Integration, Restoration and Transformation: A Systems

Overview

Presentation for the APPA Winter Training Institute Austin, Texas

Jan 31-Feb 3, 2010

Gilbert GonzalesDirector, Communications

and Diversion InitiativesThe Center for Health Care Services

Mental Health and Substance Abuse AuthorityBexar County

San Antonio, Texas ggonzales@chcsbc.org

www.chcsbc.org

Linda TavelDirector, Criminal Justice Substance Abuse Services

Mental Health and Substance Abuse Authority

Bexar CountyThe Center for Health Care Services

ltavel@chcsbc.orgwww.chcsbc.org

Collaboration

Integration

Restoration

Transformation

The Problem

Chapter I: Involvement with the Mental Health Systemo Introduction: Involvement with the Mental

Health Systemo Policy Statement 1: Access to Effective

Mental Health Services Chapter II: Contact with Law Enforcement

o Introduction: Contact with Law Enforcemento Policy Statement 2: Request for Police

Serviceo Policy Statement 3: On-Scene Assessmento Policy Statement 4: On-Scene Responseo Policy Statement 5: Incident Documentationo Policy Statement 6: Police Response

Evaluationo Conclusion: Contact with Law Enforcement

Chapter III: Pretrial Issues, Adjudication, and Sentencingo Introduction: Pretrial Issues, Adjudication

and Sentencingo Policy Statement 7: Appointment of Counsel o Policy Statement 8: Consultation with Victimo Policy Statement 9: Prosecutorial Review of

Chargeso Policy Statement 10: Modification of Pretrial

Diversion Conditionso Policy Statement 11: Pretrial Release /

Detention Hearingo Policy Statement 12: Modification of Pretrial

Release Conditionso Policy Statement 13: Intake at County /

Municipal Detention Facilityo Policy Statement 14: Adjudicationo Policy Statement 15: Sentencingo Policy Statement 16: Modification of

Conditions of Probation / Supervised Release

o Conclusion

Chapter IV: Incarceration and Reentryo Introduction: Incarceration and Reentryo Policy Statement 17: Receiving and Intake of Sentenced Inmateso Policy Statement 18: Development of Treatment Plans, Assignment to

Programs, and Classification / Housing Decisionso Policy Statement 19: Subsequent Referral for Screening and Mental

Health Evaluationo Policy Statement 20: Release Decisiono Policy Statement 21: Development of Transition Plano Policy Statement 22: Modification of Conditions of Supervised Releaseo Policy Statement 23: Maintaining Contact Between Individual and Mental

Health System Chapter V: Improving Collaboration

o Introduction: Improving Collaborationo Policy Statement 24: Obtaining and Sharing Resourceso Policy Statement 25: Sharing Informationo Policy Statement 26: Institutionalizing the Partnership

Chapter VI: Training Practioners and Policymakers and Educating the Communityo Introduction: Training Practitioners and Policymakers and Educating the

Communityo Policy Statement 27: Determining Training Goals and Objectives o Policy Statement 28: Training for Law Enforcement Personnelo Policy Statement 29: Training for Courts Personnelo Policy Statement 30: Training for Corrections Personnelo Policy Statement 31: Training for Mental Health Professionalso Policy Statement 32: Educating the Community and Building Community

Awarenesso Policy Statement 33: Identifying Trainerso Policy Statement 34: Evaluating Trainers

Chapter VII: Elements of an Effective Mental Health Systemo Introduction: Elements of an Effective Mental Health Systemo Policy Statement 35: Evidence-Based Practiceso Policy Statement 36: Integration of Services o Policy Statement 37: Co-Occuring Disorderso Policy Statement 38: Housing for People with Mental Illnesso Policy Statement 39: Consumer and Family Member Involvemento Policy Statement 40: Cultural Competencyo Policy Statement 41: Mental Health Workforceo Policy Statement 42: Accountabilityo Policy Statement 43: Advocacy

Chapter VIII: Measuring and Evaluating Outcomeso Introduction: Measuring and Evaluating Outcomeso Policy Statement 44: Identifying Outcome Measureso Policy Statement 45: Collecting Datao Policy Statement 46: Disseminating Findings

www.consensusproject.org

Intercept Points

Collaboration: It’s an unnatural act between…

…two or more unconsenting adults.

Graphic by Seth Godin

Sheriff’s Office

SAPD

CHCS

Metro Health

UniversityHealth System

AdultProbation

EMS

CPS

APS

SASH

NAMI

FIRE

DACounty Judge

Area Hospitals

University of Texas Criminal Justice

Veterans Administration Pre Trial Services

GI Forum

DSHS

ConsumersAnd Families

MagistrationFacility

City of San Antonio

Bexar County Commissioner’s Court

LawEnforcement

MentalHealthPartners Medical

DirectorsRoundtable

Children'sDiversion Collaborative

JuvenileProbation

Criminal Courts

Probate Courts

TexasA&M

DAPASAMM Ministries

PatricianMovement

Connecting Community

Leveraging Outcomes

Point of Contact with Law Enforcement

Magistrate Court

Bexar County Jail

Post-Booking Diversion

Community-based Wraparound Care

CIT/Deputy Mobile Outreach

Team

Genesis Probation, Incarceration,

Parole

Emergency Transport to

Hospital

Pre-Trial Diversion

Referrals to Community Providers

*Pre-Arrest Diversion

Residential Respite

Arrested

The Diversion ProcessThe Diversion Process

Treatment in lieu of Incarceration

24/7 CrisisServices

Circa 2002

Law EnforcementDetention/Jail

CIT

Judicial/CourtsMagistrate, County, District

Mental HealthPublic and Private

Providers

Crisis Care CenterJail DiversionPsychiatric and Medical

ClearanceSpecialty Offender Services

CommunityDynamicCrisis Jail Diversion

Information Exchange

Pol

ice,

She

riff

Pro

batio

n, P

arol

e

Civil and CriminalT

reatment

Continuity of C

are

County City-wide

Emergency Services

Data exchange through• Community Collaborative• Crisis Care Center • CIT/DMOT• Jail and Juvenile Detention• Statewide CARE Match

System County City-wideEntry Points

System Level

Circa 2006

CMAGScreeningLaw

Enforcement

MH NO

MH YES

Refer to Sherry (UHS Nurse)

RoutineEmergent

Urgent

MH

IOP Frio

CD

Release w/Referral – Bus

Pass

History

Unstable

MH/CD

Stable

24/7 CCC-CTUPresa – Business

Hrs.

Release W/Referral Bus Pass

IOP-Frio Release W/Referral

CD

MH

Detox Sobering

24/7CCC

Presa

CTU

? SP5Orig. OP

Unit

Jail Re-Entry

FACT

OP

CCC UHS-ER

UHS Nursing

Psych Eval

Agressive

Recommend ED

Find Bed

Private Hospital

ACCESS

ER CCC Jail

CD MH/CD MedicationUHS

Nursing

YES

NO

Bexar County Adult Detention

Center

Pre-Trial

UHS

PR Bond

CC12

Judge Carruthers -NGRI/IST

Eligibility

MH Court

Docket

NO

Yes

Jail Re-entry

Community

CCC

CTU

Fact

Access

Outpatient

Jail Re-Entry

CCC CTU

Mental Health Forensic Flow

a work in progress…Circa 2010,

Restoration Center

• Public Safety Triage • Detox Facility

• Outpatient Substance Abuse Services

• Community Court

• The patients served by the Center and by the local Hospital District (UHS) are the same individuals

• We combine functions to integrate care for these individuals

• Functional integration is the foundation of the best healthcare possible for the people we both serve

Behavioral Healthcare Integration with

Primary and Specialty Medical Care

New Generation Medication Program• Contract with UHS initiated in 2002

• CareLink Patients NGM Cost paid by CHCS with General Revenue

• CareLink Patients other Medication costs borne by UHS

• Savings to CHCS of between $2.4 & $2.6 million

• Savings funded the Crisis Services and Jail Diversion Initiative

The Crisis Care CenterPsychiatric Screening

Minor Medical Clearance

24/7 Access for Law EnforcementCirca 2005

Then (prior to Sept 2005)• Wait times for Medical Clearance/ Screening at UHS ER - 9 hours, 18 min.

• Wait times for Medical Clearance/ Screening and

Psychiatric Evaluation was between 12 and 14 hours.

Now• The wait time for Medical

Clearance/ Screening at the Crisis Care Center is 45 minutes.

• Wait time for Medical Clearance/Screening and Psychiatric Evaluation is 60-65 minutes.

Impact on WAIT TIME for LAW ENFORCEMENT

Public Safety Triage Facility

Restoration CenterGrand OpeningApril 15th, 2008

• Detox Facility• Community Court• Outpatient Substance Abuse Services

Circa 2008

“The immediate availability of detoxification services is priceless….”

“Providing treatment to those who desperately

need help will save taxpayers millions of dollars over the long run.” 

Gloria Padilla, Express News 9/13/2008

San Antonio Express News

o Mental Health Court – (2007) o Co-Located Mental Health, Probation and Parole Units o Competency Restoration Program – (2008) o Forensic Assertive Community Treatment Program – (2004) o Ongoing 40 Hour Crisis Intervention Training for Law Enforcement – (2003) o Ongoing 40 Hour Child Crisis Intervention Training for School District Police -

(2008) o Military Veterans Planning Collaborative with active pilot in military bases –

(2007) o Psychopharmacology Program (methadone maintenance) o Project Carino (Women of Child Bearing age, or pregnant addicted to Opiates) o Centro De Vida (HIV Outreach) o Therapeutic Justice Partnerships

Bexar County Corrections & Community Supervision and The Center for Health Care

Services programs; Residential Programs; 1. SATF-1 (100 bed Residential Treatment Program;Adult Males) an array of value

added services are provided to include family education, GED preparation and testing, parenting education, and recovery support groups.

2. SATF-2 ( 50 bed Adult Female/ 50 bed Adult Male Residential Treatment) 3. Zero Tolerance (60 bed young Adult ages 17-25 Residential Treatment) 4. Mentally Ill Offender Unit (30 bed Adult Female/30 bed Adult Male Co-Occurring

Residential Treatment Program)

Outpatient Substance Abuse Treatment Program-Provides an array of value added services; employment referrals, recovery support services, housing resources and services, parenting education, anger management)

Outpatient Dual Diagnosis Criminal Justice Substance Abuse Treatment Program Felony Drug Court Program & Misdemeanor Drug Court Program

o Community Partnerships addressing Unemployment resources, GED Classes, Housing Resources, Medical, Dental, Eye Exam resources, ID Reclain, Birth Certificates, and other Social Services.

Therapeutic Justice Service Array

The MAPThe MAP

CHCS Urgent Care Center (2)Emergency Psychiatric Screening

County Jail (6)

Community MedicalClinic (1)

CHCS Detox Center (3)

CHCS Substance Abuse Outpatient Services (5)

600 Bed HomelessResidential Facility (4)

GI Forum

Veterans Residential

1,000

Show me the DATA !!!

Forensic and Civil Court Programs

1. Outpatient Competency Restoration 1. Outpatient Competency Restoration

2. Forensic Outpatient Commitments 2. Forensic Outpatient Commitments

3. Mental Health Court 3. Mental Health Court

4. Drug Court 4. Drug Court

5. Civil – Involuntary Outpatient Commitment 5. Civil – Involuntary Outpatient Commitment

Haven for Hope

The Community Wide InitiativeHaven for Hope and CHCS

collaborationGoal:

To increase the community capacity for mental health, substance abuse and

detoxification services

Veteran’s Services

Multiple Collaboratives/Initiatives for Veterans based in Bexar County

• The San Antonio Veteran's Affairs Commission • The Military Coordinating Council for Behavioral Health• The Bexar County Veterans Service Office • Texas Resources for Iraq-Afghanistan Deployment, United Way• The Bexar County Veterans Service Office • Family Strong Advocacy

Toolkit

Alternatives to Incarceration

• Crisis Care Center and Restoration Center

• Involuntary Outpatient Commitment (IOPC)

• Outpatient Competency Restoration

• Mental Health and Drug Courts

• Veterans Initiatives

• Adult Parole/Probation Partnerships

For additional information onlineCopies of this presentation and

additional data on diversion initiatives can be found at:

http://www.diversioninitiatives.net

CIT

SAVE THE DATEFirst International CIT

Conference(Formerly the National CIT Conference)

June 1 - 3, 2010On site registration May 31,

2010

San AntonioCIT - Deep In The Heart of

Texas!For Information and Registration : http://chcsbc.org/cit

Gracias !

For Additional Information on this presentation please contact:Leon Evans, President and Chief Executive Officer

The Center for Health Care Services210 731-1300, Email: levans@chcsbc.org

www.chcsbc.org

Thank you for visiting !