Title
Recommendation to Authorize the City Manager to Execute a New Service Provider Agreement with Alameda Family Services to Provide Clinician and Case Management Services for the Community Assessment, Response, and Engagement (CARE) Team Covering July 1, 2025 to June 30, 2028, for a Total Not-To-Exceed Amount of $1,681,886; and Receive an Update on CARE Team 2024 Operations. (Fire 10032270-52010)
Body
To: Honorable Mayor and Members of the City Council
From: Jennifer Ott, City Manager
EXECUTIVE SUMMARY
This report provides an update on the Community Assessment Response and Engagement (CARE) Team program, including its implementation, progress, and future plans, as well as requesting City Council’s authorization to execute a new agreement with Alameda Family Services (AFS) to continue supporting the CARE Team Program.
Key areas addressed in this report include the CARE Team program history, collaboration with AFS, and significant developments achieved in 2024. The program has shown success in improving the City of Alameda’s (City) mental health crisis response, its cost-effectiveness, and the importance of retaining AFS for continuity of care.
This report also outlines the recommended AFS staffing model for the next three years with associated budget projections. To provide ongoing support for the CARE Team program and ensure uninterrupted client services, the Alameda Fire Department (AFD) seeks City Council approval for the City Manager to execute a new agreement with AFS for an amount not-to-exceed $1,681,886 from July 1, 2025, to June 30, 2028.
BACKGROUND
In July 2021, City Council approved the establishment of the CARE Team, a pilot program designed to address mental health crises in the community through an innovative and compassionate approach. The CARE Team focuses on providing specialized assistance to nonviolent individuals experiencing mental health challenges, reducing reliance on traditional law enforcement and emergency room interventions.
To support the program’s launch, a Request for Proposal (RFP) for clinician support services was issued in August 2021, with AFS selected as the provider and a contract approved by City Council in December 2021. The agreement was subsequently amended in 2023 to extend services through June 30, 2025.
Managed by AFD, the program incorporates licensed mental health clinicians from AFS to provide real-time consultations, follow-up care, and support for clients. Providing a 24/7 alternative response to nonviolent individuals in mental health crises, AFD personnel utilizes de-escalation techniques and authorized procedures on scene to ensure effective and humane care in crisis situations. When indicated, the program enables paramedics to issue psychiatric holds in Alameda County as authorized under state law, specifically, Welfare & Institutions Code Sections 5150 and 5585. These sections allow for the involuntary detention of a client experiencing a mental health crisis for up to 72 hrs. Section 5150 applies to adults who are a danger to themselves, others, or cannot care for themselves due to mental illness, while Section 5585 applies to minors under 18 in similar situations. The authority granted by state law to AFD personnel ensures individuals in mental health crises get immediate, specialized care.
Since its implementation, the CARE Team has demonstrated measurable success in addressing gaps in mental health crisis response while streamlining resources and reducing strain on emergency systems. The program continues to evolve through ongoing improvements in training, staffing, and operational protocols, ensuring it meets the growing demands of the community. During 2024, the CARE Team was recognized by the Alameda County Emergency Medical Services Agency (ALCO EMS) as “Program of the Year.” Retaining AFS as a partner is critical to maintaining program continuity and achieving long-term goals for mental health support in Alameda.
CARE Team key milestones with AFS include the CARE Team Pilot Program’s start of service delivery on December 16, 2021, its formal approval as an ongoing program by the City Council on February 21, 2023, and an AFS contract amendment on June 21, 2023, extending their agreement through June 30, 2025.
DISCUSSION
AFS has been integral to the CARE Team’s success, providing case management and clinician support to ensure high-quality care. Maintaining this partnership is essential to prevent disruptions in service and ensure continuity of client care. As demand for mental health crisis response grows, collaboration with AFS enables the CARE Team to address immediate crises and long-term client needs effectively.
Program Progress and Collaboration: The CARE Team operates through a collaborative model with partners such as Alameda County Behavioral Health Care Services, ALCO EMS, Alameda Police Department (APD), and AFS.
• These partnerships ensure seamless responses to mental health crises, integrating field operations, clinician support, and follow-up care.
• In 2024, the CARE Team handled 1,332 calls, including 880 direct client engagements, a 41.7% increase from 621 engagement calls in 2022.
• The program's growth highlights the effectiveness of collaboration in meeting increasing community needs.
• In 2024, the CARE Team field personnel conducted 149 consultations with AFS clinical support staff, demonstrating the importance of comprehensive care. These consultations included 21 psychiatric holds for adults (5150), 25 psychiatric holds for minors (5585), 68 crisis de-escalations, three general consultations, and 32 additional complex cases that needed clinician support.
Key Program Achievements in 2024: The CARE Team advanced its efforts in 2024 by implementing tailored care plans for high utilizers, integrating Alameda County CARE Court for structured support, and enhancing training for its 27 personnel, ensuring 24/7 crisis response. These developments highlight the program's dedication to effective, patient-focused care and community well-being.
• Qualified Personnel: The CARE Team includes 27 trained AFD personnel who completed Mental Health Responder training, county-mandated 5150/5585 certification, and Pro-ACT (Professional Assault Crisis Training) awareness. This ensures they are equipped to handle mental health crises and provide 24/7 support.
• High Utilizer Care Plans: The CARE Team supported seven individuals through customized plans that improved outcomes while reducing strain on emergency services. These efforts minimized costs, prevented hospitalizations, and ensured coordinated care.
• Alameda County CARE Court Integration: Collaborating with CARE Court, the team successfully transitioned a client into structured, court-ordered treatment as an alternative to incarceration, fostering long-term stability.
• Community Support and Resources: The CARE Team's community support and resource initiatives strengthen connections with local organizations and provide direct assistance to individuals in crisis. By addressing immediate needs and fostering collaboration, the program enhances its ability to deliver impactful and responsive care to the Alameda community.
• Community Engagement: The CARE Team participated in meetings with organizations such as Alameda Point Collaborative to raise awareness of its mission and services.
• Pre-Paid Phones: In 2024, three phones were distributed to ensure clients remained connected to AFS for critical wrap-around services.
• Gift Cards: CARE Team members utilized gift cards provided by AFS to assist clients in obtaining essential items during crises, replacing ad hoc personal contributions by City staff.
• Grant Funding: The team received a $963,000 Byrne Discretionary Grant to support operations, alongside general City funding to maintain continued services.
Successful Impacts: The CARE Team's 2024 efforts highlight its ability to effectively engage during mental health crises, provide immediate support, and ensure ongoing care through AFS. These initiatives led to positive outcomes for clients and their families. Below are examples showcasing the meaningful impact the CARE Team has had on clients’ lives:
• Client #1: A 28-year-old with a young child, experienced an acute mental health event. The CARE team transported the client to an inpatient stay on a psychiatric hold and was supported by an AFS case manager upon discharge from the facility. The client was connected with ongoing substance use disorder services and referred to the Bridge Therapy program. The client reported “having the best therapist in the world” and attended therapy regularly, supporting their stabilization.
• Client #2: A 15-year-old with volatile behavior and family challenges around loss and grief received support from the CARE team. After providing de-escalation and a safety plan to the client, the case manager connected the client’s family to family counseling through AFS’ Behavioral HealthCare Services and referred the youth to the School Based Health Center. The family has since reported improved communication, productive expression of anger by the youth, and a noticeable reduction in family conflict.
• Client #3: A student in Alameda Unified School District disclosed suicidal ideation to a trusted school staff. With the assistance of an on-call clinician, the CARE Team determined the client to be high risk and transported the client for higher level support at the County Crisis Stabilization Unit. Once referred to the AFS case management services, the client and their family were connected to individual youth counseling and family counseling services. The youth reports feeling better, and the family is thankful for the support they received.
2025 Vision and Targets: To continue enhancing the CARE Team, AFD developed the following key focus areas for 2025:
• Develop a brochure detailing the CARE Team’s services and resources for families of clients placed on psychiatric holds, while collaborating on strategies for long-term support for recurring clients with a focus on individualized care and stability.
• Strengthen partnerships with organizations such as Alameda County Behavioral Health Care Services, Alameda County Emergency Medical Services, APD, AFS, and Alameda Unified School District, to ensure seamless responses to mental health crises.
• Integrate field operations, clinician support, and follow-up care, while upgrading medical equipment on the CARE Team vehicle to align with the standards of other AFD apparatus responding to medical calls. Additionally, enhance data collection processes by including new tracking points, monitoring long-term outcomes, and refining program evaluation to effectively address the growing demand for services.
• Identify and secure sustainable funding sources through local, state, and federal opportunities, alongside one-time grants, while monitoring and evaluating new mental health programs at local and state levels to explore collaboration opportunities and enhance service delivery.
• Continue to work collaboratively with APD to enhance and streamline response systems, refining protocols to reduce police involvement in non-critical calls strategically. This cohesive approach fosters a safer, more efficient system that meets the community's unique mental health demands with precision and care.
• Maintain and expand initiatives to actively monitor and support the mental health and overall well-being of AFD responders. Collaborate with behavioral health professionals to provide counseling services, mental health check-ins, and stress management resources. These efforts aim to build resilience and ensure responders are prepared to handle challenging situations while safeguarding their well-being.
Alameda Family Service Agreement: The AFS contract is crucial to ensuring the continuity and success of the CARE Team Program. AFS has been a trusted partner since the program's inception, delivering essential mental health crisis support, care coordination, and community-focused services that are integral to the program's operations and long-term impact.
• Crisis Support and Coordination - AFS works closely with AFD to deliver crisis mental health support and effective care coordination. AFS Clinical Case Managers (CCMs) promptly gather information from First Responders and on-call staff upon receiving referrals. They contact clients within 24 hours (or the next business day for weekend referrals) to initiate the intake process. If the client is unreachable by phone, CCMs conduct in-person visits and leave follow-up requests as needed. CCMs provide at least 14 days of support, connecting clients with vital resources such as housing, healthcare, mental health services, and substance use support through a network of partnerships, including the Alameda Housing Authority and Village of Love.
• Warm Hand-Offs and Long-Term Care - To ensure continuity of care, AFS facilitates “warm hand-offs” by personally transporting clients to appointments or arranging transportation. CCMs oversee the client's transition into long-term care, manage outreach and tracking efforts, and collaborate with other service providers to ensure cohesive and coordinated care.
• Emergency In-Field Support - AFS provides critical in-field emergency support through on-call clinicians who respond to crises by offering de-escalation and counseling services on-site. During high-demand periods, an additional part-time, on-call counselor may be added to maintain consistent service for field emergencies and phone consultations. On-call staff also support clients during complex processes, such as 5150 psychiatric holds, ensuring stabilization and access to essential services in collaboration with clinical teams.
• Staffing Model and Costs - AFS and AFD have evaluated the program’s needs and agree that the current staffing model is adequate for the next three years. The proposed staffing model includes the following roles to provide 24/7 program support for FY 2026-28:
§ Program Director
§ Senior Clinical Case Manager
§ Clinical Case Manager
§ Clinical Program Assistant
§ Quality Assurance Manager
§ Quality Assurance Specialist
o The estimated costs for the proposed staffing model are:
§ FY 2025-26: $535,825
§ FY 2026-27: $561,507
§ FY 2027-28: $584,554
The total three-year amount is not-to-exceed $1,681,886.
• Importance of Retaining AFS - Transitioning to a new clinical support provider would disrupt operations and jeopardize the program’s success. AFS is integral to the CARE Team’s response model, ensuring continuity of care for clients and program stability. As a trusted partner since the program’s inception, AFS has played a pivotal role in its development, pilot phase, training, and ongoing operations. Retaining AFS is critical to maintaining the program’s effectiveness and achieving long-term impact.
ALTERNATIVES
• Approve a three-year service provider agreement with AFS to ensure the continued delivery of clinician and case management services for the CARE Team Program.
• Do not approve the Agreement with AFS and terminate services with AFS effective June 30, 2025. This would result in a loss of critical support and services for the CARE Team program and create a delay in community service levels while a Request for Proposals process is conducted.
FINANCIAL IMPACT
The projected costs associated with the proposed staffing model, inclusive of both direct and indirect expenses, are as follows:
• FY 2025-26: $535,825, reflecting an increase of less than one percent (1%) compared to the prior fiscal year.
• FY 2026-27: $561,507, representing a five percent (5%) increase from the previous fiscal year.
• FY 2027-28: $584,554, indicating a four percent (4%) increase over the preceding fiscal year.
The cumulative cost over the three-year period is estimated at $1,681,886, which constitutes a 10% increase over the total expenditures of the preceding three-year term of the contract. The FY 2025-26 and FY 2026-27 amounts are included in the staff-recommended Fiscal Year 2025-27 Biennial Budget. The FY 2027-28, the amount will be included in the subsequent biennial budget process.
MUNICIPAL CODE/POLICY DOCUMENT CROSS REFERENCE
The CARE Team report and recommended agreement with AFS supports the City Strategic Plan Priority to Enhance Community Safety and Services.
This action is subject to the Levine Act.
ENVIRONMENTAL REVIEW
This action does not constitute a “project” as defined in California Environmental Quality Act (CEQA) Guidelines Section 15378 and therefore no further CEQA analysis is required.
CLIMATE IMPACT
There are no identifiable climate impacts or climate action opportunities associated with the subject of this report.
RECOMMENDATION
Authorize the City Manager to execute a service provider agreement with AFS for clinician and case management services to support the CARE Team covering the term from July 1, 2025, to June 30, 2028 for a total not-to-exceed amount of $1,681,886, and receive an update on CARE Team 2024 operations.
Respectfully submitted,
Nicholas Luby, Fire Chief
By,
Khader Nijmeh, EMS Division Chief
Jas Singh, Management Analyst
Financial Impact section reviewed,
Ross McCarthy, Acting Finance Director
Exhibits:
1. 2024 Client Engagement Data
2. AFS Agreement