Special Report: Lessons Learned from Cross Systems Mappings in Pennsylvania Counties November 20, 2015

Transcription

1 DREXEL UNIVERSITY & UNIVERSITY OF PITTSBURGH Special Report: Lessons Learned from Cross Systems Mappings in Pennsylvania Counties November 20, 2015 Transforming Services for Persons with Mental Illness in Contact with the Criminal Justice System

2 PA Mental Health and Justice Center of Excellence Special Report November 20, 2015 Co-Directors Kirk Heilbrun, PhD Department of Psychology Drexel University Edward P. Mulvey, PhD Western Psychiatric Institute and Clinic University of Pittsburgh School of Medicine Senior Consultants David DeMatteo, JD, PhD Patricia Griffin, PhD Carol Schubert, MPH Center of Excellence Staff Shelby Arnold, BA Sarah Filone, MA Casey LaDuke, MS Sarah Phillips, BA Katy Winckworth-Prejsnar, MPH 2

3 PA Mental Health and Justice Center of Excellence Special Report November 20, 2015 Table of Contents Transforming Services for Persons with Mental Illness in Contact With the Criminal Justice System Executive Summary... 5 Background... 7 About the Workshops... 7 Method... 8 Common gaps, trends, and promising practices in Pennsylvania Intercept I: Law Enforcement / Emergency Services Intercept I: Common Gaps/ Barriers Common and Promising Emergency Dispatch Practices Common and Promising Law Enforcement Practices Common and Promising Crisis Services Common and Promising Detoxification Services Common and Promising Acute Psychiatric Stabilization Practices Other Promising Intercept I Initiatives Intercept II: Initial Detention / Initial Court Hearing Intercept II: Common Gaps/ Barriers Common and Promising Initial Detention Practices Common and Promising Preliminary Arraignment/Hearing Practices MDJ Training Initiatives Common and Promising Pre-trial Services/Diversionary Practices Intercept III: Jails / Courts Intercept III: Common Gaps/ Barriers Common and Promising Problem Solving Court Initiatives Common and Promising Jail Mental Health Screen Practices Common and Promising Jail-Based Treatment Practices Intercept III Workgroup Initiatives Intercept IV: Re-Entry

4 PA Mental Health and Justice Center of Excellence Special Report November 20, 2015 Intercept IV: Common Gaps/ Barriers Common and Promising Community Re-entry Initiatives Intercept V: Community Corrections / Community Support Intercept V: Common Gaps/ Barriers Common and Promising Probation and Parole Practices Common and Promising Housing Initiatives Common and Promising Peer Support Programs Common and Promising Vocational Services Common and Promising Behavioral Health and Community Services Summary of Common Priorities Follow-Up Technical Assistance Mappings Measuring Mapping Impact: Three Levels of Evaluation Recent Response from Northhampton County Summary and Conclusions

5 PA Mental Health and Justice Center of Excellence Special Report November 20, 2015 Special Report: Current Trends and Promising Practices in Diversion Programming across Pennsylvania Executive Summary Cross-System Mapping (CSM) workshops are a powerful tool for understanding the gaps, resources, and opportunities related to diverting justice-involved individuals with behavioral health problems from the standard arrest-incarceration-reentry process. The CSM process involves having a large group of stakeholders in a county come together for a structured 1.5-day guided discussion-and-prioritization exercise. This report describes the lessons learned from the use of these mapping workshops by the Pennsylvania Mental Health and Justice Center of Excellence (CoE) with 39 counties in Pennsylvania and the remapping of another 6 (another 4 Pennsylvania counties were mapped by Policy Research Associates prior to 2010). The first important lesson comes from looking at three data sources (participant ratings at the time of the workshop, a follow-up written survey 6 months after CSM completion, and a followup telephone interview about 9 months afterwards). These data sources indicate that the workshops substantially improved participants communication awareness of gaps/resources/opportunities networking and collaboration working with CJABs implementation of specific and helpful changes (e.g., using a screening tool for veterans, information-sharing between agencies) development of a shared vision for diversion and rehabilitation of justice-involved individuals with behavioral health problems building or strengthening structures for maintaining changes begun during CSM, and sustaining interest of key stakeholders. Moreover, nearly all counties identified specific changes in policy or practice that are a direct outgrowth of the priorities and action steps established during the workshop. Participants from various service sectors were involved in these mappings, conducted from Representation from mental health, criminal justice substance abuse, social services, housing, and consumers created this opportunity. Experienced guidance helped counties make the most of it. It is challenging to distill the other lessons learned from CSMs into something that could be generalized across all Pennsylvania counties. The single greatest challenge to implementing CSM-developed plans is limited funding. But there is variation across counties in the gaps/ opportunities they encounter and diversity in resources available to address them. What works in one county may not work in another. Our goal in this report is to identify the gaps that have emerged most frequently at each step of the sequential intercept model and to highlight promising practices that might be examples for other counties to model. We focus on themes that have emerged rather than a prescriptive list of actions to take or policies to implement. 5

6 PA Mental Health and Justice Center of Excellence Special Report November 20, 2015 The Pennsylvania counties that participated in the cross-systems mapping workshops identified barriers and opportunities for improvement at each intercept. The most commonly cited gaps at intercept one: lack of specialized training for crisis responders (e.g., dispatchers, law enforcement, and emergency medical staff); inadequate crisis response services; and a lack of access to detoxification services. The most commonly cited gaps at intercept two: lack of specialized diversion programming at jails and booking; a lack of pre-trial services to aid in legal decision making; and a general lack of training for criminal justice officials involved in initial detention and court hearing. At intercept three, the most commonly identified gaps were lack of cross-system communication and cooperation; lack of adequate mental health and substance abuse services within their local jails; and lack of specialty diversion options. The most commonly identified barriers to re-entry at intercept four: significant time between release and their first psychiatric appointment; poor discharge planning in general, but particularly regarding medications/prescriptions; trouble accessing medical assistance for individuals leaving the justice system; and a lack of housing. At intercept five, the most common issues were lack of adequate housing options for individuals with behavioral health and justice involvement in the community; overburdened parole and probation officers; barriers to employment opportunities and vocational training; and issues with transportation. These gaps notwithstanding, Pennsylvania counties were often able to develop and implement innovative and exemplary initiatives to address them. Such initiatives include crisis responder training programs, hospital-based detoxification protocols, interdisciplinary work groups, pretrial diversion programming, problem-solving court programs, medication continuity re-entry initiatives, proactive Medical Assistance application programs, and housing initiatives such as master leasing programs. This report provides information related to remaining barriers in Pennsylvania, highlights several unique and promising practices, and facilitates continued growth of similar programming throughout the Commonwealth. 6

7 PA Mental Health and Justice Center of Excellence Special Report November 20, 2015 Background The Pennsylvania Mental Health and Justice Center of Excellence (CoE) began in 2010 with grant funding from the Pennsylvania Commission on Crime and Delinquency and the Pennsylvania Department of Public Welfare s 1 Office of Mental Health and Substance Abuse Services. Since its inception, the CoE has been a collaborative effort involving Drexel University, the University of Pittsburgh Medical Center, and the Pennsylvania Mental Health and Justice Advisory Committee, which provides CoE oversight, along with PCCD and OMHSAS more broadly. The mission of the CoE is to assist Pennsylvania communities in diverting appropriate individuals with mental illness from standard prosecution, incarceration, and reentry, instead providing tools for planning for rehabilitation-oriented alternatives. The CoE offers information review, technical assistance, training and consultation to implement this mission. As part of this mission, the Center of Excellence conducts Cross-Systems Mapping workshops in communities throughout Pennsylvania. As of September 2015, the Pennsylvania Mental Health and Justice Center of Excellence has mapped 39 of the Commonwealth s 67 counties; an additional four counties were mapped by the GAINS Center prior to the CoE. This means that 43 of 67 Pennsylvania counties (64%) have participated in a cross-systems mapping workshop. Additionally, 6 follow-up technical assistance mappings have been conducted. This report documents the data gathered at each of the workshops and provides aggregate information regarding the current trends, gaps, and opportunities observed in communities throughout the commonwealth. In this way, this report offers a formal review of lessons learned from Cross-Systems Mappings in the Commonwealth. About the Workshops The CoE-conducted workshops, Cross-System Mapping and Taking Action for Change, are tailored to each Pennsylvania community. These workshops are based on the Sequential Intercept Model developed by Mark Munetz, M.D., and Patty Griffin, Ph.D., 2 in conjunction with the National GAINS Center. In these workshops, county participants were guided to identify gaps in services, resources, and opportunities at each of the five distinct intercept points. Gaps and opportunities were identified through brainstorming during the workshop; they include a broad range of input from workshop participants. These workshops thus provide an opportunity for participants to visualize how mental health, substance abuse, and other human services intersect with the criminal justice system. The CoE workshops have three primary objectives: 1. Development of a comprehensive picture of how people with mental illness and co-occurring substance use disorders move through the county s justice system along five distinct intercept points: Law Enforcement and Emergency Services, Initial Detention/Initial Court Hearings, Jails and Courts, Re-entry, and Community Corrections/Community Support. 2. Identification of gaps, resources, and opportunities at each intercept for individuals in the target population. 1 The Department of Public Welfare is now the Department of Human Services in Pennsylvania. 2 Munetz, M. & Griffin, P. (2006). A systemic approach to the de-criminalization of people with serious mental illness: The Sequential Intercept Model. Psychiatric Services, 57,

8 PA Mental Health and Justice Center of Excellence Special Report November 20, Development of priorities for activities designed to improve system and service level responses for individuals in the target population. The gaps and opportunities identified during the mapping process reflect a variety of stakeholder opinions but not necessarily a majority consensus. Upon completion of the workshops, the information shared during the workshops was organized into a Cross-System Report by Center of Excellence staff. This Report was reviewed and edited by representatives of each county, and final Reports were distributed throughout the county to relevant criminal justice and behavioral stakeholders and service providers. With the permission of mapped counties, Cross-System Reports are also posted on the Center of Excellence website: Current Review Between October and September 2015, Center of Excellence staff systematically reviewed the 42 available Cross-System Reports (see below for a list of included counties) 3 to identify trends across the counties that had participated in the Cross-System Mapping and Taking Action for Change workshops. A database was developed to quantify and analyze the gaps and opportunities reported in each Cross-System Report; gaps and opportunities were reviewed and integrated to create broad themes rather than county-specific needs and benefits. A second database was developed to identify common practices across counties, as well as countyspecific promising practices. The information derived from this systematic review is presented in this report. Trends in the challenges to effective diversion across counties are presented thematically by intercept, along with common and promising practices from Pennsylvania communities. The report provides an overview of frequently-identified gaps, common practices, and promising programs throughout Pennsylvania. Considerations cited by more than 10% of the counties (3+) during their mapping workshop are included. The practices presented provide models for criminal justice and behavioral health stakeholders across the commonwealth in their efforts to develop and implement diversion strategies for justice-involved individuals with mental illness. The 42 counties (and workshop dates) covered by the report are as follows: 1. Armstrong (February 2012) 2. Blair (June 2011) 3. Bucks (September 2010) 4. Butler (February 2012) 5. Cameron (October 2014) 6. Carbon (October 2011) 7. Chester (June 2010) 8. Centre (April 2015) 9. Clarion (August 2011) 10. Clearfield (January 2011) 11. Columbia (November 2014) 12. Cumberland (Sept 2014) 13. Delaware (May 2010) 14. Elk (October 2014) 15. Erie (June 2012) 16. Fayette (December 2010) 17. Franklin (April 2009 and June 2012) 18. Greene (March 2012) 19. Indiana (March 2011) 20. Jefferson (August 2010) 21. Lackawanna (May 2014) 22. Lancaster (June 2009) 23. Lawrence (August 2013) 24. Lebanon (February 2011) 25. Lehigh (August 2015) 26. Luzerne (July 2013) 27. Lycoming (May 2011) 28. McKean (May 2013) 29. Mercer (June 2015) 30. Monroe (July 2011) 8

9 PA Mental Health and Justice Center of Excellence Special Report November 20, Montgomery (October 2008) 32. Northampton (June 2013) 33. Pike (June 2012) 34. Schuylkill (November 2010) 35. Somerset (December 2011) 36. Sullivan (July 2015) 37. Union (March 2014) 38. Warren (November 2013) 39. Washington (May 2012) 40. Westmoreland (May 2010) 41. Wyoming (July 2015) 42. York (September 2011) 9

10 Intercept I: Law Enforcement / Emergency Services Trends Common Gaps/Barriers Intercept 1 Law enforcement A majority of counties cited a lack of specialized training for crisis responders (e.g., dispatchers, law enforcement, and emergency medical staff) in their communities (55% of counties). Many counties reported inadequate crisis response services (50%) particularly a lack of integration of emergency dispatching into crisis responding (45%), and inadequate or difficult to use 911 resources (38%). This gap was compounded in many counties by funding difficulties for emergency dispatching (24%) and law enforcement (26%). Several counties reported limited or no access to warm lines (17%). A large proportion of small and part-time law enforcement units (17%) and a lack of commitment to specialized law enforcement training (21%) were cited as additional barriers in several counties, despite reports of long hospital wait-times for law enforcement officers (29%) and unfamiliarity with involuntary commitment procedures (19%). Many counties reported a lack of community education around mental health topics and resources in general (14%), including what to do in the event of a psychiatric crisis. A majority of counties (76%) also noted lack of access to detoxification services as a significant gap related largely to the existence, availability, and ease of accessing these services. Further, a lack of drug and alcohol treatment services in general was a significant gap in many counties (24%), even considering a high prevalence of drug- and alcohol-related offenses (26%). Many counties noted additional gaps related to area hospitals related to funding difficulties (10%), insufficient beds or space (17%), and difficulty transporting individuals in crisis (17%). A significant number of counties further reported poor communication (43%), understaffing (31%), and lack of data collection (10%) among services involved in Intercept 1 diversion. These services included emergency dispatching, law enforcement, behavioral health crisis services, and emergency medical services. Several counties also described lack of communication from Veterans services and community services (10%). Finally, community resources at Intercept 1 appear to be strained by several special populations, including commuting or transient individuals (21%) and frequent flyers (individuals who frequently rotate through the behavioral health and justice systems: 12%). COMMUNITY 911 Law Enforcement 10

11 Common and Promising Practices Emergency Dispatch Services Many counties indicated that their emergency dispatch services (i.e., local 911) can directly interface with crisis services (50%) including directly connecting the caller to crisis hotlines, or including crisis services into the emergency call. Emergency dispatchers receive specialized training in mental health in several counties (24%). Finally, some counties collect data on their calls into emergency dispatch (29%), including the proportion of calls related to psychiatric crisis, suicide, and other mental health issues. Several exemplary and promising practices in emergency dispatch services include: Chester County (mapped June 2010) Emergency Service call takers contact Valley Creek Crisis Center if the caller is suicidal or indicates a need for mental health crisis services. Local dispatch can also request that Valley Creek Crisis services be involved. If an officer who has been dispatched believes the individual needs mental health crisis support, the officer can request support from Valley Creek Crisis Center directly or via dispatch. Clearfield County (January 2011) When 911 dispatchers receive a medical complaint involving a mental health issue or suicide (coded as psychiatric ), they use a standard set of questions to assess safety issues and the nature of the call. 911 dispatchers may then send law enforcement and EMS to the scene, and may also contact mobile Crisis to request assistance. In these situations, 911 dispatchers call Mobile Crisis using their crisis hotline, discuss the situation, and coordinate with Mobile Crisis to meet with law enforcement on the scene or at a designated hospital. Jefferson County (August 2010) Jefferson County 911 has no direct link to Crisis, but dispatchers call Crisis to follow up with individual callers in need, or with police officers on the scene of a crisis. Lackawanna County (May 2014) Lackawanna County ECC is involved in crisis intervention and diversion programming. The Director of Outreach of Lackawanna County ECC is on the Board of Directors for the Scranton Area Crisis Intervention Team. All Lackawanna County ECC dispatchers have received mental health training from Scranton Counseling Center. Northampton County (June 2013) Northampton Emergency Management has been a partner to the county s Crisis Intervention Team (CIT) initiative and sits on the CIT Advisory Board. Several Emergency Management staff members have completed CIT training. Schuylkill County (November 2010) Schuylkill 911 and the We Help Crisis line are able to transfer calls as needed. Washington County (May 2012) If a call does not require police intervention, 911 call takers can connect the caller to crisis services. This type of transfer occurs about 20 times each year. Westmoreland County (May 2010) In Westmoreland County, there is one countywide dispatch supervised by the Public Safety Department located in the City of Greensburg. 911 Dispatchers have a direct link 11

12 and may contact the 24/7 Crisis Hotline operated by Westmoreland Community Action if there is an individual with a mental health crisis. Law Enforcement The majority of counties (67%) reported that their local law enforcement officers receive some level of specialized training in behavioral health including procedures on transporting individuals experiencing psychiatric crises to emergency services (33%), and in the procedures for involuntary hospitalization (302/202 procedures) (48%). Most counties indicated that this occurred through informal trainings, with fewer counties reporting training through formal CIT training (21%) and part-time CIT training (10%). Several exemplary and promising practices in law enforcement services include: Blair County (June 2011) Screening and assessment procedures to identify people with mental illness and/or cooccurring substance use disorders are conducted by law enforcement at intake and prearrest screening. Law enforcement officers are trained to transport individuals to the ARHS Community Crisis Center, and will initiate involuntary commitment procedures when necessary. Bucks County (September 2010) The Bucks County Crisis Intervention Team (CIT) program was a community partnership consisting of law enforcement officers, Behavioral Health providers (Lenape Valley Foundation and a representative from substance abuse treatment), and mental health consumers and family members through NAMI. All community partners worked together to understand mental illness, invest time and effort to avert crisis, work to de-escalate crisis, and direct the consumer to appropriate care. The program was implemented through Bucks County law enforcement agencies. The objective is to stabilize the crisis and guide the consumer to appropriate care. The Bucks County CIT training was offered in several versions. The full program consisted of a 40-hour training curriculum, including exercises such as Hearing Distressing Voices, a consumer perspectives module, role-playing scenarios, and a veteran s round table consumer component. The first of these trainings was held in September 2009, with a fourth scheduled for November Seventy-nine law enforcement personnel were certified CIT officers in the county. Bucks County CIT also offered two shorter versions of the training a 6-hour Introduction to CIT class, and a 4- hour training for 911 call takers. The 6-hour version focuses on officer and consumer safety and includes an overview of CIT, descriptions of several psychiatric disorders, and a consumer component. Over a 1.5-year period, Bucks County provided the 1-day Introduction to CIT to 350 individuals representing law enforcement, corrections, crisis workers, security personnel, and ambulance crews. In addition, thirty 911 call-takers completed the 4-hour training. Bucks County CIT plans to expand training from the lower portion of the county to Central and Upper Bucks, with a goal of training 20% of all Bucks County law enforcement officers in crisis intervention practices. The Penn Foundation offered behavioral health training to police as requested regarding 302 (involuntary commitment) and 201 (voluntary commitment) procedures. In addition, the Penn Foundation recently participated in a collaborative training on domestic violence for local police departments (in conjunction with A Woman s Place and Ravenhill Psychological Services). 12

13 Centre County (April 2015) Starting in 2009, Centre County began the process of exploring opportunities to bring CIT to Centre County in response to limited collaboration between law enforcement and behavioral health services in the county at that time. By 2010, the county established a team of eight individuals from a variety of agencies to receive CIT training from the Laurel Highlands CIT Program. The team received the training in April Upon returning to Centre County and with the assistance of a grant from PCCD, the team prepared and created the Centre County CIT program. The first training was conducted in January Centre County received financial support through PCCD with a CJAB mini-grant and the support of National Alliance of Mental Illness (NAMI). Centre County hired a CIT Coordinator in March 2011 with the financial support of a PCCD CJAB Initiative Grant and a cash match provided by local agencies. A Centre County CIT Committee meets on a regular ongoing basis. This team oversees the planning and coordination of CIT Trainings and includes representatives from law enforcement, probation/parole, corrections, and first responders. In addition to law enforcement departments, Centre County has provided CIT training to individuals at each stage of criminal justice processing, including: 911, EMT and other emergency responders, mobile crisis, MH/ID/EI-D&A, MDJs, Judges, Centre County Correctional Facility, DOC Rockview staff, Centre County Probation and Parole, and PA State Probation and Parole. Indiana County (March 2011) In September of 2009, Indiana Regional Medical Center and Armstrong County Memorial Hospital hosted a two-day training for law enforcement officers, correctional officers, and court-related personnel on responses to individuals with mental illness in crisis. Prior to this training, a survey was conducted regarding perceptions of levels of comfort and effectiveness while responding to mental health crisis situations. In addition, Indiana County was currently making arrangements to train local police officers on the 40 hour Crisis Intervention Team (CIT) Model. Allegheny County scheduled a special CIT training for May 2011 with 8 spots reserved for Indiana County officers. Funds from a Staunton Farm Foundation grant paid necessary overtime for officers who attended this training. Indiana County planned to continue utilizing CIT training opportunities in Allegheny County, as well as developing county-specific training programs focusing on local resources. Lackawanna County (May 2014) The Scranton Area Crisis Intervention Team (CIT) program began in 2009 and represents a collaborative initiative across criminal justice and mental health systems. Community stakeholders for Scranton Area CIT include Lackawanna County 911, the Chief of Police of the Scranton Police Department, the District Attorney s Office of Lackawanna County, the Lackawanna/Susquehanna Counties MH/MR Program, Keystone Community Resources, Keystone College, community representatives, Scranton Counseling Center, Shiloh Baptist Church, Certified Peer Specialist/Mental Health Advocates, the Advocacy Alliance, the National Alliance on Mental Illness (NAMI PA), Lackawanna County Human Services, and Geisinger Community Medical Center. Scranton Area CIT includes coordination from the criminal justice, behavioral health, and family advocacy agencies, including supporting a Law Enforcement CIT Coordinator, MH CIT Coordinator, and NAMI (Advocacy Community) CIT coordinator. Scranton Area CIT involved a specialized 40-hour training for law enforcement officers on behavioral health to enhance officers ability to assess, de-escalate, and resolve 13

14 situations involving individuals experiencing psychiatric crises. Officers who complete the Scranton Area CIT were trained in alternatives to incarceration for individuals experiencing behavioral health issues, including diversion from standard prosecution where appropriate. Specifically, they were trained to bring such individuals to a local emergency room for crisis evaluation by hospital staff. As of May 2014, there had been six trainings (with over 100 individuals receiving training) through the Scranton Area CIT program. Approximately two-thirds of those trained are law enforcement officers, and CIT targeted part time officers that worked at several jurisdictions. The remainder of trained individuals includes (among others) Sheriff s, State Police officers, probation and parole officers, hospital security officers, university security officers, mental health providers, ambulance crews, 911 dispatchers from Lackawanna County. Lehigh County (August 2015) At the time of the mapping, Lehigh County had conducted two 40-hr Crisis Intervention Team (CIT) trainings, with a total of 35 police officers trained, representing 10 departments in the County. The City of Allentown police department had a total of 20 CIT trained officers. Luzerne County (July 2013) In 2007, the Luzerne Criminal Justice Advisory Board (CJAB) recognized the need for mental health training for law enforcement officials. The board is made up of decision makers from the courts, county government, law enforcement, victim services, human and social service agencies. In response to this need, the CJAB, along with Luzerne- Wyoming Counties MH/DS, sponsored three trainings in September 2007 for law enforcement. The trainings focused on the following areas: recognizing symptoms of mental illness; understanding the involuntary civil commitment process, including crisis protocol and working with the family; understanding mental health laws; and dispelling some common myths and misperceptions about people with mental illness. The training was followed by a panel discussion to address questions from the attendees (State Police, Local Municipal Police Agencies, Adult & Juvenile Probation, State Fish and Game, and County Corrections). Approximately 300 participants were trained in these sessions. Luzerne County took another step toward creating this specialized team by holding a training workshop in March of This training session incorporated the 302/201 process and de-escalation techniques to promote CIT concepts. There was overwhelming support to create a CIT in Luzerne-Wyoming counties after this training. Luzerne County formed a CIT Board to begin the process. They received help from Lackawanna County, which had an existing CIT and agreed to provide instructor training for Luzerne County participants. The Luzerne County CIT Board also wanted to expand the training to all first responders, including Police, Fire, EMS, Ambulance Services, 911, Corrections, Probation and Hospital and College Security Officers. In September 2012, Luzerne County sent 10 individuals to a Scranton CIT 40-hour Train the Trainer to become CIT instructors. The individuals selected to attend by the board were made up from several police agencies, corrections, 911 and social service agencies. The first 40- hr CIT training was held in March 2013, and was completed by 18 individuals from the county. Various news outlets covered the March CIT Training. McKean County (May 2013) The McKean County Law Enforcement Training Series was provided by the District Attorney, and delivered to individual law enforcement agencies and groups of agencies. 14

15 The District Attorney was also willing to advance behavioral health training for law enforcement. Northampton County (June 2013) Northampton County began their Crisis Intervention Team initiative with funding from a Gaming Revenue and Economic Redevelopment Authority grant, holding the first meeting of their CIT Advisory Board in December of The first 3-hour training was held in April 2012 as part of the monthly Police Chief s Meeting at Emergency Management. Since then, there have been eight 6-hour training sessions, one 5 day (40- hour) training, and one condensed 4-hour training in which the entire Sheriff s Department was trained. Twenty-eight individuals graduated from the full 40-hour training. Plans for the next CIT training included an additional module on Acquired Brain Injury (ABI) and expansion of the law enforcement perspective provided by the Lehigh Township Chief of Police. Schuylkill County (November 2010) The Schuylkill County MH/MR and D&A Program sponsored three trainings for law enforcement personnel on the needs of offenders with mental illness. The Schuylkill County District Attorney also provides two days of annual training to the police officers in the county on behavioral health issues. Somerset County (December 2011) Somerset County police officers have access to Crisis Intervention Team (CIT) training through the Laurel Highlands CIT program. CIT trainings are offered once a year. As of December 2011, 18 Somerset County officers had completed CIT training. Washington County (May 2012) Washington County Behavioral Health/Developmental Services had provided two trainings for Washington County officers. In 2008, they delivered the Hearing Distressing Voices workshop in five different locations. This training was successful and representatives from every police department, probation, and state police attended. In 2009, each department received day-long Suicide by Cop workshops as well. Intermittent trainings on 302 vs. 201 proceedings had also been offered. York County (September 2011) Crisis Intervention Team (CIT) training was offered four times in 2010, with a total of 85 officers trained to date. The county s 5 th CIT training was scheduled for November There are several CIT coordinators working across county systems including a Law Enforcement Coordinator, a NAMI Coordinator, and a Mental Health Coordinator. As of April 2011, 55 CIT Data sheets (incident reports) were submitted by law enforcement officers. These reports revealed that consumer age ranged from under 12 to over 60, the majority of the calls were for male consumers (37 males, 18 females), and the most prevalent race was Caucasian (44). The most common reason for a CIT call was suicide/homicide threats and/or attempts (21), followed by welfare checks (13). A total of 41 of the 55 contacts reported prior mental health treatment, and 37 of the 55 had been prescribed medication. Only 5 of 55 consumers were reported to be under the influence of drugs and/or alcohol. Some 44 of the 55 CIT contacts involved no injuries to consumers. During 11 contacts, consumers had received injuries prior to the CIT Officer arriving on the scene. Five involved superficial cuts, one was a self-inflicted gunshot wound, two were medication overdoses, and one involved minor injuries to a neighbor prior to the officer arriving on scene. Only two incidents involved the officer using physical force with no injuries to the officers or to the consumers. No CIT Officer was injured during contacts. 15

16 Crisis Services Every county reported providing crisis hotlines in their community including hotlines supported directly by their public county mental health service provider (45%), and hotlines supported by public and private community service providers (usually contracted through public county mental health service providers) (76%). More than half of the counties mapped also described supporting a warm line staffed by peers (55%). Every county reported providing mobile crisis services in their community, mostly offered on a 24/7 basis (55%). Several mobile crisis services were supported directly by the county s public county mental health service provider (33%), although the majority were supported by additional public and private community service providers (67%). Further, the majority of counties also reported supporting walk-in crisis services (57%). Several exemplary and promising practices in crisis services include: Armstrong County (February 2012) Armstrong-Indiana MH/MR began 24-7 mobile crisis services in July The telephone crisis workers triage the call and dispatch mobile crisis as appropriate. Armstrong and Clarion County residents also have access to the ARC Manor Crisis Hotline. This hotline provides specially trained staff members who are available 24-7 to respond to people in crisis or urgent situations. The hotline is staffed by trained therapists, resident managers, and clerical support staff. During fiscal year 2009/10, 1,355 calls were taken by the crisis staff. Ninety-nine percent of the calls were drug and alcohol related. Blair County (June 2011) Blair County housed CONTACT Altoona, a nationally recognized crisis services model that provides a 24/7 telephone helpline for listening services, reassurance calls, crisis intervention, and information and referral services to the community. Telephones were staffed 365 days a year by trained volunteers prepared to advise and assist people of all ages. All services were free and confidential. In addition, Blair County s hospital-based Altoona Regional Health System (ARHS) had a Mobile Crisis Unit with two full time staff members. The Mobile Crisis Unit was dispatched by the ARHS Community Crisis Center. Blair County residents also had access to Northstar Support Services, which provided services and support to people who were eligible for intellectual disability services living in Blair County. The agency had an on-call staff worker who could be accessed through the ARHS Community Crisis Center. Northstar also distributed a brochure entitled What to do if you are arrested that provides useful information to guide individuals coming into contact with the justice system. Butler County (February 2012) Butler County housed the Grapevine Drop-In Center, which operated a peer-run warmline providing free, confidential support for non-crisis related issues. Carbon County (October 2011) The New Perspectives Crisis Intervention Services, a division of Resources of Human Development (RHD), provided telephone crisis, emergency counseling, and referrals 24/7. o The Mobile Crisis Service provided assessment, crisis intervention counseling, crisis stabilization, referral and linkage with other services, and assessment of 16

17 the need for emergency hospitalization at consumers' homes or at other community locations. This service was available from 9AM to 9PM Monday through Saturday, although involuntary hospitalization assessments were available 24/7. o The Medical Mobile Crisis Intervention Service included a registered nurse and a mental health professional who, in collaboration with a psychiatrist, assessed crises related to consumers' psychiatric medication. It also provided a specialized crisis response for older adults. The team conducted an in-home assessment of the mental, physical, and social needs of older adults, and coordinated linkage to needed services. o The New Perspective Crisis Residence was an eight-bed, short-term residential program for adults in Carbon, Monroe and Pike counties. The program provided supervised mental health stabilization services as an alternative to psychiatric hospitalization for individuals in psychiatric crisis, or needing to be removed from a stressful environment while supports are identified to ensure stability. Chester County (June 2010) Valley Creek Crisis Center (VCCC) was a 24/7 crisis center staffed by master s level clinicians, a nurse, and a peer specialist with access to on-call psychiatry. VCCC could participate in dual calls with a dispatcher and a crisis specialist, and identified individuals needing mental health case management or ACT services in order to contact an ICM or ACT staff member. VCCC mobile teams would also go to local hospital emergency rooms when contacted about a person in crisis. Clearfield County (January 2011) and Jefferson County (August 2010) The Meadows Psychiatric Center provided 24-7 crisis services to Clearfield and Jefferson Counties. Crisis call-takers were able to send Mobile Crisis units operated by The Meadows Psychiatric Center. Mobile Crisis was a 24/7 service staffed by oncall workers covering both Jefferson and Clearfield Counties. Mobile Crisis also employed one Mobile Crisis Coordinator, who was responsible for coverage of any heavier volumes on the system. Mobile Crisis Workers received monthly supervision/reviews and two mandatory 8-hour trainings each year. If individuals were acutely psychotic and admission seemed necessary, Mobile Crisis workers would guide individuals in crisis to emergency rooms or other services, and release police officers whenever it was safe. In addition, there was a longstanding Mental Health Crisis System group that met quarterly to discuss crisis response issues and programs. The group included representation from Clearfield-Jefferson Mental Health/Mental Retardation Program and the Drug & Alcohol Commission, Crisis Providers (telephone, mobile, and supports), emergency rooms, and inpatient psychiatric services. Greene County (March 2012) Southwest Pennsylvania Human Services, Inc. (SPHS) provided Greene County with 24-hour mental health crisis services. These services included Walk-in, Telephone, and Mobile Crisis. Trained crisis workers were able to assist individuals by telephone, offering assessment, referral, and follow-up for callers. The 24 hours telephone crisis can also dispatch 24 hour mobile crisis services to individuals throughout Greene County. In addition, Greene County s Crisis and Behavioral Health programs have a workgroup that meets every month ( Crisis Meeting ) to improve linkages between the two systems. 17

18 Indiana County (March 2011) The Indiana Regional Medical Center houses a Psychiatric Emergency Liaison. This position was originally funded with Health Choices Reinvestment dollars. The liaison performed assessments, bed checks, referrals, and linkage to services for individuals in need of inpatient or outpatient psychiatric services. Lackawanna (May 2014) Scranton Counseling Center (SCC) provided a variety of drug and alcohol, mental health, and developmental and intellectual disability services in Lackawanna County. SCC provided Emergency/Crisis Intervention services for individuals experiencing psychiatric crisis by mental health professionals trained in crisis intervention. Emergency services were available on-site from 8:30am to 4:30pm, Monday through Friday. In addition, NHS Human Services provided Mobile Crisis Intervention Services, in which trained professional staff offered phone and face-to-face intervention to evaluate supports and services needed to help the individual access care. Care was coordinated with other providers, family members, and any others designated by the individual. Crisis resources were also available at the walk-in center located in Carbondale, PA. Finally, The Community Intervention Center (CIC) provided combined drug and alcohol, mental health, and homelessness services in Lackawanna County. CIC professional staff were trained to assess and respond to individuals experiencing psychiatric crisis, many of whom were transported to CIC by law enforcement officers. CIC developed several protocols to respond to individuals experiencing psychiatric crises, including a continuum of services ranging from basic service provision (e.g., meals and showers) to de-escalation to involuntary civil commitment depending on the need. CIC was open 8:00am through 7:00pm, 7 days per week. Lancaster County (June 2009) An MH/MR/EI crisis counselor was placed at the Lancaster County Central Booking and Arraignment. The crisis counselor could join police in responding to calls where a psychiatric crisis was suspected or when an individual known to MH/MR/EI is in crisis. Efforts were made to engage eligible individuals in treatment and to avoid arrest. Lawrence County (August 2013) The Human Services Center was a comprehensive community behavioral healthcare provider that offering Crisis Intervention Services: o Telephone Crisis Counseling - provided 24 hours a day, 7 days a week. o The Crisis Walk-in Service (an on-demand clinical service provided by the Crisis Intervention Unit at the Human Services Center). Walk-In Services were available Monday through Friday, from 9:00 a.m. to 5:00 p.m. Services included assessment, crisis counseling, and information/referral. o Mobile Crisis Intervention was a clinical service available 24 hours a day, 7 days a week, designed to put a mental health clinician at the site of a crisis situation in order to provide assessments, counseling, crisis resolution, referrals, and followup. Three full-time staff members provided mobile crisis services via an on-call system. Lebanon County (February 2011) The Lebanon County Crisis Intervention and County Information and Referral Center was a confidential and free seven day/24 hour service provided by Philhaven 18

19 Hospital and funded through a contract between the County Commissioners and Philhaven Hospital. The service was licensed through the Department of Public Welfare. The service billed medical assistance for appropriate services. It employed approximately 10 individuals (4 full-time, 6 part-time) and provided several services for Lebanon County, including: o A Walk-in Crisis Center at Good Samaritan Hospital o County Information and Referral Services o o o Mobile Crisis Services A Drug & Alcohol Commission 24/7 Hotline Arrangements for emergency detoxification services Backup for calls coming into D&A line when they are closed Emergency calls coming into Alcoholics Anonymous when their hotline is not covered. MH/MR 24/7 Hotline for Crisis Intervention Services Screen for Intensive Case Management services for MH/MR (client calls crisis instead of ICM worker during on call hours). In addition, Crisis counselors follow these clients while in the ER and complete bed searches for these clients if a 302 commitment hospitalization is necessary Backup for call coming into MH/MR line when they are closed Supportive counseling for MH/MR chronic clients Attends hearings at Philhaven or VAMC when counselor serves as petitioner for commitments Luzerne County (July 2013) Luzerne-Wyoming Counties Mental Health and Developmental Services: Crisis Intervention (previously known as Emergency Services) provided the county with crisis intervention services that included telephone, walk-in, and mobile. Additionally, crisis residential services were provided through a diversionary unit," a step down from inpatient psychiatric services that offered 24-hour intervention to people experiencing severe emotional distress. Lycoming County (May 2011) The Susquehanna Health Center employed an Assessment Referral Collaborator who conducted assessments and links individuals to treatment. McKean County (May 2013) Mental Health Crisis Services in McKean County include: o Mobile: On-location support was available for emergency situations. This service was accessed through the Mental Health Crisis hotline. o Telephone: Clients could call and speak to a trained Masters-level therapist at any time. This service provided support and direction. Crisis intervention services were available 24 hours per day, seven days per week for persons in McKean County experiencing emotional, behavioral, thinking, and/or social functioning difficulties. o Walk-In: Clients could come directly to the Crisis Center to meet face-to-face with a Crisis counselor to obtain support, referrals, or information during business hours. No appointment necessary. 19

20 o Warm Line: The Warm Line was available to residents of McKean County who needed to talk about any mental health related non-crisis issue, and was staffed by a Peer Support Specialist. The Warm Line number was available 4pm to 9pm, Monday through Friday and 4pm to 10pm Saturday and Sunday. Montgomery (October 2008) Montgomery County Emergency Services, Inc (MCES) is the sole designated involuntary civil commitment facility for adults in Montgomery County, providing general crisis services that included crisis/suicide hotline, crisis walk-in, mobile and medical mobile outreach, crisis residential services, and inpatient care to the community. Law enforcement had access to 24-hour crisis/outreach, rapid response for psychiatric evaluations, and inpatient care. In addition, MCES had a forensic case management diversion team funded through the mental health office that provided support to individuals with forensic histories. The activities of staff also included release planning and work with the courts. In addition, MCES operated a well-established mental health police training school. MCES had offered Crisis Intervention Specialist Training since 1975, with options including three-day Basic, three-day Advanced, and two-day Modified Crisis Intervention Specialist training along with roll-call, negotiations/barricade, and other training for the police. The local National Alliance for Mental Illness (NAMI) chapter provided a presentation of In Our Own Voice as part of the police training school. Advanced training included material focused on veterans. Sullivan County (July 2015) Sullivan County s 24/7 Mobile Crisis Team was dispatched through 911 with delegates as needed. Union County (March 2014) The CMSU Crisis/Emergency System had provided crisis services in Union County for over 30 years. CMSU offered telephone crisis services through TAPline, a crisis response hotline that operates 24/7 in Union County. CMSU also provided mobile crisis response across Columbia, Montour, Snyder, and Union Counties. During normal working hours this included three crisis workers and one forensic crisis worker; during off hours, there was one crisis worker on call for both Union and Snyder Counties. Crisis workers were available to respond to the Union County Prison 24 hours per day, and the forensic crisis worker provided services in the Union County Prison. Crisis workers also worked with municipal police departments and hospitals to respond to crisis situations in these settings. All crisis workers had been extensively trained in responding to psychiatric crisis. Warren County (November 2013) Warren County held ongoing meetings between county MH and hospital to develop protocols around triage, monitoring, and transportation for individuals experiencing psychiatric crises in the Emergency Care Center. York County (September 2011) York County Mental Health/ Mental Retardation provided mobile crisis services to the county. The mobile crisis team consisted of 17 full-time employees, three part-time workers, and a crisis supervisor. This team was located within York Hospital, but staff traveled to other area hospitals when crisis services were required. Mobile crisis also had a dedicated police line specifically for law enforcement use. This line was 20

21 overseen by a crisis supervisor and was used both for consultation and mobile crisis service requests. Mobile crisis worker(s) met law enforcement on the scene of an incident approximately 7-15 times each week. After hours, there was also an alternative mobile site at the NHS Human Services Crisis Diversionary Residence. This was a 10-bed short-term, non-hospital based program staffed 24 hours a day, seven days a week. It provided treatment and support for acute psychiatric crises to aid in stabilizing symptoms. In addition, there were crisis walk-in centers available in Hanover Hospital (7 days a week 8AM 8PM), and Edgar Square (WellSpan ReadyCare). Detoxification Services The majority of counties reported supporting detoxification services within the county limits (57%) including a mix of hospital based services (24%) and non-hospital based services (33%). Several counties described supporting detoxification services outside county limits (31%) including a mix of hospital based services (10%) and non-hospital based services (21%). Several exemplary and promising practices in detoxification services included: McKean County (May 2013) In McKean County, Drug & Alcohol (D&A) services were provided through Alcohol and Drug Abuse Services, Inc. (ADAS). ADAS was the Single County Authority (SCA) for Cameron, Elk and McKean counties, providing a continuum of non-hospital alcohol and drug prevention, intervention, and treatment services. ADAS offered Residential shortterm treatment (30 days or less) and outpatient treatment throughout the county. ADAS offices were located in the cities of Bradford, Kane, and Port Allegany. Indiana (March 2011) Indiana County did not have local licensed detoxification facilities; however, the Indiana Regional Medical Center had developed protocols for detoxification procedures. Once an individual was medically cleared by the Indiana Regional Medical Center, they were referred to the Armstrong-Indiana Drug & Alcohol Commission, followed by further rehabilitation or treatment in neighboring counties. At the time of the mapping workshop, Indiana County was planning for a detoxification facility and expected to open one within ten months. Somerset County (December 2011) The Twin Lakes Center in Somerset County included a "detox" unit that accepted admissions 24 hours per day, seven days per week. The medical director and nursing staff were trained to safely detox patients from a wide variety of substances. The center also treated various medical and psychological problems that accompany substance use disorders. Additional Twin Lakes services included short term residential treatment, partial hospitalization, outpatient and intensive outpatient treatment. Acute Psychiatric Stabilization Services The majority of counties (62%) reported supporting hospital-based acute psychiatric stabilization units. Many counties also described acute psychiatric stabilization residences supported by community services providers (33%). Several exemplary and promising practices in acute psychiatric stabilization services included: 21

22 Somerset County (December 2011) Footsteps Psychological Crisis Diversion Acute Stabilization Unit provided psychiatric stabilization services and had an average length of stay 3-15 days. York County(September 2011) The NHS Human Services Crisis Diversionary Residence was a 10 bed short-term, non-hospital based program that was staffed 24 hours a day, seven days a week. It provided treatment and support for acute psychiatric crises. The Crisis Diversionary Residence had been in operation since 2009 and was funded jointly by CCBH and the Crisis Intervention Team (CIT) grant. The average length of stay in this facility was 3-5 days. Other Promising Intercept 1 Initiatives The Cross-Systems Mapping workshops revealed several additional noteworthy practices at intercept one. These included the following interdisciplinary planning groups and training initiatives: Butler County (February 2012) Butler County s Sequential Intercept/Special Populations Taskforce that included: parole, probation, mental health, law enforcement, crisis, and faith-based representation. Carbon County (October 2011) Carbon County utilized HealthChoices funding to fund the train the instructor training for MH First Aid. Centre County (April 2015) Centre County s Mental Health/Intellectual Disability/Early Intervention; Drug & Alcohol and local hospital meet on a monthly basis to streamline service coordination and have periodic ad hoc meeting with administrators. Jefferson County (August 2010) Jefferson County housed a longstanding Mental Health Crisis System group that met quarterly to discuss crisis response issues and programs. The group included representation from Clearfield Jefferson Mental Health/Mental Retardation, Crisis Providers (telephone, mobile, and supports), emergency rooms, inpatient psychiatric services, Drug & Alcohol, and was open to any other stakeholder in the crisis system. Lehigh County (August 2015) Lehigh County s Team MISA was developed as an offshoot of MISA/CJAB with the initial goal of diverting low risk MH offenders from incarceration or intervening in the very early stages of incarceration. The success of the group hinged on collaboration and ensuring that there are decision makers, as well as front line staff, at the table. Weekly think tank -style meetings provided an opportunity for the team to discuss new referrals and provide updates on old referrals, streamline processes and expedite appropriate releases from jail. Individual team members collected information from their respective 22

23 offices and had release-of- information forms signed when necessary. Collectively, the team discussed the most appropriate and expeditious approach to manage the case. Schuylkill County (November 2010) The Schuylkill County Family Training and Advocacy Center for Mental Illness (FTAC) offered training to college students in the fields of Mental Health and Criminal Justice. 23

24 Intercept II: Initial Detention / Initial Court Hearing Trends Common Gaps/Barriers Encountered The majority of counties reported supporting no specialized diversion programming at Intercept II (60%). A large number of counties described a general lack of training for criminal justice officials involved in initial detention and initial court hearing (33%). This lack of training included general background on mental health topics, as well as the availability of specific resources in the community. Specific to initial detention, counties reported a lack of forensic services within area emergency rooms and hospitals (10%), problems with central booking (19%), and a lack of specialized mental health services provided by those agencies involved in initial detention (usually local law enforcement barracks or local jails) (12%). Specific to initial hearings, almost half of the counties reported a lack of pre-trial services to aid in legal decision making (45%). Several counties further cited significant delays in the assessment of mental health needs (14%). Counties also report various issues with effectively using video arraignments (24%) including developing video arraignment in the county, and the capacity to work with behavioral health problems via teleconference. Finally, counties reported largely informal and non-institutionalized relationships and outreach to Magisterial District Judges by the behavioral health system (24%), which could threaten the longevity of such relationships. Common and Promising Practices Initial Detention The majority of counties (74%) reported that initial detention occurred in local stations, although some counties indicated that both local stations and central or regional booking centers were used for initial detention. Overall, 38% reported that initial detention occurred at a central booking facility, and an additional 12% of counties endorsed use of a regional booking facility. Several counties reported that they were in the process of developing a central booking center or process during the cross-systems mapping workshop. These counties included Blair (June 2011), Bucks (September 2011), Luzerne (July 2013), Lycoming (May 2011), Monroe (July 2011), Pike (June 2012), and Washington (May 2012). Several exemplary and promising practices at initial detention included: Cumberland County (September 2014) The Central Booking Center for Cumberland County was located in the Cumberland County Prison (CCP) in Carlisle. On average, the booking center processed 16 defendants on a daily basis. All municipal police departments, including the state police, 24

25 could utilize the Central Booking Center. The Central Booking Center contained equipment for fingerprinting and processing (including Livescan and CPIN equipment and technology). Police officers inform Central Booking Center staff if an individual is displaying any suicide risk. Lackawanna County (May 2014) Once arrested, individuals in Lackawanna County were transported to the Central Processing Center ( Central Booking ), located in the Lackawanna County Courthouse and operated 24/7 by staff from the District Attorney s Office and Sheriff s Office. Lancaster County (June 2009) Lancaster County had a Crisis Intervention Worker (an MH/MR/EI counselor) stationed at Central Holding and Arraignment in Lancaster City. Lebanon County (February 2011) When an individual was arrested in Lebanon County, he/she was taken to Lebanon County Central Booking. Central booking had been operating in Lebanon County since 2003, and was overseen by the District Attorney s Office. Effective January 1, 2005, all persons arrested in Lebanon County were to be processed at Central Booking (per Administrative Order No from the President Judge). Central Booking conducted a preliminary suicide risk and mental health crisis assessment based on the account of the transporting officer. If an individual was in crisis, he/she was transported to the emergency room at Good Samaritan Hospital to be cleared by Lebanon County Crisis Intervention before returning to Central Booking. Preliminary Arraignment/Preliminary Hearing Many counties reported that in-person (62%) and video (69%) arraignments were conducted in county. Video arraignments occurred in a variety of contexts, including police stations (29%), booking facilities (26%), and jails (19%). Several exemplary and promising practices related to preliminary arraignment and hearings included: Clearfield County (January 2011) Clearfield County had video linkage with DA offices for video arraignment in every local police station, which had cut back on time and travel. Delaware County (May 2010) The NTBR and Crossroads Programs allowed inmates with a serious mental illness to be given unsecured bail, but not to be released until all mental health services were confirmed and in place. If a defendant qualified for the Crossroads Program, s/he was given unsecured bail with a Not to Be Released (NTBR) condition at the Preliminary Hearing or Arraignment. The NTBR condition was designed to ensure that an individual would not be released from jail until all services were in place. The Crossroads Program was a formal collaborative relationship with the District Attorney, Public Defenders Office, and Adult Probation & Parole. Crossroads began in 2008 and had two Mental Health and two Drug & Alcohol Forensic Liaisons who worked for probation to assess and arrange services, make referrals, complete medical assistance applications, facilitate case management services, and arrange for medications at discharge. The program participants required a letter from Crossroads before they were released from the jail. This program diverted approximately persons a year from 25

26 longer-term incarceration while allowing them to secure the necessary services. Crossroads could also fast track a case to the Preliminary Arraignment process to reduce the amount of time from an average of 3 6 months to 3-6 weeks. Lawrence County (August 2013) Preliminary hearings were held at Lawrence County Central Court. A county employed forensic liaison was available at central court 3 days a week (Tuesdays, Wednesdays, and Thursdays) to coordinate mental health services across the criminal justice system. Forensic liaison services included: Coordinating court-ordered evaluations and treatment Working with the courts, forensic units, hospitals, law enforcement and probation officers in assessing the needs of individuals for mental health services and then accessing care for them Providing care management functions shortly before the release of people who were incarcerated Providing ongoing education and training to the various agencies involved in the criminal justice system as to mental health systems and treatment Assisting individuals to transition into other community programs as needed. MDJ Training Initiatives The Cross-Systems Mapping workshops revealed several exemplary training practices at Intercept Two, including: Chester County (June 2010) Magisterial District Judges were invited to attend Montgomery County Emergency Services (MCES) crisis training programs, and some attended Franklin County (April 2009; Updated June 2012) Franklin County Magisterial District Judges participated in FTAC and NAMI-PA training. Pre Trial Services/Diversion A minority of counties reported formal (19%) or informal (12%) pretrial services at Intercept Two. Twenty-five percent of mapped counties reported pre-trial diversion programming. Several exemplary and promising practices related to pre-trial services and diversion included: Bucks County (September 2010) The Bucks County Pretrial Diversion Program, initially funded by Byrne JAG and now funded by the county, was a collaborative effort among criminal justice, TASC and treatment partners. Of the 223 pretrial offenders served before 2009, 89 percent of cases submitted for bail were approved and 78 percent of cases were closed successfully (National Criminal Justice Association 2009 Report). The project functioned under the Bucks County Department of Corrections Community Corrections Division. Treatment Alternatives for Safer Communities (TASC) was a key part of this Pre-Trial Diversion Program and served as a boundary spanner between the jail and mental health and substance abuse treatment programs in the community. Accepted individuals were monitored and tracked, and also provided with two group options using a cognitive behavioral health curriculum that addressed criminal thinking distortions. Pre-Trial participants were carefully monitored for up to three years following initial detention. Participation was voluntary. 26

27 Centre County (April 2015) Centre County s Veteran Diversion Court operated at the MDJ level. Centre County had a Magisterial District Court Veterans Diversion Program for Veterans who have been charged with a summary offense involving alcohol or drug use. If accepted, veterans undergo an assessment and 1) must comply with the treatment plan developed by the Veterans Healthcare Administration, 2) abstain from drug and alcohol use, and 3) remain offense free while in the program. Upon successful completion of the program, veterans were eligible to have the original charges dismissed or reduced. The Veterans Justice Outreach (VJO) Specialist, Melinda Shea, checks for eligibility, coordinates services for the veterans, and sends reports to the MDJ on the veteran s progress every two weeks. In addition, The Center for Alternatives in Community Justice is the Centre County Bail Agency, and provides an alternative to incarceration for pretrial detainees charged with bailable offenses. Defendants can be placed on supervised bail by a Magisterial District Judge or a Judge of the Common Pleas Court. CACJ interviews the individual, as well as two other sources for verification and will then recommend to judge for placement or not. All defendants are required to abide by a standard set of conditions governing their release, as well as special conditions imposed by the court. Any violation of these conditions can result in a motion to revoke supervised bail. All defendants released will remain under supervision until their case is properly disposed of in the court system. Additionally, the Centre County Bail Agency receives a daily from the CCCF with a list of daily commitments. Clearfield County (January 2011) Forensic Blending Case Management and Forensic Administrative Case Management were available to divert/support individuals during the initial detention/preliminary hearing Erie County (June 2012) The Erie County Adult Probation and Parole Pretrial Bond Reduction Program was a collaborative effort between Adult Probation/Parole, Erie County Drug & Alcohol, Stairways Behavioral Health, and Erie County Care Management. The program was designed to reduce the length of stay for offenders with non-violent crimes who couldn t afford bond, and may need treatment. A county PO went to the jail daily to review all new commitments from the last business day. The PO reviewed the charges and would meet with the new admissions who did not have the following charges or legal status: ICC, Non-payment of Child Support, sex offense, or violent offense. An interview was completed with the inmate who could make his/her bond and areas of need were determined. Individuals with MH and D&A needs were assessed by ECCM and Erie County D&A, respectively. A treatment plan was presented to the ADA and Court. If both were in agreement with the plan, the client was released on a reduced bond and entered into the recommended treatment. Fayette County (December 2010) The Forensic Diversion and Re-Entry Program (FDRP) provided services directly to individuals involved with the criminal justice system, starting at preliminary arraignment and continuing into the community. This Program, funded by the HealthChoices Reinvestment Project initiated in 2008, provided community-based treatment for nonviolent misdemeanor and felony offenses. FDRP had been established as a shortterm approach to link and reintegrate individuals with mental illness and often co- 27

28 occurring substance abuse histories into the community. FDRP was often used by the Magisterial District Judges during preliminary arraignment and preliminary hearing as a mental health evaluator and a treatment provider for defendants with mental health needs. Representatives from FDRP would frequently be called to assist in preliminary hearings and to consult regarding MH treatment. MDJs used Pretrial Services for defendants with the contingency that they undergo treatment with FDRP. These treatment services were provided based on fee for service, and were billed via a contract with HealthChoices (through the Fayette County Behavioral Health Administration) Franklin County (April 2009; Updated June 2012) Eligibility for Franklin County Pretrial Services was typically determined during the preliminary hearing or preliminary arraignment, when the Magisterial District Judge (MDJ) could recommend someone for mental health and/or substance abuse evaluation. Once this recommendation was made, the pretrial diversion probation officer evaluated the defendant and determined whether pre-trial services were appropriate. If an individual qualified, he/she would be referred to mental health and/or substance abuse treatment as necessary. Individuals with mental health treatment needs were typically referred to Franklin/Fulton Mental Health/Intellectual Disabilities/Early Intervention for comprehensive evaluation and treatment recommendations. Individuals with substance abuse treatment needs were either referred directly to a local provider (particularly if he/she had insurance), or to the Franklin County Drug and Alcohol Commission. An estimated 90% of individuals referred to drug and alcohol treatment received evaluations from local providers. Indiana County (March 2011) Indiana County s Pretrial Services Program was operated by the Indiana County Probation Department. The program employed one individual to meet with newly incarcerated individuals in the jail and make recommendations to the court regarding possible diversion. Pretrial Services interviewed an estimated 200 individuals each year, of whom were released as a result. Individuals who were diverted through the pretrial services program may be released with or without conditions of pretrial supervision and behavioral health treatment. At the time of the mapping workshop, an estimated 30 individuals were on pretrial supervision. Lehigh County (August 2015) Lehigh Valley Pretrial Services, Inc. administered the bail system in Lehigh County. It investigated and provided recommendations concerning the bail risk of defendants; monitored defendants released on bail supervision; and informed the Court of any breach of conditions of release. In addition, The Lehigh County Veterans Mentoring Program (VMP) was established in 2011 through the District Attorney s Office to address the issues faced by a growing number of veterans involved in the criminal justice system. It is a team approach offering mentoring services and includes members of the District Attorney s Office, Adult Probation, Pretrial Services, county Veterans Affairs, county Drug and Alcohol and Mental Health, Public Defender s Office, Lehigh County Jail, and a community volunteer, The VMP is a voluntary program, with no additional costs to the county or administrative burdens for program participants. A mentor works one-on-one with a veteran as an advocate, a non-judgmental peer, and a resource to navigate the court system, treatment availabilities, V.A. system, and generally to help them adjust to civilian life. 28

29 Mentors also provide an opportunity for the veteran to share experiences with someone who can relate to their military experience. Lycoming County (May 2011) The Lycoming County Prison System operated and maintained two alternative specialized bail programs as an alternative to incarceration: the Supervised Bail Program and an Intensive Supervised Bail / Release Program. In 1982, Lycoming County Prison System implemented the Supervised Bail Program through a grant from the Pennsylvania Commission on Crime and Delinquency (PCCD). The Supervised Bail Program was an alternate method of bail allowing pre-trial first-time offenders, indigents, or other eligible offenders to obtain community supervision. In 1996, the Lycoming County Prison System implemented the Intensive Supervised Bail Program, and then several years later the Release Program component was implemented. The Intensive Supervised Bail Program / Release Program was also established through a grant from PCCD. The Intensive Supervised Program / Release Program was an alternate method of bail and a sentenced alternative to incarceration utilizing a global positioning component. Once an inmate was placed in a Supervised Bail program, an intake process occurred in which conditions were imposed. These conditions were similar to conditions placed upon probationers and parolees, including urine surveillance and field visits from the ISBR Officer. When appropriate, clients were referred to agencies for special problems (e.g. alcohol, narcotics, psychiatric). Clients were usually interviewed on a weekly basis until their sentence was completed. When conditions were violated, the client was returned to the prison where a disciplinary hearing was held. Washington County (May 2012) Washington County offered a Magisterial District Judge Diversionary Program with the goal of preventing individuals with mental illness from further penetrating the criminal justice system. The program was diversionary with conditions that participants must satisfy--treatment and medication requirements--while abiding by terms of the program. Participants were evaluated by a Forensic Case Manager in order to establish eligibility. The caseworker tracked individual progress and compliance, and reported back to the Magisterial District Judge (MDJ) after 90 days. When the participant had successfully completed the program, the underlying charges were dismissed. If at any time the participant failed to meet the standards required by the program, the MDJ had the right to proceed with the charges. Both the arresting officer and any other involved party (e.g. victims) must agree to the participation of any individual in the diversionary program. Westmoreland (May 2010) Westmoreland s pretrial services division conducted assessments on all detainees except those charged with homicide. The Pre-Trial Division was supervised by the Adult Probation and Parole Department. At the time of the mapping workshop, three new Criminal Justice Liaison positions had been funded through Reinvestment dollars, with sustainment planned through a combination of base funding and HealthChoices billing. The three Criminal Justice Liaison positions that had received in-service training and responsibilities were still being developed during the workshop, but would likely include diversion and linking arrestees to treatment, coordination with MDJs, and system-wide training. York County (September 2011) 29

30 York County Probation operated a Supervised Bail Program through which supervision and monitoring were provided to defendants on nominal or reduced bail while awaiting case disposition. Designated Supervised Bail Officers worked with Central Booking and the York County Prison. 30

31 Intercept III: Jails / Courts Trends Common Gaps/Barriers Encountered Intercept 3 Jails / Courts Many counties reported a general lack of cross-system communication and cooperation (38%). This included a lack of collaboration among local jails, district attorney s offices, court systems, and behavioral health services; regional criminal justice and behavioral health service providers in surrounding counties; and broader organizations such as the Pennsylvania Department of Corrections and the Department of Veterans Affairs. Many counties reported specific gaps related to their local correctional institutions. Almost half of the counties mapped described a lack of adequate mental health and substance abuse services within their local jails (40%). Jails were understaffed with mental health professionals (24%), and jail staff lacked training in mental health issues (12%). Physical limitations further restricted the number of staff and number of programs offered by local jails (17%). Several counties described various problems with maintaining and monitoring psychotropic medications in their local jail (26%), which was made more difficult by a lack of data collection and sharing within and between local and regional correctional facilities (21%). Issues with medical assistance for inmates with serious mental illness further complicated their access to treatment (14%), both within the local jail and when planning community re-entry. Further, jails were overcrowded with inmates (24%), and it was difficult to transfer inmates with serious mental illness to state hospitals due to a restricted number of forensic beds (24%). Partly due to these various factors, several counties reported individuals with serious mental illness are experiencing longer times in local jails (19%). There were also several special populations that posed specific problems to local jails. Several counties reported that a significant number of individuals arrive at local jails in need of detoxification (17%), further straining their institutional resources. Further, the number of female inmates was rising in several counties (12%), and local jails were finding it difficult to house these women, given their current physical or logistical limitations. A major gap in the judicial system of some counties was the lack of specialty diversion options (45%) namely the lack of specialty courts and funding difficulties for diversion alternatives. When court diversions did exist, several counties described limits to their effectiveness due to inadequate services (14%) and limited staff (12%). Counties also faced lack of commitment and opposition to court diversion programming both externally from their local communities (10%), as well as from the offenders themselves (10%). Jail Specialty Court Dispositional Court 31

32 Common and Promising Practices Problem Solving Courts The majority of counties housed at least one problem solving court at the time of their mapping workshop (64%), and 26% operated more than one specialty court. The most prevalent type of problem-solving court was Drug Court (43% of counties), followed by Mental Health Court (19%), DUI Court (19%), Veterans Court (10%), Reentry Court (5%) one Recovery Court (2%), and one Co-Occurring Court (2%). Several counties reported that problem solving court programs (including mental health, drug, and veterans courts) were in the process of being developed or expanded during the crosssystems mapping workshops. These counties included Blair (June 2011), Bucks (September 2010), Butler (February 2012), Carbon (October 2011), Delaware (May 2010), Jefferson (August 2010), Lancaster (June 2009), Luzerne (July 2013), McKean (May 2013), Montgomery (October 2008), Pike (June 2012), Union County (March 2014), and York (September 2011). Several exemplary and promising practices related to problem solving courts included: Blair County (June 2011) Blair County had an extensive Treatment Court Program, including Drug Court, DUI Court, Reentry Court, Family Court, Juvenile Drug Court and Truancy Court. These Treatment Court Programs each consisted of treatment staff with representatives from D&A, Children Youth and Families, Probation, and Mental Health Case Managers. Centre County (April 2015) The Centre County DUI Court Program provided intensive support and supervision to those DUI offenders who were at the highest risk of reoffending and had the highest need. The court was established in December of 2009 in response to the high rates of DUIs in the county (over 1,000 DUI related arrests per year). The target populations for this program included 3rd time DUI offenders (within the last 10 years), who had the highest tier blood alcohol level at the time of arrest, and 2nd time DUI offenders with the highest tier BAC, who were previously sentenced to Intermediate Punishment but are now facing a revocation. The DUI Court program provided support with regular judicial reviews, probation supervision, treatment (as identified by the Pennsylvania Client Placement Criteria), and case management support. Cumberland County (September 2014) The Cumberland County Court of Common Pleas instituted a voluntary Adult Treatment Court in 2006 based on proven national research and program models. The program provided participants with an opportunity to pursue treatment for their addiction(s) while productively addressing associated legal problems. There was one probation and parole officer assigned to the Adult Treatment Court team. Once accepted into the program, participants could expect frequent contact with the Adult Treatment Court Judge, probation and parole officer, and treatment providers. They were required to complete a four-phase program culminating with graduation. The phase program was designed to be completed in 18 months. Following graduation, when appropriate, participants could petition the Court to dismiss and/or reduce their charges, or have their record expunged. Delaware County (May 2010) 32

33 In 2008, Delaware County started a Treatment Court targeted for female offenders with co-occurring mental health and substance use disorders. The Court was developed in response to prison overcrowding and recognition on the part of the judges that many of the women were repeat offenders. The goal was to divert the women from incarceration to community-based supervision and treatment for mental illness and substance abuse. Potential Treatment Court candidates were first identified through the self-report survey completed in the jail. The diagnostic categories were limited to Post-Traumatic Stress Disorder, Bipolar Disorder, and Anxiety disorders. Individuals with serious mental illness were excluded. The court had 2 tracks: Prison Alternative Drug and Alcohol Program (PADAP) and the Co-Occurring Disorder Women s track. The PADAP track was the Restrictive Intermediate Punishment program intended to divert Level 3 and 4 offenders with substance use disorders from state prison to mandate substance abuse treatment and supervision. Erie (June 2012) In Erie County, Treatment Court was comprised of both a Drug Court and a Mental Health Court, with a component that dealt with Family Court. Erie County Drug Court for adult offenders began in 2000; it was expanded to include Mental Health Court in 2002, and a Family Court was added in The Erie County Drug Court was a joint program between the Erie County Court, the Erie County District Attorney's Office, the Erie County Public Defender's Office, the County Drug and Alcohol Office, and several treatment providers. The Mental Health Court Component of the Erie County Treatment Court program was a partnership between the Erie County District Attorney s Office, Erie County Public Defender s Office, Erie County Office of Drug and Alcohol Abuse, Erie County Care Management, Erie County Office of Children and Youth, and Stairways Behavioral Health. Fayette (December 2010) The Fayette County Mental Health Court (MHC) was initiated in 2008 with a grant from the Pennsylvania Commission on Crime and Delinquency (PCCD) and the Pennsylvania Office of Mental Health and Substance Abuse Services (OMHSAS). The Mental Health Court initially limited its focus to mental health cases; however it later broadened its scope to include offenders with co-occurring disorders, as well as Veterans. The Mental Health Court provided services for defendants charged with non-violent misdemeanors or felonies, who had mental illness and often co-occurring substance use disorders. The Mental Health Court was assisted by the Mental Health Court Treatment Team, which included representatives from Adult Probation and Parole, Behavioral Health Administration, Forensic Re-Entry and Diversion Program (FDRP), and service providers as needed, as well as a Mental Health Court Coordinator and a department clerk who were hired specifically for this project. The MHC Treatment Team met monthly or as needed, and MHC was held approximately once every two weeks (as scheduled), with reinforcement and progress hearings held every 30 days (or as necessary). Participants for the MHC could be self-referrals, referrals from attorneys, psychiatrists, other treatment professionals, or referrals from law enforcement (judges, jail, or probation office). Eligible participants must be county residents, could not have a charge including sexual assault, violent offenses, or DUIs, and must volunteer for the MHC. After a successful referral was made, the MHC would order MH and/or D/A evaluations (as necessary for each individual defendant), after which it would work with the District 33

34 Attorney s Office and Public Defender s Office to obtain their agreement with the program for that defendant. After agreement, the MHC began looking at the treatment needs of the defendant and would work with the District Attorney s Office on charges. Indiana County (March 2011) The Indiana Court of Common Pleas has been operating the Indiana County Drug Treatment Court (DTC) since January 1, 2007, as a part of a Pennsylvania Commission on Crime and Delinquency (PCCD) grant. The Indiana Drug Treatment Court was the primary program in Indiana County for Level 3 offenders ( serious offenders and those with numerous prior convictions), and Level 4 offenders ( very serious offenders and those with numerous prior convictions, such that the standard range required state incarceration but permitted it to be served in a county facility). The Drug Treatment Court Team was composed of the President Judge, the District Attorney, the Probation Chief, the Criminal Justice Intensive Case Manager from the Armstrong-Indiana Drug and Alcohol Commission, a DTC Probation Officer, and a Defense Advocate. Intensive judicial supervision was involved, requiring the client to appear regularly in court before the Judge. Graduated incentives and sanctions were used to reward progress and require accountability of the client. Lackawanna (May 2014) Lackawanna County housed an impressive array of specialized dockets and specialty courts, including Adult Drug Court, Mental Health Court, Re-entry Court, Cooccurring court, Veterans Court, Juvenile Drug Court, Domestic Violence Court, and DUI Court. Perhaps one of the most unusual problem-solving courts in Lackawanna County was the Co-Occurring Court, which started in 2009 as a subcategory of the Adult Drug Court and provided services specifically for offenders with co-occurring mental health and substance use disorders. Many Co-Occurring Court participants began in the Adult Drug Court and were transitioned to the Co-Occurring Court once their substance use problems stabilized and mental health symptoms became more apparent. Participants in the Co-Occurring Court received case management through three dedicated case managers, and received services through NHS of Northeastern PA or the SCC. As of May 2014, the Co-Occurring Court supported a docket of participants. Lawrence (August 2013) The Lawrence County Drug Treatment Court was initiated in March of 2012 and offered substance abuse treatment as an alternative to incarceration for drug-addicted individuals arrested in Lawrence County and charged with drug related offenses. The Court emerged from the realization that a substantial number of these individuals engaged in criminal behavior as a result of their need to support a drug addiction. By offering monitored treatment, the Court aimed to decrease the prevalence of drug addiction and drug-related crime in Lawrence County by breaking the damaging and costly cycle of addiction, crime, and incarceration. The drug treatment court served both misdemeanor and felony offenders, as long as the charges were not too severe for inclusion (e.g. child sexual abuse). The drug treatment court team included a dedicated case manager from the Drug and Alcohol Commission. Luzerne County (July 2013) Luzerne County had an extensive Treatment Court Program, including a Mental Health Court, Drug Court, and plans for a Veterans Court. The crux of the Treatment 34

35 Court Program was a heightened level of judicial involvement, and intensive treatment and probation supervision. Direct and frequent contact between the offender and judge motivated program compliance. Luzerne County Drug & Alcohol Treatment Court was created in January 2006 with funding to provide non-violent offenders having drug and or alcohol problems with specialized treatment, counseling, supervision, life skills and education. Successful participants had their criminal charges expunged after program completion. This was Luzerne County s first program targeting recidivism. Screening for the program was provided by Community Counseling (D&A screening) in conjunction with the District Attorney (DA) (legal eligibility screening). Catholic Social Services coordinated treatment and provides case management services, using two drug and alcohol case managers. The Program ranged in duration from one year to eighteen months, and the charges against successful graduates were dismissed. The average caseload of Drug & Alcohol Court was roughly individuals, and there were two probation officers assigned to the court. Luzerne County Mental Health Treatment Court was created in May 2009 with the help of two grants from PCCD. The establishment of the MH Court was a complement to the existing Drug Court, in the attempt to combat recidivism and jail overcrowding. The MH Court also accepted veterans into the program, and a representative from the Department of Veterans Affairs was on the court team. Lycoming County (May 2011) Lycoming County had a Treatment Court Program including a Mental Health Court, Drug Court, DUI Court, Underage Drinking Court, and Juvenile Drug Court. Eligible offenders must submit a Treatment Court application. If approved, the applicant would receive notice of the hearing date and be advised to contact Adult Probation for review of conditions of the program. Once the applicant accepted the conditions, he or she would report to the next scheduled Treatment Court session to enter a guilty plea and be placed on the Treatment Court Program. Mental Health court participants had access to targeted case managers and a forensic peer support specialist. Mercer County (June 2015) Mercer County Veterans Treatment Court began on November 11th, 2013 (Veterans Day). The goal of Veterans Treatment Courts was to divert those with mental health issues and homelessness from the traditional justice system and to give them treatment and tools for rehabilitation and readjustment. While Veterans Treatment Court allowed the Veteran to remain in the community during treatment, a judge regularly checked on the Veteran s progress. If the Veteran failed to meet the requirements of the program for example, if he or she failed drug screenings or disobeyed court orders the Court imposed sanctions, which may include community service, fines, jail time, or transfer out of Veterans Treatment back to a traditional criminal court. Union County (March 2014) The Union County Drug Treatment Court was developed through the Union and Snyder County Criminal Justice Advisory Boards and became operational effective July 1, The Drug Treatment Court, partially funded through a grant secured from the U.S. Department of Justice, served as an alternative to incarceration for non-violent, drug-dependent offenders. Stakeholders included CMSU (including a dedicated case manager), the Public Defender s Office, the Union County Sheriff s Office, Union County Probation, and the Union County Commissioner. The Drug Treatment Court had been formally accredited through the Problem Solving Courts Program Office, Administrative 35

36 Office of Pennsylvania Courts, and Supreme Court of Pennsylvania. The program incorporates a variety of supervisory techniques including intensive offender supervision, electronic monitoring, frequent random drug screens, counseling, and regular appearances before the Court. The Union County DUI Treatment Court was established in 2011 to serve residents of Union County charged with certain DUI offenses who also had moderate to severe substance dependence. Offenders facing parole or probation revocations for substance use related violations were also eligible for placement into DUI Treatment Court, provided the underlying offense was a DUI. As of March 2014, Union County Probation had one probation officer dedicated to the DUI Treatment Court, and CMSU had one case manager dedicated to the DUI Treatment Court. Additionally, a wellness nurse through Community Care Behavioral Health was available to participants in both the Drug and DUI Treatment Courts. Wyoming and Sullivan County (July 2015) The Wyoming / Sullivan Counties Drug Treatment Court program was established in 2007 to provide a unique approach where the judge, public defender, district attorney, probation, counselor, law enforcement, and a community liaison sat on a team to address the needs of accepted defendants. Only non-violent defendants can be admitted. Program participants may still plead guilty and receive sentences, but the sentence was deferred pending completion of the two-year program. The goal of the court is to directly address the problems, such as addiction, that bring a defendant into a court system. York (September 2011) York County housed a Mental Health Court, Drug Treatment Court, and DUI Court. Mental Health Screening in Jail The majority of counties (79%) reported that mental health screening was conducted at intake in the local jail. Several exemplary and promising practices related to mental health screening included: Bucks County (September 2010) All Bucks County inmates were screened using the Level of Service Inventory Revised (LSI-R); it provided a comprehensive risk/needs assessment by considering major and minor risk factors, including mental health and drug and alcohol problems. The Texas Christian University Drug Screen-II (TCU-II) was also used for drug and alcohol assessments. The prison s medical department also screened new inmates for mental illness, and for drug and alcohol problems. An intake counselor notified CMHS if there was a new inmate with a mental illness. CMHS would see the inmate within 24 to 48 hours after referral. Every individual entering the correctional facility was also questioned about suicidal thoughts and behaviors. If there were suicidal concerns, the monitoring of the inmate began immediately. Monitoring was done by both correctional officers and other inmates. Centre County (April 2015) A Brief Jail Screening was conducted within 24 hours of admission to Centre County Correctional Facility (CCCF). The CCCF greatly enhanced the classification process in February of 2014 with the upgrade to a new Offender Management System. It was 36

37 expanded from 54 questions to a 64 question classification with separate assessments related to mental health, substance abuse, and recidivism. This expansion allowed for more questions to be asked, encouraged more interaction between the counselor and the inmate, and allowed for more specific data to be collected and evaluated. The classification process enhancement continued as a sub-committee of the Reentry Coalition studied the process and evaluated a change to evidence based risk and needs assessments. Chester (June 2010) Inmates were screened at the time of intake and referred to the mental health team if needed. If an inmate met the diagnostic criteria for a serious mental illness, there were several possibilities: divert to probation/parole, request Valley Creek Crisis Center do an evaluation for involuntary commitment, refer to Mental Health Court, or request a hearing for competency evaluation. The diagnostic categories of those inmates with serious mental illness (SMI) included Schizophrenia, Psychotic Disorders, Bipolar Disorder, Major Depression and Borderline Personality Disorder. In addition, Chester County MH/IDD generated a daily list of incarcerated individuals with histories of county treatment, which was then shared with the Prison. Erie (June 2012) Every admission to Erie County Prison included a questionnaire filled out by booking officers, followed by a complete medical assessment for mental health, substance abuse, and medical issues within three hours of admission. Once an inmate entered the housing unit, a risk-needs assessment was administered by a correctional counselor or officer. If necessary, an inmate was then referred to the Mental Health department for further follow-up and treatment. Fayette (December 2010) Fayette County inmates were screened for suicidality with the New York State Suicide Form screening instrument, with a score of 8 or higher placing someone on suicide watch until a psychiatrist could more comprehensively evaluate that person. The FCDAC and the Forensic Diversion and Re-Entry Program also provided drug and alcohol and mental health screening and assessment for individuals in the jail. Franklin (April 2009; June 2012) The Franklin County Jail s screening process identified individual risks and needs and initiated a number of innovative services that helped link people with mental illness or substance abuse problems to services. The correctional officers did a suicide screen based on the New York State correctional screening system. Mental health staff administered the Brief Jail Mental Health Screen within three hours of admission. They also did a separate suicide screen. A procedure was included to identify particularly high risk individuals under the age of 25 years and being admitted to the jail for the first time. The Texas Christian University (TCU) substance use assessment was used for inmates who were sentenced or technical violators. Lackawanna (May 2014) Individuals entering Lackawanna County Prison underwent an initial screen that included items related to mental health and substance use problems. An LCP nurse administered a similar screen upon medical processing, and followed up within 72 hours regarding these items. If an individual was on psychotropic medications or reported needs related 37

38 to mental health, their name was put on a list reviewed daily by SCC for continuity of care. A more thorough evaluation including a risk-needs evaluation utilizing the Level of Service Inventory Revised (LSI-R) was completed within 2 weeks of admission. Montgomery (October 2008) Montgomery County Correctional Facility (MCCF) had an organized admissions process that supported the identification of persons with mental illness at the time of admission. The prison used a computerized screening questionnaire that incorporated the questions included in the CMHS National GAINS Center s Brief Jail Mental Health Screen. A registered nurse (RN) was on duty in the admissions department Monday through Friday. All admissions were seen by the RN, who provided rapid access to further assessment and diagnosis for those persons identified as suicidal or who may have had a mental illness. The triage nurse had a background in psychiatry. Referrals could then be made to the medical services for follow-up and medication. In addition, MCCF, in cooperation with the Mental Health Office, developed an electronic data sharing system that expanded the ability to identify persons with severe mental illness admitted to the jail. Each week, the jail sent a list of new admissions to the Mental Health Office; the list was then run against the claims encounter data in HealthChoices and in the Base Program. The data identified persons who had received mental health and/or drug and alcohol services. The list was further refined by diagnosis to identify those whose diagnosis met minimal criteria for severe mental illness or co-occurring disorder. Washington County (May 2012) The Washington County Mental Health Court was a problem solving court devoted to handling moderate to severe mental health cases involved with the criminal justice system. Comprehensive supervision, evaluation, diagnosis, and increased judicial interaction all combined to make this court-operated program different from standard court processing. The Washington County Mental Health Court program included a dedicated probation officer and a dedicated forensic case manager. The Washington County Mental Health Court held staff meetings once a week, and court was held once a month. The program began in 2008 and initially received funding from the Pennsylvania Commission on Crime and Delinquency (PCCD). The Washington County Mental Health and Mental Retardation Department had sustained funding to support the Mental Health Court. The Washington County Treatment Court was a problem solving court that handled cases involving non-violent substance abusing offenders through comprehensive supervision, drug testing, treatment services, immediate sanctions and incentives. This court was an 18-month post-plea program that incorporated three sixmonth phases. The Washington County dedicated Treatment Court employed a fulltime probation officer as well as a full-time case manager. The treatment team was committed to meeting with the judge monthly in order to staff each participant and provide the Judge with a regular update. The Washington County Treatment Court was a co-occurring program dealing with individuals whose primary diagnosis was addiction while at times also having a secondary mental illness. This specialty court had been in operation since 2004 and had received funding from both the Pennsylvania Commission on Crime and Delinquency (PCCD) and the Bureau of Justice Assistance (BJA). Washington County Veteran s Court began in April of The Veteran s Court Team was comprised of representatives from the District Attorney s Office, the Public Defender s Office, the Adult Probation Office, the Mental Health/Mental Retardation Office, and the Veterans Justice Outreach Specialist from the Department of Veterans Affairs. The team utilized a collaborative approach to assist veterans involved in the 38

39 criminal justice system. To participate in the program, persons must have been discharged with an Honorable or General Discharge. Treatment resources were available through coordination with the Veterans Justice Outreach (VJO) Specialists from the Pittsburgh VA Medical Center, and through independent treatment providers. Jail Treatment Programs Fifteen counties provided an estimate of the proportion of the jail population with severe mental illness. Estimates ranged from 2% to 50%, with a mean estimate of 15.8% (mode: 7%). Twentysix counties provided estimates for the proportion of the jail population on psychotropic medication. Estimates ranged from 5% to 59%, with a mean estimate of 30.3% (mode: 30%). The vast majority of counties (86%) reported that general mental health services were available in the local jail, and 64% of counties reported specialized mental health services. Approximately one third (29%) of the counties reported that jail staff received training related to mental health, and 60% of counties employed a mental-health related professional within the jail. With regard to psychiatric care, the vast majority of counties utilized a contracted psychiatrist (88%). The remaining counties employed a psychiatrist on staff. With regard to specific treatment services, the majority of counties (62%) reported that the community provided in-reach services. Approximately one quarter of counties (26%) utilized peer support services in the jail, and 12% had a specialized mental health unit within the jail. Several exemplary and promising practices related to jail-based treatment included: Blair County (June 2011) Some Blair County inmates received services from a Forensic Case Manager through the Altoona Regional Health System (ARHS), funded through Medical Assistance and County funds. The Forensic Case Manager received referrals from jail, probation, and treatment providers. The FCM provides in-reach into the jail in order to help inmates complete Medical Assistance forms (typically 3 weeks prior to their release). Additionally, the FCM provided mental health screening for some court ordered cases. Bucks County (September 2010) The Bucks County Department of Corrections operated both a Men s and Women s Community Corrections Center. These two centers were community-based, minimum security work release facilities. The Men s Community Corrections Center opened on July 28, The building housed 270 male residents and provided shared treatment programming for both males and females. Shared services offered to male and female residents included intensive drug and alcohol treatment, adult basic education, case management, community service and work release. The Women s Community Corrections Center opened on July 28, This building provided 48 beds for female residents. The opening of the Women s facility offered the same levels of custody services and opportunities as the male population. Butler (February 2012) A select group of Butler County inmates (approximately 30 individuals) received mental health services through the Justice Related Recovery Team (JRRT). The JRRT utilized a Licensed Professional Counselor. Since October 2009, the primary focus of this team had been to provide mental health treatment/ case management to individuals ages 18 and older, diagnosed with a mental illness, and incarcerated in the Butler County Prison. The goal of treatment was to improve recovery/resiliency skills and 39

40 reduce recidivism upon release. Inmates were typically referred to the JRRT by the jail counselor if severe and persistent mental health problems were suspected. Justice Related Recovery Team participants had weekly appointments with the Licensed Professional Counselor, and had access to medications outside the Wexford Health Sources formulary. The team was initially funded through a Staunton Farms Foundation grant but subsequently sustained through the county MH/MR office. Centre County (April 2015) All correctional officers at the Centre County Correctional Facility received in excess of 40 hours mandatory training per year with a significant portion of this training directly related to the care and management of mentally ill inmates and inmates with cooccurring disorders. Additionally, the county correctional facility had twenty-eight personnel who have been trained in CIT. This means that almost all shifts had someone who was CIT certified who could then respond to inmates who were experiencing a crisis. In addition to having CIT certified personnel, CCCF staff also had access to and procedures for utilizing Centre County Can Help. This support was available to anyone in Centre County including individuals who are incarcerated or on probation/parole supervision. In addition, the county correctional facility gathered data during the initial inmate classification process and referred appropriate individuals to the mental health case manager at the facility. The CCCF contracted with PrimeCare Medical, Inc. for comprehensive medical and mental health care for the inmate population. This included a Case Manager, a Psychiatrist, and a MSW Licensed Clinical Social Worker; along with 24 hour, 365 day per year coverage by Nursing Staff. The Health Care Administrator, Psychiatrist, Physician Licensed Social Worker, etc. were on call 24 hours per day, 365 days per year. Chester (June 2010) Chester County Prison provided a 59-bed Mental Health Housing Unit for males with severe mental illness. This Unit was located on a dedicated Medium Security Block. Residents of this therapeutic community were provided with weekly wellness checks on the block. Unobtrusive observation by mental health staff was also conducted regularly. Beginning in November, 2009, therapeutic groups were available to unit residents (Anxiety, Dual Diagnosis, Stress and Anger Management and Life Skills were among the current or planned groups). Addiction services were also available. At the time of the mapping workshop, future plans for this unit included a token economy as well as the expansion of available groups and wellness checks. Cameron and Elk (October 2014) The Comprehensive Regional Adult Forensic Treatment (CRAFT) program (grantfunding provided by PCCD) was a critical component of care for inmates with comorbid mental health and substance abuse issues who returned to their home communities from local and state prisons. The CRAFT program followed participants from the first day of incarceration, through their release and subsequent supervision and treatment requirements. Columbia (November 2014) At the time of the mapping workshop, a Therapeutic Reentry Program was planned to begin in January 2015, modeled from therapeutic communities. It would target nonviolent offenders in need of D&A services and include pretrial and post-trial inmates. If 40

41 an inmate had a co-occurring diagnosis, he/she would be considered for participation on a case-by-case basis. Clearfield (January 2011) Clearfield County Prison had a Mental Health counselor who identified all potential consumers of mental health services. The MH Counselor was an employee of the Community Mental Health Center (funded by Clearfield-Jefferson MH/MR) and supervised mental health services at the jail 40 hours per week. After reviewing inmate records, the MH counselor assessed individuals within 24 hours of their intake using a standard mental health screening assessment developed by CMHC. After this individual assessment, the MH counselor referred the inmates to appropriate services. In addition, Clearfield County Prison hosted Peerstar LLC services. Peerstar LLC was a certified peer support service provider in Pennsylvania that offered specialized forensic peer support services in prisons and in the community to justice-involved individuals suffering from mental illnesses and/or substance abuse disorders. The Peerstar LLC in-jail program included evidence-based Citizenship Group classes and re-entry planning to assist individuals in returning to the community and breaking the cycle of reincarceration. In order to access the service, the MH counselor at CCP would check inmates for eligibility and make referrals to the Peerstar program. Cumberland County (September 2014) Cumberland County contracted with Holy Spirit Behavioral Health Center, a Geisinger affiliate employing two Forensic Case Managers (FCM) providing the following services for inmates with a serious mental illness in Cumberland and Perry counties: FCM received referrals from criminal justice system, the mental health system and the community and worked in conjunction to provide treatment and support services for clients Forensic Resource Coordination Forensic Case Management, Liaison, Monitoring Cumberland County Treatment Court Community based mental health supports (e.g., CRR s, supportive living, supported living, Fairweather Lodges, evidenced employment program, community mental health centers) Provided cross system education and support to the criminal justice and the mental health systems Assisted individuals with SMI and their families in navigating the criminal justice system. Franklin (April 2009; June 2012) Franklin County inmates had access to Moral Reconation Therapy (MRT). This systematic treatment strategy seeks to decrease recidivism among criminal offenders by increasing moral reasoning. Its cognitive-behavioral approach combines elements to address social, moral, and positive behavioral growth. MRT is administered in group and individual counseling using structured group exercises and prescribed homework assignments. The MRT workbook is structured around 16 structured steps (units) focusing on seven basic treatment issues: confrontation of beliefs, attitudes, and behaviors; assessment of current relationships; reinforcement of positive behavior and habits; positive identity formation; enhancement of self-concept; decrease in hedonism and development of frustration tolerance; and development of higher stages of moral reasoning. Participants met in groups once or twice weekly and completed all steps of 41

42 the MRT program in a minimum of 3 to 6 months. Individuals who began MRT in the jail and later transitioned to the Day Reporting Center (DRC) were able to continue with the program in the DRC (e.g. he/she would receive credit for the units completed while that person was incarcerated). Indiana County (March 2011) Indiana County inmates had access to Mental Illness and Substance Abuse (MISA) Treatment groups funded through the Armstrong-Indiana Drug and Alcohol Commission, and provided by the Open Door Alcohol and Drug Treatment Center. Individuals attending this group while incarcerated were considered clients of The Open Door outpatient center and could continue treatment without interruption upon release. The jail also housed a small Mental Health Unit for individuals experiencing mental health challenges. Lackawanna (May 2014) Various behavioral health services were provided within Lackawanna County Prison and through community in-reach programming. In-house programming was provided to the inmate population based upon their classification, and included drug and alcohol counseling, Alcoholic Anonymous meetings, Anger Management, Parenting Classes, and Computer training. According to LCP administrators, LCP conducted approximately 370 detoxifications per month. Services provided by SCC included a full-time staff member at LCP to conduct preliminary MH assessments; a psychiatrist (2 nights per week, 6-8 hours total) who worked with the SCC Director of Forensic Services (stationed in LCP) to enhance continuity of care; mental health case management; legal assistance; and post-release re-entry planning. Lawrence (August 2013) Lawrence County blended case managers were able to provide services to their clients within the jail. Lehigh County (August 2015) Lehigh County Jail contracted with Center for Humanistic Change for various programs such as Anger Management, Decision Making, Parenting, and Relapse Prevention, services for the inmate population. Additionally, there was a separate D&A Housing Unit, quasi-therapeutic community, staffed by a part-time D&A counselor and a part time Case Manager. Luzerne County (July 2013) Community Counseling Services (CSS) provided all behavioral health services in the jail, including a full-time mental health treatment coordinator, two full-time clinicians, one psychiatric nurse, and 20 hours of psychiatric time per week (split between two psychiatrists). Luzerne County inmates also had access to Moral Reconation Therapy. Lycoming (May 2011) Lycoming-Clinton MH/MR provided psychiatric, psychological, Targeted Case Management, and mental health liaison services to the Lycoming County Prison. The MH-MR Mental Health Liaison visited the jail once each week to meet with referrals. Lycoming County inmates also had access to a Correctional Counselor. Substance abuse services included drug and alcohol education program from Crossroads Counseling, drug and alcohol assessments from the West Branch Drug 42

43 and Alcohol Commission, outpatient drug and alcohol counseling (funded through a PCCD grant), Narcotics Anonymous, and Alcoholics Anonymous. Monroe County (July 2011) MH/MR administrative case managers (ACMs) went into the jail once per week to assist in identifying and linking individuals to community services and resources Montgomery County (October 2008) Montgomery County Correctional Facility provided specialized housing for inmates with mental illness. The Medical Unit typically served 22 inmates who had active psychoses, while the H2 Unit served approximately 40 higher functioning inmates. MCCF staff reported that specialized housing for this population decreased victimization and reduced the number of incidents. Pike County (June 2012) The Pike County Correctional Facility employed three full-time treatment counselors who oversaw a diverse array of recidivism reduction programs: H.O.P.E. Program (Helping Offenders Promote Excellence) o Provided a minimum of 33 hours of programming a week to eligible female inmates o Voluntary program designed to help inmates address issues of criminality, addiction, self-awareness, and emotional well-being A.R.R.O.W. Program (Actively Reducing Recidivism Opens Windows) o Offered qualified male Pike County offender s intensive rehabilitative programming. o Minimum of 660 hours of programing to approximately 128 participants a year o Vocational Training, Positive Life Skills, Drug and Alcohol Rehabilitation and Spiritual Development. o Upon successful completion, eligible offenders may graduate to the C.O.R.E. Program. C.O.R.E. Program (Correctional Offenders Reintegrating Effectively) o Continuation of rehabilitative efforts through reinforcement of solid work ethic and by learning new skills through community service. M.O.R.E. Program (Motivating Offenders to Reintegrate Effectively) o Available to all male offenders interested in making positive changes in their life. o Designed to provide incarcerated male inmates the opportunity to develop new skills and coping strategies in an effort to promote post incarceration success and community integration. o 12 week program Inmates were also served by an administrative case management caseworker from Carbon-Monroe-Pike MH/DS who goes into the jail on a weekly basis to provide referrals to services in the jail and community. Schuylkill County (November 2010) Schuylkill County Prison contracted with Prime Care Medical, which provides services for medical and mental health needs. The local MH/MR/D&A office provided a mental health caseworker who coordinated services with the Prime Care mental health coordinator. The Mental Health Coordinator (MHC) offered individual as well as group 43

44 counseling. The MHC ran psycho-educational classes on a variety of mental health topics including severe mental illness symptoms, relapse prevention, and re-entry planning. She was employed by Prime Care, the medical services provider. A Mental Health caseworker is assigned to the Prison via MH/MR/D&A department and provided by Service Access Management (SAM). He completed detailed assessments on individuals in the jail, and can provide services following release. Mental health counseling was provided by a Licensed Clinical Social Worker (LCSW) from the Regional Development Corporation (ReDCo). They were funded by local MH/MR/D&A office. In addition, the Sexual Assault Resource Counseling Center (SARCC) provided in-reach services for inmates in need of sexual assault counseling or services. Medical Detoxification is available for individuals who are chemically dependent. Typically the individual was put on a taper for days. Washington County (May 2012) Individuals with mental illness in the Washington County Correctional Facility (WCCF) received services from the Washington Communities Forensic Liaison. The incarceration list from the WCCF was sent out to all three Base Service Units to identify anyone known to the county system. The liaison then reviewed the Unified Judicial System (UJS) Portal to determine the individual s charges, sentencing, etc.; and coordinated with local providers for services. In addition, the forensic liaison conducted court ordered assessments, developed appropriate treatment plans, provided referrals for diversion programs, and assists with aftercare planning. York (September 2011) Primecare Medical was contracted to provide all medical and mental health services within the prison. In addition, MH/MR provided in-jail Intensive Case Management (ICM) to incarcerated clients on a bi-weekly basis. The York County Prison also housed a cognitive behavioral based Quasi-Therapeutic Community Program for substance use treatment. This is a county funded, voluntary program for both pre-trial and sentenced inmates with substance use issues. The prison was currently working with York College on data collection to assess the therapeutic community program and its outcomes. Intercept III Work Groups Several counties developed specialized work-groups to monitor and address issues related to intercept three. Examples include: Bucks County (September 2010) The Bucks County Correctional Facility hosted a monthly meeting to discuss inmates diagnosed with a severe and persistent mental illness (SPMI). The meeting was attended by multiple stakeholders, including representatives from behavioral health services, drug and alcohol services, pretrial services, the public defender s office, and housing specialists. Inmates at all levels of criminal justice involvement (pre-trial through post-conviction) were identified and discussed with regards to services needed and discharge planning. Franklin (April 2009; June 2012) Franklin County Jail hosted a weekly mental health service meeting that included all relevant staff both in and out of the jail along with the Jail Diversion Program and the 44

45 Day Reporting Center. This group reviewed everyone on the mental health list, the acute list, in segregation, and on report in the most recent seven days. The focus is on management and identifying what s the next step for the individuals. The Community Liaison Intervention Project (C.L.I.P.) worker and other staff met monthly to review all inmates in segregation to determine service needs. These meetings could adjust service plans and provide new referrals to better meet individual needs. Lebanon (February 2011) Lebanon County Correctional Facility (LCCF), in conjunction with Crisis Intervention, had a Critical Incident Stress Management Group (CISM) that helped debrief correction officers following crisis situations at the prison. 45

46 Intercept IV: Re Entry Trends Common Gaps/Barriers Encountered A major gap upon an individual s re-entry appears to be the significant time between release and their first psychiatric appointment (50%). Many counties reported poor discharge planning in general (43%), specifically that individuals are being discharged from jail without medication or prescriptions for medication (29%), or with insufficient medication to last until they were linked into community services (40%). Unfortunately, many counties report discontinuation of treatment services and subsequent loss of contact with individuals upon re-entry (26%). Counties also reported significant systemic barriers to successful re-entry. Trouble accessing medical assistance for individuals leaving the justice system is the most frequently cited barrier to re-entry planning (52%), and many counties report significant issues related to lack of housing (52%). Counties also report a general lack of reentry services for people with serious mental illness leaving the justice system (21%). When these services do exist in the community, their effectiveness appears restricted by difficulties in gaining transportation to access services (38%), and a lack of communication between re-entry services (21%). Many counties describe a lack of community mental health providers (14%), and further difficulties obtaining case management services (14%). Half (50%) of the counties provided formal in-jail release planning, and the majority of counties reported release planning related to in-reach from a variety of sources including the county providers (67%), benefits providers (52%), community providers (52%), volunteers (38%), housing (38%), and peers (29%). However, the majority of counties did not endorse formal reentry planning from state prison facilities, with only 12% reporting formalized procedures related to state prison re-entry. The remaining counties (88%) reported some type of informal re-entry planning for individuals returning from state prison. With regard to medication provided upon release, 64% of counties provided some medication in-hand at discharge. Days of medication ranged from zero to 30 days, with a mean of 3.96 days. A minority of counties (12%) provided individuals with medication prescriptions at discharge. Common and Promising Reentry Practices Intercept 4 Reentry Prison/ Reentry Jail Re-entry Several Pennsylvania counties housed innovative re-entry programs related to treatment and medication continuity, housing support, vocational services, and benefits. Several exemplary and promising practices related to re-entry planning and services include: 46

47 Armstrong County (February 2012) Armstrong County s Project HOPE (Helping our Peers Excel) was run through Family Psychological Associates, began in July 2012, and employed two case managers with an average caseload of 6-7 inmates and roughly one referral per month. Case managers met with individuals at the jail to help them complete medical assistance and other paperwork, arrange rides to the Department of Public Welfare office, contact housing providers to set up appointments, call food pantries, and provide other ancillary services when necessary. The case managers also spoke with probation as needed, ensuring their clients were following up with their supervision requirements. Bucks County (September 2010) The Forensic Re-Entry Enhancement Program (FREE) was a PCCD funded program that began providing direct forensic treatment, case management, peer support, and other supportive services in April 2010 focusing on offenders with significant substance abuse histories. The program was a collaboration between the Department of Corrections, Adult Parole and Probation, Aldie Counseling Center, and the Recovery Community Centers. The program was run out of the Aldie Counseling Center in Doylestown with staff located in the jail, and accepted referrals from the County Correctional Facility. Aldie had a psychiatrist on staff which facilitates prompt psychiatric care following release. In addition, the Release and Re-Entry Planning Program was initiated by the Bucks County DOC in It is a 3 day, 6 hour program and was held for both men and women. The program focused on release preparation using a cognitive-behavioral treatment curriculum, and was facilitated by Drug and Alcohol, case management and Adult Parole and Probation staff. Butler County (February 2012) Some Butler County inmates were eligible to participate in a work release program to facilitate reentry planning. This program allowed nonviolent offenders to work 40 hours each week during incarceration. Work release was typically utilized by individuals who were employed prior to incarceration. However, if an offender was able to obtain employment while in jail he/she was also eligible for the work release program. Individuals served by the Justice Related Recovery Team (JRRT) while incarcerated continued to meet with the Licensed Professional Counselor until their benefits were reactivated and they could be transferred to a new mental health provider. These individuals also received more than three days of aftercare medication and had access to as much medication as necessary to sustain him/her until a new psychiatric prescription could be obtained. In addition, the Butler County CJAB established a Prisoner Reentry Committee. At the time of the workshop, the committee was actively working on designing and implementing a Prisoner Reentry Program. Cameron and Elk Counties (October 2014) The CRAFT Reentry Services Program included the development of a CRAFT Community Re-entry Plan (CCRP) that included the Forensic Director, Forensic RN, MH Therapist, Forensic Case Manager, CE MH/MR, Recovery, ESS and CPS supervisor, Community Corrections Officer (Jail), Elcam, Probation, and Alcohol & Drug Abuse Services. The Forensic Case Manager (FCM) referred for services inside and outside of the jail; such referrals included for services from to Elcam Employment Support Services, Recovery, OVR, and Community Nurses, as indicated in the CRAFT 47

48 Community Re-entry Plan (CCRP). The CCRP was individualized and included: MH treatment and services, physical health, Substance Abuse services, Housing Supports, Benefits/entitlements, and Employment/Education domains. The FCM completed the online COMPASS application with the inmate prior to release, and assisted the inmate with accessing SSA benefits as appropriate. The FCM coordinated housing upon release. If Transitional Housing was indicated, the FCM made the referral to the CE B&D s Projects for Assistance in Transition from Homelessness (PATH) housing liaison, who could provide in-reach into the jail. FCM, CPS and other supports follow the person into transitional and/or traditional housing. Additional services as indicated in the CCRP were added. Centre County (April 2015) In June of 2014, with the aid of PCCD grant funding, Centre County began an Offender Reentry Planning Project. As part of the project, a Reentry Coalition was created, and this coalition has met on a regular basis as a subcommittee of the CJAB. The coalition developed a Strategic Reentry Plan, which was approved by the CJAB in July The mission of the Centre County Reentry Coalition was to facilitate and support the successful return of incarcerated individuals to the community. In partnership with government entities, faith and community-based organizations, and other stakeholders, the Coalition utilized a holistic approach that includes an emphasis on education, families, health services, treatment, employment, mentorship and housing. Chester (June 2010) Chester County re-entry Parole planning began six weeks prior to release. Two staff members were dedicated to the Re-entry Unit. They developed home plans, arranged risk and needs assessment, and made drug & alcohol and mental health appointments. Intensive supervision was set for the first 90 days. Assessment and referral to the community Base Service Unit, case management, and mental health providers could be conditions of parole. Columbia (November 2014) Columbia County was part of the Medical Assistance Pilot Program and reported that the program was working very well at the time of the mapping workshop. As a result, benefits were being reinstated when individuals were released from the local jail. Clearfield County (January 2011) Prison Re-Entry in Clearfield County was addressed by the Forensic Liaison, an employee of Service Access & Management, Inc. (SAM). The Pennsylvania Department of Corrections released a quarterly listing of inmates, including demographic information like names and addresses. This list was received by SAM and forwarded to the Forensic Liaison, who would then prepare for county intake, set up aftercare services, and follow the individual into community. Cumberland County (September 2014) The Cumberland County Forensic Case Manager (FCM) provided re-entry services for identified clients with SMI in Cumberland County Prison and state prison. The FCM developed a treatment plan that included plans for housing, mental health treatment, employment options, and benefit applications. The overall goal was to assess the client s needs and make sure those needs were addressed when leaving the jail to provide better continuity of care. 48

49 Delaware County (May 2010) Participants in the Crossroads Program had reentry from jail coordinated by the Forensic Liaisons. The liaisons set up the intake for community services, including the Medical Assistance benefits application, referral for residential supports, outpatient treatment and case management, medications, shelter referrals, and so on. The liaisons would assist with applying for a birth certificate and state identification if needed. If a person needed to go to a shelter, Delaware County provided Connect by Night and the Warming Center, temporary overnight shelter programs operated by the Mental Health Association of Southeast PA and the Salvation Army, respectively. Facility-based shelters, operated by Community Action Agency and City Team Ministries, had varying levels of availability. For other individuals, the REAPP (Reentry Access Prison Program) kept track of all sentenced inmates and was intended to transition persons from the prison. The REAPP prison staff met with inmates 2-3 months before release to develop a discharge plan and would arrange case management for the general population of the prison. Erie (June 2012) The jail ran a monthly Mental Health Planning Meeting to discuss all inmates on the Mental Health caseload for parole planning purposes. This group includes an institutional parole representative, Forensic Specialist from Erie County Care Management (ECCM), Stairways Behavioral Health (SBH) jail mental health staff members, Erie Co D&A case manager, and jail corrections counselors. The team identifies the needs/services of those on a list for parole; e.g. MH, D&A, housing. ECCM met the individual to conduct a holistic assessment. The SBH Jail team collaborated with ECCM and other providers in re-entry planning for inmates with mental health needs. They helped link individuals to appropriate services in the community. The Nurse Practitioner ensured that inmates were typically provided with seven days of aftercare medication and a prescription. In addition, the Erie County Office of Drug and Alcohol Abuse provided a Community Reintegration of Offenders with Mental Illness and Substance Abuse (CROMISA) project with the primary goal of reintegrating offenders from the PA Department of Corrections with mental illness and substance abuse concerns back into their home community. Inmates from Pennsylvania State Correctional facilities, including the Community Correction Centers, the Erie, Crawford and Warren County Jails or in Halfway-back status closer to home could be eligible for the project if they had diagnoses of both mental illness and substance abuse. Fayette County (December 2010) The Forensic Diversion and Re-Entry Program (FDRP) was initiated in 2008 using HealthChoices Reinvestment funding. Initial contact was made with individuals between the preliminary hearing and trial/sentencing phases. The program also established relationships with the Fayette County Prison and several Magisterial District Judges. Individuals were followed for up to 90 days in the community as they were linked to community behavioral health providers. FDRP provides services directly to individuals who were or had been involved with the criminal justice system, including mental health individual and group therapy, case management services, and services addressing cooccurring disorders (including linking these individuals to needed D&A services). Additionally, housing, transportation, and medical care were also addressed. The FDRP treatment team included a Team Leader, Medical Director, Clinician, Case Manager, 49

50 Psychiatric nurse, peer specialist, and clerical support. The team received a list from the Fayette County Jail daily that included commitments, releases, and rosters. In addition to diversion and re-entry programming, this team was involved in crisis management as needed. In addition, Fayette County employed a variety of boundary spanners who provided limited in-reach into the Fayette County Prison and assisted in re-entry initiatives to link individuals with severe mental illness leaving the jail with the appropriate community services. Two blended case managers, from Southwestern Pennsylvania Health Services, Inc., received the majority of the caseload from the Forensic Diversion and Re-Entry Program, and referred them for vocational training, housing and other community needs. The County also had a dedicated Forensic Specialist, who was the contact person to address community integration issues from the County or State Prison. Finally, the Administrative Service Manager was a caseworker with a forensic focus and forensic experience. This position prepared inmates for post-release case management and followed them into the community to enhance continuity of care. The Administrative Service Manager worked primarily with mental health cases, but he also assisted with D&A assessment personnel to overlap efforts and more quickly and completely complete assessments and refer to services. The Forensic Specialist and Administrative Service Manager positions were both funded through the Behavioral Health Administration. Franklin County (April 2009 and June 2012) The Franklin County Reentry Committee met weekly to jointly plan for reentry and communicate expectations to inmates. Participating in this committee were staff from mental health/mental retardation, jail medical/mental health, drug and alcohol abuse treatment services, the Day Reporting Center, and Probation. Assessments included jail classification, risk assessment (LSI-R), and drug abuse screening (TCU drug screen). Community drug and alcohol abuse treatment staff assessed for community placement. Sentencing was scheduled for Wednesdays with a follow up meeting on the following Tuesday. The goals were to improve use of data, avoid letting any individuals slip through the cracks, and coordinate all services/interventions. These goals helped to ensure that each individual was connected to community services and corrections and received the proper level of supervision. Greene County (March 2012) The Greene County Forensic Reentry Program was a 6-12 month post adjudication program, integrating behavioral health treatment and supports, with the criminal justice system. The reentry program provided alternatives to incarceration for offenders whose substance abuse and/or behavioral health problems contributed to their arrest and conviction of a crime. The Forensic Reentry Specialist coordinated services for Nonviolent offenders, who were identified with substance abuse and/ or behavioral health needs. These individuals could be returning to, or remaining in, Greene County. The Forensic Reentry Specialist maintained contact with the District Attorney, Defense Attorney, County Prison and Probation Office, District Attorney, Defense Attorney and Judge. At sentencing, the Judge would also determine whether the client would go directly to treatment or serves time in jail prior to release to treatment. The Forensic Reentry Specialist, on behalf of the justice system, acted as a case manager, making the necessary referrals to meet the behavioral health needs of each individual. The Forensic Reentry Specialist also gathered information from providers and reported back to the justice system to ensure that the individual was complying with recommendations. 50

51 Jefferson County (August 2010) The Forensic Liaison was an administrative case manager, employed by Services Access and Management and funded through Clearfield Jefferson Mental Health/Mental Retardation. The Forensic Liaison was able to provide voluntary in-reach services into the Jefferson County Jail, including conducting an individual assessment of offenders referring offenders to services in the jail or community, and authorizing payment by the Clearfield Jefferson MH/MR Program for those services. Even before Jefferson County inmates receiving Mental Health and Drug & Alcohol services were given a release date, the Forensic Liaison became involved via in-reach services, which ensured continuity of care via Mental Health Blended Case Management. Within 30 days of release, individuals could be referred to Mental Health Blended Case Managers to provide followup services. Referrals went through the Forensic Liaison to authorize funding through Clearfield Jefferson Mental Health/Mental Retardation. The Mental Health Blended Case Manager typically carried a caseload of 30 clients and provided services for approximately 30 days prior to release--and could continue services in the community. Service Access and Management, Inc. (SAM) and the Community Guidance Center provided this service, though SAM offered a forensic specific tract which will be trained in the Critical Time Intervention model of case management (CTI; an empirically supported training model designed to prevent homelessness, relapse, and other adverse outcomes following community re-entry). Among other services, these positions began the process of restarting clients Medical Assistance benefits, typically starting at their first meeting, and getting clients into permanent housing. Lackawanna County (May 2014) The Lackawanna County Prison (LCP) Re-Entry Manager coordinates re-entry services from the local jail. The Re-Entry Manager functions as the liaison between LCP and community agencies, and is responsible for tracking inmates in LCP, developing re-entry plans, and ensuring continuity of care for inmates with behavioral health issues upon release. LCP utilizes the COMPASS electronic system to re-establish public benefits for inmates re-entering society. The protocol at LCP is to provide inmates with 3 days of their medications for aftercare; however LCP administrators report they are able to provide more if needed. In addition, The Lackawanna County Reentry Task Force (LCRTF) is a group of local agencies dedicated to helping those re-entering society from the Lackawanna County Prison System. Members of the LCRTF include a variety of criminal justice, mental health, drug and alcohol, and community service representatives, as well as consumer and family advocates. The LCRTP supports four subcommittees on Housing, Employment, Substance Abuse/Mental Health, and Evidence-Based Practices. Regular monthly meetings are held to obtain community-wide stakeholder participation in learning about the state of reentry locally and to set strategic reentry planning priorities for Lackawanna County. Lancaster County (June 2009) The Lancaster County Reentry Management Organization (RMO) is a coalition of approximately 50 organizations that voluntarily work together. It includes government agencies, private agencies, faith-based and other organizations all united to reduce recidivism. Some organizations focus directly on reentry, while others play supportive roles. Their efforts are not specific to persons with mental illness, but do not necessarily exclude them. Lehigh County (August 2015) 51

52 S.P.O.R.E. was a joint program that supervised those offenders that have mental illness and/or intellectual disabilities that have received a county term of probation or parole. S.P.O.R.E. integrated the criminal justice system of Lehigh County and the Mental Health/Intellectual Disabilities system of Lehigh County. This collaborative effort combined the resources of two systems in order to provide a greater positive impact on behalf of the client. Adult S.P.O.R.E. provided two main functions; one being a diagnostic function/identification and the other a case management/supervision function. A part time psychiatrist and psychologist contracted with Adult S.P.O.R.E. to complete evaluations. These evaluations helped to identify a person s mental health needs as well as provided a diagnosis for appropriate case management assignment within Adult S.P.O.R.E. Another function of SPORE was provided by the SPORE Director and Forensic Case manager in identifying, tracking, and providing Forensic Service input and case management through other areas and collaborations such as Team MISA and Reentry. Luzerne County (July 2013) The Luzerne County Reentry Committee within the jail meets on a bimonthly basis with subcommittees to address specific issues or needs, such as the employment needs of inmates. The committee is comprised of community resources/services that all play a role in the reentry process. Housing, mental health services, drug & alcohol services, faith based community, medical, and employment/education are all represented. Every meeting, an existing housing option or program is presented to educate the committee on resources available. Some issues that the Reentry Committee has addressed include: Continuity of care (specifically Medical Assistance prior to release, availability of medication upon release, more efficient way to make appointments for D&A or MH services upon release). The MA program has been extremely successful in facilitating continuity of care. Increased involvement of CareerLink in the jail (coming into the jail quarterly and educating inmates on job seeking skills and services offered at CareerLink) Employment was addressed by organizing a job fair Lycoming County (May 2011) The Lycoming Pre-Release Center (PRC) is a residential community corrections program for sentenced male and female offenders which houses 105 male beds and 32 female beds in a minimum-security setting. The program is a restrictive intermediate punishment program that provides work training, life skills and substance abuse services. While housed at the facility, residents participate in AA/NA meetings, drug and alcohol groups, GED studies, religious programs, cognitive restructuring groups, a fathering program and a parenting program. In July of 2007, the Pre-Release Center opened a female unit. The Pre-Release Center also houses a Work Release Program. Residents with full-time employment are placed on work release and are charged for room and board. As a resident, responsibilities include paying costs and fines, magistrate fines, domestic support and are paying for required drug tests. When possible, monies are sent to their family or the resident saves money for their eventual release. Residents who are unemployed are assigned to 1 of the 9 community work crews. Overall, the purpose is to train the offender in basic work skills and to improve or acquire other skills. 52

53 McKean County (May 2013) McKean County Juvenile Probation Department received a $10,000 grant from PCCD for the McKean County Offender Re-entry Planning Project. The project was designed to be a 36-month snapshot of prisoner re-entry of state prison inmates returning to McKean County. Project recommendations included: o Increase in-reach into the jail and state prison in order to meet basic needs related to employment, getting identification, and housing. Montgomery County (October 2008) Montgomery County has a planning meeting that includes representatives from the criminal justice system, including the District Attorney s Office and the Public Defenders Office as well as representatives from the Office of Mental Health and the mental health provider community. The Office of Mental Health forwards the list to identified community providers who are then available to go to the prison to meet with the individuals and further assess their needs for a community support plan. This is often done in conjunction with Probation and the MCES Forensic Liaison who helps to coordinate the planning. As part of the Office of Mental Health s continuing commitment to promising practices, the county has piloted the new service of Critical Time Intervention (CTI), which focuses on the development of housing first and supports for persons who are homeless. In addition to supporting transition to the community from the Coordinated Homeless Outreach Center, the new CTI team of four CTI Specialists and one supervisor also supports individuals with severe mental illness as they transition from incarceration to the community. This nine month time-limited program has three phases. Staff from the CTI team have recently joined the monthly planning meeting at MCCF. The MCES Forensic Liaison assists with applying for Medical Assistance benefits behind the walls, applying for Social Security benefits and arranging for identification and outpatient appointments. Inmate Services staff are also able to begin the application for Medical Assistance benefits while the person is still incarcerated. Northampton County (June 2013) The Northampton County Forensic Advocacy Collaboration Team (FACT) was initiated by Northampton County Mental Health in February of The team is comprised of the mental health supervisor and forensic adult transition worker, the Northampton county Certified Peer Specialist, the Deputy Warden of the Northampton County Jail, a corrections caseworker from the jail, three members of the jail treatment team, a supervisor from pretrial services, an adult probation supervisor, and the director of the Northampton County Intake Referral Emergency Services Unit. The team meets biweekly to review and discuss individuals with serious mental health histories and either an upcoming or recent release from incarceration. The primary focus of the team is to determine the needs of each individual (e.g. housing, VA services, outpatient referrals, etc.). Once an individual s needs have been identified, the FACT team works to coordinate the necessary services. The goal of the team is to prevent incarceration and/or hasten release of individuals by providing solid treatment and support planning. In addition, the Northampton County Reentry Coalition is comprised of 70 + individuals who meet on a quarterly basis. Each meeting includes a speaker on a reentry related topic. Schuylkill County (November 2010) 53

54 The Schuylkill County Re-entry Project utilizes the APIC (Assess, Plan, Identify, & Coordinate) Model of Reentry recommended by the National GAINS Center. This model was selected as it recognizes and disperses the responsibility for transition planning to all invested stakeholders including the offender and the family thereby engaging them in the process and moving away from the systems boundaries that impede integrated care. This model also recognizes and allows for procedural differences in handling detainees and sentenced offenders. The program design requires the case manager offering services in the prison to have the skills to employ motivational interviewing techniques to engage the offender, to administer an assessment tool, to develop diagnostics and to develop a service plan based on this tool to a high need, high risk population. This case manager partners with an adult probation officer to conduct the initial assessment and to provide monitoring and assistance throughout the offenders involvement in the project. The project also utilizes peer mentors and family involvement to assist with the creation of a transition plan. In addition, Schuylkill County Service Access Management, Inc. (SAM) plays an integral role in the continuum of care in Schuylkill County. Once an individual is released from the jail, SAM can provide case management with the objective of coordinating mental health services, advocating on behalf of the consumer, and monitoring the consumer's various community services. Service Access Management, Inc. also employs a Forensic Liaison Case Manager who meets with offenders prior to release to help with Medical Assistance paperwork. He also continues to work with them during re-entry to arrange counseling and therapy. Washington County (May 2012) The Washington Communities Forensic Liaison conducts re-entry planning for inmates with mental health needs. She helps link individuals to appropriate services in the community, and often utilizes the 8-bed crisis stabilization unit as a step-down from incarceration. Individuals who are being released to the crisis stabilization unit (approximately 95% of the forensic liaison caseload) typically receive 7 days of aftercare medication. This is sufficient, as a crisis stabilization unit psychiatrist will be available to provide a prescription within the first week of residence at the stabilization unit. Westmoreland County (May 2010) The Westmoreland Case Management & Supports (WCSI) supports a Jail Liaison position (through base funding dollars) that provides mental health re-entry case management. The Jail Liaison follows cases throughout their stay in Westmoreland County Prison and gives priority to inmates ready for discharge. The Jail Liaison also makes referrals to higher level of case management. The WCSI Supervisor of the Forensic Targeted Case Management Unit also works with SCI Greensburg to develop reentry plans for state prison inmates with severe mental illness maxing out of their sentences. The supervisor provides in-reach to SCI Greensburg to conduct intake, develop a treatment plan, and establish appointments for approximately inmates per year. York County (September 2011) York County Prison (YCP) has a Re-Entry Office with two counselors and one supervisor specifically assigned to the task of preparing inmates for reintegration into the community. This service is made possible by the inmate welfare fund. Re-Entry Office services include assistance with: housing, food, employment applications, resume 54

55 writing, medication accessibility, MA benefits linkage, personal finances, etc. In addition, York County Prison operates a Work Release Program. The goal of this program is to allow inmates to maintain their employment while serving their sentence, or to allow inmates to secure employment while in YCP in order to fulfill a Domestic Relations order or to accept a new job offer. Lastly, the Pennsylvania Department of Corrections has a re-entry program pilot site in York County. This was the first pilot site of its kind and serves as a pre-release center for York County residents returning from State Prison. Inmates in this program are eligible for consideration for the work release and HACC programming. 55

56 Intercept V: Community Corrections/Community Support Trends Common Gaps/Barriers Encountered Intercept 5 Community corrections A significant gap in community support for individuals with serious mental illness leaving the justice system is Violation the lack of adequate housing options for this group in the community (55%). Counties report losing funding to develop and support housing options (12%), and having difficulties in linking individuals with those housing options that are available (29%). Specifically, counties report area housing authorities are restrictive in deciding who it will accept into their properties (29%), and are generally unwilling to accept certain populations (e.g., violence crimes, sexual offenders). As a result, many counties report a high prevalence of house Violation juggling or chronic homelessness for individuals with mental illness in the community (21%). Counties report further barriers to community integration for several special populations. This includes lack of housing for special populations (52%) and a general lack of services for special populations (29%), including women, sexual offenders, juveniles, several specific clinical populations (e.g., intellectual disability, autism, traumatic brain injury, dementia). Several counties also report a lack of services for the children and families of this group (10%). Many counties describe their parole and probation officers are overburdened in general (31%), making their ability to provide specialized community supervision for individuals with mental illness difficult. Several counties report not supporting any specialized probation caseloads, or an elimination of such caseloads that once existed in their community (17%). Finally, many counties report significant gaps in a variety of community services for individuals with mental illness involved in the justice system. Community service providers appear to struggle reconnecting individuals to services in general (24%), including medical assistance and treatment services. A significant number of counties report barriers to employment opportunities and vocational training for the population (31%). Peer support services are lacking or underutilized in many counties (31%). Transportation continues to be a barrier to accessing services (38%). Counties report poor communication between community services and the Department of Corrections and their local probation offices (19%). Several counties describe insufficient services and collaboration with their area Veteran s Administration for those with military experience (12%). Several reiterated the lack of psychiatrists and private mental health providers in the community (19%). Finally, some counties report difficulties with providing services to individuals with sub-acute symptoms, or who are clean from substance use due to incarceration, but who still may have treatment needs (14%). Parole Probation COMMUNITY 56

57 Common and Promising Practices Probation and Parole The majority of counties (62%) reported some type of specialized probation services for individuals with behavioral health concerns. Half of the counties (50%) designated specific caseloads for this population, and 45% had staff members dedicated to serving behavioral health populations. In addition, several counties reported specialized behavioral health training for probation officers (31%) or specific assessment practices aimed at screening for behavioral health concerns (33%). A minority of the counties (10%) reported utilization of SCRAM alcohol monitoring bracelet systems to help manage alcohol-related concerns. Several exemplary and promising practices related to probation and parole services include: Armstrong (February 2012) In 2009, as part of the Pennsylvania Commission on Crime and Delinquency (PCCD) grant, Armstrong County implemented the Intensive Supervision and Treatment (IST) Program. This program combines intensive supervision by a probation officer designated solely for this initiative with intensive drug and alcohol treatment and a dedicated Case Manager to provide case management services. The IST team consists of a dedicated probation officer, probation chief, ARC Manor treatment specialist, criminal justice intensive case manager, and a dedicated Case Manager from the Armstrong-Indiana-Clarion Drug and Alcohol Commission. The client is required to meet regularly with the IST team to review progress. Rewards and sanctions are used to acknowledge progress and require accountability of the client. Progress reports are provided to the Judge on a regular basis Blair County (June 2011) Motivational interviewing and other evidence-based practices are incorporated into the work of Blair County probation officers. Bucks County (September 2010) All individuals entering the Bucks County Probation and Parole System are screened using a modified GAINS APIC Model tool. The measure provides a comprehensive picture of the individual including: medical and mental health history, substance use issues, and history of homelessness. In 2005 Bucks County Probation and Parole began an initiative to train staff in evidence-based practice and motivational interviewing. With annual refreshers, all staff have been trained, along with other correctional staff, as well as many Mental Health and Drug and Alcohol therapists and case managers. The emphasis of this initiative is recidivism reduction with offenders under our supervision. Bucks County also has a Behavioral Health funded full-time Forensic Behavior Specialist position, acting as a liaison between probation and the courts. The Forensic Behavior Specialist takes referrals from probation officers regarding individuals who are on the verge of being in violation of parole. She is then able to make home visits and provide motivational interviewing and connection to services such as Medical Assistance, Social Security, food stamps, and transportation. Butler County (February 2012) The Butler County Day Reporting Center Program (DRC) is a Restrictive Intermediate Punishment sentencing alternative that can accommodate approximately 57

58 25 Level 3 and 4 offenders. These offenders must be pre-approved for the program, reside in Butler County, and meet the criteria for drug and alcohol dependency. This program allows them to remain in the community and receive appropriate substance abuse treatment while abiding by all of the rules and regulations of the DRC. The DRC is located at the Adult Probation sub-office. While involved in this program the clients have both a probation officer and a drug & alcohol case manager. Chester County (June 2010) Chester County s Mental Health Protocol is a post-sentence program to provide mental health screenings, case consultation, intensive supervision, treatment and medication monitoring for clients with serious mental illness placed on probation or parole. Compliance with a forensic mental health treatment plan is a condition of probation or parole. This program is a collaborative effort among Adult Probation, the MHMH Board, and the community treatment providers. Two specialized probation officers, each with a caseload of 75, oversee Mental Health Protocol supervision. The probation Department also employs a MH Recovery Court Coordinator, who processes all new referrals and acts as the boundary spanner between the CJ and MH systems Cumberland County (September 2014) In January 2007, Cumberland County Adult Probation launched its Day Reporting Center (DRC) program. This 4-1/2 month program is designed to provide intensive, community-based supervision of non-violent offenders in an effort to provide them with the resources and tools to serve the balance of their sentence in the community rather than in prison. Offenders meet with their probation and parole officer several times per week, maintain full-time employment, complete drug/alcohol treatment, abide by set curfews, complete daily itineraries, attend life skills programming, and report daily to the DRC in person or by telephone. Inmates who are currently serving sentences in Cumberland County Prison or are not residents of Cumberland County are not eligible for this program. The DRC is based on accountability and responsibility, and offenders understand that there is a sanction for any and every violation. Sanctions include, but are not limited to, verbal/written reprimands, increase in mandatory check-ins, reductions in curfews, an increase in breath or urine screens for substance abuse, phase extensions, assignment of community service hours, and referrals for additional training or evaluations. Repeated or major violations will result in the offender being revoked from the DRC program. Offenders who successfully complete each phase will have less restrictive curfews and fewer mandatory meetings with their probation and parole officer. Offenders who complete the DRC program may qualify for a 90-day reduction in the active supervision of their sentence provided their behavior continues to warrant such a recommendation. Erie County (June 2012) Erie County s Mentally Ill Offender Program (consisting of four probation officers) supervises offenders who have been identified as being seriously mentally ill. The program supervises and manages these offenders so they can receive more specific mental health services. The MIO program is a cooperative partnership with Erie County Care Management and Stairways Behavioral Health. Greene County (March 2012) The Greene County Mental Health & Substance Abuse (MISA) Program is designed to help consumers receive immediate access and help in the following areas: probation 58

59 support services, drug and alcohol services, mental health services, vocational rehabilitation and employment seeking, children and youth support services, housing, transportation, and other support services. If a person is involved with Greene County Probation and has a history of mental illness and drug or alcohol problems, he/she may qualify for the MISA Program. Lancaster County (June 2009) Lancaster County Probation Officers with specialized mental health caseloads are partnered with case managers employed by MH/MR/EI to work in teams. The unit is housed in the Adult Probation Department Lebanon County (February 2011) Lebanon County Adult probation and parole has a designated Intensive Mental Health Caseload Probation Officer and an MH/MR/EI Forensic Caseworker that collaborate on the handling of offenders with mental health diagnoses. This Intensive Mental Health Caseload (IMHC) is limited to approximately 35 individuals (approximately 2% of the probation/parole caseload). IMHC participants are selected based on past history, diagnosis, and medication. The program requires weekly meetings with both the IMHC Probation Officer and Forensic caseworker and provides offenders with assistance for housing, vocational/educational advancement, counseling, medication access, and other ancillary services as required. The intensive supervision and case management model is designed to reduce recidivism and provide support for symptom management. Lycoming (May 2011) The Specialized Supervision Program was established in 1984 to meet the needs of offenders with mental challenges and mentally illness under the supervision of the Adult Probation Department and who are incarcerated offenders in the Lycoming County Prison. The objective of the Specialized Supervision Program is to build competency in adjudicated offenders so the individual functions successfully within the community. The Specialized Supervision Program currently employs one targeted case manager (TCM), and two probation officers. The TCM and probation officers work closely to provide supervision, with offices in the Targeted Case Management office. Montgomery County (October 2008) The Montgomery County Mental Health and Co-occurring Disorders Unit has four officers (three supported by grant funding) that manage MH cases. The majority of the offenders have dual diagnoses of mental illness and substance use disorders. The probation officers in this unit approach their work as a partnership between the officers and the treatment community to increase adherence to treatment and improve public safety. A significant number of violations are handled therapeutically by the officers resulting in inpatient placements rather than re-incarceration, consistent with the emphasis on jail as a last resort. Mental Health Unit probation officers are required to have at least 40 hours of continuing education each year. The average tenure on the job is 15 years. The officers also participate in the Montgomery County Forensic Task Force administered by MCES. Schuylkill County (November 2010) Schuylkill County has an Intensive Parole Unit (IPU) that serves individuals with behavioral health needs. In determining a person's eligibility for Intensive Supervision the Wisconsin Risk/Need Assessment Scale questionnaire is used. The questionnaire 59

60 consists of 24 numerically stored variables related to the offender's past and current activities (e.g., academic/vocational skills, employment, marital family relationships, companions, alcohol usage, other drug usage, etc.). The rationale is that as need areas are addressed, the risks the offender poses to the community are reduced and less supervision and contact will be required to manage him/her in the community. Probation and Parole also operates a Schuylkill County Vocational Rehabilitation with Addicted Offenders (SCVR) Program. It was created to provide structured rehabilitative services for offenders who have a substance abuse problem and have been chronically unemployed or underemployed. The specific aim is to increase employability of offenders following parole in the community by offering vocational rehabilitative programs. Somerset County (December 2011) Somerset County s Specialized probation officers include intensive officers who focus on drug and alcohol, mental health, domestic violence, and sexual offenses (three adult and one juvenile intensive officers); an institutional parole officer; and a victim liaison. York County (September 2011) York County Probation has a specialized Mental Health Caseload that was created in 1999 and consists of two officers who work with offenders diagnosed with severe mental illness/mental retardation issues. York County Probation also operates a Day Reporting Center. This initiative is an Intermediate Punishment program that is an alternative to incarceration. It targets non-violent offenders who would normally receive a long county jail sentence or a short state prison sentence. In order to be eligible an offender may not have a current conviction or a conviction for a violent offense in the last 10 years, they must meet DSM-IV criteria for dependency and they must fall within levels 3 or 4 according to the Pennsylvania State Sentencing Guidelines. The Day Reporting Center (DRC) provides high accountability through daily reporting, drug screening, curfews, electronic monitoring and employment/community service coupled with appropriate levels of required substance abuse treatment and counseling. Housing Nearly every county (95%) reported that housing services were available to local residents, however more than half of the counties (55%) cited housing difficulties as a major barrier to successful re-entry and community integration. This is likely because of a lack of specialized (behavioral health and justice) individual (33%) and group (29%) housing options. Similarly, over two thirds of the counties (71%) reported that housing subsidies were available, but only 19% described subsidies for specialized populations. Several exemplary and promising practices related to housing include: Bucks County (September 2010) The Bucks County Local Housing Options Team (LHOT) has a Forensic Housing Subcommittee to improve housing options for those with mental health or substance use disorder issues and involvement in the criminal justice system. The Bucks County Housing Coalition (BCHC) is a coalition of public and private/nonprofit agencies working together to address the housing and social service needs of Bucks County s homeless population. The BCHC strives to assure the availability and sustainability of 60

61 housing for homeless persons and/or persons facing homelessness, including persons leaving the criminal justice system. Butler County (February 2012) The Center for Community Resources (CCR) operates a Homeless Case Management Program, which provides permanent supportive housing assistance for chronically homeless, disabled consumers (over the age of 18) with a mental health disorder and/or struggles with substance abuse. Housing is provided at various apartment locations. CCR housing Services include: o Emergency Shelter o Outreach and Advocacy o o o Permanent Supported Housing Case Management Life Skills Training o o o Peer Support Vocational/Educational Support Participant Savings Plan In addition, Irene Stacy Community Mental Health Center provides a Transitional Care Center for Mental Health. This 16-bed residential facility is a long-term structured residence and is a collaborative effort between the Department of Veterans Affairs Medical Center in Butler, Butler County MH/MR/D&A Program, and the Irene Stacy Community Mental Health Center, with additional support from Armstrong County and Value Behavioral Health. The Transition Care Center aims to enable individuals to avoid State Hospitalization and receive extended care within their community. Residents typically remain at the Transitional Care Center for an average of 4-6 months. Carbon County (October 2011) Carbon County s Crossroads Community Services began as a permanent supportive housing program providing service to people who have serious and persistent mental illness, and who have experienced homelessness. Services include rental subsidy; case management; individual recovery planning; links to community resources; life skills education; coordination of educational and vocational training services; and coordination of medical, dental and mental health services. A permanent supportive housing program serves homeless individuals or families with an adult member who is disabled due to a serious and persistent mental illness. Intensive case management provides recovery-oriented services to people with serious mental illness. Services are provided to persons residing in Carbon, Monroe and Pike counties. Centre County (April 2015) The Centre County Board of Commissioners, following a recommendation from the County Criminal Justice Advisory Board (CJAB), engaged Diana T. Myers and Associates, Inc. (DMA) to conduct a study focusing on the housing needs of people with mental illness involved with the criminal justice system in Centre County. The goals of the study were to: collect and analyze data on the target population; determine the resources and gaps in the existing criminal justice, mental health and housing systems; and to recommend strategies for filling those gaps. Delaware County (May 2010) 61

62 The Office of Behavioral Health maintains 330 facility-based beds for persons with mental illness. When a vacancy occurs, priority is given to the forensic, criminal justice/mental health population; however the number of facility-based beds is finite. There are also approximately 185 supported housing slots available, most of which are in scattered apartment sites and subsidized with tenant-based Bridge subsidies. Erie County (June 2012) The Housing Support Team assists consumers of mental health services find and keep safe, affordable housing through peer support, education and advocacy. The team is staffed by consumers, many of whom have experience living in low income and/or subsidized housing. Most of the team members are Certified Peer Specialists. The following housing support services are targeted to mental health consumers residing at selected residential locations: On-site individual and group peer support and education. Liaison and advocacy for services that can support consumers to find and sustain housing arrangements of their choice. Hands-on assistance with life skills including, but not limited to, problem solving, budgeting, hygiene, housekeeping, relationship skills, credit building, and communication skills. Limited transportation necessary to help consumers access services that help them maintain housing and pursue mental health recovery (appointments, shopping, events, activities, etc.) Development of individual recovery plans relevant to housing. Assistance in navigating the mental health and other human service systems Help for consumers moving into the lodge on Sass or Columbus Apartments. Close collaboration with selected residential agencies, blended case managers at Lakeshore Community Services and Stairways Behavioral Health, Inc., helping ensure successful community experiences for mental health consumers. Franklin County (April 2009 and June 2012) The Homelessness Prevention and Rapid Re-Housing Program provides financial assistance and services to prevent individuals and families from becoming homeless and help those who are experiencing homelessness to be quickly re-housed and stabilized. The funds under this program are intended to target individuals and families who would be homeless but for this assistance. The funds can provide for a variety of assistance, including: short-term or medium-term rental assistance and housing relocation and stabilization services, including such activities as mediation, credit counseling, security or utility deposits, utility payments, moving cost assistance, and case management. In Franklin County, these funds are often used to assist individuals who are sentenced to fewer than six months in jail. Franklin County also has a forensic housing reentry initiative. Indiana County (March 2011) 62

63 The Armstrong-Indiana Mental Health/Mental Retardation Program runs a Master Leasing Program for five properties, all of which house individuals with criminal justice backgrounds and mental health or co-occurring challenges Lackawanna County (May 2014) Step-by-Step, Inc., provides a variety of housing services in Lackawanna County. Step-by-Step supports a co-occurring housing facility with six singleoccupancy furnished apartments, as well as three double-occupancy furnished apartments specifically for individuals with mental health issues. Both of these facilities are staffed 24 per day, 7 days per week, and currently provide housing for participants in the Court of Common Pleas Mental Health Court and Co-Occurring Court Luzerne County (July 2013) The Volunteers of America Master Leasing Program provides rental assistance for safe and affordable housing to adults with legal difficulties and suffering serious mental illness and/or substance abuse issues. The program aims to provide community supports, education and financial assistance with housing and housing needs so that individuals will be able to live independently within the community. The program serves clients by assisting them to build a strong foundation through housing stability, obtaining a steady income, living on a budget, improving natural and community support systems, and improving/alleviating systems. The consumers are referred by the Luzerne County MH Court or the Luzerne/Wyoming MH Program. Under the supervision of a housing specialist, the goal is to work collaboratively with the consumer s case manager, parole officer and other support team members to develop an individualized program of success. The three major goals that are addressed by the Housing Specialist are: Job & Income Stability Locating and Maintaining Housing Mental Health/Drug and Alcohol Reduction of Symptoms By working closely with landlords, housing authorities and existing programs to assist clients by leasing or sub leasing affordable and safe housing, the program can enable clients to find stability. The ultimate goal is to assist the individuals to become responsible community members and to live selfsufficiently. Lycoming County (May 2011) Lycoming-Clinton has a Supported Housing Unit, which houses 16 individuals with forensic involvement. McKean County (May 2013) McKean County s NW9 Master Leasing/Bridge Subsidy program will provide recurring housing coupons for people with a history of criminal justice involvement who have difficulty accessing housing resources. This nine county initiative is intended to serve those who have difficulty accessing housing. In addition, the local Oxford House accepts individuals with criminal justice involvement. 63

64 Union County The Justice Bridge Housing Program/Family Self Sufficiency Program (JBHP) was established in 2011 between the Union County Jail and Union County Housing Authority. The JBHP is partially funded through the Pennsylvania Commission on Crime and Delinquency (PCCD) and the Department of Public Welfare, Office of Mental Health and Substance Abuse Services (DPW/OMHSAS). Forensic Peer Support The majority of counties (74%) reported that residents had access to some type of peer support service within the county, however fewer described forensic (29%) or other specialized (12%) peer support services. Two counties (Butler and Armstrong) had access to local forensic peer trainers within the county. Several exemplary and promising practices related to peer support services include: Cameron County (October 2014) Beacon Light Peer Support Services are intended for those presenting with mental illness that require, and are likely to respond to, therapeutic intervention. Individuals who have the capacity for participation in an individualized plan of care directed towards improving life skills and who are receptive to services in an unstructured environment without professional presence are appropriate. Union County (March 2014) At the time of the workshop, Union County indicated that local peer specialists would be attending a training related to military personnel and families. Vocational Services A little over half of the counties mapped (52%) described general vocational services, and 14% reported specialized vocational services for individuals with behavioral health and justice involvement. Several exemplary and promising practices related to employment services include: Butler County (February 2012) The Starting Over After Record (SOAR) workshop, facilitated by the Center for Community Resources, is offered weekly in the One-Stop. Co-facilitated by the local crisis intervention agency, the county s drug & alcohol program, the Office of Vocational Rehabilitation (OVR) and the One-Stop, the workshop is designed to provide the support and community connections needed by ex-offenders in order to stabilize their lives and get the needed assistance while also learning job search techniques and assessing their own skills to prepare for employment. The majority of SOAR participants are individuals with co-occurring disorders. Lackawanna County (May 2014) The Employment Opportunity & Training Center (EOTC) provides a variety of vocational and related services for Lackawanna County. Workforce development services include a job search group, resume and interview preparation, and 64

65 career advising and coaching. Through its court-related programs, EOTC supports employment services and life skills training (including alcohol and drug programming) for approximately non-incarcerated male offenders. EOTC also provides individual case management, job coaching, and a variety of resources in collaboration with Adult Drug Court and Lackawanna County Adult Probation/Parole Office, and operates a Transition Support Group for participants in the Reentry Court. In 2011, EOTC started a weekly support group for courtinvolved women. EOTC also supports a weekly support group for justice-involved women. Behavioral Health and Community Services Over a quarter of the counties described county-sponsored specialized services (29%) or case management (29%). Community based specialized options were more prevalent, with nearly half of the counties (45%) reporting community based specialized services and 38% describing community based specialized case management. Several exemplary and promising county/community- based behavioral health services include: Bucks County (September 2010) The Bucks County Forensic Assertive Community Treatment (FACT) program provides community-based psychiatric treatment, outreach, rehabilitation, and support to individuals with severe mental illnesses and/or cooccurring substance use disorders, who were recently released from Bucks County prisons. Support is available 24 hours a day, 7 days a week. A crisis line is also available Cameron and Elk Counties (October 2014) Beacon Light s Mobile Medication Management is a voluntary, community delivered service for adult Health Choices eligible consumers. It is for adults 18 years of age and older with a serious mental illness that experience difficulties progressing toward recovery due to the inconsistent adherence to a prescribed medication regimen. The Mobile Medication Program is a recovery focused service that allows individuals to be educated about their medications and trained to develop skills to manage their medication effectively in order to control symptoms and increase community tenure. Members of the team act as liaisons between the prescriber and the consumer to help establish better communication and to help integrate the consumer back to an outpatient setting where they will advocate more effectively for themselves with their prescribing clinician. The Mobile Medication Team operates 24 hours a day, 7 days a week, including weekends and holidays. Erie County (June 2012) The Stairways forensic outpatient program provides a structured, intensive and clinically driven team approach that includes group and individual counseling, in-house psychiatric care and prescription management. Stairways doctors and professionals currently provide service and medication management within the Erie County prison system, offering exclusive continuity of behavioral health care upon each client s release. This program is designed to bridge 65

66 services between the Erie County Prison and the Forensic Clinic. In addition, the Stairways Forensic Blended Case Management Team is routinely assigned to criminal justice involved individuals who are diagnosed with a co-occurring disorder, or to individuals who may be at high risk of criminalization due to behavioral health and substance abuse concerns. Case managers are trained in the early detection and intervention of co-occurring symptoms that may lead to the psychiatric decompensation of the individuals they serve, including those with criminal justice involvement. Case managers use a variety of diversion strategies depending upon the circumstances. These strategies may include: consulting with and making recommendations directly to local Judges, District Justices, Attorney/Public Defenders, Police and Probation/Parole officers in regards to mental health treatment, community mental health resources and general mental health education as alternatives to arrest. As a standard practice, case managers work in collaboration with community stakeholders, which may include the following: SBH Forensic and Dual Outpatient Clinics, other community behavioral health and substance abuse organizations, the criminal justice system (i.e., Mental Health & Drug Treatment Courts, Probation & Parole), the Department of Corrections, vocational/educational organizations, and programs that provide entitlements and benefits (i.e., Social Security, Department of Public Welfare, and U.S. Department of Housing and Urban Development). The Forensic Management Team has a formal relationship with probation and parole officers, treatment and drug court judges, and district attorneys and public defenders. These professional relationships are based on on-going weekly collaborations, and a long-term history of established clinical competency and positive outcomes. Fayette County (December 2010) Fayette County has a specialized mental health outpatient clinic to provide outpatient services to individuals who have completed Mental Health Court and continue to need this service. The clinic, created in September 2010, works with anyone with mental illness who has had criminal justice involvement. The clinic is funded through Reinvestment Act funding, Medical Assistance, and an alternative payment arrangement for clients. Lawrence County (August 2013) The Lawrence County Drug and Alcohol Commission also runs an 8-week Criminal Justice Intervention Group for at risk individuals. In addition The Lawrence County Mobile Medication Services of HSC are available to individuals who have difficulty managing medications on their own. The service provides support, education, and skill building for individuals to become independent and responsible for their medications. To be eligible for the program the individual must be 18 years or older with a psychiatric diagnosis, a history of inpatient psychiatric hospitalizations, and be a resident of Lawrence County. The staff members are comprised of a psychiatric nurse manager and mental health workers, all of whom have knowledge of medications and experience in the psychiatric field. The program is designed in a six-step system. Step One is the most intense as the individual will be visited for every dose of medication ordered. Step Two is a daily visit. Step Three is a visit three times a week. Step Four is a visit twice a week. 66

67 Step Five is a once a week visit. Step Six is a weekly phone call to keep in contact with the individuals for support before they are discharged from the program Lehigh County (need date) Lehigh Valley Assertive Community Treatment was a recovery-focused, multidisciplinary, assertive community treatment program that provided intensive, individual support for people in Lehigh and Northampton counties who were working to overcome the barriers to recovery from mental illness. The Assertive Community Treatment Team provided: Psychiatric assessment, medication education and monitoring, treatment for co-occurring disorders, Dialectical Behavioral Therapy, psychosocial services and education (including Wellness Management and Recovery, SAMSHA evidence-based IMR) and intervention help strengthen the individual's networks. Blended Case Management Services afforded the collaborative coordination of services and resources supportive of recovery and growth. Individuals worked with case managers to increase personal and financial independence, overcome barriers compromising access to treatment, build and expand capabilities in roles and relationships within the community and, acquire skills to support selfdetermination and self-management of the symptoms or challenges related to their illness. HUD funding allowed LVACT to respond to the residential needs of participants who have been diagnosed with a serious, persistent mental illness and have histories of homelessness. Pike County (June 2012) The Pike County Assertive Community Treatment (ACT) and Forensic Assertive Community Treatment (FACT) teams provide a continuum of treatment to minimize the need for psychiatric hospitalization and maintain housing stability for adults experiencing significant challenges living successfully in the community. It is an outcome focused treatment program that utilizes Evidence Based Practices (EBP). The program features a small professional to individual case ratio as well as a significant psychiatric, nursing and mental health professional supports. Frequent and intensive contacts assist individuals in developing and maintaining community housing, vocational or educational placement, and consistency in mental health treatment. 67

68 Summary of Common Priorities Subsequent to the completion of the Cross-Systems Mapping exercise, assembled stakeholders define specific areas of activity that could be mobilized to address the gaps and opportunities identified in the group discussion about the cross-systems map. The workshop participants identify priority areas and then individually vote for their top three priorities to address moving forward. Below is a ranking of most common identified priorities from 42 mappings. Priority % (#) of counties that cite as a top 5 priority % (#) of counties that cite as lower than top 5 priority Total % (#) of counties that cite as priority* Housing 60% (25 counties) 17% (7 counties) 74% (31 counties) Training at Intercept 1 52% (22 Counties) 26% (11 counties) 69% (29 counties) Continuity of care from local jails to 52% (22 Counties) 19% (8 counties) 62% (26 counties) community Improve communication, partnership, 31% (13 counties) 21% (9 counties) 50% (21 counties) collaboration Intercept as early as possible (Intercept.5) 26% (11 counties) 7% (3 counties) 33 % (14 counties) Intercept 2 Diversion 26% (11 counties) 21% (9 counties) 43% (18 counties) Information Sharing and Tracking 24% (10 counties) 12% (5 counties) 33% (14 counties) Cross Training and Education 12% (5 counties) 14% (6 counties) 26% (11 counties) Expand use of peers (forensic, certified 10% (4 counties) 26% (11 counties) 36% (15 counties) recovery specialists, etc.) Expanding/Linkage to Benefits (outside of 5% (2 counties) 17% (7 counties) 21% (9 counties) reentry) Employment 5% (2 counties) 14% (6 counties) 19% (8 counties) *Some counties list a sub-set of a priority twice. For example, Crisis Intervention Training (CIT) could be listed as Priority 1 and Mental Health First Aid (MHFA) training could be listed as priority 8. In those cases, the total number of counties that cite the priority is not counted twice in the last column. 68

69 Follow Up Technical Assistance Mappings In addition to the cross systems mapping workshops, counties can request a 1-day follow-up mapping to re-address their original action plan, cross-systems map, and gaps and opportunities. To date, the CoE conducted six follow-up mapping workshops, with an additional follow-up workshop scheduled in Key stakeholders in previously mapped counties can request a follow-up workshop in order to inform new stakeholders of the Sequential Intercept Model, as well as update each other on changes that have occurred since their original mapping. The Pennsylvania Mental Health and Justice Center of Excellence facilitates a one-day technical assistance meeting and update to this workshop. Technical assistance provided included: Updating the orginal map to include all current systems and services; Identifying new/different resources, gaps, and barriers in the existing systems; Reexamining the original action plan for progress, barriers, and concrete next steps; A description of each intercept along with identified gaps and opportunities; Identifying current priorities for change; and Developing an updated action plan to address these needs. Some concrete examples of growth that occurred from a mapping that were reported during a remapping include: Blair County Action Plan 2011 identified Mental Health First Aid and Crisis Intervention Team (CIT) training as priority area three and seven. During the 2015 remapping the county reported: o Blair County was one of the first counties in the country to offer MHFA for public safety personnel. o Roughly 150 law enforcement and/or criminal justice practitioners were trained in MHFA, representing 40%-50% of the total police force in the county. o The county received funding from Pennsylvania Commission on Crime and Delinquency (PCCD) under the Specialized Behavioral Health Training for Law Enforcement grant for CIT Training. o To date, there have been two classes conducted with over 50 law enforcement officers, jail correctional officers, crisis workers, and probation officers trained. It was reported at the 2014 remapping in Monroe County that as a result of the 2011 mapping in Monroe County, Carbon-Monroe-Pike (C-M-P) MH/DS receives a regular daily census list from the Monroe County Correctional Facility that is provided to the new forensic case manager for follow-up. The average daily admissions of C-M-P MH/DS clients into the jail at any time is roughly 4 individuals. During the Monroe County remapping it was reported that in response to the identified needs at Intercept I during the July 2011 Cross Systems Mapping, 69

70 Monroe County has been implementing Crisis Intervention Training (CIT) and Mental Health First Aid (MHFA) training. Monroe County Action Plan 2011 identified improving re-entry to facilitate aftercare as priority four. During the 2014 remapping the county reported: o The Forensic Case Manager works with inmates to get Medical Assistance (MA) benefits turned on immediately after release. The county has been successful with the collaboration of C-M-P MH/DS and jail staff to have the MA health standing forms completed and signed by jail psychiatrist and MH clinician 10 days prior to release. During the Fayette County remapping it was reported that in response to the priority area one, Intercept 1 issues, during the December 2010 Cross Systems Mapping, Fayette County began exploring and implementing Crisis Intervention Training (CIT). o Fayette County provides ongoing monitoring by utilizing data sheets (tracking arrest, injuries, etc.), which are submitted to Fayette County Behavioral Health Administration (FCBHA) by a CIT officer after receiving a CIT-related call. This information is then shared with the appropriate treatment provider. To date, 64 reports were submitted; no officer injuries; only 3 arrests. 70

71 Top Priorities for Franklin County Housing (22 votes) 2. Improved Information Sharing (19 votes) a. Data at front door of jail i. Even when Missy is not there 3. Earliest identification and diversion (12 votes) a. Increase diversion opportunities at police contact b. Develop expanded alternatives to arrest c. Drop off points, non-hospital, and crisis beds 4. Explore broad range of engagement strategies (10 votes) a. Develop effective treatment and supports to help people recognize their mental illness b. Peer specialists from beginning to end 5. Recruit and keep psychiatrists/psychiatric nurse practitioners (9 votes) 6. Cross-system education (9 votes) 7. Increase strategies to get benefits back (4 votes) 8. Expand Pretrial Release and Jail Diversion Programs (3 votes) 9. Develop more strategies to increase non-county funding sources for human services (3 votes) 10. Increase transportation options (3 votes) 1. Expand housing options (30 votes: 19 regular, 11 high priority), especially to sustain efforts 2. Address gaps in transportation (22 votes: 16 regular, 6 high priority) 3. Continuing funding in a tough fiscal environment (20 votes: 12 regular, 8 high priority) 4. Continue to improve information sharing (16 votes: 14 regular, 2 high priority) 5. Crisis Intervention Team (12 votes: 10 regular, 2 high priority) 6. Expand supportive employment (11 votes: 9 regular, 2 high priority) 7. Expand family support (9 votes: 9 regular) 8. Continue cross systems education (7 votes: 7 regular) 9. Continuity/System for dealing with D&A defendants in Criminal Justice system (6 votes: 3 regular, 3 high priority) 71

72 Franklin County Cross Systems Map 2009 Franklin County Follow-Up TA Cross Systems Map

73 Additional Outcomes Seven of nine (78%) counties receiving an award under Pennsylvania Commission on Crime and Delinquency (PCCD) s Specialized Behavioral Health Training for Law Enforcement grant participated in a cross systems mapping prior to being awarded these funds. At the Second Annual CIT Statewide Meeting, Armstrong County reported that the mapping facilitated subsequent CIT training. The number of individuals trained in each of the nine award sites is below. SPR 9 Funded Sites Training Numbers Individuals Trained from from April April Number of Law Enforcement and/or Criminal Justice Practioners Trained Number of Individuals Diverted from April April Number of Adult Individuals Diverted Number of Juveniles Diverted Number of Veterans Diverted

74 Sullivan County Commissioner Darla Bortz recently reported the following as a result of their Cross Systems Mapping in July 2015: o We have accomplished several things to advance the care of our citizens. We have identified ways to assist in our jail and we have encouraged an agency to provide some services in our county. We thank you for the assistance that you have given us to explore opportunities for our residents. We have met with the warden of the jail system and our residents of Sullivan County will receive the same treatment as the Columbia county residents. - from Commissioner Bortz sent on November 2 nd

75 Measuring Mapping Impact: Three Levels of Evaluation To capture the impact of completed Cross System Mappings conducted by the Pennsylvania Mental Health and Justice Center of Excellence, a three part evaluation process is used. It assesses the mappings impact on county collaboration, progress in implementing local action plans, and success in addressing gaps identified in the mappings. Information for the mapping assessment process includes: 1) an evaluation completed by workshop participants during the cross systems mapping; 2) an online survey completed approximately six months after the mapping workshop and 3) a telephone interview completed, on average, nine months after the completion of the mapping workshop. Cross-Systems Mapping in Pennsylvania: (Date Ordered) Franklin (mapped by GAINS Center, pre-pa Center of Excellence) Lancaster (mapped by GAINS Center, pre-pa Center of Excellence) Montgomery (mapped by GAINS Center, pre-pa Center of Excellence) Philadelphia (mapped by GAINS Center, pre-pa Center of Excellence) 1. Westmoreland May Delaware May Chester June Jefferson August Bucks September Schuylkill November Fayette December Clearfield January Lebanon February Indiana March Lycoming May Blair June Monroe July Clarion August York September Carbon October Somerset December Armstrong February Butler February Greene March Washington May Pike June Erie July McKean May Northampton June Luzerne July Lawrence August Warren November Union County March Lackawanna May

76 31. Cumberland - September Elk County & Cameron County October 2014 (Joint Mapping) 33. Columbia November

77 Level I: Workshop Evaluation and Feedback At the conclusion of each mapping workshop, participants are asked to complete a feedback and evaluation form. The information from 32 mappings is summarized below. On average, 24 participants from a variety of county services completed the 32 surveys. Some mappings were of joiner counties, and the number of participants providing information is thus lower than the number of counties mapped. The highest rates of completed responses were from mapping participants working in the mental health and criminal justice systems, with 37% and 26% response rates, respectively. A total of 10 questions are asked and ranked on a scale from 1 (strongly disagree) to 4 (strongly agree). Across all workshops and all 10 questions, the responses ranged from 3.40 to 3.84, demonstrating high levels of satisfaction with the workshop (see Figure 1). Figure 1: Average Evaluation Ratings Across all Workshops Questions Seri Although there are no significant differences between questions we note that the highest rated question (question 7) is in regard to the expertise of the facilitators and the lowest rated (question 2) is related to the development of attainable, low-cost action steps. More specifically, results from the evaluations indicate that the mappings helped identify gaps and opportunities, as well as prepare the county for systems change as a result of the action plan developed during the mapping. Please see below for detailed results from 32 county mapping participants. Figure 2: Average primary role of CSM participants 77

78 Social Services 6% Consumer 2% Housing 4% Substance Abuse 14% Other 17% Criminal Justice 26% Mental Health 37% Questions: (Strongly Disagree=1, Disagree=2, Agree=3, Strongly Agree=4) Note: There are two slightly different sets of questions used in the cross systems mapping workshop evaluation to date. The original questions were used in Westmoreland, Delaware, and Chester Counties. Questions were then slightly altered for the remaining mappings. Below, red indicated the original questions asked and black is current wording for the evaluations. 1. The Cross-Systems Mapping exercise helped identify resources, gaps and duplication in our community and prepared us to implement systems change. (The Cross-Systems Mapping exercise effectively helped us to collaboratively identify resources, gaps and duplication in our community and prepared us to implement systems change.) 30% 70% Strongly Agree Agree 78

79 2. The Action Plan developed during the workshop contains several attainable, lowcost action steps that will likely result in positive changes. (The Action Plan developed during the workshop contains several attainable, low-cost action steps that will likely result in positive changes in our community) 2% 54% 43% Strongly Agree Agree Disagree 3. The workshop provided opportunities for networking and information sharing. (The workshop provided ample opportunities for networking and information sharing among all participants and nurtured cross-system collaboration in our community) 5% 1% 74% Strongly Agree Agree Disagree 4. Overall I am satisfied with the content and the quality of the workshop. (overall quality of the workshop) 34% Strongly Agree 66% Agree 79

80 5. The workshop was well organized (workshop organization ) 25% 75% Strongly Agree Agree 6. Relevant examples were given during the presentations (adequacy of relevant examples given) 1% 35% 64% Strongly Agree Agree Disagree 7. The facilitator(s) demonstrated a high level of expertise on the subject matter presented (expertise of facilitators) 15% Strongly Agree Agree 85% 8. The facilitator(s) were well prepared concerning key issues and needs of the community (preparedness of facilitator about key issues and needs of the community) 80

81 1% 22% 75% Strongly Agree Agree Disagree 9. Training materials and resources provided were helpful (training materials and resources) 1% 44% 53% Strongly Agree Agree Disagree 10. There was opportunity for engagement of all participants, including consumers, mental health, substance abuse, criminal justice, housing and social service providers (engagement of all participants, including consumers, mental health, substance abuse, criminal justice, housing and social service providers) 2% 22% 73% Strongly Agree Agree Disagree 81

82 Level II & III: Workshop Follow-Up Survey A two-part follow-up survey was used to assess the impact of the mapping workshops on how counties collaborate, their progress in implementing local action plans, and their success in addressing gaps identified in the mappings. The two parts include an 1) online survey and 2) a telephone interview, both begun in the summer of Online survey Surveys are distributed broadly to mapping workshop attendees to obtain an assessment of impressions regarding the mapping workshop approximately six months later. What is currently an online survey was initially distributed via to workshop participants from 12 counties. At that time, responses were returned from 8 of the 12 counties. In response to the important feedback gathered from a broad range of workshop attendees, the CoE has systematically conducted this survey 6 months after each cross systems mapping workshop. A total of 26 follow-up surveys from 34 counties mapped have been collected 3 ; results from the Level II online survey are summarized below. Telephone Interview The online survey and the telephone interviews cover many of the same domains of information but they are distinguished by the specificity in the information obtained. The telephone interviews are conducted with one knowledgeable representative from each county on average 9 months after the mapping workshop. The primary purpose of the interview is to gather more specific information about the outcomes of the workshop in the areas of operations and collaboration within the county as well as progress on the action steps identified during the mapping workshop. Typically the individual interviewed was also the county facilitator for the mapping workshop. Information gathered in the 29 interviews completed to date is summarized below. Telephone follow-up interviews are not available for Elk/Cameron and Cumberland counties because sufficient time has not passed since their workshops. The interviews with Armstrong and Clearfield counties were inadvertently missed. *** Level II: Online Survey The online survey is distributed to workshop participants via through the Qualtrics Survey system. There were a total of 26 counties that participated in a follow-up online survey. On average, there was a 43% response rate from cross systems mapping participants (See Appendix A). Results from the online surveys indicate that the mappings have fostered increased collaboration and significant progress in each county s action plan. Roughly 83% of the survey respondents perceived the mapping as improving the county s ability/willingness to collaborate across systems. In addition, 82% of respondents reported that the action plan developed during the mapping was helpful to the initiation or continuation of programs in their counties. Finally, 96% of the respondents indicated that they would recommend the mapping workshop to other 3 Four counties did not respond to the initial follow-up survey that include, Jefferson, Lebanon, Indiana, and Blair County (4). Additionally, there is a missing follow-up survey report from York County (1). Lastly, it is too early to collect 6-month follow-up data from three counties (3). This is a total of eight counties mapped not included in this report as of 4/22/15. 82

83 counties in Pennsylvania. Please see below for detailed results from 26 county mapping participants. 1. What is your PRIMARY role in your county? Other 17% 911/Emergency Services 3% Consumer/Family 2% Criminal Justice 33% Substance Abuse 7% Housing 3% Mental Health 26% Social Services 10% 2. Do you feel the Cross-Systems Mapping exercise resulted in improvements in your county's ability/willingness to collaborate across systems? If yes, please specify the systems that have improved collaboration. 18% Yes No 82% Sample of responses: There has been more collaborations and information sharing among agencies, which helps to identify gaps in services. While we still work on improving the delivery of care & services, the communication makes it easier. 83

84 Mental Health and criminal justice systems are sharing more information about not only what is needed but what efforts are already in place to divert mental health consumers away from criminal justice involvement. We continue to meet with in the small groups that were established at the mapping exercise. We continue to prioritize and work to move the priorities forward. We openly discussed our systems, barriers, and opportunities to improve system delivery. I believe that many of us collaborated prior to this exercise, it reinforced we are doing it well and need to maintain. It brought agencies together that would not have had the opportunity to talk and problem solve. It allowed other agencies to see the challenges other agencies may face that they hadn't been able to understand before. 3. Was the action plan developed during your Cross-Systems Mapping Workshop helpful to the initiation or continuation of programs in your county? If yes, please specify 18% Yes No 82% Sample of responses: Representatives of the mental health, criminal justice, and other systems continue to meet to discuss and explore how parts of systems can play a role in identifying and addressing cross system needs. We use this as a guide. The various priorities and their action plans are still active as the sub-groups continue to meet Greene County is a small rural county; Social-Service dollars are limited. The cross system mapping has improved Agencies to communicate better now to further each other's budget allocation and reach more constituents. Increase in peer involvement in mental health and substance related providers It has helped our County look into a Crisis Intervention Team and look at the issues of Housing, engaging Faith based personnel and improve overall collaboration 4. Please briefly describe any outcomes (new programs, increased peer involvement, better collaboration, program improvement, etc.) you believe are related to the Cross-Systems Mapping Workshop. Sample of responses: Open communication with the Washington County Corrections Facility as a direct result of the mapping process BH involvement in the CJAB Meetings, increased collaboration with probation and parole on individual cases, implementation of MHFA and CIT. 84

85 Our small group met, and we determined that there is a need for individuals who are exiting child-age services need some type of service to adjust to what is available for adults. NAMI has been making plans to establish a program to address this need. Our housing staff have each participated in the Mental Health First Aid Training as a result of the workshop (we were not aware of the training prior to the mapping workshop). Continued discussion about wait times for assessment in the emergency room. Although wait time has not necessarily decreased, the ongoing discussion has been helpful. Delivery of mental health first aid training and hearing voices training for members of law enforcement, various service systems. 5. For the action plan components that directly involved YOU OR YOUR AGENCY, describe the current status of the action steps 24% 14% No Progress has been made Planning Stages 11% 22% 34% Several of the action steps have been initiated Several of the action steps have been completed I don t know 6. If progress has been slow or unsuccessful in your county, please describe the barriers you have faced during the process (e.g. funding, lack of buy-in, difficulty with collaboration). Sample of responses: Definitely funding. Collaboration is also a problem depending on which agencies the county likes at the moment. Getting many people to meet, politics, and funding Difficulty with ongoing collaboration. However, I do believe collaboration was improved since the mapping occurred, just not as much as is needed. Difficulty with collaboration. Politics. From the housing perspective, unless there are additional funding streams to allow for increased housing either temporary or permanent, there is not very much one can do. 85

86 7. What specific things can the PA Mental Health and Justice Center of Excellence do to help you meet your identified goals (e.g. technical assistance)? Sample of responses: Provide a follow-up review, formally. What good is a plan if there is no follow-up and accountability? Stick with us. We are benefitting very much from the services (via a BJA Planning grant) of a consultant who has been very helpful and clear sighted. Continuing to offer training and consultation on these matters is very useful. Cross-training sessions, informational sessions on Criminal Justice and/or Mental health matter...are all useful. The recent day training on the MH Procedures Act was attended by a very strong cross-systems group from Chester County...but I have to say we were disappointed in some of the presentations. But we (APO, MH, Courts, PD's office, provider agencies...) take every opportunity to work together and this was a useful day from that perspective. Perhaps facilitate the scheduling of the work-groups. Set up meetings in our area to go over the progress of our action plan. Try to move things forward instead of having a stalemate. Outline a cost efficient way to help with outreach and collaborations within the agencies Technical assistance after the sessions specifically to identify possible funding sources for initiatives. Concrete linkages to other counties that have been successful in implementing strategies. Offer grant writing seminars and training for local agencies so we can compete and get monies that are available. 8. Would you recommend the Cross-Systems Mapping Workshop to other counties 4% 96% Yes No 9. Has your Criminal Justice Advisory Board (CJAB) engaged in a strategic planning process? 86

87 17% 83% Yes No 10. If yes, have any of the action steps identified in the cross-systems mapping process been adopted by or incorporated into the CJAB strategic plan? 7% 91% Yes No 11. Which priorities and /or action steps from the cross-systems mapping process were incorporated into the CJAB strategic plan? Sample of responses: At last CJAB meeting all the report was discussed and efforts will be made to implement. Each of the previously identified goals and action steps has been endorsed by the Behavioral Health Subcommittee of the CJAC. BHSC personnel attend CJAC and report Subcommittee activities. Initial planning stages of a day reporting center for Adult Probation All 8 of the objectives were included and are being explored to assess the ability to develop each objective. Specialized Aftercare Services for Offenders; Better Referrals for Services; Behavioral Health Data Integration; Diversion for Offenders with Serious Mental Illness; Offender Housing Issue None specifically to date. It will be reviewed by the forensic committee 12. If your county has engaged in CJAB strategic planning, has the strategic plan been completed? 87

88 45% 55% Yes No 13. Any additional feedback/comments about the Cross-Systems Mapping Workshop? Sample of responses: Would be good to do a follow up session within two years to discuss what was implemented and what wasn't and why. Funding should be made available for those counties who want to do a mapping workshop. Lack of funding should not be a barrier to interested counties being able to participate. Probably good for the COE to continue tracking outcomes and barriers as the forensic issues are intensifying. Was very worthwhile. It brought together other individuals and agencies that may not have been part of CJAB As a Law Enforcement Officer I felt like a fish out of water. The discussion primarily involved Mental Health agencies who used acronyms that made it very difficult for me to even get a grasp of what was being talked about. Generally if we come across a mental health patient we call County Control and have them request a mental health worker meet us at the Hospital if they are available. That is the long and short of our interactions. I found the seminar overwhelming. I would recommend the workshop because the process itself was worthwhile. And sometimes, the process is as important as the product! This workshop has set us in the right direction on issues, which were never addressed in the past. Level III: Telephone Interview Background *** As noted earlier, an online survey and telephone interview were added to the mapping assessment in the summer of For the interview, one knowledgeable representative from each county was asked to participate in a telephone survey to capture, in more depth, the impact that the mapping has had on the way the county collaborates or functions as well as their views on other aspects of the COE mission (see Appendix X for a copy of the interview 88

89 questions). This is in contrast to the Level II online survey to obtain feedback from a broader range of people about progress more generally. The telephone interview is divided into three sections: 1) The interview initially focused on the priorities in general, assessing whether or not the identified priorities changed (in order or content) and the rationale and/or barriers for these changes. In addition, we assessed which priorities received the most focus of time and which have had the most progress/action and why. 2) The next section of the interview attempted to assess the status of each identified action step for the top 3 priorities identified by the county. The goal here was to determine if any actual changes to the way the county operates resulted from the mapping workshop (in lieu of actual data at this stage) and, once again, to understand barriers, changing time tables and ways the COE can provide assistance in each area. We also included a question to determine if any of the action plans identified were incorporated into the CJAB strategic plan. 3) Finally, we assessed other aspects of COE mission, such as helping the county to develop a shared vision regarding behavioral health consumers, influencing the way the county operates and communicates, changes in key personnel, the level of sustained interest in implementing change, groups or organizations that have resisted change, sustainability and technical assistance. A total of 29 telephone interviews had been completed as of February counties were mapped by the Gains Center prior to the existence of the COE (thus, we have no follow-up interview) 3 counties representing two mapping workshops (Elk/Cameron and Columbia) have not has sufficient time pass to complete the interview Interviews for two counties (Armstrong and Clearfield) were inadvertently missed On average, the interviews have been 53 minutes in length. We contacted the individual in each county who was the primary contact for the mapping workshop. In all cases but one, this individual completed the interview. One county provided an alternate individual to complete the interview. The vast majority of the interviews (21/29; 72%) were completed by someone in the mental health system, 3 from the criminal justice system (10%), 1 child advocate (3%) and 4 CJAB members (14%). Across all 29 counties, the average amount of time that elapsed between the mapping workshop and the follow-up telephone interview was 9 months. Nine of the interviews were completed six or fewer months after the mapping workshop ( 6m or fewer ), while 20 of the interviews were completed more than six months after the mapping workshop ( more than 6m ). Several themes have emerged from these interviews: Counties have been very open to completing the interview and providing feedback. Nearly all are very positive about the mapping experience and believe it has fostered better communication. Most counties have had at least 1 actual system change since the mapping this includes counties that were mapped recently. 89

90 Beyond specific changes that have been implemented, all of the counties believe that the mapping has had an impact on the way that their county operates, communicates and cooperates. Funding and sustainability are frequently expressed as an area of concern. The counties have provided multiple suggestions for continued support from the COE. 90

91 The summary statements below are ordered according to the three main interview areas (priorities-general, priorities-specific, other aspects of the COE mission). The responses to each question were examined separately for the group who had completed the mapping six or fewer months prior to the interview and those who completed the mapping more than six months prior to the interview. This was done because the passage of time is certainly related to the ability to implement change. The responses below are listed separately for each group when there is a meaningful difference in their responses. Part 1: Priorities-General Did the order of the priorities identified in the mapping change? For the most part, the order of priorities identified during the workshop does not change. 6m or fewer: No = 7 (78%) Yes= 2 More than 6m: No = 15 (75%) Yes =5 Some reasons priorities changed: o Decided to put central booking on the back burner until they update the facility in which it would be housed o Change in President Judge shifted one of their priorities (Vets Court) to a lower position o They fell behind the ball on gathering the information for the top priority so they moved to the second one until they can catch up on the top priority. Which priorities received the most focus of time and which have had the most progress (2 separate questions)? 6m or fewer: Those getting the most focus of time are those that are most practically pressing (e.g. housing) or those with a time-limited funding opportunity. Those with the most progress were those that had already been started before the mapping. This group noted that some people hadn t yet read the mapping report and others noted that because it was summer, there wasn t much progress. o A training was being offered, so we took advantage of it. This action step would probably not have been done so quickly if this training wasn t offered at this time. o We are really struggling with data collection, so we ve spent a lot of time in this area o Housing issues related to the gas drilling have received the most focus of time. This is because the prices are going up and the inmates have no place to go when they get out. More than 6m: 91

92 Those getting the most focus of time are those priorities for which they have defined working groups who meet regularly, those for which a lot of money has been invested and those that are practically pressing Those with the most progress are also those for which they received funding, it was practically pressing or an actual change has been implemented. o o o o o We focused on those priorities which involve access to services for the whole system. We have the money to spend right now and this is a good use of those funds. Because we spent money on it and there is currently a lot of commitment from people in both the MH and CJ system. Because this (housing) was the area of the greatest need. The priorities getting the most focus of time are those that are inter-agency or are ongoing initiatives which involve a lot of planning. These are areas that involve more than just a need for funding. Part 2: Priorities-Specific Have any of the action steps been completed or implemented? The number of action steps associated with the top 3 priorities is quite varied and depends on the type of priority and the level of specificity that the workshops attendees reach during this part of the workshop. For example, one county listed Explore the development of a treatment court as a priority with 10 individual action steps (e.g. determine when and how often court will take place, develop confidentiality agreement). Another county listed Conduct Mental Health First Aid training as a priority and listed 3 individual action steps (e.g. recruit trainers, secure funding, schedule training) As a result of this variability, the summary points below represent the percentage of the individual action steps that are completed, in progress, or not started across the top 3 priorities. There were additional action steps about which the respondent was unsure of the progress; those items are reflected as don t know below. Across all 29 counties, all had at least one action step which was completed by the time of the follow-up interview 6m or fewer: A total of 183 action steps involved in the top 3 priorities for these counties and the respondent was unsure of the status of 9% of these 23% of those were completed by the time of the interview. Below are some examples of actions steps that were accomplished o now using a screening tool to identify veterans o now have a behavioral health committee on the CJAB o now regularly share information between agencies 47% were in progress 21% were not started Some examples of barriers for the in progress and not started : 92

93 o o Time.just not enough time has passed. Still working on getting buy in from various groups. More than 6 months: A total of 496 action steps involved in the top 3 priorities for these counties and the respondent was unsure of the status of 10% of these. As might be expected, a larger percentage of action steps are completed with the passage of more time after the mapping. 36% of the action steps were completed by the time of the interview for this group. Below are some examples of completed action steps o have more mental health personnel in jail so they get meds more quickly o now have forensic case managers o have received training on issues like Mental Health First Aide and CIT 32% were in progress. Below are some comments related to actions steps that are in progress: o When a topic is particularly challenging, it takes a lot of coordination and that slows the progress. We started with the low-hanging fruit the things that are easier to change. o Personnel cuts have hindered and complicated progress. o The biggest challenge is to get someone to take the lead everyone is already over-committed. 22% were not started. When action steps are not started it is usually because there isn t a shared vision regarding what to do, due to funding issues or just because the issue is really big and difficult to fix. o They are just bigger issues and not as easily open to a quick fix. We are not even sure that we know where to start for some of them. o Our jail can t even sustain a computer system it s going to be difficult! o The inactivity rests on the county, it s an issue of priorities and time...we are trying to get many things done and our time is split. o Funding is going to be our biggest issue. Regarding the action steps that were completed, did the mapping workshop facilitate the completion? All 29 counties attribute the completion of at least one of the action steps to the mapping workshop. Some examples of change that they attribute to the mapping workshop include o The formation of committees to address housing and employment issues o Creation or expansion of reentry committees o Better communication with county assistance offices o Presence of peer supports o Better collaboration with police and community providers 93

94 Six months or fewer: All 9 counties in this group (62%) indicated that the mapping workshop facilitated the completion of one or more of their action steps. More than 6m: 18 of 19 counties (90%) have seen an actual change that they attribute to the mapping workshop. Have any of the priorities identified in the cross-systems mapping process been adopted by or incorporated into the CJAB strategic plan? This question was asked in relation to each of the top 3 priorities. Six months or fewer: Among the 9 counties mapped six or fewer months prior to the follow-up interview, all except one county (90%) reported that at least one of their top 3 priorities was incorporated into the strategic plan. The only exception was a county that did not have a CJAB meeting during the time between the mapping workshop and the interview. More than 6m Among the 20 counties for which more than six months had passed, 9 (45%) said at least one of their identified priorities was included in the CJAB strategic plan o The action step had already been a part of the strategic plan but we added more after our mapping. o All of our priorities have been adapted into the CJAB plan (CJAB was involved since the beginning). Our CJAB strategic plan was updated 2 weeks after the mapping. o Two weeks after the mapping we updated our strategic plan they dovetailed. 3of 20 counties (15%) reported that none of their top priorities was incorporated o The CJAB has asked us (the MH subcommittee) for feedback regarding a draft of their CJAB strategic plan. o We are still writing the strategic plan. o We haven t had a CJAB board meeting to update them. o I haven t seen our strategic plan. 3 of 18 counties (15%) said their CJAB did not meet between the mapping workshop and the follow-up interview so the inclusion of the priorities into the CJAB strategic plan was not resolved as of the time of the follow-up interview 3 of 18 counties (15%) respondents didn t know whether or not a priority identified at the mapping was incorporated into the strategic plan Part 3: Other Aspects of the COE Mission Did the cross systems mapping workshop help your county to develop a shared vision regarding behavioral health consumers who become involved with the juvenile justice system? 94

95 The vast majority of counties (28/29; 97%) indicated yes. They see evidence of this in the fact that stereotypes have been dispelled and people interact more and regularly attend meetings. The mapping provided an opportunity to learn about the perspectives of people in other systems. o Since a lot of the key players participated in the mapping, we got to learn about their concerns and issues. It was a real eye-opener. o A byproduct of the mapping meeting was to bring the MH and CJ people to the table. In the end, the CJ now understands the MH position better and the MH people now understand the job of law enforcement and their position better. It helped to dispel a lot of stereotypes. o We had a good mix of people, so there were a lot of ah-ha moments. Everyone communicated. o Mapping helped to bring the parties to the table and to re-establish priorities. o The CJ system hadn t thought at all about MH clients, prior to the mapping. o We already had collaborations between MH, CJ and other agencies in place prior to the mapping, but the mapping was helpful in crystallizing new areas of planning. o Since the mapping, the CJ system is now taking a different approach. They are more likely to ask for assistance and guidance as compared to before the collaboration. The one county that did not believe the mapping helped to develop the shared vision indicated that, although the mapping was a good starting point, they didn t develop a shared vision as a result of it. Since the mapping workshop, have there been any specific changes to the way your behavioral health or criminal justice system operate, cooperate or communicate? All counties (100%) responded yes and they feel that communication in particular is much improved and that the agencies in their county operate/cooperate differently in some way. Some examples and illustrative statements include: o There is now more reaching out between agencies - we now have a name and face for the people we are talking to. o Jail census list is now distributed to the MH/MR housing coordinator on a daily basis o We cooperate more now.we meeting regularly and are making progress on action steps. o We now have a specific contact person at the county assistance office who helps us get MA reinstated at re-entry. o We understand each other better now and there is more of a spirit of cooperation. o Probation and our VA are now mutually referring clients to each other. 95

96 o o o o o Individuals are getting their meds (30-day supply rather than 2 day supply) and treatment started more quickly upon release. We now have several actual changes in place in the way our county operates, like we have increased funds for housing now, we hired a director of mental health for the jail and we have a data sharing plan in place. When I hear no, I now understand why. We now have a lot more collaboration and we can understand other viewpoints now. Thing keep getting better, we get a lot more calls now and people are more interested in solving issues together. Since the mapping workshop, have there been changes to key individuals who were involved in this process? Changes in personnel are certainly related to the passage of time. 55% (11/20) of the counties that were mapped more than 6 months prior to the interview had a change to key individuals who were involved in the mapping while only 44% (4/9) of those interviewed within six months of the mapping experienced this sort of change. Some of the personnel changes are due to retirement, re-election, or someone simply moving on. The respondents indicate that this turnover slows the progress because you have to bring the replacement folks up to speed and you don t always have their buy-in. Have the participants in the cross-systems mapping workshops sustained their investment in implementing change? Among the counties that had their workshop 6 or fewer months prior to the interview, 100% reported a sustained interest from key stakeholders. Among the counties that had a workshop more than 6 months prior to the interview, the vast majority of counties (17/20; 85%) believe there is sustained investment because people still are attending meetings and showing interest. o 2of 20 counties (10%) answered no (e.g., no one takes any action unless one or two specific people (who were leaders in the mapping) initiate the action and keep on them. ) o The remaining 1 of 20 county representatives responded don t know to this item. Some examples and illustrative comments from the follow-up interviews: o Our meetings are still well-attended and there are a lot of examples of collaborations between agencies. o Those who attended the mapping are still invested and they have even brought in more of their colleagues! o People have continued to attend meetings and they now extend invitations for us to attend their meetings. It feels like there is more of a presence at the meetings and people now actively look for training and support. 96

97 Have you encountered groups or organizations in your county that have not been open to implementing the changes identified in the mapping workshops? The majority of counties found no resistance (17/29; 59%). About 38% of counties (n=11) indicated that they had encountered groups who were not open to implementing the changes identified in the mapping. This percentage was slightly larger (44% versus 35%) for those that completed the follow-up interview within six months of the workshop compared to those who completed the interview later. Some illustrative comments o When it involves money, some agencies are resistant to change. We have to show them that it will make it easier for them. o Our probation department doesn t seem interested or invested in the changes. They didn t stay for the full mapping and they really aren t cooperating now. o A few groups of been resistant, but mostly we can work out issues. Are there appropriate structures/resources in place to continue to implement and maintain the changes that have resulted from the workshop? Overall, 20 of 29 counties (69%) believe that there are appropriate structures and resources in place to sustain the change. The percentage with this belief is influenced by the passage of time; 89% of those that were interview within six months of their mapping workshop believed that the appropriate structures/resources were in place to continue to implement and maintain the changes that resulted from the workshop but fewer (60%) of those interviewed later reported this belief. o We have a MH court, an active judge, a forensic team, a MH treatment team and prison MH services these are all in place and will form the basis of the changes (this person later did bring up the issue of funding by indicating that it is a given that funding will be a continuous need). Funding was a theme through most comments related to this question: o When we don t have the resources, we ll have to look for funding. o We are constantly working on this issue by looking for funding opportunities o We are working on funding issues which is our biggest issue. We re currently relying a lot on in-kind support. o We have buy-in from key people/agencies, but funding is often an issue. 97

98 Recent Response from Northhampton County The following was recently received from Northhampton County. It illustrates how CSM can be used effectively when accompanied by clear planning, consensus and collaboration across stakeholders, and determined follow-through: Summary and Conclusions The Pennsylvania counties that participated in the cross-systems mapping workshops identified barriers and opportunities for improvement at each intercept. The most commonly cited gaps at intercept one were: A lack of specialized training for crisis responders (e.g., dispatchers, law enforcement, and emergency medical staff); inadequate crisis response services; and a lack of access to detoxification services. The most commonly cited gaps at intercept two were as 98