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HomeMy WebLinkAboutReg 2010-05-17 Item 7A - Crisis Diversion Facilities - Staff Report: Attachments EE-OOREQUEST FOR PROPOSAL Addendum 1 King County DATE ISSUED: March 30, 2010 RFP Title: MIDD Crisis Diversion Services REBID King County Department of Community Human Services Requesting Dept./ Div.: MHCADSD RFP Number: 1056- 10 -RLD Due Date: May 6, 2010 no later than 2:00 P.M. Buyer: Roy L. Dodman, rov.dodman(a�kincjcountv.00v, 206 263 -9293 This addendum is issued to revise the original Request for Proposal, dated March 11, 2010 as follows: 1. The proposal opening date remains the same: Thursday, May 6, 2010, no later than 2:00 p.m. exactly. 2. The sign -in sheet from the March 18, 2010 pre proposal conference is available by contacting the buyer noted above. This document may be e- mailed to you as a pdf attachment. 3. In Section II, Part 2 Intent, Item B, Physical Plant, delete 3. Within proximity of the Crisis Diversion Interim Services (CDIS) to allow for easy transfer of individuals between locations of the CDIS and CDF (which was awarded under RFP 1207- 09RLD). And replace with 3. Have policies and procedure) /agreements for easy transfer of individuals from the CDF to the CDIS 4. In Section II, Part 3 Description of Work, Item B. Mobile Crisis Team, delete the last sentence in the second paragraph They will also assist with discharge planning and transportation from the CDF to the community. And replace with They may also assist with discharge planning and transportation from the CDF to the community. (continued on page 2) TO BE ELIGIBLE FOR AWARD OF A CONTRACT, THIS ADDENDUM MUST BE SIGNED AND SUBMITTED TO KING COUNTY Sealed proposals will only be received by: King County Procurement Services Section, The Chinook Building, 3r Floor, 401 Fifth Avenue, Seattle, WA 98104 -2333. Office hours: 8:00 a.m. 5:00 p.m., Monday Friday Company Name Address 1 City State Postal Code Signature Authorized Representative/Title (Please Print) Email Phone Fax This Request for Proposal Addendum wi I be provided in alternative formats such as Braille, large print, audiocassette or computer disk for individuals with disabilities upon request. Attachment EE Department of Executive Services Finance and Business Operations Division Procurement and Contract Services Section 206- 263 -9400 TTY Relay: 711 153 154 Addendum Number 1 King County RFP 1056- 10 -RLD Page 2 of 3 5. In Section II, Part 3 Description of Work, Item B. Mobile Crisis Team, third paragraph, delete the first sentence The primary role of the mobile crisis team is to provide crisis outreach in the community by responding to requests for crisis outreach. And replace with The primary role of the mobile crisis team is to "respond to police and other first responders to" provide crisis outreach in the community.... The following information is provided in response to questions received: Q1: What is the status of the City of Tukwila's moratorium on Crisis Diversion Services? R1: The County does not have sufficient information to answer this question. However, the County recommends that any potential bidder proposing to site a facility in a King County community review their proposal with, and direct any questions they have to the jurisdiction's Planning Department. Q2: Define proximity of Crisis Diversion Facility to the Crisis Diversion Interim Services. R2: This addressed via Item 3 found on page 1 of this Addendum. Q3: Define what is meant by restraint free facility. R3: Please refer to page 10 of 34 of the RFP, "Restraint free facility: The County will give preference to proposals that use a recovery oriented model of care system that is consistent with the principles of trauma informed care, with policies and procedures that maintain the safety of service recipients an staff as well as the dignity and self determination of individuals who are in crisis. The following publication is provided as a reference: Roadmap to Seclusion and Restraint Free Mental Health Services. DHHS Pub. No. (SMA) 05 -4055. Rockville, MD, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2005." Q4: What level of clinician is needed for psychiatric evaluations? R4: Two levels of psychiatric evaluations are needed at the CDF.• 1. An evaluation the provides behavioral health diagnostic impressions, and risk assessments which can be done by the following clinicians: A psychiatrist; A psychologist; An advanced registered nurse practitioner certified in psychiatric nursing; or A person identified as a mental health professional within the regional support network (RSN) mental health treatment system provided the person's training and qualifications at a minimum include having a Master's degree and two years of mental health treatment experience. 2. A psychiatric evaluation for the purposes of determining the need for psychiatric medications and providing medication management which can be done by the following clinicians: A psychiatrist or a an advanced registered nurse practitioner certified in psychiatric nursing. Q5: Clarify what is meant by locking doors and security measures. R6: Must meet the requirements of licensing. Bidders should provide evidence /plan to ensure that people do not leave the facility without staff awareness and some ability to intervene (time release locks are preferred). Q7: Provide information on intention of preferred staffing model and why medical component. R7: The intention of the preferred staffing model is to provide bidders with information on what the county is seeking; the county intends to have a facility with a medical assessment capability. In addition, capacity to provide nursing services, ARNP and psychiatric services onsite is required. Q8: Clarify how the hospital diversion criteria are to be used. Addendum Number 1 King County RFP 1056- 10 -RLD Page 3of3 R8: The hospital diversion criteria are designed to be used by medical first responders and hospitals in order to determine which individuals are best suited for crisis responses with the CDF. First responders are defined as EMT and fire. Q9: How will we know if the staffing plan is acceptable? Are there other acceptable staffing options? R9: we will entertain other staffing plans, however, p. 10 11, the preferred staffing model is provided. The preferred staffing model will provide the basis for scoring. Q10: What are the requirements of the Mobile Crisis Team and how does that differ from Designated Mental Health Professionals? Define and clarify the requirements of mobile crisis teams. R10: Mobile Crisis Teams do not do involuntary commitment and are limited to only responding to calls from law enforcement within the community. Q11: Are you open to merging mobile crisis teams with Emergency Services Patrol. R11: No. Q12: Will agreements be in place and priority given to CDF individuals in need of detox services? R12: Yes. Q13: Is the cost of a vehicle included in the funding for the CDF and Mobile Crisis Team? R13: Yes, p. 13. Q14: Will the county negotiate with a successful bidder is the remodeling /start -up costs for the CDF exceed $500,000? R14: We have identified a start-up and remodeling budget, the costs for remodeling may be negotiated. if the proposed remodeling budget exceeds $500, 000, please provide a justification and detailed budget. Q15: Is it okay to build a budget without including the assumptions of potential Medicaid billing? R15: Yes, base the proposed budget on the county funding identified in the RFP. Q16: What should be included in the timeline? R16: Provide evidence and strategies that will be used in order to ensure full staffing capacity within 6 months of contract date. Q17: What are the requirements for the CDF Director? R17: Someone with the experience who can ensure the success of a 24/7 facility that has staff from multiple disciplines. 018: What do you mean by Partnership? R18: Partnership can take a variety of forms from simple memorandums of understanding to more complex consortium agreements including sub contracts Q 19:Is there a requirement for an agency to enter into a partnership agreement with a union in order to be eligible to receive funding? R 19: King County Ordinance 15949, section, says that no MiDD funds shall be provided to any contractor providing, annually, more than three million dollars in mental health treatment services through the King County regional support network (RSN) unless that contractor has executed a binding partnership agreement covering employees performing community mental health services funded by public moneys with a bona fide Labor organization. An applicant does not have to execute a binding partnership agreement with a bona fide union in order to receive funds unless it receives more than three million in mental health treatment services through the King County RSN. 155 156 REQUEST FOR PROPOSAL Addendum 2 DATE ISSUED: April 16, 2010 RFP Title: MIDD Crisis Diversion Services REBID King County Department of Community Human Services Requesting Dept./ Div.: MHCADSD RFP Number: 1056- 10 -RLD Remised Due Date: June 8, 2010 no later than 2:00 P.M. Buyer: Roy L. Dodman, rov.dodman(a�kinacounty.gov, 206 263 -9293 This addendum is issued to revise the original Request for Proposal, dated March 11, 2010 as follows: 1. The proposal opening date has been changed from Thursday, May 6, 2010 to Thursday, June 8, 2010, no later than 2:00 p.m. exactly. 2. The sign -in sheet from the March 18, 2010 pre proposal conference is available by contacting the buyer noted above. This document may be e- mailed to you as a pdf attachment. 3. A second, non mandatory, pre proposal conference to discuss questions related to Addendum 1 and Addendum 2 shall be held at 1 :30 p.m. on Thursday, April 29, 2010. 4. Delete Appendix A of the RFP, and replace with revised Appendix A, MIDD 10b Statement of Assurance, included as the final page of this Addendum. 5. In Section II, Part 7 Specific Proposal Requirements, Item F Program Narrative, sub -item 3, delete b. and c. (continued on page 2) TO BE ELIGIBLE FOR AWARD OF A CONTRACT, THIS ADDENDUM MUST BE SIGNED AND SUBMITTED TO KING COUNTY Sealed proposals will only be received by: King County Procurement Services Section, The Chinook Building, 3r Floor, 401 Fifth Avenue, Seattle, WA 98104 -2333. Office hours: 8:00 a.m. 5:00 p.m., Monday Friday Company Name Address Signature I Authorized Representative/Title (Please Print) Email Phone King County Department of Executive Services Finance and Business Operations Division Procurement and Contract Services Section 206 263 -9400 TTY Relay: 711 1 City State Postal Code i Fax This Request for Proposal Addendum will be provided in alternative formats such as Braille, large print, audiocassette or computer disk for individuals with disabilities upon request. Attachment FF 157 158 Addendum Number 2 King County RFP 1056- 10 -RLD Page 2 of 2 6. In Section II, Part 7 Specific Proposal Requirements, Item F Program Narrative, sub -item 3 should now read: 3. The County welcomes any location that meets the general requirements. Identify and describe the proposed location for the CDF. Include how proposed site meets the centralized location with easy access and at least 2 routes to the facility by freeway and/or major arterials and is accessible to at least one Metro bus route. a. Include evidence that the proposed site is secured or a letter of commitment from site owner verifying readiness to site CDF at proposed .location. Evidence is defined as a signed lease, letter of intent to lease contingent upon award. (Copy of letter of commitment or other evidence can be included as Appendix C and does not count toward the section page limit.) b. Copies of letters of commitment or other evidence (required in 3 a -c) can be included as Appendix C and does not count toward the section page limit. The following informational item is included in this addendum: A copy of a letter, dated April 1, 2010, from the Seattle City Council, address to King County Sheriff Sue Rahr and Shirley Havenga, Co- chairs of the MIDD Oversight Committee is attached to this Addendum. The following information is provided in response to questions received: Q1: From the MIDD Oversight Committee (OC) co- chairs, requesting bidders be notified of new developments in the implementation of the MIDD Strategy 10b, Crisis Diversion Services R9: The City of Seattle Mayor and Council sent a letter to the MIDD OC co- chairs on April 1, 2010, informing the MIDD OC that the City of Seattle strongly supports the establishment of the King County Crisis Diversion Facility. In addition, the letter states that Seattle Fleets and Facility staff are reviewing site options and looking for promising sites owned by the City. A copy of the letter of support is included as an attachment to this addendum. Any discussions with the City by potential bidders will be independent from MHCADSD, Procurement and this bid process. Q2: Can King County provide utilization data for its existing crisis services (e.g., unduplicated number of individuals served, services received) R2: The Crisis Diversion Facility and Mobile Crisis team is a new service for King County, there is not existing utilization data available. Q3: Does King County have any utilization targets it would like to achieve with either the crisis diversion facility or the mobile crisis service? R3: Projected utilization targets are included in the MIDD Implementation and Evaluation Plan htto:// www .kinacountv.aov /healthservices /MHSA /MIDDPIan /MI DDThreePlans.asox). Actual targets will be determined following award in consultation with the MIDD Evaluation Team and MIDD Oversight Committee. Q4: Is the $6,000,000 funding gross or net of Medicaid? R4: $6,000,000 is the approximate funding available for MIDD Strategy 90b, Crisis Diversion Services, one component, Crisis Diversion Interim Services, was awarded under a previous solicitation. Addendum Number 2 King County RFP 1056- 10 -RLD Page 3 of 3 Q5: What is the expected Medicaid eligibility of the clients? R5: Not sure why this question was asked in relationship to this particular RFP. See answer to Question 4 above. Q6: Does the annual funding of $6,000,000 exclude start up costs as outlined on p. 13 of the RFP? R6: The $6,000,000 figure is the approximate amount available for the MIDD 10b Crisis Diversion Services strategy. Start -up costs are a one -time expense and not included in the base funds available for the Crisis Diversion Facility and Mobile Crisis Team. Q7: The annual budgets presented on p. 13 CDF Services ($4,034,791), CDF Rent ($283,046), Mobile Crisis Team ($807,200) totals $5,125,037. Is the remaining $874,963 funding (to make up the $6,000,000 annual funding) designated for specific services or expenditures? R7: The amount of funding available for each component (CDF and Mobile Crisis Team) is included on pages 12 13, these are the figures that should be used to determine the proposed budget. The $6,000,000 figure is the approximate amount available for the MIDD 10b Crisis Diversion Services strategy. Q8: If a contractor bids on both programs, can the individual program costs deviate from the budgets presented on p. 13 if the total costs remain at or below $6,000,000? R8: No, the proposed budgets should be consistent with the figures specified for the Crisis Diversion Facility and Mobile Crisis Team funding specified as being available. Q9: What is the duration of the MiDD sales tax? R9: The sales tax expires on January 1, 2017. Q10: Under the Funding Section (Part 5), there is description that the annual funding is for the implementation of CDF, CDIS and Mobile Crisis Team. is there a budget designated for the CDIS component? Can King County provide a description of the CDIS service component? RIO: Yes, there is a budget designated for the CDiS component. A description of the CDIS component can be found in the previous RFP httn:// procurement .kinacountv.aov /arocurement OVR/rfodocs /2009/Technical /1207- 09/1207- 09.adf Q11: I've just flown to Seattle to assist Recovery Innovations with their RFP response and hoped that you might review our perspective of the geographic boundaries (see attached). While we at first believed this to be correct, we now believe that the southern boundary is just south of Tukwila. R11: There was nothing attached to review. Not sure what this question is getting at. The CDF and Mobile Crisis Team services shall be made available county wide and not within specific geographic boundaries. If the question is in regards to citing of the CDF, see p. 8 physical plant. 159 160 Seatt e City Counci April 1, 2010 Sheriff Sue Rahr, Co -Chair Shirley Havenga, Co -Chair MIDD Oversight Committee 401 -5 Ave, Suite 400 Seattle, WA 98104 Dear Sheriff Rahr and Ms. Havenga: Addendum Number 2 King County RFP 1056- 10 -RLD Page 4 of 4 We are writing to let the MIDD Oversight Committee know that after many conversations among Council members and the Mayor, the City of Seattle strongly supports the establishment of the King County Crisis Diversion Facility. We urge the County to find a location which is convenient for all municipalities involved with this worthwhile program. Such a site should be close to highways for easy vehicle access and is accessible both to Harborview Medical Center and King County Jail facilities, At our request, Seattle Fleets and Facilities staff is reviewing sites previously considered and is looking for promising sites owned by the City. We appreciate the many innovative strategies the MIDD Oversight Committee has developed to reduce the number of people using costly interventions such as jail, emergency rooms and hospitals. The 16 -bed King County Crisis Diversion Facility is vitally needed to ensure more compassionate and effective care for offenders with mental illness and drug dependencies. By providing clients with both immediate services and connection to longer term services, we can help them stabilize and move beyond the cycle of repeated trips to medical or jail facilities. We support the King County Crisis Diversion Facility and wish to see it operating as soon as possible. We look forward to working with you and our neighboring communities to find a suitable location for the King County Crisis Diversion Facility. City Hall 600 Fourth Avenue, Floor 2, PO Box 34025, Seattle, Washington 98124 -4025 (206) 684 -8888 Fax: (206) 684 -8587 TTY: (206) 233 -0025 http /www.cityofseattle.gov /council An EEO employer. Accommodations for people with disabilities provided upon request. 1 161 162 Appendix A Printed name of Authorized Representative Addendum Number 2 King County RFP 1056- 10 -RLD Page 5of5 MIDD l Ob Statement of Assurance As the authorized representative of [insert name of applicant organization] I assure King County that we have reviewed the Scope of Work and by accepting this award, we agree to comply with all elements of the Scope of Work, in addition to the following: Comply with the MIDD Evaluation Plan and MIDD Data Dictionary, which includes reporting requirements, which will be individualized upon award; Work collaboratively with the municipality on permitting and zoning requirements, in addition to a developing a neighbor relations plan in order to foster good neighbor relationships; Participate in the development of policies and procedures for the CDF, CDIS and /or Crisis Mobile Team in partnership with King County; Participate in monthly meetings with the MIDD 10b strategy oversight group; and, Comply with the terms of the negotiated contract that arises from the award. I understand that compliance with these assurances throughout the period of the project is a term and condition of the award and failure to comply with them may result in sanctions including termination of the award. Signature of Authorized Representative Date REQUEST FOR PROPOSAL Addendum 3 Department of Executive Services Finance and Business Operations Division Procurement and Contract Services Section King County 206- 263 -9400 TTY Relay: 711 DATE ISSUED: May 7, 2010 RFP Title: MIDD Crisis Diversion Services REBID Requesting Dept./ Div.: King County Department of Community Human Services MHCADSD RFP Number: 1056- 10 -RLD Due Date: June 8, 2010 no later than 2:00 P.M. Buyer: Roy L. Dodman, rov.dodmanekinacountv.aov, 206 263 -9293 This addendum is issued to revise the original Request for Proposal, dated March 11, 2010 as follows: 1. The proposal opening date remains as changed in Addendum 2: Thursday, June 8, 2010, no later than 2:00 p.m. exactly. 2. The sign -in sheet from the April 29, 2010 pre proposal conference is available by contacting the buyer noted above. This document may be e- mailed to you as a pdf attachment. 3. In Section II, Part 8 Proposal Review Process, Item A, Proposal Evaluation Criteria, Table Item "Budget Section delete "(3 pages allowed...)" and replace with "(12 pages allowed...) so that it now reads: Budget Section* -12 pages allowed for each -form, justification, start -up annual budgets) 4. In Section II, Part 7 Specific Proposal Requirements, Item H. Budget Section, sub -item 2, delete "including timelines so that it now reads: 2. Provide a detailed budget narrative and justification. including timeline& (continued on page 2) TO BE ELIGIBLE FOR AWARD OF A CONTRACT, THIS ADDENDUM MUST BE SIGNED AND SUBMITTED TO KING COUNTY Sealed proposals will only be received by: King County Procurement Services Section, The Chinook Building, 3` Floor, 401 Fifth Avenue, Seattle, WA 98104 -2333. Office hours: 8:00 a.m. 5 :00 p.m., Monday Friday Company Name Address City State Postal Code Signature Authorized Representative/Title (Please Print) Email Phone Fax This Request for Proposal Addendum will be provided in alternative formats such as Braille, large print, audiocassette or computer disk for individuals with disabilities upon request. Attachment GG 163 164 Addendum Number 3 King County RFP 1056- 10 -RLD Page 2 of 6 5. In Section ll, Part 7 Specific Proposal Requirements, Item E. Overall Program Narrative, sub -item 3, add the following as new letter h.: h. Local municipality (also describe the communication that has occurred as part of the proposal response process). The following additional information is directly provided 1. On April 28, 2010, questions were received from the City of Tukwila in regards to the MIDD Crisis Diversion Services strategy. A copy of the questions and responses is included with this Addendum as Attachment A. 2. On April 16, 2010, King County Council Chair, Bob Ferguson sent a letter of support regarding the Crisis Diversion Services strategy to King County Executive Dow Constantine. A copy of this letter is imbedded in electronic copies of this addendum as Attachment B. It is also available from the Buyer listed on page 1 of this Addendum. The following information is provided in response to questions received: Q1: What is the budget for the Crisis Diversion Facility component? R1: The budget for the Crisis Diversion Facility component is $4,034,791 (which includes approximately $900,000 of estimated Medicaid revenue) for services. An additional $283,046 is available for rent associated with the Crisis Diversion Facility. The King County Crisis Diversion Facility budget was developed based on the Pierce County model and assumes Medicaid revenue. Q2: What is the timeline for an award decision? R2: June 30, 2010. Q3: Throughout the RFP, there is reference to "mental health clinicians," "licensed mental health professionals," etc. Each of these labels implies different credentials for staff. What are the credentials required for each of the FTE's provided by the grant? R3: For the purposes of this RFP, mental health clinician, licensed mental health professional, qualified mental health professional and MHP is defined as a an individual licensed in any of the mental health professions. Q4: Is it acceptable that space be shared between different components of the overall strategy, as in showers, common rooms, etc.? R4: Yes, that is acceptable. Please include an explanation in the proposal. Q5: The rent amount is above the service amount? R5: They are separate in the RFP. King County is more interested in the overall proposal and it is fine to shift expenses to different areas. Q6: Is there flexibility in the suggested square footage of a facility? R6: Yes, this is the size we estimate will be needed based on Pierce County's program. Q7: If an agency is applying for both the Crisis Diversion Facility and the Mobile Crisis Team, should it submit two separate proposals each of which includes Part 7 A E (including either F or G depending on whether it's the CDF or the MCT proposal) and H? Or, should it submit one combined proposal that includes Part 7 A -H? R7: One combined proposal Q8: Please clarify the limit on the number of pages for Section H the sample budget justification (page 22 in the RFP) has a very limited number of positions (many fewer than the Crisis Diversion Facility or the Mobile Crisis Team will require) and is 4 pages long. The RFP seems to state that each form, i.e., the budget form, the budget justification, the start-up budget, and the annual budgets, can only be three Addendum Number 3 King County RFP 1056- 10 -RLD Page 3of6 pages EACH. It will not be possible to complete the narrative for either the CDF or the MCT budget in three pages, given what is requested in the sample. R8: See Item 3 on page 1 of this Addendum. Q9: Also, the RFP asks for a timeline in two places in the budget section (7H) and in 7.E.9. Where should it go? R9: See Item 4 on page 1 of this Addendum. Q10: Which appendix should include the resumes? R10: Appendix C, Evidence and Letters of Support (no page limit) 165 166 Attachment A Addendum Number 3 King County RFP 1056- 10 -RLD Page 4of6 MIDD Strategy 10b Questions, Follow Up for City of Tukwila 4/28/10 1. Will the CDF be able to hold a police diversion against their will if they want to leave? Do the licenses outlined the RFP allow for these types of involuntary holds? There are three processes by which individuals admitted to the CDF may be held against their will if they want to leave. First are cases in which a police officer is involved and has determined that there is probable cause to arrest a person, but chooses to divert the person to the CDF. If the officer has completed a superform, this gives the CDF the legal notification that the person can be sent to jail if he fails to comply with the diversion requirements in a 48 -hour period from the time of admission. The policy that will be in place at the CDF is that whenever the superform is on file at the facility, the police department that completed this paperwork will be contacted if the person asks to leave. A superform will not always be completed for each individual if they have not committed a criminal offense. Second, if the person appears to be presenting an imminent likelihood of serious harm, they may be held for an involuntary commitment evaluation under RSW 71.05 by a designated mental health professional (DMHP). If the person is detained by the DMHP, he or she is then transferred to a certified evaluation and treatment facility for 72 hours. Third, if the person is a danger to self or others or gravely disabled as a result of drug or alcohol dependency, he or she may be held on an administrative drug /alcohol hold for possible commitment under RCW 70.96A. In these cases, the person could be held at the facility, or transferred to a certified alcohol and drug treatment facility, such as Detox. These 'holds' are independent of the licensing of the facility. 2. Follow up on question one, if a police diversion wants to leave the CDF against the wishes of staff, lan memo notes that police will come and get the person and take them to jail; however the RFP says "may Which Police agency will come back, the one that diverted the person or the host city? The police officer has some discretion regarding whether to arrest a person and take him or her to jail, and may tell the CDF that no charges will be filed and the person may be released. For example, police may not want to take someone to jail for shoplifting a sandwich from a convenience store. The police agency that would be contacted is the police agency that diverted the individual. If police do not want the person in custody, the CDF would transport the person back to where they came from, or to an appropriate alternative such as a relative or friend's house or a shelter. Individuals will not be released to the streets surrounding the facility. 3. When we went through many of the background documents it seems like law enforcement who were present at many of the planning meeting were noting that security would needed. Yet, the staffing model in the RFP does not call our security staff. Will security be provided at the CDF? There were early discussions about what level of security would be needed at the CDF. None of the crisis diversion facilities currently operating in the state of Washington have security other than the professional staff of the facility. The facility will not accept individuals who do not agree to go there, and there is a long list of exclusionary criteria involving the current offense and the history of offenses. The clarification of the exclusionary criteria that would be in place met the concerns of law enforcement and prosecutors about whether specialized security needed to be included at the CDF. 4. Can you provide details on the screening of people who will go to the CDF? Ian's memo noted that certain previous violent offenses would preclude admission to the CDF, regardless of the current charge; however the RFP makes no mention of excluding people with past criminal convictions but only appears to reference current offenses. The RFP is not designed to be a document that includes all the policies and procedures that will be in place. These will be developed by the successful bidder in consultation with MHCADSD. However, included in the RFP (attachment B) was the June 25, 2009 memo from lan Goodhew on the legal and eligibility structure for CDF. On page 9 of that document is a statement that violent criminal history would exclude people from admission to the CDF. The specific violent history charges that are exclusionary will be included as part of the contracting process. 5. Regardless of what exclusionary criteria is used, how will non -law enforcement entities (ambulances, ERs, etc) be able to screen criminal convictions? Non- police referents will not be expected to screen for criminal history. However, there is a triage process that will be in place so that police, ambulances, E.R.s and other individuals wanting to bring someone to the CDF will first call the CDF. Addendum Number 3 King County RFP 1056- 10 -RLD Page 5 of 6 The CDF will have access to the criminal justice database, and will be able to identify and decline admission for those individuals who meet the exclusionary criteria. 6. Does someone have to have a property identified in order to successfully respond to the RFP? A proposed site must be included in the RFP response. 7. Regarding the CDF, which Police agency would respond if someone gets out of control and staff is unable to resolve the conflict? Is funding set aside for mitigation funding for the host city? As stated on Section 11, part 3 of the RFP, The CDF will have interview rooms of which at least two will have security features that would allow for containment of consumers who become behaviorally out of control. For any person diverted from jail by police and for whom there is a superform on file, the diverting police agency would be called to take the individual who was out of control to jail. For others, the DMHPs could be called. If there is immediate danger, the CDF would be expected to call 911. The experience at the Pierce County crisis triage facility was that there were approximately 6 cases per year requiring 911 response. There is no funding set aside for the host city. 8. Addendum 1 of new RFP removed the language regarding the desire to have the CDF and CDIS co- located or within close proximity. Yet, the final status report that went to the MIDD in June of 2009 of the strategy. The MIDD Oversight Committee does not have responsibility for writing or noted that the CDIS should be co- located or located close to the CDF. What process was used to modify the criteria that was approved by the MIDD in June of 2009 and was originally included in the RFP? We received feedback from bidders that they interpreted the language in the first RFP as requiring co- location or close proximity, and not just a preference for this on the part of the County. MHCADSD changed the language to read that the CDF shall be "within proximity of the CDIS to allow for easy transfer of individuals between locations of the CDIS and CDF". This change in language clarified the intent approving Requests for Proposal and the clarification is consistent with overall CDF planning. 9. When will the results of the RFP be out? We expect to complete the review process and identify the successful bidder(s) by June 30, 2010. 10. How was the price per square foot determined? We looked at the cost of the Pierce County Crisis Diversion Facility from 2006 and added inflation amounts based on 2 years (the rate was determined in 2009). 11. You have eliminated the requirement to notify the host city and replaced it with an affidavit. This seems to indicate less communication with a host city prior to submission of the bid why was this done? The intent was not to eliminate the requirement, but rather to make it stronger by placing the language to work collaboratively with the municipality on permitting and zoning requirements, in addition to a developing a neighbor relations plan in order to foster good neighbor relationships, into the Statement of Assurance. Bidders are still required to communicate with the proposed host municipality and this will be restated during the pre proposal conference and included in an addendum. 167 168 Addendum Number 3 King County RFP 1056- 10 -RLD Page 6 of 6 Attachment B April 16, 2010 Executive Dow Constantine King County Chinook Building 401 5th Ave., Suite 800 Seattle, WA 98104 Dear Executive Constantine: King County Bob Ferguson Councilmember, District 1 Metropolitan King County Council 1 am writing today regarding your support for an important regional resource, King County's Mental Illness and Drug Dependency (MIDD) Crisis Diversion Facility. The Crisis Diversion Facility seeks to improve the lives of those impacted by mental illness and substance abuse by providing therapeutic alternatives in the community, resulting in reduced admissions to jails, hospital emergency departments and psychiatric hospital inpatient units. The Crisis Diversion Facility is the cornerstone of the County's MIDD Action Plan. It was identified as one of the top priorities by community stakeholders, including the criminal justice and human services communities, during development of the MIDD Action Plan. There has been an enormous amount of planning and outreach conducted for the Crisis Diversion Facility since April 2008: Over 20 separate community stakeholder planning meetings with representation from law enforcement, courts, hospitals, advocates, consumers and treatment providers were held between April 2008 and February 2009. Workgroups of the M1DD Oversight Committee convened to develop recommendations in -the areas of transportation and crisis teams, location and facility design, licensing, target population and discharge. Workgroup members visited other crisis diversion facilities in Whatcom, Skagit, Pierce and. Yakima counties. Two other workgroup members also visited the Bexar County program in San Antonio. The Department of Community and Human Services compiled data and information to develop implementation recommendations. These recommendations were subsequently adopted by the Oversight Committee. The MIDD Oversight Committee, based on requests from south county law enforcement officers to site the facility outside of King County Courthouse, 516 Third Avenue Room 1200, Seattle, WA 98104 206 -296 -1001 bob.ferguson @kingcounty.gov www.kingcounty.gov /ferguson 169 170 downtown Seattle, identified the area south of downtown Seattle and north of Southcenter as the ideal location for the facility. In August 2009, the County released a Request for Proposals (RFP) for the Crisis Diversion Facility with the above siting criteria. The Tukwila City Council subsequently adopted an ordinance establishing a six month moratorium on the receipt and processing of building permit applications, land use applications, and any other permit application for the Crisis Diversion Facility. No awards were made in response to the August RFP, and the County released a revised RFP a few weeks ago. We need to get the Crisis Diversion Facility, and its companion, the Crisis Diversion Interim Services facility, up and running as soon as possible. Without this facility, mentally ill individuals are housed at the jail and boarded in emergency rooms where they do not receive the stabilizing treatment they need prior to being released. This costs taxpayers more money as the individuals cycle through the system. The Seattle City Council recognizes the importance of these facilities. I have attached a letter from Seattle City Councilmembers which expresses their interest in working closely with King County officials to find a suitable location for the facility. I also support these efforts. I know that you support the MIDD, and I hope we can work together with the city of Seattle to get the Crisis Diversion Facility sited, opened, and assisting clients. I ask that the Department of Community and Human Services continue to provide technical assistance to potential applicants. Sincerely, Bo Terguson Chair, King County Count; Encl. letter from Seattle City Council Cc: MIDD Oversight Committee Dan Satterberg, King County Prosecuting Attorney Alan Painter, Human Services, Health and Housing Policy Advisor Kelli Carroll, Staff, King County Council NAME Roy L Dodman 1 Senior Buyer Cathy Betts 2 Buyer 3 1 Uhat whki-vat -Dire e o 5 10 11 12 13 14 15 16 17 3 (04vAs. OAN- Co =d J 0 i /(YV'f\ Sive,q() RFP NO. 1055-09RLD MIDD Crisis Diversion Services Date: March 18, 2010 Time: 1:30 p.m. PRE PROPOSAL CONFERENCE ATTENDANCE ROSTER Please add e-mail address if available Or COMPANY King County Procurement and Contract Services King County Procurement And Contract Services 4rs�K Vt c_ m Wt.E,.- L-Jvm a•J Phoneme.. -q FAX: E -mail: M,tt G[✓t; Phone: zo6_ titee- FAX: �G 'x' �S O6 /6 E -mail: l Phone: �3°W'431-` 6dy FAX: 4 3GG`f t C r f E -mail j /See a; Fhki.i /c Phone: 30). -2 FAX: go-- a 3 l d Sound Mudd kffrl E- mail: 16C.-4 syvk 4-01- ket ?1QJ 1 4Yf '1 1�S E -mail: Svs'an/,, /eO %rKo►'a+ t 1 C, V v-r aa.r1C. Phone0263.% FAX;2e 61803 E- mail:. tic. dodo_ Phone: 003 898 -F ac4' 9c fv --o53 E -mail: Vare Sp4c(inairtKIAI.C.opeli Phone: a63 -Fq172._ FAX: V E -mail: jrr.2,64'; 9" Phone: FAX: E -mail: Phone: FAX: E -mail: leckmiuds, coare Attachment HH PHONE/E -MAIL Ph:206- 263- 9293FAX: 206- 296 -7676 E -Mail: rov.dodman aC ..kingcountv.aov Ph:206- 263 -9291 FAX:206- 296 -7676 E -Mail: cathv.betts aekinacountv.aov Phone: FAX: E -mail •..1/ !.0 Pty., _IiA Phone:(24 F E- mail: loco.. 6; "Aioulvve inn %I/ Phone: /et FAX`'a t -ern E -mail Phone: Jo zLya FAX: Jo E- mail: ..t sib tS.,f'lxhi, of Phone: 01- 62_1 FAX: Lt: t16 E mail:Qavv(r'rn S€se. o tax Phone: 4 (¢61. '4 3•bF bat. an-4 171 NAME Roy L Dodman 1 Senior Buyer Cathy Betts 2 Buyer 3 Q j i 04 Qt,—) 4 Ala 5 Kilt N o mu,� 6 iJ i Co k.e. 4,r4,-,do Ar\c1ru\ 8 &1„o P (244.0 10 41}V k 12 u 4 /Cvtv,h 13 I y 7Lr 14 E koIMas "1 fo 15 16 17 172 iin RFP NO. 1056 -09RLD M /DD Crisis Diversion Services Date: April 29, 2010 Time: 1:30 p.m. PRE PROPOSAL CONFERENCE ATTENDANCE ROSTER #2 Please ad d e-mail address if available COMPANY PHONE/E -MAIL King County Procurement Ph:206- 263- 9293FAX: 206 296 -7676 E -Mail: rov.dodmanOkinocountv.aov and Contract Services King County Procurement And Contract Services I love log 1/ 1 metst Cprvwfwatt -SL �C M l C/4 D. D FG ,A WCAb5p Nctoc75 as iNtotos 0 Ph:206 -263 -9291 FAX:206- 296 -7676 E -Mail: cathv.betts5kinacountv.aov Phone: ,7 b 6 s v c: Q Lt 8 E- mail:' e Xon oL� �Q1 to v 1 1; Phone: 66 FAX• r✓ 4- acl —r(flc� E- mail �iv�r�,,. t.tel Phone:2*(434�� FAX: -mail: KnonmAr 0,900,A —1 Phone: to6stslS14j FAX: E -mail: IN 4 C.(t deSC -ovc Phone: .615 -15 t.4 FAX: E -mail: ta.r.t.ec,.5 Phone: 431— 3671 FAX: E -mail: 6 &I,5& Ci K f Phone: FAX: E -mail: Phone: FAX: E -mail: Phone: 206 Y' FAX ,6 6 S S9 i n E -mail: otgo Phone:21ot3aZ ygAX: 206 302 2i/0 �mail�� Phone: 2 br ?1a3 FAX: $9 E -mail: i FAX: Phone: E -mail: Phone: 533 7a. E-mail: C tv otu •S Pawjk_eu v1.e Phone: FAX: E -mail: Phone: FAX: E -mail: Brandon Miles RE: CDF and Transit From: "Shoenfeld, Amnon" To: "Brandon Miles" Date: 03/30/2010 4:38 PM Subject: RE: CDF and Transit CC: "MacLean, Jackie" Hi, Brandon. Jackie is on vacation, so I'll answer. The RFP requirement is that the CDF be "accessible to a Metro bus route We do not anticipate that very many people will come to the facility by bus or need or use bus transport when they leave the facility, but we wanted to have that as an option. Access to one bus route is sufficient from our perspective. People can always transfer to and from other bus routes. Amnon From: Brandon Miles [mailto:bmiles©ci.tukwila.wa.us] Sent: Tuesday, March 30, 2010 3:15 PM To: Shoenfeld, Amnon; MacLean, Jackie Subject: CDF and Transit Hi Jackie and Amnon- I wanted to follow up on our phone conversation from last week. We are still looking at the location issue and it would be helpful if you could clarify staff's opinion regarding the level of transit needed. Thanks for your help. Brandon Brandon J. Miles Senior Planner Department of Community Development City of Tukwila tel (206) 431 -3684 fax (206) 431 -3665 bmiles @ci.tukwila.wa.us 1 ar 1 Vl 1 Attachment II file: /C:\temp\XPgrpwise\4BB228FEtuk-mail6300-po 100130796C 117ECD 1 \GW} 00001.... 05/11/201 3 174 Supportive Housing 1811 Eastlake Canaday House Evans House Kerner -Scott House Lyon Building The Morrison Rainier House Union Hotel Scattered Site Mental Health Services Crisis Respite HOST Outreach Engagement PACT- Intensive Team SAGE -Case Management Employment Support Chemical Dependency Services Emergency Shelter Connections Something Old, Something New Thrift Store Board of Directors Clark Kimerer, Chair Ron Wright, Vice Chair Laura Inveen, Secretary Merlyn Bell, Treasurer Tom Byers Mark Dales Bryan Friend Jeffrey Grant Mark Sidran Larry Smith Chris Spitters Richard Stevenson Executive Director William G. Hobson opening doors to end homelessness 515 Third Ave Seattle, Washington 98104 206- 464 -1570 fax 206.624A196 www.desc.org April 29, 2010 Via E -Mail and Hand Delivery Tukwila City Council 6200 South Center Boulevard Tukwila, WA 98188 Re: Zoning Proposal for Crisis Diversion and Interim Services Facilities The Downtown Emergency Service Center "DESC wants to thank the Tukwila City Council for directing staff to expand the proposed zoning area for the Crisis Diversion and Interim Services Facilities (the CDF and CDIS). At the hearing on April 12 DESC was heartened to hear Council Members acknowledge the need for these facilities. We assure you, the need for facilities to provide medical treatment, temporary housing and social services for people in crisis and return them to their communities with stronger support systems is profound and immediate. DESC urges the Council to adopt zoning that yields viable locations to meet this vital need. DESC noted Council Members' questions at the hearing concerning the operations of the CDF /CDIS. Attached is a brief fact sheet that we hope will answer those questions and help the Council in its review of the expanded zoning proposal. DESC also noted that public testimony at the hearing was unanimously opposed to the proposed South Center location and unanimously in favor of the existing Riverside Residences location. DESC shares the view that the Riverside location in the MIC /H zone is a far better choice for the CDF and CDIS, than the zone near South Center Mall. DESC has leased units at Riverside for years, and feels it would be an ideal location for the CDF and CDIS. Riverside is unique in having fast and easy access to freeways, without also having a busy commercial or residential character. Riverside is also already configured for temporary housing uses. DESC respectfully requests the Council to expand the zoning proposal to include the Riverside location. DISCUSSION As discussed below, Riverside meets the County's criteria, the City's criteria and the project proponent's (DESC's) criteria for the CDF and CDIS. 1. The County's Criteria. Riverside meets all of King County's locational criteria. Riverside is located just off SR 99, SR 599 and I -5, which connect within minutes to I -405, SR 518 and SR 167. Attachment 3) 175 176 Not only is Riverside located in close proximity to these freeways, but, more importantly, it has fast access to these freeways. Riverside it also located on the 124, 154 and 173 bus routes, which connect to other regional bus routes (although as discussed in our April 12' letter to the Council, DESC will provide van service for the CDIS and will propose similar van service for the CDF). Riverside has more than 7,200 sq. ft. of available square footage, sufficient for co- location of both the CDF and the CDIS. Most importantly, it has fast and easy access for police and emergency vehicles. 2. The City's Criteria. Riverside also meets the City's criteria of compatibility. Riverside is not located near a busy commercial hub or residential uses. In fact, it has few neighboring uses at all. Riverside is located on a section of Tukwila International Boulevard that is cut off from other uses by freeway ramps, access roads and the Duwamish River. Residents of DESC's existing units at Riverside have found the few surrounding uses to be compatible with their temporary housing uses. They have never complained of crime, noise or lack of privacy from industrial or airport uses that might affect other portions of the MIC /H zone. The other City criteria of availability of adjacent amenities is less relevant to the CDF and CDIS, because these are internally- focused facilities. Program participants at the CDF and CDIS will work intensively with staff to stabilize the immediate medical crisis, obtain social services and find housing; therefore, there will be little time for other activities. Also, program participants will have basic services provided within the CDF and CDIS, including meals, medical treatment, social services and housing; therefore, there will be little need or incentive to partake of adjacent amenities. In fact, DESC feels the availability of adjacent amenities might be counter productive to the CDF and CDIS, because they might distract participants from internally- focused clinical programs. 3. Project Proponent's Criteria. Riverside also meets DESC's criteria. Riverside has a functional physical layout, which can be converted to the CDF /CDIS use much more economically than structures DESC has investigated in South Center. Riverside rents are also lower than those in South Center, and Riverside is far more likely to be economically viable over the long- term than sites in the commercial hub near South Center Mall. Most importantly, because Riverside is removed from the Mall, it is a much more private location and, therefore, more conducive to the success of the Crisis Diversion Program. Clinical programs at the CDF /CDIS, will be internally focused on reversing crises, changing behaviors and getting lives back on track. The success of these clinical programs would be best served by a quiet private location that is removed from commercial activities and crowds. Conclusion For all these reasons, DESC urges the City Council to expand the proposed zoning for the CDF /CDIS to include the Riverside Residences location. By including this viable location, the Council can ensure that these essential public facilities get up and running quickly, to fulfill their vital mission of addressing mental health crises and helping participants return to their communities with stronger support systems. Enclosure cc: Brandon Miles, Tukwila Planning Division Nora Gierloff, Tukwila Planning Division Jack Pace, Tukwila Planning Director Steve Lancaster, City Administrator Jim Haggerton, Mayor Shelley Kerslake, City Attorney Cynthia Kennedy, Graham Dunn Claire Molesworth, Graham Dunn Sincerely, Downtown Emergency Service Center C:ilki ,1) 1 Bill Hobson, Executive Director 177 178 Crisis Diversion Facility Fact Sheet (This fact sheet is based on information from the MIDD RFP for CDF and DESC's plan should we be selected as the operator of the CDF) Will the facilities be staffed 24 -7 and by whom? Yes, The CDF will be staffed 24 -7 with the following specialists: Advanced Registered Nurse Practitioners Mental Health Professionals Chemical Dependency Professionals Behavioral Health Specialists Peer Specialists The staff to client ratio will be no higher than 1:5; many shifts being 1:7 Will the facilities provide transportation services? The CDF and CDIS will have van service to transport program participants to appointments, medical offices, and other necessary destinations. CDIS staff will use the van service to coordinate supervised outings to necessary destinations. Will program participants be screened and how? Three key screening practices will used for admittance to the CDF: 1. Police Officers will have the ability and expectation of running a criminal background check on all people being referred to CDF. If violent crimes are found to be in a person's past, the person will be determined ineligible for the program. 2. By MIDD specification, people presenting with current felony charges, a level of violence surpassing CDF management capacity, or presenting primarily for active sexual offender behavior will be ruled out of CDF eligibility. 3. Experienced CDF staff will carefully assess the referred person for likelihood of danger before admitting them to the program. Will the facilities be locked down or will participants be able to leave? The CDF will be locked, but it is not an involuntary treatment program. Participants may leave if they wish, but considerable effort will be made to ensure they complete their stay at CDF. The referring police force will be contacted and requested to intervene when a participant refuses to complete the 72 hour program. CDF staff will have the means and direction to transport participants to an appropriate treatment facility or back to their home community if they insist on leaving. Will agreements be in place for police pick up if participants leave? Prior to opening the CDF, Memoranda of Understanding will be developed with all municipal police forces and the King County Sheriffs Office. Emphasis will be placed on the importance of participants being returned to the referring police force should the participant demand to leave prior to completion of the three day program. In the event a participant leaves prior to police response, and they refuse to accept transportation back to their home community, the police will be alerted and requested to assist. King County Mental Illness and Drug Dependency (MIDD) Oversight Committee (OC) February 25, 2010 11:45 -12:15 networking lunch 12:15 p.m. 2:15 p.m. King County Chinook Building Room 123 Meeting Notes Members: Jim Adams, Rhonda Berry, Bill Block, Linda Brown, Nancy Dow- Witllerbee, Jaime Garcia=V. David Hocraffer, Zandrea Hardison, Shirley Havenga, Mike Heinisch, Darcy Jaffe, Norman Johnson:, Bruce Knutson, Judge Barbara Linde, Leesa Manion, designee for Dan Satterberg, AlexO'Rei11y designee for Councilmember John Chelminiak, Sheriff Susan R'ahr, Mary Taylor, designee -for Barbara Miner, Dorothy Teeter, designee for David Fleming, Dwight Thom Other Attendees: Sherry Axson, Bryan Baird, Cathy Clemens, Lisa Kimmerly, AndreaLaFazia Lapp, Brandon Miles, Alan Painter, Alessandra Pollock; ":Aaron Rubardt, Amnon'Shoenfeld, Cindy Spanton, Laurie Sylla MIDD Oversight Committee Meeting, February 25, 2010 Attachment KK 1. Welcome and Introduction hairZavenga: Co -Chair Havenga called the meeting to border, welcoming the committee and introductions were made by each person in attendance.' 2. Approval ofthe Meeth g.Notes frorii-'the January 28, 2010 Meeting, Co -Chair Havenga-- Minutes were: approved by consensus. 3. MID-- D,Project Staff Report; A Brea LaFazia— a: Statement of Financial Other "Interests Form Andrea reminded tle'`OC'to complete and return this form. Cathy Clemens, Executive Director of the Board of Ethics will provide an overview later in the meeting. b. MIDD 2009 Annual Report Andrea introduced LisaXimmerly, MIDD Program Evaluator, who provided a page by page synopsis of the new Annual Repo;tformat. She detailed numbers previously reported in quarterly reports, data pertaining to •performance` measures, success stories, strategy -by- strategy updates, graphs charting individuals touched by the MIDD, financial data, key considerations and recommendations. Final draft of the Annual Report is due to Council April 1, 2010 and will be available online soon. Members echoed comments of high accolades for the presentation and layout of the report: stating that it is attractive, easy to read, and conveys accomplishments. They are eager to share the information by sending copies to Senator Hargrove, having a press release and sharing with NIMH. Members made many revision suggestions for: more clarification on target success ratings, finding out how strategies relate to the five goals of the MIDD, data that measures results before and after MIDD, and including footnotes for unallocated funds. Judge Linde noted necessary language revisions are Page 1 of 4 179 180 needed regarding Mental Health Court (MHC) Strategy 11 b: Increase Services for new or Existing Mental Health Court Programs and that she will provide these revisions to Lisa. Members were concerned about targets being changed and suggested that aspirations not be revised by lowering targets. The evaluation team only revised the targets where original estimates were incongruous with data collected. As far as performance related revisions, due to many who exceeded expectations, tried to shy away from target revisions at this point (too soon). A footnote will be included to state original targets were estimated not knowing what the actuals would be. The OC thanked Lisa for her hard work and to extend praise to her daughter for taking the great photographs for her school project. The OC voted to approve the MIDD Annual Report as revised. 4. Co- Chairs Report, Co -Chair Rahr— Co-Chair Rahr gave a quick update regarding the Crisis Diversion Facility. strategy. The new RFP is expected to be released around March 11, 2010. Local cities will be notified; as soon as the final date is known. The definition of the location has been broadened to say "a centralized; location with access to freeways" to improve the chances of finding an appropriate „location that works=for.everyone. Co -Chair Havenga announced that both chairs' 2 year t rms.`'are_:epiring in June. Tl e :criteria for Co- chair positions are one King County and one non -King County employee. All OC members were invited to express interest and to contact both Co -c pc, An drea LaFazia. 5. Overview of MIDD Strategy Reductions, Amnon Shoenfeld Amnon gave an overview on how strategy reductions were taken for those strategies cut for 2010. An adopted budget draft was presented to the OC that-listed: ongoing funding per Adopted Action Plan amounts; 2010 Adopted amp.** that 4.nclude technical adjustments to central rates; percentage changes from the Adopted "Plan; itrizi the p Pp iach and impact of each strategy. Members discussed a ne clearer'` language in the reduction approach and impact column. Some programs have been cut' tow 0 due to project delays in those strategies. Another clarification made to this document %is:,when it' states "program's of yet started, so no impact on services or providers,” it was recommended "or providers" be taken off since this is not about providers. Amnon. stated this information was•.p'rovided per OC request and would be revised and presented again. Amnon also presented a brief overview of the programs that received supplantation funds and the process that (OMB).and MHCADSD is using to monitor. $13 million the COili l in their November 2009 budget are MIDD sales tax funds that will fund mental health, siibatanee abuse and therapeutic court programs that were previously funded by the county General Fund. Th ie are no state funds being supplanted. For the break -down of this overview, click here: htto: /www.kingcounty. aov/healthservices/ MHSA/ MIDDPIan/ MIDDCommittees /OCMeetingMaterial s.asnx. David H: For a number of court related services, those amounts were pulled out and put in a different budget line item. A lot of public defense services accounting for another $1.4 million on top of this amount, wasn't part of this $13 million. Amnon: Those public defense costs are part of various strategies. Barbara Linde: So they are within the $13 million. They just aren't broken out as a lump public defense cost and are spread out over Drug Court, MHC? MIDD Oversight Committee Meeting, February 25, 2010 Page 2 of 4 Aaron Rubardt, OMB: They are in here. Those you're referring to are for MHC, Drug Diversion, Juvenile Drug Court, multiple agencies, are part of this $13 million. Zandrea Hardison: For jail psychiatric services, you were saying there are some services that are beyond this amount. Do you know the total amount? What percentage of this is covered? Amnon: I don't have that. Medications are a pretty significant cost. We did not pay for medications. Co -Chair Rahr has been working for 3 years at the federal level to get that Medicaid policy changed and is now in Jim McDermott's office. With the finish line in sight, the way this will be possible will be to have 10 pilot sites around the country with King County being a pilot site. There isn't very good data about how many people in jail are Medicaid eligible, how many lost their coverage. The Sheriff asked for stories from the OC of individuals who were on Medicaid, getting their meds, went to jail, then cut off from Medicaid, they have trouble getting back on Medicaid, etc. Co -Chair Havenga: Asked Andrea to send an email to the OC. 6. Ethics Overview, Cathy Clemens, Executive Director, Board of Efhtcs Ms. Clemens provided an overview of Ethics in relation to serving on Boards. More information can be obtained by calling 206 296 -1586. MIDD Oversight Committee Meeting, February 25, 20/0 7. MIDD OC Member Check In Nancy Dow Witherbee, Mental Health Advisory Board Chair`and= :QCmember: The MH Board is seriously understaffed. The Board is slated`to have a maximum of 17 m embers, but currently has eight. King County employees cannot, pa ticipate on the Board but no specif e "mental health experience is necessary. Membership applications are online: To learn more about how to become a member, contact Nancy Dow Witherbee at nldW@u.washingi6n.edu or 206 744 -9691 or Rhoda Naguit at rhoda.na2uit@kinacountv.gov or 206 263 8965= :or visit: httn: /www.kinQcounty. nov/ liealthservices /MentalHealth/Board bx Bruce Knutson: The, county policy:;for supplantafian it's ok to supplement for lost county revenue and that's what all this represents. Now we're facing significant state reductions for mental health, chemical and deputy court services. It's worth reviewing that policy. Barbara Linde Should the: allocate:money from MIDD to fill some gap now left by the state, that is not a supplanting issue, it's'a `how big is pot' question and `what will be reduced to spend money .elsewhere That is a policy: question the Executive's Office, OMB and the Council needs to addres" Norman Johnson Wh at is the definition of supplanting? Barbara LindeT paraphrase, the Council passed their ordinance that allowed the MIDD tax in October 2007. Tbe:RCW state law declares the new tax cannot be used to pay for services that were provided at the level lYhen the Council enacted the tax. Whatever the County was paying for in October 2007, withotit<<the: ability to supplant, would only be able to spend new programs, new staff, and add on to what existed'then. Of course, because of the cuts, everything went down after that. The question of spending new money when funds were reduced required change, which Hargrove supported that change to allow supplantation. The limits are beginning in 2010, supplantation allowed up to 50 decreasing 10% a year until it's gone over a five year period. The County didn't use the full 50% supplanting ability, but instead used 30% that legally identified this $13 million as appropriate supplanting work. The 30% supplanting plan gives us stability over a 3 year period before having to reduce supplanting down 10% in the year 2013 and finally in 2014. Amnon Shoenfeld: The question is whether state funded programs will be considered for supplantation. Co -Chair Rahr: You have to look at the RCW. You have to look at specific law and they do usually identify federal, state and local funding. Page 3 of 4 181 182 Amnon Shoenfeld: When they amended the laws to allow supplantation, they also specified that it could replace lost federal funding. They didn't say lost state funding. Barbara Linde: Provided an update to MHC Strategy 11b, which was delayed until it received funding that starts this year. She stated that communication will go out in a variety of ways to all cities that MHC is open to them. Training will be available for city prosecutors and city public defenders on March 25th and 26th. Notices will go out to cities sometime next week and bring the MHC team on the road with the MHC judge, probation officers, court monitor (SMH professional) Public Defender and Prosecutor will go and present and hopefully inform city lawyers and professionals how to identify an appropriate case to refer to MI-IC and how to do it. i.e., if a person who's sitting in a Kent jail with a mental illness one day can the next week be in a King County MHC, in a King County jail and being released with services. The cities costs will go away and becomes a county responsibility funded by the MIDD from that point forward. So we're excited to get that training out The long -term goal, by July, we hope to be hearing once a week MHC calendars at the kegional Justice Center (RJC) in Kent and at the District Court and Courthouse in Issaquah. We have three courthouses on the Eastside we had to find that has space for probation officers, prosecutor and public defender to land and Issaquah has a little capacity where others don't. The RJC we feel pretty good about because there .are some individuals with mental illness who are in custody, who are.not housed in the downtown jail facility. Individuals are classified on how they are managed, so if they on medication and:. manageable, they will be in the general population. There are individuals in the Kent jail. who will be `much better served by having a MHC presence at the RJC. We have formed a MHC Executive Committee, chaired by:Judge" Harper: Members are holding the second committee meeting today. Other members include Mark Larson, Prosecutor's Office, V. David Hocraffer, Office of the Public Defender and Don Madsen, AGA Director (Public Defense firm that holds the MHC contract). We,will be working with stakeholders and individuals to set policy and direction for the MHC. Norman Johnson: Commended Sh ff a r andtiDan S atterberg for their "commercial" (prescription drug safe disposal public service announcement) an l at it comes across quite nicely. 8. New Business No comments: 9. Public Comment No comments. Co -Chair Haveiga: Thanked everyone for coming. ADJOURN 1:46p.m. Next Meeting March 25, 2010 King County Chinook Building 401 5th Avenue, Seattle, WA 98104 11:45 a.m. -12:15 p.m. Networking Lunch 12:15 p.m.— 2:15 p.m. Meeting Room 123 M1DD Oversight Committee Meeting, February 25, 2010 Page 4 of 4 Verbatim from April 12, 2010 Public Hearing, Speaker No. 1 Start 7:47:06 Graydon Andrus, Clinical programs director at DESC, it is a multi service agency focused on service homeless adults, and providing a range of services to meet all of their various needs to stabilize. I'm going to keep my comments focused to a couple of points about the siting and the narrow range of it and why it should be expanded. And um, First, I want to talk briefly about the purpose and operations of the Crisis Diversion Facility and the Crisis Diversion Interim Services as it relates to the siting. At the Planning Commission meeting some concerns have been represented and it's siting trying to have it really close to the transportation center so people get around easily and, also having it in a more vibrant community so,giimpfe could feel more integrated with a community instead of being tucked av ;or=isolated in some quiet neighborhood or a facility. But in fact, you know, one-of he prime-a4joals when a person comes to the CDF and then onto the CD1_riich has been arded to DESC, the second part has been awarded, 1 think Bran on may have misspoicesabout that. Um, we have not contracted officially with k►e .:ounty, but we have been selected as the provider for that part of the 3 -part service. any rate; we would be very focused on working with people in the facility to quickly underst what is going on in their lives and what we can do about that to positively affect them;, -affect their lives when they leave. So, we are not going to be tryir Miaftegrate pecTfa into any community in which the facility exists. In fact, that, that wail probe courifer- productive to our purposes, so we are going/€. e staying- what is going on now with people stabling, and asW. rucn -aswe can 'aid :getting theFFconnected them to as many resources as they„ar eligible focand they wilt accept. That takes time, the 3 days at the CDF will be qu ret1.y eaten up.:people are i=tgoing to be inclined to roam around in a community. And, in terms ofitranepetatian., to ad from and in between during the time people ar_e ft e facility-we ould have a -strong focus on getting people to appoints they ne to go to4We wd t ave transportation available, we have vehicles, and we wouldgave people in d er ro1 Wthat would facilitate and in terms of when their stay is done a #tae CDF, or theIS we=t uld be highly motivated to be returning people to their community. WhatevT. their community was from once they came, if that should happen beto W e 3 day stay or the 14 day stay at the, the CDIS program, then we would be workti bard,Aeimake sure again, that they get a ride back to their community. We arert tjinterested in letting people just roam out into any community and try to make ends tiaeet. And I doubt that many of those, many of the participants in the program would be very motivated to that. That makes for a pretty difficult life, trying to get along in a community that you don't know, you don't understand how to get your needs met. So, 1 think there would be a lot of work -to -work against that fear, that potential. Let's see, I lost my thought, I am sorry. We actually did have one site, ugh already Tined up, more or Tess, we did not have a firm contract or anything, but we had a letter of intent and it was at the Riverside Residences. And you will hear from, hear Attachment LL 183 184 Verbatim from April 12, 2010 Public Hearing, Speaker No. 1 from, the owner of that building, Mr. Summers. It was near enough major transportation routes and it had the physical plant to meet the needs of the CDIS and it was remote enough that there wouldn't be distractions, such as Southcenter for clients to be possibly interested in checking out. Keeping it, really close to Southcenter mall, is not essential at all for this program to succeed. In fact, it might work against its cause. So expanding that zone well beyond the half mile would actually enable us to succeed in multiple ways, and I strongly encourage you to think about that, and change the language that is limiting it so much. Thank you. Councilmember Ekberg: can I ask a question. Council President Robertson, certainly, Councilmember4E1Merg. Councilmember Ekberg: thank you for coming this ing;1 you clarify, I was not completely sure what, um, you mentioned DESC w,aL fo�hat were you selected for? Mr. Andrus: We were selected to operate thjasis Diversion Interim�tvices part, that's the program described as 14 day, up ioza.14 -day stash; That's the gaTzet of the Crisis Diversion facility that our homeless and r: neetome ongoing assistance to stabilize. Councilmember Ekberg: Okay, atWallou were s irdsted on that without knowing a physical location at this point. Mr. Andrus: We had made a proposa ,f thelocation at t!a:time, and Councilmember Ekberg d. that wasIkate"` 'rOk rside Residences? Mr. Andrus: and it w.a „t "7 side Re aces, yah. Councilmember EJ aerg: Woul J m, DE ever be involved with the mobile crisis team. Mr. Andrus: If, if we r rm tgappisselecl at running a Crisis Diversion Facility we would dtsc e=.applyir� I rfhe otheF h mobile crisis team, the two works well togethe I fi k. TT=t pray theme,. FP is written it implies that they would be having some pretiplegrated fundti traripl rtation being one of them. Counainember Hern ez: Respective Question Please Councifl ident Robes on: Yes, Councilmember Hernandez CouncilmeE:er HernanL: Yes, and in that 3 day period and the crisis diversion clinic would theta ents be- ble to freely leave if they did not like it there, would they be free to leave at a Mr. Andrus: 1, as I understand it, we would not be legally allowed to, um, to prevent them from leaving the facility, it would be a locked facility, there would be a lock on the door and we would control who is coming and going. And um, we have lots, lots of experience in the agency; at DESC, at engaging people in finding reason for them to participate in services they don't otherwise think that might be useful. And that's, that's where we would be putting our energy, is talking to people before they just, impulsively just walk out the door to what, they have nothing to walk out to usually if they are Verbatim from April 12, 2010 Public Hearing, Speaker No. 1 homeless. Um, But, in the end, it is my understanding, we could not literally restrain them, or keep them incarcerated, um, we may be able to delay that process, by, you know, talking to them, persuading them, working with them. But, if somebody were insisting on leaving, and they were brought in by municipal police, or King County Sherriff, quite likely, any, um, agreement we would with the various police forces would include notifying them that someone is choosing to leave, prior to the 3 days. And, we would be expecting them to come intervene, and perhaps do what they would have done in the first place and possible take them to jail. So, this is..aTJeveraged plan, clearly, you know, people are being diverted, and, and the deaJafiey get is they are not going to jail over a relatively minor crime, they are going toll opportunity to get some assistance, and, and if they reject the assistance,- ges;ey run the risk of being taken to jail then. So there is some weight there behind it. Councilmember Hernandez: Thank you Council President Robertson: Councilmembuffie Councilmember Duffie: okay now, am Ito understand tha1this facility wifffaave a 24- hour staff. Mr. Andrus: It will be heavily staffed, actually. Thexe could be, there would be, the Crisis Diversion Facility would, is maraaated in fact t 1:4 ratio, one staff for every four clients. And, and the proposal mat we ie been VV-Ming up would have even more that, that, and it would have a range of s"t J.t..woulaT ave advanced registered nurse practitioners that a e apable of dfng p striptro for psychiatric, mental illness, chemical dependency rraressionals, MeritaH alth Professionals and Peer counselors to, to help with the.,.f tinge of ter needs a d goals. Council PresideffeRobertsonre there ara,.,y:�ther Council questions. Councilmember i�egj DrtatLy, urn does DESC currently manage such a facility. Mr. A nus: ProlYably um wa ,.close to anything, we manage a program called Crisis Respite Program whit- -s also roduct of King County's funding and, and ideas, and it's thclosest thing to thJ think_ Ve get referrals from hospitals, emergency rooms, Western !f -ate Hospital, P74,v7chiatric In- patient units, like Navous (bad audio), it used to be called Hi Kline/ Seattl ental Health. And, um, we work to stabilize people that are coming out of p and we seek, and we divert people from using the emergency rd T m re or mental health courts, and. We are pretty experienced in this, this strategy in stabilizing and get connected with resources that will stop the revolving door, that's the key here. Before that, we have been running a 24 -hour emergency shelter since 1979. Along the way, we have discovered, this is the way to operate. You need to figure out people's needs and get them connected and not just slap a band aid on and let them go away and have them come back again. So we get the idea and we have been doing it in various ways for quite a long time. 185 186 Verbatim from April 12, 2010 Public Hearing, Speaker No. 1 Council President Robertson: Sir, I have a question. am a little confused, as to ways that clients can be brought in to the, either facility. Could you list the different ways they could be brought there. Mr. Andrus: Sure, the CDF would primarily be ugh, there for first responders. That would be all the municipal police forces in King County, and the King County Sheriff office. If they encounter a person in the community that is committing a disturbance or has committed a minor enough crime, and they have determined that they want to take this opportunity, and they have an apparent behavioral health isle in play, they have the opportunity to bring them there, to the facility drop them of ,.-xplain the circumstances and let the CDF take over from there. Medjie can also do it, if they, if Medic One were to determine that a, a person's healtitietindt11 is not sufficient that they need to take them to an emergency room, they p d take WI:8,to a crisis diversion facility. Those are the two main referriurces for the urtsit..Diversion Facility, but Crisis and Commitment Services4 ese are the folks that ateBdesignated as mental health professionals who can involu 1y detain pettple, could theoretically bring someone to the facility as well when they-are~ not ii to get detained for Psychiatric, Psychiatric involuntary hold. The Crisi ersion Services part, would operate as a back door for a subs -hsse people coning from the Crisis Diversion Facility, and quite likely all of that traporta-tiora would ccurring by the Crisis Diversion Facility Staff or the Mobile 0ri is tearnlae Mob k risis Team has a variety of functions and they hav �fihicle ant ►�.ould e usedEheavily, to make sure, if, if the two programs were not -r perar%lin the s 4113 wilding, tfif transportation would be reliable. We need. rake sure ople get-Wpm point A to point B that's the greatest breakdown in eves Thing, is just4Le initial cdii ection. Council President R ..+e.rt g—iEarefailize founding to specific, or almost nitpickinc,�� 'aid prim referrals-wwQuid be from first responders. Mr. Andrus: Yeo CouffarPresident �ertsonm: rimarily does not mean solely, what are the other sources Mr. Andre What I thinlWmeant to say is that, we assume that primarily it will be police forces t will be nj ing most of the referrals, and Medic One, I don't think ambulances w linot aking that kind of decisions, they are just transportation. Medic One can b ?iiZ.eople there and Crisis and Commitment Services, I am not aware of, right now I canno pink of other first responders. It is really targeting, it is creating a service, a resource for police force and Medic One to divert people. Council President Robertson: I kind of, when this first came before the City it was indicated that, that parents, friends, the, could also be referrals sources and bring them in, bring the clients in, and the clients could also voluntarily show up. Mr. Andrus: You right, you are right, I had forgotten about that element. People could walk to the door theoretically, it seem pretty unlikely, depending on where it is of course, Verbatim from April 12, 2010 Public Hearing, Speaker No. 1 there was that option that somebody could show up in crisis and ask to be let in, and most likely would be. Council President Robertson: Could you also, Thank you, could you also explain, there appears to be confusion on our part, is to whether or not the closed door, or the issue whether the issue if someone could leave or not. Mr. Andrus: I think ultimately, if someone said let me out of here and we were unable to persuade them, and the police could not get them in time, or whoever brought them there, Council President Robertson: If it was a Bellevue Police °Steer brought them there, and Mr. Andrus: if they don't get there in time, yah, the worsf cas ,eenario they would walk out the door and we would be offering to take tam home. S 6 4f they refuse to let them take them home, wherever their home community is, they wo`ut;be on their own and they would need to find their own way hon Council President Robertson: is there annd of writte ,.agreement expected or planned with the different first responders, who`fsi r dri s.:tnem off, that they will come back and pick them up, that they have to or a priori Mr. Andrus: There is no agreemer KEplace yet, tha lam aware of, but it is clearly implied in the plan and but it would f a kep art of the start -up activities and establish firm memorandums of understanding with the varaous grourssEo establish who will do what when and it would inc J8de those types ot, m'e t Council President Ro iertson: hank yo =v-ery much. Councilmember Ekberg: Two More quick i estions for you, and thank you for running the Downtown Emergency Servtee`Center. Flaere, the CDIS has been described as a 20 -bed facility. Is there =a maa: number rou 0 for some reason? Mr. Andrus EW &iave pr .gsed it be 3Th actually, to try to squeeze more out of it. That w t e propasaLthatwas accepted. 20 was the required number. Cour;Eirmember Ekberg Therraim, the final question, for a CDIS anywhere in the Natio i Io you know of °nether one=we could, you know, get some understanding. Mr. Andrus= Do I know orograms like the CDIS? Councilmember Ekberg 'S Mr. Andrus: 1ArelLthereaTe various forms of Crisis Diversion units and they all operate in a slightly differoa w conceptually there are numerous programs around, like Pierce County, you know, is in the midst of operating one. Yah, there are various forms of crisis triage centers like this. The whole idea is essential the same you don't need to put someone in a $900 a day a bed in an emergency room or put them in a several hundred a day jail bed, to solve all problems that there are some solutions that could be found that are more constructive and cost less money. Crisis Triage centers, Crisis Triage Units, there are different terms that people use for them, but yes, they certainly do exist. And so there are so models to follow, and King County would be adopting a 187 188 Verbatim from April 12, 2010 Public Hearing, Speaker No. 1 number of the practices, I think that are going on in various places, San Antonio is a good example, I think they have one there, um, but it would, it would also have its own unique shape to it of course. It's probably actually a more comprehensive model that it is in; it has the three components that are well defined. Councilmember Quinn: I have one clarifying question, um, would a facility like this, in just kind of thinking about it similar facilities, I am sure currently there is operations similar to this at Harborview, right. I mean, they admit patients whether it mental or alcohol abuse, you would be diverting some of that population tentially to wherever, you know wherever you have this operation, right. I am just er :us. Mr. Andrus: Yes, absolutely, yes part of the goal is to diEven before they show -up at the emergency room in many cases. We currently wag Mrsion in the Crisis Respite program, at our main shelter downtown, built". at* is afters have been in the emergency room and a lot of the expenses have411Zedy been incurrbut they in some cases they avoid the unnecessary expe B of becoming an inpatiellt. which is, yah, which becomes even more expensive. t. this is gettilici a step aheagaf that. But yes, many of these folks would end up at Harbn iew asatemergency rooms throughout King County; we currently get referral'ror any emergency rooms in King County for the Crisis Respite Program° Councilmember Quinn: Just the re Tor V,asked thi uestion, I used to work at Harborview and I remember this proc Ones# procbz2zes, was that nobody could leave until the office return returoeIttto HarborW, anad`lne► tl ev dispensed, kind of where were they were going:ts go. Mr. Andrus: Do y :i can thatMbey werVArought there by the police and they had charges pending Councilmember Qu'iu:,.PatitrltyAsean, 1=iould assume with the way you describe this program Fm a.,� Mr. Andarys: I dor�i -1 now`rE,it would be so formal as to guarantee that a person couli(eave as the wI und"e tand it at Harborview, many people do leave that have been Ufflught in by the MO be they don't formally press charges. They make the decisTealhat the behaTAral health crisis is the issue of most concern, and rather than incarcerate them, talhem to the emergency room, and not all, but sometimes, they do come arallakeitram to jail after they are done there. Ugh, but certainly not in all cases, but I thin 'taer, you know, there are some limits to the types of crimes that a person could commff nd be diverted to this program. It's definitely crimes more minor in nature. Councilmember Duffie: Yes, sitting here listening and it is so nice to sit here and listen to these kinds of things. What is the most danger(ous) person that could be admitted to this, to this king of facility? Mr. Andrus: You mean in terms of what they may have done? Before? Verbatim from April 12, 2010 Public Hearing, Speaker No. 1 Councilmember Duffle: Will there be anyone to check the records of the people before you admit these people to the facility or just anyone can, if you are having trouble. Say the police come up and they pick -up a guy down at the bar and they decide that they would bring them here. Who says what the guy's background records is. Mr. Andrus: I am confident that the police will have the ability to check that critically and would and we will be doing our own, if we are operating the Crisis Diversion Facility we would be doing our own screening of sorts to trim any, if their behavior is to out of contract for the facility. As for checking the background, the polirda have the greatest ability to do that, and, and um, if they weren't do it, we wouldµbesking them to do it. But, I highly doubt they would dump someone on us withositatleast looking in to the background. Councilmember Duffle: Okay, now, the question were; they couldr; he, they can, the people could also walk in right? Mr. Andrus: Yes, Councilmember Duffle: So if I walk in, you check] Mr. Andrus: We do this all the time at our eme ncy4h€lter and we do assume a certain amount of risk not knowing everybody's histo y -.vde can't possible know everybody's history. So we start of Asking a basie;series of questions and get to know them as fast as we can and we- asses heir behavior-,and how they are doing in relationship to us and if things get tesf .r out o#rtrol the=n =we start to think about alternatives. But we have; een doing thig:.kinc "thirikE-ft r:.many years; we are pretty good for sizing peoplazugaridlIdUring out en to go to p'I"an B. Plan B wouldn't be to continuing to try tptsuade theto work with us all the time. But, um, you can't always, possible know people's3story all thfime. So you know if the police are bringing them in, we ar countir-o t .;.for pfiIling up the official record and telling us honestly wb e.:;are dea in„gwith there, ancHf they walk in, then we are doing what we have been-doing fior. a .long-time. We are assessing and asking, and checking their behavior, and seeing they w nt to do with us, what they want to achieve. End at 8i ffi D9 189 190 Mental Illness and Drug Dependency (MIDD) MIDD Strategy 10b Crisis Diversion Facility (CDF) Planning Group April 20, 2009 9 a.m. to 12 noon Chinook Building, Room 121 Meeting Notes Participants: Barry Antos (Pioneer Human Services), John Bruels (Crisis and Commitment, King County Mental Health, Chemical Abuse and Dependency, MHCADSD), Kelli Carroll (King County Council), Art Chapman (King County, Mental Health Court), Nancy Cole (NAMI Greater Seattle), Lis Eddy (Seattle Police Department), Elisa Elliott (King County Sheriffs Office), Michael Finkle (Seattle Prosecutor's Office), Diana Fitschen (MHCADSD), Dan Floyd (MHCADSD), Ian Goodhew (King County Prosecuting Attorney's Office), Roycee Hasuko (King County Executive's Office), Darcy Jaffe (Harborview), Lisa Kimmerly (MIDD Evaluator, MHCADSD), Pat Knox (Recovery Centers of King County), Andrea LaFazia (MHCADSD), Dave Murphy (MHCADSD), Eleanor Owen (NAMI), Dan Peterson (DSHS), Jerry Scott (Navos), Mary Shoenfelder (DOC -SNN), Amnon Shoenfeld (MHCADSD), Michael Swenson (Evergreen Emergency Department), JoEllen Watson (Crisis and Commitment, MHCADSD). L Welcome and Introductions Participants introduced themselves and Amnon Shoenfeld outlined the handouts and objectives for the meeting. A copy of a draft of the notes for the 2/10/09 meeting was provided for participants to review at another time. II. Proposed Legal and Eligibility Structure for the CDF for Jail Bound Persons Deputy King County Prosecutor Ian Goodhew presented a 10 -page draft memo supplied to the group. This memo addresses not so much the physical structure of the CDF but the legal means by which people will be brought to the CDF. Ian emphasized the importance of gaining the trust of police officers who will often be the first responders to situations where diversion to the CDF will be an option. Police officers will want to be sure that the people they bring for diversion to the CDF are not back on the streets two, three, or four hours later in the same crisis situation the police were initially called about. He solicited email comments and feedback, especially from those who have worked on the subcommittee, which can be sent to him, Amnon, or Andrea. The document outlines the background and goals for the CDF as well as the legal basis for police to bring people to the facility. With the current budget cuts, many drug possession charges are being dealt with as misdemeanors and therefore may be appropriate for diversion to the CDF (see the memo, page nine for a list of CDF eligible charges). A hypothetical case describing a police officer's decision making process at the scene of a possible crime is included in the memo, page four. Attachment MM King County Crisis Diversion Facility, M1DD Strategy lob Planning Meeting 4/21/2009 Page 1 of 7 191 192 Attachment A is a copy of the "Superform" used by police to document contact with people, which could also be used to document the referral of a person to the CDF rather than booking that person into jail. Attachment B is a "rough -cut" draft of an "Agreement to Divert to Crisis Diversion Facility for Evaluation and Services," which would be filled out by the person being referred to the CDF as an alternative to being booked into jail, and signed by that person and by the officer. An officer may leave such a form with the CDF staff as 48 -hour legal leverage needed to help people comply with evaluation and treatment. Attachment C is a flow chart that maps out pathways to the CDF for people in crisis who have committed criminal offenses and people in crisis who have not. Darcy Jaffe indicated that often people will cooperate only as long as they know they have to. She raised the question of what to do at the end of the 48 hours. Discussion clarified that the stay at the CDF is hoped to be only 12 -24 hours; by the end of 12 or 24 or 48 hours, clients are expected to leave. If the client is disruptive and is not engaging with services being offered at the CDF and with referrals to services outside the CDF, it will be apparent well before the 48 hours are up, in which case jail would be considered again as an option. (It will also be important for CDF staff to determine what underlies a crisis that persists at the CDF; if the cause is mental illness, then it will have to be dealt with as such, but if the cause is something else, a different tack would have to be taken.) The stipulated time frame of 48 hours assures police officers that an offender they bring to the CDF won't just immediately be released. Follow -up services that are needed and agreed to by the client will vary from person to person. JoEllen Watson, Mike Finkle, and Lis Eddy emphasized how important communication will be. Police officers can call the CDF to discuss a client they are considering referring to the CDF, CDF professionals can place follow -up calls or send emails to police officers who bring in clients, and the CDF can also inform Designated Mental Health Professionals (DMHPs on staff at Crisis and Commitment Services) when clients are released from the CDF. Police officers are often frustrated that they rarely hear what happens to their cases, and calls or emails that let them know what progress their clients make at the CDF, or don't make, would increase the morale of the officers and the success of the CDF. Legible writing and legible serial numbers will be essential for this communication. Eleanor Owen emphasized that too often choices and options are laid out for people in crisis when in many cases people are too impaired to make good choices. She said the system needs to be prepared in these cases to step in and help people to make safe and healthy decisions. Lis Eddy voiced her understanding that violent offenders would be booked into jail and people who are delirious and/or psychotic who are behaviorally out of control will need to go to an Emergency Department. Darcy Jaffe reiterated that "crisis" was not the same as "emergency," and that the CDF would not be the right option in all cases. Pat Knox added that in the case of chemical dependency (CD) crises, the police officer or other first responder would have to determine when to take the person to detox and when to the CDF. Amnon Shoenfeld referred to the system used in Bexar County, Texas, where King County Crisis Diversion Facility, M1DD Strategy 10b Planning Meeting 4/21/2009 Page 2 of 7 police officers refer to laminated cards they carry around with them that profile situations and lay out the pathways to different resources. III. CDF Budget Budget projections for the combined CDF, Crisis Teams and the Crisis Diversion Interim Service (respite) programs have had to be adjusted for inflation for opening in 2010. Comparing these figures with the revenue expected from both MIDD funds and Medicaid reimbursement leaves a budget gap of over $800,000. The budget for the CDF was based on based on the budget supplied by the crisis triage program in Pierce County. Given some additions made to the CDF staffing that were not included in the Pierce County model (such as more RNs and peer staff), an upward adjustment in the proposed budget will be needed, pushing the budget gap for strategy 10b to over $1.1 million. Some revision of proposed services will be needed to close this gap, and the discussion that followed focused on where savings could be made. Eleanor Owen noted that the state legislature is debating a statewide .3% increase in sales tax for healthcare, and she urged everyone to call their legislators in support of this sales tax. But it was clarified that this revenue would not be available for crisis diversion and that our planning ought to proceed only with the revenue we know we have now. Jerry Scott indicated that the reimbursement he gets for inpatient services at Navos is much less than the projections in the CDF budget: in the proposed CDF budget, given a 16 -bed capacity, the cost per bed per day is $710, compared to less than $600 per bed per day at Navos. Darcy Jaffe responded that looking at reimbursement rates and the cost of supplying services isn't really an accurate comparison, and that the actual current cost for an inpatient client is something like $1000 per day Staffing at the CDF was discussed. The plan is to pay the provider selected to hire staff at least one month before doors are opened so that training and problem solving can be accomplished before the CDF, mobile teams, and interim respite care begin operation. The staffing plan for the CDF includes a director, an office support position, 9 FTE MHPs (2 per shift), 4.5 FTE CDPs, 4.5 FTE RNs, 0.5 FTE psychiatrists, and 4.5 FTE Peer Support Specialists. A question was asked regarding the need for so many MHPs if we have as many Peer Support Specialists as proposed. Amnon said staff would work on modifications to the staffing plan, and welcomed input from workgroup members who had expertise in managing similar programs, such as Detox and the E &T. IV. Mobile Crisis Teams The group continued its examination of budget possibilities to look for where the anticipated overall $1.1 million gap could be closed. In a hand -out titled, "Budgets for Crisis Diversion Mobile Teams," Amnon Shoenfeld laid out three options for the crisis teams: 1. Option 1 calls for four teams co- located at police stations around the county (north, south, east, and Seattle). One MHP would be on duty 24/7 at each location and would meet police officers at a crisis scene; each station would have King County Crisis Diversion Facility, MIDD Strategy lob Planning Meeting 4/21/2009 Page 3 of 7 193 1 94 a car. There would be a total of 18.66 FTEs and a yearly budget of over $1.6 million (not including vehicles or equipment). This was the model that was used to develop the original budget for the mobile teams. 2. Option 2 involves MHPs working in three teams of two, mirroring the separately funded crisis intervention pilot program of the City of Seattle Police. Operations would be seven days a week, eight hours per day, and the MHPs would be co- located at police stations, a total of 9.33 FTEs for a yearly budget of nearly $840,000 (half the cost of option 1). Because MHPs would be working in teams of two, once they arrived at a scene the police officer could leave. Since Seattle has a separately funded crisis team, the three sites would be east, south, and north. 3. Option 3 involves one team of two MHPs, centrally located at the CDF, available 24/7. The MHP team could transport people to and from the CDF, respond to police officer calls, and help at the CDF when not working out in the field. The cost of this option for 9.32 FTEs would be just over $807,000 (comparable to option 2). Eleanor Owen noted that it made sense for the MHP team to be located at the CDF. But Dan Peterson noted that travel time across the county could pose problems for a centrally located crisis team: during rush hour, it can take two hours to get from Seattle to Auburn. He asked if any data was available for travel times around the county. Lis Eddy emphasized the importance of speed for MHPs getting to a crisis situation; for unstable clients where the dynamic can change quickly, 45 minutes or an hour can be a long time. She advocated co- location at precinct offices for this reason, and also because co- location would foster better relationships between police officers and MHPs /social workers. Communication between the CDF, the MHPs, and police officers police officers who will be both city officers and county officers —will be very important in making any of the options work. Mike Finkle advocated for a combination of options two and three, and Kelli Carroll called for an "option 4 one team of MHPs at the CDF, with one or two more teams located at a precinct farther out in King County (locations such as Maple Valley, north Seattle, Federal Way). Peak evening hours (5 p.m. to 10 p.m.) would need better coverage than other hours, with a swing shift of something like 10 a.m. to 8 p.m. Workspace for MHPs at precinct officers would also need to be arranged. Again, an advantage to having some MHP presence at precinct offices would be improved communication, familiarity, and trust between CDF staff and police officers. It was pointed out that a crisis team Located at a King County Sheriffs station in south county would also need to respond to city police in the region, so that relationships would need to extend beyond the specific police unit with which the team is co- located. Liz Eddy described a common scenario, which is that a friend or family member calls police to check on a person— someone who has committed no crime and who has not threatened suicide directly. In cases where the officer determines that the person does not need to be taken to the hospital for a medical emergency or involuntarily committed to King County Crisis Diversion Facility, MIDD Strategy 10b Planning Meeting 4/21/2009 Page 4 of 7 the hospital via a Designated MHP(DHMP), but the officer doesn't feel comfortable leaving the person alone, a crisis team would be the perfect person to call upon as someone who could simply stay and talk with the person after the officer left. Again, in this case as well as others, the MHPs would have to travel in teams of two so that the officer could safely leave the scene. Although splitting some teams up might make sense if they are paired with the City of Seattle's crisis intervention team, single -MHP "teams" would not make sense in other cases because the number of MHP vehicles would have to be increased and because it would limit the police officers' ability to leave a crisis situation as there must be two MHPs or one MHP and one police officer at any given crisis scene. Roycee Hasuko raised the question of transportation to the CDF. The crisis mobile teams could transport clients to the CDF. However, if a crime has been committed and there is official paperwork (such as in Attachments A and B of the drafted "Legal and Eligibility Structure" memo), the police officer might be the more appropriate person to transport the client to the CDF. Eleanor pointed out that programming won't be perfect and we will learn what works and what doesn't along the way. Perhaps we could consider our program to be a pilot program like the City of Seattle's, but this might be a problem in respect to future budgets. V. Crisis Diversion Interim Service (CDIS) Amnon Shoenfeld outlined the CDIS, or respite program, to include 19.6 FTEs at a projected budget of nearly $2.09 million. The staffing plan did not break out the fact that Masters level staff could include a Chemical Dependency Professional (CDP) and the BA level could include peer support staff. CD needs will be met as well as MH needs, and the reason for the rich staffing level is that clients will just be getting out of crisis and will need to be linked with services. The program will have 25 beds with an average stay of one week, working out to about $200 per bed day, and the program is intended to serve homeless people who cannot "go home" after discharge from the CDF; so many clients of the system do not have homes to go to, Darcy Jaffe said. Barry Antos stated he believed the proposed plan for the CDIS was over staffed compared to his memory of what was discussed in the sub committee. As proposed, the program appears to be treatment oriented, whereas the sub committee envisioned the CDIS providing temporary housing to people who are stable and need minimal supervision while they connect or re- connect with the services they need. Barry expressed concern that a program that provides services (versus connecting people to existing services) runs into regulatory and licensing issues they were hoping to avoid. If the CDIS is located next to or very near to the CDF, as intended, it would be less important to have treatment available at the CDIS. Amnon asked if others believed the proposed level of treatment at the CDIS facility was too high, given that clients would sometimes be coming to the CDIS after 12 to 15 hours King County Crisis Diversion Facility, M1DD Strategy 10b Planning Meeting 4/21/2009 Page 5 of 7 195 196 at the CDF. He reiterated that there would be no MHPs or CDPs at night, only during the day; people admitted to the CDF under the influence of drugs and alcohol will need more than 12 to 15 hours to have their needs determined. Eleanor Owen thought this higher staffing level might be necessary for avoiding recidivism and that at $200 per person per day, it was a bargain. She suggested that an administrative staff person should be assigned to pull together data in support of evaluation of the program and also to assemble clinical history. Coordinating services among providers already working with consumers will be important for continuity of care Dan Peterson remembered that at the previous sub committee meeting, it was decided that the CDIS rather than the CDF would be the place where people would be linked with services. Diana Fitschen said that the CDIS had been envisioned as a respite home for the homeless where clients who are already linked up with services from an agency would be re- Linked to those services, but for those without agency case managers, new links with resources would have to be established, which she said would take time and skilled staff, including staff who could monitor medication. JoEllen Watson agreed that there would likely be many clients not already in the system; at the Psychiatric Emergency Services at Harborview about half of the clients are known within the system and about half are not known, and these are not necessarily "transplants" from other counties. Darcy Jaffe questioned the need for the nursing staff proposed in the budget, and she asked about the low figure budgeted for pharmaceuticals ($3,739). This figure does not include prescription drugs, which will be paid for differently. Discussion of RN services at the CDIS facility continued, with Barry Antos arguing that clients who need nursing care should not be at the CDIS and Diana Fitschen finding the place in the minutes of a previous meeting where it had been decided that some medical care would be provided. JoEllen Watson suggested that an Emergency Medical Technician could be an effective replacement for a nurse. Barry and Mike Finkle raised the possibility of linking the CDIS with the Medical Respite facility being developed under another MIDD strategy. Transporting clients to a clinic for medical care would avoid licensing requirements for the CDIS, clients would benefit from interaction at the clinic, and more of the 25 beds a CDIS might be made available. To this Amnon added the possibility of bringing staff from a medical clinic to the CDIS on an on -call basis. On -call contracts are less expensive; CDPs could also be contracted on an on -call basis. Summarizing the group consensus, Amnon said it leaned toward a CDIS facility that: functions more as a shelter where clients can be linked with services than a place where intensive services would be provided, is staffed with fewer professional staff (maybe LPNs rather than RNs, or neither) and some administrative assistance for data entry and coordinating phone calls and is located, preferably, next door to or within walking distance of the CDF, bu does not have to be. Location will depend on the RFP responses. King County Crisis Diversion Facility, MIDD Strategy 10b Planning Meeting 4/21/2009 Page 6 of 7 Other CDIS facility matters: Most rooms will be shared rooms. Dave Murphy added that space at the CDIS facility would be necessary for professionals to meet confidentially with clients and to do paperwork. Food will be outsourced: Andrea described the recommendations of Skagit and Whatcom counties that meals be brought in frozen, so that they can be reheated whenever needed, with fresh fruits and vegetables and other food available as snacks. Eleanor Owen emphasized the importance in mental health care of people being able to prepare their own food. We need to think more about how the CDIS facility should handle medication regimens begun at the CDF. V. CDF Development Timeline Andrea outlined the timeline included on the back of the agenda handout. One RFP for the CDF, Crisis Team/s and the CDIS will be circulated during the period of May to August, 2009. Organizations can develop proposals for all, one, or any combination of the programs. Sub contracting, having a lead agency or coordinating a joint proposal, will also be considered. The five months allowed for securing needed permits and licensing (October 2009 to February 2010) is ambitious but possible. Full staffing should be achieved by March, 2010 to allow for training and orientation for opening of all three programs together in April, 2010. Submitted proposals will be reviewed by MHCADSD staff with MIDD Oversight Committee input on other reviewers, perhaps including diversion center managers from other counties such as Pierce, Yakima, Spokane. After contract(s) have been selected and locations proposed, outreach will begin; all the feedback from sub committees has emphasized the importance of a public awareness campaign. Tukwila has called the MIDD program because it heard the CDF will be placed there, but no such decision has been made; proposals can include references to locations and discussions with city officials around the issue of location. The CDF should be on a major bus line, so that it's easy to get to for family members, friends, and clients themselves to get to. The person defines the crisis and does not have to be suicidal to benefit from visiting the CDF, which individuals should be welcome to do for even only a few hours at a time. The CDF would conform to the "living room" model, where people could come in for face -to -face (as opposed to over the phone) peer support. VI. Budget Revisited Returning to the earlier question of the $1.1 million budget gap, Amnon Shoenfeld said that working up option 4 for the Crisis Diversion Mobile Teams might help close that gap (this is the option that would include a centralized team and one or two outlying teams). There also could be some savings in decreasing the number or changing the professional status of the staffing at the CDIS. A new staffing model for the CDIS, possible changes to the CDF staffing model, and a new option for the crisis teams will be developed in the next few weeks and distributed by email to the group for review. Another meeting will not be scheduled, and committee members should send their email responses to Amnon and Andrea only rather than to all the members of the group because of requirements that meetings be open to the public. King County Crisis Diversion Facility, MIDD Strategy 10b Planning Meeting 4/21/2009 Page 7 of 7 ,4 1 i 197 198 Mental Illness and Drug Dependency (MIDD) MIDD Strategy 10b 1 Crisis Diversion Facility Planning Group February 10, 2009 9 a.m. to 12 noon Seattle City Hall, L -280 Meeting Notes Participants: Jim Adams (National Alliance on Mental Illness, NAMI), Barry Antos (Pioneer Human Services), Graydon Andrus (Downtown Emergency Service Center), Jim Benbow (VA), Trish Blanchard (Sound Mental Health), Krista Camenzind (King County Office of Management and Budget), Bob Cline (Kent Police), Nancy Cole (NAMI Greater Seattle), Kate Davis (OMB), Ed Dwyer O'Connor (Harborview), Diana Fitschen (King County Mental Health, Chemical Abuse and Dependency, MHCADSD), Dan Floyd (MHCADSD), Scott Enright (Seattle Police), Ian Goodhew (King County Prosecuting Attorney's Office, KCPAO), Russ Goedde (King County Office of Public Defender), Shirley Havenga (Community Psychiatric Clinic), V. David Hocraffer (King County Office of Public Defender), Judy Holman (Pioneer Human Services), Darcy Jaffe. (Harborview), Veronica Kavanagh (NAMI), Andrea LaFazia (MHCADSD), Barbara Linde (KC District Court), Kevin McCabe (ACA), Michelle McDaniel (PHSKC), Dave Murphy (MHCADSD), Anne Newcombe (Harborview), Kurt Ofsthus, Eleanor Owen (NAMI), Toni Rezab (DAJD), Jean Robertson (MHCADSD), Dan Satterberg (KC PAO), Jerry Scott (Navos), Amnon Shoenfeld (MHCADSD), Lois Smith (King County Mental Health Court), Kathleen Southwick (Crisis Clinic), Kathy Van Olst, Don Ward (for Kristyn Fix), JoEllen Watson (MHCADSD), Steve Williams (King County Mental Health Advisory Board). 1. Welcome and Introduction, Amnon Shoenfeld Amnon gave an overview of the development of the crisis diversion strategy. Discussion among stakeholders in the Mental Illness Drug Dependency (MIDD) plan began three years ago. Crisis diversion, non Medicaid mental health and chemical dependency services, and housing emerged as the three top priorities for MIDD. In April 2008, consultants (from the national award winning crisis diversion program in Bexar County (San Antonio), Texas and from the national GAIN program) were brought in to participate in our discussions, and we began to plan a Crisis Diversion Facility (CDF) for King County. Our plan was ambitious; whereas the Bexar County facility took five years to get up and running, we planned to be ready in much less time due to the pressing need for a facility of this kind. A lot of work has been done already. Now what we need to do is step back and review our plan and make sure we are in agreement about the goals and design of the facility and the overall strategy. We need to be cautious about our expectations: our CDF does not mean there will be no mentally ill people in jails or emergency rooms. The CDF will not be the place where everyone with mental illness and drug dependency goes. But we can accomplish a lot. What we don't want to do is simply hold people for an hour or so and release them without any supports to return to the situation that put them in crisis in the first place. Our success will be based on to what degree some people can be diverted from emergency rooms and jails and be Attachment NN King County Crisis Diversion Facility, MIDD Strategy 10b Planning Meeting 2/10/2009 Page 1 of 8 199 200 treated in such a way that they do not re- commit crimes or fall back into crisis. Individuals may cycle several times through the CDF, too, before they respond positively to services. Showing some quick success in placing people in needed services and avoiding criminal and emergency medical contact will be important to keep the program going. And over time, if we're successful, we'll see fewer people with mental illness and drug dependency in jail and in emergency rooms. 2. Review of Progress to Date, Jean Robertson The values, principles, and expectations that were discussed and agreed upon in the stakeholder meeting in April 2008 are listed in this meeting's handout entitled "Values, Principles, and Expectations." The fundamental values of Crisis Diversion services are that services will be collaborative (rather than judgmental or blaming), efficient, accountable (to the community while the individual is at CDF), integrated (among stakeholders), regionalized (although Seattle is the center of many services, South King County has grown and is growing; services need to be accessible to all referents, consumers, and their families), inclusive (of all stakeholders, in design, provision, and oversight of CDF services), risk reducing (for the general public, consumers, and their families), and focused on an improved quality of life (again, for the general public, consumers, and their families). The guiding principles of Crisis Diversion services are: 1) Care is holistic, trauma- focused. 2) Care is clinical rather than criminal justice in orientation; it is an alternative to jail. 3) Like the San Antonio facility, the King County CDF will not be like a hospital; instead, it will be a warm, friendly place so that people will prefer to come there instead of a hospital or jail. 4) Staff will be welcoming, collaborative, and creative, with clients, family, referents, and back -door resources. 5) Basic services such as meals and showers shall be given to consumers even if those are the only services consumers initially gain from, as a way for consumers to start to become engaged. 6) A "culture of quality improvement and problem solving" means that efforts to improve CDF services will be ongoing, that they will be based on listening, discussion, and collaboration among all the stakeholders. 7) Non violent crisis intervention and de- escalation approaches will be emphasized according to the philosophy that violent, psychotic clients can be handled non violently and without resorting to restraints; seclusion and restraints will be available at the CDF but not as a de- escalation tool -only when all attempts at de- escalation have failed. 8) Access to CDF services is user- friendly, non stigmatizing, open to walk -ins, drop -ins, drop offs by stakeholders, including family members. 9) Back -door service options, like housing, need to be available countywide; this is where we need buy -in and commitment from all stakeholders and ancillary services. 10) Racial and ethnic disproportionality needs to be addressed. 11) Professional services should not be the only ones included in treatment discussions; family and other natural supports must also be included. Dan Satterberg raised the issue of how few beds were planned for the CDF (16 beds) and that this creates a tension between hospital ER professionals and jail professionals competing for limited space. Another response he had, in particular to guiding principle #7, is that if police King County Crisis Diversion Facility, MIDD Strategy 10b Planning Meeting 2/10/2009 Page 2 of 8 officers were to be confident in using the CDF, there would need to be some rooms with locks on the outside of the doors. Jean Robertson responded by saying that having some locked rooms was different from having an entire locked -down facility, and that there would be rooms in the CDF that would lock. She also said that locked rooms could be referred to by some other term, such as quiet rooms. The list of expectations includes: 1) Decreased boarding in ER departments. 2) The CDF capacity for MI and CD involuntary commitments. 3) The inclusion of the developmentally disabled, brain damaged, and other individuals in crisis. 4) The importance of back -door resources (e.g., tolerant housing). 5) The need to protect funding. 6) The need for legislative support. 7) The collection and evaluation of outcome data to identify gaps and problems in services. 8) The necessity of professionals knowing exactly what the criteria are for admission to the CDF (an example given was of the laminated cards police officers in San Antonio carry with them, listing criteria for clients of the CDF). 9) Procedures for handling offender clients (see notes below for the discussion that followed Jean's introduction). 10) The need for the CDF to be law enforcement friendly. 11) Provide timely linkages to the continuum of services. 12) Including housing options (clients should not be released to the streets). 13) The importance of sharing client information (for example, among mental health care providers). 14) The availability of medical, sobering, and detox services (detox beds were almost reduced in recent budget cuts but have been restored through June 2009). 15) Ease and efficiency of bringing someone to the CDF (should be easier than booking that person into jail). Dan Satterberg suggested that expectation #1 include "decreased boarding in jails" as well as in hospitals. Bob Cline suggested that we add being a good neighbor to the list of expectations —in respect to both residences and businesses in the area of the CDF. Pre- screening procedures were discussed. Most models have some sort of pre- screening procedure; the Yakima facility is by invitation only, for example. But we wouldn't want our CDF to be restricted in that way. Family members should be able to bring a mentally ill person to the CDF themselves, for example —in their own car. We want police officers as well to be able to bring mentally ill individuals in crises to the CDF without arresting them. This is especially important because arresting mentally ill people in order to get them into services has contributed significantly to the criminalization of mental illness. Although police officers have to keep records of every arrest they make, they do not have to criminally charge every individual; many could be transported by police officers to the CDF without being charged with any offense, in this way avoiding the stigma of having a conviction that might later exclude clients from such services as housing and jobs. King County Crisis Diversion Facility, M1DD Strategy 10b Planning Meeting 2/10/2009 Page 3 of 8 201 202 Graydon Andrus of the Downtown Emergency Service Center noted that a capacity of 16 beds for the CDF may seem low, but it is 16 more beds than what we have now. Trying to get individual treatment plans together for people to address their specific problems and specialized backdoor services will be the key to making a capacity of this size work. His agency already uses a triage procedure to determine who needs scarce resources the most. He wonders about exploring programs for the people that are too extreme in their behavior —too violent, too scary —for the shelters. On the subject of follow -up care, he also suggested we need to think of some specialized back door services for these more extreme clients beyond the two weeks presently envisioned for follow -up care for clients leaving the CDF rather than thinking days or weeks down the road, we should think months down the road. Backdoor programs that don't already exist, especially for people with chemical dependencies, might need to be created. Eleanor Owen emphasized the importance of not releasing clients until they have the next place or next program to go to, and of formal, written agreements between individuals and providers at the time of release. Jean Robertson discussed how the continuum would not be perfect, that there would be people cycling and recycling through the facility and the programs as they made progress over time toward recovery. Darcy Jaffe noted that treating chemical dependency will be key and that there may be some trial and error in the implementation of the CDF, requiring some flexibility to make corrections. In future discussions of back -door programs, providers will be present. 3. Status Report, Andrea LaFazia In this part of the meeting, Andrea led the group through a seven -page status report that included two attachments: one is regarding CDF eligibility criteria from the perspective of the Prosecuting Attorney's Office, and the other regarding CDF eligibility according to medical criteria. The following notes supplement the material in that report. No upper age limit for the target population has been set; 18 is the minimum age for CDF clients. Consumers may be voluntary or involuntary and, if involuntary, may be required to stay for different periods of time, depending on the requirements of the condition or designation they present with. RCW 70.96A provides for involuntary holds for up to 72 hours of clients who are under the influence of alcohol. RCW 71.05 provides for involuntary holds for up to 6 hours (12 hours if originally brought in by police) for consumers suspected of being a danger to themselves or others, or gravely disabled. The purpose of this hold is to give time for the Designated Mental Health Professional to arrive and evaluate the person for commitment. If the DMHP initiates involuntary commitment, the person would need to be transferred to an evaluation and treatment facility (E &T). The CDF would not be an E &T Consumers who are brought to the CDF by police may be held up to 48 hours under a police hold, during which time the crisis might be de- escalated and treatment services arranged; police could be called back if the consumer refuses to cooperate or demands to leave. King County Crisis Diversion Facility, MIDD Strategy 10b Planning Meeting 2/10/2009 Page 4 of 8 The location will be between south of the downtown Seattle core and the Southcenter area, with easy access from I -405 and 1 -5. KC Deputy Prosecutor Ian Goodhew presented the material in the first attachment regarding criteria for entrance to the CDF. After working with King County jail administrators, it was decided that the list of offenses on the attachment could be expanded to include people with misdemeanor drug charges (people arrested with three grams or less). Failure to respond to written notices is another charge that can be added to divertable offenses, and there are lots of people in that category who have mental illness or drug dependency. Kathy Van Olst described the snapshot that had been taken of misdemeanor charges made over the last six months and said that they spent a Iot of time with people with mental illness "tags these are some of the people that would be helped by the CDF. In the six month period of the snapshot, 160 people in jail with mental illness tags were identified. Amnon noted that the significant addition the King County CDF will make to national crisis diversion programs is the inclusion of people with chemical dependency. The need for diversion for chemically dependent people is clear, with mentally ill people occupying 5 15 percent of the jail population, and people abusing alcohol and drugs occupying 60 -70 percent of the jail population. Darcy Jaffe underscored the importance of including this population. A concern was raised about the exclusion of domestic violence crimes from the list of offenses eligible for referral to the CDF. However, state law requires that domestic violence offenders be booked into the jail system. There was some discussion of advocating for a change in statute so that, for example, domestic violence crimes committed by platonic roommates (currently covered under domestic violence laws) could be excluded from the jail requirement, and officers could then have the option of referring these offenders to the CDF. The Mental Health Court might be a place to address this problem. Mike Finkle said that public safety concerns will guide decision making in the field of who should be booked into jail rather than taken to the CDF. People suspected of felonies or violent misdemeanors will be booked into jail. A criminal history of violence (within the past 5 to .7 years) would also preclude diversion to the CDF. The City Prosecutor's Office is comfortable with that time frame. Amnon Shoenfeld said that KC MHCADSD would prefer the lower number of a violent crime committed within the last five years as the standard for ineligibility for diversion. The judgment of the individual officer at the scene will be important in determining where to take the person. Amnon reviewed the suggested criminal hold procedure. A copy of the contact report a police officer files could be kept on file at the facility. If the person cooperates and follows a treatment plan, the form would go nowhere and there would be no mark on his or her criminal record. Darcy Jaffe presented the medical exclusion criteria for hospital diversion, which were arrived at after studying other CDFs, particularly one in Spokane County. She commented that emergency departments in Spokane County had not seen a decrease in Emergency Department (ED) admissions as a result of the CDF, but they did see a reduction in the length of stay. In King County Crisis Diversion Facility, M1DD Strategy 10b Planning Meeting 2/10/2009 Page 5 of 8 203 204 the King County plan, there are other MIDD strategies that may help reduce admissions to emergency departments. Another suggestion was to change the language from "divert" to the CDF to "refer" to the CDF. People who are combative and out of control are having a behavioral emergency; they need emergency department care and should not be diverted to the Crisis Diversion Facility. The question of lab work and screening was raised. Although there are CDFs where medical screening is done, it might not be a service at the King County CDF. The discussion then returned to proposed policies on police referrals to the CDF and how long clients could be held: 24 hours? 48 hours? And is this time measured from the time of arrest? How do we ensure that a client who might be prosecuted is not released back into the community from the CDF? How do we treat people for mental illness without unnecessarily criminalizing them? Ian Goodhew discussed the meaning of "diversion" as a sort of democratic coercion, offering people a choice between treatment or charges. Coercion in this sense could entail the arrested person being required to sign a paper presented by the police officer, stating that the person agreed to stay in the CDF for a certain period of time. If at any point the person decided not to stay for the agreed period of time, or treatment was not working out, that person would be given back to police custody. An example of this kind of situation would be when someone who has committed theft or property violation (breaking a shop window, for example), the police officer would have the option of taking this person to the CDF. In other words, there would be an arrest but no charge or conviction. The CDF would need to hold the person for a minimum length of time. Officers need to know that the CDF is a good choice; that the person won't be back on the street in four or six hours. Ian considers 48 hours a good outside window. Seattle Police CIT officer Scott Enright noted that the proposed criminal hold process is not much different than what is currently in place at Harborview. A problem for police officers is the impression that exists that confidentiality prevents Harborview from calling police when a person with a criminal hold is finished with his or her evaluation. Harborview professionals explained that they do collect consent from patients that the police will be called if they decide they want to leave, but that consent can be withdrawn by the patient. Officer Enright suggested that if the criminal hold process is put in place at the CDF, we need to make sure it actually operates that way. If this issue is addressed properly, it will be a great incentive for police officers to take people to the CDF rather than to the jail. He believes a civilian security officer would be necessary at the CDF. There are a number of alternatives to people in crisis being charged with crimes that might lead to eventual conviction. A person asking for help when confronted by police officers does not have to be arrested, depending on the infraction. And a person requesting transportation to the CDF might not have to agree to a minimum stay of 48 hours. Bob Cline explained that a police officer could even put handcuffs on an individual and then listen to his her story and decide whether or not to make an arrest. Police officers can even "unarrest" people. There is room for communication between officers and individuals. King County Crisis Diversion Facility, MIDD Strategy 10b Planning Meeting 2/10/2009 Page 6 of 8 Police training will be important to the success of this program, including training that helps officers adjust their sights to the likelihood of seeing some of the people they take to the CDF back on the streets again: some will be back on the streets as they go through the cycle a number of times before being helped in a long -term way, and some will be helped more immediately. Dave Murphy (MHCADSD) noted that training is already included as part of MIDD. The idea is that although not all people going through the CDF will be immediately helped by it, some will be helped over time, and although not everyone with mental illness or drug dependency will be helped by the CDF, some will be helped who would not have been without the existence of the CDF. Although the KC CDF will need some kind of security for clients who decide not to cooperate, our emphasis will not be on locked rooms, restraints, and burly guards. In the voluntary diversion program in Pierce County, only 20 -24 people out of 3,600 admissions last year needed to be put in a seclusion room, and staff only had to call 911 twice n a one year period for help with people who were out of control. Other professionals should be involved in crisis intervention in addition to police. Community Psychiatric Clinic and Harborview had a jail diversion program that could offer some kind of model for crisis intervention teams. Family members can help get a person to the CDF, either voluntarily by transporting him or her there, or involuntarily by calling Crisis and Commitment Services (CCS). There might be situations when CCS could also be called rather than the police when a client decided he or she did not want to stay at the CDF. Medical staff at EDs also need training in how to evaluate patients for mental illness and therefore who to refer to the CDF. This training should include how to consult family members for the patient's history. Amenities at the CDF: Psychiatric medication will be available. Food will be brought in as this is more cost effective than having food prepared on site. Laundry facilities will be on site for clients to use for clothing. We are still discussing whether ambulance transport to the CDF will be reimbursed by the state; police officers will also be transporting clients to the CDF. Size of the facility: Amnon acknowledged that 16 beds are not enough. But the number is based on the ceiling for Medicaid reimbursement as well as the budget for the strategy. And the 16 bed figure does not mean that only 16 clients will be served at a time. Some clients will be there for less than a day. We want to follow a no- refusal policy, so we will need to rely on back -door services a lot, referring people who come through the CDF to other facilities. 4. Stakeholder Perspectives, Jim Adams, Kathy Van Olst, Bob Cline Jim Adams (NAMI) spoke as an advocate of the mentally ill. Legislatively, a lot of progress has been made because advocates have helped train and educate legislators. Eighty -five percent of people do not know they have a mental illness until they are arrested. Two years ago, the Jail Diversion Bill was passed. In the last four years, we've seen a flood of bills that have increased the amount of dollars spent on mental health, and we've also seen a philosophical change, a structural change. One change is the emphasis now on recovery. Most mentally ill people can become productive citizens. The first step always is working past the patient's own denial. Jim spoke about his son's experience with mental illness. If the census King County Crisis Diversion Facility, M1DD Strategy 10b Planning Meeting 2/10/2009 Page 7 of 8 205 206 grows by one million, King County will have 50,000 more mentally ill people in its population. With its intellect, its experience, and its motivation, King County sets a great example of how to respond to the fact of mental illness in our community. Kathy Van Olst corroborated Jim's comments, adding that the criminal justice system is committed to being a partner. Pieces on the criminal justice side still need to be worked out, but we all feel as the community feels: that we need to move forward in decriminalizing mental illness. Bob Cline of the Kent Police Department spoke of the frustration of police officers in Auburn and Kent. Because of an increase in the population and an increase in Section 8 housing, we need to expand our resources in south KC. He spoke of the need for police officer training in compassion for the families of those with mental illness as well as for the mentally ill themselves. 6. Next Steps and Issues to be Resolved, Jean Robertson and Amnon Shoenfeld Before we are ready for Request for Proposals (RFPs) to go out for implementation of the CDF, we need to work out the policies and collaborations for backdoor services. In addition to the CDF itself, there will be mobile crisis teams, and we need to specify what their role will be and what they will look like. We will continue to work on the criteria for referral to the CDF and the hold criteria, specifically: 1) What licensing requirements we'll need to meet, 2) What the difference is between clients who are there voluntarily and those who are there involuntarily, and 3) What the hold criteria for people brought in by the police will be. Transportation is another piece of the project that needs to be worked out. Site choice will be part of the RFPs, and we plan to have the RFPs out by June 2009 with the intent to open the facility in 2010. The budget has changed due to the economy. In 2007, we submitted figures we had gathered based on the CDF in Pierce County and respite care in King County, and we came up with a $6 million budget. Now we must add 10 percent to that cost; staff will be more expensive, too, leaving a gap of approximately $1.8 million. We need to go back now and revise our plan accordingly; making sure respite care is in place. King County Crisis Diversion Facility, MIDD Strategy 10b Planning Meeting 2/10/2009 Page 8 of 8 L43 King County Mental Health, Chemical Abuse and Dependency Services Division Department of Community and Human Services CNK -HS -0400 401 Fifth Avenue, Suite 400 Seattle, WA 98104 206 263 9000 206 -296 -0583 Fax 206 205 -1634 Fax Clinical Svcs. 206 205 -0569 TTY/TDD MIDD Strategy 1Ob, Crisis Diversion Facility (CDF) Medical Population Sub Committee January 9, 2008 Chinook Building Chair: Darcy Jaffe, ARNP (Assistance Administrator, Patient Care Services, Harborview Medical Center and MIDD Oversight Committee Member) Participants: Diana Fitschen, Amnon Shoenfeld, Andrea LaFazia, John Bruels, Dan Floyd, Christi Sahlin, Mike Finkle, Barry Antos, Elise Elliot, Anne Newcombe, Mark Thomasseau, Ray Jarris, MD, Lara Knutson, Kim Baisch, Linda Crome, Sue Rahr, Christina Lacy, Gene McNatt, Jacqueline Raftery, Julianne Yu, JoEIIen Watson, Bruce Webster, Carla Trolia, Mike Finkle Overview of the Mental Illness and Drug Dependency Action Plan (MIDD) and strategy 10b (Crisis Diversion Facility) (Amnon Shoenfeld, Director of King County Mental Health, Chemical Abuse and Dependency Services Division) The Crisis Diversion Facility (CDF) is an important part of the larger MIDD to try and divert people in crisis away from the jail and hospital emergency departments. Planning for the CDF began in the spring of 2008 and started with a visit from officials from the Substance Abuse and Mental Health Services Administration's National GAINS Center and the award winning crisis center in San Antonio, Texas. Since the summer of 2008 meetings have been held discussing various aspects of the CDF project including: Backdoor services, Crisis Teams, Transportation, Licensing and defining the population to be served from a law enforcement diversion perspective. Attachment 00 207 208 MIDD Strategy 10b, CDF Population Sub Committee January 9, 2009 Page 2 The goal of this meeting will be to help define the population of people in mental health and chemical abuse crisis that normally are sent to hospital emergency departments but could be diverted to the CDF. A request for proposals could be issued for the CDF and attached services as soon as March, 2009. The RFP will be in three parts; for the CDF itself, an attached respite program (Crisis Diversion Interim Service) and a mobile crisis team. o Bids could be submitted for individual parts or all three. Concurrent with the development of the CDF will be Crisis Intervention Training (CIT) for police. County staff is working on putting together a model for how the CDF will function to present to a meeting of the larger planning group next month for feedback. Staffing at the CDF could be Master's level mental health professionals, RN's, an ARNP and peer support specialists. Hospital diversion is considered both Emergency Department visits and hospital admission. o For example: referrals could be accepted from Emergency Departments of people in crisis who would normally be admitted to a psychiatric unit for lack of any better alternative. Helpful feedback from this group would include discussion on what sort of problems people face that don't need to be addressed in an Emergency Department and could be diverted to the CDF. o Related to this would be discussion on the types of problems that really are medical emergencies and need a hospital visit to sort out. II. Goals and Discussion (Darcy Jaffe) A handout was provided that outlines the inclusion and exclusion criteria for the crisis programs for Spokane, Thurston -Mason County and San Antonio, Texas. o Generally, criteria are very similar; people must be in reasonably good behavioral control, able to manage their own activities of daily living and not be medically unstable. o The program in San Antonio is situated on a campus of service providers including a full medical center. o Spokane has no licensed medical providers on site, does not have the capacity to prescribe or dispense medications but is only block from an Emergency Department. o Thurston -Mason County's program does have a nurse on site 24/7 and the county involuntary inpatient unit (E &T) is in the same building. Since the CDF will not be licensed as an Evaluation and Treatment Facility (E &T) there will not be the capacity to accept people detained under the state commitment law. MIDD Strategy 10b, CDF Population Sub Committee January 9, 2009 Page 3 Boarding people detained by the Designated Mental Health Professionals (DMHP's) in community hospital Emergency Departments for lack of bed space in the county E &T's is a significant issue. o It is hoped that diverting people to the CDF that would normally be evaluated and possibly detained will help relieve some of the pressure on bed space that is the cause of the boarding problem. The observation was made that boarding is not as much of a problem for emergency departments as is the wait time for DMHP's to respond to referrals. o It is hoped that the CDF will represent a better option for people in crisis in the community who would normally be referred to Crisis and Commitment Services, thus relieving some of the pressure on the number of referrals and improving response time. While the planned capacity for the CDF is 16 beds, it is hoped that the number of people served at any time could be higher. o Not all people taken to the CDF may need to be admitted to a "bed" helping to improve flow. o Pierce County has been able to hold to a 20 -hour average length of stay proving the 24 hour stay target for the CDF is attainable. o The attached Crisis Diversion Interim Service (respite beds) may also help with moving people through the program. Intake to the CDF could initially be screened over the phone. o Police could call in from the scene of a situation to screen cases and see if Emergency Department, Jail booking or CDF placement is appropriate. o CIT training will be an important support of officers in this process. o Violent, restrained and out -of- control persons will probably be excluded from the CDF and will need to be either sent to an Emergency Department or booked into jail. o The CDF will probably not be a secure, involuntary facility. The observation was made that if police could not bring violent or out -of- control people to the CDF it defeats the purpose and is of no help to law enforcement. o The logic being that if public safety is not at risk, police should not intervene. o Cooperative and voluntary people could be left to themselves or concerned others to intervene and bring them to the CDF. o Co- location with a hospital or jail might help with security and improve the CDF's capacity to take people on an involuntary basis. The CDF is hoped to be a jail diversion program but still be voluntary in nature. o Police investigating suspected petty crimes where the true issue is mental health or substance use crisis could use jail booking as leverage to get a person to "volunteer" to go to the CDF. o The presence of a uniformed officer on the scene also adds leverage to a person's "choice" to go to the CDF. 209 210 MIDD Strategy 10b, CDF Population Sub Committee January 9, 2009 Page 4 o All of the programs studied in the CDF planning process are "voluntary" although most have doors and windows that are locked, preventing people from walking away unnoticed. Distinguishing a "crisis" (and could go to the CDF) from a true "emergency" (that would need a hospital visit) will be important. o A crisis might be someone thinking of suicide, behaving erratically due to psychosis or impairment by drugs or alcohol. o An emergency may be someone who is delirious, combative, in withdrawal or otherwise medically unstable. Location and transportation are key issues especially for outlaying areas such as the south and east county. o The Duwamish Valley is being considered, south of downtown to Tukwila. o With easy freeway access, it is hope this will help with access from the south county. o One possibility would be for hospitals to pay into a pool or on a case by case basis for ambulance transportation to the CDF. o Another possibility would be for hospital foundations to pay for a van to transport people. People who are seen in the field ought to be able to go directly to the CDF without having to be screened at an emergency department first. o Fire Department screening may be important here. o Also, a good reason to have medical support at the CDF (nursing staff). o Many people in crisis may medical problems but are not acute to the point of needing an emergency department. o It should be noted that requests to go to an emergency department will have to be honored. Given the voluntary aspect of the CDF it should be inviting enough to the point where people want to come. o However, a balance has to be struck between being welcoming but not encourage people to stay indefinitely. Some suggestions to help with the intake process with the CDF o Crib sheets or laminated flowchart cards for police to help sort out proper routing to medical, jail or CDF o Access to the computer database, Client Locator System, at the CDF to help direct clients of the mental health system to their providers. o A form or screening tool the police or fire department could use to help communicate important information about people they refer to the CDF. o On -line verification of medical benefits to help recoup costs. Some medical capacity would be helpful at the CDF. o Ability to address some chronic health problems such as monitor blood sugar and changing simple dressings. MIDD Strategy 10b, CDF Population Sub Committee January 9, 2009 Page 5 III. Adjournment o Ability to start new psychiatric medications may be possible but expectations should be held in check. o Co- location at a hospital might help with medical and medication issues but how to manage the cost of these services is a challenge. A date will be set for the next general work group meeting in the coming week. Contact John Bruels (iohn.bruels(@_kinacountv.aov) or Andrea LaFazia (andrea.Iafazia(a.kinacount.aov) with questions or feedback. Prepared by: John Bruels 21 1