- What is the Alameda CARE Team?
The Community Assessment Response & Engagement (CARE) Team is a program approved by the Alameda City Council that utilizes a mobile crisis team staffed by a licensed Paramedic and an Emergency Medical Technician (EMT). Paramedic personnel receive specialized training in de-escalation and behavioral health. The Alameda Fire Department operates this program in conjunction with 24/7 support from Alameda Family Services (AFS). The Alameda CARE Team was initially launched as a pilot program that concluded in December 2022 and has since transitioned into a fully implemented, ongoing service. The CARE Team is designed to provide mental health assessments and medical assessments in the field for community members experiencing a mental health crisis within the city of Alameda. The team conducts field assessments, identifies appropriate interventions and provides transportation when needed. Their primary goal is to connect clients with the pathway to safety and stability while simultaneously reducing unnecessary hospitalizations and visits to emergency rooms, including psychiatric emergency services. The CARE Team prioritizes diverting community members to voluntary alternatives to hospitalization but can initiate involuntary holds (5150/5585) when necessary and appropriate.
- What do the numbers 5150 or 5585 mean?
A “5150” applies to adults (18 and older) and is the number of the section of the California Welfare and Institutions Code which allows a person with a mental disorder to be a danger to others or themselves or who is gravely disabled to be involuntarily detained for psychiatric evaluation and treatment in a designated facility. A person on a 5150 can be held against their will for up to 72 hours. This does not mean that they will necessarily be held for the entire 72 hours; it means that the evaluating facility has the legal right to do so if determined to be necessary.
California Welfare and Institutions Code Sections 5585 provide psychiatric holds for minors (under 18) for up to 72 hours. A person can be held against their will in a psychiatric facility only if they meet at least one of the three basic criteria listed: danger to self, danger to others or grave disability.
- Is Alameda CARE Team an alternative to the Alameda Police Department (APD)?
The CARE Team is an alternative to police responses in certain instances. The CARE Team will be dispatched to calls when the community member in crisis leans towards voluntary mental health services and is not demonstrating violent behaviors. However, the CARE Team is not an alternative to police responses in every situation. If there is any indication that the community member may be violent, has a weapon or have committed a crime, APD will arrive first to secure the scene before transitioning to the CARE Team.
In addition, the CARE Team does not enforce an involuntary psychiatric hold for a community member who is not cooperative. The CARE Team will request support from APD and transport ambulances in those cases. To ensure the safety of CARE Team personnel and the client, APD may respond alongside the CARE Team depending on the nature of the call. One of the CARE Team priorities on the scene is to release APD from a call as soon as possible to make officers available for other calls for service. All CARE Team Paramedics are certified to initiate involuntary holds in Alameda County but generally do so with APD assistance. However, CARE Team Paramedics prioritize offering voluntary treatment via various diversion programs when clinically appropriate and in coordination with AFS. The CARE Team works in partnership with APD. Due to safety concerns, requests to respond without law enforcement may not always be possible.
- What are the CARE Team’s hours of operation?
The CARE Team operates 24 hours a day, seven days a week within the City of Alameda, providing around-the-clock crisis response and support.
- Who can use the Alameda CARE Team?
The CARE Team serves anyone in need within the City of Alameda, including residents, visitors and individuals passing through the area. Services are available to individuals experiencing a behavioral health crisis or in need of support, regardless of residency status.
- Is there a cost for CARE Team services?
No. CARE Team services are provided at no cost to the individual. The program is designed to ensure that anyone in need of assistance can access care without financial barriers.
- How do I access services from the Alameda CARE Team?
CARE Team services are accessed by placing a call to the Public Safety Answering Point (PSAP) for the city of Alameda. The PSAP is the Alameda Police Department Dispatch Center. If a person in the city of Alameda is experiencing or observing someone they suspect is experiencing a mental health crisis or behavioral health concern, they should call 911 or 510-337-8340 (APD non-emergency).
The APD call taker will triage the call and route it accordingly. If it is determined that the call is appropriate for CARE Team response, they will be dispatched either independently or alongside APD, depending on the circumstances. Sometimes it is determined that the request could be a medical emergency, an ambulance and fire engine will be initially dispatched.
Utilizing the information received from the reporting party, the call will be coded either as the CARE Team as the primary responder (when the situation appears stable with no known safety concerns) or APD as the primary responder to ensure the scene is safe for the CARE Team. The goal is to always release APD as soon as possible to allow APD officers to return to service.
- What happens when the CARE Team responds?
When the CARE Team arrives on scene, after responding to a call, the CARE Team conducts an on-scene assessment and determines the most appropriate next steps based on the individual’s needs, if required they will collaborate with the AFS 24/7 on-call clinician. This may include transportation to an appropriate destination, development of a care or safety plan or referral to services. When appropriate, Alameda Family Services (AFS) provides follow-up case management, including ongoing support and check-ins to help ensure continuity of care.
- What is the difference between the Alameda CARE Team and other mobile crisis teams in Alameda County?
Each mobile crisis team has a unique function within the system of care. The CARE Team is a mobile crisis team staffed by a Paramedic and EMT in Alameda County. The Paramedic and EMT can provide a comprehensive medical evaluation that can assist with the ability to bypass medical emergency rooms when transporting clients to an alternative facility. The CARE Team is fully equipped to handle calls requiring Advanced Life Support if the need arises.
The CARE Team cannot enforce an involuntary hospitalization for a community member who is not cooperative. In those situations, the CARE Team coordinates with APD for assistance.
The CARE Team is available 24 hours a day, seven days a week in the City of Alameda. They are also among the first programs in Alameda County that have firefighters trained and authorized to initiate involuntary psychiatric holds (5150/5585 holds). Per policy, all involuntary holds may require consultation with the on-call AFS licensed clinician. The CARE Team is dedicated to the City of Alameda community and is a program that includes intensive short-term case management follow-up services.
- How does the Alameda CARE Team ensure clients get the assistance they need?
Although the Alameda Fire Department operates the CARE Team, its close partnership with AFS is the essential link to ensuring an integrated system of care that guides and tracks client care over time; this is also referred to as a continuum of care. The Continuum of Care has two significant components:
- The first is 24/7 licensed clinician support for the CARE Team personnel working in the field. The unit can, at any time, speak with a licensed clinician to assist the CARE Team and help determine the most appropriate response for the client.
- The second component is that AFS provides case management follow-ups for clients in need of ongoing support. These services include 30- and 60-day follow-up for the client.
- What alternative support service provider destinations are available for the Alameda CARE Team?
Every call is handled as a unique engagement to determine the best plan for the client. During the consultation with the on-call AFS licensed clinician, the CARE Team can identify appropriate destinations or resolutions based on the client’s needs. Alternative destinations can include:
- A family member's or friend's home (if local)
- A sobering facility (based on availability)
- A temporary shelter (based on availability)
- A public transit hub
- A psychiatric facility
The CARE Team can also develop a care/safety plan on the scene for the client with AFS Case Manager follow-up the following business day.
- How is the CARE Team different from a traditional ambulance response?
While the CARE Team includes medical personnel, its primary focus is on behavioral health crisis response. The team emphasizes de-escalation, assessment and connection to appropriate services, rather than transport to an emergency department when it is not medically necessary. This approach helps connect individuals to the most appropriate level of care while reducing unnecessary hospital visits.
- Will the Alameda CARE Team respond to other calls for service in addition to mental health responses?
If the CARE Team is available, it will respond to emergency calls such as structure fires, water rescues, vehicle accidents to supplement other AFD resources and provide additional personnel to these high-risk calls. If assigned to these calls and a CARE Team call is received, the Incident Commanders will be notified by the Fire Dispatch Center and the CARE Team unit may be released if it is feasible to respond to the mental health call.
- What is the training of the Alameda CARE Team Paramedics that assists them in the delivery of these new services?
CARE Team Paramedics receive enhanced training to support their expanded service role. This includes county-approved mental health response training, authorization to issue psychiatric holds and Crisis Intervention Training (CIT). All paramedics complete these requirements before serving on the CARE Team Unit.
- What type of vehicle does Alameda CARE Team use?
The CARE Team responds with an AFD Paramedic and EMT in a Fire Department labeled mid-size SUV or pick-up truck equipped with emergency lighting capable of responding to other emergency service calls as needed. The vehicle includes a designated rear passenger area configured to support a calm and comfortable environment for everyone involved. The vehicle is equipped with a full complement of Advanced Life Saving (ALS) equipment and required technology for report writing and radio communications.
- Where is the Alameda CARE Team unit stationed?
The CARE Team response unit is currently housed at Fire Station 3, located at 1625 Buena Vista Ave, Alameda, CA.
- What is the plan for data collection and how is record-keeping completed?
AFD utilizes an enhanced module of the department's existing electronic health record (EHR) software to document all CARE Team responses, services provided and client outcomes. AFS utilizes its existing data system to track client contacts with the CARE Team and to document outcomes. AFD and AFS have an executed data sharing agreement in place: CARE Team members enter client information directly into the EHR. AFS accesses that shared record to track client contacts and outcomes in its own data system. This ensures that the client receives the continuity of care.
- Is my information confidential?
CARE Team services follow applicable privacy and confidentiality laws, including the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is a U.S. federal law that, among other things, sets national standards to protect individuals' medical records and other personal health information. Its Privacy Rule limits who can see and share your health data, and its Security Rule requires safeguards for electronic health information. It applies to health plans, health care providers, and health care clearinghouses (and their business associates). Information is shared only as necessary to coordinate care and ensure the safety and well-being of the individual and the community.
- Does the Alameda CARE Team have a system in place to ensure clinical quality improvement?
The CARE Team Program uses a Continuous Quality Improvement (CQI) process to regularly evaluate and strengthen its services. CQI involves reviewing data, assessing outcomes and incorporating feedback to guide ongoing improvements. This work is overseen by a Quality Management Team (QMT) made up of representatives from the Fire Department, Alameda Family Services and the fire department's contracted Medical Director (physician). The QMT focuses on setting program goals, reviewing cases and performance indicators, updating policies and procedures and coordinating methods for gathering client feedback. All QMT activities and reviews are conducted in compliance with HIPAA privacy requirements.
- Are services available in languages other than English?
The CARE Team works to ensure services are accessible to all community members. Language support services, including interpretation, may be available to assist individuals with limited English proficiency when needed.
- Are there additional community resources?
If you or someone you know needs support outside of a CARE Team response, these free services are available 24/7, no CARE Team response is required.
- 211 – Social Services and Basic Needs
Dial 211 to get connected to local resources such as housing assistance, food programs, transportation, healthcare and other community services.
- 988 – Suicide & Crisis Lifeline
Call or text 988 for immediate, confidential support during a mental health crisis, emotional distress or suicidal thoughts.
- See Click Fix – Quality of Life Issues: See Click Fix is the City's tool for reporting encampments or individuals living outdoors, in addition to general quality-of-life issues. When you submit a report, it goes to Housing & Human Services, who use it to track the location and check in on the person's safety and sanitary conditions. From there, the City's Homeless Outreach Team follows up and connects the individual with ongoing resources and support, including a sheltered emergency bed, when one is available.
- What agencies are involved in ensuring the success of the CARE Team?