The stakeholder meeting covered several Diversion First initiatives including: 1) A presentation on connecting jail inmates to behavioral health services after release which found that engagement with jail diversion programs and assessments significantly increased post-release service connection. 2) An update on the Community Response Team program which has engaged over 75 individuals, 12 of whom started new CSB programs. The program is looking to expand its geographic coverage. 3) A discussion of the new Mental Health Docket program which aims to divert individuals with serious mental illness from jail. It currently has 8 participants and is assessing eligibility and service connection outcomes.

1. Stakeholders Meeting | October 2, 2019

2. Meeting Agenda
• Welcome and Agenda
• Farewell and Thank You!
• Sequential Intercept Model
Mapping
− Discussion
• Connection to Care Analysis
• Community Response Team
• Mental Health Docket
• Wrap-Up
2

3. Our Gratitude and Appreciation to
Chairman Sharon Bulova and Supervisor John C. Cook

4. 2nd Lieutenant Redic Morris
Thank you for your
outstanding leadership at
the Merrifield Crisis
Response Center!

5. Sequential Intercept Model

6. Sequential Intercept Model
Mapping
• August 7 & 8
• Mapped current
services across the
intercepts
• Identified gaps
• Identified priorities
• Started Action Planning

7. Sequential Intercept Model Mapping Workshop
Lyn Tomlinson| Deputy Director, Community Service Board
Abbey May| Director, Emergency Services
Stephanie Carl | Office to Prevent and End Homelessness
Chloe Lee| Diversion First Data and Evaluation Manager
Michael T. Lane| Director, Office of Individual and Family Affairs

8. Improve
community
awareness of
available
behavioral
health services
and how to
access them.
IDENTIFY
OPPORTUNITIES TO
INCREASE
COMMUNITY
AWARENESS OF
BEHAVIORAL
HEALTH SERVICES
DEVELOP
MARKETING AND
OUTREACH PLAN
TO SUSTAIN
COMMUNICATION
EFFORTS AND
BEHAVIORAL
HEALTH SERVICES
AND HOW TO
ACCESS THEM
DETERMINE
AWARENESS OF
COMMUNITY
SERVICES BOARD
AND ANY BARRIERS
WITH NAME
RECOGNITION

9. Increase the
number of
subacute and
other crisis
service options
IDENTIFY PEER RESPITE MODELS AND
CAPACITY TO IMPLEMENT LOCALLY
RESEARCH EXISTING AND
POTENTIAL CRISIS LINES
AND WARM LINES
POTENTIAL EXPANSION
OF NAVIGATORS
REDUCE TIME SPENT BY
PUBLIC SAFETY AT THE MCRC

10. Increase
affordable and
accessible
housing
options with
appropriate
supports
DEFINE
HOUSING NEEDS
OF TARGET
POPULATION
IDENTIFY
HOUSING
MODELS THAT
ARE SUCCESSFUL
WITH THE
DIVERSION FIRST
POPULATION
SEEK POTENTIAL
FUNDING
OPPORTUNITIES
AND
COLLABORATIVELY
APPLY FOR FUNDS

11. Increase and
Improve data
and information
sharing across
all intercepts
Develop common definitions for critical data
elements
Increase knowledge and awareness of
parameters regarding Personal Health
Information (PHI)/ information sharing
In conjunction with other countywide data
sharing projects, encourage development of
data governance policies and procedures
Determine needs for Diversion First data
sharing agreements and processes, to include
community, county, regional and state entities

12. Effectively
employ peer
support
specialists
across all
intercepts
Identify or create a focused training
for Peer Support Specialists working
in forensic services
Ensure a percentage of peer support
specialist are full-time benefited
positions
Create a strategic plan for peer
supports with robust peer
involvement and stakeholders

13. How would you rank these
Diversion First priorities?

14. Connection to Service Analysis For the 2018
Jail Behavioral Health Population
Chloe Lee|Data and Evaluation Manager

15. Four Key Measures
Reduce
The number of people
with behavioral health
issues booked into jail
Shorten
The average length of stay
for people with behavioral
health issues in jail
Lower
Rates of recidivism
Increase
The percentage of people
with behavioral health
issues/SMI in jail who are
connected to care

16. Population Included (N=2,334)
16
Booked into and released from jail in 2018
Current or past CSB clients
Fairfax County residents
Clinical behavioral health diagnosis
CSB services tracked for 6 months (180 days) for each inmate from their first booking dates in 2018
Face-to-face services except for a few programs

17. Connection to Service Defined
17
Any post-incarceration community-
based CSB mental health (MH)
and/or substance use disorders
(SUD) services within 180 days from
each individual’s release date
Focus on assessment services as a first step
to receive more treatment-oriented
services

18. Demographic Information (N=2,334)
18
78.3%
21.7%
Male
Female
Gender
Race Homeless
Age
6.4%
15.9%
3.4%
34.2%
40.2%
Multi-race
Other
Asian
Black
White
4.3%
11.2%
13.3%
30.6%
40.6%
60 or higher
50-59
40-49
30-39
18-29
Average age: 35
9.5%

19. Behavioral Health Diagnosis Information
(N=2,334)
19
59% 82.6% 42%
MH SUD Co-Occurring
All individuals included in this analysis had at least one clinical
behavioral health diagnosis

20. Post-Incarceration (6 Months) Services
20
1 in 3 had (N=2,334) at least
one post incarceration service
from CSB, excluding jail-based
services.
Among the individuals who
received services after
incarceration (N=768) the
average length to the first
service from release was 39
days.
Approximately 19% (N=2,334)
had an assessment within 6
months of their release.
8.3% 5.7% 4.9%
Within 30 days Between 30 and 90 days
Between 90 and 180 days
18.9% assessed in 6 months
of the individuals who
received services from
CSB within 6 months had
their first service within
30 days.
63%
39 Days
From incarceration to first service

21. Post-Incarceration (6 Months)
Mental Health Services
• Among the individuals with a mental health diagnosis (N=1,378), 11.6% had at
least one mental health service.
• Among the individuals with a mental health diagnosis, the mental health
service rate was significantly higher for the assessed population (N=306) than
the unassessed population.
21
11.6%
Mental Health Treatment Services
among the Mental Health Population
(N=1,378)
27.1%
Mental Health Treatment Services among
the Assessed Mental Health Population
(N=306)

22. Post-Incarceration (6 Months)
SUD Services
• Among the individuals with an SUD diagnosis (N=1,928), 15.7% received
at least one SUD service.
• The SUD service rate was significantly higher for the assessed population
(N=440) than the unassessed population.
22
5.9% 6.8%
10.9%
SUD Outpatient SUD Residential SUD Detox
22.9%
24.7%
31.7%
SUD Outpatient SUD Residential SUD Detox
SUD Treatment Services
Among the SUD Population
(N=1,928)
SUD Treatment Services
Among the Assessed SUD
Population (N=440)

23. Connection To Service:
Predictors & Risk Factors
• Logistic regression model with the
assessment in 6 months of release as a
dependent variable
• (Re)assessment is often the first step to
receive treatment services and thus was
used as a proxy variable to examine the
link to service for the population
• Demographic variables such as race,
gender, and age were not significant
predictors.
23

24. Jail Diversion & Jail-Based Services
Individuals who received services from CSB
Jail Diversion Engagement team
during/shortly after their incarceration were
more likely to be assessed within 6 months
of their release.
24
Jail Diversion
Engagement: 47.8%
No Jail Diversion
Engagement:
18%
6 Month Assessment
2.6 X
Individuals who received services from CSB
Jail-Based team during their incarceration
were more likely to be assessed within 6
months of their release.
Jail-Based: 33.1%
Not Jail-Based:
14.9%
6 Month Assessment
2.2 X

25. Past Assessment & Co-Occurring Diagnosis
25
Past Assessment:
38.1%
No Past
Assessment:
12.6%
6 Month Assessment
3 X
Individuals who had been assessed in the 2
years prior to their incarceration were more
likely to be assessed within 6 months of
their release.
Individuals who had co-occurring MH/SUD
diagnosis were more likely to be assessed
within 6 months of their release.
Co-occurring:
26.1%
No Co-occurring:
13.6%
6 Month Assessment
1.9 X

26. Pre-Trial Supervision & Referral
to CSB Jail-Based Services
26
Individuals who were released on Pretrial
Supervision were more likely to be assessed
within 6 months of their release.
Individuals who were referred to CSB Jail-
Based services in jail were more likely to be
assessed within 6 months of their release.
Pre-Trial: 24.4%
No Pre-Trial:
17.1%
6 Month Assessment
Referred: 23.4%
Not Referred:
12.7%
6 Month Assessment
1.4 X 1.8 X

27. Connection to Service:
6 Month Service Rate
All predictors for 6-month assessments were significant predictors for 6-
month services (i.e. one or more community-based services).
27
3.6 X
Jail Diversion
Engagement:
94%
No Jail Diversion
Engagement:
26.4%
6 Month Service
2.2 X
Jail-Based:
57.3%
No Jail-Based:
26.1%
6 Month Service

28. Take-Aways
• Individuals who received Jail Diversion Engagement
services were more likely to get connected to care.
Re-entry programs like Jail Diversion and Jail
Diversion Engagement enhance the connection to
care for this population.
• Individuals who were referred to CSB jail-based
services and who received the services in jail were
more likely to get connected to care. Multiple touch
points in jail improve connection to care for this
population.
• Individuals who were on pretrial supervision were
more likely to get connected to care. Pretrial
supervisions with treatment options help the
population link to services.
28

29. Co-Responder Model
(Community Response Team)
Adam Willemssen| Fire and Rescue Department

30. CRT Trends - Original 35
0
10
20
30
40
50
60
0
50
100
150
200
250
January February March April May June
LEO/FRDCalls
DPSCCalls
DPSC LEO FRD

31. Community Response Team
• 12 individuals started a CSB Program not
previously enrolled
• 18 were assessed or started a new
program (10 = assessment and new
service)
Disposition/Referral:
• Referred to treatment (i.e. Intensive Case
Management, Outpatient, PATH, Detox)
• Re-engaged with providers for other services
(i.e., Medicaid, transportation, housing,
medical supplies)
• 2 voluntary hospitalizations
Impact
New to
Services
Other
Referrals
Assessment
30 Known to CSB

32. CRT Census and Engagement – Current State
CRT Stats (as of 9/30/2019)
Active 55
Tracking 13
Closed 60
Deceased 7
Total 135
Clients
Engaged 77 Challenges
• Increasing demand/referrals
• Triage - as program grows
• Geography
• No fixed address
• Action threshold not met
0
20
40
60
80
100
120
140
0
5
10
15
20
25
30
35
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
2018 2019
CRT Client Census and Referrals
Monthly Cumulative

33. Community Response Team Operational Updates
• Public safety electronic referral application (GIS capability)
• Video and training plan for public safety
• Inova Health System collaboration
• Expansion of CRT into Fairfax City, Vienna, and Herndon
• Peer Support Specialist

34. Mental Health Docket
The Honorable Judge Tina Snee
Dawn Butorac | Chief Public Defender
Casey Lingan | Chief Deputy Commonwealth Attorney
Shawn Lherisse | Court Services
Marissa Fariña-Morse | Community Services Board

35. Mental Health
Docket
Eligibility Criteria
• Resident of Fairfax County
• 18 years of age or older
• Charged in Fairfax County
• Diagnosed with a serious mental illness
as defined by DSM-5
• Medium to high risk of recidivism as
measured by a validated assessment
instrument
• Connection between the defendant's
mental illness and their criminal
charges.

36. Mental Health
Docket
Launched on July 10, 2019
• 8 participants
• 36 referrals
• Average age for participants: 27
• 63% of participants have co-occurring
substance use issues
• Participant level of care:
• 45% Intensive Case Management/Jail
Diversion
• 36% Outpatient
• 18% Residential

37. Supervised
Release
Program (SPR)
Docket
Started August 10, 2018
From August 10, 2018-August 7, 2019
• 108 SRP Violations (Diversion First population)
- 6% of total SRP Placements during that
period, 15% of Diverted SRP population
- 42% were connected or reconnected to
treatment at hearing
- 10% were removed from SRP as a result of
non-compliance
- 13% of SRP Violations were due to non-
compliance with treatment

38. What’s Next?
2020 Diversion
First Stakeholders
Meetings
Focus and
Frequency