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HomeMy WebLinkAbout3.20.23 - Commission on Equity and Public Safety Meeting MinutesCity of South San Francisco Minutes of the Commission on Equity and Public Safety Monday, March 20, 2023 Zoom Teleconference Meeting 6:00 pm Commission Members: Present: Krystle Cansino, Salvador Delgadillo, PaulaClaudine Hobson-Coard, Arnel Junio, Carol Sanders, Steven Yee, Alan Perez Staff Members: Present: Amy Ferguson, Management Fellow Maryjo Nuñez, Management Fellow Leslie Arroyo, Deputy City Manager _____________________________________________________________________________________ CALL TO ORDER The Meeting was called to order at 6:07pm. AGENDA REVIEW No changes to the agenda. APPROVAL OF MINUTES The Minutes from the February 21, 2023, minutes were approved. LAND ACKNOWLEDGEMENT Commissioner Perez volunteered to read the Land Acknowledgement. PUBLIC COMMENT No public comment, however, Commissioners remarked that they would like to see hybrid meetings come back, if possible. MATTERS FOR CONSIDERATION 1. Approval of Minutes from February 21, 2023, Meeting. Commissioner PaulaClaudine motioned to approve the minutes and were seconded by Commissioner Yee. 2. Presentation on CARES - Crisis Assistance Response and Evaluation Services by Jeffrey Essex Executive Director of El Centro De Libertad / The Freedom Center. Overview Jeff Essex, the Executive Director of El Centro de Libertad/The Freedom Center came and presented on the CARES program. Program was launched in March of 2022 as a partnership between HMB and El Centro with the goal to redirect calls away from first responders as much as possible unless they are needed/wanted. Their main job is not to provide treatment but to deescalate and stabilize so as to minimize law enforcement dispatch mental health calls (most mental health calls do NOT require PD to come) since people are not seen as a threat, this diverts folks from criminal justice system. -Story: numerous calls involving individuals and law enforcement, and they were shot, so civilian response is better bc not seen as a threat Who is on the CARES team? -two crisis intervention specialists -bilingual staff -either have one or both have EMT or BLS certification -use a lot of affirmation, summaries, meeting people where they are at (how they get buy-in for the client, helps to build rapport) Commissioner PaulaClaudine asked, “what is the term?” To which Jeff Essex shared that it is called motivational interviewing. Mr. Essex shared that they are basically copying the CAHOOTS programs, and that they got rid of the EMT requirement. He stated that if a medical emergency arises, then they would escalate the situation appropriately. He continued to emphasize the importance of lived experience: the majority of people working at El Centro have lived experience to relate to clients and thus empathy. He also clarified that the clinical director oversees the program. How do CARES get dispatched? A community member calls 911/988. If the 3 things are missing: 1) no weapons, 2) not a medical emergency, 3) no crime occurring, then CARES dispatched; it’s important to share information with deputies, if possible, i.e., location in case becomes dangerous. What happens when the CARES team arrives? There is a scene assessment, and they start de-escalation and scene stabilization. They utilize motivational interviewing and plan of action (referrals, safety plans, etc.). What if the scene can’t be stabilized? They have transportation to additional services or safe locations; voluntary 5150 holds: no restraints used typically. There can be an escalation to law enforcement, although rare. When and Where will CARES respond? -from every day 8:00am-6:30pm -mid-coast of San Mateo County -homes, businesses, schools, shelters, and homeless encampments: anywhere that needs be for juveniles, adults, elders, etc. What happens after the response? After the response, they have referrals and warm handoffs to partner agencies (after referral, it is that agency’s responsibility now, but CARES still follows-up). The next day is usually holistic follow- up visits to ensure connections made between agencies, clients, and the client’s support network. Data -over 300 calls -over 40 transports -23 engagements -19 stabilizations -360 follow-up actions (visits, phone calls, getting folks to an appointment) -Average response time: 8.5 minutes -wears civilian clothing, but also has a CARES vest -if a call goes to deputy and seems like CARES can come along, will ask and usually can come Successes: -law enforcement collaboration -recruiting mental health professionals (not looking for licensed clinicians; at least some education: registered with CA for drug support and experience with crisis management) -community support 3. Discussion of the Presentation on CARES Questions from the Commission • Commissioner Alan Perez: how long did it take for schools, 7-11 owners, etc. to know to contact you? o Mr. Essex: did lots of marketing to the schools and the various mid-coast organizations and businesses, then when people started seeing us showing up, they started to get the idea to contact us … it did take a while for word to spread, but now get lots of phone calls, esp. from those that consider mental illness on a regular basis • Commissioner Yee: appreciates that it’s a very holistic process, esp. with working with families o At one point, it was just residents, then it become non-residents? o Mr. Essex: as long as you are in the mid-coast, we will take care of you • Commissioner Yee: can you go into which lived experiences count? o Mr. Essex: that is a very wide answer, but you cannot be on parole. So, if your cases involved substance abuse, are you working towards recovery/sobriety; are you in school etc. o Luis Valdivias screens the folks then Jeff Essex will ask them why do you want to work with El Centro de Libertad • Commissioner Sanders: is BLS certification the minimum requirement? o Mr. Essex: started out with requiring EMT but then realized that don’t need that level bc if actual medical emergency, then paramedics, etc. will come in anyway o Want to have people do supplemental training • Commissioner Yee: mentioned earlier that you wanted to interpret the cycle of mental illness within a family o Mr. Essex: the way that it has been done for decades is that law enforcement will come and then once over, will go away, but there’s no follow-up … CARES has no time limit and then no need for things to just become good, but actually follow through and see how they are feeling and how they are going through the referrals • Commissioner Yee: so you are redefining the approach of mental health crisis? o Mr. Essex: that is fair to say… for example if a family has a kid who has another crisis, they can call CARES again directly like “Cara was great with him last time, can you come again?” • Vice Chair Junio: Are you housed with the station? o Mr. Essex: no, have their own suite of offices within HMB; it really is an independent entity but our success is bc we are intertwined with PD bc we trust each other: to lighten their load o Trust and rapport took partnership building for a bit but we got there … maybe another 3-4 months before starting to trust each other but as long as they are patient • Commissioner Hobson-Coard: will you return to the same place, same call, every time? o Mr. Essex: yes, we will not give up … if it’s a refused service, then we will mark it as a refusal • Vice Chair Junio: so at the moment, have 2 teams of two and a supervisor o Mr. Essex: there are two teams of 2 and Cara oversees the teams, then a clinical director who oversees that, then Luis oversees and makes sure that there is continuity o Additionally, El Centro has over 25 full time staff and about 5 who has shadowed the training too, and all of them Spanish speaking, for SSF, most likely you will discuss AAPI and Spanish-speaking hires • Commissioner Yee: Does having PD presence help? o Mr. Essex: yes, in some places like potential domestic violence, it helps to have PD there in case • Commissioner Yee: what if it is a more charged event? o Mr. Essex: about 70% of calls are a true civilian response and about 30%ish are co- responder model o Officer may get a call of suspicious person where on the surface, it looks like a PD call but then it becomes likely that mental health call • Commissioner Hobson-Coard: have you ever responded to a call where it looks like it should just be CARES but then actually needed PD there? o Mr. Essex: 3 times this happened in the last year o 2 had to issue Narcon, etc. o The other time was that someone was about to get assaulted • Commissioner Yee: so that rapport really breaks down barriers and as your program has grown, can you speak more about that seamless rapport, esp. for repeat calls? o Mr. Essex: working 4-10s on Wednesdays which they interconnect o Only 30k people too, so both teams have regular interface with them o When a CARES team starts in the week, they will look at the reports (like med folders) o CIT International is the gold standard that oversees programs throughout North America o CARES has an operational manual, its own database, etc. • Vice Chair Junio: is in awe with the little funding CARES has and yet was able to have the success that it did o Mr. Essex: AB 118 authorizes state funding for municipalities to secure funding for crisis intervention throughout the state o Mr. Essex: is able to pitch some money, about 500k annually, securing office space, the hiring, training, cars o Could share expense with Pacific bc share the radio network • Commissioner Sanders: have you incorporated what CIT did and vice versa? o Mr. Essex: when first started had to make sure that shared the same language with law enforcement and CIT international system to be streamlined • Commissioner Yee: what are some of the downsides or frustrations? o Mr. Essex: there were a lot of stuff that were nervous about, esp. about liability issues, and then think about things like insurance, had to bump that up, had to work with public safety communications, if dispatcher asks “are you fine with having civilian crisis intervention come to you?” and if folks say yes, then no liability • Commissioner Sanders: what did you think when you heard that Governor Newsom wants to turn San Quentin into a mental health facility vs. the hardcore prison facility? o Mr. Essex: would not affect CARES and would be helpful to some folks but CA still working on criminal reforms, the past years had not been the best thing perhaps, but the intention is there which is good • Commissioner Yee: so you had a resistant sheriff but supportive deputies, so how did that work? o Mr. Essex: the support from the deputies was immediate and bc the public safety communications was the agency we talked to before speaking to anyone else bc we knew that 911 needed to be on board, but there was a process with them about reworking the flow charts • Commissioner Delgadillo: could you expand on hiring non-licensed staff and if you plan on expanding in general? o Mr. Essex: Sheriff Corpus is currently looking for earmarks; Millbrae is looking to get involved; not looking for licenses bc not looking to provide therapy, we are connecting people to therapy; this is also helping with the costs • Vice Chair Junio: this is very enlightening bc in previous presentations, they have mentioned difficulties in hiring with licenses and those were bigger, more established programs • Chair Cansino: the people who have modelled after CAHOOTS, chose to have licenses required as it makes it easier to bill medi-cal and private insurance, hence why hiring licenses o Mr. Essex: when we do have to do 5150, the Director is called in and she will facilitate the paperwork and handoff What folks liked about the presentation: Commissioner PaulaClaudine Hobson-Coard: appreciates that CARES has lived experience, esp. for folks who experienced substance abuse or mental health crisis, this does help and makes it so that it’s safer for officers too bc then don’t have to second guess Vice Chair Junio: agrees that hiring people with history would really help to generate empathy. The staff that they hire are all able to do so. He is also impressed with how much they were able to do but the amount of money they have and will take a closer look at this for when they go to Council. Commissioner Carol Sanders: liked what they heard. She agrees that there is a problem that folks are not paid a living wage here, so having more emphasis on living wage makes sure that folks are able to focus on the job also so that they feel like their services are respected. Chair Cansino: agrees with Commissioner Sanders that $30/hr. for living in San Mateo County is not enough. This is her main critique of the program; this job is dangerous, and it could re-traumatize folks so she believes that it needs to be state/city job with hazard pay and benefits. If this is something we want longevity for, then we need to offer more. Commissioner Steven Yee: also agrees with Chair Cansino and Commissioner Sanders but does want to recognize that CARES knows they do not pay enough. He also wants SSF to consider whether we want to go all out? Have a start-up mindset? He was very impressed with having folks having lived experiences as well as that program is not as clinical but more personal. Commissioner Alan Perez: also agrees with the points made. They seemed very efficient with the money that they had, but he wonders if this is something that SSF could look into. They have relationships with schools, 7-11s/local businesses and this is something that we should consider, looking into these CBOs and resources. Another thing he liked was that CARES was a distinct entity from the PD but still can respond to calls jointly. Commissioner Sal Delgadillo: thought about how this team is going to be… He wonders how comprehensive SSF needs to be, especially when hearing that HMB but also mid-coast community and helps each client with what they need to be safe: we should be open 7 days a week. 24/7 is not feasible but we need information on the weekends too. Commissioner Perez: Jeff said that they have different dates and hours, so maybe we could do that too. Commissioner Yee: it seemed like he was the first to understand SSF; it seems like he studied us, so he really seems tuned in to taking care of people (not to minimize the previous presenters.) 4. Recess Recess started at 7:26pm and the Commissioners reconvened at 7:31pm. 5. Commission Discussion of Information Learned from Outside Presentations, Including Presentation on Mental Health Crisis Service Comparison by Krystle Cansino, South San Francisco Commission on Equity and Public Safety Chair. Amy Ferguson: as we chatted about in the subcommittees, would like to summarize the feedback and the dialogue you’ve done. So Krystle has started these slides, but would like to have you also include your feedback for a report to Council. Chair Cansino: have everything divided up into the problem: why the county even wanted this, then see what our expansion could look like. Data that county had collected showed that LOTS of calls of 911 were of mental health and there is not a lot of hospitals within San Mateo County. We have Mills, Kaiser, and Seton; a lot of patients were here for mental health. Often, there are unnecessary interventions, and no linkages, so a lot of families were left in the dust. There is also a lack of appropriate follow-up care: this is very important for mental health bc not just the individual, but the whole family. Community Wellness and Crisis Response Pilot Program -launched in Dec. 6, 2021 -Daly City, Redwood City, San Mateo, SSF: we are the four biggest cities -goals looking for: 1) alternative to jail and 2) de-escalate 911 calls Budget $450k from County $410k from the 4 different cities Total is 1.5M for the 4 cities Clinicians are contracted bc those who work directly under the city will be more expensive than contracted Commissioner Yee: are you processing out loud? Chair Cansino: just wanted to present the budget to keep this in the back of our minds Amy: the final numbers are different, but the idea was that the county paid half and then each city paid 12.5%, so we can try to get updated numbers Chair Cansino: this was the initial budget too -all clinicians are supervised by star vista supervisor offsite and supervised by PD onsite Current Services -have mental health and substance use -for SSF, one of the main resources that Mika sends folks to is the Daly City clinic… SSF only has a primary clinic, so like regular PCP, so there is no city clinic for mental health specifically, there are partners though like Edgewood for youth Other Models 1) CAHOOTS 2) SCRT (San Francisco) modelled after CAHOOTS, but has changed: adult-only, certified medic, mental health clinician, peer support specialist (taking away the clinicians, they weren’t 5150-ing people on the streets and doing clinical work) bc rooted in the FD, only had 15 min interaction and when had done numbers, people still upset that lots of homeless folks on street still 24/7 3) Alameda Crisis: depending on where you lived, some 24/7 some not 24/7… Commissioner Yee still thinks we could copy them in like leveraging support/resources, but most Commissioners think this is confusing Chair Cansino really likes how they have an elder specific program: GART (Geriatric Assessment) Commissioner Hobson-Coard: with her experience of taking care of her mother and has noticed this with her father as well. Her concern is definitely with our elders. There are a lots of needs that they have and with the mental health crisis comes to accompany the police, you want to address this in an educated way, so we also need something like this for our elder community. For example, an elder can have diabetes, which affects healing, so that could turn into an infection, then gangrene, then sepsis, and then psychosis. PD doesn’t always understand the medical aspect; this person is not just aggressive and angry but is so due to sepsis. She brings in experience from working with her parents and seeing the health troubles that they went through. Commissioner Yee: thanks Commissioner Hobson-Coard for her story. This is also a way to honor our long-time SSF residents. Chair Cansino: when you were taking care of your folks, did you have a licensed psych nurse for them? Commissioner Hobson-Coard: no, but also bc he makes more than the income limit even though he is a veteran. Commissioner Yee: understands bc with his parents and in-laws face a similar issue. Commissioner Hobson-Coard: also had noticed that health care staff, especially if they are seniors, don’t talk to the patient but to who brought the patient. Commissioner Yee: also wants us to consider cultural competency. Chair Cansino: not just have a clinician, but also a psych nurse asking if there is a medical condition, etc. to see if issue is rooted in medical problem. Even without this specific background, just having someone with a health/medical care experience is good to ask, even better if a psych nurse. Commissioner Yee: there is the reactive service, clinical, and then proactive, personal, and we are trying to see which direction works for us As an FYI: folks are within right to decline medical treatment unless 5150ed or 5585ed Unsheltered Youth—Commissioner Delgadillo works for Star Vista so has experience with youth in our schools, juvenile hall, foster care, etc. the high school kids need attention; there is also a lot of homelessness within SSF that is not really visible. A lot of folks live in their cars, have limited interaction. Like with what Mr. Essex mentioned, they are not going to stop attending to them until they get better, so we should help these youth. In the count, only recorded 40, so he is not sure if this is accurate bc Pacifica counted over 100. Commissioner Yee: that makes sense, and folks could be sharing a vehicle too. Commissioner Hobson-Coard: there was a case in Paradise Valley where folks died of carbon monoxide trying to stay warm in the car. Chair Cansino: looking at Alameda has shone a light on what services we need to look into like geriatric, youth services, homelessness Commissioner Yee: when are we presenting to Council? Amy thinks that one more meeting/session with another discussion/presentation would be beneficial. They have also expanded the pilot, so the final recommendations would be closer to the wrap-up of the pilot. Chair Cansino would like to have Chief Campbell, Capt. Plank, and Mika to look over and have them provide their feedback before presenting to council. Deputy City Manager Arroyo agrees, she stated: yes, this way you can come up with the recommendations together. Commissioner Yee: hasn’t heard from EMT or FD, how relevant is this? Deputy City Manager Arroyo: we should talk about this with Jess and have him come over to present to see if FD can get involved. 4) Comprehensive Crisis Services -if hospitalized youth, have a dedicated plan for linkage before they even leave the hospital -having the one supervisor who is licensed that you consult with afterwards is something that Chair Cansino likes -24/7 in person and phone Vice Chair Junio, Commissioner Yee, and Commission Perez asked if there was any feedback for the San Francisco group? They don’t have anything else to add. Vice Chair Junio would like to have a phone line 24/7 even if not able to have in-person 24/7 Chair Cansino: 80% of the calls is triage; this is what is interesting for SF bc City and County; this is a really big advantage. Commissioner Yee: doesn’t think that we are able to get into the details; he asked how long in general do we want our meetings to be? Chair Cansino: next month, we could come in with our opinions for advantages and disadvantages and tailor this into a SSF specific guideline Commissioner Yee: would like to see an executive summary/have just one graph and then after that, get together for SSF specific discussion Chair Cansino: doesn’t mind just sitting on our thoughts and coming back as a group Deputy City Manager Leslie Arroyo agrees that this would be a good launchpad for next month. Commissioner Yee: this would be helpful to look at the General Plan, asking ourselves, how closely are we aligning ourselves? Vice Chair Junio thinks that the Commission should let this soak in and since we have no presentations for next month, it would be good time to do homework and hash it out to get one step closer to finalizing a proposal to Council. He knows that they are watching the Commission, and doesn’t think that the expansion should mean that they should slow down. They are going at a good pace. Commissioner Yee: what are you thinking about next month? Vice Chair: thinks that the Commission should be able to have the full time for discussion. Chair Cansino: thinks that the Commission should do a side-by-side comparison of SSF and other cities, especially since now, SSF has the data. So, the Commission needs to bring back the data, so if the data subgroup could look at that again and bring it to the table for next month, that would be great. Items from Commission and Staff Commissioner Hobson-Coard shared that she is having her band play at Fort McKinley this Saturday. Deputy City Manager shared that the City is currently interviewing 4 finalists for the DEI officer. Amy: once they are on board, we can schedule the retreat. No sooner than the end of April though. Commissioner Perez would like staff to look into Mika replacing SSFPD for certain types of calls like for HMB and looking into community organizations/resources. ADJOURNMENT Vice Chair Junio motioned to adjourn the meeting, and the motion was seconded by Commissioner Sanders at 8:55pm.