1. 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

2. CRC System of Care
CRC System of Care

3. 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

4. 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

5. CRC Opens – April 13, 2003

6. 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

7. 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

8. 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

9. Funding History
FY – County General Revenue, Florida Hospital and Orlando Health - $2.1M
FY $2.8M in State Appropriations
FY $3M in State Appropriations
FY $2.25M in State Appropriations
FY2008- $500K in State Appropriations
FY2009 – FY $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

10. 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

11. 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

12. 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

13. 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

14. 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

15. CRC Phase II Update CARE COORDINATION
Currently 9 intensive case managers caseloads of approximately 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.

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

17. 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

19. 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

20. The Law Enforcement Perspective

21. The Law Enforcement Perspective

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. Questions ???

29. Contact Information
Sgt Jules Brace –
Laura Gailey –
Samantha Holden –