TO: Mayor and City Council
THROUGH:
FROM: Keith Stahley, City Manager
SUBJECT:
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Cost estimate and status report on community-based mobile crisis response to calls for service involving persons experiencing homelessness or behavioral health crisis, following response to Salem’s Request For Information.
Ward(s): All Wards
Councilor(s): All Councilors
Neighborhood(s): All Neighborhoods
Result Area(s): Good Governance; Safe Community; Welcoming and Livable Community.
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SUMMARY:
summary
A Request For Information (RFI) for community-based mobile crisis response was released in May to better understand available community-based resources and estimate cost for the service. One response was received before the RFI closed in July 2022. Based on information gathered from the RFI and research into experience of other communities the City would need to budget, on an annual basis, approximately $700,000 for this service.
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ISSUE:
Information only.
RECOMMENDATION:
recommendation
Information only.
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FACTS AND FINDINGS:
On March 14, 2022, staff provided Council with a report on mobile crisis response, how it works in most communities, available resources in Salem, gaps in the system, how this service may impact dispatch and any associated staffing, technology and protocol issues, and cost estimates to establish the service. To accomplish this research project, staff conducted research and consulted with CAHOOTS (Eugene), Portland Street Response, Olympia Mobile Crisis Response, Northwest Human Services (Health Outreach), Marion County (Health and Human Service, Acute/Forensic Behavioral Health), non-profit community partners, Fire/EMS, 9-1-1 Dispatch, and Police Department staff.
On April 11, 2022, Salem City Council directed staff to prepare a request for information to solicit information about local, community-based service provider interest in providing the service and to develop a budget estimate, should funds be available to be budgeted for provision of this service in Salem.
Request For Information Process
A request for information (RFI) is used to gauge cost estimates for budgeting purposes and interest in a possible, future request for proposals (RFP) for a service. Salem’s Community Based Mobile Crisis RFI was issued May 2, 2022 and closed July 1, 2022. As is Salem’s practice, it was posted to the State’s procurement network (now OregonBuys) and directly emailed to potential responders including NW Human Services, Union Gospel Mission, United Way, Mid-Willamette Valley Community Action Agency, and Pacific Source and Recovery Innovations.
The purpose of the RFI was to determine:
• Which organizations may be available to provide the service for a minimum of one year in Salem;
• How the organization would approach providing the service in Salem (staffing composition, hours, geographic scope, dispatch of the service to the field); and
• How much funding would be requested from the City to provide the service.
Salem received one response to the RFI. The review committee was comprised of members of Salem Fire, Salem Police Department, the City Manager’s Office, and Marion County Health and Human Services.
Committee Review
In reviewing the RFI response, committee members noted more specificity would be required in a possible, future RFP to yield the desired service and outcomes. Specially, the Committee noted:
• Hours of Operation. An RFP should specify hours of operation or share historic call data to organize hours of operation around demand for service.
• Staffing Composition. An RFP should specify Emergency Medical Technician (EMT) level staffing for in the field medical triage, not a Certified Nursing Assistant (CNA), to mitigate the need for transport to hospital emergency department, where patient transport would not be required.
• Community Education. An RFP should address the need for a potential future provider to conduct a community education and awareness campaign to ensure the community is aware of the new service, knows how to access it, and can use it for referrals.
• Demonstration Project. An RFP should specify the provision of this service as a limited duration with a discrete geographic scope, and how performance data can be tied to desired outcomes of the service.
• Budget. With the aforementioned staffing specification and market escalation due to current vacancies in Salem area for the behavioral health and medical triage positions, it is likely that the annual budget for this service is likely to be approximately $700,000. This budget estimate includes some contingency to cover unanticipated community provider staffing or overtime needs, and at least two additional call taker positions at WVCC to mitigate anticipated impact of the new, separately dispatched service.
o In response to the RFI, the estimate for a locally-based community service provider to offer the service is $648,900 year one.
o This cost included two certified nursing assistants. The review committee recommends the RFP shift the medical triage staffing to Emergency Medical Technician staffing. This may represent as much as a $20,000 increase in cost from the RFI.
o For the educational/awareness campaign, staff recommend adding $15,000 to the $5,000 budgeted in the RFI response for this work for a total of $20,000. Use of this service will rely heavily on awareness.
o Not Recommended for the pilot program. Staff will gather real time data on actual call volume to determine the necessary level of staffing the 911 system.
If the new program is to roll out Citywide, as proposed in the RFI response, two additional Call Taker positions (or 10 FTEs) may be required at WVCC. Data will be gathered during the pilot period to determine the actual need. If necessary, this may add $1,060,400 in cost annually. If the new program is to roll out with a limited geographic scope of service, it may be possible to accommodate the additional call taking with one additional station (5 FTE rotating for 24 hours, 7 days a week coverage) with $530,200 annually.
BACKGROUND:
To establish a community-based mobile crisis response in Salem, staff estimate the City would need to budget, on an annual basis, approximately $700,000 for this service.
In most communities, a mobile crisis response is typically a triage response to an incident or a person exhibiting signs of physical, mental or emotional distress out of doors. The goal is to safely respond to a person in need in outdoor environments like a sidewalk, camp, or other public space. This could include situations like an intoxicated person in a public location, a person experiencing psychosis, a person disrupting the peace or exhibiting signs of visible distress.
A team of at least two staff responds to calls for help. Teams are comprised of a mental health professional (qualified mental health professional or a social worker) paired with a basic medical professional (emergency medical technician (EMT), or community medic) who respond to someone experiencing a low acuity behavioral health crisis. These teams treat the immediate crisis and pass on resources or referrals in certain situations and locations. Most programs will not enter a private residence, nor respond to incidents involving weapons or threats of violence.
Courtney Knox Busch
Strategic Initiatives Manager
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