SAMHSA/CMHS Jail Diversion and Trauma Recovery Priority to Veterans

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1 SAMHSA/CMHS Jail Diversion and Trauma Recovery Priority to Veterans David Morrissette, Ph.D. LCSW SAMHSA

2 Opportunities for breaking the cycle: Sequential Intercept Model

3 Jail Diversion Works Divertees use less alcohol and drugs Have fewer arrests after diversion compared to 12 months before (2.4 vs 1.3) and fewer jail days (52 vs 41) Improved quality of life with fewer symptoms Pervasive exposure to trauma

4 Logic Model Stage 1 Stage 2 Stage 3 Improved Mental Health /Individual Outcomes Diversion Identify and Enroll People in Target Group Linkage Comprehensive/ Appropriate Community-Based Services Improved Public Safety Outcomes

5 Common Problems of Trauma PTSD Depression Alcohol and drug abuse Suicidal thoughts Self-blame, guilt and shame Anger or aggressive behavior

6 Growing Attention to Returning Veterans involved in the CJ System 1.6 Million deployed Rand s Invisible Wounds of War reports 19% of returning veterans have PTSD, Depression or both Veteran Courts (50) State legislation facilitating diversion SAMHSA and VA initiatives Reentry and VJO

7 Emerging Lessons Screening and treatment of trauma related disorders through trauma informed care (TIC) systems; Maximize participant choice; Peer involvement in Planning, Services and Evaluation

8 Jail Diversion Grantees

9 Diversion Pilot Intercept Points CT, IL, NM, RI, TX CT, IL, FL, NC, NM, OH, PA, RI CT, IL, CO, GA, MA, VT, FL, NC, OH, PA, RI CT, IL, VT, NM, OH

10 Specialized Courts Florida and North Carolina have built upon existing specialized mental health or drug courts; Many others have specialized Veterans courts/dockets Colorado, Georgia, Illinois, Ohio Pennsylvania, Texas

11 Accomplishments Policy changes related to systematic trauma screening, trauma training, and treatment Mechanisms to identify veterans in jails, courts, parole, probation Data sharing agreements with VA Priority service access for veterans Peer Certification

12 Early Pilot Challenges (con t) Domestic violence exclusions Participant reluctance to use VA services Potentially overwhelmed paid peer staff

13 Who is being diverted? 405 Individuals have been across 10 sites 313 Baseline Client interviews completed 91 Six Month Follow-Up Interviews 90% follow-up rate 12/1/09-6/15/11

14 Diversion Intercept and Charge Level (N=367) Diversion Intercept Charge Level Pre-Booking 21% Post-booking 64% Parole/Probation Violation 8% Pending 7% Felony 46% Misdemeanor 45% Technical Violation-Probation/Parole 4% Unspecified 5%

15 Most Serious Charge (N=366) 30 AOD Related Crime Crimes Against Person- Violence Property Crime Crimes Against Person Other Public Order Other Major Motor Vehicle (no DUI/DWI)

16 Demographics of Evaluation Participants (N=313) White 67% African American 24% Race Multi-racial 6% American Indian 2% Gender Male 94% Hispanic/Latino (Yes) 13% Age in Years Mean 40 yrs Some college or more 52% Education High School/GED 41% Less than High School 7%

17 Criminal Justice History of Clients (N=313) One or more prior arrests in lifetime 91% Ever on probation 71% Spent time in prison for a conviction 56% Ever had a restraining order 43% Currently have restraining order 25%

18 Military Branch and Era (N=277) % of JDTR Enrollees had served in the military BRANCH Army Navy Marine Air Force Coast ERA SERVED Afghanistan /Iraq (2002- Present) Persian Gulf ( ) Post Vietnam ( ) Vietnam ( )

19 Military Status of Clients (N=277) Military Status Separated from Military 91% Served in combat theater/zone 53% Service Length of service (mean years) 5 yrs Tours of Duty (mean) 2 Type of Discharge (N=253) Honorable 61% General/Honorable 20% General/Other than Honorable 13% Bad Conduct 2% Medical 3%

20 Military Trauma (gathered at 6 mo) N=76 Military sexual assault 4% Seen someone injured/killed 90% Seen, smelled, handled dead bodies 81% Patrol areas with landmines/ieds 79% Shot at/received fire 75% Includes only Shot or directed fire at enemy 69% the individuals who served in Attacked/Ambushed 69% combat zone (n=48) Cleared homes/blgs/bunkers 58% Provided Aid to seriously wounded 50% Wounded/injured 38% Felt responsible for death of someone 36%

21 Non-Military Trauma (N=313) Traumatic Events Experienced Non-Military Trauma 95% Experienced trauma before age 18 75% Physical violence from someone known 67% Sexual Molestation by someone known 16% Sexual Assault from someone unknown 11%

22 Substance Use and Mental Health Status of Clients (N=313) History of Substance Abuse Treatment 40% Substance Use and History Mental Health Status Military Service impact on problems (N=277) Reported Used of Illegal drugs in past 30 days 40% Meet criteria for possible alcohol problem (CAGE) 62% History of Mental Health Treatment 33% Meet Criteria for PTSD (PSL-C) 65% Moderate to Extreme Difficulty with MH Symptoms (BASIS 24) 29% Feel military service contributed to mental health problems 78%

23 Income and Primary Residence of Clients (N=313) Income /Employment Primary Residence in past 30 days Median income in past 30 days $1026 Currently working (full and parttime) 28% Own home 45% Doubled Up 28% Homeless 18% Institution 8%