CSAC 119th Annual Meeting Healthy Counties - Healthy California

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CSAC 119th Annual MeetingHealthy Counties -
Healthy California

• Restoration of Competency
• Jail Based Program
• Saves Time and Money!
• Presented By
• Terry Fillman, MBA, RN, CCHP
• Health Services Administrator
• San Bernardino County Sheriffs Depart

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Jail Bed Day Management

• Incompetent to Stand Trial (IST)
• Average Length of Stay (ALS)
• 2009/2010 the ALS for pre-sentenced IST inmates
  average was 765 days each
• 2009/2010 the ALS for pre-sentenced non-IST
  inmates average was 42 days each

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Incompetent to Stand Trial Issues

• Pre-sentenced time for IST
• Arrest court process to determine IST
• State mental hospital admission wait time
• State mental hospital admission treatment time
• Return to jail determined competent
• Return to court process
• Possible decompensation
• Repeat process
• Adjudication

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Jail-Based Program

• CA Department of State Hospital Pilot
• 20-bed jail-based treatment program
• Incompetent-to-stand trial felony cases
• Open-ended option to transfer to State Hospital
• Open new collaboration partners
• The objectives of Liberty Health ROC Program
• Restore to competency- Fast Track
• Provide less costly housing and program
  alternative to state hospital
• Help reduce State Hospital waitlist and bed
  supply
• Enable patients to receive more timely treatment

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Fast Track Model

• The Fast Lane
• IST defendants are diverse vary in terms of
  speed of restorability.
• Identify separate the rapid responders from the
  defendants requiring long-term treatment.
• Eases congestion heading to the state hospital
  reduce the waitlists.

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Team Approach

• Coordinating with the courts, judges, and DA
• Addressing public defenders concerns
• Collaborating with State Hospital
• Coordinating jail services
• Classification and security issues
• Housing and Programming space
• Custody staff training
• Health Services
• Primary healthcare, medications, labs, etc
• Jail mental health services
• Pre and Post ROC program
• Suicide Watch

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General Statistics to October 2013

• Total admissions 229
• Total discharges 215
• Restored to competency
• Average length of treatment (LOT) for restored
  patients 56 days
• LOT range for restored defendants 14 to 150 days
• Restored in lt 90 days 89
• Competency Findings upheld 98
• Transferred to State Hospital 45
• Average time between admission and transfer
  request 60 days
• Average length of stay (LOS) for transfers 90
  days

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Medication Data to October 2013

• Number of patients prescribed psychotropic
  medication(s) 90
• Choose not to force medications
• Medication compliance incentive program
• Fully compliant 87
• Intermittent compliance 3
• Refusing medication 10
• Compliance not affecting outcome

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Fiscal Outcomes

• California Legislative Analyst Office Report
• Recommended expanded use of ROC programs because
  of ability to significantly decrease costs to
  public sector
• After first nine-months of operation, LAO
  estimated
• 1.2 million savings for the State
• 200,000 savings for San Bernardino County
• ROC provided treatment at a cost of about 70,000
  less per patient.
• Information and statistics from LAO report,
  January 3, 2012 at www.lao.ca.gov

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Evidence Based Outcomes

• 2012 - 2013 ALS for pre-sentenced IST inmates
  average 296 days each
• 2012 2013 Reduction in jail bed days for IST
  469 days each
• gt 93,000 Jail Bed Days Saved since inception of
  Jail Based Restoration of Competency Program at
  San Bernardino County Sheriffs Department!

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Contact Information

• Deputy Chief Greg Garland ggarland_at_sbcsd.org
• Health Services Administrator Terry Fillman
  tfillman_at_sbcsd.org
• ROC Executive Director Kevin Rice
  karice_at_sbcsd.org