Marcus Ayers, MEd, LPC

ODMHSAS/DOC Collaboration since 2007 Prison Based and Reentry Services, under

Criminal Justice Division 6-7 full time staff embedded in prisons

focused on integrated reentry services for SMI and Co-Occurring population

5 community based reentry programs ◦ RICCT in OKC and Tulsa ◦ CCOR in Lawton and Norman ◦ CRICCT in OKC (DOC project)

Opioid State Targeted Response (STR)

Total Served in FY16 by ODMHSAS reentry providers including RICCT, SMART, and CCOR: 128

Total Released from Prison: 10,517 Total with some level of MH, SA, or co-

occurring issue: 72.8% Total served by community based

intentional reentry services: 1.7%

Quick Survey ◦ ODMHSAS Contracted SA/MH provider? Private or

insurance-based provider? Work directly in Criminal Justice system? ◦ Serve the justice involved population, including

directly CJ, specialty Court, diversion, or general provider? ◦ Served clients released from prison?

What has been your experience or challenges in working with the prison reentry population?

Are we serving them intentionally?

Capacity – 1) The maximum amount that something can contain 2) the ability or power to do something

Intentional Reentry Services – Evidence based services with an awareness of and a focus on the unique challenges and needs (including criminogenic) faced by the prison reentry population.

Ultimate goal: Every level of care is engaged in some level of intentional reentry services.

Crime and what we do with those who commit crime involves a range of opinions and solutions.

Criminal Justice Reform is under way nationwide and in Oklahoma.

The criminal justice system as it is today is complex and has an over-representation of individuals with MH and SA issues in prisons.

Individuals discharging detention with unmet substance abuse and criminogenic issues are at greater risk of being involved in crime again.

1. Building a more just justice system is foundational

2. Every part of the system (criminal justice, substance use and mental health, healthcare, community) has an important role to play in building a more just justice system

3. No one should go farther into the justice system than is necessary

Center for Health and Justice

4. Targeting risk, including criminogenic and substance use factors, creates the best chance of reducing the likelihood of contact with the CJ System

5. Metrics (data) are integral to a more just justice system

6. Seek sustainable funding streams by utilizing existing healthcare or CJ systems or seeking new funding opportunities prioritizing sustainability.

Center for Health and Justice

“To achieve better outcomes, policymakers and researchers agree that a shift away from a reliance on incarceration to an emphasis on expanding capacity to supervise and treat individuals in the community is necessary. This shift has focused attention on the importance of cross-system approaches to providing effective criminal justice and behavioral health treatment interventions with the dual goals of reducing recidivism and promoting recovery. A critical component of cross-system work occurs at the transition from jail or prison to the community.”

Guidelines for Successful Transition, GAINS Center

This Presentation will cover:

4 Unique Challenges Common for the Prison Reentry Population

4 Steps to building the Capacity of Behavioral Health to serve the Prison Reentry Population

#1 Greater Risk of Death from Overdose In first 2 weeks of release, former prisoners

have a mortality rate 13 times grater than their matched demographic - 49 deaths per 100,000 compared to 4 per 100,000.

71% due to overdose CCOR has opioid overdose prevention piece OPIOID STR project paired with MAT and

Naloxone Initiatives Is there a plan in place for this high risk

population?

#2 Shortage of Resources Discharge with $50 and a bus ticket At the mercy of transitional housing sector

or a friends/family for housing. No Drivers License (should have SS card and

BS) No food, clothing, or household items Limited or no pro-social peers Family Disruption Supervision and fines

#3 Collateral Consequences The National Inventory of Collateral

Consequences of Conviction (through the National Institute of Justice and Bureau of Justice Assistance)

1229 statutes or restrictions in Oklahoma Interview with Stephen Saltzburg, chair of

the NICCC Advisory Board https://www.youtube.com/watch?v=AqDOjYWDA8Y

&t=36s

#4 Engaging in Mental Health and Substance Abuse Services (not just a motivation issue) Housing and employment stability Probation and other legal requirements Negative perception or experience of

services (stigma, bad experience, distrust) ‘Not to mention’ the nature of trauma and

substance abuse as wall builders

Resources: Guidelines for the Successful Transition of

People with Behavioral Health Disorders from Jail and Prison (SAMHSA’s GAINS Center)

Principles of Drug Abuse Treatment for Criminal Justice Populations (National Institute on Drug Abuse)

Look for training opportunities through ODMHSAS or other sources (Reentry, RNR, EBPs for Justice Involved Population, ORAS).

Contact me: Marcus Ayers mwayers@odmhsas (405)761-1571

STEP 1 Integrate “Offender Risk” into assessment processes and case planning. Risk of what? How do we assess Risk? ◦ LSI-R, ORAS, TCU instruments

Can Risk be Reduced? What behaviors correlate with criminal

behaviors?

STEP 1 Integrate “Risk” The Great Eight ◦ Antisocial Personality Pattern ◦ Procriminal Attitudes ◦ Social Supports for Crime ◦ Substance Abuse ◦ Family/Marital Relationships ◦ Education/Employment ◦ Prosocial Recreational Activities ◦ (non-dynamic factor) History of Criminal Behavior

STEP 1 Integrate “Risk” 1. Formal Criminogenic Risk Assessment

tools should not be used for all clients but only for those who report a history of criminal behavior during the psychosocial evaluation process

2. While criminogenic risk tools include questions that screen for mental or substance use disorders they are not clinical tools and should not be used in the place of standardized clinical tools.

Guidelines for Successful Transition, GAINS Center

STEP 2 Develop collaborative relationships with local criminal justice entities who are involved with clients. Community supervision organizations such

as Probation and Parole. City and County Courts – delay or reduction

in fines? Local Police Department CIT

STEP 2 Develop Collaborative Relationships Develop an information sharing protocol with

criminal justice to clearly establish what information will be shared and under what circumstances.

Include supervision agents as part of the treatment team to strengthen cross-system approaches

Determine if any evidence based collaborative interventions are available and appropriate depending on the individual.

Convene regular meetings both inner agency and collaborative for staffing cases, monitoring the collaboration, and preventing “treater-turned-monitor”

Guidelines for Successful Transition, GAINS Center

STEP 3 Complete a community resource survey compiling resource lists and processes to meet common reentry barriers. Food Pantries Thrift/Clothing Closets IDs and/or Driver’s Licenses Assistance or Linkage to social services: DHS (food

stamps or child custody issues), Social Security Administration (SSI/SSDI)

Healthcare assistance or education for enrolment Education and Employment Resources – local

schools, DRS, CEO, TEEM

STEP 3 Community Resources Build Relationships with Housing Entities! ◦ Survey the community developing a list for

apartments, private landlords, and special housing assistance programs such as COCs and HAs ◦ Sober Living: Oxford House’s Reentry Process ◦ National Alliance for Recovery Residences ◦ FUSE model, Corporation for Supportive Housing

STEP 4 Integrate Evidence Based Practices and some level of formal structured approach to serving the reentry population. EBPs for intervention: ◦ MI, MATRIX, CBT for criminogenic thinking, and

other models integrating co-occurring treatment, mindfulness, harm reduction, and trauma informed care

STEP 2 EBPs EBPs for a structured approach to reentry: ◦ Forensic Assertive Community Treatment (FACT) ◦ Reentry Intensive Care Coordination Team (RICCT) ◦ Critical Time Intervention

Explore your options, just be intentional: ◦ Forensic Health Home ◦ Designated CJ Specialist staff: PRSS or CM, who

can manage the RNR or unique needs of the justice involved population. Can be added to any existing provider level: OP, Residential Care, Hospital, Inpatient Treatment, etc.

Marcus Ayers, MEd, LPC Manger of Prison Based and Reentry Services

(405)761-1571 mwayers@odmhsas.org