We engaged in a full partnership model with the Sheriff’s Office: Financial Assistance Fraud Investigator / Embedded Detective in Child Protection / most recently The Yellow Line Project.
It is definitely about mutuality and partnership with Law Enforcement/clean hand-offs for access to direct services, case tracking, and follow-up on goals/we are consciously engaging the complexity of diversion for acute and chronic individuals (chemical dependency/mental health).
YLP is based on the premise of attempting to screen 100% of individuals (for primary chemical dependency and mental health concerns) who could be incarcerated.
During our initial pilot, we have used the pre-booking area to centralize the screening process whenever possible.
Our focus was to make the screening as streamlined as possible for Law Enforcement Officers and offer more upstream choices to law enforcement beyond Emergency Rooms, Detox, or Jail.
We hope to standardize training and practices over time to increase reliability of decision-making and reduce inequities of access to services (this may include issues of race, poverty, etc.)
Late in 2015, conversations between Human Services leadership and the Sheriff’s Office leadership began. Human Services asserted that we had something to offer to the legally-involved population, as a way to get further upstream on issues surrounding detox, mental health hospitalizations, and treatment of various forms. We had a very small planning group – three each from Human Services and the Sheriff’s Office. The six of us spent months on root cause analysis of the trends we were seeing related to the individuals in jail. We also did research nationally and, at the time, there wasn’t a model that fit our vision. This has since changed, as the world of pre-arrest diversion and deflection has increased exponentially – which is really exciting. But, at the time, we were planning in the dark.
The “Yellow Line” really came from a discussion we were having about the most critical time of intervention. We believe a yellow marker happened to be involved, and some of us really thought there was a yellow caution tape on the floor (there wasn’t, but we’ve since put a YLP logo tape on the floor) at the door of the jail. We kept saying “what else can we do ahead of the yellow line to prevent incarceration?” The name stuck.
The goals of the project have never changed. Once we developed our charge, we held fast to it. And, it was not easy. There were other programs operating nationally that occur just after the yellow line (like pretrial) or upon release from the jail (reentry programs). These are very good, evidence-based programs. We received a grant from the Department of Human Services to do design in this specific space, and so that really helped us continue the design – and hold to our mission. It would have been very, very easy for us just to say “let’s do this other thing that we KNOW works.” We're proud that we didn’t. We're very happy that we kept our eye on prevention at the highest degree.
While we had many specific goals surrounding policy, practice, and finance, the main goal was simply to strategically place human services at a point in the law enforcement process that would allow the individual and the law enforcement officer to consider treatment options instead of just incarceration, and to link people to those services.
No, we haven’t deviated from these goals. We have gotten significantly more sophisticated with it. We have four pathways now where we can intervene on a situation. We started out focusing on the pre-arrest diversion route. Since then, we have expanded to providing services to the exception population that is incarcerated (these are individuals that we specifically want to follow closely in jail, and facilitate transitions to treatment or home once released), and we are now working on the design for street-level deflections and those individuals that are in jail for up to three days.
We also have numerous operational goals that we’ve set up under a project management structure. So, while the goals sounds succinct and simple, it is very complex and detailed. Currently, we are really focusing on bringing our data platform up in a way that is accessible to all of the leadership team, real-time, and able to manipulate for our individual needs. This is a HUGE goal, which is taking us much longer than we anticipated.
The Hub is our 10 County Psychiatric clinic that is in full operation (not changed). We also have a vendor-based contract within the jail for health services. In the next chapter of development we will continue to look for ways to streamline direct care and improve access to services using both diversion methods and in-jail services.
We do have protocols for the YLP. Everyone is screened (typically) prior to being booked into jail. Our project has moved away from holding charges in abeyance to completion of the YLP plan. We have found that this made very little impact on the success of their 'My Yellow Line Plan' and it was causing unintended hiccups with records and the county attorney’s office. We are focusing on linkage to service, as data showed that the sooner they link to services, the more successful they are. The findings were drastic, and they were not linked to types of charges, either. So, we simplified, and made it all about linking to services, regardless of charges. We ask the officer to decide on charges right away. Some decide not to charge and they link to services instead, and some still charge and link to services, too. We are now moving to a street level referral process, where the person doesn’t have to be transported to jail. We do the screening by phone, and this works well for situations where the person wouldn’t be brought to jail anyway.
For our process and protocol, view our "Operational Toolkit". Most all of our forms and workflows are on this page. Focus on Initial Screening form and the Results and Referral form (that is the step by step document), as well as the Street Level Referral Workflow. Additionally, the Pathways page will give a good overview of the workflows.
Roles and Funding
Human Services and the Sheriff's Office began a partnership to do work that the agencies could not do without each other. The Mankato Police Department joined this partnership as well. Human Services has taken on the leadership roles for both the design and operational levels of this project. Specifically, in operational terms, Human Services has dedicated two social worker positions (Community-Based Coordinators) to the project (since 1/1/18), been the linkage to our mobile crisis team, and handled the administrative aspects of the one-time grant received from the Minnesota Department of Human Services. We have also, with board support, indicated that systemic savings from detox and hospitalizations will be reinvested in diversion work.
The Sheriff's office was the first partnership created. We have since added the Mankato Police Department and then Horizon Homes (our mobile crisis and residential crisis provider). In 2019 we restructured our operations debriefing team to the Collaborative Outreach Team and as previously mentioned, added Mayo Clinic Health System, Corrections, our local law enforcement dispatch (communication center) administrator and the local housing coordinator to this team.
Our utilization of our Mobile Team was very low prior to the Yellow Line Project as Law Enforcement seldom if ever used the resource.
Since 24/7 implementation that included the Mobile Team and our Crisis Center as primary partners, utilization is dramatically higher.
The Mobile Team is currently helping to cover 24/7 access for screenings, yet they still hand off screenings to our Community Based Coordinator (provided through Human Services) who follows up with treatment planning and tracks progress on goals.
We had a one time grant from Minnesota Department of Human Services for the design and pilot phases. We now use a reinvestment of systemic cost savings to fund the project moving forward. We were successful in the legislative session in creating a MA (Medical Assistance) billable service for the care coordination associated with all contacts following a diversion. This was submitted to the Centers for Medicare and Medicaid Services and we have received approval to move forward.
We started our project with funding from DHS, and it was approved with the intention that we would create a model that is replicable beyond Blue Earth County. That funding ended, so we needed to make it sustainable. We are redirecting hospital and detox cost savings to support operations. Additionally, the Minnesota legislature approved adding the care coordination done by Community Based Coordinators to the MA benefit set. We are currently working with the state and the feds to get all of the billing details ironed out. We would expect this to be ready to go in the coming months. Services will be billable in 15-minute increments.
Human services and law enforcement, specifically the Blue Earth County Sheriff’s Office have a history of working together. A few years back we redesigned our welfare fraud investigator position and had a Sheriff’s Office deputy in our building doing this work. This was groundbreaking in terms of how our agencies work together. This hadn’t been done before. Since then, we’ve done the same thing with Child Protection with a co-located deputy. This has improved our work in these areas in more ways than we anticipated. So, coming together wasn’t difficult. Deciding on how big of a bite from the apple we were going to collectively take – that was the challenge. We kept our planning group small – contrary to what one often reads about inclusive planning and community engagement. We wanted to have something to look at and think about before we incorporated the engagement of others. We're glad we did, but it is counter to what is often expected. The Mankato Police Department and a private Mental Health provider, Horizon Homes, were the first to be added. They have both indicated that they came on board at the right time.
While leadership has been fully aligned, we continue to manage day-to-day instances of misalignment within our systems. This was a full-system change effort which does takes time and continuous evaluation of areas/processes that need to be improved. We clearly saw there were early adopters in our agencies – people who wanted to try the new thing and believed in it. We had some more that began to use the process over time, and others that just weren’t as interested. After a while, it became clear that in order to be equitable in how we delivered service, we had to offer a screening to 100% of the people who came into the booking area of the jail. That closed the gap on choice, and we believed the system was ready for that. Now, it is common practice that YLP screenings are initiated – no questions asked.Seeing law enforcement and Human Services staff work together in ways we couldn’t dream possible before this project is some of the best stuff. Of course, the personal life stories of the people we impact are the best, but the staff integration is a very close second.
Our process of development and how we rolled out the screening expectations helped. We initially facilitated a debrief meeting twice per month where all agencies discuss process barriers and challenging client situations. The Project has since expanded stakeholder involvement and created the Collaborative Outreach Team to include the County Attorney's Office, human services behavioral health Mayo Clinic Health Systems (local hospital), community corrections law enforcement dispatch and the local housing coordinator. The team meets twice a month to provide collaborative consultation on individuals incarcerated or in the community that pose a risk to self, family or others. Several of the community-based cases are referred to Yellow Line for voluntary screening and care coordination; however, consultation is also often a means of developing plans to assist to the presenting agency in helping the individual access services and prevent further involvement with law enforcement.
We’ve had our share of obstacles with the project. The people impacted motivate us to continue to overcome obstacles we encounter. And, every obstacle has created a better outcome. It may not feel like it in the middle of the conflict, but in the end, it has been worth it.
Yes, both short term and long term housing options are clearly critical components.
Sometimes it is the primary presenting need (chemical dependency and mental health can be secondary interventions in these cases)
Outcomes
Case level successes (always first and foremost)
Great improvement of mutuality with Law Enforcement (philosophically, practically with clean hand-offs, and systemically 1+1= 2½)
Financially with treatment center and detox cost reductions, as well as reductions in jail bed days, and ancillary costs savings in court time and corrections, etc.
It is a good question. There is no doubt it has made a positive impact. To assess the depth of that impact is the much more difficult part.
To measure individually, we have worked with participants:
to prevent or end homelessness by securing stable housing
to obtain gainful employment
to restore driving privileges so participants can keep appointments and maintain employment
Systemically, the measurement is more easily seen in interest and motivation. Attending our regular Yellow Line Project meetings, we have representatives from the following agencies/organizations:
The Mankato Police Department
The Sheriff’s Office (patrol,jail,dispatch)
County Attorney's Office
Blue Earth County Human Services
Mayo Clinic Health Systems
Human Services and the Mental Health Center
Horizon Homes
Brown County Detox Center
Crisis Center and Mobile Team
Other agencies and organizations depending on our topics of discussion
We also have organizations reach out to learn more about the Yellow Line Project and discuss ways we can collaborate. For example, we met with a very large church in the area. They are part of a homeless shelter network and we were planning on ways that their church and network could interface with Yellow Line Project.
The community interest has grown and we receive inquiries regularly.
From a systemic view, the greatest community impact that has been made are the professional relationships that have been formed. People are working together that would not normally interface. We are thinking about other ways we can work together as well, in other business areas (child protection, housing, data sharing, technology, etc.). This kind of collaboration and genuine relational investments do not usually happen without rallying around a common mission.
