Volunteer Supporter Toolkit

In the CARE process, each respondent can choose a volunteer supporter. The supporter is an adult who ensures the CARE process reflects the respondent’s preferences.

This Toolkit provides resources for volunteer supporters that can help both the supporter and respondent navigate the CARE process. The Toolkit includes trainings, briefs, and other resources to help supporters in their roles. These resources can be accessed on the CARE Act Resource Center resource library.

Volunteer Supporter Worksheet

Accompanying this Toolkit is a Volunteer Supporter Worksheet, which can be downloaded and used by the supporter. The worksheet provides space to take notes, write questions, and identify next steps in the CARE process.

Volunteer Supporter Toolkit

The interactive toolkit below is also available
as a PDF in multiple languages:

Roles in the CARE Act

There are many different organizations and roles to help the individual through the CARE process. The primary roles are listed below. As the supporter, it may be helpful to document this information in the Volunteer Supporter Worksheet.

ROLES

CARE Respondent/Participant

Once the petition is filed, the person who is being evaluated for participation in the CARE process is referred to as the respondent. This word is often used for individuals going through a court process. We generally refer to someone participating in CARE as a CARE participant, but you may see or hear respondent being used.

Throughout this process, this individual will have access to behavioral health services, housing, and other community supports, as appropriate.

Volunteer Supporter

An adult chosen by the respondent to provide support throughout the CARE process and to promote the respondent’s preferences, choices, and autonomy.

Petitioner

An individual who has filed a petition for the respondent to be considered for the CARE process. Example petitioners include a family member, a mental health professional, a first responder, a homeless outreach worker, or a roommate/housemate. For more resources on petitions (including a comprehensive list of those who can be a petitioner), see the CARE Act Resources For Petitioners.

County Behavioral Health Agency

County behavioral health agencies and their teams have an important role in the court process. Agencies engage the respondent in mental health treatment and connect them with additional services. Individuals could include a contracted provider, prescriber, and/or care manager.

Housing & Community Support Providers

The respondent may be connected with housing and community support providers through the CARE process.

Examples of housing providers include permanent supportive housing, affordable housing, interim/transitional housing, and Behavioral Health Bridge Housing.

Examples of community support providers may offer social services funded through Supplemental Security Income/State Supplementary Payment (SSI/SSP), financial assistance for immigrants, CalWORKs, California Food Assistance Program, In-Home Supportive Services program, and CalFresh.

CARE Court

People who work for the court system that will be involved in CARE processes include:

Counsel for Behavioral Health

They are responsible for representing the county behavioral health agency. This individual could be a county counsel or other designated attorney.

Legal Aid / Public Defender

They are responsible for representing the respondent’s interests and rights. They are court-appointed and provided regardless of the respondent’s ability to pay.

Judge

The judge serves as a neutral arbiter. Unless there is a dispute, they will conduct the case in an informal, non-adversarial atmosphere.

More Information

For more information about CARE Act roles view the training on Overview of CARE Process for Supporters.

For more information on roles in the CARE court, see the Legal Roles in the CARE Act brief.

For more information on eligibility requirements to participate in the CARE process, see the CARE Act Eligibility Criteria Fact Sheet.

Responsibilities & Guiding Principles of the Supporter Role

The CARE Act describes the supporter’s responsibilities and important principles for this role. The Supporter Role in the CARE Act brief provides helpful information on these responsibilities and principles.

How these responsibilities and principles look in practice will depend on the needs and preferences of the respondent. Consider using the Volunteer Supporter Worksheet to document your understanding of these responsibilities and preferences and to also note additional questions you may have.

Volunteer Supporter Responsibilities

Helps the respondent understand, make, and communicate decisions and express preferences throughout CARE proceedings.
Offers the respondent a flexible, culturally responsive way to maintain decisionmaking authority over their own life to the greatest extent possible by developing and maintaining voluntary support systems.
Uses a supported decisionmaking (SDM) approach to increase a respondent’s ability to make their own decisions.

Volunteer Supporter Principles

Supported decisionmaking.
Avoiding personal bias.
Trauma-informed care.
Confidentiality.

More Information

For more information on the Volunteer Supporter role, see the Supporter Role in the CARE Act brief.

For more information, see trainings on Supported Decisionmaking for Volunteer Supporters and Maintaining Neutrality as a Volunteer Supporter.

Also see training material for the trauma-informed care (TIC) trainings, including Foundations for TIC, Goals & Principles of TIC, and Applying TIC in Practice.

Strategies for Supporting the Respondent

Each respondent’s needs and preferences are unique. The supporter should use trauma-informed strategies to help the respondent build resilience throughout the CARE process.

The training on Applying Trauma-informed Care in Practice provides some strategies to support the respondent. The training discusses how to:

Plan ahead for stressful situations.
Help the respondent use calming practices.
Approach situations with compassion and humility.
Address biases that get in the way of providing support.
Emphasize the respondent’s strengths.
Truly listen.

It is important to remain neutral in the supporter role. Switching from the role of friend or family member to a ”supporter” role may be a hard transition. The supporter can use certain techniques to remain neutral while the respondent is considering a decision, such as using reflective listening skills and distinguishing between historical relationships and the volunteer supporter role. The supporter and respondent should use a supported decisionmaking framework to ensure the respondent has the supports and services needed to make independent decisions.

More Information

For more information, see the trainings on:

Possible Discussion Questions

The Volunteer Supporter Worksheet contains sample questions the supporter can use to better understand the respondent’s needs, preferences, and goals. The supporter and the respondent should consider setting aside time to discuss these questions regarding these and additional preferences.

What are your goals for participating in the CARE process? (e.g. for services, for graduation, etc.)
What broader goals do you have?
Tell me your understanding of and questions about why you are involved in the CARE process.
Tell me your understanding of and questions about the purpose of the CARE court process.
Tell me your understanding of and questions about what your responsibility is in the CARE process.
Do you understand what my role is in helping you with the CARE process?
What about the CARE process makes you most nervous or frustrated?
How do you feel around authority figures? What has been helpful to you in those situations?
What are important considerations that you would like me to keep in mind?
How do you respond to official settings, such as court rooms? What has been helpful to you in those situations?
How do you calm yourself down whenever you get nervous or frustrated? What else is helpful?
What are the types of supports you need to help you make decisions?
What can I do to help you through the CARE process?
Do you have a psychiatric advance directive (PAD)?
- If yes, do you want me to have access to it? Do others have access to it?
- If no, are you interested in creating one?

Dealing with Conflicts of Interest

The court may remove a supporter if there is a conflict of interest that cannot be resolved. For example, a conflict may exist when a supporter is not able to remain neutral because they do not agree with a respondent’s preferences or decisions. Additionally, a conflict may exist if the supporter might personally or financially benefit from the respondent’s decisions. If you as a supporter feel that you cannot support the respondent as a neutral party, please let the respondent and/or the respondent’s attorney know.

Supporter Involvement in CARE Act Process

The section provides a high-level overview of the CARE process, focusing on the supporter’s potential role.The information in this section, along with the other guidance provided in this Toolkit, digests information from the CARE Act statute.

As the court process is fairly detailed, it may feel overwhelming to the supporter. Please note that the supporter is not responsible for tracking hearing dates or documenting decisions; however, the respondent may appreciate help with understanding the process and next steps. If the supporter was not the original petitioner, then their first time participating in the process may not happen until the initial appearance.

The role a supporter plays will be different depending on the needs and preferences of each respondent. The supporter should make a plan with the respondent on how they would like the supporter to participate. This plan should be revisited with the respondent throughout the CARE process.

The supporter should consider documenting their plan for involvement in the Volunteer Supporter Worksheet.

Steps in the CARE Process

CARE Process Initiation

Initial Petition

The initial petition is filed with the court to initiate the CARE process. It must provide specific information and support for the court to consider in determining if the respondent is eligible for the process.

Engagement

Prima Facie (i.e., At First Impression) Determination

The court decides if the petition shows that the respondent is likely eligible for the CARE process.

County Report

If the petition was filed by someone other than a county behavioral health agency, the court will order the agency to investigate and report on whether the respondent meets CARE criteria. The county behavioral health agency will attempt to engage the respondent in voluntary services and report the results of those efforts to the court.

Court Process/Service Connection

Initial Appearance

This is the first time the parties appear in court. Counsel (attorney) for the respondent will have been appointed prior to this appearance. During this appearance (and throughout the process), the respondent has the option to select a supporter. The respondent can decide to be at this court hearing, or they can allow their attorney to appear for them. The county behavioral health agency will replace the petitioner if the petition was filed by another individual.

Hearing on the Merits

The court will determine if the respondent meets the CARE eligibility criteria. If so, the court will order the county behavioral health agency to work with the respondent (and their counsel and supporter) to engage in treatment and attempt to create a CARE agreement. This hearing may be combined with the Initial Appearance.

Development of CARE Agreement

A CARE agreement is a voluntary agreement developed by the respondent, their attorney, their supporter, and the county behavioral health agency (the parties). The CARE agreement sets out a range of services and supports which would benefit the respondent.

Case Management Hearing

If a CARE agreement has been reached the court will review and can approve the agreement. The court will then set a progress hearing to monitor the respondent’s compliance with the agreement. If reaching a CARE agreement is not likely, the court will order the county behavioral health agency to conduct a clinical evaluation of the respondent.

Clinical Evaluation

County behavioral health agency will report to the court on:

The respondent’s clinical diagnosis.
Whether the respondent has the legal capacity to give informed consent regarding psychotropic medications.
Any additional information and recommendations for services and supports that would assist the court in making decisions.

Clinical Evaluation Hearing

The court reviews the clinical evaluation and other evidence presented. The court will determine if the respondent meets eligibility criteria and order a CARE plan.

Development of CARE Plan

Like a CARE agreement, a CARE plan identifies a range of services and supports for the respondent. The respondent, their attorney, the behavioral health agency, and the supporter will work to create a CARE plan. If they cannot agree on a plan, the county behavioral health agency and the respondent may propose separate plans.

CARE Plan Review Hearing

The court adopts the elements of the proposed CARE plan(s) that best support the recovery and stability of the respondent and may issue orders necessary for the respondent to access those services.

Service Delivery

Status Review Hearings (every 60 days)

Status review hearings provide the court an opportunity to monitor the respondent’s progress in completing their CARE plan and consider whether any changes are needed. The court also will determine whether services are accessible to the respondent and address any issues that may arise.

Next Steps

One–Year Status Review Hearing (at month 11)

At this hearing, it is determined whether the respondent will graduate from the CARE process. If the respondent elects to graduate and the court agrees, the court will order the parties to develop a graduation plan.

Graduation Hearing

The graduation plan is presented to the court for its review. A graduation plan is a voluntary agreement that includes a strategy to support the respondent’s successful transition out of the CARE process.

Reappoint to Process

With the court’s permission, a respondent may choose to remain in the CARE process for up to an additional year. In certain circumstances, the court may involuntarily reappoint a respondent to the process for up to an additional year.

More Information

For more information on the CARE court flow, see The CARE Process Flow to Treatment, Housing, and Support brief and the Overview of CARE Process for Supporters training.

Self-Care and Resiliency for Volunteer Supporters

Serving as a supporter through the CARE process is an important and challenging role, and supporters themselves may experience stress and responses to trauma. Trauma-informed care can help supporters cultivate self-care and resilience. Trauma-informed strategies include self-care, avoiding burnout, reducing stress levels, setting boundaries, and asking for help.

Keep in mind the following:

Supporters need support: Reach out to trusted people for support. It is important to maintain the respondent’s confidentiality when seeking support.
Supporters need breaks: On a consistent basis, take time to do relaxing activities (e.g., reading, knitting, walking, meditating, watching movies, praying).
Supporters need to believe in themselves: Supporters can feel more confident about their role by learning about the CARE process through training, reading, and asking questions. Supporters should feel proud of their important role in the CARE process.

More Information

For more information on resiliency and self-care for supporters, see the training Applying Trauma-informed Care in Practice.

List of Resources for Supporters

Viewing the trainings and resources available on the CARE Act Resource Center can help supporters better understand the CARE process and how to fulfill their role.

The supporter should consider tracking progress and note any follow-up questions in the Volunteer Supporter Worksheet.

Trainings

Overview of CARE Process for Supporters

Overview of the background on the CARE Act, roles within the process, and a high- level description of the court process.

Overview of CARE Agreement & CARE Plan for Volunteer Supporters

Provides an overview of and compares the three main paths to services in the CARE process, including voluntary engagement, CARE agreement, and CARE plan. Discusses elements of a CARE agreement and CARE plan, as well as the importance of individualizing the CARE agreement and CARE plan to the needs of the individual.

Housing, Services, & Supports Availble Through the CARE Act: Training for Supporters.

Provides an overview of the volunteer supporter’s role with regards to housing and community supports in the CARE Act. Details housing and supports that may be included in the CARE process, including the housing first approach, snapshots of the housing continuum for CARE participants, and elements of the CARE agreement and plan specific to housing and community supports.

CARE Act 202: The CARE Agreement & CARE Plan; Housing and Community Supports

Information about the components of a CARE agreement and CARE plan that the client engages in throughout the stages of the CARE process. Additionally, an overview of housing and community supports is provided.

The Supporter Role in the CARE Act

Explores the role of a volunteer supporter through a case study and outlines the CARE Act volunteer supporter responsibilities, requirements, and components.

Role of the Family in the CARE Process

Discusses the ways in which family members can participate in the CARE process, including as the petitioner, volunteer supporter, or through informal support. Details action steps for families involved in the CARE process to support their family member.

Supported Decisionmaking for Volunteer Supporters

Provides definitions of supported decisionmaking (SDM) and highlights its key concepts and principles. Outlines how to support the respondent to make their own decisions under an SDM framework.

Maintaining Neutrality as a Volunteer Supporter

Discusses the relationship between the supporter and the respondent. Reviews the importance of fully supporting the respondent’s self-determination. Scenarios are used to illustrate how different relationships may pose challenges to the supported decisionmaking process.

Psychiatric Advance Directives

Reviews the background, purpose, and evidence of psychiatric advance directives (PADs). Discusses the when, who, how, and what of PADs in the CARE process.

Schizophrenia Spectrum Disorders & Evidence-based Care: Part 1 Schizophrenia Basics

Provides an overview of schizophrenia. Discusses the when and how of a schizophrenia diagnosis, along with an overview of related disorders, associated diagnoses, and complications.

Schizophrenia Spectrum Disorders & Evidence-based Care: Part 2 Evidence-based Practices in Schizophrenia

Introduces approaches and practices used to treat individuals with schizophrenia, including a person-centered approach, assertive community treatment, and medications.

Schizophrenia Spectrum Disorders & Evidence-based Care: Part 3 Supporting People with Schizophrenia

Introduces concepts to consider while supporting an individual with schizophrenia. Provides helpful strategies, including how to react to hallucinations and delusions, using a trauma-informed approach, building rapport, and meeting them where they are at. Reviews the recovery and supported decisionmaking models that can be applied to this population.