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Diversion First Stakeholders Meeting: Oct. 19, 2017

1) A 2016 analysis of the Fairfax County jail population found that 16% of inmates had documented behavioral health issues, compared to 5% of inmates without behavioral health issues. Inmates with behavioral health issues tended to be female, non-white, homeless, and Fairfax County residents. 2) The majority of inmates with behavioral health issues had substance use disorders, mental illnesses, or co-occurring disorders. They also served longer jail sentences, averaging 59 days compared to 39 days. 3) Moving forward, the Data and Evaluation Work Group aims to consistently report measures on the intersection of behavioral health and the criminal justice system, to further understand and improve outcomes.

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Stakeholders Meeting October 19, 2017
Tonight’s Agenda • Welcome • Announcements • Letter of Thanks • Design Institute Frequent Utilizers Case Studies and Recommendations • Data and Evaluation Work Group and Jail Behavioral Health Population Analysis • CSB Jail Services Updates • Court Services Updates, Needs, and News • Comments, Questions, Next meeting 2
Updates September • Fairfax County team participated in the National Justice Behavioral Health Data Design Institute • Competitive selection to participate as one of 14 jurisdictions in the country • In-depth look at super utilizer case studies • Development of a work plan for next steps to be championed by the Problem-Solving team (to be discussed later tonight) 3
Design Institute Participants with Elinore McCance-Katz, M.C., Ph.D., HHS Secretary for Mental Health and Substance Use 4 Representatives from CSB, CoEx office, FCPD, FRD, OPEH, & Sheriff
Updates September 12 • Board Matter regarding Course Corrections: Mid-Atlantic Summit on Behavioral Health and Criminal Justice Findings • Supervisor Cook asked (and received) BOS approval to direct staff to study recommendations to be included in the GA legislative program or FY 19 budget 5
Updates October 17 • Fairfax County selected to provide Diversion First information about data-driven decision making related to policy, practice and budget • Pew-MacArthur Results First Initiative- works with states and local jurisdictions to implement and innovate cost- benefit analysis approach to invest in policies and programs proven to work • Fairfax County may be included in the promising practices report due out next year 6
Updates November • Supervisor Cook selected to participate in NACo’s Stepping Up Peer Exchange Program with Maricopa County • Site visit to learn about their diversion programming and data systems • This is a scholarship program funded through NACo and prioritizing elected officials for participation Congrats to Supervisor Cook! 7
More Updates December • Fairfax County invited to present at 2nd Annual Conference “Progress Made Possible: Better Outcomes at the Intersection of Behavioral Health and Criminal Justice” and includes a site visit throughout the Miami-Dade system • Last year’s conference highlighted San Antonio • Fairfax will send a cross-system team to attend 8
Recognition 9
Design Institute on Super Utilizers Deputy Chief Jason Jenkins, FRD Daryl Washington, Deputy Director, CSB Laura Yager, CoEx Office 10
What is a Super-Utilizer? • Individuals with complex behavioral, physical, and/or social needs who are frequent users of a broad range of services and may have a high number of contacts with emergency medical technicians and law enforcement • Despite the large amount of resources devoted to this population, they are often provided in fragmented ways that do not lead to stabilization or improved outcomes for individuals 11
Design Institute- Focus on Super Utilizers • Design Institute- Three days of hands-on work to develop an approach to improve outcomes for frequent system utilizers • Work Plan developed • Two Case Studies reviewed – Identified two cases and collected cross-systems data about service frequency and utilization – Quantified costs based on per service cost rates across multiple systems – Identified gaps and needs – Developed a work plan focused on HIPAA and data sharing – Commitment to ongoing case studies and cross-system interventions 12
About Gender Female Age 35 Ethnicity Black EMS/Hospitals Police Jail 73/51 239 0 Date System Interaction 1/1/17- 7/1/17 EMS 73 calls for service, 51 transports 1/1/17- 7/1/17 ED 51 ED visits 7/1/16- 6/30/17 CSB 197 contacts (multiple services) 80 case management contacts 7/1/16- 6/30/17 CSB 15 days crisis care 6/2017 Psych Hosp 21 days+ 1/1/17- 7/1/17 Police 249 calls for service/8 reports 4/17 Health Care Enrollment in integrated primary care HIGH UTILIZER CASE STUDY TOTAL CONTACTS IN THE LAST 365 DAYS Fairfax County, VA - 1.2 million Representative Sample of Interactions UNK 197 15/2 Homeless Services Behavioral Health Crisis Care Bed Days/ Health Care Safety Net Total estimated expenditures: $262,564.20 (not including psychiatric hospitalization costs) 13
About Gender Male Age 58 Ethnicity Hispanic EMS/Hospitals Police Jail 24 17 75 Date System Interaction 1/1/17- 7/1/17 FRD 24 calls for service 1/1/17- 7/1/17 EMT 24 transports 1/1/17- 7/1/17 ED/Hospital 24 ED visits/6 admissions 7/1/16- 6/30/17 CSB 9 Jail-based services contacts 1/1/17- 7/1/17 Police 17 contacts with 13 arrests 1/1/17- 7/1/17 Jail 75 nights in jail and counting HIGH UTILIZER CASE STUDY TOTAL CONTACTS IN THE LAST 365 DAYS Fairfax County, VA - 1.2 million Representative Sample of Interactions unk 9 Hospital Homeless Services Behavioral Health 6 admissions @<48 hours 6 month total estimated expenditures: $168,179.80 14
Work Plan Action Priorities: Focus on Data-Sharing processes and New Stakeholder Engagement 1. Alleviate information (HIPAA) sharing challenges with internal and external stakeholders 2. Engage additional key stakeholders in this efforts: – Office to Prevent and End Homelessness (represented at the Design Institute!) – Local Health Care systems 3. Identify and prioritize high utilizers across systems to deliver key services – Develop release of information process – Explore and determine resource needs for cross-systems information and services 15
Next Steps: Focus on Barrier Busting and Action/Collaborative Service Interventions • Continued follow-up with DF Leadership Group – HIPAA – Data-Sharing Protocols – Leadership Group engagement with County Attorney – Consider consultation with national experts on data-sharing approaches • Continued case study approach for these unique cases – Reviewed in Problem-Solving Team – Cross System Meetings with organizations involved with the individual – Develop action plans for interventions (beyond study) – Develop monitoring system to document interventions and outcomes – Report out findings and make recommendations for possible future system focus 16
Housing Updates • Diversion First Housing Project – 16 of 18 available housing opportunities filled • SUSTAIN State Funded Housing Project – 40 individuals housed – Additional housing opportunities exist, but referrals continue to outpace available units Development of additional permanent supportive housing resources will be needed 17
Data and Evaluation Work Group Lisa Potter, CSB Chloe Lee, CSB 18
News/Changes/ Accomplishments • 2017 Q3 Data Snapshot (Jan-Sept 2017) – Total LEO encounters- 1,407 • 21% increase from 2016 – Total ECOs- 993 • 35% increase from 2016 – Diverted from potential arrest- 305 • 4% increase from 2016 • Collaboration with the Department of Information Technology and potential solutions for automation • Moving forward with evaluation plan – Focus on jail population data 19
Evaluation Plan Intercept I Intercept II 20 Clients who visited Merrifield Crisis Response Center (MCRC) MCRC with Law Enforcement Officers (LEOs) MCRC visitors with LEOs who have SMI, Fairfax County residents and had potential charges Inmates with mental illness/Serious mental illness (SMI) Inmates with SMI who are Fairfax County residents and who completed a forensic intake during the current incarceration and were released during the period of data collection
2016 Jail Behavioral Health Population Analysis October 19, 2017 Data and Evaluation Team Chloe Lee, PhD. 21
Data Analysis Process Jail CSB Integration of Jail and CSB data All 2016 jail inmates: 13,057 -Referred to CSB: 2,896 -Not referred to CSB: 10,188 All CSB clients: 140,804 -Current: 16,640 -Closed: 124,164 All inmates in 2016 who have CSB EHR IDs: 2,141 Inmates with behavioral health issues 22
16% of the jail population 5% of the jail population 23
Gender More females among inmates with behavioral health issues than inmates with no behavioral health issues (25% vs. 17%, p<.001) 25% 17% 75% 83% 0% 20% 40% 60% 80% 100% Inmates with BH issues Inmates with no BH issues Female Male 8% difference 24
Race More non-white minorities among inmates with behavioral health issues than inmates with no behavioral health issues (43% vs. 37%, p<.001) 57% 39% 3% 0% 1% 63% 31% 5% 0% 1% 0% 10% 20% 30% 40% 50% 60% 70% White Black Asian Native Hawaiian/Pacific Islander Unknown Inmates with BH issues Inmates with no BH issues 25
Homelessness More homelessness among inmates with behavioral health issues than inmates with no behavioral health issues (8% vs. 4%, p<.001) Inmates with behavioral health issues 8% 4% Inmates with no behavioral health issues 2X 26
Residency: Inmates with behavioral health issues 65%11% 15% 9% Fairfax County Out of state Other counties and cities in VA Not collected 27
Types of Behavioral Health Issues 64% 28%62% 26% Of inmates with behavioral health issues had Substance Use Disorder (SUD) Of inmates with behavioral health issues had Any Mental Illness (AMI) Of inmates with behavioral health issues had Serious Mental Illness (SMI) Of inmates with behavioral health issues had Co-occurring Disorder 50% 28
31% of the 4+ days population 9% of the 4+ days population 29
39% of the daily population 10% of the daily population 30
59 Days vs 39 days Average days in jail among Average days in jail inmates with behavioral among inmates with no health issues behavioral health issues Average Days in Jail 20 days 31
32 Criminal Justice History (Re-incarceration Only): 2013-2015 1.6 times more
Charges for Inmates with Behavioral Health Issues Felony charges Misdemeanor and/or ordinance charges without felony charges 69% 31% 33
Assessment and Jail-based CSB Services 94% of the inmates who were referred to CSB and stayed 2 weeks or more in jail received forensic intake and/or screening services. 67% of the above population received treatment and/or case management services from CSB in jail in 2016. 34
Summary 35
Next Steps: 3-6 months • Determine measures that will be consistently reported for each intercept • Focus on measures on development of automated platform • Finalize consistent, cross-system language for data points • Benchmark measures with similar jurisdictions • Develop targets and goals to measure progress • Brief Jail Mental Health Screening (BJMHS) – Refine tracking process and results • Complete analysis of 2017 Intercept 1 data – 2015 and 2016 data comparison – Trends 36
Jail-Based Services/CSB Jail Diversion Marissa Fariña-Morse, EdS, NCC, CAADC, LPC Redic Morris, 2nd Lieutenant, Office of the Sheriff 37
Jail-Based Behavioral Health Referral Process • Everyone booked into the jail passes through multiple points where screenings for mental illness take place: – Booking desk – Jail medical – Deputies CIT trained – BJMHS • Formal and Informal Referrals 38
Screening • All referrals sent to the CSB for triage – 30 average referrals per day – 55 average commitments to the ADC/Day – Includes all individuals with a reported history of mental illness, substance use or observation and individuals with serious charges (such as murder or sex offenses) • Triage Process – All referrals to be seen within 14 days – Each morning clinicians review the referrals that came in to schedule their screening – Identify those at high risk and prioritize (considerations such as severe mental illness and suicide risk) 39
Screening Factors • Safety – Suicide is the leading cause of death in jails across the country (Bureau of Justice Statistics 2015 Report) – August 2017 – Columbia-Suicide Severity Rating Scale (C-SSRS) • Treatment Linkage – Aligned with the Diversion First initiative to seek to engage individuals in services, advocate for bond if appropriate – Partner with jail diversion team (and other CSB teams) on high risk cases • Goal - review all booked regardless of referral status • Flexible with process as its refined, allow need to inform change 40
Court Services/Court Collaboration with CSB Jail Diversion Team • Levels of commitment to treatment • Desire to have a positive outcome in court • How to proactively engage the legal system – Avoid new charges – Improve treatment commitment • Referral to Merrifield (Assessment) • Existing CSB clients on SRP – Case updates – Communication more in-depth status – Partnering to improve outcomes – Plans developed with client, CSB clinician and Court Services • Signed by client, staff and Judge • Recommend level of contact with court services and courts • Flexible to be client specific and to reduce recommended contact as milestones achieved 41
Opioid Epidemic – Jail-Based Intervention 42 • High risk of overdose after release from ADC • Narcan groups began at the ADC in September 2017 – Opportunity for treatment engagement • Vivitrol Pilot – Identifying individuals with Opiate use disorder, injection one month before release – Link to CSB services upon release • Drug Court Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled. From 2000 to 2015 more than half a million people died from drug overdoses.
Stakeholder Collaboration • More work to do along the Sequential Intercept Model – Court Stakeholders Group • Identifying challenges toward successful diversion • Partnering to change practices to prioritize treatment – Intercept 4 (Reentry) • Group meeting to begin exploring next steps • Other counties have developed public/private partnerships 43
Challenges and Needs Challenges • Increased demand for services • Inability to predict release from ADC • Motivation for treatment • Turnaround time for filling vacant positions • Operations (schedule) at the ADC impacts ability to complete assessments during all available staff hours Needs • Peer support specialists to engage clients with full range of Behavioral Health needs • Continued collaboration with Courts/Court Services to enhance motivation for treatment • Opportunities for flexibility with access to inmates 44
Pretrial Services in Fairfax County Robert Bermingham, Court Services Director, Juvenile & Domestic Relations Court Colin McDonald, Court Services Director General District Court 45
Fairfax County Courts • 3 Courts in Fairfax County - Juvenile & Domestic Relations Court, General District Court and Circuit Court • J&DR (all juvenile matters, offenses committed by adults against juveniles, family matters excluding divorce) • GDC (criminal misdemeanors, local ordinance violations, traffic cases, preliminary hearings on felony charges, civil matters less than $25,000) • Circuit (felony criminal cases, civil matters in excess of $25,000, appeals from GDC & JDR) 46
Pretrial Services in Fairfax • In Fairfax, Pretrial Services’ primary functions are to make evidence-based recommendations regarding bail to the judiciary, provide the judiciary information to assist them in making good bail decisions and provide supervision services to defendants released with supervision ordered 47
Pretrial Process • Evaluation Process (BJMHS, VPTDQ, Information Verification) • Recommendation Process (Record Checks, VPRAI, Praxis) • Supervision Services (UNCOPE, Referral Process, Progress Reports, Violations) 48
How Pretrial Services impacts Diversion First • Uses BJMHS and information from CSB to identify the Diversion First target population in the ADC • Provides release recommendations to the judiciary on Diversion First defendants appropriate for release • Provides supervision services to Diversion First defendants released under supervision • Refers defendants to mental health and/or substance abuse treatment • Monitor and report on Diversion First clients’ compliance with mental health and/or substance abuse treatment 49
FY 2017 Pretrial Services’ Statistics • 4,769 Pretrial Evaluations on GDC defendants • 2,736 recommendations made to the judiciary • 96% recommendation acceptance rate by the judiciary • Supervised 1,646 defendants on SRP resulting in 179,942 days of active supervision • Ran 27,518 record checks (1,959 for adult J&DR defendants) 50
Why changes are needed in the Pretrial process in Fairfax • Presently, evaluations and recommendations are not provided on incarcerated adult J&DR defendants identified as needing a further mental health assessment by the BJMHS • From January 2017 to June 2017, 2,258 GDC pretrial evaluations were completed resulting in 242 Diversion First placements; however, none were completed for adult J&DR defendants. • In FY 2017, there were more than 1,900 adult J&DR defendants admitted to the ADC pending trial. 51
Proposed improvements and changes to the Pretrial process in Fairfax • Conduct Pretrial evaluations on all incarcerated adult J&DR defendants • Provide evidence based bail and release recommendations to the J&DR judiciary at advisements • Make available all Pretrial Services information available at J&DR bond motion hearings • Identify J&DR Diversion First population and provide specialized supervision when ordered 52
How will these changes impact Diversion First • Mental health evaluations will be completed on all eligible defendants identified as needing a further mental health assessment • Evidence based recommendations for release will be presented to the judiciary on J&DR Diversion First defendants • Mental health and/or substance abuse treatment referrals will be made for adult J&DR defendants that are appropriate for Diversion First clients 53
J&DR Adult Probation Data • Approximately 90% of adult J&DR clients are on probation for Domestic Violence • Approximately 10% of adult J&DR clients are on probation for sex offenses or violation of a protective order • 23% of adult J&DR probationers are Court ordered to undergo a mental health evaluation 54
Challenges and Needs Challenges • At present, J&DR has limited staff available to conduct pretrial evaluations on adult defendants in the ADC • At present, Adult J&DR clients do not receive sufficient access to mental health services Needs • 2 Probation Officer I positions – Duties would include conducting pretrial evaluations, collecting and disseminating pretrial information, and making release recommendations to the judiciary 55
Goals & Activities Next three months… • Use existing resources to launch pretrial evaluations for adult J&DR defendants • Coordinate training for the existing designated staff • Work with Data and Evaluation Team to collect case data with preliminary findings Next six months… • Seek funding for two PO1 positions to expand pretrial J&DR services • With funding, fully implement J&DR Pre- Trial Services Program • Develop data for performance monitoring and outcome measures 56
Update from Circuit Court The Honorable Penney Azcarate Judge, Fairfax Circuit Court 57
Supreme Court Rule 1:25 • 3 types of specialty dockets recognized: – Drug Treatment Court 18.2-254.1 – Veteran’s dockets – Behavioral health/mental health dockets • Cases are grouped together based on: – Requiring more than simple adjudication of discrete legal issues – Presenting a common dynamic underlying the legally cognizable behavior, and – Require coordination of services and treatment to address the underlying dynamic and focus on the remediation of the defendant in these dockets • The treatment, services, and disposition options are those which are otherwise available under law 58
Specialty Court Dockets • Localities have to petition the Supreme Court of Virginia for authorization prior to beginning operation and demonstrate local support and planning for its establishment and continuation • Financing is the responsibility of the locality and local court but funds may be provided via state appropriations and federal grants • Evaluation and reporting to the Supreme Court Advisory Committee 59
Drug Court News • Fairfax Circuit Court submitted an application to establish a Drug Court in September • Post-judgment felony probation violation alternative to incarceration for non-violent defendants with severe substance abuse issues • In wake of the opioid crisis that has hit our county, this is an opportunity to assist drug dependent individuals to once again become productive citizens • The Supreme Court Advisory Committee met today and the application to establish a Drug Court for Fairfax was approved! 60
General District Court Court Services Shawn Lherisse, Behavioral Health Unit – Diversion First 61
Quarterly Results (July 2017 – September 2017) PLACEMENTS – PRETRIAL SUPERVISION 549 defendants placed 138 (25%) indicated a need for further mental health assessment • 101 from bond motions • 33 from advisements • 4 from the Magistrates 37 defendants were Court ordered to undergo a mental health evaluation and follow recommended mental health treatment* * An increase of 13 from last quarter may be attributable to changes to the Pre-Trial Defendant Questionnaire (information provided to attorneys) 62
Quarterly Results (July 2017 to September 2017) 46 defendants had received mental health treatment in the past 81 defendants administered advanced screening instrument 74 (91%) defendants that were administered the advanced screening instrument indicated a need for a mental health evaluation • 81 defendants referred for mental health evaluation • 22 defendants already engaged in mental health treatment 63 PLACEMENTS – ADVANCED SCREENING
Accomplishments/Needs 64 Accomplishments • We currently have a 90% Court appearance rate • Specialized reduced caseload for high needs defendants • Changed the process for reporting pretrial violations to the Court • Improved collaboration with CSB Needs • Clinician for the completion of mental health assessments • Automatic Court appearance reminder • Completion of construction on current office space (215)
3-6 month goals and activities • Train new employees • Fully operational office for the Pre-Trial Behavioral Health Unit • CIT training for all Pre- Trial Officers in the Behavioral Health Unit (currently we have 3 trained with 1 scheduled to attend the November class) • Continue to measure outcomes • Develop and Implement new procedures for violation hearings/review dates 65 Next Three months Next Six months
Other Work Groups • Problem-Solving Team • Medical Clearance • ED Diversion • Communications • Workforce Development (CIT and MHFA) • Pop Up Team- Exploring Benefits Suspension and Re-enrollment at and post-incarceration These other work groups are still working but just not reporting out tonight! 66
Stakeholders: Comments, Questions, Announcement, Thoughts 67
Next Meeting January 29, 2018 7-9 pm, Rooms 4-5 Fairfax County Government Center 68

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Diversion First Stakeholders Meeting: Oct. 19, 2017

  • 1.
  • 2.
    Tonight’s Agenda • Welcome •Announcements • Letter of Thanks • Design Institute Frequent Utilizers Case Studies and Recommendations • Data and Evaluation Work Group and Jail Behavioral Health Population Analysis • CSB Jail Services Updates • Court Services Updates, Needs, and News • Comments, Questions, Next meeting 2
  • 3.
    Updates September • Fairfax Countyteam participated in the National Justice Behavioral Health Data Design Institute • Competitive selection to participate as one of 14 jurisdictions in the country • In-depth look at super utilizer case studies • Development of a work plan for next steps to be championed by the Problem-Solving team (to be discussed later tonight) 3
  • 4.
    Design Institute Participants withElinore McCance-Katz, M.C., Ph.D., HHS Secretary for Mental Health and Substance Use 4 Representatives from CSB, CoEx office, FCPD, FRD, OPEH, & Sheriff
  • 5.
    Updates September 12 • BoardMatter regarding Course Corrections: Mid-Atlantic Summit on Behavioral Health and Criminal Justice Findings • Supervisor Cook asked (and received) BOS approval to direct staff to study recommendations to be included in the GA legislative program or FY 19 budget 5
  • 6.
    Updates October 17 • FairfaxCounty selected to provide Diversion First information about data-driven decision making related to policy, practice and budget • Pew-MacArthur Results First Initiative- works with states and local jurisdictions to implement and innovate cost- benefit analysis approach to invest in policies and programs proven to work • Fairfax County may be included in the promising practices report due out next year 6
  • 7.
    Updates November • Supervisor Cookselected to participate in NACo’s Stepping Up Peer Exchange Program with Maricopa County • Site visit to learn about their diversion programming and data systems • This is a scholarship program funded through NACo and prioritizing elected officials for participation Congrats to Supervisor Cook! 7
  • 8.
    More Updates December • FairfaxCounty invited to present at 2nd Annual Conference “Progress Made Possible: Better Outcomes at the Intersection of Behavioral Health and Criminal Justice” and includes a site visit throughout the Miami-Dade system • Last year’s conference highlighted San Antonio • Fairfax will send a cross-system team to attend 8
  • 9.
  • 10.
    Design Institute on SuperUtilizers Deputy Chief Jason Jenkins, FRD Daryl Washington, Deputy Director, CSB Laura Yager, CoEx Office 10
  • 11.
    What is aSuper-Utilizer? • Individuals with complex behavioral, physical, and/or social needs who are frequent users of a broad range of services and may have a high number of contacts with emergency medical technicians and law enforcement • Despite the large amount of resources devoted to this population, they are often provided in fragmented ways that do not lead to stabilization or improved outcomes for individuals 11
  • 12.
    Design Institute- Focus onSuper Utilizers • Design Institute- Three days of hands-on work to develop an approach to improve outcomes for frequent system utilizers • Work Plan developed • Two Case Studies reviewed – Identified two cases and collected cross-systems data about service frequency and utilization – Quantified costs based on per service cost rates across multiple systems – Identified gaps and needs – Developed a work plan focused on HIPAA and data sharing – Commitment to ongoing case studies and cross-system interventions 12
  • 13.
    About Gender Female Age 35 EthnicityBlack EMS/Hospitals Police Jail 73/51 239 0 Date System Interaction 1/1/17- 7/1/17 EMS 73 calls for service, 51 transports 1/1/17- 7/1/17 ED 51 ED visits 7/1/16- 6/30/17 CSB 197 contacts (multiple services) 80 case management contacts 7/1/16- 6/30/17 CSB 15 days crisis care 6/2017 Psych Hosp 21 days+ 1/1/17- 7/1/17 Police 249 calls for service/8 reports 4/17 Health Care Enrollment in integrated primary care HIGH UTILIZER CASE STUDY TOTAL CONTACTS IN THE LAST 365 DAYS Fairfax County, VA - 1.2 million Representative Sample of Interactions UNK 197 15/2 Homeless Services Behavioral Health Crisis Care Bed Days/ Health Care Safety Net Total estimated expenditures: $262,564.20 (not including psychiatric hospitalization costs) 13
  • 14.
    About Gender Male Age 58 EthnicityHispanic EMS/Hospitals Police Jail 24 17 75 Date System Interaction 1/1/17- 7/1/17 FRD 24 calls for service 1/1/17- 7/1/17 EMT 24 transports 1/1/17- 7/1/17 ED/Hospital 24 ED visits/6 admissions 7/1/16- 6/30/17 CSB 9 Jail-based services contacts 1/1/17- 7/1/17 Police 17 contacts with 13 arrests 1/1/17- 7/1/17 Jail 75 nights in jail and counting HIGH UTILIZER CASE STUDY TOTAL CONTACTS IN THE LAST 365 DAYS Fairfax County, VA - 1.2 million Representative Sample of Interactions unk 9 Hospital Homeless Services Behavioral Health 6 admissions @<48 hours 6 month total estimated expenditures: $168,179.80 14
  • 15.
    Work Plan ActionPriorities: Focus on Data-Sharing processes and New Stakeholder Engagement 1. Alleviate information (HIPAA) sharing challenges with internal and external stakeholders 2. Engage additional key stakeholders in this efforts: – Office to Prevent and End Homelessness (represented at the Design Institute!) – Local Health Care systems 3. Identify and prioritize high utilizers across systems to deliver key services – Develop release of information process – Explore and determine resource needs for cross-systems information and services 15
  • 16.
    Next Steps: Focus onBarrier Busting and Action/Collaborative Service Interventions • Continued follow-up with DF Leadership Group – HIPAA – Data-Sharing Protocols – Leadership Group engagement with County Attorney – Consider consultation with national experts on data-sharing approaches • Continued case study approach for these unique cases – Reviewed in Problem-Solving Team – Cross System Meetings with organizations involved with the individual – Develop action plans for interventions (beyond study) – Develop monitoring system to document interventions and outcomes – Report out findings and make recommendations for possible future system focus 16
  • 17.
    Housing Updates • DiversionFirst Housing Project – 16 of 18 available housing opportunities filled • SUSTAIN State Funded Housing Project – 40 individuals housed – Additional housing opportunities exist, but referrals continue to outpace available units Development of additional permanent supportive housing resources will be needed 17
  • 18.
    Data and EvaluationWork Group Lisa Potter, CSB Chloe Lee, CSB 18
  • 19.
    News/Changes/ Accomplishments • 2017 Q3Data Snapshot (Jan-Sept 2017) – Total LEO encounters- 1,407 • 21% increase from 2016 – Total ECOs- 993 • 35% increase from 2016 – Diverted from potential arrest- 305 • 4% increase from 2016 • Collaboration with the Department of Information Technology and potential solutions for automation • Moving forward with evaluation plan – Focus on jail population data 19
  • 20.
    Evaluation Plan Intercept IIntercept II 20 Clients who visited Merrifield Crisis Response Center (MCRC) MCRC with Law Enforcement Officers (LEOs) MCRC visitors with LEOs who have SMI, Fairfax County residents and had potential charges Inmates with mental illness/Serious mental illness (SMI) Inmates with SMI who are Fairfax County residents and who completed a forensic intake during the current incarceration and were released during the period of data collection
  • 21.
    2016 Jail BehavioralHealth Population Analysis October 19, 2017 Data and Evaluation Team Chloe Lee, PhD. 21
  • 22.
    Data Analysis Process JailCSB Integration of Jail and CSB data All 2016 jail inmates: 13,057 -Referred to CSB: 2,896 -Not referred to CSB: 10,188 All CSB clients: 140,804 -Current: 16,640 -Closed: 124,164 All inmates in 2016 who have CSB EHR IDs: 2,141 Inmates with behavioral health issues 22
  • 23.
    16% of thejail population 5% of the jail population 23
  • 24.
    Gender More females amonginmates with behavioral health issues than inmates with no behavioral health issues (25% vs. 17%, p<.001) 25% 17% 75% 83% 0% 20% 40% 60% 80% 100% Inmates with BH issues Inmates with no BH issues Female Male 8% difference 24
  • 25.
    Race More non-white minoritiesamong inmates with behavioral health issues than inmates with no behavioral health issues (43% vs. 37%, p<.001) 57% 39% 3% 0% 1% 63% 31% 5% 0% 1% 0% 10% 20% 30% 40% 50% 60% 70% White Black Asian Native Hawaiian/Pacific Islander Unknown Inmates with BH issues Inmates with no BH issues 25
  • 26.
    Homelessness More homelessness amonginmates with behavioral health issues than inmates with no behavioral health issues (8% vs. 4%, p<.001) Inmates with behavioral health issues 8% 4% Inmates with no behavioral health issues 2X 26
  • 27.
    Residency: Inmates with behavioralhealth issues 65%11% 15% 9% Fairfax County Out of state Other counties and cities in VA Not collected 27
  • 28.
    Types of Behavioral HealthIssues 64% 28%62% 26% Of inmates with behavioral health issues had Substance Use Disorder (SUD) Of inmates with behavioral health issues had Any Mental Illness (AMI) Of inmates with behavioral health issues had Serious Mental Illness (SMI) Of inmates with behavioral health issues had Co-occurring Disorder 50% 28
  • 29.
    31% of the4+ days population 9% of the 4+ days population 29
  • 30.
    39% of thedaily population 10% of the daily population 30
  • 31.
    59 Days vs39 days Average days in jail among Average days in jail inmates with behavioral among inmates with no health issues behavioral health issues Average Days in Jail 20 days 31
  • 32.
    32 Criminal Justice History (Re-incarcerationOnly): 2013-2015 1.6 times more
  • 33.
    Charges for Inmateswith Behavioral Health Issues Felony charges Misdemeanor and/or ordinance charges without felony charges 69% 31% 33
  • 34.
    Assessment and Jail-based CSBServices 94% of the inmates who were referred to CSB and stayed 2 weeks or more in jail received forensic intake and/or screening services. 67% of the above population received treatment and/or case management services from CSB in jail in 2016. 34
  • 35.
  • 36.
    Next Steps: 3-6months • Determine measures that will be consistently reported for each intercept • Focus on measures on development of automated platform • Finalize consistent, cross-system language for data points • Benchmark measures with similar jurisdictions • Develop targets and goals to measure progress • Brief Jail Mental Health Screening (BJMHS) – Refine tracking process and results • Complete analysis of 2017 Intercept 1 data – 2015 and 2016 data comparison – Trends 36
  • 37.
    Jail-Based Services/CSB JailDiversion Marissa Fariña-Morse, EdS, NCC, CAADC, LPC Redic Morris, 2nd Lieutenant, Office of the Sheriff 37
  • 38.
    Jail-Based Behavioral Health ReferralProcess • Everyone booked into the jail passes through multiple points where screenings for mental illness take place: – Booking desk – Jail medical – Deputies CIT trained – BJMHS • Formal and Informal Referrals 38
  • 39.
    Screening • All referralssent to the CSB for triage – 30 average referrals per day – 55 average commitments to the ADC/Day – Includes all individuals with a reported history of mental illness, substance use or observation and individuals with serious charges (such as murder or sex offenses) • Triage Process – All referrals to be seen within 14 days – Each morning clinicians review the referrals that came in to schedule their screening – Identify those at high risk and prioritize (considerations such as severe mental illness and suicide risk) 39
  • 40.
    Screening Factors • Safety –Suicide is the leading cause of death in jails across the country (Bureau of Justice Statistics 2015 Report) – August 2017 – Columbia-Suicide Severity Rating Scale (C-SSRS) • Treatment Linkage – Aligned with the Diversion First initiative to seek to engage individuals in services, advocate for bond if appropriate – Partner with jail diversion team (and other CSB teams) on high risk cases • Goal - review all booked regardless of referral status • Flexible with process as its refined, allow need to inform change 40
  • 41.
    Court Services/Court Collaboration withCSB Jail Diversion Team • Levels of commitment to treatment • Desire to have a positive outcome in court • How to proactively engage the legal system – Avoid new charges – Improve treatment commitment • Referral to Merrifield (Assessment) • Existing CSB clients on SRP – Case updates – Communication more in-depth status – Partnering to improve outcomes – Plans developed with client, CSB clinician and Court Services • Signed by client, staff and Judge • Recommend level of contact with court services and courts • Flexible to be client specific and to reduce recommended contact as milestones achieved 41
  • 42.
    Opioid Epidemic – Jail-BasedIntervention 42 • High risk of overdose after release from ADC • Narcan groups began at the ADC in September 2017 – Opportunity for treatment engagement • Vivitrol Pilot – Identifying individuals with Opiate use disorder, injection one month before release – Link to CSB services upon release • Drug Court Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled. From 2000 to 2015 more than half a million people died from drug overdoses.
  • 43.
    Stakeholder Collaboration • Morework to do along the Sequential Intercept Model – Court Stakeholders Group • Identifying challenges toward successful diversion • Partnering to change practices to prioritize treatment – Intercept 4 (Reentry) • Group meeting to begin exploring next steps • Other counties have developed public/private partnerships 43
  • 44.
    Challenges and Needs Challenges •Increased demand for services • Inability to predict release from ADC • Motivation for treatment • Turnaround time for filling vacant positions • Operations (schedule) at the ADC impacts ability to complete assessments during all available staff hours Needs • Peer support specialists to engage clients with full range of Behavioral Health needs • Continued collaboration with Courts/Court Services to enhance motivation for treatment • Opportunities for flexibility with access to inmates 44
  • 45.
    Pretrial Services inFairfax County Robert Bermingham, Court Services Director, Juvenile & Domestic Relations Court Colin McDonald, Court Services Director General District Court 45
  • 46.
    Fairfax County Courts •3 Courts in Fairfax County - Juvenile & Domestic Relations Court, General District Court and Circuit Court • J&DR (all juvenile matters, offenses committed by adults against juveniles, family matters excluding divorce) • GDC (criminal misdemeanors, local ordinance violations, traffic cases, preliminary hearings on felony charges, civil matters less than $25,000) • Circuit (felony criminal cases, civil matters in excess of $25,000, appeals from GDC & JDR) 46
  • 47.
    Pretrial Services inFairfax • In Fairfax, Pretrial Services’ primary functions are to make evidence-based recommendations regarding bail to the judiciary, provide the judiciary information to assist them in making good bail decisions and provide supervision services to defendants released with supervision ordered 47
  • 48.
    Pretrial Process • EvaluationProcess (BJMHS, VPTDQ, Information Verification) • Recommendation Process (Record Checks, VPRAI, Praxis) • Supervision Services (UNCOPE, Referral Process, Progress Reports, Violations) 48
  • 49.
    How Pretrial Services impactsDiversion First • Uses BJMHS and information from CSB to identify the Diversion First target population in the ADC • Provides release recommendations to the judiciary on Diversion First defendants appropriate for release • Provides supervision services to Diversion First defendants released under supervision • Refers defendants to mental health and/or substance abuse treatment • Monitor and report on Diversion First clients’ compliance with mental health and/or substance abuse treatment 49
  • 50.
    FY 2017 PretrialServices’ Statistics • 4,769 Pretrial Evaluations on GDC defendants • 2,736 recommendations made to the judiciary • 96% recommendation acceptance rate by the judiciary • Supervised 1,646 defendants on SRP resulting in 179,942 days of active supervision • Ran 27,518 record checks (1,959 for adult J&DR defendants) 50
  • 51.
    Why changes areneeded in the Pretrial process in Fairfax • Presently, evaluations and recommendations are not provided on incarcerated adult J&DR defendants identified as needing a further mental health assessment by the BJMHS • From January 2017 to June 2017, 2,258 GDC pretrial evaluations were completed resulting in 242 Diversion First placements; however, none were completed for adult J&DR defendants. • In FY 2017, there were more than 1,900 adult J&DR defendants admitted to the ADC pending trial. 51
  • 52.
    Proposed improvements and changesto the Pretrial process in Fairfax • Conduct Pretrial evaluations on all incarcerated adult J&DR defendants • Provide evidence based bail and release recommendations to the J&DR judiciary at advisements • Make available all Pretrial Services information available at J&DR bond motion hearings • Identify J&DR Diversion First population and provide specialized supervision when ordered 52
  • 53.
    How will thesechanges impact Diversion First • Mental health evaluations will be completed on all eligible defendants identified as needing a further mental health assessment • Evidence based recommendations for release will be presented to the judiciary on J&DR Diversion First defendants • Mental health and/or substance abuse treatment referrals will be made for adult J&DR defendants that are appropriate for Diversion First clients 53
  • 54.
    J&DR Adult ProbationData • Approximately 90% of adult J&DR clients are on probation for Domestic Violence • Approximately 10% of adult J&DR clients are on probation for sex offenses or violation of a protective order • 23% of adult J&DR probationers are Court ordered to undergo a mental health evaluation 54
  • 55.
    Challenges and Needs Challenges •At present, J&DR has limited staff available to conduct pretrial evaluations on adult defendants in the ADC • At present, Adult J&DR clients do not receive sufficient access to mental health services Needs • 2 Probation Officer I positions – Duties would include conducting pretrial evaluations, collecting and disseminating pretrial information, and making release recommendations to the judiciary 55
  • 56.
    Goals & Activities Nextthree months… • Use existing resources to launch pretrial evaluations for adult J&DR defendants • Coordinate training for the existing designated staff • Work with Data and Evaluation Team to collect case data with preliminary findings Next six months… • Seek funding for two PO1 positions to expand pretrial J&DR services • With funding, fully implement J&DR Pre- Trial Services Program • Develop data for performance monitoring and outcome measures 56
  • 57.
    Update from CircuitCourt The Honorable Penney Azcarate Judge, Fairfax Circuit Court 57
  • 58.
    Supreme Court Rule1:25 • 3 types of specialty dockets recognized: – Drug Treatment Court 18.2-254.1 – Veteran’s dockets – Behavioral health/mental health dockets • Cases are grouped together based on: – Requiring more than simple adjudication of discrete legal issues – Presenting a common dynamic underlying the legally cognizable behavior, and – Require coordination of services and treatment to address the underlying dynamic and focus on the remediation of the defendant in these dockets • The treatment, services, and disposition options are those which are otherwise available under law 58
  • 59.
    Specialty Court Dockets •Localities have to petition the Supreme Court of Virginia for authorization prior to beginning operation and demonstrate local support and planning for its establishment and continuation • Financing is the responsibility of the locality and local court but funds may be provided via state appropriations and federal grants • Evaluation and reporting to the Supreme Court Advisory Committee 59
  • 60.
    Drug Court News •Fairfax Circuit Court submitted an application to establish a Drug Court in September • Post-judgment felony probation violation alternative to incarceration for non-violent defendants with severe substance abuse issues • In wake of the opioid crisis that has hit our county, this is an opportunity to assist drug dependent individuals to once again become productive citizens • The Supreme Court Advisory Committee met today and the application to establish a Drug Court for Fairfax was approved! 60
  • 61.
    General District Court CourtServices Shawn Lherisse, Behavioral Health Unit – Diversion First 61
  • 62.
    Quarterly Results (July 2017– September 2017) PLACEMENTS – PRETRIAL SUPERVISION 549 defendants placed 138 (25%) indicated a need for further mental health assessment • 101 from bond motions • 33 from advisements • 4 from the Magistrates 37 defendants were Court ordered to undergo a mental health evaluation and follow recommended mental health treatment* * An increase of 13 from last quarter may be attributable to changes to the Pre-Trial Defendant Questionnaire (information provided to attorneys) 62
  • 63.
    Quarterly Results (July 2017to September 2017) 46 defendants had received mental health treatment in the past 81 defendants administered advanced screening instrument 74 (91%) defendants that were administered the advanced screening instrument indicated a need for a mental health evaluation • 81 defendants referred for mental health evaluation • 22 defendants already engaged in mental health treatment 63 PLACEMENTS – ADVANCED SCREENING
  • 64.
    Accomplishments/Needs 64 Accomplishments • We currentlyhave a 90% Court appearance rate • Specialized reduced caseload for high needs defendants • Changed the process for reporting pretrial violations to the Court • Improved collaboration with CSB Needs • Clinician for the completion of mental health assessments • Automatic Court appearance reminder • Completion of construction on current office space (215)
  • 65.
    3-6 month goalsand activities • Train new employees • Fully operational office for the Pre-Trial Behavioral Health Unit • CIT training for all Pre- Trial Officers in the Behavioral Health Unit (currently we have 3 trained with 1 scheduled to attend the November class) • Continue to measure outcomes • Develop and Implement new procedures for violation hearings/review dates 65 Next Three months Next Six months
  • 66.
    Other Work Groups •Problem-Solving Team • Medical Clearance • ED Diversion • Communications • Workforce Development (CIT and MHFA) • Pop Up Team- Exploring Benefits Suspension and Re-enrollment at and post-incarceration These other work groups are still working but just not reporting out tonight! 66
  • 67.
  • 68.
    Next Meeting January 29,2018 7-9 pm, Rooms 4-5 Fairfax County Government Center 68