LEARNING TOGETHER: THE CIT KNOWLEDGE NETWORK Presented at the CIT International Conference August 17th, 2017 Prepared by: Detective Matthew Tinney Dr. Nils Rosenbaum Dr. Dan Duhigg Dr. Annette Crisanti Dr. Peter Winograd Detective Lawrence Saavedra Jennifer Earheart, MA

Learning Objectives Describe the CIT Knowledge Network and how it is being used to connect law enforcement agencies throughout the country. Identify the benefits of the CIT Knowledge Network including, enhancing CIT knowledge, access to CIT experts, furthering best practices in CIT, and officer knowledge and self-efficacy. Describe the process for joining weekly CIT Knowledge Network sessions.

“The Network is amazing in providing useful information “The Network is amazing in providing useful information. Although I came in with a significant amount of training in the area of CIT, the Network provides me more information, and also keeps my skills sharp.” Define the CIT Knowledge Network on this slide.

“The ability to meet across time zones, countries, states, etc “The ability to meet across time zones, countries, states, etc. whether in an office, at home, in a car…makes this a unique and valuable way to share relevant talking points, information, best practices, and staff cases. This is an invaluable opportunity for law enforcement.”

CIT Knowledge Network Session Connect to Zoom from 1:30-3:00(MST) on Tuesdays Brief didactic + Q&A for 30 minutes Debriefing cases/calls presented to network for feedback and discussion for 20 minutes Adjourn Certificates of participation given for each hour connected

PARTNERS

Grant Funding $250,000 Three-Year Grant BJA FY 2015 Justice and Mental Health Collaboration Program: Planning and Implementation

History in Law Enforcement Training historically focused on command/control and officer safety Non-compliance can result in the use of force Historically, no special training focused on interactions with people living with mental illness A lack of guidance and training on how to apply police tactics to people living with mental illness resulted in highly publicized of uses of force CIT (Crisis Intervention Team) programs are local initiatives designed to improve the way law enforcement and the community respond to people experiencing mental health crises. They are built on strong partnerships between law enforcement, mental health provider agencies and individuals and families affected by mental illness. CIT, Crisis Intervention Teams 1987 Memphis Model created Closure of long-term psychiatric treatment facilities resulted in more chronically psychiatrically ill people living in our communities Law enforcement & public safety have become a more common point of contact for people living with mental illness The CIT Knowledge Network is based on Crisis Intervention Training (CIT), a first-responder model for police interactions with people living with mental illness. CIT is a pre-booking approach to increase officers’ abilities to respectfully and safely interact with persons living with mental illness and is associated with improved knowledge and attitudes

APD’S CRISIS INTERVENTION UNIT (CIU) CIT (Crisis Intervention Team) programs are local initiatives designed to improve the way law enforcement and the community respond to people experiencing mental health crises. They are built on strong partnerships between law enforcement, mental health provider agencies and individuals and families affected by mental illness. Matt and Nils attended an ECHO clinic and thought there was a great need for a clinic dealing with behavioral health and law enforcement

ECHO Model Case based learning Demonopolizing knowledge Video-conferencing network

Traditional CIT Training The CIT ECHO Model 40 hour class. No upkeep. ! ? ? ! Pros: Impact and reach more people Keep skills fresh Lifelong learning Pro: Effective training Con: Perishable skills Con: Officer must dedicate time to learn

THE CIT KNOWLEDGE NETWORK “CIT ECHO” Law enforcement video conferencing network using case debriefings and supplemental trainings to promote Crisis Intervention Team best practices

ZOOM: Joining the CIT Knowledge Network Zoom.us Free program Apple app store (IOS/Mac) Android Store Telephone Smartphone (Apple or Android) Tablet Computer Webcam Microphone

THE CIT ECHO HUB TEAM Dr. Daniel Duhigg Addiction Psychiatrist Presbyterian Healthcare Services UNM Department of Psychiatry and Behavioral Sciences Matthew Tinney Detective Crisis Intervention Albuquerque Police Department Dr. Nils Rosenbaum Psychiatrist, Medical Director Behavioral Health Division Albuquerque Police Department Dr. Nancy Martin Psychiatrist UNM Department of Psychiatry and Behavioral Sciences Jennifer Earheart, MA Research Coordinator UNM Department of Psychiatry and Behavioral Sciences Denise Hovey-Thomas Crisis Specialist Crisis Intervention Albuquerque Police Department Det. Lawrence Saavedra Detective Crisis Intervention Albuquerque Police Department

Participating Agencies MARYLAND Wicomico County Health Department/ Core Service Agency MINNESOTA St. Paul Police Department NEW MEXICO Alamogordo Police Department Albuquerque Ambulance Albuquerque Fire Department Albuquerque Police Department Bernalillo County Sheriff’s Department Bosque Farms Police Department Corrales Police Department Farmington Police Department Las Cruces Police Department Los Lunas Police Department New Mexico Department of Public Safety New Mexico State Police Portales Police Department Rio Arriba Sheriff’s Office Rio Rancho Police Department  San Juan County Sheriff’s Department Sandoval County Sheriff’s Office United States Probation and Parole University of New Mexico Veteran’s Administration NEW YORK New York Ambulance/ Mental Health America Chaplain Center for Urban Community Services OREGON Portland Police Department TEXAS Hale County Sheriff's Office WASHINGTON Comprehensive Healthcare Everett Police Department King County Washington Sheriff's Department Kirkland Police Department Washington State Criminal Justice Training Center Yakima Police Department WISCONSIN Stevens Point Police Department

The CIT Knowledge Network Is Connecting Agencies Across The Country.

The CIT Knowledge Network Is Using Project ECHO To Provide Critical, Ongoing Training To Agencies Around New Mexico And The Nation.

Case Examples Case 1 – Impact on training policies at police academy: Using a PA system in crisis situations. Case 2 – Impact on decreasing use of force: De-escalation and positioning techniques on crisis calls. Case 3 – Impact on improving de-escalation skills for high risk suicide. Case 1 – PA System Case 2 – Sgt. Dietzel Case 3 – Murder suicide example

CIT ECHO CURRICULUM: 6 MODULES CIT Policing Resources Psychiatric Diagnoses De-escalation/communication Self-management Special training

CIT ECHO Curriculum MODULE 1: CIT POLICING MODULE 3: PSYCHIATRIC DIAGNOSES 101 MODULE 5: SELF MANAGEMENT Intro to CIT policing Schizophrenia and First Episode Psychosis Officer Suicide CIT Team Roles Bipolar Disorder Burnout prevention for police CIT Guidelines Depression Workplace mental health awareness How to Interface with the Medical System Anxiety I: GAD, OCD, Panic Mindfulness Based Stress Reduction for police Triage Anxiety II: PTSD 10 Deadly Errors: How to Avoid Becoming a Victim Cop Spree Killings Autism Spectrum Disorders Homelessness Substance Use Disorders MODULE 6: SPECIAL TRAININGS Barricades and High Risk Suicide Medication Awareness for Police Identifying Drug Induced Intoxication in the Field Recognizing signs and side-effects of medications, drugs, mental illness for police: What is a threat vs. a side-effect? Traumatic Brain Injury Rising Rates of Homicide: A look at the data Alzheimer’s and Dementia When to go to the hospital (psychiatric emergencies) MODULE 4: DE-ESCALATION & COMMUNICATION Media Relations Q&A Role of Media in Reporting Mass Shootings Hallucinations and psychosis: how to respond De-escalation Techniques Suicide by Cop MODULE 2: RESOURCES 7 Active Listening Skills Communicating with medical professionals Adult Protective Services Police Zen Disability Rights PURE Model I Sexuality and Stress Resources for Veterans PURE Model II Transgender 101

Benefits FREE Training without travel Certificates given after training Decreasing variability in tactical responses Identification of areas needing improvement/training/changes to SOPs Live access to specialty consultation with CIT experts, psychiatrists, law enforcement trainers Development of CIT programs and infrastructure Decreasing liability through peer review Development of best practices Access to medical professionals

CIT INC. www.goCIT.org Searchable for CIT program information CIT ECHO didactics No recorded cases

EVALUATION Semi-structured interviews with stakeholders to obtain feedback about the face validity and practical utility Online surveys to assess satisfaction with the technology and curriculum and impact on self-efficacy Online surveys to assess impact on knowledge related to the content presented in the session

Preliminary Data Preliminary data from online surveys shows a positive impact on officer self-efficacy. In YR1, 50 officers completed at least 3 or more sessions and were eligible to complete the survey.   82.85% agreed or strongly agreed that because of their participation in the CIT Knowledge Network they felt they were able to determine if a person living with mental illness who has committed a crime should be taken to jail or to a hospital or emergency room. 91.43% agreed or strongly agreed that after participating in the sessions they felt comfortable interacting with people living with a mental illness.

Preliminary Data When asked about how likely participants were to use the information learned in their job, the average rating on a likert scale ranging from 1 “Not at All” to 5 “Very Much” was 4.29 (SD = 0.77) for the session on First Break Psychosis, 4.31 (SD = 0.65) for the session on Paranoia, and 4.45 (SD = 0.69) for the session on Autism Spectrum Disorder. When asked about whether the information presented in the session would result in any changes in interactions with people living with mental illness, responses were also very positive. For example on the session on Communicating with People Living with Traumatic Brain Injuries, 78% of respondents reported that the information presented would result in changes in how they interacted with people with this condition during a call for service.  

Stakeholder Interviews Semi-structured interviews with key stakeholders have identified positive feedback. The four respondents interviewed thus far, including a captain, two sergeants, and a field officer have emphasized how the sessions have served as refreshers for their initial training. “I’ve been doing this job a long time. Though the information isn’t new, it’s a refresher for me. It tells me that what I’m doing is best practice. The meetings help validate my skills.”

Qualitative Feedback from Weekly Surveys “I will keep in mind that individuals with this disorder are very smart and can catch on to my reactions and behavior. Even though the likelihood that things are happening as they say are probably not, it is still very real and scary for them.” (Bipolar didactic) “I think at times you become somewhat relaxed and complacent when dealing with people who suffer from mental illness, especially those you have dealt with quite often. Be mindful and getting in the right mindset and keeping it will definitely help me on future contacts.” (10 Deadly Errors didactic) “I really enjoyed being a part of these conversations. Going beyond ‘do this, this way’ to discussing aspects officers never really would of thought about. I love these training sessions.” (Role of Media in Reporting Mass Shootings didactic) “I liked the give and take of the session and getting to hear from both LEO’s and from physicians. I enjoyed hearing all of the different perspectives. I also enjoyed hearing the feedback [case debriefing] about the delusional individuals that one of the participants was trying to deal with and find resources. I actually learned a few things from that.” (Paranoia didactic)

THE CIT ECHO: YEAR 1 OUTCOMES “These are great topics the department does not always discuss in detail and is something 34s have to learn on the fly. I think these are great and continue to improve my knowledge base.”

THE CIT ECHO: YEAR 1 OUTCOMES

Moving Forward: The Modern CIT AHRQ = Agency for Healthcare Research and Quality

QUESTIONS?