1. 1
CIT’s Role in Sustainability
And
Strengthening the Public Safety Net
October 15, 2013
CIT International Conference
Hartford, Connecticut
Leon Evans
President and Chief Executive Officer
The Center for Hope;
Mental Health and
Substance Abuse Authority
Bexar County
San Antonio, Texas
levans@chcsbc.org
Gilbert R. Gonzales
Communications and Diversion Initiatives
The Center for Hope;
Mental Health and
Substance Abuse Authority
Bexar County
San Antonio, Texas
ggonzales@chcsbc.org

2. 2

3. 3
Community Wide Jail Diversion:
The Problem
• Criminalization of Mentally Ill
• Inappropriate Cost to Society
– 20% + in jail
– Increased use of emergency rooms
– Homelessness
• Public Safety Net
– Consumers at risk
– Law Enforcement at risk
– Public at risk

4. 4
Key Elements: Effective Pre Booking Diversion
1. Identification-Intervention at earliest point Detention, Arrest, Pre
Booking
2. Partnering and training with local law enforcement, first responders,
call takers, dispatch and criminal justice
Addressing operational obstacles
Crisis Intervention Teams/Training (40 hours minimum) including
trauma informed, trauma specific curriculum
Include Magistration, Probation and Parole
3. Planning: Stakeholder/Community
Monthly priorities and implementation meetings with feedback
4. Services access and coordination; central access
Crisis (Psychiatric) Screening /Intervention/Treatment: Drop Off
Medical Clearance
Substance abuse intervention: Drop Off, Sobering, Peer
Advocates/Detox
Residential access
Boots on the Ground (boundary spanners)
No wrong door
5. Data – tracking data and $$$
Community stakeholder developed data fields
High Utilizer tracking
Wide review and distribution of descriptive data
6. Reports of Success or “Every success has a story”

5. 2002 – Bexar County Jail Diversion Collaborative meets for 1st
time
2003 – First Crisis Intervention Team Training begins
2004 – Specialty Jail Diversion Facility opens
2005 – 24/7 One Stop Crisis Care Center opened
2006 – Bexar County Jail Diversion receives APA’s Gold Award
2008 – Restoration Center opened ; Detox, Sobering, IOP Treatment
2010 – Haven for Hope 1,600 Bed Homeless Facility opened
2010 – International Crisis Intervention Team Conference hosts 1,600 Officers
2000 – CEO begins diversion efforts, full time coordinator is hired
2003 – Deputy Mobile Outreach Team begun
2011 – Prospect Courtyard Safe Sleeping reaches high of 714
2012 – Prospect Courtyard adds new MH Clinic
2012 – Prospect Courtyard adds 80 bed MH residential
2012 – Restoration Center Expansion; Building #2 added
2010 – In House Recovery Program Male and Female 104 sober living beds
TimelineTimeline
2013 – Prospects Courtyard CMS Innovation BH/Health Integration

6. 6
Law Enforcement
Detention/Jail
CIT
Judicial/Courts
Magistrate, County, District
Mental Health
Public and Private
Providers
Crisis Care Center
Jail Diversion
Psychiatric and Medical
Clearance
Specialty Offender Services
CommunityDynamic
Crisis Jail Diversion
Information Exchange
Police,Sheriff
Probation,Parole
Civil and Criminal
Treatment
ContinuityofCare
County City-wide
Emergency Services
• Community Collaborative
• Crisis Care Center
• Crisis Transitional Unit
• Crisis Hotline (Nurselink)
• CIT/DMOT
• SP5
• Jail and Juvenile Detention
• Statewide CARE Match
System County City-wide
Entry Points
System Level

7. 7
Today
2012 – Bexar County Sheriff/San Antonio Police Chief mandate 100% CIT Training for Patrol

8. 8
CIT Mental Health Detail
• Mental health professional partners
with a CIT Officer together to
respond on calls dealing with a
psychiatric crisis.
• Team responds to high utilizer calls
for the City providing follow up
services to reduce the call volume.
• Goal is to put officers back into
service for patrol as soon as
possible.
– Reduce inappropriate
incarcerations and costly
emergency room visits.
– Offer quality training to law
enforcement.
• Co-locate officer with the City unit
and Sheriff Mental Health Unit for
better collaboration and expedited
call response

9. 9
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.

10. 10
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

11. 1111
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
11

12. Restoration Center Addiction Services
12
Bldg. #1 Opened
April 15, 2008
Bldg. #2 Opened
June 27, 2012
• 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

13. 13
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

14. 14
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.

15. 15
PROSPECTS COURTYARD
Developed two years ago to address basic need
of food, clothing & shelter
Criteria:
• 18 years of age (or older).
• Physically able to care for themselves.

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

17. 17
Show me the DATA !!!

18. Data Roundtable
2003 to Present
18
COMMUNITY MEDICAL DIRECTOR’S ROUNDTABLE AGENDA
Tuesday, Aug 27, 2013 @ 8:30 a.m.
I. Welcome
II. Introduction – Dr. Jason Miller,
new Medical Director for Crisis Services
III. Crisis Care Center Services
All Reports; CCC Data, MCOT
IV. Restoration Center Services
All Reports; Detox, Sobering etc.
V. Adult MH Services Wait List
Integrated Care Team, High Utilizers
Preadmission Screening and Residential
Review Process (PASRR)
VI. Children’s Services
VII. San Antonio State Hospital (SASH)
VIII. Haven for Hope Update
IX. Prospect Courtyard
X. San Antonio Police Dept. (SAPD)
Bexar County Sheriff’s Office
XI. 1151 Waiver Update
XII New Business
XIII. Adjournment – Next meeting; September 24, 2013

19. 19
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
Emergency Room
Utilization (Medical Clearance)
What Works

20. 20
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.
Impact on WAIT TIME
for LAW ENFORCEMENT

21. 21
Recidivism Rates for Top Five CSCD’S
*Dallas rates reflect only one mental health provider, Metro Care.

22. 22
Cost Category City of San Antonio Bexar County Direct Cost Avoidance
Public Inebriates
Diverted from Detention
Facility
$435,435
$925,015
$1,322,685
A.
$1,983,574
$2,818,755*
$4,372,128
B.
$2,419,009
$3,743,770
$5,694,813
Injured Prisoner
Diverted from UHS ER
$528,000
$435,000
$421,000
C.
$1,267,200
$1,044,000
$1,010,400
D.
$1,795,200
$1,479,000
$1,431,400
Mentally Ill Diverted
from UHS ER Cost
$322,500
$283,500
$276,500
E.
$774,000
$676,000
$663,600
F.
$1,096,500
$959,500
$940,100
Mentally Ill Diverted
from Magistration
Facility
$208,159
$179,833
$126,893
G.
$371,350
$322,300
$191,125
H.
$579,509
$502,133
$310,018
Year One April 16, 2008 – March 31, 2009
Year April 16, 2009 – March31, 2010
Year Three April 16, 2010 – March 31, 2011
Summary next slide

23. 23
Summary

24. 24
• 2006 – 3,845
• 2007 – 3,960
• 2008 – 4,124
• 2009 – 4,158
• 2010 – 4,017
• 2011 – 3,743
Bexar County Detention Center System Population
(Main Annex)
In May of 2011, there were 883 empty beds in the Bexar
County Jail
In May of 2013, there were 1,000 empty beds in the Bexar
County Jail

25. 25
BEXAR COUNTY DETENTION CENTER
SYSTEM POPULATION
MONTHLY AVERAGES
(Main, Annex)
4222
3743
4133
4015
3987
3941 3946
4015
4081
4095
4171 4156
4094
3845
3807
3897
3981
4109
4263
4253
4040
3993
4062
4033
4066
3960
4079
4096
4084
4094
4095
4139
4173
4208 4261
4289
4225
4124
4158
4337
4272
4292
4197
42104254
4179 4193
4280
4357
43004300 4302
4053
4130
4001
4260
4028
4077
4231
4190
4017
379137903854
3982
3700
3800
3900
4000
4100
4200
4300
4400
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
SYSTEMPOPULATION
2006 2007 2008 2009 2010 2011
On May 2011, there were 883
empty beds in the jail

26. 26

27. 27
QUESTIONS?

28. 28
Leon Evans, President/CEO
The Center for Health Care Services
210 261-1000
www.chcsbc.org
levans@chcsbc.org