So our county had received a pilot or was part of a pilot program, and we had received grant funding for that program.

We were actually on the eve of or from my perspective, we were on the eve of signing the contract for a permanent program, which would have, in addition to providing funding for behavioral health, also provided specific funding to what's called the justice partners, and that was a million dollars each year over the next five years.

I have reached out to other counties who have already signed their contracts for their permanent funding programs with at least Sacramento and Santa Clara County, the full million dollars is going to the public defender office.

That of course would be significant in the amount of in the type of services the public defender office can provide to our clients, and that would include clinicians, dedicated attorney, and somebody who's tracking the data.

Similar type funding was allotted to the public defender office for the CARE Act, and it allowed us to leverage those funds to hire a full-time attorney, a full-time paralegal who is collecting all of the data for reporting to the state as well as a community outreach worker, the first one in our office, and it has been monumental in the type of work that our office has been able to do.

I was hoping that the permanent diversion funding would allow us to replicate what we are doing in care and providing true wraparound services to our clients and also collecting information about what's happening to our clients.

So that is funding that is available.

In terms of clinicians that are needed, because mental health diversion is um it's not a program where uh behavioral health is providing the treatment plans, it is solely the public defender that creates the treatment plans.

So the fact that there is no dedicated clinician does not mean that people are not receiving treatment, it's just that the public defender is the one who is the liaison between the court and the treatment provider to provide a treatment plan for the client.

And just going back to something that was said by the um the prosecutor, Miss Lewis about um mental health diversion overtaking our behavioral health courts.

So we have seen our numbers drop, and um Mr.

O'Neill is going to speak to this.

I believe the numbers with regards to the collaborative courts, the numbers have dropped significantly between our behavioral health court and mental health diversion.

I see that more as um, you know, I even though it is termed a collaborative court, there is still litigation that goes into any collaborative court.

Um, and even though there is a partnership, there is a veto power over who gets into the collaborative courts.

That veto power does not exist other than the court who makes the decision of whether or not somebody is eligible and suitable for mental health diversion, but it doesn't allow one party to say this person doesn't get treatment.

Um we see barriers in our we as public defenders see barriers in our collaborative courts to for mental our clients living with serious mental illness to receiving treatment.

That doesn't mean we stop trying to find treatment, it means we go a different direction.

And lately that has been mental health diversion that has provided the opportunities that we are not necessarily seeing in our collaborative courts for clients to receive services.

And did I miss it?

Uh, you said you did you get the million dollars or you didn't get the million?

We have not signed the contract yet, so um uh we had been negotiating the contract.

We at the public defender, the district attorney's office with under the former administration and behavioral health, had um gotten to a point where we'd finalized the language and were prepared to sign.

And then of course we had to change in administration and the contract is on hold.

So and this would be a million dollars per year for five years.

One million for justice partners each year for the next five years.

And that is just for justice partners.

There is additional funding for behavioral health.

Okay.

And then so once again, maybe I'm slow this morning.

So who you who are you signing the contract with?

So the contract is through the department of state hospitals and the entities within the county who would sign the contract or the public defender office, district attorney, and behavioral health.

Okay.

And we're hoping that that's going to occur.

Definitely hoping, yes.

Okay.

All right.

Um, Marquez or Dam, you have any questions of the public defender or the or the uh the judge?

No, I I appreciate the clarification and appreciate everyone's response.

Looks like we're looking how to advance to hopefully um, and everyone knows this is like my favorite term.

If you have any meetings with me, I believe strongly in a phased approach and want us to get things right, and so if we have to scale up, but we have to start somewhere is the whole point.

So I thank all of you for the coordination and the feedback.

Thank you.

All right, good morning, supervisors.

Brian Ford, Chief Probation Officer, Alameda County.

This is a uh pretrial update essentially, so in alignment with the county's uh goal to expand court-based aversion programs.

Back in July, the community corrections partnership approved uh $3 million in AB 109 funding to support a pretrial expansion.

And this initiative will provide case management services for nearly uh 2,000 medium risk individuals, and as directed uh by the full board, this represents uh truly collaborative effort among all of our justice partners.

Probation was responsible for drafting the scope of the uh scope of work, which was reviewed by the court and was distributed to providers uh back in September 8th, and proposals were due um on October 3rd.

Uh last Thursday, which was October 9th, two vendors presented their uh proposed models.

We engaged in question and answer process and began deliberations on which organization was best suited and positioned to carry out this important work.

The selection panel included representatives from probation, uh, the sheriff's office, the district attorney's office, the public defender's office, and the court.

We have not made any public announcements at this point of uh on which vendor is selected, but we do anticipate bringing a contract to the full board uh for approval by late uh November, November or early December, depending on the board calendar.

So we remain on track for um program launch by early January of 2026.

Um, want to thank you, Chief Ford, for your leadership.

Um, myself and former supervisor Keith Carson um authored a joint letter requesting pretrial services last December, kind of took a different approach than we wanted initially, but I'm just really thankful for your willingness to step up and bring the justice partners together to advance this critical work.

Um, I like the tight timeline.

Glad to see that a contract's gonna come back to us in November, but in the interim, do you know if anything's being done to track referrals?

Just want to make sure we're not losing people, referrals for individuals that would benefit for from free from pretrial.

Are we tracking those referrals?

Do you know if there's been any discussion around that?

So the court will be probably best suited to respond to that question because uh probation is responsible for supervising 125 high-risk individuals, the individuals that we are responsible for supervising.

We absolutely make uh referrals and connections to services.

The remainder of the pre-trial population, the court has been responsible as supervise for supervising.

So maybe they can speak to what they've done in the interim.

Okay.

And then could you before you step away, um, elaborate on?

I know Corey was instrumental in this work.

How has the collaboration and the touch points been with her office from with um Corey who represents the courts?

The court has been deeply involved in the process.

I mean, they helped to review the scope of work and provided feedback.

They were at the table for the vendor selections.

They even recommended some vendors to be uh considered for the process.

So the court's been involved throughout the entire study.

Okay, thank you for that working update.

Thank you.

Morning, supervisors.

My name's Gavin O'Neill.

I work for the Superior Court, and I manage the Office of the Collaborative Courts.

I've been doing that for about 12 years.

As you've heard from our justice partners, there's a number of different types of specialty courts that are dealing with mental health issues.

Under my office, I just manage the collaborative courts.

So that's what I'm gonna speak on today.

I think that really what I'm speaking on is the piece in the care first jail's last report that talks about partnering with the DA's office and the public defender's office on data that we're collecting in the collaborative courts, sharing that data and making it public-facing and transparent around outcomes and what we're doing in the collaborative courts.

I guess I want to say that I'm very familiar with collecting data in the collaborative courts.

So the collaborative courts are funded by about 10 different grants and contracts.

There's no like central state funding for this or something.

Like we're always hustling, always trying to find the next uh vine to swing to.

Um, and I always want to take the opportunity to thank Dr.

Tribble, the um ACBH is by far the biggest financial supporter of the collaborative courts.

All of those funding sources come with data collection and reporting requirements.

So I'm constantly doing reports to the feds, to the state, to local entities on our data.

And we have court-specific meetings with the treatment team in that court.

Like we'll have a meeting with the veterans court people, and we'll publish data dashboards that we're looking at in that specific court to look at the health of the court, who's getting in, who's leaving, how are people leaving, who's graduating, who's doing well in treatment, where do we need to adjust, um, what do we need to look at?

So, but in meeting with the mental health advisory board, who's been super helpful.

We've had many meetings with them.

Um, they've really been encouraging us to have uh some kind of public-facing report that the people of Alameda County can see, the board of supervisors, stuff like that, where I'm just used to responding to funders.

Um, those meetings have been really great, and then the DA's office, my partners in the DA's office and the public defender's office, have had two meetings to start to plan an annual report to do that.

We there they've been really good meetings.

We're looking at what we all believe we can collect and report on, what we do collect, what to stretch goal for us, who has what information, um, and we're putting together like the table of contents for that report and what we want to show the public or should be showing the public.

Um, next slide, please.

Oh no, sorry.

That's the end of my slide until we talk about data at the end.

Um, so I'm open for any questions or comments.

Okay, I don't think there are any, so thank you.

Thank you.

Good morning, Supervisors.

Jonathan Russell, Director for Alamina County Health Housing and Homelessness, providing updates on obviously some of the housing and homelessness related items that were selected by the Mental Health Advisory Board for Focus.

The first of those is the long-needed expansion of a coordinated entry access point at Santa Rita jail.

Coordinated entry being an access point language is our kind of front door of the homelessness response system where people can get assessed and connected to relevant services.

So we have we're underway of implementing a forensic access point to provide both in-reach services within institutional settings, including the jail, as well as mobile access services.

So services that can be in the field and meet people wherever they are at places like Care Court and others.

The goal, of course, is to ensure continued access to make sure everyone, whether it's site-based in one of our 12 regional access points across the county or at some specific institutional settings, particularly in this case the CareFirst Jill's last focus on the justice-involved population can get access to be assessed and connected to relevant services.

We're in the process of really looking at moving forward.

We've we've selected a provider that is providing those forensic services at care court currently.

They've submitted all the necessary materials to the jail in order to get access for the frontline workers and are regularly checking up, so that should start very soon in terms of their ability to provide those in-reach services at the jail to connect people to coordinated entry.

We've got a couple slides on quite different things, so happy to do all of them and come back to questions, or if any questions come up on this one as we go.

Okay, I'll keep it moving.

Next slide.

As was recently brought to your board last month.

We've launched a significant procurement process and selected a provider who will be operating a new expanded flexible housing subsidy pool.

This is going to serve to really create a core infrastructure to greatly expand the availability of long-term rental assistance for folks that are prioritized through our housing queue across the county.

This, of course, as you know, is the greatest need.

The greatest shortfall in our system is that long-term rental assistance to support people to exit homelessness and stay in housing long term.

Excited to do this in conjunction with expanded Behavioral Health Services Act investment through the behavioral health department and a forthcoming transitional rent community support through our managed care plan partners, Alameda Alliance and Kaiser.

That will be launching in January of 2026, and that is six months of time-limited rental assistance for everyone that is eligible, where the priority focus will be both in conjunction with the managed care plans and our behavioral health department is really going to focus on expanding subsidies for the behavioral health population of focus in the flex pool.

Currently, as you can see, who is in our queue for housing that is highly prioritized?

So for permanent supportive housing and long-term rental assistance.

In our current housing queue, which is as you see here, roughly the top 4,000 folks most highly prioritized for housing according to our assessment, according to our assessment.

85% of those individuals report serious mental illness, substance use disorder, or both.

So when we talk about expanding permanent supportive housing that goes toward folks that are prioritized on our queue, we are very much talking about this population of focus with wrapping around the behavioral health service needs and expand.

So we're excited that the flex pool in adding what will initially be in a thousand units that it's taking over from existing contracts and adding 250 units a year.

By units, we mean subsidies, that that will be directly impacting the need to expand these deep subsidies.

Next slide.

Shifting to focus on now the licensed boarding care recommendations.

Currently, in close partnership with our behavioral health department, HH manages the housing support program that funds licensed boarding cares.

And so right now there are 21 facilities, different sites that provide 350 beds total.

That's an expansion of three or four facilities just in the last few years.

Those sites are in Berkeley, Oakland, San Leandro, Hayward, and Fremont.

We currently use what we call a tiered patch rate.

So formerly there was tiers one through three, where those would successively get the rates would get higher as the tiers went up.

So tier three was our highest rate that was intended to serve to be able to fund services for folks with more complex needs, for example.

We've added an additional tier, which is really designed to provide a fourth tier, of course, a higher rate to really be able to support folks that have uh higher acuity needs.

We're consistently seeing in the past as part of the reason we created this, a need for comprehensive services that outstripped uh what uh current licensed boarding cares were able to provide.

So we're excited to have launched that additional tier.

We can we are regularly doing uh twice annually um RFP procurement processes through GSA to expand that portfolio for any interested partners.

Um we've just implemented as of January of this calendar year, the expansion of 40 additional uh licensed board and care beds through the behavioral health bridge housing funding from the state, and beginning in January of the next calendar year, there will be three additional licensed sites joining the housing support program related to care, specifically looking at, and we'll talk about some other capital expansion uh with CDA later, but there's a specific capital fund expansion that we'll be launching in the near future uh to be able to expand ideally two additional physical health care clinic sites, similar to our current trust clinic that operates in Oakland, and those are um frontline low barrier spaces where folks can come in and get medical care and get comprehensive support, including really those sites being able to function as a medical home for folks experiencing homelessness.

So we're excited to expand uh potentially two additional clinic spaces with a portion of the capital funding through the Home Together Fund in the coming months as well.

Before we go to the pass it off here to our partners in CDA, there was another uh update I wanted to mention, as we were directed, not necessarily selected by the mental health advisory board, but had been a significant uh growth in our interim housing.

So there was also a recommendation to continue to expand our interim housing, including non-congregate that is settings where folks can individually be on their own room as a family or an individual.

So very excited that the behavioral health bridge housing funding we received from the state allowed us to expand 200 beds over the past year of non-congregate interim housing dedicated to folks with behavioral health needs, working closely with our partners at behavioral health, uh, prioritizing care court participants for that housing.

And as you know, we released a request for information and proposals earlier this year, several months ago, to expand interim housing, non-congregate interim housing across the county, and are excited that in the next uh several months there'll be just about 300 new beds that will be coming online.

So also seeking to expand the residential facilities in that way.

Questions?

Um thank you for that presentation and uh and the optimism of bringing more beds online.

I I just need to uh understand the buckets of funding, obviously.

Sure.

So when we had approved uh or allocated back in December of last year, the $390 million dollars in measure W, and then just recently last month, we um earmarked $150 million dollars in that contract with a bold for the flexible pool.

Um, those funding sources, as you mentioned, they're basically for the coordinated entry to place people that are unhoused and with varying levels of support.

But when I talk to the folks in the probation department and some of the community groups like La Familia, they also receive funding through the county and through probation for boarding care and also like, for example, La Familia is purchased some homes in San Leandro with the intent of using it for just as involved individuals.

Where are those pockets of funding coming from?

So our funding is as always, of course, a combination of a variety of sources.

So I can't speak specifically to the specific um funder or program that uh in this case La Familia might be referring to.

Um, but our funding is is a variety of sources.

So the funding that is um expand funding the housing support program for licensed boarding cares is funding from the behavioral health department that H administers to manage that program.

Uh as you mentioned, the funding for the flex pool that will be over the course of five years, it's kind of an up to amount.

That will be a variety of funding sources.

So BHSA, Measure W will be a portion, transitional rent benefit.

So it'll be a mix of those.

Um, as you mentioned, uh our probation department also does fund transitional housing beds that we work very closely and coordinate with them on as well.

We're in discussions about uh as we move forward and the county expands its investment in interim and transitional housing, potentially having a coordinated and consolidated process where we would expand our partnership and administer more of that potentially in the coming years.

But we work very closely, you know, wherever the housing dollars are coming from and whoever's contracting to make sure we have an organized system of delivering these services.

Um but I don't I don't know specifically those La Familia beds and who they might be contracting with at the county.

I I appreciate that.

Um do you happen to know collectively how much um housing funding is available with all those buckets that you mentioned?

Um because like 150 million the flex pool you said comes from multiple sources, which a bold will help try to navigate to make sure that there's appropriate uh placements.

But do you do you know collectively between behavioral health and probation and measure W, how much collectively we are spending on housing?

Sure.

Yeah, I will I can give you the most recent data we have kind of are the completed fiscal year.

So in the in the our most recent uh report, our home, the current home together plan, we do annual progress reports that track all the finances across the county and all the partners very closely, in addition to the beds and inventories.

Uh in that most recent year three report.

So we're working on year four, so this is the 22, 23 fiscal year we're doing 2023-24 now, was 435 million dollars was spent on homelessness across the county.

So that includes the county departments that fund homelessness, that includes all of our city partners, that includes also grant funding that might come direct to CBOs or philanthropic funding.

219 million of that spending uh was awarded to one or another, uh came through the county, and the balance of that came through our city partners.

So that's the that's the kind of overall map.

And to your point, that's about 60 different funding sources that make up that that total going to, you know, 15 to 20 different uh entities at the city and the county level.

So we have a, I know, you know, since um at the time OHCC and HH has been created, you know, the desire was to at least on the county side to create uh to consolidate and reduce some duplication and really create, as we do for other departments, kind of a home for all things homelessness.

And I will say, though, we continue to have uh partnerships with SSA, for example, and the probation department where funding dedicated to homelessness, we will administer it on their behalf.

So there's also the question of where does that funding start in terms of where is it awarded through the feds or state contract, and then who's actually administering as a part of the system?

So uh we we do, and I think we have over the years.

Alameda County has coordinated more of that funding, but those are the rough total and annual amounts, and that will change with Measure W in terms of the amount of annual investment.

You know, our hope and concern is that with federal reductions, with city structural budget deficits, we won't see fall off in federal and local funding so that that expanded home together fund each year can actually be additive, and we can be over that number of annual investment.

Um but there are some real unknowns right now and potential deep cuts from the from the federal government specifically.

Thank you so much.

Good morning, Jonathan.

Good to see you.

I apologize.

You may have mentioned this in your presentation, but I didn't note it.

So I want to just be clear.

Um, you talked about the tier four, and there's also uh in your PowerPoint presentation beginning in January 2026, addition of three new licensed sites are coming online, which is great.

Uh, how are those funded?

Is that uh combination of Measure W, A1, just help me understand.

I know you mentioned the multiple 60 streams of funding sources, but specifically to licensed boarding care facilities.

Yeah, so the housing support program and the licensed board care facilities is funded through funded through the behavioral health department that we administer on their behalf.

So that's expanding the investments through that specific program that are these are licensed residential settings.

Um, and so it's a program that we administer, and that funding comes through the behavior health department, which I believe is going to be primarily BHSA going forward for the licensed boarding care.

Okay, I'm glad to see we're expanding, but are we aware similar to a year ago we were outreached that there were um a handful of shelters that were at risk of closing within Alameda County due to funding reasons we were able to administer one-time mini grant.

Are we aware of any similar situations when it comes to our boarding care facilities being um on the verge of closing?

Yeah.

It's a great question.

And it's important to, I mean, I think the short answer is yes.

Uh in the past decade, uh, we've seen um hundreds, really hundreds and hundreds of of boarding clares, boarding cares uh close up shop often due to you know financial uh reasons of the funding not working.

Um this is a much larger problem than this individual program.

This program I think represents the best of opportunities for licensed boarding cares because it's a robust patch as we call it, which is a supplemental funding that the county will put toward uh a bed at a facility to make up the gap of what's not being funded by the portion of SSI based kind of in the standard boarding care program.

So this is just a small portion of the boarding care beds we have across the county.

Um so we are seeking to expand that, but it is also um really dedicating those beds to it to a target population to coordinating with the county for matching to referrals to the behavioral health department that not all boarding cares might have a preference for.

Um but there I don't have a specific number, um, but there are, you know, as we've seen across the the state and the nation really the huge shortfalls in these programs that continue to close.

So there is great need, um, and there is a a variety of providers.

This is part of the reason that the county funded the supportive housing community land trust or Shikla uh years ago, and that contract has been extended through 2026 as well to kind of create a land trust model for this uh model of supportive housing and licensed boarding cares.

But um I think there are similar needs, um, though we don't have a direct relationship with a lot of these individual licensed boarding cares to have a sense of the number the same way we have with some of our shelters.

Okay, I'm hoping we could change that.

I think it's gonna be really important as we continue to have uh updates with respect to uh the outcomes of Measure W funding.

I think this is a huge part of the equation.

We're doing our best to um adopt the home together plan, but this is a critical component of it as well.

So thank you for your work.

Oh, yes, thanks for the presentation.

Could we go back to the first slide under strategy area seven?

7B.

Okay, great.

Okay, so the goal is to ensure any Alameda County resident who is unsheltered can be linked to full array of existing and new housing and services available in the continuum of care.

Okay.

And we're talking about point in time count, about 10,000.

10,000 at any given time.

Our annual data shows so over the course of a year, roughly 25,000 people receive services in our system, 18,000 of those being homeless.

So that's you know rough numbers, about 18,000 people a year needing some kind of housing resource not already being housed, for example.

Okay.

And then of that 18,000, the next slide.

Is it 4,000 of the 18,000 that the third bullet down?

Yes.

Who are experiencing who are homeless or experienced 85% of that are uh have serious mental illness, substance use disorder or both.

So it's 4,000 of that 18,000.

So the 4,000 is the subset.

If we imagine the 18,000 individuals, if they were all assessed, for example, and they're not, not everybody would get a coordinated entry assessment or be prioritized.

We have a triage process where we're not trying to send people through countless assessments to answer myriad questions about their lives, many of those admittedly invasive, like talking about past experiences and trauma and diagnoses.

So we do a process where we triage individuals before we identify this would be meaningful to do a housing assessment because they would likely be prioritized for housing.

So this would be the we can call this the top 4,000 of folks with the highest needs.

That's by no means exhaustive everyone who needs housing.

It's just representing those that based on our threshold scores, we would prioritize for permanent supportive housing.

So it's showing that that highest band of need has significant overlap with uh self-reported behavioral health needs as well.

But it's part of that 18,000 universe.

Correct.

Um this the 18,000, not all of them are just as involved.

Right.

Some are are homeless that are kind of working and things like that.

Lots, lots.

And and I should also say this is there is um much of what we're dealing with in the homelessness response system is self-reported data, right?

As opposed to uh system involvement data that we would be looking at the a back end, for example, of matching someone through behavioral health access, for example.

So through the coordinated entry process, it should also be noted we do prioritize questions around justice involvement and and and have us essentially a scoring mechanism to prioritize where folks would answer that question.

And we know, as anyone could imagine, sitting down for an assessment with someone who said, hey, have you know justice involvement?

That's very often underreported for obvious reasons.

Um, but it is prioritized nonetheless.

And this is where I think it's really important, not just for us to assess for these things and ask the question, but as we do working closely with our behavioral health partners, directly with the jail to to sort of insert ourselves into settings where we know that's a priority or that that's a likely overlap so that we can support people regardless of their answer to that question.

Right.

Do you have a sense of how many folks are just as involved that need housing?

Oh, I I mean I think it's a a huge proportion of the people.

I mean, a lot of folks that we have a lot of folks we serve in the homelessness response system just by being unsheltered, for example, have had lots of engagements with law enforcement, right?

Um sometimes, you know, stays in in institutional settings or not.

But the a large need that has been lifted up through this process is folks that are currently in an institutional setting longer than the feds would define as now homeless.

So if you've been in an institutional setting for more than 90 days, according to the HUD definition of homelessness, you're you're not homeless anymore.

Um so that that transition out to someplace to say, be that interim housing uh or permanent housing is really important, which is why we're we're expanding that in reach through saying coordinated entry needs to be in the Dale, not just where someone might get referred to when they leave, because that gap, as we know in our system, is it can become a um a cavernous gap.

Okay, so right now we we will be providing services in salary to jail.

Correct.

Is that occurring now?

That's correct.

That's the so BACS leadership has submitted all the necessary paperwork for the front frontline workers to get approved to operate inside the jail.

So that's to start.

Yes, to start, exactly.

It hasn't started yet, but it will be starting.

Yeah, it hasn't started inside the jail.

It started a care court, it started in the community.

Um, but they are regularly as we are regularly asking them to get updates on the progress and the approval to to launch that service.

Okay.

Um, all right, so we'll get more information on that to be um in the future.

So the coordinated entry housing queue for the 4,000, and with 85% of those individuals uh seriously mentally ill or facing substance abuse.

If we go back to that, uh one's that one slide earlier that talks about providing um you know an array of services.

Can you walk walk us through?

So when some what do you do with a person when they're housed to provide services that helps to address their mental illness or their substance abuse or both?

Can you just walk me through that and walk us through that?

Sure.

So there's really two primary ways that we support people from a um there's the subsidy, of course, if someone is prioritized and gets matched to and referred to permanent supportive housing.

That can either be what we call project based, so a new building that's built where the subsidy is tied to the unit, or it can be community based where they can be attached to a subsidy like section eight and go choose a unit in an apartment complex around the community.

So there's the whole infrastructure of the financial assistance to support people.

But to your question, what are the services, the uh the support services, the case management services that are provided?

There's really two primary mechanisms that HH utilizes one internal that we fund ourselves, and then the other, of course, the specialty mental health services and referrals uh to access the behavioral health to make sure folks that are connected to those services that are funded through the behavioral health system of care.

Um that is definitely the primary place where folks that have those complex needs are eligible for uh and prioritized for connection to those behavioral health services, would be through the behavior health department and through our through our access process.

But H funds uh through CalAM, we fund about 3,000 individuals in a given month, are being funded with what we call housing navigation or tenancy sustaining services.

So think about tenancy sustaining.

Once someone is in housing, then they would be funded by a monthly tenancy sustaining program.

So we have 24 providers that are providing that level of wraparound case management.

Again, those aren't behavioral health uh clinical specialty mental health teams, those are kind of what we would call base services in permanent supportive housing, but intended to support people with all additional connections as well.

So we've got that layer of service that H and H funds directly, and then the myriad other programs that we would refer people to.

Many people do come to us that are already on a full service partnership, for example, get assessed and get permanent supportive housing, and then their clinical team through the behavioral health department contracts would be their service provider.

Um, and then we would be uh supporting the agency that's providing the rental assistance and keeping them in the unit.

So it's really two different ways based on someone's level of need, uh, and we know that we have much we have much less of that housing navigation to support people to get into state housing than we need.

There's a there's a there's a need.

We have to, as we said, we have to just prioritize folks that have the highest needs, but there's a lot of folks down the list that need both the subsidy and the support.

We've just got limited dollars through through Cal Aim to fund those services through the Medicaid uh community support program.

Okay, and um with the board and care facilities, licensed board and care.

So, right now we have 21 sites, 350 beds.

And potentially by next year, we're looking to open maybe three more sites to give us 24 sites.

Yeah, the total will be 24.

24.

And how many more beds will that be, or do you know?

I'm sure what the total will be on that.

But there are three smaller sites.

And so we can get the exact the exact number.

But again, that's through that rolling RFP process where folks can submit each year.

Okay.

And then you also mentioned under capital acquisition, we want to start maybe two more uh trust clinics.

Because we have the one over here.

So we're looking to try to have two more.

Do you have a sense of where?

Yeah.

So there's we have the one in Oakland, the long-standing one at Oakland.

We have a trust-like clinic that's opening in Berkeley now.

The lifelong medical has opened recently.

Okay.

So our goal is to have one in mid-county and South County.

So specifically dedicated clinics.

Potentially, like in Hayward.

And what's mid-county?

So that would be in the Hayward area.

Ideally, there's been discussions potentially.

At St.

Regis, for example, and then one in the South County area.

Is that Fremont?

That would be the Fremont, yeah, exactly.

I see.

Okay.

The Fremont Union City area.

Okay.

Just to have kind of geographic representation.

One of the things we've found is that the barriers to access health care services are obviously very high for folks that are experiencing homelessness.

And the trust clinic has been an extremely successful model, not just to get people connected, but for folks that are unsheltered to be able to have that be their medical home and get connected to all the relevant services.

So in this current climate where healthcare access is going to get even harder, we think really having a front door for folks experiencing homelessness at each point in the county would be really important.

So that would be capital to help open and launch.

And then ideally the partner, you know, federally qualified health uh center, what have you would then be able to build Medicaid and eventually be stable to be operationally funded on their own.

In the trust clinics, the two new ones will be funded by Measure W.

They would be funded by Measure W capital to help launch.

Exactly.

Correct.

That would be a portion of that capital we've shared with you in the presentation that we've allocated.

Okay.

Do you have a sense of the timeline?

Get these operational, the two?

Yeah, I mean, we will probably open a specific procurement just for these clinic expansions with this with a small subset up to you know 15 to 20 to 30 million set aside for those uh in the early next year and sort of see the responses we get to try to identify sites.

So uh ideally the the procurement and uh you know interested parties would we would know and potentially have selections in the uh spring or summer, and then that the question would be how long for from a development based on the site and the expansion needed would would it take to get them open?

Okay, and back on the board and cares uh at the 2021 sites that are located in Berkeley, Oakland, San Leandro, Hayward, and Fremont.

Um, what's the average number of clients that are at each site?

Is it the greater fewer?

It's it's typically licensed for six.

Six each facility.

I will ask our um deputy director Jeanette Rodriguez who runs this program to speak more to that.

The number of beds is each site ranges.

So some of the sites have six beds all together, or some of the sites have 42?

42.

Wow.

So there's definitely a range, and it's based on the availability of beds, utilization of beds, we're not the only funding source.

Um, so other um those beds may be utilized by other funding sources or other individuals, and then going back to the question earlier about the three new sites that are coming online that'll represent the availability of 30 more beds.

Okay.

What's our uh what's our appetite for having more licensed um board and care facilities?

Do we have an appetite for more?

I think there's definitely the appetite for more, as Jonathan had mentioned.

There's also the need for additional higher tier rates.

Uh we're seeing higher acuity acuity of need of individuals.

Oh, thank you.

And um, yeah, more care that's needed directly for individuals in the sites.

There's been the expansion that Jonathan mentioned for the 40 auxiliary beds, that's the behavioral health bridge housing.

Uh those are 40 additional beds, and that's directly uh prioritized for care car population and individuals with higher present uh acuity of need.

And with the three new license sites that we're looking for, how are we going about that?

Is that a procurement process?

How are we getting those three sites?

That's based on the biannual RFP process that takes place right now that's released through GSA.

So that's released every six months.

There's applicants that then apply and demonstrate being licensed facilities, uh, demonstrate the ability to be able to provide those beds.

Um and then those three new sites that are coming online are gonna be in Hayward Union City and Berkeley.

Okay, all right.

Okay, because I do think I do think it's important that we have those, but it's also important that they you know fit into the community well and not become problematic.

Um because I just having just heard everything Jonathan said, we need the beds, we need the wraparound services, but we don't have enough of either.

I I don't think.

Um, and then that helps to uh provide care first jails last.

Otherwise, but if they are justice involved, we need to be we're gonna be in the jail at other, you know, the care courts, uh, you know, the collaborative courts, the version courts working with folks to provide them with the housing, then once again the wraparound services.

I mean, it's kind of you know what it is all linked together, and we just don't want any one aspect of this, you know, whole network to be an impediment uh to try to service um the population we're trying to serve.

Yeah, okay.

I think I think those are the only all the questions I had.

Does anybody else have any other questions on from Jonathan?

No, I just really um appreciate the updates and don't want to get ahead of myself, but I am just sitting here thinking uh this is why these reports are so important for accountability and tracking and just really commend everyone.

Um, this is significant progress.

Obviously, there's still so much more we could do for our community, but without um capturing these recommendations and having these regular check-ins, we wouldn't know the status.

So just thank you all for the coordination, it's been really impressive.

So, data.

Good afternoon or good morning still.

Michelle Sterrett, Housing Director.

Um, I'm gonna be talking a little bit about the capital side of these recommendations.

And so I think I just wanted to share.

Um, I was a member of the task force, and one of the things we heard over and over again is that the community is really looking for places to stay, places to live, and a place to recover and heal.

And I think you've heard a lot about those kinds of places.

We've been talking a lot about physical places for people to be and places for people to rest and pay places for people to sleep.

So I think that's a really good um way to sum up what we heard.

Um, the first real blockage um to housing for someone who has justice involvement is the inability to rent because of discrimination.

So we started working on a fair chance ordinance and trying to include those fair chance um requirements in our boilerplate loan documents back in 2020.

Um, however, we were asked to uh pause on adding them to our regulatory agreements until we had a local ordinance.

Um and as you know, the local ordinance didn't go through because of a lawsuit that was um being faced by uh Seattle.

That lawsuit has now been settled, and so we're hoping to talk to you about that as soon as county council has finished that review and can bring it to you.

But once that happens, we're then, according to county council, able to add it to our loan agreements and our regulatory agreements for our affordable housing portfolio, which has been our goal since 2020.

So that's one of the first and most important parts about that lawsuit getting settled, and so we're hoping to be able to move that new policy forward quickly.

So when Jonathan was talking about operations, that's critical.

We need that operating funding, but we also need the capital to help buy down the cost of the building.

So we're hoping to bring to the health committee sometime in the next few months the measure A1 interest that we've earned over the last four or five years, and we want to put some of that into the innovations fund.

And we're hoping that that innovation fund could be used for group living facilities, board and care facilities, the kind of places that we lost over the last 10 years because the housing costs, the housing prices went through the roof, and the lessors of the building turned around and said to those small mom and pop businesses that were running board and care or group living facilities, we're gonna sell your building because it's more beneficial to us to sell it and reap that real estate equity than it is to keep leasing it to you, even though you're providing a good service in the community.

So hoping to create a revolving loan fund that's dedicated to a land trust model so that we can keep these places in the community access uh for the long haul.

One of the best parts about being in the real estate division of this agency of this county is that we get to put long-term regulatory agreements that have control over the physical asset.

We get to ensure that the building is managed properly and is operated properly.

We have the right to go in and take a look and monitor these buildings.

So having real estate transactions is really critical.

And then the last part is we're excited to announce that we're gonna be releasing the first 50 million of the capital funding for new permanent supportive housing.

We're hoping to do that in the next week or so, and so those funds will be available to build more permanent supportive housing across the county.

We think that 50 million will get us another 300 units.

Primarily will be focused on studios and one bedroom apartments for folks who meet that high acuity need, but who are also you know, 90% of our homeless population are single adults.

So we need to build the type of housing that our homeless population needs rather than two and three bedroom units, which would be focused on families.

Happy to answer any questions.

Thank you, Chair.

Thank you, Mr.

for being here and for all your incredible work throughout the many many years.

Um I don't think you disclosed, do we know how much interest is in that A1 account?

Um I think it's about 43 million.

43 million.

Yeah, we had two bond issuances.

The first one in 2019, 2020, um, and then we had a second one in 2022, and that meant that all 580 million dollars was issued, and those funds have been sitting in an interest-bearing account.

Um, we've run the programs, and the vast majority of the money has either been committed and or spent.

Um, the committed funds, we have I think nine projects still in pre-development, uh, but the rest of the 53 projects are either over the finish line and occupied or in construction now.

Um, we actually have some really good data that I'd like to bring to pro and con about union utilization, so that'll be our next pro and con report.

Um, but then we also have almost 350 single family homes that we've purchased.

Um, so all toll uh between, well, I would say in the last 12 years, we've done over 400 single-family homes in our portfolio.

So it's a wealth of wealth of projects that we've been able to get over the finishing.

That's really impressive.

And um, thank you for the update on the fair chance housing ordinance.

So, based off your presentation, it's currently, is it the original ordinance that was reviewed back, I think it was December of 2020.

2022, yeah.

So we're waiting for edits from county council.

So I haven't seen any, but we would be basing it on that version.

Okay.

So I would definitely um prioritize that.

I know it's up to us to reach out to county council, but just want to make sure that um we hopefully adopt that ordinance before we advance any additional funding so that way we could ensure in this county at least with the money that we're investing that individuals have the ability to live here in their community.

So thank you for that great work.

Um thank you for that presentation.

Of the $50 million that will be released for permanent supportive housing, do you um do you know uh whether there are like community-based organizations or housing providers that um would be able to use some of these funds to maybe like purchase an existing apartment complex and and maybe um do some rehabilitation and turn it into permanent supportive housing as opposed to building from the ground up, which tends to be what's driving a lot of the costs, and then with the added tariffs, there's gonna be escalating costs that we can't exactly foresee.

Yeah, acquisition rehab is always an eligible use under production.

Um the three Ps produce um protect and preserve, um, but but production when you think about acquiring a building, um, we're really excited about acquiring buildings, but in order to house homeless individuals, there needs to be vacancy in that building.

So whether or not we would prioritize an existing building would really have to depend on whether or not the building is fully occupied or not.

Um, because we can't, we're not gonna use the measure W money to um acquire a building in which we cannot place our our home together coordinated entry clients.

Do you have a sense of um how much of our funds are used in that type of uh situation where they acquire a building like we acquired the hotel using home key funding um from back during the COVID era, but like prospectively, do you have a sense of where that potential might lie?

I don't have a vacancy report, so it's hard for me to look um at you know whether or not existing buildings would be vacant.

I have had several reports recently that we're looking at about four and a half to five percent vacancy countywide, and it's lower in the south and mid-county than it is in the north county.

So um, you know, we could do a little bit of research on that.

I would say, however, that you know, some of the buildings that um that I'm looking at with Shikla, which is the land trust model, are vacant.

They're small, already built buildings that um have been vacant for a while.

They were built as shared housing for working adults, and so that's the kind of building that we would we would prioritize in an RFP like this.

Thank you.

Thanks for the information.

I'm gonna uh follow up on supervisor TM's questions, because that was also what I was curious of.

So with um measure A1 and Measure W, we're talking about roughly a hundred million dollars, roughly.

Uh, yeah, we'll be bringing the A1 report to this committee, and it will be our recommendations will be roughly following the um adopted housing plan and expenditure plan that your board adopted last July.

Um, with the measure W, we are solely focused on permanent supportive housing.

Yes, okay.

And um the measure A1 funding, we're looking to try to uh encourage uh more board and care, more group homes.

Yeah, we're looking at about nine and a half million dollars that we'd like to target um sort of an acquisition fund.

Yeah, yeah.

Because once again, Jonathan was up here speaking.

I think that's important, but I mean, also that's why I'm always a strong proponent of small rental property owners, because those are the people who are gonna potentially want to do this and if they're getting a if they're being stigmatized and being crucified and being um looked upon as being evil and money grabbers then why would they want to do this I mean they're providing a service of which we our society and the greater public we need that so I that's why I'm always trying to defend them and then with group homes and small um you know uh board and care facilities I know historically there's been a reluctance in communities to have them because they've brought down the quality of life in communities that's why I like what you said if we're investing in them we can try to make sure that they're run and operated in a manner that doesn't impact the quality of life of the rest of the community that might be you know um rental rental providers might be single family homeowners whatever it is but the point is they're just blending into the rest of the community and we're providing once again a service for folks who are justice involved or others who need housing so I think that's really important um because I know when I lived on my street in Fairfax uh in East Oakland you know it's a board and care on my street um it it didn't cause any problems because it was operated well but I also know of other of other places where group homes and board and cares have been problems in the communities.

That's why I'm so kind of I'm not torn in a sense of not wanting them I want them I just want to make sure they're managed and operated appropriately so that you know the community doesn't suffer because a board and care or group home is located there.

Thank you for just wanted to make one comment about I think what really represents the difference between being funded by the county's housing support program, the HSP program and these 350 soon to be 380 beds and and potentially not being which I think is an incentive to participate is not just the money in these tiers which consistently that has been the the the call from our board and care operators for years is the the amount of funding that is received relative to the needs just doesn't pencil and that's why businesses closed.

So of course there's a financial benefit to say we're paying an amount that allows folks to sustain but to your point around really not just holding operators accountable but providing support we have a dedicated clinical team within H and H that works specifically with each of our partners in those sites to provide support when there's issues to work directly to liaise and make sure folks are connected to additional services but also to provide support and trauma informed care within those homes to those owners so that they really feel supported directly by our team.

So there's that added element I think that's really important I just wanted to make mention of that.

Yeah that's extremely important yes.

Because we we want them but we need to support them and help them.

So I think one of the other things that came out of the task force which is really critical is the need for the operating sources so of course you know Jonathan's operating funding is really critical but we also um on the task force we're talking about trying to appeal to the state to get higher board and care rates.

And that's something that I don't think we've tackled yet but it's still critical.

Okay now and the other thing is Supervisor Tim she went down this road now you know my mind I'm thinking we've got all these tax defaulted properties and you know that's that's a big thing with me.

And I don't know you know once again I know we've talked to the treasurer I talked to um Casey about it just recently I mean I think once again there's an opportunity there we've got you know a lot of I'm not even talking about the commercial properties and the just single family.

I mean there are a lot of properties that are either tax defaulted or not or vacant or not under uh potentially underutilized so I think there's opportunities there.

Yeah.

So we have uh a tax defaulted property loan fund.

We ran an RFP, it's now an over-the-counter RFP.

We ran a uh technical assistance group.

We ran, I think 11 organizations through that technical assistance group demonstrating what they would need to do.

Tax defaulted properties pose a very significant risk to the purchaser.

Uh one of the ways that we were hoping to mitigate that risk was to be the loan fund so that they wouldn't uh for that year when they can't get uh a title insurance that we would be the ones on the hook.

Um I just want to say that uh of the eleven, only one made the decision to move forward, and we're still working with them.

Um and we are still working with the um with the with the tax uh with Hank and his team, the treasurer.

Um, but I think the the more important part there is for us to start, you know, being a little bit more creative about how do we evaluate these sites and how do we pull them off the list and you know facilitate that that redevelopment.

We're keeping the money in the loan fund for now.

We think it's still a really viable type of program, but we have to find the right organization willing to take these down.

Okay.

Well, once again, I can only speak for myself.

I'm very open to whatever we need to do to try to use that as uh an appropriate mechanism to provide housing and provide it.

I mean, as opposed to having to build it from the ground up, it's there.

We just need to re rehabilitate it and have an effective uh property owner andor operator, and if the government can intervene and help remove barriers, I just think we should be trying to do that.

Keep working on it.

Yeah.

Cause I see like this this place over here that's being constructed.

Uh that's gonna house it's all affordable, it's gonna house a lot of folks, but it's taken a long time for that to be developed, and it still isn't prepared to be occupied.

So the faster we can get the properties so we can help people, either leaving Santa Rita, you know, the uh the um diversion courts, etc.

etc.

I think the better off we're gonna be.

Yeah.

Okay.

All right.

Um, who's gonna do data?

I think that's the last one.

There's a slide on data.

Hi, it's Gavin from the collaborative courts again.

We were named in this slide, so I can speak to this really briefly.

I mean, I said most of what I want to say in the last slide.

I'll be really brief.

Um so it's good to collect this data on the collaborative courts.

The collaborative courts have about a hundred and eighty people in them today, and these are people that are uh assessed as being high risk high needs.

So these are people with significant histories in the justice system with significant substance use disorders and mental health disorders.

You have to score in as like having a lot of need for treatment and a belief that we that the person is good, we have a belief that the person will be rearrested or lose their children or both in court to be a part of the collaborative courts.

So we're looking at um we've been meeting with the partners and the mental health advisory board to look at what is the effect of these programs on the individual, quality of life improvements, reduction of mental health symptoms, et cetera.

The impact on their families and on public safety and um the impact on Alameda County at large.

Um we see significant reductions in psych hospitalizations, et cetera.

Um we've been meeting my the collaborative court office has been meeting with the district attorney's office to reconcile our data together.

Like what do you think happened in the collaborative courts this year or last month?

And this is what we think happened, and it's down to a granular level, like we're looking at individuals.

What do you think you happened with Janie Jones on August 14th?

And that's been a really productive uh process so far, and we're meeting with the public defender's office and the DA's office to come up with an annual report that will show um what we're doing in the courts.

We haven't, this is a last thing I'll say we haven't talked about um today, like the they're there, like what are the collaborative courts, what is the magic there?

What do they do?

What are they about?

I'm happy to come back anytime um and talk about that if the board's interested.

Uh thank you.

Any questions, comments?

Well, that's great that data.

I mean, that's we're we're gonna be looking for that.

Yeah, thank you.

Right.

There's next steps.

Thank you, Supervisor.

Um, I've been tasked just to uh synthesize and wrap up what you've heard uh today.

So obviously there is quite a lot of work, a lot of questions and advocacy that have come through the mental health board and the ad hoc committee to which the departments have uh provided today's update.

And our goal going forward will continue to strengthen uh our responses but not only to the questions and the queries and recommendations that come up to you, but also the real life data and the success of the programs that you've seen to date.

Um one of the things that your board authorized when you directed this task force to begin in uh 2021 was to look at again performance and outcome based metrics and data sharing processes of which you you heard in the prior slide regarding data sharing, but I but at this phase we are moving with our RDA partners who are also here to help the departments to actually speak to your original intent to further refine and define the metrics within each of their plans and to be in a position to incorporate more specific data information.

So, for example, the question that you asked Chair Miley relative to the cost of a particular area.

Um, our department will be poised for your direction to help support that.

Um but our RDA now in this final phase will be taking on um the the burden for the departments to actually help quantify to make sure that you can monitor going forward.

Um at this point, all of our departments um have mutually agreed that there's certainly progress that been made, but there's not enough, and we are committed to continuing.

We all know that there's more to do.

Um so with that, um, we're grateful that we act have the opportunity actually to personally vet the next steps with our board, mental health boards.

If there are any other, we'll defer to them.

Um so we thank you.

Okay, so any questions of Dr.

Dribble?

Comments, questions.

Do we know when we'll get the next update?

I'm trying to was it annual?

I'm trying to remember what the report required.

Annual updates to the yes, you you require two updates, one to the health committee, and then an uh an annual update to the board proper.

So I think the next one is at least six months or so.

Okay, thank you.

So, Dr.

Triple, before you sit down, um you mentioned Prop 43, and what's the impact of Prop 43 on cares first jails last?

SB 43, yes.

So that was the legislation that thankfully your board allowed us to delay implementation that starts July, January 1st, excuse me.

That changes the criteria by which a person may be placed on a 5150.

It in it includes also grave disability based on uh medical issues, maybe unintended um lack of Medicare care that a person has looked to under look to under grade disability, as well as substance use and misuse.

So that will potentially, well, not even potentially, it will expand the number of individuals that are um in um uh eligible for 5150, and so all of our patient or Cupids will be eligible to receive those based on the new law.

So that's what I was referencing that a gap analysis is important after the implementation of the law.

So we'll have to do one anyway to look at whether we're sufficiently covered.

Yes.

So in this, and we would do that analysis sometime next year.

Sometime next year, we can we'll be in a position to see track the numbers, we'll be able to establish a baseline and the impact post and pre uh the implementation of the law.

Okay.

Um when would you expect to bring that back to us?

Um mid year towards the latter part of the year, or at what point?

Um at your convenience and in coordination with agents and recruitment.

Yeah, we don't want to have you bring it back too soon before you don't have the data.

Yes, but okay.

I would say in the fall, we'll be in a good place to really look at it because we're we've already done some of the steps that we've mentioned to you, and uh we think probably by then we can.

Okay, and then the impact of Prop One and the fact that we're gonna lose prevention dollars, and you know, I know we're looking to provide some money from measure W towards prevention, uh, because the board kind of indicated that at a work session, but um I need to understand more what we need to do, because once again, it seems to me it's it's a zero sum game.

We're gonna be doing all of this, but the prevention piece is gone, and then we've got 43 kicking in.

It to me it's like a zero-sum game.

So what what's the thinking here?

It is.

And we're trying to be organized and not appear to be the keystone cops.

We're really trying to follow the legislation and the and the information.

And I just want to be absolutely accurate.

Uh the change that we'll be looking at that we'll have to start to work with our providers and work certainly under your direction and oversight is not only a loss of prevention, but it also is a decrease in total uh BHSA funding.

So what that looks like is it will uh eliminate the prevention, our ability to fund it directly here locally, but also will limit the county's ability to fund some of the programs.

And so we will most definitely have to provide an impact to you in the in the near future.

We are have to also speak to our providers, and we're already starting that process, and just high level what we think it means is the shifting obviously of that funding source to more severe.

And because uh of the delta in terms of the allocation, we're looking at about a 75 million dollars to which we've identified about 45.5 million dollars for remaining 30 million that we're looking to close the gap.

So certainly the support that's been provided in direction through your board for measure w will help.

We're also tracking the expenditures currently in real time of all of our county partners and contract doors to see if there's any cost savings that potentially can be utilized because there is a small allowable expenditure that can be carried over for the next year.

So that's a lot to say.

Absolutely.

We would like to provide uh an update to your board, and it's going to re-terraform even some of the work that you've heard from some of our partners around things that we've achieved.

It will impact their ability to refer to other resources in the system in general, besides just PEI.

Okay.

And then my final question the forensic system redesign.

So where are we in terms of funding that?

So Royal Week collectively, I think the department we found approximately $18 million to fund the $50 million plan.

And at full disclosure, there were two additional types of programs that we were to look to expand that we had allocated uh to the tune of a few couple of million dollars.

Honestly, we may not be able to fund that portion.

We had encumbered it planning to reallocate it potentially RP or place it out in the community to our providers.

Um, so it probably will have a net decrease based on uh Prop One.

We will just not be able to do that.

So we're looking to use those allocations to fund existing providers.

Uh so we're looking at about between um 14 to 16 to 18 million as opposed to um the original solid 18 million, and the whole plan was 50 million, correct.

And so we're we're gonna be closer to 18 million of the 50 million?

We will probably be closer to about 16 million.

We'll have to take back some of the encumbered funds just to share up the delta for Prop one.

Okay, uh boy, at some point, yeah.

I I think at least the health committee, we're gonna want to have a more of a session on all this so we can understand all the implications because I think we're doing with the report today.

We're doing good work towards jails first, I mean, excuse me, care first, jails last.

You know, and the the what we need to do there, but we've got other implications on the other side that though we're moving in that direction, might once again uh um impede our ability to support um cares first jails last because people are not gonna be getting the you know the upfront and the preventative and early intervention that they need uh in order not to even get to that that other extreme.

You're absolutely correct, and that does speak to the even the earlier slide for the context of the sequential interrupt map where Alameda decided to place prevention and those early intervention models here because we value that, but it will absolutely impede our ability to look at those modalities.

Just different funding or more strained.

I think you've heard that uh from all of our partners today.

All right.

So will we be hearing from the mental health advisory?

We hope that you have asked them.

I know that you're what I want to hear from you.

We want to hear from them.

They were given the test to monitor this, and we appreciate the you know your opening overview.

It was a very it was refreshing.

It helped my memory.

Yeah.

So why don't we have the mental health advisory uh body come forward?

And one other thing I just want to say, um, when Jonathan mentioned to Supervisor Tam's question that there's like 430 some million dollars, you said going into homelessness, and then we're gonna put some more money in it based on measure W.

That's a lot of money.

You know, the public's gonna be looking at us.

Go ahead.

Thank you, supervisors.

Thanks, all of you.

Thanks for your really searching and probing questions, your engagement with this work.

Um it's a really ambitious agenda, which I guess is partly our fault because we presented to you in May.

Um, and the good news is is actually we presented 13 recommendations of the 58, so we're about a quarter of the way uh through the full recommendations.

There were nine or ten slides, but you what you've been grappling with is 13 of the 58 recommendations.

Um, to me, the takeaway that I've heard from all the, and let me just stop for a second.

How marvelous to have.

I'm Brian Bloom and then the chair of the mental health advisory board.

Sorry, supervisor, thank you.

And um, and the chair of the ad hoc committee that we created to focus really on your your mandate that we monitor implementation of these recommendations.

Um how wonderful to have all of the various or so many of the various stakeholders and agency heads in the room at the same time.

It's a really it's a daunting task uh to make collaboration and coordination and getting people out of their silos to make it real.

Um, but this is an example, and the challenges that we're having are an example of just how uh how hard the task is.

Um I just I wanted to there's a word up there that's great outcome metrics.

Um I came to you in May and presented what I think is a really important metric to keep our eyes on.

How many mentally ill people, seriously, mentally ill people are in jail?

And you'll recall from May that I created a graph for you that went back a couple years.

Um we've heard a lot about great progress.

We've heard a lot about great steps, a phase approach, as Supervisor Marquez said.

Um the reality is last night.

Well, we know this because uh uh Captain Prez and his folks uh produce every week a public-facing data dashboard on their website, and we know that last night at Santa Rita jail, there were six 361 individuals in jail suffering from serious mental illness, and that's based on the assessments that are done mandated by the Baboo legislation.

That's a couple ticks down from where it was in May.

It was 380, if you want to be precise in May.

Um, and it's still, but it's still a sizable amount of folks are in jail suffering from mental illness.

Um, by the way, that doesn't capture uh substance use disorders because the uh that assessment, that initial assessment is focused solely on uh functional impairments as they relate to uh uh mental illness.

Um 361, of course, is greater than the number of people at John George, Villa Ferramont, Gladman, and all the crisis residential uh treatment centers combined.

So we despite the good the good work that's being done and the progress that we're that we're we see now and that we're hoping to see more of by two to by 2029 and and a few years down the road, uh despite that we still use the jail as the largest uh provider of mental health services in the county.

That's a number that obviously we want to bend down, we want it to trend down.

I will continue to bring that number to you every time I talk to you because I think it's not the only metric, but it's certainly a crucial one.

Remember also in terms of of outcome metrics, and we've seen, and we should really applaud uh behavioral health and all the CBOs that got the and Alameda Health System that got the 170 million dollars of state uh B chip money for the various uh beds and programs that we've heard about.

Um, super important.

One way to measure that, of course, is that at John George, virtually every night, about 25 to 30 percent of the beds, that's 20 to 25 beds out of 69 beds, every night, those are administrative beds.

Folks that are in those beds do not need to be a John George, they're not deemed to be meet acute uh criteria, they're ready to go to a lower level of care.

Nothing's available, so they occupy a bed at John George.

That admin day rate, if you want to call it that, hovers around 25 to 30 percent, has to go down.

And we will measure our success based on all of the expansion of subacute and lower level facilities and care beds.

We'll measure our success if we see that number uh trending down.

Uh lastly, the third data point.

Um, every month at John George, 800, roughly 800 folks go to John George on a 5150.

I shouldn't say folks because they're 800 incidences.

Some people go multiple times a year, obviously.

But there's about 800, about 9,500 uh 5150 incidences at John George in a calendar year.

Of those, 72% don't get admitted to the hospital for treatment.

They spend up to 23 and a half hours at PES, the psychoemergency services, which is the crisis stabilization unit at the front end of John George.

But 72% of those folks do not get admitted to a hospital for uh for long treatment.

They get discharged from PES.

Now you could say, well, that means that they didn't really meet criteria for further intensive uh and uh involuntary treatment.

Or you could say that 69 beds might not be sufficient, and if you had the admin day rate in there, think about how many folks could get treated if uh they were if all those beds were occupied people that actually met criteria.

So we will, we the mental health advisor board, will continue to provide um these uh these metrics going forward.

In August of last year, when you accepted the uh all the recommendations from the task force, um I believe the resolution was that we would come before this body, the joint committee, uh twice a year, and then the full board of supervisors once a year.

Um we can rethink that, but that was what was said in August.

We would like to come back to you sometime in, and to you, I mean to the joint committee, um, sometime in the maybe late winter, early spring, perhaps March of 2026.

We want to monitor how what we've heard today is being continuing to be implemented because so much of what we heard are good plans and things for the future, and we want to bring to you some of the other recommendations.

I'm not saying we'll bring 13 more recommendations.

I know last time you said thank you so much, but that was a lot, so maybe we'll shave it down.

Um, it's obviously we're talking about system change.

And in Dr.

Tribble's words, a care first jail as county, a county that is that it has as its North Star uh a real approach that keeps mentally ill people in treatment and out of jail.

Um so we we uh obviously it's your your invitation that we would accept, but we would be certainly ready and uh and willing to present to you uh perhaps in early March of 2026.

Um there was a few slides um from the presentation today that we have, and I also want to just thank the members of the mental health advisory board and the members of the ad hoc committee.

Um you are I I mean, I I feel comfortable saying this.

You're very fortunate to have such dedicated uh public servants and volunteers, people that are not getting paid to do this, but we're meeting every month, and then everyone on top of the monthly meetings are talking to the various uh department heads, the CBOs that are doing the work.

Um it's really uh quite a thing to have this uh and I'm honored to be uh amongst them.

Um some of the folks have focused on specific things I know they want to share with you.

Uh the African American Wellness Hub, uh the uh the first episode um uh psychosis uh program, uh perhaps the courts uh and some of the housing systems.

If I could, I just wanted to invite up uh first Margot DeShiel to say a small piece about the African American Wellness Hub.

Perhaps we could just put up slide, I think it was slide 12, might have been 11, um, for the Act of African American Wellness Hub.

Thanks.

Uh one more, 11.

Okay, I can speak to the second point, the health and African American Health and Wellness Center.

Um, Brian just mentioned that there are, as of last night, 361 people with serious mental illness in the jail.

48% of those are African Americans.

So just under 170, I would say, are African American.

And at this time, there is no African American designated site that would deal with those clients holistically.

So it is important to get an African American Wellness Center up and running.

And we have had the commitment from Behavioral Health that they will add psychiatry into the proposal.

I think that's a no-brainer that for high needs population coming out of the jail with serious mental illness, often co-occurring disorders such as substance abuse.

After many many months, 15 months, finally been able to have a joint meeting with those who proposed, who conceptualize the wellness hub.

We have had a joint meeting.

And it takes time to define those things.

My email are answered, but I'm the one trying to move these things forward, and I wish that the leadership would come from them.

I'm told that there will be um stakeholders process set up within behavioral health.

None of us as a family member myself.

And yet I still didn't know how to deal with this as a family member.

So family members need uh education on serious mental illness and the sources.

And people don't get well without very strong caregiver support.

So I'm looking for that to be carried forward.

We also want to know more about interim services.

We have a building that is going to be demolished and rebuilt.

So are there going to be interim services for these people who are going to continue to cycle through the jail and what will they look like?

Um will they be evaluated?

We're talking about a new wellness hub with a new paradigm, as they say, coming in.

So how will it be evaluated on an interim basis?

So we know that it's working well for this high needs population?

Thank you.

Thanks so much, and I want to introduce Dr.

Alice Feller, who's going to make a brief comment about the one more.

I think there it is.

First episode Psychosis program, speaking to some of the questions that some of the supervisors had.

Thank you.

Thank you so much for hearing me and for listening to all this.

So in Alameda County, our most visible and agonizing problem is homelessness.

One quarter of our homeless population is disabled by severe mental illness, mostly schizophrenia.

Schizophrenia is a brain disease, not the result of bad parenting or even psychic trauma.

The illness itself is horrific.

Voices torment the sufferer, putting putting into words their worst fears.

For instance, your leg is gonna fall off, your mother's gonna die, and you'll lose your kids, you're a pervert, you should hang yourself.

The illness strikes in adolescents or the 20s, and if not quickly and properly treated, will leave the young person disabled for life.

Schizophrenia is treatable, but in Alameda County, we're not we're not uh providing the right treatment.

Effective treatment for schizophrenia requires first episode psychosis care, FEP for short.

This is an evidence-based treatment protocol provided in the community.

It includes psychotherapy, medication management, vocal rehab, and family members are included, very important.

If begun within months of the first psychotic episode, it can often restore the young person to their former level of functioning.

They can return to work or school, fall in love, have friends, and rejoin the rest of society.

FEP is a standalone program with its own clinic space.

This makes it convenient for family members to bring their loved ones for treatment and at the same time have their own discussions with staff.

It also allows for necessary collaboration between the clinicians.

All that is really important.

We spend vast sums of money to cope with this illness on prisons, jails, police, criminal justice, hospitals, and homeless services.

An estimated $92,000 per year per person after diagnosis.

If we treated schizophrenia properly, we would save many times the amount it would cost to fund good FEP care.

Providing effective care saves money as well as lives.

Thank you.

Any questions?

Now can we go to the uh three three more slides?

The court diversion 5C.

One more.

There it is.

That last one.

Perfect, thank you.

And Myrna Schwartz is going to speak.

Hi, uh, supervisors Myrna Schwartz.

Um, thank you so much for this hearing today, and specifically in the area of diversion for giving this platform for hearing from the um court officials, public safety partners.

Um, we this has been very high.

The the issues that you've heard about today have been very high priority for the committee.

Um, making sure that the mental health diversion court gets uh the clinical staffing that it needs, given its very large volume is really of paramount importance, and we'd love to hear sooner rather than later a plan that that's actually gonna happen.

Um the uh the data um uh process that you heard uh in play is so critical.

We don't we need to know that these courts are doing what we want them to be doing.

We want to see evidence, for example, on recidivism.

Um that's a hard problem.

We need the collaboration of the various partners, and it's it's really uh gratifying to know that that process has already begun.

I'm very proud of the process so far.

Um, I want to mention the uh again, the incompetent to stand trial program.

It's been very important to us to try to understand what is um holding up the process and getting these most unfortunate individuals who languish in jail without even knowing why they're there or being able to participate in their own care as a result of severe mental illness.

We want these people out of jail treated in the community, and tremendous resources have been made available already for that.

We have grants from the Department of Health hospital services to fund that.

We have the new EAS program in the jail for stabilizing people with medication in the jail.

So everything seems to be in place, and yet there's a hold up, which Stephanie Regular referenced, and that just we need to break through that holdup, whatever it is.

That's extremely important.

And I want to mention just a few things that we haven't talked about today.

One is in relation to the pretrial services program that Chief Ford talked about briefly in the uh in the prior um design of that program that we uh heard from Wendy Still and Corey Jacobs, one of the elements was um uh was um uh a collap cooperation collaboration between um uh assessments, clinical assessments in the jail, and early referral to uh the courts.

You heard from LD that one of the uh serious barrier to getting um people to agree to uh engaging in treatment is how long they have to wait before that opportunity is offered to them.

Um the longer they have to wait, the less likely they are to take advantage of that.

So early referrals to the court to uh those uh diversion courts is critical, and we really want to see um the piece that piece for getting those uh early referrals in place.

So perhaps um next time we hear from Chief Ford, we can get some more um information about that.

Um then the other thing that hasn't been mentioned today um specifically, but needs to be top of mind is the fact that so many of the people who are um uh in the jails with mental illness um also have co-occurring substance use disorder, so co-occurring um disorders is a very prominent um feature of the population that we're interested in.

And um and people with co-occurring disorders need specialty treatment.

Um we really need residential treatment beds in order uh specifically for people with substance use disorder and also severe mental illness.

There are very few um uh programs in place to treat those people, and that's another barrier to a collaborative court um engagement because when people are um are candidates for um for uh treatment courts, but have to wait for an appropriate bed to become available, that's kind of further delay and further impediment to participating.

So we need to hear when when we see the very, very impressive um uh growth of uh beds and services uh that are coming online.

What we haven't really seen is a breakdown of how many of these um will be appropriate to these um uh very high needs individuals with co-occurring disorders, and seeing that broken out and getting a needs gap analysis of that would be extremely helpful um to uh essentially the furthering the work of diversion in treatment courts.

That's it for me.

Thank you so much.

And last uh but certainly not least, uh John Lindsay Poland's gonna talk about uh some of the wraps some of the data, the threads around data and data needs and data analysis.

Thank you, and um thank you so much for I know it's been going on almost three hours and really just appreciating your dedication to this.

Um, I wanted to mention, you know, we uh the questions about licensed boarding cares were excellent.

And one of the things that we're seeing is that the data around existing licensed boarding care beds or unlicensed boarding care beds, um, how many have closed, how many are coming online, how many beds there are, there is no consolidated source for that information.

The state publishes information about uh licensed board and cares, but it combines um uh boarding cares that uh provide services for people with mental illness, for um people who are um elderly, and so you can't really parse out for Alameda County how many of those are actually and then what we heard from Jonathan today, um, I believe addresses those boarding cares that are supported by the county, but I believe there are other boarding cares as well that are independent from that number.

So we just as the courts have been trying to put together this data and a consolidated report about collaborative courts and diversion, um, for licensed boarding cares, there is really a need to bring together the information that exists, because we've been hearing statewide, as Jonathan said, that there's been uh an overall problem of of boarding cares closing.

Um, and so we that that needs to be tracked more clearly.

Um, second, in terms of data, is um the math for the measure w funds is has also been hard to track.

After the board made its decisions in July for the formula for how it was going to be broken down, some of the funds that would have been for capital acquisition that were first presented to you in December, um, for measure W funds, I believe were reduced, and yet how does that impact the capital acquisition versus operational funds?

There also needs to be a kind of an overall um in order to understand the progress towards the care first goals that relate to housing, which are quite a few of those 58 recommendations relate to housing.

Um, third, I um uh just wanted to mention that um although the CAO is not present today, the uh care first ad hoc committee has had uh two meetings so far with the CAO that have been because there are several recommendations around budget transparency and to understand what funds are being dedicated, whether it's to the Babu uh settlement, whether it is to uh through Calame funds, um, and or overall for the care first population.

Um those meetings have been exploring the very complex uh county budget uh uh information on unspent funds, what unspent funds from previous years are available versus what funds are going into the capital improvement projects in order to understand what could be available, which kind of goes to your question about the forensic plan and funds that could or or may or may not be available for the forensic, as was other, and start trying to define what is the care first population, what are the programs that serve the care first population, which is how the recommendation on budget transparency on uh from care first was was framed.

Um, I also just want to say something because uh one of the things that presented was presented in May was that um a request for a new first episode psychosis program.

We heard from Dr.

Tribble that BHSA funds do mandate first episode psychosis programs, but I didn't hear whether there is a plan in place to produce a new first episode psychosis program, regardless of the provider.

And finally, I just want to say, and this is maybe queuing up for the next presentation on care first when I perhaps in March, is that um Erin Armstrong has done uh heroic work, and thank you, Supervisor Miley, for really dedicating her time towards that, towards this work.

But we're also seeing um this is again for perhaps for further discussion, the need for some kind of coordinator or office or some way in which this work can be coordinated.

Many different agencies involved.

It is like herding cats, and so there's some need, whether that comes through the board, whether it comes through some new office that is um established, such as when what Wendy still did for reimagining adult justice, or through the CIO or some entity, some way in which that work can be coordinated because this is not a short-term project.

So thank you so much.

That concludes the contribution from the MHAB uh for this morning.

We look forward to seeing you again.

You know, I often tell the committee uh anything worth doing is not going to get done in our lifetime.

And that's just the nature of the work we do.

Uh so we're in it for the long haul, and we're gonna be continuing to uh point out uh what we're seeing and sharing our perspective with you.

We really appreciate uh your allowing us to engage with you at this, you know, at this level.

Thanks a lot.

I appreciate the feedback from the mental health advisory committee.

Um, because I would just acknowledge your time, your passion, your interest, dedication on this topic, because obviously, the board we're dealing with a lot of things, and you know, just to have you focused on this uh with laser attention is pretty helpful.

Uh let me see my colleagues want to say, and if they have any questions, and then we'll uh move ahead with uh public comment as well.

Okay, so do we have any public speakers?

We do have speakers.

Um three in person are Richard Spieg Spiegelman, Myrna Schwartz, and Alice Feller.

Hi, I'm Richard Spiegelman, a longtime resident of this county and chair of the interfaith coalition for justice in our jails.

Thank you for this very informative um hearing.

ICJJ has been active on Care First Jails Lost through the Care First Community Coalition and indirectly through the Care First Mental Health Advisory Board ad hoc group.

So it's nice to see some of the the results of our engagement.

Uh Care First Jails Last is critical, quote, to decrease the number of those imprisoned and close the revolving door to jail, unquote, as the ICJ mission statement puts it.

So this is really important to us.

Most of today's presentation highlighted accomplishments.

Hooray, but what are the obstacles and the needs?

Some of them have been highlighted.

I just wanted to make three brief comments on the diversion slides uh 17, 18, and 19.

Uh on the CARES Navigation Center.

We need data.

Uh there was a positive uh assessment presented, but I I don't quite believe it based on earlier conversations I've heard.

One thing that might help would be to see something online on the uh uh district attorney's uh website about dates of law enforcement trainings and even the reactions of law enforcement who've come.

Um finally on this there's a care first jails license recommendation calling for an independent evaluation, and that needs to be done.

Second, uh diversion 5A.

It's shocking, as many people have said that the mental health diversion court has no staff.

That's got to be addressed.

And finally, uh diversion 5C, the pre-heraled diversion program.

We need a presentation by the uh chief probation officer on what's really planned.

Thanks so much.

Mayorna, um Alice Feller?

Okay, um, and then John, okay.

Emma, go ahead.

Well, apologies, the name was wrong.

This is Natasha Baker.

I'm a member of the Care First Jails Class Coalition, also a resident of District 5 of Alameda County, and I want to thank the board for um addressing all of the Care First Ad hoc committee's work today, and I wanted to highlight a couple of things that to really emphasize things that have already been said.

One regarding strategy area 2C, the Safe Landing Project.

As the supervisors heard today, we had a disappointing response from the Sheriff's Office that the soonest that some type of permanent place for the Safe Landing Project is July of next year.

This was disappointing to hear and really hope that we can get something sooner, and something that is actually more aligned with what Roots wants to do, which is having a space outside of the jail rather than in the jail lobby, though that is already an improvement from the, you know, way back in the parking lot where nobody can see, and they weren't able to help everybody coming out.

But a July 2026 timeline is really not optimal, given that every day people are being released from the jail.

And I think the supervisors understand the importance of having a warm handoff.

So wanted to highlight the importance of that, and also we didn't get clarity on whether the county can leverage CalAIM funds to help with safe landing.

And the other part that I was going to comment on is on Strategy Area 5, uh 5A diversion.

Several have mentioned the importance of having clinician staff for the mental health mental health diversion court, and wondering why the behavioral health court clinicians don't assign some of their clinicians to the mental health diversion court as they do to some of the other diversion programs.

And also, I apologize if I didn't hear it discussed, but also, you know, why not explore the idea of hiring social workers to support the mental health diversion court?

It doesn't make sense that there's no support when that is the most used diversion uh program.

So those are two areas I wanted to comment on.

Thank you very much.

Jean, go ahead.

Hi, this is Jean Moses.

Um I am in Lena Tams District 3 and a member of ICJ.

Uh my comments and questions are also relating to strategy area five.

It's really wonderful to hear about the increases in collaboration and in data collection sharing and analysis across the county that are happening as a result of the carefirst jails last policy.

Thank you so much.

In slide 18, as has been mentioned, Judge Della Piana shows the approximate number of participants and the number of clinicians assigned to each court.

The mental health court with 220 participants has two and a half to 18 times as many participants as the other courts.

And most of those people are facing more serious felony charges.

Dr.

Tribble pointed out that the cost of a clinician is close to 200,000 per year.

And I'd like to reiterate what Natasha just said.

We could be focusing more on social workers than on clinicians.

And it takes both time and money, particularly in these days, to find clinicians.

And because of these circumstances, I would like to suggest that ACBH find a way to assign several of the 15 clinicians that currently work in other diversion courts to the mental health court.

I think we should follow up on that.

Also, LDL to LD Lewis's point about the importance of following a proven model.

I agree, but I also think that we should keep in mind that flexibility is often called for.

Relatedly, I look forward to having data that will show us more clearly what is working in all of the various diversion courts.

Thank you very much.

David.

Yes, hello.

Can you hear me?

Yes, go ahead.

Good.

I'm David Stern.

I'm a 48-year resident of Albany and about a five-year member of the Care First Jails Last Community Coalition as an individual.

I want to echo appreciation for the careful attention that the board is giving to this agenda and all its complexity and the continuing commitment to make good on the 2020 resolution.

I have a few specific questions related to housing and finance.

The first is about Measure W.

There's some confusion about how much money is going to be available for permanent supportive housing units.

The original recommendation from the Mental Health Advisory Board was to acquire 850 or more.

Another question is whether Measure W can pay for licensed board and cares.

We there's a lot of discussion today about that.

And that's a specific question.

A sort of out of the box question.

Would the board approve a revolving loan fund using portions of Measure A1?

For purchase of licensed board and cares.

I'm out of time.

Thank you.

Kathleen.

Kathleen Secora.

Yes, can you hear me?

Yes.

Go ahead.

Good afternoon, good afternoon, and thank you for this opportunity.

I'd like to speak again to the critical importance of licensed board and cares.

As one member said, the appetite for more and higher-tiered funding.

This has been a great discussion today, and your commitment is laudable.

Grateful for it.

So as you know, massive number of closures in recent years.

People look at the statistics and ask if if they're statewide.

I've seen uh one statistic between 2019 and 2024, 175 board and cares closed.

So that would amount to approximately 3,300 and something beds.

Now they're not all for SMI, and that's one of the complexities, but they think that perhaps over 80% are.

Anyway, um one study points to operating costs as the primary reason to spite county patches and one-time subsidies to existing board and cares, but the subsidies for persons with SNMI are still nowhere near in parity with the subsidies for persons with developmental disabilities, and that's legislative and historical.

We understand a PAL letter is in progress that relates to board and care subsidies.

So at May, at the May meeting, the question was raised as to the need for additional board and cares, and I think that's been discussed enough today.

I decided to research it and, you know, to try to find data, and I couldn't.

And um, I just you know would say honestly, it was really only by inference that I could make the case.

I couldn't find a quantitative assessment of unmet needs.

Obviously, I couldn't find out where the several thousands of residents went when their board and cares closed, so no one seemed to keep track.

My second point is that the home together is excellent.

Uh, I don't think that under permanent support of housing, it uh it will um include board and cares.

I'm sorry I've run out of time.

Thank you.

Alison.

Hello, Alison Monroe here.

I'm also on the ad hoc committee.

I thought I'd be absent today, but um the recreational activities here have gotten rained out.

Um my concern is about the supply of hospital beds and board and cares.

These beds define the footprint of the system for the most seriously mentally ill.

These beds are scarce.

They are rationed by an interagency committee.

They have been in short supply as long as I've been involved.

My daughter, who I loved, died a couple years ago because the system wasn't able to provide a support supportive enough environment for her.

She went through both hospitals and boarding cares.

She did not get early treatment that was effective for her illness because in the years that she became ill, we were trying to move people through Villa Fairmont as fast as possible.

And there's still anecdotal evidence, as Brian says that our system doesn't have enough beds.

There are people waiting and waiting try to get into villa.

There are the system tries to keep people from getting into villa and tries to discharge them from villa as fast as possible.

That's, you know, human nature that's expected.

I want an assessment of the need for hospital beds as well as an assessment of the need for boarding cares.

We need lists of what we have and where it is and what it's good for and why it falls short.

There are consultants like Endigo who know how to do such an analysis and ACBH should fund one.

And this analysis shouldn't be seen as an indictment of agencies for maybe not doing the best they can.

It's just honesty.

Thank you very much.

Willem.

This is Willem Fandy Camp.

I'm a member of the Interfaith Coalition for Justice in Our Jails and also of the Care First Community Coalition.

Thank you, Board of Supervisors and Committees for this hearing today.

I appreciate it.

And um, in reference to Area 5, I'm happy to hear that there is an increase in the referrals to the care court.

I hope the expansion will continue and you will do everything needed to achieve that.

And in regard to the mental health diversion, uh I would like to reiterate what several previous speakers have addressed already that staff should be assigned two days, considering the number but also the importance.

We know how much mental health is a major issue with co-occurring disorders, with incarceration, and if we want to achieve care first, yes, last uh goals about less incarceration, more prevention, then this is what's needed.

So I hope you will as soon as possible find ways to get staff assigned to the mental health diversion as needed and various suggestions that we made of how to do it.

Uh, I will not repeat those.

Thank you very much.

Lonnie.

Uh thank you.

If you can hear me.

Um, my name is Lonnie Haccock, and I've worked on these issues for many years in the state legislature.

And want to honestly thank everyone that participated in this.

This was a thoughtful, insightful.

I learned so much from staff, from supervisors' questions, and from the community respondents.

Um, I just want to point out that if you pull this off, which is uh a working healing mental health system continuum of care in Alameda County, you will have achieved a policy and program goal that the whole country is looking for.

And your thought partners, and the collaboration process that seems to be emerging here is so important.

I would urge you to think about beginning to budgetize some of these recommendations.

And other things.

Do we need to have an additional crisis center to John George?

We've been told only three out of 20 referrals can get in.

And we are told that there are 300 people roughly per night in the jail.

Uh maybe for our diversion to work, we need to have uh an enlarged or additional crisis center in the community.

And I would just say keep working on this.

To paraphrase Brian, though, I would say our goal should be in our lifetime.

Thank you all.

There are no more speakers.

Okay, I want to thank uh the public comments, they're very informative.

Um does the staff have any responses to anything you've heard?

Anybody because I know you've heard a lot from the public.

Yes, thank you uh for the opportunity, and I I will be brief.

I think um you heard from the public the feedback that our partners are collaboratively working on, including the diversion, and so there's a lot of opportunity that we have here, and including some of the staff reassignments, and uh I want to be very honest also.

The grant that we're very hopeful for does have a delta.

There's a 50% reduction that we're looking in from proceeds from the state, so we're trying to figure out how to match that.

So, besides the signing of the MOU, we're still committed to doing what we have to do.

So I just wanted to be frank that there's multiple factors, and so us as collaborative partners are working through that.

Um, and and I think the other piece that I wanted to acknowledge is um speaking to the questions around uh the additional facilities, just again highlighting that we have already uh expanded and are working with AHS, our partners to bring on additional acute facilities across our our systems at St.

Rose and at um San Leandra Hospital.

So those will be some things that we'll be looking forward to very soon, as well as an additional, I think 200 um bid for substance use treatment itself.

So there's a lot of happening in that world.

So thank you.

Okay.

So let me see if Supervisor Marquez has any questions or comments, and then we'll wrap things up.

Again, no, I just really appreciate that.

We're gonna have um another update, and um, I I hear the requests in terms of like a coordinator.

I um we're dealing with this on many, many serious policy issues.

How difficult it is, and um, I do want to give Aaron Armstrong her flowers.

She's done a tremendous job.

Is she I can't see you, Aaron?

Sorry, you are there, sorry, but thank you for everything.

But I do think just um, with any uh major initiative and one such as important as this that we do have responsibility as a board to figure out staff.

I know everybody is already spread so thin, everybody's doing a lot, but I really appreciate uh flagging that.

I don't have an answer for you, but it is definitely something that's top of mind.

So thank you.

And um, this is certainly giving me more clarity in terms of what's working, what's not, and as I said earlier, we've we've made um progress, and there's more work to be done.

So I know that I'm committed to continuing to collaborate with all of you, and hopefully the update in March will be even more significant.

So thank you all.

So a few things.

Yeah, so yes, we'll I think Supervisor Marquez mentioned it.

Um, the speakers mentioned it.

So we will have an update March, another joint committee meeting.

Okay, so it's one thing.

Secondly, I appreciate the fact that the county, the departments were all working uh collaboratively on this with the courts as well um and are are you kind of the I think in the presentation you're selected to be the the the quarterback?

Are you the the the go to person that's pulling everything together?

Dr.

Treble?

Well, first I will co-flower.

That's I can't think of the apropos way to say it, but really kudos to Erin, and we've given her so much feedback.

So she's the one.

She's she's the one.

I will come in at the far second uh I avoided eye contact but yes my colleagues believe that given the throughput that I could help to support given the the resolution it does rest with um our department to support the activity and the work of the mental health board okay because I really think it's important as Supervisor Mars Marquez pointed out and some of the speakers that we have um someone who's charged with you know quarterbacking all this so at the moment I'll just leave it at that so we can try to figure that out Supervisor Marquez flagged it as well because we really need to ensure that um there's coordination and continuity uh because there's a number of speakers pointed out uh what we're trying to achieve here isn't going to be achieved overnight it's it's incremental and then there are going to be some um you know some barriers and some steps back just because of other things that are taking place that might have an impact.

So we need to kind of flag that and then I heard a lot from the mental health advisory board a lot from the um public in terms of a number of things I didn't take notes I know it's recorded I hope staff was listening to your respective concerns.

I'm sure Aaron was picking stuff up as well as the other supervisors' offices and the agency head so there's just a lot there that I'm hoping we can um um capture and when we have the update in March we'll have some you know um progressary uh reports and comments around some of the things that people had flagged uh that are um essential and other things that people have raised as a possible uh suggestions and approaches uh as well so I just wanted to mention that and then the final piece is the mental health advisory board um I think you I really appreciate the fact once again that you're monitoring the implementation of this um uh do you need any other support from the board or are you are you good working with the agency in the department and is everything okay or do we need to kind of provide a little bit more oomph um well as you know currently RDA is tasked with help with facilitating our meetings and helping us uh and working on an integrated plan for the whole county um continuing allowing them to continue working with us over the course of time would be really an excellent idea I mean because that that did that's the kind of support that we really benefit from and I shudder to think of the day when I can't turn to my RDA partner uh for help and support so if you're if you're asking that's uh that would be top on my uh holiday my holiday gift list yeah and and and if I may clarify uh the holiday gift uh the behavior health department is support is paying for the RDA assignment and I think the two concrete really key uh pieces that we're looking to help finalize for them this coming June is the integrated plan so that your board can look in and I believe actually it was you supervisor um Marquez that said it about two years ago to make sure that there are trackable data outcomes and so in subsequent uh um iterations of the board we hope to have them be a part of it as well okay all right very good okay all right well this has been a lengthy meeting yes oh sorry I just wanted to there were a couple of comments related to measure W and the um change in uh allocations for funding from uh December of 2024 to what was approved in July um and one of the things that happened is that you know in December we put forward a plan that had a really significant portion allocated to capital investment um and then but that hadn't taken into account some of the changes that we saw happening with the new federal government as well as city budgets etc and so the plan that was approved by the board in July is the one that's moving forward, and in that capital funding um has gone down to about 150 uh or 100 to 150 um and that'll go out in a couple of different phases in partnership with the community development agency and our H and H team.

Okay.

So it went from three fifty to approximately one fifty based off the landscape, which is completely shifted.

Correct.

Okay, that's clear.

Thank you.

Okay.

So once again, we've dedicated an entire meeting to this, and it's been really helpful and informative.

Appreciate everybody's engagement around this.

You know, when I say everybody, I mean everybody.

So let's see if we have any uh public comment on non agendized items.

There are no speakers.

All right, okay.

So we're adjourned.

Recording stopped.