Mobile Crisis Technical Assistance Request Form

The Medi-Cal Mobile Crisis Training and Technical Assistance Center (M-TAC) provides technical assistance and training to help develop or expand Medi-Cal mobile crisis services. Please complete this request form, and a member of the M-TAC team will contact you to discuss your request. Technical assistance is available for California counties, their mobile crisis services providers, Tribes, and Indigenous organizations.



    **M-TAC is not a direct service provider and does not provide any type of crisis response. Our standard operating hours are Monday through Friday from 8 a.m. to 5 p.m. PT.


    If you are experiencing an immediate medical emergency, please call 911, or go to the nearest emergency room if it is safe to do so. If you are experiencing an immediate psychiatric emergency, please call 988, or go to the nearest emergency room if it is safe to do so.

Contact Information

This individual will be contacted regarding your request for M-TAC technical assistance.

Please list the first and last name of the individual who should be contacted regarding this request.

Organization Type*

Which of the following best describes the organization for which you are requesting technical assistance?

Please select all that apply.

Select
Caret IconCaret symbol

About Your Request

What type of training and technical assistance are you looking for? Please select all that apply.

Select
Caret IconCaret symbol

Please select all that apply. Are there particular communities or populations in your county or region that will benefit from this support?

In what time frame are you looking to have services provided? Is there a date you are hoping to start receiving support, or a date or milestone by which you’d like to complete activities?

What are the goals or intended outcomes of this request? If possible, would you prefer on-site or virtual support? Please be as specific as you can, so we can connect you with the best information and resources available.


It is okay if you do not know exactly what you need yet. We will contact you to discuss your request in more detail.

Would you like to join our mailing list?*

If you would like to join our mailing list, please let us know here. We will not share or sell your information, and we will maintain data privacy.

Thank you for your interest!

M-TAC is funded by the California Department of Health Care Services (DHCS) and provided by the Center for Applied Research Solutions (CARS) in collaboration with Advocates for Human Potential, Inc. (AHP). 

Powered by Smartsheet Modern Logo On Light
Privacy Notice|Report Abuse