Communication and Collaboration Among First Responders Success in Venango County 1
Venango County 2
Brief County Description: Population 55,488 and declining 54% live in rural settings (2 small cities) 675 square land miles; 80% forested Limited public transportation 7 police departments within county (3 major departments plus Pa State Police) 3
Demographics Venango County performs worse/much worse than average in 15 of 19 child well-being indicators tracked by PA Poverty levels higher than PA/US rates Per capita and Median Household income lower than PA/US rates High school drop out rates higher than state rates BA degree achieved by 13%, versus PA s rate of 22% and the US rate of 24% 4
Crime Profile PA had the highest prison growth in NE in 2007 In 2005 and 2006 Venango County had the 3 rd highest incarceration rate in the PA (18% increase between 2005 and 2006; 61% increase between 2002 and 2006 County prison daily census in 2007 averaged 148 National Institute of Corrections recommended capacity - 128 American Corrections Association recommended capacity - 144 40% of inmates known to the Mental Health system at any given time 46% of overall individuals incarcerated to the county prison in 2006 and 2007 were known to the MH system. 60% jailed 2 or more times 5
Venango County CJAB Membership Court of Common Pleas Judges Magisterial District Judges County Commissioners District Attorney Domestic Relations Public Defender Substance Abuse Mental Health/Mental Retardation Children and Youth Services Municipal Police Departments Pennsylvania State Police Adult/Juvenile Court Supervision Pennsylvania Board of Probation and Parole County Jail Sheriff s Department **Also members of Mental Health Procedures Committee 6
Mental Health Procedures Sub- Committee Started meeting in 2004 to plan strategies around local hospital merger which created many issues for delegates and first responders. Subcommittee of CJAB. - Met monthly initially but only quarterly now. Attendees: Local police departments, ambulance staff, ER staff, behavioral health unit staff, jail staff, public defender s office, and hospital security staff. Mix of CJAB and others.
2006 Grant Acquisition/ Initiation of System Mapping 8
Background U.S. Department of Justice announced funding for cross-system collaboration Venango County MH/MR and Adult and Juvenile Court Supervision Services collaborated to develop a funding request Notice of Funding received 9/1/06 1 of 27 Nation Wide 1 of 3 in PA 9
May 9, 2006 United States Department of Justice Office of Justice Programs Bureau of Justice Assistance Re: Justice and Mental Health Collaboration Program (CDFA # 16.745) To Whom It May Concern: Please let this letter serve as the endorsement of the Venango County Criminal Justice Advisory Committee (CJAC) for Venango County s application for the above referenced funding. Our request for Category I Planning funds, will allow stakeholders from within our criminal justice and mental health systems to develop a comprehensive plan to identify and divert appropriate offenders suffering from a mental illness from our jails to more suitable programming. The Criminal Justice Advisory Committee is comprised of a diverse group of criminal justice and social service professionals representing the Jail, Substance Abuse, Human Services, Mental Health and Mental Retardation, Courts, Probation and Parole, Juvenile Probation, Municipal and State Police, Sheriff and others; and should serve as a solid foundation to pursue technical assistance and financial support under this announcement. The CJAC supports the objectives of this program to include a reduction in recidivism of the mentally ill in the criminal justice system; increase in the number of criminal justice personnel trained in law enforcement diversion strategies; expansion of court based diversion programs and general increase in service available to the mentally ill offenders in our community. I urge the Bureau of Justice Assistance to grant favorable consideration to this funding request. Sincerely, Oliver J. Lobaugh, Judge Venango County Court of Common Pleas Chairman, Venango County Criminal Justice Advisory Committee 10
Purpose Funding was awarded to develop a comprehensive plan to identify and intercept appropriate adult offenders suffering from mental illness and/or cooccurring disorders from the Venango County justice system at the earliest point possible while promoting public safety 11
A collaborative group of stakeholders is mobilized Kick off breakfast was held Nov. 6, 2007 Invitations to breakfast sent by letter from county s President Judge Oliver Lobaugh, who did the opening welcome. Attendees were requested to sign up for smaller groups based on Intercept Points 12
Planning Approach Large planning group became a sub-committee of the Community Justice Advisory Board (CJAB) Use of Sequential Intercept Model (SIM) to carry out system assessment process 13
The Sequential Intercept Model The SIM advocates developing targeted strategies to address problems and service gaps at each of five intercept points that closely reflect the flow of individuals through the criminal justice system and the interactive nature of the mental health and criminal justice system 14
Sequential Intercept Model Intercept Points 1. Law enforcement/emergency services 2. Initial Detention/Initial Court Hearing 3. Jails, Courts, Forensic Evaluations, and Hospitalization (treatment within the correctional facility is the focus 4. Re-entry 5. Community Corrections 15
Planning Logic Model Goal: Development of a strategic/collaborative plan to initiate system change for the identification and treatment of adult offenders with a mental health or co-occurring disorder that intercepts individuals from the system at the earliest possible point and that address the six BJA objectives. INPUTS ACTIVITIES STRATEGIES OUTPUTS PLANNING OUTCOMES SEQUENTIAL INTERCEPT MODEL FUNDING STEAKHOLDER TIME LEADERSHIP RECRUIT STAKEHOLDERS HIRE FACILITATOR ASSESS NEEDS AND STRENGTHS OF SYSTEM PRIORITIZE SERVICES IDENTIFY LEAD SYSTEM IDENTIFY TRAINING NEEDS IDENTIFY STRATEGIES TO COLLECT, REPORT AND ANALYZE DATA MAKE PLANNING COMMITTEE A SUB-COMMITTEE OF CJAB. OFFER STIPENDS USE OF INTERCEPT REVIEW TOOL REVIEW LITERATURE QUERY STAFF/ LAW ENFORCEMENT ON TRAINING NEEDS REVIEW BJA PM DATA AND IDENTIFY OTHER PM DATA DETERMINE WHICH DATA EXISTS AND WHICH IS NEEDED SUB-COMMITTEE MEETING HELD STAKEHOLDERS ENGAGE IN PLANNING PROCESS INTERCEPT REVIEW TOOL COMPLETED TRAINING NEEDS FOR EACH STAKEHOLDER GROUP IDENTIFIED DATA COLLECTION STRATEGIES IDENTIFIED A COLLABORATIVE GROUP OF STAKEHOLDERS IS MOBILIZED TO DEVELOP THE PLAN AND GUIDE ITS IMPLIMENTATION AN ASSESSMENT OF THE SYSTEM S STRENGTHS AND GAPS, BASED ON THE SIM, IS COMPLETED IDEAL SERVICE COMPONENTS ARE IDENTIFIED FOR EACH INTERCEPT POINT AN IMPLIMENTATION PLAN FOR SYSTEM IMPROVEMENTS AND SUSTAINABILITY IS COMPLETED TRAINING PROGRAM DEVELOPED INCLUSIVE OF LAW ENFORCEMENT AND OTHER STAKEHOLDERS A PERFORMANCE MEASUREMENT AND OUTCOMES EVALUATION SYSTEM IS DESIGNED
An assessment of the system s strengths and gaps is completed Five subcommittees were established that corresponded to each Intercept Point (IP). Each committee met two times First meeting focused on identifying whether ideal service components were available for each intercept point. If a service was not available, the group decided if service development was a high, medium, or low priority. 17
An assessment of the system s strengths and gaps is completed Second meeting focused on the review of strengths/gaps, major themes of gaps, and identification of ideal strategies for addressing gaps. Following the second meeting of all small groups, the Planning Committee reviewed needs across all Intercept Points and observed that they fell into discrete categories (Case management in the Prison and the community, Data/Information sharing, Integrated community treatment and support, identification of diversion options, training and education) 18
Ideal service components and strategies are identified for each Intercept Point A second stakeholder wide meeting was held. Services that were brainstormed at the Intercept Point sub-committee level were prioritized using a nominal group prioritization procedure. Ultimately, prioritization of service development was decided to be largely unnecessary as a wide range of services were identified, some of which did not included additional funding. 19
An Implementation Plan for System Improvements Is Developed Implementation strategies were identified for all ideal service components Viable sustainability strategies were developed as possible Implementation Plan was developed. 20
Mission Statement Venango County will successfully intercept and divert into treatment appropriate persons who have a mental illness who would otherwise have been placed in the criminal justice system Venango County Mental Health & Justice Collaboration 21
Vision Statement People with mental illness are served in the community and diverted from the criminal justice system at the earliest possible time, while still providing for community safety. 22
Performance Measurement Outcomes Evaluation System for Implementation Plan Logic Model is developed Identification of existing data completed Additional data that is desired is identified Data collection barriers Uncertainty about the types of information that can be shared among the stakeholder groups, and at what point 23
Logic Model Outcomes/Objectives Intercept Point 1: Law Enforcement/Emergency Services Procedures to provide assistance to law enforcement are reviewed and refined Peer support provided a.s.a.p. following 1 st contact with law enforcement Family peer support program is developed 24
Logic Model Outcomes/Objectives con t Intercept Point 2: Initial Detention/Hearing Standardized screening and assessment tools are administered to identify suicide risk and presence of mental illness or co-occurring disorders Case management (i.e. boundary spanner staff) is operational to assist courts with alternative dispositions, ensure screening/assessments are completed and link individual to needed services Procedures are developed for quick access to mental health services. 25
Logic Model Outcomes/Objectives con t Intercept Point 2: Initial Detention/Hearing con t Diversion Options Developed to Include: Collaborative Intervention Strategies developed to partner existing interventions to create jail diversion alternatives. For example, house arrest/php. Mobile Psych assessment and treatment expanded from 4 hours/mo to 4 hours/wk and expand to target population. Supervised residential housing developed as an alternative to incarceration. 26
Logic Model Outcomes/Objectives con t Intercept Point 3: Post booking/jail Case Management is operational in the jail to include initial assessment, in-jail service linkage, pre-release planning, and data collection. Additional 8 hours per week of Mental Health counseling is added in the jail. 27
Logic Model Outcomes/Objectives con t Intercept Point 4: Re-Entry to Community Case management is operational (see Intercept Point 2) Individualized probation and parole pre-release plan is developed that establishes realistic conditions for treatment and graduated sanctions if relapse occurs. 28
Logic Model Outcomes/Objectives, con t Intercept Point 5: Community Support Community Support Options are expanded to include: Supported housing for target population Psycho-educational programs for target population. Individualized planning to identify work, volunteer, or training activities, and or participation in other meaningful community activities Transportation plan developed for each individual. Integrated Mental Health/Substance abuse case management for individuals with co-occurring disorders. 29
Logic Model Outcomes/Objectives, con t System Wide Outcomes: All stakeholders receive training regarding mental illness, suicide assessment, diversion options, and other desired topics. Data sharing procedures developed across all intercept points to ensure continuity of information sharing Data collection strategies are developed to ensure that data is collected in a consistent and timely manner and consistent with funding expectations. Quality measurement system developed to measure overall effectiveness of system components in diverting individuals at the earliest point possible. 30
Year One Conclusions: The Barriers Some services that were identified as needed and of high priority are expensive and have questionable sustainability (half way house) The ability to share information among first responders - - It was not clearly known what could be shared among ourselves, and at what point 31
Year 2 Grant: Limited Implementation 32
Background Year one was completed under-budget The project requested, and received approval to extend the grant into a limited implementation phase Focus in Year 2 was on achieving the no cost and low-cost Implementation Objectives and Outcomes 33
Year 2 kick off breakfast was held 9/07 to review accomplishments of planning grant and discuss limited implementation plan Two Trainings Were Presented: 1. Presentation from the Laurel Highlands Crisis Intervention Training Team 2. Training from John Petrila, JD LLM, a professor at the University of South Florida with expertise on HIPAA and Cross System Collaboration Topics were chosen with an eye towards developing an information sharing policy. 34
Crisis Intervention Training (CIT) Innovative program of police-based crisis intervention involving community health care and advocacy partnerships Pre-jail diversion program that directs individuals with mental illness into treatment rather than the criminal justice system 35
Crisis Intervention Training (CIT) Emphasis is on mental health knowledge, crisis resolution skills, and access to community services. Officer learns how to: - arrive on scene non-confrontational - approach individual in crisis - assess situation - promote one on one communication - provide assurance that he s there to help 36
HIPAA, State Law, and Cross-System Collaboration presented by John Petrila. HIPAA Permitted Non-Consented Disclosures for Law Enforcement If use or disclosure is necessary to prevent or lessen a serious threat to the health or safety of an individual or public.
PA Law on Non-Consensual Disclosure Non-consented disclosure is permitted in response to emergency medical situations when release is necessary to prevent serious risk of bodily harm or death must be pertinent to relief of emergency (PA Admin Code 5100.31) --This could be harm to self or others in the case of an individual known to act out physically. Real risk of injuring others or of being injured by first responders due to behavior.
Information Sharing Policy Is Developed as a Result of This Training Intent of Disclosure: Promote best possible outcome for the individual. Mental Health worker may disclose Protected Health Information.if necessary to prevent or lessen a serious and imminent threat to health and safety or a person or the public and if the disclosure is to a person or persons reasonably able to prevent or lessen the threat. Disclosure must be made in good faith.
Exchange of Information between First Responders and the Venango County Mental Health System Policy and Procedures Timeline 1/23/08 Draft policy is developed by Venango County Mental Health and Developmental Services Administrator Jayne Romero. Draft policy is forwarded to John Petrilia for comments/ suggestions. 2/13/08 John Petrila responds and gives basic approval. He references statute on previous slides and notes that policy should only be used in emergency situations. His final caution is that substance use regulations are more stringent so this policy will not work for that. 40
Policy and Procedures Timeline, con t 2/08 County HIPAA policy updated to parallel this policy. 2/29/08 Policy submitted to Mental Health and Developmental Services solicitor. His comments.regulation does permit disclosure of Protected Health Information without authorization of individual, however, an analysis has to be done in each instance to determine what subsection is applicable, keeping in mind that any such disclosure must always be made in good faith and consistent with applicable law and standards of ethical conduct.
Policies and Procedures Timeline, con t 7/08 Policies and Procedures are presented and approved at mental health procedures subcommittee. 10/6/08 Approved by the county s solicitor. His only comments referred to typos. 11/17/08 All policies developed by mental health procedures sub-committee presented at CJAB. 1/20/08 2 nd review of policies at CJAB 2/17/09 Policies officially adopted by CJAB ***Over 1 year to get this done including all approvals. (3 lawyers, 2 committees)
Exchange of Information between 1 st Responders and the Venango County Mental Health System Policy and Procedures Policy: In response to law enforcement official s request, Venango County Human Services through its Crisis Unit and/or Mental Health/Mental Retardation Dept, may disclose protected health information (PHI) in an emergency situation without the written authorization of an individual in situations involving first contact with law enforcement or other 1 st responders. The intent of the disclosure is to promote the best possible outcome for an individual who is known to the county mental health system. Refer to the following sources for legal authority relative to this policy: 55 Pa. Code 5100; 45 C.F.R. and Venango County HIPAA Compliance 43 Policies/Procedures.
Exchange of Information between 1 st Responders and the Venango County Mental Health System Policy and Procedures Policy(cont): The crisis or MH/MR worker may disclose PHI to law enforcement or other 1 st responders if it is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and if the disclosure is to a person or persons reasonably able to prevent or lessen the threat. If the worker believes in good faith that those 2 requirements are satisfied, s/he may disclose PHI and there is no limitation on the type of PHI which may be disclosed other than the worker must in good faith believe that the disclosure of PHI is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person of the public. 44
Exchange of Information between 1 st Responders and the Venango County Mental Health System Policy and Procedures Procedures: 1. Law Enforcement/1 st Responders will contact the CS/MH as outlined in the Individuals Needing Emergency Psychiatric Evaluation flowchart. 2. Requests for the information outlined above may be made to the CS/MH worker who takes the call. 3. The CS/MH worker will provide only the information noted above, to the degree that it is known to the CS/MH worker, or can be quickly discovered by the CS/MH worker. Strategies that the workers can use to discover the information includes but are not limited to, calls to the County Base Service Unit staff, and/or references to mental health records on file at the CS office. 4. The CS/MH worker will document any information disclosed to a 1 st responder on the Protective Services Emergency Examination sheet or in the case record.
Other Policies Developed Thru the Mental Health Procedures Sub-committee Safe Transition to Emergency Department (for 302s and other mental health admissions) Ambulance Transport for Individuals Needing Emergency Psychiatric Evaluation Flowchart Uniform Firearms Act Notification policy Exchange of information between UPMC- NW (hospital) and law enforcement
Other Policies, con t Individuals not appropriate for jail or hospitalization List of transportation options Flowchart and policy regarding those who make a serious suicide attempt and need medical stabilization Flowchart on managing intoxicated patients.
Other Policies, con t Some are joint policies and some are individual agency policies that are brought to the sub-committee for review to ensure that all agencies are apprised of policies. Once approved by Mental Health Procedures sub-committee, all policies are formally adopted by CJAB.
Year 2 Outcomes Standardized screening and assessment tools are administered to identify suicide risk/presence of mental illness Procedures are developed for quick access to mental health services 49
Year 2 Outcomes, con t. Collaborative Intervention Strategies are developed to partner existing interventions (e.g. house arrest and partial Hospitalization) to create jail diversion All stakeholders will receive training regarding mental illness, suicide assessment, diversion options, public safety, correctional procedures, and other desired topics. Data sharing procedures are developed across all intercept points to ensure continuity of information sharing 50
Standardized Screening and Assessment Tools A sub-committee is formed The major focus was to review assessment tools used by jail staff at booking and other times within the jail The Warden agreed to use standardized instruments at booking Correctional Mental Health Screen for Men Correctional Mental Health Screen for Women 51
Procedures for Quick Access to Mental Health Services Procedures are developed for same/next day access to Mental Health services with Community Mental Health Center. Pilot Program developed and implemented with Franklin Police Department to divert at Intercept Point 1. 52
Collaborative Intervention Strategies Collaborative strategies are developed between mental health and AJCSS Creation of 3 emergency shelter beds New practice initiated to discuss release plans/options for inmates who could be released on house arrest if housing/services are available Psycho-educational program expanded in collaboration with State Probation/Parole Preliminary discussions to develop community wide conferences to develop strategies for working with individuals known to all systems who are at risk of incarceration 53
All Stakeholders Receive Training A Detailed Training Plan is developed for reciprocal training The mental health system provided training to criminal justice system while the criminal justice system provided training to the mental health system. 54
Overall Service Changes Intercept Point 1 Pre-Program: Police Receive mental health training as part of ACT 120 training Crisis Services Unit available for non-commitments Current: Crisis Services continues to be available, but now staff are better trained. Extensive training completed Exchange of Information Policies and Procedures are developed Comprehensive policies developed to provide assistance to law enforcement Diversion Plan in effect with Franklin Police Department 3 Emergency beds created Procedures for same/next day access to mental health treatment is developed 55
Overall Service Changes Intercept Point 2 Pre-Program: Access to abbreviated forensic evaluations Some creativity in handling criminal charges Current: Standardized screening/assessment tools Same/next day access to mental health services Collaborative Diversion options Emergency beds Better understanding of how to access forensic evaluations at WSH 56
Overall Service Changes Intercept Point 3 Pre-Program: 4 hours psychiatric time in jail per week 8 hours mental health counseling in jail per week 4 hours Substance Abuse counseling in jail per week Jail advocate provides screening and links to in-jail services Expedited hearings for individuals with mental illness Access to local, abbreviated forensic evaluations Current: **Boundary Spanner in place. Educated jail and mental health staff Data sharing between jail and mental health staff Standardized suicide risk screening tool Mental Health Intake in the Jail setting Knowledge of how to access forensic evaluations at WSH Service planning for identified individuals 57
Overall Service Changes Intercept Point 4 Pre-Program: Mental health participation on Pre- Release Advisory Board Intensive case management for select individuals who had case management prior to incarceration A few days supply of medication Current: **Boundary spanner in place Services available at Pre- Program level Mental Health Intake for individuals receiving services in the jail Immediate access to psychiatric evaluation and continuation of medication supply 58
Overall Service Changes Intercept Point 5 Pre-Program: Emphasis on Recovery Longer criminal justice supervision for individual with a mental illness. Some graduated sanctions for relapse Access to publicly funded mental health services upon release Current: Continued emphasis on recovery, and access to expanded recovery services (MPR, Peer support, emergency housing, housing support, illness mgt group) Expanded treatment services and choice due to HealthChoices Trained community service providers Psycho-education program expansion Forensic housing program launched 59
Two Other Program Were Developed as a Result of Colloboration around the Grant 1. Diversion Pilot with the Franklin Police Department 2. Supported Housing Program Applied for a PCCD grant based on info gathered during initial grant period. 60
Diversion Protocol with Franklin Police Department Protocol developed to guide the Franklin Police Officer, Crisis Services Worker, Court Supervision Officer and the Magisterial District Judge - Police Officer Identification of mental health issues -Involvement of MH system (Crisis Services) -Involvement of Court Supervision -Recommendation to Magisterial District Judge 61
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Supported Housing Program In April 2010 Venango County was approved for a PCCD grant to start a supported housing program for individuals being released from the county jail. 64
Supported Housing Program, con t Basic Overview: Master Lease Program for those being released from the county jail who are homeless. Individuals live in apartments rented by Venango County for 1 st 6 months following release. Dedicated Caseworker works closely with the individual to gain access to benefits and/or employment 65
Supported Housing Program, con t Caseworker also helps individual make and keep follow up appointments after released from jail. Once the individual has income, the caseworker helps the individual locate supported permanent housing. 5 slots were created for transitional housing. First individual was placed in 7/10. All 5 slots filled. Two individuals are currently looking for permanent housing and no re-incarcerations (yet) 66
Contact Information Kim Woods BSU Director Venango County MH/MR 814-432-9124 kswoods@co.venango.pa.us 67