HomeMy WebLinkAboutcfjl-report-may-22,-2025-May 2025 Care First, Jails Last Implementation Report Page 1
Care First Jails Last
Implementation Report
Mental Health Advisory Board Report to Alameda County Board
of Supervisors Joint Health and Public Protection Committees
May 22, 2025
May 2025 Care First, Jails Last Implementation Report Page 2
Table of Contents
Purpose of Care First, Jails Last Work ........................................................................................................... 3
Community-Based Care for People with Mental Illness ........................................................................... 3
Scope of Recommendations ..................................................................................................................... 4
Other Initiatives in Alameda County ......................................................................................................... 4
Funding ..................................................................................................................................................... 5
Monitoring to Date: The MHAB CFJL Ad Hoc Committee ............................................................................. 6
Implementation & Monitoring Report .......................................................................................................... 7
Overview: How Are We Doing? ................................................................................................................ 7
Implementation Status of Selected Recommendations ........................................................................... 8
Data Needs for the Care First Jails Last Process ..................................................................................... 21
Summary of Requests for Action from the Board of Supervisors ............................................................... 23
Sources ........................................................................................................................................................ 25
Appendix 1. Acronyms ............................................................................................................................... 26
May 2025 Care First, Jails Last Implementation Report Page 3
Purpose of Care First, Jails Last Work
Community-Based Care for People with Mental Illness
Alameda County has conducted hearings, task forces, reports, resolutions, funding applications, and
meetings to advance a Care First, Jails Last policy. Nevertheless, devastating gaps in unmet needs remain,
impacting residents who experience mental illness and/or substance use disorders. Every day, hundreds
of people are and remain incarcerated in Santa Rita Jail, or live in the community without treatment or
housing. Despite a significantly reduced population in Santa Rita Jail over the last several years, the
number of people in jail needing the highest levels of mental health treatment has stayed the same. In
addition, last year, an estimated 34.8% of homeless people in the county reported a serious mental illness;
another 28.5% reported a substance use disorder.
In May 2021, the the Board of Supervisors adopted a policy resolution to “Reduce the number of
people with mental illness, substance use and co-occurring disorders in our jail,” by developing “a
continuum of care that includes a full spectrum of treatment and housing, including preventive
and outpatient services, inpatient acute and subacute facilities, licensed board and care homes,
and other wraparound support services so that people with mental illness, substance use, and co-
occurring disorders have a full opportunity to receive and live stable lives.”
Along with this policy resolution, the Board established a Care First, Jails Last Task Force, with
representation from nine county agencies, behavioral health service providers, and community members
with lived experience and expertise, to deliberate and produce recommendations for actions needed to
realize the goals of the Care First policy. The Task Force was chaired by the Behavioral Health Director and
worked from 2022 to 2024. In June 2024 the Task Force submitted a report to the Board, with 58
recommendations, which the Board unanimously approved in August 2024.
At that time, the Board delegated continued planning and implementation to the Mental Health Advisory
Board (MHAB), with updates to the Board of Supervisors three times a year (twice to joint Public
Protection and Health Committee meetings and once to the full Board).
The Board also directed:
● The Mental Health Advisory Board to develop an integrated implementation plan in conjunction
with Alameda County Behavioral Health;
● All relevant Alameda County agencies and departments to participate in the planning process as
requested; and Alameda County Behavioral Health to conduct a cost analysis and coordinate
Alameda County agencies and departments to identify funding sources for the recommendations
of the report and implementation plan.
To fulfill this monitoring responsibility, the MHAB created the Care First Jails Last Ad Hoc Committee
composed of MHAB members, members of the Care First Jails Last Task Force, and community members
with lived experience and expertise. This report is offered along with the verbal presentation to the Joint
Health and Public Protection Committee meeting on May 22, 2025.
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Scope of Recommendations
The Care First recommendations focus on systems change, and provide a roadmap to transform the
system of services aimed at preventing individuals with mental illness, substance use disorder, or co-
occurring disorders from entering the jail system in Alameda County. They encompass all the points of
intervention, from Prevention, Early Intervention and Community Services, to Hospitals, Crisis Care, and
Initial Detention, to Courts, Reentry and Community Corrections (these points of intervention are known
as the Sequential Intercept Model, SIM).
As set forth in the Care First Report submitted to the Board in June 2024, The Care First recommendations
are grouped into nine strategy areas::
1. African American Resource Center
2. Collaboration & Case Management
3. Community-Based Support, Outreach, & Education
4. Crisis Services & Treatment Beds
5. Diversion
6. Funding & Financial Transparency
7. Housing & Residential Facilities
8. Staff Training & Professional Development
9. Family Support
Other Initiatives in Alameda County
Prior to the Care First Jails Last resolution, the County convened the Justice Involved Mental Health Task
Force (JIMH). Guided by a racial equity lens, the JIMH consulted widely with impacted communities and
articulated overarching goals, 24 priority recommendations, indicators of success, and a roadmap.
Reimagine Adult Justice is an initiative in Alameda County to assess and inventory existing in and out of
custody justice-related programming, identify gaps and opportunities that will reduce our reliance on
incarceration, and build on our current reforms to further strengthen re-entry systems, reduce recidivism
and prevent victimization.
The Home Together plan, adopted by the Board of Supervisors in 2022, is a 5-year strategic initiative that
centers racial equity and identifies the strategies, activities, and resources needed to dramatically reduce
homelessness in Alameda County. The Plan identifies what is needed to operate a homeless response
system that has the capacity to address the needs of people experiencing homelessness and to reduce
racial disparities.
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Figure 1: Related Initiatives
As indicated by the above graphic, Care First objectives intersect with the objectives of Reimagining Adult
Justice, CalAIM, and the Home Together Plan, but also have differences, including a specific focus on adults
with mental illness or substance use disorders. Some Care First recommendations, such as for
strengthening processes for appropriate pre-trial release, align closely with RAJ recommendations, and
thus the Board also requested that the MHAB review how Care First and RAJ recommendations interact
with each other.
Funding
There are opportunities for funding a Care First, Jails Last system in Alameda County, from local, state,
and even federal sources. The Ad hoc Committee chose to highlight two sources that are most timely and
salient, but these should not be viewed as the only potential sources of funding.
Measure W
The Mental Health Advisory Board (MHAB) observes that there are large areas of alignment between
investments in permanent supportive housing, deep housing subsidies, and Board & Cares recommended
in the Care First report and housing investments recommended by County staff for the use of Measure W
funds. The availability of Measure W funds presents an unprecedented opportunity to help meet the
housing needs of people with serious mental illness, substance use disorders, or justice involvement who
might otherwise be incarcerated in the County.
CalAIM
California’s implementation of the California Advancing and Innovating MediCal (CalAIM) also provides
much-needed funding opportunities. CalAIM is a game-changing opportunity to improve behavioral
health outcomes for justice-involved individuals. CalAIM specifically includes in its “mandatory
May 2025 Care First, Jails Last Implementation Report Page 6
populations of focus” individuals transitioning from incarceration who have significant behavioral health
needs. Under CalAIM, for the first time, counties can access federal Medicaid matching funds for care
coordination services provided in jail within 90 days prior to release. This so-called “90 day jail in-reach”
service provides reimbursement for re-entry case management, including: Initial Care Needs
Assessments; transition plans for post-release community-based care; and screening and referrals to
community-based services and appointments after release. As noted by then-U.S. Secretary of Health and
Human Services, Xavier Becerra, “this is the first time in history Medicaid will be providing coverage to
justice-involved individuals before they are released.”
Monitoring to Date: The MHAB CFJL Ad Hoc
Committee
The MHAB Care First, Jails Last Ad Hoc Committee began convening in Fall 2024 and meets monthly. These
meetings are hosted by the Alameda County Behavioral Health Department and facilitated by RDA
Consulting.
For the purpose of monitoring all 58 recommendations from the Care First, Jails Last report, the Ad hoc
Committee established agency-specific subcommittees. These subcommittees are made up of members
of the Ad hoc Committee and other interested community members. The MHAB reached out to all county
agencies on behalf of the Ad Hoc Committee to establish contact and request that a liaison be assigned
to meet with and update the subcommittee members on implementation progress.
In addition, the MHAB CFJL Ad Hoc Committee established a Data Subcommittee to identify and monitor
data points that reflect progress in achieving the CFJL mission. The subcommittee is focusing on data
points that are currently collected by County departments and agencies.
Despite the challenges of working across agencies to address complex issues, there are some key areas of
progress:
● The ad hoc committee is able to monitor progress based on regular data reporting on the number
of individuals with serious mental illness (SMI) in Santa Rita Jail.
● The African American Resource Center is becoming a more tangible reality.
● Measure W offers the opportunity to do very significant good as a funding source.
● ACH Housing & Homelessness Services and Housing & Community Development are proposing
creative ways to subsidize housing for the most vulnerable and connect those exiting jail with
housing.
● Alameda County hosts a variety of diversion courts and demonstrates a will to make them work.
And challenges remain. For this inaugural report, the ad hoc committee selected several
recommendations that seem timely because they relate to one-time funding opportunities, might rescue
promising programs that are in trouble at the moment, are potentially transformative, and/or exemplify
basic, long-standing difficulties in reforming the system. The status of these recommendations and
requests for Board action to facilitate implementation make up the body of this report.
May 2025 Care First, Jails Last Implementation Report Page 7
Implementation & Monitoring Report
Overview: How Are We Doing?
One way to monitor whether the county is successfully implementing Care First recommendations and
realizing the Care First goals is to measure the size of the mentally ill population at Santa Rita Jail and track
it over time to see if it is decreasing. We have, in fact, been able to measure the size of the mentally ill
population at Santa Rita and it has not decreased.
Starting in 2023, Adult Forensic Behavioral Health (AFBH), the behavioral health unit in the jail, began
assessing all inmates and designating a “Level of Care” (LOC) number from 1 to 4 to reflect a person’s
acuity level and ability to function within a correctional setting. With these LOC designations (4 being the
most acute), it is now possible to assess and monitor the size of the mentally ill population at the jail. As
shown in the graph below, from July 2023 through April 2025, the numbers of incarcerated individuals at
the jail within each LOC has remained almost the same (except for a recent spike in the LOC 1 category).
In other words, even though the average daily population at the jail has decreased almost 8% during this
time period, the size of the mentally ill population in the jail has remained the same. In fact, the number
of incarcerated individuals with an LOC of 2, 3, or 4 (the most gravely ill inmates who are all housed in
Therapeutic Housing Units at the jail for appropriate mental health treatment) has averaged 384 for the
last two years. That number is greater than the sum total of all people in Alameda County who on any
given day are receiving mental health treatment at John George Hospital, Villa Fairmont and Gladman
Rehabilitation Centers, and all of the Crisis Residential Treatment Centers combined.
May 2025 Care First, Jails Last Implementation Report Page 8
While the MHAB is committed to measuring implementation of other objectives, this data on people with
serious mental illness in Santa Rita Jail demonstrates how much more needs to be done to achieve the
Care First Jails Last goals.
Implementation Status of Selected Recommendations
This report, which accompanies the presentation to the Board’s Joint Health and Public Protection
Committees meeting scheduled for May 2025, provides updates on implementation progress of a select
set of recommendations. The Ad Hoc Committee has selected these recommendations because they will
have a tangible impact in achieving the goals of the Care First Jails Last Resolution. For some
recommendations, there are critical steps that County departments must take to advance them. Others
address entire missing or insufficient components of mental health care or diversion. As set forth below,
for each recommendation we note progress that has been made, obstacles faced during implementation
or as part of the monitoring process, and specific requests to the Board of Supervisors to advance
implementation.
The Ad Hoc Committee selected the following nine recommendations to highlight in this report. For ease
of navigation to source materials, the recommendations are listed in the following table as they appear in
the final Care First, Jails Last Task Force Report (June 2024):
Recommendation Headline Number Page of Final
Report
May 2025 Care First, Jails Last Implementation Report Page 9
Recommendation 2C: Expand Safe Landing Project Services
Progress
When the Safe Landing Project (SLP) was launched in June 2020, its hours of operation were weekdays
from 2:00 pm to 10:00 pm. Over time, the hours of operation have more than doubled. Currently, the SLP
operates seven days a week from 8:00 am to midnight.
For the first year of its operation (FY '20 - '21) the SLP was not able to provide direct transportation for
SLP participants. Instead, the SLP provided transportation support via Uber or other rideshare services or
use of SLP cell phones to aid participants in arranging their own rides. Starting in November 2021, with a
grant from the Alameda County Probation Dept., the SLP launched a shuttle service which departs every
30 minutes from the jail, beginning at 9 am, with its last departure from the jail at 11:30 pm. Most shuttle
rides take passengers from the jail to the Dublin BART station, with two longer rides scheduled to take
passengers to the Eastmont Transit Center in Oakland at 3 pm and 9:30 pm daily.
Number of individuals served:
10,906 (June 2020 - December 2023) - during this same time period, 39,000 people were released
from jail during the days and times that the program was operating. It is estimated that 70 - 80%
of the people leaving jail are in need of SLP services upon release.
The Bridging Group has been contracted since 2020 to evaluate the SLP and provide public-facing reports
documenting their assessments. The evaluation for the full pilot period, 2020-2024, is available.
Obstacles
Since June 2020, when the SLP opened its doors, it has operated out of a mobile trailer that is parked in
the parking lot right in front of Santa Rita Jail. The mobile trailer was always meant to be a temporary
structure to house SLP operations. The MHAB has learned that the trailer is problematic in numerous
ways: it's hot in the summer and cold in the winter; the Wifi is not reliable; it's cramped; and most
significantly, people with impaired mobility (folks who use canes, walkers, wheelchairs, etc) cannot
manage the rickety stairs on the outside of the trailer. No progress has been made in creating a more
permanent home for the SLP. Initially, stakeholders envisioned the SLP as having a permanent home in
the jail (perhaps in the lobby). For a variety of reasons, a permanent home inside the jail is neither feasible
nor desirable. What Roots (the CBO that runs the SLP) wants is a permanent modular structure that is
placed where the mobile trailer is currently situated. The MHAB has learned that Roots was able to
procure a donated modular structure at no cost. Unfortunately, negotiations with ACSO for a permanent
location for the modular structure have not gone anywhere.
One of the most significant obstacles to greater success is the lack of a permanent location near the base
of the ramp for a modular structure to house the SLP operations. According to the most recent evaluation
of the SLP, "While there have been multiple efforts to reexamine and determine a different physical space
for SLP, as of the end of the pilot [June 2024], SLP was still operating in a recreational trailer without
electricity beyond portable generators, plumbing, confidential program space, or reliable Wi-Fi.... If a
more semi-permanent structure can be arranged for the program, it will greatly enhance SLP's ability to
provide a wider array of services... and assure better safety and program access for participants and staff."
May 2025 Care First, Jails Last Implementation Report Page 10
Roots would like to do more in-reach in the jail with the incarcerated population to begin pre-release
planning before an individual is released (and then continue the process once the individual is working
with SLP staff upon their release). As of April 2024, this kind of pre-release planning has been reimbursable
through CalAIM's Justice Involved Initiative. However, for reasons that are not clear to the MHAB,
Alameda County has postponed the implementation date for this aspect of CalAIM and has yet to begin
leveraging MediCal dollars for this purpose.
Requests for Action from the Board of Supervisors
1. Require that the responsible parties accomplish the simple goal of putting a modular structure in
a permanent place for the SLP to do its work.
2. Insist that the county leverage available federal money through the CalAIM Justice Involved Re-
entry Initiative to help fund Roots's effort to provide pre-release re-entry planning for
incarcerated people.
Recommendations 4D and 4E: Create More Psychiatric Beds and
Assess Unmet Need for Treatment Beds
Context:
These recommendations call for more psychiatric treatment beds, especially at the subacute level, and a
determination of how many psychiatric beds, at all levels of acuity, are needed to meet the needs of
individuals with serious mental illness. In a presentation from the Alameda Health System (AHS) to their
Board of Trustees in July 2023, it was noted that “on a given day at John George Hospital, 25-35% of the
patients have reached psychiatric stability and are waiting for a sub-acute bed to become available.”
Additionally, it was pointed out that “the movement to decriminalize mental illness which is noble and
should happen requires specialized forensic involuntary treatment centers and multiple levels of
community-based services to achieve this goal that are not currently available to meet the need.”
Progress
The Behavioral Health Department is creating more psychiatric beds: it has applied for, and plans to apply
for, millions of dollars in Behavioral Health Continuum Infrastructure Program (BHCIP) funding for dozens
of locked and unlocked beds, including subacute hospital beds, as detailed in March 2025 presentations
to the MHAB. Nevertheless, we have no assessment of how far these subacute and other beds will go
towards diverting the numbers of seriously mentally ill people we hope to divert from Santa Rita.
Understanding the physical adequacy of our treatment system, through data, is crucial to the Care First
process. Although Recommendation 4E says “this ‘Bed Assessment’ should happen at the same time as
the County is already doing the Full-Service Partnership Assessment and the Mobile Crisis Assessment
pursuant to the settlement of the Disability Rights lawsuit,” the bed assessment for subacute beds seems
to be behind the other two assessments. The unmet need for subacute beds, along with the unmet need
for board-and-care and crisis residential beds, may be a limiting factor for the whole non-jail system for
mental illness.
Obstacles
Assessments of need for subacute and other beds in Alameda County should be produced and publicly
disclosed. BHD said in its response to the Care First report that it “has already completed a system
May 2025 Care First, Jails Last Implementation Report Page 11
assessment regarding the beds required (including sub-acute) for the system.” A “systemwide assessment
of bed need countywide” is said to be ongoing, to be completed 12-24 months from the report date.
Knowing the present state of the assessment, its approach and the kinds of data it would draw on, would
help us understand the fundamentals of the system.
Requests for Action from the Board of Supervisors
Ask BHD to share with the MHAB the completed assessment of the need for subacute and other
psychiatric beds, plus the status of the ongoing assessment. BHD and its contractor Indigo have shown
they can make rough yet transparent statements about quantitative needs, as they have done for AOT
and the CARE Court program. They should share the state of their thinking on the adequacy of beds,
without waiting for further guidance from the State on the implementation of SB 43 and Prop. 1. See also
the Request for Action under Recommendations 5C and 5D below.
Recommendation 5A: Expand Point-of-Arrest Diversion
Context: C.A.R.E.S. Navigation Center
Recommendation 5A calls for the Board of Supervisors to commission an independent assessment of the
pre-arrest diversion program, run by the District Attorney’s Office, known as the CARES Navigation Center.
Part of the recommendation states that "Any decision to maintain or expand the CARES Navigation Center
must address obstacles to law enforcement participation and non-police means for people to receive
services at the Center."
Progress
Started in 2022 using Proposition 47 funds, the Center has had three different CBO contractors, and is
currently operated during daytime hours in Oakland by The Uncuffed Project. Nevertheless, for several
reasons, no one was using the Center’s services when the subcommittee interviewed its staff in March. A
2023 evaluation of the program also reported low rates of referrals from law enforcement. Last October,
the state awarded the DAO a $6 million dollar grant to continue the CARES Navigation Center until 2028
and expand its services to East and South County. The status of the final award for this grant is unclear.
CARES Navigation has two paths for participation: Law enforcement or MACRO (Mobile Assistance
Community Responders of Oakland) bring a person to the Center, or the DAO identifies someone who has
been cited and released and sends them a letter inviting them to come to the Center.
Obstacles
A wide range of persons with mental illness or substance use disorders would benefit from pre-arrest
diversion efforts. These include some unhoused persons, especially those impacted by law enforcement
encampment sweeps or criminalized by new ordinances prohibiting outdoor sleeping. Yet Prop. 47
funding, as well as additional restrictions by the DAO, impose extensive limits on who may be served: only
those with misdemeanor offenses (imposed by DAO); no sex offenders, domestic violence, or DUI
offenders; not in a psychiatric emergency, though they must have symptoms of mental illness or
substance use; must participate voluntarily; must include law enforcement involvement; and they must
be ambulatory or able to use a wheelchair.
May 2025 Care First, Jails Last Implementation Report Page 12
Moreover, according to Uncuffed staff, some of those referred by the DAO either never receive their
referral letters or decide not to respond to a letter from the DA. One suggestion was that the referral
letter come instead, or additionally, from Uncuffed.
Requests for Action From the Board of Supervisors
The Center is already due for a second independent evaluation in 2026. Before that time, however,
especially in light of plans to expand the Center’s service to East and South County, it is urgent to address
the lack of law enforcement participation. It is also critical to explore support for pre-arrest diversion that
would serve the large number of people excluded from CARES Navigation by Prop. 47 or DAO restrictions.
Recommendation 5C: Expand Court-Based Diversion Programs
Context
Alameda County is a pioneer of court-based diversion programs. The number and diversity of programs
offered today provide both opportunities and challenges. Recommendation 5C addresses collaborative
and other court-based diversion programs serving people with mental illness and/or substance use
disorders; it calls for:
● Independent evaluation of performance and outcome metrics;
● Increased capacity to divert individuals with co-occurring MI-SUD;
● Lowest possible barriers to treatment engagement and court attendance;
● More timely in-custody assessments and referrals to diversion courts; and
● Creation of a family liaison role.
Progress
Court officials and agency liaisons have shown a strong commitment to implementing Recommendation
5C. The engagement of DAO throughout the leadership transition is notable.
1. In just a few years, statutory Mental Health Diversion Court has grown to become the County’s
most effective diversionary off-ramp for incarcerated people with mental illness. The court’s 200+
docket includes people with SMI, SUD, and co-occurring MI/SUD.
2. The Superior Court’s Collaborative Court Program includes Felony Drug Court, which serves a high
proportion of individuals with co-occurring MI/SUD and is currently operating at or near its 70-
person capacity.
3. It is becoming routine for these courts to monitor progress by remote interviews, making court
appearances less onerous for participants.
4. Judge Della-Piana, supervising judge for Behavioral Health Court (BHC), has begun working with
Alameda Forensic Behavioral Health to ensure that in-custody assessments of potential
candidates to BHC are available within two weeks of booking.
5. Alameda Co. Superior Court’s proposed expansion of its Pretrial Services Program promises to
increase and expedite referrals to treatment courts through early identification and removal of
barriers to referrals and participation
May 2025 Care First, Jails Last Implementation Report Page 13
Obstacles
1. MH Diversion Court has grown despite its lack of dedicated resources, depending primarily on
those of the Public Defender’s Office. This Court needs dedicated mental health and
administrative personnel for performing assessments, matching clients to programs, and
monitoring progress. Additionally, the Public Defender’s Office needs funding to place at least one
dedicated PD attorney within this court. Work is underway to define the need, budget, and
potential funding sources.
2. All the diversion courts are hampered by the limited number of suitable treatment programs and
beds, in particular, Crisis Residential Treatment beds, and residential treatments for co-occurring
SMI/SUD.
3. Data elements critical for evaluating the court-based diversion programs are maintained
by different departments and agencies, necessitating a role for cross-agency
collaboration.
4. There is significant confusion about the organizational structure of the different court-based
diversion programs. The lack of a centralized source of complete information makes it very
difficult for practitioners, clients/defendants, and family members to navigate the system.
Requests for Action from the Board of Supervisors
1. Give direction to the ACBHD to assess the unmet needs across the court-based diversion programs
for residential and treatment beds for SMI, SUD, and Co-occurring disorders. This assessment
should consider how many of the anticipated BHCIP-funded facilities/beds (see March 2025
reports by Behavioral Health) will be capable of serving justice-involved, high-need individuals,
including those judged incompetent to stand trial (see Recommendation 5D).
2. Direct collaborative-court partners and ACSO to coordinate efforts to identify key
performance and outcome metrics, share current data-gathering practices, and create a
plan for cross-agency collaboration. Court-based diversion is a prime example of the lack
of coordination among agencies, a problem that CFJL called attention to in
Recommendation 2B, on Interagency Communication and Coordination.
3. Direct Public Safety Partners and CAO to produce the Board’s requested funding plan for the
Pretrial Services expansion without further delay.
Recommendation 1A: Create and Support an African American
Resource Center
Context
Care First, Jails Last Task Force Recommendation 1A reads as follows:
Create and support ongoing funding of an African American Resource Center (The Center) that
provides information and culturally responsive services in the areas of education, physical
health(e.g., nutrition, meal services, and medical services) and psychiatric support, medication
management, and individual and group therapy.
In order to support the Center in community responsiveness, the County should develop an African
American advisory committee with minimum 50% representation of people with lived experience,
May 2025 Care First, Jails Last Implementation Report Page 14
including family members, with the goal of identifying necessary services, culturally responsive
resources, and to support the expansion and dissemination of funds relative to the Center.
Progress
Status: On the Way to Reality!
The African American Resource Center had a forerunner in the comprehensive African American Mental
Health Center in West Oakland. A first-class, comprehensive Wellness Hub, for the most vulnerable BHD
clients living with mental Illness or substance abuse, is on its way. A long-held vision in the African
American community, the Center will take clients from diagnosis to care, with personal affirmation and
groups designed to rebuild a sense of competence, and socially strengthening, cohesion-building,
purpose-finding experiences.
The African American Wellness Hub has a centrally located site and design plans that will combine a core
of healing services with comprehensive supportive services to embrace this mission: to avoid the frequent
passage of our affected community members through the jail and repetitive hospitalizations, and to usher
reentry clients away from jail distress toward restorative programs.
Productive Discussion between Implementation Committee and ACBHS
The subcommittee’s discussions with the Behavioral Health Department centered on a pivotal
recommendation: Integration of the voices of those with lived experience directly into the Center’s
management.
The Center should embody the struggles and triumphs of those who have managed serious illness and or
substance abuse AND those whose love has carried them through the pain of caregiving. It must bring to
fuller utilization in the department family members who know the impact of serious mental illness or
substance abuse on the family. They should be a vital resource to the Center’s management in the ongoing
direction of the project. Family members and those with direct lived experience should play a direct role
in advising the Center on ideas for meeting the needs of both clients and their family members who need
support in learning how to support recovery in loved ones.
The subcommittee was pleased to confirm that BHS leadership intends that the Center will include
psychiatric services, and an interdisciplinary approach to the care of clients, in which psychiatrists,
psychologists and other trained providers would be part of a collaborative team in working to restore
client growth. The challenge is to actually learn how the organization contracted to direct the Wellness
Center plans to weave the two distinct psychiatric and psychological services into a seamless collaborative
whole plan. To date, one is seeking confirmation from the proposed service provider that it has expertise
with system involved individuals with serious mental illness and that it understands that a primary cause
of serious mental illness has a biological basis. While harsh social conditions play a part, most scientists
tell us that serious mental illness has a genetic component. For this reason, the Ad Hoc Sub Committee
on Implementation has recommended that, in the interim while a new building in under construction, the
service plan be field tested and refined prior to the opening of a new Center.
BHD leadership and Committee members are open to ongoing discussions about how to include the
insights of those who are so closely affected by the everyday challenges of living with or caring for those
with brain and behavioral illnesses.
May 2025 Care First, Jails Last Implementation Report Page 15
Obstacles
At present, funding challenges for non-chargeable ‘lived experience’ participation are a barrier to
institutionalizing this role among the Center’s services.
Ways Forward
In the interim, while the current building is razed and the site developed, investigate the potential to field
test a version of the program model already underway in the community with Front-Line Healers;
incorporate a feedback role for family caregivers.
Requests for Action from the Board of Supervisors
To its great credit, the Board has already taken key steps to support the building of a Wellness Hub.
What will be important, in this era of funding challenges, is:
1. To support BHD in locating private and public monies to sustain vital navigational and case
management services to the Center’s clients.
2. To use its platform to build community awareness of this innovative service center.
Recommendation 3L: Establish a First Episode Psychosis Program
Context
People with schizophrenia suffer a loss of contact with reality. They endure terrifying hallucinations and
can’t understand that the voices they hear are coming from their own minds. Schizophrenia is treatable.
If we start soon enough—in the first three months—and provide the proper care, people can return to
their former lives.
In Alameda County we don’t provide enough of such care, and people with schizophrenia often end up on
the streets, behind bars, or dead (for example, see Rosenlicht 2024). Felton runs Re(Mind), an early
psychosis program for people up to age 25 who have Medi-Cal, but the program has been struggling.
The proper treatment is First Episode Psychosis (FEP) care, based on the EPI-CAL model. This model is a
five-part outpatient program including family participation, psychotherapy, medication, vocational rehab
and social services, with an emphasis on collaboration between all the providers.
The five elements of the EPI-CAL model are:
1. Family support and collaboration
2. Psychotherapy to help the young person cope with the illness and return to their previous life
3. Psychiatric care with medication management, including frequent meetings to build trust and
assess the effects of treatment (e.g. medication side effects, quieting of hallucinations)
4. Vocational rehab to help the young person return to school or work.
5. Case management as needed to provide food and housing, and help with insurance and medical
appointments.
May 2025 Care First, Jails Last Implementation Report Page 16
Every part of the FEP model is essential. Families need support and have valuable insights for us clinicians.
Their participation is vital. Psychotherapy is invaluable. Our young patients need a chance to explain their
experiences to a sympathetic listener, one who can respond when appropriate with timely feedback.
Medication is essential, with prompt follow-up to build trust and to hear about side effects or hoped-for
improvements, such as quieting of the voices. Vocational rehabilitation counselors help with return to
school or work, to bridge the gap between disability and renewed participation in the community. Case
management is needed to provide food and housing, and help with insurance and medical appointments.
Close collaboration between the team members is a crucial aspect of this model and we would want
everyone to work from the same home base for purposes of enhanced communication
About 900 people a year in Alameda County have their first episode of psychosis and thus join the
population with early schizophrenia (based on a 2019 estimate by Radigan and others that 272 Medicaid
recipients per 100,000 have a first episode). We need to provide them with proper care. There’s no time
to waste.
Progress
The subcommittee has studied the state-endorsed model on the Early Psychosis Intervention-CAL (EPI-
CAL) model for first episode psychosis (FEP) care and learned that ACBH is one of 36 counties that have
publicly committed to implement this model.
The Care First Plan recommendation 3L (see p. 101 of the CFJL report) has three parts:
A. Make available an evaluation of the Felton Alameda program
B. Felton to develop a public information campaign to increase its census to 100.
C. Study age restrictions and program location as barriers to participation.
The subcommittee met with Dr. Tribble of Behavioral Health on April 10 to obtain the agency response
(see the ACBH subcommittee notes for that date on Google Drive). We have been invited to submit
further questions and to have a second meeting.
Obstacles
So far, the subcommittee responsible for monitoring this recommendation has been unable to find an
evaluation of the Felton program. We have been provided with information from 2022-2023,
documenting that their census was down to 47 that year, and that they lost several staff members during
the pandemic, leaving them with only two staff members. ACBH/MHSA has given Felton a corrective
action plan. At this time, it does not appear that any U.C. Davis state-funded evaluations of FEPs have
been completed for Alameda County’s Felton program.
As of April 2025, it appears that Felton’s First Episode program is not fully functioning, since its enrollment
falls under the 100-person census, and the target population has been estimated at 800-1000 or more
(using a formula published in 2019 by the UC Davis team of Radigan and others.) Felton’s program doesn’t
appear to have an active component that involves families, and the meetings with a psychiatrist appear
to occur only quarterly.
As the subcommittee understands from our interview with ACBH, BH does not aim to expand Early
Intervention through a dedicated first episode program by Felton or others. Instead, BH plans to offer
May 2025 Care First, Jails Last Implementation Report Page 17
Early Intervention through the use of Full Service Partnerships (FSPs). We are seeking clarity on how this
might work, since FSPs in Alameda County are reserved for people who have long tenure in the illness.
The target population for FSPs (as described by the MHSOAC’s report to the Legislature on FSPs) is
different than that envisioned in the EPI-CAL model, and focuses on those who already have a history:
California’s Full Service Partnership (FSP) programs are recovery-oriented, comprehensive services
targeted to individuals who are unhoused, or at risk of becoming unhoused, and who have a
severe mental illness often with a history of criminal justice involvement and repeat
hospitalizations [emphasis added].
The subcommittee identified a need for a second FEP, to serve those not served by Felton, and we expect
further discussion to come to a mutual understanding as to how we can implement a new FEP program.
Requests for Action from the Board of Supervisors
The subcommittee will continue to work with BH to explore funding possibilities. First Episode Psychosis
programs can be funded under the Behavioral Health Services Act (BHSA, or Prop. 1).
1. We recommend a new First Episode Psychosis program, modeled after the EPI-CAL design, be
established in Alameda County. Alameda County should follow other Bay Area counties and admit
patients up to 30 years old into First Episode Psychosis programs modeled after EPI-CAL.
A note on Public Awareness:
Recommendation 3L includes making the public aware of the County’s first episode psychosis program.
Family member organizations can do this, by reaching out to organizations like NAMI, hospitals and
emergency rooms, mental health providers, schools and Parent-Teacher Associations, and the criminal
justice system. But before we begin this project, we need to have a program in place to refer to.
Recommendations 7I, 7J, 7O: Expand Licensed Board and Care
Facilities Through Land Trusts and Innovative Housing Models
Context
The CFJL Report’s housing recommendations were assigned to the Alameda County Housing and
Community Development Agency (HCD), Housing and Homelessness Services (HHS), or (often) both.
The housing recommendations for both agencies overlap significantly with the recommendations in HHS’s
Home Together Plan (Phase 2), which includes $350M to purchase, lease, and complete renovations for
interim and permanent housing, and clinical services for people experiencing homelessness. If these long-
term and permanent housing recommendations are funded and prioritized, the County will go far towards
breaking the cycle of homelessness for residents at the intersection of criminalization and mental health
crisis: one of the most vulnerable and underserved populations.
Licensed Board and Care facilities, sometimes included in the “permanent supportive housing” category
but often left out, are covered in Recommendations 7I, 7J, and 7O. Board-and-cares are licensed,
supportive, permanent housing specifically for the seriously mentally ill; they are often vital for people on
LPS (Mental Health) conservatorships, people who need medication, and people needing help with daily
May 2025 Care First, Jails Last Implementation Report Page 18
living or with crises, Nevertheless board-and-cares are disappearing, in part because of low state
reimbursement rates for seriously mentally ill clients (much lower than state rates for the intellectually
disabled) and in part because of rising real estate costs.
For decades, we have experienced a drastic reduction in the number of Board and Care facilities in
Alameda County. Public Consulting Group (2023) and the Supportive SHCLA (2024) report that from 2019
to 2024, 116 Residential Care Facilities (RCFE) and 59 Adult Residential Facilities (ARF) closed, for a total
loss of 3367 beds in these two categories (state licensing data lists Board and Cares in both categories).
HCD reported the bed loss figures in May 2025 to a joint Health and Social Services Committee meeting.
Just last month, in April 2025, two additional Board & Care facilities - in Castro Valley and Oakland - closed
their doors.
Progress
Care First Ad Hoc Committee members met with department heads of HHS and HCD agencies to review
the recommendations assigned to each agency and their progress.
HHS funds “patches” (operating subsidies), using state BHSA/MHSA money, for 17 higher-quality Board
and Cares through the Housing Support Program (HSP). Recently it awarded one-time State Community
Care Expansion and Preservation funds for capital and operating costs of existing Board and Cares. This
funding, however, does not increase the number of Board and Cares; new operators enter the HSP
program but others leave it due to operating costs or other reasons. For the purpose of creating new
Board and Cares, MHSA funding has sustained the operation of the Supportive Community Housing Land
Alliance (SCHLA), and SCHLA has secured funding from the City of Oakland for one Board and Care site,
but it’s not clear where more money to buy more new sites will come from.
Obstacles
HHS needs to develop data, more specific than that in the Year 2 Home Together report, breaking down
the unmet needs and related costs for the Care First population (specifically, those who are justice-
involved or have re-entry housing needs) including the need for Board and Cares. The Home Together
reports do provide some data on unmet needs for those with SMI and SUD.
To increase the number of Board and Cares, HHS needs to increase its capacity to recruit potential
operators, who need technical assistance for state licensing and operations support.
For both permanent supportive housing and Board and Cares, we need to identify a funding source for
capital costs to acquire buildings, as well as operational costs to maintain properties.
Requests for Action From the Board of Supervisors
1. The Home Together plan should specifically call for an analysis to support the needs of those with
SMI, SUD, and co-occurring disorders, as well as the needs of the justice-involved population.
2. Use Measure W funding to fund the $350 million proposal HHS presented to the Board of
Supervisors on December 9, 2024, including:
○ A Capital Acquisition Fund to support the purchase, leasing, and capital improvements
for:
■ 750-1,000 beds of interim housing;
■ At least 850 units of permanent housing; and
May 2025 Care First, Jails Last Implementation Report Page 19
■ Clinic space to serve people experiencing homelessness.
○ We urge that this fund provide capital funding for SHCLA to support buying or leasing and
making capital improvements to licensed board-and-cares, to begin replacing the beds
that Alameda County has lost since 2019.
3. Request state funding through legislation or the budget to keep existing Board and Cares alive
through increased rate subsidies (through a Personnel-Administration-Legislation Committee
letter, for example).
Recommendations 7E, 7F: Increase Access to Deep Housing Subsidies
for Individuals with Justice Involvement and Serious Behavioral Health
Concerns
Context
Housing recommendations 7E and 7F address the need for long-term, targeted rental support to
individuals with very low incomes who are justice-involved and/or have serious behavioral health
concerns. A “deep subsidy” is a type of rental assistance that allows residents to pay a fixed percentage
of their income (typically 30% or under) while the program provides the remaining housing costs; deep
subsidies allow households with very low incomes or those with ongoing needs due to disabilities to
maintain their stability despite rising housing costs. Because federal Section 8 housing subsidy programs
exclude people who have been incarcerated, and the County’s Coordinated Entry System does not
currently prioritize the housing needs of SMI/SUD or justice-involved individuals, these high-need
populations have very limited access to the types of long-term rental subsidies that are proven to prevent
homelessness and increase housing stability.
To address these gaps, the County should set aside funds for deep rental subsidies specifically for
individuals with these compounding vulnerabilities (justice-involvement, behavioral health needs) who
are extremely low-income or have fixed incomes.
Progress
HHS has proposed creating a Flex Pool to add 2,900 permanent housing options, and creating a centralized
system of rental subsidy administration, in conjunction with Prop 1 and CalAIM.
HHS has proposed that Measure W be used to fund these deep subsidies for justice-involved people and
people with serious behavioral health concerns. Additionally, the BHSA-funded portion of the flex pool is
intended to be used to connect individuals with serious behavioral health needs to a service team.
HHS is working to instate a Forensic Access Point in order to embed Coordinated Entry System services
into Santa Rita Jail and facilitate access to transitional and permanent housing for individuals preparing to
exit incarceration.
Obstacles
In 2024, 1,148 more Alameda County residents entered homelessness than gained housing through the
homeless response system, indicating the need to scale up the homeless prevention work of HHS and
HCD.
May 2025 Care First, Jails Last Implementation Report Page 20
HHS receives $14M/year from AB109 for transitional housing provided for 3-6 months after incarceration;
however, AB109 funding is only focused on transitional – not permanent – housing resources. To prevent
and interrupt the cycle of homelessness, particularly for people at the intersection of behavioral health
needs and justice involvement, the County must provide additional ongoing long-term rental subsidies to
these low-income populations.
The County also lacks long-term operating funds to resource this work. According to County staff, only
25% of people who are eligible and qualify get access through a lottery-based system that is not based on
highest need. Current federal actions could further reduce HUD funding, which is the source of most HCD
operating funds.
Requests for Action from the Board of Supervisors
1. Measure W funding should be directed toward implementing the Home Together Plan, including
the proposed flex pool and long-term rental subsidies dedicated to households with justice-
involvement and serious behavioral health concerns, as outlined above. The Board should move
forward on the proposal by HHS to use a portion of the $350M accrued revenue from Measure W
to acquire 850+ PSH units; a portion of these units should be dedicated to justice-involved people.
2. The Home Together plan should specifically include an analysis of housing needs for people with
SMI, SUD, Co-Occurring Disorders, and Justice-Involvement.
3. The BOS should enact a policy to ensure that our County’s Coordinated Entry System prioritizes
housing services to people with serious behavioral health needs, and those who are justice-
involved – regardless of whether they are diagnosed with a co-occurring disorder.
Recommendation 6A: Provide Transparent Public Reporting on Funds
Allocated to Care First Population
Context
Transparent information about the availability and use of funds, and the constraints on those funds, is
critical for the Board of Supervisors to make sound decisions regarding CFJL goals. This recommendation
states that:
The County Administrator’s Office (CAO) must transparently report the funds that are available,
earmarked, budgeted, and allocated to support the Care First population and make this information
publicly viewable on a website. This information includes:
● For all reporting: the funding source, amount of allocation, intention for funds, and agency
receiving the funding.
● Realignment/Reentry funding that comes from and/or goes into general funds, reserves, or other
pots of funding.
● Tracking of CalAIM funds including PATH and other reimbursements.
● Funding available for reinvestment and cost savings, funding which must remain within the Care
First population.
● Unspent funds and funding balances in reported accounts.
● Unspent funds in Santa Rita Jail for County and contractor staff, including agency allocations,
overtime, and unfilled staff positions.
● Funding allocated to address the Babu settlement.
May 2025 Care First, Jails Last Implementation Report Page 21
Furthermore, this information should be updated every six months after an initial report.
Progress
Beginning in January 2025, Care First Ad Hoc Committee members and the Behavioral Health Department
reached out to the County Administrator’s Office (CAO) six times to request a time to discuss progress in
implementing these recommendations. This included one conversation in person at a county budget
meeting, at which the Administrator confirmed who the Care First liaison would be.
Obstacles
As of April 2025, the CAO has not followed up to help the Ad Hoc Committee monitor its progress toward
these objectives.
Requests for Action from the Board of Supervisors
The Care First Ad Hoc Committee recommends that the Board of Supervisors give direction to the CAO to
fully implement the Care First recommendations assigned to the Office, and meet with representatives of
the Ad Hoc Committee to discuss progress to that end.
Data Needs for the Care First Jails Last Process
Besides monitoring agency performance in other ways, the MHAB Ad Hoc committee has a subcommittee
that monitors the county’s progress in making data transparent and useful. The original Care First Jails
Last resolution in 2021 centers the importance of data in implementing the Care First policy. It states that:
“All Alameda County agencies that can contribute to advancing a Care First, Jails Last policy will
gather and share data with the Alameda County Behavioral Health Care department, where
permitted by health privacy and confidentiality and not prohibited by other applicable laws, for
the purposes of:
1) coordinating the systems of criminal justice, behavioral health care, and wraparound
services including public benefits, social services, and housing;
2) identifying and measuring unmet needs for behavioral health and other wraparound
services, and, to the extent possible, measuring the impact of behavioral health and other
wraparound services, and
3) reducing the number of people with mental illness, substance use disorder, or co-
occurring disorders in our jail.”
Progress and Obstacles
Since 2023, several county agencies have created data dashboards, responded to data requests, and
provided some data analyses that are responsive to these objectives. However, there remain numerous
large gaps in data–both that which is gathered by the County and that which is shared with the public–to
gauge unmet needs in diverse areas, measure services and outcomes, and assess the extent to which Care
First recommendations are implemented.
May 2025 Care First, Jails Last Implementation Report Page 22
The Behavioral Health Department has produced reports on mobile crisis services and the Safe Landing
Project, including data on services provided and estimates of unmet needs. The Ad Hoc Committee awaits
an assessment produced by BHD on Full Service Partnerships (mandated by the Disability Rights
settlement), and on the unmet need for psychiatric beds (as called for in Recommendation 4E).
Some data on program outcomes that respond to Care First recommendations, such as in collaborative
courts, is tracked by county agencies for the purpose of reporting on grants, but is not disclosed and is
not tracked in accordance with Care First goals.
Several Care First recommendations seek financial data. These include a detailed recommendation to the
County Administrator’s Office to bi-annually publish data on funds allocated and expended to support the
Care First population, by funding source and county agency, unspent balances and funds for contractor
and County staff, reserve accounts, and funds allocated and spent to implement the Babu settlement
(Recommendations 6A / 6D). To date, this data has neither been published nor provided to the Care First
Ad Hoc Committee.
The Care First Jails Last Task Force in 2023 requested that the Sheriff’s Office and District Attorney’s Office
provide the Behavioral Health Department with individual-level information on justice-involved persons,
including stays in Santa Rita and charging information since 2015. It also asked BHD to cross-reference
and analyze this data with its own databases of behavioral health clients, in order to produce an analysis
that joins data on justice involvement, behavioral health, and county services. This could indicate what
types of criminal charges and jail stays behavioral health clients face and how these compare with persons
without behavioral health diagnoses.
The Sheriff’s Office provided the information and BHD produced aggregated data to show how many
people are incarcerated before and after receiving BHD services. The DAO, however, only provided data
more than a year after it was requested, only included information through 2021, and excluded
information on charging categories.
Requests for Action from the Board of Supervisors
1. Give direction to the District Attorney’s Office, Superior Court, Public Defender’s Office and
Behavioral Health Department to coordinate in compiling data on outcomes of each collaborative
court and the Mental Health Court, regarding how many persons petition for participation, how
many are accepted, how many are released from jail, after how long in jail, how many are in
housing or are re-arrested after a year or other relevant period of time. The agencies should be
directed to share this data with each other and (in de-identified form) with the Care First Ad Hoc
Committee of the MHAB.
2. Give direction to the County Administrator’s Office to implement Recommendations 6A and 6D
regarding the publication of financial data.
3. Give direction to BHD to share with the MHAB its assessments of need for Full Service Partnerships
and psychiatric beds.
May 2025 Care First, Jails Last Implementation Report Page 23
Summary of Requests for Action from the Board of
Supervisors
Safe Landing Project (2C):
1. Require that the responsible parties accomplish the simple goal of putting a modular structure in
a permanent place for the SLP to do its work.
2. Insist that the county leverage available federal money through the CalAIM Justice Involved Re-
entry Initiative to help fund Roots's effort to provide pre-release re-entry planning for
incarcerated people.
Psychiatric Treatment Beds (4D & 4E):
3. Direct BHD to share with the MHAB the completed assessment of the need for subacute and other
psychiatric beds, plus the status of the ongoing assessment. See also the Request for Action under
Recommendations 5C and 5D below.
Point of Arrest Diversion & CARES Navigation Center (5A):
4. Address the lack of law enforcement participation.
5. Explore support for pre-arrest diversion that would serve the large number of people excluded
from CARES Navigation by Prop. 47 or DAO restrictions.
Court-Based Diversion Programs (5C):
6. Give direction to the ACBHD to assess the unmet needs across the court-based diversion programs
for residential and treatment beds for SMI, SUD, and Co-occurring disorders. This assessment
should consider how many of the anticipated BHCIP-funded facilities/beds (see March 2025
reports by Behavioral Health) will be capable of serving justice-involved, high-need individuals,
including those judged incompetent to stand trial (see Recommendation 5D).
7. Direct collaborative-court partners and ACSO to coordinate efforts to identify key performance
and outcome metrics, share current data-gathering practices, and create a plan for cross-agency
collaboration. Court-based diversion is a prime example of the lack of coordination among
agencies, a problem that CFJL called attention to in Recommendation 2B, on Interagency
Communication and Coordination.
8. Direct Public Safety Partners and CAO to produce the Board’s requested funding plan for the
Pretrial Services expansion without further delay.
African American Resource Center (1A & 1B):
9. Support BHD in locating private and public monies to sustain vital navigational and case
management services to the Center’s clients.
10. Use platforms to build community awareness of this innovative service center.
May 2025 Care First, Jails Last Implementation Report Page 24
First Episode Psychosis Program (3L):
11. We recommend a new First Episode Psychosis program, modeled after the EPI-CAL design, be
established in Alameda County. Alameda County should follow other Bay Area counties and admit
patients up to 30 years old into First Episode Psychosis programs modeled after EPI-CAL.
Licensed Board and Care Facilities, Land Trusts and Innovative
Housing Models (7I, 7J, 7O):
12. The Home Together plan should specifically call for an analysis to support the needs of those with
SMI, SUD, and co-occurring disorders, as well as the needs of the justice-involved population.
13. Use Measure W funding to fund the $350 million proposal HHS presented to the Board of
Supervisors on December 9, 2024, including:
○ Capital Acquisition Fund to support the purchase, leasing, and capital improvements for:
■ 750-1,000 beds of interim housing;
■ At least 850 units of permanent housing; and
■ Clinic space to serve people experiencing homelessness.
○ We urge that this fund provide capital funding for SHCLA to support buying or leasing and
making capital improvements to licensed Board and Cares, to begin replacing the beds
that Alameda County has lost since 2019.
14. Request state funding through legislation or the budget to keep existing Board and Cares alive
through increased rate subsidies (through a Personnel-Administration-Legislation Committee
letter, for example).
Deep Housing Subsidies for Individuals with Justice Involvement and
Serious Behavioral Health Concerns (7E & 7F):
15. Measure W funding should be directed toward implementing the Home Together Plan, including
the proposed flex pool and long-term rental subsidies dedicated to households with justice-
involvement and serious behavioral health concerns. The Board should move forward on the
proposal by HHS to use a portion of the $350M accrued revenue from Measure W to acquire 850+
PSH units; a portion of these units should be dedicated to justice-involved people.
16. The Home Together plan should specifically include an analysis of housing needs for people with
SMI, SUD, Co-Occurring Disorders, and Justice-Involvement.
17. The BOS should enact a policy to ensure that our County’s Coordinated Entry System prioritizes
housing services to people with serious behavioral health needs, and those who are justice-
involved – regardless of whether they are diagnosed with a co-occurring disorder. Transparent Public Reporting on Funds Allocated to Care First
Population (6A):
18. Direct the CAO to fully implement the Care First recommendations assigned to the Office, and
meet with representatives of the Ad Hoc Committee to discuss progress to that end.
May 2025 Care First, Jails Last Implementation Report Page 25
Sources
Behavioral Health Department, March 25, 2025, “BHSA Updates: Early Intervention Transition Process.”
Presentation by Tracy Hazelton to the Adult Committee of the Alameda County Mental Health Advisory Board.
https://www.acbhcs.org/wp-content/uploads/2025/03/BHSA-Updates-Early-Intervention-Transition-Process-
March-25-2025.pdf. Accessed April 15, 2025.
Behavioral Health Department, March 17, 2025, BHCIP Application Updates. https://www.acbhcs.org/wp-
content/uploads/2025/03/BHCIP-Application-Updates.pdf. Accessed May 11, 2025.
Behavioral Health Department equity dashboard: https://data.acbhcs.org/RunDashboard.i4;tab_token=b09c2d84-
56c6-4378-a033-e97d1315f9d9?dashUUID=5b6f4baf-6a12-4167-8808-5c03de51bad2&primaryOrg=1&clientOrg=1
Radigan, Marleen, Gyojeong Gu, Eric Y. Frimpong, Rui Wang, Steven Huz, Mengxuan Li, Ilana Nossel, and Lisa
Dixon. "A new method for estimating incidence of first psychotic diagnosis in a Medicaid population." Psychiatric
Services 70, no. 8 (2019): 665-673. This was a retrospective population-based study of NY State Medicaid data over
five years (2013-2017).
Carson, Keith, December 12, 2024, “Subject: Designate Accrued and Projected Measure W Revenue to Support
Homelessness Response Consistent with the Adopted Home Together Plan”
https://www.acgov.org/board/bos_calendar/documents/DocsAgendaReg_12_17_24/GENERAL%20ADMINISTRATI
ON/Regular%20Calendar/Supervisor%20Carson_HCSA_380432.pdf Accessed May 12, 2025
District Attorney’s Office dashboard: https://da.alamedacountyca.gov/data-dashboard/
EPI-CAL Training and Technical Assistance Center, July 5, 2023, “Overview of EPI-CAL TTA.” YouTube video.
https://youtu.be/23MtXpzPgAc?si=xyTVeL4iRPtquFK_ Accessed April 15, 2025.
Supportive Community Land Alliance, July 15, 2024, “Housing as Healthcare: SHCLA’s Role in the Production of
Licensed Residential Facilities and Family Participation in the Affordable Behavioral Housing Continuum.”
Presentation to Alameda County Mental Health Advisory Board. https://www.acbhcs.org/wp-
content/uploads/2024/07/Housing-as-HealthCare-Presentation-July-2024.pdf Accessed May 12, 2025.
Mental Health Services Oversight and Accountability Commission, January 25, 2023, “Report to the Legislature on
Full Service Partnerships.” https://bhsoac.ca.gov/wp-content/uploads/SB-465-Report-to-the-
Legislature_approved_ADA.pdf. Accessed May 9, 2025
Public Consulting Group, July 2023, “Alameda County Board and Care Assessment.” Prepared for Alameda County
Health Care Services Agency.
Rosenlicht, Nicholas, 2024, My Brother’s Keeper: The Untold Stories Behind the Business of Mental Health–and
How to Stop the Abandonment of the Mentally Ill. Pegasus Books/Simon and Schuster.
Sheriff’s Office Detention and Corrections documents: https://www.alamedasheriff.gov/about-us/public-
documents/-folder-20#docfold_756_82_115_20
Wagner, James, “Behavioral Health Continuum Infrastructure Program (BHCIP), the Department of State Hospitals
(DSH), and Bridge Housing Awards” March 17, 2025. Presentation to the Alameda Mental Health Advisory Board. https://www.acbhcs.org/wp-content/uploads/2025/03/BHCIP-and-State-Hospital-Awards-Presentation-March-
2025.pdf. Accessed May 11, 2025.
May 2025 Care First, Jails Last Implementation Report Page 26
Appendix 1. Acronyms
AOT Advanced Outpatient Treatment
ACSO Alameda County Sheriff’s Office
AFBH Adult Forensic Behavioral Health
BHCIP Behavioral Health Continuum Infrastructure Program
BHD Behavioral Health Department
BHSA Behavioral Health Services Act
CalAIM California Advancing and Innovating Medicaid
CFJL Care First Jails Last
CAO County Administrator’s Office
CBO Community Based Organization
DAO District Attorney’s Office
FEP First Episode Psychosis
FSP Full Service Partnership
HCD Housing and Community Development
HHS Housing and Homelessness Services
HUD Housing and Urban Development
JIMH Justice Involved Mental Health
LOC Level of Care
MACRO Mobile Assistance Community Responders of Oakland
MHAB Mental Health Advisory Board
NAMI National Alliance on Mental Illness
PSH Permanently Supportive Housing
RAJ Reimagine Adult Justice
SCHLA Supportive Community Housing Land Alliance
May 2025 Care First, Jails Last Implementation Report Page 27
SLP
SMI
SUD