Town hall 2019 

 

Q&A Follow-up

 

Placer Town Hall attendees were called upon to participate in the event by submitting questions and comments on the information being presented. Three questions were discussed during the live Q&A at the event, however, more than two dozen total questions were received!

 

As promised, all the questions submitted at the event have been responded to by the panelists and provided below. 

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Attendee Questions & Panelist Answers

For those in the substance use disorder/mental health community, can technology help work towards healing trauma? What do you suggest?


Yes, technology can be helpful in addressing trauma. For instance, their are text lines and “apps” for people to get real-time mental health support. Tele-mental health is really taking off and it may be true that we are underutilizing these innovations in Placer County relative to some other places. ~Dr. Robert Oldham




How can we address the 5150 suicide process? Currently the process is very harsh and demeaning. We already have a monthly convening of critical partners (hospitals, EMS, law enforcement, etc) with the goal of continually improving the process.


It is a complicated process with lots of different players and opportunities for things to go haywire and to lose sight of the person-served. Part of the problem is that the 5150 law is almost 50 years old and needs updating. As much as we try to improve the implementation at the local level, there are probably some things we can’t fix locally. Anyone with specific concerns about this process is encouraged to reach out to Placer County Health & Human Services and we can bring them to the monthly meeting. ~Dr, Robert Oldham




What plans do you have to expand mental health facilities here in Placer County? The not in my backyard" nimby is prevalent from city to city.


We are already hospitalizing more than most other counties. So simply building more inpatient facilities is not the whole answer. While we have a richer continuum of care than most places, we certainly could use more beds locally, especially for children, adolescents, people with medical conditions, and women who are pregnant postpartum. NIMBYism is a very real thing in Placer. We try to listen and respond to community concerns while countering with factual information. But it seems like we have an even greater need for the lower levels of care (crisis stabilization, urgent care, intensive outpatient, partial hospitalization, etc.) that might help keep people out of the hospital.

~Dr. Robert Oldham

Identifying locations in Placer County that can support mental health facilities can be challenging. Planning commissions need to be clear in where these facilities are planned in general plans. Early town hall meetings and MAC presentations to identify and address concerns should be planned. I would encourage you to reach out to your local planning department to identify where these facilities can exist in the current general plans.

~Dr. Nathan Herzog




Can 211 help and why don't we have this program in Placer County?


Placer County is currently exploring the implementation of a sustainable 211 model with support from multiple stakeholders. This item will likely be brought to the Board of Supervisors in 2019 for their review and consideration.

~Jeff Brown




Do we in Placer County have anything that resembles universal parenting place? If not, how do we create that in our community?


Family Resource Centers are the closest Placer County has to parenting places. FRCs provide a large amount of services, which are free to families, including prevention: education and outreach; intervention: linking to other more intensive services, parenting classes, after school programs, referrals for basic needs, housing, transportation, job readiness, financial and legal literacy; and treatment: including TF-CBT, PCIT, EMDR, postpartum depression counseling, new moms support groups, etc. Many of the resources and classes are held in English and in Spanish. ~Dr. Robert Oldham, Twylla Abrahamson

I know that KidsFirst offers no cost parenting classes for all income levels. If you are wondering what a Universal Parenting Place is, here is a link to become educated on this topic. These are a good ideas and Robin Karr-Morse recommended Universal Parenting Places as a wonderful way to address some of the issues that are related to child abuse and neglect.

~Dr. Nathan Herzog




What is Placer County doing to embed access to developmental screening and connection to early intervention services for children 0-5?


Our Public Health Nurses do developmental screens and home visits, but they are serving less than 200 families per year. For our child welfare population, foster care nurses are available to conduct developmental screenings and try to do as many as possible. This is not a service that is court mandated, so sometimes families do not want this screening conducted, which is often in the home. ~Dr. Robert Oldham, Twylla Abrahamson




Rates of autism, neurological disorders and allergies have skyrocketed in the past 20 years. My observation and personal experience as a parent and school nurse correlates with the data. What studies have been done to assess environmental impacts, such as pesticides, which are nearly impossible to avoid?


Studies show association, but not clear yet that there is causation. Here is a review of the evidence that may be helpful on this topic. ~Dr. Robert Oldham




With high functioning autism diagnoses on the rise, what services are available for families to help these children mature into contributors to our community instead of burdens? Also, what are we doing to slow this trend?


The State Department of Health Care Services has clarified that Managed Care Health Plans, such as Anthem and California Health and Wellness are the providers of services for those who have Autism diagnoses. The treatment gold standard is ABA services. In addition, Alta California is still the entity that is most well trained to provide these services over the lifespan from early childhood to and through adulthood. They are, like many other state and federally funded programs, always seeking to maximize their resources and services for the greatest amount of individuals and it is sometimes difficult to access those same services. County mental health plans, however, do assist in this effort by offering some services when the individual has been deemed capable of benefiting from “talk based” therapies, which is not usually the best treatment for autism so it is more of an ancillary service. ~Twylla Abrahamson




NICU babies experience an overwhelming amount of trauma. What can be done to make sure parents are provided resources they may need to manage the unforeseen challenges of those babies as they grow into young children?


Social workers and therapists are already imbedded in NICU, but more can be done. Would love to have a PHN in the NICU, similar to the model we have with Sutter Birthing Center.




Have all of our law enforcement officers received training on this topic?


Training for police officers regarding child maltreatment varies across a spectrum. There is initial academy training that introduces and discusses at a high level how to detect child maltreatment and interventions. Once they are in field training, they again are required to properly identify and investigate these incidents including understanding the collaborative effort towards intervention. Some officers, and frequently too few, who are designated to investigate crimes related to domestic violence, child sexual assault and child maltreatment receive more in depth training about the effects on children and the appropriate interventions related to investigating and prosecuting these cases. In depth training of this magnitude is rare and should be sought out by more police officers and/or mandated as a basic part of police training by California Standards. It’s an area we, as law enforcement, should certainly seek to grow. ~Lt. Doug Blake




Developing a one-stop shop for services, like the family justice center, is a great example of how cross-community resources can improve the care of families and children. Any thoughts on this approach?


The ‘one stop shop’ is a wonderful concept; folks in the community too often receive the “run around” treatment as they seek help for issues they face. I have seen and am a part of changing police culture in this regard. As we are on the front lines with community members and are called upon to assist them in facing and solving their problems, we can’t pass the buck to someone else. Police ought to be familiar with services offered throughout the county and have a mechanism to refer people with the goal that folks can get the help they need without feeling aimlessly deferred. I am proud of the collaborative effort in Placer County and the work that is being done to make services as accessible as possible. ~Lt. Doug Blake




What programs can we support in Placer County to help build resiliency?


Resiliency is an important ingredient to assist children with being successful in life despite some of the adverse childhood experiences they have faced. An important note is that resiliency services and organizations are a part of the overall solution, which includes appropriate effort at detection and intervention. In the police world, we are a partner with the Roseville Police Athletics League (RPAL), which provides a variety of programs for children who are at risk. The connection they receive with police officers and the influence they get in the way of human connection helps them build the resiliency they need to carry on in life despite the obstacles they face. The Office of Juvenile Justice and Delinquency Prevention has provided reports that show camps and programs where kids work with animals on a regular basis are tremendously successful and I would love to see more programs built around that concept. Other services in the county that support healthy families are successful as well. The police department offers something called “parent project” to assist parents and at risk kids with conflict resolution and some emotional intelligence issues. That program has proven to be successful at reducing police calls for service and the need for law enforcement intervention. ~Lt. Doug Blake

Many schools have grit and resliliency programs to help students get through difficult circumstances. Programs that help facilitate student growth mindset with an understanding of “not yet” vs. “I can’t” are critical in children developing coping and character building that is essential for adulthood. KidsFirst has no cost programs to support students through various levels of adverse experiences so they are able to build resiliency. Placer County Health and Human Services may be a good place to identify additional programs available to families that can support these efforts.

~Dr. Nathan Herzog




Should we put more resources in prevention or law enforcement?


Prevention resources vs. law enforcement: The need to provide resources to prevention programs is not at odds with the need to support law enforcement. Law enforcement is paid for in ways that are different than prevention programs are supported, so there is no crossroads there. Also law enforcement in general has so many other required obligations such as crime solving, property crime and theft, traffic related enforcement, etc. Supporting law enforcement accomplishes so many things. Additionally, law enforcement is involved in so many aspects of detecting, intervening and solving issues surrounding domestic violence and child maltreatment that supporting programs in either direction would only assist in the overall goal. Prevention as a strategy is a vital piece of the overall solution puzzle, but so is detection (as early as possible), intervention, and resilience efforts at repairing the effects of family violence. Since it is never wise to place all of our eggs into one basket a balanced and collaborative approach is what proves and will ultimately result in the greatest success. ~Lt. Doug Blake




Describe ways we can purposefully reduce stigma around this issue?


Great question! Reducing stigma is such an important step. It starts with believing survivors when they speak up, spreading the word about how prevalent violence is in families, understanding that it is not the fault of the victim of the violence, supporting the entire family who wants help,. If the person who has been violent wants to change, then support them with resources, education, and counseling to help them to change. Support victims of violence who need to escape and need help with safe housing, therapy, or legal assistance. Allow families a safe place to talk about what they have experienced without fear of judgement or losing their kids. ~Jenny Davidson




Are there any underlying trends that you see as the reason for the increase in domestic violence?


The society as a whole has become very divided over the past few years. We have seen that people who have a strong need to control their environment and the people in their lives are feeling out of control. They then turn to violence to gain a sense of control. That violence has escalated as well. People who may have shoved or slapped in the past, are now hitting, kicking, and using weapons against their significant other. Untreated substance issues and gaps in mental health services also leave people more vulnerable. This has produced more vulnerable victims as well as more violent abusers. ~Jenny Davidson

Are we better at identifying these issues and addressing them, or is there a true increase in the numbers of domestic violence in our community? When the panel discussed this issue, it was shared that there is actually is an increase in domestic violence cases. Some of the themes regarding this trend include alcohol and drug abuse, fatherless homes, CSEC, and financial issues.

~Dr. Nathan Herzog




Is there a list, or can you compile one, of the county helping agencies, with contact info, that could be sent out, so people can see where they might get involved, either with time or money?


Placer Collaborative Network has a great list that can be found on their website. Any organization on this list would welcome support in some way To provide an example, Stand Up Placer always has a great need for volunteers as well as funding for services for clients. ~Jenny Davidson




How are you marketing to the community to get the word out to community groups?


Many nonprofits and service providers are frequently asked to speak at service clubs, churches, community outreach events etc to get information to the general public about how to get assistance for safety. That said, there is always a need to raise awareness and provide outreach to reach as many people in our community as possible with education and resources about childhood trauma. ~Jenny Davidson




Placer doesn't really have a funding problem. We have ample mental health, special ed, and other public revenues. A much better focus might be a conversation about synthesizing those resources for right client, right time, in the right way.


Nonprofits across Placer County report insufficient funding and resources for all of those services. Nonprofits and community organizations work very closely to make sure that clients are cross referred for services. A family experiencing trauma may need many different services. They may need therapy for adults, teens, children, and babies all in one home. They may have a need for substance treatment. One or more person may be suffering from major mental illness. They may not have transportation to get to all of those services. They may need other services such as WIC, CalFresh, MediCal, etc that they need transportation to. The organizations working together to provide those different services will do their best to schedule together so that the client has the ability to attend all of them, but some just don't exist at the level of need. Someone with high substance, mental illness, violence, and homelessness all in one family may not have access to services that can accommodate their high level cross needs, example, the agency providing for their mental illness treatment, may not have trained substance use staff on board, and none of their staff may feel safe/comfortable addressing the violence in the home. They may work with adults but not children. That means the family has to travel to many different agencies and most of these high needs families do not have reliable transportation. They may also not have safe or adequate housing. ~Jenny Davidson Synthesizing or leveraging resources is always a great idea, and the reality is that there are not enough funds when it comes to trauma informed care and a resources for our youngest children who need mental health resources. Whether it is funding for one-on-one aids to assist children in early learning settings, funding to train and attract early mental health providers, and funding to train and support early educators, there are not enough dollars in Placer to support our youngest children who are experiencing trauma and their families. ~Catherine Goins




What role can the faith community play?


Many faith based institutions provide services to the community to support families. Please contact your area of worship directly to inquire about these opportunities. Engaging the faith community through chaplain engagement, church partnerships, and faith-based non-profit connection is essential to address these issues. There are many faith organizations that require community service. Connecting with the people that organize the community service aspect may help to engage the faith community.

Dr. Nathan Herzog




Do we have resources going to things we don't really need that should be realigned?


The most obvious is “sick care” which is taking about 20% of our GDP. Mass incarceration is also pretty expensive and ineffective. There are probably several areas that folks may identify, but finding agreement on what those are is a challenge. ~Dr. Robert Oldham




Why are quality pediatricians are hard to find with Medi-Cal funding?


The rates are too low and major health systems not taking Medicaid. It is certainly a complex challenge that is not unique to Placer County. ~Dr. Robert Oldham




What is the Placer County Office of Education doing to help support children and families? What are the wins for our county to prepare students for school?


Placer County has some of the finest schools in the state. PCOE has ensured that thousands of children are prepared for school and PCOE is working hard to prevent the achievement and equity gaps where some children start school already behind their peers. PCOE has also helped thousands of early learning educators be better teachers of young children, particularly those children who have experienced trauma. ~Catherine Goins




Are young placed children in the system automatically placed into Early Head Start programs since we know they have already experienced some trauma and thus need aggressive early intervention?


Early Head Start is a federally funded program that serves families who meet federal poverty guidelines. No child is automatically placed into it as it is a voluntary program.




I know in federally funded Head Start programs preschoolers cannot be expelled for social/emotional/behavioral difficulties. How can this policy be operationalized in state and locally funded preschool programs here in Placer County?


Great question! It’s complicated and while there is no easy answer some successful strategies include:

  • Implementing a research based social/emotional/behavioral curriculum for ALL children

  • Planning for some children to have challenges by having a behavioral specialist in place

  • Funding for a short term one on one aide

  • Having a solid referral system in place to access the Head Start mental health coordinator

  • Knowing that in some extreme cases, you may need to go to the Head Start grantee and say for the health and safety of all of the children, this child may have to stay out of the program until a more appropriate placement can be found and working with the Head Start Regional Office.

The intent is to make sure all avenues have been exhausted – it is hard and difficult to turn around a young child’s behavior. Programs do not have all the support that they need. Honestly, I am not sure policy was well thought out before it was put into place.

~Catherine Goins




Do foster children qualify for Early Head Start because it is based off the child supplement and not the resource parents income?


Foster children are generally considered a family of one and resource family income would not be counted. Foster children are automatically eligible for Early Head Start and Head Start. ~Catherine Goins




I have a question about trauma screening in schools. What would it take to incorporate a simple (e.g. 5 question) trauma screening with required vision and hearing screening. It may be an opportunity for early intervention.


That is not an easy question because parents would have to be involved, and for a variety of reasons, the families who most need assistance may not want to participate in the screening. For children who are In high quality early learning programs, families are given a social, emotional, behavioral screening to complete, and then children and families are connected to supportive services. For now, only Early Head Start and Head Start programs require vision and hearing screening.





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