Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health and Recovery Services
Subject: Agreement with Telecare Corporation for Mobile Crisis Response Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Telecare Corporation for Mobile Crisis Response Services, for the term of July 1, 2025 through June 30, 2027, in an amount not to exceed $7,528,000.
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BACKGROUND:
Behavioral Health and Recovery Services (BHRS) was awarded the State’s Crisis Care Mobile Unit (CCMU) Planning Grant in the winter of 2021 to conduct a thorough mobile crisis response system assessment in San Mateo County for individuals 25 years and younger to determine ways to implement, optimize, and align current mobile crisis practices within San Mateo County to the national best practice standards. Concurrent with the CCMU Planning grant, California’s Department of Health Care Services (DHCS) submitted to the Centers for Medicare and Medicaid Services a State Plan Amendment to establish 24/7/365 community-based mobile crisis intervention services for all ages as a new benefit in the Medi-Cal program. DHCS issued a Behavioral Health Information Notice 23-025 on this new benefit in June 2023.
In August 2023, BHRS issued a Request for Proposals for San Mateo Mobile Crisis Response. Telecare Corporation (Telecare) responded and was recommended based, in part, on their proven track record and successful history in providing Mobile Crisis Services to another County; currently, Telecare is providing Mobile Crisis Services in San Diego and Stanislaus counties. Telecare has an existing partnership with BHRS in providing crisis continuum of care, including a crisis stabilization facility. Telecare also has established community partnerships in San Mateo County with other mental health service providers.
DISCUSSION:
Telecare shall provide 24/7/365 mobile crisis response team (MCRT) services to anyone within San Mateo County who is experiencing a behavioral health crisis, as screened to be eligible for an in-person crisis response by the StarVista Crisis Hotline. Telecare shall provide mobile crisis services, which will include a rapid in-person response, individualized crisis assessment, crisis de-escalation, crisis intervention, community-based stabilization (including a crisis safety plan or completion of a 5150 involuntary hold), and needed transportation to facilitate a warm hand-off to the next appropriate care. In addition, Telecare shall also provide a follow-up within 24 business hours of the initial crisis encounter to support continued resolution of the crisis, as well as additional needed clinical interventions and case management support to ensure service/treatment connection and resolution of the current crisis episode for the individual and their significant others.
The County derives direct benefit from the implementation of this agreement by increasing its ability to directly respond to community members in mental health crisis; providing Medi-Cal reimbursable services to County clients; enhancing response time for those in need of mental health services and resources; and creating a broader and more effective continuum of care that results in a decrease in psychiatric hospitalizations and justice system contacts.
The resolution contains the County’s standard provision allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
This agreement and resolution have been reviewed and approved by the County Attorney as to form.
It is anticipated that the MCRT will respond in person to provide crisis assessment and crisis evaluation for 100% of calls screened to be eligible for dispatch by the StarVista Crisis Hotline using the standard Dispatch Screening Tool developed by DHCS. It is also anticipated that 80% of Medi-Cal clients will be provided with at least three documented follow-ups post-crisis assessment.
PERFORMANCE MEASURES:
|
Measure |
FY 2025-26 Estimated |
FY 2026-27 Projected |
|
Percentage of calls to which MCRT will respond in person, to provide crisis assessment and evaluation |
100% |
100% |
|
Percentage of Medi-Cal clients that will be provided with at least three follow-ups post-crisis assessment |
80% |
85% |
COMMUNITY IMPACT:
Services provided by this contract will positively impact the emotional well-being, psychological stability, and safety of our residents. They will further reduce unnecessary psychiatric emergency admissions, inpatient hospitalizations, and incarcerations by bringing the crisis response to anyone experiencing a behavioral health crisis any time of the day, wherever they are within the County, in a compassionate, culturally-and-linguistically appropriate, and timely manner. Services provided will include crisis de-escalation, individualized support to achieve safety, and follow-ups to continue stabilization and connection to longer-term services.
In addition to fulfilling the State’s mandate, the need for these services is substantiated by significant data:
• 200 individuals per 100,000 will experience a crisis on a monthly basis that requires a service level more acute than can be accommodated by outpatient services or a phone intervention (National Action Alliance for Suicide Prevention).
• “Suicide is an urgent and growing public health crisis. More than 49,000 people in the United States died by suicide in 2022. That’s one death every 11 minutes!” (US Department of Health and Human Services’ 2024 National Strategy for Suicide Prevention).
• In 2017, suicide, a sentinel event of mental distress, was the second-leading cause of death in California among young adults ages 15-34 years. Furthermore, 13.2% of Californian adults seriously thought about committing suicide during 2018-2020, along with 13.7% female, 12.7% male, 15.2% White, 24.1% multiracial, 45.6% bisexual, and 52.5% transgender (State’s Health Data for California through 2021).
FISCAL IMPACT:
The term of the agreement is July 1, 2025 through June 30, 2027. The amount of the agreement is not to exceed $7,528,000 for the two-year term. Funds in the amount of $3,691,489 are included in the BHRS FY 2025-26 Recommended Budget and will be funded by multiple funding streams, including Medi-Cal Patient Care Revenue and Realignment. Net County Cost will be $854,530. Similar arrangements will be made for FY 2026-27.