1. Stepping Up for CIT— Mapping Opportunities for Diversion CIT International- August 16, 2018
Tenasha Y. Hildebrand, Crisis and Veteran Services Administrator, Mercy Care
Detective Amanda Stamps, Crisis Intervention Team Coordinator, Mesa Police Department
Detective Sabrina Taylor, Crisis Intervention Team Coordinator, Phoenix Police Department
Sarah Blanka, Crisis Regional Director, RI International
Steven Scott, Director of Operations, Connections AZ

2. Objectives
Overview of the Sequential Intercept Model: What is it? What does it look like in Maricopa County? Why is it important for individuals with mental illness/substance use disorder and the criminal justice system?
Prevention: Using preventative measures, such as connection to ongoing services, peer supports, and highlighting the work of community providers, to reduce likelihood of recidivism in Maricopa County, Arizona.
First Interactions: Understanding the intersection of law enforcement and community. Police drop-offs at urgent psychiatric facilities, work being done at these centers and partnerships with law enforcement.

3. Overview of the SAMHSA Sequential Intercept Model
Intercept 1: Community and Law Enforcement
Intercept 2: Arrest and Initial Detention/Court Hearings
Intercept 3: Jails/Specialty Court
Intercept 4: Reentry from Jails and Prisons to the Community
Intercept 5: Community Corrections
Have your agencies mapped out your system using the sequential intercept model?
Overview of the Sequential Intercept Model- During this presentation, you will have an understanding of what the sequential intercept model is, what it looks like in Maricopa County, Arizona, and highlighting the importance from SAMHSA for individuals with mental illness and/or substance use disorders and the criminal justice system.
#1- divert people with mental health, substance use, or co-occurring disorders from criminal justice into community services without going through the courts.
#2- community supports, criminal justice system, and courts working collaboratively, so that the individual can receive treatment and support
#3- drug courts, mental health courts, vet courts, domestic violence courts, and tribal wellness courts
#4- encourages stakeholders to work together to ensure people coming out of jails and prisons have access to substance use treatment and mental health services; help individual to become fully participating member in the community
#5- probation, parole (
Patty Griffin, PhD- SAMHSA Gains Center

4. Arizona Geographical Service Areas
Mercy Care contracts with behavioral health providers to deliver services for those in crisis, as well as ongoing supports for adults and children.
Operates the largest, by population, integrated public behavioral health system in the United States.
Tenasha
6.9 million Arizona residents and 4.2 million reside in Maricopa County
9,224 square miles in Maricopa County
Mercy Care membership is 900,000 and 1% self-reported veterans

5. Maricopa County, Arizona Crisis System Overview
Walk-in centers for emergent psychiatric and medical needs
Detoxification services
Respite services
Mobile teams
Hospital Rapid Response Teams
Crisis Navigators
Connect to ongoing care
Emergency psychiatric facilities
Process
Involuntary process
ED Hold Coordination
Portal to the Crisis System
Warm Line
Crisis hotline
Urgent psychiatric facilities
Voluntary and
detox facilities
Tenasha
Crisis phones- average 22,000 calls per month; only 0.40% of those calls transferred to 911 and only 8% result in mobile team dispatch
Mobile Teams- 60 mins or less response time; prioritize law enforcement
Urgent Psychiatric Facilities- 57% of the volume for the involuntary and voluntary facilities in 2017 was by law enforcement (UPC, RRC, CPEC)
**In 2017, a total of 22, 169 individuals were diverted by police to one of our behavioral health facilities or mobile teams.
Voluntary Adult Facilities
Detox
**Explain emergency psychiatric facilities and transition throughout the presentation to be receiving centers**

6. Maricopa County Intercept Map

7. Divider Slides 2

8. Law Enforcement: Phoenix Police Department
5th largest city in the U.S.
1.4 million people and growing
4.5 million people in Maricopa County
517 square miles
2,900 officers
Bigger than Philly and gaining on Chicago

9. Law Enforcement: Mesa Police Department
3rd largest city in Arizona
Suburb of the Metro Phoenix area
485,000 people
140 square miles
850 officers

10. Law Enforcement: Phoenix Police Department
Organization
25% of patrol is CIT certified
Uniform pin
CAD log in visible to dispatchers
2 squads of CIT detectives to help with more complex calls
Pickup orders
Barricades
Q & A
1 full-time CIT coordinator
All negotiators are CIT certified
40 hours of disability training for new officers (post academy)

11. Law Enforcement: Mesa Police Department
Organization
25% of patrol is CIT certified
Quarterly training provided
Dispatchers attend 16 hour Crisis Intervention Partners (CIP) class
1 squad of Crisis Response Team (CRT) detectives to help with more complex calls
Pickup orders
Follow-up calls for high utilizers and high-risk citizens
Patrol Assists
Q & A
1 full time CIT coordinator
16 hours Mental Health and De-escalation Training provided to all sworn personnel

12. Law Enforcement: Phoenix and Mesa Police
There are basically two ways a community member can “intersect” with law enforcement:
1. Call comes into 911, either from community or Crisis Line
911 will type “possible CIT situation”
The dispatcher will read “possible CIT situation” to officers
If a CIT officer is available they will respond or respond with the closest available officer
If it is an Emergent Pickup Order, dispatch will send a CIT officer and a supervisor
In Mesa, 75% of Pick-up orders are served by CRT Unit
-Non-emergent orders are held for CRT

13. Law Enforcement: Phoenix and Mesa Police
There are basically two ways a community member can “intersect” with law enforcement:
2. An officer on routine patrol is “flagged down”
If they discover that the person they are contacting has a cognitive impairment, they can request a CIT officer

14. Law Enforcement- Phoenix Police Department
If the officer chooses to refer an individual to a resource, they have a few choices.
In order of least restrictive, they are:
Give Crisis Line number or call for them
Request a mobile team
Transport voluntarily to:
Receiving Centers: UPC/RRC/CPEC
Access point/detox: east, west, or central
Transport involuntarily to:

15. Law Enforcement: Phoenix Police Department

16. Total Law Enforcement Diversions

17. Maricopa County CIT Programs
Prior to 2015, one CIT Program provided training for the Metro Phoenix Area
Crisis Collaboration was established
On average, 2 schools were conducted a year
Run by Phoenix PD and Tempe PD
In 2015, The East Valley CIT Program Collaboration was established
Need for more CIT officers
Directed by command staff
Run by 4 different agencies
In 2016, the West Valley CIT Program was created
Includes 8 West Valley agencies

18. Maricopa County CIT Programs
Agency
Number of officers trained
ASU PD 2
ASU West PD 1
Avondale 18
Buckeye 13
Chandler 15
DPS 6
El Mirage 14
FBI 4
GCU PD
Gila River PD 5
Gilbert
Glendale 12
Goodyear 24
MCAO
MCSO 21
Mesa 23
Peoria
Phoenix 31
Pinal Co SO
Salt River PD
Scottsdale 20
Surprise
Tempe 28
Tolleson 3
VA Police
Wickenburg
Since 2017, 310 officers trained by the 3 schools.

19. Divider Slides 2

20. Receiving Centers: Connections AZ and RI International
“No wrong door” with immediate access to care
Commitment to LE and the community
Truly no wrong door – aggression, ok
Utilization of peers
Crisis Advisory Council
Monthly meetings with law enforcement
Diversions from emergency departments
Familiar Face programs
Observation and Inpatient services
Sarah and Steven

21. Connections AZ and RI International
Crisis navigators/PRT
Leadership are regular CIT educators
Post-discharge metrics of success
Seamless partnership
Collaboration with LE on community events
Post-discharge follow up
Reduction in psychiatric boarding
Police drop off time (less than 10 min for over 1,000/month)
Sarah and Steven

22. Connections AZ: UPC (Urgent Psychiatric Center) Unique Services
Front Lobby
Bridge medications
Low escalation to observation
Triage for appropriate care
MAT services – direct referrals from crisis unit to MAT clinic
Community Assisters
20 fully integrated RSS staff
Steven

23. RI International: RRC (Recovery Response Center) Unique Services
More than 50% of the transitional living beds in the county
Permanent Supported Housing units
Crisis Respite unit
National leader in peer employment training
More than 50% of employees nationally are peers
Wellness City – outpatient program
Sarah

24. Maricopa County Data

25. Urgent Psychiatric Facility Average Monthly Volume
Maricopa County Data
Urgent Psychiatric Facility Average Monthly Volume
CPEC
1,002
RRC
411
UPC
947
Jan- June 2018 Data
CPEC= =6016/6=1002
RRC= =2576/6=429
UPC= =5682/6= 947

26. Divider Slides 2

27. Prevention What if… There was an intercept 0
Assertive Community Treatment (ACT) and Forensic Assertive Community Treatment (FACT)
24 total teams in Maricopa County
Respond to crisis situations
Case Management
Mobile Team Follow Up
Community Outreach and Engagement
Mesa Mental Health Awareness Fair
Peoria Homeless Outreach Event
Be Safe Events
Prevention- During this presentation, you will develop greater knowledge of the efforts in Maricopa County, Arizona to provide preventative measures to reduce the likelihood of recidivism by connection to ongoing services, using peer supports, and highlighting the work of community providers.
Move Prevention to the end
What do we do to prevent crisis/police interaction- ACT/FACT Teams
Mental Health Fairs/Peoria Homeless Outreach- events that we do to help people have information and hopefully prevent a need for police/crisis interaction
ACT/FACT
Individually tailored with each member to address their preferences and identified goals for those with severe and persistent mental illness to make improvements in functioning to better manage symptoms, achieve individual goals, and maintain optimism.
Developed to work with those who have avoided or have been unresponsive to traditional outpatient mental health care, as well as those with co-existing situations
Team approach, community setting, flexibility, multidisciplinary, and crisis management.
Staffing- includes specialty positions and all team members work with all other members.
Available 24/7/365- they are the crisis provider for the people they work with!

28. Partnerships between law enforcement and behavioral health
Collaboration is key!
Monthly meeting between police and urgent psychiatric facilities
Crisis Community Collaborative
CIT Training
Police culture training

29. Summary
Using the SAMHSA Intercept Model to assess opportunities for diversion and collaboration between law enforcement and behavioral health
Can be done quite successfully
Maricopa County’s example
Ongoing collaboration and communication
Commitment to law enforcement

30. Resources Mercy Care City of Phoenix Police Department
City of Mesa Police Department
City of Phoenix Police Department
RI International
Connections Health Solutions
Works Cited
AHCCCS Behavioral Health Service Locator. (2018). Retrieved 07 02, 2018, from AHCCCS Arizona Health Care Cost Containment System:
Community Corrections. (2018, 04 24). Retrieved 07 02, 2018, from National Institute of Justice:
SAMHSA GAINS Center for Behavioral Health and Justice Transformation. (2017, January 17). Retrieved August 07, 2018, from SAMHSA Substance Abuse and Mental Health Services Administration: (Patty Griffin, PhD)
SAMHSA’s Efforts on Criminal and Juvenile Justice Issues . (2017, 12 11). Retrieved 07 02, 2018, from SAMHSA Substance Abuse and Mental Health Services Administration:  
Patty Griffin, PhD- SAMHSA Gains Center

31. Thank You