Stanislaus County expands care team that targets highly distressed homeless people
Stanislaus County is updating a team that engages homeless people who cause disturbances or generate numerous calls to local agencies.
Starting in August 2018, the CARE team has focused resources on some of the most troubled individuals in Modesto, who might be seen standing in a crosswalk yelling at motorists or are frequent visitors to hospital emergency departments and the psychiatric center on Claus Road.
The CARE team goes to downtown Modesto, McHenry Avenue and nearby parks to make contact with these people, to build trust and design intervention plans connecting them to the services they need. The city and county hope to take the edge off the homeless crisis by the reducing behavior that causes the most distress for the public.
In some cases, the team’s work is a life-or-death intervention for homeless people who have serious medical problems, county officials said.
The team, including staff from the Modesto police, county mental health, probation, district attorney, health services and the public defender’s office, originally identified 143 homeless people for the special effort.
They discovered most of these high-need individuals don’t have severe mental illness. Earlier this month, county supervisors were asked to approve intensive case management services that are deemed necessary to achieving more results from the program.
According to a staff presentation to the Board of Supervisors, evaluations showed the behavior of most of the targeted individuals was rooted in substance abuse disorders. Heavy drug use may lead to disorders like substance-induced delirium and psychosis that can be hard to distinguish from classic psychiatric illness.
Supervisors gave approval June 8 for an expanded CARE 2.0 team to include case managers for the majority of clients who don’t have severe mental illness and the ones that struggle with psychiatric disorders.
The case managers will connect the clients with health care, housing, mental health and substance abuse services, income, benefits or help with resolving court cases. One goal is moving some of the clients through the criminal justice system, where they can receive drug-addiction treatment or behavioral health services.
Some of the clients are referred to local agencies for supportive housing, conservatorship, health care or outpatient mental health treatment.
With 12 additional staff members, the CARE 2.0 program will have a $1.86 million budget for the fiscal year beginning July 1. The county hopes the case managers will have daily or weekly contact with clients.
The program’s goal is to reduce homelessness, hospital stays and incarcerations and help the individuals become self-sufficient. Once the effort has more success in Modesto, the county can bring the CARE team approach to other cities, county Chief Executive Officer Jody Hayes said.
Officials said the county can’t use federal and state funding for case management of homeless people who don’t suffer from severe mental illness. A plan for expanding to CARE 2.0 was delayed through 2020 by the coronavirus pandemic.
Outcomes for homeless clients
Of the 143 homeless people on the original list, 60 are current clients of the CARE program, including 37 who are “actively engaged” with getting help and 23 not so engaged. (CARE stands for Community Assessment, Response and Engagement.)
In the past 22 months, the program linked 21 clients to county mental health services and placed 10 clients in housing. Today, six of the individuals are in state prison or hospital facilities; one is in county jail; and one was referred to veterans services.
Staff said 16 of the original 143 have died. The team has lost contact with 28 people, some of whom probably left the county.
Raul Dominguez, manager of the program, shared some success stories during the presentation two weeks ago.
One client, who was homeless for several years, had a record of arrests and numerous contacts with police. The CARE team was able to establish trust after talking with him several times. The man agreed to be evaluated and entered a treatment program for substance abuse.
The man is now getting outpatient treatment and has been sober for 120 days. He has reconnected with his son after the two had not spoken with each other for years, Dominguez said.
The CARE team also helped a homeless couple with their serious health problems and domestic violence issues, according to staff. After many attempts, team members persuaded the woman, who was a victim of domestic violence, to see a primary care doctor and get mental health treatment through the county.
The man was arrested on a domestic violence charge. He had medical issues requiring surgery and received help from the CARE team in recovering from the operation. He also received assistance with applying for housing and Social Security and was close to completing 30 domestic violence classes.
More resources needed for success
The new phase of the program will re-evaluate who should qualify and could result in identifying more potential clients for the team.
Hayes said the case management staff should keep many of the homeless clients from falling through the cracks. “If we want substantial progress or the vast majority to reach a level of stabilization, we have to put more resources into it,” Hayes said.
The dozen positions added to the CARE 2.0 program include behavioral health specialists, mental health clinicians, a coordinator, peer navigators, a public health nurse and crime analyst. The staffing will allow for three teams to make contact with homeless individuals and assist clients.
This story was originally published June 23, 2021 at 5:00 AM.
