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Clergy campaign for indigent care

Published: May 23, 2013 | No Comments

By Chris Richard
California Health Report

In a first step in a campaign to emphasize a moral and religious imperative in the state budget debate, clergy from a coalition of Los Angeles County churches and synagogues delivered sermons over last weekend calling on Gov. Jerry Brown to retain current state support for county indigent care.

Speaking at Los Angeles’ historic La Placita Church on Sunday, Father Richard Estrada urged his parishioners to join in a petition drive that asks the governor not to reduce the funding.

Preaching in Spanish, Estrada thanked his congregation for supporting efforts by the coalition, OneLA, to increase enrollment in Los Angeles’ County’s Medi-Cal expansion program.

But he said many of those enrolled at La Placita and other OneLA churches fail to qualify for federal programs because they are undocumented, and will be dependent on hospital emergency rooms for health care.

The governor has proposed cutting state support for counties’ indigent care by $300 million in the 2013-14, $900 million in 2014-15 and $1.3 billion in 2015-16. Brown argues that federal health care reform will cover these expenses, and that counties won’t need the money if they are not providing the services.

Health care advocates say it’s too early to predict what it will cost to serve those who will remain uninsured because they don’t qualify for federal programs, in part due to their immigration status.

Some estimates put Los Angeles County’s undocumented population dependent on such services at half a million, Estrada said. He told parishioners Sunday that signing the petition falls within the church’s tradition of serving the poor and the forgotten, as well as Jesus’ healing ministry.

“Gov. Jerry Brown is a very powerful man,” he said. “Don’t be afraid to proclaim the truth to the powerful. That is the spirit of Jesus.”

In an interview after the sermon, Tom Holler, executive director and lead organizer at OneLA, called health care coverage the reasonable consequence of a de facto arrangement.

“There was a bargain on the part of companies, on the part of people who wanted to come here and work and on the part of government to look the other way for 20 years,” he said.

“All the powers that be knew that this was happening, and now it’s time to make it right, and part of making it right is hearing everybody’s voice and coming up with a reasonable plan, and it’s reasonable for people to have access to health care if they’re here and they’re all paying taxes.”

There are estimates that as many as 1.3 million Los Angeles County residents – including the undocumented, people who missed enrollment deadlines and those who don’t qualify for Medi-Cal but still can’t afford coverage — could remain uninsured once national health reform takes effect.

But such figures are based on computer modeling.

“It’s hard to get real numbers yet because we haven’t started health reform yet,” said Dr. Anish Mahajan, who oversees the planning of service delivery for the Los Angeles County Department of Health Services.

He questioned Brown’s basis for the gradually increasing share of funds he expects to recover from county medical systems, starting with the proposed withdrawal of $300 million from indigent care in the pending fiscal year.

“If the governor takes money in fiscal year 2013-14, he’ll be taking money based on a lot of estimates and unknowns. It’s too soon to assume that every county’s going to have real savings.”

Ira Mehlman, spokesman for the Federation for American Immigration Reform, said the new public health issue arises from poor immigration policy and enforcement.

“We shouldn’t be dealing with the issues of illegal immigration at the hospital door. If you don’t enforce your immigration laws, you wind up with all kinds of other social issues,” he said.

“It happened that the government refused to take steps to stop illegal immigration. California and the various jurisdictions encouraged it. But that doesn’t mean that the American people entered into any sort of compact. Just because you show up and say, ‘I want to work’ doesn’t mean that we have to allow you to, and that we owe you something in terms of extended social benefits.”

The Protect the Health Care Safety Net Coalition – which includes Health Access, the California Immigrant Policy Center and the Western Center on Law and Poverty – has called on state legislators to adopt what the coalition calls a compromise between the governor’s call for thrift and health care advocates’ warnings against cutting too deeply.

It would preserve the state dollars that go to county services for at least three years, when demand for services by the newly insured is expected to peak and while the federal government continues to cover the full cost of their care. At the same time, the proposal would keep in place the counties’ Low-Income Health Programs, bare-bones coverage for persons not eligible for the expanded Medi-Cal services. Currently, those programs are set to expire at the end of this year.

After three years, the coalition proposes to tie a portion of state funding to enrollment in LIHP-like coverage programs. Proponents argue that this would allow counties that show continued demand to obtain needed state funds, while allowing Sacramento to claim savings if the needs of the uninsured are reduced.

“This isn’t gold or platinum coverage. This is a very basic service. But we do believe that everybody should have access to some very basic level of service in order for our communities to be healthy and economically vital,” said Anthony Wright, executive director at Health Access.

 

Low-income kids face a wide summer nutrition gap

Published: May 23, 2013 | No Comments

By Lily Dayton
California Health Report

For some kids, the end of the school year means summer camp, family vacations and backyard barbecues. For others, the end of the school year means hunger.

“Many parents don’t have enough money for healthy food, or they leave for work very early in the morning so it’s difficult to feed their kids,” said Gloria Arizaga, who has been serving meals to children in the North Monterey County Unified School District (NMCUSD) for 30 years. She speaks Spanish as her first language, like many of the students in her district—over 70 percent of whom qualify for federally funded meals.

“The breakfast and lunch we give to kids are the only meals they have during the school day,” she said in Spanish. “If they aren’t in programs during the summer, I imagine they don’t have enough food.”

Over half the kids in California receive a free or reduced price lunch at school—yet the majority of these low-income kids don’t receive federally funded meals during the summer. Now schools and community organizations are coming together to make sure summer lunch reaches kids in need, even if they aren’t in summer school.

According to California Food Policy Advocates’ (CFPA) analysis of California Department of Education (CDE) data, over 84 percent of those who benefitted from school lunch programs in 2011—more than 2 million children—did not use summer lunch programs. And the data show that this summer nutrition gap is widening. While the number of children eligible for free lunch has increased in California over recent years, the number of children participating in summer nutrition programs has plummeted. CFPA’s analysis shows that over the past ten years summer meal participation has decreased by over 50 percent.

This trend doesn’t reflect a lack of federal funding for summer nutrition—the funds are available, but the state isn’t using them. The CFPA report estimated that during July 2011, California missed out on $34 million that could have gone towards feeding the state’s low-income children. CFPA ties the growing summer nutrition gap to the decrease in summer school programs throughout the state.

“If you look at historical trends, the vast majority of summer meals for low-income kids are served by schools at school sites,” explained Tia Shimada, an advocate with CFPA. “With recent budget cuts, there is much less summer programming.”

Earlier this year, the USDA selected California as one of five states to target with additional technical assistance for summer meal programs—a decision driven largely by California’s declining participation rates.

“State Superintendent Tom Torlakson has been very proactive,” said Sandip Kaur, director of nutritional services for the CDE. “He sent out 500 letters to community leaders in February 2013, encouraging them to get onto summer food service programs—churches, libraries, Parks and Recreation departments, YMCAs, and Boys and Girls Clubs.”

This highlights an up-and-coming venue for summer meal programs in California: With summer school disappearing across the state, school districts and community organizations are forging partnerships to create a summer safety net for low-income kids.

Last summer was the first that NMCUSD partnered with the local parks and recreation center to help feed the community’s children. The rec center lies within blocks of Castroville Elementary School, where over 80 percent of students qualify for free or reduced lunch. Since the district already planned to serve meals for their two-week summer school session, they decided to feed kids in the community all summer long.

“We figured if we’re going to do summer school, why not take on more?” said Kathleen Cleary, Child Nutrition Supervisor for NMCUSD. “Our summer school session is so small, and the need here is so high.”

Arizaga was one of the servers on the catering truck they used to deliver food to local parks and low-income housing areas. At first, she wasn’t sure what response the community would have. But once word got out, neighborhood kids came running to meet the truck.

“They love that we offer them fruits and vegetables, and healthy food they don’t normally eat,” said Arizaga. “The part of my job I value most is la sonrisa de mis niños—the smile on my kids’ faces.”

In efforts to prevent obesity—an epidemic that disproportionately affects low-income children and adults—some summer lunch providers offer activities and education along with food.

“Our theme is ‘eat smart, play hard,’” said Norma Johnson, program specialist with San Diego Unified School District—one of California’s largest summer meal providers. “We host activities so it makes for a fun-filled event. That way kids aren’t sitting in front of the TV, playing video games and eating junk food. As a school district, we need to make sure the gap has been filled so learning doesn’t stop due to lack of nutrition and physical activity.”

Last year, SDUSD partnered with the San Diego Food Bank, local farmers and over 45 other community organizations to provide food at 68 sites for 48 days throughout the summer. In addition, they held 38 community barbecues with health resource fairs, fresh fruit and vegetable sampling and cooking demonstrations. At each of their sites, they offered a safe place for children to play.

Despite local successes, Shimada said the numbers still don’t add up to fill California’s summer nutrition gap. Even SDUSD’s acclaimed program—third in the state for highest number of summer meal participants—still only reached 31 percent of the district’s low-income children in 2011. Overall, there aren’t enough providers, there aren’t enough sites, and there aren’t enough children being fed.

One of the challenges is getting the word out to families in need, said Patrice Chamberlain, director of California Summer Meals Coalition. “The biggest thing we can do is engage credible spokespeople—teachers, principles, school board members—to let people know there are safe places to send their kids.”

As the school year comes to a close, NMCUSD, SDUSD, and other summer nutrition providers across the state are gearing up to spread the word in their communities through banners, flyers, radio announcements, newspaper advertisements and the Internet.

Of her district’s summertime reach so far, Johnson said, “It’s good, but we could do a lot more. We really need more children to come to our sites.”

The CDE posts summer meal sites on their website. People without Internet access can find site locations by calling 1-866-3-Hungry or 1-877-8-Hambre.

 

Instead of prison, felons get jail and rehab

Published: May 21, 2013 | No Comments

R.I.S.E. participant Michael Nickerson, second row, second from left, and Inmate and Programs Liaison Officer Louie Hevia, back row far right, visit Cabrillo College in Santa Cruz with other R.I.S.E. participants to explore educational opportunities.

By Lynn Graebner
California Health Report

Larry Gardner was a drug dealer and user for 25 years. At age 41, incarcerated again after a long string of jail sentences, he’s ready to change — with help from a new program in Santa Cruz County called R.I.S.E. The program aims to help people like him improve their chances of success – and make it less likely that they’ll end up back in prison or jail.

Gardner is one of 129 convicted felons who have become the responsibility of Santa Cruz County since the state instituted sweeping criminal justice reforms in October 2011. That was when California started transferring responsibility for certain non-serious, non-sex and non-violent offenders to the county to reduce prison overcrowding.

Counties were given funding to manage the new felons and could choose how to spend it. Some counties have used it to expand their jails, others have expanded rehabilitation options, and some have chosen to do both. Santa Cruz has opted to invest in 16 treatment and intervention programs to keep offenders from coming back to jail.

R.I.S.E., (Reclaiming Integrity, Self Awareness and Empowerment,) is one of those. It operates out of the Rountree Medium Facility, a medium security jail in Watsonville.

The program is based largely on another successful program for women called Gemma, part of the nonprofit Community Action Board. Gemma has helped 250 women, during and after incarceration, through a day program, transitional housing and ongoing support. R.I.S.E is also run by the Community Action Board.

Just three in ten Gemma graduates commit another offense within three years after being released from jail, compared to a national rate of seven in 10, said Cynthia Chase, Program Director for Gemma and R.I.S.E.

The state funding that came with criminal justice reform allowed Gemma to start R.I.S.E for men. The program also works with the sheriff’s office and the probation department.

At a year old and with only 50 participants so far, R.I.S.E. still has to prove itself.

The program has one staff member, program coordinator Jason Murphy, who blends in well with the inmates given his tattoos and his past incarceration in Santa Cruz County.

“What makes the R.I.S.E. program is Jason. He can speak their language. They find they can trust him and that’s huge in this business,” said Louie Hevia, Inmate and Programs Liaison Officer at Rountree.

“It’s a close knit community and we consider Jason part of our class,” said Gardner.

Along with his personal experience, Murphy draws from an educational background in counseling psychology, psycho pharmacology and mindfulness-based stress reduction.

“I blend Eastern practices with Western psychodynamic theory,” he said.

R.I.S.E. is designed for three 10-week phases. The first phase focuses on mind work. Participants start by taking responsibility for their actions, identifying problems and habitual behaviors, and learning how their brains work neurologically.

For instance, if people suffer from trauma due to a history of abuse, triggers can cause part of the brain to physically swell and become more hypersensitive under stress. And that in turn can trigger risky or addictive behavior.

“What if you have a panic attack every time someone slams a door?” Murphy asks.

To help them take control of and change the way they react to situations, he teaches his students mindfulness-based stress reduction, an evidence-based approach.

“It’s learning how not to jump into fight or flight response,” he said.

Michael Nickerson, 55, is a third-time offender who just completed an 11-month sentence on May 6. This time he was in for a probation violation, resisting arrest and other offenses.

Before his release he was in phase two of the R.I.S.E. program, which continues with some of the emotional work from phase one, but focuses more on vocational issues like resume writing, job skill readiness, mock interviews and answering that tough question about convictions. There is some computer skill training, as well as classes addressing diet, overall health, family strengthening and positive discipline.

Nickerson said he was uncomfortable at first with the group sessions in phase one when he started R.I.S.E.

“As the class progressed we formed a brotherhood, we trusted each other and became open with each other,” he said. He said it’s been a good source of life skills.

“I absolutely can stay clean when I get out. My mind is set on it,” he said.

If Nickerson succeeds, he will be bucking the trend in a state where slightly more than 65 percent of felons return to prison within three years, according to the most recent information reported by the California Department of Corrections and Rehabilitation.

But graduates of the Gemma program demonstrate that a desire to change can make a difference, even when the road to recovery is bumpy.

Clare Geyer spiraled into heroin addiction and homelessness and was living in the woods before she went to jail, which led her to Gemma. After 16 months of hard introspective work, she relapsed. But it was such a horrible experience she hasn’t used drugs since, she said.

“I spent so much time working on myself at Gemma and securing a life I’m proud of… there was no spot for the drugs to go in and fill and make me feel better,” she said.

Now living in a studio apartment with a full-time job as a quality control inspector at a vitamin company, Geyer will also start working as a part-time Gemma house manager.

Another Gemma graduate, Hannah Hughes, was a methamphetamine addict, which led to theft and jail. She’s been clean and sober for 15 months, has a waitress job and is back in college. She now teaches a class at Gemma.

Hughes said a lot of the R.I.S.E. graduates were friends of hers when she was doing drugs.

“I’ve seen guys who I never in a million years thought would get clean and sober and they’re going out and getting jobs,” she said.

R.I.S.E.’s $110,000 annual budget is being funded by the roughly $5.2 million the state gave the county this fiscal year to manage felons.

“It’s a lot cheaper than prison,” said Scott MacDonald, chief probation officer for Santa Cruz County. “California’s prison population has quintupled over the last 30 years and a lot of that is a result of adding time for drug offenders, which has not had any discernable impact on crime,” he said.

“We’ve got into a punishment frenzy and it’s bankrupted our prison system.”

“The problem with our system is we take people who have been traumatized throughout their lives and put them in an institution that retraumatizes them and expects them to come out differently. That’s the insanity of it,” Chase said.

One of the things that Gemma and R.I.S.E. facilitators drive home to participants is that they need to be connected to other people to heal. The programs are based on mentorship.

“We tell people you’re not just in it for you, you’re laying the path for others,” Chase said.

Phase three of the R.I.S.E. program was intended to include some job training, such as using the jail kitchen to provide culinary classes. But there’s no funding yet for that.

The Sheriff’s office plans to apply for $24 million of funding created by Senate Bill 1022 to renovate a former minimum security facility next to the Rountree jail to give about 50 inmates their own rooms with space for R.I.S.E. programs, college prep and vocational programs like bike maintenance, horticulture and computers, said Johnson.

“The problem is we get these guys for three and half hours [three days a week] and then they go back and get reinfected with the gang mentality and peer pressure,” Hevia said. It would be ideal to have the R.I.S.E. participants living full-time next door, he said.

Gardner, due to be released in December, says he’s done with jail. He made up his mind when he signed the application for R.I.S.E. He plans to finish college, where he’s studied sociology and psychology.

“I want to reach people before they get to my age,” he said. “My father went to prison when I was nine months old. He passed away in prison. They tell me like father like son. That’s the reason I have to change this.”

 

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?”

 
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