dallas county behavioral health leadership team thursday ......presentation dr. joseph guillory,...

Dallas County Behavioral Health Leadership Team Thursday, November 14, 2019

Henry Wade Juvenile Justice Center 2600 Lone Star Drive, Dallas, TX Room 203-A at 9:30am -11:00am.

I. Welcome and Call to Order

Review/ Approval of Minutes *October 10, 2019*

II. Introductions

III. * Proposed Representatives

Resolution 08-2019

CMHP (Adolescent)- Andy Wolfskill, CEO, Child and Family Guidance Center Dallas

IV. Presentation

Dr. Joseph Guillory, Parkland Hospital and Joe Powell, APAA

Overview of Recovery 101: A Community Psychoeducation Program

V. NTBHA Update

VI. Meadows Mental Health Policy Inst. (MMHPI)

VII. Dallas County Behavioral Health Housing Workgroup

VIII. 1115 Waiver Crisis Services Project Update

IX. Legislative Update

X. Funding Opportunities

Cottages Update

SAMHSA Residential Treatment Grant Update

Community Courts Grant Update (Public Defender’s Office)

XI. Upcoming Events and Notifications

XII. Public Comments

XIII. Adjournment

* Indicates items requiring approval from Dallas County Behavioral Health Leadership Team The following reports from BHLT Committees are included for your records: ACOT, BHSC, PD Mental Health Stats and North Texas Behavioral Health Authority. Unless action is required, there will be no verbal updates from those committees.

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DALLAS COUNTY, TEXAS Minutes of the Behavioral Health Leadership Team (BHLT) Meeting

Thursday, October 10, 2019 https://www.dallascounty.org/departments/criminal-justice/bhlt/

Welcome and Call to Order Commissioner John Wiley Price called the Behavioral Health Leadership Team meeting to order at 9:35 AM. Review/Approval of Minutes The minutes of the BHLT meeting held on September 12, 2019 were included in the meeting packet. A motion was made and second by Doug Denton and Ken Medlock, respectively, for acceptance with no discussion or corrections. The motion was unanimously passed by the committee members accepting the minutes as read without objection or modifications. Introductions Commissioner John Wiley Price welcomed all attendees and allowed all first-time attendees to introduce themselves. The following individuals identified themselves as first-time attendees to the BHLT: Morganne Brownlee, Transicare; Rolanda Williams, Southern Area Behavioral Healthcare; Brian Roy, City Square; Saira Bhatti, Meadows Mental Health Policy Institute; Dawn Marchetto, Parkland Health & Hospital System. The CSP staff received no notice of absence from committee members. Commissioner John Wiley Price thanked the committee for their hard work and dedication toward the population served. He also thanked everyone who attended the 4th Annual Mental Health Symposium: “Navigating the path to Liberation and Healing” held Saturday, October 5, 2019 (8:00am to 3:30pm) at the St. Luke Community United Methodist Church. Proposed Representatives (Resolution 07-2019) Commissioner John Wiley Price provided a brief description of the resolution, which was included in the meeting materials and the BHLT recommends the following changes and additions to the BHLT membership to fill two vacancies on the board:

UTSW – Dr. Kenneth Rogers

Parkland Health & Hospital System – Kurtis Young Commissioner John Wiley Price asked the committee if there is any unreadiness regarding the resolution and asked for a motion to approve BHLT membership for both Dr. Kenneth Rogers (UTSW) and Kurtis Young (Parkland Health & Hospital System). Dr. John Burruss made the motion for approval and second by Becca Crowell. The motion was unanimously passed accepting the resolution without objection. Presentation Assistant Chief Brian Redburn (Irving Police Department) provided a presentational update on the Irving Mental Health Response Right Care Team (MHRT) and the Irving Behavioral Leadership Team. The Irving

BHLT-November 2019 2

https://www.dallascounty.org/departments/criminal-justice/bhlt/

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Police Department MHRT is a multidisciplinary team tasked with responding to individuals suffering from mental illness, substance abuse disorders, or other behavioral health issues. The unit consists of one sergeant supervising three officers and one civilian mental health clinician. Each officer is a certified mental health peace officer and has received specialized training specifically to aid individuals suffering from a mental health crisis. The civilian clinician has extensive experience and certifications in the mental health field. The team answers calls for service, assists patrol and other units with in-progress calls, and conducts follow-up outreach to individuals who have intersected emergency services personnel in Irving or local hospitals. The Irving Police MHRT is one part of a larger group of cooperating entities that seek to provide services to individuals in the community. The project is funded by grants from the Department of Justice, Bureau of Justice Assistance Project Coordinator Grant, Community-Oriented Policing Services (funding for the clinician’s and three police officers’ salaries). Conversation ensued and questions were asked from committee members. Outcomes from the program include: MHRT Results

2018: 734 calls for service, including an attempt to suicide and other mental health-related calls. 2 addresses accounted for 129 calls. 710 APOWWs.

2019 (YTD):

Better data collection gives an appearance of increased activity. 481 calls for service. 715 mental health incident reports and supplements created in last 12 months. 361 APOWWs. 83% reduction in calls for service at two high-utilizer addresses from 2018.

Irving BHLT Results

Better coordination of services locally and regionally. BHLT collaboration led to first outpatient clinic in Irving (IPS & Irving Cares partnership). NTBHA provided a dedicated Care Coordinator:

Improved continuity of care and direct line of communication with funding authority. Streamlined process for jail referrals and compliance with Sandra Bland Act.

Improved communications: Business Associate Agreements with care providers. Monthly briefings and case strategy sessions between MHRT and local clinic.

80% of clients have no prior connection to mental health service provider. NTBHA Update Carol Lucky, CEO of North Texas Behavioral Health Authority (NTBHA), provided the update. She stated they are completing their contract process and all contracts should be available by the end of next week. The process has been tedious between receiving contracts from the state and getting contracts out to providers. A group of new providers will join the network and include Innovations Mental Health, Multicultural Recovery Center, Bienstar Counseling Services (the latter two specialize in bilingual services), and Robinson House Behavioral Health Services. The group attended a Community Mental Health Provider (CMHP) training last week to be eligible to provide state-based services. An offer was also extended to Jordan Health to join the network, but they are uncertain if they fit their business model. NTBHA looks forward to future opportunities to serve individuals whose primary language is Spanish. Serenity Crisis previously provided crisis residential services, but was on suspension for a fire code issue causing the service line to be briefly offline. The crisis residential service line has now been restated. Serenity Crisis worked diligently with NTBHA’s QM Staff to re-train staff so compliance was met. As of midnight on October 1, 2019, the crisis line is now being answered by the Harris Center, a local community center in Harris County, and the phone number is same. The Harris Center also answers calls for 33 different counties, and has a large phone bank, so no one should be placed on hold. As of midnight on October 1, 2019, Transicare now responds to the mobile crisis phone calls. Carol Lucky thanked Adapt for the services they provide to the community and their previous work with the mobile crisis phone line. The Tenant-Based Rental Assistance (TBRA) program has housed 30 individuals: 22 in


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Dallas, 6 in Kaufman, 2 in Rockwall, and 1 in Ellis counties and many are listed under the disability and drug/alcohol category. DA, John Creuzot, has changed the name of the Jail Diversion Center to the “Jail Deflection Center” since the center will focus on preventing individuals from coming into the criminal justice system. Homeward Bound will be the drop-off location for the Jail Deflection Center. Julie Turnbull stated that the DA’s office is excited about the collaboration with the various partners and the rapid pace that the program is making to become established. Ron Stretcher stated that Doug Denton is working on operational budgets for the program. The Dallas Sherriff’s Office (DSO) is working with Harris County to schedule a tour of Homeward Bound to establish the security/safety portion of the project. He stated that there are three other critical entities to the continuum and include: The Living Room, The Salvation Army, and City Detention Center. NTBHA is working with Chief Lindsey, City of Dallas Marshall’s Office, to get more services. The project has attracted the interest of various private funders such as AT&T and other downtown Dallas businesses. The planning committee plans to leverage the Jail Deflection Center to enhance and address housing opportunities for the homeless. Last, Mr. Stretcher stated that Commissioner Dr. Theresa Daniel is working to coordinate opportunities to house the homeless and the planning committee along with various private corporations is focusing on MHDA’s new D-One plan. Carol Lucky stated that the Jail-Based Competency Restoration (JBCR) program has been a success and since opening earlier in 2019, have served 107 individuals, 41 had felony charges and 66 had misdemeanor charges. NTBHA also funds field Outpatient Competency Restoration, which is provided by Metrocare, IPS, and Children and Family Guidance Center. The Rally for Recover was also a success. The Grand opening of the Living Room will be held Tuesday, October 15, 2019 at 2:00pm-6:00pm. Commissioner John Wiley Price thanked Joe Powell for organizing the Rally for Recovery event and everyone who attended. He also thanked Adapt for the services they provide to the community and their previous work with the mobile crisis phone line. Meadows Mental Health Policy Institute There were no additional updates. Behavioral Health Housing Work Group (BHHWG) Update Commissioner Dr. Theresa Daniel reported that the group discussed the inclement weather policy and various methods regarding housing the homeless during inclement weather seasons. The City of Dallas will provide reports regarding the inclement weather outcome in either February or March 2020. The committee has been researching other communities’ inclement weather policies to see how Dallas County can address the situation. The cities of Garland, Irving, and Mesquite are implementing policies and are collaborating with local clinics, churches, and transportation services to prevent potential weather related tragedies. They are exploring collecting efficient data, so that both the committee and community partners can use for reporting and executive decisions. For project and industry updates, they are excited about the future campus expansions of both Salvation Army and Homeward Bound, the Grand Opening of the Living Room and other committee projects. St. Jude is planning another housing project opportunities. The committee is also researching ways to address the Dallas County Homeless Youth population. Last, they are working to add the housing portion as a complement with the opening of the Deflection Center and are working with various private corporations to assist with potential funding opportunities for future homeless housing developments. Commissioner John Wiley Price asked when the housing portion with the various private corporations would begin. Commissioner Dr. Theresa Daniel answered stating she has spoken with a variety of developers and many are planning to build mixed-use payment housing developments. She spoke with one developer who plans to build 5-unit townhomes for homeless female veterans in Garland, TX. 1115 Waiver Crisis Services Project (CSP) Update Joyce White, CSP Program Manager, reported that the CSP is working on the October 2019, reporting and it is due at the end of the month to the State of Texas. The main item that the team will report is the Return on Investment (ROI) and Cost Benefit Analysis (CBA) of all monies spent on the CSP project thus far and the benefits and savings to Dallas County. The CSP is also completing a plan, due November 6, 2019, to discuss and strategize how to structure the program over the next two years. Last, the CSP is working with the CSP Governance and Transition Planning Committee and discussing how to transition the program post-waiver funding. Various community partners who are a part of the committee have separate assigned tasks to complete and share with the group. The individual assigned tasks will be combined into one document and


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shared with the BHLT. Commissioner John Wiley Price asked the expected timeframe of completion for the transitional plan. Joyce White answered stating next year. Commissioner John Wiley Price asked that the transitional plan be completed over the next 6-8 months to review before the new budget for Dallas County is established. Legislative Update Janie Metzinger, NTBHA Legislative Coordinator, reported that this morning, the Texas House of Representatives Committee on Mass Violence Prevention and Community Safety is hosting a public hearing meeting at Brookhaven College. She stated that the items discussed could be posed for the next legislative session. Some studies were authorized into legislation last session, one being to research Suicide rates. She will also monitor the hearings and analyze reports to see what legislation could potentially be created around those hearings. Last, she will provide future updates regarding legislation from the 116th Congress. Funding Opportunities

Cottages Update: Jennifer Jaynes, Director of the Cottages, reported that the data is on pages 33 and 34 of the meeting materials. The Cottages ended the month of September 2019 with 42 residents. Four individuals were screened and placed on the waiting list and only two were eligible for move in. Five individuals were engaged last month for move-in for this month. On page, 33 under the incident reports section, Ms. Jaynes stated that the number of residents involved in EMS transport categories on the data report were zero for the last two months. Ms. Jaynes thanked The Cottages and Metrocare Staff for their diligent work with helping keep those occurrences down. Jail bookin stays have also decreased. On page 34, the graph illustrates an overview of The Cottages, Emergency Departments (EDs), and Jail bookin stays from July 2017-August 2019, and both categories show a downward trend. The highest data collected was for ED visits, which was 43 residents in one month and the lowest was 3 residents. For overnight Jail bookin stays, the highest resident count was 6, and the lowest was zero. Jennifer Jaynes also stated that this would be her last meeting as she has accepted a position with Baylor, Scott, and White starting Monday, October 14, 2019. Ms. Jaynes also stated that some staffing changes would occur. Last, she introduced Brian Roy (City Square Housing) and stated he will provide future reporting. Mr. Roy introduced himself to the committee, provided his background experience, and future affordable housing opportunity plans. Mr. Roy solicited both the committee’s and community partner’s help with developers or funders contact information to discuss potential affordable housing opportunities in Dallas County. Commissioner John Wiley Price asked if their plans would target populations who cannot afford affordable housing opportunities and are chronically homeless. Commissioner Dr. Theresa Daniel also asked what the occupancy in their developments is. Brian Roy answered stating most of their units have a 9+% occupancy rate. He hopes to improve The Cottages occupancy rates to help serve the population who cannot afford affordable housing opportunities (chronically homeless) and the City Walk development in downtown Dallas, TX. He also stated that his team has expertise with that specific population and are working to address challenges. Commissioner Dr. Theresa Daniel stated she would like to meet with him to discuss ways to house that population. She also thanked Jennifer Jaynes for her work at The Cottages. Sharel Key (Metrocare) reported that there are 33 assigned individuals through Metrocare, 15 agreed to engage with Metrocare and 14 individuals met the needed engagement requirements. Last, she stated that the Psychiatric Crisis Services for engaged Metrocare individuals for the month” category has decreased.

SAMHSA Grant Update: Shenna Oriabure, Specialty Court/Special Populations Coordinator (Dallas County Criminal Justice Department), stated the data is on page 36 and reported that they had 36 admissions, 5 pending admissions totaling 41 referrals and the goal was 40 referrals, exceeding the goal. The team will also provide a detailed update once the evaluator has completed the data for the year, which ended September 30, 2019.


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Community Courts Grant Update (Public Defender’s Office) Lynn Richardson, Chief of the Dallas County Public Defender’s Office, stated that the PD’s Office handles 47% of the Adult Indigent Defense cases with the Criminal Courts. Last year, the PD’s Office handled 25,000 cases, and many had mental health issues. Their data was provided to the committee as a separate handout and reflects both the Specialty and Diversion Court programs specifically related to mental illness because they are staffing for most of the specialty and problem-solving courts in Dallas County. The report shows data for Harry Ingram who is in charge of three programs: ATLAS, S.E.T., and AIM. Two mental health trial attorneys handle all the mental health cases that are referred to the division and all felony and misdemeanor Dallas County Courts. The PDs Office has a team of attorneys who handle both inpatient and outpatient competency cases. The Civil Commitment team handles cases in the Mental Illness court. As of this week, the PDs Office will work the entire caseload except for cases with a conflict of interest. This change will save Dallas County a significant amount of revenue and she thanked Commissioner John Wiley Price and staff for assisting with making the change possible. The PDs Office has a partnership with the South Dallas Drug Court, City Prosecutor’s Office, and District Attorney’s (DAs) Office with diverting individuals with traffic tickets who are in felony and misdemeanor courts with mental/substance disorders and are in the recovery process. She thanked all the Judges for their hard work and dedication with assisting individuals with completing specialty and problem-solving court programs. The SKIP program with Lonestar Injustice Alliance (LSJA) and their partnership with the DAs Office will begin once funding is received from the Indigent Defense Commission. The PD’s Office provided a presentation to the Criminal Justice Advisory Board (CJAB) and provided statics regarding young males of color in certain areas with higher levels of poverty, crime, and recidivism. The PD’s Office will launch a pilot program to examine young males of color who bookin into the Dallas County Jail and compare those who participate in the program with those who do not participate with similar situations to analyze outcomes and determine the program’s effectiveness. She also stated housing continues to be an issue. Last, she announced Vickie Rice is participating in Dallas County’s newly emerging leaders course over the next 6-8 months and Michaela Himes will temporarily represent at BHLT in her absence. Commissioner John Wiley Price announced that both Parkland Health & Hospital System and Dallas County Health and Human Services (DCHHS) have collaborated to develop a Community Health Needs Assessment (CHNA) to identify the geographic areas and populations that experience the most significant health disparities in Dallas County. The report will be released on a later date.

Public Comments Dr. John Burruss announced that Mara Wilson would be the guest speaker at the Metrocare Annual Meals for the Minds Luncheon on October 11, 2019. Veronica Moore (Department of Health and Human Services) thanked everyone for participating in the Big Texas Rally on September 21, 2019 at Globe Life Park. Lynn Richardson announced that the PD’s Office is working with the Sesame Street foundation to address children whose parents are involved in the criminal justice system. They just announced the introduction of a new character dealing with children with mental health/substance abuse disorders name Karli. Commissioner Dr. Theresa Daniel reiterated the Grand Opening of the Living Room scheduled for Tuesday, October 15, 2019.

Adjournment The meeting was adjourned at 11 am with a motion by Commissioner Dr. Theresa Daniel.


RESOLUTION

DALLAS COUNTY BEHAVIORAL HEALTH LEADERSHIP TEAM

RESOLUTION NO: 08-2019

DATE: November 14, 2019

STATE OF TEXAS }

COUNTY OF DALLAS }

BE IT REMEMBERED at a regular meeting of the Dallas County Behavioral Health Leadership Team held

on the 14th day of November 2019, the following Resolution was adopted:

WHEREAS, On January 4, 2011 Dallas County Commissioners Court was briefed to establish the Behavioral Health Leadership Team (BHLT); and

WHEREAS, the Dallas County BHLT was comprised of key stakeholders and organizations

throughout the county, including the Dallas County Hospital District.; and

WHEREAS, the body is made up of five (5) Advocates, thirteen (13) County/City organizations, seven (7) Residential Facilities, sixteen (16) Outpatient Providers, and three (3) Payers/Funders; and

WHEREAS, in the nine years since the BHLT’s inception, a number of membership seats have

become vacant and additional stakeholder groups have been identified for representation in the BHLT; and

WHEREAS, the BHLT recommends the following changes and additions to the BHLT

membership:

Child and Family Guidance (CMHP- Adolescent)–Andy Wolfskill

IT IS THEREFORE RESOLVED that the Dallas County Behavioral Health Leadership Team appoints the above listed individuals as active members of the BHLT.

DONE IN OPEN MEETING this the 14th day of November, 2019.

________________________ ________________________ John Wiley Price Dr. Theresa Daniel Commissioner District #3 Commissioner District #1 Dallas County Dallas County ________________________ J.J. Koch Commissioner District #2 Dallas County


Caruth Smart Justice Planning Grant, Community Stakeholder Project Status Update 1

Meadows Mental Health Policy Institute Caruth Community Update – Third Quarter 2019

The Meadows Mental Health Policy Institute (MMHPI) submitted the Caruth Smart Justice Planning Grant Phase II proposal to the W. W. Caruth, Jr. Fund at the Communities Foundation of Texas on July 15, 2016.1 Our implementation of the Caruth Smart Justice Project (Caruth Project) began in January 2017. The project aligns with and supports the local behavioral health system and its efforts to meet the needs of residents with mental health conditions in North Texas. As we proceed with Year 3 of the grant, we continue to make progress in implementing each of the points of contact within the Sequential Intercept Model. The Caruth Project has developed an active collaboration with community providers and stakeholders, working together to reduce the number of people with co-occurring mental health needs and criminal justice involvement in order to increase access to high-quality community-based treatment. To ensure the project’s success, we have formal agreements with the following agencies:

• The Dallas Police Department (DPD); • The Dallas Fire and Rescue Department (DFRD); • Parkland Health & Hospital System (Parkland); • North Texas Behavioral Health Authority (NTBHA); and • Community providers of Assertive Community Treatment (ACT) and Forensic Assertive

Community Treatment (FACT): Transicare, Integrated Psychotherapeutic Services (IPS), the Child & Family Guidance Center, and Metrocare Services (Metrocare).

Our work with Parkland has been instrumental, beginning with Parkland’s initial partnership with the Rapid Integrated Group Healthcare Team (RIGHT) Care units. In this partnership, Parkland hired and trained the clinicians for the RIGHT Care units and agreed to provide mental health clinicians for clinical support to 911 dispatch. Parkland further contributed to the Caruth Project by forming a referral pool of people needing Caruth-supported treatment: Parkland staff and NTBHA staff stationed at Parkland help identify and refer people who are eligible for Level of Care 4 services. Through the Dallas County Criminal Justice Department (DCCJD) and the Dallas County Sheriff’s Department, Dallas County has collaborated with Parkland’s Jail Health staff to transform screening and assessment procedures.

1 On October 5, 2016, the trustees of the W. W. Caruth, Jr. Fund at the Communities Foundation of Texas approved the grant proposal, which enables the Meadows Mental Health Policy Institute to work closely with Dallas County, the City of Dallas, and a broad array of partners to implement the Dallas County Smart Justice Project.



We have contracted with Loopback Analytics (Loopback) to create a real-time patient surveillance/tracking system that integrates data from primary systems involved with the Caruth Project. As of the midpoint of Year 3 in the Caruth Project, the Loopback data system has been fully deployed and used in multiple locations, including emergency departments and by NTBHA and its providers. Loopback has two years of historical data from the Dallas-Fort Worth Hospital Council Foundation (DFWHCF) and receives real-time data feeds from the following partners: Parkland, Texas Health Resources, Methodist Health System, Baylor Scott & White Health, NTBHA, and the Dallas County Jail (one-way feed of jail admission and release data). We wish to thank our partners for their continued support and energy in advancing the Caruth Project. Intercept 1. Law Enforcement

RIGHT Care – the multidisciplinary response team that is critical to reducing the burden on law enforcement in responding to 911 mental health calls in the Dallas community – provides regular outcomes analysis of call data provided by DPD, Parkland, and DFRD. Parkland has led the collection and organization of data we use to prepare reports for executive leadership and, when approved, public distribution. Partnerships between the City of Dallas, Parkland, IPS, Metrocare, the Child & Family Guidance Center, and other community providers have been critical to the successful launch of the RIGHT Care program. Over the past quarter, the MMHPI Smart Justice and Adult Policy team has continued to work closely with partners at Parkland, DFRD, the City of Dallas, NTBHA, and DPD to review the efforts of RIGHT Care’s implementation and identify opportunities for program improvement. A preliminary analysis of call data provided by DPD, Parkland, and DFR for the April 2, 2018, through September 22, 2019, time period found:

• There was a total of 4,976 interactions.2 - The team had interacted with 3,163 unique people. - The team responded to 1,579 calls for service and referrals. - One thousand one hundred and six (1,106) interactions involved team-initiated

outreach or non-crisis follow-up care by the team (“follow-up care” is defined as either subsequent phone calls or in-person visits).

2 Some people had more than one interaction with the team; each interaction, regardless of whether it involved a unique or a repeated contact with the same person, is included in this total.



• One hundred and eighty-seven (187) interactions resulted in a traditional law enforcement response. - Ninety-eight (98) arrests were for previous warrants. - Eighty-nine (89) arrests were for an offense on-scene. - Arrests accounted for fewer than 3.7% of total interactions.

• Over thirteen hundred (1,381) interactions resulted in overall linkages with care, allowing diversion from jail and emergency rooms in many cases, including the following highlights: - One hundred and seventy-six (176) people were taken to an outpatient clinic. - One hundred and fifty-eight (158) people were immediately connected to housing

resources.3 - Fifty-eight (58) people were linked to ACT. - Six (6) people were linked to ADAPT Mobile Crisis Services. - Seven hundred and four (704) people were provided with other resources and

referrals. - Two hundred and eighty-four (284) people were transported to a medical hospital

by an ambulance. - One hundred and three (103) people were taken to a psychiatric facility by RIGHT

Care or a family member. - Hospitalizations only accounted for 5.67% of total interactions.4

• Over seventeen hundred (1,731) interactions resulted in diversions, including:5, 6 - Eleven hundred and nineteen (1,119) diversions to outpatient care or home-based

treatment rather than inpatient treatment, which would have occurred without the RIGHT Care intervention.

- Six hundred and twelve (612) jail diversions for people with behavior that constituted low-level criminal behavior, such as trespass or disorderly conduct; these people were linked to treatment rather than arrested.

Far too often, people with complex mental health needs become entangled in the criminal justice system and are at high risk of repeatedly cycling through jail and emergency departments instead of receiving effective treatment. This pattern contributes to increases in recidivism rates, impeded recovery, destroyed lives, and added burdens to the community

3 Housing resources include a person’s own home or a family member’s home. 4 Medical/surgical hospitalizations are tracked separately from Apprehensions by Peace Officer Without Warrant (APOWWs). 5 Hospital diversions are determined by Parkland’s clinical program support, whereas jail diversions are determined by DPD. 6 Interactions resulting in linkages to care are commonly diversions from the hospital or jail; because they are not mutually exclusive, a single interaction may be considered both a linkage to care and a diversion.



through misallocated resources. The data show that RIGHT Care can connect people with complex needs to appropriate care. The 911 dispatch clinicians currently serve as a resource to call center employees and assist in appropriately identifying behavioral health calls. Since implementation, these clinicians have assisted with 1,901 calls.7 Additional developments include increased oversight from the City of Dallas and improved triage efforts by RIGHT Care clinicians in the field through their use of Loopback’s real-time patient surveillance platform. In October 2019, the RIGHT Care program received the Community Health and Safety Award from the International City/County Management Association. This award recognizes “local government programs or processes that demonstrate innovation, excellence, and success in the community's safety, health, and/or wellness, including enhancement in the quality of life for the disadvantaged.”8 RIGHT Care’s success has attracted attention from across the state and country. Other communities are exploring the opportunity to adapt the program to their own needs. For example, the International Association of Chiefs of Police has invited RIGHT Care to present at its annual conference and convention in Chicago for hundreds of law enforcement executives from across the country. Intercepts 2–4: Promoting Diversion from Booking Through Reentry

Intercept 2 focuses on a defendant’s arrest and initial detention in jail. This intercept also includes initial court hearings while a defendant awaits trial. Intercept 3 targets the provision of behavioral health services in the jail to restore a person’s mental health, prevent the exacerbation of symptoms, and facilitate a successful transition back into the community. At Intercept 4, jail programs work closely with behavioral health providers to ensure a well-planned and effective “hand-off” from detention and jail-based treatment to community-based treatment and, when needed or required, community supervision. Early in the project, the DCCJD met several key Caruth Project goals:

• It implemented a risk assessment screening – using a widely recognized, reliable, and valid tool – to facilitate data-driven jail diversion and behavioral health treatment program referrals.

7 Dates of implementation are April 2, 2018, through September 22, 2019. 8 International City/County Management Association. (n.d.). Program excellence awards. Retrieved from https://icma.org/meet-2019-award-winners#program



• It developed and implemented comprehensive plans to comply with existing state statutes that require people with mental illness to be considered for jail diversion programming.

• It developed pretrial supervision capacity for people currently released from jail so that court personnel can monitor compliance with release conditions related to treatment.

DCCJD staff have developed internal data tracking tools to monitor program activities and performance outcomes. These tracking tools are undergoing continuous quality improvement to better reflect the measurement needs of the project. Each month, DCCJD provides us with Caruth Project data to help identify improvements in screening and moving people with mental health needs through pretrial and into treatment, when appropriate. Although we have been collecting data since April 17, 2017, we would like to highlight program activity and performance data we have collected since January 2019, which is shown below:

• There were 12,651 inmates who were identified as having a mental health record. • There were 1,720 inmates who were initially identified as eligible for a mental health

bond after DCCJD staff applied statutory exclusions that disqualify people from access to a bond.

• There were 476 cases that were presented to a magistrate after the jail applied other exclusions (e.g., queries of national databases for convictions and a lack of readily available housing).

• Judges granted bond in 399 cases, denied bond in 74 cases, and made no bond determination in three cases. This represents a very high rate of judges accepting recommendations from jail staff, which is encouraging given that these are outcomes from new processes.9

DCCJD staff are using the Ohio Risk Assessment System Pretrial Assessment Tool (ORAS-PAT) for people being considered for personal bond release under the newly developed Smart Justice processes. One outcome of the Caruth Project is that Dallas district and county criminal court judges have agreed on which nonviolent offenses are appropriate for release to community treatment. All people who were booked into the jail with these offenses were screened and assessed for release (screening included completion of the ORAS-PAT). For people who are being considered for release and qualify for Level of Care 4 services (which include ACT and FACT) as defined by the state of Texas, the results of the ORAS-PAT determine placement into ACT (low to moderate risk levels) or FACT (high risk levels). From January 2018 through the most recent report from the DCCJD, a subset of 134 Caruth Project clients have been referred from the jail. This subset of people was screened with the ORAS-PAT tool to assess for criminogenic risk and then referred to one of the four Caruth-supported ACT or FACT providers.

9 Program activity and performance data reflect the time period of January 1, 2019, to September 30, 2019.



Intercept 5. Community Corrections and Services

We have identified four community treatment providers that are able to provide the most appropriate services for Caruth Project service expansion: Metrocare (two ACT teams), IPS (one FACT team), Transicare (one FACT team), and the Child & Family Guidance Center (one ACT team). This list reflects five total ACT and FACT teams as our designated treatment providers we use for Caruth Project referrals. Currently, Dr. Amanda Mathias, Senior Director of Innovation with MMHPI, is planning fidelity reviews of the four original ACT and FACT units. These reviews offer an opportunity to create a benchmark to help providers transform the behavioral health system in Dallas County beyond the Caruth Project’s efforts and into a system that fully embraces evidence-based and best practices. The most recently established FACT team developed by IPS completed its full baseline review in March 2019 and has received the final report and scoring. We will soon be contacting teams to schedule a brief assessment to gauge their progress in implementing the recommendations provided in their baseline assessments. NTBHA has supported expansion of ACT and FACT services through Senate Bill 292 and general revenue funds. From August 1, 2018, to June 30, 2019, 266 new clients were enrolled in ACT and FACT services. Data from the Loopback system shows that emergency department dwell times 90 days after enrollment decreased by 38% compared to dwell times 90 days prior to enrollment. For the same comparison period (90 days post enrollment versus 90 days pre enrollment), inpatient days were reduced by 94%. We are conducting a rigorous randomized control trial (funded by the Laura and John Arnold Foundation) to continue our evaluation of the outcomes of the Caruth Project implementation. Through this randomized control trial, we are analyzing the impact of the new ACT and FACT teams on “super-utilization” of services (the condition in which people with complex needs are trapped in cycles of high utilization of restrictive and expensive services) and overall costs. These efforts have extended our collaboration with Parkland as it has become an additional referral source for the Caruth-supported teams. Leadership at the Parkland Emergency Department, who added an extended observation unit in partnership with NTBHA, have collaborated with NTBHA Care Coordinators, who were placed at Parkland in fall 2018, to identify and refer emergency department patients who were flagged by Loopback as potential ACT and FACT clients. Our first referrals took place in February 2019. As we continue to work closely with NTBHA and Parkland to expand the number of people referred to treatment, while simultaneously meeting the stringent Arnold Foundation study criteria, we expect to improve and streamline our processes.



Real-Time Information Systems: Loopback Analytics Partnership Across All Five Intercepts

We have contracted with Loopback Analytics (Loopback) to create a real-time patient surveillance/tracking system that integrates data from primary systems that are involved with the Caruth Project. The Dallas-Fort Worth Hospital Council Foundation (DFWHCF) and NTBHA have been key partners in developing and implementing the Loopback data system. DFWHCF convened hospital leadership, gained their support for the project, and facilitated data transfers. DFWHCF also convenes the ongoing governance meetings of partners as well as the utilization management reviews to improve the system and associated processes. NTBHA was an early adopter of Loopback and its involvement has been essential to encouraging the various hospital systems in Dallas County to join Loopback’s system. With the combination of real-time and historical data feeds from Texas Health Resources (THR), Parkland, Methodist Health System, Baylor Scott & White Health, the Dallas County Jail, and NTBHA, Loopback developed a series of analytic dashboards that enable the Caruth Project to more precisely identify and target people who meet established state criteria for ACT or FACT services. In addition to the state’s definition of Level of Care 4 criteria, which qualifies a person for ACT or FACT services, the dashboard allows the program to identify potential candidates for ACT and FACT services based on a detailed analysis of utilization patterns, diagnoses, criminal justice history, and social determinants of health. The objective of this process is to assign candidates to the most appropriate treatment level. The real-time live feed from THR, Parkland, Methodist Health System, and Baylor Scott & White Health (BSW) is being augmented with two years of historical patient data made available through a contract with the Dallas-Fort Worth Hospital Council. This hospital data set, mental health encounter data from NTBHA, and jail admission/release data from Dallas County formed the basis for the electronic staff notifications that were deployed at THR and Parkland emergency departments in April 2018. The list of hospitals receiving electronic notifications of any kind that identify clients who enter their emergency departments has expanded and now includes the following locations:

• Parkland, • THR – Dallas, • THR – Hurst-Euless-Bedford, • THR – Plano, • THR – Arlington, • Methodist Dallas, • Methodist Charlton, • BSW – Irving, and • Baylor University Medical Center.



With THR, Parkland, Methodist Health System, Baylor Scott & White Health, Dallas County, and NTBHA data feeds fully integrated into the platform, Loopback created electronic data feeds to participating emergency departments for nearly 236,000 encounters from June 2019 through September 2019, resulting in nearly 9,000 notifications related to the Smart Justice target population. This identification and linkage to transitional services helps to reduce the need for more restrictive and expensive levels of care. People who are currently enrolled in ACT and FACT are a priority population, and NTBHA works with providers to respond quickly when one of its clients presents in an emergency department. NTBHA also uses notifications to activate transitional services and to rapidly develop a community release plan. On June 17, 2019, Metrocare began receiving notifications from Loopback that further support rapid release of clients from emergency departments to community-based services. All six of Metrocare’s ACT and FACT teams, including two Caruth teams, receive these notifications when one of its clients enters an emergency department within the Loopback platform. Metrocare can then act more quickly in helping its clients re-engage with its services and transport them to an appropriate step-down program (or step up to an inpatient facility or crisis respite facility if that is most appropriate). Our analysis of the shared data feeds indicates that this type of information sharing may be valuable and sustainable beyond our Caruth Project efforts. Loopback has the ability to demonstrate how near-real-time health information can depict patterns that can help the crisis system identify where there are gaps in the continuum of care, how multiple medication prescriptions contribute to clients being trapped in cycles of frequent utilization of different emergency departments, and how contact with an ACT or FACT team and/or a community provider can significantly reduce a person’s number of emergency department visits. Additionally, the Loopback platform often has the ability to integrate with a large hospital system’s electronic health record (EHR), increasing the fluidity of notifications received and reacted upon by hospital staff; in September 2019, Parkland successfully launched the integration between its EHR (EPIC) and the Loopback platform. The data sharing platform has the capability to predict trends in the Dallas Metroplex’s crisis system. This platform can serve as a model of how local crisis and treatment providers may collaborate in real-time to create a more responsive system of care. We look forward to further developing this analytic capacity in the future.


Dallas County Behavioral Health Housing Work Group Dallas County Administration, 411 Elm Street, 1st Floor, Dallas Texas 75202

October 23rd, 2019 Minutes

Mission Statement: The Dallas County BH Housing Work Group, with diverse representation, will formulate recommendations on the creation of housing and housing related support services designed to safely divert members of

special populations in crisis away from frequent utilization of expensive and sometimes unnecessary inpatient stays, emergency department visits and incarceration.

Success will be measured in placement of consumers in housing and the decreased utilization of higher levels of care

(hospitals and emergency care visits) and reduced incarceration in the Dallas County Jail. The Dallas County BH Housing Work Group is committed to a data driven decision-making process with a focus on data supported outcomes.

ATTENDEES: Dr. Theresa Daniel, Commissioner; Josh Cogan, Outlast Youth; Doug Denton, Homeward Bound; Edd Eason, The Cottages; Carl Falconer, MDHA; Jennifer Jaynes, The Cottages; Tzeggabrhan Kidane, Dallas County; Ellen Magnis, Family Gateway; Sara Mahsi, Salvation Army; Eric McCarty, NTBHA; Ann Margolin, City of Dallas; Janie Metzinger; NTBHA, Charlene Randolph, DCCJ; Ron Stretcher, MMHPI; Wyndll Robertson, Dallas County; Justin Vander, Prism Health North Texas; Joyce White, Dallas County; Erin Moore, Dallas County CALL TO ORDER: Minutes approved with no changes. GOVERNANCE Dallas Area Partnership to End and Prevent Homelessness: Dr. Theresa Daniel, Commissioner Commissioner Daniel reported a Partnership meeting is planned for November 18th at Catholic Charities. Dallas County Citizen Committee: Dr. Theresa Daniel, Commissioner Commissioner Daniel mentioned the committee is moving forward and continuing to collect information to be packaged into a comprehensive directory of resources. IT is working on storage space for said data. Federal and State Legislative Update: Josh Cogan, Outlast Youth Mr. Cogan reported that the HUD Equal Access Rule will be up for vote next Wednesday in the House. He added that his name and Blake Fetterman’s were contacted for possible testimony. The vote will be live on C-SPAN. PRESENTATION Grant Opportunity Discussion: Ron Stretcher, MMHPI Mr. Stretcher spoke on the Substance Abuse and Mental Health Services Administration Grants for the Benefit of Homeless Individuals (GBHI). There are 13 awards nationally for up to $400,000/yr. The purpose of this program is to support the development and/or expansion of local community infrastructure that integrates behavioral health treatment and services for substance use disorders (SUD) and co-occurring mental and substance use disorders (COD), permanent housing, and other critical services for individuals (including youth) and families experiencing homelessness. DEVELOPMENT ACTIVITIES Crisis Residential and Respite Services: Edd Eason, City Square Mr. Edd Eason reported a CitySquare project that will focus on homeless age 55 and older and 100-150 units will be moving forward, though it will not be ready until late 2020 or early 2021. Ms. Ellen Magnis reported there were 20 families currently in hotels. Ms. Magnis announced Family Gateway’s second location is open, co-located with Catholic Charities. Call Center, Assessment Team, Housing Team, Admin Team and other staff will be housed in this location. Families are now coming and being assessed to move to family shelters. The center has allowed them to open up five additional shelter rooms and 20 beds. All shelters are currently full and they are paying for 15 families at Dallas Life.


Ms. Magnis also reported that after notices of pre-awards were issued, the City of Dallas canceled Emergency Solutions Grants (ESG) funding ($200,000 Family Gateway/$268,000 Salvation Army) for rapid rehousing/shelter due to a lack of new bidders. RESOURCES Shelter Discussions: Josh Cogan, Outlast Youth Mr. Cogan spoke on a meeting of the Homeless Commission Short-term Solution sub-committee. They wanted to further define weather/temperature parameters for inclement weather shelters. Additionally, the group came to a consensus that above all else, the permitting process needs to be as accessible as possible, especially for faith-based organizations. Commissioner Daniel added that other cities have come to agreements with faith-based organizations to put together inclement weather plans without zoning changes. Doug Denton mentioned examples of Memorandums of Agreement in which organizations put together inclement weather plans and the cities support the plans at no cost to themselves. Commissioner Daniel proposed doing something similar in conjunction with the City of Dallas. North Texas Behavioral Health Authority (NTBHA): Eric McCarty; NTBHA Housing Department Mr. McCarty restated the need for property owners in Addison, DeSoto, Richardson and Rowlett to step forward. These cities would be ideal for individuals whose support systems are based in Dallas County. The current waiting list is at 164 individuals. Housing Navigator: Joyce White, Dallas County Crisis Services Ms. White reported St. Jude had one person move out, one person move in and one is slated for eviction. There is a new referral waiting for an opening. She went on to add that on Friday, October 25th, Dallas County would be having an orientation for internal jail staff to prepare for the shuttle project between jail and community. FUSE Grant: Edd Eason, CitySquare Mr. Edd Eason reported United Way was making GAP funding available for at least one year. All FUSE partners will reconvene Wednesday, October 30th to discuss the funding ($293,000) for years two and three. In its current state, the funding would provide for seven Housing Navigators embedded in the jail, Parkland, CitySquare Outreach teams and Homeward Bound. PROJECTS AND INDUSTRY UPDATES CAS Coordinated Access System (CAS): Carl Falconer, MDHA Mr. Falconer reported that 19 persons were added to the Housing Priority List (HPL) and 74 were removed (mostly cleanup of inactives), and 2 people were housed in the past month. Homeless Jail Dashboard: Joyce White, DCCJ Ms. White highlighted the change in how the information is now being presented due to work done by Mr. Bob Costello. Total book-ins average length of stay (LOS) for the month of August is 41 days, homeless book-ins LOS is 23 days. For the month of September those numbers are 34 and 15, respectively. Ms. White explained the reason the average length of stay for homeless individuals was lower is because they commit fewer serious offenses on average. Homeward Bound: Doug Denton, Homeward Bound Mr. Denton reported that Homeward Bound was working with Meadows Mental Health Policy Institute and District Attorney Creuzot to create a Deflection (drop-off) Center. The purpose of the center would be to deflect homeless individuals and individuals with mental health or substance abuse issues away from jails.


The Cottages: Edd Eason, The Cottages Mr. Eason reported 46 units are available with 44 of those currently occupied. Two evictions are scheduled for November with six on the eviction prevention schedules. As of the end of November, Metrocare will no longer be onsite. However, discussions have been had with IPS about coming in as a mental health provider. Mr. Eason also spoke about The Cottages move to a mixed status model with roughly 25% chronic homeless in need of mental health/substance abuse services, 25% high criminal justice involvement, etc. Youth Housing: Josh Cogan, Outlast Youth Mr. Cogan made note of the Youth Homeless Address which will take place on November 19th. The law governing the ID Fee for Unaccompanied and Homeless minors under 18, went into effect September 1st. Additionally, school districts can no longer use Out-of-School suspension as a disciplinary measure for homeless students.

Next Meeting: December 11, 2019 (9:30 AM)

Dallas County Administration Building, 411 Elm Street, 1st Floor, Allen Clemson Courtroom


Last Refresh: 10/31/19 at 9:22:03 AM GMT-05:00DY8 CSP Monthly Report_No Graphs(with LCN)CSP TotalCrisis

ProjectServices

Total Encounters by Type: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 2019-08 2019-09 Average: Sum:

Triage 338 285 318 333 336 365 416 406 370 420 390 374 362.58 4,351

Care Coordination 2,117 2,199 2,000 1,835 1,685 1,752 2,276 2,293 1,801 2,195 1,895 1,659 1,975.58 23,707

F2F Encounter 262 244 248 299 287 242 298 320 300 322 309 298 285.75 3,429

Sum: 2,717 2,728 2,566 2,467 2,308 2,359 2,990 3,019 2,471 2,937 2,594 2,331 2,623.92 31,487

Total Unique CID: 589 433 364 343 334 334 343 381 385 328 372 337 316 355.83 4,270

Total Unique SID: 433 364 343 333 333 343 379 384 328 372 336 315 355.25 4,263

% Change to DY 4 by CID73.51% 61.80% 58.23% 56.71% 56.71% 58.23% 64.69% 65.37% 55.69% 63.16% 57.22% 53.65%

PastYearAvg 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 2019-08 2019-09 Average: Sum:

Total Service Episodes: 768 338 285 318 333 336 365 416 406 370 420 390 374 362.58 4,351

F2F Encounter 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 2019-08 2019-09 Average: Sum:

MHPR Bond 155 128 164 178 157 141 172 179 168 204 178 158 165.17 1,982

Non-MHPR 107 116 84 121 130 101 126 141 132 118 131 140 120.58 1,447

Sum: 262 244 248 299 287 242 298 320 300 322 309 298 285.75 3,429

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DY8 CSP Monthly Report_No Graphs(with LCN)Frank Crowley

Last Refresh: 10/31/19 at 9:22:03 AM GMT-05:00

CrisisServicesProject

2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 2019-08 2019-09 Average: Sum:

Service Episodes: 338 285 318 333 336 365 416 406 370 420 390 374 362.58 4,351

Unique Consumers: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 2019-08 2019-09 Average: Sum:

By N* ID 158 153 144 112 137 134 133 149 117 127 99 101 130.33 1,564

By LCN 151 119 111 118 86 101 124 97 105 128 104 99 111.92 1,343

By Client ID 124 92 88 104 111 108 124 139 106 117 134 116 113.58 1,363

TOTAL Unique Consumers: 433 364 343 334 334 343 381 385 328 372 337 316 355.83 4,270

TOTAL Unique Consumers as %:128.11% 127.72% 107.86% 100.30% 99.40% 93.97% 91.59% 94.83% 88.65% 88.57% 86.41% 84.49%

Unique F2F: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 2019-08 2019-09 Average: Sum:

By N* ID 115 99 93 86 111 70 79 97 93 87 79 77 90.5 1,086

By LCN 107 85 69 90 66 58 84 63 74 89 71 79 77.92 935

By Client ID 87 84 69 88 83 79 99 120 84 81 95 93 88.5 1,062

TOTAL Unique F2F: 309 268 231 264 260 207 262 280 251 257 245 249 237.15 3,083

TOTAL Unique F2F as %: 117.94% 109.84% 93.15% 88.29% 90.59% 85.54% 87.92% 87.50% 83.67% 79.81% 79.29% 83.56%

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Encounters by Type: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 2019-08 2019-09 Average: Sum:

Triage 338 285 318 333 336 365 416 406 370 420 390 374 362.58 4,351

Care Coordination 2,117 2,199 2,000 1,835 1,685 1,752 2,276 2,293 1,801 2,195 1,895 1,659 1,975.58 23,707

F2F Encounter 262 244 248 299 287 242 298 320 300 322 309 298 285.75 3,429

TOTAL Encounters: 2,717 2,728 2,566 2,467 2,308 2,359 2,990 3,019 2,471 2,937 2,594 2,331 2,623.92 31,487

Female: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 2019-08 2019-09 Average: Sum:

Black 45 38 40 41 41 43 31 57 69 55 56 55 47.58 571

White 38 28 34 23 23 34 48 29 14 36 28 23 29.83 358

Hispanic 9 10 7 9 14 14 12 10 11 6 6 14 10.17 122

Other 1 2 1 1.33 4

Unknown 5 11 1 5 1 1 2 1 3.38 27

TOTAL Female: 97 88 84 78 79 92 91 97 94 97 92 93 90.17 1,082

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Age of Triage Encounters: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 2019-08 2019-09 Average: Sum:

Adult 423 354 340 332 328 340 379 375 323 368 330 311 350.25 4,203

Minor 9 10 2 2 5 3 2 10 4 4 7 5 5.25 63

Uncollected 1 1 1 1 1 4

TOTAL Age of Triage Encounters: 433 364 343 334 334 343 381 385 328 372 337 316 355.83 4,270

Age of F2F Encounters: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 2019-08 2019-09 Average: Sum:

Adult 305 261 230 263 257 204 260 273 248 255 241 243 253.33 3,040

Minor 4 7 1 1 3 3 2 7 3 2 4 6 3.58 43

TOTAL Age of F2F Encounters: 309 268 231 264 260 207 262 280 251 257 245 249 256.92 3,083

Male: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 2019-08 2019-09 Average: Sum:

Black 194 163 152 140 146 137 166 181 127 152 152 133 153.58 1,843

White 75 76 61 70 73 71 72 63 53 72 64 59 67.42 809

Hispanic 40 30 40 34 34 36 46 37 48 45 28 29 37.25 447

Other 2 1 7 3 4 5 2 5 1 1 3.1 31

Unknown 25 5 6 5 2 2 2 2 4 5.89 53

TOTAL Male: 336 275 259 256 255 249 290 288 234 274 245 222 265.25 3,183

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F2F Recidivism Summary for 01/01/2019 to 09/30/2019

QPI_DY8 Multi-version Recidivism - New


Triage 12 w/F2F 1,846

Recidivism 12-12 w/F2F 464

Recidivism 12-12 w/F2F Percentage 25.14%

Month Name January February March April May June July August September

Year MO 2019/01 2019/02 2019/03 2019/04 2019/05 2019/06 2019/07 2019/08 2019/09

Triage w/F2F:

Triage 12 w/F2F 216 421 600 828 1,048 1,239 1,455 1,666 1,846

Recidivism 12-12 5 23 61 101 166 218 305 389 464

Recidivism 12-12% 2.31% 5.46% 10.17% 12.20% 15.84% 17.59% 20.96% 23.35% 25.14%

PAP:

Count of PAP 308 614 839 1,106 1,387 1,673 1,935 2,200 2,489

PAP Recidivism 8 27 69 109 161 212 282 369 439

PAP Recidivism% 2.60% 4.40% 8.22% 9.86% 11.61% 12.67% 14.57% 16.77% 17.64%

Total:

Count of F2F & PAP 524 1,035 1,439 1,934 2,435 2,912 3,390 3,866 4,335

Recidivism F2F& PAP 13 50 130 210 327 430 587 758 903

Recidivism% 2.48% 4.83% 9.03% 10.86% 13.43% 14.77% 17.32% 19.61% 20.83%

Bookins 12 w/PAP 2,489

Recidivism 12-12 w/PAP 439

Recidivism 12-12 w/PAP Percentage 17.64%

Total F2F and PAP 4,335

Recidivistic Individuals 903

Recidivism Percentage 20.83%


ForensicDiversionUnit(FDU)ReportJan‐19 Feb‐19 Mar‐19 Apr‐19 May‐19 Jun‐19 Jul‐19 Aug‐19 Sep‐19 Oct‐19 Nov‐19 Dec‐19

BeginningCensus: 28 20 24 24 17 18 17 24 31NumberofReferralsReceivedfromCSP:

Adapt 0 4 4 2 3 3 14 13 14Metrocare 1 1 0 0 1 0 0 0 0

DistrictAttorney'sOffice 0 0 0 1 0 0 0 0 0PublicDefender'sOffice 4 3 6 2 2 1 0 0 1

Numbernotaccepteddueto:QualifiedforanotherLOC 0 0 3 0 1 1 1 1 0DidnotmeetLOCrequired 1 1 1 1 1 0 1 1 2

Other 0 0 1 0 0 1 3 1 1

NumberofAdmissions: 4 4 4 0 3 2 1 7 5

ServiceUtilization:TotalFacetoFace 137.4 135.2 209.7 193 153 140.82 120.92 121.83 131.17

TotalEngagement/ServiceCoordination 16.58 25.83 34.83 34.52 29.4 27.92 30.33 26.16 18.27

NumberofHigherLevelofCareEpisodes:EmergencyRoom(medical) 1 4 3 2 0 0 0 0 323‐hourobservation(psych) 0 2 0 1 0 1 2 3 2

Inpatient(med/psych) 0 1 0 0 0 0 2 2 2JailBook‐in 0 3 1 2 3 2 2 2 3

NumberDischarged: 10 3 5 11 2 3 2 3 11ReasonsforDischarge:

Graduate 1 0 0 1 1 1 0 0 0ClientDisengagement 7 1 2 3 0 1 0 2 5

ExtendedJailStay(case‐bycasebasis) 2 1 0 6 1 0 2 1 6Other 0 1 3 1 0 1 0 0 0

EndofMonthStats:#ofClientswaitingtobeReleasedfromJail 4 4 3 3 1 1 8 12 12

#ofActiveFDUClients 18 20 21 14 18 16 16 19 20Total 22 24 24 17 19 17 24 31 32

MaximumCensus 33 33 25 25 25 25 25 25 25 25 25


2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 2019-08 2019-09 TOTALBeginning Census 117 121 114 98 102 109 118 128 127 133 132 119

Referrals 19 21 6 29 29 32 47 38 28 42 31 25 347

AdmissionsReferred Admitted 7 0 0 0 11 8 13 17 13 8 7 3 87

No Admit Client Refusal 1 0 0 0 0 0 2 1 1 2 1 0 8No Admit Criteria 1 0 0 0 0 0 1 0 0 0 2 0 4

No Admit Structural 0 0 0 1 0 0 5 1 0 3 3 3 16Pending 10 21 6 28 18 24 26 19 14 29 18 19 232

Prior PendingPending Admitted 20 9 4 6 3 10 10 5 8 10 3 3 91

No Admit Client Refusal 1 1 0 0 1 1 1 3 1 1 0 0 10No Admit Criteria 1 0 0 0 1 0 0 0 1 0 6 0 9

No Admit Structural 7 2 13 12 5 6 13 15 13 14 9 6 115

Total Admissions 27 9 4 6 14 18 23 22 21 18 10 6 178

DischargesSuccess Transfer 5 4 3 1 1 0 3 5 2 4 8 4 40

DC Midterm Disengage 4 7 12 3 5 6 4 8 4 10 7 7 77DC Rapid Disengage 6 3 2 0 0 0 2 3 4 3 2 2 27

DC Structural 8 2 3 0 1 3 4 7 5 2 6 1 42Total Discharged 23 16 20 2 7 9 13 23 15 19 23 14 184

Active End Of Month 121 114 98 102 109 118 128 127 133 132 119 111

Outcome DataTerrell State Hospital Linkages

≤7 Connect To Prescriber 4 9 7 10 3 3 7 6 5 5 4 2 65Missed ≤7 Day Connect 3 1 0 0 1 2 0 2 0 2 0 0 11

≤30 Connect To Prescriber 6 9 7 10 3 3 7 6 5 5 4 2 67Missed ≤30 Day Connect 1 1 0 0 1 2 0 2 0 2 0 0 9

Total Missed Metric 1 1 0 0 1 2 0 2 0 2 0 0 9Total Released 7 9 7 10 4 5 7 8 5 7 4 2 75

Transicare Reporting Crisis Services Project


2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 2019-08 2019-09 TOTALCummulative ≤7 Connect % 57.1% 81.3% 87.0% 90.9% 89.2% 85.7% 87.8% 86.0% 87.1% 85.5% 86.3% 86.7% 86.7%

Cummulative ≤30 Connect % 85.7% 93.8% 95.7% 97.0% 94.6% 90.5% 91.8% 89.5% 90.3% 88.4% 89.0% 89.3% 89.3%Missed Metric 14.3% 12.5% 8.7% 6.1% 8.1% 11.9% 10.2% 12.3% 11.3% 13.0% 12.3% 12.0% 12.0%

Unduplicated ServedMonthly Unduplicated 141 95 83 108 103 127 125 118 133 117 117 88

DSRIP YTD Unduplicated Served 142 146 148 173 195 225 248 298 323 336 357 369

Encounter DataF2F Encounter 757 698 554 768 725 744 775 620 526 517 495 451 7630

Care Coord 44 19 31 40 42 47 54 31 22 11 16 11 368Total 801 717 585 808 767 791 829 651 548 528 511 462 7998


2017

2018

2019

Metric Criteria Ju

ly

Au

g

Sep

t

Oct

No

v

Dec

Jan

Feb

Mar

Ap

ril

May

Jun

e

July

Au

g

Sep

t

Oct

No

v

Dec

Jan

Feb

Mar

Ap

ril

May

Jun

e

July

Au

g

Sep

t

Oct

NotesCitySquare/Property

ManagementBeginning Census 45 44 40 44 45 46 44 44 42 43 40 41 44 47 46 45 38 38 40 39 39 36 37 40 42 43 41 42Evictions 3 2 0 0 1 1 1 0 1 0 0 0 0 2 3 5 1 3 1 0 4 1 0 0 1 1 1 0Terminations 0 2 0 0 2 1 2 3 2 2 0 0 0 0 0 2 0 0 0 0 0 0 1 2 2 2 0 0Exit to Permanency 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0Move-ins 2 0 4 1 3 0 3 1 5 0 2 3 3 1 2 0 1 5 0 0 1 3 4 2 4 1 2 1Ending Census 44 40 44 45 46 44 44 42 43 40 41 44 47 46 45 38 38 40 39 39 36 37 40 42 43 41 42 43New screenings for waitlist 4 16 11 13 11 5 6 9 11 9 5 5 5 24 37 25 3 0 0 24 43 41 0 5 2 4 5 3DHA Inspections 2 0 9 1 0 1 0 4 9 0 3 3 3 1 2 1 0 5 0 0 1 3 3 4 2 1 2 3Total residents housed since

opening 52 52 56 57 60 60 63 64 69 69 71 74 77 78 80 80 81 86 86 86 87 90 93 99 100 101 103 104 1

Residents in Cottages for less

than 90 days 2 2 7 6 7 4 6 3 9 6 5 5 8 8 6 3 3 6 6 6 1 4 8 9 16 16 7 4Residents in Cottages 91-180

days 14 8 5 7 8 10 12 15 12 14 14 16 15 14 14 19 16 16 16 16 16 16 12 12 10 7 21 22Residents in Cottages 181 days

or more 36 42 44 44 45 43 42 45 47 29 52 53 54 57 60 60 63 64 64 64 70 70 84 79 74 74 75 78CitySquare/Case Residents receiving case

management services 33 38 43 42 37 39 40 38 37 32 34 27 33 38 35 38 37 37 37 39 35 34 39 39 43 43 42 41Residents served by Community

Nurse 11 11 6 8 4 9 9 10 9 9 13 7 7 3 4 7 8 7 5 5 0 0 4 4 2 3 4 12Residents served by CitySquare

Clinic 5 6 7 6 6 6 8 8 7 6 8 7 7 0 5 3 3 2 4 4 3 5 4 4 2 5 8 0Residents attending Lifeskills

Groups 10 5 4 16 0 0 0 21 5 9 0 18 12 7 13 21 0 0 0 5 14 2 0 7 11 0 0 0Residents attending Community

Groups 27 29 36 25 28 27 21 24 37 33 24 30 35 33 26 28 27 17 0 29 21 24 12 4 29 33 31 22Metrocare ServicesEncounter BreakdownPsychosocial Rehab Individual

Sessions 74 138 148 208 183 177 179 130 165 219 132 158 151 127 120 152 116 118 147 141 141 123 135 120 139 136 125 137CBT sessions 0 18 16 7 27 40 44 19 8 11 11 - - - - - - - - - - - - - - - - -Psychosocial Group Sessions

(clinical groups only) 25 6 15 9 26 16 24 25 20 46 33 32 23 15 13 17 10 6 9 5 4 0 0 0 0 0 0 0Appointments made with

prescriber 39 41 37 44 21 34 40 40 27 72 80 93 82 81 92 58 95 25 64 61 43 15 19 31 36 30 19 31Appointments attended 21 27 27 29 16 23 30 29 20 61 74 76 69 64 79 44 82 21 58 57 33 11 19 20 24 21 13 23Residents that were prescribed

medication 19 23 19 26 17 18 27 19 21 24 25 30 28 29 26 21 23 20 23 25 18 11 18 17 19 19 13 23Incident Reports by Medical 2 3 4 2 5 4 2 1 6 1 3 2 4 2 6 0 1 0 3 4 3 2 0 1 1 0 0 0Psychiatric 1 0 1 0 1 3 1 1 9 0 0 0 3 4 1 0 0 0 2 2 2 1 3 1 2 0 0 0Residents Accessing Higher

Number of residents involved in

EMS transports - - - - - - - 0 6 1 1 0 3 2 3 0 0 0 2 1 1 0 2 3 1 0 0 0Emergency Room visits (Baylor

and Parkland)/Does not include

ER admit's 38 43 20 30 15 29 7 6 12 5 7 5 14 11 13 3 5 3 8 6 5 9 3 9 5 7 9 0

Psychiatric (inpatient and 23

hour obs) 5 2 1 3 3 11 3 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 3 0 0 0 0 0

Jail Book-In (number of Cottage

residents arrested and stayed in

jail during the month) 6 5 5 4 4 2 0 2 3 2 1 4 3 3 5 4 1 0 0 0 1 2 3 0 0 1 1 0SUD Treatment Centers 2 1 4 1 1 1 0 0 1 2 0 0 0 0 0 0 1 1 0 0 0 2 0 0 0 0 0 0

The Cottages: Monthly Metrics Summary


April- December 2019

Metrocare Services at the Cottages Metric Criteria April May June July August Sept October Nov Dec Notes

Beginning Cottages Census 36 37 40 42 43 41 42

Ending Cottages Census 37 40 42 43 41 42 43

Treatment Compliance

Metrocare Assigned Individuals 29 29 31 33 35 34 34 Total number of Individuals who are assigned to services through Metrocare.

Metrocare Engaged Individuals 18 16 17 16 15 15 14 Total number of Individuals who agreed to 6 hours of services per month and have signed contracts.

Non-Engaged Metrocare Individuals 13 13 14 17 20 19 20 Total number of Individuals who have not agreed to the engagement contract.

Percentage of Metrocare assigned individuals who met Engagement Agreement 50% 88% 82% 88% 93% 80% 86% 12 of the 14 individuals received an average of 6 hours of service for the month of October.

Percentage of Non-Engaged Metrocare Assigned Individuals with weekly

outreach: Applicable for Metrocare clients who have been residing at the

Cottages for 1-59 days 100% 50% 50% 100% 66% 100% 67% There are 3 individuals who fit these parameters, 2 received weekly outreach.

Percentage of Non- Engaged Metrocare Assigned Individuals with bi-weekly

outreach: Applicable for Metrocare clients who have been residing at the

Cottages for 60 plus days. 70% 81% 66% 79% 94% 93% 100% There are 17 individuals who fit these parameters, all received outreach bi-weekly.

Psychiatric Crisis Services

Psychiatric Crisis Services for actively engaged Metrocare Individuals for the

month. 1 2 0 0 0 0 0 There were no Psychiatric Crisis Services in the month of October.

Percentage of engaged Individuals who did not obtain Crisis Services for the

month. 95% 88% 100% 100% 100% 100% 100% There were no Psychiatric Crisis Services in the month of October for the 14 engaged individuals.

Metrocare Services at the Cottages Metrics


Oct Nov Dec Jan Feb Mar April May June July Aug SeptFY2020

Total

FY2019

Total

4 4 25

14 14 8

5 5 11

13 13 7

7 7 27

0 0 3

AIM 4 0 STAR 1

ATLAS 0 IIP 0 Veterans 0

Competency 1 Legacy Family 0 4-C 8DDC 0 MHJD/SET 1

DIVERT 3 STAC 3

DWI Misd/Felony

Specialty Courts

Number of Referrals by

FY2020 SAMHSA Grant Project

Unsuccessful Completions

REFERRING SPECIALTY COURTS FY2020

Department of Criminal Justice

RESIDENTIAL TREATMENT DISCHARGES

Successful Completions

Nexus New Admissions

Nexus Average Days in Jail from Referral to Admission

Homeward Bound New Admissions

Homeward Bound Average Days in Jail from Referral to Admission


MONTH

BEGINNING #

OF PENDING

CASES

+NEW CASES

RECEIVED

THIS MONTH

=TOTAL

CASESTBJ TBC PLEAS REV GRADUATES

PROBATIO

N

MODIFICAT

IONS

DISMISS

ALSOTHERS

TOTAL

DISPOSI

TIONS

ENDING

#

PENDING

CASES **

CURREN

T ATLAS

PARTICIP

ANTS

CURRENT

PARTICIPA

NTS IN

CUSTODY

FORMER

ATLAS

PARTICIPA

NTS

BOND

October 19 11 30 0 0 0 1 0 0 0 0 1 29 12 0 0 0

HARRY INGRAM

MONTH

BEGINNING

# OF

PENDING

CASES

Rediverts

+NEW

CASES

RECEIVED

THIS

MONTH

=TOTAL

CASESTBJ TBC PLEAS DISMISSAL OTHER

TOTAL

DISPO

SITION

S

ENDING

#

PENDIN

G

CASES

**

CURRE

NT

PARTIC

IPANTS

NUMBE

R OF

GRADU

ATES

BOND***

October 17 0 4 21 0 0 0 1 0 1 20 14 1 14

MONTH

BEGINNING #

OF PENDING

CASES

+NEW CASES

RECEIVED

THIS MONTH

=TOTAL

CASESTBJ TBC PLEAS REV GRADUATES

PROBATIO

N

MODIFICAT

IONS

DISMISS

ALSOTHERS

TOTAL

DISPOSI

TIONS

ENDING

#

PENDING

CASES **

CURREN

T

PARTICIP

ANTS

CURRENT

PARTICIPA

NTS IN

CUSTODY

FORMER

PARTICIPA

NTS

BOND

October 89 7 96 0 0 0 0 0 0 0 1 1 95 36 7 0 29

FY2019 MHPD STATS

BEGINNING

# OF

PENDING

CASES

+NEW

CASES

RECEIVED

THIS

MONTH

=TOTAL

CASESTRIALS PLEAS

COND.

DISM.

REVO-

CATIONDISMISSALS

INCOMPET

ENT

REFER

RALS

OTHER

COUNSE

L APPT.

TOTAL

CLOSED

R. Lenox 257 39 296 0 5 0 0 3 1 0 5 14

L. Strather 237 36 273 0 3 0 2 2 5 0 0 12

October

MONTHBEGINNING

# OF CASES

NEW CASES

THIS

MONTH

TBJ TBC

Alt.

Trial

Dispos.

PLEA

S

REVO-

CATION

S

DISMISSALSPROBATI

ON

COMP.

HRG.

EXTENS

IONS

CIVIL

COMMI

T.

MHMR

REFERR

AL

CONSU

LTSOTHER

ENDING #

OF

PEOPLE

IN OCR

M. Harden 151 19 0 0 0 0 1 5 0 10 3 0 0 0 1 11

R. Scott 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1

RANDALL SCOTT

MONTHBEGINNING

# OF CASES

NEW CASES

THIS

MONTH

TBJ TBC

Alt.

Trial

Dispos.

PLEA

S

REVO-

CATION

S

DISMISSALSPROBATI

ON

COMP.

HRG.

EXTENS

IONS

CIVIL

COMMI

T.

MHMR

REFERR

AL

CONSU

LTSOTHER

ENDING #

OF

PEOPLE

IN OCR

October 164 49 0 0 0 1 0 29 0 30 0 1 0 0 0 17

MONTH

TOTAL NEW

CASES

RECEIVED

NEW

CLIENTS AT

TERRELL

NEW

CLIENTS

AT GREEN

OAKS

NEW

CLIENTS

AT

MEDICAL

CENTER

MCKINNE

Y

NEW

CLIENT

S AT

PARKL

AND

NEW

CLIEN

TS AT

DALL

AS

BEHA

VIORA

L

HEALT

H

NEW

CLIENT

S AT

GARLA

ND

BEHAVI

ORAL

NEW

CLIENTS AT

ZALE

LIPSHY

NEW

CLIENTS

AT

SUNDANC

E

BEHAVIOR

AL

HEALTHCA

RE

NEW

CLIENT

S AT

HICKOR

Y

TRAILS

NEW

CLIENTS

AT

METHODI

ST

RICHARD

SON

NEW

CLIENT

S AT

DALLAS

PRESBY

TERIAN

NEW

CLIENTS

AT VA

NEW

CLIENT

S AT

WELLB

RIDGE

NEW

CLIENTS

AT

TIMBERL

AWN

NEW

CLIENTS

AT GLEN

OAKS

NEW

CLIENT

S AT

TEXOM

A

NEW

CLIENTS

AT

HAVEN

PROBAB

LE

CAUSE

HEARING

S HELD

NO

CONTEST

COMMIT

CONTESTE

D COMMIT

FORCED

MEDS

HEARING

IN COURT

L. Roberts 135 19 0 38 0 0 69 0 0 0 0 0 0 0 0 9 0 0 5 2 10 16

C. Cox 167 0 0 0 148 0 0 12 0 0 0 7 0 0 0 0 0 0 6 0 17 14

K. Nelson 84 0 0 0 0 37 0 0 0 36 0 0 11 0 0 0 0 0 3 0 4 4

R. Black 132 0 103 0 0 0 0 0 0 0 18 0 0 11 0 0 0 0 8 3 0 3

DAN ECKSTEIN MHPR BOND STATS

MONTH

TOTAL

HEARING

S (# of

clients)

Total #

of

Cases

Total #

of

Felony

Cases

# of

Felonie

s

Approv

ed

# of

Felonies

Denied

Total #

of Misd.

Cases

# of

Misd's

Approved

# of

Misd's

Denied

October 43 61 34 32 2 27 25 2

HARRY INGRAM FY2019 S.E.T. STATISTICS 291st

HARRY INGRAM FY2019 ATLAS STATISTICS 203/HAWTHORNE

FY2019 MISDEMEANOR DIVERT MENTAL HEALTH COURT STATS CCCAP1/WADE

FY2019 FELONY COMPETENCY STATISTICS

FY2019 MISDEMEANOR COMPETENCY STATISTICS

October MI Court

1247 152 40 3

October

INITIAL ELIGIBILITY DAILY

LIST (MH FLAGS)

MHPR BOND

APPOINTMENTS

FROM DAILY LIST (MH

FLAGS MINUS THOSE

SCREENED-OUT)

MHPR BOND

HEARING-

BOND

GRANTED (# of

clients)

MHPR BOND

HEARING-BOND

DENIED (# of

clients)


dallas county behavioral health leadership team thursday ......presentation dr. joseph guillory,...

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