In 2021, the CAHOOTS Act was passed as a part of the American Rescue Plan, and as its own act. The Act was made to fund crisis response models, like CAHOOTS, around the country. In this episode Senator Ron Wyden tells us about creating the CAHOOTS Act, and the motivation behind it. Executive Coordinator Chris Hecht shares about his contributions and the process of working with Senator Wyden's team.
To find out more about White Bird Clinic, visit whitebirdclinic.org.
In 2021, the CAHOOTS Act was passed as a part of the American Rescue Plan, and as its own act. The Act was made to fund crisis response models, like CAHOOTS, around the country. In this episode Senator Ron Wyden tells us about creating the CAHOOTS Act, and the motivation behind it. Executive Coordinator Chris Hecht shares about his contributions and the process of working with Senator Wyden's team.
To find out more about White Bird Clinic, visit whitebirdclinic.org.
You're listening to White Bird Mutual Aid. I'm Hana Francis. This show was funded by a White Bird clinic in Eugene, Oregon, to create more awareness about social services, especially nonprofits and their importance in our communities. Today I'm joined by two guests to talk about their work on the CAHOOTS Act. The CAHOOTS Act, which is named after a White Bird clinic department CAHOOTS, also known as Crisis Assistance, helping out on the streets as a means of supporting the development of alternative crisis intervention models by making state funding available for communities and organizations who want to have alternatives to the police or crisis intervention alternatives. US Senator Ron Wyden has been a consistent advocate for a White Bird clinic, even going so far as to be the lead author of the kids act.
Ron Wyden:I'm Ron Wyden. I'm one of Oregon's United States senators and I'm the lead author. As the chairman of the Senate Finance Committee of the CAHOOTS Act.
Hana Francis:Senator Ron Wyden worked with folks at wiper clinic in CAHOOTS to create the CAHOOTS Act, and hopes of encouraging alternative crisis intervention and other communities around Oregon and across the nation. Executive coordinator of White Bird Clinic, Chris Hecht also contributed to the creation of this Act.
Chris Hecht:So I'm Chris Hecht, executive coordinator of White Bird Clinic. I use he him pronouns. I've been at White Bird, around four and a half years now.
Hana Francis:The Cahoots Act was originally introduced by US Representative Peter De Fazio in 2020. And it was later reintroduced by Senator Wyden and passed as a part of the American rescue plan and 2021. The act was written by Ron Wyden and his team in collaboration with white bird clinic staff, including executive coordinator, Chris Hecht. The act was co sponsored by Senators Catherine Cortez Masto, Sheldon Whitehouse, Dianne Feinstein, Bernie Sanders, Tina Smith, Robert Casey, Jeff Merkley, and Sherrod Brown. The Cahoots Act allows state Medicaid programs to match funding of certain community based mobile crisis intervention services for individuals experiencing a mental health or substance use crisis outside of a facility setting. So how does this work? Do individual states must apply for funding from the federal government, then they must be approved and awarded funding. And then state organizations and independent programs apply to the state to receive funding for their crisis intervention service. As of February 2023, there are 21 states that have applied for or received funding. Oregon was the first to receive funding from this act. And 2022, Oregon received almost $1 million to start up organizations with a crisis intervention aim. This funding is for the first three years of service, as it is seen as a startup investment. The Act matches 85 cents to every dollar that the city or community provides in a budget.
Ron Wyden:What I can tell you is a lot of my colleagues are still getting their arms around the concept. So there are a lot of questions that I get, we still will need some data to show what has been shown over the years in Wayne County is that the vast majority of calls that come in don't require the police backup. In other words, they're mostly mental health costs calls. And in reality, folks in law enforcement will tell you that they're very sympathetic to the Cahoots model because they want to do what they were trained to do. People in mental health, conversely, will say almost the same thing is they know that there are areas where law enforcement is required. If you know people are shooting guns for, for example, they understand that, but they to know that most of the challenges that we're talking about in most communities are mental health ones. So I'm in the process of getting that word out to colleagues. There are colleagues as you know, From being at White burden doing good work, you know, regularly there, you get calls from all over the country. And people say, hey, explain to me what Cahoots is about and they were doing that, you know, before I wrote a bill.
Hana Francis:There are three qualifications that organizations must meet in order to get funding from the state. Services must be one provided by multidisciplinary teams composed of behavioral health professionals, who are trained in trauma and de escalation techniques to available 24/7 And three, voluntary for the individual experiencing the mental health or substance use disorder crisis. This last one is really important because it works against the power dynamics that are already in place with so much existing crisis response. CAHOOTS as a department has existed for over 30 years in Eugene. And before this Act was passed, the basic model had been loosely reproduced by communities all over the United States. Some of these organizations include Portland Street response, the Denver STAR program, Atlantis pad program, Olympia as Crew Program, and many more. Most of these can be found as a part of the alternative Mobile Services Association, a recently formed National Association of alternative street response models. The idea behind the CAHOOTS Act is to make models like this more commonplace. While some believe that this act has the potential to make Crisis Response more conventional in a way that may ultimately dampen the radical empathy and efficacy of these programs. There is still a market move towards Person Centered crisis response.
Chris Hecht:Senator Wyden in his role as head of the Senate Senate Finance Committee, made sure that funding for the CAHOOTS Bill was included in the American rescue plan. And in the scope of the trillions of dollars of the American rescue plan, the funding for CAHOOTS was not even really pocket change. So it went in there and enjoyed unanimous support. When the bill was when it was voted on for the for the rescue plan.
Hana Francis:Can you tell me how it was decided that it was going to be a part of the American rescue plan?
Ron Wyden:I made the judgment. You know, Hana, having been to Eugene a lot over the years, and I'm chairman of the committee, the rescue plan was key, I think, and I just made it a priority, a personal priority to try to give it some permanent footing in the whole federal landscape of health care services. And because the Finance Committee has authority over Medicaid, I said, I'm going to put it there. And I was amazed that as I talked to my colleagues, people really had a good response to this. I would talk to Senator Booker, New Jersey and Democrat, he thought CAHOOTS was a terrific contribution, the way we deal with healthcare, mental health and the challenge of how to find a proper role for folks in mental health and law enforcement. I also talked to Tim Scott, who is a member of the Senate Finance Committee, certainly he would call himself a conservative Republican, he to light the direction. CAHOOTS was moving, so I was pretty sure I could get some visibility for the cause. I wasn't sure that we'd be able to give it this prominence in the Medicaid program to secure what amounts to in effect a billion dollars worth of funds. And now I'm working to make it permanent.
Hana Francis:Chris Hecht, the executive coordinator at wiper clinic, worked with Wyden's team to help create the CAHOOTS Act. Chris Hecht's role at White Bird clinic is to act as a liaison of sorts between the agency, the government and different parts of Eugene and Oregon communities. He learned his skills working with legislation, from his previous profession, starting charter schools, on the Big Island of Hawaii, and working as an advocate for children and families of native Hawaiian communities.
Chris Hecht:I think of myself as the outward facing leader. whiteboard is so big, it really takes up a team of us to work together in leadership. And so, over time, building on the skills that I've developed in working outside To our agency, with the community and sometimes folks in government, I've really started to specialize a bit in that part of the work. So that means a lot of times all attend community meetings of folks that are in Human Services. Sometimes it's working on care coordination with some of the really big players in town, like, how do we best help folks, when they're coming out of the hospital, and they're on housed, and we don't want, you know, sometimes, the worst option is, we call just treating people, like, Hey, you're discharged, here's your stuff. And you know, you're out on the sidewalk. So instead, we try really hard to coordinate care, help people get into the right place, as they as they finish up an inpatient stay, but still need some support, and some transition back into their usual setting. Other times, all join in, in meetings with our CCOs, which provide Medicaid coverage through the Oregon Health Plan. And they're very interested in hearing from white bird about what we see as the community needs very often. That is why we're working together. And so when I have one of those meetings coming up, I have to do my homework and check in with programs, because I'm a little bit in an ivory tower on that, and I benefit tremendously from getting to connect with the people that are, are out there daily, making it happen for the patients and clients we care for. That's who I really learned from, and I value, I value that opportunity to have a better sense, because I need in my role as advocate for those folks, I need to have a really direct and accurate picture of the challenges they're facing and what we might do better to serve them.
Hana Francis:Senator Wyden came to whitebread clinic to help create an act to replicate the agency's work. When this happened, it was a bit of a shock to the organization that had been developed with a foundation and such a counterculture community.
Chris Hecht:Right now, in Oregon, we have the tremendous good fortune that one of our Oregon senators, Senator Ron Wyden is the chair of the Senate Finance Committee, which is one of the most powerful committees in all of the federal government. And he's a longtime advocate for mental health services, behavioral health services, and homeless health services nationwide. He has personal family experience of homelessness, and its impact on a family member and the whole family. And so like so many people we meet, that are allies of white bird, he's coming from a really heartfelt place of actually having experienced tremendous loss and hardship himself.
Ron Wyden:Well, mental health has always been a priority of mine. My brother died of really died of schizophrenia. He was the smartest of the two Wyden boys and got it, you know, late in high school and early in college. And there were nights when my brother was walking the streets and whiten food, go to bed where he was going to hurt himself for somebody else. So this is very personal to us. And I really, I really believe that a country is rich and strong as ours can get mental health care to people who need it when they need it.
Hana Francis:It's an issue that affects so many
Ron Wyden:family, families everywhere will have very, very similar stories to the one I just described.
Chris Hecht:And he approached us wanting to work together to develop federal support for communities that wished to develop mobile crisis intervention programs. More modeled after Coots. And so that was just mind blowing pretty much and amazing to hear. But we'd meet with him pretty much monthly, and lots and lots of phone calls with his staff. And once we were, at first it was mostly local folks. But then after a while, we started working directly with his legislative team. So that consisted of people that were expert at writing new laws, his lead analyst on behavioral health, his lead person on homelessness, and a whole team of his staff. And they really got marching orders from the Senator and wrote, drafted a really strong bill, that and the Cahoots, there was then a bill, that Kahoots bill proposed to provide money for startup and initial three, I think, initial three years operation of mobile crisis intervention programs, in communities that didn't have them. The big thing, you know, they got, they got the details really right. And they were just kind of stuck on how to get the money out. And it was really exciting and fun to play a small role in developing the bill, by coming up with the funding mechanism for for it, which was nothing more than just noting that our partners locally, and at the at one of the CCOs were really great allies, and interested in funding codes. Because as they said, you know, we know that what you do with programs like hoots helps keep our community healthy, helps divert folks from the emergency medical system. So they're not taking ambulance rides, and they're not going to the emergency room. And we know that saves us money when our patients aren't doing that. And we just think it's the right thing to do to share that savings with you. And this is the folks at Pacific source, which is a local nonprofit insurer, and they really, really care. So I was just thinking about that. And I said, Well, why not just run all this money through Medicaid through behavioral health? Because in my mind, I was like, Oh, well, that's kind of what we're doing. And, you know, if you want to look clever, just bring an idea to somewhere or no one else has thought of it yet. So the the Cahoots bill takes federal money and allocates it through the Medicaid system, states have to apply to the federal government to be included in the allocation. And then within the state communities applied to the Health Authority. In this case, it's called the Oregon Health Authority for funding. Of course, White Bird isn't eligible for any of it. Because, well, for about 34 years, we've already have goods, the payoff is that other communities in the country will get to benefit from this homegrown solution that we're all so proud of having figured out here, and we'll know where it came from, and all of us will get to feel a little bit of the success.
Ron Wyden:The, you know, legislation makes it part of Medicaid. And Medicaid is an entitlement program. And so the projection of a billion dollars is what the government made an assessment of in terms of embedding this in Medicaid. And the argument that I think was winning for us is the one that came from home in Lane County. You all showed at white bird that it was possible to reimagine mental health and law enforcement and come up with a model that would work well in Oregon and had great to impact on the rest of the country, we've seen Portland Street response, you know, for example, it's a little bit different than goods, but it's built on the same kind of principles, we can make much better use of scarce dollars, giving mental health a higher profile on the streets of our city.
Hana Francis:While none of the CAHOOTS Act funding will go towards codes, since it has been an active department for over 30 years. And the funding is for startups. Senator Wyden and Merkley did find some funding for wildbird clinic to get a new center with a grant of $275,000.
Chris Hecht:One way that we get supported by government directly is grants and aid or federal appropriations. Just like just a couple of weeks ago, we heard that Oregon Senators Wyden and Merkley, had championed 275k appropriation in the Omnibus Budget Act that President Biden just signed. And that money will allow us to remodel some space into a brand new and about twice as big counseling office to address the backlog of mental health. And therapy needs in Lane County that folks with OHP are experiencing right now. So sometimes we just get blobs of money that fall out of the sky. And they tend to relate to long term relationships we've developed. And in this case, over the last three years, we've developed a really wonderful relationship with Senator Ron Wyden
Hana Francis:In the $1.9 trillion American rescue plan. About a billion was allocated for planning grants for the states to start their own crisis intervention projects. According to CMS, Alabama, Colorado, Delaware, Kentucky, Massachusetts, Maryland, Maine, Missouri, Montana, New Mexico, Nevada, Oklahoma, Pennsylvania, Utah, Vermont, Wisconsin, and West Virginia have received the federal planning grants. Additionally, North Carolina and Arizona have been approved for the higher Medicaid match for mobile crisis services. New York and California are also seeking the enhanced Medicaid match
Chris Hecht:in a gesture recognizing Senator Wyden's work. Oregon was the very first state to be allocated, Cahoots Act funding by the Federal Medicaid administration. And so that was a really wonderful moment. And three Oregon communities I believe, currently have been funded to develop mobile crisis intervention.
Ron Wyden:What is going on formally, this money goes to the state, the state of Oregon, which runs the Medicaid program, and it's very generous funding 85 cents on the dollar, which is almost unprecedented in terms of resources, and last for the three years for the trial, you know, period and counties and programs across the state are now working with the state of Oregon, particularly the Department of Human Resources they're in in Salem to make it possible to secure the funds we've heard from Pendleton, we've heard from Astoria, we've heard from other communities around the state as I have townhall meetings, I've had 10 of them just in the last week or so being home, sitting in my kitchen in beautiful Southeast Portland. And I'm really pleased on in terms of where we are. And it just doesn't happen without the incredibly dedicated work of White Bird all these years. And in other words, you know, there's something I always think of as sweat equity. You know, I went to school on a basketball scholarship, I was dreaming of playing in the NBA that was pretty ridiculous. But you practice and you practice and you practice in order to really build a kind of sweat equity if an opportunity comes up. That's what White Bird has done. That's what CAHOOTS been all about, in Eugene, to constantly over. Now quite some Are yours, you know, showing you know how to pull people together. We also, I really want to commend white bird for this. And I think it's been a part of our arguments, we know that there's a lot more a lot more to do you know, it always comes up is you know, what's going to be done about wraparound services, because clearly helping somebody who's in the middle of a crisis, as white bird does its goods does as Portland Street response has been doing in our state's biggest city. That's enormous ly important. But we also know that there are next steps and our society has never done a perfect job on the wraparound services. What What I can tell you is everybody in Lane County white bird basically designed the roadmap, and you all design the row roadmap, that's going to give other communities a leg up in terms of pursuing a proven path, a proven path, pioneered by white bird, and I'm really thrilled that as, as your site, Senator is chairman of the Senate Finance Committee, I yeah, I could have an opportunity to pursue this and get into federal legislation. I remember the first meeting, when I called and said, I'd like to come down and talk to everybody about it. People were kind of stunned. You know, it's kind of like, yeah, we know Ron, and Ron's a good guy. And he's always been interested in health care. He wants to do what that was kind of the attitude. And I said, Yeah, I know that this is a little different. But never miss an opportunity. I'm chairman of the committee that has jurisdiction over Medicaid, a federal state partnership, a lifeline for vulnerable people, particularly those needing mental health. Let's figure out how to do this. And so what was interesting, from the time that discussions started, were all these wonderful people work at White Bird, you know, who I think would be the first to tell you they're not really political, you know, the vote and everything but you know, not political in terms of their orientation, their their compassionate advocates for vulnerable people. By the time the meeting was over, it went from what to, hey, let's see what we can do here. And let's roll up our sleeves and see if we can figure it out. And
Hana Francis:since there's nothing written into the act about any sort of mentoring, it's assumed that the individual organizations will find where to look for proper training. The wiper clinic used to have a consulting department and recently shut down in hopes of creating a more streamlined training approach. There was not enough capacity at the agency to keep the consulting department going for now. We now have some basic online trainings that people can get for their business or organization. If you or your organization are curious about trainings, please fill out the kahootz media and training inquiries form at whitebirdclinic.org/cahoots. Chris Hecht explained that the concept is the main contribution that kahootz has made to this act, the way that it is implemented will look very different in each community.
Chris Hecht:You know, we're not doing as much consulting, because there's not an even people, that enough folks to staff the van right now. Over the past few years, we've talked to a lot of these communities kind of just ad hoc about stuff, but there's nothing built into the bill. That directly connects us with this development. You know, I think, speaking for myself, at first, I thought that we would really need to sink a lot of time and energy into helping communities develop this. But I've since learned, it's just this idea that makes so much sense. And that needs to be a little bit. It needs to be responsive to and it'll look different in every community. Because different communities have different needs. They have different resources that are already existing. And all of that kind of factor really impacts what mobile crisis intervention is going to look like.
Hana Francis:Senator Ron Wyden hopes that this act will have a lasting impact on the way that that our country addresses mental health.
Ron Wyden:I want this to be said and show part of how we move forward on mental health. For example, I was able to get something over $10 billion for mental health services in the gun safety bill. With Senator Mike Crapo, Republican of Idaho. We got money for the schools. In terms of mental health. We know that's really crucial to identify kids who are facing some mental health challenges. We got money up for the anti suicide lines, and that's very important also for young people who are so digitally savvy, we've got money for behavioral health, for behavioral health training, which I think is a hugely important issue. And I've been very interested in public private partnerships along the lines of what Connie and Steve Ballmer have started at the University of Oregon. So I really see CAHOOTS being an essential part of looking back at this time and saying, here's what we did that was really meaningful for mental health.
Hana Francis:Go to your local state government to get more information on your state's CAHOOTS Act. As always, if you have any questions, comments or concerns, please contact me at whitebirdmutualaid@gmail.com. You've been listening to whiteboard mutual aid. I'm Hana Francis.