Joint Legislative Committee on Emergency Management

Good morning and welcome to Committee on Emergency Management. Our hearing is on California's 911 system, a review of the state's implementation of the 988 Suicide Prevention hotline, and next-generation 911.

Thank you for joining us. I'm looking forward to productive hearing.

We seek to protect the rights of all who participate participate in the legislative process so that we can effectively deliberate and decisions on the critical issues facing California. in order to facilitate these goals, we will not permit conduct that disrupts, disturbs, or otherwise impedes the orderly conduct of the legislative process.

At the end of the hearing, we'll have time for limited public comment.

You can submit written testimony by visiting the Committee's website, at www. AEM.Assembly.CA.gov.

Please note that any written testimony submitted to the Committee is considered public comment and may be read into the record or reprinted. As a career first responder, I've seen firsthand the limitations of our current 911 system as it fails to meet modern technological standards and the demands for our state ever growing disaster environment.

A prime example occurred last week when the magnitude 5.5 earthquake in Plumas County disrupted CHP's 911 dispatch line for roughly five minutes. This was not a major earthquake, and I'm concerned about the resiliency of our 911 system when a big one does strike.

I'm excited about the potential of the next-generation nine-one system and the 988 system hold for improving emergency communications and response. As the next step of the evolution of emergency communications, MextGen 911 will ideally provide a reliable, flexible, and scalable system that can integrate with modern communication technology, enable faster and more effective emergency response, reduce response times, and improve situational awareness.

However, as with any new technology, the implementation of these systems requires careful oversight and continuous planning to ensure their success. I have witnessed the domino effect of the nine-one system flooded with nonemergency calls, hospitals become overcrowded, first responders experience long wall times, and patients needing immediate care do not receive such.

To prevent this from enduring in the future, we must ensure NextGen 911 and the 988 system continue to be implemented in a collaborative manner. It is also imperative that the NextGen 911 and 988 systems are properly integrated in interoperable as well as prepared to adapt new challenges and emergent technologies.

And we cannot forget about the dedicated first responders who operate these systems. By embracing the potential of NextGen 911 and the 988 system, we have the opportunity to revolutionize emergency communications and provide a faster, more efficient emergency response.

Let us work together to ensure that these technologies are properly implemented and supported so that we can continue to serve and protect the people of California.

With that, I look forward to hearing from our panelists on the status of the NextGen 911 and 988 systems.

The needs of the locals to ensure these systems are effective and how the Legislature can support these systems in the years to come. So with that, I also have joining me Assembly Member Boerner Horvath and Assembly Member Bauer-Kahan if they have any remarks before we proceed.

Thank you very much. I wanted to thank our Chair of our Emergency Management and Vice Chair of the Joint Emergency Management Committee. I'm very grateful for this hearing.

When I first became chair of Communication Conveyance, one of the things I've heard on that committee over the last few years is how do we ensure connectivity and telecommunications when we have emergencies.

And I know you're a veteran of this and I really appreciate all your work and I'm very grateful that my colleague Bauer-Kahan is here today. We call her the 998 Queen. And it's been a passion of hers for many years and we have agreed and disagreed on 998.

But there's nobody in California who hasn't experienced an emergency and needed to call 911. There's nobody who hasn't had a mental health crisis in their families where they wish there was another number and help they could get other than calling 911.

And so when we look at the resiliency of both the 911 system as we prepare for the future and future devastating effects of, not only, earthquakes that recently happened, of the climate crisis, combined with what we know is a growing mental health crisis in our state, we know that we have to ensure that California is ready for that task.

And it's a very big task. So I look forward to hearing the panelists today.

Again, thank our vice chair and I see our chair of local government who's also here, who I've had the pleasure to work with. And with that, I think I'll pass it over to Bauer-Kahan. Thank you.

Thank you. I want to start by thanking the chairs for inviting me to be here today. As most people know, 988 is a passion of mine and one born out of the personal experience of everybody that I had the privilege of talking to through that work.

And I want to highlight where California is because we are ahead of most states in this country.

The federal government enabled every state to pass 988 enabling legislation that went further than the suicide prevention hotline and very few have done it. But California has.

And we are one of the few that passed a fee to fund the 988 system in perpetuity. And that is such critical work, and we did it in a bipartisan way. We did it with incredible support from Roth, the Legislature and the Administration.

And we did it because, like Assembly Member Boerner said, there wasn't one person that had the privilege of voting for it who didn't say, I know what this is about, I've lived this. I have a loved one, whether it was a staff Member or a Member or one of the advocates working on it.

We knew the importance of the 988 system. And the 988 system is built on the fundamental principle that when someone is in a mental health crisis, they have someone to call, someone to help and somewhere to go.

And that is the continuum of care that California is working to build. And 988 is the first step in that continuum. It is the phone line that people call the access point into the care people need when they're in mental health crisis. Now and prior to this, people had to call 911 and they got a police response. And this is a health care crisis.

And what we as a state want to do is provide a health care response to a health care crisis.

And so the vision of 988 that this Legislature put forward and continues to fight for and advocate for is one where every Californian has that mental health care support that they need in the moment of crisis.

As I said, it is the first step. The funding really helps with ensuring the interoperability of 911 and 988, which I know we're going to hear about today and is so critical to the success of the system.

It's such a pleasure to be with the people that I've had so much time working with, both Budge and Deputy Secretary Welch, who I know the passion behind the support that they want to provide as an Administration is really there in the work they do every day.

But we also need to ensure that we provide that full continuum of care. So this is the first step in ensuring those stabilization services are alive and well in every single one of our counties. Rural, urban, suburban north, south, the central valley, everywhere in California looks different. And every Californian deserves the care that we're going to talk about today and the support system that this will provide.

So I just want to thank all of my colleagues who supported this along the way who continue to support for it and the work is just beginning, but I know today we'll hear about the incredible work that they've done and what we have in the future. Thank you.

Thank you, Senator, Assembly Members do you have any questions? No.

I'm looking forward to the conversation and thank you for putting this together. All of you work really hard on it as well as the presenters. But it's all good work and let's make sure we spread the word what we're doing.

Thank you. Senator Archuleta, questions?

Yes. It's an honor to be with such distinguished Members of the Assembly and I'm honored to be here with you and of course our speakers today. And we've heard about the importance of saving lives and I believe this hotline, we'll call it, is there to save lives.

When people dial that number, it's a life and death situation. And now, we have communications, the sister program, 911. We can all acknowledge what that's done over the years. Now we're going to open up a new chapter in saving lives.

But it also will keep law enforcement from maybe getting involved when it isn't necessary, when counseling is there, emergency medical treatment is there, or some other way to go ahead and treat those with mental illness. And I think that's one of our major problems when we come with our homeless teenagers.

And it goes on and on. And thank you for your leadership in this venue and this event. So thank you all for being here.

Thank you. And also, Senator Ashby, any questions before we start? Comments?

Thank you so much. Right on queue, right? Okay, perfect. It's already a crazy morning and it's barely 09:00.

First of all, I just want to thank you so much. You've been such a great partner, especially with a freshman Senator on the other half of the equation. Thanks for showing me the ropes and including the Senate in these discussions.

I've been pretty vocal about this, that I feel like the Senate needs to catch up with the Assembly on our efforts to really look at emergency management. So I'm very grateful to the chairman for bringing this forward today.

And you know what? I have a very long standing relationship going back to being a council Member and a vice mayor and all that in the city with the 911 system and with how we respond to people's emergencies in our communities.

And so I'm very interested in, what folks have to say today. My team will be watching very carefully.

And I know the chairman and I are both looking for some themes that might emerge, that might allow this committee to talk about and the Members of this committee to talk about various legislative goals.

I know that we haven't and he probably talked a little bit about this already, but we haven't really taken a hard look at how we provide emergency management in a few decades.

And it's probably time for the state of California to do that, especially with the 988 system coming online and how we make sure we're responsive to folks and that we're sending the right responders for success, successful outcomes across the state of California.

So thanks to everyone who's going to participate today. And I know there are a lot of people that are watching this hearing. I've already heard from several.

And to the Members who are sitting up here today, there are a ton of committees.

This is a very busy time for the Legislature, I'm sure there are seven other places each one of these people could be. And I know you can't stay the whole time, but thank you for choosing to be here.

The fact that they're here means their staff are also watching, which means there are people taking notes and trying to figure out how we work together to proceed. And I'm just really grateful to all of you for that. Thanks for your leadership.

Thank you. Great. So now we'll begin with our first panel. As a reminder, we'll hold questions until the end of the presentations.

So first panel will hear from Assistant Director of Public Safety Walter Budge, courier, California Office of Emergency Services. So when you're ready.

All right, thank you and good morning chairs, and thank you for inviting us here to participate in this conversation. As was stated, I'm the Assistant Director of Public Safety Communications.

So under my responsibility is statewide land mobile radio. That's the push to talk radio systems that all of our first responders at the state agencies are using, statewide microwave system 911, 988, and also emergency communication.

So when a disaster happens and communication is not going the way it should, my group oversees that as well. So lots of folks obviously participating in that, they allow me to come speak at these hearings and they do all the work while I'm doing this. So I want to start with the 911 system.

So we've started the transition from our legacy system, which is built on analog technology. The Chairman talked about some of the limitations of that technology that exists today. We recognize that the system is failing, the failure rates are increasing, there's limitations to integrate new technologies, and we recognize that. So we came to the Legislature and with your assistance in 2019, AB 96 and SB 96 was passed.

That provided the funding mechanism for us to begin the transition to NextGen 911. So we started on that endeavor. We signed contracts in 2019, we were off to a great start in 2020 and then you probably all remember what happened shortly thereafter, pandemic.

Which impacted our ability to obviously get into the centers, supply chain equipment. It's a major project that we've undertaken. The largest 911 system in the world is what we have in California. The reason why it's the biggest is obviously our state is large, and we centrally manage this at the state level. Which is unlike some of the others, large states like Texas, Florida, and New York. They all push a lot of the responsibility down to local levels.

So we're coordinating this at the state level.

Just want to give you a sense that where we've come since 2019 and some of the huge gains that we've made. I'll kind of give you kind of an overview. We're active in NextGen 911, the new technology that replaces that analog system in El Dorado County, Los Angeles County, Imperial County, and Tualamy County.

So we've started that deployment, as with any deployment of new technology, we are literally the first in the nation doing this at this scale. We've learned some things. We roll this out in front of one, PSAP Public Safety Answering Point, and they say, hey, this thing is good to go. We go to the next one and they're like, what about this? What about this? What about this? Because every center does things slightly different.

We've also completed end-to-end interoperability testing for four different NextGen 911 vendors. The way we built our system is two providers are connected to every 911 center so that if we have one that has a problem, could be anything, their data centers go offline. they're impacted by some kind of cyber event.

Somebody makes a mistake and programs something wrong, we immediately fail over to the other system. So we've built in redundancies across the entire system. So that's been completed.

We've got integrated. We have over 100 carriers that deliver 911 calls into our system. It's really a lot more than that, but some are aggregated, so it's more like 1000. But that 100 helps to serve some of the other smaller ones.

We've completed the installation of the NextGen 911 equipment at 450 PSAPs across the state.

Some may not be aware that if you are in an accident on I-5 going through Camp Pendleton, it's actually Camp Pendleton that will respond with paramedics and fire.

So we've got to have a really close relationship with DoD. We're leading the way in that space as well. You can imagine how difficult it is to work with that federal partner.

We've transitioned all of our 450 PSAPs from legacy text to 911 to NextGen tech 911 text to 911. And we built out our network to all these PSAPs.

So just to give you a quick stat, we're seeing right now about 120,000 minutes of outage every month on our legacy system. That means some PSAP, somewhere, is not able to receive 911 because of the failings we have in the legacy network. During that same time period 0 seconds of outage on our NextGen 911 system.

So the technology works. We are certainly eager to continue to roll this out. And then obviously, we've built in cybersecurity and some of the same technologies that you leverage on your mobile device when you're accessing your bank account, we have those same technologies built into the system.

We also have the ability with this system to integrate newer technologies like 988. I'll talk about that in a moment and obviously a project of this scope. Lots of moving parts, lots of pieces.

Initially it was the pandemic that was delaying us a bit. And now we're at the point where we have this legacy call-handling equipment that answers the 911 call at each of the centers.

We're working through the final details to integrate that equipment into this newer technology. And we're forming some very specific teams to go around the state and make sure that we're ready to go.

So we're making some huge progress with NextGen 911.

We're certainly not as far along as I wanted us to be at this point, but we've learned a lot and I think we're at the point where you're going to see some huge gains in what's left of this year and then the beginning of next year.

We've also integrated an alert and warning system into this platform. It's available to the local agencies. If they want to use it, they obviously can have their own solution that they want to use. But the one we provide integrates with this solution as well, and it does what we call wireless emergency alerts.

Those that escalate up to that level where you can send it to everybody's device or just simple alerts and warnings, like there's a parade or a road closure in this particular area. We've integrated that into the solution as well.

So happy to answer any questions related to alert and warning and the final piece, and I want to keep my comments brief so we can have time for questions.

Obviously, the 988 system is something that we looked at. We came to the Legislature, in FY 22 23, to ask for a budget change proposal to give us the initial funding to start that baseline technology. We were moving down that path.

Well, the Legislature was doing work on AB 988. So we really focused on moving past sort of what we call a basic transfer between 988 and 911.

This is where the 988 call would come in, and you transfer it over to an administrative line in the 911 center. It doesn't come in with any information, It's just an audio connection.

You got to manually relay all this information. We want to move that to the next level where whatever data and information is available in 988 that can be pushed into 911 becomes available and vice versa, a call that starts in 911 and really should be over in 988, we can move that same data and information between the systems.

So we've begun that build-out where we are with that. We've done a competitive bid process, that's how this works. We have to go through a request for proposals process, we've completed that. We selected a vendor.

We've done site surveys at all the twelve centers, detailed work of what needs to be done at each of these centers in terms of backup power and connectivity and how many pieces of equipment needs to be installed.

And we've also begun the workflow analysis at each of those centers to figure out when a 988 call comes in, and what information needs to be included in this new unified platform. We've begun to talk to the national provider, and the way that these 988 calls are delivered today is by area code.

We agree that that is not the best routing mechanism. We're in conversations with the FCC to fix that, but it's what we have now. We'll get the call into the system. If we can determine a better place to deliver that call, our system can do that.

And we're in the process right now of validating the interaction between the NextGen 911 system and the 988 system in our lab. And our goal is to have the first center online by the end of June. Some of that is dependent on the federal partners being willing to connect into our system.

And we're in those conversations now and then as like I said, as we got started, AB 988 was passed. And so we started that in September of 2022. So we've established a technical advisory board. We established three working groups on that advisory board. One looking at the interface between 911 and 988, looking at best practices in general.

What are folks doing out there in this space now? Can we make sure the technology and the policies that are being put in place match those best practices? Matter of fact, this Thursday will be the third meeting of our Technical Advisory Board. And that is a live broadcast meeting.

Previous meetings are available if you want to view those.

And then we're looking at mobile crisis response and some of the follow-on pieces that are a part of AB 988 and obviously the surcharge.

And so we've got various budget proposals that are in front of the Legislature this year to make sure that that 988 fee that's being collected is being used in accordance with what's established in the Legislature.

So we're really looking forward to finishing this budget process so we can begin to use those funds.

And really the goal is to make sure that no matter what choice an individual makes, whether they call 911 or 988t or what we call a warm line, they get the same access to those services that they need, even if they may have made the wrong choice.

They should have called 988 and they called 911 or they should have called 988 and they called a warm line or vice versa. We want to get them the best services available. A lot of that hinges on policies, procedures, and implementation plans.

And we've been working in close collaboration with Health and Human Services. They are the experts on how to deliver service. We're the experts on technology. And so we've done a lot of collaboration.

And I'm sure Deputy Secretary Welch is going to share some of that during her testimony. So thank you.

Thank you very much.

Now let's hear from Deputy Secretary of Behavioral Health, Stephanie Welch, from the California Health and Human Services Agency.

Thank you.

Go ahead when ready.

Yes, good morning, Honorable Chair Rodriguez and Members.

It's actually it's incredible to see so many of you here it really speaks volumes to how important this topic is.

Thank you for inviting the Health and Human Services to come to today's hearing about this important topic.

My name is Stephanie Welch. I'm the deputy Secretary of behavioral health at our Health and Human Services agency.

And in that role, I support our agency and our departments and fulfill responsibilities related to supporting a healthy and robust crisis care continuum, which today includes 988, a simple, easy-to-remember three-digit number for individuals experiencing a behavioral health crisis.

These centers used to be referred to as our national Suicide Prevention Crisis Lifeline designated hotlines and they have been working diligently to build capacity to support the transition to 988.

Today I want to talk about three areas of issues. First would be the Health and Human Services Crisis Care continuum plan. The next would be our work underway to support 988 suicide and crisis line capacity.

And lastly, next steps for our agency to launch post-budget, the development of a five-year implementation plan to realize the vision of AB 988.

So first, the crisis care continuum plan. Unfortunately, I don't have to tell anyone in this room, it's probably one of the reasons why you're here that we are reminded daily that we have far too many Californians who are experiencing behavioral health crisis.

This range from thoughts of suicide and self-harm to people who are at high risk of overdose to people who are paralyzed by grief, isolation, and anxiety.

Every Californian in their lifetime will be touched by some sort of behavioral health crisis and unfortunately probably multiple times. What we also know is that this experience is not experienced equitably.

Black, indigenous and communities of color, younger, and older individuals, people who identify as LGBTQ, veterans, people who are involved in the justice system, and people who are homeless, amongst others, carry the hardest burden when it comes to untreated behavioral health conditions.

When AB 988 was introduced over two years ago, we were obviously in the peak of a pandemic and we were very busy responding to that pandemic.

But we also knew that it was only a matter of time that we would experience a behavioral health crisis to the scale that we had not seen before. This would be additive to an underfunded system that we have been playing catch up to build very feverishly in the last several years. In fact, very much so.

With the incredible support of the Legislature, we decided that what would be very important at that point in time was really to develop a strategic plan for what the ideal behavioral health crisis care system in California could look like.

Prior to doing any specific planning around the goals of AB 988, which was still going through the legislative process, and one of the reasons we wanted to do this was because we didn't want to lose sight of the very essential need to prevent imminent crisis.

Knowing that there are not just financial reasons for doing that, but crisis is traumatic, we should and can always do better to avoid future trauma.

So how should our future state of a strong crisis care continuum look like? And what does that mean? We worked really hard to develop a plan with multiple subject matter experts, stakeholder engagement and vetted it through our agency's behavioral Health task Force that does the following it identifies the statewide vision for a full set of services that individuals experiencing crisis, including their interactions between 988, 911, mobile crisis response, crisis receiving facilities, and long term crisis residential services could and should look like.

We articulate a statewide set of minimum standards and metrics that can be used to monitor the performance of this crisis system. We lift up models and prototypes of what this could look like on a statewide basis.

I really want to underscore that part of the message in this plan that we are disseminating to you this week is that this is really going to look different on a county-by-county basis.

That being said, we can have some standards that we can all work towards as a state so that no matter where you live, what your zip code is, that you can have access to high-quality crisis services.

The plan also provides a really high-level outline of a governance structure and identifies major milestones in planning that we need to achieve over the course of the next several years.

We will make sure that Members of the committee and people who are in attendance today, in the Legislature, get a copy of this plan. I really think it's an important thing to take in as we get ready to launch into the next phase of this, which will be planning specifically around 988.

So second, I really want to focus on the capacity that has been built at our current 988 crisis centers, similar to kind of what Budge outlined. We really needed to take this as a developmental process.

And the first and most important thing was to make sure that there was somebody who could answer those calls that increased call volume, the chat volume, and the text volume, and to do it in a way that was more reflective of the diversity of California.

And so in the last several years, starting in fiscal year 21 22, with the support of the Legislature, we dedicated 20 million in General Fund to this capacity.

We were able to secure a grant from SAMHSA, our Substance Abuse and Mental Health Services Authority, the following year for another nearly 15 million. This year we are dedicating 19 million and the May revise includes 12.5 million in fiscal year 24 25, ongoing.

The reason I mentioned this is that there has been an increase. Significantly and more importantly, I kind of glossed over it, but moving from a suicide prevention lifeline to a full-blown behavioral health crisis call center is an additional set of responsibilities and skill sets.

You're dealing with people who might be really struggling with substance use disorder, they might be at risk of overdose. It's just a more complex set of issues you might be dealing with on the call line.

And that's not a bad thing, that's a good thing. And we can build to get there. But we do need to support our crisis centers to not only have the capacity to literally answer the call, but to answer it with high quality.

So our Department of Managed Healthcare Services manages several contracts that are designed to disseminate these dollars and to fund our 12-988 suicide and crisis call centers.

To date, most of the resources have gone towards maintenance and expansion of their systems, expansion of their workforce to respond to this increased call volume.

And right now, I wanted to point out that California currently has the highest 988 call volume in the country. We have an in-state answer rate of over of 90% as of April of this year. So what that means is we're really performing at a high level, being able to take calls from Californians close to home.

California is actually answering more 988 calls than the combined call volume of 26 other states, more than twice the individual call volume of other states, except for large states like New York and Texas.

So I hope that that attests to the importance of making sure that we focused on building the capacity of those centers first. And we've got a lot more to do. We have to create more cultural and linguistic competencies. We have to have skills that reflect, again, the increased complexity of the work.

And so we continue to also, our Department of Healthcare Services as well as agency with Cal OES, to ensure that our California 988 call centers have the handling equipment they need to support the new Federal Communications Commission's mandates to transfer 988 and 911 calls and vice versa.

This partnership has gone on for the last several years, and we continue to work together. Cal OES has begun efforts to provide full interoperability between 988 and 911 through the call handling system, and Budge mentioned this before, creating a consumer relationship management platform.

This allows us to create a detailed workflow analysis and to monitor the performance of the systems. Installation on this is happening. Now, I'm not going to go into detail about that. That's more your area of expertise.

But I do want to say that this is, and I know that the Assembly Member has passed, but I wanted her to know that we are most certainly also really thinking about building out our crisis care continuum in terms of the actual services that's deeply important to our Administration and to our agency.

And just wanted to lift up real quickly that we've already awarded over $200 million in what we call infrastructure dollars for mobile crisis teams. We are in the process of creating a system in which Medical can reimburse for mobile crisis response.

And last year, with federal and state dollars, this could add up to over one billion, close to $1.4 billion in resources going into building out this system.

And then lastly, we are continuing to fund what we feel is a really critical resource. Our CalHOPE warm line. And Budge alluded it to earlier, there are a lot of people who need just ongoing support. Talked a little bit about isolation, loneliness, and anxiety.

We have CalHOPE, I hope you've heard of it. May is Mental Health Month. We talk about it quite a bit as a resource for anyone in California who needs support as they're going through challenging times.

Lastly, and real quickly, I just wanted to talk about what the future looks like ahead.

As part of AB 988, the California Health and Human Services Agency is required to develop a comprehensive set of recommendations for a five-year Implementation Plan.

And I want to share with you a list of some of the things that we will be required to develop recommendations for.

So what are the resources and policy changes that need to be in place in order to create a statewide capacity to address needs? What are quantifiable goals for the state? For our behavioral health crisis system? We are required to do a comprehensive assessment of the behavioral health crisis system.

To date, we have to create statewide and regional public communication strategies and convene quarterly meetings of the state 988 policy advisory group, which must include a diverse group of stakeholders and subject matter experts to advise on the plan.

We currently have a budget change proposal in the works that includes support for both agency as well as our two impacted departments, the Department of Managed Healthcare and the Department of Healthcare Services.

We'll be working hard to publish and widely disseminate the Crisis Care Continuum plan as kind of a great primer as we launch into this planning process. We continue to be very active in the Technical Advisory Board at Calloes and chair one of their working groups on accessibility and equity. And we're really excited.

We're ready to go with an RFP and to go out into our competitive bid process after the budget wraps up so that we can start launching into this plan.

We have two years to complete the plan. It'll be a fast and furious process of developing the plan, but really look forward to continuing to engage with the Legislature on this issue and I can be available for any questions. Thank you.

Thank you.

Now let's hear from Assistant Chief Brent Carter from the California Highway Patrol. Thank you.

Good morning, chairs and committee Members.

It's a pleasure to be with you today to represent the California Highway Patrol and to talk briefly about the legacy system that the CHP plays a significant role in statewide and also the next Gen 911 system, as well as the benefits of that technology once it's fully implemented.

We're a critical partner, a critical stakeholder with CalOES in this project, with Cal Fire, and with the vendors that are included in this project as well. And we appreciate the efforts that have been made so far.

And as this makes a significant impact to the operations of the CHP and most importantly, will improve the public service that we provide to the public, our motoring public specifically, a quick overview of the CHP's 911 system and this kind of illustrates the impact of the Next Gen 911 system on the CHP.

As again, we're a statewide footprint. We have 24 call centers statewide. All of them are public safety answering points we employ.

Each center has between five dispatchers to as many as 55, and we have approximately 700 public safety dispatchers and public safety operators employed statewide.

For context, the CHP answered 4.8911 million 911 calls in 2022, which is just under 20% of all calls statewide on the 911 system. And 85% of all calls, 911 calls are wireless calls nowadays.

So we take any of those calls through the CHP. We're also the default system for 911. If a system is to fail somewhere, they roll over to the CHP and then we work on transferring those calls to the correct agency.

Over the last 15 years, the CHP has worked collaboratively with CalEOS to continue to improve the legacy system that's in place and to ensure that we're delivering those calls to the right agency as efficiently as possible on the first time without having to transfer those calls.

Despite those efforts, it's not a perfect system. It's based upon the cell tower location as opposed to the actual caller, which then leads to calls being transferred to the right agency.

If it's on a jurisdictional border at times, which again can delay a call, and when seconds sometimes matter in an emergency situation, those are precious seconds that can be lost.

The 911 system, the Next Gen 911 system, will close that gap. It'll be based upon the actual location of the caller versus the cell tower, and we look forward to that improvement. Most importantly, we hope that it will limit those call transfers between the CHP and local allied agencies.

Our agency is currently facing a near 25% vacancy rate of dispatchers, working aggressively to recruit and to retain our dispatchers.

But we know that if we could be more efficient, it will improve our operations and lighten the workload of some of our dispatchers and, again, improve the service to the public.

Again, the most important benefit of the Next Gen 911 system is that the location is based upon maps that are provided by the agencies.

And we should be able to tell within, sometimes within meters, of where a caller is. There are times when a caller may be on the freeway or maybe on an adjacent roadway, and that cell tower may go to the CHP, or it may go to a local allied agency when in actuality it is meant to be the other way around.

The new system will hopefully prevent that. It will know exactly where that person is on the freeway or an adjacent roadway next to that freeway. Another capability for the CHP that we're optimistic about is the ability to load share.

We'll be able to transfer an entire center in terms of 911 calls coming into another center.

If there was a natural disaster, such as a fire or we were depleted in terms of staffing or having staffing shortages.

With the Next Gen 911 system, we can transfer the entire call system to another call center within the CHP. Again, that's a significant benefit to us and to the public that we serve.

Additionally, this is kind of down the road with the Next Gen 911 system, but we're excited about this as well, and this not only serves law enforcement but the public as well, is that vehicle telemetrics.

As vehicle technology continues to advance amd information can be broadcast from a vehicle to a 911 center, including number of occupants, type of collision, the exact location of that vehicle off of a roadway, in the dark, or down in embankment, and so on and so forth.

In the future, telemetrics can be transferred through the 911 system to our call centers not only to help us get to the right location but also to deploy the right resources and ensure the right agency, of course, is Min route as well.

Currently, the Next Gen 911 system, were live in about four areas, in California. Our CHP Merced communications center has been taking calls since November of 2021.

Our CHP, Chico and Sacramento call centers are also taking some Next Gen 911 calls as well. And then down in El Centro in our southern region, are also taking Next Gen 911 calls.

A project of this magnitude, of course, doesn't come without some challenges, as Budges alluded to, not only timelines but with the multiple vendors and technology interfaces have certainly provided some challenges that I think that the CHP is continuing to work with CalOES as a strategic partner to overcome those challenges and ensure that this project is a success.

We're very supportive of it, and we look forward to, again, not only improving CHP operations, but more importantly, improving the service of the public that we serve each and every day.

Thank you very much.

I want to thank all three panelists for your discussions, and I'll bring it back to Members for any questions.

Assembly Member Boerner.

Thank you.

Did I understand that was 120,000 hours per month of outages? Is that the correct number?

Yes, that is. So the way we calculate that is if any center is down, then we count those minutes for that center concurrent with any other center that's down.

So if, say, a critical point in the network is down, there's a single point of failure. That's the way the legacy system is. You could have ten PS apps offline at the same time. We count the minutes for all of those.

And what do you think when you look at the data, what's the major reason for those outages?

Aging infrastructure and a single point of failure. It just isn't built with a redundant system with redundancy in mind. So we realized that and the new system, we overcame those challenges.

And when you think about building out a redundant system, what do you think your major challenges are? Or our major challenges are as California?

As we go forward, it's a big state, and so in some parts of the state, ideally we'd like to have multiple fiber connections into a 911 center.

Plus we bring in It's LTE, so the same technology you have for your phone, we bring min every single carrier that's in that area. So that would be five connections if you count the three major lee providers, two fiber connections.

In some areas of the state, we don't have that flexibility. So we may only have one fiber provider and say one or two cell providers.

So we still have multiple connections, which is better than we have today. But that's probably one of the limiting factors in terms of providing that reliability.

When we think about outages do you categorize the outages between accidents, routine maintenance, or the quality of the infrastructure? Do you categorize when you look at those hours and you were saying what you attribute it to, do you categorize it?

We do, and we have stats on all of that. But the bottom line is, regardless of the reason for the outage, still an outage. And the response remains the same in the center, they're down.

So we lump all those together, but we certainly know those that are.

It's amazing the damage a backhoe does, or in the case of the winter storms that happened when you have overhead lines and trees go down and take those jones out.

Those are some of the longer term outages that we Lee, because you have to go and rebuild all that infrastructure and that takes hours, if not sometimes days to repair.

And one last question. When we think about the redundancy that you were talking about between LTE and fiber, what do you think the state can do to help address the network reliability from the providers, if that's what we're dependent on?

So there are a couple of initiatives that are already underway. The California Public Utilities Commission has developed the wireless resiliency, and they've also done the same thing for voiceover IP and wireline providers.

We've seen a huge uptick in the reliability of the networks as a result of those efforts. We get outages reported to us. It's a public portal, and we're able to track those going all the way back to 2017.

So we're seeing an improvement there.

So that's really backup power and multiple paths into those center sites as well in terms of multiple fiber and everything that I just described, we're doing in 911.

That's really what's making the difference and having access to the data. We work very closely with the Carrillo and obviously with the CPUC to make sure that what they're mandating is actually being reflected in the data. And it takes time.

If you imagine a backup generator, there's sometimes local ordinances and restrictions, site restrictions that are in place where you really want a backup generator there, but there's procedures you haney to go through in order to get that there, and that takes time.

Thank you.

Archuleta, do you have a question?

Thank you once again for coming. Thank you, Mr. Chair. I'm excited to be here.

The future of 9-8-8 as it involves think ahead. I perceive the individual on the other side of that phone as a counselor, a professional, where the 9-1-1 dispatcher is sending out those calls, fire, paramedics, police officers, whatever. And that's minutes that are so vital. The other one 9-8-8, it's someone who's hanging on, who's about to either inject themselves or slice themselves or whatever mental issue they have. Does that tie up the line? Do you see that happening in the future where that counselor has to stay on the line with that individual for a considerable length of time and or do they transfer it to someone else that is on call? How would that work in the future?

I'll take the first attempt at this. So our current 9-8-8 designated centers do go undergo a lot of training, and I could probably get the specifics on that. I don't know it off the top of my head, but I would point out that many of them are just incredibly well trained volunteers that are overseen or supervised by a clinician or somebody else who in your world. Since I'm a social worker here in front of all you guys, it's like triage, right? So they are able to do really quick assessments, risk assessments, to make sure that if somebody is in a life and death situation that they are immediately getting them to an appropriate response.

And so that is something like I mentioned in terms of the additional training we want to do with complexities and our whole world is getting more complex, frankly. And so I think that this is a good thing. But I would agree in that there are all sorts of both training in place as well as oversight with clinical staff to make some of those really critical decisions.

I do want to point out I failed to mention, but I thought you'd be interested in these statistics based on some of the points that were made at the top of the opening remarks. The vast, vast majority of people who call these hotlines are not in need of any kind of they're not in imminent danger, they're not at risk of harming themselves. They really need someone to de-escalate the crisis and help them think through a plan of what is next. And so just to illustrate that, we had over 70,000 calls last month into our 9-8-8 call centers. About 1500, just shy of 1500. Of those, 70,000 resulted in an emergency rescue, and another 2500, roughly 2500 resulted in a mobile crisis outreach in response.

So we're definitely making some progress where there is a concern that somebody needs a crisis counselor in person to come and respond to their situation, that we're building that capacity to do so. But I do really want to underscore that our crisis counselors are really well-trained in de-escalating crises, and many of them, depending on where you are in the state, already have their own transfers and protocols with 9-1-1 that they've had in place for a very long time. The new technology is going to allow us to expedite that and do things a little bit better. But the vast majority of people who call these lifeline centers, I think it's less than 6%, are really referred to higher levels of care response because the crisis itself was able to be stabilized and de-escalated.

And my follow-up, Chief, you had mentioned that there's about 25% vacancy across the board, how are we addressing that because obviously finding these professionals, retaining these professionals is so vital?

That's correct, sir, and our recruitment efforts have increased dramatically around the state. We have some dedicated positions now to recruiting dispatchers specifically. And so that's made an impact so far. And we're looking to increase those dispatch-related recruiters specifically at our call centers and more of a community outreach, social media. Of course, we're there with a big footprint there as well. And so, so far, we've seen some significant numbers and see some improvement in terms of recruitment.

We're looking at the overall hiring process to ensure that things aren't delayed inappropriately. Hiring processes, of course, for safety-sensitive positions can take a long time, as you might be aware. And so we're looking at ways to improve those timelines and to decrease those timelines to ensure that they're not delayed in terms of backgrounds or other parts of the screening process as we determine suitability. Retention is a concern as well. It's certainly a competitive position with other agencies as well. And so we're looking at all aspects of the hiring process and recruitment process and retention efforts to ensure that we're doing the best that we can to serve the public.

Thank you.

Yes, Assembly Member Aguiar-Curry.

Good morning, thank you for your presentations. We haven't always been really thoughtful on the jobs you do, and here we are up against the wall when we should have identified legacy infrastructure years ago, right, and spent the money. And we do that through many of our agencies today. And it came directly to me this past week we had an incident over in Davis, in 9-1-1. Someone called 9-1-1 and it went to a highway patrol call center and we lost some time.

The next call went directly, I believe, to Woodland. So we had the lack of time. So what I just want to share is that. Thank you very much. I'm glad we're moving things forward. I think that if we can pinpoint these issues right on, it'll be better for the public, and our constituents. But I'm full support whatever you need to do, but I want it today and not in five years. And many of our constituents are asking, why can't we get this done sooner, particularly within the 9-8-8 call center? That would be really great. But nevertheless, I know you have a big job ahead of you.

Let's hope you guys can get some of the workforce that can help to reinforce the things you're doing. But again, thank you very much for coming today and sharing and telling us what's going to be in the future. Thank you.

Thank you. Senator Cortese had a question.

Yeah. Thank you, Mr. Chair. I think the question is probably best directed to Deputy Secretary Welch. I guess my observations just in the community in terms of lived experience over the years, is that there's not always a clear defining set of facts upon dispatch or upon a call in to dispatch as to what's actually going on in terms of suicidal ideation versus not. And that's, again, just an observation. It seems to in some areas lead to more of a traditional law enforcement response, imminent danger to others in some cases rather than others.

Just not to be overly to make an oversimplification, but a call in that somebody standing on an overpass and appears to be ready to jump, I think would strike most folks, lay folks, dispatchers law enforcement, that somebody needs to get out there and try to de-escalate what is going to be an attempted suicide. Somebody calls in and says frantically and says, my adult son has a knife and is bleeding and I need help. Right? Not so clear. Not so clear. And my experience has been that in the latter case, oftentimes we have law enforcement showing up essentially with firearms unholstered, without mobile crisis intervention, able to try to de-escalate, at least in my own county.

I guess the question I just want to set that up is to what extent are we working at sort of discriminating or articulating as calls come into something that is set up as a suicide prevention hotline and by the same token, calls that are coming into 9-1-1? Because that's just what somebody thinks they're supposed to do in a situation like I described with the household fact pattern. How are, we discriminating what's the best practice for that so that these calls don't just get pigeonholed to, well, that was a suicide call, the other one was sort of a more traditional emergency response call. I get it that dispatchers can ask questions and so forth, but it just seems like there's a lot of improvement that we can make there in terms of what I'm trying to say is, as you've said, I think as we all understand, it's actually a continuum with a lot of gray area in it, and it's not so clearly set up as this is a suicide call. This is not. Could you respond to that? The best practice question is are there places in other states or municipalities where they've made progress in that area?

Yeah definitely. To your last point, part of what we do on our Crisis Care Continuum Plan is like a compendium of some best practices in different places. Clearly being able to triage the more difficult cases up to somebody in a call center who has just a significant amount of expertise or experience is part of that approach. But I would agree with you that, as I mentioned before, I really do think we live in a very complex world in terms of what people are calling in with. It could be a parent who is struggling with a child and their aggressive behavior, and that might be a different, quote-unquote number to call.

So the challenge that we have is the beauty of an easy to remember three digit number and the complexity of the people's needs when they call that number. That's not a bad challenge to Have. It is, in some ways is still a step in the right direction, I think. A couple of things to answer your question. As part of our five year implementation plan, we also will be lifting up protocols and best practices in the transfer between 9-1-1 and 9-8-8 and vice versa.

We've already started having maybe some of those conversations, at least on the technology side, as part of our 9-8-8 technical advisory board, our policy advisory committee will be tasked with developing more recommendations in that space. That's one. I think, also we do have a public education challenge. One thing that we learned in putting together our plan is not only do we have locally run and very successful warmlines, we have population and issue-specific warmlines. We have a friendship line for older adults that's very, very popular. It gets an enormous amount of calls every month and has a very specific purpose in mind.

As I mentioned before, we have Cal Hopes. We'll have our virtual platform from our children and youth as part of our Children and Youth Behavior Health Initiative. So one of the other things that we're tasked to do in this plan is to come up with some recommendations around public education, marketing, helping the public to know. It took us all a long time to realize I'm a social worker, so I was trained to use both 3-1-1 and 2-1-1, but maybe people don't know what those are. We also have an incredible web, and you may hear about it later of all sorts of local mental health access lines. These are people who need help and need services and are trying to call to get an appointment or to be seen.

And so we have a web of work to do. I'm not going to sugarcoat that in terms of what we'd like to accomplish. But I think we all have the same goal where the best thing to do is to have people come to the if they're in a behavioral health crisis, dial 9-8-8. And we need to do the really hard work to figure out how to be the navigation system for that person once they choose to make that particular call. And that's going to be a very long build up to get there. I don't want to sugarcoat that either. It is going to take us several, several years to the end of this decade, I would assume, and that's hart of why we're developing a five year implementation plan to figure out what do we need to do first, what makes the most sense.

And my last point in answering some of your question is I spent a lot of my career working min criminal diversion and criminal justice diversion. And we have decades of work that has been happening with our law enforcement and public safety partners to embed clinicians, social workers, peer support specialists into their teams.

I think we're going to have to work on using a variety of different models, not only because of capacity issues, but also because of some of the issues that you mentioned. And again, the complexity of responding to crisis when someone may be in a really compromised position or there are substances involved that might be dangerous. There's no one single way to do this. And so we have to be open to a lot of different models. But the most important thing is to continue, I think, on our quest to support our local partners to design things that work for their communities.

In your community, Senator, you have a 9-8-8 center that's working really hard to create mobile crisis response and to do it in a way that is sensitive to the cultural differences that you have in particular a large city of San Jose. They need to be empowered to design what works for them. And that's going to potentially look very different than pick somebody else, but somebody in the northern part of the state. They may have to have different partnerships to be able to meet the demand. And so we just really want to empower communities within some basic broad principles to design what might make sense for them and support them in building their capacity to have kind of that robust crisis continuum. So I hope that answered your question.

Yes. Thank you. Thank you, Mr. Chair.

Senator Ashby, do you have the question?

Yeah just kind of a little bit of a statement, I think. I sort of try to think of. All of this in sort of three parts in my own mind because it is really complicated and we do have a long way to go. We're also a lot better off than most places. So try to leave room to be encouraged about where California is at and also know that we've all seen where the system has failed, and sometimes we focus on those areas because it's the opportunity for improvement. But here are the three sort of buckets I look at, and some of these areas. There's been tremendous amount of work as of late.

So the first area, I think, where I think there's been a lot of work is the system itself. This is where next-gen plays in and you have this sort of antiquated 9-1-1 system, but you've added 9-8-8, and then the counties have their 2-1-1, or whatever, but the average person in the community doesn't know all those numbers or know where they plug into those numbers.

But the system itself, where you talk about technology and integration and fiber optics and mobile devices and the cell towers that people ping off of in that regard, I think we're on the forefront. I really do. I think we're pushing hard on the envelope there to make sure that we do have redundancies, that we don't have as many system failures. I think if you go to rural America, you will come back very proud of California and be grateful that this is where you live and that there are these opportunities and that the worst thing that happened to you is you got CHP instead of your local police department, but they transferred you pretty quickly. That's good compared to a lot of places. But as Assemblywoman Aguiar Curry said, we also don't want to lose those precious moments on some of those calls. So there's room to grow there.

But the next piece is arguably the piece where I think we're falling down the most, and this is the education piece. What number should people call? And the one number everybody does know is 9-1-1. So it's overburdened. And the 9-1-1 system historically led to police or fire. And as Senator Cortese has said, especially in big cities, we've changed that. Now there's these other alternatives for who might show up when you call 9-1-1, which I think is very appropriate, but it calls for us to make the right decision during that 9-1-1 call or else people's lives are at risk, both the responder and the person in need of assistance.

We have to do a good job of making sure we send the right first responder to the right incident. And that really requires us having a good partner on the other end of the line. And so it's going to be incumbent on this Legislature and on local governments across the state of California to really pour into this system and I think get out in the schools and begin very early teaching young people which number to call based on what's happening in their life.

We have to make that just part a just routine part, like 9-1-1 has been for all of our lives. And for me, the third bucket is the service bucket. And that's making sure that cities and counties and areas all across the state have a level of care, that when an ambulance shows up, that there is a minimum standard in the state of California for what you get. When that ambulance shows up, or how well trained your officer is, or what kind of background your social worker has, or your behavioral health specialist that showed up that people are receiving a standard of care.

And this is where I think the Legislature plays a role. And this is where I think we have an antiquated system. I do not think that we have done enough to look at our policies and procedures to make sure that we're responding to people across the state of California with the highest possible standard that we can achieve in this state.

And the rest of the system has to work really well. But this is where the people at this dice need to be thinking about what are we doing to make sure that the laws and the policies are in place to support the progress of this 9-1-1/9-8-8 integrated next-gen system? How are we standing up social workers? How are we supporting the distinction between highway patrol and local police and local sheriffs? And what are we doing with ambulance care, which is vastly different across the state of California to make sure that when we get there that the person on the other end has the greatest opportunity flora successfully addressing whatever it is that made them pick up and make that call that day.

And we used to have a police chief in Sacramento who always said to all of us, when you're up here, we hear about lots of calls and we hear about lots of incidences. But you just always have to remember that for the person who picked up the phone that day and made the call, it was one of the roughest days of their life because they decided to call for help. And we always have to remember that and make sure that we're putting in place policies and procedures to support the person who hit the spot where they said, this situation is bigger than me, I need some help, that we're sending them the right help.

And that's my encouragement to everyone on this board is take this information in today and think about what you're hearing from these experts and what we need to do. I don't have all the answers, but it's clear to me that there's a policy role to be played here to support the progress that we're expecting from the experts that are sending in front of us. That's my statement.

Thank you, and I think Rebecca had a question.

Yes. Thank you, Mr. Chair, and I want to just echo the comments of my colleagues and something we heard from Deputy Secretary Welch, which is the incredible diversity of the state and the needs of what that looks like throughout the state. And I think one of the great partnerships and things that came out of AB 98 was the empowerment to go figure out in every county what that looks like.

But I think it is really critical, and I heard you say this many times, that we as policymakers need to set the standards of what every Californian gets. And that delivery system may look different in different counties, but every single person in California should have access to this 9-8-8 system that's interchangeable with 9-1-1 to a mobile crisis response that is not centered around law enforcement if they're in a health care crisis.

And I think the beauty of local government that we've heard about now a couple of times is that they've been out there piloting this, right? I mean, L.A. County has a great system where they decide who responds and whether law enforcement needs to come in a co-response or whether a health care response alone is sufficient. And so we're seeing that on the ground already in many counties and are able, as Budge said, to learn from those best practices and put them into place. And I think that's really important learning that will happen through the report that's coming, the first one this week, but I know it's only the first of many that we'll see from all of you on how this will play out in the years to come.

And I wanted to touch a little bit on the funding. And I think one thing that was highlighted that I think is really important was the Administration did come with those BCPS well before AB 98 was even possible to start this rollout and to start knowing 9-8-8 was coming from the federal government, to know that we would want interoperability that that was really crucial to the safety and security of Californians. If you call the wrong number, you get the right response, no matter whether that's calling 9-8-8 or 9-1-1. And I think that will make Californians safer. And so a huge kudos to the Administration and your teams for coming to us and proposing those funds and the Legislature partnering with you to get that work well underway before those funds that are now rolling off people's phone bills were coming your way.

So I just wanted to ask about those funds. We talked about the use of those for technology and the build-up of those call centers. Are they also being used? I know there was an anticipation of more calls coming in through the 9-88- system. As Deputy Secretary Welch mentioned, it's a lot easier to call 9-8-8, so we expected there to be an uptick in calls. So are we also funding increased personnel? Like, how are those funds that have gone out being used today to build up the 9-8-8 system?

Yeah, good question. And I can get maybe some more specificity from our Department of Healthcare Services, but generally speaking, the funds that we've given 9-8-8 call centers have been for them to build their workforce in terms of actual people as well as enhance training for the people who are working there.

We're taking many of you might be familiar with like a very large call center like DiDi Hirsch they're one of the largest in the countries, if not the largest in the country, but then we have much smaller ones who may not have been operating 24/7 or they weren't able to operate the extensive hours. And whenever that happens, similar to what you were explaining with 9-1-1, there is another call center that is always available flora someone who might be calling in Shasta County needing someone to talk to.

But that's what the majority of the services have been for too. And we have been working with our twelve crisis senators to kind of monitor what the trends are in terms of the uptick. I don't specifically have a trend report, although I think we create them that we could probably send to you. But right now we're holding pretty stable at the same amount. But I do think we have months like this month where I only have the data from last month, but this month is May as mental health month I wouldn't be surprised if things go up a little bit just because people are talking about 9-8-8. I believe that the Federal Government might be doing some more outreach to educate people that 9-8-8 is there and that might result in more of an uptick.

The primary goals have really been to make sure that the centers have the capacity to input into the is it called a Consumer Response System. I'm Sorry.

The CRM is the acronym, and really that's I think a big key to the technology right now. The stats we get are fairly limited in terms of call disposition, time to answer the call, what happened to the call if it wasn't answered, where did it go? Because the data we get from the national system is rather limited. So I think that's going to really help inform us.

I provide the stats to the experts who then say, okay, this is what we need in terms of capacity and training and policy and procedure. And so really good data is going to help us make better decisions as well. And I think that's a big part of it and that's really what this ongoing BCP and the 9-8-8 fund and the surcharge is really focused on is how do we take those resources and best use them, identify the problem and put the resource to fill the gap that exists. And that's really what we're going to be doing over the next year or two as we learn about what's really happening in the system.

I had the privilege of touring Didi Hirsch, which is an incredible facility. The folks there are trained to handle people in crisis, I think brilliantly. But as I saw when I went before the passage of 9-8-8, it was going to take, as you said, some changes right in their technology to allow for the interoperability, to allow for them to give us the data we need to allow for a co-response if necessary. So as you've started that rollout, I think, with Didi Hirsch, how is that going? Are we seeing technological problems>

So we have not deployed the first system. So what we're doing now, we're calling it a minimally viable solution. So in other words, you ask a center what they want and they give you five pages of stuff we'd really love to have. Some exist, some doesn't exist. So we go back and say, okay, where's the critical line here? What do you need in this technology to do your job on day one? And then what's next? Important next. Next. And we continue to build the system out. We're having those conversations now. Those demonstrations are happening with the centers.

We're technology people. The last thing you want is for us to design this by ourselves without consulting those who are actually going to use the system. So that's really where we are now by the end of June, I'll have a much better answer for you on sort of where we are with the technology. This is technology that doesn't exist today. I mean, it's not like you can go buy this off the shelf from a provider. There's different pieces and expertise and sort of stove pipe systems. But putting it all together in a unified platform is really where we're at now. So by the end of June, I'll have some better answers for you, but that's where we are right now.

Awesome. Thank you. And I think one of the things that I think got us bipartisan support on a nine eight eight Fund, it's not easy to get a two-thirds vote on a fund in a great budget year was how tightly we created that fund to mirror the 9-1-1 fund.

I think that what we believed as the Legislature was that no matter what our budget cycle looked like, people are in crisis, and that we needed to ensure ongoing funding for that. And it was tightly crafted to ensure it would fund the phone system, the call centers, and those crisis response teams that would be needed no matter what the year looked like, which was great, because here we are in not a great budget year, and we know that that fund will continue. So I think it's really critical that we maintain that level of service no matter what and ensure that that fund has the integrity that was passed with broad bipartisan support.

My last question is about coordination with locals. I mentioned that many counties, and we heard it from my colleagues who worked at the local level, have started this. Are trying to provide this kind of response. I know the San Ramon Valley in my district is having fire respond through actually our 9-1-1 center right now. So how is that going? In counties that were already underway, right? I mean, different counties were in different places, different cities, et cetera. But I just wanted to hear a little bit about how we're working with those local entities to support and transition their ongoing efforts so that what they're already providing, which was better than what was going on before, continues and ensures continuity of care for their communities.

Okay, so we have started meeting with all twelve centers to get their workflow. Each county does it differently. The large centers like Didi Hirsch and Wellspace that serve multiple counties have different needs, obviously, than, say, someone like Santa Clara County, which is focused on a single county. So that's where we are now. Just to go through, what do you need in the system? How do you handle it when a call comes in? What's your interaction with 911? What stats do you need? What data do you need? What workflows do you need to support? That's where we are right now. We've done that analysis, and it takes a while, right? Because you're used to this local agency operating sort of autonomously, and then in comes the state to help. And so a lot of what we've done over the last six months was build a relationship and a trust. We're not trying to come in and take over or mandate or be overly heavy handed. We literally want to give you better resources to equip you to do what you do every single day. That's where we are right now, and we're making some huge progress there.

The work that DHCS had done to have those centers all talking to one another before Cal OES even came along was huge. And so we're just continuing that dialogue. We formed the Technical Advisory Board and we really focus that down on local representation. It's not a heavy state agency board. I chair the board, but I don't even get to vote. So it's really local driven and we did that on purpose. So that's where we are now. And then I think Stephanie will probably address where we're headed next.

Yeah, so, really important question. I do think that when we establish our 9-8-8 Advisory Policy Group that it'll be of the same principle. And I know that you and I talked about this when we were getting ready to put together the Technical Advisory Board. How important it would be to have people who are working in the field come and sit on that particular body to give us lots of examples.

I actually would say I think we have a lot more work to do in our side. I mean, the complexities of wanting to design that robust crisis care continuum and what it looks like, for example, in Contra Costa versus even Sacramento, which are kind of similar in terms of size and population, is going to look really different. And so I think we're really hopeful that part of what the five year implementation plan can do is to lift up some examples of what a local planning process could also look like.

I want to acknowledge how much change we have put on our counties in terms of the rapid fire of behavioral health initiatives, but there are also incredible opportunities with those initiatives. One of the things that we do in the plan that I'll get to you guys soon is really lift up the various different $10 billion plus investments that this administration has made so far in behavioral health to think about, oh, this is where if I were to design this system, in several years, money is going to start coming online through medical for our mobile crisis teams. And then also being able to say, you know what? There's a real gap when it comes to prevention. Like, we don't necessarily have a sustainable funding source that's going to support this particular prevention service.

So the idea is to really lay a foundation for local planning. I do think that we have some difficult questions to ask ourselves that we're ready to talk about in that particular working group. Senator Ashby alluded to it, and you did too, of course. We really want to have non law enforcement responses, especially if someone's in the midst of a behavioral health crisis or a health crisis, as you said. But we may not have that capacity. And it may not just be bodies. It may be that we have more training to do it's, more planning to do, more technology. And I don't necessarily think we have to be patient. I think we've made incredible progress already. And part of what we plan to do with our plan is to create an outline of major things that we need to accomplish in terms of milestones up through the end of this particular decade in order to start building out that system. So I think we're really excited to get started, as are the counties who are already in the midst of doing this work.

I love that, and I think I've had the privilege of hearing your vision for California's continuum, and I think it's incredibly robust. And as Senator Ashby said, people will continue to feel grateful to live here because we provide such incredible services here in California. So I want to thank you for your hard work on that. And as I said in the opening, I think that the 9-8-8 fund is the first step. It's the opening, it's the phone number to call, but it doesn't provide the full continuum of care that Californians need. And I think it's really important that we protect the integrity of that Fund and at the same time listen through this five-year process at what more counties need to provide that full continuum of care for folks, to get them stabilized, healthy and back to where they need to be to enjoy the California that we provide for them. So thank you guys.

Assemblymember Boerner had a question.

Yeah, I want to go back and ask if you could walk us through the budget change proposal and the expansion to the health crisis services, how that will be handled between the local and the state? If you could just walk us through that.

Very glad I brought my notes. Absolutely.

And with that, just for the context, one of the things I'm very concerned about is telephone users and what telephone users through the fee are actually paying for because we don't use telephone fees to pay for public health or public safety. That's not something we do. So if you can just with that context, walk us through that. Thank you.

So you are correct that as part of the signing message from the Governor last year that he directed our agency to develop Trailer Bill Language. So a couple of highlights of what is in our Trailer Bill Language. We do revise the definition of 9-8-8 to be consistent with what is at the federal level. And that means that as currently written, the act says that in addition, I'm sorry, the addition of and with the capacity to connect callers to behavioral health crisis services currently goes beyond the federal 9-8-8 requirement. And so because that hasn't happened yet at the federal level, we feel that at this point in time that our particular statute here in California should conform to the federal definition and just identify 9-8-8.

It removes that the 9-8-8 surcharge be used solely for the operation of 9-8-8 centers and mobile crisis centers. I'll come back to that. And the TBL allows instead the 9-8-8 surcharge revenue to be used to pay for our state department's Administration of these particular resources before it is dispersed to the 9-8-8 suicide and crisis lifelines. There's no prohibition on using the 9-8-8 surcharge for mobile crisis teams responding to or dispatching directly by the 9-8-8 hotline. But that being said, there's no prohibition, but it's not directed as the third kind of prong of what the fund can be used for. And we do expect that the Federal Communications Commission will promulgate regulations in this space and when that is the case that we will conform to that federal rulemaking.

The behavioral health context that are made or routed to 9-1-1 we felt was a little bit too broad and wasn't consistent with our definition of mobile crisis as it relates to our Medical Mobile Crisis Program. And part of this is because we didn't talk about it a lot today, although I highlighted that less than 6% of anyone who calls a 9-8-8 crisis center today needs any kind of mobile crisis response or emergency response frankly, to be clear. And so we may have mobile crisis people dispatching all over the place, but it's not necessarily linked to 9-8-8. It doesn't mean we don't want it to be linked to 9-8-8, but we want to recognize that how the system works now is that in many cases it's not. And we expect our mobile crisis units to be working freely in the community.

And I think, I think lastly, let me see, we also did some work to try to align commercial plan coverage with services that are covered under medical plans and to shore up we thought were some gaps in ensuring that there could be commercial reimbursement for some of these services. And we also gave ourselves one more year to develop the plan. And I think lastly, what I would just say very specific to, I think both of your questions. It is absolutely not our intent that we don't wish to Fund the crisis centers. And I know that there's some real specificities in terms of how the actual statute is written in terms of order. Like fees come in, the first set of fees have to go to pay for this, fees come in, the next set of fees have to pay for this.

And it really is done in a way, as you mentioned, that is consistent with 9-1-1 in our attempt it's not to detach mobile crisis from nine eight eight, but it's to recognize that there could be some opportunities in the future to be very specific about what we needed in terms of behavioral health crisis services. And so we updated with a broader definition and then defined it in statute to make sure that there was some flexibilities to ensure that we could be nimble and meet the needs of our state. But again, with the projections of the costs that may be well, we're very grateful to have a surcharge. I don't know if it's going to be an enormous amount of resources. I think that by the time we pay for the work that you guys need to do on the technology side and to support our crisis centers at this point, we haven't really thought about what that other piece looks like.

But we've talked a lot today about how different locals are, that there's different needs, that the state's needs change. And we just wanted to make sure that we were giving ourselves some flexibility to use that fund in a way that could best meet the needs of the vision of 9-8-8. And do you want to speak to the other piece? I'm not sure.

Yeah, I don't know if the question had a part on how the fee was charged to the providers and how the fee is remitted, but I can provide any detail on that. If anybody has any questions on that, like the mechanics of the fee you had a question?

I just wanted to make one comment on what Deputy Secretary Welch said, which is I agree it's not an enormous amount of resources. Right. And that is why we were so careful in what it is going to pay for. Because if it becomes nimble and flexible, as to be clear, many mental health funds in the state have they are not being used for what we as a Legislature want them to use for, which is the caring of mental health issues. And so it is really, really important that that Fund not be flexible and nimble, that that fund be very clearly structured to fund the 9-8-8 system that this Legislature intended for it to fund. And that was the phone lines, the call centers and the mobile crisis response teams.

And I couldn't agree more that in those five or six years we may find that our vision of what this would look like is different, that the structures that we put around that fee don't cover everything that is needed in every part of California. And I want to say that my commitment has been and continues to be that in four years, if that group comes to us and says, oh my gosh, in Shasta County you can't have a mobile crisis team, you need to have this, that we will be open to that conversation.

But at this point in time, without knowing what those things are, opening up that fee to be nimble and flexible I believe means that fee will become meaningless in California. So it is critical that we keep the structure and protections that were put into place last year. And that is obviously a conversation of a budget committee, but I couldn't go without saying it.

Thank you. I have one more question. Archuleta yes.

Thank you, chief, this would go to you. You had mentioned that we had 4.8 million calls, 9-1-1 calls in California in 2022. Would you walk us through a typical call that would go to the CHP, which in turn is dispatched to the local police, which in turn is dispatched to a unit, whether it be an ambulance, fire department or a patrol unit. Walk us through that because my colleague here mentioned about time. Walk us through that so we can get a good idea of how the sequence goes.

Sure. good question. So again, most of our we've worked really hard to ensure that when a call comes in that it's dispatched to the right organization, right agency, the right jurisdiction based upon those cell tower locations. And we work to fine-tune that with call us over the years and we're pretty good at it. But again, you've got jurisdictional boundaries or freeways, of course, that run through all jurisdictions for the most part.

You're always going to have some areas where the cell tower may alert to say Sacramento Police Department, but in reality it's along the 50 corridor somewhere or Business 80 and it should be Highway Patrol. So there's a chance that an I one call comes in from someone that's involved in a collision, for example, a crash on the freeway that ends up going to Sac PD that depend upon their call intake at the time it may be delayed before a dispatcher answers.

Eventually, they notify dispatch that they're looking for CHP for a crash or that they're involved in a crash. And Sac PD knows, of course, to transfer it to CHP. It's then transferred to the CHP dispatch center, who then ensures that there's no injuries. Or if there is, then they can actually hold that call and transfer it to the fire Department as well at the same time. So they can hold a call, and they can have multiple calls going at the same time. At the same time, they're dispatching it to a unit as well. They'll hold that call again with the caller on the call, and we'll then put out over the radio to dispatch the unit to that crash at the same time. So our goal is to get EMS rolling first and foremost. That's the priority, of course, and then followed by our units who follow right behind.

Very good. Thank you. All right. And before we go onto the next point, I just had one quick question with the evolving technology and the next-gen 9-1-1 and everything we're on into doing, what measures or steps are being put in place to protect that system from any cyber threats that we see out there?

Yeah, obviously, we built the system. There's a technology called Private Key Infrastructure. It's the same thing you use on your mobile device when you're using your banking app. Same exact technology. No packet goes through the network unless it has an appropriate Credential. It's called the Zero Trust Environment. So we don't trust you at all. We have to validate who you are, and then your data can flow through the network. That's the way it works.

And then we took another step because we realized that whenever you ask somebody to self-certify, they, of course, say, I'm good to go. So we hired a third party to come in and actually do an assessment of the network, and they came in and looked at each and every vendor that is providing services in this next-gen 9-1-1 environment. The good news is they were all following the rules.

The only thing we found was when you do an initial deployment and you're trying to get the system just to work from a testing perspective, and you put that device in place, you didn't go back and reimage it with the production-level version of what should be there. It was those kinds of things that we found, or like a data center had an extra piece of equipment in there that was connected and not really being used. So why is it even connected? Get rid of it, those kinds of things.

We then had a tabletop exercise where we talked through if some kind of cyber event happened? Who do you call? Who's the decision makers? How do you work through this process to make sure that if an event occurs, how do you mitigate the event? Who's the decision maker? How do you get a hold of them? How much time does it take to respond to either a denial of service type tack or maybe a ransomware attack? And then we continue to collaborate because we know that this is an ever changing environment. So Cal EOS has the State Threat Assessment Center, which focuses on cybersecurity.

I work directly with CISA at the federal level to make sure that what we're doing down here at the state level aligns with all the best practices and what we know is going on at the federal level. And it's a reality that there are nation state actors out there who want to come in and disrupt this network. And so we're continually analyzing that. And if anybody else has any great ideas of other things we could do, we're all for it because we want to make sure this network is secure. Zero trust. That's the key.

All right. Well, thank you very much. I want to thank the first panel for coming and sharing a lot of the work being done. So now we can move on to our second panel. It's so the second panel is going to be our local perspectives on enhancing the effectiveness of California's 9-1-1 system.

Good morning. Thank you for having us. My name is Mark Chase. I'm a business analyst for the city of Palo Alto. I work to maintain 911 and communications infrastructure, as well as I've been a 911 dispatcher for 18 years. I also work at four Bay Area 911 centers, so I'm an active 911 dispatcher.

Piggybacking on Chief Carter's earlier comments, 911 centers are critically understaffed, and that's really the challenge we're facing right now. PCEPs are struggling to recruit and maintain staffing. The COVID pandemic truly affected 911 centers in a profound way when everyone shut down and was able to start working remotely from home, for many professions; 911 centers were unable to do that.

Dispatchers still needed to report into work, and due to the close quarters we work in so we can coordinate police, fire, medical responses, COVID came through many of our centers and caused many of our dispatchers to become COVID positive.

Competing employers offer better salaries and benefits. There's more flexibility in areas such as working remotely. The jobs are not as sedentary. Nine One shifts typically last 10, 12, even up to 24 hours in certain fire centers, and dispatchers don't have their own office, right? We all work at terminals and need to potentially sit and stand, but that's really the extent of how far we can move. The 911 calls always need to be answered.

As one example, one Bay Area center is requiring a minimum of 70 additional hours of overtime of all of their employees. If one thinks about the burdens this would place on one's family, in addition to working 160 hours of overtime--I'm sorry, working your normal schedule of 160 hours a month, and then requiring a minimum of 70 hours of additional overtime, you can understand the stresses that would put on one's family and cause candidates and dispatchers to consider a different, less demanding profession.

Another concern is the classification of dispatchers. We're currently classified at the federal level as either admin or clerical staff, even though we have recognition as first responders here in California, that's in title only. The result of that is most of our dispatchers are 2.0 at 62 for the retirement formula for PERS; the mental acuity and the physical demands that are required, as well as the sedentary work and the overnight shifts that dispatchers have to work, it really causes a lot of concern for some of our older Members.

If they're at the 2.0 at 62 formula and they wish to work their way up to 2.5, they're going to be there until they're 67. And in a similar way to an airline pilot or a police officer or anything like that a firefighter, you truly need to have mental and physical acuity and be able to quickly adjust to the different calls that are coming in. So that's a great point of our centers.

Also, the Fentanyl crisis and the homelessness epidemic truly affects our work. Every day we get multiple 911 calls from people needing assistance. Chairman Rodriguez, to your point, as far as Wall Times and Medics, the COVID pandemic has severely affected the ability or the availability of paramedics.

I worked a shift on Saturday in a Santa Clara County agency. When we first called for an ambulance, we were told there was no ETA for an ambulance and then when we called back about five to ten minutes later, it was a 30 minutes ETA for an ambulance. So, these are serious concerns.

During the pandemic, both paramedic and EMT academies were not held and that really has put a strong strain on the EMS system. Also, we had an overdose on Saturday. Multiple doses of Narcan were required to stabilize the patient as we've seen the deaths rise, so it's really creating a huge impact on all of our work.

In recent years we've obtained location technology. Systems such as Rapid SOS and Rapid Deploy have truly helped to revolutionize our ability to locate a caller. We now have the same technology that Uber and some of these other softwares have. So that's made an incredible amount of difference in my career.

I remember when we first were calling, sometimes it would take us 10, 20 minutes just to locate a caller and even longer at times depending on the cell technology and where they were, if they were in a rural or a metropolitan area. So those technologies have been instrumental in increasing our response times and locating callers who are min crisis.

As far as 988, the advisory board has begun to meet the 988 advisory Board and the Policy Advisory Committee has been formed. Many agencies are waiting for the recommendations of the Policy Advisory Committee to see exactly as far as liability and other things, what calls they are going to take or transfer. I did speak with one sheriff's office in Southern California who's begun transferring calls based on a specific amount of criteria from 911 to 988.

So those efforts are ongoing, but it is early and that's one of the first agencies that I've heard that's actually doing those transfers. To Budge's point earlier, 988 does route to an area code. We all know that if one tends to move, especially in California, because there are so many area codes, you may be getting a center that's either somewhere else in the state or if you've moved from another state, you may be getting a crisis center back in your home state, or wherever you've moved from. So that is a clear point for us.

And then Senator Ashby, to your point, CALNENA is sponsoring a Bill AB 296 with Assemblyman Rodriguez. It's a 911 public education campaign and our hope is that we do can better educate the public on what numbers to call, when it's appropriate to call 911 versus when it's not, and we truly want to ensure that we are getting people help as quickly as possible. So thank you very much for having us, and I'm happy to take any questions.

That's a good author you chose.

I wish I knew them too.

Thank you very much. Next we'll hear from Phebe Bell, the Behavioral Health Director for Nevada County. When you're ready.

Good morning, Chairs and Members. Thank you for having me today. Again, my name is Phebe Bell. I'm the Behavioral Health Director for Nevada County and past President of the Behavioral Health Directors Association.

In the SAMHSA Best Practices Toolkit for Behavioral Health crisis care, the federal government laid out a vision for 988: someone to talk to, someone to respond, and somewhere to go, as Assembly Member Bauer Chen mentioned earlier. County behavioral health agencies play a crucial role in all three of these responses.

Two of our state's twelve 988 call centers are county-run--Kern and Santa Clara--and most are county behavioral health funded largely with MHSA funding. In addition, every county runs a local crisis line that is also an access line to the public behavioral health system.

Secondly, all counties are on a march to lift up the new mobile crisis benefit under MediCal by next year, and counties operate and finance the behavioral health safety net throughout the state, which often includes crisis stabilization and other receiving services outside of hospital emergency departments.

I think it's important to understand where we're starting from in building toward this federal vision, not just in California, but also nationally, and as a matter of policy and practice on the ground level. Because behavioral health mobile crisis has traditionally not been well supported as a standalone insurance benefit under commercial or public insurance, including MediCal, whether mobile crisis available and how much of it is available depends on where one is, literally.

As of today, 41 out of 58 counties have some mobile crisis services, but, often if these teams exist, their coverage is not 24/7 and, in fact, only 14 California counties today would be ready with some 24/7 mobile crisis services, here and now.

And, even when we're at full implementation, an investment we are very grateful for, the new benefit will only be covered for one out of every three Californians. Counties will still lack coverage for the 70% of Californians with private insurance. This is important to flag, because when the public calls 911, or 988 for that matter, their expectation rightfully is that this is a public service, open and available to all, because emergencies impact all of us.

A second big issue is that 988 call centers are not set up today, for the most part, to serve as mobile crisis dispatch centers. The National Suicide Prevention Lifeline started in the early 2000s and counties have been big funders, helping not only to build out and support the network in California, but my predecessors also ensured that we invested in building out a strong capacity to take calls in Spanish

California's nine eight eight call centers now serve as a hub flora Spanish language 988 nationally, actually. Historically, however, this network has not been highly professional in their staffing. The majority of 988 call centers rely on volunteers to stop the lines. These volunteers are trained in providing emotional support and screening for suicide risk, and they do a phenomenal job. But, most often, they are not clinicians, and they're not generally trained to take on responsibilities associated with triage, assessment and dispatch for mobile crisis services.

Today, a majority of our mobile crisis services are dispatched at a county level in coordination with 911 and law enforcement. In some communities, counties have embedded clinicians in 911 dispatch centers to increase that coordination and communication, but building toward the future will require more than technology: It requires clinical expertise to stabilize a crisis in real time, triage, and assess.

Moreover, the interface between 911 and 988 is complex clinically, as well as technically. For example, the federal government has not yet decided whether to add geolocation functionality to 988, because when a person calls 911, their expectation is they want someone to come and provide assistance. When someone calls the National Suicide Prevention Lifeline, they may not want to have anyone know who they are or where they are. Anonymity can be important to establishing the network as a safe, trusted place to call for people experiencing crisis.

How and whether to change this has been the subject of study and debate at the FCC, and this is just one example of the technical and detailed issues that still need to be worked out. For our part, Nevada County has been actively working over the last several years to build out our crisis care continuum to both prevent and respond to crisis and risk of death by suicide.

Consistent with national statistics, rural counties, particularly those in Northern California like mine, have the highest suicide rates in the state, as those who are most at risk for suicide are older white men with ready access to firearms. We are lucky as a smaller county to have had some mobile crisis services in place, though it has primarily been through corresponder mobile crisis teams.

We're hopeful about the opportunity to build out a mobile crisis service under the medical benefit to begin to build out our capacity to also respond without law enforcement. Despite my community's need for more suicide prevention services, rural and small communities like mine often feel quite disconnected from 988.

And in our case, we were quite literally disconnected. A few months ago, our county learned that the 988 call center that had been serving our community abruptly closed its doors with no notice. Prior to its closure, we did not have much of a relationship with this call center, which was located fairly far away, beyond providing financial support for their operations.

It's hard to imagine how 988 can be a true hub for a crisis care continuum when a single call center is expected to serve more than a dozen rural counties covering almost half the state geographically. I want to flag how incredibly critical connectedness to place is, particularly for our rural communities in Nevada County, we typically know each other by name, whether client or staff.

We run into each other at the grocery store, share stories about the weather, the big storm that just hit the fire in the distance. Distrust of outsiders and big, urban centers runs high, so knowledge and understanding of our community is key to serving their needs effectively. In part, I imagine that is why we have over 450 peace ops.

If 988 is intended to be the entry point into our behavioral health crisis system, we will need to ensure a better pathway forward for closer connections between the twelve crisis lines that serve California today, the more than 400 peace ops, and the diverse needs of our community crisis continuums of care.

It will take time for us to develop the infrastructure, both physical and fiscal, to build out a fully parallel response system throughout the state, and we are incredibly grateful for the investments made today to start us on our way. I'm happy to answer any questions.

Thank you. Finally, let's hear from Frank Crespo, a firefighter, paramedic, and licensed physician assistant from the Hayward Fire Department. When you're ready.

Good morning, Chair, Senators, and Assembly Members. My name is Frank Crespo. I've spent my life growing up in the city of Hayward, where I currently serve as a firefighter, paramedic, and licensed physician assistant assigned to Hayward Fire Department's Mobile Integrated Health Unit.

Under the Hayward Evaluation and Response Team, or HEART, the Mobile Integrated Health Unit is Hayward Fire Department's community paramedic response to 911 calls involving homelessness, substance abuse, and mental illness, and it augments this community paramedic response with case management and social services.

In addition, we have the Mobile Evaluation Team, which pairs a mental health clinician with a Hayward police officer in response to acute mental crisis, as well as placement of psychiatric holden. Together, these two teams under the HEART program are two of eleven mobile crisis teams that are currently active in responding within Alameda County's 988 system.

In May of 2021, Hayward City Council received the final report from the Public Safety Policy Innovation Workshop and instructed city staff to implement nine high priority projects intended to address concerns raised in Fall 2020's community conversations with public safety. In response to the evolving needs of our community, the Hayward Fire Department and Local 1909 accepted the city's request to implement one of the nine high priority projects designated the Mobile Integrated Health Unit.

Our immediate aim is to increase access to mental health, medical, and other supportive services to those members in our community experiencing homelessness, substance abuse, and mental illness. These three patient populations are at the heart of evolving our future fire and police response models.

While we operate from a position that understands that we are not able to solve such deeply rooted, complex, systemic issues, we remain focused on how do we best respond to them. So, while we may not be able to solve these types of problems, how best, as a city and as a Department do we continue to respond to these types of emergencies? The long term objective is to get to the right team, to the right call for service by creating an integrated continuum of care and ultimately reducing the need for police officers to intervene.

Getting the right team and the right resource to the right call for service starts at the moment of call taking. Alameda County's 988 system provides three direct services: someone to talk to, someone to respond, and somewhere safe to go to receive help.

What I would like to focus on today, and stress the importance of, is that 911 remains the number that our residents call when they need someone to respond. While 988 is well positioned to augment the 911 system, it cannot, and should not, attempt to compete with the 911 system's ability to assess for scene safety and medical need. Even with the best call takers, dispatchers, and protocols in place, scene safety and medical need are continually assessed by our first responders as a scene and an incident continue to progress.

To assist understanding how homelessness, substance abuse, and mental illness impact our 911 system, it's helpful to visualize each of these on a spectrum. For example, homelessness can present to the 911 system in a variety of ways.

Homelessness may present as simply as a man down, where an unhoused individual is sleeping on the sidewalk or in a publicly exposed place. However, there are instances where this individual, where this type of call may quickly turn into a full code, where that individual is not sleeping, they are not breathing, they're unresponsive, and they have no pulse, and we immediately need to take life saving measures.

So kind of just drawn this spectrum of how homelessness may present, or substance abuse--substance abuse may present as intoxication and they may be altered, altered level of consciousness; they may display violent behavior; they may ultimately need to be restrained.

Suicides attempt can present very simply as superficial cuts to the wrist, or overtaking over the counter pills, or it may present with ammo, weapons, a clear plan or intention to hurt others as well as self. And I draw these situations out to highlight the need for first responders to still be able to respond to these types of calls and ensure scene safety and medical need are addressed prior to delving into these underlining issues. And I'll be here to answer any questions. I appreciate your time. Thank you.

Thank you very much. Questions? Comments? Senator?

Yeah, Thank you, Mr. Chair. I've got to leave, but I want to thank you all for being here and thank you for your total knowledge of the 911 situation, and I say situation because, as we heard about the earlier calls, mental health and people perhaps thinking of taking their life, whatever, but then we realize that someone else might have a gun in their hand and about to take out some other people-- it calls for different things, but I still see a partnership, a brother-sister relationship that we can't overlook, and as it develops on one, it enhances the other.

And I think it's up to us to go ahead and make sure the funding is there, for both of you, and to encourage those to get into the field of law enforcement, into the field of paramedics and firefighting, and also social work, and so on, because we definitely need you both.

My concern is that the general public doesn't know enough about your situation and your call, but they all know the 911. And I think that as we educate, I think we will get a better bang for our buck, as they say, on one, but it'll enhance the other. And if there's quick reaction, you can ascertain what's going on, switch it over or go back the other way.

But I would just like to say that all of us here are here to support you in any way we can. And your testimony today has been fantastic. And I thank you for your service, all three of you. Thank you.

No, she's fine.

Senator Ashby had a question.

So, first of all, just thank you very much for coming and contributing. Your comments are very well thought out and well received, and what I love about all three of you on this panel is that you're doing this in your everyday life, so it sort of takes the lid off for us, as senators and Assembly Members, to be able to kind of hear what you're dealing with on a larger scale, but also like yesterday, right?

And because I come from the city, I relate very much to the 911 dispatch and I very much understand the call for the guy laying on the sidewalk, which can be challenging in multiple directions because you got to go out every time and you just don't know what you're going to find, right? And it's a really large demand on resources across our region too.

So, just a couple of things. One, I would say that 988 is not perfect, that's for sure, but it is, I think, a useful tool, and it does function differently in different areas. In Sacramento, for example, there's a really good mental health provider who has the contract, who's able to take on that call volume, a well known entity that does clinics in our region that supports a lot of mental health services. It's actually a provider where many folks would end up anyway if they had called 911 and gone through a longer system, they would have landed at the same place with the same support.

But right now it is functioning sort of like our previous teen suicide runaway hotline where you call and it's somebody to talk to. It's really that first tier of what you discussed. It's hard to get from there to somebody responding without transferring to 911 and even harder to get from there to a safe space because it's really a safe person to talk to.

And I think I'm going to take away from this hearing today some of your comments around Nevada and thinking of the word connected in two terms, because we do need those 988providers to be connected to 911 and large service providers and be able to dial in with who the providers are across the whole state, but we also need them to be rooted, connected in their communities because if you call from Red Bluff and you get a really great therapist, but they're in LA they might not understand the social dynamic of what you're dealing with in Red Bluff that day.

And so I hear you on that and I think that's going to be a big challenge for us in this great big state. But it's always a challenge to move the resources around appropriately, right? And I would encourage all three of you to just really stay engaged in the dialogue. You have a lot to offer and I hope you know that. I hope you over the last few days, as you were asked to come to this, I hope you now today can feel that your voices are really important in moving us forward. I do have one question for you on the Hayward's Mobile Integrated Health Unit. First of all, how long has it been up and running?

It started in last year, beginning of last year.

So you have a year under?

A year under.

Any early data on reductions to emergency room inundation?

I would say it's still very early to show actual reduction in 911 call volume.

Not so much 911 call volume, but emergency room. So one of the reasons why Mobile Integrated Health has been able to rise to the top of being something folks want to fund is that it can help reduce the number of people in the emergency rooms. So that we're really just dealing with sick people in the emergency rooms and that people who are in a different kind of crisis can receive care from a mobile unit without having to be transported. Any idea how it's done with transports?

Yes, I can talk around a little bit of that and give an example. One aspect of how homelessness presents itself in the 911 setting is people--hygiene, just simple hygiene, change of clean clothes, usually an emergency shower, sometimes feces, urine, clothes are soiled.

Normally that routes through the 911 system, through fire, through the ambulance, sometimes police is involved. It takes an ambulance transport to an emergency room. The emergency room has a protocol where they give clean clothes, fresh meal, and a bus ticket back to wherever that resident wants to go, which is back to the street. There's kind of a parade of units and resources that are strung along within that kind of continuum.

Sure.

What we've done with the unit is we can recreate what's being done in the emergency room in the back of an ambulance. We can provide someone a fresh set of clothes. We can do an emergency shower in the back. We can also have facilities that we've taken clients to to get them showered, clean clothes, and basically reset them back to a homeostasis right there on the on scene.

So what percentage of your calls are providing that kind of service without a transport?

Roughly, 25%. Roughly about a quarter of 911 calls that we're encountering, we're able to do something different.

And how many calls has the Mobile Integrated Health Unit done in about a year? So, in other words, 25% of what?

These are rough, rough numbers, but I think we're around 200 calls for service within this last--

Per, in the year?

Within the year. But we've been operating at half capacity, specific hours we've had.

And you only have one unit, right?

We have one unit with four community paramedics assigned to it.

And how often does that run?

Ten to 12 hours a day, Monday through Friday.

Okay.

What's the population of Hayward?

About 160,000.

Okay, thank you.

If I may just add a couple of things to that. What we know from our crisis assessment system, currently, is about 80% of the people that come into our emergency departments for a behavioral health crisis--pretty broad categories, and I really appreciate you shining a light on the breadth of types of situations that lead someone to a crisis--about 80% of folks don't end up needing a higher level of care. Meaning, to your point, a lot of them, ideally, could have been diverted to community resources like what you're describing, or outpatient care of some kind that can happen elsewhere.

Again, I think it's that crux piece, and I appreciated how you phrased it, that rootedness in community, as well as connectedness, that's going to allow this to be successful as sort of creating a parallel system, which I think has to be deeply connected at every level.

Something that the chairman and I talk a lot about is how to take some of the issues that are inside of emergency management and solve for them while reducing other problems that are inside of emergency management. So, alleviating transfers into the emergency room helps us as a society, but it doesn't reduce a city budget, and how do you, while you're benefiting a hospital budget, how do you also benefit a city budget? And so this is something we spend quite a bit of time talking about.

So just even early data like 25% of calls, even, Hayward is a pretty small city, but if you were to play that out across a larger city and bear out that maybe 25% of those calls could be diverted, that's a substantial savings, not only to our hospital system and therefore freeing up those services, but it would also be very helpful to our 911 system and to our firefighters and to the over-inundation we have on that system.

But again, it's rooted in knowing the community and getting to know those people. The most important two words I think he actually uttered in what they do is case management. For those of us who know what that means, they're tracking who the people are, frequent flyers, so if somebody needs a sandwich that they're not in the ER, or they need a prescription refill that they're not in the ER, or they need new socks and shoes that they're not in the ER, that we don't become over reliant on the ERs to the point that we have to shut them down.

At the same time that our chairman is carrying really important bills about informing people, the difference between 988 and 911, he's also carrying bills that have to do with trying to clear up the ERs so that sick people can get in. So, trying to take two problems and solve for them uniquely is part of, I think, the goal of this joint committee and what we're doing today.

Yeah, thank you very much, Senator, for those words. And just real quick, back to Frank with Hayward and you, maybe I've said a little bit it about already, with those 200 patients that you see, are a lot of those patients kind of like what we talked to as frequent flyers? Same calls for the service, the same people, or how is that trying to transition out of those folks from continuously calling you guys for the same service?

So, about 75% of the time, they either don't want help, and it's unfortunate to say, a lot of people don't want help. They're set in their ways, they have a certain way of life, and they are content. Or, within that 75%, they actually need to go to the hospital. Homelessness, substance abuse, mental illness, whatever the issue underlining there is, they still need to get medically cleared through the emergency room.

So 75% of the time, it's business as usual, but that 25% of the time, that roughly quarter we're able to do something different, whether that is just getting someone emergency showered, getting someone off the street, and over to a wellness center such as Hedco; we've given people rides just back to across town, back to their residence.

They're interacting with the 911 system, and then with the case management social services piece, we have a case manager, licensed clinician that we can refer and direct those clients to for follow up and follow through to try to get to the root of what's generating a lot of this high frequency 911 use.

And so one more, one last question, too, on that. I guess maybe to one of the to the dispatchers, or however it works in Hayward, so what are the key words when somebody does call 911 that as you're screening that call, the call taker is, okay, who do we send, an actual rescue BLS or the mobile unit? Right? What would be the key phrases or components that will tell you, okay, this is who we're going to respond to, or who would be the appropriate response? Right? I don't know how that would be. I know it's a very unique system you guys have there, so just kind of curious how that would work as a call comes in.

I can speak to Alameda County. I work at an agency in Alameda County. There is a very specific list of protocols that set of criteria that the call must make: The person can't be argumentative, the person can't be under the influence of anything like that, and as long as they meet all of the criteria, then at that point we would contact Alameda County Fire and we would dispatch out the mental crisis team, which consists of a paramedic, a social worker, and some other personnel.

Again, it's really a question of staffing these units. I know that Alameda County has struggled to get a team out there seven days a week. Oftentimes it's three or four days a week and just either during day shift, so your peak hours when you might have people in crisis, say a Friday night, a Saturday night, something like that, oftentimes you have to dispatch either a fire or a police response because the teams are unavailable.

Okay, thank you and any questions, comments? Comment, Senator?

Hi, thank you so much for being here today and sharing what you're seeing and experiencing. I know this is a new system and still kind of being worked out. I guess I come out of working on homelessness. I co founded an organization in the West San Fernando Valley that has the largest homeless outreach program there, and have done a lot of that outreach myself to encampments, and what I have found is that people do want to come inside when they feel safe.

And so during the pandemic, for example, we did outreach. I personally did outreach to the area that I would go to every week, and I have relationships with folks, and I think that's an important piece of it.

But when Project Room Key came online and people could get into a room and lock the door and have a safe place to be, not in congregate shelter, then every person I wanted, I talked to wanted to get inside, with the exception of one person who was not sure if their partner could come, one person was not sure if their dog could come, and one person was not sure if they could bring all of their tools because they needed that to survive and make money, right? So completely reasonable reasons that people would maybe not have that situation work for them.

So, I know that a lot of times people are calling 911 for homelessness, for people experiencing homelessness because they basically want people off the streets. Everyone wants folks to get off the streets. And, I'm concerned that, while it's important to give a change of clothes and a meal and a shower and kind of triage that situation, people are still homeless at the end of that situation, right? And part of the idea behind having these different types of units responding is to connect people to the supports and services that they need to get out of the experiencing homelessness.

And so I wonder what's happening, how is that connection happening? Right? And I think part of it is the relationship building and having that trust, right? Because folks on the streets have been promised all kinds of things and they get scammed and things stolen and experience all kinds of trauma when you are experiencing homelessness.

It's hard to trust that we're going to hook you up with housing when they've heard that a million times before and it never came through. It's also hard to trust when we don't have enough housing to put people into, and people don't want to go into shelters: 80% of people experiencing homelessness don't want to be in a shelter.

What are you seeing? What are examples of where these connections are being made? Because I feel like that's such a critical part of why we wanted to go min this direction in the first place to make sure that there is that connection to services, to solutions, right? We want to connect to solutions and would love to hear kind of where there are models of that, examples of that, and how that's working or not working and things need to be adjusted.

Super great points. Really appreciate the clear expertise you bring to that understanding of the situation. And I think the core challenge is the long term solutions. And I think we're all deeply aware of the ways that we don't have adequate permanent housing for people and there's a lot of great investments happening in that area, and, speaking for county behavioral health departments, we are working like crazy to do more of that.

In Nevada County, we added 72 beds of permanent housing, as a Behavioral Health Department, in the course of a year, which is wild in a small county. And, in that same year, 200 people became homeless for the first time, and so it's a little bit like finger in the dike-ish in that way.

Having said that, we work really hard and I think, again, this is the kind of local relationships piece that you're speaking to. Our crisis team is deeply connected to our homeless services team.

And so we have a CalAIM enhanced care management funded team right now that their job is working, building long term, trusting relationships with people experiencing homelessness, and so there can be a warm handoff from the mobile crisis team to that team, who can then can start to work on a longer term game plan that ideally leads to permanent housing, if we can find some, but, at the very least, leads to some stabilizing forces being in place and helping work with that person to identify, like, steps towards that housing solution--IDs and birth certificates and all the things that people need to start working down that path.

I would just volunteer: I work in Palo Alto, which is Santa Clara County, and we piloted a program of an officer and a social worker responding, a Santa Clara County social worker as well as an officer. The vehicle was unmarked. The officer was in just a black vest, no visible police markings, and the program was incredibly successful.

Any kind of, they, they weren't dispatched to specific calls, but if they heard something on the radio of someone who seemed like they were in crisis or something, they would automatically self dispatch to the call. And they were able to help a lot of people. They reduced transports in the area.

Our only issue was, unfortunately ,due to the high cost of living in the Bay Area, our social worker resigned. And so we've been working with Santa Clara County to obtain another social worker. But so far we haven't been able to fill the position. But all of these types of efforts really do make a difference. And, by responding in an unmarked vehicle, having the social worker there, it really creates bridges to trying to help people find a better solution.

And, just to kind of add and speak to around your question, one thing I quickly realized in the beginning of the program was, as paramedics, how we're documenting these types of calls, our electronic health record's really good at documenting interventions, vital signs, medications, treatments; what it's not great at doing, or didn't have the functionality for, is actually documenting like what's generating, what are the underlining reasons that are adding up to these 911 calls.

If people don't have housing, the food insecurity, they don't have a primary care provider, they don't have medical insurance, they don't have transportation, they can't fill prescriptions; as long as these unmet needs continue to go unmet, they generate crisis or it generates 911 response.

So the first step was just documenting, like, as we run these types of calls, homelessness, substance abuse, mental illness, it was making referrals over to our community medicine team and social work case manager. Those referrals started to add up and document what these unmet needs of our 911 system actually look like, and it's kind of given us a reference point on where to direct our focus, our time, our energy, so one part of the program is the actual 911 response.

The other part of it is the case management, the follow up, the follow through, and trying to meet those unmet needs or attempt to be able to refer patients and clients to these different organizations which really mimic like, social determinants of health or Maslow's hierarchy of needs. If you don't have these basic human safety and physiological needs met, it generates crisis.

So that was a big thing in the beginning for us, was documenting what these unmet needs within the 911 system look like, and then building a team that's capable of following up, following through, and starting to match clients with these types of resources.

Thank you. And I think you're making an excellent case for why housing first is an important policy, because people have to have their basic needs met before you can address other issues that may need to be addressed around mental health or health care, getting a job, or anything that people need to get on their feet. Housing, housing, housing, permanent housing. And hopefully it will help with real solutions to calls that you get over and over and over until we get there. Thank you.

Thank you. And I have a comment before we go into public comment. Really, I just want to thank everybody for participating today. It's been a very useful discussion from both panels. I've learned a lot as what we're dealing with now, moving ahead to the future.

I'll go back to my time working at ambulance. Back in 1984, when I started working in the field, those 911 calls were really 911 calls, right, for the life and death emergencies. It has really transformed now, from then till now.

Obviously, we all know the systems are misused, right? And we can all agree that probably in every hospital right now in California, or across the nation, half of those patients, or more, don't need to be in the ER, right, with mental health, homelessness, drug addiction, whatever the case may be, it's really inundated our health care system.

Now, as we look forward to how do we prepare to deliver a different type of emergency services out there, it's challenging. It's unique, with the next gen coming in, 988. And one thing, how do we hopefully educate our communities on why you really should be calling 911 on top of everything else that goes on? So really, my hats off to everybody out there dealing with these calls, from the start of the call takers to the folks providing the service at the end of the day whether you're police, fire, EMS.

I know somebody, I think in the first panel talked about the mental health component and talking back from my education and my real life experiences. My son is a deputy sheriff in LA, and he can tell me almost weekly, if not more, how many calls that he goes out. They're dealing with mental health issues, right.

And how they have to go and deescalate those folks, right, that are contemplating doing suicide or jumping off that bridge and sometimes those police officers are the first ones there, not to mention our firefighters, when you get that person down, right? Sometimes that engine company is going to be for the first one there. And is it really a person down or is somebody suffering from a mental health crisis, right? It's just really evolved on, top of the fentanyl issues, right?

That's I think another issue that's affecting our first responders to be careful with, as some of these folks do have that with them and are overdosing by them, and some of these first responders becoming overdosing as well because of what's dealing with them. So it's really come a long way.

Hopefully with everything we talked about today, moving forward, we can get there to that point. It's going to take some time. It's change, right? But we all do it for the right reasons and ultimately provide the best services to the people here in California.

So with that, thank you all for being here, and now we'll move on to public comment. Due to time--we went a little bit over than I thought we would be--but please limit your comments to no more than 1 minute. So if there's anybody in the audience for public comment, please come forward. Thank you.

Good morning, Chair and Members. Tara Gamboa-Eastman with the Steinberg Institute, Here on behalf of both the Steinberg Institute and the Kennedy Forum, the lead co-sponsors of AB 988, really want to thank you for the rich discussion today and thank the Administration for the tremendous work over the last couple of years.

As was mentioned, there is trailer bill language moving forward that would amend AB 988. We do have some concerns with it as currently drafted. While we think we share the same goals of the Administration, we are worried that it could undermine the original intent of AB 988 and just continue to look forward to working with you and with the Legislature as well. Thank you so much.

Thank you.

Alright. Good morning. My name is Andrew Ghali. I'm a captain with the Hayward Fire Department and also the union President for Hayward firefighters local 1909. Not going to touch too much on what Firefighter Crespo said. He did an amazing job representing the Department.

But, I would urge you guys all, if you have any time in your busy schedule, to come out and see what we're doing with the Mobile Integrated Health Unit. Also visit our firehouse clinic. We opened one of the first ones in the nations. They're almost integrated together where we're taking the calls that Firefighter Crespo is responding to, making appointments to them instead of loading up the emergency room. We all know there's a high call volume there.

Also to touch base, in the first year of our Mobile Integrated Health unit, we only had it budgeted for 20 hours a week, for 20 hours a week, Monday through Friday, wasn't much. We just got it, as of February, to be 40 hours a week by pulling our line personnel, making them community paramedics. But it's been successful.

It's been a reduction in call volume to the firefighters, our engine companies, our truck companies, and our hospitals. It's been doing an amazing job. The community appreciates it. And we only touched on a fraction of what they're actually doing. They're day in and day out serving our community. So I urge you guys, come visit us, spend time with us, spend time with them and see what we're actually doing. We'd appreciate it.

Thank you.

Thank you.

Anyone else for public comment? With that, I want to thank everybody for attending, and this meeting is adjourned. Thank you.