Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 1 of 102 DECLARATION OF NICHOLAS WILLIAMSON EXHIBIT 1 (QUARTERLY STATUS REPORT) Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 2 of 102 Trueblood Quarterly Implementation Status Report May 2020 PURSUANT TO THE TRUEBLOOD V. DSHS 2ND REVISED AGREEMENT Submitted jointly by the Parties May 4, 2020 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 3 of 102 I. Introduction On December 11, 2018 the Court approved the amended Settlement Agreement submitted by the Parties. During that proceeding, Judge Pechman directed the parties to submit quarterly reports on the implementation beginning in April of 2019. With regard to completed milestones, each section of this report contains only those milestones that have been completed since the last report to the Court. For a complete list of completed actions, please refer to prior reports. II. COVID 19 Impacts to Evaluation and Restoration Due to the COVIDǦ19 pandemic, and in an effort to protect both patients and staff in accord with guidance from federal, state, and local health departments and the DSHS incident command center, most forensic admissions are temporarily being diverted from Western State Hospital (WSH). Felony conversions will continue to be admitted to WSH at this time. The Department of Health (DOH) has encouraged limited admissions to WSH to limit exposure of COVIDǦ19 among patients. To date, WSH has had eight confirmed cases of COVIDǦ19 in patients and twentyǦnine confirmed cases in staff members, impacting eight separate wards, including forensic wards. As of the filing of this report, two patient cases are active, and all staff cases have been resolved. In addition, 15% of staff across all disciplines (including those needed to process new admissions such as doctors, nurses, and social workers) are on leave due to meeting the highǦrisk criteria. This is in addition to staff who are on leave due to illness. Due to staffing shortages, WSH is actively trying to decrease the number of active wards in order to protect patients and maintain the appropriate staff to patient ratios. In order accommodate the loss of staffing and need for social distancing, WSH is operating a modified treatment programming on the competency restoration wards. While patients would normally move from their ward to a centralized treatment mall for daily programming, the common treatment mall is not currently being utilized. The treatment mall will remain temporarily closed until social distancing and patient movement restrictions can be lifted or eased. Instead, onǦward staff is engaging with patients on a daily basis, including short oneǦtoǦone meetings with patients. Nursing staff is also performing daily checkǦins with each patient. Plans are underway to recreate more of the treatment mall programming on each ward, and the additional core competency programming is planned to be deployed in the next several weeks. Staff is also ensuring that each competency ward has daily access to the yard for an hour a day, in addition to fresh air breaks, and 30 minutes gymnasium time. However, this is a reduction from preǦCOVID levels. PAGE 1 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 4 of 102 At the residential treatment facilities (including Maple Lane, Fort Steilacoom, and Yakima) regular programming has been modified, but remains at preǦCOVID levels. For example, at Maple Lane treatment groups have been divided into smaller groups and are meeting separately in order to enforce social distancing. This means classes may sometimes be shorter, but are still being held. The census at both Yakima and Maple Lane has been reduced to twentyǦone and twentyǦfive, respectively, in order to allow for additional social distancing. For Steilacoom is currently operating with a census of up to nineteen, which is reduced by several patients until additional psychiatry coverage begins on May 11, 2020. At that point, the census will increase to a still slightly reduced twentyǦfive, in order to facilitate social distancing. To date, there have been no patient COVIDǦ19 cases at any of the residential facilities. Inpatient competency evaluations, competency restorations, and Not Guilty by Reason of Insanity (NGRI) admissions are being diverted to Eastern State Hospital (ESH) and, wherever possible for inpatient restoration, to the Residential Treatment Facilities (RTFs). For Sell returns and second 90Ǧday competency restoration patients already admitted to WSH, the hospital will work with the attorneys to conduct the hearings remotely. If these hearings cannot be held remotely and the patient leaves WSH, then the patient cannot be reǦadmitted to WSH but would instead go to ESH or an RTF, if appropriate. For competency evaluation and restoration admissions to ESH, the process will alternate in that ESH will admit one person for westside referrals, then east, then west again. This process will lead to longer admission times for both westside and eastside patients; although with ESH catchment being smaller in referral density, the ESH wait times could be comparably smaller than the WSH wait times. RTF screening and admissions are currently planned to continue for the available beds. DSHS is continuing to encourage and accept triage referrals and prioritize triage admissions where clinically appropriate, and triage admissions will be made to ESH. In addition, outǦofǦcustody admissions are temporarily suspended statewide. These are temporary measures that are necessary in order to implement COVIDǦ19 protections at WSH, and DSHS will increase forensic admissions to WSH as soon as that can safely be accomplished. These measures are subject to change at any time as additional information is received. Under current conditions, DSHS has seen the estimated wait times for forensic admissions increase by three months; under a hypothetical situation where no WSH admissions can resume, the increase could be as high as six months or more. These increased estimates are caused by the limitations on admissions at WSH while that facility works to prevent any further spread of COVID. Once those admission restrictions are eased, the pace of admissions will increase, and wait times will decrease. Attached as Attachments A and B is recent correspondence between the advocate community and the Department regarding the COVIDǦ19 pandemic. In an effort to reduce patient census at WSH, DSHS has undertaken an accelerated release of civil patients who were already in the process of discharge planning, or were otherwise determined to be suitable for release to a less restrictive placement. DSHS has not yet pursued several of the advocate community suggestions. PAGE 2 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 5 of 102 Additionally, a number of efforts have been made at all Department facilities to protect patients and prevent the spread of the virus, including establishing an isolation ward for individuals who have tested positive, implementing social distancing guidelines for patients and staff, discharging civil patients to community settings, and screening of patients and staff. Additional details are contained in the attached documents. Similar efforts, including the reduction of patient censuses, have been implemented at the Department facilities that are contracted to provide services to class members. In addition, to protect staff, attorneys, and defendants, jailǦbased evaluations are currently being conducted using noǦcontact booths or via teleǦvideo presence. The Department has rapidly deployed additional telehealth equipment to support the ability to conduct telehealth evaluations in multiple settings around the state. Despite these capabilities, limitations in various jail settings that make it difficult to accommodate social distancing or remote participation by evaluators and defense counsel are impacting completion of a number of evaluations. For example, although the King County Jail can now accommodate social distancing and remote participation by counsel and the evaluator, there continue to be questions as to who is able to supervise the class member during the evaluation. The Department continues to engage system partners, and attorneys from Plaintiffs’ counsel have been helping to facilitate communication and coordination between multiple entities. Since March 15, the Department has been able to successfully increase telehealth capabilities at a number of jails and complete jailǦbased evaluations via teleǦvideo presence with defense counsel participation. Prior to the COVIDǦ19 pandemic Snohomish, Island, and Yakima county jails facilitated teleǦvideo evaluations with both defense counsel and the evaluator participating remotely, and following the COVIDǦ19 outbreak the following jails began facilitating teleǦvideo evaluations in this same way: SCORE, Aberdeen, Kent, Benton, Ferry, Okanagan, Thurston, Grant, and Whitman. Additional jails are being added regularly. However, communications and facilitation in these areas is still ongoing to ensure that the relevant parties are aware of the telehealth option. Although the infrastructure is in place, not all of the relevant parties are universally aware of it, or the process for utilizing telehealth. In March 2020, 6 telehealth evaluations were completed and in April 2020, 20 telehealth evaluations were completed. The first look data for March indicates that 73% of inǦjail evaluations were completed timely. Dkt. No. 735Ǧ1, at 1. As usual, this number should increase once it has matured. However, the complications discussed above are expected to impact overall compliance with the inǦjail evaluation timelines while COVIDǦ19 restrictions persist. Although many jails have worked to reduce their populations significantly over the past month due to COVIDǦ19, there are concerns that class members are not benefiting from these reductions. On April 28, 2020, Disability Rights Washington and the Office of the Court Monitor contacted all Trueblood Diversion Program providers and their criminal PAGE 3 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 6 of 102 system partners to request data, protocol, and plans for increasing diversion in light of COVIDǦ19. Program responses are ongoing. III. Status of Implementation On June 27, 2019 the parties filed with the court a final implementation plan for the settlement agreement. Several action steps within sections of the settlement agreement were completed during the period following the filing of the preliminary implementation plan up to the filing of the final implementation plan. In the final implementation plan those were captured in each section as “completed” action items. Below is information about the implementation status of each of the fourteen discreet sections captured within the Final Implementation Plan as of April 30, 2020. A.1. Additional Forensic Evaluators – Ahead of schedule As a mitigation to the COVIDǦ19 pandemic, all interviews have transitioned to phone or teleǦvideo. All final implementation plan task items have been completed including beginning the hiring of evaluators. Currently all thirteen evaluator positions have been filled. The Settlement Agreement requires the hiring of five additional evaluators starting July 2021. Hiring is already underway to fill those positions sooner. Interviews are underway and some job offers have been extended. In addition to the evaluator positions, the State has hired an additional supervisor and support staff person. B.1. Legislative Changes – Completed B.2. Community Outpatient Restoration Services – On track Due to the COVIDǦ19 pandemic, two of the four regional contractors did not return signed contracts by the desired due date of April 1, 2020. While this delay does not impact a final implementation plan deadline, it does reduce the amount of time available for the contractors to onboard employees before the required July 1, 2020 go live date. OCRP community providers have been greatly impacted by COVIDǦ19, with most reporting a reduction in faceǦtoǦface encounters with service recipients and reduced or suspended intakes. They are working on mitigation strategies to support efficient and effective continued service provision for service recipients. Two key trainings for OCRP staff were provided virtually – Forensic PATH and Forensic HARPS. Two other necessary trainings, Breaking Barriers and Enhanced Peer Support Training, are being evaluated for virtual presentation. Recent completed activities include: x x The OCR workgroup finalized the program model, core elements and referral criteria by February 29, 2020 Metrics were determined in conjunction with data staff by March 31, 2020 PAGE 4 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 7 of 102 x x OCR workgroup, in partnership with the HCA contracts team and DSHS, solidified the necessary contract language and processes by March 31, 2020 The OCR workgroup coordinated with the Forensic Navigator and Residential Support workgroups to coordinate contract efforts by March 31, 2020 B.3. Forensic Navigator – On track Work on the Forensic Navigator caseload management system continues. Assigned programmers had a oneǦweek interruption in their work because they were reassigned to support work on a critical communication system as a result of the COVIDǦ19 pandemic. Despite this, the system is still anticipated to be functional by the July 1, 2020 go live date for the Forensic Navigator program. Interviews for the newly created Forensic Navigator positions continued virtually in response to the Stay Home, Stay Healthy edict from Governor Inslee. Job offers have been extended to applicants for all open positions with start dates of May 1, 2020. Recent completed activities include: x x x x x Submitted necessary human resource paperwork to create the forensic navigator program positions in each region by January 31, 2020. Advertised forensic navigator positions by February 29, 2020 Met with partners (courts, AOC, jails) to develop processes and documentation to include forms used in the court system by March 31, 2020 Met with partners (OCR providers and evaluators) to develop processes and documentation to include forms used in the court system by March 31, 2020 Completed recruitment activities including screening, interviewing and job offers by April 30, 2020 B.4. Eastern State Hospital Bed Addition – Delayed Construction ESH beds had been fully on track for completion by June 30, 2020, however due to COVIDǦ19 the contractor invoked the force majeure clause (citing the “pandemic” term) to suspend work. The availability of contractor workforce has also been impacted by individuals following the mandates of the Stay Home, Stay Healthy order. As of April 24, 2020, some construction has resumed, and DSHS will work with the contractors to ensure that the appropriate health and safety measures are in place for those individuals who choose to return to work. The full impact of this disruption will not be known until the future becomes more certain, and restrictions related to the state of emergency are lifted or eased. Specific time delays are unknown at this point, but will be provided as more information becomes available. This project was designated as an essential project under the Governor’s proclamations. A motion will be filed with the Court to seek additional time needed beyond June 30, 2020. PAGE 5 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 8 of 102 Staffing Due to the COVIDǦ19 pandemic, several job fairs ESH staff planned to attend to attract new employees were cancelled. In addition, hiring managers note an increase in the number of noǦshows amongst interviewees. While these do not impact a final implementation plan deadline, it does make their recruiting efforts more difficult. To mitigate this impact, they have sought and received additional funding to pay for boosted electronic ads on Facebook and Indeed.com. They have also increased their sourcing efforts to include coldǦcalling applicants from previously closed job postings and others who have never applied at ESH. Interviews have transitioned to virtual interviews. B.4. Western State Hospital Bed Addition – Delayed The state will require additional time beyond June 30, 2020 to complete the renovations of E3 and E4 at WSH. DSHS has been working diligently to identify all of the efficiencies possible to keep the timeline short, but due to COVIDǦ19 additional delays are occurring in construction because of limitations being experienced by the contractor, a disruption in supply chain deliveries, and availability of workforce. The availability of contractor workforce has been impacted by individuals following the mandates of the Stay Home, Stay Healthy order. The full impact of these disruptions will not be known until the future becomes more certain, and restrictions related to the state of emergency are lifted or eased. In the meantime, DSHS is working with the contractors to institute the appropriate health and safety measures for those who can continue working. This has allowed work to continue on some portions of the project, but at a greatly reduced pace. This project was also designated as an essential project under the Governor’s proclamations. Specific time delays are unknown at this point, but will be provided as more information becomes available. A motion will be filed with the Court to seek additional time needed beyond June 30, 2020. B.5. Closure of Maple Lane and Yakima – On track As previously reported, all milestones to prepare for the closure of the facilities have been completed. The remaining closure tasks will be triggered by wait times reaching the agreed target, or when the hard closure date nears. C.1. Crisis Triage and Diversion Capacity – On track Addition of 16 Beds in Spokane Region: Department of Commerce awarded the contract to the Spokane Mental Health Crisis Stabilization Facility, operated by Pioneer Human Services. One of the final implementation plan task items was found to be duplicated from the crisis enhancements section in error – FIP 7.7.4. “Using stakeholder input, crisis triage and diversion supports workgroup coordinates with HCA contracts team to develop RFA language or amend current MCO/ASO contracts to allocate the funds by March 1, 2020.” PAGE 6 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 9 of 102 HCA was not responsible for the development or procurement of this contract and both parties have agreed to delete this inapplicable task. Enhancements in Pierce and Southwest Regions: The Health Care Authority has had four providers sign contracts to enhance their regional facilities. They are meeting with providers on a regular basis to help them troubleshoot concerns or barriers that are resulting from the COVIDǦ19 pandemic. In the previous quarterly report, a challenge was identified related to the closure of the potential partner facility in the Southwest region. The Health Care Authority was able to identify an alternative regional facility in the region to target for enhancement efforts. With that adjustment, HCA was able to keep the enhancements on schedule in this region. HCA is also working with the facility that is scheduled to open soon in the Southwest region. Recent completed activities include: x x HCA determined that the best path to achieve the desired outcomes was to complete new contracts with existing providers. Those contracts were signed by March 1, 2020 The crisis triage and diversion support workgroup used stakeholder input and coordinated with the contracts team to develop the contract language and allocated funds by March 31, 2020 A summary of enhancements is provided as Attachment C. Gap Analysis: Recent completed activities include: x HCA developed recommendations on how to increase crisis capacity in the phased regions. Their report was shared with the General Advisory Committee and key stakeholders on March 30, 2020 x After Plaintiff’s Counsel raised some concerns regarding the March 30th document, the parties have met to discuss, and HCA will gathering additional information from crisis/triage providers and be providing a supplemental report by June 1, 2020. C.2. Residential Supports – On track Short term voucher contracts were awarded to the following organizations in Phase 1 regions for use beginning in December 2019: x x x Recovery Response (Pierce) for $50,000 Northeast Washington (Spokane) for $15,000 Frontier Mental Health (Spokane) for $35,000 PAGE 7 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 10 of 102 x x Columbia River (Southwest) for $20,000 Lifeline Connections (Southwest) for $30,000 The contracted providers have very recently provided the first data sets related to use of the vouchers. The Research and Data Analysis group is currently in the process of reviewing the data and preparing it for reporting. Training for the HARPS teams that was scheduled for March 2020 was postponed due to the COVIDǦ19 pandemic. A training on permanent supportive housing conducted by National TA was transitioned into a twoǦhour virtual training with a necessary inǦperson followǦup still to be scheduled at some time in the future. The contract for National TA expires June 30, 2020. The completion of this training is tied to a final implementation plan task item due June 30, 2020. Recent completed activities include: x HARPS teams hired staff and services were available by March 1, 2020 C.3. Mobile Crisis and CoǦresponder Programs – On track Mobile Crisis BHASOs are required to submit changes in response to the feedback provided by April 30, 2020. Because of the impacts on their resources due to the COVIDǦ19 pandemic, a delay in returning edits would potentially impact the finalization of contracts required by May 31, 2020. Recent completed activities include: x x x Developed Mobile Crisis Response draft contract language by December 30, 2019 BHASO responses to the Request for Plans was received by January 31, 2020 HCA, DSHS, and WASPC reviewed Request for Plans responses by February 28, 2020 Co Responder (WASPC) The State recently learned that the grant provided to Vancouver was not used during this fiscal year, and the funds have been returned to WASPC. COVIDǦ19 impacts reportedly played a role in this, and WASPC indicates Vancouver will attempt to deploy funds in the upcoming fiscal year. Original grant recipients include the following Phase 1 areas: x x x Vancouver Police Department for $314,917 Spokane County Sheriff’s Office and Police Department, joint for $698,750 Pierce County Sheriff’s Office for $350,733 PAGE 8 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 11 of 102 Two agencies in the Phase 2 area also received funding: x x Kirkland Police Department $80,000 Redmond Police Department $46,513 WASPC, DSHS, and HCA are continuing quarterly sync meetings and WASPC is a member of the General Advisory Committee for Phase 1. C.4. Forensic PATH (Intensive Case Management) – On track As a result of the pandemic, program manager site visits were rescheduled as virtual calls. In addition, training originally scheduled to occur in March was postponed. A training on how to track data was transitioned to a virtual training. A training on permanent supportive housing conducted by National TA was transitioned into a twoǦhour virtual training with a necessary inǦperson followǦup still to be scheduled at some time in the future. The contract for National TA expires June 30, 2020. Recent completed activities include: x x Contractors hired staff to include at least one peer support person by January 1, 2020 HCA conducted specialized training on effective outreach and engagement strategies for staff hired within all three regions by the end of February 2020 Work was completed on the model that will be used to identify high utilizers supported by the FPATH program. The distribution logistics were also established. D.1. Crisis Intervention Training – On track The Criminal Justice Training Commission has had to cancel one 40Ǧhour course for patrol officers, three eightǦhour courses for corrections staff, and two eightǦhour courses for telecom operators as a result of the COVIDǦ19 pandemic. D.2. Technical Assistance to Jails – Ahead of schedule The Guidebook is in final review and should be published before June 30, 2020. Webinars on guidebook topics in the coming months are anticipated to have limited live attendance because jail staff availability is expected to be significantly reduced due to pandemic impacts. Recordings of these training sessions will be loaded to the Jail Technical Assistance website for onǦdemand viewing when staff have availability. PAGE 9 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 12 of 102 E.1. Enhanced Peer Support – Delayed The HCA Enhanced Peer Support workgroup is working closely with the DSHS Workforce Development workgroup to build the Enhanced Peer Support curriculum. While inǦperson foundational enhancement training is not able to occur by May 1, 2020 due to COVID 19 restrictions, a virtual overview of the training modules will be deployed before that deadline. InǦperson training will be rescheduled once COVIDǦ19 restrictions are lifted. HCA has preǦrecorded this overview and will make it available to all Certified Peer Counselors (CPC) that are working with Trueblood serviceǦrelated teams by May 1, 2020. Once social distancing measures are relaxed, all CPCs will be able to attend inǦperson training events. The enhanced peer services program will offer ongoing continuing education training titled “The Intersection of Behavioral Health and the Law” to all CPCs and to other professionals who support those involved with the criminal court system. These trainings will roll out in Phase 1 regions. In addition, HCA is providing ongoing technical support to all organizations providing certified peer counselling services. A webinar was conducted on April 24, 2020 to all Trueblood providers. E.2. Workforce Development – On track A course catalogue of available trainings is being built and will be published to the newly created Workforce Development website once finished. Recent completed activities include: x x Developed surveys and assessed training needs in the identified functional areas by February 1, 2020 Send surveys by February 15, 2020 IV. Department Meetings and Workgroups In order to facilitate the timely and successful implementation of the settlement agreement, the State has convened multiple workgroups as described below. For the months of January, February, and March of 2020, there have been over 430 meetings conducted representing PAGE 10 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 13 of 102 over 475.25 hours of collaboration between and amongst state agencies, partners, and stakeholders. The work needed for each of the fourteen different sections or elements of the settlement agreement is being accomplished frequently through paired internal and external element workgroups. x x Internal element groups provide a core of team members from within the agencies to develop the overarching plan for how to organize the work and coordinate program intersections along with planning around key deliverables. Broader, external element workgroups involve regional stakeholders and partners in developing programs that fit within each regional structure and facilitate decisionǦmaking. All of the element workgroups have a Research and Data Analysis (RDA) team member embedded to support the development and collection of data. In addition to element workgroups, several infrastructure groups support the overall project and facilitate consistent implementation, core processes, and provide specialty area consultation and supports. They include: x x x x x x x Statewide Implementation Team Budget workgroup Communications workgroup Contracts workgroup Data workgroup and subǦworkgroups Public Disclosure, Discovery, and Records workgroup Tribal consultation workgroup As previously reported, this does not represent the full scope of the work in progress as many topics have required oneǦtime meetings to develop plans of action or assign responsibility. V. Stakeholder and Partner Engagements A. Statewide Informational WebExs The Statewide Implementation team conducts quarterly implementation update webinars that are open to everyone, but primarily geared to partners and stakeholders in the Phase 1 regions. The first WebEx occurred in February 2020 using the same slide deck on implementation status that was shared with the General Advisory Committee. Future WebExs are scheduled each quarter through the end of Phase 1 and are advertised using the Trueblood listserv. PAGE 11 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 14 of 102 VI. Fort Steilacoom Residential Treatment Facility Since the last quarterly status hearing, there has been leadership changes and additions at the Fort Steilacoom Residential Treatment Facility. In early March Brian Shirley was appointed as the Program Director, Miguel Messina was hired as the Clinical Service Manager and Maria EngelhardtǦParales was hired as the RN4 Nurse Manager. Shortly after, the Chief Medical Officer submitted her resignation as she was offered and accepted a position in King County. Dr. Brian Waiblinger, the DSHS Medical Director, is acting as Chief Medical Officer in the interim until the position is filled. The current Locums Psychiatrist requested to do telehealth due to concerns regarding COVID 19. Despite these changes/additions, the census has remained steady, between sixteen and eighteen patients. Ongoing hiring efforts have resulted in a second Locums Psychiatrist that will start midǦMay. Interviews have been conducted for two vacant Psychologist 4 positions and offers are pending. There are open recruitments for one Social Worker, one RN4, two RN2s, one RN3, and three Institutional Counselor 2 positions. OFMHS is working with the Director of Maintenance and Operations to replace approximately 25 of the locks in the program. Given COVID 19 and necessary notifications to hire and utilize a contractor, he anticipates this will be completed by the end of August. VII. Court Funded Diversion Projects The contemptǦfunded diversion programs continue to operate separate and apart from implementation of the settlement agreement, although there is significant work being done to identify areas of overlap. For example, there is currently a workgroup, comprised of Plaintiff’s counsel, HCA, DSHS, and King County staff, tasked with identifying the specific existing King County programs that may provide the same services as those planned under the Trueblood contempt settlement agreement, how to best interface existing programs with planned Trueblood elements, as well as King CountyǦspecific implementation needs for Phase Two in 2021Ǧ2023. The parties have jointly submitted a motion to this Court to provide additional funding to some of our diversion grantees to sustain operations until the 2021Ǧ2023 biennial budget. This is part of broader efforts to assist the programs in achieving longerǦterm sustainability. The Trueblood Diversion Review Committee is also currently distributing a formal survey to diversion providers and their partners to determine the services and needs best addressed through any additional Request for Proposals. PAGE 12 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 15 of 102 VIII. Executive Committee Meetings Since the last quarterly status hearing, the Executive Committee met twice, once on December 18, 2019 and again March 24, 2020. The minutes from these Executive Committee meeting are attached as Attachments D and E. The next Executive Committee meeting is scheduled for June 23, 2020. In addition, the Research and Data Analysis Office has begun providing data monthly on the number of misdemeanor restoration orders entered since the law change. The most recent data is attached as Attachment F. IX. General Advisory Committee The General Advisory Committee was convened in November 2019. They held their second meeting on February 3, 2020. Members were provided an agenda and multiple handouts and presentations, which are attached G, H, I, and J. The meeting also provided general updates about the status of implementation, including the material attached as Attachment K. Due to the pandemic, the May meeting will be held as a webinar instead of inǦperson. X. Next Steps/ Upcoming Milestones There are 17 task milestones that will come due between May 1 and July 31, 2020 across many areas of the agreement. The State intends to provide updates during the next Status Report in the same format as was provided here. PAGE 13 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 16 of 102 4XDUWHUO\ ,PSOHPHQWDWLRQ 6WDWXV 5HSRUW 0D\ Attachment A Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 17 of 102 April 2, 2020 Secretary Cheryl Strange Washington State Department of Social and Health Services 1115 Washington Street SE Olympia, WA 98504 Via email: strance@dshs.wa.gov Dear Secretary Strange, The signatories of this letter (Disability Rights Washington, the American Civil Liberties Union of Washington, Washington Defender Association, and the Washington Association of Criminal Defense Lawyers) acknowledge the unprecedented crisis presented by the COVID-19 outbreak, especially in large facilities like Western and Eastern State Hospitals (WSH, ESH). We are writing to request that the Department of Social and Health Services (DSHS) immediately undertake efforts to reduce the patient population at both WSH and ESH. At the time of this writing, WSH has seen its first death from COVID-19 and ESH is reporting its first positive tests. We applaud your leadership and the many efforts already underway to maintain the safety and health of patients and staff at WSH and ESH. This includes efforts that could reduce overall patient population and thereby better prevent COVID infection and improve care of sick patients. For example, we understand that Washington recently sought a Medicaid 1115 waiver to establish a COVID-19 Disaster Relief Fund that would provide temporary shelter for people awaiting discharge from institutional care. This could present valuable options to quickly house WSH and ESH patients who have already been waiting for discharge for some time. Even with these steps, DRW believes the state must take additional action to move patients— even temporarily—out of WSH and ESH right away. The Center for Disease Control and the Centers for Medicaid and Medicare Services have provided guidance to facilities making clear how important it is to maintain separation and adequate social distance for patients. This is very difficult to achieve at WSH and ESH, since both facilities operate at full capacity with patients on many wards routinely sharing a room. Potential staffing shortages at both hospitals adds to the need to reduce patient population. The usual procedures to discharge patients have long-resulted in lengthy waitlists of patients waiting to get out. It is therefore imperative to undertake non-traditional methods to reduce the population of both hospitals right away in order to most effectively protect staff and patients Quarterly Implementation Status Report - May 2020 Attachment A - Page 1 of 3 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 18 of 102 from COVID-19. DSHS should consider all options and should work with Governor Inslee to identify additional executive action. We are suggesting some specific options below: 1) Temporary release of civil patients RCW 71.05.270 authorizes WSH and ESH to temporarily release civil patients “for prescribed periods during the term of the person's detention, under such conditions as may be appropriate.” Thus, WSH and ESH should immediately release appropriate civil patients on a temporary basis. Both hospitals should identify civil patients who may be successfully moved into another space for at least one month, with the possibility of continuance. This could include temporary releases to family, friends, or other facilities procured by the state for this purpose. 2) Review all civil patients for full release or LROs Our understanding is that, although the courts are largely shut down, they are currently still approving stipulations for release and Less Restrictive Orders (LRO) for civil patients. WSH and ESH should immediately review civil patients who can be safely released prior to the expiration of their commitment period or pursuant to an LRO. Both hospitals should be prioritizing this work with defense counsel and patients’ family and friends to achieve this. DSHS should also ensure close cooperation between Behavioral Health Administration, Developmental Disability Administration, and Home and Community Services to streamline release of patients who are eligible for residential services—for example, by using the recently approved Appendix K waivers that are encouraging provider capacity in the community and moving those at high risk out of institutional care. 3) Furlough NGRI patients NGRI patients on conditional release may receive a furlough with the consent of the DSHS Secretary. See RCW 10.77.163 and BHA Policy 5.3. Notice must generally be provided to prosecutors and law enforcement, but this notice may be waived in the case of emergency. Id. Washington State Governor Inslee declared a state of emergency in response to COVID-19 on February 29, 2020. Therefore, notice on a significantly reduced timeline, or even a waiver of notice, is acceptable. WSH and ESH should immediately review NGRI patients who already have been granted conditional release status by a court and grant furlough to those who can safely reside with family, friends, or in other appropriate arrangements that do not present the same risk of COVID-19 infection as WSH and ESH. DSHS should also undertake review of NGRI patients who are on the verge of conditional release and fast track recommendations to achieve conditional release for those patients. A furlough may be cancelled at any time and DSHS may undertake procedures for final discharge for these patients while they are on furlough, as appropriate. Quarterly Implementation Status Report - May 2020 Attachment A - Page 2 of 3 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 19 of 102 4) Use COVID-related Medicaid waiver funds and flexibility to facilitate patient release We appreciate how proactive Washington has been in seeking COVID-related Medicaid 1135, 1115, and Appendix K waivers. To the extent that emergency funding and flexibility becomes available through Medicaid waivers, DRW is asking that you prioritize moving individuals safely out of institutions, especially WSH and ESH. For example, funding for housing under the 1115 waiver or increased rates for providers under the Appendix K waivers could be key to releasing WSH and ESH much more quickly. We are requesting that DSHS be aggressive and creative in reducing the patient population at WSH and ESH, but we are not advocating release to homelessness or otherwise dangerous situations. We recognize that patients often benefit from ongoing treatment and support once released from the hospital and that this is in short supply at the moment. We would like to discuss ways of addressing this issue with you, but we strongly believe that there are patients at WSH and ESH who can be safely supported in an immediate temporary release, furlough, LRO, or full release. Weighed against the current COVID-19 situation at WSH and ESH, this is imperative. Thank you for your ongoing efforts and attention to our concerns. We look forward to learning about how DSHS plans to reduce WSH and ESH patient population. Please contact Kimberly Mosolf at Disability Rights Washington, 206-324-1521, with response, questions, or concerns. Sincerely, s/ Kimberly Mosolf Director of Treatment Facilities Program Disability Rights Washington s/ Christie Hedman Executive Director Washington Defender Association s/ Michele Storms Executive Director ACLU of Washington s/ Amy Hirotaka Executive Director Washington Association of Criminal Defense Lawyers s/ Merf Ehman Executive Director Columbia Legal Services CC: Sean Murphy, Assistant Secretary, BHA Amber Leaders, Senior Policy Advisor to Gov. Inslee Nicholas Williamson, Assistant Attorney General Quarterly Implementation Status Report - May 2020 Attachment A - Page 3 of 3 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 20 of 102 4XDUWHUO\ ,PSOHPHQWDWLRQ 6WDWXV 5HSRUW 0D\ $WWDFKPHQW % Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 21 of 102 STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES 1115 Washington Street SE, Olympia, Washington 98504-5010 April 4, 2020 Ms. Kimberly Mosolf Director of the Treatment Facilities Program Disability Rights Washington 315 5th Ave S., Suite 850 Seattle, WA 98104 Dear Kim, Thank you for your letter. I want to start by assuring you that we share your concerns for patient safety at Eastern and Western State Hospitals. DSHS and hospital leadership, as well as the staff of our institutions, have been working around the clock to react to this quickly-evolving emergency. At this time, our objective is clear: reduce the number of patients so there are enough staff to care for patients and to minimize COVID related risks for patients and staff. All of our facilities have been engaged in a number of patient-focused efforts to minimize the risk of exposure or infection from COVID-19. Oversight and guidance for these efforts is being provided at all levels of the Executive branch, including through the focused efforts of the Unified Command and the State- Emergency Operations Command Center. DSHS has utilized infectious disease experts to create and implement procedures and protocols, all with the goal of protecting the patients we care for, and the staff who provide that care. We are also dealing with the reality that staff absences will impact our ability to provide care. Staff absences are greatly increased due to COVID-19, and we anticipate that this problem will, in all likelihood, grow. We have worked closely with the DOH in implementing effective, statewide strategies for state institutions and are strictly adhering to DOH guidelines for patient and staff screening for infection. This strict adherence means that staff who screen positive for any risk of COVID-19, COVID-19 exposure, or other infection risks like influenza, cannot provide care on our campuses. In order to further minimize exposure risk for our patient and staff populations, DSHS is complying with Governor Inslee’s Stay Home, Stay Healthy initiative. DSHS has identified several hundred positions at WSH and ESH that are now redeployed to telework off campus. Additional announcements by the Governor could further impact staffing availability for DSHS. We care about our staff and our patients and want to minimize potential exposure to COVID-19. Before receiving your letter, we had already begun an urgent process to reduce the patient population at WSH. We have asked our partners at the Health Care Authority (HCA) and our own DSHS Aging and Long Term Care Administration (ALTSA) to intensely focus on helping us reduce the patient population at WSH by 60 patients within a short period of time. . We began our efforts by focusing on patients who can be transferred from WSH to other community based inpatient care settings that can meet all of a patient’s needs. For example, ALTSA is working to Quarterly Implementation Status Report - May 2020 Attachment B - Page 1 of 5 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 22 of 102 Ms. Kimberly Mosolf Disability Rights Washington April 4, 2020 Page 2 identify and move patients who are discharge ready, and need a level of care that involves an Adult Family Home, Enhanced Service Facility, nursing facility, or assisted living. HCA and ALTSA will continue to work together to provide effective wrap-around services for individuals discharged as part of this effort. DSHS is also taking steps to slow admissions to WSH and is prepared to do so at other facilities as needed. Our efforts cannot be meaningful if patients are discharged only to be replaced by new patients arriving from many other high-risk settings. To achieve this, WSH is currently evaluating each admission to assess whether that admission can be diverted to a different setting. Some of these diversions are lateral in nature, and some patients will be admitted at ESH instead of WSH. Given the presence of COVID-19 within the patient population at WSH, this facility is the current priority of our efforts to reduce admissions. We will also be reviewing the suggestions that you have provided in your letter. Some of the legal authority you reference is already being considered in our efforts—for each patient that can have their needs safely met in another setting, we will be reviewing the legal authority for their detention and exercising whatever legal authority available to us to effectuate the transfer or discharge. In addition, HCA continues to advocate for waivers to support increased flexibility within the Medicaid program. Several additional amendments have been completed beyond those mentioned in your letter, and the State is continuing to think creatively about how to access funding to support these critical efforts. We also appreciate the offer of help from Northwest Justice and others who represent this population, and we truly appreciate your involvement in identifying options. I am also attaching a message that went out from Assistant Secretary Sean Murphy, of the Behavioral Health Administration, regarding this effort. The message provides additional information on our efforts. This is an amazing effort by the State of Washington’s health care delivery system. We are incredibly grateful and proud for all of the hard work that is happening to support this. Thank you for your continued advocacy for our patients, we are glad that we have a strong partnership in working towards solutions during these unprecedented times. Fondly, Cheryl Strange Secretary Attachment Quarterly Implementation Status Report - May 2020 Attachment B - Page 2 of 5 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 23 of 102 Ms. Kimberly Mosolf Disability Rights Washington April 4, 2020 Page 3 cc: Amber Leaders, Senior Policy Advisor, Office of the Governor Christie Hedman, Executive Director, Washington Defender Association Michele Storms, Executive Director, ACLU of Washington Amy Hirotaka, Executive Director, WA Association of Criminal Defense Lawyers Merf Elman, Executive Director, Columbia Legal Services John Purbaugh, Managing Attorney, NJP Tacoma Office Robert Hervatine, Interim Managing Attorney, NJP Spokane Office Sujatha Jagadeesh Branch, Statewide Advocacy Counsel Sue Birch, Director, Health Care Authority MaryAnne Lindeblad, Medicaid Director, Health Care Authority Bill Moss, Assistant Secretary, Aging & Long Term Care Administration, DSHS Sean Murphy, Assistant Secretary, Behavioral Health Administration, DSHS Nicholas Williamson, Assistant Attorney General Angela Coats-McCarthy, Assistant Attorney General Quarterly Implementation Status Report - May 2020 Attachment B - Page 3 of 5 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 24 of 102 :LOOLDPVRQ 1LFKRODV $ $7* )URP 6HQW 7R &F 6XEMHFW 0XUSK\ 6HDQ '6+6 %+$ VHDQ PXUSK\#GVKV ZD JRY! 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They work to triage individuals coming into the facility by identifying what are the perceived needs of its guests, referring them to the appropriate level of care as determined by assessment. RRC has been willing to share their experience by providing technical assistance with other crisis facilities in the Phase One regions that have not been willing to accept high acuity individuals. Enhancements to preserve and increase RRC’s work to serve even higher acuity individuals include: Salary enhancements to maintain staffing consistency (RN, MHP): Enhancements were provided for RRC in order to assist their meeting a goal for providing speedier service and increasing the experience of individuals already traumatized and experiencing difficulties. These enhancements included an increase in wages of seasoned staff members to maintain retention, the addition of both floor staff and Licensed Practical Nursing staff to assist with milieu support Addition of staffing to the units for a more acute population (LPN & Milieu specialists): These enhancements included the addition of both floor staff and Licensed Practical Nursing staff to assist with milieu support Infrastructure such as technology, medical equipment and furniture: These enhancements included ordering of medical supplies for the reduction of sending guest out for routine evaluation or check-ups thus avoiding needlessly crowding emergency rooms, and guest centered supports to decrease the trauma experience while working to provide a more meaningful experience for the client. Client Experience Enhancement Strategies: Items will be purchased to ensure the environment and staffing are addressing a trauma informed approach to help individuals in a mental health crisis. Items may assist with engagement, provide support and comfort, providing coping skills, address current needs, improve social support. Programmatic supplies that promote wellness: Items will be purchased that promote relaxation & stress reduction Exercise: Engaging in simple physical activities can be a strategy to address mental health symptoms The Arts: Creative activities (drawing, writing, music, etc.) to help with self-expression Socialization: Activities & events that promote socialization and decrease isolation Peaceful Spaces: Opportunities for the individual to find personal comfort and self-soothing techniques $138,034 FBH summary of enhancements: $279,642 Frontier Behavioral Health (FBH) has been accepting community hospital referrals and voluntary walk-ins in the Spokane Region for years. While not historically known for working with individuals presenting with aggressive behaviors, in December 2019, FBH identified a willingness to provide services for individuals experiencing acute symptoms or with individuals dropped off by police or being placed on behavioral health hold. After extended conversations by HCA with FBH, both internal and external, FBH identified an interest in providing services for a more severe or agitated population based upon the presenting level of agitation. FBH reports that they will be engaging in conversations with Spokane’s local law enforcement to establish inclusion criteria for admission as well as the process for triaging to appropriate level of care. Adding staff to the facility to serve an acute population: Funding for additional full time staffer to provide milieu support, one additional prescribing staff member Salary enhancements for staffing: Enhancements were provided for FBH in order to assist their meeting a goal for retaining a workforce in a region that often has difficulty with recruitment and retention. Facility improvements for a more therapeutic environment: Building out of one office which can be used for assessments and evaluation of needs Client Experience Enhancement Strategies: Items will be purchased to ensure the environment and staffing are addressing a trauma informed approach to help individuals in a mental health crisis. Items may assist with engagement, provide support and comfort, providing coping skills, address current needs, improve social support Medical equipment such as a lab testing machine: In an effort to reduce emergency room visits, the purchase of an iSTAT machine that is capable of taking rapid vital signs and providing lab results. Quarterly Implementation Status Report - May 2020 Attachment C - Page 1 of 2 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 28 of 102 SFY 20 Total $267,770 AGENCY: Columbia River Mental Health/Elahan Place: SFY 21 Total $184,434 While licensed as a Residential Treatment Facility (RTF) in the Southwest Region, Elahan Place (EP) is not licensed as either a crisis stabilization or a crisis triage facility and as such does not accept police holds. However, EP is able to accept drop offs prior to arrest and has long served as a facility providing assistance in transition and support for individuals in need of community follow up and to provide services to prevent rearrests and institutionalization. EP currently offers four (4) crisis beds for short term stays for individuals that experience acute distress. ‘Stab-bed’ individuals are on a facility hold (hourly checks and cannot leave the facility without staff) for the duration of their stay and are usually transitioned to residential treatment services after a week or two if their presenting issues improve. Additional staffing for increased acuity in the population served: A Case Manager position that would be added and act as a liaison role, regularly meeting with hospitals, the jail and EP staff to ensure smooth transitions into the facility. A Medical Assistant position would assist our .5 FTE ARNP at the facility in order to improve efficiency so she can see more clients more often. Adding Peers to the staffing model particularly to create a 'peer bridger' for the RTF: The two peers would be Peer Bridgers based at EP, helping individuals transition out of EP by following them in the community until they can find stable housing and engage in other treatment services. This would increase the throughput of the individuals thus increasing capacity. Client Experience Enhancement Strategies: Items will be purchased to ensure the environment and staffing are addressing a trauma informed approach to help individuals in a mental health crisis. Items may assist with engagement, provide support and comfort, providing coping skills, address current needs, improve social support Improvements to the facility for a safe and therapeutic environment: Enhancements that EP determined would assist them in meeting the needs of the Southwest region includes the reconfiguration of one office which will be used for increased assessments, replacement of current existing security system with electronic locks, additional electronic devices to aid in rapid evaluation, assessment and transition services $95,703 Lifeline Connections: $90,640 Lifeline Connections (LLC) will be a licensed crisis stabilization facility in the Southwest Region. Scheduled to open in May 2020, LLC is requesting training and technical assistance in their enhancement request to open the new facility with staff trained in best practices. Transportation to and from facility + staffing for the van: Transportation assistance through the purchase of a modified van, staffing for the van as well as funding for alternative transportation (Uber, Lyft, etc.) is requested as there are no public transportation lines in the vicinity of this facility. Specialized training for staff: As Lifeline begins to hire staff for this new building and service, it is important to create a workforce that is trained in the best practices within a crisis environment. De-escalation techniques that are trauma informed will be provided with the enhancement funds. Client Experience Enhancement Strategies Items will be purchased to ensure the environment and staffing are addressing a trauma informed approach to help individuals in a mental health crisis. Items may assist with engagement, provide support and comfort, providing coping skills, address current needs, improve social support Start-up funding for housing specialist within the facility: Startup funding for a housing specialist that can assist in transitioning individuals post stabilization services will help the individual be successful with discharge planning and transitioning to the community. It will be assumed that the housing specialist will be able to be sustained through Foundational Community Supports. TOTAL: SFY 20 Total $716,750 SFY 21 Total $1,028,197 Quarterly Implementation Status Report - May 2020 Attachment C - Page 2 of 2 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 29 of 102 4XDUWHUO\ ,PSOHPHQWDWLRQ 6WDWXV 5HSRUW 0D\ $WWDFKPHQW ' Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 30 of 102 Executive Committee Planning Meeting December 18, 2019; 1:00 p.m. – 4:00 p.m. Attendees: MaryAnne Lindeblad (HCA), Michael Brown (HCA), Sean Murphy (DSHS/BHA), Ken Taylor (DSHS/BHA), Tom Kinlen (DSHS/BHA), Aura MacArthur (DSHS/BHA), Josh Stuller, Christopher Carney (CGI), Kim Mosolf (DRW), David Carlson (DRW), Beth Leonard (DRW), Darya Farivar (DRW), Nick Williamson (ATG), Randy Head (ATG), and Jes Erickson (ATG) Special Guest: Keri Waterland (HCA) Action Item: Aura will add assigned lead for topics on Executive Committee agendas in future. General Advisory Committee held 11/19 Ͳ Debrief Feedback/recommendations for future meetings: x x x x x Assign person from Executive Committee to lead each topic Have people identify themselves each time when speaking Did have some technology issues at some locations, but worked through them Had a question on the value of inͲperson if everyone just staring at screen. In order to increase value of the inͲperson connections, will: o Have PM rotate through meeting locations o Try to work in activities for each location, even if it’s giving Executive committee members talking points to pepper into conversations o Encourage discussions during unstructured time (breaks) Include element leads in meeting discussions; to serve as resource and hear firsthand discussion Contempt Funds Access Committee agreed that the general message is “we have a process for our team for diversion programs”. We also have a process available for TB programs through motion to the court. But when regions ask “Who do we contact directly” to talk about accessing funds what is our answer? Kim agreed to serve as that contact in future. Can also share with those asking the that they can sign up for a mailing list Darya manages that is focused on advocacy and also advertises the diversion RFPs that go out. Action Item: Darya will send Aura the signͲup information so she can share with Executive Committee. [DONE] Here is the link to sign up: https://www.disabilityrightswa.org/subscribeͲtoͲtruebloodͲupdates/ Regional Participation in Implementation Concern expressed by members that judges in Pierce region are not as interested as other regions in Outpatient Competency Restoration (OCR). They’ve said they don’t see the effectiveness of OCR. Believe only PRs or misdemeanors would be appropriate, which is not the same vision that Executive Committee holds. 1 Quarterly Implementation Status Report - May 2020 Attachment D - Page 1 of 4 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 31 of 102 Element leads have had trouble explaining value and getting them onboard. Seems to be a lot of misinformation about who would be eligible or how it would be used. Executive Committee members engaged in brainstorming. Could we, Executive Committee members, partner in regional meetings? DRW willing to do an informational session with Pros, judges, etc. to go out collectively and engage stakeholders. Have had some challenges with Pierce Pros with prosecutorial diversion too. Think it would be important to have them involved in the informational sessions so that we can make sure we are hearing their feedback and correcting any misinformation. Could do a joint meeting with Pierce and King to work through thinking on it. Could also bring in folks in other states who have moved forward with OCR in their states. Are organizational change management supports needed? Do we ask for money to bring in an outside firm to help us with that? Committee agrees that best approach is to hold an information meeting and then can talk about approaches that could support next steps. Sounds like an informational meeting would be the same approach we would use if a party outright refuses to participate with a particular element, which was another outstanding question. We have talked about the need to influence local leaders to join us in our ambitious vision. But we all acknowledge that they are not mandated to do what we hope. Agree convincing/influencing is an important aspect. Many times they do respond to their constituents, so long range the Committee should think about how to engage with the constituencies in the community around these coming programs. Leverage the community’s interest in these programs and excitement to spur their involvement and engagement. Action Item: MaryAnne will work with Melodie to pull together a joint King/Pierce information session. Attendees would include: HCA, DSHS, DRW, Pros, courts, judges, etc. Action Item: Tom will get information about Organizational Change Management to share with Executive Committee. Misdemeanor Restoration Committee reviewed a slide prepared by Research and Data Analysis that tracks misdemeanor restoration orders. It includes all misdemeanors from all courts. Unsure how frequently it is produced. Executive Committee would like to see regular updates on this. Ideally would see order numbers drop below 10 for the state. The Department has previously discussed how to educate courts. OFMHS Processing and Referral team is watching orders as they come in and have prepared form letter they send out. Calling those courts in some cases to help educate. Recently had seven or eight that they had questions about so they called and orders were amended, etc. Still some courts that haven’t started using the update forms from AOC. Added language to process staff emails to courts with alert about law change. Plan was to get on District Court agenda to talk to them. Is that still necessary? Discussion of recent email chain w/Judge Zimmerman, James Doctor, Charles Short, Judge Finkle and others that touched on the 2 Quarterly Implementation Status Report - May 2020 Attachment D - Page 2 of 4 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 32 of 102 upcoming DMCJA conference where a topic of SIM and competency, with some focus on Trueblood was discussed. Kim will followͲup and get clarity about if we can join them in that discussion/presentation. Action Item: Aura will find out how often this is produced and see if able to share both PowerPoint and Excel file with Executive Committee. [DONE] NOTE: This PowerPoint file is produced monthly and Aura will receive and share it and an edited version of the Excel file, with numbers smaller than 11 xx’d out, with Exec each month. Action Item: Kim will reconnect with the WA Defenders Association to share information. Action Item: Kim will reach out to get clarity about partnering on DMCJA presentation/session. Crisis Enhancements The Southwest region had an Evaluation and Treatment (E&T) facility close unexpectedly in the fall. It was run by Telecare. HCA has been engaged in conversations in their agency and with the community about how to pass through enhancement funds in this situation. Region is exploring opening similar facility in the same location but no firm solutions have been decided on. Asking community to weigh in on what would be best to replace the E&T in that location? Community so far has indicated they don’t need an E&T. Once community identifies what they need and develops plan will provide an update to Executive Committee. HCA does not believe that this will delay the timelines for disbursing enhancement monies that is written into the Final Implementation Plan. Action Item: HCA will place this topic back on an agenda once more information is known. Crisis Vouchers – Data DRW had originally asked some questions about the crisis vouchers with the hope that it could be discussed during the General Advisory Committee. One piece of information, the recipients of the contracts, was available and shared during GAC. But the other requested details around short and longͲterm data collection conversations wasn’t received in time. The Committee reviewed the excel sheet provided to voucher recipient organizations as a draft. HCA is currently engaged in conversations with each provider to ensure that this represents the data that is needed and can be collected. This reflects the shortͲterm data plan for vouchers and is a manual model using Excel sheets. Conversations within the TB Data Workgroup about longͲterm data goals and collection methods are still in progress. DRW wondering if HCA can compare recipients against existing criminal databases to get the demographic info that is listed? Aura shared that her understanding is that there are issues with data accuracy because of identity theft/aliases. AAGs confirmed there are flaws around data, is part of the discussion with RDA and DRW that is scheduled for January. DRW believes the voucher info may be good info to share info with jails. Will HCA receive regular reports on disbursal so they can anticipate when funds will run out? Action Item: Aura will seek answers to the above questions to share with Executive Committee. 3 Quarterly Implementation Status Report - May 2020 Attachment D - Page 3 of 4 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 33 of 102 Reduction in Bed Count DRW thought they should have heard about this beforehand and were disappointed the news wasn’t shared sooner. Their hope is that we can have frank discussions in the future. State had very little advance warning themselves. There was a very small timeframe between when they heard and when that info was shared. They are extremely sensitive to fact that they are already right up against the June 30th timeline. Not much cushion left and know any further changes are likely to require conversation with court which we do not want. Jump Start Funds Generally in support of both requests. If there were more immediate needs that would directly impact class members then those would take priority for DRW. If housing vouchers, for example, ran out because demand was higher than anticipated. State also supportive of making additional requests for gaps as they arise. Action Item: Nick will write up a joint motion for SW SIM and additional PM and send to DRW for review/signature. 10.31.110 DRW working Hard to find someone willing to take lead on getting changes. DRW wrote up 2 pager which describes what the new statutes does and suggests what jurisdictions could do to implement guidelines. Reached out WASPC and WAPA initially. They sent out announcement and twoͲpager to their membership. DRW has meeting scheduled in Thurston in January. Hoping someone will take lead from that organization. State happy to support if that is valuable. Action Item: Chris will send a one pager to share on the RCW 10.31.110 changes. [DONE] King County Chris has started sending out one pagers and emails to King County contacts. Due to the holidays he has had no meetings yet. Plan is to start scheduling those for January. Contacts are mostly court and legal partners in King County but he is willing to branch out if others have ideas. OFMHS is participating in outreach with King County Competency Continuum Workgroup. Kim also attends those meetings. Best Practice Guidebook for JTA Dr. Luxton left and is now working for the Department of Corrections. OFMHS is working to fill that position. In the interim, Dr. Kinlen is providing coverage and Erik is a point of contact. 4 Quarterly Implementation Status Report - May 2020 Attachment D - Page 4 of 4 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 34 of 102 4XDUWHUO\ ,PSOHPHQWDWLRQ 6WDWXV 5HSRUW 0D\ $WWDFKPHQW ( Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 35 of 102 Executive Committee Meeting March 24, 2020; 1:00 p.m. – 4:00 p.m. Attendees: Michael Brown (HCA), Sean Murphy (DSHS/BHA), Tom Kinlen (DSHS/BHA), Aura MacArthur (DSHS/BHA), Josh Stuller, Christopher Carney (CGI), Kim Mosolf (DRW), David Carlson (DRW), Beth Leonard (DRW), Darya Farivar (DRW), Nick Williamson (ATG), and Jes Erickson (ATG) Special Guests: Keri Waterland (HCA), Melodie Pazolt (HCA), Jason Karpen (DSHS), Shanna Clinton (King County), and Susan Schoeld (King County) General Updates/Discussion x x x In December, agreed to an action item of convening a group meeting between Kinga and Pierce. Idea was to provide support and information sharing to both counties at the same time. Given the increased involvement of Pierce County in programs coming online and the current COVID situation, committee members agree this action item is no longer needed. Tom shared that he has OFMHS staff trained in Organizational Change Management and is able and willing to assign them to support any project teams that need that type of expertise to support program implementation. Since the December Executive Committee meeting, several topics have had special focused meetings and/or email chains to address questions or issues. Members agreed those separate activities are enough and there is no need to memorialize outcomes from those separate efforts in the quarterly minutes. Action Item: Aura will schedule a separate meeting of this type to dig more into the specifics of the crisis enhancements expected in each region. x AAGs sent formal notice to Executive Committee that the state intends to seek a time extension for WSH. Because of the impacts of COVID on supply chains and contractors, identifying an exact time delay has been difficult. AAGs plan to send a motion prior to the April status hearing so that we can discuss this issue with Judge Pechman. Action Item: AAGs will send a message to Steven Crozier with the Federal Court (cc’ing DRW) to seek information on how the April status hearing will proceed given the COVIDͲ19 impacts. COVID 19 Impacts on Trueblood Implementation Members briefly discussed the email sent earlier by the AAGs around the impacts being experienced by state staff and regional members due to the COVID 19 pandemic. Discussion on how the team can keep connected and aligned around impacts in a quickly changing environment. State staff are maxed out, this situation is absolutely taxing our resources in every way. One suggested idea, interval digests, was determined to be overly burdensome. 1 Quarterly Implementation Status Report - May 2020 Attachment E - Page 1 of 5 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 36 of 102 Currently, project teams are sharing impacts and potential barriers with Aura and the PM team, who then flag them for leadership and AAG review/action. AAGs have been sharing issues and impacts with DRW when they are anticipated to impact implementation. Recent example the WSH timeline. Members appreciate the proactive communication and believe the current process is working well. Team is good with continuing this process moving forward. Housing supports as part of OCRP, Forensic PATH, and Forensic HARPS Concern expressed by members about how housing for OCRP and the crisis system (10%) residential supports are being provided. Melodie shared that all housing subsidies from the legislature were in the same line item for HARPS. Both OCRP and Forensic PATH will have access to client support funds of about $3 million. Also had $1 million in additional funds authorized from the misdemeanor funds budget held at HCA. HCA’s goal in design was to use as many housing strategies as possible to get people shelter. They want providers to be flexible and creative in what they look at, including master leasing, etc. Want services to be fast and low barrier. DRW stressed importance of having options that would support court release for the OCR program. OCRP contractors are Greater Lakes Mental Health in Pierce, Lifeline Connections in Southwest, and Frontier Behavioral Health in Spokane regions. They all have a lot of experience providing services in their regions already and have quite an array available. Action Item: Melodie will provide specific amounts of funding for housing to Executive Committee. Action Item: Melodie will share finalized FHARPS contracts with Executive Committee. Action Item: Melodie will ask Monica R. to share OCRP contract language. Forensic PATH Training Kim and Chris attended an FPATH training and were really impressed. Darya is scheduled to attend a future training. They appreciated the access and were able to meet a couple of the Forensic Navigators that were just hired. Wondered how FPATH will be able to access the shortͲterm vouchers? Melodie shared that each program (OCRP, FPATH, etc.) will have their own individual resources available to deploy and the overarching support of the HARPS program. HCA issued upfront funds to FHARPS teams to remove barriers. Members acknowledge this is a difficult population to house and there is a housing shortage. This will require monitoring to see how they bridge the gap. HCA hired Nicole Mims who has worked in this field and is very knowledgeable. She has been doing great work in bringing everyone together around this effort. DRW would like to review the contracts and see how the flexible funds are working. Action Item: Melodie will share finalized FPATH contracts with Executive Committee. 2 Quarterly Implementation Status Report - May 2020 Attachment E - Page 2 of 5 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 37 of 102 Mobile Crisis During discussion at General Advisory Committee, a request was made to talk more about response times and contracts at Executive Committee. A 2Ͳhour response time (baseline) for emergent and 24 hours for urgent calls and each provider must have a tollͲfree crisis line. Melodie shared the link to review a model ASO contract which shows MCR response times in Section 16.3.1: https://www.hca.wa.gov/assets/billersͲandͲproviders/model_contract_ASO.pdf When asked if law enforcement, like WASPC, reviewed the proposals, Melodie shared that WASPC requested local jurisdictions conduct that review. HCA held listening sessions and then teamed up with local law enforcement to review what was submitted. They have sent feedback to the BHASOs so that they can make adjustments. These contracts are still in process. King County GAC Membership DRW suggests adding a King County member, specifically Shanna Clinton, to the GAC. Idea is to have a Bridger role that would stay on for this second half of Phase 1 and all of Phase 2. Shanna is very aware of the Trueblood work underway and deeply connected to the systems in King County, which is why she seems like an obvious choice. Committee is in full agreement. Action Item: Aura will: x x x Send Shanna an appointment letter [DONE] Forward her invites to the Phase 1 GAC meetings [DONE] Send GAC an announcement of her joining, and provide updated contact lists, etc. Forensic Navigator (FN) – Potential Gap There is a potential gap between the wording in the Settlement Agreement (FN will be assigned) versus the language in RCW 10.77.074 (may be appointed). Jason and his growing team have had numerous engagements with the courts within the ten Phase 1 counties over the last several months and has been encouraging courts to appoint a forensic navigator whenever they are considering conditional release. It seems unlikely that courts will grant conditional release in some cases, like Class A and B felonies, violent crimes, gun crimes, and certain DV cases. He is concerned about how the FNs will be able to invoke authority to perform their duties without having the courts appoint an FN. Jason is seeking Executive Committee feedback on this issue. Members expressed concern with planned approach as the whole reason for appointing an FN is to determine what resources are available and whether conditional release should be considered. The judges will not likely know if they would do conditional release at the point that they decide on FN appointment. Discussion on whether DSHS can appoint and whether that would impact legal authority to grant access needed by FNs or compel cooperation. Appears section (6) says the competency evaluation order, not the order assigning an FN, is what grants an FN the authority to get access. Action Item: Jason will forward list of engagements to Aura so it can be shared with Executive Committee. 3 Quarterly Implementation Status Report - May 2020 Attachment E - Page 3 of 5 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 38 of 102 Action Item: AAGs will review 10.77.074 to see if DSHS appointment of FNs is a viable alternative path. Action Item: Plaintiffs will discuss the Forensic Navigator SA and RCW gap further and provide additional feedback. Possible longͲterm actions may include cleaning up language in RCW or getting on the same page with how we message the courts around this topic. Once Aura has the forwarded document, she will send to all to start the email exchange needed to report back on each action item and reach resolution on this topic. Monthly Restoration Order Data from RDA Based on a previous request from Executive Committee, RDA has been building a slide each month that reflects the current amount of Misdemeanor Restorations ordered across the state. That slide is shared monthly via email. Chris asked that we get data that shows the number of orders for each county and whether it is proportionate to the population of the county so that Executive Committee could see if interventions might be needed. The top three counties with a largerͲthanͲexpected number of orders compared to population were Pierce, Kitsap and Thurston. Currently, the staff in OFMHS do quality assurance checks where they make sure incoming misdemeanor restoration orders have a finding of “compelling state interest”. That process started some time ago and that continues today. Question raised as to whether charges are categorically eligible for restoration. Unknown currently. Action Item: Tom will have his team take a random sample of orders from the three top counties to see what crimes are being charged and report back to Executive Committee. Depending on what is found, may want to have targeted education to help bring the numbers down further. In order to move the needle, need to have a peek behind the curtain of what is contributing to a ‘compelling’ state interest. Action Item: Kim and Chris will reach out the Public Defenders office in Pierce County to see if they can gain any insight into the compelling state interest question and share what they learn with Executive Committee. RCW 10.77.088 Last week the Governor signed the technical adjustment bill to correct the unclear language. Goes into effect June 11th, but unclear how long it will take the code revisor to publish the updated text/section. Action Item: Nick will reach out to Amber Leaders to see if there is any way to get publication of this edit expedited. GAC Survey Members approved the GAC survey content to move forward. Aura will work with RDA to develop and have ready to 1) share intent during 5/4/20 GAC and 2) send the first survey immediately following the 5/4/20 meeting. 4 Quarterly Implementation Status Report - May 2020 Attachment E - Page 4 of 5 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 39 of 102 King County Presentation Shanna Clinton and Susan Schoeld provided a detailed presentation on the efforts currently underway in King County and how those may intersect with Trueblood projects coming in Phase 2. Some additional info provided includes: x x Shanna and Susan are the official main contacts for King County as it relates to King County implementation Crisis facility is licensed as an RTF, but not as triage or CSU. Decision was made not to move forward because of expense of retrofitting facility to make it a locked facility and because of significant neighborhood resistance to a locked facility. A lawsuit was filed. Action Item: Once Crisis Gap Recommendation report is released, HCA will share with Shanna and Susan for their review. x x King County has been contracting with the Criminal Justice Training Commission for CIT training since 2010 The King County Continuum workgroup has a subcommittee working on building a crosswalk between existing programs and Trueblood projects. Action Item: Chris will share the King County Crosswalk document once ready with Executive Committee. x x The LINC program, Phase 1, is a Prosecutorial diversion program paid for by OFMHS. They complete 150 diversions per year. That is counting people, not orders, which is higher. The 1/10th of 1 percent sales tax in King County is funding most of their programs like LEAD and coͲ responder programs. 5 Quarterly Implementation Status Report - May 2020 Attachment E - Page 5 of 5 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 40 of 102 4XDUWHUO\ ,PSOHPHQWDWLRQ 6WDWXV 5HSRUW 0D\ Attachment ) 0 10 20 30 40 50 F M 2017 J A CALENDAR YEAR 12 Quarterly Implementation Status Report - May 2020 Attachment F - Page 1 of 1 J A S O N D J M 2018 F DATA SOURCE: Forensic Data System (FDS). J A M J J A S O N D F M 2019 J DSHS Facilities, Finance, and Analytics Administration Research and Data Analysis Division M Effective July 28, 2019, if a defendant charged with a misdemeanor crime is found not competent the court shall dismiss the proceedings and detain the defendant for sufficient time to allow an evaluation for civil commitment, unless the prosecutor objects to the dismissal and proves there is a compelling state interest in ordering competency restoration. RCW 10.77.088 Misdemeanor Restoration Law Change: Compelling State Interest A M J J A S O N Misdemeanor Restoration Law Change “BEFORE” _ ` “AFTER” D J F M A 15 2020 Misdemeanor Restoration Orders and the 2019 Law Change Requiring “Compelling State Interest” M STATUS UPDATED April 2020 1 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 41 of 102 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 42 of 102 4XDUWHUO\ ,PSOHPHQWDWLRQ 6WDWXV 5HSRUW 0D\ $WWDFKPHQW * Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 43 of 102 Trueblood General Advisory Committee Agenda February 3, 2019; 1:00 P.M. – 5:00 P.M. Multiple Locations WebEx Link Meeting #/Access Code: 802 535 329 Password: True2320 Host Key: 661073 Audio: 1Ͳ415Ͳ655Ͳ0001 toll free Executive CommitteeͲͲͲ Sean Murphy (DSHS), Ken Taylor (DSHS), Tom Kinlen (DSHS/OFMHS), MaryAnne Lindeblad (HCA), Michael Brown (HCA), David Carlson (DRW), Kim Mosolf (DRW), Chris Carney (CGI), Darya Farivar (DRW), David Lord (DRW), Beth Leonard (DRW), Josh Stuller (Peer), Jessica Erickson (ATG), Nick Williamson (ATG), and Randy Head (ATG) General Advisory CommitteeͲͲ Aimee Maurer (Spokane District Court), Alison Poulsen (BHT), Amber Leaders (GOV), Barbe West (SWACH), Brad Forbes (NAMI), Carol Mitchell (Pierce Co.), Caitlin Safford (AWHP), Danna Mauch (Court Monitor), Darvin Zimmerman (Clark District Court), Dawn Marie Rubio (AOC), Dory Nicpon (AOC), Grant Blinn (Pierce SC), Inna Liu (Beacon), Jason Schwarz (Snohomish OPD), John McGrath (WASPC), John Nourse (Pierce Pros), Leah Becknell (Beacon), Maggie Yates (SRLJC), Marilyn Roberts (NAMI), Melissa HurtͲMoran (Kalispel Tribe), Michael Finkle (King District Court), Tonya Stern (Spokane BHͲASO) Project Leads/Special GuestsͲͲͲ Bob Graham (CJTC), Mark Kettner (DSHS), David Holt (DSHS), Jason Karpen (DSHS), Darla Dawson (DSHS), Susan Copeland (DSHS), Erik Knudson (DSHS), Tim Hunter (DSHS), Alice Huber (DSHS), Paige Harrison (DSHS), Paula Henzel (DSHS), Josh Waguespack (DSHS), Jessica Alves (DSHS), Keri Waterland (HCA), Melodie Pazolt (HCA), Kara Panek (HCA), Monica Reeves (HCA), Teesha Kirschbaum (HCA), Keith Lewis (HCA), Nicole Mims (HCA), and Mo Bailey (HCA) Time Duration Topic 1:00Ͳ1:15 PM 15 min Welcome and Introductions 1:15Ͳ1:35 PM 20 min Housekeeping & Updates 1:35Ͳ1:45 PM 10 min Crisis Vouchers 1:45Ͳ2:25 PM 40 min Behavioral Health System Changes 2:25Ͳ2:35 PM 10 min RCW 10.31.110 2:35Ͳ2:55 PM 20 min Break Notes / Detail Meeting the Team x Introduce yourself, name and organization Aura Housekeeping x Meeting scope/parking lot Updates x Action Items *Glossary, version 1 Melodie Data Collection – Info Sharing *One Pager_crisis housing voucher MaryAnne Integrated Behavioral Health System Governor’s 5 Year Plan *Behavioral Health PowerPoint Chris Carney Implementation of policy making process 1 P a g e Quarterly Implementation Status Report - May 2020 Attachment G - Page 1 of 2 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 44 of 102 2:55Ͳ3:15 PM 20 min Crisis Gap Analysis 3:15Ͳ3:25 PM 10 min RCW 10.77.088 3:25Ͳ3:35 PM 10 min Diversion collaboration 3:35Ͳ4:15 PM 40 min Implementation Updates 4:15Ͳ4:30 PM 15 min Next Steps Melodie Recommendations and next steps; DRAFT legislative report on rate changes Amber/Nick Report out on efforts to clarify language Chris Carney Quashing bench warrants to support diversion efforts Project Leads *2Ͳ3Ͳ20 Implementation Status PowerPoint Aura x Review Action assignments x Review any Parking Lot items x Other? 2 P a g e Quarterly Implementation Status Report - May 2020 Attachment G - Page 2 of 2 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 45 of 102 4XDUWHUO\ ,PSOHPHQWDWLRQ 6WDWXV 5HSRUW 0D\ $WWDFKPHQW + Crisis Triage/Stabilization Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 46 of 102 Quarterly Implementation Status Report - May 2020 Attachment H - Page 1 of 12 A place for individuals recovering from a behavioral health crisis to receive stabilization support from a multiͲdisciplinary treatment team Can help divert individuals from inpatient hospitalization or incarceration Treatment may include counseling, medication management and administration, peer support, and other resources About Crisis Triage/Stabilization Services Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 47 of 102 Quarterly Implementation Status Report - May 2020 Attachment H - Page 2 of 12 Increase the capacity to accept individuals brought in by police for a six to 12Ͳhour hold for assessment Increase coordination with crisis responders and forensic navigators Provide shortͲterm housing vouchers if needed by an individual Adding 16 beds in the Spokane region to serve both rural and urban needs Assessing capacity in King, Pierce, Southwest and Spokane regions Increasing rates for licensed community behavioral health agencies that operate crisis triage and stabilization facilities in the Southwest and Pierce regions to: Funding to enhance crisis triage and stabilization services: 2019-21 Budget for Crisis Triage/Stabilization Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 48 of 102 Quarterly Implementation Status Report - May 2020 Attachment H - Page 3 of 12 Individual trauma results from an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful, or life threatening These experiences have lasting adverse effects on the individual’s functioning and wellͲbeing TraumaͲinformed approach offers behavioral health, health care, and other providers a way to gain the knowledge and skills needed to promote healing, recovery, and wellness Recognizes people’s symptoms and behaviors as signs of resilience—the ways in which they have bounced back, beaten the odds, or transformed their pain into something positive Infusing a Trauma-Informed Approach to BH services Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 49 of 102 Quarterly Implementation Status Report - May 2020 Attachment H - Page 4 of 12 DOHͲlicensed CBHA, RTF license and crisis triage/stabilization services certification Follow the Medicaid state plan service Contracts with MCOs, BHͲASOs Using the Service Encounter Reporting Instruction (SERI) definition and medical billing codes BA(1 Requirements for Crisis Triage/Stabilization Services Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 50 of 102 Quarterly Implementation Status Report - May 2020 Attachment H - Page 5 of 12 BA(1 Slide 5 Blondin, Amy (HCA), 1/31/2020 Is this the best title for this slide? This doesn't seem like services, more like requirements Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 51 of 102 Quarterly Implementation Status Report - May 2020 Attachment H - Page 6 of 12 Services provided to Medicaid enrolled individuals who are experiencing a mental health crisis. Are to be provided in person’s home, or another homeͲlike setting, or a setting which provides safety for the individual and the mental health professional Shall include shortͲterm (less than two weeks per episode) faceͲtoͲface assistance with life skills training, and understanding of medication effects. This service includes: a) follow up to crisis services; and b) other individuals determined by a mental health professional to need additional stabilization services. Stabilization services may be provided prior to an intake evaluation for mental health services. Medicaid State Plan and Stabilization Services Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 52 of 102 Quarterly Implementation Status Report - May 2020 Attachment H - Page 7 of 12 Hourly services (S9484) Services provided in person’s own home or other home like setting. 55 mins minimum for the first hour, standard halfway service rounding rules apply thereafter. Services reported may be discontinuous, but must be reported on the date of service where they occur. This service may last from 55 minutes to 24:00 hours per date of service and must be provided by staff specifically assigned to this program. Not to be used for services provided in a facility licensed by Department of Health and certified by HCA/DBHR as either Crisis Stabilization Units or Crisis Triage Facilities. Per Diem services (S9485) Use this code for Stabilization Services provided in a facility licensed by Department of Health and certified by DBHR as either Crisis Stabilization Units or Crisis Triage Facilities. A client may be admitted and discharged within the same day. Service Encounter Reporting Instruction (SERI) Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 53 of 102 Quarterly Implementation Status Report - May 2020 Attachment H - Page 8 of 12 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 54 of 102 Quarterly Implementation Status Report - May 2020 Attachment H - Page 9 of 12 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 55 of 102 Quarterly Implementation Status Report - May 2020 Attachment H - Page 10 of 12 Mobile Crisis Outreach – Enhancing the plans to meet and exceed timely response (less than 2 hours) Expand WASPC coͲresponder programs through Misdemeanor Diversion funds Expanding the use of Peers and Peer Bridgers in local inpatient behavioral health facilities, emergency rooms as well as crisis respite/stabilization Developing Peer Respites and a Mental Health DropͲin Facility HCA’s Efforts to Provide Options in Intercept 0 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 56 of 102 Quarterly Implementation Status Report - May 2020 Attachment H - Page 11 of 12 Funding for capacity rather than feeͲforͲservice model Rate study from actuary will be submitted to Legislature based on provider costs Policy/rules regarding operating within residential treatment facilities Facility costs Report to the Legislature submitted to OFM – December 2019 More evaluation is necessary to determine facility needs and payment methods for those individuals who need care, regardless of insurance coverage: Legislative recommendations Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 57 of 102 Quarterly Implementation Status Report - May 2020 Attachment H - Page 12 of 12 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 58 of 102 4XDUWHUO\ ,PSOHPHQWDWLRQ 6WDWXV 5HSRUW 0D\ $WWDFKPHQW , Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 59 of 102 CHANGES TO RCW 10.31.110: WHAT PROSECUTORS AND LAW ENFORCEMENT SHOULD KNOW Greater Discretion Former statute excluded many offenses from diversion, but now when there is “reasonable cause to believe that the individual has committed acts constituting a crime …as an alternative to arrest, the arresting officer is authorized and encouraged” to divert Diversion options include: • Crisis stabilization unit • Triage facility • Designated crisis responder • Release to voluntary outpatient treatment Statute includes good faith immunity for law enforcement officers Policy-Making Mandate Statute requires local law enforcement and prosecuting attorney to develop mutually-agreed upon diversion guidelines “with an opportunity for consultation and comment by the defense bar and disability community” Guidelines must address “at a minimum”: • the length, seriousness, and recency of the known criminal history of the individual, • the mental health history of the individual, if available, • the opinions of a mental health professional, if available, and • the circumstances surrounding the commission of the alleged offense. Outstanding warrants are not disqualifying and the guidelines must: • Define the circumstances when a warrant does not preclude diversion • Address clearing warrants or referrals to clear warrants/set new court dates Other Things to Consider How will you facilitate meaningful consultation by the defense bar and disability community? What are the current or soon to be available resources in your community that police can use to facilitate diversion? E.g., Mobile Crisis Response or crisis beds Who might be easily identifiable candidates for RCW 10.31.110 diversion? E.g., people already in a treatment facility receiving care or people whose “victim” would support diversion from arrest What kind of resources and training are needed to ensure meaningful implementation of this change in the law? Prepared by counsel for Plaintiff in AB v DSHS (Trueblood), please contact Disability Rights Washington for more information Quarterly Implementation Status Report - May 2020 Attachment I - Page 1 of 1 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 60 of 102 4XDUWHUO\ ,PSOHPHQWDWLRQ 6WDWXV 5HSRUW 0D\ $WWDFKPHQW - Overview of the Washington State Public BH System and 2019 Major Initiatives Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 61 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 1 of 24 Department of Social and Health Services (DSHS) Inpatient Services Outpatient Services Behavioral Health Organizations Division of Behavioral Health and Recovery Behavioral Health Administration Health Care Authority (HCA) Center for Medicare & Medicaid Services (CMS) Behavioral Health Funding Before Integration Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 62 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 2 of 24 3 Created a pathway for regions to fully integrate early, starting in April 2016 Directed the State to integrate mental health and substance use disorder services through Behavioral Health Organizations (BHOS) as an interim step to 2020 Directed the State to fully integrate the financing and delivery of physical health, mental health and substance use disorder services in the Medicaid program via managed care by 2020 Changed how the State purchases mental health and substance use disorder services in the Medicaid program Substitute Senate Bill (SSB) 6312 passed in 2014 2014: Initial Legislative Direction Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 63 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 3 of 24 4 No single entity with accountability, nor with the data and information necessary to manage the whole person Consumers with co-occurring disorders navigating disparate systems with no single point of contact Care coordination is duplicated Access to Care standards set an arbitrary barrier to higher-level services Bi-furcated funding streams make it challenging for providers to move to integrated care models. Current Silos Why Integrate? One managed care plan is accountable for keeping people healthy, both mind and body Individuals have 1 point of contact for questions and information Individuals have 1 Care Coordinator Access to care standards eliminated – care is based on level of care guidelines Over time, providers and MCOs can work together to establish new payment methodologies and integrated care models Integrated System Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 64 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 4 of 24 Behavioral Health Administrative Organizations Inpatient Services Managed Care Organizations Outpatient Services Health Care Authority (HCA) Center for Medicare & Medicaid Services (CMS) Behavioral Health Funding After Integration Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 65 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 5 of 24 Federal Block Grant Funds services Used to fund outpatient Services for nonMedicaid services/inpatient/crisis/ individuals or nonresidential services Medicaid billable Medicaid State allocated funds BHO’s choose how to spend the funds Local Tax Funding 1/10th of 1% Behavioral Health Funding Sources Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 66 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 6 of 24 Update on implementation 2016-2020 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 67 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 7 of 24 Managed Care Organizations per region Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 68 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 8 of 24 •Includes DCRs Crisis services for all members of the community Criminal justice related services Block- Grant Funded services State-funded services for Non-Medicaid beneficiaries In Some Regions: County-funded services for Medicaid and Non-Medicaid •Writing block grant project plans •Committees formerly led by BHO – WISe, CLIP, BH Advisory Board, FYSPRT, etc. •BH Ombudsman Miscellaneous Behavioral Health – Administrative Service Organization’s Contracts Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 69 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 9 of 24 Conduct ITA investigations Write ITA petitions and detain individuals when indicated Monitor compliance with less restrictive treatment services Coordinate necessary services include due process Administer Involuntary Treatment Act (ITA) Crisis line Face-to-face crisis intervention services Provide crisis services to all individuals, regardless of insurance Behavioral Health-Administrative Service Organization population-based services Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 70 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 10 of 24 Fully Integrated MCO County or Procured Organization HCA Contract with BHASO Required sub-contract 8 Individual Client Continuum of Integrated Clinical Services Required sub-contract HCA Fully Integrated MCO Contracting and services structure Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 71 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 11 of 24 https://www.hca.wa.gov/health-care-services-supports/behavioral-healthrecovery/american-indians-and-alaska-natives Fee-for-service Integrated managed care (in regions that have integrated physical and behavioral health care for Apple Health clients) See website American Indians and Alaska Natives may choose their coverage for behavioral health services Behavioral health services for AI/AN Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 72 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 12 of 24 Data and outcomes Contract compliance monitoring Interlocal Leadership Structure Rapid response calls – frequent check-ins with each region as it implements IMC Early warning system metrics Monthly early warning system webinars Processes to ensure a successful transition Targeted readiness processes for each newly integrated region Processes to ensure successful transition Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 73 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 13 of 24 Medicaid benefits remain the same Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 74 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 14 of 24 Only three indicators show unfavorable change (95% confidence level) Plan All-Cause 30-Day Readmission Percent Arrested Two indicators show favorable change at the 90% confidence level: Substance Use Disorder Treatment Penetration Mental Health Treatment Penetration - Broad Definition Follow-up after ED Visit for AOD Dependence-Within 7 and 30 Days Follow-up after ED Visit for Mental Illness - Within 7 and 30 Days Inpatient Utilization per 1000 Coverage Months – Combined Medical and Psychiatric Percent Employed Nine indicators show favorable change at the 95% confidence level, e.g.: Research and Data Analysis compared findings in SWWA to the rest of the state from implementation of IMC through September 30, 2018 Early Adopter Region Successes Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 75 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 15 of 24 0% Relative change statistically significant at p < .05 AFTER 10/1/2017 to 9/30/2018 BEFORE 4/1/2015 to 3/31/2017 SOURCE: DSHS Research and Data Analysis Division, Client Outcomes Database Includes Clark and Skamania Counties 24.2% 36.3% Southwest Washington AGE 18 to 64 4/1/2015 to 3/31/2017 BEFORE 25.4% 10/1/2017 to 9/30/2018 AFTER 31.8% Statewide Includes all counties Substance Use Disorder Treatment Penetration Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 76 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 16 of 24 0% Relative change statistically significant at p < .05 AFTER 10/1/2017 to 9/30/2018 BEFORE 4/1/2015 to 3/31/2017 47.7% SOURCE: DSHS Research and Data Analysis Division, Client Outcomes Database Includes Clark and Skamania Counties 45.1% Southwest Washington AGE 18 to 64 4/1/2015 to 3/31/2017 BEFORE 46.1% 10/1/2017 to 9/30/2018 AFTER 47.7% Statewide Mental Health Service Penetration - Broad Definition Includes all counties Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 77 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 17 of 24 0% Relative change not statistically significant AFTER 10/1/2017 to 9/30/2018 BEFORE 4/1/2015 to 3/31/2017 10.6% SOURCE: DSHS Research and Data Analysis Division, Client Outcomes Database Includes Clark and Skamania Counties 12.3% Southwest Washington AGE 18 to 64 4/1/2015 to 3/31/2017 BEFORE 13.8% 10/1/2017 to 9/30/2018 AFTER 11.7% Statewide Psychiatric 30-Day Readmission (HEDIS®) Includes all counties Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 78 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 18 of 24 0% Relative change not statistically significant AFTER 10/1/2017 to 9/30/2018 BEFORE 4/1/2015 to 3/31/2017 SOURCE: DSHS Research and Data Analysis Division, Client Outcomes Database Includes Clark and Skamania Counties 34.3% 44.2% Southwest Washington AGE 18 to 64 4/1/2015 to 3/31/2017 BEFORE 31.2% 10/1/2017 to 9/30/2018 AFTER 35.7% Statewide Includes all counties Follow-up after Emergency Department Visit for Alcohol or Drug Dependence within 30 Days (HEDIS®) Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 79 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 19 of 24 0% Relative change not statistically significant AFTER 10/1/2017 to 9/30/2018 BEFORE 4/1/2015 to 3/31/2017 58.5% SOURCE: DSHS Research and Data Analysis Division, Client Outcomes Database Includes Clark and Skamania Counties 55.4% Southwest Washington AGE 18 to 64 4/1/2015 to 3/31/2017 BEFORE 62.4% 10/1/2017 to 9/30/2018 AFTER 67.0% Statewide Follow-up after Emergency Department Visit for Mental Illness within 7 Days (HEDIS®) Includes all counties Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 80 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 20 of 24 0% Relative change statistically significant at p < .05 AFTER 10/1/2017 to 9/30/2018 BEFORE 4/1/2015 to 3/31/2017 5.2% SOURCE: DSHS Research and Data Analysis Division, Client Outcomes Database Includes Clark and Skamania Counties 5.7% Southwest Washington AGE 18 to 64 BEFORE 4/1/2015 to 3/31/2017 10/1/2017 to 9/30/2018 AFTER 7.0% Statewide 6.7% (WSP WASIS Match) Percent Arrested Includes all counties Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 81 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 21 of 24 Transformation Projects • Each region, through its Accountable Community of Health, will be able to pursue projects that will transform the Medicaid delivery system to serve the whole person and use resources more wisely. • Services such as individualized job coaching and training, employer relations, and assistance with job placement. Benefit: Supported Employment • Individualized, critical services and supports that will assist Medicaid clients to obtain and maintain housing. The housing-related services do not include Medicaid payment for room and board. Benefit: Supportive Housing Targeted Foundational Community Supports Initiative 3 Medicaid Benefits/Services • For individuals “at risk” of future Medicaid LTSS not currently meeting Medicaid financial eligibility criteria • Primarily services to support unpaid family caregivers Benefit: Tailored Supports for Older Adults (TSOA) • Community based option for Medicaid clients and their families • Services to support unpaid family caregivers Benefit: Medicaid Alternative Care (MAC) Enable Older Adults to Stay at Home; Delay or Avoid the Need for More Intensive Care Transformation through Accountable Communities of Health Delivery System Reform Initiative 2 Initiative 1 1115 Medicaid Demonstration Waiver Initiatives Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 82 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 22 of 24 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 83 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 23 of 24 • $35M for PSH for individuals with serious mental illness Housing Trust Fund (SHB1102) Department of Commerce • • • • • • 2 ESF 4 Intensive BH treatment facilities 4 peer respite centers ESF for long-term placement of dementia Hospitals/freestan ding E&Ts for 90180 day capacity Community BH grants to address regional needs BH Capacity Grants (SHB1102) Department of Commerce • 16-bed DSHS Facility for civil commitments • Two 48-bed DSHS Facilities • 150-bed Teaching Hospital to include civil capacity and be operated by the University of Washington • Forensic Hospital that would be between 250-350 beds on the current grounds of Western State Hospital. DSHS – BHA (SHB1102) • • • • • • Increase provider skill and competence to serve population Behavioral health technical assistance with regulations Develop additional ESFs Supportive Housing and rental subsidies 150 Specialized dementia beds Add new strategic plan measures DSHS – ALTSA (2SHB1394) (ESHB1109) • • • • • • 8 PACT Teams Intensive Residential Treatment Teams MH Drop-in Center Pilot Peer Respite BH Intensive Facilities 90-180 civil bed capacity within community settings (2SHB1394) (ESHB1109) HCA – DBHR Governor’s Initiative to transition individuals under civil commitment to community settings Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 84 of 102 Quarterly Implementation Status Report - May 2020 Attachment J - Page 24 of 24 Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 85 of 102 4XDUWHUO\ ,PSOHPHQWDWLRQ 6WDWXV 5HSRUW 0D\ $WWDFKPHQW . Implementation Update February 3, 2019 General Advisory Committee Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 86 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 1 of 17 • OFMHS received notice in December than an evaluator who was starting on February 1st has rescinded the offer. That leaves OFMHS still recruiting for one position on the west side and one on the east side (11/13 positions are filled) • Recruitment is on-going with attendance at two forensic psychologist specific conferences scheduled in January (Portland) and March (New Orleans) Hire Additional Evaluators Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 87 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 2 of 17 • New contract proposals were received 1/17/2020 • Apparent Successful Bidders to be announced by early February • OCRP and FN’s will be visiting implementation region courts in the first quarter of 2020 to discuss how these programs will integrate into current programs Outpatient Competency Restoration Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 88 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 3 of 17 • Navigators will be deployed to each region; four in Pierce region, three in Spokane region, and two in Southwest region • Conducting meetings with partners in all three regions and the OCR workgroup to develop program and processes • First two Navigators are onboard, a third to come 2/1/2020 and hiring under way for the remaining positions Create a forensic navigator role that serves as officer of the court by collecting and sharing data to support courts’ decision on placement in Outpatient Competency Restoration. Assigned at time of evaluation order. Program online 7/1/2020. Forensic Navigators Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 89 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 4 of 17 Project to add 50 new beds on schedule for opening this spring. • Construction is on schedule • Equipment, furniture and fixtures have been ordered and many items have arrived • ESH has filled 45 of the 135 new staff positions Additional Beds – Eastern State Hospital Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 90 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 5 of 17 • Western is still on track to open E3 and E4 for 20 beds each this spring • Mental Health Technician 1s are being converted to the required class of Psychiatric Security Attendant Additional Beds – Western State Hospital Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 91 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 6 of 17 Hard closure date for Yakima is 12/31/21 (Phase 2). Hard closure date for Maple Lane is 7/1/24 (Phase 3). Earlier closure can be triggered by significantly reduced wait times for inpatient services. • Site visits continue at both locations • There is a meeting set for 1/23/2020 with communications to work on templates for letters to community partners, staff, and family members for when the closures begin Ramp Down of Maple Lane & Yakima Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 92 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 7 of 17 OCT CALENDAR YEAR JUL 2018 0 APR 2020 JUL OCT JUL APR JAN 2021 JAN 2022 APR OCT JUL OCT 2023 2024 MEASURE DEFINITION: The median wait time represents the number of days from the beginning of a period of waiting in jail for competency services to order completion among orders completed in the specified month. Includes all inpatient competency evaluation or restoration orders for individuals waiting for services in jail. The order is completed when the individual is admitted for inpatient services, or when the order is dismissed, withdrawn or when the individual is physically released from jail (e.g. on personal recognizance or work release). Includes admissions to WSH, ESH, Maple Lane and Yakima Residential Treatment Facilities. DATA SOURCE: BHA Forensic Data System. 2019 JAN Maple Lane ramp down will begin if median wait time is 9 days or less for four consecutive months. JUL Yakima ramp down will begin if median wait time is 13 days or less for four consecutive months. JAN Maple Lane to close no later than 7/1/2024 OCT 10 APR Yakima to close no later than 12/31/2021 JAN 20 26.0 Inpatient Evaluations 30.0 Inpatient Restorations 30.0 OVERALL MEDIAN (All Inpatient) APR 30.5 JUL 30 OCT 33.0 JAN 35.0 APR 40 JUL 50 Median number of days from court order signature for inpatient competency services to hospital admission or order completion Closure of Maple Lane and Yakima Residential Treatment Facilities Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 93 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 8 of 17 • Spokane Region RFP for creation of 16 bed facility received by the Department of Commerce on December 31, 2019. Proposal is currently under review by both Department of Commerce and Department of Health • Pierce and Southwest Region crisis triage and stabilization facilities to be enhanced based on the funding needs of services provided through Medicaid and State based funding • Additional conversation with regions to determine if needs beyond those identified through the initial implementation plan are needed and available Crisis Beds & Enhancements Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 94 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 9 of 17 • Training for Forensic HARPS teams is scheduled for mid March. The training will focus on defining each data element to be collected, the importance of data integrity and to answer questions from the teams. • On-going training will be offered to the teams related to supportive housing best practices. • All four Forensic HARPS teams have contracts. Each team is in the process of hiring staff. Services will begin on March 1, 2020 • An effective data collection system for Forensic HARPS teams has been created Residential Supports Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 95 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 10 of 17 • Mobile Crisis Response services in Phase 1 regions are available within their communities and provided according to the signed contracts between the HCA and the BHASO of that region • Teams identify that they are meeting contractual agreed intervention of two (2) hours or less • Either served by DCR’s trained to provide crisis intervention skills or by dedicated Mobile Crisis interventionist • Factors influencing the construction of the regional MCR teams include workforce availability, location and salary constraints • Regions are designing services based on current needs with identified enhancement for providing a more timely response to community crisis calls and the acceptance of potential Trueblood class member from coresponders Mobile Crisis Response Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 96 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 11 of 17 • Year 2 grant submissions will be open in April 2020 – Vancouver Police Department $314,917 – Spokane Co. Sheriff/Spokane Valley PD/Spokane PD (joint) $698,750 – Pierce County Sheriff's Office $350,733 • Year 1 grants were awarded 8/28/19 Provide WASPC with funding for Mental Health Field Response Teams in the Phase 1 regions. Co-Responders Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 97 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 12 of 17 • The Forensic PATH Program Administrator has been hired and starts on February 3, 2020 • Four Forensic PATH teams have executed contracts and are now hiring staff • HCA has contracted with a national technical assistance agency, Advocates for Human Potential, who will provide best practices training to both the Forensic PATH and HARPS teams • The first training will be in mid-February. All Forensic PATH teams will come together in Olympia for a training on assertive outreach and engagement to a targeted “list” and effective rapport/relationship building with this population Forensic PATH Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 98 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 13 of 17 • Developed training deployment plan for the regions • Completed audit of current training levels and staffing needs • Training courses have been underway since April 2019 thanks to jump start funds provided by the court During Phase 1, the Criminal Justice Training Commission will provide 40 hour CIT training for 25% of patrol officers and an 8 hour CIT training to 100% of 911 dispatchers and correctional officers in the Phase 1 regions. Does not include federal employees or WA Department of Corrections. Crisis Intervention Training Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 99 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 14 of 17 • List of behavioral health resources related to guidebook content have been posted on JTA website, included in guidebook and webinar trainings • Ongoing monthly JTA trainings offered via WebEx. Schedule and PowerPoint trainings are posted on website: https://www.dshs.wa.gov/bha/office-forensic-mental-healthservices/trainings • JTA Training course catalogue is in final stages for publication on website • Onsite jail visits were conducted at multiple Phase 1 sites to assess training needs regarding subject matter and method of delivery – On track to complete early. Remaining tasks include near final review by SMEs and AAG team and a couple layers of vetting for final approval and publication. • Guidebook of Best Practices for Behavioral Health Services in a Jail Setting due 6/01/2020 – Ongoing collaboration has been productive Technical Assistance to Jails Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 100 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 15 of 17 • Audience for this training is Certified Peer Counselors and other professionals working with individuals who are dually engaged with the criminal court and behavioral health systems • First training will be held on April 29th and April 30th with a target audience of Certified Peer Counselors that are working on Trueblood funded projects • Student and instructor manuals will be completed by March 1, 2020 • The Enhanced Peer Services Program in partnership with The Office of Forensic Mental Health Services has developed a foundational 2-day training explaining the forensic mental health system Enhanced Peer Support Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 101 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 16 of 17 • Breaking Barriers Training and Certification Program in progress with final trainer workshop scheduled for May 2020 • WFD team members are participating in various regional Workforce Development workgroups with external stakeholders • WFD staff and HCA are on track for completion of Forensic Certification program scheduled to deploy by May 1, 2020 • WFD team is coordinating with Groundswell as they conduct research and gap analysis to assist in further determination of state workforce needs and challenges • Phase 1 surveys are ongoing Workforce Development Case 2:14-cv-01178-MJP Document 742-1 Filed 05/04/20 Page 102 of 102 Quarterly Implementation Status Report - May 2020 Attachment K - Page 17 of 17