To: Sonoma County Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera, 707-565-4774
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Sexual Assault Response Team - Sexual Assault Nurse Examiner Multi-County Agreement
End
Recommended Action:
Recommended action
Authorize the Director of Health Services, or designee, to execute an agreement with Napa-Solano SANE/SART agency for the provision of sexual assault exam services for all adult and child victims in Sonoma County from July 1, 2024 through June 30, 2027, in an amount not to exceed $1,148,202.
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Executive Summary:
Beginning in 1998, the Sonoma County Department of Health Services (hereinafter, “DHS” or “the Department”) has been providing Sexual Assault Exam services to victims of sexual assault. Initially, exams were focused on child victims; but in 2003, at the request of the Law Enforcement Chief’s Association, the Board of Supervisors authorized the implementation of a Sexual Assault Response Team (SART) to conduct medical forensic exams for all adult and child victims in Sonoma County. The SART team, comprised of specially trained medical forensic examiners, operates under a memorandum of understanding (MOU) with local law enforcement agencies.
In response to staffing difficulties, DHS sought support from the Napa-Solano SANE/SART (Sexual Assault Nurse Examiner/Sexual Assault Response Team) in 2012 and 2022. Despite efforts to address ongoing staffing concerns, the need for additional back up support persists. This item recommends Board authorization for the Director of Health Services, or designee, to execute a formal agreement with Napa-Solano SANE/SART, and for them to assume provision of all sexual assault exam services in Sonoma County, ensuring local coverage and eliminating the necessity of transporting victims to neighboring counties. The agreement term is from July 1, 2024 through June 30, 2027, in an amount not to exceed $1,148,202. The Department has begun the review of impacted agreements and will take action to update necessary terms as necessary with the approval of this item.
Discussion:
In 1998, the Department initiated pediatric Sexual Assault Exam services as part of a broader consortium to address child sexual abuse in Sonoma County. In 2003, the Board authorized the implementation of a Sonoma County Sexual Assault Response Team (SART) to conduct forensic exams for both adult and child victims in response to a request from the Law Enforcement Chiefs Association. The SART team, comprised of specially trained medical examiners, operates under a memorandum of understanding (MOU) with local law enforcement agencies. Prior to the current system, exams were conducted at Sutter Hospital's emergency department.
Despite ongoing recruitment efforts and increased examiner pay, the Department has struggled to maintain adequate staffing levels to support the SART team. In 2012 and 2022, the Department sought support from neighboring agency, the Napa-Solano SANE/SART due to staffing shortages. While the Napa-Solano team has been a dedicated resource, the lack of local examiners has resulted in victims being transported to neighboring counties for exams.
Napa-Solano SANE/SART, a 501(c)(3) agency providing regional sexual assault examiner services since 1988, has extended support to Sonoma County multiple times. In 2022, they successfully launched a second sexual assault nurse examiner team at Kaiser Medical Center in San Rafael, resulting in a 70% increase in examination rates at Kaiser San Rafael since 2021. The agency has consistently provided backup support to the Sonoma County SART team.
The Department is seeking Board authorization for the Director of Health Services, or designee, to execute an agreement with Napa-Solano SANE/SART for the provision of sexual assault exam services in Sonoma County from July 1, 2024 through June 30, 2027, in an amount not to exceed $1,148,202. This agreement aims to enhance in-county SART coverage, eliminating the need to transport victims out of the county for exam services. If approved, the Department would transition exam responsibilities full time to Napa-Solano SANE/SART with services to be provided at Sonoma County locations, Sutter Hospital and Redwood Children’s Center. The contractor has assured the Department that their examiners will maintain a physical presence in Sonoma County to assure the assault victims’ needs can be met locally. DHS would continue to manage the program by providing coordinating responsibility and managing the subject contract.
The proposed contract would provide all necessary examiners through Napa-Solano SANE/SART. If approved, the proposed agreement with Napa-Solano SANE/SART would eliminate the need for DHS staff to provide direct services for the program. Existing staff would retain the ability to pick up call team shifts with the Napa-Solano SANE/SART. Napa-Solano SANE/SART have expressed an interest in bringing on additional staff to support this body of work within Sonoma County to serve the community in a greater capacity. Staffing impacts include the following:
• Program Manager (1.0 FTE) would continue to manage the program and associated contracts
• Physician Assistant (0.75 FTE) would transfer to an existing vacancy in the Valley of the Moon program where staff member is currently assigned at 0.5 FTE.
• Staff Nurse II (.75 FTE) would transfer to an existing departmental vacancy
• Staff Nurse II Extra Help staff would have an opportunity to join Napa-Solano SANE/SART and continue to serve Sonoma County residents.
Strategic Plan:
N/A
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
On September 12, 2023 the Board authorized the Director of Health Services to execute an MOU with Sonoma County Law Enforcement Agencies, establishing roles related to the County providing sexual assault forensic medical examinations as requested by law enforcement agencies and terms for payment to the County for services, with an estimated fiscal year 2023-2024 amount of $235,200, with a term that is automatically extended each fiscal year.
On March 16, 2021 the Board approved a memorandum of understanding with Sonoma County Law Enforcement Agencies, establishing respective roles related to the County providing sexual assault forensic medical examinations as requested by law enforcement agencies and receiving payment for services, with an estimated fiscal year 2021-2022 amount of $176,400 and a term that is automatically extended each fiscal year.
On January 6, 2009 the Board authorized and approved SART budget fiscal adjustments.
On February 4, 2003 the Board authorized an agreement between Health Services and Law Enforcement for SART services.
Fiscal Summary
|
Expenditures |
FY23-24 Adopted |
FY24-25 Projected |
FY25-26 Projected |
|
Budgeted Expenses |
|
$382,734 |
$382,734 |
|
Additional Appropriation Requested |
|
|
|
|
Total Expenditures |
0 |
$382,734 |
$382,734 |
|
Funding Sources |
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|
|
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General Fund/WA GF |
|
|
|
|
State/Federal |
|
|
|
|
Fees/Other |
|
$382,734 |
$382,734 |
|
Use of Fund Balance |
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General Fund Contingencies |
|
|
|
|
Total Sources |
0 |
$382,734 |
$382,734 |
Narrative Explanation of Fiscal Impacts:
Funding for this contract will be a mix of exam fees charged to Sonoma County Law Enforcement agencies, Sutter Hospital, and 1991 Health Realignment along with Health Services annual general fund allocation. Fiscal Year 2024-2025 appropriations will be included in the recommended budget process, future year appropriations will be included through normal budgeted process. A fiscal analysis showed that this approach would reduce total annual County outlays on the program by $84,000.
The Department currently funds the SART system through a combination of revenues from law enforcement, Health Realignment, General Fund, and a federal draw down. The new model would eliminate the federal drawdown and decrease the draw from Realignment.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Agreement with Napa-Solano SANE/SART
Related Items “On File” with the Clerk of the Board:
None