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Integration, Restoration and Transformation: A Systems Overview Presentation for the National Association of Counties Conference; “Restore the Partnership for Community Corrections, Reentry, Reinvestment and Public Safety” January 21, 2010 Leon Evans President and Chief Executive Officer The Center for Health Care Services ental Health and Substance Abuse Authority Bexar County San Antonio, Texas [email protected] www.chcsbc.org Kathryn Jones Director, Substance Abuse Services Aaron Diaz Director, Crisis and Jail Diversion Services Gilbert Gonzales Director, Communications and Diversion Initiative The Center for Health Care Services 210 731-1300

NACo Jan 2010 Justice and Public Safety Conference

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Page 1: NACo Jan 2010 Justice and Public Safety Conference

Integration, Restoration and Transformation: A Systems

OverviewPresentation for the National Association of

Counties Conference; “Restore the Partnership for Community Corrections, Reentry,

Reinvestment and Public Safety” January 21, 2010

Leon EvansPresident and Chief Executive OfficerThe Center for Health Care Services

Mental Health and Substance Abuse AuthorityBexar County

San Antonio, Texas [email protected]

www.chcsbc.org

Kathryn JonesDirector, Substance Abuse Services

Aaron DiazDirector, Crisis and Jail Diversion Services

Gilbert GonzalesDirector, Communications and Diversion Initiatives

The Center for Health Care Services210 731-1300

Page 2: NACo Jan 2010 Justice and Public Safety Conference
Page 3: NACo Jan 2010 Justice and Public Safety Conference

Collaboration

Integration

Restoration

Transformation

Page 5: NACo Jan 2010 Justice and Public Safety Conference

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

Page 6: NACo Jan 2010 Justice and Public Safety Conference

Collaboration: It’s an unnatural act between…

…two or more unconsenting adults.

Page 7: NACo Jan 2010 Justice and Public Safety Conference

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

Page 8: NACo Jan 2010 Justice and Public Safety Conference

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…

Page 9: NACo Jan 2010 Justice and Public Safety Conference

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

Page 10: NACo Jan 2010 Justice and Public Safety Conference

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 2004

Page 11: NACo Jan 2010 Justice and Public Safety Conference

The Crisis Care CenterPsychiatric Screening

Minor Medical Clearance

24/7 Access for Law EnforcementCirca 2005

Page 12: NACo Jan 2010 Justice and Public Safety Conference

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

Page 13: NACo Jan 2010 Justice and Public Safety Conference

Public Safety Triage Facility

Restoration CenterGrand OpeningApril 15th, 2008

• Detox Facility• Community Court• Outpatient Substance Abuse Services

Circa 2008

Page 14: NACo Jan 2010 Justice and Public Safety Conference

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

Page 15: NACo Jan 2010 Justice and Public Safety Conference
Page 16: NACo Jan 2010 Justice and Public Safety Conference

Show me the DATA !!!

Page 17: NACo Jan 2010 Justice and Public Safety Conference

Forensic 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

Page 18: NACo Jan 2010 Justice and Public Safety Conference

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

Page 19: NACo Jan 2010 Justice and Public Safety Conference

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

Page 20: NACo Jan 2010 Justice and Public Safety Conference

Toolkit

Page 21: NACo Jan 2010 Justice and Public Safety Conference

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

Page 22: NACo Jan 2010 Justice and Public Safety Conference

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

Page 23: NACo Jan 2010 Justice and Public Safety Conference

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: [email protected]

www.chcsbc.org

Thank you for visiting !