Exhibit H - Fidelity Implementation Plan.docx

Exhibit H - PREVAIL Fidelity Implementation Guide Policies, Procedures, and Protocols for BHA Deflection and Diversion Programs

Updated August 2024 Table of Contents

BHA Deflection and Diversion Programs Program Overview PREVAIL (formerly known as LEAD) is a collaborative initiative led by the Colorado Behavioral Health Administration. It partners with law enforcement, community programs, and criminal justice organizations to provide an alternative to the traditional process for youth and adults whose low-level offenses may be due to unmet behavioral health needs or substance use concerns.

Through PREVAIL, participants are connected to a trauma-informed, intensive case-management program that offers wraparound services and individually tailored intervention plans.

While making referrals, law enforcement officers are able to use discretionary authority at the point of contact to divert or deflect eligible individuals away from booking, detention, prosecution, and incarceration.

Each community has adapted the model in ways best suited to meet its unique community needs. This is accomplished through the sites’ governing bodies that identify the program priorities and referral criteria while taking into account the strengths, resources, and barriers of that community.

PREVAIL is a voluntary, community-based alternative to arrest and traditional criminal justice processing. The program seeks to:

· Reduce high-risk behaviors by addressing underlying behavioral health, substance use, and social service needs.

· Redirect eligible individuals away from the justice system and toward supportive, person-centered services.

· Strengthen community safety and well-being through collaborative partnerships between law enforcement, service providers, and the community.

Target Populations PREVAIL operates in two parallel tracks:

· Adult Track-Adults aged 18 and older who are at risk of repeated justice system involvement due to unmet behavioral health or substance use needs.

· Youth/Young Adult Track-Youth and young adult ages 15–18 (or 18-20 for purposes of MIP charges), who are eligible for diversion or deflection, utilizing family-centered, school-connected, and developmentally appropriate engagement strategies.

· Priority Population-Priority shall be given to individuals receiving pre-arrest diversion referrals from law enforcement, followed by social contact and community referrals, consistent with BHA guidance.

Key Benefits For participants:

· Access to housing, treatment, employment, education, and other supportive services.

· Reduced justice system involvement.

· Improved stability, safety, and quality of life.

For the community:

· Decreased burden on courts, jails, and law enforcement.

· Increased public safety through addressing the root causes of behavior.

· Stronger coordination between justice and human service systems.

Evidence-based Practices Each site shall use evidence-based and promising practices (EBP) with a screening and service delivery structure to support effective outcomes. The use of a risk/need/responsivity (RNR) model is also encouraged to assess various factors such as substance use disorders, mental illness, cognitive or physical impairments, financial issues, family dynamics, housing instability, developmental disabilities, low literacy levels, and lack of transportation, all of which may need to be addressed to support success.

Services and Resources Participants are offered intensive case management featuring individually tailored intervention plans as an alternative to incarceration and prosecution. The services and resources must address criminogenic needs and social determinants of health consistent with evidence-based and promising practices, including, but not limited to:

a. Intensive case management, which includes individually tailored intervention plans

b. Temporary and permanent housing that includes individualized supportive services

c. Medical care and/or medication management

d. Mental health care, psychological counseling, and/or psychiatric medication management

e. Treatment for alcohol or substance use disorders

f. Benefit acquisition

g. Education, employment assistance, and vocational training

h. Civil legal services

i. System (s) navigation Programs shall ensure that participants do not receive preferential access to scarce resources that would prevent others in need or on wait lists from being served.

Principles All key principles are directly aligned with the Colorado Behavioral Health Administration’s. (https://bha.colorado.gov)

Purpose All people in Colorado deserve to experience whole-person health.

Vision Behavioral health services in Colorado are accessible, meaningful, and trusted.

Mission Co-create a people-first behavioral health system that meets the needs of all people in Colorado

Values Truth. Equity. Collaboration. Community Informed Practice. Generational Impact.

Program Structure Contracting All contracts shall be held by government agencies in Colorado. The agency must determine if it will maintain the program within the agency or if the program will be subcontracted out to a different agency (with the BHA’s approval).

Subcontractor/Partnership Termination If partnerships with a subcontractor, such as a case management or treatment provider, are terminated, the Contractor shall transition to a new partnership no later than 30 days from termination to ensure continuity of care for all participants of the Program.

Roles and responsibilities Criminal Justice Partners

Law Enforcement Law enforcement plays an important role in the program. Aside from having the discretion to make social and pre-arrest diversion referrals, law enforcement is a crucial component in the success of the program.

Judicial/District Attorney Having the support and partnership of the district attorney and judicial systems is imperative in diversion referrals. Open communication between the contractor, law enforcement, and the district attorney needs to be a priority.

Probation/Parole/Co-Responder As an extension of law enforcement, probation, parole, and co-responders are vital partners for the program. All referrals from these agencies are considered social referrals.

Community Partners Community partners can include medical agencies, treatment facilities, or any other agency that the policy workgroup approves. All agencies making referrals should be invited to the community workgroup.

Program Staff

· Provide leadership to staff

· Coordinates with the Case Manager Supervisor to ensure that staff are operating at the level expected.

· Report to the policy workgroup

· Meet and report to the BHA

· Schedule and conduct training for partners

· Schedule community events

· Manage budget

· Create internal policies that directly align with BHA

· Create and maintain partnerships

· Ensure that all data is being accurately recorded

· Accepts and screens all referrals

· Oversee the daily operations of case managers

· Assign referrals to case managers based on participant difficulty and case manager experience

· Manage the number of participants each case manager has

· Assist with difficult cases

· Ensure that data is being accurately recorded

· Ensure that all assessments are being conducted

· Conduct weekly meetings with staff

· Organize and operate monthly OWG meetings

· Ensures that all diversions are handled appropriately

· Ensures that all partners are updated monthly

· Ensure that an assessment is conducted when needed

· Ensure that all case notes and data are entered

· Assess participant needs and link them to necessary resources

· Work with participants on goals to ensure that they are making progress

· Does not carry a case load but does work with participants as directed by the supervisor

Program Oversight

Required Governance Structures A Policy Workgroup (PWG) is responsible for governance, policy approval, eligibility criteria, and oversight.

A Community Workgroup (CWG) is responsible for day-to-day coordination, case review, and system problem-solving.

Policy Workgroup The Contractor shall develop and maintain a key stakeholder policy workgroup composed of senior members of their respective agencies who are authorized to make decisions on behalf of their offices. The workgroup is responsible for ensuring sufficient resources are dedicated to the success of the program, developing and modifying policies and procedures, creating participant eligibility criteria, and establishing and modifying diversion-eligible criminal charges and exclusionary criteria. The workgroup shall make decisions by consensus. The workgroup shall review reports submitted by the project manager, develop policies, and approve the project’s budget. The policy workgroup shall also oversee the case management agency.

The Contractor shall enter into a written agreement, such as a Memorandum of Understanding, with each Committee member and shall address in each agreement the member agency’s commitment to participating in the implementation and ongoing development of the Program and any key challenges inherent in multidisciplinary collaboration.

Community Workgroup The Contractor shall maintain a Community Work Group to ensure the daily operations of the Program are consistent with policies established by the PWG. The Contractor shall ensure the workgroup convenes in person or via video/phone conference monthly. The workgroup shall address system barriers, conduct case reviews, and work jointly to identify options and potential solutions to support participant progress. All members attending community workgroup meetings shall sign a confidentiality agreement.

Contractor Trainings Officer Training: The Contractor shall provide officer training to improve officers’ responses to people with behavioral health needs and to educate officers on the Program. The Contractor shall determine the amount of training necessary to ensure, at a minimum, that there is a group of officers sufficient to cover all time shifts and geographic districts.

Cross-training: The Contractor shall provide opportunities to behavioral health personnel and other stakeholders to help improve cross-system understanding of agencies’ roles and responsibilities, law enforcement issues, Program policies and procedures, information sharing, safety, and other opportunities to see policies translated into action.

Staff Time Tracking and Invoicing All staff time and expenses need to be tracked and invoiced separately from any other programs an organization or contractor has.

Data Sharing Agreements The Contractor shall ensure that a data-sharing Business Associates Agreement (BAA) is developed between the partner agencies. The data-sharing agreement shall ensure that each partner agency complies with the terms of the HIPAA BAA attached to this contract.

Program Implementation

Referrals All referrals should be sent to the program manager to best track referrals and eligibility screening. Referrals must be screened for eligibility within 3 business days of being received. All referrals should be uploaded into the agency’s database system for auditing purposes, even if the referral was declined after screening. The status of each participant must be documented accordingly. The worksheet for these referrals must be approved by the agency’s policy work group and by the BHA. There will be a referral form provided by the BHA to use as guidance.

Each agency should have an average of 125-150 participants referred annually, with no fewer than 100 referrals. Ideally, each case manager should work with 20-30 individuals on an annual basis.

The referral process should follow the flow chart below.

Law Enforcement and Criminal Justice Partner Referrals

Social Social referrals come from law enforcement, probation, parole, or co-responders. These referrals allow criminal justice partners to make a referral regardless of charges being filed. The eligibility for these referrals and diversion must be set by the agency’s policy work group.

Diversion Pre-Arrest Diversion Pre-arrest diversion referrals come only from law enforcement. These referrals allow officers to divert a low-level crime by allowing the individual to enroll in the program instead of being charged. The eligibility for these referrals and diversion must be set by the agency’s policy work group. Individuals should be enrolled in the program within 30 business days, and the officer will be notified of the status of the participant. The officer has the discretion to file the charges based on the information provided.

Post-Arrest Diversion Post-arrest diversion referrals can come from judicial agencies or the district attorney’s office. These referrals allow judicial systems to divert charges by allowing the individual to enroll in the program instead of continuing forward with the traditional system of sentencing. The eligibility for these referrals and diversion must be set by the agency’s policy work group and approved by the BHA. Individuals should be enrolled in the program within 30 business days, and the referring agency will be notified of the status of the participant.

Community All community referrals can come from any agency that has, or will be, a community partner. These partnerships can include MAT providers, medical providers, treatment facilities, DSS, or any other partners in the local or state communities. These partnerships must be approved by the policy work group.

Enrollment A participant can only be considered enrolled once a GAIN assessment is completed. All participants must continue to receive the GAIN assessment every 90 days to track progress and collect data. No BHA funding can be used on a participant until the assessment is completed.

Eligibility Priority for resources must be for individuals who are at risk of repeated contact with law enforcement, have unmet behavioral health needs, or have substance use disorders.

The eligibility must be set by the agency’s policy work group and approved by the BHA. The eligibility guidelines should abide by the following criteria:

1. Anyone who has been charged and prosecuted with the following crimes may not be considered for referral: Possession with the intent to distribute, or distribution

a. Felony Sexual Offenses

b. Felony Child Abuse

c. Homicide or Attempted Homicide

ROI

A release of information must be signed by a participant prior to being considered enrolled. If the agency does not have the express consent of the individual to share information, no information may be shared with outside agencies (other than the BHA), with the exception of law enforcement or a judicial agency, if the referral was a diversion referral. All ROI documents must be approved by the agency’s policy work group and approved by the BHA.

Assessment A BHA-approved assessment must be conducted for a participant to be considered for enrollment in the program. This is to be done within 14 business days of the participant being referred to the program. This assessment will be conducted every 90 days for the duration of the participant's engagement in the program. 6-10 attempts

Status

Pending

· This status begins immediately when an individual is referred.

· The individual must be enrolled within 30 business days, with at least 6-10 attempts documented, in order to move to another status.

Active

· This status begins immediately upon completion of the ROI/Consent and assessment.

· This status can also be changed from outreach or inactive based on activity with the case manager and participant.

· Active status implies the participant is actively participating in the program, which includes working towards any goals.

Outreach

· Outreach status is a step down from active status; however, it should not hold negative connotations.

· Outreach status can be reached when there has been no active communication between the participant and case manager for 90days or if the participant has found stability and has not been as dependent on the case manager for support.

Maintenance (Stability)

· This status is meant to be a reflection of stability for the participant. A participant may remain on this status indefinitely, and it can be interchangeable with any other status depending on any changes in stability (relapse, jail, ect.).

· Participants may reach out intermittently, are stable, but are still choosing to be in the program, and lean on case managers for support.

· The case manager and participant should have contact at least once every 60 days.

Inactive

· Inactive status should be noted when the participant and case manager have determined that the program is no longer wanted or needed.

· Inactive status is also when a participant who is on outreach status has had no communication with a case manager for 120 days.

· There should be a documented subcategory for why the participant became inactive.

Deceased

· This status is only for participants who have been enrolled in the program and are deceased.

Program declined

· This is for individuals who have not met the program eligibility criteria.

Participant declined

· This status is based on the withdrawal of interest from the referred individual. This is to be used only when the participant has expressly stated that they are no longer interested in attempting to enroll in the program.

Not enrolled

· This status is to be documented after 30 business days of receiving the referral, AND 10 documented attempts at reaching a participant.

Case Management Principles

Staff Safety Staff should never be alone with a participant or meet in an area that is considered unsafe. Case managers should address any safety concerns to their supervisor immediately, and a safety plan should be implemented. Each case manager should ensure that they are in a well-lit, public place and ideally with another staff member.

Confidentiality, HIPAA, Privacy, and Mandated Reporters Data Tracking Tools:

· Civicore

· Chestnut GAIN No shared logins for these sites, and no data may be shared with any other agency without the express written consent of the BHA.

Confidentiality is a must. Anything not marked by the client on the ROI may not be shared, other than the status information of the participant with the referring party.

All information that is protected by HIPAA may not be shared with any agency.

All staff members are mandated reporters and must follow state law.

Training Training required for all case managers includes Mental Health First Aid, BHA Case Management Training, Motivational Interviewing, HIPAA, and Mandated Reporter.

Warm Handoff/Initial Meeting A warm handoff is the ideal way of receiving referrals. If an agency is able to facilitate a warm handoff, the agency staff may obtain the referral in person. Studies have shown that individuals are more likely to enroll and engage in a program when a warm handoff is conducted.

If a warm handoff is not an option, it is best practice to have the initial meeting with the participant as soon as possible.

Golden Thread Case management decisions are guided by participant needs, goals, and progress.

Ensure needs addressed, goals tracked, referrals and outcomes documented.

Weekly Supervisor Meetings All programs shall have a weekly staff meeting with the case manager supervisor to check files and staff participants, and their needs.

Information Sharing/ROI The case manager shall have the participant sign the ROI and consent upon intake of the program. With the ROI, the case manager has the permission to share updates (within reason), with the referring party.

Case Loads The case manager supervisor is responsible for tracking the case loads of all case managers. The following items should be considered when assigning case loads:

· Experience of a case manager

· Complexity of participant needs

· Case managers should have 12-18 participants at a time, based on their experience and the complexity of clients.

General Expectations

· Do no harm, do not disclose information that can cause harm to our participants

· Meet where they are at-physically and emotionally

· Do for, do with, and cheer on. Do not enable.

· What would Kyle Clark say?

Case Management Tracking

Outgoing referrals It is important to track outgoing referrals because if they enroll in those services, you are a direct result of that outcome. These referrals show that you are using the data and information provided to offer the best support for your participant. Documented outgoing referrals=linkage to resources.

Outcomes We track outcomes because these are positive events that happen with participants that can be shown to have a direct link to work. These outcomes are a result of our outgoing referrals, time spent with participants, support, advocacy, and wraparound services with partners.

Goals Each participant should have their own goals charted and tracked. Once goals are achieved, that should be noted as an outcome. This shows that we meet participants where we are at. Document individual goals; completed goals = positive outcomes.

Notes Each case manager is responsible for completing notes for documented contacts with partners or the participant within 72 hours of contact.

Expenses All programs should consider using financial support as a last resort. All other resources should be used before financial assistance, and this should be documented in the notes. Housing should be considered as a priority for participant funds and needs.

An individual who is not enrolled in the program may not receive any financial assistance from the program. Any financial assistance that the program gives can ONLY be given to individuals who are enrolled.

Allowable Costs Have Defined Attributes:

• Necessary

• Reasonable

• Allocable

• Consistent

• Not included as a match

• Net of applicable credits

• Adequately documented

Allowable uses of funds:

Housing, treatment, emergency supplies, emergency shelter, participant costs, travel, food for training, medical, and moderate partner needs.

Gift cards, phone cards, transportation vouchers/passes, or any items purchased in bulk must include an inventory log and the recipient’s signature.

Unallowable uses of funds:

Alcohol, tobacco, or marijuana (even with a medical card), bad debts, entertainment, fundraising, fines and penalties, goods or services for personal use, purchase of a vehicle, legal fees, and food for eating out with partners.

Glossary and Acronyms

· “BAA” means Business Associate Agreement, as defined in Exhibit D - HIPAA Business Associate Addendum - Qualified Service Organization Addendum

· “BHA” means Behavioral Health Administration.

· “Community Referral” (CR) means when a community member (someone who is not a law enforcement officer) genuinely believes someone is experiencing substance use issues and/or mental health concerns that are driving life difficulties that have led, or may lead to, involvement with the criminal justice system, and makes a referral.

· “DCE” means contracted Data Collection Entity

· “Diversion Referral” means when a law enforcement officer has probable cause to arrest for an eligible offense (see Table I), and instead chooses to divert charges by making a referral into the program.

· “GAIN” means Global Appraisal of Individual Needs Assessment

· “HIPAA” means the Health Insurance Portability and Accountability Act of 1996.

· “LEO” means Law Enforcement Officer

· “LEAD” means Law Enforcement Assisted Diversion/Let Everyone Advance with Dignity

· “CWG” means Community Work Group

· “PWG” means Policy Coordination Group or Policy Work Group

· “Program” means the PREVAIL program.

· “Program/Project Manager” means the person responsible and accountable for managing the Contractor’s PREVAIL Program.

· “Program Coordination Group” means the group that oversees the Program’s implementation and progress.

· “RNR” means the Risk-Need-Responsivity model

· “Social Contact Referral” means when a law enforcement officer believes an individual is at high risk of arrest in the future and chooses to make a referral into the program, regardless of whether charges are made.

· MIP

· MOU

· PREVAIL

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