Presented by: Shinobu Watanabe-Galloway Steve Spelic

1. Heartland CIT: Toward Comprehensive Evaluation International Crisis Intervention Team Conference 2010 San Antonio, Texas June 1, 2010 Shinobu Watanabe-Galloway Steve Spelic 1

2. Acknowledgement Consumers, families, and advocates who made the implementation of Heartland CIT program possible Officers and agency leaders who have participated and embraced the program Providers and other professionals who have helped the planning and implementation CIT Council members and all other individuals and organizations involved University of Nebraska Medical Center College of Public Health Evaluation Team 2

3. Workshop Objectives Learn about a comprehensive evaluation approach used by Heartland CIT Program Learn how Heartland CIT used evaluation data to improve curriculum and identify training needs 3

4. Heartland CIT Program 4

6. Douglas County: 510,199 (Omaha: 419,949)

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9. CIT Participating Agencies 8

10. Heartland CIT Program Evaluation 9

11. 10 2006 2007 2008 2010 2009 Wksp 1 Wksp 2 Wksp 3 Wksp 4 Wksp 5 Wksp 6 Wksp 7 Wksp 8 Wksp 9 Wksp 10 Wksp 11 Wksp 12 Onsite Paper & Pencil Survey 2007 January 2008 October Follow-up Mailed Survey Follow-up Internet Survey 2009 Jun - Dec Encounter Forms 2010 Apr - May Focus Groups

12. 11 2006 2007 2008 2010 2009 Wksp 1 Wksp 2 Wksp 3 Wksp 4 Wksp 5 Wksp 6 Wksp 7 Wksp 8 Wksp 9 Wksp 10 Wksp 11 Wksp 12 Onsite Paper & Pencil Survey

13. On-Site Survey To evaluate participant’s assessment of Usefulness of each session in terms of content covered and instruction methods used Instructor / instruction Logistics (e.g., facility, communication prior to workshop) Benefits of overall CIT workshop Data has been used to: Improve the overall curriculum (changing schedule, time allocation, new topics added, etc) Refine materials for specific sessions Identify alternative instructors in a few cases 12

14. 13 Onsite Questionnaires - Paper-and-pencil survey - Curriculum / instruction survey Session Survey 1-page survey completed after each session Summary Survey 2-page survey completed at the end of 1-week workshop. Session Survey Example

15. 14 Summary Survey Example

16. Onsite Surveys: Major Findings About 70% of officers reported that they did not have adequate knowledge prior to the workshop Overview of mental illness, substance abuse Older adults / children, developmental disabilities Active listening, crisis de-escalation, suicide prevention Community resources Cultural aspects 15

17. Major Findings (cont’d) More than 90% of officers reported enhancement of knowledge from all 21 topics except 3 (children – 89%; substance abuse 86%; co-occurring 78%) Sessions that received very positive ratings were: Consumer / Family Perspectives Scenario-based training Hearing Voices Site Visits Workshops provided opportunities for interaction and gaining insight about mental illness 16

18. Addressing CIT Class The Chief of Police and the Douglas County Sheriff addressing the class at the beginning of training. Family Perspectives Family members sharing their stories with the class.

19. 18 Hearing Voices & Virtual Hallucination Sessions Two of the most popular sessions of CIT Workshop.

20. 19 Scenario Based Training: Two officers just beginning a scenario and coming to a person’s apartment. The lady in the picture is one of our actors who is portraying a client in crisis. Officers are just showing up “on the scene” to deal with a mental health crisis. Interaction – Outside of Scenario Based Training Shows interaction between actors of the scenario training, an officer, and a consumer (the officer and consumer are the evaluators of the scenarios) - this is occurring just outside the rooms where we do the scenario training.

21. 20 Opportunities for Interactions: During the workshop, especially around scenario-based sessions, lots of interactions and conversations happened among officers, between officers and consumers and workshop coordinator.

22. 21 2006 2007 2008 2010 2009 Wksp 1 Wksp 2 Wksp 3 Wksp 4 Wksp 5 Wksp 6 Wksp 7 Wksp 8 Wksp 9 Wksp 10 Wksp 11 Wksp 12 Onsite Paper & Pencil Survey 2007 Fall/Winter 2008 Fall Follow-up Mailed Survey Follow-up Internet Survey

23. 5-Month Mailed Follow-up Survey of Sep 2006 Graduates (N=20 / 23) (January 2007) I used different questions and handled the person differently than in the past. I have a more calm and open approach with the person in crisis. I gave the party involved more time to process the questions that I asked. I have asked about their book if they have one or if they have a plan as to what we can do to assist them better especially when they have a history of documented mental illness. 22

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26. Internet Follow-up Survey of OPD Graduates (N=24/104) (October 2008) Survey monkey makes it easy to collect and analyze data The downside is low response rate Reminder and notice from the department may increase response rate 25

27. Usefulness of CIT Classes 26

28. 27 2006 2007 2008 2010 2009 Wksp 1 Wksp 2 Wksp 3 Wksp 4 Wksp 5 Wksp 6 Wksp 7 Wksp 8 Wksp 9 Wksp 10 Wksp 11 Wksp 12 Onsite Paper & Pencil Survey 2007 January 2008 October Follow-up Mailed Survey Follow-up Internet Survey 2009 Jun - Dec Encounter Forms

29. 28 Incidence Tracking Form Pilot tested for Douglas Co. Sheriff’s Dept and Omaha PD June – Dec. 2009 135 forms completed

30. Consumer Demographics

31. 30 Reporting Party Known Person? Repeated Call?

32. Nature of Incident (“Check all that apply”)

33. Behaviors at time of Incident (“Check all that apply”) Diagnosis (“If known” / “Check all that apply”)

34. Encounter Outcomes

35. Consumer Characteristics: Sheriff’s Dpt vs. OPD (CIT officers) Similarities: Age, gender, race, diagnosis Differences in disposition of consumers Disorderly /disruptive (Sheriff: 41% vs. OPD:13%) Neglect of self care (Sheriff: 30% vs. OPD: 14%) 34

36. CIT vs. Non-CIT (Sheriff’s Dpt Data) Disorderly/Disruptive disposition Sheriff: 40.5% vs. OPD: 12.7% Female consumers Sheriff: 64.9% vs. OPD: 45.1% 35

37. 36 2006 2007 2008 2010 2009 Wksp 1 Wksp 2 Wksp 3 Wksp 4 Wksp 5 Wksp 6 Wksp 7 Wksp 8 Wksp 9 Wksp 10 Wksp 11 Wksp 12 Onsite Paper & Pencil Survey 2007 January 2008 October Follow-up Mailed Survey Follow-up Internet Survey 2009 Jun - Dec Encounter Forms 2010 Apr - May Focus Groups

38. Focus Groups – Preliminary Results Three focus groups OPD Douglas County Corrections Douglas County Sheriff’s Department Conducted in March – April 2010 4 – 10 people participated for each group Five Questions 37

39. 1. Skills or knowledge areas gained 2. Training needs Awareness and knowledge of mental illness Knowledge of medication Communication and de-escalation skills Attitudes (tolerance and openness) More options for handling crisis situations WRAP plan helped to establish trust Learned about community resources and organizations Continuing education on new medications/ updates on mental illness and treatment Expansion on communication techniques Training tailored to meet specific needs of agencies Intervention with youths Section that addresses mental health of officers (to remove stigma) 38

40. 3. Refresher Course? 4. Youth Specific CIT Program Needed? Follow up within 6 months Continuing education annually Give participants a chance to go back to CIT workshop and help train others Networking opportunities Update contact information for current resources Video-tape session to make the CIT available to officers who cannot attend Yes because it will Remove a current gap in the CIT program Prepare officers for interacting with youth Help remove stigma and labeling of youth, and improve acceptance of youth with mental illnesses Could be a 1-day program that would attract more participants 39

41. 5. Other Suggestions Have a ‘Corrections’ specific class: different needs and many facilities could participate Develop a better policy for dealing with hospitals: need more standardization between hospitals and officers need to know which one is best equipped to handle different situations. More information on interacting with the elderly. More applied, hands-on learning. 40

42. Future Directions Information from multiple sources – Key stakeholders including consumers, families, providers System-level analysis Economic analysis Impact on community 41

43. 42 Community Consumers and Families Criminal Justice Providers Law Enforcement Community