 a few announcements and then we'll move on to our regular meeting today's meeting is being broadcast live on community television channel 25 and streaming on the city's website city of Santa Cruz stop please note there's a delay in streaming so if you continue to listen on your television streaming device you may miss your out here Matthew Boulder you mentioned my name is Bernie Escolani deputy chief police here at the police department we have a quick PowerPoint Bonnie's gonna help me hopefully share that and I'll go through that PowerPoint as quick as I can to try to educate counsel and the public of what the department does currently and you know always looking for ways to improve our services go ahead the next slide Bonnie please try to summarize what we're gonna cover today just again I'll cover the definition of the the welfare and institutions code and 5150 that we're gonna be talking about a lot today our current responses and procedures for the licensed clinicians that we have that ride with our officers today and then I'm gonna have some data for you as far as the number of 5150 holds that we currently have done actually up to date for 2019 2020 and as well as a heat map and a point map showing where we're most busy with these types of calls go ahead next slide here's the definition of the 5150 at welfare and institutions code mental health disorder they have to be a danger to themselves or others or gravely disabled and really what it comes down to is who has the ability or the authority to put somebody on a 72-hour assessment or hold for further evaluation and there's very few people that have that authority one being a peace officer another one being a doctor and the other one being the licensed clinicians which we have riding with our officers on patrol seven days a week next slide seizure for our officers and the and the two mental health clinicians that we have working with us from the county basically a call for service will be initiated by either the community someone in crisis can call directly or an officer can on view certain behaviors out in public that cause a concern and a need to do what we would refer to as a welfare check on an individual based off of their behavior usually our clinical social workers ride with an officer again I mentioned seven days a week and I'll show you their their work days and hours here shortly but right now because of COVID they're actually riding in in separate cars and they have our radios and they log in with dispatch every day just like a patrol officer does and they listen to the radio and sometimes they will either self dispatch themselves to a call or attach themselves to a call and respond sometimes they'll just let us know that they're going to make a phone call to either the community member that has a concern sometimes it's a family member or actually call the person in crisis and and try to negotiate and have a conversation with that individual and get them services just by telephone which does not require our response and usually they like I said they normally are riding with our officers but when they're not with us typically we get these sort of mental health in crisis kind of calls and and our officers have a lot of training and they are the ones that ultimately are the ones responding to the call if if the mental health clinicians are not available you go to the next slide then we have two clinical social workers that ride with us 20 not 24 hours a day but seven days a week they split the week and half one Sunday through Wednesday that's Danielle and the other one works Wednesday through Saturday so there's an overlap on Wednesdays their hours currently are 8 to 6 p.m. and just keep in mind that both Danielle and Danielle and Julie are employees of the county so we do not necessarily have the authority by ourselves to change those hours or change their work schedules but we do have a really good working relationship with the county and we've negotiated to this point these are the hours and the days next slide I mentioned when we are required or needed to respond to these crisis situations our officers have a tremendous amount of training that they've received that we really started ramping up about three four years ago we started with we have a crisis intervention training it's 24 hours long so three days three consecutive days all of our officers will receive this training before they actually get released out into the street after they've graduated from from the academy we also have had four hours of county mental health training that obviously Santa Cruz County has provided and our entire department has received this this training as well and any new hires that come in also receive that training and then back in December 2019 we received everybody in the department received tactical communications training how to de-escalate a situation and how to try to properly communicate with people that are in in crisis next slide please so this is some data that we collected from 2019 and 2020 this will show you on the left side obviously is the days of the week across the top is is the time of the day I apologize for those that don't do military time but that's what we operate under so this gives you kind of a sense of which days of the week if there are any or time of the day that we are most likely to receive a 5150 call now keep in mind there's some room for error here as far as sometimes we get a call and it might just come out as a disturbance or even a fight or something other than a 5150 call so sometimes you know we all of that doesn't get captured but you what you'll find here is there's really no significant day of the week between the two years we did both 2019 and 2020 up to date because obviously this year has been very unique in a lot of ways so we wanted to have the data to compare with 2019 so what you will see is most of the activity is around midday and there really is no trend that shows us necessarily the day of the week or a particular day of the week that's more prevalent than others I'll just give you a second to take a look at that data there it's it's a lot to capture but it's all really helpful information that we utilize to try to structure obviously when our licensed clinicians are riding with us and go ahead to the next slide you know we receive 5150 mental health crisis calls around the clock seven days a week 365 days out of the year the highest concentration over those two years that I just showed you was about 11 from 11 a.m. to roughly 8 p.m. and again there were no real trends related to the days of the week that was most prevalent for 2019 this was the data that actually the mental health clinicians provided us and provided the county for 2019 they tallied over 1300 contacts and you'll see down at the bottom there mh1 mh5 those are just their call signs on the radio so that that just shows you though with the workload for for each one of our clinicians by the month over the the year of 2019 next slide so for 2019 of those over 1300 calls or contacts that they were involved in this shows the number of 5150 evaluations that were completed and the number of 5150 holds that were written by the clinicians not by the officers that's solely by the clinicians themselves and then down at the bottom there that you get the referrals for services and keep in mind one of the things like having the conversation with the county that's very helpful to remind everybody that the referral for services is you know just the actual referral this does not unfortunately indicate the number of people that were helped out of their situation or out of the situation of being homeless often times unfortunately people don't actually act on those referrals but these are referrals that are provided by the mental health clinicians that ride with their officers and again this is the same data but for 2020 up to date the total number of contacts up to date is over 1200 for both of our mental health clinicians once again here's the 2020 outcomes and you had over 900 almost a thousand evaluations that were completed and then you have the smaller number is the actual holds written by the by the clinicians and then down below again is a lot more referrals in 2020 and a lot more excuse me homeless services referrals that were provided by the clinicians next slide calls that are clinical social workers have been involved in have come mostly on Tuesdays and Thursdays or is there a right around midday 12 12 to noon the previous numbers that I showed you those were for officers and kind of a combination of officers and clinical social workers these numbers are more just for the clinical social workers and what they've been involved in and when are their their peak times 51 50 holds that are written by our officers these are not holds written by the mental health clinicians these numbers are significantly lower than than usual just because the clinicians are able to write the holds and we just do simply a transport and we don't actually write the holds these are the ones that our officers have written either because the social worker is not available or it's after after hours also want to just provide you as far as locations within the city it really doesn't indicate much just for your own information obviously in our downtown area and a couple other little hot spots there are the most prevalent locations for us to and or the social workers to be addressing some people that are in a mental health crisis and one more slide I believe and this is basically the same information other than the heat on the heat map but a point map that shows you all the calls from 2019 to 2020 up to date that we've received either our officers have dealt with or the social workers have assisted us with and to take any any questions hear me okay okay I think Christy Brenda is going to start actually are you there Chris I am thank you I just unmuted myself thank you so much for having us here today I'm Christy Brenda I'm the senior manager with our health and housing service area with encompassed community services I'm sure most of you are familiar with encompass where our large nonprofit here in Santa Cruz health and service health and human services agency the service area that we work under is mainly mainly focused on our our homeless and most medically vulnerable here in Santa Cruz County a little bit about Dow the history of Dow it was a program through the county that started I believe a partnership back in maybe 1994 so I think that was according to Daniel Long and as a way of connecting our folks to the downtown area and services that are needed and it seems like in back in 2013 is when encompass took over that program and we started out with having one full time outreach worker in that downtown corridor and now their program over the last few years was grown to be able to have two full-time workers and hopefully more in the future so the Dow program we operate with a budget at about a hundred and a little a little under 154,000 per year we contract with the county and again it's a collaboration of funds between the city and county see what else I'm gonna Chris is gonna be doing a side show to go into more detail about what she and our other downtown outreach worker married to do on a day-to-day basis but they are they are full-time for they do four tens and we cover all all seven days a week downtown and just today Chris and I were talking this morning and we thought we would talk a little bit about downtown outreach post COVID when COVID hit back in March we kind you know everybody kind of stopped went home and you know tried to conduct business from home as much as they could but with with with downtown outreach and with our with our most vulnerable folks down homeless we had to kind of kick into high gear and we did a great collaboration with the county and so Chris is going to talk a little bit more about that so with that I'm going to hand it over to Chris and again we'll be willing to answer any questions that you guys have at the end thanks thanks Chrissy okay just want to check in and make sure everyone can see the slides let me see if I can figure this out everyone yeah so I'm going to just fill in a little bit of information about the downtown outreach worker program which again is managed by encompass community services so it looks like some information is actually missing here there it is so there's it's a pretty small program there's just two of us it's Meredith Juarez she works Sunday through Wednesday from 8 a.m. to 6 p.m. and then my name is Chrissy Youngren I work Wednesday through Saturday from 9 a.m. to 7 p.m. the program is the direct supervisor is Jayce Freeman and their email address is below and then the senior manager who just spoke is Chrissy Brenda the slide so able to see for some reason I'm having a hard time progressing my slides okay I did email them to let's see okay thank you so much sorry about that you guys stuck on that one anyone maybe talking through and then we can catch up on the slides yeah absolutely so sorry I think I think I have can you guys see the screen now yeah okay great so next slide please yeah and then one more after that so we have a pretty narrow geographic footprint it literally is just the downtown corridor from Water Street in the north to the street yeah I'm sorry about that so are you guys able to see my screen at this point okay I apologize I will go ahead and oh so you do see a slide that was geographic I got it okay yeah so our footprint is pretty narrow it's basically from Water Street in the north to rural Street in the south and includes front Street Pacific Avenue and Cedar Street a sort of basic description of what we do is we connect people experiencing homelessness in the downtown area to resources that increase stability health and wellness so sometimes these are urgent needs like food clothing shelter and hygiene we also help with longer-term needs like housing employment benefits medical mental health and substance use disorder services and occasionally emergency EMS and emergency mental health crisis intervention that sort of thing how clients reach us usually is we can always you can always reach us at our phone number email address we also travel throughout the downtown quarter and engage with people experiencing homelessness we receive a lot of referrals from the downtown ambassadors merchants downtown other service providers and just the general public we also have regular outreach hours at the downtown branch of the public library on Monday and Thursday from 2 to 4 and in the portable trailer behind the courthouse on Wednesday and Friday from 10 to 2 so we're one of a handful of providers that offer the homework bound program it's a city-funded program that provides individuals with transportation to their city of origin in order to reunite with housing and support in that area it's part of a larger strategy that we're sort of adopting community-wide of diversion which seeks to kind of prevent homelessness at the front door by helping individuals identify immediate alternate housing arrangements and then connecting them with services to help them return to housing in fiscal year 2019-2020 we provided 65 greyhound bus tickets for individuals returning home consider the outreach that we do to be housing focused outreach kind of based on the idea that housing is ultimately the solution to homelessness there's a large body of evidence that shows that permanent supportive housing is a cost-effective way to not only improve health outcomes but reduce the use of emergency services including emergency psychiatric services so as part of this housing focused outreach concept we also participate in the smart path system we provide smart path assessments which is a way for folks to get on wait lists for housing that they might be eligible for we work to try to identify a current case management support that might be able to connect individuals to housing and we try to identify open wait lists whenever possible and assist clients in applying to those open wait lists so our work really changed quite a bit in the time of COVID a lot of the businesses downtown were closed for an extended period of time and we partnered at that time and continue to partner with the county health department the county led hopes team the homeless persons health project the downtown streets team and there were a few volunteers to provide COVID-19 screening supplies to help with social distancing masks food water and referrals to motels and shelter the supplies and supports were available and are still available at pop-up sites most notably probably the MLN Avenue site on Tuesday at 9 30 a.m. and then we're also doing offering the same services and supports and screening during outreach out in the field in terms of our outreach outcomes we contact approximately 120 unduplicated individuals each month a lot of those individuals we make contact with more than once during the month we make over 200 referrals each month and that results in over 150 service connections we can manage 10 individuals per month and provide I would say approximately 10 or so homeward bound tickets on average every month and that is the end of my presentation or my part Chris and Christie thank you for the for the presentation I'm wondering about the success of the homeward bound tickets you mentioned that you know you provide a number of tickets do you do you find that those folks that you don't see them coming back into town again or I'm just curious about the effectiveness of you know when you do get somebody reacquaint you know we back in touch with their family and they do take take advantage of the homeward bound I'm just curious about this for the efficacy of that and and just your reflections on that since been working with it for a while yeah I mean I would say that there definitely are people that return but then there's also I think really huge successes I can think of one young guy who was actually connected to our mental health system here in Santa Cruz County who went to his place of origin which was Pennsylvania and ended up in housing he his housing actually there was affordable for him he ended up connecting with mental health services back then so I think in those cases it I mean the successes probably shine a little brighter than than the people who are returning I don't have exact numbers of that though great thank you and then I did have a question for you mentioned in your presentation that you had a category on the referral slide that it was something of the orange color that just said medical and I'm just curious that you were it was referring it was regarding the referral so there was referrals that sound like homeless services medical and what is the other one blue bars an orange bar and I was trying to remember what is the medical when someone gets referred for medical is that the emergency I'm just curious what medical means is it treated there on site or is it referred to other services for example at the ER or just curious about that most of not necessarily you know sending the patient out to Dominican hospital it could be more referrals out at dam line center okay over on coal street they also have some they provide medical attention over there so yeah it's most of those numbers are lower level if you will then emergency room sort of visit but you would refer them to MLI or HP HP and do the no is there I'm just I guess I'm wondering is there and a sort of when we when there's a medical evaluation are they is it is there also a physical at least to the extent that maybe someone has a wound or maybe somebody you know has I'm just curious like when someone's assessed what's kind of what's in that assessment I guess most of that is probably going to be better provided that that detail by the county they probably be able to answer answer that question better than I would okay thank you yeah maybe James could chime in on that that that question keeping in mind that the mental health liaisons are behavioral health so our primary we're not doing medical interventions but obviously we see someone tells us something that when does the thing that hey you need some medical follow-up we're going to refer you over to the IVH clinics which is over at amline or Planned Parenthood clinic some of those other lower level clinics if it's a ER thing then obviously that's an immediate concern and they're going to be taken by ambulance right away so again that's kind of some preventive things that we're like wow this is probably going to go to a ER visit if you don't get some lower level of care right away so we're just trying to divert things get them set up because again those medical issues can turn into crisis issues later on down the road if we don't attend to them as quickly as possible okay thank you James a couple questions I noticed the hours that Bernie gave of their heavy hours at call to service were 11 a.m. to 8 p.m. but for the social workers and downtown workers I think the hours are more 8 a.m. 6 p.m. at least for the social workers so I just wondered to what extent it doesn't have to be asking now but it raises the question of making this thinking out better the working hours with when the call to service come in so I don't know if anyone wants to comment on that it was just something that left out at me comments not comments then I will ask my other question and that is about we have we have been having the downtown out each workers and the the social workers attached to be for a good long time and I know they're out there in the field I see them and I've talked to them and they're making a lot of contact it's my impression that a large number of those are repeat repeat repeat so there's a lot of stories and they know a lot about them and so and it is interesting we just had the study session last week on the focus strategies and trying to be a sense of better coordination so we're moving people to a better place not wanting to necessarily define progress or cure but moving to a better place so I'm just wondering if either the downtown outreach workers the social workers have a comment on those observations of my mature obviously not directly in the field but over time and trying to pay attention yeah well I'm happy to start yeah I I feel like a lot of the contacts that we have are people that we know well and I think for Meredith and myself the goal is to always try to someone and getting one step ahead of at least where they are now so oftentimes that's getting people into shelter first I know that with our expanded shelter that we have now there's probably more people are sheltered or staying in motels than we probably ever have in the had in the past which is a good a good step in the right direction but yeah I feel like for people that we see repeatedly there is a lot of coordination behind the scenes in trying to figure out sort of how can we move this person forward in some way yeah thanks and I'll just comment I think that's kind of what we hear from the public you know so much effort and good intention and and yet seeing so much out there that needs to be done with the same people over and over yeah yeah for the presentations and kind of an overview and some of the numbers it's really helpful to be the those the data and kind of help and understand a little bit more what that's like on the ground my question is kind of a big picture question and for anybody who is up for trying to answer this and I want to ask everybody who's involved in these systems the question you know what do you see as the biggest obstacles or challenges to doing you know and and I know that that's really big and there's a lot of things that we could talk about and obviously it's resources resources resources is a huge piece of that but just like I can't like if something that like gosh if we just have this or if we could do it the different way or if we you know what what is it that's problematic for you all in getting your work done effectively I might need a couple minutes to think about that kind of a tough one I just mentioned you know and if you don't have immediate responses it's something that I feel like talking about that you know with with the council with leaders who are making decisions and also for the public to understand what that what that looks like for you all well I was just going to say that I think resources is a huge one I think also it may be difficult so we case manage ten individuals per month ourselves but it may it seems like it's difficult at times from our position doing outreach and engagement to perhaps do the work of case management which can be really hard to sort of follow people and get them where they need to be or assist them in getting where they need to be if that makes sense and also I just like to add I think you know it's great that we're able the downtown average workers are able to case manage a handful of people at a time but you know a lot of times we get we get folks that you know maybe are calling because they've moved on maybe they're not downtown but you know sometimes we get into this pinch where we're supporting people that aren't technically in the downtown corridor at that time and it's really hard to say to say no to certain folks but I know that you know one of the biggest pieces that we everybody is talking about at nauseam is is the lack of housing resources and the lack of like the long-term case management for people a lot of times you know folks you know will have gotten successfully housed but then the support stops and Chris and Mary to find themselves you know getting phone calls from landlords or different people in the community to try to help this this spoke this person and try to get them connected to case management and that's something we really really are lacking so that's what I would say bandwidth I guess not only as a city but the entire county I've talked to a lot of county employees as well that are involved in the same field and it's just the bandwidth is really just not there to handle the volume of the issues that we have I'm gonna add a little bit of a different component that I know I've gotten from even our clinical workers we have a tremendous methamphetamine problem in our community and it is really difficult even for the professionals to tell the difference between you know the use of methamphetamines and somebody in mental health crisis and don't necessarily have the data on this but just from my professional opinion I think that it is very common for people to self-medicate and it makes things very difficult to assess what really the problem is and and really kind of which direction to go as far as looking for a solution but I think that we also as a community could just do quite a bit more in the area of drug addiction and methamphetamines in our in our streets right now yeah for now thank you appreciate your thoughts mayor I'm thinking view I think the two of you maybe the third person I can't seem to see as caseworkers it's gotta be very I know it's very difficult I'm on the housing matters board and I just hear so much about from the caseworkers and they just all of you are just the heroes in this whole system you really are it's got to be very difficult I know we need many many more for sure and raise your salaries of course as well but there was a statement and when you first open the presentation I'm not sure whether it's Chris or Christie I mentioned how the housing where everyone is I pretty much is this understood now that getting people in housing is the way to end homelessness and the way to help people and I don't know that encompasses much unhousing and we're here to talk about the mental health we're not here talking about you know ending homelessness by getting me in a house but I just are there some special programs where the mental ill are they prioritized with some of the housing programs and maybe maybe a narrow question but maybe you could just answer a bit of it yeah help me on that yeah yeah so and with our health and housing service area we have we have a few different programs that offer housing and we have a couple we're part of our local CoC our continuum of care and we have some HUD grants with support that has put together some small programs so we do have housing for health which we collaborate which is a HUD funded program and we work to house our most vulnerability medically vulnerable and homeless and mentally ill here in Santa Cruz and those referrals it's a referral based program and those come through smart pass and you know we we do both the housing navigation and the long-term case management for that and we found that to be an extremely successful program in our and keeping those folks finding housing for them and then keeping them housed we have a believe it's a very small program it's right now it's funded for one one full-time FT and we have 14 14 folks I believe housed right now we also have another small program called new roots and that is a collaboration also through our local CoC HUD grant and we are the sub recipients for that with housing authority and that is focused on that's a white actually our youth homeless demonstration project part of that program and that focused on housing the same youth that are also very that are also most vulnerable and have some health experiences and we are currently currently I think we are our goal is housing six youth so it's incredibly hard again those come also come through smart pass but it's hard it's hard to one locate the folks it's hard to get them housing ready but there are with that particular program there are vouchers ready for those folks and then with our adults we get them on our section eight vouchers as well so we do have some not a lot but we have some small and mighty programs and we would love to to continue to grow in this area of encompass for sure thank you thank you a lot thank you program that they have 17 started as a downtown outreach worker and you know we saw the work and some successes so much that we recruited to start writing with our officers because we were frequently driving down down picking her up and taking her to other parts of the city to utilize her skills and then we added a second one I want to say it's been about a year and a half now some businesses should have our contact information I know Sonya has been really amazing at putting together periodic information sessions where usually the PD is introduced businesses can talk about sort of the issues that they're experiencing and then the outreach program is introduced and we try to make sure everyone has our contact information and try to really be responsive to to those calls I think some of the things that can happen or that businesses experience or workers experience downtown can be quite scary and so it's definitely helpful I think to have someone for any for really any issue related to our department we've done some sort of de-escalation training as well with some of the merchants and business owners downtown as well to try to handle some of the difficult situations that Chris is referring to and then I guess it's a follow-up to that so if you know someone wanted to call you know the police this is which obviously with being downtown and then we have our own clinicians typically if there's a 911 call not emergency or or or not the call comes out and the officers prepared to respond but if we have a clinician that's working oftentimes that clinician will kind of take the call from the officer and sometimes and oftentimes be able to resolve it themselves and right now oftentimes it's just by phone so yeah just go through the same but I think there are specific numbers to be able to come into contact with Chris and her team times we get called and it turns out to be somebody in a mental health crisis situation but it didn't come out that way sometimes it could be listed as a battery report it could be even a shoplifting but it turns out to be actually somebody that really needs some referrals and services I thought of one other thing actually two other things if would it be possible to get those PowerPoint presentations access to those we got the agenda reports but it's I didn't have a chance to write down all those numbers and it would be great to just be able to reference them so that's one and then since you brought this up Mr. Escalante I am or Deputy Chief Escalante I am wondering if so so one question I have and I was gonna ask the county folks about this treatment beds you know I've heard that that can can be an issue when someone's ready for treatment actually she knows what's talking about this the other night I was on a panel with him and and there's not a bed available right so there's let me know if there's a limit there but how many beds are there do any of you know or could you share that with us and you know and then kind of just thinking about you know I brought that up in the context of your comment about the the difficulty differentiating between you know methamphetamine induced behavioral issues and mental health kind of on their own and I know there's a lot of dual diagnosis is the term that I am familiar with but I know it's changing and so but so dual diagnosis is an issue I guess I'm just wondering if you could talk about that in terms of how you know how the channels that people end up in depending on you know how that plays out and kind of what what the landscape looks like for you know getting people treatment for meth addiction and other addictions as well question the first one probably best to come from somebody at the county as far as the number of beds typically if we come into contact with somebody that's acting out depending on how violent they are or cooperative or not you know it's really hard to do an assessment and and sit down and have a rational conversation with them to really decide for whether it's mental illness or or use of methamphetamines or some sort of narcotic oftentimes if we believe the person is under the influence and they're not able to care for themselves because by signs of their behavior they they end up going to the county jail until they sober up and and then they're released inside the jail there are services I can't speak to those the county probably could provide more detail but that's where you know sometimes somebody that really needs the resources may not necessarily get it because they're either under the influence of methamphetamine or at least suspected to be under the influence of methamphetamine based off of their behavior it's you know we don't test their blood or anything like that it's really hard to tell and sometimes they may not get the resources or services that would best suit them for their situation Mr. Mayor thank you everybody for the presentation this is Serge Cagno I do some homeless outreach and some advocacy and I'm on the county's mental health advisory board too I really appreciate all of the services that we've been talking about and definitely supportive services trying to help people change their lives I just had a few comments about the numbers that we were talking about for just pointing out that part of what we're talking about is when we're talking about the 5150 calls significantly different numbers than the whole to the people that are actually eligible for part of that because that's such a high number that was over the 600 I believe and the actual whole it's been down about a hundred there's some community education how many of those people are not eligible for services but get getting an arrest or a citation or whether it's somebody's getting referral stated you know it's just a referral there's no follow-up which is part of the challenge of our system that we don't have enough people that are taking the time to help somebody move forward part of that also is with the homeward bound program there's a lot of money that goes into that there are other programs that actually do that too it's great when somebody actually is connected but if you look at that the studies across the country there's it's actually a pretty low positivity rate for you know actual because there's no hello this is Richard Gallo calling state ambassador for access California I just want to say it's good presentation I do believe that we need to move into a more better model to assist the mental health community especially when it comes to 24-7 instead of the hours that's currently being provided by the county according to a report 43.8 million adults United States experience mental illness every year 10 million people report struggling with a severe mental illness the interferes with their major life activities individual or mental health is sometimes more likely to be killed by law enforcement than any other suspects and there is currently a 24-hour line for the mental health community run by the California Pier 1 line that number is 18558457415 and it's 24-7 including holidays we need to explore and help the mental health community the tragedy that happened with Jeffrey art I realized that police officers were doing their job how they were trained when he was unfortunately killed I strongly believe what the mother wrote in the article back then that that could have been my adult son shoot his leg shoot his arm instead of killing him so there's a working progress that needs to be done there is lack of affordable housing in Santa Cruz County that is a major barrier for our community second issue relating to housing is for those are homeless they have eviction record criminal record bad credit record it makes it even more difficult to obtain housing we don't we need more specialized housing like they have in San Jose East Bay in the Bay area there's a lot of programs there that we can thank you very much thank you thank you the outreach program that really connects people to resources for me this is three questions about the homeward bound program which I really would love to answer one is before putting people on a bus do you contact the family members or wherever you're sending them home to make sure there'll be somebody waiting for them to help them second do you doing follow-up on them after you've sent them home and three how do you measure success is it as councilmember mayer suggested that they don't come back to Santa Cruz or is it instead that the person has gotten for treatment where they were sent thank you I think I can't answer that yes we do require that a person has contact in the area that they're headed to where the place that they can stay essentially so we do require that and we speak to that person before we purchase a great one ticket for them unfortunately we don't do a lot of follow-up after that point and I don't think that we really have any information and you know how many people return end up returning to the area and I think just someone arriving back home and having a place to stay is really the success or how success has been defined so far but that it's worth looking at hopefully that answers your question Reggie calling in presentation I really as someone who really cares about making sure people get taken care of and someone who really likes to guarantee use for poor people and not sort of like hand-waving or just like hopefully it works out kind of policies I really do not like the Homeward Bound program I don't like similarly sweeps of RVs without guaranteed spots and safe parking places and to get a little bit more specific though the officer didn't have numbers on the police report 27 scene police report which was the last robust police report that the public actually got said that nearly half of calls 46% of calls for service were checked and then of course today 50% of the police budget is spent on patrolling so this obviously feels like quite a bit of resources and effort is going towards police just investigating things that they don't even know about I think we should really replace with mental health services with social workers thank you we go ahead and get up and we have this from the County of Santa Cruz's behavioral health division mental health and substance abuse disorders Cummings for the introduction is in community engagement and James Russell our forensic services manager organization and we make up about 50% of the overall health services agency budget so we're the largest division within HSA substance use disorder services public garden and and they need state eligibility requirement to any resident of the county and that's regardless of who requires substance use disorder county and our local nonprofits fully on the care of residents of the county common electronic health record to support collaboration and communication between our providers and we have a system that's built both on the provision of mental health as well as substance use disorder things I also wanted to point out is that the county behavioral health is a managed care organization and we're responsible for administering the specialty mental medical mental health and substance use disorders services plan for on behalf of the state of California behavioral health services in the county relies on a number of partnerships with nonprofits in the community and comes from a number of different sources including funding from the county which is about five acts from the state of California makes up about 15% of our funding behavioral health realignment funds makes up about 20% of our funding the largest portion comes from federal financial participation in the Medicaid program which is about 40% of our funding and then other agency county fees insurance grant funding and contributions from local municipalities total about 20% some key areas of our services on the first of which are crisis services we have a kingdom of care and I'm going to provide walk-in crisis services to any again any resident of the county which includes prevention services for adults and children and we also have a focus on providing linkage and referral to other treatment providers for follow-up care including providers within the county system that walk-in crisis service program operates Monday through Friday 8 a.m. to 5 p.m. and it's located at mobile emergency response team which operates Monday through Friday 8 to 7 and we also have weekend coverage now it's a field-based program so we will see individuals in crisis both within the office and out in the community and we are responding primarily to individuals who have are having a serious mental health crisis and then gaze on program where we have mental health police department program began as early as 2013 and we've been expanding it year after year since then our Santa Cruz police department liaison program operates seven days a week the Santa Cruz Sheriff's Office and with Watsonville police department we have one mental health liaison who works five days a week our mobile emergency response team which we call Mart is the goal is to address mental health emergencies in the community and increase access and linkage to appropriate services by providing field-based response for both children and adults we provide crisis assessment response intervention and stabilization and safety planning psycho education and support to children and adults as well as their families and referral linkage and follow-up sessions for anyone needing those until they're connected with them is our Merdy program our Merch mobile emergency response team for youth this is going to be based in South County we have received a grant to actually construct a mobile behavioral health often we will be rolling that out at the end of December and the staff will include a bilingual clinician as well as a family specialist who will respond to crisis calls in the Watsonville community as a program we've talked a little bit about already this is a core response 50s referrals to services and they also do follow-up so after the crisis has averted they will reach out to people that they've had contact with and do that critical follow-up to engage that will help the asons are working with law enforcement out in the field and as I mentioned before we currently have five full-time staff working that program strong interest and to include additional total about 2600 in 2020 and we've broken down the multiple engagements with the same individuals during a one month period of time you can see that varies from between 8 and close to 15 percent in terms of our outcomes I believe there's a question about what percentage of assessments that were done by the mental health liaison actually resulted in a 5150 hold those vary between 20 and 36 percent averaging about 30 percent so on average about 70 percent of those assessments and context do not result in a 5150 hold rather their focus is on engaging the individual in follow-up services and treatment this is just a quick illustration for the Santa Cruz County Sheriff's Office where we're seeing those contacts by location and as you can see most of them 52% are taking place in mid-county area again for Santa Cruz Sheriff's Office these are the contacts by type so the majority 43% are with individuals who have a serious mental illness followed by substance use disorder and then other de-escalation issues just another representation of the percentage of contacts that result in different referrals for follow-up the majority of referrals 57% are for additional mental health services and then followed by other community-based resources medical services with our clinics and our homeless persons health project and then some of the smaller categories listed below the Santa Cruz Police Department again most of our contacts are 14% taking place three sources at 24% liaison per hour being referred for mental health treatment and 34% are for other community-based social service resources hopes team which was mentioned earlier is our homeless outreach team as a public safety program that was created through a tax measure by the Sheriff's Office focused intervention team the 15 is a public safety pilot program structured to engage individuals in the community who have had repeated contacts with law enforcement and whose behaviors are threatening to the public safety so these are individuals who for the majority of them are actually homeless but they're the ones that are attracting the most attention from law enforcement there's repeated calls for threatening behavior in the public primarily a pro in the community for a small number of people who meet the criteria for the program and pre-covid County Jail Nation model to put these individuals in a secure setting if their behavior rose to the occasion where previously they would have been booked and released which provides us an opportunity to really engage them and have a different way of connecting them with services and again for our fit program the goal is to support individuals in the community and link them to treatment and engage them in that critical treatment they also do the outreach and engagement model so for many of these individuals they're folks who are not amenable to treatment they're not someone that you can give them a number to call or bring them to an appointment it often takes multiple attempts in order to connect them with services and the fit clients tend to be some of the most difficult people in the community that we're working with in terms of community engagement so as visible as the program may be and as many contacts that happen with these folks the rate of engagement tends to be much smaller than some of our other programs in terms of the these individuals in the community about 83% are homeless at the time of engagement so the vast majority of referrals are already homeless 37% are already connected with mental health services 30% have had a smart engagement around their housing needs 13% have had a psychiatric hospitalization within the last six months and 13% our hopes team which stands for homeless outreach and proactive engagement strategies team is a collaboration between the city of Santa Cruz and County behavioral health department with a focus on outreach to homeless individuals in the community for assessment engagement and connection to services and there are multiple pathways that are connected to the hopes program including linkage to our specialty courts within the county the behavioral health court for individuals with felony charges pending and then the PACT court which has more of a focus on homeless individuals with misdemeanor charges here's a quick graphic from presentation we had done to the city council several years ago it shows those four different pathways depending on the level of court involvement for the individual as well as the severity of their mental illness or substance use disorder there are these four different tracks that people can go down including repeated efforts at outreach and engagement for people until they eventually get connected with treatment quick illustration the referral sources for the hopes program majority right now are actually an outreach worker which you heard from earlier this afternoon as well as in South County so there's a significant homeless problem in South County tend to get quite a few referrals my presentation and I'm happy to answer any questions that you might have a quick question and maybe this is more of a broader sort of state legislative question but what intervention occurred to support that individual who gravely disabled and that's really the offices under behavioral health is the public guardianship program and individuals who are not able to care to meet some very stringent legal requirements although we might see someone who's refusing treatment and struggling to take care of themselves out in the community the court holds us to a very high standard that has to be met and rights can be taken away and if they can answer some basic questions around where they're going to get food and where they're going to sleep at night the courts are hesitant to take that individual's rights away and appoint a public guardian now when we admit someone to an inpatient program due to a grave disability so if they've come to the attention of law enforcement and they're at imminent risk and we've now admitted them involuntarily that's often the point that we are able to pursue a conservatorship and appoint a public guardian who will then oversee that individual's care and placement in the community for services there is pending legislation that's been reviewed and particularly down in Southern California that may be applied statewide to broaden the criteria for who meets the conservatorship requirements I was certainly interested in that the challenge with any broadening of that legislative community capacity so if we start putting more people under a conservatorship it requires an expansion of that program which is very expensive it also requires community resources additional community resources for placement so many of the locked care facilities that we place our residents are actually out of county because we don't have in-counting capacity to provide that level you know I recognize the complexity of it as well as just the threshold but I do think that many we observe on our streets here you do need sort of a wait-and-fail model right you have to be so civil to not be able to get feels also like the humane thing to do and so however we can advocate for a more conservative conservatorship thank you a couple of questions Eric related to that very last slide you showed I was under the impression that the Bobby's HACS program wasn't working in effect anymore and the FIT program had been put on hold for decommissioned because of budget issues do I understand that incorrectly or maybe you could just I'll answer the FIT program question first and then I'm gonna kick it over to Jeff yes when COVID hit the county it wasn't because of budgetary reasons it was because earlier we relied heavily on the use of the jail to do these what we call flash incarceration so for having multiple contacts with with an individual who's behaving badly in the community we had actually a section of the jail reserved for our use to be able to put folks in there and use some different strategies and engagement but with COVID and the risk for simultaneously to the program we're also dealing with the high community needs hoping that resumes James to add anything I might have missed about FIT clinicians continue to work out in the field to continue those folks who there's a total of 90 that at any time we're on the FIT list so any of those folks that need some type of case management on a limited basis or connection to other services they're really trying to outreach that again it was a focused deterrence model and so the deterrence part of it is not there it's just the clinical component of it I'm regarding the PAC court it's continued to morph but it is still in existence it did as many of the courts it went dark for a little while at the outset of COVID but it has reinstated now some of the clients in there are the hopes clients that go through that there has been a couple FIT clients and there's several people that aren't anyone's clients they just end up in the PAC court for review and the city attorney is very involved with that as well I believe okay and then I did have another question member watching mentioned some of my concerns those individuals and we see you all see them and just seems so gravely disabled that if they seem in humans that there's not a more active intervention and I recall that the governor in his state of the state message earlier this year talked about needing a review of the criteria that there at least this was as he described it so strict that they're actually cool so I would just appreciate your comments on that and the other is about the multiple incarceration that get into another topic there it's just it seems like the system we have is not working and you know I sent around a message to people about a case that was reported to me from the community someone was identifiable the mental illness referred to a state hospital told me would never be really released because he was doing well on on so-called honest meds and then continued to be a fan was compacted by a local resident when the status chest that's in on property the guy says I need help and and was deeply confused now I understand there's always multiple versions of any given story I know that and I know there's a backstory but you know we these are the kinds of stories over and over and over again overlapping mental illness and substance abuse and and re-incarceration for what appeared to be minor offenses and goals etc. So treating the policymakers and frustrating the community and I can't imagine they're not also frustrating the civil providers. Responding to all these folks is that we forget about the need for capacity upstream housing and it's as you can imagine extraordinarily difficult to think about or even engage in any treatment when you're homeless on the street and you're constantly worrying about where you're going to get your next meal from or where you're going to sleep that night are you going to be attacked by and that's just a huge challenge for anyone doing homeless outreach you know we can have the conversation with someone about hey we have this treatment program available for you but that's often the last thing on their mind and if we have the opportunity to take a more upstream approach and we had housing available for people to first provide them a stable safe place to live it then opens up a lot of doors and gives us the opportunity to engage them when they're not having to worry about being homeless we need to do and locations to build these types of programs that are community so desperate. Thanks Eric. Yes Chris and Christie noted in the very beginning that the homelessness is the key if you can find housing for somebody you can almost immediately change the trajectory of their quality of life is for the better and there are a lot of models that are proven to be quite effective that are out there but that do require that housing first housing is health care type of approach and I think that the more that we're able to secure low barrier housing you know so not having to wait for a voucher or rise to the top of the coordinated entry list through smart pop assessment or you know wait for you know to have some sort of income coming through through your benefits if you're applying for benefits to be able to pay rent in a in a regular housing situation that might accept you with your issues you know we need to have low barrier quick access housing and I think that for example Eric and I were talking about an SRO model which I come from up in Portland we've had a tremendous success up there integrating clinic services into housing making sure that people have all the services that they have wrapped around them and that is really where you're going to start seeing the most success of long-term on the street it's very challenging for them to take and partake of and participate in continuously any kind of treatment services and then I would say coupled with that is the availability of the right dose of the right kind of treatment at the right time so meeting somebody's readiness for you know yes it's time for me to want to change my life and I think that one last thing the comorbidity of substance use disorder with mental health is extremely high people use substances to self-medicate the substances may be masking the mental health symptoms and maybe exacerbating the mental health system and so when you have a co-occurring approach to care you're often left with treating one or the other but not both and so that makes it equally challenging. Our human services department on this and it was borne out for folks that we were having contacts within the community there is this other group of people who tend to be very difficult and engaging and what we found with a number of them is they actually have a history of a traumatic brain injury and for those folks who have a traumatic brain injury after the age of 18 there's really no one responsible for them and as hard as we can try in providing behavioral health services or substance use treatment services it really isn't what they need and what they're going to respond to and there's a unique group of people that you know they don't they don't fit in to any one service provider there is there are regional centers throughout the state that focus and have the expertise in working with that population but only if the traumatic brain injury occurred before age 18 so there was legislation to do a study committee on this I don't know what ended up happening to that I think COVID in the budget state budgets are real that process but there was a lot of interest from other counties in the governor's office and taking a closer look at this because we have this group of people who are really struggling out in the community and they don't qualify or fit into any of our existing systems to provide care to them thank you well so many questions I'll try to keep them brief thank you for the the overview and I you know I kind of have been trying to draw out what I would appear to be responsive to the question I asked the first group of speakers about the biggest challenges and obstacles to getting your work done effectively so I have a couple I so my questions to kind of around the the question of referral capacity it seems to me that a lot of the challenge is related to that so regardless of where people are I mean there's the siloing of services challenge you know and the pathways that don't necessarily fit you know with a messiness of where people with experience and condition but then there's the capacity and so a lot of the conversation is about making these referrals and then but then we don't have like I mean my understanding is we don't have that space for you know people who want to go into treatment we don't have I mean we really have very little supportive housing all of these are known then the answer is to you know build more and resource them so that they can provide those services but I guess I'm just I'd like to get a lay of the land because I think this is something that the public really also needs to understand what is available you know there's what we get messages like so many messages but you know these people all need to go to treatment and you know with you know without editorializing on the kind of limited nature of the response you know well like so what does that look like I mean how is there you know if somebody wants to go into treatment is there a place for them to go with respect to the relationship with the jail and loss of that and I have some questions about that that I'll say for a second on a moment but like the Tilbury Center's closed you know I'm just trying to understand like where do people go where where you send people if they're not you know jail ready or you know and I I don't really feel this way about it I'm sorry for lack of a better shorthand the jail ready or hospital ready you know what do you what's the capacity where can people go where can you yeah and I'm happy to share that perspective my perspective on that and I'll also ask members of my team to chime in as well you know I think we have capacity if you look at a continuum of care so least restrictive setting to most restrictive setting we have capacity that's been built on either end so we are heavily reliant on using independent housing in the community so working with people to find an apartment in the community and then we bring supports to them and then on the other end locked care settings and in patient psychiatric units that we can admit people to if they're in imminent risk to themselves or others but a lot of what's missing is everything in between so for the person that needs residential care that has 24 7 staffing available to them on site we have very little capacity in that area intensive supported housing services for people who are living independently in the community where we have enough staff to see that person every single day twice a day if needed to support their independent living that we don't have enough capacity of it's it's all of those things in between that are lacking even the housing stock availability you know on the low end of the continuum of affordable housing that's safe and secure for our folks they are competing with everybody else in the county for housing and it's very difficult even if they have have the fortunate luck of getting a housing voucher that will support their rent it's very difficult to find them when there might be competing with 50 or a hundred other people for that same apartment thank you yeah the perennial problem so in terms of relationship with law enforcement I'm I'm just I'm hoping you can talk a little bit more about that because it sounds like the that relationship with the jail program it's in that zip I keep paying the acronym straight so but but you're continuing to provide some kind of service so if I mean can you see a way forward for that type of program to continue without law enforcement participation I mean I think that's one of the things that we are all talking about is ways to separate you know non non-violence emergency response or non-life-threatening emergency response and I know sometimes it's hard to know in the moment right where that's going to go but just you know how to how to how to do that without having the jail as a place for them right so what are your thoughts on that the fit program no because fit is actually a public safety program so we're providing the mental health the behavioral health support to law enforcemently continue extremely skills well-qualified who are in the fit program that we will likely have to lots of places we could put them and stakeholders but if if a decision is made not to continue fit there's certainly some opportunities to use those staff given their skillset in other areas they're most similar to our mental health liaisons and we've heard repeatedly from law enforcement that they would like to expand capacity in that program particularly in South County because we only have one current did you have anything during this time of COVID the jail is not we never use the jail for mentally individuals who are suffering from mental illness that is not the goal and that's that has never been used for that it folks are committing crimes in which again we would like to circumvent someone who has a mental illness that being how it's being portrayed in the community is is that they're loitering or you know trespassing acting out in a way we want to try and get that taken care of before it results in some type of jail thing anyone going to jail right now is only going because it's a repetitive it's going to continue unless they read the officer removes that individual from the scene because of COVID it's site and release pretty much on misdemeanors on which all those crimes are so again in fit in and of itself no one is on the fit team unless they met a pretty high bar for being very aggressive individuals or history of violence on their records so again they weren't just put on fit the majority of the folks are not diagnosed with severe mental illness or unfit that's it's purely behavioral and then again rises to that level of concern in the community that's a great point James that's important to make is that if we are working with someone in the community who has a serious mental illness and they're in crisis the last place we want them in it's a jail it's a jail because of the severity of charges so if they may ultimately end up at the jail but we provide the supports and the assess how they remain at the jail don't remain unsupported while they're there. Thank you and last question why did the sobering sector close with the COVID related program? I know it was operated through contract with Janice but perhaps you can put in locally using Ford to open up the IMD exclusion it would pick up zero and interestingly when we the MediCal organized delivery system waiver which dramatically expanded substance use disorder treatment services in the community our residential programs were subject to the same IMD exclusion we were paying the full cost of those residential waiver that the state of California applied for they also applied for a waiver to the IMD for any substance use disorder treatment that the SUD side without having to worry about that IMD excluding flexibility on the mental health side there are federal waiver and all what's wants to see is revenue neutrality lives for a new waiver which you have to be able to demonstrate that there will be cost savings and what for you to do when they've considered we'd have to show. This is Reggie calling in again I was curious about where like the Benchlands encampment fits into these models if someone is living in an encampment funding since it is so much cheaper the number of people who get access to resources it seemed like Benchlands encampment had a pretty high number of people who could be served with a very wide variety of wraparound services was my understanding so I'm wondering what that looks like in the broader system of services thanks. Jan because our focus is not providing services to the homeless actually support services at the Benchlands and that's the homeless persons health project and I would really encourage a future presentation by HP HP both the medical and behavioral health needs of the people living there. So other than that we tend to get called in if if there's a crisis occurring and they need our Merck team or our mental health liaisons to respond and evaluate the person for a 51 50 hold but James Karen I don't know if you had anything else you wanted to add to that details on how they respond via 911. Can you send out the Merck some detail on how that response works. I'll go back to the original question in that it the 800 number per county behavioral health is not a dispatch number it's more of a triage number where you're calling in to access services or to ask some general questions related to what might be happening in the moment with you or a family member related to mental health. So again it's a triage number and that person triaging might say wow this sounds like you're in the middle of an emergency right now that is very emergent that you need to call 911 and let me help you do that or they might say hey can you get this individual down to the clinic and we'll set things up so that you can have an appointment in the next couple hours or whatever or meet with a Merck clinician or if it's at a secure site the the Merck team will go to that site to meet with individuals. So again it's not a dispatch number it is a triage number to access the appropriate level of services or consultation hope that answer that. And James how does the mental health liaisons get dispatched? So the mental health liaisons are always going to be dispatched in as the caller indicated they will be dispatched with a police officer sometimes those calls can be triaged without responding ie they can call up on the phone and settle things over the phone because it might not have been a true emergent need in the moment it was just something that might have been going that way so they can handle things over the phone but otherwise if it is an in-person response the mental health liaison is responding with law enforcement. In regards the IMD exclusion it's most likely a very naive question. Hello can you hear me? Yes we can hear you. Okay my apology I thought I unmuted I guess I didn't I just have a question for Eric regarding the mental health services act funding pertain to prudent reserve that's sitting there it's my understanding there's millions of dollars that just sitting there not being utilized and I think we need to utilize to meet the needs of the mental health community by tapping into the prudent reserve. Second comment I have regarding the homeless persons health project I have extreme reservation regarding that program I've had personal experience working with homeless individuals where the staff pick and choose who gets help and who doesn't get help this particular program everyone is not treated equally thank you. On the HPHP again it's it's not within my division at all it's within our clinics division so they would be that only is required their services to tap into those prudent reserve funds so they are not accessible to us at this point but our county as well as the other counties continues to work on advocating for that should we need it and setting up a process with the state to be able to act again they are funds that were required to volunteer at Food Not Mom I would like to first of all thank everyone who's working in the mental health services for everything that they do in our community and just comment on seconding someone's comment previously about 50% of police being 50% of the police budget being for patrolling and those funds could very well be reallocated probably to things like housing first for our community as well as tapping into resources like UCSC hotels and motels and increasing vouchers for that and on top of that just trying to re divert people away from the criminal system and into housing and mental health thank you very much thank you so this is Sarah Ringler I've been listening to the presentation and I guess what I'm most gratified to hear is what I think we already know that we need housing the needs for mental health and substance abuse abuse the main thing people need housing it's a really clear message and it's no big surprise idea of making it easier to I am here that's your name mayor did you hear that I was here Renee yeah we can hear you okay we're here me the public who were interested in crisis assistance helping out on the streets program that was launched in Eugene Oregon and so today we were able to invite Ben Adams in crisis counselor with Whitebird Clinic to provide a presentation on the Kahoot program and so then I'll turn it over to you thank you happy Monday and thank you all for sitting through several hours of communication and presentations before before this one I appreciate you all hanging in there and some interesting stuff certainly good stuff good things to hear about I'm gonna see if I can share my screen it's gonna let me it does currently work as the as a consultant out of Eugene Springfield Oregon I'm actually in Oregon right now but I typically live in Pasadena California where I also have a another job with LA County and Department of Health Services and I do this kind of in my free time I have a brother-in-law and a sister-in-law who live in Santa Cruz my wife sister lives there and goes to UCSC studies there and my brother-in-law is a public defender so I have a good connection to you Santa Cruz I've been there numerous times there's a beautiful place and my afternoon referred to it is you know kind of like the Garden of Eden to people it's one of the most beautiful spots that I think I've ever been and really love visiting so I'm here today to talk about cahoots and more than just talk about cahoots but also sort of start the imagination process of what it might look like for a cahoots program to come to Santa Cruz both in the city and also maybe surrounding areas as well so back in 1988 and 89 the the 911 system was very new four or five years old it hadn't been around very long and the city of Eugene was about to hire two new police officers because they had a very low police officer to pop to population ratio the city council came said we're gonna hire two new police officers unless somebody has a better idea and at that at that time the executive director of Whitebird Clinic said you know we've been running this 24-hour phone and walk-in crisis center for about 20 years now and a lot of times we have people that we'd like to go meet with them in the community because they are they don't have the ability to come to us they don't have the money they don't have transportation they're scared to ride the bus that kind of stuff so he said so he said you know we were thinking maybe it'd be cool to have a crisis assistance team like our crisis center who would help out on the street and and and you could maybe put us into the 911 system you give us radios just like the police and the fire department and the city council said well that sounds kind of cool you know so they agreed and that was how cahoots was born Whitebird was started and run by you know the counterculture in the 60s a lot of hippies so they thought it was really funny the thought the acronym cahoots because they're in cahoots with the cops so they thought it was hilarious and and that's really how it was born and and now what you see with cahoots is it's grown significantly changed quite a bit and has it become significantly more comprehensive and robust and in how we respond to things but this picture that you see here in the background this is a very typical cahoots call there's a young man his name is Christian EMT and a young woman her name is Ashley she's a crisis counselor and they're just checking on this person who's asleep on on the sidewalk you know Eugene's probably pretty cold doesn't look to be too cold but it's probably pretty cold still that you know they're making sure this person has food water if they are intoxicated maybe they might want to go the sobering center for a little bit of warm or spot to sleep maybe they're sick they need to take them to the hospital they can check their vitals you know offer them any kind of services if they want to go to the shelter for the night and there's availability there they can take them and so on so cahoots is cahoots and and ultimately cahoots is not interested in franchising our mod ourselves out to other cities so we're kind of thinking more about what our model is so I brought those presentations I'll refer to our model as the mobile crisis intervention services or MCIS model I might also just refer to it as cahoots style mobile crisis as well those two things essentially the same as I said it's a new model for first response however it has been around for 30 years but the idea is just is sort of just starting to catch hold in other places including Olympia Denver Oakland somewhat San Francisco with their new program Portland is going to be implementing a very robust $5 million program to cover the whole city there and based on our model so it's catching hold and growing so what it is so MCIS is a non-emergency first response to residents experiencing mental health substance use and homelessness related crises when people ask what cahoots is in a in a very simple nutshell that's that's what it is that's that's who we are basically you have any one of those kinds of crises and you call for assistance and you'll get this fellow here you'll get Matt and a partner of his and instead of the police or the fire department so what do we do we really alleviate the burden that has been placed on police and the fired EMS systems to manage crises that derive from emotional distress substance use and homelessness a lot of the conversation around policing today is about the immense burden that we have placed on that that system to manage things in these areas and so cahoots and a mobile crisis team like cahoots is really geared to alleviate that burden we also try to deescalate situations that are potentially very volatile they could escalate to the point where they need police or they need fire and EMS and we try to sort of head those off early on as I mentioned already the EMT and a crisis counselor I when I worked on the van and I was on the streets I I started out of the crisis counselor and then I got my EMT license so I worked both roles as called a cross-trained person and you can see this is just another team in action here there's a Oregon is very wet I imagine Santa Cruz being next to the ocean probably has a lot of similar issues with people live on the street having a lot of trench foot and things like that wounds that need to be taken care of because of the moisture in the air this man his name is Manning he's doing wound care probably on somebody's feet and this woman is the crisis counselor and she's just hanging out and making sure no one bothers them while they're doing that and giving them help know how they're privacy the crisis counselor does a lot of things they do suicide assessments and interventions kind of family mediation just general deescalation of people who might be very upset very overwhelmed feeling kind of out of control they they are we ask a lot of them they they need to be very multi-talented multi-skilled and they also need to be very good at connecting with people very quickly the EMT's are a fantastic resource for us because what they allow us to do is they love to determine whether or not somebody's mental health symptoms are in fact deriving from some kind of physical health issues so for example people who are hypoglycemic in their diabetic sometimes they can seem intoxicated or maybe just kind of little out of it and maybe they seem like they're having some kind of mental health episode but actually you check their blood sugar it's 40 50 60 and we know okay this is actually hypoglycemia very simple fix the EMT allows us to manage that kind of situations without having to take the person to the hospital or to call the fire department similarly when we're on a mental health call let's say somebody who's self-harmed who's cut their arms or something like that the EMT won't take care of that kind of stuff without having to get a bunch of people involved which can be very overwhelming for the patient and every once in a while you have some calls that might just go sideways and somebody might go unconscious or overdose just something like that and the EMT is there to help us with that those types of situations so the EMT is really a distinctive part of our kind of mobile crisis intervention style another distinctive part is that we are accessed and we are not law enforcement but we are accessed the same way that law enforcement and the fire department is accessed which is you can get us through the 9-1-1 or non-emergency phone call system the vast majority of our calls come from the non-emergency number however some people who don't have enough money to pay for for their phone bills that still want to get us they can call 9-1-1 because it's free and then and access us that way just like police and fire the call takers take the calls the dispatchers qualify prioritize and then send us as accordingly as we need to go wherever we need to go so the welfare check of our primary type of call that's the thing we do the most of and this can be on a wide range wide array of people for people sleeping in the park people are not returning phone calls people making vague and oftentimes also explicit suicidal statements via text or social media I know Santa Cruz you know as a university town just like Eugene a lot of times these can be students whose parents maybe you know have some conversations with their their young one and they can't really you know they don't know who to send they don't know what to call they don't want to call the cops send codes people who are unseen by neighbors with mail building up there's some concern that maybe they've got their deceased inside and then just generally you know your everyday a run-of-the-mill person screaming on the side of the corner they're not breaking any laws they're not doing anything you know dangerous but somebody should check on them that would be a cool mobile crisis call so a little bit about welfare checks in Santa Cruz City and County about 22% of all the police department calls are welfare checks in 2020 so far the sheriff's office had had anywhere between 43 and 56% of all their calls as welfare checks and these two combined are about 30,000 calls per year a mobile crisis team an empty is seen could handle a large portion of these and and this would allow for faster police response times to emergencies because a lot of these types of calls are not emergent they're not they don't require emergency responders and as we'll see later based on the CPSM report back in 2017 2018 those those those calls actually take the police a long time to respond to and so this would actually create a faster response time for those types of situation we receive services everyone everyone received services I think who's is often portrayed in some some people portray us as being a great response to homelessness and that's very true other people portray us as a great response to mental health calls and that is also true but the reality is that we focus on on all of those things on both of those things and and much more we're very similar we're a first responder team we're a crisis response team we're very similar to the police and the fire in the sense that it doesn't matter who you are if you're in the city limits you can get a you can have us come out to you so people living on the street people with Brooklyn suicidal family members in dispute but a lot of group home permanent supportive housing board and cares all those types of resources access us very frequently the shelter in Eugene we have a great relationship with them they call us multiple times a day and we have a little bit of a you scratch our back will scratch your relationship we provide them with a lot of support and then they allow us to bring people in to the shelter after hours even sometimes when they don't really have room they'll make room for us so that's really nice and there's a lot of talk around sort of like race and and and the coots model so I guess I just want to point out a couple things one is it just by our sort of existence we do we do prevent police interactions with black indigenous people of color who are experiencing mental health crises it's just kind of by default that's something we do it's also good it's good work it's a good job we also don't we don't rely on the western model of mental health and we can we are conversant in it so we can talk to you about you know your experience of being bipolar or schizophrenic but if you're somebody from a different ethnicity or different cultural background who doesn't think of their experiences that way we're not necessarily we don't have to talk to you about those types of things in that way we can just help you and support you with however you want to interpret your own experiences and it's also really exciting community work that I think is important for people who that they might not have the opportunity so much because they may not want to join the police or the fire department a little bit about outcomes these are most common interventions although I've mentioned almost all of these already I think some some important ones to to point out our transportation to staff services so we take people to the shelter the urgent care the emergency room crisis center sobering center clinics and on and on we take people all over the place you know we transport them to get food to get water to get you know meals any kind of things like that we also have a really great relationship with the local food bank in town we're called a mobile food pantry they give us a couple of pallets of food every couple of weeks and then we're able to hand that out to people who are food insecure because they're living on the street or because they just are economically food insecure due to their income a little bit about our relationship with the police we do have a really good relationship with the police in both cities both Eugene and Springfield and some there's a recent Eugene Police Department report that I do want to highlight that showed that we're diverting somewhere between 8 and 10 percent of all police calls and and that in in 2019 of the tens of thousands of calls that we took only 24 of them ended with the police responding to us code 3 which is day with lights and sirens so there's a lot of questions about the safety of Cahoots and and how it is that we can do this safely I think this shows that very very infrequently are we in emergency situations where our lives are at risk almost never and in 31 years no Cahoots worker has ever been injured on the job no one's ever been stabbed or shot or anything like that I would say I've been I have been punched by a 90 pound woman who is very intoxicated so that was you know very difficult but sometimes that happens and it comes with the job but but but no one's ever been very hurt 86% of all of our responses did not involve police at all so the vast majority of what we're doing does not have police and involvement and those those calls that do involve the police that do involve the fire department very very frequently those are the police or the fire department calling for us and not calling us calling for them so like I said very very few times are they are they request are we requesting them first so one of our key kind of work the key kind of work that we do is our responses to suicidality just under 70% of what we do with our suicide interventions us alone with no police involvement the other percentage that involves the police or the fire department again those are calls where we're either being sent out with them or they're calling for us after the fact and 64% of all of our suicidal interventions did not involve us taking people to the hospital we were able to sort of handle those types of calls in the person's home or on the street with the person sometimes we do them in businesses or therapist offices as well and a large large proportion of them we don't end up doing any kind of hospital visit we were very proud of these numbers last year we did almost we did just over 2000 calls with some kind of suicidality you can see here Ashley and Christian again on a on a regular crisis call and you can see this is this is in a restaurant of some kind or some kind of a cafeteria so really common for you know for these types of calls to happen just out in the community I do want to point out something from the CSM report with Santa Cruz and thinking about what a mobile crisis team might look like and what kinds of calls they could hopefully divert from police so they can have more time to do their emergency calls from the CPSM report almost 6500 or 13.7% of all the community initiated calls for service we're some we're basically a call which is a citizen in Eugene we call those public assists just a check we call those welfare checks and then medical or mental health calls in that report it states most of this effort is an inappropriate use of emergency personnel that which is to say these types of calls welfare checks used up and welfare checks alone used up approximately 6500 officer hours another great quote from that report that I thought was really important the city has defaulted the handling of almost all social ills in the city to the police department especially those dealing with the homeless population through the focus groups conducted with the department supervisors and line-level personnel it was obvious there's a high level frustration among all employees regarding the level of responsibilities of dealing with the homeless issue I think this is really critical when thinking about Kahoot's model for your city because that frustration is real and probably all cities and we really exist to try to alleviate that frustration to really help the police departments and the fire department to focus their energies on other things and then finally here's a quote from chief mills of law I recently spoke with a sergeant about this funding he said if somebody could take the homeless issues entirely from us and stop us from responding to mental health call please take the money the sad reality is that no one else has stepped up as the first responder to those issues and I think that mainly what what's being said there is that it's hard to know what the what a good model would be for this how do you how do you structure it and and we think that we have a really great model for that keep going on medical outcomes we do approximately three thousand or more emergency room diversions every year two thousand or so ambulance diversions and we take about these are these are 2017 numbers and they're kind of low we expanded our hours since then so these numbers are probably higher now we did find that last year we saved between the fire and EMS Medicaid CCO and hospitals combined we saved approximately 8.5 million local community dollars and and I also want to point out here this photo which I think is a really good image about what a hoot van looks like from the inside and also sort of illustrates some of our safety measures that we put in place for ourselves in order to keep us safe while doing the work so here's the patient compartment what you see here's the patient compartment this is a fiberglass barrier it's only accessible from the cab side so it can't be open from the patient compartment it's a roomy space but it's got plastic walls plastic seats it's very easy to clean and very you know very good for people to lay down in or reconstruct bicycle you know restore you can transport bicycles and all that kind of stuff and you can see this woman here her name is Niles she's she's she's grabbing hold of the door so there's no handle on the door so once the patient's in the back of the van the only way they can be let out is by us this is for their safety as well as ours it you know the people who are experiencing psychosis or things like that may be at risk to get out of the van while it's moving or something dangerous of that of that nature so we don't trap anybody in there if they request to be let out we stop and we let them out but that's a one way that we practice safety so look a look a little bit of numbers the Eugene Springfield population is about 230 thousand so between those two cities it's just a little bit smaller than the entire county of Santa Cruz that being said the city of Springfield itself is almost identical in size to the city of Santa Cruz and we took about 6,500 calls last year in Springfield to compare that a little bit to what we said earlier with the let's say like the mental health liaison program they were taking just over 3,000 calls total in the entire county so we're doing about double the amount of calls just a little over double amount of calls in the city of Springfield then that program is throughout the entire county and that's partly because we are very a very efficient model because we are first responders and not not as much second responders and also because we just are degraded into the system I'm pointing this out I don't want to be not to do to be controversial just saying because I think people will be interested in this a little bit about how much I think it would cost to run a mobile crisis team and just a point just to show that it really is not that much money and and and could be implemented fairly cheaply just to give a little comparison to the Santa Cruz Police Department so a mobile crisis team I think this is my sort of estimation based on how much the cost of living and how much social service workers and EMPs get paid in the area would cost you about $1.5 million for a 24-hour unit to run 365 days a year this would come to a total of about $23 per resident of the city of Santa Cruz and it would look at if they could probably take somewhere between 10 and $15,000 which would come to about $150 per call the Santa Cruz Police Department is a very busy police department they respond to a lot of calls every year in comparison to cities of other a similar size they actually responding to probably more than than most typical police departments do so they they seem like they're very busy the more I look at their numbers and I must be I think it's probably pretty overwhelming so the main main primary sort of other types of crisis response in in the country who really is the co-response model about 2,200 cities around the country utilize the co-response model and we've already heard a little bit about that the mental health liaison model is that so one is it the the mobile crisis with the CUSA we're not coercive so we don't do any involuntary holds we don't do 5150s we try to do a wide array of services a wider a wider array and that's partly why we have the EMT but also why we do family disputes and that kind of stuff stuff that most co-response models don't handle we are a cheaper in the long run because we don't use licensed clinicians we also have that medical component and then ultimately we do divert the police because the co-response model is police with somebody else which means that the police still have to go out on those types of calls this is a this is a story it's a really good example I think of where the the co-response teams do a really good job and at the same time where mobile crisis intervention services would be more efficient and would provide a cheaper and better result so here's that is the West Hollywood Sheriff's station in the West Hollywood co-response team is called the Met and they they responded to a man he was 65 years old recently homeless he'd never been on the street before and the sheriff met with him called the Met the co-response team called the paramedics so by my count there's got at least eight people out here responding to this one fellow there's four things that happen there's the first response there's the mental evaluation the Met the medical the physical health evaluation and the transport all of those services could be handled by a coot-style mobile crisis team the way that that the LA Sheriff Department estimates this kind of a call it would cost them with the paramedics and the sheriff and the Met it would cost about thirty nine hundred dollars to have that huge response this one fellow but with a coot-style mobile crisis team you could do it for you know an average about a hundred and fifty finally just want to make a little bit of an analogy and what our sort of model how our model works which is to say that we're a paraclinical model so paramedics are not doctors right paramedics that ride around on ambulances but they're very skilled at being able to assess if someone needs to see a doctor similarly who does not license clinicians we're not we're not like masters level people with licenses but we're very skilled at being able to say this person should or should not go see a licensed clinician and that's really kind of similar that's we're very similar to the ambulance model that way we are a triage and a transport type of unit designed specifically so that we can be more efficient in how we allocate our resources rather than and then making sending out the doctors to the people determining who really needs to see a doctor the most and then efficiently getting them to that situation okay so you know thank you so much for for listening to this presentation I love giving these presentations I love talking with folks about this and I'm really looking forward to all your questions and and you know seeing talking more about about what the model is and and and how it works and anything that you might be interested in knowing I'd be really happy to answer a very interesting presentation I appreciate it my understanding is that this is a program that operates out of existing and I understand that correctly and that your service area is the gene and spring field metro area is for lack of a better term so I'm in some stale and I guess I'll leave it at that the program is operated by the Whitebird Clinic as I said before there they started out in 1969 as a sort of counter-cultural clinic and they've evolved into a clinic that provides services medical dental counseling behavioral health crisis assistance on the streets crisis assistance in in a crisis clinic 24-hour phone line that's a dental that all of this stuff is a huge huge organization that that mostly works with people who have low or no income although with cahoots we work with obviously anyone so sometimes we'll be working with people on the street sometimes we'll be working with them in there you know seven thousand square foot homes we work with anyone and then the city of Eugene pays for the cahoots services in the city of Eugene so they fund that through the police department so they give the money to the police please give the money to us some of that stuff is owned by us so the hiring and the benefits and all that kind of stuff is owned and run by a Whitebird Clinic the vans are maintained and fueled by the city and owned by the city and then in the city of spring field we are funded mostly by the county of Lane County partly by the city of spring field and then we've also recently picked up a little bit of money from the local Medicaid CCO so the local Medicaid CCO realized that we were saving them a ton of money because they're doing wound care and all that kind of stuff for people on the street rather than doing it in the emergency room and so they said hey we'd like to pay you some money to make sure that you're doing that really well and so they started paying us some fun too so then of those two cities we have a 24-hour van in spring field and we have a 24-hour van and a 12-hour overlap van in Eugene and we run oh what is it now we have we've right around it's right around 30 to 31 I think full-time employees FTE but we think we employ more like 40 people thank you it just occurred to me there was a difference in scale for Eugene it's about three times bigger than Santa Cruz and also as you described here this multi-directional support for this contract yeah a third party anyway you don't need to go into more detail but okay yeah would like to hear a little bit more about your funding because I think it's you know it's important to understand like where the money is being saved is that is that being redirected or is it are you getting funding from additional funding sources probably a combination I'd love to hear so more about that well yeah those four funding sources are all of our funding so city of Eugene Medicaid CCO County and City of Springfield the city of Springfield like I said earlier is identical in size to the city of Santa Cruz both population and and area we in terms of funding Eugene is a cheaper place to live than Santa Cruz so thinking about someplace like here it would need to be more expensive it would just cost more just because folks would need to you know be paid a little bit more and and then we also we also we get we garner a certain amount of donations every year you know I think it just varies from year to year it's often you know $50,000 to $100,000 we're very well regarded program people really like us we win the ball we always win like some award every year or whatever and and so we usually use all that donation money to do things like buy blankets buy sleeping bags buy tents and that kind of stuff tarps and those kinds of things as well so donation money often covers a lot of this sort of resources that we hand out I want to say thank you for the presentation I first heard about this model 2013 when I was on a public safety course for the city and I really have found it fascinating and since then I visited Eugene a couple of times and I've just felt like it's safe and welcoming and like a great place so I appreciate all the work that everyone's doing up there as well and I just have a question about the level of training for the individuals and I'm sure it varies I know you mentioned you got your EMT but typically like what's your entry you know I don't know entry level and then you know how long do the employees stay with you usually and is there a high turnover rate or is this kind of a career or a stepping stone and can you just speak a little bit more about that yeah absolutely so to be a crisis counselor with us you have to have two years of what we call mental health experience in a or experience in a non-traditional mental health setting so typically this is something like a group home a shelter a drop-in center but mostly it's environments where people have a tendency to become easily escalated or there can be a lot of conflict and the person has to show that they're skilled at maintaining peace and and sort of order by by interacting with people in a positive and welcoming way to do that and so people who are skilled doing that so what I also tell people sometimes that we really like people who have been bartenders baristas people like that that that really need to be good at making you feel positive you know making you feel good somebody who can talk to you and immediately make you feel like you're their best friend because that's a lot of what crisis work is it's going into somebody's home in their life where they're the most vulnerable they're the most overwhelmed they may be in the worst moment of their life and they need you to be able to come in and speak with them and make them feel positive right away and connect with you very quickly so somebody who can do that that's what we're looking for obviously with the EMT on the medic side we require them to have a licensure that's either an EMT basic an advanced EMT a paramedic or an RN licensure so any one of those four licensures can can work with us and then we kind of also need them to have some some of that similar crisis counselor skills you know people that are that are good at doing medical evals on somebody who might be suicidal and things like that it's very difficult so they've got to be skilled at that kind of stuff too we train them we train them for a long time they need to and it's difficult because they need to show that they know how to do pretty much everything they need to show us that they know how to do a suicide assessment they need to show us they know how to do a family mediation they need to show us they know how to do you know talking with people who are experienced mania people are hearing voices all that kind of stuff and so because we can't control what kind of calls they're going to get on on any given shift while they're training then the training can last rather long additionally we do about 20 hours of sort of classroom work with them before to get on the van before they get working and that's really to introduce them to a lot of the concepts that that they need to know and and just kind of get up to speed on some of the stuff that they might not be so skilled at some people come to us with a lot of experience like one of the women who's the current director of the program she came to us with a ton of crisis experience it was just amazing we barely had to train her at all some people like myself who had worked in drop-in centers and stuff like that was kind of doofusy on the suicide assessments you know I had to learn how to you know they had to really get me up to speed and skilled on those types of things so it just sort of depends on how long it's going to take people that did that answer earlier questions it does how long do people usually stay I mean do people see us clear or like a stepping stone to I think if it paid better more people would see it as a career but we can have one everyone wants their job to pay better so you know some people stay for a very long time so my friend Robert has been on the team since 2004 he's been around over half the life of the program and then some folks especially some of the EMTs that's really great for them to come in work there for two years and get their hours so that they can apply to physicians assistant school or medical school or things like that so sometimes it works really well as a leaving off point for people to go on to further study thank you yeah I appreciate that now I was yeah thank you but anyone who works on cahoots is like a cahoots junkie we're all obsessed with it I mean I'm obsessed with that I would I'd go I love it I go back by the way maybe back to the funding maybe you covered this but it seems to me you did say how the amount of trips to the ER you've saved do you get money to medicare that way or are the hospitals I'm just familiar with a nonprofit program that has four beds when they get released from the hospital where they go back on the street you know we give them a bed till they're up and about and that really helps fund you know this nonprofit yeah so we don't we don't do any billing so and even when our money comes from Medicaid we don't bill them for that they just kind of give us a lump sum for and I can't remember what the number is but they they just recognize that that look we're saving them a grip of money okay you know and and so then they just pay us out that much and then you know there's been there's been a back and forth about whether we should try to bill but crisis services are very difficult to bill for a lot of times you know health insurance companies don't want to pay for it they'll figure out any way they can not to so then it just becomes too much of a burden to figure out how to sort of like chase down all these bills and stuff like that so we've just stayed away from that I thought of one more question which probably doesn't have any definitive answer but um actually really just to get your thoughts so um and it was helpful because I know about the program I've been to a couple of your presentations and other vets so I'm really glad to be here today thank you um but I what I hadn't thought about was um the kind of timing and development of your program so you know so having started having whitebird kind of be established and doing this kind of activity um is and then kind of and then integrating into a system that was newly developing is really different than our situation where we have I mean and not just an existing system but an existing system that is like like really complex pretty convoluted with these siloed funding streams and qualifications and eligibility and all of that and um and so it's it's just it's really overwhelming to think about how to try to map something like this onto an existing system that's just as kind of challenging challenged and challenging as it is um so I'm wondering if you have any um thoughts on you know how we move forward you know advice this is just kind of the elevator version I'd love I hope that we can continue to work with y'all uh moving forward uh more direct but just for now what your thoughts are yeah certainly so we do I mean I guess you're asking me maybe a little bit for my sales pitch um we at Cougs we do offer consulting services to cities who are interested in this kind of stuff um that that that involves a few steps of things one of which is to look at all your police and fire data and sort of give a good sense about okay what are these calls could we could a mobile crisis team potentially handle and then also you know looking at your your area and doing sort of a resource map and saying okay who who would probably be most interested in calling a program like this um what where could the team transport people to is it feasible to have them transporting to here or there or there what's already existing so you know something like the mental health liaison how would um a mobile crisis intervention team like who's fit into that you know um a lot of cities that have corresponds have really talked about the idea of maybe creating what is essentially a tiered system so you have kind of like the the the cahoots style team is is um you know the the first responders and then if if there needs to be a whole if they feel like there needs to be a whole then they then they get the corresponds team involved and um things like that we would we would look at that kind of stuff and then um help identify maybe a local nonprofit that could run the program and help write the RFP for that and then ultimately since I live in California and I you know have a good relationship with um my sister-in-law um then we could I we would come up and um actually train the folks and and help get that whole thing going and off the ground we we do have a lot of experience doing that we did that in Denver we did that in Olympia but although we did it sort of in Springfield as well um there's a lot of things that we learned from that experience expanding into Springfield um and so I think there's a lot of lessons that we would be happy to impart um upon whoever ends up doing this kind of thing if you guys are interested in creating something like that awesome around ask the question I really had in mind which is sort of we can't um we can't create the same history that you evolved in in your region but where can we start from with what we have here in Santa Cruz now and so I appreciated your response to that one of the things that you did mention was that um you sort of build capacity based on sort of a gap and needs assessment but also a partnership with a nonprofit and so my question is I think is a nonprofit essential to how this model works in various regions or have you seen any other forms of structure well I uh and there's some there's some disagreement between me and other people at whitebird about this so this is uh maybe my opinion not the opinion of whitebird clinic um I think that it can work just fine not doing it through a nonprofit um I think it can also work really well through a nonprofit and there's positives in mine this is to both so um the portland version of it is not going to be through a nonprofit it's going to be funneled through the fire department um similarly with the um san francisco version although the san francisco version is going to be kind of beefed up and um I think I think they're they're having too many employees on each um on each team they're but they're going to use three people instead of two which I think is too much um and it's going to cost them a lot and it's going to be really hard to stop it um so you know so they're also going to run it through the fire department um but then cities like denver they're doing it through a nonprofit and also I think something like the city where like the crisis worker is funded through the county or something like that and the EMPs funded through like a hospital um so there's other ways to do it like that too um and I know other cities have kind of considered doing a similar thing um and then there's just and then like Olympia they just do straight nonprofit so you know it's there's there's different ways to do it and think about it and think about what might work best for your city in your area all right I also have one of thank you so it sounds like it just sort of is um based on the various cities and then my other question is in terms of reimbursement you mentioned that um you know your program doesn't do the doesn't kind of go through the the process of reimbursement but are other programs in other cities are they using that model because it seems to me that that although your gift of the dollars it seems to me that often you need to have some sort of form of reimbursement for them for the medicare Medicaid dollars no no it's billing I don't think any any other programs are doing billing it's like I said it's just really difficult to bill for crisis services so and and I should say too you know one of the things that we get around is that we're able to do transport to hospitals um and urgent cares and things like that we're not mandated to transport to the emergency room the way the ambulances are um precisely because we're not an ambulance um and sort of what what makes something an ambulance is that you are going to give drugs and route right you like have somebody on a gurney and you're going to give them some kind of medication so we don't do that at all so it will give you Narcan if you're lying on the street but as soon as you get in the van and we're driving we don't Narcan you you know and that that keeps us from getting that ambulance designation which makes us more flexible around where we can transport to because we have that flexibility that also means that we can't do things like bill for medical transport or bill for something you know of that major so we we try to avoid billing at all costs because it just allows us to be more flexible and then the Medicaid money that we get is like I said it's just a lump sum they just recognize that we're saving the money so they start to pay us a little bit I'm sorry I have one last question in in terms um in terms of legal liability with like you know health and and willingness is there has that been worked out in this model yeah I mean we've never been sued before things that sort of like keep us um safe on that kind of stuff a lot of uh you know policies and things like that to keep us from that happening um one of which is that you know as I mentioned in the presentation if somebody wants to get out then we let them out you know we don't we don't like crap people um similarly we pay for our own malpractice insurance the EMT's EMT's have to pay have to work under a medical license of a doctor so we have a medical director who's the the medical director for the program he's an emergency room doctor he provides and he provides us with um you know sort of oversight and and gives us a lot of uh sort of direction on what we can and cannot do so we have that as well put in place um to sort of keep us uh our liability low yeah I just wanted to thank you Ben for your presentation um really interesting work that you guys are doing and um just a great history to learn about um I'm just curious a couple quick questions and most of my questions have been asked by other council members so I won't I won't take too long um I'm curious about I'm just curious about how you know the assistance and the treatment and um sort of all the efforts whether or not there's an integrated system at all with for example so you know here I'm sure you're I think I saw you online all day today so with us so yeah we've got this obviously this um system of care between our behavioral health and um fire fire police response um I'm just curious about how your data or I'm just curious about that integration with either other public safety entities or into the county mental health behavioral health um homeless um homeless kinds of structures are are are you guys feeding information back in or how to how do you how do you integrate so in other words you're doing all this work on the street but you know you're part of a system where you're we're basically hopefully trying to serve people and get them you know into a more stable situation initially but then hopefully as we've heard many times today into you know into stabilizing themselves in their with their lives and you know their their uh health and other things do you guys integrate back into kind of the larger system of care continue oh yeah okay yeah definitely so um the metaphor that I like to use is that we at cahoots really view ourselves as the spokes on a wheel so if the if the patient is the hub and the services available to them are the wheel that that can sort of move them forward cahoots use ourselves very much as the spokes we're there to connect that patient to those services and we're also there to support those services when they need us to provide crisis intervention or something else so there's a lot of things going on in Eugene there's um homeless outreach teams there's permit supportive housing there's crisis center there's a sobering center um there's uh you know there's there's uh what's called the high-risk team or the HRT that that looks at okay who are the sort of top 20 utilizers of the emergency room and services and are living on the street and how can we get them into housing so that they aren't using those services so much we're a part of that team um we're we're in a lot of meetings with all of those services we um you know we're we our administrators end up just having meetings constantly with all of these types of areas so crisis sobering um you know homeless shelters everything because we're connected into all of them we're sort of we're like I said we're sort of the spokes to all of them um and and one of the great things about our service is that not only are we making referrals to those types of services but when we make that referral to that service if it's within business hours and it's during the day we can just take you to it you know um it's it's not a like oh here you should go here and um and please do that tomorrow it's like uh yeah here you want to go to talk to the people over there about getting into treatment cool we'll drive you down there you know and we get in the van we drive them down there and they can do a talk you know um you call them up hey you you're free to do an intake for this person for for mental services yes all right we'll be there in 15 minutes you know um so that's a really great part of our program um and similarly if I go out on on a call at 2 a.m. and the person says you know I really want to get into this program but I don't know how and we're like oh that's cool we'll help you um I can just put in a call for that person at 9 a.m. the next day uh and one of our vans will go out and take them over there uh when when it that call comes up so yeah we're very integrated into that whole system um and I think that uh that system really relies on us um and similarly um you know case managers and people who do permanent supportive housing they work really difficult jobs um that also end up with them responding to their clients on weekends and after hours and all that kind of stuff and so with who's it um really frees up people who do that kind of work to just call us up and say hey can you please just go check on my on my client who's suicidal or why not so so I can just have my Saturday um and and so we do a lot of that support as well that's yeah that actually that was my next question was I was you know so much of well there's a number of you know number of different kind of situations but but yeah that sort of that integration was specifically on the case managers so it sounds like you guys um are you know you're part of that system and um I mean do you have a sense in Eugene uh since you work there and you guys have been working there so long I mean do you have a sense that how many case managers are part of that system through various nonprofits or county government or not quite sure how it all falls together up there in Oregon yeah that's a lot of uh let's see in permanent permanent well permanent supportive house in permanent supportive housing and just homeless uh case management there's um there's three really big programs there's a place called shelter care place the Catholic community services which is in a lot of areas and then white bird as well okay um and there's probably uh between those three organizations well shelter goes by far the largest they probably have like 50 I mean it's a very large organization um Catholic community services is probably smaller probably more like 20 or 25 and then white bird has like four um case managers so you know it's it's probably in the realm of like 70 to 80 case managers working on that kind of stuff um at any given time cool well I really appreciate um and all your work that you guys are super inspiring and um I was reading all the materials and looked at through everything and went on and read a bunch more and so very inspiring work so thank you very much for the presentation appreciate it yeah thank you it was fun thank you um I wanted to just say I did talk with um people at the county to get uh there um to end with our police chief as well following on the discussions that we've had just recently the the study session all from on the focus strategies report having to do homelessness which I understand is not entirely unique um service some cluster that that your talk because it talks about but certainly related to the large extent um and we did have at our previous study session a very long long presentation on a major rethinking of the county's organization of homeless services which was a lot of the focus was on better coordination um among county departments and other partners in this um and I did just confirm with uh the police chief and I had heard from the people at the county as well that there there there are active conversations now aiming exactly towards this goal so that's very encouraging um and we seem to have gotten a lot of good background study again it's not exactly um comparable but it's it's uh very much related um and I guess it's a question to the mayor are you looking for a motion here to accept these reports um I would be happy to propose something along that line um if you are my thought would be to accept the three reports um and uh at some point in the coming early in the coming year request an update on the uh discussions between the city and the county the various divisions of the county um for re-arrivalization and improving service delivery and also some courage continued communication with SAHOOT I think they have a lot to offer it's different but sitting there um um yeah I think that's a relationship with continuing yeah absolutely that would be my motion the one issue that we still haven't opened up for public comment so okay um but yeah I'm happy to uh return to that once we're going back to it yeah thank you no problem size of the city and so on so we have to put together bid for you um yeah and I you know you're free to request that and I'd be happy to provide that okay and then how long to try to get it done from start to finish in nine months hands on the ground trained up by uh so it depends that really obviously depends largely on on sort of political will and funding and all that kind of stuff um but if if you sort of like get it figured out all right we're gonna you make a determination we're gonna do something like this and you hire us then we're gonna we're gonna get you you're gonna get you to having a kahoots style thing on the ground whether that's 12 hours a day 24 hours a day 18 hours a day whatever you know five days a week seven days a week not it's not clear but we try to have that you know going within within nine months great thanks I just wanted to add a couple other partners I don't know if we've talked about that we might want to consider including would be obviously like dignity, camps, Kaiser, um any of the other health organizations that I'm not thinking of and then obviously AMR I'm sure they they transport a large number of people and I know someone my husband used to work on the ambulance how expensive that that little taxi ride is for some people or not taxi ride you know I mean like a ride but sometimes it's not necessarily what's needed so I don't know if there's funding that could be diverted away from that towards something like this or who pays for that I don't even know so and I've never talked with AMR about this but I I have some suspicion that they might be kind of interested in hearing more about something like this because they're an organization that because of their responsibilities of you know transporting people having you know they're requesting to go to the hospital so many of those don't end up being reimbursed from uh medical or Medicare that could easily go to a kahoots style program for especially for what's essentially a non-emergency transport um you know so that they that bogs them down and it ends up sort of like preventing them from getting to actual emergency quicker so um yeah definitely would I I think they might be interested yeah you read read read my mind that's exactly what I was thinking because I know they have a lot of unreimbursed expenses when they take people just because if you call them and you ask for a ride you get that ride they have to so I felt like they would be a partner that would be worth 6-1-2 anyway and city council members will go to the public who want to comment the presentation that was that provided for you you're talking to me okay my name is gray g rey um we uh volunteer a lot out here in san jacuzzi county one of the places I do volunteer food not bombs I didn't get on earlier I I mean I got on the phone line but I wasn't called on was wondering if anybody I didn't hear this if anybody on any of these committees including the one that just gave out the information one I was interested in knowing if any of them are homeless or really or close to somebody that's homeless and the other thing is I wanted to comment maybe it'd be a question too personally I've been you know my vehicles anybody on your committee or in your group is homeless thank you um is that a question I'm not sure if that's a question from you know uh can you hear me hey Reggie um Reggie here I love this program I want to see this program um and I want to see it uh really taken seriously and looked at you know I think what the county was working on was nice but you know it's clearly not meeting the same scope and demand that could be meeting it's not diverting calls which as I said earlier today they are like half of calls are about check or suspicious activity I mean this is not uh appropriate it's not an appropriate use of resources and it's not appropriate for people who have mental health crises who are being called on um and I know you know um council member Matthews is visibly um you know uncomfortable during this meeting she doesn't want this to happen she wants to push it out to uh early this year because then it'll be a new council and a new mayor who is possibly not as interested in a program like this but Santa Cruz is a great place for this program we have tons of free activist driven um uh like food and uh other assistance programs that could work in tandem with this warming center day night storage food not bombs dsa Santa Cruz deployed there's tons of just basically free coordinated resources and labor here and uh and the community really wants this and so I would like to meet before next year before we have a total council member shake up and uh really get moving on this thank you can you hear me yes um this is she like Rio and I am speaking from two different directions here the first is I'm an activist community member who's part of the dsa alternative emergency response working group and I've also had a personal experience of of a 51 50 on a uh young person and wanted to share that as well um I wanted to say I'm I'm excited and thrilled to see that hello hi um my name is josh for Hinsky I live in town I'm calling um I had probably a question for Ben but also just sort of a comment which is that it sounds like like this is an interesting proposal uh like the whole idea is something that it sounds like there would be tremendous support for in this community it's really very different sounding than a lot of the other things that we disagree about um but but I think the idea that that that we could do something that saves money and that does better treatment for people and um and and can work in a way that's pretty simple within the community that doesn't require a big complex mess it's something to think about so I think one of the things that I would ask for the city council to think about today is can you ask them formally for a you know proposed budget for the support that he could give to this um work uh and I think the question I have for for all of you to think about is and for Ben in particular is is there a way to do this like to pilot this in a small uh can is this the kind of thing you could pilot and test over like without too much setup like could we say try it in some small number of calls in the city and see if it works um and see what the problems are and also just sort of give ourselves a chance to get used to it and see what that's like um have you done something like that before uh is that possible Justin is that something that's possible here um in our city that's the question okay thanks thank you mr mayor for bringing this up to the agenda I'm really glad that we're having this conversation um I personally have been a part of um a few informational sessions with cahoots in the past and just really inspired by the work that they're doing um and I think especially in a city like Santa Cruz I think we have a whole lot of precedent to do a kazoo style program um given that the police chief himself has said that um if we have the services and the resources for homelessness then please please do it basically I'm paraphrasing that but I think we really have a really great opportunity to do that and um I'm really just personally inspired by this I'm glad that the council has taken up this conversation um and I'm just hoping that the council will consider moving forward with um you know whether it be a pilot program or some form of program to be a kazoo style program um but with that being said I feel very strongly that it should be a program that is independent um of the police department um and I feel like it is a potential for a really awesome and compassionate and empathetic solution to um a lot of the issues our community members face so I'm really excited about the program really appreciate the council on hearing this and having the study session and really encourage the council to move forward with this program so thanks so much. Can you hear me? Good evening. This is Serge Kagnil again. I quick comments um absolutely thank you for presenting this evening and for the city council to give time for this um this was one of the intermediate recommendations from our community advisory committee on homelessness um it seems like a possible way forward would be trying to figure out what the basic details of the program are and uh sending out a um LOI letter of interest programs in the county that would like to apply for something um and having them offer up budgets as they to provide services depending on what the details are at the same time starting to talk to the county about different ways of funding this kind of program just hoping that we can actually move forward on this sort of an amazing program that does a lot of collaboration uh to help people on the streets but also to get people off the streets. Thank you. Thank you. Carol Williamson from the National Alliance on Mental Illness of Santa Cruz County. I'm calling to say thank you this has been really interesting and I think it's important to continue this discussion. It's so complex like um like some of you have mentioned figuring out how to interweave this with what exists already to enhance and expand the capacity through the whole county not just the city would be really great to look at how do we get some law enforcement response eliminated from encounters where where it's um overkill not needed and there's many many cases where we have tremendous partnerships with law enforcement and I appreciate them so much but the opportunity to um have an option like cahoots is is um exciting to me some so many calls are just someone who's suicidal depressed or just need someone to talk to not be further frightened. So uh the downtown outreach program um that encompass runs seems like sort of similar but would need expansion with a lot more staff uh capability to cover more territory and a van and um so there's just sort of a starting point in my mind of what would be a frame of reference um but I also hope that you create a study session that looks at capacity it sounds like everyone doesn't have a handle on the numbers the scarcity of the capacity for mental health housing of all levels so um thank you for your study and thank you for putting on the session and thank you uh Ben Kleimer. You've been unmuted you'll be given two minutes. This is Sheila Carrillo again I'm this is a really complex system for me I just wanted to say that in the short time our alternative emergency response group has been working to educate ourselves and the community there's been an incredible community response in favor of instituting such a program um and we have had a petition on actually I was just notified that you already had an opportunity to speak and so unfortunately I'm gonna have to ask uh you said that you didn't you wanted to give other people so you said you were gonna come back around to my question so my question was to the person that just gave the last information and actually to um hello I I don't think you can get a better issue that is bipartisan um both the fiscal conservatives and as well as the progressives can both agree on this um issue that will save the county money especially during this economically uncertain time but in particular I I think that we should also focus on how this Kahootz program has helped maybe those who've experienced homeless to become mental health counselors themselves maybe even um become the EMTs to help service the very population that they once were a part of because I know that Santa Cruz has a very successful program such as the streets teams but I also think that the Kahootz model could provide an opportunity for our community to um provide a job for those who are here who are being um diverted to the services that are there for them but are also having trouble sticking to a job that provides meaning and oftentimes you know where you have come from what circumstances you have overcome can provide you a passion in which to go into helping those who you identify with so I think that's something that should be put on the table as well as um I would like to say a quote you know a developed world isn't where the poor drive cars but where the rich use public transportation and I think I have heard of a Kahootz presentation before where one of the members actually went to a politician's kid who was having a mental health crisis and was able to service that and I think that this system is able to service people uh of wide demographics and wide socioeconomic background but also can maybe um employ those of the same type and I think especially in a community in which um mental health is very foreign and we don't have an integration and where um average people can learn about mental health this can really provide an opportunity for us to learn more about it so as citizens we can be more aware and and do much better for our community and and for the world so thank you and uh appreciate this time with that we're going to close public comment I think there were a few questions kind of knock heads and find out what it might look like if we were to one with just paramedics and a person such as a mental health liaison or more of a Kahootz model which is obviously a little bit different it was a fantastic explanation of what they have done and uh so that's as far as we have gotten uh we have not put any structure behind it but just the commitment to work together and to see what that might look like in the future I was going to just um ask uh we try to get those questions answered but I think that happened um you know I and I understand um council member Matthews wants to make a motion um but so I'll just make a couple of comments here um um you know I believe that this um the model that's been described to us um the level in the community and you know kind of be on aside from the um uh how to say this um well the interest in the community the um the wonderful presentation we've received about how this model this kind of model can work um and the potential savings um to be achieved of course that would happen over time um you know as well as just having you know moving towards a more compassionate and effective responses to mental health crises and other crises um you know I don't I think we must really really seriously consider pursuing this kind of model and I think that um we have somebody here who is an expert in this who is advising um city you know a lot greater population a lot greater you know challenges or different kinds of challenges and I think that we we're really taking this seriously and and take um Mr. Kleimer and Adam up on the offer to provide us with some information about what it would cost you know a proposal um so I I really think that that's a serious um serious thing for us to consider and I um you know I'm just going to be honest here and say I'm not really interested in hearing all of the reasons why we can't afford it and it's going to interfere with our work plan that's been adopted um this is something that um would not you know divert other staff from you know working on all the other issues it would be an opportunity to have more of a dialogue with partners in the community and um and I think that could happen at you know the city manager's office level um and given that the police chief has already said that this is something that he's made a commitment to at least converse about um that now is a is really a good time to be considering that so I'm just going to say that for now um I will um you know be trying to offer up uh you know some kind of direction related to that after we hear uh from uh council member Matthews thank you um I'm not sure that our direction is all that different frankly um this is um a very interesting presentation and the background material that you provided ahead of time I think we hear from our own public safety staff and openness to explore this uh an interest in exploring it um my own feeling is that for um a meaningful scale it should involve the county that's open for discussion but that's certainly something we've heard about uh the youth model is a sense of scale and that that gets back to the cost and capacity um it's clear that we have a lot of really good community resources here um and that there's active interest in new time in improving the coordination um body service and cost of the kind of emergency cost and crisis intervention that we get so there's a community desire to do that um then we have actually contracted with other groups outside the county for various programs we contracted downtown streets with block by block etc so this is definitely an option um as also that's been mentioned by the earlier presentation um and even Mr. Hoot an obstacle for us is capacity and and that's another whole issue we have to work on so the motion that I would would prepare would be the following um to accept the three reports delivered today from scpd and encompassed from community from county mental health and to request the report back to council in early 2021 regarding the conversations currently underway between city and county for reorganizing and improvement improving local emergency crisis response engage additional community partners in the discussion of improving coordination service and cost and continue the conversation with the Hoot for consulting on further options including involvement of the county for the most exciting possibilities we've been dealing with homeless well I have since 1988 and there's there's nothing been new I mean we're innovating new we keep doing the same thing and here's a chance I I agree with the motion I'm not absolutely all the four points in the motion but I think the city of Santa Cruz receives all the homeless the county is very important but I would hate to see it bogged down because we can't serve the whole county but absolutely they have to be a partner but I would hope as you go forward um next year uh and look at this carefully and just just think in terms of why don't we try something that just hasn't been tried great that's all thanks thank you for walking did you raise your hand in your video yes sorry no I wanted to see if maybe we could get the motion back on the screen I apologize something popped up on my screen and I couldn't see it so I was um blocked out from being able to see the whole motion um but as as maybe we do that I can just maybe share my appreciation for the presentation I think we do really have a great opportunity to revisit how we've done things and to think about doing differently and also really base it on the results we want to see and hopefully good humane outcomes for individuals who are experiencing crises in our community um so thank you very much I just wanted to make sure I fully understood what was part of this motion yeah this sounds really great okay I don't have any further questions I agree I appreciate the motion I completely agree with all of it and I will support it I am going to make a motion now to amend this main motion to direct the city manager or uh designate to explore uh requests for a bid from um bedanum climber and cahoots insulting services uh to establish uh an mcis is that what it is mobile crisis intervention uh and to communicate with the county our interest in coordinating this effort with them as the maker of the most motion um I am happy to accept the second part of that I think uh asking for a bid right now it's premature we don't know what services we're asking for um so I'm happy to communicate with the county our interest in coordinating the effort with them that's a friendly amendment uh I'm not interested in accepting the first one so I I had a feeling that was going to be the case so I'm just offering an amendment motion um and we'll see if I get a second on that I was trying to second the motion Justin I was oh no I was just trying to see with what I was second the motion but uh I'd also like to add uh to me I I think what the motion says to me is we want to move forward and explore this program and all the components of it which I think to use the wheel as an example because everything I heard is what I see is so needed both better service and of course to save money so I would hope what the motion is you know let's not fool around let us invite them start the ball rolling in terms of looking at that program or how to apply it went to apply it and one of the stuff it's not going to happen overnight I'm sure it's a quite a lengthy uh um it would be a lengthy process but uh I interpret this to move forward on Kahoo's program seems perfect for the city absolutely perfect so if I could just ask the clarification the motion to amend was to amend the main motion to add items one and two to the main one not not a substitute for it got it got it yeah this is council this is my I wonder if um because I I appreciate the direction that I think we all share I'm wanting to go in so I wonder if one potential um like compromise solution could be that conversation with some of the partners that we get more clarity on what a potential um consultation to our city so that we're able to flesh out I think what some of the um just would be sequentially in kind of the whole council along to say sure after we have these discussions with what our key partners are with including our key partners and then also identifying clarity of what the bid would look like that then the potential or once that's been that is a conversation that we would more productively have if Kahoo was involved in that conversation because what I have found in my over 25 years now of watching um how um our local government structures respond to homelessness issues um is we always say yes we want to explore this we want to move forward of course it sounds like a no-brainer and then nothing changes so if we don't have concrete steps to move forward um I I fear that it'll just be you know a six six months from now another report on progress that the county's made um from their focus strategies consultant which is great all of that work is great but that is not what we're talking about here so I'm going to leave that amendment um table as it's written um I think that that it's like we are serious about this we need to make a commitment to get the support the expertise that we need to move forward appropriately so I feel awkward interjecting after what councilmember brown just said but um item one to me is it's a little unclear as to what the direction is and I'm wondering if it might be clearer to uh direct the city manager or designate me to request a proposal for consulting services okay yeah that's good make it more palatable for but you're right this clarity is important my question was for ben and I'm wondering typically what kind of information does he need before providing a bid like it sounds like we would need to do some background work before the bid or is that something you could throw out I'm just a little confused about that no I don't need any more information to give you a bid because you know we like I said we kind of structure these based on size of cities um so you know because obviously we're working with the city of Los Angeles versus the city of Santa Cruz is getting the significant difference so that's the main information that we need to know so which we know so um we can get that to you probably within 24 or 48 hours alluded to I just wanted to point out a couple of things also that um are you just muted yourself working I'm sorry uh can you hear me now all right thank you uh yeah I just wanted to uh comment on some item you alluded to and that is uh with respect to the process one is that of course the other the major issue that will have to be addressed to is funding um and Mayor noted the mid-year budget review because you know we've got a major deficit that we'll be dealing with uh next year unless there's some kind of stimulus package which we don't really know and probably won't know till probably next year sometime as to whether there'll be anything that will allow us to not have to cut we're now we're looking at another four million dollars that we have to cut from our budget next year just to remain solvent so that is a big major issue by you know finding funding in an environment where we're having to cut significantly to our general fund and then the I think I think that's oh I'm sorry then the other component of this of course is that before you next week will be the the interim recovery plan so that's the other thing you have to keep in mind in terms of the context of the work plan and how does this fall into priority so just a reminder that we that will be coming before you and you have to keep keep in mind how it all fits in with everything else that we're doing and and how it sits in terms of priorities as well so just a couple of comments there on on two items thank you these and councilmember walkins and I would say if we could keep our comments sure we do have a heart yeah I'll keep my comment that this model is is worth looking at especially in terms of bringing them in to once once we've had some discussion with our own within our own system of care I think that you know we've been doing a lot of work with the county and and actually there's been a lot of work with our service providers COVID has really exponentially you know made the county and all the service providers really work towards you know creating systems much better communication I just feel like you know asking for a bid right now without going and doing our due diligence with our partners it's just it feels a little bit cart before the horse so I understand the urgency I understand the interest I think it's a interest very very interesting model we should look at but I think I'm not going to support issuing a request for proposals right now we have to go out to our partners which we spent a couple of years trying to build a partnership and a good communication system with and we need to go backwards and talk with them and and then we can bring this information forward you know as appropriate during the budget hoping mid-year so unfortunately I'm not going to support it because I think it's pushing us too far and having been on the two by two and worked through this whole year on COVID related and being in contact with folks almost every week I feel like we need to honor those coordination and communication structures we've been in place so we've put in place over the last year so those are my comments thank you I can just really quickly interject responding to the mayor's comment it's the mayor's parodia to defy the question or it could be done by motion as well I am willing to modify that fourth item in my motion to say and direct city staff to continue conversation I think it's more than city manager's office city attorney kind of alluded to this or designee I mean I think it's our public safety staff but if we said this and and direct city staff to continue conversation you know you would put that on me go to my motion up there well maybe that's not how you take your minutes well you said number four and there is no number four so I just put it where I'm at look where you see my motion it doesn't say what you think yeah there's accept request oh that's what I hear yeah so that one can we just say and direct city staff to continue conversation I think the question here is whether the maker of the motion to amend accept that as a friendly amendment and withdraw the motion to amend you know I'm happy to I'm happy to see it in the main motion I am not going to withdraw that that request I think again if we're serious we need to do something rather than say we want about thinking about it down the road it's not getting tight to lay I'm thinking it anyway I will again reiterate I believe this is responsive I think it's premature to get into an RFP right now the staff can have this discussion bring it back I'm deceived there I would like to divide the motion and I would like in my original motion I would like the fourth item to say and direct city staff to just add it right there and insert at the beginning I think everyone understands what yeah take out most of that really I'm sorry I'm using up time here should I just read it then would read and direct city staff to continue conversation with the group for consulting on further option including involvement of the county here just been wanting to get getting an RFP I think you know it really it will be important information to understand what could be potentially offered to the city I also recognize the interest in wanting to bring our partners along and wanting to have their their buy-in and potential shared ownership over what a future strategy could look like for our city and for our county so I'm wondering if maybe a potential compromise could be to have the two by two decision and our county has already really embraced having these diversion services that there is a real opportunity for us to co-create you know a shared model and so how can we I think ultimately get to what I believe Councilor Brown and Councilor Matthews are expressing in a way that's collaborative but hopefully going to be more sustainable so just the potential motion it could be the kind of compromise and I'm I'm fine with moving that direction about where the majority of the council wants to go but I'm I'd like to vote on the the amendment and I think if we're serious we need to again demonstrate that we're going to take some action if it means you know we you know talk with cahoots and they can prepare a bid and it seems like that you know and then two by two doesn't talk to the county and you know the county expresses interest in going in this direction then we can we can address that when the time comes but I'd like to vote on the the amendment and the or the amendment is a separate motion if that's the will of the mayor to divide them and then we can vote on the both separately before included the maker and the seconder of the motion because that will help inform my vote for the amended motion you know actually not for me I really think it's premature to go out for an RFP what are you getting an RFP for that's why I'm interested in continuing the conversation with cahoots consulting for the option they've mentioned that there's is one model and it's a good model but they there are similar programs that operate differently in different cities we have we have our own resources here and we have a clear intention to improve them but I would rather to have a little bit broader picture rather than saying what's your bid to go to this service here in Santa Cruz I think that's frankly jumping to gun I think involving our partners looking at our resources is a critical step when we look at what are the options open to us so the council should vote on whether to accept the amendment to the motion first and if that passes then you can vote on the main motion with as amended only one friendly amendment accepted yes don't we have to vote on the amendment to accept it this one and then language is hot the table Bonnie right right so we still have the amendment right and and to put here strictly through the rules you would vote on the amendment first and then vote on the main motion with on them just for clarification on the minutes purposes councilmember bat brown would have went through her amendment and made a second motion yes no because I this is I'm not me so I'm not calling this a substitute motion I know councilmember Matthews has included and so this would be like a another motion I guess right in addition that we vote after whether it makes perfect sense as an amendment to the main motion and so you can vote on the amendment first and then vote on the main motion okay no vice mayor Myers and mayor Cummings golder