CATT
Community Assessment
Transport Team
405,059
911-Emergency
Transports in
Alameda County
(2016-June 30, 2019)
BRIEF HISTORY
11%
5150 Transport
Non-5150 vs. 5150 Transports
89%
Non-5150
Transport
Historical 5150 Transport Destinations
56%
44%
Willow Rock included
43,093
5150 Transports
(2016-Q2 2019)
Challenges with Ambulance
Response Model
• Ambulance personnel are not trained in delivering psychiatric care and Emergency Departments are not optimal locations for these clients. • Behavioral health clients are not transported to other - more appropriate - levels of care (e.g., crisis stabilization units, crisis treatment facilities, etc.). • John George Psychiatric Hospital is overcrowded due to one-solution-forall model, which doesn’t often meet individual needs. • Transporting behavioral health clients without need for medical attention by 911 ambulance is costly.
CATT Design Begins in 2018
• Implement and support a crisis response system that reduces the rate of involuntary detentions and increases the efficiency and effectiveness of linking clients to needed services.
• Innovated combination staffing by pairing an EMT and a Behavioral Health Clinician in a non-emergency vehicle.
• Staffing model enables assessment and transport for a broad range of dispositions (Psychiatric Emergency Services, Crisis Residential Treatment Facility, sobering center, shelter, emergency departments, etc.). • Team will be equipped with technology that helps understand the best diagnosis and disposition possibilities for a client experiencing a behavioral health crisis.
CATT FUNDING
MEASURE A & MENTAL HEALTH
SERVICES ACT (MHSA) Proposition 63
• Measure A provides financial support for emergency medical, hospital inpatient, outpatient, public health, mental health, and substance abuse services to indigent, low income, and uninsured adults, children, families, seniors, and other residents of Alameda County. Measure A funds were utilized to purchase vehicles.
• MHSA - Proposition 63 emphasizes transformation of the mental health system while improving the quality of life for Californians living with a mental illness.
CATT
&
Stakeholders
Alameda County Behavioral Health (ACBH)
Local health care agency dedicated to maximizing the recovery, resilience and wellness of all eligible Alameda County residents who are developing or experiencing serious mental health, alcohol or drug concerns.
Alameda County Care Connect
An initiative of the Alameda County Health Care Services Agency (HCSA) to improve care for Medi-Cal eligible residents who face the most difficult combination of physical health, mental health, and housing challenges.
CATT will work with Care Connect’s Community Health Record (CHR), which aims to bring together data from multiple organizations to better share information among providers and improve care coordination efforts.
Alameda County Emergency Medical Services
Plans, implements, and oversees all Emergency Medical Services (EMS) activities conducted in Alameda County.
Bonita House, Inc.
Organization working to build community, dignity, hope and wellness with people recovering from mental health and substance use disorders.
FALCK
Alameda County’s 9-1-1 provider
Additional support from Board of Supervisors, HCSA
finance department, dispatch centers, PD, OPD with
Crisis Intervention Training
CATT Progress Report
• Received $9,878,082 from Mental Health Services
Oversight and Accountability Commission (MHSOAC)
• Ongoing CATT Program Management
• CATT Overview Committee to assist with development and oversight
• CATT Budget Committee to manage finances
• CATT Training Committee to develop and implement a
training curriculum for the CATT EMT and Licensed
Clinician
CATT Staff
Licensed Clinician – Hired by Bonita House
Licensed Clinicians shall complete required BH hiring process.
Emergency Medical Technician (EMT) – Hired by Falck
EMTs shall have 6 Months experience (or FT equivalent hours) as an accredited EMT working on an ambulance.
• Both team members shall demonstrate strong clinical expertise and decision-making skills.
• Both team members shall be successful in completing the EMS and Behavior Health approved Crisis Intervention and CATT Training Programs.
CATT TRAINING
• Both team members will have Crisis Intervention
Training arranged by Alameda County Behavioral Health
Cares Services in partnership with Oakland Police
Department.
• Both team members will have at least 40 hours of
classroom sessions with ongoing curriculum.
• CATT Licensed Clinician will have 5150 certification
training to place 5150/5585 (minors) holds.
CATT Teams
POLICE DISPATCHED
FOR POSSIBLE
BEHAVIORAL HEALTH
ISSUE
OFFICER ARRIVES ON
SCENE TO DETERMINE
IF PERSON WILL
BENEFIT FROM CATT
SERVICES
AMBULANCE
TRANSPORT
REQUIRED
• NEEDS MEDICAL CARE
• HAS A TRAUMATIC
INJURY NEEDS
TREATMENT
• UNCOOPERATIVE-NEEDS
RESTRAINTS
• UNABLE TO WALK
WITHOUT ASSISTANCE
Officer determines client
can benefit from CATT
services or would like a
consultation.
Officer requests
CATT to be
dispatched to
the scene.
CATT Unit
• Comprised of a
Licensed Clinician and
EMT
• When CATT arrives on
scene and they feel
comfortable, they will
release the Officer
and render care to the
client.
• The Licensed Clinician
has received the
necessary training
and can write a
5150/5585 hold.
• The Licensed
Clinician and EMT
can work together
to determine if
there are any
medical concerns
or if the client will
benefit from
alternative
resources.
Services Available to CATT Clients
• Physician or Mental Health Provider’s office/clinic
• Shelter
• Crisis Residential Treatment Facility
• Sobering Center
• APS or CPS services
• Emergency Room, John George Pavilion, or Willow Rock
• Other appropriate services
Assessment, Diversion, Transport,
Referral, 5150/5585 Hold, and
Transport
• CATT will perform a physical and mental status
assessment, in accordance with County
protocols.
• CATT will determine a disposition attempting to
avoid placing the client on a 5150/5585 hold or
transporting to John George Psychiatric
Hospital, Willow Rock, or an Emergency
Department.
• CATT will be able to utilize ReddiNet and other
services to refer the client to an appropriate
treatment/crisis facility.
Ambulance or CATT
Countywide Involuntary Holds by City 2016 - 2022
2016 2017 2018 2019 2020 2021 2022*
Alameda 410 437 460 263 214 190 95
Albany 126 105 105 100 55 60 21
Berkeley 1298 1278 1240 1038 907 889 397
Castro
Valley 407 324 322 249 259 238 118
Dublin 214 229 275 242 287 386 158
Emeryville 223 232 246 169 177 192 87
Fremont 921 823 759 599 520 570 242
Hayward 1535 1366 1360 1069 1038 1109 458
Livermore 385 393 457 393 389 364 141
Newark 240 190 194 141 149 158 84
Oakland 5335 5317 4914 3484 3035 3061 1401
Piedmont 23 22 14 18 26 11 106
Pleasanton 299 330 327 276 246 249 106
San
Leandro 1242 1183 1064 795 882 952 406
San
Lorenzo 191 163 195 144 120 126 70
Sunol 12 7 8 6 14 15 12
Union City 321 292 299 249 266 303 164
Grand
Total 13182 12691 12239 9235 8584 8873 4066
24 13182
12691
12239
9235
8584 8873
8132
0 2000
4000
6000
8000
10000
12000
14000
2016 2017 2018 2019 2020 2021 2022*
Countywide EMS 5150 Holds by Year
Data Presented by Public Consulting Group -
August 2022
CATT Program City Involuntary Hold Comparison 2017 - 2018 Baseline (2017-2018) Implementation
Period (2021-2022) % Change
Fremont 1582 1054 33.4%
Hayward 2726 2025 25.7%
Oakland 10231 5863 42.7%
San Leandro 2247 1764 21.5%
Union City 591 631 6.8%
County Total 24930 17005 31.8%
www.publicconsultinggroup.com Data Presented by Public Consulting Group - August 2022 CATT Program City Involuntary Hold Comparison 2018 - 2019 Baseline (2018-2019) Implementation
Period (2021-2022) % Change
Fremont 1358 1054 22.4%
Hayward 2429 2025 16.6%
Oakland 8398 5863 30.2%
San Leandro 1859 1764 5.1%
Union City 548 631 15.1%
County Total 21474 17005 20.8%
www.publicconsultinggroup.com Data Presented by Public Consulting Group - August 2022 CATT Program City Involuntary Hold Comparison 2019 - 2020 Baseline (2019-
2020)
Implementation
Period (2021-2022) % Change
Fremont 1119 1054 5.8%
Hayward 2107 2025 3.9%
Oakland 6519 5863 10.1%
San Leandro 1677 1764 5.2%
Union City 515 631 22.5%
County Total 17819 17005 4.6%
www.publicconsultinggroup.com Data Presented by Public Consulting Group - August 2022 San Leandro Trend
28 1242
1183
1064
795
882
952
812
0 200
400
600
800
1000
1200
1400
2016 2017 2018 2019 2020 2021 2022*
San Leandro 5150 Counts
San Leandro
Data Presented by Public
Consulting Group - August 2022
Hospital and CBO Transport Locations
• John George PES is the hospital CATT teams
are most likely to transport clients to
(21.5%)
• Amber House is the CBO CATT teams are
most likely to transport clients to (82.5%)
1.8%
1.2%
3.0%
3.0%
5.4%
8.4%
7.2%
5.4%
7.2%
12.7%
12.7%
8.4%
21.7%
2.1%
2.4%
2.6%
3.1%
3.5%
4.0%
5.7%
6.4%
6.4%
9.2%
9.7%
10.4%
10.6%
21.5%
0.0% 5.0% 10.0% 15.0% 20.0% 25.0%
Alta Bates Summit Medical Center, Summit
Campus
Willow Rock Center
Kaiser Permanente, Oakland Medical Center
Kaiser Permanente, Fremont
Alta Bates Summit Medical Center, Alta Bates
Campus
Children''s Hospital & Research Center
Oakland
First Presbyterian
Eden Medical Center
Alameda County Medical Center, Highland
Saint Rose Hospital
Kaiser Permanente, San Leandro Medical
Center
Washington Hospital, Fremont
San Leandro Hospital
John George Psychiatric Pavilion
Overall In Last Six Months
82.5%
6.7% 5.0% 3.3%
85.7%
14.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Amber House Cherry Hill Jay Mahler Woodroe Place
Overall In Last Six Months
www.publicconsultinggroup.com Data obtained from PCG Year Two Interim Evaluation – April 2022 TEAM Physical ID UNIT- Posting Area SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY CREW 1 (LC) CREW 2 (EMT) DEPLOYMENT HUB Pay Period 413 OAKLAND 09:00-21:00 09:00-21:00 09:00-21:00 week1
CATT 20 09:00-21:00 09:00-21:00 09:00-21:00 09:00-21:00 week2 410 SAN LEANDRO 07:00-19:00 07:00-19:00 07:00-19:00 week1 CATT 30 07:00-19:00 07:00-19:00 07:00-19:00 07:00-19:00 week2 420 HAYWARD 08:00-20:00 08:00-20:00 08:00-20:00 week1
CATT 31 08:00-20:00 08:00-20:00 08:00-20:00 08:00-20:00 week2 411 OAKLAND 10:00-22:00 10:00-22:00 10:00-22:00 10:00-22:00 week1 CATT 21 10:00-22:00 10:00-22:00 10:00-22:00 week2
HAYWARD 07:00-19:00 07:00-19:00 07:00-19:00 week1
CATT 32 07:00-19:00 07:00-19:00 07:00-19:00 07:00-19:00 week2 424 FREMONT 08:00-20:00 08:00-20:00 08:00-20:00 08:00-20:00 week1 CATT 40 08:00-20:00 08:00-20:00 08:00-20:00 week2
421 OAKLAND 11:00-23:00 11:00-23:00 11:00-23:00 11:00-23:00 week1 CATT 22 11:00-23:00 11:00-23:00 11:00-23:00 week2
SAN LEANDRO 07:00-19:00 07:00-19:00 07:00-19:00 week1
CATT 33 07:00-19:00 07:00-19:00 07:00-19:00 07:00-19:00 week2 HAYWARD 09:00-21:00 09:00-21:00 09:00-21:00 09:00-21:00 week1 CATT 34 09:00-21:00 09:00-21:00 09:00-21:00 week2
414 OAKLAND 08:00-20:00 08:00-20:00 08:00-20:00 week 1
CATT 23 08:00-20:00 08:00-20:00 08:00-20:00 08:00-20:00 week 2 SAN LEANDRO 11:00-23:00 11:00-23:00 11:00-23:00 11:00-23:00 week1 CATT 35 11:00-23:00 11:00-23:00 11:00-23:00 week2
FREMONT
10:00-22:00
10:00-22:00 10:00-22:00 10:00-22:00 week1
CATT 41 10:00-22:00 10:00-22:00 10:00-22:00 week2
Vacant FTE Clinican 12.0
Relief Clinicians: Lewie Hodge, Renikia Brown, Samantha Plateau, Jeff Beal EMT 8.0 Supervisors: Samantha Plateau, Jeff Beal
** Teams are allowed to log in 15 minutes after start of shift and will log off 60 minutes prior to end of shift. **Crews have meeting every Wednesday. Crews will be out of services from 8am-9am.
Maggie Kuhn Bianca Stern
Union City Hub
Fallon Hub
Cesia Perez Industrial Hub
Eloise Gerken Andy Maravilla
David Steger Fallon Hub
VACANT VACANT
Michelle Summersett Union City Hub
Fallon Hub
Rubin Rubio
12 VACANT VACANT Union City Hub
Jessica Dean Merle McIntoch
Union City Hub
Union City Hub
VACANT VACANT
7 10
VACANT VACANT Industrial Hub
Anureet Sandhu
Industrial Hub
1 6
11 9
5 3
8 2
4 Sonya Lauster
VACANT VACANT Fallon Hub
Caitlin Asels
Shanelle Cotton
CALL RESPONSE GUIDELINES:
▪ CATT is requested by Law enforcement.
▪ CATT can respond to all cities within Alameda
County except Berkeley and the City of Alameda.
▪ Response time is 30 minutes and determined by
location, not by their assigned post.
FINAL NOTES
• The soft rollout for CATT was Monday July 20th, 2020. The end of our CATT Pilot will be June 30, 2023.
• Goal for 12 Teams on 12 hour shifts 7 days a weeks. Hours 7AM-11PM. The current schedule has units located in Oakland, San Leandro, Hayward, and Fremont.
• We are continuing to work on staffing, which has been a challenge since the start of the program.
• We will be evaluating the CATT program on a regular basis, taking into account the data and input we receive. We will share our updates accordingly.
This project will be a success because of the
Incredible support we have received from all
of our partners!
QUESTIONS?
Mental Health
Response Unit
October 17, 2022
1 Mission
• Program Goal: Provide an alternative immediate response to individuals that are experiencing a mental health crisis. The Unit will respond with trained providers that can provide real-time assistance to non-violent mental health and substance abuse patients. These individuals would otherwise be left to enter into the 911 system or be placed on a psychiatric hold.
• Secondary mission: Respond to and treat low-level acuity medical calls
• Overall goal is to more efficiently utilize the relevant health care services to meet the needs of the residents of San Leandro, and prevent unnecessary hospital admissions and readmissions. 2 Details
• One year pilot program
• Coordination between Police, Fire, and Human Services • Based out of San Leandro fire station
Unit will be mobile during operating hours
• Available 40 hours/week
Exact hours to be determined by:
Call volume
Partner referral center operational hours
3 Staffing
• Mental Health Response Unit will be staffed with:
Psychiatric Nurse Practitioner
ACFD County Accredited Paramedic
• Flexible combination allows for:
Direct patient care
Ability to prescribe and follow up on treatment/referrals made Case management
Work in collaboration with established San Leandro outreach teams Part of a multi-disciplinary team with established mental health providers to provide care, prescription, or follow-up assessments as needed Advanced medical care up to paramedic level when required 4 Service
• Unit to serve:
Non-violent persons experiencing a mental health problem Unhoused individuals
Individuals experiencing low-level acuity medical issues • Unit can respond in place of or simultaneously with police CATT currently can only be requested by an on-scene police officer Dispatch can send Unit directly if scene is safe (person not a direct harm to himself or others, no weapons present, etc)
Potentially unsafe scene: Unit can respond and stage near the scene for quick access
5 Points of Entry
• Several Options
On View of patient
Police – through ACRECC
Similar to current request for CATT unit
Fire - ACRECC
Direct Phone Line
• Telehealth (FaceTime, phone call) a future consideration if unit is not immediately available to respond.
6 Service Area
• The Unit will be available throughout the entire City. • Unit will partner with current outreach teams in the area for followup care Building Futures
Bonita House
Family Violence Law Center
San Leandro Human Services
7 Impact
• 2021 – 856 calls to SLPD with a mental health component 396: resulted in the placement of a 5150 hold
172: referred to CATT
Potential to respond in place of CATT with no PD response needed 288: did not meet the 5150 criteria
The Unit would fill this need that cannot currently be met by PD or CATT • Reduction in law enforcement responses to non-violent calls for service, specifically this Unit responding in place of PD. Potential to respond to up to 54% of mental health-related calls that now go to SLPD
8 Budget
9 • One year pilot program – 40-hour week
• San Leandro share: $325,000
• ACFD share: $250,000
• Total cost: $575,000
Current Status
• Timeline: Unit operational in 6 -12 months
Exploring options for agreement with Nurse Practitioner (NP) Secure ACFD Paramedic (meet and confer implications)
Confirm dispatch protocols
• Contract with NP would include regular comprehensive reports of program status, associated outcomes, and analysis.
Success metrics after one year would measure number of mental healthrelated calls that were diverted from SLPD Number of individuals that receive case management
Track follow-up care and referrals
10 Questions?
11