http://www.youtube.com/watch?v=Wjy3ueOtGls&feature=related

The Role of the Peer The Role of the Peer SpecialistSpecialist

Completing the CIT PictureCompleting the CIT Picture

SCRANTON AREA CITSCRANTON AREA CIT Location: Northeastern PennsylvaniaLocation: Northeastern Pennsylvania 125 miles north of Philadelphia125 miles north of Philadelphia Population: 76,089Population: 76,089 Area: 26 square milesArea: 26 square miles

Scranton CITScranton CITBorn of a TragedyBorn of a Tragedy

May 28, 2009 – May 28, 2009 –

Scranton Woman Shot and Killed by Scranton Woman Shot and Killed by Police: “Routine Mental Health Call Police: “Routine Mental Health Call Goes Bad”Goes Bad”

Public OutragePublic Outrage

Task Force CreatedTask Force Created

Final Report and RecommendationsFinal Report and Recommendations

Task Force RecommendationsTask Force Recommendations

Adopt CITAdopt CIT

Establish Response ProtocolEstablish Response Protocol

Create Culture of CooperationCreate Culture of Cooperation

Educational ProgramsEducational Programs

Establish Advisory BoardEstablish Advisory Board

Scranton Police DepartmentScranton Police Department

Total Sworn ComplementTotal Sworn Complement

January 1, 2011 – 150 OfficersJanuary 1, 2011 – 150 Officers

CIT ClassesCIT Classes

Since Inception – 2 CIT Classes Have Since Inception – 2 CIT Classes Have Been ConductedBeen Conducted

CIT OfficersCIT Officers

21 Trained Officers21 Trained Officers

18 male18 male

3 female3 female

14 of 21 – less than 10 years of 14 of 21 – less than 10 years of serviceservice

CIT Officer DeploymentCIT Officer Deployment

Day ShiftDay Shift 4 Officers – (3 SRO)4 Officers – (3 SRO)

AfternoonAfternoon 9 Officers9 Officers

MidnightMidnight 7 Officers7 Officers

Drug UnitDrug Unit 1 Officer1 Officer

TotalTotal 21 Officers21 Officers

Many Cracks to Fall Through Many Cracks to Fall Through OROR

Many Opportunities for DiversionMany Opportunities for Diversion

FamilyFamilyFriendsFriendsCommunityCommunity NeighborsNeighbors ChurchChurch SchoolSchool BusinessesBusinesses

ServicesServices PhysiciansPhysicians Mental health treatment providersMental health treatment providers 11stst Responders Responders

The Scope of the Problem…Why Divert?

8 percent of annual jail bookings have current symptoms of serious mental illness

Costly and time consuming for law enforcement officers and local jails.

Courts become backlogged

Cycle in and out of the mental health, substance abuse, and criminal justice systems

Many become homeless, engaging in survival activities Many become homeless, engaging in survival activities

The Scope of the Problem…The Scope of the Problem…Why Divert? Why Divert?

More likely to:More likely to: be poor and uninsured be poor and uninsured be detained because they cannot post even very low bailbe detained because they cannot post even very low bail be charged with more serious crimes and have stiffer penaltiesbe charged with more serious crimes and have stiffer penalties to spend two to five times longer in jailto spend two to five times longer in jail to be involved in more fights, infractions, and sanctionsto be involved in more fights, infractions, and sanctions to return to jail on a probation violationto return to jail on a probation violation

Frequently, Frequently, people who are caught in the “revolving door” of people who are caught in the “revolving door” of corrections, mental health treatment, and homelessnesscorrections, mental health treatment, and homelessness are are thought of as “bad clients” or “treatment resistant,” when in reality, thought of as “bad clients” or “treatment resistant,” when in reality, they are casualties of they are casualties of “client resistant services”“client resistant services” (H. J. Steadman, (H. J. Steadman, personal conversation, March 6, 2006).personal conversation, March 6, 2006).

Simply put:Simply put: Diversion is the Right Thing To DoDiversion is the Right Thing To Do

The Scope of the Problem…The Scope of the Problem…Why Divert?Why Divert?

What Jail Diversion Has to OfferWhat Jail Diversion Has to Offer

A A viable and humaneviable and humane solution solution

positive outcomespositive outcomes for people with mental illness, systems, and communities for people with mental illness, systems, and communities

In particular, jail diversion:In particular, jail diversion: ReducesReduces time spent in jail time spent in jail LinksLinks people to community-based services people to community-based services Results in Results in lowerlower criminal justice costs criminal justice costs Does not increase Does not increase public safetypublic safety risk risk

Jail diversion programs Jail diversion programs Develop and build on Develop and build on broad-based community consensus and collaborationbroad-based community consensus and collaboration IntegrateIntegrate services and systems and services and systems and bridge the gapbridge the gap in fragmented systems in fragmented systems Break the cycleBreak the cycle of recidivism, revolving door of recidivism, revolving door Reflect a holistic, systemic approach to mental health service delivery that will allow most people with mental disorders Reflect a holistic, systemic approach to mental health service delivery that will allow most people with mental disorders

to live, work, learn, and participate fully and safely in their communities. to live, work, learn, and participate fully and safely in their communities.

* Practical Advice on Jail Diversion: Ten Years of Learnings on Jail Diversion from the CMHS National GAINS Center (2007)* Practical Advice on Jail Diversion: Ten Years of Learnings on Jail Diversion from the CMHS National GAINS Center (2007)

http://www.gainscenter.samhsa.govhttp://www.gainscenter.samhsa.gov

I. Law Enforcement/Emergency Services

II. Post-Arrest: Initial Detention/Initial Hearings

III. Post-Initial Hearings: Jail/Prison, Courts, Forensic Evaluations & Commitments

IV. Re-Entry from Jails, State Prisons, & Forensic Hospitalization

V. Community Corrections

& Community Support

Munetz & GriffinPsychiatric Services 57: 544–549, 2006

15

Sequential InterceptsSequential Intercepts

How are Certified Peer Specialists How are Certified Peer Specialists currently being used in CIT programs?currently being used in CIT programs?Training: role play & critique the officers actions in the role playingTraining: role play & critique the officers actions in the role playing

CIT planning committees, help arrange visits to consumer sites or arrange CIT planning committees, help arrange visits to consumer sites or arrange consumer/family panels as part of the curriculum  consumer/family panels as part of the curriculum 

IOOV for the consumer perspective and also have consumers represented on IOOV for the consumer perspective and also have consumers represented on planning committeeplanning committee

community resource panel and the site visits had Peer Specialists on the panelcommunity resource panel and the site visits had Peer Specialists on the panel

post-booking jail diversion programs like mental health courtspost-booking jail diversion programs like mental health courts

once the person is linked to their local mental health service provider, Peer once the person is linked to their local mental health service provider, Peer Specialists who work with those providers can become involved on an as Specialists who work with those providers can become involved on an as needed basis needed basis

(based on informal survey of NAMI Executive Directors nationwide)(based on informal survey of NAMI Executive Directors nationwide)

The Mission of the CertifiedThe Mission of the CertifiedPeer SpecialistPeer Specialist

Education and TrainingEducation and Training

EmpowermentEmpowerment

HopeHope

Promote RecoveryPromote Recovery

Scranton Area CIT Peer Specialist Scranton Area CIT Peer Specialist Pilot ProgramPilot Program

Rationale/Research SupportRationale/Research Support1999 Surgeon General’s Report on Mental Health 1999 Surgeon General’s Report on Mental Health

recognized the value of peer support in recoveryrecognized the value of peer support in recovery encouraged states and communities to incorporate peer servicesencouraged states and communities to incorporate peer services

Research suggests:Research suggests:

Peer providers are often able to more readily forge favorable Peer providers are often able to more readily forge favorable relationships with clients because of shared perspectives and relationships with clients because of shared perspectives and experiencesexperiences

Early use of peer support can:Early use of peer support can:engage those most alienated (“treatment resistant”)engage those most alienated (“treatment resistant”)help people feel empowered in their recovery planshelp people feel empowered in their recovery planskeep people engaged in traditional treatment and community self-helpkeep people engaged in traditional treatment and community self-helpresult in fewer police calls and arrests result in fewer police calls and arrests

those engaged in treatment are less likely to experience mental health crises or those engaged in treatment are less likely to experience mental health crises or require police intervention if they dorequire police intervention if they do

if police intervention does occur, those who have peer specialist services are if police intervention does occur, those who have peer specialist services are more likely to have developed recovery tools.more likely to have developed recovery tools.

Small group of CIT officers selected at Small group of CIT officers selected at random to participaterandom to participate

Peer specialist services described to officersPeer specialist services described to officers

Instructions given on how to describe peer Instructions given on how to describe peer specialist services specialist services

(“someone who has been in the same kind of situation”)(“someone who has been in the same kind of situation”)

Officers offer peer services after CIT crisis call Officers offer peer services after CIT crisis call is resolved on sceneis resolved on scene

Not if arrest occursNot if arrest occurs

Not if person is transported to the hospital Not if person is transported to the hospital Phase IIPhase II

ProcedureProcedureOfficer asks if person would like to receive Officer asks if person would like to receive a call from a peer specialista call from a peer specialist If no, card/brochure left with person or familyIf no, card/brochure left with person or family If yes, officer calls peer specialist coordinatorIf yes, officer calls peer specialist coordinator

Coordinator assigns peer specialist to the caseCoordinator assigns peer specialist to the case

Peer specialist makes call w/i 12-24 hours of crisisPeer specialist makes call w/i 12-24 hours of crisis

Describes peer support services, treatment Describes peer support services, treatment options, community programs, etc.; offers peer options, community programs, etc.; offers peer support services if appropriatesupport services if appropriate

CIT Call

ArrestCrisis resolved

on scene

Transport to hospital

{Phase II}

Peer specialist described; permission requested to refer to peer specialist for outreach call

Permission refused; peer specialist

card given

Permission granted; officer contacts

peer specialist coordinator

Peer specialist makes outreach call within12-24 hours of crisis

(describes services, treatment options, community programs)

Peer services accepted

Peer services rejected

Data collection:Date of call

1, 3 & 6 months later

Data collectionDate of call

1, 3 & 6 months later

Data CollectionData Collection

Peer specialist gathers data (during call, Peer specialist gathers data (during call, two weeks later, one month later, three two weeks later, one month later, three months later, six months later)months later, six months later) services being usedservices being used community involvementcommunity involvement engagement in treatmentengagement in treatment satisfaction with treatmentsatisfaction with treatment

Police records reviewed (three months & Police records reviewed (three months & six months later -- crisis calls/arrests)six months later -- crisis calls/arrests)

Post-Pilot StrategyPost-Pilot Strategy

Use of pilot results to:Use of pilot results to:

Demonstrate effectiveness of early peer services to Demonstrate effectiveness of early peer services to divert people from criminal justice system, reduce divert people from criminal justice system, reduce repeat police calls, engage people in treatmentrepeat police calls, engage people in treatment

Support funding requests and grant proposals to Support funding requests and grant proposals to incorporate peer specialist services in all appropriate incorporate peer specialist services in all appropriate CIT callsCIT calls

Support other CIT programs in seeking funding Support other CIT programs in seeking funding sources to incorporate peer specialist servicessources to incorporate peer specialist services

Total Sworn ComplimentTotal Sworn Compliment

January 1, 2011 – 150 OfficersJanuary 1, 2011 – 150 Officers

August 31, 2011 – 134 OfficersAugust 31, 2011 – 134 Officers

Obstacles to ImplementationObstacles to Implementation

PolicePolice Lay Offs – Loss of CIT OfficersLay Offs – Loss of CIT Officers Data collection problemsData collection problems

ObstaclesObstacles

Paying for CPS services Paying for CPS services State regulations:State regulations:

Medical necessity for CPS ServicesMedical necessity for CPS ServicesAgreement of the individual to receive servicesAgreement of the individual to receive servicesStrict provider qualifications for MA compensable Strict provider qualifications for MA compensable Peer Support Services providersPeer Support Services providers

Hospital & provider buy-inHospital & provider buy-in Resistance to change from medical model to Resistance to change from medical model to

recovery-oriented modelrecovery-oriented model

ReferencesReferencesClarke, G., Herinckx, H., Kinney, R., Paulson, R., Cutler, D., Lewis, K., & Oxman, E. (2000). Psychiatric hospitalizations, arrests, emergency Clarke, G., Herinckx, H., Kinney, R., Paulson, R., Cutler, D., Lewis, K., & Oxman, E. (2000). Psychiatric hospitalizations, arrests, emergency

room visits, and homelessness of clients with serious and persistent mental illness: findings from a randomized trial of two ACT room visits, and homelessness of clients with serious and persistent mental illness: findings from a randomized trial of two ACT programs vs. usual care. programs vs. usual care. Mental Health ServicesMental Health Services Research Research. Retrieved from . Retrieved from http://springerlink.metapress.com/openurl.asp?genre=article&id=doi:10.1023/A:1010141826867http://springerlink.metapress.com/openurl.asp?genre=article&id=doi:10.1023/A:1010141826867

CMHS National Gains Center. (2007). Practical Advice on Jail Diversion: Ten Years of Learnings on Jail DiversionCMHS National Gains Center. (2007). Practical Advice on Jail Diversion: Ten Years of Learnings on Jail Diversion

Felton, C.J., Stastny, P., Shern, D.L., Blanch, A., Donahue, S.A., Knight, E., Brown, C. (1995). Consumers as peer specialists on intensive case Felton, C.J., Stastny, P., Shern, D.L., Blanch, A., Donahue, S.A., Knight, E., Brown, C. (1995). Consumers as peer specialists on intensive case management teams: impact on client outcomes. management teams: impact on client outcomes. Psychiatric Services, 46Psychiatric Services, 46, 1037-1044., 1037-1044.

Lucksted, A., McNulty, K., Lorener, B., Forbes, C. (2009). Initial evaluation of the peer-to-peer program. Lucksted, A., McNulty, K., Lorener, B., Forbes, C. (2009). Initial evaluation of the peer-to-peer program. Psychiatric Services, 60Psychiatric Services, 60, 250-253., 250-253.

Lyons, J.S., Cook, J.A., Amity, R.R., Karver, M., Slagg, N.B. (1996). Service delivery using consumer staff in a mobile crisis assessment Lyons, J.S., Cook, J.A., Amity, R.R., Karver, M., Slagg, N.B. (1996). Service delivery using consumer staff in a mobile crisis assessment program. program. Community Mental Health Journal, 32(1)Community Mental Health Journal, 32(1), 33-__. , 33-__.

Mayor’s Task Force on Law Enforcement and Mental Health (2010). Final Report. Scranton, PA. Mayor’s Task Force on Law Enforcement and Mental Health (2010). Final Report. Scranton, PA. http://www.scrantonpa.gov/images/Final%20Report%20and%20Recommendations%20of%20the%20Mayor's%20Task%20Force.pdfhttp://www.scrantonpa.gov/images/Final%20Report%20and%20Recommendations%20of%20the%20Mayor's%20Task%20Force.pdf

Meehan, T., Bergen, H., Coveney, C., & Thornton, R. (2002). Development and evaluation of a training program in peer support for former Meehan, T., Bergen, H., Coveney, C., & Thornton, R. (2002). Development and evaluation of a training program in peer support for former consumers. consumers. International Joural of Mental Health Nursing, 11International Joural of Mental Health Nursing, 11, 34-39., 34-39.

Munetz & Griffin, Psychiatric Services 57: 544–549, 2006Munetz & Griffin, Psychiatric Services 57: 544–549, 2006

Sells, E., Black, R., Davidson, L., Rowe, M. (2008). Beyond generic support: Incidence and impact of invalidation in peer services for clients with Sells, E., Black, R., Davidson, L., Rowe, M. (2008). Beyond generic support: Incidence and impact of invalidation in peer services for clients with severe mental illness. severe mental illness. Psychiatric ServicesPsychiatric Services, , 59(11)59(11), 1322-1327., 1322-1327.

Sells, D, Davidson, L., Jewell, C., Falzer, P., Rowe, M. (2006). The treatment relationship in peer-based and regular case management for Sells, D, Davidson, L., Jewell, C., Falzer, P., Rowe, M. (2006). The treatment relationship in peer-based and regular case management for clients with severe mental illness. clients with severe mental illness. Psychiatric ServicesPsychiatric Services. . 57(8)57(8), 1179-1184., 1179-1184.

U.S. Department of Health and Human Services (1999). U.S. Department of Health and Human Services (1999). Mental Health: A Report of the Surgeon General—Executive SummaryMental Health: A Report of the Surgeon General—Executive Summary. Rockville, MD: . Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.Health Services, National Institutes of Health, National Institute of Mental Health.