Application_Questions_-_Section_3._Project_Facility_and_Property_Site_Information.pdf

Section 3: Project, Facility, and Property/Site Information

12. Project Information 12a. Describe how the proposed project fits into and bolsters the community’s behavioral health continuum of care. What gaps in the continuum does it address?

500 Word Limit

The existing Coral Street Campus surrounds the proposed project to the North, South, and East.

This campus is the most comprehensive mental health and homeless service centers in all of Santa Cruz County. Existing services include: 28 beds of family homeless shelter, 19 beds of adult homeless shelter, 40 pallet shelters, outreach and intake, problem solving and homeward bound, mailroom, hygiene bay with showers and bathrooms, CalFresh Employment and Training, Dientes Community Dental clinic, Homeless Persons Health Project, and 127 units of permanent supportive housing.

Santa Cruz County Behavioral Health internal research shows that there is a significant gap in the continuum of care for two specific target populations: Justice involved people with SUD as they exit incarceration, and homeless persons with SUD. According to recent Santa Cruz County research, 55% of the Santa Cruz County homeless population has a SUD diagnosis. The proposed residential SUD facility is a perfect complement to the existing services provided on campus because there are few existing residential SUD options for clients to step up.

Furthermore, within the proposed facility, clients can step up and down in ASAM treatment levels depending on the need. Finally, and perhaps most crucially, clients exiting the proposed facility can step down to permanent supportive housing – space permitting – and outpatient services all within the same campus. This co-location of services and different levels of care will lead to improved client outcomes by reducing the barriers to ongoing treatment and recovery.

In Santa Cruz County, substance use is a problem that starts in childhood. According to the California Healthy Kids Survey in Santa Cruz County, 34% of 11th graders had reported alcohol use within the last 30 days, with 21% reporting binge drinking within the last 30 days. 59% of 11th grade respondents reported alcohol use by age 17. 43% had used marijuana by age 17. By adulthood, 5.4% of Santa Cruz Medi-Cal enrollees have SUD, but there are only 5 ASAM Level 3.1, 2 ASAM Level 3.5, and one ASAM Level 3.2-WM SUD treatment centers in the entire county based on the DHCS Assessing the Continuum of Care for Behavioral Health Services in California.

12b. Describe how the proposed project will expand behavioral health services in the community or region.

This proposed project will expand behavioral health services in the community and the region by providing 50 licensed beds of SUD residential care, with ASAM levels of 3.1, 3.5, and 3.2 WM. It is estimated that the facility will serve approximately 521 clients per year, based on an average stay of 5 weeks and 90% bed utilization.

Santa Cruz County is a small county of less than 300,000 people. Its largest city, Santa Cruz, has approximately 60,000 residents and is the County seat. This mostly rural County has always grappled with drug abuse and homelessness, but in recent years the crisis has deepened.

Downtown Santa Cruz, adjacent to the County administration offices has been heavily impacted by homelessness and mentally ill constituents, creating a public health crisis that voters and elected officials are desperate to address. The Coral Street campus has become ground zero for these issues, with every single inch of space used for treatment, services, emergency shelter or housing. Outreach to County behavioral health officials attest/revealed that SUD prevalence among homeless and mentally ill clients is the highest shared common denominator, and that residential facilities are under-provided in the City. While residential SUD facilities are in development in other parts of the County, the high cost of land and extremely low site inventory has severely limited development led to a lack of residential SUD services in the city.

Central to the project is the strategic hiring of a multidisciplinary team of behavioral health professionals and support staff. There will be 2 LPHA therapists, 4 certified SUD counselors, 2 LPHA counselors, 2 LVN’s, and 2.5 care coordinators and intake counselors. There will be a registered nurse, nurse practitioner, and medical director. These staff will be supported by 20 other staff, from clinical supervisors to QA manager, receptionist, biller, 8 monitors/overnight techs, and 2 cooks.

Clinical staff will practice within a trauma-informed framework to acknowledge that program participants are survivors of trauma, violence, abuse, or neglect. Clinicians respond with supportive services that match the need of each program participant to promote recovery, resilience, and wellness.

12c. Describe the types of service(s) and level of care designation(s) to be offered in the facility once this project has been completed.

This proposed project will provide 50 licensed beds of SUD residential care. It is estimated that 35 beds will be set aside for ASAM level 3.1; 10 beds for ASAM level 3.5, and 5 beds for ASAM level 3.2 Withdrawal Management.

ASAM Level 3.1, also known as Clinically Managed Low-Intensity Residential Services, provides structured and supportive living environments with therapeutic services designed for individuals with substance use disorders. Facilities offering ASAM Level 3.1 aim to provide a stable environment conducive to recovery while teaching individuals the skills needed to transition back into the community and maintain sobriety. It is a Residential Living Environment, with 24-hour supportive housing in a safe and stable environment. Supervision and monitoring are provided to ensure client safety and adherence to recovery goals. Peer-based and community-oriented support are provided to foster accountability and connection. Therapeutic services, case management, care coordination, recovery and relapse prevention, and behavioral health monitoring are part of this level of care.

ASAM Level 3.5, also referred to as Clinically Managed High-Intensity Residential Services, is designed for individuals with significant substance use disorders and co-occurring challenges that require structured, 24-hour care in a highly supportive setting. Clients have a history of relapse or inability to maintain recovery without significant support. These facilities provide intensive therapeutic interventions, monitoring, and support to help clients achieve stability and progress in their recovery. ASAM Level 3.5 facilities aim to provide the intensive care necessary for individuals to stabilize, develop skills for long-term recovery, and prepare for less intensive levels of care (e.g., outpatient or sober living). This level of care consists of 24/7 Residential Support and Supervision, with highly structured, 24-hour staffing and supervision. It is a safe and stable living environment, free from substances. There is 24/7 monitoring of behaviors, health, and safety. Clients receive individualized treatment planning, intensive therapeutic services, psychoeducation, behavioral health interventions, case management and care coordination, non-hospital based medical services including withdrawal management, life skills training, relapse prevention, recovery planning, and peer support.

ASAM Level 3.2-WM, or Clinically Managed Residential Withdrawal Management, provides 24-hour care for individuals undergoing withdrawal from substances in a residential, non-hospital setting. This level of care is appropriate for individuals who require a structured environment and support to safely manage withdrawal symptoms but do not need the intensive medical interventions of a hospital-based detoxification program. This level of care is a critical first step in the recovery process, helping individuals transition safely from active substance use to a state of readiness for ongoing treatment. Services include 24-hour supervision and monitoring, withdrawal management services, assessment and evaluation, psychoeducation and emotional support, non-hospital medical support, case management, transition planning, wraparound supportive services, and coordination with behavioral healthcare.

12d. Describe how the proposed project will receive referrals into the program.

The proposed project will receive referrals from a number of different sources. The primary referral channels will be from the adjacent Coral Street campus, where clients will be referred out by case workers if they need a step up in level of care. The other referral method is via the justice system. Individuals released from jail with substance abuse disorder are at a high risk of becoming homeless and/or committing further crimes. Providing an opportunity and program for these prospective clients will disrupt the recidivism cycle experienced by addicts when they are released from jail. The County operates the Homeless Management Information System (HMIS) a secure state of the art online database that stores data on homelessness services to match them to clients.

12e. Is the proposed project connected to step-up/-down services?

This project is both a step up and a step down in the level of care already provided at the Coral Street campus. It is a step up because clients receiving existing outpatient services, or living in permanent supportive housing, can enter this residential SUD facility and experience 24/7 care.

Within the facility, clients can step up or down between ASAM level 3.1, 3.5, and 3.2-WM depending on their needs. When the client has completed their stay at the proposed facility, they can step down to permanent supportive housing, or transitional housing at the adjacent Coral Street campus. By the time this project opens, there will also be a new 120 unit permanent supportive housing building in operation on the campus, just to the south of the site.

12f. Describe the priority considerations or unmet needs that will be addressed by the proposed project; please reference state or local needs assessments as applicable.

The City of Santa Cruz is many years into a crisis, as homelessness, mental illness, and drug abuse are pervasive in the City. Every Santa Cruz resident and nearly every block of the city have been impacted in some way.

The 2024 Point in Time (PIT) count in Santa Cruz County estimated a total of 1,850 people experiencing homelessness in the County. Tellingly, 22% of those surveyed listed Substance Use Disorder as the primary condition that led to their homelessness. 46% of homeless respondents self-reported SUD, while 37% self-reported having a psychiatric or emotional condition. While the City has limited resources to provide economic assistance and housing assistance to those who became homeless for economic reasons, there are fewer resources available to those with SUD. Services at the Coral Street campus do not have intensive residential SUD treatment. The Coral Street campus can treat clients on an outpatient basis, but the more intensive cases involving SUD and mental illness that need 24/7 supervision are not being addressed. There are residential SUD facilities in the County, but they are far from the downtown area where the target population is located and the wait times for space are long.

HMIS baseline data over the past three years shows a 25% higher rate of returns to homelessness among those with behavioral health conditions, particularly those with substance use disorders.

Working toward reducing the risk of relapse and housing loss will be an important area of focus over the next three years. The Homeless Housing Action Plan (HHAP) for Santa Cruz County aims to reduce returns to homelessness among those with behavioral health conditions, particularly those with substance use disorders by 5%. The aim is to get to 20% or lower.

Within the population of clients being served by the Santa Cruz County Behavioral Health System of Care, 20% are experiencing homelessness. This statistic is important because clients receiving SUD treatment are at much higher risk of relapse if they must live with the stress of being homeless. Providing SUD services to these clients in a monitored 24/7 residential environment will lead to better outcomes and a lower burden on the overall behavioral health system.

13. Proposed population(s) of focus: