Exploring Technology Solutions
- So welcome, good afternoon. We're really excited to have you all join us for today's webinar. Our national webinar today is presented by SAMHSA's GAINS Center with the support of SAMHSA, which is the Substance Abuse and Mental Health Services Administration. And our webinar today is exploring technology solutions for criminal justice, substance use treatment and mental health agency partnerships. And we'll be hearing today from Beya Thayer and Sean Gunderson and I'll introduce them shortly. But first, I would like to just cover a few introductory items.
I am Dr. Melissa Stein and I go by the pronouns she, her. I'm a senior research associate at SAMHSA's GAINS Center and Policy Research Associates. And you'll see a chat box at the bottom of your screen or an icon for chat box.
Feel free to use that to introduce yourself and share where you're joining us from. I am joining from Charlotte, North Carolina. We can move to the next slide. So the views, opinions and content expressed in this presentation and discussion do not necessarily reflect the views, opinions or policies of the Center for Mental Health Services, the Center for Substance Abuse Treatment, the Substance Abuse and Mental Health Services Administration or the US Department of Health and Human Services. And throughout the presentations, we welcome your questions in regards to the presentation or the technology. Please type your questions in the Q and A pod and you'll see the icon for the Q and A pod at the bottom of your screen.
At the conclusion of the presentations, we'll cover as many questions as time permits. We'll also be conducting a couple of polls throughout the event and really appreciate your participation. When you see a poll pop up, just select and submit your choices and that you should have just seen a poll pop up right now. And the webinar is being recorded and slides and a notification about the posting of this recording to SAMHSA's YouTube channel will be shared with everyone who has registered for this event. We'll also be sharing a certificate of attendance for download at the end of today's webinar. Please note that this certificate is for your personal portfolio and we're not able to offer CEU credits.
We do have ASL interpretation for today's event. Our interpreters today are Pamela Mitchell and Dave Gratzer. We also have live transcript available. To view live captioning, click Live Transcript CC and then select Show Subtitle. Just a quick look at our agenda today. We're gonna open with some remarks from Jon Berg on behalf of SAMHSA and then move into our presentations with Beya Thayer and Sean Gunderson.
And at the conclusion of the presentation, we'll have time set aside for Q and A. But first, I'd like to turn things over to Jon Berg, who is a senior public health advisor at the Center for Substance Abuse Treatment at SAMHSA. And he has some opening remarks for us, Jon.
- Thank you, Dr. Stein. And I would like to welcome everyone to today's webinar, Exploring Technology Solutions for Criminal Justice, Substance Use Treatment and Mental Health Agency Partnerships. Thank you for taking time to join us today. I believe that you will find today's webinar very beneficial. SAMHSA is pleased to provide this webinar that focuses on the importance of finding technology solutions for your organization and those you interface with.
SAMHSA believes it is important that the best care and services are provided to individuals that are served by the criminal justice system, substance use treatment providers and mental health partners. For this to happen, finding effective technology solutions to work across these systems is highly important. Technology can equip agencies with the most current, accurate information and foster an organized process for storing and analyzing data across multiple systems and organizations.
While having an integrated technology solution is ideal for supporting data collection and sharing, criminal justice agencies, substance use treatment providers and mental health partners often don't know where to start when considering the development or adoption of technology solutions for their own systems. Our presenters today will provide information and helpful considerations for organizations to explore when trying to determine the best technology solution for your agencies and partnerships. The presenters will cover a number of technology solutions available in the field that organizations and their partners can use to drive interoperability and support informed decision making for their community. You'll also gain insight during this webinar from an organization at the local level regarding their approach and lessons learned in selecting and implementing their own technology solution for information data sharing. Our presenters today, Beya Thayer and Sean Gunderson, will discuss aspects of technology that can support data collection, information sharing and collaboration.
I want to thank them for sharing the knowledge and expertise with us today about this very important topic. And I also wanna thank the GAINS Center staff for their work in developing and facilitating today's webinar. Oh, and I also wanna wish everyone a wonderful and safe holiday season that we're approaching very quickly. At this time, I'll turn it back to you, Dr. Stein. - Thank you, Jon.
And now I'd like to introduce our speakers for today. Beya Thayer is a systems advocate supporting enhanced collaborations among multidisciplinary teams and enjoys the opportunity to work as the director of Behavioral Health Services for the Yavapai County Sheriff's Office as well as the executive director of the Yavapai Justice and Mental Health Coalition. And Beya works to develop and implement strategies that lead to the long-term and sustainable involvement of community institutions, organizations and individuals within the intersections of justice, mental health, substance use and social determinants of health. And her goal is in addressing partnerships, systemic change and affecting policy on both the micro and macro levels. Sean Gunderson is an executive leader with over 20 years of experience creating business value through design, development and application of technology as a business solution for national and international organizations. And he is the founder of iTether Technologies, a client engagement digital solution that provides coordination of care for clients across the justice, health and social domains.
And he has participated in NIH-funded research projects to measure the effects of applying digital health solutions to engage individuals with opioid use disorders. And he's a co-author of Delivering Information about Medication Assisted Treatment to Individuals who Misuse Opioids through a Mobile App. This was a pilot study published in the Journal of Public Health in 2020. And he served as a co-leader of the team that won a Phase I award for the Addressing Opioid Use Disorder in Pregnant Women and New Moms, which is a Grand Challenge created by The Health Resources and Services Administration's Maternal and Child Health Bureau. Prior to his work in digital justice and help, he spent 15 years providing technology and business solutions to major law enforcement agencies across North America.
He designed, developed, implemented and trained local law enforcement staff on business intelligence solutions for crime analysis at 30 agencies across North America. And while researching data analytics for law enforcement, he designed the Officer Wellness Learning System as a proposed system to assist the early detection and treatment of trauma related injury that negatively impacts first responders. So you've learned who will be speaking with you and presenting to you during this webinar, but we'd also like to learn a little more about you all who are joining us today. Thanks so much for sharing your information in the chat.
And it looks like a majority of you are joining from urban settings, about 51% of you with a pretty even breakout of folks joining from both rural and suburban locations. And we do have a very small handful of people joining from tribal lands such as Reservations, Pueblo or Alaska Native villages. And then in terms of organizations, let's see, looks like the majority of you are joining from a government or policy organizations. We've also got about 20% of you joining from academia and research and then we've got a good representation from community-based providers, corrections, probation, parole, as well as the judiciary. So thank you so much for taking time out of a busy holiday week to join us for today's webinar. Without further ado, I'm gonna turn it over to Beya Thayer to kick off her presentation, Beya.
- Thank you, Melissa and Jon, for the great introduction and for inviting Sean and I to come and speak with your colleagues from around the country. This is quite a privilege to be able to do so. Yavapai County, I'll begin there, is in Arizona.
It's of north central above Maricopa, which is the Phoenix area. We are geographically the size of the state of New Jersey and we have half or a quarter of a million people in that big area. We have a mountain range that goes down the center of the county. Lots of different rural towns and cities make up Yavapai County.
Our big main jail is on the eastern side of the county, but probably about 60% of the arrests come from the other side. Like I said, there's a mountain range that goes down the middle of it. We don't have public transportation to get from one side to the other. The jail is not in the middle of a city or a town. We're three miles from an interstate that goes north and south through the state. And then we're about 15 miles from the another town, Cottonwood, as well.
So when people do get arrested and come into our facility, they're left out in the middle to try to get themselves back to where they are, which is part of the reason for some jail reentry coordination and also part of the reason for a lot of coordination around first responders and the crisis response system as well, because we are so rural and spread out. So I wanted to give you a picture of where Yavapai County is. The Yavapai Justice and Mental Health Coalition is a coordinated community response to address the needs of our community members here who have behavioral health needs and intersect or might intersect with the justice system.
And the Justice and Mental Health Coalition is under the umbrella of the Sheriff's office, but as I said, it's definite partnership. We work with adults and youth and children partners and I'll get into a little bit of that later. And then the Behavioral Health Services is also, of course, under the Sheriff's office and that also oversees inmate services division within our jails and a lot of the jail reentry coordination that we have going on. So the reason why we put all this together, as I going to explain a little bit, of course, about our database and our data system that we have pieced together throughout the years.
So this is a preview of what we're able to pull from that data system. But just to give a why, for the reason why our Sheriff's Masher and now Sheriff's Rhodes took such a huge interest in designing the coalition and designing our reentry coordination program. The folks that have been screened by our inmate services division and answered and disclosed some answers, 53% of individuals over a two-year period disclosed that they have moderate to high mental health risk. We have 40% of the people who answered the questions for the adverse childhood experiences have four more ACEs under their belt. And then we know that 48% of the individuals who have been booked into our jail disclosed having moderate to high substance use. So, of course, this is the baseline to the reason why the Sheriff's office wanted to pull together all of our systems partners to tackle what is happening.
We also know from the answers from our folks who have been booked in that a quarter of our individuals do not have consistent and safe housing. We have a third of our individuals who are unemployed. We asked that transportation question, because like I said, we're out in the middle of nowhere. We have a Veterans Administration here in Yavapai County. So looking to see who's a veteran can be a huge risk factor for folks who have some trauma going on and knowing where we can connect them back with.
So it might seem odd that the jail could be the center hub for trying to pull all of these different entities together in an attempt to keep people out of the jail. Of course, prevention and going up river is our goal. But here at Yavapai, and I'm sure this is the way around the country for a lot of jails, you can see what's happening throughout your community by the people who are getting booked in to jail and how long they're staying in jail and what happens throughout the different courts.
So we have a superior court that has seven divisions, we have about 26 lower court divisions. We can see now what's happening in the different areas of the corners of the county. We know out of our 12 law enforcement agencies, which ones are more apt to arrest somebody, because they are sleeping, homeless underneath the bridge and don't have somewhere else to go and there might be some disorderly conduct going on. We understand a little bit more what's going on with our child safety or mental health treatment just by this viewpoint of who's coming in the jail, how long they're staying, what's happening as they're cycling back and forth and recidivating and coming back. So the idea was to get the coalition together with all of these partners, adult and youth, like I said, and really try to look at who are the individuals that we share, who's the friendly faces that we have, what are the processes that we have.
One of the very common ideas that folks have in rural areas is that we don't have resources. We don't have resources like they have down in the Phoenix area. We don't have the resources like they have in bigger cities and in bigger counties.
But what I have found out throughout the years and working with other counties as well is a lot of times, you do have the resources. You just don't necessarily have the processes and the same language to get from point A or help a person get from point A to point B. Mental health and criminal justice, they can say the same words and they can mean completely different meanings with them. And then even within the court system, there's a ton of different languages and a ton of different databases and a ton of different referral sources between the different courts and probation and the attorney's office and the public defender's office.
So the idea was to get all of these stakeholders together and form our coalition and look at our goals and look at our needs. I have no doubt that the vast majority of folks on this call know what this image is. This is the sequential intercept model.
But very briefly, for those who don't, this was developed by the SAMHSA GAINS Center a couple decades ago, but it's definitely getting some movement going on and it's looking at the different intercepts where somebody with behavioral health needs could come into contact with the justice system. And then how can that person be identified as somebody who needs mental health and substance use and social determinants of health needs and how to get that process in place to get them to the services that they need. The idea of getting them out of the criminal justice system, but even if they stay in, even if you're gonna be on probation for a while, but what does that mean with probation of how to identify individuals and get them also the other support that they could benefit to continue a healthy lifestyle.
So the Yavapai Justice and Mental Health Coalition, a lot of communities, they take that graph that you saw and they graph it out themselves of what might be in place. Like, "Oh, we have crisis," but we pulled it apart even further. And so these are just kind of snapshots of what it looks like for each of our intercepts where we look at what's our strengths on one side, what's our gaps and challenges on the other side. And we have used this over the past five years to create our community needs assessment and our goals and something to look back on on a regular basis of how do we get what's on the right addressed and taken care of and be able to put it on the strengths to the left.
And like I said, we revisit it on a regular basis and sometimes we add to it and we discover more treasures in the treasure box of other issues to work on. So as we were putting together our jail reentry coordination program to begin with, we also realized that we definitely want our people not to come into our facility. And so as we're building it, we were also building our pre-arrest deflection intercept one as well.
In Yavapai, we've put together a pretty robust crisis intervention team training that happens a couple times a year on either side of the county, inviting multiple entities to participate in that. We do mental health first aid training for law enforcement and first responders. We've put together a couple different workshops for identifying people with autism and then really trying to strengthen our mobile crisis teams, our crisis stabilization unit, our civil commitment process and how that can work alongside with law enforcement and the court system, 'cause, of course, as I said, we all speak a lot of different languages. So back in the end of 2016, Yavapai County Sheriff's Office received a Bureau of Justice Administration Mental Health-Criminal Justice collaboration grant. And with that, the sheriff put together a post-arrest diversion program along with that strengthening the pre-arrest, diversion and deflection.
And through that grant, since we had to do an evaluation and we partnered and collaborated with the Wellington Corporation and Jane Dowling there who started us off on this journey of our cross-system recidivism tracking database. And it has grown significantly throughout the years as a new idea has come up and a new idea has emerged. And currently, this database is on the FileMaker system and it's hosted by Productive Computing. And I have explained to the world that now we have ourselves the Taj Mahal on stilts, because we have just grown and grown and grown and added a ton of data into this database. But I'm gonna spend my portion with you this morning to describe what it is that we're collecting, what it looks like what we're collecting and what we've done trying to think through the future in order to rebuild this database in a way that the counties across Arizona, we have 15 counties in our state, how they could use the same platform, the same basis in order to build out their reentry coordination programs along with their pre-arrest deflection programs.
How do we really build this into something that is beneficial for all who utilize it? So our system has the three core sections to it. We have that piece prior to coming into jail, the pre-arrest deflection, we have in our jail and processing as we're working with people who are incarcerated currently. And then we have the portion as the person's getting released and then also, we've worked with our behavioral health providers asking them to incorporate post-release information into the system as well so that we can ensure that our program is working effectively and that our treatment providers also have access to the information that our coordinators had received from this individual while the person was here and a lot of the notes and the coordinating that we had done while the time the person was incarcerated with us. So I'm gonna give you some screenshots for what our system looks like at this time. This is the pre-arrest deflection portion and we have five dispatch agencies throughout Yavapai that, like I said, work with the 12 law enforcement agencies that we have.
So we have asked the dispatch to input information when law enforcement has had contact with an individual in the community and that individual did not come into jail, was not booked in, but something related to behavioral health happened. Whether the law enforcement agency gave the person a crisis number and a referral list and left them to be, whether they had a warm handoff to a mobile crisis team, if they took them to the hospital or into the crisis stabilization unit for a civil commitment process, if they could add some information in there, because this database then can be used later if law enforcement comes across the same subject and says, huh, I have a funny feeling that there's probably something more going on with this individual and they look up Beya Thayer and dispatch can say, yeah, over in Prescott PD three weeks ago, Beya had mobile crisis meet them or Prescott PD had mobile crisis meet Beya and hopefully that will inspire law enforcement to then reach back out to mobile crisis instead of making an arrest if they feel that that is appropriate. Also this information then is available if the individual does ever get booked into jail. Inmate services can see, oh, Beya has had previous contact for a civil commitment, so let me find out who that agency was, if there was, what happened at the end of that and try to pull that agency back in in order to coordinate care while that subject is in jail.
And then on the coalition side, we can also see if I look back and say, oh, there's a lot of contacts with this one person, I wonder what's going on? And just pull a couple of our stakeholders together and say I see that you guys have had a lot of contact for this one individual, is there something that we can do as a community to try to strengthen our work to support that individual? So when a person does get booked in to our detention facility, everybody has the opportunity to meet with an inmate service coordinator. We have a screening that consists of mental health questions, adverse childhood questions, substance use, social determinants of health. You saw those risk factors. Have they ever been enrolled with services before? Would they like to get enrolled with services? With some kind of information, what are you planning on doing right when you get out? Do you have a ride? Something that we can put in there. Even if the individual does not want to participate in the screening at that time, or they're too acute or not sober to participate, we still can keep notes in there as we're attempting to coordinate any kind of releases at all.
The screening report turns into a post-screening report that would say, Beya Thayer participated in the screening, disclosed moderate risk to mental health and is homeless. If released, Beya is willing to engage in the following services and then go back to her treatment provider or go to this housing, whatever might come out of that post-screening report. That post-screening report then is able to get into the court prior to initial appearance if that judge wants to use that information as a tool in making a decision of the person's release conditions. And that's there throughout, of course, the person's stay through their court system.
We try to begin coordination immediately. We try to begin a plan immediately upon booking. So that whether a person's released at initial appearance or not immediately released, we have some kind of background and information that we can utilize. We have quite a handful of folks in here who are on a probation revocation in which the judge has said, hey, I know you're struggling, but with the probation violations that you've had, they might sentence the person to 90 days, but gives them an early release to treatment ability.
That takes a heck of a lot of coordination to do early release to treatment. We need to do intake packets, we need to get the substance abuse screenings done by our partnering behavioral health partners. We need to look for beds, we have to continually see what's happening and coordinate this release and then have probation put in a release order to try to get folks out.
There's a lot of movement happening, but those are fantastic. We also do other early release to treatment for in-patient, mental health in-patient and having the coordinators within the jail working with the behavioral health partners outside of the jail, with the court system, with probation on the outside and some of our most highest need and highest risk individuals can have more of a robust release plan or handoff when they are able to be released. So here's some more of our screenshots of what the database looks like.
This first one on that post-arrest up at the top, after you enter a person's name, Christy's name, and then it would pop up what her booking picture looks like. We have to enter all of that from our jail management system. Right now, we enter her booking number. If she is screened, then that screening results automatically populate itself.
We have that release of information button as well. That's extremely important. We have it in a couple different places, because as soon as the person wants to coordinate and engage a release with our treatment providers, then that's uploaded into the database at that point. So this is what it looks like as we enter some more of our screening information. Those are the questions related to substance use that we utilize. The questions for substance use and mental health, we have taken them from an evidence-based screening and I'm sorry I don't have the name of those screenings here in front of me.
They were about 17 questions each and we brought them down to 10 questions. We continue to put in what kind of charges that they had under the felony level, if they qualified for that post-arrest diversion, which was our original grant a long time ago. But that helps to let our coordinators know that this was a low level felony and that they've disclosed substance use and that we can have a conversation with the court and the attorneys to see if they want to try to get a treatment plan together. When we do referrals, we have some dropdown buttons here and we add those referrals into the system, but we only have them for these three main categories at this time. This is what it looks like when the person's released. We'll go back in and say if the person received services, if they were connected or diverted, if there was any special notes.
And then this bottom part starts our case notes area that can just go for pages and pages. So like I said, we worked with our main community behavioral health partners when we started this, asking if they would go in at 30 and 90 days and add some follow-up information, saying if the person participated in treatment, was it satisfactory, was it not? And so what they can see, what the behavioral health partners can see is everybody who had a release of information uploaded for them. The only folks that they can see are the ones that we had a dropdown button that would say Polara Healthcare and then Polara opens it up and then it's their list of people. So not only can they add if there was some follow up done, I don't know if I have, oh, I do have a slide. They can go in and add this information, but they can also see the case notes that we had provided about what we did for coordination of care and they can also have access to the screening forms as well.
And then if the person does come back to jail at the end, that recidivism, return to jail, our side, inmate services puts that in and the reason for their return. So with that, we're able to pull lots of different data. We have a fantastic relationship with Northern Arizona University Center for Health Equity Research and they can provide a lot of third party data for us.
And so out of this you could see that the amount of people over a two-year period who are referred to treatment, who are connected to treatment and that diverted piece are the individuals who we know that we got out of jail early. It was the early release to treatment, because of the information provided by our inmate services coordinators. And so then the graph on the bottom is just saying that the percentage of people that we're referring and working with are the folks with the higher risk factors.
So moving forward, we would like to expand our database, like I said, out on a statewide level so that the other counties can have a baseline to start their jail reentry coordination program. We contracted with an agency called the Nerdery, literally the Nerdery, a few years ago, back in 2020 and they did a total deep dive into our system and started mapping it out. And so we have a blueprint to move forward. We're looking on some grant funding right now actually to try to contract with somebody to help build this out for the state. And the idea behind it would be like, of course, the counties would have their own, we would be able to put in our own information, but very similar so that we would have apples to apples.
Some of the information can be shared with other counties as well, at least to know that this person, hey, I have somebody at Yavapai, but they were in Apache County two weeks ago and perhaps Apache has some care coordination information or some behavioral health information that would be really beneficial for us to assist this person in a release plan that would be successful. And with that, I am going to pass it off to Sean, because because of Sean, we were able to get a lot of different wonderful ideas of what this future might look like between behavioral health and law enforcement and the jails and the court systems and how everybody can use it together. And with that, I'm gonna let Sean jump on. - Thank you very much, Beya. I appreciate the opportunity to share with you today and I really appreciate the opportunity to follow Beya, because she really clearly illustrates the need for interoperability and has been doing it, is looking to take it to the next level. As my bio says, I have a background in technology with a focus in justice and healthcare.
I'm an advocate for building networks and trying to drive collaboration between justice providers for supervision and also collaboration with health and social services. So when we look at interoperability, really, it comes down to breaking down silos and connecting the different boxes and wires. And I often say the technology is the easy part. It's all the other work that you have to do and policies and processes where the entities, that's where the real benefits come in. Daniel Stein and his team at Stewards of Change and the National Interoperability Collaborative have coined the term interoptimability, which is optimum and that really is what you can do once you've connected the boxes and wires and it's something that is available as part of our resource.
Looking at the status quo often, siloed solutions do not solve systemic issues and we have a plethora of disconnected software solutions. Often you can think of it as abundant and redundant, but not always effective. So we have the disconnected flow through even within our own departments and then between different entities across the spectrum of health and justice.
So let's look at connecting those dots. Obviously, as I mentioned, the technology is part of it, but you wanna build some consensus amongst your partners. Often it's easy to start small, build some successes and go on from there, identify the gaps, establish a framework for data governance and that cross domain operations and policy. And what we're really gonna talk about today is more on the technology side and some of the benefits so that once you've done the hard work, you can start looking at what do we need to have our software system do to facilitate the communication, the data flow, the workflow that we've defined in the earlier work.
So we talked really, for me, it's the why, what is the why? It's really network effects and network effects refers to the value that users receive when they use an integrated solution. Social media is a prime example. The more people you have on it, the more people get from it. Now that might not be a good example, but let's use a closed loop referral system for, say, social determinants of health. That's a good example where you have people on it, using it and sharing information on housing, on food sources and getting that information out to justice-involved individuals and then finding out on the closed loop that it actually happened, that someone actually got the house and that's the beauty of the network effect. The more the network is used, the more it delivers to the users.
So that, for me, is really the why of doing this. One of the ways to get started on this and connecting the digital dots is, and I've seen this and Beya illustrated this as well, is using the sequential intercept model as your framework. It really sets at each intercept, you can look and say who's involved at this stage and what data elements need to move back and forth? And you can figure out what policies need to go into place to be able to share that information. I've been very impressed with that as a model. It connect the desired data, the documents and outcome at each intercept just as Beya referenced on her slide 16.
Also, this framework is used to bind, annually, to determine how are we doing at each intercept and how can we make improvements across that. So it works out as a founding or framing document. When we look at a little bit more on the business side is the SIM more on the practical applications or functionality? We use that same model and we really like to advocate having the justice-involved individual part of that communication on a mobile or browser-based component to allow integration and communication. On the left-hand side, we talk about an integrated view where we have full visibility into caseloads and support or activity that's happened along the way around that justice-involved individual.
I'm gonna talk about some of these particular functional areas, compliance, content, et cetera. On this particular slide, I'm referencing calendars and calendaring is really key, but it's one of the hard ones to do to be able to connect everybody's calendar. But we are making some inroads in that. I think one thing I would say as a takeaway here is that your technology solution should provide you with an integrated view of the current status and history of the justice-involved individual and the providers and services that were delivered along the way.
And they give you that to you in a single view. When we look at compliance and how a digital compliance management can drive that, it really allows the justice-involved individual to stay connected and report interaction with local law enforcement or emergency departments. It also allows the individual to stay compliant by filling out reports and surveys remotely. So you really help meet that individual where they are as opposed to making them, for instance, drive across town to fill out a form or a report. So helping them stay compliant can really be enhanced through digital compliance management. Looking at consent management, this area here is also somewhat complex, but fortunately, there's people doing good work in this area.
So sharing consent across the digital network. The client can voluntarily agree to do that all the way through, the courts can order compliance and we could actually do a whole webinar just on compliance, but as I mentioned, there are people doing work on that and SAMHSA is sharing a resource at the end of this webinar via email that will have some of those resources that you can dig into the compliance. But there's some great progress that's being made in this area.
Let's take a look at workflow. And this here is looking at how policy can dictate how people, documents and data flow. In this case here, we have custody workflow in Yavapai County and the reach out initiative where we're determining whether it's going to be deflection or incarceration.
You have the roles defined. Using an interoperability system with workflow allows you to standardize your processes and deliver consistent results. You can move through this process to deliver the results that you're looking for on a consistent basis and also measure how effective it is. So your takeaway here would be that your solution should have a workflow engine as an integral part of its solution. It's key that you can connect different organizations and they can all have their role within a workflow as it moves through your interoperable system.
Looking at assessments, really, again, looking across the intercept model, we can look and see who is delivering what assessment across that model and are there opportunities where there's duplications that can be eliminated or data can be shared. If we don't have to do the same or different entity within the organization is delivering the same assessment, can we consolidate that? Can we share the data? Look to also where we can consolidate. Beya mentioned that they took it from 17 questions down to 10.
Those types of opportunities are available where you can share that information. My takeaway on this is that your technology solution must have the ability to create your own assessments and share some or all the data across your interoperability network. It really drives that value. Looking at communication today with the speed of business, we really have a lot of realtime communication needs to be multi-threaded that it's text, voice, video, all part of it. So today we need to have a system that can facilitate that communication, can document that communication and show the chronology of when that communication occurred. And that should be part of the record and part of any solid interoperable system.
Looking at social determinants of health, I really believe that supervising officers in justice should have access to either state, county or regional closed loop referral system. In my experience, that's typically handled at the behavioral health level, but it seems like that would be a role since the supervising officer are closest to that individual in the drug court. That would be a great place to make that housing, that treatment, that referral and then visibility into that social determinants of health.
The system allows supervising officers, healthcare providers and service providers on the social side be able to see what has been delivered, what's working and what is being used. It really helps from a resource standpoint and the ability to share, for instance, to prepare here as a screen as to who needs what and get into the automation behind sharing this information and collaborating across different organizations. I think we can say the same thing applies when you're looking at a behavioral health network and whether it's referring to treatment or as a justice organization, you want to know, how is my client doing in this program? Are they completing it, are they compliant? That type of communication is really useful and helps drive success for the justice-involved individual. So visibility into those resources and the resources that other providers have.
So your takeaway here would be your technology solutions should integrate with state or regional closed loop referral systems and with behavioral health to help drive a compliance when it's appropriate. Another benefit of interoperability is having a real time dashboard that pushes the work that needs to be done to the individual that needs it. So it's in context of the work that you're doing, also helps you get at analytics and metrics to show what works and what needs to be done and you can see it all on one dashboard. In this example here, we can see caseload, we can see alerts that are coming up and we have an inbox that we can go and see where we're getting information from that needs to be acted on. So real-time dashboards help you make decisions that you can see what needs to be done and you can take action on that same screen.
Same concept lies with alert, risks and tasks. As part of that, we have real time alerting where events like a visit to emergency room, an arrest, a jail discharge, those are all could warrant real time. Your workflow engine needs to be configurable so that when you do get alerts, you don't get alert fatigue.
You get it when you want it or need it. Looking at a system that delivers risk stratification, both on the individual and population, is really key for staff response around risk and also justification for staffing allocations. And then task management as it's flowing through your inter-agency or into your inter-partner collaboration, the task can be issued through workflow management or they could be issued by staff, but it's nice to have a central location that you can go to to see what needs to be done, what steps do I need to take. Your technology solution should present alerts, risks and next steps in a timely manner that drives the appropriate response. And then looking at, really, the whole system.
It looks and is somewhat complex, but if we start small, if we do, for instance, the sheriff's department and the reentry center and the justice courts and build on that interoperability, we don't boil the ocean in a day, we do it one cup at a time. So then as you get some success, start adding communication with your regional behavioral health where you're sending them an update when individuals are scheduled for release or arrest, when someone comes in. So you've got that driving that communication and as you go around that diagram, you can add additional organizations to your interoperability network. But there's a lot of value and the work that we see going on in Yavapai County and a few other counties around the country, there are some great successes if it's done in an incremental manner.
I wanna have for you today, we also will be sharing an interoperability solutions resource and as you can see on this document, it's some technology solutions that you might want to take a look at. And then by using this document, it'll be sent to you via email, if you click on the name of the company, in this case here, Cloud Nine, that'll take you to their website. You can view some images and text around what they offer, see if it's something you wanna explore. On the right-hand side there, you see a video camera image and then you click on the text to the right, that'll take you to a webinar for that particular company and you can then step through and learn more about that product. So it's brought all together, both some technology companies and then some resources around the Stewards of Change, around Amazon Web Services, what they offer, American Probation and Parole, some information they have on consent.
It's a great starting place for you to dive in as you look around into doing interoperability for your agency and your surrounding partners. So thank you very much. - Thank you. And so for those of you with questions, as Sean said, we will be sharing that webinar supporting document that he just referenced.
We will be sharing that with everyone who registered for this event and we will share it as soon as it's available, as soon as it's ready. So we still have a little bit of formatting to do on it, but as soon as it's ready, we'll send that out. And our intention is that you can take all of the information that you've gained from this event and then look at that handout and see what might be some technology solutions in the field that might fit with what your system needs based on what you took away from Sean's presentation today. Now we have some time for Q and A and we really want to get to as many questions as we can and lots of questions in here about privacy concern, particularly with behavioral health providers that are involved with the work. There were some references to an assigned release form, but maybe we could just get a little bit more information about how Yavapai County is addressing privacy and confidentiality issues. And then Sean, certainly would love your input as well from some of the national work that you've done.
Beya, could we start with you and just really talk through some of how you all overcame challenges to sharing information across your behavioral health and criminal justice partners? - Yeah, definitely. We have a couple areas that we wanted to address in that. One is that if the participant who wants to complete the screening and give this information out, we want them to understand what the court system will or will not do with that information.
We do, of course, tell them that all of this is voluntary and that the information will not be used in their court case. So that means that even though the post-screening report might say that the participant is at high risk for substance use, none of that screening information saying where that came from, what they use, what they do, none of that is used in their case at all. None of that is privy to the case. And also that's just the information for the judge then to understand.
Or even our county attorney's office who does diversion programs, they get those as well to say, hey, this person is disclosing that they do have behavioral health needs, can we get them coordinated? So it's not like advocacy to get stuff released or dropped, it's what can we do to try to get this person connected to the services. So that was the first piece was that for people to understand that just because they say that they have a lot of mental health issues does not mean that this is gonna get them a get-out-of-jail free card on one hand. And the other hand, just because they say that they have substance use issues doesn't mean that, oh, this is gonna look into more charges because you have risk for substance use. Then the other piece, of course still, it is voluntary.
So if they say that they want us, they would like for the inmate services division to work with their behavioral health providers to coordinate care for a release plan, then we do ask them if they would sign the release of information form, because then that allows us to have that conversation back and forth regarding that person's care. We do have business associates and communication agreements with our Medicaid health plans. That's been very beneficial for inmate services staff to be able to reach out and say, hey, does this person, are they enrolled currently with our Medicaid plan? Do you know where they've had services in the past? So we can try to, again, work to coordinate care and then work to get that release of information moving along.
The pre-arrest deflection piece, the information that's put in there is information from law enforcement. And so it doesn't have any diagnosis in there, it doesn't have anything really HIPAA related at all in there to say that, hey, we dropped this person off with Spectrum Healthcare, doesn't mean that the person became enrolled with Spectrum Healthcare. It doesn't say any of the further up information that's going on. Sometimes law enforcement might say, oh, this person's SMI with a serious mental illness, but they don't know if the person's really SMI with a serious mental illness.
They just know that this person is displaying behaviors that means, hey, we might have a better outcome if we don't arrest them and we get them into the hands of providers. I hope that's helpful. - I think that is a really important distinction to make that that database will reflect entries from law enforcement and so it's not that a behavioral health provider is then imparting HIPAA-protected information. It's a law enforcement provider, law enforcement agent or officer just providing an update.
And according to HIPAA policy, that's not necessarily HIPAA's covered information. So that is one way to facilitate information sharing across your partners is to remember that there are provisions where law enforcement can share information, particularly information that is provided to them by the person themselves, whereas a behavioral provider might be more limited in the situations in which they can share information. So thank you for that, Beya. And Sean, also wanted just turn it to you. Any other thoughts on this? - I have a just kind of quick comment.
In the resource document that's being sent out, there's the American Probation and Parole Association has a note on HIPAA and 42 CFR Part II titled, Dispelling the Myths about Justice Health Information Sharing. I think that's a great place to take a look at as well. - Thank you for that reminder. And maybe that's something that we could look into linking with the resource that we send out following this webinar for those of you who aren't familiar with that. And then we had a question about ownership. That's a big question.
Who's gonna really house the database, who's gonna be responsible for maintaining it? So this question comes in and we'll start with Beya once again 'cause it's specific to your presentation, but then, Sean, also would love your thoughts on this. So the question is, which agency is responsible for the cross system recidivism database? Was the data sharing agreement required and how is that process managed? - The Yavapai County Sheriff's Office is responsible for our database, for housing it, for paying the hosting fees on it, for all the upkeep with it and also to the point if somebody were to go to one of our behavioral health providers or to one of our law enforcement providers and say, hey, we have a records request. We've said, send all of that information our way, because it's under our ownership for it. I do believe that the way that our statute, we have a statute that was written to support our jail reentry coordination and it even refers to using a cross system recidivism tracking database and that the counties are able to do jail reentry coordination. And under that, it gives me the reason to believe that when we spread this statewide, it will still be each county.
They're gonna be responsible, each county or the county sheriff's office will be responsible for housing and the upkeep on their portion of the database. And then yes, when it comes to working with our behavioral health providers, we had put together some data agreements of just saying that we're all working together and utilizing the ROI process and then, of course, using the business associates agreement with the health plans. - Sean, are there any thoughts you have around how communities could navigate, partners could navigate these conversations about ownership? - Yeah, I agree with Beya's approach. I think that that should be justice-focused and justice-hosted, if you will, because there's multiple behavioral health entities and social determinants of health providers. But typically in a county, you obviously have a sheriff's department and they're dealing with the flows of in and out.
And I believe they have the most to benefit from this system where they can better, they can reduce the number of people coming back in for incarceration if they're able to drive that communication. So they should host it and control it. - Thank you for that. So what challenges are you currently seeing with the system that we might wanna consider when developing our coordinated systems? And so Sean, for this one, we'll start with you. What might be some challenges that people should anticipate and plan to work through with their partners? And then Beya, we certainly would wanna hear from you.
- My experience is probably, at first, has been funding, is getting adequate funding. I have experienced, of course, this is just my opinion. It seems like we are willing to build buildings and put people of different domains in the same building, but we don't connect their computer systems. And if we start focusing on that digital connection, I think that's where the value is going to come, whether they're in the same building or not, if their systems aren't talking, if there isn't that level of coordination behind the scenes, that's one of the biggest challenges. I think we've been evolving from a brick and mortar into a digital world where we can gain more value.
- So our barrier, like I said, we built the Taj Mahal piece by piece on stilts. And so when we started this, we didn't necessarily see all of these ways that it could keep moving and moving and moving. And when I see presentations like Sean gave and meet the people that Sean know and they've shown me what the whole system could look like, the communication back and forth. We don't have the whole red flags that pop up, the means to talk to these different entities in real time and our partners.
So that's definitely been a barrier, the way that you have to enter our system. And then from just working with our partners and with other discussions and trying to see what's happening with our closed loop referral system that we're trying to put together in Arizona, I think a lot of the barriers might be that probation has their electronic system, a jail has their jail management system and our behavioral health partner has their electronic medical records system. And I mean, just to ask dispatch to pull open a window, to go in and enter some other data, it was a huge lift. It's a lot that we are requesting. If there was some ways that the already established management and medical records systems could implement their info into a broader system would make it less cumbersome on the people that we're asking to get their hands on this. - And that segues right into the next question that I was gonna cover.
I'd like to maybe delve into that a little deeper. Someone asked, would you recommend finding ways to share information between each party's personal system or having everyone switch to a new shared system? And that's a huge question. So again, Sean, we'll start with you on your thoughts of that and then Beya and end with you on your thoughts of that. - I think the only solution, because there's such an investment in disparate systems, is that you have to bridge that gap with a solution that brings the data together from a view standpoint. So you can see it in a consolidated view, but it still exists in the jail management system, in the electronic health record system.
So it has to be a consolidated view through policy and security privileges, the ability to update or not within that. So it is that part of that foundational work that you do across the sequential model, say at this level, what information do we need to share, who can see it, who can change it? And that's a lot of work, but I think it's good work. It's work that needs to be done. - I agree, everybody, they have their system and they're way far into their system, but I completely agree with Sean's solution.
And either with or without that, we need to get more buy-in from our partners who want to put the data in. So for example, on the slide that I had that showed were you involved in treatment at 30 days and at 90 days and what the treatment was? That was developed without any opinion or implementation, any feedback from our behavioral health providers. And so some of the language or some of what was being asked for doesn't match what they do or what they collect. There's not even a button that says never showed up.
So we've had to piece things together. So on top of all of it, I would say it's hard. It's gonna be really, really, really difficult to get one big huge system that all the partners can touch equally or wanna use instead of their own electronic system. But to have as many of them at the table when you're developing it would solve some of the issues of how easy it could be to make records from here go to records over there.
- Thank you for that. So that's just such an important takeaway that as you're developing the system, have the folks at the table who know about their systems who can help you decide, a, what data do we want to bring into this shared database and then b, what does that look like in my system as we think about funneling it into a shared database? And so that you can resolve some of those challenges on the front end rather than creating a system and then trying to fit in your partner's systems to the shared database. And another question kind of related to this is, so what if there's an item on a shared database and multiple agencies collect data on that item? How do you navigate challenges with different agencies collecting the same kind of data and how do you decide whose data is gonna be imported into the database? Does that question make sense? - No. - No. - Data governance. You have to have those conversations in the data governance conversation and decide how it's gonna be presented, who's gonna own it and what is the system of record. - So if there are several partners collecting data such as a person's visit to a hospital, then you would just need to have conversations to decide which partner's data is going to go into the shared database around hospital phase, for example.
- Correct. - And then another question was, how do you handle data related to expunged or dismissed records? And Beya, I'll start with Beya, I'll start with you on that. - Our data is just about the coordinating of care.
It's not even about the person's criminal charges. There's really no information in there about the criminal charges other than it was a felony or a misdemeanor and what level that might've been at. But it doesn't even say that the person's necessarily sentenced. Sometimes at the end, it might say sentenced and going to DOC because that's part of the release. Like your release plan is that you're going to DOC. But our information currently, it doesn't have any criminal history related to it.
- Thank you for that, that's helpful. - But we will have historical data. So even if somebody is expunged and then they got rearrested for a new charge two years later, we could look back and say, hey, two years ago we were able to get you connected to what services, is that still of interest to you? - So that's great for continuit
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