An Overview of Risk-Needs- Responsivity Model: Application to Behavioral Health Populations

Transcription

1 Reducing Criminal Behavior: Selecting and Delivering Effective Cognitive Behavioral Treatment (CBT) Dr. Fred C. Osher Director of Health Services and Systems Policy CSG Justice Center Bob Kingman Correctional Health Care and Jail Diversion Services Ann Marie Louison Director Adult Behavioral Health Programs CASES, NYC Cindy Schwartz Project Director, The 11th District Judicial Criminal Mental Health Project An Overview of Risk-Needs- Responsivity Model: Application to Behavioral Health Populations Fred C. Osher, M.D. Director of Health Systems and Service Policy CSG Justice Center 1 1

2 The Problem: Overrepresentation of Persons with Behavioral Disorders Arrested at disproportionately higher rates -Co-occurring Disorders -Homelessness Low utilization of EBPs Stay longer in jail and prison High recidivism rates Limited access to health care More criminogenic risk factors 2 Incarceration is Not Always a Direct Product of Mental Illness How likely is it that the inmates offenses were a result of serious mental illness (SMI) or substance abuse (SA)? 4% 4% 66% 19% 7% Direct Effect of SMI Indirect Effect of SMI Direct Effect of SA Indirect Effect of SA Other Factors Source: Junginger, Claypoole, Laygo, & Cristina (2006) Council of State Governments Justice Center 3 2

3 Those with Mental Disorders Have Many Central 8 Dynamic Risk Factors ** LS/CMI Tot Persons with mental illnesses Persons without mental illnesses.and these predict recidivism more strongly than mental illness Source: Skeem, Nicholson, & Kregg (2008) Council of State Governments Justice Center 4 Recidivism Is Not Simply a Product of Mental Illness: Criminogenic Risk Risk: Crime type Dangerousness Failure to appear Sentence or disposition Custody or security classification level Risk = How likely is a person to commit a crime or violate the conditions of supervision? Council of State Governments Justice Center 5 3

4 What Do We Measure to Determine Criminogenic Risk? Conditions of an individual s behavior that are associated with the risk of committing a crime. Static factors Unchangeable conditions Dynamic factors Conditions that can change over time and are amenable to treatment interventions Council of State Governments Justice Center 6 Static Risk Factors Criminal history number of arrests number of convictions type of offenses Current charges Age at first arrest Current age Gender Council of State Governments Justice Center 7 4

5 Dynamic Risk Factors 1. History of antisocial behavior 2. Antisocial personality pattern 3. Antisocial cognition 4. Antisocial associates 5. Family and/or marital factors 6. Poor school and/ or work performance 7. Few leisure or recreational activities 8. Substance abuse Council of State Governments Justice Center 8 History of Addressing Criminogenic Risk Factors as Part of Behavioral Health Services Dynamic risk factors and associated needs Dynamic Risk Factor History of antisocial behavior Antisocial personality pattern Antisocial cognition Antisocial associates Family and/or marital discord Poor school and/or work performance Few leisure or recreation activities Substance abuse Need Build alternative behaviors Problem solving skills, anger management Develop less risky thinking Reduce association with criminal others Reduce conflict, build positive relationships Enhance performance, rewards Enhance outside involvement Reduce use through integrated treatment Andrews (2006) 9 5

6 Selecting and Delivering Effective CBT: Corrections & Community Behavioral Health Partnerships The CARA Program Expansion Bob Kingman, J.D., M.Ed., LCPC, CCS Director of Correctional Health and Jail Diversion Services Crisis and Counseling Centers Augusta, ME 11 6

7 Program Overview Criminogenic Addiction Recovery Academy (CARA) 5 ½ weeks Male and female programs participants Programming from 7 a.m. to 7 p.m. Corrections officer training Isolated from General Population Focus on CBT: targeting key risk factors The Mechanics Statewide referral High risk of recidivism/relapse 90+ day sentence/deferred disposition Release upon completion Mandatory 5 weeks community treatment (IOP level of care, plus 1:1) Weekly CARA team review Interdisciplinary collaboration 7

8 The Screening Multiple Instruments LSI-R:SV; AC-OK; BJMHSF3; TCU Drug Screen; TCU CT Scale & TCU Motform Participant application(written) Interview (1:1 or small group) Probation/community supervision and correctional officer input The Programming Five primary programs: professional/volunteer Substance abuse Criminogenic behavior/thinking Problem-solving Parenting Work readiness Closed group, gender responsive Graduates participation Baseline/re-eval (Criminal Thinking Scale, Tx Motivation Scale) Aftercare/re-entry IOP curriculum incorporates facility-based programming; IOP is grant-funded 8

9 The Philosophy Entrenched criminal behavior can change Participant/Professional partnership Target individualized criminogenic risk Enhance desistence through pro-social engagement Motivation-Skills-Support 9

10 The Outcomes 43 rd group- Over 350 participants served 76% male; 24% female Sustained partnerships Jail, District Attorney and Sheriff, community providers Recidivism (+IOP aftercare): 29% PV, 14% new charges Average days released early: 57 Second Chance Grant: OP treatment focus, with referral & collaboration with multiple community providers Recidivism rates appear lower with IOP requirement Translating criminogenic risk into treatment targets Anti-social associates: Social skills Impulse control Trauma re-enactment Key Factors Multi-disciplinary Collaboration Administration Clinical providers Legal (probation, etc.) Corrections staff Use what works Discreet programming Flexibility/Adaptability Re-entry focus Sustained support 10

11 Addressing Criminogenic Needs: Selecting and Delivering Effective CBT Ann-Marie Louison Director Adult Behavioral Health CASES New York, NY 20 Recipients 21 11

12 Criminogenic Need Clinical Profiles 22 Reasoning & Rehabilitation 2 For Youth and Adults with Mental Health Problems Improving Attentional Control Improving Memory Skilled Thinking, Feeling & Behaving Managing Thoughts & Feelings Managing Thoughts & Emotions Improving Impulse Control Scanning for Information Problem Identification & Thinking of Solutions Detecting Thinking Errors Recognizing Thoughts & Feelings (Non-verbal Behavior) Recognizing Thoughts & Feelings (Social Perspective Taking) Consequential Thinking Recognizing Thoughts & Feelings (Empathy) Constructive Planning Managing Conflict Making Choices Group Treatment 23 12

13 Criminogenic Needs Influence Outcomes 24 Who Pays? Medicaid Psychotherapy? County MH and SA Agency Managed Care Mental Health Substance Use Rehabilitation Provider State Office of Mental Health Forensic Division Medicaid Rehabilitation/ Habilitation? Criminal Justice Agency 25 13

14 Addressing Criminogenic Needs: Selecting and Delivering Effective CBT Cindy A. Schwartz, MS, MBA Eleventh Judicial Circuit Criminal Mental Health Project Miami, Florida 26 Eleventh Judicial Circuit Criminal Mental Health Program Designed and implemented to divert people with serious mental illnesses away from the criminal justice system into communitybased treatment and services 14

15 Program Context and Setting Court based Initiative, established in year 2000 Serves 500 individuals annually State, County and Grant funded operations Located in Miami, Florida Programs Pre booking Diversion CIT Post booking, pre trial jail diversion (misdemeanor) Post booking, pre trial jail diversion (felony) Post booking, state forensic hospital diversion Entitlement Unit SOAR Bristol Meyer Squibb Foundation Project 15

16 Bristol Meyer Squibb Foundation Project Coordinated system of care demonstration project awarded in 2010 Targets high risk, high utilizers Primary goal is to ensure timely and efficient access to a comprehensive array of community based treatment and services based on enhanced, individualized assessment of clinical and criminogenic needs and risk factors Eligibility for BMS Adults with SMI referred to CMHP 2.7+ lifetime arrests or 3+ in past three years Moderate/High risk for one or more of Violence, Self Harm, Suicide, Self Neglect, and General Offending Utilize the START Risk assessment tool 16

17 Evaluation 1. Treatment As Usual (TAU) Peer specialist support, assistance in benefits, linkages to services, treatment referrals, etc. 2. Care Coordination (CC) Above, plus care coordinator Advocacy, liaison between providers, additional resources 3. CC & Cognitive Behavioral Therapy (CC CBT) Above, plus Reasoning & Rehabilitation 2 8 weeks, 16 sessions, manualized CBT program CBT Group Tracking 29 participants were randomly assigned to the CBT group 8 participants (27.6%) attended at least one group 10 group sessions was the mean attendance 1 participant attended all 16 sessions 17

18 Barriers One community provider Geography Language Functional Capacity Court Disposition Preliminary Findings Due to the low CBT group attendance, the CC and CC+CBT groups have been collapsed for the purpose of analyses Compared to the TAU Group Mean number of arrests Violence and victimization Psychotic symptoms Frequency and severity of alcohol use and drug use Self reported Mental health 18

19 Next Steps Encourage community based treatment providers that serve the target population to add CBT to continuum of treatment and services Advocate for State and Local funding Develop integrated strategies among court, treatment providers and stakeholders to ensure successful outcomes Thank you! Fred C. Osher Bob Kingman crisisandcounseling.org Ann Marie Louison Cindy A. Schwartz 19