Discussion on proposed amendment to the Professional Services Contract between the City and Terros Health for the operation of the Community Alliance, Response & Engagement (CARE) Unit
 

The initial three year term of the City's contract with Terros Health to staff a mobile alternate response team is expiring in October 2024.  The initial term may be extended for up to two successive one year terms upon mutual consent of both the City and Terros.  City staff and Terros Health have been in discussions regarding the upcoming contract extension. The focus of the discussions have revolved around ways to improve the program.  The proposed amendment would change the contract between the City and Terros Health to allow Terros Health to provide the certified Emergency Medical Technician to staff the CARE Unit instead of the Flagstaff Fire Department. Terros Health staff members believe this staffing recommendation will positively impact the interactions with the clients significantly improving the effectiveness of the CARE Unit.  

Opportunities leveraged through the proposed amendment:
The City has considered various models to deliver an alternate response over the past 8-10 years to improve services provided.  

• Increases mental health care and response for the vulnerable population.
• Provides call volume reduction for public safety which allow for higher risk/acuity type calls based on system reliability.
• Assists with Team cohesion and oversight on the unit and provides a better unified support system for the client without consistent turnover in Flagstaff Fire Department personnel assigned.
• Assists with Flagstaff Fire Department recruitment, retention and moral by allowing those trained in the All-Risk field to focus on that professional responsibility.

Features of the Unit Operation with the proposed amendment:
The program is very successful, and we are looking for opportunities to improve without losing sight of the scope.

• Mission and scope of the alternate response program will remain the same with Emergency Medical Service Battalion Chief as the City liaison.
• Dispatch and response criteria will remain consistent with the Emergency Medical Service Battalion Chief oversight through emergency medical dispatch.  The Emergency Medical Battalion Chief is the link between the program objectives and the 9-1-1 Dispatch system.
• Consistent focus on performance metrics related to reducing recidivism, crisis calls, arrests related to alcohol, and emergency department transports related to alcohol.
• Maintain City vehicle, base operation for vehicle, fuel and maintenance.

The City has been interested in providing an alternate response model for the past 8-10 years.  The Flagstaff Fire Department has tried various models and the Criminal Justice Coordinating Council also considered diversion programs.  The City continued to pursue the vision to provide the community with crisis intervention and mental health stabilization services through a mobile response unit and implemented the Community Alliance, Response & Engagement (CARE) Unit in 2021.  The CARE Unit began operations in 2022 and provides proactive outreach to the community and responds to public safety calls, such as, public intoxication, substance abuse, trauma informed, and mental or behavioral health related events received through the 9-1-1 Dispatch center. This CARE Unit is staffed with a behavior health Crisis Specialist and Emergency Medical Technician. 

Terros Health provides for Crisis Specialists, a Lead Crisis Specialist, Clinical Manager, Director of Northern Arizona Crisis Services, Senior Director of Crisis Services, and support from Terros Health corporate.  The proposed amendment would include the addition of certified Emegency Medical Technicians to Terros Health staffing.  Terros Health has evaluated their staffing expenses related to the current contract and indicated the addition of the Emergency Medical Technicians would be $19,764 for year four of the contract and $22,488 for year five.  The City has budget allocation available for the CARE Unit to cover these additional expenses. 

Currently the Crisis Specialist operates under the direct supervision of Terros Health and Terros Health is solely responsible for the actions of the Crisis Specialist.  The proposed amendment would include the Emergency Medical Technicians under the supervision and responsibility of Terros Health.  The Crisis Specialist and Emergency Medical Technicians would decide when there is a need for a higher level of professional behavioral health care, medical response, and/or law enforcement support.  This is accomplished by requesting assistance through the 9-1-1 Dispatch center. 

The City will continue to provide the base of operation for the vehicle at Fire Station #6, the vehicle, and fuel and maintenance for the vehicle. The staff assigned to the CARE Unit will utilize the City's radio system to interact with the 9-1-1 Dispatch center.  The City will provide the training to CARE Unit personnel on City fleet, radio, and dispatch protocols. 

The CARE Unit will continue to operate seven days per week from 9:00 a.m. to 7:00 p.m. to conduct proactive outreach and provide intervention to individuals who may be experiencing mental health or substance abuse crisis events.  CARE Unit staff work to assist individuals with positive coping skills and identifying resources to reduce instance of recurrent crisis episodes.  The proposed amendment would place two staff members on the CARE Unit that are trained in behavioral health which will lead to greater effectiveness in serving the client.

City and Terros Health staff meet quarterly to discuss data collected, identify key findings including lessons learned and programmatic recommendations.  The performance metrics are reviewed ongoing and reported annually for reductions of recidivism and crisis calls for the Flagstaff Police and Fire Departments; reduction of arrests, bookings and prosecutions for alcohol use related offenses; and reduction of individuals transported to the emergency department for intoxication and detox issues.  This process helps to ensure success in meeting the scope and mission of the CARE Unit. 

In addition to providing a better unified support for the client when staffing the unit with two behavioral health trained personnel, this proposed amendment will assist with recruitment, retention and moral of Flagstaff Fire Department personnel.  Removing the requirement to staff the CARE Unit every day with a Flagstaff Fire Department Emergency Medical Technician will free up Fire Department personnel to utilize their training on the higher risk calls related to fire and advance medical services. This in turn increases moral and retention of existing employees and addresses what has been shared by prospective employees.