1. Central Receiving Center A Community Effort
Sgt. Jules Brace
Orange County Sheriff's Office
Youth Services Section
Crisis Intervention Team
Samantha Holden, LMHC
Senior Clinical Manager
Central Receiving Center and Access Center
Aspire Health Partners

2. Belvin Perry Jr. Central Receiving Center (CRC) System of Care
August 16, 2018

3. Before the CRC
Inappropriate use of the local hospital emergency departments – creating long waits for emergent care
Bookings in the Orange County Jail, and the costs associated with high risk, psychotropic medications and jail resources to manage these vulnerable consumers

4. Before the CRC
Inability to recognize substance use withdrawal resulted in (2) deaths in our local jail
CRC was one of 200+ recommendations from the Orange County Jail Oversight Commission
Long waits for a consumer to be placed in a treatment bed at every entry point

5. Pre CRC System of Care CONSUMER Mental Health Baker Act
Center for
Drug Free Living
Addition Receiving
Facility (ARF)
Lakeside
Behavioral
Healthcare
Florida Hospital
Emergency Room
CONSUMER
Mental Health
Baker Act
Substance Abuse
Marchman Act
Law Enforcement
Officer
Orlando Regional
Hospital
Emergency Room
Pre CRC System of Care
Jail
Other local
Hospitals

6. CRC Opens
CRC OPENS APRIL 13, 2003

7. History of the CRC
Central Receiving Center system of care for Orange County
Central point of access for integrated assessment for involuntary mental health (Baker Act) and substance abuse (Marchman Act).
Jail Diversion for Law Enforcement use in Orange County
State of the art facility, only one of its kind in the State of Florida – currently being replicated through State Funding
Initial Partnerships
Department of Children and Families
Lakeside Behavioral Healthcare - Aspire Health Partners
The Center for Drug Free Living – Aspire Health Partners
Florida Hospital and Orlando Regional Healthcare

8. History of the CRC
A transportation waiver was approved to allow all law enforcement to bring to CRC, one central location
With an ASO, utilized a rotation of placing insured clients appropriately and the uninsured stayed in the public system
On going collaboration among community and providers
Since 2007, Florida Hospital and Orlando Health purchase CSU beds within Aspire to serve uninsured in emergency department

9. CRC System of Care Central Receiving Center < 23 hours
Asipre Health Partners
Center for
Drug Free Living
Detox
5-7 days
Aspire Health Partners
Lakeside
Crisis Stabilization Unit / Detox?
Short-term Residential
Treatment Unit
3-5 days
Other Psychiatric Home Hospital
Hospital
VOLUNTARY / INVOLUNTARY
Law Enforcement Officer
Central Receiving Center
< 23 hours 9

10. CRC System of Care Central Receiving Center < 23 hours
Asipre Health Partners
Center for
Drug Free Living
Detox
5-7 days
Aspire Health Partners
Lakeside
Crisis Stabilization Unit / Detox?
Short-term Residential
Treatment Unit
3-5 days
Other Psychiatric Home Hospital
Hospital
VOLUNTARY / INVOLUNTARY
Law Enforcement Officer
Central Receiving Center
< 23 hours 10

11. Funding History
FY – County General Revenue, Florida Hospital and Orlando Health - $2.1M
FY $2.8M in State Appropriations
FY $3M in State Appropriations
FY $2.25M in State Appropriations
FY2008- $500K in State Appropriations
FY2009 – FY $0 in State Appropriations
FY 2015 $3M ($500K – non recurring) in State Appropriations
* Orange County Board of County Commissioners/Mayor fund the CRC $2M annually since 2003

12. Current CRC System of Care
Aspire Health Partners Center for
Drug Free Living
Detox
5-7 days
Aspire Health Partners
Crisis Stabilization Unit / Detox/
Lakeside
Short-term Residential
Treatment Unit
3-5 days
Other Psychiatric Home Hospital
Hospital
VOLUNTARY /INVOLUNTARY
Law Enforcement Officer
Central Receiving Center
< 23 hours
Central Receiving Center
Phase Two
Intensive Care Coordination
Permanent Housing
Transitional Housing
Residential Treatment
(2008)
CRC

13. CRC Update HISTORY Operational since April 2003 Integrated 24/7 model
April 2003/June 2015:
Approximately 61,000 screened
98% Law Enforcement, 2% Hospitals
Of those screened:
74% Baker Acts
7% Marchman Acts
23% of those brought to the CRC are homeless

14. CRC Update JAIL DIVERSION EFFORTS
Jail had become the defacto mental health facility
Average length of jail time for mental health misdemeanant - 51 days
To date over 200,000 saved (Jail Bed Days)
Provides an alternative to arrest
Law enforcement drop off averaging 12 minutes
Cost Savings to law enforcement approximately $3.8M

15. Local Hospital Savings
Prior to the CRC, LEO would take clients to the closest Emergency Department
Cost avoidance to local hospitals
$25M – $56M
Diverted over 28,000 patients from local emergency departments

16. CRC Phase II Update ANCHOR – TRANSITIONAL HOUSING PROGRAM
Provided services and housing to over 621 chronically homeless individuals with co-occurring disorder since 2008
45% of residents who stay longer than 30 days transition to permanent housing
93% of residents receiving employment services are gainfully employed
Average length of time in the program is 4-6 months

17. CRC Phase II Update CARE COORDINATION
Currently 9 intensive case managers caseloads of approximately clients
Prior to CRC Care Coordinator intervention, targeted consumers maintained an average of 10.7 bed days per month and after engagement and intervention for at least 90 days these consumers averaged 3.8 bed days per month.

18. THE LAW ENFORCEMENT PERSPECTIVE
The best car safety device is a rear-view mirror with a cop in it.
~ Dudley Moore

19. Astynomiaphobia THE LAW ENFORCEMENT PERSPECTIVE
Anxiety associated with LEO contact
LEO often 1st contact with persons in crisis
Minimize time with LEO & maximize time with MH professionals
Programs should mirror community needs
Astynomiaphobia- one does not have to have this condition to have anxieties when dealing with the police. Perhaps the most useful aspect of a CRC is that it minimizes the contact with police for persons in crisis and expeditiously gets them to Mental Health and Medical professionals for services.
DOJ Report (05/2006) Police officers frequently encounter people with mental illness—approximately 5 percent of U.S. residents have a serious mental illness,§ and 10 to 15 percent of jailed people have severe mental illness.2 An estimated 7 percent of police contacts in jurisdictions with 100,000 or more people involve the mentally ill.
Orange County census, the population was 1,145,956, Note: Duval County census, the population was 864,263.
A three-city study found that 92 percent of patrol officers had at least one encounter with a mentally ill person in crisis in the previous month and officers averaged six such encounters per month.
Captain Obvious

20. Statistics THE LAW ENFORCEMENT PERSPECTIVE
More people with mental illness are roaming the streets
Half of Police Shootings Involve People with Mental Illness
2 million mentally ill go untreated
$15 billion is spent incarcerating mentally ill
One-third of the homeless are mentally ill
1,000 homicides a year are committed by mentally ill
10-17% of seriously mentally ill kill themselves
Statistics
There are no federal statistics on police shootings of mentally ill people, but according to the investigation published this week , “a review of available reports indicates that at least half of the estimated 375 to 500 people shot and killed by police each year in this country have mental health problems.”
There’s broad agreement that an inadequate public mental health care system, further eroded by $4.53 billion in state-level budget cuts since 2009, has put police on the front lines of a crisis in our society that few officers are adequately trained to handle. As a result, police officials across the country report spending more time and money responding to calls for service that involve mentally ill or emotionally disturbed people, but little data has been gathered to quantify the strain on public resources
mentalillnesspolicy.org

21. THE LAW ENFORCEMENT PERSPECTIVE
Policy Response
The Janus Effect
CIT / CRC
Recognition & Resources
Single Source Intake
Difficult Metric
The Janus Effect- how did we get here? How we did it in the 90’s; a personal perspective
CIT (Crisis Intervention Training) / CRC Central Receiving Center
CIT Model can be broken down to Recognition at first contact by officers and Resources available in the community to assist persons in crisis
CRC provides a single-source intake for persons in crisis. Reduces time spent by officers assisting persons in crisis (cops take the path of least resistance) and provides a sole source for processing persons in crisis. This minimizes the typical layers of MH contacts for officers
Finally identifying a proper metric to measure program effectiveness can be difficult. We all have work to do but one indicator could be repeat visits by adults in crises. Were they properly assisted during the initial episode?

22. THE LAW ENFORCEMENT PERSPECTIVE
We have more work to do nationwide however statistics suggest progress in Orange County using the CIT & CRC model

23. THE LAW ENFORCEMENT PERSPECTIVE
Policy Response
There is more work to be done on the juvenile front…
Orange County: 24 % - According to the information received from the Juvenile Assessment Center, in Orange County, of the 3,159 juvenile arrests made last year there were 560 juveniles that received mental health referrals.
That youth in the juvenile justice system experience mental health disorders at a rate that is more than three times higher than that of the general youth population.
Almost 30% of arrested youth have disorders that are serious enough to require immediate and significant treatment.
At least 75% of youth in the juvenile justice system have experienced traumatic victimization

24. CRC Floor Plan BOS Entry Exit Outgoing Incoming Electrical
Assessment workroom
Med room
LPN office
Sleeping Room
RN Office
Tech Station
Office
Copy room 1
Sup Office 2
Seclusion room 2
Screening Rooms
Seclusion room 1
Break Room
Office
Linen
Laundry 3 4a 4b 5
Property

25. The Client Experience - Incoming
LEO hands off the client to the Behavioral Tech
Tech pats the client down
LEO goes to complete paperwork
Registration is completed
Property/Valuable are inventoried
Client showers and changes into scrubs
Vitals, BAL, UDS

26. The Client Experience - LPN/RN
Document UDS results
Completes Health Screening
Med Reconciliation/Drug Disposition
Disposition Options:
Continue with Process
Sent out for Medical Clearance
Sent out as Exclusionary

27. The Client Experience - Assessment Specialist
Completes an Intake Screening
Includes SA Assessment
Admin forms (ROI, HIPAA, Client Rights, AFT, etc)
Diagnosis
Insurance Pre-certs
Bed Assignment – 24/7 census staff

28. The Client Experience - Outgoing
A second pat down
Collect Belongings/Valuables
Collect medications
Transport via Aspire transportation department
CSU, Hospital Unit, Detox, Medical Hospital, Home

29. Staffing Patterns 8 hours shifts RN – 1 per shift
LPN – 1 on 7-3 and 3-11 shift
Techs- four on 7-3 and 3-11, three on 11-7
Driver – 1 per shift
Assessors – 3-5 per shift
Census – 1 per shift
One Clinical Manager
One Nurse Manager

30. Questions ???