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HomeMy WebLinkAboutacbh-a-systems-approach-plan-to-reduce-forensic-involvement-with-behavioral-health-clients-finalA Systems Approach & Plan to Reduce Forensic involvement with Behavioral Health Clients Alameda County Board of Supervisors (BOS) Presentation Board Retreat –October 27, 2020 Karyn Tribble, PsyD, LCSW, Director Alameda County Behavioral Health Care Services (ACBH) Colleen Chawla, Director, Health Care Services Agency (HCSA) A Systems Approach & Plan to Reduce Forensic Involvement with Behavioral Health Clients Contents Summary: A.ACBH Departmental Overview B.Forensic Services Redesign & Planning C.Emerging Findings & Themes D.Formal Recommendations E.Next Steps ACBH Departmental Overview •Mental Health Managed Care Plan •Substance Use Managed Care Plan •Care Delivery System, Contractual Organization, & Behavioral Health Jurisdiction for safety net beneficiaries (MH & SUD) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 3 •Contracting Organizations deliver approximately 86% -87% of all Mental Health and 100% of all Substance Use Services for the Department. •Fiscal Year (FY)19-20 Budget: •$540 Million Dollars ➢Adult Forensic Behavioral Health (AFBH) $16M •693.45 FTE County Civil Service Positions •20,414 individuals served in Outpatient Mental Health Programs. •5317 Individuals served in Substance Use Programs. •Fiscal Year (FY)20-21 Budget: •$563 Million Dollars ➢Adult Forensic Behavioral Health (AFBH) $16M + 22M (Approved by BOS May 2020) •700.00 FTE+ County Civil Service Positions •Client-level encounter data pending A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 4A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration ACBH Departmental Overview Service Delivery: •Adolescent Substance Use Treatment & Prevention •Community Outpatient Services •Educationally Related Mental Health Services •Early Childhood (Birth –8) •School Based Behavioral Health •Full Service Partnerships (FSPs) •Psychiatric Emergency Services •Intensive Case Management •First Episode Psychosis •Housing •Juvenile Justice Center & Santa Rita Jail •Vocational & Employment Support •In-Home Outreach Team 5 Child & Young Adults Home Clinic Office School Comm- unity Foster Home Juvenile Hall Child and Young Adult System of Care Serving Children & Youth from Birth –24 years A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Service Delivery: •County and Non-profit service teams •Full Service Partnerships •Forensic behavioral health •Vocational support •Supportive housing •Medication clinics •Wellness Centers •Harm reduction skill building •Mobile Teams •Early Intervention Services •Evidence Based Treatment Models •Co-Occurring Mental health & Substance Use services 6 Adult and Older Adult System of Care Adult & Older Adult Home Clinics Work Site Comm- unity Wellness Centers Adult Forensic Serving Adults 25 Years & Older A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Service Delivery: •Sobering Center & Social Model Detox: Receives clients for less than 24 hours of safe sobering. •Residential Treatment: 20+ hours of programming per week. •Recovery Residence (Sober Living Environments): Temporary housing in combination with outpatient treatment. •Intensive Outpatient Treatment: More than 9 hours per week. •Narcotic Treatment Programs: Provides methadone and individual drug counseling. •Screening, Brief Treatment, Referral to Treatment: Integrated in primary care teams across Federally Qualified Health Centers (FQHCs). 7 Substance Use Treatment Screening, Brief Treatment, Referral to Treatment (30) Sobering Center & Social Model Detox (1) Residential Treatment (12) Recovery Residence (Sober Living Environments) (5) Intensive Outpatient Treatment (17) Outpatient Treatment (32) Narcotic Treatment Programs (7)Continuum of Care with Gender & Age-Specific Programs A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Context •On May 12, 2020, Alameda County Board of Supervisors (BOS) authorized additional staffing and related costs at the Santa Rita Jail for the Sheriff's Office and Health Care Services Agency/Behavioral Health (BOS Agenda, Item 72). •Alameda County Behavioral Health (ACBH) was directed to develop a plan to reduce the number of incarcerated individuals with behavioral health conditions within the jail. •As a result of this action, ACBH recalibrated it’s 2019 Forensic System Redesign & Stakeholder work to include a comprehensive plan to respond to this direction from our County BOS. A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 8 Forensic Services System Redesign & Planning: A 3-Tiered Methodology 1)External Stakeholder Process 2)Extensive Department-wide Internal Research, Planning & Direct Stakeholder Engagement (In-reach/ Outreach) 3)Consultation A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 9 External Stakeholder Process: Community Stakeholders A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 10 •Peers & Family Members; Consumer & Family Member Organizations •Justice Involved Mental Health (JIMH) Taskforce* •Community Based Organizations (CBOs) •Mental Health Advisory Board •Federally Qualified Health Centers (FQHCs) •Mental Health Services Act (MHSA) Community Program Planning (CPP) •Courts, Public Defender, District Attorney, Probation, & Law Enforcement 11 Forensic Services System Redesign & Planning: Community Stakeholders A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration External Stakeholder Process: Community Stakeholders Justice Involved Mental Health (JIMH) Taskforce * c/o Jeweld Legacy Group (JLG) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 12 External Stakeholder Process: Justice Involved Mental Health (JIMH) Taskforce •Inclusive Stakeholder Process •Expansive Membership: •Community Members & Families •County Departments/ Agencies •Advocacy & Equity Groups •Mental Health, Substance Use, & Health Care Organizations •Faith Community •Law Enforcement •Local & State Affiliated Organizations •Court & Legal System •JIMH Taskforce Steering Committee A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 13A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Sequential Intercept Map 14A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Intercept 0 Hospital, Crisis Respite, Peer & Community Services Intercept 1 Law Enforcement & Emergency Services Intercept 2 Initial Detention & Initial Court Hearings Intercept 3 Jails & Courts Intercept 4 Reentry Intercept 5 Community Corrections & Community Supports Sequential Intercept Map → Additional Intercepts added by JIMH Taskforce 15A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Intercept -2 Prevention Intercept -1 Early Intervention Intercept 0 Hospital, Crisis Respite, Peer & Community Services Intercept 1 Law Enforcement & Emergency Services Intercept 2 Initial Detention & Initial Court Hearings Intercept 3 Jails & Courts Intercept 4 Reentry Intercept 5 Community Corrections & Community Supports External Stakeholder Process: Justice Involved Mental Health (JIMH) Taskforce Ad-Hoc Steering Committee Proposed Prioritizations for Consideration 1)The plans and programs that are adopted must be data-driven 2)Set concrete goals to reduce number of people with serious mental illness in SRJ to zero 3)Focus attention and resources on negative and initial stages 4)Establish an independent, Brown-Acted task force to move plan forward 5)The County should appropriate new dollars to begin to implement plan in 2021 A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 16A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Departmental Research & Planning: Internal Research, Planning & Direct Stakeholder Engagement (In-reach & Outreach) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 17 Departmental Research & Planning: Internal Research, Planning & Direct Stakeholder Engagement (In-reach/ Outreach) 1)Forensic Services Redesign & Restructuring a)Forensic Services “System of Care” (within clinical operations; executive team membership) 2)Departmental Operations & Clinical Services Planning a)Service Inventory & Review b)Client “access” c)Care Coordination 3)Finance Planning & Budget Review a)Budgetary Trends & Forecasting b)Current Expenditures c)Projected Cost Allocations (approximates) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 18A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Consultation: Departmental Support, Data Review, & Analysis c/o Indigo Project A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 19 Consultation: Departmental Support, Data Review, & Analysis •Primary Focus Areas: ❑Develop and communicate a unifying vision for the Department’s approach to serving individuals receiving forensic-based care; ❑Provide an array of evidence-based & promising practices that maximize community-based services settings and diversion from the justice system while improving programming across forensic settings; and ❑Strengthen connections between and across sectors in order to close any gaps and improve post release service participation. Data-Centered Consultation: ❑Assessment & recommendations related to – ❖Underlying risk factors; ❖ethnic or racial disparities; ❖comprehensive assessment & care coordination; ❖and general service trends & effectiveness. ❑Internal & External stakeholder participation and engagement A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 20A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Emerging Findings: Across the ACBH System A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 21 Research & Planning Emerging Findings: Across the ACBH System System Strengths •Readiness for change •Attention and collective investment in forensic populations •Relationship with Sherriff’s Department Areas for Consideration •Concern about fidelity to program models •Lack of knowledge about criminogenic and Risk Need Responsivity (RNR) model •Groups of individuals who are unserved because they may be unwilling to engage in voluntary services A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 22A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Consultation Emerging Findings: At Intercept Points System Strengths •Shared dedication to community services •Mobile crisis and community crisis response development •Success with the Forensic Conditional Release Program (CONREP) Areas for Consideration •Crisis Intervention Training (CIT) and Multidisciplinary Forensic Teams (MFT) require attention. •Diversion and mechanisms to divert are underdeveloped •Challenges around competency restoration •Re-entry in transition, limited in-reach, and challenges around discharge planning and connectedness to services upon release A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 23A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Consultation: Departmental Financials Review A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 24 FY 18-19 FY 19-20 Other Alternatives to Incarceration AFBH Forensic & Diversion Programs Total Other Alternatives to Incarceration AFBH Forensic & Diversion Programs Total MH $178M $14M $192M $200M $16m $216M SUD $45M -$45M $46M -$46M Program Total $223M $14M $237M $246M $16m $262M Youth Forensic $8.3M ACBH Total $476M*$537M* (*NOTE: ↑Above does not include other Contract or Infrastructure Costs)TOTAL FY19/20 $540M (NOTE: →TOTAL FY/21 Includes BOS Increase in May 2020 → $16M + $22 = $38M AFBH Budget) TOTAL FY/21 $563M Consultation Emerging Findings: Data Analysis & FY 18/19 Historical Trends •10% only received BH Services at Santa Rita Jail •15% received services both at Santa Rita Jail & Community •In FY 18/19, 75% of ACBH clients did not receive BH services at Santa Rita Jail. •In FY18/19, 49% of TAY consumers received CJMH Services at Santa Rita; while 19% of them received BH services only while incarcerated. A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 25A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Only Received BH Services at Santa Rita, 1721, 10% Received BH Services at Santa Rita and in Community , 2714, 15% Did NOT receive BH Services at Santa Rita, 13440, 75% FY 18/19 ACBH Clients, N=17,875 Consultation –Corrected Slide Emerging Findings: Data Analysis & FY 18/19 Historical Trends •32% of all African American ACBH clients received services through AFBH (as compared to 25% overall, slide 26). •69% of ACBH African American Transitional Age Youth clients received services through AFBH. •77% of AFBH Consumers who are Asian/Pacific Islander only receive AFBH (as they do not connect to care outside of the jail). A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 26A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Alaska Native or America n Indian Asian/ Pacific Islander Black or African America n Hispani c or Latino Other/ Unknow n White Total ACBH Clients 61 1659 5389 2226 4808 3732 17875 ACBH Clients Served at AFBH 13 345 1709 392 1140 836 4435 ACBH Clients Only Served at AFBH 7 267 1066 209 650 515 2714 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Race/Ethnicity of ACBH Consumers Served at AFBH Consultation Emerging Findings: FY 18/19 Service Utilization A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 27A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 0-3 days, 769, 13% 4-7 days, 887, 15% 8-30 days, 1421, 24% 31-90 days, 1343, 23% 91+ days, 1462, 25% AFBH Episode Length for ACBH Consumers Served at CJMH in FY18/19, n=4,367 0 200 400 600 800 1000 1200 1400 Service Utilization for ACBH Consumers Served at AFBH in FY18/19, n=4,367 FY 2017-2018 FY 2018-2019 FY 2019-2020 *Individuals may have received more than one service Additional Review –18 Years & Under Emerging Findings: Data Analysis Historical Trends (FY19/20) •Alameda County Guidance Clinic (ACBH Operated) -$2.6 Million •Multi-Systemic Therapy & Intensive Case Management (ICM) -$1.96 Million •Intensive home-based supports for Youth involved with Foster Care &/ Juvenile Justice System (“Wraparound”) -$3.73 Million •TOTAL FY19/20 Youth Services (under 18) = $8,347,236 Million A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 28A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Consultation Global Recommendations: Services Delivery & System Change •Strengthen cultural, ethnic, and linguistically relevant and inclusive service delivery. •Divert at every intercept, where safe and feasible, from the criminal justice system into treatment •Formalize use of Sequential Intercept Model for ALL forensic based services •Comprehensive assessment needed: Assess Risk Needs Responsivity (RNR) at intersection of mental health, criminogenic risk, and substance use •Maximize treatment in-custody to stabilize and transition to appropriate mental health setting based upon RNR approach •Clearly identify Target Populations (Screening, Assessment, Care Coordination, & Treatment) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 29A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Consultation Global Recommendations: Services Delivery & System Change Clearly identify Target Populations… More Effective: •Care Coordination •Interagency Communication •Referral & Treatment •Outcomes •Group A: People with significant mental health needs, low criminogenic risk and need, high rates of low-level offenses, unlikely to accept voluntary services •Group B: People with mild to moderate mental health needs, significant substance use and associated behaviors, high rates of re-arrest, unlikely to meaningfully engage with voluntary services •Group C: People with significant mental health needs, moderate to high criminogenic risk and need, present personal and public ongoing safety risk, unlikely to sustain participation in voluntary services A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 30A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Forensic Services System Redesign & Stakeholder Planning: Emerging Themes & Recommendations A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 31 Forensic Services System Redesign & Stakeholder Planning: Emerging Themes & Recommendations •Data Driven Metrics to measure progress & impacts. •Develop concrete goals to eliminate number of incarcerated individuals with Severe Mental Illness (SMI). •Formal Adoption of Sequential Intercept Map (SIM) Framework; and focus on negative & initial stages. •Co-location of Programs within existing service areas. •Organized care delivery system with a core approach of Case Management & Coordination. •Universal Assessment & Risk Needs Responsivity (RNR; the intersection of mental health, criminogenic risk, and substance abuse). •Structured Decision-Making Tools for effectively managing client care. •Improve Interagency Coordination 32 PROCESS & APPROACH: A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration •Expand Level II LPS designations (provider & facilities capacity to initiate & release 5150/5585 LPS Holds). •Increase Crisis Stabilization Units (CSUs) & Crisis Residential Treatment (CRTs) Programs county wide (regional approach). •Improve client and family access to 24/hour care (including use of crisis services). •Explore 5170 receiving facilities for Substance Use Disorder (SUD) clients •Develop Forensic Psychiatric Health Facility (PHF) for Inpatient Care •Develop programming & coordination for Forensic High Utilizers 33 CRISIS & ACUTE CARE: A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Forensic Services System Redesign & Stakeholder Planning: Emerging Themes & Recommendations •Standardize use of High Fidelity Forensic Assertive Community Treatment (FACT) programs; including the expansion of linkage programs from Santa Rita Jail. •Expand Full Service Partnerships (FSPs) & Intensive Case Management Programs •Increase Funding to Collaborative Courts •Expand Care Coordinators working in Primary Care settings •Increase Employment opportunities for forensic clients •Develop system Navigation support & Call Centers for forensic clients & families •Enhance Crisis Intervention Training (CIT) for Law Enforcement 34 COMMUNITY BASED CARE & COORDINATION: A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Forensic Services System Redesign & Stakeholder Planning: Emerging Themes & Recommendations •Develop Emergency Shelters & Emergency Housing options for forensic clients. •Develop (or by contract) additional Board & Care options for forensic clients. •Expand Locked Psychiatric & Unlocked Sub-Acute facilities/capacity countywide. •Re-purpose Glenn Dyer Jail for Residential Locked and Unlocked Mental Health Treatment. 35 CAPITAL EXPANSION, HOUSING, & COUNTY INFRASTRUCTURE: Forensic Services System Redesign & Stakeholder Planning: Emerging Themes & Recommendations A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Process & Strategy) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 36 Key Strategies & Assumptions – ➢Health Equity Lens ➢Data Driven Metrics with Concrete system goals. ➢Sequential Intercept Map (SIM) Framework for all Forensic Services ➢Target Populations: Group A, Group B, Group C ➢Case Management & Interagency Coordination ➢Universal Assessment & Risk Needs Responsivity (RNR; at intersection of mental health, criminogenic risk, and substance use) ➢Structured Decision-Making Tool for RNR Implementation 37 Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Process) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Strategy Framework) Duration Framework – ➢Short-Term Objectives & Recommendations (>6 Months) ➢Medium-Term Objectives & Recommendations (6-12 Months) ➢Long-Term Objectives & Recommendations (12+ Months) Prioritization Framework – ➢Benefit/Value to System (High/Low) ➢Cost/ Effort required to Implement (High/Low) Costs – ➢Approximate/ Average Costs ➢Based upon actuals & projected estimates. ➢Funding sources not yet identified A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 38 Short-Term Objectives & Recommendations (>6 Months) 1)Direct In Home Outreach Team (IHOT) Referrals by Law Enforcement Departments ($0 Cost) (Int 1) •Explore Forensic IHOT Expansion (Approximate Cost $560K/ Team) 2)Regional Approach to South County Services ($0 Cost) (Int -2) 3)High fidelity Assertive Community Treatment (ACT) & Forensic Assertive Community Treatment (FACT) Teams ($50K Cost) (Int 4) 39 Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Strategy Actions) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Short-Term Objectives & Recommendations (>6 Months) 4)Create Director of Forensic, Diversion, & Re-Entry Services Position ($0 Cost) (Int -2) 5)Re-Tool Crisis Intervention Training (CIT) ($100K Cost) (Int -1) 40 Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Strategy Actions) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Medium-Term Objectives & Recommendations (6-12 Months) 1)Design Forensic, Diversion, & Re-Entry Services System of Care ($0 Cost) (Int 4) •Re-design & organize forensic services, including “ACCESS” for forensic clients •Create Forensic Care Coordination Teams o Create Forensic Re-entry team (Multi-Disciplinary Forensic Teams) o Create Forensic “Acute Care Team” •Complete Quality review of Youth & Adult/Older Adult Forensic Programs 2)Pre Trial Diversion: Increase Funding to Collaborative Courts/ Mental Health Courts ($141K) (Int 2) 3)Expand 5150 & 5585 capacity to place/release countywide ($0 Cost) (Int -1) 41 Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Strategy Actions) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Medium-Term Objectives & Recommendations (6-12 Months) 4)Expand Satellite Urgent Care Clinic Hours & Services •Services targeting SMI/SUD clients •Expansion of services to include Nights & Weekends ($2M) (Int 0) 5)Overnight Mobile Crisis Services & Crisis Calls •In person overnight, 7 nights per week, 365 days/year ($2.2M) (Int 0) •Regional overnight coverage in South County 6)Expand Forensic Linkage Program at Santa Rita ($524K) (Int 3) 42 Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Strategy Actions) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Medium-Term Objectives & Recommendations (6-12 Months) 7)Develop TAY Full Service Partnership (50 Client FSP) ($1.5M) (Int 0) 8)Overnight Crisis Services & Crisis Calls •In person overnight, 7 nights per week, 365 days/year ($2.2M) (Int 0) •Regional overnight coverage in South County 9)Initiate Feasibility Study to explore Capital Expansion for Acute Inpatient Treatment (General & Forensic) ($TBD) (Int 0) 43 Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Strategy Actions) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Long-Term Objectives & Recommendations (12+ Months) 1)Prioritize the care of “high utilizers” of county behavioral health and forensic services to ensure that they are connected to appropriate treatment and facilities ($0 Cost) (Int 4) 2)Co-locate TAY behavioral health services ($15K, Int -2) & Develop Forensic TAY Programming targeting African American Youth: •New 50-Client TAY FSP ($1.4M) (Int -1) •Youth Prevention Program ($380K) (Int -2) •Expansion of TAY Clinical Treatment & Outreach Services ($450K) (Int -2) 44 Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Strategy Actions) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Long-Term Objectives & Recommendations (12+ Months) 3)Significantly increase the capacity of residential treatment beds countywide •Crisis Stabilization Unit (CSU; 14-bed)($4.5M) (Int 0) •6-Bed Crisis Residential Treatment (CRT) facility ($1.1M) (Int 0) •12-Bed CRT (MH & SUD) ($2.2M) (Int 0) •16-Bed Psychiatric Hospitalization Facility ($5.5M) (Int 0) •10 Additional Board & Care Beds (Forensic beds) ($1M) (Int 4) 4)Adult Residential Co-Occurring Forensic Treatment facility with direct linkage from Santa Rita •Co-Occurring (MH & SUD Treatment) Residential 10-Bed ($1.05M) (Int 4) 45 Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Strategy Actions) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Long-Term Objectives & Recommendations (12+ Months) 5)Expand Short Term & Permanent Housing; Board & Care Facility Options ($2.2M) (Int -2) 6)Develop (2) Multi-disciplinary Re-Entry Teams (MRTs) ($1.08M) (Int 4) •Continuity of care from Santa Rita 7)(6) Bed Forensic Peer Respite (from Santa Rita Jail, on Probation, or at-risk) ($1M) (Int 0) 46 Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Strategy Actions) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Long-Term Objectives & Recommendations (12+ Months) 8)Expand Crisis Services: •Embedded Clinicians with Law Enforcement locations (Regional South County Expansion) ($480K) (Int 1) •Countywide CATT Expansion –6 New Teams (+$6.6M*) (Int 0) •Mobile Evaluation Team –Fremont ($75K) (Int 1) 9)Expand 24/hour Crisis Services Call Center: •Peer-based & Clinical Warmline ($670K) (Int -1) •Overnight Call Center capacity ($12K) (Int -1) 47 Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Strategy Actions) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Long-Term Objectives & Recommendations (12+ Months) 10)Competency Restoration & Diversion: •Develop New 16-Bed Psychiatric Health Facility (PHF) ($5.5M) (Int 5) •Develop New 25-Bed Sub-Acute Facility ($4M) (Int 5) 11)Develop (2) Substance Use Mobile Outreach Teams ($1.2M) (Int -1) 12)Re-design & Create New Outpatient Service Team(s) Model ($1.5 M) (Int -1) 10)Shift from Office Based care to Trauma Informed, forensic & co-occurring treatment model 48 Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Strategy Actions) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 49 Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Strategy Actions) A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Short-Term (>6 Months) 6 Recommendations Medium-Term (6-12 Months) 9 Recommendations Long-Term (12+ Months) 12 Recommendations $150,000 $8,565,000 $41,912,000 Total Estimated Costs $50,627,000 Estimated Cost Summary –Duration 50A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Intercept -2 Prevention Intercept -1 Early Intervention Intercept 0 Hospital, Crisis Respite, Peer & Community Services Intercept 1 Law Enforcement & Emergency Services Intercept 2 Initial Detention & Initial Court Hearings Intercept 3 Jails & Courts Intercept 4 Reentry Intercept 5 Community Corrections & Community Supports $3.045M $4.882M $28.8M $555K $141K $524K $3.18M $9.5M Total Estimated Costs $50,627,000 Estimated Cost Summary –By Intercept Forensic Services System Redesign & Stakeholder Planning: ACBH Formal Recommendations (Strategy Actions) A Systems Approach & Plan to Reduce Forensic Involvement with Behavioral Health Clients: Next Steps A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 51 Forensic Services System Redesign & Stakeholder Planning: Next Steps •Board of Supervisor Review (October 27, 2020) –Pending Approval •Departmental Implementation Planning & Consultation (3, 5, 10 Year Workplan) •Forensic Services System Redesign: 1)Intradepartmental Forensic Services Redesign Taskforce 2)JIMH Taskforce –Stage 2 (Interagency Planning thru June 30, 2021) 3)Mental Health Advisory Board, Criminal Justice Committee (Regulatory Oversight) •Ongoing BOS & MHAB Progress Updates 52A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration Thank you A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration 53A Systems Approach -ACBH Plan to Reduce Forensic Involvement & Incarceration