2013 10-15 cit international conf hartford conn

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2013 10-15 cit international conf hartford conn

  1. 1. 1 CIT’s Role in Sustainability And Strengthening the Public Safety Net October 15, 2013 CIT International Conference Hartford, Connecticut Leon Evans President and Chief Executive Officer The Center for Hope; Mental Health and Substance Abuse Authority Bexar County San Antonio, Texas levans@chcsbc.org Gilbert R. Gonzales Communications and Diversion Initiatives The Center for Hope; Mental Health and Substance Abuse Authority Bexar County San Antonio, Texas ggonzales@chcsbc.org
  2. 2. 2
  3. 3. 3 Community Wide Jail Diversion: The Problem • Criminalization of Mentally Ill • Inappropriate Cost to Society – 20% + in jail – Increased use of emergency rooms – Homelessness • Public Safety Net – Consumers at risk – Law Enforcement at risk – Public at risk
  4. 4. 4 Key Elements: Effective Pre Booking Diversion 1. Identification-Intervention at earliest point Detention, Arrest, Pre Booking 2. Partnering and training with local law enforcement, first responders, call takers, dispatch and criminal justice Addressing operational obstacles Crisis Intervention Teams/Training (40 hours minimum) including trauma informed, trauma specific curriculum Include Magistration, Probation and Parole 3. Planning: Stakeholder/Community Monthly priorities and implementation meetings with feedback 4. Services access and coordination; central access Crisis (Psychiatric) Screening /Intervention/Treatment: Drop Off Medical Clearance Substance abuse intervention: Drop Off, Sobering, Peer Advocates/Detox Residential access Boots on the Ground (boundary spanners) No wrong door 5. Data – tracking data and $$$ Community stakeholder developed data fields High Utilizer tracking Wide review and distribution of descriptive data 6. Reports of Success or “Every success has a story”
  5. 5. 2002 – Bexar County Jail Diversion Collaborative meets for 1st time 2003 – First Crisis Intervention Team Training begins 2004 – Specialty Jail Diversion Facility opens 2005 – 24/7 One Stop Crisis Care Center opened 2006 – Bexar County Jail Diversion receives APA’s Gold Award 2008 – Restoration Center opened ; Detox, Sobering, IOP Treatment 2010 – Haven for Hope 1,600 Bed Homeless Facility opened 2010 – International Crisis Intervention Team Conference hosts 1,600 Officers 2000 – CEO begins diversion efforts, full time coordinator is hired 2003 – Deputy Mobile Outreach Team begun 2011 – Prospect Courtyard Safe Sleeping reaches high of 714 2012 – Prospect Courtyard adds new MH Clinic 2012 – Prospect Courtyard adds 80 bed MH residential 2012 – Restoration Center Expansion; Building #2 added 2010 – In House Recovery Program Male and Female 104 sober living beds TimelineTimeline 2013 – Prospects Courtyard CMS Innovation BH/Health Integration
  6. 6. 6 Law Enforcement Detention/Jail CIT Judicial/Courts Magistrate, County, District Mental Health Public and Private Providers Crisis Care Center Jail Diversion Psychiatric and Medical Clearance Specialty Offender Services CommunityDynamic Crisis Jail Diversion Information Exchange Police,Sheriff Probation,Parole Civil and Criminal Treatment ContinuityofCare County City-wide Emergency Services • Community Collaborative • Crisis Care Center • Crisis Transitional Unit • Crisis Hotline (Nurselink) • CIT/DMOT • SP5 • Jail and Juvenile Detention • Statewide CARE Match System County City-wide Entry Points System Level
  7. 7. 7 Today 2012 – Bexar County Sheriff/San Antonio Police Chief mandate 100% CIT Training for Patrol
  8. 8. 8 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
  9. 9. 9 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.
  10. 10. 10 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
  11. 11. 1111 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 11
  12. 12. Restoration Center Addiction Services 12 Bldg. #1 Opened April 15, 2008 Bldg. #2 Opened June 27, 2012 • 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
  13. 13. 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, hospitals
  14. 14. 14 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. 15. 15 PROSPECTS COURTYARD Developed two years ago to address basic need of food, clothing & shelter Criteria: • 18 years of age (or older). • Physically able to care for themselves.
  16. 16. 16 Haven for Hope Homeless Transitional Facility www.havenforhope.org
  17. 17. 17 Show me the DATA !!!
  18. 18. Data Roundtable 2003 to Present 18 COMMUNITY MEDICAL DIRECTOR’S ROUNDTABLE AGENDA Tuesday, Aug 27, 2013 @ 8:30 a.m. I. Welcome II. Introduction – Dr. Jason Miller, new Medical Director for Crisis Services III. Crisis Care Center Services All Reports; CCC Data, MCOT IV. Restoration Center Services All Reports; Detox, Sobering etc. V. Adult MH Services Wait List Integrated Care Team, High Utilizers Preadmission Screening and Residential Review Process (PASRR) VI. Children’s Services VII. San Antonio State Hospital (SASH) VIII. Haven for Hope Update IX. Prospect Courtyard X. San Antonio Police Dept. (SAPD) Bexar County Sheriff’s Office XI. 1151 Waiver Update XII New Business XIII. Adjournment – Next meeting; September 24, 2013
  19. 19. 19 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 Emergency Room Utilization (Medical Clearance) What Works
  20. 20. 20 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. Impact on WAIT TIME for LAW ENFORCEMENT
  21. 21. 21 Recidivism Rates for Top Five CSCD’S *Dallas rates reflect only one mental health provider, Metro Care.
  22. 22. 22 Cost Category City of San Antonio Bexar County Direct Cost Avoidance   Public Inebriates Diverted from Detention Facility     $435,435   $925,015 $1,322,685 A.   $1,983,574   $2,818,755* $4,372,128 B.   $2,419,009   $3,743,770 $5,694,813   Injured Prisoner Diverted from UHS ER     $528,000 $435,000 $421,000   C.   $1,267,200   $1,044,000 $1,010,400 D.   $1,795,200 $1,479,000 $1,431,400   Mentally Ill Diverted from UHS ER Cost     $322,500   $283,500 $276,500 E.   $774,000   $676,000 $663,600 F.   $1,096,500 $959,500 $940,100   Mentally Ill Diverted from Magistration Facility     $208,159   $179,833 $126,893 G.   $371,350   $322,300 $191,125   H.   $579,509 $502,133 $310,018 Year One April 16, 2008 – March 31, 2009 Year April 16, 2009 – March31, 2010 Year Three April 16, 2010 – March 31, 2011 Summary next slide
  23. 23. 23 Summary 
  24. 24. 24 • 2006 – 3,845 • 2007 – 3,960 • 2008 – 4,124 • 2009 – 4,158 • 2010 – 4,017 • 2011 – 3,743 Bexar County Detention Center System Population (Main Annex) In May of 2011, there were 883 empty beds in the Bexar County Jail In May of 2013, there were 1,000 empty beds in the Bexar County Jail
  25. 25. 25 BEXAR COUNTY DETENTION CENTER SYSTEM POPULATION MONTHLY AVERAGES (Main, Annex) 4222 3743 4133 4015 3987 3941 3946 4015 4081 4095 4171 4156 4094 3845 3807 3897 3981 4109 4263 4253 4040 3993 4062 4033 4066 3960 4079 4096 4084 4094 4095 4139 4173 4208 4261 4289 4225 4124 4158 4337 4272 4292 4197 42104254 4179 4193 4280 4357 43004300 4302 4053 4130 4001 4260 4028 4077 4231 4190 4017 379137903854 3982 3700 3800 3900 4000 4100 4200 4300 4400 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC SYSTEMPOPULATION 2006 2007 2008 2009 2010 2011 On May 2011, there were 883 empty beds in the jail
  26. 26. 26
  27. 27. 27 QUESTIONS?
  28. 28. 28 Leon Evans, President/CEO The Center for Health Care Services 210 261-1000 www.chcsbc.org levans@chcsbc.org

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