Integra(on of Behavioral Health and Risk Assessments Into Case Plans

Transcription

1 Integra(on of Behavioral Health and Risk Assessments Into Case Plans Na4onal Reentry Resource Center Behavioral Health Training Summit August 4, 2015 New York, NY Council of State Governments Jus4ce Center 1

2 Presenters Faye Taxman, Ph.D. University Professor, Criminology, Law and Society Department and Director, Center for Advancing Correc4onal Excellence, George Mason University Debra A. Pinals, M.D. Assistant Commissioner, Forensic Services, MassachuseJs Department of Mental Health Miguel Avila Proba4on Officer, San Joaquin County, CA Council of State Governments Jus4ce Center 2

3 Learning Objec(ves Determine the difference between criminogenic and non- criminogenic needs Apply the risk- need- responsivity principle to case planning and service delivery Discuss how to u4lize behavioral health screening and assessment tools in coordina4on with criminogenic risk assessments Iden4fy trainings for staff to effec4vely incorporate the risk- need- responsivity and behavioral health principles in their work Council of State Governments Jus4ce Center 3

4 Faye S. Taxman, Ph.D. Amy Murphy, MPP Center for Advancing Correc4onal Excellence Criminology, Law and Society George Mason University Council of State Governments Jus4ce Center 4

5 5 Acknowledgements Bureau of Jus4ce Assistance BJA: DG- BX- K026 BJA: DG- BX- K026; SAMHSA: Ed Banks, Ph.D. Thanks to my team Amy Murphy Stephanie Maass Brandy Blasko Lincoln Sloas Lauren Duhaime Council of State Governments Jus4ce Center 5 5

6 Andrews & Bonta s RNR Model Risk Needs Responsivity Priori(ze Programs Tailor Recidivism Reduc4on Council of State Governments Jus4ce Center 6

7 Housing Social Supports Mental Health What To Do & With Whom? High Risk Moderate Risk Low Risk??? Criminal Thinking Substance Dependence Family/Marital Dysfunction Anti-Social Peers Education??? Employment Co-Occurring Disorders Financial?? Substance Use???? Council of State Governments Jus4ce Center 7

8 RNR Hierarchy of Dynamic Needs Criminogenic Needs Destabilizers/Stabilizers Criminal Thinking Substance Dependence An(social Peers Low Self- Control/Criminal Personality An(social Values Mental Health Substance Abuse Employment Educa(on Housing Family Dysfunc(on Together these dynamic factors influence the ideal level of care under the RNR model 8 Council of State Governments Jus4ce Center 8

9 Side tour: What is Criminal Thinking? Criminal Thinking is thinking that ra4onalizes and jus4fies criminal and illegal behaviors. Important points about Criminal Thinking: Criminal Thinking is not always connected to offending behavior. Not all ra4onaliza4ons and jus4fica4ons are criminal in nature. When people are asked why they did certain things, they usually ajribute the cause of their behavior to what they believe brought about the ac4on. They give a reason for their behavior. This does not mean the person is engaged in Criminal Thinking. It is normal for individuals (prosocial and an4social) to ra4onalize behaviors An individual might call out sick from work without actually being sick, and and ra4onalize their behavior by telling themselves they deserve a day off. Council of State Governments Jus4ce Center 9

10 Criminal Lifestyle A Criminal Lifestyle serves to jus4fy, support, and/or ra4onalize criminal behavior: Criminal Family Members, Criminal Peers and/or Associates, Low Self- Control, Criminal Thinking, and Offender Schemas. Ask ques4ons to determine whose opinions majer and who he/she considers important. These are the most likely people to have an influence on the person and affect behavior. When listening to an offender, dis4nguish between Criminal Thinking and Offender Schemas. an4social values and beliefs associated with an Offender Schema will require more intensive treatment for a longer dura4on. Council of State Governments Jus4ce Center 10

11 GED SUD Proba4on Officer Criminal Thinking Arlotto, Pam. "HITECH's Impact on "Whack-A-Mole" Healthcare. October 16, 2010 Council of State Governments Jus4ce Center 11

12 Challenges to Prioritizing Needs Many clients present with mul4ple dynamic needs- - substance abuse, criminal peers, lack of employment Tempta4on is to address the easier issues, such as comple4ng GED, or place clients in places with available slots Programming for life skills is much less expensive than drug treatment or criminal thinking Client preference may be to focus on job- seeking, etc. 12 Council of State Governments Jus4ce Center 12

13 Decision Rules Points Risk Level Defines likelihood of CJ involvement Functions as a comorbid condition Criminogenic Needs What are the drivers of criminal behavior? What programs exist to address these needs? Clinical Destabilizers What interferes with change? What Comorbid conditions exist? Lifestyle Destabilizers & Stabilizers What recovery environment exists? What protective factors exist? Factors that affect receptiveness to programming Gender Motivation Age Mental Health Literacy Housing stability or food insecurity 13 Council of State Governments Jus4ce Center 13

14 Why Responsivity? Increase mo4va4on to change Increase relevance of programming to the individual Addresses factors that affect progress Humanizes the experience not one size fits all Recognize that programming needs to be relevant and it can be when Gender Age Appropriate Literacy and Cogni4ve Abili4es Mental Health (integrated care) 14 Council of State Governments Jus4ce Center 14

15 Myth: Severity of Substance Use is Not Related to Recidivism Substance dependence vs. substance use/abuse Criminal thinking is less of a driver of recidivism for substance dependent individuals (Caudy, et al., 2014) More criminogenic needs = more need for structure More need for engagement related issues Programs need to be structured to improve recidivism rates Drug(s) of choice majer! Harder drugs vs other substances 15 Council of State Governments Jus4ce Center 15

16 Clarifying the Silver Bullet Myth Substance dependence is equal to criminal lifestyle/thinking errors in terms of affec4ng recidivism Effec4ve programs for substance dependence exist Co- morbid criminal thinking may be addressed through posi4ve reinforcers to shape decisions Risk level and unmet criminogenic needs should drive who receives programming Priori4ze high- need (both criminogenic and noncriminogenic) people for programming to improve supervision performance Risk level can drive supervision level, but type/severity of criminogenic need(s) should drive programming 16 Council of State Governments Jus4ce Center 16

17 What s wrong with that approach? Determine what is driving the criminal behavior and address those drivers Employment and educa4on are not directly 4ed to repeated criminal behavior Clients with more serious needs like SUD and homelessness may not engage in voca4onal classes or hold a job, without addressing stability needs first Knowing the destabilizers can help determine intensity and addi4onal supports needed 17 Council of State Governments Jus4ce Center 17

18 Myth: Low-Risk Offenders Don t Need any Services Fact: An offender s risk level is INDEPENDENT of their needs Risk level is some4mes a factor of age Even low risk offenders can have high needs (i.e. SUD, MH) An offender s needs may some4mes override their risk level, par4cularly substance abuse Example: Low- risk offender with cocaine dependence 18 Council of State Governments Jus4ce Center 18

19 Myth: All High-Risk Offenders are Criminal Thinkers Risk level is a func4on of number of 4mes in the jus4ce system High- risk offenders tend to have more needs, and tend to be more entangled in criminal lifestyle But some4mes they can be SUD, and therefore this needs to be assessed 19 Council of State Governments Jus4ce Center 19

20 Myth: Non-Criminogenic Needs are Not Important Fact: Non- Criminogenic needs act as destabilizers and can impact how well a person responds to treatment and supervision Evidence is mixed regarding the impact of needs such as educa4on and employment Not the star of the case plan, but should play a suppor4ng role Match to treatment based on criminogenic needs, then refer to services to build stabilizers 20 Council of State Governments Jus4ce Center 20

21 Hierarchy of Dynamic Needs Criminogenic Needs Destabilizers/Stabilizers Criminal Thinking Substance Dependence An(social Peers Low Self- Control/Criminal Personality An(social Values Mental Health Substance Abuse Employment Educa(on Housing Family Dysfunc(on Together these dynamic factors influence the ideal level of care under the RNR model 21 Council of State Governments Jus4ce Center 21

22 Program Groups Six program groups based on specific target behaviors RISK Levels Needs Stabilizing Factors 22 Council of State Governments Jus4ce Center 22

23 PROGRAM GROUP MECHANISM OF ACTION RESEARCH EVIDENCE 23 Group A Severe Substance Use/Dependence Group B Criminal Thinking Group C Self- Improvement and Management (abuse) Group D Social and Interpersonal Skills Treatments to reduce use of heroin, cocaine, amphetamines, and methamphetamine Cogni4ve restructuring to change maladap4ve thinking and behavior pajerns Developing social and problem solving skills to address MH, SA, and self- control. Structured counseling and modeling of behavior to reduce interpersonal conflict and develop more posi4ve interac4ons. Holloway, BenneJ, & Farrington, 2006; Prendergast, Huang, & Hser, 2008; Prendergast, Podus, Chang & Urada, 2002; Lipton, Pearson, Cleland & Yee, 2008; Mitchell, Wilson & MacKenzie, 2007 Andrews & Bonta, 2010; Lipsey, Landenberger & Wilson, 2007; Wilson, Bouffard & MacKenzie, 2005; LiJle, 2005; Tong & Farrington, 2006 & 2008 Botvin & Wills, 1984; Botvin, Griffin, & Nichols, 2006; Mar4n, Dorken, Wamboldt & WooJen, 2011 Botvin & Wills, 1984; Beckmeyer, 2006; Wilson, Gallagher & MacKenzie, 2000; Visher, Winterfield & Coggeshall, 2005 Group E Life Skills Stabilize educa4on, housing, employment, and financial Andrews & Bonta, 2010; Beckmeyer, 2006 Council of State Governments Jus4ce Center 23

24 The most serious criminogenic need should be addressed first Program Group A Program Group B Program Group C Program Group D Severe Substance Use Disorder Criminal Thinking/Cogni4ve Restructuring Self- Improvement & Self- Management (Abuse, MH) Social and Interpersonal Skills Program Group E Life Skills Program Group F Punishment Council of State Governments Jus4ce Center 24

25 Step Up/Down Depending on Responsivity Factors Program Group A Severe Substance Use Disorder Program Group B Program Group C Criminal Thinking/Cogni4ve Restructuring Self- Improvement & Self- Management (Abuse, MH) Program Group D Social and Interpersonal Skills Program Group E Life Skills Program Group F Punishment Council of State Governments Jus4ce Center 25

26 Intensify Dosage & Program Structure from Key Lifestyle Issues ü Anti-social Peers ü Social Support/Lack of Social Supports ü Housing Instability Education Level Employment Status Mental Health Financial Issues Program Intensity Council of State Governments Jus4ce Center 26

27 No Whack a Mole: Decision Rules Severe Substance Use Disorder? u Always Group A! Criminal Thinking? u Schemas, regardless of risk Always Group B u Criminal Thinking (elevate), moderate to high risk, destabilizers Group B Intensity Programming with.. u Housing Instability u Lack social supports (prosocial) u Criminal Schemas Council of State Governments Jus4ce Center 27

28 28 Council of State Governments Jus4ce Center 28

29 Does your system have the correct programs for the offenders Iden4fies gaps and surpluses of programming U4lizes The RNR Program Tool 29 Guides resource alloca4on and system planning BeJer alignment of services to popula4on needs Facilitates selec4on of providers Focus on system- wide change Council of State Governments Jus4ce Center 29

30 30 Group A Group B Group C Group D Group E Group F Council of State Governments Jus4ce Center 30

31 APD Estimated Responsivity 31 Gap Greatest unfulfilled needs are cogni4ve restructuring programs, mental health, co- occurring disorders, and substance abuse Council of State Governments Jus4ce Center 31

32 Sequencing of Needs for Comorbid Clients Core+MH +Social Skills Core+MH Core (high) Core(med) Criml Thinking SUD 32 Council of State Governments Jus4ce Center 32

33 DOC Population Needs & Recidivism Rates (n=2844) 30% 25% 20% 15% 10% 5% 0% High Dosage Moderate Dosage 33 Council of State Governments Jus4ce Center 33

34 Probation Population Needs & Recidivism Rates (n=1000) 25% 20% 15% 10% 5% 0% High Dosage Moderate Dosage 34 Council of State Governments Jus4ce Center 34

35 35 Council of State Governments Jus4ce Center 35

36 36 Responding to Risk and Needs How well do the programs adhere to EBPs? How well does my system address risk- needs of offenders? What type of risk/needs does a par4cular Person need? Council of State Governments Jus4ce Center 36

37 Council of State Governments Jus4ce Center 37

38 Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking- Integrated Re-entry and Peer Support (MISSION-I-RAPS) Debra A. Pinals, M.D. Assistant Commissioner Forensic Services MassachuseJs Department of Mental Health David Smelson, Psy.D. Stephanie Hartwell, Ph.D. Lena Campana, M.A. Jay Byron, M.A. Ayorkor Gaba, Psy.D. Grant # RW- BX- 0003: Funded By the Department of Jus(ce Second Chance Act Targe(ng Offenders with Co- Occurring Substance use and Mental Health ProBlems- - Awarded to the MassachuseVs Department of Mental Health in collabora(on with Depts of Correc(on and Public Health, Umass Medical School, Umass Boston, MassachuseVs Proba(on, Parole, MassHealth, and Span, Inc. Council of State Governments Jus4ce Center 38

39 MISSION Criminal Justice Edition: Understanding the Criminal Justice Sequential Intercept Framework Clinical Evaluation and Treatment of Substance Use 39 Council of State Governments Jus4ce Center 39

40 Criminogenic Risk Factors: The Risk- Need- Responsivity Paradigm and Sup Risk Factor History of an4social behavior An4social personality pajern An4social cogni4on An4social aytudes Family and/or marital discord Poor school and/or work performance Few leisure or recrea4on ac4vi4es Substance abuse Adapted from Council of State Governments Jus4ce Center Source: Andrews (2006) 40 Council of State Governments Jus4ce Center 40

41 MISSION is TRAUMA INFORMED Adverse Childhood Events Data for Youth Referred to Massachusetts Juvenile Court Clinics Six Month Data 10/2/12-3/31/13 Findings: CDC Study of General Popula(on Median Score 1 5 JCC Referred Youth (ACES data scores 1-10) 63% had scores of 4 or more (compared with 12.5% in the CDC sample) Short and long- term outcomes: health and social difficul4es (Source: MassachuseJs Alliance of Juvenile Court Clinics data report 2013) Council of State Governments Jus4ce Center 41

42 Creating Cross-System Collaboration What Works in Substance Abuse Treatment What Works in Mental Health Treatment MISSION CJ Framework What Works in Recidivism Reduc4on Council of State Governments Jus4ce 42 Center; Osher 2013 Council of State Governments Jus4ce Center 42

43 MISSION: Criminal Justice Edition Systems Level (Sequen(al Intercept Model) Reduce penetra(on of persons with mental illness into CJ system/reduce recidivism Iden4fy and Link individuals to community- based mental health treatment Improve mental health outcomes Improve public safety Assessment Level (RNR) Match level of treatment to the level of risk to re- offend Iden4fy criminogenic needs and use these to inform treatment Maximize engagement by understanding responsivity of the individual to treatment interven4ons and the ability of providers to address the risk factors iden4fied Interven(on/Person Level (MISSION- CJ) Provide direct treatment Addi4onal focus on criminogenic services to address co- occurring needs and responsivity to reduce disorders with trauma- informed recidivism approaches that support recovery Promote stable and successful living with posi4ve daily ac4vi4es and health and wellness, with explicit ajen4on to the addi4onal goal of decreased recidivism Coordinate care, access to housing, employment supports and other services as needed Council of State Governments Jus4ce Center 43

44 MISSION- CJ: Overview of the Treatment Model Goal (s): Provide wraparound support for mental health and substance use Help clients avoid further arrests and reincarcera4on Engagement Strategies: Asser4ve Community Outreach (Peer and Case Manager/Reentry service specialist) Skills development Care Coordina(on with Reentry Services: Facilitate treatment plans Case Manager/Peer link to court 44 Council of State Governments Jus4ce Center 44

45 MISSION- CJ Model Combining evidence- based services into a comprehensive system of care Core Services Cri(cal Time Interven(on (CTI) Dual Recovery Therapy (DRT) Risk- Need- Responsivity (RNR) Support Services Voca(onal and Educa(onal Support Trauma Informed Care Peer Support 45 Council of State Governments Jus4ce Center 45

46 Housing Educa4onal and Voca4onal Support Case Management and Peer Support Benefits General Medical Care Mental Health Services Substance Abuse Treatment Criminal Jus4ce Council of State Governments Jus4ce Center 46

47 MISSION Key Clinical/Social Outcomes Increase community tenure Reduce re- hospitaliza4ons Improve psychiatric and substance abuse outcomes Increase the number of days employed and wages earned - Smelson, et al. (2005). Preliminary outcomes from a community linkage interven4on for individuals with co- occurring substance abuse and serious mental illness. Journal of Dual Diagnosis, 3(1), Smelson, et al, (2007). Six month outcomes from a booster case management program for individuals with a co- occurring substance abuse and a persistent psychiatric disorder. European Journal of Psychiatry, 21, Smelson, et al, (2012). A Brief Treatment Engagement Interven4on for Individuals with Co- occurring Mental Illness and Substance Use Disorders: Results of a Randomized Clinical Trial. Community Mental Health Journal, 48(2), Smelson, et al, (2013). A Wraparound Treatment Engagement Interven4on for Homeless Veterans with Co- occurring Disorders. Psychological Services, 10(2), Council of State Governments Jus4ce Center 47

48 Model Development ( ) PI David Smelson Supported by VA OPCS/VISN 3 MIRECC Brief 2- month Interven(on ( ) PI David Smelson Supported by VA HSR&D MISSION NJ ( ) PI David Smelson Supported by SAMHSA MISSION- VET Model Development (2010) PI David Smelson Supported by VA ORD/HSR&D/ Na4onal Center for Homeless Veterans SAMPLE PRIOR MISSION PROJECTS Components: Model Development, Pilot Tes4ng SeBng: Acute psychiatry/inpa4ent treatment program Components: Cri4cal Time Interven4on (CTI), Dual Recovery Therapy (DRT), and Peer Support. SeBng: Acute psychiatry/inpa4ent treatment program Components: CTI, DRT, Peer Support, and Voca4onal Support; Treatment Length: 12 months SeBng: Residen4al treatment program Components: CTI, DRT, Peer Support, Voca4onal/Educa4onal Supports, and Trauma- Informed Care Considera4ons Treatment Length: 2 months, 6 months, or 12 months SeBng: Inpa4ent treatment program, residen4al treatment program, or once placed in housing MISSION CREW ( ) PI Debra Pinals Supported by the Bureau of Jus4ce Assistance (BJA) MISSION Jail Diversion Project ( ) PI Debra Pinals Supported by SAMHSA- CMHS. Components: Dual Recovery Therapy, Cri4cal Time Interven4on, and Voca4onal Support with trauma- sensi4ve contribu4ons; Treatment Length: 3 months pre- release and 6 months post- release Target PopulaHon: female offenders with co- occurring substance abuse and mental health disorders who commijed a non- violent offense Treatment Length: 12 months (treatment begins a]er adjudica4on) Target PopulaHon: returning OIF/OEF Dually Diagnosed Veterans with a Trauma History who have been diverted from jail and selected by judge to receive treatment rather than serve jail 4me HUD- VASH Randomized Controlled Trial ( ) PI David Smelson Supported by VA Na4onal Center for Homeless Veterans MISSION- Vet Implementa(on Study ( ) PI David Smelson Supported by VA ORD/HSR&D/Na4onal Center on Homelessness Among Veterans MASS- MISSION: Ending Chronic Homelessness in Central and Western MA( ) PI David Smelson Supported by SAMHSA- CABHI MISSION IRAPS ( ) PI Debra Pinals Supported by the DOJ Second Chance Act CURRENT MISSION PROJECTS Components: In addi4on to standard HUD- VASH Case Management, for 6 months, par4cipa4ng Veterans will receive either MISSION- VET, Telephone Counseling or symptom monitoring via telephone; Treatment Length: 6 months SeBng: Formerly homeless, dually diagnosed Veterans who have received housing placements through HUD- VA Suppor4ve Housing Program Components: Compare Implementa4on as Usual to Geyng To Outcomes (GTO) to determine the most effec4ve implementa4on strategy for the MISSION- Vet Interven4on within VA Homeless Services SeBng: Formerly homeless, dually diagnosed Veterans who have received housing placements through HUD- VA Suppor4ve Housing Program in Boston, MA, Washington D.C., and Denver, CO. Components: Housing Placement, CTI, DRT, Peer Support, Trauma- Informed Care, Voca4onal and Educa4onal Support Treatment Length: 12 months SeBng: Place chronically homeless individuals in permanent housing and receive case management and peer support services for co- occurring disorders Treatment Length: 3 months pre- release and 6 months post- release Target PopulaHon: medium- and high- risk female and male offenders with co- occurring substance abuse and mental health disorders (may have commijed a violent or non- violent offense) Components: Dual Recovery Therapy, Cri4cal Time Interven4on, Council of and State Voca4onal Governments Support with Jus4ce trauma- sensi4ve Center 48

49 Adapting MISSION to Reentry Services Grant Funding Source Target Popula(on Risk Level MISSION- CREW (Community Reentry for Women) DOJ/JMHCP MO- BX Female Offenders; CODs and Trauma Non- violent MISSION- RAPS (Reentry and Peer Support); DOJ/SCA RW- BX Female Offenders Medium and High Risk MISSION- IRAPS (Integrated Reentry and Peer Support); DOJ/SCA RW- BX Male & Female Offenders; CODs and Trauma Medium and High Risk Council of State Governments Jus4ce Center 49

50 MISSION Implementa(on Materials Treatment Manual Participant Workbook Additional Resources: Fidelity Measure Measure that tracks the integration of the complex service structure Consultation conducted during projects 50 Council of State Governments Jus4ce Center 50

51 Iden(fy Eligible Inmates Rule out out- of- area releases and others who don t fulfill eligibility criteria 45 days to 6 months prior to release MISSION IRAPS (M- IRAPS) FLOW CHART Approach Inmate Re: Interest in Program Arrange Screening if interested in Program DOC staff member obtains release to send research team informa4on 45 Days to 6 Months Prior to Release M- RAPS Eligibility Screening 45 Days to 6 Months prior to release M- RAPS Services Commence RSS* and PSS** meet with inmate in pre- release groups (1 month prior to release) Individual Released from DOC facility Evalua(on Referral RSS sends RA contact informa4on Evalua(on Consent Evalua4on team consents interested par4cipants to evalua4on, second release obtained (for Span records) Up to 1 week from par4cipants ini4al mee4ng with RA Baseline Assessment Conducted at same 4me period as evalua4on consent, if possible; otherwise, rescheduled for a later date/4me (Only for those Consen4ng to Evalua4on) M- RAPS Services Con4nues upon release and is ongoing for 4-5 months 6th Month Follow Up Assessment (Only for those consen4ng to Evalua4on) Addi(onal follow- up data collec(on (Only for those consen4ng to Evalua4on) Up to a year and a half a]er follow- up assessment *RSS = Re- entry Services Specialist or M- RAPS Clinical Case Manager **PSS = Peer Services Specialist or M- RAPS Peer Support Specialist Council of State Governments Jus4ce Center 51

52 Criminogenic Risks Needs Poten(al Approaches/Enhance Responsivity An4social Behaviors Reduce an4social acts Educa4on, frequent contact with case manager/ peer, strong communica4on between provider and proba4on/parole An4social Personality PaJerns An4social Cogni4ons An4social Peers Decrease impulsivity, irritability, irresponsibility, help coping, problem- solving Decrease an4social cogni4ons, risk thinking Decrease associa4on with other criminals, enhance prosocial contacts Family/marital rela4onships Improve rela4onships with family and significant others when possible Employment/Educa4on CRIMINOGENIC RISKS, NEEDS AND SAMPLE TREATMENT PLANNING Assist in enhancing employment/ academic skills and achieving goals Stress management exercises, problem- solving exercises, trauma informed care (TIC) Referral to EBPs such as MRT, Thinking for a Change, etc. Peer supports, ac4vi4es that allow for prosocial associa4ons (e.g. volunteering, community service), fostering hope and posi4ve connec4ons Treat symptoms of mental illness, Help examine broken 4es and how to rebuild, TIC, factor in criminal issues (e.g., DV) Iden4fy housing, treat mental illness, Voca4onal skills linkages, employment supports, rewards for posi4ve achievement Leisure and recrea4on Increase 4me in prosocial ac4vi4es Iden4fy schedules, ac4vi4es, community service Substance abuse Decrease substance use, enhance mo4va4on for change Ac4ve treatment (not just detox), monitoring as needed, plan for relapses, treat co- occurring mental illness Council of State Governments Jus4ce Center 52

53 Recovery a process of change through which individuals improve their health and wellness, live a selfdirected life, and strive to reach their full potential (SAMHSA 2014) E.G., Symptom ResoluNon, Sobriety, Reduced Recidivism, Social Connectedness, Employment, EducaNon, Independent Living, Self- Reliance 53 Council of State Governments Jus4ce Center 53

54 Guidance on Treatment Needs (specialized PTSD) How to Coordinate Care with PTSD Service Discharge Planning Clinical Tools for Trauma Symptoms Develop plan for increased safety Establish both perceived and real trust Provide psychoeduca4on about trauma and substance abuse Teach coping skills to control trauma symptoms Najavits & CoRler (In Press) 54 Council of State Governments Jus4ce Center 54

55 Age IRAPS Evaluation: Baseline Demographics (N=31) Educa(onal AVainment Race/Ethnicity Marital Status Council of State Governments Jus4ce Center 55

56 Baseline Data for MISSION IRAPS Clients (N=31) Average number of life4me arrests =21 Average Drug use in past 30 days= Years of substance use in the histories Compas scores show anger/hos4lity, rela4onship dysfunc4on, and criminal thinking among other pajerns Council of State Governments Jus4ce Center 56

57 IRAPS, RAPS, and CREW Sample: Baseline 62-75% have chronic medical problems which con4nue to interfere with life 55-74% have been troubled by psychological or emo4onal problems in past 30 days 45-80% repor4ng trauma4c symptoms and/or trauma exposure to par4cular events, o]en both recently and before age 18 Council of State Governments Jus4ce Center 57

58 RAPS Significant Findings From Baseline to 6 Month Managing Day to Day Life (.004) Coping with Problems in Life (.048) Less Trauma Witnessing serious injury, death, or physical/sexual assault (.000) Physical Violence (.004) Sexual Violence (.000) Having Problems from Drinking or Drug Use (.016) Past 30 days Alcohol Use (.000) Methadone Use (.000) Cannabis Use (.000) Council of State Governments Jus4ce Center 58

59 RAPS Clinical/Social Initial Outcome Evaluation Baseline Geyng along well with family most of the 4me (28%) Have someone to turn to for help all of the 4me (37%) 6 Month Geyng along well with family most of the 4me (50%) Have someone to turn to for help all of the 4me (50%) Council of State Governments Jus4ce Center 59

60 Conclusions Popula4on with complex need, but poten4ally improved outcomes Criminogenic Psychosocial Trauma Drug Use Early recidivism data shows variable re- arrest but likely reduced reincarcera4on. Majority of par4cipants successfully complete 6 month post- release services. Parole/Proba4on intensive surveillance because of program enrollment, possibly higher likelihood to violate. MISSION- CJ holds promise Helps behavioral health providers work more closely with criminal jus4ce en44es Ongoing learning lessons con4nue Council of State Governments Jus4ce Center 60

61 TYGR Transi4on- age Youth Grounds for Recovery Council of State Governments Jus4ce Center 61

62 TYGR Overview A collabora4ve program between the San Joaquin County Sheriff s Department, San Joaquin County Behavioral Health Services and San Joaquin County Proba4on The program provides pre and post release services to young adults with co- occuring disorders sentences to at least 120 days and a 3-5 year formal proba4on grant Council of State Governments Jus4ce Center 62

63 TYGR (Phase 1) Program is currently voluntary for all offenders Offender starts program while in custody a]er sentencing Offenders receive evidence based screening and assessments K6 mental health screening tool Criminogenic risk assessment (STRONG) Council of State Governments Jus4ce Center 63

64 TYGR (Phase 2) Intensive family based re- entry transi4on planning and cogni4ve behavioral therapy while in custody Offenders par4cipate in and complete Seeking Safety and CBI for substance abuse AJempt to get buy in from offenders family to establish a solid founda4on upon release 9-12 month program dura4on Council of State Governments Jus4ce Center 64

65 TYGR Correction Officer Capacity Building All Correc4on officers who work with TYGR clients are specially trained in Mo4va4onal Interviewing K6 screen for mental health disorders Crisis Interven4on Training (CIT) for law enforcement An all staff adapta4on to understand Seeking Safety as an evidence based approach Council of State Governments Jus4ce Center 65

66 TYGR Clinician TYGR has a dedicated clinician trained in duel disorders to conduct assessments Will facilitate groups both in custody and out of custody to build raport Previously only one clinician was available for the en4re jail facility Council of State Governments Jus4ce Center 66

67 TYGR Probation Officer One dedicated officer to the TYGR program who is also trained in Mo4va4onal Interviewing Evidence Based theory Crisis Interven4on Training (CIT) for law enforcement Council of State Governments Jus4ce Center 67

68 TYGR Treatment/Case Plan Collaboration The dedicated TYGR Clinician and Proba4on Officer will conduct the assessments of the individual offender as a team - STRONG Assessment - Addic4on Severity Index - Mental Health Services Adult Assessment This is done so that both staff have the same informa4on from the offender, it allows for bejer collabora4on and treatment integra4on Council of State Governments Jus4ce Center 68

69 TYGR Treatment/Case Plan Collaboration BHS treatment and Proba4on case plans do not always align - The targeted interven4ons may be different due to the difference in what the agencies are targe4ng (re- offend vs MH treatment) Due to this all technical viola4ons of proba4on are discussed with the TYGR clinician and a decisions and recommenda4ons are made as a team. Council of State Governments Jus4ce Center 69

70 TYGR Treatment/Case Plan Collaboration In dealing with these offenders it is important to understand that some of the decisions that the offender makes may not necessarily be controlled by them Due to MH status Drug induced psychosis which is a result of self medica4ng. Council of State Governments Jus4ce Center 70

71 TYGR Treatment/Case Plan Collaboration It is integral that both the Clinician and the Proba4on officer work in close collabora4on for the bejer of the offender. Geyng as much informa4on as possible from both the Proba4on and BHS side are integral and will allow both staff to target the treatment goals and case plan goals simultaneously Council of State Governments Jus4ce Center 71

72 TYGR Results During the first grant the program was able to reduce recidivism on this target popula4on by approximately 70 percent 6 months a]er comple4ng the program (pending latest numbers regarding recidivism a]er 2 years) Incidents against staff in the correc4onal ins4tu4on were reduced by 80 percent Has helped Correc4ons administra4on provide MI to all its officers in the ins4tu4on Council of State Governments Jus4ce Center 72

73 Thank You Join our distribu4on list to receive CSG Jus4ce Center project updates! The presentation was developed by members of the Council of State Governments Justice Center staff. The statements made reflect the views of the authors, and should not be considered the official position of the Justice Center, the members of the Council of State Governments, or the funding agency supporting the work. Citations available for statistics presented in preceding slides available on CSG Justice Center web site. Council of State Governments Jus4ce Center 73