Yellow Line Project 2017 Quarter 2 Report

This information contained in this report is a summary of Blue Earth County’s Yellow Line Project for the dates of April 1, 2017 through June 30, 2017. This is the second of four reports to be issued in 2017.

Introduction

The Yellow Line Project has evolved significantly during the time period of this report. Yet, it has not wavered from the original design which is to provide an early response to individuals with acute or chronic mental or chemical health problems who have become involved with law enforcement and are not a risk to the community.

This quarter’s major focus was implementation of a 24-hour, 7-days per week response located within the pre-booking area connected to the Blue Earth County Jail. Concurrent to implementation, development efforts remained at a fast pace to assure that the project would remain viable long term. Most notably were legislative changes to support Medicaid reimbursements, the kick-off of a data dashboard to show project outcomes, and continued conversations regarding leadership and inclusion in the project.

Major Project Milestones / Successes

Many project milestones and successes were reached during the second quarter of 2017. This is a listing of the items:

  • Implementation of a 24/7 Screening Team: Plans were underway to begin 24/7 staffing of the pre-booking area to be effective on April 3, 2017. This goal date was agreed upon by all partners, although it was noted as being very aggressive given the status of planning and staffing. While our planning and workflows were in place, ready for an April 3rd start date, our staffing patterns were not. As the Horizon Homes mobile team stepped up to the challenge of staffing a team 24/7, enough time was not given to them to do so in a way that supported long term staffing viability. It was agreed by project leadership that we would delay the start until later in the quarter. The Community Based Coordinator (CBC) would formally enter into an ongoing pilot status on weekdays from 8:00 a.m. through 5:00 p.m. The delay was negotiated, and a new 24/7 start date was set for May 12, 2017. The Blue Earth County CBC staffs the pre-booking area during regular business hours, and also follows up with all individuals who are diverted to assure follow through with their My Yellow Line Plan. The mobile team provides staffing response, either on site, or by physical response for all other times of the day. Further efforts are underway to determine exactly what kind of staffing pattern is most workable into the future, for both volume management and the workforce resourcing.
  • Mobile Services Integration: The linkage with Horizon Home’s Mobile Team has been critical, and further underscores the reality that we are working with one population, regardless if they are in the jail or in the community. A conversation held on May 19, 2017 with Carol LaBine and Dominique Jones affirmed this belief, and assisted in the integration process of what was once thought of as separate missions between the Yellow Line Project and the Mobile Crisis Team. Early in the quarter, a comparison of the forms developed for the YLP and the Mobile Crisis Team were compared, and the result was that both forms were very similar. In fact, only three areas of difference existed. Leadership felt that the screenings could be combined so they could be interchangeable, as the screening component was virtually the same for the CBC or Mobile Team member. Additionally, having a member of the mobile staff cover non-business hours of the pre-booking area to conduct screenings has been a substantial benefit to the Mobile Team utilization in the community overall. Data has shown a dramatic increase in volume of utilization of the Mobile Team by law enforcement since Horizon Homes joined the YLP mid-first quarter 2017 (see below). Leadership attributes this rise to the relationships being built in this multidisciplinary effort. Early in the planning process, theories circulated as to where possible increases in service delivery would occur. Given the focus on pre-booking, many assumed dramatic connections would be made at the site of pre-booking, which has occurred. However, there was hope that officers would also use their new relationships to request the presence of the Mobile Team during calls that were not due to criminal activity. This appears to be the case. While leadership is pleased with the integration that has occurred thus far, more efforts are planned to continue the “One Mission, One Population, One Team” philosophies that have been adopted.
  • Community Based Coordinator and Jail Staffing: In the original proposal, we envisioned one social worker, now known as the Community Based Coordinator, and one nurse as a central staffing component to this project. Attempts to hire a nurse for the specific role planned did not produce a viable candidate, and in turn, it demonstrated that we may run into workforce issues with this type of role. This reality only further solidifies the unification of Mobile Services with the YLP, as there are only negative outcomes for all when we have competition with such a slim workforce. We have also found that we can get medical consultation when needed, which minimizes the need for nursing services to be readily available. As the CBC has gained volume with screenings and the intensive follow-up necessary to create a My Yellow Line Plan, the work initially being done in the jail (past the yellow line) has taken a backseat to the YLP primary duties. As expected when a service lessens, the effects have been felt widely from the jail, to Human Services, and beyond. The coordination efforts to get people linked to services once incarcerated has demonstrated value beyond initial expectations. The streamlined communication and case planning were a direct connection to our reduced AMRTC costs. The Behavioral Health unit experienced delays in communication related to civil commitments, Rule 20 evaluations, and chemical health services. It was apparent that continuing to push the CBC role upstream to do prevention did leave a gap for those individuals that were not focus of the YLP’s diversion efforts. Human Services and the Sheriff’s Department has submitted a formal request to the Blue Earth County Board for permission and ongoing support to add a full time social worker within the jail. Many discussions occurred during the second quarter regarding this position. At the close of the quarter, this position is being considered with all other position requests for 2018. Even with grant funding secured for 2017, the ongoing nature of this request has caused delays in decision making. The intention is that this position would also work within the pre-booking and jail settings alongside the CBC. Additional value added through this position would be coverage for the CBC to assure continuity of care, as well as to be the linkage with the Mental Health Center as they expand their clinical services to individuals in the jail.
  • Post-Arrest Community Based Coordination: Bills in the Senate and House for Post-Arrest Community Based Coordination continued to move through the Legislature during the second quarter. The Senate adopted the bill in their final recommendation, but the House did not. Ultimately, the language was adopted in the final compromise bill signed by the Governor. The champions in the Legislature included Senators Rosen and Benson and Representative Cornish, among others. The agreed upon language can be found in the final bill in Article 4, Section 36. The Department must now seek a federal waiver for this service. This was a significant breakthrough for the project, as it will provide a revenue stream for the CBC’s work once a diversion is in motion. It is estimated that approximately 70% of the CBC’s time will be spent in service coordination efforts of those diverted from incarceration and/or charges. This also helps other projects like the YLP be financially viable from a revenue standpoint, and not just a costs-savings perspective.
  • Law Enforcement Trainings: Commander DuRose of the Mankato Department of Public Safety and Captain Barta of the Blue Earth County Sheriff’s Department developed a training curriculum to inform all law enforcement agencies and their personnel of the YLP practices and expectations. All personnel law enforcement from both agencies have been trained, as has the State Patrol and many smaller law enforcement agencies from the surrounding communities. Interest has been wide on this project, and adoption has been as expected. Because this project relies on law enforcement’s willingness to look at alternative options, known as “officer discretion,” some personnel are more apt to divert than others. This willingness is growing rapidly as officers are becoming more accustomed to having a conversation with the screener regarding options, or since they have seen project successes. Following a diversion, our CBC submits a le[er to the officer indicating if the person did or did not successfully complete their My Yellow Line Plan. In response to receiving a letter of successful completion, the YLP received written correspondence back from a local law enforcement officer. He wrote, “Thank you for the update on R., much appreciated. I saw in the letter the "recommendation" of R. not being charged with any criminal/traffic offenses, which I completely agree with. Ultimately, I believe the best option for her was what your program had offered. Thanks again, stay safe!”
  • Language Development: Developing a common language has been key to the successes of this project. Many times we have stumbled upon the creation of a new phrase, understanding, or title. One of the most important communication developments has been with defining “diversion.” When diversion is referenced, we quickly learned in the pilot phase that diversion meant more than one thing. When a person agrees to the YLP to prevent incarceration but charges still remain, it is called a Placement Diversion. When the plan is for charges to be held for dismissal and also prevent incarceration, it is called a Charges Diversion in our terminology. Additionally, we are witnessing law enforcement speak to one another about their use of the services offered by the YLP, they open say they “Yellow Lined” an individual. These language developments are examples of how the law enforcement culture is changing, rather quickly.
  • Unified Data Plan: Houlton Consulting provided a report summarizing the work that was conducted primarily in the first quarter relative to key performance indicators and a plan for data collection and dissemination. The resulting report identified that we were collecting most of the necessary data elements needed to track measures that inform business practices and display systemic outcomes. The report from Houlton Consulting is attached.
  • Data Dashboard: The YLP leadership convened a group of individuals from all YLP partner organizations to work on the development of a Data Dashboard for real-time use by all project partners. The report from Houlton Consulting served as the framework for this build. Much of the build out has occurred in the second quarter, with hopes that the dashboard will be live mid-third quarter. A sampling of the visual representation of data from this effort is included in this report. Significant work has been done to assure stability of data sources, and the reliability and validity of the data elements. The project team is currently building the platform within Microsoft products, but is also currently exploring the possibility of purchasing Tableau. One deliverable is that the data dashboard must be accessible to all members of the YLP leadership, regardless of agency. Using non-identified client data at the dashboard level has helped to overcome some barriers.
  • Statewide/National Project Interest: Interest in this project remains high. Early in the quarter, we received a direct request to apply to present at the Minnesota Association of Community Mental Health Providers (MACMHP) conference. Four members of the YLP leadership team will be presenting at this conference on September 13, 2017. Following our January brief presentation at the Association of Minnesota Counties (AMC) conference, AMC requested a presentation of the YLP at their May FUTURES meeting. This meeting is a[ended by a select grouping of county commissioners, administrators and department heads across the state to focus on innovative trends and options to consider for county business. This presentation generated a significant amount of dialogue which has continued for months. Multiple counties have requested further information, conversations and consultation about how to initiate a project like the YLP. Some of these counties have taken steps to align leadership on this topic. Additionally, the YLP has gained attention from both political parties and legislators from across the state. Nationally, the NACo sponsored Stepping Up Initiative highlighted our project during a national phone conference on June 15, 2017. Feedback received is that the YLP project has a strong basis of data and outcome measurement, and the stage of implementation has progressed at a much faster pace than many projects across the nation. The YLP primary practices are placed in a unique spot in the arresting workflow, whereas most diversion programs focus on pre-trial and discharge planning efforts.
  • New Partnerships Considered: Throughout the development of this project, leadership has expressed a desire to include every organization interested at some level, but to maintain the leadership partners to only those necessary in an effort to reduce scope-creep. Essentially, everyone at the leadership table also joins with the assumption that they will do their part to resource this effort as well. The second quarter’s implementation efforts highlighted possible opportunities with other departments, organizations, or agencies. Specifically, some of the details surrounding charging and the legal practices thereafter could be benefited by participation from the County Attorney’s office. A request has been made for a representative to participate in this project. Additionally, warm transfers from pre-booking or the jail are being made to our local hospital. Mayo Hospital has approached the YLP to inquire how they may be a partner at the table, as they are witnessing possible advantages of working collectively for the needs of this shared population. Finally, efforts are reemerging with the leadership of our local detox unit, and we hope to begin conversations that benefit this shared mission.
  • Stabilization Bed Planning: The increased volume of the Mobile Crisis Team and the South Central Crisis Center has forced Horizon Homes to explore a new physical space for their services. The current building is at capacity, and they are not able to expand the building’s footprint due to land limitations. Plans are underway for Horizon Homes to purchase land co-owned by the City of Mankato and the County of Blue Earth to build a new 16-bed crisis residential unit and adjacent office space for their Mobile Crisis Team. This proximity is ideal for the needs of the YLP, as a response by the Mobile Crisis Team could occur within minutes. Horizon Homes’ leadership has included YLP leadership in the development and planning of the building space and programming design. Given the extremely high volume of people presenting to pre-booking with mental health needs, this resource is sure to be sought after.
  • Operational Toolkit: Most of the work for the Operational Toolkit occurred in the first quarter. During the second quarter, final reviews, formatting and printing occurred on all of the associated forms. One additional form was created so that a person may be released to a responsible party as part of a diversion if the person is suspected of being under the influence at the time of the diversion. Workflows of all forms has been developed, along with expectations on quality and communication. All forms have also been built within the Mental Health Center’s electronic health record, and all interactions are being documented within a separate instance of CareLogic, the electronic record.
  • Video: Due to the significant number of inquiries of the YLP, a decision has been made to create a video account of the project so that the information may be more easily shared amongst interested parties. Work with a professional videographer is underway to produce a series of videos for this project. An informational video will showcase the work of the project to provide the viewer with an understanding of the project’s mission. Two training videos will be completed to take the place of the time intensive face-to-face training of all law enforcement personnel and Mobile Crisis Team members. Lastly, a series of small videos will be compiled to demonstrate the “how to” pieces of this project, including forms, workflow, communications, decision-making, etc. The bulk of the work for this project will take place in the third quarter.

Barriers/Challenges/Opportunities

  • Mobile Crisis Team: Although great gains have been made, we still have opportunities ahead of us to further integrate the mobile team with the YLP. Mobile-trained staff have been a critical addition to the YLP process, and we’ve seen great gains in the community because of this. The mobile team has responded to more crises in the community than prior to YLP involvement, based primarily on local law enforcement using the mobile team. Symptoms of programmatic confusion are mostly in language development and data tracking. It is easy to separate, or silo, the community-based mobile nature from that within pre-booking, but that also furthers the divide. We need more conversations regarding data tracking, to demonstrate the overall community impact, regardless of where the crisis intervention occurs. One other point of confusion has been the screening form. In our “one population, one community, one mission” approach, we are still operating under two separate sets of forms. One set exists for the traditional mobile team’s response, and another set of forms exists for the mobile staff in the pre-booking area of the jail. Leadership has discussed the notion of modeling the integration through the creation of one set of forms to use during a screening, and include the YLP section as an “add on” if there are criminal activity concerns. This would further advance the YLP philosophies within responses in the community, the mobile team has expressed positive outcomes with the increased referrals from law enforcement, but they have also admitted that when responding in the community, law enforcement may be more likely to not consider any charges. While this may be helpful in some instances, there are others where the option of charges may be a valuable tool to leverage cooperation in voluntary services by the mobile team. The addition of the YLP philosophies the entire continuum of crisis services is a concept that project leadership must further consider.
  • Mobile Crisis Training: During the implementation of 24/7 screening coverage, extensive time and attention was dedicated to the training of law enforcement personnel from all agencies. In hindsight, leadership should have also done more to support the training of the staff that provide the screenings. While most of the workflows have been executed seamlessly and without concern, we have learned that individual style must also blend with protocols. Efforts are being made to design core duties and standards of this role, so as to eliminate any need for assumption or question.
  • Jail Clinical Services: Since the leadership’s initial self-assessment on the Continuum of Care document, it was noted that specialized clinical services for mental and chemical health were lacking in the jail. Ironically, Blue Earth County has extensive resources available to its residents through the Blue Earth County Mental Health Center. Evolving those services and expanding to provide clinical services within the jail has been a part of the YLP design from early on. Yet, we appear to be struggling to make this a reality. Part of the reason for the delay is due to leadership resourcing, in that other priorities with the project and other basic job duties are taking lead. However, given the roles of the CBC and Jail Social Worker, or possible blend of the two, the availability of that position has been the primary reason for the delay in designing clinical specialty services to individuals within the jail. The new staff will be the primary connection to facilitating the needs of people within the jail with the resources available within the Mental Health Center. Early advancements were made to obtain the appropriate technology to assure a swift face-to-face response could occur, but the workflows are not able to be put into place for lack of staff resource to do the communication work. It is our hope that significant strides will be taken in this area during the next quarter.
  • Grant Funding vs. Ongoing Strategic Planning: Although having grant resources has allowed us to think and plan about rapid programmatic changes, such as staffing, the reality that we function in a system that needs to have long term financial assurances in place has meant we have been slower to move on some developments than others. Approaching hiring practices from a “grant-funded, temporary” lens is much different than what “full time, permanent” affords us. Capturing a pool of qualified candidates is very difficult when positing for the former option, and our preference is to do the latter. This reality makes the rapid cycle (Plan, Do, Check, Act) of most innovation and program development grants much more challenging when the goal is to have a position for the long term. The grant has indeed offered us many opportunities that we wouldn’t have had without it, but we must start switching to the reality that this program will no longer be grant funded, and must be sustainable.
  • Splitting Charges: We never believed that we would move into the implementation of newly created YLP philosophies and get everything “right,” 100% of the time. However, it was our goal to follow policies and protocols at 100% accuracy. In an effort to be creative, screening staff and law enforcement “split” charges in one instance. This means, a person was charged with more than one offense, and the officer diverted one charge, but had the other remain as is. This practice was determined to be an unfavorable one, as the ripples it sends into the legal arena are not easily managed. The County Attorney’s office advised to refrain from such “splitting” of charges. Training has been done, and this expectation has been documented and posted for all screeners to remain acutely aware of.
  • Central Call Line: One attempt to streamline communication and provide a direct line for resources to law enforcement was the creation of a central call line for the YLP. The central call number is given to all law enforcement, to use when they are bringing someone to pre-booking, and also to use if they need to consult on a situation. In theory, this has many, substantial benefits. In reality, law enforcement has been slow adopters to using this number. In some instances, it has been confused with other phone numbers. More training and strategizing surrounding this communication tool needs to happen in order to achieve the intended results.

Program Data

The focus on moving raw data into useable, real-time and visually understanding formats has been a significant focus of this quarter. For the purposes of this report, a sampling of some of the data dashboard is included in the final pages. As noted earlier, we are in the design and build phase of the data dashboard, and the ongoing platform is currently being considered.

The project data thus far has led us to some interesting trends, conclusions, outcomes and questions. The most notable are listed below:

  • In the second quarter, 13 people were diverted from jail, and possibly charges. As a sneak peak, July’s numbers are trending higher
  • The number of diversions increases as the number of screenings are completed
  • Law Enforcement is more apt to do a placement diversion with charges remaining than diverting away all charges, at this time
  • Information collected by the screener is more accurate regarding a person’s mental and chemical health history than that of the information collected by the jailer during booking with the standard questionnaires. People are substantially more forthcoming with the screener than jail staff
  • 81% of people screened shared mental health, chemical health or MI/CD history in June
  • Law enforcement utilization of mobile services has increased dramatically since their participation in the YLP. The increases are directly tied to the time-frame of YLP training to law enforcement.
  • Mobile response services are at an all-time high for utilization.
  • Although little focus has been on detox to date, projections show this to be the second year with decreased spending.
  • Jail bed management is a real thing – jail expansion is a threat many jails face. The YLP appears to have some impact on jail population, yet it is too early to determine just how much impact is being realized.

As we know, data can only tell a portion of the story. To understand the individual impact, a selection of personal stories are included:

Person # 1 – 49 year old male, arrested and detained for disturbance-related charges, was uncooperative with the officer while in the field and while being transported to the jail. Person came in under the influence and refused to submit to a personal breath test. The Yellow Line Project Screening was completed with the individual while in pre-booking. Person was cooperative with the CBC, he was willing and wanting to participate in the Yellow Line Project and agreed to the standards. Officer was not trained or aware of the Yellow Line Project but was receptive and agreed to allow a diversion. However, prior to the arrival of the officer and person into pre-booking, the officer had made arrangements and still felt the need for the person to be admitted into detox. While at detox, CBC completed the My Yellow Line plan identifying three goals and arranged for Rule 25 to be completed in detox. Person was released and entered into a residential co-occurring facility within one week. CBC coordinated urgent care psychiatry services through the Hub. Person successfully completed the residential program and transitioned into a local medium intensity residential treatment. Person is now established with a mental health professional and psychiatrist. Person actively seeks employment and is a[ending more than required AA/NA and other support meetings. Person successfully completed all three goals of their plan.

Person #2 – 28 year old male, arrested and detained for theft charges, while speaking with the community based coordinator, he readily admits that his poor decisions are causing him extra problems. Person was cooperative with the screening intake as well as with the officer during the arrest. Person was cited for theft and diverted from incarceration. This allowed person to ensure no disruption, temporary or permanent, at person’s place of employment. Community Based Coordinator has met with person to complete the My Yellow Line Plan. At this meeting, it was discussed with person to think about potential consequences of their actions, the importance of being honest with self, family and others. Person received education on local employers and temp agencies to assist person with extra income. Person had significant other involved with case planning.

Person #3 – 24 year old male, arrested and detained for multiple driving violations. Person is a single working parent of four children and is on probation for several DUIs. Due to person’s cooperation and information provided from the screening, local law enforcement was agreeable to diversion from jail. Person developed My Yellow Line Plan and is working to successfully complete their goals.

Person #4 – 23 year female, arrested and detained for driving violations. Local law enforcement contacted the Community Based Coordinator for assistance and possible diversion. Person was driving across states in a severely damaged vehicle to be with a friend that she had never meet in person. Law enforcement had concerns about the person’s story and over all well-being. Community Based Coordinator met the person and law enforcement at the Salvation Army to complete the screening intake. Person denied any history of mental health and/or chemical dependency however appeared to be “running” from something. Multiple cues were present signifying possible MI or CD issues. She appeared to be struggling with even the most basic of personal needs. Community Based Coordinator arranged for person to enter the South Central Crisis Center to assess mental health crises for the night until person could be transported to Rapid City, South Dakota by Land to Air. After further conversation with the likelihood of this plan in Rapid City, South Dakota not being successful the decision was made to have person take Land to Air that day back to Minneapolis. Local Law Enforcement was agreeable to said plan and agreed to not charge the person with driving violations. This is beneficial to local county court as well as the individual. Person has no outstanding court involvement or need to return to local area.  Since person left Blue Earth County, person is back home with parents and reunited with their child. Person completed all goals of their My Yellow Line Plan and a successful discharge letter was sent to the person and local law enforcement. Local law enforcement sent a thank you letter back to the YLP team thanking the CBC for her involvement, expertise and swift care coordination efforts.

Person #5 – 29 year old male, arrested and detained for a driving violation, person was screened in pre-booking and the officer agreed to hold charges with the intent that person met with Community Based Coordinator to complete My Yellow Line Plan. (Person had been cited and convicted for three separate DWIs). Person is a full time college student who is double majoring, currently works and is completing a voluntary internship to further his experience. Person and Community Based Coordinator have meet and completed the goals which he is working towards. Person has applied for ignition interlock grant to assist with the cost of installing the ignition interlock device which is the next step for person to obtain their driver’s license.

Summary:

All five persons were diverted from jail, 2 of the 5 have regular charges in the court system. Two have charges pending/held over their head, and if successful will not be charged. One successfully completed their plan and has no risk of having that charge come back. All were diverted from jail which saved county money and resources. Three of the five are employed and were not at risk of losing their employment due to involvement with YLP, which they would have been otherwise without YLP involvement.

Plan for Next Quarter

Quarter three will likely see a number of programmatic adjustments to attend to areas of quality, refinement, and long-term planning. By the end of the third quarter, the 24/7 service will have substantial data from which to make decisions from, and truly highlight what is working, and what is not.

Some specific areas of focus will be:

  • Creation of a series of videos to:
    • Serve as an informational toolkit for other counties or agencies exploring such a program,
    • Provide consistent training to law enforcement personnel and the screeners in pre-booking, and
    • Provide a “how to” snapshot of all pieces of the Operational Toolkit for use by other agencies or programs.
  • Providing a number of community engagement events and conference presentations. Currently scheduled for quarters three and four are presentations to:
    • Mayo Clinic Health Systems, medical and administrative leadership
    • All Blue Earth County Human Services personnel
    • NAMI Annual Conference
    • Minnesota Association of Community Mental Health Providers Fall Conference
    • Association of Minnesota Counties Annual Conference
    • Stepping Up Initiative: Midsize Counties Forum
  • Creation of a full financial plan to address the programmatic and financial sustainability of the project
  • Refinement of the screening form, to continue the integration process by using a “one form” methodology to crisis services
  • Work with Horizon Homes to jointly design a strategic plan to stabilize the involvement of the mobile services team, and to address issues surrounding workforce sustainability, and
  • Expand our partnerships as we entertain involvement of other community leadership.

In closing, this project is an extremely rewarding venture for the individuals involved in the YLP, and we are pleased to see and feel the positive systemic and personal impacts of this project. Blue Earth County sincerely thanks the Department of Human Services for their willingness to invest in the innovative thinking, leadership and risk-taking of the Blue Earth County YLP project team.