Mental Health Board

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Minutes for May 27, 2020

Sonoma County Mental Health Board
MHSA Plan Update/public hearing
Minutes of May 27, 2020

This Meeting is Virtually via Zoom Webinar

Minutes are posted in draft form and after approval at www.sonoma-county.org/mhboard
Email: dhs-mhb@sonoma-county.org

Please Note: A list of commonly used abbreviations and acronyms is attached

This meeting’s Zoom webinar audio recording will also be posted on the Mental Health Board web page as an attachment to these minutes.

CALL TO ORDER

Meeting called to order at 5:00 PM by Chair, Kathy Smith
Present:
Kathy Smith, District 5
Bob Cobb, District 4
Carol West, District 2
Mary Ann Swanson, District 2
Sherry Weyers, District 5
Becky Ennis, District 3
Patricia Gray, District 1
Peterson Pierre, District 1
Peter McAweeney, District 4
Bob Hales, District 5
Excused:    Fran Adams, District 2
PEERS Coalition Representative: Maria Arreguin (present)

Sonoma County DHS, Behavioral Health Division:
Bill Carter (BH Director); Melissa Ladrech (MHSA Coordinator); Julie Kawahara (SCBH/MHSA Consultant); Sid McColley (Acute & Forensic Services); Bruce Robbins (MHSA Analyst); Phyllis King (YFS); Melissa Totz (SCBH); Rhonda Darrow (SCBH/MHB Clerk/Recorder)
Public Attendees: Michele Rogers (Early Learning Institute); Tina Moss (Early Learning Institute); Guadalupe Navarro (Latino Service Providers); Sean Kelson (Goodwill Industries); Sean Bolan (Goodwill Industries); Kate Roberge (Goodwill Industries); Brandy Evans (Goodwill Industries); Honor Jackson (Community Baptist Church Collaborative); Theresa Comstock (CALBHB/C); Luigi Valencia (SOS Counseling-MST); Mitsumasa Walts; Jeanne Erlenborn (SRJC-PEERS); Christy Davila (West County Community Services); Mary-Frances Walsh (NAMI); Betzy Chavez (Hanna Institute); Chris Kughn (Buckelew); Christi Tays; David Cox; Elizabeth Vermilyea (California Parenting Institute); Erika Klohe (St. Joseph’s Health); Jessica Carroll (Positive Images); Kerry Ahearn (Aldea); Katie Swan (Buckelew); Maddison Vernon; Michael Johnson; Shirley Gordon; Susan Keller (Community Network); Vicki Kalish; Vivian Sedney (Corrine Camp Coalition); VOICES Sonoma Zoom and nine call-ins.

Note: These meeting minutes are transcribed from a digital recording. Sections have been edited to increase clarity, where the speaker was readily available to modify the language; however, other sections have not been edited and may include unintended errors resulting from the transcription process.

ANNOUNCEMENTS /MHB MEMBER INTRODUCTIONS & BOARD BUSINESS
Kathy Smith, MHB Chair, District 5: Okay, I am going to call this meeting to order, and I'm going to make announcements. The Mental Health Board is an advisory board and is empowered to listen to the concerns of our constituents and to help formulate policies that offer a consistent continuum of care for all those with mental health challenges. We are further empowered to advise the county board of supervisors on the mental health system of care. The Mental Health Board Mission: The Mental Health Board acts as a community focal point for mental health issues and advocates for the development of a community network to promote the following. Coalition building that will create a unified voice to impact public policy and awareness, a wider understanding and knowledge of mental health issues. The integrity of mental health services and the involvement of clients and families in mental health planning. The Mental Health Board Vision: Sonoma County Mental Health Board collaborates with the Mental Health Services Division of the Sonoma County Department of Health Services to increase public and professional awareness of persons with mental health challenges and to help eliminate the stigma attached to those mental illnesses. We strive to positively impact the mental health system by listening to public input and working with mental health services to create policy that will offer hope to families and individuals living with mental illness. Okay, you may submit agenda items for consideration prior to the Executive Committee meeting normally held on the first Wednesday of each month, 10:30 to noon. Email or call the Mental Health Board Clerk, Rhonda Darrow, 565‑4850. Her email is Rhonda.Darrow@Sonoma-county.org if you want to add an item or confirm the meeting has been cancelled. This information is also on the web site. We have vacancies in Districts 1 and 3. If you are interested in serving on the board, please contact Rhonda. I am going to introduce or have the Mental Health Board members who are present to introduce themselves. I am Kathy Smith from District 5.

Patricia Gray, MHB, District 1: Hi, I can start. I am Patricia Gray. I am from District 1. I am a psychologist here, and I have been on the board. This is my second term. Happy to serve.

Peterson Pierre, MHB, District 1: I am Peterson Pierre. I am in District 1.

Bob Hales, MHB, District 5: Bob Hales, psychiatrist.

Becky Ennis, MHB, District 3: Becky Ennis, District 3, Executive Director SOS Community Counseling.

Bob Cobb, MHB, District 4: Bob Cobb, District 4, a social worker.

Carol West, MHB, District 2: I'm Carol West, District 2. Peer, peer counselor.

Mary Ann Swanson, MHB District 2: I am from District 2, Supervisor Rabbitt’s district. Welcome to Carol West, our new District 2 member.

Peter McAweeney, MHB District 4: I am Peter McAweeney. I am an attorney in Cloverdale.

Maria Arreguin, MHB SRJC PEERS Coalition: I am Maria Arreguin from the SRJC Peers Coalition.

Kathy Smith, MHB Chair: Okay, welcome everybody. One of the business activities that we need to do is to hear from the nominating committee who is going to read the slate of nominees for the Mental Health Board Executive Committee officers and our voting will take place at the June 2020 meeting. Nominating committee is going to read the slate of officers.

Becky Ennis, MHB: So for the position of chair, Kathy, you are on the slate to return. For vice chair, we have two nominations to bring forward: Bob Hales and Peterson Pierre.

Kathy Smith, Chair: Thank you, and we will vote on those in June. That took care of business.

SPECIAL PRESENTATION: MHSA Plan Update (Melissa Ladrech, MHSA Coordinator, and Bill Carter, SCBH Director)

Melissa Ladrech, MHSA Coordinator: (Please see attached PowerPoint slides).You can go to the first slide. Welcome! My name is Melissa Ladrech, and I am the Mental Health Services Act Coordinator. I wanted to say, first, thank you so much to the Mental Health Board for hosting the public hearing tonight, and thank you all for participating. This is the very first time that we are having a virtual Mental Health Services Act public hearing. It is virtual for all of our safety, and we really ask that you have patience with us as we are still learning how to have a virtual public hearing, and I would really like to thank you in advance for your patience.

Tonight, we are here to provide the mental health providers, stakeholders, contractors and the community information and to hear your comments about the Mental Health Services Act Three‑Year Plan. The Plan has been available for review and posted on the webpage for 30 days. It was posted on April 27, 2020. Our distribution included emails sent to everyone who signed up to receive MHSA updates which is over 2,000 contacts. Emails were also sent to contractors, the MHSA Steering Committee and MHSA Stakeholder Committee, which is over 230 contacts and posted on our websites.

For the public hearing, all comments, questions, etc. are directed to the mental health board. I will take my queues from the Board Chairperson, Kathy Smith. I believe we have eight individuals that have signed up to make a public comment so far. At the end of the PowerPoint presentation is when we are going be taking public comments, and more information about how to sign up to make a public comment will be provided then. The public comment period is your opportunity to address the Mental Health Board about the 3‑Year Plan that I will be talking about. We are going to be recording this meeting, as well as taking notes on your comments and the minutes from the meeting will be posted on our web site. We may make changes to the plan based on substantive recommendations and thank you again for participating tonight. The PowerPoint is posted on the web site if you are not able to see it on the screen.

The PowerPoint is a very brief overview of what you have seen in the plan. Stakeholders have had an opportunity to provide feedback over the last 30 days and after we incorporate any substantial public comments into the document, the Sonoma County Board of Supervisors is going to review and hopefully approve the plan on June 9, 2020. Once the plan is approved by the Board of Supervisors, it will be submitted to the Mental Health Services Oversight and Accountability Commission and the Department of Healthcare Services.

Regulations require that the draft plan must be circulated for review and comment for at least 30 days, which we have done and allow people to provide comments about the plan and then Title 9 of the California Code of Regulations Sections 3300 and 3315 further describe the required community planning and local review processes which are also described in the plan itself. And just a reminder that all comments will be directed to the Mental Health Board.

You can see on the agenda slide that we are going to provide a brief overview of the plan, the annual program report and Bill Carter, our Behavioral Health Director, is going to talk about the unknown impacts of post-COVID budget. Then we will open it up to public comment.

I wanted to give you a bit of background on Mental Health Services Act which we will be referring to as MHSA. In 2004, California voters approved Proposition 63 which is the Mental Health Services Act, and it established a 1% tax on personal income in excess of $1 million. Mental Health Services Act has five components. Community supports and Services (CSS) is 76% of the funds that we receive in Mental Health Services Act. CSS is the largest component. Then there's Prevention and Early Intervention which receives 19% of the funding. Innovation receives 5%, and Workforce, Education and Training as well as Capitol Facilities and Technology Needs are funded by CSS.

This slide shows part of the cover of our 3‑Year Plan, which reflects the time that we're in, people wearing masks and people on these teleconference calls. The first portion of the plan, the introduction, includes an executive summary, description of the County, our community planning process and the timeline for that as well as the capacity assessment process and findings. We've had a number of Stakeholders' and Steering Committee meetings to discuss the information in the introduction section, and we also presented it to the Mental Health Board in February.

The next portion of the plan is the 3‑Year Program work plan, and the first statements that we make in that plan address that this is a time of unprecedented uncertainty and the expenditure plans, so that's the budget, and the work plan may have currently unknown and significant changes in the future due to the economic impact of the pandemic. This is our best effort based on the information that we have available. There may be some changes to come. The next section has a summary of changes which I'll review. There are five main changes that I wanted to highlight about tonight.

There is a new contractor for the peer services in FY20-21, the services were previously provided by Goodwill Industries. Goodwill has decided to step out of peer services, and a request for a proposal was put out. West County Community Services was awarded the contract to assume all of the former Goodwill peer services. The annual funding amount remains the same.
MHSA funding for peer services has been restored. Last year, due to budget cuts, MHSA was not going be able to fund peer services and the Board of Supervisors provided funding for peer services. For the next 3 years in the plan, MHSA funding has been restored to peer services and peer services are being funded with community services and supports, general service development funds. There's one exception and that's Interlink which continues to receive funding from the SAMHSA Mental Health Block Grant which covers all of their expenses. The annual funding amount remains the same.
Whole Person Care pilot program will end on December 31, 2020. This is a state pilot program and currently the state is developing a new program to replace Whole Person Care beginning in January. It's anticipated that the new program will have lower overall expenditures, and this is because that instead of having Department of Health Services contract with health providers, the state is planning to have a different entity contract with the health providers, and this will reduce the expenditures of Whole Person Care.
We are expanding the 32-hour crisis intervention training for law enforcement. Department of Health Services and Probation are working together to offer two CIT trainings in FY20-21. Once we offer the two trainings, then we'll offer one annually for Probation. DHS is splitting the cost with Probation and Mental Health Services Act through Prevention and Early Intervention, the Outreach for Increasing Recognition of Early Signs of Mental Illness is going to be spending $3,250 on each 32‑hour crisis intervention training for approximately 28 officers in each course. This is an effective way for Probation to gain a much better understanding of how they can work together and collaborate with people that have mental health issues.
DHS Behavioral Health Division is developing seven innovation projects. The seven projects are being refined, and we're working through our community program planning process and with the Mental Health Services Oversight and Accountability Commission to gain approval for these. The programs can be implemented once the Mental Health Services Oversight and Accountability Commission approves them. The total expenditures are $2.5 million in this next year. The first projects that's going to move forward is an addition to a project that some counties have already implemented: Early Psychosis Learning Healthcare Network.

This slide displays our draft FY 20-21 estimated funding and expenditure summary:

Community Services and Support the estimated funding is $15 million
Prevention and Early Intervention estimated funding is $3.9 million
Innovation the estimated funding is $2.5 million
Workforce Education and Training the estimated funding is $154,000
Capital Facilities and Technology Needs the estimated funding is $1.1 million.

As you look down the slide at D1, $944,000 are in prudent reserves.

Mental Health Services Act Annual Program Report is the last section of the plan. In this report the MHSA outcomes for FY 18-19 are presented. Community Services and Supports component is allocated the largest amount of funding for Mental Health Services Act, and this provides enhanced mental health services for seriously emotionally disturbed children and youth as well as seriously mentally ill adults. At least half of the funds in this component are to be spent on the Full Service Partnerships (FSPs), which are wraparound, “whatever it takes” treatment partnerships with clients.

There are six indicators that the state measures for FSPs:

Homelessness
Emergency shelter use
Group homes and community treatment
Arrests
Psychiatric hospitalization
Mental health emergency events

This table shows that in all the indicators the FSP clients are improving. Additionally, FSPs FY 18-19 served 405 unduplicated clients. The General Systems Development category of CSS provided over 4,800 services. Outreach and Engagement category of CSS provided over 2,500 services. Workforce Education and Training provided over 195 serves.

Prevention and Early Intervention (PEI) is the next largest category of funding for Mental Health Services Act, and these are programs that prevent mental illness from becoming severe and disabling, emphasizing improvement on getting timely access to services, particularly for underserved or unserved populations. In the PEI programs in FY 18-19:

Prevention programs provided over 80,000 service contacts
Early Intervention provided over 3,500 service contacts
Access and Linkage to Treatment provided services to 575 clients
Stigma and Discrimination Reduction provided over 1,000 service contacts
Suicide Prevention received over 4,300 calls by North Bay Suicide Prevention Hotline of Sonoma County.

Bill Carter, Sonoma County Behavioral Health Director: Good evening, I will share as much background as we have right now regarding what is happening with the budget--so we don't know right now specifically what's going to happen with the budget. We can only know it's not good, and I wanted to 1) lay out what we know is happening; and 2) what we know about the strategies that we will have to take as we look at addressing the shortfalls we can, except this year. So, right now the County has decided to submit a status quo budget, so we will submit the same budget we had this year going into June and July, and wait until later in the year until the late summer, early fall to make decisions so that'll give us time to figure out what's going on with the County budget, what's going on with the State budget and what relief, if any, will be coming our way. So, what we know about the changes in the economic situation are that, you know, in the January, the budget proposal and things looked great. Money looked good and programs were being slated to be expanded. There was a $220 billion State general fund projection, and in the May revision, it has been reduced to $203 billion. We went from historically low unemployment, 3.9 percent, to historically high unemployment, 18 percent. CalAIM had a proposal in process to modify our Medi-Cal program to begin to make improvements that expand coverage and included added efficiencies. At this point, the State is proposing the elimination of 13 option benefits in the Medi-Cal plan. There was going to be a Medi-Cal expansion to include older adults who are undocumented. At this point, we're projecting a growth in Medi-Cal caseload of 2 million in 2020. The Medi-Cal expenditures were estimated to be just $100 billion and the estimate now is well over $112 billion. And next slide, there we go. So, these are the projections regarding our revenue. So, the first two revenues are realignment, so the first four rows of this table are our primary revenue sources. So, the first two are realignment. This is vehicle license fees and sales tax. We share that with Public Health and Social Services, and Social Services is the primary recipient of all growth. You can see that the projections we look at and we see a reduction this year that continues into the next two fiscal years. We see the same thing with 2011 realignment with some of the amount picking up because they're assuming a recovery will at some point in Fiscal Years 20/21 and 21/22. The Mental Health Services Act is the third source of funding. This is the taxes on income after a million dollars. This revenue source is three years in arrears, so the funding we get today was money that was coming into the system three years ago. You'll see a drop this year that was expected and then you'll see an increase the next two years, as there were projections. In Fiscal Year 22/23 and the years that follow, we should expect more of a downturn in MHSA because that's when the economic impacts of today will hit that revenue source. And then, FFP is the money that we draw is Federal Funds we draw down when we provide Medi-Cal to the services, and we expect there to be a minor downturn or to stay the same. A couple of things impacting there. One is the federal government has made some changes to our reimbursement that are favorable, as in response to COVID; but our ability to provide services this year and into the next is severely impacted. So volume will go down. The others I won't go through because they are less relevant to our budget. Next slide. So, the impact on the funding is there's going to be less federal Medi‑Cal payments. So, as I just said, because we will be providing fewer services as we see cancelled appointments, provider staffing challenges, illness, we are providing services over, uh, the internet, virtual and telephonic services, but those, uh, are impacted by who has access to those, um, resources and in general you don't provide as many services at the same volume. There's going be a loss of core fundings, as I described sales tax, the millionaire's tax, and vehicle license fees will decrease significantly over the next 1 to 5 years. So that's our primary funding source. And then there's going to be our resources decreasing, the need is going to increase; which is one of the unfortunate structural problems with California's healthcare budget which is when, when you need the funds because there's an economic crisis, there's an economic crisis that assures you don't get the adequate funding and so we're going have more beneficiaries at the same time our, uh, revenues are decreasing. Next slide please. There's going be increased community need for emergency crisis supports so, on the, hierarchy of services we have to provide, um, when somebody is in an emergency we have to serve them, uh, and generally our strategy is we want to provide more prevention services to, uh, avoid spending, uh, uh, money on emergency services; but what happens in the situation, uh, we just reviewed, is there is generally, uh, an increase meeting in emergency crisis services. Um, the migration to tele-help and phone base services, um, uh, there's, there's no new funding for this. This has resulted in a significant amount of costs us as we try to get laptops and phones to, uh, staff. In some cases, we're trying to get those, uh, that equipment to clients and our current system doesn't truly, uh, reimburse us well for that. There's alternative sites for new and existing clients so we have to, uh, figure out how to finance settings to help with isolation and new populations, um, alternatives are residential and congregate care setting. So, all of the places our clients live that are impacted by COVID create service provision challenges that we are going have to address. And then contact the providers. We are going to be severely hit by this as well. Private and non‑profit agencies generally don't have the same kind of reserves and margins that a government entity might have so they are very vulnerable during this type of economic environment. Next slide. So, this is, you know, I, what I want to do here is outline the principles that we will have to use to make decisions when, when the time comes. Because I, I think it's important that we understand why we're doing what we're doing as we do it. Um, you can imagine that, uh, as we deal with the budget cuts there's going to be decisions made that we don't like. So we have to do the best job we can making decisions based on the strongest principles and consistent principles we have available to us. So, the first thing we will do is prioritize entitlement obligations that by virtue of the fact that there are entitlements where we have some services we are wired to provide as long as we accept the role we have in the system. We have to provide all the Medi-Cal entitlement services, and we're required to provide acute psychiatric inpatient services and IMDs. So, this is our highest cost services and these are also children's EPS DT services. Our next principle will be to maximize revenue. We only have one option for this that is consistent and that's FFP so, to the degree we can provide Medi‑Cal eligible services to Medi‑Cal eligible clients we draw down a dollar for every dollar we invest. So, we expand our systems, uh, with our money when, when we do that. Um, there are services that are very attractive and very important that don't draw down FFP and that's where tough decisions have to be made. Um, so we let go of those services when, um, in a, uh, in a time of paucity you have to get as much out of the resources you have on hand if you can. And then we will be looking at, uh, what the CARES Act and other federal funds designed to help local, uh, jurisdictions, uh, maintain their system. So, we will be, we are already following those grants and other funding sources. We have to use revenues strategically, so we have to blend funding, um, and make sure that we are getting the, the biggest impact we can out of every dollar. So, every dollar we get comes with certain requirements; those requirements, um, uh, benefit from being spent strategically. Uh, so if a funding source has a lot of limitations you want to spend it in that area of limitation. If the funding source is very flexible you want to hang on to that as long as possible and not spend it until you can spend it in a way that brings down additional funds and meets important needs in the system. Unfortunately, uh, in situations like we are, uh, approaching you reduce as many programs that are optional or not cost-effective. So, these are programs that aren't required; they're often funded by MHSA because when MHSA, um, was added to our system the, um, approach at that time was to use MHSA to augment and add on to the existing system. So, when that existing system is eaten away, MHSA programs those added programs are jeopardized and MHSA gets redirected to more of the core programs and core functions of our system, and we have to evaluate cost effectiveness. All right, so one of the examples that was offered in a CBHDA presentation which is where I got this information by the way he offered as the example crisis stabilization units are not required and they're very expensive. I'm not proposing we eliminate our Crisis Stabilization Unit; again, that's just material I took from a presentation by CBHDA. Next slide. So that is an overview of what we will be thinking about as we look at the budget shortfall and behavioral health this upcoming year.

Melissa Ladrech: Okay, so it's time for public comment. We will have three minutes, and we will have a list of individuals that signed up to make a comment prior to the meeting. You may enter a request into the Chat Box or put your hand up, I guess, if you would like to make a public comment. Or enter the request into the Chat Box. And for those of you that have called in, we're going to unmute everyone for a couple of minutes for you to provide us with your name and then we'll call your name when it's your turn to make comments. And, Bill, at some point if you would like to say anything else about what's happening. We'll give you that opportunity as well. Now it's time for public comments. So, Rhonda, did you have the list of people?

Rhonda Darrow, MHB Clerk: I am going to the attendees list; and the first person who RSVP’d is Michelle Rogers.

Michele Rogers, Early Learning Institute: Thanks. I am Michelle Rogers. I am the executive director of the Early Learning Institute. Our Watch Me Grow Program has been funded with MHSA dollars for the past 10 years. In that time, we have screened over 12,000 children, birth to 5 years, living in high-risk situations for social and emotional issues. These include kids in foster care, children who have concerning behaviors and children whose parents wanted them to have social and emotional screenings, but there was no other place for that to happen. We do our screenings in‑home. They are free to families and then we navigate them to services that they might need. Our other program, Instructions Not Included, is one of the innovation projects, that's working its way through the process, and we're very anxious to roll it out in Sonoma County. I have to tell you that I've always been so proud that Sonoma County has utilized part of our MHSA funds for the kids. We're very innovative in that way and one of the first counties to do so and continue to do so. So, I'm so pleased that the funding under PEI has been retained for the kids in partnership with First Five. I'm also a First Five commissioner, and so I just wanted to say that I think the plan is a good one. We are also, as you know, being impacted by COVID‑19 and having to go to virtual services and yet it hasn't slowed down the referrals or the screenings that our Watch Me Grow Program has been doing. Parents are amazingly resilient and they're rolling with it. So, I just wanted to say that tonight.

Tina Moss, Early Learning Institute: So, following up on Michelle's piece, first off, I would like to thank you all for funding the Watch Me Grow Program for the last 10 years. Another piece of our program that you guys fund is our Navigator Program. Our Navigator Program connects families to a variety of services, from mental health services for the child to developmental support, from parent education to programs for perinatal mood disorders. The parents and the Navigator notes the entrance criteria, as well as, they just serve for a variety of the programs. These include, but aren't limited to, early-start services. The local special education preschool systems, medical resources, behavioral health resources, as well as community programs such as family resource centers and groups. By serving or by helping the families navigate the system for their children and/or themselves as they respond to their children, this is a totally two‑generational approach to community well-being, and we're really happy that we've been able to provide this service to the community for the last 10 years. Over the last fiscal year, our Navigator received 460 calls from families with a total of over a thousand contacts from web referrals or faxes or email requests for support. I'd like to share one quick story about what our Navigator entails on a daily basis. They were moving from another state into California and their child had been receiving developmental services and behavioral health supports in that state and she was wondering if there were services in California, in Sonoma County. Our Navigator connected the family to the local school district that's responsible for the address the family was moving to and instructed the mother on which documents to bring to the new district so they could work on his IEP before he got here so he would be ready to go when he arrived. Our Navigator also referred the family to the Behavioral Health Youth Access team to see if they could determine if he was eligible for therapy based on his existing services. This mother was very happy to have a course of action in place for her child before they arrived in California, and she called back the Navigator after they arrived and thanked her because he started school immediately when he got to Sonoma County, had a good IEP in place, and was receiving mental health reports.

Guadalupe Navarro, Latino Service Providers: Hi, my name is Guadalupe Navarro. I am the executive director of Latino Service Providers (LSP), and again I want to thank you all for this opportunity to review and discuss, MHSA's current funding, as well as future funding. LSP has been funded by MHSA for the past few years. Under my leadership, we have expanded our role in the community given that we are one of the few ready-only MHSA funded organization that focuses specifically on the Latino population of Sonoma County. However, our organization has evolved to support the community after the fires, Tubbs and Kincaid, and now COVID‑19. We are directing our approach to be more of direct and ensuring that our community has access to the resources and services that are in dire need, especially with the Latinx community of Sonoma County. We are absolutely overwhelmed by the number of individuals that are calling our offices looking for resources and services. We are thin at this point, as our budget was drastically cut for the past few years. We've lost over 40 percent of the MHSA funding due to the budget cuts; but we are definitely experiencing a high volume and high needs in our Latino community. You've all probably have seen that the Press Democrat just recently shared a number of statistics that are concerning and alarming to the Latino community, the Latino organizations of Sonoma County and we're definitely looking for ways in which we can at least create some relief and advocacy for our community. There's definitely a lot of work to be done and. I understand that we have once again another potential budget impact, but I ask that you please help us to continue to expand our services to the Latinx community, as I'm fearful that with the pandemic now after three hard hits in a vulnerable community, we're definitely hearing increased anxiety and increased depression. I'm afraid of suicide rates for the Latinx community. I'm afraid of what is to come and, I ask for your support at this time as I'm very much feeling emotional, overwhelmed and personally exhausted because I feel like I'm carrying the weights of so many Latino community members on me right now. Thank you.

Sean Kelson, Goodwill Industries, Interlink Self-Help Center and Petaluma Peer Recovery Program: Good evening. Good to see, or at least hear you-all. I am Sean Kelson, the program manager of Interlink Self-help Center; and I oversee the Petaluma Peer Recovery Center, PPRC, an MHSA funded program staffed by certified graduates of the peer support training offered through the Peer Education and Training Program. At PPRC we provide one to one peer support, socialization opportunities, groups, classes, help with resource navigation, and more.

We are very thankful to again being MHSA funded and pleased that we have been able to continue to provide warmline services through the shelter in place order, with some participants calling in very regularly to share, be heard, brainstorm, etc. There have been times when staff also goes virtually online with a participant to be involved in online activities together, so to speak. This has been a challenging time for us all and we are grateful for the funding and to be able to provide support over the telephone during this time of sheltering in place.

We are also in the process of transitioning over to West County Community Services, which is exciting as well as a little unnerving dealing with more change, yet we are thankful for how smooth the transition is going and think this will be a win/win for us as a Center, for West County Community Services as an organization and for our community as a whole.

I have great appreciation for the support and stability our relationship with Goodwill-Redwood Empire has provided, and continues to provide, from helping PPRC get established as a funded program, to helping us make the community aware of the value of peer services when funding was threatened, which culminated in a decision to not bid on these programs this year, supporting us to get picked up by an organization with a mental health focus, better suited to support these programs and take us to new levels. This has been quite a process and a bittersweet experience for me. And again, I am very excited, very hopeful and very grateful for these new opportunities, and all the support. Thank you for yours.

Sean Bolan, Goodwill Industries, Wellness and Advocacy Center: Good afternoon, I am Sean Bolan, Program Manager of the Wellness and Advocacy Center. Can I just say that this has been a weird year? Last year at this time, our membership and the community came together to advocate for this program to remain in existence and they succeeded. We were granted bridge funding to continue serving the community and that we did. During the first 9 months of this fiscal year, nearly 1,500 unique individuals accessed the Wellness and Advocacy Center and in the first half of March, we averaged 82 people per day at the center. 336 people discovered Wellness for the first time this year and signed up as members of the center. Every aspect of the program continued to see increased utilization throughout the year, from emotional and psychological support such as one to one peer support and group attendance to practical support such as showers and laundry. And then the reality of a pandemic set in and we shut our doors to drop in support in mid-March. This was an incredibly painful decision. Over 70 percent of our new sign-ups identify as homeless and we know how much this resource has been relied upon by many long time members; however, the risk to the health and safety of our community had to be our top priority even if temporarily suspending drop in services would also cause temporary pain to our community. Since that time, we have been offering emotional support and resource navigation over the phone to anyone who calls. We are currently looking at the best way to partially reopen the center to some in person support services while maintaining the safety of members and staff. We will look different when some in person services resume and we won’t be serving 82 people per day for quite a while. My crystal ball stopped working a long time ago so I have come to embrace a level of uncertainty in this work. Despite the current climate of uncertainty regarding the future, we are happy to announce that West County Community Services has been awarded the contract to operate the center starting July 1st and we are scheduled to once again be funded by the Mental Health Services Act. I would like to personally thank Goodwill Industries Redwood Empire for supporting the Wellness and Advocacy Center since its inception in 2007 and throughout the last 13 years that we have been serving the community.
Thank you.

Brandy Evans, Goodwill Industries: As the present CEO of Goodwill Industries and the Redwood Empire, I have a prepared statement I would like to share: Esteemed Directors of the Mental Health Board and Director Carter. It has been a great honor for Goodwill Industries of Redwood Empire to deliver the services of what I believe was in the first ever county contract for peer-provided mental health services operated and offered at Interlink Self-Help Center since 1996. In the decade since, Goodwill proudly accepted new opportunities to expand the peer-run services with the addition of so many programs, including the Wellness and Advocacy Center, Petaluma Peer Recovery Center and the peer education and training program. Every successful venture requires a passionate champion and Goodwill had the good fortune to have Laurie Petta, former director of behavioral health, at the help for the past 13 years. Laurie’s unexpected retirement last summer notwithstanding, had made it clear that in order for the now behavioral health programs operated by Goodwill to continue their growth, a new provider was needed. I could not be more pleased for the peers, the community or the recipient of the award for these services. West County Community Services under the leadership of Tim Miller has proven to be a strong provider with a heart of gold for their work with the homeless population, providing counseling services to youth, adults and seniors, as well as their work through the Empowerment Center for people with chronic mental health challenges. It is always bittersweet to turn over a program, but in West County Community Services we feel blessed to have found a provider that will continue the excellent work of the peer community that was started at Goodwill. Tim and the West County Community Services Director of Counseling and Behavioral Health, Christy Davila, have already done an outstanding job on the transition for which I am particularly thankful under these unexpected circumstances a remote working and I'm absolutely certain with their leadership, all six of these programs will continue to thrive. Again, it has been on our honor to serve the community and the County of Sonoma's Behavioral Health Department. Thank you.

Honor Jackson, Community Baptist Church Collaborative: First of all, we would like to thank you for again for making Community Baptist Church Collaborative a part of your program. Without it, we would have not reached nearly as many people as we do. We have four programs, the Safe Harbor Project provides music as, as a relief, stress prevention, music and sustainable living. We provide calming, relaxing sounds, music outreach to churches, civic groups, healthcare providers and individuals throughout Sonoma County, as well as fairs and mental health fairs and what not. We have Saturday Academy and the Village Project as our second and third programs. They will provide faith-based targeted education to enhance life skills, self-esteem, personal growth, coping skills and knowledge of community resources. Our target age groups are 5 to 12 for the Village project and 13 to 18 for Saturday Academy. Services will be provided to a, a diverse cultural population in Sonoma County; however, outreach and program design will primarily focus on the African American community. Our fourth program is the Bridge to the Future Rights of Passage Program. It is an 8‑month program. The others are year-round. Bridge to the Future is a 8‑month program for youth 14 to 18. This program uses adult mentors, civil and community leaders, elected officials, etc., volunteers and curriculum specialists to provide youth with life skills such as self-esteem, team building, wellness, nutrition, etiquette, cultural awareness, time management, financial awareness, career planning, public speaking, college preparation, exploration and community service. These skills in turn will assist the youth in a successful transition for the future and adulthood in a culturally diverse community. Activities and/or workshops consist of monthly 3‑hour sessions, field trips, and field trips to practice acquired skills. During this pandemic has been tough, but we've, thanks to services of Zoom and Facebook and the like, been able to focus primarily on those outlets to reach the number of youth that we do. We're very thankful that we have those outlets which we actually have increased some of our numbers by using these outlets through Zoom and through Facebook particularly. We'll like to thank you again and say God bless you and thank you for the work that you do so that we can continue to do the work that we do.

Kate Roberge, Goodwill Industries, Peer Education and Training Program: Well, hello everybody, Mental Health Board. This is Kate Roberge, and I'm the program manager for the Peer Education and Training Program which is an MHSA program currently with Goodwill Industries and soon to be with West County Community Services as you've heard today. I want to thank you for the opportunity to speak tonight, long distance as it may be. I wanted to start by saying that I think of this year as a gift. Back in spring of 2019, Sonoma County peer programs were really in grave danger of being eliminated, and it didn't look like there was actually going to be a 2019/20 for us. I'm so appreciative that our programs and many others were funded and stayed open. I'm deeply grateful that MHSA will continue to fund the peer education and training program. The Peer Program's mission has been to nurture and amplify the voices of peers in Sonoma County bringing their perspectives on recovery to the Sonoma County mental health work force and community. During our nearly nine years of existence, the program's focus has changed a little bit and now centers on providing education and job skills that peers need to contribute to the Sonoma County mental health workforce and community. Members of the local peer community are trained to become peer support specialists assisting others with lived experience on their recovery journeys. As peer specialists continue their own mental health recovery work, they model the process for others. To date we've had over 100 peer support specialists have gone through the program and been trained. The trained peer support specialists can serve in a variety of roles. At this time in Sonoma County, most specialists work in the peer-run mental health centers. It's the Peer Education and Training Program's mission to teach people with mental health challenges to do this work. PET offers a comprehensive 3‑1/2‑month class in peer support. In order to polish their new skills, graduates of the class are placed in internships at one of the peer-run centers or other local mental health agencies. Graduates are then supported to apply for local positions as peer support specialists. Like many programs, PET, especially the peer support specialist's training class, has been greatly impacted by the shelter-in-place order. We hope to be back up and running very soon with quite a few changes and precautions. As I mentioned at the beginning, Goodwill's six peer programs will soon be transferring to West County Community Services. I wanted to express my gratitude to Goodwill for all the years of guidance and support. I especially want to thank Laurie Petta, our former director of mental health services, whose understanding of the special needs of peer programs and years of attention, expertise and deep commitment have helped us grow to this point. I would also like to thank Brandy Evans, Goodwill's president and CEO, for shepherding us, first through the transition of Laurie's leaving and now as we move on to West County Community Services. And, to West County thanks for welcoming us aboard. I'm looking forward to new adventures. Thank you.

Theresa Comstock, California Association of Local Behavioral Health Boards and Commissions: Hi. I just had a brief comment. The organization I am with is California Association of Local Behavioral Health Boards and Commissions (CALBHB/C), and I wanted to just mention I really appreciate the staff putting the outcomes on Pages 12 and 13. That is really a good model for how to put that information in and that you're collecting that data and reporting that in the outcomes are so good for those full service partnership programs is outstanding. I hope that there's some information on the Prevention and Early Intervention programs. I had looked at your MHSA update from years 2019 and 2020 and noticed that you had done quite a bit with employment serving 313 individuals. So I hope to see information also on that for outcomes. But nonetheless, I'm going to use this as a model, as we help to advise and support the Boards and Commissions around California so that they can get this kind of data. Thanks.

Luigi Valencia, SOS Community Counseling/MST: Hi. Thanks for having me. My name is Luigi Valencia. I'm a justice program specialist for SOS Community Counseling and my reason of being here for this meeting is I oversee our Mobile Support Team (MST), so I first just want to thank the Board, thank Bruce, Phil, Melissa, Karin Sellite Karen Barnes-Flores, and all the tremendous work and support they've had to be able to do with us. For those of you who do not know MST, it is a crisis intervention team who gets dispatched on every time there's a call out in the community. So basically at last quarter's reporting, we had a 120 crisis calls, 25 percent of those resulted in a 5150, five (5) percent of them were a danger to self, five (5) percent of those were danger to others, and seven (7) percent of those were gravely disabled. We are actually working hand-in-hand in this study being conducted by the County to assess the needs of the community and basically looking at the long-term cost benefits of maintaining MST so it's something we're really proud of. The beginning of our work this fiscal year was rough given the fires and just displacement of a lot of our staff. However, we were able to end our finishing stronger than we started with fulltime staff employed and also looking forward to the future. So, I just basically want to be a part of this meeting for a) again thanking those who are in support of us, and b) just ensuring you that we are delivering on the things that we are trying to accomplish, so yeah. Thank you so much. And I also am a member of Latino Service Providers Board of Directors so hi to Lupe. Hope you're doing well. Thank you so much for your time.

Jeane Erlenborn, Santa Rosa Junior College: Yes, hello. Thank you for letting me join in last minute. I am a health promotion specialist at Santa Rosa Junior College. I work with the PEI and PEERS program there. We've been grateful to have funding through PEI for the past 10 years and so just to update you on some of our recent accomplishments. This past year we actually moved our program over into the Office of Student Equity which is right off the main quad, and we just loved that location and being able to collaborate with all the different student leaders, including the learning communities of the Queer Resource Center, Quintay Native American Summer Bridge, Emoja Apassk, so we were doing some really important work looking at the intersection of mental health with each of these communities. The peers put on workshops which had 40 to 80 people attending each one, and it was peer-to-peer information on stress, depression, seasonal affective disorder and nutrition and mental health. That one was really popular and included a cooking demo with our culinary academy and then that was followed up by a very powerful and personal panel on body image. So, all of their workshops include some information on some students sharing their lived experience. The peers also this year created a video for the directing change contest which won an honorable mention in suicide prevention in the statewide competition. We were really excited by this and the video is based on a poem written by one of our own peers, Sara E., about her experience with seasonal affective disorder. Luckily this year, we had already been doing a lot of amazing social media work. Our Instagram following went from 150 up to almost 1,200. We also launched a Twitter page, YouTube channel, created posts for Facebook, for the overall SRJC Facebook. So, this has set us up well for reaching students now that we are virtual learning. We were the main outlet for letting students know about mental health resources both countywide and to know that our on‑campus therapists were offering continued counseling through telehealth. We are currently working on how to provide suicide prevention and mental health for state training virtually which both programs are making that transition. And, I think that actually we might reach more staff and faculty this way since they're all working virtually, and they might have the time to attend more of these trainings. Overall you know, the peers are just doing amazing work behind the scenes integrating discussions about mental health throughout campus, change in the conversation, demonstrating the power of vulnerability, compassion and how to support others. And lastly, I'm happy to announce that two of our peers, who will be staying with us next year will also be holding positions in our student government SRJC. One of our peers, Joselyn, will also be the student trustee which means she'll sit on the SRJC Board of Trustees and our own Maria Arrequin, who is here on this Mental Health Board, will be our new VP of Student Health. So, I just think it is amazing having these student mental health advocates in these positions to help bring that voice and moving positive mental health policy forward on campus. So, we thank you for your continued support and we look forward to continuing our great work in PEI. Thank you.

Christy Davila, West County Community Services: Hi, my name is Christy Davila, and I'm the director of Counseling and Behavioral Health with West County Community Services. I wanted to offer some words as we are stepping in and supporting this transition for all of the peer programs that are moving from Goodwill to West County Community Services. As a community provider offering a variety of counseling services, from serving our youth and schools to peer programs to serving our seniors in peer counseling and clinical treatment, I am really honored and grateful to be able to support these additional peer programs to continue working together and collaborating all of our peer programs to the Russian River Empowerment Center and the Wellness Center, Petaluma Peer Recovery, Interlink, and the training program. The coming years are going be a struggle for everyone in our community, financially, emotionally and psychologically, and as our peer programs have already proven over and over again how effective they are and how hard they work. I really am honored to be able to work alongside the program managers to look at how we can continue serving Sonoma County in the mental health well-being of all, not just the people that we identify or that that seek out our services, but that identify as having mental health struggles, because I think we all are struggling right now. And, I'm just really grateful to be able to be a part of this larger team now. So, thank you.

Becky Ennis, MHB: Rhonda, I just have a question. Comments in the chat are recorded, correct?

Rhonda Darrow, MHB Clerk: Yes, they are. We have one more chat. There are some chats from Mitsumasa Walts, but, Mitsumasa is asking them to be read out loud.

Mitsumasa Walts read aloud by Kathy Smith, MHB Chair: I second what Guadalupe Navarro has said. Any mental health support structures moving forward should center on the community. Any of those in the county most impacted will benefit all of our health collectively. And then a second chat—I am an internment camp survivor who deals with intergenerational trauma. Think generations down the line here. Support community today for collective resilience tomorrow. It is so important to acknowledge that this is indigenous land. Many of the workers whose labor feeds the community and does basic care are indigenous and/or undocumented. It's that the community has had to create and document to try and help with the gap in fending that the state should provide prioritizing the needs of all people. We need to recognize the trajectories of healing which require generations of support to attempt recreation to black immigrant and indigenous people for generations of harm. When we prioritize those of us being most impacted, it creates groundwork for longevity in community healing for all of us. Don't make the mistake of unhearing the advocates here who are speaking to the need to center people of color in the county -- that's the end of the public comment.

Kathy Smith, MHB Chair: And thank you, Mitsumasa, for submitting those comments. All right, welcome, Mary Frances.

Mary-Frances Walsh, National Alliance on Mental Illness (NAMI): Thank you. I will just be brief. Thank you very much. I'm executive director at NAMI Sonoma County. I don't have any prepared remarks. I just really want to express my thanks to the Mental Health Board for keeping mental health at the top of everyone's mind. Thank you to the group of advocates that have already spoken on behalf of so many great organizations in Sonoma County, and thank you to Bill Carter and Melissa Ladrech for really being open and honest about the situation that we're all facing together. I just wanted to speak up on behalf of the families of those who live with mental health conditions and say that they're being impacted by the pandemic, and in many cases, their loved ones are experiencing the effects of the stress of this crisis. The families are there trying to support them, but they experience their own levels of stress, and our numbers are growing. We moved our services online to resume, and I just cannot believe how many more people are feeling comfortable to seek help or seek somebody to talk to about what's going on in their lives. So, this move to Zoom has been a very good thing, and I am just as anxious about cuts that will come ahead because every time we experience cuts in the behavioral health world, you lose talent, you lose a lot of knowledge. I'm not saying anything that any of you don't already know that we'll do whatever we can to hang in there. If times are slimmer, but you have a lot of talent in the mental health world in this county, and I just want to thank everybody. I know that we will work together to do the best we can under new circumstances. Thank you.

Thomas: Great. My name is Thomas, and I want to thank you for having this meeting and for all you're doing with regard to mental health in Sonoma County. As I was listening to Director Carter's remarks, and it sounded as though, and I was hoping to get clarification, on what he was saying there's sort of a deferred or a reserve fund that pays three years in arrears. He was indicating that the effects of budgetary events would be felt two or three years from now at least on some items, and I was trying to figure out on how much of the budget would have deferred effects and how much would not have deferred effects due to that withholding, if you will, and how much in a dollar amount. Thank you.

Kathy Smith, MHB Chair: Bill, would you like to talk to that?

Bill Carter, SCBH Director: All right. So there are four revenue sources, and the one you're referencing is MHSA. Those are taxes that come in, and the way they're distributed to us, there's a lag time. The downturn that we're experiencing now will be felt in that one of four revenue sources, largely in 2020, beginning in 2022, 2023. So, that's what I don't have the forecast with me right now. The two of the four revenue sources which are realignment are taxes and legal license fees, and we will feel those in the near term but because people and economists are forecasting a recovery, you know, that would begin perhaps a year from now. Some of the forecasting shows slight upticks over time in that funding source. It's still lower, but they show it trending upward. Did that make sense to answer your question?

Thomas: Yes. I was interested in the gross amounts as well. You indicated that the state budget was increased to 280 billion, I believe, and then both in from January and then reduced to 213, but you didn't indicate what was last year's budget. So, it might be, you know, that would be like almost a 25 percent reduction, but it may have been an increase, and we don't know the increase in relative. So, if you could give last year's budget comparison to the 213 that would be great.

Bill Carter, SCBH Director: So, I don't have last year's budget in front of me. The state budget numbers on the slide that was presented, I think, indicated that going into the year before COVID, we have a $222 billion budget, and I believe that reduces to $202 billion or $212. I don't have it in front of me, again, but it's an overall state budget reduction that reflects the reduction in revenues.

Thomas: Thank you.

Rhonda Darrow, MHB Clerk: Okay. I am just looking here. There are some little chats --Tina Moss has thanked Bill and Melissa for the budget update; callers like your signs, Bill, behind your head. Thanks for the humor. And I don't see any others. Anyone else that I'm missing that would like to speak? I see no raised hands. I see no chats. Oh, I see there's one more chat. Erika Klohe of St. Joseph’s Health shared she is grateful to work with you all and look forward to working together. Petersen Pierre, MHB Member, is asking what is meant by realignment.

Bill Carter, SCBH Director: Two of the funding sources that we rely upon in the behavioral health system are 1991 realignment and 2011 realignment. The term realignment refers to the fact that in that legislation, the state realigned responsibilities to the county and made and dedicated revenues to support the realignment of those responsibilities. And there are vehicle license fees and sales tax that generally make up the realignment funds, so that downturns in the economy result in less realignment, which is the core funding for the behavioral health system.

Carol West, MHB Member: Sure. I just had been reading about the governor's budget, and I think that really kind of was quite sobering in that it was on May 14th, a revision from a $6 billion surplus to a $54.3 billion deficit. I'm not sure how that affects us locally but that does seem to be a huge swing in fortune, and I cannot imagine that that's not going to impact us in some shape or form. I'm not sure if that's been incorporated into the calculations, Bill?

Bill Carter, SCBH Director: Yeah. So, the reductions I described in our revenue is in the state budget.

Kerry Ahearn: Question: Any idea how DHCS’s CMS approval on their 4/3 State Plan Amendment (SPA 20-0024) request will help Sonoma BH Services? Answer from Bill Carter: DHS benefits from some of the flexibility and clarity the SPA offers re: telehealth service provision.

Rhonda Darrow, MHB Clerk: Okay, let me check again on chats. Okay, so Mitsumasa also mentioned they should pay for everyone's mental health glaring at the Sonoma County Board of Supervisors and their questionable motives.

Becky Ennis, MHB Member: Just kind of a nerdy geeky question, and I guess maybe this is for Melissa. The capacity assessment, the date, the time period it appeared to be like in the fall, and the Kincaid fire was in October. How did that factor into any of the assessment that was done at that time?

Melissa Ladrech, MHSA Coordinator: Great. The capacity assessment went back two fiscal years. So, it actually wasn't looking at the timeframe that the fire actually happened. It was the two previous fiscal years. It did impact the capacity assessment because they had to reschedule and kind of do double work, but it didn't impact the findings of the capacity assessment.

Rhonda Darrow, MHB Clerk: There is one raised hand in the attendees.

Kathy Smith, MHB Chair: Okay. I think that that's. I think that that is all for the Mental Health Services Act portion. We still have a little bit of time, Bill, if you wanted to comment on any other things that are going on? I notice there was an article in the paper today about the possibility of the psychiatric health facility (PHF) going through?

Bill Carter, SCBH Director: Yeah, so the psychiatric health facility, we selected a site which is the former children's shelter at the Los Guilicos property. The Board of Supervisors is moving forward with entering into contracts with Crestwood and its parent company to do tenant improvements to the facility and to open the six-bed facility we talked about. In the past when I've said we should stop guessing when it would open until they start signing contracts, we're just about there. Once contracts start getting signed, we should get some better deadlines, but you should figure it's a year out. We are also recruiting for a medical director. One of the Mental Health Board members pointed out that in the previous report I failed to mention that we have an opening again in the medical director position. So, we're active in recruitment for that. The Behavioral Health Division is operating much as I described in previous reports. We have a series of programs that continue to operate as they were designed, which is seeing clients up close and personal. As far as the Crisis Stability Unit (CSU), it continues to operate. They have now instituted a number of the safety procedures we all have in our offices asking clients to wear masks and screening of staff before they enter. We've also trained our nurses at the CSU to do testing. We're more independent in monitoring our clients and staff. Medication support also continues to function. This was where our nursing staff provide nursing services such as injection services to clients and then we have a number of services that are still doing things in person, but they're modifying. In Access, when someone comes to the door, we maintain safe distancing and wear masks and show them to a room which has a video setup. We go into the next room, next door, and do the interview. Then after that, we have staff in just about all of our programs that are up and running as they can with virtual services. We're just beginning to, for the last couple of weeks, have offered staff who want to come back to the office and work, if they desire, to do that now. We are creating policies, procedures for maintaining safety, and how we'll function when people come back to work; but there has been no decision about bringing everybody back to work yet. Almost all of my time is in the Department Operation Center (DOC) since mid-March. So, my work directly with the division is much limited. My thanks to Sid McColley, Chris Marlow and Diane Madrigal and Jenny Simmons for keeping us up and running, and Melissa for keeping us up and running in the MHSA world. In the DOC, we're operating a number of shelters for people who are vulnerable who cannot safely shelter in place, for people who have a test pending and cannot isolate safely, and for individuals who are positive and cannot isolate safely. We have sites at Sonoma State University. We have a set of trailers at the fairgrounds, and there's a motel in town that we're utilizing for that sheltering service. We are providing testing and doing surveillance in the community. A lot of that information is being tracked in the paper, so I imagine you have that. If you've been following it, you'll see that over the last week we've had a significant uptick in infections and and hospitalizations. That's consistent with the models that showed Sonoma County peaking in late May, early June. So, that's happening now, and we're watching that to see what happens. Any questions I can answer about what's happening?

Becky Ennis, MHB Member: It is a DOC question, so if you don't know the answer, Bill, that's totally fine. I was part of COVID testing in Cloverdale this past Saturday, and a question came up that I didn't know the answer to, and I wondered the sites that you were talking about for people that are infected or test positive where they can't isolate themselves, any sense on anyone in the Latinx community that is taking the county up on those places, or do they have a choice in the matter or are they placed there? Anything around that.

Bill Carter, SCBH Director: So, over the last three weeks, we have focused our surveillance in testing and education on the Latinx community. That has resulted in an identification of increased infection rates, and yes, those folks are taking advantage of the shelter options we have. There's also a work group, Environmental Health, Disease Control and our PIO that are working on creating educational materials and guidelines for people in the community who are having a difficult time maintaining social distancing. So, if you are in a worksite that makes that difficult, if you have to carpool, if you live in a household with many people as opposed to few people, we are creating materials and going to be offering them more in our community activities--on our radio and Facebook and newspaper publications.

Carol West, MHB Member: I am in my third day of the training to be a contact tracer. My understanding is that there are many people being trained. I'm not sure what the number is in Sonoma County, but I know today I did bump into at least two other people from Sonoma County, and I must say there is a real emphasis on respect and empowering people with choices. So, I just wanted to put it out there that I'm not sure what the consequences are for people who are unable to or refusing to follow through. I'm not sure if that's something you can address today. It might be out of the scope of this meeting.

Bill Carter, SCBH Director: Yeah. I mean if somebody is positive or they've been exposed, there's a public health order to quarantine, right? It's one of those situations where there is the legal authority of the public health officer behind that order. It's not generally something that there's been any need to enforce it or to do the things that would be unfortunate. In most cases, when folks are informed of their situation and informed of the order, across the board folks have followed that. When they haven't, we work with them to help them understand the order better, and we've been successful with follow up with those. But you are part of the program that really has an emphasis right now. So, as we increase testing, that's surveillance, so that helps us see what's happening. As I said earlier, the percentage of infections in the Latinx community is in excess of the representation in the population. So, that's a problem area. The other areas there are worksites and there are congregate care facilities for the elderly. So, we're very concerned about skilled nursing facilities and residential care facilities for the elderly because we are concerned that, if exposed, they have a potential to have very bad outcomes for the folks involved, staff and clients. So, we're doing a lot of surveillance there. When we do surveillance, we identify more positive individuals who test positive. When that happens, we have to do case interviews, and case interviews involve what you're going be doing, Carol, which is finding out where folks have been and creating a contact list and then following up with them and making sure those people have information that they've been exposed, how to take care of themselves, and we check in on them every day to see if they're developing the infection—to check in on them until they have safely passed the incubation period and make sure they get tested. So, this will be our effort as we open up to manage the virus and now what's going on is to exercise a level of control so it can help us make decisions about opening up the community or pulling back.

Carol West, MHB Member: There is just one follow-up question to that. Do you know if there is a centralized web site or perhaps it is part of 2-1-1 or the Redwood Health Coalition, the new resources that have been put in place to be able to help people with the barriers to isolation or quarantine? So, you know, who the contact person is for the alternative housing or where people can get food or who is willing to be a driver, that kind of thing that elder care or childcare, the things that are really coming up as I want to do that, but I just can't.

Bill Carter, SCBH Director: Right. I am aware that the various private nonprofits in the community are providing those services and advertising those services. In general, in the county you access our alternate, our non-congregate shelter sites, as you come in contact with the public health system through a test or a test pending. You can access that through your healthcare provider. You can access that through the surveillance we are doing. You can access that through the testing sites we have up and running and the Optum Serve sites in Santa Rosa and in Petaluma.

Kathy Smith, MHB Chair: It is good to see all of you, too. Okay. Do I have a motion to adjourn the meeting? Somebody say I move that we adjourn.

MHB Member: I move to adjourn the meeting and not ask any more questions.

Bob Cobb, MHB Member: I second.

Kathy Smith, MHB Chair: Good. Okay. The meeting is adjourned. Thank you, everybody.

Meeting adjourned at 6:55 p.m.
Respectfully submitted,
Rhonda Darrow, Mental Health Board Clerk