Incorporating Gender-Responsive Services Into Specialty Courts

June 1, 2018 Incorporating Gender-Responsive Services Into Specialty Courts Adult and Juvenile Courts 2018 The Council of State Governments Justice Center

Speakers Jeannie Von Stultz, Ph.D., Deputy Chief - Mental Health Services, Bexar County Juvenile Probation Jamie Vaske, Ph.D., Associate Professor, Department of Criminology & Criminal Justice, Western Carolina University Sarah Wurzburg, Deputy Program Director, Behavioral Health, The Council of State Governments Justice Center 2

Overview Gender-Responsive Services Survey of Adult Gender-Responsive Courts Girls and Boys Mental Health Courts in Bexar County, TX 3

National nonprofit, nonpartisan membership association of state government officials Represents all three branches of state government Provides practical advice informed by the best available evidence 4 4

Mission of the JPLI The Judges and Psychiatrists Leadership Initiative (JPLI) aims to stimulate, support, and enhance efforts by judges and psychiatrists to improve judicial, community, and systemic responses to people with behavioral health needs who are involved in the justice system. Creating a community of judges and psychiatrists Increasing the reach of trainings Developing educational resources Three Judges Guides Subscribe to the JPLI Newsletter 6

Resources https://csgjusticecenter.org/courts/judges-leadership-initiative/ 7

Definition: Gender-Responsive Approach Creating an environment through site selection, staff selection, program development, content and material that reflects an understanding of the realities of women s lives, and is responsive to the issues of the clients. (Covington, S., 2007) Covington, S. (2007) Women and addiction: A gender-responsive approach (the clinical innovators services). Center City, MN: Hazeldon. Council of State Governments Justice Center 8

Utilize a Multi-Faceted APPROACH Relational Develop policies, practices, and programs that are relational and promote healthy connections Strengths-Based Create an environment based on safety, respect, and dignity Trauma-Informed Address substance abuse, trauma, and mental health issues Culturally Competent Provide women with opportunities to improve their socioeconomic conditions Holistic Establish a system of community supervision and reentry with comprehensive, collaborative services The Five CORE Practice Areas of Gender Responsiveness, CORE Associates The National Resource Center for Justice Involved Women. Effective Strategies to Meet the Unique Needs of Justice Involved Women. Developed February 2016.

Sex and Gender Differences Sex and gender do not mean the same thing. Sex differences are related to biology. Gender is part of a person s self-representation. It relates to culturally defined characteristics of masculinity and femininity. There are both sex and gender differences that relate to SUDs and SUD treatment for men and women. SAMHSA Addressing the Gender-specific Service Needs of Women with Substance Use Disorders Tool Kit, MODULE 1 Women, Substance Use, and Substance Use Disorders (SUDs), 2017. Slide 7

Telescoping and Other Sex-related Differences Telescoping, in this use of the term, refers to an effect whereby women progress faster than men from initial use to alcohol- and drug-related problems, even when using a similar or lesser amount of substances. (Substance Abuse and Mental Health Services Administration [SAMHSA], 2009, p. 27; Piazza et al., 1989) SAMHSA Addressing the Gender-specific Service Needs of Women with Substance Use Disorders Tool Kit, MODULE 1 Women, Substance Use, and Substance Use Disorders (SUDs), 2017. Slide 8

Gender Differences Factors such as culture, age, socioeconomic status, religion, disability, race/ethnicity, and sexual orientation all influence gender roles and expectations. Some gender traits are common, but none are absolute. SAMHSA Addressing the Gender-specific Service Needs of Women with Substance Use Disorders Tool Kit, MODULE 1 Women, Substance Use, and Substance Use Disorders (SUDs), 2017. Slide 9

Sex and Gender Differences Related to SUDs Women often differ from men in their: Pathways to substance use Risk factors for use Consequences of use Barriers to treatment/recovery Recovery support needs SAMHSA Addressing the Gender-specific Service Needs of Women with Substance Use Disorders Tool Kit, MODULE 1 Women, Substance Use, and Substance Use Disorders (SUDs), 2017. Slide 12

Activity Women and Men

Past Year Treatment for Depression Among Adolescents Aged 12 17 with Major Depressive Episode (MDE) in the United States, by Gender (2014) Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2014. 15

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2014. 16

Prisoners were 3 times more likely to have SPD than the total adult general population (GP). Jail inmates were 5 times more likely to have SPD than the total adult GP. Female prisoners and jail inmates were more likely than males to have an indicator of a mental health problem. Bronson, J. Berzofsky, B. Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011-12Bureau of Justice Statistics. June 2017. Retrieved from: https://www.bjs.gov/content/pub/pdf/imhprpji1112.pdf

Percentage Substance Use: Women vs. Men Women have lower rates of substance use and SUDs than men. 12 10 8 6 4 2 0 8.5 4.4 past year alcohol dependence 10.2 3.3 past month heavy alcohol use men women 3.4 1.9 past year illicit drug dependence or abuse Source: Substance Abuse and Mental Health Services Administration. (2015a). Behavioral health barometer: United States, 2015. HHS Publication No. SMA-16-Baro-2015. Rockville, MD: Substance Abuse and Mental Health Services Administration. SAMHSA Addressing the Gender-specific Service Needs of Women with Substance Use Disorders Tool Kit, MODULE 1 Women, Substance Use, and Substance Use Disorders (SUDs), 2017.

58% of state prisoners and 63% of sentenced jail inmates met the DSM-IV criteria for dependence or abuse. This compared to about 5% of the total general population. www.bjs.gov A larger percentage of females than males used drugs in the month before the offense. Bronson, J. Stroop, J. Zimmer, S. Berzofksy, M. Illicit Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007-09. June 2017. Retrieved from: https://www.bjs.gov/content/pub/pdf/dudaspji0709.pdf. 19

Protective Factors for Girls/Young Women Feeling connected to family, cared about, and supported; high parental warmth Parent disapproval of substance use Religious/spiritual practices Coping skills SAMHSA Addressing the Gender-specific Service Needs of Women with Substance Use Disorders Tool Kit, MODULE 1 Women, Substance Use, and Substance Use Disorders (SUDs), 2017.

History of Women s Services Generic Treatment 1960s Gender Specific 1980s 1970s Gender Differences 1990s- 2000s Gender Responsive Grella, C. From Generic to Gender-Responsive Treatment: Changes in Social Policies, Treatment Services, and Outcomes of Women in Substance Abuse Treatment. Journal of Psychoactive Drugs. 5 November 2008. Council of State Governments Justice Center 21

Substance Use, Trauma, and Mental Health Cycle Criminal Justice Adapted from: SAMHSA Addressing the Gender-specific Service Needs of Women with Substance Use Disorders Tool Kit, MODULE 1 Women, Substance Use, and Substance Use Disorders (SUDs), 2017. Institute for Health and Recovery

Women in the Justice System Increase in number of women incarcerated While rest of the population is declining Women offenders are: Low-income Undereducated Unskilled with sporadic employment Disproportionately women of color Less likely to have committed a violent crime Bloom, B., Covington, S., Messina, N., Selvaggi, K., Owen, B. Gender-Responsive Policy and Practice Assessment Manual. February 18, 2014 for National Institute of Corrections. Council of State Governments Justice Center 23

Core Competencies: Women and Girls Sex and gender differences Relational approach in working with women and girls Understanding trauma in women and girls Family-centered needs of women and girls Special considerations during pregnancy Women s health and healthcare Collaboration and interdisciplinary effectiveness Substance Abuse and Mental Health Services Administration (2011). Addressing the Needs of Women and Girls: Developing Core Competencies for Mental Health and Substance Abuse Service Professionals. HHS Pub. No. (SMA) 11-4657. Rockville, MD: Substance Abuse and Mental Health Services Administration. Council of State Governments Justice Center 24

Familycentered Personcentered Co- Occurring Disorders Treatment Culturally Competent Integrated Care Genderresponsive Recoveryoriented Strengthsbased Traumainformed Adapted from Wurzburg, S. Zentgraf, K. Russell, C. State Adolescent Substance Use Treatment Practice Guide. In review, 2014. Council of State Governments Justice Center 25

Overview Gender-Responsive Services Survey of Adult Gender-Responsive Courts Girls and Boys Mental Health Courts in Bexar County, TX 26

Introduction to Adult Gender-Responsive Courts Two approaches Female only docket or court Prostitution or human trafficking courts Greater attention to gender-responsive courts Legislation Outcome evaluations of female only DTCs 27

Despite Growing Attention Do not know: Eligibility and screening criteria Requirements and procedures How can we improve upon these courts 28

Current Project 29

Female-Only Courts: Entry Female-only courts Eligibility Identification Screening Females only Moderate to high risk Non-violent SUD Arraignment, probation, or treatment providers Treatment provider Gender-neutral assessment 30

Female-Only Courts: Structure Female-only courts Length 18 months Requirements Traditional problem solving court requirements (supervision, treatment, court appearances) Mentors Available but not required by all 31

Family relations Education Employment Social support Physical health Parenting skills Housing Trauma Substance use Mental health 0% 50% 50% 50% 100% 100% 100% 100% 100% 100% 32

Eligibility Identification Prostitution diversion courts Prostitution All genders Diversion Courts All risk levels Non-violent SUD or No SUD Traffic offenses Initial appearance, booking, arraignment Female-only courts Females only Moderate to high risk Non-violent SUD Arraignment, probation, or treatment providers Screening Treatment provider, Coordinator, Pretrial Gender-neutral assessments Treatment provider Gender-neutral assessment 33

Prostitution diversion courts Female-only courts Length 3-12 months 18 months Requirements Varies Traditional problem solving court requirements (supervision, treatment, court appearances) Mentors Available but not required Available but not required 34

Tracking program dropout Incentives Sanctions Other Observations 35

Benefits Increased collaboration between judicial services and treatment providers Increased supervision and treatment of high-risk, transient clients Reductions in recidivism and increased reunification of parents with children Clients experience significant increases in perceived procedural justice Challenges Stable funding mechanisms and reductions in key staff members Identifying gender-responsive, culturally-sensitive treatment providers Disproportionate minority contact in program participation and termination Disagreement in treatment goals between clients and treatment team 36

Recommendations Sustainability of programs and clients needs Conduct a needs assessment of community programs prior to implementation Ground policies and procedures in NADCP s Best Practice Standards and gender-responsive principles 37

Treatment Courts Best Practice Inventory 38

Overview Gender-Responsive Services Survey of Adult Gender-Responsive Courts Girls and Boys Mental Health Courts in Bexar County, TX 39

Gender Specific Court Models Crossroads Court Girls Mental Health Court Pre-Adjudication Specialty Court First-time non-violent offenders Ages: 12-16 History of Mental Health issues and Trauma 40

Gender Specific Court Models MIND (Males in Need of Direction) Court Boys Mental Health Court Pre-Adjudication Specialty Court First-time non-violent offenders Ages: 12-16 History of Mental Health issues 41

Program Comparisons DIFFERENCES MIND Court (Males) Crossroads Court (Females) Presenting Problem Physically aggressive behavior Risky behaviors Bullying (Bullied and Bullier) Running away, older peer associates Underlying Issues Low emotional maturity Pseudo-emotional maturity Reactive Strategic Hypervigilant of school/home behavior Hypervigilant regarding social relationships & activities Parental enmeshment Parental disengagement Program Structure Less structured program increases accountability More structured program increases accountability Supervision Issues More often at home or at friend s home More often out in community location unknown Substance use minimal to moderate testing Substance use minimal to moderate testing Individual Treatment Focus Emotional Regulation Emotional Attachment Anger management Trauma-focused treatment Impulse control Risk behavior reduction Culture of males Skills Training Focus Personal and social relationships (maintaining friendships) Personal & social relationships (healthy relationships) Emotional Regulation Health & safety Problem-solving Independent living skills Stress management Life decisions and responsibilities Joven Noble Family Treatment Focus Strengthen family structure Strengthen family attachment Strengthen boundaries Strength-focused communication Equine Therapy Focus Running with Mustangs Girls Rule Self-regulation Assertiveness Internal and external triggers Boundaries Observation and Environmental Cues Problem Solving Styles and Communication Awareness of Thoughts and Internal Dialogue Positive Body Image Problem Solving Obstacles and Distractions Changing negative thought patterns Family Roles Objective Perspective of Others and Empathy Leadership and Empowerment 42

Program Comparisons DIFFERENCES (continued) MIND Court (Males) Crossroads Court (Females) Program Strategies Monitor group dynamics - alpha male Monitor group dynamics alliances/cliques Male probation officer fosters role modeling Female probation officer fosters role modeling Male case manager fosters open discussions Female treatment providers foster open discussions Pregnancy Prevention Efforts Empower to accept limits (OK to go slow) Empower to set limits (Ok to say no) Healthy relationships Healthy relationships Long acting reversible contraceptives Incentives Focused on graduation not phases Focused on phase advancement Dress shirt/tie Viewed as rite of passage Symbolic graduation blanket Prefers gift cards Phase One watch Pillows Activities Minor league baseball games Amusement park Hockey games Water park Bowling College tours Structured art therapy Process art therapy Creative writing SIMILARITIES Need help with basic needs such as food/utilities/transportation/housing (more so for males) Need help connecting to community treatment services Parent/child benefit from psychoeducation regarding mental health diagnoses and treatment Benefit from advocacy and support during ARD (Assessment, Review and Dismissal) Process Child and Parent benefits from communication and interpersonal skills training Child and Parent benefits from time and money management training Child benefits from vocational readiness training 43

Presenting Problem MIND Court (Boys) Physically aggressive Bullied or bullying Crossroads (Girls) Risky behaviors Running away Older peer associates 44

Underlying Issues MIND (Boys) Low emotional maturity Reactive Hypervigilant of school/home behavior Parental enmeshment Crossroads (Girls) Pseudo-emotional maturity Strategic Hypervigilant of social relationships/activities Parental disengagement 45

Program Structure MIND (Boys) Less structured program increases accountability Crossroads (Girls) More structured program increases accountability 46

Supervision Issues MIND (Boys) More often at home or at friend s home Substance Use: minimal - moderate testing Crossroads (Girls) More often out in community Location unknown Substance Use: minimal moderate testing 47

Individual Treatment Focus MIND (Boys) Emotional Regulation Anger Management Impulse Control Culture of Males Crossroads (Girls) Emotional Attachment Trauma-focused Treatment Risk Behavior Reduction 48

Skills Training Focus MIND (Boys) Personal/social relationships (maintain friendships) Emotional regulation Problem-solving Stress management Joven Noble Crossroads (Girls) Personal/social relationships (healthy relationships) Health and safety Independent living skills Life decisions and responsibilities 49

Family Treatment Focus MIND (Boys) Strengthen family structure Strengthen boundaries Crossroads (Girls) Strengthen family attachment Strength-focused communication 50

Equine Therapy Focus MIND (Boys) Running with Mustangs Self-regulation Internal/external triggers Observation and environmental cues Crossroads (Girls) Girls Rule Assertiveness Boundaries Problem solving styles and communication Positive body image 51

Equine Therapy Focus MIND (Boys) Awareness of thought and internal dialogue Problem solving Changing negative thought patterns Objective perspective of others and empathy Crossroads (Girls) Obstacles and distractions Family roles Leadership and empowerment 52

Program Strategies MIND (Boys) Monitor group dynamics (alpha male) Male probation officer fosters role modeling Male case manager fosters open discussions Crossroads (Girls) Monitor group dynamics (alliances/cliques) Female probation officer fosters role modeling Female treatment providers fosters open discussions 53

Pregnancy Prevention Efforts MIND (Boys) Empower to accept limits (OK to go slow) Healthy relationships Crossroads (Girls) Empower to set limits (OK to say no) Healthy relationships Long acting reversible contraceptives 54

Incentives MIND (Boys) Focused on graduation not phases Dress shirt/tie (Rites of Passage) Prefers gift cards Crossroads (Girls) Focused on phase advancement Symbolic graduation blanket Phase I watch Pillows 55

Activities MIND (Boys) Minor League Bball Hockey games Bowling Structure art therapy Crossroads (Girls) Amusement park Water park College tours Process art therapy Creative writing 56

Similarities Assistance with basic needs (food, utilities, transportation, housing) Connecting to community-based treatment services Psychoeducation re: mental health diagnoses and treatment (parent & child) 57

Similarities Advocacy and support during ARDs Communication and interpersonal training (parent and child) Time and money management training (parent and child) Vocational readiness training (child) 58

Questions and Answers 59

Key Resources: Gender-Responsive Services Addressing the Needs of Women and Girls: Developing Core Competencies for Mental Health and Substance Abuse Service Professionals: https://store.samhsa.gov/shin/content/sma11-4657/sma11-4657.pdf Bloom, B., Covington, S., Messina, N., Selvaggi, K., Owen, B. Gender-Responsive Policy and Practice Assessment Manual. February 18, 2014 for National Institute of Corrections. Ten Truths That Matter When Working With Justice Involved Women: http://cjinvolvedwomen.org/wp-content/uploads/2015/09/ten_truths.pdf Mandell, Kara, and Werner, Deborah, Guidance to States: Treatment Standards for Women with Substance Use Disorders, National Association of State Alcohol and Drug Abuse Directors, 2008. http://nasadad.org/wp-content/uploads/2010/12/guidance-to-states-treatment-standards-for- Women1.pdf SAMHSA TIP 56: Addressing the Specific Behavioral Health Needs of Men: https://store.samhsa.gov/shin/content/sma14-4882/sma14-4882.pdf 60

Key Resources: Trauma Websites National Center for Trauma Informed Care: http://www.nasmhpd.org/ta/nctic.aspx National Institute of Corrections, Women Offenders: http://nicic.gov/womenoffenders The National Resource Center on Justice Involved Women: http://www.cjinvolvedwomen.org SAMHSA, Trauma and Justice Initiative: http://www.samhsa.gov/traumajustice/ Publications SAMHSA TIP 57: Trauma-Informed Care in Behavioral Health Services: http://store.samhsa.gov/product/tip-57-trauma-informed-care-in-behavioral-health- Services/SMA14-4816 SAMHSA Creating a Trauma Informed Criminal Justice System for Women: http://www.nasmhpd.org/docs/nctic/women%20in%20corrections%20tic%20sr.pdf Blanch, A. Filson, B. Penney, D. Engaging Women in Trauma-Informed Peer Support: A Guidebook: http://www.nasmhpd.org/publications/engagingwomen.aspx Braude, L. & Miller, N. RSAT Training Tool: Understanding Co-occurring Disorders and Applying Integrated Treatment Strategies for Adult Correctional Populations: http://www.rsattta.com/training-curricula/curricula Council of State Governments Justice Center 61

CSG Justice Center Developing a Mental Health Court: An Interdisciplinary Curriculum learning.csgjusticecenter.org Developing a Mental Health Court is a free multimedia curriculum for individuals and teams seeking to start, maintain, or just learn about mental health courts or other criminal justice/mental health collaborations.

Criminal Justice/Mental Health Learning Sites https://csgjusticecenter.org/mental-health/learning-sites/

Contact Information Jamie Vaske, Ph.D., Associate Professor, Department of Criminology & Criminal Justice, Western Carolina University jvaske@email.wcu.edu Sarah Wurzburg, Deputy Program Director, Behavioral Health, The Council of State Governments Justice Center swurzburg@csg.org Jeannie Von Stultz, Ph.D., Deputy Chief - Mental Health Services, Bexar County Juvenile Probation jvonstultz@bexar.org 64

Join our distribution list to receive CSG Justice Center updates and announcements! www.csgjusticecenter.org/subscribe The presentation was developed by members of The Council of State Governments Justice Center staff. The statements made reflect the views of the authors, and should not be considered the official position of The Council of State Governments Justice Center, the members of The Council of State Governments, or the funding agency supporting the work.

June 1, 2018 Behavioral Health Diversion Interventions Moving from On-Off Programs to a System-Wide Strategy 2018 The Council of State Governments Justice Center

Speakers Honorable Stephen Goss DOUGHERTY JUDICIAL CIRCUIT SUPERIOR COURT, GEORGIA Sarah Wurzburg, Deputy Program Director, Behavioral Health THE COUNCIL OF STATE GOVERNMENTS JUSTICE CENTER 2

Overview Challenges in the Field What is Diversion? Moving from One-Off Program to a Systems Strategy 3

police chiefs consumers pretrial service administrators probation officials state legislators substance abuse providers state corrections directors judges district attorneys families parole board members county executives public defenders crime victims state corrections directors prosecutors mental health advocates court administrators mental health providers researchers jail administrators sheriffs correctional mental health providers state mental health directors victim advocates parole officials Behavioral Health at the CSG Justice Center Criminal Justice / Mental Health Consensus Project Criminal Justice/Mental Health Learning Sites Program Council of State Governments Justice Center 5

Resources https://csgjusticecenter.org/courts/judges-leadership-initiative/ 7

Addressing a National Crisis of Too Many People with Mental Illnesses in Jails

An Unprecedented Response More than 430 counties across 43 states, representing 40% of the U.S. population, have resolved to reduce the number of people with mental illnesses in jails. Council of State Governments Justice Center 9

The Stepping Up Initiative s Data-Driven Approach to Systems Change Six Questions County Leaders Need to Ask 1. Is your leadership committed? 2. Do you have timely screening and assessment? 3. Do you have baseline data? 4. Have you conducted a comprehensive process analysis and service inventory? 5. Have you prioritized policy, practice, and funding? 6. Do you track progress? 1 Reduce The number of people with SMI booked into jail Strategies Should Focus on Four Key Measures 2 3 4 Shorten The average length of stay for people SMI in jails Increase The percentage of connection to care for people with SMI in jail Lower Rates of recidivism Council of State Governments Justice Center 10

Framework for Police-Mental Health Collaborations Is our leadership committed to the police-mental health collaboration (PMHC)? Are we following clear protocols to respond to people who have mental illnesses? Are we providing staff with quality mental health and de-escalation training? Do we have the resources and service connections for people who have mental illnesses? Do we collect and analyze data? Do we have a process for reviewing and improving performance? Council of State Governments Justice Center 11

Primary Practice-Level Challenges Targeting Interventions Based on BH Needs and Criminogenic Risk Assessing serious mental illnesses, substance use disorders, and criminogenic risk factors in courts and correctional facilities Targeting and tailoring appropriate services and supervision based on level of needs and risk Incorporating Assessment Information into Case Plans Utilizing the assessment information for BOTH behavioral health criminogenic risk in case plans Defining lead case planner at an agency and outlining case conferencing procedures Knowing When to Refer to Which Intervention Taking the assessment information to guide program referral such as cognitive behavioral intervention Council of State Governments Justice Center 12

Primary Systems-Level Challenges Quantification of Needs Using Data Systematic identification of people with behavioral health needs by courts and corrections, using validated tools and standard definitions of mental illness and SUDs Accurate data collection and reporting on prevalence, entries, length of stay, and connections to treatment Identifying System Improvements and Treatment Gaps Using Data Selecting strategies and designing programs based on projected impact on key outcome measures Specifying gaps in community-based services and treatment based on data on connections to care Council of State Governments Justice Center 13

Use of data to identify and prioritize systems improvements Jurisdiction Metric Finding Action Taken Bexar County, Texas The number of people with mental illnesses in jail County does not know how many people with mental illnesses are in the jail. Bexar County established universal screening for mental illnesses. New York City, New York Length of stay People with mental illnesses stayed in jail 112 days on average as compared to 61 days for those without mental illnesses. New York City implemented early pretrial diversion options to move people with mental illnesses out of jail in a timely way. Franklin County, Ohio Connection to care post- release More than one in three of people who had contact with the behavioral health care system in the year prior to their incarceration did not have contact with the behavioral health care system in the year following their release from jail. The local Alcohol Drug And Mental Health (ADAMH) board established a jail liaison team to provide in-reach service to get follow-up appointments within two weeks of release. Salt Lake County, Utah Recidivism rate One out of three people on pretrial supervision and one out of two people on county probation did not fulfill the requirements of their supervision. Salt Lake County recommendations included establishing intensive supervision caseloads for people who are assessed as being moderate to high risk of reoffending and who are also assessed as having an SMI. 14

What does the term diversion mean to you?

Behavioral Health Diversion Terms Diversion Jail Diversion Deflection Early Intervention

What is Behavioral Health Diversion? Jail diversion is a community-based, collaborative criminal justice mental health response for justice-involved people with mental illnesses where jail time is reduced or avoided, and the individual is linked to comprehensive and appropriate services. Judges Criminal Justice/Mental Health Leadership Initiative. (2010). Judges guide to mental health diversion: A reference for justice system practitioners. Delmar, NY: Policy Research Associates, CMHS National GAINS Center.

Behavioral Health Diversion Intervention This term includes common name brand programs (like LEAD) and local practices (e.g., court processes that lead to a diversion-related outcome). These programs and practices share the following diversion-related goals: (1) connecting people who have behavioral health needs to treatment and support services, and (2) reducing or eliminating jail time by exploring alternatives to traditional case processing. 18

Behavioral Health Diversion Strategy Diversion strategies that address systems enhancements Opportunities for diversion at multiple intercept points Ability to divert eligible individuals at different points in the criminal justice system For those not eligible for diversion providing providing reentry services that include connection to behavioral health services in the community

Discussion Questions Do you consider your specialty court diversion? Do you know about other diversion interventions in the court system? Is there a larger strategy across agencies in the criminal justice system for people with BH needs? 20

Challenges to Developing Continuum of Diversion Responses No clear common language standards for diversion related terminology Diversion programs and practices constantly evolving No clear strategies on how to build diversion opportunities throughout the criminal justice system

Key Questions What is behavioral health diversion? Providing definition for diversion How is a system of diversion developed? Key components needed for strategic development What are options for behavioral health diversion? Describing common BH diversion interventions, programs/practices How do you develop multiple diversion options for your systems? Key components tailored for each subpart of system (LE, pretrial, courts, jails)

Overview Challenges in the Field What is Diversion? Moving from One-Off Program to a Systems Strategy 23

Agency-Specific Diversion Interventions Programs and practices that are designed to divert people at specific process-oriented phases (i.e., pre-arrest, pre/post-booking, and pre-trial) and implemented by the main agency that has the best opportunity and resources. 24

Continuum of BH Diversion Interventions A range of behavioral health diversion programs and practices that span a community s criminal justice system starting from first contact with law enforcement (arrest) through incarceration. 25

Behavioral Health Diversion Decision Points

Behavioral Health Diversion Options

Multiple Behavioral Health Diversion Options Law Enforcement Considerations Pretrial Considerations Court Considerations Jail Considerations Is our leadership committed to the policemental health collaboration (PMHC)? Are we following clear protocols to respond to people who have mental illnesses? Are we providing staff with quality mental health and de-escalation training? Do we have the resources and service connections for people who have mental illnesses? Do we collect and analyze data? Engage stakeholders Identify target population Conduct a comprehensive process analysis and inventory of services Identify and leverage funding streams Information sharing Track progress Engage stakeholders Identify target population Conduct a comprehensive process analysis and inventory of services Identify and leverage funding streams Information sharing Track progress Is our leadership committed? Do we conduct timely screening and assessments? Do we have baseline data? Have we conducted a comprehensive process analysis and inventory of services? Have we prioritized policy, practice, and funding improvements? Do we track progress? Do we have a process for reviewing and improving performance? Specific questions are in development

Behavioral Health Diversion Continuum Components Engage stakeholders Identify target population Conduct a comprehensive process analysis and inventory of services Identify and leverage funding streams Information sharing Track progress

A Framework for Prioritizing Resources Subgrouping A Low criminogenic risk/ some significant BH treatment needs Subgrouping B High criminogenic risk/ some significant BH treatment needs Divert from criminal justice system without intensive community supervision if connected to appropriate treatment and supports Prioritize for intensive supervision (in lieu of incarceration or as condition of release) coordinated with appropriate treatment and supports 30

Collaborative Case Planning 1. Interagency Collaboration and Information-Sharing 2. Staff Training 3. Screening and Assessment 4. Case Conference Procedures 5. Participant Engagement 6. Prioritized Needs and Goals 7. Responsivity 8. Legal Information 9. Participant Strengths 10. Gender Considerations https://csgjusticecenter.org/nrrc/collaborative-comprehensive-case-plans/ 31

Goal of BH Diversion Resources Provide information on diversion Agency-specific information on possible interventions Law enforcement Courts Pretrial Jails Assist jurisdictions to develop, or modify, a continuum of diversion responses for people with behavioral health disorders in the criminal justice system identification of BH issues, alternatives to traditional case processing, reduction or avoidance of jail time, and linkage to comprehensive and appropriate community-based services.

Questions and Answers 33

Resources 34

Criminal Justice/Mental Health Learning Sites https://csgjusticecenter.org/mental-health/learning-sites/

Contact Information Judge Stephen Goss, Dougherty Judicial Circuit Superior Court, Georgia judgestevegoss@bellsouth.net Sarah Wurzburg Deputy Program Director, Behavioral Health The Council of State Governments Justice Center swurzburg@csg.org 37