1. September 25, 2014 DUAL DIAGNOSIS CROSS-FUNCTIONAL TEAM LOUISVILLE METRO GOVERNMENT 2 nd Annual Report-Out Session

2. DDCFT Overview Convened in January 2013 First Cft to include external community partners and Metro agency representatives First time diverse group came to share information and discuss systemic issues

3. Coalescing Events Rising number of heroin abusers displacing alcohol intoxicants in jail LouieStat and MCJC analysis of the jail population found the category of “revolving door” individuals was a primary driver of overall population Jail Policy Committee established subcommittee to focus on “revolving door" population which led to Forensic Assertive Community Treatment (ACT) Pilot Program University Hospital initiative targeting top utilizers of the Emergency Room

4. LMDC Detox Police historically dropped off chronic alcohol intoxicants at The Healing Place Open access detox beds were filled by a younger population of individuals abusing heroin and opiates Metro Corrections operating a detox center with 30-70 inmates going through detox on any given day During CY13, over 70% in detox unit had abused heroin and other opiates

5. DDCFT Charter

6. First Report-Out Session The First Report-Out Session was held in July 2013 with five potential solutions identified including:  Pursing grants and external funding *  Developing a repository of local programs *  Developing a registry of the top 100 system utilizers  Developing community-wide pathways and protocols  Coordinating advocacy efforts * * In process of implementation

7. GAINS Sequential Intercept Mapping February 2014, DDCFT applied and selected as one of seven cities nationally to host a Sequential Intercept Mapping Workshop July 2014, workshop focused on identifying early opportunities for diverting individuals with a dual diagnosis from the criminal justice system

8. GAINS SIM Priorities and Recommendations Priorities identified included:  Early diversion opportunities for law enforcement/Mobile Response Team  Need for additional open access detox beds  Expand technology for data/information sharing (HMIS) GAINS recommendations included:  Creating a centralized database of services and programs  Reduce reliance on Metro Corrections as a detox facility  Address gaps in services for people under the care of State Guardianship  Increase training related to HIPAA and information sharing  Expand Peer Support  Expand reentry case management

9. Evolution of DDCFT Focus on Chronic Alcohol Intoxicants CCMN

10. Community Care Management Network

11. Review of jail and cross-agency data indicated five possible entry points from the high utilizer population  Mental Health  Supportive Housing  Criminal Justice  Substance Abuse  Medical & Dental

12. Release of Information Common release of information to permit sharing of client information

13. Research Projects National Pretrial Demonstration Site National Inventory of ACA Initiatives for Justice-Involved Populations

14. Affordable Care Act Advocacy for Health Home Pilot Partnership with Health Re-Entry Coalition

15. Next Steps Community Care Management Network Implementation Meet with Managed Care Organizations to discuss identified service delivery issues related to Medicaid expansion (detox and Assertive Community Treatment) Network agencies to begin manual data collection based on established data elements and outcomes Establish parameters for HMIS Network operation, begin enrolling network agencies and provide necessary training Complete Release of Information and MOU for data sharing Encourage clients to self-report information with “advanced directives” services plan Establish governance body to oversee access to information and data sharing through network Develop early diversion (pre-arrest) protocols Develop research design and proposal for Institutional Review Board process Pursue grant or foundation funding for demonstration project and research component

16. Next Steps Advocacy/Legislative Agenda Consideration of Jefferson County as Urban Health Home Pilot Pursue grants and funding opportunities to expand capacity for community treatment and open access detox beds Continue and expand the Forensic Assertive Community Treatment (ACT) Program Suspension of Medicaid benefits upon incarceration versus termination Address gaps in services for people under the care of State Guardianship Expand use and understanding of the importance of peer support Expand reentry case management or peer support to provide a “warm hand-off” to ensure successful reentry Provide specific statutory authority for Day Reporting Centers versus operation under existing Home Incarceration statute (KRS Chapter 532)