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File #: 2021-1005   
Type: Regular Calendar Item Status: Agenda Ready
File created: 9/9/2021 In control: Health Services
On agenda: 10/26/2021 Final action:
Title: Measure O Discussion - Mobile Support Team (MST)/Cahoots Programs
Department or Agency Name(s): Health Services, Community Development Commission
Attachments: 1. Summary Report, 2. Attachment 1 - Budget Resolution, 3. Presentation - Measure O Discussion on Mobile Support Team (MST).pdf
Date Action ByActionResultAction DetailsMeeting DetailsVideo
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To: Board of Supervisors of Sonoma County and Board of Commissioners of the Community Development Commission

Department or Agency Name(s): Department of Health Services and Sonoma County Community Development Commission

Staff Name and Phone Number: Tina Rivera, 565-4774; Bill Carter, 565-5157

Vote Requirement: 4/5th

Supervisorial District(s): Countywide

 

Title:

Title

Measure O Discussion - Mobile Support Team (MST)/Cahoots Programs

End

 

Recommended Action:

Recommended action

A)                     Accept staff report on Mobile Support Team (MST)/CAHOOTS Programs.

B)                     Allocate a one-time investment of $428,000 to Cotati/Rohnert Park and Petaluma each and $85,887 to Santa Rosa to assist those jurisdictions in developing their MST program for a total of $941,887, and authorize the Interim Director of Health Services to enter into funding agreements with the jurisdictions.

C)                     Direct staff to lead collaborative evaluation in January - December 2022 of all mobile crisis support programs using evaluation criteria suggested, and determine path forward for most sustainable and successful model to adapt and scale countywide.

D)                     Adopt a resolution adjusting the Department of Health Services fiscal year 2021-2022 final budget by increasing revenues and expenditures by $941,887 to fund one-time investment to assist the jurisdictions in developing their MST program.

(4/5th Vote Required)

end

 

Executive Summary:

On August 4, 2020 the Board of Supervisors adopted a resolution calling an election to submit to the voters of Sonoma County a proposed one-quarter cent sales tax measure entitled the "Mental Health, Addiction and Homeless Services Measure Transactions and Use Tax Ordinance," and ordering that the election be consolidated with the statewide general election to be conducted on November 3, 2020. The final election results for the November 3, 2020 election showed that the 2020 Measure O was approved by 67 percent of the voters. Pursuant to Revenue and Taxation Code 7285.5, the new one-quarter cent sales tax became operative as of April 1, 2021.

As part of the measure, the voters approved an expenditure plan for the sales tax. The expenditure plan had five categories with set allocation percentages per categories. Measure O sets aside 44 percent of revenue for the Emergency Psychiatric/Crisis Services category. Four service areas are currently under consideration for Emergency Psychiatric/Crisis Services, one of which is the Mobile Support Team (MST) Expansion/Crisis Assessment, Prevention, and Education (CAPE).

Sonoma County Department of Health Services (DHS) has operated the MST program since 2012. The MST responds to law enforcement requests for support on calls in which individuals may be experiencing a behavioral health crisis. The MST program has expanded or retracted as funding has fluctuated; however, it has been the intention of Sonoma County to eventually serve all geographic regions with 24/7 mobile crisis services.

In response to community interest in expanded mobile crisis services, several cities within Sonoma County committed to establishing mobile crisis services, developing models consistent with the Eugene, Oregon, White Bird Clinic CAHOOTS program. (CAHOOTS stands for Crisis Assistance Helping Out on the Street.) The most significant innovation of the CAHOOTS model is that behavioral health and emergency medical service teams act as first responders to service calls that do not require law enforcement resources. The development of programs in Santa Rosa, Petaluma, Rohnert Park, and Cotati creates additional opportunities for the Board of Supervisors’ investment of Measure O funds in mobile crisis services, as well as development of other collaborative city/county efforts.

This report provides the Board with an update on the development of the four existing and planned mobile support teams that will operate in the county in 2021-2022, as well as the development of collaborative efforts amongst the four cities and the county. The report also recommends that your Board direct staff to convene a Sonoma Cities/ County Collaborative for the purpose of sharing information and analyses that will result in programs integration and a common set of evaluation criteria to support program improvement and expansion of mobile crisis programs across Sonoma County cities and the unincorporated areas of the County.

This item proposes that your Board authorize the Interim Director of Health Services to enter into funding agreements to allocate one-time investment of $428,000 to Cotati/Rohnert Park and Petaluma each and $85,887 to Santa Rosa to assist those jurisdictions in developing their MST program for a total of $941,887, and includes a budget resolution to increase the revenues and expenditures by the corresponding amount.

 

Discussion:

Background

In November 2020 Sonoma County passed Measure O to provide essential funding for mental health and homeless services with 68.07 percent of the vote. Measure O, a one-quarter cent sales tax, generates $25 million each year for 10 years to help protect essential mental health and homelessness services and is one of just two measures for mental health and homeless funding in the state (Mendocino County’s Measure B passed in 2017).

The Measure O Sales Tax Ordinance identified five categories of services to be funded with the revenue: (1) Behavioral Health Facilities, (2) Emergency Psychiatric and Crisis Services, (3) Mental Health and Substance Use Disorder Outpatient Services, (4) Behavioral Health Homeless and Care Coordination, and (5) Transitional and Permanent Supportive Housing. The Expenditure Plan designates a set percentage of funding for each of the categories. The Board may adjust these allocations with a four-fifths vote.

Summary and Purpose of Ad Hoc

In January 2021 the Board created a Measure O Ad Hoc committee and appointed Supervisors Gore and Coursey to the committee. The Measure O Ad Hoc Committee was formed to guide the Department of Health Services’ and Community Development Commission’s implementation of Measure O. The purpose of the Ad Hoc is to inform the Board of how Measure O funding will support the Behavioral Health budget in both existing and new programming, and provide homeless services support as defined in the measure. The Ad Hoc committee is supported by staff from the Department of Health Services (DHS), the County Administrator’s Office (CAO) and County Counsel.

At the August 31, 2021 Board Meeting, the Board reviewed and approved recommended options for investments to make for new and redesigned programs using Measure O funds, and directed staff to continue developing recommendations in specific areas. Staff were directed to reconvene the Ad Hoc committee to look specifically at the sub-category Mobile Support Team (MST) and Crisis, Assessment, Prevention, and Education (CAPE) ($3,574,520 available) and make further recommendations regarding investment in city-level mobile crisis support pilots.

DHS - MST Program Background

The Sonoma County DHS MST program accompanies law enforcement on calls to provide crisis intervention to individuals in psychiatric and substance use disorder distress. MST was established in 2012 and funded with revenue from the Mental Health Services Act (MHSA), County General Fund and temporary grants. Current funding for MST consists of MHSA, County Discretionary Funding (for 3 years), Federal Financial Participation (Medi-Cal Administrative Activities, Utilization Review), and Grant Funding from the Triage program that will end in fiscal year 2022-2023.

MST, while very valuable, is a discretionary program, not mandated by the state. The use of MHSA funds for MST means that these funds are not available to support mandated or core Mental Health Plan services, where service capacity is inadequate to meet community mental health services for adults with severe mental illness, and children with serious emotional disturbance.

The MST is highly utilized by law enforcement. In fiscal years 2018-2019 and 2019-2020, MST answered 693 calls, serving 620 unique individuals in 1,679 encounters. Follow up contacts included 926, or 55 percent, of the encounters. A quarter of all contacts resulted in a 5150 hold.

The following shows a breakdown of referral sources for MST calls in FY 19-20. (Note: Call logs do not always include all information. Subtotals listed do not equal the total calls reported for this reason.)

Referral Source

Total Calls

Total 5150s

College - SRJC Santa Rosa Campus

1

1

County - Child Protective Services

1

0

County - SCBH Program

3

1

Health Center - Russian River HC

2

0

Law Enforcement - Cotati Police

13

4

Law Enforcement - Healdsburg Police

2

0

Law Enforcement - Petaluma Police

44

14

Law Enforcement - Rohnert Park Police and Fire

19

6

Law Enforcement - Santa Rosa Police

101

30

Law Enforcement - SCSO - Cotati/Penngrove/RP

3

1

Law Enforcement - SCSO - Petaluma

2

1

Law Enforcement - SCSO - Sonoma Valley

11

3

Law Enforcement - SCSO - West County

32

13

Law Enforcement - Sebastopol Police

16

5

Law Enforcement - Sonoma County Sheriff's Office

38

15

Law Enforcement - Sonoma Police

1

0

Law Enforcement - SRJC Police - Santa Rosa

2

0

Law Enforcement - Windsor Police

4

4

Other

10

0

Other - Self-Referred

1

0

West County Community Services

1

0

Total

307

98

 

Current Teams operate Monday through Friday from 1 pm-9 pm in the following areas:

-                     Santa Rosa and Windsor (incl. SRJC Santa Rosa campus, unincorporated areas)

-                     West County (Guerneville, Forestville, Sebastopol, Graton, unincorporated areas)

-                     South County/Sonoma Valley (SSU, SRJC Petaluma, Petaluma, Cotati, Rohnert Park, unincorporated areas)

During budget hearings in September 2020, the Board expanded the MST program to add the North County team and add Saturday/Sunday services to all teams using PG&E Settlement funding. DHS is in the process of expanding MST to add a team to the north county region, which will place MST within all of the 5 Sonoma County electoral districts. All teams will be expanded from 5 to 7 days a week, moving from 8 to 10-hour shifts. Staff will continue recruitment for MST expansion and is exploring adding activities to the current MST program, such as hospital emergency department support.

DHS is currently developing a plan to modify MST to act as a first responder to calls that do not require law enforcement and provide transport as appropriate, including partnering with Santa Rosa’s inRESPONSE program, along the lines of the CAHOOTS model in Oregon. DHS is looking to the Board to provide direction on further program modification of MST.

Cities Developing Mobile Crisis Services

In response to community interest, several cities within Sonoma County committed to establishing mobile crisis services, developing models consistent with the Eugene, Oregon, White Bird Clinic CAHOOTS program. The most significant innovation of the CAHOOTS model is that behavioral health and emergency medical service teams act as first responders to service calls that do not require law enforcement resources.

The development of programs in Santa Rosa, Petaluma, Rohnert Park and Cotati creates additional opportunities for the Board of Supervisors’ investment of Measure O funds, as well as development of other collaborative city/county efforts. The Petaluma Specialized Access for Everyone (SAFE) program operated by Petaluma Peoples Services Center (PPSC) began providing mobile support services in Petaluma in July 2021. The Santa Rosa Police Department is establishing the inRESPONSE program, a partnership with Santa Rosa Fire Dept, DHS, Buckelew Programs and Catholic Charities, which is scheduled for a soft launch in November 2021.

The cities of Rohnert Park and Cotati hired Ben Adam Climber, Crisis Consulting, to assist in getting the alternative response unit up and running in their respective communities. This is the same consultant the City of Petaluma used for its team. The City of Petaluma and the cities of Rohnert Park and Cotati signed an MOU with Petaluma People Services Center to run the programs. The Rohnert Park/Cotati SAFE Team started training on October 18th. The team is expected to begin orientation in the cities of Rohnert Park and Cotati on November 1st.

An earlier recommendation to your Board regarding committing funds to mobile crisis was to wait for the outcome of state grant opportunities that would support mobile crisis efforts. Since that recommendation DHS partnered with Santa Rosa, Petaluma, Rohnert Park and Cotati to apply to the California State Department of Health Care Services (DHCS) Crisis Care Mobile Units (CCMU) grant program. DHS has received conditional approval of the application in the amount of $2,498,899. The CCMU award requires that 75 percent of the funds be committed to infrastructure costs and 25 percent set aside for services to individuals who do not have insurance coverage. Rohnert Park and Cotati will receive $1,000,000 to support establishment of their program in 2021-2022. The City of Petaluma Specialized Assistance for Everyone (SAFE) program will receive $1,000,000 to expand its services. Finally, the City of Santa Rosa will receive $498,899 for the inRESPONSE program.

The grant includes $500,000 to establish a collaborative program outcome and evaluation workgroup led by the DHS Health Policy, Planning and Evaluation (HPPE) Division. Within this project, Sonoma County Mobile Support Team (MST), Santa Rosa inRESPONSE, Petaluma SAFE and Rohnert Park/Cotati mobile crisis programs will share common data definitions, data platforms and analyses to ensure that the cities and county are identifying lessons learned from their programs to support program quality improvement, as well as the expansion of these enriched mobile crisis services across all of Sonoma County’s communities.

Staff Recommendation for Measure O Funding for City Pilots

DHS recommends investing a one-time amount of $941,887 of Measure O funding in the three City pilot programs, and to direct staff to lead a collaborative evaluation in calendar year 2022 of all MST programs in order to determine the most sustainable and successful model to adopt and scale countywide.

The following chart shows the recommended investment for each jurisdiction:

City

Est Cost year 1

Start-up Cost*

Request for fund

Staff Recommendation***

Cotati/ Rohnert Park

$1,295,174

$178,000

$500,000

$428,000

Petaluma

$1,322,234

$178,000

$500,000

$428,000

Santa Rosa**

$1,185,887

$254,870

$85,887****

$85,887

 

 

 

Total:

$941,887

*Start-up included in Year 1 cost **Santa Rosa City contribution $1.1m Year 1 - DHS Recommendation is also taking into consideration the potential in-kind contribution of DHS staff participating in the SR program ***Staff recommendation: Start-up cost plus $250,000 for Cotati/Rohnert Park and Petaluma ****Based upon preliminary budget, $85,887 was listed as shortfall for Santa Rosa program

 

These funds may be used by the cities to cover start-up and operational costs not covered by other funding sources, including potentially a common database, vehicles, technology, and other infrastructure needed.

Additionally, DHS is recommending direction to lead the collaborative evaluation of all MST-type programs to identify lessons learned, improve program quality and support, and determine expansion of more intensive mobile support services across the cities and county.

 

Prior Board Actions:

On August 31, 2021 the Board A) accepted staff report on Measure O Planning and Implementation and B) reviewed options for investments to make for new or redesigned programs, and provided direction to staff.

On December 15, 2020 the Board A) Adopted a resolution to authorize the County Administrator to execute agreements with the California Department of Tax and Fee Administration for implementation of the local transaction and use tax on behalf of the County of Sonoma authorized by Sonoma County voters. B) Adopted a resolution to authorize the Examination of Transaction and Use (Sales) Tax Records and retain a consultant to assist with sales tax economic analysis and audit service. C) Authorized the Director of Health Services, or designee, to coordinate with the California Department of Tax and Fee Administration to execute any other necessary documents to proceed with the administration of the tax.

On August 4, 2020 the Board A) adopted an ordinance entitled the “Sonoma County Local Mental Health, Addiction and Homeless Services Measure Transaction and Use Tax Ordinance” imposing a countywide one- quarter cent special transactions and use tax (sales tax) in Sonoma County for Sonoma County behavioral health and homeless services pursuant to Revenue and Taxation Code section 7285.5; B) authorized the Department of Health Services to coordinate with the County Administrator to contract with the California Department of Tax and Fee Administration to administer the tax, if approved by voters; and C) adopted a resolution calling a special election to submit to the voters of Sonoma County a one-quarter of one percent (0.25%) sales tax measure entitled “the Sonoma County Local Mental Health, Addiction and Homeless Services Measure Transaction and Use Tax Ordinance” and ordering that the special election be consolidated with the statewide general election to be conducted on November 3, 2020.

On July 28, 2020 the Board adopted a resolution introducing a proposed ordinance imposing a countywide one-quarter cent transactions and use tax (sales tax) in Sonoma County for Sonoma County behavioral health and homeless services and waiving further reading.

On July 14, 2020 the Board A) received a report from staff on proposed November 2020 Sonoma County Local Mental Health, Addiction and Homeless Services Measure Transactions and Use Tax Ordinance, including polling results and draft expenditure plan; and B) directed staff to return on July 28, 2020 to introduce and waive further reading of a proposed ordinance imposing a one-quarter cent countywide transactions and use tax (sales tax) in Sonoma County for Sonoma County behavioral health and homeless services.

On May 19, 2020 the Board approved a Master PHF Lease and Development Agreement with University Partners, LLC for the leasing, design, construction, and maintenance operations of a psychiatric health facility (“PHF”) for the County at the former Valley of the Moon Children’s Center at Los Guilicos.

 

Fiscal Summary

 Expenditures

FY 21-22 Adopted

FY 22-23 Projected

FY 23-24 Projected

Budgeted Expenses

 

 

 

Additional Appropriation Requested

941,887

 

 

Total Expenditures

941,887

 

 

Funding Sources

 

 

 

General Fund/WA GF

 

 

 

State/Federal

 

 

 

Fees/Other

941,887

 

 

Use of Fund Balance

 

 

 

Contingencies

 

 

 

Total Sources

941,887

 

 

 

Narrative Explanation of Fiscal Impacts:

The increase of revenues and expenditures of $941,887 to support the one-time investment to assist the jurisdictions developing their MST program will be funded with Measure O funding from the Mobile Support Team (MST) and Crisis, Assessment, Prevention, and Education (CAPE) Expenditures Plan category.

Appropriation adjustments with the attached budget resolution are necessary to transfer FY 21-22 budgeted Measure O revenue from its Special Revenue Account into DHS fund to offset the projected expenditures of $941,887. The Year 1 remaining uncommitted balance for the Mobile Support Team (MST) and Crisis, Assessment, Prevention, and Education (CAPE) Expenditures Plan category after this expenditure is projected at $2,632,633.

 

Staffing Impacts:

 

 

 

Position Title (Payroll Classification)

Monthly Salary Range (A-I Step)

Additions (Number)

Deletions (Number)

 

 

 

 

 

 

 

 

 

Narrative Explanation of Staffing Impacts (If Required):

N/A

 

Attachments:

Attachment 1 - Budget Resolution

 

Related Items “On File” with the Clerk of the Board:

None