Title
Recommendation to Authorize the City Manager to Negotiate and Execute an Agreement with Alameda Family Services for an Amount Not to Exceed $500,000 for One-Year, with an Option to Extend for an Additional Year for an Amount Not To Exceed $1,000,000 for Two-Years, to Provide for Mental Health Services Related to the City’s Alternative Response to Calls for Mental Health Crisis Support Pilot Program. (City Manager 10021030)
Body
To: Honorable Mayor and Members of the City Council
EXECUTIVE SUMMARY
In July of 2021, the City Council authorized the City Manager to initiate a pilot program focused on an alternative responses to individuals facing a mental health crisis. The Alameda Fire Department (AFD) is leading this effort, and needs to add a professional mental health clinician to the pilot program. While AFD staff would handle crisis management, the clinician would be responsible for follow-up care for clients in need of support and real-time consultation, including for AFD-assigned 5150 holds. A request for proposal (RFP) was posted by the City of Alameda (City) in early August (see Exhibit 1) - the response deadline was extended to August 26 to allow for additional questions to be clarified. The City received one proposal to participate as a partner with AFD. The proposal is from Alameda Family Services (AFS) (see Exhibit 2). The proposal contains several options. Based on staff’s review and follow-up discussions with AFS leadership, staff is recommending that the City Council approve a combination of Option 1A and 1C at this time. That combination allows for 24/7 support from AFS for the pilot program.
BACKGROUND
The City, like many other cities around the state and country, is exploring a different way of responding to calls for service involving individuals experiencing a mental health crisis. In July of 2021, the City Council authorized the City Manager to initiate a pilot program, to be led by the AFD. The AFD has been in communication with various departments at Alameda County (County) to better understand the County’s expectations and requirements, particularly around training requirements for AFD personnel who will be part of the pilot program and the authority to use the 5150 process (involuntary hold when a person with a mental health disorder is a danger to others, themselves). The status of various aspects of the project are summarized below.
AFD Personnel
Eighteen AFD personnel have been assigned to the pilot program. Nine of these personnel are firefighter paramedics and nine are firefighter emergency medical technicians (EMTs). Six personnel will be assigned to one of three shifts, in order to provide 24-hour, 7-day per week coverage.
Training
Nine firefighter paramedics have already received a 7-day mental health responder training provided by the non-profit Bonita House. That training began on September 13, 2021 and was completed on September 20, 2021. Staff is now coordinating additional crisis intervention behavioral health training (CIT) for all eighteen personnel. That training will be provided by the Oakland Police Department. Finally, a ride-along with the San Francisco Street Crisis Mobile Unit will be scheduled for each of the eighteen AFD personnel.
Dispatch (Fire)
Calls for service for the AFD are currently routed to the Alameda County Regional Emergency Communications Center (ACRECC). ACRECC will dispatch the Crisis Response Unit. ACRECC currently dispatches calls for the Alameda County Community Assessment Transport Team (CATT) and is already trained to process these call types. Staff will work with ACRECC to establish protocols for use on the pilot program.
Dispatch (Police)
The Alameda Police Department (APD) dispatch will work with AFD and AFS team-members to develop protocols and processes to triage calls for service.
Vehicle
One Ford Interceptor has been provided by the APD. This vehicle is being outfitted as a low-profile response unit labeled as the Alameda Mobile Crisis Unit.
County Approval for 5150 Authority
Currently, sworn APD personnel are the sole authority through the County who is authorized to assign a 5150 psychiatric hold. The City is in active discussions with County Behavioral Health to authorize AFD firefighter paramedics to assign 5150 holds, contingent upon the City contracting with a licensed clinician (which would be Alameda Family Services), who would be available to provide either an in-person or telemedicine consultation at the time the hold is being assigned to a patient. County approval has not yet been provided, and discussions are ongoing.
Metrics
If approved, the City would work collaboratively with AFS to develop and refine inputs and outcomes to allow for a thorough evaluation of the pilot program. The initial metrics will be established prior to the start of the pilot program. Staff will work with AFS, and other experts on the inputs, actions, and outcomes that are most appropriate to evaluate the success of the pilot program.
Clinician(s)
City staff issued an RFP to secure the services of a clinician for both real-time consultation and for case management/follow-up care. The City received one proposal from AFS. This topic is the focus of this report.
DISCUSSION
AFS submitted a detailed proposal designed to address the mental health support and follow-up care for the City’s pilot program. Specifically, AFS will undertake follow-up and/or case management for individuals that are contacted by the field teams and support the field teams with 5150 holds (pending County approval) and other more complicated mental health situations.
After review of the proposal, staff met with AFS leadership to discuss possible efficiencies, while still meeting the needs of the program. A supplemental budget was provided and has been added to Exhibit 2. Based on the follow-up conversations, staff is recommending that the City proceed with the following staffing, which would allow for 24/7 support:
• Program Director 40 hours/week
• Program Supervisor 40 hours/week
• Quality Assurance Specialist 40 hours/week
• Billing Specialist/Program Admin. 40 hours/week
• Crisis Response Case Manager 40 hours/week
• On-call Clinician (Daytime)
• On-call Clinician (Evening)
• On-call Clinician (Weekend Day)
• On-call Clinician (Weekend Night)
The estimated cost of the program staff is $315,418. The indirect and direct costs are estimated at $83,585, bringing the estimated total annual cost to approximately $399,003 for Option 1A & 1C.
The demand for service and amount of demand for on-call services will be carefully evaluated as the pilot program gets underway. Staff has conservatively requested a not to exceed $500,000 per year, for a not to exceed amount of $1,000,000 for two years, to ensure adequate funding for this component of the pilot program due to the nature of the program.
Staff is recommending that the Council authorize the City Manager to execute an agreement, with the foregoing terms, in a form substantially similar to the agreement attached as Exhibit 3.
ALTERNATIVES
At this time, staff is recommending a custom option not specifically identified in the AFS proposal. The City Council may consider:
• Directing an option detailed in the AFS proposal;
• Directing staff to consider other options for meeting this pilot project needs; or
• Directing staff to redo the RFP process with a modified scope of work.
• Approve a one year contract and not have an option for a second year.
FINANCIAL IMPACT
During the Fiscal Year 2021-23 budget process, the City Council authorized $1,000,000 for each year of the budget to fund a pilot program for an alternative response to mental health crisis and $300,000 in the first year and $900,000 in the second year to fund additional support services and staffing during the pilot program. If the pilot program does not result in the desired outcome(s), FD personnel may transition back to the expanded ambulance program that was originally contemplated.
MUNICIPAL CODE/POLICY DOCUMENT CROSS REFERENCE
This action is in conformance with the Alameda Municipal Code and all policy documents.
ENVIRONMENTAL REVIEW
This action is not subject to environmental review as the activity is not a "project" for purposes of the California Environmental Quality Act (CEQA) because it is an organizational or administrative activity of the City that will not result in direct or indirect physical changes in the environment, per CEQA Guidelines, Section 15378(b)(5).
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 negotiate and execute an agreement with Alameda Family Services for an amount not to exceed $500,000 for one-year, with an option to extend for an additional year for a not to exceed amount not to exceed $1,000,000for two-years, to provide for mental health services related to the City’s alternative response to calls for mental health crisis support pilot program.
CITY MANAGER RECOMMENDATION
Due to the desire of the City Council to have the Pilot Program in operation prior to the end of the calendar year, we are bringing the proposal forward in September with the understanding that metrics will be developed prior to the start-up of Pilot Program. The amount requested is not to exceed $500,000 for one year. We have an option for a second year in the contract dependent upon the success of the PILOT program.
Respectfully submitted,
Gerry Beaudin, Assistant City Manager
Financial Impact section reviewed,
Annie To, Finance Director
Exhibits:
1. Request for Proposals
2. Alameda Family Services Proposal
3. Draft Agreement
cc: Eric Levitt, City Manager
Gerry Beaudin, Assistant City Manager
Nishant Joshi, Police Chief
Ricci Zombeck, Interim Fire Chief
Jeff Delbono, Deputy Fire Chief