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EXHIBIT A SCOPE OF SERVICES PROJECT PROPOSAL: Mental Health Urgent Care Services for Tri-Valley Residents Prepared by: Sue Compton, CEO Dr. Jennifer Penney, Chief of Behavioral Health Services Valerie Jonas, Chief Development Officer A Growing Need in Our Community The need for mental health services in the Tri-Valley has increased dramatically in the last decade and has been further exacerbated by the COVID pandemic. A growing number of people are experiencing depression and anxiety, and the number of involuntary detentions for 72-hour psychiatric hospitalizations (5150s) continues to increase. Stanford HealthCare-ValleyCare's 2019 Community Health Needs Assessments identified behavioral health/mental health as the number one priority out of eleven health needs in the Tri-Valley. All three Tri-Valley school districts indicate growing concerns regarding student mental health issues, and local law enforcement agencies are recording growing numbers of psychiatric calls, which involve all ages, from children to seniors. Limited Access to Immediate Treatment Tri-Valley providers, including Axis Community Health, have responded to the increasing need for mental health services by expanding capacity for ongoing treatment. Yet, even with increased capacity, patients-- particularly those who have not yet established care with a provider—frequently wait weeks for an appointment with a licensed therapist or psychiatrist. Families that have health insurance face a confusing array of options for services that requires an intake process and often results in placement on a waiting list for services. Uninsured patients have limited choices for services and, because service providers are overburdened, often face delays in accessing care. Patients and families are left with the choice of calling 911, utilizing an emergency room for immediate treatment, navigating a complicated delivery system, or waiting until an appointment with their provider is available. All of these choices are especially difficult in a crisis situation. The inability to access assessment and treatment in a timely manner negatively impacts patients and those who care about them, including families and friends. The waiting period for assessment and treatment prolongs patient suffering and can exacerbate symptoms, leading to a more acute situation. Patients in distress arrive with increasing frequency at emergency rooms at Stanford Health Care–ValleyCare, Sutter Health, John Muir, Kaiser Permanente or Alameda County's John George Psychiatric Hospital—either voluntarily or involuntary (5150). Local law enforcement agencies are often involved as well, both in situations that could be handled effectively with a mental health professional or in more concerning situations in which the patient is combative or potentially a risk to others. Once assessed in an emergency department setting, a lack of community-based resources often results in a challenge in connecting the patient and family with non-emergency room assessment, treatment and care coordination. The result is a significant gap in accessing continuing behavioral health care services. Those who reach out for assistance from law enforcement face the difficult choice of being 5150'd or having to Consulting Services Agreement between City of Dublin and April 1, 2021 Axis Community Health for Mental Health Urgent Care Services Pilot Program Exhibit A–Page 1 of 6