THE PROGRAM FORMERLY KNOWN AS ALTERNATIVES TO 911 STARTS TO TAKE SHAPE
The Wellness Crisis Call Center and Response Treatment Program (WCCCRT), Sacramento County’s Alternative Crisis Response Program for Behavioral Health Crises or the program finally known as Alternatives to 911, finally got some action this week. And it was BIG.
On Monday December 13, Sac County Behavioral Health Services had what they called a “Report Back,” which really was just a regurgitation of the labor they crowdsourced without compensation from the interested and invested individuals that signed up to participate, or what they like to call “community stakeholder workgroups.”
This crowdsourcing was done back in August during four two-hour sessions where “community stakeholders” were asked for their detailed input on:
1) Program Operations and Training Suggestions
2) Community Partner Collaborations
3) Advisory Committee (the placeholder for this body currently resides under the Mental Health Board as a sub-committee)
4) Community Outreach and Communication Plan.
Over 150 individuals participated in one or more community stakeholder workgroup meetings and/or surveys. No demographic information for participants was provided cuz fewer than half (29%) of participants completed the demographic survey that followed each two hour meeting.
Participants were invited to different breakout groups for each topic area, and these breakout groups were facilitated by 2-3 county staff. First, Sac County got community members to design and develop their marketing and advertising strategy for the WCCCRT.
Participants provided thoughtful recommendations regarding ways in which the Wellness Crisis Call Center and Response Team could be promoted, including the locations where advertising could be placed and types of groups that could advertise, how to best reach specific ethnic/cultural communities, and specific images and phrases that should be included or avoided on the advertising materials
Next, community members recommended that the WCCCRT teams receive training in specific areas and some participants even hooked it up with specific training resource recommendations. The specific areas of training recommended include Mental Health, Substance Use-Related, and Clinical Skills (including trauma-informed care); Crisis De-escalation and Suicide Intervention; Peer Training; Training on Cultural Competence and Cultural Responsiveness (especially as it relates to the impact of racialized trauma on the individual experiencing a crisis); Program Operations (like the legal rights of individuals with disabilities and individuals receiving mental health services); and Familiarity with Existing Community Resources and Having the Ability to Access and/or Conduct Warm Hand-Offs to Them.
For the Implementation topic area, community members were shown a graphic from a report on the the LA County Department of Mental Health's Alternative Crisis Response (ACR) Program that defines levels of risk in Behavioral Health Crisis, and asked “Do you agree with the 4 levels of risk and criteria that define the levels of risk or do you recommend any changes?”
Most participants indicated that mental health and substance use concerns and crises should not be handled by law enforcement but instead should be referred to Behavioral Health…Many participants articulated ‘high risk’ situations as involving immediate danger/threats to others (with consideration to severity of the threat and ability to carry it out) and situations in which law enforcement dispatch is legally required.
A few participants agreed with the levels of risk and criteria provided in Los Angeles’ crisis triage framework and stated that the levels of risk outlined are standard protocol that many counties and states use. Other participants recommended reviewing the CAHOOTS and MH First models’ risk factors and triage framework
Regarding Program Evaluation, participants were asked:
“If you were a recipient of this service, how would you like to give feedback (follow up via online link, phone call, etc.) and what metrics would you recommend be tracked to evaluate the Wellness Crisis Call Center and Response Team?” Most participants stated that a phone call is a good option for obtaining feedback because it is more personal and conversational. Some participants suggested that the WCCCRP offer a follow-up call to ask how the caller is doing and for feedback.
Because everyone loves to fill out a satisfaction survey after they’ve just had a mental health crisis, right?
Next, community members were presented with the topic of the Advisory Committee for the WCCCRT being a sub-committee of the Mental Health Board (MHB), that its membership would be broader than existing MHB members, and that its function would be to review outcomes and make program recommendations. Peeps were asked “what types of experiences and backgrounds would you recommend be included on the Advisory Committee and what other important considerations should be factored in the selection of the Advisory Committee members?”
Most participants recommended prioritizing and centering those who are most impacted: individuals with behavioral health lived experience, people who have been arrested or formerly incarcerated, people who have previously or are currently experiencing homelessness, and family members and caregivers of those with lived experience.
Most participant groups indicated that they did not recommend including individuals involved in law enforcement or criminal justice (e.g., sheriff, police, probation). Some participants cited concerns regarding biases and a desire for people who are thinking outside of the cultural status quo.
Community members continued to develop the WCCCRT program for Sac County Behavioral Health Services by identifying resources they would like the WCCCRP to be able to refer individuals to &/or provide warm hand-offs. Over 8 pages of community resources, notes, and considerations were collected.
Although this “Report Back” was only a regurgitation, it’s important that Sac County as a whole and BHS in particular starts to be somewhat transparent regarding their efforts to develop and implement this behavioral health crisis response program, and this Report Back was a slightly decent start. It serves as an accountability measure. We know they know what we need.
WE are the experts, WE have a Ph.D. in experience. WE are the subject matter experts.
Sac County has yet to compensate these community subject matter experts that they have resourced. Thus far, community engagement has been performative, a decoration at best. At this point, Sac County needs to get busy building up community trust for this program to be successful by giving us what we need. And now we get to hold them accountable. Let’s see if they’re gonna implement the methods, procedures, and policies that the subject matter experts have recommended.
The next steps are for Sacramento County Behavioral Health Services, County Counsel, Risk Management, and Labor Organizations to review the input in this report and incorporate recommendations as appropriate and feasible into the WCCCRT program design. On December 15, the Mental Health Board held a special meeting to review and approve recommendations to inform their development of and appointments to the Advisory Committee (another write up on this in this month’s newsletter, so keep reading!)