Wednesday, April 14 | Value-based Care, Client Success Stories, Partnerships and Collaboration

Consolidated Technology Platform Will Maximize Effectiveness of Bernalillo County Resource Re-Entry Center

By Netsmart

“Soft Landing Spot” for Re-Connecting to the Community

The rate of serious mental illness in jails is three to six times higher compared to the general population, according to a report from the Council of State Governments Justice Center. When persons with a mental illness or a substance use disorder are released from detention, they are often reincarcerated at a later time, in part because they do not receive the necessary behavioral health care and other life-changing services that could help prevent their re-entry into the justice system.

Bernalillo County (NM) experienced these trends and moved proactively and intentionally to successfully transition justice-involved individuals back into their communities. Through its Behavioral Health Initiative, the county developed a variety of programs tailored to address not only mental health, but also physical health and social determinants of health (SDoH).

One of Bernalillo County’s most notable initiatives is its Resource Re-Entry Center, an award-winning program built to reduce recidivism and connect individuals with behavioral health needs to resources upon release from jail. Nearly 50 people enter the center daily as their first stop after being released from the county’s detention center.

“Our Resource Re-Entry Center is that soft landing spot for folks to get connected to services,” said Margarita Chavez-Sanchez, M.S., Director, Bernalillo County Department of Behavioral Health Services. “Case managers and transition planners are available to connect individuals to long-term supportive services.”

Single Technology Platform for Informed Decisions

Technology and data sharing is critical in Resource Re-Entry Center, allowing staff to coordinate care, make informed decisions at the point of care and seamlessly facilitate referrals to community partners. Initially, staff was using a separate electronic record for mental health services and tracking information on Excel spreadsheets.

Recognizing the efficiencies and integration capabilities of a single, consolidated technology platform for the Resource Re-Entry Center, the Bernalillo County Department of Behavioral Health Services is partnering with Netsmart to implement their CareManager platform.

Making a Difference

Transition planning begins at booking, starting with assessment and other pertinent information being sent electronically to the platform. The CareManager platform will consolidate all authorized information about persons transitioning through the Resource Re-Entry Center into a single view, with the ability to drill down to more details.

“This will enable transition planners to review information prior to meeting with persons transitioning through the Resource Re-Entry Center, creating a seamless transition from jail to the re-entry center and then into the community. Not only will it be valuable for the transition planners and case managers, it will also give the individuals being served a much better experience and minimize the need to retell their story,” said Julie Hiett, MSMW, Netsmart Senior Director of Population Health Management.

Using a single platform will also eliminate data siloes and empower a more holistic and whole-person view within the system. This view is more than a convenience for Bernalillo case managers; it will also ensure data does not get missed and help reduce treatment redundancies. The platform will allow Bernalillo County case managers to see a variety of data, assessments and care plans from the time a person is booked into the jail all the way through their arrival at the Resource Re-Entry Center. They also plan to also integrate the platform with both Bernalillo County jail IT systems, improving efficiencies and client experience.

A total of 12,468 persons met with Resource Re-Entry Center case managers in 2020 after being released from incarceration. Referrals (including follow-up) are made to a variety of community-based providers for behavioral health services, housing, transportation, education and training, medical care and more. With comprehensive data that will be available at their fingertips from the Netsmart CareManager platform, county case managers will be able to spend quality time with those they meet with and make informed referral decisions based on a person’s unique circumstances.

The ultimate goal: Provide the support needed to help persons stabilize, stay healthy, regain self-sufficiency and break the cycle of recidivism.

This piece was originally published in the March 22, 2021 NACo County News



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