The Center Collaborative: Creative Solutions in Behavioral Health and Criminal Justice

We have reached the end of Season 3 on the Center Collaborative. Closing out this year, we’re bringing you a fascinating discussion about how professional peers are making a difference in first responder culture in Eastern Oregon.

Peer Coordinator Sergeant Tyler Reddington, Retired Firefighter and Department Chaplain Kevin Coleman, and Dr. Lindsay Tice PsyD, Clinical Psychologist, discuss: 

• Fire and police often experience the same traumatic events, which is why it made sense to collaborate on the peer program.

• Undoing the old thought-process that traumatic events don’t affect all aspects of a first responders well-being.

• After a series of traumatic events in the community had a clearly negative impact on the first responders, the need for more support was recognized.

• First responders need a place to unload traumatic stress that doesn’t feel like they’re placing an undue burden on family and friends. 

• Trauma isn’t always a big event - it can be a result of the accumulation of traumatic stress from any area of a person’s life over time.

• Peers are a sounding board, encouraging ongoing communication about stresses whether they’re related to the job or not.

• If a person feels they would like more skills or help with processing trauma, they can be referred to Dr. Tice, who is culturally competent with first responder culture.

• The  Eastern Oregon Peer Team is adding peers to the team who have first-hand knowledge of an array of life experiences, for example, divorce.

• They are also adding peers from additional agencies in the area to continue building cross-agency relationships.

• The beginning shift in the resistance of the first responder culture to seeking support, as there is a level of understanding from peers. Seeking help and talking about stresses has been normalized during the culture shift.

• Peers are required to complete a 3 day training to be certified, and also must sign a confidentiality agreement.

• The peer team is working on relationship building with partner agencies by doing presentations, and hosting department breakfasts. 

• They are working to implement a call-tree to be dispatched out to trauma scenes in order to have a timely response to critical incidents to provide support to first-responders.

• After experiencing a significant trauma incident, first responders should be treated as though they’ve been injured, and be allowed time to process the incident before going out on more calls. Not being allowed time to process critical incidents can result in reduced job performance, increased stress, and potentially, the development of PTSD.

• A peer is a person who has had a similar experience who you can talk to about your experiences. Peers also have access to other resources, such as Dr. Tice, if a person needs them.

For more information about the intersection between criminal justice and behavioral health in Oregon, please reach out to us through our website at http://www.ocbhji.org/podcast and Facebook page at https://www.facebook.com/OCBHJI/. We’d love to hear from you.

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Holly Harris, LPC, Deschutes County Behavioral Health Director, and Sheriff L. Shane Nelson, Deschutes County Sheriff discuss:

• The benefits of having a 24 hour walk-in crisis stabilization center with therapists on staff.

• The stabilization center takes anyone unless there is a safety concern, and law enforcement can voluntarily drop people off in lieu of taking them to jail. The attitude is, “Coming from a place of yes.”

• The staff can de-escalate situations early for people by providing basic needs - food, rest, shower, etc - so the crisis doesn’t escalate, and the person can stabilize.

• Diverting people to services rather than taking them to jail makes the community and the jails safer.

• The center opened during COVID, and staff wellness has been a focus through safety implementation, debriefing, the betterment committee, and being mission-driven. It creates psychological safety for both staff and clients.

• The staff was provided with situational awareness and tactical training from law enforcement, and they rarely need to call police for back-up and initiate the involuntary process.

• The stabilization center staff also provided training to law enforcement, but it's not just training - it's about the partnership, and creating the trust to be able to provide the best services for the clients.

• The initial funding came through the sheriff’s department to start the project. The stabilization center later applied for, and received, funding from the IMPACTS grant.

• Approximately 400 people were diverted from jail in one year, with an average of 1500 mental health calls. Having behavioral health taking the non-law enforcement response calls straight from dispatch to respond to behavioral health crisis situations has helped to save an estimated $75,000 in officer time.

• Substance use goes hand-in-hand with the behavioral health problems, and won’t exclude a person from receiving services from the stabilization center.

For more information about the intersection between criminal justice and behavioral health in Oregon, please reach out to us through our website at http://www.ocbhji.org/podcast and Facebook page at https://www.facebook.com/OCBHJI/. We’d love to hear from you.

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Dr. Andrew Orf, partner of Lithia Forensic and Consulting LCC and a certified forensic evaluator, discusses:

• Oregon began the certification for forensic evaluators in 2012 for fitness to proceed evaluations, and the courts now prefer Certified Forensic Evaluators for pre-adjudication services.

• The level of nuance between evaluations, as it is combining the clinical perspective with the legal perspective. 

• The many clinical components to consider, such as neurocognitive conditions, personality disorders, or substance use. 

• Legal considerations for statutory evaluations are related to an individual’s intent. Evaluations are also conducted in order to determine if a person’s qualifying mental health disorder impacted their capacity to form intent.

• The pressing need for more Certified Forensic Evaluators, as a lot of people are in correctional settings, and end up waiting for evaluations.

• When people are acutely ill, there are few, if any places to send them for help, as the bar for civil commitment in Oregon is very high.

• Rapid evaluations increase access, and timeliness in more rural areas, as the majority of certified evaluators are in the Portland, Eugene, and Salem areas. There is a collaborative effort between community mental health programs, district attorney, courts and the defense attorney to identify who needs a rapid evaluation.

• Regular consultation with other evaluators is important for maintaining wellness as a clinician doing the evaluations day in and day out.

• Certified Forensic Evaluators can conduct several different types of evaluations based on the requests from the court, such as: guilty except for insanity, juvenile waiver evaluations, risk assessments, mental health evaluations for qualification, neuropsychological evaluations, and civil evaluations.

• People assume that evaluators are advocates, but they strive to be independent and ethical.

• There are layers of complexity within human beings. People can have multiple underlying conditions that make it difficult to know a conclusive answer as to what drives behavior. Two well-trained, experienced evaluators can disagree on a diagnosis, and neither are necessarily wrong.

• Nuanced and well thought-out evaluations are crucial due to the real world implications and ripple effects for people.

• There is a vested interest from the general public because once the process is initiated, costs pile up. One day at the Oregon State Hospital for a person is over $1000.

• Oregon is in a transitional phase with mental health conversations and legislature. It’s easy for everyone involved to point out the problems, but very hard to come up with solutions.
  

For more information about the intersection between criminal justice and behavioral health in Oregon, please reach out to us through our website at http://www.ocbhji.org/podcast and Facebook page at https://www.facebook.com/OCBHJI/. We’d love to hear from you.

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Sue Goldberg, Senior Director Decision Support for Umpqua Health Alliance Coordinated Care Organization and Cheryl McDonald, Licensed Clinical Social Worker, Crisis Program Director for ADAPT Integrated Health Care discuss:

• IMPACTS Grant can uniquely meet people’s previously unmet needs.

• Grant covers 3 full-time outreach navigators, 1 part-time therapist housed in the E.D., 23-hour crisis resolution room, and a sobering center.

• Doesn’t require cohort members to engage in treatment to receive program support.

• Allow the cohort member to be the expert in their lived experience, and allow them to identify what they need to be stable.

• Reducing recidivism by providing Law Enforcement options for diverting people to where they need to be, rather than incarcerating them due to lack of an appropriate treatment environment.

• IMPACTS can fund services that aren't traditionally covered by insurances, such as peer support, phone calls, showers, clothing needs, food, etc.

• Timely and thorough data is allowing better outreach and getting the correct people into the cohort.

• Outcomes indicate a cost reduction in healthcare and jail costs for the individuals in the cohort (approximately 333).

• Community support: It’s not all about the money - people’s lives have been changed.

For more information about the intersection between criminal justice and behavioral health in Oregon, please reach out to us through our website at http://www.ocbhji.org/podcast and Facebook page at https://www.facebook.com/OCBHJI/. We’d love to hear from you.

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Kailee Evans, Oregon Department of Corrections Lead Correctional Counselor, Team Lead for the Peer Support Team, and CIT Coordinator for High Desert CIT, discusses: 

• History of the Memphis Model CIT curriculum development, and how she altered the format to fit within the corrections environment.

• How the Oregon Way was developed through a partnership with the Norway prison system, and involved staff from the prison in Oregon traveling to Norway to learn about the different cultural approach.

• The Oregon accountability process utilizes staff wellness to model prosocial behavior to the AIC’s in order to teach them how to react and behave by example. 

• 99% of people in prison get released, so the more focus spent on rehabilitation, the better neighbors we will all have. 

• The Oregon Department of Corrections puts emphasis on staff wellness, and has added CIT and peer support to policy.

• The 40-hour CIT training incorporates different methods, including utilizing real-life scenarios for role-plays in order to practice the skills learned.
  

For more information about the intersection between criminal justice and behavioral health in Oregon, please reach out to us through our website at http://www.ocbhji.org/podcast and Facebook page at https://www.facebook.com/OCBHJI/. We’d love to hear from you.

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Lane County Jail Captain Clint Riley and Sergeant Chuck Hardy, discuss:

• Programming in jail started due to a desire to improve behavior of the Adults In Custody (AIC) through teaching new skill sets to address their behavioral health conditions, and thus providing a better environment for AIC’s and staff.

• Multi-disciplinary team meets weekly to discuss the needs of the AIC’s and staff. The team can be assembled as needed for interventions.

• Wellness and socialization program provides people with privileges before they’ve earned it. They have something to look forward to, but also something to lose. “People will rise to the level of expectation you set for them.”

• There is no requirement for length of time in jail in order to participate in the program.

• Working with AIC’s in a trauma-informed capacity is a mindset, not necessarily related to credentialing. 

• Providing SUD treatment and medication assisted treatment helps to make the community safer.

• Peers teaching trauma-informed pro-social cognitive skills, like how to spend time sober, conveys the power of hope to AIC’s.

• The jail levy makes the programming possible. It also increases the available jail beds, so AIC’s can be housed for the entire duration of their sentence, and can engage in the programming. The goal is a safer community, accountability, and for AIC’s to leave the jail better than how they arrived.

For more information about the intersection between criminal justice and behavioral health in Oregon, please reach out to us through our website at http://www.ocbhji.org/podcast and Facebook page at https://www.facebook.com/OCBHJI/. We’d love to hear from you.

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Dr. John Gotchall, Pulmonary and Critical Care Doctor, The Arc of Benton County Justice Advocate, and The Arc of Benton County Board Member; Diane Scottaline, Executive Director of The Arc of Benton County; and Cody Gotchall, Self-Advocate and The Arc of Benton County Board member, discuss: 

• How a person receives services through the community Intellectual and Developmental Disability (IDD) services program, and how accommodations are accessed if a person doesn’t meet services criteria.

• Accommodations are independent of county services, and the onus is typically on the individual who needs the accommodations to ask for them.

• Accommodations are typically very low-cost, and “should be applied as generously and liberally as possible.”

• Approximately 18% of Americans experience IDD, but only about 1.5-2% receive services.

• Co-occurrence of mental health disorders along with IDD are very common, and if accommodations aren’t provided, mental health symptoms may be exacerbated.

• How CommCards can identify communication impairments, express personalized accommodations, and can improve interactions between individuals with IDD and the justice system.

• Distinctions between “soft” and “hard” accommodations, and how both are in-line with the ADA’s goals for nondiscrimination.

• People with IDD tend to be victims more frequently as they are a vulnerable population. This should be considered during the adjudication process for people with disabilities in order to avoid disability bias and unconstitutional procedures.

To reach John, please email [email protected] 

For more information about the intersection between criminal justice and behavioral health in Oregon, please reach out to us through our website at http://www.ocbhji.org/podcast and Facebook page at https://www.facebook.com/OCBHJI/. We’d love to hear from you.

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We are taking a break. We are at the end of a fantastic second season and in the midst of interviewing and editing, so we can bring season three to you in the new year.

Thank you so much, listeners, guests, and supporters of our podcast. We could not do this without you. We look forward to bringing you fantastic interviews and nuanced conversations in 2023. Happy Holidays.

For more information about the intersection between criminal justice and behavioral health in Oregon, please reach out to us through our website at http://www.ocbhji.org/podcast and Facebook page at https://www.facebook.com/OCBHJI/. We’d love to hear from you.

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Quinn Berry, MS, LPC, CACD-I, owner of Wallowa Health Services and Brandon Miller, CSWA, CADC-I, Wallowa Valley Center for Wellness Mental Health Therapist, Crisis Coordinator, and CIT Coordinator discuss:

• Establishing a CIT program in a small community presents unique challenges, but also better opportunities for connections and trusting relationships between community partners. Building those relationships outside of the crisis situations pays dividends when the next crisis occurs.
• Interactions with community members in a small community are different, as there will be ongoing interactions with the same individuals. Every call is somebody you know.
• The CIT program is working to change the culture of first responders, moving away from the underlying belief that the expectation is to “toughen up and keep going.” Part of the local culture shift has involved the Fire Department. They have had regular debriefing sessions at the Fire Hall with a culturally competent counselor in order to process events and improve overall wellness. How having a background as law enforcement officers helps to make them more culturally competent mental health providers for first responders.
• Promoting education such as Law Enforcement 101 for mental health clinicians helps to build relationships within CIT programs, as it broadens understanding of different perspectives.
• Recognizing that Law Enforcement is part of the public health apparatus, as most community policing responses are service-related. 
• Experiencing a different order of magnitude of events makes it difficult to relate to others outside the profession, which impacts resiliency. Defining what resilience is and what it means for first responders. 

For more information about the intersection between criminal justice and behavioral health in Oregon, please reach out to us through our website at http://www.ocbhji.org/podcast and Facebook page at https://www.facebook.com/OCBHJI/. We’d love to hear from you.

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Alton Harvey, Jr., CADC-I, Mentor, Public Defense Services Commissioner, and man in recovery discusses:

• His story and what was helpful in his recovery; One man’s journey from addiction to inspiration. Alton’s personal journey and insights into the perspectives that helped him realize he was ready for recovery.
• The important role of mentors, and how they can show a person a new way to live based on lived experiences. Supporting clients during their own personal process, and applying the evidence-based approach of harm reduction when needed.  
• Recognition of how meeting people where they’re at allows engagement at any point, and can help to motivate change prior to criminal justice involvement. This engagement approach can help to build trust with “the system”
• Fostering connections based on shared or similar lived experiences, and recognizing how that knowledge differs from “book learning.”
• A compassionate approach from treatment providers can help to “put the pieces of the puzzle together” for a person’s recovery.

For more information about the intersection between criminal justice and behavioral health in Oregon, please reach out to us through our website at http://www.ocbhji.org/podcast and Facebook page at https://www.facebook.com/OCBHJI/. We’d love to hear from you.

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