DRAFT JULY 24TH, 2012 - University of Pittsburgh

D R E X E L U N I V E R S I T Y &

U N I V E R S I T Y O F P I T T S B U R G H

Erie County Report of the Cross-Systems Mapping Workshop

July 11th & 12th, 2012

Transforming Services for Persons with Mental Illness in Contact with the Criminal Justice System

Erie County, PA Mental Health and Justice Center of Excellence Report, June 2012

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Facilitator

Patricia A. Griffin, PhD, Senior Consultant

Other Support

Amanda Cross, PhD, Senior Research Associate

Sarah Filone, MA, Project Coordinator Katy Winckworth-Prejsnar, Research Coordinator

Center of Excellence Staff

David DeMatteo, JD, PhD Sarah Filone, MA

Patricia Griffin, PhD Kirk Heilbrun, PhD Casey LaDuke, MS Amanda Cross, PhD

Edward P. Mulvey, PhD Carol Schubert, MPH

Katy Winckworth-Prejsnar, BA


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Table of Contents

Transforming Services for Persons with Mental Illness in Contact With the Criminal Justice System

Introduction ...................................................................................................................................... 5

Background ...................................................................................................................................... 5

About the Workshop ......................................................................................................................... 6

Objectives of the Cross-Systems Mapping Exercise ....................................................................... 6

Keys to Success ............................................................................................................................... 7

Erie County, Pennsylvania Cross Systems Mapping

Erie County Cross Systems Map .................................................................................................................. 8

Erie County Cross Systems Narrative ............................................................................................. 9

Intercept I: Law Enforcement / Emergency Services ........................................................ 11

Intercept II: Initial Detention / Initial Court Hearing ........................................................... 16

Intercept III: Jails / Courts ................................................................................................. 18

Intercept IV: Re-Entry........................................................................................................ 22

Intercept V: Community Corrections / Community Support .............................................. 25

Erie County Action Planning

Erie County Priorities ..................................................................................................................... 33

Erie County Action Plan ................................................................................................................. 35

Conclusions and Summary

Conclusion ..................................................................................................................................... 39

Closing ........................................................................................................................................... 39


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List of Appendices

Appendix A – Participant List ......................................................................................................... 40

Appendix B – PA State Parole Reentry System Chart ................................................................. 47

Appendix C – Peer Specialist/Support Services Referral Form .................................................. 48


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Erie County, Pennsylvania

Transforming Services for Persons with Mental Illness in Contact with the Criminal Justice System

Introduction

The purpose of this report is to provide a summary of the Pennsylvania Mental Health and Justice Center of Excellence Cross-Systems Mapping workshop held in Erie County, Pennsylvania, on July 11th and 12th, conducted at Barber National Institute. Erie County Prison hosted the workshop as part of an ongoing process of developing collaborative systems of support for individuals who have mental illness and who come in contact with criminal justice. This report (and accompanying electronic file) includes: A brief review of the origins and background for the workshop; A summary of the information gathered at the workshop; A cross-systems intercept map as developed by the group during the workshop; A description of each intercept along with identified gaps and opportunities; An action planning matrix as developed by the group; and Observations, comments, and recommendations to help Erie County achieve its goals.

Background

Erie County Prison and multiple other stakeholders requested the Center of Excellence Cross-Systems Mapping workshop to promote progress in addressing criminal justice diversion and treatment needs of adults with mental illness in contact with the criminal justice system. As part of the workshop, the Center of Excellence was requested to provide assistance to Erie County with: Creation of a map indicating points of interface among all relevant Erie County systems; Identification of resources, gaps, and barriers in the existing systems; and Development of priorities to promote progress in addressing the criminal justice diversion

and treatment needs of adults with mental illness in contact with the criminal justice system. Prior to the workshops, the Center of Excellence gathered information about Erie County through a Community Collaboration Questionnaire and gathering of documents relevant to the target population. The participants in the workshops included 50 individuals representing multiple stakeholder systems including mental health, substance abuse treatment, human services, corrections, advocates, family members, consumers, law enforcement, and the courts. A complete list of participants is available in Appendix A (pg. 42) of this document. Patricia A. Griffin, PhD, facilitated the workshop sessions. Sarah Filone, MA, Katy Winckworth-Prejsnar, and Amanda Cross, PhD, also provided support.


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About the Workshop

Upon receiving a grant from the Pennsylvania Commission on Crime and Delinquency and the Pennsylvania Department of Public Welfare’s Office of Mental Health and Substance Abuse Services in late 2009, the Pennsylvania Mental Health and Justice Center of Excellence was developed as a collaborative effort by Drexel University and the University of Pittsburgh. The mission of the Center of Excellence is to work with Pennsylvania communities to identify points of interception at which action can be taken to prevent individuals with mental illness from entering and penetrating deeper into the justice system. The Center of Excellence workshops, Cross-System Mapping and Taking Action for Change, are unique services tailored to each Pennsylvania community. These workshops provide an opportunity for participants to visualize how mental health, substance abuse, and other human services intersect with the criminal justice system.

This workshop is unlike other types of consultations or staff development training programs. A key element is the collaborative process. Meaningful cross-system collaboration is required to establish effective and efficient services for people with mental illness and co-occurring substance use disorders involved in the criminal justice system. This makes the composition of the group extremely important. While some workshops involve advertising to the entire provider community, it is essential in the Cross-System Mapping workshops that the organizers gather a group that represents key decision makers and varied levels of staff from the relevant provider systems. Center of Excellence staff work with this group, serving as expert guides to help:

Create a cross-systems map indicating points of interface among all relevant local systems; Identify gaps, opportunities, and barriers in the existing systems; Optimize use of local resources; Identify and prioritize necessary actions for change; and Develop an action plan to facilitate this change. Upon completion of the workshops, the Cross-Systems Map included in the report is provided in both print and electronic formats. It is meant to be a starting point. The electronic files can be revised over time to reflect the accomplishments and changes in the planning process.

Objectives of the Cross-Systems Mapping Exercise

The Cross-Systems Mapping Exercise has three primary objectives: 1. Development of a comprehensive picture of how people with mental illness and co-occurring

substance use disorders move through the Erie County criminal justice system along five distinct intercept points: Law Enforcement and Emergency Services, Initial Detention/Initial Court Hearings, Jails and Courts, Re-entry, and Community Corrections/Community Support.

2. Identification of gaps, resources, and opportunities at each intercept for individuals in the

target population. 3. Development of priorities for activities designed to improve system and service level

responses for individuals in the target population.


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Keys to Success

Existing Cross-Systems Partnerships Erie County’s history of collaboration between the criminal justice and behavioral health systems is reflected in a number of existing local efforts that were identified prior to the mapping. For example:

Erie County Criminal Justice Advisory Committee (CJAB) o Sub-committee that works on issues regarding community mental health issues and

the mental health population within the jail

Erie County Treatment Court o Works with both Mental Health and Drug & Alcohol populations

Consumer/Family Involvement in the Workshops Consumers were represented by Dave Wooledge, Forensic Peer Specialist, who added

valuable information to the discussion by sharing first person experiences of multiple Erie County systems.

Family representatives included representation from Erie County NAMI. Representatives contributed unique perspectives of family members’ experiences in Erie County and helped facilitate cross-systems communication.

Representation from Key Decision Makers in the Workshops The workshops included wide cross-system representation and involved many of the key

decision makers. Opening remarks by Director of Corrections/Warden James S. Veshecco and Shari Gross, Director, Erie County Department of Human Services set the stage and established a clear message as to the importance of the workshop. Honorable Ernest J. DiSantis, President Judge, Chair, Erie County Criminal Justice Coalition, welcomed participants and introduced the facilitator.

Data Collection In addition to the information gained during the workshop, the information in this report was

developed from conversations with and questionnaires completed by key stakeholders in Erie County in preparation for the workshop.


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Erie County Cross Systems Map


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Erie County Cross Systems Narrative

The Cross-Systems Mapping exercise is based on the Sequential Intercept Model developed by Mark Munetz, M.D. and Patty Griffin, Ph.D.,1 in conjunction with the National GAINS Center. In this workshop, participants were guided to identify gaps in services, resources, and opportunities at each of the five distinct intercept points. This narrative reflects information gathered during the Cross-Systems Mapping Workshop. It provides a description of local activities at each intercept point, as well as gaps and opportunities identified at each point. This narrative may be used as a reference in reviewing the Erie County Cross-Systems Map. The cross-systems local task force may choose to revise or expand information gathered in the activity. The gaps and opportunities identified in this report are the result of “brain storming” during the workshop and include a broad range of input from workshop participants. These points reflect a variety of stakeholder opinions and are, therefore, subjective rather than a majority consensus. General Description of Services and Cross-System Collaboration According to the U.S. Census Bureau, the county has a total area of 1,558 square miles (4,035.2 km2), the largest county in Pennsylvania, of which 798.9 square miles (2,069 km2) is land and 759.1 square miles (1,966 km2) (48.7%) is water. There are only two cities in Erie County: the City of Erie and the City of Corry.

Erie County is bordered on the northeast by Chautauqua County, New York, on the east by Warren County, on the south by Crawford County, and on the west by Ashtabula County, Ohio. It is the only county in the state that occupies a significant amount of land north of the 42nd parallel.

The County has been building a continuum of criminal justice and mental/behavioral health services that provides a basic foundation for continued growth and reorganization on all levels. There are a number of established links, both formal and informal, between the courts, probation, police departments, corrections and the mental health system that include, but are not limited to:

Peer Support within the Criminal Justice System o Collaborative training offered by PCCD/OMHSAS/Drexel University which trains

consumers

Erie County Drug and Alcohol Prevention Conference

The Erie County Criminal Justice Coalition serves as the primary collaborative board for local criminal justice practitioners and follows governance guidelines set forth from the Pennsylvania Commission on Crime and Delinquency. The collaborative group consists of membership from various community entities, including county level and magisterial district courts, court administration, public defender’s office, district attorney’s office, public safety, county and state level probation/parole departments, local police bureaus, service providers and case management, victims groups, sheriff’s departments, local colleges and government leaders. The Erie County Criminal Justice Coalition continued

1 Munetz, M. & Griffin, P. (2006). A systemic approach to the de-criminalization of people with serious

mental illness: The Sequential Intercept Model. Psychiatric Services, 57, 544-549.


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to be presided over by President Ernest J. DiSantis, Jr. Staff of the Mercyhurst University Civic Institute offers facilitation and planning services for the coalition, as well as various other services.

During the first half of 2011, the board focused their efforts on four main goals: truancy, offenders with mental illness, sex offender containment and the prison population. These goals were overseen by subcommittees, and had been part of the coalitions’ agenda for the previous two years. During the Summer of 2011, the board held a strategic planning retreat at the Tom Ridge Environmental Center in Erie and began discussions on adopting a new working strategic plan to guide their efforts over the next one to two years. The result of the process saw the continuation of the sex offender containment committee as well as the merging of the offenders with mental illness and prison population committees. Due to the increasing rise in the number and percentage of local prison inmates with mental illnesses, the ECCJA members believed it was best to focus on this precise issue within the county.

Erie County provides an extensive and detailed network of care website for individuals, families and agencies concerned with behavioral health. It provides information about behavioral health services, laws, and related news, as well as communication tools and other feature is available at:

http://erie.pa.networkofcare.org/mh/

http://erie.pa.networkofcare.org/mh/


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Intercept I: Law Enforcement / Emergency Services

Erie County 911 Center

Erie County installed the present enhanced 911 system in 1993. The enhanced system is able to display the caller phone number, the name of the phone subscriber, and the address. There is also a secondary screen which can display specific guidelines as be needed.

In Erie County all 911 calls are answered at the Erie County 911 Center. Call takers answer the call, determine if there is an actual emergency, and confirm caller information. The call takers then connect the call with the dispatch center that covers the area where emergency help is needed. This exchange typically takes approximately 30 seconds.

Erie County 911 currently employs 40 dispatchers and three supervisors. They operate on three 8-hour shifts, with eight dispatchers and one supervisor on each shift.

Erie 911 receives an average of 4,700 calls per month, with 5,673 calls in June of 2012. Call takers collect data on calls that may involve behavioral health concerns. See the chart below for 2011 data:

Call Code # of calls in 2011

“Suicidal Person/Attempted”

502

“Overdose/Poison-OD Intentional”

19

“Mental Disorder” 123

“Psychiatric …” or “Psych/…”

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“Drugs – Priority” 267

*** Note: The numbers above do not reflect every behavioral health related call in Erie County, because calls are coded by the primary disturbance (e.g. “Domestic Disturbance/Violence,” “Damage/ Vandalism/Mischief P2”). These calls may involve behavioral health concerns, but are not coded as such.

Crisis Services

Safe Harbor Behavioral Heath Call 814-456-2014 or 1-800-300-9558

Located at 2560 West 12th Street, Erie PA

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Telephone: Clients can call and speak to a trained Crisis staff member anytime. Staff will assess the situation and offer assistance or help refer the individual to community resources and information.

Walk-In: Clients may come directly to the Crisis Center to meet face-to-face with a Crisis counselor to obtain support, referrals, or information. No appointment necessary.

Mobile: On-location support is available for emergency situations. One crisis staff member is always available for support, assistance to the hospital for evaluation, and other on-scene support.

Follow-Up: Crisis Services will provide a follow-up program to assist individuals with support after initial contact. This can be done in-office or at the client’s home.

Warm Line: The Warm Line is available to anyone who just needs to talk about any non-crisis issue and is staffed by a Peer Support Specialist. The Warm Line number is 1-877-550-4007 and is currently available on weekdays.

Law Enforcement

Erie County houses 36 local police departments, the largest of which is the City of Erie Police, which employs roughly 173 officers. Millcreek Police Department surrounds the City of Erie and employs about 60 police officers.

State Police

The Pennsylvania State Police was created by an act of the legislation, signed into law by Governor Samuel W. Pennypacker on May 2, 1905. It was the first uniformed police organization of its kind in the United States. The Pennsylvania State Police has jurisdiction in all political subdivisions in the Commonwealth.

Erie County is served by State Police Troop E-Erie that additionally covers the counties of Crawford, Warren, and Venango. State Police Troop E covers approximately 3,373 square miles, a total population of 470,326, and employs 285 enlisted and civilian personnel. Erie County houses three local state police barracks (Corry, Girard, Lawrence Park).

Hospitals

Millcreek Community Hospital is located at 5515 Peach Street, Erie, PA (814.864.4031). Millcreek Behavioral Care (MBH), established in 2001 to fulfill an urgent need for psychiatric inpatient services, is dedicated to meeting the mental health needs of individuals residing throughout Northwestern Pennsylvania.

Millcreek Community Hospital 24-hour Emergency care meets all requirements of basic emergency service. MCH currently maintains a 14-bed capacity for assisting patients -10 medical and four behavioral health beds.

The MCH Psychiatric Partial Hospitalization Program provides intensive, short-term outpatient treatment for adults coping with mental illness, family issues, and/or substance abuse problems. This program can be utilized as either a “step down” program from inpatient treatment, or as a more intensive level of care than outpatient services.

Saint Vincent’s Hospital is located at 232 West 25 St., Erie, PA (814.452.5000). Trained behavioral health professionals are available 24/7 in the Saint Vincent Emergency Department to provide support and complete evaluations to determine if further mental health treatment is


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needed. Needs assessment staff meet with patients in the Lincoln behavioral health assessment area, a four-room unit located off the Saint Vincent Emergency Department. This area provides comfort and privacy while the evaluation is being completed.

Adult Inpatient Services are provided through a treatment team. This team includes a psychiatrist, nursing staff, inpatient therapist/social worker, recreational therapist and other professionals if necessary, such as dietitians, counselors, psychologists and occupational therapists. The treatment team works with the patient's existing support system and identifies additional sources of support when needed.

Detoxification Services

Gaudenzia Erie, Inc. (814-459-4775) provides 24-hour medically monitored detoxification services for adult men and women. Clients undergo complete medical exams within 24 hours of admission. When appropriate, they may also meet with a staff psychiatrist to treat any other conditions.

Treatment is based upon the client's need, usually lasting 1-3 days. Once a client becomes stable with his/her detoxification, Gaudenzia staff encourages participation in group and individual therapy sessions. Clients will learn about treatment options and are encouraged to continue their path to recovery.

Millcreek Community Hospital is located at 5515 Peach Street, Erie, PA (814.864.4031) has a detox unit. This is provided in a medical setting and evaluation is accessed through the emergency room.

Additionally, VA eligible residents can utilize Erie VA Medical Center’s Detox Unit.

Victims Services

The Pennsylvania Commission on Crime and Delinquency’s Victim Resources website provides the following victim services resources for Erie County. Further information can be found at: http://www.portal.state.pa.us/portal/server.pt/community/find_help_in_your_county/14752

Victim Service

Program Type of Program Street Address City

Crime Victim Center of

Erie County, Inc. We help victims of all crimes 125 West 18th Street Erie

MADD - Western Affiliate

Office We help victims of impaired driving

crashes 222 W. Cunningham

Street Butler

Safe Journeys We help victims of domestic

violence P.O. Box 208 Union City

SafeNet: Domestic

Violence Safety Network We help victims of domestic

violence P.O. Box 1436 Erie

In addition, Erie County residents have access to the following resources:

PA Coalition Against Domestic Violence 6400 Flank Drive, Ste. 1300 Harrisburg, PA 17112

daytime: 800-932-4632 website: www.pcadv.org

http://www.portal.state.pa.us/portal/server.pt/community/find_help_in_your_county/14752

http://www.pbpp.state.pa.us/ova/OVA_Redirector.asp?U=www.pcadv.org


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PA Coalition Against Rape 125 North Enola Drive Enola, PA 17025

daytime: 717-728-9740 24 hour hot line: 888-772-PCAR website: www.pcar.org

PCCD Victims Compensation Program 3101 N. Front Street Harrisburg, PA 17108

daytime: 717-783-5153 800-233-2339 website: www.pccd.state.pa.us

MADD, PA State Office 2323 Patton Road Harrisburg, PA 17112

daytime: 717-657-3911 24 hour hotline: 866-439-6233 (Pittsburgh) 800-848-6233 (Harrisburg) website: www.maddpa.org

Identified Gaps

When Crisis goes through a mediator (b/w police and a caller), information can get “muddy”

Calls between crisis and law enforcement still take too long (even with specialized triage)

Mobile crisis only has one person on at any given time; often need law enforcement to accompany them on mobile calls

Law enforcement spends a lot of time on crisis calls

911 is not involved with CJAB

Not a single 911 system

Tsunami of veterans returning – cannot keep up with the volume

In 2004/2005 local law enforcement suffered large lay offs

Law enforcement communication problems between Mill Creek and the City of Erie (radio and computer issues)

State Police can be stretched trying to help crisis and patrol rural areas

No law enforcement training outside of MPOEC training

No financial resources to provide more training

Law enforcement could use more officers

Erie police had a family crisis intervention unit that was discontinued in 2004 due to lack of man power (along with several other specialized units)

Gun violence has been an issue in the City of Erie

Drug trafficking and drug related retail thefts are large issues

Law enforcement’s primary problem related to individuals with mental illness is hospital wait times before the individual is admitted (typical wait time = 2-3 hours)

http://www.pbpp.state.pa.us/ova/OVA_Redirector.asp?U=www.pcar.org

http://www.pccd.state.pa.us/

http://www.pbpp.state.pa.us/ova/OVA_Redirector.asp?U=www.maddpa.org


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Hospital security is understaffed and undertrained in management/supervision of persons with mental illness and frequently unable to relieve officers so that they might return to duty

Perception that the hospitals view behavioral health patients as a “nuisance”

Crisis is located in the west of the county, so it can take 45 – 60 minutes for them to drive to calls on the East side

No single forensic psychiatrist in the county

No pre-certs are done in Erie County (all done in Pittsburgh)

Admittance to Millcreek Detox facility can be slowed by insurance check process

Frequent users can be a challenge for law enforcement (some folks are seen multiple times each week and care is denied)

Currently no way to reach out to individuals with mental health issues (particularly frequent users) who do not yet feel they need MH services

Identified Opportunities

Crisis has a special triage process for law enforcement (less than 10 questions)

Crisis is a highly utilized service

Cooperation amongst the law enforcement departments (state and local) is great

Crisis and law enforcement have a close working relationship

The hospital wait times have improved some

VA Police on the VA Medical Center Campus

CIT training for the VA Police will be begin shortly

Recent meeting with hospital administrators to try to help solve respective issues

Access to two in-county detox facilities

Stairways Behavioral Health has an individual that is trained to facilitate Mental Health First Aid training

EMS would be interested in MHFA training

Two Suicide Prevention Coordinators based out of the VA

Crisis Residential Unit (CRU) is an 8 bed facility that helps individuals in a MH crisis for up to a 5 day stay.


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Intercept II: Initial Detention / Initial Court Hearing

Arrest and Initial Detention

When an individual is arrested in Erie County, he or she is initially detained in a holding cell at the state police barracks or local police department until the paperwork has been processed. The City of Erie Police Department has a holding facility with 12 holding cells, and Millcreek Police Department uses three temporary holding cells.

Preliminary Arraignment

Erie County houses 15 Magisterial District Judges (MDJs) who conduct preliminary arraignment. The preliminary arraignment is currently split between video and face-to- face arraignment.

Preliminary arraignment is the first instance in which the accused person is brought before the MDJ. The MDJ identifies the criminal charges and explains certain important rights of the accused. Bail is discussed and the amount is determined by the MDJ. Bail can be unsecured (e.g., no money need be posted for release) or monetary. Conditions that must be complied with while the case is pending can also be imposed. Counsel is not generally present at this stage of proceedings.

Magisterial District Judges #

Suzanne Mack 06 -1-01

Paul G. Urbaniak 06 -1-02

Thomas Camey 06 -1-03

Joseph R. Lefaiver 06 -1-04

Dominick D. Dipaolo 06 -1-05

Thomas Robie 06 -2-01

Paul Manzi 06 -2-02

Brenda Nichols 06 -2-04

Mark R. Krahe 06 -3-01

Scott Hammer 06 -3-02

Susan Strohmeyer 06 -3-03

Carol Southwick 06 -3-04

Brian McGowan 06 -3-05

Denise Stuck-Lewis 06 -3-06

Chris MacKendrick 06 -3-07


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Erie County Adult Probation and Parole Pretrial Bond Reduction Program This pre-trial program is a collaborative effort between Adult Probation/Parole, Erie Co D&A, Stairways Behavioral Health, and Erie County Care Management. The program is designed to reduce the length of stay for offenders with non-violent crimes, who cannot afford a bond, and may be in need of treatment. County PO daily goes to the jail to review all new commitments from the last business day. The PO reviews the charges and will meet with the new admissions that do not have the following charges or legal status: ICC, Non-payment of Child Support, sex offense, violent offense. An interview is completed with the inmate who cannot make their bond and areas of need are determined. Individuals with MH and D&A needs are assessed by ECCM and Erie Co D&A respectively. A treatment plan is presented to the ADA and Court. If both are in agreement with the plan, the client is released on a reduced bond and enters into the recommended treatment.

Identified Gaps

No specific sobering stations

MDJ quarterly meetings do not always have great attendance (typically 5-6 of the 15 MDJs)

Some MDJs do not utilize local resources for diversion

It can be difficult to ensure individuals follow recommendations from the judges about community support services – for this reason MDJs may be hesitant to use diversion options

There aren’t many options for MDJs to place individuals who do not belong at the county jail, but clearly need supervision of some kind

Only one Probation Officer (PO) to do pre-trial services

Probation has limited jurisdiction during the pre-trial stage

Pre-trial PO has a large caseload

There is not a monitoring piece in place for those offenders who do not follow through with the bond reduction agreement and plan.


Suicide is not a particular problem during initial detention

Law enforcement does have holding cells

Crisis will go to the MDJ office to do assessments prior to arraignment

MDJs in Erie have taken the veterans’ specific training offered by the AOPC

MDJs have quarterly meetings

MDJs have been trained on local resources

MDJs have a strong working relationship with crisis

There is an informal diversion system (90 day continuance at preliminary hearing) for individuals with anger management/substance abuse needs – could be expanded to include individuals with mental health challenges


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Intercept III: Jails / Courts

Erie County Prison

The Erie County Prison, located at 1618 Ash Street, Erie, PA, is a County owned and operated facility. The Facility provides for the maintenance of those being held in custody pending disposition of their charges and those who are sentenced to two years or less.

The average daily population is roughly 640 inmates, and the facility processes approximately 4,500 admissions each year. In 2011, roughly 832 people are identified as having a mental health issue by jail booking staff at the front door and 187 are identified while incarcerated (by corrections officers, health staff or others). The average length of stay for these individuals is 59.4 days and approximately 1.29 bookings per person. For those identified as persons with mental health, substance abuse, or developmental disabilities (by jail, other criminal justice, or treatment systems), charges included:

535 - Misdemeanors

601 - Felonies

137 - Violent behavior

373 - Violations of probation

Behavioral Health Services

Screening

Every admission to Erie County Prison includes a questionnaire filled out by booking officers, followed by a complete medical assessment for mental health, substance abuse, and medical issues within three hours of admission. Once an inmate enters the housing unit, a risk-needs assessment is administered by a correctional counselor or officer. If necessary, an inmate is then referred to the Mental Health department for further follow-up and treatment.

Mental Health Services

Mental Health Services are contracted with Stairways Behavioral Health (SBH). Staff in the jail includes: a Nurse Practitioner, two Mental Health Counselors, a Psychiatric Nurse, and a Psychiatrist (12 hours/week).

D&A Services

Stairways Behavioral Health provides in-house Dual D&A services. D&A staff provides individual and group counseling.

For those who will need treatment following their release, a case manager from the Erie County Office of Drug and Alcohol Abuse goes into the jail once a week to conduct approximately 10-12 Drug & Alcohol assessments to determine the appropriate level of care.

Intercept 3 Jails / Courts

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Courts

The Sixth Judicial District of Pennsylvania Court of Common Pleas covers all of Erie County and has a compliment of 9 full-time judges.

Judges of the Court of Common Pleas are elected officials, and are elected to ten-year terms. Once a judge is elected for his or her first term, the judge may seek an addition ten-year term by way of the retention process, as provided for in the Pennsylvania State Constitution. Judges are state employees.

Treatment Court

In Erie County, Treatment Court is comprised of both a Drug Court and a Mental Health Court with a component that deals with Family Court. Erie County Drug Court for adult offenders began in 2000; it was expanded to include Mental Health court in 2002 and a Family Court component was added in 2011.

Throughout 2011, the Drug Court team supervised a monthly average of 22 offenders with substance use issues. As part of that active caseload, the Drug Court team of two Probation Officers also supervises, on average, 31 offenders “graduated” each month in 2011 who are serving the balance of their supervision time after successful graduation from Drug Court.

The intensive supervision given to Drug Court participants focuses on absolute compliance with treatment objectives with judicial overview. It is a program goal that the outcome of continued drug/alcohol recovery will result in law-abiding behavior.

The Erie County Drug Court is a joint program between the Erie County Court, the Erie County District Attorney's Office, the Erie County Public Defender's Office, the County Drug and Alcohol Office, and several treatment providers. Erie County houses one of over 2,600 Drug Courts in operation in the United States today. In Pennsylvania, there are now 99 problem-solving courts. The Erie County Drug Court is a member of both the National and Pennsylvania Association of Drug Court Professionals.

The Mental Health Court Component of the Erie County Treatment Court program started in 2002. In 2011, the Mental Health Court had an average monthly caseload of 12 offenders who have been identified as “seriously mentally ill.” Partners in the Mental Health Court are the Erie County District Attorney’s Office, Erie County Public Defender’s Office, Erie County Office of Drug and Alcohol Abuse, Erie County Care Management, Erie County Office of Children and Youth and Stairways Behavioral Health.

Accelerated Rehabilitative Disposition (ARD)

The Erie County Court of Common Pleas utilizes the statewide Accelerated Rehabilitative Disposition (ARD) program specifically for first-time DUI offenders.

ARD is a pre-trial program designed to allow the least-dangerous defendants – first-time, non-violent offenders – to circumvent the usually lengthy trial process. The ARD program suspends the formal criminal prosecution before trial if the defendant agrees to certain conditions, such as completing substance abuse treatment. The district attorney chooses who is accepted into the ARD program, and has considerable discretion when formulating polices or deciding which cases will be referred to the ARD program.


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Defendants who are accepted into an ARD program are placed under supervision, typically by the Erie County Adult Probation & Parole department. The maximum period of supervision for someone on ARD is two years. If the accused successfully completes the ARD program, the underlying criminal charges are dismissed and the defendant’s record is expunged of the arrest record and of the ARD disposition.

District Court Administrator

The District Court Administrator manages the day-to-day operations of the Court of Common Pleas, which includes the overseeing of all Court departments – Court Administration, Law Library, Computer Bureau, Court Reporters, Adult Probation, Domestic Relations, Juvenile Probation, Office of Custody Conciliation, the Protection From Abuse Office and the Jury Coordinator’s Office.

The Court Administrator also serves as the Court representative on the County Automation Steering Committee, Criminal Justice Coalition, the Security Committee, the (COOP) Continuity of Operations Plan Committee, Constable Task Force, the Video Conference Task Force Project and Long-Range Planning Committee. In addition, the Court Administrator and the Court Solicitor have instituted semi-annual staff training for all court supervisors and department heads.

Identified Gaps

There is a high population of a pre-trial inmates who cannot make bond (bond is too high for their financial situation)

Technical violation of probation/parole population is also high

Bail Bond services have been decreased in Erie County (one particular agency no longer does business in Erie County)

After an inmate is admitted to jail it can take several days to acquire all the releases necessary to gain access to the individual’s medical information, including current prescription information. Patients can go for days with their psychiatric meds.

Female offender population has increased recently (mostly drug offenses and probation violations)

This can cause problems because there is limited space for women (one “pod”)

Average length of stay at the jail has increased

Large stumbling block at intake - Some individuals do not want to disclose who their treatment providers are at intake; OR the individual doesn’t know what medications he/she is on - issues with continuity of care in the jail

The specialty courts are underused (could serve 50 additional individuals)

Underutilization of treatment courts is due in part to the perception that tx court could result in longer/harsher sentences

Some in the defense bar do not recommend treatment court to their clients because the defendant must accept an unusually long sentence (e.g. 20 years probation) in order to be accepted into treatment court

Medical Assistance is terminated (not suspended) when an individual enters jail


21

Unable to provide peer support services in the jail because of the lack of medical assistance in the jail and cuts in base funding

When individuals pick up new charges, there is no way to reduce length of stay


Jail admissions are down overall

Thorough intake screening at the jail, including a risk/needs assessment

Prison MH Department services have increased significantly over the past three years

Stairways Behavioral Health (local) provides BH services in the jail – it has been working very well to have local providers in the jail

ECCM, Erie County’s Base Service Unit, does cross-check their client list with the jail census

PA Courts Website provides information on incarcerated individuals (public record information)

A medical to medical release between the jail and local providers might help with communication and continuity of care

The jail just switched to electronic medical records on July 1

Electronic records allow jail BH staff to pull up the pharmacy medication list

Stairways clients’ (e.g. individuals who are clients of Stairways BH in the community) records are readily available to Jail BH staff

Current D&A services in the prison are meeting the needs of the population

Three specialty courts

Additional capacity of the mental health court (50 individuals) is an opportunity to serve more county citizens

There are some informal processes for peer support in the court systems (e.g. a peer may accompany an individual to court hearings)

Veterans Justice Outreach specialist can go into the jail to do assessments


22

Intercept IV: Re-Entry

Erie County Prison Reentry

The jail runs a monthly Mental Health Planning Meeting to discuss all inmates on the Mental Health caseload for parole planning purposes. This group includes an institutional parole representative, Forensic Specialist from ECCM, SBH jail mental health staff members, Erie Co D&A case manager, and jail corrections counselors. The team identifies the needs/services of those on a list for parole; e.g. MH, D&A, housing. ECCM will meet the individual to conduct a holistic assessment

The SBH Jail team collaborates with ECCM and other providers in re-entry planning for inmates with mental health needs. They help link individuals to appropriate services in the community. The Nurse Practitioner oversees that inmates are typically provided with seven days of aftercare medication and a prescription.

Community Corrections Center

The Erie County Community Corrections Center, opened in 2008 on the same campus as the main jail, is a 208-bed facility that houses both male and female offenders who are serving county imposed sentences for non-violent offenses. The Center allows offenders to seek and maintain employment during their confinement there while offering treatment and education programs for those diagnosed as mentally ill and substance abuse.

Re-Entry from Pennsylvania Department of Corrections

Community Reintegration of Offenders with Mental Illness and Substance Abuse (CROMISA)

In 2001, the Erie County Office of Drug and Alcohol Abuse was funded to provide the CROMISA project with the primary goal to reintegrate offenders from the PA Department of Corrections with mental illness and substance abuse concerns back into their home community. The project developed into a program and continues today.

Inmates from Pennsylvania State Correctional facilities, including the Community Correction Centers, the Erie, Crawford and Warren County Jails or in “Halfway-back” status closer to home may be eligible for the project if they have diagnoses of both mental illness and substance abuse.

Additional criterions for participation in the program are:

Prospective participant intends to return to Erie, Warren, or Crawford counties.

Intercept 4 Reentry

Pri

so

n/

Ree

ntr

y

Ja

il

Re

-en

try


23

Must have one year of supervision remaining on their maximum sentence in order to participate in the program.

Must be recommended for parole and inclusion in the program by the Parole Board and/or the State Parole Office.

The Erie County Care Management (ECCM) Case Manager from the CROMISA program works

with representatives from the State Correctional Institutions and other facilities to identify

potential program participants. An assessment is usually completed while the inmate is still

incarcerated, but can also occur after the individual has been paroled to a Community

Correction Center or is in Halfway-back status.

CROMISA Participants receive intensive, community-based services delivered via a community

treatment team for a period up to 12 months. Phases of treatment include:

1. Dual residential treatment program (if needed)

2. Halfway house (if needed)

3. Community Reintegration

4. Program Discharge Preparation

Once accepted into the program, plans are made for the individual to enter treatment at the

appropriate level of care. Throughout their involvement, participants are supported by a multi-

disciplinary, multi-agency team which includes a mental health forensic case manager, drug and

alcohol case management, a State Parole Agent, and housing stabilization services. This team,

which integrates the mental health and drug and alcohol treatment systems, follows the

individual in every phase of the program, including when the individual transitions to more

independent living and outpatient treatment services. Program participants are linked with

resources and supported as they develop and maintain relationships within the community.

The CROMISA program also includes a Supportive Transitional Extension Program (STEP), a joint project with Stairways Behavioral Health and the Erie County Office of Drug & Alcohol Abuse. STEP provides transitional housing and support to CROMISA clients leaving the criminal justice system and also seeking treatment for substance abuse. The CROMISA Case Manager, Donna Kloss, LPC, can be contacted at ECCM; 814-528-0695.

Other individuals being paroled or maxing out of state prison

Individuals who are being paroled to home or are maxing out from state prison also have access to ECCM services for treatment and resource linkage through ECCM’s Forensic Specialist, Meghan Lewis, M.S.; 814-528-0678.

Veterans Services

Erie County is served by the Erie VA Medical Center, located at 135 East 38th Street Boulevard Erie, PA 16504. (Phone: 814-868-8661; Toll Free: 1-800-274-8387) The Erie VA Medical Center (http://www.erie.va.gov/) has a Veterans Justice Outreach (VJO) Specialist to coordinate forensic services for veterans in the criminal justice system. Erie County is served by Terry Yeager, MA, CAACD, LPC, ([email protected]) from the Erie

http://www.erie.va.gov/

mailto:[email protected]


24

VA Medical Center. For more information on the Veterans Justice Outreach Initiative and the Veterans Health Administration (VHA), please see Guide 7 – “Information Sheet on Justice-Involved Veterans for Judicial System” located in the Resource Guide Document. In 1930, the Department of Veterans Affairs was established and was known at that time as the Soldiers, Sailors and Service Personnel Graves Registration. After the Second World War, the office expanded its services and became known as the Department of Veterans Affairs. In Erie County Mary Knight-Strong is the Director of Veterans Affairs.

Identified Gaps

Gap in communication between DOC and parole

SCIs do not always do paperwork to reactivate benefits upon release

DOC’s aftercare of 30 days of medication sometimes leaves a gap in care

Six prescription medication limit can be a problem for medication continuity


Stairways Behavioral Health as the BH provider helps with continuity of care upon reentry

Case managers can help facilitate information sharing and support for individuals

Individuals are given assistance with benefits paperwork before they leave the county jail

Jail staff will take application to the county assistance office to help with benefits activation

Erie County Care Management is able to visit inmates in state prison prior to their release in order to help begin transition planning (finding housing etc.)

Department of Public Welfare (DPW) is revising the COMPASS system so that attachments can be sent – easier to get approved roughly 30 days prior to release

Plans in place to add CCBH (managed care) to the mental health planning meeting at the jail


25

Intercept V: Community Corrections / Community Support

Community Corrections Centers (CCC)

In Erie County, the Community Corrections Center is located at 137 West 2nd Street, Erie, PA.

The Pennsylvania Department of Corrections operates 15 Community Corrections Centers (CCCs) in Philadelphia, Pittsburgh, Erie, Johnstown, Scranton, Allentown, Harrisburg, York and Waynesburg. The facilities house inmates in pre-release status and inmates granted parole by the Pennsylvania Board of Probation and Parole. These sites provide a structured, supervised living arrangement to inmates and parolees. For about 12,000 former inmates each year the first stop is a community corrections center. Inmates that serve at least nine months in a federal, state or local prison, with no major rule violations, are eligible to stay in a community corrections center. Offenders who receive life sentences or serve their maximum sentence are not eligible.

State Parole

The Parole Board was established by the Parole Act of 1941, which states “The parole system provides several benefits to the criminal justice system, including the provision of adequate supervision of the offender while protecting the public, the opportunity for the offender to become a useful member of society and the diversion of appropriate offenders from prison.”

The Board has the responsibility to parole, recommit for violations of parole, and to discharge from parole offenders sentenced to two years or more and offenders requested by the court for special probation. State parole utilizes a specialty unit for Mental Health caseloads.

As of May 2012, the total population of state parolees for four counties, including Erie, was 1,682 and 85% were male with an employment rate of 64% in the labor force.

Please see Appendix B – Pennsylvania State Parole Re-entry System for more information

County Probation and Parole

The Erie County Adult Probation and Parole Department operates under the immediate direction of the Erie County Court of Common Pleas. The six bureaus contained within Adult Probation provide a variety of court services. Erie County Adult Probation is responsible for the paroling and supervision of parole, probation, ARD, PWOV, electronic monitoring and pre-trial cases. In 2011, the entire department made approximately 65,921 offender-related contacts, an increase of 2.82% from 2010. The entire department's offender caseload as of the end of 2011 was 2,905 offenders. This was a 1.68% decrease from 2010.

Pa

role

CO

MM

UN

ITY

Intercept 5 Community corrections

Pro

ba

tio

n

Violation

Violation


26

The department is composed of the following 70 member staff: Director, Deputy Director, 5 Supervisors, 43 Probation Officers, 1 Therapist, 2 Collections Compliance Officers, 1 Community Service Work Crew Leader, 1 Staff Accountant, 1 Executive Secretary Office Manager, 12 full-time Clerical Support Personnel and 2 part-time Clerical Support.

The Mentally III Offender (MIO) Program

The Mentally Ill Offender Program (consisting of four probation officers) supervises offenders who have been identified as being “seriously mentally ill.” The program supervises and manages these offenders so they can receive more specific mental health services. In 2011, this caseload saw an increase of 4.1%. The MIO program is a cooperative partnership with Erie County Care Management and Stairways Behavioral Health. Because of Departmental restructuring, another probation officer was added to this program in 2011.

Additionally, there are several other specialty units that include:

Collections Bureau - collects monies from all probation, parole, ARD, PWOV, Community Services sentences, Electronic Monitoring, and Collections only cases.

Community Oriented Probation Services (COPS) - is a program offered in conjunction with the Housing Authority of the City of Erie. This program offers on site supervision in several Housing Authority sites within the city and is particularly effective there.

Community Service - places and monitors the completion of volunteer hours order by the Court.

Drug Court - a unit in and of itself dedicated to the treatment and recovery of drug-addicted offenders who have been sentenced in Drug Court. This program is funded in part by the Erie County Office of Drug and Alcohol.

Electronic Monitoring - this program tracks the whereabouts of offenders via an electronic monitoring unit, or ankle bracelet. This program acts as an alternative to incarceration for non-violent offenders, thus helping to reduce prison overcrowding.

Field Services - this group of 16 agents has an average caseload of approximately 192 offenders at any given time. Supervision occurs through office, home and employment visits. Compliance is ensured through breathalyzers, urinalysis, home inspections and contacts with local Law Enforcement and the offender’s family, friends and neighbors.

Sexual Offender Program - this program and the officers involved intensively monitor the offenders both at home and in the treatment setting. This program involves the use of both a licensed psychologist and a polygrapher to help ensure community safety.

Special Probation Services - this program is also offered in conjunction with the Erie County Office of Mental Health and Mental Retardation. Services in this program are offered to a population that are clinically diagnosed as mentally retarded and need additional services.

The department also operates two off-site locations (Developmentally Disabled Program and Housing Authority Program) as well as four monthly satellite offices that are staged in outlying areas of the county. The satellite offices are located in North East, Edinboro, Corry and Girard.

Housing Erie County Care Management (ECCM)


27

Homeless Case Management

Erie County Care Management, Inc. provides case management to individuals who are

homeless to help them link with mental health treatment, rehabilitation, and housing

resources.

Shelter Plus Care

Shelter Plus Care is a HUD funded program that provides participants with a housing

subsidy as long as they agree to participate in necessary mental health and/or drug and

alcohol treatment. The goal of the program is to assist participants in increasing their

income and achieving stability in housing. Shelter Plus Care does accept referrals for

individuals with criminal justice histories, although individuals with violent and/or sex

offense convictions are not eligible for this program.

Lakeshore Community Services. Inc.

Community Homes

Spacious, bright single-family homes in quiet neighborhoods have been the trademark of the core service offered by Lakeshore Community Services. The agency has its roots in quality care for individuals with mental retardation in settings well integrated in the local community. Initiating its efforts with four homes in 1987, Lakeshore now offers supports in twenty homes across multiple counties in Northwest Pennsylvania.

Supported Living

For individuals requiring assistance with negotiating the complexity of finding a suitable place to live, a meaningful job, and/or other necessities; Lakeshore offers a Supported Living Program. Staff in the Supported Living program offer individuals with mental retardation the education and fortitude they need to negotiate with landlords, budget their money or access available means of community assistance such as food stamps or medical care.

Semi-Independent Living

Semi-Independent Living offers persons with serious and persistent mental illness stability as they pursue their goals of recovery.

Initiated in 1993, the Semi-Independent Living program was founded on the principles of permanence and consumer directed supports. Semi-Independent living has assisted and continues to assist individuals who have left institutional settings or who seek an alternative to the same. The program aids individuals in locating affordable housing and in understanding and negotiating the details associated with successfully living in the community. Staff in Semi-Independent living are available 24 hours a day and 7 days a week to resolve problems, respond to a crisis or simply offer a ride to the store.

Stairways Behavioral Health


28

Fairweather Lodge is a peer-supported residential and vocational community program providing individual diagnosed with persistent mental health challenges. By providing emotional support, a place to live and employment for it members, the Fairweather Lodge Program help s people with mental illness reintegrate into the community. Stairways currently operates 8 Fairweather Lodges in Erie County – the highest number of lodges in any county across the commonwealth.

Mental Health Association of Northwestern PA (MHANP)

Housing Support Team This team assists consumers of mental health services find and keep safe, affordable housing through peer support, education and advocacy. The team is staffed by consumers, many of whom have lived experience residing in low income and/or subsidized housing. Most of the team members are Certified Peer Specialists. The following housing support services are targeted to mental health consumers residing at selected residential locations:

On-site individual and group peer support and education.

Liaison and advocacy for services that can support consumers to find and sustain housing arrangements of their choice.

Hands-on assistance with life skills including, but not limited to, problem solving, budgeting, hygiene, housekeeping, relationship skills, credit building, and communication skills.

Limited transportation necessary to help consumers access services that help them maintain housing and pursue mental health recovery (appointments, shopping, events, activities, etc.)

Development of individual recovery plans relevant to housing.

Assistance in navigating the mental health and other human service systems

Help for consumers moving into the lodge on Sass or Columbus Apartments.

Close collaboration with selected residential agencies, blended case managers at Lakeshore Community Services and Stairways Behavioral Health, Inc., helping ensure successful community experiences for mental health consumers.

Community Resources

Erie County Care Management (ECCM) serves as the Base Service Unit for Erie County. It is a private not-for-profit organization and was established in June 2006 by an act of Erie County Council as a conflict-free care management entity. ECCM serves the behavioral health and developmental disabilities systems in Erie County by providing Mental Health Administrative Case Management, Developmental Disabilities and Early Intervention Service Coordination.

The ECCM Mental Health Administrative Case Management program is responsible for the case management of approximately 12,000 individuals with mental illness. This service provides intake, assessment, referral, authorization, and monitoring of children, adults and senior citizens with mental health concerns. Additionally, clinical staff develops diversion options for individuals admitted to local inpatient mental health units, who are at risk for state hospitalization, and actively participate in discharge planning for all Erie County residents during their treatment at Warren State Hospital. Mental Health Administrative Case Management is also the point of entry for the enrollment of individuals in the public mental health system. ECCM has a call center where Erie County residents or support person of a resident can call for help in


29

accessing services, help navigating the mental health system, or assistance/guidance for other needs. For help, an ECCM mental health professional can be reached at 814-878-1640.

The ECCM Forensic Mental Health Administrative Case Management program provides

services to individuals with a serious mental illness who are involved in all stages of the criminal

justice system.

Stairways Behavioral Health assists persons with behavioral health needs in their recovery by providing comprehensive rehabilitation, treatment and supports essential for living, working, learning and participating fully in the community. Services include:

Treatment Programs Stairways Forensic Outpatient Clinic

o The Stairways forensic outpatient program provides a structured, intensive and clinically driven team approach that includes group and individual counseling, in-house psychiatric care and prescription management. Stairways doctors and professionals currently provide service and medication management within the Erie County prison system, offering exclusive continuity of behavioral health care upon each client’s release. This program is designed to bridge services between the Erie County Prison and the Forensic Clinic.

Stairways Outpatient Clinic o Therapists use a holistic approach to mental health treatment, offering

complementary and alternative therapies in addition to traditional treatments for serious mental illness, anxiety, depression, postpartum depression, and eating disorders, among a wider variety of mental and emotional difficulties.

o Psychiatric consultation, nursing services, medication monitoring, individual and group therapy are also available.

Stairways Counseling Center o Erie County residents who live under 150% of the poverty level and have

no insurance or medical assistance can take advantage of counseling services for little or no cost.

Stairways Outpatient Dual Diagnosis Clinic o Provides integrated co-occurring mental health and substance about

treatment for adults. o Provides both intensive and regular levels of outpatient care through

individual and group interventions and treatment. Assertive Community Team (ACT)

o The Act program is a client-centered, recovery-oriented mental health service providing community-based treatment to persons with serious mental illness who have typically not benefited from more traditional outpatient services.

o The Act program provides intensive rehabilitation, treatment and supportive services tailored to the specific needs of each participant.

o The Act program in made up of a multidisciplinary team who work together to provide the majority of the services, all geared towards assisting each individual achieve his or hers life goals.

o ACT members have 24/7 availability to a psychiatrist, three nurses, five mental health professionals, three mental health workers and a peer specialist.

Residential Treatment Facility for Adults (RTFA)


30

o Provides short-term (up to 30 days) voluntary mental health residential treatment, with 24/7 care for adults diagnosed with a severe mental illness in need of a structured supportive environment who meet specific medical necessity criteria.

o Provides psychiatric, nursing, social work, and case management consultation and individual and family oriented treatment.

o Provides weekly, on-site community treatment team meetings.

o Provides a step-down level of psychiatric care for individuals transitioning from a more structured environment (i.e., state and community psychiatric hospitals, jail) who are still in need of transitional treatment and support.

Deerfield Dual Diagnosis

o Provides persons struggling with both substance abuse and mental illness with integrated treatment and support in a 24-hour residential setting.

o Provides psychiatric, nursing, social work and case management consultation, including individual and group treatment.

Rehabilitation Based Programs Blended Case Management & Forensic Blended Case Management

o The Stairways Forensic Blended Case Management Team is routinely assigned to criminal justice involved individuals who are diagnosed with a co-occurring disorder, or to individuals who may be at high risk of criminalization due to behavioral health and substance abuse concerns.

o Case managers are trained in the early detection and intervention of co-occurring symptoms that may lead to the psychiatric decompensation of the individuals they serve, including those with criminal justice involvement.

o Case managers use a variety of diversion strategies depending upon the circumstances. These strategies may include: consulting with and making recommendations directly to local Judges, District Justices, Attorney/Public Defenders, Police and Probation/Parole officers in regards to mental health treatment, community mental health resources and general mental health education as alternatives to arrest.

o As a standard practice, case managers work in collaboration with community stakeholders, which may include the following: SBH Forensic and Dual Outpatient Clinics, other community behavioral health and substance abuse organizations, the criminal justice system (i.e., Mental Health & Drug Treatment Courts, Probation & Parole), the Department of Corrections, vocational/educational organizations, and programs that provide entitlements and benefits (i.e., Social Security, Department of Public Welfare, and U.S. Department of Housing and Urban Development).

o The Forensic Management Team has a formal relationship with probation and parole officers, treatment and drug court judges, and district attorneys and public defenders. These professional relationships are based on on-going weekly collaborations, and a long-term history of established clinical competency and positive outcomes.

Mobile Psychiatric Rehabilitation


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o This community-based program helps persons with mental illness identify recovery goals and provides support and skills development for living, learning, working and socializing while pursing those goals.

Youth in Transition o A residential supports program providing men, ages 18-21, support in

transitioning from the adolescent mental health system to the adult community.

o Provides life skills training, recourse coordination, case management and psychosocial support.

Certified Peer Specialists (CPS) o CPS complements medical and mental health treatment by serving as a

model of the recovery process. o CPS can help individuals with their social, vocational, educational and

self-care goals in many ways, including: crisis support, individual advocacy, social networking, self-improvement, self-help, developing communication skills, and exploring housing resources.

The Mental Health Association of Northwestern PA (MHANP) is organized for individuals diagnosed with mental illness. MHANP is a consumer run organization. The goal is to support and promote mental health recovery. The Consumer/Family Satisfaction Team functions as a service for consumers and family members to voice opinions regarding their own mental health services. Advocacy efforts range from navigating systems such as: mental health, housing, vocational, educational, and financial to writing a résumé or helping someone register to vote. Volunteering provides opportunities as a means to help ease the transition back into gainful employment.

Consumer Center The Center is a place for consumers of mental health services to pursue recovery through mutual support and consumer driven programs. Consumers determine when and how they participate in and share their own recovery experience. The mission of the Mental Health Association Consumer Center is to create a safe, supportive, recovery-orientated environment, dedicated to preserving: dignity, respect, advocacy, empowerment and is flexible to personal growth.

Certified Peer Specialists

There are 82 Certified Peer Specialist in Erie County. Some work in various settings such as: Center Team (MHA) Housing Team (MHA), Consumer Employment Outreach Coordinator (MHA), Consumer/Family Satisfaction Team (MHA), Peer Support to individuals in the Community (Stairways BH), Youth in Transition (Stairways BH), ACT (Stairways BH), Customer Representative (Stairways BH),Personal Care Home (Stairways BH), Fairweather Lodge, (Stairways BH), Peer Support in Crisis and Outpatient (Safe Harbor BH), Director of Advocacy and Recovery (ECCM). Certified Peer Specialists work to help people see their inherent rights and responsibilities and advocate for respectful and professional treatment from the rest of a person's treatment team.

For more information on Erie County Peer Support Services, please see Appendix C – Peer Specialist/Support Services Referral Form


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Lakeshore Community Services. Inc. (Intake specialist can be reached at 814-456-9962, extension 1184) began Intensive Case Management in 2003 and transitioned to Targeted Case Management in 2007. Targeted Case Management allows a consumer to have the same case manager across all levels of need, rather than having to switch case managers because of changing needs.

Lakeshore's Targeted Case Management program provides access to and advocacy for appropriate mental health services. It assists persons in treatment planning, developing systems of support, accessing appropriate medical services and obtaining and maintaining basic living needs and skills. Targeted Case Managers are on call 24 hours a day, 7 days a week.

Any individual seeking Targeted Case Management services can call the intake specialist at Lakeshore Community Services. The intake specialist will briefly ask the caller about mental health issues and schedule the caller for a face-to-face intake. Lakeshore also provides in-home intakes to avoid transportation difficulties.

During the face to face intake, the Lakeshore intake specialist will gather information from the individual about current treatment, past treatment, family history, medical issues and other areas. This information is used to verify a person's eligibility for Targeted Case Management services. The potential consumer will also be asked to sign Releases of Information, which also aid in verifying eligibility for services. The intake specialist also uses this meeting to further explain TCM services and answer any questions the individual has about Targeted Case Management.

Identified Gaps

Medicare options in the area are very limited for MIO program

Medicare does not reimburse at the same rates as other insurance, so providers are not incentivized to accept Medicare and clients can have difficulty finding providers

Data collection on veterans in the criminal justice system is very poor

Not enough crisis housing options

Brick and mortar housing options are not available (i.e. residential facilities, crisis housing units). These units could house mentally ill offenders to help stabilize them without revoking their probation/parole.

Public housing has long wait lists

Individuals are often denied public housing due criminal history


Specialized probation for mentally ill offenders (MIO Program)

Specialty parole officer for State Parole

Great working relationship between VA & Probation

Two probation officers assigned to a veterans docket and reach out to Terry (VJO) if needed

MHA Supportive Housing with HUD funds will start in September/October

There is currently a High Risk Committee for individuals with mental health issues – could possibly be expanded to include individuals with mental health and criminal justice involvement


33

Erie County Priorities

Subsequent to the completion of the Cross-Systems Mapping exercise, the assembled stakeholders began to define specific areas of activity that could be mobilized to address the gaps and opportunities identified in the group discussion about the cross-systems map. Listed below are the priority areas identified by the workshop participants and the votes received for each proposed priority.

Top Priorities

1. Expand Crisis Services – 24 total votes/ 15 high priority

a. Help supplement law enforcement

b. For instance crisis drop-off/pick back up

c. Alternatives to ER

2. Improve relationships with hospitals 18 tv / 2 hp

a. Get their involvement

3. Hire more police officers 15 tv / 2 hp

b. Allows specialized police response units

4. Address funding shortfalls – 14 tv

c. Get buy-in from commissioners

d. Address both short-term and long-term strategies

5. Improved communication across Intercept II thru V – 11 tv

6. Address under utilization of treatment court - 11 tv

e. Re-education

7. Reconsideration of law enforcement’s role in civil commitment – 7 tv / 2 hp

a. Mental Health deputy sheriff (like Texas)

b. Firefighters/EMT

c. Especially at Intercept 1 and hospitals

8a. More affordable housing for individuals with forensic background - 4 tv

8b. Window for presumptive eligibility for jails, prison, and hospital releases - 4 tv

a. Improve access to med records/documentation

9. Diversion - 3 tv / 2 hp

a. Intercept .5

10. Forensic Peer Support across intercepts 3 tv / 1 hp

11a. Increase behavioral/medical support to probation - 1 tv

a. Like the jail has

b. Increase sharing of info

11b. Training for law enforcement regarding civil commitment laws – 1 tv


34

Listed below is a list of revised/ condensed priority areas identified by the workshop participants as a group on Day two.

Revised Top Priorities

1. Expand Crisis Services

a. Help supplement law enforcement

b. For instance crisis drop-off/pick back up

c. Alternatives to ER

2. Diversion before 911 – Intercept .5

3. Improved communication across Intercept II thru V

4. More affordable housing for individuals with forensic background


35

Erie County Action Plan

Priority: Moving Forward

Objective Action Step Who When

Cross System Mapping

Report 1. Revised Map will be

sent to Erie County

2. First Draft of whole

report will be sent to

Erie County

3. MH Corrections

subcommittee will

revise the first draft

CoE

MH Corrections

Subcommittee

By next week By July 26

th,

2012 Next meeting

(October?)

Moving CJAB forward 1. Consider how these

new work groups will

operate 2. Mercyhurst 3. First report back to

CJAB in 3 months

a. October &

February 4. Reporting back re

progress in 6 months 5. Bringing the group

back together in one

year, at the minimum

Priority Area 1: Expand Crisis Services Work Group: Mandy, Dave G, Mary Ann, DJ, Dante, John D, Mary Objective Action Step Who When 1.1 Help to supplement

Law Enforcement

CIT Training for other

public safety entities

University Police

Hospital security

Sheriffs

1.2 Examining protocol for

crisis drop-off/pick

back up

Mandy can meet with

Millcreek and Erie PD to

pilot a project to facilitate

drop off for certain folks

Like what Guardenzia

does for the D&A folks

Mandy

1.3 Alternatives to the ER Examine options with Crisis

Residential


36

Current utilization?

Access by law

enforcement through

crisis 1.4 Improve relationships

with hospital Get their involvement

Staffing hospital security

sufficiently

Look at well-trained

staff at Saint Vincent’s

Across all shifts

So law enforcement

doesn't have to wait long

periods for security to

show

1.5 Incorporate Drug and

Alcohol and resources

available

Priority Area 2: Diversion before 911 (Intercept .5)

Work Group: Sue, LuAnn, Dave W, Bill Grove, NAMI, Terry, Shirley Objective Action Step Who When 2.1 Critical points to

identify warning signs

prior to crisis

Identify at earliest point

possible

Develop mechanisms to

serve people who don't yet

think they need help

2.2 Education program for

families, friends, and

others

Mental Health First Aid

Instructor in the county

(Stairways) and EMS

can bring bodies

2.3 Examine insurance and

finance issues

2.4 Veterans 2.5 Focus on wellness 2.6 Focus on improved

access to treatment and

others supports like

faith based community,

peer-to-peer, family

support (NAMI), and

other community

organizations

2.7 Education for outlying

law enforcement


37

agencies so that they

are more aware of

mental health issues

Priority Area 3: Improved communication across Intercepts II-V Work Group: Glynn, Judge Mack, Char, Warden, Dave Brooks, Dave W., Dave B., Matt, John,

Sheila, Public Defenders Objective Action Step Who When 3.1 Focus on transitional

planning

3.2 Address lag time

moving through the CJ

systems

3.3 Expand the informal 90

day program diversion

from anger

management and D&A

to include mental health

MDJ Piece Dave

3.4 Focus on high users Build on the work of the High

Risk Committee

Which only focus on MA

Clients o Already has action

plan developed

How to address the non-

MA clients

Mary Ann,

Penny, Dave

B, Dante

Solicit suggestions from LE

and 911 and other CJ

Perhaps a monthly or

quarterly report for BH

system?

Real time awareness of CJ

system involvement

What databases might give

early warning signs? o D&A o ECCM data o MDJ

Perhaps AOPC

to generate a

report o DA’s database

targeting violent

offenders DA opens 3300

cases a year that

make it past

preliminary


38

hearing to trail o 911 database –

tracking frequency of

care

Develop formal

communication

channels b/w CJ and

behavioral MH

Priority Area 4: Housing Work Group: Heather, Craig, Dave W. Shelia, Patty, Mark A) Objective Action Step Who When 4.1 HUD Supportive

Housing for MH and

CJ and homelessness

4.2 Explore strategies to

remove barriers to

housing

Adding more restrictions to

the federal requirements

How to help case managers

to advocate for their clients re

housing restrictions

Address income issues o Social Security benefits Explore SOAR


39

Conclusion

Participants in the Cross-Systems Mapping workshop showed much enthusiasm in working together to improve the services available for people with severe mental illness and often co-occurring substance use disorders involved in the Erie County criminal justice system. Erie County is poised to tackle a number of critical issues that will greatly improve services for this group. The assembled stakeholders spent time gaining a greater understanding of their shared systems, as well as crafting strategies related to improving the collaborative infrastructure for the group and addressing the gaps and opportunities at each intercept.

Considerable work has already been undertaken to improve services for people with severe mental illness and often co-occurring substance use disorders involved in the Erie County criminal justice system. Expanding crisis services, collaboration across the intercepts, and behavioral health training for public service entities are some examples of current Erie County initiatives. Local stakeholders participating in the Cross-Systems Mapping were clearly interested in building on current successes to better serve this population.

The expansion of the planning group to tackle the priorities established during the Cross-Systems Mapping workshop is an essential next step in a true systems change process. It will be important to create effective working relationships with other groups that did not attend the workshop, including the hospitals, other police jurisdictions including State Police, other local Magisterial District Judges, Social Security Administration, and additional local peers. Regular meetings should be held by this larger group to facilitate information sharing, planning, networking, development and coordination of resources, and problem solving.

Closing

Erie County is fortunate to have a wide range of stakeholders across the mental health, substance abuse and criminal justice systems that have made significant efforts to understand and support the challenging issues discussed in this workshop. The Cross-Systems Mapping workshop gave these stakeholders a chance to develop a coordinated strategy to move forward with the identified priorities.

By reconvening and supporting the work of the group in coming months, it will be possible to maintain the momentum created during the Cross-Systems Mapping workshop and build on the creativity and drive of key local stakeholders. The Pennsylvania Mental Health and Justice Center of Excellence hopes to continue its relationship with Erie County and to observe its progress. Please visit the Pennsylvania Mental Health and Justice Center of Excellence website for more information, www.pacenterofexcellence.pitt.edu.

http://www.pacenterofexcellence.pitt.edu/


40

Appendix A: Participant List

Last Name, First Name

Agency / Title Street Address City, State, Zip

Phone E-Mail

Tom Aaron

Court Administrator –

Erie County

Courthouse

140 West 6th

St.

Erie, PA 16501 814-451-6295 [email protected]

Emily Adiutori Program Coordinator –

NAMI of Erie County

1611 Peach St., Suite 105


MaryAnne Albaugh, MD Erie County DHS 154 W. 9

th St.

Erie, PA 16501 814-451-1545

[email protected]

[email protected]

om

Art Amann, Ed.D Mercyhurst Public

Safety Institute Mercyhurst Northeast 814-725-6230 [email protected]

Dante Battles

Supervisor –

Erie Co. Adult

Probation

140 West 6th

St.

Erie, PA 16501

814-451-6470

[email protected]

Sue Bennett Lakeshore Community

Services

1350 W. 26th

St

Erie, PA 814-456-9962 [email protected]










41

Randy Bowers City of Erie Police 626 State St.


David Brooks Division Director –

Gaudenzia Erie

414 West 5th

St.

Erie, PA 16507

814-459-4775

x19

[email protected]

rg

Gail Cash CPS- MHA 1038 Newton Ave.

Erie, PA 16511 814-899-0997

Penny Chapman CCBH 1314 Griswold Plaza

Erie, PA [email protected]

Glynn Chase

Regional Director –

Community Care

Behavioral Health

1314 Griswold Plaza


Yvonne Costelloe

Erie County 911 2880 Flower Road


Karen Croyle

Executive Director –

Corry Counseling

Center

45 East Washington

Corry, PA 16407

814-664-7761

x 112 [email protected]

Matthew Cullen

Assistant District

Attorney –

Office of the Erie Co.

District Attorney

140 West 6th

St.

Erie, PA 16501

814-451-7033

[email protected]










42

Jack Daneri

District Attorney –

District Attorney’s

Office

Erie County Courthouse

140 West 6th

Street

Erie, PA 16501

814-451-7023 [email protected]

John DiMattio

Executive Director –

Erie Co. Office of Drug

and Alcohol Abuse

155 West 8th

St., Suite

401

Erie, PA 16501


Shirley Dinger Official Visitor PA Prison Society 814-756-3879 [email protected]

Randy Faipler

Captain- Patrol

Division Commander –

Millcreek Police

Department

3608 West 26th

St.

Erie, PA 16506 814-833-7777

[email protected]

m

Mandy Fauble

Vice President of

Clinical Operations –

Safe Harbor Behavioral

Health

1330 West 12th

St.


George Fickenworth Mercyhurst Civic

Institute

501 E. 38th

St.

Erie, PA 16546 824-2183 [email protected]

Heather Filson

Co-Director of BCM

Services –

Stairways Behavioral

Health

2185 West 8th

St.

Erie, PA 16505


D.J. Fuhrmann City of Erie Police 626 State St.












43

Joe Giles

County Councilman –

Erie County Council

140 West 6th

St.

Erie, PA 16501

814-451-6303

[email protected]

LuAnn Gosset

Administrative

Assistant-

Mental Health

Association of NWPA

1101 Peach Street

Erie, PA 16501

814-452-4462

Ex) 126 [email protected]

Shari Gross DHS Director –

MH/MR

154 West 9th

Street

4th

Floor

Erie, PA 16502


Barry Grossman

County Executive –

Erie County

Courthouse

140 West 6th

St.

Suite 504

Erie, PA 16501


Bill Grove

CEO –

Mental Health

Association of NWPA

1101 Peach Street


Scott Hammer Magisterial District

Judge

10300 West Main Road

PO Box 8

North East, PA


Mary Hayes

Robert Wiley

Community Charter

School

1446 E. Lake Rd.


Sheryl Hoetzel Erie County 911

2880 Flower Road

Erie, PA 16509

814-451-7946

[email protected]










44

Scott Irwin

Sergeant- Patrol

Division –

Millcreek Police

Department

3608 West 26th

St.

Erie, PA 16506 814-833-7777

[email protected]

m

Wendy Jacobs Erie County MH/MR

Program Specialist

154 W. 9th

St


David Jeannerat

Mental Health Team

Leader –

Erie County MH/MR

154 West 9th

St.

Erie, PA 16501

814-451-6820

[email protected]

Bobby Juip PCCD 3101 N. Front St.

Harrisburg, PA [email protected]

Denise Kolivoski NAMI

Executive Director

1611 Peach St. Suite 105


Meghan Lewis

Forensic Specialist –

Erie County Care

Management

1601 Sassafras St.

Erie, PA 16502

814-528-0678

[email protected]

Patricia Lightner

District Director, Erie

Office –

Pa Board of Probation

& Parole

221 East 18th

St.

Erie, PA 16503

814-871-4201

x223

[email protected]

Suzanne Mack Magisterial District

Judge

824 West 6th

St.

Erie, PA 16507

814-451-6524

[email protected]











45

Craig Montgomery

MIO Probation/Parole

Officer

Erie Co. Adult

Probation

140 West 6th

St.

Erie, PA 16501

814-451-6392

cmontgomery@eriecountygov.

org

Brenda Nichols Magisterial District

Judge

732 Worth St.

Corry, PA 16407

[email protected]

Dan Rettger Income Maintenance

Casework Supervisor

PA Dept. of Public

Welfare

1316 Holland St.

Erie, PA 16503

814-461-2110

[email protected]

Char Riddle

Nurse Practitioner –

Stairways Behavioral

Health Erie County

Prison Program

2911 State St.

Erie, PA 16508

814-882-2702

[email protected]

Adam Saeler Mercyhurst Civic

Institute

501 E. 38th

St.

Erie, PA 16546 824.2441 [email protected]

Jeff Shaw

Director –

Erie County Adult

Probation

140 West 6th

Street

Erie, PA 16501

814-451-7068

[email protected]

Sheila Silman

Director, Support

Living & Forensic

Services

ECCM

1601 Sassafras St.

Erie, PA 16502

814-528-0727

[email protected]

Mike Suchy City of Erie Police 626 State St.












46

David Ungerman

Chief Public Defender

Erie Co. Public

Defender Office

509 Sassafras St.

Erie, PA 16507

814-451-6502

[email protected]

Jim Veshecco Warden –

Erie County Prison

1618 Ash Street


Dave Wooledge Team Leader –

MHA of NWPA

1101 Peach St.

Erie, PA 16501

814-452-4462

x117

[email protected]

Terry Yeager Veterans Outreach

Officer

Erie VA Medical Center

135 East 38th

St.

Erie, PA 16504







47

Appendix B: State Parole Reentry System Chart

PA Board of Probation and Parole - October 2011

5 Months Prior to

Minimum Date

4 Months Prior to

Minimum Date

3 Months Prior to

Minimum Date

8 Months Prior to

Minimum Date

Convicted Parole

Violator (CPV) –

Commits another

crime while on parole

supervision and is

convicted.

Parole agent and

offender jointly

develop a supervision

plan. The agent uses

problem solving

strategies to assist the

offender.

Secure Technical

Parole Violator

Centers for non-

assaultive TPVs.

Parole agent reviews

conditions of parole

with offender.

Technical Parole

Violator (TPV) –

Violates a condition

of parole.

Judge and District

Attorney letters

mailed.

Begin documentation

gathering for parole

interview.

Institutional Parole

Agent reviews Board

file and gathers

additional documents.

Decision maker

reviews offender file

and reentry plan to

prepare for the

interview.

Decision maker

reviews file.


Agent works with

offender on reentry

planning – home and

employment.

Parole Decisional

Instrument assists

decision maker.

Home plan

investigation occurs

for offenders granted

parole.

Average

Recommitment

Time is 9 to 12

Months.

Pre-Interview

Case Review

The Parole

Interview

Offender reports to

parole supervision

staff within 24 hours.

Presumptive ranges

for recommitment.

Violent offender

certification. Review

for detainer. Office

of Victim Advocate

notification.

If parole is denied,

offender is advised of

reasons for denial and

issued a review date.

Offender drug screen.

Payment of victim

fees. DNA sample.

Megan’s Law

registration. Victim

impact education

class.

Conditions of parole

explained to offender.

Offender attends

community

orientation

reintegration class.

Offender signs

release order and

conditions of parole.

The Pennsylvania State Parole Reentry System

Post Parole

InterviewPrior to Release Supervision Parole Violators

Preparation of

Case File

Institutional

Parole Agent

Average Time in a

Parole Violator

Center is 3 to 4

months.


Agent conducts pre-

parole interview and

assessment.

Vote occurs in person

and video conference

(additional rotation

votes if required).

Special agents assist

offenders at risk of

parole failure through

interventions in the

community.


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Appendix C: Peer Specialist/Support Services Referral Form


49

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