1. Fulton County Justice & Mental Health Task Force
Stepping up initiative
June 21, 2017

2. 5 Sequential Intercept Mapping - Priorities
Develop pre-arrest diversion strategies
Expand housing options
Improve collaboration between courts
Refine and expand reentry/community options
Improve individual data sharing
Work Groups

3. Work Groups/Chairs Develop Pre-Arrest Diversion Strategies
Shedra Jones, Director, Atlanta/Fulton County Pre-Arrest Diversion Initiative
Expand Housing Options
George Chidi, Social Impact Director, Atlanta Downtown Improvement District, Central Atlanta Progress
Improve Collaboration between Courts
Judge Doris Downs, Behavioral Health Treatment Court
Refine and Expand Reentry/Community Options
Violet Ricks, Asst. Chief Strategy Officer, Fulton County Managers Office
Improve Individual Data Sharing
Phenix Ayers-Gaston, Director, Accountability Courts, Superior Court of Fulton County

4. Chair/Grant Recipient
Stepping Up Guide
ORG Structure
1. Committed Leadership
Mandate from County leaders
Representative planning team
Commitment to vision, mission, guiding principles
Planning team chairperson
Project Coordinator
4. Process Analysis
Detailed Analysis – Client Experience journey
Service capacity and gaps
Evidence-based program & practices identifies
Chair/Grant Recipient
Judge Doris Downs
FCSC Staff
Governance Committee
2. Screening & Assessment
Definition of MI, SAD
Validated Screening and Assessment Tools
Efficient process of screening and assessment
Validated assessment for pretrial risk
Mechanisms for data sharing
5. Improvements
Prioritized strategies
Descriptions of needs
Estimates of impact (key outcomes)
Advisory Committee
Work Group Chairs, Law Enforcement, Judges, other key Behavioral Health leaders from the Task Force to ensure system components are represented
Task Force
6. Track Progress
4 Key measures
Process for reporting
Ongoing implementation monitoring
Impact evaluation
3. Data
Define recidivism
Electronically collected data
Baseline data on General population
Routine reports
Work Group 1
Pre-Arrest
Work Group 2
Housing
Work Group 3
Court Collaboration
Work Group 4
ReEntry
Work Group 5
Ind. Data Sharing

5. June July Aug Sept Oct Nov Dec
FCJMHTF Calendar
Group
June
July
Aug
Sept
Oct
Nov
Dec
Location
WG Chairs
9th
(2:00-4:00)
TBD
Fulton County Courthouse, 6th Fl
Task Force
21st *
22nd
(9:00-12:00)
24th
12th
Fulton County Juvenile Court
Advisory Committee
Pre-Arrest WG
(10:30-12:00)
13th
(9:30-11:00)
10th
14th
236 Forsyth Street
Court Collaboration WG
Re-Entry WG
11th
(12:00-1:00)
8th
FC Govt Ctr, 2nd Floor
Data WG ?
Housing WG
21st *(10:30-12:00) 22nd (11:00-12:300
Central Atlanta Progress
* Location is Fulton County Juvenile Court
Other
BJA Visit
Evidence-Based Practice Seminar
Governance Committee

6. Violations Arrest Max-outs Violations 4 local jails in Fulton County
911 Dispatch
GA Crisis Access Line
24/hr ACT Crisis Line
4 local jails in Fulton County
Fulton County Jail: 25-30K bookings; DA’s Office completes intakes;
pre-booking medical screening; MH pre-screening then meet w/clinician (4 Psychiatrists); “1013” involuntary
Atlanta City Jail: Dept. Corr.; 30K bookings (20% to FC Jail); Psych. Unit w/4 clinicians, 8am-midnight; Airport/ICE/State Patrol/Atlanta PD
Violations
Parole
Integrated Residential Substance Abuse Treatment:
4-9 months, to ITF
Grady EMS
40hr/week only
Juvenile Drug- 10
Mental Health- 10
HOPE- 19
Accountability Courts: “Intake Teams”
Veterans
Drug- 125
Mental Health- 125
Corrections
Mental health screening; 30-days of aftercare medication
Police Departments
80% of arrests in Fulton County are by Atlanta PD;
BH Link- CIT training w/LE (suicide, child adolescent, community resources)
Jordan MH Comm. Network
Dept. of Comm. Supervision- Forensic Peer Specialists
Atlanta PD (Homeless bus, HOPE program)
Arrest
Mental Health
BH Link
Medical
Mobile Crisis Access Team
Work w/all 30 LE agencies
Max-outs
State Court
MH only- less than 40; DUI- 119
Pre-trial Services screen for all 3 Courts
PD’s Office interviews everyone for MH issues
Misdemeanor DC MH Court
3-6 months; about 60
Grady Emergency Dept.
150/month w/psychiatric needs; 12-bed psychiatric ED; 2 inpatient units (32-bed crisis unit, about 33 hours and 24-bed inpatient unit, 7 days)-
4% 30-day readmission rate; Discharge- 22,000 community-based services, 3 ACT, case management (600 capacity), outpatient clinic (45,000/year)
First Appearance
Prior to first appearance, referral to Veterans/Drug/MH Courts
Track B calendar
Jail Reentry
Correct Care Solutions: 2 staff; Discharge Planners/Reentry Coordinators; 1,800 clients/5 staff;
misdemeanors/felonies; coordinate w/Public Defenders; 10 staff Alternative Sentencing & Reentry; housing/treatment services
Fulton Co. BHDD Treatment Diversion Court: misdemeanors; 160 in 2016
City Jail: reentry w/sentenced persons
Grady Jail Team
Department of Community Supervision
19,061 individuals; 2 Probation Officers & 2 Counselors on SMI caseload (minimum of 60 active cases); Counselors provide intake/MH screening
Fulton County Jail & Satellites
Average daily census: 2,500
Correct Care Solutions provides mental health services (12-14% are on psychotropic medications)
Competency Restoration Program: mobile in-reach; 75 admissions; 15/yr, mainly psych.; 1/3 restore, 1/3 divert, 1/3 to GA Regional
Atlanta City Detention Center
Census: 700; W/Th/F evening clinics and one other clinic to stabilize to avoid Fulton County Jail; 349 in 2/2017 that were under the influence, SPMI, or first episode psychosis; 3 special management units
Violations
Bound over from Municipal
Magistrate Court
Day Reporting Center
1 MH Officer
Pilot project for women w/SMI and misdemeanors
Supervision Program
About 1,100 felonies/600 misdemeanors
Mercy Care Services
BH Provider
Flag for TOC Calendar
Conflict Defenders
St. Jude’s Recovery- detox
Grady- detox, suicidality, psychotic/stabilization
Track 13
Georgia Regional
Behavioral Health
The Gateway Center
Recovery Supports
Salvation Army; The Gateway Center
Housing/Shelter
The Gateway Center (24/hrs, 330 beds, 8 residential programs, veteran services); Atlanta City Baptist Rescue Mission (men’s housing)

7. Stepping Up Guidelines
Committed Leadership
Timely Screening and Assessment
Baseline Data
Comprehensive Process Analysis/Inventory of Services
Prioritized Policy, Practice, and funding Improvements
Progress Tracking

8. Reducing the Prevalence of People with Serious Mental Illnesses in Jails
The process counties are recommended to take in order to have accurate and accessible data, at any given time, on the prevalence of people with SMIs in jail*:
SMI Definition: Use one common definition for SMI for the purposes of the planning process and to track progress. Each state has a definition of SMI, which is used to obtain federal behavioral health block grants or to establish eligibility for Medicaid insurance, and may be a good starting point.
Screen & Assess: Use a validated MH screening tool upon booking into jail and refer people who screen positive for mental illness to a follow-up clinical assessment by a licensed mental health professional in a timely manner.
Record & Plan: Record screening and assessment results in a database that can be queried, and report regularly on this population.
Track Connections & Progress: When people with SMI are released from jail, develop mechanisms to track their connection to follow-up care in the community, as well as progress to reduce the prevalence of people with SMI in jails

9. Stepping Up Goals Based on Four Key Measures1
Reduce
The number 2
Shorten 3
Increase 4
Lower
The average length of stay for people SMI in jails
The percentage of connection to care for people with SMI in jail
Rates of
recidivism
of people with SMI booked Into jail
Checklist to Establish Baseline Data:
✔ System-wide definition of recidivism ✔
Electronically collected data ✔
Baseline data on the general population in the jail
Routine reports generated by a county agency,
state agency, or outside contractor ✔

10. Prevalence of Mental Illness in Jails as a Function of 4 Key Measures3.
Percentage of People Connected to Care 1.
Jail Bookings among People with SMI +
DIVERTED -
BOOKED 4.
Recidivism
Rate 2.
Average
Length of Stay 9

12. Measuring the Average Length of Stay
Main measure =
Average length of stay for people with SMI, by release type
(pretrial population, sentenced population, etc.)
Additional sub-measures:
Number of unique individuals with SMI screened as low, medium, and high for pretrial risk factors (risk for failure to appear, new criminal activity, etc.)
Comparison of average length of stay for people with SMI vs. general jail population, along with comparison of demographic, legal, and criminogenic information (age, sex/gender, race/ethnicity, offense type/level, etc.)

13. Measuring the Percentage of People with SMI Connected to Treatment
Main measures =
Percentage of people with SMI connected to community-based
behavioral health services upon release,
by release type
Percentage of people with SMI connected to community
supervision and/or treatment programs, by release type
Additional sub-measure:
Comparison of the above data to bookings for the general population, including demographic and criminogenic information (age, sex/gender, race/ethnicity, offense type/level, etc.)

14. Measuring the Rate of Recidivism
Main measures =
Percentage of failures to appear and/or re-arrest for people with SMI released pre-adjudication, and re-arrest for post-jail sentences population with SMI
Percentage of technical violations and new criminal charges for sentenced population with SMI who are assigned to community supervision
Number of prior jail admissions for people identified with SMI
Additional sub-measure:
Comparison of the above data to the general population

15. Why is Collecting Baseline Data Important?
The core premise of Stepping Up is to reduce the prevalence of people with mental illnesses in jails.
In order to do this, counties must have accurate and accessible data on the number of people with SMI in jails, and then measure their progress against that benchmark.

16. Standardized Definitions
We are encouraging all Task Force members to bring and review the different definitions your agency is using and come to a group consensus on the definition that makes the most sense with the data that we have available and for the decision-making purposes that we will be using it for.
Serious Mental Illness
Co-Occurring
Substance Abuse/Use
Recidivism
Length of Stay

17. Process Mapping

18. Next Steps…………….. Updates from Work Groups
Standardized Definitions and Baseline Data
Brief Jail MH Screen
Swim Lane Exercise

19. 1