Dallas County Behavioral Health Leadership Team Thursday ......Welcome and Call to Order ... Gia...

Dallas County Behavioral Health Leadership Team

Thursday, September 12, 2019

Henry Wade Juvenile Justice Center

2600 Lone Star Drive, Dallas, TX

Room 203-A at 9:30am -11:00am.

I. Welcome and Call to Order

Review/ Approval of Minutes *August 12, 2019*

II. Introductions

III. Presentation

UT Southwestern Medical Center, Dr. Betsy Kennard, Program Director, Suicide

Prevention and Resilience at Children’s (SPARC)

Update on Children’s Health and Metrocare’s partnership on Teen

Suicide Prevention Program

IV. NTBHA Update

V. Meadows Mental Health Policy Inst. (MMHPI)

VI. Dallas County Behavioral Health Housing Workgroup

VII. 1115 Waiver Crisis Services Project Update

Resolution: Renewal of Adapt and Transicare Contracts

VIII. Legislative Update

IX. Funding Opportunities

Cottages Update

SAMHSA Residential Treatment Grant Update

Community Courts Grant Update (Public Defender’s Office)

X. Upcoming Events and Notifications

XI. Public Comments

XII. Adjournment

* Indicates items requiring approval from Dallas County Behavioral Health Leadership Team

The following reports from BHLT Committees are included for your records: ACOT, BHSC, PD

Mental Health Stats and North Texas Behavioral Health Authority. Unless action is required,

there will be no verbal updates from those committees.

Dallas County

Behavioral Health Leadership Team

Meeting Notes

Thursday, August 8, 2019

https://www.dallascounty.org/departments/criminal-justice/bhlt/

Welcome and Call to Order

The Behavioral Health Leadership Team meeting was called to order by Commissioner John Wiley Price at 9:30 AM,

with a motion from Commissioner Theresa Daniel and seconded by Commissioner J.J. Koch.

Review/Approval of Minutes/BHLT Website

The minutes of the BHLT meeting held on July 11, 2019, were included in the meeting packet (pgs. 2-4). A motion was

made by Commissioner Koch to accept the minutes and then seconded by Chief Lynn Richardson, Public Defender’s

Office. The committee members voted to approve the minutes with no modifications. Commissioner Price welcomed all

attendees that were in attendance and allowed all first time attendees to introduce themselves.

Presentation:

Judge John Creuzot, Dallas County District Attorney, provided remarks to introduce Lee Pierson, Division Chief of the

Dallas County District Attorney’s Office Mental Health Division. Mr. Pierson provided an overview of the Mental Health

Division and stated that the mission statement for the District Attorney’s (DA) office is to stop the cycle of those with

mental health and addiction issues being caught in the criminal justice system while continuing to safeguard the

community. The DA’s Mental Health Division is composed of 6 attorneys and a clerk. Chief Pierson reviewed the

caseloads and job descriptions for each of the staff members in the division. He also acknowledged the department clerk, Gia Slayton, as she manages the schedules of all attorneys, prepares competency and insanity paperwork, maintains

statistics on intake, handles the processing of all intakes, sometimes helps as an investigator, and assists with whatever

needs to be done in the office. Each attorney handles a caseload of approximately 175+ cases with the Public Defender’s

Office and the private bar. Assistant DA Ron Wright also handles the misdemeanor docket.

The DA’s office primary goal is Diversion and to provide service linkage in cases where probation or jail sentence is the

outcome. A few of the diversion programs the DA’s Office provides services to include: Mental Health Jail Diversion,

Stabilization Engagement Transition (SET), and Pre-Trial Intervention Agreement (formally known as conditional

dismissals). The DA’s office determines what to do and/or what decisions to make by using risk assessments,

psychological evaluations competency reports, hospital reports, reports from service providers (i.e. Adapt Community

Solutions, North Texas Behavioral Health Authority, etc.) and caseworker reports (Public Defender’s Office).

A few changes that the DA’s office has made to their Mental Health Division (MHD) in 2019 are:

The MHD is now allowed to take a greater range of cases with the full support of the District Attorney.

The MHD has now been placed in the Restorative Justice Division of the DA’s office .

The MHD has been expanded to include another felony level attorney. Judge Creuzot is asking for another

attorney, two case managers, and an investigator for the MHD and a reclassification of the clerk to an

administrative assistant in this year’s budget process.

The attorneys in the MHD are no longer being rotated in and out of the Division on a frequent basis like in the

past.

The MHD no longer has to get permission to take a case from other prosecutors.

The MHD is now being sent all criminal trespass cases which intake believes are based on mental health issues.

The Commissioners commended Judge Creuzot and the District Attorney’s office on all their hard work and

collaborations with the Public Defender’s Office and the great changes that they made within their department.

https://www.dallascounty.org/departments/criminal-justice/bhlt/

NTBHA Update:

Walter Taylor, CSO of North Texas Behavioral Health Authority, introduced Ron Stretcher, Senior Director of Systems at

MMHPI, to discuss the new Jail Diversion Continuum of Care initiative. Mr. Stretcher stated that the information was

provided to the members in the supplemental packet and the first meeting is scheduled for Monday, August 12, 2019 at

Frank Crowley Court Building. There is going to be a two stage approach to this initiative. Chad Anderson and Jessica

Martinez with NTBHA are putting together budget information to the state to reallocate SB 292 funding. The initial phase

of the project will utilize State and local match funds through the SB 292 and HB 13 grant programs existing in the

NTBHA general revenue funds and leveraged funds and /or in-kind resources from the project partners. The committee is

currently working on reviewing the expansion of existing services such as: adding 16 crisis respite beds at Homeward

Bound, adding treatment and recovery support resources to increase the capacity specifically for diversion and allow for

limited drop-offs for the RIGHT Care team, increasing capacity to allow for transportation from jail, providing short-term

rental assistance and expanding access to NTBHA Care Coordinators.

After reviewing the plan for a full continuum of care to support diversion from jail, Mr. Stretcher introduced Dr. Sarah

Baker with UTSW & MMHPI.. Mr. Taylor informed the BHLT members that NTBHA is wrapping up their final RFP

process and, at the September NTBHA Board meeting, they will be making their final funding decisions. Current

contracts will be extended until new contracts have been executed. After speaking with Sonja Gaines they will be

receiving an increase of $2 million for outpatient treatment. The grand opening for the Living Room is scheduled for

Tuesday, October 15th from 2pm until 6pm; Sonja Gaines, Deputy Executive Commissioner for Intellectual &

Developmental Disability and Behavioral Health Services, will be in attendance along with her staff.

Meadows Mental Health Policy Institute:

Ron Stretcher, Senior Director of Systems Management for MMHPI stated that there were no additional comments..

Behavioral Health Housing Work Group (BH HWG) Update:

Commissioner Daniel stated that the committee continues to move forward with a comprehensive directory of resources.

Commissioner Daniel also informed the members that the BHHWG continues to review data and reports that are being

utilized. Commissioner Price requested that the Criminal Justice staff complete an inventory of beds available in Dallas

County. After a few discussions Charlene Randolph, Director of Dallas County Criminal Justice Department, and Mr.

Stretcher stated that they would work together to gather that information.

1115 Waiver Crisis Services Project (CSP) Update:

Laura Edmonds, Assistant Director of Dallas County Criminal Justice Department, stated that she will be reaching out to

members for the next Transition Planning Committee meeting. CSP is also finalizing the FY20 contracts and they should

be available at the next scheduled or October BHLT meeting. Legislative Update

Janie Metzinger, NTBHA Legislative Coordinator, informed the members that she is completing a summary of all bills

dealing strictly with local Mental Health Authority and local Behavioral Health Authority. The NTBHA staff should have

the entire summary available for the NTBHA Board to review at their next meeting. The Commissioners requested that

staff generate a letter to the delegation on behalf of the Commissioners and the BHLT Committee showing their support

of the delegation.

Funding Opportunities:

Cottages Update:

Jennifer Jaynes, Director of the Cottages, was unable to make it to the meeting but their current census is 43.

SAMHSA Grant Update:

Shenna Oriabure, Criminal Justice Department reported that there are currently 26 referrals. SAMHSA had their partners

meeting the day before and everything seems to be on track and moving forward.

Community Courts Grant Update (Public Defender’s Office):

Chief Lynn Richardson, Public Defenders Office, stated that Vickie Rice provided a separate handout which included the

PD’s monthly statistics. Chief Richardson also wanted to thank State Representative Toni Rose and Charles Reed, Dallas

County Assistant County Administrator of Governmental Affairs, for their hard work at the last hearing. She also thanked

Commissioners Court and Ryan Brown, Director of Dallas County Budget Department, for the approval of a Civil

Commitment Attorney, which will help reduce reliance on the private defense bar.

Public Comments:

Joe Powell, President and CEO of APAA, announced the Big Texas Rally on September 21, 2019 at the Globe Life Park.

Katelyn Bradwell, Intern for Mental Health America, announced they will be hosting Mental Health First Aid training on

Thursday, August 29th. Mental Health America also announced their Neighborhood Block Party, September 28, 2019.

Adjournment:

The meeting was adjourned at 10:59 am. A motion was made by Commissioner Daniel and then seconded by

Commissioner Koch.

Caruth Smart Justice Planning Grant, Community Stakeholder Project Status Update 1

Meadows Mental Health Policy Institute

Caruth Community Update – Mid Year 2019

The Meadows Mental Health Policy Institute (MMHPI) submitted the Caruth Smart Justice

Planning Grant Phase II proposal to the W. W. Caruth, Jr. Fund at the Communities Foundation

of Texas on July 15, 2016.1 Our implementation of the Caruth Smart Justice Project (Caruth

Project) began in January 2017. The project aligns with and supports the local behavioral health

system and its efforts to meet the needs of residents with mental health conditions in North

Texas. As we proceed with Year 3 of the grant, we continue to make progress in implementing

each of the points of contact within the Sequential Intercept Model.

The Caruth Project has developed an active collaboration with community providers and

stakeholders, working together to reduce the number of people with co-occurring mental

health needs and criminal justice involvement in order to increase access to high-quality

community-based treatment. We have formal agreements with agencies, including:

The Dallas Police Department (DPD);

The Dallas Fire and Rescue Department (DFRD);

Parkland Health & Hospital System (Parkland);

North Texas Behavioral Health Authority (NTBHA); and

Community providers of Assertive Community Treatment (ACT) and Forensic Assertive

Community Treatment (FACT): Transicare, Integrated Psychotherapeutic Services (IPS),

Child & Family Guidance Center, and Metrocare Services (Metrocare).

Our work with Parkland has been instrumental, beginning with Parkland’s initial partnership

with the Rapid Integrated Group Healthcare Team (RIGHT) Care units. In this partnership,

Parkland hired and trained the clinicians for the RIGHT Care units and agreed to provide the

mental health clinicians for the 911 dispatch clinical support. Parkland further contributed to

the Caruth Project by forming a referral pool of people needing Caruth-supported treatment:

Parkland staff and NTBHA staff stationed at Parkland help identify and refer people who are

eligible for Level of Care 4 services.

Through the Dallas County Criminal Justice Department (DCCJD) and the Dallas County Sheriff’s

Department, Dallas County has collaborated with Parkland’s Jail Health staff to transform

screening and assessment procedures.

1 On October 5, 2016, the trustees of the W. W. Caruth, Jr. Fund at the Communities Foundation of Texas approved

the grant proposal, which enables the Meadows Mental Health Policy Institute to work closely with Dallas County, the City of Dallas, and a broad array of partners to implement the Dallas County Smart Justice Project.


We have contracted with Loopback Analytics (Loopback) to create a real-time patient

surveillance/tracking system that integrates data from primary systems involved with the

Caruth Project. As of the midpoint of the Caruth Project Year 3, the Loopback data system has

been fully deployed and used in multiple locations, including emergency departments and by

NTBHA and its providers. Loopback has two years of historical data from Dallas-Fort Worth

Hospital Council Foundation (DFWHCF) and receives real-time data feeds from the following

partners: Parkland, Texas Health Resources, Methodist Health System, Baylor Scott & White

Health, NTBHA, and the Dallas County Jail (one-way feed of jail admission and release data).

We wish to thank our partners for their continued support and energy in advancing the Caruth

Smart Justice Project.

Intercept 1. Law Enforcement

RIGHT Care – the multidisciplinary response team that is critical to reducing the burden on law

enforcement in responding to 911 mental health calls in the Dallas community – provides

regular outcomes analysis of call data provided by DPD, Parkland, and DFRD. Parkland has led

the collection and organization of data we use to prepare reports for executive leadership and,

when approved, public distribution. Partnerships between the City of Dallas, Parkland, IPS,

Metrocare, the Child & Family Guidance Center, and other community providers have been

critical to the successful launch of the RIGHT Care program.

Over the past quarter, the MMHPI Smart Justice and Adult Policy team has continued to work

closely with partners at Parkland, DFRD, the City of Dallas, NTBHA, and DPD to review the first

year of RIGHT Care’s implementation and identify opportunities for program improvement.

A preliminary analysis of call data provided by DPD, Parkland, and DFR for the April 2, 2018,

through May 5, 2019, time period found:

There was a total of 3,790 interactions:2

The team had interacted with 1,963 unique people.

The team responded to 1,294 calls for service and referrals.

Eight hundred and fifty-one (851) interactions involved team-initiated outreach or

non-crisis follow-up care by the team (“follow-up care” is defined as either

subsequent phone calls or in-person visits).

One hundred and thirty-three (133) interactions resulted in a traditional law

enforcement response:

Sixty-nine (69) arrests were for previous warrants.

2 Some people had more than one interaction with the team; each interaction, regardless of whether it involved a unique or repeated person, is included in this total.


Sixty-four (64) arrests were for an offense on-scene.

Arrests accounted for fewer than 3.51% of total interactions.

Over eleven hundred (1,111) interactions resulted in overall linkages with care, allowing

diversion from jail and emergency rooms in many cases, including the following

highlights:

One hundred and forty-three (143) people were taken to an outpatient clinic.

One hundred and forty-four (144) people were immediately connected to housing

resources.3

Forty-nine (49) people were linked to ACT.

Four (4) people were linked to ADAPT Mobile Crisis Services.

Four hundred and eighty-eight (488) people were provided with other resources and

referrals.

Two hundred and three (203) people were transported to a medical hospital by an

ambulance.

Eighty (80) people were taken to a psychiatric facility via RIGHT Care or a family

member.

Hospitalizations only accounted for 5.37% of total interactions.4

Over twelve hundred (1,245) interactions resulted in diversions including:5, 6

Eight hundred and eighteen (818) diversions to outpatient care or home-based

treatment rather than inpatient treatment, which would have occurred without the

RIGHT Care intervention.

Four hundred and twenty-seven (427) jail diversions for people with behavior that

constituted low-level criminal behavior, such as trespass or disorderly conduct;

these people were linked to treatment rather than arrested.

Far too often, people with complex mental health needs become entangled in the justice

system and are at high risk of repeatedly cycling through jail and emergency departments

instead of receiving effective treatment. This pattern contributes to increases in recidivism

rates, impeded recovery, destroyed lives, and added burdens to the community through

misallocated resources. The data show that RIGHT Care can connect people with complex

needs to appropriate care.

3 Housing resources include a person’s own home or a family member’s home.

4 Medical/surgical hospitalizations are tracked separately from Apprehensions by Peace Officer Without Warrant

(APOWWs). 5

Hospital diversions are determined by Parkland’s clinical program support whereas jail diversions are determined by DPD. 6

Interactions resulting in linkages to care are commonly diversions from the hospital or jail; because they are not mutually exclusive, a single interaction may be considered both a linkage to care and a diversion.


The 911 dispatch clinicians currently serve as a resource to call center employees and assist in

appropriately identifying behavioral health calls. Since implementation, these clinicians have

assisted with 1,295 calls.7

Additional developments include increased oversight from the City of Dallas and improved

triage efforts through Loopback’s real-time patient surveillance platform by RIGHT Care

clinicians in the field. In July 2019, a Public Safety/RIGHT Care Coordinator was hired at Dallas

City Hall to provide comprehensive program coordination. The coordinator will oversee the

collaboration efforts among DFRD, Parkland, and DPD and will report directly to the Assistant

City Manager. The Public Safety/RIGHT Care Coordinator is responsible for guiding the work of

all agencies with RIGHT Care-invested staff members, collecting and reporting on data,

monitoring outcomes and program impact, and working closely with NTBHA.

In May 2019, Loopback Analytics began providing RIGHT Care clinicians with look-up access to

the patient registry. These clinicians were provided laptops that are also used in the field to

enter data that are integrated with the surveillance platform. This arrangement allows the

clinicians to access client notifications and prior diagnoses, treatment, and service histories

while responding to mental health calls for service in the field. The clinicians in dispatch also

use Loopback data to better triage incoming behavioral health calls and to determine the

appropriate response.

RIGHT Care’s success has attracted attention from across the state and country. Other

communities are exploring the opportunity to adapt the program to their own needs.

Intercepts 2–4: Promoting Diversion from Booking Through Reentry

Intercept 2 focuses on a defendant’s arrest and initial detention in jail. This intercept also

includes initial court hearings while a defendant awaits trial. Intercept 3 targets the provision of

behavioral health services in the jail to restore a person’s mental health, prevent the

exacerbation of symptoms, and facilitate a successful transition back into the community. At

Intercept 4, jail programs work closely with behavioral health providers to ensure a well-

planned and effective “hand-off” from detention and jail-based treatment to community-based

treatment and, when needed or required, community supervision.

By the middle of Year 3, the DCCJD has met several key Caruth Project goals:

It implemented a risk assessment screening – using a widely recognized, reliable, and

valid tool – to facilitate data-driven jail diversion and behavioral health treatment

program referrals.

7 Dates of implementation are April 2, 2018, through May 5, 2019.


It developed and implemented comprehensive plans to comply with existing state

statutes that require people with mental illness to be considered for jail diversion

programming.

It developed pre-trial supervision capacity for people currently released from jail so that

court personnel can monitor compliance with release conditions related to treatment.

DCCJD staff have developed internal data tracking tools to monitor program activities and

performance outcomes. These tracking tools are undergoing continuous quality improvement

to better reflect the measurement needs of the project. Each month, DCCJD provides Caruth

Project data to help identify improvements in screening and moving people with mental health

needs through pretrial and into treatment, when appropriate. Highlights of program activity

and performance data for the period of April 17, 2017, through April 30, 2019 are as follows:

There were 32,387 inmates who were identified as having a mental health record.

There were 4,710 inmates who were initially identified as eligible for a mental health

bond after DCCJD staff applied statutory exclusions that disqualify people from access to

a bond.

There were 1,310 cases that were presented to a magistrate after the jail applied other

exclusions (e.g., queries of national databases for convictions and a lack of readily

available housing).

Judges granted bond in 1,100 cases, denied bond in 184 cases, and made no bond

determination in 24 cases. This represents a very high rate of judges accepting

recommendations from jail staff, which is encouraging given that these are outcomes

from new processes.

DCCJD staff are using the Ohio Risk Assessment System Pretrial Assessment Tool (ORAS-PAT) for

people being considered for personal bond release under the newly developed Smart Justice

processes. One outcome of the Caruth Project is that Dallas district and county criminal court

judges have agreed on nonviolent offenses that are appropriate for release to community

treatment. All people who were booked into the jail with these offenses were screened and

assessed for release (screening included completion of the ORAS-PAT). For people who are

being considered for release and qualify for the state of Texas defined Levels of Care 4, the

results of the ORAS-PAT determine placement into ACT (low to moderate risk levels) or FACT

(high risk levels). A total of 2,237 ORAS-PAT assessments have been completed to date, with

13.6% scoring as low risk, 57.4% as moderate risk, and 29.1% as high risk.

We continue to evaluate the outcomes of the Caruth Project implementation using a rigorous

random control trial to analyze the impact of the new ACT and FACT teams on “super-

utilization” of services (the condition in which people with complex needs are trapped in cycles

of high utilization of restrictive and expensive services) and overall costs. These efforts have


extended our collaboration with Parkland as it has become an additional referral source for the

Caruth-supported teams. Leadership at the Parkland Emergency Department, who added an

extended observation unit and newly-placed NTBHA Care Coordinators to the emergency

department in fall 2018, has agreed to take responsibility for identifying and referring

emergency department patients who were flagged by Loopback as potential ACT and FACT

clients. Our first referrals took place in February 2019.

Intercept 5. Community Corrections and Services

We have identified four community treatment providers that are able to provide the most

appropriate services for Caruth Project service expansion: Metrocare (two ACT teams), IPS (one

FACT team), Transicare (one FACT team), and Child & Family Guidance Center (one ACT team).

This list reflects five total ACT and FACT teams as our designated referral treatment providers.

Currently, Dr. Amanda Mathias, Senior Director of Innovation with MMHPI, is planning fidelity

reviews of the four original ACT and FACT units. Opportunities such as these reviews create a

benchmark to help providers transform the behavioral health system in Dallas County beyond

the Caruth Project’s efforts and into a system that fully embraces evidence-based and best

practices. The newer IPS FACT team had its full baseline review in March 2019. We are currently

scheduling a feedback session to review the findings with IPS leadership. We will soon be

contacting teams to schedule a brief six-month assessment to gauge their progress in

implementing the recommendations provided in their baseline assessments.

From January 2018 through the most recent report from the DCCJD, a subset of 109 Caruth

Project clients have been referred from the jail. This subset of people was screened with the

ORAS-PAT tool to assess for criminogenic risk and then referred to one of the four Caruth-

supported ACT or FACT providers. From February 2019 through July 2019, six people have been

referred from Parkland using the newly created Arnold Study random assignment processes.

We look forward to improving and streamlining processes at Parkland as the new referral pool

continues to expand from its February 2019 start date.

Real-Time Information Systems: Loopback Analytics Partnership Across All Five Intercepts

We have contracted with Loopback Analytics (Loopback) to create a real-time patient

surveillance/tracking system that integrates data from primary systems that are involved with

the Caruth Project. The Dallas-Fort Worth Hospital Council Foundation (DFWHCF) and NTBHA

have been key partners in developing and implementing the Loopback data system. DFWHCF

convened hospital leadership, gained their support for the project, and facilitated data

transfers. DFWHCF also convenes the ongoing governance meetings of partners as well as the

utilization management reviews to improve the system and associated processes. NTBHA was


an early adopter of Loopback, and its involvement has been essential to encouraging the

various hospital systems in Dallas County to join Loopback’s system.

With the combination of real-time and historical data feeds from Texas Health Resources (THR),

Parkland, Methodist Health System, Baylor Scott & White Health, the Dallas County Jail, and

NTBHA, Loopback developed a series of analytic dashboards that enable the Caruth Project to

more precisely identify and target people who meet established state criteria for ACT or FACT

services. In addition to the state’s definition of Level of Care 4 criteria, which qualifies a person

for ACT or FACT, the dashboard allows the program to identify candidates for ACT and FACT

based on a detailed analysis of utilization patterns, diagnoses, and social determinants of

health. The objective of this process is to assign candidates to the most appropriate treatment

level.

The real-time live feed from THR, Parkland, Methodist Health System, and Baylor Scott & White

Health is being augmented with two years of historical patient data made available by contract

with the Dallas-Fort Worth Hospital Council. This hospital data set and mental health encounter

data from NTBHA form the basis for the electronic staff notifications that were deployed at THR

and Parkland emergency departments in April 2018.

In addition to the state’s definition of Level of Care 4 (LOC 4) criteria, which qualifies a person

for ACT or FACT services, the Loopback dashboard allows the program to identify appropriate

treatment levels for candidates – including ACT or FACT services – based on a detailed analysis

of utilization patterns, diagnoses, and social determinants of health. With THR, Parkland,

Methodist Health System, Baylor Scott & White Health, Dallas County, and NTBHA data feeds

fully integrated into the platform, Loopback created electronic data feeds to participating

emergency departments for nearly 107,000 encounters in April and May 2019, resulting in

nearly 4,000 notifications related to the Smart Justice target population. This identification and

linkage to transitional services helps to reduce the need for more restrictive and expensive

levels of care.

The Loopback system has also enhanced collaboration among hospital emergency departments,

NTBHA Care Coordinators, and community providers. People currently enrolled in ACT and

FACT are a priority population, and NTBHA has ensured that providers respond quickly when

one of its clients presents in the emergency department. NTBHA also uses notifications to

activate transitional services and to rapidly develop a community release plan. Beginning June

17, 2019, Metrocare began receiving notifications from Loopback that further help encourage

rapid release of clients from emergency departments to community-based services. All six of

Metrocare’s LOC 4 teams, including two Caruth teams, receive these notifications when one of

their clients enters an emergency department within the Loopback platform. Metrocare can


then act more quickly in helping their clients re-engage with their services and transport them

to an appropriate step-down program (or step up to an inpatient facility or crisis respite facility

if that is most appropriate).

Our analysis of the shared data feeds indicates that this type of information sharing may be

valuable and sustainable beyond our Caruth Project efforts. Loopback has the ability to

demonstrate how near-real-time health information can depict patterns that can help the crisis

system identify where there are gaps in the continuum of care, how multiple medication

prescriptions contribute to clients being trapped in cycles of frequent utilization of different

emergency departments, and how contact with an ACT or FACT team can significantly reduce a

person’s number of emergency department visits. The data sharing platform has the capability

to predict trends in the Dallas Metroplex’s crisis system. This platform can serve as a model for

all local crisis and treatment providers. We look forward to further developing this analytic

capacity in the future.

Dallas County Behavioral Health Housing Work Group Dallas County Administration, 411 Elm Street, 1st Floor, Dallas Texas 75202

August 29th, 2019 Minutes

Mission Statement: The Dallas County BH Housing Work Group, with diverse representation, will formulate recommendations on the creation of housing and housing related support services designed to safely divert members of

special populations in crisis away from frequent utilization of expensive and sometimes unnecessary inpatient stays, emergency department visits and incarceration.

Success will be measured in placement of consumers in housing and the decreased utilization of higher levels of care

(hospitals and emergency care visits) and reduced incarceration in the Dallas County Jail. The Dallas County BH Housing Work Group is committed to a data driven decision-making process with a focus on data supported outcomes.

ATTENDEES: Dr. Theresa Daniel, Commissioner; , Robert Costello, Dallas County; Doug Denton, Homeward Bound; Edd Eason, City Square; Laura Edmunds, DCCJ; Carl Falconer, MDHA; Jola Giwa, NTBHA; Jennifer Jaynes, The Cottages; Tzeggabrhan Kidane, Dallas County; Thomas Lewis, Dallas County; Candice Linnex, Dallas County; Traswell Livingston III, AIDS Services of Dallas; Elizzabeth Loomis, City of Dallas; Ellen Magnis, Family Gateway; Eric McCarty, NTBHA; Charlene Randolph, DCCJ; Keri Stitt, Promise House; Ron Stretcher, MMHPI; Wyndll Robertson, Dallas County; Joyce White, Dallas County; David Woody, The Bridge CALL TO ORDER: Minutes approved with no changes. GOVERNANCE Dallas Area Partnership to End and Prevent Homelessness: Dr. Theresa Daniel, Commissioner Commissioner Daniel commented on the meeting held Tuesday, August 27th in the Allen Clemson Courtroom. She reported the partnership is continuing its forward momentum and organizing its resources. Dallas County Citizen Committee: Dr. Theresa Daniel, Commissioner Commissioner Daniel mentioned the committee is moving forward with a comprehensive directory of resources. Federal and State Legislative Update: Ellen Magnis, Family Gateway Ms. Ellen Magnis reported on the status of a proposed rule put forward for public comment by HUD on mixed status families. Under previous presidential administrations, federal funds were available for use to provide housing for mixed status families. Under the proposed rule, if any member of a family is undocumented, federal funds may not be used to house them. Any members of mixed families currently housed, would be evicted upon the rule going into effect. PRESENTATION D-One Strategic Plan: Carl Falconer, MDHA The presentation covered a plan of collaboration between multiple entities, organizations and persons to effectively end homelessness in Dallas and Collin Counties while becoming the top performing Housing and Urban Development Continuum of Care in the country. Mr. Falconer noted the Veteran’s Challenge carried out by MDHA in which 115 homeless veterans were placed into permanent housing in 100 days. Another 15 veterans have vouchers and are waiting on inspections before being housed. DEVELOPMENT ACTIVITIES Crisis Residential and Respite Services: No report.

RESOURCES Shelter Discussions: Elizzabeth Loomis, City of Dallas Ms. Loomis reported the Inclement Weather Shelter program would be presented at the next Zoning Ordinance Advisory Committee (ZOAC) meeting on September 19th, 2019. The current planning department will propose amendments to Chapter 51A Dallas City Code. There may be an additional ZOAC meeting prior to going before the City Council. The program will hopefully launch in time for 2020’s winter weather. Mr. Falconer announced the annual PIT Count will take place on Thursday, January 23rd, 2020. North Texas Behavioral Health Authority (NTBHA): Eric McCarty; NTBHA Housing Department Mr. McCarty reported delays in the Tenant Based Rental Assistance (TBRA) waitlist due to processing and lack of available funding. There are currently 170 individuals who are waitlisted. There is $1,070, 483.98 in reserve. Within Dallas County, the general funds can be used in four cities: Addison, DeSoto, Richardson, and Rowlett. Rowlett placement has been successful with three families having moved in. FUSE Grant: Edd Eason, City Square Mr. Eason reported the United Way is still seeking alternative funding in order to fully fund the project beyond the grant. A meeting was held with a potential donor with Mr. Eason voicing hope about sustainability of funding. The total funds required for the project are $750,000. Partners are willing to fund half and the United Way is willing to put in $100,000. There remains to be found $250,000 annually for a minimum of three years to continue the project. PROJECTS AND INDUSTRY UPDATES CAS Coordinated Access System (CAS): Carl Falconer, MDHA Mr. Falconer offered a brief report on merging the Coordinated Access System with their Homeless Management Information System in order to streamline the process. Homeless Jail Dashboard: Joyce White, DCCJ Ms. White highlighted that the month of July has seen a 50% increase in book-ins of homeless individuals with suspected mental health. There was an overall increase in total book-ins of 488 individuals and homeless book-ins of 164 individuals. One explanation for the increase was the increased Department of Public Safety presence in the southern sector of the county. Pretrial Diversion and MH Screening: Laura Edmunds, DCCJ Ms. Edmunds reported the county is working with the District Attorney’s mental health division in which they are creating a misdemeanor mental health docket. The goal is to dismiss many of these cases and steer these individuals toward the appropriate services. The Cottages: Jennifer Jaynes, The Cottages Ms. Jaynes reported there are currently 41 residents. An additional unit, previously occupied by MetroCare, is now opened for other individuals. Their three-year pilot is ending, bringing about some changes in January, 2020. These will be mostly program changes but the details are still being worked on. Mental health America released their Prism Award Recipients with The Cottages receiving a special recognition. St. Jude’s: Joyce White, DCCJ Ms. White reported that along with their original location, St. Jude was looking to open two additional sites. There are currently 12 of 13 units occupied. One individual abandoned their unit in July due to rent requirements. Dallas County is currently seeking referrals in order to fill the 13th unit. Homeward Bound: Doug Denton, Homeward Bound Mr. Denton stated NTBHA contracts are currently in bid process and awards will be announced September 14th at their board meeting. Additionally, they are rebidding their criminal justice diversion specialty court contracts.

Youth Housing: Kerri Stitt, Promise House Ms. Stitt reported on a recently submitted by the Youth Committee to A Way Home America to participate in their grand challenge which aims to address homelessness among youth of color and LGBTQ youth. They have been announced as a finalist for that challenge. Next week word should be received about the HUD Youth Homeless Demonstration Program which would mean a substantial amount of money awarded to the Youth Continuum. Ms. Ellen Magnis reported that Family Gateway is at capacity with 32 families in shelters, 20 families in hotels and 20 families at Dallas Life. As a solution to free up more capacity, they will be relocating their call center, assessment team, housing team and administrative team out of the shelter. They will also be building out 6000 square feet within Catholic Charities. Non-shelter focused services will be housed in a Family Gateway Resource Center. CitySquare and Family Gateway were awarded funding from the city which will allow them to move 50 families and 25 individuals out of shelters and into rapid rehousing. Additionally, they are applying for various grants and other monies from previously overlooked resources. Announcements: The Dallas Connector Project will be ready to launch in next 30 days. A 25-passenger bus has been ordered and interviews are being conducted for a driver. With the bus and a 15-passenger shuttle, the goal is to provide 35,000 rides per year to a minimum of 1,350 homeless individuals in and around the central business district at no charge to them. This will provide them access to the workforce center (jobs), necessary documents and eliminate the need to hand out numerous bus passes. A schedule, in both English and Spanish, will be posted at various places around the city. Mr. Edd Eason announced that Texas Health Resources (Presbyterian Healthcare System) has recently made it known they are willing to fund a medical respite program for the homeless. The when and how of resource allocation has yet to be decided but a workgroup of made up of Texas Health Resources, CitySquare and Austin Street has been tasked with moving this forward. Mr. Traswell Livingston III spoke on the Paris Declaration signed by Judge Clay Jenkins, Mayor of Highland Park, and Mayor of DeSoto which is an agreement of more than 300 cities, across many nations. Through education, engagement and viral suppression, the goal of the agreement is to end the AIDS epidemic by the year 2030. He also announced that The Gateway Program has been officially awarded and in the Fall there will be a formal groundbreaking on construction of a 16-unit, graduate model, affordable housing project to enable LGBTQ or HIV positive individuals to move on from homelessness.

Next Meeting: September 25th, 2019

Dallas County Administration Building, 411 Elm Street, 1st Floor, Allen Clemson Courtroom

RESOLUTION

DALLAS COUNTY BEHAVIORAL HEALTH LEADERSHIP TEAM

RESOLUTION NO: 06-2019

DATE: September 12, 2019

STATE OF TEXAS }

COUNTY OF DALLAS }

BE IT REMEMBERED at a regular meeting of the Dallas County Behavioral Health Leadership Team held on the

12th day of September 2019,the following Resolution was adopted:

WHEREAS, on February 14, 2013 the Dallas County Behavioral Health Leadership Team endorsed the 1115 Healthcare Transformation Waiver DSRIP Project, and development of Behavioral Health Crisis Stabilization Services as alternatives to hospitalization; and

WHEREAS, the Dallas County Behavioral Health Leadership Team is the governing body for the

DSRIP project through a standing committee known as the Crisis Services Project (CSP) Governance Committee; and

WHEREAS, the Crisis Services Project currently utilizes Adapt Community Solutions to provide

behavioral health triage, assessment, and treatment linkage in the jail, along with Transicare, Inc. to provide intensive community based services for offenders with mental illness; and

WHEREAS, Adapt Community Solutions and Transicare, Inc. are core CSP providers tied to both of the

CSP 1115 Waiver metrics; and WHEREAS, both of their service contracts are set to expire on September 30, 2019; and WHEREAS, the Crisis Services Project is looking for the Behavioral Health Leadership Team to

endorse the extension of the Adapt community Solutions contract and the Transicare, Inc. until September 30, 2020 in order to maintain core CSP operations.

IT IS THEREFORE RESOLVED that the Dallas County Behavioral Health Leadership Team endorses the contract to continue contract services through Adapt Community Solutions and Transicare, Inc. for an additional one-year term and funded out of the Crisis Services Project, 1115 Healthcare Transformation Waiver.

DONE IN OPEN MEETING this the 12

th day of September, 2019.

________________________ ________________________ Dr. Theresa Daniel J.J. Koch Commissioner District #1 Commissioner District #2 Dallas County Dallas County ________________________ John Wiley Price Commissioner District #3 Dallas County

DY8 CSP Monthly Report_No Graphs(with LCN)Frank Crowley

Last Refresh: 8/8/19 at 1:46:50 PM GMT-05:00

CrisisServicesProject

2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 Average: Sum:

Service Episodes: 338 285 317 333 336 365 416 406 370 421 358.7 3,587

Unique Consumers: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 Average: Sum:

By N* ID 160 155 144 111 137 134 133 150 117 126 136.7 1,367

By LCN 150 118 111 118 86 101 124 96 104 128 113.6 1,136

By Client ID 124 92 88 105 111 108 124 140 107 119 111.8 1,118

TOTAL Unique Consumers: 434 365 343 334 334 343 381 386 328 373 362.1 3,621

TOTAL Unique Consumers as %:128.40% 128.07% 108.20% 100.30% 99.40% 93.97% 91.59% 95.07% 88.65% 88.60%

Unique F2F: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 Average: Sum:

By N* ID 117 101 93 86 110 70 79 98 93 86 93.3 933

By LCN 106 84 69 90 66 58 84 62 73 89 78.1 781

By Client ID 87 84 69 88 84 79 99 120 85 82 87.7 877

TOTAL Unique F2F: 310 269 231 264 260 207 262 280 251 257 235.55 2,591

TOTAL Unique F2F as %: 118.32% 110.25% 93.52% 88.29% 90.59% 85.54% 87.92% 87.50% 83.67% 79.81%

-1--1 2018-10 2018-11 2018-12 Average: Sum:

F2F Percentages: 77.51% 85.61% 77.92% 80.35% 241.05%

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Encounters by Type: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 Average: Sum:

Triage 338 285 317 333 336 365 416 406 370 421 358.7 3,587

Care Coordination 2,117 2,199 1,996 1,834 1,685 1,752 2,276 2,293 1,801 2,197 2,015 20,150

F2F Encounter 262 244 247 299 287 242 298 320 300 322 282.1 2,821

TOTAL Encounters: 2,717 2,728 2,560 2,466 2,308 2,359 2,990 3,019 2,471 2,940 2,655.8 26,558

Female: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 Average: Sum:

Black 45 38 40 41 41 43 31 57 69 54 45.9 459

White 38 29 34 23 23 34 48 29 14 36 30.8 308

Hispanic 9 10 7 9 14 14 12 10 11 6 10.2 102

Other 1 2 1 1.33 4

Unknown 5 11 1 5 1 1 1 3.57 25

TOTAL Female: 97 89 84 78 79 92 91 97 94 97 89.8 898

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Age of Triage Encounters: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 Average: Sum:

Adult 424 355 340 332 328 340 379 376 323 369 356.6 3,566

Minor 9 10 2 2 5 3 2 10 4 4 5.1 51

Uncollected 1 1 1 1 1 4

TOTAL Age of Triage Encounters: 434 365 343 334 334 343 381 386 328 373 362.1 3,621

Age of F2F Encounters: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 Average: Sum:

Adult 306 262 230 263 257 204 260 273 248 255 255.8 2,558

Minor 4 7 1 1 3 3 2 7 3 2 3.3 33

TOTAL Age of F2F Encounters: 310 269 231 264 260 207 262 280 251 257 259.1 2,591

Male: 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 Average: Sum:

Black 194 163 152 140 146 137 166 181 127 152 155.8 1,558

White 76 76 61 70 73 71 72 64 53 73 68.9 689

Hispanic 40 30 40 34 34 36 46 37 48 45 39 390

Other 2 1 7 3 4 5 2 5 3.63 29

Unknown 25 5 6 5 2 2 2 2 4 5.89 53

TOTAL Male: 337 275 259 256 255 249 290 289 234 275 271.9 2,719

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F2F Recidivism Summary for 01/01/2019 to 07/31/2019

QPI_DY8 Multi-version Recidivism - New


Triage 12 w/F2F 1,427

Recidivism 12-12 w/F2F 305

Recidivism 12-12 w/F2F Percentage 21.37%

Month Name January February March April May June July

Year MO 2019/01 2019/02 2019/03 2019/04 2019/05 2019/06 2019/07

Triage w/F2F:

Triage 12 w/F2F 216 421 600 828 1,045 1,233 1,427

Recidivism 12-12 5 23 61 101 166 218 305

Recidivism 12-12% 2.31% 5.46% 10.17% 12.20% 15.89% 17.68% 21.37%

PAP:

Count of PAP 308 619 848 1,117 1,404 1,693 1,962

PAP Recidivism 8 27 69 111 163 215 287

PAP Recidivism% 2.60% 4.36% 8.14% 9.94% 11.61% 12.70% 14.63%

Total:

Count of F2F & PAP 524 1,040 1,448 1,945 2,449 2,926 3,389

Recidivism F2F& PAP 13 50 130 212 329 433 592

Recidivism% 2.48% 4.81% 8.98% 10.90% 13.43% 14.80% 17.47%

Bookins 12 w/PAP 1,962

Recidivism 12-12 w/PAP 287

Recidivism 12-12 w/PAP Percentage 14.63%

Total F2F and PAP 3,389

Recidivistic Individuals 592

Recidivism Percentage 17.47%

2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2019-06 2019-07 TOTALBeginning Census 117 121 114 98 102 109 118 128 127 132

Referrals 19 21 6 29 29 32 47 38 28 43 292

AdmissionsReferred Admitted 7 0 0 0 11 8 13 17 12 8 76

No Admit Client Refusal 1 0 0 0 0 0 2 1 1 2 7No Admit Criteria 1 0 0 0 0 0 1 0 0 0 2

No Admit Structural 0 0 0 1 0 0 5 1 1 3 11Pending 10 21 6 28 18 24 26 19 14 30 196

Prior PendingPending Admitted 20 9 4 6 3 10 10 5 8 9 84

No Admit Client Refusal 1 1 0 0 1 1 1 3 1 1 10No Admit Criteria 1 0 0 0 1 0 0 0 1 0 3

No Admit Structural 7 2 13 12 5 6 13 15 13 14 100

Total Admissions 27 9 4 6 14 18 23 22 20 17 160

DischargesSuccess Transfer 5 4 3 1 1 0 3 5 2 4 28

DC Midterm Disengage 4 7 12 3 5 6 4 8 4 10 63DC Rapid Disengage 6 3 2 0 0 0 2 3 4 3 23

DC Structural 8 2 3 0 1 3 4 7 5 2 35Total Discharged 23 16 20 2 7 9 13 23 15 19 147

Active End Of Month 121 114 98 102 109 118 128 127 132 130

Outcome DataTerrell State Hospital Linkages

≤7 Connect To Prescriber 4 9 7 10 3 3 7 6 5 5 59Missed ≤7 Day Connect 3 1 0 0 1 2 0 2 0 2 11

≤30 Connect To Prescriber 6 9 7 10 3 3 7 6 5 5 61Missed ≤30 Day Connect 1 1 0 0 1 2 0 2 0 2 9

Total Missed Metric 1 1 0 0 1 2 0 2 0 2 9Total Released 7 9 7 10 4 5 7 8 5 7 69

Transicare Reporting Crisis Services Project

Cummulative ≤7 Connect % 57.1% 81.3% 87.0% 90.9% 89.2% 85.7% 87.8% 86.0% 87.1% 85.5% 85.5%Cummulative ≤30 Connect % 85.7% 93.8% 95.7% 97.0% 94.6% 90.5% 91.8% 89.5% 90.3% 88.4% 88.4%

Missed Metric 14.3% 12.5% 8.7% 6.1% 8.1% 11.9% 10.2% 12.3% 11.3% 13.0% 13.0%Unduplicated Served

Monthly Unduplicated 141 95 83 108 103 127 125 118 133 117DSRIP YTD Unduplicated Served 142 146 148 173 195 225 248 298 323 336

Encounter DataF2F Encounter 757 698 554 768 725 744 775 620 526 517 6684

Care Coord 44 19 31 40 42 47 54 31 22 11 341Total 801 717 585 808 767 791 829 651 548 528 7025

Forensic Diversion Unit (FDU) ReportJan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19

Beginning Census: 28 20 24 24 17 18

Number of Referrals Received from CSP:

Adapt 0 4 4 2 3 3

Metrocare 1 1 0 0 1 0

District Attorney's Office 0 0 0 1 0 0

Public Defender's Office 4 3 6 2 2 1

Number not accepted due to:

Qualified for another LOC 0 0 3 0 1 1

Did not meet LOC required 1 1 1 1 1 0

Other 0 0 1 0 0 1

Number of Admissions: 4 4 4 0 3 2

Service Utilization:

Total Face to Face 137.4 135.2 209.7 193 153 140.82

Total Engagement/Service Coordination 16.58 25.83 34.83 34.52 29.4 27.92

Number of Higher Level of Care Episodes:

Emergency Room (medical) 1 4 3 2 0 0

23-hour observation (psych) 0 2 0 1 0 1

Inpatient (med/psych) 0 1 0 0 0 0

Jail Book-in 0 3 1 2 3 2

Number Discharged: 10 3 5 11 2 3

Reasons for Discharge:

Graduate 1 0 0 1 1 1

Client Disengagement 7 1 2 3 0 1

Extended Jail Stay (case-bycase basis) 2 1 0 6 1

Other 0 1 3 1 0 1

End of Month Stats:

# of Clients waiting to be Released from Jail 4 4 3 3 1 1

# of Active FDU Clients 18 20 21 14 18 16

Total 22 24 24 17 19 17

Maximum Census 33 33 25 25 25 25 25 25 25 25 25

Department of Criminal Justice

FY2019 SAMHSA Grant Project

Dec Jan Feb Mar Apr May June July Aug Sept Pending

FY2019

Total

2 0 1 2 0 2 1 7 6 5 21

8 5 2 13 0 5 6.5 10 13 7

0 2 1 3 1 0 1 1 1 1 10

0 4 20 5 7 0 8 10 1 7

0 0 2 2 2 5 2 1 2 16

0 0 0 0 0 0 0 1 3 4

1

10

11

Active in Peer Recovery Services 0

1

2

0

0

3

6 DWI Misd/Felony 0 3

Number of Referrals by 1 0 Veterans 0

0 Legacy Family 6 0

1 MHJD/SET 5

11 4

Unsuccessful Completions

Nexus New Female Admissions

Nexus Average Days in Jail from Referral to

Admission

Homeward Bound New Male Admissions

Homeward Bound Average Days in Jail from Referral to

Admission

Successful Completions

REFERRING SPECIALTY COURTS

In Jail (Bond Violation)

In Jail (Parole Violation)

Specialty Courts

MONTHLY SNAPSHOT OF PROGRAM REFRRALS (after treatment per grant year)

Graduated Court Program

AIM

ATLAS

DDC

Competency

DIVERT

IIP

4-C

STAR

STAC

Active In Court Program

In Jail (New Charge)

TDCJ or State Jail

Active In Inpatient Treatment

Active Warrant (Absconded)

Dallas County Behavioral Health Leadership Team Thursday ......Welcome and Call to Order ... Gia...

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