Behavioral Health Center for teens "one step closer to reality"

SAN JOSE - Santa Clara County’s only inpatient youth psychiatric hospital – part of a sparkling new center for behavioral health services – reached a significant milestone today with the unveiling of its state-of-the-art design. 

The three-story, tree-encircled Child and Adolescent Psychiatric Facility/Behavioral Health Services Center – linked by skyway and tunnel to Santa Clara Valley Medical Center (VMC) – will provide inpatient hospital care as well as emergency and outpatient psychiatric services for children, adolescents, and adults. 

At the County Health and Hospital Committee (HHC) meeting on Wednesday, County staff presented detailed 3-D drawings of the 190,000 square-foot facility, featuring divided age-appropriate amenities, including indoor and outdoor therapeutic environments, that allow for a continuum of care in one setting.

“This couldn’t be more welcome news,” said Santa Clara County Supervisor and HHC Chair Joe Simitian. “This is the kind of acute care facility we’ve long needed in Santa Clara County for young people in crisis – a sanctuary where they can safely begin to heal, close to home.”

Filling the behavioral health treatment gap

Simitian led the effort to add inpatient care to youth-focused mental health services in the County after hearing a simple question from a constituent: “Why aren’t there any inpatient hospital beds for kids and teens in mental health crisis here in Santa Clara County?”

Simitian was alarmed to learn that each year several hundred young people were transferred from emergency rooms in the County to hospitals as far as 100 miles away for acute psychiatric care. 

“This is about troubled teens at risk of doing damage to themselves or others. This is about families struggling through the hardest thing they'll ever face, and being torn apart at precisely the time they need to be together,” said Simitian. “This goes to the heart of community health and wellness.”

In 2018, at Simitian’s request, the Board unanimously approved development of the first County-run acute inpatient psychiatric facility for children and adolescents – one that would also provide a much-needed physical upgrade for adult behavioral health services that were scattered in aging buildings on the medical center campus.

Designing an Environment for Healing

The new facility – wrapped in terracotta tiles and glass, with tree-lined terraces for privacy and to bring “the outdoors inside” – will replace the 50-year-old Don Lowe Pavilion, which housed adult Emergency Psychiatric Services and Mental Health Urgent Care.  Designed by HGA and Cunningham Group architects, and located on the west side of the Valley Medical Center campus, design features include:

• Emergency Psychiatric Services (EPS) on the ground level, with separate secured ambulance entry bays and treatment spaces for minors and adults. This level will also house: a shared pharmacy; divided outpatient urgent care for minors and adults; separate outdoor spaces for minors and adults walled for privacy and security; an outdoor courtyard for staff respite. The light-filled main lobby and atrium entrance faces Middle Drive.
• Adult inpatient units occupy the second level, with 42 beds and two tree-screened outdoor terraces. 
• Adolescent inpatient care is on third floor with 21 beds for patients ages 13 to 17 years, and an outdoor terrace. Children 12 years and younger have a separate unit with 14 beds and their own outdoor space. 
• A rooftop basketball court, part of a walled and mesh-covered outdoor recreation space.

All of the services share resources such as professional staff, support staff, and storage. A skyway linked to VMC’s Emergency Department will allow patients who have co-occurring medical issues to be treated on-site. An underground tunnel connects the facility with VMC’s Receiving and Support Center, allowing for easy transport of prepared meals and supplies. 

County staff will present the design update to the full Board of Supervisors at its Feb. 23 meeting. Construction of the facility is on track to begin in February 2022, and open to patients in November 2023. 

Forging a Solution for Santa Clara County Kids in Crisis

Simitian began the process of bringing inpatient psychiatric care for children and adolescents to the County in 2015, reaching out to behavioral health staff, local hospitals and mental health agencies, school districts, and parent advocates to assess needs and obstacles. 

When youth are diagnosed as being a danger to themselves or others, they are placed on a “5150” – an involuntary 72-hour hold – and transferred to the nearest inpatient facility.  

With hospital beds in San Mateo, Alameda, and San Francisco counties in short supply, some families are referred to facilities in Vallejo, Concord, Santa Rosa, or Sacramento. Because of liability and safety protocols, parents are often not allowed to drive their children, which can mean hours in an ER waiting for an available bed, and paying thousands of dollars for ambulance transport out of pocket.  

“On any given day more than a dozen Santa Clara County children are being hospitalized for psychiatric emergencies outside the County. Separating these kids from their families at one of the toughest times in their lives, that's just hell on them,” Simitian said. “I’m also worried that the specter of long-distance treatment could deter kids and families from seeking the help they need in the first place.”

Currently the County contracts with San Jose Behavioral Health to serve teens ages 14 to 17 years. “It’s far from what is needed to meet the demand, and doesn’t offer anything for younger kids” said Simitian, noting also that the psychiatric facility is in South San Jose, “far removed from significant portions of the County.”

The VMC site has the added benefit of being part of a larger county-owned health and hospital complex, “with all the medical resources that provides,” Simitian added. “It's better therapeutically for these kids to be close to their community when they’re in crisis – close to their family, their friends, and their own local mental health providers.”

A Shared Responsibility

The facility’s psychiatric services for teens and children will have a collaborative foundation, utilizing the breadth of community expertise to provide a comprehensive safety net, including preventive, emergency, acute, transitional, and long-term mental health services for youth.

"We see this as a shared responsibility, an approach that captures the talent and resources of healthcare providers throughout the county,” said Simitian. "Whether a family is commercially insured, paying out-of-pocket, relying on Medi-Cal, or wholly uninsured, I want to be sure there's a place for their kids when and where they need it most.”

Key health partners include Stanford University, Kaiser Permanente, Uplift Family Services, and El Camino Health, which has provided inpatient adult psychiatric services for many years, as well as ASPIRE (After School Program Interventions and Resiliency Education), a highly regarded outpatient education program for youth from middle school to 25 years of age.

It is anticipated that the child/adolescent unit will receive referrals from Kaiser, Lucile Packard Children’s Hospital, El Camino and others, as appropriate, due to the lack of available community resources and high need for these services. 

Centralized Care with a Network of Support

The County plans to work closely with community-based partners on services to ensure full family involvement, rapid stabilization, and transition home with support, as well as on expanding and developing programs for kids to prevent additional hospital stays.  

“That’s one of the clear advantages of the County operating a centralized facility designed purposefully to support behavioral health,” said Paul Lorenz, VMC’s Chief Executive Officer. “We’re particularly gratified to be offering a spectrum of much-needed care for children and adolescents.”

“A collaborative approach will enable us to address acute mental health needs for youths by delivering inpatient care, and to reduce the number of patients who reach the point of requiring hospitalization by strengthening early intervention and outpatient services,” Lorenz added. “When a child is ready for discharge, we will be able to work in tandem with Behavioral Health Services on case management and transition to a community-based setting, involving a patient’s family every step of the way.”

Simitian noted that a 35-bed inpatient facility for children and adolescents has the potential to serve "hundreds and hundreds of families” annually, given that the typical patient stay in such a facility is just over six days.

“The need was clear. The partnerships were there. This was a solvable problem. But somebody had to take the lead. I’m proud that our County staff have stepped up in this way. This new design brings the project one step closer to reality,” Simitian said. “But truly, given the need, we can’t get it done too soon.”

###

Santa Clara County Child and Adolescent Psychiatric Facility
District Five Project Timeline

In December of 2014 Supervisor Joe Simitian learns that there are no inpatient hospital beds for kids and teens in mental health crisis in Santa Clara County. None.

2015  Simitian reaches out to County Behavioral Health staff, local hospitals, mental health agencies, school districts, and parent advocates to better understand the need for and obstacles to providing inpatient youth psychiatric care locally.

2016  County staff prepares a Request for Proposals (RFP) which closes without a successful bidder, the financial undertaking being too much for any one entity.

2017 Simitian re-engages with County staff and potential partners to forge a collaborative local solution. At Simitian’s urging, the Board of Supervisors unanimously approves development of a Child and Adolescent Psychiatric Facility on the Valley Medical Center campus.

2018 The Board unanimously approves construction of a state-of-the-art behavioral health facility that will house the first County-run inpatient psychiatric services for children and adolescents.

2019  County staff commences stakeholder and user group meetings, programming development, site selection, and financial planning.

2020  At Simitian’s request, County staff provides monthly status reports to the Board’s Health and Hospital Committee on facility design, planning, and construction to ensure the project stays on track.

In February of this year County staff present the facility design to the County Health and Hospital Committee and the Board of Supervisors. Design documents are submitted to California’s Office of Statewide Health Planning and Development for review and approval.

Other Efforts

Inpatient psychiatric care for County children and adolescents builds on previous efforts by Supervisor Simitian to ensure that youth in the County have access to the mental health services they need:

• Allcove, stand-alone one-stop mental health centers for youth. With the opening of in-person programs in Palo Alto and San Jose delayed until later this year because of the pandemic, the County supported the November 2020 launch of Virtual You: Navigating Wellness Online, a teen mental health program to engage youngsters before they hit a crisis point.
• Mental health services for teens on Medi-Cal in the North County through El Camino Hospital’s After-School Program Interventions and Resiliency Education® (ASPIRE) program.
• The Mountain View-based Community Health Awareness Council’s “School First” program, utilizing individual, group and family counseling, teacher training and support, life skills and peer leadership training to keep North County at-risk kids in school.
• The Youth Connectedness Initiative, led by Youth Community Services, aimed at providing meaningful connections promoting youth mental health.