Combining Forces in the Field Victoria Hatch, CBI Consultants Ltd. Sherry Adam, CBI Consultants Ltd.

Cpl Taylor Quee, RCMP (Police Mental Health Intervention Unit)

Police and PBS interventions for Clients with Critical Behaviours

One year later

Tellusaboutyou….

Presentation Overview

• Introducesystemforcasemanagementofsharedclientsbetweenemergencyresponsesystemsandcommunitybasedagencies

• Reviewandoverviewthesystemandhowitisimplemented

• Presentcasestudiesupdatestodemonstratetheprocess

• Reviewsomestrategiestohelpyoudevelopyourownpartnerships

A Little About CBI Consultants

•  CBIConsultants(Communica@on,BehaviourandInstruc@on)hasbeenprovidingprofessionalsupportservicesforavarietyofindividualssince1988

•  CBIhassupportedover5500individualsandtheirteamsinPosi@veBehaviourSupport,LifestyleDevelopment,Func@onalBehaviourAssessment,and/orCustomizedEmployment

•  CBIalsoprovidesindividual,team,andagencywidetrainingandhasexpandedtoaddaTechnicalTrainingandAssistanceCentre

•  CBISupportsindividualsacrosstheprovinceofBri@shColumbia,thecountryofCanada,andhasrecentlyexpandedworldwideprovidingdirectconsulta@onandtrainingtoChina,IndiaandJapan

Positive Behaviour Support (PBS)

• Anapproachthatblendsthevaluesandrightsofpeoplewithandwithoutdisabili@eswithprac@calscience

• Anevidence-basedstrategy

• Discusseshowlearningandbehaviourchangeoccur

• Founda@onisbasedonthefactthatbehaviouriscommunica@on

• Focusesonproac@vesupportsandstrategies

Positive Behaviour Support (PBS)

Designedto:• Decreasechallengingbehaviour

• Increase:§ Qualityoflife§ Communica@on§ Self-regula@on§ Choice§ Communityinclusion§ Socialconnec@ons§ Skills

LDP Flowchart

(Malette, P., Miranda, P., Kandborg, T., Jones, P., Bunz, T., Rogow, S., 1992)

Police and Mental Health

Cpl Taylor Quee • Surrey RCMP – Police Mental Health Intervention Unit

Police Mental Health Liaison Officer

RevolvingDoor

HospitalDischarged

911

GD

Car67

HospitalDischarged

Police involvement with DD population

Withtheclosureofins@tu@onsbeginninginthe1970’s(Francis,Blue-BanningandTurnbull2014)

Thedevelopmentaldisabili@espopula@onhasbeenmovingfromins@tu@onalfacili@estocommunitybasedresidences(BigbyandBeadle-Brown2016;Francisetal2014)

Communitybasedresidenceforpersonswithintellectualand/orlearningdisabili@eswhilesuperiorforqualityoflifeoutcomesmayincreaseinstancesofchallengingbehaviourandtheneedforaddi@onalcommunitysupports(Joyce,DitchfieldandHarris2001)

Police involvement with DD population

CommunitybasedChallengingbehavioursmayincreaseinvolvementofpoliceand/orlawenforcement(ColemanandCo`on2015;HenshawandThomas2012;McNultyetal2010;Mar@n2015;Raina,Arenovich,JonesandLunsky2013)

PolicecontactwiththeLDpopula@onisgrowing(ColemanandCo`on2015;HollandandPersson2011;SpivakandThomas2013)

Currentpoliceinterven@onincludesmainlyreac@vestrategiesincludingrestraint(Taylor2002)andextremeforce(ColemanandCo`on2015)

Police involvement with DD population

Onceindividualsareinvolvedwithbothcommunityandlawenforcementsystems,interven@onandsupportsbecomeproblema@cduetovarianceinservicedeliveryandmodelsofsupport(Lunskyetal2012)

Policeofficersarenottrainedinsuppor@ngthesespecificindividuals(Eadens,D.M.,Cranston-Gingras,DupouxandEadens,D.W.2016)

Thesetypesofinterven@onsaremorelikelytocon@nuetoinvolvepoliceandalsocreatefurthercriminaljus@ceinvolvement.Policearethereforebeingusedasaddi@onalsupportsforstafftoprovidesupportinhighneedscri@calincidents.(McNultyetal2010)

Police involvement with DD population

ModellandMak’s2008studyfoundbothknowledgeandpercep@onofthepersonswithadisabilityplayedaroleinbothinterven@onsandoutcomesforcrisisinterven@ons.Itcon@nuestobedifficultforlawenforcementtoiden@fythispopula@oninthelineofduty.(HenshawandThomas2012)

Policewerefoundtousepreviousknowledgeofanindividualasthefirstlineofinterven@onbutthiswasnotthemosteffec@vestrategy(KellyandHasse`-Walker2016)

Police Mental Health Intervention Unit

Police Mental Health Liaison

• Policeofficerassignedtomanageclientswithmentalhealthneedswhohavehighriskcontactwithpoliceorhighresourcecontact

• PMHL§ EmbeddedwithinthePoliceMentalHealthInterven@onUnit§ Workswithcommunitypartnerstocreateacollabora@veapproachwhichinformscrisisresponse

§ Completeslongtermstrategiesforriskmanagement§ Communityandpartnereduca@ononpoliceresponse§ Policeofficereduca@ononmentalhealth

Plan Case Studies

• CaseStudies:§ Tash§ Anna§ Alex§ Jimmy

• Clientconsenthavebeenprovidedtosharethefollowinginforma@on

Tash – Police Observations from Data Review

• TimeofcasereviewPolicecontacts(2001-2017)

• 252contacts2007-present• 215911callsbetween2008-2011§  Sheenjoyedpolicecontactsassocialinterac@on§  Staffstartedusingpolicetoassistindailyrou@nes§  Policecalledduetopropertydamageand§  Presenceofaweapon

Tash Police Data Tash – Emotional Thermometer

Tash – Safety Plan Anna – Police Observations from Data Review

• Timeofcasereview178Policecontacts(2001-2017)

• 59contacts12monthsprecedingreview§  EqualnumberofcallsfromcareteamasfromAnna§  Annatakentohospitalbypolice20@mesfrom2010-2014§  Bannedfromsheltersandbouncedtodifferentcarehomes§  Beganassocialneedcalls§  By2012therewasaggressionandthreats§  Shewasreportedashavingmentalhealthneedsbutnooneknewwhatorhowtheyaffectedher§  Sheenjoyedpolicecontactsandhospitalstays

Anna: Police Data Alex – Police Observations from Data Review

•  Timeofcasereview62policecallssince2012

•  2013-2016combinedtotal=56calls• OnecallsinceJune2016•  Enjoyedthecookiesandjuicegivenathospital

•  Theplanallowedstafftocancelpolicea`endanceifAlexwasde-escalatedwhentheyarrived.Policewould“be-friend”Alextode-escalatehim.

Alex: Police Data Jimmy- Police observations and Data Review

•  TimeofcasereviewPolicecontacts(2012-2017)

•  32contacts6monthsprecedingreviewJanuary–June2016§  CBIinvolvedApril2014-June2015§  Re-involvementJuly2016present§  Jimmywouldbetakentohospitalbypolice§  By2012therewasaggressionandthreats§  Heenjoyedpolicecontactsandhospitalstays§  NocallssinceNov2016

Integrated Case Management

Whodoyoubringtothetable?

Crisis Cycle…. Response

Hospital

Getting “buy in” from the team

• Foralotofpeoplethemostexci@ngpartoftheirjobis“success”andimplemen@ngasuccessfulstrategy

• Mee@ngsareyourprimarytooltofindsuccessininteragencyproblemsolving

• Whenusedcorrectlyyoucanmobilizethetalentofthediverseskillsintheroom

• Howeveritisachallengetoconnectwitharoomofpeopleversesoneperson

Meeting TIPS

• Mostpeoplejust“showuptomee@ngs”andtalkabouttheissues…thatiswhymee@ngsgetabadrap

• UsingRobHorner’s“ProblemadmiringversesProblemSolving”

• “Itreatmymee@ngslikeaformalinterview”CplQuee.Theyareplannedpurposefullyanddesignedtoaddressbarrierstosuccess.

Meeting Prep

Lookattheclient’sdailylifeandcycleofcrisisandconsiderwhointeractswiththem–iden@fyeachagency• Ambulance,police,hospital,crisismentalhealthworker,residen@alstaff,communitysupportworkersetc.

Consideryoursupportplanorpolicyaroundthisclient.Aretheagenciesincludedinyourplanawareofyourplan?

CreateanInter-AgencyMee@ng–inviterepresenta@vesfromtheaboveiden@fiedagencies

Reviewyourdataonyourclientandcomepreparedtopresentatthemee@ng.Asktheotherpar@cipantstodothesame.•  Iden@fyyouragency’sroleinclientinterac@ons.Howdoestheclientrespondtoyourstaffandhowdoyourstaffrespondtotheclient?

Meeting Prep

Reachouttolocallawenforcementtoseeiftheyhaveanofficerassignedtoamentalhealthunit•  Ifyoudonothaveanofficerassignedtomentalhealth,perhapsacommunityliaisonofficerorsomeonefromthecrimereduc@onunitwouldberecep@ve

Createbuyinbetweenagencies–considerhowtheseplansbenefiteveryone(e.g.,harmreduc@on,riskmanagement,be`eruseofresources,increasedclientcare)

Meeting Tips

• Beforeyourfirstmee@ngyourshouldhave;§ Createdastrategicpar@cipantlist§ Sentinvitesandanagenda§ Assignedpar@cipantsspecificdatatocomepreparedtopresentandcontribute§ Haveanideaofwhatyouwantsuccesslookslikeforthiscase§ Satdownanddeliberatelyconsideredbarriertosuccessandhowtoaddressthesewiththeroom

• Arriveearlyandnetworkwiththeroompriortothestartofthemee@ng(peopleneedtofeelateaseandwanttotalktoyou–thisstartswhentheywalkinthedoor–notatthebeginningoftheformalmee@ng)

§ Ifyou’renotgoodatthis-putsomethoughtintolightconversa@on

Meeting Tips

• Atyourfirstmee@ngbeginby;§  Iden@fyingthepurposeofmee@ng§  Thankeveryoneforcomingandrecognizethehardworkalreadyputintothiscase

§  Outlinethestructureofthemee@ng• Addresscommonfearsorbarriersintheroom• Beginbyaskingeachagencytopresenttheirroleandmandateintheclient’slife

Meeting Tips

• ExploretheSafetyPlan/BehaviouralPlan/CarePlan-iden@fytheroleofeachagency§ Theagencyrepresenta@veshouldadaptthatcareplansothatitmergeswiththeirorganiza@onspoliciesandproceduresbuts@llworkstowardthebehaviouralprinciples.

§  IfthebehaviouralplancontradictsyourpoliciesthenworkwithyourConsultanttoalignbothplans.Forexample,ifthesupportstaffaretellingtheclient“Policewillarrestyouifyouhitthewallagain”,butpolicedonothavetheauthoritytoarrestinthesecircumstancesthenthismessagingisaproblem.Policeandthecareteamcanexplorewhataneffec@vepoliceresponselookslikeandwhattheappropriatemessagefortheclientis.Allpar@esinvolvedinsuppor@ngtheclientneedtounderstandtheplan.

• Leavemee@ngwithtasksandstrategies• schedulethenextmee@ngbeforeyouleave• Minuteswhichincludethetaskscommi`edtobyeachpersoncancreateaccountability

VictoriaHatchvictoria@cbiconsultants.comCPlQueetaylor.quee@rcmp-grc.gc.caSherryAdamSherry@cbiconsultants.com

Our contact info:

.

Bigby,C.&Beadle-Brown,J.(2016)Improvingqualityoflifeoutcomesinsupportedaccommoda@on

forpeoplewithintellectualdisability:whatmakesadifference.JournalofAppliedResearchinIntellectualDisabili7es,3,3-19.

Cummins.R.A.(1997)Assessingqualityoflife.AssessingQualityofLifeforPeoplewithDisabili7es:Models,Research,andPrac7ce,R.I.Brown,Ed.,pp.116–150.

Francis,G.F.,Blue-Banning,M.&Turnbull,R.(2014)Variableswithinahouseholdthatinfluencequalityoflifeoutcomesforindividualswithintellectualanddevelopmentaldisabili@eslivingincommunity:discoveringthegaps.ResearchandPrac7ceforPersonswithSevereDisabili7es,39,3-10.

Haruord,K.,Carey,R.,Mendonca,J.(2006).Pre-arrestDiversionofPeoplewithMentalIllness:LiteratureReviewandInterna7onalSurvey.JournalofBehavioralSciences&theLaw24,845-856.

Hayes,S.(2007)Missingout:offenderswithlearningdisabili@esandthecriminaljus@cesystem.Bri7shJournalofLearningDisabili7es,35,146-153.

Henshaw,M.&Thomas,S.(2012)Policeencounterswithpeoplewithintellectualdisability:prevalence,characteris@csandchallenges.JournalofIntellectualDisabilityResearch,56,620-631.

REFERENCES .

Joyce,T.,Ditchfield,H.&Harris,P.(2001)Challengingbehaviourincommunityservices.JournalofIntellectualDisabilityResearch,45,130-138.

Kelly,E.&Hasse`-Walker,C.(2016)ThetrainingofNewJerseyemergencyservicefirstrespondersinau@smawareness.PolicePrac7ceandResearch,17,543-554.

McNulty,C.,Kissi-Deborah,R.&Newsom-Davies,I.(2010)Policeinvolvementwithclientshavingintellectualdisabili@es:apilotstudyinSouthLondon.MentalHandicapResearch,8,129-136.

Modell,S.J.&Mak,S.(2008)Aprimaryassessmentofpoliceofficers’knowledgeandpercep@onsofpersonswithdisabili@es.IntellectualandDevelopmentalDisabili7es,46,183-189.

Shalock,R.Brown,I.Brown,I.Cummins,R.Felce,D.Ma@kka,K.Keith,K.&Parmenter,T.(2002)Conceptualiza@on,Measurement,andApplica@onofQualityofLifeforPersonsWithIntellectualDisabili@es:ReportofanInterna@onalPanelofExperts.MentalRetarda7on,V40(6),457-470.

Townsend-White,C.PhamN.T.&Vassos,M.V.(2012)Asystema@creviewofqualityoflifemeasuresforpeoplewithintellectualdisabili@esandChallengingbehaviours.JournalofIntellectualdisabilityresearch,v56(3),pp270–284.

Wilson-Bates,F.(2008)LostInTransi7on:HowalackofCapacityintheMentalHealthSystemisFailingVancouver’sMentallyIllandDrainingPoliceResources.TheVancouverPoliceBoard.

www.pmhl.caCanadianna@onalcommi`eeforpolice/mentalhealthliaison.