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HomeMy WebLinkAbout9.18.23_CEPS_PacketMonday, September 18, 2023 6:00 PM City of South San Francisco P.O. Box 711 (City Hall, 400 Grand Avenue) South San Francisco, CA City Manager's Conference Room, City Hall Commission on Equity and Public Safety Krystle Cansino, Chair Arnel Junio, Vice Chair Salvador Delgadillo, Commissioner PaulaClaudine Hobson-Coard, Commissioner Alan Perez, Commissioner Carol Sanders, Commissioner Steven Yee, Commissioner Regular Meeting Agenda 1 September 18, 2023Commission on Equity and Public Safety Regular Meeting Agenda 23-818 How to submit written Public Comment before the Meeting: Members of the public are encouraged to submit public comments in writing in advance of the meeting by emailing: [email protected] How to provide Public Comment during the Meeting: COMMENTS ARE LIMITED TO THREE (3) MINUTES PER SPEAKER Under the Public Comment section of the agenda, members of the public may speak on any item not listed on the Agenda. Pursuant to provisions of the Brown Act, no action may be taken on a matter unless it is listed on the agenda, or unless certain emergency or special circumstances exist. The Chair may direct staff to investigate and/or schedule certain matters for consideration at a future meeting. If there appears to be a large number of speakers, the Chair may reduce speaking time to limit the total amount of time for public comments (Gov. Code sec. 54954.3(b)(1).). American Disability Act: The City Clerk will provide materials in appropriate alternative formats to comply with the Americans with Disabilities Act. Please send a written request to City Clerk Rosa Govea Acosta at 400 Grand Avenue, South San Francisco, CA 94080, or email at [email protected]. Include your name, address, phone number, a brief description of the requested materials, and preferred alternative format service at least 24-hours before the meeting. Accommodations: Individuals who require special assistance of a disability-related modification or accommodation to participate in the meeting, including Interpretation Services, should contact the Office of the City Clerk by email at [email protected], 24-hours before the meeting. Page 2 City of South San Francisco Printed on 9/15/2023 2 September 18, 2023Commission on Equity and Public Safety Regular Meeting Agenda CALL TO ORDER ROLL CALL AGENDA REVIEW ITEMS FROM STAFF MEMBERS PUBLIC COMMENT MATTERS FOR CONSIDERATION Approval of Minutes from the August 21, 2023 Meeting1 Develop the presentation to council including date from the Gardener Reports, specific data collected from the police update to Council on 7/27/23, and the mental health clinician presentations from late 2022/early 2023 2 ITEMS FROM BOARD MEMBERS, COMMISSIONERS, COMMITTEE MEMBERS ADJOURNMENT Page 3 City of South San Francisco Printed on 9/15/2023 3 City of South San Francisco Legislation Text P.O. Box 711 (City Hall, 400 Grand Avenue) South San Francisco, CA File #:23-817 Agenda Date:9/18/2023 Version:1 Item #:1 City of South San Francisco Printed on 9/15/2023Page 1 of 1 powered by Legistar™4 City of South San Francisco Minutes of the Commission on Equity and Public Safety Monday, August 21, 2023 Regular Meeting 6:00 pm Committee Members: Present: Arnel Junio, Salvador Delgadillo, Alan Perez, Carol Sanders, Steven Yee (arrived at 6:31pm) Absent: Krystle Cansino, PaulaClaudine Hobson-Coard Staff Members: Present: Devin Stenhouse, Diversity, Equity, and Inclusion Officer Kasey Jo Cullinan, Seniors Program Supervisor Laura Armanino, Recreation Manager Scott Campbell, Chief of Police Greg Mediati, Director of Parks and Recreation Kathy Ko, Administrative Assistant II CALL TO ORDER The Meeting was called to order at 6:15pm. AGENDA REVIEW There are no changes to the agenda. APPROVAL OF MINUTES The Minutes from the July 18, 2023, minutes were approved. ITEMS FROM STAFF MEMBERS DEI Officer Stenhouse made announcements: 1. The County is taking input from the community regarding Measure K on Wednesday, 6 p.m. at the Fernekes building. 2. Women’s Leadership Conference is Saturday, 8 a.m. to 2 p.m. 3. Citizen’s Academy registration is currently taking place. Registration ends Friday at 5 p.m. a. Vice Chair Junio comments that he has attended Citizen’s Academy before and encourages everyone to attend. b. DEI Officer Stenhouse states that Commissioner Yee is a former participant of Citizen’s Academy and a discussion can be had about how he can contribute to the upcoming event as a former participant. 4. Fiestas Patrias is September 17th at City Hall. 5 5. The City’s participation in Pistahan Parade from two Saturdays ago. DEI Officer Stenhouse provides background information and a summary of the event. PUBLIC COMMENT No public comments were made. MATTERS OF CONSIDERATIONS 1. Approval of Minutes from July 18, 2023. Commissioner Sanders motioned and Commissioner Perez seconded. The Commission voted to approve the minutes 4-0. 2. Presentation on the history and current state of the Recreation Division’s Full of Fun Program by Kasey Jo Cullinan, Seniors Program Supervisor. Background on Supervisor Cullinan She grew up in South San Francisco and has been working for the City for the past 15 years (started as an aide at Summer Camp). She made the switch from Child Care to Seniors about a year ago. How did the Program start? - The Program began in 2007. Families asked for programming to accommodate teens and young adults with special needs who are aging out of other programs. All programs from preschool through teen camp are inclusionary, but at around age 14 is where teens age out and have nowhere else to go. - The program started off small with only ten campers, three volunteers, and two staff, and ran for about a week. It was absorbed into the child care budget (and is still a part of the child care budget). - The goal is to provide space for special needs teens to hang out in a safe environment with non-disabled peers. This encourages growth between teens with special needs and the high school volunteers. It provides social support, learning opportunities, and peer interaction in a safe and loving environment for both groups. - Eligibility was for individuals aged 14 to 22 years old. - Recreation activities included art, cooking, playground time, and field trips. Where are we now? - The Program has grown a lot over the last 16 years. It is still a social club for participants to hang out, be themselves, and do fun activities with peers they don’t normally have positive interactions with. This is a place to have fun outside of focusing on their occupational/academic/behavioral goals. - Eligibility is now for individuals aged 14 years old and up. There is no maximum age limit. - The Program takes up to 30 campers per session and maintains 1-on-1 volunteers with campers each day. 6 - The Program tries to incorporate goals from the family members into daily activities. - 9 a.m. to 4 p.m. 1-on-1 activities include art, science, cooking, playground/basketball, at least one field trip per session. Volunteers are with a different camper each day. - The Program has been a huge success, so there are lots of success stories (many campers from 2007 still attend, 2 campers are employed with the City, some have gone back to college after building confidence to go into a traditional classroom). - Families have seen growth in their children, confidence built, happiness and joy. Nights of Fun - Events take place from September through May, one night per month, 6:30 p.m. to 8:30 p.m. at different locations to give campers something to look forward to during the school year. - Activities are usually themed. In the past, participants have celebrated holidays, gone bowling, and attended a Giants game. - There is a fee of $5 per camper. - Nights of Fun started in 2015. There is no official staff, but a few members have taken on duties to maintain this offering. Questions from the Commission - Vice Chair Junio: There are no ratios to adhere to? o Supervisor Cullinan: Full of Fun is not licensed, so technically we do not need to. Most clients are adults over 18 years old. We maintain 1-to-1 ratio with volunteers, and we have three to five staff there each day. - Commissioner Perez: Did you say where the field trips were? o Supervisor Cullinan: We’ve done a lot: Santa Cruz Beach Boardwalk, water park in Fremont, San Jose Giants games, Oakland and San Francisco zoos, Great America (never again), therapeutic horseback riding, berry picking. - Vice Chair Junio: Volunteers, are they cleared? o Supervisor Cullinan: There is an application process for volunteers. They are all under 18 years old (not adults). We do conduct interviews, and we have a volunteer orientation. - Commissioner Yee: Thrilled about this program. Pandemically speaking, what have you noticed about participants? o : The first year was a big struggle, enrollment was down, families were concerned because many campers have health issues, and personalities have changed. This summer, families are ready to be back. o Manager Armanino: Many campers struggled socially, some got depressed and needed medication. Some had a really hard time coming out of that. One of the campers (Gabriel) was very sad and angry about Disneyland being closed. Tough when places they loved closed. The first year was tough. Some enjoyed meeting virtually, some struggled. o Supervisor Cullinan: Only having virtual meetings was really hard for some non- verbal clients. It was really hard for them to communicate and participate during those interactions. 7 - DEI Officer Stenhouse: What was the first summer they came back? o Supervisor Cullinan & Manager Armanino: 2021. o Supervisor Cullinan: We only missed one summer. We were only closed 2020. - Commissioner Yee: What did you find that we’re carrying? o Supervisor Cullinan: Biggest part is the socialization. That’s why the volunteers are so integral. We’re selecting good volunteers. We try to match personalities. We’re back to many campers/volunteers, so there’s more at play with spatial awareness. - Commissioner Yee: This isn’t licensed. How do you address mental wellness? How is that different now? o Supervisor Cullinan: We work closely with the families and have open communication. They disclose as much information as they can to us. We touch base with parents and check in with how things are going. All families are making sure campers are in a safe and loving environment. - Commissioner Yee: Great America, why never again? o Supervisor Cullinan: It was really hot. o Manager Armanino: It’s really overwhelming. There are a lot of people—not a lot of nice people. We have to take into consideration everyone’s wants and needs within the environment. It was too big of an environment for them. They had fun, but we were stressed out. o Supervisor Cullinan: We were getting a lot of looks, a lot of comments. There are only so many corrective actions we could make when they are members of the public. It wears on our campers. It was also really hot, and some of our campers don’t do well when it’s really hot. o Manager Armanino: In terms of mental health, this is their safe place. We support whatever they want to do. We want them to take a break from all the pressures outside of camp. - DEI Officer Stenhouse: Are there comparable programs? o Supervisor Cullinan: Not very many. This is the only one framed this way. Full of Fun is the only program running like this. o Manager Armanino: San Carlos has a program but is run differently. A couple of kids bounce around programs. We’re mindful of programming so campers don’t have to choose between programs. - Commissioner Yee: Is there a day at the venue where there is a specific day for a specific audience? o Manager Armanino: San Mateo County fair does. They open it up to families of kids with special needs, and it’s free. o Supervisor Cullinan: We have brought our campers there on a free day before. - DEI Officer Stenhouse: Can you speak to the ranges of the different needs of the kids? o Supervisor Cullinan: We have campers who are non-verbal, some who will talk your ear off, some who have physical limitations, some are high-functioning, some need more assistance. We have one requirement: must be self-sufficient in using the bathroom. We have a wide range of abilities in this program. 8 o Manager Armanino: We ask that they be free of aggressive behaviors because we have volunteers working with them. o Supervisor Cullinan: If we do have any issues, they get addressed. - DEI Officer Stenhouse: How can commissioners help support the program and be advocates for the program? o Manager Armanino: Encourage families to go. Come see the program for yourself, firsthand. Speak to trust for families to hand children over. o Supervisor Cullinan: We’d love to have you guys come to upcoming Nights of Fun. o DEI Officer Stenhouse: Every time I’m around the group, they call me by name. It warms my heart to see the joy. Speaks to the level of leadership and dedicated staff within the program. o Supervisor Cullinan: All staff were former volunteers. o Manager Armanino: Over 90% of volunteers have never worked with this group. o Supervisor Cullinan: It’s a great learning opportunity for volunteers. - DEI Officer Stenhouse: Nights of Fun, primarily email communications? Send flyers and invites. What’s the next one? o Supervisor Cullinan: September. Next one we’re thinking bowling or swim night. - Commissioner Yee: What’s your radius of trips? o Supervisor Cullinan: Nights of Fun are within South City. Field trips can be anywhere. 3. Discussion on whether to present an update to City Council regarding various jurisdictions practicing mental health crisis response models. - DEI Officer Stenhouse: There was a conversation about potentially presenting to Council an update on Gardner Center reports. A report has been given to Council from PD on Gardner Center. Do we have an informational update on different municipalities? It feels like the Commission has been strong advocates for the clinician mental health program. Would that presentation be worth it, or a variation of the presentation? - Commissioner Yee: A variation as long as it’s of value. - Chief Campbell: Sept/Oct there should be a new report. - Vice Chair Junio: Did you touch on this last session? - DEI Officer Stenhouse: Two months ago, let’s refine the presentation. A month ago, question of what is the value of this? Krystle initially intended for internal eyes only. As far as potential report to Council, that would center around Gardner. Is that the presentation we provide, or do we revise the report? Budget approval is around the corner. Is there value in bringing it up before then? - Commissioner Yee: The report specific to South City, how can we get it? - DEI Officer Stenhouse: It’s public. I can forward. Do we see value in presenting background knowledge? Amy was advocating the findings from reports. If the City wants to advocate for this program, is there another way to do that? Does the Commission want to show support? 9 - Commissioner Sanders: Can we just send a statement, letter, or document, as opposed to showing up to present? - DEI Officer Stenhouse: If that’s the case, I would recommend a subcommittee. - Vice Chair Junio: What is the Council expecting of us? I’m still in this gray area. - DEI Officer Stenhouse: They’re not expecting anything. This would just be the Commission being publicly, overtly supporting the program. - Commissioner Yee: We need to show that. We have to be out there, be the voice of the people. It’s important. This is very clear an opportunity to advocate, to represent the people. - DEI Officer Stenhouse: Hopefully within a month we’ll receive the 3rd report. Perhaps what the presentation would look like is a fusion of the Gardner report (combination of 4 cities) applied with the report provided by PD (about SSF). Side by side comparison of stats/data. Identify benefits. Of the organizations participating in program including SSF, 4 other models can be included. Additional resources. - Commissioner Yee: We’re almost a year out. How long are we going to…? - DEI Officer Stenhouse: These are summaries you have received. Presentations included information not in the summaries. Might be worth it to reference videos on City website. You can sit on it for another month if you want to. Goal is to express advocacy for the program. There are potential opportunities to advocate for yourself and the commission at upcoming events. If you want to have a table at Farmers’ Market, that is an opportunity to think about. No need to vote or motion right now, these are considerations to take. - Commissioner Yee: If we’re to present, what’s the date? - DEI Officer Stenhouse: Not September. No specific date. Recommend before the year is over. Things change as holidays approach. - Commissioner Yee: What do we do? What’s the decision? I’m not clear. - DEI Officer Stenhouse: Consider if so, how to advocate for the program at a public setting at Council? Nothing to be decided right now. What’s the Commission’s way to advocate for the program, considering the reports that have been sent? You’ll get a report from PD, you’ll receive within the next month the 3rd report. Final report will be in March. Question is how to use the reports? Does it make sense to incorporate them in how we advocate for the program? - Commissioner Yee: As a group, do we want to present to Council? What do each of you think? - DEI Officer Stenhouse: Question 1, do you want to advocate for the program? - Commissioner Perez: Yes. - Vice Chair Junio: Yea. - Commissioner Sanders: It goes without saying. - DEI Officer Stenhouse: Question 2, do you want to advocate for the program in a public setting? - Vice Chair Junio: I think you’ve made it clear we should do that. - Commissioner Sanders: I think we discussed this before. We decided that we will go in this direction. - DEI Officer Stenhouse: Before it was mental health crisis comparison. Then Krystle thought report/presentation was for internal eyes. 10 - Commissioner Yee: You (Vice Chair Junio) said you were shot down before, how do you feel about where we are in the process now? - Vice Chair Junio: I still want to go before Council. We should do it in a public setting, have our voices heard, our faces seen. It’s just not clear to me, what we’re presenting. I don’t want to look foolish. They have expectations, I would like to meet those expectations. Getting all 7 of us here has been a challenge. Hopefully, we can nail this down and go to Council. - Commissioner Sanders: I come to the meetings thinking we’ll come up with something to present. We haven’t done that yet. It’s now August. - Vice Chair Junio: Like a special meeting? - Commissioner Sanders: Yes, more than one. - DEI Officer Stenhouse: I’m not expecting a 3rd report before our next meeting. - Commissioner Sanders: So, there’s no way we’ll have all the information to present? - DEI Officer Stenhouse: We’re getting a report in September, but will we get it by the 3rd Monday? - Commissioner Yee: An option, we can do a special meeting. - Vice Chair Junio: I like the idea of a subcommittee. - DEI Officer Stenhouse: We can have a subcommittee for the report, one for the presentation. Maybe there is a special meeting where we can all come together by October. The report can come from me. The presentation would be where you would all be alignment on. - Chief Campbell: Council is anxious to see data, we’ve been hesitant to release. We’ll have new data points over the next month. We may do a joint presentation. We can do the data, you guys can make recommendations based on the data or give options based on SSF. - Commissioner Perez: Even when we don’t have the data, it’s interesting. What it looks like with/out clinician. - Chief Campbell: We can let you know when/days our clinician was out. - Commissioner Yee: That is valuable data. I appreciate the tag team. - Chief Campbell: We’re just presenting the facts. You guys present what you think is best for SSF. - DEI Officer Stenhouse: PD will be presenting specifically for SSF. It’s up to the commission to connect data points with Gardner Center. - Commissioner Perez: At Council meeting, we’re not saying we’re advocating for the program and these are the things we would modify? We’re not at that stage yet? - DEI Officer Stenhouse: It’s a favorable program. The numbers speak for themselves. - Commissioner Yee: We can comment on what we’re seeing at this point. - Commissioner Sanders: You mentioned a march report. - DEI Officer Stenhouse: Yes, there’s a march report but we don’t want to wait that long. There’s financial support coming from outside the City. Showing support goes a long way. Half of the budget, if not more, is coming from the County. The current budget is not going to support what we’re currently seeing. We would like to see some type of extension of the program. - Commissioner Yee: We’re not built for financial analysis or projections. - DEI Officer Stenhouse: We’re not. We are presenting facts. 11 - Vice Chair Junio: Just the benefits. - Commissioner Perez: I suggest for next meeting we all come with suggestions for what to present to Council. - DEI Officer Stenhouse: I’ll send the 2 previous reports. - Commissioner Yee: Are we also thinking by the end of the next session we’ll have a decision on what the presentation looks like? - DEI Officer Stenhouse: That depends if everybody does their homework. The September report may or may not be included. Let’s look to focus on what this would look like. - Commissioner Yee: Anything we’re missing? - Commissioner Delgadillo: I think what’s important is the Gardner Center data and PD data. I’ll do my homework. - DEI Officer Stenhouse: I’ve watched the videos. We’re at the point, are we doing this or not? Commission can advocate for itself. - Commissioner Sanders: What does it take to do that? - DEI Officer Stenhouse: Farmers’ Market as an example: it’s common for organizations to show up knowing people are walking for hours, put up a canopy and table, include knickknacks or flyers to promote what the group is about. For people who walk by to see the message. Opportunity to strike up conversation with the public. - Commissioner Sanders: What would it take for us to do that? Do we need a banner? - DEI Officer Stenhouse: If the commission is interested in tabling, there are a lot of upcoming events. - Commissioner Sanders: Can I motion to have us do something? - DEI Officer Stenhouse: October 28 is LPR opening. - Commissioner Yee: I think that is a key one, a big one, a can’t miss. Banner, we do not need anything big. It can be simple. - Commissioner Sanders: We need consistent things to say. - Commissioner Yee: That I agree with you. Are there any organization who have experience we can tap on shoulders? - DEI Officer Stenhouse: There are other equity commissions. Yes. - Commissioner Yee: How connected are we with other commissions/organizations? - DEI Officer Stenhouse: There are other cities/municipalities in terms of equity. Connecting with them would not be a difficult task. - Commissioner Yee: I was thinking internally, other South City organizations, but I appreciate you bringing that up. - DEI Officer Stenhouse: There are a number of resources we can tap into. It’s very easy to reach out to other equity officers. Question is, how to keep you in the loop? These questions are not unique to this commission. I’m happy to ask. ITEMS FROM BOARD MEMBERS, COMMISSIONERS, COMMITTEE MEMBERS There were no items from the Commission. ADJOURNMENT Vice Chair Junio motioned to adjourn the meeting, and the motion was seconded by Commissioner Perez at 7:58pm. 12 City of South San Francisco Legislation Text P.O. Box 711 (City Hall, 400 Grand Avenue) South San Francisco, CA File #:23-821 Agenda Date:9/18/2023 Version:1 Item #:2 City of South San Francisco Printed on 9/15/2023Page 1 of 1 powered by Legistar™13 Staff report on Commissioner feedback on Mental Health Clinician program. Title Recommendations from the Commission on Equity and Public Safety to inform the possible continuation of the Community Wellness and Crisis Response Team in South San Francisco. Recommendation It is recommended that the Commission on Equity and Public Safety continue to review their feedback on other Bay Area mental health crisis response models. As recommended during the June commission meeting, the “Other Models” pages have been condensed into a single matrix. Additionally, commissioners should consider incorporating the September 2022 and March 2023 Gardener Center Interim reports into their report. This review can be used to help the Commission prepare to present to the South San Francisco City Council with their recommendations on how to expand the Community Wellness and Crisis Response Team (CWCRT) program in South San Francisco. Background/Discussion Since October 2022, the Commission on Equity and Public Safety has been receiving presentations from nearby jurisdictions on their alternative mental health crisis response models. They have met South San Francisco’s mental health clinician, Mika Celli, and received presentations from Alameda County Behavioral Health Care Services Crisis System of Care, San Francisco Department of Public Health Comprehensive Crisis Services, Berkeley Mental Health Crisis Services Program, and Half Moon Bay Crisis Assistance Response & Evaluation Services. The Commission has also reviewed data and received a data presentation from SSF Captain Adam Plank and James Pyne of the Stanford Gardner Center, the latter of which are evaluating the Community Wellness and Crisis Response Team to determine whether the program is meeting its intended objectives. In the April 2023 meeting, the Commission discussed their takeaways from presentations from nearby jurisdictions. The following summary captures these takeaways. It is recommended that the Commission use this staff report to inform their presentation to City Council with interim recommendations on how to expand the program. The current program is slated to run until the end of the 2023 – 2024 fiscal year. The Gardner Center evaluation will be released after the end of the program. It is therefore recommended for the Commission’s recommendations to be received as interim recommendations for further investigation, before the actual program concludes, is evaluated, and is determined whether to continue or not. Working with Police The Commission learned that different jurisdictions have differing methods of responding to a crisis, with or without police. Some models involve a co-response with police, such as the City of Berkeley, where the mental health responder arrives separately from a police officer during the day, and together at night. In Berkeley, mental health responders also have access to police radios. The San Francisco team found that sometimes community members respond better to a civilian, and sometimes they respond better to a police officer. They noted that police can also stage nearby, and join the scene if it becomes necessary. 14 In Half Moon Bay, the team responds separately from police, as long as there are no weapons, medical emergencies, or crimes. They found that most mental health calls do not require an armed response. However, the team can call the police if needed. The Commission preferred this model. It was also noted that the responding team should wear a non-threatening uniform. Team Makeup and Expertise Especially if police are not always co-responding, the Commission preferred two-person teams, for safety and to have a peer with whom to problem solve. Staff would have to examine costs to see the feasibility of this approach. The Commission also noted a preference for supervisors to have relevant knowledge and experience, as the current supervisors for CWCRT do not have as much field experience. In Half Moon Bay, a Clinical Director who is a licensed LCSW supervises. Some other programs make use of interns, who could potentially help with paperwork, follow-ups, or other tasks. Half Moon Bay found that they did not always need a licensed clinician to respond. They found that crisis specialists, civilian peers, were effective and provided cost savings. Their two-person responding teams have either one or both bilingual in Spanish, one or both with training as Emergency Medical Technicians or in Basic Life Support certification, and one or both having lived experience. As it was difficult to obtain clinicians to work on the CWCRT, scaling back the desired qualifications could make hiring more feasible, and there would be less competition among Bay Area jurisdictions for the same pool of clinicians. However, this approach also has tradeoffs, as peer specialists cannot write involuntary 5150 holds, to force someone in need of mental health to be placed on a hold. Only doctors, clinicians, and police officers can write involuntary 5150s. In Half Moon Bay, their responders can do voluntary 5150 holds only. The Commission appreciated models with diverse teams who were multi-disciplinary. They preferred to have some team members who are bilingual (if not only hiring clinicians, this would expand the pool of eligible bilingual crisis specialists). They appreciated teams that get cultural humility training. They also appreciated that Half Moon Bay’s program hires people with lived experience, such as experience with mental health issues or substance use. The Commission liked that some of Alameda County’s programs are specialized to populations like repeat clients, seniors, and/or youth. Some training in these areas would be beneficial in South San Francisco’s program. Lastly, Half Moon Bay’s program reported decreased costs by hiring peer specialists, however, the Commission noted the importance of adequate pay. The role is challenging and at times, potentially dangerous. They also recommended sufficient benefits and hazard pay. Jurisdiction The Commission discussed that South San Francisco could save on costs by partnering with other local cities to share a program that can respond regionally. Half Moon Bay’s program is able to respond along the mid-coast area. Alameda County’s program also responds to multiple cities. These cities do not pay into the program but do assist with the cost of vehicles and gas. It may be beneficial to partner with non-profit organizations as well. South San Francisco’s program currently partners with StarVista. Half Moon Bay’s program is run by El Centro de Libertad, a non-profit 15 organization with a real footprint in the community. Commissioners appreciated that the organization has deep and direct engagement with the community, and an authentic community awareness. Funding will be a challenge for the South San Francisco program. Staff should seek funding from the County, from grants, and from any other sources. One potential method is to use insurance to reimburse costs. Ecosystem The Alameda County team noted the importance of mapping the ecosystem of resources, including detox centers, diversion centers, and others. In South San Francisco, this network could include the Homeless Outreach Team and StarVista. Clinician Celli has also noted that through StarVista, the partner non-profit to CWCRT, she can access county health records that can provide useful background information on clients. Another question is whether the responding team can transport clients to services. Crisis team transports can cut down on fuel, time, and labor costs associated with calling an ambulance to take a client to the emergency room. South San Francisco’s current model does not allow the clinician to transport clients. Timing Commissioners agreed that the current model of Monday through Friday, 9 am to 5 pm is not sufficient for the community. Commissioners noted that weekend and evening service are needed. Using the data on times of calls, staff may recommend the program extend somewhat, if not 24/7. For example, the program could run until 9 pm, 11 pm, or even 5 am, depending on the need and tradeoff with cost. One of Alameda County’s programs runs from 7 am to 11 pm. South San Francisco’s data shows that the times with the fewest calls are from 5 am to 9 am. As the cost for 24/7 service may not be justifiable, an overnight phone line may be a useful tool. San Francisco has a 24/7 phone line. Next Steps Commissioners noted the importance of receiving the Gardner Center report on effectiveness of the program. The evaluation seeks to answer the following 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? Commissioners were interested in the impact of the program on arrests, use of force, take-up of social services, and other indicators. They hoped to see in the evaluation public safety outcomes, feasibility/efficiency, individual outcomes, and public perception and trust. They wanted to know whether some clients are repeat utilizers. The Commissioners also wanted staff to look at data including 16 locations and times of calls as whether the top reasons for calls. For an example of the importance here, a call for danger to self could require a very different response from a call for danger to others. Lastly, the Commission requested a method for the community to weigh in. This includes surveys or other methods. On a recent community survey, 46.4% of South San Francisco residents selected that “Adding mental health and substance emergency professionals to the first responder teams” would help ensure that the South San Francisco Police Department treated residents fairly. This was the top answer for this question. One-third of residents selected “Shifting mental health and substance emergency calls to other agencies” (residents could check more than one answer). Conclusion It is recommended that the Commission use this staff report to complete their design of a presentation to City Council on recommendations for the CWCRT possible expansion. 17 MENTAL HEALTH CRISIS SERVICE COMPARISON 18 Table of contents Problem Pilot Program Other Models Expansion 01 02 03 04 19 Problem 01 20 Data Overuse of 911/EMS Police responding to non-violent MH calls, full emergency rooms Unnecessary Interventions Triage, Referral, Linkage Appropriate follow-up care Appropriate level of care for acuity 21 02 Pilot Program 22 Community Wellness & Crisis Response Pilot Project •Launched December 6, 2021 •Mental health professionals' team with law enforcement in San Mateo County’s four largest cities DALY CITY SOUTH SAN FRANCISCO REDWOOD CITY SAN MATEO 23 GOALS •Twin goals: •Provide an alternative to jail and overburdened hospital emergency rooms for non-violent individuals undergoing a behavioral health crisis •De-escalate 9-1-1 calls and providing appropriate, compassionate care for non-violent individuals 24 County Contribution $468,388x2 Years City Contribution $408,388x2 Years Total for the 2 year Pilot $1.5 Million BUDGET 25 Contracted Clinicians Catherine Maguire, LCSW Redwood City Patricia Baker, LMFT Briana Fair, ASW San Mateo Mika Celli, LCSW Daly City South San Francisco 26 Current Services Mental Health/Substance Use Triage an effective response for individuals having an acute MH crisis, safety risk assessment (5150/5585) Conflict Management/De- escalation Reduce contact between individuals with a behavioral health issue and the criminal justice system Training Increase and improve training and collaboration between BHRS and law enforcement Linkage/Resources Increase access to appropriate resources 27 COMMUNITY WELLNESS & CRISIS RESPONSE PILOT PROGRAM San Mateo County, California Team Mental Health Clinician & SSF Police Officer Response Child & Adult: Non-criminal crisis, behavioral & mental health related problems, critical incidents, natural disasters, community violence, Services Crisis intervention, de-escalation, support services, 5150 evaluation, follow-up, resources, and safety plan. 28 Other Models 03 29 CAHOOTS Eugene, Oregon Team Certified medic and a trained mental health crisis worker. Response Non-criminal crisis, homelessness, intoxication, disorientation, substance abuse and mental health related problems, dispute resolution. Services Non-emergency medical assessment/care, first aid, transportation to social services, crisis intervention, counseling services, and mediation. 30 SCRT San Francisco, California Team Certified medic, Mental Health clinician, Peer support specialist Response Adult Only: Non-criminal crisis, homelessness, intoxication, disorientation, substance abuse and mental health related problems, dispute resolution. Services Non-emergency medical assessment/care, first aid, transportation to social services, crisis intervention, counseling services, and mediation. 31 ALAMEDA CRISIS Alameda County, California Team MCT (Mobile Crisis Team), MET (Mobile Evaluation Team), CATT (Community Assessment & Tx Team, Mobile Crisis/Outreach & Engagement, Crisis Connect (Post-crisis follow-up team), Familiar Faces Team, Community Connections Team, GART (Geriatric Assessment & Response Team), CARE Team (City of Alameda Community Assessment Response & Engagement Team, MACRO (City of Oakland Mobile Assistance Community Responders of Oakland, BART Police Department Progressive Policing Bureau, HEART (Hayward Evaluation & Response Team), MIHU (Mobile Integrated Health Unit) Response Services 32 COMPREHENSIVE CRISIS SERVICES San Francisco, California Team 2 Crisis Clinicians & AOD, SFPD PRN Response Non-criminal crisis, substance abuse and mental health related problems, dispute resolution. Services Crisis intervention, de-escalation, support services, 5150 evaluation, follow-up, resources, and safety plan. 33 ADVANTAGES & DISADVANTAGES 34 Community Wellness & Crisis Response Pilot Program Agency Team Response Services Hours of Operation San Mateo County, CA •Mental Health Clinician •SSF Police Officer Child & Adult: Non-criminal crisis, behavioral & mental health related problems, critical incidents, natural disasters, community violence. Crisis intervention, de-escalation, support services, 5150 evaluation, follow up, resources, and safety plan. M - F: 9:00 am – 5:00 pm CAHOOTS (Eugene, OR) •Certified Medic •Trained Mental Health Crisis Worker Non-criminal crisis, homelessness, intoxication, disorientation, substance abuse and mental health related problems, dispute resolution. Non-emergency medical assessment/care, first aid, transportation to social services, crisis intervention, counseling services, and mediation. Every day: 24 hours/day SCRT (San Francisco, CA) •Certified medic •Mental Health Clinician •Peer Support Specialist Adult Only: Non-criminal crisis, homelessness, intoxication, disorientation, substance abuse and mental health related problems, dispute resolution. Non-emergency medical assessment/care, first aid, transportation to social services, crisis intervention, counseling services, and mediation. Every day: 24 hours/day ALAMEDA CRISIS (Alameda County, CA) •MCT (Mobile Crisis Team) •MET (Mobile Evaluation Team) •CATT (Community Assessment & Tx Team) •Mobile Crisis/Outreach & Engagement •Crisis Connect (Post crisis follow up team) •Familiar Faces Team •Community Connections Team •GART (Geriatric Assessment & Response Team) •CARE Team (City of Alameda Community Assessment Response & Engagement Team) •MACRO (City of Oakland Mobile Assistance Community Responders of Oakland) •BART Police Department Progressive Policing Bureau •HEART (Hayward Evaluation &Response Team) •MIHU (Mobile Integrated Health Unit) COMPREHENSIVE CRISIS SERVICES (San Francisco, CA) •2 Crisis Clinicians •AOD (Alcohol and Other Drug) Clinician •SFPD PRN (or as needed) Noncriminal crisis, substance abuse and mental health related problems, dispute resolution. Crisis intervention, de-escalation, support services, 5150 evaluation, follow up, resources, and safety plan. 35 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. 36 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]. 37 interim report March 2023 SAN MATEO COUNTY’S COMMUNITY WELLNESS AND CRISIS RESPONSE TEAM PILOT PROGRAM: REQUESTING AND DISPATCHING CO-RESPONSE TEAMS To address ongoing local needs for immediate mental health services, San Mateo County (SMC) is 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). The shared goal is 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’s research and evaluation, SMC has engaged Stanford University’s John W. Gardner Center for Youth and their Communities (Gardner Center). Research activities by the Gardner Center have been underway for the entirety of 2022. In their research and evaluation role, the Gardner Center provides regular updates to CWCRT partners to inform continuous learning and improvement as the pilot program unfolds. The first interim report in September 2022 described details of the pilot program’s start-up and first months of activity. Subsequent to the current the interim report discussed below, the Gardner Center will release a third interim report in September 2023 and a final report in March 2024. This interim report will focus on one of the pilot’s core program elements: co-response team dispatch. We define dispatch as the process by which the four participating cities’ dispatch centers send a “co-response team” (i.e., a mental health clinician and police officer) to emergency and non-emergency calls for service. Specifically, we describe preliminary findings related to four questions: 1. How are co-response teams dispatched and what factors influence determining when to dispatch a co-response team? 2. How often are co-response teams dispatched, and to what types of calls? 3. How do the individuals involved in program implementation experience the dispatching function of the pilot program? 4. What factors appear to facilitate and/or complicate dispatch? In the following sections, we answer each of these research questions based on our preliminary analyses of data collected from documents, interviews, observations, and police agency records. 38 CWCRT Pilot Program: March 2023 Interim Report ● 2 How are co-response teams dispatched? The dispatch process begins with a request for service. Such requests originate from a variety of sources, including: • Community member calls to 9-1-1 and non-emergency police department phone lines. Community members may call to request assistance with many types of emergencies or non-emergencies that may or may not include a mental health component. • Community member calls to a clinician’s direct phone line. Community members seeking support for a mental health-related concern may call the clinician directly. Sometimes, either the clinician or the caller (at the clinician’s prompting) contact dispatch to initiate a call for service. • Community member “walk-ins” or in-person queries for assistance. Community members may walk into a police department seeking assistance with a range of situations. After speaking with the front desk staff, mental health clinician, and/or police officer, this encounter may result in one party calling dispatch to initiate a call for service. • Officer requests. Officers who respond to a call for service without a clinician (e.g., when the clinician is off duty) may note the individuals served could benefit from the clinician’s expertise and/or the individuals served have had prior contact with the department’s clinician. Sometimes, the officer follows up by reaching out to the clinician to bring the call to their attention. The clinician may then contact dispatch to initiate a call for service. While available administrative data do not completely denote which calls originate from each of these sources, program partners and police agency data suggest the majority of co-response dispatches originate from calls to 9-1-1 or non-emergency police phone lines. Criteria informing dispatch As the first point of contact with callers, dispatchers listen for cues indicating the call would be well-served by a clinician’s involvement. At the start of the pilot program, dispatchers often listened for specific words or phrases to prompt dispatch of a co-response team, such as a reference to a mental health diagnosis, erratic behaviors (e.g., hallucinations or delusions), suicidal ideation, or a request for assistance conducting a mental health assessment (typically originating from schools or care facilities). However, as officers, clinicians, and dispatchers have become more familiar with the types of calls that are well-served by a co-response team, the dispatch process has evolved in two ways: 39 CWCRT Pilot Program: March 2023 Interim Report ● 3 First, dispatchers’ criteria for dispatching a co-response team have expanded beyond listening for specific words or phrases to include: • Prior information on the individuals involved in the call. For example, a call may come in requesting a welfare check at a particular address. Dispatch’s query of the police department database reveals an individual at the address has had prior contact with the department’s mental health clinician, which may then prompt a co-response dispatch. • Considering the needs of others involved in the situation. For example, a car accident may not prompt a co-response, but when it becomes apparent the accident involves a critical or fatal injury, dispatchers may send the clinician as part of the response team to support the injured party’s loved ones. Second, dispatchers rarely make dispatch decisions in isolation, but rather collaborate with officers and clinicians. Drawing upon their diverse expertise, the group then determines whether a co-response team is needed. For example, a caller may not say anything to indicate there is a mental health component to their situation. However, upon hearing the call dispatched over the police radio, the clinician may recognize the call involves someone with whom they have had previous contact through an encounter that would not appear in police agency records (e.g., from the city’s homeless outreach team). In such cases, the clinician will communicate over police radio to let the responding officer and dispatcher know of their prior contact with the individual. In these situations, the officer will typically respond by asking the clinician to join the response team, and the dispatcher will attach the clinician to the call. We also find that while dispatch decisions are informed by dispatchers, clinicians, and police officers, it is ultimately the officer who determines whether a clinician will join a co-response team, since the officer bears responsibility for ensuring the safety of all parties involved in an emergency response. Even so, we find no evidence suggesting officers are barriers to co-response dispatch; to the contrary, our preliminary analyses suggest officers generally prefer responding to calls as part of a co-response team. In addition to observing the many factors informing a decision to dispatch a co-response team, we also observe a few considerations that inform a decision not to dispatch a co-response team: • Safety. Dispatchers do not immediately dispatch a co-response team if there is a credible safety concern for anyone involved in the call, including community members, clinicians, officers, and other first responders. • Fire / medic response. Dispatchers do not typically send a clinician when a call involves a fire or significant medical situation. • Resources. Only one full-time clinician works with each police agency, meaning dispatchers, officers, and clinicians are mindful of dispatching co-response teams to 40 CWCRT Pilot Program: March 2023 Interim Report ● 4 situations that can be well-served by the presence of a mental health clinician. For example, if a non-emergency call comes in regarding a “welfare check” or a “suspicious incident” without any indication the situation involves a mental health concern, a dispatcher may first send an officer to respond and learn more about the situation before deciding whether to dispatch a co-response team. Overall, in emergency situations we find dispatchers will send a co-response team when there is some indication that those involved could be well-served by immediate support of a clinician. In non-emergency situations, dispatchers, clinicians, and officers all contribute to making the decision. Our current findings suggest all involved believe this collaborative process works well. How often are clinicians dispatched? Over the course of the pilot program in 2022, clinicians responded to 838 total reported calls for service in the four cities participating in the program (Table 1). On average, there are 17 reported co-response dispatches in each city per month. Although this averages to a little less than one new crisis response per work day (i.e., Monday through Friday) per city, prevalence of incidents can vary considerably from day to day and month to month (see Appendix Table A1 for clinician responses by city and month of the year).1 Importantly, when clinicians are not participating in dispatched co-response calls, they take on many responsibilities, including conducting follow-ups with individuals involved in prior incidents, intermittent trainings, incident paperwork, and other administrative tasks.2 Table 1. CWCRT Co-Response Call Types in 2022 Co-Response Calls N % Welfare Check 345 41% Mental Health Incident 198 24% Disturbance 75 9% Suspicious Incident 33 4% Homelessness-related 12 1% Other 175 21% TOTAL 838 100% Note: Data come from police agency administrative records. 1 Demographic information (e.g., race, gender, age) on those coming into contact with co-response is limited to the research team. Dispatchers will often code such information for the caller (who may not be involved in the incident further) and only on the key subjects involved if the incident escalates to a criminal complaint. 2 Early findings related to clinician’s additional responsibilities are described in the Gardner Center’s September 2022 CWCRT interim report and will be discussed in greater detail in the final report (March 2024). 41 CWCRT Pilot Program: March 2023 Interim Report ● 5 Of those calls-for-service in which a clinician responded in 2022, police records document 41% as welfare checks, 24% as explicitly considered a mental health incident (e.g., suicide attempt), 9% as some kind of disturbance (e.g., verbal altercation, trespassing), 4% as a “suspicious incident,” 1% as specific to homeless outreach, and another 21% as one of many infrequent types of incidents in the data connected to clinicians (e.g., meeting a citizen to take a report, assisting a non-police government agency, following up on previous calls). Figure 1. CWCRT Responses in 2022 Across Four Cities, by Day of Week and Time of Day Note: Data come from police agency administrative records (N = 838). As Figure 1 suggests, clinicians across all four cities typically respond to calls between Monday and Friday, between 8 a.m. (hour 8) and 6 p.m. (hour 18), depending on the date, city, and clinician availability. Clinicians have been dispatched to roughly 20 to 25 calls across these days and times, but they appear to be dispatched more frequently between 11 a.m. and 1 p.m. Even though clinicians do not typically work weekends, documentation suggests clinicians have responded to calls very rarely on Saturdays. Among the 838 responses involving clinicians, 21 (2.5%) led to police opening a criminal case (i.e., citation or arrest) and two resulted in documented police use of force.3 How do those who implement the program experience dispatch? Data suggest dispatchers and officers appreciate opportunities to dispatch a skilled mental health clinician to support community members who are in distress through the CWCRT pilot program. Overall, they perceive co-response dispatch processes going “very smoothly,” noting it is similar 3 There are no universal protocols guiding how police agencies define and document “police use of force”; thus, how participating police agencies define and document these incidents may vary. According to documented police accounts, among the two incidents involving a clinician being dispatched, the first occurred after the clinician tried for more than an hour to negotiate a voluntary 5150 hold with the subject. After that time, police officers intervened and used force to compel detention of the subject. In the second incident, the clinician gained initial cooperation with the subject and determined a 5150 hold was justified. However, as officers escorted the subject to the ambulance, the subject fled. When police later located the subject and initiated force, the clinician was no longer on scene. 42 CWCRT Pilot Program: March 2023 Interim Report ● 6 to their experience dispatching other special units (e.g., chaplains). In terms of clinician availability and response, partners agree it would be helpful if co-response teams could be available 24/7. However, many broadly feel that having one clinician on duty at a time allows them to meet current demand; often, a clinician is not needed in two places at once. Since the onset of the program, dispatchers and clinicians have experienced a reduction in the number of calls coming from individuals who call 9-1-1 frequently (e.g., multiple times/day or week) for mental health-related concerns. They perceive co-response teams are generally more effective than officers alone at supporting callers who struggle with complex and/or chronic mental health challenges. They posit that as community members’ needs are better understood and addressed, they rely less on 9-1-1 to access support. According to one dispatcher: There was one person that used to always call…he [had a complex mental health diagnosis]. … The only thing we can do is either put him on a hold, a 5150 hold … but then after 72 hours…they put him back out there, [and we] get a call, literally, right when they get released from the hospital, he's calling again. … So the officer goes back out there, they 5150 him again. … But ever since the mental health clinician came, I don't know exactly what she's been doing, but definitely I've been hearing less and actually stopped hearing from him for a couple months… We still hear from him, but way less frequently. Similarly, one clinician described her role in addressing mental health crises in this way: I think I have a lot more resources than the officers did, and I think that's the biggest piece. So [a community member] that made the suicidal statement that has no intent but maybe had some sort of plan…I'm able to do a safety plan with them and call their therapist and say, … "Can you do a check-in within the week because we just did a safety plan and they were having these thoughts." Whereas officers don't have that option so it's to the hospital. Same for clients who utilize services a lot who are [experiencing homelessness] or just [struggling with severe mental illness] in their homes. A lot of times I can go out and I can work with the family and get different resources out to the family and provide connections to different options because that person probably doesn't need to go to the hospital. They can manage today and we can get support in there. … So I think that that's the biggest shift is that not everybody needs to go to the hospital. That's not the only option anymore.” 4 Also of note, dispatchers and officers perceive clinicians as building capacity to triage mental health-related calls effectively. In one of many examples, during a large storm in January 2023, a clinician stopped by the dispatch center to offer additional support for anticipated calls involving emergency shelter needs. The dispatchers indicated they were already receiving such calls. Yet when dispatchers called the local inclement weather shelter, they were sent straight to voicemail. Before ending her shift, the clinician provided the dispatchers with the contact information for an individual who would answer their calls and help them connect community members with beds. 4 Resources available to clinicians also include full access to the county’s electronic health record system (Avatar), allowing clinicians to identify past and present treatment teams, safety planning, coordinating hand-offs, and more. 43 CWCRT Pilot Program: March 2023 Interim Report ● 7 What factors appear to facilitate and/or complicate dispatch? Our preliminary data suggest three factors that facilitate dispatch: • Police/dispatch precedent for working with additional units. Officers and dispatchers are accustomed to working with additional units (e.g., chaplains); thus, police agencies quickly adapted processes already in place to support dispatch of additional units to then facilitate the dispatch of co-response teams. • Police chiefs championing the pilot program. When the program first launched, the police chiefs each championed the effort. This set the tone and expectation for supporting co- response dispatch throughout each police agency’s chain-of-command. • Formal and informal mechanisms supporting collaboration among clinicians, officers, and dispatchers. Formal mechanisms include locating clinicians’ offices at their respective police departments, including them in morning line up, and enabling them to lead professional development or training for the officers in their department. Informal mechanisms include unscheduled conversations to pre-brief or debrief calls, quick check- ins, ride-alongs and sit-alongs, and a variety of efforts to consider each others’ expertise. Our data also suggest three factors that complicate dispatch: • Uncertainty regarding expectations. Clinicians, officers, and dispatchers note they are uncertain if the various program partners (police agencies, the county, and StarVista) have different rules or expectations regarding dispatch. While this doesn’t necessarily impact their practice, it creates a lingering sense of concern, and they wish they could confirm they are acting in ways consistent with the various contracts. • Limited opportunity for peer learning across all four cities. No formal opportunities currently exist for dispatchers across all cities to share practices in dispatch, and while clinicians from all four cities meet periodically with a program coordinator, they have limited time in meetings to share experiences that could inform improvements to the dispatch process. • Data entry / data quality. Dispatchers note that the number one challenge for them is consistently recording requests and responses for co-response teams. This is particularly challenging when the clinicians are not on duty. We find that police agencies consistently document clinician responses but may inconsistently document requests for clinicians when they know no clinician is available. Quantitative data suggests documented clinician responses are fairly uniform across cities but clinician need varies across them (see Appendix Tables A1 and A2).5 Qualitative data suggest dispatchers often know such 5 As Appendix Tables A1 suggests, participating cities vary slightly in their reports of the number of co-response incidents clinicians respond to, by month and over the year. In our current data, we cannot be certain of whether this 44 CWCRT Pilot Program: March 2023 Interim Report ● 8 documentation is important, but they struggle to follow the established processes when they know a clinician is unavailable to respond. Opportunities and Recommendations Based on preliminary findings concerning dispatch, we believe dedicated attention to documenting the need for mental health clinicians is crucial for three reasons. First, documenting need helps cities understand which kinds of calls most often require a clinician be present. Although it may seem obvious that clinicians respond mostly to incidents with a clear mental health component, that may not always be the case. For example, other presenting incidents involve drug or alcohol use, homelessness, and reported suspicious activity. Second, documenting incident-level need for clinicians helps determine need for the CWCRT program broadly by geography, time of day, day of week, and time of year. Understanding the ebb and flow of need—both within and across cities—helps partners regulate workflow and plan for the future, especially when there is more need than is available in a given time or place. Finally, documenting clinician need helps cities determine what to do next. Accurately documenting all calls potentially requiring a clinician helps clarify which types of calls to look for in the future, especially if the program expands and the pilot phase of CWCRT concludes. Accurate documentation of clinician need will also help determine how to “right-size” the program for each city and for the county more generally. For example, if cities and police agencies find the CWCRT program important and useful, accurately documenting clinician requests in addition to clinician responses helps city and county leaders advocate for more resources if need for clinicians exceeds availability. With current data collection procedures, we cannot make confident claims about the degree to which need for clinicians meets or exceeds availability in 2022. To better understand how often clinicians are needed, we encourage police agencies to review and discuss their protocols for recording co-response dispatch data. Although perfect reporting is of course unrealistic, understanding and removing impediments for documenting need (e.g., reducing the number of steps for coding calls as requiring a clinician) will improve long-term accuracy as the program matures. One specific strategy for more accurately documenting mental health calls for service is to target specific days and weeks in which dispatchers and officers prioritize attention to recording co- response requests, helping ensure a focused yet highly accurate count of calls for a very limited amount of time (e.g., 5-10 days). These focused data collection efforts can then be considered a “snapshot” of clinician need in a typical day or week without imposing an indefinite expectation on those involved with many different responsibilities that require their focus and attention.6 variation is due to a higher need for clinicians when they are available or due to some confounding factor (e.g., differences in city sizes or in logging follow-up calls to community members). 6 As of this writing, dispatch managers from all participating cities have agreed to meet to discuss best practices, common issues, and ways to best dispatch the clinician. Dispatch managers are also taking steps to review data collection protocols and consider options such as the point-in-time data collection approach described above. 45 CWCRT Pilot Program: March 2023 Interim Report ● 9 Conclusion This report has documented the dispatch process over the first year of the CWCRT pilot program. The nearly 850 calls clinicians have responded to in 2022 typically involve welfare checks, calls with a clear primary mental health component, and minor disturbances or suspicious activity. In less than 3% of those calls, a criminal case is opened, and in only two incidents we observe police use of force (one occurring when the clinician was no longer involved). Our data on the dispatch of co-response teams reveal three important findings. First, dispatchers, clinicians, and officers play an important role in discerning which calls may be well-served by a co-response team, listening for cues provided by the caller (e.g., direct references to mental health diagnoses or crises such as hallucinations or suicidality) as well as other factors related to the context of the call (e.g., if the caller has had prior contact with the clinician). Second, dispatchers and officers value opportunities to work alongside a skilled mental health clinician. They believe the CWCRT model effectively supports community members who are in distress, and report that through their collaboration with clinicians are improving their capacity to triage mental health-related calls more effectively. Third, program partners perceive co-response dispatch processes going very smoothly. Our findings suggest this is largely due to three factors: (1) existing norms and procedures for dispatching additional units which could be easily adapted to facilitate the dispatch of co-response teams; (2) police chiefs championing the program, setting the tone and expectation for supporting co-response dispatch throughout each police agency’s chain-of-command; and (3) formal and informal mechanisms supporting clinicians, officers, and dispatchers to understand and amplify one others’ expertise. While our analyses suggest dispatch of CWCRT clinicians is functioning as intended, our data also indicate that at least three factors complicate dispatch: uncertainty about expectations among partners, limited opportunities for clinician peer learning, and consistency in complying with dispatch protocols. Additionally, better understanding clinician need beyond clinician responses will require re-considering data collection strategies. Ultimately, dispatch to calls for service are crucial to understand and document, as this is the primary focus of the program’s clinicians. However, responding to calls is just one part of a clinician's job. Future updates will examine other aspects of the clinician’s work—such as their critical role in follow-up with subjects and referral to long-term services—that will provide important context for understanding their dispatch to program-related calls for service. 46 CWCRT Pilot Program: March 2023 Interim Report ● 10 Appendix Additional information on clinician requests and responses Table A1. Reported CWCRT Responses in 2022, by City and Month Daly City Redwood City San Mateo South San Francisco Total Jan 2022 23 21 26 19 89 Feb 2022 21 10 23 18 72 Mar 2022 32 24 22 16 94 Apr 2022 21 8 27 16 72 May 2022 12 13 25 22 72 Jun 2022 21 12 24 8 65 Jul 2022 15 18 19 15 67 Aug 2022 11 16 21 19 67 Sep 2022 16 0 25 13 54 Oct 2022 18 20 25 10 73 Nov 2022 9 9 27 15 60 Dec 2022 9 14 16 14 53 Note: Data comes from police agency administrative records. Numbers indicate the total number of incidents in which a CWCRT clinician responded. 47 CWCRT Pilot Program: March 2023 Interim Report ● 11 Table A2. Reported CWCRT Requests in 2022, by City and Month Daly City* Redwood City San Mateo South San Francisco Total Jan 2022 23 25 90 59 197 Feb 2022 21 11 118 67 217 Mar 2022 32 89 152 49 322 Apr 2022 22 13 149 58 242 May 2022 13 24 125 49 211 Jun 2022 21 32 142 39 234 Jul 2022 15 34 145 34 228 Aug 2022 11 27 166 33 237 Sep 2022 21 5 120 42 188 Oct 2022 26 21 140 34 221 Nov 2022 10 9 120 38 177 Dec 2022 13 18 127 30 188 Note: Data comes from police agency administrative records. Frequencies reflect clinician requests from January 1, 2022 to December 31, 2022, whether a clinician was available to respond or not. * Prior to July 2022, Daly City only reported incidents in which a clinician responded to a call for service. 48 CITY OF SOUTH SAN FRANCISCO INTEROFFICE MEMORANDUM DATE: July 27, 2023 TO: Mayor, Vice Mayor, and Councilmembers FROM: Scott Campbell, Chief of Police SUBJECT: Community Wellness and Crisis Response Team Update The purpose of this memorandum is to provide City Council with an 18-month update regarding the CWCRT pilot program. Overview: The Community Wellness and Crisis Response Team (CWCRT) pilot program began in December of 2021. Our department has had a full-time mental health clinician who responds to behavioral health crisis calls with officers from Monday through Friday between the hours of 9 am to 5pm. In addition to providing assistance on calls for service, the mental health clinician also follows up with clients, offers resources to individuals and their families, develops safety plans, and routinely provides valuable training to our officers. We have received clinician support from the San Mateo and Daly City clinicians during a five-month period when our department’s clinician was unavailable. With the assistance of Starvista, we anticipate a new, highly qualified mental health clinician joining the department in late August of 2023. Within the past 18 months, our department has responded to 550 calls for service that resulted in an individual being transported to a medical facility for a mental health evaluation. A mental health clinician was the primary contact on 18% of those calls, while police officers were the primary contact on 82% of calls. Based on current data, the number of behavioral health calls are consistent throughout each day of the week. The most frequent time we receive behavioral health calls for service occur between 9 am and 5 pm when the clinician is on duty. The following charts illustrate data from several categories related to the CWCRT pilot program for the past 18 months. It is important to note that some chart values include repeated contacts with the same individual. The average is 31 mental health holds per month which has remained consistent after the first two months of the pilot program that indicated higher data. 49 47 27 25 34 32 34 26 36 33 24 27 25 22 29 29 28 23 0 50 100 January 2022 to June 2023 Monthly Data 49 Community Wellness and Crisis Response Team Update July 27, 2023 Page 2 of 3 The most frequent age of individuals placed on a mental health evaluation ranged from 18-39 years old, which accounted for 44% of the total reports. The race of individuals placed on a mental health hold consist of the following: White - 33% Hispanic - 32% Asian - 15% Black - 13% Other - 7% The housing status of individuals placed on a mental health hold shows 75% were housed and 25% were unhoused. 0 50 100 150 Under 18 18 - 29 30 - 39 40 - 49 50 - 59 Over 59 54 121 124 90 65 96 Ages of Involved People 0 50 100 150 200 Other White Hispanic Black Asian 39 183 177 72 79 Race & Ethnicity 0 200 400 600 Housed Homeless 414 136 Housing Status 50 Community Wellness and Crisis Response Team Update July 27, 2023 Page 3 of 3 The calls for service resulting in a mental health hold remained consistent each day of the week. The most frequent time of day when individuals were placed on a mental health hold was between 9 am and 5 pm, which accounted for 44% (242) of the total reports. The mental health clinician was the main contact with the individual in crisis on 37% (90) of those calls. Additional Charges Of the 550 mental health evaluations, 55 associated police reports were sent to the District Attorney’s Office to consider filing additional charges. The other 495 cases involved only a mental health component. Use of Force Information Of the 550 mental health evaluations, 20 required that officers use some level of physical force to safely detain the involved individual. Use of force involved 4% of all mental health evaluations resulting in a psychiatric hold. 53 66 56 56 68 76 78 19 20 24 21 9 1 3 0 20 40 60 80 100 Monday Tuesday Wednesday Thursday Friday Saturday Sunday Response - Day of Week Officer Response Clinician Response 64 43 75 77 100 917 44 46 3 0 50 100 150 1am to 5 am 5am to 9 am 9am to 1 pm 1pm to 5pm 5pm to 9 pm 9pm to 1am Response - Time of Day Officer Response Clinician Response 51