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F:\HumanServices\Share\CD PROGRAM-PROGRAM AREAS\Homeless Programs\Staff Reports\update on homelessness march
2005.doc
Council MeetingMarch 22, 2005 Santa Monica, California
:
TO: Mayor and City Council
FROM: City Staff
SUBJECT: Update on Implementation of Strategies to Address Homelessness in
Santa Monica including Recommendations to Allocate $10,000 to Support
the Securing of a Building in Los Angeles for a Proposed Regional
Psychiatric Urgent Care and Sobering Center Facility; Adopt a Resolution
in Conjunction with the Westside Council of Governments and Direct Staff
Regarding any Appropriate Modifications to City Policy or Law.
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Introduction
This report provides an update on implementation of strategies to address
homelessness in Santa Monica including recommendations to allocate $10,000 to
support the securing of a building in Los Angeles for a regional Psychiatric Urgent Care
and Sobering Center facility; adopt a resolution in conjunction with the Westside Council
of Governments (COG) and direct staff regarding any appropriate modifications to City
policy or law.
Background
The current policy framework regarding homelessness was established in 1991 with
adoption of the Homeless Task Force Report, refined in 1994 with Council adoption of
the Public Safety Initiative and reaffirmed numerous times in the intervening years –
most recently earlier this year. This framework sets forth the goal that homeless people
in Santa Monica’s community be encouraged and supported in their efforts to get off the
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streets and into programs, housing and when possible, employment. While, recognizing
homeless people’s need for basic supports and supplying substantial funding for those
supports, the City has called for such supports to be linked with the continuum of care to
ensure that people actively move out of homelessness rather than continue to live on
the streets. Continued alignment with this policy framework is an important goal for the
City and its service providers.
In spite of the significant achievements made by homeless persons availing themselves
of Santa Monica’s network of services, the impact of homelessness in Santa Monica
remains a top community concern. Balancing homeless people’s needs for space, food
and sanitary facilities with the larger community need to preserve public open space for
all to use and share has been a key policy and operational challenge for the City. As in
communities across the region and throughout the country, homeless people
congregate in parks and other public spaces with their personal belongings. Charitable
groups continue to come to Santa Monica from outside the community to distribute food
outdoors and outside the continuum of care framework. Some homeless individuals,
particularly those plagued by mental illness and addiction, do not abide by the laws and
regulations that govern behavior in public spaces. Such unlawful and anti-social
behavior continues to arouse fears and concerns about the safety of public parks and
other public spaces. On the other hand, many community members remain very
sympathetic with the plight of the homeless.
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Complaints to the City about objectionable behavior focus on people aggressively
panhandling near restaurants; prolonged and heavy use of some parks by people who
congregate there with all their belongings and drive others away; people using public
restrooms for bathing and washing clothes; people roaming alleys at night noisily
gathering cans and bottles from recycling containers; people sleeping or lying in parking
structures, alleys and benches; people lying on sidewalks often obstructing pedestrians;
and people leaving property unattended in public spaces.
In the citywide resident satisfaction survey conducted by Goodwin Simon Strategic
Research in January 2005, homelessness once again emerged as the top resident
issue, with 39 percent of residents identifying “too many homeless” as the most
important problem facing Santa Monica in response to an open-ended question. This
is a significant increase of 14 percent from the 2002 survey. Another 6 percent said the
main problem is that there are too few services for the homeless, about the same
proportion as in 2002. In a separate question asking how serious is the problem of
homelessness in Santa Monica, 74 percent of respondents rated it as serious.
In other homeless-related questions, 33 percent said the City spends too little on
services for the homeless, while 17 percent said the city spends too much. Ratings
regarding the enforcement of laws against overnight camping in parks and downtown
doorways and aggressive begging or panhandling were weighted more to fair/poor than
excellent/good. Negative ratings were higher among those with higher incomes and
those dissatisfied with other City services. Those most concerned about homelessness
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as an issue for the city, according to the survey, are people who have become residents
in the last four years, persons aged 35-49, men under 50, and persons living in the
downtown (zip 90401) and Wilshire-Montana area (90403). A full report on the findings
from the citywide resident satisfaction survey can be found on the City’s website.
At the January 11 and February 8, 2005 Council meetings, Council discussed and
directed implementation of a range of strategies to address homelessness in Santa
Monica. This report provides an update, possible next steps for Council consideration
and recommended actions in areas including: Sobering Center/Psychiatric Urgent
Facility; the Chronic Homeless Pilot Project; possible ordinance or policy changes;
Westside Council of Governments (COG) and advocacy efforts.
Discussion
Staff has gathered information on a variety of possible measures which could address
the community’s concerns and homeless people’s needs.
Sobering Center/Psychiatric Urgent Facility:
One of the contributing factors to
homelessness, particularly among the chronic street population, is drug and alcohol
abuse. According to the data available through the City’s homeless services database
(ClientTrack), 25% of homeless persons seeking services in Santa Monica self-report a
substance abuse problem. Service providers report that the actual rate is closer to
50%. The U.S. Department of Health and Human Services estimates that nationwide,
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50% of homeless adults experience substance abuse. For half of those, alcohol is the
substance of choice.
The residential components of Santa Monica’s continuum of care are currently not
equipped to deal with chronic inebriates while they are still intoxicated. Many of them
are simply transported to local hospitals and use expensive emergency room services.
The absence of a “sobering center” where people can be safely taken by Police and
Paramedics while they are still inebriated coupled with intensive services designed to
steer participants toward sobriety, has been identified as a gap not just in Santa
Monica’s continuum of care, but across the entire Westside.
At its January 11, 2005 meeting, City Council directed staff to move forward with the
development of a sobering center on an expedited basis and expressed an interest in a
regional approach, including the potential to include a sobering center in a County-
operated psychiatric urgent care center on the Westside. Further, the Council
established the following goals for a sobering center.
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To slow or stop the cycle of chronic alcoholics going in and out of detoxification
centers, jail and emergency rooms;
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To divert this population off the street and into treatment programs;
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To significantly reduce the uncompensated costs, time constraints and personnel
burden to healthcare, law enforcement, fire and paramedics, and judicial
infrastructure caused by homeless chronic alcoholics;
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To give people who routinely live on the street an opportunity to create a stable
mainstream lifestyle;
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To link with the criminal justice system to promote treatment as an alternative to
incarceration;
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To develop a program which does not draw additional homeless persons to
Santa Monica from other jurisdictions.
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Since the January meeting, staff from Community and Cultural Services, Police, Fire
and the City Attorney’s Office have been working with the Los Angeles County
Department of Mental Health (DMH), local hospitals, and non-profit service providers to
examine the potential for both a regional out-patient psychiatric urgent care center and
sobering station, and to begin planning for the possible development and
implementation of co-located programs.
Planning efforts have included a thorough review of current best-practice models of
sobering centers. The models reviewed include free-standing sobering centers (not co-
located with mental health programs) in Santa Rosa, Escondido, Santa Clara County
(San Jose) and Santa Barbara; and sobering centers linked with psychiatric urgent care
in San Francisco and Santa Cruz. In addition, models of court-linked programs that
offer serial inebriates a treatment option as an alternative to incarceration were studied,
including San Diego, Santa Clara County (San Jose), Sonoma County, and Escondido.
In San Jose, a free standing sobering center was opened in 1995 – however it was
closed in 2003 due to declining use by the Police and the need by clients for medical
treatment which could not be met by the center. However, a court-linked drug treatment
program in Santa Clara County (San Jose), was instituted in 1997. This program
provides one year of treatment as an alternative to incarceration and involves
coordination between all sectors of the criminal justice system. Sources estimate the
program saves Santa Clara County $1.8 million per year.
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A literature review indicates that, given the frequent co-occurrence of substance abuse
with mental health issues among the chronic street population, the linkage of a sobering
station with psychiatric urgent care would yield the most immediate and seamless
model of intervention, increasing the likelihood of engaging participants in on-going
treatment and ultimately housing. Incorporating the criminal justice system through
outreach and alternative sentencing has also been a valuable tool for engaging serial
inebriants into the continuum of care in some communities. In other counties, where
misdemeanor offenders may actually serve jail time, such programs appear to have
been successful. In Los Angeles County, where misdemeanors are seldom sentenced
to jail time, the dynamics are very different because criminal prosecution does not pose
the same threat.
Planning efforts also included a survey of local hospital emergency rooms to determine
how many emergency room visits could have been redirected to a psychiatric urgent
care and/or sobering center, if those facilities would have been available. During the
week of February 14 – 22, emergency room staff from Brotman Medical Center, Saint
John’s Hospital, Daniel Freeman Marina Hospital, UCLA and Santa Monica/UCLA
completed surveys regarding 100 individuals who were brought to their emergency
rooms for the purpose of psychiatric evaluation or hospitalization. Overall, 34% were
homeless (80% at Santa Monica/UCLA); 41% did not require inpatient psychiatric
hospitalization (and thus could have been taken to an urgent care facility); and 33%
would have been appropriate for a sobering center.
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The findings of the survey validate both the need for a psychiatric urgent care facility
and a sobering center. At this time, County DMH is working with a regional provider to
secure funding through the Mental Health Services Act established by Proposition 63 for
the operation of a psychiatric urgent care facility. It is anticipated that services could
begin as early as October, 2005. An available site at 10000 Venice Blvd., directly
across from Brotman Medical Center has been identified, and Exodus Recovery, the
non-profit provider, is negotiating with the property owner to secure the 10,000 sq. ft.
building. Exodus Recovery estimates that they would not need the entire facility for
urgent care, thus making it possible to co-locate or integrate a sobering center in the
same building.
Exodus Recovery needs $30,000 for an initial payment to secure the building. Under the
terms of the lease, monthly payments would not begin until September, 2005. DMH is in
the process of identifying approximately $20,000 in funding for Exodus Recovery to
secure the building, which is highly desirable given its size, location, ample parking and
compatible zoning. City staff recommends that the City Council allocate $10,000 to be
granted to Exodus Recovery contingent on their receiving the County funds or the
equivalent from other sources to meet the shortfall for the initial payment.
Between now and September, City staff will continue to work with DMH, other county
agencies, and service providers to refine a sobering center program, identify the
provider (possibly the CLARE Foundation), develop operating protocols and budget,
resolve legal and liability issues, and identify funding sources. Potential funding
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sources could include local hospitals that will benefit from lower utilization in their
emergency rooms, public funds (County, other local jurisdictions or the federal
government including Medi-cal reimbursement for eligible clients), and private
foundations. Tenant improvements for both the urgent care center and sobering center
will be developed and implemented.
Finally, City staff will continue to explore ways to involve the criminal justice system in
the continuum of care. For example, protocols for the sobering center could include a
“cap” on the number of repeat visits, after which inebriates would be arrested, charged,
and taken to court, where treatment could be offered as an alternative to incarceration.
However, as noted above, one significant barrier to this model in Los Angeles County is
the fact that typically, the LA County Jail does not hold persons for misdemeanor
violations for longer than 48-72 hours. The review of the literature for court-linked
sobering centers does indicate that the prospect of longer incarceration—90-180 days—
motivates some inebriates to choose treatment.
Chronic Homeless Pilot Project Update:
Another service delivery approach
continues to focus efforts on individual homeless people who are gravely mentally ill
and therefore unable to improve their own lives without significant support. Many
communities across the region and nation are turning to models which actively engage
and specifically target the most gravely mentally disabled and long time homeless
people – with the goal of getting them housed with support services to sustain them in
permanent housing. This entails reconfiguration of services, ensuring the availability of
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housing and effective, coordinated use of public health and law enforcement resources.
For the past eight months, City staff (Human Services, Police, Fire, Housing), service
providers (OPCC, CLARE, St. Joseph Center, Step Up on Second) and the County
Department of Mental Health (Edelman Mental Health and Countywide staff) have
developed a pilot project to more effectively target services to those chronic, most
difficult to reach and “service resistant” homeless people who have been on Santa
Monica’s streets for an extended period of time. The goal of the pilot is to reach these
chronic homeless people with a well coordinated, strategic, interdisciplinary and
sustained effort - and get them off the streets permanently. To date, 19 people have
been enrolled in this pilot project, 11 are off the streets, and all have a service plan.
A secondary goal of the pilot project is to understand more about the service delivery
systems and processes that enable, and unfortunately sometimes constrain, the ability
to achieve substantial and sustainable outcomes for the gravely disabled, chronic
homeless population; and, to integrate this understanding into new approaches to
service delivery. Lessons learned from the Chronic Homeless Pilot include:
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Individual Needs
: The situation of each client is unique.
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Multiple Systems:
The prevalence of co-occurring disorders, the severity of the
individual’s health, substance abuse and mental health issues, past negative
experiences with service delivery, public benefit and criminal justice systems,
records of arrest, poor credit, lack of traditional social supports (e.g., family),
creates a complicated path out of homelessness with numerous points for a
person to lose contact with the systems designed to serve him or her. This
complexity requires sustained intervention from multiple service delivery
systems: law enforcement and criminal justice; public health, mental health and
social services; private non-profits; and personal social networks such as friends
and family.
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Need for Informed Consent
: The ability and willingness of individuals to give or
withhold informed consent for providers in these multiple systems to share
information is critical.
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Communication:
Communication between these multiple systems of service
delivery is critical, and often requires providers to rely on personal contacts with
colleagues, spend time on weekends or evenings following up, and work with
multiple staff within a particular organization to identify the key person with whom
to collaborate.
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High Level of Staff Expertise:
The level of intensity required, and the need to
sustain the intensity over time, requires that higher level staff step-out of their
normal routine of service provision to expend extraordinary efforts to coordinate
services for one individual. At current staffing levels, this could mean that the
level of service to other clients will decrease.
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Timing and Planning:
The succession and timing of events in the path out of
homelessness is critical. Planning elements of the path out of homelessness
ahead of time, for example, ensuring the availability of key staff from one delivery
system to take the “hand off” from another system, can increase the probability of
a successful outcome at the key moment an intervention becomes possible.
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Role of Law Enforcement
: For many, the first event in the path out of
homelessness is interaction with law-enforcement. Police can play a crucial role
in making the linkage with outreach and services. Sometimes, an arrest and
incarceration can be the precipitating incident for a psychiatric assessment and
subsequent care.
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Courts:
The criminal and civil court systems can also play a key role. In
criminal matters, offering services as an alternative to incarceration can be
effective. Civil matters, such as the process for placing persons on a 72-hour
hold, or into a conservatorship, can be key ways to initiate and sustain treatment
and contact with service providers. Existing laws vary in the effectiveness of
their application toward positive outcomes.
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Cost:
Staff are assessing the costs involved in this intensive and focused
approach to service delivery for the most gravely disabled. It is clear that most of
these gravely disabled people will require a lifetime of support to maintain
housing and remain off the streets. However, based on studies in San Diego
(1997-98) and elsewhere, it is also clear that these chronically homeless people
use a disproportionate share of police, paramedics, hospital and other public
resources – costly resource use which is reduced when people are in treatment
and housing.
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The successes and lessons from the pilot effort have led participating agencies to agree
to continue and expand the pilot in the coming year. One of the challenges will be to
institutionalize the lessons learned by developing policies and procedures across the
multiple systems of service delivery. A second will be to make sure that the existing
resources in Santa Monica’s continuum of care are deployed with maximum
effectiveness toward meeting the needs of this population.
Possible Ordinance or Policy Changes:
Changes in policy and law may help
address problem behaviors which impact the entire community. Staff from various City
departments, including the City Attorney’s Office, Police, Community and Cultural
Services and Environmental and Public Works Management continue to review City
ordinances for effectiveness and enforceability, consider revisions or new ordinances as
appropriate, and assess the enforcement of ordinances to ensure public safety and the
balanced use of public spaces. Key areas of focus include threats to safety, camping
and other high impact use of public facilities. Parks and community facilities are
intended for shared use by the entire community. Behavior which tends to pose safety
threats or monopolize public space forecloses shared use and undermines public safety
and welfare. Therefore, staff have focused the following areas:
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Abandoned property
: Current City law prohibits leaving unattended property on
City sidewalks for more than 10 minutes. This prohibition may be extended to all
public parks and open spaces and that extension would serve the need to ensure
security in all public spaces in the post-9/11 environment. Also, current practice
includes storing abandoned property for 90 days. This amount of storage time
can probably be reduced. Increased enforcement may, however, require an
additional storage facility.
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Lying or Sitting on Sidewalks
: The Los Angeles Municipal Code prohibits
sitting or lying on sidewalks everywhere in the City. Santa Monica has a parallel
law applying only to the City’s more crowded public space, the Third Street
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Promenade. Otherwise, blocking sidewalks is prohibited only if less than four
feet of width is left clear. A provision similar to Los Angeles’ ordinance could be
considered. However, care would be required to avoid the risk of adopting an
anti-loitering law because such laws are unconstitutional.
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Overnight use of car in park and beach parking lots:
Current local ordinance
prohibits being in a car overnight – except to enter or leave a parking lot – in
downtown parking structures. This ordinance could be extended to park and
beach parking lots throughout the City.
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Use of freeway underpasses and off ramps:
While the City’s current
prohibition against camping on public property extends citywide, the City could
explore developing a law specifically applicable to someone being present in
these locations – since they are a dangerous place to be and such a law may be
useful as these locations are not technically City property.
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Vehicular camping:
The Council previously previously declined to prohibit
vehicular camping on City streets. However, residents continue to lodge
complaints. One serious concern is that passenger vehicles lack sanitary
facilities. The Council may wish to revisit this issue.
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Pier and Memorial Park Showers:
Public showers are available at Memorial
Park and under the Santa Monica Pier. The Memorial Park showers are open
from 6:00 am to 9:00 a.m. and serve approximately 20 to 25 homeless people
per day. The Pier showers are open from 5:00 am to 9:00 a.m. and serve about
the same number. The showers, while originally intended to supplement park
gym use or Pier and beach use, have become an amenity for homeless people.
Individuals tend to congregate in front of the facilities before they open and after
they close. The presence of homeless individuals has attracted food distribution
programs to Memorial Park. Park Rangers and/or Police are called to intercede
and manage problems that occur in these locations.
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The SWASHLOCK facility located at Olympic and 5 Street (linked to the local
continuum of care which assists people in getting off the streets and into housing
and services) will be expanded and improved in the coming months. It contains
showers, restrooms, lockers and washing machines. It is a more appropriate
resource to be offered by the City than the free standing shower facilities at
Memorial Park and the Pier. Restricting the showers at Memorial Park to gym
users and closure of showers under the Pier may reduce the number of
homeless people who congregate at those locations.
Westside Council of Governments (COG):
The Westside COG has begun
collaboration on regional strategies to address homelessness. Following COG
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discussion in November 2004, staff formed a regional working group including all the
Westside Cities and representatives from the County, Congressman Henry Waxman’s
office and service providers to outline steps for joint regional efforts to address
homelessness including potential use of the federally owned Veteran’s Administration
(VA) property in West Los Angeles. On February 17, 2005, the Westside COG devoted
substantial time on its agenda to discussion of homelessness and how the cities might
successfully cooperate. After an initial presentation from Supervisor Zev Yaroslavsky,
each of the COG cities (West Hollywood, Culver City, Beverly Hills, and Los Angeles)
agreed to bring a resolution to its City Councils for collective action. The resolution
(See attachment) calls for creation of a regional year-round shelter (including pursuing
capital, operating and program funding) and continued advocacy to both secure funds
and needed legislative reform to realize this vision. Better use of the VA property is a
centerpiece of this effort. The proposed resolution represents the policy framework for
joint action and is complemented by formation of a subcommittee of the COG, in
addition to the staff working group, charged with developing next steps.
Advocacy:
The programmatic efforts and local policy actions described above
endeavor to assist homeless people and manage the impact of homelessness on the
general community. It is important that the City continue and expand its legislative and
policy advocacy efforts to ensure that the mental health, public health, criminal justice
and other levels of government do all they can to address and end chronic
homelessness across the region and nation. Towards that end, specific issues to be
addressed include the following:
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Mental Health
: All effective laws must be employed on behalf of homeless
individuals that suffer from chronic mental illness. Life on the street is not
acceptable for the healthy and certainly is not viable for those with serious mental
illness. Laws such as the Lanterman-Petri-Short (LPS) may preclude the
involuntary detainment of people who are seriously mentally disabled. The
language of LPS, as well as its interpretation and implementation, have
continued to allow many chronic homeless and gravely disabled people to remain
on the streets of Santa Monica. Passed over thirty years ago, LPS is a California
law that states that people rendered incapable of making rational decisions - no
matter how psychotic or delusional - must be an immediate danger to themselves
or others before being placed in treatment. Moreover, even when they are
permitted, interventions are usually limited to short inpatient stays. More
recently, Laura’s Law (AB 1421), fashioned after New York’s proven “Kendra’s
Law”, was enacted in California to make sustained and court-mandated assisted
outpatient treatment available – with a progressive eligibility standard for those
who do not meet LPS’s restrictive dangerousness threshold for inpatient
hospitalization. However, this vital assistance will only be available in Los
Angeles County when a full implementation program is established and funded.
While the new Mental Health Services Act funds (Proposition 63) will provide a
15% increase to the Department of Mental Health’s operating budget, use of
legal tools such as Laura’s Law must be a priority.
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Criminal Justice System:
It is widely known that no one committing a “quality
of life” offense goes to jail in Los Angeles County due to actual or perceived
operating funding shortfalls. And yet often approaches like the SOS (Streets or
Services) program motivate individuals to choose an alternative rehabilitation
program rather than jail time. The County must redirect resources to utilize now
empty facilities rather than turn offenders back on the streets either without
consequences for their actions or the skills they desperately need to survive in
society. As described earlier in this report, a review of best practice programs in
other communities clearly demonstrates the important role of court mandated
alternative sentencing programs. However, these court mandated programs will
only work if the alternative of serving time in jail is real.
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Enforcement of Public Health Laws:
In spite of several years of joint planning
with hard working and committed Department of Public Health staff, enforcement
of County and State health regulations regarding outdoor food distribution is not
a priority for the County. This hinders City efforts to ensure that outdoor food
groups are in compliance with health laws. County implementation of health
regulations requires consistent application of public health enforcement
resources.
Should the Council concur, these advocacy issues will be an important focus of efforts
in the coming months.
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Budget/Financial Impact
Funds ($10,000) to support the securing of the building that would house the psychiatric
urgent care facility and sobering center are in account #01202.544390.
Recommendation
City staff recommends that the City Council; 1) support securing a building for a regional
psychiatric urgent care facility and sobering center with an allocation of $10,000
contingent on receipt of County or alternative funding for the balance required; 2)
provide direction regarding any appropriate modifications to City policy (e.g. specified
public restroom closures or limitations on use) or law; and 3) adopt the attached COG
resolution.
Prepared by: Barbara Stinchfield, Director of Community and Cultural Services
Julie Rusk, Human Services Manager
Stacy Rowe, Human Services Administrator
Setareh Yavari, Acting Homeless Services Coordinator
Marsha Jones Moutrie, City Attorney
James Butts, Chief of Police
Phil Sanchez, Deputy Police Chief
Jim Hone, Fire Chief
Bruce Davis, Fire Captain
Kate Vernez, Assistant to the City Manager - Intergovernmental Affairs
(See Adopted Resolution No. 10028 (CCS)
Attachment: COG Resolution ).
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