In December 2017, over fifty community leaders were convened to discuss noticeable problem behaviors in and around the core of downtown Modesto. The group made a commitment to support a 90-day review and strategy process focused on addressing what many see as a crisis in our community. Out of that meeting, the Community Assessment Response Engagement (CARE) program began as an intensive effort to address the issues that arise in communities when homelessness is coupled with mental illness and substance use and/or alcohol abuse.
While recent efforts such as Focus on Prevention have begun to make progress in strengthening the community's system of care in response to local homelessness, an urgent response was not available. A small population is in need of immediate help- individuals experiencing significant distress for themselves while also causing distress to the community. These are individuals that often exhibit high-risk health and safety behaviors, engage in vagrancy-related criminal behavior, experience high-frequency emergency department use, high-frequency jail detention due to behavior resulting from serious mental illness and substance use disorders, and many experience frequent detention for evaluation and treatment.
The CARE initiative is an innovative approach to a complex problem. Over a 90 day period, a work group met weekly to map assets, unpack problematic processes, and identify service gaps while building a new approach that could increase accountability, and alignment- developing a system and service model that has never been utilized in our community. The group was made up of representatives of twenty or more partners who directly serve this population, regularly working with those who show signs of high-risk health and safety behaviors, mental illness, criminal behavior and substance use. This effort was led by Stanislaus County and the City of Modesto with Emergency Medical Services, Doctor's Hospital, Probation, Board and Care Homes, Probation, District Attorney and many others at the table.
"This really represents what a true partnership is. With public agencies joining together, along with the private sector," said County CEO Jody Hayes. "It began with a discussion about what we can realistically expect to accomplish through the long term efforts of the Focus on Prevention initiative, recognizing that even with all of our work, it is going to take us some time to see meaningful results. But many of us are driving to work each day seeing individuals in distress in our community. We knew we needed to challenge ourselves to come up with something else to serve individuals who are not being served through the system."
A Multi-Disciplinary Team(MDT) made up of police & fire department from the Homeless Engagement and Response (HEART) Team, behavioral health and recovery services clinicians and other support services were deployed as a pilot program model to engage this priority population, determine how individuals might be helped, and how ongoing issues might be addressed. Over a span of two weeks the pilot program tested a new service model with multiple agencies working in tandem to engage individuals on a case-by-case basis. Results of the two week pilot indicated that many were willing to engage (75% signed the release of information, 25% agreed to services).
On June 26, the Stanislaus County Board of Supervisors approved the continuation of the CARE MDT strategy to address vagrancy and help individuals in distress due to severe mental illness and substance use disorders in our county. Contingency funds of $500,000 from the Focus on Prevention budget will be used if needed, along with the following approved resources:
- Three staff including one Fire Fighter-Paramedic, one Police Officer, and one Police Sergeant provided by the City of Modesto at an estimated total cost of $616,000.
- One Public Health Nurse/Registered Nurse provided by external partners at an estimated total cost of $241,000.
- One Deputy District Attorney allocated to the Stanislaus County District Attorney's Office at an estimated total cost of $157,000.
- One Supervising Deputy Probation Officer and one Probation Officer provided by the Stanislaus County Probation Department at an estimated total cost of $274,000.
- Staffing and funding for one data analyst will be determined.
- One Social Worker Case Manager provided by the Stanislaus County Community Services Agency at an estimated total cost of $104,000.
- A Mental Health Team comprised of two case managers and one Mental Health Clinician provided by the Stanislaus County Behavioral Health and Recovery Services Department at an estimated total cost of $273,000.
- One Public Defender provided by the Stanislaus County Public Defender's Office on a part-time basis at an estimated total cost of $66,000.
- A placeholder of approximately $121,000, should resources not be available from any of the partner agencies to provide needed training, operating supplies, and/or emergency client support services that could include meals, clothing, temporary shelter, etc.
The City of Modesto will continue to support the HEART team by sustaining and adding public safety personnel. For the 18/19 budget, the city has added a dedicated crew who will come in after the MDT and HEART teams have delivered care in order to provide the necessary restorative clean-up work throughout impacted areas of the city.
Interim Modesto City Manager Joe Lopez is very encouraged by this process, stating, "This effort has proven to be a tremendously successful collaboration with the County. It's a unique program that seeks to help - not only our community who sees the effects of mental illness and homeless in their neighborhoods - but also the individuals who need additional support in connecting with the necessary services. The City has learned a lot in this process about the need that exists, and the services aimed at providing help."
In addition to the fiscal resources allocated, the Board of Supervisors adopted a resolution in support of Senate Bill 1045 Conservatorship: Chronic Homelessness, Mental Illness and Substance Use Disorders and issued a letter of support for this conservatorship bill requesting inclusion in the legislative language. As written, this bill proposes targeted treatment of homeless individuals who struggle with mental illness and substance abuse disorders, individuals that experience high-frequency emergency department use, high-frequency jail detention due to behavior resulting from serious mental illness and substance use disorders, etc. in San Francisco and Los Angeles Counties only.
CARE Program Report