HomeMy WebLinkAboutCommission on Equity and Public Safety 2.21.23 Special Meeting Agenda PacketTuesday, February 21, 2023
6:00 PM
City of South San Francisco
P.O. Box 711 (City Hall, 400 Grand Avenue)
South San Francisco, CA
Teleconference
Commission on Equity and Public Safety
Special Meeting Agenda
1
February 21, 2023Commission on Equity and Public
Safety
Special Meeting Agenda
Welcome to the Special Meeting of the Commission on Equity and Public Safety. The regular meetings are held
on the third Monday of each month. The following is a general outline of our procedures.
This meeting is being held in accordance with the Brown Act as currently in effect under the provisions of
Assembly Bill 361 which allows attendance by members of the Commission, City Staff, and the public to
participate and conduct the meeting by teleconference.
In accordance with the California Government Code Section 54957.5, any writing or document that is a public
record, relates to an open session agenda item, and is distributed less than 72 hours prior to a regular meeting
will be made available for public inspection at the City Manager's Office in City Hall. If, however, the
documents or writing is not distributed until the regular meeting to which it relates, then the documents or writing
will be made available to the public at the location of the meeting, as listed on this agenda.
The public may view or comment during this meeting from a computer, laptop, tablet, or smartphone:
Please click the link below to join the webinar:
https://ssf-net.zoom.us/j/85862947353
Or One tap mobile:
US: +16699006833,,85862947353# or +13462487799,,85862947353#
Or Telephone:
Dial (for higher quality, dial a number based on your current location):
US: +1 669 900 6833 or +1 346 248 7799 (Toll Free) or 877 853 5257 (Toll Free)
Webinar ID: 858 6294 7353
How to provide Public Comment during the meeting:
Please note that dialing in will only allow you to listen in on the meeting. To make a public comment during the
Zoom session, join the meeting from your computer or mobile device, enter your name, and request to comment
by selecting "Raise Hand" in Zoom, and a staff person will add you to the queue for comments and unmute your
microphone during the comment period. Please be sure to indicate the Agenda item number you wish to
address or the topic of your public comment. California law prevents the Commission from taking action on any
item not on the Agenda (except in emergency circumstances). Your question or problem may be referred to
staff for investigation an/or action where appropriate or the matter may be placed on a future Agenda for more
comprehensive action or report.
COMMENTS ARE LIMITED TO THREE (3) MINUTES PER SPEAKER. Thank you for your cooperation.
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February 21, 2023Commission on Equity and Public
Safety
Special Meeting Agenda
How to provide Public Comment before the meeting:
Members of the public wishing to participate are encouraged to submit public comments in writing in advance of
the meeting. The email and phone line below will be monitored during the meeting and public comments
received will be read into the record. The City encourages the submission of comments by 6:00 pm before the
start of the meeting, to facilitate inclusion in the meeting record. A maximum of 3 minutes per individual
comment will be read into the record. Comments that are not in compliance with the Commission's rules of
decorum may be summarized for the record rather than read verbatim.
Email: [email protected]
Staff Phone Number: (650) 291-5643
Share a Concern about Employee Compliance with City Regulations or Policy
The Commission provides an alternative channel for members of the public to share concerns regarding
compliance with City policies and applicable laws by City personnel. This process is under the South San
Francisco municipal code, chapter 8.25. If you wish to share your concern, including in the format of a
compliant, under this section of the municipal code, you can do so during Public Comment. The Commission
cannot investigate complaints will refer the complaint to the Human Resources Department in accordance with
the municipal code. Confidential personnel information will not be shared.
Translation Services
The City of South San Francisco proactively provide live interpretation and translation of agenda for community
members that are not proficient in the English language. Materials can be translated into Spanish, Tagalog, and
Chinese (Cantonese).
How to request these services:
To ensure the availability of services, members of the public must request assistance 72 hours in advance of the
meeting.
Members of the public can email the staff liaison, Amy Ferguson at [email protected], to request these
services. If email is not an option, you can also reach her (650) 291-5643.
Servicios de Traducción
La Ciudad de Sur San Francisco ofrece traducciones de materiales escritos para los miembros de la comunidad
que no dominan el idioma inglés. Los materiales se traducen al español, tagalo y chino (cantonés).
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February 21, 2023Commission on Equity and Public
Safety
Special Meeting Agenda
Cómo Solicitar Estos Servicios
Para garantizar la disponibilidad de los servicios, miembros del público deben solicitar asistencia 72 horas antes
de la reunión.
Los miembros del público pueden enviar en correo electrónico a Amy Ferguson [email protected] para
solicitar estos servicios. Si correo electrónico no es una opción, también puede comunicarse al (650)
291-5643.
Mga serbisyo sa pagsasalin
Ang Lungsog ng Timong San Francisco ay aktibong magbibigay ng live na interpretasyon at pagsasalin ng mga
miyembro ng komunidad na hindi bihasa sa wikand Ingles. Maaring isalin ang mga materyales sa Espanyo,
Tagalog, at Chinese (Cantonese).
Paano Humiling ng mga serbisyong ito
Upang matiyak ang pagkakaroon ng mga serbisyo, ang mga miyembro ng publiko ay dapat humiling ng
pitumpu't dalawny (72) oras bago ang pulong.
Maaring mag-email ang mga miyembro ng publiko sa Staff Liasion, Amy Ferguson sa [email protected] at
sa opisina ng City Clerk sa [email protected] para hilingin ang mga serbisyong ito. Kung hindi opsyion ang email,
maari mo rin siland tawagan sa (650) 291-5643.
Individuals with disabilities who require auxiliary aids or services to attend and participate in this
meeting should contact the ADA Coordinator at (650) 877-8518, 72 hours before the meeting.
If you have special questions, please contact the staff liaison in the City Manager's office. Staff will
be pleased to answer your questions when the Commission is not in session.
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February 21, 2023Commission on Equity and Public
Safety
Special Meeting Agenda
Equity and Public Safety Commissioners
Krystle Cansino, Chair
Arnel Junio, Vice Chair
Salvador Delgadillo, Commissioner
PaulaClaudine Hobson-Coard, Commissioner
Alan Perez, Commissioner
Carol Sanders, Commissioner
Steven Yee, Commissioner
City of South San Francisco Staff
Leslie Arroyo, Deputy City Manager
Amy Ferguson, Staff Liaison
Maryjo Nuñez, Management Fellow
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February 21, 2023Commission on Equity and Public
Safety
Special Meeting Agenda
Call to Order.
Roll Call.
Reading of the Land Acknowledgement
Agenda Review.
Public Comment.
MATTERS FOR CONSIDERATION
Approval of Minutes from the January 17, 2023 meeting.1.
Presentation of scorecard for Commissioners’ use.2.
Presentation on Berkeley’s Mobile Crisis Team by Allyson Nakayama LCSW, Mental
Health Program Supervisor.
3.
4. Discussion of presentation on Berkeley’s Mobile Crisis Team by Allyson Nakayama LCSW, Mental Health
Program Supervisor.
5. Recess.
Presentation of Data on the Community Wellness and Crisis Response Team by
Captain Adam Plank, SSF Police Department and Jaymes Pyne, John W. Gardner
Center at Stanford University.
6.
7. Discussion of presentation of Data on the Community Wellness and Crisis Response Team by Captain
Adam Plank, SSF Police Department and Jaymes Pyne, John W. Gardner Center at Stanford University.
8. Updates from Staff on upcoming meetings.
Items from Commission and Staff.
Adjournment.
Next meeting: March 20, 2023.
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City of South San Francisco
Legislation Text
P.O. Box 711 (City Hall, 400
Grand Avenue)
South San Francisco, CA
File #:22-977 Agenda Date:12/5/2022
Version:1 Item #:
Reading of the Land Acknowledgement
City of South San Francisco Printed on 11/30/2022Page 1 of 1
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Land
Acknowledgment
We want to acknowledge that we gather in San
Mateo County on the traditional land of the
Ohlone Peoples past and present, and honor
with gratitude the land itself and the people who have stewarded it throughout the generations. We honor and respect the Ohlone Peoples’ long history here that reaches beyond European colonization. We honor and respect the Indigenous people who lived and continue to live upon this territory, and whose practices and spiritualities are tied to the land and its other inhabitants today.
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City of South San Francisco
Legislation Text
P.O. Box 711 (City Hall, 400
Grand Avenue)
South San Francisco, CA
File #:23-152 Agenda Date:2/21/2023
Version:1 Item #:1.
Approval of Minutes from the January 17, 2023 meeting.
City of South San Francisco Printed on 2/17/2023Page 1 of 1
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City of South San Francisco
Minutes of the Commission on Equity and Public Safety
Tuesday, January 17, 2022
Zoom Teleconference Meeting
6:00 pm
Commission Members:
Present: Krystle Cansino, Salvador Delgadillo, PaulaClaudine Hobson-Coard,
Arnel Junio, Alan Perez, Carol Sanders, Steven Yee
Staff Members:
Present: Amy Ferguson, Staff Liaison
Maryjo Nuñez, Management Fellow
Guests: Deputy City Manager Arroyo, Police Chief Campbell,
Director of Public Works Kim
_____________________________________________________________________________________
CALL TO ORDER
The Meeting was called to order at 6:05pm.
AGENDA REVIEW
No changes to the agenda.
APPROVAL OF MINUTES
The Minutes from the December 5, 2022, minutes were approved.
LAND ACKNOWLEDGEMENT
Commissioner PaulaClaudine Hobson-Coard read the Land Acknowledgement.
PUBLIC COMMENT
No public comment.
AGENDA REVIEW
No changes to the agenda.
MATTERS FOR CONSIDERATION
1. Approval of Minutes from December 5, 2022.
Commissioner Yee motioned to approve the minutes, seconded by Commissioner Hobson-Coard. The
Minutes were approved 7-0.
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2. Presentation from Comprehensive Crisis Services from San Francisco Department of Public
Health by Cheryl Martin, Ricardo Carrillo, Stephanie Felder, Neftali Ramirez, Shivika
Dharamrup.
Part One—Presentation Overview
-Provide a holistic approach in terms of serving the clients
-Many languages: Spanish, Tagalog, Chinese, Russian, Arabic, Vietnamese—team meant to reflect the
diversity of San Francisco.
-Basic needs: not eating, sleeping, no shelter will place folks in
-Program created to fill gap when little to no assistance
Part Two—Questions from the Commissioners
Commissioner Yee shared that he is still learning and appreciates learning about 5150 and 5585. He
asked about if they break down the two main groups into different subgroups.
Cheryl Martin: We have the data and can pull it up.
Commissioner Perez had 2 questions and asked 1) if they have a sense of which groups are
disproportionately represented and 2) if the data/the trends has changed during the pandemic?
Felder: doesn’t know if the demographics have changed since the pandemic as collecting data. From her
experience, it doesn’t really vary from this, and it could have changed slightly during the pandemic.
Ramirez: with the street crisis response teams, don’t see children, so the data is not going to be
responsive to that.
Amy Ferguson: staff can work with SFDPH to acquire the data and send it to the Commissioners after the
meeting.
Commissioner Yee asked what is the chunk that is called “other?”
Cheryl Martin shared that she’s not aware of other.
Chair Cansino shared that it could be Suicide Hotline that called in, basically just calls not attached to the
City and County, for example parents who live outside the United States but have adult children living in
San Francisco.
Chair Cansino asked on average how many years per year does SFDPH receive?
Director Felder shared that it’s about 30,000.
Chair Cansino shared that when you are looking at the data and going out into the field, data is
important to look at because more than half are for “Danger to Self” so this helps moving forward. The
way SSF has its pilot program in here, with Mika and a team of officers to make sure the scene is safe,
and then she is able to do her assessment to see which services they need. So, if half the cases are more
so about danger to self, then there might need to be more focus on what else are we looking at? Mental
health at home vs. if danger to others, then have to think about public safety. Especially, as we are
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tasked with expanding the SSF program, this is something I’d like us to have in the back of our minds as
we discuss.
Chair Cansino: the triage aspect of calls, sometimes it’s a focus on the linkage: already linked to services,
so this is something on the back end that we can help with. Basically, looking at natural safety nets
rather than looking/getting strangers—unless it’s warranted—so there is quite a bit of effort, de-
escalation starts before and sometimes don’t have to get crisis team on the field, still provide that
linkages and do follow-ups.
Commissioner Yee: what kind of transformational data do you have?
Cheryl Martin: from an operational standpoint, we do have a data person…
Chair Cansino: there is data available online and every year, puts together a presentation with the
context. Those numbers are based on what to do for budget—where are we going to allocate the city’s
budget—so when looking at the data, that helps to see where outreach is needed/where the gaps are.
The big gaps are for example, the building has never gotten bigger, but now we need 8 doors.
Cheryl: if there is not a consensus among the crisis care specialists, go back to the Director and present
the case, so it’s not necessarily all up to one person about what happens clinically. Also, this is a very
intense job, as supervisors, we need to make sure people are safe to minimize burnout.
Commissioner Yee asked the presenters if they would describe this more as homegrown?
Dr. Carrillo: we say that the job is like going to boot camp—you have a lot to learn, learn the newest
technologies, do training, then go out as a observer and do this at least 6 times to be a leader. But you
have to know theory so you can incorporate that. This job is no joke. And this relates to quality of care;
not everyone can do this job, so we need to find out if folks are committed to team, city and county.
Chair Cansino: it is homegrown. We start our practice when you walk into the door. Our clinic is very
unique and constantly changing.
Neftali: it started out by going out to folks in the street, homeless, drug induced psychosis, business
owners wanted them to move, domestic violence… so whether that be someone who wants shelter, we
are allotted beds in the city’s shelter, so those arrangements could be made to get folks out of the
street. For his other team, we do have the capability of working with police; the collab that we have with
comprehensive services is better than the street crisis response team (working with police) probably
because we don’t train with them.
As of November 2022, we are at 18,000 calls. We get dispatched like ambulances, so if we are in the
vicinity, we send whoever is closest and there is a 15 min. timeline, so beyond 15 min., will send an
ambulance.
Commissioner Yee: is the ~20,000 a good or bad number?
Neftali: well, folks describe crisis in different ways. For example, in the mornings, we usually get calls
from business owners when someone is on their business. So sometimes, the client is not necessarily
the person needing the services, so we educate them on what we can do as well as the rights of the
unhoused. We cannot move the unhoused.
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Amy Ferguson asked if there perceived some different pros/cons with working with or without the
police?
Shivika: also working with Berkeley and responds with the Police with the most of time; have a police
radio, get dispatched like how officers do. It depends on the agency, BPD has good de-escalation
techniques; sometimes it depends on the relationship too, with PD due to their uniform, sometimes
they have the better relationship or sometimes they have a better relationship with her because of that.
She also works with Marin County mobile crisis team but theirs is not based with police.
Chair Cansino: when we do get referrals from the public, sometimes it is requested that police do not
accompany; if it is safe then ok, but if there is an inkling of uncertainty, sometimes police are stationed
nearby. There is a new law that unless there is a crime being committed, officers cannot break down
that door, so if there is someone who needs more help, police cannot drag someone out, etc. This will
be a big game changer to the field in general.
Neftali: working with the police, you can get more information. Some officers do know about the clients
and what their triggers are, so we can receive that information when working/engaging with the clients.
Chair Cansino wonders if this is different for Mika and SSFPD, Chief Campbell does Mika have collateral
information for a patient is about to see?
Chief Campbell; yes, she does have access to county records.
Commissioner Yee: what is something that you recognize that you are not going to do again, systems-
wise?
Shivika: if there’s an inkling of unsafety, then will not chance it. She has been in situations where it was
not fine.
Neftali: it is very important to have a colleague with you, especially when going indoors into a confined
safe, so yes, the safety aspect is very important.
The questions that dispatch is asking is also about judging the safety of the officers, as well as the client.
Chair Cansino shared that next month, the Commission will have Berkeley, so they are doing their due
diligence to look at what our neighboring cities are doing so that they can offer recommendations to
City Council.
3. Election of Chair and Vice Chair for 2023
Commissioner Junio nominates Krystle Cansino for Chair. She accepts the nomination.
Hobson-Coard nominated Arnel Junio for Chair. He declines the nomination.
Votes for Krystle Cansino:
Commissioner Yee: Yes
Commissioner Sanders: Yes
Commissioner Perez: Yes
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Commissioner Hobson-Coard: Yes
Commissioner Junio: Yes
Commissioner Delgadillo: Yes
Commissioner Cansino: abstained
Motion passes and Krystle Cansino remains the Chair.
Chair Cansino nominates Arnel Junio for Vice Chair and Steven Yee for Vice Chair.
Commissioner Yee declines the nomination.
Commissioner Yee: Yes
Commissioner Sanders: Yes
Commissioner Perez: Yes
Commissioner Hobson-Coard: Yes
Commissioner Junio: Yes
Commissioner Delgadillo: Yes
Commissioner Cansino: Yes
Motion passes and Arnel Junio remains the Vice Chair.
4. Future Agenda Items
Commissioner Yee: I’m noticing we explore different agencies which is interesting, but it might be
helpful to have some sort of scorecard of some core things to cross-check.
Chair Cansino: yes, she is on the same page. She also would like discussion time. Is that something that
we’d like to have agendized?
Sanders: yes, would appreciate this.
Amy: There will be staff reports moving forward.
Cansino: and maybe the mental health subcommittee can meet more regularly.
Amy: Also, Commissioner Perez had asked for data to be received earlier, so staff can work on this.
Chair Cansino: is everyone still good with Feb. 21?
Commissioner Yee: can still make it but will have to be 30 minutes late.
Deputy City Manager Arroyo: we have DEI application in CalOpps, so we are moving forward that as a
high priority. She appreciates the work that the Commission is doing.
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ADJOURNMENT
The meeting adjourned at 8:08pm.
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City of South San Francisco
Legislation Text
P.O. Box 711 (City Hall, 400
Grand Avenue)
South San Francisco, CA
File #:23-153 Agenda Date:2/21/2023
Version:1 Item #:2.
Presentation of scorecard for Commissioners’ use.
RECOMMENDATION
It is recommended that the Commissioners utilize the scorecard for the various organization
presentations they hear.
BACKGROUND/DISCUSSION
The Commission on Equity and Public Safety have been engaged in learning about many of the mental health
teams throughout the Bay Area,and given the similarities and differences,Commissioners have expressed a
desire for a “scorecard”or tool to help them organize the information presented.Staff then created such a
scorecard for the Commissioners to utilize and follow along as more groups present their organization’s
structure, team, and mission.
CONCLUSION
This scorecard aims to give the Commissioners a streamlined way of gathering information and facilitate
discussion. By keeping track in this way, Commissioners can share feedback for the organization’s structure,
team, and mission.
City of South San Francisco Printed on 2/17/2023Page 1 of 1
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Scorecard for Commission on Equity and Public Safety
This scorecard is intended to guide Commissioners in learning from presentations on alternative mental
health crisis response models.
1) What do you like about this program?
a. Eg. What is their system? How are they targeting certain populations? Do they work
with Police or not?
2) How does this program differ from the SSF program?
3) What is something new in this program that you think SSF should adopt?
4) What challenges does this program have that we can learn from?
a. Eg. How do they manage populations that don’t want to call the police? What kinds of
services do they provide? Do they have case management or not? Where are the gaps?
5) How is this program funded?
6) What other assessments do you have?
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City of South San Francisco
Legislation Text
P.O. Box 711 (City Hall, 400
Grand Avenue)
South San Francisco, CA
File #:23-143 Agenda Date:2/21/2023
Version:1 Item #:3.
Presentation on Berkeley’s Mobile Crisis Team by Allyson Nakayama LCSW,Mental Health Program
Supervisor.
RECOMMENDATION
It is recommended that the Commission on Equity and Public Safety meet staff from Berkeley’s
Mobile Crisis Team and receive an introduction to the team and its work.
BACKGROUND/DISCUSSION
Berkeley’s Mobile Crisis Team also is a co-responder model,though the clinicians are based out of the adult
mental health clinic and not in the police department.
The Berkely City Council has approved funding and a community-based organization has been selected for the
Specialized Care Unit (SCU)’s two-year pilot project, the selection was announced in December of 2022.
Allyson Nakayama can speak about the recommendations that were provided to the City of Berkeley’s City
Council by a consulting firm that was hired to collect feedback and information from the agency,as well as
community organizations and other stakeholders,about the core components and what the desired model of the
SCU.
CONCLUSION
After learning more about Berkeley’s Mobile Crisis Team, the Commission should be more aware of
other mental health services within the Bay Area and acquire more information to utilize when
discussing mental health within South San Francisco specifically.
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Mental Health Division
Crisis Services
Program
Berkeley Mental
Health
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Table of
Contents
Mobile Crisis History
MCT Basics
Goals and Purpose of MCT
Additional Crisis Response
Options
Specialized Care Unit
Key Recommendations for
SCU
Proposal from Bonita House
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CITY OF BERKELEY Mental Health 3
Brief History of the Mobile Crisis Team (MCT)
•1970s: Individuals with mental health challenges returned from
institutionalization to community-based care as part of the consumer and recovery movements
•This led to many of these individuals having increased police contact in the community, including Berkeley
Crisis Services Program
Mobile Crisis
History
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CITY OF BERKELEY Mental Health 4
Brief History of the Mobile Crisis Team (MCT)
•1979: “Berkeley Mental Health Police Project” pilot established and MH staff were paired with BPD on patrol
•Today: Two staff are able to respond separately during the day and are paired up at night.
•Team is based on a co-responder model.
Crisis Services Program
Mobile Crisis
History
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CITY OF BERKELEY Mental Health 5
Days and Hours of Operation
Mondays, Wednesdays, Thursdays, Fridays
and Sundays: 11:30am to 10pm
No Service on Tuesdays or Saturdays
Crisis Services Program
Mobile Crisis Basics
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CITY OF BERKELEY Mental Health 6
•Provide first response crisis
intervention and on scene
consultation to BPD and other
regional police departments
•Divert individuals with mental health
disorders from the criminal justice
system into treatment
Crisis Services Program
Goals and Purpose of MCT
•Reduce the impact of mental health
emergencies through immediate
response to crisis situations at the
street-level and through coordination
and consultation with local public
safety organizations, hospitals and
other community groups.
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CITY OF BERKELEY Mental Health 7
Specialized Care Unit (SCU)
Non-law enforcement option for response to mental health crises and substance use emergencies made up of a mental health clinician, peer specialist, and medical professional.
https://berkeleyca.gov/sites/default/files/documents/Berkeley-MH-SCU_Final-Recommendations_FINAL.pdf
UC Berkeley Campus Mobile Crisis Response ProjectNon-law enforcement option for responses to mental health crises on and around campus/campus properties.
https://bpm.berkeley.edu/projects/active-projects/reimagining-uc-berkeley-campus-and-community-safety-program/campus-mobile#MostRecentStatus
Crisis Services Program
Additional Crisis Response Options
25
CITY OF BERKELEY Mental Health 8
•The contract was awarded to Bonita House,
who has a similar contract with Alameda
County, in December 2022
•Contract was signed on Feb. 9, 2023 and
Bonita House will now be moving forward with
operational planning and structuring
Crisis Services Program
Specialized Care Unit
(SCU)
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CITY OF BERKELEY Mental Health 9
1.The SCU should respond to mental health crises
and substance use emergencies without a police
co-response.
2.The SCU should operate 24/7.
3.Staff a three-person SCU mobile team to respond
to mental health and substance use emergencies.
4.Equip the SCU mobile team with vans.
5.The SCU mobile team should provide transport to a
variety of locations.
6.Equip the SCU mobile team with supplies to meet
the array of clients’ needs.
Crisis Services Program
Key Recommendation for
SCU
7. Clearly distinguish the SCU from MCT.
8. Participate in the Dispatch assessment and planning
process to prepare for future integration.
9. Ensure the community has a 24/7 live phone line to
access the SCU.
10. Plan for embedding a mental health or behavioral
health clinician into Dispatch to support triage and SCU
deployment.
11. Fully staff a comprehensive model to ensure the
success of the SCU mobile team, including supervisory
and administrative support.
12. Operate one SCU mobile team per shift for three 10-
hour shifts.
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CITY OF BERKELEY Mental Health 10
13. SCU staff and Dispatch personnel should travel to
alternative crisis programs for in person observation and
training.
14. Prepare the SCU mobile team with training.
15. Contract the SCU model to a CBO.
16. Integrate the SCU into existing data systems.
17. Collect and publish mental health crisis response data
publicly on Berkeley’s Open Data Portal.
18. Implement care coordination case management
meetings for crisis service providers.
Crisis Services Program
Key Recommendation for
SCU
19. Implement centralized coordination and leadership across city agencies to support the success of mental health crisis response.
20. Continue the existing SCU Steering Committee as an advisory body.
21. Solicit ongoing community input and feedback.
22. Adopt a rapid monitoring, assessment, and learning process.
23. Conduct a formal annual evaluation.
24. Launch a public awareness campaign to promote community awareness and education about the SCU.
25. The SCU mobile team should conduct outreach and build relationships with potential service utilizers.
https://berkeleyca.gov/sites/default/files/documents/Berkeley-MH-SCU_Final-Recommendations_FINAL.pdf
28
CITY OF BERKELEY Mental Health 11
Anticipated launch date:
Summer 2023
•Three person team (Clinician, EMT,
and Peer) who can complete 5150
psychiatric evaluations, provide
basic medical services, and linkage
•Each team would work 10 hr shifts
over a 24 hr period to allow for
overlap between teams
Crisis Services Program
Proposal from
Bonita House
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CITY OF BERKELEY Mental Health 12
•Receive calls for service through
hotline, onview, and referrals from
911
•Protocol for how to receive referrals
from 911 pending
•Starting Feb. 2023, community will
be provided monthly updates re:
progress
Crisis Services Program
Proposal from
Bonita House
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Thank you!
Allyson Nakayama, LCSW
[email protected]
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City of South San Francisco
Legislation Text
P.O. Box 711 (City Hall, 400
Grand Avenue)
South San Francisco, CA
File #:23-155 Agenda Date:2/21/2023
Version:1 Item #:6.
Presentation of Data on the Community Wellness and Crisis Response Team by Captain Adam Plank,SSF
Police Department and Jaymes Pyne, John W. Gardner Center at Stanford University.
RECOMMENDATION
It is recommended that the Commission on Equity and Public Safety receive a presentation on data on the
Community Wellness and Crisis Response Team and ask any questions about the data.
BACKGROUND/DISCUSSION
The Community Wellness and Crisis Response Team is a law enforcement and mental health partnership
between the South San Francisco Police Department (SSFPD), the non-profit StarVista, and Behavioral Health
and Recovery Services (BHRS) of San Mateo County Health Department. The program involves San Mateo
County and four cities, each with their own clinician to partner with their respective police departments. The
four cities are South San Francisco, Daly City, Redwood City, and the City of San Mateo.
A team from the Gardner Center at Stanford University is conducting regular data analysis to determine the
program's effects, assess outcomes, and consider appropriate adjustments. Desired outcomes include reduced
use of public safety and emergency services, reduced contact between individuals with behavioral health issues
and the criminal justice system, improved residential and behavioral health stability, and others.
The program is a pilot program that officially started responding to calls on December 8, 2021. The pilot
program will last for two years and then be evaluated for continuation.
In fall of 2022, SSFPD prepared a data analysis of the CWCRT program from January through August of 2022.
The data showed that Clinician Celli had responded to 65 of the 274 incidents throughout the year that resulted
in a mental health evaluation. The report breaks down timing of calls; age, race, and housing status of
individuals involved; and description of use of force incidents. Additional information is available in the report.
In September 2022,the Gardner Center team released an interim report showing their data analysis on the
program thus far.This includes defining a Theory of Change;data from interviews,observations,documents,
and police records; and emerging themes. Additional information is available in the report.
CONCLUSION
As the Equity Commission considers recommendations for expansion of the Community Wellness and Crisis
Response Team, it is beneficial that they review the data on the program thus far to see how well the program is
meeting its intended objectives. It is recommended for the Commission to ask any questions about the data to
inform their perspective. The Commission will continue to receive data on the program as the pilot continues
until December 2023.
City of South San Francisco Printed on 2/17/2023Page 1 of 1
powered by Legistar™32
Community Wellness –Crisis Response Team
Data Presentation
Captain Adam Plank –South San Francisco Police Department
Doctor Jaymes Pyne –John W. Gardner Center
33
CWCRT Pilot Program Review
▪December 2021 to December 2023
▪Clinician hours Monday to Friday from 9am to 5pm
▪Co-response model (officer and clinician)
▪Responds via dispatch, officer request, or self-initiated contacts with community members
▪Attempts minimally one follow-up after initial response
34
Historical Data
400
317
406
465
397
0
50
100
150
200
250
300
350
400
450
500
2018 2019 2020 2021 2022
5150 W&I Mental Health Calls
35
Location of Calls -2018
36
Location of Calls -2019
37
Location of Calls -2020
38
Location of Calls -2021
39
Location of Calls -2022
40
City of South San Francisco
41
Total 5150 W&I Holds
49 47
27 25
34 32 34
26
36
33
24
27
0
10
20
30
40
50
60
January February March April May June July August September October November December
2022 Monthly Data
42
Officer/Clinician Contacts
36
41
19
23 25 26 25
13
31 29
23 23
13
6 8
2
9
6
9
13
5 4
1
4
0
5
10
15
20
25
30
35
40
45
January February March April May June July August September October November December
2022 Monthly Data -5150 W&I holds
Officer
Clinician
43
Daily Totals
54 55
51
62
57 58 57
0
10
20
30
40
50
60
70
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
2022 –Day of Calls
44
Time of Calls
79 80 79
71
57
28
0
10
20
30
40
50
60
70
80
90
9am-1pm 1pm-5pm 5pm-9pm 9pm-1am 1am-5am 5am-9am
2022 -Time of Calls
45
Age Range
34
89 87
66
55
63
0
10
20
30
40
50
60
70
80
90
100
Under 18 18-29 30-39 40-49 50-59 Over 59
2022 Age of Involved Individuals
46
Race/Ethnicity
49
54
129
135
27
0 20 40 60 80 100 120 140 160
Asian
Black
Hispanic
White
Other
2022 Race/Ethnicity of Involved Individuals
47
Gender
Male
57%
Female
2022 Gender of Involved Individuals
48
Housing Status
Housed
73%
Unhoused
27%
2022 Housing Status of Involved Individuals
Housed
Unhoused
49
Residence
235
113
9
1
2
5
1
3
4
13
6
2
0 50 100 150 200 250
SSF
Out of County
San Bruno
Broadmoor
Burlingame
Daly City
Millbrae
Brisbane
Pacifica
San Mateo
Redwood City
East Palo Alto
2022 City of Residence of Involved Individuals
50
Incidents Involving Crimes -Frequency
14
1 2 3
1
3 2 3 3
6
1 1
0
2
4
6
8
10
12
14
16
Additional Charges Involved
51
Use of Force -Frequency
3
1 1
0 0 0 0
2
0
1
0 00
0.5
1
1.5
2
2.5
3
3.5
Incidents Involving Use of Force
52
CWCRT Pilot Program Data
Clinician Activity
•278 total incident responses and follow-ups
•320 additional incidents reported when “off-duty”
•29 incidents reported during scheduled hours, but when clinician unavailable
•Department trainings (formal/informal)
•Support (critical incidents)
53
Calls Initiating Clinician Response
1.Welfare Checks
2.Mental Health Crisis
3.Miscellaneous Call for Services
4.Disturbances
5.Suspicious Person/Vehicle
6.Fire Department Assist
7.Trespassing
8.Juvenile Cases
9.Court Order Violations
10.Assaults
54
Frequency of Actions Taken
1.Emotional Support
2.Provided Resources
3.5150 W&I Evaluation
4.5150 W&I hold/transport
5.Safety Plan
6.Subject Declined Services
7.Referred to Outside Agency
55
Community Wellness and Crisis Response Team
The Community Wellness and Crisis Response Team data in this report includes calls for service within South San Francisco from January through
August of 2022. Our Mental Health Clinician, Mikaela Celli, works Monday to Friday from 9:00 am to 5:00 pm and is available in person, by
telephone, and via a portable police radio. Clinician Celli responds to mental health related calls for service at the request of officers, at the
request of dispatchers, or at the request of community members who call for assistance. From January to August, the police department was
involved with 274 incidents where a subject was transported to a medical facility for a mental health evaluation. The criteria for a mental health
evaluation involves someone who is presently a danger to themselves, a danger to other individuals, or someone who is gravely disabled and
unable to care for themselves.
Clinician Celli responded to 65 of the 274 incidents resulting in a mental health evaluation. Clinician Celli responded to a total of 137 behavior
health related calls and had successful follow-up conversations with 90 of the involved individuals (66%). On the cases where follow-up could
not be completed, the individuals refused additional assistance or did not have a working telephone. During the calls that did not result in the
subject being placed on a mental health evaluation hold, Clinician Celli provided alternative outcomes like emotional support, developing safety
plans, and referring the involved individual and/or their family to resources.
The following charts illustrate the Community Wellness and Crisis Response Team activity of the South San Francisco Police Department:
56
Between January and August, the police department received a total of 274 calls for service that resulted in an individual being transported to a
medical facility on a mental health evaluation hold. Clinician Celli was the primary point of contact in 65 of those incidents (24%) and police
officers were the primary contact in 209 incidents (76%).
36
41
19
23
25
27
25
13
13
6
8
2
9
5
9
13
0 5 10 15 20 25 30 35 40 45
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
Mental Health Evaluations -Total
Clinician Response
Officer Response
57
Clinician Celli currently works Monday through Friday from 9:00 am to 5:00 pm. The most frequent days of the week when Clinician Celli
responded to calls involving a mental health evaluation hold was Tuesdays and Thursdays.
27
28
23
29
35
34
33
14
15
12
16
7
1
0
0 5 10 15 20 25 30 35 40
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
Method of Response -Clinician / Officer
Clinician Response
Officer Response
58
As a department, the most frequent age of individuals placed on a mental health evaluation from January through August was those between 18
to 29 years old.
Under 18: 9% 18-29: 24% 30-39: 21% 40-49: 18% 50-59: 12% Over 59: 16%
0 2 4 6 8 10 12 14 16 18 20
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
Age of Involved Individuals
Over 59
50-59
40-49
30-39
18-29
Under 18
59
The following chart represents the race of all individuals who were transported to a medical facility for a mental health evaluation. The data also
includes individuals who had more than one incident where they were placed on a mental health evaluation hold.
Asian: 13% Black: 13% Hispanic: 32% White: 34% Other: 8%
0 2 4 6 8 10 12 14 16 18 20
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
Race of Involved Individuals
Other
White
Hispanic
Black
Asian
60
Within South San Francisco, the housing status of involved individuals showed 72% were housed at the time of the incident while 28%
experienced homelessness. The most frequent month where homeless individuals were placed on a mental health evaluation was February.
0 5 10 15 20 25 30 35 40 45
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
Housing Status of Individuals
Homeless
Housed
61
As a department, the mental health incidents occurred most frequently on Tuesdays (50) and Thursdays (45) but occurred regularly every day of
the week. At this point in the program, the data supports Clinician Celli’s current schedule of Monday through Friday.
0 2 4 6 8 10 12
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
Response -Day of Week (Total)
Sunday
Saturday
Friday
Thursday
Wednesday
Tuesday
Monday
62
As a department, the mental health evaluations occur most frequently between 9:00 pm and 1:00 am and accounts for 22% of the total calls
from January to July. The least frequent time of day is between 5am and 9am, which is 7% of all calls. The clinician schedule is between 9:00 am
to 5:00 pm and she was on-duty for 38% of all mental health evaluation calls. However, Clinician Celli could not respond to every incident due to
trainings, meetings, or simultaneous calls for service.
0 2 4 6 8 10 12 14 16
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
Response -Time of Day (Total)
9pm-1am
5pm-9pm
1pm-5pm
9am-1pm
5am-9am
1am-5am
63
To date, there have been 29 cases (11%) where the involved individual committed a criminal violation resulting in a police report being sent to
the District Attorney’s Office for prosecution. In all cases, the involved individual was transported to a medical facility for a mental health
evaluation before proceeding with any custody or court proceedings.
14
1
2
3
1
3
2
3
0
2
4
6
8
10
12
14
16
JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST
Additional Charges
Additional Charges
64
There was a total of 7 incidents when officers used force to detain or overcome physical resistance during a mental health evaluation when an
individual was transported to a medical facility. Force was used during 2% of the 274 mental health evaluations and was not required in April,
May, June, or July.
• Officers were investigating a domestic violence incident when the involved female began intentionally hitting her head on the wall of a
building. Officers successfully de-escalated the situation with verbal commands and tried to continue their investigation, but the female
attempted to flee and ignored orders to remain at the scene. The officers placed the female in handcuffs based on her erratic behavior and
attempts to leave. While in handcuffs, the female attempted to bite one of the officers on the hand two separate times.
• Officers were investigating a behavioral health call where a subject was destroying property inside of a residence and threatening to harm
himself with a glass bottle. Officers were able to verbally de-escalate the situation and safely contact the subject outside of the residence,
but he suddenly became agitated and intentionally struck his head on the side of a parked vehicle. The officers attempted to move the
subject away from the vehicle to prevent further injury, but he physically resisted the officers and was detained in handcuffs to limit his
movements. The subject injured an officer during the incident when he forcefully grabbed the officer’s genitals two separate times.
• Officers were investigating a behavioral health call where a subject was actively assaulting one of his family members while officers were on
scene. When the officers were attempting to detain the subject in handcuffs to prevent a continued assault, he punched an officer in the
chest and kicked the officer in the leg before he could be restrained.
• Officers responded to a hotel room at the Travelodge Hotel on a report of a verbal disturbance that possibly involved a physical assault. A
second caller reported an assault inside the hotel room, and they heard a male, a female, and children screaming from inside. When officers
arrived, they contacted two females inside the room. The room was in disarray and one of the females immediately ran away from officers
before they could determine if a crime occurred. Officers detained the female in handcuffs a short distance away so they could investigate
the original incident. Officers determined the female who attempted to flee had assaulted the other female by pushing her into the frame of
a door, which caused visible injuries. Based on suicidal statements during the investigation, the female was transported to the hospital on a
mental health evaluation hold and the report was sent to the District Attorney’s Office to review for prosecution of additional charges.
• Officers responded to the Comfort Suites Hotel to contact an individual who was on Post Release Community Supervision and had an active
arrest warrant for violating a restraining order. The individual resisted arrest and threatened officers when they attempted to place him in
handcuffs. Officers physically restrained the individual’s hands behind his back while placing him in handcuffs. After the arrest, the individual
made suicidal statements and was transported to a medical facility.
65
• Officers responded to a residence on the report of a 35-year-old male who punched his elderly father in the face two times because the son
had not been taking his prescribed medication. When officers were conducting their investigation, the same individual punched a second
resident in the face and then attempted to flee from the scene. Officers briefly struggled with the individual but were able to safely detain
him in handcuffs to prevent additional attacks. The individual was transported to a medical facility for a mental health evaluation before
being booked at the county jail for violations of elder abuse and battery.
• Officers responded to a residence on the report of a 37-year-old female who made suicidal statements. Clinician Celli determined the
individual met the criteria for a mental health evaluation and fire department personnel assisted her into the back of an ambulance. Once in
the ambulance, the individual began throwing medical equipment at the first responders and they were forced to restrain her hands to the
gurney. The individual scratched an EMT on the hand and bit/scratched an officer on the wrist during the incident. The individual was
transported to a medical facility for a mental health evaluation and the report was forwarded to the District Attorney’s Office to review for
prosecution of the battery charges.
66
CWCRT Pilot Program: September 2022 Interim Report ● 1
interim report
September 2022
SAN MATEO COUNTY COMMUNITY WELLNESS AND CRISIS RESPONSE TEAM PILOT
PROGRAM
Cities across the country are deploying models of collaboration between police and mental health
providers. To address ongoing local needs for immediate mental health services, San Mateo
County (SMC) began piloting the Community Wellness and Crisis Response Team (CWCRT)
program in its four largest cities: Daly City, South San Francisco, San Mateo, and Redwood City.
The pilot includes collaboration between the four cities, San Mateo County’s Behavioral Health
and Recovery Services (BHRS), and StarVista (a nonprofit organization offering counseling and
crisis prevention services) to implement a co-response model partnering sworn law-enforcement
officers with mental health clinicians in a first-responder framework. This pilot program is slated
to function for two years, from December 2021 through December 2023.
As part of the pilot program, SMC engaged the John W. Gardner Center for Youth and their
Communities (Gardner Center) to conduct an independent evaluation of program implementation
and outcomes. The evaluation aims to describe the pilot program, identify factors impacting
implementation, understand key outcomes, and highlight opportunities for learning and
improvement. With these goals in mind, researchers designed the evaluation to investigate four
questions:
1. What are the key elements, activities, and intended outcomes of the CWCRT program?
2. How do the individuals involved in program implementation (e.g., those designing and
leading the work as well as clinicians and officers) experience the co-response model?
3. What factors appear to facilitate and/or complicate implementation of the CWCRT
program?
4. What outcomes (e.g., arrest rates, officer time-on-scene, emergency hold rates) are
associated with or attributed to the CWCRT program?
This interim report comes nearer to the beginning of the pilot program than its end. It is thus not
intended to answer the above research questions fully, nor make any summative evaluation of
the pilot program or its effectiveness over the first seven months of the pilot phase. Rather, this
interim report is formative by design, documenting the Gardner Center’s progress towards
answering these key research questions, and presenting emerging themes in the preliminary
analysis of data collected December 2021–June 2022.
The report begins with a background of the CWCRT pilot program, positioning it in the context of
the county and the national climate around police reform. Next, we focus on research progress
and emerging themes among the four core elements of implementation: Dispatch, Co-Response,
Continuum of Care, and Professional Development. From there, we describe three factors that
appear to impact the early phase of implementation. Finally, we offer emerging findings related to
three of the program’s short-term outcomes and highlight next steps in the evaluation.
67
CWCRT Pilot Program: September 2022 Interim Report ● 2
PILOT PROGRAM BACKGROUND
Given the volume of 911 calls involving a mental health component, first responders (e.g., police
officers, deputies, medics, and dispatchers) are part of the county’s ecosystem of mental health
services. Recognizing the importance of a first responder’s role in promoting a positive outcome
for those in such a crisis, SMC began partnering with the National Alliance on Mental Illness San
Mateo, the Sheriff’s Office, and Behavioral Health and Recovery Services (BHRS) in 2005 to
provide first responders with crisis intervention training (CIT). While CIT-trained first responders
are capable of attending to individuals experiencing a mental health crisis, they do not have
clinical mental health expertise. Therefore, they are often limited to stabilizing the situation, or at
most connecting individuals in crisis to a clinician via emergency psychiatric services.
San Mateo County has several public services in place to support those experiencing mental
health crises, such as the San Mateo Assessment and Referral Team, the Psychiatric Emergency
Response Team, and health-related programs affiliated with local school districts (e.g., San Mateo
Union High School District’s School Based Mental Health and Wellness Program). While these
services provide essential and potentially life-saving support, many community members will, in
a moment of crisis, access support simply by dialing 911.
The county’s two-year pilot of the CWCRT program addresses such needs. A part of the pilot
phase includes an evaluation conducted by Stanford University’s John W. Gardner Center for
Youth and their Communities, a center with expertise in studying the implementation and
outcomes of cross-sector collaborations designed to improve the lives of youth, families, and
communities. The CWCRT evaluation will provide valuable data for improving public safety and
health in the County, and it will contribute to the growing field of evidence-based models for
improving the outcomes of individuals who call 911 for support with a mental health-related crisis.
The four largest cities in the county (Daly City, Redwood City, San Mateo, and South San
Francisco) have collaborated with BHRS and StarVista to develop a “co-response” model to
optimize outcomes for those experiencing a mental health-related crisis. Launched in fall 2021,
the CWCRT Pilot Program embeds a mental health clinician within each police department. The
program dispatches the department’s clinician to calls with a known or suspected mental health
component, at the same time as sworn law-enforcement officers are dispatched, and arriving on
scene in a separate, unmarked vehicle and in plain clothes (County of San Mateo, 2021). A key
goal of this collaborative effort is to combine the expertise and resources of both law enforcement
and mental health professionals to best serve the public in a timely manner, and, in turn, to
improve the outcomes of those served.
San Mateo County is not alone in this work. Various models of collaborations between police and
mental health providers have been implemented across the country, some of which have been
studied to assess their effectiveness (Puntis, 2018; Seo, Kim, & Kruis, 2020a; Seo, Kim, & Kruis,
2020b; Shapiro et al., 2015; White & Weisburd, 2018). So far, efforts to credibly evaluate the
effectiveness of such co-response programs have been limited (Dee & Pyne, 2022), with one
group of evaluators emphasizing “… caution against drawing conclusions related to causality
based on these findings” (Seo, Kim & Kruis 2020a, p. 12). Under the right conditions, our
innovative approach to understanding the co-response program in San Mateo County will add to
the evidentiary basis of this class of emergency response programs.
68
CWCRT Pilot Program: September 2022 Interim Report ● 3
RESEARCH ACTIVITY PROGRESS
Theory of Change (Complete)
The first step in an evaluation attending to both implementation and outcomes is to develop a
theory of change (TOC). A TOC is more than just a program overview: it makes explicit the
assumptions embedded within the program design, specifically those regarding the relationship
between program elements and program outcomes. The members of the CWCRT Pilot Program’s
advisory group and working group engaged in a collaborative process to develop the program’s
TOC, completed in August 2022.1 The TOC provides the foundation for program implementation
and evaluation and is a living document. Circumstances change over the course of program
implementation, often prompting modifications to the TOC. The intention is to begin the evaluation
with a sound TOC describing the assumptions embedded within the program design, and then
revisit and revise the TOC as needed until the conclusion of the evaluation.
Data Collection (Phase 1 Complete)
The Gardner Center is collecting data on (a) implementation of the pilot program and (b) the pilot
program’s outcomes. In studying the CWCRT pilot program’s implementation, we are collecting
data via interviews, observations, video recordings of meetings, and program-related documents.
Each of these research methods helps us understand how a program is implemented in a
particular context, the strengths and challenges of that process, and the factors that impact
implementation. In examining available and actionable outcomes of the program (e.g., incident
and arrest rates, officer time-on-scene, 5150 referral rates), we are procuring police agency
administrative records.2 Phase 1 of data collection, focusing on the first seven months of
implementation, is complete and consisted of the following:
Interviews
We conducted and are in the process of analyzing data gathered through 30 interviews with
individuals representing all four participating cities (24% from Daly City, 21% from Redwood City,
24% from San Mateo, and 21% from South San Francisco). The remaining 10% of the
interviewees are affiliated with organizations that are not city-specific (e.g., San Mateo County,
StarVista, BHRS). Half of the interviewees are affiliated with one of the four participating police
departments (including chiefs, captains, sergeants, and officers). The other half of the
interviewees are city or county government staff, such as city managers, leaders of city equity
and inclusion efforts, and county supervisors (17%) and staff from BHRS and StarVista (including
mental health clinicians) (33%).
1 The CWCRT Advisory Group provides cross-sector collaborative leadership for the pilot program, and it includes
representatives from county and city governance, police, BHRS, and StarVista. The CWCRT Working Group oversees
the day-to-day implementation of the pilot program, and it includes representation from all four participating cities’ police
departments, BHRS, and StarVista. The final TOC developed in collaboration with both the Working and Advisory
Groups is included in Appendix A. The graphic representation of the TOC is also included Figure 1.
2 Police records are certainly not the only data sources to help understand key programmatic outcomes, nor are our
focal outcomes the only ones important to policymakers and stakeholders. Our decision to use police records comes
down to two crucial considerations: (1) Police records are detailed and offer many direct links to the program’s
implementation; and (2) they provide clear pathways to evaluating the program’s impact in credibly causal ways.
69
CWCRT Pilot Program: September 2022 Interim Report ● 4
Observations
We conducted and are in the process of analyzing data gathered through 22 observations of
regularly occurring meetings held as part of program implementation. These observations
included regular meetings of the Advisory Group (n=8), the Working Group (n=7), BHRS/StarVista
(n=3), police advisory committees (n=2), as well as meetings with city staff in leadership roles
connected to the pilot program, such as equity and inclusion officers and dispatch services (n=2).
In addition to observing live meetings, we also collected and are in the process of viewing and
analyzing video recordings of one city’s Police Advisory Committee (n=16) and one city’s virtual
town hall with a focus on the CWCRT pilot program.
Documents
We collected and are in the process of analyzing 54 documents that were developed by program
partners in the course of program planning, design, and implementation, such as the program’s
original proposal for funding and various policy documents developed by program partners (n=7),
local news articles and press releases regarding the pilot program (n=14), personal
communications from project partners (n=3), and meeting agendas and minutes from one city’s
police advisory meetings (n=30).
Police Agency Administrative Records
Each police agency collects data on each call for service (i.e., “incidents”), which include some
basic information such as the incident type, the officer time on scene, and whether a case was
opened for the incident that may involve a charge, arrest, or citation. Procuring incident-level
police agency administrative records has involved several procedural stages. First, we have
conducted site visits to three of the four police agencies to better understand administrative data
collection and storage as well as data availability and structure. Researchers have also met on
many occasions with each of the agencies to discuss data use agreements (DUAs) and data
transfers. All four agencies agreed to and signed DUAs and have transferred incident-level data
from January 1, 2019 through June 30, 2022 to the Gardner Center’s secure servers. We observe
a total of 121,065 calls for service recorded by 911 dispatchers in the four participating cities
during this time period. The co-response incidents we track are a subset of these calls for service,
and Gardner Center continues to process data from the four police agencies in a way that
standardizes key variables across agencies.
EMERGING THEMES IN CORE PROGRAM ELEMENTS
Preliminary analyses of data collected during the first seven months of implementation yields a
few emerging themes described below, drawn from interviews, observations, documents, and
police agency administrative data. We report on these themes to present descriptive progress on
key outcomes of the program. That is, we do not intend our current reporting on these emerging
themes to make causal claims about the pilot program’s effectiveness; they instead describe the
program’s progress, and the concurrent progress the Gardner Center is making for a more
summative evaluation at the conclusion of the pilot program. Gardner Center researchers will
70
CWCRT Pilot Program: September 2022 Interim Report ● 5
continue to follow these themes throughout the upcoming phases of data collection, analysis, and
reporting.
Figure 1. Program Theory of Change
Long-Term Outcomes
Individuals receiving emergency
services via 911 for a crisis
involving a mental health
component experience positive outcomes including but not
limited to low rates of involvement with the criminal
justice system (e.g., reduced
recidivism).
Goals
Improve public safety and public
health throughout San Mateo
County through cross-sector
collaboration and coordination among law enforcement, criminal
justice, and health/human services.
Short-Term Outcomes
Co-response team meets the immediate
need(s) of the client experiencing a
crisis involving a mental health
component as evidenced by:
•Reduced rate of use of force
•Reduced rate of arrests•Reduced rate of criminal offenses
•Reduced case to incident ratio
•Improved cross-sector collaboration
optimizes response to individual
experiencing a crisis with a mental health component
•Improved community utilization of mental health services and
resources
•Reduced strain on emergency
services and systems
Problem statement: When experiencing a crisis that requires immediate assistance, community members are encouraged to call
911. Emergency responders dispatched to the incident(police, fire, medic) do not typically have clinical mental health expertise, yet
many of the incidents to which they –particularly law enforcement –are dispatched involve a mental health component. Given the
prevalence of such crises, and recognition that the individuals involved would benefit from a response to their emergency that
includes additional clinical expertise, San Mateo County and four cities within the county are piloting a Community Wellness and
Crisis Response Team Program, partnering law enforcement officers with mental health clinicians within a first-responder framework.
Community Wellness and Crisis Response Team Pilot Program Theory of Change
Developed through a partnership between the County of San Mateo and Stanford University’s John W. Gardner Center.
Core Program Elements
Dispatch
Co-response team dispatched to 911 calls with
a known or suspected mental health crisis.
Co-responseCo-response team de-escalates the situation,
assesses the client for risk to self/others, provides appropriate intervention, and guides
client toward appropriate health services.
Continuum of care
Mental health clinicians follow up with client to connect them to resources through Behavioral
Health and Recovery Services.
Professional development
Intentionally fostering capacity building of
individuals (professional growth and
development), organizations (norms, policies, processes), and systems (e.g., cross-sector
collaboration and coordination related to data).
Updated 8.11.22
According to the program’s theory of change (see Figure 1), progress related to implementation
consists of four core elements:
• Dispatch. When a 911 call involves a known or suspected mental health component, both
a law enforcement officer and a mental health clinician are dispatched to the scene.
• Co-response. After arriving on the scene, the law enforcement officer and the mental
health clinician function as a co-response team to address the needs of the client(s) and
resolve the situation. The law enforcement officer takes the lead on de-escalating and
ensuring the safety of everyone present, including the mental health clinician. Once the
scene is secure, the clinician takes the lead on assessing the client; determining the
appropriate intervention, such as whether action pursuant to section 5150 of the Health
and Safety Code is required;3 and guiding the client toward appropriate health services.
• Continuum of care. Following the resolution of the call, the mental health clinician makes
a follow up call (typically via phone) to further facilitate the client’s connection to resources
through BHRS or their private insurance.
• Professional development and capacity building. By centering the program around a
collaborative response to crises, the pilot program includes formal and informal
3 “The 72‐hour hold, also called a 5150, provides legal authority to detain a person involuntarily…for assessment,
evaluation and treatment…when a person, as a result of a mental health disorder, is a danger to others, or to
themselves; or is gravely disabled due to a mental disorder ‐ defined as unable to provide for their own basic needs
such as food, clothing or shelter.” (San Mateo County Health System, 1993, pp. 1-2)
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opportunities for capacity-building of individual law enforcement officers and mental health
clinicians, their respective agencies and organizations, and cross-sector systems of
collaboration.
Below, we focus on emerging themes among these four core elements of implementation.
Dispatch
The original TOC focused on the co-response model as a strategy that would be deployed, via
911 dispatch, to support individuals during a crisis with a known or suspected mental health
component. “Dispatch,” therefore, was identified as a core program element, for 911 dispatchers
were expected to discern whether a call could potentially benefit from a co-response and then
deploy both a law enforcement officer and a mental health clinician to the scene. The original
program design also assumed there would be some calls to which a co-response team might not
be dispatched, but then determined by the officer at the scene to be a situation that could benefit
from a co-response team. In those cases, it was expected that the officer would go through
dispatch to obtain the support of a clinician. This means “dispatch” can refer to a clinician being
sent to a call for service through the 911 system or a clinician being deployed at the request of a
police officer in the field.
Table 1. Program Requests, by Month
Daly
City*
South
San
Francisco
San
Mateo
Redwood
City TOTAL
Dec. 2021 19 57 91 35 202
Jan. 2022 19 59 90 25 193
Feb. 2022 17 67 118 11 213
Mar. 2022 29 49 152 89 319
Apr. 2022 21 58 149 13 241
May 2022 12 49 125 24 210
Jun. 2022 21 39 137 32 229
TOTAL 138 378 862 229 1,607
Note: Frequencies reflect clinician requests from December 15, 2021 to June 30,
2022, whether a clinician was available to respond or not. We observe a total of
121,065 non-medical calls for service recorded in the four participating cities during
this time period.
* Daly City only reports incidents in which a clinician responded to a call for service.
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CWCRT Pilot Program: September 2022 Interim Report ● 7
Police agency administrative records indicate that, of the 121,065 non-medical calls for service
documented across the four cities, the first seven months of the CWCRT pilot program have
resulted in nearly 1,500 reported requests that a clinician be dispatched to a call for service, or
about 1.2% of all calls for service we collect (Table 1). This averages to about 200 reported
requests for a clinician per month across the four agencies. Within agencies, South San Francisco
reports about 50-70 requests per month (378 total from December 15, 2021 to June 30, 2022),
while San Mateo reports 100-150 requests per month (862 total) and Redwood City documents
anywhere from 11-89 requests in a month (229 total). Daly City data only documents clinician
responses, showing clinicians responding to about 20 calls for service a month (138 total).
Reported requests for a clinician’s services varied by day of the week and hour of the day in the
first seven months of the program. Figure 2 suggests that the number of calls for service
(indicated by both the number count and shade reported in each cell) were most prevalent from
10am to 9pm on Mondays and Tuesdays, 8am to 4pm Wednesdays and Thursdays, 11am to
8pm on Fridays, and from 9am to 5pm Saturdays.
Figure 2. Requests for Program Services, by Day of Week and Hour of Day
Note: Darker cells indicate more requests for service on a given day of the week during a given hour of the day.
Each police agency employed one full-time clinician who worked a maximum of 40 hours per
week (including administrative duties, professional development, etc.). Due to the limited
availability of program services during the pilot phase, clinicians are only able to respond to a
fraction of requests made for a clinician to be dispatched. Table 2 suggests clinicians were
available to respond to about a third of reported requests for their service across the four cities.
Daly City’s and South San Francisco’s clinicians responded to about 20 calls for service a month
(of 138 and 118 total calls, respectively), while the city of San Mateo reported more clinician
responses by comparison (190 total), with between 22 to 27 responses per month in San Mateo
(with the exception of 42 responses in December 2021). In Redwood City, data suggest clinician
responses varied considerably from month to month, having responded to anywhere from 10 to
33 calls a month (121 total). The request-to-response ratio varied widely among the three cities
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CWCRT Pilot Program: September 2022 Interim Report ● 8
for which full information on requests is available. For example, San Mateo reports many more
requests for service than any other city (about 860 over this time period), indicating about a 25%
response rate. Meanwhile, South San Francisco records a 31% response rate and Redwood City
has a 53% response rate.4
Table 2. Program Responses, by Month
Daly
City
South
San
Francisco
San
Mateo
Redwood
City TOTAL
Dec. 2021 19 19 42 33 113
Jan. 2022 19 19 26 21 85
Feb. 2022 17 18 23 10 68
Mar. 2022 29 16 22 24 91
Apr. 2022 21 16 27 8 72
May 2022 12 22 25 13 72
Jun. 2022 21 8 25 12 66
TOTAL 138 118 190 121 567
Note: Frequencies reflect clinician responses from December 15, 2021 to June 30,
2022. We observe a total of 121,065 non-medical calls for service recorded in the
four participating cities during this time period.
Table 3 reports the types of calls for service associated with a request for a clinician. By far, the
most prevalent type of call for service involving a clinician request is a welfare check (50% of all
clinician requests). Another 16 percent of requests were categorized as an incident involving a
person in mental health distress.5 Following those, roughly 13 percent of requests for a clinician
involved a disturbance or a suspicious person or circumstance, 4 percent involved prostitution (all
occurring in Redwood City), 3 percent were requests from an “outside agency,” 2 percent involved
a request involving a homeless or transient person, 2 percent were calls to “meet a citizen,” 2
percent involved a suicide attempt or commitment case, and another 8 percent were requested
for other reasons, some of which would not be readily identified as related to the program (e.g., a
call for a “warrant service”).
In the early weeks of program implementation, dispatchers and police officers mostly dispatched
clinicians to make contact with community members. This is evident in police records, which
suggest officers initiated program-requested calls 12% of the time in the early weeks of the
4 We are currently investigating whether these response rates suffer from under-reporting of requests when a
clinician is unavailable.
5 In the administrative data we examine, these incidents often refer to a “mental case” or “insane person.”
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CWCRT Pilot Program: September 2022 Interim Report ● 9
program and between 2-7% of the time in subsequent months up to June 2022 (Figure 3). All
other sources originated from a “wireless phone,” “telephone,” or an indicator of a call for service
coming from 911.6
Table 3. Program Requests, by Top Call Types
Call Type N Percent
Welfare check 803 50%
Person in mental health distress* 258 16%
Disturbance 132 8%
Suspicious person/circumstance 83 5%
Prostitution** 59 4%
Outside agency assist 54 3%
Homeless/transient 33 2%
Meet citizen 24 2%
Suicide attempt / commitment 29 2%
Other 132 8%
TOTAL 1,607 100%
Note: Frequencies reflect clinician requests from December 15, 2021 to June 30,
2022, whether a clinician was available to respond or not. Daly City only reported
clinician responses (not all requests) during this time period. We observe a total
of 121,065 non-medical calls for service recorded in the four participating cities
during this time period.
* In the administrative data we examine, these incidents often refer to a “mental
case” or “insane person.”
**All requests for a clinician’s service involving prostitution come from Redwood
City.
Our interviews and observations suggest that over time, clinicians began connecting with
members of the public via additional dispatch strategies. For example, a clinician may hear, over
the police radio, that a 911 dispatcher is sending an officer to assist an individual who, based on
what the individual has shared, does not appear to be experiencing a mental health-related crisis.
Recognizing the client as someone with whom they have had previous contact, the clinician will
typically let the responding officer know they have had prior contact with the individual and offer
6 None of the agencies currently record a clinician-initiated call as the source of a call for service. We are looking into
the possibility that dispatchers are flagging these as "telephone" or "wireless" because they are not technically "officer
initiated", even if they are presumably coming up over the police radio.
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CWCRT Pilot Program: September 2022 Interim Report ● 10
to join them in a co-response. The clinician would then wait to be dispatched to the scene by
either the officer or the dispatcher before heading to the incident to join the officer.
Figure 3. Proportion of Officer-Initiated Requests for Co-Response Program Services, by Month
While early data affirm that co-response teams are prioritizing 911 calls, data also indicate that
they are supporting a wider range of incidents, including non-emergency situations which do not
involve any formal dispatch process. For example, data gathered through interviews and
observations suggest that if a clinician has time between 911 calls, they may self-dispatch to work
alongside officers conducting welfare checks or serving alongside the department’s Homeless
Outreach Team. Data also indicate that as community members learn about the CWCRT
program, they are beginning to reach out to the clinicians by calling their direct line or walking into
police departments and requesting to see them (individually – not as part of a co-response team).
One clinician shared:
“Just yesterday, I had a woman come in and she actually wanted to know what she could
do for someone else that she sees on the street all the time and has gotten to know and
just worries about, and so [she] just wanted to check in [to see] if there's anything we could
do for her. I've had parents or loved ones reach out and say, ‘Hey, my kid has a mental
illness. They're really struggling with this...How do I know when to call [911]?’ … I've [had
people call, and I’ve also] had people actually come into the station and ask for me.”
Overall, within the first seven months of program implementation we are seeing early indicators
that dispatch involves more strategies than originally envisioned. Program partners report that—
so far—they experience the combination of dispatch strategies to be working well. While police
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CWCRT Pilot Program: September 2022 Interim Report ● 11
administrative records appear to provide valid information regarding dispatch occurring via 911
dispatch and police officers, they do not document additional points of contact initiated by the
clinician or a member of the community. One of the opportunities going forward will be to develop
a strategy for capturing data regarding self-dispatch or community-initiated contact with a clinician
or co-response team.
Co-Response
The program originally envisioned that when dispatched to the same call, a law enforcement
officer and a mental health clinician would function as a “co-response team” in the field to provide
a timely and effective response to an individual experiencing a mental health-related crisis.
Various program documents further described the general outline for this response, namely that
the law enforcement officer would assess and address any safety concerns, and then once the
situation was deemed safe, the clinician, in civilian dress,7 would approach and assess the
individual in crisis. Following these initial assessments, the officer and the clinician would then
collaboratively develop (a) a shared understanding of the situation, and (b) the most appropriate
way to respond to both resolve the immediate situation and optimize the longer-term outcomes
for the individual in crisis.
Data collected through interviews, observations, and documents to date affirm that the co-
response model is generally unfolding as designed; officers are taking the lead on securing the
safety of a situation, clinicians are taking the lead on assessing the individual in crisis and
recommending a response, and the team collaboratively works through any differences in
perspective in order to reach an agreement regarding the best action to take to resolve the
situation. Clinicians report that they value the officer’s ability to secure the situation before they
interact with the individual in crisis, and officers report that they value the clinician’s expertise and
perspective, particularly if there is a question regarding whether or not to pursue a 5150 hold.
While officers are required to complete a report for each incident, the clinician typically completes
the paperwork required as part of a 5150 hold, which not only reduces the amount of paperwork
officers are required to complete, but (according to the officers interviewed) improves the quality
of the 5150 hold documentation because the clinician has the expertise to describe the situation
in greater detail and with more clinical language. The degree of complexity involved in reaching
agreement regarding the plan for resolution varied from call to call. There are three degrees of
complexity we identify from our interviews and observations: situations with little, moderate, and
significant complexity.
In situations with little complexity, there is a clear division of roles, and the members of the team
address the needs of the individual(s) with ease of communication and collaboration. An example
of this type of situation is a car accident involving a parent (driver) and a child (passenger); the
child is severely injured, and the parent is having a traumatic response. In this case, the officer
attends to the child, facilitates coordination with emergency medical technicians and
7 The program partners are intentional in ensuring that clinicians do not wear anything that would reflect a police
uniform. Clinicians wear tan (khaki) pants, gray collared polo shirts and closed-toe black footwear. Some shirts are silk-
screened with “Crisis Response Clinician” on the back, others are not. Clinicians also have a green hooded sweatshirts
for cooler days. There are some variations of this uniform based on the season (long-sleeved shirt in winter and short-
sleeved shirt in summer), but the color scheme remains the same. In addition, they always wear their StarVista name
tag which identifies the program (CWCRT), their name, and their designation. They also carry personalized StarVista
business cards and business cell phones.
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CWCRT Pilot Program: September 2022 Interim Report ● 12
transportation to the hospital, writes the police report, and handles additional follow-up such as
connecting with a tow company. At the same time, the clinician attends to the parent, helps them
understand what is happening, what they can expect in terms of next steps at the hospital, and
the resources they may want to access for follow-up support.
In situations with moderate complexity, the law enforcement officer and the clinician may interpret
the situation differently but agree rather quickly on the appropriate action to be taken. Consider a
hypothetical situation in which an officer and clinician are called to determine whether an
individual meets the criteria for “grave disability.” The officer observes that an individual is unable
to provide for needs of food and shelter. The clinician observes this as well, but in speaking with
the individual learns he is off his prescribed medication. The clinician determines a relationship
between the individual’s need for medication and his inability to provide for his needs of food and
shelter. Thus, while the clinician gains additional insight into the circumstances surrounding the
situations during their assessment of the individual, both the clinician and the officer quickly agree
that the appropriate step is to process a 5150 hold. From there, the clinician notes on the
paperwork what has been learned regarding the individual’s diagnosis and medication, reporting
that the individual in need has not been taking their medication. This would end with the clinician
facilitating an effective hand-off to PES.
In situations with a high degree of complexity, the officer and the clinician may have different
interpretations of the situation that translate into different opinions regarding the most appropriate
action to be taken to resolve a call. In some of these cases, they may not reach complete
agreement, but instead reach resolution by deferring to one member of the team or the other.
Based on our interviews and observations, we have no reason to believe that this tends to fall
more in the favor of the officer’s perspective or the clinician’s perspective, but in fact varies from
incident to incident. For example, one interviewee described a call from a community resident
who was concerned about an individual who had been living in their car for some time, but now
appeared to be living underneath their car. The co-response team previously had been called to
this same individual twice in recent weeks. In both instances, there was evidence of grave
disability and the co-response team quickly agreed they had a responsibility to place the individual
on an involuntary 5150 hold. During this third co-response to the same individual, the officer felt
that the individual again met the criteria for grave disability and would need another involuntary
hold. The clinician, however, observed that some of the factors that had indicated grave disability
in the prior visits were no longer present, and the individual, in turn, did not meet the criteria for a
5150 hold. In this particular situation, the officer felt comfortable deferring to the clinician’s more
nuanced understanding of what constitutes “grave disability” and their recommendation not to
proceed with a 5150 hold.
In another example of a situation with a high degree of complexity, a resident of a senior
independent living center called the suicide hotline and reported that they wanted to shoot
themself. The hotline staff reached out to the local police department. Dispatch was familiar with
the individual because they had been involved in at least two previous calls, one of which involved
a domestic violence situation and the presence of a weapon in the home. Once the officers
confirmed the situation was secure, the clinician sat with the individual in crisis and talked for a
bit. According to the clinician, they were:
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CWCRT Pilot Program: September 2022 Interim Report ● 13
“really, really quite lonely. And I know that for liability and other reasons you want to take
them [at their word] when they say something like that, but [they] didn't have that intention.
[They] didn't have a way, [they] didn't have a means. [They] didn't have anything like that.
And we were able to do a safety plan and I contacted [their] social worker and we all talked
together… We talked about it later in a briefing, and [I explained] like, yes, there are some
tricky ones, but you have to look at what they- [this person] was disabled and [had limited
mobility] [and they] had a lot of other issues going on. So you have to consider–what are
they capable of?”
In some cases, typically when an officer feels concerned regarding the potential liability involved
for not taking a more conservative approach, they might engage a police captain for additional
guidance. In those situations, the captain tends to coach the officer to be mindful of concerns
related to safety and liability, but to defer to the clinician's expertise with regard to interpreting and
responding to the mental health aspects of the situation. These situations often served as good
“case studies” to talk through with the department during morning briefings as a form of
professional development and capacity building.
As these examples suggest, leveraging the unique strengths of both officers and clinicians during
a co-response requires thoughtful attention and collaboration. In the words of several
interviewees, it also involves “a learning curve”—a period of time during which both the clinicians
and the officers are learning what each other paid attention to when assessing a situation, the
kinds of questions they ask, and the way they interpret different words or behaviors. For example,
Figure 4. Reported Monthly Total Officer On-Scene Time, among Incidents Reporting a
Clinician’s Response
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CWCRT Pilot Program: September 2022 Interim Report ● 14
officers are trained to position their bodies in relationship to the individual in crisis in ways that
reduce the risk of injury to either party. This might include remaining standing while talking with
an individual who is seated. Clinicians, on the other hand, are trained to think about how they can
position their body in relationship to an individual in crisis in ways that facilitate co-regulation and
optimize the other individual’s sense of safety, trust, and agency. This might include sitting next
to an individual who is seated on the floor. In another example, when assessing whether an
individual in crisis is at risk of committing suicide, an officer may ask the individual if they are
thinking of “harming” themself and then interpret an affirmative response as an indication of
suicidality. A clinician, on the other hand, recognizes that thoughts of self-harm do not necessarily
include suicide and would word the question differently.
Figure 5. Number of Reported Monthly 5150 Holds
Note: Months to the left of the red vertical line signify months prior to the pilot program’s implementation. Months to
the right of the red vertical line signify the two years of the pilot program (some of which will occur in the future).
It may be surprising then that, in the early stages of implementation, officers reported co-response
calls often took longer than usual. Officers and clinicians have reported to us in interviews that
they have resolved most of the initial issues that contributed to extending officers’ on-scene time
and have found ways to be mindful of the time spent on an individual call without sacrificing the
value of the clinician’s contribution to the response. Such officer and clinician accounts are born
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out in the administrative records available to us. Specifically, Figure 4 shows that reported on-
scene times for incidents involving a clinician increased gradually between December 2021 and
March 2022 from an average of 63 to 74 minutes per incident. However, those numbers dropped
to an average of 63 minutes per incident between April and June 2022.
The ways in which the co-response teams navigate their collaboration during a co-response have
the potential to influence what kind of response is provided to those experiencing a mental health
crisis. Embedded within the program’s TOC is an assumption that, over time, the number of calls
resolved with a 5150 will decrease, but program partners were not sure how long it would take to
see this happen. Descriptive preliminary data in Figure 5 reports the number of 5150-related
incidents recorded in police agency data from January 2019 through June 2022. Although only
preliminary, trends suggest that write-ups of 5150 holds have tended to decline since the onset
of the CWCRT program. For example, in January–March 2019, there were about 70 incidents
involving 5150 holds per month across the participating cities. From April 2019 through December
2020, there were often between 80 and 130 reports of 5150 holds per month. In contrast, between
April and June 2022 (three months after program implementation), there were about 50 reports
of 5150 holds reported per month. These trends correspond to how officers and clinicians
describe their approach to supporting an individual in crisis in the early weeks of implementation.
Continuum of Care
The original program design assumed that, following a co-response, the clinician would make one
follow up call with the individual in crisis to further facilitate their connection to appropriate
services. Early evidence suggests clinicians are consistently following up with the individuals they
serve and taking steps to help them connect to appropriate services. At the same time,
interviewees acknowledge that advancing a continuum of care, where a client sustains their
connection to the resource(s) that are well aligned with their needs over time, (a) requires more
than one follow up; (b) involves follow up with additional parties, such as the client’s loved ones
or various members of the client’s care team; and (c) is complicated by a number of factors that
are outside the scope of a clinician’s practice, such as the availability of appropriate services or a
client’s ability to schedule and follow through on an appointment with a resource provider.
Clinicians are mindful of not taking on the role of a case manager; however, they often find
themselves engaging in more than one follow-up conversation with or on behalf of their clients.
While we see early signals that this is one of the strengths of the program, we also see how follow-
up conversations may, at times, raise questions regarding the scope of a clinician’s role and the
proportion of their limited hours that should be devoted to connecting clients to resources and
facilitating a continuum of care that extends beyond the initial co-response.
Follow-ups include a range of activities including speaking directly with the individual served to
support their next steps, speaking with family members regarding how they can support their
loved one, and speaking directly with service providers to facilitate coordination of care. While the
original program design assumed that clinicians would be the ones facilitating continuity of care
through their follow up to individual calls, early data suggest that the StarVista and BHRS staff
are providing some additional support in this area, especially when it comes to understanding and
addressing some of the barriers to care clinicians are discovering in the course of their follow up
efforts. As we continue to collect, analyze, and report on data regarding program implementation,
we will continue to pay attention to how the pilot attends to follow-up and continuity of care.
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Professional Development and Capacity Building
The pilot’s original TOC acknowledges that the short-term and long-term outcomes program
partners envisioned would not be achieved through changes to dispatch, co-response, and
continuity of care alone—they would also require intentional efforts to foster professional growth,
development, and capacity building among the officers and clinicians, the program’s different
partner organizations and what we refer to as the “system,” or the broader county-level
infrastructure for supporting the kind of cross-sector collaboration required of this pilot program.
With this in mind, the TOC includes professional development and capacity building as a core
program element. Early data suggest that this element is being implemented in a number of formal
and informal strategies. For example, at the very start of program implementation, StarVista and
BHRS collaborated to provide clinicians with their initial training which focused on program-wide
roles, responsibilities, policies, and practices and oriented them to the ecosystem of support in
SMC, including but not limited to BHRS and StarVista. From there, each police department
developed their own training and onboarding program designed to integrate the clinician into their
particular department and community. Throughout the first seven months of implementation, both
StarVista and BHRS have collaborated to provide ongoing professional development for clinicians
which has covered a range of topics, including best practices related to recording clinical notes in
the county’s data system, navigating the different requests they field in the course of their day-to-
day work (e.g., invitations to speak at community events), and collaborating with other mental
health crisis resources such the Psychiatric Emergency Response Team. Interview and
observation data also indicate clinicians are providing formal professional development for police
staff on a variety of topics related specifically to responding to an individual experiencing a mental
health crisis.
In addition to these more formal efforts, data suggest that professional development and capacity
building are occurring through more informal methods. For example, both officers and clinicians
report that they learn much by observing one another’s practices in the field during a co-response
call--including observations of physical stance and positioning of one’s body in relationship to the
individual in crisis, nuances in language including the tone one uses and the questions one asks,
and the notes one includes in a report. They note that additional learning occurs when they talk
through complex situations either during a call or immediately following the call. In addition to
debriefing calls in the field, preliminary interview data suggest that officers and clinicians also take
time to further debrief some calls back at the police department. Opportunities for others to build
their capacity through the pilot program—including those who may not have direct experience
with a co-response call— are provided when co-response calls are debriefed during line-up or
briefings. Learning, growth, and development are also fostered through impromptu conversations
that take place at the police department. Initiated by either an officer or a clinician, these
interactions last anywhere from two to twenty minutes and typically involve sharing an update
related to a previous co-response call.
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FACTORS FACILITATING AND COMPLICATING IMPLEMENTATION
In addition to understanding the degree to which core program elements are being implemented
and short-term outcomes are being met, an implementation study also investigates the factors
that facilitate and complicate implementation. When program partners understand elements that
promote or inhibit implementation, they are able to use the evaluation to inform program
improvement by continuing to invest in program elements that facilitate and support
implementation and by addressing the factors that complicate or challenge implementation. While
it is too early to draw any summative conclusions regarding what impacts the implementation of
the CWCRT pilot, this interim report can inform program learning and improvement in the next
phase of implementation by highlighting three factors that appear, in our early stages of data
analysis, to impact implementation: cross-sector collaboration, community engagement, and data
coherence.
Cross-sector collaboration
Program partners acknowledge that there have been advances in the field of mental health which
provide new insight regarding the practices that optimize the outcomes of those who experience
a mental health-related crisis. In many ways, this is precisely the context that lends itself to cross-
sector collaboration, for “[a]s knowledge becomes increasingly specialized and distributed and as
institutional infrastructures become more complex and interdependent, the demand for
collaboration increases” (Ansell & Gash, 2008, p. 544).
One factor that seems to contribute to the implementation of this pilot is that program partners
recognize the imperative for cross-sector collaboration not just in theory but in practice: they
express a genuine respect for each other’s expertise across roles, cities, and agencies and
participate in the formal structures set up to sustain cross-sector collaboration throughout
implementation, including a cadence of regular meetings that are skillfully planned and facilitated.
While the literature suggests that in such collaborations there are often tensions between the
need for partner autonomy the interdependence of collective interests (see, for example,
Thomson and Perry, 2006), at this early stage in the pilot program, CWCRT program partners are
generally pleased with the way in which the pilot honors both their autonomy and the collective
effort. This includes officers at the forefront of interactions with clinicians; for example, as one
chief shared,
“I think it's 100% [of the officers in our department] who are supportive right now, which is
somewhat surprising, right? But it's so well received. I think in large part, because prior to
developing this program, officers were often tasked with responding to calls of persons in
crisis, but they weren't given the tools to do so. … Ultimately, officers want to solve the
problem…and now this gives them another avenue to be able to solve the problem in the
long term.”
Among the partners overseeing program design and implementation there is also a shared
recognition that this pilot is not the “end-all, be-all” but an important component of the county’s
broader ecosystem of resources designed to support public health and safety. This framing, in
turn, appears to foster a sense of commitment to the work that is accompanied by a sense of
curiosity regarding not only the pilot’s implementation and outcomes, but how the learnings from
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this project can inform (and be informed by) other efforts within the county to advance public
health and safety.
Community engagement
While there are many aspects of cross-sector collaboration that appear to facilitate program
implementation, there is one aspect partners note as an important, and even urgent, area for
growth, and that is the way in which community members are involved as collaborative partners.
Program partners have taken a number of steps to foster communication and collaboration with
the communities served by the pilot program, such as distributing press releases, creating city-
level and county-level data dashboards, conducting virtual town hall-style updates such as Real
Talk San Mateo, participating in police advisory groups such as Redwood City’s Police Advisory
Committee, and soliciting feedback from members of the community whom the pilot serves (via
StarVista). Our data also reveal that one city leveraged May, as “mental health month,” to
collaborate with county agencies to conduct “mental health first aid” trainings with community
members. This effort focused on raising awareness and de-stigmatizing mental health amongst
community members and leaders to garner momentum for programs such as the community
wellness and co-response program. While project partners have taken these preliminary steps
to connect with the community, they are also quick to acknowledge that they have not done this
as well as they could have, especially in the early stage of the pilot when they were consumed by
the logistics involved with preparing for implementation, but they are committed to improving these
efforts going forward.
Data coherence
Creating coherent data systems within and across organizations is a key task of a cross-sector
collaboration. This is especially true for efforts like the CWCRT pilot that include a commitment to
data transparency for the purposes of fostering collective understanding and engagement among
a wide range of interested, invested, and impacted parties. As the collaboration discovered
barriers to data coherence, they responded by developing innovative responses. For example,
when they discovered that it was much more challenging than expected to extract meaningful
program data from available administrative data sets, one police department engaged its IT
department in developing an app that clinicians use to record a few key data points following each
co-response. Likewise, as all four cities began uploading data from the pilot program to their public
data dashboards, the County of San Mateo provided IT support to integrate those individual
dashboards into one project-wide dashboard. While the collaborative has made great strides in
advancing data coherence through the creation of the app and the integrated data dashboard,
sustained attention to data coherence will require attention to a number of factors, ranging from
developing common language and defining terms to ensure data validity, to more pragmatic
considerations such as ensuring technical compatibility across data collection and reporting
platforms.
One challenge is ensuring that clinician requests and dispatches are accurately documented in
agency administrative data, as it appears that accuracy varies across agencies. Some of this
variation likely arises from inter-agency collaboration—particularly between Daly City and their
outsourcing of emergency dispatch to the county. This challenge does not affect our outcomes
study critically; because clinician requests and responses are endogenous to the program’s
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implementation, we intend to study program-eligible incidents more broadly to be able to track
trends in program-eligible incidents and cases both before and after CWCRT implementation.
Ultimately, accurate collection of clinician requests and responses most squarely affects program
expansion, public perception, and accountability for the program.
Progress in relationship to the TOC’s short-term outcomes:
While it is too early to look for evidence of the degree to which the program is reaching its short-
term outcomes in the administrative data, it is appropriate to begin looking at the data collected
through interviews, observations, and documents, with an eye toward the short-term outcomes
related to cross-sector collaboration, use of community mental health resources, and strain on
emergency services. The intention in offering emerging themes in these three short-term
outcomes is to provide program partners with information that may support their ongoing efforts
to understand and improve the co-response approach. We will continue to examine both the
qualitative and quantitative data for evidence related to short-term outcomes, and will provide
updates in future reports.
“Improved cross-sector collaboration optimizes response to individuals experiencing a
crisis with a mental health component.”
One of the short-term outcomes included in the program’s TOC states that the pilot will “improve
cross-sector collaboration in ways that optimize the emergency response provided to individuals
experiencing a mental health-related crisis.” “Optimize” is further defined by additional indicators
(e.g., reduced rate of use of force, reduced rate of arrest) which will be examined in future data
analysis and reporting. However, through an implementation lens, we are also interested in
understanding how the pilot’s cross-sector collaboration may provide early or lead indicators
related to this short-term outcome.
Across roles and across all four cities, we are hearing that cross-sector collaboration is changing
the response individuals receive when they call 911 for an emergency that includes a mental
health component. Police officers who are part of these co-response collaborations report that
these changes are positive and likely to optimize the experience of individuals in crisis. To
illustrate their point, they shared a number of stories. Several stories provide accounts of how
youth experiencing crises in school are benefiting from the co-response approach. One law
enforcement officer’s account revealed that, since clinicians do not wear police uniforms, the co-
response team was able to provide services to the student without the tension of having uniformed
police on campus:
“A patrol car or uniformed officer…is a source of attention and [prior to the pilot] we [were]
magnifying that on the kids. [With the co-response model], the kid doesn't have to deal
with the undue attention. We can extract ourselves from that right away. So that's a helpful
alternative for them just to not draw so much attention to them.”
In addition to de-escalating the situation, the presence of the clinician provides opportunities to
take a different approach to school disciplinary issues, as well as new networks or partnerships
that optimize the response youth receive both in the moment of crisis and longer-term. Another
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law enforcement officer describes how this plays out in a different city in the context of responding
to a school’s request for emergency services:
“We went to a call [involving] a student who was being disruptive, [and] had history in the
past of possibly having an undiagnosed mental illness. But the way the call came out
initially, [it] was more like the child was having a crisis. But when we got there and spoke
to the school counselors, it was determined that [the student] was just being disruptive
and not following the teacher's instructions. So in that case, right there, once we
determined the scene is safe, then [the officers are] not needed. [The clinician] actually
sat down and came up with a safety plan with the school counselors [and] with the child
to prevent this from happening again. So I thought that that was great. That's another
example of if we had the time we would gladly do it, but we don't have the time and based
on her just specializing in mental health, it's great for her to actually take the time to sit
down and work with a safety plan with the school and the student.”
In another example, a co-response team was dispatched in response to a parent’s call for
emergency support related to a family member experiencing a mental health-related crisis. The
young adult in crisis had locked themself in the family home. The parent who had called for help
was outside the home, and they were concerned that their loved one was at risk of harming
themself or others. Upon arriving at the scene, the officer determined that there was no imminent
danger to self/others, and the clinician affirmed this determination. The clinician was able to
communicate with the person inside the home via the family member’s telephone. The individual
in crisis ultimately left the residence on their own accord. The officer noted that if the clinician had
not been there, the officer may not have been as effective in communicating with the individual in
distress, and may have eventually needed to force entry into the home which could have added
to the individual’s distress, added to the parent’s distress, and potentially escalated the situation.
Instead, the co-response team was able to optimize the response to the individual in crisis.
In addition to sharing individual stories illustrating the program’s potential for optimizing responses
to individuals in crisis, police department staff across all four participating cities also report that,
through their collaboration with the clinicians, they are learning and changing their practice in
ways that may improve emergency responses even when clinicians are not present. One officer
described it this way:
“I think the best part of [the pilot program] is, usually when we, when officers respond to
it, at least me, before the clinician was there, we like to fit things in certain boxes and
everything's kind of black and white. … And with the clinician there, … I can kind of see
how she was doing things … there were some extra questions she would ask or maybe
spending more time [talking to a person in crisis] than I would. So that's been a good thing
for me. She's not there on [one of my shifts], so I'm starting to use some of the questions,
and some of the things that she sees… And so I'm picking up on some of the language
that she uses, some of the things that she was looking out for, that she notices with people
that I noticed too, but I wasn't able to articulate it until I read it on her [report]... So that's
been great, it's kind of opened my eyes to a lot of different ways of handling things and
maybe spending more time, like she does.”
Early data analyses suggest that, through their collaboration with mental health clinicians, some
police staff are shifting the language and approach they use to interact with community members.
Police officers integrating mental health perspectives into their practice is key to their professional
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learning and has potential implications for how law enforcement is conducted across the cities
involved in the CWCRT program.
“Improved community utilization of mental health services and resources.”
The vast majority of interviewees affiliated with the four participating police departments noted
that the role the clinician plays in connecting clients to services is a significant improvement from
the practice prior to the pilot, when emergency responders had neither the time nor the expertise
to facilitate this kind of support. Early evidence suggests that clinicians are playing an important
role in brokering individuals’ access to community mental health services and resources. As one
mental health clinician put it:
“I refer people. So I've written referrals to organizations such as like Legal Aid and
Peninsula Family Services. And then I've also called referral sources to consult before
giving a resource to a person. So if I know what their insurance is, and I know what they're
kind of looking for, I can call resources, say, ‘Hey, do you take this insurance? Like, is this
somebody that'd be a good fit for your program?’ And they'll let me know. And then I can
kind of give the information, because I think one thing I've learned just over years of being
in this field is resources change. … Like they stop providing services or change the way
they provide services frequently.”
Clinicians also play a role in following up with individuals who are placed on an involuntary hold.
As one officer described:
“There is an individual here in our city who has a lot of mental health issues, unfortunately.
… And so we’re getting called practically daily. And so when we place [them] on a hold at
a hospital, [the clinician] helps with finding out, because this is becoming daily, can you
see what [PES is] doing? Because [they are] out in a few hours. Is it lack of information?
Is it because we're not communicating well? So that's where…she will reach out to the
family to see if she can get more information.”
Early data show that clinicians are taking a number of steps to foster a more holistic approach to
public safety by developing relationships with people with mental health problems and serving as
advocates that connect them to the services they need. While it seems that this approach has the
potential to improve utilization of community services and resources, what is not yet clear is how
the program partners will measure any changes to utilization.
Reduced strain on emergency services and systems.
One of the short-term outcomes included in the TOC highlights the intention for the pilot to reduce
strain on emergency services and systems. When this was originally discussed during program
design and implementation meetings, the focus was primarily on reducing strain at a system-level,
meaning that if individuals in crisis were better supported during the initial response provided by
a co-response team, then they might be more likely to connect to services to address the
challenges contributing to their crisis. Consequently, they might be less likely to use 911 as
frequently, which in turn, would reduce the strain on emergency services. While it is too early to
speak to the ways in which the pilot program may reduce strain on the system beyond what we
have already described about the rates of 5150s, we are observing some early signals that the
pilot is reducing strain in a way that was perhaps not anticipated: the way in which the program is
reducing the personal and professional strain mental health-related crises place on law
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enforcement officers. Multiple officers described how it was a relief to know that their mental health
clinician was on-call to be able to handle certain calls or situations. For example, one officer
mentioned:
“I knew it would be helpful. I didn't realize it would be as helpful, I guess, if I could say that.
It's been... I mean, I have a lot of anxiety when she's off, when I know she's not working,
you know? … That's always the thing, "Is [our clinician] working?" Because [mental health
crises are] just a daily thing.”
Based on numerous accounts, early data suggest that clinicians provide support and peace of
mind to officers in the field because they bring a level of expertise to situations involving a mental
health component that the officers just do not have. Officers note a number of specific
contributions the clinicians make that reduce the strain they experience with regard to mental
health related crises, including their ability to (1) provide a more nuanced assessment of an
individual’s mental state which then informs the co-response strategy for resolution of a crisis
response; (2) contribute to determinations involving an involuntary hold and, when implementing
a 5150, complete the paperwork and other follow-up involved with a higher caliber of clinical
expertise; (3) attend to the family members and loved ones of the individual in crisis in ways that
they just don’t have the time or the expertise to do; and (4) follow up with service providers,
including PES, to strengthen the coordination of care and hopefully reduce the individual’s
reliance on 911 as a primary mental health resource.
One officer describes the value the clinician provides in this way:
“…after the scene is safe, she'll stick around and talk to the family and offer suggestions,
advice on other organizations that can help as well. So when it comes to time, and
because she plays a different role, it helps not only us on the street, but it helps the people
in the city who are experiencing this, because they actually now have somebody that has
the time to sit down and go over this. As much as we would love to sit down and go over
this, we don't have the time to do that.”
Some officers hypothesize that if they are feeling less strained, then they may be able to respond
more thoughtfully not only to co-response calls but to other calls as well. Some also noted that
reducing strain in this way has collateral benefits on their working relationships, personal
relationships, and potentially even, over time, may render them less prone to anxiety, depression,
and burnout. Early data analysis also signals that clinicians are vulnerable to experiencing
sustained stress as they move through their day and week as part of a co-response team, and it
will be important to consider how the pilot program might, over time, also reduce their strain. As
we continue to examine the relationship between the pilot program and strain on emergency
services at the setting-level and system-level, we will also pay attention to this emerging theme
and note the ways in which the program may reduce strain at the individual-level as well.
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NEXT STEPS IN THE RESEARCH PROCESS
The Gardner Center’s independent evaluation of the CWCRT program includes two additional
interim reports—a second in March 2023 and a third in September 2023—meaning the research
agenda is far from concluded. In general, these upcoming interim reports will each continue to
provide key updates regarding our progress in understanding the core elements of the program’s
theory of change. Additionally, subsequent interim reports will begin to explore emerging themes
in other elements of the program’s theory of change, including short- and long-term outcomes
and goals. To do so, Gardner Center researchers will continue to conduct interviews and
observations and collect documents and administrative data within the participating cities.
Regarding the research progress and emerging themes shared in this interim report, we have four
main areas of focus moving forward. First, we will continue to examine the co-response process
in each of the four core program elements identified in the TOC. For example, as the evaluation
progresses, we will look more closely at the criteria dispatchers use to deploy a co-response
team. We will also continue to investigate the different ways co-response teams are dispatched
in both emergency and non-emergency situations and any patterns when (days, times) co-
response teams are requested. While preliminary data suggest program participants (including
officers and clinicians) perceive current dispatch practices to be effective, we will seek to better
understand some of the strengths and challenges experienced in relationship to current dispatch
practices and how those might evolve over the course of implementation.
Second, our implementation study will continue to examine the factors that impact program
implementation, including the three we have noted in this research update. We will conduct a
second and possibly third round of interviews, continue conducting observations gathering
relevant program documents, and use that data, alongside the data collected to date, to develop
a more complete understanding of the implementation process.
Third, we will continue to track and evaluate outcomes of interest to stakeholders and program
partners, including longitudinal trends in the frequency of 5150 holds, frequency of all program-
related calls for service, frequency of program-related criminal cases, frequency with which
program-related incidents lead to citation or arrest, the amount of time spent on-scene for
program-related incidents, use-of-force indicators, and more. As a next step toward final
evaluation measures, Gardner Center researchers have procured additional signed data use
agreements from San Mateo County and additional non-participating police agencies across the
county, including Belmont, Burlingame, East Palo Alto, Foster City, Menlo Park, and Pacifica.
These additional agencies’ data will be incorporated into the project over the coming year as
comparison cases, which we plan to include in the final report.
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REFERENCES
AdvancED. (2011). Consistent Improvement: Achieving Systems Coherence in a Data-Rich
World. Alpharetta, GA: AdvancED. https://www.advanc-
ed.org/sites/default/files/documents/Continuous-Improvement.pdf
Ansell, C. & Gash, A. (2008). Collaborative governance in theory and practice. Journal of Public
Administration Research and Theory(18)4, 543–71.
https://academic.oup.com/jpart/article/18/4/543/1090370
County of San Mateo. (2021). A New Approach to Mental Health Crisis Calls: Mental Health
Professionals Partner with Police: Clinicians pair with law enforcement in county’s four
largest cities. Retrieved on September 13, 2022 from https://www.smcgov.org/ceo/news/
new-approach-mental-health-crisis-calls-mental-health-professionals-partner-police.
Dee, T. S., & Pyne, J. (2022). A community response approach to mental health and substance
abuse crises reduced crime. Science Advances, 8(23), eabm2106.
Mathematica Policy Research. Developing a Coherent Plan for Effectively Using Data (InFocus
Brief). Princeton, NJ: Mathematica Policy Research, 2013. https://www.mathematica-
mpr.com/our-publications-and-findings/publications/developing-a-coherent-plan-for-
effectively-using-data
Puntis, S., Perfect, D., Kirubarajan, A., Bolton, S., Davies, F., Hayes, A., ... & Molodynski, A.
(2018). A systematic review of co-responder models of police mental health ‘street’
triage. BMC Psychiatry, 18(1), 1-11.
San Mateo County Health System. (1993). Policy 93-07: 72 Hour Hold/5150 Policy and
Procedures. https://www.smchealth.org/sites/main/files/file-attachments/93-
07_instituting_5150_procedures.pdf?1531322765#:~:text=A%20routine%205150%20do
es%20not,liability%20for%20county%20or%20contractor.
Seo, C., Kim, B., & Kruis, N. E. (2020a). Variation across police response models for handling
encounters with people with mental illnesses: A systematic review and meta-analysis.
Journal of Criminal Justice, 72, 101752.
Seo, C., Kim, B., & Kruis, N. E. (2020b). A meta-analysis of police response models for handling
people with mental illnesses: cross-country evidence on the effectiveness. International
criminal justice review, 31(2), 182-202.
Shapiro, G. K., Cusi, A., Kirst, M., O’Campo, P., Nakhost, A., & Stergiopoulos, V. (2015). Co-
responding police-mental health programs: A review. Administration and Policy in Mental
Health and Mental Health Services Research, 42(5), 606-620.
Thomson, A. M., & Perry, J. L. (2006). Collaboration processes: Inside the black box. Special
issue, Public Administration Review(66), 20–32.
https://onlinelibrary.wiley.com/doi/10.1111/j.1540-6210.2006.00663.x
White, C., & Weisburd, D. (2018). A co-responder model for policing mental health problems at
crime hot spots: Findings from a pilot project. Policing: a journal of policy and practice,
12(2), 194-209.
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APPENDIX A: SAN MATEO COUNTY COMMUNITY WELLNESS AND CRISIS RESPONSE
TEAM PILOT PROGRAM: THEORY OF CHANGE
Project Background
San Mateo County (SMC) has a variety of public services to support those experiencing mental
health crises, such as the San Mateo Assessment and Referral Team (SMART), the Psychiatric
Emergency Response Team (PERT), and health-related programs affiliated with local school
districts (e.g., San Mateo Union High School District’s School Based Mental Health and Wellness
Program). While these services provide essential and potentially life-saving support, many
community members will, in a moment of crisis, access support by simply dialing 9-1-1.
Given the volume of 9-1-1 calls involving a mental health component, first responders (e.g., police
officers, deputies, medics, and dispatchers) are part of the county’s ecosystem of mental health
services. Recognizing the importance of a first responder’s role in promoting a positive outcome
for those in such a crisis, SMC began partnering with the National Alliance on Mental Illness
(NAMI) San Mateo,8 the Sheriff’s Office, and Behavioral Health and Recovery Services (BHRS)
in 2005 to provide first responders with crisis intervention training (CIT). While CIT-trained first
responders are equipped to skillfully attend to individuals experiencing a mental health crisis, they
do not have clinical mental health expertise. Therefore, their scope of practice is limited to
stabilizing the situation, and in some cases, connecting the individual(s) in crisis to a licensed
clinician via emergency psychiatric services. In order to optimize outcomes for those experiencing
a mental health-related crisis, the Daly City, Redwood City, San Mateo, and South San Francisco
Police Departments have collaborated with BHRS and StarVista9 to develop a “co-response”
model for responding to such calls.
Launched in fall of 2021, the Community Wellness and Crisis Response Team (CWCRT) Pilot
Program embeds a mental health clinician within each police department and dispatches sworn
law-enforcement officers with a clinician as a co-response team to calls with a known or suspected
mental health component (County of San Mateo, 2021). A key goal of this collaborative effort is
to combine the expertise and resources of both law enforcement and mental health professionals
to best serve the public in a timely manner, and, in turn, to improve the outcomes of those they
are serving.
SMC is not alone in this work. Various models of collaborations between police and mental health
providers have been implemented across the country, some of which have been studied to assess
their effectiveness (Compton et. al., 2014; Hails & Borum, 2003; Hollender, et al., 2012;
Steadman, et. al., 2000; Zealberg, et al., 1992). SMC’s two-year pilot of the CWCRT program
includes an evaluation conducted by Stanford University’s John W. Gardner Center for Youth and
their Communities, a center with expertise in studying the implementation and outcomes of cross-
sector collaborations designed to improve the lives of youth, families, and communities. The
CWCRT evaluation will provide valuable data for improving public safety and public health in San
8 NAMI (National) originally began as a small group of San Mateo County parent leaders, families, friends and professionals
who gathered in 1974 with a shared vision of ensuring that their children and family members who experienced mental
illness would be well cared for in their own communities (NAMI San Mateo, 2022).
9 StarVista is a San Mateo-based nonprofit organization delivering services through counseling, case management, skill
development, and crisis prevention to children, youth, adults, and families (StarVista, 2022.
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Mateo County, and it will contribute to the growing field of evidence-based models for improving
the outcomes of individuals who call 9-1-1 for support with a mental health-related crisis.
The Purpose of a Theory of Change
The first step in an evaluation that attends to both implementation and outcomes is to develop a
theory of change (TOC). A TOC consists of two documents⎯a graphic representation and a
narrative⎯that articulate the specific inputs and outcomes of a program and the means through
which they are generated. The TOC is more than just a program overview: it makes explicit the
“if-then” assumptions embedded within the program design.
The TOC begins by stating the problem that will be addressed if program goals are met. From
there, the TOC identifies the core program elements which are the key strategies or inputs that,
if implemented, will hypothetically advance progress toward program goals. Because goals are,
by design, aspirational and take several years to reach, short-term outcomes are essential. If
achieved, they will indicate that the program is on course to reach its goals. Short-term outcomes
foster shared understanding and expectations among the different partners who are involved in
program implementation and, importantly, are measurable and reasonable to expect within a
timeframe that is meaningful to a range of interested, invested, and impacted parties. The TOC
therefore enables collaborative and continuous learning and improvement among program
partners and informs a robust program evaluation.
San Mateo County Community Wellness and Crisis Response Pilot Program: Theory of
Change Narrative
Problem Statement
When experiencing a crisis that requires immediate assistance, community members are
encouraged to call 9-1-1. Emergency responders dispatched to the incident (police, fire, medic)
do not typically have clinical mental health expertise, yet many of the incidents to which they⎯
particularly law enforcement⎯are dispatched involve a mental health component. Given the
prevalence of such crises, and recognition that the individuals involved would benefit from a
response to their emergency that includes additional clinical expertise, San Mateo County and
four cities within the county are piloting a Community Wellness and Crisis Response Team
Program, partnering law enforcement officers with mental health clinicians within a first-responder
framework.
Core Program Elements
Four core elements are central to program implementation:
• Dispatch. When a 9-1-1 call involves a known or suspected mental health component,
both a law enforcement officer and a mental health clinician are dispatched to the scene.
• Co-response. After arriving on the scene, the law enforcement officer and the mental
health clinician function as a co-response team to address the needs of the client(s) and
resolve the situation effectively. The law enforcement officer takes the lead on de-
escalating and securing the situation to ensure the safety of everyone present, including
the mental health clinician. Once the scene is secure, the clinician takes the lead on
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assessing the client; determining the appropriate intervention, including whether action
pursuant to section 5150 of the Health and Safety Code is required; and guiding the client
toward appropriate health services.
• Continuum of care. Following the resolution of the call, the mental health clinician makes
one follow-up call (typically via phone) to further facilitate their connection to resources
through Behavioral Health and Recovery Services or through their private insurance.
• Professional development and capacity building. By centering the program around a
collaborative response to crises, the pilot program includes formal and informal
opportunities for capacity building of individual law enforcement officers and mental health
clinicians, their respective agencies and organizations, and cross-sector systems of
collaboration.
Outcomes
If implemented as designed, it is expected that the core program elements will contribute to
measurable changes toward the program's short-term and ultimately long-term outcomes. The
TOC articulates several short-term outcomes that can be measured during the course of the
program implementation and provide “lead indicators” or early signals regarding the degree to
which the program is on course to achieve its long-term outcomes.
Within the first year or two of program implementation, the program design assumes that when a
co-response team is dispatched to a crisis situation involving a known or suspected mental health
component, the co-response team will meet the immediate need(s) of the client and resolve the
crisis without further complicating the mental health and wellbeing of the person in crisis as
evidenced by short-term outcomes such as reduced rates of use of force, arrests, criminal
offenses, and case-to-incident ratio in situations where there is a co-response.
In addition, it is anticipated that within the first two years of implementation, the program will (1)
improve cross-sector collaboration in ways that optimize the emergency response provided to
individuals experiencing a mental health-related crisis and (2) connect individuals in crisis to
appropriate mental health services beyond emergency psychiatric services. As a result of
improving the quality of the emergency response and connecting individuals in crisis to
appropriate resources, the theory is that those who receive a co-response will be better resourced
and less likely to dial 9-1-1 to access mental health support in the future. This would, in turn,
enable emergency services to be less strained by mental health-related incidents and more
available to attend to different opportunities to promote and support public safety.
If the short-term outcomes are achieved, then the co-response model will be on its way to
achieving its intended long-term outcome, which is for individuals receiving emergency services
via 9-1-1 for a mental health-related crisis to experience positive outcomes including low rates of
involvement with the criminal justice system.
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Goals
If the long-term program outcome is achieved, then the program will be advancing the long-term
goal of contributing to the improvement of public safety and public health throughout San Mateo
County through cross-sector collaboration and coordination among law enforcement, criminal
justice, and health and human services.
Conclusion
While the TOC provides the foundation for program implementation and evaluation, it is important
to note that it is a living map. Circumstances (e.g., conditions related to Covid-19) commonly
change over the course of program implementation, requiring adjustments to core program
elements or short-term outcomes prior to the evaluation’s completion. In addition, study findings
themselves often inspire modifications informing future program implementation. The intention is
to begin the evaluation with a sound TOC that reflects the assumptions embedded within the
program design and to revisit it as needed, though certainly as a touchpoint at the conclusion of
the evaluation.
APPENDIX A REFERENCES
Compton, M. T., Bakeman, R., Broussard, B., Hankerson-Dyson, D., Husbands, L., Krishan, S.,
Stewart-Hutto, T., D’Orio, B. M., Oliva, J. R., Thompson, N. J., & Watson, A. C. (2014).
The police-based crisis intervention team (CIT) model: I. Effects on officers’
knowledge,attitudes, and skills. Psychiatric Services, 65(4), 517-522.
County of San Mateo. (2021, December 2). A new approach to mental health crisis calls: Mental
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approach-mental-health-crisis-calls-mental-health-professionals-partner-police
Hails, J., & Borum, R. (2003). Police training and specialized approaches to respond to people
with mental illnesses. Crime & Delinquency, 49(1), 52–61.
Hollander, Y., Lee, S. J., Tahtalian, S., Young, D., & Kulkarni, J. (2012). Challenges relating to
the interface between crisis mental health clinicians and police when engaging with
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executive summary
September 2022 Interim Report
SAN MATEO COUNTY COMMUNITY WELLNESS AND CRISIS RESPONSE TEAM
PILOT PROGRAM
To address ongoing local needs for immediate mental health services, San Mateo County (SMC)
and its Behavioral Health and Recovery Services (BHRS) division began a partnership with local
police agencies and StarVista (a nonprofit organization offering counseling and crisis intervention
services) to pilot the Community Wellness and Crisis Response Team (CWCRT) program in its four
largest cities: Daly City, South San Francisco, San Mateo, and Redwood City. The CWCRT program,
which partners mental health clinicians with sworn law-enforcement officers as a “co-response” team
in a first-responder framework, is slated to run from December 2021 through December 2023.
RESEARCH ACTIVITY PROGRESS
Theory of Change (Complete). The CWCRT Pilot Program’s advisory group and working group
collaboratively developed the program’s theory of change, completed in August 2022.
Data Collection (Phase 1 Complete). The Gardner Center conducted and is analyzing data from
30 interviews in participating cities and agencies, 22 observations of regularly-occurring program-
related meetings, 54 documents developed by program partners, and incident-level police agency
administrative data both before and after the pilot program began—from January 1, 2019 through
June 30, 2022.
EMERGING THEMES
Preliminary analysis of data collected during the first seven months of implementation yields a few
emerging themes. We report on these themes to present descriptive progress only.
• Dispatch. The first seven months of the CWCRT pilot program have resulted in over 1,600
reported requests by 911 dispatchers for a clinician to participate in a co-response with a
police agency. We are also seeing early indicators that clinicians are connecting with
members of the public via several additional dispatch strategies and responding to both
emergency and non-emergency situations.
• Co-Response. Co-response teams report 500 responses to calls for emergency service.
Officers take the lead on securing the situation safely, clinicians take the lead on assessing
the individual in crisis, and they collaboratively develop a plan for the best action to take.
Preliminary trends suggest 5150 hold write-ups have declined since the onset of the program.
• Continuum of Care. Early evidence suggests clinicians are consistently following up with
served individuals and taking steps to help connect them to appropriate services. Clinicians
often engage in more than one follow-up conversation with or on behalf of the individual.
• Professional Development and Capacity Building. Agencies are using several formal and
informal strategies for professional development, including formal trainings and informal field
observations and conversations.
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While it is too early to look for evidence of the degree to which the program is reaching its short-
term outcomes, it is appropriate to begin looking at the data with an eye toward these goals.
• Preliminary analyses suggest cross-sector collaborations are changing the response to
individuals in crisis when they call 911 for an emergency that includes a mental health
component. This suggests the program is making progress toward its goal of improving cross-
sector collaboration and optimizing responses to those with a mental health-related crisis.
• Early evidence suggests clinicians are playing an important role in brokering individuals’
access to community mental health services and resources. Clinicians are also shaping a
holistic approach to public safety by developing relationships and serving as advocates
connecting those in mental health crisis to critical services. The program thus makes progress
toward its goal of improving community use of mental health services and resources.
• Although it is too early to tell whether the pilot program reduces strain on emergency services
and systems, we are observing some early signals that the pilot is reducing the personal and
professional strain mental health-related crises place on law enforcement officers.
FACTORS FACILITATING AND COMPLICATING IMPLEMENTATION
Three factors impact program implementation in our early stages of data analysis:
• Cross-sector collaboration. Program partners recognize the imperative for cross-sector
collaboration, participate in regular cross-agency program implementation meetings, and
express a genuine respect for each other’s expertise across roles, cities, and agencies.
• Community engagement. Program partners have taken a number of steps to foster
communication and collaboration with the communities served by the pilot program, such as
distributing press releases and soliciting feedback from community members served by the
program. However, they are also quick to acknowledge they could improve in this area.
• Data coherence. Creating coherent data systems within and across organizations is a key
task of a cross-sector collaboration. While the collaborative has made great strides in
advancing data coherence through innovative responses to the needs that arise, sustained
improvements to data coherence will require attention to several factors moving forward.
NEXT STEPS
The Gardner Center’s independent evaluation of the CWCRT program includes two additional
interim reports, a second in March 2023 and a third in September 2023. We will continue to examine
the co-response process in each of the four core program elements and collect additional interview,
observation, document, and administrative data throughout the pilot phase and in our final report.
For more information on San Mateo County’s CWCRT pilot program, please contact Daryl Tilghman,
[email protected]; for more information on this research, please contact Dr. Jaymes Pyne,
[email protected].
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