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Ballot-mandated drug treatment cut, despite success

Published: May 9, 2013 | 1 Comment

Photo: JohnnyCashsAshes/Flickr

By Robin Urevich
California Health Report

In 2000, California voters overwhelmingly approved Prop 36, a ballot measure that offers non-violent drug offenders treatment instead of jail. But now the Substance Abuse and Crime Prevention Act is on life support, if not altogether dead, despite data that shows it has saved taxpayers money and tamped down recidivism among its participants.

After an initial five-year allocation of $120 million to California counties for drug treatment, the legislature hasn’t approved additional funding, and counties have slashed drug programs while waiting lists for rehab grow longer.

Orange County is no exception, but unlike many counties, it still maintains a Santa Ana courtroom exclusively for Prop 36 cases.

Superior Court Commissioner Ed Hall, who presides over those matters, has tried to make up for at least some of the $8 million in state Prop 36 funding that the county has lost.

One woman’s success

Cameras are rolling on a recent Wednesday afternoon as Hall calls Katherine Wimber’s case. The 20-year old stood beside her attorney, her sandy brown hair cascading down her back, as Hall ruled from the bench.

“It is hereby ordered that your conviction be set aside,” Hall intoned to applause from court staff, Wimber’s boyfriend, and her mom, who cradled Wimber’s two-month-old son, Murdoch on the hard benches in the audience.

Two years ago, Wimber was a suburban high school student-turned-heroin addict. Now, she’s a poster child for recovery from the wave of addiction to opiates—from prescription drugs like Vicodin and Oxycontin to black tar heroin—that has swept affluent South Orange County.

Hall is so pleased with the outcome of Wimber’s case that the dismissal is actually a reenactment for a TV crew from the town of Mission Viejo, where Wimber grew up. The publicity is part of Hall’s efforts to raise awareness about opiate addiction.

At 17, Wimber started smoking heroin with friends.

“It was so innocent, you just smoke it…it’s not like putting a needle in your arm. It’s just $10 to get high,” Wimber said.

But a couple of years later, the girl who said she once dreamed of a family, a white picket fence, and a career as a kindergarten teacher, was using needles, had overdosed twice, and was stealing to support her habit.

Wimber was a few days into a court-ordered Salvation Army treatment program when she realized that she needed help with depression and Post Traumatic Stress Disorder, which she says is the result of her experiences as a drug addict.

She came to Hall sobbing and asking to enroll in a local hospital program that would address her mental health needs.

Hall said he was thrilled to let her try.

Under Prop 36, defendants are granted probation while they submit to drug tests and attend 12-step meetings, detox, or rehab programs. If, like Wimber, they complete their programs, their cases are dismissed.

Wimber’s success was hard won. Like many Prop 36 clients, she’d failed at rehab before. But unlike most of her peers, she didn’t have to depend on county programs for recovery.

She attended a three-month long program at a private hospital that cost more than $4,000 and was covered by her parents’ insurance.

By contrast, many Prop 36 participants are poor and uninsured. Those who don’t qualify for Medi-Cal must either convince a rehab program to admit them for free or at reduced cost, or scrape together the cash themselves. For the less severely addicted, a bare bones program of 12 step meetings and drug testing costs about $200, while the tab for those with more serious problems is as much as $1100 for out-patient rehab.

Programs that offer both mental health and substance abuse care, like the one Wimber attended, are tough to get into, as is residential treatment. Participants who need a live-in program face waits of as much as three months, according to the director of a local treatment program.

Judge tries a personal touch

Hall, who spent 30 years as a criminal defense attorney, tries to pick up the slack, occasionally stepping down from the bench to give face to face encouragement or a kick in the pants.

With his hands folded in front of his black robes as he huddles with a 30-something defendant on a recent Wednesday morning, he looks more like a minister than a judge. He is tall and slim with a full head of graying hair and a quiet demeanor. As he talks—out of earshot of the audience—Hall reaches out for a long moment to pat the man on the arm, as his defense attorney and a probation officer look on.

Hall could do his job somewhat mechanically; he sees about 60 people a day, and he’s required to do no more than send defendants to treatment, monitor their progress and sentence them or dismiss their cases.

But, Hall seems to relish making connections with those who come before him, and revels in their successes. After Wimber’s dismissal he invited the family to his chambers and they emerged with a wrapped baby gift.

“I want to show them that I care…it’s not just showing them. I really do care.”

After a talk with his 19-year old granddaughter, Hall decided to invite younger defendants to afternoon sessions where they listen to their peers who have successfully completed the program, or discuss the reasons they started doing drugs.

“She said you wear a robe, you’re older, they’re not going to listen to you,” Hall recalled.

Prop 36 missteps

Despite Hall’s efforts, fewer Orange County defendants are enrolling in treatment than did when the program had full state funding. Of those who do get treatment, slightly fewer are finishing their programs than they did when the program was fully funded. But UCLA researcher Darren Urada cautioned that Prop 36 may be in worse shape than the completion rates suggest because treatment programs have been shortened. “Keep in mind that the lower the requirements are, the more people will complete,” Urada wrote in an email.

Prop 36 backer Daniel Abrahamson, legal director of the Drug Policy Alliance, said he and his colleagues erred when they wrote the initiative to require only five years worth of funding. He said he thought that lawmakers would continue to funnel money to the program if it produced results, but that was a major miscalculation.

“We felt the data should guide the funding and policy, and boy we made a political mistake there,” Abrahamson said.

In fact, UCLA researchers studied Prop 36 from 2000 to 2008 and reported that for every dollar spent on the program, nearly $2.50 was saved, mostly in reduced prison and jail costs. The researchers noted that Prop 36 graduates were less likely to be re-arrested, even up to six years after they completed treatment.

The state’s economic crash played a big part in Prop 36’s collapse, but so did law enforcement’s influence on the legislature, Abrahamson said. Judges, police and probation officers, and district attorneys opposed the measure when it was on the ballot.

Once the law was in effect, they wanted Prop 36 scofflaws jailed for short stints if they didn’t comply with their programs, as a condition of renewed funding. In 2005, the legislature passed SB 803, a bill that would allow so-called flash incarceration for recalcitrant Prop 36 clients, while funding the program for five more years.

The UCLA researchers also recommend giving judges the right to jail non-compliant Prop 36 participants for short periods, and some drug treatment professionals also supported the change.

But Abrahamson’s group went to court, arguing that such a reform subverted the will of the voters, who expressly voted to keep non-violent drug offenders out of jail, and was therefore unconstitutional.

Abrahamson prevailed, but it was a somewhat hollow win. The language of the initiative remains intact, but the funding impasse continues.

“We didn’t expect the entire economy to essentially take a dive such that the legislature would refuse to invest any money even when it was shown that investing money saved money.

“I don’t see any hope of convincing the legislature,” Abrahamson said.

But there is still a chance that the measure will get new life — thanks to federal health reform.

In 2014, when the Affordable Care Act takes full effect, many previously uninsured Prop 36 defendants will no longer have to rely on county programs for drug treatment because they’ll be covered by either Medi-Cal or private insurance. And, under the new law, insurers must offer mental health and substance abuse coverage that is comparable to medical and surgical coverage.

 

San Mateo County courts strained by state prison reforms

Published: May 7, 2013 | 1 Comment

Photo: Marc Soller/Flickr.

By Callie Shanafelt
California Health Report

State prison reforms are supposed to reduce dangerously overcrowded prison populations and help to alleviate the state’s fiscal crisis. But now county trial judges in San Mateo County say they feel the squeeze of the reforms, which are happening in tandem with budget cuts to courts.

As San Mateo County courts face unprecedented state budget cuts, they are also experiencing a higher caseload because of prison reforms and a jail that is at more than 130 percent of its capacity. San Mateo Presiding Judge Robert Foiles said if something doesn’t change soon, citizens face significantly reduced access to justice.

Over the past five years, trial courts throughout the state have had their budgets slashed by about $1 billion because of the state’s fiscal crisis. Before the cuts San Mateo County had $12 million in reserve. They are now down to $1.2 million. The governor’s proposed budget for this year would mean another $4.5 million budget shortfall.

“We’re having difficulty servicing the public as it stands,” Foiles said.

The court has cut more than 30 percent of its workforce. If the Governor’s proposed budget passes, they will have to shutter the central courthouse and reduce the South San Francisco courthouse to two judges – who will only hear the most serious cases.

“People needing restraining orders have to come to Redwood City,” Foiles said. “If they don’t drive, it’s a pretty long bus ride.”

San Mateo is a microcosm of what is happening throughout the state, Foiles said. In a recent survey of trial courts for the Judicial Council, 11 of the 48 counties that responded reported they weren’t able to process domestic violence temporary restraining orders on the same day they’re filed.

Also, state prison reforms will advance in July, so that people who violate their parole will come before the county courts. Now, they face the state parole board.

The state reforms are a result of AB 109, also known as realignment. In an effort to reduce the state prison population, legislators said counties could no longer send low-level offenders to state prison. Instead they must send them to county jails.

Realignment is proving an impossible task in his courtroom, San Mateo Superior Court Judge John Grandsaert said.

Before reforms, parole violators faced up to a year in prison for a violation, though the often served far less, between 75 and 100 days. Realignment means judges can only sentence them up to 6 months. Under current credit rules, this means they serve 90 days.

“Ninety days is just not a lot of time to serve, especially in the county jail,” Grandsaert said.

At professional events, Grandsaert said, judges are complaining that their sentences mean nothing.

People he used to sentence to three or four years in a state facility are only serving 10 percent of their time. “There’s no way county jail can support those kind of sentences,” Grandsaert said.

The San Mateo County Jail is meant for a one-year maximum sentence. It is currently operating at 130 to 140 percent capacity. It has yet to reach dangerous over-capacity levels because judges are doing all they can to keep people out of the state facility.

But San Mateo County is building a new jail with more than 500 new beds and space for rehabilitation programming to replace the current county jail.

The state reforms created a new tool to keep jail populations to capacity —the split sentence. With a split sentence, Judge Grandsaert can separate a sentence between a period of jail time and a period of probation supervision. For example, someone sentenced to four years would serve the first year in county jail and the rest under supervision.

“The beauty of that is they’re not in for very long initially, but they are subject to re-incarceration for violations,” Grandsaert said.

After 30 days served, a year in jail can also be converted to a residential treatment program under split sentencing.

Grandsaert now uses split sentencing in practically every case. San Mateo is third in the state for split-sentencing frequency.

Grandsaret, who also runs the Veteran’s Treatment Court, said before realignment, the county was making efforts to focus on more rehabilitation and deferment programs. He said being forced by the state to reform because of fiscal circumstances may have a negative impact.

“I think it does affect community safety,” Grandsaert said. “One of these guys who gets out who shouldn’t is going to commit a horrendous crime.”

The state provided a little less than $5 million to San Mateo County to help with realignment but most of that goes towards in-custody and out-of-custody supervision. The San Mateo courts got some money for hearing judges.

“It’s relatively small,” Foiles said. “It’s not going to cover our shortfall.”

They are hoping the state will allocate more to the courts in the new budget, but Foiles said he isn’t holding his breath.

 

Gardening to build community, change habits

Published: May 1, 2013 | No Comments

LAGreengrounds co-founder Ron Finley, center, shows volunteers at a community garden planting project how to apply organic fertilizer. Photo: Chris Richard/California Health Report

By Chris Richard
California Health Report

As city planners consider lifting a five-year-old ban on new fast-food vendors in South Los Angeles, urban gardening activists say it’s especially important to promote healthy eating habits by planting publicly available produce gardens on front lawns and city parkways.

On a recent Sunday, activists met at a South Los Angeles home to build such a garden.

“We are going to create a lifestyle for our garden recipients,” said Sachiko Speaks, who organized the LAGreenGrounds event.

“We’re not just installing these beautiful edible gardens and just leaving them. There’s so much involved with a person’s emotional state, their spiritual state, their nutrition, health and wellbeing. So we’re trying to create a lifestyle.”

At LAGreenGrounds’ “Dig-in” events, volunteers help property owners plant gardens in their yards and the city-owned parkway areas between sidewalk and street. The produce grown there is offered free to anyone who cares to pick it.

In addition to building a sense of community, the goal is to turn around fundamental dietary choices. According to the Los Angeles County Department of Public Health, more than a quarter of the children in South Los Angeles are considered obese, as are nearly a third of adults. The area has the county’s highest rate of consumption for sugary drinks. Some 70 percent of the region’s restaurants are fast-food outlets, nearly double the concentration in the rest of Los Angeles.

Some recent research has cast doubt on how much a person’s health can be improved by dietary changes. In October, for instance, federal researches announced that they had been unable to show diet and weight loss can prevent heart attacks and strokes in overweight and obese people with Type 2 diabetes.

LAGreenGrounds co-founder Ron Finley, who drew international attention to the lack of fresh fruits and vegetables early this year with a well-received talk at the TED conference, said the evidence of the links between diet and health is clear.

“Have you ever been to Brentwood and seen used wheelchairs on the street? All that represents to me is that somebody died in that chair. And now there’s another space for somebody else to die,” he said.

“I’m no scientist. I’m not even no academic. I got common sense, though. I know what I see.”

Other health activists deplored a proposal by planning officials to lift restrictions on fast-food restaurants in a portion of South Los Angeles.

Five years ago, city officials imposed a ban on new fast food restaurants when another such outlet was already in business within half a mile. At an April 11 public meeting, planning officials proposed lifting that restriction. After speakers at the meeting vehemently opposed the suggestion, the planning officials withdrew it. Still, Gwendolyn Flynn, policy director of non-profit health advocacy group Community Health Councils, said she remains concerned.

“When you live in a community where you have no options, where you’re kind of locked in because you don’t have personal transportation, and all you have is exposure to food that are high in sodium and sugar and high calorie, and just processed foods, it has a detrimental effect on your health,” she said.

Community Health Councils has called for additional restrictions for South Los Angeles, including a requirement that fast food restaurants be located at least half a mile from schools, parks, playgrounds, child care centers, recreation facilities, and other facilities that serve children.

But Yang Lu, a research professor at the University of Southern California’s Schaeffer Center for Health Policy and Economics, questioned the effectiveness of prohibitions in changing dietary habits.

“If you have a ban for however many years, if people want fast foods, it still will be available,” she said. “They just go to existing food outlets. Addressing only the supply won’t remove the problem.”

Finley said projects like the recent garden planting are aimed at reversing demand.

“People don’t know what food looks like in its natural form,” he said. “Unless it’s in the store and labeled, they don’t know that this is cabbage, this is broccoli, this is chard. But gardening changes your molecular structure. And if I’m eating food from a garden, why would I want to eat something genetically modified or something like that?”

 

Advocates and activists allege environmental racism in the Coachella Valley

Published: April 30, 2013 | 1 Comment

Speakers asked community members in the audience to get involved in promoting environmental justice in the valley.

By Suzanne Potter
California Health Report

Toxic waste dumps. Poor air quality. And the slow death of the Salton Sea. The Eastern Coachella Valley has serious environmental problems – and now locals are getting involved.

Recently several hundred people gathered at a high school in Thermal, California at the inaugural Coachella Valley Environmental Health Leadership Summit. They listened to experts and brainstormed solutions on a variety of topics.

Eduardo Guevara, with a group called Promotores Communitarios del Desierto, organized the event. “We just want to bring awareness of environmental health and environmental problems that we have in the area, and to get the agencies and the residents closer together.”

Rosie Nava-Bermudez, an activist with Comite Civico del Valle, says at the summit, “Partnerships are being formed. We’re providing a map of future steps that need to be taken. The next step is to formulate a plan of action and prioritize the different problems in the community.”

The keynote speaker, Jose Bravo of the Just Transition Alliance, said that poor, non-white communities in the East Valley harbor more than their share of pollution – and called it a case of environmental racism. “So what is environmental justice? Communities that bear a disproportionate environmental impact by polluting industries, waste dumps, incinerators, polluted air, water and soil.”

Mr. Kim Floyd, a volunteer for the Sierra Club, agrees. “If this were happening in a wealthy area I’m convinced we’d get solutions much more quickly than we have here in the east valley.” Floyd is particularly troubled by the massive odor problem reported in 2010-11 at Western Environmental – a soil recycling facility in Mecca that sits on property owned by the Cabazon Band of Mission Indians.

Neighbors said the stench from the giant piles of contaminated dirt made them sick. Celia Garcia, who taught at nearby Saul Martinez Elementary School, said it disrupted much of the school year. “Exposure to the noxious smells at Saul Martinez was really, really bad.”

The authorities took soil samples and tested the air quality but everything came back within legal limits. At a public meeting in May 2012, the experts said they couldn’t definitively explain how, or if, the odors made people sick. The company denied it was the cause of the odor. It’s the kind of thing that frustrates Floyd. “There have been odor problems and a lot of investigation, a lot of work done but we really struggle on solving the issue. How do we get something actually fixed is our dilemma I think.”

County Supervisor John Benoit said he’s helped secure funding for a number of air quality projects in the east valley.

That includes money to install a new air filtration system at that elementary school, retrofit or replace diesel school buses, synchronize traffic lights and pave more dirt roads. “Children will no longer have to walk to school along a dirt road where their parents are driving to get to work in the morning.” Benoit told the crowd. “They will be breathing much cleaner air and the valley will have cleaner air as a result.”

Organizers pleaded with residents to take action by talking to their legislators, speaking at public hearings and reporting new cases of pollution.

A new computer system – highlighted at the conference – will ensure that environmental complaints get the attention they deserve. IVAN, which stands for Imperial Visions Action Network, is a website launched by a community task force where people can report pollution. IVAN’s activists follow up and then route the case to the appropriate authorities.

Bravo says that in the past, poor immigrant communities have served as a sort of sentinel for environmental abuse. “Agencies, who we at some point believed have our best interests in mind, have been using us as the canaries in the coal mine. And that’s a fact.”

An incident at the Salton Sea last year is instructive. In September a storm churned up the waters, releasing nasty sulfur-smelling gas caused by rotting vegetation and dead fish at the bottom of the polluted lake. The stink is a periodic problem in the Coachella Valley but this time the fumes blanketed most of Southern California. All of a sudden, the longstanding problem at the sea became statewide news.

People in the east valley are used to the nasty smell from the Salton Sea’s regular fish die-offs. They occur when pesticides from agricultural runoff trigger an algae bloom, which lowers the water’s oxygen level and kills millions of fish. The problem has been studied for decades but very little has been done because the proposed fix could cost billions of dollars.

Experts have warned for years that the Salton Sea is shrinking, so the problems will only get worse. “It will dry and all the sediments that are in the water now are going to be exposed and the wind is going to blow them away,” Guevara says. “And that’s gonna cause a lot of respiratory issues. It’s a problem that it’s gonna affect us all. If we make more people aware of that, we will get more people to get involved and start pushing for a solution. “

 

Therapy to help close revolving door on prisons and jails

Published: April 24, 2013 | 1 Comment

Photo by Marc Soller via Flickr.

By Clare Noonan
California Health Report

When California legislators decided that certain felons no longer would be held in the state’s overflowing prisons, they were under pressure from a court order to relieve the system’s dangerously overcrowded conditions. But part of their goal also was to keep lower-level convicts near rehabilitative programs in their own communities. Some counties are embracing the goal of rehabilitation, too, and are turning to local non-profits to help people convicted of non-violent, non-serious and non-sexual crimes start a new life.

Counties didn’t necessarily have all the resources they needed for rehabilitation in place before the criminal justice reform law, AB109, and the funding from the state that went with it, began in October 2011. When the Stanislaus County Probation Department asked the Center for Human Services in Modesto to conduct a program aimed at keeping ex-offenders from returning to jail, the center’s program manager, Jody Vasquez, had to start by identifying successful approaches. She found one called Moral Reconation Therapy (MRT).

The program, developed in the ’80s as drug therapy for offenders in Tennessee, expanded over the years and now is used to treat a variety of problems, including antisocial behavior, juvenile delinquency and sex offenses. “It’s been used about 25 years both in and out of prison,” Vasquez said of MRT. The goal of the program is to reduce recidivism by changing behavior and patterns of thought.

California’s prisons were overflowing in part because of their so-called revolving door. More than 60 percent of offenders return to prison within three years of their release. Now, people convicted of non-serious, non-violent and non-sexual crimes may receive a split sentence – part jail, part probation – with the period of probation meant in part to provide support for those who want to start a new life.

MRT’s goal is to change how ex-offenders think and act through cognitive-behavioral therapy. MRT classes deal with seven issues: confronting beliefs, attitudes and behaviors; assessing current relationships; reinforcing positive behaviors and habits; providing positive identity formation; enhancing self-concept; decreasing hedonism and developing frustration tolerance and developing higher stages of moral reasoning.

A workbook called “How To Escape Your Prison” leads ex-offenders through 12 steps, different from those in Alcoholic Anonymous. There is no timetable for completion, but most participants can finish the steps in three months. Class participants vote on whether a peer has completed a step and can move on. “They get to be in the position of judging did they meet standards,” Vasquez said.

The first exercise is called Pyramid of Life. The participant illustrates one half of the pyramid with “Real Life Happenings” from 20 years ago to the present. The other half of the pyramid pictures “What Could Have Been.”

Vasquez described an ex-offender who appeared surly during the first MRT class. His attitude softened after he explained his drawing to his classmates, telling them that a major What Could Have Been for him was the chance to play on a football team.

Ex-offenders learn about themselves as they complete an action plan for a life outside prison, explore their worries, wants and needs and take a moral inventory of their lives. Vasquez and a colleague are co-facilitators and the classes’ “only goal,” Vasquez said, “is to reduce recidivism.” They took a 32-hour workshop to learn how to teach MRT and Vasquez admitted that some of the exercises seemed like they wouldn’t work.

The ex-offenders feel the same way. “They say, ‘Can this really work?’ ” Vasquez said, adding that the classes sometimes “seem hokey,” but they’re “well designed.”

She didn’t know what to expect from the class, having never worked with ex-offenders. Her expertise had been in treating adults and children as a licensed marriage and family therapist and later supervising therapists who work with adults and children.

Yet the twice-a-week class that started in February is going so well, “It’s blowing my mind, actually,” Vasquez said. “I love it. They’re so much fun and they appear to be responding. There’s something going on in there.”

“The atmosphere is really, really helpful,” said Vasquez. “The curriculum facilitates a positive atmosphere in class.” But there are rules, she continued. A Life Wheel exercise has to be completed in two to three weeks. If it takes longer, it doesn’t count and the step has to be started again.

“It’s very energizing,” Vasquez said of the atmosphere in the MRT classes. Ex-offenders are “doing things, helping each other. It’s a new way to feel good about yourself.”

Research indicates Moral Reconation Therapy works in reducing recidivism. The Cognitive Behavioral Treatment Review in 2010 published a 20-year follow-up of 1,052 MRT-treated offenders and a control group of 329 individuals.

MRT-treated offenders had a 46 percent reincarceration rate after 10 years, compared with 65 percent in controls, the study found.

Those statistics might seem depressing. Not to Edward Latessa, though.

He directs the School of Criminal Justice at the University of Cincinnati and has spent his career considering criminal behavior and how to change it.

While some look at California’s recidivism figures and see the 60-plus percent who have broken the terms of their parole or reoffended within three years, Latessa focuses on those who have not.

“We have programs that have tremendous effects,” he said.

MRT is not his favorite, Latessa noted, calling it too heavy on cognitive therapy and too light on behavioral. He favors Thinking for Change, which is free as opposed to the proprietary Moral Reconation Therapy.

“I’m a big believer in skill building,” Latessa continued. Say the ex-offender got into legal trouble after getting paid on Friday and heading straight to the bar, where he would get drunk and belligerent and end up arrested. Latessa would have him practice alternatives: Drink only one drink at the bar. Skip the bar and drink at home.

“If I get you to understand why you shouldn’t continue to go to bars,” said Latessa, the next step is change.

“What we try to do is build alternatives to your risky behavior,” he said. The major risks factors in criminal behavior, according to Latessa, are attitudes, values and beliefs. “You think what you do is OK,” he said, or you justify your bad behavior. That makes you more likely to keep doing it.

Cognitive behavior classes are all about challenging an individual’s thinking. When an ex-offender says he doesn’t want to return to jail, Latessa’s question is this: What changes do you have to make to avoid that?

He acknowledged that age is key to recidivism rates. Young ex-offenders return to custody at a rate of 70.3 percent if they’re freed at the age of 24 or younger, according to the California Department of Corrections and Rehabilitation. The three-year recidivism rate for all felons released in 2007-08 was 63.7 percent.

“The problem with age is it’s not dynamic, can’t change it. So we work on age maturity,” Latessa said.

“A lot of offenders, they’re like teenagers,” he continued. “A lot of them say, ‘I’m never coming back (to prison).’ ” But in the case of the ex-offender who always got in trouble at the bars after getting paid on Fridays, it’s not enough to say, “I just won’t do that.”

“You have to work on ways to change the risk,” Latessa advised. “The truth is what we do to change them is yell at them, threaten them.”

Better to work on changing an ex-offender’s thought processes and behavior.

“You can’t arrest your way out of the crime problem, you can’t incarcerate your way out of the crime problem,” Latessa said. “If jail works so well, why the hell do they keep coming back?”

 

Faith-based organizations help step up ACA enrollment efforts

Published: April 17, 2013 | No Comments

Adelaida Macias signs her Medi-Cal insurance application as OneLA volunteer Marissa Gallegos looks on at a recent church-based enrollment fair. Photo: Chris Richard/California Health Report

By Chris Richard
California Health Report

By the time national health-care reform takes effect next year, Los Angeles County health officials expect to enroll 300,000 people in an expanded Medi-Cal program.

But some estimates put the number of people eligible for the low-income insurance coverage countywide at more than half a million.

To help make up the difference, a coalition of churches, synagogues and nonprofits has launched an enrollment drive that invites people to sign up at the neighborhood church.

“Depending on the policy decision at the state and county level, [health-care reform] can merely be an exchange that provides more insurance and still leaves a million or so people out, or there can really be an aim to provide health-care coverage for everybody in LA county,” said Tom Holler, executive director and lead organizer at OneLA.

“And that was the decision the OneLA leaders made, to make sure the enrollment is done in a way that eventually provides insurance for everybody.”

Los Angeles County’s Medi-Cal expansion, Healthy Way LA, provides free primary and specialty care, mental health services, chronic disease management, medication and emergency treatment.

Enrollment is open to citizens or permanent legal residents between the ages of 19 and 64 who earn less than 133 percent of the federal poverty benchmark. That’s about $14,500 for an individual and $29,700 for a family of four.

Lambreni Waddell, who organizes OneLA’s church recruitment events, said working through relationships in a congregation makes it easier to correct widespread ignorance about the program.

“Our strategy is actually going to the people who are not yet at the point of needing health-care coverage,” she said.

“It’s meeting them when they’re healthy, when they’re bringing their kids to confirmation class, and saying, ‘Hey, why not begin now learning what your options are? Let’s get you connected now.’”

At an enrollment fair Sunday at St. Agnes Church south of downtown Los Angeles, Adelaida Macias, 59, brought a thick sheaf of documents, including her United States citizenship naturalization certificate. A volunteer from OneLa took about half an hour to help her complete her Medi-Cal enrollment forms.

“I’ve been worrying a lot,” Macias said, explaining that she suffers from severe bronchitis and arthritic knees. “So when I heard at Mass about this event, I signed up right away.”

Until now, only Los Angeles County health department employees or professional enrollment agents employed by county-authorized community clinics could enter new people into the county’s Healthy Way LA database, said Katie Murphy, supervising attorney at Neighborhood Legal Services of Los Angeles County.

“This project is the first time that community leaders are being trained to help people in their own communities,” Murphy said. “So it’s really about building capacity.”

Waddell said some 15 churches and other organizations will hold enrollment events in coming months, hoping to begin the insurance qualification process for several thousand people.

Amy Luftig-Viste, director of the county health services department’s community partner program, noted that one problem with enrolling people exclusively within the clinic setting is that by definition, that means signing people up once they are already sick.

“Part of what we are trying to do here is help people get their health coverage (and understand it) well before they need it,” Luftig-Viste wrote in an email.

Neighborhood Legal Services already trains county and community clinic staff to help people with the insurance signup process. OneLA’s enroller training is based upon the same instruction, Murphy said. Volunteers learn the range of public insurance programs, what documentation is required for each program and how to enter applicants into the county’s online enrollment system. They also sign the same confidentiality agreements required of professional staff.

Brother Lucio Cruz, whose Mary Immaculate Catholic Church in Pacoima hosted the first enrollment event in early March, said parishioners clearly are more comfortable completing the insurance documents with the help of OneLA volunteers they already know in his congregation.

“When it comes to a church where they go for Mass, people come because they trust,” he said. “They come because they know this is a safe place. And it’s the same for this program.”

Ellen Israel, who chairs the social justice committee at Temple Judea, a Tarzana synagogue and OneLA member, thinks the local effort could offer a broader model.

“We really look at Los Angeles as being ground zero for all of this health care reform,” she said. “We have such a big population and so many uninsured individuals that this is a good place to do a pilot. We’ll see. We’ll see. But it looks to me like it’s going to be successful.”

Luftig-Viste, the county health official, said county officials plan their own variation on the OneLA model, training about 200 certified application assisters to help people complete applications at centers of community throughout the county. These agents are more familiar with the application procedures than is the typical volunteer and should be able to complete application materials more easily, Luftig-Viste said.

Even as OneLA presses for broader enrollment, Holler said, the organization’s leaders are concerned that Gov. Jerry Brown has yet to sign state legislation enabling the full Medi-Cal expansion once national healthcare reform takes effect.

At first, the federal government will cover nearly the entire program cost as part of the Affordable Care Act. Starting in 2017, California would be required to pay a maximum 10 percent of care costs, as well as half the program’s administrative expenses. By 2020, the state would pay about $600 million in exchange for a health care package valued at $6 billion.

Holler said he’s confident Brown will eventually come to an agreement with local officials throughout the state on paying California’s share. But if discussions extend into May, that could cause interruptions in health coverage for people already enrolled in Medi-Cal transitional programs, he said.

“For the bureaucrats, that may be OK,” Holler said. “But if you’ve got a disease and you’ve got to go to the hospital, that’s not OK.”

He said OneLA leaders are discussing a coordinated series of sermons this month on the need for a speedy resolution to the impasse.

 

Special court helps veterans with addictions

Published: April 15, 2013 | No Comments

San Mateo County Superior Court Judge John Grandsaert started Northern California’s newest veteran’s treatment court last July. Photo: Callie Shanafelt/California Health Report

By Callie Shanafelt
California Health Report

San Mateo County’s Veteran’s Treatment Court looks like a typical criminal courtroom on a recent morning. Three men in orange jumpsuits sit in a holding area in the front near two bailiffs as the session begins. A row of lawyers and court staff, all wearing business suits, has case files at the ready. At the back of the room, social workers and defendants sit in army green and gray theater-style seats.

But what happens at Veteran’s Treatment Court is anything but typical. Modeled on drug treatment courts, this court provides extra support and treatment opportunities for military veterans.

San Mateo Judge John Grandsaert started Northern California’s newest veteran’s treatment court last July.
First, he had to convince the county that the court would not mean an additional hit to the county budget. In the past five years, California trial courts have lost nearly one billion dollars to budget cuts – an unprecedented amount. San Mateo Court has cut its total staff by 30 percent, even as caseloads increased after reforms to the state prison system.

“It’s not a good environment for starting new courts in light of the terrible budget squeeze that we’re under,” Grandsaert said.

But he was able to create the Veteran’s Treatment Court by limiting admission to the program and tapping into the resources of veteran support networks.

Judge Grandsaert sits behind a raised corner desk framed by the U.S. and California flags when court is in session. The state seal hangs above his head. He speaks in a soothing and encouraging tone to each veteran that comes before him—reminiscent of how a supportive father would speak to his son.

In fact, Grandsaert has a particular passion for veterans because his own son is in the Air Force and he spent 17 years in the Army reserve. He thinks vets deserve special treatment in the criminal justice system.

“Veterans have already sacrificed part of their life in service to their country,” Grandsaert said.

There are more than 23 million vets in the United States, according to the Veteran’s Administration. The VA also estimates that one third of the homeless population has served in the military. Vets aren’t more likely to be arrested, but those who are in the criminal justice system are more likely to have problems with addiction.

Vets in the San Mateo Court have already been convicted of a crime. They usually end up on Grandsaert’s radar because of a probation violation or referral. Defendants agree to be closely monitored during probation. In exchange, they get extra support and opportunities through the court. If they successfully complete the program, Grandsaert expunges their record and forgives their fines.

He estimates it will take vets 18 months to three years to go through the program. If they don’t progress with their treatment, they can be removed.

Halfway through the April proceedings, Clarence Young is called before Judge Grandsaert. He is a stout man with silver highlights in his beard, with his t-shirt tucked neatly into navy blue work-pants.

Grandsaert announces that he’s heard Young is a star at the shelter where he lives.

“I’m doing well, keeping busy,” Young tells Grandsaert.

“You’re being modest,” replies Grandsaert.

Young approaches the bench with a folder of paperwork. He shows Grandsaert a to-do list with twenty items, all of which have been checked off.

Grandsaert gives Young a Target gift card to reward his progress, and says he has advanced to the stage where he only has to report in every couple months.

Other courtroom participants applaud and smile.

About twenty vets, all men, are currently on the vet court docket. Most of them come before Judge Grandsaert once a month to report their progress. About half of the people who came before him in April were petitioning to be included in the court.

Grandsaert asks them each if they feel confident that they could complete the program.

Grandsaert has limited participation to San Mateo vets who can show that their substance abuse or mental health issues are related to their service. They also have to qualify for Veteran’s Administration benefits.

Grandsaert estimates that about half of the vets in his court are from the Vietnam era and half are from the Gulf wars. Combat service is not required to be eligible for vet court.

Grandsaert also created a volunteer mentor program where each defendant is paired with a mentor to keep tabs on them to better provide intensive support to the vets in his court and to keep the court sustainable.

He asked Derrick Felton, a team leader at the Peninsula Vet Center, to set up the program.

“It’s unpaid, it’s gonna be terribly annoying for these guys, they’re gonna be called at all hours of the day or night,” Grandsaert remembers saying.

But Felton jumped at the chance to organize it.

Tim Healy, a mentor at the nearby Veteran’s Treatment Court in Santa Clara County, has been one of three San Mateo mentors since the court started.

Healy understands what these guys are going through. “I am a two-strike convict,” he explained.

He was an air crewman in the Navy from 1986 to 1990. He developed a meth habit after his discharge, which led to his criminal offenses.

He was facing his third strike in Fresno County when he came before a sympathetic judge. He decided to have Healy evaluated for the Homeless Vet Rehab Program in Menlo Park.

“The judge told me out loud in court, ‘Mr. Healy, I’m going to do everything in my power to send you to this program’,” Healy said. “At that time I’d kind of given up.”

Healy was released from jail for 12 hours to go to Menlo Park for evaluation. Afterwards, he had to turn himself in.

“It was probably one of the hardest things I’ve ever done,” Healy said.

But he was approved to go into the treatment program instead of prison and began his road to recovery. He’s been sober for four years and works as a case manager with homeless veterans, most of who have criminal backgrounds.

“If I didn’t get a deferment, I would still be in prison,” Healy said.

He wanted to volunteer for the Veteran’s Treatment Court because he knew what a difference it can make when someone believes in you.

“I’ll tell my clients they may not believe they can change but lean on me cause I believe they can,” Healy said.

Healy points out that by joining the Veteran’s Treatment Court, vets are actually consenting to more restrictions.

“The majority of my clients are very compliant—they have that military background,” Healy said.

He checks in with everyone at least once a week but sometimes he gets a call at odd hours from someone in crisis.

Healy is also going to school to get his drug and alcohol counselor certification. He said it takes those skills as well as his personal experience with addiction to get through to these guys.

“If guys look like they’re slipping, I’ll call them on their garbage,” Healy said.

He feels proud when his mentees succeed and blames himself when someone ends up back in custody. He’s developed lasting friendships with some of them.

Judge Grandsaert was surprised at how grateful the vets who come through the court are for this opportunity.

“I think they’re surprised that their service has entitled them to this kind of support, attention and treatment,” Grandsaert said. “They are proud once again of their military service, because of what it is doing for them in this court.”

 

Farm to school flourishes in SD

Published: April 11, 2013 | No Comments

By Marty Graham
California Health Report

When the San Diego Unified Schools District began its Farms to School program three years ago, it had the extra leverage of serving 130,000 meals each day during the school year. That makes its purchases on par with a major grocery chain.

But with the goal of serving meals where at least 15 percent of the food is grown locally, that means finding an awful lot of food nearby.

“We asked ourselves, how can we get the food that’s served at white tablecloth restaurants here, in our schools for our kids,” said Vanessa Zafjens, the district’s Farm to School specialist. “Because of the relationships we have with local farmers and our ability to commit to large, regular purchases, we’ve been able to get very high quality, very fresh organic fruits and vegetables.”

Zafjens points out that she’s the only fulltime Farm to School specialist in a California school district.

Moving kids towards healthier food isn’t new to the district. The lunch program launched salad bars nine years ago, Zafjens points out.

“There are kids who’ve been eating with us their whole lives,” she said.

The school district wants to lead students towards healthier food at a time when childhood obesity has been declared an epidemic, by serving fruits and vegetables so tasty that kids will naturally come back for more.

“It’s a learning process for the kids and it’s picking up steam, said Fred Espinoza, manager of acquisition and production for the district. “We’ve implemented the federal Healthy, Hunger-Free Kids Act beginning this year.”

Healthy Kids is a shift from the Food Pyramid concept to the healthy plate idea, with emphasis on fruits and vegetables, healthier grains and better quality food – which means fresh and local.

“The whole nation is trying to get their arms around this,” Espinoza said. “It really helps us that we have a great farm to school program – we love to have kids eating food that’s nutritious and delicious, and that has to start with fresh and local.”

But the county’s declared obesity epidemic, and the childhood obesity initiative have brought stronger emphasis – and better financing – than ever before.

Our first year, we purchased 180,000 pounds of local food,” Zafjens said. “Last year, it was 360,000 pounds.”

“One of our problems is we can buy all the produce a farmer can grow,” she said. “But at first, that’s asking farms to take a lot of risk. Now we commit to large quantities and we’re a consistent purchaser so more things become available.”

For example, this year the district is buying local nuts and tofu, for the first time. Micro greens, from another local organic farm, are part of every salad and every salad bar.

“We get opportunity buys, like tomatoes, avocados, oranges and even blueberries and blackberries,” Zafjens said.

The school districts commitment to purchase has helped organic farmers, including Stehly Farms Organics and Suzie’s Farm, according to Jared Bray, produce manager for Stehly Frams Organics.

“We started a number of years ago with navel oranges – having a reliable client of this size helps us plan our farming,” Bray said. “And if we can sell at near the price we sell to our retail outlets and it helps get kids interested in fresh, healthy food then we’re happy to do it.”

How fresh?

“What we pick today we ship within 24 hours,” Bray said.

“We started a number of years ago with navel oranges – having a reliable client of this size helps us plan our farming,” Bray said. “Knowing I this extra 10,000 pounds sold, it allows me to plan my harvest.”

Right now, Stehly is getting ready to ship blackberries, a fruit the students probably didn’t get a lot of.

The prices Stehly offers the school district are lower than the rest of its retail outlets, but Bray sees that as a good deal.

“The kids thoroughly enjoy the fresh fruit – you get them young and give them an interest in fruit they probably wouldn’t have gotten from eating the weeks old trucked in produce that once was the norm,” he said. “The kids are driving the demand and what they want is often something new to them, something the schools were able to introduce because of our special relationship.”

 
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