SPECIAL	MASTER	REPORT	to	JUDGE	WANG	

Submitted	August	28,	2019	

CENTER FOR	LEGAL	ADVOCACY,	d/b/a	

DISABILITY	LAW	COLORADO,	

Plaintiff,	

v.

MICHELLE	BARNES,	

in	her	official	capacity	as	Executive	Director of	the	Colorado	

Department	of	Human	Services,	and

JILL	MARSHALL,	

in	her	official	capacity	as	Chief	Executive	Officer	of	the	Colorado	Mental	

Health	Institute	at	Pueblo,	Defendants.

	

	

	

	

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August 28,	2019

Re:	Civil	Action	No.		11-cv-02285-NYW		

The	Honorable	Judge	Nina	Wang

United	States	Magistrate	Judge

District	of	Colorado

Alfred	A.	Arraj	United	States	Courthouse

901	19th Street

Denver,	CO	80294

Judge	Wang,	

This	report	serves	as	our	August 28,	2019 status	report	mandated	by	the	Consent	Decree	filed	

March	15,	2019	pursuant	to	Case	No.	1:11-cv-02285-NYW.		As	you	know,	the	Consent	Decree	

(following	your	earlier	court	order) requires	us	to	monitor	progress and	provide	

recommendations	for	improvement	to	the	Colorado	Department	of	Human	Services	(CDHS).		

Specifically,	the	Consent	Decree	(p.24)	indicates,	

(i) As part of the duties, the Special Master shall provide the Court and the Parties with status 

reports every other month for the first six months, and then quarterly thereafter. The Special 

Master’s status report was submitted on January 28, 2019. Dkt. 146. The next report shall be 

submitted to the Court and the Parties on March 28, 2019, and then May 28, 2019, and then 

quarterly thereafter. Such reports shall address the Department’s compliance with the 

timeframe requirements of the Consent Decree concerning Competency Services and shall 

provide a detailed summary of information and recommendations the Special Master believes 

the Court and Parties should consider relating to the Department’s compliance with the 

Consent Decree timeframes concerning Competency Services. 

(ii) The Special Master’s report shall include, but is not limited to, reporting on the number of 

Pretrial Detainees ordered to receive Competency Services, an assessment of the 

Department’s operations, systems, and admissions practices and policies relating to the 

Department’s ability to comply with the Consent Decree timeframes, and guidance to the 

Department for improvement and increasing efficiencies in these areas. 

Since	our	appointment	as	Special	Master	on	January	2,	2019,	the	parties	entered	into	mediation,	

resulting	in	the	Consent	Decree	filed	March	15,	2019.		This	Consent	Decree	prescribed	a	variety	

of	steps	the	Department	must	take	to	improve	the	competency	assessment	and	restoration	

system	in	Colorado,	and	eventually	attain	compliance	with	all	time frames	and	deadlines	

mandated	in	the	Consent	Decree.		The	Department	has	initiated	many	of	these	steps,	

demonstrating	meaningful	progress,	in	ways	we	detail	through	the	remainder	of	this	report.	In	

particular,	this	report	will	focus	on developments	since	our	prior	quarterly	report,	which	was	

submitted	May	28,	2019.	

	

	 	

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TABLE	OF	CONTENTS	

	

INTRODUCTION..............................................................................................................................4

KEY	METRICS	FOR	PROGRESS:	COMPLIANCE	WITH	TIME	FRAME	REQUIREMENTS.................................6

KEY	METRIC:		COMPETENCE	EVALUATION	TIME	FRAMES...................................................................7

KEY	METRIC:		COMPETENCE	RESTORATION	TIME	FRAMES.................................................................8

KEY	METRIC:		THE	WAITLIST	FOR	COMPETENCE	RESTORATION	SERVICES........................................11

CONSENT	DECREE	SECTION	VI	UPDATES......................................................................................12

ADMISSION	OF	PRETRIAL	DETAINEES	FOR	INPATIENT	COMPETENCY	EVALUATIONS	AND	RESTORATION	

TREATMENT ...........................................................................................................................................12

Wait	Times	for	Inpatient	Evaluation..................................................................................................13

Wait	Times	for	Inpatient	Restoration................................................................................................15

PERFORMANCE	OF	JAIL	COMPETENCY	EVALUATIONS ..........................................................................19

INTERIM	JAIL	MENTAL	HEALTH	TREATMENT.........................................................................................21

RELEASE	OF	PRETRIAL	DETAINEES	FOR	COMMUNITY-BASED	RESTORATION	TREATMENT...................23

TRANSPORTATION	OF	PRETRIAL	DETAINEES .........................................................................................24

NOTIFICATION	OF	NON-COMPLIANCE	WITH	TIME	FRAMES..................................................................25

CONSENT	DECREE	SECTION	VII	UPDATES.....................................................................................26

CIVIL	BED	FREEZE ...................................................................................................................................26

COMPREHENSIVE	AND	COHESIVE	PLAN ................................................................................................27

INCREASE	COMMUNITY	RESTORATION	SERVICES .................................................................................30

CONCLUSION................................................................................................................................34

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INTRODUCTION	

The Consent	Decree	filed	March	15,	2019	prescribed	a	variety	of	steps	the	Department	must	

take,	and	timelines	it	must	meet,	to	improve	the	competency	assessment	and	restoration	system	

in	Colorado.		Since	the	Consent Decree	was	filed	in	March,	the	Department	has	begun	taking	

many	of	these	steps	(detailed	through	the	remainder	of	this	report),	in	ways	that	we	consider	

generally	responsive,	and	in	ways	that	appear	to	recognize	the	gravity	and	complexity	of	the	

challenges	they	face.		

Nevertheless,	the	Department’s	important	planning	and	action	steps	thus	far	have	not yet	

caused	significant	changes	to	the	waiting	list,	or	waiting	times,	of	the	defendants	ordered	to	

receive	competency-related	services.		As	you’ll	see	in	the	next	section,	these	important	markers	

of	progress	have	changed	little	since	the	implementation	of	the	Consent	Decree.		We	are	not	yet	

alarmed	by	this;	many	of	the	key	interventions	prescribed	in	the	Consent	Decree	began	only	

recently.		For	example,	the	triage	system	began	June	1,	2019,	and	the	Forensic	Support	Team	

(FST)	has	only	very	recently	hired	staff	and	begun	training.		Whereas	the	Department’s	progress	

preceding	our	May	28th report	was	largely organizing	and planning	key	interventions,	their	

progress	since	our	May	28th report	has	been	largely	launching	these key	interventions.		In	

particular,	significant	steps	since	our	last	report	include:

• Enacting	the	Triage	system,	a	key	compromise	from	the	Consent	Decree,	which	requires	

the	Department	to rapidly	(i.e.,	within	7	days) admit	for	competence	restoration	the	

most	acutely	ill	defendants	(“Tier	1”)	and	less	rapidly	admit	those	who	less	urgently	need	

hospitalization	(“Tier	2”).

• Admitting	these	Tier	1	defendants	for	inpatient	restoration	in	a	prompt	manner,	

consistent	with	the	requirements	of	the	Consent	Decree.

• Hiring	new,	well-qualified staff	for key	leadership	roles,	i.e.,	the	Forensic	Services	

Director	and	the	Forensic	Services	Support	Team Director.

1

• Launching	the	Forensic	Support	Team	(FST),	another	key	component	of	the	Consent	

Decree.		The	FST will	ensure	monitoring	and	treatment	for	those	incompetent-toproceed	(ITP)	defendants	in	jail	awaiting	hospitalization,	as	well	as	those	ITP	defendants	

ordered	to	community-based	restoration.

• Developing	a	draft	of	a	“comprehensive	and	cohesive	plan” for	competency	services	in	

Colorado,	and	sharing	this	draft	plan	beyond	the	Department.	

																																																						

1 We	support	the	position	descriptions	and	the	two	individuals	hired	for	these	two	positions.	

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• Dramatically	improving	data	systems,	analysis,	and	reporting	of	competency-related	

information.	

• Implementing	enhanced	competency	evaluation	reports,	consistent	with	mandates	from

the	Consent	Decree	and	SB19-223.	These	reports	now	include	more	in-depth	

information	regarding	competency	of	the	defendant	as	well	as	opinions	on	placement	

for	restoration	(inpatient	vs.	community-based	restoration)	and	urgency	of	clinical	need	

(Tier	1	vs.	Tier	2).	

• Opening	18	new	beds	for	competency	restoration	at	the	Boulder	County	Jail’s	RISE	

program.	This	program	replicates	the	RISE	program	at	Arapahoe	County	Jail.

• Disseminating	a	request for	proposals	for	sheriff’s	departments	across	Colorado	to	

request	funding	for	enhanced	mental	health	services	for	defendants awaiting	

competency	services	in	local	county	jails.	This	funding	was	provided	by	SB19-223.	

We	have	not	expected	the	planning	and	launch	of	these	interventions	to	have	substantial	effect	

on	CDHS	competency-related timelines	immediately.		However,	we	do expect	these	

interventions	should yield some	progress	towards	meeting	key	time frame	requirements	and	

reducing	waitlists	by	our	next	reporting	period.		

Since the	Department	has	just	launched	several	key	interventions,	some	of	the	primary	

challenges	(i.e.,	the	areas	for	closest	scrutiny	and	support)	we	identified	in	our	prior	quarterly	

report	still	remain:

• Better	educating	the	court and	the	bar	about	the	triage	system	and	other	new	

interventions,	so	that	they	will	act	in	ways	that	support	(rather	than	undermine)	the

triage	system	and	the	broader	goals	of	admitting	the	most	acutely	ill	defendants	most	

rapidly.		These	educational	efforts	will	need	to	be	prompt	and	assertive	in	order	to	help	

courts	understand	and	support	new	procedures	and	less	often	issue	“show	cause”	orders	

that	compromise	CDHS	goals	of	triaging	by	greatest	clinical	need.	Although	the	

Department	has	described	some	dissemination	efforts,	we	consider	further	dissemination	

efforts	crucial	in	the	very	near	future.	

• Ensuring	adequate	training	and	reliability	among	evaluators	as	learn to	include	triage	

opinions	and	restoration	placement	recommendations	in	their	competence	evaluation

reports. Furthermore,	these	changes	for	evaluators	require	attention	to	their	morale	and	

engagement.	Generally,	the	evaluators	have	been	frustrated	with	the	ways	changes	have	

been	implemented,	and	it	will	remain	crucial	to	enlist	their	engagement	in	these	changes	

and	improve	collaborative	relationships	with	the	Department	leadership.

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We	also	anticipate	the	following	new	challenges:	

• Using	the	newly	launched Forensic	Support	Team	to	assist	and	support	defendants	found	

incompetent	to	proceed	(ITP)	who	are	either	in	jail	awaiting	transfer	to	Colorado	Mental	

Health	Institute	at	Pueblo (CMHIP)	or in	the	community	receiving	community-based	

restoration	treatment.		As	the	Department	knows,	the	first	several	months	after	

launching	any	new	initiative	will	require	significant	monitoring,	revision,	and	changes	as	

unanticipated	challenges	inevitably	arise.

• Accelerating	restoration	services	for	defendants	designated	Tier	2.	Whereas	the	

Department	has	been	remarkably	prompt	in	hospitalizing	the	Tier	1	patients,	full	

adherence	to	the	Consent	Decree	will	require	improving	timely	service	to	Tier	2	

defendants	as	well.	

Overall,	we	continue	to	affirm	the	Department’s	efforts	to	enact	the	changes	prescribed	in	the	

Consent	Decree.		As	detailed	throughout	the	report,	there	remain	several	significant	challenges,	

and	room	for	improvement	in	certain	areas.		But,	broadly,	the	Department’s	efforts	to	comply	

with	the	Consent	Decree	have	been	well-conceived,	and	usually well-executed.			

We	begin	by	addressing	the	Department’s compliance	with	time	frame	requirements,	because	

this	is	the	primary	focus	of	the	Consent	Decree	(and	the	focus	that	the	Consent	Decree	

prescribes	for	these	quarterly	reports).		Indeed,	we	consider	these	time	frames	our	“key	metrics”	

— or	primary	markers	of	progress	— that	we	review	in	each quarterly	report.		However,	we	then	

expand	to	address	the	other	interventions	prescribed	by	the	Consent	Decree	because	progress	in	

these	interventions	will	likely	contribute	to	progress	in	achieving	the	overall	goal	of	compliance	

with	time	frame	requirements.		

KEY	METRICS	FOR	PROGRESS:	COMPLIANCE	WITH	TIME	FRAME	REQUIREMENTS	

As	prescribed	in	the	Consent	Decree, a	primary	focus	of	our	quarterly	reports	must	be	the	

Department’s	compliance	with	time frame	requirements:

(i) As part of the duties, the Special Master shall provide the Court and the Parties with status 

reports ... Such reports shall address the Department’s compliance with the timeframe 

requirements of the Consent Decree concerning Competency Services and shall provide a 

detailed summary of information and recommendations the Special Master believes the Court 

and Parties should consider relating to the Department’s compliance with the Consent Decree 

timeframes concerning Competency Services. (Consent Decree p.24)

(ii) The Special Master’s report shall include, but is not limited to, reporting on the number of 

Pretrial Detainees ordered to receive Competency Services, an assessment of the 

Department’s operations, systems, and admissions practices and policies relating to the 

Department’s ability to comply with the Consent Decree timeframes, and guidance to the 

Department for improvement and increasing efficiencies in these areas. 

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Therefore,	a primary	focus	of	our	review	is	the	Department’s	progress	in	meeting	the	time

frames	delineated	in	the	Consent	Decree.		This	includes	both	time	frames	for	competence	

evaluation and	for	competence	restoration.		We	anticipate	that	these	will	be	the	key	metrics	to	

demonstrate	progress	over	the	next	few	years,	so	they	are	our starting	point	in	the	report,	as	

well	as a	primary	focus.		Of	course,	performance	in	meeting	these	time frames	depends	greatly	

on	enacting	the	other	steps	prescribed	in	the	Consent	Decree,	so	we	review	those	steps	in	

subsequent	sections	of	the	report.

KEY	METRIC:		COMPETENCE	EVALUATION	TIME	FRAMES	

As	summarized	in	the	table	below,	the	Department	has	been	meeting	the	timelines	for	

competence	evaluation	that	the	Consent	Decree	prescribed	beginning	June	2019.		Indeed,	the	

Department	was	meeting	these	evaluation	time frames	even	before	June	2019.

	

Wait	Times	for	Competence	Evaluation	Services2		

June	2019	

Average	Wait	

July	2019	

Average	Wait	

June	2019	

Requirement	

January	2020	

Requirement	

Jail-based	

Competency	

Evaluations	

21.8 23.7 28	days 8	days

	

Inpatient	

Competency	

Evaluations	

11.2 14.4 21	days 21	days

Generally,	timely	competence	evaluation	has	been	a	relative	strength	of	the	Department.		Well	

before	the	recent	Consent	Decree,	they	followed	the	national	trend	of	de-centralizing	

evaluations,	moving	them	from	solely	an	inpatient	service	to	a	localized	service	in	the	

community.		During	recent	history,	their	evaluations	have	almost	always	met	the	prescribed	time	

frames.		Quite	recently,	they	appeared	at	risk	of	failing	to	meet	these	time frames,	due	to	a	

shortage	of	evaluators	(some	permanently	left	positions,	while	others	were	on	temporary	leave).		

But	rapid	hiring	and	contracting	of	evaluators	seems	to	have	averted	significant	delays,3 and	the	

Department	appears	likely	to	meet	evaluation	time	frames	in	the	next	month.		However,	as	

																																																						

2 Data	from	July	2019	is	the	most	recent	data	available	from	CDHS.

3 According	to	the	CDHS	representatives	with	whom	we	have	spoken	about	this.		Ultimately,	the	August	

2019	Monthly	Compliance	Report	(due	September	7,	2019)	will	reveal	evaluation	timelines	for	the	month	

of	August.	

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detailed	later	in	the	report	(addressing	Consent	Decree	paragraph	33), we	anticipate	they	will	

need	to	take	additional	steps	over	the	next	year	to	maintain	their	compliance,	particularly	when	

the	prescribed	time	frames	decrease in	July 2020.		But	overall,	the	Department	has	performed	

well	with	respect	to	competence	evaluation	time	frames.

	

KEY	METRIC:		COMPETENCE	RESTORATION	TIME	FRAMES	

In	contrast	to	their	prompt	evaluation services,	the	Department	has	consistently	failed	to	provide

prompt	restoration services.		Over	the	past	six	months preceding	our	last	report,	defendants	

who	were	admitted for	inpatient	restoration	treatment	at	CMHIP	or	RISE	waited,	on	average,	71

days.4 Of	course,	this	figure	included	all	defendants	referred	for	restoration,	without	distinction	

between	those	more,	versus	less,	acute	needs.		Since	that	last	quarterly	report,	however, a	key	

change	prescribed in	the	Consent	Decree	came into	effect on	June	1,	2019.		The Consent	Decree	

prescribed a	new	triage	system5 designed	to	prioritize	the	defendants	with	the	most	acute	

clinical	needs	(“Tier	1”)	over	those	with	less	acute	clinical	needs	(“Tier	2”).		Tier	1	defendants

must	receive	services	within	7	days of	the	competency	hearing,	whereas	Tier	2 defendants need	

not	receive	services	for	56	days	(with	Tier	2	deadlines	shortening	in	the	future).		

Overall,	recent	CDHS	monthly	reports	describe excellent	adherence	to	the	7-day deadline	for	

defendants	whom	the	court	has	designated	as	Tier	1	(i.e.,	average	wait	times	well	under	7	days).6		

However,	wait	times	for	Tier	2	defendants	still	far	exceed	the	time	frames	prescribed in	the	

Consent	Decree	(i.e.,	average	wait	times	exceeding	80	days,	approximately	one	month	beyond	

the	required	56	days).	

																																																						

4 Average	waiting	period	November	2018	– April	2019,	as	calculated	from	data	provided	by	the	

Department	(see	p.7	of	their	Monthly	report	filed	May	7,	2019).

5 See	Consent	Decree	paragraph	43.

6 According	to	Special	Master	Compliance	Plan	report	July	2019	p.10	(submitted	August	7,	2019).

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Summary	statistics	are	presented	below:

	

Average	Wait	Times	for	Inpatient	Competence	Restoration	Services		

	

June	2019	 July	2019	 June	2019	

Requirement	

January	2020	

Requirement	

	

Tier	1	 1 4.4 7	days 7	days

	

Tier	2	 80.8 93.6 56	days 49	days

However,	each	of	these	summary	statistics	requires	more	discussion.		First,	the	figures	for	Tier	1	

defendants	reflect only	Tier	1	defendants	as	defined	in	the	Consent	Decree,	that	is,	defendants	

whom	the	court	has	designated as	Tier	1	and	ordered	to	the	hospital.		This	represents	only	a	

fraction	of	the	number	of	defendants	whom	CDHS	evaluators	have	recommended	as	Tier	1	(for	

example, the	June	figure	is	based	on	two	defendants	and	the	July	figure	is	based	on	7	

defendants)	because	many	of	their cases	are	resolved	before	the	court	enters	an	order	

designating them	as	Tier	1.		

Specifically,	CDHS7 explained that since	the	implementation	of	the	triage	system	on	June	1,	there	

have	been	53	unique	individuals	whom	the Court	Services	evaluators have	opined	as	Tier	1 (as	of	

August	23).	Of	those	53,	most	(37) were	admitted to	CMHIP,	usually	well	before	the	court	

ordered	admission.	For	one	defendant	whom an	evaluator	recommended	Tier	1	status,	jail	

medical	staff	conveyed	he	was	stabilized	and	the	Court	did	not	enter	an	order	for	hospitalization	

(he	remained	in	jail).		Another individual	was	ordered	to	outpatient restoration	services,	and	one

individual	was	stabilized to	the	point	he	did	not	require	hospitalization.		For	the	remaining,	CDHS	

is	reportedly	awaiting	a	court	order (as	of	their	last	update).

In	many	respects,	this	summary	bodes	well	for	CDHS	efforts	to	implement	the	triage	system.		

According	to	CDHS	administrators	and	data	management	personnel,	the	vast	majority	of	

defendants	whom	evaluators	designate	as	Tier	1	are	admitted	to	the	hospital	promptly	(i.e.,	well	

within	seven	days),	and	often	even	before	the	Court	designates	them	as	Tier	1	and	orders	

admission. For	those	that	have	not,	CDHS	has	offered	what	appear	to	be	plausible	explanations.		

Frankly,	it	is	difficult	at	this	stage	to	understand	these	few	exceptions	or	the	circumstances	

surrounding	them.	Once	the	Forensic	Support	Team	(FST;	see	later	in	this	report)	launches	later	

this	month,	the	FST	will	have	close	oversight	of	these	defendants.		But	in	this	brief	interim	period	

(i.e.,	after	the	launch	of	the	Triage	system	but	before	the	launch	of	FST),	there	has	been	little	

																																																						

7 According	to	email	from	CDHS	staff	Stephanie	Sollie	to	Special	Masters	dated	August	23,	2019.	

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mechanism	for	close	oversight	of	these	situations.		Consequently,	we	have	requested	CDHS	to	

provide	an	individualized	accounting	of	each	person	opined	by	evaluators	as	Tier	1	(i.e.,	dates	of	

admission	for	those	that	were	admitted	and	a	detailed	description	of	the	remainder).		We	view	

this	Tier	1	population	as	the	heart	of	the	Consent	Decree — those	defendants	who are	identified	

most	urgently needing hospital-level	care — and	we	must	ensure	that	their	needs	are	met	in	

ways consistent	with the	letter	and	spirit	of	the	Consent	Decree.	 We	look	forward	to	reviewing	

CDHS’s detailed	account	of	each	Tier	1	defendant’s pathway, and	reporting	this	information	to	

you	in	our	next	quarterly	report to	the	Court.	

Regarding	Tier	2	defendants,	progress	has	been limited.		Average	wait	times	still	far	exceed	the	

time	limits	in	the	Consent	Decree,	just	as	they	did	for	all	defendants	in	prior	months.	 Thus,	the	

Tier	1	figures	suggest	that	the	Triage	System	serves the	purpose	for	which	it	was	designed:	i.e.,	

prioritizing	the	most	acutely	ill	defendants	and	moving	them	into	the	hospital	rapidly.		However,	

the	Tier	2	figures	reveal	that	CDHS	continues	to	struggle	with	some	of	the	primary	challenges	

that	prompted	the	Consent	Decree:	i.e.,	responding	to the	volume	of	defendants	referred	for	

inpatient	restoration,	and	admitting	them	into	the	hospital	within	a	reasonable	time	frame.	

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KEY	METRIC:		THE	WAITLIST	FOR	COMPETENCE	RESTORATION	SERVICES	

Beyond	the	wait	times	for	restoration	services	(and	progress	towards	the	time frame	

requirements	of	the	Consent	Decree),	another	key	metric	for	gauging	the	Department’s	progress	

is	the	waiting	list for	competence restoration	services.		In	the	months	preceding	our	prior	report,	

the	waitlist	averaged	around	150 to	160	defendants.

8

		But	again,	with	the	initiation	of	the	Triage	

system	on	June	1,	we	must	consider	the	waitlist	according	to	Tier	status.		Central	to	the	Triage	

system	is	an	acknowledgement	that	some	incompetent	defendants	are	so	acutely	ill	that	they	

require	treatment	almost	immediately	(Tier	1,	who	require	treatment	within	7	days),	whereas	

others	can	safely	await	treatment	(Tier	2,	who	can	wait	several	weeks).		

	

Number	of	Defendants	on	Waiting	List	for	Inpatient	Restoration9

	

	

		 March	2019	 April	2019	 May	2019	 June	2019	 July	2019		

Combined	 153.29 158.63 159.96 N/A N/A

Tier	1	 N/A N/A N/A 6 8

Tier	2	 N/A N/A N/A 182 168

	

																																																						

8 At	present,	the	Department	provides	waitlist	data	as	daily	figures,	so	the	monthly	figures	in	the	table	

reflect	averaged	daily	figures.			

9 According	to	Special	Master	Compliance	Plan	report	July	2019	p.10	(submitted	August	7,	2019)

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CONSENT	DECREE	SECTION	VI	UPDATES	 	

ADMISSION	OF	PRETRIAL	DETAINEES10	FOR	INPATIENT	COMPETENCY	

EVALUATIONS	AND	RESTORATION	TREATMENT		

33. (a) Admission of Pretrial Detainees for Inpatient Competency Evaluations and Restoration 

Treatment. The Department shall Offer Admission to Pretrial Detainees to the Hospital for Inpatient 

Restoration Treatment or Inpatient Competency Evaluations pursuant to the attached table (Table 1). 

Compliance with this measure shall be calculated based on the number of Days Waiting for each 

Pretrial Detainee. 

The	Consent	Decree	prescribes	the	following	time frames	for	admitting	defendants to	inpatient	

competence	restoration	and	for	performing	competence evaluations	(whether	inpatient	or in	

jail).

11		Admission	time frames	become	progressively	shorter	at	each	six-month	increment.		

Evaluation	time frames	are	reduced	in	July	2020.		

	

	

Deadlines	

Tier	1:	Maximum	

Time	to	Offer	

Admission	for	

Inpatient	

Restoration	

Tier	2:	Maximum	

Time	to	Offer	

Admission	for	

Inpatient	

Restoration	

Maximum	Time	to	

Offer	Admission	

for	Inpatient	

Competency	

Evaluations	

Maximum	time	to	

Complete	Jail	

Competency	

Evaluations	

June 1,	2019 7	days 56	days 21	days 28	days

January	1,	2020 7	days 49	days 21	days 28	days

July	1,	2020 7	days 42	days 14	days 21	days

January	1,	2021 7	days 35	days 14	days 21	days

July	1,	2021 7	days 28	days 14	days 21	days

																																																						

10 “Pretrial	Detainee”	means	a	person	who	is	being	held	in	the	custody	of	a	County	Jail	and	whom	a	court	

has	ordered to	undergo	Competency	Services.		Persons	serving	a	sentence	in	the	Department	of	

Corrections	and	juveniles	are	excluded	from	this	Consent	Decree.

11 Fine	amounts	are	tied	to	delays	beyond	each	of	the	time frames	listed.		However,	these	fines	are	

discussed	elsewhere	in	this	report.

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As	summarized	earlier	in	this	report (“Key	Metrics”),	the	Department	generally meets June	1	time

frames	for	competency	evaluations, and	even	meets	the	time frame	for	admitting	Tier	1	

defendants	to	restoration.		But	they	far	exceed	the	time frames for	Tier	2	admissions to	

competency	restoration.		

	

Wait	Times	for	Inpatient	Evaluation	

As	detailed	below,	the	Department	has	been	quite	successful	in	timely	admission	for	inpatient	

competence	evaluations (versus	restoration):

	

Recent	Wait	Times	for	Inpatient	Evaluation	

	

Month	 Number	admitted	to	

CHMIP	for	inpatient	

evaluation	

Average	days	waited	

prior	to	admission	to	

CMHIP	or	RISE	

	

People	who	waited	more	

than	28	days		

Jul 19 18 14.4 0

Jun	19 14 11.2 0

May	19 12 11.7 0

Apr	19 18 12.6 0

Mar	19 18 16.4 1

Feb	19 13 13.3 0

Average	 15.5	 13.2	 .17	

	

Over	the	past	six	months,	15.5 people	per	month,	on	average,	were	admitted	for	an inpatient	

evaluation at	CMHIP.		The average	wait	time	for	admission	to	CMHIP for	inpatient	competency	

evaluation	was	13.2 days (almost	4	days	fewer	than	the	6-month	average	we	reported	in	the	

prior	quarterly	report).		The Department	regularly	met	its	goal	of	admitting	all	people	ordered	

for	inpatient	evaluation	within	28	days. Indeed,	the average	wait	prior	to	admission	has	

generally	decreased	over the	past year.	 Overall	then,	the	Department	has	consistently	met	the	

time frames	for	inpatient	competence	evaluation.		

According	to	CDHS	reports,	only a	fraction	of	those	defendants	ordered	for	inpatient	evaluation	

actually	met the	strict	criteria	for	involuntary	hospitalization (C.R.S.	§	27-65-105).

12		Specifically,	

																																																						

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CDHS reported that	during	the	past	5 months,	only	about	1	in	5	admissions	for	inpatient	

evaluation	met that	strict	“27-65”	criteria.

13		Certainly some	defendants	warrant	hospitalization	

even	if	they	do	not	meet	the	strict	criteria,	so more	analysis	is	needed	to	determine	just	how	

many	of	these	referrals	urgently	needed hospitalization	(even	if	they	did	not	meet	strict	criteria	

for	civil	commitment).		

At	the	time of	our	last	Quarterly	report,	there	appeared	to	be	an	increase	in admissions for	

inpatient	evaluation,	perhaps	reflecting	increasing	court	efforts	to	“fast	track”	defendants	for	

admission	at	the	evaluation	stage,	in	an	effort	to	bypass lengthy	delays	at	the	restoration	stage	

(i.e.,	following	a	finding	of	incompetence	in	a	jail-based	evaluation).		However,	this	trend	has	not	

continued.		That	is,	admissions	of	inpatient	evaluations	have	held	generally	steady,	rather	than	

continued	their	rapid	increase.		Therefore,	although	CMHIP should	always	make	efforts	to

minimize inappropriate	admissions	at	the	evaluation	stage,	we	are	no	longer	as	concerned	that	

courts	are	ordering	inordinate	inpatient	evaluations	to	“workaround” delays	in	admission	for	

restoration.		We	anticipate	that	as	CDHS	disseminates	information	about	the	triage	system	to	

courts	and	counsel,	fewer	“workarounds”	will	occur.		

	

	

	

																																																																																																																																																																														 12 C.R.S.	§	27-65-105:	(1) Emergency	procedure	may	be	invoked	under	either	one	of	the	following	two	

conditions:

(a)(I) When	any	person	appears	to	have	a	mental	health	disorder	and,	as	a	result	of	such	mental	health	

disorder,	appears	to	be	an	imminent	danger	to	others	or	to	himself	or	herself	or	appears	to	be	gravely	

disabled,	then	an	intervening	professional,	as	specified	in	subsection	(1)(a)(II)	of	this	section,	upon	

probable	cause	and	with	such	assistance	as	may	be	required,	may	take	the	person	into	custody,	or	cause

the	person	to	be	taken	into	custody,	and	placed	in	a	facility	designated	or	approved	by	the	executive	

director	for	a	seventy-two-hour	treatment	and	evaluation...

(b) Upon	an	affidavit	sworn	to	or	affirmed	before	a	judge	that	relates	sufficient	facts	to	establish	that	a	

person	appears	to	have	a	mental	health	disorder	and,	as	a	result	of	the	mental	health	disorder,	appears	

to	be	an	imminent	danger	to	others	or	to	himself	or	herself	or	appears	to	be	gravely	disabled,	the	court

may	order	the	person	described	in	the	affidavit	to	be	taken	into	custody	and	placed	in	a	facility	

designated	or	approved	by	the	executive	director	for	a	seventy-two-hour	treatment	and	evaluation.	

13 From	the	August 7,	2019	CDHS	Monthly	Compliance	Plan	Report	(p.	17).

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Wait	Times	for	Inpatient	Restoration			

Compared	to	the	timely	inpatient	competence	evaluations,	there	are	far	more	concerns	

regarding	inpatient restoration	at	CMHIP.		Over	the	past	few	years, wait	times consistently

exceeded the	30-day	time frames mandated	by	an	earlier	Settlement	Agreement. However,	the	

required	time frames	changed significantly	as	of	June	1,	2019,	per	the	Consent	Decree.		The	

maximum	time frame	for	many	defendants	(those	labeled	as	Tier	2)	waiting	in	jails	has	been	

extended to	56	days.		The	time frame	for	defendants	with	the	most	urgent	clinical	needs	(those	

labeled	Tier	1)	will	be	only	7	days.

	

Recent	Wait	Times	for	Inpatient	Restoration14	

Month	 Number	of	people	

admitted	to	CHMIP	for	

inpatient	restoration	

Average	days	waited	

for	admission	to	

CMHIP	inpatient	

restoration	

People	who	waited	more	

than	the	max	days	for	

admission	to	CMHIP	

inpatient	restoration	

Tier	1											Tier	2 Tier	1											Tier	2 Tier	1												Tier	2

Jul 19 6																	59 4.4												93.6 1													*

Jun 19 2																	44 1															80.8 0													*

May 19 57 106.6 56

Apr 19 51 59.1 39

Mar	19 41 61.6 32

Feb	19 54 65.6 43

*	CDHS	has	not	provided	in	their	monthly	report	the	number	of	Tier	2	individuals	who	waited	

more	than	the	maximum	allowable	days	for	admission	to	CMHIP	for	inpatient	restoration.	

(Perhaps	because	56	days	had	not	passed	between	the	start	of	the	triage	system	and	their	

August	7,	2019	report).		We	have	requested	these	data.	

																																																						

14 According	to	Special	Master	Compliance	Plan	report	July	2019	p.9-10	(submitted	August	7,	2019).

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As	the	table	reveals,	most	of	the	defendants	now	designated	as	Tier	2 wait	much	longer	than	the	

required 56 days	before	admission. In	June	and	July,	a	total	of	103	Tier	2	individuals	were	

admitted	to	CMHIP,	with	their	days	waited	prior	to	admission	averaging	88.1 days.	However,	the	

much	smaller	group	of	patients	designated	as	Tier	1	were	admitted	rapidly,	consistent	with	the	

mandates	of	the	Consent	Decree.	 In	June	and	July,	a	total	of	8	Tier	1	individuals	were	admitted	

to	CMHIP,	with	their	days	waited	prior	to	admission	averaging	3.55	days.

In	many	ways,	these	Tier	1	numbers are commendable.	As	mentioned	previously,	we	view	the	

Tier	1	individuals	as	the	highest	priority	for	the	Consent	Decree	and	the	CDHS	competency	

system.		We	are	pleased	that	those	whom	CDHS	categorized	as	Tier	1	were	admitted	rapidly	(on	

average).		However,	confusion	remains	regarding the discrepancy	between	the	numbers	of	

individuals	opined	by	evaluators	as	Tier	1	in	June	and	July	(40	in	total)

15 and	the	numbers	

admitted.		CDHS	has	explained that	many	of	these	individuals	were	subsequently	admitted	in	

August,	that	some	had	orders	vacated,	and	that	some	were	awaiting	decisions	from	court.	

However,	the	discrepancy	seems	unexpectedly	large;	we	have	asked	CDHS	to	track	each	of	these	

Tier	1	individuals	and provide	specific	information	regarding each	person’s	location,	dates	of	

transfer,	updated	legal	status,	and	other	information.	

The	Tier	2	timelines	are	more	problematic.	Tier	2	individuals	are	mandated	to	CMHIP,	but	with	

less	urgency. To	date,	CMHIP	has	been	able	to	nimbly	create	space	for	Tier	1	individuals,	

inevitably by	prioritizing	them	over Tier	2	individuals.	 However,	Tier	2	individuals	must	also	be	

admitted	within	certain	time	frames.	 The	only	options	for	reducing	their	wait	times	are	to	create

space	for	them	in	CMHIP	(by	reducing restoration lengths	of	stay	or	creating	new	beds)	or	to	

transfer	them	to	community-based	treatment	(if	they	are	appropriate	for	such	treatment).	 In	

short,	while	Tier	1	individuals	must	be	prioritized for	admission	(thereby	treating	those	who	need	

it	most),	successful	compliance	with	the	Consent	Decree	must also reduce	Tier	2	time	frames;	

such	compliance	will	demonstrate	that	CDHS’	competency	system	has	created	adequate	capacity	

for	all	levels	of	competency	restoration.			

In	our	last	Quarterly	Report,	we	identified	several	pending	developments	that	would	greatly	

influence	the	Department’s	capacity	to	reduce	these	wait	times	for	inpatient	restoration.		

Fortunately,	most of	these	developed	in	ways	conducive	to	meeting	the	requirements	of	the	

Consent	Decree,	though	a	few	challenges	remain.		For	example,

• First,	all	parties	recognized	that	the	launch	of	the Triage	System	would	be	pivotal	to	the	

Department’s	success,	and that	many	(then	unknown)	aspects	of	the	triage	decisions	

would	influence	the	Department’s ability	to	comply	with	the	timelines	in	the	Consent	

Decree.		In	particular,	all	were concerned	that	a	very	high	proportion	of	Tier	1	

designations	might	make	it	nearly	impossible	to	admit	such	defendants	in	the	required	

time	frame	(7	days).			But	preliminary	data	suggests	that	evaluators	designated	roughly	

																																																						

15 Information	taken	from	August	7,	2019	CDHS	Monthly	Compliance	Report,	p.16.	

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one-third	of	defendants	as	Tier	1,	a	proportion	that	has	proven	manageable	for	the	

Department.		Indeed,	the	Department	reports	that	most	of	these	were	admitted	for	

inpatient	restoration	even	before	the	Court	ordered	admission.		More	broadly,	this	

suggests	the	new	Triage	procedures	have	been	successful	in	making	meaningful	

distinctions	among	defendants,	and	identifying	those	at	highest	need.

• Second,	the	Boulder	County	Jail’s	RISE	program	— which	opened	as	scheduled	in	June —

provided	another	option	for	inpatient-like	restoration	service.		These	18	new	beds	

reduced	the	pressure	on	the	CMHIP	inpatient	restoration	waitlist and	(though	

calculations	are	impossible	given	the	new	triage	policy	separating	Tier	1	and	Tier	2	

waitlists)	likely	decreased	wait	times	for	some defendants.		Although the	exact impact	of	

the	RISE	beds	cannot	be	precisely	determined	(amid	other	simultaneous	changes in	the	

complex	CDHS	competency	system),	18	new	beds	are beneficial.	

• On	the	other	hand,	the	Department	continued	to	struggle	with “show	cause”	orders from	

judges	ordering	defendants	into	inpatient	restoration	before	their	standing	on	the	

waitlist	would	warrant,	thereby	bypassing	other	defendants	who	have	been	waiting	

longer,	and	contributing	to	overall	delays.		All	parties	anticipated	that	these	orders	would	

decrease,	given	efforts	by	CDHS	and	DLC to	educate the	bar	and	the courts on	these	risks.		

However,	the	Department	reports	that	the	number	of	show	cause	orders	has	remained	

roughly	consistent,	and	(because	of	their	unpredictable	nature)	actually	pose	more	

challenges	to	CMHIP	admissions	than	the	Tier	1	urgent	admissions. We	continue	to	

recommend	an	aggressive	“marketing”	campaign	to	educate	the	judiciary	about	the	new	

triage	system and	discourage	use	of	show	cause	orders.	

At	least	two	other	emerging	factors	should influence	inpatient	restoration	waitlists:

• First,	the	Department	is	launching	the	Forensic	Support	Team	(FST)	near	the	end	of	

August.		Mandated	by	the	Consent	Decree,	the	FST	consists	of	18	mental	health	positions	

(1	director,	2 supervisory	“Coordinator”	positions, and	15	“Forensic	Navigator”	positions),	

providing	coverage	to	all	of	Colorado’s	judicial	districts. This	team,	dedicated	exclusively	

to	persons	receiving	competency	services,	is	responsible	for	monitoring	defendants	

awaiting	transfer	to	CMHIP	for	inpatient	competency	restoration	while	in	jail,	

coordinating	jail-to-community	based	restoration	treatment	discharges,	monitoring	care	

and	restoration	progress	for	defendants	in	community-based	restoration	treatment,	

supporting	their	community	tenure,	and	providing	a	centralized	and	consistent	point	of	

contact	for	competency-related	stakeholders.	

The	FST	will	be	operational	later	than	the	August	1	date	mandated	in	the	Consent	

Decree.	 This	is	disappointing.	 But	other	than	this	delay,	we	have	been	impressed	with	

most	aspects	of	the	FST	development.		The	Department	has	hired	a	strong	FST	leader and	

has	begun	carefully	detailing	the	ways	in	which	the	FST	will	supplement	and	coordinate	

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Page	18

with	the	Bridges	Program	liaisons16 (who	are	employed	by	the	courts,	rather	than	the	

Department).		The	Department	created	a	comprehensive	two-week	orientation	for	the	

FST	Navigators,	including	coordination	with	the Bridges	liaisons. Indeed,	these	

complementary	services	appear	to	be	developing	solid	lines	of	communications	and	

procedures	for	collaboration,	to	deliver	complementary	services	that	minimize	

redundancy	or	gaps	in	responsibilities.

We	anticipate	that	the	FST	will	help	fine-tune	the	Triage	System.		For	example,	when	a	

Tier	2	defendant	becomes	acutely	ill,	the	FST	can	facilitate	transition	to	Tier	1	status.	

Likewise,	when	a	Tier	2	defendant	improves,	FST may	facilitate	transition	to	CommunityBased	Restoration	Treatment	(CBRT).		The	latter	circumstance	is	especially	important	in	

ultimately	reducing	the	waitlist	for	competency	restoration.		Similarly,	we	anticipate	that	

as	FST	proves	reliable	to	Courts,	Courts	will	become increasingly	comfortable	

recommending	certain	types	of	defendants	for	CBRT (as	described	next).	

• Finally,	the	impending	policy	of	including	placement	recommendations (i.e.,	inpatient	vs.

outpatient restoration)	in evaluator	reports may	influence	waitlists.		Optimally,	as	

community-based	restoration	treatment	options become	increasingly	available,	along	

with a	stronger support	system	(through	the	relatively	new	Bridges	liaisons	and	the	

entirely	new	FST) for	defendants	in	outpatient	restoration,	evaluators	and	courts	will	be	

increasingly	comfortable	prioritizing	community-based	restoration	treatment	(CBRT)	over	

inpatient	restoration	at	CMHIP.		This	should reduce	substantially	the	number	of	

defendants waiting	for	inpatient	restoration.		Again,	this	will	require evaluators	who	

consistently	and	reliably	offer well-informed	placement	opinions.		It	will	also	require	a	

proactive Bridges	and	FST system,	and	available	slots	among	CBRT	providers (all	

discussed	later	in	this	report).

																																																						

16 The	Statewide	Behavioral	Health	Court	Liaison	Program	(or	“Bridges	Program”)	is	a	recentlyimplemented	program	operated	by	the	Colorado	State	Court	Administrator	pursuant	to	SB18-251.	It	

created	27	mental	health	positions,	placed	in	each	of	Colorado’s	judicial	districts,	for	the	purpose	of	

facilitating	communication	and	collaboration	among	judicial,	health	care,	and	behavioral	health	systems.	

Liaisons	are	primarily	dedicated	to	working	with	competency-related	cases	and	defendants.	

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Page	19

PERFORMANCE	OF	JAIL	COMPETENCY	EVALUATIONS	

33. (b) Performance of Jail Competency Evaluations. The Department shall complete all Jail 

Competency Evaluations of a Pretrial Detainee pursuant to the attached table (Table 1), after the 

Department’s receipt of a Court Order directing the evaluation and receipt of Collateral Materials. 

This timeframe requirement shall apply to the following counties: Adams, Alamosa, Arapahoe, 

Boulder, Broomfield, Crowley, Custer, Denver, Douglas, El Paso, Elbert, Fremont, Huerfano, 

Jefferson, Larimer, Mesa, Otero, Pueblo, Teller, and Weld. Counties not specifically identified are 

counties that use the “Hold and Wait” court ordered process. Counties utilizing the Hold and Wait 

Evaluation process will be offered a meeting date within 30 days of the Department’s receipt of the 

Court Order and Collateral Materials, and the evaluation will be completed within 30 days of the 

meeting. Beginning January 1, 2020, counties utilizing the Hold and Wait Evaluation process will be 

offered a meeting date within 30 days of the Department’s receipt of the Court Order and Collateral 

Materials, and the evaluation will be completed within 14 days of the meeting. 

During	this	past	quarter,	the	mandated	time	limit	for	a	jail-based	evaluation	decreased	from	30	

to 28	days,	per	the	Consent	Decree.	According	to	data they	provided,	the	Department still

achieved	almost	perfect compliance	with	this time	frame.

17 The	exceptions	were	brief,	and	they	

could	be	reasonably	categorized	as Individual	Special	Circumstances.	 Our	understanding	is	that	

the	Department	faced	some	challenges due	to	periods	in	which	they	were	short-staffed	(some	

evaluators	left	their	positions,	while	others	were	on	temporary	leave),	but	they	ultimately	met	

the	timelines.		Prior	to	this	period,	the	Department	had	maintained	perfect	compliance	with	the

previous 30-day	time	frame for	many	months.		The	Department	has	also	taken	strides to	hire	

additional	contracted	evaluators	in	the	community,	pursue	increased	pay	in	order	to	recruit	and	

retain	high	quality	evaluators,	and	proceed	with	creating	new	evaluator	positions	in	early	2020.	

As	in	our	prior	Quarterly	Report,	we	continue	to commend the	Department’s	timely	completion	

of	jail-based	evaluations,	but	also	encourage	them	to	consider	several	developments	that	may	

make	it more	challenging	to	maintain	this	success	in	the	future.		We	are	confident	the	

Department	can	continue	providing	timely	jail-based	evaluations,	particularly	if	they	plan	well	for	

the	following:			

• The	recent	“close	call”	in	which	the	Department	came	close	to	missing	more	jail-based	

evaluation	deadlines,	and	averted	problems	by	rapidly	contracting	with	new	evaluators,	

demonstrates	their	commitment	to	meeting	deadlines.		But	the	incident	also	

demonstrates	that	compliance	can	be	precarious	without	a	steady,	sufficient	workforce.		

In	the	past,	the	Department	has	sometimes	been	in	a	position	of	providing	hasty	

responses	to	unanticipated	challenges.	We	encourage	the	Department	to	carefully	

anticipate	workforce	challenges and	needs	(e.g.,	compensation	and	retention)	well	in	

advance	of	crises.	

																																																						

17 Data	taken	from	the	August 7,	2019	CDHS	Monthly	Compliance	Plan	Report covering	July (pp.	20).	

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Page	20

• One challenge	in	maintaining	a	strong	workforce	of	evaluators	involves	morale.		In	

general,	CDHS	evaluators	have	expressed	frustration	with	the	ways	in	which	CDHS	

administration	implemented the	recent	changes	in	evaluations	that	were	mandated	by	

the	Consent	Decree	and	SB19-223.		Evaluators	have	complained	that	implementation	has	

been	hasty,	ill-defined,	and	neglected	evaluator	expertise.		In	many	respects,	we	are	

sympathetic	to	the	evaluators’	frustrations.		We	are	urging	CDHS	to	better	enlist	

evaluator	expertise.		After	an	initial	meeting	between	evaluator	supervisors	and	CDHS	

upper	administration,	we	are	more	optimistic	about	a	path	forward	in	which	CDHS	better	

enlists	evaluators	in	these	systematic	changes.

• On July	1,	2020, the	new	time	frame	for	jail-based evaluations	will	decrease to	21	days.		

The	Department must	produce	data	well	in advance	of	this	change	to	determine how	

many	additional	evaluators	they	will	need	to	hire	in	order	to	meet	this	shortened	

deadline.		Their analysis	should	occur	soon	enough	to adjust	the	budget	and	secure	

funding to	hire	these	additional	positions.		Our	understanding	is	that	the	Department	has	

been	preparing	a	“time	study”	of	evaluator	workloads	and	time	required.		They have	

recently	opted	to	pursue	a	consultant	to	conduct	the	time	study;	we	encourage	them	to	

proceed	as	soon	as	possible.

• Also, as	the	time frames	change,	workloads	must	be	reasonable.		We	have	not	reviewed	

data	on	the	number	of	evaluations	assigned	to	a	1.0	FTE	Court	Services	evaluator;	again,	

we	will	do	so	in	the	future.		We	raise	this	issue	for	three reasons:

o The	upcoming	2020	time	frames.		It	may be	unreasonable	to	expect	evaluators	to	

complete	evaluations	25%	sooner without	a	review	of	appropriate	workloads	

and/or	without	hiring	additional	evaluators.		Workloads	will	almost	certainly	need	

to	be	adjusted	as	these	new	time frames	are	implemented.		

o New	required	content.		The	Consent	Decree	and	SB19-223	both	require	that	

evaluators	include	additional	content	in	their	evaluation	reports.	Evaluators	have	

already	raised	concerns	that	these new	demands	will	require	more	time.	

o Involvement	in	training	and	setting	policy. We	strongly	encourage	CDHS	to	solicit	

input	from	the	Court	Services	evaluator	team	in	terms	of	trainings	and	policy. The	

branch	has	special	expertise	in	forensic	evaluations	and	forensic	standards;	CDHS	

administration	should	capitalize	on	this	knowledge	when	developing	training	

materials,	quality	assurance	standards,	workload	expectations,	and	other	

evaluation	matters.	

Finally,	with	respect	to	competence	evaluations,	we	completed	a preliminary	quality	review	of	

sample	competence	evaluation	reports	(i.e.,	one	report	from	each	CDHS	evaluator). Generally,	

our	impressions	were	positive. Though	there	was	some	room	for	improvement	(which	we	

addressed	in	feedback)	the	reports	generally	reflected	good	professional	practice,	and	revealed	

no	gross	problems.

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INTERIM	JAIL	MENTAL	HEALTH	TREATMENT18		

34. Interim Jail Mental Health Treatment. If the court does not release the Pretrial Detainee to 

Community-Based Restoration Treatment and the Pretrial Detainee is awaiting receipt of Inpatient 

Restoration Treatment, the Department shall work with the County Jails to develop a program to 

assist in the provision of coordinated services for individuals in accordance with C.R.S. §§ 27-60-105 

et seq. to screen, treat, assess, and monitor for triage purposes Pretrial Detainees in the least 

restrictive setting possible. This paragraph does not toll or otherwise modify the Department’s 

obligation to Offer Admission to the Pretrial Detainees for Inpatient Restoration Treatment. Interim 

Jail Mental Health Treatment shall not replace or be used as a substitute for Inpatient Restoration 

Treatment but does not preclude the Department from providing Restoration Treatment. A member 

of the Forensic Support Team shall report to the Court Liaison every 10 days concerning the clinical 

status and progress towards competency of the Pretrial Detainee. 

The	Department	is	required	to	partner	with	county	jails	to	develop	a	program	of	coordinated	

services	for	individuals	receiving	competency-related	services.		These services	are	currently	

managed	statewide	through	the	Jail-Based	Behavioral	Services	program	(JBBS) and	are	funded	by	

the	approximately	$2.5	million	per	year recently	appropriated	by	SB19-223.		

Essentially,	the	Department	utilizes	JBBS	as	a	hub	for	coordinating	subcontracted	services	across	

Colorado.		These	subcontracted	providers	are	now	asked	to	provide	adequate	mental	health	

services	to	inmates	involved	with	competency-related	services.		Interim	mental	health	treatment	

for	defendants	receiving	competency-related	services	is	critical.		It	lies	at	the	heart	of	the	long	

litigation	and	conflict	between	the	Disability	Law	Center	(DLC)	and	the	Department.		DLC	and	its	

constituents	have	long	argued	that	county	jail	conditions — and	insufficient	mental	health

services — cause	harm	to	incarcerated	incompetent	defendants	as	they	wait	in	jail	for	transfer	to	

CMHIP.		If	services	were	substantially	improved,	however,	this	concern	could	be	assuaged.		The	

goal	of	Interim	Mental	Health	Treatment	is	to	do	just	that — screen,	monitor,	assess,	and	treat	

those	receiving	competency-related	services	in	county	jails	so	that	they	remain	physically	safe	

and	clinically	stable	until	their	transfer	to	competency	restoration	services.		

However,	the	structure	of	JBBS	creates	some	challenges.		Because	the	JBBS-subcontracted	

providers	differ	across	counties	and	jurisdictions, no	two	providers	are	alike.	 Services	differ.		

Some	providers	have	strong	connections	with	local	and	private	inpatient	hospitalization	facilities,	

while	others	have	weaker ties.	 Workforce	and	qualifications	also	differ	among	providers.		This	

poses	some	challenges	for	CDHS;	while	individualized	services	are	enhanced	given	the	local	

nature	of	the	providers	within	JBBS,	uniformity	and	leverage	across	providers	are	more	difficult.	

																																																						

18 “Interim	Jail	Mental	Health	Treatment”	means	mental	health	treatment	of	a	Pretrial	Detainee	that	is	

performed	in	the	County	Jail	where	the	Pretrial	Detainee	is	held	while	the	Pretrial	Detainee	awaits	

Community-Based	or	Inpatient	Restoration	Treatment	per	Court	Order	consistent	with	the	time	frames	in	

the	Consent	Decree.		It	is	NOT	a	proxy	or	substitute	for	competency	restoration	services.	

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Page	22

This	challenge	is	currently	embodied	in	the	Department’s	push	to	encourage	JBBS	providers	to	

expand	jail	mental	health	services	to	competency-related	defendants.		Since	our	last	quarterly	

report,	CDHS	has	made	considerable	progress	in	a	number	of	areas	regarding	JBBS	and	enhanced	

mental	health	services	for	competency-involved	inmates;	however,	challenges	remain.	

Two	significant	positive	developments	have	occurred	since	our	last	quarterly	report.	First,	the	

Department	hired	Jagruti	Shah	as	the	new	Forensic	Services	Director.		This	is	particularly	helpful	

for	the	Interim	Jail	Mental	Health	requirement,	because	Ms.	Shah’s	former	position	oversaw	

JBBS	and	all	related	contracts.		Her	promotion	ensures	that	a	working	knowledge	of	JBBS	will	be	

well-represented	in	the	highest	levels	of	the	Department’s	forensic	mental	health	

administration.	Secondly,	the	Department	put	out	a	call	to	expand	contracts	to	all	current	JBBScontracted	providers	to	expand	existing	mental	health	services	to	competency-involved	inmates	

in	July	2019.	

However,	responses	so	far	illustrate	the	challenges	of	relying	on a	system	built	of	subcontractors.		

To	date,	CDHS	has	received	responses	from	six	providers.		Two	contractors	requested	funding,	

two	declined funding,	and	two	stated	that	there	are	still	considering a	response.		This	is	the	

definition	of	a	“mixed	bag.”		While	we	are	pleased	that	two	county	providers	will	be	seeking	

funding,	we	are	somewhat	disappointed	that	the	response	rate	has	been	so	lukewarm.		Such	is	

the	reality	of	relying	upon	a	network	of	contracted	providers.	

In	conversations	with	Ms.	Shah,	she	has	stated	that	this	has	been	a	typical	pattern	for	most	

providers	with	previous	initiatives.		She	remains	optimistic	that	several	other	providers	will	

submit	proposals,	and	she	maintains	that	she	is	in	close	contact	with	counties	who	have	yet	to	

submit	responses.		We	rely	on	Ms.	Shah’s	experience	and	expertise	in	this	area,	and	tentatively	

defer	to	her	optimism	as	it	is	based	on	years	of	experience	with	these	providers	in	similar	

contexts.		However,	Interim	Jail	Mental	Health	Treatment	is	a	key	focus in	the	Consent	Decree,	

and	if	many	providers	continue	to	decline	funding,	the	Department	must	find	alternate	ways	to	

meet	the	needs	of	those	inmates	receiving	competency	services	in	county	jails.	

Therefore,	we	have	requested	the	Department	to	provide	a	list	of	all	JBBS	providers	and	a	list	of	

those	who	are	seeking	funding.		We	will	also	ask	to	review	the	requests	for	funding.		We	want	to	

ensure	that	the	mental	health	services	at	each	county	jail	adequately	address	the	individualized	

clinical	needs	of	each	person	receiving	competency-related	services.

19		To	be	fair,	some	

providers	who legitimately	decline	funding	may already	be able	to	offer	a	sufficient	continuum	of	

services.		However,	we	are	reluctant to	assume	this	to	be	true	for	all	providers	that	decline	

funding	– or	even	those	that	request	funding.		We	therefore	will	more	carefully	monitor	the	

quality	of	the	proposed	service	plans	before	our	next	quarterly	report,	and	we	plan	to	follow	up	

with	in-person	visits	afterward.	

																																																						

19 This	service	continuum	and	its	associated	decision-making	processes	are	detailed	in	our	May	2019	

quarterly	report.	

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Page	23

RELEASE	OF	PRETRIAL	DETAINEES	FOR	COMMUNITY-BASED	RESTORATION	

TREATMENT20	

35. Release of Pretrial Detainees for Community-Based Restoration Treatment. If the court releases 

the Pretrial Detainee on bond to commence Community-Based Restoration Treatment, the 

Department shall coordinate with the Court Liaison to develop a discharge plan (in a format approved 

by the Special Master) within seven days of the order to all parties involved in the Community-Based 

Services Recipient’s case, and the Court Liaison and community-based provider. 

The	Department	has	made further progress	on	the	requirement	to	develop discharge	plans	for	

persons	identified	as	appropriate	for	Community-Based	Restoration	Treatment	(CBRT).		

However,	important	work	remains.	 In	the quarter preceding	our	prior	report,	the	Department	

solicited	drafted	discharge	plans	from	the	Bridges	Program	and	compared	them	with	their	own	

CMHIP	and	CMHIFL discharge	plans.		They	also	reviewed	other	policies	and	procedures	from	

Bridges.	

Ultimately,	it	became	clear	that	the	Bridges	Program	and	the	new	Forensic	Support	Team	(FST)	

must	work	together	to	facilitate	discharge	and	share responsibilities.		The	teams	will	be	relying	

on	similar	(partially,	but	not	entirely,	overlapping)	bodies	of	information.		Thus,	a	crucial	task	

over	the	past	quarter	has	been	for	the	Department	and	the	Bridges	team	to	communicate	in	

planning	services,	so	that	they	can	ultimately	collaborate	in	a	way	that	minimizes	redundancies	

and	gaps.		The	Department	recently	developed	a	“responsibility	matrix”	to	delineate	

responsibilities	for	the	FST	and	the	Department,	particularly	as	they	relate	to	the	Bridges	Team.	

This	was	not	implemented	on	July	1,	as	scheduled,	because	the	Forensic	Support	Team	was	not	

hired	until	recently,	and	begins	work	near	the	end	of	August.	

As	the	FST	launches,	it	will	be	crucial	that	they	work	collaboratively	with	the	Bridges	court	

liaisons.	Thus	far,	the	leadership	of	each	service	has	met	to	plan	collaboratively,	and	the	FST	

training	has	incorporated	the	Bridges	team.		They	have	scheduled	additional	meetings	(including	

some	in	which	we	will	be	involved)	for	broad	planning,	and	for	collaborative	problem-solving	as	

the	FST	program	becomes	operational.		Given	these	collaborative	efforts	surrounding	the	FST	

launch,	we	are	optimistic	that	FST	and	Bridges	will	jointly	work	to	care	for	defendants	involved	in	

the	competency	services,	and	facilitate	transitions	to	the	community	as	appropriate.	

As	the	FST	launches	at	the	end	of	this	month,	we	continue	to	request	the	specific	documents,	

policies,	and	protocols	that	FST	will	use	to	facilitate	services	and	transitions	between	levels	of	

care.

																																																						

20 “Community-Based	Restoration	Treatment”	means	Restoration	Treatment	of	a	Community-Based	

Recipient	that	is	ordered	to	be	performed	out	of	custody	and	in	conjunction	with	a	community-based	

mental	health	center	or	community	organization.

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TRANSPORTATION	OF	PRETRIAL	DETAINEES		

36. Transportation of Pretrial Detainees. If a Pretrial Detainee is transported to the Hospital for an 

Inpatient Competency Evaluation and the Department or a medical professional opines that the 

Pretrial Detainee is incompetent and the provisions of C.R.S. § 27-65-125 have been met, the 

Department shall not transport the Pretrial Detainee back to his/her originating jail. 

Over	the	past	quarter,	a	total	of	44	defendants	were	admitted	to	CMHIP	for	an	inpatient	

competency	evaluation,	of	whom	only	12 met C.R.S. §	27-65-125	criteria,	according	to	hospital	

staff.

21 None	of	these defendants	who	met	civil	commitment	criteria	were	returned	to	a	local	

jail.

22		

As	mentioned	in	our	prior	quarterly	report,	the	recent	SB19-223	includes	language	that	could	

allow	CMHIP	to	keep	a	defendant	ordered	for	inpatient	evaluation	at	CMHIP	from the	time	that	

the	evaluator	opines	him or	her incompetent	to	proceed	(rather	than	requiring	C.R.S.	§	27-65-

125	criteria	be	met,	or	that	the	originating	court	adjudicates	the	defendant	as	incompetent).		

This	is	now	found	in	C.R.S.	§	16-8.5-105	(IV-b-5)	and	reads as	follows:	

When	the	court	orders	an	inpatient	evaluation,	the	court	shall	advise	the	defendant	that	

restoration	services	may	commence	immediately	if	the	evaluation	concludes	that	the	

defendant	is	incompetent	to	proceed, unless	either	party	objects	at	the	time	of	the	

advisement,	or	within	72	hours	after	the	receipt	of	the	written	evaluation	submitted	to	the	

court.

This	is	a	significant	change	in	the	law	that will	require	CMHIP	and	Department	administrators	to	

determine	policies	and	procedures	governing	the	decision-making	in	these	circumstances.		At	

times,	CMHIP	may	need	to	balance	these	incompetent	individuals	already	in	the	hospital	and	in	

need	of	hospital-level	care	with	those	Tier	1	or	Tier	2	defendants	in	county	jails	approaching

their	deadlines	for	admission.		We	recommend	that	the	decisions	among	these	individuals	be	

made	primarily	on	clinical	grounds,	but	we	also	understand	the	need	to	admit	individuals	who	

have	been	waiting	in	county	jails	for	extended	periods	of	time.		We	anticipate	further	discussion	

discussion	with	the	Department	around	their	plans	for	these	situations.

																																																						

21 According	to	the	July	Special	Master	Compliance	Report	(p.24),	submitted	by	CDHS	on	August	7,	2019.	

22 See	the	Department’s	monthly	report	(p.	16)	filed	May	7,	2019.

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NOTIFICATION	OF	NON-COMPLIANCE	WITH	TIME	FRAMES		

38. Notification of Non-Compliance with Timeframes. The Department shall notify the Special 

Master and DLC weekly regarding any non-compliance with timeframes. 

(a) Only one notice per Pretrial Detainee shall be provided and should include: (i) The name of the 

Pretrial Detainee; (ii) The Pretrial Detainee’s location; (iii) The Pretrial Detainee’s charges based on 

information available to the Department; (iv) The Pretrial Detainee’s bond amount based on 

information available to the Department; (v) Whether a forensic assessment has been made on 

whether restoration in the community is appropriate; (vi) Whether the Pretrial Detainee has 

previously been found incompetent; (vii) What efforts are being made to provide timely Competency 

Services to the Pretrial Detainee, including communications with the court, Court Liaisons, and 

community mental health providers;

(b) The Department shall accompany its Monthly Data Report (see Paragraph 52) with a separate 

“Fines Report” which will include the names of the Pretrial Detainees for whom the Department has 

accrued a fine during the preceding month, the number of days each Pretrial Detainee waited in the 

County Jails past the timeframes for compliance, and the total fines owed by the Department for the 

preceding month. 

(c) The Department shall pay the total fines owed on the date the Fines Report is submitted to the 

Special Master to be deposited in a trust account created for the purpose of funding non-Department 

mental health services. The account will be managed by a court-appointed administrator. Decisions 

concerning payments out of the account will be made by a committee consisting of a representative 

from the Plaintiff, a representative from the Department, and the Special Master. Any disputes 

regarding the fines shall be handled through the dispute resolution process identified in Paragraph 59. 

The	Department	has	indeed	consistently	provided	notification of	non-compliance	of	time frames	

on	a	weekly	basis,	as	required	by	the	Consent	Decree	(since	June	1,	2019).	 Likewise,	the	

Department	has	completed	a	“Fines	Report,”	as	prescribed	by	the	Consent	Decree.		Finally,	as	

prescribed	by	the	Consent	Decree,	the	Department	has	indeed	paid	these	fines	into	a	trust	

account (managed	by	Cordes	&	Company,	LLP).

Regarding	the	use	of	these	fines,	a	small	committee	comprising	Department	administration	

(Worthwein,	Scofidio),	a	representative	from	the	Plaintiff	(i.e.,	Disability	Law	Colorado	leader,	

Ivandick),	and	the	Special	Masters	has	begun	meeting.		Thus	far,	the	committee	has	explored	

how	funds	from	the fines	will	be	collected,	managed,	and	distributed	(including	the	need	for	an	

identified,	formal	procedure	for	reviewing	available	funds,	interested	vendors,	and	outcomes	of	

expenditures).		But	this	committee	has	not	formalized	or	finalized	these	procedures.		The	

committee	has	also	held	discussions	about	priorities	for	funding	(i.e.,	services	beyond	those	

which	the	Department	is	responsible	for	delivering,	that	will	nevertheless	serve	those	likely	to	be	

involved	in	the	competency	system	and	will	likely	reduce	waitlists	and	wait	times).		As	of	now,	

over	$1	million	in	fines	have	been	collected,	so	it	will	be	important	to	finalize	procedures	in	the	

relatively	near	future,	in	order	to	make	use	of	those	fines	in	the	fairly	near	future.	

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CONSENT	DECREE	SECTION	VII	UPDATES	

CIVIL	BED	FREEZE	

39. Civil Bed Freeze. The Department’s 2018 Plan included an effort to freeze civil admissions to its 

beds to devote Hospital beds to perform Inpatient Restoration Treatment services. On February 7, 

2019, the Department agreed to stop this practice. The Department will continue to leave the state’s 

civil and juvenile beds allocated as of the execution of this Consent Decree for civil and juvenile 

psychiatric admissions and will not freeze or convert those beds to provide competency services for 

Pretrial Detainees, unless the Department receives prior agreement from the Special Master to use 

unutilized beds for such purposes. This strategy to facilitate compliance with the Consent Decree 

shall only be re-implemented in the future upon agreement of the Special Master. 

The	Department	continues	to	report that	they	have	removed	the	“civil	bed	freeze”	as	mandated	

by	the	Consent	Decree.		That	is,	they	have	not	re-purposed	the	civil	beds	at	CMHIFL	for	

competence	restoration,	as	they	had	once	proposed.		Per	our	request,	the	Department	

continues	to	provide	a	census	report	on	the	CMHIFL	patients	in	their	monthly	report.		As	of	their	

most	recent	report,	the	CMHIFL	population	includes	a	total	of	90	patients,	85 of	whom	were	civil	

patients.		Although	five	patients	have	a	forensic	status,	the	Department	has	explained	these	

special	circumstances	to	the	Plaintiff	and the	Special	Master,	and	provided	reasonable	

justification	in	the	monthly	report.		All	parties	have	agreed	these	reflect	reasonable	exceptions.	

During	monthly multi-party	meetings,	the	Department	has	discussed	any	potential	changes	to	

the	use	of	any	CMHIFL	beds	(e.g.,	allocating	a	few	new	beds	at	CMHIFL	to	accommodate	

inpatient	competence	evaluations,	not	restoration,	which	may	reduce	the	need	to	transport	

Denver-area	defendants	to	CMHIP	for	inpatient	evaluation).		Generally,	the	Plaintiffs	and	Special	

Masters	have	agreed	with	the	minor	changes	they	have	proposed,	because	these	tend	to	reflect	

efficient	steps	that	better	serve	the	Departments’	consumers.			

For	the	foreseeable	future,	the	Department	will	continue	to	wrestle	with	the	reality	that	too	few	

civil	beds	exist	in	Colorado.	 One	of	the	Consent	Decree’s	indirect	goals	is	to	increase	civil	

capacity	through	the	reduced	need	for	forensic	beds;	the	Department	will	need	to	continue	to	

monitor	this	trend	and	the	outcomes	of	relevant	initiatives	in	the	Consent	Decree	to	determine	

the	ongoing	and	future	needs	for	civil	beds.		

	

	

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COMPREHENSIVE	AND	COHESIVE	PLAN	

40. Comprehensive and Cohesive Plan. The Special Master’s first recommendation was to revise the 

Department’s 2018 Plan into a more comprehensive and cohesive plan. Dkt. 146. By or about 

January 2020, the Department will produce an initial plan resulting from a long-term visioning 

process with DLC, the Special Master, and stakeholders that will consolidate disparate pieces of the 

Department’s current plan, along with legislative initiatives, in a cohesive package for courts, 

administrators, service providers, and legislators to consider. As referenced in the Special Master’s 

Recommendation Number 7, the 2020 Plan will highlight the methods to prioritize quality amid 

quantity and time pressures. Dkt. 146 at 42. On an annual basis thereafter, the Department will 

review and revise the plan as appropriate based upon data provided by the Department. 

The	Department	continues	to	move	closer	to developing	a	comprehensive,	cohesive	plan.		The	

final	plan	is	due	to	be	submitted	in	January	2020.		As	we	detailed	in	our	last	quarterly	report,	the	

Department	has	taken	substantial	steps	to:

1. Coordinate	and	align	policies	and	services	within	a	long-term	vision	for	competencyrelated	services,	and

2. Ensure that	their	emerging plan	is	supported	by,	and	integrated	with,	statutory	

improvements	and	efforts	from	other	stakeholders	regarding	competency	services.		

Indeed,	they	have	shared	the	preliminary	plan	with	the	Governor’s	Blueprint	Task	Force	

subcommittee	that	is	addressing	competence-related	issues.	

The	Department	has	continued	developing	the	plan	through	the	efforts	detailed	in	our	previous	

quarterly	report	(i.e.,	various	internal	meetings,	specific	coordination	initiatives,	participation	in	

the	Governor’s	blueprint	taskforce	committee,	etc.).		We	affirm	these	efforts	and	encourage	

them	to	continue.	

Along	with	these	important	accomplishments,	we	see	the	following	as	important,	remaining	next	

steps	towards	a	“Comprehensive,	Cohesive	Plan”	for	the	Department	to	take	in	the	near	future:

• Write	the	plan.		The	final,	written	plan	is	due	in	January	2020,	though	it	will	be	important	

to	share	drafts	with	us	and	other	stakeholders	before	then.		The	written	plan	should	

include	an	articulation	of	the	larger	vision	for	competency	services	in	Colorado,	along	

with	specific	goals.		It	should	also	include	descriptions	of	the	components	of	the	

competency	services	system,	policies	and	protocols,	a	glossary,	desired	outcomes,	and	

visual	representations	of	the	entire	system	(described	below)	and	the	smaller	component	

parts.		

• Create	a	visual	representation	of	the	new	competency	services	system.	 This	should	be	a	

1-2	page	representation	of	how	the	different	components	are	integrated	and	

interconnected.		It	should	be	tailored	to	a	lay	audience,	so	that	stakeholders	outside	the	

Department	can	see	the	system,	see	where	they	fit	into	the	system,	and	understand	the	

context	for	their	functions	and	roles	in	the	system.		

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• Educating	all	stakeholders,	both	within	and	outside	of	the	Department.		A	comprehensive	

system	cannot	be	cohesive	if	employees	do	not	understand	how	they	fit	into	the	larger	

plan,	and	a	cohesive	system	cannot	be	comprehensive	if	external	stakeholders	are	not	

aligned	with	the	vision	and	mission	of	the	system.		It	is	important	for	Department

employees	to	understand	the	changing	system	in	which	they	work.		While	important	for	

all	employees,	some	particular	sets	of	employees	will	need	special	attention:

o Court	Services	evaluators: They	will	soon	be	asked	to	opine	on	issues	they	have	

never	before	been	asked	to	address	(triage	priority,	inpatient	vs. outpatient	

placement,	and	legislatively-mandated	details	about	their	cases).		This	is	the	most	

significant	change	in	Court	Services	since	the	transition	to	conducting	jail-based	

evaluations	many	years	ago.		Evaluators	must	understand	the	new	system	in	

which	they	work — how	their	opinions	will	affect	clinical	care,	triage	priority,	and	

so	on.		A	large	system	of	care	will	soon	surround	ITP	defendants.		Without	

knowledge	of	this	system	(or	a	proper	understanding	of	their	role	in	it),	evaluators	

may	resort	to	overly	conservative,	risk	aversive	decisions.		

o CMHIP	staff: The	makeup	of	the	hospital	continues	to	change	to	a	

disproportionately	forensic	population.		The	hospital	is	accredited	as	an	acutecare	facility.		Long-time	staff	may	be	frustrated	by	this	gradual	change.		Long-term	

care	is	at	times	being	supplanted by	shorter-term	restoration	efforts.		Continued	

efforts	to	maintain	morale	and	help	CMHIP	personnel	see	their	critical	role	in	

addressing	important	clinical	functions	for	ITP	defendants	are	important.		

o CMHIFL	staff: Even	more	so,	the	exclusively	civil	Ft.	Logan	hospital	is	slated	to	

begin	admitting	forensic	patients	in	the	coming	year.		This	will be	a	substantial

shift	for	hospital	administrators	and	the	personnel	working	in	those	units	alike.		

Cross-training	from	CMHIP	and	dedicated	planning	to	that	transition	will	be	

critical.		

o New	positions	(Forensic	Support	Team,	Data	Management):	These	new	positions	

were	created	exclusively	for	the	new	competency	services	system.		Data	positions	

need	to	understand	the	larger	system	so	that	data	can	best	be	collected	and	

analyzed.		Perhaps	more	than	any	other	positions,	the	Forensic	Support	Team	

(FST)	positions	must	understand	how	they	fit	into	the	continuum	of	competency	

services	so	that	they	can	reliably	and	accurately	monitor	clinical	status,	

competency	progress,	and	options	for	placement.		In	addition,	the	FST	positions	

will	at	times	need	to	act	as	buffers	against	stakeholder	pressures	to	hospitalize	

CBRT	participants,	attend	to	crises,	and	provide	a	voice	of	expertise	and	reason	

during	court	proceedings.		A	thorough	knowledge	of	the	system	is	imperative.	

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• Coordinating	with	NASMHPD	and	other	resources. The	Forensic	Services	Director	must	

reach	out	and	utilize	the	network	of	national	professionals	in	the	National	Association	for	

State	Mental	Health	Program	Directors	(NASMHPD),	particularly	the	Forensic	Division,	

the	American	Psychology-Law	Society,	and	other	organizations.		Colorado	can	learn	

lessons	from	other	state	administrators	about	how	similar	programs	have	been	

successfully	launched	and	implemented,	how	to	maintain	evaluator	morale,	how	to	

evaluate	evaluator	and	programmatic	outcomes,	and	so	on.		The	forensic	leaders	at	the	

Department	should	have	the	resources	to	attend	national	meetings	of	these	

organizations	and	become	involved	in	ways	that	help	the	Department.		

• Refine	legislative	bills. Inevitably,	SB19-222	and	SB19-223	will	require	adjustment	as	they	

are	implemented.		The	Department must	collect	outcome	data	for	each	bill	and	begin	

making	drafted	adjustments	to	both	bills	in	late	2019	/	early	2020.		

• Refine	workloads	and	expectations	within	new	programs.		Analogously,	the	new	

Department programs	(triage,	CBRT,	data	team)	will	require	careful	monitoring	of	

outcomes	so	that	necessary	adjustments	can	be	made.		Adjustments	might	include	

revised	workloads	for Court	Service	evaluators,	jurisdictions	for	FST	Navigators,	contracts	

for	CBRT	providers,	intensity	of	JBBS	services	for	defendants	at	various	stages	of	the	

competency	process,	and	so	on.		Additional	positions	may	be	needed	over	time	(Court	

Service	evaluators,	for	example).		In	short,	the	Department	is	launching	many	promising	

initiatives;	all	of	these	are	new	and	complicated	enough	that	they	will	inevitably	require	

close	observation	and	fine-tuning.	

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INCREASE	COMMUNITY	RESTORATION	SERVICES	

41. (a) Implement a coordinated wide-scale outpatient (community-based) competency restoration 

(OCR) system. This system shall be integrated and submitted with the “Comprehensive and 

Cohesive Plan” referenced in Paragraph 40 herein. This plan shall be approved by the Special 

Master. 

As	in	our	past	quarterly	report,	the Department	continues	to	make progress	in	developing	a	

wide-scale	outpatient,	community-based	restoration	treatment	program	(CBRT).		Their	formal	

CBRT	program	began	in	March	of	2018,	and	referrals	for	outpatient	restoration	have	tended	to	

hover	around	34	defendants	per	month	for	the	past	several	months	(though	June	referrals	

dropped	to	an	unusual	low	of	29).		Although	we	hope	to	see	these	referrals — in	particular,	the	

proportion	of	defendants	referred	for CBRT	(detailed	in	41(c)	below) — increase	further,	we	

perceive	the	Department	taking	meaningful	steps	towards	further	CBRT:

• The	Department	has	increasingly	established	contracts	with	the	community	mental	

health	centers	(nearly	all	of	them,	at	this	point)	to	provide	CBRT.

• The	Department	increasingly	considers	and	describes	outpatient	restoration	the	default	

approach for	restoration,	unless	there	is	clear	reason	for	inpatient	restoration.	Simply	

shifting	the	“default	setting”	(particularly	as	evaluators	and	judges	understand	it)	will	

help	to	increase	community-based	restoration,	and	decrease	unnecessary	inpatient	

admissions.

• Part	of	SB19-223	allocated an	additional	$2.26	million	to	support	community	services	

consistent	with	competence	restoration	goals (and,	as	we	understand	it,	with	a	

substantial	portion	of	that	funding	earmarked	exclusively	for	competency-related	

services).

• The	Department	has	allocated $500,000 to Mental	Health	Center	of	Denver	(MHCD)	and	

Denver	Pre-trial	Services	to	establish	a	pilot	program	that	bolsters	case	management,	

treatment,	and	supervision	in	order	to	expand	CBRT	in	the	Denver	metro	area.		Though	a	

pilot	program,	this	type	of	targeted	intervention	in	such	a	high-need	area	may	be	

sufficient,	even	by	itself,	to	influence waiting	list	and	wait	time	figures	for	the	state.	The	

Department	reports	that	they	expect	to	finalize	the	contract	late	in	August	2019.	

Along	with	these	important	accomplishments,	we	see	the	following	as	important,	remaining	next	

steps	for	the	Department	to	take	in	the	near	future:

• Consistently	increase	the	number,	and	percentage,	of	incompetent	defendants	to	CBRT	

(see	discussion	of	41c	below).

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• Continue	educating	evaluators,	the	defense	bar,	and	the	courts	that	CBRT	is	available,	

and	should	be	considered	the	default	option.

• Further	train evaluators,	who	must	soon include	recommendations	for	restoration	

location	(inpatient	or	outpatient)	in	the	conclusion	of	any	report	that	opines	a	defendant	

is	not	competent.		Evaluators	will	need	to	better	understand	the CBRT	system,	and	

become	reliable	with	one	another	(i.e.,	offering	similar	opinions	in	similar	cases)	in	

recommending	CBRT	versus	inpatient	restoration.	

• Provide	to	the	Special	Masters	requested	data	on	CBRT	process	and	outcomes.		Such	

data	will	be	important	for	quality	assurance,	improving	services,	and	further	planning.	

41. (b) The Department may utilize private hospital beds to meet the needs of Pretrial Detainees 

meeting C.R.S. § 27-65-105(a) civil commitment criteria and with prioritization to Pretrial Detainees 

already residing within the same geographic location. The Department shall create a plan to 

implement this subsection (b) to be approved by the Special Master. 

At	this	point,	the	Department	has	explored	contracts	for	private	hospital	beds,	but	does	not	

seem	to	consider	this	an	urgent	priority	relative	to	other	tasks.		We	agree	that	private	hospital	

beds	are	unlikely	to	be	a	primary	part	of	improving	the	waitlist.		Rather,	we	believe	they	may	play	

a	small	role,	such	as	the	following	examples:

• Serving	as	a	local	site	for	defendants	receiving	outpatient	restoration	services — when	

they	decompensate	either	in	jail	or	in	the	community	and	warrant	more	intensive	clinical	

care — to	receive	local	services	rapidly	(rather	than	await	transfer	to	CMHIP).

• Serving	as	additional	inpatient	restoration	sites,	akin	to	providing	additional	CMHIP	beds	

in	various	locations	around	Colorado.	

Again,	we	consider	use	of	private	hospital	beds	one	of	many	plausible,	minor supportive	

strategies	that	may	augment	the	much	broader	improvements	in	the	Department’s	system	of	

competency-related	services.		But	we	see	this	strategy	as	far	less	urgent	(and	far	less	likely	to	

make	a	broad	impact)	than	the	other	steps	they	are	pursuing,	detailed	throughout	this	report.		

41. (c) The Department currently estimates that 10-20% of Pretrial Detainees admitted for inpatient 

restoration do not need hospital-level care. Dkt. 146 at 29. The Department will make best efforts to 

reduce inpatient restoration hospitalizations by 10% and increase community restorations by 10% in 

six-month increments beginning June 1, 2019. The baseline for the preceding sentence will be 

determined by the Special Master by June 1, 2019, utilizing data provided by the Department. On 

June 1, 2020, the Special Master will establish a modification of this guideline based upon a survey of 

the data collection and implementation of the Department’s Plan.

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Prior	to	our	last	quarterly	report,	we	used	the most	recent	six-month	period	of	available	data	

(i.e.,	Nov	2018	– April	2019)	to	set	the “baseline”	for	future	performance	goals.		We	also	

recommend	using	proportional	metrics	when	pursuing	goals	that	are	fundamentally	proportional	

in	nature	(i.e.,	a	10%	increase	in	community-based	restoration	and	a	10%	decrease	in	inpatient	

restoration).		In	other	words,	while	the	Department	may	not	have	full	control	over	the	actual	

number	of	referrals,	they	have	greater	control	over	the	proportion	of	referrals	they	direct	to	

outpatient	versus	inpatient	restoration.		Therefore,	we chose	to	set	the	baseline	figures,	and	

establish	subsequent	performance	goals,	based	on	proportions	instead	of raw	numbers. Thus,	

calculating	target	goals	for	restoration	based	on	these	percentages	of	individuals referred	to	

inpatient	versus	outpatient	services	yields	the	following	goals:

	 	

Inpatient	Restorations	

	

	

Outpatient	Restorations	

	

Baseline	(past	6	months)	

	

Recent	6-month	average: 69% Recent	6-month	average: 31%

December	1,	2019	goal	

	

69% reduced	by 10%	=	62% 31%	increased	by 10%	=	34%

June	1,	2020	goal	 62%	reduced	by 10%	=	56% 34%	increased	by 10%	=	37%

Note:	All	percentages	rounded	to	nearest	1%.

Therefore,	the	December	1,	2019	performance	goal	to	reduce	inpatient	restoration	by	10%	and	

increase outpatient	restoration	by	10%	should	yield	no	more	than	62%	of	defendants	referred	

for	inpatient	restoration	and	no	less	than	34%	of	defendants	referred	for	outpatient	

(community-based)	restoration.		

As	of	this	quarter (i.e.,	preceding	August	28,	2019), the	portion	of	defendants	referred	to CBRT	

has	averaged	28.8%,	which	was	lower	than	the	prior	period.

23		Indeed,	the	Department	had	

maintained	34%	(their	December	2019	goal)	for	a	few	months	prior	to	the	last	quarterly	report,	

but	inpatient	referrals	inexplicably	decreased	in	May	(27%)	and	June	(26%)	of	2019.		The	

Department	could	identify	no	clear	reason	for	this	decrease,	but	this	decrease	suggests	they	may

require	more	concentrated	efforts	to	increase	CBRT	referrals	among	all	defendants	for	whom	

they	are	appropriate.

We	are	hopeful that	the following	interventions	(already	underway)	will	help	the	Department	

comply	with	Paragraph	41	of	the	Consent	Decree	by	increasing	outpatient	restoration	to	34%,	on	

average,	for	the	period	spanning	June	1,	2019	through	December	1,	2019.	Specifically,	we	

																																																						

23 According	to	the	July	Special	Master	Compliance	Report	(p.31-32),	submitted	by	CDHS	on	August	7,	

2019.

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recommend:

• Further	efforts	to	educate	evaluators,	the	bar,	and	the	judiciary	about	CBRT,	particularly	

the	ways	in	which	the	newly	launched	FST	can	support	CBRT	efforts.

• Launching	the	FST	with	special	attention	to	supporting	CBRT in	all	instances	when	the	

defendants	are	an	appropriate	fit	for	outpatient	restoration.

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CONCLUSION	

As	detailed	throughout	this	report,	we	perceive	the	Department	has	made	significant	and	

meaningful	progress	in	enacting	the	elements	prescribed	in	the	Consent	Decree.		Indeed,	key	

interventions	prescribed	by	the	Consent	Decree	(e.g.,	the	triage	system,	the	Forensic	Support	

Team)	have	launched	during	this	reporting	period.		At	present,	these	have	not	significantly	

changed the	overall key	metrics	such as	the	waiting	list	or	waiting	times	for	restoration	services,	

but	they	do	reveal	that	the	Department	is	generally	responding	promptly	to	those	identified	as	

Tier	1.		Put	simply,	the	most	acutely	ill	defendants — those	whose	welfare	was	a	primary	focus	in	

the	current legislation	and	Consent	Decree — do	seem	to	be	receiving	more	prompt	treatment	

upon	launch	of	the	Triage	System. We	have	requested	the	Department	provide	even	more	detail	

on	this	population	in	the	coming	months,	and	we	hope	to	see	continued,	prompt	service	to	

them.		At	the	same	time,	it	will	be	important	for	the	Department	to	begin	accelerating	inpatient	

restoration	treatment	for	Tier	2	defendants,	whose	needs	may	be	less	urgent,	but	nevertheless	

important.		We will	continue	to	work	with	the	Department on	these	(and	other)	matters,	and	we	

encourage	you	to	contact	us	with	any	questions	or	requests.		We	appreciate	the	opportunity	to	

serve	the	court,	and	the	state	of	Colorado,	in	these	important	efforts.

Neil	Gowensmith,	Ph.D.

President,	Groundswell	Services	Inc.	

Daniel	Murrie,	Ph.D.

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