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1
Communication and Collaboration
Among First Responders
Success in Venango County
Venango County
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Brief County Description:
• Population 55,488 and declining
• 54% live in rural settings (2 small cities)
• 675 square land miles; 80% forested
• Limited public transportation
• 7 police departments within county (3
major departments plus Pa State Police)
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Demographics
• Venango County performs worse/much worse than
average in 15 of 19 child well-being indicators tracked by
PA
• Poverty levels higher than PA/US rates
• Per capita and Median Household income lower than
PA/US rates
• High school drop out rates higher than state rates
• BA degree achieved by 13%, versus PA’s rate of 22%
and the US rate of 24%
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Crime Profile
• PA had the highest prison growth in NE in 2007
• In 2005 and 2006 Venango County had the 3rd highest incarceration
rate in the PA (18% increase between 2005 and 2006; 61% increase
between 2002 and 2006
• County prison daily census in 2007 averaged 148
– National Institute of Corrections recommended capacity - 128
– American Corrections Association recommended capacity - 144
• 40% of inmates known to the Mental Health system at any given
time
• 46% of overall individuals incarcerated to the county prison in 2006
and 2007 were known to the MH system. 60% jailed 2 or more
times
Venango County CJAB Membership
• Court of Common Pleas Judges
Magisterial District Judges
County Commissioners
District Attorney
Domestic Relations
Public Defender
Substance Abuse
Mental Health/Mental Retardation
Children and Youth Services
Municipal Police Departments
Pennsylvania State Police
Adult/Juvenile Court Supervision
Pennsylvania Board of Probation and Parole
County Jail
Sheriff’s Department
**Also members of Mental Health Procedures Committee 6
Mental Health Procedures Sub-Committee
Started meeting in 2004 to plan strategies around local hospital merger which created many issues for delegates and first responders. Subcommittee of CJAB.
- Met monthly initially but only quarterly now.
Attendees: Local police departments, ambulance staff , ER staff, behavioral health unit staff, jail staff, public defender’s office, and hospital security staff. Mix of CJAB and others.
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2006 Grant Acquisition/ Initiation
of System Mapping
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Background
• U.S. Department of Justice announced
funding for cross-system collaboration
• Venango County MH/MR and Adult and
Juvenile Court Supervision Services
collaborated to develop a funding request
• Notice of Funding received 9/1/06
– 1 of 27 Nation Wide
– 1 of 3 in PA
May 9, 2006
United States Department of JusticeOffice of Justice ProgramsBureau of Justice AssistanceRe: Justice and Mental Health Collaboration Program
(CDFA # 16.745)
To Whom It May Concern:
Please let this letter serve as the endorsement of the Venango County Criminal Justice Advisory Committee(CJAC) for Venango County’s application for the above referenced funding. Our request for Category I– Planning funds, will allow stakeholders from within our criminal justice and mental health systems todevelop a comprehensive plan to identify and divert appropriate offenders suffering from a mental illnessfrom our jails to more suitable programming.
The Criminal Justice Advisory Committee is comprised of a diverse group of criminal justice and social serviceprofessionals representing the Jail, Substance Abuse, Human Services, Mental Health and MentalRetardation, Courts, Probation and Parole, Juvenile Probation, Municipal and State Police, Sheriff andothers; and should serve as a solid foundation to pursue technical assistance and financial support underthis announcement.
The CJAC supports the objectives of this program to include a reduction in recidivism of the mentally ill in thecriminal justice system; increase in the number of criminal justice personnel trained in law enforcementdiversion strategies; expansion of court based diversion programs and general increase in serviceavailable to the mentally ill offenders in our community.
I urge the Bureau of Justice Assistance to grant favorable consideration to this funding request.
Sincerely, Oliver J. Lobaugh, JudgeVenango County Court of Common PleasChairman, Venango County Criminal Justice Advisory Committee
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Purpose• Funding was awarded to develop a
comprehensive plan to identify and
intercept appropriate adult offenders
suffering from mental illness and/or co-
occurring disorders from the Venango
County justice system at the earliest point
possible while promoting public safety
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Kick off breakfast was held Nov. 6, 2007
• Invitations to breakfast sent by letter from
county’s President Judge Oliver Lobaugh,
who did the opening welcome.
• Attendees were requested to sign up for
smaller groups based on Intercept Points
A collaborative group of
stakeholders is mobilized
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Planning Approach
• Large planning group became a sub-committee
of the Community Justice Advisory Board
(CJAB)
• Use of Sequential Intercept Model (SIM) to carry
out system assessment process
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The Sequential Intercept Model
• The SIM advocates developing targeted
strategies to address problems and
service gaps at each of five ―intercept‖
points that closely reflect the flow of
individuals through the criminal justice
system and the interactive nature of the
mental health and criminal justice system
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Sequential Intercept Model
Intercept Points
1. Law enforcement/emergency services
2. Initial Detention/Initial Court Hearing
3. Jails, Courts, Forensic Evaluations, and
Hospitalization (treatment within the
correctional facility is the focus
4. Re-entry
5. Community Corrections
Planning Logic Model
Goal: Development of a strategic/collaborative plan to initiate system change for the identification and treatment
of adult offenders with a mental health or co-occurring disorder that intercepts individuals from the system at the
earliest possible point and that address the six BJA objectives.
INPUTS ACTIVITIES STRATEGIES
OUTPUTS PLANNING OUTCOMES
SEQUENTIAL
INTERCEPT
MODEL
FUNDING
STEAKHOLDER
TIME
LEADERSHIP
RECRUIT
STAKEHOLDERS
HIRE FACILITATOR
ASSESS NEEDS
AND STRENGTHS
OF SYSTEM
PRIORITIZE
SERVICES
IDENTIFY LEAD
SYSTEM
MAKE PLANNING
COMMITTEE A
SUB-COMMITTEE
OF CJAB.
OFFER STIPENDS
USE OF INTERCEPT
REVIEW TOOL
IDENTIFY
TRAINING NEEDS
IDENTIFY
STRATEGIES TO
COLLECT, REPORT
AND ANALYZE
DATA
INTERCEPT
REVIEW TOOL
COMPLETED
REVIEW
LITERATURE
QUERY STAFF/
LAW
ENFORCEMENT ON
TRAINING NEEDS
REVIEW BJA PM
DATA AND
IDENTIFY OTHER
PM DATA
DETERMINE
WHICH DATA
EXISTS AND
WHICH IS NEEDED
SUB-COMMITTEE
MEETING HELD
STAKEHOLDERS
ENGAGE IN
PLANNING
PROCESS
TRAINING NEEDS
FOR EACH
STAKEHOLDER
GROUP
IDENTIFIED
DATA
COLLECTION
STRATEGIES
IDENTIFIED
A COLLABORATIVE GROUP OF
STAKEHOLDERS IS MOBILIZED
TO DEVELOP THE PLAN AND
GUIDE ITS IMPLIMENTATION
AN ASSESSMENT OF THE
SYSTEM’S STRENGTHS AND
GAPS, BASED ON THE SIM, IS
COMPLETED
IDEAL SERVICE COMPONENTS
ARE IDENTIFIED FOR EACH
INTERCEPT POINT
AN IMPLIMENTATION PLAN FOR
SYSTEM IMPROVEMENTS AND
SUSTAINABILITY IS COMPLETED
TRAINING PROGRAM
DEVELOPED INCLUSIVE OF LAW
ENFORCEMENT AND OTHER
STAKEHOLDERS
A PERFORMANCE
MEASUREMENT AND OUTCOMES
EVALUATION SYSTEM IS
DESIGNED
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An assessment of the system’s strengths and gaps is completed
• Five subcommittees were established that corresponded to each Intercept Point (IP).
• Each committee met two times
• First meeting focused on identifying whether ideal service components were available for each intercept point.
• If a service was not available, the group decided if service development was a high, medium, or low priority.
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An assessment of the system’s strengths and gaps is completed
• Second meeting focused on the review of strengths/gaps, major themes of gaps, and identification of ideal strategies for addressing gaps.
• Following the second meeting of all small groups, the Planning Committee reviewed needs across all Intercept Points and observed that they fell into discrete categories (Case management
in the Prison and the community, Data/Information sharing, Integrated community treatment and support, identification of diversion options, training and education)
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Ideal service components and
strategies are identified for each
Intercept Point
• A second stakeholder wide meeting was held.
• Services that were brainstormed at the Intercept Point sub-committee level were prioritized using a nominal group prioritization procedure.
• Ultimately, prioritization of service development was decided to be largely unnecessary as a wide range of services were identified, some of which did not included additional funding.
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An Implementation Plan for System
Improvements Is Developed
• Implementation strategies were identified
for all ideal service components
• Viable sustainability strategies were
developed as possible
• Implementation Plan was developed.
21Venango County Mental Health & Justice Collaboration
Mission Statement
• Venango County will successfully intercept
and divert into treatment appropriate
persons who have a mental illness who
would otherwise have been placed in the
criminal justice system
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Vision Statement
• People with mental illness are served in
the community and diverted from the
criminal justice system at the earliest
possible time, while still providing for
community safety.
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Performance Measurement
Outcomes Evaluation System for
Implementation Plan
• Logic Model is developed
• Identification of existing data completed
• Additional data that is desired is identified
• Data collection barriers– Uncertainty about the types of information that can be
shared among the stakeholder groups, and at what
point
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Logic Model
Outcomes/Objectives
Intercept Point 1: Law
Enforcement/Emergency Services
Procedures to provide assistance to law enforcement are
reviewed and refined
Peer support provided a.s.a.p. following 1st contact with law
enforcement
Family peer support program is developed
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Intercept Point 2: Initial Detention/Hearing
Standardized screening and assessment tools are
administered to identify suicide risk and presence of mental
illness or co-occurring disorders
Case management (i.e. boundary spanner staff) is
operational to assist courts with alternative dispositions,
ensure screening/assessments are completed and link
individual to needed services
Procedures are developed for quick access to mental
health services.
Logic Model
Outcomes/Objectives con’t
26
Intercept Point 2: Initial Detention/Hearing con’t
Diversion Options Developed to Include:
• ―Collaborative Intervention Strategies‖ developed to
partner existing interventions to create jail diversion
alternatives. For example, house arrest/PHP.
• Mobile Psych assessment and treatment expanded from
4 hours/mo to 4 hours/wk and expand to target
population.
• Supervised residential housing developed as an
alternative to incarceration.
Logic Model
Outcomes/Objectives con’t
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Intercept Point 3: Post booking/Jail
Case Management is operational in the jail to
include initial assessment, in-jail service linkage,
pre-release planning, and data collection.
Additional 8 hours per week of Mental Health
counseling is added in the jail.
Logic Model
Outcomes/Objectives con’t
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Intercept Point 4: Re-Entry to Community
Case management is operational (see Intercept Point 2)
Individualized probation and parole pre-release plan is
developed that establishes realistic conditions for treatment
and graduated sanctions if relapse occurs.
Logic Model
Outcomes/Objectives con’t
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Intercept Point 5: Community Support
Community Support Options are expanded to include:
• Supported housing for target population
• Psycho-educational programs for target population.
• Individualized planning to identify work, volunteer, or
training activities, and or participation in other
meaningful community activities
• Transportation plan developed for each individual.
• Integrated Mental Health/Substance abuse case
management for individuals with co-occurring
disorders.
Logic Model
Outcomes/Objectives, con’t
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System Wide Outcomes:
• All stakeholders receive training regarding mental illness, suicide
assessment, diversion options, and other desired topics.
• Data sharing procedures developed across all intercept points to
ensure continuity of information sharing
• Data collection strategies are developed to ensure that data is
collected in a consistent and timely manner and consistent with
funding expectations.
• Quality measurement system developed to measure overall
effectiveness of system components in diverting individuals at the
earliest point possible.
Logic Model
Outcomes/Objectives, con’t
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Year One Conclusions: The Barriers
• Some services that were identified as needed and of
high priority are expensive and have questionable
sustainability (half way house)
• The ability to share information among first responders -
- It was not clearly known what could be shared among
ourselves, and at what point
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Year 2 Grant: Limited
Implementation
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Background
• Year one was completed under-budget
• The project requested, and received approval to extend the grant into a limited implementation phase
• Focus in Year 2 was on achieving the no cost and low-cost Implementation Objectives and Outcomes
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Year 2 kick off breakfast was held 9/07 to review
accomplishments of planning grant and discuss
limited implementation plan
Two Trainings Were Presented:
1. Presentation from the Laurel Highlands Crisis Intervention
Training Team
2. Training from John Petrila, JD LLM, a professor at the
University of South Florida with expertise on HIPAA and
Cross System Collaboration
Topics were chosen with an eye towards developing an
information sharing policy.
Crisis Intervention Training (CIT)
Innovative program of police-based crisis intervention involving community health care and advocacy partnerships
Pre-jail diversion program that directs individuals with mental illness into treatment rather than the criminal justice system
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Emphasis is on mental health knowledge, crisis resolution skills, and access to community services.
Officer learns how to: - arrive on scene non-confrontational - approach individual in crisis - assess situation - promote one on one communication - provide assurance that he’s there to help
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Crisis Intervention Training (CIT)
“HIPAA, State Law, and Cross-System Collaboration presented by John Petrila.
HIPAA Permitted Non-Consented Disclosures for Law Enforcement
“If use or disclosure is necessary to prevent or lessen a serious threat to the health or safety of an individual or public.”
PA Law on Non-Consensual Disclosure
Non-consented disclosure is permitted in response to emergency medical situations when release is necessary to prevent serious risk of bodily harm or death…must be pertinent to relief of emergency (PA Admin Code 5100.31)
--This could be harm to self or others in the case of an individual known to act out physically. Real risk of injuring others or of being injured by first responders due to behavior.
Information Sharing Policy Is Developed as a Result of This Training
Intent of Disclosure: “Promote best possible outcome for the individual”.
“Mental Health worker may disclose Protected Health Information…….if necessary to prevent or lessen a serious and imminent threat to health and safety or a person or the public and if the disclosure is to a person or persons reasonably able to prevent or lessen the threat.”
Disclosure must be made “in good faith”.
Exchange of Information between First Responders and the Venango County Mental
Health System Policy and Procedures Timeline
1/23/08 Draft policy is developed by Venango County Mental Health and Developmental Services Administrator Jayne Romero. Draft policy is forwarded to John Petrilia for comments/ suggestions.
2/13/08 John Petrila responds and gives basic approval. He references statute on previous slides and notes that policy should only be used in emergency situations. His final caution is that substance use regulations are more stringent so this policy will not work for that.
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2/08 County HIPAA policy updated to parallel this policy.
2/29/08 Policy submitted to Mental Health and Developmental Services solicitor. His comments “….regulation does permit
disclosure of Protected Health Information without authorization of individual, however, an analysis has to be done in each instance to determine what subsection is applicable, keeping in mind that any such disclosure must always be made in good faith and consistent with applicable law and standards of ethical conduct.”
Policy and Procedures Timeline, con’t
7/08 Policies and Procedures are presented and approved at mental health procedures subcommittee.
10/6/08 Approved by the county’s solicitor. His only comments referred to typos.
11/17/08 All policies developed by mental health procedures sub-committee presented at CJAB.
1/20/08 2nd review of policies at CJAB
2/17/09 Policies officially adopted by CJAB
***Over 1 year to get this done including all approvals. (3 lawyers, 2 committees)
Policies and Procedures Timeline, con’t
Exchange of Information between 1st Responders and the Venango County Mental Health System
Policy and Procedures
Policy: In response to law enforcement official’s request, Venango County Human Services through its Crisis Unit and/or Mental Health/Mental Retardation Dept, may disclose protected health information (PHI) in an emergency situation without the written authorization of an individual in situations involving first contact with law enforcement or other 1st responders. The intent of the disclosure is to promote the best possible outcome for an individual who is “known” to the county mental health system. Refer to the following sources for legal authority relative to this policy: 55 Pa. Code 5100; 45 C.F.R. and Venango County HIPAA Compliance Policies/Procedures. 43
Exchange of Information between 1st Responders and the Venango County Mental Health System
Policy and Procedures
Policy(cont):
The crisis or MH/MR worker may disclose PHI to law enforcement or other 1st responders if it is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and if the disclosure is to a person or persons reasonably able to prevent or lessen the threat. If the worker believes in good faith that those 2 requirements are satisfied, s/he may disclose PHI and there is no limitation on the type of PHI which may be disclosed other than the worker must in good faith believe that the disclosure of PHI is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person of the public. 44
Exchange of Information between 1st Responders and the Venango County Mental Health System
Policy and Procedures
Procedures:
1. Law Enforcement/1st Responders will contact the CS/MH as outlined in the “Individuals Needing Emergency Psychiatric Evaluation” flowchart.
2. Requests for the information outlined above may be made to the CS/MH worker who takes the call.
3. The CS/MH worker will provide only the information noted above, to the degree that it is known to the CS/MH worker, or can be quickly discovered by the CS/MH worker. Strategies that the workers can use to discover the information includes but are not limited to, calls to the County Base Service Unit staff, and/or references to mental health records on file at the CS office.
4. The CS/MH worker will document any information disclosed to a 1st
responder on the Protective Services Emergency Examination sheet or in the case record.
Other Policies Developed Thru the Mental Health Procedures Sub-committee
Safe Transition to Emergency Department (for 302s and other mental health admissions)
Ambulance Transport for Individuals Needing Emergency Psychiatric Evaluation Flowchart
Uniform Firearms Act Notification policy
Exchange of information between UPMC-NW (hospital) and law enforcement
Other Policies, con’t
Individuals not appropriate for jail or hospitalization
List of transportation options
Flowchart and policy regarding those who make a serious suicide attempt and need medical stabilization
Flowchart on managing intoxicated patients.
Other Policies, con’t
Some are joint policies and some are individual agency policies that are brought to the sub-committee for review to ensure that all agencies are apprised of policies.
Once approved by Mental Health Procedures sub-committee, all policies are formally adopted by CJAB.
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Year 2 Outcomes
• Standardized screening and assessment
tools are administered to identify suicide
risk/presence of mental illness
• Procedures are developed for quick
access to mental health services
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Year 2 Outcomes, con’t.
• Collaborative Intervention Strategies are developed to partner existing interventions (e.g. house arrest and partial Hospitalization) to create jail diversion
• All stakeholders will receive training regarding mental illness, suicide assessment, diversion options, public safety, correctional procedures, and other desired topics.
• Data sharing procedures are developed across all intercept points to ensure continuity of information sharing
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Standardized Screening and
Assessment Tools
• A sub-committee is formed
• The major focus was to review assessment tools used by jail staff at booking and other times within the jail
• The Warden agreed to use standardized
instruments at booking
– Correctional Mental Health Screen for Men
– Correctional Mental Health Screen for Women
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Procedures for Quick Access to
Mental Health Services
• Procedures are developed for same/next
day access to Mental Health services with
Community Mental Health Center.
• Pilot Program developed and implemented
with Franklin Police Department to divert
at Intercept Point 1.
53
Collaborative Intervention Strategies
• Collaborative strategies are developed between mental health and AJCSS
• Creation of 3 emergency shelter beds
• New practice initiated to discuss release plans/options for inmates who could be released on house arrest if housing/services are available
• Psycho-educational program expanded in collaboration with State Probation/Parole
• Preliminary discussions to develop community wide conferences to develop strategies for working with individuals known to all systems who are at risk of incarceration
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All Stakeholders Receive Training
• A Detailed Training Plan is developed for
reciprocal training
The mental health system provided
training to criminal justice system while the
criminal justice system provided training
to the mental health system.
55
Overall Service Changes
Intercept Point 1Pre-Program:• Police Receive mental health
training as part of ACT 120 training
• Crisis Services Unit available for non-commitments
Current:• Crisis Services continues to be
available, but now staff are better trained.
• Extensive training completed
• Exchange of Information Policies and Procedures are developed
• Comprehensive policies developed to provide assistance to law enforcement
• Diversion Plan in effect with Franklin Police Department
• 3 Emergency beds created
• Procedures for same/next day access to mental health treatment is developed
56
Overall Service Changes
Intercept Point 2
Pre-Program:
• Access to abbreviated
forensic evaluations
• Some creativity in handling
criminal charges
Current:
• Standardized
screening/assessment
tools
• Same/next day access to
mental health services
• Collaborative Diversion
options
• Emergency beds
• Better understanding of
how to access forensic
evaluations at WSH
57
Overall Service Changes
Intercept Point 3
Pre-Program:• 4 hours psychiatric time in jail
per week
• 8 hours mental health counseling in jail per week
• 4 hours Substance Abuse counseling in jail per week
• Jail advocate provides screening and links to in-jail services
• Expedited hearings for individuals with mental illness
• Access to local, abbreviated forensic evaluations
Current:**Boundary Spanner in place.
• Educated jail and mental health staff
• Data sharing between jail and mental health staff
• Standardized suicide risk screening tool
• Mental Health Intake in the Jail setting
• Knowledge of how to access forensic evaluations at WSH
• Service planning for identified individuals
58
Overall Service Changes
Intercept Point 4Pre-Program:• Mental health
participation on Pre-Release Advisory Board
• Intensive case management for select individuals who had case management prior to incarceration
• A few days supply of medication
Current:**Boundary spanner in
place
• Services available at Pre-Program level
• Mental Health Intake for individuals receiving services in the jail
• Immediate access to psychiatric evaluation and continuation of medication supply
59
Overall Service Changes
Intercept Point 5Pre-Program:• Emphasis on Recovery
• Longer criminal justice supervision for individual with a mental illness. Some graduated sanctions for relapse
• Access to publicly funded mental health services upon release
Current:• Continued emphasis on
recovery, and access to expanded recovery services (MPR, Peer support, emergency housing, housing support, illness mgt group)
• Expanded treatment services and choice due to HealthChoices
• Trained community service providers
• Psycho-education program expansion
• Forensic housing program launched
60
Two Other Program Were Developed as a Result of
Colloboration around the Grant
1. Diversion Pilot with the Franklin Police
Department
2. Supported Housing Program—Applied for
a PCCD grant based on info gathered
during initial grant period.
Diversion Protocol with Franklin Police Department
Protocol developed to guide the Franklin Police Officer, Crisis Services Worker, Court Supervision Officer and the Magisterial District Judge
- Police Officer Identification of mental health issues
-Involvement of MH system (Crisis Services)
-Involvement of Court Supervision
-Recommendation to Magisterial District Judge
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Supported Housing Program
In April 2010 Venango County was approved for a PCCD grant to start a supported housing program for individuals being released from the county jail.
64
Supported Housing Program, con’t
Basic Overview:
Master Lease Program for those being released from the county jail who are homeless.
Individuals live in apartments rented by Venango County for 1st 6 months following release.
Dedicated Caseworker works closely with the individual to gain access to benefits and/or employment 65
Supported Housing Program, con’t
Caseworker also helps individual make and keep follow up appointments after released from jail.
Once the individual has income, the caseworker helps the individual locate supported permanent housing.
5 slots were created for transitional housing.
First individual was placed in 7/10. All 5 slots filled. Two individuals are currently looking for permanent housing and no re-incarcerations (yet)
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