Integra(on*of*Behavioral* Health*and*Risk* Assessments*Into*Case* Plans* Na4onal(Reentry(Resource(Center( Behavioral(Health(Training(Summit( August(4,(2015(( New(York,(NY(
Council(of(State(Governments(Jus4ce(Center((|(1(
Presenters* Faye*Taxman,*Ph.D.*
University(Professor,(Criminology,(Law(and(Society(Department(and(Director,( Center(for(Advancing(Correc4onal(Excellence,(George(Mason(University(( (
Debra*A.*Pinals,*M.D.*
Assistant(Commissioner,(Forensic(Services,(MassachuseJs(Department(of( Mental(Health((
Miguel*Avila*
Proba4on(OďŹƒcer,(San(Joaquin(County,(CA(
Council(of(State(Governments(Jus4ce(Center((|(2(
Learning*Objec(ves** • Determine(the(difference(between(criminogenic( and(nonYcriminogenic(needs( • Apply(the(riskYneedYresponsivity(principle(to(case( planning(and(service(delivery( • Discuss(how(to(u4lize(behavioral(health(screening( and(assessment(tools(in(coordina4on(with( criminogenic(risk(assessments( • Iden4fy(trainings(for(staff(to(effec4vely( incorporate(the(riskYneedYresponsivity(and( behavioral(health(principles(in(their(work(
(
Council(of(State(Governments(Jus4ce(Center((|(3(
Faye(S.(Taxman,(Ph.D.( Amy(Murphy,(MPP( (
Center(for(Advancing(Correc4onal( Excellence( Criminology,(Law(and(Society(( George(Mason(University( www.gmuace.org( ]axman@gmu.edu( Council(of(State(Governments(Jus4ce(Center((|(4(
5(
Acknowledgements( • Bureau(of(Jus4ce(Assistance( • BJA:(2009YDGYBXYK026( • BJA:(2010YDGYBXYK026;(SAMHSA:(202171( • Ed(Banks,(Ph.D.( • Thanks(to(my(team( • Amy(Murphy( • Stephanie(Maass( • Brandy(Blasko( • Lincoln(Sloas( • Lauren(Duhaime( Council(of(State(Governments(Jus4ce(Center((|(5(
Andrews & Bonta’s RNR Model Risk(
Needs(
Responsivity* • Priori(ze*Programs* • Tailor***
Recidivism(Reduc4on( Council(of(State(Governments(Jus4ce(Center((|(6(
What To Do & With Whom? Moderate Risk
High Risk Housing
?(
Substance Dependence Family/Marital Dysfunction
?(
Social Supports
?(
Anti-Social Peers Education
Mental Health
Low Risk
?(
?(
Co-Occurring Disorders
?( Financial
Criminal Thinking
?(
Employment
?(
?(
?(
?( Substance Use
?(
Council(of(State(Governments(Jus4ce(Center((|(7(
RNR Hierarchy of Dynamic Needs Criminogenic*Needs*
Destabilizers/Stabilizers**
• Criminal*Thinking* • Substance*Dependence*
• • * • • • •
• An(social*Peers* • Low*SelfNControl/Criminal* Personality* • An(social*Values*
Mental*Health* Substance*Abuse* Employment* Educa(on* Housing* Family*Dysfunc(on*
Together these dynamic factors influence the ideal level of * care under the RNR model 8( Council(of(State(Governments(Jus4ce(Center((|(8(
Side tour: What is Criminal Thinking? • Criminal*Thinking(is(thinking(that(ra4onalizes(and( jus4fies(criminal(and(illegal(behaviors.( • Important(points(about(Criminal*Thinking:( • Criminal*Thinking(is(not(always(connected(to(offending(behavior.(Not( all(ra4onaliza4ons(and(jus4fica4ons(are(criminal(in(nature.( • When(people(are(asked(why(they(did(certain(things,(they(usually( aJribute(the(cause(of(their(behavior(to(what(they(believe(brought( about(the(ac4on.((They(give(a(reason(for(their(behavior.(This(does( not(mean(the(person(is(engaged(in(Criminal*Thinking.( • It(is(“normal”(for(individuals((prosocial(and(an4social)(to(ra4onalize( behaviors(( • An(individual(might(call(out(sick(from(work(without(actually(being(sick,( and(and(ra4onalize(their(behavior(by(telling(themselves(they(deserve(a( day(off.( Council(of(State(Governments(Jus4ce(Center((|(9(
Criminal Lifestyle A(Criminal*Lifestyle(serves(to(jus4fy,(support,(and/or(ra4onalize(criminal( behavior:(Criminal*Family*Members,(Criminal*Peers*and/or*Associates,(Low*SelfNControl,( Criminal*Thinking,(and(Offender(Schemas.(
• Ask(ques4ons(to(determine(whose(opinions(maJer(and(who(he/she( considers(important.(( • These(are(the(most(likely(people(to(have(an(influence(on(the(person( and(affect(behavior.( • When(listening(to(an(offender,(dis4nguish(between(Criminal*Thinking( and(Offender*Schemas.*** • an4social(values(and(beliefs(associated(with(an(Offender*Schema( will(require(more(intensive(treatment(for(a(longer(dura4on.(
Council(of(State(Governments(Jus4ce(Center((|(10(
GED( SUD( Proba4on( OďŹƒcer(
Criminal( Thinking(
Arlotto, Pam. "HITECH's Impact on "Whack-A-Mole" Healthcare. October 16, 2010 Council(of(State(Governments(Jus4ce(Center((|(11(
Challenges to Prioritizing Needs • Many(clients(present(with(mul4ple(dynamic(needsYYsubstance( abuse,(criminal(peers,(lack(of(employment( • Tempta4on(is(to(address(the(“easier”(issues,(such(as( comple4ng(GED,(or(place(clients(in(places(with(available(slots(( • Programming(for(life(skills(is(much(less(expensive(than(drug( treatment(or(criminal(thinking( • Client(preference(may(be(to(focus(on(jobYseeking,(etc.(
Council(of(State(Governments(Jus4ce(Center((|(12(
Decision Rules Points • Risk Level • Defines likelihood of CJ involvement • Functions as a comorbid condition
• Criminogenic Needs • What are the drivers of criminal behavior? • What programs exist to address these needs?
• Clinical Destabilizers • What interferes with change? • What Comorbid conditions exist?
• Lifestyle Destabilizers & Stabilizers • What “recovery” environment exists? • What protective factors exist?
• Factors that affect receptiveness to programming Gender Age Literacy
Motivation Mental Health Housing stability or food insecurity
(
Council(of(State(Governments(Jus4ce(Center((|(13(
Why Responsivity? • • • • •
Increase(mo4va4on(to(change( Increase(relevance(of(programming(to(the(individual( Addresses(factors(that(affect(progress( Humanizes(the(experience—not(one(size(fits(all( Recognize(that(programming(needs(to(be(relevant(and(it(can( be(when( • Gender(( • Age(Appropriate( • Literacy(and(Cogni4ve(Abili4es( • Mental(Health((integrated(care)(
( Council(of(State(Governments(Jus4ce(Center((|(14(
Myth: Severity of Substance Use is Not Related to Recidivism • Substance(dependence(vs.(substance(use/abuse( • Criminal(thinking(is(less(of(a(driver(of(recidivism(for( substance(dependent(individuals((Caudy,(et(al.,(2014)( • More(criminogenic(needs(=(more(need(for(structure( (
• More(need(for(engagement(related(issues( (
• Programs(need(to(be(structured(to(improve(recidivism( rates( (
• Drug(s)(of(choice(maJer!((Harder(drugs(vs(other( substances( Council(of(State(Governments(Jus4ce(Center((|(15(
Clarifying the “Silver Bullet” Myth • Substance(dependence(is(equal(to(criminal(lifestyle/thinking( errors(in(terms(of(affec4ng(recidivism(( • Effec4ve(programs(for(substance(dependence(exist( • CoYmorbid(criminal(thinking(may(be(addressed(through( posi4ve(reinforcers(to(shape(decisions(( • Risk(level(and(unmet(criminogenic(needs(should(drive(who( receives(programming( • Priori4ze(highYneed((both(criminogenic(and(noncriminogenic)( people(for(programming(to(improve(supervision( performance( • Risk(level(can(drive(supervision(level,(but(type/severity(of( criminogenic(need(s)(should(drive(programming( Council(of(State(Governments(Jus4ce(Center((|(16(
What’s wrong with that approach? • Determine(what(is(driving(the(criminal(behavior(and( address(those(drivers( • Employment(and(educa4on(are(not(directly(4ed(to( repeated(criminal(behavior( • Clients(with(more(serious(needs(like(SUD(and( homelessness(may(not(engage(in(voca4onal(classes( or(hold(a(job,(without(addressing(stability(needs(first( • Knowing(the(destabilizers(can(help(determine( intensity(and(addi4onal(supports(needed( Council(of(State(Governments(Jus4ce(Center((|(17(
Myth: Low-Risk Offenders Don’t Need any Services • Fact:(An(offender’s(risk(level(is(INDEPENDENT( of(their(needs( • Risk(level(is(some4mes(a(factor(of(age( • Even(low(risk(offenders(can(have(‘high’(needs((i.e.( SUD,(MH)( • An(offender’s(needs(may(some4mes(override( their(risk(level,(par4cularly(substance(abuse( (
• Example:(LowYrisk(offender(with(cocaine( dependence( Council(of(State(Governments(Jus4ce(Center((|(18(
Myth: All High-Risk Offenders are Criminal Thinkers • Risk(level(is(a(func4on(of(number(of(4mes(in( the(jus4ce(system( ( • HighYrisk(offenders(tend(to(have(more(needs,( and(tend(to(be(more(entangled(in(criminal( lifestyle( ( • But(some4mes(they(can(be(SUD,(and( therefore(this(needs(to(be(assessed( Council(of(State(Governments(Jus4ce(Center((|(19(
Myth: Non-Criminogenic Needs are Not Important • Fact:(NonYCriminogenic(needs(act(as(destabilizers( and(can(impact(how(well(a(person(responds(to( treatment(and(supervision( • Evidence(is(mixed(regarding(the(impact(of(needs( such(as(educa4on(and(employment( • Not(the(“star”(of(the(case(plan,(but(should(play(a( suppor4ng(role( • Match(to(treatment(based(on(criminogenic(needs,( then(refer(to(services(to(build(stabilizers(
Council(of(State(Governments(Jus4ce(Center((|(20(
Hierarchy of Dynamic Needs Criminogenic*Needs* • Criminal*Thinking* • Substance*Dependence* • An(social*Peers* • Low*SelfNControl/Criminal* Personality* • An(social*Values*
Destabilizers/Stabilizers** • • * • • • •
Mental*Health* Substance*Abuse* Employment* Educa(on* Housing* Family*Dysfunc(on*
Together these dynamic factors influence the ideal level of * care under the RNR model Council(of(State(Governments(Jus4ce(Center((|(21(
Program Groups • Six(program(groups(based(on(specific(target(behaviors( RISK(Levels(((Needs((((Stabilizing(Factors(
Council(of(State(Governments(Jus4ce(Center((|(22(
PROGRAM*GROUP*
MECHANISM*OF*ACTION*
RESEARCH*EVIDENCE*
Group*A*** Severe*Substance* Use/Dependence*
Treatments(to(reduce(use(of( heroin,(cocaine,(amphetamines,( and(methamphetamine(
Holloway,(BenneJ,(&(Farrington,( 2006;(Prendergast,(Huang,(&(Hser,( 2008;(Prendergast,(Podus,(Chang(&( Urada,(2002;(Lipton,(Pearson,(Cleland( &(Yee,(2008;(Mitchell,(Wilson(&( MacKenzie,(2007(
Group*B** Criminal*Thinking*
Cogni4ve(restructuring(to(change( maladap4ve(thinking(and(behavior( paJerns(
Andrews(&(Bonta,(2010;(Lipsey,( Landenberger(&(Wilson,(2007;(Wilson,( Bouffard(&(MacKenzie,(2005;(LiJle,( 2005;(Tong(&(Farrington,(2006(&(2008(
Group*C(( Self;Improvement* and*Management* (abuse)*
Developing(social(and(problem( solving(skills(to(address(MH,(SA,( and(selfYcontrol.(
Botvin(&(Wills,(1984;(Botvin,(Griffin,(&( Nichols,(2006;(Mar4n,(Dorken,( Wamboldt(&(WooJen,(2011((
Group*D(( Social*and* Interpersonal*Skills*
Structured(counseling(and( modeling(of(behavior(to(reduce( interpersonal(conflict(and(develop( more(posi4ve(interac4ons.((
Botvin(&(Wills,(1984;(Beckmeyer,( 2006;(Wilson,(Gallagher(&(MacKenzie,( 2000;((Visher,(Winterfield(&( Coggeshall,(2005(
Group*E** Life*Skills*
Stabilize(educa4on,(housing,( employment,(and(financial(
Andrews(&(Bonta,(2010;(Beckmeyer,( 2006((
23(
Council(of(State(Governments(Jus4ce(Center((|(23(
The most serious criminogenic need should be addressed first Program(Group(A(
Severe(Substance(Use(Disorder(
Program(Group(B(
Criminal(Thinking/Cogni4ve( Restructuring(
Program(Group(C(
SelfYImprovement(&(SelfYManagement( (Abuse,(MH)(
Program(Group(D(
Social(and(Interpersonal(Skills(
Program(Group(E(
Life(Skills(
Program(Group(F(
Punishment(
Council(of(State(Governments(Jus4ce(Center((|(24(
Step Up/Down Depending on Responsivity Factors Program(Group(A(
Severe(Substance(Use(Disorder(
Program(Group(B(
Criminal(Thinking/Cogni4ve( Restructuring(
Program(Group(C(
SelfYImprovement(&(SelfYManagement( (Abuse,(MH)(
Program(Group(D(
Social(and(Interpersonal(Skills(
Program(Group(E( Program(Group(F(
Life(Skills( Punishment(
Council(of(State(Governments(Jus4ce(Center((|(25(
Intensify Dosage & Program Structure from Key Lifestyle Issues (
Program Intensity
! Anti-social Peers ! Social Support/Lack of Social Supports ! Housing Instability • Education Level • Employment Status • Mental Health • Financial Issues (
Council(of(State(Governments(Jus4ce(Center((|(26(
No Whack a Mole: Decision Rules Severe Substance Use Disorder? " Always Group A! Criminal Thinking? " Schemas, regardless of risk—Always Group B " Criminal Thinking (elevate), moderate to high risk, destabilizers—Group B Intensity Programming with….. " Housing Instability " Lack social supports (prosocial) " Criminal Schemas Council(of(State(Governments(Jus4ce(Center((|(27(
28(
Council(of(State(Governments(Jus4ce(Center((|(28(
29(
Does your system have the correct programs for the offenders • Iden4fies(gaps(and(surpluses(of(programming( • U4lizes(The(RNR(Program(Tool( ( • Guides(resource(alloca4on(and(system(planning( • BeJer(alignment(of(services(to(popula4on(needs( • Facilitates(selec4on(of(providers( ( • Focus(on(systemYwide(change(
(
Council(of(State(Governments(Jus4ce(Center((|(29(
30(
Group A
Group B
Group C
Group D
Group E
Group F
Council(of(State(Governments(Jus4ce(Center((|(30(
APD Estimated Responsivity Gap
31(
• Greatest(unfulfilled(needs(are(cogni4ve(restructuring( programs,(mental(health,(coYoccurring(disorders,( and(substance(abuse( Council(of(State(Governments(Jus4ce(Center((|(31(
Sequencing(of(Needs(for(Comorbid(Clients(( Core+MH +Social Skills
Core+MH
Core (high)
Core(med) 0
20
40
Criml Thinking
60
80
SUD Council(of(State(Governments(Jus4ce(Center((|(32(
DOC Population Needs & Recidivism Rates (n=2844) 30% 25% 20% 15% 10% 5% 0%
High Dosage
Moderate Dosage
33( Council(of(State(Governments(Jus4ce(Center((|(33(
Probation Population Needs & Recidivism Rates (n=1000) 25% 20% 15% 10% 5% 0%
High Dosage
Moderate Dosage
34( Council(of(State(Governments(Jus4ce(Center((|(34(
35( Council(of(State(Governments(Jus4ce(Center((|(35(
Responding to Risk and Needs How(well(do( the(programs( adhere(to( EBPs?(
How(well(does(my(system(address(riskY needs(of(oenders?(
What(type(of(risk/needs(does(a(par4cular(( Person(need?( Council(of(State(Governments(Jus4ce(Center((|(36(
( www.gmuace.org/tools(
Council(of(State(Governments(Jus4ce(Center((|(37(
Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking- Integrated Re-entry and Peer Support (MISSION-I-RAPS) Debra(A.(Pinals,(M.D.(( Assistant(Commissioner(Forensic(Services( MassachuseJs(Department(of(Mental(Health( Debra.pinals@massmail.state.ma.us( David(Smelson,(Psy.D.( Stephanie(Hartwell,(Ph.D.( Lena(Campana,(M.A.( Jay(Byron,(M.A.( Ayorkor(Gaba,(Psy.D.(
Grant&#&2013,RW,BX,0003:*Funded*By*the*Department*of*Jus(ce*Second*Chance*Act*Targe(ng*Oenders*with*CoN Occurring*Substance*use*and*Mental*Health*ProBlemsNNAwarded*to*the*MassachuseVs*Department*of*Mental* Health*in*collabora(on*with*Depts*of*Correc(on*and*Public*Health,*Umass*Medical*School,*Umass*Boston,* MassachuseVs*Proba(on,*Parole,*MassHealth,*and*Span,*Inc.*
(
Council(of(State(Governments(Jus4ce(Center((|(38(
MISSION Criminal Justice Edition: Understanding the Criminal Justice Sequential Intercept Framework
Clinical Evaluation and Treatment of Substance Use
39
Council(of(State(Governments(Jus4ce(Center((|(39(
Criminogenic*Risk*Factors:* The*Risk5Need5Responsivity*Paradigm*and*Sup Risk*Factor** History(of(an4social(behavior( An4social(personality(paJern( An4social(cogni4on( An4social(aytudes( Family(and/or(marital(discord( Poor(school(and/or(work(performance( Few(leisure(or(recrea4on(ac4vi4es(
Substance*abuse* Adapted(from(Council(of(State( Governments(Jus4ce(Center(
Source: Andrews (2006) Council(of(State(Governments(Jus4ce(Center((|(40(
MISSION is TRAUMA INFORMED Adverse Childhood Events Data for Youth Referred to Massachusetts Juvenile Court Clinics •
Six(Month(Data(10/2/12Y3/31/13(Findings:( Median*Score*
CDC*Study*of*General* Popula(on*
JCC*Referred*Youth*
1*
5*
• (ACES(data(scores(1Y10)(
•
63%(had(scores(of(4(or(more((compared(with(12.5%(in(the(CDC( sample)( Short(and(longYterm(outcomes:(health(and(social(difficul4es(
•
(Source:(MassachuseJs(Alliance(of(Juvenile(Court(Clinics(data(report(2013)(
•
Council(of(State(Governments(Jus4ce(Center((|(41(
Creating Cross-System Collaboration What(Works(in( Mental(Health( Treatment( What(Works(in( Substance(Abuse( Treatment(
What(Works(in( Recidivism( Reduc4on( MISSION(CJ( Framework(
Council(of(State(Governments(Jus4ce( Center;(Osher(2013( Council(of(State(Governments(Jus4ce(Center((|(42(
MISSION: Criminal Justice Edition Systems*Level*(Sequen(al*Intercept*Model)* Reduce*penetra(on*of*persons* Iden4fy(and(Link(individuals(to( with*mental*illness*into*CJ* communityYbased(mental(health( system/Reduce*recidivism ** treatment( * (
Assessment*Level*(RNR) Match*level*of*treatment*to*the* Iden4fy(criminogenic(needs(and( level*of*risk*to*reNoend* use(these(to(inform(treatment( * (
Interven(on/Person*Level*(MISSIONNCJ) Provide*direct*treatment* Addi4onal(focus(on(criminogenic( services*to*address*coNoccurring* needs(and(responsivity(to(reduce( disorders*with*traumaNinformed* recidivism( approaches*that*support* ( recovery** *
Improve(mental(health(outcomes( (
Improve(public(safety( (
Maximize(engagement(by(understanding(responsivity(of(the( individual(to(treatment(interven4ons(and(the(ability(of( providers(to(address(the(risk(factors(iden4ďŹ ed( (
Promote(stable(and(successful(living( with(posi4ve(daily(ac4vi4es(and( health(and(wellness,(with(explicit( aJen4on(to(the(addi4onal(goal(of( decreased(recidivism( (
Coordinate(care,( access(to(housing,( employment(supports( and(other(services(as( needed( (
Council(of(State(Governments(Jus4ce(Center((|(43(
MISSIONNCJ:*Overview*of*the* Treatment*Model** • Goal*(s):((((
• Provide(wraparound(support(for(mental(health(and( substance(use(( • Help(clients(avoid(further(arrests(and(reincarcera4on( (
• Engagement*Strategies:(
• Asser4ve(Community(Outreach((Peer(and(Case( Manager/Reentry(service(specialist)( • Skills(development(
( • Care*Coordina(on*with*Reentry*Services:* • Facilitate(treatment(plans( • Case(Manager/Peer(link(to(court(
44
Council(of(State(Governments(Jus4ce(Center((|(44(
MISSIONNCJ*Model* Combining&evidence,based&services&into&a&comprehensive& system&of&care&(
Core*Services( Cri(cal*Time*Interven(on* (CTI)** Dual*Recovery*Therapy* (DRT)*
RiskNNeedN Responsivity*(RNR)(
Support*Services( Voca(onal*and* Educa(onal*Support* Trauma*Informed*Care*
Peer*Support*
45
Council(of(State(Governments(Jus4ce(Center((|(45(
Educa4onal(and( Voca4onal(Support(
Housing(
Case Management and Peer Support
General(Medical(Care(
BeneďŹ ts(
Mental(Health( Services(
Substance(Abuse( Treatment(
Criminal(Jus4ce( Council(of(State(Governments(Jus4ce(Center((|(46(
MISSION*Key*Clinical/Social* Outcomes*
Increase( community( tenure( (
Reduce(( reYhospitaliza4ons( (
Improve(psychiatric( Increase(the(number( and(substance(abuse( of(days(employed(and( outcomes( wages(earned( ( (
YSmelson,((et(al.((2005).(Preliminary(outcomes(from(a(community(linkage(interven4on(for(individuals(with(coY occurring(substance(abuse(and(serious(mental(illness.(Journal(of(Dual(Diagnosis,(3(1),(47Y59.(( YSmelson,(et(al,((2007).(Six(month(outcomes(from(a(booster(case(management(program(for(individuals(with(a(coY occurring((substance(abuse(and(a(persistent(psychiatric(disorder.(European(Journal(of(Psychiatry,(21,(143Y152.( YSmelson,((et(al,((2012).(A(Brief(Treatment(Engagement(Interven4on(for(Individuals(with(CoYoccurring(Mental( Illness(and(Substance(Use(Disorders:(Results(of(a(Randomized(Clinical(Trial.(Community(Mental(Health(Journal,( 48(2),(127Y132.(( YSmelson,((et(al,((2013).(A(Wraparound(Treatment(Engagement(Interven4on(for(Homeless(Veterans(with(CoY occurring(Disorders.(Psychological*Services,*10(2),(161Y7.(
47
Council(of(State(Governments(Jus4ce(Center((|(47(
SAMPLE'PRIOR'MISSION'PROJECTS Model*Development*(1999N2005)*PI*David* Smelson*Supported(by(VA(OPCS/VISN(3(MIRECC(
Components:&Model(Development,(Pilot(Tes4ng(( SeBng:&Acute(psychiatry/inpa4ent(treatment(program((
Brief*2Nmonth*Interven(on*(2005N2009)**PI*David* Smelson*Supported(by(VA(HSR&D(*
Components:&Cri4cal(Time(Interven4on((CTI),(Dual(Recovery(Therapy((DRT),(and(Peer(Support.((( SeBng:&Acute(psychiatry/inpa4ent(treatment(program((
MISSION*NJ*(2004N2010)**PI*David*Smelson* Supported(by(SAMHSA(
Components:&CTI,(DRT,(Peer(Support,(and(Voca4onal(Support;(Treatment&Length:(12(months( SeBng:&Residen4al(treatment(program((
MISSIONNVET*Model*Development*(2010)**PI* David*Smelson*Supported(by(VA(ORD/HSR&D/ Na4onal(Center(for(Homeless(Veterans*
Components:(CTI,(DRT,(Peer(Support,(Voca4onal/Educa4onal(Supports,(and(TraumaYInformed(Care(Considera4ons(( Treatment&Length:&2(months,(6(months,(or(12(months(((( SeBng:&(Inpa4ent(treatment(program,(residen4al(treatment(program,(or((once(placed(in(housing((
MISSION*CREW*(2009N2011)**PI*Debra*Pinals* Supported(by(the(Bureau(of(Jus4ce(Assistance( (BJA)(((
Components:*Dual(Recovery(Therapy,(Cri4cal(Time(Interven4on,(and(Voca4onal(Support(with(traumaYsensi4ve( contribu4ons;(Treatment&Length:&3(months(preYrelease(and(6(months(postYrelease( Target&PopulaHon:**female(offenders(with(coYoccurring(substance(abuse(and(mental(health(disorders(who(commiJed( a(nonYviolent(offense(
MISSION*Jail*Diversion*Project*(2008N2013)**PI* Debra*Pinals*Supported(by((SAMHSAYCMHS.((&
Treatment&Length:&12(months(((treatment(begins(a]er(adjudica4on)( Target&PopulaHon:((returning(OIF/OEF(Dually(Diagnosed(Veterans(with(a(Trauma(History(who(have(been(diverted(from( jail(and(selected(by(judge(to(receive(treatment(rather(than(serve(jail(4me(
CURRENT'MISSION'PROJECTS HUDNVASH*Randomized*Controlled*Trial** (2011N2013)**PI*David*Smelson*Supported(by(VA( Na4onal(Center(for(Homeless(Veterans*
Components:((In(addi4on(to(standard(HUDYVASH(Case(Management,(for(6(months,(par4cipa4ng(Veterans(will(receive(( either(MISSIONYVET,(Telephone(Counseling(or((symptom(monitoring(via(telephone;(Treatment&Length:(6(months(( SeBng:((Formerly(homeless,(dually(diagnosed((Veterans(who(have(received(housing(placements(through(HUDYVA( Suppor4ve(Housing(Program(
MISSIONNVet*Implementa(on*Study*(2011N2014)*** PI*David*Smelson* Supported(by(VA(ORD/HSR&D/Na4onal(Center(on( Homelessness(Among(Veterans((*
Components:&Compare(Implementa4on(as(Usual(to(Geyng(To(Outcomes((GTO)(to(determine(the(most(effec4ve(( implementa4on(strategy(for(the(MISSIONYVet(Interven4on(within(VA(Homeless(Services( SeBng:&Formerly(homeless,(dually(diagnosed((Veterans(who(have(received(housing(placements(through(HUDYVA( Suppor4ve(Housing(Program(in(Boston,(MA,(Washington(D.C.,(and(Denver,(CO.&
MASSNMISSION:*Ending*Chronic*Homelessness*in* Central*and*Western*MA(2011N2014)*PI*David* Smelson*Supported(by(SAMHSAYCABHI(
Components:(Housing(Placement,(CTI,(DRT,(Peer(Support,(TraumaYInformed(Care,(Voca4onal(and(Educa4onal(Support( Treatment&Length:&12(months(( SeBng:*Place(chronically(homeless(individuals(in(permanent(housing(and(receive(case(management(and(peer(support( services(for(coYoccurring(disorders&
MISSION*IRAPS*(2013N2015)**PI*Debra*Pinals* Supported(by(the(DOJ(Second(Chance(Act(
Treatment&Length:(3(months(preYrelease(and(6(months(postYrelease( Target&PopulaHon:((mediumY(and(highYrisk(female(and(male(offenders(with(coYoccurring(substance(abuse(and(mental( health(disorders((may(have(commiJed(a(violent(or(nonYviolent(offense)( Council(of(State(Governments(Jus4ce(Center((|(48( Components:(Dual(Recovery(Therapy,(Cri4cal(Time(Interven4on,(and(Voca4onal(Support(with(traumaYsensi4ve(
Adapting MISSION to Reentry Services Grant*
Funding*Source*
Target* Popula(on*
Risk*Level*
MISSIONYCREW((Community( Reentry(for(Women)( 2009Y2011(
DOJ/JMHCP( Female( 2009YMOYBXY0037( Offenders;( CODs(and( Trauma(
NonYviolent(
MISSIONYRAPS( (Reentry(and(Peer(Support);( 2011Y2013(
DOJ/SCA( Female( 2011YRWYBXY0010( Offenders(
Medium(and( High(Risk(
MISSIONYIRAPS( DOJ/SCA( Male(&( (Integrated(Reentry(and(Peer( 2013YRWYBXY0003( Female( Support);(2013Y2015( Offenders;( CODs(and( Trauma(
Medium(and( High(Risk(
Council(of(State(Governments(Jus4ce(Center((|(49(
MISSION*Implementa(on*Materials* • Treatment Manual • Participant Workbook Additional Resources: • Fidelity Measure • Measure that tracks the integration of the complex service structure • Consultation conducted during projects 50
Council(of(State(Governments(Jus4ce(Center((|(50(
MISSION(IRAPS((MYIRAPS)(FLOW(CHART( Iden(fy*Eligible*Inmates* Rule(out(outYofYarea( releases(and(others(who( don’t(fulfill(eligibility(criteria( 45(days(to(6(months(prior(to( release(
Individual*Released*from* DOC*facility*
Approach*Inmate*Re:* Interest*in*Program* Arrange(Screening(if(interested(in( Program( DOC(staff(member(obtains(release( to(send(research(team( informa4on( 45(Days(to(6(Months(Prior(to( Release(
Evalua(on*Referral* RSS(sends(RA(contact( informa4on((
MNRAPS*Eligibility*Screening** 45(Days(to(6(Months(prior(to( release(
(1(month(prior(to(release)(
Evalua(on*Consent* Evalua4on(team(consents( interested(par4cipants(to( evalua4on,(second(release( obtained((for(Span(records)( Up(to(1(week(from(par4cipants’( ini4al(mee4ng(with(RA(
(
MNRAPS*Services* Con4nues(upon(release(and( is(ongoing(for(4Y5(months(
6th*Month*Follow*Up* Assessment* (Only(for(those(consen4ng( to(Evalua4on)(
MNRAPS*Services* Commence* RSS*(and(PSS**(meet(with( inmate(in(preYrelease( groups(
Baseline*Assessment* Conducted(at(same(4me( period(as(evalua4on( consent,(if(possible;( otherwise,(rescheduled(for(a( later(date/4me( (Only(for(those(Consen4ng( to(Evalua4on)(
Addi(onal*followNup*data* collec(on* (Only(for(those(consen4ng( to(Evalua4on)( Up(to(a(year(and(a(half(a]er(( followYup(assessment(
*RSS(=(ReYentry(Services(Specialist(or(MYRAPS(Clinical(Case(Manager( **PSS(=(Peer(Services(Specialist(or(MYRAPS(Peer(Support(Specialist(
Council(of(State(Governments(Jus4ce(Center((|(51(
CRIMINOGENIC RISKS, NEEDS AND SAMPLE TREATMENT PLANNING Criminogenic*Risks* An4social(Behaviors(
Needs* Reduce(an4social(acts((
Poten(al*Approaches/Enhance*Responsivity* Educa4on,(frequent(contact(with(case(manager/ peer,(strong(communica4on(between(provider( and(proba4on/parole(
An4social(Personality( PaJerns(
Decrease(impulsivity,(irritability,( Stress(management(exercises,(problemYsolving( irresponsibility,(help(coping,(problemY exercises,(trauma(informed(care((TIC)( solving(
An4social(Cogni4ons(
Decrease(an4social(cogni4ons,(risk( thinking(
An4social(Peers(
Decrease(associa4on(with(other( Peer(supports,(ac4vi4es(that(allow(for(prosocial( criminals,(enhance(prosocial(contacts( associa4ons((e.g.(volunteering,(community( service),(fostering(hope(and(posi4ve(connec4ons(
Referral(to(EBPs(such(as(MRT,(Thinking(for(a( Change,(etc.(
Family/marital(rela4onships( Improve(rela4onships(with(family(and( Treat(symptoms(of(mental(illness,(Help(examine( signiďŹ cant(others(when(possible( broken(4es(and(how(to(rebuild,(TIC,(factor(in( criminal(issues((e.g.,(DV)( Employment/Educa4on(
Assist(in(enhancing(employment/ academic(skills(and(achieving(goals(
Iden4fy(housing,(treat(mental(illness,(Voca4onal( skills(linkages,(employment(supports,(rewards(for( posi4ve(achievement(
Leisure(and(recrea4on(
Increase(4me(in(prosocial(ac4vi4es(
Iden4fy(schedules,(ac4vi4es,(community(service(
Substance(abuse(
Decrease(substance(use,(enhance( mo4va4on(for(change(
Ac4ve(treatment((not(just(detox),(monitoring(as( needed,(plan(for(relapses,(treat(coYoccurring( mental(illness( Council(of(State(Governments(Jus4ce(Center((|(52(
Recovery a process of change through which individuals improve their health and wellness, live a selfdirected life, and strive to reach their full potential
(SAMHSA 2014)
E.G.,*Symptom*ResoluNon,*Sobriety,*Reduced* Recidivism,*Social*Connectedness,* Employment,*EducaNon,*Independent*Living,* Self;Reliance* 53
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• Guidance(on(Treatment(Needs((specialized(PTSD)(( • How(to(Coordinate(Care(with(PTSD(Service( • Discharge(Planning( • Clinical(Tools(for(Trauma(Symptoms( • Develop(plan(for(increased(safety( • Establish(both(perceived(and(real(trust( • Provide(psychoeduca4on(about(trauma(and(substance(abuse( • Teach(coping(skills(to(control(trauma(symptoms( * Najavits*&*CoRler*(In*Press)( * 54 * Council(of(State(Governments(Jus4ce(Center((|(54(
IRAPS Evaluation: Baseline Demographics (N=31) *Age*
Race/Ethnicity*
Educa(onal*AVainment*
Marital*Status*
Council(of(State(Governments(Jus4ce(Center((|(55(
Baseline Data for MISSION IRAPS Clients (N=31) • • • •
Average(number(of(life4me(arrests(=21( Average(Drug(use(in(past(30(days=(13.17( Years(of(substance(use(in(the(histories( Compas(scores(show(anger/hos4lity,(rela4onship( dysfunc4on,(and(criminal(thinking(among(other( paJerns(
Council(of(State(Governments(Jus4ce(Center((|(56(
IRAPS, RAPS, and CREW Sample: Baseline • 62Y75%(have(chronic(medical(problems(which( con4nue(to(interfere(with(life( • 55Y74%(have(been(troubled(by(psychological(or( emo4onal(problems(in(past(30(days(( • 45Y80%(repor4ng(trauma4c(symptoms(and/or( trauma(exposure(to(par4cular(events,(o]en(both( recently(and(before(age(18( (
Council(of(State(Governments(Jus4ce(Center((|(57(
RAPS Significant Findings • From(Baseline(to(6(Month(
• Managing(Day(to(Day(Life((.004)( • Coping(with(Problems(in(Life((.048)( • Less(Trauma(
• Witnessing(serious(injury,(death,(or(physical/sexual( assault((.000)( • Physical(Violence((.004)( • Sexual(Violence((.000)(
• Having(Problems(from(Drinking(or(Drug(Use((.016)( • Past(30(days( • Alcohol(Use((.000)( • Methadone(Use((.000)( • Cannabis(Use((.000)(
Council(of(State(Governments(Jus4ce(Center((|(58(
RAPS Clinical/Social Initial Outcome Evaluation 6*Month* Baseline* • Geyng(along(well(with(family( • Geyng(along(well(with( most(of(the(4me((50%)( family(most(of(the(4me( (28%)( • Have(someone(to(turn(to(for( help(all(of(the(4me((50%)( • Have(someone(to(turn(to(for( help(all(of(the(4me((37%)(
Council(of(State(Governments(Jus4ce(Center((|(59(
Conclusions • Popula4on(with(complex(need,(but(poten4ally(improved(outcomes( • • • •
Criminogenic( Psychosocial( Trauma( Drug(Use(
• Early(recidivism(data(shows(variable(reYarrest(but(likely(reduced( reincarcera4on.(Majority(of(par4cipants(successfully(complete(6( month(postYrelease(services.((( • Parole/Proba4on(intensive(surveillance(because(of(program( enrollment,(possibly(higher(likelihood(to(violate.( • MISSIONYCJ(holds(promise( • Helps(behavioral(health(providers(work(more(closely(with(criminal( jus4ce(en44es( • Ongoing(learning(lessons(con4nue(
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TYGR Transi4onYage(Youth(Grounds(for( Recovery(
Council(of(State(Governments(Jus4ce(Center((|(61(
TYGR Overview • A(collabora4ve(program(between(the(San( Joaquin(County(Sheriff’s(Department,(San( Joaquin(County(Behavioral(Health(Services( and(San(Joaquin(County(Proba4on( • The(program(provides(pre(and(post(release( services(to(young(adults(18Y25(with(coY occuring(disorders(sentences(to(at(least(120( days(and(a(3Y5(year(formal(proba4on(grant( ( (
Council(of(State(Governments(Jus4ce(Center((|(62(
TYGR (Phase 1) • Program(is(currently(voluntary(for(all( offenders( • Offender(starts(program(while(in(custody(a]er( sentencing(( • Offenders(receive(evidence(based(screening( and(assessments( • K6(mental(health(screening(tool( • Criminogenic(risk(assessment((STRONG)(
( Council(of(State(Governments(Jus4ce(Center((|(63(
TYGR (Phase 2) • Intensive(family(based(reYentry(transi4on( planning(and(cogni4ve(behavioral(therapy( while(in(custody( • Offenders(par4cipate(in(and(complete(Seeking( Safety(and(CBI(for(substance(abuse( • AJempt(to(get(buy(in(from(offenders(family(to( establish(a(solid(founda4on(upon(release( 9Y12(month(program(dura4on(
Council(of(State(Governments(Jus4ce(Center((|(64(
TYGR Correction Officer Capacity Building • All(Correc4on(officers(who(work(with(TYGR( clients(are(specially(trained(in( • Mo4va4onal(Interviewing( • K6(screen(for(mental(health(disorders( • Crisis(Interven4on(Training((CIT)(for(law( enforcement( • An(all(staff(adapta4on(to(understand(Seeking( Safety(as(an(evidence(based(approach(
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TYGR Clinician • TYGR(has(a(dedicated(clinician(trained(in(duel( disorders(to(conduct(assessments( • Will(facilitate(groups(both(in(custody(and(out( of(custody(to(build(raport( • Previously(only(one(clinician(was(available(for( the(en4re(jail(facility(
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TYGR Probation Officer • One(dedicated(officer(to(the(TYGR(program( who(is(also(trained(in( (( • Mo4va4onal(Interviewing( • Evidence(Based(theory( • Crisis(Interven4on(Training((CIT)(for(law( enforcement(
Council(of(State(Governments(Jus4ce(Center((|(67(
TYGR Treatment/Case Plan Collaboration
( The(dedicated(TYGR(Clinician(and(Proba4on(Officer(will( conduct(the(assessments(of(the(individual(offender(as(a( team( (Y(STRONG(Assessment( (Y(Addic4on(Severity(Index( (Y(Mental(Health(Services(Adult(Assessment( ( (This(is(done(so(that(both(staff(have(the(same(informa4on( from(the(offender,(it(allows(for(beJer(collabora4on(and( treatment(integra4on( (( ( Council(of(State(Governments(Jus4ce(Center((|(68(
TYGR Treatment/Case Plan Collaboration
• BHS(treatment(and(Proba4on(case(plans(do( not(always(align( (Y(The(targeted(interven4ons(may(be(different( due(to(the(difference(in(what(the(agencies(are( targe4ng((reYoffend(vs(MH(treatment)( (Due(to(this(all(technical(viola4ons(of(proba4on( are(discussed(with(the(TYGR(clinician(and(a( decisions(and(recommenda4ons(are(made(as( a(team.(( Council(of(State(Governments(Jus4ce(Center((|(69(
TYGR Treatment/Case Plan Collaboration • In(dealing(with(these(offenders(it(is(important( to(understand(that(some(of(the(decisions(that( the(offender(makes(may(not(necessarily(be( controlled(by(them( • (Due(to(MH(status( • Drug(induced(psychosis(which(is(a(result(of(self( medica4ng.((
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TYGR Treatment/Case Plan Collaboration
• It(is(integral(that(both(the(Clinician(and(the( Proba4on(officer(work(in(close(collabora4on( for(the(beJer(of(the(offender.((Geyng(as( much(informa4on(as(possible(from(both(the( Proba4on(and(BHS(side(are(integral(and(will( allow(both(staff(to(target(the(treatment(goals(( and(case(plan(goals(simultaneously(
Council(of(State(Governments(Jus4ce(Center((|(71(
TYGR Results • During(the(first(grant(the(program(was(able(to( reduce(recidivism(on(this(target(popula4on(by( approximately(70(percent(6(months(a]er( comple4ng(the(program((pending(latest( numbers(regarding(recidivism(a]er(2(years)( • Incidents(against(staff(in(the(correc4onal( ins4tu4on(were(reduced(by(80(percent( • Has(helped(Correc4ons(administra4on(provide( MI(to(all(its(officers(in(the(ins4tu4on(( Council(of(State(Governments(Jus4ce(Center((|(72(
Thank*You* Join(our(distribu4on(list(to(receive(( CSG(Jus4ce(Center(project(updates!( www.csgjus4cecenter.org/subscribe( (www.na4onalreentryresourcecenter.org((
The presentation was developed by members of the Council of State Governments Justice Center staff. The statements made reflect the views of the authors, and should not be considered the official position of the Justice Center, the members of the Council of State Governments, or the funding agency supporting the work. Citations available for statistics presented in preceding slides available on CSG Justice Center web site. Council(of(State(Governments(Jus4ce(Center((|(73(