Public Health & Safety Committee

TUMWATER PUBLIC HEALTH AND SAFETY COMMITTEE MINUTES OF VIRTUAL MEETING October 8, 2024 Page 1 CONVENE: 8:02 a.m. PRESENT: Chair Peter Agabi and Councilmembers Leatta Dahlhoff and Kelly Von Holtz. Staff: City Administrator Lisa Parks, Assistant City Attorney Davis Abbott, Finance Director Troy Niemeyer, Fire Chief Brian Hurley, Assistant Fire Chief Shawn Crimmins, Police Commander Jay Mason, Communications Manager Jason Wettstein, and Police Administrative Supervisor Laura Wohl. CHANGES TO AGENDA: APPROVAL OF MINUTES: SEPTEMBER 10, 2024: MOTION: Councilmember Von Holtz moved, seconded by Chair Agabi, to approve the minutes of October 8, 2024 as published. A voice vote approved the motion. CRISIS RESPONSE Fire Chief Hurley introduced Joe Avalos, Executive Director, Thurston UPDATE: Mason Behavioral Health Administrative Services Organization (TMBHO), an administrative services organization. Mr. Avalos shared information on a program involving community-based crisis teams (CBCTs). Mr. Avalos reported that TMBHO includes Olympic Health and Recovery Services (OHRS), a behavior health agency. The organizational structure is a quasi-governmental entity governed by two Thurston County Commissioners and one Mason County Commissioner. The organization is tasked as the Behavioral Health-Administrative Services Organization (BH- ASO) to provide funding for behavioral crisis healthcare not related to Medicaid. Prior to 2020, the organization received all Medicaid funding for the Thurston/Mason region of approximately $60 million annually. In 2020, the state moved funding to managed care organizations leaving regional BH-ASOs with non-Medicaid funding. One of the tasks is to provide a crisis service system for the region in addition to other services. The organization contracts with 20 providers for non-Medicaid services. In 2017, Commissioners elected to improve outreach to the community. Subsequently, OHRS was created as a licensed behavioral health agency working primarily in Mason and Thurston Counties. Councilmember Dahlhoff joined the meeting. TUMWATER PUBLIC HEALTH AND SAFETY COMMITTEE MINUTES OF VIRTUAL MEETING October 8, 2024 Page 2 The mission is to provide outreach service to communities in Mason County and Thurston County served by 150 employees throughout the different programs. OHRS operates a 24/7 Regional Crisis Line. The line receives approximately 3,000 calls each month. Of those calls, OHRS triages calls and responds with traditional mobile crisis teams from Lacey, Shelton, or dispatches a Thurston Mason designated crisis responder capable of involuntarily detaining someone based on being a danger to themselves or others. The flagship model of care is law enforcement co-response. The teams include crisis clinicians embedded within local law enforcement jurisdictions. The effective program has been in place since 2021 and has experienced positive outcomes. The co-response model is an evidenced- based team comprised of a crisis clinician and a certified peer counselor. The clinician pursues engagement to ascertain risk level by assessing whether the person is a danger to themselves, to others, or is suicidal to identify next steps. Certified peer counselors use a softer approach as they typically are individuals with lived experience in behavioral health crisis, substance abuse, or who are in recovery. Counselors provide individuals in crisis with support in ways clinicians are unable to provide in the field. The program require instances of partnering with law enforcement to help secure a safe situation because teams are often dispatched to unknown situations or lack the history of an individual experiencing a crisis. The first outreach team was embedded with the Lacey Police Department in August 2021. Within the first six months of the program, all four staff members received a commendation from the Lacey Police Chief and the Lacey team. The collaboration led to the Thurston County Sheriff Department’s Scout Team using the same model. In August 2023, the model was implemented by the Mason County Sheriff’s Department. All teams have experienced success. Although the City of Olympia has its funded Crew Teams, the program has provided several embedded crisis responders with the Olympia Police Department. Another team is embedded with the Shelton Police Department. The team works with the Mason County co-response team. In May 2022, another team was added to the Lacey Police Department. Some reported impacts from all the jurisdictions include quick response by the teams to community crisis situations increasing an officer’s efficiency as the team can often provide data on the individual’s history affording a better way to triage. In many instances, where the history reveals no violence, the team can respond without the presence of law enforcement. The program has resulted in a decrease in responses to repeat calls for service as police officers often have access to notes documenting an existing plan in place that enables only the team to respond to the scene. TUMWATER PUBLIC HEALTH AND SAFETY COMMITTEE MINUTES OF VIRTUAL MEETING October 8, 2024 Page 3 As more of the community and more jurisdictions have become aware of the teams, more services have been offered. The teams are dispatched directly from law enforcement and 911 bypassing the organization’s triage system while remaining in contact with the organization. The process enables a quicker response. In most situations, the team has stabilized individuals in the field or with a follow-up call and referral to resources. Often, individuals are referred to outreach services for housing, substance abuse recovery, or other community resources. To date, most responses are without law enforcement (85%) enabling police officers and first responders to focus on their jobs. The teams rely on all service providers and other organizations within the communities to include churches, SafePlace, Sidewalk, and other social services in the region. Approximately 40% to 45% of the funding is paid by Medicaid for the service. Other funds to help offset costs are from federal and state sources. Local funding varies. In Thurston County, the Treatment Tax Program provides 1/10th of 1% from sales tax revenue. The City of Lacey and the City of Olympia provide funding from city budgets, as well as training. In response to recent reform legislation, the state is implementing a program of community-based crisis teams. House Bill 1134 is the state’s investment in 988 (intended to serve as 911 for behavioral health). Legislation moved forward because of a federal mandate to establish 988 as the primary vehicle for people experiencing behavioral health crisis rather than calling 911. The state wants to replace regional crisis lines with 988 by January 2026. However, to accomplish the switch, a response system similar to regional crisis lines and 911 and first responders are necessary. Investment has occurred to increase mobile crisis teams and community-based crisis teams. Community-based crisis teams are embedded with fire service agencies and EMS agencies rather than with law enforcement. The model has been demonstrated to be effective. To meet the conditions of a community-based crisis team, fire service agencies must be partnered and contracted with a behavioral health agency. Funding will flow from the Health Care Authority to BH-ASO and to the provider (fire service agency). During the last legislative session, grants were established along with $144 million for service delivery. Based on recent information, some funds will pay for clinical staff through OHRS and some funds may be available to fund first responder personnel. Community-based crisis teams (CBCTs) can be an emergency medical services agency, a fire service agency, a public health agency, a medical facility, a nonprofit crisis response provider, or a city or county government entity other than a law enforcement agency, that provides on-site community-based interventions of a mobile rapid response crisis team for individuals who are experiencing a behavioral health crisis. TUMWATER PUBLIC HEALTH AND SAFETY COMMITTEE MINUTES OF VIRTUAL MEETING October 8, 2024 Page 4 To meet the conditions of a CBCT, a fire agency must be partnered with a Behavioral Health Agency (BHA) that also has a contract with the regional Behavioral Health Administrative Service Organization in the region. Any interested CBCT must submit an application to the HCA by January 2025. On-site reviews are then scheduled by HCA program staff in February through March, with service delivery anticipated to begin in July 2025. Based on prior experience and the organizational structure of the TMBHO, both regions are positioned to successfully launch a CBCT based on similar work with local law enforcement. A contract with Tumwater would be the first fire service-based CBCT. Based on available funding, the service could be budget neutral for the City. Mr. Avalos invited questions. Fire Chief Hurley said that historically, the programs have been embedded with law enforcement representing a shift to embedding with the fire service. He asked for feedback on the advantages of offering services through the fire department. Mr. Avalos responded that although the regional program has been embedded with law enforcement, other programs across the state have co-responder teams successfully embedded with fire. The new model and the proposed approach would replicate existing models with most incidents not needing mutual response; however, it would be important for the team to rely on the fire department’s relationship with the police department, as there could be instances where police response would be required. Councilmember Dahlhoff commented that the proposal would serve as a way to highlight how the fire and police departments work together and respond to the community. She supports the proposal as it addresses needs as well as the concerns with respect to the type of calls. She noted that the Thurston County Sheriff’s Office is scheduled to move near Tumwater City Hall within the next several years. She questioned the possibility of pursuing conversations about the possibility of moving some Tumwater police officers to the new location to develop a stronger relationship with the Scout Teams. Mr. Avalos advised that he is unsure as to why the funding model excludes law enforcement and plans to follow up with several legislators. He believes the state wanted to move away from the model of having law enforcement respond to all crisis calls. Chair Agabi asked whether the law enforcement teams participate in the involuntary commitment of individuals. Mr. Avalos said involuntary commitment is a civil issue and typically occurs with community mobile teams and only when required. Designated crisis responder (DCRs) teams require law enforcement support because DCRs advise individuals of their rights creating a different engagement model than the mobile teams that TUMWATER PUBLIC HEALTH AND SAFETY COMMITTEE MINUTES OF VIRTUAL MEETING October 8, 2024 Page 5 respond to a crisis situation. DCRs entail legal investigations that create some instances of escalation as reading a person their rights can create a negative connotation of an impending arrest. Chair Agabi asked about the number of behavioral crisis beds available in Thurston County. Mr. Avalos said South Sound Behavioral Hospital is located across the street from the organization’s office in Lacey. The hospital provides 134 beds comprised of voluntary and involuntary beds. Three other facilities are operated by another entity providing 15 involuntary beds, 11 long-term civil commitment beds in Olympia, and 10 beds of short-term involuntary beds and six beds of long-term civil commitment beds in Tumwater. Another facility, currently empty, is located off South Bay Road and is scheduled to open soon by a local provider. As the organization is a phase 3 implementation site, the organization provides in-patient and outpatient services. The organization is gearing up to release a request for proposal for a crisis stabilization facility (voluntary unit) of approximately 16 beds for police drop off. The state offers more involuntary beds. Councilmember Von Holtz acknowledged and thanked Mr. Avalos for the services offered in the community. Mr. Avalos replied that the organization is providing more crisis services to the communities than in other regions that are much larger. It speaks to both the need and the ongoing gap in the community. Councilmember Holtz cited information reflecting that in 2021, one in five Washingtonians were diagnosed with some form of mental illness. She asked whether the number has changed since the COVID pandemic. Mr. Avalos said he would follow up with information. However, the organization has increased crisis service mobile outreach by at least four times more than three years ago. No change in numbers has occurred with respect to involuntary evaluations. Chair Agabi asked about the next steps. City Administrator Parks advised that staff is working with Mr. Avalos to explore the application process. The City plans to move forward with a partnership. The next tentative action by the Council could entail approval if the City must be a party to the grant application. Any service agreement would be reviewed by the committee and the Council. RESOLUTION Manager Wettstein presented the proposed resolution affirming the R2024-015, Council’s commitment to equality, dignity, and the protection of civil rights AFFIRMING THE and standing against hate, bigotry, and discrimination. Recent events at the COUNCIL’S national, state, and local levels highlighted the need for the community to COMMITMENT TO take a stand against hate and the violation of civil rights and reaffirm a EQUALITY, shared commitment to justice, equality, and human dignity. DIGNITY AND THE PROTECTION OF The proposed action provides a values-based foundation for the City and CIVIL RIGHTS, supports the Council’s Strategic Priorities to build a community recognized TUMWATER PUBLIC HEALTH AND SAFETY COMMITTEE MINUTES OF VIRTUAL MEETING October 8, 2024 Page 6 AND STANDING for quality, compassion, and humanity. AGAINST HATE, BIGOTRY AND Staff recommends the committee recommend the Council adopt the DISCRIMINATION: proposed resolution. Chair Agabi said the resolution is proposed because of an incident experienced by Councilmember Dahlhoff. He questioned how the resolution would align with the City’s establishment of an Equity Commission. City Administrator Parks responded that the resolution is a first step in creating a platform in the City to assist in pursuing community conversations surrounding hate, racism, and bigotry. The community has experienced instances of hate, racism, and bigotry including the recent incident experienced by Councilmember Dahlhoff. The purpose of the Equity Commission is to outreach to the community to learn about the community’s lived experiences and issues. The resolution serves as a next step for staff to prepare another resolution specific to establishing an Equity Commission and identifying its goals and priorities. Councilmember Dahlhoff asked about the possibility of receiving an update concerning an incident that occurred in May, which served as the impetus for the proposed resolution. Police Commander Mason advised that he contacted the parties and received some information. However, some individuals did not respond. The police department strives to provide service based on relationships with a goal to improve relationships. While outreach and response is the desired outcome, it is also important to respect those individuals who do not feel comfortable talking with law enforcement as opposed to continually pursuing conversations. The process to build trust and relationships is an ongoing process. Based on experience and participating in some community events, he recognizes there may be some events that do not want participation by uniformed officers. Those types of communications are ongoing and the department in some instances provides services while other events include no participation by the department. The goal is to balance the wishes and needs of the community. Councilmember Dahlhoff conveyed her preference for the resolution to speak specifically to Tumwater. The resolution should be action-oriented and specific to Tumwater. City Administrator Parks said the resolution could include more specificity- based feedback from the committee. Following additional comments by Councilmember Dahlhoff, City Administrator Parks recommended working with Manager Wettstein to review some specific requests. TUMWATER PUBLIC HEALTH AND SAFETY COMMITTEE MINUTES OF VIRTUAL MEETING October 8, 2024 Page 7 Councilmember Von Holtz shared that she is aware Chair Agabi has experienced instances of racism and she as a woman of color has experienced racism in the schools and in the community. She is appreciative of the proposal and supports Councilmember Dahlhoff’s recommendation that the resolution should not represent just “words on paper” because it is time for the City to stand against hate that is prominent in the community. Chair Agabi requested information as to the recommendation to include specific actions. Councilmember Dahlhoff cited some examples, such as a joint meeting with the Tumwater School Board as an example of partnership and collaboration and conversations surrounding the formation of the Equity Commission. The resolution should speak to partnerships and convey intentional actions rather than speaking to only building more trust and respect. The issue is how to build more trust and respect. In response, Chair Agabi recommended continuing the discussion to revise the resolution. ADDITIONAL There were no additional items. ITEMS: ADJOURNMENT: With there being no further business, Chair Agabi adjourned the meeting at 9:03 a.m. Prepared by Valerie L. Gow, Recording Secretary/President Puget Sound Meeting Services, psmsoly@earthlink.net