CCHS Director Anna Roth

Message From The Director

Connecting With Our Communities: At the Heart of What We Do

As the largest department in Contra Costa, Health Services has a central role in our county's future. We are one of the few counties in the nation to offer a full spectrum of health-related services under one organizational structure.

Our integrated system puts us at an advantage to enhance the quality of life of our residents. However, we can only achieve our mission by partnering with our communities to understand what matters most to them and to create health together, including developing and transforming services and programs.

We have a history of working with our communities, and throughout this edition of the Director's Report you will see various examples of how we do just that, from responding to community concerns about environmental safety at Keller Canyon Landfill to our redesign efforts in adult behavioral health services.

Partnering with our community is at the heart of what we do, which is why we are focusing on how we can make CCHS more client and community centered at the next Contra Costa 2020 (COCO 2020) event in late September. COCO 2020 is our annual learning collaborative where we discuss new ideas to make our health department better.

This year's COCO 2020 will feature speakers from the Institute for Patient & Family Centered Care discussing best practices. Representatives from all divisions will be invited to attend and take back what they learned to their workplaces. Other County agencies, community partners and family and patient partners will be invited to attend as well. Talk to your supervisor if you're interested in getting involved with COCO 2020.

At COCO 2020 we will also debut a new, employee award program to highlight innovative work collaborating with communities we serve. The CCHS Partnering for Health Awards will recognize outstanding collaboration in three categories: equity, improvement and data, and public health/population health.

For criteria and information about the Partnering for Health Award, check the nomination form on iSITE. Nominations are due by the end of business Aug. 31.

We will continue to feature excellent work through our Service Excellence awards throughout the year. Please consider nominating a worthy coworker for either of these awards, and thank you all for the excellent work you do!

Going the Extra Mile:

These CCHS Employees are GEMs

Find out how the people named below went the extra mile.

Lupe Godoy Villalobos
Margarita Vargas
Milagros Garcia, RN
Michael Duran
Will Harper
Andi Bivens
Lee Schugar
Paloma Herce Garrido
Christine Porter
Community Health Workers
La Shan Haynes
Dave Woodhouse
Perri Vavricka
Augustine Hume
Clarine Wong
Kate Deleon
Linde Yoeono
Benjamin Shaver
Monica Gutierrez
Paul Crosby
Noel Rasmussen
Josie Moral, LVN
Danilo Bondoc
Gilbert Estrada
Eddie Mendoza-Ong, RN
Mariana Noy
Alvaro Rivas
Marcus Houston, MD
Elizabeth Rojas
Camila Monroy

Gurbir Kaur, RN
Bonnie Kwok, MD
Monica Rodas Landeo
Aldrin Bernabeo
Adam Hernandez
India Diggins
Lashawn Miggins
Saraphi Chawengchot
Marcia Furtado, FNP
Thomas McDonald, MD
Leah Carlon
Janice Jimenez
Veronica Gonzalez-Heredia
Gina Reed
Wendy Escamilla
Michael Windt
Joseph Mega, MD
Medical Outreach Team
Nula Lakha-Jackson
Jacqueline Ban
Jeanine Saavedra
Okee Nwadigo
Kalona Ledward
Mae Torres, RN
Rose Marie Delgadillo-Marshall, RN
Danielle Anderson, RN
Cheryl Esperanza
Jackie Peterson
Erin Thomas
Hope Tucker

Personnel

Dr. Chris Farnitano Named Contra Costa Health Officer

The Board of Supervisors recently approved the appointment of Dr. Christopher Farnitano to serve as Contra Costa County's Health Officer.

The health officer is the chief medical official in Contra Costa, with broad authority under California Health & Safety Code to protect the health and safety of county residents. Dr. Farnitano, who joined CCHS in 1991, succeeds Dr. William B. Walker in the position. Dr. Walker was both CCHS director and health officer until he retired in January.

The county health officer provides medical oversight and enforcement of public health laws and regulations in Contra Costa, including communicable disease control, environmental health, hazardous materials, vital records and emergency medical services.

Dr. Farnitano was previously a deputy county health officer and Director of Process Redesign and System Integration at Contra Costa Regional Medical Center (CCRMC) & Health Center. At CCRMC & HCs, Dr. Farnitano also served for several years as the medical director of ambulatory care.

During his 27-year career at CCHS, Dr. Farnitano has been a key driver of improvement efforts within CCHS related to eliminating health disparities, increasing access to health care delivery, developing population health management systems and reducing infectious diseases through promoting immunizations and ensuring treatment.

He received his medical degree from the Duke University School of Medicine and joined CCHS as a family medicine resident.

Healthcare for the Homeless

Outreach Team Providing Anti-Addiction Meds to Homeless People

Patients struggling with opioid addiction who are living on the streets are being prescribed anti-addiction medication by our Healthcare for the Homeless (HCH) outreach providers.

For the past several months, HCH Medical Director Dr. Joe Mega has been prescribing buprenorphine to opioid addicts living in homeless encampments around the county two times a week. The medication alleviates withdrawal symptoms and helps people stay off opiates.

"There are too many barriers for our homeless patients to get to the clinics to get treatment, so I started prescribing them buprenorphine on the spot," Dr. Mega said.

But having a prescription and getting it filled are two different things. Patients need an ID to pick up their prescriptions; many homeless individuals do not have any form of identification. That's why HCH has been collaborating with the new Coordinated Outreach Referral and Engagement (CORE) team. CORE team members will help homeless patients get free IDs and have given them rides to pharmacies to get their prescriptions filled.

According to Dr. Mega, 15 of 31 homeless patients he has prescribed buprenorphine in recent months are still taking their medication.

Patient Engagement

Patients Will Soon Be Able to See Providers' Notes, Radiology Results Online

Starting in September, patients who use our myccLink portal will be able to read their providers' visit notes and see radiology results online.

Patients can currently see their providers' visit notes by going to our medical records unit in person. Making these notes available through myccLink will be much more convenient and patient centered. Several health systems across the country have already implemented the practice of “open notes.”

The decision to make the notes available online came after years of discussion with clinical stakeholders. By default, all outpatient provider notes will be shared on myccLink except for notes from behavioral health departments and notes for teens or those in foster care. Concerned providers can opt out from having their notes shared online.

A 2017 survey of nearly 300 myccLink users showed that patients overwhelmingly wanted the ability to see their providers' notes on the portal.

The same survey showed even more desire to be able to see more test results on myccLink. Well, good news myccLink users: In September, we will begin releasing radiology reports, including for X-Rays and MRIs, to the portal! The radiology results will be released seven days after completion.

For more information, contact Dr. Adam Buck at Adam.Buck@hsd.cccounty.us.

Opioid Epidemic

CCHP Pilot Helps Patients Reduce Usage of Painkillers

Under a new pilot program, Contra Costa Health Plan (CCHP) members reliant on addictive opiates to manage their pain are being helped taper off the drugs, and will have access to expanded benefits to encourage the use of safer alternative treatments such as chiropractic and acupuncture.

Using pharmacy claims data, CCHP has identified members who are the highest utilizers of opiate painkillers for participation in the pilot program.

This is CCHP's latest effort to reduce certain members' reliance on opiate painkillers, including Norco and Percocet, which can cause fatal overdoses even when used exactly as prescribed. In recent years, CCHP has begun flagging members who have received opiates at three or more pharmacies--or have had prescriptions written by three or more providers--in a given month. CCHP has also created reports that spot outlier opiate prescribers used to alert clinical leadership of possible over-prescribing, and allow the opportunity for peer-to-peer education.

As a result of these and other efforts, CCHP has seen a 23% reduction in the number of opiate prescriptions in its network from 2015 to 2017, and a 27% reduction in the number of prescribed opiate tablets during this same time period, CCHP Pharmacy Director Andrew Haydon said.

In another effort to prevent addiction, starting August 1, CCHP will begin limiting new prescriptions for short-acting opiates for patients not currently taking opiate medications to a seven-day supply. The following month, CCHP will begin limiting the total dose of long-acting opiates that can be prescribed to members.

It is important to note that the new opiate restrictions will not apply to members with cancer, or members enrolled in palliative care or hospice. Also, when clinically appropriate, providers can always request additional pain medications as needed through the CCHP medication prior authorization process.

Mental Health

Behavioral Health Launches Mobile Crisis Response Team

The Behavioral Health Services Division (BHS) began a new service this month to quickly deliver mental health crisis intervention to Contra Costa residents.

The Mobile Crisis Response Team (MCRT) provides professional home visits for adult clients and their families to prevent acute psychiatric crises from becoming emergencies that require law enforcement involvement or involuntary hospitalization.

The team, which includes licensed mental health clinicians, community and family support workers and a family nurse practitioner, is part of the Forensic Mental Health program. It currently operates from 7 a.m. to 11:30 p.m. weekdays, but will ramp up to 24-hour service in coming months.

MCRT does not provide emergency services – call 911 if someone is in danger – but helps to de-escalate crises before they become dangerous. Team members work closely with local law enforcement and can initiate an involuntary psychiatric hold if needed.

Access the MCRT hotline by calling 1-833-443-2672. For patients who are 17 or younger, call the Seneca Family of Agencies at 1-877-441-1089.

Health Disparities

Computer Giveaway Helps Bridge Digital Divide

CCHS recently teamed up with Tech Exchange, an Oakland-based nonprofit dedicated to digital equity, to give away free computers to Spanish-speaking patients to help bridge the digital divide between Latinos and other patient populations in the county.

At a July 23 tech fair held at our West County Health Center, Tech Exchange gave refurbished used computers and accessories to 36 Spanish-speaking patients and their families.

Tech Exchange provided attendees with instructions on how to set up the hardware at home and how to access the Internet using a Web browser. A representative from our Community Education & Information (CEI) unit also did a live demonstration of how to use the Spanish version of our online patient portal, myccLink.

Patients who came to the tech fair were recruited by our Spanish-speaking health navigators known as promotores, who signed up many participants for myccLink.

The event was planned and coordinated by our Reducing Health Disparities Unit, promotores and CEI staff as part of a larger effort in our department to address digital disparities in the Latino Spanish-speaking patient population.

As of July 2018, only 9% of our Spanish-speaking patients have signed up for myccLink compared to 31.6% of English-speaking patients. It is hoped that this intervention, as well as the promotion of low-cost internet service, will encourage Spanish-speaking patients to enroll in myccLink.

For more information, contact Connie James, manager of the Reducing Health Disparities Unit, or Will Harper from CEI.

Contra Costa Regional Medical Center

Hospital Making Regular Followup Calls to Discharged Patients

Contra Costa Regional Medical Center (CCRMC) recently began a comprehensive campaign to call most patients recently discharged from the hospital to check in on their health.

The hospital hired NRC Health to contact patients shortly after they leave CCRMC and ask if they have questions about their care and to see how they're feeling. If there are concerns, utilization review nurses make a followup call to the patient.

Prior to discharge, hospital staff should let patients know to expect this check-in call, which typically lasts less than three minutes. The goal of the post-discharge calls is to improve health outcomes, reduce readmissions and increase patient satisfaction.

For more information, contact Yvonne Hollister at Yvonne.Hollister@hsd.cccounty.us.

Community Engagement

Hundreds Attend Forum about Potentially Radioactive Materials at Keller Canyon Landfill

Hundreds of Contra Costa residents turned out June 21 to hear the latest from health and safety experts investigating the alleged disposal of potentially radioactive materials at Keller Canyon Landfill in Pittsburg.

The meeting at Ambrose Community Center in Bay Point, organized by the Environmental Health Division (CCEH) and Supervisor Federal Glover, included technical experts from the California Department of Public Health, the U.S. Navy and the San Francisco Bay Area Regional Water Quality Control Board to discuss risk and potential health impacts, and answer questions from the public.

Contra Costa County learned in April that potentially radioactive landfill material from the Hunters Point Naval Shipyard in San Francisco may have been improperly delivered to Keller Canyon between 2009 and 2017.

The Navy disclosed that a contractor involved with the Hunters Point cleanup had deliberately falsified radiological sampling data for soil that remained at the San Francisco site.

Sampling data from the same contractor was used to determine that shipments to Keller Canyon were safe.

While there is currently no evidence that the falsification of data extended to those shipments, CCEH and numerous other public agencies have been investigating what happened, and if there is any potential health or environmental impact to surrounding communities.

Visit cchealth.org/kellercanyon to keep up to date on the investigation.

Information Technology

Trainings for Upcoming Conversion from Lotus Notes to Outlook

In preparation for our upcoming switch from Lotus Notes to Microsoft Outlook/Office 365, Information Technology (IT) is offering training to CCHS employees on how to use the new Web-based email system.

Employees will have the option of using online tutorials or taking in-person classes.

All current Lotus Notes users recently received a "QuickHelp Notification" from the training website Brainstorm, which offers easy-to-understand videos on everything from sending emails to creating meetings. To log in to Brainstorm/QuickHelp, use your Lotus Notes email address as your user ID; the password for everyone is "Password2018" (case sensitive). If you have trouble logging in to QuickHelp, please call the service desk at 925-957-7272 for assistance.

For those who prefer a hands-on classroom style training, 90-minute classes will be available. A schedule for the class is in the Learning Management System.

The classes will be held at various places to make it more convenient. You can sign up through the Learning Management System after receiving approval from your supervisor.

Employees are welcome to do either the web or instructor training. It is highly encouraged that all CCHS staff get some form of Outlook training, although the trainings are optional.

All CCHS staff will receive a laminated card with the most common Outlook tasks and various tips. IT expects the conversion to Outlook to be completed by late August.

For more information, contact project manager Bryan Thomas at Bryan.Thomas@hsd.cccounty.us.

Residency Program

Congratulations to the Residency's Class of 2018!

Graduates from our Family Medicine Residency Program recently celebrated completing the three-year program at MoMo's in Walnut Creek. We're please to report that four graduating physicians will be staying on with us in Contra Costa: Erik Gonzalez (West County Health Center), Kari Kompaniez (CCRMC), Marcella Torres (Pittsburg Health Center) and Mariel Lougee (Healthcare for the Homeless).

Emergency Response

EMT Members Inventory Shelter Medical Cache in Pittsburg

Members of the CCHS Emergency Management Team (EMT) spent two days cataloguing the contents of two shipping containers full of medical supplies during a disaster preparedness exercise in Pittsburg.

The Alternate Care Site (ACS) cache includes medical beds and other equipment and supplies that may be needed quickly after a catastrophic event to help us meet the medical needs of patients in an emergency shelter.

CCHS acquired these caches from the California Department of Public Health several years ago when it was updating its own system of medical caches. The containers are strategically located in East County for easy access and rapid deployment.

Organized by EMS Emergency Preparedness Program Manager Lisa Vajgrt-Smith, EMT members took careful inventory of the cache on June 14 and 15, removed expired or superfluous supplies and arranged the cache so high-priority equipment can be quickly accessed.

Our EMT helps coordinate emergency training for employees and advises department leadership on disaster preparedness policy and planning.

For more information, contact Kim Cox at Kim.Cox@hsd.cccounty.us.

Honors & Recognitions

Contra Costa EMS System Receives Award from American Heart Association

Our Emergency Medical Services (EMS) Division and stakeholders received the American Heart Association's Mission: Lifeline EMS Gold Plus Award for implementing quality improvement measures for the treatment of patients who experience severe heart attacks.

The award recognized EMS for establishing coordinated private and public efforts in improving systems of care to rapidly identify suspected heart attack patients, promptly notify the medical center and trigger an early response from the awaiting hospital personnel. The Mission: Lifeline initiative provides tools, training and other resources to support heart attack care following protocols from the most recent evidence-based treatment guidelines.

Congrats to our EMS staff being recognized for all their great work!

Culture of Continuous Improvement

Team Begins Work to Improve Access to Care for Behavioral Health Clients

A multidisciplinary CCHS team recently took an in-depth look at challenges facing patients trying to access services at the East County Adult Mental Health Clinic.

The team's week-long review focused on how long it takes patients to get mental health services after their initial point of contact with our system.

The team learned there is a median four-month gap between the time patients receive their initial assessments and when they actually get to see a psychiatrist. As a result of that time gap, some patients don't show up for their psychiatric appointments or give up on accessing services.

The team included representatives from Behavioral Health – including the access line, Alcohol and Other Drugs Services and Adult Services – Contra Costa Health Plan, the Sheriff's office, IT, as well as nurses, psychiatrists, mental health consumers, program managers, mental health clinicians, and family and consumer support workers.

The next step will be identifying issues that can be fixed immediately. They are also planning two rapid improvement events, with the first one being focused on re-designing the initial visit at our mental health clinics, to be held the week of Sept 10-14. A presentation about the team's findings will be at the Pittsburg Health Center on Friday Sept 14 at noon, and all are welcome.

Watch a video of the team's June report-out of its findings.

For more information, contact Erika Jenssen at Erika.Jenssen@hsd.cccounty.us.

Send feedback and story ideas to editor Will Harper at will.harper@hsd.cccounty.us