A Winning Collaboration CIT International Conference Enlightened Alternatives: How CIT and Diversion Are Cutting Recidivism and Saving Millions August 20, 2012 Clark County, Nevada Leon Evans Gilbert GonzalesPresident and Chief Executive Officer Melanie Lane Romana Lopez The Center for Health Care Services Aaron Diaz SergeantMental Health and Substance Abuse Jeanie Paradise CIT Unit Authority The Center for Health Care Services San Antonio Police Department Bexar County Bexar County, San Antonio Texas San Antonio, Texas firstname.lastname@example.org 1
2012 – Restoration Center Expansion; Building #2 added 2012 – Prospect Courtyard adds 80 bed MH residentialTimeline 2012 – Prospect Courtyard adds new MH Clinic 2011 – Prospect Courtyard Safe Sleeping reaches high of 714 2010 – In House Recovery Program Male and Female 104 sober living beds 2010 – Haven for Hope 1,600 Bed Homeless Facility opened 2010 – International Crisis Intervention Team Conference hosts 1,600 Officers 2008 – Restoration Center opened ; Detox, Sobering, IOP Treatment 2006 – Bexar County Jail Diversion receives APA’s Gold Award 2005 – 24/7 One Stop Crisis Care Center opened 2004 – Specialty Jail Diversion Facility opens 2003 – First Crisis Intervention Team Training begins 2003 – Deputy Mobile Outreach Team begun 2002 – Bexar County Jail Diversion Collaborative meets for 1 st time 2000 – CEO begins diversion efforts, full time coordinator is hired
Collaboration: It’s an unnatural act between… …two or more unconsenting adults. 4
Civil and CriminalSystem County City-wide System Level Entry Points Judicial/Courts Magistrate, County, District Probation, Parole County City-wide Continuity of Care Police, Sheriff Treatment Law Enforcement Crisis Care Center Detention/Jail Jail Diversion Mental Health CIT Psychiatric and Medical Public and Private Providers Clearance Specialty Offender Services Emergency Services • Community Collaborative • Crisis Care Center • Crisis Transitional Unit • Crisis Hotline (Nurselink) Dynamic • CIT/DMOT Community • SP5 Crisis Jail Diversion • Jail and Juvenile Detention Information Exchange • Statewide CARE Match 5
Today 62012 – The Bexar County Sheriff and San Antonio Police Chief mandate CIT Training
CIT Mental Health Detail • Mental health professional partners with a CIT Officer together to respond on calls dealing with a psychiatric crisis. • Team responds to high utilizer calls for the City providing follow up services to reduce the call volume. • Goal is to put officers back into service for patrol as soon as possible. – Reduce inappropriate incarcerations and costly emergency room visits. – Offer quality training to law enforcement. • Co-locate officer with the City unit and Sheriff Mental Health Unit for better collaboration and expedited call response
Dispatcher Training for 911Call Takers and Dispatchers • In 2007 - decided that dispatchers would also benefit from CIT Instruction and met with SAPD leadership to establish training. • Provided an abbreviated 12 hour CIT course for call takers and dispatchers in collaboration with CHCS • The goal of this training is to increase safety by educating caller takers on essential intelligence gathering and dispatching a CIT Trained officer to the scene.
Partnered with Fire and EMS • As of 2007 SAFD has attended every community training • has become co trainers with joint PD and Sheriff’s Officers • Have added a CIT component to their EMS In-service training. • Partnering for Integrated training with Fire/EMS has extended numerous opportunities for growth: – Officer and Fire/EMS better communication – Safety – Better utilization of resources
CRISIS CARE CENTER• Crisis Line• Crisis Assessment • Receives consumers• Mobile Crisis Outreach Team from law enforcement• Crisis Transitional Unit 24/7 7137 W. Military 645-1651 • Minor medical clearance • Call ahead preferred 210 225-5481 • Can not take violent or medically compromised individuals 10
Texas Veteran Jail Diversion and Trauma Recovery Project (TVJDTR)VETERANS SERVICES program :• inclusion and expansion of trauma specific treatment and trauma informed practice• monitoring of the delivery of veteran peer support services related to behavioral health issues• monitoring of the implementation of family member facilitated family-to-family education groups related to behavioral health issues• developing of collaborative advisory groups for supports and services for veterans and their families to initiate• enhance or expand community resource coordination related to basic needs with community partners, individuals and organizations• linkage to Therapeutic Justice Services
Restoration Center Addiction Services• Public Safety- Sobering Unit• Injured Prisoner Medical Services• Residential & Ambulatory Detoxification• Opiate Addiction Treatment Services• Outpatient Substance Abuse Services• Felony Drug Court COPSD Outpatient Services• In House Recovery Program Sober Living Bldg. #1 Opened April 15, 2008 Bldg. #2 Opened June 27, 2012 13
Serial Inebriants Program• Originally was staffed with nursing on front end• Re-organized to have EMT/Recovery Support Specialists on unit• Not treating medical, just sobering and engaging in relationship• Educating funders that multiple admissions not viewed as failure• Continued collaborations with law enforcement, EMS, 14 hospitals
Injured Prisoner Clinic • Added service to reduce ER waits and get police back on street • Blended funding through City and County • Open when University Hospital Clinic is closed. • PA/NP on duty fills dual roles of medical care and physicals for detox after hours. 15
Residential Detox• Originally licensed 44 beds. Reduced after 6 months to 27 due to flow from sobering to detox.• Barriers include low $$ reimbursement rates and wait list• Intervention only unless followed by additional treatment• Open to ER 24 hour admits• Funded by hospitals, DSHS, Medicaid 16
Outpatient Addiction Services• Originally started with clients who completed detox and were living at shelter• Barriers including safe and sober living environment and limited residential treatment beds in community• Need for individuals to be in recovery environment• Developed a short term ambulatory detox over 2-3 month period.• Partnered with Haven for Hope to start In House Recovery Program. 17
Recent Additions • Expansion into new building • 550 Opioid Addiction Treatment clients daily • Added 200 Outpatient clients to equal 400 • Project Carino – Pregnant Women Opioid Addiction Treatment. 18
Restoration Center Admissions14% (888 clients) went from sobering to detox 19
IHRP Mission Statement To provide a safe, structured, sober-living dormitory that supports residents committedto living sober lives and becoming productive, contributing members of society. 20
Outpatient Treatment12-Step PeerProgram Support Community
IHRP Outcomes• Total clients admitted Dec 2010 to March 2012 735• Total transferred from Residential Detoxification 413• Total clients still in care 96• Total Discharges 639• Total clients completing with positive outcomes 316• % completing with positive outcome 49.5%Positive outcomes are defined as having no alcohol/drug use, employment or other positive endeavor at discharge, development of recovery support system (e.g., 12-Step, church). 23
PROSPECTS COURTYARDDeveloped two years ago to address basic needs of food, clothing & shelterCriteria:• 18 years of age (or older).• Physically able to care for themselves.
5 MAJOR GROUPS IN PCY1. Recently out of prison2. Mental Health Issues3. Substance Abuse Issues4. Elderly5. Young people aged out of foster care – or no longer allowed at home
Funded by The City of San Antonio & Private Donations• Capacity was set at 400 per night by contract April – June 2012.• Averaged 516 sleeping• Averaged 694 receiving some service during the day
IN-HOUSE WELLNESS PROGRAM MISSION STATEMENT: The mission of the CHCS In-House Wellness Program is to provide the following:
MISSION STATEMENT1. A safe, comprehensive, structured dormitory environment with a treatment plan tailored to meet the needs of the chronic, homeless, mentally ill who may suffer from co-occurring diseases including substance abuse.
MISSION STATEMENT2. A program including mental health medication and compliance to take said medications by the residents.
MISSION STATEMENT3. A program directed toward mental health stabilization and an ultimate transition to a more stable, individual living environment.
MISSION STATEMENT4. An environment of trust between staff and the residents that gradually assists them in their recovery to become self-reliant and independent.
ADULT MENTAL HEALTH CLINICConsumers referred will receive thefollowing services:
CONSUMER BENEFITS SPECIALIST• To provide benefits screening
PSYCHIATRIC AND NURSING SERVICES• Medications• Medication Management
Haven for Hope Homeless Facility CNN Video Clip “Texas officials hope a massive new facility will keep the homeless out of jail, emergency rooms and re-integrated into society”. • http://www.diversioninitiatives.net/2010/07/haven-for-hope-cnn-video-just-before.html 35
Haven for Hope Homeless Transitional Facility 36 www.havenforhope.org
What Works Emergency Room Utilization (Medical Clearance)Emergency Room utilization has dropped 40% sincethe inception of the Crisis Care Center.40% of (7619 total seen at CCC) 3048Persons diverted from the ER (in 2006 first year) X $1545Cost Savings relative to ER Utilization $4,709,160 Source: University Health System 39
Impact on WAIT TIME for LAW ENFORCEMENTThen (prior to Sept 2005) Now• Wait times for Medical • The wait time for Medical Clearance/ Screening at Clearance/ Screening at the UHS ER - 9 hours, 18 min. Crisis Care Center is 45 minutes.• Wait times for Medical • Wait time for Medical Clearance/ Screening and Clearance/Screening and Psychiatric Evaluation was Psychiatric Evaluation is between 12 and 14 hours. 60-65 minutes. 40
Recidivism Rates for Top Five CSCD’S35.0% 30.3%30.0%25.0% 22.6% Bexar 20.6% Harris20.0% Average 17.6% Tarrant15.0% Dallas* 12.7% Travis10.0% 6.6%5.0%0.0% Bexar Harris Average Tarrant Dallas* Travis *Dallas rates reflect only one mental health provider, Metro Care. 41
Combined CCC and Restoration Documented and Immediate Cost Avoidance Year One April 16, 2008 – March 31, 2009 Year Two April 16, 2009 – March31, 2010 Year Three April 16, 2010 – March 31, 2011 Cost Category City of San Antonio Bexar County Direct Cost Avoidance Public Inebriates Diverted from Detention $435,435 $1,983,574 $2,419,009 Facility $925,015 $2,818,755* $3,743,770 $1,322,685 $4,372,128 $5,694,813 A. B. Injured Prisoner Diverted from UHS ER $528,000 $1,267,200 $1,795,200 $435,000 $1,044,000 $1,479,000 $421,000 $1,010,400 $1,431,400 C. D. Mentally Ill Diverted from UHS ER Cost $322,500 $774,000 $1,096,500 $283,500 $676,000 $959,500 $276,500 $663,600 $940,100 E. F. Mentally Ill Diverted from Magistration $208,159 $371,350 $579,509 Facility $179,833 $322,300 $502,133 $126,893 $191,125 $310,018 G. H. 44 Summary next slide
BEXAR COUNTY DETENTION CENTER SYSTEM POPULATION MONTHLY AVERAGES (Main, Annex) 4400 4357 4337 4292 4300 4302 4300 4280 4289 4300 4260 4263 4253 4272 4222 4231 4225 4254 4210 4208 4261 4193SYSTEM POPULATION 4179 4200 4173 4171 4158 4156 4130 4139 4197 4190 4109 4133 4124 4095 4095 4094 4079 4084 4081 4100 4062 4094 4053 4040 4096 4028 4033 4015 4017 4077 4066 3987 4001 3993 4000 3981 4015 3960 3941 3946 3982 3897 On May 2011, there were 883 3900 empty beds in the jail 3845 3807 3854 3790 3791 3800 3743 3700 FEB DEC MAY SEP APR JAN MAR JUN AUG OCT JUL NOV 2006 2007 2008 2009 2010 2011
The End Result• Comprehensive service for most in need• Increased availability of comprehensive coordinated services• Reduced barriers to service access and increase motivation with treatment compliance• Employ evidence based practices known to be effective• Utilization of system tracking and outcome based treatment 47