EVALUATION OF THE INDIANAPOLIS MOBILE CRISIS

2y ago
12 Views
2 Downloads
3.05 MB
30 Pages
Last View : 16d ago
Last Download : 2m ago
Upload by : Roy Essex
Transcription

EVALUATION OF THE INDIANAPOLIS MOBILE CRISIS ASSISTANCE TEAMReport to the Indianapolis Office of Public Health & Safety and the Fairbanks FoundationMARCH 2018HORIZONTAL VERSIONCENTER FOR CRIMINAL JUSTICE RESEARCHVERTICAL VERSIONAUTHORSKatie Bailey, Program Analyst, IU Public Policy InstituteBrad Ray, Director of the Center for Criminal Justice ResearchCENTER FOR CRIMINAL JUSTICE RESEARCH

CONTRIBUTING AUTHORSEric Grommon, Senior Research Associate, IU Public Policy InstituteEvan Lowder, Research Associate, IUPUI School of Public & Environmental AffairsStaci Rising Paquet, Research Assistant, Center for Criminal Justice ResearchRESEARCH SUPPORTSpencer Lawson, Research Assistant, Center for Criminal Justice ResearchJoti K. Martin, Program Analyst, IU Public Policy InstituteElle Yang, Graduate Research Assistant, IU Public Policy InstituteHORIZONTAL VERSIONCENTER FOR CRIMINAL JUSTICE RESEARCHVERTICAL VERSIONCENTER FOR CRIMINAL JUSTICE RESEARCH334 N Senate Avenue, Suite 300Indianapolis, IN 46204policyinstitute.iu.edu

CONTENTSEXECUTIVE SUMMARY1KEY FINDINGS1BACKGROUND2LITERATURE REVIEW3INDIANAPOLIS MOBILE CRISIS ASSISTANCE TEAM5STUDY DESIGNFocus GroupsInterviews with StakeholdersField ObservationsOfficer SurveyMCAT Response Data667777BARRIERS AND FACILITATORS TO MCAT IMPLEMENTATIONBarriers to Program ImplementationPolicies and ProceduresExternal CoordinationOutpatient ResourcesRole Conflict and StigmaFacilitators to Program ImplementationInitial Citywide Collaboration and Buy-InInformation SharingTeam Building888891011111213IMPD EAST DISTRICT OFFICER SURVEYExhibit 1: Clarity of Roles and Expectations of the MCAT UnitExhibit 2: Perceptions of MCAT Usefulness131414QUANTITATIVE DATA ON MCAT RESPONSESClient DemographicsExhibit 3: Demographic Characteristics of MCAT Response CasesReason for ResponseExhibit 4: Reasons for MCAT ResponseExhibit 5: MCAT Response Types over TimeScene of an MCAT ResponseMCAT Response OutcomesExhibit 6: MCAT Response OutcomesRepeat EncountersExhibit 7: MCAT Repeat EncountersDifferences by MCAT UnitsExhibit 8: Variation by MCAT Units16161617171818191919202021CONCLUSIONS AND FUTURE RESEARCH22REFERENCES24

EXECUTIVE SUMMARYIn May 2016, Indianapolis Mayor Joe Hogsett formed the Criminal Justice Reform Task Force to address,among other issues, the significant number of individuals entering the criminal justice system with mental healthor substance abuse issues. This resulted in the establishment of a Mobile Crisis Assistance Team (MCAT) pilotprogram that integrated police, paramedics and mental health professionals into teams to respond to emergencycalls involving people with behavioral health and/or substance use issues. The pilot program aimed to divertthose people to mental health and social services instead of the criminal justice system, and to relieve otherfirst-responders from the scene of these time-consuming and complicated emergency situations. The MCAT pilotbegan in the Indianapolis Metropolitan Police Department (IMPD) East District.The Center for Criminal Justice Research at the Indiana University Public Policy Institute evaluated the pilotprogram using data from MCAT run reports between August 1 and December 9, 2017. Additionally, East DistrictIMPD officers were surveyed, key stakeholders and program designers were interviewed, focus groups wereheld with the MCAT team members, and field observations were completed.KEY FINDINGS1 MCAT transported a person to jail in less than 2% of all responses during the pilot MCAT units were able to relieve one or more other first response units from the scene of anemergency in two-thirds of all runs during the study period The majority of MCAT encounters were completed in under 90 minutes - In encounters thattook longer than 90 minutes, MCAT had relieved other first response units 80% of the time MCAT units encountered a small subset of “frequent flyers”—individuals receiving multipleMCAT responses during the study period—who were more likely to be gravely disabled and/or have mental health issues than those who had only received one MCAT response Eighty-five percent of IMPD East District police officers surveyed indicated the MCAT unit wasvery useful or extremely useful to them as an additional resource in responding to emergencies One-third of IMPD East District police officers surveyed indicated being interested in servingas an MCAT officer in the future A lack of outpatient treatment options and clear policies and procedures appeared as themost salient barriers to implementation of the MCAT pilot program Access to and triangulation of collaborating agency information on persons experiencingemergencies; support from city officials; and team building exercises during MCAT trainingemerged as the most salient facilitators to implementation of the MCAT pilot program.

BACKGROUNDAccording to the Marion County Sheriff’s Office, approximately 40% of detainees in Marion County’s jails atany one time suffer from mental illness, resulting in 8 million of medical care and services annually (McQuaid,2015). In addition, roughly 85% of detainees with a mental illness are also diagnosed as suffering fromsubstance abuse issues (McQuaid, 2017). The past five years have shown an alarming increase in police andemergency medical service runs involving individuals suffering from mental illness and drug addiction. Althoughlaw enforcement experts estimate that as many as 7% to 10% of patrol officer encounters involve personswith mental illness, historically police officers report feeling ill equipped to respond (Deane, Steadman, Borum,Veysey, & Morrissey, 1999).In May 2016, Indianapolis Mayor Joe Hogsett formed the Criminal Justice Reform Task Force. In December ofthat year, the Task Force issued a comprehensive plan for criminal justice reform that included, among otherinitiatives, diverting persons suffering from mental illness and addiction away from the criminal justice systemand into evidence-based treatment and services, when appropriate.This resulted in the establishment of a Mobile Crisis Assistance Team (MCAT) pilot program, an integratedco-responding police-mental health team model with the addition of a medical professional. The MCAT pilotbegan August 1, 2017 with four teams operating within the boundaries of the Indianapolis Metropolitan PoliceDepartment (IMPD) East District. The MCAT teams consist of specially-trained police officers (IMPD), paramedicsfrom Indianapolis Emergency Medical Services (IEMS), and crisis specialists from Eskenazi Health MidtownCommunity Mental Health (Midtown). The pilot program aimed to divert time-consuming, challenging, andcomplicated pre-arrest situations to a dedicated, specially-trained team that could better assess and engageindividuals, routing them to mental health and social services instead of the criminal justice system.The Indianapolis Office of Public Health and Safety partnered with the Indiana University Center for CriminalJustice Research (CCJR) of the Indiana University Public Policy Institute (PPI), to provide an evaluation of theMCAT pilot program. This evaluation was based on an expansion design where evaluators used a mixed-methodsapproach to extend the scope, breadth, and range of inquiry (Greene, Caracelli, & Graham, 1989). In thisapproach, qualitative methods are generally used to assess program implementation and quantitative methodsto assess program outcomes. For the MCAT evaluation, qualitative data collection included: focus groups withMCAT units, interviews with key program developers and community stakeholders, field observations with anMCAT unit, and a survey of East District police officers. Quantitative analysis examined MCAT response dataprovided by MCAT units. The primary purpose of qualitative data collection was to better understand barriersand facilitators to program implementation, while quantitative data points from MCAT runs were developedusing a program-theory approach whereby the measures captured are based on stakeholder beliefs regardingthe important outcomes of the pilot program.This report begins by providing an overview of the academic literature on the challenges presented by personswith a mental illness and co-occurring substance use to police officers and the criminal justice system as a whole,along with efforts to mitigate these challenges. Next, this report describes the MCAT pilot program in greaterdetail before presenting the study design and results. Implications for research and future pilot programs arediscussed.2

LITERATURE REVIEWSince the 1970s, persons with mental illness (hereafter, “PMI”) have been handled increasingly by the criminaljustice system, a process referred to as the “criminalization of mentally-disordered behavior.” Many suspectthat deinstitutionalization contributed to increases in the incarceration of PMI (Lamb & Grant, 1982; Stelovich,1979; Swank & Winer, 1976; Whitmer, 1980), as these individuals were no longer in hospitals, but out in thecommunity and at risk of arrest (Whitmer, 1980). Today, PMI are three times more likely to be in jail or prisonthan in a hospital receiving appropriate treatment (Taheri, 2016). This is largely because the criminal justicesystem is the only social institution that cannot turn away these cases. Private centers can refuse to treat patientsthey deem to be risky or disruptive; community mental health providers can reject those who have a criminalhistory; and hospitals can turn away those who appear threatening or intoxicated.Criminal justice systems across the country have responded by developing programs aimed at reducingincarcerated PMI by diverting them away from the criminal justice system and into community-based treatmentsand services. Services provided by many of these programs occur “post-booking” (e.g., mental health courts)and can only be accessed once an individual has been arrested or charged with a crime. Many studies suggest,however, that the most effective way of diverting PMI from the criminal justice system is by intervening “prebooking” as police officers respond to 911 emergency calls (Muntez & Griffin, 2006).Approximately 10% of law enforcement encounters involve PMI, about three quarters of whom have cooccurring substance use disorders (Steadman, 2005; Skubby et al., 2013). Often, police officers don’t havethe resources or training to handle mental health crises effectively, or the people who experience them. Duringthese encounters, PMI in crisis can exhibit strange or hostile behavior, creating a situational ambiguity that cancompromise the safety of officers (Taheri, 2016). One of the most popular responses to this issue has been theimplementation of Crisis Intervention Training (CIT), where police officers are trained about mental illness andhow to respectfully and safely interact with PMI (Dupont, Cochran, & Pillsbury, 2007; Compton, Bahora, Watson,& Oliva, 2008). Additionally, CIT curriculum also provides training for officers on co-occurring mental health andsubstance use disorders that as many as three quarters of PMI experience (Steadman, 2005; Dupont, Cochran,& Pillsbury, 2007). Empirical evidence on CIT has been encouraging and suggests that CIT-trained officers havemore positive attitudes, beliefs, and knowledge about mental illness, and agencies with CIT programs have lowerarrest rates than other types of diversion programs (Compton, et al., 2008).Even with the emergence of CIT programs, police agencies struggle to engage with PMI safely in the communitiesthey serve. To this end, several police departments have partnered with community healthcare providers tocreate co-responding police-mental health teams, known alternatively as mobile crisis intervention teams, crisisoutreach and support teams, and ambulance and clinical early response teams (Shapiro et al., 2014). Thegeneral co-response team model involves partnering a sworn police officer with a mental health professional,although many agencies create three-person teams by adding a medical professional (such as a nurse orparamedic) or a peer specialist (such as an individual in recovery from mental illness or substance use disorder)(Hay, 2015). Dozens of such teams currently operate in North America from Los Angeles, California to Halifax,Nova Scotia, and have several common goals, including diverting PMI away from the criminal justice system andincreasing consumer access to mental health and substance abuse treatment (Steadman et al., 2001; Shapiroet al., 2014). However, one important distinction among these co-responding units is the timing of the response:3

some units are first responders to the scene of an emergency while other units provide follow up after a mentalhealth or substance abuse crisis.As these co-response programs are relatively new, only a handful of studies have examined the effectiveness ofthis approach, though results have been generally positive in finding that co-response teams are cost effective,well-received by the communities they serve, and reduce burdens on the criminal justice and healthcare systems.For example, a 2005 program evaluation of Victoria City (Canada) Police Department’s Integrated Mobile CrisisResponse Team found many positive outcomes, including increased crisis call response rates, decreased relianceon hospital emergency rooms, and increased information sharing between agencies. The findings, however,suggest these outcomes depended on adequate staffing, appropriate vehicles, sufficient team member training,a centralized dispatch location, and access to pertinent medical and criminal histories about the PMI served(Baess, 2005). In 2006, Hartford and colleagues used a mixed-methods approach and reviewed over sevenstudies and fifty two police department surveys from three continents about pre-booking diversion programs(including co-responding police-mental health teams) and identified four key elements that were associatedwith positive outcomes: involving all agencies in the program’s development, conducting regular meetings withprogram stakeholders, creating a 24/7 no refusal policy for drop off centers, and appointing an individual toact as a liaison between all agencies involved. A similar 2014 review by Shapiro and colleagues of over twentypeer-reviewed studies, reports, and dissertations on co-response teams suggested that successful teams createdimportant bonds between PMI and community mental health resources while lessening the burden on the criminaljustice system by making fewer arrests and reducing time on scene for first responders.Finally, an evaluation of a mobile police-mental health crisis team in an urban setting by Kirst and colleagues in2015 found that stakeholders felt that the program was meeting its goals of reducing criminalization of mentalillness and assisting PMI in crisis via positive partnerships between individual team members and their respectiveagencies. Despite positive outcomes, however, several barriers to co-response program implementation areconsistently reported throughout the literature. Most importantly, all studies have reported that the lack ofa 24/7 psychiatric drop off location center with a no-refusal policy is a critical barrier to program success.Additionally, there are recurring issues with role clarity and differences in professional cultures between teammembers as contributing to implementation difficulties.4

INDIANAPOLIS MOBILE CRISIS ASSISTANCE TEAMThe Indianapolis MCAT pilot project launched on August 1, 2017 as a police-mental health co-response teammodel with the addition of a medical professional. The Indianapolis pilot model consists of an IMPD police officer,an IEMS paramedic, and a mental health clinician from Midtown. MCAT is based in and serves the IMPD EastDistrict. This district was chosen because it ranks high on the Social Disorder Index and has high rates of mental/emotional 911 calls and ambulance runs for medical emergencies. Each entity involved identified a coordinatorwithin its leadership to design and implement the MCAT program in concert. These official coordinators developedand implemented training, identified team members from their respective agencies, and made procedural andlogistical decisions with support from the Office of Public Health and Safety. In preparation for launch, abusiness associate agreement between the Health and Hospital Corporation of Marion County, of which IEMSand Midtown are part, and IMPD was created to protect personal health information of those with whom theMCAT teams come in contact.Four MCAT units were formed for the pilot project, each working in 12-hour shifts, resulting in 24/7 MCATavailability. MCAT members have unique uniforms identifying them as both MCAT personnel and members oftheir respective agencies. The teams operate out of a non-emergent van with an MCAT logo on the outside. Eachteam member utilizes their own laptop to access necessary agency-specific information and the MCAT vehicleis additionally equipped with a medical equipment bag, automated external defibrillator and standard issuedIMPD equipment. MCAT may transport individuals to an emergency department, other assessment center, or jailwhen deemed appropriate.One aspect of the MCAT that is especially important to note is that it is primarily a first-response unit, not afollow-up unit. Thus, the MCAT may respond to the scene of a crisis at the request of other first-responders,or self-dispatch upon hearing of a relevant crisis via IMPD or IEMS dispatch radio. However, when necessary,MCAT may also conduct follow-ups with individuals they previously encountered to encourage linkage withservices. The roles of MCAT team members are fluid to allow for them to respond dynamically, but generallythe officers ensure security at the scene; clinicians facilitate mental health assessments and treatment linkage;and paramedics address any medical issues, check patient vitals, and perform assessments related to substanceuse symptoms when necessary. Officers and paramedics are authorized to maneuver the vehicle and any of thethree team members may input information regarding runs into the electronic data collection system.The mission of the MCAT pilot program is to provide a real-time response to individuals in crisis by facilitatingassessment, triage, and linkage with appropriate services. In doing so, MCAT aims to (1) utilize alternatives toarrests of citizens in behavioral health and substance use crises, when appropriate; (2) seek safe outcomes forindividuals, families, and public safety personnel during a crisis; (3) reduce the overutilization of emergencyservices through linking individuals to appropriate support resources; (4) encourage utilization of appropriatecommunity-based support resources as an alternative to emergency room and inpatient hospitalizations; and (5)decrease the time other first response units (i.e., police, fire, and EMS) spend at the scene of a crisis by assumingcontrol when appropriate.MCAT training was primarily developed by Midtown leadership and included classroom learning, stakeholderand expert presentations, site visits, and police ride-alongs. Training included the following topics:5

1. Mental health overview – including CIT training for those who had not yet received it, study of themental health and treatment system, language use and stigma, and relevant legislation;2. First person accounts – including input from individuals with experience in substance use recovery;3. Legal and Risk management – – including discussion of relevant legal and ethical issues of inter-agencyinformation sharing and overview of relevant aspects of the criminal justice system;4. Clinical information – including training related to populations with behavioral health and substanceabuse issues as well as self-care;5. Special populations – including topics related to persons with developmental disabilities and autism,persons experiencing homelessness, the LGBTQ population, older adults, sex trafficking and prostitution,veterans, and youth and family issues;6. IMPD related training – including use of force, situational awareness, drug and narcotic identification,de-escalation strategies and street safety;7. IEMS related training – including first aid, CPR and naloxone use;8. Faith-Based community solutions – including introductions to existing programs aimed at assistingrelevant populations; and,9. Organizational team building.STUDY DESIGNThe MCAT evaluation focused on barriers and facilitators of program implementation as well as outcomesassociated with crisis responses. Barriers are problems, setbacks, challenges or obstacles to programdevelopment or implementation, whereas facilitators are support systems, synergies or bridges that madeprogram development or implementation easier. The evaluation included qualitative data collection from focusgroups with MCAT members, interviews with key stakeholders, and field observations during MCAT responses.In order to examine MCAT crisis responses, CCJR researchers worked with key stakeholders to identify thenecessary data points and develop data collection protocols. The following types of data were collected forthis evaluation.Focus GroupsCCJR researchers conducted two semi-structured focus groups with members of the MCAT units. Each focus groupconsisted of two teams (six members in each focus group) and lasted approximately 2 hours each. There wasa broad interview guide that was used to facilitate these focus groups in a semi-structured manner, allowingfor diversion and probing when appropriate. One lead researcher guided the focus group and two additionaltrained researchers took notes.6

Interviews with StakeholdersCCJR researchers completed nine, one-on-one interviews with MCAT program developers and stakeholders. Thisincluded leadership personnel from IMPD, IEMS, the Indianapolis Department of Public Health & Safety, andEskenazi Health. Interviews followed a structured survey guide, were audio recorded, and lasted approximatelyone hour each.Field ObservationsTwo CCJR researchers conducted observations of an MCAT unit via a “ride-along” which lasted approximatelyfive hours. This field observation began in the MCAT office based at the IMPD East District Headquarters.Researchers then accompanied the MCAT unit in the van to three separate responses and took field notes onobservations.Qualitative data were transcribed and researchers reviewed transcripts using content analysis to identifybarriers and facilitators to MCAT development and implementation. To establish inter-rater agreement,researchers individually coded three qualitative sources using NVivo qualitative analysis software, and metagain to discuss emerging themes around barriers and facilitators and to develop coding procedures for theadditional qualitative sources. Upon individually coding all qualitative materials, researchers met a final time toreview the major themes gleaned. Major themes are those identified by four or more individuals from at leasttwo different agencies during qualitative data gathering.Officer SurveyIn an effort to triangulate these qualitative results, researchers also conducted a survey of officers from the IMPDEast District in which MCAT operates. CCJR researchers developed a web-based survey using Qualtrics surveysoftware to solicit knowledge, attitudes and opinions of officers who share the district with the MCAT units. Thesurvey was anonymous and sent via email to approximately 140 patrol officers who were given one month tocomplete the survey.MCAT Response DataFinally, the research team collected quantitative data on each MCAT crisis response. CCJR researchers developeda database where MCAT members were responsible for inputting information for each response completed.MCAT stakeholders assisted in designing these data collection points.Quantitative data were imported into SPSS for statistical analysis. Analysis largely consisted of descriptivestatistics regarding MCAT responses, but variation in response and outcomes based on key measures were alsoexamined. To this end, CCJR researchers exami

to assess program outcomes. For the MCAT evaluation, qualitative data collection included: focus groups with MCAT units, interviews with key program developers and community stakeholders, fieldobservations with an MCAT unit, and a survey of East District police officers.Quantitative analysis examined MCAT

Related Documents:

May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)

Silat is a combative art of self-defense and survival rooted from Matay archipelago. It was traced at thé early of Langkasuka Kingdom (2nd century CE) till thé reign of Melaka (Malaysia) Sultanate era (13th century). Silat has now evolved to become part of social culture and tradition with thé appearance of a fine physical and spiritual .

On an exceptional basis, Member States may request UNESCO to provide thé candidates with access to thé platform so they can complète thé form by themselves. Thèse requests must be addressed to esd rize unesco. or by 15 A ril 2021 UNESCO will provide thé nomineewith accessto thé platform via their émail address.

̶The leading indicator of employee engagement is based on the quality of the relationship between employee and supervisor Empower your managers! ̶Help them understand the impact on the organization ̶Share important changes, plan options, tasks, and deadlines ̶Provide key messages and talking points ̶Prepare them to answer employee questions

Dr. Sunita Bharatwal** Dr. Pawan Garga*** Abstract Customer satisfaction is derived from thè functionalities and values, a product or Service can provide. The current study aims to segregate thè dimensions of ordine Service quality and gather insights on its impact on web shopping. The trends of purchases have

Chính Văn.- Còn đức Thế tôn thì tuệ giác cực kỳ trong sạch 8: hiện hành bất nhị 9, đạt đến vô tướng 10, đứng vào chỗ đứng của các đức Thế tôn 11, thể hiện tính bình đẳng của các Ngài, đến chỗ không còn chướng ngại 12, giáo pháp không thể khuynh đảo, tâm thức không bị cản trở, cái được

Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. Crawford M., Marsh D. The driving force : food in human evolution and the future.

Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. 3 Crawford M., Marsh D. The driving force : food in human evolution and the future.