FY17 Planning & Implementation Guide Justice and Mental Health Collaboration Program Category 1: Collaborative County Approaches to Reducing the Prevalence of Individuals with Mental Disorders in Jail DESCRIPTION This Planning & Implementation Guide is intended for recipients of Justice and Mental Health Collaboration Program (JMHCP) grants administered by the U.S. Department of Justice s Bureau of Justice Assistance. JMHCP grantees will complete this guide in partnership with a technical assistance provider from The Council of State Governments Justice Center. The Council of State Governments Justice Center prepared this guide with support from the U.S. Department of Justice s Bureau of Justice Assistance (BJA). The contents of this document do not necessarily reflect the official position or policies of the U.S. Department of Justice. 1
About the Planning & Implementation Guide The Council of State Governments (CSG) Justice Center has prepared this Planning & Implementation Guide (P&I Guide) to support grantees in developing and refining their initiative. The guide is intended for the state, local, or tribal government agencies that have received JMHCP grants to plan initiatives and programs serving adult populations. This guide is not intended to serve as a step-by-step blueprint, but rather to foster discussion on best practices, identify considerations for your collaborative effort, and help you work through key decisions and implementation considerations. Although the guide was developed as a tool for grantees, it also serves as an important tool for your CSG Justice Center technical assistance provider ( TA provider ) to understand the status and progress of your project, the types of challenges you are encountering, and the ways your TA provider might be helpful to you in making your project successful. Your TA Provider will use your responses to the self-assessment to work with you to develop priorities for technical assistance. Any questions about this guide should be directed to your TA provider. Contents of the Guide This guide is divided into seven sections that include a variety of exercises aimed at helping guide your county s system planning process. You will be prompted to write short responses, attach relevant documents, and answer yes or no questions. Your answers will provide insight into your initiative s strengths and identify areas for improvement. As you work through the sections, take note of the supporting resources in the appendix. Your TA provider may also send you additional information on relevant topics to complement certain sections. If you need additional information or resources on a topic, please reach out to your TA provider. TA Provider Contact Information Name: Marilyn Leake Phone: 301-915-9717 Email: mleake@csg.org 2
Contents Section 1: Getting Started and Identifying Goals Exercise 1: Initiative Snapshot A. Grantee Information B. Grant Initiative Updates and Information Section 2: Collaborative Planning Team Exercise 2: Developing Your Planning Team Section 3: Jail Identification Process and Data Collection Exercise 3: Jail Identification Process and the Determination of Prevalence Rates and Risk Levels A. Local Definition of Mental Illness and SMI B. Jail Identification Process for Mental Illness or SMI C. Local Definition of Substance Use Disorder D. Jail Identification Process for Co-occurring Substance Use Disorder Information E. Local Definition of Recidivism F. Risk and Needs Identification Process G. Connection to Community Supervision H. Connection to Community-Based Services Exercise 4: Expanding Screening and Assessment Section 4: County System Analysis Exercise 5: System Mapping, Process Analysis, and Identifying Gaps A. System Mapping by Intercept Points B. System Mapping by Key Outcomes C. Addressing Gaps in the System Section 5: Data-Driven Findings Exercise 6: Measuring Outcomes Exercise 7: Collecting Data and Key Findings A. Tracking Sub-measures of the Four Key Measures B. Key Findings Section 6: Strategic Plan Exercise 8: Planning and Prioritizing Section 7: Evaluation and Sustainability Exercise 9: Tracking Progress A. Using Data to Track Progress B. Other Sustainability Strategies C. Tracking Progress from Start to Finish Appendix A: Supporting Resources Appendix B: Sequential Intercept Model 3
SECTION 1: GETTING STARTED AND IDENTIFYING GOALS Your TA provider has read the project narrative that you submitted in response to the JMHCP solicitation, but there may have been updates or developments since you submitted your original application. This exercise is intended to give your TA provider a sense of your current project goals and your initial technical assistance needs. Please provide the following documents, if available, to your TA provider at your earliest convenience: Memoranda of understanding (MOUs) and Letters of support information-sharing agreements Current strategic plan Staffing and budgeting information County organizational and hierarchical Additional planning materials charts EXERCISE 1: INITIATIVE SNAPSHOT A. Grantee Information Please complete the chart below. A. Grantee Information Grantee Name and Award Number: Geographic Location: (City/County/State) Type: (Rural/Suburban/Urban) Project Name: Mental Health Partner(s): Mental Health and Criminal Justice Point(s) of Contact: Criminal Justice Partner(s): Name: Email: Agency: Name: Email: Agency: Name: Email: Agency: Collaborators: Include project partners, sub-contractors, and their intended roles 4
B. Grant Initiative Updates and Information Your TA provider would find it helpful to know about any major developments that have occurred between the time you wrote your grant application/narrative and the next TA call. When completing the exercise below, be sure to reference any major changes in goals, stakeholders, etc., that may have occurred. B. Grant Initiative Updates and Information 1. What do you want to accomplish with this grant initiative? 2. What is the relationship, if any, between this initiative and any pre-existing initiatives or programs focusing on people with mental illnesses involved with the criminal justice system, either locally or at the state level? 3. Has your state participated in a Justice Reinvestment Initiative, and are there any programs funded through this initiative in your county? 4. What intercepts in the criminal justice system do you anticipate primarily focusing on? (Intercept 1: law enforcement; intercept 2: initial detention; intercept 3: jails/courts; intercept 4: reentry; intercept 5: community supervision and treatment) 5. Has your jurisdiction ever conducted a system mapping exercise, gap analysis, or other needs assessment about the services available in your community? If so, attach copies of these materials. 5
SECTION 2: COLLABORATIVE PLANNING TEAM In order to conduct a comprehensive, data-driven plan to safely reduce the prevalence of people with mental illnesses in your county s jail, it is essential that you establish a team (or use a pre-existing team) of county leaders and decision makers from multiple agencies to engage in the planning process. EXERCISE 2: DEVELOPING YOUR PLANNING TEAM 1. Will an existing decision-making entity guide the direction of this project? If not, is a new planning team being developed as part of this initiative? 2. How will this planning team communicate/coordinate with other entities that are currently engaged in criminal justice/mental health planning for your county/? 3. List the members of your collaborative planning team. Name: Title: Organization: Specific role on collaborative planning team: Signed a letter of agreement committing to involvement in project? Yes Yes No No 6
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No 4. Who are the additional stakeholders you would like to join the planning team to ensure that there is system-wide representation? 5. Who are the local champions for mental health- and criminal justice-related issues? Are they participating in your planning team? If not, do you plan to include them in the planning team? 6. Does the planning team include sub-committees or working groups? If so, what are they? 7
7. Have you developed MOUs or letters of agreement (LOAs) for the planning team members respective agencies? 8. How often will the planning team meet? 9. Who coordinates the planning team s meeting schedule, agenda, and logistics? How is the agenda developed and shared with planning team members? What will the process be for reporting on the team s progress (internally and externally)? 10. What are your planning team s vision, mission, and guiding principles? If these have not been established, do you plan to do so? 8
SECTION 3: JAIL IDENTIFICATION PROCESS AND DATA COLLECTION In order to safely and effectively reduce the number of adults with mental illnesses in jails, counties need to know how many people with mental illnesses are entering and leaving their jails and the extent of their needs. While it may seem simple to count the number of people with mental illnesses who have treatment needs, it is not uncommon to see different ways of defining and measuring the presence of mental illnesses and co-occurring substance use disorders. The following exercises will help ensure that you and your TA provider are on the same page when discussing your county s data. EXERCISE 3: JAIL IDENTIFICATION PROCESS AND THE DETERMINATION OF PREVALENCE RATES AND RISK LEVELS Jail staff and behavioral health care providers, who are represented in the collaborative planning team, need to agree on a consistent screening and assessment process that accurately identifies people s mental illnesses, substance use disorders, and criminogenic risk. As you consider what screening and assessment practices are already in place, keep in mind that meaningful reductions of the prevalence of mental illness in jails should be measured according to the following four key outcomes: 1. Reduce the number (and percentage) of people who have mental illnesses who are booked into jail 2. Reduce their average length of stay in jail 3. Increase the percentage of people who have mental illnesses who are connected to treatment 4. Reduce their recidivism rates This exercise will help you determine whether your existing screening and assessment process is operating effectively and gathering the information necessary to improve outcomes in your criminal justice system. A. Local Definitions of Mental Illness and Serious Mental Illness (SMI) 1. Are there state or county definitions of mental illness and SMI that determine eligibility for publicly funded services in your community? If yes, what are they? 2. What are the definitions of mental illness and SMI that your planning team has decided to adopt? Are these 9
definitions of mental illness and SMI currently used in your jail as well? If no, what are they? B. Jail Identification Process for Mental Illness and SMI 1. How does the jail staff determine when a person may have a mental illness or SMI? 2. Is there an objective, validated screening tool in place to screen for SMI (e.g., Brief Jail Mental Health Screen)? 1 If yes, what is the tool and who administers it? 3. Whom do you screen and at what times (e.g., everyone at booking, everyone who has been in jail for 48 hours)? 4. Is there a process in place to conduct a full clinical assessment for someone who screens positive for a possible 1 The tools referenced in the planning guide are meant to merely serve as examples; their inclusion does not in any way reflect the endorsement of it. In response to requests from the field for examples, when appropriate an example of a commonly used proprietary and nonproprietary tool is provided. 10
mental illness? If yes, what is it? 5. Is there a process in place to conduct a substance use disorder screening for someone who screens positive for a possible mental illness? If yes, what is it? 6. Do you track data electronically on how many people are screened and assessed? If yes, how is this data tracked? 7. Is there a process that determines whether a person meets state/county criteria for serious or persistent mental illnesses or eligibility for mental health treatment services? If yes, must a social worker, counselor, psychiatrist, or qualified mental health professional make the clinical determination? 8. For people who meet your collaborative planning team s definition of having a mental illness, does your jail collect data regarding the following? 11
i. Their length of stay Answer (yes/no): ii. Their status as pretrial or sentenced Answer (yes/no): iii. Their history of prior incarceration at the jail Answer (yes/no): iv. Their history of prior community supervision Answer (yes/no): v. Their prior contact with mental health care providers in the community Answer (yes/no): C. Local Definition of Substance Use Disorder 1. Is there a state or county definition of substance use disorder that determines eligibility for publicly funded services in your community? If yes, what is it? 2. What is the definition of substance use disorder that your planning team has decided to adopt? D. Jail Identification Process for Co-occurring Substance Use Disorder Information 1. How does the jail staff determine when a person may have a substance use disorder? 12
2. Is there a validated screening tool in place to screen for substance use? If so, what tool do you use? Who administers the tool? 3. Whom do you screen and at what times (e.g., everyone at booking, everyone who has been in jail for 48 hours)? 4. Is there a process in place to conduct a full substance use disorder assessment for people who screen positive for a substance use disorder? If yes, what is it? 5. Do you track data electronically on how many people are screened and assessed? If yes, how is this data tracked? 6. Is there a process that determines whether a person meets state/county eligibility for substance use disorder treatment services? If yes, must a social worker, counselor, psychiatrist, or qualified mental health professional make the clinical determination? 13
E. Local Definition of Recidivism 1. What is your state or county s definition of recidivism (e.g. reincarceration within a year of release for reoffending, violating conditions of supervision)? F. Risk and Needs Identification Process 1. Do you use a validated assessment tool to assess for risk at the following points? i. Pretrial detention (assessing for the likelihood of committing a new crime during the pretrial period or failing to appear in court) Answer (yes/no): ii. Post-conviction (assessing for risk of recidivism) Answer (yes/no): 2. Can you determine how many people with mental illnesses in your jail are at a high, medium, and low risk for recidivism? G. Connection to Community Supervision 1. Do you have a process for tracking people on community supervision to identify recidivism rates for those who have mental illnesses? If yes, what is that process? 14
2. Is there a process for alerting the appropriate community supervision officer that a person on supervision has been booked into jail? If yes, does the supervision officer connect with the person prior to release from jail? H. Connection to Community-Based Services 1. How does your county define connections to treatment (e.g., contact with a community-based behavioral health provider prior to release from jail)? 2. Do you have a process for tracking how many people who have mental illnesses receive services from communitybased treatment providers after release from jail? If yes, what is this process? 3. Is there a process to notify community-based treatment providers when a person who has screened positive for mental illness or has previously used their services has been booked into jail? If yes, what is this process? 15
EXERCISE 4: EXPANDING SCREENING AND ASSESSMENT To prioritize county resources based on risk and needs, there should be screening and assessments for mental illnesses, substance use disorders, and pretrial/criminogenic risk in place. This chart will help you develop a plan to implement screenings and assessments that address any gaps identified in Exercise 3. If the appropriate screening or assessment is already in place, simply indicate that below. Pretrial Risk Assessment What tool or process would you like to implement? Who would administer it and when would it take place? How will the information be recorded (e.g., entered into a database)? What agencies would be able to access this information? Mental Illness Screen Substance Use Disorder Screen Criminogenic Risk Assessment Mental Illness Assessment Substance Use Disorder Assessment 16
SECTION 4: COUNTY SYSTEM ANALYSIS For any county plan to be effective, a person s mental health, substance use, and criminogenic needs (the factors that make people more likely to reoffend) should be identified and addressed at the earliest points possible using law enforcement diversion, screening and identification, connections to services, and community supervision. Meaningful reductions in the prevalence of mental illnesses in jails cannot be realized without examining which programs and strategies are in place and effective. Each of these programs or strategies that is identified in the planning process should achieve at least one of the following four key measures that were previously discussed in Section 2: 1. Reduce the number (and percentage) of people who have mental illnesses and are booked into jail 2. Reduce their average length of stay in jail 3. Increase the percentage of people who have mental illnesses who are connected to treatment 4. Reduce their recidivism rates The following exercises will help you identify gaps in your county s policies, practices, and programs. EXERCISE 5: SYSTEM MAPPING, PROCESS ANALYSIS, AND IDENTIFYING GAPS A. System Mapping by Intercept Points The following flow chart is an example of how a county planning team, or perhaps a subcommittee of the planning team, traces each step of a person s involvement in the justice system from the moment police receive a mental health call for service, to the person s admission to jail, to his or her release from jail and connection to community-based treatment, services, and supervision. At each decision point, the planning team should ask: What is the process associated with the decision? Is the process timely and efficient? What information is collected at that point in the process? How is that information shared and with whom? How is that information acted upon? Are the people involved in each decision point trained in their role? While completing the exercise, it is important to discuss each step of a person s involvement in the justice system from the time of initial law enforcement contact to case completion in order to identify opportunities to make improvements and identify any gaps. An example of a Sequential Intercept Mapping exercise is available in Appendix B for counties interested in following this model. Additional information on process analysis can be obtained through your TA provider as well. Please complete a system flow chart for your jurisdiction and attach it to the P&I Guide. Note that the flow chart below illustrates one county s process, but does not show the county s entire criminal justice and behavioral health systems. 17
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B. System Mapping by Key Outcomes Use the following four tables to identify current policies, practices, programs, and treatment options in your county that address each of the four key measures described at the beginning of this section. Measure 1: Reduce the number (and percentage) of people with mental illnesses who are booked into jail Instructions List the relevant policies, practices, evidence-based programs, and treatment options that currently exist in your system and include a brief description of each. Pre-Arrest Identification of Mental Illnesses and Co-occurring Substance Use Disorders 1. EXAMPLE: Mental health crisis identified on 911 call Process for identifying whether a 911 call requires a response by the mobile crisis outreach team 2. 2. 3. 3. 4. 4. 5. 5. Law Enforcement Responses 1. EXAMPLE: Crisis Intervention Training (CIT) All law enforcement in the county are required to be trained in CIT Screening for Mental Illnesses, Co-occurring Substance Use Disorders, and Risk at Booking to Inform Pretrial Release Decisions 1. EXAMPLE: The Brief Jail Mental Health Screening is administered to people at booking into jail Everyone booked into jail receives the screening, and results are shared with the appropriate parties while maintaining confidentiality 2. 2. 3. 3. 4. 4. 5. 5. Jail Diversion Opportunities 1. EXAMPLE: Crisis Center Provides short-term mental health crisis stabilization in a secure unit 19
Measure 2: Reduce the average length of stay in jail Instructions List the relevant policies, practices, evidence-based programs, and treatment options that currently exist in your system and include a brief description of each. Screening for Mental Illnesses, Co-occurring Substance Use Disorders, and Risk in Jail 1. EXAMPLE: A pretrial risk assessment tool is administered Everyone booked into jail receives the screening, with the results shared appropriately 2. 2. Pretrial Release Decision Making 1. EXAMPLE: Pretrial risk information is made available to inform the court regarding release at the first appearance The information is electronically submitted to judge, prosecutor, and defense lawyer 3. 3. 4. 4. 5. 5. Pretrial Treatment Programs 1. EXAMPLE: Referral to treatment included in pretrial release order All who are screened and/or assessed as needing treatment receive an appointment for follow-up care upon release 2. 2. 3. 3. 4. 4. 5. 5. Pretrial Community Supervision 1. EXAMPLE: Pretrial supervision ordered for people identified as moderate to high risk People assigned to pretrial supervision and identified as needing mental health services are connected to care 20
Measure 3: Increase the percentage of people who have mental illnesses released from jail who are connected to treatment Instructions List the relevant policies, practices, evidence-based programs, and treatment options that currently exist in your system and include a brief description of each. Assessments for Mental Illnesses, Co-occurring Substance Use Disorders in Jail/Community 1. EXAMPLE: People who screen positive for mental illness receive a full assessment There is process in place for both in-jail and community-based assessments 2. 2. 3. 3. Information-Sharing Policies 1. EXAMPLE: Release of information policies are in place to allow for information sharing The sheriff s office shares relevant information with the local behavioral health authority 4. 4. 5. 5. Case Management/Supervision 1. EXAMPLE: A community supervision officer and behavioral health clinician provide collaborative case management Roles and responsibilities are clearly defined to increase consistency in care and supervision expectations 2. 2. 3. 3. 4. 4. 5. 5. Mental Health and Substance Use Treatment 1. EXAMPLE: The local behavioral health agency administers an in-reach program in the jail The local behavioral health agency provides jail-based services and ensures connection to care upon release 21
Measure 4: Reduce their recidivism rates Instructions Assessments for Risk in Jail/Community Risk-Reduction Policies List the relevant policies, practices, evidence-based programs, and treatment options that currently exist in your system and include a brief description of each. 1. EXAMPLE: A post-conviction risk and needs assessment tool is administered Everyone assigned to community supervision receives a risk and needs assessment and a case management plan, which is developed based on risk and needs 2. 2. 3. 3. 4. 4. 5. 5. Community Supervision Focused on Risk Reduction 1. EXAMPLE: Community supervision follows the principles of Risk, Needs, and Responsivity More intense supervision is provided to moderate- to high-risk people 2. 2. 3. 3. 4. 4. 5. 5. 1. EXAMPLE: The community supervision provider implements evidence-based practices that are proven to reduce recidivism Interventions such as cognitive behavioral therapy (CBT) are in place to address criminal thinking Behavioral Health Services Focused on Sick Reduction 1. EXAMPLE: Treatment plans follow the principles of Risk, Needs, and Responsivity For people who are assessed as moderate to high risk of recidivism and have mental health needs, treatment includes interventions based on CBT C. Addressing Gaps in the System 22
Use the following four tables to identify the policies, practices, programs, and treatment options across all four key measures that do not currently exist in your system. Later in this guide, you will be asked to prioritize these responses, so this exercise can be used as a wish list. Refer to the previous charts in this exercise to identify gaps in services and practices. Key Outcome 1: Reduce the number (and percentage) of people with mental illnesses and co-occurring disorders who are booked into jail Instructions List the relevant policies, practices, evidence-based programs, and treatment options that do not currently exist in your system but would improve your system s outcomes, and include a brief description of each. Pre-Arrest Identification of Mental Illnesses and Co-occurring Substance Use Disorders 1. 1. 2. 2. 3. 3. 4. 4. 5. 5. Screening for Mental Illnesses, Co-occurring Substance Use Disorders, and Risk at Booking to Inform Pretrial Release Decisions 1. 1. 2. 2. 3. 3. 4. 4. 5. 5. Law Enforcement Responses Jail Diversion Opportunities 23
Measure 2: Reduce their average length of stay in jail Instructions List the relevant policies, practices, evidence-based programs, and treatment options that do not currently exist in your system but would improve your system s outcomes, and include a brief description of each. Screening for Mental Illnesses, Co-occurring Substance Use Disorders, and Risk in Jail 1. 1. 2. 2. 3. 3. 4. 4. 5. 5. Pretrial Release Decision Making Pretrial Treatment Programs 1. 1. Pretrial Community Supervision 2. 2. 3. 3. 4. 4. 5. 5. 24
Measure 3: Increase the percentage of people released from jail who are connected to treatment Instructions List the relevant policies, practices, evidence-based programs, and treatment options that do not currently exist in your system but would improve your system s outcomes, and include a brief description of each. Assessments for Mental Illnesses and Cooccurring Substance Use Disorders in Jail/Community 1. 1. 2. 2. 3. 3. 4. 4. 5. 5. Information-Sharing Policies Case Management/Supervision 1. 1. Mental Health and Substance Use Treatment 2. 2. 3. 3. 4. 4. 5. 5. 25
Measure 4: Reduce their recidivism rates Instructions Assessments for Risk in Jail/Community Risk-Reduction Policies List the relevant policies, practices, evidence-based programs, and treatment options that do not currently exist in your system but would improve your system s outcomes, and include a brief description of each. 1. 1. 2. 2. 3. 3. 4. 4. 5. 5. Community Supervision Focused on Risk Reduction 1. 1. Behavioral Health Services Focused on Risk Reduction 2. 2. 3. 3. 4. 4. 5. 5. 26
SECTION 5: DATA-DRIVEN FINDINGS The following exercises will help you understand whether your county is currently able to measure these key measures, and advise you on the types of data findings that will help your collaborative planning team understand whether your county is effectively reducing the prevalence of mental illnesses and co-occurring substance use disorders in its jail. EXERCISE 6: MEASURING OUTCOMES Answer the following questions about data your county collects to measure progress toward achieving key outcomes. Outcomes Measures Reduce the number (and percentage) of people who have mental illnesses who are booked into jail Reduce their average length of stay in jail Increase the percentage of people released from jail who are connected to treatment Reduce their recidivism rates Is there a way to flag people identified through screening and assessment as having mental illnesses in a searchable electronic database? Yes No Does your county track lengths of stay for pretrial and sentenced populations? Yes No Does your county match every person booked into jail to the local behavioral health authority s database to establish whether connections to care are being made? Yes No Does your county track recidivism, according to your identified definition, for people at both the pretrial and post-conviction stages? Yes No Does your county assess criminogenic risk levels of people booked into jail and on community supervision? Yes No 27
EXERCISE 7: COLLECTING DATA AND KEY FINDINGS A. Tracking Sub-measures of the Four Key Measures In addition to the broader measures addressed in Exercise 6, below is a list of sub-measures that counties should track to demonstrate progress toward achieving the four key measures: reducing the number of people with mental illnesses and co-occurring substance use disorders booked into jail, shortening their average length of stay in jail, increasing the percentage of people connected to treatment in the community, and lowering their recidivism rates. These sub-measures will provide a more detailed data analysis to inform your key findings and determine where to target interventions. The chart below provides information on the sub-measures and general recommendations on which agencies would have this data, although this may vary by jurisdiction. Guidance has not been provided on the timeframe for collecting this data, as that may change based on a number of factors. Your TA provider can provide additional advice regarding the recommended timeframe for collecting this data. Please complete the rest of the chart to answer whether these sub-measures are being collected, and if so, what the data findings are. 1. Reduce the number (and percentage) of people who have Serious Mental Illness (SMI) who are booked into jail Sub-measures How to Obtain Data Has data been collected? If so, Data and Related Findings by which agency? Number of calls to 911 dispatch identified as a mental health crisis (this data may not be available) Request data from 911 dispatch or police departments Number of total and unique individuals who screened positive for SMI according to a validated mental health screening conducted at jail booking Number of people who were confirmed as having SMI through a clinical assessment at the jail or data matching with state or local behavioral health systems Comparison of the above data to bookings for general population, including demographic and criminogenic information (e.g., age, sex/gender, race/ethnicity, offense type/level, etc.) Request data from the jail and/or jail s mental health provider Request data from the jail and/or jail s mental health provider Request data from the jail 28
2. Reduce their average length of stay in jail Sub-measures How to Obtain Data Has data been collected? If so, by which agency? Number of unique individuals who have SMI screened as low, medium, and high for pretrial risk (including risk for failure to appear, new criminal activity, and/or dangerousness during pretrial period) Request data from the jail or outside agency performing screenings Data and Related Findings Average length of stay for people who have SMI by release type (including pretrial population, sentenced population, surety bond release, federal holds, etc.) Request data from the jail Comparison of the above data to bookings for the general population, including demographic and criminogenic information (e.g., age, sex/ gender, race/ethnicity, offense type/level, etc.) Request data from the jail and the agency that collects pretrial risk information 3. Increase the percentage of people who have SMI connected to treatment in the community Sub-measures How to Obtain Data Has data been collected? If so, Data and Related Findings by which agency? Percentage of people who have SMI connected to communitybased behavioral health services upon release (by release type) Request data from the jail and the community behavioral health provider to perform a data match (additional information may come from community supervision) Percentage of people who have SMI connected to community Request data from the community supervision provider 29
supervision (by release type) (i.e., probation) Comparison of the above data to bookings for the general population, including demographic and criminogenic information (age, sex/gender, race/ethnicity, offense type/level, etc.) Request data from the jail, community supervision provider, and community-based behavioral health provider 4. Reduce their recidivism rates Sub-measures How to Obtain Data Has data been collected? If so, by which agency? Percentage of failures to appear and/or rearrests for people who have SMI released preadjudication People identified as having mental illnesses, and their release dates should be matched to a request from the state criminal history repository. Most counties do not record failures to appear in a way that can be extracted for data analyses. Data and Related Findings Percentage of people who have SMI who were rearrested after serving a jail sentence People identified with mental illnesses, and their release dates should be matched to a request from the state criminal history repository Percentage of technical violations for sentenced population who have SMI and who are assigned to community supervision Request data from the community supervision provider Percentage of new criminal charges for sentenced population Request data from the 30
who have SMI and who are assigned to community supervision community supervision provider Total number of prior jail admissions for people identified who have SMI If the jail can t calculate this variable, a longitudinal review of past bookings at the jail would be required Comparison of the above data to bookings for the general population, including demographic and criminogenic information (e.g., age, sex/ gender, race/ethnicity, offense type/level, etc.) Request data from the criminal history repository, community supervision provider, and jail B. Key Findings Now that you have identified the appropriate sub-measures of the four key measures, use this chart to identify the key findings that can be reported to your planning team and stakeholders in the community. Analysis Questions Answers/Data 31
Indicate the prevalence of people with SMI in your jail. Is the average length of stay in jail for people with SMI longer than for people without SMI? Please provide the data in your explanation. What is the percentage of people identified with a SMI in jail who are connected to care in the community? What is the recidivism rate for people identified with a SMI in jail and then released to the community? Please describe any additional findings. Please identify missing data that you would still like to collect. SECTION 6: STRATEGIC PLAN In this exercise, all of your collaborative work is now coming together in one master planning chart that includes the data you have gathered, policies, practices, and programs you currently have in place, as well as those that are on your wish list to fill identified gaps. The next step involves analysis and the prioritization of interventions that will result in achieving the four key measures. 32
EXERCISE 8: PLANNING AND PRIORITIZING Complete the following table with your planning team knowing it will take multiple meetings or need to be accomplished at a planning retreat. Each of the four sections of the chart addresses one of the four key measures. Once all four sections are completed, the planning team should identify prioritized responses for each outcome and develop consensus around an action plan that is data-based, cost effective, and provides the most potential for reducing the prevalence of people with mental illnesses in your jail. Use the following four tables to identify the policies, practices, programs, and treatment options across all four key measures that do not currently exist in your system. Later in this guide, you will be asked to prioritize these responses, so this exercise can be used as a wish list. Refer to the previous charts in this handbook to identify gaps in services and practices. Measure 1. Reduce the number (and percentage) of people who have mental illnesses and are booked into jail Current Policies, Practices, and Programs Key data (e.g., mental illness prevalence, recidivism) List of effective policies, practices, and programs Identified gaps in policies, practices, and programs Planning for Implementation of Policies, Practices, and Programs Policies and evidence-based responses to be implemented Projected number of people to be served Projected cost/funding source List of evidence-based responses for implementation in order of highest priority Timeline for implementation Measure 2. Reduce their average length of stay in jail Current Policies, Practices, and Programs Key data (e.g., mental illness prevalence, recidivism) 33
List of effective policies, practices, and programs Identified gaps in policies, practices, and programs Planning for Implementation of Policies, Practices, and Programs Policies and evidenced-based responses to be implemented Projected number of people to be served Projected cost/funding source List of evidence-based responses for implementation in order of highest priority Timeline for implementation Measure 3. Increase the percentage of people who have mental illnesses released from jail who are connected to treatment Current Policies, Practices, and Programs Key data (e.g., mental illness prevalence, recidivism) 34
List of effective policies, practices, and programs Identified gaps in policies, practices, and programs Planning for Implementation of Policies, Practices, and Programs Policies and evidence-based responses to be implemented Projected number of people to be served Projected cost/funding source List of evidence-based responses for implementation in order of highest priority Timeline for implementation Measure 4. Reduce their recidivism rates Current Policies, Practices, and Programs Key data (e.g., mental illness prevalence, recidivism) 35
List of effective policies, practices, and programs Identified gaps in policies, practices, and programs Planning for Implementation of Policies, Practices, and Programs Policies and evidence-based responses to be implemented Projected number of people to be served Projected cost/funding source List of evidence-based responses for implementation in order of highest priority Timeline for implementation 36
SECTION 7: EVALUATION AND SUSTAINABILITY Once your planning is completed, the work of tracking progress and ongoing evaluation starts. Identifying the essential data and tracking the four key measures will provide your collaborative planning team with clear indicators of progress. As your planning segues to implementation, sustainability will become a focus. This section will help you ensure that your plan is implemented appropriately and can continue beyond the completion of this grant. EXERCISE 9: TRACKING PROGRESS A. Using Data to Track Progress 1. Is data available to share on a consistent basis with key stakeholders? 2. How often will the four key measures be reported to or discussed with key stakeholders? 3. How will you communicate the four key measures to stakeholders? B. Other Sustainability Strategies 1. Identify any policy (internal, local, state, federal) challenges that need to be addressed in order to achieve your program goals. 37
C. Tracking Progress from Start to Finish Organized by the four key measures, this chart will help you keep track of what you had in place prior to beginning your grant s efforts, what initiatives are currently underway as a result of your planning process, and what you would like to achieve moving forward. Measure 1: Reduce the number (and percentage) of people who have mental illnesses booked into jail Current Number (and Percentage): Year 2 Number (and Percentage): Year 3 Number (and Percentage): Prior to Project Implementation Future Implementation Measure 2: Shorten the average length of stay in jail Current Average Length (in days): Year 2 Average Length: Year 3 Average Length: Prior to Project Implementation Future Implementation Measure 3: Increase the percentage of people released from jail who are connected to treatment in the community Current Percentage: Year 2 Percentage: Year 3 Percentage: Prior to Project Implementation Future Implementation 38
Measure 4: Lower recidivism rates Current Rate: Year 2 Rate: Year 3 Rate: Prior to Project Implementation Future Implementation 39
i. The Stepping Up Initiative Appendix A Supporting Resources Recognizing the critical role local and state officials play in supporting systems changes, the National Association of Counties (NACo), the American Psychiatric Association Foundation, and The Council of State Governments Justice Center launched Stepping Up in May 2015. Stepping Up is a national initiative to reduce the number of people with mental illnesses in jails. More than 325 counties have passed a resolution to participate in the initiative. With support from public and private entities, the initiative builds on the many innovative and proven practices being implemented across the country. Stepping Up engages a diverse group of organizations with expertise on these issues, including those representing sheriffs, jail administrators, judges, community corrections professionals, treatment providers, people with mental illnesses and their families, mental health and substance use program directors, and others. The following resources available through Stepping Up can help local leaders develop a plan for reducing the prevalence of mental illnesses in jail: i. Reducing the Number of People with Mental Illnesses in Jail: Six Questions County Leaders Need to Ask is the foundational document of Stepping Up that encourages counties to assess their existing efforts to reduce the number of people with mental illnesses in jail by considering the following questions: 1. Is our leadership committed? 2. Do we conduct timely screening and assessments? 3. Do we have baseline data? 4. Do we conduct a comprehensive process analysis and inventory of services? 5. Have we prioritized policy, practice, and funding improvements? 6. Do we track progress? ii. Stepping Up partners have developed an online Resources Toolkit. Below are resources that are currently available or will be developed in 2017: 1. Monthly webinars and networking calls 2. Educational workshops at NACo Conferences 3. A Project Coordinator Handbook 4. Guidance on measuring the number of people with mental illnesses in jail 5. Companion tools for the Six Questions report with the latest research and case studies for county officials 6. Key Resources ii. Criminogenic Risk and Behavioral Health Needs Framework With mounting research that demonstrates the value of science-based tools to predict a person s likelihood of reoffending, criminal justice practitioners are increasingly using these tools to focus limited resources on the people who are most likely to reoffend. At the same time, mental health and substance use practitioners are trying to prioritize their scarce treatment resources for people with the most serious behavioral health needs. A person who screens positive for mental illness and/or substance use should be connected to appropriate treatment at the soonest opportunity; however, when that person is also assessed as being at a moderate to high risk of reoffending, connection to treatment is an even higher priority, along with interventions such as supervision and cognitive behavioral therapy to reduce the risk of recidivism. The framework depicted below outlines a structure for state and local agencies to consider how information about risk of reoffending and substance use and mental health treatment needs can be considered in combination to prioritize interventions 40
to have the greatest impact on recidivism. For more information, read Adults with Behavioral Health Needs under Correctional Supervision: A Shared Framework for Reducing Recidivism and Promoting Recovery. 41
Appendix B Sequential Intercept Model The following table includes the Sequential Intercept Model 2 for your reference. It may be helpful to use this model to identify existing policies, practices, programs, and treatments that currently exist in your system. 2 The Sequential Intercept Model developed by Mark Munetz, MD, and Patricia Griffin, PhD is described in this article and was subsequently adapted into a user-friendly handout in partnership with SAMHSA s GAINS Center for Behavioral Health and Justice Transformation. 42