Diversion First Stakeholders Group: Jan. 29, 2018

1. Diversion First Stakeholders Group
January 29, 2018

2. Tonight’s Agenda
• Welcome
• Year in Review and Year Ahead
• Updates from Last Quarter
• Recognition
• Comments from Federal Visitors
• LFI Program Day
• Budget Process – 5-Year Budget Plan
• Merrifield Crisis Response Center
• Court System
• Data and Evaluation
• Problem-Solving /Super Utilizers
• Communications
• Questions, Comments, Discussion
• Adjourn
2

3. Tonight: The Year in Review
and Plans in the New Year
• Key outcomes from 2017
– This year’s focus was on broadening court efforts
• Where we’re heading in 2018
– Continue refining current initiatives
– Design pilot for co-responders
– Re-entry
But first, some updates and announcements…
3

4. Supervisor John Cook
Selected for NACo Peer Exchange
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http://www.naco.org/node/221565

5. NACo Maricopa County
Site Visit/Peer Exchange
The Peer Exchange was organized around the
four key measures of the Stepping Up
initiative:
• The number of people with mental illnesses
booked into jails
• Their length of stay
• Connections to treatment, and
• Recidivism
5

6. “Progress Made Possible”
Conference 12/17
• Fairfax team in
attendance
• Opportunity to learn
about the Miami-Dade
System
• Laura presented on our
local Diversion First
efforts
6

7. IACP Highlights Diversion First at
Progress Made Possible
Conference!
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8. Gathering Effective Service Designs
to Inform our Local Efforts
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Also from 2017 (in review):
• Best Practices Design
Implementation
Academy-Fairfax County
invited as a best practice
community
• Fairfax selected to
participate in Data-Driven
Justice and Behavioral
Health Design Institute

9. Recognition and
Welcome Guests
Sheriff Stacey Kincaid
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10. Congrats!
Lt. Redic Morris
Distinguished Service Award
“It’s staggering to see how many people come to us experiencing a mental health
crisis,” said Morris. “This job is one of the hardest I’ve had, but it’s very rewarding. I can
leverage the skills I’ve developed over the years to effectively interface with other
agencies and organizations. Working collaboratively, we are making progress by getting
people into treatment and avoiding or reducing jail time.” –Lt. Redic Morris
10
“Redic has served as a role model
throughout his career. His wealth of
knowledge, calm demeanor and
impeccable judgment have
contributed to his well-deserved
reputation as a go-to-guy His
passion is evident in all of the work
he does in the community.”
-Sheriff Stacey Kincaid

11. Welcome to our National
Partners!
11

12. National Institute of
Corrections (NIC)
The National Institute of
Corrections is a center of
learning, innovation, and
leadership that shapes
and advances effective
correctional practice and
public policy.
12
s
Aurora, CO

13. NIC Strategic Outcomes
The outcomes of NIC's activities contribute
significantly to the achievement of state, local, and
federal correctional goals and priorities:
– Effectively managed prisons, jails, and community
corrections programs and facilities
– Enhanced organizational and professional performance in
corrections
– Community, staff, and offender safety
– Improved correctional practices through the exploration
of trends and public policy issues
– Enhanced services through improved organizational and
staff effectiveness
13

14. Centers of Innovation
NIC Centers of Innovation (COI) Jail Based Promising
Behavioral Health Efforts
– Crisis Intervention Training (CIT)
• Franklin County, Ohio
• Broward County, FL
• Dane County, WI
• Douglas County, NE
– Medication Assisted Treatment (MAT)
• Louisville Metro Jail
• Sacramento County, CA Jail
• Middlesex, MA County House of Corrections
• Montgomery County, MD Jail
• Rhode Island Department of Jail Facility
14

15. Bureau of
Justice Assistance (BJA)
BJA supports programs and
initiatives in the areas of law
enforcement, justice
information sharing,
countering terrorism,
managing offenders,
combating drug crime and
abuse, adjudication, advancing
tribal justice, crime prevention,
protecting vulnerable
populations, and capacity
building.
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16. Leadership Fairfax Program Day
Sharon Arndt
Director, Community Health
Development and Preparedness
Division, Health Department
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17. Leadership Fairfax, Inc.
1/18/18 Diversion First Program Day
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18. Budget Updates
• Presented a five-year, cross-agency, fiscally
constrained Diversion First budget to BOS Public
Safety Committee on 11/28/17
– Organized around the intercepts, not agencies
• FY 2019 Budget Process
– February 20: County Executive releases FY 2019
Advertised Budget
– April 10-12: BOS Public Hearings on Budget
– April 24: Budget Markup
– May 1: Final Budget, tax rate, and school budget
transfer
18

19. Five-Year Proposed
Budget
• Strengthens operations at the MCRC
• Establishes a third Mobile Crisis Unit with a co-responder
design
• Provides court system resources
• Provides needed housing, transport and other resources
• Strengthens behavioral health services at needed
intercepts
19
Diversion First Multi-Year Proposed Budget
FY 2019 FY 2020 FY 2021 FY 2022 FY 2023
14 FTEs 13 FTEs 10 FTEs 9.0 FTEs 5.0 FTE
$1,929,049 $2,078,357 $2,207,156 $1,814,832 $848,373

20. Merrifield Crisis Response Center
Abbey May, CSB
Lt. Redic Morris, Sheriff’s office
Lt. Mike Tucker, PD

21. Merrifield Crisis
Response Center
• 2017 Accomplishments
Law Enforcement
• Increases in volume-ECOs/Law Enforcement involved
• 24/7 coverage
– Increase in cases transferred
• Training
• 2018 Goals
Law Enforcement
• Increase staffing
• Training
• Co-responder model
21

22. Merrifield Crisis
Response Center
• 2017 Accomplishments
Emergency Services
• Collaboration with law enforcement
• Staffing
• MCU 2
• Medical Clearance
• 2018 Goals
Emergency Services
• Care Coordinator position
– Super utilizers
• Fully staffed
• Medical Clearance
• MCU 3 Co-responder model
22

23. The Honorable Tina Snee, Judge, GDC
Shawn Lherisse, Court Services
Marissa Fariña-Morse, EdS, NCC, CAADC, LPC
Bob Bermingham, Director, JDRDC Services
23

24. Court Services 2017
• Court Services – Hiring
– MH Unit: 3 new full time hires
• 4 Probation Officers CIT trained
• Pre-trial Questionnaire Enhancements
• Court Services Diversion First statistics
• 20% jump in average daily caseload
24

25. CSB 2017
(Jail Based/Jail Diversion)
• CSB Hiring
– Jail-Based: 12 new full time hires
– Jail Diversion: 7 new full time hires
• Jail Based Diversion
– Jail-Based ECO/TDO
– Jail Diversion “engagement”
– Enhanced partnerships / improved processes with
GDC, Circuit, JDR and Court Services
25

26. CSB 2017
(Jail Based/Jail Diversion)
• Jail-Based Psychiatric Services
– Additional provider (on-site services 4 days/week)
– Added full time Behavioral Health Nurse
• Veterans Docket
• Drug Court
• Opioid Epidemic
– Medication Assisted Treatment - ADC
• Vivitrol
• Narcan
26

27. CSB/Court Services 2017
• Attorney Outreach (CLE)
• Release Planning
– ECO/TDO’s
– SRP Recommendations
– Identification of Mental Health Needs
• Use of BJMHS
• CSB / Court Services Partnership
– Faster appointment of Public Defender
27

28. Where are we going -
2018
• Supervised Release Plan - Reporting
• Courthouse - CSB/Court Services Co-location
- New Space for Court Services
MH Team
• Intercept 4 - (Re-entry) Expanded Focus
• Mental Health Review Hearings
• Length of Stay at the ADC - Recidivism
28

29. More - 2018
• “High Needs” Caseload
– Designated Probation Officer
• Expedite Diversion First Placements at
Arraignment/Advisement rather than Bond
Motion.
• Specialized Training of new Court Services
Staff
29

30. Juvenile and Domestic
Relations District Court
2017
• GDC staff have begun to conduct interview/assessments on
JDRDC cases
• JDRDC cases can now be included in the Veterans Docket
• Multi-organizational planning to launch Multi-systemic
Therapy (MST) and Functional Family Therapy (FFT) initiatives
• Continuing progress on juvenile justice system transformation
2018
• Two jail-based JDRDC staff will be on-boarded next month to
mirror the GDC assessment process
• JDRDC Community Correction Pre-trial Staff are already
supervising 30 cases in the community
• Continued development on the of MST and FFT efforts
30

31. Data and Evaluation Team
Lisa Potter, CSB
Chloe Lee, CSB
31

32. 2017 Key
Accomplishments
• Completed a jail behavioral health population
analysis
• Developed evaluation plans to track outcomes
• Established both cross-sectional and
longitudinal outcomes for the MCRC
population
• Instituted tracking processes for the Brief Jail
Mental Health Screening (BJMHS)
32

33. 33
2017 AT A GLANCE
1,931
MCRC LEO
cases
UP 22%
from 2016
1,365
ECOs
UP 32%
from 2016
584
MCU LEO
cases
UP 25%
from 2016
40% of the
total MCRC
LEO cases
IN THE FIELD
CIT TRAININGS
ADULT DETENTION CENTER
74%
67%

34. 2016 MCRC Population (Intercept 1)
Longitudinal Outcome Evaluation
January 29, 2018
Data and Evaluation Team
Chloe Lee, PhD
34

35. Review: Intercept 1
Evaluation Plan
35
MCRC visitors with
LEOs who have
SMI, are Fairfax
County residents,
had potential
charges and are
over 17 (N=125)
Clients who visited
MCRC with LEOs
To identify trends
and changes in the
MCRC population
To track changes in
longitudinal
outcomes (criminal
justice involvement
and CSB services)

36. MCRC Longitudinal
Analysis Overview
36
Population
selection
Data Tracking-
12 months
Predictive
analysis
Selected 2016 MCRC visitors
with LEOs who have SMI, are
Fairfax County/City residents,
had potential charges and
are over 17 (N=125)
Tracked both behavioral
health care (CSB services)
and criminal justice
outcomes (arrests and jail
incarcerations) for 12 months
following the MCRC visit
Determined risk factors for
criminal justice outcomes

37. Demographic Analysis:
Gender & Age
37
34%
Female
66%
Male
GENDER
7%
12%
15%
24%
42%
60 and up
50 to 59
40 to 49
30 to 39
17 to 29
AGE

38. Demographic Analysis:
Race & Ethnicity
38
16%
7%
6%
24%
47%
Other
Multi-race
Asian
African American
White
HISPANIC
OR LATINO
15%
RACE

39. Demographic Analysis:
Homelessness
1 in 10 (11%) were homeless.
39

40. Diagnosis: Mental Health
Bipolar Schizoaffective Major depression Schizophrenia
40
34%
22%
17%
12%

41. Substance Use Disorder
(SUD) & Developmental
Disability (DD)
41
Non-alcohol Alcohol Use DD
SUD
34%
26%
11%

42. Outcome Analysis:
CSB Services
82% of the 125 individuals received services from CSB
within 12 months following their MCRC visit with LEOs.
% received services:
42
8%
14%
20%
46%
50%
61%
Residential
Outpatient Treatment
Crisis Stabilization
Medication
Case Management
Emergency/MCU

43. 30%
Outcome Analysis:
Criminal Justice
43
23% 83%
Of the individuals
were arrested within
12 months following
their visit to MCRC
(Fairfax County arrest
only)
Of the individuals
were incarcerated
within 12 months
following their visit to
MCRC
Of the individuals
who were
incarcerated
received CSB jail-
based services

44. A Predictive Model of
Criminal Justice Outcomes
• Predictors used in the model: age, race,
gender, SUD (no alcohol), alcohol-related
diagnosis, homelessness, jail incarceration history
in the past three years
• Model with jail incarceration: χ₂=49.6, df=7,
p<.001, Cox & Snell R Square=.33, Nagelkerke R
Square=.5).
• Non-significant predicators: age, race, gender,
non-alcohol SUD
44

45. Risk Factors for Criminal
Justice Outcomes
• Homelessness: A significant predictor for
incarceration [EXP(B)=48.1, 95% CI=7.5 to 305,
p<.001]
45
5X
86% were
incarcerated
within 12
months
15% were
incarcerated
within 12 months
HOMELESS: YES
HOMELESS: NO

46. Risk Factors for Criminal
Justice Outcomes
• Alcohol use: A significant predictor for incarceration
[EXP(B)=3.5, 95% CI=3.9 to 130.1, p=.05]
46
3X
ALCOHOL: YES
ALCOHOL: NO
44% were
incarcerated
within 12
months
16% were
incarcerated
within 12 months

47. Risk Factors for Criminal
Justice Outcomes
• Previous jail incarceration history (Past 3 years):
A significant predictor for incarceration [EXP(B)=1.6,
95% CI=1.0 to 2.5, p<.05]
47
JAIL HISTORY: YES
55% were
incarcerated
within 12
months
JAIL HISTORY: NO
17% were
incarcerated
within 12 months
3X

48. Implications and Future
Plans
48

49. Intercept 1 Interventions
Identification of the at-risk population for the
implementation of targeted interventions
Increase in the number of people who are
diverted from arrest & Increase in the number
of people who are connected to care
Decrease in the number of people with
behavioral health needs in jail
49

50. Outcome Evaluation:
4 Key Measures (NACo)
50
Reduce
The number of
people with
behavioral
health /SMI
booked into jail
Shorten
The average
length of stay
for people with
behavioral
health/SMI in jail
Increase
The percentage
of connection
to care for
people with
behavioral
health/SMI in
jail
Lower
Rates of
recidivism
Intercept 1, 2, 3:
MCRC, Jail, Court,
Police, Fire and
Rescue
Intercept 2, 3:
Jail, Court
Intercept 4:
Jail, Court, Police,
CSB
Intercept 5:
CSB, DFS/DRS, Office
to prevent and end
homelessness Homeless
shelters, etc.

51. Jail Population Analysis:
Review and Plan
51
DAYS
Roughly 1 in 3 Inmates with More than half
jail inmates have behavioral health issues of the population
behavioral health stay 20 days longer recidivate in 3
issues in jail than inmates years
without behavioral health
issues
2017 Jail Population Analysis
will be conducted to compare
the changes in the jail
behavioral health population

52. Plans for 2018
• 4 key measures (NACo)
• 2017 jail population analysis
• Infographic communication tools
• Continued focus on automated data
integration and data sharing solutions
52

53. Problem-Solving Team
Using Data Findings to Inform
Service Delivery
Daryl Washington
Acting Executive Director
Community Services Board
53

54. Ideas around use of data
to shape service delivery
changes
• Targeting interventions
• Focus on people at risk for
recidivism
• Help with future service
need identification
Problem-Solving Team
• Change of chair
• Continued response to
family concerns
• Back to reviewing low-level
criminal arrests for quality
improvement
• Identification of Super
Utilizers to form a
collaborative response team
• Focus of super utilizers:
ADC utilization
• Developing data tracking
measures
54

55. Communications
55

56. Check out the Revamped
Website!
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https://www.fairfaxcounty.gov/topics/diversion-first

57. Questions, Comments…
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58. Next Stakeholders Meeting
May 7, 7-9 pm
Government Center, Rooms 4 and 5
12000 Government Center Parkway
Fairfax, VA 22035
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