Integration of Services for Justice-Involved Clients

Stanislaus County’s Perspective Debra Buckles

October 28, 2015

Objective

• Understand the Development of Stanislaus County’s Forensic System of Care

• Walk away with some ideas, tips, strategies to take back to your County

• Hopefully, strengthen your passion to work with the underserved co-occurring population caught up in the criminal justice system

A little bit about me…

• Public Guardian, Chief of Forensic Services and CIT Coordinator for Stanislaus County

• Worked in this field since 1988• Started with BHRS in 1994• Conservatorship Investigator for BHRS from 1996 –

2006

• Participant in our first CIT Academy in 2004• Since 2006 programs under my leadership include:

Restorative Policing, CIT, MHTC, IFT, CJO, Drug Court, Community Corrections, Public Guardian and Conservatorship Investigations

The Problem

• The criminal justice system has become the de facto mental health system

• Persons with mental illnesses are disproportionately coming into contact with the criminal justice system

• Many in both the behavioral health and the criminal justice systems don’t see it as their job or responsibility to intervene

Road to Integration

• Daily Data Matching (1990’s)– Sheriff’s Department booking data is downloaded

into our Electronic Health Record every night– Current open clients who have been booked are

flagged and that information is sent in the morning to the serving program

– This is a one-way sharing of information

Data Matching

• Subtle benefits– Forced both of our leadership teams to work

through the pros and cons to this type of relationship

– Forced our treatment teams to understand they have a role in continuing to provide services/support while their client is in jail

– Supported our assumption that a majority of the individuals were co-occurring

Data Matching

• Direct Benefits– Continuity of care for our clients

– Data!

MIOCR Grants

• Received both grants – 1999 and 2007– Our Data was key in our applications but more so

in building local consensus

– $$$ can be the impetus to bring partners together• What you do with that partnership will determine if it

continues to grow beyond the money

1999 MIOCR Grant

• Introduced Assertive Community Treatment to our County

• Funded a Probation Officer as part of our MH team– Both teams saw the benefit of the combination of

legal leverage and treatment incentives to engage a very difficult co-occurring population

– BHRS saw the benefit of having a voice at the table during criminal proceedings

Restorative Policing

• Introduced in Stanislaus County in 2002• Pursuant to W & I Code Section 15750 –

15755 Multi-Disciplinary Team• Law Enforcement sets the agenda • Problem solve – Intervention planning for

individuals who cross multiple agencies

Crisis Intervention Training

• Originated with the Memphis Tennessee Police Department in 1988

• Nationally recognized curriculum for law enforcement

• 2005-First CIT Academy in Stanislaus• September of 2015 completed our 16th

Academy

It is NOT about the Nail

• Law Enforcement are action oriented quick problem solvers

• This comedy sketch on communication styles between the sexes allows a quick illustration about the goals for engagement and the problem solving comes later….

Goals of CIT

• Reduce use-of-force• Reduce related injuries to officer and citizens• Reduce misdemeanor arrests among SMI

individuals• Reduce involuntary psychiatric hospitalizations

and• Improve relationships between law enforcement,

local behavioral health and other service providers and consumers and their families

CIT-How it works

• 40-hours, 8-5, Monday-Friday, twice a year• Open to all LEA in Stanislaus County• 20-24 experienced officers participate• 10 presenters• 9 role play actors• 6 family/consumer panel members• 5 drivers – BHRS staff for site visits

CIT-How it works

Mental Health History Emotional Disturbances in Children & Adolescents

Mental Health Law Mental Illness and Recovery

Major Mental Disorders Panel Discussion with Family & Consumers

Alzheimer’s Disease Suicide Risk Assessment

Developmental Disabilities Suicide-by-cop

Dual Disorders/Co-Occurring Disorders The Criminal Justice System and the Mentally Ill

Crisis Intervention Skills Site Visits

Role Play Exercises

CIT – why it works

• Commitment from all agencies to have CIT in our community

• We have two very good presenters that hold credibility with both clinical staff and law enforcement

• Site visits• Role play exercises• Family/consumer panel– Personal stories are powerful!

Road to Integration

• Restorative Policing and Crisis Intervention Training were two initiatives recognized by LE as having a direct benefit to them– Help with difficult individuals in our downtown

area– Training

Forensic SOC

• In 2006 using Mental Health Service Act dollars our Forensic System of Care was created– Drug Court– SUT detention services– Restoration to Competency– Integrated Forensic Team – Full Service

Partnership– Restorative Policing and CIT

2007 MIOCR Grant

• Although this grant was short lived…..• We used the opportunity to establish a Mental

Health Treatment Court and fund in-custody deputies specifically dedicated to working with SMI inmates

• When the funding quickly ended both the Courts and the Sheriff wanted to keep both intact

Forensic SOC

• Stanislaus County is a Behavioral Health Organization – Both Substance Use and Mental Health Treatment are in one department

• We have had flexibility in designing programs to address both needs of this co-occurring difficult to engage population

Examples

• Drug Court– IFT created capacity for individuals who were struggling

with success due to their MH needs• In-custody services– Both providers work together – providing in-custody

care, release planning and linking to community services

• SUT staff combined in team gatherings with MH Staff– Nothing like a good potluck to break down barriers

2011 Realignment

• Our partnerships with the criminal justice system were established

• Moving forward as part of the Community Corrections Partnership was not difficult

• Expanded services in all areas, SUT, Detention Services and created a second Integrated Forensic Team for the AB109 population

• Just moved into our new Day Reporting Center!

Final Thoughts

• Partnering with the criminal justice system is not always easy

• Requires patience, persistence and a champion on both sides

• Understanding each other’s culture, policies, legal responsibility is essential

• Having a well-defined understanding of each other’s role is key