Diversion First Stakeholders Meeting Sept. 22, 2020

1. Diversion First Stakeholders Group Meeting
September 22, 2020

2. Welcome!
John C. Cook
Chairman, Diversion First
Stakeholders Group
2

3. Welcoming
Remarks
Jeffrey C. McKay
Chairman, Fairfax
County Board of
Supervisors
3

4. Agenda
Welcome
Opening Remarks by John C. Cook, Chairman, Diversion First Stakeholders Meeting
Jeffrey C. McKay, Chairman, Fairfax County Board of Supervisors
Announcements and Updates
Program Updates
Community Response Team- Freddie Pedreira
Diversion First Analysis- Linda Mount
Drug Court, Veterans Treatment Docket, Mental Health Docket- Judge Penney
Azcarate and Judge Tina Snee
STAR Program- Sheriff Stacey Kincaid
Jail-Based Medical and Behavioral Health Services- Laura Yager and Marissa Fariña-Morse
Diversion First Housing- Mike Suppa
Stepping Up Initiative and National Trends
Nastassia Walsh, Associate Program Director for Community Health and Justice, National
Association of Counties
Questions and Comments
Wrap Up
4

5. Announcement
and Updates
Lisa Potter, Director,
Diversion Initiatives
Office of Strategy
Management
5
2020…a new reality
New ways of doing business
Fiscal constraints
Collaboration and focus on solutions

6. Updates
2019 Annual Report
Highlights from 2019
Data Snapshot
Future Plans
Fairfax County named Stepping
Up Innovator County!
6

7. Diversion and Community Re-Entry Center
(Judicial Center Complex)
The Massey Building demolition and site restoration is anticipated to be
complete in Fall 2020. A new master plan will be developed to provide a
coordinated long-term plan to meet the needs of the complex’s multiple
stakeholders.
As conceptualized, this Center would provide:
 Resources for those re-entering the community from jail
 Greater access to services that provide alternatives to arrest
 Integrated behavioral health and care coordination
 Resources for employment, healthcare, benefits and other services
necessary to keep individuals from recurring involvement with the
criminal justice system
 Housing location and stabilization services, along with on-site
housing options
Enhance public safety and promote a healthier community with a more
efficient use of public funding
Anticipated that master plan proposal will be presented in the coming
months
7

8. Medical Assessment Program
Partnership with Neighborhood Health, a Federal Qualified
Health Center (FQHC) to provide onsite services at the
Merrifield Crisis Response Center (MCRC) for individuals in
need of medical clearance for psychiatric hospitalization or
crisis stabilization admission.
Reduce patient and law enforcement time spent in
Emergency Department and improve experience
Reduce injuries to law enforcement and individuals served
Increase connection to follow up primary care services
Reduce costs for medical assessment in an outpatient
ambulatory setting versus an inpatient Emergency
Department.
Planning for October 2020 launch
8

9. Sequential Intercept Model (SIM)
A framework to inform community-based responses to the
involvement of people with mental and substance use
disorders in the criminal justice system.
Intercept 0- community-based services designed to
intervene at the earlier possible point, either before a
behavioral health crisis and/or to prevent criminal justice
involvement
 Identified in 2019 county SIM mapping workshop as a
need/priority
 Currently exploring ways to expand these services
9

10. Community Response Team
Providing outreach and appropriate care and referral
services with persons with unmet needs
FREDDIE PEDREIRA
COMMUNITY HEALTH ANALYST/PUBLIC
HEALTH NURSE, FIRE & RESCUE
DEPARTMENT
10

11. Current CRT Process and Statistics
11
ACTIVE 13
ACTIVE-OPP 10
TRACKING 157
CLOSED 82
Current CRT Census
Modified response during COVID
Added equipment to vehicle for screening
• Reduce non-emergency ER visits
• Clear police from mental health calls earlier
[Statistics as of 9/1/20]
EXAMPLE: 2019 2020
FRD CALLS 975 693
FRD TRANSPORTS 845 568
FRD SERVICE CALLS - 117

12. 12
CAD
(DPSC/FRD)
iLeads
(LEO)
ImageTrend
(FRD)
SIMS
(LEO)
Collaborative Data Workspace:

13. 13
CRT Online Referral
Application
Emergency Department
Information Exchange
Local Hospital/Health Care
System
New Vehicle
UpdatesOther Community/County
Resources

14. Diversion First
Analysis
Linda Mount
Director, Analytics and Evaluation
Community Services Board
14

15. Jail Behavioral Health Population - 2019
15
1,854
1,614
1,492 1,507
1,551
1,000
1,100
1,200
1,300
1,400
1,500
1,600
1,700
1,800
1,900
2,000
2015 2016 2017 2018 2019
22,545
19,337
18,351 18,672
19,205
15,000
16,000
17,000
18,000
19,000
20,000
21,000
22,000
23,000
24,000
25,000
2015 2016 2017 2018 2019
Number of Inmates with Behavioral Health Issues
There was a 16% decrease in 2019 from 2015 of
inmates with behavioral health issues booked into
jail with misdemeanor charges.
16% Decrease in Jail Bookings 15% Decrease in Days in Jail
Total Days in Jail for Inmates with BH Issues
There was a 15% decrease in 2019 from 2015 in the
total days in jail per year for inmates with behavioral
health issues with misdemeanor charges (and no
felony).
2,286
2,632
3,028
3,275
3,536
1,000
1,500
2,000
2,500
3,000
3,500
4,000
2015 2016 2017 2018 2019
55% Increase in Referrals
Inmates Referred to CSB Jail-Based Services
There was a 55% increase in 2019 from 2015 in the
number of inmates referred to CSB behavioral health
program staff in the jail. There was an 8% increase in
referrals from 2018.

16. Merrifield Crisis
Response
Center (MCRC)
16
340
368
305
148
163
212 210
234
52 47 44
28 38
50 42 46
133 154
145
147
142
137
127
134
0
50
100
150
200
250
300
350
400
Jan Feb March April May June July August
Merrifield Crisis Response Center – 2020
Service Encounters by Type
General Emergency Services (non-law enforcement involved)
Law Enforcement Involved - Emergency Custody Order Transports
Law Enforcement Involved - Voluntary Transports
Diverted from potential arrest

17. 17
Looking Ahead
 Working with DIT on Phase I testing and
validation of Diversion First dashboard to
provide more real-time data
 Defining & refining data collection processes
 Expanding data collection & measurement for
Stepping Up’s Four Key Measures
 Creating use cases for Phase II of the Diversion
First dashboard

18. Drug Court
Veterans Docket
Mental Health
Docket
Penney Azcarate,
Judge, Fairfax County
Circuit Court
Tina Snee
Judge, Fairfax County
General District Court
18

19. Current Stats
DRUG COURT VETS DOCKETS MH DOCKET
Participants 19 currently 18 currently combined 18 currently
Demographics
Race
Ethnicity
Age
Gender
40% White
35% African American
15% Other
10% Multiracial
10% Hispanic
Average age is 33.4
75% Male
55% White
44% African American
6% Multiracial
22% Hispanic
Average age is 37
83% Male
52% White
24% African American
24% Asian
24% Hispanic
Average age is 29.5
88% Male
Graduates 3 to graduate in Sept. 21 graduates
4 to graduate in Oct.
3 to graduate in Oct.
19

20. Recent News
DRUG
COURT
 Part-time treatment coordinator
 Peer Support Manager
 2nd State Probation Officer
 Docket Recovery Challenge
 Randomizing Drug Screens - AIB assisting
VETS
DOCKET
 New BJA grant funding for the Docket
Coordinator; incentives; drug kits,
scram
 Dividing the three dockets
 Pre-sentencing cases
 Directly working with CSB for placement
of clients for treatment and housing
 Docket Supervisor Position through CSB
MH
DOCKET
 State grant to cover some expenses
 Grant for integrating family therapy
 Expanded SRP docket
 Sharing Resources
20

21. SPECIALTY DOCKETS
Needs
Full Time Treatment Coordinators
Currently part-time treatment coordinators
for Drug Court and Vet Dockets
No treatment coordinator for Mental Health
Docket
Sourcing Drug Screening
Collection, notification, and testing
Non-Profit Umbrella for Donations
Funding for On-Going Operations
Administrative Assistance
21

22. STAR
Program
SHERIFF
STACEY KINCAID
22

23. STAR: Striving to Achieve Recovery
Fairfax County Sheriff’s Office
Current participants in STAR unit: 14
• Phase 1 – 18 weeks. Attend 4-5 groups/day.
Develop skills, accountability & connections
needed for a lifetime of recovery.
• Phase 2 – Groups continue. Use assessment tool
to track progress & identify areas in which work is
needed. Develop recovery plan & take part in
family support group.
• Phase 3 – Focus on community re-entry. Plan with
CSB & OAR for post-jail success. Potentially move
to Alternative Incarceration Branch for work
opportunities.
23
STAR yoga class
pre-COVID-19

24. STAR: Striving to Achieve Recovery
Fairfax County Sheriff’s Office
COVID-related ZOOM Videoconferencing
• 12-step meetings
• Mentors
• CSB clinicians
• Peer recovery specialists (PRS)
In-Person conferencing
• PRS: one-on-one
• Sheriff’s Office re-entry specialist: one-on-one,
providing case management and wraparound
services.
STAR program manual
• Covers eligibility and screening criteria,
three phases, group session options,
program rules, assessments
• Includes evaluation tools to dig deeper and
measure how well the program works.
24

25. STAR: Striving to Achieve Recovery
Fairfax County Sheriff’s Office
Former STAR unit participants: 25
Of those 25:
• 10 have been released to the community, are still engaged in recovery
services, and have not re-offended, relapsed, or violated probation. (40%)
• 4 are still incarcerated, have completed Phases I and II in the STAR unit and are
currently doing Phase III in the Alternative Incarceration Branch.
• 1 was sent to VA Department of Corrections due to length of sentence.
• 2 are still incarcerated but left the program by their own choice.
• 6 have been released but current status is unknown.
• 2 were released, but relapsed. Of those, 1 died from overdose.
25

26. Jail-Based
Medical and
Behavioral
Health
Services
Laura Yager
Director, Correctional Health and Human Services
Fairfax County Sheriff’s Office
Marissa Fariña-Morse
Service Director, Diversion and Jail-Based Services
Community Services Board
26

27. Why Medication Assisted Treatment (MAT) and
Wraparound Reentry Services
Behavioral health issues are chronic health conditions just like diabetes, heart
disease, or asthma. Jails are required to provide medical care for these chronic
conditions.
◦ People in jails have much higher rates of chronic health conditions than the
general population. This includes behavioral health issues.
Surveillance data tells us that rates of relapse, use, and overdose deaths have
increased during COVID-19.
People released from incarceration have 129 times the risk of overdose death
than the general
Rhode Island Dept. of Corrections saw a 61% drop in opioid overdose deaths
after launching jail/prison-based MAT launch contributing to a 12% overall drop
in overdose rates across the state!
Recovery reentry supports are key to a safe and healthy community and
changing the life trajectory for individuals
27
Enhancing
Services at
Intercepts 3 and
4 to reduce
relapse,
overdose
deaths, and
recidivism
Innovation!
Collaboration!
Integration!

28. Looking Beyond Incarceration
Holistic, integrated care approach under Sheriff Stacey Kincaid’s leadership- Adult Detention
Center Medical, CSB Services, and sworn officers united in collaboration
o Relationships building and culture change
o Information-sharing, and collaborative services
Intensive training by national consultants: prescribing, med administration, understanding
addictions, policies and protocol changes
Like Brief Jail Mental Health Screening, screening for addictions at booking
o Includes validated withdrawal tools to guide clinicians
In-depth medical monitoring for withdrawal and ongoing treatment with MAT beyond
withdrawal!
HIDTA grant- Wraparound supports at release (HIGHEST RISK TIME!!!)
o Sheriff’s Office Recovery Navigator and Reentry Counselor + CSB MAT Coordinator
o Medicaid, Transportation. and Recovery Housing
o Reentry HOT HANDOFFS: CSB Addiction Medicine Clinic, housing, transportation, release
meds to reduce barriers and risk (and it’s working!)
28

29. What’s on the Horizon: Beyond our Foundation
Going to Scale: Building our medical staff resources and capacity to meet the
growing need and to follow best practice guidelines
oContinued HIDTA partnership including Health Management Associates (HMA)
technical assistance
oOngoing resource development efforts
oPeers! Peers! Peers!
Practice-Based Evidence and Outcomes: Leveraging our current HIDTA grant
resources to demonstrate solid outcomes and build a sustainable, resourced
program
Collaborations:
oDrug Court, Court Services, Re-Entry Council
oLocal MAT community providers
oHMA
oFederally Qualified Health Centers
oChris Atwood Foundation
GMU partnership for Technical Assistance and Training and HMA relationship
29

30. CSB Services
• Community Based
• Adult Detention Center
• Courts
• Telehealth
FY 2020 Services Provided:
• Jail Based Behavioral Health
2,052 Individuals Served
• Jail Diversion (community-based
case management)
1,034 Individuals Served

31. Creating
Opportunities
Telehealth
- Reentry Planning
- Clinician Response Time
- Access to Psychiatry Services
Successes

32. Diversion First
Housing
Mike Suppa
Special Housing and Facilities
Development Manager, Community
Services Board
32

33. Diversion First Housing
Permanent Supportive Housing for 30
individuals in single occupancy units.
Priority: Homeless individuals; unstably
housed Jail Diversion population.
Contractor is New Hope Housing and CSB
offers: Case Management, Psychiatric
Services, and management of referrals.
35 people served to date
- 86% have maintained housing
33

34. Diversion First Housing
FY 2019 Outcomes
86% had no psychiatric hospitalizations
79% didn’t require CSB Emergency Services
85% of people remained engaged with CSB
Over 50% less expensive than jail
34

35. Stepping Up Initiative and
National Trends
Nastassia Walsh | September 2020

36. #StepUp4MentalHealth
www.StepUpTogether.org
Stepping Up is a national initiative to reduce the number of people with
mental illnesses in jails.

37. 22

38. 22
Stepping Up
Innovator
Counties

39. Prioritizing System Improvements Along
Four Key Measures
• Police-Mental
Health
Collaboration
programs
• CIT training
• Co-responder
models
• Crisis diversion
centers
• Serving frequent
utilizers
• Expand community-
based treatment
options
• Streamline access
to services
• Telehealth
• Leverage Medicaid
and other federal,
state, and local
resources
• Routine screening
and assessment for
mental health and
SUD in jail
• Pretrial mental
health diversion
• Pretrial risk
screening, release,
and supervision
• Bail policy reform
• Apply Risk-Need-
Responsivity
principle
• Use evidence-based
practices
• Specialized
probation
• Social services, like
housing
1.
Jail Bookings
3.
Connection to
Treatment
4.
Recidivism
2.
Jail Length
of Stay

40. Five Years of Stepping Up
Wednesday, September 30
2:00 - 3:30 p.m. ET
Register: www.NACo.org/Webinars
Upcoming Webinar

41. New Resource: Stepping Up Strategy Lab
• An interactive library of over
65 programs, policies, and
practices
• Features over 100 examples
from 40 counties
• Updated every 6 months to
reflect progress and changes in
the field

42. Nastassia Walsh, MA
Associate Program Director, Community
Health and Justice
National Association of Counties
nwalsh@naco.org

43. Questions and
Comments
43

44. Thank you!
DiversionFirst@fairfaxcounty.gov
44