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Diversion First Stakeholders Group Meeting: Sept. 17, 2018

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Diversion First Stakeholders Group Meeting: Sept. 17, 2018

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Diversion First Stakeholders Group Meeting: Sept. 17, 2018

  1. 1. Diversion First Stakeholders Group September 17, 2018 1
  2. 2. Tonight’s Agenda • Recognition • Updates and Announcements • MCRC • Updates from the Courts • Housing • Data and Evaluation • Leadership Lab • Data Warehouse • Discussion, Questions, Comments • Adjourn and Next Meeting Information 2
  3. 3. Announcing… New Diversion First Director! Welcome, Lisa Potter! Lisa.potter@fairfaxcounty.gov 3
  4. 4. Thank you! “Diversion First would not be the success it has become without the incredible support of Laura Yager. Her professional expertise matched with unsurpassed energy and enthusiasm has been the secret ingredient for moving us forward.” Chairman Sharon Bulova 4
  5. 5. Diversion First Award Chairman Sharon Bulova Fairfax County Board of Supervisors 5
  6. 6. Award Announcement • Diversion First recognized by the Northern Virginia Chamber • This is a significant recognition simply because it is from a “mainstream” organization • Third place in the “Public Sector of the Year” category – Award focuses on outstanding and visionary contributions to the community during the past year with demonstrated excellence in collaboration. This award recognizes community impact, particularly as it relates to the DC metro region. 6
  7. 7. Other Information and Announcements Laura Yager Director of Systems Transformation 7
  8. 8. Budget Update • Diversion First Leadership Group support for pilot projects included in the multi-year budget plan: – Co-Responder Model Pilot (originally proposed for FY 2020) – On-Site Medical Clearance Pilot (originally proposed for FY 2021 and FY 2022) – Support for specialty court and jail services (originally proposed in FY 2020) • Benefits – Pilots will help refine services and determine effectiveness – Uses one-time savings to launch in FY 2019, committing baseline funding in FY 2020 to continue initiatives • Presentation to the BOS Public Safety Committee on 9/18/18 8
  9. 9. Grants Still awaiting word on Bureau of Justice Assistance grant applications: • Comprehensive Opioid Abuse Program funds for data governance structuring (just <$1 million) • Drug Court ($500K) for coordination support • Justice and Mental Health Collaboration Program $750K for community supports for people with mental illness who are court-involved 9
  10. 10. Updates: Justice-Behavioral Health Data Sharing Efforts Beth Teare County Attorney 10
  11. 11. Merrifield Crisis Response Center (MCRC) Lt. Dwayne Machosky, Police Dept. 2nd Lt. Redic Morris, Sheriff’s Office Deputy Chief Jason Jenkins, Fire and Rescue Belinda Massaro, Manager CSB Mobile Crisis Unit Anna Davis, Supervisor of Peer Program 11
  12. 12. MCRC Growth of the MCRC- Services and Utilization • Currently 18 law enforcement staff members are assigned to MCRC- Emergency Services with 24/7 coverage for over one year • Two law enforcement supervisors and Fire Department personnel are part of the FY19 Diversion First Budget request • Onsite medical clearance staff from Inova are anticipated to become part of this effort and co-locate at the MCRC • Ongoing space challenges: Existing law enforcement offices are currently the same as originally launched with four law enforcement officers 12
  13. 13. MCRC 13 Outreach
  14. 14. MCRC Co-Responder Model • Budget requested for FY 2020 • Developing a pilot program for Fall 2018 to inform FY 2020 • Inclusion of Best Practices – CIT International Conference – Jurisdictional visits and ride-along – Fact finding and networking nationwide 14
  15. 15. MCRC 15 Technology Upgrades
  16. 16. MCRC Technology Upgrades 16 • Increased Productivity • Improve accuracy of MCRC data • Accountability
  17. 17. MCRC 17 Personal Impact
  18. 18. MCRC Data: April-June 2018 • Law Enforcement Officer (LEO) involved- 618  50% increase from 2016 – Emergency Custody Orders (ECOs)- 447  66% increase from 2016 – Voluntary transports- 171  21% increase from 2016 – Diverted from potential arrest- 136  28% increase from 2016 • MCU – Services- 460  27% increase from 2016 – Services with law enforcement involvement- 201  60% increase from 2016 18
  19. 19. MCRC: On-Site Medical Clearance (CSB and County partnership) • One year pilot under development – Staffing of two Nurse Practitioners and Licensed Practical Nurses – Hours: 12pm-12am, 6 days per week – Serving: Individuals under ECO/TDO prioritized plus voluntary inpatient admissions, crisis care admissions, medical consultations • Goals and outcomes – Decrease number of clearances requiring Emergency Department visits – Improve client experience and increase safety for all – Decrease clearance time and off-site time for law enforcement – Create efficiencies and billing capacity 19
  20. 20. MCRC: Co-Responder Model Co-responder Model: Public Safety and CSB Responding Together on Effective Super-Utilizer Intervention • Workgroup started (monthly meeting) – Research and site visits on other models- Henrico, Tucson, San Antonio, Colorado – Pilot plans to start in October one day per week on Wednesdays noon- 8:00pm – Plan to dual encumber public safety positions to expand pilot in January – Current collaboration on EMS super utilizers  Multi-disciplinary meetings and home visits  Case examples and success stories 20
  21. 21. MCRC: Super Utilizers • Youth Peer-Run Walk-In Group – Low Initial Census – Outreach efforts:  Youth services, flyers in ES, posted on CSB Facebook page, CSB newsletter, outreach calls to youth post-TDO • CSB Super Utilizer Staffing Calls – Presenting at Emergency Services but not enrolled in CSB treatment services 21
  22. 22. MCRC ES Care Coordinator 22
  23. 23. MCRC: Care Coordinator • Follow-up with additional 20 individuals not identified as super utilizers to engage and connect • Post-hospital youth calls/outreach • Examples of other success – Individual called Mt Vernon police 92 times in July. Utilization has reduced by 80% – Individual in treatment with CSB BHOP hospitalized monthly hasn’t been hospitalized in 3 months 23
  24. 24. Tina Snee, Judge, Fairfax County General District Court Penney Azcarate, Judge, Fairfax County Circuit Court Shawn Lherisse, Court Services Marissa Fariña-Morse, Community Services Board Casey Lingan, Office of the Commonwealth’s Attorney 24
  25. 25. Dockets/Courts Veterans Treatment Docket Supervised Release Docket Drug Court 25
  26. 26. Supervised Release Docket General District Court • Collaboration – Commonwealth Attorney, Public Defender, Community Services Board • Goals/Purpose of SRP Docket – Have CSB and Court services present in the courtroom with attorneys to fashion supervision for defendants with mental health, drug issues and co-occurring issues – Work with Defendants towards compliance with supervision to diminish recidivism – Intervene faster when individuals are not in compliance and work towards compliance 2nd and 4th Friday of each month, Courtroom 2K 26
  27. 27. Drug Court – Circuit Court • Have a pending violation of probation on a felony charge and admit the violation AND • Reside in Fairfax County • Meet the DSM-5 criteria for being drug and/or alcohol dependent • Be placed on supervised probation with District 29 Adult Probation and Parole office for the felony offense • No prior convictions for violent felonies or weapons offenses (as defined in 17.1- 805 or 19.2-297.1) within the past 10 years • The Commonwealth’s Attorney has reviewed the charges and agreed • Resolution of other pending felony, or jail-able misdemeanor offense • Not be a confidential informant Weekly, beginning - October 4, 2018 in Courtroom 4H 27
  28. 28. Veterans Treatment Docket • Increased participants – total number (15) is double from one year ago • Court Services – offering MRT weekly groups for participants • CSB transitioning – positions moved to CSB, in final recruitment for coordinator • Bureau of Justice Assistance Grant – extended 9/2019 • Data reporting requirements in compliance with Virginia Supreme Court 2nd and 4th Thursday of each month, Courtroom 1E 28
  29. 29. Court Services - Collaboration CSB – Bi-weekly meetings to discuss interventions for non-compliant clients – Monthly Intercept 2 team meetings – Daily interaction regarding clients placed on pretrial or probation with mental health concerns Sheriff’s Office – Email alerts when clients return to the Adult Detention Center from hospitalization Police Department – Co-responder model between agencies JDR – Partner to develop Pretrial Services Outside Agencies – Loudoun County-assisted them in selecting both Probation and Pretrial Supervisors – Consults regularly with other jurisdictions (Prince William County, Loudoun County, Arlington) – National Alliance for Mental Illness (NAMI) Presented on June 7, 2018, at our office – Dockets 29
  30. 30. Court Services • Data – DIT – web based Pretrial Arrest and Case Management Database – Impacts from electronic BJMHS • Reminder Call service – Text or phone – Court appearance reminder 30
  31. 31. CSB Court-Based Services Launched this summer – Assessments for entry to CSB services in the courthouse – Close collaboration with Court Services – Individuals who have been released from the ADC – Attempt to minimize barriers toward accessing services – Office space in planning phases 31
  32. 32. CSB Jail Diversion SRP Docket – JD Staff member attending court to provide information on cases scheduled who may be receiving CSB services – Opportunities to collaborate with the entire CSB Partnerships with CSB Emergency Services, Entry, Court Services – Helping to link individuals to service and to communicate about compliance concerns – Developing relationships that can be leveraged CSB wide Super Utilizer Phone Staffing (ADC, Jail Diversion, ES, plus more) 32
  33. 33. CSB Adult Detention Center • Continued collaboration with Courts, Court Services and the Sheriff’s Office to work toward early diversion and process improvement. • Hospitalization at NVMHI • ADC Based Substance Use Treatment • Mental Health First Aid • Correctek Electronic Health Record – Process enhancements to CSB workflow • Hiring – Positions created for FY19 – Long Term Dual Encumbrance BH Manager (On site ADC) – Veterans Treatment Docket Coordinator 33
  34. 34. Housing Updates Lyn Tomlinson CSB Deputy Director 34
  35. 35. Why Permanent Supportive Housing (PSH)? • It Benefits the community- Unlike shelters, PSH looks like any other type of housing in the community. In all cases, people have integrated housing along with every other member of society. • It saves Money- Many of these clients circle through jails, life on the street, hospital emergency rooms and mental health facilities. The average daily cost of a PSH unit in Virginia is $49.00 versus $70.00 for a jail bed or even $959.50 for an adult psychiatric state hospital. 35
  36. 36. Success Story Client B was accepted into housing on 8/22/17, he is a 54 yr male with major depression, alcohol dependence with a history of homelessness and arrests. He has used many services including Detox, Residential Treatment, Crisis Care and Jail Services. Since being housed, there has been a overall decrease in use of these services, he states: “Living in my home has been a life changer. I can focus on my goals and become more independent…I have a job AND volunteer.” 36
  37. 37. Housing • Currently there are 30 accepted clients in the CSB’s Diversion First Housing initiative. With a waiting list of about 30 and increasing every week. • Five are in the housing search process (accepted within the last 60 days). • Only two clients have been evicted due to unresolved lease violations since program start up in 2017. • Referrals come from every Service area of the CSB, with clients referred from the Adult Detention Center, Jail Diversion team and those with frequent use of Crisis and Detox services receiving priority. 37
  38. 38. Jail Behavioral Health Population Recidivism Analysis: Risk Assessment Data and Evaluation Team Chloe Lee September 17, 2018
  39. 39. Evaluation Plan 39 Inmates with behavioral health issues Inmates with SMI who are Fairfax County residents and who did forensic intake during the current incarceration and were released during the period of data collection N=293 2016 Incarceration
  40. 40. Sequential Intercept Model 40
  41. 41. Four Key Measures 41 Reduce The number of people with behavioral health issues booked into jail Shorten The average length of stay for people with behavioral health issues in jail Increase The percentage of connection to care for people with behavioral health issues/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.
  42. 42. Demographic Characteristics (N=293) 42 4% 4% 14% 0% 6% 36% 36% Unknown Multirace Other Native Hawaiian or Pacific Islander Asian Black White Race 21% Homeless
  43. 43. Behavioral Health Characteristics 43 Alcohol 45% Opioid 11% Schizophrenia 23% Bipolar 16% Depression 16% Schizoaffective 13% 1 2 3 Mental Health Diagnosis Substance Use Disorder (SUD) Diagnosis
  44. 44. CSB Services 60% 83% 48%Emergency 45% Case Management 30% Outpatient Treatment 2% Diversion First Housing 44 Active CSB Clients as of July 2018 Received at least one face-to-face service from CSB after release
  45. 45. Criminal Justice Characteristics (N=293, 2016 first incarceration) 45 Most serious charge Released on bond or pre-trial supervision Average days in jail by charge 94% 75% 59% Ordinance Misdemeanor Felony 6 25 63 Ordinance Misdemeanor Felony 44% 38% 18% Felony Misdemeanor Ordinance
  46. 46. Recidivism Overview ] 182 of 193 (62%) inmates recidivated within the time frame. 23% had alcohol and/or drug-related charges and 17% of them had legal condition violations. 46 62% 22% 11% 11% 13% 5% 33% 44% 57% 62% By 1 month By 3 months By 6 months By 12 months 12 months or greater Recidivism by month after release % Recidivated Cumulative % Recidivated Highest recidivism rate during the first month Recidivism by most serious charge 62% 58% 73% Felony Misdemeanor Ordinance
  47. 47. Recidivism among Diversion First Housing Recipients 47 100% of the Diversion First Housing recipients (5) have successfully stayed out of jail after their housing placements.
  48. 48. Recidivism: Risk Factors 48 Recidivism 1 SUD 1.7 times higher for inmates with SUD than those without the diagnosis (p<.001) 3 Behavioral health needs 2.3 times higher for inmates with high behavioral health needs than those with low behavioral health needs (p<.001) 2 Released on bond or pretrial supervision 2.3 times higher for inmates who were released on bond or pretrial supervision than those who were not released on those terms (p<.001) 4 Previous incarceration(s): 1 year 13% higher for inmates with previous incarceration(s) in the past year [2015] than those with no incarceration history (p<.001)
  49. 49. Executive Summary Take-aways Recidivism rate over 60% • The first few months of release are the best time to intervene the cycle of recidivism. • Inmates with low level offenses are more likely to be high utilizers of jail than inmates with more serious offenses. • Inmates with high behavioral health needs and SUD tend to be high utilizers of jail. • A significant number of inmates recidivate with drug/alcohol related charges or legal condition violations. • Inmates with an extensive history of incarceration are likely to be high utilizers of jail in the future. Moving forward • Identify high risk populations at the earliest stage. • Targeted interventions are needed for different groups with different levels of criminal justice and behavioral health risk. • Help inmates with SMI comply with the terms of pretrial release and/or probation in order to reduce the recidivism due to the violations of these conditions. 49
  50. 50. NACo’s Advancing Cross-System Partnerships Leadership Lab • One of four counties selected to participate • Counties will focus on emerging issues and challenges to align health and human services and justice systems, and to improve the health and well-being of target populations • Goal is to demonstrate progress in connecting systems and using and analyzing data to create/ expand opportunities that improve the well-being, self-sufficiency, stability and health outcomes (e.g., educational attainment, housing, food security, workforce participation, treatment engagement, health care, etc.) 50
  51. 51. NACo’s Advancing Cross-System Partnerships Leadership Lab • Designing a pilot for sub-population identified based on risk factors- homelessness, substance abuse and previous incarceration • Pilot will involve a cross-section of partners to provide services and supports to identified population • Processes and outcomes will be tracked, with lessons learned to take to scale • Leadership Lab participants will document planning and implementation and will submit a final report detailing efforts 51
  52. 52. Data Warehouse Satwinder Singh (Romy) DIT Solutions Architect 52
  53. 53. Current State 53
  54. 54. Future State 54
  55. 55. Achievements  Walkthroughs  Documentation  Data Points Identification  In-Scope and Future-Phase project charter  Data Governance Policies 55
  56. 56. 56
  57. 57. Next Stakeholders Group Meeting January 28, 2019 7:00-9:00 pm Rooms 2-3 57

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