CARE
(Community
Assistance,
Recovery and
Empowerment)
Court
March 14, 2022
Accessibility Resources
• American Sign Language (ASL) Interpreter available on screen during this meeting
• Zoom Closed Captioning available during this meeting
• Communication Access Real-Time Translation (CART)
transcription available at
https://www.streamtext.net/player?event=DOR
• Real-time Spanish translation
Call1-877-402-9753 Passcode: 1424990#
For future CARE Court stakeholder updates, please email accessibility requests 48 hours in advance of the meeting to Today’s Agenda
• What is CARE Court?
• CARE Court Pathway
• Frequently Asked Questions
• Next steps for engagement and feedback
• Q&A: Please email questions to be answered during today’s Q&A to [email protected]
Slides will be posted on the CARE Court website at
chhs.ca.gov/care-court/
CARE Court Pathway
4 CLINICAL EVALUATION
CARE PLAN
SUPPORT
REFERRAL SUCCESS
What is CARE Court?
• CARE Court is a new approach and a paradigm shift.
• CARE Court aims to deliver behavioral health services to the most severely ill and vulnerable individuals, while preserving self- determination and community living.
• CARE Court is an upstream diversion to prevent more restrictive conservatorships or incarceration.
• CARE Court is based on evidence which demonstrates that many people can stabilize, begin healing, and exit homelessness in less restrictive, community-based care settings.
• CARE Court holds accountable both government and participants.
Referral & Clinical Evaluation
REFERRAL
Individual with untreated schizophrenia
spectrum or other psychotic disorder who
lacks medical decision-making capacity
may be referred to the court by a family
member, behavioral health provider, first
responder, or other approved party to
provide care and prevent
institutionalization.
CLINICAL EVALUATION
The civil court orders a clinical evaluation
and appoints public defender and
Supporter. Court reviews the clinical
evaluation and, if the individual meets the
criteria, the court orders the development
of a Care Plan.
Care Plan & Support
CARE PLAN
Care Plan is developed by county
behavioral health, participant and
Supporter including behavioral health
treatment, stabilization medication, and a
housing plan. Court reviews and adopts
the Care Plan with both the individual and
county behavioral health as party to the
court order for up to 12 months.
SUPPORT
County behavioral health care team, with
participant, and Supporter, begin
treatment and regularly review and
update Care Plan, as needed, as well as a
Mental Health Advance Directive for any
future crises. Court provides accountability
with status hearings, for up to a second 12
months, as needed.
Success
SUCCESS
Successful completion and graduation by
the Court. Participant remains eligible for
ongoing treatment, supportive services, and
housing in the community to support long
term recovery. Mental Health Advance
Directive put in place for any future crises.
What is the clinical criteria for CARE Court?
Individuals with:
a) A schizophrenia spectrum or other
psychotic disorder diagnosis
AND
b) Whose judgment is so impaired by
symptoms of their mental illness (e.g.,
hallucinations, delusions, disorganization
and/or cognitive impairment) that they
lack the capacity to make informed or
rational decisions about their medically
necessary treatment.
• CARE Court is NOT for everyone
experiencing homelessness or mental
illness.
• It is designed to serve these Californians
before they enter the criminal justice
system or become so impaired that
they end up in a Lanterman-Petris-Short
(LPS) Mental Health Conservatorship.
What does the Care Plan entail?
CARE Court will provide clinically appropriate, community-based set of services and supports that are culturally and linguistically competent.
Core components of the Care Plan
Community
based
behavioral
health services
Stabilization
medication Housing plan
Supporting a self-determined path to recovery and self-sufficiency is core to CARE Court, with a Public Defender and the newly established Supporter for each participant in addition to their full clinical team.
The Supporter
The role of the Supporter
is to help the participant
understand, consider,
and communicate
decisions
Ensure the participant
understands the CARE
Court pathway
Help the participant
understand, consider,
and communicate
decisions
Give the participant the
tools to make self-
directed choices to the
greatest extent possible
Help develop of a
Mental Health
Advanced Directive for
future episodes
Create a “graduation”
plan for recovery and
wellness after
CARE Court
Supporters are trained in
supportive decision
making and will
represent a diversity of
life experiences.
EXAMPLE CARE COURT SCENARIO: Susan*
WHO?
A 55-year-old woman with a diagnosis of
schizophrenia. The voices in her head scream
at her and she can’t tell which are her
thoughts and or if other people are yelling at
her. The voices get in the way of taking care
of her poorly controlled diabetes. She feel
safe only in her car, alone with her cat,
isolated from others. She was briefly enrolled
in mental health treatment, but shortly after
enrolling she declined services and
treatment. She is at risk of conservatorship.
*The above example is not based on real life people or scenarios.
EXAMPLE CARE COURT PATHWAY: Susan*
REFERRAL
A homeless outreach worker
identifies her need for CARE
Court services.
CLINICAL EVALUATION
Diagnosis of schizophrenia
CARE PLAN
Her Supporter helps her to express
her desire for a female clinician and
case manager and a housing
placement that allows her cat.
SUPPORT
Immediately connected to mental
health services and clinically-
enriched interim housing.
SUCCESS
Successfully graduates from CARE
Court at 12 months, moves into
permanent supportive housing with her
cat and participates in arts
programming on site regularly.
*The above example pathway is not based on real life people or scenarios.
EXAMPLE CARE COURT SCENARIO: Victor*
WHO?
A 25-year-old male diagnosed with
schizoaffective disorder and substance
use disorder who typically takes
medication as directed but recently
stopped completely due to side effects.
His housing is unstable. Living part time
with family and part time on the street.
Recently, his substance misuse has
substantially increased.
*The above example is not based on real life people or scenarios.
EXAMPLE CARE COURT PATHWAY: Victor*
REFERRAL
A loved one refers him while
hospitalized on 5250**.
CARE PLAN
His Supporter helps to express his desire to
find housing where he can come and go
during the day and to be prescribed
different medications than in the past.
SUPPORT
Immediately connected to integrated mental
health and substance use disorder treatment
and soon thereafter, he enrolls in a vocational
training program.
CARE COURT JOURNEY
At 6 months goes off medication, relapses,
hospitalized on 5150**. Works with judge, public
defender, supporter, and care team to address
challenges and recommit to the care plan.
SUCCESS
Successfully graduates from CARE Court at
24 months, initially moves back in with
family, within 12 months starts a new job
and moves into a shared apartment.
*The above example pathway is not based on real life people or scenarios. **A 5150 or 5250 hold describes when an individual is involuntarily placed in a psychiatric facility. This happens when a per son is deemed a danger to others or themselves or is gravely disabled (Grave disability is defined as an individual's lack of ability, due to their mental illness, to provide for their food, clothing, or shelter.) What are court ordered stabilization medications?
• Court ordered stabilization medications are distinct from an involuntary medication order in that they cannot be forcibly administered. Seeking an involuntary medication order for a participant would be outside the CARE Court proceedings and subject to existing law. • Stabilization medications would be prescribed by the treating licensed behavioral healthcare provider/prescriber and medication management supports will be offered by the care team.
• As an active participant in the development and on-going maintenance of the Care Plan, the participant will work with their behavioral healthcare provider and their Supporter to address medication concerns and make changes to their individualized treatment plan.
What housing options are available through CARE Court?
• Housing is an important component of CARE Court—finding stability and staying connected to treatment, even with the proper supports, is next to impossible while living outdoors, in a tent or a vehicle.
• Care Plans will include a housing plan. Individuals who are served by CARE Court will have diverse housing needs on a continuum ranging from clinically enhanced interim or bridge housing, licensed adult and senior care settings, supportive housing, or housing with family and friends.
• 2021 Budget Act made a historic $12 billion investment to prevent and end homelessness. • Additionally, the Governor's proposed 2022-2023 budget includes $1.5 billion to support Behavioral Health Bridge Housing, which will fund clinically enhanced bridge housing settings that are well suited to serve CARE Court participants.
What if an individual does not participate in court
ordered Care Plan?
• An individual who does not participate in the court-ordered Care Plan may be subject to additional court hearing(s). If a participant cannot successfully complete a Care Plan, the individual may be referred by the Court for a conservatorship, consistent with current law.
• For individuals whose prior conservatorship proceedings were diverted, those proceedings will resume under a new presumption that no suitable alternatives to conservatorship are available.
• For individuals whose criminal cases were diverted, those proceedings would resume.
What if a local government does not provide the
court-ordered Care Plan?
• If local governments do not meet their specified responsibilities under the court-ordered Care Plans, the Court will have the ability to order sanctions and, in extreme cases, appoint an agent to ensure services are provided.
How is CARE Court different from current approaches in California - namely Mental Health (or LPS) Conservatorship and the more recent Laura’s Law (Assisted Outpatient Treatment)?
• CARE Court differs fundamentally from Mental Health/LPS Conservatorship in that it does not include custodial settings or long-term involuntary medications. • CARE Court is different from both Mental Health/LPS Conservatorship and Laura’s Law in several important ways:
• CARE Court may be initiated on a petition to the Court by family members, service providers, and other authorized parties, in addition to County Behavioral Health.
• Local government is also part of the court order, along with the participant, to ensure accountability to the provision of treatment and care. • CARE Court provides a new Supporter role, to empower the individual in directing their care as much as possible.
How is CARE Court funded?
• Existing funding sources for the Care Plan services and supports include nearly $10 billion annually for behavioral healthcare (including Mental Health Services Act, mental health realignment, federal funds) and the proposed $1.5 billion for behavioral health bridge housing, as well as various housing and clinical residential placements available to cities and counties under the Governor’s $12 billion homelessness investments which began in 2021.
• Costs for the Court, the Public Defender, the new Supporter program, and state oversight will require new funding. The state will provide technical assistance to the Counties and will be responsible for data collection, evaluation, and reporting.
Stakeholder Engagement
This is a framework that requires meaningful engagement with the community to shape solutions for Californians as we move urgently forward to respond to the humanitarian crisis in our midst. We are engaging a broad set of stakeholders to further build this framework out and ensure it can deliver meaningful results for some of our most vulnerable neighbors as soon as possible.
To date we have received significant feedback on:
• Opportunity for early services and supports engagement • Importance of the supporter role (supported decision-making model) as well as the role of peer support as part of the ongoing Care Plan
• Trauma informed policy and practices
• Need for housing resources to meet the needs of the participant • Despite significant recent investments in the behavioral health continuum, concerns over service capacity, including workforce
• Concern that narrow eligibly criteria misses other high need, high vulnerability populations Ongoing Stakeholder Engagement
Since the March 3rd launch and ongoing:
o Public Briefings
o Local Roundtables
o Stakeholder engagement with representatives from a wide variety of networks, including disability rights, peers, families, racial equity advocates, counties, cities, homeless stakeholders, behavioral health providers, behavioral health professional associations and more
• Check out the CARE Court webpage
• New CARE Court FAQ recently posted on the webpage
• Please share feedback and sign up for CARE Court listserv, by emailing us at [email protected]
We are requesting initial feedback by Friday, March 25th, and welcome it ongoing.
Question and Answer
Please email your questions for today’s Q&A
to [email protected]