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Diversion First Stakeholders Meeting: July 17, 2017

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Diversion First Stakeholders Meeting: July 17, 2017

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Diversion First Stakeholders Meeting: July 17, 2017

  1. 1. Stakeholders Meeting July 17, 2017 1
  2. 2. Tonight’s Agenda • Stakeholders Meeting Changes • Announcements • Super Utilizers Briefing and Case Study • Housing Update • Problem-Solving Team • MCRC • Court Services and Jail Services • Data and Evaluation • Discussion and Comments 2
  3. 3. Stakeholders Meetings Past Focus • Group Formation • Discovery and Learning • Process • Development • Focus on Needs New Approach • Issue/trend-specific information • Work group outcomes and near-future goals when there are milestones to report • Identification of needs that require attention/ action in order to move forward 3
  4. 4. Current Diversion Groups • Stakeholders • Leadership • Data and Evaluation* • Communication • Courts and Jail Services* • MCRC* • Problem-Solving Team* • Medical Clearance ___________________________ * Reporting Tonight 4
  5. 5. NACo Award 5
  6. 6. SAMHSA’s Best Practices Implementation Academy • Fairfax was 1 of 9 teams invited from across the country after site visit • Presented on our best practices and offered technical assistance to the 13 selected teams just starting out • Discussed our best practices in building a diversion system • Hosted by SAMHSA, GAINs Center, and NACo • Pat Harrison, Office of the CoEx • Lt. Derrick Ledford, Office of the Sheriff • Lt. Ryan Morgan, FCPD • Lt. Redic Morris, Office of the Sheriff • Marissa Farina-Morse, CSB • Laura Yager, Office of the CoEx 6 About the BPIA Thank You Fairfax Participants
  7. 7. Updates Diversion First representatives invited to serve on expert panel for “Principles for Community-Based Behavioral Health Service Delivery for Justice Involved Populations with Mental and Substance Use Disorders” on August 2 • Our representatives are Marissa Farina-Morse and Redic Morris Application submitted for September’s Data-Driven Justice and Behavioral Health Design Institute • Only 14 teams across the country will be accepted • Institute will allow for in- depth consultation related to best practice data and evaluation efforts, especially with Super Utilizers • Keep your fingers crossed! 7
  8. 8. Super-Utilizers 8
  9. 9. What’s in a name? • High System Utilizers • Frequent Flyers • High Volume Service Users • Most Loyal Customers • Super Utilizers • Familiar Faces • Complex Cases 9
  10. 10. What is a Super-Utilizer? • Individuals with complex behavioral, physical, and/or social needs who are frequent users of a broad range of services and may have a high number of contacts with emergency medical technicians and law enforcement. • Despite the large amount of resources devoted to this population, they are often provided in fragmented ways that do not lead to stabilization or improved outcomes for individuals. 10
  11. 11. Bottom Line… • Small numbers of highly vulnerable people cycle repeatedly through jail, hospitals, shelters, other public systems • Fragmented, uncoordinated care • Poor outcomes • HUGE cost Small changes will make a big difference! 11
  12. 12. What are other communities doing? • “Golden Thread” Care Management approach and Cross-Sector Data Integration - King County, Washington • Predictive Data Analysis and future Mental Health embedded with PD- Johnson County, Kansas • Community Care Management Cross- Functional Team- Louisville, KY • Mental Health Jail Diversion Project developed by Public Defenders Office- Pinellas County, FL 12
  13. 13. Super Utilizer Case Study 13
  14. 14. Super Utilizers Next Steps • Case Study Approach – Document process, outcomes, learnings, barriers – Use findings to immediately support individuals as well as consider future service system adjustments – Bring information and ideas to stakeholders group for consideration 14
  15. 15. Super Utilizer Next Steps • Identify people we hope to serve – Present: • Individual case study approach for “extreme” super utilizers • Problem-Solving Team focus on super utilizers – Future: • Data and Evaluation Team data analysis from multi- systems to identify people we hope to serve • Develop strategies through integrated work group for warm handoffs and information-sharing • Determine ongoing needs for improvements 15
  16. 16. A Peek at Future Data and Evaluation Team Effort with Super Utilizers • Individuals who exceed a certain threshold of service use • Threshold is determine by each agency based on the median number of service visits during a 12-month period • Develop approach to collect cross system data around these super utilizers 16
  17. 17. Housing Update • Diversion First Housing – 8 individuals housed – 13 in process of being housed • Sustain State Housing Grant – 14 individuals housed – 18 in process of being housed • CSB awarded additional $467,000 in FY18 bringing total state housing dollars to over $1 million! 17
  18. 18. Problem Solving Team Gary Ambrose, Diversion First Stakeholders Group Chair Deputy Chief Jason Jenkins, Fairfax County Fire and Rescue Major Ron Kidwell, Office of the Sheriff Captain Matt Owens, Fairfax County Police Department David Rohrer, Deputy County Executive Cynthia Tianti, Office of the County Attorney Daryl Washington*, CSB Deputy Director Laura Yager, Office of the County Executive + Ad Hoc Members * Chair 18
  19. 19. News/Changes/Accomplishments • Continue to triage cross-agency improvement opportunities  Solutions in real time and during the meeting • Agreement to track and problem-solve high utilizers  ECOs  MCRC  Fire/EMS  CSB Jail Services  911 Call Center • Identify and resolve system level issues identified by other teams and groups 19
  20. 20. Challenges and Needs • Sharing of confidential information • Complexity of population • CSB to lead getting releases to share information with targeted group before in-depth discussion • Flexible, responsive services that can respond to individuals needing assistance • Invite Inova to the table since super utilizers impact the health system 20 Challenges Needs
  21. 21. 3-6 Month Goals and Activities • Signed releases for current identified cases to facilitate ongoing detailed problem- solving as practice standard • Developing intervention plans for high utilizers • Continue to address emergent system issues for discussion and resolution • Developing approach to track and report team processes • Documentation of interventions and outcomes • Monitoring utilization of services • Identifying super utilizers across multiple systems 21 Next Three months Next Six months
  22. 22. Merrifield Crisis Response Center 1st Lt. Ryan Morgan, PD CIT Coordinator 1st Lt. Mike Tucker, New PD CIT Coordinator 2nd Lt. Redic Morris, Sheriff’s Office, MCRC Coordinator Abbey May, Service Director Acute Services Michelle Mullany, Assistant Vice President Inova BH 22
  23. 23. News/Changes/Accomplishments • New CIT Coordinator! – 1st Lt. Mike Tucker – FCPD • 24/7 LEO Coverage! – Three shifts will comprise 24/7 coverage – Two Officers/Deputies per shift 23
  24. 24. News/Changes/Accomplishments Continuing to see increases in LEO-Involvement with MCRC 24
  25. 25. News/Changes/Accomplishments Continuing to see ECO increases as well 25
  26. 26. News/Changes/Accomplishments • Hiring – Fill remaining Crisis Intervention Specialist and Peer Specialist positions – Recruiting for Care Coordinator • Focus on high utilizers/diversion cases • MCU – Increased focus on community cases • Medical Clearance launch with CHCN – Developed triage protocol, workflow and trained staff 26
  27. 27. Emergency Services Medical Clearance ED Medical Clearance Consult with psychiatrist• .2 or greater BAL • BP =/>160/100 • Pulse >120 or below 50 • Temperature >100.4 Refer to CHCN for Medical Clearance If all of the above is WNL, consult with psychiatrist ED Medical Clearance If none of the above medical issues, proceed with Triage and complete the following: • UDS • Breathalyzer • Vitals • Temperature • Finger stick if indicated • Pregnancy test if indicated Consult with psychiatrist Medical Clearance Triage Protocol • Acute altered mental status – delirium/confusion • Highly agitated • Complex medical issues • Greater than age 65
  28. 28. Challenges and Needs Challenges • Reminder to include both Sheriff and PD when we talk about LEOs. This is a unique partnership that we need to highlight whenever possible! • Operational on-site Medical Clearance from 8am-2pm, W-F Needs • Pilot on-site Medical Clearance after 4pm (Inova) • Determining need for ongoing/post-pilot resources • Site and collaboration policy changes (in process now) 28
  29. 29. 3-6 Month Goals and Activities Next Three months • Hiring new staff – Crisis Intervention Specialists – Care Coordinator position targeting CSB service engagement post-MCRC • Expand MCU hours and explore LEO partnerships • Develop tracking and outcome measures for Care Coordinator/Recovery Specialists Next Six months • Medical Clearance 12pm -12am – Inova Partnership 29
  30. 30. General District Court - Court Services Community Services Board – Jail Based/Jail Diversion Shawn Lherisse, Court Services Marissa Fariña-Morse, CSB 30
  31. 31. Data Collection Quarterly Results (April 2017 – June 2017) BRIEF JAIL MENTAL HEALTH SCREENS Increase in instruments administered 4220 (due to 100% of people being screened at booking) administered* vs. 1053 administered** *slightly more than 3 months of data 03/22/17 – 06/30/17 (Sheriff’s Office) **slightly less than 3 months of data 01/01/17 – 03/21/17 (Court Services) Change in Process (March 2017) Screens Administered at the Booking Desk Results - • Dramatic Decrease in percentage requiring advanced screening • 881 (21%) by Sheriff’s Office vs. 329 (31%) by Court Services 31
  32. 32. Quarterly Results (April 2017 – June 2017) PLACEMENTS – PRETRIAL SUPERVISION 496 defendants placed 128 (26%) indicated a need for further mental health assessment • 106 from bond motions • 17 from advisements • 5 from the Magistrates 20 (16%) defendants were Court-ordered to undergo a mental health evaluation and follow recommended mental health treatment 32
  33. 33. Quarterly Results (April 2017 to June 2017) 56 (90%) defendants that were administered the advanced screening instrument indicated a need for a mental health evaluation • 56 defendants referred for mental health evaluation (CSB or other) • 23 defendants already engaged in mental health treatment (CSB or other) 33 PLACEMENTS – ADVANCED SCREENING
  34. 34. Challenges and Needs • Connecting clients to services before Court • Providing assistance to clients who do not reside in the county • Collecting data effectively to measure outcomes • Court cases spread out many different appearances for CSB caseload • Obtaining services for clients who do not have SMI • A clinician in the courthouse to perform mental health evaluations (coming soon) • Hire and train new staff (Court Services/CSB) • Co-Located office space (pending) • Construction on current office space (pending) • Develop tracking mechanisms (Data and Evaluation Team support needed) for Court referrals to the CSB 34 Challenges Needs
  35. 35. New Resources • CSB Mental Health Screening and Assessment – On-site at the courthouse • CSB Emergency Services – Care Coordinator – Target high utilizers – Decrease treatment gaps • Veterans Treatment Docket – Positions with CSB – Increase collaboration 35
  36. 36. 3 Month Goals and Activities • Interview and hire new staff • Continue to evaluate and analyze the BJMHS to improve outcomes • Develop methods to effectively measure outcomes • Implement changes to the Pre-Trial Defendant Questionnaire (information provided to attorneys) – Anticipate increasing referrals for further Court-ordered mental health assessment and treatment • Bed to Bed Order  Detox, SA Programming, Other • Jail Transfer (Western State- ECO/TDO Criteria) – Focus on Returns/SRP Mental Health 36 Next Three months
  37. 37. 6 Month Goals and Activities • Fully operational office for the Pre-Trial Behavioral Health Unit • Continue to improve the flow and results of intercepts 2 - 5 • CIT training for all Pre-Trial Officers in the Behavioral Health Unit • Move to have Mental Health cases assigned on the same day (Bond Motions) 37
  38. 38. Data and Evaluation Workgroup Chloe Lee, CSB Lisa Potter, CSB 38
  39. 39. News/Changes/Accomplishments • New linkages with Information Technology (IT) leads across systems • Completed data pilot and determined critical variables for ongoing evaluation • Developed automated solutions to assist with the behavioral health components of the Virginia Compensation Board Survey • CIT Assessment Site data reporting for the Department of Behavioral Health and Developmental Services 39
  40. 40. Challenges and Needs Challenges • Each intercept has a range of data points for process and outcome evaluation • As intercepts expand, ensuring that key indicators are folded into the evaluation • Gathering baseline data beyond Intercept I • Multiple data systems • Incorporating data from all jurisdictions (currently Fairfax County only) Needs • Automated BJMHS so that data can be easily accessed • Diversion “identifier” in police and CSB data systems to support tracking efforts • Data reporting from police for people with mental illness who were arrested 40
  41. 41. Evaluation Plan Intercept I Intercept II 41 Clients who visited Merrifield Crisis Response Center (MCRC) with Law Enforcement Officers (LEOs) MCRC visitors with LEOs who have SMI, are Fairfax County residents and had potential charges Inmates with mental illness/Serious mental illness (SMI) Inmates with SMI who are Fairfax County residents and who completed a forensic intake during the current incarceration and were released during the period of data collection
  42. 42. 3-6 Month Goals and Activities • BJMHS process flow and use of the tool across systems – Administration of the tool and documentation of results – How results are communicated and used to triage, assess and refer • Ongoing BJMHS data collection and reporting • Re-charter work group to include IT staff in addition to program and evaluation staff • Work with Detox Diversion to track data elements • Categorize data elements across systems for potential DIT automated solutions • Jail baseline data – Populations characteristics – SMI prevalence – Average number of days in jail – Linkages to CSB Forensic Intake and Jail-based services • Make recommendations based on findings 42
  43. 43. Future Stakeholders Group Topics Brainstorm • Housing and homelessness • Jail population • Post-jail release services and supports • Private sector partnerships • Intersection of opioid crisis and diversion • Information-sharing challenges 43
  44. 44. Next Meeting October 19, 2017 7 - 9pm, Rooms 4 - 5 Fairfax County Government Center 44

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