Jail Diversion Trauma Recovery, Unspoken Wounds: Breaking the Silence 2013 10-22

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Overview presentation of the successful jail diversion program in Bexar County presented by Gilbert Gonzales at the Georgia JDTR Conference, October 20-22, 2013 Hyatt Regency, Savannah, Georgia

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  • 7.3List the mental health facilities in your area that can be utilized as a resource when encountering a subject/suspect you identify as having possible mental health issues
    Instructor Note: Use MHMR or comparable entity for state referral sources per region. Have students compile a referral list and research appropriate contact numbers.
  • Jail Diversion Trauma Recovery, Unspoken Wounds: Breaking the Silence 2013 10-22

    1. 1. "Jail Diversion Trauma Recovery in Texas: Challenges & Successes in Program Implementation & State Policy Change" Jail Diversion and Trauma Recovery Priority to Veterans: Program Department of Behavioral Health and Developmental Disabilities Division of Mental Health Conference, Savannah, GA October 22, 2013 Gilbert R. Gonzales Communications and Diversion Initiatives The Center for Health Care Services Mental Health and Substance Abuse Authority Bexar County San Antonio, Texas ggonzales@chcsbc.org 1
    2. 2. 2
    3. 3. Military Bases • Lackland Air Force Training Center • Randoph • Brook Army Medical Center • Ft. Sam Houston BRAC: 2.1 Billion in Military Construction Center for the Intrepid Center for the Intrepid
    4. 4. 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
    5. 5. 5
    6. 6. Today 2012 – Bexar County Sheriff/San Antonio Police Chief mandate 100% CIT Training for Patrol 6
    7. 7. Dispatcher Training for 911 Call 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.
    8. 8. 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
    9. 9. Police Roll Call Video 9
    10. 10. CRISIS CARE CENTER • • • • Crisis Line Crisis Assessment Mobile Crisis Outreach Team Crisis Transitional Unit 7137 W. Military 645-1651 • Receives consumers from law enforcement 24/7 • Minor medical clearance • Call ahead preferred 210 225-5481 • Can not take violent or medically compromised individuals 10 10
    11. 11. The Restoration Center • Opened April 15, 2008 • Public Safety- Sobering Unit • Detoxification Facility • Community Court • Outpatient Substance Abuse Services 11
    12. 12. 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, hospitals 12
    13. 13. 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. 13
    14. 14. 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 14
    15. 15. PROSPECTS COURTYARD Developed two years ago to address basic needs of food, clothing & shelter Criteria: • 18 years of age (or older). • Physically able to care for themselves. • Sleeping 500 to 750 per night
    16. 16. Haven for Hope Homeless Transitional Facility 16 www.havenforhope.org
    17. 17. Show me the DATA !!! 17
    18. 18. COMMUNITY MEDICAL DIRECTOR’S ROUNDTABLE Data Roundtable: Monthly Meeting from 2003 to Present Tuesday, Aug 27, 2013 @ 8:30 a.m. I. II. Welcome Introduction – Dr. Jason Miller, new Medical Director for Crisis Services III. Crisis Care Center Services All Reports; CCC Data, MCOT Restoration Center Services All Reports; Detox, Sobering etc. Adult MH Services Wait List Integrated Care Team, High Utilizers Preadmission Screening and Residential Review Process (PASRR) Children’s Services San Antonio State Hospital (SASH) Haven for Hope Update Prospect Courtyard San Antonio Police Dept. (SAPD) Bexar County Sheriff’s Office 1151 Waiver Update New Business Adjournment – Next meeting; September 24, 2013 IV. V. VI. VII. VIII. IX. X. XI. XII XIII. 18
    19. 19. What Works Emergency Room Utilization (Medical Clearance) Emergency Room utilization has dropped 40% since the inception of the Crisis Care Center. 40% of (7619 total seen at CCC) 3048 Persons diverted from the ER (in 2006 first year) X $1545 Cost Savings relative to ER Utilization $4,709,160 Source: University Health System 19
    20. 20. Impact on WAIT TIME for LAW ENFORCEMENT Then (prior to Sept 2005) • Wait times for Medical Clearance/ Screening at UHS ER - 9 hours, 18 min. • Wait times for Medical Clearance/ Screening and Psychiatric Evaluation was between 12 and 14 hours. Now • The wait time for Medical Clearance/ Screening at the Crisis Care Center is 10 minutes. • Wait time for Medical Clearance/Screening and Psychiatric Evaluation is 20 minutes. 20
    21. 21. Recidivism Rates for Top Five CSCD’S 35.0% 30.3% 30.0% 25.0% 22.6% Bexar Harris Average Tarrant Dallas* Travis 20.6% 20.0% 17.6% 15.0% 12.7% 10.0% 6.6% 5.0% 0.0% Bexar Harris Average Tarrant Dallas* Travis *Dallas rates reflect only one mental health provider, Metro Care. 21
    22. 22. 1,600 22
    23. 23. Combined CCC and Restoration Documented and Immediate Cost Avoidance Cost Category Year One April 16, 2008 – March 31, 2009 Year Two April 16, 2009 – March31, 2010 City of San Antonio Bexar County Year Three April 16, 2010 – March 31, 2011   Public Inebriates Diverted from Detention Facility   Direct Cost Avoidance $4,372,128 $5,694,813 B.   $528,000   $1,267,200   $1,044,000   $1,795,200 $421,000   C. $1,010,400 $1,431,400   $322,500   $283,500   $774,000   $676,000   $1,096,500 $276,500 $663,600 $940,100 E.   Mentally Ill Diverted from Magistration Facility     $2,419,009   $3,743,770 A.   Mentally Ill Diverted from UHS ER Cost     $1,983,574   $2,818,755* $1,322,685   Injured Prisoner Diverted from UHS ER     $435,435   $925,015 F.   $208,159   $179,833   $371,350   $322,300   $579,509 $126,893 $191,125   H. $310,018 $435,000 G. $1,479,000 D. $959,500 $502,133 Summary next slide 23
    24. 24. Summary Savings 2008 - 2013 Summary  24
    25. 25. BEXAR COUNTY DETENTION CENTER SYSTEM POPULATION MONTHLY AVERAGES (Main, Annex) 4400 4280 4260 4200 4179 4100 4015 3987 4000 3982 4253 4139 4084 4096 4263 4028 3981 3941 4109 4094 4001 4095 4222 4210 4173 4133 4081 4053 4302 4300 4292 4193 4130 4079 4337 4208 4272 4261 4197 4171 4231 4156 4095 4225 4158 4190 4033 4066 3993 4015 4300 4094 4062 4040 4077 4289 3897 2008 2009 2010 2011 NOV OCT SEP AUG 2007 JUL 2006 On May 2011, there were 883 empty beds in the jail JUN 3743 MAY 3791 APR 3790 MAR 3700 3854 FEB 3800 4017 3960 3946 3900 3807 4124 3845 DEC 4254 JAN SYSTEM POPULATION 4300 4357
    26. 26. “The best time to plant a tree is 20 years ago. The second best time is now.” 2013 – Prospects Courtyard CMS Innovation BH/Health Integration      2012 – Restoration Center Expansion; Building #2 added      Timeline Timeline 2012 – Prospect Courtyard adds 80 bed MH residential 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
    27. 27. QUESTIONS? 27
    28. 28. The Center for Health Care Services Gilbert Gonzales The Center for Health Care Services Mental Health Authority 210 731-1300 www.chcsbc.org ggonzales@chcsbc.org 28

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