Title
Adopt a Resolution Approving and 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
Staffreport
COUNCIL PRIORITY
• Public Safety
• Housing and Homelessness
SUMMARY AND RECCOMENDATION
The Alternative Response Unit (ARU) is a collaborative pilot program between Alameda County Fire Department (ACFD), the City of San Leandro, 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 will provide an alternative immediate response to individuals that are experiencing a mental health crisis. The ARU will respond with trained providers that can 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.
Staff recommends the City Council adopt a resolution approving and authorizing the City Manager to negotiate and execute a Memorandum of Understanding with ACFD to implement and operate the ARU program in San Leandro for a period of 18 months in an amount not-to-exceed $1,350,000 in previously allocated funds.
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 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.
ANALYSIS
Pursuant to Council direction, staff and ACFD explored options to implement an ARU for individuals appearing in a mental health crisis.
ACFD issued an initial Request for Proposals on June 12, 2023, which yielded no responses from qualified vendors. ACFD again issued an RFP on August 21, 2023, which again yielded no responses from qualified vendors. On November 22, 2023, ACFD issued a third RFP which yielded two proposals from qualified vendors. The vendors participated in an interview panel comprised of staff from City of San Leandro Police Department and Human Services, Alameda County Library, and City of Hayward Fire Department. The panel unanimously approved and recommended one of the vendors as the selected mental health provider for the ARU. In late July 2024, the Alameda County Board of Supervisors will receive ACFD’s vendor recommendation to co-operate the ARU. The vendor selection will become public once the Alameda County Board of Supervisors approves the agreement.
Proposed Service Model
Pending Council approval on this item, the ARU will be an 18-month pilot program, commencing in late 2024 or early 2025. The ARU will be operated by ACFD and its recommended subcontractor for mental health services and will operate within San Leandro city limits. During the 18-month pilot, the ARU will run 40 hours per week, four (4) days a week in 10-hour shifts. Once the schedule is finalized it will be communicated widely.
The San Leandro Police Department Communications Center (dispatch) will triage all calls for service. Calls that meet criteria for the ARU will be forwarded by SLPD Dispatch to the Alameda County Regional Emergency Communications Center (ACRECC).
The ARU will be staffed by three personnel, including 1) an ACFD State Licensed Emergency Medical Technician (EMT) or Paramedic; 2) a licensed Nurse Practitioner or other licensed medical practitioner or mental health professional; and 3) a Community Health Outreach Worker.
The recommended vendor proposes including a Community Health Outreach Worker (CHOW) on the ARU. Including CHOWs onto the ARU is a direct approach to addressing clients' social needs. CHOWs often share lived experience with the target population and are adept at connecting clients with resources, conducting follow up, and building rapport. The vendor aims to connect these patients with the health and housing resources they need, ensuring a seamless transition from emergency response to ongoing care, primarily led by CHOWs.
Additionally, the recommended vendor operates a medically supported shelter staffed 24 hours a day with shelter support personnel, including nursing staff available 16 hours a day, 7 days a week. Personal caregivers and home health aides actively engage in the daily care and assistance of clients. To enhance coordination, the facility is equipped with on-call medical and site directors and a full-time care coordinator. As part of the ARU pilot program, the vendor will set aside two shelter beds for immediate use in response to non-violent emergency calls. This proactive approach aims to provide swift relief, avoiding potential arrests and unnecessary emergency room visits.
Eligible Scenarios
Scenarios appropriate for ARU response include situations in which:
- An individual is experiencing suicidal thoughts
- An individual is thinking of self-harm or has already harmed themselves
- A person is in emotional distress
- An individual is known to, or there is a strong suspicion that they are, experiencing hallucinations, psychosis, or other significant mental health symptoms
- Families, neighbors or individuals are arguing or in need of mediation
- People are coming to the attention of others because of their behavior (e.g., shoplifting, panhandling, trespassing, yelling) and there is suspicion or knowledge that substance abuse, mental health issues, intellectual disabilities, homelessness or other human service needs are driving their behavior
Exclusionary Criteria
Scenarios inappropriate for ARU response include situations in which:
- Medical Emergency: The caller or subject of a call is experiencing a medical emergency
- Unknown/Non-Present Subject: The caller does not know the subject of the 9-1-1 call AND is not near the person at the time they make the 9-1-1 call
- Gun on premises: The caller or subject of the call is known to have a gun in their home or on their person
- Physical Threats Made: The caller or subject of the call is making direct physical threats of harm to others at the time of the 9-1-1 call
- Current or Known History of Physical Violence: Physical person-on-person violence is happening at the time of the 9-1-1 call or the subject of the call has a known history of being physically violent
- Property Destruction: The caller or subject of the 9-1-1 call has destroyed someone else’s property or is currently destroying (their or anyone else’s) property
- Current Self-Harm: The caller or subject of the call is currently harming themselves and is using a weapon to do so
- Current Suicide Attempt: The subject of the call is currently attempting suicide
- Threatening Suicide with Plan and Weapon Means: The caller or subject of the call is threatening suicide, has a plan to kill themself and the means to do so, and the means include a weapon (e.g., knife, gun)
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 American Rescue Plan Act (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.
Previous Actions
City Council adopted Resolution No. 24-084 on March 18, 2024, approving a reallocation of unspent ARPA funds, including $750,000 to supplement existing General Fund monies for the ARU. Additional information can be found in the associated item 24-084.
Legal Analysis
The City Attorney drafted the MOU, reviewed edits and comments to the documents, and approved them as to form.
Financial Impacts
This item has no additional financial impact because funds were previously allocated to the program through the use of American Rescue Plan Act and General Fund monies. It should be noted, however, that the ARU pilot program is funded by one-time funding sources and additional funds will need to be identified if considered for ongoing implementation.
190-69-803: $725,000
010-63-014-5120: $650,000
Total $1,350,000
ATTACHMENTS
• Attachment A: Resolution
• Attachment B: Memorandum of Understanding
PREPARED BY:
Jessica Lobedan, Director, Human Services Department