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HomeMy WebLinkAboutCrisis Intervention TeamBJA FY 2013 JUSTICE AND MENTAL HEALTH COLLABORATION PROGRAM Deschutes County Crisis Intervention Team Project Program Abstract The Bend Police Department, as lead agency, in collaboration with Deschutes County Behavioral Health, St. Charles Health System, Black Butte Police Department, Deschutes County Mental Health Court, Deschutes County Parole & Probation, Deschutes County 911, National Alliance on Mental Illness (NAMI), Oregon State Police, Public Defenders Office, Redmond Police Department, and Sunriver Police Department is requesting $196,786 to improve the Deschutes County Crisis Intervention Team's (CIT) ability to increase public safety by promoting positive interactions between individuals with mental illness or co-occurring mental health and substance abuse disorders and law enforcement officers through specialized training; facilitating communication, collaboration and data sharing among community partners; maximizing diversion opportunities to multisystem-involved individuals; and maintaining an on-going working involvement with community advocates seeking educational opportunities to end the destructive and harmful effects of the stigma of mental illness. This project meets the Expansion Category criteria for an existing CIT collaborative team expanding upon the currently implemented program. Deschutes County CIT plans to reach this expansion goal by utilizing a coordinator to focus on early intervention through specialized training for law enforcement officers, local partners, and justice and treatment professionals; acting as a boundary spanner between law enforcement, legal, and mental health agencies to provide support and problem-solving to reduce the impact of allegedly mentally ill individuals on these systems; diverting individuals from punitive incarceration to appropriate treatment services; and promoting public education and involvement by actively engaging new community partners. Expected outcomes of this expansion project include, but are not limited to, creation of local agency data collection systems and data reports, implementation of specialized training to an additional 3% oflaw enforcement patrol staffin year one and an additional 4% in the second year, administering a Criminal Justice Professionals Training, and preparation of Action Plans for addressing program effectiveness and deficiencies. This expansion project's target population will be adults with mental illness or co-occurring mental health and substance abuse disorders who come into contact with the criminal justice system. During the two-year grant period, an estimated 1,000 individuals will be served. The total population of Deschutes County, Oregon in 2011 was estimated to be 160,338 (United States Census Bureau, 2012). An estimated 6,227 Deschutes County residents received county behavioral health services in 2011. The Bend Police Department has not previously received JMHCP grant funds. on February 26, 2013 U.S. Department of Justice Office ofJustice Programs Bureau of Justice Assistance HEALTH SERVICES 2577 NE Courtney Drive • Bend. Oregon 97701 Public Health (541) 322-7400 -FAX (541) 322-7465 Behavioral Health (541) 322-7500· FAX (541) 322-7565 www.deschutes.org RE: Bend Police Department Application for Justice and Mental Health Collaboration Program Grnnt . The Deschutes County Health Services Department, in partnership with local agencies that include the Oregon Judicial Department, Distiict Attorney's Office, Parole and Probation Department, Sheriff's Office, St. Charles Health Care, and Bend Police Department has collaboratively operated the Crisis Intervention Team (CIl) Steering Committee since 2010. Using grant funds from the Justice and Mental Health Collaboration Grnnt Program, the County is seeking to improve services· and treatment outcomes for people with mental illness who are involved in the criminal justice system. . While our existing programs including our Mobile Crisis Team, Multi-Disciplinary Team Meetings, and specialty courts such as Mental Health Court, have resulted in positive outcomes, I believe we can accomplish more. In 2012, our COmniunity was the recipient of a Sequential Intercept Mapping (SIM) workshop by the GAINS Center. By improving training and identification processes for law enforcement and more closely coordinating early mental health treatment interventions fot the mentally ill, funding from thiS grant award would allow our community to incorporate SIM' recommendations to create a healthier and safer community. Likewise. by providing a wider range of supportive services, with continued and enhanced investment from local stakeholders. we can b~ more effective in helping mentally ill individuals reintegrate into our community more efficiently. The Justice and Mental Health Collaboration Grant proposal would increase communication and collaboration, making more effective use of resources, improving the client assessment and assignment process. and expanding the range ofservices available to criminal justice involved people with mental illness. Without a doubt, this is a priority for the Deschutes County Health Department and Central Oregon. A grant from the Justice and Mental Health Collaboration Grant Program will go a long way toward improving oUr community outcomes. eschutes County Health Services Enhancing the lives of citizens by delivering quality servioes in a cost effective manner. 1 of 15 - Deschutes County Crisis Intervention Team Project BJA FY 2013 JUSTICE AND MENTAL HEALTH COLLABORATION PROGRAM Deschutes County Crisis Intervention Team Project Program Narrative Statement of the Problem The Deschutes County Crisis Intervention Team (CIT) was formed in 2010 as a partnership between local agencies to achieve the common goals of safety, understanding, and service to persons in crisis, the mentally ill, and their families. A Steering Committee was formed consisting of representatives from Deschutes County Behavioral Health (DCBH), St. Charles Health System, Deschutes County Sheriff’s Office, National Alliance on Mental Illness (NAMI), Deschutes County Parole and Probation, Redmond Police Department, Bend Police Department, Oregon State Police and Deschutes County 911. This group later expanded to include representatives from the Deschutes County District Attorney’s Office and Public Defenders Office. This Committee developed the current CIT program for Deschutes County. These stakeholders have begun to effectively engage and divert persons with behavioral health challenges and signs of mental health crisis. Existing county efforts include a Mobile Crisis Assessment Team (MCAT), a Multi-Disciplinary Team (MDT), multiple specialty court diversion programs, including Mental Health Court, Family Drug Court, and a newly developed Veteran’s Court, treatment services for offenders with mental health and co-occurring disorders in jail who are returning to the community, and membership on the recently formed State of Oregon CIT Association. Members of the Steering Committee attended the National CIT convention in San Antonio, Texas, and a 40-hour CIT training in Clackamas County, Oregon. The Committee attended these 2 of 15 - Deschutes County Crisis Intervention Team Project trainings to learn about crisis intervention and how to utilize this information to further develop the Deschutes County program. In October of 2011, the Committee offered the first 40-hour CIT training for Deschutes County. As of February 2013, the Steering Committee has organized and presented three 40-hour CIT trainings using the core elements of the Memphis CIT model. The Committee has trained over 75 law enforcement officers, including: 27% of City of Bend Police; 35% of City of Redmond Police; 37% of Deschutes County Sheriff’s Office Patrol/Detectives, and 20% of Corrections; 20% of Sunriver Police Department; 33% of Black Butte Ranch Police Department; and, 25% of Oregon State Police Troopers assigned to the region. Law enforcement officers are often the first-line responders when someone has a psychiatric crisis and acts out because of mental illness. While Deschutes County CIT has trained many officers, there is still a need for additional training to ensure enough CIT officers are available on every shift to respond to multiple calls involving allegedly mental ill (AMI) individuals. The more competent these first-line responders, the better they can handle these challenging, potentially dangerous and time-consuming situations. CIT trained officers provide immediate response and de-escalation to these crisis situations, thereby reducing arrests by increasing the opportunity for voluntary commitment, offering assistance and providing a link to community services. In 2012, local law enforcement responded to over 1,800 AMI, mental hold or suicide attempt calls. This was in addition to the numerous calls where mental health was at least partly an issue. Each arrest taxes local law enforcement resources because there is no available mental health service or the mentally ill person fails to respond appropriately to an officer request. Jails and 3 of 15 - Deschutes County Crisis Intervention Team Project prisons, rather than medical facilities, are increasingly used to house and treat people with mental illnesses. Once incarcerated, often for non-violent offenses, people with mental illnesses do not always receive the needed services, are vulnerable to abuse, have difficulty reconnecting with services upon release, and, on average, are incarcerated longer than other inmates. The result, for many, is years of cycling between prisons and jails, shelters, and emergency rooms. This cycle is costly for communities, a burden on law enforcement and corrections, and tragic for people with mental illnesses. Due to the large number of arrestees under the influence of a controlled substance or alcohol, screening and assessment for medical or behavioral health needs can also be complicated. Each arrest involves police intervention and the potential for violence. In 2012, the Deschutes County Jail (DCJ) had 8 serious suicide attempts. DCJ estimates that approximately 25-30% of the inmates are currently prescribed psychotropic medications. On average medical staff at the jail see 80 individuals monthly for mental health issues, 25 people for crisis intervention, 5 to 10 for suicide watch, and 15 are monitored at the request of command staff. In 2012, the DCJ reported: 66 Emergency Room visits for inmates requiring medical or behavioral health treatment or evaluation from ER staff. 46 inmates placed on behavioral health observation (threat of harm to self). 29 arrestees refused at initial booking due to a medical issue: 8 for behavioral health issues, and 10 for high BAC. 119 calls to Mental Health (MCAT) for evaluations. 4 of 15 - Deschutes County Crisis Intervention Team Project The main DCJ facility has a capacity of 228; it has an average daily population of 250 inmates. In 2012, the Deschutes County Sheriff’s Office contracted with nearby Jefferson County to rent additional beds due to overcrowding issues. Better training, resources and community collaboration would improve the flow of individuals through the jail system, thereby decreasing unnecessary incarceration time, improving transitional plans for after release, and better utilizing Deschutes County resources to treat this pressing community need. Deschutes County has seen significant increases (tripled in five years) in the number of indigent persons who need services under the Oregon Health Plan (OHP). OHP estimates up to a 30% increase in enrollment beginning January 2014. The increasing Medicaid population is affecting eligibility criteria of indigent services and reducing the availability of services. The county is being forced to refer patients to outside providers; ultimately the system is spread too thin. In a shared awareness of community deficits, the CIT Steering Committee applied for and was awarded participation in a Sequential Intercept Mapping (SIM) workshop facilitated by Substance Abuse and Mental Health Services Administration (SAMHSA). The objective of the SIM workshop was to develop a comprehensive picture of how people with mental illness and co-occurring disorders flow through the Deschutes County behavioral health and criminal justice systems along five distinct intercept points. The SIM workshop took place in Deschutes County in September 2012, and included thirty-five community leaders representing facets of the mental health and criminal justice systems. Upon completion of the workshop, the assembled stakeholders formed an Action Plan to develop priorities to improve system and service level responses for individuals in the target population and explore expanding the existing CIT program. Some of the identified gaps include: 5 of 15 - Deschutes County Crisis Intervention Team Project Expanding CIT and providing additional law enforcement training. Offering additional training to assist first responders in identification of primary illness (substance use and mental illnesses). Improving identification of AMI or mental health factors at dispatch. Reestablishing the “shared clients list” between the jail and DCBH. Assisting persons with co-occurring mental health and substance use disorders who have difficulty getting into either service system. Identifying frequent users of emergency services and the justice system at earlier points to prevent arrest and jail time. Providing additional Cross-Training. Expanding data gathering and tracking across all intercepts. The expansion of the Deschutes County CIT program would significantly enhance the capacity to address these high priority areas through additional training, improved collaboration and consultation between law enforcement and mental health personnel. Deschutes County is comprised of small, but progressive communities, with extensive support from local agencies to improve the services to those suffering from mental illnesses or co- occurring disorders. But, it is becoming increasingly difficult to respond to the increased need for services within current budgets. 2012 saw a 67% increase over 2011 in the number of AMI calls requiring law enforcement response. Although Deschutes County CIT has strong organizational capabilities and stakeholders willing to provide the 20% match required for this project expansion, adequate funds for this program cannot be obtained without federal funding. Deschutes County must meet the demands of its 6 of 15 - Deschutes County Crisis Intervention Team Project changing community and the growing population of mentally ill or dual diagnosed individuals. These grant funds will be utilized to address the limitations identified by the SIM workshop and to make meaningful and substantial improvements in the community. Project Design and Implementation The primary goal of this proposed enhancement project is to improve the current Deschutes County CIT’s ability to increase public safety by promoting positive interactions between individuals with mental illness or co-occurring mental health and substance abuse disorders and law enforcement officers through training; facilitating communication, collaboration and data sharing among community partners; maximizing diversion opportunities to multisystem-involved individuals; and maintaining an on-going working involvement with community advocates seeking educational opportunities to end the destructive and harmful effects of mental illness stigma. Deschutes County CIT seeks to accomplish this goal by achieving the following objectives: Objective #1: The CIT Steering Committee will design a job description and implement the new position of CIT Coordinator to establish an improved, standardized protocol for managing people with mental illness in the criminal justice system. Objective #2: The CIT Steering Committee and CIT Coordinator will design and implement an efficient system for gathering, maintaining, analyzing and disseminating appropriate records for each partner agency. Objective #3: The CIT Steering Committee and CIT Coordinator will provide specialized training to an additional 3% of law enforcement patrol staff in the first year and an additional 4% 7 of 15 - Deschutes County Crisis Intervention Team Project in the second year. At least one Criminal Justice Professionals Training (including, but not limited to, attorneys, probation/parole officers, dispatchers and local partners) will be conducted. The CIT Steering Committee and CIT Coordinator will develop an Advanced/Recertification Training curriculum, pilot an Introduction to CIT Training, and create a method for obtaining Training feedback. The CIT Coordinator and a designated agency representative will attend a Motivational Interviewing workshop, to facilitate implementation of a program on this evidence- based practice into the 40-hour CIT training. The CIT Coordinator will explore incorporating Trauma-Informed Care (TIC) into the offered trainings to build awareness and skills of this practice. The strategies Deschutes County CIT will use to identify and respond to incidents involving individuals with mental illnesses include the continued collaboration and efforts of CIT Steering Committee members, the 40-hour CIT Memphis-Model based training, the Criminal Justice Professionals Training, creation of curriculums for the Advanced/Recertification Training and Introduction to CIT Trainings, attendance at a Motivational Interviewing workshop, exploration of TIC Training, and obtaining and review of participant feedback to improve all trainings. The CIT Committee is committed to providing the resources necessary to deliver all CIT trainings. The CIT Coordinator, in cooperation with the Steering Committee, will have a comprehensive understanding of community resources and will build relationships with key stakeholders to create a uniform protocol for referral. A priority of this program expansion is increasing the number of trained CIT officers available for each shift. CIT officers can rely upon their training and these existing county services: Mobile Crisis Assessment Team (MCAT), Multi-Disciplinary Team (MDT), multiple specialty 8 of 15 - Deschutes County Crisis Intervention Team Project court diversion programs including Mental Health Court, Family Drug Court, and a newly developed Veteran’s Court. The CIT Coordinator will review law enforcement reports to identify training and/or service needs, address these needs with the Administrative Lieutenant, and participate in debriefings when applicable. A system is already in place to provide timely information to appropriate personnel through established inter-agency relationships and regular CIT Steering Committee and MDT meetings. Another significant objective of this program expansion is improving the collaboration among all key stakeholders at each supporting agency. The following mechanisms will be put in place to ensure the accountability of the service delivery system: the CIT Coordinator will spend 25% of their time in the field with law enforcement, data collection systems will be implemented in identified agencies, training feedback will be gathered, evaluated and used to implement meaningful changes, and the CIT Coordinator will collect quantitative and qualitative data on an on-going basis to demonstrate the impact of the project as well as identif y deficits and submit regular Action Plans to the CIT Steering Committee for follow up. Objective #4: The CIT Coordinator will work with the criminal justice system, county and private social services, mental health services, state and other systems to screen high risk/high utilizing individuals to assist in accessing appropriate support and resources, maximizing diversion opportunities, and monitoring the system for recidivism. The CIT Coordinator will pilot the use of a Field Assessment Screening Tool for law enforcement use on-scene with the expected outcome of increasing the number of calls resolved on-site and reducing the number of AMIs entering the criminal justice system. 9 of 15 - Deschutes County Crisis Intervention Team Project Objective #5: The CIT Steering Committee and CIT Coordinator will promote public education and involvement by actively engaging community partners and implementing positive law enforcement programs in the community. Objective #6: Continuous program evaluation is important to the Deschutes County CIT project. The CIT Steering Committee and CIT Coordinator will continually evaluate the ability of Deschutes County CIT to meet its goals and objectives, modify the program as needed, and disseminate the results of the project. The CIT Steering Committee will meet regularly to review collected data to determine program effectiveness and expansion, and address potential impediments to project success. The specific implementation plans, responsible parties, and performance measures for each objective are outlined in the attached Timeline. The proposed Deschutes County CIT enhancement project does not include offering direct services to individuals with mental illnesses or co-occurring mental health and substance abuse disorders; the CIT Coordinator will act as a boundary spanner to help establish stronger relationships between local agencies to facilitate services to this target population. Capabilities and Competencies Current efforts are represented by the Deschutes County CIT Steering Committee, which has been developing, implementing, and expanding this program for over two years. Each of the Committee members works full-time in their primary occupations. The Committee members, though ad hoc, are dedicated to enhancing the program and diligent in attending meetings. Committee representatives, who are also committed partners in this project, represent the 10 of 15 - Deschutes County Crisis Intervention Team Project following agencies: Bend Police Department, Deschutes County Behavioral Health, St. Charles Health System, Deschutes County Mental Health Court, Deschutes County Parole and Probation, Deschutes County 911, NAMI, Oregon State Police, Public Defenders Office, and Redmond Police Department. Currently, the Committee is able to provide a 40-hour CIT training for local law enforcement twice per year. If the Steering Committee remains at this capacity, it can only maintain the current training blocks and level of mental health services for Deschutes County. There is not capacity to improve or expand services because there is not enough manpower or funding to do so. Additionally, while the CIT Steering Committee has made lasting and ambitious improvements to the community, only a fraction of the potential beneficiaries are currently served because of programmatic limitations. These limitations include the absence of a general identification process for targeted individuals and lack of uniform protocol for staffing and addressing high needs cases. This has been identified as insufficient for the size and need of the current mental health population. The Committee’s goal is to coordinate resources more effectively among key stakeholders to implement the recommendations identified in the SIM workshop. Further, if the grant is awarded, Deschutes County CIT could explore a more Advanced CIT training for identified CIT officers. Program enhancement will also allow for more hands-on evaluation of the existing CIT officers to provide them with immediate feedback on interventions and resources available to assist with crises. Funding this proposal will allow Deschutes County CIT to make more efficient and timely connections between agencies to facilitate smoother and earlier identification of mentally ill within the law enforcement system 11 of 15 - Deschutes County Crisis Intervention Team Project and streamline access to the appropriate resources. The proposed program will allow the various stakeholders to collaborate more efficiently to achieve the results of the SIM workshop. The collaboration structure includes members of law enforcement agencies, local and private mental health providers, the criminal justice s ystem, and local NAMI advocates. With community growth patterns and significant increases in AMI calls, maintaining the current level of functioning will no longer solve community problems. Deschutes County needs additional support the current CIT Steering Committee cannot provide. The addition of a dedicated CIT Coordinator position will provide much-needed focus on identified gaps in the current system, and provide direction and guidance to CIT efforts. This enhanced program will identify training needs for law enforcement, provide advanced curriculum for specialized CIT response, allow for report review and follow-up to ensure appropriate mental health services are adequate and available to the mental health population. By addressing identified SIM gaps, the proposed project will enable Deschutes County to comprehensively and successfully address mental health issues within the criminal justice system. Likewise, the improved program will provide a more streamlined and direct avenue for law enforcement to divert individuals suffering from mental illnesses away from the criminal justice system and into appropriate mental health services. The success of this project hinges on the hiring of a qualified CIT Coordinator who will be an effective boundary spanner to bridge communication gaps between agencies and achieve productive collaboration. The existing Deschutes County CIT Committee has already demonstrated its commitment to this program through the creation of the committee by its significant accomplishments over the past two years. This group of dedicated partners is 12 of 15 - Deschutes County Crisis Intervention Team Project committed to the success of this program expansion and will implement any needed strategies to overcome potential barriers. As the lead agency in this grant proposal, the Bend Police Department will implement, manage, and evaluate all aspects of this project. If a grant is awarded, the Administrative Lieutenant will allocate 7% of his time to fulfilling project administration and responsibilities directly related to the proposed program. The Director of Sage View Psychiatric Center, as part of St. Charles Health System, will allocate 2 hours every other week for clinical supervision consisting of practical sessions with direct feedback to the CIT Coordinator. The organizational relationships, structures and dedication of Deschutes County will ensure successful implementation. ___ letters of commitment for the Deschutes County CIT Project have already been received from local stakeholders. The relationship between these partners is well established and is designed to identify local solutions to the problems facing Deschutes County. Deschutes County CIT will meet all goals within two years, beginning on October 1, 2013, and ending on September 30, 2015. Specific timelines for each objective are outlined in the attached Timeline. Plan for Collecting Data Essential to this program expansion is the design and implementation of an efficient system for gathering, maintaining and analyzing all appropriate records. If a grant is awarded, the CIT Steering Committee will begin collecting baseline data and reviewing data collection plans to facilitate the CIT Coordinator’s workflow. The CIT Coordinator and designated agency representatives will work jointly to create data collection systems to track the necessary data in the most efficient manner. The CIT Coordinator and designated agency representatives will also prepare and present semi-annual Data Reports to the CIT Steering Committee. All stakeholders 13 of 15 - Deschutes County Crisis Intervention Team Project will be familiar with the data requirements and participate in providing on-going feedback about project status and outcomes at regularly scheduled CIT Committee meetings. Designated agency representatives will be responsible for tracking, maintaining, and disseminating data after the system is established. For the two-year grant period, the CIT Coordinator will gather, organize, and disseminate information to agencies and work with the grant manager on reporting requirements. As a result, 5% of the CIT Coordinator’s salary, and this project’s budget, will be used specifically for data collection. The following list of expected outcome measures clearly meet the deficiencies outlined in the SIM workshop and, once achieved, will move the Deschutes County CIT program forward in its ability to provide services to mentally ill individuals: Data collection systems created in partner agencies to track: o Number of calls for police services; o Number of calls for police services involving persons with mental illness events; o Number of calls responded to by someone trained to provide a specialized police- based response to people with mental illness; o Number of people receiving a field assessment or screening; o Number of current participants arrested or sent to jail, prison or a hospital for administrative violations of their condition of supervision, new offenses, or a mental health crisis; and, 14 of 15 - Deschutes County Crisis Intervention Team Project o Number of days program participants spent in jail, prison or a hospital for administrative violations of their condition of supervision, new offenses or a mental health crisis. Data Reports presented that demonstrate program effectiveness in increasing diversion rates and on-scene resolutions, and decreasing recidivism. Training Agenda created and implemented with the following results: o Two annual 40-hour CIT Trainings conducted. o An Advanced/Recertification Training Curriculum created, evaluated, and implemented, if applicable. o An Introduction to CIT Training series piloted at Bend Police Department, with feedback obtained for future application. o One Criminal Justice Professionals Training conducted. o Method for obtaining feedback on trainings established. o Motivational Interviewing workshop attended and reviewed for implementation into the 40-hour CIT training. o Trauma-Informed Care (TIC) trainings researched. A Field Assessment Screening Tool for law enforcement use on-scene, piloted by the CIT Coordinator. Quarterly CIT Newsletters distributed. Action Plans created and reviewed for addressing program deficiencies. 15 of 15 - Deschutes County Crisis Intervention Team Project Plan for Measuring Program Success to Inform Plans for Sustainment Stakeholder support will be measured by attendance at regular CIT Committee meetings, creation and maintenance of internal data collection systems, semi-annual presentations of Data Reports to the CIT Committee, participation in CIT Trainings, on-going collaboration and data- sharing with other partners. The CIT Coordinator will create Action Plans for addressing program deficiencies and submit these to the CIT Steering Committee for follow-up, ensuring continuous program evaluation and expansion. The existing Deschutes County CIT will continue to function effectively, as it has for the previous two years, through active support by all participating agencies. No policies, statutes or regulations are required to support or sustain service delivery. New services associated with the proposed project will primarily be funded with a grant from the Bureau of Justice Assistance FY 2013 Justice and Mental Health Collaboration Program for the initial two-year period. At the conclusion of the grant, Deschutes County CIT will make every effort to continue to fund the CIT Coordinator position. Failing that, the Committee will take advantage of the groundwork laid by the CIT Coordinator by continuing to maintain and implement data collection systems, improve training, and continue to strive for program enhancement. It is imperative to Deschutes County CIT that this important work continue long after the expiration of grant funding. A wide range of additional funding measures will be explored to further expand Deschutes County CIT in the long-term, including additional grant funding, community support, and contributions from various agencies. The feasibility of each of these sustainability concepts will be thoroughly investigated during the next two years by both the CIT Coordinator and Deschutes County CIT agencies.