1. Learning Together: The CIT ECHO for Training Law Enforcement
International Association of Chiefs of Police
October 22, 2017
Presented by:
Detective Matthew Tinney Dr. Nils Rosenbaum
Dr. Dan Duhigg
MATT

2. “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.”
MATT
Define the CIT Knowledge Network on this slide.

3. Zoom Cloud Meetings How to download Zoom
MATT
Instruct participants to download the zoom app during at the beginning of the presentation so they can use the app by the end of the talk.
95% of CIT ECHO participants agreed/strongly agreed that they were satisfied with their overall experience with the technology

4. Multiple Points of Interaction with Individuals with Mental Illness and Substance Use Disorders
One in four people with mental illness have histories of police arrest
One in 10 individuals have police involved in their pathway to mental health care.1
One in 100 police dispatches and encounters involve people with mental health problems.1
Among males aged (2009 data).2
Probation
Parole
General Pop
Serious Psychological Distress
20%
16.8%
9.7%
Illicit drug or alcohol dependence or abuse in past year
40.7%
34.6%
15.8%
Any mental illness
33.3%
29%
18.8%
MATT
A review of over 85 studies found that.. (Livingston in 2016).
Serious Psychological Distress (SPD) is defined for this table as having a score of 13 or higher on the K6 scale during the past year
The Kessler 6 (K6) nonspecific psychological distress scale was used to assess those who met the threshold for SPD in the 30 days prior to the interview. The K6 is a six-question tool developed to screen for serious mental illness among adults age 18 or older in the general U.S. population, with a score of 13 or higher indicating SPD.1 Inmates were asked how often during the 30 days prior to the interview they felt— ƒ nervous ƒ hopeless ƒ restless or fidgety ƒ so depressed that nothing could cheer them up ƒ everything was an effort ƒ worthless. The response options were (1) all of the time, (2) most of the time, (3) some of the time, (4) a little of the time, and (5) none of the time. The responses were recoded from 4 to 0, with 4 assigned to “all of the time” and 0 assigned to “none of the time.
Any Mental Illness (AMI) is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a substance use disorder, that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In 2008, a split-sample design assigned adults aged 18 or older randomly to one of two impairment scales, the World Health Organization Disability Assessment Schedule (WHODAS) or the Sheehan Disability Scale (SDS). For comparability purposes, estimates for Any Mental Illness for 2008 are based only on the WHODAS half-sample. For details, see Section B.4.3 in Appendix B of the Results from the 2009 National Survey on Drug Use and Health: Mental Health Findings.
1Livingston, (2016), Contact Between Police and People with Mental Disorders: A Review of Rates, Psychiatric Services, 67:8, 2016; 2Feucht & Gfroerer, (2011) Mental and Substance Use Disorders among Adult Men on Probation or Parole: Substance Abuse and Mental Health Services Administration Data Review, Summer May 2011

5. Need for Specialized and Ongoing Training
Training historically focused on command/control and officer safety
Non-compliance may 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
MATT
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

6. APD’S CRISIS INTERVENTION UNIT (CIU)
MATT
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

7. PARTNERS
MATT

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

9. Traditional CIT Training The CIT ECHO Model
40 hour class.
No upkeep. ! ? ? !
DAN
Pros:
Impact and reach more people
Keep skills fresh
Lifelong learning
Pro:
Effective training
Con:
Perishable skills
Con:
Officer must dedicate time to learn

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

11. THE CIT ECHO HUB TEAM DAN 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
DAN
Dr. Nancy Martin
Psychiatrist
UNM Department of Psychiatry and Behavioral Sciences
Denise Hovey-Thomas
Crisis Specialist
Crisis Intervention
Albuquerque Police Department
Jennifer Earheart
Project Coordinator
UNM Department of Psychiatry and Behavioral Sciences

12. CIT ECHO 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
DAN

13. The CIT ECHO Is Using Project ECHO To Provide Critical, Ongoing Training To Agencies Around New Mexico And The Nation.
NILS

14. 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
NILS

15. THE CIT ECHO: First Year Reach
NILS
The data presented here is from the project’s pilot year – which was in 2016
Mention that the project first launched with the bootcamp (bootcamp is important bc this shows where the program started to where we are now)
At the bootcamp 31 public safety personnel attended representing 9 agencies across New Mexico

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

17. 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
PURE Model I
Disability Rights
PURE Model II
Sexuality and Stress
Resources for Veterans
Transgender 101
NILS

18. What are the benefits to law enforcement?
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
MATT
Matt – this may be a good place to talk about leadership buy-in/what reception to the project has been like.

19. 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.
MATT
Case 1 – PA System
Case 2 – Sgt. Dietzel
Case 3 – Murder suicide example

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

21. 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
DAN

22. Preliminary Data: Impact on self-efficacy
61 officers completed at least 3 or more sessions and were thus eligible to complete the survey.  
Preliminary data from online surveys (N=42) shows a positive impact on officer self-efficacy.
Because of my participation in the CIT ECHO sessions I feel I am 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.
DAN
82.93% agreed or strongly agreed that after participation in the CIT ECHO 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.

23. Preliminary Data: Impact on self-efficacy
It is the job of law enforcement to link/connect people living with mental illness into treatment.
DAN
Law enforcement are more likely to agree that they have a role in linking/connecting people with mental illness to treatment after participating in the CIT ECHO.

24. Preliminary Data: Impact on self-efficacy
People living with mental illness often require the use of force to maintain officer safety.
DAN
Law enforcement are more likely to strongly disagree that use of force is necessary to maintain officers’ safety when interacting with people with mental illness after participating in the CIT ECHO.

25. Preliminary Data: Weekly Feedback Surveys
Table 1. Means, impact on knowledge and practical utility
Date
Didactic
Mean 1
1/10/2017
Rising Homicide
4.09
1/17/2017
Bipolar Disorder
4.55
1/24/2017
Mindfulness
4.67
1/31/2017
Deadly Errors
3.71
2/7/2017
Barricades/High Risk Suicide
3.89
3/7/2017
First Episode Psychosis
4.29
3/21/2017
Suicide by Cop
3.91
3/28/2017
Stress Management
3.85
4/4/2017
Media & Mass Shootings
3.92
4/18/2017
Identifying Intoxication
4.42
4/25/2017
Psychiatric Emergenices
4.18
5/2/2017
PURE Model I
4.1
5/9/2017
PURE Model II
4.46
5/16/2017
Paranoia
4.36
5/30/2017
Effective Coping Mechanisms
3.5
6/6/2017
Communicating with TBI
4.44
6/13/2017
Jumpers/High Risk Suicide 4
6/20/2017
Autism Spectrum Disorder
4.25
6/27/2017
First Break Psychosis
7/11/2017
PURE Model III
4.13
7/25/2017
Alcohol Use Disorder
4.17
8/1/2017
PURE Model IV
4.33
8/8/2017
Alzheimer's & Dementia
4.23
8/22/2017
Sequential Intercept Model
3.94
8/29/2017
Psychiatric Illness due to Medical Causes
4.06
Totals:
4.1496
To what extent did
the information improve
your knowledge
of the topic?
Not at All
Very Little
Somewhat
Much
Very Much
DAN

26. Preliminary Data: Weekly Feedback Surveys
Table 2. Means, impact on knowledge and practical utility
Date
Didactic
Mean 2
1/10/2017
Rising Homicide
3.73
1/17/2017
Bipolar Disorder
4.27
1/24/2017
Mindfulness
4.44
1/31/2017
Deadly Errors 4
2/7/2017
Barricades/High Risk Suicide
4.33
3/7/2017
First Episode Psychosis
4.29
3/21/2017
Suicide by Cop
3.82
3/28/2017
Stress Management
4/4/2017
Media & Mass Shootings
3.75
4/18/2017
Identifying Intoxication
4.17
4/25/2017
Psychiatric Emergenices
4.18
5/2/2017
PURE Model I
4.1
5/9/2017
PURE Model II
4.31
5/16/2017
Paranoia
4.43
5/30/2017
Effective Coping Mechanisms
3.88
6/6/2017
Communicating with TBI
4.39
6/13/2017
Jumpers/High Risk Suicide
6/20/2017
Autism Spectrum Disorder
4.45
6/27/2017
First Break Psychosis
7/11/2017
PURE Model III
4.13
7/25/2017
Alcohol Use Disorder
8/1/2017
PURE Model IV
4.47
8/8/2017
Alzheimer's & Dementia
4.54
8/22/2017
Sequential Intercept Model
3.53
8/29/2017
Psychiatric Illness due to Medical Causes
4.06
Totals:
4.158
How likely are you to use the information you learned in this week’s session in your job?
Not at All
Very Little
Somewhat
Much
Very Much
DAN

27. Qualitative Feedback: Weekly Feedback
“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.”
“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.”
“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.”
“I liked the give and take of the session and getting to hear from both law enforcement officers 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.”
DAN

28. 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.”
DAN

29. Questions? Matthew Tinney mtinney@cabq.gov 505-553-2229
Nils Rosenbaum, MD
Daniel Duhigg, DO
Jennifer Earheart
DAN