Sequential Intercept Model and Problem Solving/Specialty Courts: The Intersection with Brain Injury

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Spencer Dorsey
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SAMHSA Regional Administrator Region VIII (CO, MT, ND, SD, UT,

1 Sequential Intercept Model and Problem Solving/Specialty Courts: The Intersection with Brain Injury Charles Smith, Ph.D. SAMHSA Regional Administrator Region VIII (CO, MT, ND, SD, UT, WY) National Association of State Head Injury Directors October 26, 2015

2 Substance Abuse and Mental Health Services Administration (SAMHSA) Mission Reduce the impact of substance abuse and mental illness on America s communities Behavioral Health Is Essential To Health Prevention Works Treatment Is Effective People Recover

3 SAMHSA Roles Leadership & Voice Data & Surveillance Practice Improvement Grant Making Regulation/Guidelines Public Awareness/Education Strategic Initiatives Prevention of Substance Abuse & Mental Illness Health Care and Health Systems Integration Trauma and Justice Recovery Support Health Information Technology Workforce Development

5 SAMHSA s Funding Opportunities State Block Grants o Community Mental Health Services o Substance Abuse Prevention and Treatment Discretionary/Competitive Grants (examples) o Mental Health First Aid o Integrated Housing and Health Care o Trauma-Informed Care o Drug Free Communities o Offender Diversion & Re-Entry Services o Suicide Prevention o Tribal Behavioral Health o Behavioral Health Workforce

6 Criminal Justice Grant Programs FY2015 Grants to Develop and Expand Behavioral Health Treatment Court Collaboratives Grants to Expand Substance Abuse Treatment Capacity in Adult Tribal Healing to Wellness Courts and Juvenile Drug Courts Joint Adult Drug Court Solicitation to Enhance Services, Coordination, and Treatment (DOJ/BJA) Offender Reentry Program (ORP)

7 GAINS is an acronym for Gather, Assess, Integrate, Network, and Stimulate. The SAMHSA GAINS Center focuses on expanding access to services for people with mental and/or substance use disorders who come into contact with the justice system.

8 Thank You Charles H. Smith, PhD Regional Administrator - Region VIII (Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming) Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services th Street, South Tower, Room Denver, CO (office) (cell) charles.smith@samhsa.hhs.gov

10 What is Drug Court Based on a National Model Non- Adversarial team approach Drug Court Integration of Substance Abuse Treatment 10 Key Components

11 Meet Jane First arrested at 14 Convicted of possession four years ago Sentenced to probation three different times Unemployed 3 children; none in her custody

12 Meet Jane Continued History of Trauma Mental Health Diagnoses Injecting meth Previously served a year in prison Currently facing probation revocation

13 Key Component #3: Participants are identified early Jane s PO identifies her as a candidate for drug court Motion to revoke her probation Defense attorney talks to Jane

14 What s the Difference Standard Court Process Event oriented Drug Court Process oriented Offensespecific Behaviorspecific

15 Key Component #1: Drug courts treatment services with justice system case Jane reluctantly decides to try drug court Sentenced to drug court Meets treatment provider and PO at court hearing

outpatient treatment A mental health and medication

16 Key Component #4: Access to a continuum of treatment and rehabilitation services Substance evaluation Enhanced outpatient treatment A mental health and medication evaluation Treatment to address past trauma Individualized referrals and resources

17 Key Component #5: Abstinence is monitored Jane must comply with random drug testing Urinalysis up to 3 times a week Calls daily to UA hotline Could require other types of monitoring such as hair follicle testing, SCRAM or breathalyzers

18 Key Component #7: Ongoing judicial interaction Jane starts treatment and is compliant first couple weeks Still using but is showing up to all appointments and appears in court for her review hearing

19 Key Component #2: Non-adversarial approach Defense Council and Prosecutor are members of the drug court team Work together to reduce litigation Prosecutor balances community safety with recovery process Defense attorney balances protecting individual rights with recovery process

Incentives Honesty and attendance at all required services

20 Key Component #6: Responses to participants behavior Sanctions Based on the Science of Behavior Modification Incentives Honesty and attendance at all required services are ALWAYS expected Imposed immediately or shortly after a targeted behavior

21 Ten Key Components: Program Key Component #8: Monitoring and evaluation Key Component #9 Interdisciplinary education Key Component #10: Forging partnerships Components

22 Why a Drug Court? Drug offenders make up about 20% of the inmate population in Colorado¹ More people are serving prison terms for drug offenses than any other type of crime¹ In drug offenders were in prison in Colorado compared to 4,000 in 2008.¹ 1Przybylski, Roger. (2008 February) What Works: Effective Recidivism Reduction and Risk-Focused Prevention Programs, prepared for the Colorado Division of Criminal Justice and the Colorado Department of Public Safety Number of inmates

23 1 National Center on Addiction and Substance Abuse at Columbia University (2010). Behind Bars II 2 Rhodes, W., King, R., & Shively, M. (2006) Suffolk County Court Evaluation. Cambridge, MA: Abt Associates. 65% of prison inmates meet diagnostic criteria for chemical dependence₁ 60 to 80 percent of substance abusers commit a new crime after being released from prison.² Why a Drug Court?

24 Meta Analyses Compiled by Doug Marlow, J.D., PhD of the National Association of Drug Court Professionals Citation Institute Number of Drug Courts Crime Reduced on average Wilson et al. (2006) Latimer et al. (2006) Shaffer (2006) Lowenkamp et. al. (2005) Aos et al. (2006) Campbell Collaborative Canada Dept. of Justice University of Nevada University of Cincinnati Washington State Inst. For Public Policy to 26% 66 14% 76 9% 22 8% 57 8%

25 Cost Effectiveness Compiled by Doug Marlow, J.D., PhD of the National Association of Drug Court Professionals Citation No. of Drug Courts Avg. Benefit per $1 invested Avg. Cost savings Per Client Loman (2004) 1 (St. Louis) $2.80 to $6.32 $2,615 to $7,707 Finigan et al. (2007) 1 (Portland, OR) $2.63 $11,000 Carey et al. 9 (California) $3.50 $6,744 to $12, 218 Barnoski & Aos (2003) 5 (Washington St.) $1.74 $2, 888 Aos et al. (2006) National Data N/A $4, 767 Bhati et al. National Data $2.21 N/A

26 In other words We can slow the Revolving Door Hold individuals personally accountable Save taxpayer s money Give participants the opportunity to become contributing members to our community

27 Recovery of the whole person Graduated program in 15 months 410 days of sobriety No new law violations Employed for the last 10 months at the same job Attending college for associates degree Building a relationship with her children Getting mental health treatment and taking medication

30 Problem Solving Court State Profile 79 Operational 10 in Planning Now serving over 4,000 participants a year Most Commonly used drugs: Alcohol Marijuana Amphetamines Cocaine heroine and prescription drug use

31 Colorado Problem-Solving Courts CR/DUI Hybrid Veterans Trauma 1% 6% Family D&N Drug Court 17% Adult Mental Health 8% Adult Drug Court 33% DUI Courts 17% Juvenile Drug Court 15% Juvenile Mental Health Court 3%

32 Growth in Colorado Adult DUI Courts Family Mental Health Juvenile Veterans

33 Colorado Problem-Solving Courts Total Problem Solving Courts Total Problem Solving Courts

34 Colorado Evaluation The results of the outcome analysis for Colorado s adult drug courts and DUI courts are overwhelmingly positive.

35 Average # of Re-Arrests Adult Drug Court Impact Months Prior to Program Entry 24 Months After Program Entry ADC All Participants (N = 1207) ADC Graduates (N = 527) ADC Non-Graduates (N = 594)

36 Average # of Re-Arrests DUI Court Impact Months Prior to Program Entry DUI All Participants (N = 100) DUI Graduates (N = 54) DUI Non-Graduates (N = 35)

37 Brenidy A. Rice State Problem Solving Court Coordinator Colorado Judicial Branch 1300 Broadway, Ste Denver, CO Office - (720) brenidy.rice@judicial.state.co.us

PRINCE GEORGES COUNTY VETERANS TREATMENT COURT

PRINCE GEORGES COUNTY VETERANS TREATMENT COURT Ten Key Components of Veterans Treatment Court Integrate alcohol, drug treatment, mental health treatment, medical services with justice system case processing.