September 25, 2014

DUAL DIAGNOSIS CROSS-FUNCTIONAL TEAM

LOUISVILLE METRO GOVERNMENT

2nd Annual Report-Out Session

DDCFT Overview

• Convened in January 2013

• First Cft to include external community partners and Metro agency representatives

• First time diverse group came to share information and discuss systemic issues

Coalescing Events

• Rising number of heroin abusers displacing alcohol intoxicants in jail

• LouieStat and MCJC analysis of the jail population found the category of “revolving door” individuals was a primary driver of overall population

• Jail Policy Committee established subcommittee to focus on “revolving door" population which led to Forensic Assertive Community Treatment (ACT) Pilot Program

• University Hospital initiative targeting top utilizers of the Emergency Room

LMDC Detox• Police historically dropped off chronic alcohol intoxicants at The Healing

Place

• Open access detox beds were filled by a younger population of individuals abusing heroin and opiates

• Metro Corrections operating a detox center with 30-70 inmates going through detox on any given day

• During CY13, over 70% in detox unit had abused heroin and other opiates

DDCFT Charter

First Report-Out Session

• The First Report-Out Session was held in July 2013 with five potential solutions identified including:

Pursing grants and external funding *

Developing a repository of local programs *

Developing a registry of the top 100 system utilizers

Developing community-wide pathways and protocols

Coordinating advocacy efforts *

* In process of implementation

GAINS Sequential Intercept Mapping• February 2014, DDCFT applied

and selected as one of seven cities nationally to host a Sequential Intercept Mapping Workshop

• July 2014, workshop focused on identifying early opportunities for diverting individuals with a dual diagnosis from the criminal justice system

GAINS SIM Priorities and Recommendations

• Priorities identified included:

Early diversion opportunities for law enforcement/Mobile Response Team Need for additional open access detox beds Expand technology for data/information sharing (HMIS)

• GAINS recommendations included: Creating a centralized database of services and programs Reduce reliance on Metro Corrections as a detox facility Address gaps in services for people under the care of State Guardianship Increase training related to HIPAA and information sharing Expand Peer Support Expand reentry case management

Evolution of DDCFT

Focus on Chronic Alcohol

Intoxicants

CCMN

Community Care Management Network

Community Care Management Network• Review of jail and cross-agency data

indicated five possible entry points from the high utilizer population

Mental Health

Supportive Housing

Criminal Justice

Substance Abuse

Medical & Dental

Release of Information• Common release of

information to permit sharing of client information

Research Projects

• National Pretrial Demonstration Site

• National Inventory of ACA Initiatives for Justice-Involved Populations

Affordable Care Act

• Advocacy for Health Home Pilot

• Partnership with Health Re-Entry Coalition

Next StepsCommunity Care Management Network Implementation

• Meet with Managed Care Organizations to discuss identified service delivery issues related to Medicaid expansion (detox and Assertive Community Treatment)

• Network agencies to begin manual data collection based on established data elements and outcomes

• Establish parameters for HMIS Network operation , begin enrolling network agencies and provide necessary training

• Complete Release of Information and MOU for data sharing• Encourage clients to self-report information with “advanced directives”

services plan• Establish governance body to oversee access to information and data sharing

through network• Develop early diversion (pre-arrest) protocols• Develop research design and proposal for Institutional Review Board

process• Pursue grant or foundation funding for demonstration project and

research component

Next StepsAdvocacy/Legislative Agenda

• Consideration of Jefferson County as Urban Health Home Pilot• Pursue grants and funding opportunities to expand capacity for

community treatment and open access detox beds• Continue and expand the Forensic Assertive Community Treatment

(ACT) Program• Suspension of Medicaid benefits upon incarceration versus termination• Address gaps in services for people under the care of State

Guardianship• Expand use and understanding of the importance of peer support• Expand reentry case management or peer support to provide a “warm

hand-off” to ensure successful reentry• Provide specific statutory authority for Day Reporting Centers versus

operation under existing Home Incarceration statute (KRS Chapter 532)