Loading...
HomeMy WebLinkAboutAgenda 09-16-2025; 6-c - Review of Options for the Design of Crisis Diversion Facility 1 ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: September 16, 2025 Action Agenda Item No. 6-c SUBJECT: Review of Options for the Design of Crisis Diversion Facility DEPARTMENT: Asset Management Services ATTACHMENT(S): INFORMATION CONTACT: Presentation Travis Myren, County Manager, 919- 245-2308 Caitlin Fenhagen, Deputy County Manager, 919-245-2303 Alan Dorman, Director of AMS, 919-245- 2627 PURPOSE: To review five alternative design options and project budgets to build the Crisis Diversion Facility, select an option, and then direct the Manager to finalize the design and prepare a guaranteed maximum price for the Board to approve in the Winter of 2025. BACKGROUND: Efforts regarding the proposed Crisis Diversion Facility development over the last six (6) years are as follows: 2019 — The Board established The Orange County Behavioral Health Task Force (BHTF), and its Crisis Diversion Facility Subcommittee, in November 2019. The Crisis Diversion Facility Subcommittee was comprised of subject matter experts in behavioral health clinical services, emergency services, law enforcement, and criminal justice, in conjunction with Orange County government. 2021 —The Subcommittee received approval from the Board of County Commissioners("BOCC") In April 2021 to develop a recommendation for the Crisis Diversion Facility, along with additional funding of $250,000 for pre-planning services in November 2021. The County completed an request for qualifications (RFQ) process and selected CPL Architecture to perform preliminary and schematic-level design and analysis services for developing the Crisis Diversion Facility. 2023 — The Board approved the FY 2023-33 Capital Investment Plan ("CIP"), which included $2,047,155 for design services for the Crisis Diversion Facility and $22,952,845 for construction in FY 2024-25. 2024 — The Boad approved $1,100,000 for land acquisition. An RFQ process selected CPL to begin the design at a cost of $1,172,000. 2 2025 — In April 2025, the firm Gilbane was selected through an RFQ process to be the Construction Manager at Risk for the project. Gilbane began working with CPL to design the facility, including providing cost estimates through each step of the design process. The Board agreed to pay Gilbane $179,928 for pre-construction services. At its April 15, 2025 Business meeting, the Board approved the purchase of a five-acre plot of land close to UNC Hospital in Hillsborough for $1,350,000 for the site. Original Scope of the Facility The facility was originally programmed and designed to have two primary functions, with additional space for integrated discharge services and community resources. Behavioral Health Urgent Care ("BHUC") — This is a service for individuals four (4) years or older who are experiencing a behavioral health crisis related to a substance use disorder, mental health disorder, and/or intellectual/developmental diagnosis. The BHUC offers a safe alternative for up to 23 hours for stabilization and assessment and provides a diversion from the use of the hospital emergency departments. The current design calls for twelve (12) bays to serve patients: eight (8) bays for adults and four (4) bays for children. Facility-Based Crisis and Non-hospital Medical Detox Services ("FBC") —This service offers short-term, intensive therapeutic interventions and stabilization services for individuals experiencing mental health crises as well as those struggling with substance use and addiction. The current design calls for sixteen (16) beds, the maximum allowed under current regulations. Through the FBC/Detox service, individuals will receive assessment, treatment, 24-hour medical supervision, case management, and group and individual therapy in a short-term residential setting. Individuals will spend time with clinicians and Peer Support Specialists, both individually and in groups, to identify strengths, individual support, and treatment needs, and to make a plan for recovery. An important part of the treatment process is preparation for individuals to return home and/or arranging for further treatments, so that individuals can continue their path towards recovery. Community Services — The original concept also included a peer living area, a resource room with information about behavioral health resources, a large conference room, and several offices for County staff to support the integrated discharge planning for patients of the Crisis Diversion Facility. Current Available Budget: Crisis Diversion Facility Budget Description Budget Spent/Encumbered Available Land $1,360,000.00 $1,353,265.54 $6,734.46 Professional Services $2,322,155.00 $2,035,272.00 $286,883.00 Construction $21,813,484.00 $179,928.00 $21,633,556.00 Equipment $557,711.00 $0.00 $557,711.00 Total: $26,053,350.00 $3,568,465.54 $22,484,884.46 3 Proiect Budget: Gilbane, the Construction Manager at Risk, provided a budget estimate for the project in July 2025 of $25,700,000. That budget was incomplete as it did not include estimates for furniture, fixtures and equipment (FIFE) or owner's contingency. However, given the significant increase over the approved budget, the County asked CPL and Gilbane to provide several options for reducing the scope to ensure the project could stay within the approved budget. Please note that the cost figures below do not include the cost of land acquisition or professional services, which have already been encumbered or spent. Crisis Diversion Facility-Value Engineering Options Original Design Option A Option B Option B.1 Option C Building Square Footage 21,270 10,500 15,850 TBD 19,825 Core Services: BHUC Bays 12(8 Adult,4 Pediatric) 6(4 Adult,2 Pediatric) 12(8 Adult,4 Pediatric) 12(8 Adult,4 Pediatric) 12(8 Adult,4 Pediatric) FBC Beds 16 8 16 16 16 Features: Architectural Features' Yes Dual-Sided Entry Yes Yes FBC Courtyard Yes Yes Yes Yes Yes Coordinated Discharge Yes Yes Yes Conference Space Yes Yes Peer Living Yes Yes Resource Center Yes Yes Community Support Spaces Yes Yes Healing garden Yes Yes Overall Project Budget $ 28,347,044 $ 20,858,704 $ 25,490,277 $ 26,300,0003 $ 27,276,345 Changefrom Budget $ 5,862,160 $ (1,626,180) $ 3,005,393 $ 3,800,000 $ 4,791,461 Average Annual Debt Service $ 2,220,416 $ 1,663,248 $ 2,007,859 $ 2,068,106 $ 2,140,751 Changefrom Budget $ 436,173 $ (120,996) $ 223,616 $ 283,863 $ 356,508 Tax Increase for All Capital Projects in Debt Mode 14 9.63 9.501 9.581 9.591 9.61 Change from Budget 0.10 -0.03 0.05 0.06 0.08 Tax Impact on$400,000 Home $ 385.20 $ 380.00 1 $ 383.20 1 $ 383.60 1 $ 384.40 Change from Budget $ 4.00 $ (1.20)1 $ 2.001 $ 2.401 $ 3.20 Notes: 1.)Architectural features may include raised ceilings,large windows,and otherfacade and interior improvements. 2.) Coordinated discharge includes a conference room and several offices for County staff.Thesetypes ofspace are incorporated into the Original Design and Option C,but are broken outto showtheirinclusion in Option B.1 3.) The project budgetforOption B.1 is not based actual estimates,but is only shown toil lustratethatthe likely cost is between Option B and Option C. 4.)Based on Incremental Increase Debt Model over10yearCapital Improvement Plan. FINANCIAL IMPACT: No additional funding is necessary at this time. However, if a design option is selected above the current project budget, additional funding would be needed when the Board is presented with the guaranteed maximum price in the Winter of 2025. ALIGNMENT WITH STRATEGIC PLAN: This item supports: • GOAL 2: HEALTH COMMUNITY OBJECTIVE 1. Improve harm reduction, prevention, and support services for adults and children experiencing behavioral health issues, substance use disorder, and intellectual or developmental disability. 4 OBJECTIVE 4. Reduce impacts and barriers for justice-involved children and adults through deflection, diversion, therapeutic interventions, and re-entry support, including housing. RECOMMENDATION(S): The Manager recommends that the Board: 1.) Select an option from the five alternative design options to build the Crisis Diversion Facility; 2.) Direct the Manager to finalize the design and prepare a guaranteed maximum price ("GMP") based on that design; and 3.) Submit the GMP to the Board for final approval before constructing the Crisis Diversion Facility. - - 5 OR- -A-NGE COUNTY NORTH CAR(3LINA Crisis Diversion Facility: The Need, Services Provided, and Design Options 9-16-2025 6 AGENDA • The Need • Services • Timeline • Design Options ORANGE COUNTY NORTH CAROLINA 7 THE NEED • In 2019 Orange County held Sequential Intercept Mapping and Taking Action for Change Workshops (referred collectively to as SIM Workshop). • SIM Workshop participants included community stakeholders who routinely respond to Behavioral Health (BH) crises. BH includes mental health, serious and persistent mental illness, IDD and substance use disorders. • Workshop participants identified gaps in our BH Crisis Continuum of Care and developed an action plan to address these gaps. • Action plan includes a high priority need for a 24/7/365 Crisis-Diversion Center for walk-ins and diversions from the emergency room and Detention Center. ORANGE COUNTY NORTH CAROLINA 8 THE NEED : STAKEHOLDERS ■ Over the last four plus years, stakeholders across the county have been working to design a facility that will fulfill the community's needs by sharing expertise and joining in a commitment to collaboration. ■ This effort has included participation from a wide array of community stakeholders: ■ Law enforcement community ■ Alliance Health ■ Criminal justice community ■ Orange County Emergency Medical ■ Orange County Sheriff's Office Services ■ UNC Health ■ Orange County courts Orange County municipalities ■ Public schools ■ Orange County Board of County ■ Social services Commissioners ■ Behavioral health experts and community members ORANGE COUNTY NORTH CAROLINA 9 THE NEED : IDENTIFIED GAPS A stakeholder analysis supplemented the SIM Workshop assessment. Together these assessments show that existing services in Orange County's crisis system are limited by one or more of the following: Do not provide a default no wrong door option Do not always provide adequate discharge planning with for law enforcement or emergency services. peer support for follow up. Do not integrate well with CJ diversion Do not offer immediate access to MAT. programs. Do not facilitate warm handoff to community treatment and/or social services. Do not serve anyone: limit access due to Do not have the capacity to facilitate holistic support extensive exclusionary criteria. (recognize all determinants of health). Do not provide an appropriate setting for BH Only Freedom House and the UNC ED allow access by crisis care (not the least restrictive setting). the public on a 24/7/365 basis, and services are often Do not have the capacity to provide readily- at or over capacity. available clinical services for CJ proceedings. Do not serve incarcerated individuals due to various restrictions and limited services. ORANGE COUNTY NORTH CAROLINA 10 THE NEED : CURRENT DEMAND Concerns by Year 6OG 529* 500 416 460 400 425 aa3 371 300 '2025 is projected based on activity from January 1-August 31. 2020 2421 2422 24923 20124 2025 ORANGE COUNTY NORTH CAROLINA 11 SERVICES : BENEFITS • Divert individuals experiencing a BH crisis from the emergency department, the court system or the detention center and to immediate specialized services at substantially lower cost. • Enable stakeholders, especially law enforcement, emergency medical services, and criminal justice, who respond to BH crises every day, to provide a more appropriate and efficient response and often at lower cost. • Integrates County treatment services resources through individual discharge planning. • Substantially lower overall health care costs as compared to sole reliance on emergency departments and inpatient hospital-based services. • Provide individuals and families with access to information, clinical care, support services, and assistance to navigate the complexities of BH challenges thus reducing costs and mitigating risk of repeat crisis episodes. • Serve anyone in Orange County/surrounding communities. ORANGE COUNTY NORTH CAROLINA 12 SERVICES : SCOPE AND FUNCTION - USE • Some 50 items define scope/function of the CDF (see supplemental information) • In summary: • Behavioral Health Urgent Care (Tier 4) unit for individuals four years and older. • Facility Based Crisis unit for adults needing more than 23 hours of care. • Peer living room to support discharge and navigation of ongoing treatment resources and social services. • Resource Center to guide individuals/families through the complexities of behavioral health care and services. • The CDF will be housed in a new facility that Orange County will own. • Orange County will contract with providers for clinical and medical services. • Peer support embedded in the facility and holistic discharge planning are critical components. ORANGE COUNTY NORTH CAROLINA 9 13 TIMELINE 2019 ✓ Orange County SIM Workshop identifies gaps and action items (April 2019). ✓ Crisis-Diversion Facility recommended to and endorsed by BOCC (April 2021 ). ✓ Preliminary facility design and cost estimation completed (early 2023). ✓ Site location and land purchase (June 30, 2025). • Final facility architectural design work (4Q2025). • Construction Documents/Permitting/Bid/GMP Approval (2Q 2026). 2027 • Construction complete (2Q 2027). • CDF start up and begin operation (3Q 2027). 14 B H Crisis Diversion Facility Board Meeting September 16, 2025 c COe R ORANGE COUNTY HITECTURE ENGINEERINGRING PLANNING NOR'T'H CAROLINA CPLteam.com 15 Original Design Building Size 21,270sf BHuc . r Cost Estimate J " " $28,090,123 FBC Beds: 16 B H U C Bays: 12 w.. o o ®4 oIff U4!T (4 Pediatric, 8 Adult) o ® 4v O er o ® 7 a cm _ �RX;A . o �. 'G�c .o. .o o o Q '^^, o 'may Dual-Side Entry -4 L FBC Requested Room Count .,g -� _ � FBc J ca"L o �°� m a BHUC Requested Bay Count FBC Courtyard V Conference Space Peer Living Resource Center o o Community Support Space Healing Garden 16 Design Option A BHUC Building Size 10,080 sf ,w°F !"oxen N"°oFry - nrNaP mar ^"a xr:"x FUFuel,iaaFuu,m a RF Cost Estimate $20,712,612 P cPoaFr cvu °r am -- ------------ Futur Community Addition $842,5 $842,526 �l°Nkw_N.,"l�M� �r�m F„BF T gF Or BF %aF FBC FBCBeds: 8 a 0 nTr°xoxln MTlNflOOIA Arinrnm! rnoo° B H U C Bays: 6 (2 Pediatric,4 Adult) _ Ne arAFFnr R Dual-Side Entry "om ATlNTPOOM TFNTPOW ATI0rtFi00FF PATlM�dl FBC Requested Room Count B H U C Requested Bay Count ur FBC Courtyard Conference Space Other: Reduced S F by 53% Peer Living Split Entrances, Same Vestibule Resource Center Squared up building architecture Community Support Space Reduced Parking from 50 to 25 Healing Garden No Underground Stormwater Retention 17 Design Option B ^` BHUC j I exPcoeuv exuc°uev 1[OS PfPi EMS VEbI CONSULL WINING MMNVEii Building Size a5F d5f 21 Si Pl Sf SSSSf 21 SF 15,850 sf Mf RANSFER RFG/9lCPMfY Afc/WAM FUTURE COMMUNITY IW SS IpsF ,Id SF I56 si 2045E ,nxs 1675F SIAff.:P l CONSUIi/ Ih f COMPEL Cost Estimate °;/;;;A PIP i"n usf $25,311,125 ers FBC CONSUIi/ IMAxf�� Sd SF FSC FK f2t fIC 1NPC OeSR IHUO NVAS! SFXSpT2 WAK. FF IMAKF I]SF NSf WSF 94.5! Future Community Addition „55F SN/MEPS „]5P M 7 166 IF 112 Sf PA$84fIMNT RiISXWR PAT 0.00M11.1�.Ir]177.71 2,526 Y[9P ill bf 121 3F �u e01�wA auN 1,asf LxAM Mms IM/KE FBC Beds: 16 AN°GouRx `x°c°" 25f TbY T1IF TIS 1ffibf 12PSP 1P25f E.1 nT]SNWROfWC BHUC Bays: 12 969 965E yisMNG/ D� MOH 31AWR1 IXUC015AV eNUCOeE If2 IF SGILFPI eFP ]95f Msf Rr/SNWA PAT AODM PAT AOOM PATIWM PATROOM ]bM ]6 E! d65i 1195E ,IJSf RAI MOR FBC 925f T21M 1215f 1215E 12151 (4 Pediatric,8 Adult) lu� 923F PIXXN GRtlPPI NIUCONR4 6XUCORI APTIVAY }b Sf ]63f U+UNORY Im SF FIlC AMCX MfC WARMING BHUC eXUCO eNUC 1275E I-21 195g x11CXF Dual-Side Entry )I Sf ]63f WGARROGA YIOEOCILL 266Af 2164f 933f FBC Requested Room Count nifSxWR n,]SxwR 92M 919f 1 BHUC Requested Bay Count 1,1V Y FBC Courtyard ,2,Si ,21 Sf Conference Space Other: Reduced SF by 53% PAF AODM PAT ROOM Peer Living Split Entrance Vestibules,Some Side ,z,aF 2TSf Squared up building architecture Resource Center PAf4WM fu 0.00M — — Community Support Space Reduced Parking from 50 to 40 121 Ei s,sf 25%Decrease of Underground Stormwater rIT AODM PAI ROOM Healing Garden Retention I213F 1215! 18 Design Option B.1 BHUC axu�a1sRv exec o�uRv �� eG/secvelr 1��`u�sF'' xux vas IYI SF BuildingSize "'SF exec l5eew exec onAv � � FUTURE COMMUNITY P®S rin5 P0.I IRAN5/9 IAA SF tY3F 17,435 s f REGIVIMENG COIAALI/ 0.513f INWFR sAxsGRr ixtARF 9NcxAAGe nr CM6uI7 115E 9a SF ltd Sf 391 EP NSF 90.4 Cost Estimate $26,300,00 FBC IF MAQ aP0.R 50R FAC eN9COKe mucNo"t 1e SF YSF R5I!EA19SSi sIW/MEt19 IYSF IYlsf ����� Future Community Addition 2"� NRSHWS PAi ROOM PdS ROCM PA9 ROOM PAI ROOM 135E i113F I115F IRI SF 1113E $842,526 "" ^'+ to SF 015E 1 ' enAKE F233F e1WCOeSAY ex9C OeFR �� CNA11 I13Sf COMAIIr 1E%AM tM�S I/VI FBC Beds: 16 ]d5 76 SF /SMMR RC ARSESM ��a 945E V Slgl SIAFf RT BHUC Bays: 12 RPRICORS IXIICOISR SOIIWYAEO 7951 N5f N/55IYIR tMA00M tAtA00M 1A]AOOM F0.tA00M eUCa IAe SIARARFA3 /1 SF 121 SF I21A 1219E 1213E RSR 79 SF 1179E 31131 Ff9C (4 Pediatric,8 Adult) sruFn' nsf GN�GN m 'C v WAWN;5F Dual-Side Entry FBC Requested Room Count ni/5NWR 933E 933E BHUC Requested Bay Count CO MI7Am I,aa23f n1114�1'" � !eG 17F g{�A1 FBC Courtyard Conference Space other: Reduced SF by 18% FIAI.,— PAT Peer Living „ Split Entrance Vestibules,Some Side A sl Resource Center Squared up building architecture PAi ROOM PAT 900A9 Reduced Parking from 50 to 40 a,sF u3s Discharge Planning Conference Room 25% Decrease of Underground Stormwater Retention HealingGarden rA7 RGOM III IIF Added space for Community Offices and Discharge 111 s1 ,15s 19 Design Option C VVV COMMUNITY BNIFC 00O . 0 Building Size 19,825 sf 00 0 "" 000 Cost Estimate $27,079,674 L1�1� FBC Beds: 16 `�J g" FOC B H U C Bays: 12 (4 Pediatric, 8 Adult) Dual-Side Entry FBC Requested Room Count BHUC Requested Bay Count FBC Courtyard El" 1 Conference Space Other: Squared up building architecture Peer Living a Resource Center q" Community Support Space Healing Garden �" J o 1 - I RECAP - e i Original Design VE Option A VE Option B VE Option B.1 VE Option C Total SF21,270 10,080 15,850 • ; Difference in SF .•, ;'. Cost $28,090,123 $26,300,000 Difference in Cost 6% 07. app4% FBC Beds16 ; 16 16 16 BHUC Bays12 6 12 12 12 Community SpaceYes No No No Yes Peer Support SpaceYes No No No Yes Distinct Building _s No No No _ Entrance mi (LE/Public) Discharge _s No No _ _ Planning/Services Office Spaces FBC CourtyardYes Yes - - - Healing GardenYes No No No Yes Simplified No Yes Yes - - Building Architecture 17 21 SUPPLEMENTAL INFORMATION : FACILITY SPECIFICATIONS 22 ORIGINAL FACILITY SPECIFICATIONS: CLINICAL SERVICES BH urgent care (BHUC-4), 24 stabilization chairs. 0 Peer support specialists. Facility Based Crisis (FBC) for adults (16 beds). a Multi-day temporary boarding while waiting for transfers Serve short-term IVC patients. or as a bridge between crisis care and community Emergency SUD treatment services (24/7). treatment. Non-hospitalization detoxification services. M On-site pharmacy services to serve patients in Facility Urgent Medical Care Services for individuals in crisis and allow patient to be discharged with medication. (allow treatment of non-life-threatening conditions). Third-party laboratory with available, expedited courier Point of Care Testing (quick turnaround laboratory service. Serve patients in Facility. services). Serve patients in Facility. Clinical services for minors ages 4 — 17 in BHUC. Capacity to manage individuals who are agitated, but Walk-in Services for general public (24/7/365). do not require secured space and restraints. Short-term ambulatory treatment services (e.g., non- Referral and transportation to hospital and other medical detox) to facilitate stabilization prior to discharge. treatment facilities (after dropping off by LE/EMS). Initiate MAT treatment in anticipation of transfer to Serve individuals with special needs (e.g., IDD). community treatment provider. Clinical and forensic assessments. Sobering services. 23 FACILITY SPECIFICATIONS: CJ DIVERSION-DEFLECTION ■ On-site CIT and MHFA-trained LE personnel to maintain facility security. ■ Locked, secure facility space available, if needed. ■ On-site security personnel and peer support specialists to maintain calm and safe environment and to provide readily available transportation for patients in custody, as needed for IVC transportation, and to provide court paperwork to and from Facility. ■ On-site space (and video conference link) for criminal justice stakeholders (e.g., Magistrate, District Attorney, Public Defender, courts/judges, CJRD personnel, clinicians). ■ On-site security to provide warm hand-off for patients who are in custody (e.g., transfers from jail). ■ FIT (Formally Incarcerated Transitions) program liaison. ■ Readily available medical and LE transportation for IVC patients. ■ Forensic assessment services for court processes. ■ Clinical services for individuals who are in custody (temporary transfers from detention facility) or awaiting court processing/hearings. ■ No refusal admission for law enforcement and emergency medical services (24/7/365) including individuals who are agitated or under an IVC order except where there is a serious security concern and/or acute medical needs. 24 FACILITY SPECIFICATIONS: NETWORKING Community Treatment Services Networking ■ Serve as community resource providing information about available treatment services (for all conditions) where Facility is well integrated with community providers. ■ Referral to out-patient/in-patient BH treatment services. ■ Referral to out-patient/in-patient SUD treatment services (e.g., MAT, ADATC). ■ UNC Hospital referral liaison (facilitate transfer of patients needing higher level of care without involvement of LE or EMS who may have brought patient to Facility). ■ Patient transfer to other treatment facilities (e.g., UNC Hospitals, detox facilities). ■ LME/MCO liaison. ■ Warm handoff to community treatment services with support from peer specialist and/or case manager. Social Services Networking ■ OC Partnership to End Homelessness Access. ■ Liaison for NAMI programs. ■ Health insurance enrollment liaison including legal representation. ■ Warm handoff regarding referrals to social services/peer specialist. ■ Transportation assistance. 25 ORIGINAL FACILITY SPECIFICATIONS: FACILITY ATTRIBUTES ■ Dual entry (dedicated entry) for LE and EMS. • Calming area or setting. ■ Rooms/beds for agitated patients. ■ Space for law enforcement and emergency medical personnel. ■ Video conference facility to provide access to magistrate. ■ Video conference room for robust link between Facility and Magistrate, Courts, District Attorney. ■ On-site criminal justice space to support criminal justice stakeholders. ■ Short-term boarding for patients awaiting transfer to third party community service. ■ Dedicated space/rooms for patients housed in Facility in lieu of jail. ■ Short-term boarding for patients awaiting IVC or other hearing. ■ Clinical space for minors (4 years old and older). ■ Call center coordination including 911/988, EMS, LE/Crisis Units, Hospitals. ■ Resource Center providing information by phone or in-person to members of the community about available treatment services (for all conditions) and supportive social services.