Cenpatico Crisis Protocols with Law Enforcement Agencies in Pima County

Cenpatico and Pima County Law Enforcement- Crisis Protocols Cenpatico and Pima County Law Enforcement- Crisis Protocols Table of Contents

Cenpatico Integrated Care Pima Community Colleges Police City of South Tucson Police Department Department Tucson Police Department Pima County Sheriff’s Department Marana Police Department Sahuarita Police Department NurseWise Tohono O’Odham Nation Police Oro Valley Police Department Department Pascua Yaqui Police Department University of Arizona Police Department

Overview & Purpose The Protocols are guidelines that describe how we will work together to ensure that behavioral health services are delivered to those in need in Pima County when law enforcement are involved. The purpose is to enhance the network and response capability to address mental health crisis in Pima County through ongoing communication and collaborative agreements. These agreements between law enforcement and Cenpatico are intended to develop an environment where there is “No Wrong Door.” No Wrong Door means a person can enter the crisis system at any point or through any ‘door’ and the provider will ensure the person gets the appropriate service. The intention is for this to be seamless for law enforcement. Cenpatico Integrated Care (herein referred to as Cenpatico), their contracted providers and Pima County Law Enforcement System Partners agree to work in partnership on behalf of persons experiencing a behavioral health crisis to ensure they receive the appropriate services and level of care that promotes resiliency and protects the community.

The Crisis Protocols are meant to provide information about the use and availability of crisis services in Pima County available through Cenpatico. These guidelines will be active from date of signature until modified by the involved parties. These guidelines do not create or delegate obligations or financial responsibilities. These guidelines are not a legal and binding contract or Memorandum of Understanding. These guidelines should never 2 Cenpatico and Pima County Law Enforcement- Crisis Protocols override the obligation to provide the most clinically appropriate intervention based on each individual situation nor should they override law or professional responsibility to members or citizens.

Goals of the Crisis System Crisis services are available to any person regardless of the ability to pay.

The goal of the Crisis System is to ensure persons (adult and youth) receive the appropriate services and level of care, stabilize persons in the community whenever possible, support individuals in their recovery, promote resiliency and protect the community. Cenpatico is committed to providing crisis services in collaboration with law enforcement and first responders to avoid unnecessary detentions, use of hospital emergency departments, involuntary psychiatric commitments under Title 36 and other facilities in lieu of community based treatment services.

Crisis at local provider agencies During regular business hours (8-5 Monday through Friday) outpatient service providers will provide crisis intervention to enrolled members who are in a crisis and in the presence of their treatment provider. Provider agencies are expected to have emergency appointments and those agencies serving high need members are required to offer supportive services beyond regular business hours.

Crisis Services The NurseWise crisis line (NW) The NurseWise crisis line is available 24 hours a day, 7 days per week by calling 866-495- 6735. If a crisis mobile team (CMT) is needed the request must be made to NurseWise who will triage and dispatch CMTs. NW will check enrollment status for every call and will track response times.

Crisis Mobile Teams (CMT) There are three CMT providers in Pima County including Community Intervention Associates (CIA), LifeShare, and Pasadera. LifeShare provides specialty CMT services for persons with developmental disabilities and the remaining mobile teams respond Cenpatico and Pima County Law Enforcement- Crisis Protocols throughout the entire County. Beginning 10-1-15, the number of crisis mobile teams available is doubling in order to assure quick response times and serve special populations. CMT assessment and intervention services in the community are available to any person in the county regardless of insurance or enrollment status.

What is considered a crisis? A crisis is measured by the person experiencing it. If the situation exceeds the person’s coping skills, then the person is in crisis.

Crisis Mobile Team Response in the Community Services available A Crisis Mobile Team is available to all persons in the community to assist persons in overcoming a crisis situation, assess for the need for an out-of-home placement, and coordinate safety planning. Crisis Mobile Teams are committed to responding to the community including but not limited to places such as the home, school, church, the streets, and jails. There is no need to bring a person in crisis to the Emergency Room unless there is a medical emergency.

NOTE: CMTs are required to have vehicles to facilitate transportation and field interventions as well as cell phones and laptops for communications.

Crisis Mobile Team Response on the Reservations 1. Cenpatico serves the entire county and is obligated to provide crisis services to any person who requests services in the county. CMTs are permitted to intervene on reservation property. Police escorts can be arranged on reservations as needed. Reservation areas included in Pima County are:

 Tohono O’odham Nation –Police number- 520-383-6412

2. Neither Cenpatico nor its contracted agencies have the authority to remove an American Indian involuntarily from tribal land or petition an American Indian under a Title 36 on Tribal land. In these situations, the Tribal Police should be contacted to ensure the safety of the tribal member.

More information regarding crisis services on the reservation may be described in crisis protocols developed between Cenpatico and Local Tribal Nations. 4 Cenpatico and Pima County Law Enforcement- Crisis Protocols Continuity of covered services during a crisis Cenpatico has a business continuity plan to ensure continuity if operations and services in the event of a crisis or disaster. Cenpatico will be working with local emergency and disaster preparedness entities to ensure Cenpatico is included into the County’s response plans. Separate protocols and agreements will be developed outside of the crisis system protocols.

Involuntary Persons in Need of Mental Health Treatment Per ARS 36-545.06 “Each county… shall provide directly or by contract the services of a screening agency and an evaluation agency for the purposes of this chapter” [Title 36 Chapter 5]. THERE IS NO NEED TO PETITION SOMEONE SIMPLY BECAUSE THE PERSON IS IN CRISIS! In Pima County the County oversees and manages the T36 process. Cenpatico will follow the County process AND will actively triage all calls to see if immediate crisis services are needed. If immediate crisis services are needed, Cenpatico will dispatch a CMT (to the community or the ED) to address immediate needs and offer voluntary treatment options.

Law Enforcement and the Crisis System All First Responder calls are treated as priority and quickly triaged so the crisis can be addressed immediately. Similarly, CMTs are dispatched with priority for all law enforcement requests for crisis services and CMT resources are concentrated in high volume call areas.

Crisis drop off center process Crisis Response Center (CRC)-Law enforcement can take both voluntary and involuntary persons in crisis to the crisis response center. Processing time for a police drop off should not exceed 15 minutes.

Community Bridges Access Point-Law enforcement may drop off voluntary persons in crisis at the Community Bridges Access Point Facility. Community Bridges is able to assess and treat persons for both substance use and mental health related crisis. Community Bridges also offers a drop off time under 15 minutes. In addition, Community Bridges employs EMTs who provide medical triage for all persons dropped off at the facility so there is no need for medical clearance prior to dropping them off. Cenpatico and Pima County Law Enforcement- Crisis Protocols Jail diversion and safety The goal of the crisis system is to intervene quickly in a crisis and stabilize the person in the community whenever possible. Facility based crisis services are also available when a person needs an additional level of support. As of 10-1-15, Cenpatico is adding at least 3 additional facility based crisis services options. The Cenpatico crisis system is a partner with law enforcement to ensure diversion at the patrol level as well as a reduction in the amount of persons going to local emergency rooms when there is no known medical problem. All community members who remain in the community after a crisis have a safety plan developed by the CMT as well as 72 hour follow up after the initial crisis to avoid a subsequent crisis.

Agreements, protocols and Memorandums of Understanding may be developed with the County Jail to further define collaborative efforts to divert persons in need of mental health and substance use treatment away from the jails.

Non-Emergency Requests for Involuntary Evaluation (Persistently and Acutely Disabled or Gravely Disabled) The County process will be followed when a request for a non-emergency request for involuntary evaluation is made. The CMT is always available to address any immediate crisis. In these situations, the CMT can ensure safety plans are put in place until the paperwork is approved.

Revocation of the outpatient treatment portion of an Existing COT If all attempts at outreach and engagement and crisis planning have failed to re-engage a member under court ordered treatment, a revocation of the outpatient treatment may be necessary. The County Process will be followed for all revocations. If immediate crisis services are needed, Cenpatico will dispatch a CMT to address immediate needs and develop safety plans.

Meeting Attendance The strength of the crisis system is in part dependent upon the level of participation of involved stakeholders, system partners, Cenpatico and local agencies. All local Cenpatico contracted provider agencies are required to participate in the Quarterly Crisis System 6 Cenpatico and Pima County Law Enforcement- Crisis Protocols Meeting, hosted and run by Cenpatico. Successful meetings will require active participation and a focus on systems issues. Specific complaints about individual situations should be handled as outlined in the Problem Resolution Process or through Cenpatico Liaisons assigned to work with stakeholders and system partners on individual client issues. All parties agree to have representation at meetings and agree to participate actively in the process.

Problem Resolution Process Pima County Crisis System Meeting Strengthening relationships between first responders and local Cenpatico contracted providers will be a key factor to success in meeting the needs of the community. The crisis system meeting has been established as a primary means for stakeholders, system partners, the Cenpatico and Cenpatico contracted agencies to discuss and examine the current procedures to address and intervene during a mental health crisis. The meeting also serves as a venue to learn about each involved entities system, process, challenges and strengths and to pool resources. The group represents a collaborative effort to identify barriers and strengths in the crisis system and to develop agreements and processes to build on strengths and resolve barriers.

Regular Crisis Team Meetings Cenpatico convenes and runs internal meetings on a monthly basis to follow up with Crisis Mobile Team providers and NurseWise Crisis Line on how the crisis system is working.

Procedures to identify and address joint training needs Cenpatico is committed to working collaboratively with local law enforcement agencies to identify trainings that will be needed as well as trainings that will be continued. Trainings that are available may include but are not limited to AZPOST trainings, CIT training, Crisis Intervention and Stress Management Debriefing (CISM) training and mental health first aide.

Problem Resolution Process Strengthening relationships between first responders and Cenpatico contracted providers will be a key factor to success in meeting the needs of the community. Conflicts between Cenpatico and Pima County Law Enforcement- Crisis Protocols agencies or regarding specific situations are to be handled between the agencies involved. Cenpatico is always willing to assist in this process if called upon to do so. It is agreed that problem resolution is best completed in real time by following the chain of command.

It is agreed upon that for effective problem solving, system issues that present a problem will be discussed in the Pima County Mental Health Crisis Systems Meeting.

The First Responder and Court Liaisons are also a resource for Pima County when concerns arise. The Liaison can help resolve problems related to specific situations as they relate to the crisis system and can also help file official complaints with Cenpatico Customer Service if necessary.

Conflicts or disagreements that arise regarding specific member situations should be handled in real time by contacting a NW Supervisor (for after hours assistance) or the Cenpatico Liaisons (during regular business hours).

Drug and/or Alcohol Use - Services Available for Substance Use Per ADHS Practice Protocol Co-occurring Psychiatric and Substance Disorders, “Assessment begins at the point of clinical contact, regardless of the client’s clinical presentation. Initiation of assessment should not be made conditional on arbitrary criteria such as length of abstinence, non-intoxicated alcohol level, negative drug screen, absence of psychiatric medication, and so on.”

Thus, a person under the influence who self identifies as being in crisis is eligible for the array of crisis services offered by Cenpatico. There is no requirement for the person to reach a certain level of sobriety before being assessed. The only requirement is that the person must be able to physically participate in an interview.

The Title 36 statute does not preclude a person under the influence of substances from being petitioned for involuntary treatment. The statute does require that there be evidence of a “mental disorder” as defined in ARS 36-501.25.

8 Cenpatico and Pima County Law Enforcement- Crisis Protocols Signature Pages Cenpatico and Law enforcement System Partners agree to work in partnership on behalf of persons experiencing a behavioral health crisis to ensure they receive the appropriate services and level of care that promote resiliency and protect the community.

This agreement will be in force from date of signature until modified by the involved parties. This agreement does not identify or delegate financial responsibility. This is not a legal or binding contract or memorandum of understanding.

Effective Date: 10-1-15 Last Revision Date(s): (To be reviewed in one year.)

______Cenpatico Integrated Care Date

______City of South Tucson Police Department Date

______Tucson Police Department Date

______Marana Police Department Date

______NurseWise Date

______Oro Valley Police Department Date

______Pima Community Colleges Police Department Date

______Pima County Sheriff’s Department Date

______Sahuarita Police Department Date Cenpatico and Pima County Law Enforcement- Crisis Protocols

______Tohono O’Odham Nation Police Department Date

______University of Arizona Police Department Date