For training and technical assistance needs or questions, please email [email protected].

Frequently Asked Questions​

CARE Act TTA Frequently Asked Questions​

The following are frequently asked questions related to Community Assistance, Recovery, and Empowerment (CARE) Act training and technical assistance. For background information on the CARE Act, please visit our About page and/or visit the CalHHS CARE Act landing page

Have a question or comment? Do you have a question for us? Please reach out to us to share your question and feedback. We value your expertise and experience.

Filter FAQs

  • Topic(s)

  • Reset Filters
  • What is the CARE Act?

    Senate Bill 1338 established the Community Assistance, Recovery, and Empowerment (CARE) Act to provide community-based behavioral health services and supports to Californians living with untreated schizophrenia spectrum or other psychotic disorders through a new civil court process. CARE Act is intended to serve as an upstream intervention for the most severely impaired Californians to prevent avoidable psychiatric hospitalizations, incarcerations, and Lanterman-Petris-Short Mental Health Conservatorships. The CARE Process will provide earlier action, support, and accountability for both CARE participants and the local governments responsible for providing behavioral health services to these individuals. The CARE Act authorizes specified adult persons to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan that may include treatment, housing resources, and other services.


  • Who is the intended audience of the CARE Act training and technical assistance?

    As specified in Section 5970.5 of SB 1338, training and technical assistance will be provided to county behavioral health agencies (including organizations and individuals that county behavioral health agencies include in the training and technical assistance opportunities as specified in Section 5983 (b), volunteer supporters, CARE Act providers, counsel, and other relevant stakeholders to support the implementation of the CARE Act. 

    Training and technical assistance will be in consultation with relevant state departments, disability rights groups, county behavioral health and aging agencies, peers, the California Interagency Council on Homelessness, the Judicial Counsel of California, and other relevant stakeholders.


  • When will the CARE Act be implemented?

    Implementation will take place in two phases. Counties will be divided into the first phase (Cohort 1) and the second phase (Cohort 2).

    Cohort 1 counties will implement CARE Act processes by October 1, 2023 and include:

    • Glenn
    • Orange
    • Riverside
    • San Diego
    • San Francisco
    • Stanislaus
    • Tuolumne

    Los Angeles is a Cohort 2 county that will implement by December 1, 2023.

    Cohort 2 counties include the remaining 50 counties and will implement by December 1, 2024.


  • How does a county apply for the CARE Act delayed implementation process?

    Counties can apply for a delayed implementation process as outlined in Behavioral Health Information Notice 23-016.

    As part of the application for an extension requirement, please also submit a Delayed Implementation TTA request here in order to work with the CARE Act TTA provider to develop a plan for implementing the CARE Act by your county’s proposed implementation date. Additional questions can be sent to [email protected]


  • What information will the CARE Act annual report provide?

     As specified in Welfare and Institutions Code 5985, subd. (e) and (f), the Department of Health Care Services (DHCS) will develop an annual report to examine the scope of impact and monitor the performance of CARE Act model implementation. The first annual report will be published in July 2025 on the DHCS website. The report will include information on the effectiveness of the CARE Act model in reducing disparities and improving outcomes in homelessness, criminal justice involvement, conservatorships, and hospitalization of participants.


  • Under the CARE Act, what level of licensure is required to conduct the clinical evaluation that may be ordered by the court?

    The CARE Act specifies that the clinical evaluation, which may be ordered by the court pursuant to Welfare and Institutions Code (WIC) 5977.1(b),  shall be conducted by the county behavioral health agency through a licensed behavioral health professional. The CARE Act defines the licensed behavioral health professional in conjunction with other applicable statutes. The clinical evaluation may be conducted by:

    • a psychiatrist, psychologist, clinical social worker, marriage and family therapist or professional clinical counselor licensed in accordance with the Business and Professions Code; or
    • individuals working under supervision to gain necessary experience to meet any of the above licensure requirements as long as they meet the professional training requirements applicable to their license as detailed in the Business and Professions Code, for up to five years; or
    • the same type of clinicians who were recruited for employment from outside the state who have sufficient experience to gain admission to a licensing exam, for up to five years.


  • What is the impact on the process if an individual voluntarily engages in services?

    The CARE Process is intended to encourage voluntary engagement. After the petition is filed, if the respondent is enrolled or likely to enroll in voluntary treatment, the court will dismiss the matter.


  • What is the impact if a respondent cannot be located or chooses not to engage in the early stages of CARE process?

    The court may conduct the initial hearing in the respondent’s absence if:

    • the respondent does not waive personal appearance and does not appear at the hearing; and
    • the court determines that reasonable attempts to engage the respondent have failed; and
    • the court makes a finding that conducting the hearing without the participation or presence of the respondent would be in the respondent’s best interest.

    If the respondent engages but chooses not to be present at the initial hearing, they may instead appear through counsel. (Welfare and Institutions Code 5977 (b)(3))


  • Can a supporter be subpoenaed to testify against the respondent?
    A supporter shall not be subpoenaed or called to testify against the respondent in any CARE Act proceedings. However, this provision only references CARE Act proceedings, and it does not prevent a supporter from being called to testify in any other civil or criminal proceedings.


  • Can a supporter be removed from the CARE process due to a conflict of interest?
    The court shall remove a supporter due to a conflict of interest with the respondent if the conflict cannot be managed in such a way to avoid any possible harm to the respondent. The process for removing a supporter will be determined by the court.


  • How can family members participate in CARE Act proceedings?
    Family members can take various roles in CARE Act proceedings. If the family member is the original petitioner, they shall have the right to participate in the initial hearing to determine the merits of the petition. The court may assign ongoing rights of notice to the original petitioner. The court may also allow participation in the respondent’s CARE Act proceedings, if the respondent consents. Additionally, the respondent may choose to elect a family member to serve as their volunteer supporter.


  • Can someone who is experiencing a mental health crisis participate in a supported decisionmaking arrangement?

    During the CARE Act process, the goal is to optimize the respondent’s opportunities to make decisions. As the respondent’s symptoms fluctuate, their willingness and availability to participate in supported decisionmaking may likely also change. During a mental health crisis, an individual may not be able to communicate their preferences and wishes, and therefore supported decisionmaking may not always be possible. These scenarios must be evaluated on an individual case-by-case basis. Ideally, once the respondent is capable of understanding the decisions to be made, they can resume engaging in supported decisionmaking.


  • What happens when a CARE participant does not adhere to their CARE plan?
    If the respondent is not adhering to their CARE plan, the court may terminate their participation in the CARE process. There are no legal penalties for not complying with a CARE plan. The respondent may instead be referred to a higher level of care, such as a conservatorship.
    For more information, see Welfare and Institutions Code Section 5979 .


  • What are the legal roles throughout the CARE process?

    The CARE process includes multiple legal representatives that serve specific roles, including:

    • Respondent’s counsel: An attorney is provided to the respondent at no cost. The respondent’s counsel will work with the county behavioral health agency and respondent’s volunteer supporter (if applicable) to help the respondent access behavioral health treatment. They also represent the respondent in any court proceedings and advise on the CARE process.
    • Judicial officers: Judicial officers – also known as judges – are responsible for making sure the court proceedings are conducted in a collaborative way. Additional responsibilities include determining eligibility, explaining the respondent’s rights, evaluating what services were or were not provided, and issuing orders to support the respondent’s access to services.
    • Petitioner’s counsel: The “petitioner” is an adult person who petitions a civil court to consider the respondent for the CARE process. It is not required that the petitioner have an attorney help them file the petition, but they may choose to do so at their own expense. Alternatively, if a petition is filed by a county behavioral health agency, the agency may choose to be advised by counsel.

    For more information, see the CARE Act Brief on Legal Roles in the CARE Act on the CARE Act Resource Center.


  • What is the difference between a progress review hearing and a status review hearing?

    A progress review hearing is scheduled if the respondent and county behavioral health agency have reached a CARE agreement. The court will schedule a progress review hearing for 60 days from when it approves the CARE agreement (Welfare and Institutions Code Section 5977.1). The statute does not specify any additional progress review hearings; however, the court, at its discretion, may include additional hearings as it deems beneficial to monitor and encourage the parties’ progress in fulfilling the terms of the CARE agreement. The statute does not specify the content or structure of the progress review hearings.

    Status review hearings will be scheduled by the court at least every 60 days after the court orders a CARE plan. The court will review the respondent’s progress on the CARE plan, what services were or were not provided, issues the respondent may be having with adhering to the plan, and recommendations for changes that would make the CARE plan more successful. The county behavioral health agency or the respondent may request, or the court may set, a hearing at any time during the CARE process to address a change of circumstances during the CARE process. (Welfare and Institutions Code Section 5977.2)


  • What happens during the CARE process?

    A summary of the CARE process is outlined below:

    • A case begins with the filing of a petition, followed by the court assessing eligibility.
    • If a respondent is found to be eligible, and efforts at voluntary engagement by the county behavioral health agency are not successful, there is a process to develop a voluntary CARE agreement.
    • If a CARE agreement is not likely to be reached, the court will order the county behavioral health agency to conduct a clinical evaluation of the respondent and provide a report to the court.
    • If, based on that report, the court determines that the respondent meets the eligibility criteria, the court shall order a CARE plan. Both a CARE agreement and a CARE plan will outline services and supports that the individual is entitled to receive under the CARE proceedings.
    • The court will monitor the respondent’s progress with the CARE plan or CARE agreement.
    • If the respondent has a CARE plan, then after a year there will be a determination of next steps. The respondent may graduate or be reappointed to the CARE process for up to one additional year.

    For a more detailed description of each step in the process, please see the CARE Act Process Flow to Treatment, Housing, and Support resource or The Client’s Journey Through the CARE Act training.


  • What is the court’s role in ensuring that the volunteer supporter is following the supported decisionmaking framework?

    The court does not have a mandated process to ensure that a supporter follows a supported decisionmaking framework. However, if the court finds that the volunteer supporter is overstepping the boundaries of their role, such as (imposing their own beliefs on the respondent), the court may remind the supporter of their duties. A court may ultimately remove a supporter because of any conflict of interest with the respondent that cannot be managed.

    For more information, see the Supported Decisionmaking for Volunteer Supporters training on the CARE Act Resource Center.


  • What is the role of the volunteer supporter?

    A volunteer supporter (also referred to as a supporter) is an adult chosen by the respondent to provide support throughout the CARE process. The supporter should help the respondent understand, make, and communicate decisions and express preferences throughout CARE proceedings. This could include assisting with the development of a CARE agreement or CARE plan, a graduation plan, and a Psychiatric Advance Directive (PAD). The supporter should use a supported decisionmaking framework to empower the respondent to make their own informed decisions.

    The CARE Act Supporter Role Brief provides an overview of the Supporter Role, key operating principles of the supporter’s role, and available trainings for supporters.


  • What are the requirements for official service notifying a respondent of the CARE Act proceedings?

    The CARE Act requires that the respondent be personally served notice of several events throughout the CARE process. During the initial stages, the county behavioral health agency is to personally serve the respondent with a copy of the petition packet as well as information on the process and their rights in the process. If personal service is not practicable, the county behavioral health agency may use any method reasonably calculated to give the respondent actual notice. The proof of service must explain why personal service was impractical and why the alternative method was thought to provide actual notice.

    For more information, see the 2023 California Rules of Court (Rule 7.2235) or the Judicial Council of California’s FAQs for CARE Act Service Requirements.


  • What data will counties be required to collect?

    Counties will collect data on:

    • CARE Act Respondents with a CARE plan and CARE agreement, which are referred to as “CARE participants.”
    • Former CARE Act respondents who meet prima facie and CARE criteria but elected to voluntary engagement in county services. These individuals are referred to as “Elective clients.”

    County behavioral health agencies will capture respondent data at the individual level, while Judicial Council will capture aggregated trial court data.


  • When do counties start tracking CARE respondents?

    Data will be collected on CARE respondents from the time of petition as follows:

    • If the county behavioral health agency is the original petitioner, data collection begins at the time of petition.
    • If the county behavioral health agency is not the petitioner, data collection begins when the court orders an investigation by the county.


  • Are counties required to gather information provided by non-Behavioral Health entities?

    County behavioral health agencies are required to obtain information via client consent whenever possible. Administrative data should be collected to the extent available.

    If the county is unable to obtain information, an “Unknown” response option is available.


  • How will the data collected be shared with the public?

    Data metrics identified in Welfare and Institutions Code sections 5985 and 5986 for the Annual Report and Independent Evaluation will be shared in accordance with the DHCS Public Reporting Guidelines to maintain privacy and security.


  • Will the respondent receive notice of disclosure of their health information?

    The CARE Act authorizes, and in some instances requires, the disclosure of a respondent’s health information, including protected health information and mental health records, to the county behavioral health agency and/or the court. The CARE Act requires that the county behavioral health agency notify the respondent of disclosure of their health information. That notice is to be sent to respondent’s last known address, if one exists, and to respondent’s counsel. The notification shall also be included with the next notice of hearing, if any, served upon the respondent. All information that was shared shall be disclosed to the respondent, their counsel, and (with the respondent’s consent) their supporter.


  • What is a Psychiatric Advance Directive (PAD)?

    A Psychiatric Advance Directive (PAD) is a type of Advance Health Care Directive. It is a self-directed legal document that states a person’s preferences and provides instructions for mental health treatment in advance of a mental health crisis. Physicians, hospitals, and other providers should refer to a PAD in situations when the individual is unable to articulate their own care preferences. A PAD may be incorporated into ongoing mental health treatment, serving as a blueprint for the individual’s preferences regarding their physical and mental health.

    In California, the general provisions for an advance health care directive are found in Probate Code Sections 4600-4678 . For more information, see the PADs in the CARE Act training located in the Resource Library or visit the PADs Mental Health Services Act (MHSA) Multi-County Psychiatric Advance Directives Innovations Project .


  • Can a Psychiatric Advance Directive (PAD) be registered with the State?

    State law requires the Secretary of State to maintain an Advance Health Care Directive Registry (Cal. Probate Code Section 4800). This registry allows those with an Advance Health Care Directive to register information that can be made available upon request to the registrant’s health care provider, public guardian, or legal representative. Although this registry was not created for PADs, if a PAD meets the requirements for Advanced Health Care Directives (Cal. Probate Code Section 4670 – 4743), the owner of the PAD can register it with the state.

    You can find information about how to register an Advance Health Care Directive or a PAD on the California Secretary of State’s Advance Health Care Directive Registry webpage.