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Diversion First Stakeholders Meeting: May 16, 2019

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Diversion First Stakeholders Meeting: May 16, 2019

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Diversion First Stakeholders Meeting: May 16, 2019

  1. 1. Stakeholders Meeting | May 16, 2019
  2. 2. Meeting Agenda • Welcome • Announcements • Peer Recovery Supports • Discussion • Community Response Team • 2018 Jail Population Data • Wrap-Up 2
  3. 3. With Gratitude and Admiration… Gary Ambrose, Brigadier General, USAF (retired)
  4. 4. 2018 Annual Report • Overview of Diversion First • Highlights from 2018 • Specialty dockets • Community Response Team • Strive to Achieve Recovery (STAR) program • 2018 Data Snapshot • Plans for 2019 4
  5. 5. Contributing to the Field… • Published in early 2019 • A SAMHSA practice guide outlining principles for a quality, community-based behavioral health treatment system • Acknowledged as Expert Panelists! • Captain Tony Shobe, Sheriff’s Office • 2nd Lieutenant Redic Morris, Sheriff’s Office • Marissa Fariña-Morse, Service Director, CSB 5
  6. 6. Stepping Up for Mental Health • Stakeholders Meeting! • Annual Report • Mental Health Docket- News4 interview • Veterans Docket Graduation • SAMHSA Webinar on Early Diversion programs • Community presentations
  7. 7. FY 2020 Budget May 7, 2019- Board of Supervisors approved the FY 2020 budget, which included funding for the fourth year of Diversion First: • 12 positions • 6 Health and Human Services • 6 Public Safety • Additional funds for housing assistance and programming 7
  8. 8. FY 2020 Funding Highlights • Mental Health Docket Coordinator • Behavioral Health positions for Jail Diversion Team • Police and Sheriff’s Sergeants for MCRC • Fire and Rescue Technician and Crisis Intervention Specialists for Community Response Team • Probation Officer for JDRDC • Commonwealth Attorney 8 8
  9. 9. Mental Health Docket News Mental Health Docket Approved by the Virginia Supreme Court! Anticipated start- July, 2019 9
  10. 10. Well Done! 10
  11. 11. Peer Recovery Supports Michael Lane | Individual and Family Affairs Director Pictures courtesy of unsplash.com, used with permission
  12. 12. Why Peer Support? Experience of Disconnection: • Trauma • Unsustainable way of life • Criminality • A reality not shared by others • Devastated Relationships • Irreversible Consequences 12
  13. 13. Peer Support Connects/ Reconnects • Hope • Options • Treatment • Other Supports • Honesty • Healthy relationships 13
  14. 14. Shared Experience & New Experiences A Peer Supporter is a model of: • Overcoming obstacles • Creating and sustaining healthy relationships • Successful employment • Effectively dealing with trauma • Having fun in Recovery • Becoming one’s best self • A fulfilling life 14
  15. 15. “Natural” vs. “Professional” Peer Support • “Natural” Peer Support • Examples: • Breast Cancer Survivors • 12-Step Groups and Sponsors • No one is paid for their role • Boundaries determined only by the individuals involved. • “Professional” Peer Support • One individual is paid for their role. • Boundaries are determined by the employer, and the individuals involved
  16. 16. In Fairfax County STAR Program Specialty Dockets Emergency Services Residential Substance Use Treatment Programs Jail Diversion Opioid Task Force Wellness & Recovery Centers … and many more
  17. 17. CSB Emergency Services • Connect to: transportation, food banks, clothing closets, shelters, services at Merrifield and other CSB sites • De-escalate and provide support to address emergent crisis • Drop In group for parents and teenagers (HEADS UP, TALK IT OUT!) • Support groups and workshops • Monitor various spaces … and more!
  18. 18. Programs across US • Inpatient Treatment • Mobile Crisis Teams • Peer-Run Respites • Emergency Departments • Primary Care • Outpatient programs • Re-Entry programs • Inreach to incarcerated …and many more
  19. 19. Training and Skills • 72 hour training • 500 hours of supervised experience • 1 year of demonstrated recovery • Ability to share personal experiences in an intentional, positive manner • Capacity to listen to others share traumatic experiences • Ability to work effectively in multi-disciplinary teams
  20. 20. Peer Support Values • Hope • Many Paths • Relationship-Focused • Trauma-Informed • Shared Experience • Professionalism 20
  21. 21. Evidence Base • A study of 76 individuals who had been admitted to Yale-New Haven Psychiatric Hospital (all who had at least two psychiatric hospitalizations in the previous 18 months) compared the outcomes of those who had been assigned a peer mentor with the outcomes of those who received standard post-discharge services. The individuals in the peer mentor group had double the average time to psychiatric rehospitalization than those receiving standard care – 270 days compared to 135 days. (O’Connell, et al.; 2018) • Pierce County Washington reduced involuntary hospitalization by 32% by using certified peer specialists offering respite services, leading to a savings of 1.99 million dollars in one year (Bergeson; 2011)
  22. 22. More Evidence • A Federally Qualified Health Center in Denver (FQHC) that used peer support had an ROI of $2.28 for every $1 spent. • 90% of individuals who used a peer crisis respite in Orange County, NY did not return to the hospital in the subsequent two years. • A Connecticut program demonstrated a significant reduction in criminal charges and alcohol use in the 12 months subsequent to the peer interventions.
  23. 23. Source: Substance Abuse and Mental Health Services Administration
  24. 24. Important Considerations • Voluntary • Well-trained supervisors • Integration in teams OR Stand-alone • Connection with other Peer Supporters • Avoid • Clinical Drift • Informant Drift
  25. 25. Where along the Sequential Intercept Model would peer supports be most effective? Email: DiversionFirst@fairfaxcounty.gov
  26. 26. Co-Responder Model (Community Response Team) Abbey May| Emergency and Acute Services Director Kristina Deemark| Public Safety Communication Operations Laura Maddock| Emergency Services Supervisor
  27. 27. Co-Responder Model Community Response Team (CRT)- Public Safety and CSB responding together on super utilizers of public safety Diversion Proactive outreach, intervention, Diversion from arrest Reduction Reduction in calls for service for public safety Improvements Increased public safety and community health, more efficient and appropriate use of resources 27
  28. 28. Community Response Team CRT Pilot Operational Updates • MOU • Public Safety Electronic Referral Application Prototype (GIS capability) • CRT Brochure, Intro letter • FRD Internal email referral process CRTPartnerships • Inova ER Social workers (CareView access) • Office to Prevent and End Homelessness • PATH • Shelters • Adult Protective Services and Adult Services • Code Compliance • Peer Recovery Specialists CRTReferrals • MCRC • Crisis Link • Adult Protective Services • Older Adult Programs • Physician/Durable Medical Goods • CSB Services • Inpatient Psychiatric Care • Coordinated Services Planning
  29. 29. Community Response Team CRT Next Steps • Law Enforcement roll call training • Fire and Rescue Department (FRD) station outreach • Referral reference built into Computer-Aided Dispatch (CAD) system • FRD Emergency Medical Service (EMS) web based training tool 29
  30. 30. Community Response Team Current Super-Utilizer Count 30
  31. 31. Community Response Team
  32. 32. Community Response Team
  33. 33. 2018 Jail Behavioral Health Population Analysis Chloe Lee| Data and Evaluation Manager
  34. 34. Behavioral Health Population Booked into Jail: 2015-2018 • There was an 8% decrease in the number of inmates in the behavioral health population booked into jail from 2015 to 2018. However, the percentage remained the same (35%). 4,492 4,276 3,983 4,127 35.2% 34.5% 32.1% 35.0% 20% 22% 24% 26% 28% 30% 32% 34% 36% 38% 3,000 3,200 3,400 3,600 3,800 4,000 4,200 4,400 4,600 4,800 5,000 2015 2016 2017 2018 Number of inmates in behavioral health population % of inmates in behavioral health population 34
  35. 35. Behavioral Health Population with Misdemeanor Charges: 2015-2018 • The Diversion First population is individuals with behavioral health issues who are frequently in and out of jail with low level charges. • Data shows that the number and the percentage of the target population has decreased over time. 1,854 1,614 1,492 1,507 41.3% 37.8% 37.4% 36.5% 34% 35% 36% 37% 38% 39% 40% 41% 42% 0 200 400 600 800 1,000 1,200 1,400 1,600 1,800 2,000 2015 2016 2017 2018 Number of behavioral health population with misdmeanor charges and no felony in 2018 % of behavioral health population with misdemeanor charges and no felony 35
  36. 36. Inmates who were Referred to CSB Jail- based Services: 2015- 2018 • There was a 43% increase in the number of inmates who were referred to CSB jail-based services from 2015 to 2018. 2,286 2,632 3,028 3,275 17.8% 21.2% 24.4% 27.8% 0% 5% 10% 15% 20% 25% 30% 0 500 1,000 1,500 2,000 2,500 3,000 3,500 2015 2016 2017 2018 Number of inmates referred to CSB jail-based services % of inmates referred to CSB jail-based servies (all jail population) 36
  37. 37. 2018 Jail Behavioral Health Population: Demographic Characteristics (N=4,127) 55.2% 41.0% 3.6% 0.2% 0% 10% 20% 30% 40% 50% 60% White Black Asian Other Race 4.1% 10.6% 14.8% 30.1% 20.7% 19.7% 60 or higher 50-59 40-49 30-39 25-29 18-24 Age categories BH No BH Homelessness Gender 6.2% 4%
  38. 38. 2018 Jail Behavioral Health Population: Mental Health Diagnosis (N=4,127) • Over 41% of the behavioral health population (15% of the jail population) had at least one mental health diagnosis. • The most common mental health diagnosis among the behavioral health population was depression. • Female inmates in the behavioral health population were more likely to have a mental health diagnosis than male inmates. 01 • DEPRESSION 12.1% 02 • PTSD 7.2% 03 • BIPOLAR DISORDER 6.6% Most Common MH Diagnosis 59% of the female inmates in the behavioral health population had mental health diagnosis (21% of all female inmates booked into jail in 2018). of the male inmates in the behavioral health population had mental health diagnosis (13% of all male inmates booked into jail in 2018).38% 38
  39. 39. 2018 Jail Behavioral Health Population: Substance Use Disorder (SUD) Diagnosis (N=4,127) • 58% of the behavioral health population (20% of the jail population) had at least one SUD diagnosis, including alcohol. • Male inmates in the behavioral health population were more likely to have an SUD diagnosis than female except for opioid- related diagnosis. • 62% of the white inmates in the behavioral health population had an SUD diagnosis. 30% 19% 38%36% 13% 43% Alcohol Opioid Other SUD SUD by Gender % of male/female behavioral health population Female Male 62% 54% 45% White Black Asian SUD by Race % of white/black/Asian behavioral health population
  40. 40. Days in Jail • There was a 17% decrease in total days in jail per year for the behavioral health population with misdemeanor charges (no felony) in the year. 22,545 19,377 18,351 18,672 2015 2016 2017 2018 Total days in jail per year for the behavioral health population with misdemeanor charges (no felony) in the year 2015-2018: 17% decrease 40
  41. 41. Released to Pretrial Supervision • There was a significant increase in the percentage of inmates in the behavioral health population released to pretrial supervision in 2018 from the previous year. • Among the behavioral health population, those with felony charges who were released to pretrial supervision at least once in 2018 stayed less days in jail than those who were not released to pretrial supervision. 22% 16% 31% 19% Felony Misdemeanor Released to pre-trial supervision among the behavioral health population: 2017 vs. 2018 % of behavioral health population 2017 2018 Pretrial supervision up from 2017 among inmates in the behavioral health population 30 DAYS 48 DAYS Average total days in jail in 2018 for the behavioral health population with felony: Pretrial supervision vs. No pretrial supervision BH with one or more felony on pretrial supervision BH with one or more felony not on pretrial supervision
  42. 42. Most Common Charge Types: BH vs. No BH • There was a significant difference between inmates in the behavioral health population and inmates not in the behavioral population in most common types of charge. • The most frequent charge type for the behavioral health population was violation of conditions. 2015-2018: 17% decrease 29% 8% 19% 13% 14% 15% 12% 13% 18% 21% 23% 38% DWI Assault/Battery Alcohol-related charges Robbery/theft/Larceny Drug-related charges Violation of conditions Most common charge types: Behavioral health population vs. Non- behavioral health population* BH No BH * Ordered by most common charge types among the behavioral health population
  43. 43. Takeaways • Over time, there has been a decrease in the number and the percentage of inmates with behavioral health issues with low level charges who are frequently in and out of jail. • There has been a significant increase in the number of inmates who are referred to CSB services in jail. • There has been an increase in the number and the percentage of the behavioral health population released to pretrial supervision. For those who were released to pretrial supervision, days in jail was significantly lower, especially among the inmates with felony charges.
  44. 44. Methodology & Limitations • Jail population analysis: Only the inmates who were booked into jail each year were included. • Length of Stay and Release analysis: Only the inmates who were booked and released in the same year were included. • “Behavioral health population” was identified from CSB Electronic Health Record (EHR). The analysis includes all inmates known to the CSB behavioral health system regardless of screening results of the Brief Jail Mental Health Screening or referral to CSB jail-based services during their stay in jail. Inmates may not have had active behavioral health issues upon their booking in 2018.
  45. 45. 2019 Sequential Intercept Model Mapping Community Reentry National Association of Counties (NACo) Leadership Lab Opportunities for stakeholder feedback
  46. 46. Next Stakeholders Meeting September 30, 2019 7 p.m. Government Center, Rooms 9 & 10 46

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