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Diversion First Stakeholders Meeting: Oct. 2, 2019

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Diversion First Stakeholders Meeting: Oct. 2, 2019

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Diversion First Stakeholders Meeting: Oct. 2, 2019

  1. 1. Stakeholders Meeting | October 2, 2019
  2. 2. Meeting Agenda • Welcome and Agenda • Farewell and Thank You! • Sequential Intercept Model Mapping − Discussion • Connection to Care Analysis • Community Response Team • Mental Health Docket • Wrap-Up 2
  3. 3. Our Gratitude and Appreciation to Chairman Sharon Bulova and Supervisor John C. Cook
  4. 4. 2nd Lieutenant Redic Morris Thank you for your outstanding leadership at the Merrifield Crisis Response Center!
  5. 5. Sequential Intercept Model
  6. 6. Sequential Intercept Model Mapping • August 7 & 8 • Mapped current services across the intercepts • Identified gaps • Identified priorities • Started Action Planning
  7. 7. Sequential Intercept Model Mapping Workshop Lyn Tomlinson| Deputy Director, Community Service Board Abbey May| Director, Emergency Services Stephanie Carl | Office to Prevent and End Homelessness Chloe Lee| Diversion First Data and Evaluation Manager Michael T. Lane| Director, Office of Individual and Family Affairs
  8. 8. Improve community awareness of available behavioral health services and how to access them. IDENTIFY OPPORTUNITIES TO INCREASE COMMUNITY AWARENESS OF BEHAVIORAL HEALTH SERVICES DEVELOP MARKETING AND OUTREACH PLAN TO SUSTAIN COMMUNICATION EFFORTS AND BEHAVIORAL HEALTH SERVICES AND HOW TO ACCESS THEM DETERMINE AWARENESS OF COMMUNITY SERVICES BOARD AND ANY BARRIERS WITH NAME RECOGNITION
  9. 9. Increase the number of subacute and other crisis service options IDENTIFY PEER RESPITE MODELS AND CAPACITY TO IMPLEMENT LOCALLY RESEARCH EXISTING AND POTENTIAL CRISIS LINES AND WARM LINES POTENTIAL EXPANSION OF NAVIGATORS REDUCE TIME SPENT BY PUBLIC SAFETY AT THE MCRC
  10. 10. Increase affordable and accessible housing options with appropriate supports DEFINE HOUSING NEEDS OF TARGET POPULATION IDENTIFY HOUSING MODELS THAT ARE SUCCESSFUL WITH THE DIVERSION FIRST POPULATION SEEK POTENTIAL FUNDING OPPORTUNITIES AND COLLABORATIVELY APPLY FOR FUNDS
  11. 11. Increase and Improve data and information sharing across all intercepts Develop common definitions for critical data elements Increase knowledge and awareness of parameters regarding Personal Health Information (PHI)/ information sharing In conjunction with other countywide data sharing projects, encourage development of data governance policies and procedures Determine needs for Diversion First data sharing agreements and processes, to include community, county, regional and state entities
  12. 12. Effectively employ peer support specialists across all intercepts Identify or create a focused training for Peer Support Specialists working in forensic services Ensure a percentage of peer support specialist are full-time benefited positions Create a strategic plan for peer supports with robust peer involvement and stakeholders
  13. 13. How would you rank these Diversion First priorities?
  14. 14. Connection to Service Analysis For the 2018 Jail Behavioral Health Population Chloe Lee|Data and Evaluation Manager
  15. 15. Four Key Measures 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 Lower Rates of recidivism Increase The percentage of people with behavioral health issues/SMI in jail who are connected to care
  16. 16. Population Included (N=2,334) 16 Booked into and released from jail in 2018 Current or past CSB clients Fairfax County residents Clinical behavioral health diagnosis CSB services tracked for 6 months (180 days) for each inmate from their first booking dates in 2018 Face-to-face services except for a few programs
  17. 17. Connection to Service Defined 17 Any post-incarceration community- based CSB mental health (MH) and/or substance use disorders (SUD) services within 180 days from each individual’s release date Focus on assessment services as a first step to receive more treatment-oriented services
  18. 18. Demographic Information (N=2,334) 18 78.3% 21.7% Male Female Gender Race Homeless Age 6.4% 15.9% 3.4% 34.2% 40.2% Multi-race Other Asian Black White 4.3% 11.2% 13.3% 30.6% 40.6% 60 or higher 50-59 40-49 30-39 18-29 Average age: 35 9.5%
  19. 19. Behavioral Health Diagnosis Information (N=2,334) 19 59% 82.6% 42% MH SUD Co-Occurring All individuals included in this analysis had at least one clinical behavioral health diagnosis
  20. 20. Post-Incarceration (6 Months) Services 20 1 in 3 had (N=2,334) at least one post incarceration service from CSB, excluding jail-based services. Among the individuals who received services after incarceration (N=768) the average length to the first service from release was 39 days. Approximately 19% (N=2,334) had an assessment within 6 months of their release. 8.3% 5.7% 4.9% Within 30 days Between 30 and 90 days Between 90 and 180 days 18.9% assessed in 6 months of the individuals who received services from CSB within 6 months had their first service within 30 days. 63% 39 Days From incarceration to first service
  21. 21. Post-Incarceration (6 Months) Mental Health Services • Among the individuals with a mental health diagnosis (N=1,378), 11.6% had at least one mental health service. • Among the individuals with a mental health diagnosis, the mental health service rate was significantly higher for the assessed population (N=306) than the unassessed population. 21 11.6% Mental Health Treatment Services among the Mental Health Population (N=1,378) 27.1% Mental Health Treatment Services among the Assessed Mental Health Population (N=306)
  22. 22. Post-Incarceration (6 Months) SUD Services • Among the individuals with an SUD diagnosis (N=1,928), 15.7% received at least one SUD service. • The SUD service rate was significantly higher for the assessed population (N=440) than the unassessed population. 22 5.9% 6.8% 10.9% SUD Outpatient SUD Residential SUD Detox 22.9% 24.7% 31.7% SUD Outpatient SUD Residential SUD Detox SUD Treatment Services Among the SUD Population (N=1,928) SUD Treatment Services Among the Assessed SUD Population (N=440)
  23. 23. Connection To Service: Predictors & Risk Factors • Logistic regression model with the assessment in 6 months of release as a dependent variable • (Re)assessment is often the first step to receive treatment services and thus was used as a proxy variable to examine the link to service for the population • Demographic variables such as race, gender, and age were not significant predictors. 23
  24. 24. Jail Diversion & Jail-Based Services Individuals who received services from CSB Jail Diversion Engagement team during/shortly after their incarceration were more likely to be assessed within 6 months of their release. 24 Jail Diversion Engagement: 47.8% No Jail Diversion Engagement: 18% 6 Month Assessment 2.6 X Individuals who received services from CSB Jail-Based team during their incarceration were more likely to be assessed within 6 months of their release. Jail-Based: 33.1% Not Jail-Based: 14.9% 6 Month Assessment 2.2 X
  25. 25. Past Assessment & Co-Occurring Diagnosis 25 Past Assessment: 38.1% No Past Assessment: 12.6% 6 Month Assessment 3 X Individuals who had been assessed in the 2 years prior to their incarceration were more likely to be assessed within 6 months of their release. Individuals who had co-occurring MH/SUD diagnosis were more likely to be assessed within 6 months of their release. Co-occurring: 26.1% No Co-occurring: 13.6% 6 Month Assessment 1.9 X
  26. 26. Pre-Trial Supervision & Referral to CSB Jail-Based Services 26 Individuals who were released on Pretrial Supervision were more likely to be assessed within 6 months of their release. Individuals who were referred to CSB Jail- Based services in jail were more likely to be assessed within 6 months of their release. Pre-Trial: 24.4% No Pre-Trial: 17.1% 6 Month Assessment Referred: 23.4% Not Referred: 12.7% 6 Month Assessment 1.4 X 1.8 X
  27. 27. Connection to Service: 6 Month Service Rate All predictors for 6-month assessments were significant predictors for 6- month services (i.e. one or more community-based services). 27 3.6 X Jail Diversion Engagement: 94% No Jail Diversion Engagement: 26.4% 6 Month Service 2.2 X Jail-Based: 57.3% No Jail-Based: 26.1% 6 Month Service
  28. 28. Take-Aways • Individuals who received Jail Diversion Engagement services were more likely to get connected to care. Re-entry programs like Jail Diversion and Jail Diversion Engagement enhance the connection to care for this population. • Individuals who were referred to CSB jail-based services and who received the services in jail were more likely to get connected to care. Multiple touch points in jail improve connection to care for this population. • Individuals who were on pretrial supervision were more likely to get connected to care. Pretrial supervisions with treatment options help the population link to services. 28
  29. 29. Co-Responder Model (Community Response Team) Adam Willemssen| Fire and Rescue Department
  30. 30. CRT Trends - Original 35 0 10 20 30 40 50 60 0 50 100 150 200 250 January February March April May June LEO/FRDCalls DPSCCalls DPSC LEO FRD
  31. 31. Community Response Team • 12 individuals started a CSB Program not previously enrolled • 18 were assessed or started a new program (10 = assessment and new service) Disposition/Referral: • Referred to treatment (i.e. Intensive Case Management, Outpatient, PATH, Detox) • Re-engaged with providers for other services (i.e., Medicaid, transportation, housing, medical supplies) • 2 voluntary hospitalizations Impact New to Services Other Referrals Assessment 30 Known to CSB
  32. 32. CRT Census and Engagement – Current State CRT Stats (as of 9/30/2019) Active 55 Tracking 13 Closed 60 Deceased 7 Total 135 Clients Engaged 77 Challenges • Increasing demand/referrals • Triage - as program grows • Geography • No fixed address • Action threshold not met 0 20 40 60 80 100 120 140 0 5 10 15 20 25 30 35 Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep 2018 2019 CRT Client Census and Referrals Monthly Cumulative
  33. 33. Community Response Team Operational Updates • Public safety electronic referral application (GIS capability) • Video and training plan for public safety • Inova Health System collaboration • Expansion of CRT into Fairfax City, Vienna, and Herndon • Peer Support Specialist
  34. 34. Mental Health Docket The Honorable Judge Tina Snee Dawn Butorac | Chief Public Defender Casey Lingan | Chief Deputy Commonwealth Attorney Shawn Lherisse | Court Services Marissa Fariña-Morse | Community Services Board
  35. 35. Mental Health Docket Eligibility Criteria • Resident of Fairfax County • 18 years of age or older • Charged in Fairfax County • Diagnosed with a serious mental illness as defined by DSM-5 • Medium to high risk of recidivism as measured by a validated assessment instrument • Connection between the defendant's mental illness and their criminal charges.
  36. 36. Mental Health Docket Launched on July 10, 2019 • 8 participants • 36 referrals • Average age for participants: 27 • 63% of participants have co-occurring substance use issues • Participant level of care: • 45% Intensive Case Management/Jail Diversion • 36% Outpatient • 18% Residential
  37. 37. Supervised Release Program (SPR) Docket Started August 10, 2018 From August 10, 2018-August 7, 2019 • 108 SRP Violations (Diversion First population) - 6% of total SRP Placements during that period, 15% of Diverted SRP population - 42% were connected or reconnected to treatment at hearing - 10% were removed from SRP as a result of non-compliance - 13% of SRP Violations were due to non- compliance with treatment
  38. 38. What’s Next? 2020 Diversion First Stakeholders Meetings Focus and Frequency

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