diversion first - feb. 7, 2017: stakeholders update

Stakeholders Update

Diversion-Oriented System of Care Collaborative

February 7, 2017

1

Tonight’s AgendaDiversion-Oriented System of Care Collaborative

February 7, 2017

Review of our evening

Success story sharing

Broad View AccomplishmentsWork Group Report Outs

Leadership GroupCommunications TeamData and EvaluationWorkforce DevelopmentDepartment of Information TechnologyGeneral District Court UpdatesJuvenile DiversionProblem-Solving TeamCSB Updates

Collaborative Updates, Announcements, Discussion

Announcements and Updates from Collaborative

2

What Happens Tonight

• Review accomplishments and progress in 2016• Discuss some of the challenges we are facing• Hear some success stories• Look at our plans and goals for 2017 and

beyond

3

Accomplishments Beyond Service System Changes

(that we’ll hear about from work groups)

National Involvement:– Stepping Up National Summit – 1 of 50 in USA selected to participate– Stepping Up Behavioral Health-Justice Leadership Institute - 1 of 20

in USA to participate– White House Data Justice Initiative

Local, State, and National Funding– Local budget $3.89 Million– DBHDS CIT Funds of $600K+ for 2 years– DCJS $1K for CIT Training costs

Multiple contacts from around the country and many regional presentations (COG, Mid-Atlantic, Loudoun Co.)

4

Original Goals

Launch a data-driven multi-faceted diversion system by January 1, 2016– Built around Sequential Intercept Model– CIT-trained first responders– Crisis Assessment Site and custody transfer

Expanding Mobile Crisis UnitWorking toward mental health docketUse data to manage and evolve a robust Diversion-

Oriented Services Program over next 3 to 5 yearsExpand diversion services to all 5 intercepts

5

Leadership Group

Presented by:Tisha Deeghan

CSB Executive Director

6

Leadership Group

• Meeting monthly, reviewing progress, removing identified barriers, working through budget processes

• Added General District Court and Juvenile and Domestic Relations Court to the group

• Ongoing commitment and partnership • This group replicates many around the country

designed to keep process moving forward• All challenges/barriers presented tonight will go to

this group for planning, discussion, and “working”

7

Diversion First Survey

• Sent to Stakeholders Group by Chairman Bulova in January 2017

• Purpose: to get input from stakeholders about where we’ve been and our future priorities

• 80 out of 164 (49% response rate) completed the survey (this is good!)

• Broad stakeholders represented in respondents

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Survey Results: In an effort to create a diversion-oriented system of care, please choose what you

believe are the top three accomplishments

1. Launch of Merrifield Crisis Response Center (MCRC) (88.75%)

2. Crisis Intervention Team and Mental Health First Aid training for key stakeholders (82.5%)

3. Establishing cross-system approaches for Intercept 1 (police-involved situations and MCRC diversions) (52.5%)

4. It’s a tie:– Communication Efforts (31.25%)– Galvanized Leadership (31.25%)

5. Juvenile Diversion Efforts (11.25%)

9

What do you see as the top three priorities over the next 12 months?

1. Significant progress towards specialized court services for people with mental illness including efforts to establish a docket (66.25%)

2. Evaluation System allowing us to share data and measure recidivism, return on investment, and engagement in treatment for people diverted, as well as better define the population of people with serious mental illness in jail (62.50%)

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What do you see as the top three priorities over the next 12 months?

3. Prioritized access to treatment for people with serious mental illness who have been diverted from the criminal justice system (50%)

4. Three-Way Tie! (32.5% each)– Improved medical clearance processes for people needing

psychiatric hospitalization– Changes to protocols in the ADC related to access to

psychiatry, medication, and CSB assessments to determine treatment needs

– Greater focus on ensuring that diversion-eligible people don’t “fall through the cracks”

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What do you see as the top three priorities over the next 12 months?

6. Juvenile Diversion Efforts (10%)7. Other (13.75%) included training, housing, EMS

transports to MCRC, staffing concerns, studying “fails” to improve, MH staff working with magistrates, downstream (post diversion) focus, response to people with DD, and improved interception points, resource needs

8. Full comments can be reviewed in the handout

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So what do we do with this survey?

• Use priorities to address 2017 directions• Keep these priorities in mind tonight as we

hear from the work groups to see how they align

• For your reading pleasure-- Results are posted online at www.fairfaxcounty.gov/diversionfirst

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Communications and PublicOutreach Team

Presented by:Tony Castrilli, Office of Public Affairs

Andrea Ceisler, Sheriff’s Office

Annual Report

• 2017 Annual Report now available– Report first released at tonight’s stakeholders

meeting– Will submit to media (via Newswire) tomorrow 2/8– Communications team will look for ways to highlight

data using county tools (audio, video, etc.)• Available online (PDF) at

www.fairfaxcounty.gov/diversionfirst

15

Public Outreach

• We continue to provide presentations to groups interested in Diversion First– March 30 presentation to GMU MPA students– To request a presentation, email

diversionfirst@fairfacounty.gov

16

Moving Forward

• Team will continue to focus on different areas in small work groups:– Outreach and Presentations– Website Updates and Maintenance– Hotline Consolidation and Education– Internal Communications

17

Data and Evaluation Workgroup

Chloe Lee, Community Services BoardRyan Morgan, Police Department

Redic Morris, Sheriff’s OfficeLisa Potter, Community Services Board

MCRC/Diverted from Potential Arrest

Instances in which law enforcement officers diverted individuals from arrest and provided an opportunity for mental health services

In 2016, • 1,580 people were transported by law enforcement to

Merrifield Crisis Response Center • 375 or 24% had potential criminal charges but were diverted to

mental health services• Includes both voluntary and ECO

• On average, 35% of all LEO transports to the MCRC involved a CIT trained officer

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Data Snapshot

Jan-Mar, 2016

Apr-Jun, 2016

Jul-Sept,2016

Oct.-Dec, 2016

Total

Jan-Dec 2016

Police DepartmentMental health investigations in the field – Fairfax County Police Dept.

831

916

900

919

3,566

- Resolved in the field (Fairfax County) 471 505 479 504 1,959 - Involved Merrifield Crisis Response Center (MCRC) for all jurisdictions

360 411 393 416 1,580

Merrifield Crisis Response Center/Emergency ServicesTotal service encounters 1,296 1,380 1,170 1,178 5,024

– General Emergency Services (non-law enforcement involved) 936 969 777 762 3,444

– Involved Law Enforcement 360 411 393 416 1,580

- Voluntary transports to MCRC 158 141 127 121 547 - Emergency Custody Order (ECO) transports to MCRC

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270 266 295 1,033

Diverted from potential arrest 103 106 85 81 375Unduplicated number of people served at Emergency Services 3,081Mobile Crisis Unit– Total number of services (attempts and contacts) 319 361 415 389 1,484 - Total number of services (contacts) 215 242 294 278 1,029– Services with law enforcement involvement or referral 79 126 148 114 467Unduplicated number of people served (contacts) 791Office of the Sheriff– Emergency Custody Orders and Criminal Temporary Detention Orders

(ECOs/CTDOs) from Jail 3

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9

10

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– Transports from MCRC to out of region MH hospitals 26 37 28 37 128– Jail transfers to Western State Hospital (forensic) 5 2 6 10 23Crisis Intervention Training (CIT)– Graduates 265– Dispatchers trained 42Mental Health First Aid (MHFA)– Magistrates 30– Sheriff Deputies 248

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123% increase in ECOs from 2015 to 2016

ECO 2015-2016 Comparison

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1st Q 2nd Q 3rd Q 4th Q Total0

200

400

600

800

1000

1200

74126 126 137

463

202270 266 295

1033

20152016

2016 Preliminary Data Findings

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Who We Served(police-involved at MCRC)

55% Male 51% White18.4% Hispanic or Latino17.6% African American10.2% Asian32.6 Average Age

6.74% of the clients had no fixed address 23

Age Groups

The two largest populations served were 13-18 and 23-29, followed closely by 30-39

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60 or older

50-59

40-49

30-39

23-29

19-22

13-18

9--12

0% 5% 10% 15% 20% 25%

7.9%

9.2%

11.5%

18.4%

19.3%

12.5%

19.7%

1.5%

Age Groups by Gender

13-18 was the largest group served for female whereas 23-29 was for male (p<.001)

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13-18 23-29 30-390%

5%

10%

15%

20%

25%

16.5%

22.9%

20.4%

23.5%

14.8%15.9%

Male

Female

Age Group

Race

While people who are white were the largest group served, people who are black were overrepresented in this population, as compared to the Fairfax county population

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Other

Multirace

Asian

Black

White

0% 10% 20% 30% 40% 50% 60%

17.4%

3.8%

10.2%

17.6%

51.0%

Frequency of Visits

14.8% of individuals came to MCRC with LEOs more than once

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4 times or more

3 times

2 times

1 time

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

1.2%

2.6%

11%

85.2%

14.8%

Disposition

50.4% of the MCRC visits with LEOs led to TDO (Civil)

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Other

Voluntary Hopitalization

Referred to Other Voluntary Treatment

Released with Safety Plan

TDO Civil

0% 10% 20% 30% 40% 50% 60%

11.7%

7.0%

12.3%

18.6%

50.4%

ECO to TDO

64.7% of ECOs led to TDOs whereas 26.7% of non-ECO cases led to TDOs * (p<0.001)

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ECO: No ECO: Yes0%

10%

20%

30%

40%

50%

60%

70%

80%73.3%

35.3%

26.7%

64.7%

TDO NoTDO Yes

ECO Rate by CIT Training

CIT trained officers were more likely to issue ECOs than officers who were not CIT trained (73.4% vs. 66.1% *, p<.01)

30CIT: No CIT: Yes

0%

10%

20%

30%

40%

50%

60%

70%

80%

33.9%

26.6%

66.1%

73.4%

ECO NoECO Yes

ECO to TDO Rate by CIT Training

ECOs issued by CIT trained officers were more likely to lead to TDOs than ECOs by non-CIT trained officers (70.6 vs. 61.8%, p<.001)

31CIT: NO CIT: YES

20%

30%

40%

50%

60%

70%

80%

61.8%

70.6%

MCRC - ECOExchange of Custody

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Workforce Development: Crisis Intervention Training

• Graduates since June 2015 – 265 total (22% of patrol officers trained)

• Dispatcher training - 47 trained

• Coordinating additional classes

•Mental health overview has been added to the Criminal Justice Academy training - 232 trained to date

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Mental Health First Aid (MHFA)

Trained to date:•Deputies - 248 (over 50% of jail-based)•Magistrates - 30 (100%)• Juvenile Intake Officers - 23 (100%)• Fire and Rescue - 165–adaptation of MHFA curriculum

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Sheriff’s Office Data

January-December 2016• Emergency Custody Orders (ECOs) and Criminal

Temporary Detention Orders (CTDOs) - 35 Includes those with mental health issues who would be better

served in a psychiatric hospital• Transports from MCRC to out of region psychiatric

hospitals - 128 Transport requires 2 deputies, at least one CIT-trained Accumulating in 34,576 round trip miles driven.

• Jail transfers to Western State Hospital (forensic) - 23

Individuals taken to jail (not bonded out) but need hospitalization due to decompensation

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Sheriff’s Office

• Developing strategy to determine prevalence rates for serious mental illness– Progressing to adoption of validated screening

instrument– Determine changes in these rates over time

• Reviewing and analyzing data for those with serious mental illness who are incarcerated to identify demographics, recidivism rates and charges

• New focus on high utilizers

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Progress and Next Steps

Data pilot underway• Purpose is to review what happened to people post-

MCRC, inform overall evaluation framework, learn about gaps, and areas for improvement

• Includes 50 people who came through the MCRC in January 2016; also reviewing sample of jail population

• Will include data from 2015 and 2016 (arrests, CSB services, convictions, probation violations, Fire and Rescue interactions)

• Preliminary findings targeted for April37

Progress and Next Steps

Challenges:• Complex process of pulling data from various

systems, spreadsheets, and record review• Data requires extensive quality checks to ensure

accuracy and consistency• No system interoperability • Different language for data variables• Bringing to scale will not be sustainable without

technology solution

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Data Solutions Through Technology

Debra DunbarDepartment of Information Technology

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Data Solutions Through Technology

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• Market Intelligence and Demonstrations & Best Practices– Select Organizations Deploying IT Assets in Support of Diversion Efforts

• Pima County, AZ• Bexar County, TX• Dallas County, TX• Queens, NY• Miami-Dade, FL

– Technology Approaches• Data exchange between Jail and Behavioral Health systems• Data exchange between Courts and Behavioral Health systems• Manual/Spreadsheet Data Aggregation and Reporting• Niche Software Applications• Case Management Software Solutions

– Data Sharing Agreements• County Asset Review• County Business Requirements

Data Solutions Through Technology

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• Short Term Solution– Ability for Public Safety and Behavioral Health systems to

exchange data: indicator, flag– Aggregation of health data across multiple health resources– Data Sharing Agreements

• Long Term Solution– Exchange of healthcare information electronically: Health

Care Services Information System, Case Management System

– Reporting & Analytics tool

19th Judicial District CourtFairfax County and Fairfax City General District Courts

Michael J. CassidyChief Judge

Court Orders

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“No, You Can’t Recuse Yourself From Taking Out the Trash”

Why Judges Are Not Called Your Honor at Home

Problems

• Long Pre-Trial Detention– Court Delays for Competency Treatment at Western

State Hospital– Bond Risk Posed by Mental Health Defendants– Time Served Pre-Trial exceed Reasonable Sentence

losing Probation Options• Sentencing– Need for Supervision & Treatment Alternatives– Lack of Court Services Staff for Pre-Trial & Probation

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Changes in Last Year

• Reducing Pre-Trial Detention– Expediting Hearing Dates after Return from

Competency Treatment at Western State– Identification & Supervision of Appropriate but

Challenged Defendants with Reasonable Bond• Sentencing– Pre-Trial Programs may lead to Sentencing Options– Increase in Court Services Supervision Capacity

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Future

A Marathon, without a Reliable Course Map, not a Sprint with a

Visible Finish Line

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GDC Court Services

Colin McDonald Director

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GDC Court ServicesInitiative Implementation

• Implementation of the Diversion First Initiative for Court Services is at the Pretrial Stage

• Diverting defendants incarcerated in the Fairfax ADC to the Supervised Release Program (pretrial supervision)

• Adapting our Pretrial program to continue to meet the Court’s needs as well as those of the Diversion First initiative

• Utilize existing staff resources within the Court Services’ Pretrial Evaluation Unit to complete the simple screening instrument in a timely fashion

• Work within the framework of existing workflow and timelines• Provide a seamless handoff of Diversion First defendants to the

CSB

Implementation Timeline• April – Changed the methodology for recommending pretrial release to

include higher needs clients• May – Began research of Mental Health Courts and conducted site visits to

other jurisdictions (Baltimore, Harrisburg, Philadelphia, Washington, D.C.)• June – Conducted interviews for the Diversion First Positions• July – Hired the Diversion First staff and began the pilot of the mental health

simple screening instrument, the Brief Jail Mental Health Screen (BJMHS)• August – Conducted research on various advanced mental health screening

instruments• September – Selected 3 advanced mental health screening instruments to

pilot• October – Completed a 1 month pilot of K-6 Screening Scale• November – Completed a 1 month pilot of Modified-Mini Screen• December – Completed a 1 month pilot of Jackson Mental Health Form III• January – Selected the Jackson Mental Health Form III as our advanced mental

health screening instrument and began the development of Diversion First participant database

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Pilot Period Results(July 2016 – December 2016)

• 2491 Pretrial evaluations were conducted by staff on defendants remanded to the jail by the magistrate or pending bond motions before the courts

• 1782 Brief Jail Mental Health Screens were administered by the GDC Court Services’ staff

• 559 (approximately 31%) screen results indicated a need for an advanced screening

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Pilot Period Results(July 2016 – December 2016)

• 818 defendants were placed on pretrial supervision during the pilot period

• 95 defendants were placed on pretrial supervision that indicated a need for further mental health assessment (74 from bond motions, 17 from advisements and 4 from the Magistrates)

• 48 of the defendants placed on pretrial supervision were Court ordered to undergo a mental health evaluation and follow any recommended mental health treatment

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Participant Database(est. March 2017)

• Number of defendants on pretrial supervision who are administered advanced screening instrument

• Number of defendants on pretrial supervision who are administered the advanced screening instrument and indicate a need for a mental health evaluation

• Number of defendants on pretrial supervision that are referred to CSB for a mental health evaluation

• Number of defendants on pretrial supervision that were previously engaged in mental health treatment

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Impact on Court Services

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1

2

3

4

60,000 70,000 80,000 90,000 100,000 110,000 120,000 130,000 140,000 150,000 160,000 170,000 180,000

115710

125458

132275

169644

Days of Supervision Provided by Pretrial Services

(estimate)

FY 14

FY 17

FY 16

FY 15

Impact on Court Services

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1 2 3 4200

225

250

275

300

325

350

375

400

425

450

475

317

344

361

461

Daily Caseload

Case

s und

er su

perv

ision

FY 15

FY 16

FY 17

FY 14

The number of defendants on pretrial supervision has increased dramatically since the change in methodology for recommending higher needs defendants for pretrial supervision began. It is noteworthy that the defendants that represent this increase had a high probability of remaining incarcerated until their cases were adjudicated and that they typically required a more intensive level of supervision.

Accomplishments• Ongoing advanced mental health training for the GDC Diversion First

Mental Health Team. • All GDC Court Services’ Staff are trained in Mental Health First Aid• 1 member of the Diversion First Mental Health Team was CIT trained• Established monthly & quarterly conferences with the Jail Diversion

Team, Mobile Crisis, Emergency Services, and the Merrifield Leadership Team.

• Formation of Diversion First Court Steering Committee, chaired by Judge Tina Snee.

• Secured office space for the Diversion First Mental Health Team (room 215).

• Began development of the Diversion First participant database.• Created a more efficient & informational referral process with the CSB

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Obstacles/Challenges

• HIPAA regulations regarding data sharing• ECO concerns on non-incarcerated defendants• How to address the defendants placed on pretrial supervision

without simple screening instrument (mostly J&DR Court)• Permission for record checks for recidivism studies• CIT training for the Diversion First Mental Health Team• Ongoing construction for the new Diversion First space• Lack of Probation Counselors. Large caseloads of high needs

clients are very labor intensive (most likely 500+ active pretrial cases moving forward)

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Juvenile Court Diversion Efforts

Bob Bermingham CSU Director

Juvenile Diversion Initiative

• Improved data collection around diversion eligibility

• Developed baseline data to judge improvements

• Identified diversion policies in need of review• Added new programs for diversion eligible

youth

58

Diversion Pilot Data

All Intakes Black Youth Hispanic Youth White Youth

38% 34% 30%50%

93%90%

88%

98%

Eligibility for Diversion

Eligible for Diversion Received Diversion Services

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Reasons NOT Eligible for Diversion

• Youth of color represent a greater proportion of those ineligible for diversion due to: – Prior or current court

involvement (prior truancy complaints, prior diversion, currently/ previously under court supervision)

– Youth on the run

Youth of Color

75%

66%

80%

Top 3 Reasons YOC are not El-igible for Diversion

Youth in Custody, Unable to ReleaseExcessive RestitutionExcessive Charges

60

JDRDC Responses

• Policy changes to eligibility criteria– Maximum number of charges (at one time)

allowed increased from 3 to 5– Removed restitution as an eligibility factor

• As these changes occurred in June 2016, the impact of these changes is unknown and additional data analysis is forthcoming

61

New Programs/Initiatives

• Implementation of “informal diversion” – Decreased the number of low risk youth formally involved with

the court through diversion– Increased the number of youth eligible for “double diversion”

depending on the charges

• Implementation of the Domestic Assault Response Initiative (DARI)– Developed to increase diversion options for youth eligible for

diversion based on charge and history but remanded to Shelter Care due to the nature of the crime (assault against parent/guardian)

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Outcomes to Date

17%

Youth Receiving New Charges within 6 Months of Completing

Diversion

Diversion Completed: Aug 2015 and Feb 2016

84%95%

Youth Successfully Completing Di-version and Avoiding a Criminal

Record

FY 2015 FY 2016

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Increased youth successfully completing diversion (informal or formal) and avoiding a criminal record after pilot implementation

Only 17% of youth received new charges within 6 months of

completing diversion.

Alternative Accountability Program

• 81% of referrals reach an agreement– 99% of youth are compliant with the agreed

sanctions/outcomes64

Patrol Of -ficers; 25%

School Re-source Of -ficers; 75%

AAP Referral Source

Youth of Color; 55%White Youth;

31%

Other; 14%

Race/Ethnicity of Youth Referred to AAP (n=108)

Updates

• AAP Expansion• Finalists for Capstone of the Year with

Georgetown

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Problem-Solving Team

Daryl WashingtonCSB Deputy Director

66

Problem-Solving Team

• Membership: – Major Ron Kidwell, Office of the Sheriff– Captain Matt Owens, Fairfax County Police Department– Daryl Washington, CSB Deputy Director– Cynthia Tianti, Deputy County Attorney– Other Ad Hoc members when needed

• Membership includes staff who can make decisions and rapidly implement change

• Any process/systems changes will be reported at future stakeholders meetings.

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Problem-Solving Team Focus Areas

• Cross system case reviews of people with low-level crimes who were not diverted

• Will focus on data-sharing needs while aligning with confidentiality regulation

• Will focus on interventions that allow for better diversion data collection across data systems

• Daryl Washington is the point of contact for any situations that should be brought to this group (daryl.washington@fairfaxcounty.gov)

68

CSB Updates

Daryl Washington, CSB Deputy DirectorAbbey May, Emergency Services Director

Marissa Fariña-Morse, Diversion First Service Director

69

CSB Diversion Efforts

Accomplishments (more detail to follow by service directors)• MCRC Launch• Review of CSB Priority Access Guidelines in

process• Housing updates

70

Merrifield Crisis Response Center

• Successes 2016– Working relationship with law enforcement– Increase in ECOs– Training of CIT law enforcement officers and dispatchers

• 3 CSB CIT Trainers– Expansion of MCU

• Total Cases 1484• MCU 2 10am-10pm 5 days a week

– Single coverage to secure locations– 211 cases Sept 2016-Jan 2017 (5 months)– Average 42 cases per month– Increase in response time

– Hiring• 2 Crisis Intervention Specialists • 1 Supervisor• Approval for Mental Health Tech position

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Merrifield Crisis Response Center

• Challenges and goals 2017– Development and implementation of medical

clearance– Staffing of Emergency Service and MCRC law

enforcement– Volume management– Integration of Jail Diversion with MCRC– Care Coordination

72

CSB Behavioral Health Services in the Jail and Courts:

Staffing Updates

• New Hires/Expanded Focus:– service director– clinical staff– peer staff

• Increased Psychiatric Hours at the Jail• Collaboration of Jail Based and Merrifield

Based Teams

73

CSB Behavioral Health Services in the Jail and Courts:

Practice Improvements

• New collaborations with Court Services staff– Shifting staff hours to add early mental health screening,

increased responsiveness to referrals and collaboration– Improved collective release planning across agencies

• Example: people returning from hospitals to supervised release

• Increased collaboration with CSB emergency services for ECO and TDO processes

• Ongoing partner discussions to best use existing resources and improve variety of processes

• New focus on High Utilizers of Multiple Systems (HUMS)

74

CSB Behavioral Health Services in the Jail and Courts:Anticipated Needs

• More responsive/rapid mental health assessments to align with court services

• Increased screening for ECOs before bond• Additional mental health supports to be responsive to courts and

court services• High utilizer focus may require focused interventions and support• Strengthened efforts to identify jail population with mental

health needs • Additional case work with people jailed for low level crimes (case

reviews, interventions, case management to transition to services)

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Additional Updates

Laura YagerOffice of County Executive

76

Sequential Intercept Model Mapping Update

• Completing application to update current SIM model developed in Fairfax County in 2011

• Competitive application through GAINS center• If technical assistance award is granted, multiple

stakeholders will be engaged in the process.• Completed process mapping at jail, Magistrate’s

office, police, and courts will support this effort

77

Updates

• Course Corrections: Mid-Atlantic Behavioral Health and Criminal Justice Summit

• March 22-23, NACo HQ• Diversion First speakers may be featured• Small grant opportunity for additional DBHDS

jail diversion funding

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Collaborative:Comments, Updates, Questions and Announcements

79

Spring is just around the corner!Next meeting will be in mid April

Date TBD7 to 9 p.m.

Fairfax County Government Center

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