Community Assistance, �Recovery and Empowerment:�The CARE Act / CARE Court

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Roberta Chambers, PsyD

roberta@indigoproject.net

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Pre-launch Family and Consumer Training

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October/November 2024

CARE Act Overview and Updates

The CARE Act

• The CARE Act is a legislation that authorizes CARE Court, a new civil court process to ensure that individuals most impacted by mental health challenges receive the services that they need.
• The purpose of CARE Court is to engage a targeted group of people in community-based treatment to avoid unnecessary crisis, hospitalization, homelessness, and incarceration.
• CARE Court establishes a civil court process whereby the courts can order eligible individuals to participate in a CARE agreement or plan provided by a CARE team for up to 12 months with the possibility to extend for an additional 12 months.
• CARE Court is not optional.
• If a county does not comply with CARE court they can be fined.
• If an individual does not comply with their CARE plan, this can be used as evidence as a presumption of eligibility in an LPS Conservatorship hearing.
• Alameda County is required to begin implementation by December 2024.

Why CARE Court?

• Although homelessness has many faces in California, among the most tragic is the face of the sickest who suffer from treatable mental health conditions— [CARE Court] aims to connect these individuals to effective treatment and support, mapping a path to long-term recovery. 

- CalHHS

• The CARE Act provides a critical new on-ramp into the behavioral health system for a population of people that are the hardest to reach. Basic human dignity requires us to put our full effort into helping get care for people struggling with severe mental illness on our streets. 

- Senator Susan Talamantes Eggman (D-Stockton)

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What do we know about programs like CARE Court?

• Is CARE Court new?
• CARE court is a type of Assisted Outpatient Treatment, AOT is an “umbrella” term that refers to court-ordered outpatient mental health services.
• 47 states have legislation authorizing AOT.
• Will CARE Court work?
• Programs like CARE Court have been shown to increase treatment participation and compliance
• Individuals who participate in programs like CARE Court are associated with reduced hospitalization, arrest, incarceration, crime, victimization, and violence
• Jurisdictions with programs like CARE Court are associated with increased accountability
• How does CARE Court work
• CARE Court combines two evidence-based practices: Outpatient mental health services and the collaborative or problem-solving court model

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Who is eligible for CARE court?

Penal Code Revisions

The CARE Act amends the penal code and allows for judges to refer someone who is determined to be incompetent to stand trial and ineligible for diversion over to CARE court.

SB1400 further clarifies that a judge must hold a hearing to determine if a person is eligible for diversion, outpatient services, or CARE before dismissing the case.

Health Insurance Code Revisions

The CARE Act requires that health insurance plans pay for the evaluation to determine CARE court eligibility and establish the CARE plan. It also requires that health plans pay for the services included in a CARE plan.

5972. An individual shall qualify for the CARE process only if all of the following criteria are met:

1. The person is 18 years of age or older.
2. The person is currently experiencing a severe mental illness…and has a diagnosis identified in the disorder class: schizophrenia spectrum and other psychotic disorders, including substance induced psychosis.
3. The person is not clinically stabilized in on-going voluntary treatment.
4. At least one of the following is true:

(1) The person is unlikely to survive safely in the community without supervision and the person’s condition is substantially deteriorating, and/or

(2) The person is in need of services and supports in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to the person or others, as defined in Section 5150.

• Participation in a CARE plan or CARE agreement would be the least restrictive alternative necessary to ensure the person’s recovery and stability.
• It is likely that the person will benefit from participation in a CARE plan or CARE agreement

Who can file a CARE Court petition?

5974. The following adult persons may file a petition to initiate the CARE process:

• A person with whom the respondent resides.
• A spouse, parent, sibling, child, or grandparent or other individual who stands in loco parentis to the respondent.
• The hospital where a person is receiving treatment, including psychiatric hospitalization.
• The agency that has provided within the past 30 days or who is currently providing behavioral health services to the respondent or in whose institution the respondent resides.
• A licensed behavioral health professional who has supervised the treatment or been treating the respondent for a mental illness within the past 30 days.
• The county behavioral health agency of the county in which the respondent resides or is found.
• A first responder, including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker, who has had repeated interactions with the respondent
• The public guardian or adult protective services
• California Indian health services program or California tribal behavioral health department
• The judge of a tribal court that is located in California, or their designee.
• The respondent.

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SB42 establishes ongoing noticing rights for a petitioner

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SB42 also adds a provision about the required documentation for the petition.

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Originally, the petition required either a signed declaration from a licensed behavioral health professional or evidence of 2- 5250s, one of which was in the last 60 days.

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SB42 amends the petition requirements so that a petitioner can sign a declaration in lieu of healthcare documentation.

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What specific services can be included in a CARE plan?

5982. (a) The CARE plan may include only the following:

1. Behavioral health services funded through the 1991 and 2011 Realignment, Medi-Cal behavioral health, health care plans and insurers, and services supported by the Mental Health Services Act pursuant to Part 3 (commencing with Section 5800).
2. Medically necessary stabilization medications, to the extent not described in paragraph (1).
3. Housing resources
4. Social services funded through Supplemental Security Income/State Supplementary Payment (SSI/SSP), Cash Assistance Program for Immigrants (CAPI), CalWORKs, California Food Assistance Program, In-Home Supportive Services program, and CalFresh.
5. Services provided pursuant to Part 5 (commencing with Section 17000) of Division 9.

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ACBH engaged in a competitive procurement process for outreach and engagement services and a Full Service Partnership Program.

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Bay Area Community Services was the successful bidder, and they are currently in the start-up phase of the program.

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ACBH is meeting with the BACS team twice weekly through December 1 in order to support program launch.

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What if someone doesn’t do what’s in the CARE plan?

• If a County does not comply with the court orders or fails to provide the services in the CARE plan,
• The presiding judge can issue a fine of $1,000 per day up to $25,000 per instance. These funds go into an account that will be redistributed back to the County to fund CARE court services.
• If a county is determined to be persistently noncompliant, the presiding judge may appoint a special master to secure court-ordered care for the respondent at the local government entity’s cost.

CARE Act Court

Care Court Partners

CARE Court Proceedings

• CARE Act Hearings to be held in Wiley Manuel Courthouse Department 103 with Honorable Judge Bean to be the presiding judge.
• The CARE Act calendar will be held on Thursdays, starting with a pre-court “huddle.”
• The Court will begin accepting petitions on November 28, 2024 and the court calendar will begin on December 12, 2024.
• The Public Defender secured the contract to provide client representation and is working on staffing model.
• Bay Area Community Services, through a contract with ACBH, will provide the outreach, investigation, and ongoing service delivery for individuals enrolled in CARE.
• Housing and Homelessness (formerly OHCC) will provide housing for individuals for whom CARE is included in their agreement with the court.

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Petitioners can contact Alameda County Superior Court’s Self-Help Center at the Hayward Hall of Justice for

assistance in filing a CARE Act Court Petition.

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Petitioners can make an appointment for an in-person

meeting, reach someone in a live chat or call 510-272-1393 Monday through Thursday, 2 p.m. to 4 p.m.

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For more information about the Self-Help Center please visit:

https://www.alameda.courts.ca.gov/self-help

CARE Process At-A-Glance

AC Health Bridge Housing Model Overview

Frequently Asked Questions

FAQs - Petition Process

How does someone sign up for CARE Court? How does someone refer an individual to CARE Court?

You cannot sign up for CARE Court, and there is no process to “refer” someone to CARE Court. If any eligible petitioner would like for the Courts to consider CARE Court for an individual, they can file a petition with the courts or go to the Self Help Center for assistance with filing a petition.

What if I would like my current provider or my loved one’s current provider to file a petition for CARE Court?

If you are an eligible petitioner and you would like to file a petition for CARE Court, you may do so directly with the courts or with the assistance of the Self Help Center. Providers will make their own independent determinations about petition filing.

FAQs - Petitioning

What information is required to be included with the petition?

The state has developed standard court forms, including the petition form and a mental health declaration.

The petition is CARE-100. The petition should be accompanied by:

• A CARE-101 form completed by a licensed mental health professional,
• Documentation of at least 2-5250s of which one was in the last 60 days, or
• A signed declaration of personal knowledge of the 5250s.

Will a current provider complete the CARE-101 Mental Health Declaration or provide documentation to support the petition?

Providers are not expected to complete court forms or provide other documentation to support a petition. If the courts need information to determine eligibility, they may order ACBH to provide a mental health evaluation after reviewing the petition.

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FAQs - Outreach and Engagement

What happens once ACBH has been ordered to conduct an assessment?

ACBH will review the person’s records and share relevant information with the BACS O&E team. The BACS O&E team will attempt to locate and engage the person in services, including the court-ordered evaluation.

When BACS locates the person, they must “serve” them with the notice of the court-ordered evaluation, provide them with a copy of the petition, inform them of who their public defender is, and attempt to engage them in the process.

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FAQs - Outreach and Engagement

Many individuals who may be petitioned to CARE Court are difficult to locate and/or may be hard to engage. What happens if they can’t be located or refuse to participate?

ACBH is developing a push notification to alert the BACS O&E team when a respondent presents at an ED, PES, hospital, sobering center, CSU, or CRT so that the BACS O&E team can attempt to make contact with that individual while they are still in a known location.

Ultimately, a person can refuse to participate in this process and there are no consequences for the individual. However, the BACS O&E team will make multiple attempts using assertive outreach strategies to attempt to engage the person in the process and in services.

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FAQs - Outreach and Engagement

Will the BACS O&E team offer housing as a part of the engagement process?

The BACS O&E team will offer the individual referral and linkage support to connect with any resources for which they may be eligible. The BACS O&E team will also have access to a limited number of emergency motel vouchers. However, there is no guarantee that a person will receive housing in advance of a CARE Agreement or Plan.

What if the person asks for or agrees to voluntary services? Does the court process end?

If a person agrees to participate in voluntary services, the courts may dismiss the petition if all parties agree or continue the case to allow time for the person to demonstrate engagement in voluntary services.

FAQs - Eligibility

Who determines eligibility for CARE Court?

An Alameda County Superior Court Judge will review all CARE Court petitions that are filed to determine if individuals meet the criteria for CARE. The judge will then either dismiss the petition, order a report from a county behavioral health agency, or set an initial court appearance.

If the individual is found to be eligible, the court will work with the county behavioral health agency, the individual, the individual’s attorney, and a volunteer supporter (if applicable) to connect the individual with services. This connection will happen either through voluntary engagement, a CARE agreement, or a CARE plan.

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FAQs - Eligibility

What disorders are included in the eligibility criteria?

Schizophrenia spectrum disorders include: Schizophrenia, Schizoaffective Disorder, Schizophreniform Disorder, Other Specified Schizophrenia Spectrum and Other Psychotic Disorder, Unspecified Schizophrenia Spectrum and Other Psychotic Disorder.

Other psychotic disorders include: Brief Psychotic Disorder, Delusional Disorder, Schizotypal Personality Disorder, Substance Medication Induced Psychotic Disorder, Catatonia Associated with Another Mental Disorder, Unspecified Catatonia.

Psychiatric diagnoses that do not meet eligibility requirements:* · Psychotic Disorder Due to a General Medical Condition · Catatonia Associated with Another Medical Condition · Major Depression with Psychotic Features · Bipolar Disorder with Psychotic Features · Any other Substance-Related Disorder not listed above

* Except When Accompanied by Another Diagnosis Listed Above

FAQs - Court Process

What happens once a person is determined to be eligible for CARE Court?

Once a judge has ruled that the person is eligible, the judge directs the individual, behavioral health, and their attorneys to develop a CARE Agreement. This is an agreement that all parties voluntarily enter into. If an agreement cannot be reached, the judge may choose to order a CARE Plan.

Does a person have to attend court?

There is no requirement that the person attend court. However, the courts have worked to set up a court that is as welcoming and approachable as possible, including equipping the courts with incentives, including giveaways and gift cards.

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FAQs – Service Planning

What services are available to an individual once they are determined to be eligible for CARE by the judge?

The BACS O&E team will continue to engage with the person while the CARE agreement is being negotiated. There are no additional services available until the person agrees to a CARE Agreement or the judge order a CARE Plan.

What services are available to an individual once they have a CARE Agreement or CARE Plan?

A CARE Agreement or CARE Plan can include behavioral health services, medically necessary stabilization medications, housing, benefits assistance, and any other rehabilitative services.

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FAQs - Service Delivery

Will all CARE Court clients be served by the dedicated BACS FSP team?

While the BACS team provides dedicated capacity, all treatment decisions will be individually determined in partnership with ACBH, the client, and their attorneys. A client may have a different service or service provider included in their CARE Agreement.

How long does CARE Court last? What happens after dismissal?

The initial CARE Court enrollment is for a period of one year, with the option to extend for an additional year.

Once a person completes their term with CARE Court, they would have the opportunity to continue in any of the services for which they are eligible and willing.

A person’s case may also be dismissed for non-participation at any point during the process.

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CARE Act Communications

CARE Court Community Information Sessions

Each virtual session will share information about CARE Court, eligibility, the CARE petition, where to file a petition, roles and responsibilities, a review of CARE resources, and Q&A. Presented jointly by the Alameda County Behavioral Health Department (ACBHD), the Superior Court of Alameda County, the Alameda County Public Defender’s Office, and The Indigo Project.

Session I: November 13, 2024 @ 6pm – 7:30pm

https://us06web.zoom.us/j/2852636270?pwd=bWhQbTFzeC83eWRDdjI5YWIrdStLZz09&omn=89298812735

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Session II: November 19, 2024 @ 12:30pm – 2pm

https://us06web.zoom.us/j/2852636270?pwd=bWhQbTFzeC83eWRDdjI5YWIrdStLZz09&omn=84349030234

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Session III: November 21, 2024 @ 6pm – 7:30pm

https://us06web.zoom.us/j/2852636270?pwd=bWhQbTFzeC83eWRDdjI5YWIrdStLZz09&omn=84349030234

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