Heartland CIT: Toward Comprehensive Evaluation


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Presented by: Shinobu Watanabe-Galloway
Steve Spelic

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  • Population: (2009 Census Estimates)Nebraska: 1,796,619Douglas County: 510,199 (83% White; 12% Black; 10% Hispanic; 3% Asian)Omaha: 419,945Sarpy County: 153,504 Lancaster County: 281,531Lincoln: 241,167Council Bluff: 60,271
  • 70% of the CIT participants are from police departments. The Omaha Police Department had the highest number (160 officers). Their total workforce number is 776, this means that 21% of their workforce has been trained for CIT. Douglas County Sheriff’s Dpt has had 38 officers. They have total of 130 officers in their workforce, meaning 30% of the workforce has been trained for CIT. Douglas County Corrections’ total workforce is 316; this means that 10% of workforce has been trained for CIT.
  • Heartland CIT: Toward Comprehensive Evaluation

    1. 1. Heartland CIT: Toward Comprehensive Evaluation<br />International Crisis Intervention Team Conference 2010 <br />San Antonio, Texas<br />June 1, 2010<br />Shinobu Watanabe-Galloway<br />Steve Spelic<br />1<br />
    2. 2. Acknowledgement <br />Consumers, families, and advocates who made the implementation of Heartland CIT program possible<br />Officers and agency leaders who have participated and embraced the program<br />Providers and other professionals who have helped the planning and implementation <br />CIT Council members and all other individuals and organizations involved<br />University of Nebraska Medical Center College of Public Health Evaluation Team<br />2<br />
    3. 3. Workshop Objectives <br />Learn about a comprehensive evaluation approach used by Heartland CIT Program<br />Learn how Heartland CIT used evaluation data to improve curriculum and identify training needs<br />3<br />
    4. 4. Heartland CIT Program <br />4<br />
    5. 5. U.S. Census 2009 Estimates<br /><ul><li>Nebraska: 1.8 million
    6. 6. Douglas County: 510,199 (Omaha: 419,949)
    7. 7. Sarpy County: 153,504</li></li></ul><li>Background<br />Nebraska Chapter of NAMI coordinated an effort for diversion programs including CIT<br />Consumers/families have played an important role in planning and implementation<br />CIT Council established in December 2005<br />Began with 2 workshop per year with three agencies to 3 workshops per year<br />6<br />
    8. 8. 7<br />
    9. 9. CIT Participating Agencies<br />8<br />
    10. 10. Heartland CIT Program Evaluation<br />9<br />
    11. 11. 10<br />2006<br />2007<br />2008<br />2010<br />2009<br />Wksp 1<br />Wksp 2<br />Wksp 3<br />Wksp 4<br />Wksp 5<br />Wksp 6<br />Wksp 7<br />Wksp 8<br />Wksp 9<br />Wksp 10<br />Wksp 11<br />Wksp 12<br />Onsite Paper & Pencil Survey<br />2007 January<br />2008 <br />October<br />Follow-up <br />Mailed<br /> Survey<br />Follow-up <br />Internet<br /> Survey<br />2009 Jun - Dec<br /> Encounter<br />Forms<br />2010 Apr - May<br />Focus <br />Groups<br />
    12. 12. 11<br />2006<br />2007<br />2008<br />2010<br />2009<br />Wksp 1<br />Wksp 2<br />Wksp 3<br />Wksp 4<br />Wksp 5<br />Wksp 6<br />Wksp 7<br />Wksp 8<br />Wksp 9<br />Wksp 10<br />Wksp 11<br />Wksp 12<br />Onsite Paper & Pencil Survey<br />
    13. 13. On-Site Survey<br />To evaluate participant’s assessment of <br />Usefulness of each session in terms of content covered and instruction methods used<br />Instructor / instruction <br />Logistics (e.g., facility, communication prior to workshop)<br />Benefits of overall CIT workshop<br />Data has been used to:<br />Improve the overall curriculum (changing schedule, time allocation, new topics added, etc)<br />Refine materials for specific sessions<br />Identify alternative instructors in a few cases<br />12<br />
    14. 14. 13<br />Onsite Questionnaires<br />- Paper-and-pencil survey<br />- Curriculum / instruction <br /> survey<br />Session Survey<br />1-page survey completed after each session<br />Summary Survey<br />2-page survey completed at the end of 1-week workshop.<br />Session Survey Example<br />
    15. 15. 14<br />Summary Survey Example<br />
    16. 16. Onsite Surveys: Major Findings<br />About 70% of officers reported that they did not have adequate knowledge prior to the workshop<br />Overview of mental illness, substance abuse<br />Older adults / children, developmental disabilities<br />Active listening, crisis de-escalation, suicide prevention<br />Community resources<br />Cultural aspects<br />15<br />
    17. 17. Major Findings (cont’d)<br />More than 90% of officers reported enhancement of knowledge from all 21 topics except 3 (children – 89%; substance abuse 86%; co-occurring 78%)<br />Sessions that received very positive ratings were:<br />Consumer / Family Perspectives<br />Scenario-based training <br />Hearing Voices<br />Site Visits<br />Workshops provided opportunities for interaction and gaining insight about mental illness<br />16<br />
    18. 18. Addressing CIT Class<br />The Chief of Police and the Douglas County Sheriff addressing the class at the beginning of training.<br />Family Perspectives<br />Family members sharing their stories with the class.<br />
    19. 19. 18<br />Hearing Voices & Virtual Hallucination Sessions<br />Two of the most popular sessions of CIT Workshop.<br />
    20. 20. 19<br />Scenario Based Training:<br />Two officers just beginning a scenario <br />and coming to a person’s apartment. <br />The lady in the picture is one of our <br />actors who is portraying a client in crisis. Officers are just showing up “on the scene” to deal with a mental health crisis.<br />Interaction – Outside of Scenario Based Training <br />Shows interaction between actors of the scenario training, an officer, and a consumer (the officer and consumer are the evaluators of the scenarios) - this is occurring just outside the rooms where we do the scenario training.<br />
    21. 21. 20<br />Opportunities for Interactions:<br />During the workshop, especially around scenario-based sessions, lots of interactions and conversations happened among officers, between officers and consumers and workshop coordinator. <br />
    22. 22. 21<br />2006<br />2007<br />2008<br />2010<br />2009<br />Wksp 1<br />Wksp 2<br />Wksp 3<br />Wksp 4<br />Wksp 5<br />Wksp 6<br />Wksp 7<br />Wksp 8<br />Wksp 9<br />Wksp 10<br />Wksp 11<br />Wksp 12<br />Onsite Paper & Pencil Survey<br />2007 Fall/Winter<br />2008 <br />Fall<br />Follow-up <br />Mailed<br /> Survey<br />Follow-up <br />Internet<br /> Survey<br />
    23. 23. 5-Month Mailed Follow-up Survey of Sep 2006 Graduates (N=20 / 23) (January 2007)<br />I used different questions and handled the person differently than in the past. <br />I have a more calm and open approach with the person in crisis. <br />I gave the party involved more time to process the questions that I asked.<br />I have asked about their book if they have one or if they have a plan as to what we can do to assist them better especially when they have a history of documented mental illness. <br />22<br />
    24. 24. 23<br />
    25. 25. 24<br />
    26. 26. Internet Follow-up Survey of OPD Graduates (N=24/104) (October 2008)<br />Survey monkey makes it easy to collect and analyze data<br />The downside is low response rate<br />Reminder and notice from the department may increase response rate <br />25<br />
    27. 27. Usefulness of CIT Classes <br />26<br />
    28. 28. 27<br />2006<br />2007<br />2008<br />2010<br />2009<br />Wksp 1<br />Wksp 2<br />Wksp 3<br />Wksp 4<br />Wksp 5<br />Wksp 6<br />Wksp 7<br />Wksp 8<br />Wksp 9<br />Wksp 10<br />Wksp 11<br />Wksp 12<br />Onsite Paper & Pencil Survey<br />2007 January<br />2008 <br />October<br />Follow-up <br />Mailed<br /> Survey<br />Follow-up <br />Internet<br /> Survey<br />2009 Jun - Dec<br /> Encounter<br />Forms<br />
    29. 29. 28<br />Incidence Tracking Form<br />Pilot tested for Douglas Co. <br />Sheriff’s Dept and Omaha PD<br />June – Dec. 2009<br />135 forms completed <br />
    30. 30. Consumer Demographics<br />
    31. 31. 30<br />Reporting Party<br />Known Person?<br />Repeated Call?<br />
    32. 32. Nature of Incident<br /> (“Check all that apply”)<br />
    33. 33. Behaviors at time of Incident <br />(“Check all that apply”)<br />Diagnosis <br />(“If known” / “Check all that apply”)<br />
    34. 34. Encounter Outcomes <br />
    35. 35. Consumer Characteristics: Sheriff’s Dpt vs. OPD (CIT officers)<br />Similarities: Age, gender, race, diagnosis<br />Differences in disposition of consumers <br />Disorderly /disruptive (Sheriff: 41% vs. OPD:13%)<br />Neglect of self care (Sheriff: 30% vs. OPD: 14%)<br />34<br />
    36. 36. CIT vs. Non-CIT (Sheriff’s Dpt Data)<br />Disorderly/Disruptive disposition <br />Sheriff: 40.5% vs. OPD: 12.7%<br />Female consumers <br />Sheriff: 64.9% vs. OPD: 45.1%<br />35<br />
    37. 37. 36<br />2006<br />2007<br />2008<br />2010<br />2009<br />Wksp 1<br />Wksp 2<br />Wksp 3<br />Wksp 4<br />Wksp 5<br />Wksp 6<br />Wksp 7<br />Wksp 8<br />Wksp 9<br />Wksp 10<br />Wksp 11<br />Wksp 12<br />Onsite Paper & Pencil Survey<br />2007 January<br />2008 <br />October<br />Follow-up <br />Mailed<br /> Survey<br />Follow-up <br />Internet<br /> Survey<br />2009 Jun - Dec<br /> Encounter<br />Forms<br />2010 Apr - May<br />Focus <br />Groups<br />
    38. 38. Focus Groups – Preliminary Results<br />Three focus groups<br />OPD<br />Douglas County Corrections<br />Douglas County Sheriff’s Department<br />Conducted in March – April 2010<br />4 – 10 people participated for each group<br />Five Questions<br />37<br />
    39. 39. 1. Skills or knowledge areas gained<br />2. Training needs<br />Awareness and knowledge of mental illness<br />Knowledge of medication<br />Communication and de-escalation skills <br />Attitudes (tolerance and openness) <br />More options for handling crisis situations <br />WRAP plan helped to establish trust<br />Learned about community resources and organizations<br />Continuing education on new medications/ updates on mental illness and treatment<br />Expansion on communication techniques<br />Training tailored to meet specific needs of agencies <br />Intervention with youths <br />Section that addresses mental health of officers (to remove stigma)<br />38<br />
    40. 40. 3. Refresher Course?<br />4. Youth Specific CIT Program Needed?<br />Follow up within 6 months<br />Continuing education annually <br />Give participants a chance to go back to CIT workshop and help train others <br />Networking opportunities<br />Update contact information for current resources<br />Video-tape session to make the CIT available to officers who cannot attend<br />Yes because it will <br />Remove a current gap in the CIT program<br />Prepare officers for interacting with youth<br />Help remove stigma and labeling of youth, and improve acceptance of youth with mental illnesses<br />Could be a 1-day program that would attract more participants<br />39<br />
    41. 41. 5. Other Suggestions<br />Have a ‘Corrections’ specific class: different needs and many facilities could participate<br />Develop a better policy for dealing with hospitals: need more standardization between hospitals and officers need to know which one is best equipped to handle different situations.<br />More information on interacting with the elderly.<br />More applied, hands-on learning.<br />40<br />
    42. 42. Future Directions<br />Information from multiple sources – Key stakeholders including consumers, families, providers<br />System-level analysis<br />Economic analysis <br />Impact on community <br />41<br />
    43. 43. 42<br />Community<br />Consumers and Families <br />Criminal <br />Justice <br />Providers<br />Law Enforcement<br />Community<br />
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