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CIT’s Role in Sustainability And

Strengthening the Public Safety Net

October 15, 2013

CIT International ConferenceHartford, Connecticut

Leon EvansPresident and Chief Executive Officer

The Center for Hope;Mental Health and

Substance Abuse AuthorityBexar County

San Antonio, Texas levans@chcsbc.org

Gilbert R. GonzalesCommunications and Diversion Initiatives

The Center for Hope;Mental Health and

Substance Abuse AuthorityBexar County

San Antonio, Texas ggonzales@chcsbc.org

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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

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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 obstaclesCrisis Intervention Teams/Training (40 hours minimum) including trauma informed, trauma specific curriculum Include Magistration, Probation and Parole

 3. Planning: Stakeholder/CommunityMonthly priorities and implementation meetings with feedback

 4. Services access and coordination; central accessCrisis (Psychiatric) Screening /Intervention/Treatment: Drop OffMedical Clearance Substance abuse intervention: Drop Off, Sobering, Peer Advocates/DetoxResidential accessBoots on the Ground (boundary spanners)No wrong door

 5. Data – tracking data and $$$ Community stakeholder developed data fieldsHigh Utilizer trackingWide review and distribution of descriptive data

  6. Reports of Success or “Every success has a story” 

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

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Law EnforcementDetention/Jail

CIT

Judicial/CourtsMagistrate, County, District

Mental HealthPublic and Private

Providers

Crisis Care CenterJail DiversionPsychiatric and Medical

ClearanceSpecialty Offender Services

CommunityDynamicCrisis Jail Diversion

Information Exchange

Pol

ice,

She

riff

Pro

batio

n, P

arol

e

Civil and CriminalT

reatment

Continuity of C

are

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-wideEntry Points System Level

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Today2012 – Bexar County Sheriff/San Antonio Police Chief mandate 100% CIT Training for Patrol

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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

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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.

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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

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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

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Restoration Center Addiction Services

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Bldg. #1 Opened April 15, 2008

Bldg. #2 OpenedJune 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

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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

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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.

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PROSPECTS COURTYARD

Developed two years ago to address basic needof food, clothing & shelter

Criteria:

• 18 years of age (or older).• Physically able to care for themselves.

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Haven for Hope Homeless Transitional Facility

www.havenforhope.org

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Show me the DATA !!!

Data Roundtable2003 to Present

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COMMUNITY MEDICAL DIRECTOR’S ROUNDTABLE AGENDATuesday, 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 UpdateXII New BusinessXIII. Adjournment – Next meeting; September 24, 2013

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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 $1545Cost Savings relative to ER Utilization $4,709,160

Source: University Health System

Emergency Room Utilization (Medical Clearance)

What Works

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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

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Recidivism Rates for Top Five CSCD’S

*Dallas rates reflect only one mental health provider, Metro Care.

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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, 2010Year Three April 16, 2010 – March 31, 2011

Summary next slide

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Summary

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• 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

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BEXAR COUNTY DETENTION CENTERSYSTEM POPULATIONMONTHLY AVERAGES

(Main, Annex)

4222

3743

4133

40153987

3941 39464015

40814095

4171 4156

4094

38453807

3897

3981

4109

42634253

4040

3993

40624033

4066

3960

4079

4096

4084

4094

4095

41394173

4208 4261

4289

4225

4124

4158

4337

4272

4292

4197

421042544179 4193

4280

4357

43004300 4302

4053

4130

4001

4260

40284077

4231

4190

4017

379137903854

3982

3700

3800

3900

4000

4100

4200

4300

4400

JAN

FE

B

MA

R

AP

R

MA

Y

JUN

JUL

AU

G

SE

P

OC

T

NO

V

DE

C

SY

ST

EM

PO

PU

LA

TIO

N

2006 2007 2008 2009 2010 2011

On May 2011, there were 883 empty beds in the jail

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QUESTIONS?

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Leon Evans, President/CEOThe Center for Health Care Services

210 261-1000www.chcsbc.org

levans@chcsbc.org