1. Crisis Intervention Team (CIT) Engagement in Assisted Outpatient Treatment (AOT)

2. Disclaimer
The views, opinions, and content expressed in this presentation do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS).

3. Reminders Noise Control Recording
Please keep your phones on mute if not taking part of the discussion.
Please do not put your phones on hold!
Recording
This webinar is being recorded.

4. Webinar Purpose
To help ensure sustainability of the AOT program at the conclusion of the SAMHSA grant cycle by engaging non-traditional partners. 
CIT coordinators and officers are key nontraditional AOT partners.

5. CIT Engagement in AOT Overview of AOT
Betsy Johnson, Policy and Legislative Advisor,
Treatment Advocacy Center
Overview of CIT
Lt. Mike Woody, (Ret); Past President, CIT International
The Intersection of CIT and AOT
Mark Giuliano, MSW; Program Director Community Support
Sara Servadio, MA, AOT Coordinator
Westchester County DCMH
Lessons Learned from Cuyahoga County; SAMHSA AOT Grant Recipient
Carole Ballard, CIT Coordinator; Cuyahoga County ADAMH Board
Capt. James Purcell, CIT Coordinator; Cleveland Police Dept.
Questions/Wrap Up

6. AOT Overview Betsy Johnson Legislative and Policy Advisor
Treatment Advocacy Center

7. What is Assisted Outpatient Treatment?
Court-ordered, community-based intervention for individuals with serious mental illness (schizophrenia or bipolar disorder) who cannot, on their own, recognize their need for treatment. 
Person under AOT order receives intensive services and supports in the community to help prevent further psychiatric deterioration.

8. History of AOT

9. AOT Process
Petition/affidavit/application filed in civil (probate) court alleging person meets criteria for AOT spelled out in the law
Court holds hearing
All due process protections afforded
Petitioner bears burden of proof
Expert testimony provided
Evidence presented must be clear and convincing

10. AOT Process Con’t
AOT intended for stabilized patient based on risk of future deterioration.
Timing of petition?
Black Robe Effect:
Judge commands respect as symbol of authority
Judge must embrace the role of primary motivator
Works on treatment system, too
Rapid response to non-adherence
Lack of punishment for non-adherence doesn’t mean lack of consequences

11. AOT – a court procedure or a program?
Successful implementation requires program approach
Proactively identify AOT criteria
Established process for filing petition/program removes need for families to file petition
Deliver treatment, services and intensive case management by dedicated staff
Effectively monitor clients
Take swift corrective action if client becomes non-adherent
Determine point at which AOT is no longer needed

12. AOT Research Findings Of participants in New York’s AOT program
77% fewer experienced psychiatric hospitalization
74% fewer experienced homelessness
83% fewer experienced arrest
87% fewer experienced incarceration
Source: NY Office of Mental Health: Kendra’s Law: Final Report on the Status of Assisted Outpatient Treatment (2005)

13. Overview of Crisis Intervention Team (CIT)
Lt. Mike Woody, (Ret)
Akron, OH Police Department
Immediate Past President
CIT International

14. What is Crisis Intervention Team (CIT)?
Community partnership of law enforcement, mental health/addiction professionals, individuals living with mental illness and/or addiction disorders, families and other advocates.
Police-based crisis intervention helps those with mental health disorders and/or addiction disorders access medical treatment rather than placement in criminal justice system due to illness related behaviors.  
Promotes officer safety and safety of individual in crisis.

15. History of CIT
CIT Model developed in Memphis and has spread throughout the country. It is known as the “Memphis Model.” 
The Memphis Police Department 2 years before “The Incident” (1986)
The Catalyst (1988)
The Memphis PD after the incident

16. Core Elements of CIT - 1 Ongoing Elements
Partnerships: Law Enforcement, Advocacy, Mental Health
Community Ownership: Planning, Implementation and Networking
Policies and Procedures

17. Core Elements of CIT - 2 Operational Elements
CIT: Officer, Dispatcher, Coordinator
Curriculum: CIT Training (Basic Strategies, Basic Verbal Skills, Stages of Escalation, One on One Interactions, Complex Interventions)
Mental Health Receiving Facility: Emergency Services

18. Core Elements of CIT - 3 Sustaining Elements
Evaluation and Research, Evidence of Effectiveness
In-Service Training
Recognition and Honors
Outreach: Developing CIT in Other
Communities

19. CIT - A training or a program?
CIT programs are the foundation for developing meaningful collaborations with community behavioral health services, and not merely training for police.
CIT programs serve as a catalyst to create a spectrum of interconnected community health services with a “no-wrong door” philosophy, which leads to greater accessibility, improved public safety, and efficient utilization of limited resources.
Source: MHFA/CIT White Paper

20. CIT Research Findings CIT Diversion - Compared to Jail (after 90 days)
better connection to community treatment
improved mental status symptoms
lower rate of re-arrest
Source: SAMHSA: Final Report, Dupont (2003) Criminal Justice Jail Diversion Project

21. Intersection of CIT and AOT
Mark Giuliano, MSW
Program Director Community Support
Sara Servadio, MA
AOT Coordinator
Westchester County DCMH

22. Vignettes of AOT and CIT Working Together

23. Importance of Establishing a Point Person
CIT team extends beyond the individual police department
CIT is more than just a law enforcement training
Avoid the danger of diffusion of responsibility
Always have a back-up

24. Trust and Follow Through
Role of Law Enforcement
Practical and pragmatic
Burden of decision making
Time sensitivity
Role of Mental Health
Responsive
Accessible

25. Responding to Families and Individuals in Crisis
Sensitivity and de-escalation skills a must
CIT cannot do it alone
Collaborative response between mental health and law enforcement
What to do when collaborative response is not available

26. Addressing Systems Issues
Collaboration on individual cases.
Forum to discuss system issues.
Accessibility, responsiveness, communication and follow through.
Partnership leads to more responsive community supports for people with lived mental health and substance use experiences.

27. Lessons Learned Carole Ballard CIT Coordinator;
Cuyahoga County Alcohol, Drug Addiction
and Mental Health Services Board
Capt. James Purcell
Cleveland Police Department

28. Dos and Don’ts - 1
Do have a full understanding about each other’s roles.
Don’t develop programs that involve actions that impact law enforcement/mental health system without their input.
Don’t make assumptions about law enforcement’s ability to hold or transport.
Do communicate and collaborate with the CIT Coordinator (including updates on potential warrants and AWOL clients).

29. Dos and Don’ts - 2
Do read and understand the Assisted Outpatient Treatment law.
Do be explicit about what you are able to do if no legal warrant and or order is available.
Do include law enforcement in regular meetings regarding the status of AOT Program.

30. Responding to Transport/Order to Convey following AOT Order
Mental Health Provider:
Completes Client Profile Sheet
Coordinates request with local dispatch
Contacts CIT Coordinator in order to provide the heads up on the client and order
Meets CIT officer at the client address or is available by telephone to the responding CIT officer
CIT Officer:
Completes CIT Stat Sheet and indicates AOT on the sheet

31. AOT Order to Convey Purpose for order Communication needs/preferences
Triggers/Trauma
High risk behaviors/violence/ aggression
Suicidal/homicidal ideation past or present
Access to weapons
Recent stressors

32. Data Collection of Repeat Orders to Convey
Officers complete CIT stat sheet on every encounter/ Indicate if Order to Convey
Data compiled/Repeat AOT clients identified and reviewed
Concerns addressed by cross systems collaboration committee
Use of Force: Law enforcement, in collaboration with representatives from DOJ, review and discuss AOT concerns for problem solving and recommendations

33. Next Steps for AOT Order to Convey Protocols
Information regarding AOT Protocols to be introduced in 2018
AOT Protocols to be part of annual In Service Training beginning 2018
AOT Program to present AOT Protocols at Ohio Association of Chiefs of Police meeting in February, 2018

34. Q & A
Lisa

35. Communities of Practice
Each community of practice will have four (4) quarterly webinar/conference calls that will focus on topics of interest.
1.5 office hours/month will be available for one-on-one technical assistance and guidance by each expert consultant.
To schedule one-on-one office hours with Betsy Johnson, please contact:
Ashley Schultz
(518) Ext. 5277
Lisa

36. For more information, contact:
Betsy Johnson