Community Triage Center: Preliminary Baseline Data · 11/9/2017  · Community Triage Center:...

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Community Triage Center: Preliminary Baseline Data November 9, 2017 [email protected]

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Community Triage Center:Preliminary Baseline Data

November 9, 2017

[email protected]

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INTERCEPT 0COMMUNITY SERVICES

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Intercept 0: Community Services

• Helpline

• Lutheran Social Services

• Southeastern Behavioral Health

• Carroll Institute

• Falls Community Health

• Avera and Sanford ERs

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Helpline Calls

National Suicide Prevention Lifeline: 1,538 calls

2016 Identified Needs for Mental Health & Addictions (Summary)

Triage Services 756

Substance Abuse 1,128

Mental Health 537

Other (counseling, support groups, etc.) 1,666

Suicide Prevention 2,056

Talklines/Warmlines 3,005

Grand Total 9,148

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Lutheran Social Services (Counseling)

Total clients served: 667

21 2853

13 17 24 40

451434

0

50

100

150

200

250

300

350

400

450

500

Clients by Service

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Southeastern Behavioral Health

Total clients served annually: about 5,000

Top referral sources:

– Department of Social Services

– Schools

– Family / self / friends

– Hospital / medical facilities

– Court / criminal justice

– Human Services Center

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Carroll Institute

Clients served annually: 2,000

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Carroll Institute: The Arch

3%

0%

83%

4%

5%

0% 0%

5%

0%

Referral Sources, FY2017

Alcohol/Drug Provider

Community Hospital

Court/Criminal Justice

Department of Social Services

Family/Self/Friend

Human Services Center

Indian Health Services

Other

Other Social Services

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Carroll Institute: The Arch

41.72%

27.51% 26.34%

0.47% 0.47% 1.63%0.23% 0.00% 0.70% 0.47% 0.23% 0.23%

31.76%

7.62%

26.32%

5.08%

10.89%9.26%

0.00%

4.36%1.27% 2.54%

0.54% 0.36%0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

Discharges, FY16 and FY17

FY16 FY17

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New Horizons

2015 2016

Total Admissions 145 63

Average Length of Stay 11.3 9.8

Average Daily Census 6.9 2.4

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New Horizons

2015 2016

To Inpatient 51 13

To Slip Slot 27 16

To Outpatient 45 16

IVC Dropped 6 1

Terminated 20 20

Total Discharges 149 66

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Falls Community Health

1,998

231

871

543446

86

292 231

0

500

1,000

1,500

2,000

2,500

Behavioral health Chemical dependence Substance abuse:Alcohol

Substance abuse:Drugs

Encounters and Patients

Encounters Patients

Medical encounters 27,096

Medical patients 8,852

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Hospital ERs

6364 6081

25422024

5560

1000

2000

3000

4000

5000

6000

7000

Encounters(total)

Mental health Substance abuse Substance abuse:Alcohol

Substance abuse:Drugs

ER Encounters (2016)

Total

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Arrival to ER

3929

2341

73 240

500

1000

1500

2000

2500

3000

3500

4000

4500

Walk In EMS Law enforcement Unlisted/Other

Means of Arrival (2016)

Total

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Length of ER Stay

Average stay: 190 minutes (3.2 hours)

Total ER time: 1,197,973 minutes

832 days

2.28 beds per day

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Disposition after ER

4722

593 556218 199 161 1120

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Disposition (2016)

Total

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Intercept 0: SummaryOrganization Behavioral Health Clients Served (2016)

Helpline > 9,000 calls statewide

Falls Community Health 500 to 1,000 behavioral health patients

Lutheran Social Services 667 counseling clients

Carroll Institute 2,000 clients

Southeastern Behavioral Health 5,000 clients

Hospital ERs 6,589 behavioral health encounters

Adults with SMI (est. 5% MSA) 9,156

Adults with SUD (est. 15% MSA) 27,468

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INTERCEPT 1LAW ENFORCEMENT

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Intercept 1: Law Enforcement

• Calls for Service

• Mobile Crisis Team

• Arrests and Charges

• Detox and Sobering Center

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Calls for Service

Total calls in 2016: 127,547

Incident Type Calls % of All Calls

Disorderly Subjects 12,462 9.77

Accident 8,988 7.05

Larceny 4,594 3.60

Family Dispute 4,416 3.46

24/7 Violation 4,048 3.17

Check Wellbeing 3,946 3.09

Narcotics Violation 3,738 2.93

Intoxicated Subject 2,769 2.17

Prisoner Transport 2,611 2.05

Vandalism 2,537 1.99

Abandoned Vehicles 2,466 1.93

Assault 2,419 1.90

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Calls for Service

Most calls are resolved on scene.

127,547

79,114

15,145 9,734

1,326 98 -

20,000

40,000

60,000

80,000

100,000

120,000

140,000

Total calls NecessaryAction Taken

Arrest / Lodgedat Jail

Citation Lodged at Detox Lodged atMcKennan

Selected Call Outcomes, 2016

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Mobile Crisis Team

In 2016, MCT’s diversion rate was 94.7%.

Calls Received 572

Calls Declined 85

Calls Taken 487

Remained Home 417 85.6%

Voluntary Admission to

Avera Behavioral Health 30 6.2%

Detox / Other Placement 14 2.9%

Involuntary Hold 26 5.3%

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Which calls result in arrest?

Incident Type

Calls

Resulting

in Arrest

% of Incident

Type Resulting

in Arrest

% of All Calls

Resulting in

Arrest

24/7 Violation 2,272 56.13% 15.00%

Narcotics Violation 2,014 53.88% 13.30%

Disorderly Subjects 1,545 12.40% 10.20%

Warrant Service 1,352 59.09% 8.93%

Assault 922 38.11% 6.09%

Shoplifting 848 44.40% 5.60%

DWI 842 61.59% 5.56%

Runaway 517 31.51% 3.41%

Family Dispute 472 10.69% 3.12%

Non Hazardous Moving Violations 371 36.92% 2.45%

Traffic 337 47.13% 2.23%

Intoxicated Subject 293 10.58% 1.93%

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Which calls result in arrest?

12,462

8,988

4,594 4,4164,048 3,946 3,738

2,769 2,611 2,537

1,545

260 116472

2,272

62

2,014

29328 69

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

DisorderlySubjects

Accident Larceny FamilyDispute

24/7Violation

CheckWellbeing

NarcoticsViolation

IntoxicatedSubject

PrisonerTransport

Vandalism

Calls and Arrests by Call Type, 2016

Calls Arrests

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Arrests and Charges

Total arrests in 2016: 11,993

2314

986

474859

160341

608

886

799 108

492 77

0

500

1000

1500

2000

2500

3000

3500

Drug/Narcotic DisorderlyConduct

DUI Shoplifting Liquor LawViolations

Trespassing

SFPD and Sheriff's Office Arrests, 2016(Selected Charges)

Alone Plus Other Charges

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Detox

Clients: 241 (165 IVCs)

Bed days: 1,552

Average daily census: 4.25

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Sobering Center

Total bookings: 2,621

Bookings per day: 7.18

Average length of stay: 9.7 hours

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Intercept 1: SummaryOrganization Instances (2016)

Calls for service 127,547 calls

Necessary action taken 79,114 calls

Arrests 15,145 calls

MCT calls 572 calls

Detox 241 clients

Sobering Center 2,621 bookings

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INTERCEPTS 2 AND 3INITIAL DETENTION AND JAIL

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Intercepts 2 and 3: Jail

• Bookings

• Mental health and substance abuse

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Bookings

24%

76%

All Bookings (2016)

MH or SUD

Neither MH nor SUD

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Bookings

Bookings % of all bookings

MH or SUD 4,201 24.1%

SUD alone 1,942 11.1%

MH alone 1,465 8.4%

Co-occurring 794 4.5%

Neither MH nor SUD 13,256 75.9%

All bookings 17,454

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Bookings

10,308

1,039 1,428478

3,139

240468

3540

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

Unsentenced (MinnehahaCounty)

Sentenced (MinnehahaCounty)

Contract / Other County All others

Bookings by Legal Status

Neither MH nor SUD MH or SUD

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Bookings

10,455

2,798

1,556 419

2,811

1,390

560

2740

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Misdemeanor Felony Violent Probation violation

Selected Characteristics

Neither MH nor SUD MH or SUD

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Length of Stay

331

353

247

434

180

216

0

50

100

150

200

250

300

350

400

450

500

MH or SUD SUD MH Co-occurring Neither MH norSUD

All bookings

Average Length of Stay (hours)

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Length of Stay

119

757

177

263279

1,147

264

342

0

200

400

600

800

1000

1200

1400

Unsentenced (MinnehahaCounty)

Sentenced (MinnehahaCounty)

Contract / Other County All others

Average Length of Stay by Legal Status

Neither MH nor SUD MH or SUD

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Length of Stay and Self-Reported MH/SUD

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

< 12 hours 12 to 24 hours 24 to 48 hours > 48 hours

Positive Report by Length of Stay

SUD MH COOC None

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Intercepts 2 and 3: Jail

• Next steps:

– Improve data quality with universal mental health screening at intake

– Data matching to identify at booking people known to community-based behavioral health providers

– Criminogenic risk assessment tool

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SUPER UTILIZERS

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Super Utilizers

62.1%

17.9%

8.2%

4.2%2.6% 1.4% 1.1% 0.7% 0.5% 0.2% 0.2% 1.1%

29.4%

16.9%

11.6%

7.9%6.0%

4.0% 3.5% 2.5% 2.2% 1.1% 1.0%

14.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

1 2 3 4 5 6 7 8 9 10 11 12+

Number of Bookings in 2016

Super Utilizers (All Bookings)

People (%) Bookings (%)

n=9,533 n=20,169

Top 5%490 people

28.3% of bookings

Top 1%102 people

14.0% of bookings

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Super Utilizers

66.9%

12.7%

5.5%1.7% 2.6% 1.3% 0.6% 0.9% 1.2% 0.3% 0.4% 0.3% 0.1% 0.3% 0.4%

5.1%

19.3%

7.3%4.8%

1.9%3.7% 2.2% 1.3% 2.1% 3.0%

0.7% 1.2% 0.9% 0.5% 1.0% 1.7%

48.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Number of Bookings in 2016

Super Utilizers (Detox and Sobering Center)

People (%) Bookings (%)

Top 5%20 people

48.4% of bookings

n=782 n=2,708

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Super Utilizers

62.6%

17.9%

8.3%

4.2%2.5% 1.4% 1.0% 0.7% 1.3%

33.0%

18.8%

13.1%

8.9%6.7%

4.5% 3.6% 2.8%

8.0%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

1 2 3 4 5 6 7 8 9+

Number of Bookings in 2016

Super Utilizers (Jail Bookings)

People (%) Bookings (%)

n=9,203 n=17,461

Top 5%638 people

25.6% of bookings

Top 1%123 people

8.0% of bookings

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Super Utilizers

18.32%

34.95%

46.93%

54.87%

69.91%

6.52%

13.80%

21.70%19.49%

29.31%

8.88%13.01% 12.16%

15.38%10.66%

2.91%

8.15%

13.07%

20.00%

29.94%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

1 2 3 4 5+

Number of Bookings in 2016

Self-reported SUD and MH Disorders by Number of Bookings

SUD or MH SUD alone MH alone Co-occurring

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Super Utilizers

Compared to those who don’t report problems, people who self-report behavioral health problems are:

• 2.14 times as likely to have multiple bookings

• 5.74 times as likely to have 5+ bookingsMultiple (2+)

bookings RR

RR 95% conf.

interval

SUD or MH 2.14 2.03 to 2.25

SUD 1.87 1.77 to 1.97

MH 1.26 1.17 to 1.36

COOC 2.18 2.07 to 2.30

5+ bookings

RR

RR 95% conf. interval

SUD or MH 5.74 4.88 to 6.76

SUD 3.28 2.80 to 3.84

MH 1.04 0.82 to 1.33

COOC 5.43 4.68 to 6.31

n=9,203

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Takeaway

• Behavioral health problems contribute to cycling through the criminal justice system.

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COSTS AND CAPACITY

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Super Utilizers: Jail

Top 1% and self-reported behavioral health problems

• 106 people with 5+ bookings in 2016

• 71 total days in jail per person, on average

• 7,510 bed days annually

• 21 beds per day

• $713,427 annually

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Super Utilizers: Jail

Top 5% and self-reported behavioral health problems

• 446 people with 5+ bookings in 2016

• 62 total days in jail per person, on average

• 27,710 bed days annually

• 76 beds per day

• $2,632,518 annually

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Cost of Care: Avera and Sanford ERs

• Total charges: $40,037,269

• Average charges per encounter: $6,076

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Insurance: Avera and Sanford ERs

4348

2020

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Insured Uninsured

Insurance Rate for ER Encounters, 2016

Total

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Insurance: Falls Community Health

4,2994,839

0

1,000

2,000

3,000

4,000

5,000

6,000

Insured Uninsured

Payer

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Estimated Cost Summary

Organization Behavioral Health Cost Estimate (2016)

Jail (super users) $700,000 to $2.6 million

Hospital ER (total) $40 million

Uninsured (est.) $9.7 million

Medicaid (est.) $6.1 million

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Estimated Potential Demand

Source

Annual

Admissions

Daily

Admissions

Length of

Stay (hours)

Daily Beds

Occupied

Detox 241 0.66 155 4.3

Sobering Center 2,621 7.2 9.7 3

Pre-arrest triage 2,656 7.3 279 84.6

Redirected from hospital 636 1.7 3 0.2

Total 6,154 16.86 92.1

Observed length of stay

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Estimated Potential Demand

Source

Annual

Admissions

Daily

Admissions

Length of

Stay (hours)

Daily Beds

Occupied

Detox 241 0.66 72 2

Sobering Center 2,621 7.2 9.7 3

Pre-arrest triage 2,656 7.3 72 21.8

Redirected from hospital 636 1.7 3 0.2

Total 6,154 16.86 27

72 hour maximum

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Estimated Potential Demand

Source

Annual

Admissions

Daily

Admissions

Length of

Stay (hours)

Daily Beds

Occupied

Detox 241 0.66 155 4.3

Sobering Center 2,621 7.2 9.7 3

Pre-arrest triage 266 0.73 12 0.37

Redirected from hospital 636 1.7 3 0.2

Total 3,764 10.29 7.87

Conservative Pilot

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DEMOGRAPHICS

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Gender

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Arrests(SFPD &

SO)

CarrollInstitute

MCT Falls CH LSS Avera ER Sanford ER

Male Female Unknown/Other

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Race

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Arrests Carroll MCT Falls CH LSS Population

White Native American Black Asian Multiracial Hispanic Other Unknown

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Language

Falls Community Health clients best served in another language:

23%

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Arrests by Age

0

100

200

300

400

500

600

700

0 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 80

Arrests by Age, 2016 (SFPD & SO)

30 years

40 years

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POLICY QUESTIONS

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Policy Questions

• Goal

– Shift burden from CJ / ED, or

– Engage underserved groups?

• Target population

– Super utilizers, or

– Unreached, new clients?

• Point of intervention

• Services