Florida’s First Central Receiving Center: A Collaborative Community Effort Sgt. Jules Brace Laura Gailey, LMHC Vice President of Hospital Acute Care/ Hospital Administrator Aspire Health Partners Crisis Intervention Team Coordinator Samantha Holden, LMHC Clinical Manager of Central Receiving Center Aspire Health Partners CIT Trainer Orange County Sheriff’s Office Youth Services Section School Resource Officer Unit Crisis Intervention Team

CRC System of Care CRC System of Care

Before the CRC Inappropriate use of the local hospital emergency departments This created long wait times for all emergent care Higher cost to treat patient in Emergency Departments Bookings in the Orange County Jail Inability to recognize substance use withdrawal resulted in 2 deaths High cost of jail resources Difficulty with psychotropic medications Agencies Fighting over clients Insured vs Uninsured Litigation

Pre CRC System of Care Mental Health Baker Act Substance Abuse Center for Drug Free Living Addition Receiving Facility (ARF) Pre CRC System of Care Lakeside Behavioral Healthcare Florida Hospital Emergency Room CONSUMER Mental Health Baker Act Substance Abuse Marchman Act Law Enforcement Officer Orlando Regional Hospital Emergency Room Jail Other local Hospitals

CRC Opens – April 13, 2003

History of the CRC Designed to be the System of Care for all of Orange County for adults To be a jail diversion for law enforcement To be a state of the art facility, only one of its kind in the state of Florida It is currently being replicated throughout the state through State Funding However, some funding was just eliminated after one year Initial Partnerships Department of Children and Families Lakeside Behavioral Healthcare - Aspire Health Partners The Center for Drug Free Living – Aspire Health Partners Florida Hospital Orlando Regional Healthcare

History of the CRC A transportation waiver was approved to allow all law enforcement to bring to CRC, one central location With an ASO, utilized a rotation of placing insured clients appropriately and the uninsured stayed in the public system On-going collaboration among community and providers Since 2007, Florida Hospital and Orlando Health purchase CSU beds within Aspire to serve uninsured in emergency department

CRC System of Care Central Receiving Center < 23 hours Asipre Health Partners Center for Drug Free Living Detox 5-7 days Aspire Health Partners Lakeside Crisis Stabilization Unit / Detox? Short-term Residential Treatment Unit 3-5 days Other Psychiatric Home Hospital Hospital Law Enforcement Officer Central Receiving Center < 23 hours

Funding History FY 2003-2005 – County General Revenue, Florida Hospital and Orlando Health - $2.1M FY2005 - $2.8M in State Appropriations FY2006 - $3M in State Appropriations FY2007 - $2.25M in State Appropriations FY2008- $500K in State Appropriations FY2009 – FY2104 - $0 in State Appropriations FY 2015 $3M ($500K – non recurring) in State Appropriations * Orange County Board of County Commissioners/Mayor fund the CRC $2M annually since 2003

CRC (2008) Central Receiving Center < 23 hours Aspire Health Partners Center for Drug Free Living Detox 5-7 days Aspire Health Partners Crisis Stabilization Unit / Detox/ Lakeside Short-term Residential Treatment Unit 3-5 days Other Psychiatric Home Hospital Hospital Law Enforcement Officer Central Receiving Center < 23 hours Central Receiving Center Phase Two Intensive Care Coordination Permanent Housing Transitional Housing Residential Treatment (2008) CRC

CRC Update Operational since April 2003 Integrated 24/7 model HISTORY Operational since April 2003 Integrated 24/7 model April 2003/June 2017: Approximately 70,000 screened 98% Law Enforcement, 2% Hospitals Of those screened: 74% Baker Acts 7% Marchman Acts 23% of those brought to the CRC are homeless

CRC Update JAIL DIVERSION EFFORTS Jail had become the defacto mental health facility Average length of jail time for mental health misdemeanant - 51 days To date over 200,000 saved (Jail Bed Days) Provides an alternative to arrest Law enforcement drop off averaging 12 minutes Cost Savings to law enforcement approximately $3.8M

Local Hospital Savings Prior to the CRC, LEO would take clients to the closest Emergency Department Cost Avoidance to local hospitals $25M-$56M Diverted over 30,000 patients from local emergency departments

CRC Phase II Update ANCHOR – TRANSITIONAL HOUSING PROGRAM Provided services and housing to over 621 chronically homeless individuals with co-occurring disorder since 2008 45% of residents who stay longer than 30 days transition to permanent housing 93% of residents receiving employment services are gainfully employed Average length of time in the program is 4-6 months

CRC Phase II Update CARE COORDINATION Currently 9 intensive case managers caseloads of approximately 10 - 15 clients Prior to CRC Care Coordinator intervention, targeted consumers maintained an average of 10.7 bed days per month and after engagement and intervention for at least 90 days these consumers averaged 3.8 bed days per month.

The Law Enforcement Perspective The best car safety device is a rear-view mirror with a cop in it. ~ Dudley Moore ~

The Law Enforcement Perspective Astynomiaphobia Anxiety associated with LEO contact LEO often 1st contact with persons in crisis Minimize time with LEO & maximize time with MH professionals Programs should mirror community needs

The Law Enforcement Perspective Statistics More people with mental illness are roaming the streets Half of Police Shootings Involve People with Mental Illness 2 million mentally ill go untreated $15 billion is spent incarcerating mentally ill One-third of the homeless are mentally ill 1,000 homicides a year are committed by mentally ill 10-17% of seriously mentally ill kill themselves

The Law Enforcement Perspective

The Law Enforcement Perspective

CRC Floor Plan BOS Entry Exit Outgoing Incoming Electrical Assessment workroom Med room LPN office Sleeping Room RN Office Tech Station Office Copy room 1 Sup Office 2 Seclusion room 2 Screening Rooms Seclusion room 1 Break Room Office Linen Laundry 3 4a 4b 5 Property

The Client Experience - Incoming LEO hands off the client to the Behavioral Tech Tech pats the client down LEO goes to complete paperwork Registration is completed Property/Valuable are inventoried Client showers and changes into scrubs Vitals, BAL, UDS

The Client Experience – LPN/RN Document UDS results Completes Health Screening Completes Nursing Assessment Med Reconciliation/Drug Disposition Disposition Options: Continue with Process Sent out for Medical Clearance Sent out as Exclusionary

The Client Experience – Assessment Specialist Completes an Intake Screening Completes a SA Screening (if needed) Admin forms (ROI, HIPAA, Client Rights, AFT, etc) Diagnosis Insurance Pre-certs Bed Assignment – 24/7 census staff

The Client Experience - Outgoing A second pat down Collect Belongings/Valuables Collect medications Transport via Aspire transportation department CSU, Hospital Unit, Detox, Medical Hospital, Home

Staffing Patterns 8 hours shifts RN – 1 per shift LPN – 1 on 3-11 shift only Techs- four on 7-3 and 3-11, three on 11-7 Driver – 1 per shift Assessors – 3-5 per shift Census – 1 per shift One Clinical Manager One Nurse Manager

Questions ???

Contact Information Sgt Jules Brace – Jules.Brace@ocfl.net Laura Gailey – Laura.Gailey@aspirehp.org Samantha Holden – Samantha.Holden@aspirehp.org