Delaware County Report of the Cross Systems Mapping Workshop May 19 & 20, 2010

Transcription

1 DREXEL UNIVERSITY & UNIVERSITY OF PITTSBURGH Delaware County Report of the Cross Systems Mapping Workshop May 19 & 20, 2010 Transforming Services for Persons with Mental Illness in Contact with the Criminal Justice System

2 Facilitators Patricia A. Griffin, PhD, Center of Excellence Senior Consultant Mary Gregorio, MA, Consultant Other Support Tory Bright, Southeast Regional Mental Health Services Coordinator Kathleen Kemp, MA, MS, Center of Excellence Research Associate Center of Excellence Staff David DeMatteo, JD, PhD Sarah Dorrell, MSW Sarah Filone, MA Kirk Heilbrun, PhD Edward P. Mulvey, PhD Marcel Schipper Carol Schubert, MPH ii

3 Transforming Services for Persons with Mental Illness in Contact with the Criminal Justice System Table of Contents Transforming Services for Persons with Mental Illness in Contact With the Criminal Justice System Introduction...1 Background...1 Objectives of the Cross-Systems Mapping Exercise...2 Keys to Success...2 Delaware County, Pennsylvania Systems Map DelawareCounty Cross-Systems Map Narrative...6 Intercept I: Law Enforcement / Emergency Services...9 Intercept II: Initial Detention / Initial Court Hearing...13 Intercept III: Jails / Courts...15 Intercept IV: Re-Entry...18 Intercept V: Community Corrections / Community Support...21 Delaware County Taking Action for Change Delaware County Priorities...26 Delaware County Action Planning Matrix...27 Conclusions and Recommendations: Summary Summary of Recommendations...34 Participant List...56 iii

4 List of Appendices Appendix A: Collaboration Grid Appendix B: Resources on Planning for Housing Appendix C: Resources on Cultural Competence for Criminal Justice/Behavioral Health Appendix D: Evidence Based Practices Appendix E: Resources for specialized police response and law enforcement/bh collaboration at Intercept 1 Appendix F: Directory of Delaware County Mental Health and Drug and Alcohol Services Appendix G: Acronym List iv

5 Delaware County, Pennsylvania Transforming Services for Persons with Mental Illness in Contact with the Criminal Justice System Introduction The purpose of this report is to provide a summary of the Pennsylvania Mental Health and Justice Center of Excellence Cross-Systems Mapping and Taking Action for Change workshops held in Delaware County, Pennsylvania, on May 20 th and May 21 st, conducted by the Pennsylvania Mental Health and Justice Center of Excellence. The 2-day workshop was sponsored by the Behavioral Health Subcommittee of the Delaware County Criminal Justice Advisory Committee as part of an ongoing process of developing collaborative systems of support for individuals who have mental illness who come in contact with criminal justice. This report (and accompanying electronic file) includes: A brief review of the origins and background for the workshop A summary of the information gathered at the workshop A cross-systems intercept map as developed by the group during the workshop An action planning matrix as developed by the group Observations, comments, and recommendations to help Delaware County achieve its goals Recommendations contained in this report are based on information received prior to or during the PA Center of Excellence workshops and any other information during the course of the workshop. Additional information is provided that may be relevant to future action planning. Background The Delaware County Office of Behavioral Health and multiple other local stakeholders requested the PA CoE Cross-Systems Mapping and Taking Action for Change workshops to promote progress in addressing criminal justice diversion and treatment needs of adults with mental illness in contact with the criminal justice system and provide assistance to Delaware County with: Creation of a map indicating points of interface among all relevant Delaware County systems Identification of resources, gaps, and barriers in the existing systems Development of priorities as well as a strategic action plan to promote progress in addressing the criminal justice diversion and treatment needs of adults with mental illness in contact with the criminal justice system. Prior to the workshops, the PA CoE gathered information about Delaware County through a Community Collaboration Questionnaire, a preliminary meeting by conference call, and gathering of documents relevant to the population. The participants in the workshops included 47 individuals representing multiple stakeholder systems including mental health, substance abuse treatment, human services, corrections, advocates, family members, consumers, law enforcement, and the courts. A complete list of participants is available in the Additional Resources (page 56) section of this document. Patricia A. Griffin, PhD, Senior Consultant from the Pennsylvania Mental Health and Justice Center of Excellence and the CMHS National GAINS Center and Mary M. Gregorio, MA, Consultant for the Southeast Regional Mental Health Services Coordination Office facilitated the workshop sessions. Tory Bright of the Southeast Regional Mental - 1 -

6 Health Services Coordination Office and Kathleen Kemp of the Center of Excellence also provided support. About the Workshop PA CoE Cross-System Mapping and Taking Action for Change Upon receiving a grant from the Pennsylvania Commission on Crime and Delinquency and the Pennsylvania Department of Public Welfare s Office of Mental Health and Substance Abuse Services, the Pennsylvania Mental Health and Justice Center of Excellence was developed as a collaborative effort by Drexel University and University of Pittsburgh. The mission of the PA CoE is to work with Pennsylvania communities to identify points of interception at which an intercept can be made to prevent individuals with mental illness from entering and penetrating deeper into the justice system. The PA CoE workshops, Cross-System Mapping and Taking Action for Change, are unique services tailored to each Pennsylvania community. These workshops provide an opportunity for participants to visualize how mental health, substance abuse, and other human services intersect with the criminal justice system. These two consecutive workshops are unlike other types of consultations or staff development training programs. A key element is the collaborative process. Meaningful cross-system collaboration is required to establish effective and efficient services for people with mental illness and co-occurring substance use disorders involved in the criminal justice system. This makes the composition of the group extremely important. While some workshops involve advertising to the entire provider community, it is essential in the PA CoE workshops that the organizers gather a group that represents key decision makers and varied levels of staff from the relevant provider systems. PA CoE staff work with this group, serving as expert guides to help the group: Create a cross-systems map indicating points of interface among all relevant local systems Identify gaps, opportunities, and barriers in the existing systems Optimize use of local resources Identify and prioritize necessary actions for change Develop an action plan to facilitate this change Upon completion of the workshops, the Cross-Systems Map included in the report is provided in both print and electronic formats. It is meant to be a starting point. The electronic files can be revised over time to reflect the accomplishments and changes in the planning process. Objectives of the Cross-Systems Mapping Exercise The Cross-Systems Mapping Exercise has three primary objectives: 1. Development of a comprehensive picture of how people with mental illness and co-occurring substance use disorders move through the Delaware County criminal 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. 3. Development of priorities for activities designed to improve system and service level responses for individuals in the target population

7 Keys to Success: Cross-System Task Force, Consumer Involvement, Representation from Key Decision Makers, Data Collection Existing Cross-Systems Partnerships Delaware County s history of collaboration between the criminal justice and behavioral health systems is reflected in a number of existing local efforts that were identified prior to the mapping. For example: Cross-systems two-day symposium was held for stakeholders ranging from judges, police officers, other court personnel, mental health providers and consumers and family members. The Behavioral Health Subcommittee of the Delaware County Criminal Justice Advisory Committee The BSU/Forensic Meeting The development of a Mental Health Treatment Court (6/08) The creation of four Behavioral Health Forensic Liaison positions (who provide screening of offenders and linkage to community-based services and who are involved in the Mental Health Treatment Court) Police training in crisis response and diversion Criminal Justice training for Mental Health providers (outlining the typical steps from arrest through case disposition) Shared funding agreement between the Office of Behavioral Health and the Mental Health Treatment Court for access to housing and mental health and drug and alcohol treatment An agreement that allows money to flow between OBH and Court for the forensic liaison positions. Criminal Justice Advisory Committee, (CJAC) Chaired by Judge Ann A. Osborne, is a joint venture between leaders in Criminal Justice and related county government agencies. The CJAC meets monthly throughout the year to review local criminal justice issues in Delaware County. Behavioral health issues are considered along with the operation and interface of the various criminal justice entities. The CJAC reviews the activities and recommendations of the Behavioral Health Subcommittee The Behavioral Health Subcommittee (BHS) of the CJAC is comprised of leaders from the Delaware County CJAC, Court Services, Office of Behavioral Health, Office of the Public Defender, Office of the District Attorney, (DUI) Diagnostic Services, Mental Health Treatment Court, Police Chief s Association, Delaware County Prison, and SCA Case Management. The BHS meets quarterly to review behavioral health issues affecting the offender population and includes: collaboration on fiscal and resource issues; barriers to treatment; identification of new resources; cross-system training; etc. The BHS reports to the CJAC and oversees the Forensic Liaison program. The Base Service Unit (BSU) Forensic Meeting: comprised of representatives from OBH, Adult Probation/Parole (AP/P), Case Management Services The BSU Forensic Meeting is held monthly to coordinate information about an individual s treatment needs in prison and in the community upon release. Informal case reviews update inmate status and plan for release back to the community. The Forensic Liaison Program was initially funded by PCCD to provide two Mental Health Liaisons at Delaware County Prison and later was expanded to include two D&A Liaisons. OBH and AP/P now provide 100% of Liaison Program funding. Regional Forensic Services Coordination: The five Counties in the Southeast region meet with the Regional Mental Health and Forensic Coordinators and consultants on a bi-weekly basis, with MH/MR Administrators, MH Directors and CHIPP Liaisons participating as needed. Crossroads Program allows for inmates with a serious mental illness to be given unsecured bail, but not to be released until all mental health services are confirmed and in place

8 Consumer/Family Involvement in the Workshops Consumers were represented by three Peer Specialists and two Peer Advocates. Consumers added valuable information to the discussion especially about the role of Peer Specialists. The National Alliance for the Mentally Ill (NAMI) PA Main Line was represented in the workshop and provided important information from the family perspective. Representation from Key Decision Makers in the Workshops The workshops included wide cross-system representation and involved many of the key decision makers Opening remarks set the stage and established a clear message as to the importance of the workshop o Phillip W. Damiani, Jr., Executive Director, Office of Court Services o Bill Chambers, Mental Health Program Director, Office of Behavioral Health Data Collection Limited data was available to illustrate the scope and complexity of the problems discussed during the workshop While there was some data available, it was generally informal. Participants were eager to pursue data collection following the conclusion of the workshop

9 Cross-Systems Mapping Delaware County, PA - 5 -

10 -MAP- The cross-systems map image can be accessed separately on the mapping reports page under Delaware County. (Please see

11 Delaware County Cross-Systems Map Narrative The Cross-Systems Mapping exercise is based on the Sequential Intercept Model developed by Mark Munetz, M.D. and Patty Griffin, Ph.D. 1 in conjunction with the National GAINS Center. In this workshop, participants were guided to identify gaps in services, resources, and opportunities at each of the five distinct intercept points. This narrative reflects information gathered during the Cross-Systems Mapping Workshop. It provides a description of local activities at each intercept point, as well as gaps and opportunities identified at each point. This narrative may be used as a reference in reviewing the Delaware County Cross-Systems Map. The cross-systems local task force may choose to revise or expand information gathered in the activity. General Description of Services and Cross-System Collaboration Delaware County is located in Southeastern Pennsylvania. With a population of 553,619, it is the fifth most populous county in the Commonwealth behind Philadelphia, Allegheny, Montgomery and Bucks Counties. Delaware County, which covers 191 square miles, is home to a diverse population and socioeconomic strata from working class communities to prosperous suburban neighborhoods. It is reported that one in every 23 Delaware County adults is under some sort of criminal justice supervision. The County has been building a continuum of criminal justice and behavioral health services that provide a solid foundation for continued growth and reorganization on all levels. There are a number of established links, both formal and informal, between the courts, probation, police departments, corrections and the behavioral health system that include, but are not limited to: 24-hour emergency/crisis services Rapid access to emergency inpatient services as well as access to an increasing array of community mental health and drug and alcohol services Increasing participation of local police departments in specialized mental health training The development of specialized forensic liaison positions Shared funding arrangements between criminal justice and behavioral health The development of a mental health treatment court Several ongoing meeting structures for information sharing and problem solving. The Delaware County Office of Behavioral Health (OBH) combines the services for mental health and drug and alcohol. This office provides a wide range of community-based services for adults suffering from mental illness and children with emotional disorders, as well as for those facing challenges with alcohol and other drugs. Services are planned, coordinated and monitored by OBH and are provided through contracts with private community agencies and hospitals. OBH oversees and monitors contracts with Magellan Behavioral Health for the delivery of mental health and substance abuse services for Medicaid recipients. The budget of this program is based on the number of Medical Assistance-eligible people in the County and is approximately $93,840,172. Approximately 14,000 people receive services on an annual basis through Magellan. 1 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,

12 The base allocation for the community program is $31,456,003. The drug and alcohol base allocation for the community is $5,778,430. Together, these allocations support a community-based infrastructure of services located throughout the county that is readily available to residents. There are 2 Base Service Units (BSU s) for mental health service access and 3 Anchor Providers for drug and alcohol service access. Mental Health BSU s: Northwestern Human Services Crozer Chester Medical Center Drug and Alcohol Anchor Providers: Northwestern Human Services Crozer Chester Medical Center KeyStone Center The county has a strong commitment to non-institutional community-based mental health care and has actively engaged in bed closure initiatives since 1997 with the closure of Haverford State Hospital. Current proposed initiatives will result in the closure of 5 additional civil beds at Norristown State Hospital

13 Delaware County, PA: Intercept I: Law Enforcement / Emergency Services 911 Intercept 1 Law enforcement If a person is in crisis or involved with criminal behavior, the 911 Center is the first point of emergency contact and system response. Delaware County, Pennsylvania has one centralized 911 system called Emergency Dispatch, which is operated by the County Emergency Services Department. There are separate dispatchers for fire, ambulance, and police. Emergency Dispatch and police officers are able to retrieve the previous call history at a location. Law Enforcement In Delaware County, there are 42 municipal police departments and one State Police barracks (located in Media). The largest of the jurisdictions are: Media, Upper Darby, and Springfield. COMMUNITY 911 Law Enforcement The Delaware County Police Training Academy provides basic, countywide training to law enforcement. Although there is no current specialized training through the training academy focusing on persons with mental illness, the Delaware County Department of Behavioral Health offers an annual training on the Mental Health Procedures Act (302) to law enforcement, criminal justice personnel and first responders. Crisis services staff present information about the mobile crisis services available in Delaware County. Multiple police jurisdictions including Upper Darby, Haverford, Sharon Hill are interested in planning and developing Crisis Intervention Team (CIT) training. Officers from the Springfield Township Police Department have participated in the Montgomery County Police School located at Montgomery County Emergency Services. This is a 3-5 day training for police officers that includes topics such as recognizing signs and symptoms of a person with mental illness, Mental Health 101, understanding when a person is hearing voices, and resources in the community as well as how to use the Mental Health Procedures Act and how to complete a 302 petition. The Springfield and Upper Darby Township Police Departments, along with a number of other local departments, have an expressed interest in training their officers in the CIT model and are currently pursuing opportunities for implementing this plan. Springfield Township has recently started collecting data about mental health calls. When law enforcement comes in contact with a person who is exhibiting signs of mental illness or intoxication, there are several options available. Police can: Contact the Mobile Crisis Team, Project REACH, which is a 24/7 mobile team. Project REACH will assess the situation to see if crisis intervention services are necessary and they will contact Emergency Medical Services for transportation if the person is deemed dangerous. The police also have the option to take the person directly to a hospital-based Psychiatric Crisis Center, at either Crozer Chester or Fitzgerald Mercy. A separate crisis unit is available for evaluation and each hospital has a separate locked unit. Fitzgerald has a 21-bed unit and Crozer has a 32-bed inpatient unit with a separate child/adolescent unit

14 If the person is intoxicated, he or she must go to an emergency room first to be evaluated and medically stabilized to ensure his or her safety; generally the person is held overnight and then re-evaluated. Police transfer time to crisis service is minimal; it may be 5 to 10 minutes, particularly if family is involved and willing to complete necessary paperwork. If family is not able or willing, then the time an officer spends is only to complete the paperwork. Crisis Response Project REACH, Holcomb Behavioral Health Systems, operates the County suicide hotline. Project REACH determines whether services are needed and can activate their Mobile Crisis Service, which has 6 or 7 staff and is available 24/7. Behavioral health staff is also able to call the hotline and activate outreach. Project REACH may also complete welfare checks on individuals if there is concern for the safety of a consumer. Emergency and Inpatient Psychiatric Services The Delaware County Office of Behavioral Health contracts with a number of established provider agencies that have informal connections to local law enforcement. If law enforcement comes in contact with a person who is known to them and to an agency, then the police can make direct contact with the agency. Some services, such as Program for Assertive Community Treatment (PACT), have an identified client group for whom they provide support. In the event that a person from this group comes in contact with the police, PACT will respond with support as soon as they are made aware of the incident. Similarly, the MAST- Mobile Assessment Stabilization and Treatment Team enjoy a good relationship with the Sharon Hill police department who will sometimes call upon them to help with de-escalation of a critical situation. Delaware County also has a Crisis Residential Program operated by Elwyn. The Natale program offers short-term diversions from hospitalization and step down from hospitalization to connect to community resources. Individuals are admitted to Natale through a centralized referral process. Veterans The Coatesville Veterans Affairs Medical Center, which serves Delaware County, has a new Veterans Justice Outreach Specialist, Torrie Osterholm, who is available as a resource and is dedicated for the diversion of veterans from the criminal justice system. The national VA Suicide Hotline number is Local Coatesville suicide crisis information for veterans and their families can be obtained from Rebecca Baird, x3011. Nationally, a veteran may contact x5160 and the veteran will be matched to talk with someone with similar military service. Identified Gaps Law Enforcement have limited knowledge and trainings of crisis intervention services (Project REACH) Police training for the persons after recognition of mental illness Gaps Opportunities Police training academy training limited in mental illness o De-escalation skills not incorporated into academy training or recent Crisis Intervention Specialist Training in Montgomery County Current frequency and level of mental health training for Emergency Dispatch is unknown

15 Officers have reported a time response issue in that it may take the Project Reach team extended amount of time to report to scene and police officers need more immediate response Project REACH cannot transport an individual Some police officers will not transport a 302 to crisis services, but will instead call an ambulance for transport No centralized EMS entity therefore no uniform training for mental health population 911 does not have a current relationship with the crisis mental health unit and cannot transfer calls to experienced mental health workers The current Warm Line run by peers is not centralized to cover all of Delaware County Difficulty accessing crisis centers when person is intoxicated detox occurs in the jails vs. non-hospital detox/hospital. Families unsure where to access or call in a crisis Magisterial District Judge s are unfamiliar with resources for individuals with misdemeanor charges or to access treatment as condition of bail evaluation after the bail is set. Crisis hotline link for frequent callers and document who is frequent caller Police and crisis services do not currently ask at arrest if the individual has a history of military service No specific training for returning OEF/OIF veterans Need greater information dissemination of available resources at multiple levels of the system Identified Opportunities NAMI PA Main Line offers a training in Family to Family program including a modified hearing voices exercises could offer to law enforcement Montgomery County Emergency Services police school for law enforcement - Began Crisis Intervention Specialist training with 5 officers in Springfield Township, May 2010 Multiple police jurisdictions, such as Upper Darby, Haverford, Sharon Hill, Springfield Township, etc, have expressed interest in planning and developing CIT training and support cross system development of a planning task force. Expressed interest from GW Hill Correctional Facility for CIT training for correctional officers June 25 th Annual Crisis Intervention and 302 Procedures Act Training 1 full day with Don Kline and Pr oj ect REACH located at the Emergency Services Center, Sharon Hill for general law enforcement and EMS Personnel Veteran s Administration has a connection to the National Suicide Hotline. Veterans Justice Outreach Specialist Torrie Osterholm is available as a resource and position is dedicated for diversion of veterans from the criminal justice system Sgt. (ret.) Jeff Bare formerly of Lancaster City Police Department may be available as a trainer for CIT training PACT and MAST have developed good informal relationships with several police jurisdictions for their specific caseloads Strong coordination between mental health crisis services including case management, PACT, MAST, and Project REACH Several offices are working simultaneously on resource flyers/pamphlets/booklets for community, consumers, and professionals o Treatment Court working on educational materials for clients o Public Defenders office came out with a pamphlet to help individuals who are in need of treatment o Forensic Liaisons- have 80 page booklet about services

16 Time for police handoff to crisis services is minimal; limited to amount of time it takes to complete paperwork

17 Delaware County, PA: Intercept II: Initial Detention / Initial Court Hearing General Description and Cross-System Collaboration Arrest or Summons An individual who is arrested in Delaware County is usually detained in the police department. Some police departments share resources and some precincts will house individuals for other districts. There are also three Regional Booking Centers located in Media, Ridley, and Upper Darby that are utilized for booking. Arraignment and Preliminary Hearing There are 34 Magisterial District Judges (MDJ) in the county. The MDJs have met with the local chapter of the National Alliance for the Mentally Ill (NAMI) on two occasions previously. The MDJs have 3 call groups for weekend rotations with the West end group doing calls every 10 weeks. Videoconferencing is used in some cases, but not all areas have video conferencing available. Not all police departments have video arraignment due to networking issues. There are approximately 10,000 preliminary arraignments completed annually. The Prison has contracted with MCES to be the designated treatment provider for incarcerated individuals under MHPA 302. Pretrial Bail Services, which are available 24/7 for bail interviews in Delaware County, is under court jurisdiction. They have video capabilities during the week, but have to go out to the site on the weekends. NTBR and Crossroads Program If a defendant qualifies for the Crossroads Program, they are given unsecured bail with a Not to Be Released (NTBR) condition at the Preliminary Hearing or Arraignment. The NTBR condition is designed to ensure that an individual will not be released from jail until all services are in place. The Crossroads Program is a formal collaborative relationship with the District Attorney, Public Defenders Office, and Adult Probation & Parole. Crossroads began in 2008 and has two Mental Health and two Drug & Alcohol Forensic Liaisons who work 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 require a letter from Crossroads before they are released from the jail. This program diverts approximately persons a year from longer-term incarceration while allowing them to secure the necessary services. Crossroads can 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. If the person is involved with Probation, the supervisors are contacted to decide whether the warrant will be issued and whether or not special probation will be considered

18 Identified Gaps Not all jurisdictions have video conferencing capabilities for preliminary arraignment Limited mental health training for MDJs and Pre-Trial Bail Services interviewers Limited knowledge about the Crossroads Program and diversion opportunities Protocol for exchange of information between MDJ and AP/P Not compliant with treatment Not enough housing Gaps Opportunities Crossroads has reached capacity and needs more resources in order to reach more of the target population. Lot of cases that fall through cracks because no method of identifying individuals at this intercept Veterans are not uniformly identified No e mail in MDJ s Difficult to contact and/or identify Public Defenders in MDJ Court Identified Opportunities Crossroads and the NTBR process allow for diversions and reentry linkages Build on the NTBR process at the pretrial bail services Examine the position in Lancaster County for the crisis DAVE position Veterans Justice Outreach Specialist for the region can connect to the courts and Magisterial District Justice level Mobile arraignment with MDJs Already have procedures in place for individuals needing involuntary commitment hospitalization Training information sessions about the NTBR bail condition and the Forensic Liaison positions Unsecured bail Not to be released until all services in place (NTBR) Can be asked at Preliminary Arraignment or Hearing Close collaboration between public defender and district attorney s office in planning and coordination of NTBR bail diversion program

19 Delaware County, PA: Intercept III: Jails / Courts General Description of Services and Cross-System Collaboration George W. Hill Correctional Facility Intercept 3 Jails / Courts Delaware County has one county jail, George W. Hill Correctional Facility, built in In 2009, there were approximately 9,519 commitments. The current population in the jail is 1,588 persons (as of May 2010 mapping) and the jail census generally fluctuates between 1,550 and 1,590. This is a decrease from 5 years ago in which the total population reached 2,100. Approximately 40% of the inmates at George W. Hill are on psychiatric medications. 90% have a substance abuse diagnosis. At the time of intake, individuals are referred for a mental health screening by the prison psychologist. There has been formalized training for the correctional officers through FTAC (Family Training and Advocacy Center) and coordinated by Delaware County OBH. The full-time psychologist, Dr. Dana Dantzler, conducts the mental health evaluations and refers to the psychiatrist for individuals who present with a serious mental illness and/or who are in need of medications. A self-report survey is completed for almost every admission to the jail, which includes information such as mental health diagnosis, medications at admission, drug and alcohol history, and history of treatment. Only those individuals who are directed immediately to the medical unit do not complete the self-report survey. This may include individuals with suicidal behaviors and individuals hearing voices. Jail Specialty Court Dispositional In the last year, approximately 375 persons self-reported mental health issues, dual diagnosis and 1975 self-reported drug and alcohol issues. 910 self-reported George W. Hill Correctional Facility offers mental health programs and services in the jail, however does not have a designated mental health inpatient unit. The diagnostic categories of those inmates with serious mental illness (SMI) include: bipolar, depression, anxiety, personality disorders, PTSD, and substance abuse. Drug and alcohol counseling is offered in the jail. The counseling services and specific programs within the jail include: Prep 1 and Prep 2 programs which are educational programs designated for drug and alcohol clients, Thresholds focused on teaching decision-making, Anger management programs including House of Healing, an advance anger management program Sex offender program (5 weeks), Positive Living Assistance Network (PLAN), an 8 week life skills course for individuals with a mental health diagnosis, Parenting classes, NA/AA, Work Place Essentials Skills ( WES), D&A Assessments (Diagnostic Services) Individuals who were receiving medication while in prison are given at least 14 days of medications at the time of their release

20 Courts 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. In 2007, there were 1,604 female admissions to the county prison; of those, 296 females were dually-diagnosed. Admissions of women to the jail were increasing by 10% every year. The goal is to divert the women from incarceration to community-based supervision and treatment for mental illness and substance abuse. Judge Frank T. Hazel currently oversees the Court. A nolo contendere plea is submitted to the court. Potential Treatment Court candidates are first identified through the self-report survey completed in the jail. The diagnostic categories are limited to: Post-Traumatic Stress Disorder, Bipolar Disorder, and Anxiety disorders. Individuals with serious mental illness are currently excluded. The court has 2 tracks: Prison Alternative Drug and Alcohol Program (PADAP) and the Co-Occurring Disorder Women s track, which includes approximately active women in the program, and 16 women terminated and sentenced. The PADAP track is 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. Diagnostic Services have placed a D&A Assessor in G.W. Hill Prison. If a D&A evaluation is ordered by the court, inmates will receive an assessment in order to determine a level of care. If a residential level is appropriate, the inmate will be admitted to a D&A treatment facility, which will provide transportation with the approval of OBH. Authorization for Track l and ll Treatment Court offenders requires the same approval from OBH. Crossroads works at Intercept 2 and 3 to help ensure that incarcerated clients are seen by prison psychologist and psychiatrist, and stabilized on medications. Where appropriate, Crossroads will help fast-track the case to a disposition that reduces or dismisses charges with a release plan in place, via NTBR, Fast Track, and Rule 150. More details about NTBR and Crossroads can be found on page 13 of this document. If an individual requires inpatient level of care to determine competency, Crossroads commences commitment proceedings for the individual to be placed on the waiting list at the Regional Forensic Center at Norristown State Hospital. The majority of commitments are sent on 402 or 405 commitments. Crossroads works with Norristown State Hospital social workers to coordinate referrals and aftercare discharge planning to the community rather than returning those inmates who are not competent to stand trial to the jail. Identified Gaps No forensic peer specialist in the jail Limited in-reach into the jail Limited cost data of individuals with mental illness in county jail including staffing, medications, treatment, and costs to house persons in jail Only females are served by Treatment Court There are an insufficient number of forensic beds available at NSH, leading to a longer prison stay Competency evaluations from Diagnostic Services are not always clear. This may lead to having a second evaluation done Gaps Opportunities

21 There is a delay at reaching a disposition for individuals who have been at the Regional Forensic Center for an extended period of time (i.e. not likely to ever be competent, moving the individual to the civil side or finding community placement) Identified Opportunities Forensic liaisons are contacted by numerous services including probation, MAST/PACT, etc Full-time psychologist works at county jail Local jail has a coordinated referral process for individuals with mental health issues Most inmates complete a self-report mental health survey that guides referral to additional mental health assessment and referral Self-report is also source of referrals for Women s Track of Treatment Court Gender specific Treatment Court for women; Hope to expand to males depending upon funding availability Local jail decreased population in last 18 months Forensic Liaisons have worked to develop relationships with Norristown State Hospital social workers VJO Specialist works with jail (example Chester County)

22 Delaware County, PA: Intercept IV: Re-entry Reentry Planning for release to the community from the County s jail occurs through two primary methods: Crossroads participants have 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, etc. The liaisons will assist with applying for a birth certificate and state identification if needed. If a person must go to a shelter, Delaware County provides 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, have varying levels of availability. Intercept 4 Reentry Prison/ Reentry Jail Re-entry For other individuals, the REAPP (Reentry Access Prison Program) keeps track of all sentenced inmates and is intended to transition persons from the prison. The REAPP prison staff meets with inmates 2-3 months before release to develop a discharge plan and will arrange case management for the general population of the prison. The REAPP program discharges approximately inmates per month. At the time of release from jail, a person who has been receiving medications while in jail is provided with a minimum of 14 days worth of medication. The NTBR condition may be used for parole plans as well as those who are early release. The NTBR is designed to ensure services are in place prior to an individual being discharged from jail. When an inmate is reentering the community from the Department of Corrections State Correctional Institutions (SCI), the Regional Mental Health Services Coordination Office coordinates referrals for community services at the time of reentry. This process begins six to twelve months in advance of the maximum sentence date and is coordinated with the SCI and the county to access the necessary supports that the individual needs. The SCIs provide the psychological reports and the DC 551 and then the Regional Forensic Liaison coordinates with the county s Base Service Units and other community resources as necessary. Identified Gaps No mental health halfway house not like in D&A (MH use the shelter system typically if they don t have housing) Can wait months in jail for MH residential services Even if have housing, if in for more than 30 days, the individual Gaps Opportunities

23 may lose housing In case management if the person is in the prison the case manager has to close the case which is a problem when they don t reconnect Need identification at time of release to access jobs, resources, etc. Criminal background checks by housing management and the housing authority limit access to housing for persons with a criminal record Need to do more skill teaching for accessing services such as master leasing program Need more structured supports than that of the master leasing program No formal connection to the VA system 15% of incarcerated vets may not be eligible for VA benefits upon discharge Veterans are not systematically identified when incarcerated Judges are not aware of full array of services provided by VAMC Difficult to get a mental health appointment to meet with psychiatrist and get prescriptions for medication For bail purposes, MDJs need to know the housing placement, to ensure the individual shows up Warrants people are often unaware that they have warrants No systematic way to check for bench warrants that would impede ability to get services Police departments may do a warrant check as a matter of course when arresting the individual but courts often find out by accident that an individual is involved with another court Prison does a warrant search at admission and discharge No funding for medications - when run out of medications they are discharged with and have no medical assistance card Need MA to suspend rather then terminate benefits Medical assistance can be turned on the same day if have proper paperwork No success with local county assistance office to turn on medical assistance benefits on day of discharge from prison. Insufficient transportation Limited re-entry team Identified Opportunities Form a nonprofit to work on housing options Master leasing programs prioritize CJ/SMI persons Priority for Housing for forensic population DA will do bail stipulation to save housing Discharge medications provided from the jail --- at least 14 days or whatever is left in bubble pack (whatever is more) In local jail, a birth certificate can be obtained and sent to prison, and placed in personal effects Case Managers do wait until Preliminary Hearing to see if individual will receive bail before closing case Forensic Liaisons can help facilitate IDs CRR program referrals triage to the master leasing programs with forensic histories or cj involvement Social Security office collaborates and will take a letter from the jail, their prison id, and birth certificate to apply for social security card,

24 Can leave the Social Security office with letter that can get the individual a state id VJO Specialist can determine eligibility for veterans benefits services and assist with diversions and access to housing; just need Social Security and name State Department of Corrections SCI Max-outs Re-entry referrals provided by Southeast Regional Mental Health Services Coordination Office Center of Excellence website can link you to statewide network of providers and Delaware County website

25 Delaware County, PA: Intercept V: Community Corrections / Community Support General Description of Services and Cross-System Collaboration Probation In Delaware County, there are approximately 13,000 individuals on the total probation caseload. The Office of Probation and Parole has two 2 dedicated mental health probation officers. The caseload size is approximately 100 persons each. Clients are seen at least monthly but more typically biweekly. Each mental health probation officer handles his/her caseload differently and there is no current systematic method of following the individuals. The specialized probation officers may go to treatment team meetings and psychiatric wards, and may work with the individual s case manager as well. In addition, the Office of Probation and Parole has a dedicated sex offender supervisor and 2 specialized probation officers who work with this population. Crozer meets regularly with sex offender probation officers. Diversion from jail is done on a case-by-case basis. If an individual violates his or her probation with a new arrest, this may result in a more serious sanction. If the consumer is compliant with treatment, the probation officer may consider diversion; if the person is not compliant with treatment, the case may result in accessing treatment services within the jurisdiction of the criminal justice system. If the person is re-incarcerated, the probation officer will make a phone call immediately to the Forensic Liaisons to let them know the individual was re-incarcerated. Intercept 5 Community Violatio Violation Parole Probation COMMUNITY An individual can be assigned to Special Probation by: Recommendation of the District Attorney and Public Defender; Judge s order to the mental health caseload in order to get the service; Determination of the Probation Office Community Behavioral Health Services There are a number of behavioral health agencies that support a person once they reenter the community. In Delaware County, the Office of Behavioral Health and Magellan Behavioral Health provide funding for a comprehensive array of community-based services serving persons with mental illness, substance use disorders and COD. The primary categories of community services, all of which are available to the forensic population, include: treatment, case management, rehabilitation, emergency and inpatient. The MAST and PACT Teams provide intensive mobile services within their largely self-contained team structures. Other services are provided at Base Service Units (BSU s), Anchor Providers, and program locations throughout the county, or by mobile teams that provide interventions in various

26 community settings, including people s residences. See the roster of MH and D&A services in the Appendix for more information about the available array of community behavioral health services. The Delaware County Office of Behavioral Health currently has contracts with three providers for Intensive Case Management (ICM) services. These services continue to link clients with an array of services. Case management services assist with healthcare, psychiatric care, housing, support networks, education, vocational training, and employment. PRO-ACT (Pennsylvania Recovery Organization - Achieving Community Together) is a highly visible and vibrant grassroots organization for people affected by substance use disorders and their family members. This organization helps to reduce the stigma of addiction and promotes recovery through community programs and activities. There are many established 12 Step programs throughout Delaware County. Housing and Homelessness OBH 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. Through a newly developed project with the county and Horizon House, persons with forensic backgrounds are offered housing through a Master Leasing arrangement. This housing program is specifically designed for persons whose forensic history would prevent them from leasing on their own. Horizon House leases the apartment and the person enters into an agreement with Horizon House. Support services are then wrapped around the person. OBH and Magellan also provide funding for Halfway House and Residential treatment for persons with substance use disorders. The county received approximately $3 million in American Recovery and Reinvestment Act stimulus funding for various Homeless Prevention Rapid Re-housing Program (HPRP) housing projects. Other homeless resources available in the Delaware County Continuum of Care include: outreach, emergency shelter, transitional housing, permanent supportive housing, and supportive services. In 2009, Delaware County received $3,500,000 in annual funding from the U.S. Department of Housing and Urban Development under the Stuart B. McKinney Homeless Assistance Act to support these homeless services. Identified Gaps Community resistance backlash re: housing forensic population Landlords unwilling to work with people with mental illness; Difficulty spending housing money associated Treatment Court grant Limited housing with outreach support Consumers who may have a warrant may face difficulties and face re-entry to jail Gaps Opportunities o Includes traffic warrants o No one specifically assigned to address this o Warrants people are often unaware that they have warrants o No systematic way to check for bench warrants that would impede ability to get services No dedicated mental health forensic case management upon reentry

27 Large probation caseloads; not all mental health clients on mental health probation officer caseload Lack of transportation dollars in order to get to appointments, including Medical Assistance applications appointments No money for medications if the Medical Assistance benefits aren t set up For general population who aren t a part of Crossroads = No connection for BSUs for outpatient services Reentry team for general population is still new. Identified Opportunities 2 specialized mental health probation officers Probation officers will call Forensic Liaisons to let them know the individual was reincarcerated Upcoming forensic peer specialist state training initiative UJS portal.pacourts.us o Name and birth date will tell you criminal justice case Public Defenders Office has bench warrant division to help Base Service Unit Forensic Meeting Crozer collaborates with probation - specialized sex offender unit Lots of treatment system contact with probation cases Ozark report HUD programs federal funds with priority to homeless veterans population Mental Health initiative = PCCD initiative funds

28 Taking Action for Change Delaware County, Pennsylvania

29 Objectives of the Action Planning Activity The action planning activity begins a detailed plan for the community. It identifies tasks, time frames and responsible parties for the first few identified priorities. Action Planning Process A copy of the first draft of the Delaware County Action Plan can be found beginning on page 27 of this document. The action planning process promotes the development of specific objectives and action steps related to each of the priority areas, the individuals responsible for implementation of each action step, and a reasonable timeframe for completion of the identified tasks. The next step should be the completion of the Action Plan matrix. The remaining priority areas will require additional work to clarify and complete the full matrix. Opportunities for both early and quick victories and longer-term strategies should be identified for the objectives for each priority area. The Action Plan matrix should be completed by the Behavioral Health Subcommittee of the Delaware County Criminal Justice Advisory Committee as soon as is feasible. The remaining priority areas will require additional work in order to clarify and complete the full matrix. Opportunities for both short-term and longer-term strategies should be identified for the objectives for each priority area

30 Delaware County Priorities Subsequent to the completion of the Cross-Systems Mapping exercise, the assembled stakeholders began to 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. Listed below are the priority areas as ranked by the workshop participants. Delaware County, PA: Top Priorities Develop Crisis Intervention Team training/pre-arrest diversion (19 votes) o Improve collaboration among police, crisis services, and community services (16) Expand housing options (15) o Develop transitional housing targeted for jail reentry community Develop systemic reentry preparation/assessment/planning (14) o o Consider a Reentry Team Ensure Medical Assistance benefits upon release from jail or hospital Expand Forensic Behavioral Health capacity (9) o o o o Expand size and expertise working with the forensic population Develop In reach into the jail with a focus on engagement Include peer specialists Include evidence based practices Expand Treatment Court (8) Develop a position (like Lancaster s Dave) for crisis assessment and intervention at the front door of police and initial detention (6) Activate medical assistance benefits on day of release from jail or hospital (5) Expand Vocational/Work/ Employment /Education opportunities (3) o o Literacy Volunteer activities also Improve collaboration between probation and treatment providers (2) o Focus on skills for succeeding on probation and work related skills

31 Delaware County, Pennsylvania: 2010 Vehicle to Move Priorities Forward Objective Action Step Who When Behavioral Health Subcommittee of the CJAC Smaller subcommittee to make action plan happen Take back to CJAC to get players on board Phil Damiani, Jonna DiStefano, other BHS members June 16 th Delaware County, Pennsylvania: 2010 Priority Area 1: Develop Crisis Intervention Team training/pre-arrest diversion OBJECTIVE ACTION STEP WHO WHEN Organize materials Planning meeting **Have report to Bill prior to June 15 th Develop organizing body/steering committee Invite CIT police from other counties Behavioral health partners Approach Chief Chitwood for possible pilot project Approach Head of Chief of Police Approach law enforcement Funding for training Decide on CIT Training Model Identify what is currently being done and who is interested in developing CIT training Hear about CIT training from other counties in PA including Lt. Healy, Laurel Highlands, John MacAlarney **Patty to give training schedule of Philadelphia and Bucks, maybe Montgomery Invite crisis services and Upper Darby to attend training with Joe and Nick Contact Chief Chitwood of Upper Darby Police Department Approach Chief Joseph Daly Springfield Township Attend Chief of Police Meeting and discuss CIT training Look at funding sources as possibilities for CIT coordinator position Attend Laurel Highlands and Philadelphia CIT Training CJAC Subcommittee - Bill if interested in attending CJAC Phil Damiani to arrange Bill Joe O Berg Bill Donna Frank Joe O Berg Donna Frank Joe O Berg Joe O Berg Nick Paytas June 15 th, 2pm June 16 th September Bucks County --- Tony Sevick, Office of BH - Especially for the two-three hour

32 Recruit Faculty intro to CIT Possible faculty include: - Dave --- Substance Use Disorders and Trauma - Charles and Russell --- Prison MH; Crossroads; What happens when they bring an incompetent person to jail - Barb --- MH signs and symptoms - Judy --- Family panel - Plus perhaps 2 psychiatrists from NAMI Mainline Board - Torie Osterholm --- vets - Crisis and suicide ---Crisis folks --- Leslie Lipson from Project REACH; MD from NAMI board; Lindsey Whitted - Suicide by Cop --- Sgt (ret.) Jeff Bare - Homeless and Housing stability --- Horizon House - Connect and Connect to Permanency --- MHA; homelessness - Dr. Brown --- services from consumer and family perspectives; Consumer Satisfaction Team - Mike H and Donna F --- MHPA; liability - Dr. Susan Ball --- older adults - Forensic Peer Specialist --- Steve will work with group to find someone - Shannon Thomas, CASSP Coordinator for OBH --- child and youth - Dr. Burock, NHS --- child and youth - Cultural issues - Hearing Distressing Voices --- equipment - De-escalation --- Joe and Nick and some crisis staff - Role plays and scenarios - Graduation - Include a Forensic Peer Specialist in the steering committee

33 Delaware County, Pennsylvania: 2010 PRIORITY AREA 2: Improve collaboration among police, crisis services, and community services OBJECTIVE ACTION STEP WHO WHEN Expand training OBH training system wide Bill October 2010 OBH training behavioral health training Increase knowledge of mental health resources Roll call training at various Identify contacts at each police department Develop brochure/pocket manual for police officers on shift -Joe O Berg BH Subcommittee Delaware County, Pennsylvania: 2010 PRIORITY AREA 3: Expand housing options Develop transitional housing targeted for jail re-entry into the community OBJECTIVE ACTION STEP WHO WHEN Investigate the opportunity to create a forensic transitional Phil Damiani: meeting with provider initiate discussion about any building possibilities P. Damiani/provider 5/25/10 housing program Begin to explore funding sources with a treatment (e.g., Phil, Alan, Jonna component either PCCD for startup, SAMHSA) Steering group: related site to Schedule a visit/tour of the Maryland Phil, Jonna, serve Behavioral (Rockville) Community Corrections Donna, Bill, Julie Health in general, Program to consider replicating the mental health, and model co-occurring on that site or a disorders. Identified an existing location: Could be considered for diversion as well as re-entry programs Research possibilities for match funds from re-investment Jonna Have Master Leasing: Continue to expand Master Leasing to allow Initial 5-year funding under reinvestment As a structured residential program is converted, money is funneled to

34 people to get into their own housing Critical Time Intervention Team expanding the leasing opportunities Transition residential supervisor staff will become support staff for independent living Explore ways to develop a Critical Time Intervention (CTI) team to support housing stability OBH Delaware County, Pennsylvania: 2010 PRIORITY AREA 4: Develop systemic reentry preparation/assessment/planning OBJECTIVE ACTION STEP WHO WHEN Create a Re-entry team Identify re-entry team (Liaisons, Treatment Providers, PO, Psych, Forensic Peer Specialist) Providers Now Identify consumers for prison discharge 30 days in advance Identify consumer needs link to reentry team County Forensic Liaisons Liaisons +\- 30 days prior to d/c Prior to d/c Possible in-house evaluations prior to discharge if needed Liaisons Prior to d/c. Convene Re-entry team coordinating care with outpatient providers / housing. Re-entry team After meeting, schedule appointments and notify medical Focus on engagement strategies Ensure Medical Assistance benefits Expand Behavioral Health Capacity Complete MA paperwork ID Employability form Application 1671 (If necessary) Possible improvement VIA online apps. Connect consumer to MA office on discharge Specialized provider staff for Forensics County Forensic Liaisons Re-entry team / Forensic Liaison Providers Pre d/c On d/c ongoing

35 and Expertise Specialized forensic peer specialists Funding streams Provider driven Regularly monthly meeting monthly to attach to county BSU meeting to discuss expansion and education among providers and establish specialized forensics team. Providers / OBH / Magellan Providers, Forensic Liaisons, administrators, OBH, prison officials. ongoing Monthly (To attach) Incorporate evidence-based practices Develop a social worker position in the Public Defenders Office Develop funding for the position Mike H Delaware County, Pennsylvania: 2010 PRIORITY AREA 5: Expand Treatment Court to other populations OBJECTIVE ACTION STEP WHO WHEN Enhance Treatment Court services Develop subcommittee to organize efforts - Communicate with current Judge Linda and Mike Improve referral/screening process Identify additional target populations - Possibly VOP - Cooccurring men Develop plan of action Identify funding sources Write grant Think about team approach to screening and referral Subcommittee Subcommittee Subcommittee Mike Subcommittee plus Phil

36 Delaware County, Pennsylvania: 2010 PRIORITY AREA 6: Develop a position (like Lancaster s Dave) for crisis assessment and intervention at the front door of police and initial detention OBJECTIVE ACTION STEP WHO WHEN Delaware County, Pennsylvania: 2010 PRIORITY AREA 7: Expand Vocational/Work/ Employment /Education opportunities Literacy Volunteer activities also OBJECTIVE ACTION STEP WHO WHEN Delaware County, Pennsylvania: 2010 PRIORITY AREA 8: Improve collaboration between probation and treatment providers OBJECTIVE ACTION STEP WHO WHEN Problem: Violation of Probations occur when the Develop communication process / notification protocol person is not reporting that they are in tx, releases, etc Protocol Upon release from prison- CEC reentry to notify PO If not coming from prison directly From treatment side Prison to notify of treatment needs probation status connection need to be created with the CEC and probation 1 month before PO. Creation of a form to interoffice mail reentry staff from prison (only sentenced over 3 months) Case gets assigned 2 weeks these are the cases that may be falling through the cracks mh history Website review UJS website to review and to identify Donna Mellon/ Mark Reentry staff from prison PO intake Each MH provider Next Friday 5/28 meeting with PO department

37 Focus on skills for succeeding on probation and work related skills - At intake access UJS portal website to determine the services From treatment side (HIPPA regs) prevent from the provider to speak to the P.O. Jointly - - Let s you know if the individual has an active case Need clarification re: court ordered tx communication is problem (ie: Jim Hanlon DUI system has a method to receive letter that the person was in treatment.) Communication/Notification process that allows tx provider to notify of tx to P.O. - especially if the person revokes their confidentiality release Invite D&A tx providers to BSU Meeting for review of cases PRN Draft Uniform form that will be shared with BSUs and the P.O.s BSUs will draft entry / closure form letter of treatment notification to present to P.O. - on wait list/in treatment/closed from treatment OBH representative & Probation Director to formalize in MOU/procedure to BSUs/P.O Clarification of HIPPA re: court mandated tx OBH to clarify the HIPPA requirements in order for the BSUs to release letter Mark from Keystone Mark and Mark/ Donna present at the BSU meeting Barbara Walsh Mark Murphy (PO) Bill Chambers / designee June 17 th meeting By July/ August

38 Conclusions and Recommendations: Summary Participants in the Cross-Systems Mapping and Taking Action for Change workshops showed genuine interest in improving the continuum of resources available for people with severe mental illness, substance use disorders and COD involved in the Delaware County criminal justice system. Delaware County is poised to tackle a number of critical issues that will greatly improve services for this group. The assembled stakeholders spent time crafting strategies related to improving the collaborative infrastructure for the group and addressing the gaps and opportunities at each intercept. The Delaware County Action Plan matrix should be completed by the planning group as soon as is feasible. The remaining priority areas will require additional work in order to clarify and complete the full matrix. Opportunities for both early and quick victories and longer-term strategies should be identified in each priority area. We suggest that the group start by reviewing the Sequential Intercept crosssystems map and supporting information developed through the workshop for accuracy and completeness. Delaware County is currently doing excellent work to enhance collaboration, improve services, and increase community alternatives for people with mental illness involved in the criminal justice system. The recommendations offered below can be used to build on recent accomplishments to enhance cross-system collaboration and the current service delivery system. Summary of Recommendations The priorities developed during the Cross-Systems Mapping workshop along with the first draft of the Action Plan provide a strong framework to improve services for persons with mental illness, substance use disorders and COD involved in the criminal justice system in Delaware County. The expansion of the planning group to tackle the priorities established during the Cross-Systems Mapping and Action Planning exercises is an essential first step in a true systems change process. It will be important to create effective working relationships with other groups that did not attend the workshop including other police jurisdictions. Regular meetings should be held by this larger group to facilitate information sharing, planning, networking, development and coordination of resources, and problem solving. The recommendations are organized according to the Sequential Intercept Model. Some of the recommendations cross all the intercepts and may reflect a need for larger regional and statewide initiatives or coordination. Cross-Intercepts At all stages of the Sequential Intercept Model, data should be developed to document the involvement of people with severe mental illness, substance use disorders and COD involved in the Delaware County criminal justice system. Limited data was available to illustrate the scope and complexity of the problems discussed during the workshop. Efforts should be made to summarize important information on a regular basis and share with the larger planning group, other stakeholders, and funders Consider the Mental Health Report Card used by the King County Washington Mental Health, Chemical Abuse and Dependency Services to document progress in meeting relevant client outcomes o For example, one outcome measure asks: Are we decreasing the number of times adults and older adults are incarcerated? o See:

39 Initiate ongoing meetings with the Coatesville Veterans Affairs Medical Center (VAMC) including the Veterans Justice Outreach Specialist (Contact: and VAMC-Re-entry Coordinator from state prison (Contact: Examine screening procedures to identify veterans entering the criminal justice system o A possible list of questions for screening might include the following: Did you ever serve in the US Armed Forces? In what branch (es) of the Armed Forces did you serve? When did you first enter the Armed Forces? During this time did you see combat in a combat line unit? When were you last discharged? Altogether, how much time did you serve in the Armed Forces? What type of discharge did you receive? Identify resources to help veterans successfully reenter into the community o Seehttp://www1.va.gov/HOMELESS/Reentry_Guides.asp Expand forensic peer counseling, support, and specialists to promote recovery. Build on the energy and interest of consumers who attended the workshop by expanding the work of the peer specialists to criminal justice-involved populations. The consumers attending the workshop were knowledgeable, experienced, and had many thoughtful ideas about ways services can be improved in Delaware County. Several localities around the country (New York City and Memphis, for example) have found that peer specialists with a personal history of involvement in the mental health and criminal justice systems have been effective in engaging individuals who have previously resisted traditional mental health efforts Continue to include consumers in future planning efforts Continue to include and build upon the work of the consumers, family members, and advocates who have shown interest in collaborating to improve the continuum of criminal justice/behavioral health services. Many communities have found family members and consumers to be the most effective voices in helping to bring increased resources to the community. Review screening and assessment procedures for mental illness, substance abuse, and cooccurring disorders across the intercepts. As noted in the appendix on Evidence Based practices, the recently published GAINS Center monograph by Peters, Bartoi, and Sherman, Screening and Assessment of Co-Occurring Disorders in the Justice System, includes the most up to date information about screening and assessment tools in criminal justice settings See The author s note: Accurate screening and assessment of co-occurring disorders in the justice system is essential for rapid engagement in specialized treatment and supervision services. Screening for co-occurring disorders should be provided at the earliest possible point in the justice system to expedite consideration of these issues in decisions related to sentencing, release from custody, placement in institutional or community settings, and referral to treatment and other related services. Due to the high prevalence of co-occurring disorders among offenders, all screening and assessment protocols used in justice settings should address both disorders. The high prevalence of trauma and physical/sexual abuse among offenders indicates the need for universal screening in this area as well. Motivation for treatment is an important predictor of treatment outcome and can be readily examined during screening. Drug testing is also an important component of screening and serves to enhance motivation and adherence to treatment

40 Explore grant-funded opportunities for diversion and reentry, specifically those planned to be offered in Pennsylvania in the near future. Work closely with your assigned Pennsylvania Commission on Crime and Delinquency (PCCD) Regional Representative, Kim Mackey, to identify upcoming PCCD funding opportunities. Examine the state plan disseminated in 2009 entitled, Developing a Statewide Strategic Plan to Guide Pennsylvania s Response to People with Mental Illnesses Involved with the Criminal Justice System o The Mental Health Task Force developing the plan used the Sequential Intercept Model to frame the inquiry and partnered with the Council of State Governments, the Department of Public Welfare s Office of Mental Health and Substance Abuse Services, the Pennsylvania Commission on Crime and Delinquency, other state agencies, and other stakeholders to develop the plan o See: Intercept I: Law Enforcement and Emergency Services Provide regular behavioral health/crisis training for local law enforcement, State Police, probation, and other first responders. Include local law enforcement agencies and State Police in the planning for this training Include the 911 Dispatch Call Center staff and the State Police Call Center Dispatch in the training Cross train and train collaboratively the mobile mental health crisis responders, 911, and State Police Dispatch staff, and other first responders Include consumers and family members in the planning for the training and the training itself Offer a variety of training alternatives: roll call training, introductory training of two to four hours; one day training, and more extensive training of two to five days Consider current Pennsylvania work being done to provide training to law enforcement on mental health issues such as: o o o Family Training and Advocacy Center; contact John MacAlarney, JD (jmacii@comcast.net) Montgomery County Emergency Services; contact Don Kline, PhD (dkline@mces.org) Crisis Intervention Team (CIT) programs currently in operation or in planning: Allegheny: contact Amy Kroll (AKroll@dhs.county.allegheny.pa.us) Philadelphia: contact Michele Dowell (MDowell@pmhcc.org) Laurel Highland Region: see: Bucks County: see o Officer (ret.) Lindsie Whitted, retired from the Philadelphia Police Department, provides training on suicide prevention for consumers and law enforcement, post-traumatic stress disorder, and other topics. Contact him at chaplainroc@aol.com

41 o Sgt. (ret.) Jeff Bare, retired from the Lancaster Police Department, provides training on suicide by cop, compassion fatigue, and other topics Completing a master s degree in marriage and family therapy Provides training to Philadelphia s CIT on de-escalation and suicide by cop Contact him at jeffbare@supernet.com or (717) A recent publication by the Council of State Governments Justice Center is a helpful resource in these efforts: o o Improving Responses to People with Mental Illnesses: Tailoring Law Enforcement Initiatives to Individual Jurisdictions ves.pdf Consider including the Hearing Distressing Voices Exercise ode=curricula-hearingvoicesdistressing&category_code=hearingvoices Intercept II: Initial Detention and Initial Hearing Provide additional training and resources to the Magisterial District Judges (MDJ) to enhance their role in diversion. Provide resource information and 24/7 contact information for crisis staff to assist in identifying people with mental illness who could be diverted and allow for prompt referrals Intercept III: Jails and Courts Build on the work of Treatment Court by incorporating problem-solving concepts and processes in other settings See National Center for State Courts Intercept IV: Reentry Formalize and systematize the reentry process for all individuals with mental illness leaving the prison. This is an ideal opportunity to ensure continuity of care and work proactively to avoid return to the criminal justice system. Develop a protocol for ensuring continuity of care when the release from prison was not anticipated by the prison mental health staff

42 Focus particular, intensive attention on those with repeated prison admissions Build on current work to systematically develop in-reach efforts into the prison to identify those with severe mental illness and often co-occurring disorders in order to facilitate continuity of care and alternatives to incarceration. Determine who has been missed in these efforts Coordinate the resources offered by the prison s mental health staff, community providers, probation, and others o Data from Pierce County, Washington indicates that individuals with severe mental illness were four times more likely to attend their first post-release mental health appointment if someone from the community mental health system met with them while they were still in prison Examine the work in Erie County where the criminal justice and behavioral health systems collaborate closely on two teams to work on developing discharge plans for people leaving their prison: the Aftercare Mental Health Team at the Erie County Prison and the Community Mental Health Treatment Team o The two teams meet on alternating weeks to anticipate, plan for, and follow up on transitions to the community; they focus on both individual cases and addressing systemic issues o Contact Sheila Silman, M.S. at ssilman@eccaremgt.org or (814) Expand involvement of peer support specialists to help with reentry. Utilize the experience and resources of The Main Link Forensic Peer Support program in Bradford and Sullivan counties o See: o Contact D.J. Reese at jdjrees@gmail.com or (570) Examine the new Main Link work release program for prison inmates with severe mental illness Continue to discuss strategies to systemically expedite access to Medical Assistance, Social Security, and other benefits to facilitate successful reentry to the community. See further information about Social Security benefits and the SOAR program in appendix on evidence-based practices Intercept V: Community Corrections and Community Support Consider the growing empirical research working to identify which community corrections strategies improve outcomes (including reducing criminal recidivism) for people with mental illness under community corrections supervision The Justice Center of the Council of State Governments recently published a monograph summarizing the most up to date research and thinking on this topic For instance, research suggests that three strategies by community corrections officers can reduce criminal recidivism or improve linkages to services for probationers with mental illness o Firm but fair o Officers use of compliance strategies that favor problem solving rather than threats of incarceration and other negative pressures o Officers boundary spanning work to develop knowledge about behavioral health and community resources, establish and maintain relationships with clinicians, and advocate for services

43 Specialized probation caseloads are regarded as promising practice for improving outcomes with this population Defining features of specialized caseloads include: o Smaller caseloads composed exclusively of people with mental illness o Significant and sustained training on mental health issues o Extensive collaboration with community-based service providers o Problem-solving strategies to enhance compliance with supervision requirements For more information, see: Jennifer Skeem, PhD of the University of California at Irvine will be speaking to Philadelphia s Forensic Task Force on the research described above on December 16. Arrangements are currently being made to include the surrounding counties in her presentations. Please hold the date for further information This information may also be useful for inclusion in diversion efforts Expand supportive employment options. Continue to explore expansion of housing options for people with mental illness involved with the criminal justice system. Housing is essential for successful reentry and to reduce recidivism. The workshop was particularly strong on including housing staff; continue to build on that collaboration See Appendix A for a listing of resources to address expansion of housing for this population. Two groups are doing interesting work examining housing instability, mental health, and criminal justice in order to develop housing alternatives for this population o The Corporation for Supportive Housing s Frequent Users Initiative has been implemented in a number of cities and states across the country to foster innovative cross-system strategies to improve quality of life and reduce public costs among persons whose complex, unmet needs result in frequent engagement with emergency health, shelter and correctional services These programs identify and target a small group of individuals whose overlapping health and mental health needs place them at high risk of repeated, costly and avoidable involvement with correctional and crisis care systems The Corporation leverages local partnerships and community-based services linked with housing to improve outcomes at a reduced public cost for the frequent user population The New York City Departments of Correction and Homeless Services, with assistance from the Department of Health and Mental Hygiene and the New York City Housing Authority have implemented the Frequent Users of Jail and Shelter Initiative Initial results show that the average number of days in jail decrease by 52% among housed participants, while jail days actually increased for members of a comparison group

44 For information about the New York City and other Frequent User initiatives: o Diana T. Myers and Associates is a housing and community development consulting firm based in Pennsylvania that specializes in planning affordable, accessible housing for people with disabilities and works with government and nonprofit clients to design and coordinate programs and develop housing for people with disabilities The York County Criminal Justice Advisory Board (CJAB) engaged this group in 2007 to conduct a housing study targeting people with serious mental illness involved with the criminal justice system. The group recently completed a similar study in Centre County. See: _Housing_and_the_Sequential_Intercept_Model.pdf Develop data to document the impact homelessness or unstable housing has upon people with mental illness and other behavioral health problems involved in the criminal justice system o Consider including the prison in the annual one day count of homelessness in the county Centre County included the county jail in their January 2009 study That information has been useful in planning for housing resources specifically targeted for this population Include this information in the Delaware County 10 Year Plan to End Homelessness o Document the numbers of people being held in jail who could be released if they had suitable housing Compile information on jail inmates under probation supervision who are waiting for an address in order to be released from jail Explore collaboration and coordination with the faith-based community, especially in the areas of reentry, housing, transportation, and community support

45 Closing Delaware County is fortunate to have a wide range of stakeholders across the mental health, substance abuse and criminal justice systems that have made significant efforts to understand and support the challenging issues discussed in this workshop. The ACTION: Cross-Systems Mapping and Taking Action for Change workshop participants displayed genuine interest in improving the continuum of criminal justice/behavioral health services in Delaware County by developing a coordinated strategy to move forward with the identified priorities. By reconvening and supporting the work of the group in coming months, it will be possible to maintain the momentum created during the Cross-Systems Mapping and Taking Action for Change workshops and build on the creativity and drive of key local stakeholders. Pennsylvania Mental Health and Justice Center of Excellence hopes to continue its relationship with Delaware County and to observe its progress. Please visit the Pennsylvania Mental Health and Justice Center of Excellence website for more information,

46 Transforming Services for Persons with Mental Illness in Contact with the Criminal Justice System Additional Resources Pennsylvania Mental Health and Justice Center of Excellence Pennsylvania Web Sites Pennsylvania Commission on Crime and Delinquency Pennsylvania Recovery and Resiliency --- Adult Justice Related Services Additional Web Sites Center for Mental Health Services Center for Substance Abuse Prevention Center for Substance Abuse Treatment Council of State Governments Consensus Project Justice Center Mental Health America National Alliance on Mental Illness (NAMI) National Alliance on Mental Illness Crisis Intervention Team Resource Center; Toolkit National Center on Cultural Competence National Center for Trauma Informed Care National Clearinghouse for Alcohol and Drug Information National Criminal Justice Reference Service National GAINS Center/ TAPA Center for Jail Diversion National Institute of Corrections National Institute on Drug Abuse Network of Care Office of Justice Programs Ohio Criminal Justice Center for Excellence Partners for Recovery Policy Research Associates SOAR: SSI/SSDI Outreach and Recovery Substance Abuse and Mental Health Services Administration USF Criminal Justice Mental Health & Substance Abuse Technical Assistance Center www11.georgetown.edu/research/gucchd/nccc/ networkofcare.org

47 Appendix A: Delaware County Community Collaboration Grid

48 - 44 -

49 Appendix B: Assisting Communities in Planning for Housing The lack of safe, supportive, and affordable housing alternatives for people with mental illness and often co-occurring substance use disorders involved in the criminal justice system ranks in the top five priorities determined by most communities involved in the cross-systems mapping workshops. The communities consistently describe this issue as a significant barrier to instituting and expanding diversion and reentry opportunities. Communities would like to develop housing alternatives for this population but have few tools to begin and sustain such an effort. There is little understanding of what strategies can be taken at the local level to effectively address this issue and, as a result, a high level of frustration. Three efforts, two national and one in Pennsylvania, have shown some promise in assisting communities to address this issue. - The Council for State Governments Justice Center just released a policymakers guide to reentry housing options which outlines three approaches to increasing housing capacity: creating greater access to existing housing units, increasing the number of housing units specifically available to the target population, and engaging in comprehensive neighborhood revitalization to expand affordable housing for at-risk populations. The benefits and limitations of commonly used housing approaches are described along with examples in place in communities. (See: - The Corporation for Supportive Housing has targeted this problem by assisting states and localities in developing supporting housing for people being diverted from the criminal justice system and those reentering the community from local jails or state prisons. Their work directly addresses the broad range of public organizations involved in serving this population --- corrections, courts, homeless shelters, behavioral health services, and others --- and coordinates these usually fragmented efforts to create housing and supportive services to break the cycle of incarceration and homelessness. Efforts in New York City, Chicago, Rhode Island, and a number of other communities have shown reductions in days spent in shelter and jail along with increases in stable housing. (See: ) - The Pennsylvania s Department of Public Welfare s Office of Mental Health and Substance Abuse Services has recently disseminated a document to help communities address this issue, Housing and the Sequential Intercept Model: A How-to Guide for Planning for the Housing Needs of Individuals with Justice Involvement and Mental Illness. The guide, tailored to Pennsylvania, comprehensively describes how to define the problem, collect data, get the right people at the table, identify housing resources and gaps, examine potential housing models, and formulate strategies to fill the gaps. A wide range of housing options are described including strategies for public housing authorities, private landlords, master leasing, emergency shelter/crisis residential, transitional or bridge housing, and permanent supportive housing. (See:

50 Appendix C: Resources on Cultural Competence for Criminal Justice/Behavioral Health Adapting Offender Treatment for Specific Populations. In Center for Substance Abuse Treatment, Substance Abuse Treatment for Adults in the Criminal Justice System. Treatment Improvement Protocol (TIP) Series 44. DHHS Pub. No. (SMA) Rockville, MD: Substance Abuse and Mental Health Services Administration, pp New Freedom Commission on Mental Health, Subcommittee on Criminal Justice: Background Paper. DHHS Pub. No. SMA Rockville, MD: Primm, A., Osher, F, & Gomez, M. Race and Ethnicity, Mental Health Services and Cultural Competency in the Criminal Justice System: Are We Ready to Change? Community Mental Health Journal, Volume 1, Number 5, , Statement on Cultural Competence. In Evidence Based Practices: Shaping Mental Health Services Toward Recovery. Retrieved U.S. Department of Health and Human Services. Mental health: culture, race, and ethnicity: A report of the Surgeon General. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health. Rockville, MD:

51 Appendix D: Evidence-Based and Promising Practices Specific screening, assessment, engagement, treatment, service or criminal justice practices were not examined during the course of the Cross-Systems Mapping workshop. At some point, Delaware County may want to assess its successful use of evidenced-based and promising practices in each of these areas. Key areas to examine are listed below. Many resources to illustrate these evidence-based practices can be found at the National GAINS Center website, Justice A focus on increasing cultural competence and decreasing disparities in access/availability to behavioral healthcare in all system changes planned and at each intercept o A short bibliography of helpful resources that address cultural competency issues in criminal justice and behavioral health settings [Appendix B] o Sensitizing Providers to the Effects of Treatment and Risk Management: Expanding the Mental Health Workforce Response to Justice-Involved Persons with Mental Illness, the SPECTRM program, uses a cultural competence model to help service providers better understand the needs of the population they serve and deliver services tailored to their unique needs, see Consideration of the impact of trauma in regard to policy and procedures at all intercepts o Policy Research Associates provides cross-training to help criminal justice professionals and service providers to become trauma-informed [training@prainc.com] The need for gender-informed practices at all intercepts Facilitation of transitional planning and linkage of individuals to appropriate services in the community o A Best Practice Approach to Community Re-Entry for Inmates with Co-Occurring Disorders: The APIC Model; the APIC model and the transitional planning checklist, currently being used by the Jericho Project in Memphis, Tennessee, provides criminal justice, behavioral health, and others with a concrete model to consider for implementing transitional planning across all intercepts, see Information sharing across criminal justice and treatment settings o Dispelling the Myths about Information Sharing Between the Mental Health and Criminal Justice Systems and an example of an information sharing MOU, see Screening, Assessment, Engagement, and Treatment Screening and assessment of co-occurring disorders o See the monograph Screening and Assessment of Co-Occurring Disorders in the Justice System for the most up to date information about screening and assessment tools in criminal justice settings Integrated treatment of co-occurring mental illness and substance use disorders that focuses on recovery and includes illness self-management strategies and services for families o Illness Management and Recovery; a fact sheet developed by the GAINS Center on the use of this evidence-based practice for criminal justice involved populations that may be of value to the jail mental health staff and community providers, see o Integrating Mental Health and Substance Abuse Services for Justice-Involved Persons with Co- Occurring Disorders; a fact sheet focused on integrated treatment, see Services that are gender sensitive and trauma informed

52 o See the monograph The Special Needs of Women with Co-Occurring Disorders Diverted from the Criminal Justice System Treatment of trauma-related disorders for both men and women in criminal justice settings is covered in Addressing Histories of Trauma and Victimization through Treatment; see Assertive Community Treatment and intensive forensic case management programs o Extending Assertive Community Treatment to Criminal Justice Settings; a fact sheet on ACT for forensic populations, see Services that seek to engage individuals and help them remain engaged in services beyond any court mandate o The EXIT Program: Engaging Diverted Individuals Through Voluntary Services, see Service Utilization of a systemic approach to accessing benefits for individuals who qualify for Medical Assistance, SSI, and SSDI, including individuals who are homeless and those recently released from jail or prison o Maintaining Medicaid Benefits for Jail Detainees with Co-Occurring Mental Health and Substance Use Disorders, see o See Policy Research Associates SSI/SSDI Outreach and Recovery (SOAR) website for planning and technical assistance efforts designed to improve access to Social Security benefits Employing consumers in delivery of in-reach, case management and training services o Peer Support within Criminal Justice Settings: The Role of Forensic Peer Specialists, see o Overcoming Legal Impediments to Hiring Forensic Peer Specialists, The use of natural community supports, including families, to expand service capacity to this vulnerable population Supported Employment; a fact sheet on supported employment programs and programs that assist individuals in accessing mainstream employment opportunities, see Moving Toward Evidence-Based Housing Programs for Persons with Mental Illness in Contact with the Justice System; a fact sheet on safe housing for persons with mental illness involved with the criminal justice system, see Addressing the needs of veterans who become involved in the criminal justice system; Responding to the Needs of Justice-Involved Combat Veterans with Service-Related Trauma and Mental Health Conditions, see

53 Appendix E: Resources for Specialized Police Response and Law Enforcement/Behavioral Health Collaboration at Intercept 1 Improving Responses to People with Mental Illnesses: Tailoring Law Enforcement Initiatives to Individual Jurisdictions. Manuscript published by the Justice Center. This monograph assists communities develop effective specialized police response and collaboration between law enforcement and behavioral health systems tailored to the needs of the local community. It provides a step by step program design process and numerous examples of how localities have implemented collaborative police and behavioral health responses to produce better outcomes when law enforcement encounters a person with mental illness in crisis. Available at: Law Enforcement Responses to People with Mental Illness: A Guide to Research-Informed Policy and Practice. Manuscript published by the Justice Center. Examines studies on law enforcement interactions with people with mental illnesses and translates the findings to help policymakers and practitioners develop safe and effective interventions. Supported by the John D. and Catherine T. MacArthur Foundation, it reviews research on the scope and nature of the problem and on a range of law enforcement responses. Available at: Ohio s Crisis Intervention Team (CIT) Initiative. Video developed by the Ohio s Criminal Justice Coordinating Center of Excellence. This recently released brief video describes Ohio s successful development and promotion of CIT programs. The video presents an overview of CIT and the Criminal Justice CCoE and provides a brief introduction of CIT. Ohio Supreme Court Justice Evelyn Stratton is among the speakers. Available at Bucks County (PA) Crisis Intervention Team. NAMI PA Bucks County Official website of the Bucks County CIT, include an overview of the program, news reports and more. Available at: Laurel Highlands Region (PA) Crisis Intervention Team Official website of the Laural Highlands Region CIT, including a brief overview and description, resources and contact information. Available at:

54 A Specialized Crisis Response Site as a Core Element of Police-Based Diversion Programs. Article in Psychiatric Services, This article covers three communities, including Montgomery County (PA), that have developed pre-booking diversion programs that rely on specialized crisis response sites where police can drop off individuals in psychiatric crisis and return to their regular patrol duties. Available at: A Comprehensive Review of Extant Research on Crisis Intervention Team (CIT) Programs. Article in Journal of the American Academy of Psychiatry and Law, This article reviews available research of CIT programs nationally, specifically reporting on officerlevel outcomes, the dispositions of calls eliciting a CIT response, and available models. Available at: Presentations from the 2010 International CIT Conference website. A catalogue of presentations from the 2010 International CIT Conference (June 2010) is included on this website. Chester County may be especially interested in the following presentations: o Persuading Policy Makers: Effective CIT Program Evaluation and Public Relations (page 1) o A Co-response Model Mental Health and Policing (page 1) o How CIT Works in a Small Rural County (page 1) o Keys to the Successful Development and Implementation of a CIT Program (page 2) o Steps to Successful Community Collaboration (page 3) o An Innovative Community Collaboration to Enhance the Continuum of Care (page 3) Available at: Making Jail Diversion Work in Rural Counties. Presentation at the GAINS TAPA Center for Jail Diversion Easy Access Net/Teleconference, March 27, This is a presentation by Brown County (OH) and New River Valley (VA) on implementing CIT in rural communities. It covers initial barriers, planning stages, modifications and eventual implementation of pre-booking diversion programs in small, rural communities in Ohio and Virginia. Available at: MCES Mobile Crisis Intervention Service Montgomery County Emergency Service, Inc. (MCES) is a non-profit hospital founded in 1974 and is nationally renowned for its innovative programs to assist law enforcement agencies in dealing with mental health, behavioral and substance abuse issues, including their Mobile Crisis Intervention Service. Available at:

55 Family Training and Advocacy Center Official website of the Philadelphia Department of Behavioral Health/Mental Retardation Services Family Training and Advocacy Center (FTAC), which provides support to families and family groups dealing with a family member's behavioral health and/or addiction issues. Among its many activities, FTAC provides training to criminal justice staff. Available at: Exchange of Information Between First Responders And the Venango County Mental Health System: Policy and Procedures. Example of an information sharing agreement in Venango County (PA) between law enforcement, Venango County Human Services Integrated Crisis Services Unit (ICS) and Mental Health/Mental Retardation Department (MH). Please contact: Jayne Romero, MH/MR Administrator Venango County, at (814) Police 3x5 Crisis Intervention Quick Referral Cards This set of nine 3x5 cards are provided to San Antonio Texas Crisis Intervention Team officers during their initial 40 hour training. They are provided as handy reference tools and updated before every new CIT class. Available at: -

56 Hearing Voices That Are Distressing Exercise Philadelphia RESPONDS Crisis Intervention Team The Philadelphia RESPONDS Crisis Intervention Team includes a two hour segment in the 40 hour CIT training entitled Hearing Voices That Are Distressing. This training curriculum is a simulation experience designed to allow participants to gain a better understanding of what it is like for a person with mental illness to hear voices. The curriculum was developed by Patricia Deegan, PhD and the National Empowerment Center in Massachusetts. Participants of the program first watch a DVD presentation by Dr. Deegan regarding hearing voices and then use headphones to listen to a specially designed CD developed by people with mental illness who hear voices. During the simulated experience of hearing voices, participants undertake a series of tasks such as: interaction in the community, a psychiatric interview, psychological testing and activities that mimic a day treatment program. The simulation experience is followed by a short wrap up DVD presentation by Dr. Deegan specifically focused on first responders then a debriefing and discussion period. Philadelphia s CIT uses brief Power Point presentations based on Dr. Deegan s presentations rather than the DVD itself. Patricia Deegan, PhD, holds a doctorate in clinical psychology and developed the curriculum as part of her work with the National Empowerment Center. Dr. Deegan was diagnosed with schizophrenia at the age of seventeen. She has experienced hearing voices that are distressing and integrates that experience into her presentations. The primary goals for the participants of the Hearing Voices experience are: Understand the day to day challenges that face people with psychiatric disabilities and better appreciate the strength and resiliency a person who hears voices must have Learn about the subjective experience of hearing voices that are distressing Become more empathic toward people who hear distressing voices Change practices to better address the needs of people who hear distressing voices Become familiar with coping strategies for voice hearers Philadelphia began using the Hearing Voices curriculum shortly after the inception of the Crisis Intervention Team program in January Many CIT and other police mental health programs around the country have used this curriculum for training, including Connecticut s Alliance to Benefit Law Enforcement (CABLE). All have found it a helpful tool for learning and engagement of law enforcement officers. The exercise is consistently one of the highest rated sections by Philadelphia CIT officers and has become essential in developing a compassionate understanding of severe mental illness. The Hearing Voices That Are Distressing exercise has attracted much interest in Philadelphia from other organizations who have requested the exercise include the Philadelphia Forensic Task Force, the jail, District Attorney s Office, Defenders Association, and Mental Health Court. Administrators from the jail have expressed an interest in including the exercise in their regular correctional officer training. For more information on Philadelphia RESPONDS Crisis Intervention Team: Michele Dowell, MSW, CIT Coordinator, (215) ext. 3511, mdowell@pmhcc.org or Lt. Francis Healy, Philadelphia Police Department, (215) , Francis.Healy@phila.gov For more information on the Hearing Voices That Are Distressing Curriculum and Dr. Deegan videos: National Empowerment Center Patricia Deegan, PhD (978) HearingVoicesDistressing&Category_Code=hearingvoi

57 Appendix F: Directory of Delaware County Mental Health and Drug and Alcohol Services The mission of the Office of Behavioral Health is to assure the provision of a comprehensive array of quality mental health and alcohol and other drug services for eligible children and adults that will assist them to maximize their human potential. As such, OBH has created a comprehensive directory of Adult Drug and Alcohol (D&A) and Mental Health (MH) Services. This document contains an alphabetical list of contracted providers, and the services provided with telephone contact information for each program or service listed. The Directory is updated regularly to reflect new adult behavioral healthcare programs and services contracted by Delaware County. The directory of resources and other information about the Delaware County Office of Behavioral Health can be found at

58 Appendix G: Acronym List Acronym AA AP/P BHS BSU CAO CASSP CEC CCMC CCP CHIPP CIT CJ CJAC COD CoE CPS CRS CST D/C DA D&A Detox DPW DUI EASR HIPAA HPRP HUD ICM MA MAST MCES MCMC MCO MDJ MH MHA MHPA Description Alcoholics Anonymous Adult Probation/Parole Behavioral Health Subcommittee Base Service Unit County Assistance Office Child/Adolescent Service System Program Community Education Centers, Inc. Crozer Chester Medical Center Community Care Program Community Hospital Integration Project Program Crisis Intervention Training Criminal Justice Criminal Justice Advisory Committee Co-Occurring Disorder Center of Excellence Certified Peer Specialist Community Residential Services Consumer Satisfaction Team Discharge District Attorney Drug and Alcohol Detoxification (Emergency D&A Intervention) Department of Public Welfare Driving Under the Influence Engagement, Assessment, Stabilization, Referral (Homeless Outreach) Healthcare Insurance Portability and Accountability Act Homeless Prevention Rapid Re-housing Program Housing and Urban Development (U. S. Department of) Intensive Case Management Medical Assistance Mobile Assessment Stabilization Treatment (Community Treatment Team) Montgomery County Emergency Services Mercy Catholic Medical Center Managed Care Organization Magisterial District Judges Mental Health Mental Health Association Mental Health Procedures Act

59 Acronym MOU NA NAMI NHS NSH NTBR OBH OEF OIF OMHSAS PA PACT PADAP PCCD PLAN PO PREP PRN PRO-ACT PTSD REAPP SAMHSA SCA SCI SE SMI SSDI SSI Tx UHS UJS VA VAMC VJO VOP WES Description Memorandum of Understanding Narcotics Anonymous National Alliance for the Mentally Ill Northwestern Human Services Norristown State Hospital Not To Be Released Office of Behavioral Health Operation Enduring Freedom Operation Iraqi Freedom Office of Mental Health and Substance Abuse Services Pennsylvania Program of Assertive Community Treatment (ACT Team) Prison Alternative Drug and Alcohol Program Pennsylvania Commission on Crime and Delinquency Positive Living Assistance Network Probation Officer Pyramid Recovery Education Program Per Required Need PA Recovery Organization-Achieving Community Together Post Traumatic Stress Disorder Reentry Access Prison Program Substance Abuse Mental Health Services Administration Single County Authority (D&A Division of OBH) State Correctional Institution Southeast Serious Mental Illness Social Security Disability Income Supplemental Security Income Treatment United Health Systems (KeyStone Center) Unified Judicial System Veterans Administration Veterans Administration Medical Center Veterans Justice Outreach Violation of Probation/Parole Work Place Essentials Skills

60 Transforming Services for Persons with Mental Illness in Contact with the Criminal Justice System Cross-Systems Mapping and Taking Action for Change Participant List Joannie Adams-White Health Services Administrator CEC, International Delaware County Prison PO Box 23A Cheyney Road, Thornton, PA Phone: Fax: Linda Barbera Coordinator Mental Health Treatment Court Office of Adult Probation/Parole Media Court House 201 W. Front Street Media, PA Phone: Fax: Cheryl Brown Director, Consumer Satisfaction Team 20 S. 69 th Street, 3 rd Floor Upper Darby, PA Phone: Fax: browncl@co.delaware.pa.us Paul Butler, Regional Forensic Liaison Regional MH Services Coordination Office Norristown State Hospital Building 2, Room Sterigere Street Norristown, PA Phone: Fax: pbutler@pmhcc.org Julie K. Brown Delaware County Program Director Magellan Behavioral Health of PA, Inc. 105 Terry Drive, Suite 103 Newtown, PA Phone: Fax: jkbrown@magellanhealth.com Bill Chambers MH Program Director Office of Behavioral Health 20 S 69 th Street Upper Darby, PA Phone: Fax: chambersw@co.delaware.pa.us Dawn Connors Director, BCM Northwestern Human Services 370 Reed Road Broomall, PA Phone: Fax: dconnors@nhsonline.org Phillip W. Damiani, Jr. Executive Director Office of Court Services Media Court House 201 W. Front Street Media, PA Phone: Fax: damianip@co.delaware.pa.us

61 Cross-Systems Mapping and Taking Action for Change Participant List Dana Dantzler, Ph.D. Psychologist CEC, Inc. Delaware County Prison PO Box 23A Cheyney Road, Thornton, PA Phone: Fax: Michael Harper, Esq. Asst Public Defender Office of the Public Defender Media Court House 201 W. Front Street Media, PA Phone: Fax: Donna T. Frank, Assistant DA Office of the District Attorney Media Court House 201 W. Front Street Media, PA Phone: Fax: Judith Green Board Member NAMI PA Main Line P.O. Box 333, 264 Forrest Rd. Merion Station, PA, Phone: James T. Hanlon Director Diagnostic Services (DUI) Media Court House (Basement) 201 West Front Street Media, PA Phone: Fax: Samuel W. Harris Recovery Specialist, CPS Holcomb Behavioral Health Services Burmont House 115 Burmont Road Drexel Hill, PA Phone: Fax: Anne Jennings SCA CM Supervisor Office of Behavioral Health 20 S 69 th Street Upper Darby, PA Phone: Fax; jennningsa@co.delaware.pa.us Stephanie H. Klein, Esq. Magisterial District Judge District Justice s Association 349 West Baltimore Avenue Media, PA Phone: kleins@co.delaware.pa.us

62 Cross-Systems Mapping and Taking Action for Change Participant List Elisa C. Lacianca, Esq. Magisterial District Judge District Justice s Association 525 West Chester Pike Suites 103 & 105 Havertown, PA Phone: Fax: Lisalac@comcast.net Russell Long Behavioral Health Specialist Delaware County Prison CEC, Inc. PO Box 23A Cheyney Road Thornton, PA Phone: Fax: longr@co.delaware.pa.us Stephanie Lucas Del. Co. Peer Specialist Magellan Behavioral Health of PA, Inc. 105 Terry Drive Suite 103 Newtown, PA Phone: Fax: slucas@magellanhealth.com Kimberly A. Mackey, Esq. CJAB Specialist SE Region PCCD 3101 North Front Street Harrisburg, PA Phone: Fax: c-kimackey@state.pa.us Steve Markind Certified Peer Specialist Horizon House 1601 Parkland Road Swarthmore, PA Phone: Fax: Jeanne McDonnell Team Leader, MAST Northwestern Human Services 800 Chester Pike Sharon Hill, PA Phone: x 1741 Fax: jmcdonne@nshonline.org John McFadden Peer Advocate Northwestern Human Services 370 Reed Road Broomall, PA Phone: ext Fax: jmcfadden@nhsonline.org Donna Mellon Assistant Superintendent Delaware County Prison CEC, Inc. PO Box 23A Cheyney Road Thornton, PA Phone: Fax: mellond@co.delaware.pa.us

63 Cross-Systems Mapping and Taking Action for Change Participant List David Moran Director, D& A Recovery Center Crozer Chester Medical Center Community Div W. 9 th Street Chester, PA Phone: Fax: david.moran@crozer.org Theresa Murphy Director Homeless & Residential Services Horizon House 1601 Parklane Road Swarthmore, PA Phone: Fax: theresa.murphy@hhinc.org Mark T. Murray Deputy Director Office of Adult Probation/Parole Media Court House 201 West Front Street Media, PA Phone: Fax: murraym@co.delaware.pa.us Joseph O Berg Patrolman Springfield Police Department 50 Powell Road Springfield, PA Phone: Fax: joberg@springfieldpd.com Torrie Osterholm Veteran s Justice Outreach Specialist Coatesville VA Center 1400 Black Horse Hill Road Coatesville, PA Phone: Fax: torrie.osterholm@va.gov Erin Page Certified Peer Specialist Mercy Catholic Medical Center 204 Mackenzie Avenue Prospect Park, PA Phone: erinpage1015@aol.com Linda Pansulla Corporate Medical Director of Risk Management CEC, Inc. Delaware County Prison PO Box 23A Cheyney Road Thornton, PA linda.pansulla@cecintl.com Nicholas Paytas Patrolman Springfield Police Department 50 Powell Road Springfield, Pa Phone: Fax: npaytas@springfieldpd.com

64 Cross-Systems Mapping and Taking Action for Change Participant List Mark Pepper Aftercare Coordinator KeyStone Center UHS Recovery Foundation Inc. Keystone Center 2001 S. Providence Avenue Chester, PA, Phone: Fax: Kathie Ruger Director, PACT Team Horizon House 1601 Parklane Road Swarthmore, PA Phone: Fax: Dawn Scott Clark MH Probation Officer Office of Adult Probation/Parole 8909 Ludlow Street, 6 th Floor Upper Darby, PA Phone: Fax: clarkds@co.delaware.pa.us Terri Venello Director, MH Outpatient Crozer Chester Medical Center CCMC-Community Division 2600 W 9 th Street Chester, PA Phone: Fax: terri.venello@crozer.org Barbara Walsh Blended Case Manager Mercy Catholic Medical Center Mercy Fitzgerald Hospital-CCP 1500 Lansdowne Avenue Mail Stop 094 Darby, PA Phone: Fax: bwalsh@mercyhealth.org Richard Ziegler Delaware County Director Horizon House 1601 Parklane Road Swarthmore, PA Phone: Fax: rich.ziegler@hhinc.org Charles Van Ravenswaay Forensic BH Specialist Delaware County Prison CEC, Inc. PO Box 23A Cheyney Road Thornton, PA Phone: Fax: vanravenswaay@co.delaware.pa.us

65 Cross-Systems Mapping and Taking Action for Change Participant List Tory Bright MH Services Coordination Office Norristown State Hospital Bldg 2 Rm Sterigere Street Norristown, PA Phone: Fax: regional.mh@verizon.net Mary Gregorio, Facilitator Consultant, MH Services Coordination Office Norristown State Hospital Bldg 2 Rm Sterigere Street Norristown, PA Phone: gregorio.consulting@gmail.com Patty Griffin, Ph.D. Senior Consultant Pennsylvania Mental Health and Justice Center of Excellence 8503 Flourtown Avenue Wyndmoor, PA Phone: (215) pgriffin@navpoint.com Kathleen Kemp, M.A., M.S. Pennsylvania Mental Health and Justice Center of Excellence 123 South Broad Street, 22 nd floor Philadelphia, PA Phone: (215) x3320 kkemp@pmhcc.org