COUNTY OF SAN MATEO

COUNTY OF SAN MATEO

Inter-Departmental Correspondence

County Manager’s Office

DATE:

July 31, 2006

BOARD MEETING DATE:

August 15, 2006

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

None

TO:

Honorable Board of Supervisors

FROM:

John L. Maltbie, County Manager

SUBJECT:

2005-06 Grand Jury Responses

Recommendation

Accept this report containing the County’s responses to the following 2005-06 Grand Jury reports: “Emancipation from Foster Care” and “Nursing Shortage in San Mateo County.”

VISION ALIGNMENT:

Commitment: Responsive, effective and collaborative government.

Goal 20: Government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain.

This activity contributes to the goal by ensuring that all Grand Jury findings and recommendations are thoroughly reviewed by the appropriate County departments and that, when appropriate, process improvements are made to improve the quality and efficiency of services provided to the public and other agencies.

Discussion:

The County is mandated to respond to the Grand Jury within 90 days from the date that reports are filed with the County Clerk, and Elected Officials are mandated to respond within 60 days. It is also the County’s policy to provide periodic updates to the Board and the Grand Jury on the progress of past Grand Jury recommendations requiring ongoing or further action. To that end, attached are the County’s responses to the Grand Jury’s reports on “Emancipation from Foster Care” issued May 25, 2006 and “Nursing Shortage in San Mateo County” issued June 7, 2006.

Emancipation from Foster Care

Findings:

The report findings indicate that the Grand Jury interviewed three emancipated youth reporting retrospectively on their experience in the system. These teens indicated that their input often was not sought or listened to, especially with regard to decisions about counseling and therapy. The teens also indicated that they were not aware of their legal rights, had minimal contact with their attorneys, and were not told of their right to meet directly with the Judge. The attorney interviewed stated that teens often “didn’t wish to take advantage of the opportunity.” Several of the findings in the report mention issues between the teens and their attorneys, and the department cannot directly address that part of the report.

Adolescence is often a difficult time even under the best of circumstances. It is not unusual for teens that live in their own homes with their own families to be resistant to counseling and therapy. As the Grand Jury noted, these teens come from difficult life circumstances. It would be difficult to generalize too much from the comments about counseling and therapy. The Human Services Agency (HSA) has noted the need to involve teens more in making life decisions and has been making every effort to include teens more in this process. Team Decision Making (TDM) has been implemented in San Mateo County. TDM brings together friends, family, relatives and others with the teen and Social Worker to make placement and case plan decisions.

The findings also note that the Independent Living Skills Program (ILSP) has a 90% participation rate and begins at age 15.5. ILSP is the cornerstone of helping youth prepare for emancipation, and the successes of ILSP graduates support our efforts. ILSP teaches youth of their legal rights and San Mateo County has an active California Youth Connection Chapter, which involves dependents in shaping legislation affecting their rights and opportunities. Youth are encouraged to develop permanent bonds with responsible, caring adults. Permanent role models are the best way to cement the lessons learned in ILSP and move into adulthood.

At a recent Adolescent conference, internationally known lecturer Michael Nerney, who had been studying adolescent brain development, noted the significant difference in the brains of latency age youth (9-13) and adolescents (14-19). Mr. Nerney also noted that the brain does not generally mature until age 23 or 24. This research was based on improved technology in brain scans and looking at various parts of the brain. The point of this workshop was to note that there is a significant difference between latency age youth and adolescents and that turning 18 does not dictate a youth’s readiness for independence. This was an opinion agreed upon by many in the audience who had 20+ year old children still living in their homes. HSA applies the same standards to foster youth as for all other adolescents; that is, the period between ages 18-24 remains one of evolving maturity requiring adult guidance and support.

Finally the report notes the difficulty in recruiting foster parents in San Mateo County. HSA agrees that this is a problem and has worked diligently over the last several years to improve in this area. Youth currently assist in new Foster Parent Orientations to tell their point of view. This has increased the willingness of new foster parents to consider teen placements by 30%. Recruiting foster parents for adolescents is often even more difficult. Providing additional training for foster parents who have older youth in their homes is a good idea. At the most recent Foster Parent Executive Board meeting attended by the Director of Children and Family Services (CFS), the Foster Parent Association President acknowledged the improved relationship and stated, “everything on our list has been taken care of.”

The commitment of the Board of Supervisors and the County overall to recruit and retain foster homes has been outstanding. The Board recently sponsored legislation to provide regional rates for foster parents in SMC. The Grand Jury indicates that about 40% of SMC youth are placed out of the County due to a lack of foster homes. This is only partially true. Many youth are placed out of the County with a relative which is a high priority. Approximately 35% of San Mateo County youth are placed with relatives.

Overall, HSA is moving in the right direction in supporting emancipating foster youth. The Agency has a ways to go, and there is always room for improvement. HSA questions the idea that the “programs do not focus on developing the attitude and mindset for personal power and responsibility.” The Board of Supervisors has made Youth Asset building a part of its agenda. The Agency incorporates Asset building into its programs. The Grand Jury notes the difficult circumstances that our youth have had to deal with in their lives. As stated earlier, adolescence is a difficult time under the best of circumstances. It is particularly difficult for many foster youth who have experienced challenging family situations. Staff individually tailors support for these youth and it would be inappropriate to prematurely withdraw needed help or over-emphasize responsibility. Each youth must be accorded the respect and independence they deserve and can handle. All of the participants need to work together as a team to help foster youth develop personal power/responsibility appropriately and emancipate. It is not easy to be a parent, and the system struggles with that role.

Recommendations:

1.

Take steps to improve clients’ understanding of their rights as dependents of the court. Prepare the CS 230 (3/02) “Child’s Personal Rights” document in several versions that are appropriate for the varying ages of the clients involved. In addition, amend these documents to include a listing of the following rights:

a.

The right to communicate directly with the judge to request intervention in their circumstances, should other avenues not be working.

b.

The right to request a change in therapy (drop or move to peer or family group).

c.

The right to be in contact with their lawyers prior to each hearing of their cases.

Response: Partially agree. HSA agrees that the youth have the right to directly communicate with the Judge. However, the Agency believes it is the attorney’s responsibility to communicate with the client to facilitate talking with the Judge. Foster youth should have a right to change therapy regarding placement issues after discussions with social workers and TDMs. HSA is in the process of updating its Children and Family Services handbook. Included in the revision will be a modified personal rights document that is written in easily understood and youth-friendly language. The document will explain that foster youth have the right to attend court hearings and reference how to access their attorneys, and how to work with these attorneys prior to hearings. The document will also explain how to participate in decisions regarding therapy, placement, visitation and other court orders. This revision will be completed by the end of this calendar year.

2.

Develop the proposed earlier ILSP responsibility training program for youth between 14 and 15.5 to reach youth as young as 10 or 12. This will allow more time to introduce the concepts and to help develop an attitude of self-reliance and individual responsibility.

Response: Disagree. Ages 10 and 12 are too young to start ILSP. Concepts of adult self-sufficiency are too abstract for this age group. Other asset development strategies are more effective. Currently a partnership with the Fostering the Future/Peninsula Community Foundation program provides three asset coaches to current and former foster youth. One coach is assigned specifically to middle school age children in foster care. The role of the Asset Coach is to develop personal responsibility and resiliency through involvement with community, healthy use of time, and productive child/adult relationships. These youth are some of the most vulnerable in the community and have come through very difficult experiences. Through Asset Development Strategies, youth ages 10-14 can develop resiliency, self-confidence, and a connection to a caring community. This will prepare them for Pre ILSP at age 14. Adolescent Services is currently developing curriculum and interviewing trainers for the Early ILSP Program for 14-15 year olds. Classes are anticipated to begin by October 2006.

3.

Expand both the initial and annual training of foster parents to include methods of teaching individual responsibility to their charges.

Response: Agree. This is a good idea. HSA is open to discussions with foster parents regarding further training. This will be discussed at the Foster Parent Association meetings and made part of the Strengthening Partnership workshops. HSA has already started to incorporate Asset Development in the foster parent training and is looking at a more strength-based approach for working with these youth. This training will be reworked and improved during FY 2006-07.

4.

The County Board of Supervisors seek legislation from the State of California that would allow an exception from the State confidentiality laws to enable the promoting of individual children in foster care, their personal life circumstances, and their need for foster or adoptive parents.

Response: Disagree. The County Board of Supervisors is currently involved in multiple legislative efforts related to foster children. The Agency has some concerns about making foster children’s lives too public. HSA currently shares confidential information with foster parents that is relevant to the youth’s care and supervision. The Judge can also authorize disclosure of confidential information relating to foster children. Foster parents are currently allowed to participate in court proceedings unless the parent requests they not be there. Foster children have indicated numerous times that they do not want others in their school or personal lives to know about their status. Foster children should have the same rights as other children to keep their personal and family background private. HSA does not support releasing confidential information of individual children in foster care except in specific and limited circumstances; e.g., approval by the court.

Nursing Shortage in San Mateo County

Findings:

Agree with the two findings which discuss innovative partnering beyond the County as noted on page seven of the report in the section entitled, “Findings II: Creative Approaches to the Problem.” Those findings discuss efforts to work with the Gordon and Betty Moore Foundation to launch a simulation lab as part of the Silicon Valley Center for Health Professions (SVCHP). The findings also discuss the efforts to plan and launch the SVCHP facility itself. The San Mateo WIB and its partners have devoted significant effort and resources to addressing the nursing shortage in San Mateo County. This workforce partnership has generated positive outcomes and secured grant funding for initiatives such as the “Caregiver Training Initiative” and the “Nurse Workforce Initiative.” These initiatives, respectively, resulted in a healthcare careers conference and creation of a healthcare career ladder directory for job seekers, and funding an expansion of the nursing program at the College of San Mateo, which graduated new students in the spring of 2005. In 2005, San Mateo partnered with the Community College Districts and the Workforce Investment Boards of San Mateo County, Santa Clara County, and the City of San Jose to create a business plan for a regional healthcare training center, known as the “Silicon Valley Center for Health Professions.” That business plan also included plans for a regional simulation lab, as noted in the findings. Currently, the SVCHP project is still in the planning stages. The San Mateo Medical Center has provided representatives to participate in the planning process, and has committed its support for this project as a site for student placement.

Additionally, the San Mateo WIB and the San Mateo Medical Center have worked closely together over the past two years. Staff from the two organizations have been meeting since December 2004 to share information about critical workforce needs at the Medical Center and to outline potential strategies for addressing those needs.

Do not disagree with the additional findings in the report; however, there is insufficient knowledge to verify whether the statements are factual regarding the actions of other entities, such as the Sequoia Healthcare District.

Recommendations:

1.

The Grand Jury recommends that the San Mateo County Board of Supervisors:

1.1

Actively support SB1309, which addresses the nursing shortage and is currently being considered by the California State Legislature.

Response: Agree. The Board of Supervisors adopted Resolution No. 068127 in support of SB1309 at their July 11, 2006 meeting.

1.2

Continue to fund and otherwise support the Workforce Investment Board in its ongoing effort to establish the Silicon Valley Center for Health Professions and in its exploration of other efforts to partner in finding solutions for the nursing shortage.

Response: Agree. This recommendation has already been implemented and is ongoing. The San Mateo County Board of Supervisors supports the Workforce Investment Board (WIB) and its efforts. The WIB will continue to seek funding and solutions for this critical growth sector of nursing.

1.3

Extend to nurses who are already employed at the San Mateo Medical Center, and who meet certain criteria, its current recruiting strategy of offering prospective nurses rental discounts at selected apartment complexes.

Response: Agree. The discounts at Westlake Village Apartments in Daly City and Hillside Gardens in San Mateo are available to current nursing staff as well as prospective nurse recruits. All new nurses at the Medical Center are made aware of the rental discounts and the discounts are advertised once a year in the San Mateo Medical Center newsletter which is distributed to all Medical Center staff.



COUNTY OF SAN MATEO Inter-Departmental Correspondence
County Manager’s Office

DATE:				July 31, 2006
BOARD MEETING DATE:				August 15, 2006
SPECIAL NOTICE/HEARING:				None
VOTE REQUIRED:				None

TO:			Honorable Board of Supervisors
FROM:			John L. Maltbie, County Manager
SUBJECT:			2005-06 Grand Jury Responses

Recommendation
Accept this report containing the County’s responses to the following 2005-06 Grand Jury reports: “Emancipation from Foster Care” and “Nursing Shortage in San Mateo County.”

VISION ALIGNMENT:
Commitment: Responsive, effective and collaborative government.
Goal 20: Government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain.

This activity contributes to the goal by ensuring that all Grand Jury findings and recommendations are thoroughly reviewed by the appropriate County departments and that, when appropriate, process improvements are made to improve the quality and efficiency of services provided to the public and other agencies.

Discussion:
The County is mandated to respond to the Grand Jury within 90 days from the date that reports are filed with the County Clerk, and Elected Officials are mandated to respond within 60 days. It is also the County’s policy to provide periodic updates to the Board and the Grand Jury on the progress of past Grand Jury recommendations requiring ongoing or further action. To that end, attached are the County’s responses to the Grand Jury’s reports on “Emancipation from Foster Care” issued May 25, 2006 and “Nursing Shortage in San Mateo County” issued June 7, 2006.
Emancipation from Foster Care
Findings:
The report findings indicate that the Grand Jury interviewed three emancipated youth reporting retrospectively on their experience in the system. These teens indicated that their input often was not sought or listened to, especially with regard to decisions about counseling and therapy. The teens also indicated that they were not aware of their legal rights, had minimal contact with their attorneys, and were not told of their right to meet directly with the Judge. The attorney interviewed stated that teens often “didn’t wish to take advantage of the opportunity.” Several of the findings in the report mention issues between the teens and their attorneys, and the department cannot directly address that part of the report.

Adolescence is often a difficult time even under the best of circumstances. It is not unusual for teens that live in their own homes with their own families to be resistant to counseling and therapy. As the Grand Jury noted, these teens come from difficult life circumstances. It would be difficult to generalize too much from the comments about counseling and therapy. The Human Services Agency (HSA) has noted the need to involve teens more in making life decisions and has been making every effort to include teens more in this process. Team Decision Making (TDM) has been implemented in San Mateo County. TDM brings together friends, family, relatives and others with the teen and Social Worker to make placement and case plan decisions.

The findings also note that the Independent Living Skills Program (ILSP) has a 90% participation rate and begins at age 15.5. ILSP is the cornerstone of helping youth prepare for emancipation, and the successes of ILSP graduates support our efforts. ILSP teaches youth of their legal rights and San Mateo County has an active California Youth Connection Chapter, which involves dependents in shaping legislation affecting their rights and opportunities. Youth are encouraged to develop permanent bonds with responsible, caring adults. Permanent role models are the best way to cement the lessons learned in ILSP and move into adulthood.

At a recent Adolescent conference, internationally known lecturer Michael Nerney, who had been studying adolescent brain development, noted the significant difference in the brains of latency age youth (9-13) and adolescents (14-19). Mr. Nerney also noted that the brain does not generally mature until age 23 or 24. This research was based on improved technology in brain scans and looking at various parts of the brain. The point of this workshop was to note that there is a significant difference between latency age youth and adolescents and that turning 18 does not dictate a youth’s readiness for independence. This was an opinion agreed upon by many in the audience who had 20+ year old children still living in their homes. HSA applies the same standards to foster youth as for all other adolescents; that is, the period between ages 18-24 remains one of evolving maturity requiring adult guidance and support.

Finally the report notes the difficulty in recruiting foster parents in San Mateo County. HSA agrees that this is a problem and has worked diligently over the last several years to improve in this area. Youth currently assist in new Foster Parent Orientations to tell their point of view. This has increased the willingness of new foster parents to consider teen placements by 30%. Recruiting foster parents for adolescents is often even more difficult. Providing additional training for foster parents who have older youth in their homes is a good idea. At the most recent Foster Parent Executive Board meeting attended by the Director of Children and Family Services (CFS), the Foster Parent Association President acknowledged the improved relationship and stated, “everything on our list has been taken care of.”

The commitment of the Board of Supervisors and the County overall to recruit and retain foster homes has been outstanding. The Board recently sponsored legislation to provide regional rates for foster parents in SMC. The Grand Jury indicates that about 40% of SMC youth are placed out of the County due to a lack of foster homes. This is only partially true. Many youth are placed out of the County with a relative which is a high priority. Approximately 35% of San Mateo County youth are placed with relatives.

Overall, HSA is moving in the right direction in supporting emancipating foster youth. The Agency has a ways to go, and there is always room for improvement. HSA questions the idea that the “programs do not focus on developing the attitude and mindset for personal power and responsibility.” The Board of Supervisors has made Youth Asset building a part of its agenda. The Agency incorporates Asset building into its programs. The Grand Jury notes the difficult circumstances that our youth have had to deal with in their lives. As stated earlier, adolescence is a difficult time under the best of circumstances. It is particularly difficult for many foster youth who have experienced challenging family situations. Staff individually tailors support for these youth and it would be inappropriate to prematurely withdraw needed help or over-emphasize responsibility. Each youth must be accorded the respect and independence they deserve and can handle. All of the participants need to work together as a team to help foster youth develop personal power/responsibility appropriately and emancipate. It is not easy to be a parent, and the system struggles with that role.

Recommendations:

1.	Take steps to improve clients’ understanding of their rights as dependents of the court. Prepare the CS 230 (3/02) “Child’s Personal Rights” document in several versions that are appropriate for the varying ages of the clients involved. In addition, amend these documents to include a listing of the following rights:

a.		The right to communicate directly with the judge to request intervention in their circumstances, should other avenues not be working.
b.		The right to request a change in therapy (drop or move to peer or family group).
c.		The right to be in contact with their lawyers prior to each hearing of their cases.
Response: Partially agree. HSA agrees that the youth have the right to directly communicate with the Judge. However, the Agency believes it is the attorney’s responsibility to communicate with the client to facilitate talking with the Judge. Foster youth should have a right to change therapy regarding placement issues after discussions with social workers and TDMs. HSA is in the process of updating its Children and Family Services handbook. Included in the revision will be a modified personal rights document that is written in easily understood and youth-friendly language. The document will explain that foster youth have the right to attend court hearings and reference how to access their attorneys, and how to work with these attorneys prior to hearings. The document will also explain how to participate in decisions regarding therapy, placement, visitation and other court orders. This revision will be completed by the end of this calendar year.

2.	Develop the proposed earlier ILSP responsibility training program for youth between 14 and 15.5 to reach youth as young as 10 or 12. This will allow more time to introduce the concepts and to help develop an attitude of self-reliance and individual responsibility.

Response: Disagree. Ages 10 and 12 are too young to start ILSP. Concepts of adult self-sufficiency are too abstract for this age group. Other asset development strategies are more effective. Currently a partnership with the Fostering the Future/Peninsula Community Foundation program provides three asset coaches to current and former foster youth. One coach is assigned specifically to middle school age children in foster care. The role of the Asset Coach is to develop personal responsibility and resiliency through involvement with community, healthy use of time, and productive child/adult relationships. These youth are some of the most vulnerable in the community and have come through very difficult experiences. Through Asset Development Strategies, youth ages 10-14 can develop resiliency, self-confidence, and a connection to a caring community. This will prepare them for Pre ILSP at age 14. Adolescent Services is currently developing curriculum and interviewing trainers for the Early ILSP Program for 14-15 year olds. Classes are anticipated to begin by October 2006.

3.	Expand both the initial and annual training of foster parents to include methods of teaching individual responsibility to their charges.

Response: Agree. This is a good idea. HSA is open to discussions with foster parents regarding further training. This will be discussed at the Foster Parent Association meetings and made part of the Strengthening Partnership workshops. HSA has already started to incorporate Asset Development in the foster parent training and is looking at a more strength-based approach for working with these youth. This training will be reworked and improved during FY 2006-07.

4.	The County Board of Supervisors seek legislation from the State of California that would allow an exception from the State confidentiality laws to enable the promoting of individual children in foster care, their personal life circumstances, and their need for foster or adoptive parents.
Response: Disagree. The County Board of Supervisors is currently involved in multiple legislative efforts related to foster children. The Agency has some concerns about making foster children’s lives too public. HSA currently shares confidential information with foster parents that is relevant to the youth’s care and supervision. The Judge can also authorize disclosure of confidential information relating to foster children. Foster parents are currently allowed to participate in court proceedings unless the parent requests they not be there. Foster children have indicated numerous times that they do not want others in their school or personal lives to know about their status. Foster children should have the same rights as other children to keep their personal and family background private. HSA does not support releasing confidential information of individual children in foster care except in specific and limited circumstances; e.g., approval by the court.

Nursing Shortage in San Mateo County
Findings:
Agree with the two findings which discuss innovative partnering beyond the County as noted on page seven of the report in the section entitled, “Findings II: Creative Approaches to the Problem.” Those findings discuss efforts to work with the Gordon and Betty Moore Foundation to launch a simulation lab as part of the Silicon Valley Center for Health Professions (SVCHP). The findings also discuss the efforts to plan and launch the SVCHP facility itself. The San Mateo WIB and its partners have devoted significant effort and resources to addressing the nursing shortage in San Mateo County. This workforce partnership has generated positive outcomes and secured grant funding for initiatives such as the “Caregiver Training Initiative” and the “Nurse Workforce Initiative.” These initiatives, respectively, resulted in a healthcare careers conference and creation of a healthcare career ladder directory for job seekers, and funding an expansion of the nursing program at the College of San Mateo, which graduated new students in the spring of 2005. In 2005, San Mateo partnered with the Community College Districts and the Workforce Investment Boards of San Mateo County, Santa Clara County, and the City of San Jose to create a business plan for a regional healthcare training center, known as the “Silicon Valley Center for Health Professions.” That business plan also included plans for a regional simulation lab, as noted in the findings. Currently, the SVCHP project is still in the planning stages. The San Mateo Medical Center has provided representatives to participate in the planning process, and has committed its support for this project as a site for student placement. Additionally, the San Mateo WIB and the San Mateo Medical Center have worked closely together over the past two years. Staff from the two organizations have been meeting since December 2004 to share information about critical workforce needs at the Medical Center and to outline potential strategies for addressing those needs. Do not disagree with the additional findings in the report; however, there is insufficient knowledge to verify whether the statements are factual regarding the actions of other entities, such as the Sequoia Healthcare District.

Recommendations:

1.	The Grand Jury recommends that the San Mateo County Board of Supervisors:

1.1		Actively support SB1309, which addresses the nursing shortage and is currently being considered by the California State Legislature.

Response: Agree. The Board of Supervisors adopted Resolution No. 068127 in support of SB1309 at their July 11, 2006 meeting.

1.2		Continue to fund and otherwise support the Workforce Investment Board in its ongoing effort to establish the Silicon Valley Center for Health Professions and in its exploration of other efforts to partner in finding solutions for the nursing shortage.
Response: Agree. This recommendation has already been implemented and is ongoing. The San Mateo County Board of Supervisors supports the Workforce Investment Board (WIB) and its efforts. The WIB will continue to seek funding and solutions for this critical growth sector of nursing.

1.3		Extend to nurses who are already employed at the San Mateo Medical Center, and who meet certain criteria, its current recruiting strategy of offering prospective nurses rental discounts at selected apartment complexes.

Response: Agree. The discounts at Westlake Village Apartments in Daly City and Hillside Gardens in San Mateo are available to current nursing staff as well as prospective nurse recruits. All new nurses at the Medical Center are made aware of the rental discounts and the discounts are advertised once a year in the San Mateo Medical Center newsletter which is distributed to all Medical Center staff.