SM-18-005 Individual Grant Awards

Knoxville Early Diversion Co-Response TEAM (KEDCRT) The Knoxville Early Diversion Co-Response Team (KEDCRT), compose of the Knoxville Police Department and Helen Ross McNabb Center, will respond to 80 individuals annually during the initial co-response to provide evaluations and referrals serving 400 individuals during the full grant cycle. KEDCRT will serve 40 veterans in peer recovery services annually serving 200 veterans during the full grant cycle. The Knoxville Early Diversion Co-Response Team would allow our community the opportunity to develop a specialized co-responder team to address current gaps in service delivery. The co-response team would consist of KPD officers (often partnering with the Homeless Outreach Officer) and Helen Ross McNabb Master’s Co-Response Clinician and a Veteran Peer Recovery Specialist. The staff would be available during identified high volume times to work side by side with law enforcement in the community to intervene and effectively divert individuals at police encounter. Once the "warm hand off” occurs, the Master’s Co-Response Clinician will triage, assess, and identify possible treatment options for those individuals. If the service recipient needs further assistance in accessing resources and assistance, they will be assigned to the Veteran Peer Recovery Specialist. Goals: *Develop and disseminate a thoroughly documented evaluation. *Develop a “Law Enforcement and Behavioral Health Partnership”, referred to as the community collaborative. *Reduce the number of arrests for individuals with behavioral health conditions by diverting from the criminal justice system. *Improve understanding and awareness of the legal/law enforcement and mental health system for community collaborative. *Assure that all services and protocols used (screening and assessment) are culturally appropriate. Objectives: *Upgrade the data infrastructure to track and respond to mental health calls for service by month 12 of grant *Develop guidelines for the community collaborative team by the third month of receiving grant. *Provide veteran peer support services for 50% of the individuals referred through the co-response team. *Provide bi-annual client satisfaction surveys to all individuals enrolled in peer recovery services that incorporates information on cultural sensitivity and demonstrate a 90% satisfaction in services provided

The Hennepin County Early Diversion Project will improve early diversion capacity in Minneapolis and its suburbs. Co-Responder Teams will respond to Emotionally Disturbed Person (EDP) 911 calls and make follow-up visits for assessments and referrals to community services. A new Behavioral Health Care Center will function as a law enforcement transfer point diverting individuals with SMI or COD away from jail and justice system involvement into immediate and ongoing community mental health and substance abuse services. Hennepin County will sustain and expand Minneapolis Police Department Co-Responder services to three officer/psychiatric social worker teams that will respond to an estimated 1,800 EDP 911 calls (approximately 400 per full year of the grant) and refer an estimated 1,050 individuals for ongoing SMI/COD services (approximately 300 per full year of the grant). Hennepin County will also implement its new Behavioral Health Care Center. The Center will be an early diversion site where MPD officers can conduct warm hand-offs to a wide variety of mental health and substance abuse services. The focus of grant activity is to embed SW/LADC case managers and two peer recovery specialists contracted from community mental health providers at the Center to successfully enroll an estimated 360 Center users with SMI/COD in ongoing evidence-based and medically necessary services and supports (approximately 80 per full year of the grant). Parallel Center services funded by Hennepin County tax dollars and third-party billing will provide withdrawal management services, short-term residential mental health crisis stabilization services, a primary/urgent care clinic specializing in individuals with SMI/COD, and intakes for social services at the same site. Hennepin County’s goals are to increase successful enrollment and retention of diverted individuals into ongoing care, reduce arrests and use of force, reduce overall bookings of individuals with SMI/COD into the Hennepin County Detention Center, and reduce the number of post-enrollment detention events within the population of participants vs. pre-enrollment baselines. Through this project, Hennepin County will expand and extend its Co-Responder services and implement an innovative Behavioral Health Care Center model that successfully diverts hundreds of individuals with SMI/COD from arrest and detention into ongoing, evidence-based mental health and substance use disorder services and supports.

Summary: This is a proposal that will enhance and expand an existing Erie County, NY Crisis Intervention Team (CIT) Model for pre-booking diversion of adults with co-occurring disorders (COD) in partnership with police departments and treatment networks. It will expand the number of established partnerships with law enforcement in all cities and large towns, dramatically increase the percentage of personnel trained in CIT core elements, enhance with the MISSION evidence-based practice model, and expand case load capacity of the diversion program. This Enhanced Partnership is headed by a Leadership Team comprised of consumer representatives, the Erie County Commissioner of Mental Health, Police and First Responder representatives, the CEO of Crisis Services- the lead Crisis Intervention Team agency, the President of a multiagency Behavior Health Network, treatment providers, and veteran representatives, as well as the Project Director and Evaluator. Population Served: The population of focus are adults with Serious Mental Illness and/or a co-occurring substance use disorder who have or may come into contact with the criminal justice system in Erie County, NY. Veterans and those with a history of opioid overdose will be a special focus of this proposal. Project Objectives: (Obj. 1) Expand the number of Established Partnerships with law enforcement by establishing committed working relationships with 15 jurisdictions across Erie County (up from 8) within one year; (Obj. 2) Expand the proportion of police personnel trained in the CIT core elements from 16% to 50% over five years; (Obj. 3) Enhance the “Mental Health Receiving Team” at Crisis Services of Western New York with the adoption of MISSION-VET evidence-based practice; and (Obj. 4) Expand the caseload of the Early Diversion Program by 280 individuals over 5 years. Approach: The program will be implemented to enhance and expand the capacity and effectiveness of the Erie County Early Diversion Program so as to: a) better address the challenges when law enforcement encounters non-violent adults with COD; b) better enable the warm hand off by law enforcement to the mental health receiving emergency team; and c) better engage participants in long-term services that nurture recovery and self-sufficiency.

CHICAGO SOUTHSIDE EARLY DIVERSION PROGRAM. The Chicago Southside Early Diversion Program (CSEDP) aims to divert and prevent 375 people, over five years, with serious mental illness (SMI) or co-occurring disorder (COD) who have experienced or are at high risk of experiencing mental health crises, from detention and connect them to community-based behavioral health treatment. The target area is Chicago Police Department (CPD) Districts 4, 5, 6, 7, and 22, areas within South Chicago that disproportionately experience SMI and substance use disorder. In 2017, 26% (5,270) of all mental-health related dispatches occurred in the target area. In 2014, the rate of hospitalization due to substance use or mental health disorders within the target area was 195.4 per 100,000 persons, while the rate in Chicago was 176.3 per 100,000. The target population largely consists of minorities and those who are economically disadvantaged and disconnected from care—27.6% of individuals live below the poverty line and 16.5% do not have insurance. The total population is about 500,000 people, and 10.4% are Non-Hispanic White, 78.6% Non-Hispanic Black, 0.5% Non-Hispanic Asian/Pacific Islander, and 9.3% Hispanic. About 5% of people within the target population are foreign-born and 3.6% have limited English proficiency. In Chicago, 4% of adults identify as gay or lesbian, the number identifying as transgender or bi-sexual is insignificant. The CSEDP has three main goals: (1) strengthen the existing infrastructure that is responsible for coordinating, developing, planning, supporting, and providing effective early intervention services for individuals who are at risk of detention due to behavioral health disorders, (2) improve the identification and response to individuals who are experiencing mental health crises and determined to have an SMI or COD to divert them from the criminal-justice system to community-based services, and (3) reduce recidivism among program participants through the provision of evidence-based models and practices. To achieve these goals, we will foster partnerships among CCHHS, Cook County Government’s criminal justice system, the CPD, the Behavioral Health Consortium (BHC) (a group of 12 behavioral health providers), and the University of Chicago Health Lab, creating an interagency group to guide the CSEDP, identify infrastructural needs, and develop and implement a plan to address those needs. In addition, the CSEDP will employ the Recovery Support Model, specifically Recovery Coaching. The program will include evidence-based practices such as motivational interviewing, cognitive behavioral therapy, and medication-assisted treatment. For other behavioral health treatment, CSEDP will engage with the BHC who offers services that span the entire continuum of care. We hope to serve 75 individuals per year, totaling 375 throughout the lifetime of the project. Through evaluation and data collection, CSEDP will implement any necessary changes to ensure quality throughout the program, and at the close of the program, discuss best practices and strategies to ensure sustainability. Through the CSEDP, the CSEDP partners will help decrease the jail population and ensure that those with SMI and COD receive the treatment they need.

The goal of the Veterans Behavioral Health Partnership Initiative, Ocean County, New Jersey is to preserve public safety through addressing the behavioral health needs of veterans who encounter law enforcement due to serious mental illness (SMI) or co-occurring substance use disorder (COD). This proposal will support CIT training, expand access to evidence- and community-based behavioral health care for veterans throughout the county, and develop local infrastructure to sustain care for veterans with SMI or COD. The program will leverage the clinical expertise available to police officers through existing behavioral health partnerships to identify and engage veterans with SMI or COD. The veterans program will provide care coordination and multidisciplinary clinical services through an Assertive Community Treatment (ACT) model that incorporates Prolonged Exposure Therapy and best practice psychopharmacology. The objective of the CIT element will be to enhance the capability of up to 200 law enforcement offers and 150 behavioral health professionals to respond to veterans in crisis and identify candidates for diversion and warm handoffs to behavioral health providers. Two sessions per year for 35 participants will be held over the five year grant period. The objective of the veterans PACT will be to improve symptomology, reduce psychiatric hospitalizations, and reduce encounters with police for 54 veterans over the contract period. Each year, 12 veterans will be enrolled in the PACT component and will be provided comprehensive and integrated rehabilitation, treatment and support services, as well as a veteran mentor, and care coordination across veteran and civilian service systems. Staff of the veterans PACT will received training and certification in Prolonged Exposure Therapy and advanced continuing education in psychopharmacology to improve their competency and expertise with veterans, who often experience Post Traumatic Stress Disorder and complex physical and behavioral health needs. The objective of the VA Health Choice and Tricare incentives will be to expand accessibility of behavioral health care to 42,500 local veterans and to sustain the clinical outpatient service components of the veterans PACT. As a result, up to 10 local behavioral health providers in Ocean County will become in-network providers through VA Health Choice and/or Tricare over the five year grant period.

The Deschutes County Co-Responder Program is a law enforcement and behavioral health partnership between Deschutes County Health Services and Bend Police Department. A Crisis Intervention Team (CIT) trained police officer and a behavioral health professional will work shifts together to divert adults with serious mental illness (SMI) or a co-occurring disorder (COD) from the criminal justice system prior to arrest and booking. The Co-Responder Team's approach will allow for real time, in the field, interventions focused on assessing the needs of the individual, evaluating opportunities for diversion, and connecting the individuals with community-based services. In addition to the behavioral health professional, the Co-Responder Program will include a Peer Support Specialist (PSS). The PSS will be an individual with lived life experience who will engage the individual, reduce barriers to necessary services, and provide ongoing support to ensure successful follow through and engagement. Integration into community-based services will be accomplished through coordination with DCHS programs as well as other SMI and COD community providers. Embedded within the DCHS Crisis Program, Co-Responder staff will be part of the largest community SMI and COD organization in Deschutes County. DCHS provides a wide array of evidence-based practices and services that range from traditional outpatient services to intensive community-based supports. The level of need for a co-responder program has been growing over the years. Data from the Bend PD regarding AMI (allegedly mental ill) shows ongoing increases, e.g. 2010: 664 calls compared to the 1,809 calls received in 2017 for an overall increase of 172%. The Co-Responder Program will build upon the foundation created by the CIT Program and well as the Sequential Intercept Mapping that was conducted by the Substance Abuse and Mental Health Services Administration in 2012. Project goals and objectives include: 1) increasing the number of individuals with SMI or COD who are diverted from the criminal justice system, 2) increasing the number of diverted individuals with SMI or COD who are enrolled in community-based behavioral health services, 3) increasing the number of diverted individual with SMI or COD who are enrolled in an integrated medial and behavioral health setting, 4) increasing the number of diverted veterans with SMI or COD who are receiving community-based services, and 5) increasing the number of individuals referred by law enforcement who are screened for SMI or COD. The Co-Responder Program will serve 400 individuals on an annual basis and 2,210 over a five-year period.

Hillsborough County intends to expand an existing pre and post booking jail diversion program in order to divert adults with serious mental illness (SMI) or a co-occurring disorder (COD) from the criminal justice system to community-based services prior to arrest and booking. The program is expected to serve 40 clients annually in years 1-4 and 30 clients in year 5. Data collected by the Hillsborough County Sheriff’s Office on jail inmates indicates that more than one in ten has a diagnosed mental and/or co-occurring substance use disorder, 15.4% in 2014-15, and 12.52% in 2015-16. On average, 785 inmates per month received psychotropic medications. In order to address the prevalence of SMI and COD in the Hillsborough County jail, County government has partnered with the Agency for Community Treatment Service (ACTS) and the University of South Florida (USF), with support from the Hillsborough County Public Safety Coordinating Council. ACTS will be tasked with providing direct services, case management and data collection under this grant. USF will be the independent evaluator. Hillsborough County’s Criminal Justice Office proposes to expand and enhance the County’s existing jail diversion program. The current program diverts persons who are experiencing minor behavioral health issues and are accused of committing certain misdemeanors and ordinance violations from jail. The individuals subsequently are referred to a number of behavioral health interventions including: case management, counseling, mental health and substance abuse treatment, residential services, vocational services, and community monitoring. Services are limited to those already available in the community through other payors. Services are up to three months in duration. A three-year analysis conducted by USF clients of the current program who receive more intensive services and closer supervision in the community benefitted from better long-term outcomes. The County Criminal Justice Office proposes to enhance existing services for community jail diversion by expanding the length of service up to 12 months and implementing an intensive service team component. ACTS is the current jail diversion program partner and has committed to providing all necessary services to implement this new program as well as collecting and reporting the required match funds. The current model is funded through a variety of state, private and local funds. USF has committed to performing all necessary data collection, evaluations and reporting, as well as providing technical assistance and support for evidence based practices and implementation. Efforts sponsored by this grant will improve access to behavioral health services and entitlements for those with SMI or COD who would otherwise be arrested and taken to jail; reduce the number of people with SMI or COD in the County’s jail population; reduce the burden on the Court system for initial arrests and repeat offenders; reduce recidivism for those enrolled in the program; and reduce symptomology for those enrolled and receiving services through the program.

The project name is the North Central CT Diversion Team. It will be led by the Town of Suffield Police Department in partnership with mental health and substance use provider, CHR, to effectively divert individuals with serious mental illness (SMI) or co-occurring disorders (COD) from the criminal justice system into appropriate community-based behavioral healthcare services. The population to be served includes four contiguous towns: Suffield, East Windsor, East Granby and Windsor Locks. With a total population of 34,714 adults, all of the towns are rural with significant rates of mental health issues, substance use disorders and suicide. Of note, the region is in the midst of an unprecedented opioid use crisis that has touched people of all ages, including veterans. Strategies and interventions will include robust training for police teams; outreach within the participating communities; and the expansion of access to mental health and substance use services by embedding a crisis clinician on the Team to help divert individuals in crisis. The project goals include: diverting individuals with SMI and COD encountered by law enforcement into community behavioral healthcare services and ensuring that individuals have safe and supportive encounters with police and behavioral health professionals. Both of these overarching goals are supported by measurable objectives that are rooted in rigorous training and community education, including the implementation of an Early Diversion Oversight Committee that will meet regularly and will include all key members of the Team as well as a Veterans' Advocate and a family member of someone with SMI or COD. All clinical services and training will be guided by a range of proven, evidence-based practices. In addition, the Oversight Committee will ensure that goals are being met and will review data captured and analyzed to ensure that goals and objectives are being met. The total number of individuals expected to be served through the North Central CT Diversion Team is 225 individuals over the five-year span of funding.

The Partners Diversion Program (PDP) will expand current diversion practices and provide comprehensive evidence-based services, including a 24/7 Drop Off center, to an unduplicated 270-480 individuals annually for a total of 1,950 individuals served over the life of the grant. A comprehensive evaluation and performance management system will support the PDP as an adaptable data-responsive program. Persons served will be 18-years of age or older, have a Serious Mental Illness or Co-occurring Substance Use Disorder (SMI/COD) and will be found to be in need of service or engaged in low level crimes by local law-enforcement officers (LEOs). An integrated system of care targeting low-level offenders with SMI/COD will be delivered via a comprehensive assessment leading to provision of evidence-based practices (EBPs) that include the Memphis Crisis Intervention Team (CIT), Law-Enforcement Assisted Diversion (LEAD), Integrated Dual Disorder Treatment (IDDT), Assertive Community Treatment Teams (ACTT), Medication Management According to Protocol (MedMAP), and SSI/SSDI Outreach, Access, and Recovery Technical Assistance (SOAR). Persons served will be 18-years of age or older and have been diagnosed with a serious mental illness and/or a comorbid substance use disorder. The project will meet two overall goals: (1) to create a sustainable pre-booking diversion program that will successfully meet outcomes as well as the infrastructure to collect performance measure and other data; and, (2) to integrate the PDP into the system of care and integrated care models that PBHM is creating via internal funds and other grant dollars, e.g. a SAMHSA system of care grant recently awarded and the Whole Person Integrated Care (WPIC) initiative. Four outcomes are being targeted to assess program impact. These include: (1) an 85% reduction in treatment/assessment scores on well validated tools (e.g. the CDC Health Days survey); (2a) an 80% reduction in subsequent contacts with LEOs within six-months of PDP intake and (2b) a 70% reduction within 12-months of intake; (3) 25% decrease in arrests of individuals known or suspected of being afflicted by SMI-COD in Year 1, increasing 5% each year; and, (4) increase psychiatric medication compliance by 50%. A series of mandated performance measures, additional performance measures and outputs will also be targeted for data collection. Key activities/infrastructure development include (1) to ensure community-based interagency community coordination; (2) hold regular meetings with a central group (Law Enforcement and Behavioral Health Partnership group (LEBHP) for decision-making and support; (3) an integrated system of EBPs and other services and support at all stages of diversion (Encounter, Enable, Engage); (4) effective data sharing; (5) strong leadership via the Project Implementation Team (PIT); (6) culturally competent participating staff; (7) training and support of LE with cross-training of LE principles/perspective for behavioral health (BH) practitioners; (8) implementation of a community outreach and awareness plan, and, (9) a strong evaluation approach to meet all SAMHSA requirements and support rapid feedback to all PDP partners.

This project would take place in Cuyahoga County in northeast Ohio, in the first and second police districts of the City of Cleveland. The purpose of the project is to expand staffing and Peer Supporter services at the Crisis Stabilization Unit to create a diversion point for law enforcement when encountering persons with Serious Mental Illness/Co-Occurring Disorders who are in crisis. With a population of nearly 1.4 million, it's estimated that each year, as many as 52,000 persons in the county are challenged by an episode Serious Mental Illness (SMI). The county's population is 64% Caucasian, and 31% African American; 6% identify as Latino. Outside of a transport to the psychiatric ER for crises posing immediate danger, law enforcement lacks a consistent diversion point for a warm handoff to behavioral health providers who can provide a secure environment that is less restrictive than a hospital. An individual's behavior in the community then escalates over hours or days, leading to arrest and jail. This proposal is submitted by the Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County (ADAMHSCC), in partnership with the Cleveland Division of Police and a provider of crisis behavioral health services, Frontline Service. The ADAMHSCC will contract with Case Western Reserve University for evaluation services. The ADAMHSCC and its partners propose adding the capacity for 2 dedicated diversion beds, after hours assessment, prescriber availability after hours, and rapid stabilization at the CSU. Before discharge, clients with SMI will be linked to a certified Peer Supporter for ongoing support in the community and navigation of the treatment system. Each year 50 persons would receive these services, or 250 people over the life of the project.

The County of San Luis Obispo’s Behavioral Health Department is excited to implement its Community Action Teams (CATs) project as part of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Law Enforcement and Behavioral Health Partnerships for Early Diversion grant program. Along with integrating the proposed early diversion CATs program into the existing system of care the County will launch a Law Enforcement and Behavioral Health Partnership collaborative, and an interagency plan to address the stages of early diversion using evidence-based practices, additional training, outreach, and expanding the continuum of behavioral health care. The program uses an outreach and early intervention strategy to assist law enforcement in safe, productive encounters with individuals demonstrating issues related to severe mental illness (SMI) or co-occurring disorders (COD). Much like the community-based Mobile Crisis program model, the CATs program embeds clinical staff alongside responding field officers in targeted areas to provide immediate, warm, and safe engagement with individuals exhibiting mental health or substance use challenges. While some encounters will be related to psychiatric crises, the focus of the CATs intervention will be to create a proactive, preventive approach to support LE who often have limited options other than arrest. The CATs will divert individuals from arrest and booking, and will expand mobile crisis and evaluation services which can then reduce impacts on the jail, emergency departments, and the inpatient Psychiatric Health Facility. Two CATs will be created and deployed. Two Behavioral Health Clinicians will be assigned to both the Sheriff’s Community Action Team, and a CAT partnership between the Atascadero and Paso Robles Police Departments. Each team will focus on identifying homeless and other high-risk (e.g. frequently encountered) individuals, and individuals in mental health crisis situations in the unincorporated and northern areas of the county. The Clinicians will dispatch with officers assigned to the CAT to help engage and assess individuals, and then provide access to services, referral, or assist in transport for those meeting the criteria for an involuntary hold. In addition to field interventions, the CATs’ Clinicians and law enforcement partners will establish a procedure to identify individuals with SMI or COD who are frequently or routinely encountered by LE or the criminal justice system. CATs will outreach to those individuals prior to their next encounter to offer services and support in order to reduce recidivism. The CATs project will serve 285 unduplicated individuals in ongoing treatment and care over the course of the five year grant. After the start-up year, six hundred (600) individuals will be engaged annually through contacts in the field, and by outreach to known individuals who are frequently encountered by law enforcement and have a SMI or COD. Each year, approximately 120 will be provided with screening, brief intervention and referral contacts and 60 unduplicated clients will receive ongoing treatment and wellness care.

The Mississippi Department of Mental Health (DMH) is applying in partnership with Pine Belt Mental Healthcare Resources (PBMHR) to target and deliver services to individuals with SMI/COD in Forrest County, Mississippi. For the purposes of this project, these individuals will be identified when encountered by trained and certified CIT (Crisis Intervention Team) officers. CIT officers are trained and have protocols in place to enable them to identify individuals with mental health or co-occurring conditions, de-escalate them, and then conduct warm hand offs and transfers to MCeRT (Mobile Crisis Emergency Response Team) staff. Using motivational interviewing techniques, MCeRT will engage individuals into evidence-based mental health treatment and recovery support services. Lessons learned from this endeavor will be applied to expand CIT to other counties in southern Mississippi. The purpose of this project is to expand the CIT and MCeRT programs in order to divert individuals and veterans with SMI/COD from arrest to community-based recovery services. Specifically, Pine Belt CIT expects to divert and provide MH/COD treatment and recovery support services to a minimum of 70 individuals per year, for a total of 350 over the project period. Following are the goals and objectives: Goal 1: Increase the capacity of service providers in southern Mississippi to divert individuals with SMI/COD from arrest and booking into treatment; Objective 1a: Utilize social marketing activities to generate interest and engage 4 additional communities in the development of a CIT program; Objective 1b: By the end of the project period, four additional counties in southern Mississippi will have convened Interagency Law Enforcement & Behavioral Health Partnership groups; Objective 1c: Utilize outside expert consultation advice to provide guidance and feedback on the development of new CIT programs three times each year; Objective 1d: A minimum of 24 officers will become CIT certified each year of the project; Objective 1e: Provide professional development opportunities to at least two staff each year through SAMHSA and CIT International Conferences; Objective 1f: A Law Enforcement & Behavioral Health Diversion Toolkit will be developed and available for dissemination by the end of the project period. Goal 2: Enroll and engage individuals with SMI/COD into community-based care; Objective 2a: Within 2 months of start of project, increase the capacity of MCeRT to serve Forrest County by adding a Forrest County based team. Objective 2b: All Forrest CIT encounters will be reported to PBMHR for follow-up within 24 hours in a written CIT Incident Report; Objective 2c: Annually, MCeRT will engage a minimum of 70 individuals with SMI/COD encountered by CIT officers to participate in Seeking Safety; Objective 2d: All participants will collaborate with a clinician to develop and participate in an individualized service plan that is consistent with clinical standards of care in the least restrictive environment; Objective 2e: Within one week of enrollment in project participation, Community Support Specialists (CSS) will assess all participants’ life domains, develop fluid service plans, and assist participants with accessing supports; Objective 2f: Participants will have access to psychiatric services within 2 weeks of enrollment.