2018-98-Minutes for Meeting January 24,2018 Recorded 3/21/2018Recorded in Deschutes County CJ2018-98
Nancy Blankenship, County Clerk
Commissioners' Journal 03/21/2018 2:45:25 PM
'rg# � �'1 IIIIIIIIII�IIIIIIIIIIII O III
2018-98
For Recording Stamp Only
Deschutes County Board of Commissioners
1300 NW Wall St., Bend, OR 97703-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
MINUTES OF WORK SESSION
DESCHUTES COUNTY BOARD OF COMMISSIONERS
Allen Conference Room
Wednesday, January 24, 2018
Present were Commissioners Anthony DeBone and Tammy Baney. Commissioner Phil
Henderson was absent. Also present were Tom Anderson, County Administrator; Erik Kropp,
Deputy County Administrator; David Doyle, County Counsel; and Sharon Ross, Board Executive
Assistant.
CALL TO ORDER: Chair DeBone opened the meeting at 1:30 p.m.
ACTION ITEMS
1. Habitat for Humanity - Scott Rohrer
Mr. Rohrer reported that Habitat for Humanity builds single family homes in Central Oregon. He
explained the typical family pays 70% of their income for housing and families are not in good
shape with income levels. Rents are high in the area and affordable homes are hard to find for
families. Habitat for Humanity provides classes to prepare for owning a home and for caring for
family. In a recent study it was found that within 3 months of living in a home 63% of children
in Habitat families have improved grades in school. Mr. Rohrer also noted the revenue from the
Re -Store covers 100% of administrative costs associated with helping families into homes. The
largest challenge here is Bend is land.
Minutes of Board of Commissioners' Work Session January 24, 2018 Page 1 of 3
2. Stepping Up Initiative
Community Justice Director Ken Hales, Health Services Director George Conway, Sheriff's Office
Captains McMaster and Shults presented and explained that this is a program recognized by
Association of Oregon Counties and National Association of Counties. This concept has been
presented at the Local Public Safety Coordinating Council (LPSCC) and a recommended that the
Board approve a Resolution of support. Goal of the initiative is to reduce jail population of
people with serious mental or behavioral health illnesses. Commissioner Baney noted the link
of LPSCC for data collection and would look to the Board for consideration of support.
Commissioner DeBone commented on positives of the program and wondered if there would be
additional staffing required. Commissioner Baney suggested we also look to the future of caring
for and educating our youth as well. Roger Olson of NAMI was also present and suggested
finding volunteers to help shepherd some of these areas. Commissioner DeBone asked for
business review on the program including reporting requirements. Captain Shults commented
on the need to assess what we already have in place and what items could be collected through
the development of the program. Commissioner DeBone suggested identification of the
goals of the program during the assessment. This item will come back to a business meeting
for consideration of a Resolution. County Administrator Anderson distributed several versions
of Resolutions for the team to consider of the best fit for Deschutes County. An update will be
made at the February 6th LPSCC meeting.
3. Electronic Monitoring Services Review Recommendations
Deevy Holcomb, Trevor Stephens, and Ken Hales of Community Justice Department presented
the item for discussion. The department would like to bring in electronic monitoring services to
help control costs and the increasing demand on staff. Current monitoring programs were
reviewed. The current monitoring contract expires June 30, 2018 and requires a request for
proposal to renew or award. A review committee was formed in the fall and has made
recommendations for program changes. The review committee was comprised of
representatives from the court, district attorney's office, and jail supports department. One
recommendation is for the court ordered monitoring to be contracted out of the department
removing excess workload. Ms. Holcomb reviewed the current program for court ordered
monitoring. The current monitoring equipment is leased from the vendor.
4. Branding Project Update
Public Information Officer Whitney Hale reported on the project scope and goals for marketing
materials to provide consistency and standardization within the County. A work group was
formed with staff from several County departments to provide feedback. An update was
provided to the Board for consideration. Current formats were shown as examples. New
formats of education materials, letterhead, and business cards were presented sticking with a
logo that is very comparable to the current logo. Ms. Hale will be working with departments to
Minutes of Board of Commissioners' Work Session January 24, 2018 Page 2 of 3
move forward with new marketing material templates. The Board expressed support. Ms. Hale
will review the new templates with Commissioner Henderson.
OTHER ITEMS: None were offered
ADJOURN: Being no further discussion, the meeting adjourned at 2:50 p.m.
DATED this Day of (� ��{ A _ 2018 for the Deschutes County Board of
Commissioners.
r
EST:
�Iytwc
Weecord4Secretary
Anthony DeBone, Chair
f
Philip G. HenAerson, Vice Chair
Tammy Baney, Commis 'oner
Minutes of Board of Commissioners' Work Session January 24, 2018 Page 3 of 3
Deschutes County Board of Commissioners
1300 NW Wall St, Bend, OR 97703
(541) 388-6570 — Fax (541) 385-3202 — https://www.deschutes.org/
WORK SESSION AGENDA
DESCHUTES COUNTY BOARD OF COMMISSIONERS
1:30 PM, WEDNESDAY, JANUARY 24, 2018
Allen Conference Room - Deschutes Services Building, 2ND Floor — 1300 NW Wall Street — Bend
Pursuant to ORS 192.640, this agenda includes a list of the principal subjects anticipated to be addressed at the
meeting. This notice does not limit the ability of the Board to address additional subjects. Meetings are subject to
cancellation without notice. This meeting is open to the public and interested citizens are invited to attend.
Work Sessions allow the Board to discuss items in a less formal setting. Citizen comment is not allowed,
although it may be permitted at the Board's discretion. If allowed, citizen comments regarding matters that are or
have been the subject of a public hearing process will NOT be included in the official record of that hearing. Work
Sessions are not normally video or audio recorded, but written minutes are taken for the record.
CALL TO ORDER
ACTION ITEMS
1. Habitat for Humanity Presentation - Scott Rohrer, Executive Director
2. Stepping Up Initiative - Ken Hales, Community Justice Director
3. Electronic Monitoring Services Review Recommendations - Deevy Holcomb, Senior
Administrative Manager
4. Update on Branding Project - Whitney Hale, Public Information Officer
EXECUTIVE SESSION
Executive Session under ORS 192.660 (2) (e) Real Property Negotiations
At any time during the meeting, an executive session could be called to address issues relating to ORS
192.660(2)(e), real property negotiations; ORS 192.660(2)(h), litigation; ORS 192.660(2)(d), labor
negotiations; ORS 192.660(2)(b), personnel issues; or other executive session categories.
Executive sessions are closed to the public, however, with few exceptions and under specific
guidelines, are open to the media.
Board of Commissioners Work Session Agenda Wednesday, January 24, 2018 Page 1 of 2
OTHER ITEMS
These can be any items not included on the agenda that the Commissioners wish to discuss as part of
the meeting, pursuant to ORS 192.640.
"-10 100101►]
Deschutes County encourages persons with disabilities to participate in all programs and
activities. To request this information in an alternate format please call (541) 617-4747.
FUTURE MEETINGS:
Additional meeting dates available at www.deschutes.org/meetingcalendar
(Please note: Meeting dates and times are subject to change. All meetings take place in the Board of
Commissioners' meeting rooms at 9300 NW Wall St., Bend, unless otherwise indicated. If you have questions
regarding a meeting, please call 388-6572.)
Board of Commissioners Work Session Agenda Wednesday, January 24, 2018 Page 2 of 2
Deschutes County Board of Commissioners
1300 NW Wall St, Bend, OR 97703
(541) 388-6570 — Fax (541) 385-3202 — https://www.deschutes.org/
AGENDA REQUEST & STAFF REPORT
For Board of Commissioners Work Session of January 24, 2018
DATE: January 19, 2018
FROM: Ken Hales, Juvenile Community Justice, 541-317-3115
TITLE OF AGENDA ITEM:
Stepping Up Initiative
RECOMMENDATION & ACTION REQUESTED:
The Public Safety Coordinating Council recommends Board discussion to sign Stepping Up
Initiative Resolution.
ATTENDANCE: Ken Hales, Community Justice Director; Dr. George Conway, Health
Services Director; Captain McMaster and Captain Shults, Sheriff's Office.
SUMMARY: An estimated 2 million people with serious mental illnesses - almost three-
quarters of whom also have substance use disorders - are booked in local jails each year.
Federal and state policy and funding barriers, along with limited opportunities for law
enforcement training and arrest alternatives in many communities, have made county and
other local jails the de facto mental health hospitals for people who cannot access appropriate
community-based mental health treatment and services. Counties recognize the need for
systems -level change to help them better link people to treatment and services while improving
public safety in fiscally responsible and effective ways. The publication Reducing the Number
of People with Mental Illnesses in Jail: Six Questions County Leaders Need to Ask, which was
released January 2017, provides a planning framework for counties to address these
challenges and help reduce the number of people with mental illnesses who continue to cycle
through the criminal justice system.
Recognizing the critical role local and state officials play in supporting systems change, the
National Association of Counties (NACo), the American Psychiatric Association Foundation
and The Council of State Governments Justice Center launched the Stepping Up initiative in
May 2015. Stepping Up is a national movement to provide counties with the tools they need to
develop cross -systems, data -driven strategies that can lead to measurable reductions in the
number of people with mental illnesses and co-occurring disorders in jails.
More than 360 counties have passed a resolution or proclamation to participate in the initiative.
TRE
U A
National Initiative
Reduce the Number of People
P with Mental Illnesses in Jails
An estimated 2 million people with serious mental illnesses—almost three-quarters of whom also have substance use disor-
ders—are booked into local jails each year. Federal and state policy and funding barriers, along with limited opportunities
for law enforcement training and arrest alternatives in many communities, have made county and other local jails the de
facto mental health hospitals for people who cannot access appropriate community-based mental health treatment and
services. Counties recognize the need for systems -level change to help them better link people to treatment and services
white improving public safety in fiscally responsible and effective ways. The publication Reducing the Number of People with
Mental Illnesses in Jails Six Questions County Leaders Need to Ask, which was released January 2017, provides a planning
framework for counties to address these challenges and help reduce the number of people with mental illnesses who continue
to cycle through the criminal justice system.
Recognizing the critical role local and state officials play in supporting systems change, the National Association of Counties
(NACo), the American Psychiatric Association Foundation and The Council of State Governments Justice Center launched the
Stepping Up initiative in May 2015, Stepping Up is a national movement to provide counties with the tools they need to develop
cross -systems, data -driven strategies that can lead to measurable reductions in the number of people with mental illnesses
and co-occurring disorders in jails.
More than 360 counties have passed a
resolution or proclamation to partici-
pate in the initiative. With support from
public and private entities, the initiative
builds on the many innovative and proven
practices being implemented across the
country. Stepping Up engages a diverse
group of organizations with expertise
on these issues, including those repre-
senting sheriffs, jail administrators, judges,
community corrections professionals,
treatment providers, people with mental
illnesses and their families, mental health
and substance use program directors and
other stakeholders.
The initiative supports counties in devel-
oping and adopting a cross -systems
action plan through strategies such as:
COUNTY RESOLUTIONS RECEIVED AS OF MAY 1, 2017
3
0 States with county resolutions Counties with resolutions No resolutions
• Providing a small number of counties with intensive technical assistance that includes onsite work to help use the plan-
ning framework, implement evidence -based practices and demonstrate strategies that result in measurable change
• Providing counties with broad-based technical assistance for applying the planning framework through webinars, network
calls and other information -sharing opportunities
• Assisting states that support counties' efforts to implement the Stepping Up framework statewide; and
• Promoting federal policies that support counties' efforts to reduce the prevalence of people with mental illnesses in jails.
Reducing the Number of People with Mental Illnesses in Jail: Six Questions County Leaders Need to Ask (Six Questions)
represents foundational thinking of the Stepping Up initiative that encourages counties to assess their existing efforts to reduce
the number of people with mental illnesses in jail by considering the following questions:
Is our leadership committed?
Do we conduct timely screening and assessments?
Do we have baseline data?
Do we conduct a comprehensive process analysis and inventory of services?
Have we prioritized policy, practice and funding improvements?
Do we track progress?
Stepping Up urges county leaders to review current practices and to adopt policies, programs and practices that are informed
by their impact on the following measures:
Reducing the number of people with
mental illnesses booked into jail
Increasing connections to treatment
1>.
Reducing the length of time spent in jail
Reducing recidivism
The Stepping Up partners have developed an online toolkit with a wealth of resources that are continuously updated to provide
the latest information on research and best practices to counties. Resources are all publicly available on the Stepping Up
website and include:
Monthly webinars and networking calls
Educational workshops at NACo and partner
conferences
A project coordinator handbook
Guidance on measuring the number of people
with mental illnesses in jail
Quarterly calls of smaller networking groups Written and online tools that are
of rural, mid-size and large/urban counties companions to the Six Questions report that
that have passed Stepping Up resolutions " present the latest research and case studies
for county officials
,t`r f/' 1 11111111 11111111 11�11 F l'
3`
'The Stepping Up partners would like to thank the following agencies and organizations for their generous support of Stepping Up: the U S Department of Justice's Bureau of Justice Assistance. the Jacob and Valeria
Langeloth Foundation, the John 1) and Cather inc C MacArthw foundation, The Margaret Clark Morgan Foundation, the California Stale Sheriffs' Association. the Pennsylvania Department of Corrections, the Pennsylvania
Department of Human Services, the Pennsylvania Commission on Crime and Delinquency, Alkermes plc, Janssen: Pharmaceutical Companies of Johnson b Johnson, the Elizabeth K Dollard Charitable Trust and Otsuka
America Pharmaceutical This pioject was supported by Grant No 2012-CZ-Bx-1(071 awarded by the Bureau of Justice Assistance The Bureau of Justice Assistance is a component of the Depa) hnent of Justice's Office
of Justice Programs, which also includes the Bureau or Justice Statistics, the National Instituteof,lustice, the Office of Juvenile Justice and Delinquency Prevention, the Office forVictims of Crime, and the SMARI Office
Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S Department of Justice
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Reducing the Number of People
with Mental Illnesses in Jail
Six Questions County Leaders Need to Ask
Rise Haneberg, Dr. Tony Fabelo, Dr. Fred Osher, and Michael Thompson
Introduction
Notlong ago the observation that the Los Angeles County Jail serves more people with mental illnesses than any single mental
health facility in the United States elicited gasps among elected officials. Today, most county leaders are quickto point out
that the large number of people with mental illnesses in theirjails is nothing short of a public health crisis, and doing something
about itis atop priority.
Over the past decade, police, judges, corrections administrators, public defenders, prosecutors, community-based service providers, and
advocates have mobilized tobetterrespond to peoplewith mental illnesses. Mostlarge urban counties, and many smaller counties, have
created specialized police response programs, established programs to divert people with mental illnesses charged with low-level crimes
from thejusticesystem, launched specialized courtsto meetthe uniqueneeds of defendants with mental illnesses, and embedded mental
health professionals in thejail to improvethe likelihood thatpeoplewith mental illnesses are connected to community-based services.
Despite these tremendous efforts, the problem persists. By some measures, it is more acute today than it was ten years ago, as
counties report a greater number of people with mental illnesses in locaijails than ever before.' Why?
After reviewing a growing body of research aboutthe characteristics of people with mental illnesses who are in contact with local
criminal justice systems; analyzing millions of individual arrest, jail, and behavioral health records in a cross-section of counties
acrossthe United States; examining initiatives designed to improve outcomes forthis population; and meeting with countless people
who work in localjustice and behavioral health systems, as well as people with mental illnesses and their families, the authors of
this brief offer four reasons why efforts to date have not had the impactcounties are desperate to see:
There are insufficient data to identify the target population and to inform efforts to develop a system -wide
response. New initiatives are frequently designed and launched after considerable discussion butwithout sufficient local data. Data
that establish a baseline in a jurisdiction—such as the number of people with mental illnesses currently booked into jail and their
length of stay once incarcerated, their connection to treatment, and their rate of rearrest—inform a plan's design and maximize
its impact. Furthermore, eligibility criteria are frequently established fordiversion programs without the data that would show how
manypeople actually meetthese criteria. As a result, county leaders su bsequentlyfind themselves disappointed bythe impactoftheir
initiative. Counties that recognize the importance of using this data to plan their effort often find the data they need do not exist. It
is rare to find a countythat effectively and systematically collects information aboutthe mental health and substance use treatment
needs of each person booked intothejail, and records this information so it can be analyzed at a system level.
Program design and implementation is not evidence based. Research that Is emerging on the subject of people with
mental illnesses in the justice system demonstrates that it is notjust a person's untreated mental illness but also co-occurring
substance use disorders and criminogenic risk factors that contribute to his or her involvement in thejusticesystem. Programs that
treat only a person's mental illness and/or substance use disorder but do not address otherfactors that contribute to the likelihood of
a person reoffending are unlikely to have much of an impact. Further, intensive supervision and limited treatment resources
are often not targeted to the people who will benefit most from them, and community-based behavioral health care providers are
rarely familiar with (or skilled in delivering) the approaches that need to be integrated into their treatment models to reduce the
likelihood of someone reoffending.
THE
I N I T I A T I V E
The initiative is small in scale. Due to scarce resources, diversion programs or improvements to reentry planning are
frequently launched as pilots, rarely taken to scale, and as a result unable to serve many of the people who would be eligible for
them. And community-based treatment and other supports are frequently stretched so thin that they are only able to reach a small
fraction of the people who need them.
The impact of the initiative is not tracked. County leaders making a significant investment in community-based services
and supervision for people with mental illnesses should know what im pact that investment has had on these four key measures:
reducing the number of people with mental illnesses booked into jail, reducing the length of time people
with mental illnesses remain in jail, increasing connections to treatment, and reducing recidivism. But few
counties have benchmarked these numbers, and capacity to collect and analyze data is so limited that manycounty leadersare
unabletogetdata on how many people received treatmentand otherservices orhow many people completed a program. Without
outcome data, however, itis hard forthe people who administer programs and services to focus on cleartargets. Similarly, it is hard
forcounty leadersto hold program administrators accountable fordesired results.
What Does "Mental Illness" Mean?
The term "mental illness" is defined by The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, as "a
syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior
that reflects dysfunction in the psychological, biological, or developmental processes underlying mental functioning."'
For the purposes of the Stepping Up initiative, "people with mental illnesses" should be understood also to encompass people
with co-occurring substance usedisorders, aswell as"serious mental illness"(SMI) or"seriousand persistent mental illness"
(SPMI), which are defined as a mental, behavioral, or emotional disorder that is diagnosable within the past year, is chronic
or long lasting, and results in a significant impairment in social, occupational, or other important areas of functioning.' Some
states use SMI and SPMI interchangeably, while others differentiate between SMI and SPMI based on the severity of the
associated functional impairment.
Some states specify the diagnoses that they accept as qualifying for an SMI, including schizophrenia, schizoaffective disorder,
bipolar disorder, and severe forms of major depression and anxiety.
The Six Questions Counties Need to Ask
Despite these challenges, manycountieshavemadesignificant strides toward reducingthe number of people with mentalillnesses
in theirjails. Other counties are just starting their efforts or may be unsure of efforts already underway in various parts of their
systems. To assess their community's existing effortstoreducethenumberofpeoplewith mental illnesses injail, county leaders
should ask themselves the following questions:
1. Is our leadership committed?
2. Dowe conduct timely screening and assessments?
3. Do we have baseline data?
4. Havewe conducted a comprehensive process analysis and inventory of services?
5. Have we prioritized policy,practice, and funding improvements?
6. Do we track progress?
Leaders in counties acrossthe U.S. who scan these q uestionswill readily respond affirmatively. Indeed, there are many counties
that can provide excellentexam ples of what successfully addressing one ormore of these questions looks like. Butfew counties have
taken the steps necessary to satisfy all the above questions. Doing soishard—extraordinarily hard. These issues are complex.
Resources are limited. And a host of independently elected officials and a tangled web of private and not-for-profit service providers
must set aside their own agendas and collaborate extensively.
To be clear, this brief does not assume that the number of people with mental illnesses in jail can be reduced ott#when counties have
addressed all of these questions. But county leaders will find that thoughtful consideration of each of these six questions will help
them determine to what extent their efforts will have a system -level impact, not only resulting in fewer people with mental illnesses in
jail, but doing so in away that increases publicsafety, applies resources most effectively, and puts more people on a path to recovery.
1. Is Our Leadership Committed?
Are county policymakers—such as commissioners, supervisors, or managers—and key leaders from the criminaljustice and
behavioral health fields fully invested in the goal of reducing the number of people with mental illnesses in jail?
Reducing the numberof adultswith mental illnesses in jails requires cross -systems, collaborative approach involving a county -wide
committee or planning team. Strong leadership, including the active involvement of people responsible forthe county budget, is essential
to rally agenciesreporting to a variety of independently elected officials. The designation of a person to coordinate the planning team's
meetings and activities and to manage behind -the -scenes details pushes the project forward and ensures that the work gets done.
tI Mandate from leaders responsible for the county budget: The elected body representing the county (e.g.,
county commissioners) has established a clear mandate in the form of a resolution or other formal commitment for
behavioral health and criminaljusticesystem administratorsto implement systems -level reforms necessary to reduce the
number of people with mental illnesses in jail.'
rt Representative planning team: The planning team comprises key leaders from thejustice system, such as the
sheriff orjail administrator,judges, prosecutors, defense bar, law enforcement executives, and community supervision
officials; key leaders from the behavioral health system, such as the directorofinental health services, other community-
based behavioral health care providers, such as substance use treatment providers, and health care financing experts;
representatives from the community, including organizations representing people with mental illnesses and theirfamilies
(e.g., National Alliance on Mental Illness [NAM 1]); and representatives from county government, such as commissioners
ora county manager, and representatives of municipal government, such as the mayor or police chief. The planning team
might be part of an existing criminal justice coordinating council or task force.
Commitment to vision, mission, and guiding principles: The planning team is clear on the mandate, and is
committed to making the necessary agency -level changes. Formal agreements, such as memorandums of understanding
(MOUs), are in place to effectuate team function and document the initiative's vision, mission, and guiding principles, as
well as to formalizethe expectation thattop decision makers will be in attendance for planning meetings.
Designated planning team chairperson: The chairperson is a county elected official or other senior -level
policymakerwho is in routine contactwith leaders responsible fordeveloping the county budget and administering the law
enforcement and behavioral health systems, and who can engage the stakeholders necessary to the success of the initiative.
County leaders have charged the chairperson with holding agency administrators accountable forthe implementation ofthe
plan. These agency administrators are awarethatthe chairperson must provide routine updatesto county leaders, often in
an open forum, such as a commission meeting.
V' Designated project coordinator: The planning team has assigned a project coordinatorto work across system agencies
to manage the planning process. The project coordinator—who might also be the county's criminal justice coordinator—
facilitates meetings, builds agendas, provides meeting minutes, and organizes subcommittee work as needed. The project
coordinatoralso assists with research and data analysis, and is in constant communication with planning team members.
Reducing the Number of People with Mental Illnesses in Jail: Six Questions County Leaders Need toAsk 3
2. Do We Conduct Timely Screening and Assessments?
Is screening for mental illness and substance use conducted for everyone booked into jail, along with full, follow-up assessments,
as time allows, for people who screen positive forthese conditions? Are assessments measuring a person's risk of flight and risk
of reoffending while awaiting trial also conducted and combined with screening information to guide decision making from the
pretrial phase through final casedischarge?
Wby tmattet s
To reduce the numberof people with mental illnesses in jail, counties first need to have a clear and accurate understanding of the
prevalence of mental illnesses in theirjail populations. This requires the universal screening of every person booked intojail for
mentalillness,aswellasforotherbehavioral health needs, such assubstance use. Additionally, assessing forcriminogenic risk
(orthe likelihood that someone will commit additional offenses) further informs release decisions, such as whetherto require
supervision or services to reduce the risk of reoffending. Without this foundational information, counties are ill equipped to track
whetherthe number of people with mental illnesses in jail is actually being reduced, and if those identified with behavioral health
needsare getting connectedtothe righttypes of interventions. [See Figure 1]
What i look z fike
F System -wide definition of mental illness: The county has established a definition of mental illness that is
consistently applied throughout the local criminal justice and behavioral health systems. At the state level, a definition
of mental illness and/or serious mental illness (SMI) exists to determine eligibility for treatment and services funded by
the state. In many counties, health officials use the state's definition to guide service -de livery decisions, butthatis not
the case in every county. Healthcare providers working in the jail often use a definition of mental illness that is distinct
from what local or state health officials use. For example, a jail may screen only for suicide risk rather than screening
for mental illness based on a system -wide definition of mental illness. Judges may receive pretrial release and sentencing
recommendations concerning behavioral health needs that are not based on formal screening. Or mental health clinicians
working inside the jail may describe a person's mental health needs in terms that do not align with the state's definition of
who qualifies for publicly funded mental health services. Adopting a single definition of mental illness that is consistently
used by local behavioral health systems, as well asthejail, courts, and community corrections, ensures that all systems are
using the same measure to consistently identify the population that is the focus of the initiative's efforts.
Adoptinga Definitionof Mental Illness
When establishing its definition of mental illness, a county may decide to focus on the population with SMI, which is defined by
the state and denotes the population with the most severe impairments who are often eligible for publicly funded services. The
planning team may adopt the state's definition, or may choose another definition based more on local considerations. In any
case, the definition is one that both criminal justice and mental health professionals can understand and use with confidence.
Although this may at first seem a simple task, many planning teams struggle with this exercise. The focus needs to remain on
the practical use of the definition to determine the target population of the initiative. For example, a county may agree to use the
state's definition of SMI but describe it in more detail to include a diagnosis established through an assessment process that,
without treatment, impairs the day-to-day functioning of the individual.
Because many people are released from jail within 24 hours, screening immediately at booking for mental illness based
on the county's established definition casts thewidest net to include peoplewith mental illnesses of varying degrees of
severity, thus capturing the true prevalence of mental illness in the jail.
System -wide definition of substance use disorders: The planning team agrees on a consistent definition of
substance use disorders, a definition that may include substance use disorders that co-occurwith mental illnesses. Itis
critical to be aware ofthe presence and severity of a substance use disorder both to identify a clinical need and to address
the condition as a risk factor for reoffending.
Validated screening and assessment tools formental illness and substance use: To ensure the accurate
identification of the behavioral health needs of everyone booked intojail, the county has implemented validated screening tools
and assessment processes.' The Brief Jail Mental Health Screen and the Texas Christian University Drug Screen V (TCUDS V) are
validated mental health and substance use screening tools that are available in the publicdomain, are easy and efficientto
administer, and do not require specialized staff such as a sworn officer ora mental health professional to conduct.'
v/ Efficient screening and assessment process: The development of a screening and assessment process requires
the planning team to determine the best party to conduct the screening. In some jurisdictions, jail personnel do the
screening; in others, it is a contracted or embedded medical or behavioral healthcare provider. The logical time and
place for screening for mental illnesses and substance use disorders is at booking into the jail, and within this churning
environment, quick and efficient processing is necessary. If person screens positive fora mental illness, a full clinical
assessmentbya mental health professional is necessaryto confirm the screening result. Because an individual maybe
released from jail before the assessment can be completed, a process is in place to connect him orherto a mental health
care provider to complete the assessment process.
Validated assessment for pretrial risk: Manyjurisdictions do not screen for criminogenic risk until after a
defendant's case is adjudicated. Itis also essential, however, to conduct pretrial risk assessment to inform decisions about
a defendant's pretrial release, eligibility for pretrial diversion, and conditions of pretrial supervision. Such screenings are
conducted prior to a person's first appearance/arraignment in order to inform the court of pretrial risk of failure to appear
and risk for new criminal activity.' Mental illness in and of itself is not considered to be a risk factor, but is considered in
relation to release and case -planning decisions.'
V Mechanisms for information sharing: The planning team has developed information -sharing agreements for
agencies that protectthe individual's privacy and supportthe need to share behavioral health information. The results of
screening and assessments are used to inform key decisions related to pretrial release, diversion, discharge planning, and
specialized pretrial and post -conviction community supervision. Jurisdictions often create a flag process that serves as an
indicator of the need to connect a person to services and to gather the necessary releases to enable discussing the case. A
data match of all people booked intojail and the behavioral health system's database identifies people who have previously
received behavioral health care services and may require reestablishment of services.
Good communication is at the heart of effective collaborations between criminal justice and behavioral health systems, but
often concerns about confidentiality and privacy laws, as well as incompatible information systems, often hamper best
efforts to share information effectively. Counties need to develop the information -sharing policies and protocols necessary
to facilitate system analysis and case management, while adhering to professional codes of ethics and privacy law. Some
key considerations are:
• Identifying information: A discussion with interagency stakeholders about what information is needed to inform
decision making and case planning and how this information will be used can help address concerns about
confidentiality and build trust across agencies. Identifying the minimum necessary information to share helps keep
the flow of information manageable and also adheres to the principles underlying privacy law.
• Agreements: It's critical to understand relevant federal and state law relating to privacy and information sharing,
and to develop appropriate interagency agreements (such as MOUs) and local protocols (such as release -of -
information forms) when protected information is involved.
• Training: Ongoing staff training must be a priority when collecting, sharing, and analyzing information.
• Regular reviews: Regular reviews are necessary to identify opportunities to improve information -sharing processes
and data analyses and to ensure confidentiality and privacy requirements are being met.
Reducing the Number of People with Mental Illnesses in Jail: Six Questions County Leaders Need to Ask 6
Salt Lake County, Utah, screens for mental health, substance use, and criminogenic risk at booking for everyone charged
with a class B misdemeanor or above. This process was implemented in December 2015, and county officials are tackling
challenges such as information sharing and staffing needs, as well as coordinating with a statewide data bank. Moving
forward, an accurate assessment of prevalence will better inform Salt Lake County of the service and supervision needs of
people booked intojail, as well as provide a baseline to measure progress in reducing the number of people with mental
illnesses in theirjail.
The Criminogenic Risk and Behavioral Health Needs Framework
With mounting research that demonstrates the value of science -based tools to predict a person's likelihood of reoffending,
criminal justice practitioners are increasingly using these tools to focus limited resources on the people who are most likely
to reoffend. At the same time, mental health and substance use practitioners are trying to prioritize theirscarce treatment
resources for people with the most serious behavioral health needs. A person who screens positive for mental illness and/
or substance use should be connected to appropriate treatment at the soonest opportunity; however, when that person is
also assessed as being at a moderate to high risk of reoffending, connection to treatment is an even higher priority, along
with interventions such as supervision and cognitive behavioral therapy to reduce the risk of recidivism.
The framework depicted in Figure 1 outlines a structure for state and local agencies to consider how information about
risk of reoffending, and substance use and mental health treatment needs can be considered in combination to prioritize
interventions to have the greatest impact on recidivism.
F I(=UR 1. THE ( ESIMIN()GENIC RISK AND BEHAVIORAL HEALTH H NF.i":€ S i R!kMB t_'RK
Group
GroUp l 2 Group 3 Grow'
p p
-L ll -L 111-L 1vL.
CR: low CR: low CR: tow CRx loyu
SA: low SA: low SA: medl S,Amed/
6 B
MI: low MI: med/ high:
high Ml: low MR 601i,
3. Do We Have Baseline Data?
Has the county established baseline measures of:
• The number of people with mental illnesses booked into jail
• Their average length of stay
• The percentage of people connected to treatment
• Their recidivism rates
Wfhy Gimatters
Baseline data highlight where some of the best opportunities exist to reduce the number of people with mental illnesses in the jail,
and provide benchmarks againstwhich progress can be measured. Knowing the current number of people with mental
illnesses admitted into the jail helps county leaders determine whether new prevention and diversion strategies are resulting in
fewerjail bookings of people with mental illnesses. Calculating the average length ofstay for people who screen positive for
mental illness helps the county recognize whether people with mental illnesses are especially likely to languish in thejail. Tracking
connections to treatment illuminates to what extent there is continuity in care, post release. Without a baseline recidivism
rate, the county cannot assess whether investments in community-based supervision and treatmentare reducingtherearrestand
reincarceration ratesamongpeoplewith mental illnesses released fromjail.
#Irar if ,00 ks itks
:/ System -wide definition of recidivism:
The planning team agrees on how it is
measuring recidivism, recognizing that rearrest,
convictions for a new crime, or the return to
custody forviolating conditions of release (i.e.,
technical violations) are each important, but
distinct, ways of measuring whethera person
engages in criminal activity and/or how law
enforcement, the courts, and corrections respond
to the behavior of someone released from jail
and/orundercommunity supervision. Agreeing
on a definition of recidivism also requires using a
consistenttime period for reporting recidivism
data (e.g., one, two, and/or more years).
Electronically collected data: Data
In Practice: Adopting a Definition of
Recidivism in Bexar, Dallas, Ell Paso,
Harris, , and Tarrant Counties, Texas
The five most populous counties in Texas follow the state's standard
measure of recidivism as rearrest within one, two, and three years of
release from jail. These counties use the same recidivism definition
to measure recidivism for people diverted to community-based
supervision orother alternatives to incarceration. These counties
also frequently measure recidivism in additional ways, such as
reincarceration fora violation of condition of release, but agreeing
on a common measurement of recidivism allows for consistency,
which iscritical forthe purposes ofthiswork.
that draw on results of screening and assessments that are conducted foreach person admitted tojail are collected
electronically to support ongoing analysis. In many cases, this analysis requires access to multiple databases. Some counties
have navigated this situation by creating an integrated data management system. Others use a more "home-grown" data
warehouse system, and still others may rely on a master spreadsheet approach. The end goal isto havethe capacityto
capture and analyze key data effectively.
Y Baseline data on the general population in the jail: Data must be collected for people with and without mental
illnesses, to provide a point of comparison that can be used to determine whetherdisparities between these populations exist
in bookings, length of stay, or recidivism rates. These comparisons can be especially useful when data on both populations
are d isagg regaled further by risk level, race, orgender.
Reducing the Number of People with Mental Illnesses in Jail: Six Questions County Leaders Need toAsk 7
V, Routine reports generated by a county agency, state agency, or outside contractor: Reports containing
information about the number of people with mental illnesses in jail, length of stay in jail, connections to treatment, and
recidivism should not be a one-time deliverable. The baseline data should be generated with the understanding that this will
be a reportthatis updated at least annually, using consistent definitionsto track changes year to year.
Key Consideraflons or DeWoping an Integrated Data Systema
County officials must know the number of people booked into jail. For most counties, collecting and analyzing data, and
doing so on a regular basis, is challenging, to say the least. It is not unusual forjail admission and release data to be in
one information system maintained by the county, while arrest data may be found in a statewide database, and gathering
information about people who have received community-based health services requires the cooperation of behavioral
health care agencies. The gold standard for a system that enables a county to establish baseline data, share information,
and track progress is an integrated system that allows multiple agencies to enter as well as access the data. A single,
integrated information system also enables rich reporting that includes connections to treatment or other data related to a
person's experience after he or she returns to the community. Some jurisdictions in the country have implemented a fully
integrated system, while others have developed progressive systems that store and share date across agencies.'
It is essential for information technology (IT) staff to be involved in the planning discussion about developing an integrated
data system. For some counties the IT staff may be a stand-alone department, for others it is a single person in the Sheriff's
Office, and for others it might be a private contractor or local university research partner. The IT staff can assist the planning
team to develop a programming solution to the challenge of tracking the flow of people with mental illnesses as they move
through the criminal justice and behavioral health systems and receive treatment in the community. The system should also
provide the ability to track recidivism for this population and to identify high utilizers of justice, behavioral health, and other
social services.
InPractice: HowBaseline DataInfort fanning
When a cou my analyzesthe numberof peoplewith mental illnesses inthejail, the average length of stay injailforthis
population, rates at which they are connected to treatment, and their rearrest rates—or determines whether this information
can even be assembled—the findings help illuminate strategies that will deliver the greatest return on investments.
Jurisdiction
Metdc
Finding
Action Taken
ear
The number of people with
County does not know howmany people
BexarCounty established universal
County,
mental illnesses injail
with mental illnessesareinthejail.
screening for mental illnesses.
TeaII
--__..__._ _7
New York
Length of stay
People with mental illnesses stayed in
New York City implemented early
City,
jail 112 days on average as compared
pretrial diversion options to move
Newyork
to 61 days for those without mental
peoplewith mental illnessesout ofjail
illnesses.
inatimelyway.
Franklin
Connection to care post-
Morethanone inthree ofpeoplewho
The local Alcohol Drug And Mental
County,
release
had contact with the behavioral health
Health (ADAMH) board established
Ohio
care system in the year priortotheir
ajailliaison teamtoprovide in -reach
incarceration did not have contact with
service to get follow-up appointments
the behavioral health care system in the
within two weeks of release.
year following their release from jail.
altt,-ake
Recidivismrate
One out of three people on pretrial
Salt Lake County recommendations
County,
supervision and one out of two people
included establishing intensive
Utah
on county probation did not fulfill the
supervision caseloadsforpeoplewho
requirements of their supervision.
areassessed asbeing moderateto high
risk of reoffending and who are also
assessed as having an SMI.
4. Have We Conducted a Comprehensive Process Analysis and Inventory of
Services?
Has the planning team completed an exhaustive, end-to-end analysis ofthe system's processes from the point of law enforcement's
contactwith aperson with a mental illness through final case discharge? Does the analysis go beyond the sequential intercept
mapping exercise familiarto many counties that have reviewed what programs and services exist at arrest, booking, pretrial
detention, release, and community supervision? Are decisions and actions—as well as failures to act—that contribute to the high
prevalence of people with mental illnesses in jail flagged? Are existing services and supports in the community identified, along
with those that are missing?
Why tsr ttteii°
In every county, there is a timeline that includes the moment when a 911 call center receives a mental health call for service,
or when a person identified with having a mental illness is booked into jail, orwhen defense counsel receives the results of that
person's mental health screening–each an opportunity to improve the response to the person's mental health needs. Counties
must create policies and processes that ensure that a person's mental health needs are accurately identified and the right type of
information is shared appropriately and efficiently to inform key decisions related to diversion, pretrial release, specialized probation
supervision, and connection to community-based services.
Without completing a comprehensive process analysis, these opportunities are often not identified and thus are missed. Timely
information is notgenerated or shared appropriately, or perhaps a defense counsel,judge, or probation officer receives this
information butdoes not use itto inform their decisions. The detailed, point -by -point system review helps county leaders determine
where these breakdowns in process occurand where improvements can be made. Recognizing thatsuccessful implementation of
a plan hinges on the accessibility of community-based treatment, which typically is in limited supply (if it exists at all) in most
counties, it is im portant that an inventory of services and supports also be conducted.
kAVI t i't kooks I=tc
4 Detailedprocess analysis: The county planning team, perhaps organized into subcommittees, traces each step of a
person's involvement in the justice system, from the moment when police receive a mental health (MH) call for service to
the person's admission to jail to the person's release from jail and connection to community-based treatment, services, and
supervision. Ateach decision point, the team asks questions such as:
• What is the process associated with the decision?
• Isthe process timely and efficient?
• What information is collected at that point in the process?
• How is that information shared and with whom?
• How is that information acted upon?
Are the people involved in each decision point trained in their role?
l' Service capacity and gaps identified: The planning team identifies what options exist at each decision point,
including crisis services, diversion opportunities, and community-based treatment, services, and supervision. The team also
identifies what services are notavailable, orexist butdo notmeetcapacity needs.
Evidence -based programs and practices identified: County leaders are provided with a detailed description
ofexisting servicesand gapsin services that apply the latest research aboutwhatworksto meetthe needsofpeoplewith
mental illnesses and reduce the likelihood thattheywill commit new offense. This scan of service capacityalso reflects
historical data or best estimates related to demand for these services.
Reducing the Number of People with Mental Illnesses in Jail: Six Questions County Leaders Need to Ask 9
FIGURE UR 2. A COUNTY'S PROCESS ANALYSI4 FO DHEA RRESTIBOOKINGSTAGE
10
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5. Have We Prioritized Policy, Practice, and Funding Improvements?
Do key findings from the system analysis inform the development of action items? Are these action items realistically prioritized
by county leaders to maximize the impact of existing resources and to identify new resources to reduce the number of people with
mental illnesses in their jail?
Whyiflaiatters
County leaders should provide guidance to the planning team on how to make policy recommendations and budget requests that
are practical, concrete, and aligned with the fiscal realities and budget process of the county. Routine communication with the
people responsible forthe county budget(e.g., county commissioners and otherofficials) engagesthese leaders in the planning
team's ongoing efforts and increases the likelihood thattherecommendations will be received favorably.
Recognizing the limitations (and opportunities) that distinct funding streams present is critically important. The planning
team's budget proposal should identify external funding streams, including federal programs such as Medicaid, federal grant
opportunities, and state block grant dollars as the first source for funding. Opportunities for local philanthropic support should also
be considered. The final gaps in funding will represent new county investments.
Wfllaa't ift looks hke
Prioritized strategies: Fora county to reduce the prevalence of mental illness in jail, it must accomplish one or
more of the fol lowl ng: reduce the number ofpeople with mental illnesses admitted to jail, reduce their
length of stay, increase their connections to treatment, and reduce recidivism. Drawing on the system
analysis described earlier, the planning team determines the most achievable ways of accomplishing one or more of these
goals, with anemphasis on strategies that impact people with the most serious behavioral health needs who are also at the
highest risk of reoffending. [See Figure 1]
V Detailed description of needs: Per county leaders' guidance, the planning team submits a proposal to the county
board related to its identified priorities. If necessary, the planning team's proposal identifies the need for additional
personnel, increased capacity for mental health and substance use treatment services and support services, such as housing
and employment, and infrastructure improvements, such as information systems updates and training.All programming
requests includeevidence-based approachesthatare carefully matched to the particularneeds of the population. The
proposal addresses implementation considerations regarding staffing requests such as staff placement and supervision,
whether personnel are sworn orunsworn, whether mental health clinicians are behavioral health agency employees who are
embedded in thejail or community supervision agencies, or if outsourcing to private providers is an appropriate option.
Estimates/projections of the impact of new strategies: At a minimum, the plan projects the numberof people
to be served and explainsto whatextent new investments made will affectone ormore of the following key measures:
• Reduce the number of people with mental illnesses booked into jail
• Reduce the length of time people with mental illnesses remain in jail
• Increase connections to treatment
• Reduce recidivism
The county commission does not endorse a plan that does not set outto meet these requirements. If policies or programs are
adopted that that do not address the key measures, the county cannot expect to reduce prevalence rates. The proposed strategies
includean impact analysis that describes the numberof peopleto be served andthe estimated improvement in services.
Reducing the Number of People with Mental Illnesses in Jail: Six Questions County Leaders Need to Ask 11
Key Coorm erati ns forTirahning
Training is an ongoing process that is critical to implementing and sustaining new policies and programs. The implementation
of evidence -based practices, such as risk assessment or curriculum -based interventions, necessitate adherence totraining
requirements to ensure fidelity. If a program or practice is implemented without a plan for quality assurance that includes
training, the anticipated outcomes of the intervention will be jeopardized. A county's training plan should include a regular
check for current certifications, refresher training, and internal coaching to maintain quality and consistency. Many "off-the-
shelf' curricula include web -based training that can help a county provide necessary training on a meaningful scale.
v7 Estimates/projections account for external funding streams: The plan describes to what extent external
funding streams can be leveraged tofund new staff, treatmentand services, and one-time and ongoing costs. These external
funding sources may include:
• Federal program funding, including Medicaid, veterans'benefits, and housing assistance
• State grants for mental health and substance use treatment services
• Federal and state discretionary grants
• Local philanthropic resources
v/ Description of gaps in funding best met through county investment: Per budget process guidelines, the
planning team's proposal should include specific suggestions for how county funds can meet a particular need, or fill a gap
that no other funding source can.
In Practice: Haw
Process Analysis
Informs
Planning
Jurisdictions that have
completed an
analysis oftheir
jail population
have identified key findings and related
system -wide
responses that can
potentially help to
reduce the number
of people
with mental illnesses in theirjails.
Identified
Data
Objective
Measure
Projected Cost and
Data to be
Gap
Illustrating
Addressed
Identified Sources of
Tracked
Gap
Funding
Crisis Intervention
Number of mental
Increase level
Measure#1:
Cost: Specialized one-week
Number of mental
Team(CIT)-
health calls for
of trained CIT
the number
training of 25 officers atatime;
health calls; percent
trained officers
service that did
officers to
of people
overtime (OT) costs for the
of calls responded
are notavailable
not have CIT-
achieve 2417
with mental
officers, training materials
to by CIT -trained
toprovide24/7
trained officers
coverage
illnesses
Funding: Local lawenforcement
officers; number of
coverage
booked into
assumes the cost for OT, all other
calls disposed of
jail
costs shared by participating
withoutjail booking
agencies on pro -rated formula
Compare against
baseline data of the
number of people
booked intojailwho
arescreenedfor
mental illness
— ... ......
Specialized
Numberof
Develop
Measure #4:
Cost: Full-time probation officer
._.......
Trackthenumberof
probation
probation
specialized
recidivism
and mental health professional
probation revocations;
supervision
revocationsfor
caseload
staff; other staff -related needs,
track successful
alternatives are
this population,
that is co-
such as space and equipment
probation completion
not available for
including
supervised
Funding: Determine whether low-
rates; track recidivism
people identified
for technical
by probation
risk caseloads canbeconsolidated
ratesforpeople
withSMland
violations and
staff and a
to create capacity for specialized
assigned to special
moderate -to-
newcrimes
mental health
caseloads; identify potential grant
caseloads
high-criminogenic
professional
opportunities; determine whether
risk
Medicaid funding can be utilized for
case management
12
6. Do We Track Progress?
Is there an established process for tracking the impact of the plan on the four key outcomes (the number of people with mental
illnesses booked into jail, their length of stay in jail, connections to treatment, and recidivism)?
Once planning is completed and the prioritized strategies are implemented, tracking progress and ongoing evaluation begin.10The
planning team must remain intact and the project coordinator must continue to manage the implementation of the new strategies.
Monitoring the completion of short-term, intermediate, and long-term goals is important, as it may take years to demonstrate
measurable changesin prevalence rates. Showing evidence of more immediate accomplishments, such asthe implementation of
new procedures, policies, and evidence -based practices, contributes to the momentum and commitment necessary to ensure this
is a permanent initiative. Tracking outcome data also gives the planning team the justification necessaryto secure continuation
funding and/or additional implementation funding. Outcome data should be included in any budget requests to provide
justification for continued or additional funding.
What it looks hike
` Reporting timeline on four key measures: County leaders receive regular reports that include the data that is
tracked, as well as progress updates on process improvement and program implementation.
Process for progress reporting: The planning team continues to meet regularly to monitor progress on implementing
the plan. The project coordinator remains the designated facilitatorforthis process and continues to coordinate
subcommittees involved in the implementation ofthe policy, practice, and program changes, as well as to manage unforeseen
challenges. As it may take several yearsto demonstrate significant change in prevalence rates, itis importantto capture
incremental progress, including policy and system improvements, such as implementing screening and assessments,
establishing connectionsto treatment, and developing data tracking capacity. In addition, the planning team remains abreast
of developing research in the field and the introduction of new and/or improved evidence -based strategies forconsideration.
Ongoing evaluation of programming implementation: The evidenced -based programs adopted by the county
are implemented with fidelity to the program model to ensure the highest likelihood that these interventions will achieve the
anticipated outcomes. Afidelity checklist process ensures that all program certifications and requirements are maintained,
and that ongoing training and skills coaching for staff are provided.
Ongoing evaluation of programming impact: Particularly for curriculum -based programming and screening and risk
assessment, itis important to assess whethertheactivity isachieving whatwas intended. Many counties establish a relationship
with a local university to assistwith research and evaluation, as well as with the validation of screening and risk tools.
Reducing the Number of People with Mental Illnesses in Jail: Six Questions County Leaders Need toAsk 13
In 2008, Johnson County, Kansas, began an effort to reduce the number of people with mental illnesses in its jail with
the establishment of a Criminal Justice Advisory Council (CJAC) that, as a first project, studied how people with mental
illnesses moved through the county'sjustice system. After process mapping and data analysis was completed, the county
decided to pilot a "Co -Responder Program" to deploy a mental health professional to respond to law enforcement calls for
service involving people with mental illnesses. The program was funded through a 2010 federal Justice and Mental Health
Collaboration Program (JMHCP) grant that supported a collaborative effort among the City of Olathe (Kansas) Police
Department, the Johnson County Mental Health Center, and the Johnson County Sheriff's Office. Upon completion of the grant
in 2013, a comparison of 2010/2011 data (the year prior to the implementation of program) to 2011/2012 data showed:
• 808 contacts were made by the co -responder; 10 resulted in a jail admission
• Hospitalizations decreased from 54 percent to 17 percent
• Referrals to services increased from 1 percent to 39 percent
Over the period of the grant, repeat calls for service to the same address are estimated to have decreased 20 percent. Through
a survey, Olathe Police Department officers reported marked improvement in their ability to respond to the needs of people
with mental illnesses. It was the top priority of the Olathe Police Chief, Steven Menke, to fully fund the co -responder position,
which was approved by the Olathe City Council.
In 2013, a JMHCP Expansion Grant was awarded to expand the program to the City of Overland Park, Kansas. On completion
of the grant, a comparison of 2013/2014 data (the year prior to the implementation of the program) to 2014/2015 data showed
significant improvements:
• 1,281 contacts were made by the co -responder; 25 resulted in a jail admission
• Hospitalizations decreased from 35.1 percent to 3.1 percent
• Officer surveys showed a 59 -percent increase in officers feeling prepared to respond to calls involving people
with mental illnesses
The Overland Park City Commission approved fully funding the co -responder position upon completion of the grant. The use
of data to demonstrate the effectiveness of the Co -Responder Program proved essential to establishing continuation funding,
as well as to efforts to grow the program county wide.
14
In Practice; A County DemonstratesProgress
Below is an example of findings and the resulting responses that have taken place in Bexar County, TX.
2015,w€ ily 125ofove,rr'1 000
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Reducing the Number of People with Mental Illnesses in Jail; Six Questions County Leaders Need to Ask 15
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Reducing the Number of People with Mental Illnesses in Jail; Six Questions County Leaders Need to Ask 15
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Reducing the Number of People with Mental Illnesses in Jail; Six Questions County Leaders Need to Ask 15
Endnotes
' https//www.hrw.org/news/2006109/05/us-number-mentally-ill-prisons-quadrupled.
2 Diagiiosticand Statistiealillanual oJd-fe„talDisorrtes: DSnI-3. Washington, D.C.: American PsychiatricAssociation, 2013.
3 http://w w w.nimh.nih.gov/health/statistics /prevalence /serious-mental-illness-smi-among-us-adults.shtml.
'Resolutionsmayneed tofollowthe county's prescribed template; alternatively, seethe Stepping Uptemplate.
'Validation of a screening tool requires completing a study based on data analysis to confirm if a tool is accurately screening for the need to conduct an
additional assessment. Validation of risk and needs assessment tool requires completing a study based on data analysis to confirm if atool is predicting
forthe intended result (i.e., risk ofreoffending), based on the characteristics of the population being assessed in the jurisdiction. As populations may
changeover time, it is important to validate this tool periodically. A properly validated tool should be predictively accurate across race and gender.
'For information about the Brief Jail Mental Health Screen, see http://www,prainc.com/?product=brief-jail-mental-health-screen. For information about
the Texas University Drug Screen V, see http://ibr.tcu.edu/wp-content/uploads/2014/11/TCUDS-V-sq-v,Septl4.pdf. Stepping Up does not endorse the use
of any specific tools; the Brief Jail Mental Health Screen and the Texas Christian University Drug Screen are examples of tools that are available for use
without proprietary requirements.
' Fader-Towe, H. and Osher, Fred C. JVrovins PerponsertoPeopleivitbhleutallllnesses attliePretnalState. E sentialEleeventr. (New York: The
Council of State Governments Justice Center, 2015)
'The Council of State Governments Justice Centerand the American PsychiatricAssociation Foundation, "On the Over -Valuation of Risk for Peoplewith
Mental Illnesses." (New York, The Council of State Governments Justice Center, 2015).
e Jurisdictions considered to have fully integrated data systems include Johnson County, Kansas, Multnomah County, Oregon, and Hennepin County,
Minnesota. Jurisdictions with progressive systems include Maricopa County, Arizona, Salt Lake County, Utah, and Camden County, Utah. See Borakove,
Elaine M., Robin Wosje, Franklin Cruz, Aimee Wickman, Tim Dibble, and Carolyn Harbus. "From Siloto System: What Makesa Criminal Justice System
Operate Like a System?" MacArthur Foundation, 2015.
70Forinformationonimplementation strategies and examples, gotowww.stepupto etc�her.org/toolkit.
THE UpStepping Up: A National Initiative to Reduce the Number of People with Mental
Illnesses in Jails—which is sponsored by the National Association of Counties,
the American PsychiatricAssociation Foundation, and The Council of State
Governments Justice Center, in partnership with the U.S. Department of Justice's
N I T I A T I V E Bureau of Justice Assistance—calls on counties across the country to reduce the
prevalenceof peoplewith mental illnesses being held in countyjails.
coy gra ie_
.lus-1 ICI CI N I'ER
PSYCHIATRIC
, Oil _iIJ�J
FOUNDATION C97
This project was supported by Grant No. 2012-CZ-BX-KO71 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a
component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office
of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, the Community Capacity Development Office, and the Office
of Sex Offender Sentencing, Monitoring, Apprehending, Registering, and Tracking. Points of view or opinions in this document are those of
the author and do not necessarily represent the official position or policies of the U.S. Departmentof Justice.
To learn more about the Bureau of Justice Assistance, please visit ba. ov.
16
"Stepping Up to Reduce the Number of People with Mental Illnesses in Jails"
WHEREAS, counties routinely provide treatment services to the estimated 2 million people with serious
mental illnesses booked into jail each year;
WHEREAS, prevalence rates of serious mental illnesses in jails are three to six times higher than for the
general public;
WHEREAS, almost three-quarters of adults with serious mental illnesses in jails have co-occurring substance
use disorders;
WHEREAS, adults with mental illnesses tend to stay longer in jail and, upon release, are at a higher risk of
recidivism than people without these disorders;
WHEREAS, county jails spend two to three times more on adults with mental illnesses that require
interventions compared to those without these treatment needs;
WHEREAS, without the appropriate treatment and services, people with mental illnesses continue to cycle
through the criminal justice system, often resulting in tragic outcomes for these individuals and their families;
WHEREAS, [INSERT YOUR COUNTY'S NAME] and all counties take pride in their responsibility to
protect and enhance the health, welfare, and safety of its residents in efficient and cost-effective ways;
WHEREAS, [INSERT COUNTY -SPECIFIC INFO/DATA TO HIGHLIGHT (e.g., Bexar County has
developed its Restoration Center, which helps people stay out of jail by offering mental health and substance
use disorder treatment)]; and
WHEREAS, through Stepping Up, the National Association of Counties, The Council of State Governments
Justice Center, and the American Psychiatric Association Foundation are encouraging public, private, and
nonprofit partners to reduce the number of people with mental illnesses in jails.
NOW, THEREFORE, LET IT BE RESOLVED, THAT I, [INSERT NAME & TITLE OF CHIEF
ELECTED OFFICIAL], do hereby sign on to the Call to Action to reduce the number of people with mental
illnesses in our county jail, commit to sharing lessons learned with other counties in my state and across the
country to support a national initiative and encourage all county officials, employees, and residents to
participate in Stepping Up. We resolve to utilize the comprehensive resources available through Stepping Up
to:
• Convene or draw on a diverse team of leaders and decision makers from multiple agencies committed
to safely reducing the number of people with mental illnesses in jails;
• Collect and review prevalence numbers and assess individuals' needs to better identify adults entering
jails with mental illnesses and their recidivism risk, and use that baseline information to guide decision
making at the system, program, and case levels;
• Examine treatment and service capacity to determine which programs and services are available in the
county for people with mental illnesses and co-occurring substance use disorders, and identify state
and local policy and funding barriers to minimizing contact with the justice system and providing
treatment and supports in the community;
• Develop a plan with measurable outcomes that draws on the jail assessment and prevalence data and
the examination of available treatment and service capacity, while considering identified barriers;
• Implement research -based approaches that advance the plan; and
• Create a process to track progress using data and information systems, and to report on successes.
Deschutes County Board of Commissioners
1300 NW Wall St, Bend, OR 97703
(541) 388-6570 — Fax (541) 385-3202 — https://www.deschutes.org/
AGENDA REQUEST & STAFF REPORT
For Board of Commissioners Work Session of January 24, 2018
DATE: January 19, 2018
FROM: Deevy Holcomb, Juvenile Community Justice, 541-322-7644
TITLE OF AGENDA ITEM:
Electronic Monitoring Services Review Recommendations
RECOMMENDATION & ACTION REQUESTED:
Provide update and information on the county's Electronic Monitoring (EM) services, informing
a competitive Request For Proposals for EM services to be issued in February 2018, with an
award and new contract date of July 1, 2018.
ATTENDANCE: J. Kenneth Hales, Deevy Holcomb, Trevor Stephens
SUMMARY: Adult Parole & Probation's current electronic monitoring contract expires June
30, 2018 and requires a RFP process to renew/award for future. To prepare, the department
convened a Review Committee to review the current program and design the RFP. The
Committee, comprised of representatives from Court, District Attorney and Jail supports
department recommendations for several program changes to be implemented prior to, and as
part of any newly awarded EM contract. We seek to update BOCC as to the nature of changes
and goals for future EM services prior to issuing the RFP in February.
Deschutes County Community Justice Department
J. Kenneth Hales, Director
Memorandum
Date: January 19, 2018
To: Deschutes County Board of County Commissioners
From: J. Kenneth I-lale
Ref: Changes to the ectronie Monitoring Program in 2018
At the Board work session meeting on January 24, department staff will discuss proposed changes to
electronic monitoring services provided by the department.
Background:
The Community Justice Department's Parole & Probation division has managed the county's electronic
monitoring services for nearly two decades. The scope, nature, and volume of the services provided has
evolved as needs and technology changed. Initially electronic monitoring was used for surveillance of
high-risk offenders on department supervision. Now electronic monitoring is most frequently used for
monitoring defendants awaiting trial. With the availability of transdermal alcohol monitoring devices
electronic monitoring became widely used by the courts for persons awaiting trial for driving while under
the influence of intoxicants (DUII), and to a lesser extent to sentence DUII offenders to electronic
monitoring. The global positioning system tracking devices are favored by the deputy district attorneys
for pretrial monitoring of sex offenders. Although fewer defendants are on pretrial monitoring awaiting
trial for sex crimes, those that are tend to be on monitoring for significantly longer periods of time. Since
2012, three dozen persons awaiting trial for sex crimes have been on pretrial monitoring for more than a
year, a few as long as three years.
The utility of the devices and the lack of program controls on the number and duration of assignments to
electronic monitoring have resulted in a dramatic increase in the number served, the cost of equipment
rental, and the demand on department staff. Since 2008, the number served and the equipment costs have
increased over 500%. See attachment 1 figure 1. In 2017, an average of 115 persons were on electronic
monitoring each day at a cost of $240,000 for equipment rental alone. Total cost including personnel is
close to $475,000 annually. Fees cover approximately 33% of this cost and another 10% is covered by
funds provided by the Deschutes County Sheriff for alternative to jail incarceration. The remainder is
covered by county general funds and community corrections grant in aid.
Service Model:
Currently the department uses a transdermal alcohol monitor, a breath test alcohol monitor, and a global
positioning system tracking device. A fifth of those on electronic monitoring are under department
supervision and are assigned to monitoring by the department for surveillance or as a sanction. The
department has full control of the number and duration of offenders under department supervision
assigned to electronic monitoring.
Eighty percent of those on electronic monitoring are misdemeanors awaiting trial for DLIII, sex offenders
awaiting trial, and DLIII offenders sentenced to electronic monitoring. These persons are assigned to and
removed from electronic monitoring at the direction of the court, most often ordered by the court on a
Juvenile Community Justice 63360 NW Britta Street, Building 1 Bend, OR 97701 (541) 388-6671
Adult Parole and Probation 63360 NW Britta Street, Building 2 Bend, OR 97701 (541) 385-3246 Phone
motion of the prosecuting attorney. Heretofore, the department has not exercised any restriction to whom
it will service or for how long.
Review Committee:
Our current contract for electronic monitoring services expires June 30, 2018. Prior to issuing a request
for proposal (RFP) Business Manager Holcomb has convened a committee to assess the effectiveness and
sustainability of the current service model and to recommend the scope, nature and volume of services to
be sought through the yet to be issued RFP. Participants on the committee included representatives
designated by the Deschutes County Circuit Court Presiding Judge, the Deschutes County District
Attorney, and the Deschutes County Sheriff's Office jail captain. The committee met periodically from
September 2017 through December 2017. The committee makes the following findings and
recommendations.
Review Committee Findings:
1. The purpose for use of electronic monitoring is not uniformly understood.
2. Public safety stakeholders have different opinions on why and how to use electronic monitoring.
3. The way we use electronic monitoring is not always consistent with best practices.
4. Fee collection has not increased with increased participation.
5. Public safety stakeholders have different opinions regarding court authority to order defendants to
comply with electronic monitoring in relation to the court's authority to order the department to
provide electronic monitoring services.
Review Committee Recommendations:
1. Continue to provide the same array of electronic monitoring devices.
2. Define program purpose.
3. Establish eligibility criteria and commensurate referral procedures.
4. Establish termination criteria and commensurate procedures.
5. Apply best practices to the extent possible.
6. Increase fee collection and limit fiscal exposure to the County.
7. Clarify court authority as related to services provided.
Departmental Next Steps:
In response to the committee's findings and recommendations, the department proposes to bifurcate the
electronic monitoring program into two components; the departmental support component and the court
support component. The mission of the departmental support program is to 1) enhance public safety by
use of electronic monitoring technology for surveillance of high risk offenders under department
supervision, and 2) as warranted, use electronic monitoring as a sanction in lieu of detention for violating
conditions of supervision. The mission of the court support program is to provide electronic monitoring
1) as a noncustodial sentencing option for selected DLIII offenders, and 2) to enhance public safety by
increased surveillance of specified offenders in the community awaiting trial for domestic violence
crimes, driving while under the influence, or sex crimes.
The department will establish eligibility and termination criteria for the court support program. The
department will seek to have the court include treatment as a condition of sentence to electronic
monitoring. The department will seek to outsource delivery of electronic monitoring services for the court
support program to a contracted provider. The department will contract for services to meet the service
needs of the court while limiting financial exposure to the county. If the department is able to outsource
electronic monitoring for the court support program it proposes to assign noncertified, department
employees to monitor compliance of treatment conditions for persons sentenced to electronic monitoring.
c: Tom Anderson, County Administrator
2
EMD Meeting Notes
January 24, 2018
Figure is Percentage of intakes to electronic monitoring by type 2016
1)0/ 2%
Pre-trial
Sentence
Manction
Surveillance
Eighty percent of all persons placed on electronic monitoring are court ordered to electronic monitoring while
awaiting trial or sentenced to electronic monitoring. Twenty percent of those placed on electronic monitoring are on
department supervision and assigned to electronic monitoring by the department as a sanction or for surveillance. A
small percent placed on electronic monitoring are released from jail to electronic monitoring by authority of the
sheriff or local supervisory authority.
Figure 2 Two Electronic Monitoring Functions
• •
Department Support Surveillance & Sanction TV
• • • • • • a a
Court Support Pretrial & Sentenced mmmmmmmm
Figure 3: Cost of electronic monitoring equipment rental
$350,000
$300,000
$250,000
$200,000
$150,000
$100,000`
$50,000
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
The increase of use of electronic monitoring with renew interest in jail population management in 2008 and
corresponds with the availability of improved reliable GPS devises. The decrease in 2010 corresponds to a
reduction in work force during the recession. The increase beginning 2012 corresponds to the availability of the
transdermal alcohol monitoring devices. The decrease in cost over 2015 and 2016 was due to a newly negotiated
rate with the electronic monitoring service provider.
Juvenile Community Justice 63360 NW Britta Street, Building 1 Bend, OR 97701 (541) 388-6671
Adult Parole and Probation 63360 NW Britta Street, Building 2 Bend, OR 97701 (541) 385-3246 Phone
Deschutes County Board of Commissioners
1300 NW Wall St, Bend, OR 97703
(541) 388-6570 — Fax (541) 385-3202 — https://www.deschutes.org/
AGENDA REQUEST & STAFF REPORT
For Board of Commissioners Work Session of January 24, 2018
DATE: January 5, 2018
FROM: Whitney Hale, Administrative Services, 541-330-4640
TITLE OF AGENDA ITEM:
Update on Branding Project
ATTENDANCE: Whitney Hale
SUMMARY: Providing an update on our efforts to develop new templates for marketing
materials.