Diversion First Stakeholders Meeting: July 17, 2017

1. Stakeholders Meeting
July 17, 2017
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2. Tonight’s Agenda
• Stakeholders Meeting Changes
• Announcements
• Super Utilizers Briefing and Case Study
• Housing Update
• Problem-Solving Team
• MCRC
• Court Services and Jail Services
• Data and Evaluation
• Discussion and Comments
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3. Stakeholders Meetings
Past Focus
• Group Formation
• Discovery and Learning
• Process
• Development
• Focus on Needs
New Approach
• Issue/trend-specific
information
• Work group outcomes
and near-future goals
when there are
milestones to report
• Identification of needs
that require attention/
action in order to move
forward
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4. Current Diversion
Groups
• Stakeholders
• Leadership
• Data and Evaluation*
• Communication
• Courts and Jail Services*
• MCRC*
• Problem-Solving Team*
• Medical Clearance
___________________________
* Reporting Tonight
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5. NACo Award
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6. SAMHSA’s Best Practices
Implementation Academy
• Fairfax was 1 of 9 teams
invited from across the
country after site visit
• Presented on our best
practices and offered
technical assistance to the 13
selected teams just starting
out
• Discussed our best practices
in building a diversion system
• Hosted by SAMHSA, GAINs
Center, and NACo
• Pat Harrison, Office of the
CoEx
• Lt. Derrick Ledford, Office of
the Sheriff
• Lt. Ryan Morgan, FCPD
• Lt. Redic Morris, Office of the
Sheriff
• Marissa Farina-Morse, CSB
• Laura Yager, Office of the
CoEx
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About the BPIA Thank You Fairfax Participants

7. Updates
Diversion First representatives
invited to serve on expert
panel for “Principles for
Community-Based Behavioral
Health Service Delivery for
Justice Involved Populations
with Mental and Substance
Use Disorders” on August 2
• Our representatives are
Marissa Farina-Morse and
Redic Morris
Application submitted for
September’s Data-Driven
Justice and Behavioral Health
Design Institute
• Only 14 teams across the
country will be accepted
• Institute will allow for in-
depth consultation related
to best practice data and
evaluation efforts,
especially with Super
Utilizers
• Keep your fingers crossed!
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8. Super-Utilizers
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9. What’s in a name?
• High System Utilizers
• Frequent Flyers
• High Volume Service Users
• Most Loyal Customers
• Super Utilizers
• Familiar Faces
• Complex Cases
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10. What is a Super-Utilizer?
• Individuals with complex behavioral, physical,
and/or social needs who are frequent users of a
broad range of services and may have a high
number of contacts with emergency medical
technicians and law enforcement.
• Despite the large amount of resources devoted to
this population, they are often provided in
fragmented ways that do not lead to stabilization
or improved outcomes for individuals.
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11. Bottom Line…
• Small numbers of highly vulnerable people
cycle repeatedly through jail, hospitals,
shelters, other public systems
• Fragmented, uncoordinated care
• Poor outcomes
• HUGE cost
Small changes will make a big difference!
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12. What are other
communities doing?
• “Golden Thread” Care Management approach
and Cross-Sector Data Integration - King County,
Washington
• Predictive Data Analysis and future Mental
Health embedded with PD- Johnson County, Kansas
• Community Care Management Cross-
Functional Team- Louisville, KY
• Mental Health Jail Diversion Project developed
by Public Defenders Office- Pinellas County, FL
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13. Super Utilizer Case Study
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14. Super Utilizers Next Steps
• Case Study Approach
– Document process, outcomes, learnings, barriers
– Use findings to immediately support individuals as
well as consider future service system
adjustments
– Bring information and ideas to stakeholders group
for consideration
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15. Super Utilizer Next Steps
• Identify people we hope to serve
– Present:
• Individual case study approach for “extreme” super
utilizers
• Problem-Solving Team focus on super utilizers
– Future:
• Data and Evaluation Team data analysis from multi-
systems to identify people we hope to serve
• Develop strategies through integrated work group
for warm handoffs and information-sharing
• Determine ongoing needs for improvements
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16. A Peek at Future Data and
Evaluation Team Effort with
Super Utilizers
• Individuals who exceed a certain threshold of service
use
• Threshold is determine by each agency based on the
median number of service visits during a 12-month
period
• Develop approach to collect cross system data
around these super utilizers
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17. Housing Update
• Diversion First Housing
– 8 individuals housed
– 13 in process of being housed
• Sustain State Housing Grant
– 14 individuals housed
– 18 in process of being housed
• CSB awarded additional $467,000 in FY18
bringing total state housing dollars to over $1
million!
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18. Problem Solving Team
Gary Ambrose, Diversion First Stakeholders Group Chair
Deputy Chief Jason Jenkins, Fairfax County Fire and Rescue
Major Ron Kidwell, Office of the Sheriff
Captain Matt Owens, Fairfax County Police Department
David Rohrer, Deputy County Executive
Cynthia Tianti, Office of the County Attorney
Daryl Washington*, CSB Deputy Director
Laura Yager, Office of the County Executive
+ Ad Hoc Members
* Chair
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19. News/Changes/Accomplishments
• Continue to triage cross-agency improvement
opportunities
 Solutions in real time and during the meeting
• Agreement to track and problem-solve high utilizers
 ECOs
 MCRC
 Fire/EMS
 CSB Jail Services
 911 Call Center
• Identify and resolve system level issues identified by
other teams and groups
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20. Challenges and Needs
• Sharing of confidential
information
• Complexity of population
• CSB to lead getting
releases to share
information with targeted
group before in-depth
discussion
• Flexible, responsive
services that can respond
to individuals needing
assistance
• Invite Inova to the table
since super utilizers
impact the health system
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Challenges Needs

21. 3-6 Month Goals and
Activities
• Signed releases for current
identified cases to facilitate
ongoing detailed problem-
solving as practice standard
• Developing intervention
plans for high utilizers
• Continue to address
emergent system issues for
discussion and resolution
• Developing approach to
track and report team
processes
• Documentation of
interventions and outcomes
• Monitoring utilization of
services
• Identifying super utilizers
across multiple systems
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Next Three months Next Six months

22. Merrifield Crisis Response Center
1st Lt. Ryan Morgan, PD CIT Coordinator
1st Lt. Mike Tucker, New PD CIT Coordinator
2nd Lt. Redic Morris, Sheriff’s Office, MCRC Coordinator
Abbey May, Service Director Acute Services
Michelle Mullany, Assistant Vice President Inova BH
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23. News/Changes/Accomplishments
• New CIT Coordinator!
– 1st Lt. Mike Tucker – FCPD
• 24/7 LEO Coverage!
– Three shifts will comprise 24/7 coverage
– Two Officers/Deputies per shift
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24. News/Changes/Accomplishments
Continuing to see increases in LEO-Involvement
with MCRC
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25. News/Changes/Accomplishments
Continuing to see ECO increases as well
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26. News/Changes/Accomplishments
• Hiring
– Fill remaining Crisis Intervention Specialist and
Peer Specialist positions
– Recruiting for Care Coordinator
• Focus on high utilizers/diversion cases
• MCU
– Increased focus on community cases
• Medical Clearance launch with CHCN
– Developed triage protocol, workflow and trained
staff
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27. Emergency Services
Medical Clearance
ED Medical Clearance
Consult with psychiatrist• .2 or greater BAL
• BP =/>160/100
• Pulse >120 or below 50
• Temperature >100.4
Refer to CHCN for Medical Clearance
If all of the above is WNL, consult with psychiatrist
ED Medical Clearance
If none of the above medical issues, proceed with
Triage and complete the following:
• UDS
• Breathalyzer
• Vitals
• Temperature
• Finger stick if indicated
• Pregnancy test if indicated
Consult with psychiatrist
Medical Clearance Triage Protocol
• Acute altered mental status –
delirium/confusion
• Highly agitated
• Complex medical issues
• Greater than age 65

28. Challenges and Needs
Challenges
• Reminder to include both
Sheriff and PD when we talk
about LEOs. This is a unique
partnership that we need to
highlight whenever
possible!
• Operational on-site Medical
Clearance from 8am-2pm,
W-F
Needs
• Pilot on-site Medical
Clearance after 4pm (Inova)
• Determining need for
ongoing/post-pilot
resources
• Site and collaboration policy
changes (in process now)
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29. 3-6 Month Goals and
Activities
Next Three months
• Hiring new staff
– Crisis Intervention Specialists
– Care Coordinator position
targeting CSB service
engagement post-MCRC
• Expand MCU hours and
explore LEO partnerships
• Develop tracking and
outcome measures for Care
Coordinator/Recovery
Specialists
Next Six months
• Medical Clearance
12pm -12am
– Inova Partnership
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30. General District Court - Court Services
Community Services Board – Jail Based/Jail
Diversion
Shawn Lherisse, Court Services
Marissa Fariña-Morse, CSB
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31. Data Collection
Quarterly Results
(April 2017 – June 2017)
BRIEF JAIL MENTAL HEALTH SCREENS
Increase in instruments administered 4220
(due to 100% of people being screened at booking)
administered* vs. 1053 administered**
*slightly more than 3 months of data 03/22/17 – 06/30/17 (Sheriff’s Office)
**slightly less than 3 months of data 01/01/17 – 03/21/17 (Court Services)
Change in Process (March 2017) Screens Administered at the Booking Desk
Results -
• Dramatic Decrease in percentage requiring advanced
screening
• 881 (21%) by Sheriff’s Office vs. 329 (31%) by Court Services
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32. Quarterly Results
(April 2017 – June 2017)
PLACEMENTS – PRETRIAL SUPERVISION
496 defendants placed
128 (26%) indicated a need for further mental health assessment
• 106 from bond motions
• 17 from advisements
• 5 from the Magistrates
20 (16%) defendants were Court-ordered to undergo a mental
health evaluation and follow recommended mental health
treatment
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33. Quarterly Results
(April 2017 to June 2017)
56 (90%) defendants that were administered the advanced
screening instrument indicated a need for a mental
health evaluation
• 56 defendants referred for mental health evaluation
(CSB or other)
• 23 defendants already engaged in mental health
treatment (CSB or other)
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PLACEMENTS – ADVANCED SCREENING

34. Challenges and Needs
• Connecting clients to services
before Court
• Providing assistance to clients
who do not reside in the
county
• Collecting data effectively to
measure outcomes
• Court cases spread out many
different appearances for CSB
caseload
• Obtaining services for clients
who do not have SMI
• A clinician in the courthouse to
perform mental health
evaluations (coming soon)
• Hire and train new staff (Court
Services/CSB)
• Co-Located office space
(pending)
• Construction on current office
space (pending)
• Develop tracking mechanisms
(Data and Evaluation Team
support needed) for Court
referrals to the CSB
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Challenges Needs

35. New Resources
• CSB Mental Health Screening and Assessment
– On-site at the courthouse
• CSB Emergency Services – Care Coordinator
– Target high utilizers
– Decrease treatment gaps
• Veterans Treatment Docket
– Positions with CSB
– Increase collaboration
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36. 3 Month Goals and
Activities
• Interview and hire new staff
• Continue to evaluate and analyze the BJMHS to improve outcomes
• Develop methods to effectively measure outcomes
• Implement changes to the Pre-Trial Defendant Questionnaire (information
provided to attorneys)
– Anticipate increasing referrals for further Court-ordered mental health
assessment and treatment
• Bed to Bed Order
 Detox, SA Programming, Other
• Jail Transfer (Western State- ECO/TDO Criteria)
– Focus on Returns/SRP Mental Health
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Next Three months

37. 6 Month Goals and
Activities
• Fully operational office for the Pre-Trial Behavioral
Health Unit
• Continue to improve the flow and results of intercepts
2 - 5
• CIT training for all Pre-Trial Officers in the Behavioral
Health Unit
• Move to have Mental Health cases assigned on the
same day (Bond Motions)
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38. Data and Evaluation Workgroup
Chloe Lee, CSB
Lisa Potter, CSB
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39. News/Changes/Accomplishments
• New linkages with Information Technology (IT)
leads across systems
• Completed data pilot and determined critical
variables for ongoing evaluation
• Developed automated solutions to assist with the
behavioral health components of the Virginia
Compensation Board Survey
• CIT Assessment Site data reporting for the
Department of Behavioral Health and
Developmental Services
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40. Challenges and Needs
Challenges
• Each intercept has a range of
data points for process and
outcome evaluation
• As intercepts expand,
ensuring that key indicators
are folded into the evaluation
• Gathering baseline data
beyond Intercept I
• Multiple data systems
• Incorporating data from all
jurisdictions (currently Fairfax
County only)
Needs
• Automated BJMHS so that
data can be easily accessed
• Diversion “identifier” in
police and CSB data systems
to support tracking efforts
• Data reporting from police
for people with mental
illness who were arrested
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41. Evaluation Plan
Intercept I Intercept II
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Clients who visited
Merrifield Crisis Response
Center (MCRC) with Law
Enforcement Officers
(LEOs)
MCRC visitors with LEOs
who have SMI, are
Fairfax County residents
and had potential
charges
Inmates with mental
illness/Serious mental
illness (SMI)
Inmates with SMI who
are Fairfax County
residents and who
completed a forensic
intake during the current
incarceration and were
released during the
period of data collection

42. 3-6 Month Goals
and Activities
• BJMHS process flow and use of the tool
across systems
– Administration of the tool and
documentation of results
– How results are communicated and
used to triage, assess and refer
• Ongoing BJMHS data collection and
reporting
• Re-charter work group to include IT
staff in addition to program and
evaluation staff
• Work with Detox Diversion to track data
elements
• Categorize data elements across
systems for potential DIT automated
solutions
• Jail baseline data
– Populations characteristics
– SMI prevalence
– Average number of days in jail
– Linkages to CSB Forensic
Intake and Jail-based services
• Make recommendations based on
findings
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43. Future Stakeholders
Group Topics Brainstorm
• Housing and homelessness
• Jail population
• Post-jail release services and supports
• Private sector partnerships
• Intersection of opioid crisis and diversion
• Information-sharing challenges
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44. Next Meeting
October 19, 2017
7 - 9pm, Rooms 4 - 5
Fairfax County Government Center
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