enlightened alternatives: how cit and diversion are cutting recidivism and saving millions
DESCRIPTION
Powerpoint showing how CIT and Diversion programs can reduce recidivism and strengthen the public safety net.TRANSCRIPT
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Leon EvansPresident and Chief Executive OfficerThe Center for Health Care ServicesMental Health and Substance Abuse
AuthorityBexar County
San Antonio, Texas [email protected]
Enlightened Alternatives: How CIT and DiversionAre Cutting Recidivism
and Saving MillionsAugust 20, 2012
Clark County, Nevada
Gilbert GonzalesMelanie LaneAaron Diaz
Jeanie ParadiseThe Center for Health Care ServicesBexar County, San Antonio Texas
A Winning CollaborationCIT International Conference
Romana LopezSergeantCIT Unit
San Antonio Police Department
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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
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Collaboration: It’s an unnatural act between…
…two or more unconsenting adults.
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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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6Today2012 – The Bexar County Sheriff and San Antonio Police Chief mandate CIT Training
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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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Texas Veteran Jail Diversion and Trauma
Recovery Project (TVJDTR)
VETERANS SERVICES program :
• inclusion and expansion of trauma specific treatment and trauma informed practice
• monitoring of the delivery of veteran peer support services related to behavioral health issues
• monitoring of the implementation of family member facilitated family-to-family education groups related to behavioral health issues
• developing of collaborative advisory groups for supports and services for veterans and their families to initiate
• enhance or expand community resource coordination related to basic needs with community partners, individuals and organizations • linkage to Therapeutic Justice Services
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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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Residential Detox• Originally licensed 44 beds.
Reduced after 6 months to 27 due to flow from sobering to detox.
• Barriers include low $$ reimbursement rates and wait list
• Intervention only unless followed by additional treatment
• Open to ER 24 hour admits
• Funded by hospitals, DSHS, Medicaid 16
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Outpatient Addiction Services• Originally started with clients who
completed detox and were living at shelter
• Barriers including safe and sober living environment and limited residential treatment beds in community
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• Need for individuals to be in recovery environment
• Developed a short term ambulatory detox over 2-3 month period.
• Partnered with Haven for Hope to start In House Recovery Program.
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• Expansion into new building
• 550 Opioid Addiction Treatment clients daily
• Added 200 Outpatient clients to equal 400
• Project Carino – Pregnant Women Opioid Addiction Treatment.
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Recent Additions
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Restoration Center Admissions
1914% (888 clients) went from sobering to detox
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IHRP Mission Statement
To provide a safe, structured, sober-living
dormitory that supports residents committed
to living sober lives and becoming productive, contributing members of
society.20
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Outpatient Treatment
PeerSupport
Community
12-Step Program
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Dorm Sleeping
Area
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IHRP Outcomes
• Total clients admitted Dec 2010 to March 2012 735• Total transferred from Residential Detoxification 413
• Total clients still in care 96
• Total Discharges639
• Total clients completing with positive outcomes 316• % completing with positive outcome
49.5%
Positive outcomes are defined as having no alcohol/drug use, employment or other positive endeavor at discharge, development of recovery support system (e.g., 12-Step, church).
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PROSPECTS COURTYARD
Developed two years ago to address basic needs of food, clothing & shelter
Criteria:
• 18 years of age (or older).• Physically able to care for themselves.
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5 MAJOR GROUPS IN PCY
1. Recently out of prison
2. Mental Health Issues
3. Substance Abuse Issues
4. Elderly
5. Young people aged out of foster care – or no longer allowed at home
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Funded by The City of San Antonio & Private Donations
• Capacity was set at 400 per night by contract April – June 2012.
• Averaged 516 sleeping
• Averaged 694 receiving some service during the day
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IN-HOUSE WELLNESS PROGRAM
MISSION STATEMENT:
The mission of the CHCS In-House Wellness Program is to provide the
following:
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MISSION STATEMENT
1. A safe, comprehensive, structured dormitory environment with a treatment plan tailored to meet the needs of the chronic, homeless, mentally ill who may suffer from co-occurring diseases including substance abuse.
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MISSION STATEMENT
2. A program including mental health medication and compliance to take said medications by the residents.
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MISSION STATEMENT
3. A program directed toward mental health stabilization and an ultimate transition to a more stable, individual living environment.
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MISSION STATEMENT
4. An environment of trust between staff and the residents that gradually assists them in their recovery to become self-reliant and independent.
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ADULT MENTAL HEALTH CLINIC
Consumers referred will receive the following services:
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CONSUMER BENEFITS SPECIALIST
• To provide benefits screening
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PSYCHIATRIC AND NURSING SERVICES
• Medications• Medication Management
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Haven for Hope Homeless Facility CNN Video Clip
• http://www.diversioninitiatives.net/2010/07/haven-for-hope-cnn-video-just-before.html
“Texas officials hope a massive new facility will keep the homeless
out of jail, emergency rooms and re-integrated into society”.
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Haven for Hope Homeless Transitional Facility
www.havenforhope.org
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Show me the DATA !!!
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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 45 minutes.
• Wait time for Medical Clearance/Screening and Psychiatric Evaluation is 60-65 minutes.
Impact on WAIT TIME for LAW ENFORCEMENT
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Recidivism Rates for Top Five CSCD’S
6.6%
12.7%
17.6%
20.6%
22.6%
30.3%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Bexar Harris Average Tarrant Dallas* Travis
Bexar
Harris
Average
Tarrant
Dallas*
Travis
*Dallas rates reflect only one mental health provider, Metro Care.
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1,600
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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
Combined CCC and Restoration Documented and Immediate Cost AvoidanceYear One April 16, 2008 – March 31, 2009Year Two April 16, 2009 – March31, 2010
Year Three April 16, 2010 – March 31, 2011
Summary next slide
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Summary
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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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The End Result
• Comprehensive service for most in need• Increased availability of comprehensive
coordinated services• Reduced barriers to service access and
increase motivation with treatment compliance
• Employ evidence based practices known to be effective
• Utilization of system tracking and outcome based treatment
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The Center for Health Care Services
Leon Evans, President/CEOThe Center for Health Care Services
Mental Health Authority210 731-1300