Stepping Up for CIT— Mapping Opportunities for Diversion CIT International- August 16, 2018 Tenasha Y. Hildebrand, Crisis and Veteran Services Administrator, Mercy Care Detective Amanda Stamps, Crisis Intervention Team Coordinator, Mesa Police Department Detective Sabrina Taylor, Crisis Intervention Team Coordinator, Phoenix Police Department Sarah Blanka, Crisis Regional Director, RI International Steven Scott, Director of Operations, Connections AZ

Objectives Overview of the Sequential Intercept Model: What is it? What does it look like in Maricopa County? Why is it important for individuals with mental illness/substance use disorder and the criminal justice system? Prevention: Using preventative measures, such as connection to ongoing services, peer supports, and highlighting the work of community providers, to reduce likelihood of recidivism in Maricopa County, Arizona. First Interactions: Understanding the intersection of law enforcement and community. Police drop-offs at urgent psychiatric facilities, work being done at these centers and partnerships with law enforcement.

Overview of the SAMHSA Sequential Intercept Model Intercept 1: Community and Law Enforcement Intercept 2: Arrest and Initial Detention/Court Hearings Intercept 3: Jails/Specialty Court Intercept 4: Reentry from Jails and Prisons to the Community Intercept 5: Community Corrections Have your agencies mapped out your system using the sequential intercept model? Overview of the Sequential Intercept Model- During this presentation, you will have an understanding of what the sequential intercept model is, what it looks like in Maricopa County, Arizona, and highlighting the importance from SAMHSA for individuals with mental illness and/or substance use disorders and the criminal justice system. #1- divert people with mental health, substance use, or co-occurring disorders from criminal justice into community services without going through the courts. #2- community supports, criminal justice system, and courts working collaboratively, so that the individual can receive treatment and support #3- drug courts, mental health courts, vet courts, domestic violence courts, and tribal wellness courts #4- encourages stakeholders to work together to ensure people coming out of jails and prisons have access to substance use treatment and mental health services; help individual to become fully participating member in the community #5- probation, parole (https://www.nij.gov/topics/corrections/community/Pages/welcome.aspx) https://www.samhsa.gov/criminal-juvenile-justice/samhsas-efforts Patty Griffin, PhD- SAMHSA Gains Center https://www.samhsa.gov/gains-center

Arizona Geographical Service Areas Mercy Care contracts with behavioral health providers to deliver services for those in crisis, as well as ongoing supports for adults and children. Operates the largest, by population, integrated public behavioral health system in the United States. Tenasha 6.9 million Arizona residents and 4.2 million reside in Maricopa County 9,224 square miles in Maricopa County Mercy Care membership is 900,000 and 1% self-reported veterans

Maricopa County, Arizona Crisis System Overview Walk-in centers for emergent psychiatric and medical needs Detoxification services Respite services Mobile teams Hospital Rapid Response Teams Crisis Navigators Connect to ongoing care Emergency psychiatric facilities Process Involuntary process ED Hold Coordination Portal to the Crisis System Warm Line Crisis hotline Urgent psychiatric facilities Voluntary and detox facilities Tenasha Crisis phones- average 22,000 calls per month; only 0.40% of those calls transferred to 911 and only 8% result in mobile team dispatch Mobile Teams- 60 mins or less response time; prioritize law enforcement Urgent Psychiatric Facilities- 57% of the volume for the involuntary and voluntary facilities in 2017 was by law enforcement (UPC, RRC, CPEC) **In 2017, a total of 22, 169 individuals were diverted by police to one of our behavioral health facilities or mobile teams. Voluntary Adult Facilities Detox **Explain emergency psychiatric facilities and transition throughout the presentation to be receiving centers**

Maricopa County Intercept Map

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Law Enforcement: Phoenix Police Department 5th largest city in the U.S. 1.4 million people and growing 4.5 million people in Maricopa County 517 square miles 2,900 officers Bigger than Philly and gaining on Chicago

Law Enforcement: Mesa Police Department 3rd largest city in Arizona Suburb of the Metro Phoenix area 485,000 people 140 square miles 850 officers

Law Enforcement: Phoenix Police Department Organization 25% of patrol is CIT certified Uniform pin CAD log in visible to dispatchers 2 squads of CIT detectives to help with more complex calls Pickup orders Barricades Q & A 1 full-time CIT coordinator All negotiators are CIT certified 40 hours of disability training for new officers (post academy)

Law Enforcement: Mesa Police Department Organization 25% of patrol is CIT certified Quarterly training provided Dispatchers attend 16 hour Crisis Intervention Partners (CIP) class 1 squad of Crisis Response Team (CRT) detectives to help with more complex calls Pickup orders Follow-up calls for high utilizers and high-risk citizens Patrol Assists Q & A 1 full time CIT coordinator 16 hours Mental Health and De-escalation Training provided to all sworn personnel

Law Enforcement: Phoenix and Mesa Police There are basically two ways a community member can “intersect” with law enforcement: 1. Call comes into 911, either from community or Crisis Line 911 will type “possible CIT situation” The dispatcher will read “possible CIT situation” to officers If a CIT officer is available they will respond or respond with the closest available officer If it is an Emergent Pickup Order, dispatch will send a CIT officer and a supervisor In Mesa, 75% of Pick-up orders are served by CRT Unit -Non-emergent orders are held for CRT

Law Enforcement: Phoenix and Mesa Police There are basically two ways a community member can “intersect” with law enforcement: 2. An officer on routine patrol is “flagged down” If they discover that the person they are contacting has a cognitive impairment, they can request a CIT officer

Law Enforcement- Phoenix Police Department If the officer chooses to refer an individual to a resource, they have a few choices. In order of least restrictive, they are: Give Crisis Line number or call for them Request a mobile team Transport voluntarily to: Receiving Centers: UPC/RRC/CPEC Access point/detox: east, west, or central Transport involuntarily to:

Law Enforcement: Phoenix Police Department

Total Law Enforcement Diversions

Maricopa County CIT Programs Prior to 2015, one CIT Program provided training for the Metro Phoenix Area Crisis Collaboration was established On average, 2 schools were conducted a year Run by Phoenix PD and Tempe PD In 2015, The East Valley CIT Program Collaboration was established Need for more CIT officers Directed by command staff Run by 4 different agencies In 2016, the West Valley CIT Program was created Includes 8 West Valley agencies

Maricopa County CIT Programs Agency Number of officers trained ASU PD 2 ASU West PD 1 Avondale 18 Buckeye 13 Chandler 15 DPS 6 El Mirage 14 FBI 4 GCU PD Gila River PD 5 Gilbert Glendale 12 Goodyear 24 MCAO MCSO 21 Mesa 23 Peoria Phoenix 31 Pinal Co SO Salt River PD Scottsdale 20 Surprise Tempe 28 Tolleson 3 VA Police Wickenburg Since 2017, 310 officers trained by the 3 schools.

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Receiving Centers: Connections AZ and RI International “No wrong door” with immediate access to care Commitment to LE and the community Truly no wrong door – aggression, ok Utilization of peers Crisis Advisory Council Monthly meetings with law enforcement Diversions from emergency departments Familiar Face programs Observation and Inpatient services Sarah and Steven

Connections AZ and RI International Crisis navigators/PRT Leadership are regular CIT educators Post-discharge metrics of success Seamless partnership Collaboration with LE on community events Post-discharge follow up Reduction in psychiatric boarding Police drop off time (less than 10 min for over 1,000/month) Sarah and Steven

Connections AZ: UPC (Urgent Psychiatric Center) Unique Services Front Lobby Bridge medications Low escalation to observation Triage for appropriate care MAT services – direct referrals from crisis unit to MAT clinic Community Assisters 20 fully integrated RSS staff Steven

RI International: RRC (Recovery Response Center) Unique Services More than 50% of the transitional living beds in the county Permanent Supported Housing units Crisis Respite unit National leader in peer employment training More than 50% of employees nationally are peers Wellness City – outpatient program Sarah

Maricopa County Data

Urgent Psychiatric Facility Average Monthly Volume Maricopa County Data Urgent Psychiatric Facility Average Monthly Volume CPEC 1,002 RRC 411 UPC 947 Jan- June 2018 Data CPEC= 973+922+1009+1044+1058+1010=6016/6=1002 RRC= 441+422+421+424+427+441=2576/6=429 UPC= 917+835+1003+1010+953+964=5682/6= 947

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Prevention What if… There was an intercept 0 Assertive Community Treatment (ACT) and Forensic Assertive Community Treatment (FACT) 24 total teams in Maricopa County Respond to crisis situations http://www.actassociation.org/actModel/ Case Management Mobile Team Follow Up Community Outreach and Engagement Mesa Mental Health Awareness Fair Peoria Homeless Outreach Event Be Safe Events Prevention- During this presentation, you will develop greater knowledge of the efforts in Maricopa County, Arizona to provide preventative measures to reduce the likelihood of recidivism by connection to ongoing services, using peer supports, and highlighting the work of community providers. Move Prevention to the end What do we do to prevent crisis/police interaction- ACT/FACT Teams Mental Health Fairs/Peoria Homeless Outreach- events that we do to help people have information and hopefully prevent a need for police/crisis interaction ACT/FACT Individually tailored with each member to address their preferences and identified goals for those with severe and persistent mental illness to make improvements in functioning to better manage symptoms, achieve individual goals, and maintain optimism. Developed to work with those who have avoided or have been unresponsive to traditional outpatient mental health care, as well as those with co-existing situations Team approach, community setting, flexibility, multidisciplinary, and crisis management. Staffing- includes specialty positions and all team members work with all other members. Available 24/7/365- they are the crisis provider for the people they work with!

Partnerships between law enforcement and behavioral health Collaboration is key! Monthly meeting between police and urgent psychiatric facilities Crisis Community Collaborative CIT Training Police culture training

Summary Using the SAMHSA Intercept Model to assess opportunities for diversion and collaboration between law enforcement and behavioral health Can be done quite successfully Maricopa County’s example Ongoing collaboration and communication Commitment to law enforcement

Resources Mercy Care City of Phoenix Police Department https://www.mercycareaz.org/ City of Mesa Police Department http://www.mesaaz.gov/residents/police City of Phoenix Police Department https://www.phoenix.gov/police RI International https://riinternational.com/ Connections Health Solutions www.connectionshs.com Works Cited AHCCCS Behavioral Health Service Locator. (2018). Retrieved 07 02, 2018, from AHCCCS Arizona Health Care Cost Containment System: https://www.azahcccs.gov/Members/ProgramsAndCoveredServices/behavioralhealthservicesmap.html Community Corrections. (2018, 04 24). Retrieved 07 02, 2018, from National Institute of Justice: https://www.nij.gov/topics/corrections/community/Pages/welcome.aspx SAMHSA GAINS Center for Behavioral Health and Justice Transformation. (2017, January 17). Retrieved August 07, 2018, from SAMHSA Substance Abuse and Mental Health Services Administration: https://www.samhsa.gov/gains-center (Patty Griffin, PhD) SAMHSA’s Efforts on Criminal and Juvenile Justice Issues . (2017, 12 11). Retrieved 07 02, 2018, from SAMHSA Substance Abuse and Mental Health Services Administration: https://www.samhsa.gov/criminal-juvenile-justice/samhsas-efforts   Patty Griffin, PhD- SAMHSA Gains Center https://www.samhsa.gov/gains-center

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