20152016
Cenpatico Crisis Protocols with
Law Enforcement Agencies in
Pima County
Cenpatico and Pima County Law EnforcementCrisis Protocols
Table of Contents
Overview & Purpose ............................................................................................................................ 1
Goals of the Crisis System................................................................................................................... 1
Crisis at local provider agencies .......................................................................................................... 1
Crisis Services ..................................................................................................................................... 1
The NurseWise crisis line (NW)........................................................................................................ 1
Crisis Mobile Teams (CMT) .............................................................................................................. 1
What is considered a crisis? ............................................................................................................. 1
Crisis Mobile Team Response in the Community................................................................................. 1
Services available ............................................................................................................................ 1
Crisis Mobile Team Response on the Reservations ......................................................................... 2
Continuity of covered services during a crisis ...................................................................................... 2
Involuntary Persons in Need of Mental Health Treatment .................................................................... 2
Law Enforcement and the Crisis System ............................................................................................. 2
Crisis drop off center process ........................................................................................................... 3
Jail diversion and safety ................................................................................................................... 3
Non-Emergency Requests for Involuntary Evaluation (Persistently and Acutely Disabled or Gravely
Disabled) ............................................................................................................................................. 3
Revocation of the outpatient treatment portion of an Existing COT ...................................................... 3
Problem Resolution Process................................................................................................................ 4
Pima County Crisis System Meeting ................................................................................................ 4
Regular Crisis Team Meetings ......................................................................................................... 4
Procedures to identify and address joint training needs. ...................................................................... 4
Problem Resolution Process................................................................................................................ 4
Drug and/or Alcohol Use - Services Available for Substance Use ........................................................ 5
Signature Pages .................................................................................................................................. 5
Cenpatico and Pima County Law EnforcementCrisis Protocols
Cenpatico Integrated Care
City of South Tucson Police Department
Tucson Police Department
Marana Police Department
NurseWise
Oro Valley Police Department
Pascua Yaqui Police Department
Pima Community Colleges Police Department
Pima County Sheriff’s Department
Sahuarita Police Department
Tohono O’Odham Nation Police Department
University of Arizona Police Department
Overview & Purpose
The Protocols are guidelines that describe how we will work together to ensure that behavioral health
services are delivered to those in need in Pima County when law enforcement are involved. The
purpose is to enhance the network and response capability to address mental health crisis in Pima
County through ongoing communication and collaborative agreements. These agreements between
law enforcement and Cenpatico are intended to develop an environment where there is “No Wrong
Door.” No Wrong Door means a person can enter the crisis system at any point or through any ‘door’
and the provider will ensure the person gets the appropriate service. The intention is for this to be
seamless for law enforcement. Cenpatico Integrated Care (herein referred to as Cenpatico), their
contracted providers and Pima County Law Enforcement System Partners agree to work in
partnership on behalf of persons experiencing a behavioral health crisis to ensure they receive the
appropriate services and level of care that promotes resiliency and protects the community.
The Crisis Protocols are meant to provide information about the use and availability of crisis services
in Pima County available through Cenpatico. These guidelines will be active from date of signature
until modified by the involved parties. These guidelines do not create or delegate obligations or
financial responsibilities. These guidelines are not a legal and binding contract or Memorandum of
Understanding. These guidelines should never override the obligation to provide the most clinically
appropriate intervention based on each individual situation nor should they override law or
professional responsibility to members or citizens.
Goals of the Crisis System
Crisis services are available to any person regardless of the ability to pay.
The goal of the Crisis System is to ensure persons (adult and youth) receive the appropriate services
and level of care, stabilize persons in the community whenever possible, support individuals in their
recovery, promote resiliency and protect the community. Cenpatico is committed to providing crisis
services in collaboration with law enforcement and first responders to avoid unnecessary detentions,
use of hospital emergency departments, involuntary psychiatric commitments under Title 36 and other
facilities in lieu of community based treatment services.
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Cenpatico and Pima County Law EnforcementCrisis Protocols
Crisis at local provider agencies
During regular business hours (8-5 Monday through Friday) outpatient service providers will provide
crisis intervention to enrolled members who are in a crisis and in the presence of their treatment
provider. Provider agencies are expected to have emergency appointments and those agencies
serving high need members are required to offer supportive services beyond regular business hours.
Crisis Services
The NurseWise crisis line (NW)
The NurseWise crisis line is available 24 hours a day, 7 days per week by calling 866-495-6735. If a
crisis mobile team (CMT) is needed the request must be made to NurseWise who will triage and
dispatch CMTs. NW will check enrollment status for every call and will track response times.
Crisis Mobile Teams (CMT)
There are three CMT providers in Pima County including Community Intervention Associates (CIA),
LifeShare, and Pasadera. LifeShare provides specialty CMT services for persons with developmental
disabilities and the remaining mobile teams respond throughout the entire County. Beginning 10-115, the number of crisis mobile teams available is doubling in order to assure quick response times
and serve special populations. CMT assessment and intervention services in the community are
available to any person in the county regardless of insurance or enrollment status.
What is considered a crisis?
A crisis is measured by the person experiencing it. If the situation exceeds the person’s coping skills,
then the person is in crisis.
Crisis Mobile Team Response in the Community
Services available
A Crisis Mobile Team is available to all persons in the community to assist persons in overcoming a
crisis situation, assess for the need for an out-of-home placement, and coordinate safety planning.
Crisis Mobile Teams are committed to responding to the community including but not limited to places
such as the home, school, church, the streets, and jails. There is no need to bring a person in
crisis to the Emergency Room unless there is a medical emergency.
NOTE: CMTs are required to have vehicles to facilitate transportation and field interventions as
well as cell phones and laptops for communications.
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Cenpatico and Pima County Law EnforcementCrisis Protocols
Crisis Mobile Team Response on the Reservations
1. Cenpatico serves the entire county and is obligated to provide crisis services to any person
who requests services in the county. CMTs are permitted to intervene on reservation property.
Police escorts can be arranged on reservations as needed. Reservation areas included in
Pima County are:
 Tohono O’odham Nation –Police number- 520-383-6412
2. Neither Cenpatico nor its contracted agencies have the authority to remove an American
Indian involuntarily from tribal land or petition an American Indian under a Title 36 on Tribal
land. In these situations, the Tribal Police should be contacted to ensure the safety of the
tribal member.
More information regarding crisis services on the reservation may be described in crisis
protocols developed between Cenpatico and Local Tribal Nations.
Continuity of covered services during a crisis
Cenpatico has a business continuity plan to ensure continuity if operations and services in the event
of a crisis or disaster. Cenpatico will be working with local emergency and disaster preparedness
entities to ensure Cenpatico is included into the County’s response plans. Separate protocols and
agreements will be developed outside of the crisis system protocols.
Involuntary Persons in Need of Mental Health Treatment
Per ARS 36-545.06 “Each county… shall provide directly or by contract the services of a screening
agency and an evaluation agency for the purposes of this chapter” [Title 36 Chapter 5].
THERE IS NO NEED TO PETITION SOMEONE SIMPLY BECAUSE THE PERSON IS IN CRISIS!
In Pima County the County oversees and manages the T36 process. Cenpatico will follow the County
process AND will actively triage all calls to see if immediate crisis services are needed. If immediate
crisis services are needed, Cenpatico will dispatch a CMT (to the community or the ED) to address
immediate needs and offer voluntary treatment options.
Law Enforcement and the Crisis System
All First Responder calls are treated as priority and quickly triaged so the crisis can be addressed
immediately. Similarly, CMTs are dispatched with priority for all law enforcement requests for crisis
services and CMT resources are concentrated in high volume call areas.
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Cenpatico and Pima County Law EnforcementCrisis Protocols
Crisis drop off center process
Crisis Response Center (CRC)-Law enforcement can take both voluntary and involuntary persons in
crisis to the crisis response center. Processing time for a police drop off should not exceed 15
minutes.
Community Bridges Access Point-Law enforcement may drop off voluntary persons in crisis at the
Community Bridges Access Point Facility. Community Bridges is able to assess and treat persons for
both substance use and mental health related crisis. Community Bridges also offers a drop off time
under 15 minutes. In addition, Community Bridges employs EMTs who provide medical triage for all
persons dropped off at the facility so there is no need for medical clearance prior to dropping them off.
Jail diversion and safety
The goal of the crisis system is to intervene quickly in a crisis and stabilize the person in the
community whenever possible. Facility based crisis services are also available when a person needs
an additional level of support. As of 10-1-15, Cenpatico is adding at least 3 additional facility based
crisis services options. The Cenpatico crisis system is a partner with law enforcement to ensure
diversion at the patrol level as well as a reduction in the amount of persons going to local emergency
rooms when there is no known medical problem. All community members who remain in the
community after a crisis have a safety plan developed by the CMT as well as 72 hour follow up after
the initial crisis to avoid a subsequent crisis.
Agreements, protocols and Memorandums of Understanding may be developed with the County Jail
to further define collaborative efforts to divert persons in need of mental health and substance use
treatment away from the jails.
Non-Emergency Requests for Involuntary Evaluation (Persistently and Acutely Disabled or
Gravely Disabled)
The County process will be followed when a request for a non-emergency request for involuntary
evaluation is made. The CMT is always available to address any immediate crisis. In these
situations, the CMT can ensure safety plans are put in place until the paperwork is approved.
Revocation of the outpatient treatment portion of an Existing COT
If all attempts at outreach and engagement and crisis planning have failed to re-engage a member
under court ordered treatment, a revocation of the outpatient treatment may be necessary. The
County Process will be followed for all revocations. If immediate crisis services are needed,
Cenpatico will dispatch a CMT to address immediate needs and develop safety plans.
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Cenpatico and Pima County Law EnforcementCrisis Protocols
Meeting Attendance
The strength of the crisis system is in part dependent upon the level of participation of involved
stakeholders, system partners, Cenpatico and local agencies. All local Cenpatico contracted provider
agencies are required to participate in the Quarterly Crisis System Meeting, hosted and run by
Cenpatico. Successful meetings will require active participation and a focus on systems issues.
Specific complaints about individual situations should be handled as outlined in the Problem
Resolution Process or through Cenpatico Liaisons assigned to work with stakeholders and system
partners on individual client issues. All parties agree to have representation at meetings and agree to
participate actively in the process.
Problem Resolution Process
Pima County Crisis System Meeting
Strengthening relationships between first responders and local Cenpatico contracted providers will be
a key factor to success in meeting the needs of the community. The crisis system meeting has been
established as a primary means for stakeholders, system partners, the Cenpatico and Cenpatico
contracted agencies to discuss and examine the current procedures to address and intervene during
a mental health crisis. The meeting also serves as a venue to learn about each involved entities
system, process, challenges and strengths and to pool resources. The group represents a
collaborative effort to identify barriers and strengths in the crisis system and to develop agreements
and processes to build on strengths and resolve barriers.
Regular Crisis Team Meetings
Cenpatico convenes and runs internal meetings on a monthly basis to follow up with Crisis Mobile
Team providers and NurseWise Crisis Line on how the crisis system is working.
Procedures to identify and address joint training needs
Cenpatico is committed to working collaboratively with local law enforcement agencies to identify
trainings that will be needed as well as trainings that will be continued. Trainings that are available
may include but are not limited to AZPOST trainings, CIT training, Crisis Intervention and Stress
Management Debriefing (CISM) training and mental health first aide.
Problem Resolution Process
Strengthening relationships between first responders and Cenpatico contracted providers will be a key
factor to success in meeting the needs of the community. Conflicts between agencies or regarding
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Cenpatico and Pima County Law EnforcementCrisis Protocols
specific situations are to be handled between the agencies involved. Cenpatico is always willing to
assist in this process if called upon to do so. It is agreed that problem resolution is best completed in
real time by following the chain of command.
It is agreed upon that for effective problem solving, system issues that present a problem will be
discussed in the Pima County Mental Health Crisis Systems Meeting.
The First Responder and Court Liaisons are also a resource for Pima County when concerns arise.
The Liaison can help resolve problems related to specific situations as they relate to the crisis system
and can also help file official complaints with Cenpatico Customer Service if necessary.
Conflicts or disagreements that arise regarding specific member situations should be handled in real
time by contacting a NW Supervisor (for after hours assistance) or the Cenpatico Liaisons (during
regular business hours).
Drug and/or Alcohol Use - Services Available for Substance Use
Per ADHS Practice Protocol Co-occurring Psychiatric and Substance Disorders, “Assessment begins
at the point of clinical contact, regardless of the client’s clinical presentation. Initiation of assessment
should not be made conditional on arbitrary criteria such as length of abstinence, non-intoxicated
alcohol level, negative drug screen, absence of psychiatric medication, and so on.”
Thus, a person under the influence who self identifies as being in crisis is eligible for the array of crisis
services offered by Cenpatico. There is no requirement for the person to reach a certain level of
sobriety before being assessed. The only requirement is that the person must be able to physically
participate in an interview.
The Title 36 statute does not preclude a person under the influence of substances from being
petitioned for involuntary treatment. The statute does require that there be evidence of a “mental
disorder” as defined in ARS 36-501.25.
Signature Pages
Cenpatico and Law enforcement System Partners agree to work in partnership on behalf of persons
experiencing a behavioral health crisis to ensure they receive the appropriate services and level of
care that promote resiliency and protect the community.
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Cenpatico and Pima County Law EnforcementCrisis Protocols
This agreement will be in force from date of signature until modified by the involved parties. This
agreement does not identify or delegate financial responsibility. This is not a legal or binding contract
or memorandum of understanding.
Effective Date:
10-1-15
(To be reviewed in one year.)
Last Revision Date(s):
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Cenpatico Integrated Care
_______________________
Date
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City of South Tucson Police Department
_______________________
Date
_______________________________________
Tucson Police Department
_______________________
Date
_______________________________________
Marana Police Department
_______________________
Date
_______________________________________
NurseWise
_______________________
Date
_______________________________________
Oro Valley Police Department
_______________________
Date
_______________________________________
Pima Community Colleges Police Department
_______________________
Date
_______________________________________
Pima County Sheriff’s Department
_______________________
Date
_______________________________________
Sahuarita Police Department
_______________________
Date
_______________________________________
Tohono O’Odham Nation Police Department
_______________________
Date
_______________________________________
University of Arizona Police Department
_______________________
Date
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