Integration, Restoration and Transformation: A Systems Overview Presentation for the APPA Winter Training Institute Austin, Texas Jan 31-Feb 3, 2010 Gilbert Gonzales Director, Communications and Diversion Initiatives The Center for Health Care Services Mental Health and Substance Abuse Authority Bexar County San Antonio, Texas [email protected]www.chcsbc.org Linda Tavel Director, Criminal Justice Substance Abuse Services Mental Health and Substance Abuse Authority Bexar County The Center for Health Care Services [email protected]www.chcsbc.org
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Integration, Restoration and Transformation: A Systems
Overview
Presentation for the APPA Winter Training Institute Austin, Texas
Jan 31-Feb 3, 2010
Gilbert GonzalesDirector, Communications
and Diversion InitiativesThe Center for Health Care Services
Mental Health and Substance Abuse AuthorityBexar County
Detention Hearingo Policy Statement 12: Modification of Pretrial
Release Conditionso Policy Statement 13: Intake at County /
Municipal Detention Facilityo Policy Statement 14: Adjudicationo Policy Statement 15: Sentencingo Policy Statement 16: Modification of
Conditions of Probation / Supervised Release
o Conclusion
Chapter IV: Incarceration and Reentryo Introduction: Incarceration and Reentryo Policy Statement 17: Receiving and Intake of Sentenced Inmateso Policy Statement 18: Development of Treatment Plans, Assignment to
Programs, and Classification / Housing Decisionso Policy Statement 19: Subsequent Referral for Screening and Mental
Health Evaluationo Policy Statement 20: Release Decisiono Policy Statement 21: Development of Transition Plano Policy Statement 22: Modification of Conditions of Supervised Releaseo Policy Statement 23: Maintaining Contact Between Individual and Mental
Health System Chapter V: Improving Collaboration
o Introduction: Improving Collaborationo Policy Statement 24: Obtaining and Sharing Resourceso Policy Statement 25: Sharing Informationo Policy Statement 26: Institutionalizing the Partnership
Chapter VI: Training Practioners and Policymakers and Educating the Communityo Introduction: Training Practitioners and Policymakers and Educating the
Communityo Policy Statement 27: Determining Training Goals and Objectives o Policy Statement 28: Training for Law Enforcement Personnelo Policy Statement 29: Training for Courts Personnelo Policy Statement 30: Training for Corrections Personnelo Policy Statement 31: Training for Mental Health Professionalso Policy Statement 32: Educating the Community and Building Community
Chapter VII: Elements of an Effective Mental Health Systemo Introduction: Elements of an Effective Mental Health Systemo Policy Statement 35: Evidence-Based Practiceso Policy Statement 36: Integration of Services o Policy Statement 37: Co-Occuring Disorderso Policy Statement 38: Housing for People with Mental Illnesso Policy Statement 39: Consumer and Family Member Involvemento Policy Statement 40: Cultural Competencyo Policy Statement 41: Mental Health Workforceo Policy Statement 42: Accountabilityo Policy Statement 43: Advocacy
Crisis Care CenterJail DiversionPsychiatric and Medical
ClearanceSpecialty Offender Services
CommunityDynamicCrisis Jail Diversion
Information Exchange
Pol
ice,
She
riff
Pro
batio
n, P
arol
e
Civil and CriminalT
reatment
Continuity of C
are
County City-wide
Emergency Services
Data exchange through• Community Collaborative• Crisis Care Center • CIT/DMOT• Jail and Juvenile Detention• Statewide CARE Match
System County City-wideEntry Points
System Level
Circa 2006
CMAGScreeningLaw
Enforcement
MH NO
MH YES
Refer to Sherry (UHS Nurse)
RoutineEmergent
Urgent
MH
IOP Frio
CD
Release w/Referral – Bus
Pass
History
Unstable
MH/CD
Stable
24/7 CCC-CTUPresa – Business
Hrs.
Release W/Referral Bus Pass
IOP-Frio Release W/Referral
CD
MH
Detox Sobering
24/7CCC
Presa
CTU
? SP5Orig. OP
Unit
Jail Re-Entry
FACT
OP
CCC UHS-ER
UHS Nursing
Psych Eval
Agressive
Recommend ED
Find Bed
Private Hospital
ACCESS
ER CCC Jail
CD MH/CD MedicationUHS
Nursing
YES
NO
Bexar County Adult Detention
Center
Pre-Trial
UHS
PR Bond
CC12
Judge Carruthers -NGRI/IST
Eligibility
MH Court
Docket
NO
Yes
Jail Re-entry
Community
CCC
CTU
Fact
Access
Outpatient
Jail Re-Entry
CCC CTU
Mental Health Forensic Flow
a work in progress…Circa 2010,
Restoration Center
• Public Safety Triage • Detox Facility
• Outpatient Substance Abuse Services
• Community Court
• The patients served by the Center and by the local Hospital District (UHS) are the same individuals
• We combine functions to integrate care for these individuals
• Functional integration is the foundation of the best healthcare possible for the people we both serve
Behavioral Healthcare Integration with
Primary and Specialty Medical Care
New Generation Medication Program• Contract with UHS initiated in 2002
• CareLink Patients NGM Cost paid by CHCS with General Revenue
• CareLink Patients other Medication costs borne by UHS
• Savings to CHCS of between $2.4 & $2.6 million
• Savings funded the Crisis Services and Jail Diversion Initiative
The Crisis Care CenterPsychiatric Screening
Minor Medical Clearance
24/7 Access for Law EnforcementCirca 2005
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 45 minutes.
• Wait time for Medical Clearance/Screening and Psychiatric Evaluation is 60-65 minutes.
Impact on WAIT TIME for LAW ENFORCEMENT
Public Safety Triage Facility
Restoration CenterGrand OpeningApril 15th, 2008
• Detox Facility• Community Court• Outpatient Substance Abuse Services
Circa 2008
“The immediate availability of detoxification services is priceless….”
“Providing treatment to those who desperately
need help will save taxpayers millions of dollars over the long run.”
Gloria Padilla, Express News 9/13/2008
San Antonio Express News
o Mental Health Court – (2007) o Co-Located Mental Health, Probation and Parole Units o Competency Restoration Program – (2008) o Forensic Assertive Community Treatment Program – (2004) o Ongoing 40 Hour Crisis Intervention Training for Law Enforcement – (2003) o Ongoing 40 Hour Child Crisis Intervention Training for School District Police -
(2008) o Military Veterans Planning Collaborative with active pilot in military bases –
(2007) o Psychopharmacology Program (methadone maintenance) o Project Carino (Women of Child Bearing age, or pregnant addicted to Opiates) o Centro De Vida (HIV Outreach) o Therapeutic Justice Partnerships
Bexar County Corrections & Community Supervision and The Center for Health Care
Services programs; Residential Programs; 1. SATF-1 (100 bed Residential Treatment Program;Adult Males) an array of value
added services are provided to include family education, GED preparation and testing, parenting education, and recovery support groups.
2. SATF-2 ( 50 bed Adult Female/ 50 bed Adult Male Residential Treatment) 3. Zero Tolerance (60 bed young Adult ages 17-25 Residential Treatment) 4. Mentally Ill Offender Unit (30 bed Adult Female/30 bed Adult Male Co-Occurring
Residential Treatment Program)
Outpatient Substance Abuse Treatment Program-Provides an array of value added services; employment referrals, recovery support services, housing resources and services, parenting education, anger management)
Outpatient Dual Diagnosis Criminal Justice Substance Abuse Treatment Program Felony Drug Court Program & Misdemeanor Drug Court Program
o Community Partnerships addressing Unemployment resources, GED Classes, Housing Resources, Medical, Dental, Eye Exam resources, ID Reclain, Birth Certificates, and other Social Services.
Therapeutic Justice Service Array
The MAPThe MAP
CHCS Urgent Care Center (2)Emergency Psychiatric Screening
The Community Wide InitiativeHaven for Hope and CHCS
collaborationGoal:
To increase the community capacity for mental health, substance abuse and
detoxification services
Veteran’s Services
Multiple Collaboratives/Initiatives for Veterans based in Bexar County
• The San Antonio Veteran's Affairs Commission • The Military Coordinating Council for Behavioral Health• The Bexar County Veterans Service Office • Texas Resources for Iraq-Afghanistan Deployment, United Way• The Bexar County Veterans Service Office • Family Strong Advocacy
Toolkit
Alternatives to Incarceration
• Crisis Care Center and Restoration Center
• Involuntary Outpatient Commitment (IOPC)
• Outpatient Competency Restoration
• Mental Health and Drug Courts
• Veterans Initiatives
• Adult Parole/Probation Partnerships
For additional information onlineCopies of this presentation and
additional data on diversion initiatives can be found at:
http://www.diversioninitiatives.net
CIT
SAVE THE DATEFirst International CIT
Conference(Formerly the National CIT Conference)
June 1 - 3, 2010On site registration May 31,
2010
San AntonioCIT - Deep In The Heart of
Texas!For Information and Registration : http://chcsbc.org/cit
Gracias !
For Additional Information on this presentation please contact:Leon Evans, President and Chief Executive Officer
The Center for Health Care Services210 731-1300, Email: [email protected]