Central Receiving Center A Community Effort Sgt. Jules Brace Orange County Sheriff's Office Youth Services Section Crisis Intervention Team Samantha Holden, LMHC Senior Clinical Manager Central Receiving Center and Access Center Aspire Health Partners

Belvin Perry Jr. Central Receiving Center (CRC) System of Care August 16, 2018

Before the CRC Inappropriate use of the local hospital emergency departments – creating long waits for emergent care Bookings in the Orange County Jail, and the costs associated with high risk, psychotropic medications and jail resources to manage these vulnerable consumers

Before the CRC Inability to recognize substance use withdrawal resulted in (2) deaths in our local jail CRC was one of 200+ recommendations from the Orange County Jail Oversight Commission Long waits for a consumer to be placed in a treatment bed at every entry point

Pre CRC System of Care CONSUMER Mental Health Baker Act Center for Drug Free Living Addition Receiving Facility (ARF) Lakeside Behavioral Healthcare Florida Hospital Emergency Room CONSUMER Mental Health Baker Act Substance Abuse Marchman Act Law Enforcement Officer Orlando Regional Hospital Emergency Room Pre CRC System of Care Jail Other local Hospitals

CRC Opens CRC OPENS APRIL 13, 2003

History of the CRC Central Receiving Center system of care for Orange County Central point of access for integrated assessment for involuntary mental health (Baker Act) and substance abuse (Marchman Act). Jail Diversion for Law Enforcement use in Orange County State of the art facility, only one of its kind in the State of Florida – currently being replicated through State Funding Initial Partnerships Department of Children and Families Lakeside Behavioral Healthcare - Aspire Health Partners The Center for Drug Free Living – Aspire Health Partners Florida Hospital and Orlando Regional Healthcare

History of the CRC A transportation waiver was approved to allow all law enforcement to bring to CRC, one central location With an ASO, utilized a rotation of placing insured clients appropriately and the uninsured stayed in the public system On going collaboration among community and providers Since 2007, Florida Hospital and Orlando Health purchase CSU beds within Aspire to serve uninsured in emergency department

CRC System of Care Central Receiving Center < 23 hours Asipre Health Partners Center for Drug Free Living Detox 5-7 days Aspire Health Partners Lakeside Crisis Stabilization Unit / Detox? Short-term Residential Treatment Unit 3-5 days Other Psychiatric Home Hospital Hospital VOLUNTARY / INVOLUNTARY Law Enforcement Officer Central Receiving Center < 23 hours 9

CRC System of Care Central Receiving Center < 23 hours Asipre Health Partners Center for Drug Free Living Detox 5-7 days Aspire Health Partners Lakeside Crisis Stabilization Unit / Detox? Short-term Residential Treatment Unit 3-5 days Other Psychiatric Home Hospital Hospital VOLUNTARY / INVOLUNTARY Law Enforcement Officer Central Receiving Center < 23 hours 10

Funding History FY 2003-2005 – County General Revenue, Florida Hospital and Orlando Health - $2.1M FY2005 - $2.8M in State Appropriations FY2006 - $3M in State Appropriations FY2007 - $2.25M in State Appropriations FY2008- $500K in State Appropriations FY2009 – FY2104 - $0 in State Appropriations FY 2015 $3M ($500K – non recurring) in State Appropriations * Orange County Board of County Commissioners/Mayor fund the CRC $2M annually since 2003

Current CRC System of Care Aspire Health Partners Center for Drug Free Living Detox 5-7 days Aspire Health Partners Crisis Stabilization Unit / Detox/ Lakeside Short-term Residential Treatment Unit 3-5 days Other Psychiatric Home Hospital Hospital VOLUNTARY /INVOLUNTARY Law Enforcement Officer Central Receiving Center < 23 hours Central Receiving Center Phase Two Intensive Care Coordination Permanent Housing Transitional Housing Residential Treatment (2008) CRC

CRC Update HISTORY Operational since April 2003 Integrated 24/7 model April 2003/June 2015: Approximately 61,000 screened 98% Law Enforcement, 2% Hospitals Of those screened: 74% Baker Acts 7% Marchman Acts 23% of those brought to the CRC are homeless

CRC Update JAIL DIVERSION EFFORTS Jail had become the defacto mental health facility Average length of jail time for mental health misdemeanant - 51 days To date over 200,000 saved (Jail Bed Days) Provides an alternative to arrest Law enforcement drop off averaging 12 minutes Cost Savings to law enforcement approximately $3.8M

Local Hospital Savings Prior to the CRC, LEO would take clients to the closest Emergency Department Cost avoidance to local hospitals $25M – $56M Diverted over 28,000 patients from local emergency departments

CRC Phase II Update ANCHOR – TRANSITIONAL HOUSING PROGRAM Provided services and housing to over 621 chronically homeless individuals with co-occurring disorder since 2008 45% of residents who stay longer than 30 days transition to permanent housing 93% of residents receiving employment services are gainfully employed Average length of time in the program is 4-6 months

CRC Phase II Update CARE COORDINATION Currently 9 intensive case managers caseloads of approximately 10 - 15 clients Prior to CRC Care Coordinator intervention, targeted consumers maintained an average of 10.7 bed days per month and after engagement and intervention for at least 90 days these consumers averaged 3.8 bed days per month.

THE LAW ENFORCEMENT PERSPECTIVE The best car safety device is a rear-view mirror with a cop in it. ~ Dudley Moore

Astynomiaphobia THE LAW ENFORCEMENT PERSPECTIVE Anxiety associated with LEO contact LEO often 1st contact with persons in crisis Minimize time with LEO & maximize time with MH professionals Programs should mirror community needs Astynomiaphobia- one does not have to have this condition to have anxieties when dealing with the police. Perhaps the most useful aspect of a CRC is that it minimizes the contact with police for persons in crisis and expeditiously gets them to Mental Health and Medical professionals for services. DOJ Report (05/2006) Police officers frequently encounter people with mental illness—approximately 5 percent of U.S. residents have a serious mental illness,§ and 10 to 15 percent of jailed people have severe mental illness.2 An estimated 7 percent of police contacts in jurisdictions with 100,000 or more people involve the mentally ill. Orange County- 2010 census, the population was 1,145,956, Note: Duval County- 2010 census, the population was 864,263. A three-city study found that 92 percent of patrol officers had at least one encounter with a mentally ill person in crisis in the previous month and officers averaged six such encounters per month. Captain Obvious

Statistics THE LAW ENFORCEMENT PERSPECTIVE More people with mental illness are roaming the streets Half of Police Shootings Involve People with Mental Illness 2 million mentally ill go untreated $15 billion is spent incarcerating mentally ill One-third of the homeless are mentally ill 1,000 homicides a year are committed by mentally ill 10-17% of seriously mentally ill kill themselves Statistics There are no federal statistics on police shootings of mentally ill people, but according to the investigation published this week , “a review of available reports indicates that at least half of the estimated 375 to 500 people shot and killed by police each year in this country have mental health problems.” There’s broad agreement that an inadequate public mental health care system, further eroded by $4.53 billion in state-level budget cuts since 2009, has put police on the front lines of a crisis in our society that few officers are adequately trained to handle. As a result, police officials across the country report spending more time and money responding to calls for service that involve mentally ill or emotionally disturbed people, but little data has been gathered to quantify the strain on public resources mentalillnesspolicy.org

THE LAW ENFORCEMENT PERSPECTIVE Policy Response The Janus Effect CIT / CRC Recognition & Resources Single Source Intake Difficult Metric The Janus Effect- how did we get here? How we did it in the 90’s; a personal perspective CIT (Crisis Intervention Training) / CRC Central Receiving Center CIT Model can be broken down to Recognition at first contact by officers and Resources available in the community to assist persons in crisis CRC provides a single-source intake for persons in crisis. Reduces time spent by officers assisting persons in crisis (cops take the path of least resistance) and provides a sole source for processing persons in crisis. This minimizes the typical layers of MH contacts for officers Finally identifying a proper metric to measure program effectiveness can be difficult. We all have work to do but one indicator could be repeat visits by adults in crises. Were they properly assisted during the initial episode?

THE LAW ENFORCEMENT PERSPECTIVE We have more work to do nationwide however statistics suggest progress in Orange County using the CIT & CRC model

THE LAW ENFORCEMENT PERSPECTIVE Policy Response There is more work to be done on the juvenile front… Orange County: 24 % - According to the information received from the Juvenile Assessment Center, in Orange County, of the 3,159 juvenile arrests made last year there were 560 juveniles that received mental health referrals. That youth in the juvenile justice system experience mental health disorders at a rate that is more than three times higher than that of the general youth population. Almost 30% of arrested youth have disorders that are serious enough to require immediate and significant treatment. At least 75% of youth in the juvenile justice system have experienced traumatic victimization

CRC Floor Plan BOS Entry Exit Outgoing Incoming Electrical Assessment workroom Med room LPN office Sleeping Room RN Office Tech Station Office Copy room 1 Sup Office 2 Seclusion room 2 Screening Rooms Seclusion room 1 Break Room Office Linen Laundry 3 4a 4b 5 Property

The Client Experience - Incoming LEO hands off the client to the Behavioral Tech Tech pats the client down LEO goes to complete paperwork Registration is completed Property/Valuable are inventoried Client showers and changes into scrubs Vitals, BAL, UDS

The Client Experience - LPN/RN Document UDS results Completes Health Screening Med Reconciliation/Drug Disposition Disposition Options: Continue with Process Sent out for Medical Clearance Sent out as Exclusionary

The Client Experience - Assessment Specialist Completes an Intake Screening Includes SA Assessment Admin forms (ROI, HIPAA, Client Rights, AFT, etc) Diagnosis Insurance Pre-certs Bed Assignment – 24/7 census staff

The Client Experience - Outgoing A second pat down Collect Belongings/Valuables Collect medications Transport via Aspire transportation department CSU, Hospital Unit, Detox, Medical Hospital, Home

Staffing Patterns 8 hours shifts RN – 1 per shift LPN – 1 on 7-3 and 3-11 shift Techs- four on 7-3 and 3-11, three on 11-7 Driver – 1 per shift Assessors – 3-5 per shift Census – 1 per shift One Clinical Manager One Nurse Manager

Questions ???