1. 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

2. 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.

3. “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.

4. “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.”

5. 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

6. PARTNERS

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

8. 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

9. 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

10. ECHO Model Case based learning Demonopolizing knowledge
Video-conferencing network

11. 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

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

13. 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

14. 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

15. 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

16. The CIT Knowledge Network Is Connecting Agencies Across The Country.

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

18. 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

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

20. 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

21. 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

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

23. 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

24. 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.

25. 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.  

26. 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.”

27. 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)

28. 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.”

29. THE CIT ECHO: YEAR 1 OUTCOMES

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

31. QUESTIONS?