Making Jail Diversion Work in Rural Communities

1. Making Jail Diversion Work in Rural Communities GAINS TAPA Center for Jail Diversion Easy Access Net/Teleconference March 27, 2006

2. C.I.T. in a Rural Community Brown County, Ohio�s Experience Colleen Chamberlain, LSW, M. Ed CIT Project Director Brown County is located in southwestern Ohio, on the Ohio river. It is approximately 40 east of Cincinnati. The Brown County Community Board of Alcohol, Drug addiction and Mental Health Services is the agency that receives state and federal funding to contract for needed services in the community. We also seek grants for other programs, such as This one.Brown County is located in southwestern Ohio, on the Ohio river. It is approximately 40 east of Cincinnati. The Brown County Community Board of Alcohol, Drug addiction and Mental Health Services is the agency that receives state and federal funding to contract for needed services in the community. We also seek grants for other programs, such as This one.

3. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Brown County, Ohio Population = 42,890 Total square miles = 492 Population per square mile = 86 Per capita income = $17,100 Medical facilities = 1 hospital with 35 beds Psychiatric facilities = none Detention facilities = 1 with 36 beds Here is a brief overview of the countyHere is a brief overview of the county

4. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Before CIT: Us and Them Lack of Understanding about Mental Illness Lack of Understanding about Mental Health Services Lack of Understanding about Law Enforcement�s Role and Responsibility When looking at the development of a CIT , there were some definite issues that had to be resolved� ANECDOTE about john and Steve at the election boardWhen looking at the development of a CIT , there were some definite issues that had to be resolved� ANECDOTE about john and Steve at the election board

5. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities More Reasons Not to Get Along Lack of Historical Cooperation Resistance to Change Territorialism Scarce Resources and Little Funding There was no history of cooperation.. This is not really an exclusively rural issue No reason to do anything any differently than we have always done� worked for 20 years, why change This is your dance space, this is my dance space�. When there is nothing, everyone fights over the crumbsThere was no history of cooperation.. This is not really an exclusively rural issue No reason to do anything any differently than we have always done� worked for 20 years, why change This is your dance space, this is my dance space�. When there is nothing, everyone fights over the crumbs

6. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities The Cast of Collaboration You must have the Key Stakeholders involved from the very beginning. Brown County Prosecutor Brown County Sheriff�s Office* Brown County Community Hospital Brown County Juvenile Court Brown County EMT�s Brown County Municipal Court Probation Department Brown County Counseling Brown County Common Pleas Court Brown County Board of Alcohol, Drug Addiction and Mental Health Services *represented law enforcement in the county as they are the largest agency This is a quick overview of the group that we identified as KEY stakeholders in the planning and implementation of this project. The chance of success would have diminished if we had left out any of these stakeholdersThis is a quick overview of the group that we identified as KEY stakeholders in the planning and implementation of this project. The chance of success would have diminished if we had left out any of these stakeholders

7. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities The Background Police Perspective and Goals Increase officers� awareness of mental illness and mental health crisis Increase safety for officers and individuals in crisis Reduce return calls to residences on other days and other shifts by making an appropriate disposition initially Increase the tools available to officers dealing with a mental health crisis What were the selling point for the cops? They face these situations all the time A hands off approach is always preferable Anything to reduce the number of frequent flyer calls Free resources available to them with the ease of a call Decrease the people going to jail Increase the care of those in jail when mental health services are necessaryWhat were the selling point for the cops? They face these situations all the time A hands off approach is always preferable Anything to reduce the number of frequent flyer calls Free resources available to them with the ease of a call Decrease the people going to jail Increase the care of those in jail when mental health services are necessary

8. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Making C.I.T. Viable Inventory of Services Adapting an Urban Model Supporting CIT Implementation Here are the necessary elements to make this work�Here are the necessary elements to make this work�

9. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Inventory of Services Community Resources as the Foundation General Community Hospital Telephone Helpline Counseling Center State Psychiatric Hospital Psychiatric Beds in Neighboring Counties Talk briefly about each of these. Emphasis on the fact that none were connected in any meaningful way.Talk briefly about each of these. Emphasis on the fact that none were connected in any meaningful way.

10. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Adapting an Urban Model Making Modifications Assessing what will work Gaining consensus Maintaining commitment Ensuring sustainability Maintaining fidelity to the intent and purpose of CIT Poor Fit with Urban Best Practice Model Community resources available Training opportunities and obstacles Geography Law enforcement demographics within the county The biggest start up challenge was to take the Memphis model which requires a 40 hour program that selected 25% of the officers to participate, and providing a 24 hour drop off triage site and modify it in such a way that is was do-able with our limited resources , covered all shifts, and met the needs of our officers and lour clients�. IE homelessness is not as big a problem in our Appalachian community ( family steps in most of the time), but there are many isolated locations in which the elderly live� these house often have limited conveniences .. The need for education about adult protective services and resources for elderly caregivers who may be caring for an adult child with MR was necessary here were several issues to consider� , Creating dispositional options other than jail for the CIT officers to access when none existed in the county Lack of a quick turnaround 24 hour access point for officers to drop off clients 2.Absolute impossibility of getting officers off for a 40 hour training� how much was enough time without compromising the integrity of the training. The need to train 100% of officers including CO�s, opening up the training to EMT�s and probation officers and hospital personnel 3.Logistically finding a way to do the training which would open the opportunity to departments that had less than 10 officers.. Some only have 2. And not create tremendous overtime pay issues for communities barely keeping their heads above water�.. Days of the week. Starting times. 3. Finding a way to give officers a chance to interact with mental health consumers in a non-crisis situation� without having group homes or social clubhouses to visit 4. Since it takes over an hour to travel from one side of the county to the other, it was important to facilitate the development of CIT mutual aid� although this existed with �real� emergency calls, often, mental health calls were seen as a nuisance rather than a crisis and hands off was the unofficial response policy� 5. Engaging the small department� face to face meetings�. Using the influence of your champions�. Making use of the first graduates in recruiting their buddies from other departments Making modifications�. Fidelity is an important part of any best practice, but the ability to replicate the Memphis model or even the Ohio Akron model was impossible for us� we had to start with what we had�. Not what we wish we had.. Honing down the CORE ELEMENTS of CIT and focusing on them to create the training.. What is CIT really? general education and improved understanding about mental illness- symptoms, behaviors Providing perspectives from the �other side� for officers Enhancing verbal de-escalation abilities. Increasing ability to communicate with those in mental health crisis Increasing knowledge about dispositional options and improving the resource base for officers to use Making sure mental health support is available to officers 24/7 3. The advisory group of key stakeholders became critical� evaluation of the curriculum, getting in as many �experts� to teach� these are local experts and the very same people that officers may encounter or hear of in their response to CIT calls, securing consumer support for CIT and using them in meeting with officers one to one along with the case management staff 4. Securing on-going involvement and commitment from the stakeholders so that sustainability really becomes a moot point as CIT becomes a part of the professional culture in the county The biggest start up challenge was to take the Memphis model which requires a 40 hour program that selected 25% of the officers to participate, and providing a 24 hour drop off triage site and modify it in such a way that is was do-able with our limited resources , covered all shifts, and met the needs of our officers and lour clients�. IE homelessness is not as big a problem in our Appalachian community ( family steps in most of the time), but there are many isolated locations in which the elderly live� these house often have limited conveniences .. The need for education about adult protective services and resources for elderly caregivers who may be caring for an adult child with MR was necessary here were several issues to consider� , Creating dispositional options other than jail for the CIT officers to access when none existed in the county Lack of a quick turnaround 24 hour access point for officers to drop off clients 2.Absolute impossibility of getting officers off for a 40 hour training� how much was enough time without compromising the integrity of the training. The need to train 100% of officers including CO�s, opening up the training to EMT�s and probation officers and hospital personnel 3.Logistically finding a way to do the training which would open the opportunity to departments that had less than 10 officers.. Some only have 2. And not create tremendous overtime pay issues for communities barely keeping their heads above water�.. Days of the week. Starting times. 3. Finding a way to give officers a chance to interact with mental health consumers in a non-crisis situation� without having group homes or social clubhouses to visit 4. Since it takes over an hour to travel from one side of the county to the other, it was important to facilitate the development of CIT mutual aid� although this existed with �real� emergency calls, often, mental health calls were seen as a nuisance rather than a crisis and hands off was the unofficial response policy� 5. Engaging the small department� face to face meetings�. Using the influence of your champions�. Making use of the first graduates in recruiting their buddies from other departments Making modifications�. Fidelity is an important part of any best practice, but the ability to replicate the Memphis model or even the Ohio Akron model was impossible for us� we had to start with what we had�. Not what we wish we had.. Honing down the CORE ELEMENTS of CIT and focusing on them to create the training.. What is CIT really? general education and improved understanding about mental illness- symptoms, behaviors Providing perspectives from the �other side� for officers Enhancing verbal de-escalation abilities. Increasing ability to communicate with those in mental health crisis Increasing knowledge about dispositional options and improving the resource base for officers to use Making sure mental health support is available to officers 24/7 3. The advisory group of key stakeholders became critical� evaluation of the curriculum, getting in as many �experts� to teach� these are local experts and the very same people that officers may encounter or hear of in their response to CIT calls, securing consumer support for CIT and using them in meeting with officers one to one along with the case management staff 4. Securing on-going involvement and commitment from the stakeholders so that sustainability really becomes a moot point as CIT becomes a part of the professional culture in the county

11. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Supporting CIT Train officers Develop CIT curriculum for rural county and adapt urban model for local community Jail Boundary Spanner Work with requirements for jails and hire RN that has psychiatric experience Develop screening tool for mental health and substance abuse issues Develop operational policies Linkage to community services The placement of a full time RN with psychiatric experience has immensely improved the jail medical services and has introduced mental health screening for all inmates. When issues are identified that need attention, referral is made to the psychiatrist that is funded by this grant or the substance abuse counselor who is funded through a byrne grant. Linkage is made for inmates who are released from jail to appropriate community services. Whenever you make systemic changes, there are secondary consequences of all actions� some good and some not so good there are complaints from the local officials about the costs of psych meds being perscribed for inmates while in the jail. There was also thousands of dollars of medical cost savings as the full time nurse was able to deal with medical issues that in the past were sent out to the local hospital for treatment.The placement of a full time RN with psychiatric experience has immensely improved the jail medical services and has introduced mental health screening for all inmates. When issues are identified that need attention, referral is made to the psychiatrist that is funded by this grant or the substance abuse counselor who is funded through a byrne grant. Linkage is made for inmates who are released from jail to appropriate community services. Whenever you make systemic changes, there are secondary consequences of all actions� some good and some not so good there are complaints from the local officials about the costs of psych meds being perscribed for inmates while in the jail. There was also thousands of dollars of medical cost savings as the full time nurse was able to deal with medical issues that in the past were sent out to the local hospital for treatment.

12. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Supporting CIT (Continued) Expanded Helpline Services Provide direct cell phone access for officers to mental health responders Provide 30 minute response time to secure triage site Psych Triage Sites Establish relationship with community hospital to provide a safe environment for assessment Set up area at the jail for psych triage that is pre-booking Security provided by transporting officer Crisis Responders follow case through disposition The help line services in our community were virtually telephone only. On the rare occasion, a counselor would do a face to face evaluation. The responsibilities of this position have changed and face to face evals are required for all officer involved calls. We have introduced the Suicide assessment scale and the Indicator of Violence prediction scale to the tools that the evaluators are using to provided objective data to support their clinical decisions. Triage sites at the local hospital with the creation of a mental health room and at the jail have given CIT officers the opportunity to get a quick evaluation of a person without having to drive to the next county, wait in the ED, and then return, often taking 3-6 hoursThe help line services in our community were virtually telephone only. On the rare occasion, a counselor would do a face to face evaluation. The responsibilities of this position have changed and face to face evals are required for all officer involved calls. We have introduced the Suicide assessment scale and the Indicator of Violence prediction scale to the tools that the evaluators are using to provided objective data to support their clinical decisions. Triage sites at the local hospital with the creation of a mental health room and at the jail have given CIT officers the opportunity to get a quick evaluation of a person without having to drive to the next county, wait in the ED, and then return, often taking 3-6 hours

13. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Supporting CIT (Continued) Psychiatrist for Consultation Consultation services for jail inmates who can�t be diverted, but are presenting symptoms of mental illness Crisis Stabilization Contract with facilities that have crisis services Issues continue with distance and transportation Psychiatric time has been added for the jail. This provided consultation and supervision for the RN and medical physician, medication management for the inmates who are on or need to be on psychiatric meds. Crisis stabilization contract for inpatient alternative.. But once again this is 2 couties awsayPsychiatric time has been added for the jail. This provided consultation and supervision for the RN and medical physician, medication management for the inmates who are on or need to be on psychiatric meds. Crisis stabilization contract for inpatient alternative.. But once again this is 2 couties awsay

14. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Implementation Develop contracts Develop protocols Develop policies Develop CIT curriculum, recruit speakers, begin training Set up outcome monitors Prepare for Murphy�s Law This si a quick checklist of the very basics for implementation, There were a million little things that have cropped up since the start. If you hope for the best and prepare for the worst, you are likely to succeed. This si a quick checklist of the very basics for implementation, There were a million little things that have cropped up since the start. If you hope for the best and prepare for the worst, you are likely to succeed.

15. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Contact Information Colleen Chamberlain, LSW, M. Ed Associate Director CIT Project Director 85 Banting Dr. Georgetown, OH 45121 937-378-3504

16. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Implementing Jail Diversion in Virginia�s New River Valley Victoria Huber Cochran, JD Amy Forsyth-Stephens, MSW Mental Health Association of the New River Valley Blacksburg, Virginia

18. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities

19. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities 1,458 square miles Population 165,000 Four counties One small city (pop. 15,000) Ten towns Fourteen Law Enforcement Agencies Two jails (one regional, one local) Two public universities One community college

20. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Montgomery County Jail Booked approximately 4,400 individuals in 2005 ~60% non-violent crimes ~75% released w/in 72 hrs. ~150 potentially eligible for post-booking jail diversion New River Valley Regional Jail Average Daily Census: ~500 inmates About half within catchment's service area 16% anticipated to have MI/co-occurring SA disorders

21. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Mental Health Services in the New River Valley Public mental health needs met by one community service board agency No public mental health in-patient beds available in the NRV Nearest state hospital facility is two hours away One private, proprietary medical facility with an in-patient behavioral health unit�Carilion New River Valley Medical Center

22. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Our Mantra: �It�s All About Change!� We always all we accomplished was to bring people together to develop relationships and educate one another, then we would have accomplished so much! CIT is a MINDSET, not just about the training!!! If it was that easy, why all the fuss? Importance of consumer piece- cathartic meeting at the jail, everyone opening up and recognizing the need for improvement. Largely due to consumer disclosures. So, we asked ourselves the age old questions, �How do we eat this elephant?� We always all we accomplished was to bring people together to develop relationships and educate one another, then we would have accomplished so much! CIT is a MINDSET, not just about the training!!! If it was that easy, why all the fuss? Importance of consumer piece- cathartic meeting at the jail, everyone opening up and recognizing the need for improvement. Largely due to consumer disclosures. So, we asked ourselves the age old questions, �How do we eat this elephant?�

23. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities The Mechanisms for Making Change� Identifying the needs Targeting the programmatic solutions Identifying and organizing the stakeholders Identifying the leaders/power brokers Acknowledging barriers Allowing ownership in developing solutions Providing consistent organizational support throughout the process

24. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities The Criminal Justice Continuum and Mental Health Intervention Intersections: Pre-booking Post-booking Trial Post-Trial Post-Incarceration (prisoner re-entry)

25. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Two SAMHSA Community Action Grants for Consensus Building, Planning and Implementation of CIT (April 1, 2002 - September 30, 2005) One SAMHSA Targeted Capacity Expansion Grant to Enhance CIT and Create a New Post-Booking Diversion Program (The Bridge) (October 1, 2005 � September 30, 2008)

26. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Pre Booking Diversion: The Crisis Intervention TeamMaking Change in Our Community Post Booking Diversion: The Bridge Program Putting the Puzzle Together

27. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities

28. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Organized 65 Stakeholders into 3 �Strands� Mental Health Law Enforcement Consumer/Community Leaders from 14 law enforcement agencies Representatives from 5 separate governmental entities Consumers, family members and advocates Public and private mental health care providers Magistrates Community organizations

29. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Basics of Rural CIT Implementation Centralized CIT Program coordination with a neutral agency Assemble local volunteer CIT Faculty Conduct at least two trainings per year Reduce/eliminate training fees as resources allow Establish goal for all agencies to train 20% Allow each agency to establish own CIT policies Establish ongoing quarterly meetings of chiefs and sheriffs Train dispatchers Establish centrally located CIT triage facility

30. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities

32. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities

34. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities

35. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities THE OBSTACLES WE ALL FACE Under-funded public mental health systems Stigma Lack of effective means of communication among disparate stakeholder groups Keeping people at the table Developing EBPs and establishing mechanisms to deliver comprehensive services Read slide. Let me read from the letter of support that Major Sam Cochran, CIT Memphis expert, wrote for our grant proposal: �Your project offers particular interest. First, the community effort is not about establishing just a crisis program and moving on. It is about dedication and commitment to introduce a change�one that allows not only a collaboration of systems, but also, a collaboration of communities working together. Secondly, your project in the NRV is unique because you serve a diverse, rural, multi-jurisdictional area. To date, CIT has primarily been replicated in large municipalities. Replicating in a rural setting that involves collaboration between multiple city and county law enforcement jurisdictions is a new challenge, but one very worthy of attention.� Let me now reintroduce Victoria Huber, our Project Facilitator. I�m not sure we could have gotten even this far without the passion, dedication, and caffeine consumption of Victoria. She was the obvious choice as Facilitator, and you�ll now learn why I feel that way!Read slide. Let me read from the letter of support that Major Sam Cochran, CIT Memphis expert, wrote for our grant proposal: �Your project offers particular interest. First, the community effort is not about establishing just a crisis program and moving on. It is about dedication and commitment to introduce a change�one that allows not only a collaboration of systems, but also, a collaboration of communities working together. Secondly, your project in the NRV is unique because you serve a diverse, rural, multi-jurisdictional area. To date, CIT has primarily been replicated in large municipalities. Replicating in a rural setting that involves collaboration between multiple city and county law enforcement jurisdictions is a new challenge, but one very worthy of attention.� Let me now reintroduce Victoria Huber, our Project Facilitator. I�m not sure we could have gotten even this far without the passion, dedication, and caffeine consumption of Victoria. She was the obvious choice as Facilitator, and you�ll now learn why I feel that way!

36. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities MORE OBSTACLES WE ALL FACE Identifying resources for support services e.g., housing, transportation Overcoming consumer resistance Addressing criminal justice systems needs Obtaining judicial buy-in Obtaining prosecutorial buy-in

37. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities � and on top of THAT because we�re RURAL! Coordinating 14 Law Enforcement Agencies and 2 Jails Coordinating multiple public and private service providers Closest public psychiatric hospital is two hours away (Marion) Enlisting support from a local private hospital to develop a modified triage facility Distance/transportation issues Appalachian cultural mindset/values

38. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities AND THAT�S NOT ALL! Complicated, multi-faceted interpersonal relationships Historical suspicion of change Resentment of inequitable resource distribution Multiple court levels, jurisdictions, judges and prosecutors in relatively autonomous court sub-systems

39. GAINS TAPA Net/Teleconference: Making Jail Diversion Work in Rural Communities Recognizing the needs Identifying the solutions Creating the context for change Turning obstacles into opportunities

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