Overview presentation of the successful jail diversion program in Bexar County presented by Gilbert Gonzales at the Georgia JDTR Conference, October 20-22, 2013 Hyatt Regency, Savannah, Georgia

1. "Jail Diversion Trauma Recovery in Texas:
Challenges & Successes in
Program Implementation &
State Policy Change"
Jail Diversion and Trauma Recovery Priority to Veterans:
Program Department of
Behavioral Health and Developmental Disabilities Division of Mental Health
Conference, Savannah, GA
October 22, 2013
Gilbert R. Gonzales
Communications and Diversion Initiatives
The Center for Health Care Services
Mental Health and Substance Abuse
Authority
Bexar County
San Antonio, Texas
ggonzales@chcsbc.org
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2. 2

3. Military
Bases
• Lackland
Air Force
Training Center
• Randoph
• Brook Army
Medical Center
• Ft. Sam
Houston
BRAC: 2.1 Billion in Military Construction
Center for the Intrepid
Center for the Intrepid

4. Texas Veteran Jail Diversion
and Trauma
Recovery Project (TVJDTR)
VETERANS SERVICES program :
• inclusion and expansion of trauma specific treatment and trauma informed practice
• monitoring of the delivery of veteran peer support services related to behavioral
health issues
• monitoring of the implementation of family member facilitated family-to-family
education groups related to behavioral health issues
• developing of collaborative advisory groups for supports and services for veterans
and their families to initiate
• enhance or expand community resource coordination related to basic needs with
community partners, individuals and organizations
• linkage to Therapeutic Justice Services

5. 5

6. Today
2012 – Bexar County Sheriff/San Antonio Police Chief mandate 100% CIT Training for Patrol
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7. Dispatcher Training for 911 Call
Takers and Dispatchers
•
•
•
In 2007 - decided that dispatchers
would also benefit from CIT Instruction
and met with SAPD leadership to
establish training.
Provided an abbreviated 12 hour CIT
course for call takers and dispatchers in
collaboration with CHCS
The goal of this training is to increase
safety by educating caller takers on
essential intelligence gathering and
dispatching a CIT Trained officer to the
scene.

8. Partnered with Fire and EMS
•
•
•
•
As of 2007 SAFD has attended
every community training
has become co trainers with joint
PD and Sheriff’s Officers
Have added a CIT component to
their EMS In-service training.
Partnering for Integrated training
with Fire/EMS has extended
numerous opportunities for
growth:
– Officer and Fire/EMS better
communication
– Safety
– Better utilization of resources

9. Police Roll Call
Video
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10. CRISIS CARE CENTER
•
•
•
•
Crisis Line
Crisis Assessment
Mobile Crisis Outreach Team
Crisis Transitional Unit
7137 W. Military 645-1651
• Receives consumers from
law enforcement 24/7
• Minor medical clearance
• Call ahead preferred
210 225-5481
• Can not take violent or
medically compromised
individuals
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10

11. The
Restoration Center
•
Opened
April 15, 2008
• Public Safety- Sobering
Unit
• Detoxification Facility
• Community Court
• Outpatient Substance
Abuse Services
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12. Serial Inebriants Program
•
Originally was staffed with
nursing on front end
•
Re-organized to have
EMT/Recovery Support
Specialists on unit
•
Not treating medical, just
sobering and engaging in
relationship
•
Educating funders that multiple
admissions not viewed as failure
•
Continued collaborations with
law enforcement, EMS, hospitals
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13. Injured Prisoner Clinic
• Added service to reduce ER
waits and get police back on
street
• Blended funding through
City and County
• Open when University
Hospital Clinic is closed.
• PA/NP on duty fills dual
roles of medical care and
physicals for detox after
hours.
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14. Restoration Center Addiction Services
• Public Safety- Sobering Unit
• Injured Prisoner Medical Services
• Residential & Ambulatory Detoxification
• Opiate Addiction Treatment Services
• Outpatient Substance Abuse Services
• Felony Drug Court COPSD Outpatient Services
• In House Recovery Program Sober Living
Bldg. #1 Opened
April 15, 2008
Bldg. #2 Opened
June 27, 2012
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15. PROSPECTS COURTYARD
Developed two years ago to address basic needs of
food, clothing & shelter
Criteria:
• 18 years of age (or older).
• Physically able to care for themselves.
• Sleeping 500 to 750 per night

16. Haven for Hope Homeless Transitional Facility
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www.havenforhope.org

17. Show me the DATA !!!
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18. COMMUNITY MEDICAL DIRECTOR’S ROUNDTABLE
Data Roundtable: Monthly Meeting from 2003 to Present
Tuesday, Aug 27, 2013 @ 8:30 a.m.
I.
II.
Welcome
Introduction – Dr. Jason Miller,
new Medical Director for Crisis Services
III.
Crisis Care Center Services
All Reports; CCC Data, MCOT
Restoration Center Services
All Reports; Detox, Sobering etc.
Adult MH Services Wait List
Integrated Care Team, High Utilizers
Preadmission Screening and Residential
Review Process (PASRR)
Children’s Services
San Antonio State Hospital (SASH)
Haven for Hope Update
Prospect Courtyard
San Antonio Police Dept. (SAPD)
Bexar County Sheriff’s Office
1151 Waiver Update
New Business
Adjournment – Next meeting; September 24, 2013
IV.
V.
VI.
VII.
VIII.
IX.
X.
XI.
XII
XIII.
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19. What Works
Emergency Room
Utilization (Medical Clearance)
Emergency Room utilization has dropped 40% since
the inception of the Crisis Care Center.
40% of (7619 total seen at CCC)
3048
Persons diverted from the ER (in 2006 first year)
X $1545
Cost Savings relative to ER Utilization
$4,709,160
Source: University Health System
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20. Impact on WAIT TIME
for LAW ENFORCEMENT
Then (prior to Sept 2005)
• Wait times for Medical
Clearance/ Screening at
UHS ER - 9 hours, 18 min.
• Wait times for Medical
Clearance/ Screening and
Psychiatric Evaluation was
between 12 and 14 hours.
Now
• The wait time for Medical
Clearance/ Screening at the
Crisis Care Center is 10
minutes.
• Wait time for Medical
Clearance/Screening and
Psychiatric Evaluation is
20 minutes.
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21. Recidivism Rates for Top Five CSCD’S
35.0%
30.3%
30.0%
25.0%
22.6%
Bexar
Harris
Average
Tarrant
Dallas*
Travis
20.6%
20.0%
17.6%
15.0%
12.7%
10.0%
6.6%
5.0%
0.0%
Bexar
Harris
Average
Tarrant
Dallas*
Travis
*Dallas rates reflect only one mental health provider, Metro Care.
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22. 1,600
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23. Combined CCC and Restoration Documented and Immediate Cost Avoidance
Cost Category
Year One April 16, 2008 – March 31, 2009
Year Two April 16, 2009 – March31, 2010
City of San Antonio
Bexar County
Year Three April 16, 2010 – March 31, 2011
Public Inebriates Diverted from Detention
Facility
Direct Cost Avoidance
$4,372,128
$5,694,813
B.
$528,000
$1,267,200
$1,044,000
$1,795,200
$421,000
C.
$1,010,400
$1,431,400
$322,500
$283,500
$774,000
$676,000
$1,096,500
$276,500
$663,600
$940,100
E.
Mentally Ill Diverted from Magistration
Facility
$2,419,009
$3,743,770
A.
Mentally Ill Diverted from UHS ER Cost
$1,983,574
$2,818,755*
$1,322,685
Injured Prisoner Diverted from UHS ER
$435,435
$925,015
F.
$208,159
$179,833
$371,350
$322,300
$579,509
$126,893
$191,125
H.
$310,018
$435,000
G.
$1,479,000
D.
$959,500
$502,133
Summary next slide
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24. Summary Savings 2008 - 2013
Summary
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25. BEXAR COUNTY DETENTION CENTER
SYSTEM POPULATION
MONTHLY AVERAGES
(Main, Annex)
4400
4280
4260
4200
4179
4100
4015
3987
4000
3982
4253
4139
4084
4096
4263
4028
3981
3941
4109
4094
4001
4095
4222
4210
4173
4133
4081
4053
4302
4300
4292
4193
4130
4079
4337
4208
4272
4261
4197
4171
4231
4156
4095
4225
4158
4190
4033
4066
3993
4015
4300
4094
4062
4040
4077
4289
3897
2008
2009
2010
2011
NOV
OCT
SEP
AUG
2007
JUL
2006
On May 2011, there were 883
empty beds in the jail
JUN
3743
MAY
3791
APR
3790
MAR
3700
3854
FEB
3800
4017
3960
3946
3900
3807
4124
3845
DEC
4254
JAN
SYSTEM POPULATION
4300
4357

26. “The best time to plant a tree is 20 years ago.
The second best time is now.”
2013 – Prospects Courtyard CMS Innovation BH/Health Integration
2012 – Restoration Center Expansion; Building #2 added
Timeline
Timeline
2012 – Prospect Courtyard adds 80 bed MH residential
2012 – Prospect Courtyard adds new MH Clinic
2011 – Prospect Courtyard Safe Sleeping reaches high of 714
2010 – In House Recovery Program Male and Female 104 sober living beds
2010 – Haven for Hope 1,600 Bed Homeless Facility opened
2010 – International Crisis Intervention Team Conference hosts 1,600 Officers
2008 – Restoration Center opened ; Detox, Sobering, IOP Treatment
2006 – Bexar County Jail Diversion receives APA’s Gold Award
2005 – 24/7 One Stop Crisis Care Center opened
2004 – Specialty Jail Diversion Facility opens
2003 – First Crisis Intervention Team Training begins
2003 – Deputy Mobile Outreach Team begun
2002 – Bexar County Jail Diversion Collaborative meets for 1 st time
2000 – CEO begins diversion efforts, full time coordinator is hired

27. QUESTIONS?
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28. The Center for
Health Care Services
Gilbert Gonzales
The Center for Health Care Services
Mental Health Authority
210 731-1300
www.chcsbc.org
ggonzales@chcsbc.org
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