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Criminal Justice and Behavioral Health LinkagesGrant Overview

John R. Kasich, GovernorTracy J. Plouck, Director

Tracy Plouck, Director

Promoting Wellness and Recovery

• A significant percentage of individuals incarcerated in jails have diagnosable mental illness and/or substance abuse disorder.

• Many of these individuals repeatedly shift between the criminal justice and the behavioral health system and experience poor outcomes.

• The ability of jails to treat inmates with behavioral health disorders is limited.

CJ/BH Overview

CJ/BH Needs Identified

• Divert appropriate individuals from the legal system and into behavioral health services

• Identify and treat inmates with behavioral health problems while incarcerated

• Promptly link them to behavioral health services upon release to improve both health and legal outcomes for these individuals

CJ/BH Objectives

• Reduce state and local correction costs• Reduce recidivism• Promote public safety• Promote behavioral health treatment• Support local partnerships• Increase/develop community capacity

CJ/BH Funding

• $1.5 million for FY14 and $1.5million for FY15

• 12 projects were funded in FY14

• 17 projects were funded in FY15

• Serving 24 counties in FY14 and 30 counties in FY15

Preble County TASC andTreatment ServicesTreatment Accountability for

Safer Communities

Preble County TASC and Treatment Services

What is TASC?TASC is an Model Program that provides an objective and

effective bridge between the justice system and the treatment community.

Justice System TASC Treatment

TASC reduces criminal recidivism and promotes public safety by linking clients to community based treatment services

Preble County TASC and Treatment Services

TASC is certified by the Ohio Department of Mental Health and Addiction Services and provides the following services:

Assessment Case Management Referral Urinalysis Testing

Requirements to successfully complete our program

1. Client must successfully complete an approved treatment program2. Remain drug-free for a minimum of 60 days 3. Maintain stable housing4. Obtain legal employment and/or obtain a GED or enroll in further education5. Have no further court/legal involvement

Clients who violate their Case Management Plan of Care receive sanctions and could be placed on Jeopardy Status.

Preble County TASC and Treatment Services

1. Clients will remain engaged in the program as evidenced by client attending weekly treatment sessions

Goal: Abstinence At 10 months

95%

2. Clients will verbalize relapse triggers and behavior changes needed for abstinence as evidenced by client participation in counseling sessions

3. Clients will be abstinent at completion of treatment as evidenced by negative urine screens for a minimum of 60 consecutive days

95%

100%

Preble County TASC and Treatment Services

1. Clients will remain engaged in treatment as evidenced by client enrolling in and attending first treatment session

Goal: No New Arrests At 10 months

95%

2. Clients will comply with all court hearings as evidenced by client engaging in productive case management activities

3. Clients will incur no new arrests at completion of treatment as evidenced by arrests reports from police and community control officers

95%

100%

Preble County TASC and Treatment Services

All clients in the program were actively using at the time of Intake.

Regular and random urinalysis testing have been conducted on all clients.

To date, 334 urines have been collected, with only 26% (88) coming back as

positive for illegal substances.

100% have shown a reduction in illegal substance use.

Preble County TASC and Treatment Services

Linkage to ServicesClients have been linked to the following services

through participation in the TASC program:

22 - Drug & Alcohol Treatment 15 - Mental Health Services 1 - Community Action Partnership 3 - Medical Services 3 - Transportation Assistance 1 - Help Me Grow 1 - Strengthening Families Classes 1 - Housing Assistance 1 - Employment Placement Services 1 – Food Bank

12 - Job & Family Services (Medicaid enrollment)

Lucas County

Community Innovations Project

The project connects inmates to needed mental health services upon release from jail by providing: in-reach services focusing on engagement, and

the development of a pre-release plan brief case management support (up to 60 days)

until a connection (“warm hand-off”) is made with a community mental health center and other needed services i.e. DMV, Social Security, etc.

Lucas County Community Innovations

Almost one-quarter (23%) of the jail’s bookings in Lucas County was from 6% (993 individuals)of the offenders

Cross system analysis revealed that 698 individuals had been enrolled in the MHRSB system at some point, of those, 664 individuals received at least one billable service

Only 221 of the 664 individuals had received mental health services between July 1, 2012 to present

The remaining two thirds of these individuals have not engaged in mental health services

The Need…

Treatment Accountability for Safer Communities of Northwest Ohio (TASC)

Lucas County Corrections Center (LCCC)

Mental Health and Recovery Services Board

Sheriff’s Office

Collaborative Partners

Increase the number of individuals with severe mental illness referred to treatment upon release

-Target: 50% of clients recommended for treatment will successfully connect with a treatment provider

Decrease number of rearrests within six months of release-Target: Of the individuals who engaged in treatment, 60%

will not be rearrested (too early to determine)

Number of Clients Served-Since July, 2014, 26 inmates identified, 5 have been

successfully linked to community mental health services, 11 have been sentenced or gave false contact information upon release, and 10 continue to be located in the jail awaiting court date

Outcomes, Clients Served, etc

Some projects take longer than others to implement

In spite of good faith efforts some individuals do not want to engage in behavioral health services

Staff turn-over greatly impacts project implementation

Need for Continuous Quality Improvement

Lessons Learned

Criminal Justice and Behavioral Health

Linkages Grant:Summit County

Ashley N. Stead, LSW- Summit Psychological Associates, Inc.

205 E. Crosier St.

Akron, Oh 44308

astead@summit-psychological.com

Summit County Grant Specifics

Goal:

•To increase efficacy of referral from jail release to connection with a community provider and to reduce relapse of symptoms within 30 days of release through use of a “long-acting” injectable. (i.e. Invega-Sustenna, Vivitrol)

Target Population:

• Inmates with diagnoses of opiate dependence and psychosis.

Approach

Assess

Plan

Identify

Coordinate

(Developed by The National GAINS Center, SAMHSA & The U.S. Department of Justice)

Vision and Mission

• Vision Statement: The Reentry Program strives to assist clients with severe mental illness and substance abuse issues to successfully re-enter society, maintain sobriety and mental health stability, and reduce their rates of recidivism by collaborating with local community providers to coordinate treatment services upon the clients release from the Summit County Jail.

• Mission Statement: The Reentry Program will facilitate continuity of mental health care and substance abuse services for clients leaving the Summit County Jail by assessing the client’s needs, collaborating with community providers to coordinate treatment linkages, assisting with Medicaid applications, and monitoring client’s follow-up services with treatment providers. This model will promote client stability and self-sufficiency within the community, thus reducing rates of relapse and recidivism.

The Basic Needs of Reentry

Food & Clothing-SNAP Applications

-Hot Meal Sites, Pantries

-Clothing Resource List

Housing-Shelters/Transitional

Housing-Sex Offender Housing-Housing Applications

Medical/Rx-Medicaid Applications

-Extended Release Injections-Pharmacy

Collaborations

AOD/MH Treatment-Vivitrol Collaborations

-Pregnancy Protocol-Jail Assessments-Reentry Groups

Employment/Education

-Ex-Offender Services-Educational Resources

Outcomes

172- Total number of inmates seen by reentry

7%- Re-incarcerated within 30 days of release

12%- Re-incarcerated within 30-60 days

8%- Re-incarcerated within 60-90 days

27%- Re-incarcerated <90 Days

1- Vivitrol Injection

5- Invega clients

Barriers

• Unpredictable release dates• Timing of injections

• Issues with providers accepting Vivitrol clients in the community

• Inability to schedule client community appointments• Clients transferred to ODRC or other treatment facilities

• Electronic Medical Records• Compatibility issues with community providers

• Jail Protocol• Limited in-reach• Finding ways to integrate re-entry into current jail

procedures

What’s Next?

• Vivitrol Outpatient Clinic & Recovery Club & Café

• Case Management services offered at Summit Psychological

• Glenwood Jail program expansion

• Collaborations with:• Drug Court & opiate specific PO’s• Medicaid• Housing Resources• Food & Clothing Resources

• Reentry Case Plan Transition Meetings

• Full Reentry Center

References

Osher F, Steadman H, Barr H. A best practice approach to community re-entry from jails for inmates with co-occurring disorders: the APIC model. National GAINS Center for People with Co-occurring Disorders in the Justice System, Delmar, NY; 2002. Available from : http://gainscenter.samhsa.gov/pdfs/reentry/apic.pdf

Mellow J, Mukamal D, LoBuglio S, Solomon A, Osborne J. The Jail Administrator’s Toolkit for Reentry. Washington, DC: Urban Institute Justice policy Center; 2008. Available from : http://www.jjay.cuny.edu/Jail_Admin_Toolkit.pdf

AN OUTPATIENT COMPETENCY RESTORATION PROGRAM FOR CRIMINAL COURT DEFENDANTS

Supported by a grant from OHIO Mental Health and Addiction Services, Criminal Justice and Behavioral Health Linkages

Prepared 9/20/2014

Jenny O’Donnell, Psy.D, and Kim Rosenzweig, Psy.D. Forensic Services, Forensic and Mental Health, Inc.

WHY OUTPATIENT COMPETENCY RESTORATION?

Least Restrictive Setting; Cost of Inpatient Bed Days; Long Wait Lists for State Hospital Restoration Beds

Delay is not therapeutic; Delays court proceedings

ID clients going to SMI facilities; Disruption of Client-connected community based

services; Effective Intervention for:

Psycho-Legal Education Anxiety management Communication Skills

CREATION OF A PROGRAM

Researched what is out there Florida, Washington Ohio –

Created a Referral Process Created a Psycho-educational

Intervention Protocol Educated the courts and boards about

the availability and cost benefit analysis.

PSYCHO-EDUCATIONAL INTERVENTION

Workbook

Incorporated videos

Multi-media gets and holds attention

Homework

Repetition, Repetition, Repetition

Environment

START WHERE THEY AREWHAT IS COMPETENCY?

WHAT IS INCOMPETENCY?Being competent means that you are able to do something.

A competent mechanic can

fix your car

A competent chef can cook a great meal

Being incompetent means that you are not able to do something.

Someone may be incompetent at cooking

Or may be incompetent at gardening

LEGAL DEFINITION OF COMPETENCY

LEGAL DEFINITION OF INCOMPETENCY

ORC 2945.371 “Whether the defendant is capable of understanding the nature and objective of the proceedings against the defendant or of assisting in the defendant's defense.”Simply put, it means that you

understand what goes on in court and can help your legalteam with your defense.

ORC 2945.37 “…because of the defendant's present mental condition, the defendant is incapable of understanding the nature and objective of the proceedings…or of assisting in the defendant's defense…”This means that the Judge

thinks that right now you can’t understand what’s going on well enough to help your lawyer and defend yourself.

Dr. Jenny O’Donnell, Director of Forensic Services, St. Aloysius

WE’D BE HAPPY TO DISCUSS THIS WITH YOU FURTHER.

ODonnell.Consulting@gmail.com513-869-4014