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2019-121-Minutes for Meeting February 22,2019 Recorded 4/11/2019Recorded in Deschutes County CJ2019-121 Nancy Blankenship, County Clerk Commissioners' Journal 04/11/2019 3:35:21 PM 111111 IN I I III 717r 2019-121 Do not remove this page from original document. Deschutes County Clerk Certificate Page ES BOARD OF o COMMISSIONERS 1300 NW Wall Street, Bend, Oregon (541 ) 388-6570 3y�� Y�� � ��� 2 3 2 d 3 5•. e 1 "�� FRIDAY, February 22, 2019 ALLEN CONFERENCE ROOM Present were Commissioners Phil Henderson, Patti Adair, and Anthony DeBone. Also present were Tom Anderson, County Administrator; Erik Kropp, Deputy County Administrator; David Doyle, County Counsel; and Sharon Keith, Board Executive Assistant. Several citizens and representatives of the media were in attendance. CALL TO ORDER: Chair Henderson reconvened the Work Session of February 20, 2019 and called the meeting to order at 9:00 a.m. ACTION ITEMS 1. Health Services Stabilization Center Presentation Dr. George Conway, Janice Garceau, and Holly Harris of the Health Services Department presented. Ms. Harris reviewed the history of the concept of the Crisis Stabilization Center. A sequential intercept mapping meeting of 40 community partners in health and public safety was held in May of 2018 acknowledging the stabilization center was the community's number one priority. The community was defined as 40 community partners including advocacy groups, court systems, health and public safety groups. The BOCC WORK SESSION FEBRUARY 22, 2019 PAGE 1 OF 4 information wasn't shared with the Board at the time but shared with the Local Public Safety Coordinating Council. The Board noted this would have been a beneficial piece of information that would have allowed for consideration for budgetary purposes. The Health Services staff toured approximately 10 facilities including three out of state. Ms. Harris reviewed the staff goals in reviewing the facilities. Commissioner Henderson suggested the importance of a relationship with the hospital for this service to the community. Dr. Conway stated it is a complicated issue and explained there have been conversations with St. Charles. Ms. Harris stated the hospital standards are strict in Deschutes County. The facility locations reviewed in the presentation were: Marion County, Clackamas County, Washington County, Lane County, Multnomah County, Coos Bay, Grants Pass, Snohomish County in Washington, Kansas City in Missouri, and San Francisco. Commissioner Henderson suggested visitingJackson and Klamath Counties as well. Commissioner Adair asked Health Services staff to do research of anv ePrvirP nrnvirlPrl thrni iuh the l 1nivPr-,ifv of nrPann. ...J - -- - - -- F- - - - -- -- _...--.o.. _..- -...---•--1 -- -•-o-... Deputy County Administrator Erik Kropp inquired on the Board's direction of construction process. Commissioner Henderson reiterated his direction at the Work session two days ago that he was not ready for a construction process and wanted to visit more facilities prior to that decision. Commissioner DeBone supported starting the process of the construction management process and concludes the repurposing of parole and probation and also there are other projects that would follow. Commissioner Adair feels she is also not comfortable until additional site visits could be completed and expressed the importance of the Board's responsibility of spending taxpayer money and also would like to see a partnership with our local hospital. The Board is scheduled to tour the facilities in Washington and Clackamas Counties on March 15. BOCC WORK SESSION FEBRUARY 22, 2019 PAGE 2 OF 4 2. 2019 Legislative Priorities and Positions Continued Discussion Judith Ure, Management presented the legislative bills sheet that was started on Wednesday for discussion and direction of the Board's priority and position. The Board's recommendations will be incorporated into a revised tracking sheet. Commissioner DeBone expressed support of including House Bill 2222 in the bill tracking list. Ms. Ure will draft a letter of support to the House Committee on Natural Resources in support of House Bill 2222 proposed to require the State Forestry Department to annually report to Legislative Assembly or interim committee regarding development, implementation and administration of Oregon Forestland Urban Interface Fire Protection Act. Commissioner DeBone expressed the need to address the proposed 2 amendment sanctuary ordinance presented to the Board by a Redmond resident during the Business Meeting of January 23, 2019 as a part of Citizen Input and stated there is no support of this citizen proposed ordinance as official business of Deschutes County. Commissioner Adair agrees this is not the business of the County. Commissioner Henderson stated the County did not nrnnnsP this nrrlinanrP but wnnrlers if this rliscussinn is annronriatP in this meeting format. County Counsel spoke on the preemption by state statute. Commissioner Henderson feels there should be an actual statement sent out to the public and Commissioner DeBone also supports a statement. County Counsel noted that since the press is present, this discussion may end up serving as the County's statement. 3. Future Meeting Schedule Discussion Commissioner Henderson stated his calendar is booked today and recommended moving this item for discussion at Wednesday's Work Session. BOCC WORK SESSION FEBRUARY 22, 2019 PAGE 3 OF 4 COMMISSIONER UPDATE: Commissioner DeBone reported he spoke on Discretionary Grant program at the last Project Wildfire meeting and explained the neighborhood associations have interest in the program. Commissioner Henderson commented on the participation in the community with Firewise. Commissioner Adair recommended the Firefree program should be advertised. Commissioner Adair reported on Sisters EDCO meeting and they are working on rebranding. = Being no further items to come before the Board, the meeting was adjourned at 11:57 a.m. BOCC WORK SESSION FEBRUARY 22, 2019 PAGE 4 OF 4 Deschutes County Board of Commissioners 1300 NW Wall St, Bend, OR 97703 (541) 388-6570 - www.deschutes.org WORK SESSION AGENDA DESCHUTES COUNTY BOARD OF COMMISSIONERS 9:00 AM, FRIDAY, FEBRUARY 22, 2019 Allen Conference Room - Deschutes Services Building, 2ND Floor - 1300 NW Wall Street - Bend Work Session, which are open to the public, allow the Board to gather information and give direction to staff. Public comment is not normally accepted. Written minutes are taken for the record Pursuant to ORS 192.640, this agenda includes a list of the main topics that are anticipated to be considered or discussed. This notice does not limit the Board's ability to address other topics. Meetings are subject to cancellation without notice. Item start times are estimated and subject to change without notice. rAl 1 TnnRns:Q This meeting will be the reconvening of the Work Session of February 20, 2019 ACTION ITEMS 1. Health Services Stabilization Center Presentation - Dr. George Conway 2. 2019 Legislative Priorities and Positions Continued Discussion - Judith Ure, Management Analyst 3. Future Meeting Schedule Discussion THER 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. Board of Commissioners Work Session Agenda Friday, February 22, 2019 Pagel of 2 ADJOURN 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 Meeting dates and times are subject to change. If you have question, please call (541) 388-6572. Board of Commissioners Work Session Agenda Friday, February 22, 2019 Page 2 of 2 'a1 C N .Q W L CL 4- 0 a� co CL 'a1 Site Visit Summary Presented by Deschutes County Health Services Holly Harris, Crisis Program Manager Site Visit Locations Pg. 2-3 ............. Marion County Psychiatric Crisis Center (PCC) Pg. 4-5 ............. Clackamas County Urgent Mental Health Walk-in Center Pg. 6-7 ............. Washington County: Hawthorn Walk-in Center Pg. 8-9 ............ Lane County: Hourglass Pg. 10-12 ......... Multnomah County Crisis Assessment and Treatment Center (CATC) & Triage Program Pg. 14-15 ......... Coos Bay Crisis Resolution Center Pg. 16-17 ......... Grants Pass: Crisis Resolution Center Pg. 18-19 ......... Snohomish County Triage Center Pg. 20-21 ......... Kansas City Assessment and Triage Center Pg. 22 .............. Grants Pass Sobering Center Pg. 24-25 ......... San Francisco Sobering Center 2 1 P a g e Marion County Psychiatric Crisis Center (PCC) Salem, Oregon CIP • Walk in Crisis Receiving Center that makes referrals to community resources • County operated • Voluntary only • No shelter regulations or licensing requirements • • • Salem, Oregon • Located on hospital campus, but not affiliated with the hospital • Transports to hospital are through 911 or law enforcement • All hospital evaluations are done by community mental health - location near hospital reduces staff travel time. • Relationship with hospital is strained MODEL:ISERVICE • Walk in crisis center responsible for all • Civil commitment investigations mental health crisis in Marion County — • Conduct aid and assist and 37o evaluations Children and Adults • Mental health court • Case management • 7 transitional houses (up to a z week stay) • Medication management (adults only) e Crisis respite for adults only, average length • Authorize inpatient hospitalization of stay 1-3 days, 5 days on weekends • Behavioral health services in the jail • No security • Hospital security does not respond • Policy that staff is only allowed to call 911 if they are asking for arrestor commitment, otherwise, are expected manage the situation. • Has had issues over the years. Stated that their furniture gets "re -arranged" several times per week. 31 Page go + staff Leadership/Supervision: • Program Supervisors, minimum 1 per shift • Director — Anne Marie Banfield • Public model - not privately run • 20 years old, Started in 1995 • Originally through MHO • Funded through encounter data, 6 digits in the red in the beginning • Started as a crisis center, through the years added medication management, transitional housing and respite, in addition to other services. • Currently in their 4th building • Public model - not privately run • 20 years old, Started in 1995 • Originally through MHO • Funded through encounter data, 6 digits in the red in the beginning • Started as a crisis center, through the years added medication management, transitional housing and respite, in addition to other services. • Currently in their 4th building • Population of Marion County 323, 614 • Less than l000 screenings first year • 2014, did 4900 screenings • 120o respite placements per year • 40 percent indigent, 6o insurance (mostly OHP • Separate people in the lobby • Increased medication management services • Front desk trained in crisis/QMHA'S • Continued improvement between law enforcement and mental health 4 1 P a g e Clackamas County Urgent Mental Health Walk-in Center Happy Valley, Oregon Vol i ' Wl j DESCRIPTION: • Walk in Crisis Center that makes referrals to community resources • County run • Voluntary only • Hours: • Monday through Friday, g a.m. to 7 P.M. • Saturday to a.m. to 7 p.m. • Sunday closed • • • Happy Valley, OR • Located on in a strip center shopping area • Neighboring businesses have not been very receptive • Tried to expand into the space next door in order to do 23 hour respite but ran into leasing issues • Near other county buildings • Near County Jail • Nearest hospital only a few miles away SERVICE•D • 24-hour phone crisis intervention • phone screening and referral to appropriate provider(s) • emergent (same day) or urgent (within 48 hours) intake appointments • brief (3-6) treatment sessions for crisis stabilization • community consultation, information and referral to other agencies or services SAFETY & SECURITY • No security on site • Unknown if there have been issues 51 Page STAFFING • 5.5 therapists • 3.0 case managers • 3.o FTE of peer supports • Two of the therapists and 1.o FTE of the case managers are classified as leads. • This FTE is augmented by on-call staff, who cover weekends and absences iFUNDING: • SE 25 Community Crisis finds • OHP monthly allotment • Tobacco tax • County general funds • Population of Clackamas County — 4o,8o62 • 700 people served their first year (2012) • 2o18 - served 1400 individuals LESSONS LEARNED; WISH LIST: • Wished they had marketed their services • 23 Hour Respite better in the beginning — had a very slow start _61Page Washington County: Hawthorn Walk-in Center Hillsboro, Oregon t �' a �_�� ` u 'i }n Yd, V i 1 ?% C 1 is 1 , , Wa ll k:i 7 i Center ,DESCRIPTION: • Walk in Crisis Center that makes referrals to community resources • Washington County contracts with Lifeworks NW to operate it • Voluntary only • Open everyday from g am to 8:30 pm • • • Hillsboro, OR • Located in the Washington County Health and Human Services building • Near public transportation • Not particularly near law enforcement or the hospital MODEL: • Assessment • Crisis counseling and education regarding mental health and addiction • Peer support • Connection to treatment providers and other social services. • All ages are welcome at the center. • There is no out-of-pocket cost for seeking help at the center. If individuals have insurance, they may bill for the service. If individuals are uninsured, there is no cost. SAFETY & SECURITY • No security on site • Unknown if there have been issues 71 Page • Master's -level clinicians • Bachelor's -level case managers • Peer support specialists • Psychiatrists and psychiatric mental health nurse practitioners provide urgent medication evaluation and consultation FUNDING: • Washington county contracts with Lifeworks to provide the services • Lifeworks bills insurance • Population of Washington County - 582,779 • In 2o18: • 1572 individuals were served on the phone • 2758 individuals served at our Walk In Center • No information on lessons learned or wish list on this tour as it was done prior to 2015. _81Page Lane County: Hourglass Eugene, Oregon ii 3 �� � � a � i nt ;t y CH's Wa l k,i n Center DESCRIPTION: • Walk in Crisis Center that makes referrals to community resources • Law enforcement drop off • Lane County contracts with Columbia Care to operate it • Voluntary only • Open 24/7 365 days a year • • • Eugene, OR • Located in a strip center next to a marijuana dispensary • Located about to minutes from the hospital and law enforcement • Very near County Mental Health • Close to many homeless camps SERVICE•D • Short-term, mental health crisis assessment and stabilization • Connection to treatment providers and other social services. • 23 hour respite, but most only stay 3-4 hours SAFETY e SECURITY • No security on sight • Challenges with getting law enforcement to respond timely • Staff trained in de-escalation • Most incidents have been primarily self -injury, assaults have been rare 9 1 P a g e STAFFING • 1 Master's -level clinician and 1 Bachelor's -level case manager on site at all times. • Supervisors on sight all but 8 hours during the night but are available on call every night • No medical providers on staff • Funded Primarily through Contract with Lane County and Trillium Behavioral Health s • Population of Lane County - 369,519 • Currently serving approximately 300 individuals per month LESSONS LEARNED: WISH LIST: • Wished they had marketed their services • Different location and space better in the beginning • Respite beds and individual rooms did not work well - changed to recliners and shared space recently (working much better) io1Page Multnomah County Crisis Assessment and Treatment Center (CATC) & Triage Program Portland, Oregon (NE Downtown) Crisis Assessi .9 ,ment a . d ,J I e f :1 j i 17e rA Center DESCRIPTION: • Not a crisis drop off center or Sobering Station • Privately run Telecare facility • Sub -acute, 16 bed secure 24/7 crisis program • State Licensed Non Hospital Hold facility • Not walk in, referral only • Only take indigent or OHP • Step down inpatient unit, hospital diversion • Voluntary locked unit • • • Located in NE Portland, near downtown • Busy intersection, very crowded • Near high-end apartments • Sobering station next door, not affiliated with CATC • Not near the hospital, law enforcement, or community mental health dept. MODEL:SERVICE • Primarily a peer run program • Average length of stay 7-10 days, but usually closer to 2 weeks • Adults only • Provide treatment (group, individual therapy, etc.) in a voluntary locked residential setting • Men and Women — co mingled SAFETY & SECURITY • No security staff • Badge and code entry - if badge is stolen, code is still needed • Had escapes of individuals under Civil Commitment • Had serious incidents in the past, declined to give more details • Use of physical restraint goes against telecare's philosophy 11IPage STAFFING 24/7 Staffing Includes: H I STO RY: • Established in 2011 to meet a gap of sub -acute care in the community • Created to reduce repeated admissions to jail and hospital • Recovery centered model run by peers is MOU between Multnomah County and City of Portland • Works in conjunction with other crisis services, including project respond and urgent walk in clinics in the area. • Funded solely through Multnomah County -Only take indigent and CCO capitated OHP Total Persons Served Since June 21, 2011 Ethnicity Total (Unduplicated) Discharge Destinations Hospital or Emergency Dept. A&D Inpatient Respite Family/Friends Home Shelter Other 1328 African American 13% 1020 Caucasian 69% Hispanic/Latino 4% Native American 3%, Other 11% Diagnosis of Persons Served 6% Schizophrenia 9% 2% Schizoaffective Disorder 140/4 4% Bipolar/Other Mood Disorders I60/4 21% Major Depressive Disorder 201Y4 37% Depressive Disorder NOS 25% 14% Other Axis I Disorders 16% 16%, With Co -Occurring Substance Abuse 39%, With Co -Occurring Medical Diagnosis 46% LESSONS LEARNED: WISH LIST: • Marking to the community — let them know • Increased medication management what you will or won't be doing up front • Fix insurance hang-up. Example: Due to • Appropriate referrals and pre-screening are funding stream, individuals whose insurance key has lapsed (due to recently being released • Fought hard to not be a drop off center from jail) are not eligible for services at CATC. _12 1 Page Multnomah County (continued) DESCRIPTION: • Safe respectful environment for individuals in the criminal justice system • 18 older with mental health diagnosis • 24/7 • Rapid access to clinical staff, assessment, medication support, counseling, and discharge planning • Linkage to resource (entitlements, housing, etc.) • Referral based — largely though P&P • PO can divert from the jail to triage center for probation violations • Individuals released from jail can come there directly • Room for 4 individuals at a time, 2 beds reserved at CRTC for Triage individuals • Food, water, recliners provided • Incentive program — jail released with voucher, if they stay for assessment, McDonald's card given HISTORY: • 1.5 years old • Created to fill a gap of those in crisis who are involved in the criminal justice system • Goal is reduce recidivism and avoid the need for higher level of care • Funded through Oregon Health Authority and contract with Multnomah County • Insurance doesn't matter • They do not bill for services 131 Page Coos Bay Crisis Resolution Center Coos Bay, Oregon , 61 t o" i 1. { i"I s ll s „ e .z eir', DESCRIPTION: • Privately run — Columbia Care • 6 bed licensed short term residential treatment facility, up to 13o days • Alternative to emergency, short term psychiatric hospitalization • Can dispense Medication, but does not offer psychiatric care or prescribing • Do not provide treatment, or traditional case management • Not a walk in model, referral only • Voluntary only • Clients are primarily referred from Coos County Mental Health, but Curry County and Douglas County are also served. • • • Located in a residential neighborhood • Directly across from Bay Area Hospital A F L I ' : 5 EC#. • No security staff • No camera • No locks • Previous incidents not disclosed • No QMHP • QMHA only, staffed 24/7 • One administrator, who is a QMHA •R • Established in 2003, as a diversion and step down from acute care hospitalization • No crisis service in their community, all crisis go to ED • Contract with Curry County 151 Page • Take CCO capitated OHP, private insurance and self -pay • County must authorize admission for individuals with OHP • Referrals come from the hospital or county mental health • No uninsured • Self -pay — $355/day cost • 6 beds, average 3-4 at a time • Men and Women, co -mingled • Average length of stay is to days, max up to 3o days • No holds or civil commitments • No kids 161 Page Grants Pass: Crisis Resolution Center Grants Pass, Oregon Vo;ku, .rr.ii � r1y d1S, .1 i.�i a ,..'� I '� ,, �. � � �� 7 1, � and ° I'd sri -�, 5:,� � 1 i �;,�� Res � il� ?� °f .) t ,; 1 ! i r is r i 1, Ei a c.f I i t yR ,. `._ "�,r: ,DESCRI' • • Fully licensed as a Secure Residential Treatment Facility (SRTF), Non Hospital hold and Residential Alcohol and Drug treatment program, including gambling • Voluntary Crisis respite unit • Non -hospital hold unit (involuntary) • Privately run by Options for Southern Oregon, Inc. • Serve Josephine, Jackson, and Douglas Counties • Male and Female, Adults only • • • Grants Pass • 3 blocks from Hospital, 7 blocks from Law Enforcement • Options campus, includes addictions and commitment services, as well as other residential options SERVICE•D • Take individuals on a z MD hold 0 5 bed secure unit to stable individuals who are danger to themselves or others o Civil commitment hearings held on site • Crisis respite o Individual and group therapy, NA and AA o Medication management o Individuals must be deemed "safe" to be there o No detox o Men and women's unit totally separate • Addiction assessment and treatment referral o Prevention, education and treatment 171Page • No security staff • Holding facilities o Locked facility with security cameras o Double locked door o Sally Port o No medical or physical restraint ability • Crisis Respite - No locks on doors • Police respond for security needs • Serious incidents in the past, including suicide attempts and assaults on staff • 7 full time QMHP until qpm, daily. Rotating on-call after hours • z nurses per day • Medical Technicians & QMHA's • No nursing from midnight — 7am • LMP for Medication Management - 5 days/week oR • Options has handled mental health treatment in Josephine County for 25 years • Director was new and could not give us a history of the agency • This was a joint project between Josephine County Mental Health and Options through a Community Development Block Grant program • Population of Josephine County 83,000 • Only serve CCO capitated OHP • 14-3o days average length of stay for respite • No other stats available LESSONS LEARNED: WISH LIST: • Understanding the power structure and • Not enough respite beds, the need is always having a clear understanding of the vision too great • Clear referral process • Detox is too risky, LMP's refused to participate due to liability • Lack of discharge resources — need long term housing options so they don't have to discharge to the mission • Transitional housing 181 Page Snohomish County Triage Center Everett, Washington oa st i,i t a3 yiiCrisis Respite.and Secure �, Residen 1 • • Run by community mental health provider (Compass Health) • Opened as an alternative to jail and emergency rooms for people in crisis • 16 bed, voluntary locked unit • Five 23 -hour recliners for short term observation • • • Everett, WA located in building with community mental health and peer support program. • 11 blocks from Hospital, 3 blocks from law enforcement • In an old school building MODEL-ISERVICE • Referral only, but anybody can refer o 1/3 hospital, 1/3 law enforcement, 1/3 community providers • Non-medical sobering support o Treat the negative symptoms of substance use in the context of crisis. Not a detox facility. • Full nursing staff and LMP on-site • Exam room • Pharmacy on-site (privately run) • Groups • Case management heavy • Facility did have security on site • Low level of incidents reported • Security trained in CIT • Maintained Trauma Informed environment __ 19I Page 34 staff including: • Peer Counselors • Mental Health Technicians • Master's level Clinicians • Nurses • Psychiatric providers • On call support • Compass Health is a 501c3 • A tax was passed in their area that helps support their ongoing funding (1/10 income tax) • Donations and grants also support their operations • They are a large organization that serves four large counties in Washington • g+ million dollar budget • Population of Snohomish County 801,633 • In 2015, served 1755 unique individuals LESSONS LEARNED: WISH LIST: • Come from a place of "yes" • More medical providers • Medication costs were unexpected • Important to have staff trained in de- escalation • Important to educate community on what you are doing - marketing 201Page Kansas City Assessment and Triage Center Kansas City, Missouri DESCRIPTION: • Voluntary only —doors lock from the outside only • Police, EMS, and hospital referral only • Police are in and out in 5-10 min • There is a separate room set aside for officers to use • They never say no to officers, but will often say no to the hospital • Very CIT driven model • Kansas City, MO • No directly near hospital, law enforcement or community mental health • 7 hospitals within 10-15 min of the facility • Law Enforcement approximately 20 minutes away MODEL:ERVICE • 24/7 Crisis Stabilization Center • 23 hour crisis respite (recliners) • Sobering Center • No walk-ins (they make exceptions for people that have been there before who are requesting help). • Medication Management • Referrals and connection to resources in the community • The decision to place someone in sobering vs respite is dependent upon the reason they were brought in. Both respite and sobering are co-ed. Both have single rooms within the units for those that need it. ,SAFETY & SECURITY • Full time 24/7 security that manages the front door and monitors the unit. • A few minor incidents reported • 1 supervisor, 1 licensed clinician and 1 RN per shift • 2 psychiatric nurse practitioners (total) available during daytime hours only. • 6 case managers day time only Monday through Friday. • Front desk person Nursing assessment done on every person that enters that includes blood sugar, breathalyzer and UA. This is required for admission. • The only criteria for admission is that they are ambulatory - they need to be able to talk, but don't have to talk well. 21IPage • Options has handled mental health treatment in Josephine County for 25 years • Director was new and could not give us a history of the agency Project was driven by a Judge who oversaw the treatment courts there (of which they have many) and wanted to find a way to not have them enter the system at all. Project took about 2 1/2 years to develop. Goal to divert from the criminal justice system and ED's • They opened in October 2o16 • 20 million dollars over to years from Ascension Health Systems (large for profit hospital that bought out two smaller nonprofit hospitals and the profit of 20 million had to go to the community per law). • Other funding includes 1 million total form 7 local hospitals. • No funding from LE. • The City of Kansas City contributed 2 1/2 million towards renovation costs and the building they renovated belongs to the Department of Mental Health. • Re -Discover is one of 5 nonprofits that operate mental health services and contract with the Department of Mental Health. They were chosen to run it through an RFP process. • 4,192 patients referred in year one. • 64% of patients came from Emergency Department and 34 % from law enforcement • 71% of patients were male • 77% of patients were between the ages of 25 and 54 • Average length of stay for a client is 16 hours • Cost -savings analysis looking only at individuals referred directly by KC Police estimated a $2.3 million cost savings from police bringing people to the center instead of the ED. LESSONS LEARNED: WISH LIST: • Advance practice RNs only permitted to • Increase capacity beyond 18 patient cap prescribe medication one time to clients but refills are often needed before outpatient follow up appointment. • Improve awareness among first responders 221 Page Grants Pass Sobering Center Grants Pass, Oregon Soberi,irtig Ci nter "line�10 • Involuntary — cannot leave until BAC is below a .05 • Mattress on the floor, rooms look like a jail cell • Officers stay with the person while vitals are taken and only un -handcuff them once they are in their room and door is locked STAFFING • 1 "sobering tech" per 6 people • No medical staff • Sobering tech monitors the camera feed which monitors each room EXCLUSIONPROTOCOLS: • Categories in place for monitoring based on vitals (done by sobering tech): o Category 1- 8 hour checks o Category 2 — 3 hour checks o Category 3 — i hour checks o Category 4 — not accepted • Cannot be accepted if BAC is above a .3 231 Page San Francisco Sobering Center San Francisco, California Soberling Center • Voluntary — medical model • Intoxicated clients with no acute medical condition or co- existing medical complaints may be transported to the San Francisco Sobering Center, if the client meets the following criteria: • All of the following must be present: • Indication of alcohol intoxication (odor • Temperature above 93° F (33.90 C) and of alcoholic beverages on breath, bottle) • Glasgow coma score 13 or greater • Systolic blood pressure above 80 • Diastolic blood pressure under 110 • Pulse rate over 6o and under 140 below 101.5 ° F (38.6' C) tympanic • Blood sugar level over 5o and below 250 • No active bleeding noted • Not actively seizing • No open wounds or lacerations • Ability to provide basic information • Oxygen saturation above 89% • Age 18 or older • Respiratory rate over 8 and under 24 REFERRAL • . • Clients may enter via one of the following sources of entry: o Ambulance (EMS) transports; o Homeless Van Service; o Police Department custody; o Screened and cleared by Hospital ED or Clinic and sent via Van; o Case management/ outreach service providers; o Client pre -approved by Sobering management; o Walk-ins & case managed clients. (no walk in's as a regular practice but on occasion.) EXCLUSIONPROTOCOLS: • Client has not consumed alcohol. • Client is intoxicated solely with other drugs, illicit or prescription. • Client has obvious trauma which does not have corresponding documentation stating condition has been medically cleared. These clients must be refused by nursing staff upon arrival. 251 Page • If client is found to not meet inclusion criteria, or is in need of immediate medical attention after intake, refer to appropriate protocol(s). • 5 FTE total (2 full time nurses and part time nurses fill the gap that equal 5 FTE) • 1 Social Worker M -F to help with engagement • No security • No meals served - Ramon noodles available • All staff have de-escalation training • 8 men's cots, 4 women's cots - separate units • They do dispense medication PROTOCOLS: • Categories in place for monitoring based on vitals (done by sobering tech): o Category 1- 8 hour checks o Category 2 - 3 hour checks o Category 3 -1 hour checks o Category 4 - not accepted • Cannot be accepted if BAC is above a .3 OTHER DETAILS • When they are full they call dispatch to let them know and keep them updated on census • Operating for 14 years — had 2 deaths • Do not require ID, do not bill insurance • 1 million dollar operating budget • Access to Detox is key for success 261 Page 2/21/2019 BRITISH -'..SASKATCHEWAN COLUMBIA ONTARIO Calgary;. .Reg na W nnjpeg - ... 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