Telehealth
technology in law enforcementOur Story
Harris County started a telehealth pilot program in December 2017 with three deputies. Today, the Harris County program is the largest of its type in the nation with 250 deputies with a computer tablet.
The Harris County Sheriff's Office collaborated with private and public sector companies to develop a telehealth program for patrol deputies with the following goals: the safety of citizens and deputies, diverting individuals from jail into treatment when appropriate, better triage of calls, elimination of unnecessary transports to hospital emergency departments, and quick and affordable access to behavioral health professionals.
An evaluation of Harris County's program, funded by Arnold Ventures, proved the program is an effective and efficient alternative for managing 911 crisis calls with a mental or behavioral health component.
Dr. Avrim Fishkind
The idea to start a telehealth program in Harris County was that of Dr. Avrim Fishkind, a psychiatrist and first medical director of Harris County's NeuroPsychiatric Center. Dr. Fishkind is responsible for many of Harris County's mental health crisis programs and has designed comprehensive psychiatric emergency programs across Texas, the nation, and Canada.
In 2017, Dr. Fishkind formed a collaboration of the Harris County Sheriff's Office (HCSO), Verizon Wireless, The University of Texas Health Science Center in Houston, Harris County Emergency Corps, and JSA Health Telepsychiatry (JSA).
The group piloted a three-week telehealth program in December 2017. The pilot connected three patrol deputies with psychiatrists from JSA via an iPad. The goals of the pilot were to test the concept, test the software and hardware, improve the triage of calls, and divert people from hospital emergency departments and jail when appropriate.
The pilot was a complete success. The three deputies responded to 33 calls for service utilizing the iPad. Forty-five percent of the calls were diverted. The University of Texas Health Science Center determined
the cost savings of the pilot was $26,244.
Due to the success of the pilot, a second phase was started in July 2018 with Harris County's local mental health authority, The Harris Center for Mental Health and IDD (The Harris Center). The change from JSA to The Harris Center had to do with cost. The HCSO was completely satisfied with JSA and the other collaborating partners and will always be indebted to Dr. Fishkind for bringing this idea to Harris County and making our program possible.
ABOUT DR. FISHKIND: He is a past president of the American Association for Emergency Psychiatry. He has designed multiple comprehensive psychiatric emergency programs including Psychiatric Emergency Rooms, 23 Hour Observation Units, Mobile Crisis Teams, Crisis Residential and Stabilization Units, Crisis Hotlines, and short-term Crisis Counseling Units. He has worked in New York City (NY), Austin (TX), Houston (TX), Washington (DC), and Toronto, Canada.
In 2005, Dr. Fishkind led the clinical workgroup for crisis services redesign for the state of Texas. In 2007he formed JSA. In 2018, JSA was acquired by SOC Telemed.
Wayne Young, CEO
Harris County has several model law enforcement programs for responding to individuals with behavioral health and Intellectual and Developmental Disability needs. The key to the success of these programs is the collaboration that exists between law enforcement and their private and public sector partners. The Harris Center is at the forefront of this collaboration.
Harris County Law enforcement started collaborating with The Harris Center in 1991. Chief Executive Officer Wayne Young has strengthened and expanded this collaboration. The Harris Center is using the latest technology to deliver patient care on the streets of Houston. CORE is one example of this effort.
Mr. Young has fully embraced CORE and would like to see all law enforcement officers in Harris County with a computer tablet. This is a bold vision and one that is shared by the management of the Harris County Sheriff's Office.
Harris County law enforcement is very fortunate to have Mr. Young leading The Harris Center. He is passionate about serving the citizens of Harris County and equally passionate about working with law enforcement to help officers as they increasingly respond to
individuals with behavioral health and intellectual and developmental disability needs.
The Harris Center received the Excellence Award for Innovation from the National Council on Behavioral Health for its work on the Clinician and Officer Remote Evaluation Telehealth Program.
ABOUT WAYNE YOUNG: Wayne Young, MBA, LPC, FACHE is the Chief Executive Officer of The Harris Center for Mental Health and Intellectual and Developmental Disability (The Harris Center), the largest behavioral health and developmental disability care center in Texas. The Harris served over 85,000 individuals in FY 2018 with a full range of community-based programs.
Mr. Young previously served as the chair of the Texas Health and Human Services Commission Behavioral Health Advisory Council and was recently appointed to the Texas Judicial Commission on Mental Health. In 2019, Wayne was honored to have been named to Modern Healthcare's list of Top 25 Innovators. Wayne also received the Charley H. Shannon Advocated for Justice Award from the Texas Chapter of the National Alliance on Mental Illness (NAMI).
Evaluation
A sampling of the results of an evaluation of Harris County's CORE Telehealth program. The evaluation was conducted by the University of Houston Downtown. For additional evaluation data, see our Special Projects Annual Report on this website.
- Percent of deputies who would have transported consumer if not for CORE 78%
- Percent of deputies who stated the clinician helped them de-escalate the consumer 86%
- Percent of deputies who stated the clinician helped them handle the call in a shorter period of time 88%
- Percent of deputies who stated the clinician helped them identify resources 89%
- Percent of deputies who stated the clinician helped them decide the course of action to take 93%
Achievement
Achievement Award from the National Association of Counties (NACO)
Great Idea
Recognized as a Great Idea by the IACP's Police Chief Magazine
CORE Elements
Aspects of Harris County's CORE Telehealth Program.
Harris Center Personnel
Clinicians: 6
Team Lead: 1
Time to Connect Deputy to Clinician
Avg Time: One minute
Time to Conduct Assessment
Avg Time: 20 mins
Clinician Work Location
Home
FAQs
How did your program progress from the start to where you are today?
We started phase one of our pilot program in December 2017. Three deputies responded to 31 calls in three weeks where they utilized the iPads. The goal of this phase was to test the concept, software, and hardware. In phase one, the deputies connected to a psychiatrist (see information above).
Phase two started in July 2018 with the same three deputies. They responded to 49 calls where they utilized the iPads in 11 weeks. The goal of this phase was to test a different video conferencing software and the change from deputies connecting to a psychiatrist to connecting to a crisis clinician (see information above).
Phase three was one year and involved 20 deputies. The goals of this phase were citizen and deputy safety, triage of calls, jail diversion, quick and affordable access to crisis clinicians, and the elimination of unnecessary transports of individuals to hospital emergency departments and mental health facilities.
The program became a permanent program in January 2020. As of April 2021, the Harris County Sheriff's Office has 150 deputies with an iPad. Additionally, 100 deputies in seven Harris County constable offices received iPads in April 2021.
How many crisis clinicians does Harris County have to provide services to the 250 deputies with iPads and who do the clinicians work for?
Seven. Six clinicians and one team lead. They are employees of Harris County's local mental health authority, The Harris Center for Mental Health and Intellectual and Developmental Disability.
Where are your clinicians located?
They all work remotely.
What is the cost of your program and who pays for it?
$900k annually. Harris County Commissioners' Court funds the program. Most of the cost goes to the salaries and benefits of the crisis clinicians.
How were you able to obtain funding?
An evaluation funded by Arnold Ventures and conducted by the University of Houston Downtown was instrumental in obtaining funding. The evaluation proved the success of the program and demonstrated significant cost savings. Harris County commissioners want to see quantitative data to support funding requests.
What kind of consent do you obtain from consumers to speak with a clinician?
Verbal
How many calls do you average a month where an assessment is completed?
With 100 deputies we averaged 40 assessments per month. We found the clinicians could conduct additional assessments. That is the reason we expanded the program from 100 deputies in the HCSO to 150 and are adding an additional 100 deputies in seven Harris County constable offices. We do not have the average number of calls per month at this time for the additional deputies.
Is your program 24/7?
Yes
Do you have anyone coordinating your program? If so, what are the duties of that person?
Yes. We have one full-time deputy. She reviews offense reports where the iPad was used, obtains data, prepares reports/statistics, provides a four-hour training to all new CORE deputies, liaisons with the seven constable agencies, liaisons with The Harris Center, responds to technical issues, inventories iPads, maintains a roster of all CORE deputies, replaces deputies as they leave the program, and responds to inquiries about the program.
Gallery
Harris County's CORE Telehealth Program provides patrol deputies and officers with quick and affordable access to behavioral health clinicians when deputies and officers respond to people with mental or behavioral health problems.
Original Personnel
The deputies and the project manager who worked on the first phase of the pilot program in December 2017: (left to right) Sergeant Jose Gomez (a deputy in 2017), Deputy Donald Hess, Deputy Fred Lerma, and Project Manager Frank Webb. Their commitment and hard work were integral to the success of the pilot.
Contacts
Sergeant Jose Gomez coordinates CORE for the sheriff's office. Kisha Lorio coordinates the program for Harris County's local mental health authority. Frank Webb is project manager for CORE.
Implementation Guide
Arnold Ventures' grant to the University of Houston Downtown to evaluate Harris County's CORE Telehealth Program included a request to develop an implementation guide for jurisdictions interested in implementing a program. The implementation guide was a collaboration between the Harris County Sheriff's Office, the University of Houston Downtown, and The Harris Center for Mental Health and IDD. The guide contains a wealth of information and has been requested by jurisdictions across the nation.
