Title
Adopt a Resolution to Approve and Authorize the City Manager to Negotiate and Execute an Amendment to the Agreement with Alameda County Fire Department for the Alternative Response Unit to Extend Operations Through June 30, 2027 And Add $1,096,913 in Previously Approved General Funds Bringing the Total-Not-to-Exceed Amount to $2,446,913
Staffreport
COUNCIL PRIORITY
• Public Safety
• Housing and Homelessness
SUMMARY
On July 15, 2024, the City Council adopted a resolution authorizing the City Manager to negotiate and execute a Memorandum Of Understanding (MOU) with Alameda County Fire Department to implement and operate the Alternative Response Unit (ARU) pilot program in San Leandro for a period of 18 months (July 15, 2024 through January 15, 2025) in an amount not to exceed $1,350,000. The pilot program was funded using American Rescue Plan Action (ARPA) funds.
The Alternative Response Unit is a collaborative pilot program between Alameda County Fire Department (ACFD), the City of San Leandro, Cardea Health, and community providers to more efficiently utilize the relevant health care services to meet the behavioral health and medical needs of the residents of San Leandro and prevent unnecessary hospital admissions and readmissions. The ARU provides an alternative immediate response to individuals that are experiencing a mental health crisis. The ARU responds with trained providers that provide real-time assistance to individuals with non-violent mental health and substance abuse needs that might otherwise be left to, among other outcomes, enter the 911 system or be placed on a psychiatric hold. The goals of the ARU are to reduce police response to 911 calls related to behavioral health of unhoused residents; deliver an appropriate and timely response to behavioral health calls that meet the individual’s needs; decrease the number of unnecessary emergency room visits and hospitalizations; and bridge and facilitate community and governmental service connections for individuals.
RECOMMENDATIONS
Staff recommend that the City Council adopt a resolution authorizing the City Manager to negotiate and execute an amendment to the MOU with Alameda County Fire Department for the Alternatives Response Unit (ARU) program to extend operations for another 18 months, through June 30, 2027, and add $1,096,913 from already approved General Fund monies, bringing the total not-to-exceed amount to $2,446,913.
BACKGROUND
On October 18, 2021, staff presented to City Council a suite of mental health first responder models for Council consideration. Staff recommended that the City explore a model with ACFD contracting for mental health services through a nurse practitioner with mental health training. Additional information can be found in the associated item 21-563.
On October 17, 2022, staff presented an update to City Council on the County run Community Assessment Transport Team (CATT) and provided an update on the proposed ARU model. Additional information can be found in the associated item 22-337.
On February 25, 2023, the City held a planning session wherein launching the mental health response unit was formally integrated into the City’s three-year workplan. Additional information can be found in the associated item 23-064.
On November 22, 2023, ACFD issued a third RFP which yielded two proposals from qualified vendors to be the mental health provider for the ARU. The vendors participated in an interview process where the panel unanimously recommended Cardea Health. In late 2024, the Alameda County Board of Supervisors approved the agreement that made Cardea health a co-operator of the ARU.
Analysis
Pursuant to Council direction, staff, ACFD, and Cardea Health piloted the ARU program during the period of July 15, 2024 and will continue the pilot through January 15, 2025. During the first nine months of the program, the following accomplishments were achieved in the following areas:
1. High Call Volume and Rapid Response
• Over 1,300 calls (i.e., 911) across three quarters.
• Average Response Time: Consistently under 10 minutes, with 99%+ of calls responded to within the target 30-minute window.
• Time-on-Task: Averaged 24-30 minutes, enabling efficient client engagement and service delivery.
2. Effective Diversion from Law Enforcement and Emergency Services
• Police Co-Responses: Maintained a balance between solo responses (~60%) and co-responses with San Leandro Police Department (~35-40%), with only a handful of cases requiring police backup (mostly for psychiatric holds).
• EMS/Fire Diversion: Less than 2% of calls required EMS or Fire Department backup, indicating successful triage and appropriate dispatching.
• Emergency Department Diversion: Data suggests a significant number of calls were diverted from unnecessary ER visits.
3. Strong Client Engagement and Follow-Up
• Clients Served: Over 600 unique individuals.
• Follow-Up Interactions: More than 3,800 follow-up contacts (e.g., calls, texts, emails, brief visits).
• High-Frequency Utilizers: ARU engagement led to a reduction in 911 call volume from repeat callers, with preliminary feedback from dispatchers confirming fewer calls from “high utilizers.”
4. Service Connections and Resource Distribution
• Referrals: Hundreds of clients connected to behavioral health, shelter, legal, senior, and medical services.
• On-Scene Support: Distribution of basic necessities (e.g., clothing, food, hygiene kits, detox/harm reduction supplies) during calls.
• Transportation: Provided rides to shelters, therapy, and other service locations.
5. Eddie’s Place Integration
• 16 clients transported and placed at Eddie’s Place (a medically supported emergency shelter). All received substance abuse treatment, and several were transitioned to longer-term care.
• Average Stay: 30-32 days.
• Service Connections: Clients were linked to managed care, primary care, behavioral health, and housing resources.
6. CARE Court and Enhanced Care Management (ECM) Referrals
• CARE Court Engagement: ARU filed 20+ Care Court petitions, including support for families navigating the process.
• Impact: Documented cases show significant reductions in community disturbances and improved client outcomes through coordinated care.
7. Data-Driven Operations and Continuous Improvement
• Stacked Call Monitoring: ARU tracked calls received while engaged with other clients, identifying capacity constraints and adjusting outreach strategies.
• Trend Analysis: Demonstrated increasing call volume and service demand, with stabilization in monthly incident counts, indicating full operational ramp-up.
8. Equity and Access
• Demographics: ARU served a diverse population, with overrepresentation of African American clients, highlighting the program’s role in addressing systemic disparities.
• Barriers Identified: High percentage of clients without ID (63-73%) and common reasons for declining services (e.g., inability to bring pets, distrust of systems) were documented to inform future service design.
9. Community Impact and Success Stories
• De-escalation Excellence: ARU successfully resolved complex behavioral health crises without law enforcement involvement, including high-risk situations involving paranoia, substance use, and public disturbances.
• Client Testimonials: Clients expressed gratitude for ARU’s compassionate approach, with some re-engaging voluntarily after initial resistance.
In addition to the highlights from the current service period, this new contract extension will provide for:
• Four (4) beds at Eddie's place, doubling the City’s capacity to provide medically supported shelter. Additional beds remain the most frequent request from ARU team members.
• Implementing a maximum stay of 30 days for clients at Eddie’s, allowing providers to serve more individuals in need of shelter throughout the year.
These improvements are being achieved while operating under a reduced budget relative to the initial pilot program.
Given the needs for services and the program outcomes in the first nine months, staff recommend extending the MOU with ACFD through June 30, 2027, and increased funding to continue the implementation of the ARU Program.
Committee Review and Actions
At the February 28, 2024, meeting of the City Council Finance Committee, the Committee provided approval of staff’s recommendation to reallocate unspent ARPA monies for a variety of programs, including $750,000 for the ARU to supplement an existing General Fund appropriation of $625,000 to provide a total funding amount of $1,350,000 for these services.
At the April 23, 2025, meeting of the City Council Finance Committee, Staff presented the City’s proposed Fiscal Year 2025-2026 (FY 2026) and Fiscal Year 2026-2027 (FY 2027) Biennial Budget. At this meeting, staff presented a list of eight projects that had been funded using ARPA funding, including the ARU pilot program. Staff shared that without an ongoing General Fund allocation, ARU operations would cease. The City Council Finance Committee provided staff feedback and direction to move forward with identifying General Fund allocation for the ARU in FY 2026 and FY 2027, by establishing budget amounts of $303,000 and $909,999, respectively.
At the May 12, 2025, special meeting of the City Council Finance Committee, the Committee provided approval of staff’s recommendation to present the proposed Biennial Budget to the City Council. The proposed budget included an appropriation of $303,000 in FY 2026, and an appropriation of $909,999 in FY 2027, for ARU operations.
Previous Actions
1. City Council adopted Resolution No. 2024-024 on March 18, 2024, approving a reallocation of unspent ARPA funds, including $750,000 to supplement existing General Fund monies for the ARU.
2. City Council adopted Resolution No. 2024-106 on July 15, 2024, authorizing the City Manager to negotiate and execute a Memorandum of Understanding with Alameda County Fire Department to implement and operate the Alternative Response Unit Program in San Leandro for a period of 18 months in an amount not-to-exceed $1,350,000 in previously allocated funds.
3. On June 16, 2025, the City Council adopted the Biennial Budget, including appropriations of $219,383 and $877,530 for ARU operations in FY 2026 and FY 2027, respectively.
Legal Analysis
The City Attorney has reviewed the documents and approved them as to form.
Financial Impacts
There are sufficient funds available in the adopted FY 2026 and FY 2027 budget to fund the amendment to the agreement with Alameda County Fire Department for the Alternative Response Unit (ARU) program through June 30, 2027.
The adopted FY 2026 and FY 2027 budget includes an appropriation of $1,096,913 to support ARU operations.
ATTACHMENT(S)
Attachment A: Resolution to Authorize the City Manager to Negotiate and Execute an Amendment to the Agreement with ACFD for ARU program
Attachment B: Original MOU between City of San Leandro and ACFD
PREPARED BY: Pedro Naranjo, Manager, Human Services Department
APPROVED BY: Jessica Lobedan, Director, Human Services Department