Anderson-Cherokee
Community Enrichment ServiceS
Jail
and Detention
Diversion
Action Plan
February
2007
Draft
Revision 3-1-2010
Revised
7-27-2010
The
ACCESS Diversion Action Plan was developed in accordance with the Texas Health
Safety Code (THSC) §533.0354(d) as amended by the Texas State Legislature, 78th
session, in House Bill 2292 and in accordance with THSC §533.108. The plan addresses jail and detention
diversion strategies, as required by the Texas Department of State Health
Services’ Performance Contract, for adults with serious mental illnesses and
for juveniles with serious emotional disturbances.
Objectives of the ACCESS Diversion Action
Plan
·
Development
and ongoing oversight of the Jail Diversion Task Force, which provides
collaboration and coordination of stakeholders
·
Identification
of consumers at high risk of involvement in criminal justice and juvenile
justice systems; early and ongoing identification of ACCESS, consumers already in the criminal justice and
juvenile justice systems; and, transition to more appropriate ongoing community-based services when
feasible.
·
Pre-Booking
Strategies
·
Post-Booking Strategies
·
Memoranda of Understanding/Other Communication
Methods
·
Process
to match jail and detention records with CARE
·
Procedures for Referrals from Criminal Justice
System
·
Crisis Screening and Assessment Protocol for
Detained Juveniles
·
Law Enforcement Training
·
Stakeholder Collaboration, Coordination, and
Integrated Funding
·
Action Steps, Timeline for Implementation, and
Responsible Staff
Development and ongoing oversight of the Jail Diversion
Task Force, which provides collaboration and coordination of stakeholders:
ACCESS serves two counties in rural East Texas, Anderson and
Cherokee. Because the Center is small
and serves a small number of criminal justice system entities, the people
involved in law enforcement, the court system, the healthcare system, and the
MHMR system often know each other by name.
As a result, service providers in all areas often pick up the phone to
do on-the-spot problem-solving and planning for persons with mental illness who
have come in contact with the law enforcement officers, the jails, or the
courts.
Prior
to any requirement by the State to have a Jail Diversion Plan, ACCESS hosted
meetings with representatives from the criminal justice system and other
community agencies involved in handling emergencies. Representatives were present from emergency
rooms, private providers, public agencies, judges, and law enforcement. These meetings, held six times over a three
year period, helped inform stakeholders about what everyone else could -- or
could not -- do within the regulations and resources available. At these meetings, the sheriff’s departments
expressed a need to be able to pick persons up and drop them off at an
appropriate treatment facility within a very short time frame without waiting,
as they were understaffed for the large territory they cover. Emergency room doctors did not want to admit
people to a medical hospital whose primary need appeared to be
psychiatric. Judges preferred to find
solutions for families rather than issue orders that could interfere with
possible treatment options. Mental
health professionals wanted persons with mental disorders to get effective
treatment in the community, rather than go to jail or a state hospital. Through cooperation, all these components
worked together to meet the needs of consumers and families. The joint planning meetings resolved many
issues and improved working relationships significantly.
During FY2005, two Jail Diversion Task Forces were formed, one in each
of the two counties served. Stakeholders for each County (Anderson and
Cherokee) were identified per DSHS recommendations. At a minimum, stakeholders
identified for each County, and identified below, were: client representatives; client family member
representatives; child and family advocates; mental health service providers;
emergency healthcare providers (i.e. hospital emergency room personnel); local
public healthcare providers; law enforcement representatives from each
jurisdiction in the Local Service Area (LSA); probation and parole department
representatives; judicial representatives from each county in the LSA; regional
Outreach Screening and Referral (OSAR) representative; and, other concerned
citizens and service providers.
|
Anderson County Sheriff’s
Department
|
Cherokee County Sheriff’s
Department
|
|
Anderson County Judiciary
|
Cherokee County Judiciary
|
|
ETBHN Regional Planning and
Network Advisory Committee
|
OSAR/ETCADA
|
|
Anderson County CRCG
|
Anderson County Juvenile
Probation
|
|
Cherokee County CRCG
|
ACCESS
|
|
Cherokee County Juvenile
Probation
|
East Texas Crisis Center of
Anderson and Cherokee Counties
|
|
Jacksonville Police Department
|
Rusk Police Department
|
|
Palestine Police Department
|
East Texas Medical Center
|
|
Palestine Regional Medical Center
|
Trinity Mother Francis Hospital
|
|
Cherokee County Health Department
|
Cherokee Care Collaboration
|
|
Partners in Health Advisory Board
|
Mental Health Providers
|
|
Clients and Family Members
|
Rusk State Hospital
|
These coalition groups continued to meet
quarterly in FY2006 and
continuing in each Fiscal Year thereafter to share information that
enhances access to community services and supports, to discuss barriers to
services within the various agencies, and to address problems that arose during
the preceding quarter. ACCESS provides
training to members on the duties of the Task Force in the following areas:
identification of high risk persons, protocols for pre-booking in jail or
detention, aftercare services, and benefits of collaborative efforts to address
common problems. Training also includes
information on how to arrange face to face screenings around the clock,
criteria for outpatient and inpatient admission, and procedures for continuity
of care. The Task Force provides oversight of the ACCESS Jail Diversion Plan,
including review of the procedures for jail diversion activities. The Task
Force members work to improve collaboration and cooperation among agencies and
stakeholders and to identify and remove barriers impeding diversion activities.
Letters
of invitation are sent quarterly to stakeholders --including public and private
providers, consumers, family members, advocates, law enforcement, probation and
parole departments, and members of the judiciary -- to invite them to
participate. (Update: Invitations occur more often now by
email, text messages, and/or personal phone calls to stakeholders).
ACCESS will continue efforts to recruit additional stakeholders that represent
all categories to participate in the Diversion Task Forces.
Update: A number of concerns and barriers to effective
diversion identified by the Task Forces have been addressed through expanded
crisis support services developed with additional crisis funds allocated by the
80th and 81st Sessions of the Texas State Legislature. The new
crisis funding has been used to meet the following objectives of a rapid
response mobile crisis outreach team:
provide for expedited local stabilization; aid in diversion from
incarceration; and, reduce the burden on law enforcement and emergency health
care resources. This has been
accomplished by improved crisis response team infrastructure, training, and
response processes.
ACCESS has implemented a Mobile Crisis Outreach Team
(MCOT) staffed by 4 QMHP-CSs, one of whom is the Continuity of Care worker for
ACCESS. A MCOT worker is stationed in
each County ready to immediately respond for a face to face evaluation and
intervention within the one hour timeframe required for responses to “emergent”
crisis events and within 8 hours for “urgent” events during peak hours. In addition, existing staff will
continue to be used as “back ups” to the MCOT to ensure emergent and urgent
timeframe requirements are met. This will improve the consistency and
timeliness of rapid responses in the community.
Furthermore, these individuals will facilitate the enhanced provision of
crisis services, particularly crisis follow-up and crisis intervention. It is anticipated that the outcome will be a
reduction in jail incarcerations, ER visits, and inpatient hospitalizations, as
well as a decrease in individuals’ repeated use of emergency medical services.
Crisis redesign funding also allowed the MHA to offset
transportation costs incurred by law enforcement, as well as costs incurred by
their lengthy detainments at ERs, by underwriting a Mental Health Peace Officer
(MHPO) in each County. The inclusion of
a MHPO as part of the Mobile Crisis Outreach Team is expected to result in a
reduced burden on the ER’s maintenance of a consumer who is in need of
transportation and rapid stabilization.
ACCESS also expects that having a MHPO working in conjunction with a
mobile unit will contribute to increased diversions from incarceration, and
address, if needed, the security and safety concerns involved with evaluations
in the community. Each County now has a trained MHPO available to transport
individuals needing crisis services, as well as providing security and support
to the MCOT and ACCESS on-call crisis staff. ACCESS also purchased vehicles for
use by the MHPOs. The addition of the MHPOs, along with their vehicles, has
achieved the desired effect of reducing time spent in ERs by individuals in
crisis, as well as reducing the burden on local law enforcement, with the additional
benefit of strengthening the working relationships between law enforcement and ACCESS.
One of the goals of diversion is also to divert
individuals found incompetent to stand trial through some form of competency
restoration. Unfortunately, local and state funds are not available in the
two-County area to implement a competency restoration program and, due to the
economic downturn, it is not anticipated that such funds will become available
during the next two years.
Identification of consumers at high
risk of involvement in criminal justice and juvenile justice systems, and early
and ongoing identification of ACCESS consumers already in the criminal justice
and juvenile justice systems:
ACCESS
recognizes that consumers who have serious mental illnesses and/or serious
emotional disturbances, who are currently on probation or parole, or who have
co-occurring psychiatric and substance abuse disorders, are at risk for future
law enforcement involvement. Therefore, the Center trained clinical staff, beginning
in FY2004 and in each year
thereafter, to recognize and provide intervention services to consumers
who are both mentally ill and have drug/alcohol abuse problems or involvement
in the criminal justice system. For new
clinical employees, training is provided within the first three months of
employment, so staff will recognize the signs, symptoms, and appropriate
treatment modalities. The
Center provides all clinical staff with initial and annual training that
ensures competency in all of the areas related to their job requirements,
including crisis assessments and interventions.
The
ACCESS assessment process, which utilizes the Texas Recommended Authorization
Guidelines, identifies persons with a history of criminal justice contact or
persons who exhibit behaviors likely to
lead to involvement with law enforcement or the judicial system (such as,
violence toward others, breaking laws, destroying property, substance abuse, or
threat of suicide). The goal is to address
symptoms that may trigger behaviors that result in law enforcement
intervention, and whenever
possible divert such individuals to appropriate community-based treatment
options, including any needed detoxification or other substance abuse treatment
services.
Another
method for identification of high-risk consumers occurs through communication
with the local adult and juvenile probation offices to coordinate
services. The process begins with the
initial referral to the Center from probation for mentally ill or seriously
emotionally disturbed offenders who are considered high risk. An appointment is scheduled for an intake
assessment, and if the individual is determined to be eligible for services, a
plan is formulated that addresses issues related to both the mental illness and
the conditions of probation.
Update:
ACCESS has a contract with TCOOMMI to provide Continuity of Care
services to work toward improved systems of coordination and communication
among local and/or state criminal justice systems, social service providers and
other appropriate disciplines to ensure responsiveness to the special needs of
offenders. ACCESS provides screening and
referral to appropriate inter- and intra- agency resources for offenders with
special needs who are being released to the Center’s catchment area. Responsibilities include participating in
joint treatment planning, to include, but not limited to, parole, community
supervision, and the local jail community for both adult and juveniles in order
to provide supportive transition from incarceration to the community.
FY 2009 statistics indicate that ACCESS
served 66 adults with a history of involvement with law enforcement, in
addition to 49 other individuals referred by TCOOMMI.
Pre-Booking Strategies:
ACCESS
provides crisis screening and assessment for persons who may be in need of
mental health services, in order to divert persons from inappropriate
incarceration.
Prior
to arrest, a law enforcement officer may bring a person who seems to exhibit
symptoms of mental illness to the ACCESS clinic during regular business hours
without an appointment, and a staff person provides immediate triage
service. Alternately, a law enforcement
officer may request that an ACCESS staff person come to a law enforcement site to
conduct an assessment. After business
hours, a law enforcement officer may phone the MHMR Crisis Line
(1-800-621-1693) to arrange a face-to-face triage of an individual who seems to
exhibit symptoms of mental illness, at a site agreeable to the peace officer
and the screener. If the person meets
criteria for admission to services, the ACCESS staff makes a plan with the
consumer, family (if available), and the peace officer for immediate safety
concerns and prompt admission into treatment.
If this plan is for voluntary admission to a hospital, ACCESS staff
makes arrangement by phone to prepare for a voluntary admission. If a person does not wish to agree to a
voluntary admission, steps are taken to obtain a magistrate’s involuntary
order. Involuntary admission requires that the person is mentally ill, AND
likely to cause serious harm to self or others; OR will, if not treated,
continue to suffer severe and abnormal mental, emotional, or physical distress,
and will continue to experience deterioration of the ability to function
independently and is unable to make a rational and informed decision as to
whether or not to submit to treatment. If a person meets the criteria for
outpatient treatment and can be safely released to family or friends, treatment
is arranged at the ACCESS Clinic at the earliest possible time (same day or
next day). If the person does not meet
criteria for admission to services, an ACCESS staff person informs the law
enforcement officer of the finding. The
law enforcement officer decides upon the next step (whether or not to proceed
with arrest). The law enforcement officer is responsible for transportation of
the person to and from the assessment site, unless family or friends are
available to transport.
Update: As noted previously, Crisis Redesign funding allowed the LMHA
to implement Mobile Crisis Outreach Teams for rapid deployment of face to face
screening and referral activities. The new funds also offset transportation
costs incurred by law enforcement, as well as costs incurred by their lengthy
detainments at ERs, by underwriting a Mental Health Peace Officer (MHPO) in
each County. The inclusion of a MHPO as
part of the Mobile Crisis Outreach Team is expected to result in a reduced
burden on the ER’s maintenance of a consumer who is in need of transportation
and rapid stabilization. ACCESS also
expects that having a MHPO working in conjunction with a mobile unit will
contribute to increased diversions from incarceration, and address, if needed,
the security and safety concerns involved with evaluations in the community.
Each County now has a trained MHPO available to transport individuals needing
crisis services, as well as providing security and support to the MCOT and
ACCESS on-call crisis staff.
Referrals from County or City Judges or other criminal justice system
personnel receive high priority from ACCESS staff, in order to prevent
unnecessary or inappropriate detention. A law enforcement officer, officer of
the court, or family member may bring a person who seems to exhibit symptoms of
mental illness to the ACCESS clinic during regular business hours without an
appointment, and a staff person provides immediate triage service; or, an
ACCESS staff person may go to an alternate, but safe and secure, site to
conduct an assessment. After hours, a person may phone the MHMR Crisis Line to
arrange a face-to-face triage of an individual who seems to exhibit symptoms of
mental illness, at a site agreeable to the caller and the screener. If the person meets criteria for admission to
services, the ACCESS staff makes a plan with the consumer, family (if
available), and any officer involved for immediate safety concerns and prompt
admission into treatment. If this plan
is for voluntary admission to a hospital, ACCESS staff person makes arrangement
by phone to prepare for a voluntary admission. If a person does not wish to
agree to a voluntary admission, steps are taken to obtain a magistrate’s
involuntary order.
Involuntary
admission requires that the person is mentally ill, AND likely to cause serious
harm to self or others; OR will, if not treated, continue to suffer severe and
abnormal mental, emotional, or physical distress, and will continue to
experience deterioration of the ability to function independently and is unable
to make a rational and informed decision as to whether or not to submit to
treatment.
If
a person meets the criteria for outpatient treatment and can be safely released
to family or friends, treatment is arranged at the ACCESS Clinic at the
earliest possible time (same day or next day). If the person does not meet
criteria for admission to services, an ACCESS staff person informs the law
enforcement officer of the finding. The
law enforcement officer decides upon the next step (whether or not to proceed
with arrest).The officer or family are responsible for transportation of the
person to and from the assessment site and to the inpatient site, if necessary.
Referrals
from a Juvenile Probation Officer or Juvenile Court Judge are given high
priority. An officer of the juvenile court, or a family member upon direction
by a Juvenile Probation Officer, may bring a person who seems to exhibit
symptoms of mental illness to the ACCESS clinic during regular business hours
without an appointment, and a staff person provides immediate triage service.
After hours, an officer of the juvenile court, or a parent or conservator upon
direction by a Juvenile Probation Officer, may phone the MHMR Crisis Line to
arrange a face-to-face triage of an individual who seems to exhibit symptoms of
mental illness, at a site agreeable to all. If the person meets criteria for
admission to services, the ACCESS staff person makes a plan with the consumer,
parent or conservator, and any peace officer involved, for immediate safety
concerns and prompt admission into treatment.
If this plan is for voluntary admission to a hospital, the ACCESS staff
person makes arrangement by phone to prepare for a voluntary admission. If a person
does not wish to agree to a voluntary admission, steps are taken to obtain a
magistrate’s involuntary order. Involuntary admission requires that the person
is mentally ill, AND likely to cause serious harm to self or others; OR will,
if not treated, continue to suffer severe and abnormal mental, emotional, or
physical distress, and will continue to experience deterioration of the ability
to function independently and is unable to make a rational and informed
decision as to whether or not to submit to treatment.
If a person meets the criteria for outpatient
treatment and can be safely released a parent or conservator, or to other
family or friends with parental consent, treatment is arranged at the ACCESS
Clinic at the earliest possible time (same day or next day). If the person does
not meet criteria for admission to services, an ACCESS staff person informs the
parent, conservator, or officer of the court of the finding. The officer of the court decides upon the
next step. The officer of the court or the parent/conservator is responsible
for transportation of the person to and from the assessment site.
If
the jailer at the county or city jail observes a person exhibiting possible
symptoms of mental illness, the jailer or any member of the sheriff’s
department may request a screening. The
sheriff’s department may transport the person to an ACCESS site during regular
business hours. Alternately, an ACCESS
screener may visit the jail in order to perform the screening. If the person
screened meets the criteria for admission into services: ACCESS staff makes
recommendations for treatment while the person is in jail, to the extent
allowed by law and available through the jail’s resources. The ACCESS staff person arranges for
aftercare treatment upon release. If inpatient treatment is recommended, ACCESS
staff facilitates admission to a hospital, if charges can be dropped or
deferred prior to admission. Involuntary admission requires that the person is
mentally ill, AND likely to cause serious harm to self or others; OR will, if
not treated, continue to suffer severe and abnormal mental, emotional, or
physical distress, and will continue to experience deterioration of the ability
to function independently and is unable to make a rational and informed
decision as to whether or not to submit to treatment. If the person screened
does not meet the criteria for admission into services, the ACCESS staff person
provides a written statement of denial of services to the person and to the
authorities.
As part of its evolving Continuity of Care and Services
Program, ACCESS recently integrated its Aftercare/Continuity of Care functions
into the MCOT unit. This added another QMHP-CS position to the Team and
facilitates a seamless transition of care for individuals served, before,
during, and after psychiatric hospitalizations, or incarcerations -
strengthening the relationship between the MCOT and State Hospitals and local
psychiatric facilities and local law enforcement.
Post Booking
Strategies:
In
accordance with jail standards and the Texas Juvenile Probation Commission, all
detainees in jails or detention centers must be screened for mental illness,
suicidal ideations, or mental retardation, regardless of any known or unknown
history.
Adult
and juvenile offenders taken into custody are assessed at admission by facility
staff. Although ACCESS encourages the
use of standardized instruments (such as The Mental Disability/Suicide Intake
Screening Form for adults or the Massachusetts Assessment Youth Screening
Instrument for children), the use of these or any other methods is the choice
of the jail or detention facility. In
addition to initial screenings, jail or detention staff may at any time observe
symptoms of depression or suicidal intent.
If the detainee is determined to be a high risk, the jail or detention
center staff contact ACCESS for additional evaluation. The Center responds, depending on the
circumstances, with a face-to-face on-site evaluation or with a psychiatric
assessment at a clinic site, in order to determine if the detainee meets the
admission criteria for psychiatric services.
Note: Transportation to ACCESS is
the responsibility of the facility at which the person is in custody.
Once
identified, intervention by the Center ensures that placement in the most
appropriate, and least restrictive, therapeutic treatment setting occurs,
including referral to crisis outpatient services and referral to available
community resources. Hospitalization may
be indicated for those individuals who present an imminent danger to themselves
or others due to their psychiatric symptoms and who cannot be safely maintained
in a custodial setting.
If
they do not present an imminent danger to themselves or others, individuals are
screened for eligibility into services, using the Resiliency and Disease
Management criteria. ACCESS provides
psychiatric and medication related services to incarcerated consumers who have
a case assignment open with the Center, to the extent allowed by the jail or
detention center.
Upon
release from incarceration, the person either receives an intake appointment
(if not currently a consumer), or a follow-up appointment with service
coordinator (if currently a consumer).
For persons from Cherokee or Anderson County who are released outside
the ACCESS service area, the ACCESS Continuity of Care staff person coordinates
aftercare with the MHMR Center for that area.
Memoranda of
Understanding/Other
Communication Methods:
In addition to the state
Memorandum of Understanding (MOU) with the Texas Department of Criminal Justice
(TDCJ) and Community Supervision and Corrections Department (CSCD), ACCESS recognizes that frequent
and efficient communication between the Local Mental health Authority (LMHA)
and local law enforcement groups is essential to diversion efforts,
particularly those directed towards keeping individuals out of jail who have
committed non-violent crimes and are in need of treatment.
Continuity
of Care and MCOT staff function as the primary contact for all law enforcement
in the two counties, acting as liaisons between ACCESS, probation/parole
officers, local jails, TCOOMMI, and the Juvenile Detention Center. Having trained crisis staff handle almost all
law enforcement contacts results in a collaborative relationship focused on
problem-solving rather than on arrest and incarceration. ACCESS staff provide training
to law enforcement entities on referral processes, treatment options, and
crisis intervention protocols, and also participate in cross training with
local law enforcement agencies.
ACCESS, through funds provided through
its contract with TCOOMMI, installed televideo equipment in the jails in
Cherokee County and is in the process of installing similar equipment in
Anderson County. This equipment is
facilitating safer and more rapid assessments of incarcerated persons
exhibiting signs and symptoms of mental illness, including telepsychiatry
services provided by the Center’s psychiatrists. Judges in both Counties have also requested
installation of the televideo equipment to assist them in providing hearings
more quickly and installation of those units is pending.
NOTE: Televideo equipment has been installed in the
Anderson County Jail, as well as in the County Judge’s office, resulting in
faster and safer assessments and hearings.
Process to match jail and detention records
with CARE:
The
Center cross-matches inmates in the two county jails to the CARE system weekly
(or upon request). Jail personnel notify
the Continuity of Care staff regarding all new admissions believed to be
mentally ill. The Continuity of Care staff person visits weekly at each jail
with the jailor and reviews the list of identified persons to determine what
services might be needed at the current time. Services may include an
assessment for eligibility to services, and if eligible, treatment
recommendations, as appropriate to the person’s legal situation. If the individual
is appropriate for diversion, the Continuity of Care staff will coordinate the
diversion with jail personnel and other appropriate collaterals. The individual
will be admitted into mental health services at ACCESS and provided with
appropriate community referrals. Upon notification of an identified person’s
release to the ACCESS service area, the Continuity of Care staff person
provides a follow-up appointment for community services and links with the
appropriate law enforcement collateral.
Note: LMHA
responsibility for the above process has been discontinued in the DSHS
contract, with jail staff now being responsible for submitting the information
through an interface created between the Texas Law Enforcement
Telecommunications System (TLETS) and the Clinical Management for Behavioral
Health Services (CMBHS) of DSHS.
Unfortunately, the TCOOMMI contract still requires the LMHA to provide
cross-matching services with CARE and ACCESS, which had discontinued the above
process, has again begun the cross-matching process.
Procedures for
Referrals from Criminal Justice System:
Law Enforcement:
The
jailers in county and city jails have information about how to contact ACCESS (and now have televideo access,
as well as support from the MHPOs).
When the contact is made, basic information regarding the person is
obtained (initial screening) and Center staff schedule an intake evaluation as
appropriate.
Adult and Juvenile Probation and Adult Parole: For
either adult or juvenile offenders, the Probation or Parole Officer makes the
referral to ACCESS, which results in the person going through the intake
process. If determined to be eligible
for services, the person’s level of need takes into account the involvement with
probation.
Texas Youth Commission (TYC) Referrals: If
a child/youth incarcerated by the Texas Youth Commission has a mental illness
or emotional disturbance and is pending discharge, the parent or Legally
Authorized Representative (LAR) has the option of being referred to a local
MHMR Center or of obtaining a private psychiatrist. If the LAR wishes for the child to receive
MHMR Center services, TYC staff contact ACCESS with prescreening information
and the release date. Youth Services
staff review the information and contact TYC and/or the LAR to arrange the
intake appointment.
Update:
In FY 2009, ACCESS served 5 youth referred from TYC.
All
referrals from law enforcement and the criminal justice system are given high
priority and prompt attention. To the extent allowed by state statues,
Memoranda of Understanding with agencies, and/or individual consents by the
consumer, feedback is provided to the referring source about outcomes.
Crisis Screening
and Assessment Protocol for Detained Juveniles:
If the child is in crisis (suicidal/homicidal) ACCESS staff
go to the facility and assess the youth.
Based upon this crisis assessment, staff determines if hospitalization
is needed. If the child is hospitalized,
upon release from the hospital, he/she returns to the detention facility. At discharge from the detention facility,
the youth that was hospitalized is referred to ACCESS for continuity of
services. If a child in detention
appears to need mental health services, but is not expressing suicidal or
homicidal thoughts or intent, the staff at the detention facility tell parents
how to contact ACCESS upon the child’s release.
ACCESS
cooperates with the juvenile detention center to implement their suicide plan
protocol (pursuant to TAC 37, Chapter 343, Subchapter B 343:10) for the Center’s
service area. Meanwhile, the juvenile
probation offices in the two counties, the detention center, and ACCESS staff
have maintained good informal relations and have cooperated to ensure
continuity of services for youth detained and/or coming out of detention.
Crisis
on-call services are available through the MHMR Crisis Line 800 number. Through
the answering service, trained on-call staff persons are contacted and respond
to calls. Family members and youth in
services have the toll free number and know to call in emergencies. The on-call staff can provide face-to-face
assessment and crisis intervention. Hospitalization is arranged if the youth is
suicidal or homicidal. ACCESS clinicians
respond to on-call 24 hours a day, 7 days a week, so there is always someone
familiar with the system to provide crisis response services.
Law
Enforcement Training:
ACCESS
plans to offer updated training in FY 2007 to dispatchers at county and city
law enforcement agencies on how to handle crisis calls from mental health
consumers, including de-escalating the caller and linking the caller up with
ACCESS on-call crisis staff. Also,
training will be offered on identifying possible consumers and the referral
process.
Training
of center staff, law enforcement, adult probation, juvenile justice staff, and
other first responders is essential to the success of the Diversion Action
Plan. In the course of their duties, these professionals are often the first
individuals to make a preliminary assessment and determination regarding
whether or not a person’s behavior is criminal or not. That first assessment generally determines
whether a person will become involved in the criminal justice system, the
mental health system, or both. Training
on early identification, intervention and how to access the mental health
system will be offered to law enforcement staff in both counties in the near
future. Training will address the
following:
·
Identification
of persons who are mentally ill, who have developmental disabilities, or who
have substance abuse problems.
- De-fusing crisis situations for persons
with mental disabilities.
- Processes for obtaining assessment from
ACCESS.
- Transportation and custody
responsibilities.
- Commitment processes.
Update: Training and technical assistance are
provided to law enforcement agencies and other community stakeholders upon
request and at least once per year. The Mental Health Peace Officers are required to demonstrate competency in
order to carry the certification authorized by the Peace Officers credentialing
body (TCLEOSE). In addition to the Peace Officers certified training, ACCESS
requires that these 2 law enforcement officials receive additional training
regarding:
1) Center Operations
2) Co-occurring psychiatric and
substance abuse disorders
3) Community resources
4) OSAR
5) Understanding the nature of
severe and persistent mental illness and serious emotional disturbance
6) Cultural competency
7) Screening and crisis
interventions
Stakeholder
Collaboration, Coordination, and Integrated Funding:
Update: ACCESS has partnered with the Cherokee County
Juvenile Probation Department in a Commitment Reduction Program Grant funded
through TCOOMMI to divert youth from TYC.
ACCESS will receive $35,900 to provide 18 scheduled (emergency)
psychiatric assessments, to include service coordination, treatment planning,
medication-related services and any other appropriate and needed behavioral
health services. ACCESS has hired a
QMHP-CS to work as a team with a Juvenile Probation Officer to provide
intensive in-home services to approximately 24 family units, utilizing the
TCOOMMI Special Needs Diversionary Program as a model. The goal is to reduce
the number of juveniles placed in residential treatment by providing intensive
community based services to the entire family and, when the juvenile does
require placement, to provide intensive counseling to parents so that the youth
returns to a more stable home environment, hopefully reducing the likelihood of
future involvement with judicial and law enforcement systems. The ultimate goal
is to divert at least 2 youths from being placed at TYC during the grant
period.
There
are Community Resource Coordination Groups (CRCG) for both children and adults
in the counties that ACCESS serves.
These groups are comprised of community service agencies, ACCESS mental
health staff and/or mental retardation services staff, health department
services, probation and parole officers, school representatives, child and
adult protective services (DFPS), and other representatives. These groups address specific cases in which
intensive, multi-agency services are needed.
At these meetings, the representatives brainstorm on ways to collaborate
and coordinate services to meet the needs of the individuals being staffed and
their families.
ACCESS
provides advocacy services or assists advocacy representatives to carry out
their responsibilities. ACCESS will provide persons identified as having a
mental illness and incarcerated in jail or detention, written materials that
describe their rights as a person with mental illness. Upon request by the
person and approval by the jail or detention staff, ACCESS will arrange a visit
by the ACCESS Consumer Relations Officer. ACCESS will provide for persons
identified as having mental illness, in preparation for release, information
about available community resources (such as, mental health clinic services,
substance abuse support groups, GED programs, charitable organizations,
employment opportunities).
Finally, ACCESS recognizes the
importance of maintaining community input to sustain existing diversion
activities and will continue collaborative meetings with stakeholders to plan
for future enhancements of diversion activities Some of these include further
integration of diversion activities with the evolving crisis response system,
as well as the need to develop resources currently lacking in the local
communities for implementation of a competency restoration program.
ACCESS MHMR Diversion Services
Continuity of Care and Service Program Implementation Timeline – 2010
Planning Cycle
|
Date
|
Key Activities
|
Responsible Party
|
|
Ongoing
|
Jail Diversion Task Force Meetings
|
Allyn Lang, ACCESS Executive Director; Dennis
Phillips, ACCESS Chief Programs Officer
|
|
Ongoing
|
Mental health awareness and crisis response system
technical assistance & training for local law enforcement; other
community stakeholders
|
Dennis Phillips, ACCESS CPO; ACCESS Continuity of Care
staff; MCOT staff
|
|
Ongoing
|
Diversion advocacy on behalf of individuals in jail or
juvenile detention w/ serious mental illness or severe emotional disturbance
|
ACCESS Continuity of Care and MCOT staff; ACCESS
Executive Management Team; other ACCESS clinical staff
|
|
January 27, 2010
|
Official Notice from DSHS about start of LSAP planning
timeline for Cohort 1
|
DSHS
|
|
January 29, 2010
|
DSHS training on 2010 LPND template – Houston, Texas
|
DSHS
|
|
March 1, 2010
|
Updated Crisis & Diversion Plans due – in draft
format
|
Karen Pate, ACCESS Chief Administrative Officer (CAO)
|
|
March 11, 2010
|
ETBHN Regional PNAC Review of LPND Timelines &
results of previous LPND planning cycle
|
ETBHN RPNAC
|
|
|
|
|
|
April 2010 -
July, 2010
|
Local Planning Meetings w/Community Stakeholders,
Consumer Groups, & Advocacy Groups in both Counties
|
Allyn Lang, ACCESS Executive Director; Karen Pate,
ACCESS CAO; Dennis Phillips, ACCESS CPO
|
|
May, 2010 – July, 2010
|
Planning Surveys distributed
|
Karen Pate, ACCESS CAO; Anna Cox, ACCESS QM
Coordinator
|
|
May, 2010 - July, 2010
|
Plans written/revised
|
Karen Pate, ACCESS CAO
|
|
July 7, 2010
|
ETBHN Regional PNAC Review of LSAP Drafts
|
ETBHN RPNAC
|
|
June, 2010 – July, 2010
|
Review of draft plans by Executive/Management
Teams/Stakeholder Groups
|
ACCESS Executive and Management Teams; Jail Diversion
Task Force; Others
|
|
July 27, 2010
|
LSAP, LPND, Crisis, Diversion, and MH QM Plans
approved by Board of Trustees
|
ACCESS Board of Trustees
|
|
July 27, 2010
|
Plans due to DSHS & post on website
|
Karen Pate, ACCESS CAO
|
|
August 2010
|
DSHS review of Plans (LANAC review of LPND Plan)
|
DSHS/LANAC
|
|
***
|
Make revisions to Plans as required by DSHS
|
ACCESS Executive & Management Teams
|
|
***
|
Post revised Plans on website
|
Karen Pate, ACCESS CAO
|
|
Spring, 2011
|
Initiate Planning Update Cycle
|
Karen Pate, ACCESS CAO
|
|
Summer, 2011
|
Revise/Update Plans as indicated from planning
activities
|
Karen Pate, ACCESS CAO; ACCESS Executive /Management
Teams
|