Not that kind of chatroom: A videoconferencing program CIT continuing education CIT International Conference August 15, 2018 MATT

TODAY’S PANEL Detective Benjamin Melendrez Detective Lawrence Saavedra Detective Matthew Tinney MATT

Learning objectives Identify the need for continuing education for law enforcement in the areas of mental health and substance use. Describe how the CIT ECHO is being used to train law enforcement throughout New Mexico and the country. Describe the mixed methods approach being used to evaluate the CIT ECHO program and understand implications of the evaluation’s findings. MATT

Why do we need more accessible continuing education for CIT? MATT

Multiple Points of Interaction between Police and Individuals with Mental Illness and Substance Use Disorders History of police arrest 25% of people with serious mental illness have histories of police arrest 25% 5% 12% Calls for Service 5% of police calls for service involve people with behavioral health problems Pathway to care 12% of individuals have police involved in their pathway to mental healthcare MATT Source: Livingston, J. D. (2016). Contact Between Police and People With Mental Disorders: A Review of Rates. Psychiatric Services, 67(8), 850–857.

There is tremendous variation in the type and amount of training police departments provide for their officers in how to respond to people in behavioral health crisis Continuing education and specialized trainings do not receive the same degree of attention as entry level training Funding opportunities for field officers remains a top concern for many departments MATT In 2017, the Council of State Governments Justice Center released a report on state standards for training law enforcement in mental health and crisis de-escalation training. A survey was distributed to all state POST (peace officer standards and training) or other law enforcement training authority in 50 states and 3 territories 42 states responded These three bullet points are from their primary findings Source: Plotkin, M., & Peckerman, T. (2017). The Variability in Law Enforcement State Standards: A 42-State Survey on Mental Health and Crisis De-escalation Training. The Council of State Governments Justice Center.

The Number Of Behavioral Health Related Calls By Year for APD MATT We’ve seen an increase in the number of behavioral health related calls and we expect to see this number to continue to increase Source: Winograd, Peter and Brown, Kylynn. The Albuquerque Police Department Crisis Intervention Unit Data Book: A Working Compendium. June 15, 2018.

Traditional CIT Training 40 hour class. Limited upkeep. ? MATT

GRANT FUNDING & TIMELINE $250,000 for a three year grant: 10/1/2015 – 9/30/2018 BJA FY 2015 Justice and Mental Health Collaboration Program: Planning and Implementation Grant 2014 APD attends Project ECHO Clinic Received BJA Grant Funding 2015 Launch of First CIT ECHO 2016 116 ECHO Sessions Held Present MATT Matt, you can use this timeline as a cue to explain the brief history of how CIT ECHO got started and what you all did to get up and running with the weekly sessions. You can also mention that in May 2018 we were awarded funding through the New Mexico State Targeted Response (STR) Initiative her or later.

Implementing the CIT ECHO Partners: Albuquerque Police Department Project ECHO University of New Mexico, Department of Psychiatry & Behavioral Sciences, Division of Community Behavioral Health Crisis Intervention Team Inc. Presbyterian Healthcare Services Implementing the CIT ECHO BEN The program began hosting weekly sessions in January 2016

PROJECT ECHO CORE CONCEPTS Video-Conferencing Network Hub & Spoke Model Case Based Learning Demonopolizing Knowledge Develops Subspecialty Expertise Over Time BEN

CIT ECHO FACILITATION BEN Hub and spoke model

Traditional CIT Training The CIT ECHO Model 40 hour class. Limited upkeep. ! ? ? ! BEN

Each CIT ECHO Session Consist of Two Parts Brief DIDACTIC (45 minutes) Debriefing CASES BEN

DIDACTICS Curriculum Modules: CIT Policing Psychiatric Diagnoses Substance Use De-escalation & Communication Officer Self-Care Resources Special Trainings BEN Didactics last approx. 45 minutes Curriculum topics must be related to 1 or more of these 7 identified curriculum areas Pie chart shows a break down of the curriculum areas we have covered since implementing the CIT ECHO. Pie chart starts with CIY policing and runs clockwise to correspond with the legend

DIDACTIC CURRICULUM 1. CIT POLICING 3. SUBSTANCE USE Barricade Situations Suicide by Cop Communicating with Doctors Certificates of Evaluation 2. PSYCHIATRIC DIAGNOSES Bipolar Affective Disorder Schizophrenia Psychosis Paranoia Autism Spectrum Disorders PTSD 3. SUBSTANCE USE International Drug Trafficking Suboxone vs. Methadone Alcohol Use Disorder Opioid 101 for Law Enforcement Common Drug Street Names Cannabis Myth Busting 4. DE-ESCALATION & COMMUNICATION Basics of the PURE Model Active Listening Skills Verbal Judo 5. OFFICER SELF-CARE Tactics for Officer Well-Being Mindfulness Exercise in the Treatment of Depression 6. RESOURCES New Mexico Crisis & Access Line NAMI: An Overview of Services APD’S C.O.A.S.T. Program 7. SPECIAL TRAININGS Transgender 101 Media’s role in Reporting Mass Shootings Motivations of a Serial Killer BEN

DEBRIEFING CASES Debriefing Template LAWRENCE Case Debriefings give officers an opportunity to receive feedback and recommendations from their peers, experienced detectives, and a team of psychiatrists on on-going cases, or calls for service, involving behavioral health. Debriefing template is completed by the psychiatrist and then notes and recommendations are sent to the presenting officer by the project coordinator.

Case Example Collateral: Female, 94 y.o., good physical health, recent hospitalization, prior contact with family reference female’s erratic behavior Reason for contact: Subject refusing to exit taxi cab and wanted to be driven to a party for family member celebrating the death of an ex-spouse, this turned out to be a delusion. Family members called for police assistance and officers on-scene called the on-call CIU detective. LAWRENCE

Case Example Clarifying Questions How quick was the onset to her behaviors? Has she been treated for any infections? Was she on any medications and what were they? History of dementia, violence, or drug use? Availability of weapons? LAWRENCE

Case Example Outcomes Short-term Subject admitted to geriatric unit, received treatment and was given a discharge plan with prescribed medications Long-term Treatment Guardian Admitted to long-term care facility LAWRENCE

BENEFITS OF CASE DEBRIEFING CIT ECHO works hand-in-hand with the Crisis Intervention Unit LAWRENCE Discussion of the benefits of presenting this case – how you were able to discuss the details of the case with both doctors

Evaluating the CIT ECHO MATT

Mixed Methods Approach Online surveys to assess impact on knowledge related to the content presented in the session (weekly) Online surveys to assess satisfaction with the technology and curriculum and impact on self-efficacy (3+ sessions) Semi-structured interviews with stakeholders to obtain feedback about the face validity and practical utility MATT Here you can mention that Dr. Annette Crisanti is the PI (Principle Investigator) for the evaluation of the program. Jenn Earheart, Project Coordinator of CIT ECHO, also serves as the RA (Research Assistant) for the evaluation. The objective of the evaluation is to determine the reach and effectiveness of the CIT ECHO with respect to: (1) satisfaction with training content and technology among stakeholders and participants, and (2) impact on knowledge among participants of Crisis Intervention Training policing and self-efficacy when interacting with individuals living with mental illness. Preliminary process [e.g. number of trainees] and outcome data will be presented and implications of the findings will be discussed.

Participating Agencies: January 2017 – July 2018 Albuquerque Ambulance Service Albuquerque Fire & Rescue Albuquerque Police Department American University of Antigua Aurora, IL Police Department Bernalillo County, NM Sheriff’s Office Chicago, IL Police Department Comprehensive Healthcare Yakima, WA Dayton, OH Police Department Everett, WA Police Department Gastonia, NC Police Department Huntington, WV VA Medical Center Jicarilla Apache Police Johnston County, NC Mental Health Center King County, WA Sheriff’s Office Las Cruces, NM Police Department McKinley County, NM Sheriff’s Office New Mexico Law Enforcement Academy New Mexico Probation & Parole New Mexico State Police New York EMS North Richland Hills, TX Police Department Ontario Canada Police College Pinellas County, FL Sheriff’s Office Portland, OR Police Bureau Rio Arriba County, NM Sheriff’s Office Rio Rancho, NM Police Department San Juan County, NM Sheriff’s Office St. Martin’s Mobile Crisis Teams St. Paul, MN Police Department Stevens Point, WI Police Department Tulane University U.S. Probation & Parole Wicomico County, MD Health Department MATT We have participants from Washington, Oregon, Wisconsin, Illinois, Florida, Maryland, and Ontario, Canada

Process Data: January 2017 – July 2018 34 Agencies 203 unduplicated participants 28.2 participants per session 100.73 hours of continuing education 51 calls for service debriefed MATT January 1, 2017 – July 31, 2018: 100.73 hours of continuing education 28.2 people per session 51 calls for service debriefed

PARTICIPANT DEMOGRAPHICS MATT The ‘N’ for the Fire Department is 2 Define COAST acronym – Crisis Outreach and Support Specialists Other Category includes CIT Coordinators, Chaplain, Curriculum/Training Personnel

PARTICIPANT DEMOGRAPHICS MATT Interesting that our participants are early in their career or veterans

EVALUATING OUR EFFECTIVENESS To what extent did the information in this week’s session improve your knowledge of the presentation topic? How likely are you to use the information that you learned in this week’s session in your job? To what degree did this week’s session impact your knowledge of resources in the community? After attending this week’s session how would you now rate your ability to interact with an individual in a mental health crisis? MATT In the weekly survey we also ask participants the following questions, Based on the information you rec’d in this week’s session are there any changes that you would make in your interactions with people living with mental illness? If yes, they can elaborate. Are there any challenges or concerns about implementing the information that you rec’d in this week’s session? If yes, they can elaborate. What did you like best about this week’s session? What did you like least about this week’s session?

Session Impact on Perceived Ability to Interact with Individuals with Mental Illness for all CIT ECHO Didactics MATT Highest rated curriculum area is psychiatric diagnoses De-escalation is also highly rated, even higher than the traditional CIT policing module You can talk about how the self-care module wasn’t originally a part of the curriculum and then we decided to incorporate based on need and officer response

What’s Next? Success Changes to SOPs and curriculum/training Identification of best practices Challenges Officers debriefing cases Meeting time doesn’t work for all officers MATT

THANK YOU! ANY QUESTIONS? Contact Information: Detective Benjamin Melendrez - bmelendrez@cabq.gov Detective Lawrence Saavedra - ldsaavedra@cabq.gov Detective Matthew Tinney - mtinney@cabq.gov MATT Maybe at this point also mention that we have a sign-up sheet at the front of the room that people can sign if they have more questions but don’t have time to stay or if they’d like to sign-up for the CIT ECHO.

Using Zoom Run through these slides if time permits

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