Extreme cuts to vital mental health services for Santa Cruz residents planned

I agree these cuts are wrong. People should call and email and come to the meetings and Rally. But if you think that is enough to stop these cuts -- I fear you may very wrong. Please post the documents you reference as attachments so people can download and distribute. Particularly the tactics document you speak of in how people can help stop this madness.

We need to tell them where else to trim the budget, development maybe. I am no expert on budget matters but know these proposed changes are not the answer.

Is the SEIU going to join with you?

Peace
Tim Rumford

Rallies and hearings

On Tuesday June 10th, there is a meeting and we are planning a big rally along with the mental health contractors and maybe County workers. So plan on making signs and bringing people to the rally at 9:30 am on June 10th on the steps of the County building.

The week of budget hearings there will be 3 opportunities for clients, families, and community members to show up and/or speak. Supervisors really like hearing from people who have used services and their families and they are very kind and supportive - it usually is a great experience for people even if they are nervous about getting up there (as we all are!)

Monday June 16 - evening meeting in Watsonville at 7:30 - place to be determined

Tuesday June 17 - evening meeting in Santa Cruz at 7:00 - 701 Ocean St. 5th floor (Board Chambers)

Friday June 20 final budget hearing at 9:00 am - Santa Cruz Board Chambers -

For the two evening hearings anyone can show up and speak - there will be no limit
For the Friday 6/20 hearing, we have a time limit.

Postcards

You can pick up postcards at Pioneer House at 290 Pioneer St. or at SCCCC at 195 Harvey West Blvd (across from Costco). The idea is to send these to the Board of Supervisors over the next week or so, before budget hearings on 6/20. They can be sent by staff or clients or anyone concerned about health and human service cuts. There is space on the postcard for people to put a short message if they want. It would be best to address it specifically to the supervisor of your district, if you know who that is. On the County government website is a map of supervisorial districts so that people can figure out who their supervisor is. But the general breakdown is:

District 1 - Jan Beautz - basically Live Oak, Soquel, Capitola
District 2 - Ellen Pirie - Aptos
District 3 Neal Coonerty - Santa Cruz City, Bonny Doon and North Coast
District 4 - Tony Campos - Watsonville -
District 5 - Mark Stone - San Lorenzo Valley -

Phone and email

If people prefer phone or email, that is a good alternative also. People can also call the Board at 454-2200 - this is a central number for all Board members. If you call during working hours you can ask for a specific Board member's voice mail. If you look on the Santa Cruz County government website http://www.co.santa-cruz.ca.us under "Meet the Board" each Board member has a link to their email address.

Thanks for your participation in this process - it is very important. In order for Board members to vote to take money from somewhere else they need to feel it is a huge community issue.

*************************************************************
NOTICE OF PUBLIC HEARING JUNE 20, 2008, 1:30 P.M.
BOARD OF SUPERVISORS SANTA CRUZ COUNTY
701 OCEAN STREET, 5TH FLOOR
SANTA CRUZ, CALIFORNIA
*************************************************************
THE COUNTY OF SANTA CRUZ, HEALTH SERVICES AGENCY, IS RECOMMENDING THE FOLLOWING REDUCTIONS IN HEALTH CARE SERVICES BECAUSE OF REQUIRED REDUCTIONS IN THE AGENCY’S BUDGET. THE BOARD OF SUPERVISORS IS LEGALLY REQUIRED TO HOLD A PUBLIC HEARING TO CONSIDER THE RECOMMENDED REDUCTIONS

At the time, date and place stated above, the Board of Supervisors shall hear and consider all objections or protests, if any, to the proposed reductions in health care services. For questions related to these assessment/service charge reports, please contact the Health Services Agency at (831) 454-5405.

The County of Santa Cruz does not discriminate and no person shall, by reason of a disability, be denied the benefits of its services, programs or activities. The Board of Supervisors Chambers is located in an accessible facility. If you wish to attend this meeting and you require special assistance in order to participate, please contact the ADA Coordinator, at (831) 454-2348 (TDD number (831) 454-2123 at least 72 hours in advance of the meeting to make arrangements.

As a courtesy to those persons affected, please attend the meeting smoke and scent free.


SERVICE REDUCTIONS:

DESCRIPTION 1- MEDICRUZ: Changes to the MediCruz Indigent Healthcare Program are proposed for July 1, 2008 and including the following modifications to eligibility- Undocumented persons will no longer have inpatient and emergency care paid for through the MediCruz program. Hospitals can bill the federal government (Center for Medical Services-CMS) for these services. In addition MediCruz eligibility will be for local residents whose income level is from Zero to 100% of Federal Poverty. Service co-payments are modified to include the following: $45.00 per hospital emergency department visit unless admitted (new), $7 per medical visit including clinic visits, specialist visits, and physical therapy (increased from $5); $10 for retinal screening exam (new) and $3 per prescription (increased from $2). MediCruz will also be moving to a preferred provider system for specialist treatment, surgery, radiology, oncology, lab services, etc.

IMPACTS: The MediCruz program services an average of 2464 individuals per year. Primary care and Dental care services to the homeless are not reduced. Undocumented individuals who may use emergency inpatient care or emergency department services are 182 per year. Federal funding can be claimed for these services. Individuals affected by the reduction to 100% of federal poverty are 209 based on prior year actuals. All 2464 individuals in the program are impacted by the co-payments if they use these services. Sites impacted are 1080 Emeline Ave., Santa Cruz and 1430 Freedom/9 Crestview in Watsonville plus Dominican, Watsonville, and Sutter hospitals.

POSITION REDUCTIONS: NONE

FINANCIAL SAVINGS OR REVENUES EARNED: The change to undocumented inpatient and emergency department services saves $520,000. The reduction from 200 to 100% of federal poverty saves $375,000. The revenues earned through the co-payments are as follows: $9450 Emergency Department visits, $9630 pharmacy, $12,010 clinic, specialist, physical therapy visits, $560 retinal screening.
________________________________________________________________________
DESCRIPTION 2 - CHILDREN’S MENTAL HEALTH: Mental Health Services are reduced or eliminated for children and their families in both County and Contract programs. These services include therapy, case management, assessment, rehabilitation, therapeutic behavioral services, and medication. Sites impacted include all schools, Juvenile Hall, Dominican and Watsonville Hospitals, County Clinics at 1400 Emeline Ave., Santa Cruz and 12 West Beach, Watsonville, Pajaro Valley Prevention and Student Assistance at 335 E. Lake Ave., 240 E. Lake Ave., and 294 Green Valley Rd. in Watsonville, Family Service Agency of the Central Coast at 104 Walnut Ave., Santa Cruz and 11-D Alexander St. in Watsonville, Parents Center at 530 Soquel Ave. in Santa Cruz and 255 E. Lake Ave. in Watsonville, Volunteer Center of Santa Cruz/Family Partnership/Child & Family Advocacy at 300 Harvey West Blvd., Santa Cruz County Community Counseling Centers at 241 E. Lake Ave., 9 Marea Ave., and 9-C Marea Ave. in Watsonville and 709 Mission St. in Santa Cruz, Santa Cruz Community Counseling Center, Court Ward at 241 E. Lake Ave. in Watsonville and 191 Harvey West Blvd. in Santa Cruz, Santa Cruz Community Counseling Center, Court Dependents at 191 Harvey West Blvd. and 290 Pioneer St. in Santa Cruz and 360 Whiskey Hill Dr. in Watsonville, and Unity Care, Inc. at 237 Race St., San Jose, CA.

IMPACTS: These reductions will eliminate services to approximately 500 children/youth and their families, a combination of ongoing intensive treatment as well as crisis-oriented services at local hospitals and juvenile hall. Additionally, 160 children/youth will not receive services from Children’s contract agencies.

POSITION REDUCTIONS: 20.5 County positions are reduced. Contractor reductions amount to 10% across the board in county funds, and approximately 10 FTE clinicians across multiple contractors.

FINANCIAL SAVINGS OR REVENUES EARNED: These reductions will result in approximately $1.9 million in cost avoidance, including local, state and federal revenues. In addition, approximately $600,000 in Contractor costs will be avoided, also including local, state and federal revenues. Expect County foster care costs and inpatient services to rise with reduced treatment options for Probation wards and Child Welfare dependents.
_____ _________
DESCRIPTION 3 – ADULT MENTAL HEALTH: There are reductions to all programs as detailed below. County programs are listed first and then contract programs.

ACCESS AND ACUTE SERVICES:
• Eliminate 2.5 FTE of Senior Mental Health Client Specialists from Access/Crisis services. The elimination of these positions significantly limits the ability to provide crisis and assessment services at the entry point of services to County Mental Health.
1. Positions impacted: County positions: 2.5 FTE of Senior Mental Health Client Specialists.
2. Impact on clients: There are currently 325 assessments conducted, 617 face-to-face crisis/walk-in services provided and 4,447 logged contacts annually in Access with 4.5 FTEs. With a reduction in staffing, wait times will likely increase and fewer people will be able to be seen.
3. Money saved or costs avoided: $280,720.
4. Sites impacted: North County Mental Health Services at 1400 Emeline Avenue and 12 West Beach in Watsonville.

DETENTION HEALTH SERVICES:
• Eliminate 1.0 FTE of Senior Mental Health Client Specialist from Jail Crisis Services. The elimination of this position would have significant impact of the delivery of Jail Crisis Mental Health Services. The Jail Crisis Intervention Team (CIT) service provides mental health evaluations for individuals who appear at risk or suffer from a major psychiatric condition. The Jail CIT service had over 2,500 inmate contacts last year.
1. Positions impacted: County position: 1.0 FTE of Senior Mental Health Client Specialist.
2. Impact on clients: CIT services have an average of 134 cases open each month to mental health crisis services in the Water Street Jail facility. This position is the primary provider of these services. The ability to provide crisis assessments and services will be reduced by approximately 75%.
3. Money saved or costs avoided: $106,566.
4. Sites impacted: Water Street Jail.

• Reduction in Jail Pharmacy expenditures based on new formulary. With the assistance of the new Forensic Psychiatrist, the formulary at the Jail for consumers with mental health conditions was updated to take into account current standards of care for Jail service.
1. Positions impacted: none
2. Impact on clients: Change of medication available in formulary.
3. Money saved or costs avoided: $50,000.
4. Sites impacted: Water Street Jail.

LOCKED SKILLED NURSING BED WITH SPECIALTY SUPPORTS:
• Eliminate 1 specialty locked care bed at Telecare in Alameda County. This particular contract was to meet the needs of a specific individual with complex mental health and physical health care needs. This bed was discontinued when the individual passed away this past year.
1. Positions impacted: none
2. Impact on clients: none
3. Money saved or costs avoided: $90,908.
4. Sites impacted: Telecare Alameda County

LOCKED SKILLED NURSING BEDS FOR CONSERVATEES:
• Reduce locked care beds by 3 at Creekside and 7th Avenue Center.
1. Positions impacted: none
2. Impact on clients: This will result in a loss of 3 locked care beds for consumers that are conserved and require intensive locked care services due to grave disability.
3. Money saved or costs avoided: $157,942.
4. Sites impacted: Creekside, Santa Rosa - 2 beds reduced & 7th Avenue Center, Santa Cruz (Front Street, Inc) – 1 bed reduced

HOSPITAL CARE:
• Reduce Dominican Behavioral Health bed utilization by $100,000 of Medi-Cal expenditures and $20,000 of indigent utilization. These figures are based on the estimated actuals for BY 2007-2008.
1. Positions impacted: none
2. Impact on clients: none
3. Money saved or costs avoided: $120,000.
4. Sites impacted: Dominican Behavioral Health Unit, 1555 Soquel Dr., Santa Cruz

JANUS SOBERING BED:
• Eliminate Janus Sobering bed contract, which served as a diversion site from Dominican Behavior Health. This helped to deflect costs from in-patient services.
1. Positions impacted: Contract: Unclear if Janus positions are affected.
2. Impact on clients: Rather than utilize an in-patient bed for individuals who are recovering from intoxication, individuals that could be safely diverted were allowed up to three days in the Sobering bed.
3. Money saved or costs avoided: $52,700.
4. Sites impacted: Janus, 200 – 7th Ave., Santa Cruz.

OUTPATIENT SUPPORT & SERVICES:
• Eliminate Santa Cruz Community Counseling Center’s (SCCCC) Intensive Community Assertive Treatment Team.
1. Positions impacted: Contract: Santa Cruz Community Counseling Center - 6.5 FTE’s.
2. Impact on clients: This team has focused on serving 75 individuals with a serious psychiatric disability as well as a serious substance abuse problem; many of these individuals have criminal justice involvement and are homeless.
3. Money saved or costs avoided: $633,154.
4. Sites impacted: field based service

• Eliminate 7.0 FTE County Mental Health Client Specialist positions on outpatient teams. We currently have 5 Adult and Older Adult Teams that provide case management services, 3 of these teams are Full Service Partnerships that provide intensive case management support services, 2 are general teams that serve all of North and South County.
1. Positions impacted: County: 7.0 FTE Mental Health Client Specialist positions.
2. Impact on clients: This reduction of staff will have significant impacts on our ability to continue providing person centered support to assist individuals in maintaining their housing, finding meaningful daily activities and preventing hospitalizations and locked care. Caseload size will potentially double to 60 clients to each FTE. Case management services will be provided to those individuals with high intensity needs.
3. Money saved or costs avoided: $808,812.
4. Sites impacted: North County at 1400 Emeline and South County Mental Health Clinics at 12 W. Beach St., Watsonville.

ON-CALL SERVICES:
• Reduce the number of After Hour On-Call Staff Services by consolidating from 6 teams responding 7 days per week after hours and on weekends to 1 team.
1. Positions impacted: Loss of on-call pay to SEIU employees.
2. Impact on clients: This eliminates specialty services by teams who have long relationships with clients, know their history and have the ability to diffuse crisis situations, thus creating increased risk of in-patient admissions.
3. Money saved or costs avoided: $100,000.
4. Sites impacted: field based services

THERAPY SERVICES:
• Significantly reduce use of Medi-Cal Managed Care panel contract providers.
1. Positions impacted: Currently 50 community providers in panel. Will reduce number of providers by an unknown number.
2. Impact on clients: Limited access to community providers for Medi-Cal managed care therapy services. Number of sessions will be limited and referral to internal therapy pool within County Mental Health to provide services to offset loss of services.
3. Money saved or costs avoided: $113,365.
4. Sites impacted: Countywide.

THERAPY SERVICES FOR MEDICARE PATIENTS:
• Restructure Family Service Association’s Renaissance program that provides therapy services to Medicare recipients by utilizing Mental Health Service Act one-time funds to pilot revised program.
1. Positions impacted: none
2. Impact on clients: Medicare therapy services will be focused on supporting those individuals with a history or at risk of in-patient hospitalization.
3. Money saved or costs avoided: $40,000
4. Sites impacted: Family Services Offices in Watsonville and Santa Cruz

PATIENT TRANSPORTATION:
• Reduce funding for consumer transportation and staff mileage.
1. Positions impacted: none
2. Impact on clients: 6-10 rides per week
3. Money saved or costs avoided: $20,000.
4. SITES IMPACTED: N/A

STORAGE OF CLIENT BELONGINGS:
• Significantly reduce rental storage space for consumer belongings to be used while in locked care.
1. Positions impacted: none
2. Impact on clients: No place to store belongings when between housing or in locked care. 15-20 patients per month.
3. Money saved or costs avoided: $25,000.
4. Sites impacted: n/a

HOUSING LOAN FUNDS:
• Reduce funding to consumer housing loan fund that provides first/last month and deposit funds for securing housing.
1. Positions impacted: none
2. Impact on clients: Less money to assist clients to access housing. 15 patients per year estimated impact.
3. Money saved or costs avoided: $11,000.
4. Sites impacted: n/a


Residential Treatment Programs:

DRAKE HOUSE CONTRACT FOR ADULTS AND OLDER ADULTS WITH MENTAL ILLNESS:
• Eliminate Drake House 5-bed contract that provided specialty mental health care to seniors with complex medical conditions.
1. Positions impacted: Contract: Front Street Inc – 0 positions lost.
2. Impact on clients: Older adults with complex medical problems no longer have a Board and Care level facility for their specialty needs.
3. Money saved or costs avoided: $318,800.
4. Sites impacted: Drake Residential operated by Front Street, Inc at Drake St., in Monterey.
PALOMA HOUSE:
• Eliminate Paloma 12-bed residential dual diagnosis treatment program in South County.
1. Positions impacted: Contract: Santa Cruz Community Counseling Center – 7.5 FTEs.
2. Impact on clients: 55 clients serviced annually. It is the only residential dual diagnosis treatment program in the county.
3. Money saved or costs avoided: $447,367.
4. Sites impacted: Located at 321 East Beach St. in Watsonville. This is the only residential treatment program in South County.

OPAL CLIFFS AND DARWIN HOUSE:
• Eliminate Opal Cliffs and Darwin House Residential Social Rehabilitation programs that provided 30 treatment beds focused on learning independent living skills which would enable clients to move to permanent independent housing in the community.
1. Positions impacted: Contract: Front Street, Inc – 22 FTEs inclusive of both programs.
2. Impact on clients: There are 81 clients served by these programs annually. These programs are “step-down” programs from higher levels of care. The programs focus on teaching independent living skills in preparation for permanent housing. Individuals can stay in these programs for up to 18 months.
3. Money saved or costs avoided: $1,088,432.
4. Sites impacted: Front Street Inc., 126 Front St., Santa Cruz; Opal Cliffs, 4795 Opal Cliff Dr., Santa Cruz; Capitola & Darwin, 707 Darwin, Santa Cruz.

• Convert the 16-bed El Dorado Residential program to a Board and Care facility. This program has been used as a “step down’ from DBHU and locked care.
1. Positions impacted: Contract: Santa Cruz Community Counseling Center – 6 FTEs.
2. Impact on clients: This conversion will significantly reduce staff and program services to consumers who are stepping down from acute levels of care. It also serves as an in-patient diversion placement for individuals that need additional support and structure. There are 325 clients served there annually. Conversion to a Board and Care will eliminate the ability to serve individuals that are sub-acute at this site.
3. Money saved or costs avoided: $73,000 County General Fund.
4. Sites impacted: El Dorado Center, 941 El Dorado Ave., Santa Cruz County.

Day Support Programs:
VOLUNTEER CENTER:
• Drastically reduced pre-employment and education support services from contract with Volunteer Center.
1. Positions impacted: Contract: Volunteer Center – 5.5 FTEs.
2. Impact on clients: 400 individual consumers annually for Puentes Homeless program, Transition Age Youth, students at Cabrillo College and clients using pre-employment services to prepare for Department of Rehabilitation services and support.
3. Money saved or costs avoided: $485,124
4. Sites impacted: Community Connections operated by the Volunteer Center, 300 Harvey West Blvd., Santa Cruz

MENTAL HEALTH CLIENT ACTION NETWORK:
• Cut $25,000 from Mental Health Client Action Network self-help advocacy program’s Friends Program.
1. Positions impacted: Contract: Mental Health Client Action Network - .5 FTE.
2. Impact on clients: The Friends Program serves 25 clients per year to match volunteers with mental health clients to assist them with developing natural supports.
3. Money saved or costs avoided: $25,000.
4. Sites impacted: MHCAN, 1051 Cayuga St., Santa Cruz.

PIONEER DUAL DIAGNOSIS DAY TREATMENT:
• Reduce Santa Cruz Community Counseling Center’s Pioneer Treatment Program that serves 16 dually diagnosed homeless consumers in a day treatment program. This program will be partially refinanced by the Mentally Ill Offender grant.
1. Positions impacted: Contract: Santa Cruz Community Counseling Center – 2.4 FTEs.
2. Impact on clients: Previous program was able to serve 110 clients per year. New program will have reduced services and serve 70 clients per year.
3. Money saved or costs avoided: $142,000.
4. Sites impacted: Pioneer House, 290 Pioneer St., Santa Cruz Community Counseling Center, Santa Cruz.

___________________
DESCRIPTION 4 - PUBLIC HEALTH: Reductions in public health services and administrative support are included in both the County Programs and contract agencies. These reductions will result in reduced access to care in terms of physical and occupational therapy for children, case management, nursing services, oral health, risk reduction counseling, follow-up for Sexually Transmitted Diseases, and emergency response, as well as reduced nutritional services at school sites and field-based services to families in the community. Sites impacted include reduced services for County programs at: 1080/1070/1060 Emeline, Santa Cruz; 12 West Beach, Watsonville; 1430 Freedom Blvd, Watsonville; 115A Coral Street, Santa Cruz; 4444 Scotts Valley Drive, Suite 5, Scotts Valley; 140 Herman Ave., Watsonville; and 18 East Lake Avenue, Suite G, Watsonville. Contract sites with reduced services are as follows: Salud Para La Gente, 204 E Beach, Watsonville; Dientes Community Dental Clinic, 1830 Commercial Way, Santa Cruz; Planned Parenthood, 1119 Pacific Ave., Santa Cruz; Santa Cruz Women’s Health Center, 250 Locust Street, Santa Cruz; Santa Cruz AIDS Project, 113 Cooper St., Santa Cruz; Santa Cruz AIDS Project Watsonville, 326 Main, Watsonville; Santa Cruz AIDS Project Drop-In Center, 412 Front St., Santa Cruz; Janus of Santa Cruz, 200-7th Avenue, Santa Cruz.

IMPACTS:

COMMUNICABLE DISEASE:
• Significantly decreased Sexually Transmitted Diseases (specifically chlamydia) follow-up capacity because:
- 0.5 FTE of PHN time will be moved to the immunization Program.
• Decreased emergency response capacity due to loss of 2.5 FTE.
• Supervising PHN III (0.8 FTE) will have additional responsibilities/direct reports, as her supervisor will be assigned responsibility of Family Health Unit.
• Diminished oversight capacity in unit due to additional responsibility of the Family Health Unit being assigned to the CD Manager.

HOMELESS PERSONS HEALTH PROJECT:
• A 0.50 FTE PHN/Nurse Practitioner was deleted in Project Connect, which would have supported doubling of provider hours and clinic visits in Coral Street Clinic.
o It will likely be necessary to reduce Nurse Practitioner hours dedicated to Project Connect, so that he/she can increase his/her provider hours for Coral Street Clinic.
o This results in further reduction of staff time dedicated to Project Connect, and reduction in the number of individuals that can be outreached and enrolled in that project next year. Project Connect carries a point-in-time caseload of 70, and the intervention lasts 18 months per client, on average. The point-in-time caseload will need to be reduced by 10 to 20 clients.
• A 1.0 FTE Senior Mental Health Client Specialist was deleted in the HRSA Health Care for the Homeless Program, Youth and Families Team. This position is a critical part of a very small interdisciplinary team (make-up is: 1 Supervising LCSW, 1 Public Health Nurse, 1 Mental Health Client Specialist and 1 MSW intern) that focus on homeless health outreach, care and care coordination services to homeless run-away youth, and families with young children.
o The homeless youth (including transitional-aged young people 12-24 years old) targeted are outreached primarily in the downtown and surrounding areas of Santa Cruz. Many are young people who have blown out or aged out of the foster care system locally and in surrounding counties. The families targeted come primarily from the Rebele Family Shelter and the Pajaro Valley Shelter Services and Salvation Army Programs in Watsonville.
o Eliminating this position means that we will be left with a two-person team to provide services to this population throughout the county. Services will be limited to medical triage and crisis response. Intensive case management focused on integrating housing, health, employment, and other needed services to support long-term change for this population will be discontinued.
o An estimated 20 of 70 homeless and previously homeless adults will lose access to money management (representative payee) services and may be at risk to lose housing.

CHRONIC DISEASE PREVENTION – HEALTH EDUCATION:
• HSA's involvement with the community-wide efforts to work towards reducing childhood obesity/overweight will be severely curtailed. With limited County resources, we will be providing fewer classrooms with oral health presentations which include how to brush and floss.
• We will be unable to participate in Go For Health! and Diabetes Regional Collaborative unless it aligns with what we are obligated to do in our State grants, primarily as it relates to the OTS grant and bicycle/pedestrian safety. We will be unable to provide support to the Fitness Subcommittee, the Food Industry Subcommittee, the Youth and Environment subcommittee and the Steering Committee. We will be unable to sit on the Regional Diabetes Collaborative and participate on the Policy Subcommittee and Steering Committee.
• HSA’s efforts to provide leadership on the obesity epidemic will be severely limited due to fewer staff available to work on this important public health issue.
• We will be only be able to provide nutrition education to a few schools and a few grades and we won't be able to offer food tastings as part of the nutritional educational experience. A nutrition education contract with Pajaro Valley Unified School District will be eliminated. Impact on 300 kids.

HIV/AIDS SERVICES:
• Programmatic oversight for HIV/AIDS Services will be reduced and consolidated.
• Education & Prevention - We will no longer be able to work with a facilitated HIV prevention group for Spanish Speaking men who have sex with men. This group provides support to a high-risk group to help them stay HIV negative. Prevention counseling to those who are infected or at high risk of becoming infected will be limited. Fewer HIV tests will be administered due to reduced staffing availability.
• CARE Team/Early Intervention Services - Nurse Case Management for persons living with HIV/AIDS will be reduced. Nurses and Social Workers will maintain higher caseloads and clients will receive less attention and support than in prior years.
• The county-funded portions of the HIV/AIDS contract with Santa Cruz AIDS Project will be reduced by 10%.

FAMILY HEALTH:
• Reduction from 3 FTE Nurse positions to1.5 FTE Nurse positions for the collaborative HSA/HSD effort for Families Together and Primeros Pasos. There are 120 cases alone in the Families Together program and these reductions will severely limit activities and both of the programs’ abilities to achieve the desired outcomes.

EMERGENCY PREPAREDNESS:
• Total preparedness funding from federal sources decreased by $200,000 in federal CDC/Hospital Preparedness Programs and from the elimination of federal Pandemic Influenza funds. These cuts necessitate the elimination of 2.0 FTE and diminution of program activities. Plans for significant outreach to the healthcare sector and the public must be curtailed, hampering the county’s ability to coordinate medical surge activities. There will be only one functional exercise planned versus prior year averages of 3-5/year. Plans for establishing Alternate Care Centers must be significantly reduced.

POSITION REDUCTIONS: 38.20 County positions were reduced.

FINANCIAL SAVINGS OR REVENUES EARNED: $4.6 million savings in position reductions including 5% salary savings; $400,000 savings in contracted service reductions.


DESCRIPTION 5 – PRIMARY CARE CLINICS: Walk-in immunizations for both Children and Adults will only be available from 1:00-5:00 p.m. daily. Previously, these services were also available from 8:00 a.m. – 12:00 p.m. Behavioral counseling services to about 250 patients have been cut. The budget for MediCruz pharmaceuticals has been reduced, necessitating a reduced formulary. Education services for diabetic MediCruz patients will no longer be available; patients will be referred to the Diabetic Teaching Center. Fewer hours will be available for Patient Assistance for medications due to reduced staff. Sites impacted are the 9 Crestview facility in Watsonville and the 1080 Emeline Ave. Clinic in Santa Cruz.

IMPACTS: Reductions in staff and services will result in longer waits for appointments and for assistance in receiving free medications. Longer waits will impact approximately 7349 patients.

POSITION REDUCTIONS: 4.5 FTE total positions cut.

FINANCIAL SAVINGS OR REVENUES EARNED: Reduction in walk-in hours for immunizations will result in $64,000 in savings, but the number of patients affected is unknown. Cutting behavioral counseling services will result in $94,000 savings affecting 250 patients. Cuts to the pharmaceutical budget result in $106,090 with the number of patients affected unknown. Reducing diabetic teaching services results in $27,000 savings.


DESCRIPTION 6 – PUBLIC GUARDIAN: The changes to the Public Guardian’s Office are proposed for July 1, 2008 and include the elimination of one full time position. In addition, the office has moved to the basement of 1080 Emeline, Santa Cruz, CA.

IMPACTS: The Public Guardian’s office will continue to accept cases but will have less time to monitor each case.

POSITION REDUCTIONS: One Deputy Public Guardian

FINANCIAL SAVINGS OR REVENUES EARNED: None.


DESCRIPTION 7 – SUBSTANCE ABUSE: Cuts to services in the Alcohol and Drug Program will affect residential treatment programs, alternatives to incarceration for jail inmates whose alcohol and drug abuse is an underlying factor in criminal involvement, outpatient and day treatment services, Prevention Program, and the public information and referral line, which assists the public in how to access local treatment programs. Sites impacted are the Hermanas facility at 640 Rodriguez St. in Watsonville, the Mental Health Clinic at 1400 Emeline Ave., Santa Cruz, Jail Transition Counselor Program – Water Street Jail in Santa Cruz, Outpatient and Adult Drug Court Services – Water Street Jail and Outpatient services 1400 Emeline, Santa Cruz, Prevention Services – community public settings).

IMPACTS: Partial year funding will keep Hermanas, a 16-bed treatment program for women and children, open until December 31, 2008. Closure would affect 75 clients. Elimination of the Jail Transition Counselor Program will affect 180 jail inmates per year, who will likely spend more time in jail or prison without this alternative program. Reduction in Outpatient and Adult Drug Court services will impact 65 clients. Elimination of the Prevention Program will result in decreased availability of prevention services in schools and lost opportunities for collaboration with community partners to prevent alcohol and drug problems locally. Losses of positions in administration will reduce ability to staff the public information and referral line.

POSITION REDUCTIONS: A loss of 9.5 FTE positions in county and contract agencies.

FINANCIAL SAVINGS OR REVENUES EARNED: Closure of Hermanas will save approximately $180,000 in 2008-09 and $360,000/year in subsequent years. Elimination of the Jail Transition Counselor Program will save approximately $94,036 per year. Reduction in the Outpatient and Adult Drug Court services will result in $59,850 in savings. Decreasing the Prevention Program will save $94,414, and administrative staff cuts will save $37,527.

We need equal access and we don't have that now.

The changes to the programs such as the Renaissance Program suggested will impact both the disabled and people who are simply retired, like my husband and anyone, whatever their income on Medicare. Psychiatrists and psychologists are simply non-existent for 99% of people looking for one now. There are programs for a very select group. For those who have Medicare the Renaissance Program offers therapy by trained counselors to many people who have no where else to go. But even now is very limited as they only accept Medicare. If I understand the reductions, it will now serve people in "dire need" only if passed as stated. There are already people in DIRE NEED now, getting no help who call daily and are offered nothing from the County Mental Health Services.

I agree that people sending emails and calling will not be enough unless a massive amount of people show, and even then we will be left with a worse system than we have now, which is horrid. Cuts will happen. Who will get what? I have looked for care under County Mental Health Services under Medicare and Medi-cal for 10 years for family members and friends who desperately need help and have little financial resources. I was given a list by the County years ago. Three people on it were dead and the rest were out of practice. Currently they tell me not to even bother trying. This is now, prior to these proposed cuts. Even for those well off, most psychologists and Psychiatrists are booked anyway, and many psychiatrists over medicate in my opinion.

I hope that the City Council and Board of supervisors revoke their increase in pay before they even introduce these outlandish reductions at the next Board meeting. I wait with baited breath. We need a whole new approach to these issues. Some of these programs should be eliminated and replaced with better programs. Thats the hard truth. Not all of these agencies and programs are great or even good. They will all fight for their piece of the pie to the "nice and accommodating supervisors." How are we to decide which programs are best serving the community in the next 10-20 days?

The people need to act, and not the agencies serving them pander to the politicians. Let the people demand what they need from their community.

This needs to be looked at in much more detail than simple stats of reduction and elimination. We need the County to offer solutions too, rather than just make sweeping cuts with admitted ramifications that will impact everyone.

This is what we get for puting up with such bad services in the first place. Don't pander, demand equal access to care so not one person is turned away as they are now daily, when they are crying out for help now!

Judy
Aptos





If people feel that the County Board of Supervisors are "kind and willing to listen" as the second posts hints at, as if they are waiting for you to lead them in a better direction, you will be sadly mistaken. They will play that part but the end result will not be good. The fact is, the current system is horrible. I understand this Rally is being basically sponsored by many organizations impacted like NAMI. People who get money from the county to do the services they do. Thus I suspect you are pandering to the powers that be, afraid to take a harsher stand as UCSC workers did last week.


I don't think a Sit In is the best idea, but some sort of direct action is needed beyond emailing and pandering to the people who came up with these cuts, which should tell you they are fairly ready to go forth with them. If they really cared that much, this document would not exist in its current form.

Yet another medical cut. We already have a huge problem here as SC is considered rural so Medicare physicians get paid far less. So they flock over the hill. Few private practice doctors take it at all. The few that do are booked. \

Starting July 1st 2008 Medicare will cut payments to ALL physicians in SC county by 10%. There is a bill being considered by the senate, still being prepared to prevent these cuts and considering adding a provision called the "GPCI PROVISION" which would remove this status. People are being asked from doctors and medical foundations and concerned to write the Speaker of the House Nancy Pelosi, Senator Barbra Boxer & Senator Diannne Feinstein. I will post with contact info Below.

People have fought for this change since as long as I can remember. It really makes SC have bad care everyone as Medicare patients end up in the ER. This effects the retired, elderly and anyone disabled with Medicare, most all disabled.

Again, I will write but the time for direct action is now.

Speaker of The House Nancy Peolsi
House of Representatives
235 Cannon HOB
Washington, DC 20515

email - http:/http://www.house.gov/pelosi/contact.html

Senator Barbra Boxer
United States Senate
112 Hart Senate Office Bldg.
Washington, D.C. 20510

to email go to - http://boxer.senate.gov/contact/email/

Senator Dianne Feinstein
United States Senate
112 Hart Senate Office Bldg.
Washington, D.C. 20510

to email - http:/http://www.feinstein.senate.gov/public/index.cfm?FuseAction=ContactUS.Emailme

Maybe add the Medicare cuts comment with contact info to senators etc. to the main post about heath care. Whatever you deem correct. If not I will post it as a seperate issue. Possibly just add a button saying "New Medicare Cuts" or something? Thanks for all you do. I know you work hard.
Tim

300 people showed up at the last rally. With 106 Job losses at hand, thats not a great showing. If each worker brought 2 friends, theres your rally. Don't get me wrong. I am all for the rally, but ia m not for pandering to the board and having agencies each fight for their little slice of the pie. I was not present due to health reasons. I am disabled and had a test I have been waiting three months for. Please post updates. How did it go? What solutions are you coming up with?

I am worried that the agencies involved, some effective and good and some not, are not coming up with a solution that not only addresses the current budget cuts, but the already flawed system. Will they fight for their piece of the pie or join together and demand and present a solution that addresses the entire system? I am appalled at the apathy in this community about this, evident by the lack of comments.

UCSC fights for better health care and gets it. They do direct action for better pay. Will they climb off the Hill and help the very City that helps give them the education they seek?

I see a lack of war protests, wages, and poverty and general apathy.

I as a disabled poor male called the County mental Health with Medicare and Medi-cal, I am told there is nothing they can offer me as far as psychologists or psychiatrists. If am considering suicide, go to the Dominican prison for people with problems.

The system is already flawed, unfair and a travesty. Do we that are struggling and disabled need to become budget experts in a week in order to find a solution???

The time for direct action is NOW! Not by the agencies -- but by the people and workers who are effected or denied access eve prior to these proposed cuts.

Tim Rumford

I though the last sentence of the article was... on the mark.

http://www.santacruzsentinel.com/ci_9593373

"As a courtesy to those persons affected, please attend the meeting smoke and scent free."

I guess medical marijuana patients aren't welcome. Not to mention cigarette smokers.

So when you talk about "everybody", maybe you should include a list of the groups that does not include.

As for the last Sentence of the editorial, the Mental Health regime in this county is the most intransigent when it comes to medical marijuana. They oppose it tooth and nail.

Maybe I should show up at the meeting and see if they toss me out or arrest me for medicating.

Santa Cruz does NOT care about everybody, or much of anybody except fundamentalist pill-junkies to the twelve-step tango to demostrate for more basket-weaving and stain-glass classes at their drop-in center, from which medical marijuana patients are excluded.

And your Santa Cruz mental health establishment is tooth and nail against housing mental health patients who use medical marijuana.

Go have your dog and pony show and help the Sentinel proclaim Coonerty the great savior of social services in Santa Cruz.

I'm suprised that this nasty comment wasn't hidden, but I do want to respond to it:
"As a courtesy to those persons affected, please attend the meeting smoke and scent free." I guess medical marijuana patients aren't welcome. Not to mention cigarette smokers. So when you talk about "everybody", maybe you should include a list of the groups that does not include.

Hi, I have chemical sensitivities and I am a medical cannabis patient. Cigarette smoke causes immediate physiological effects for me- my heart rate picks up, I start wheezing or coughing from my asthma, and out of the blue, I get angry. Can you imagine if you're like me, in an enclosed space, and someone finishes their cigarette and comes into the building and, like someone just did to me at work, flings their hair around, spreading bits of ash and stench everywhere? It gets hard to breathe really fast. And then there's whatever chemicals come from the cigarettes that are making me angry. It sucks really bad.

As far as smoke goes, I try to vaporize my cannabis whenever possible and hope to expand into edible ways of taking it, as well. Some things that can help minimize the lasting stench effect are for the smoker to smoke outdoors, not under cover, and to wait several minutes before entering a building after finishing smoking (this would include that they should breathe it all long minutes before entering a building). But really, when we talk about discrimination against cigarette smokers, the fact is, smoking is harmful to the smoker and eveyone nearby, so aside from feeling bad for them for having started smoking to begin with, there's really no other consideration that need be made.

Not everyone is a smoker, but lots of people wear products that contain this very harmful ingredient: fragrance. It's in shampoos, conditioners, soaps, perfume and cologne, sunscreens, deodorants, shaving creams, aftershave, moisturizers, oh, god, just about everything. And that smell stays on you all day. It's mixed with sweat that comes out of your pores, and ugh, it makes me weak. Many of us are also sensitive to building materials. And even our own clothes!

in response to "So when you talk about "everybody", maybe you should include a list of the groups that does not include..." Ok, this is one attempt to make it so that people with chemical sensitivities can go to a public event (not that I'm into government, but some are), even for a few minutes, and you want to take this away from us?

Craig's comment was not nasty and certainly abides by the Rules of Indybay. He is entitled to an opinion.

Yes Craig, your right. The system, the forum at the Board of sups, don't want to talk about medical marijuana. and they should as many of these agencies are bad, way over medicating people etc. Thats why people need to do more than pander to the Board of Sups. You should show up. I may wearing something... I think your perspective is needed. You will have an entore 2-3 minutes. My concern if for not any one agency, but the medical system as a whole and equal access. I think some of these cuts to certain agencies are great, if they had a plan for the backlash which they don't. Mostly we will here from people talking on one agencies behalf. I would rather see people who have had a hard time even before these cuts come and talk. I did not write this post, but a commentary calling for some direct action rather than pandering to the board, which we know works so well. But people don't care, which is evident by the lack of response, by the rally, and by the lack of coverage to this issue.

For those who use Emiline services, things will be much harder.

Thanks for chiming in -- scent free or not.
Tim