Crisis Intervention Team (CIT) Engagement in Assisted Outpatient Treatment (AOT)

Disclaimer The views, opinions, and content expressed in this presentation do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS).

Reminders Noise Control Recording Please keep your phones on mute if not taking part of the discussion. Please do not put your phones on hold! Recording This webinar is being recorded.

Webinar Purpose To help ensure sustainability of the AOT program at the conclusion of the SAMHSA grant cycle by engaging non-traditional partners.  CIT coordinators and officers are key nontraditional AOT partners.

CIT Engagement in AOT Overview of AOT Betsy Johnson, Policy and Legislative Advisor, Treatment Advocacy Center Overview of CIT Lt. Mike Woody, (Ret); Past President, CIT International The Intersection of CIT and AOT Mark Giuliano, MSW; Program Director Community Support Sara Servadio, MA, AOT Coordinator Westchester County DCMH Lessons Learned from Cuyahoga County; SAMHSA AOT Grant Recipient Carole Ballard, CIT Coordinator; Cuyahoga County ADAMH Board Capt. James Purcell, CIT Coordinator; Cleveland Police Dept. Questions/Wrap Up

AOT Overview Betsy Johnson Legislative and Policy Advisor Treatment Advocacy Center

What is Assisted Outpatient Treatment? Court-ordered, community-based intervention for individuals with serious mental illness (schizophrenia or bipolar disorder) who cannot, on their own, recognize their need for treatment.  Person under AOT order receives intensive services and supports in the community to help prevent further psychiatric deterioration.

History of AOT

AOT Process Petition/affidavit/application filed in civil (probate) court alleging person meets criteria for AOT spelled out in the law Court holds hearing All due process protections afforded Petitioner bears burden of proof Expert testimony provided Evidence presented must be clear and convincing

AOT Process Con’t AOT intended for stabilized patient based on risk of future deterioration. Timing of petition? Black Robe Effect: Judge commands respect as symbol of authority Judge must embrace the role of primary motivator Works on treatment system, too Rapid response to non-adherence Lack of punishment for non-adherence doesn’t mean lack of consequences

AOT – a court procedure or a program? Successful implementation requires program approach Proactively identify AOT criteria Established process for filing petition/program removes need for families to file petition Deliver treatment, services and intensive case management by dedicated staff Effectively monitor clients Take swift corrective action if client becomes non-adherent Determine point at which AOT is no longer needed

AOT Research Findings Of participants in New York’s AOT program 77% fewer experienced psychiatric hospitalization 74% fewer experienced homelessness 83% fewer experienced arrest 87% fewer experienced incarceration Source: NY Office of Mental Health: Kendra’s Law: Final Report on the Status of Assisted Outpatient Treatment (2005)

Overview of Crisis Intervention Team (CIT) Lt. Mike Woody, (Ret) Akron, OH Police Department Immediate Past President CIT International

What is Crisis Intervention Team (CIT)? Community partnership of law enforcement, mental health/addiction professionals, individuals living with mental illness and/or addiction disorders, families and other advocates. Police-based crisis intervention helps those with mental health disorders and/or addiction disorders access medical treatment rather than placement in criminal justice system due to illness related behaviors.   Promotes officer safety and safety of individual in crisis.

History of CIT CIT Model developed in Memphis and has spread throughout the country. It is known as the “Memphis Model.”  The Memphis Police Department 2 years before “The Incident” (1986) The Catalyst (1988) The Memphis PD after the incident

Core Elements of CIT - 1 Ongoing Elements Partnerships: Law Enforcement, Advocacy, Mental Health Community Ownership: Planning, Implementation and Networking Policies and Procedures

Core Elements of CIT - 2 Operational Elements CIT: Officer, Dispatcher, Coordinator Curriculum: CIT Training (Basic Strategies, Basic Verbal Skills, Stages of Escalation, One on One Interactions, Complex Interventions) Mental Health Receiving Facility: Emergency Services

Core Elements of CIT - 3 Sustaining Elements Evaluation and Research, Evidence of Effectiveness In-Service Training Recognition and Honors Outreach: Developing CIT in Other Communities

CIT - A training or a program? CIT programs are the foundation for developing meaningful collaborations with community behavioral health services, and not merely training for police. CIT programs serve as a catalyst to create a spectrum of interconnected community health services with a “no-wrong door” philosophy, which leads to greater accessibility, improved public safety, and efficient utilization of limited resources. Source: MHFA/CIT White Paper

CIT Research Findings CIT Diversion - Compared to Jail (after 90 days) better connection to community treatment improved mental status symptoms lower rate of re-arrest Source: SAMHSA: Final Report, Dupont (2003) Criminal Justice Jail Diversion Project

Intersection of CIT and AOT Mark Giuliano, MSW Program Director Community Support Sara Servadio, MA AOT Coordinator Westchester County DCMH

Vignettes of AOT and CIT Working Together

Importance of Establishing a Point Person CIT team extends beyond the individual police department CIT is more than just a law enforcement training   Avoid the danger of diffusion of responsibility Always have a back-up

Trust and Follow Through Role of Law Enforcement Practical and pragmatic Burden of decision making Time sensitivity Role of Mental Health Responsive Accessible

Responding to Families and Individuals in Crisis Sensitivity and de-escalation skills a must CIT cannot do it alone Collaborative response between mental health and law enforcement What to do when collaborative response is not available

Addressing Systems Issues Collaboration on individual cases. Forum to discuss system issues. Accessibility, responsiveness, communication and follow through. Partnership leads to more responsive community supports for people with lived mental health and substance use experiences.

Lessons Learned Carole Ballard CIT Coordinator; Cuyahoga County Alcohol, Drug Addiction and Mental Health Services Board Capt. James Purcell Cleveland Police Department

Dos and Don’ts - 1 Do have a full understanding about each other’s roles. Don’t develop programs that involve actions that impact law enforcement/mental health system without their input. Don’t make assumptions about law enforcement’s ability to hold or transport. Do communicate and collaborate with the CIT Coordinator (including updates on potential warrants and AWOL clients).

Dos and Don’ts - 2 Do read and understand the Assisted Outpatient Treatment law. Do be explicit about what you are able to do if no legal warrant and or order is available. Do include law enforcement in regular meetings regarding the status of AOT Program.

Responding to Transport/Order to Convey following AOT Order Mental Health Provider: Completes Client Profile Sheet Coordinates request with local dispatch Contacts CIT Coordinator in order to provide the heads up on the client and order Meets CIT officer at the client address or is available by telephone to the responding CIT officer CIT Officer: Completes CIT Stat Sheet and indicates AOT on the sheet

AOT Order to Convey Purpose for order Communication needs/preferences Triggers/Trauma High risk behaviors/violence/ aggression Suicidal/homicidal ideation past or present Access to weapons Recent stressors

Data Collection of Repeat Orders to Convey Officers complete CIT stat sheet on every encounter/ Indicate if Order to Convey Data compiled/Repeat AOT clients identified and reviewed Concerns addressed by cross systems collaboration committee Use of Force: Law enforcement, in collaboration with representatives from DOJ, review and discuss AOT concerns for problem solving and recommendations

Next Steps for AOT Order to Convey Protocols Information regarding AOT Protocols to be introduced in 2018 AOT Protocols to be part of annual In Service Training beginning 2018 AOT Program to present AOT Protocols at Ohio Association of Chiefs of Police meeting in February, 2018

Q & A Lisa

Communities of Practice Each community of practice will have four (4) quarterly webinar/conference calls that will focus on topics of interest. 1.5 office hours/month will be available for one-on-one technical assistance and guidance by each expert consultant. To schedule one-on-one office hours with Betsy Johnson, please contact: Ashley Schultz aschultz@prainc.com (518) 439-7415 Ext. 5277 Lisa

For more information, contact: Betsy Johnson johnsonb@treatmentadvocacycenter.org