To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Nolan Sullivan, 707-565-4774; Jan Cobaleda-Kegler, 707-565-5157
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Behavioral Health Youth Family Services
End
Recommended Action:
Recommended action
Adopt a Resolution amending the Department Allocation List, for the Department of Health Services, effective December 9, 2025, which will effectively increase staffing allocations by 0.7 Full-Time Equivalent position.
end
Executive Summary:
The Department of Health Services is requesting approval to restructure staffing within Behavioral Health’s Youth and Family Services by deleting one vacant 1.0 Full-Time Equivalent Psychiatric Nurse position and one vacant 0.3 Full-Time Equivalent Behavioral Health Clinician position. To better support the program, the Department proposes adding a 1.0 Full-Time Equivalent Licensed Vocational Nurse (LVN) II and a 1.0 Full-Time Equivalent Senior Office Assistant (SOA). These changes will result in a more efficient Foster Services workflow, with duties more closely aligned with job class. Deleting the higher cost Psychiatric Nurse position allows for tasks to be done by an LVN, whose skills better align with operational needs. The addition of an SOA will ensure the medical staff member is relieved from clerical tasks. Costs for the increased 0.7 FTE will be covered by a Memorandum of Understanding with the Human Services Department and Mental Health Services Act funds.
Discussion:
The Department of Health Services (hereinafter, “the Department” or “DHS”) Youth and Family Services program, currently includes a 1.0 Full-Time Equivalent (FTE) Psychiatric Nurse position to support foster youth medication monitoring. This monitoring is required through a combination of legislation, regulations, and judicial procedures, including:
• Senate Bill 238 <https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB238> (2015) Required the development of statewide guidelines for the use of psychotropic medications in foster care. It also mandated training for child welfare workers and public health nurses to better monitor and understand these prescriptions.
• Senate Bill 319 <https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB319> (2015) Strengthened oversight by requiring public health nurses to participate in monitoring psychotropic medication use among foster youth.
• Senate Bill 377 <https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200SB377> (2019) Expanded the scope of oversight and clarified procedures for court authorization of medications.
• Senate Bill 528 <https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB528> (2022) Updated protocols to ensure caregivers receive copies of all relevant medication information and the forms that are filed to request court authorization for prescribing psychotropic drugs to a juvenile within two business days of court orders. It also reinforced the role of juvenile courts and public health nurses in the monitoring process.
• California Rules of Court Rule 5.640 <https://courts.ca.gov/cms/rules/index/five/rule5_640> Psychotropic Medication court authorization process for foster youth.
This position, funded through a Memorandum of Understanding (MOU) with the Human Services Department (HSD), recently became vacant. Following a joint review by DHS and HSD, it was determined that the duties associated with this role do not require the qualifications of a Psychiatric Nurse. Instead, these responsibilities can be effectively performed by a Licensed Vocational Nurse II (LVN II).
Historically, the Psychiatric Nurse position has included significant data-related tasks such as maintaining lists of foster youth prescribed psychiatric medications, tracking consenting parties, gathering required documentation for prescriptions and second opinions, monitoring due dates for court-mandated forms, and compiling data for state reporting. These administrative functions can be carried out by a Senior Office Assistant (SOA), allowing the LVN II to focus on responsibilities requiring medical expertise, including:
• Educating HSD staff on procedures for submitting psychiatric medication approval paperwork for foster youth
• Collaborating with psychiatrists providing second opinions for youth medication cases
• Coordinating with prescribing physicians and psychiatrists to complete necessary documentation
• Participating in treatment team meetings for outpatient foster youth mental health services and at Valley of the Moon, ensuring timely and appropriate care
HSD has agreed to amend the MOU, enabling DHS to reallocate the vacant 1.0 FTE Psychiatric Nurse position into a 1.0 FTE LVN II and a 0.5 FTE SOA.
The remaining 0.5 FTE SOA, needed to support additional Youth and Family Services tasks, will be funded by DHS via the deletion of a vacant 0.3 FTE Behavioral Health Clinician allocation. The 0.3 FTE was a portion of a clinician position that has not been used for several years, since the clinician in the 0.8 allocation requested to decrease their FTE to 0.5as their duties had moved from primarily caseload carrying to managing another body of work that did not require 0.8 FTE. The proposed 0.5 FTE SOA will carry responsibility for coordination and scheduling of Child and Family Team meetings for Youth and Family Service clients. This is a new service that YFS has just begun to offer. Currently the coordination and scheduling is being done by the Senior Client Support Specialists who facilitates the Child and Family Team Meetings. As coordination and scheduling are clerical tasks, the Senior Client Support Specialist staff cannot bill Medi-Cal for these activities, and they should be performed by clerical staff. In addition, the Senior Client Support Specialists will not have time to manage the scheduling of the meetings. It is anticipated that we will need to facilitate over 1,000 Child and Family Team Meetings per year, scheduling children, family members, school staff, child welfare and juvenile probation partners, and other treatment team members to attend meetings focused on the needs of our clients. A Senior Office Assistant is needed to manage this significant load of scheduling.
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 3: Create a “no wrong door” approach where clients who need services across multiple departments and programs are able to access the array of services needed regardless of where they enter the system.
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
None
Fiscal Summary
|
Expenditures |
FY 25-26 Adopted |
FY 26-27 Projected |
FY 27-28 Projected |
|
Budgeted Expenses |
$240,248 |
$338,782 |
$347,445 |
|
Additional Appropriation Requested |
|
|
|
|
Total Expenditures |
$240,248 |
$338,782 |
$347,445 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
$23,017 |
$79,843 |
$81,863 |
|
Fees/Other |
$217,231 |
$258,939 |
$265,582 |
|
Use of Fund Balance |
|
|
|
|
General Fund Contingencies |
|
|
|
|
Total Sources |
$240,248 |
$338,782 |
$347,445 |
Narrative Explanation of Fiscal Impacts:
The staffing restructure will not result in an operational and/or funding change. Funds now budgeted for Fiscal Year 2025-2026 cover the expenditures. Future expenditures will be requested through the annual budget process. The positions of a Licensed Vocational Nurse II (LVN II) and a Senior Office Assistant (SOA) for the remainder of Fiscal Year 2025-2026 are estimated to cost $240,248. Payroll costs for these positions, for the remainder of Fiscal Year 2025-2026 (prorated for 8 months) include salary, benefits, overhead and one-time expenses are approximately as follows:
• LVN II- Base Salary/Wage - $58,281 Benefits - $41,457, overhead - $16,667, and one-time costs of $10,000, totaling $126,405. These costs will be funded by the MOU with HSD.
• SOA- Base Salary/Wage - $49,494, Benefits - $37,682, overhead - $16,667, and one-time costs of $10,000, totaling $113,843. These costs will be split evenly between the MOU with HSD and Mental Health Services Act.
Funds currently budgeted for this section in the Behavioral Health Division come from a Memorandum of Understanding with the Human Services Department and Mental Health Services Act, redirecting the funds of eliminating the 0.3 FTE described in this Board item. These sources are sufficient to cover the costs of these new positions. Funding in future years will be part of the annual budget requests of the department and assume a 3% COLA increase.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
LICENSED VOCATIONAL NURSE II |
5,932.64-7,211.00 |
1.00 |
0.00 |
|
PSYCHIATRIC NURSE |
10,444.30-12,694.91 |
0.00 |
1.00 |
|
SENIOR OFFICE ASSISTANT |
5,036.92-6,123.96 |
1.00 |
0.00 |
|
BEHAVIORAL HEALTH CLINICIAN |
8,541.54-10,383.42 |
0.00 |
0.30 |
Narrative Explanation of Staffing Impacts (If Required):
There will be no impact on existing staff, as the positions proposed for deletion are presently vacant. The new positions will better align with the responsibilities required. The Department will work with Human Resources to conduct the necessary recruitments to fill the positions.
Attachments:
Attachment 1 - Personnel Resolution
Related Items “On File” with the Clerk of the Board:
None