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Item C37 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: May 20. 2009 Bulk Item: Yes r8J No D Division: Budget and Finance Department: Grants Administration AGENDA ITEM WORDING: Approval of submission of final program report for contract with the State of Florida Department of Children and Families for the Criminal Justice, Mental Health, and Substance Abuse Reinvestment Grant as required by DCF. ITEM BACKGROUND: This was a planning grant to develop a strategic plan and apply for an implementation grant to establish a program which will provide an alternative to detention for offenders who are mentally ill and have substance abuse problems. Monroe County developed the required strategic plan document and has completed the scope of work. The final program report, with the Strategic Plan is attached. PREVIOUS RELEVANT BOCC ACTION: Approval to apply for grant funds and creation of Planning Council at August 2007 meeting. CONTRACT/AGREEMENT CHANGES: NA STAFF RECOMMENDATION: Approval TOTAL COST: $ 185.136.00 (grant amount) BUDGETED: Yes r8J No D (in-kind) COST TO COUNTY: $92.568.00 (in kind match) REVENUE PRODUCING: Yes D No r8J AMOUNT PER MONTH YEAR APPROVED BY:COUNTY ATTY D OMB/PURCHASING D RISK MGT D DOCUMENTATION: INCLUDED: r8J TO FOLLOW: D NOT REQUIRED: D DISPOSITION: AGENDA ITEM #: Monroe County Criminal Justice. Mental Health. & Substance Abuse Reinvestment Act - Plannina Grant Final Report ReportinQ Period: April 10. 2008 throuQh April 9. 2009 Section 1. Contact Information This report was completed by Clare S. Shaw, MA. Contact Information: Clare S. Shaw, MA Criminal Justice, Mental Health & Substance Abuse Diversion Project Director Monroe County Sheriff's Office 5501 College Road Key West, FL 33040 Telephone: (305) 293-7422 FAX (305)293-7353 cshaw@keysso.net Section 2. Detailed Progress Summary Proiect Specific Performance Measures Objective Outcome Measure Status Establish on-going communication, 1. Develop formal Memoranda of Completed collaboration, and partnerships among Understanding, including January all the relevant partners by increasing partnerships about the exchange of 2009 the number of partnerships formed information and data related to the among municipal, county, mental target population. health, substance abuse and other entities to identify, divert, and treat adults and/or juveniles who have a mental illness, substance abuse or co- occurrina disorders Have in place a strategic plan for 2. Submit a completed Strategic Completed systemic change in order to identify, Plan. April 2009 divert, and treat adults and/ or juveniles who have a mental illness, substance abuse disorder, or co-occurring disorders, and who are in, or at risk of entering the criminal and/or juvenile iustice systems 1 Program Specific Performance Measures Objective Outcome Measure Status Sustain the Criminal Justice, Mental 3. Maintain current roster of members Due to the Health, and Substance Abuse Council for the Council and Committees. shortened and the four associated Committees 4. Schedule at least 12 Council and period - 9 24 Committee* meetings annually. monthly *(Committees discontinued - replaced meetings by specifically scheduled workgroups) occurred Conduct Needs and Resource 5. Review and select the Needs and Completed Assessment Resource Assessment - Adults 6. Administer the Needs and January Resource Assessment 2009 - Juveniles February 2009 Identify a Target Population 7. Select a target population that is Completed consistent with the findings from the March 2009 Needs and Resource Assessment. Support and Sustain the Initiative 8. Maintain communication, See collaborations, and partnerships with Comments County agencies below Comments: Originally, Counties receiving Planning Grants anticipated receiving Implementation Grants to move forward on the work completed in the Planning Process. Unfortunately the Florida Legislature did not include funding for this purpose. The Monroe County Sheriff's Office has continued to support the position while applying for funding from multiple sources in order to continue the work initiated by the Planning Grant. It is not clear how long the Sheriff's Office will be able to carry this position. A. Per HB 1477, the Monroe County Criminal Justice, Mental Health, & Substance Abuse Diversion Planning Council, the agencies / representatives required to participate are as follows: State Attorney - C. Vogel Public Defender - R. Enright Circuit Judge - D. Audlin County Judge - W. Miller Chief Corrections Officer - T. Taylor County Sheriff - R. Roth Key West Police Department - D. Lee State Probation - P. Burns Local Court Administrator - E York Monroe County Commissioner - M. DeGennaro County Probation - R. Valdivia Director of a Substance Abuse Program - J. Brancel Director of a Mental Health Program - J. Pipher DCF Substance Abuse/Mental Health Department Representative - J. Laino 2 DCF designated Mental Health Consumer Representative - R. Feinberg DCF designated Substance Abuse Consumer Representative - B. Noack DCF designated Consumer Family Member - S. Read Supportive Housing Representative - E. Leto Homeless Provider - W. Coles DJJ Chief Probation Officer - R. Avael DJJ Detention Director - L. Tynes · In addition, the at the recommendation of the Council, the Monroe County Board of County Commissioners also appointed to the Council membership, a representative from the Lower Keys, Middle Keys, and Upper Keys. Lower Keys - J. Drewing (Heron-Peacock) Middle Keys - B. Gottschalk (NAMI) Upper Keys - B. Clark (Care Center) · In addition to the stakeholders required to participate on the Council, Monroe County has additional stakeholders and individuals that volunteer to participate in the planning process. 12 Step Community - 1. Healey Legal Consultants - D. Wells, J. Gedmin Juvenile Justice - K. Kirkland Teen Court - Karol Cotton MC Social Services - D. Barsell DCF - E. Herrera Westcare Foundation (Nt!. Behavioral Health Services) - F. Rabbito Guidance Clinic of the Middle Keys - S. Furey GCMK Performance Growth Center - L. Marciniak DePoo Hospital - C. Baugh Catholic Charities - M. Zurek Health Management Consultation - G. Becker AIDS Help - P. Sanders MCSO - 1. Snider, L. Knowles Monroe County - L. Tennyson Community Member assisting with Sustainability Planning - J. Taylor Volunteers of America - P. Lindsay Westcare Grants Dept. - P. Goldberg Eleventh Judicial Circuit Court Diversion Program - C. Schwartz State Consultant on the Baker Act - M. Lenderman FL Technical Assistance Center / USF-FMHI - M. Engelhardt FL Technical Assistance Center / USF-FMHI - N. Springer FL Technical Assistance Center / USF-FMHI - J. Petrila FL Partners in Crisis - M. Saunders Data Collection: J. Painter - MCSO P. Phelps - MCSO K. Reams - KWPD L. Waite, L Barnette - Pre-Trial Services S. Reams - State Attorney Office 3 S. Pearce - Public Defenders Office N. Banks - Florida Keys Outreach Coalition D. Genners - Guidance Clinic of the Middle Keys and Care Center S. Pridgen - AIDS Help J. Muir Isherwood - Drug Court A. McKeever - JIP Program J. Cruz - Samuel's House W. Lalemont - SHAL C. Condra - Heron-Peacock (USFF) · In addition to the individuals identified above, there are staff from various agencies or organizations, who participate on a limited "as needed" basis. · The Council has experienced difficulty in getting some representatives to attend the monthly meetings, due to conflicts with employment schedules. The majority of meetings are held in Key West, in the Lower Keys, to enable greater participation by the majority of members and stake holders. However, focus groups, educational presentations and individual meetings with Council members, stakeholders and consumers are held in the Middle and Upper Keys as well. B. Planning Council meetings were held on a monthly basis. Due to the difficulties of distance and time commitment, the Council is not utilizing committees, but instead, has defined areas of focus. · The Project Director then meets with the stakeholders involved in these areas, and then reports back to the Council. These areas include: Needs and Resources Assessment Evidenced Based Practices Review Data Collection and Communication Supported Housing and Employment Sustainability · The original Committees - Grant Writing, Budget, Matching Funds, Personnel, and Community Commitment to Collaboration, were discontinued, once the Grant was awarded, and the Project Director was employed - April 1 0, 2008 and July 7, 2008. · The Public Relations Committee usually meets following the regular Council meeting on an as needed basis. The primary areas of responsibility for the Public Relations Committee are as follows: 1. Identifying and meeting with Key Persons relating to the Criminal Justice Diversion Process in Monroe County to promote and understanding andco- operation with the Criminal Justice Diversion Project. This includes but is not limited to: Politicians; County Commissioners; Community Leaders; Grant Managers. 2. Develop a Public Relations / Educational Program oriented towards increasing public understanding of the problem, that will be delivered to business groups and neighborhood organizations, and would include the development of materials; public speaking; and use of the media. 4 The Planning Council had anticipated having a year from the date of hiring a director to complete the objectives of the Project. However, this was a misunderstanding. The Project Director was employed on July 7,2008. The Project end date was April 9, 2008. This left us only 9 months to complete the Project goals. The major goals of the Project were completed, including the completion and approval of a Strategic Plan (which is attached.) The area which was unable to be addressed included the PR / Educational program which the Council had hoped to complete. An interview with the local newspaper was conducted immediately prior to the end of the grant, with a publication occurring two weeks following the grant. Also, the Project Director regularly participated in Community Alliance meetings, the Juvenile Justice Board Meetings, the Southernmost Homeless Assistance Coalition, and the Monroe County Substance Abuse and Mental Health Planning Council meetings, to report on the Criminal Justice Diversion Project. In addition, throughout the grant period, the Chairperson and Vice Chairperson of the Criminal Justice, Mental Health & Substance Abuse Planning Council spoke at various meetings they attended in the community, updating the groups on the Criminal Justice Diversion Project. C. The project focused on a comprehensive assessment of needs involving numerous agencies, consumers and family members throughout the Keys. Needs Assessment surveys were sent to 150 individuals throughout the County, representing stakeholders, consumers, community members, family service organizations, criminal justice, law enforcement, schools, and business representatives. From this, a summary was submitted to the CJMHSAD Planning Council for consideration. Based upon this survey, and their own experiences, the Council utilized this information for recommendations for specific areas of system and services development for both adult and juvenile diversion services. As a result of the planning efforts, the CJMHSAD Planning Council determined that inmates with a history of severely and persistently mentally illness and frequent incarcerations, would be the identified target population for immediate services development and implementation. The Council provided Diversion recommendations for a number of services for both Adults and Juveniles, but a priority was place on this target population. In addition to the needs assessment data, a number of studies and cost analyses were conducted within the Monroe County Detention Center, and the Key West Police Department, Pre-Trial Services, the State Attorney's Office, to assess the costs of current services related to individuals with Mental Illness or Co-Occurring Disorders, who would be appropriate for jail diversion services. The Project also conducted surveys with the local Homeless providers and Substance Abuse and Mental Health treatment providers to further identify the populations most in need of jail diversion, and well as the needs of the clients within their programs. Finally, a Housing Study was completed to look at the potential and related issues Housing for the Mentally III within Monroe County. D. As the needs for various services have been identified, related sources of funding are identified. Persons participating in the Sustainability Work Group have focused on identifying and pursuing funding opportunities in both the public and private sectors. As indicated previously, Monroe County had expected the assistance of State funding through an Implementation Grant, to support forward movement of this initiative. The 5 Sheriff's Office has applied for grants through the Bureau of Justice Assistance, and the Edward Byrne Memorial Justice Assistance Grant for local solicitation. A grant is Currently being developed for submission to SAMHSA. E. As indicated previously, the main barrier has been in obtaining the maximum involvement of Council membership. This is primarily due to the fact that in a small community where the Leadership of Community agencies and organizations are called upon to participate in so many roles, initiatives, and functions, in addition to directing the internal activities of their own organizations, there is very little time available to devote to external commitments. The main approach used thus far, has been for the Project Director to go to the agencies, and stakeholders, rather than request them to come to group meetings. F. The Monroe County Project has not been in a position to leverage additional funds beyond matching funds requirements. Section 3. Technical Assistance (if applicable) The Monroe County Criminal Justice, Mental Health, & Substance Abuse Diversion Planning Council has greatly benefited from Florida Mental Health Institute's Technical Assistance Center. Immediately upon hearing that Monroe County had received a Reinvestment Act Planning Grant, the Planning Council contacted the FL TAC staff and requested the Sequential Intercept - Cross System Mapping Training to give us direction and guidance in proceeding with our strategic planning. The FL TAC came to Monroe and conducted the 2-day training, and subsequently provided us with an Action Plan for Monroe County. (See the Monroe County Action Plan Priorities, and our Project Timeline attached to this report.) The Project has used this plan as a guide to proceed in our planning process. In addition, the FL TAC has been very responsive to any request for information or recommendations. Finally, the FL TAC has agreed to provide trainings/consultations, which were recommended by the Action Plan. Three of these trainings/consultations were conducted throughout the course of the grant. They include a Data Collection Training; A HIPAA Training; and a Supportive Housing: Principles, Practices, Models: Recovery-oriented Partnerships, Housing First and Other Models of Housing for Persons with Mental Illness. These trainings were of tremendous benefit to Monroe County because distance and expense frequently prohibit stakeholders from being able to travel to Miami and other locations where trainings are routinely provided. This partnership has not only been extremely successful but also supportive and motivating to Monroe County. 6 'i: ~c:9:1 ~.~~ ""C c.. 0 cE- alcaE Ja<':>2~ al~.eE ,~ CD CO E J:O=Ce. o 00- Q) e..!.!"8 E. c me .2: c. <( c:: .0 U D<( 0.0:= <( I: 00 OJ" ! c~Ii~.8 co ::J ~ i oS ..! ii: iiJ ~ :E.; 8 c o ;:;- . (,) <( <( I .r:. (,) ... co :E I co ~ ... .c Q) LL I co ~ c co .., sejlJI 1 oe ~ ~ I ~~, ,~~- j ~ -~8>.e ~e I~ ~ ~ i i" i ,; Ji .5 Ii ~ .~ '~ j ~. ! 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E 0..0 Eu Monroe County Criminal Justice, Mental Health & Substance Abuse Diversion Planning Council Monroe County Strategic Plan Submitted in compliance with the Florida Department of Children and Family Services - Criminal Justice, Mental Health & Substance Abuse Reinvestment Grant Program April 9, 2009 Table of Contents Narrative Sections A - E A. Statement of the Problem... ............ ..... ......... ... ......... ...1 B. Regional Partnership Strategic Planning Process................8 C. Vision / Mission Statement...................................... ..10 D. Values / Principles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..1 0 E. Conceptual ModeL... ... ...... ......... ............. ........... .....11 F . Strategic Goals. . .. . . . . . .. . . . . . . .. .. . . .. . .. . .. . . . .. .. . .. .. . . . . . . . . . . . 13 Summary.......... ............... ......... ...... .............. ..... ....... .......22 For More Information Contact. ................... ...... ... ...... ... ..........23 A. Statement of the Problem / Critical Issues faciru!: the County: Current estimates suggest that as many as 700,000 adults entering jails each year have active symptoms of mental illness and three-quarters of these individuals meet criteria for a co- occurring addictive disorder (Gains, 2001). Almost all jail inmates with co-occurring mental illness and substance use disorders will leave correctional settings and return to the community. Inadequate transition planning puts people with co-occurring disorders who enter a jail, in a state of crisis back on the streets in the middle of the same crisis. The outcomes of inadequate transition planning include the compromise of public safety! and increased incidence of psychiatric symptoms, relapse to substance abuse, hospitalization, suicide, homelessness and re- arrest. Nowhere is transition planning more valuable and essential than injails. Jails have, in many parts of the country, become psychiatric crisis centers oflast resort. Many homeless people with co-occurring disorders receive behavioral health services only in jail, because they have been unable to successfully access behavioral health services in the community. Lack of connection to behavioral health services in the community may lead some people to cycle through jail dozens or even hundreds of times (Osher, Steadman, and Barr, 2002 Serious mental illness is highly correlated with substance dependency or abuse. The National Survey on Drug Use and Health found that more than 23% of adults with a serious mental disorder also have a diagnosable substance abuse disorder (CSA T 2005). The survey also found that 20% of adults with substance abuse/dependency also have a serious mental illness. Researchers project that state prisoners have lifetime prevalence of bipolar disorder 4%, major depression 19%, schizophrenia 4%, anxiety disorder 30%, Post traumatic stress disorder 12%, and dysthymia 13% (National Commission on Correctional Health Care 2002). The Bureau of Justice Statistics examined. rates of mental illness using prisoner self-reports and found that 16% of state prison inmates had an emotional illness or an overnight stay in a mental hospital or mental health facility (petersilia 2003). Nationally and locally, "criminalization of mental illness, stems in part from deinstitutionalization (depopulation of state mental hospitals), inadequate or inaccessible community mental health services, and stringent involuntary commitment criteria. (Lamb and Weinburger, 1998; Wachholz and Mullaly, 1993; Perkins et al., 1999; Teplin, 2000; Vickers, 2000). The failure to adequately finance integrated community- based systems has resulted in the growing rate of"criminalization", and has attributed. to a lack of integration of mental health and other treatment systems and deinstitutionalization (T eplin, 1991). Now large numbers of those with mental illness are involved. in the justice system by being arrested for vagrancy and other minor charges (Durhan, 1989; Grob, 1991; Shadish, 1989; Teplin, 1991). Monroe County ProfIle- Adults: Based upon a state survey conducted in 2006 by the University of South Florida - Florida Mental Health Institute - Florida Criminal Justice, Mental Health, and Substance Abuse Technical Assistance Center, the following information was identified for Monroe County. Where available, 2008 updates are provided. Social and Economic Characteristics - 2006 County Population - 79589 Unemployment - 3% Uninsured - 20% Update 2008 74737 6.2% 1 Below Poverty Level - 10.6% Demoli2niohics: Male- 53.2% Female - 46.8% African American - 5.1 % White - 96.98% Other-4.015% Hispanic - 16.87% 53.2% 46.8% 4.8% 90.7% 4.5% 15.8% Utilization of Mental Health, Substance Abuse. and / or Dual Diamosis Services within County Number of Individuals Utilizing Mental Health (MH) Services 2114 Percentages ofIndividuals Utilizing Mental Health (MH) Services 2.63 Number of Individuals Utilizing Substance Abuse (SA) Services 411 Percentages ofIndividuals Utilizing Substance Abuse (SA) Services 0.51 Number ofIndividuals Utilizing Dual Diagnosis Disorder (DD) Services 1058 Percentages of Individuals Utilizing Dual Diagnosis Disorder (DD) Services 1.31 Numbers ofIndividuals Utilizing Services for MH, SA, and/or DD Services 3583 Percentages ofIndividuals Utilizing Services for MH, SA, and/or DD Services 4.45 Number of Females Mental Health or Substance Abuse Services 1815 Percentages of Females Mental Health or Substance Abuse Services 2.25 Number of Males Mental Health or Substance Abuse Services 1767 Percentages of Males Mental Health or Substance Abuse Services 2.19 Percentages of African Americans Mental Health or Substance Abuse Services 0.21 Percentages of Whites Mental Health or Substance Abuse Services 1.69 Percentages of Others Mental Health or Substance Abuse Services 0.09 Percentages of Hispanics Mental Health or Substance Abuse Services 2.45 Number of Medicaid Enrolled Individuals Mental Health or Substance Abuse Services 3661 Percentages of Medicaid Enrolled Individuals Mental Health or Substance Abuse Services 4.45 Baker Act within County: Total Number of Baker Act Initiations Number of Individuals Number of Females Percentage of Females Number of Males Percentage of Males 405 350 166 47.43 184 52.57 Crime Data Number of Arrests in County Number ofIndividuals Arrested in County 10753 5121 Demographics of Arrestees within County Male % Female % African American % 81.43 18.28 13 .26 2 White % Other % Number of Medicaid Enrolled Individuals Percentage of Medicaid Enrolled Individuals 85.55 1.19 949 18.53 · MenmIly IU I Substance Impaired Offenders Serious mental illness is highly correlated with substance dependency or abuse. On a local level, the Monroe County Jail estimates that approximately 10% to 15% of inmates experience mental illness. In 2008, a group composed of representatives of Pre- Trial Services, Public Defender, Monroe County Detention Center Classification, Prison Health Services, Jail In-House Program, Jail Diversion and Forensic staff, and Watch Commanders, identified forty-four (44) frequent repeaters who are considered to have a Mental illness or Co-Occurring (Mental Illness and Substance Abuse) Disorders. They were incarcerated a total of 5,053 days during FY 2007- 2008 period, costing the Jail/County $372,204. 75% were male, 25% were female, and 36% were homeless. Fifty three percent (53%) were repeat offenders during the same year. This study also indicates a progression in the seriousness of the crimes committed, as their Mental Illness progressed untreated, resulting in subsequent incarceration for felony offenses. A second study reviewed inmates with the highest number of incarcerations and their charges. There were 14 inmates with histories of Mental Illness or Co-Occurring Disorders, with the number of incarcerations ranging from 5 to 11 during the FY 2007 - 2008. Eleven or 79% had 7 or more incarcerations. 86% were male, 14% female. Nine had misdemeanor charges- all for municipal ordinance violations. Five or 36% were homeless. They accounted for 2,501 days in jail, for a cost of $184,000 to Monroe County. . A third study of individuals with the charge of Trespassing (a frequent indicator of both Mental Illness and homelessness) indicated 10 individuals with a total of39 incarcerations for more than a total of 1,487 days in jail. 80% were male, 20% female. The unduplicated days of incarceration of the above three groups reviewed was a total of8,358 days during that FY, at a cost to the County of$617,860. During the 14 month period of 12/07 through 2/09, the Jail had 37 individuals booked under the Code of Signal 20 or Mental Illness. During that same period 37 inmates received 3.210's or psychiatric evaluations. The Key West Police Department reported in 2008, a total of 4,604 incidents responded to relating to the following classifications: intoxicated drivers, intoxicated persons, mentally disturbed, trespass / unwanted persons, suicide attempts/suicide completion, quality of life nuisance, city ordinance violations. These incidents required a total of3,900. hours by an average of2.5 officers, costing the City of Key West approximately $263,250. · Substance Abuse - Specific: According to data furnished by the Monroe County Sheriff's Office, from March 2008 through March 2009, there were 2,231 drug and alcohol related arrests in the Keys. The Monroe County Detention Center has an in-house 6 month substance abuse treatment program that has demonstrated the effectiveness of treatment for inmates. The recidivism rate for the overall inmate population is approximately 70% re-incarceration within 1 year. The recidivism rate for the Jail In-house Program for Substance Abuse Treatment (JIP) inmates was 20%. 3 · Homelessness: A study conducted in 2008, by the Monroe Criminal Justice, Mental Health and Substance Abuse Diversion Project of Emergency and Transitional Housing services in Key West reported that 50% to 72% of the Transitional Housing populations and 60 % of the Emergency Housing population have been arrested. In addition, the study reported that 47% to 67% of the Transitional Housing participants have received counseling for Mental Health or Substance Abuse, while only 14% of the Emergency Housing participants reported receiving counseling for Mental or Substance Abuse. According to the Florida Keys Outreach Coalition, 79% of their clients have substance abuse issues. Monroe County Profile: Juveniles According to the Florida Department of Juvenile Justice, Office of Research and Planning, the following information is reported for Monroe County. A total of297 Monroe County Youth were charged with delinquency offenses during FY 2007-08. An estimated 6,249 youth, ages 10- 17 lived in Monroe County. Since FY2003-04, the number of youth charged with violent felony offenses (murder, attempted murder, manslaughter, felony sex offenses, robbery, aggravated assault, shooting or throwing a deadly missile, and resisting arrest with violence) has decreased from 55 to 3.4 per 1,000 during the FY 2007-08. Between FY 2003-04 and FY 2007-08, in Monroe County, the number of youth charged with violent offenses decreased from 36 to 21, a 41.7% change. There was an overall decrease of 17.6% in the number of delinquency referrals received. The number of white males charged with delinquency offences decreased 11.1 % from FY 2003-04 to FY 2007-08. During the same period the number of black males charged with delinquency offenses increased by 37.8% while the number of white females increased by 4.3% and the number of black females decreased by 0%. The number of Hispanic males referred decreased by 45.8% and the number of Hispanic females decreased 11.8%. For the FY 2007-08, the total number of youth referred was 297. The total number of delinquency referrals diverted from Court was 249. The number of delinquency referrals received for felonies was 115; misdemeanors were 257, other delinquency offenses 64, for a total of 436. The total number of referrals received for felonies against persons was 23. The total number of transfers to Adult Court: 1. The total number of Juvenile probation dispositions were 71. The number of Commitments to Residential: 14. The number of Judicial dispositions: 109. The Monroe County Sheriffs Office assumed responsibility for three important juvenile crime prevention programs in January of 200 1, based upon the belief that immediate involvement with youthful offenders will help prevent further delinquent behavior and will assist in preventing youthful offenders becoming adult offenders. The intervention programs are: Intensive Delinquency Diversion Services or IDDS; the Civil Citation Program, and Teen Court. The target population for the IDDS program includes all male and female youths under 18 years of age with a focus upon youth 16 years old and younger. These youth are referred to the Department of Juvenile Justice for delinquent behaviors that if committed by an adult, would be criminal acts. These youth are at high risk of becoming serious or chronic offenders. The Civil Citation program offers immediate intervention with counseling, education and other appropriate community resources to divert first or second time juvenile misdemeanor offenders form the juvenile justice system. The program allows law enforcement officers the option of issuing civil citations instead of arresting the juvenile. The Sheriffs Office will then process the citation so 4 that it proceeds to court as a law violation. The Teen Court is a nationally recognized program aimed at preventing further delinquent behavior by youthful offenders. Law enforcement officers have the option of referring a teen offender to the Teen Court Program. However the youthful offender must ftrst admit guilt before entering the program. Teen Court is aimed at first offenders in minor cases. In addition, Monroe County now has a Neighborhood Accountability Board, a restorative justice model program serving Juvenile offenders. According to the Florida Department of Juvenile Justice - Office of Probation and Community Intervention Circuit 16 (Monroe) PACT Data, the following information was obtained from the assessments conducted on Monroe County youth. PACT Indicator Youth has a Prior Suspension or Expulsion Youth Not Currently Enrolled in School Youth with Anti-Social Peers Youth with Out-of-Home Placement Youth with a Dependency Petition Youth with a Parent with a Problem (Mental Health/Substance Abuse) Youth has Inadequate Parental Supervision Youth has Used Alcohol Youth has a Problem with Alcohol Youth has Used Drugs Youth has a Problem with Drugs Youth has Practiced Self Mutilation Youth has Attempted Suicide Youth has been Physically Abused Youth has been Sexually Abused Youth has a Mental Health Problem Youth has an Anger Problem Youth has Experienced a Traumatic Event Youth Committed the Crime due to Revenge Youth Committed the Crime due to Impulse Youth Committed the Crime due to Sexual Desire Youth Committed the Crime due to Money / Drugs Youth Committed the Crime due to the Thrill Youth Committed the Crime due to Peers Youth Use of Substance Abuse / Drugs Contributed to Crime Youth Use of Substance Abuse / Drugs Disrupted Education Youth Use of Substance Abuse / Drugs Caused Family Conflict Drusz Use Tvpes Youth Used Marijuana Youth Used Amphetamines Youth Used Other Drugs Monroe 76% 7% 86% 23% 12% 29% 63% 59% 15% 73% 32% 1% 2% 15% 7% 16% 70% 19% 18% 32% 0% 8% 12% 30% 16% 7% 7% 31% 3% 14% Statewide 80% 6% 83% 16% 11% 21% 51% 43% 11% 60% 25% 1% 4% 14% 5% 12% 60% 13% 19% 34% 2% 16% 8% 22% 1 I% 9% 11% 26% 2% 7% 5 Other Data # PACTs Completed # Full Assessments Completed Youth Determined Low Risk to Re-offend Youth Determined Moderate Risk to Re-offend Youth Determined Moderate High Risk to Re-offend Youth Determined High Risk to Re-offend 523 189 46.8% 16.4% 22% 15% 168,533 36,630 52.3% 15.5% 17% 14.5% Treatment Providers Data: For the FY 2007 - 2008, the two primary providers of Mental Health, Substance Abuse, and Co-Occurring Disorder Services in Monroe County reported the following information. Care Center for Mental Health Total Clients in Treatment Number of Homeless Clients Percent Adults in Treatment Adults Arrested Total # of Arrests Percent Juveniles in Treatment Juveniles Arrested Total # of Arrests Percent Juveniles in Custody Percent 585 10 1.7% 395 204 398 51.17% 190 15 18 7.9% 170 89.47% Guidance Clinic of the Middle Keys Total Clients in Treatment 412 Number of Homeless Clients 56 Percent 13.59% Adults in Treatment 351 Adults Arrested 20 Total # of Arrests 58 Percent 5.69% Juveniles in Treatment 61 Juveniles Arrested 0 Juveniles in Custody 58 Percent 95.08% SWOT Analvsis - Stren2ths. Weaknesses. Oooortunities and Threats The Monroe County Criminal Justice, Mental Health and Substance Abuse Diversion Planning Council conducted a brief SWOT analysis, in January, 2009 as a basis for discussion and review of the current conditions related to Jail Diversion services for the person with Mentally Illness or Co-Occurring Disorders in Monroe County and the related implications for 6 the Strategic Plan. The Planning Council identified several factors that will support the evolution of the Strategic Plan in the next several years. Strengths: · Planning Council's knowledge of the community · Experience of Planning Council Members · Commitment to collaboration by participating partners · Smtelevelsupport · Interdisciplinary approach (not just in treatment) · Size of the community - small, which supports access, interagency coordination and communication. Ideal for Pilot projects · Current services - clinical, criminal justice · Experience with the CCISC Model of treatment for Co-Occurring Disorders · President's American Recovery and Reinvestment Act of2009 Weaknesses and Challenges: · No previous experience in creating this type of structure · Lack of collaboration / communication among some providers · Lack of public awareness · Lack of represenmtion by members at Council meetings · Lack of involvement by the private business community · Lack of appropriate services for the Mentally III · Lack of available funding for services · Geographical status (I 3 5 miles in length, majority of services located in Key West) Opportunities: · New funding opportunities · Increased collaboration · SOAR Training for community providers · Programs current involvement in implementing "Best Practices" · Additional related training opportunities Threats: · Reductions in local and state funding sources resulting in decreased services · Lack of community tolerance and stigma of persons with mental illnesses, often results in a '"not in my back yard" philosophy. · Uninfonned County / Community Leadership (Politicians, Media, Community) · Lack of appropriate available professionals (Psychiatrists, Clinicians) · Diminishing philanthropy resources (i.e., JEHT Foundation) · Increased need for services 7 B. Re2ional Partnenhin Stratetrlc Plannin2 Process and Its Participants In 2007, Monroe County sought a state grant for the planning and development of a jail diversion service delivery system. The grant was awarded in April 2008. As a result of this grant, the Monroe County Criminal Justice Mental Health and Substance Abuse Diversion Project, under the auspices of the Monroe County Sheriffs Office, was initiated, in collaboration with a host of community partners, with the purpose of developing an array of jail diversion interventions recommendations for persons with mental illness and/or substance use disorders. In compliance with the requirements of House Bill 1477, the Criminal Justice, Mental Health and Substance Abuse Re-investment Act, with the Project established under the Monroe County Sheriffs Office as the Lead Agency, the Community Partners include: · Citizens, consumers and family members receiving and recovering from mental health and substance use disorders in Monroe County. · Board of County Commissioner · Monroe County Sheriff · Chief Corrections Officer · Public Defender · State Attorney . 16th Judicial Circuit · Monroe County Pre-Trial Services · Monroe County Drug Court · Key West Police Department · Florida Department of Corrections · County Probation Department · Chief Probation Officer from the Department Juvenile Justice · Monroe County Juvenile Justice Detention Center Director · Southernmost Homeless Assistance League · Florida Keys Outreach Coalition · Samuel's House / Kathy's Hope · Care Center for Mental Health · Guidance Clinic of the Middle Keys · Lower Keys Medical Center / DePoo Hospital · Heron - Peacock Supportive Living · National Alliance for the Mentally III (Key West and Marathon) · Florida Department of Children and Families (DC F) Substance Abuse and Mental Health Program Office · Community Representatives of the Lower, Middle and Upper Keys. The Monroe County Criminal Justice, Mental Health and Substance Abuse Diversion Planning Council has completed key activities in preparation for the development of this Strategic Plan including: implementing community needs and resource assessments; researching and reviewing evidenced-based best practice models for Adult and Juvenile diversion; examining of service capacity and options - identifying needs and gaps; involving stakeholders representing all of the Keys (Lower, Middle and Upper); establishing additional collaborations and partnerships to provide for inter-agency coordination and communication; reviewing and recommending the expansion of existing professional, consumer and family support systems; 8 reviewing various screening and assessment tools; examining various jail - court processes and procedures; identifying target populations within the Adult and Juvenile Detention systems; identifying training needs and implementing County-wide trainings on the Baker Act, HIP AA, Supportive Housing, and Data Training; examining local housing needs and researching national best practices for housing the Diversion population; reviewing information, data reporting and information sharing policies. Operationally, the Project has established financial procedures between the County and the Monroe County Sheriff's Office; developed an In-Kind Match documentation and monitoring system; developed a resource library of publications and materials relating to Criminal Justice Diversion and Evidence-based Practices for the treatment of Mentally III or Co-Occurring Disorder Offenders; and lastly participating as a resource for the community (Law Enforcement, Criminal Justice, Corrections, and Treatment Providers) relating to Diversion Issues. These planning activities were implemented through Council Meetings, Work group meetings; participation in established community partnerships such as the Monroe County Community Alliance; the Juvenile Justice Board; the Monroe County Substance Abuse and Mental Health Planning Council; Southernmost Homeless Assistance League (SHAL); and collaboration meetings with criminal justice, juvenile justice; corrections, treat providers; homeless providers; and community providers. 9 C. Vision and Mission It is the vision of the Monroe County Jail Diversion partners that persons arrested for misdemeanors and certain felonies, that are in need of mental health and/or substance abuse services should be offered treatment as an alternative to incarceration. The Jail Diversion partners recognize that recovery-oriented services that are evidenced-based will yield positive outcomes for persons and enhance their opportunities to be productive citizens. It is also envisioned that a comprehensive, continuous and integrated system of care be established in Monroe County for persons who will benefit from a wide-array of community-based jail diversion services. The Mission of the partners, in order to implement the vision, includes: 1. To define the target group for diversion, 2. To identify individuals as early as possible in there processing by the justice system, 3. To negotiate community-based treatment alternatives to incarceration, and, 4. To develop resources and implement linkages to comprehensive systems of care and appropriate community supervision consistent with the disposition of the criminal justice contact. D. Values I Princiules The Values and Principles upon which the MCCJMHSA Diversion Program are based, are both Consumer and Family driven, and have been adopted from the SAMHSA's National Consensus Statement on Mental Health which states: "Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential." The ten fundamental components of recovery include the following: 1. Responsibility 2. Self-direction 3. Individualized and person-centered 4. Empowerment 5. Holistic 6. Non-linear 7. Strengths-based 8. Peer Support 9. Respect to. Hope 10 E. Concentual Model The following comprehensive goals are agreed upon by the Monroe County Jail Diversion Partners: 1. Implement the Strategic Plan and Memorandum of Understanding developed by the Diversion Planning Council through the development of operating policies and procedures, which define the relationships and service delivery processes of the Project partners. 2. Build on existing capabilities to better utilize post-booking diversion capabilities 3. Formally adopt a policy level commitment to the diversion of the mentally ill and co- occurring offenders. 4. Establish specific modalities to assume accountability for the referral, care and support of the target adult and juvenile diversion populations. 5. Divert persons with a mental illness or co-occurring disorders to appropriate recovery- oriented services. 6. Incorporate and acculturate the CCISC and Recovery models of best practices across diversion (law enforcement, criminal justice and corrections), treatment and support service provider approaches. 7. Improve quality, accessibility, and availability of mental health and co-occurring disorder service delivery through evidence-based models. In order to most effectively and efficiently accomplish these goals, a tri-Ievel approach needs to be utilized. This includes the following: System Level: · To seek federal, state and local support to assist in the development and coordination of a Jail Diversion service delivery system in Monroe County. · To achieve universal adoption of the Recovery-oriented principles to drive the development of the Jail Diversion service delivery system. · To establish output and outcome evaluation for the Jail Diversion service delivery system for Monroe County. · To continue to work with the USF-FMHI Florida Criminal Justice, Mental Health & Substance Abuse Technical Assistance Center Program Level: · To develop and implement specific recommendations for Adult Diversion Services in Monroe County · To develop and implement specific recommendations for Juvenile Diversion Services in Monroe County · All programs and services are developed and implemented consistent with evidenced- based mental health, substance abuse and co-occurring (SAMH) models and best practices. · To encourage and participate in the development of wrap-around community services/resources which are currently unavailable in Monroe County, which will address the unmet needs of jail diversion client population. 11 . 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E (1:1 11)'- I!) ._ I!) = ;:j= Jl . ..... "" .- 0. .Q 0.<.)- e o 0.5 e Q.._ Summarv: Monroe County is considered to be an area of critical need with inadequate resources, to meet the requirements of a disproportionately high percentage of individuals with Mental Illness or Co-Occurring Disorders, in need of services. Monroe County has the third highest incarceration rate in the State of Florida. The Homeless rate in Monroe County is the one of the highest per capita, in the State of Florida. Monroe County has no residential treatment services for Juveniles, and only 12 Adult residential Substance Abuse treatment beds. There is only 1 Assisted Living Facility with a Mental Health License serving a total of 16 clients, and usually has a 1 year waiting list; and only 1 permanent Housing facility with a total of28 beds willing to take individuals with serious Mental lllness. While the County is fortunate to have Adult and Juvenile Drug Courts, the availability of treatment options for referral is minimal. The Community Mental Health Centers are under funded and over capacity. There is no Mental Health Court or special docket to handle the high number of persons arrested for misdemeanors and certain felonies, who are in need of mental health and/or co-occurring disorder services. The Monroe County Juvenile Justice Detention Center is on the "chopping block" - and has been identified as one of a number of small county Detention Centers scheduled to be closed. While certain services or aspects of care within the service delivery system are considered to be of high quality, Monroe County lacks an infrastructure to coordinate services, which could maximize effectiveness and efficiency. The Monroe County Criminal Justice, Mental Health and Substance Abuse Diversion Planning Council, and the Criminal Justice Diversion Project, has served exactly this purpose. This Strategic Plan demonstrates the vision of a service delivery system which, with a Iimited infusion of funding, can assist the County in meeting the needs of this extremely vulnerable, but highly resource consumptive population. It can enable the County to substantially decrease the number of days this population spends in jail, and also significantly reduce their recidivism rates. This Project proposes safe humane alternatives to continued incarceration for persons suffering from Mental Illness and substance impairments. 22 For more information contact: Clare S. Shaw, MA, Director Criminal Justice Diversion Project Monroe County Sheriff's Office 5501 College Road Key West, FL 33040 Office: (305) 293-7422 Cell: (305) 7697-6268 E-Mail: cshaw@keysso.net 23