Growing CIT in a Dynamic Community

1. Hillsborough County Sheriff’s Office Growing CIT in a Dynamic Community

2. How do we implement the CIT concept? Administration Foresight Mental Health Professionals/Facilities Specialized Training Application in the Appropriate Fields

3. Where To Begin Identify stakeholders to aid in training --- use community meetings to invite participants to brainstorming sessions. --- mishandled incidents can become the impetus for change within CIT. --- family members are good resources to identify appropriate participants.

4. Team Membership Our goal is to have everyone within the agency familiar with the concept of CIT, so that when an incident arises we are able to effectively work together to obtain the most appropriate response and result. Goal is to have everyone familiar with the concept of CIT, so that when an incident arises we are able to effectively work together to get the best possible end result

5. Team Membership • Over 500 Law Enforcement team members trained • More than 200 Detention team members trained • Communications and Dispatch receive training as well

6. Team Membership • Membership is by application only • 40 hour training using the Memphis Model • Members assigned to all Districts and Divisions

7. Implementation of C.I.T. • 40 hour training • on-duty, difficult to achieve with staffing issues • Law Enforcement, Detention & Civilian staff train together

8. Crisis Intervention Team Culture • It was determined that there was a need to have earlier Crisis Intervention for the mentally ill population in the Hillsborough County jails. • Modeled after the Hillsborough County Sheriff’s Office Law Enforcement program.

9. Detention Team Membership • Conducted introductory roll call training for our facilities that house our inmates, Transportation Bureau and Judicial Protection Bureau (Bailiff’s). • Presentations for our Medical and Classification personnel.

10. How Crisis Intervention Team is utilized within the Detention Facilities • Identify mentally ill inmates at any point during their incarceration • Make referrals to community resources • Referrals to medical staff • Psychiatric evaluation • Document contact in a report and follow-up in 15 days (in most cases)

11. HCSO Medical Advisor • Supervises and coordinates outside community case management, diversion services (VA, diversion, State hospital), and grants • Coordinates with medical/psychiatric staff • Direct involvement in weekly lockdown meetings with detention/psychiatric staff

12. HCSO Medical Advisor Liaison to Public Defender, State Attorney, and courthouse for diversions, ROR, and early release for “at risk” inmates Provides assistance and assurance to family members, attorneys, and community case managers who call with concerns about an inmate’s medical and/or mental health issues

13. Jail In-Reach Mental Health Programs • Jail Diversion Program (MHC) • Jail Case Management/reentry services (MHC – new grant, effective Oct 2011) • Northside Forensic In-Jail Services

14. MHC Diversion Specialist • Diverts misdemeanor/nonviolent offenders • Goes before the Judge for ROR to MHC • Released to CSU on Baker Act • Office located in the detention facility

15. Northside Forensic In-Jail • Work with “Incompetent to proceed” (returns from Florida State Hospital) • Case Manager • Office at detention facility • Psychiatrist • Evaluates for diversion to CARE or Northside CSU

16. HIV Case Manager • Metropolitan Charities • Assistance with medications • Adherence to medications • Housing • Follow-up medical care • Mental health referrals

17. Armor Medical Discharge Planning Program • Operates out of both facilities • Office in facility clinic area • Enrolls in Public Assistance programs if eligible • Assists with placement for chronically ill

18. Veterans Assistance – “Alternatives to Incarceration” • Licensed Clinical Social Worker (LCSW) based at Veterans Administration • Diversion and Case management in the jail for Veterans with PTSD; collaboration with county and state and Veterans Administration.

19. Inmate in Crisis • At approximately 0020 hours, while conducting well being checks in 6C, Module 1, Inmate White stated “I believe the guy on cell 7 is cutting.” • The Deputy responded to cell 7, turned on the light and observed the inmate making slashing motions on his left forearm with a concealed object.

23. Crisis Assessment • Review history – • Past behavior is the best predictor of future behavior, taken into context. • Review medication compliance • Assess willingness to adhere and understand need for medications (if meds recommended by psych)

24. Crisis Assessment Assess willingness to adhere/conform to rules Assess ability to balance actions and consequences Assess orientation to person, place, time

25. Procedural and Operational Mechanisms Standard Operational Procedures (S.O.P.) Implementation of S.O.P. via training Updated training

26. Training Goals Asked for an on-going commitment for future trainings --- plan first year’s schedule --- set goal for number to be trained

27. Agency Outreach Inform other jurisdictions about trainings --- Identify surrounding municipalities to become part of those being trained --- Identify those with expertise in particular topics to volunteer

28. On-going Training Goals Schedule 3-4 CIT trainings per year --- determine where they need to occur --- which agency has the appropriate facility and resources

29. Refresher Training Design/create refresher courses for CIT officers --- Identify additional instructors if necessary --- review curriculum from 40 hour course for appropriateness of what to retain/discard --- determine amount of time between 40 hrs. course and first refresher course

30. Expanding the Support Base Contact and work with statewide coalitions to foster fidelity to the CIT model make composition of group broad enough to include all perspectives

31. Accessing the Legislature Cultivate a working relationship with local legislative delegation --- find out when they meet as a group --- who has an identity with mental health or law enforcement

32. What is needed to sustain the program? Interacting with key law enforcement agencies in the local communities. Supplying instructors for on-going training and refresher courses. Participating with the appropriate regional and statewide coalitions.