REPORT TO COUNCIL
SUBJECT
Title
Action on an Agreement with Care Solace, Inc. to Provide Coordination for Mental Health Care and Social Services to Residents and Employees of the City of Santa Clara and Related Budget Amendment
Report
COUNCIL PILLAR
Deliver and Enhance High-Quality Efficient Services and Infrastructure
BACKGROUND
According to the National Alliance on Mental Illness (NAMI), 1 in 5 U.S. adults experience mental illness each year and 1 in 6 U.S. youth, aged 6-17, experience a mental health disorder each year. According to NAMI, individuals experiencing a mental health issue can find it challenging to live everyday life and maintain recovery. Without treatment, the consequences of mental illness for the individual and society are staggering. Untreated mental health conditions can result in unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide, and poor quality of life.
The following are a few facts and statistics on mental illness listed on NAMI’s website:
• In 2020, 1 in 15 U.S adults experienced both a substance use disorder and mental illness
• In 2020, among U.S. adults who received mental health services:
o 17.7 million experienced delays or cancellations in appointments
o 7.3 million experienced delays in getting prescriptions
o 4.9 million were unable to access needed care
• High school students with significant symptoms of depression are more than twice as likely to drop out compared to their peers
• 21.1% of people experiencing homelessness in the U.S. have a serious mental health condition
• Suicide is the 2nd leading cause of death among people aged 10-34
• Caregivers of adults with mental or emotional health issues spend an average of 32 hours per week providing unpaid care
• The rate of unemployment is higher among U.S. adults who have mental illness (7.4%) compared to those who do not (4.6%)
• Across the U.S. economy, serious mental illness causes $193.2 billion in lost earnings each year
The City of Santa Clara is committed to ensuring and supporting a culture of safety and wellbeing for its residents and employees. The City continues to actively explore new partnerships and services that will complement and/or enhance existing services with the goal of improving the provision of and connections to mental health care services and social services for the community, including those who may be experiencing homelessness and/or affected by opioid use disorder (OUD) or substance use disorder/mental health conditions.
In alignment with supporting a culture of safety and wellbeing, staff is requesting Council consideration and approval to authorize the City Manager to negotiate and execute an Agreement with Care Solace, Inc. (Care Solace) for a three-year term in an amount not to exceed $390,000 ($130,000 annually), with the option to extend for two (2) additional one-year periods. The contract will provide coordination for mental health care and social services to residents and employees of the City of Santa Clara at a cost equivalent to approximately $1 per person annually.
DISCUSSION
The sections below describe Care Solace’s services and how the proposed partnership will further complement City services through a streamlined system that will improve residents and employees’ access to mental health care and social services, regardless of coverage.
Care Solace
Care Solace is a mental health care coordination service on a mission to improve access to care, regardless of circumstances. By providing a tech-enabled human approach, Care Solace ensures that individuals receive equitable access to reliable, ethical, and high-quality mental health care, regardless of coverage, including private insurance, Employee Assistance Program (EAP), Medicaid, and sliding scale options for those without insurance. This enables referred individuals, regardless of need severity or type, to receive a rapid connection to well-matched care. Care Solace provides timely connections to verified mental health providers and City and County of Santa Clara (County) social services, expands on existing programs, and bridges the gaps for needs that exceed the scope of those services.
Serving as a coordinated point of entry to mental health and social services, Care Solace supports the entire City ecosystem, including but not limited to: City departments, first responders, crisis centers, social workers, courts/jails, and the school district(s). Care Solace’s services will be made available to all City of Santa Clara residents and employees (“Eligible Users”). Staff is currently in the process of engaging the Santa Clara Unified School District (SCUSD) on its interest to utilize Care Solace’s services through the City’s agreement for school district families and employees (who are not City residents), at no cost to SCUSD and no additional cost to the City. Should SCUSD confirm its interest, staff will include SCUSD families and employees as “Eligible Users” in the City’s final agreement with Care Solace.
Care Solace's two main services - Care Match and Care Companion™(s) - will enhance the City’s current services while filling gaps. Care Solace will be accessible to all City residents and employees through a simple warm handoff process, or self-guided process through Care Match. Care Solace will deliver these services to City residents and employees through the following:
Care Companions provide care coordination to users by assessing the situation, finding appropriate providers, securing an appointment, and following through on care in a Warm Handoff® process.
Care Companions provide empathetic, personal support that lowers stigma and expedites connection to well-matched care. The team is available by phone, email, video chat, or text 24 hours per day, 7 days per week, 365 days per year, and can coordinate care in over 200 languages. Care Companions are dedicated advocates that help people looking for treatment every step of the way, finding providers based on needs, making calls to confirm availability and specialties, scheduling appointments, following up to see if appointments are attended, and if Care Solace and provider services have met expectations. If not, they will assist in locating additional providers.
Care Companions will research options based on language, treatment modalities, preferences for cultural identity, religious background, gender of a therapist, or insurance: free, low-cost, or private pay options, and more. Before connecting an individual with a resource, the Care Companion will verify that the provider matches the needs of the individual and will confirm the provider has been through our verification process.
Care Companions are experienced in care coordination and empathetic customer service - supporting individuals in need from diverse cultural and socioeconomic backgrounds - and navigating the mental health and insurance systems. Each Care Companion receives 150 hours of extensive training before supporting Care Solace users. Their initial training and ongoing professional development cover topics including: mandated reporting; mental health and substance use awareness; pathways of care; cultural and LGBTQIA+ awareness; nuances of mental health and insurance systems; suicidal ideation; and supporting vulnerable populations.
Care Companions will be available and work directly with users to connect them with mental health and social services providers. The team is supervised by Care Solace’s licensed mental health team, which manages complex needs and escalated cases.
Care Match is Care Solace’s online tool for self-guided care navigation. This portal/software supports self-guided access to the Care Solace provider network. This is an anonymous search tool that offers the same providers' search capabilities to all Eligible Users. The link to this software can be co-branded with the City’s logo, subject to the express written consent of the City, and will be made available to residents and employees on any website or benefit platform.
Care Match is a self-service 24/7/365 online portal that provides an anonymous way for individuals to find care matched to their needs. Care Solace will create and operate a proprietary custom web link to Care Match, branded for the City, allowing authorized users access to its robust proprietary database of mental health care providers serving all pathways of care. From any cell phone, mobile device, or computer, any individual can confidentially search Care Solace’s proprietary database in any language. They will be matched to verified community providers based on their needs and preferences, including mental health concern(s), wait, availability, insurance or financial needs, type of preferred treatment, language, or other preferences for care such as proximity, gender, or cultural identity of a therapist, faith-based services or LGBTQIA+ allied services.
Care Solace’s Provider Database offers Eligible Users access to a continually growing more than 673,000 verified mental health providers, including those offering advanced pathways to care. Providers are geo-coded so an individual can select a local provider for in-person sessions if that is their preference. Selection filters also include language, ethnicity, age, specialization, and more.
Care Solace’s robust proprietary database of community health partners serves all care pathways and severity of need. Care Solace’s Provider Research and Development Team continuously updates its database to ensure it contains extensive options and the most recent information on providers. Care Solace maintains high standards for verifying and including providers in the database. For an individual provider to be listed in the database, they must be a licensed, master’s level clinician.
The verification process includes confirming the following:
● The provider or facility possesses a current and active professional state license authorizing the practice of the type of services being provided
● The professional state license is in good standing: i.e., there are no disciplinary entries, the provider is not on probation, or the license is not expired, etc.
● The individual provider or facility does not appear on the current State (if available) or Federal Office of Inspector General’s List of Excluded Individuals/Entities. The individual provider or organization has not received a “D” or “F” from the Better Business Bureau.
● Location, specialty/ies, phone number, and accepted insurances are also confirmed.
Care Solace does not have a financial relationship with any community providers and does not pay or collect monies to/from providers, or have an agreement in place to promote mental health resources, and does not accept advertisements or sponsorship sales. This allows Care Solace to have an unbiased and objective approach to identifying providers for users.
Social Services Coordination: Additionally, the City and Care Solace recognize that users utilizing Care Solace’s services may also require connections to available social services, including but not limited to food and shelter. Care Solace will work with the City to build and implement a Social Services database that offers users connections to social services offered by the City, County, service providers, and/or community organizations to support all of the social determinants of health.
Reporting: Understanding the importance of data and how it guides decision making, Care Solace will provide a monthly impact report including key performance indicators (KPIs) on total utilization, number of users, total communications, confirmed appointments, type of needs, anonymous searches, referrals from staff, insurance pathways utilized for services, and the primary community-based mental health services that people are connecting with. Reporting of services provided can be delineated by age, gender, and ethnicity. Data also includes the number of individuals who declined services or were unreachable, individual time saved, and communications breakdown by the time of day. Reporting of services provided can be delineated by office location, age, gender, and ethnicity. As part of the proposed agreement, Care Solace will attend City Council meetings to present on its reporting and impact as requested by the City.
Enhancement of City Services
The City provides a variety of services related to mental health care access and response to the community and its employees respectively through existing programs and partnerships. These services and partnerships include but are not limited to the following:
Community Services
• The City’s Police Department Community Response Team (CRT) conducts outreach and responds to the most concerning societal issues facing our community today including homelessness and mental health crises. CRT implements a wide range of work efforts, including connecting people experiencing homelessness to existing services in partnership with service providers. The Police Department has an existing Memorandum of Understanding (MOU) with the County of Santa Clara to establish a Psychiatric Emergency Response Team (PERT) program and dedicate a mental health clinician to support CRT. This cross-system collaboration is intended to provide rapid intervention and improved response and outcomes for individuals with mental illness and substance abuse who come in contact with law enforcement.
• In partnership with WeHOPE, the City provides weekly mobile shower and laundry services (Dignity on Wheels) for unsheltered individuals. Dignity on Wheels also provides connections to other support services.
Employee Resources
• The City provides a confidential Employee Assistance Program (EAP) to employees and their spouse/domestic partner, household members, and dependent children up to age 26 at no cost to the employee. The EAP includes 1) confidential counseling on a variety of issues including stress, substance use, emotional wellbeing, 2) work-life resources and services (including financial and legal consultations) and parenting and childcare referrals, and 3) coaching. Attached to the report is a flyer summarizing the City’s EAP benefits.
• The City has also hired a Wellness Coordinator to provide coaching and counseling to employees on various matters.
The City plans to incorporate Care Solace’s services to further enhance the programs and services described above and complement future services that City staff is currently in the process of developing to better support community members from vulnerable populations, including those experiencing homelessness.
Sole Source Justification
The recommendation to enter into an agreement with Care Solace is being made under the authority of Santa Clara City Code (SCCC) Section 2.105.280(b)(4) which allows for an exemption from the City’s purchasing requirements when a service is considered unique such that requirements for competitive procurement are contrary to public interest. A sole source contract with Care Solace is being recommended for the following reasons:
• Uniqueness of the Services. Care Solace’s provides a single interface to social and mental health services and thereby ensures that communities have access to reliable, ethical, and equitable mental health care services, regardless of the circumstances. Care Solace is the only service provider that aggregates hundreds of thousands of clinical therapy and telehealth resources as well as insurance information from state Medicaid agencies, sliding scale, and private insurances into one database to streamline care coordination and reduce time, frustration, and attrition in accessing mental health care. Care Solace provides flexible options to those in need of care so that they can utilize an anonymous pathway to care, a self-service portal, and/or a specially-tailored collaborative process with dedicated care companions to assist in finding the right mental health and social services match. The uniqueness of Care Solace’s services makes a competitive procurement contrary to public interest, particularly given the urgent need for social and mental health coordination services.
• Proven Track Record. Care Solace’s services have been widely adopted by school districts and public agencies in the State, underscoring their effectiveness in providing mental health care coordination. Notably, many of these agencies have entered into sole source contracts with Care Solace based on the uniqueness of their services and the urgency to address mental health need. The following agencies are among those utilizing Care Solace:
o Cupertino Union School District
o San Mateo County Office of Education
o Moreland School District
o Cambrian School District
o San Leandro Unified School District
o Oak Grove School District
o East Side Union High School District
o Fremont Unified School District
o City of Stockton
Opioid Settlements Funds
On July 21, 2021, a proposed settlement was announced to resolve lawsuits against three pharmaceutical distributors (McKesson, Americource, and Cardinal Health) and Janssen (Johnson & Johnson) (“Settlement Agreements”). Under the Settlement Agreements, the three large distributors and Janssen are required to pay up to $5 billion to an abatement account fund (“Abatement Fund”) for distribution to eligible counties and cities. While the City did not participate as a named party in the litigation, the City did qualify to receive annual payments from the Abatement Fund. On December 21, 2021, the City Council authorized the City Manager to execute the Settlement Agreements.
In December 2022, California Attorney General Rob Bonta signed on to new settlement agreements with Teva, Allergan, Walgreens, Walmart, and CVS (“New Settlements”). The terms and conditions of the New Settlements mirror those of the original Settlement Agreements. Eligible cities and counties stand to receive up to $1.8 billion under the New Settlements, which is in addition to the (up to) $2.2 billion California agencies are expected to receive under the original Settlement Agreement, and that the City is already participating in.
Under the New Settlements, the City would receive 0.067% of Abatement Funds for a weighted total of 0.0549723%. Assuming all 431 eligible counties and cities join the agreements, the City may receive up to $845,000 over the course of 15 years.
Funds received through the Abatement Fund must be spent on eligible abatement activities and expenditures. In addition, at least 50% of the funds received each year must be used for the following high impact abatement activities:
1. The provision of matching funds or operating costs for substance use disorder facilities within the Behavioral Health Continuum Infrastructure Program;
2. Creating new or expanded Substance Use Disorder (SUD) treatment infrastructure;
3. Addressing the needs of communities of color and vulnerable populations that are disproportionately impacted by SUD;
4. Diversion of people from the justice system into treatment, including by providing training and resources to first responders and implementing best practices for outreach, diversion and deflection, employability, restorative justice, and harm reduction; and/or
5. Interventions to prevent drug addiction in vulnerable youth.
The services provided by Care Solace align with the following categories defined under the California State-Subdivision Agreements:
• High Impact Abatement Activity 3: Addressing the needs of communities of color and vulnerable populations (including sheltered and unsheltered homeless populations) that are disproportionately impacted by SUD. Opioid remediation activities specifically addressing the needs of those at risk of developing an SUD within communities of color, including racial and/or ethnic minorities, and vulnerable populations. Vulnerable populations include, but are not limited to, individuals with limited or no access to health care, individuals experiencing adversities related to socioeconomic status, gender, sexual orientation, and/or mental health conditions, unhoused individuals, pregnant and parenting individuals, and/or at-risk children and youth.
• High Impact Abatement Activity 4: Diversion of people with SUD from the justice system into treatment, including by providing training and resources to first and early responders (sworn and non-sworn) and implementing best practices for outreach, diversion and deflection, employability, restorative justice, and harm reduction.
In addition to High Impact Activities noted above, the services provisioned under the Care Solace agreement align with the following allowable expenditures identified in the settlement agreements:
• Support centralized call centers that provide information and connections to appropriate services and supports for persons with Opioid Use Disorder (OUD) and any co-occurring Substance Use Disorder / Mental Health (SUD/MH) conditions.
• Purchase automated versions of Screening, Brief Intervention, and Referral to Treatment (SBIRT) services, and support ongoing costs of the technology.
• Expand warm-hand-off services to transition recovery.
As such, staff is recommending use of the opioid settlement funds, and approval of a related budget amendment, to cover the service costs in an amount not to exceed $390,000 ($130,000 annually) for the three-year agreement with Care Solace to provide the described social services and mental health care coordination services.
The attached agreement’s terms and conditions have been agreed upon by both the City and Care Solace; however, the City would like to complete its engagement with SCUSD to confirm its interest in participating in the scope of service before finalizing the agreement for execution, pending Council approval of staff’s recommendations. Unless modified otherwise as part of Council’s direction/actions, the Services described in this report and in the draft agreement will be provided.
ENVIRONMENTAL REVIEW
The action being considered does not constitute a “project” within the meaning of the California Environmental Quality Act (“CEQA”) pursuant to CEQA Guidelines section 15378(a) as it has no potential for resulting in either a direct physical change in the environment, or a reasonably foreseeable indirect physical change in the environment.
FISCAL IMPACT
Staff recommends using opioid settlement funds to cover the agreement with Care Solace, Inc., in an amount not to exceed $390,000 for a term of three years. The opioid settlement funds are appropriated in the Expendable Trust Fund. As approved as part of the FY 2023/24 Budget Year-End Report on December 3, 2024, the opioid settlement funds appropriation was carried over totaling $210,963. In the current fiscal year, an additional $335,000 has been received by the City. The recommended action to appropriate the additional opioid funding received is detailed in the table below.
Budget Amendment
FY 2024/25
|
|
Current |
Increase/ (Decrease) |
Revised |
|
Expendable Trust Fund |
|
|
|
|
Revenue |
|
|
|
|
Other Agencies Revenue |
$0 |
$335,000 |
$335,000 |
|
|
|
|
|
|
Expenditure |
|
|
|
|
Opioid Settlement Funds |
$210,963 |
$335,000 |
$545,963 |
Any funding related to exercising the City’s option to extend the Agreement will be subject to future budget appropriations.
COORDINATION
This report has been coordinated with the City Attorney’s Office and the Finance Department.
PUBLIC CONTACT
Public contact was made by posting the Council agenda on the City’s official-notice bulletin board outside City Hall Council Chambers. A complete agenda packet is available on the City’s website and in the City Clerk’s Office at least 72 hours prior to a Regular Meeting and 24 hours prior to a Special Meeting. A hard copy of any agenda report may be requested by contacting the City Clerk’s Office at (408) 615-2220, email clerk@santaclaraca.gov.
RECOMMENDATION
Recommendation:
1. Authorize the City Manager or designee to negotiate and execute an agreement with Care Solace, Inc. to provide coordination for mental health care and social services to residents and employees of the City of Santa Clara, for a three-year term in an amount not to exceed $390,000, with the option to extend for two additional one-year periods, subject to budget appropriations, in a final form approved by the City Attorney;
2. Authorize the City Manager or designee to take any actions as necessary to implement and administer the agreement; and
3. Approve the FY 2024/25 budget amendment in the Expendable Trust Fund to recognize other agencies revenue in the amount of $335,000 and increase the opioid settlement funds appropriation in the amount of $335,000 (five affirmative Council votes required to appropriate additional revenue).
Staff
Prepared by: Christine Jung, Deputy City Manager
Reviewed by: Jovan D. Grogan, City Manager
ATTACHMENTS
1. Proposed Agreement with Care Solace Inc. (DRAFT)
2. EAP Benefits Summary Flyer