Agenda Item Name:
Title
Presentation of an Overview of a Central Receiving Facility for Alachua County
End
Presenter:
Stuart Wegener, Court Services (352)548-3708
Description:
A Presentation to Explain the Components of a Central Receiving Facility for Citizens Experiencing a Behavioral Health Crisis
Recommended Action:
Recommended Action
Receive the Presentation and Discuss the Opportunity for Development
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Prior Board Motions:
$250,000 in General Fund reserves for capital expenses
Fiscal Consideration:
Fiscal Consideration
Estimated $923,000 in annual operating costs. Total operating costs expected to be $1.1 million, however revenue is expected from Medicaid for uninsured or underinsured, others.Under consideration is the use of $1.5 million potentially from American Rescue Plan Funds.
If the Board decides to move forward with the Central Receiving Facility, then funding will need to be identified.
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Background:
A Central Receiving Facility (CRF) provides a single point of entry into the mental health and substance abuse system for assessment and appropriate placement of adults experiencing a behavioral health (Baker Act) or substance abuse (Marchman Act) crisis.
It serves as a single point of entry/drop off for law enforcement (LE) officers, also by individuals such as caregivers or family members. Access to services is available for such on a 24 hour/7 day basis for those who need help on crisis with mental health and/or substance use disorder crisis assessment and assistance.
The Baker Act provides in our State for the involuntary commitment of an individual experiencing a mental health crisis (FL Statute #394) and may be in danger to themselves or others due to their illness.
The Marchman Act provides for the involuntary commitment of someone who experiences a substance abuse crisis (FL Statute#397) and may be dangerous to self or others due to their substance use.
The CRF offers immediate, short-term assessment, evaluation, stabilization and brief intervention services to those experiencing an acute mental or emotional crisis to prevent further deterioration of his/her mental health and to get them the help they and their families need to address the crisis. The goal of most CRF’s is to complete the assessment within a 23 hour period, and to identify the most appropriate level of care needed.
Through its single point of entry, there is greater coordination of care for individuals in need who use multiple systems. More effective and efficient use of resources is also leveraged by a CRF, with enhanced quality and quantity of service delivery.
The single access point feature of a CRF reduces processing time for persons served and LE alike. The average drop-off time by a LE officer can be 5 to 10 minutes, sometimes less. This enables LE to return to their efforts on behalf of community safety.
CRF’s represent the use of essentially a pre-arrest diversion method from criminal justice, and also a diversion from inappropriate care. CRF enables LE to have a safe alternative to arrest for those in crisis. For those individuals with CJ involvement or a pending warrant, there is the option available for transport to the Jail.
Finally, the CRF provides alternative to hospitalization, and thereby reduces in appropriate & costly use of hospital ER departments by diverting such persons.
There are now 9 Central Receiving Facilities or Systems operating in 23 of Florida’s counties. During FY 19-20, these Facilities served 43,298 unduplicated individuals and effectively diverted over 8,000 from hospitals for a cost avoidance of $51 million in emergency room expenditures.
Many such Facilities were initiated over five years ago with funding provided by the Department of Children and Families. The State made matching funds available through a competitive grant process, with local entities, including counties/cities, behavioral health providers, hospitals, and other organizations committing cash or in-kind support. Alachua sought to participate but was unable to galvanize an application which met the DCF match requirements in full.
Since that time there has been considerable interest on the part of the County and the City as well as those concerned about behavioral health advancement in pursuit of developing a CRF. The vehicle for developing greater information and awareness more recently has been the Alachua County Public Safety Coordinating Council (PSCC) which in 2020 created a Subcommittee on Oversight for the Justice and Mental Health Collaboration Grant Program, a new initiative of the County’s implemented by Court Services. Under the leadership of Chief Judge Nilon, the Subcommittee mission was to “advance the concept of a CRF” for Alachua County. Chaired by Judge Ferrero, the composition of the Subcommittee includes at a minimum the leadership of all stakeholders in the local criminal justice and behavioral health systems. Participants included representatives of the region’s 3 hospital systems, including North Florida Regional Medical Center, UF Health, and the Malcolm Randall Veterans Medical Center.
Between June 2020 and now, the Subcommittee has focused its work on obtaining greater clarity about existing models of CRF’s in Florida -how they are structured, governed, operated and funded. The Subcommittee has heard from a panel comprised of the leaders in three communities with CRF’s: Tallahassee (Apalachee Center); Tampa (Gracepoint Wellness); and, Orlando (Orange County/Aspire Health Partners.) On August 4, the Subcommittee will visit Apalachee Center for a fact-finding investigation, to witness it in operation and have the opportunity to learn of its activities, progress and future plans.
Governance of CRF does vary according to community need and availability of local capacities for CRF system development. It is standard to have a regional collaboration of stakeholders including representation from law enforcement, behavioral health providers, participating hospitals, and county and city government.
The effort in the behavioral health community locally to advocate for the development of a CRF has come from Meridian Behavioral Health Care. They serve as one of the public providers and designated receiving centers engaged in the local coordinated receiving system for the County.
The Meridian concept paper for a CRF envisions a regional CRF, using Meridian as a hub for Alachua and seven other counties. Its proposal identifies two key funding elements, the first of which is a required $500,000 investment to reconstruct MBHC’s current screening area to be able to accommodate the CRF. Second, the proposal outlines required staffing, administrative and related costs necessary to operationalize a CRF, for 24 hour/7 day, 365 per year coverage. The estimated total budget is $1.1 million in annual operating costs. It is also estimated that $213,000 in revenue would be achieved and applied toward reducing the operating budget. The source of the revenue is slated to be from Medicaid reimbursement for indigent care and funds from private payors.
At this juncture, the financial component of the proposed project provides for $250,000 from the City of Gainesville and $250,000 from Alachua County which formal commitments are made several years ago. These sums are restricted to the identified capital needs required by Meridian.
Simply put, the challenge for actualizing the CRF concept as expressed, should the BoCC fully endorse its implementation, is securing the operating costs on a sustainable basis. The use of American Rescue Plan funds can assist in initial years of operations.
A potential option expressed and researched by Meridian is the use of State funds, namely through a funding vehicle called the Low Income Pool. (The funding is used for hospitals and other health care providers who provide uncompensated care to Medicaid recipients, or other Floridians who are either uninsured or underinsured.)The opportunity to use this funding mechanism has been approached more recently by Volusia County. Meridian intends to employ this option for securing ongoing financial support through the State. Plans include working in the next session of the Legislature to present the case. The option for continued financial support for the existing CRF’s or a new cohort supported in part by DCF does not appear to be viable. An alternative means is required to support the operating costs beyond an initial period, if approved.