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Leon EvansPresident and Chief Executive OfficerThe Center for Health Care ServicesMental Health and Substance Abuse

AuthorityBexar County

San Antonio, Texas levans@chcsbc.org

Enlightened Alternatives: How CIT and DiversionAre Cutting Recidivism

and Saving MillionsAugust 20, 2012

Clark County, Nevada

Gilbert GonzalesMelanie LaneAaron Diaz

Jeanie ParadiseThe Center for Health Care ServicesBexar County, San Antonio Texas

A Winning CollaborationCIT International Conference

Romana LopezSergeantCIT Unit

San Antonio Police Department

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2002 – Bexar County Jail Diversion Collaborative meets for 1st time

2003 – First Crisis Intervention Team Training begins

2004 – Specialty Jail Diversion Facility opens

2005 – 24/7 One Stop Crisis Care Center opened

2006 – Bexar County Jail Diversion receives APA’s Gold Award

2008 – Restoration Center opened ; Detox, Sobering, IOP Treatment

2010 – Haven for Hope 1,600 Bed Homeless Facility opened

2010 – International Crisis Intervention Team Conference hosts 1,600 Officers

2000 – CEO begins diversion efforts, full time coordinator is hired

2003 – Deputy Mobile Outreach Team begun

2011 – Prospect Courtyard Safe Sleeping reaches high of 714

2012 – Prospect Courtyard adds new MH Clinic

2012 – Prospect Courtyard adds 80 bed MH residential

2012 – Restoration Center Expansion; Building #2 added

2010 – In House Recovery Program Male and Female 104 sober living beds

TimelineTimeline

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Collaboration: It’s an unnatural act between…

…two or more unconsenting adults.

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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• Community Collaborative• Crisis Care Center• Crisis Transitional Unit• Crisis Hotline (Nurselink)• CIT/DMOT• SP5• Jail and Juvenile Detention• Statewide CARE Match

System County City-wideEntry Points

System Level

6Today2012 – The Bexar County Sheriff and San Antonio Police Chief mandate CIT Training

CIT Mental Health Detail• Mental health professional partners

with a CIT Officer together to respond on calls dealing with a psychiatric crisis.

• Team responds to high utilizer calls for the City providing follow up services to reduce the call volume.

• Goal is to put officers back into service for patrol as soon as possible.

– Reduce inappropriate incarcerations and costly emergency room visits.

– Offer quality training to law enforcement.

• Co-locate officer with the City unit and Sheriff Mental Health Unit for better collaboration and expedited call response

Dispatcher Training for 911 Call Takers and Dispatchers

• In 2007 - decided that dispatchers would also benefit from CIT Instruction and met with SAPD leadership to establish training.

• Provided an abbreviated 12 hour CIT course for call takers and dispatchers in collaboration with CHCS

• The goal of this training is to increase safety by educating caller takers on essential intelligence gathering and dispatching a CIT Trained officer to the scene.

Partnered with Fire and EMS• As of 2007 SAFD has attended

every community training

• has become co trainers with joint PD and Sheriff’s Officers

• Have added a CIT component to their EMS In-service training.

• Partnering for Integrated training with Fire/EMS has extended numerous opportunities for growth:

– Officer and Fire/EMS better communication

– Safety

– Better utilization of resources

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CRISIS CARE CENTER• Crisis Line• Crisis Assessment• Mobile Crisis Outreach Team• Crisis Transitional Unit

7137 W. Military 645-1651

• Receives consumers from law enforcement 24/7

• Minor medical clearance • Call ahead preferred

210 225-5481• Can not take violent or

medically compromised individuals

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Texas Veteran Jail Diversion and Trauma

Recovery Project (TVJDTR)

VETERANS SERVICES program :

• inclusion and expansion of trauma specific treatment and trauma informed practice

• monitoring of the delivery of veteran peer support services related to behavioral health issues

• monitoring of the implementation of family member facilitated family-to-family education groups related to behavioral health issues

• developing of collaborative advisory groups for supports and services for veterans and their families to initiate

• enhance or expand community resource coordination related to basic needs with community partners, individuals and organizations • linkage to Therapeutic Justice Services

Restoration Center Addiction Services

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Bldg. #1 Opened April 15, 2008

Bldg. #2 OpenedJune 27, 2012

• Public Safety- Sobering Unit• Injured Prisoner Medical Services• Residential & Ambulatory Detoxification• Opiate Addiction Treatment Services• Outpatient Substance Abuse Services• Felony Drug Court COPSD Outpatient Services• In House Recovery Program Sober Living

Serial Inebriants Program• Originally was staffed with

nursing on front end

• Re-organized to have EMT/Recovery Support Specialists on unit

• Not treating medical, just sobering and engaging in relationship

• Educating funders that multiple admissions not viewed as failure

• Continued collaborations with law enforcement, EMS, hospitals

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Injured Prisoner Clinic• Added service to reduce

ER waits and get police back on street

• Blended funding through City and County

• Open when University Hospital Clinic is closed.

• PA/NP on duty fills dual roles of medical care and physicals for detox after hours.

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Residential Detox• Originally licensed 44 beds.

Reduced after 6 months to 27 due to flow from sobering to detox.

• Barriers include low $$ reimbursement rates and wait list

• Intervention only unless followed by additional treatment

• Open to ER 24 hour admits

• Funded by hospitals, DSHS, Medicaid 16

Outpatient Addiction Services• Originally started with clients who

completed detox and were living at shelter

• Barriers including safe and sober living environment and limited residential treatment beds in community

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• Need for individuals to be in recovery environment

• Developed a short term ambulatory detox over 2-3 month period.

• Partnered with Haven for Hope to start In House Recovery Program.

• Expansion into new building

• 550 Opioid Addiction Treatment clients daily

• Added 200 Outpatient clients to equal 400

• Project Carino – Pregnant Women Opioid Addiction Treatment.

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Recent Additions

Restoration Center Admissions

1914% (888 clients) went from sobering to detox

IHRP Mission Statement

To provide a safe, structured, sober-living

dormitory that supports residents committed

to living sober lives and becoming productive, contributing members of

society.20

Outpatient Treatment

PeerSupport

Community

12-Step Program

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Dorm Sleeping

Area

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IHRP Outcomes

• Total clients admitted Dec 2010 to March 2012 735• Total transferred from Residential Detoxification 413

• Total clients still in care 96

• Total Discharges639

• Total clients completing with positive outcomes 316• % completing with positive outcome

49.5%

Positive outcomes are defined as having no alcohol/drug use, employment or other positive endeavor at discharge, development of recovery support system (e.g., 12-Step, church).

PROSPECTS COURTYARD

Developed two years ago to address basic needs of food, clothing & shelter

Criteria:

• 18 years of age (or older).• Physically able to care for themselves.

5 MAJOR GROUPS IN PCY

1. Recently out of prison

2. Mental Health Issues

3. Substance Abuse Issues

4. Elderly

5. Young people aged out of foster care – or no longer allowed at home

Funded by The City of San Antonio & Private Donations

• Capacity was set at 400 per night by contract April – June 2012.

• Averaged 516 sleeping

• Averaged 694 receiving some service during the day

IN-HOUSE WELLNESS PROGRAM

MISSION STATEMENT:

The mission of the CHCS In-House Wellness Program is to provide the

following:

MISSION STATEMENT

1. A safe, comprehensive, structured dormitory environment with a treatment plan tailored to meet the needs of the chronic, homeless, mentally ill who may suffer from co-occurring diseases including substance abuse.

MISSION STATEMENT

2. A program including mental health medication and compliance to take said medications by the residents.

MISSION STATEMENT

3. A program directed toward mental health stabilization and an ultimate transition to a more stable, individual living environment.

MISSION STATEMENT

4. An environment of trust between staff and the residents that gradually assists them in their recovery to become self-reliant and independent.

ADULT MENTAL HEALTH CLINIC

Consumers referred will receive the following services:

CONSUMER BENEFITS SPECIALIST

• To provide benefits screening

PSYCHIATRIC AND NURSING SERVICES

• Medications• Medication Management

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Haven for Hope Homeless Facility CNN Video Clip

• http://www.diversioninitiatives.net/2010/07/haven-for-hope-cnn-video-just-before.html

“Texas officials hope a massive new facility will keep the homeless

out of jail, emergency rooms and re-integrated into society”.

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Haven for Hope Homeless Transitional Facility

www.havenforhope.org

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Show me the DATA !!!

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Emergency Room utilization has dropped 40% since the inception of the Crisis Care Center.

40% of (7619 total seen at CCC) 3048 Persons diverted from the ER (in 2006 first year)

X $1545Cost Savings relative to ER Utilization $4,709,160

Source: University Health System

Emergency Room Utilization (Medical Clearance)

What Works

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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

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Recidivism Rates for Top Five CSCD’S

6.6%

12.7%

17.6%

20.6%

22.6%

30.3%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Bexar Harris Average Tarrant Dallas* Travis

Bexar

Harris

Average

Tarrant

Dallas*

Travis

*Dallas rates reflect only one mental health provider, Metro Care.

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1,600

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Cost Category City of San Antonio Bexar County Direct Cost Avoidance

 Public Inebriates Diverted from Detention

Facility 

 $435,435

 $925,015

 $1,322,685

 A.

 $1,983,574

 $2,818,755*

 $4,372,128

 B.

 $2,419,009

 $3,743,770

 $5,694,813

 

 Injured Prisoner Diverted from UHS ER

 

 $528,000

 $435,000

 $421,000

 C.

 $1,267,200

 $1,044,000

 $1,010,400

 D.

 $1,795,200

 $1,479,000

 $1,431,400

 

 Mentally Ill Diverted from UHS ER Cost

 

 $322,500

 $283,500

 $276,500

 E.

 $774,000

 $676,000

 $663,600

 F.

 $1,096,500

 $959,500

 $940,100

 

 Mentally Ill Diverted from Magistration

Facility 

 $208,159

 $179,833

 $126,893

 G.

 $371,350

 $322,300

 $191,125

 H.

 $579,509

 $502,133

 $310,018

 

Combined CCC and Restoration Documented and Immediate Cost AvoidanceYear One April 16, 2008 – March 31, 2009Year Two April 16, 2009 – March31, 2010

Year Three April 16, 2010 – March 31, 2011

Summary next slide

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Summary

BEXAR COUNTY DETENTION CENTERSYSTEM POPULATIONMONTHLY AVERAGES

(Main, Annex)

4222

3743

4133

40153987

3941 39464015

40814095

4171 4156

4094

38453807

3897

3981

4109

42634253

4040

3993

40624033

4066

3960

4079

4096

4084

4094

4095

41394173

4208 4261

4289

4225

4124

4158

4337

4272

4292

4197

421042544179 4193

4280

4357

43004300 4302

4053

4130

4001

4260

40284077

4231

4190

4017

379137903854

3982

3700

3800

3900

4000

4100

4200

4300

4400

JAN

FE

B

MA

R

AP

R

MA

Y

JUN

JUL

AU

G

SE

P

OC

T

NO

V

DE

C

SY

ST

EM

PO

PU

LA

TIO

N

2006 2007 2008 2009 2010 2011

On May 2011, there were 883 empty beds in the jail

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The End Result

• Comprehensive service for most in need• Increased availability of comprehensive

coordinated services• Reduced barriers to service access and

increase motivation with treatment compliance

• Employ evidence based practices known to be effective

• Utilization of system tracking and outcome based treatment

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The Center for Health Care Services

Leon Evans, President/CEOThe Center for Health Care Services

Mental Health Authority210 731-1300

www.chcsbc.orglevans@chcsbc.org