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H4. 2023 Opioid settlement crisis team agreementcrrYoF City of Kalispell KTALISPELL post Office Box 1997 -Kalispell, Montana 59903-1997 elephone (406) 758-7700 Fax - (406) 758-7758 MEMORANDUM To: Honorable Mayor Johnson and City Council From: Doug Russell, City Manager Re: Crisis Assistance Team Funding Agreement, funding from Opioid Settlements Meeting Date: November 6, 2023 BACKGROUND: In December of 2021, the City Council reviewed and authorized participation in the national Opioid Settlement Agreements. As was discussed at the time, funding received from the settlements needed to be appropriated to areas that had a nexus with addressing concerns emerging from opioid use. At the time, it was anticipated that the portion of Kalispell's funds would be delivered directly to the Health Department for services that would address areas covered by the settlements. Ultimately, the City of Kalispell has been receiving these distributions directly. As was discussed during budget sessions, we have been working with the Flathead County and the City/County Health Department to use these funds toward our co -responder program housed within law enforcement offices. As we are facing call in law enforcement that stem from drug use and the resulting behavioral impacts, the co -responder program provides a valuable tool to aid in the intervention and or connection to resources for individuals that may be in need of alternative services that fall outside traditional law enforcement provision. Upon approval of the Crisis Team Funding Agreement, we will distribute the funds that we have already received from the Opioid settlement and continue this distribution until funds have been exhausted from the two settlement periods, which are scheduled to end in 2031 and 2038, respectively. FISCAL IMPACTS: Kalispell's funding obligation for the Crisis Assistance Team comes from the National Opioid Settlements, equal to the respective amounts of the annual distribution which fluctuates on an annual basis. RECOMMENDATION: It is recommended that the City Council move to authorize the City Manager to sign the agreement with Flathead County for the Crisis Assistance Team Agreement. ATTACHMENTS: Crisis Assistance Team Funding Agreement and Exhibits Crisis Assistance Team Funding Agreement This Agreement ("Agreement") is entered into this _ day of , 2023, by and between the Flathead County Board of Commissioners ("County") and the City of Kalispell ("City"). WHEREAS, the purpose of this Agreement is to support collaboration between the City of Kalispell and County to achieve the goals of the Crisis Diversion Grant; WHEREAS, the Montana State Department of Public Health and Human Services Behavioral Health and Developmental Disabilities Divisions (previously known as "Addictive & Mental Disorder Division") and County entered into the Crisis Diversion Grant Contract No. ("Grant Contract"); WHEREAS, the Grant Contract is designed to provide effective response to acute mental health crises, to prevent unnecessary restrictive placements such as incarceration or Montana State Hospital placement, and divert individuals experiencing behavioral health crises from involvement with law enforcement or the emergency department to more appropriate crisis services; WHEREAS, the Flathead City -County Health Department ("FCCHD") is entered into agreement with County to set forth guidelines under which the County transfers to FCCHD all duties, rights and responsibilities contained in the Grant Contract. It is the intent of the Parties that the County shall, as Contractor under the Grant Contract, subcontract with FCCHD and that FCCHD shall perform all work and services as subcontractor under the Grant Contract; WHEREAS, the City of Kalispell has received or is in the process of receiving funds through National Opioid Settlement Agreements and as a result will make financial contributions as provided herein; WHEREAS, the Parties are committed to partnering with each other to support a continuum of crisis services and improve the coordination of behavioral health crisis services in Flathead County. NOW THEREFORE, the Parties agree as follows: The above recitals as well as the Grant Contract are incorporated by reference herein. 1. Cooperative Agreement: Parties agree to cooperate with each other in pursuit of the terms contained in this Agreement. This Agreement and any cooperation among the Parties in furtherance of the Agreement does not create a partnership or joint venture between the Parties. 2. Crisis Assistance Team: Parties acknowledge that the monies to be provided to and expended by FCCHD, as subcontractor under the Grant Contract, are to provide the following: a. Mobile Crisis Co -Responder also known as Crisis Assistance Team ("C.A.T.") that will operate in Flathead County, serve the cities of Kalispell, Whitefish, and Columbia Falls and serve the entirety of Flathead County. C.A.T. will be a collaboration between County, Flathead County Sheriff's office, Flathead Emergency Communication Center, and Kalispell Police Department. b. Criteria for response: C.A.T. will serve all ages that contact 911 for mental health or behavioral health assistance. c. C.A.T. will respond to a variety of crisis calls that include domestic violence, suicide, child abuse or neglect, and any other social disruption. d. C.A.T. will provide services directly in homes, businesses, and health care offices without the presence of law enforcement once the situation has been cleared. e. Personnel for the C.A.T. shall include: i. 2.0 FTE Crisis Co -Responder Community Based Therapists who are either a LCSW or LCPC and who shall perform the following services and responsibilities: - Respond to crisis behavioral health and mental health emergencies within the community; - Co -respond on scene with law enforcement to 911 calls involving crisis, mental health, and behavioral health; - Consult with law enforcement via face-to-face, phone, video, or radio to identify, triage, and manage individuals in crisis; - Provide trauma briefing to law enforcement and detention center officers; - Transport clients to appointments or crisis facilities via a partitioned vehicle; and - Refer to the Care Coordinator for referral of follow up care and treatment. - Additional responsibilities are outlined in the Co -Responder Licensed Clinical Social Worker job description attached hereto as Exhibit A and incorporated fully herein. ii. 1.0 FTE Care Coordinator who may be stationed at a crisis stabilization facility and shall perform the following services and responsibilities: - Coordination and communication between co -responder team and agency partners; functions as point of contact for informational resources for C.A.T.; - Completes follow up calls for all served by C.A.T.; - Care coordination including providing and following up on referrals for individuals identified in crisis as well as engaging family and natural supports; and - Assists in data gathering and outcome reporting. - Additional responsibilities are outlined in the Care Coordinator job description attached hereto as Exhibit B and incorporated fully herein. 3. Employment: Any personnel positions designated as FTE (full time employee) set forth above as being part of the C.A.T. shall be County employees, subject to County insurance coverage, worker's compensation coverage, etc. County will be responsible for verifying and/or providing FTEs with the appropriate or requisite training for the respective positions. The City shall not provide any insurance coverage or training for C.A.T. or its employees, volunteers, agents, contractors, or consultants. 4. C.A.T. Operations: C.A.T. is organized and operated by Flathead County and FCCHD and as such, any organizational or operational requirements not specifically mentioned in the Agreement remain within the discretion of Flathead County and FCCHD respectively. 5. City of Kalispell Funding: City of Kalispell shall pay Flathead County an amount equal to the amount the City of Kalispell receives from the "Distributor and Janssen Settlements," which were part of the National Opioid Settlement Agreements. These payments shall be made by the City to the County annually on September 30t" for the duration of the Agreement unless the Agreement is terminated by either Party as provided herein. In the event that the Agreement is terminated, the County shall reimburse the City for a pro rata portion of the payment. The projected amounts are outlined in Exhibit C attached hereto. Flathead County agrees to act as the pass through between the City of Kalispell and FCCHD to deliver in a timely fashion, designated funding that flows to the Flathead County from the City of Kalispell directly to FCCHD, so that FCCHD can deliver the services as described in the Grant Contract. The Parties acknowledge that funds received from the Grant Contract are temporary funds to be used as start-up funds in the development of the behavioral health crisis services continuum. The Parties acknowledge that funding to further develop and continue to provide the behavioral health crisis services in Flathead County will be dependent on contributions from all mentioned Parties and additional community organizations within Flathead County. This acknowledgement does not constitute a binding agreement by any of the Parties to renew this Agreement or to provide future funding for any program or position described in this Agreement. 6. Funding Contingency: Parties acknowledge and agree this Agreement is contingent upon County receiving the proper funding through resources including but not limited to grants, Medicaid, and/or City of Kalispell National Opioid Settlements. The Parties may freely seek additional, supplemental, or other sources of funding. Should funding from any three sources mentioned herein, or otherwise, fail to provide adequate resources to continue the C.A.T. as described herein, the Agreement may be terminated upon written notice by any Party to the other Party. The Parties may mutually agree to tailor or "pair down" the program to meet any shortcomings in funding in order to prevent termination of the Agreement. 7. Term of Agreement: This Agreement shall be effective for a five (5) year period, beginning on the date it is fully executed. On the fifth (5t") anniversary, this Agreement shall automatically renew for an additional five (5) year period. Should either Party desire to prevent automatic renewal and terminate the Agreement at the five (5) year mark, that Party shall provide written notice to the other Party six (6) months prior to the automatic renewal of the intent to disqualify the automatic renewal and terminate the Agreement. 8. Breach/Termination: Each term in this Agreement is material to the underlying agreement and failure of performance of any item contained herein shall be deemed a material breach of this Agreement. 9. Indemnification: Each Party shall indemnify or defend and hold harmless the other Party, including its officials, employees, and agents, from all claims whatsoever, whether absolute or contingent, arising from the other Party's breach of this Agreement or from any negligent or intentional act. This indemnification includes providing a defense and payment of all expenses including attorney's fees but shall not include claims arising solely from first Party's negligent or intentional conduct. 10. Entire Agreement/Writing: This Agreement constitutes the entire understanding between the Parties for the contemplated transaction, and all prior or contemporaneous agreements, understandings, representations and statements, oral or written, are merged into this Agreement. Each Party understands that if a term or condition is important to them, and it is not contained in this Agreement, then the term or condition is not enforceable against the other Party. This Agreement may not be waived, amended or terminated except in a document signed by all Parties. 11. Enforceability: Both Parties believe this Agreement to be wholly legal and enforceable in every aspect; however, in the event any term is found to be illegal or otherwise unenforceable, such term shall be stricken and the remaining portions of the Agreement shall remain enforceable. 12. Venue: This Agreement shall be construed pursuant to Montana law. The proper forum for legal disputes shall be Flathead County, Montana, 13. Costs/Attorney Fees: In the event of a dispute arising from this Agreement, the substantially prevailing Party shall be entitled to its costs and reasonable attorney's fees, including fees to enforce this provision. Board of County Commissioners City Manager Flathead County, Montana City of Kalispell By: Brad Abell, Chairman By: Signature Signature Date Signed Date Signed Flathead County is an equal opportunity employer. Flathead County shall, upon request, provide reasonable accommodations to otherwise qualified individuals with disabilities. This job description is intended to reflect core areas of responsibility and an incumbent employees' knowledge and skill set needed to complete those functions. This document is not intended to catalog each individual duty, employees are routinely called upon to address emerging employer requirements in alignment with individual work units and assignments of jobs. The job description does not constitute Job Title: Co -Responder Licensed Clinical Social Worker Job Code: Department: Health Department Pay Grade: Unclassified Reportsto: Health Officer/Deputy Health Officer FLSA Status: _Non -Exempt Exempt an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer change. Department Overview: The Flathead City -County Health Department is a public health agency providing certain statutorily -mandated services and other contracted services to people who reside in or visit Flathead County. The divisions of the Health Department offering primary prevention services include: Environmental Health Services, Community Health Services, Population Health and the Flathead County Animal Shelter. The Health Department offers primary health care and prevention services through Flathead Family Planning. Environmental Health services offered include food safety, water quality, land use development and air quality. Community Health services offered include immunization services, maternal, infant and early childhood managed care programs and the Women Infant and Children (WIC) program. Population Health services offered include cancer screening, tobacco use prevention, injury prevention, public health preparedness, behavioral health coordination and communicable disease prevention and control. The Flathead Family Planning clinic is operated under Title X of the Public Health Service Act and provides medical and reproductive health care. Job Summary: Under the general supervision of the Health Officer or Deputy Health Officer, the Co -responder Licensed Clinical Social Worker works as a member of the health department embedded within local law enforcement to identify, triage, and manage patients in crisis as part of the mobile crisis response team. As a LCSW, the Co -responder performs duties under regulations as described within their clinical licensure. This position provides in -home and community -based crisis assessments, diversion therapy services to reduce hospitalizations and/or incarcerations, and formulates recommended referral and treatment options for best care for patients with behavioral health problems or who are in crisis with potential or existing substance use, mental health, behavioral health, or co- occurring symptoms. Essential Functions (Major Duties or Responsibilities): These duties are the essential functions and are not all-inclusive of all duties that the incumbent performs. Functions as part of the mobile crisis response team collaborating with law enforcement, care coordinators, outpatient treatment teams, crisis services, and other mental health care providers in the county to improve behavioral health response to crisis in the community. • Responds to calls by dispatch to directly intervene in crisis situations as reported by law enforcement providing behavioral health care such as assessing mental status, risk, and clinical needs of patients in high -stress situations with a focus on stabilizing patients in the least restrictive setting when possible in the community. • Conducts behavioral health screening and assessment, provides referrals for treatment to individuals with mental disorders, provides individualized resources and connection to care coordination for further services and treatment. • Evaluates clinical need for hospitalization or appropriateness for involuntary treatment according to legal criteria and make recommendation to law enforcement when needed. • Provides consultation on evaluation forms and safety planning to outside entities such as hospitals as well as caregivers of persons in acute distress. • Provides consultation and mental health assessments to the county jail and other law enforcement entities as needed. • Documents and communicates confidential information in a professional manner. • Completes clinical records and data reports according to established policies and procedures. • Develop and maintain programmatic needs, data, and outcomes required for grant purposes as requested. • Assures billing is completed accurately and in a timely manner as necessary. • Attends and participates in meetings and quality assurance activities as required. • Attends community coordination meetings as needed. • Coordinates with crisis care coordinator in Crisis Assistance Team to ensure maximum utilization of community resources for clients and facility in interagency treatment planning for crisis clients. • Participates in providing staff education and training for Crisis Intervention Academy trainings. Non -Essential Functions: Performs related duties as required or directed. Physical Demands and Working Conditions: • The employee is constantly required to use hands to handle objects and to keyboard. • Frequently required to sit, talk, write, listen and read. • The employee may frequently be required to stand, walk, climb, balance, stoop, kneel, crouch, or crawl and reach with hands and arms. • Specific vision abilities required by thisjob include close vision, distance vision, color vision, peripheral vision and depth perception. • The employee is infrequently required to lift and/or move up to 25 pounds. • The noise level of the building is usually moderate. Supervision Exercised: This position does not provide direct supervision. Knowledge, Skills, and Abilities: • Knowledge, education, and training in the field of mental health and substance abuse. • Working knowledge of client confidentiality, and the ethical and legal requirements of the profession. • Maintain a quality code of conduct, ethics, and professionalism upholding professional standards of care per licensure. • Extensive knowledge of community resources, social services, and behavioral health agencies pertaining to the service area. • Skill in interviewing techniques, listening, facilitating problem solving, crisis intervention, and de-escalation techniques. • Skill in utilizing electronic medical records with proficiency in computer and software programs. • Ability to work independently and collaboratively exhibiting effective communication with law enforcement entities within the community. • Ability to maintain professional, non -judgmental attitude towards clients in crisis. • Ability to follow law enforcement protocols when on crisis calls and on active scenes. • Ability to communicate effectively, both verbal and written. • Ability to establish and maintain effective working relationships with diverse individuals and groups. Minimum Qualification Requirements: EDUCATION: Requires graduation from an accredited university or college with a Master's degree in social work and licensure as a Licensed Clinical Social Worker (LCSW) or licensure as a Clinical Psychologist with focus on clinical counseling, psychological counseling, and have ability to perform biopsychosocial assessments. EXPERIENCE: Must have a minimum of two years' experience in a clinical, behavioral health, or mental health setting or any combination of education and experience which indicates the possession of the knowledge, skills, and ability listed. SPECIAL REQUIREMENT: Requires a current license from the State of Montana's Board of Behavioral Health as a LCPC or LCSW. Requires a valid Montana Driver's License. Action Fite Reference Adopted 3/20/2023 Flathead County is an equal opportunity employer. Flathead County shall, upon request, provide reasonable accommodations to otherwise qualified individuals with disabilities. This job description is intended to reflect core areas of responsibility and an incumbent employees' knowledge and skill set needed to complete those functions. This document is not intended to catalog each individual duty, employees are routinely called upon to address emerging employer requirements in alignment with individual work units and assignments of jobs. The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer change. Job Title: Crisis Care Coordinator Job Code: Department: Health Department Pay Grade: Health 6 Reports to: Deputy Health Officer/Population Health Manager FLSAStatus: x Non -Exempt Exempt Department Overview: The Flathead City -County Health Department is a public health agency providing certain statutorily -mandated services and other contracted services to people who reside in or visit Flathead County. The divisions of the Health Department offering primary prevention services include: Environmental Health Services, Community Health Services, Population Health and the Flathead County Animal Shelter. The Health Department offers primary health care and prevention services through Flathead Family Planning. Environmental Health services offered include food safety, water quality, land use development and air quality. Community Health services offered include immunization services, maternal, infant and early childhood managed care programs and the Women Infant and Children (WIC) program. Population Health services offered include cancer screening, tobacco use prevention, injury prevention, public health preparedness, behavioral health coordination and communicable disease prevention and control. The Flathead Family Planning clinic is operated under Title X of the Public Health Service Act and provides medical and reproductive health care. Job Summary: Under the general supervision of the Deputy Health Officer, the Crisis Care Coordinator works as a member of the health department embedded within local law enforcement to provide patient support as part of the mobile crisis response team. As part of the Crisis Assistance T (C.A.T.), the coordinator performs duties This position is directly supervised bythe Population Health Manager, with overarching supervision/direction by the Deputy Health Officer. Essential Functions (Major Duties or Responsibilities): These duties are the essential functions and are not all-inclusive of all duties that the incumbent performs. • Functions as contact point, advocate, and informational resource for co -responders, law enforcement, community resources, and individuals in crisis and caregivers. • Assesses unmet health and social needs of individuals identified in crisis; develop care plan and treatment plan within scope of care coordination. • Provide, facilitate, and follow up on referrals given to individuals in crisis regarding care, community resources, social service programs, and other needs identified on behavioral health care plan. • Assists in identification of high utilizers of crisis resources such as chronically mental ill and those with specialty health care needs. • Documents and communicates confidential information in a professional manner. • Assists with data collection and reporting utilizing the electronic health records (EHR). • Aides to assist with scheduling diagnostic tests, consults and procedures with referral providers. • Attends and participates in meetings and quality assurance activities as required. • Attends community coordination meetings as needed. Non -Essential Functions: Performs functions relevant to the position as required or directed. Physical Demands and Working Conditions: • The employee is constantly required to use hands to handle objects and to keyboard. • Frequently required to sit, talk, write, listen and read. • The employee may frequently be required to stand, walk, climb, balance, stoop, kneel, crouch, or crawl and reach with hands and arms. • Specificvision abilities required bythisjob include close vision, distance vision, colorvision, peripheral vision and depth perception. • The employee is infrequently required to lift and/or move up to 25 pounds. • The noise level of the building is usually moderate. Supervision Exercised: This is a non -supervisory position. Knowledge, Skills, and Abilities: • Knowledge, education, and training in the field of mental health, substance abuse, and co -occurrence. • Extensive knowledge of community resources, social services, and behavioral health agencies pertaining to the service area. • Skill in listening, facilitating problem solving, crisis intervention, and de-escalation techniques. • Skill in utilizing electronic medical records with proficiency in computers, electronic data processing systems, database, spreadsheet and word processing applications. • Ability to communicate effectively both orally and in writing. • Ability to maintain accurate documentation and record keeping. • Working knowledge of client confidentiality and ability to maintain professional, non -judgmental attitude towards clients in crisis. • Ability to work independently and collaboratively with multiple law enforcement agencies in the service area. • Knowledgeable of 911 dispatch system SOPS, radio 10-codes, and able to follow law enforcement protocols when on crisis calls and on active scenes. • Ability to establish and maintain effective working relationships with diverse individuals and groups. Minimum Qualification Requirements: EDUCATION: Requires graduation from an accredited university or college with a Bachelor's degree, preferably in the field of social work, sociology, psychology, or similar. EXPERIENCE: Must have a minimum of two years' experience in clinic or health coordination setting or any combination of education and experience which indicates the possession of the knowledge, skills, and ability listed. SPECIAL REQUIREMENT: Requires a valid Montana Driver's License. Exhibit C • 1017 Row Projected Payment Type Allocations Projected Allocation Amount 1. Distributor Projected Payment 4 (July, 2024) $12,508.47 2. Distributor Projected Payment 5 (July, 2025) $12,508.47 3. Distributor Projected Payment 6 (July, 2026) $12,508.47 4. Distributor Projected Payment 7 (July, 2027) $12,508.47 5. Distributor Projected Payment 8 (July, 2028) $14,711.47 6. Distributor Projected Payment 9 (July, 2029) $14,711.47 7. Distributor Projected Payment 10 (July, 2030) $14,711.47 8. Distributor Projected Payment 11 (July, 2031) $12,366.47 9. Distributor Projected Payment 12 (July, 2032) $12,366.47 10. Distributor Projected Payment 13 (July, 2033) $12,366.47 11. Distributor Projected Payment 14 (July, 2034) $12,366.47 12. Distributor Projected Payment 15 (July, 2035) $12,366.47 13. Distributor Projected Payment 16 (July, 2036) $12,366.47 14. Distributor Projected Payment 17 (July, 2037) $12,366.47 15. Distributor Projected Payment 18 (July, 2038) $12,366.47 • 1017 Row Projected Payment Type Allocations Projected Allocation Amount 1. Janssen Projected Payment 4 (June, 2024) $9,808.64 2. Janssen Projected Payment 5 (June, 2025) $10,871.83 3. Janssen Projected Payment 6 (June, 2026) $1,940.35 4. Janssen Projected Payment 7 (June, 2027) $1,940.35 5. Janssen Projected Payment 8 (June, 2028) $1,940.35 6. Janssen Projected Payment 9 (June, 2029) $2,470.41 7. Janssen Projected Payment 10 (June, 2030) $2,470.41 8. JJanssen Projected Payment 11 (June, 2031) $2,470.41