Cotati City Council
Agenda Staff Report
Item type: REGULAR AGENDA (ACTION)
To: City Council
Subject: SAFE Program Expansion to Include Sonoma State University Date: October 25, 2022
Written by: Damien O'Bid, City Manager
Recommendation
It is recommended that the City Council approve a resolution authorizing the City Manager to enter into and execute a revised Memorandum of Understanding (MOU) with the City of Rohnert Park, Sonoma State University and Petaluma People Services Center to Operate and Manage the Rohnert Park/Cotati SAFE Team (Specialized Assistance for Everyone) to provide crisis response services to our communities.
Background
In 1989, the City of Eugene, Oregon developed an innovative community-based public safety system to provide mental health first response for crises involving mental illness, homelessness, and addiction. As a result, the White Bird Clinic launched CAHOOTS (Crisis Assistance Helping Out On The Streets) as a community policing initiative.
The CAHOOTS model mobilizes two-person teams consisting of a medic (a nurse, paramedic, or EMT) and a crisis worker who has substantial training and experience in the mental health field.
The CAHOOTS teams deal with a wide range of mental health-related crises, including conflict resolution, welfare checks, substance abuse, suicide threats, and more, relying on trauma- informed de-escalation and harm reduction techniques. They also can handle non-emergency medical issues, avoiding ambulance transport and emergency room treatment.
CAHOOTS staff are not law enforcement officers and do not carry weapons and are dispatched through 911 or through a non-emergency line for issues that do not involve an immediate safety threat to the individual in crisis or the general public.
After approval by the Cotati City Council, the City of Cotati (City), in partnership with Rohnert Park, launched a 12 hour per day crisis response team in November 2021. This has gradually grown to cover 18 hours per day, with the goal of eventually covering 24 hours per day. The program is run by Petaluma People Services (PPSC) and has been branded the “SAFE Team” (Specialized Assistance for Everyone) to align with the City of Petaluma’s pilot program that had already launched as the “SAFE Team”. This was intended to reduce public confusion over the service.
Analysis/Discussion
After launch, Sonoma State University (SSU) approached the City to explore joining the Cotati/Rohnert Park SAFE Team. The City led the multi-party negotiations and was able to negotiate a revised MOU, which is attached to the resolution. If approved, it is believed that this is one of the first state universities to deploy a mobile mental health crisis team on campus.
The MOU identifies the roles and responsibilities of PPSC, the City of Rohnert Park, SSU and the City of Cotati. PPSC will provide the personnel, supplies, management and oversight of the program, while the City of Rohnert will provide and maintain the vehicle assigned to the SAFE Team. The revised MOU includes general clean up language throughout, including changes to terms to incorporate SSU, changes that allow operational details to be modified outside of the MOU (such as which agency maintains the vehicles), and how costs are determined as new agencies join. Previously, costs were set for the first 2 years and then would phase in based on actual call volumes. The proposed change only bases costs on estimated calls for the first year, and then starts averaging in actual calls in year 2. During negotiations, staff recognized that this is the first multi-agency mental health crisis team MOU in Sonoma County, so will likely be used as the template for program expansion.
While the pilot programs continue to build capacity, the County continues to also provide MST services, as needed. Additionally, the City of Santa Rosa is starting up their “In-Response” program, which is a different model from the CAHOOTS model used by Cotati/Rohnert Park and Petaluma.
Financial Considerations
Program Costs
From October 2021 through June 2022, the total cost of the SAFE team was approximately $350,000. The City’s share (currently 16%) was approximately $56,000. At 18 hours per day, the typical total monthly cost is approximately $75,000 (or $12,000 for Cotati). When the SAFE Team moves to 24 hours per day (anticipated to occur in January or February 2023), this cost will increase and is expected to be approximately $85,000 per month. Note that these are operating costs only and do not include purchase and upfit of the vehicles and related equipment, which are billed separately at the same percentages.
While the cost of the SAFE team does not offset existing costs, it can provide a more appropriate response for some types of calls, perform welfare checks, and transport individuals for treatment to free up police time for more pro-active policing work (traffic enforcement, etc.). Overall, it provides better local services for mental health and homelessness. The SAFE program also reduces local hospital costs by reducing non-covered emergency room visits with a more proactive intervention. As the program matures, seeking contributions from the local health systems to support the mental health crisis teams will be a priority.
The cost of the program, including the cost of the vehicles, vehicle maintenance, and fuel will be shared with Rohnert Park and SSU, based on the initial percentages in the MOU. In the second year, the costs will be phased into a two-year moving average of actual calls initiated by each City.
Using this methodology, the initial split will be 78% cost share for Rohnert Park, a 6% share for SSU and a 16% cost share for Cotati. Each entity will be invoiced for its’ respective cost share separately by PPSC. Rohnert Park will invoice Cotati and SSU directly for the vehicle, vehicle maintenance, and fuel based on the same proportional split of costs.
The County of Sonoma is the conduit for all social service program funding locally (i.e. property taxes, etc.) as well as receipt of any State or Federal funds for this purpose. This program represents a change to this model by requiring the use of the City General Fund to support these types of services. It should be considered that a program like this, particularly beyond the pilot phase, would likely work best and be more cost efficient if regionalized. This would allow shared overhead, as well as potentially shared coverage regionally during off-peak hours. A regional program could also facilitate joint participation with local health care systems who would likely benefit by reduced non-covered emergency room visits.
Grant Funding
At this time, the City has received grants from the County in the first year of the program from Measure O (local mental health sales tax) and from the State Department of Health Services as part of a joint application with Rohnert Park, Petaluma, Santa Rosa, and Sonoma County. Measure O granted to Cotati totals $68,480 for the start-up year only, with no future commitment of funds.
Funding for the Cotati/Rohnert Park program from the State Department of Health Services is indicated in the table below, minus $85,000 deducted for County program management.
FY Year Grant 21-22
$ 179,667 22-23
$ 291,667 23-24 $
264,333 24-25 $
264,333 Total $
1,000,000
The American Recovery Plan (ARP) funding may be available to offset a portion of the costs. It included funding with an 85% match for a Cahoots-type of program for 3 years. Funding is expected to pass through States that opt into the program. Important questions exist about this funding source include eligibility rules, primarily around when costs are reimbursable and what program elements are required to be eligible for coverage. Typically, Medicare only reimburses costs when working directly with an eligible patient, which could be important with potentially significant off-call time for the SAFE team. At this time, it is unknown if this will benefit the SAFE team, and in any event this funding will only be available for 3 years, at which time it is expected that the full costs will fall back to the local jurisdictions.
Environmental Issues
This action is exempt from the California Environmental Quality Act (CEQA) because it is not a project which has a potential for resulting in either a direct physical change in the environment, or a reasonably foreseeable indirect physical change in the environment, pursuant to CEQA Guideline section 15378.