Powerpoint showing how CIT and Diversion programs can reduce recidivism and strengthen the public safety net.

1. A Winning Collaboration
CIT International Conference
Enlightened Alternatives:
How CIT and Diversion
Are Cutting Recidivism
and Saving Millions
August 20, 2012
Clark County, Nevada
Leon Evans Gilbert Gonzales
President and Chief Executive Officer Melanie Lane Romana Lopez
The Center for Health Care Services Aaron Diaz Sergeant
Mental Health and Substance Abuse Jeanie Paradise CIT Unit
Authority The Center for Health Care Services San Antonio Police Department
Bexar County Bexar County, San Antonio Texas
San Antonio, Texas
levans@chcsbc.org 1

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3. 2012 – Restoration Center Expansion; Building #2 added
2012 – Prospect Courtyard adds 80 bed MH residential
Timeline
2012 – Prospect Courtyard adds new MH Clinic
2011 – Prospect Courtyard Safe Sleeping reaches high of 714
2010 – In House Recovery Program Male and Female 104 sober living beds
2010 – Haven for Hope 1,600 Bed Homeless Facility opened
2010 – International Crisis Intervention Team Conference hosts 1,600 Officers
2008 – Restoration Center opened ; Detox, Sobering, IOP Treatment
2006 – Bexar County Jail Diversion receives APA’s Gold Award
2005 – 24/7 One Stop Crisis Care Center opened
2004 – Specialty Jail Diversion Facility opens
2003 – First Crisis Intervention Team Training begins
2003 – Deputy Mobile Outreach Team begun
2002 – Bexar County Jail Diversion Collaborative meets for 1 st time
2000 – CEO begins diversion efforts, full time coordinator is hired

4. Collaboration: It’s an unnatural act between…
…two or more unconsenting adults.
4

5. Civil and Criminal
System County City-wide System Level
Entry Points
Judicial/Courts
Magistrate, County, District
Probation, Parole
County City-wide
Continuity of Care
Police, Sheriff
Treatment
Law Enforcement Crisis Care Center
Detention/Jail
Jail Diversion Mental Health
CIT Psychiatric and Medical
Public and Private
Providers
Clearance
Specialty Offender Services
Emergency Services
• Community Collaborative
• Crisis Care Center
• Crisis Transitional Unit
• Crisis Hotline (Nurselink)
Dynamic • CIT/DMOT
Community
• SP5
Crisis Jail Diversion • Jail and Juvenile Detention
Information Exchange • Statewide CARE Match
5

6. Today 6
2012 – The Bexar County Sheriff and San Antonio Police Chief mandate CIT Training

7. 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

8. 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.

9. 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

10. CRISIS CARE CENTER
• Crisis Line
• Crisis Assessment • Receives consumers
• Mobile Crisis Outreach Team
from law enforcement
• Crisis Transitional Unit
24/7
7137 W. Military 645-1651
• Minor medical clearance
• Call ahead preferred
210 225-5481
• Can not take violent or
medically compromised
individuals
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12. 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

13. Restoration Center Addiction Services
• 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
Bldg. #1 Opened
April 15, 2008
Bldg. #2 Opened
June 27, 2012
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14. 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,
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hospitals

15. 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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16. 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

17. 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
• 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. 17

18. Recent Additions
• Expansion into new
building
• 550 Opioid Addiction
Treatment clients daily
• Added 200 Outpatient
clients to equal 400
• Project Carino –
Pregnant Women Opioid
Addiction Treatment.
18

19. Restoration Center Admissions
14% (888 clients) went from sobering to detox 19

20. 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.
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21. Outpatient
Treatment
12-Step Peer
Program Support
Community

22. Dorm Sleeping
Area
22

23. IHRP Outcomes
• Total clients admitted Dec 2010 to March 2012 735
• Total transferred from Residential Detoxification 413
• Total clients still in care 96
• Total Discharges 639
• 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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24. 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.

25. 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

26. 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

27. IN-HOUSE WELLNESS PROGRAM
MISSION STATEMENT:
The mission of the CHCS In-House
Wellness Program is to provide the
following:

28. 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.

29. MISSION STATEMENT
2. A program including mental health medication
and compliance to take said medications by
the residents.

30. MISSION STATEMENT
3. A program directed toward mental health
stabilization and an ultimate transition to a
more stable, individual living environment.

31. 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.

32. ADULT MENTAL HEALTH CLINIC
Consumers referred will receive the
following services:

33. CONSUMER BENEFITS
SPECIALIST
• To provide benefits screening

34. PSYCHIATRIC AND NURSING
SERVICES
• Medications
• Medication Management

35. Haven for Hope Homeless Facility
CNN Video Clip
“Texas officials hope a massive new facility will keep
the homeless
out of jail, emergency rooms and re-integrated into
society”.
• http://www.diversioninitiatives.net/2010/07/haven-for-hope-cnn-video-just-before.html
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36. Haven for Hope Homeless Transitional Facility
36
www.havenforhope.org

37. Show me the DATA !!!
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39. What Works
Emergency Room
Utilization (Medical Clearance)
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 $1545
Cost Savings relative to ER Utilization $4,709,160
Source: University Health System
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40. Impact on WAIT TIME
for LAW ENFORCEMENT
Then (prior to Sept 2005) Now
• Wait times for Medical • The wait time for Medical
Clearance/ Screening at Clearance/ Screening at the
UHS ER - 9 hours, 18 min. Crisis Care Center is 45
minutes.
• Wait times for Medical • Wait time for Medical
Clearance/ Screening and Clearance/Screening and
Psychiatric Evaluation was Psychiatric Evaluation is
between 12 and 14 hours. 60-65 minutes. 40

41. Recidivism Rates for Top Five
CSCD’S
35.0%
30.3%
30.0%
25.0%
22.6% Bexar
20.6% Harris
20.0% Average
17.6%
Tarrant
15.0% Dallas*
12.7%
Travis
10.0%
6.6%
5.0%
0.0%
Bexar Harris Average Tarrant Dallas* Travis
*Dallas rates reflect only one mental health provider, Metro Care.
41

42. 1,600
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44. Combined CCC and Restoration Documented and Immediate Cost Avoidance
Year One April 16, 2008 – March 31, 2009
Year Two April 16, 2009 – March31, 2010
Year Three April 16, 2010 – March 31, 2011
Cost Category City of San Antonio Bexar County Direct Cost Avoidance
Public Inebriates Diverted from Detention $435,435 $1,983,574 $2,419,009
Facility
$925,015 $2,818,755* $3,743,770
$1,322,685 $4,372,128 $5,694,813
A. B.
Injured Prisoner Diverted from UHS ER $528,000 $1,267,200 $1,795,200
$435,000 $1,044,000 $1,479,000
$421,000 $1,010,400 $1,431,400
C. D.
Mentally Ill Diverted from UHS ER Cost $322,500 $774,000 $1,096,500
$283,500 $676,000 $959,500
$276,500 $663,600 $940,100
E. F.
Mentally Ill Diverted from Magistration $208,159 $371,350 $579,509
Facility
$179,833 $322,300 $502,133
$126,893 $191,125 $310,018
G. H.
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Summary next slide

45. Summary
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46. BEXAR COUNTY DETENTION CENTER
SYSTEM POPULATION
MONTHLY AVERAGES
(Main, Annex)
4400 4357
4337
4292 4300 4302 4300
4280 4289
4300 4260 4263
4253 4272
4222 4231 4225
4254 4210 4208 4261
4193
SYSTEM POPULATION
4179
4200 4173 4171 4158
4156
4130 4139 4197 4190
4109 4133 4124
4095 4095 4094
4079 4084 4081
4100 4062
4094 4053 4040
4096 4028 4033
4015 4017
4077 4066
3987 4001 3993
4000 3981 4015
3960
3941 3946
3982
3897 On May 2011, there were 883
3900
empty beds in the jail 3845
3807
3854 3790 3791
3800 3743
3700
FEB
DEC
MAY
SEP
APR
JAN
MAR
JUN
AUG
OCT
JUL
NOV
2006 2007 2008 2009 2010 2011

47. 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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48. 48

49. The Center for
Health Care Services
Leon Evans, President/CEO
The Center for Health Care Services
Mental Health Authority
210 731-1300
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www.chcsbc.org
levans@chcsbc.org