Case Study: Bernalillo County, N.M.
In September 2017, the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Association of Counties (NACo) and the Laura and John Arnold Foundation (LJAF) hosted the Data-Driven Justice and Behavioral Health Design Institute (Design Institute) in Rockville, Md. The Design Institute convened 13 teams committed to the Data-Driven Justice (DDJ) initiative. Teams were selected through a competitive process to work directly with expert faculty in facilitated sessions and workshops to create action plans for developing and using integrated data systems that would aid their jurisdictions in identifying high utilizers of jails and crisis services. This case study is part of a series highlighting counties that participated in the Design Institute.
GETTING STARTED
Developing resources to treat the behavioral health conditions of high utilizers—also called frequent utilizers—is one of the major strategies Bernalillo County is using to reform its justice system and improve health outcomes. Through the Albuquerque/Bernalillo County Government Commission (ABCGC), the county and city collaborate to design and implement community-based programs that help the high utilizer population access the treatment and programs they need to live well, including supportive housing for people leaving the jail and mobile crisis teams that deescalate situations stemming from 911 calls that involve people in a behavioral health emergency.
The Bernalillo County Criminal Justice Coordinating Council (BCCJCC), which includes representation from the Bernalillo County Board of Commissioners, law enforcement and major stakeholders in the criminal justice system, has been essential in developing and implementing new programs and resources for frequent utilizers of the justice system. To begin identifying this population, Bernalillo County uses data from the jail—also referred to as the Metropolitan Detention Center (MDC)—and its Psychiatric Acute Care (PAC) housing unit, which has 100 beds and provides both mental health and substance abuse treatment. Bernalillo County defines high utilizers as
individuals who have had five or more interactions with PAC within three years. The county has conducted several studies to determine the needs and impact of frequent utilizers on systems and to examine their outcomes. There is a countywide understanding, from residents to elected officials, that individuals with complex physical health, behavioral health, criminal justice and social service needs consume disproportionate amounts of local services and resources.
Bernalillo County and the City of Albuquerque share data and collaborate with local hospitals, behavioral health service providers, criminal justice partners and other community organizations to connect people to programs and services upon their release from MDC. Through a partnership with University of New Mexico (UNM) and its Institute for Social Research (ISR), researchers have matched jail data with information from the Bernalillo County Department of Addiction Treatment Services (DATS), the sheriff’s Crisis
Intervention Unit, which responds to calls involving mental health crises, and Albuquerque Health Care for the Homeless, which is a federally qualified health center providing services to homeless people. The courts recently agreed to share their data with the county in order to better understand how cases move across the justice system and the impact of the court system on the Bernalillo County corrections system. While Bernalillo County has access to a variety of data sources, data collection is often done manually. There is no integrated data system or warehouse, making the data-matching process labor intensive and time consuming.
Through its involvement in the Data-Driven Justice (DDJ) initiative, Bernalillo County has deepened its commitment to using data to steer and inform its policy and programming decisions. Under the direction of the BCCJCC and the county’s dedicated DDJ team, which attended the Design Institute, the county has prioritized building upon its existing data-driven efforts to improve service delivery and health outcomes for individuals with complex health and social needs. Ultimately, it wants to have a county-wide data integration strategy that includes the operational definition of frequent utilizers and uses a software program for aggregating and analyzing data.
MAKING PROGRESS BY LEVERAGING RESOURCES AND RELATIONSHIPS
In 2015, Bernalillo County enacted a new tax to support the expansion of behavioral health services within the county. The tax supports the Behavioral Health Initiative (BHI), which is a business plan for a comprehensive system of behavioral health services, with an emphasis on coordinated crisis, stabilization and long-term services. The plan includes an administrative structure with formal oversight of service coordination and funding allocations. To guide the development of the business plan, the county enlisted the assistance of outside consultants to help it identify priorities, gaps and needs and to design new service delivery models.
Four subcommittees recommend how funding should support behavioral health services in four domains, including 1) crisis services, 2) community supports, 3) supportive housing and 4) prevention, intervention and harm reduction. Each subcommittee has a formal goal and is assigned projects that are identified in the business plan. For example, the community supports subcommittee is responsible for improving services in the community that will stabilize individuals and prevent crisis. It works on projects that include crisis respite, forensic assertive community treatment and peer-supported and drop-in services. Each subcommittee has a chair and co-chair and these leaders also sit on the BHI steering committee. The steering committee is overseen by the ABCGC.
BHI is funding the expansion of an existing supportive housing program. The program connects people leaving jail with a place to live and services to support their health and well-being. To be eligible, participants must meet criteria related to income, homelessness and behavioral health needs and they must be able to live independently. Priority is given to people who are frequently booked into MDC and have more severe behavioral health conditions. Eligible individuals are then referred to one of three service providers for an assessment. After intake and assessment—processes that begin in the jail—the service provider will develop a transition plan. Housing begins immediately upon release from jail. The county leverages the Housing Choice Voucher Program supported by the U.S. Department of Housing and Urban Development to directly pay landlords.
Mobile Crisis Teams (MCTs) have also been implemented through the BHI. MCTs embed social workers and counselors with at least a master’s degree in the Bernalillo County Sheriff’s Office and Albuquerque Police Department. These behavioral health professionals are employed by St. Martin’s Hospitality Center, a non-profit that operates shelter and housing programs and offers employment and mental health services. The teams are dispatched through 911 calls involving people experiencing a behavioral health emergency with the goal of reducing unnecessary jail bookings and emergency room transports by stabilizing people in the field. MCT is different from crisis intervention training used by law enforcement officers, which aims to educate officers on the signs of mental illness, train them to deescalate crisis situations and exercise their discretion to divert or refer to additional resources. MCT leverages the training and certifications of social workers and counselors to recommend treatment options and, because of their affiliation with St. Martin’s Hospitality Center, they can
broker access to community-based programs.
MOVING FORWARD AND ADVANCING NEW IDEAS
Because of its relationship with UNM, Bernalillo County is able to advance a commitment to evidence-based decision-making. The Institute for Social Research (ISR) provides assistance in support of numerous county initiatives, including identifying the evidence on which to develop programs and evaluating the impact of jail population reduction initiatives, the BHI and the county’s substance abuse programs.
The university also plays a direct role in implementation. Bernalillo County is getting ready to launch Project ECHO with the University of New Mexico Hospital (UNMH) to improve how people leaving the jail are linked to services. The first part of the project involves training jail and reentry staff on motivational interviewing and client-driven, strengths-based counseling approaches. UNMH will then do biweekly meetings with staff after the initial training to ensure processes are implemented with fidelity to design. Quarterly meetings will be held
to focus on gaps in community-based service systems and how to address them.
Project ECHO is also being used to support the success of the Resource Re-entry Center (RRC), which the county opened in May 2018. Bernalillo County MDC discharges 70 to 80 people a day and between one-quarter and one-third of those people were involved with PAC while in jail, including a handful of individuals who are classified as frequent utilizers. In conjunction with transition planning that begins while someone is in jail, the resource center’s purpose is to connect people with a wide spectrum of services that will support their health and wellbeing
in the community. Transition planners and service navigators affiliated with UNMH staff the RRC and MDC provides transportation from the jail to the resource center, which is open 24/7. The county expects that close to 21,000 people will access the RRC each year.
Bernalillo County is also expanding access to medication-assisted treatment (MAT) for people in jail. More than 360 people detox from opioids while in MDC each month. Research shows that people are more likely to die of an opioid overdose in the first week of discharge from a correctional facility than other times following release. Studies also show that increasing the availability of MAT—which combines pharmaceuticals with counseling to address the physiological and psychological dimensions of addiction—can significantly decrease overdoses. For more than 10 years, the county has provided MAT to people in MDC who were already receiving methadone
treatment prior to entering jail. The jail’s contracted health provider verifies the prescription and dosing regimen with the community-based prescriber. Bernalillo County recently began offering people in the jail the option to start MAT and then continue treatment in the community with a self-selected provider when released. The program currently operates at no cost to the county through a grant from the state.
County leaders are leveraging their experience with using data and evidence-based strategies to strengthen the continuum of care for people who are involved in the justice system. As the county continues its work to create comprehensive service delivery models, it looks for ways to enhance its use of data and analytics to inform its decisions and evaluate the impact of its investments. Through its participation in the Design Institute, Bernalillo County identified new ways to approach its data integration goals and continue its mission to efficiently address the needs of frequent utilizers.
NACo would like to thank Bernalillo County Commissioner Maggie Hart Stebbins and Technical Advisor to the County on Adult Detention Reform Elizabeth Simpson for sharing information on the county’s efforts.