Diversion First Stakeholders Update 2017 First Quarter (January-March): April 18, 2017

1. Diversion First Stakeholders Update
2017 First Quarter
(January-March)
April 18, 2017
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2. Tonight’s Agenda
• Welcome
• Leadership Group
• Problem-Solving Team
• Communications Team
• Data and Evaluation
• CSB Updates
• Court Services Updates
• New Teams
• Questions, Discussions, Other Announcements
• Adjourn 2

3. Leadership Group
Bob Bermingham
Director of Court Services
Juvenile and Domestic Relations Court
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4. Leadership Group
• Continues to meet regularly with additional
membership
• Budget Updates
– Diversion First update provided to BOS Public Safety
Committee March 21
– Budget Consideration Item of $1.995 introduced for
Diversion First by Supervisor Cook
• Funding needs identified for Court Services and CSB
(intercepts 2-3) and additional Law Enforcement staffing at
MCRC
– Budget hearings were April 4-6 with extensive testimony in
support of Diversion First
– Final budget will be adopted May 2
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5. Leadership Group
2017 Priority Solution-Focused Areas
(in addition to our focus on Intercepts 2-3)
• Medical Clearance
– Current process takes LEOs off-site from MCRC
– Improve capacity for on-site clearance and faster ED
processes
• High System Utilizers
– Begin review across systems
– Develop recommendations for better interventions to
improve outcomes
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6. Leadership Group
Additional 2017 Focus Areas
• Jail Population Data
– Use of Brief Jail Mental Health Screen will allow for more
accurate measures of MI prevalence
– Develop approaches to track and report populations change
• Medium and Long Term Data System
– Complete pilot with recommendations for data collection
elements across systems
– Determine medium term evaluation approach
– Work with Department of Information Technology to identify
longer term solution and work in collaboration with broader
system IT efforts
You will hear more about all of these priority areas tonight!
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7. Leadership Group
• Diversion First considered national model!
– Fairfax County invited to participate as a Best
Practice Team at SAMHSA’s Best Practices
Implementation Academy to Reduce the Number
of People with Mental Illness and Substance Use
Disorders in Jails (BPIA), June 20-22, to provide
technical assistance with 14 other jurisdictions
– Recognition comes from the leadership of
Stepping Up, One Mind Campaign, and Data-
Driven Justice Initiative
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8. Problem-Solving Team
Daryl Washington
Deputy Director
Fairfax-Falls Church CSB
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9. Problem-Solving Team
• Meetings scheduled through next quarter
• Reviewing all concerns brought to attention of
team (contact Daryl.Washington@fairfaxcounty.gov)
• Currently reviewing any low-level crime
arrests (that may have been diverted) and
following up as needed
• Working through data-sharing protocols
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10. Communications Team
Andi Ceisler
Office of the Sheriff
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11. Communications Team
Ongoing community presentations about Diversion
First:
• 2 recent Inside Scoop and Your Need to Know cable shows
on Diversion First
• GMU MPA students
National level presentations:
• Course Corrections: Mid-Atlantic Justice and Behavioral
Health Summit
– Fairfax County well-represented
– Sheriff Kincaid was a featured speaker
• American Public Health Association’s National Public
Health Week forum discussing cross-sector partnerships.
– Sheriff Kincaid was a featured speaker
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12. Communications Team
In the category of “it’s an honor to be
nominated”…
The Communications Team prepared and
submitted a nomination for a National
Association of Counties Achievement Award.
We will know the outcome by the next
Stakeholders meeting!
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13. Data and Evaluation Workgroup
Chloe Lee, Fairfax-Falls Church CSB
Ryan Morgan, Police Department
Redic Morris, Sheriff’s Office
Lisa Potter, Fairfax-Falls Church CSB

14. Law Enforcement Officer
Transports to MCRC
14
January February March
Total cases 2016 107 111 142
Total cases 2017 165 124 160
0
20
40
60
80
100
120
140
160
180
Law Enforcement Officer (LEO) Transports to MCRC

15. Emergency Custody
Order Data
15
January February March 3 month average
ECO 2016 42 70 90
ECO 2017 114 93 107
Avg. # ECO 2016 67
Avg. # ECO 2017 105
Emergency Custody Order Data

16. Crisis Intervention Training
• Graduates since September, 2015 – 289 total
- 188 FCPD (24% of patrol officers trained)
• Dispatcher training - 67 trained
• CIT training classes are ongoing
• Mental health overview has been added to the
Criminal Justice Academy training - 274 trained
to date
16

17. Mental Health First Aid
(MHFA)
Training continues:
• Deputies – 304 (over 50% of jail-based)
• Magistrates – 30
• Juvenile Intake Officers – 23
• General workforce and community members- nearly
1000 annually
• Fire and Rescue - 246
– adaptation of MHFA curriculum
17

18. Sheriff’s Office Data
January-March 2017
• Emergency Custody Orders (ECOs) and Criminal Temporary
Detention Orders (CTDOs) - 13 (3 in Q1 2016)
• Includes those with mental health concerns who would be
better served in a psychiatric hospital
• Transports from MCRC to out of region psychiatric hospitals -
42 (26 in Q1 2016)
• Transport requires 2 deputies; at least 1 CIT-trained
• Accumulating in 10,622 (7,103 in Q1 2016) round trip miles
driven
• Jail transfers to Western State Hospital (forensic) -
8 (5 in Q1 2016)
• Includes individuals currently incarcerated who require
psychiatric hospitalization due to decompensation
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19. Sheriff’s Office
2017 Projections
Based on Q1 Annualized
19
2017 Projected 2016 Stats
ECOs from ADC 48 28
Criminal TDOs from ADC 4 7
Jail Transfers 40 23
Out of Region Transports 168 128
Out of Region Transport Mileage
42,650 34,577
Local Transports by MCRC Deputies
456
269
Post Hearing Transports 120 216
ECO’s Assumed by MCRC Deputies
360 255

20. MCRC/Diverted from
Potential Arrest
Instances in which law enforcement officers diverted
individuals from arrest and provided an opportunity
for mental health services
January 1-March 31:
• 449 people were transported by law enforcement to
Merrifield Crisis Response Center
• 96 or 21% had potential criminal charges but were
diverted to mental health services
• Includes both voluntary and ECO
• On average, 39% of all LEO transports to the MCRC
involved a CIT trained officer
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21. Data Snapshot
Jan-Mar, 2017 Jan-Mar, 2016 Jan-Dec, 2016 Jan-Dec, 2015
Police Department
Mental health investigations in the field
– Fairfax County Police Dept. 993 831 3,566 -
- Resolved in the field (Fairfax County) 555 471 1,959 -
- Involved Merrifield Crisis Response Center
(MCRC) for all jurisdictions 449 360 1,580 NA
Merrifield Crisis Response Center/Emergency Services
Total service encounters 1,475 1,296 5,024 4,861
– General Emergency Services (non-law enforcement involved) 1,026 936
3,444
3,590
– Involved Law Enforcement 449 360 1,580 1,271
- Voluntary transports to MCRC 135 158 547 808
- Emergency Custody Order (ECO)
transports to MCRC 314
202 1,033 463
Diverted from potential arrest 96 103 375 NA
Unduplicated number of people served at Emergency Services 1,080 922 3,081 2,637
Mobile Crisis Unit
– Total number of services (attempts and contacts) 385 319 1,484 1,153
- Total number of services (contacts) 284 215 1,029 852
– Services with law enforcement involvement or referral 121 79 467 354
Unduplicated number of people served (contacts) 284 172 791 638
Office of the Sheriff
– Emergency Custody Orders and Criminal Temporary Detention Orders
(ECOs/CTDOs) from Jail 13 3 35 NA
– Transports from MCRC to out of region MH hospitals 42 26 128 NA
– Jail transfers to Western State Hospital (forensic) 8 5 23 98
Crisis Intervention Training (CIT)- trained to date
– Graduates 289
– Dispatchers trained 67
Mental Health First Aid (MHFA)- trained to date
– Magistrates 30
– Sheriff Deputies 296
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22. Purpose of Data Pilot
Inform overall evaluation framework
– Identify data elements that are accessible vs. what
needs to be further developed/refined
– For the data variables that are accessible, determine
which available through manual vs. automated
processes
– Determine which data variables are most useful
moving forward
Learn more about system outcomes, gaps and areas
for improvement
– Although a small sample, useful in determining areas
for further analysis and exploration
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23. Preliminary
Pilot Findings
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24. Sampling, Data Collection
and Analysis
• Selected 49 individuals (adults, Fairfax residents, and
with SMI) from 109 LEO involved MCRC cases in
January 2016
– 29 with potential charges and 20 with no potential charges
• Tracked LEO encounters, arrests, ADC records and
CSB services for two years (2015-2016)
• Collected data from four different agencies (Police,
Sheriff, Fire and Rescue and CSB). Had 130+ variables
• Combined, cleaned and coded the data for analysis
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25. Demographic
Information (N=49)
• 40.8% Female, 59.2% Male
• 63.4% White
• 14.6% Black
• 14.6% Asian
• 14.3% Hispanic or Latino
• Average Age: 38 (Min: 18, Max: 70)
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6.1%
22.5%
14.3%
20.4%
36.7%
0% 5% 10% 15% 20% 25% 30% 35% 40%
60+
50-59
40-49
30-39
18-29

26. Open to CSB Before
28.6% (14) of the 49 individuals were not open
to CSB before the January MCRC visit.
Of the 14 individuals, 57.1% (8) received at
least one CSB service following the visit.
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27. What Happened
Afterwards: CSB Services
55% (27) of the 49 individuals received at least one service
from CSB after the January MCRC visit. Of the 27, 55.6% (15)
of their first service was Emergency/MCU. The average length
between the MCRC visit and the next service was 51 days.
27
3.7%
3.7%
7.4%
11.1%
18.5%
55.6%
0% 10% 20% 30% 40% 50% 60%
OP Therapy
Detox
Psychiatric Med Management
Forensic Intake/CSB Jail-based…
Case Management
Emergency/MCU

28. LEO Encounters
73.5% (36) of the 49 individuals had LEO encounters
(services, not arrests) at least once in 2016.
28
6.0%
4.1%
10.2%
8.2%
14.3%
20.4%
10.2%
26.5%
0% 5% 10% 15% 20% 25% 30%
12+ times
6 times
5 times
4 times
3 times
2 times
1 time
None
73.5%

29. Fire and Rescue
24.5% (12) of the 49 individuals had encounters with
Fire and Rescue at some point in 2016.
29
75.5%
24.5%
0% 10% 20% 30% 40% 50% 60% 70% 80%
No
Yes

30. Arrests
32.7% (16) of the 49 individuals were arrested at some
point in 2016.
30
4.1%
2.0%
14.3%
12.2%
67.3%
0% 10% 20% 30% 40% 50% 60% 70% 80%
4 times
3 times
2 times
1 time
None
32.7%

31. ADC Incarcerations
26.5% (13) of the 49 individuals were incarcerated in
ADC at some point in 2016. The average number of
days in jail was 19.8 days.
**Of the 8 individuals who stayed in jail for more than 3 consecutive days in
2016, 75% (6) received CSB jail-based services.
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2.0%
2.0%
6.1%
18.4%
71.4%
0% 10% 20% 30% 40% 50% 60% 70% 80%
4
times
3
times
2
times
1 time
None
28.6%

32. Potential Charges vs. No
Potential Charges
Consistent with findings from other jurisdictions across the
country, the individuals with potential charges (diverted) in
January were more likely to…
 Have encounters with LEOs
 Get arrested
 Be incarcerated in ADC
32
75.0%
79.3%
30.0% 34.5%
20.0%
34.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
No potential charge Yes potential charge
LEO Encounter
Arrest
ADC Incarceration

33. High Utilization of
Services
The number of CSB services and the number of LEO
encounters and arrests were highly correlated
(p<.001***).
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34. Pilot: Lessons Learned
So Far
• Need to create data sharing protocols among
different agencies
• Need to secure a data collection/sharing system
across agencies
• Need to target interventions for high utilizers and
individuals with potential charges
• Enhance linkages to CSB services and programs
after the MCRC visit
• Enhance post-diversion services
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35. Next Steps
• A deeper dive into the jail population: what
happened before, during, and after the
incarceration
• Will track CSB services, law enforcement
encounters and ADC incarcerations
• Reviewing and narrowing down the
parameters for sustainable, scalable
evaluation plans
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36. CSB Updates
Daryl Washington, Deputy Director
Marissa Farina-Morse, Diversion First Service Director
Abbey May, Emergency Services Director
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37. CSB Updates
Housing
• 8 people housed (6 with state $ and 2 with
diversion $)
• 6 have pending apartment approvals (1 state $, 5
diversion $)
• 12 more have been referred and in placement
process
Permanent Supportive housing is a key need!
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38. Merrifield Crisis
Response Center
– NEW: Jail Diversion staff stationed in Emergency Services
• Since Feb 22nd 41 individuals have been seen
– Early intervention to partner with a provider outside of ES to enhance likelihood of follow up
service
– Build relationships with clients and improved collaboration with ES staff
– Consultation with ES staff on ability to serve individuals in real time
– Immediate access and better continuity of care
– Jail Based staff currently training with Emergency Services to be Certified Pre-
screeners
• Better response time at Jail to transfer individuals to State Hospitals
• Provide TDO evaluations longer term
– Medical Clearance
• Status
• Goals
– Positions
• 6 Recovery Specialist positions starting this month
– Assistance with follow up with Diversion cases to link with services
– Creation of a youth drop in group to discuss wellness and resources
• Care Coordinator position
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39. CSB Updates
Partnership with Court Services:
• Court Services reviews Brief Jail Mental Health
Screen (BJMHS) results
• All positive screens get referred to CSB
• Supervised Release Program or Personal
Recognizance Bond is considered for various
charges to move people more rapidly out of jail
• CSB and Court Services staff are working
collaboratively in these new efforts
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40. CSB Updates
Adjusted staff time for Jail Based and Jail
Diversion teams to align with Court Services.
Goal - staff to intervene early and evaluate
people in jail prior to advisement hearings.
• Since 1/27/17, have seen 50 individuals
• Form release plans with mental health treatment
recommendations for consideration by the courts
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41. CSB Updates
More in-depth look at what CSB does…
• Evaluates for mental illness, developmental
disability, or substance use disorder
• Early determination if additional evaluation is
needed and communicate recommendation to
Court Services staff
• Goal is to incorporate a treatment
recommendation at advisement hearing and
increase opportunities for Intercept 2/3 Diversion
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42. CSB Updates
• CSB staff works to obtain appropriate
releases in order to communicate and
collaborate with attorneys, and court staff in
order to make treatment recommendations
• CSB staff can also make recommendations
for treatment post-advisement such as at
bond hearings
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43. CSB Updates
Future Goals
• Review all BJMHS to include those who do not
score positive
• Responsiveness to court required Mental
Health and Substance Use assessments
• Staff/Peers to focus work with high utilizers
• Availability to attend court as requested to
provide mental health treatment information
43

44. General District Court
Court Services
Colin McDonald, Director

45. Quarterly Results
(January 2017 – March 2017)
PRETRIAL EVALUATIONS (by GDC Court Services)
1141 on defendants remanded to the jail by the magistrate or
pending bond motions vs. 2491 during 6 month pilot
BRIEF JAIL MENTAL HEALTH SCREENS (by GDC Court Services)
959 administered* vs. 1782 during 6 month pilot
*less than 3 months of data 12/11/16 – 3/7/17 as opposed to 3 months
286 (30%) screen results indicated a need for
advanced screening vs. 559 (31%) during 6 month pilot

46. Quarterly Results
(January 2017 – March 2017)
PLACEMENTS – PRETRIAL SUPERVISION
485 defendants vs. 818 during 6-month pilot
108 defendants indicated a need for further mental health
assessment vs. 95 during 6-month pilot
• 82 from bond motions
• 21 from advisements
• 5 from the Magistrates
44 defendants were Court ordered to undergo a mental health
evaluation and follow recommended mental health treatment
vs. 48 during 6-month pilot
46

47. Quarterly Results
(January 2017 to March 2017)
85 defendants had received mental health treatment in the past
64 defendants administered advanced screening instrument
57 (89%) defendants that were administered the advanced
screening instrument indicated a need for a mental
health evaluation
• 43 defendants referred for mental health evaluation
• 10 defendants already engaged in mental health treatment
No data from pilot for comparison
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PLACEMENTS – ADVANCED SCREENING

48. ACCOMPLISHMENTS
Completion of Diversion First participant
database
The Virginia State Police authorized the
request for criminal history data for a pilot
study of 60 law enforcement involved
individuals for the Mental Health Diversion
Program in Fairfax County
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49. CHALLENGES
• More effective BJMHS transfer between CSB, Sheriff’s
Department and Court Services
• Inputting backlog of January - March data into the new
participant database
• CIT training for the Diversion First Mental Health Team
• Ongoing construction for the new Diversion First space
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STAFFING: Lack of Probation Counselors
Large caseloads of high needs clients are very
labor intensive.
Estimate 500+ active pretrial cases moving
forward.

50. Additional Updates
Laura Yager
Office of the County Executive
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51. Additional Updates
New Team Announcement:
High Utilizers Work Group
• Define high system utilization by each partner organization
and identify high utilizers
• Develop approaches to intervene and identify system needs
• Develop data tracking mechanisms including system costs
• Make recommendations as additional needs are identified
Work Group Chair:
Jason Jenkins, Deputy Chief, Fairfax Fire and Rescue
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52. Additional Updates
New Work Group Announcement:
Medical Clearance Work Group
• Continue to improve processes for during-business-hours at
CHCN (4th Floor)
• Develop processes for after-hours clearance both on-site
and at the ED
Work Group Chairs:
Abbey May, CSB Emergency Services Director
Michelle Mullaney, Assistant VP for Behavioral Health, Inova
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53. Stakeholders
Discussion
• Announcements
• Questions
• Comments
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54. Mark Your Calendar!
Next Stakeholders Group meeting:
July 17, 2017
7:00 - 9:00 pm
Government Center, Rooms 9-10
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