Tri-Occurring supervision in the criminal Justice System

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Cassandra Beasley
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1 Tri-Occurring supervision in the criminal Justice System How AIIM Alternatives to Incarceration for Individuals with Mental Health needs uses IDDT Integrated Dual Disorder Treatment model in the criminal justice system

describe what IDDT is and how it can be adapted within the criminal justice

2 Objectives You will be able to describe what trioccurring supervision is You will be able to describe what AIIM is and how it functions You will be able to describe what IDDT is and how it can be adapted within the criminal justice system You will be able to define what a true multidisciplinary team is and how it functions

3 Tri-Occurring supervision and treatment - a three legged stool

4 Leg #1 - Mental Health

5 Pharmacological interventions Monitored medication administration Individual and group therapy Motivational Interviewing and interventions based on stages of change model Embedded into each disciplines work

6 Leg #2 Substance Abuse

7 Strategies for self improvement and change curricula Integrated curricula Encouragement to be involved in AA/NA and twelve step programs Substance monitoring Embedded into each disciplines work

8 Leg #3 Criminogenic Risk Needs and Responsivity

9 Identifying the needs that are the focus of treatment History of Antisocial Behavior. For this Risk factor help the offender identify underlying factors in their history that have impacted their behavior Antisocial Personality Pattern. For this risk factor, the dynamic need to be targeted is weak self-control, weak anger management skills, and poor problem solving. Antisocial Cognition. For this risk factor, the dynamic need to be targeted is, reduction of antisocial thinking and feeling and through building and practicing less risky thought and feelings. Antisocial Associates. For this risk factor, the dynamic need to be targeted is, reduce association with procriminal others and enhance association and prosocial others. Family/marital circumstances. For this risk factor, the dynamic need to be targeted is to address the natural supports in the individuals life and help them explore new means to gain support. Strong nurturance and caring in combination with strong monitoring and supervision. School/Work. For this risk factor, the dynamic need to be targeted is, Enhance performance, involvement, rewards and satisfactions. Leisure/Recreation. - For this risk factor, the dynamic need to be targeted is, Enhance involvement, rewards and satisfactions. Embedded into every disciplines work

10 The fourth is physical health SOMETIMES THERE ARE FOUR LEGS TO THE STOOL

11 How the 3/4 legs of the stool make it stand It s different for every client Address what the client is showing at the moment. Does not matter what came first the chicken or the egg Combining strategies from addictions treatment and psychiatric/mental health betters outcomes (Minkoff, 2001). We propose incorporating criminal justice would only improve the outcomes for this population.

12 Alternatives to Incarceration for Individuals with Mental Health needs WHAT IS AIIM

AIIM This program is intended for individuals presenting with serious substance abuse problems, chronic mental illness, and a history of criminal conduct.

13 AIIM This program is intended for individuals presenting with serious substance abuse problems, chronic mental illness, and a history of criminal conduct. The purpose of the program is to provide an alternative to incarceration for individuals that are involved in the criminal justice system with mental health issues that are related to their crimes and to provide services and supervision to adults who are involved in the system due to their mental health issues. The program will provide probation level supervision, intensive mental health treatment, and substance abuse treatment to these individuals as well as monitored medications, substance abuse monitoring, and intensive case management assistance with basic needs, housing, and employment.

14 And how to adapt it within the criminal justice system WHAT IS IDDT

Integrated dual diagnosis treatment (IDDT) is an evidence-based model that addresses a person s substance use in the context of the treatment of their mental illness.

15 Integrated dual diagnosis treatment (IDDT) is an evidence-based model that addresses a person s substance use in the context of the treatment of their mental illness. IDDT provides combination of clinical and rehabilitative interventions that address all aspects of a person s life. Within IDDT, both disorders are addressed at the same time with close collaboration between a multidisciplinary team trained and competent in co-occurring disorders. IDDT seeks to treat the whole person instead of looking only at one issue at a time. Mental illnesses, substance use disorders, and other needs are seen as intertwined, not separate. IDDT utilizes harm-reduction principles. That is, the staff tries to reduce the negative consequences of alcohol or drug use and of mental illness. Abstinence from substances and consistently taking recommended psychiatric prescriptions may be an individual s goals, but neither condition should be required to enter treatment

Core elements of IDDT Multidisciplinary team Stage-wise interventions Access to comprehensive services residential, employment services, benefits acquisition etc.

16 Core elements of IDDT Multidisciplinary team Stage-wise interventions Access to comprehensive services residential, employment services, benefits acquisition etc. Time-unlimited services Assertive outreach Motivational Interviewing Contingency management Substance Abuse counseling Mental Health treatment Cognitive Behavioral Interventions addressing Criminal Conduct Participation in self-help groups Pharmacological treatment Interventions to promote health

needed Modified harm reduction has to be adapted in the criminal

17 Adding Criminal Justice Supervision to IDDT It can be done Takes a team that understands everyone s roles and can switch hats when needed Modified harm reduction has to be adapted in the criminal justice system Outreach, outreach, outreach. Engagement, engagement, enegagement

18 STAGES OF CHANGE AND CLINICAL FOCUS

19 Stages of Change Stages of IDDT Treatment AIIM Phase Clinical Focus Pre- Contemplation Engagement Phase I Assess candidates for admission to program; build a relationship and working alliance with the offender-client; provide practical support for daily living; assess continuously. Pre- Contemplation, Contemplation, and Preparation Engagement and Persuasion Phase II & III Help the engaged offender-client develop the motivation to reduce substance use and to participate in other recovery-oriented interventions Action Active Treatment Phase IV Help the motivated client acquire skills and supports for managing symptoms of both disorders and for pursuing goals. Action and Maintenance Active Treatment and Relapse Prevention Transition to services after AIIM Help the motivated client acquire skills and supports for managing symptoms of both disorders and for pursuing goals; and help clients in stable remission develop and use strategies for maintaining abstinence and recovery. Maintenance Relapse Prevention Outpatient treatment Help clients in stable remission develop and use strategies for maintaining abstinence and recovery.

20 And how it really functions WHAT IS A MULTI- DISCIPLINARY TEAM

Definition s interdisciplinary team a group that consists of specialists from several fields combining skills and resources to present guidance and information.

multidisciplinary team a team of professionals including representatives of different disciplines who coordinate the contributions of each profession, which are not considered to overlap, in order to

21 Definition s interdisciplinary team a group that consists of specialists from several fields combining skills and resources to present guidance and information. intraprofessional team a team of professionals who are all from the same profession, such as three physical therapists collaborating on the same case. multidisciplinary team a team of professionals including representatives of different disciplines who coordinate the contributions of each profession, which are not considered to overlap, in order to improve patient care. rehabilitation team the individuals involved in establishing a plan and goals for the achievement of a patient's maximum potential. The composition of the team will vary depending on the nature of the patient's problems; the patient is always included as a member of the rehabilitation team. transdisciplinary team a team composed of members of a number of different professions cooperating across disciplines to improve patient care through practice or research.

Core components to a healthy team Leadership and management - Having a clear leader of the team, with clear direction; democratic; shared power; support/supervision; leader who acts and listens.

22 Core components to a healthy team Leadership and management - Having a clear leader of the team, with clear direction; democratic; shared power; support/supervision; leader who acts and listens. Communication - Individuals with communication skills; ensuring that there are appropriate systems to promote communication within the team. Respecting/understanding roles - Importance of respecting and understanding the roles of other team members; that the limitations and boundaries of each role were well understood; and to have an understanding of how the roles have the potential to impact on patients. Practitioners should also be aware of how their own role fits within the team, and differs from that of other team members, and that roles and responsibilities are made explicit. Sharing power, joint working, autonomy. Personal rewards, trainning and development Learning; training and career development opportunities; incorporates individual rewards and opportunity, morale and motivation.

Core components to a healthy team Appropriate resources and procedures - Structures (for example, team meetings, organizational factors, team members working from the same location).

23 Core components to a healthy team Appropriate resources and procedures - Structures (for example, team meetings, organizational factors, team members working from the same location). Ensuring that appropriate procedures are in place to uphold the vision of the service. Appropriate skill mix - Competencies, practitioner mix, balance of personalities; having a full complement of staff, timely replacement/cover for empty or absent posts. Climate - Team culture of trust, valuing contributions, nurturing consensus; need to create an interprofessional atmosphere. Individual characteristics - Knowledge, experience, initiative, knowing strengths and weaknesses, listening skills, reflexive practice; desire to work on the same goals. Clarity of vision - Having a clear set of values that drive the direction of the service and the care provided. Portraying a uniform and consistent external image. Quality and outcomes of care - Patient-centered focus, outcomes and satisfaction, encouraging feedback, capturing and recording evidence of the effectiveness of care and using that as part of a feedback cycle to improve care.

24 Working as a team allows for: Working for common goals Pooling of expertise A forum for problem solving Opportunities for personal growth and development Shared burden and personal support, particularly for professional self-care Better outcomes

25 Who is on the team On Site Supervisor or Team Lead Probation Officer/Case Manager Therapists Basic Needs Case Manager Psychiatric Provider

26 OUTCOMES

AIIM start up 2005-2007 In the first 2 years of the AIIM program there were 13

27 AIIM start up In the first 2 years of the AIIM program there were 13 successful completions and of those only 1 client spent 2 days in jail, 1 year post AIIM.

AIIM establishment 2007-2009 AIIM settled into what we do which is supervision, treatment and outreach.

28 AIIM establishment AIIM settled into what we do which is supervision, treatment and outreach. We added a phase system based on the stages of change From 2007 to 2009 there were 13 successful completions and of those 2 clients served a combined 9 days in custody the year after successful completion

29 AIIM current 2009-today From 2009 to today AIIM has had 36 successful completions and of those 5 clients have spent 124 days in custody the year after AIIM. During this time AIIM expanded and began taking on higher risk clients including ISP and Drug Court clients.

30 AIIM historical Since it s start AIIM has served 180 clients We started small and have grown to having 5 full time staff serving 35 clients 87% of our successful completions did not return to custody 1 year after their graduation and 76% still have not returned to custody.

31 Lessons learned Transition to services after AIIM need to start while they are still in the program. More is not always better these clients are time consuming so if you take on too many clients, then they don t get the resources they need to be successful. Having as many of the services as possible at the same location is important Interdisciplinary Team Leaders from the multiple agencies need to be on the same page Building in Peer Leadership Staff selection

IDDT Fidelity Action Planning Guidelines

1a. Multidisciplinary Team IDDT Fidelity Action Planning Guidelines Definition: All clients targeted for IDDT receive care from a multidisciplinary team. A multi-disciplinary team consists of, in addition