Specialized Policing Responses: Law Enforcement/Mental Health Learning Sites TECHNICAL ASSISTANCE REQUEST FORM The Law Enforcement/Mental Health Learning Sites project provides peer-to-peer support for groups interested in improving upon an existing—or planning a new—specialized policing response (SPR) to people with mental illnesses. Technical assistance from learning site representatives may include telephone and e-mail consultations, in addition to site visits to learn more from these agencies. To request technical assistance from a learning site, please complete this form and submit to Nicola Smith-Kea by e-mail (nsmith-kea@csg.org) or fax (240-497-0568). Your answers to these questions will help Justice Center staff identify the most appropriate learning site to respond to your inquiries.
Contact Information—Please place an asterisk (*) next to your preferred method of contact. Name Title Address Telephone E-mail Do you currently have, or have you had a BJA Justice and Mental Health Collaboration Program (JMHCP) grant?
Yes
No
Yes
No
(http://csgjusticecenter.org/mental-health/projects/cp-technical-assistance/justice-and-mental-healthcollaboration-program-jmhcp)
If no, have you considered applying for one?
Our ability to refer you to the appropriate learning site depends on the information you provide. Please be as specific as possible and select all that applies to your jurisdiction Concerns about:
□ □ □ □
Time spent on calls for service involving persons with mental disorders Repeat contacts with high utilizers of emergency services Working collaboratively with mental health service providers Injuries to officers and civilians as a result of encounters between law enforcement and people with mental disorders Other: ________________________________ _____________________________________________
Interest in learning more about:
□ □ □ □ □ □
Specialized training Program design process Alternative dispositions (e.g. crisis receiving centers) Dispatcher protocol Information sharing protocols Special populations (e.g. juveniles, college, homeless) Other: _____________________________________________________________________________
Law Enforcement/Mental Health Learning Sites Technical Assistance Request Form
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Target Audience—Who is the target audience for the technical assistance? (Check all that apply.)
□ □ □ □ □ □ □
Patrol officers Law enforcement leadership Mental health personnel Family and/or advocacy group Consumer of mental health services Elected officials or other local leadership Other (please explain) _______________________________________________________
Program Description—Provide a brief description of your planned or existing SPR. Please note how long it has been in the planning stages or in operation; actual or planned target population; and key agencies involved, etc.
Jurisdiction Description—Provide a brief description of your community, including size; urban/rural/suburban; and special issues such as jail overcrowding, lack of services, etc.
Time Frame—Provide a time frame within which you would like to receive technical assistance. Please note any important, relevant upcoming dates for your jurisdiction or program.
Please submit completed applications via e-mail or fax to: Nicola Smith-Kea The Council of State Governments Justice Center 4630 Montgomery Ave. Suite 650, Bethesda, MD 20814 nsmith-kea@csg.org / p: 301-915-9718 / c: 646- 592- 2472/ f: 240-497-0568
Law Enforcement/Mental Health Learning Sites Technical Assistance Request Form
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