Healthcare Transformation in Criminal Justice System
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1 Healthcare Transformation in Criminal Justice System Richard G. Soper, MD,JD,MS,DFASAM,FABAM,FACP Center for Behavioral Wellness Nashville, Tennessee 37204
2 OBJECTIVES 1- Gain insight into developments advancing healthcare in US Justice system 2-Develop some understanding of Public Health system and role in Criminal Justice care delivery 3- Discuss Opportunity to engage Academic Medicine healthcare delivery in Justice System 4- Q/A
3 Criminal Justice and Health Care Servicespremised on different primary goals Healthcare- Protect and Improve Individual and Community Health Criminal Justice- Protect Public Safety and reduce Recidivism
4 Rehabilitative Services- Justice System and Healthcare goals intersect Challenge- Cost Containment
5 Criminal Justice Populations 49-87%- - At Arrest [+]for Illicit Substances- (1,2) 68-75% Jail detainees meet clinical criteria for SUD Also, Adult detainees: 15% men, 31% womenmeet clinical criteria for co-occurring mental health disorder
6 U.S Jail Detainees Demographics 88% male; 39% Black, 16% Hispanic, 57% white 30%- Age 24 or younger(44% of arrestees) 26% have HS diploma or GED 60% have no Health Insur- 90% in states not in ACA HCV %; 32% of all cases/us; 35% all TB cases 80 % have chronic health problems Women-12% of population- Use 33% of health svcs. In US Jail- young male, persons of color, indigent, uneducated with health problems
7 Jail/Prison Population Intersection of Poverty Poor Health Justice 3 factors are interwoven, not accidental
8 Poverty Core of Need for Correctional facility based healthcare At arrest (75-90%) of individuals- need for acute psychiatric care and/or have active addictions 49-87%-(ONDCP 2014) No resources/no bail Severe mentally ill- 3x more likely to be in jail than hospital or healthcare facility (TASC-2015)
9 Jail Demographics million people admitted to local jails ~10 million- first arrest/year 50% any given day- confined for probation/parole violation or bond forfeiture Unconvicted-detainees- Increas 56% since 2008 BOJ Stat-2016
10 Jail (aka People Processing Institutions) 40% US jails-hold 50 or less-58% of jail pop. 80% no onsite clinical care 50%+ No educational programs 57%- No clinical treatment program 64% turn over/week Avg stay/sentenced inmate- 60 days CJC-2014
11 Jail Populations (Inmates/Detainees- Not arrest charges) 30% drug related 27% property crimes 22%-violent crimes 20% public disorder,other Vast majority- misdemeanor charges
12 People Processing Institutions From Jail pop. & under supervision: Increased 22% Released to Receive Drug, Alcohol, Mental Health treatment- Decreased 64% COCHS-2012
13 Constitutional Mandate to provide Adequate Health Care US Supreme Court- Estelle v Gamble Fed. Appeals Ct.- Bowring v Godwin Case law- Establishes right to receive medical care and mental health treatment while confined
14 People Processing Institutions 20%+ increase/detainees- ( ) Substance Use Disorder Alcohol & illicit Substances- 50+% 75+% detainees- SUD- role in incarceration Most common substances- Male and Female- Opiates & Marijuana DOJ-2014
15 People Processing Institutions 74%- Women admitted to jail have SUD (33% alcohol, 64% substances freq. overlap) 82%- Males admitted- (51% alcohol, 45%-sub.) Terplin-2016 ADAM-2014
16 People Processing Institutions Jails have become our psychiatric hospitals- 50+% of jail detainees have history of mental health issues 1/8 detainees/inmates reports injury after detained Ctr. Healthcare Strategies 2014
17 Jail Healthcare Systems Health and Psychiatric Services- marked variation- Breadth of services Organization Staffing Jail size- Large (>500 inmates)- internal staff Small (<50) rely on community svcs Small- opportunity for continuity of care/if avail
18 Jail Healthcare Systems Carefully planned pre-trial release-purpose of maintaining non-violent accused in hometown, possibly increasing treatment,engagement & improving continuity of care-> direct effect on patient healthcare outcome and decrease expenses to legal system
19 Jail Healthcare Systems Among the incarcerated population, drug overdose is the leading cause of death postrelease. The U.S. has the highest rate of incarceration in the world (937 per 100,000 adults)
20 Jail Healthcare Systems The FOUNDATION of specialty courts: Directing arrestees from jail to community based treatment centers, maintaining individuals in community, maintaining employment and family support, and allowing cost containment of treatment.
21 Criminal Justice Strategies to reduce Public Expenditures & Maintain Public Safety Strategy Target Group Impact Diversion at Arrest Conditional Release Screen/Brief Intervention Arrest/Pretrial Intervention Re-entry Services Link People with Mental health disorders-disturb cmty Mental health &chronic health charged with misdem/lo felonies All jail detainees Charged-drug offenses-elig for alt programs All detainees with Psy and/or SUD Reduce jail costs Reduce recidivism Reduce jail costs Reduce recidivism Determine-who needs linked svcs Reduce substance reuse Reduce jail costs and Recid Link with svcs- reduce recidivism
22 Adverse Childhood Experiences 90+%- jail detainees-positive Abuse/victim: 92+knew perpetrator 46%- family member- was/had been incarcerated 60+%-single parent ACE s-early childhood trauma causes impaired neurodevelopment, adoption of risk behaviors in adolescence, chronic health problems, early death USDOJ-2014
23 Legal and Medical Systems Medical science community has concluded drug courts work better than jail or prison, better than probation, and better than treatment alone. Outcomes improve when justice and healthcare communities work together to treat, monitor, educate, and guide participants
24 ~2,500 Drug Courts in USA 1,096 Problem solving Courts in USA New Landscape for Public Health and Public Safety Rethinking connection between Crim Justice and Addiction Community jails are people processing institutions Drug Courts-access to care, service use and health literacy Federal and state cost-shifting
25 Principles of Drug Abuse Treatment for Criminal Justice Populations Key Components of Drug courts includemultidisciplinary team approach, an ongoing schedule of judicial hearings, weekly drug testing, contingency sanctions and incentives NADCP,1997
26 Principles of Drug Abuse Treatment for Criminal Justice Populations Key Component #1 Drug courts integrate alcohol and other drug treatment services with the justice system ae processionng
27 Principles of Drug Abuse Treatment for Criminal Justice Populations Key Component #2 Using a nonadversarial approach, prosecutio and defense counsel promote public safety while proteting participants due process rights
28 Principles of Drug Abuse Treatment for Criminal Justice Populations Key Component #3 Eligible participants ae identified early and promptly placed in the drug court program
29 Principles of Drug Abuse Treatment for Criminal Justice Populations Key Component #4 Drug courts provide access to a continuum of alcohol, drug, and other related treatment and rehabilitation services
30 Principles of Drug Abuse Treatment for Criminal Justice Populations Key Component #5 Abstinence ( include Medication tx.) is monitored by frequent alcohol and urine drug testing
31 Principles of Drug Abuse Treatment for Criminal Justice Populations Key Component #6 Coordinated strategy governs drug court responses to participants compliance
32 Principles of Drug Abuse Treatment for Criminal Justice Populations Key Component #7 Ongoing judicial interaction with each drug court participant is essential
33 Principles of Drug Abuse Treatment for Criminal Justice Populations Key Component #8 Monitoring and evaluation measure the achievement of program goals and gauge effectiveness (outcomes)
34 Principles of Drug Abuse Treatment for Criminal Justice Populations Key Component #9 Continuing interdisciplinary education promotes effective drugcourt planning, implementation, and operations
35 Principles of Drug Abuse Treatment for Criminal Justice Populations Key Component #10 Forging partnerships among drug courts, public agencies, and community-based organiations program enhances drug court effectiveness
36 Physicians & Nurses Role Step away from tradition Gatekeeper-changing decisions Confidentiality Active team member Balance perspective Promote Public Safety Continuity of care
37 Potential of Reform and Transformation of Criminal Justice and Health Care Rationale for Collaboration Effective management of incarcerated persons Extend to physical, behavioral and social services Cross-system coordination Federal incentives to collaborate Cost savings ( 5 states spend more on CJ than education) NEJM-2016
38 Potential of Reform and Transformation of Criminal Justice and Health Care Rationale for Collaboration Earlier intervention and sustained care Propel community based treatment expansion Leverage criminal justice mandates to increase recovery
39 Realizing the Potential of Healthcare Reform Jails- front door to criminal justice system Nations largest catchment areas for SUD, Mental Health, and other Chronic Health issues 60-90% jail detainees have no Health Ins Funding skewed towards problems rahter than solutions AJPH-2012
40 Advancing Criminal Justice HealthCare Earlier Interventions & Sustained Recovery Protocols for screening Intervention Programs Healthcare enrollment Align provider choice and mandated participation Coordinated Community-based care and management Strengthen Community support
41 Criminal Justice/Health Care Potential to reverse long standing era of mass incarceration Improvements in healthcare with lower popul Case management of soon-to-be released inmates (Diabetes, HCV,HIV,SUD,Pregnancy) 2 weeks after release former inmates 130% increased risk of OD death than gen l popl 25% HIV, 33% HCV US patients pass thru Criminal Justice system ea year NEJM-2016
42 Healthcare in Criminal Justice 78 individuals dies each day in USA from overdose to opiates (CDC 2016) Community response to promote overdose teatment is lifesaving Increased access and availability to Naloxone is helping in many communities
43
44 Healthcare and Criminal Justice System Questions and Discussion
45
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