Planning & Implementation Guide Justice and Mental Health Collaboration Program Category 1: Collaborative County Approaches to Reducing the Prevalence of Individuals with Mental Disorders in Jail
DESCRIPTION This Planning & Implementation Guide is intended for recipients of Justice and Mental Health Collaboration Program (JMHCP) grants administered by the U.S. Department of Justice’s Bureau of Justice Assistance. JMHCP grantees will complete this guide in partnership with a technical assistance provider from The Council of State Governments Justice Center.
The Council of State Governments Justice Center prepared this guide with support from the U.S. Department of Justice’s Bureau of Justice Assistance (BJA). The contents of this document do not necessarily reflect the official position or policies of the U.S. Department of Justice.
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About the Planning & Implementation Guide The Council of State Governments (CSG) Justice Center has prepared this Planning & Implementation Guide (P&I Guide) to support grantees in developing and refining their initiative. The guide is intended for the state, local, or tribal government agencies that have received JMHCP grants to plan initiatives and programs serving adult populations. This guide is not intended to serve as a step-by-step blueprint, but rather to foster discussion on best practices, identify considerations for your collaborative effort, and help you work through key decisions and implementation considerations. Although the guide was developed as a tool for grantees, it also serves as an important tool for your CSG Justice Center technical assistance provider (“TA provider”) to understand the status and progress of your project, the types of challenges you are encountering, and the ways your TA provider might be helpful to you in making your project successful. Your TA Provider will use your responses to the self-assessment to work with you to develop priorities for technical assistance. Any questions about this guide should be directed to your TA provider. Contents of the Guide This guide is divided into seven sections that include a variety of exercises aimed at helping guide your county’s system planning process. You will be prompted to write short responses, attach relevant documents, and answer yes or no questions. Your answers will provide insight into your initiative’s strengths and identify areas for improvement. As you work through the sections, take note of the supporting resources in the appendix. Your TA provider may also send you additional information on relevant topics to complement certain sections. If you need additional information or resources on a topic, please reach out to your TA provider.
TA Provider Contact Information Name: Phone: Email:
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Contents Section 1: Getting Started and Identifying Goals Exercise 1: Initiative Snapshot A. Grantee Information B. Grant Initiative Updates and Information Section 2: Collaborative Planning Team Exercise 2: Developing Your Collaborative Planning Team Section 3: Jail Identification Process and Data Collection Exercise 3: Jail Identification Process and the Determination of Prevalence Rates and Risk Levels A. Local Definition of Mental Illness B. Jail Identification Process for Mental Illness C. Local Definition of Substance Use Disorder D. Jail Identification Process for Co-occurring Substance Use Disorder Information E. Local Definition of Recidivism F. Risk and Needs Identification Process G. Connection to Community Supervision H. Connection to Community-Based Services Exercise 4: Expanding Screening and Assessment Section 4: County System Analysis Exercise 5: System Mapping, Process Analysis, and Identifying Gaps A. System Mapping by Intercept Points B. System Mapping by Key Outcomes C. Addressing Gaps in the System Section 5: Data-Driven Findings Exercise 6: Measuring Outcomes Exercise 7: Collecting Data and Key Findings A. Tracking Sub-measures of the Four Key Outcomes B. Key Findings Section 6: Strategic Plan Exercise 8: Planning and Prioritizing Section 7: Evaluation and Sustainability Exercise 9: Tracking Progress A. Using Data to Track Progress B. Other Sustainability Strategies C. Tracking Progress from Start to Finish Appendix A: Supporting Resources Appendix B: Flow of Defendants through a County System
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SECTION 1: GETTING STARTED AND IDENTIFYING GOALS Your TA provider has read the project narrative that you submitted in response to the JMHCP solicitation, but there may have been updates or developments since you submitted your original application. This exercise is intended to give your TA provider a sense of your current project goals and your initial technical assistance needs. Please provide the following documents, if available, to your TA provider at your earliest convenience: ☐ Memoranda of understanding (MOUs) and ☐ Letters of support information-sharing agreements ☐ Current strategic plan ☐ Staffing and budgeting information ☐ County organizational and hierarchical ☐ Additional planning materials charts
EXERCISE 1: INITIATIVE SNAPSHOT A. Grantee Information Please complete the chart below. A. Grantee Information Grantee Name and Award Number: Geographic Location: (City/County/State) Type: (Rural/Suburban/Urban) Project Name: Mental Health Partner(s): Mental Health and Criminal Justice Point(s) of Contact:
Criminal Justice Partner(s): Name:
Email:
Agency:
Name:
Email:
Agency:
Name:
Email:
Agency:
Collaborators: Include project partners, sub-contractors, and their intended roles
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B. Grant Initiative Updates and Information Your TA provider would find it helpful to know about any major developments that have occurred between the time you wrote your grant application/narrative and our next TA call. When completing the exercise below, be sure to reference any major changes in goals, stakeholders, etc., that may have occurred. B. Grant Initiative Updates and Information 1. What do you want to accomplish with this grant initiative? Answer: 2. What is the relationship between this initiative and any pre-existing initiatives or programs focusing on people with mental illnesses involved with the criminal justice system, either locally or at the state level? Answer: 3. Has your state participated in a Justice Reinvestment Initiative and are there any programs funded through this initiative in your county? Answer: 4. What intercepts in the criminal justice system do you anticipate primarily focusing on? (Intercept 1: law enforcement; Intercept 2: initial detention; Intercept 3: jails/courts; Intercept 4: reentry; Intercept 5: community supervision and treatment) Answer: 5. Has your jurisdiction ever conducted a system mapping exercise, gap analysis, or other needs assessment about the services available in your community? If so, attach copies of these materials. Answer:
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SECTION 2: COLLABORATIVE PLANNING TEAM In order to conduct a comprehensive, data-driven plan to safely reduce the prevalence of people with mental illnesses in your county’s jail, it is essential that you establish a team (or use a pre-existing team) of county leaders and decision makers from multiple agencies to engage in the planning process.
EXERCISE 2: DEVELOPING YOUR COLLABORATIVE PLANNING TEAM 1. Will an existing decision-making entity guide the direction of this project? If not, is a new collaborative planning team being developed as part of this initiative? Answer: 2. How will this collaborative planning team communicate/coordinate with other entities that are currently engaged in criminal justice/mental health planning for your county/? Answer: 3. List the members of your collaborative planning team. Name
Title
Organization
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Specific role on collaborative planning team
Signed a letter of agreement committing to involvement in project? Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
4. Are there additional stakeholders you would like to join the planning team to ensure that there is system-wide representation? Answer: 5. Who are the local “champions” for mental health- and criminal justice-related issues? Are they participating in your planning team? If not, do you plan to include them in the planning team? Answer: 6. Does the planning team include sub-committees or working groups? If so, what are they? Answer: 7. Have you developed MOUs or letters of agreement (LOAs) for the planning team members’ respective agencies? Do you anticipate needing to develop additional agreements? Answer: 8. How often will the planning team meet?
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Answer: 9. Who coordinates the planning team’s meeting schedule, agenda, and logistics? How is the agenda developed and shared with collaborative planning team members? What will the process be for reporting on the team’s progress (internally and externally)? Answer: 10. Has your planning team developed vision, mission, and guiding principles statements? If not, do you plan to do so? Answer:
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SECTION 3: JAIL IDENTIFICATION PROCESS AND DATA COLLECTION In order to safely and effectively reduce the number of adults with mental illnesses in jails, counties need to know how many people with mental illnesses are entering and leaving their jails, and the extent of their needs. While it may seem simple to count the number of people with mental illnesses who have treatment needs, it is not uncommon to see different ways of defining and measuring the presence of mental illnesses and cooccurring substance use disorders. The following exercises will help ensure that you and your TA provider are on the same page when discussing your county’s data.
EXERCISE 3: JAIL IDENTIFICATION PROCESS AND THE DETERMINATION OF PREVALENCE RATES AND RISK LEVELS Jail staff and behavioral health care providers, who are represented in the collaborative planning team, need to agree on a consistent screening and assessment process that accurately identifies people’s mental illnesses, substance use disorders, and criminogenic risk. As you consider what screening and assessment practices are already in place, keep in mind that meaningful reductions of the prevalence of mental illness in jails should be measured according to the following four key outcomes: 1. 2. 3. 4.
Reduce the number of people with mental illnesses (MIs) and co-occurring disorders (CODs) who are booked into jail Reduce their average length of stay in jail Increase the percentage of people released from jail who are connected to treatment Reduce their recidivism rates
This exercise will help you determine whether your existing screening and assessment process is operating effectively and gathering the information necessary to improve outcomes in your criminal justice system. A. Local Definition of Mental Illness 1. Is there a state or county definition of mental illness that governs access to services in your community? If yes, what is it? Answer: 2. Is this or another definition of mental illness currently used within your jail? If yes, what is it? Answer: 9
B. Jail Identification Process for Mental Illness 1. How does the jail staff determine when a person may have a mental illness and/or substance use disorder? Answer: 2. Is there an objective, standardized screening tool in place to screen for mental illnesses (e.g., Brief Jail Mental Health Screen)?1 If yes, what is it? Answer: 3. Whom do you screen and at what times (e.g., everyone at booking, everyone who has been in jail for 48 hours)? Answer: 4. Is there a process in place to conduct a full clinical assessment for someone who screens positive for a possible mental illness? If yes, what is it? Answer: 5. Is there a process in place to conduct a substance use disorder screen for someone who screens positive for a possible mental illness? If yes, what is it? Answer: 6. Do you track data electronically on how many people are screened and assessed? If yes, please describe how this is tracked. Answer: 7. Is there a process that determines whether a person meets state/county criteria for serious or persistent mental illnesses? If yes, must a social worker, counselor, psychiatrist, or qualified mental health professional make the clinical determination? Answer:
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The tools referenced in the planning guide are meant to merely serve as examples; their inclusion does not in any way reflect the endorsement of it. In response to requests from the field for examples, when appropriate an example of a commonly used proprietary and nonproprietary tool is provided.
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8. For people who meet your collaborative planning team’s definition of having a mental illness, does your jail collect data regarding the following? i.
Their length of stay
Answer (yes/no):
ii.
Their status as pretrial or sentenced
Answer (yes/no):
iii.
Their history of prior incarceration at the jail
Answer (yes/no):
iv.
Their history of prior community supervision
Answer (yes/no):
v.
Their prior contact with mental health care providers in the community
Answer (yes/no):
C. Local Definition of Substance Use Disorder 1. Is there a state or county definition of substance use disorder that governs access to services in your community? If yes, what is it? Answer:
D. Jail Identification Process for Co-occurring Substance Use Disorder Information 1. Do you have a process to identify how many people with mental illnesses also have a co-occurring substance use disorder? If yes, what is the process? Answer: 2. Do you use a validated tool to screen people for substance use disorders? If so, what tool do you use? Who administers the tool? Answer: 3. Is there a process in place to conduct a full substance use assessment for people who screen positive for a substance use disorder? If so, who conducts the full assessment? Answer: 11
E. Local Definition of Recidivism 1. What is your state or county definition of recidivism (e.g. reincarceration within a year of release for reoffending or violating conditions of supervision)? Answer:
F. Risk and Needs Identification Process 1. Do you use a validated assessment tool to assess for risk at the following points? i.
Pretrial detention (assessing for likelihood of failing to appear in court or commit a new crime during the pretrial period)
Answer (yes/no):
ii.
Post-conviction (assessing for risk of recidivism)
Answer (yes/no):
2. Can you determine how many people with mental illnesses in your jail are at a high, medium, and low risk for recidivism? Answer:
G. Connection to Community Supervision 1. Do you have a process for tracking people on community supervision to identify recidivism rates for those with mental illnesses and co-occurring substance use disorders? If yes, what is that process? Answer: 2. Is there a process for alerting the appropriate community supervision officer that a person on supervision has been booked into jail? If yes, does the supervision officer connect with the person prior to release from jail? Answer:
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H. Connection to Community-Based Services 1. Do you have a process for tracking how many people with mental illnesses and co-occurring substance use disorders receive services from community-based treatment providers after release from jail? If yes, what is this process? Answer: 1. Is there a process to notify community-based treatment providers when a person who has screened positive for mental illness and co-occurring substance use disorder(s) or has previously used their services has been booked into jail? If yes, what is this process? Answer:
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EXERCISE 4: EXPANDING SCREENING AND ASSESSMENT To prioritize county resources based on risk and needs, screening and assessment for mental illnesses, substance use disorders, and risk should be in place. This chart will help you develop a plan to implement screenings and assessments, to address any gaps identified in exercise 3. If the appropriate screening or assessment is already in place, simply indicate that below. What tool or process would you like to implement? Who would administer it and when would it take place?
How will the information be recorded (e.g., entered into a database)?
Pretrial Risk Assessment Mental Illness Screen Substance Use Disorder Screen Post-Conviction Risk Assessment Mental Illness Assessment Substance Use Disorder Assessment
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What agencies would be able to access this information?
SECTION 4: COUNTY SYSTEM ANALYSIS For any county plan to be effective, a person’s mental health, substance use, and criminogenic needs (the factors that make people more likely to reoffend) should be identified and addressed at the earliest points possible using law enforcement diversion, screening and identification, connections to services, and community supervision. Meaningful reductions in the prevalence of mental illnesses in jails cannot be realized without examining which programs and strategies are in place and effective. Each of these programs or strategies that is identified in the planning process should achieve at least one of the following four key outcomes that was previously discussed in Section 2: 2. Reduce the number of people with mental illnesses (MIs) and co-occurring disorders (CODs) who are booked into jail 3. Reduce their average length of stay in jail 4. Increase the percentage of people released from jail who are connected to treatment 5. Reduce their recidivism rates The following exercises will help you identify gaps in your county’s policies, practices, and programs.
EXERCISE 5: SYSTEM MAPPING, PROCESS ANALYSIS, AND IDENTIFYING GAPS A. System Mapping by Intercept Points The following table includes the Sequential Intercept Model2 for your reference. Using this model, identify existing policies, practices, programs, and treatments that currently exist in your system. While completing the exercise, it is important to discuss each step of a person’s involvement in the justice system—from the time of first law enforcement contact to case completion—in order to identify opportunities to make improvements and identify any gaps. Additional information on process analysis can be obtained through your TA provider and an example of a flow analysis performed in another county is available in Appendix B.
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The Sequential Intercept Model—developed by Mark Munetz, MD, and Patricia Griffin, PhD—is described in this article and was subsequently adapted into a user-friendly handout in partnership with SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation.
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Ini0al$Deten0on/Ini0al$ Court$Hearings$
Intercept(4(
Jails/Courts$
Reentry$
Intercept 5:
Intercept(5( Community$ Correc0ons$
Parole$ Proba0on$
Prison/ Reentry$ Jail/ Reentry$
Disposi0onal$ Court$
First$Appearance$ Court$
Ini0al$Deten0on$
COMMUNITY(
Local$Law$ Enforcement$
Intercept 4:
Intercept(3(
Intercept 1:
Intercept 2:
Intercept 3:
Intercept 4:
Intercept 5:
Policies and Practices:
Policies and Practices:
Policies and Practices:
Policies and Practices:
Policies and Practices:
Evidence-Based Programs and Treatments:
Evidence-Based Programs and Treatments:
Evidence-Based Programs and Treatments:
Evidence-Based Programs and Treatments:
Evidence-Based Programs and Treatments:
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COMMUNITY(
Intercept 3:
Intercept(2(
911$
Law$Enforcement$
Intercept 2:
Specialty$ Court$
Intercept(1(
Jail$
Intercept 1:
B. System Mapping by Key Outcomes Use the following four tables to identify current policies, practices, programs, and treatment options in your county that address each of the four key outcomes described at the beginning of this section.
Key Outcome 1: Reduce the number of people with mental illnesses and co-occurring disorders who are booked into jail Instructions List the relevant policies, practices, evidence-based programs, and treatment options that currently exist in your system and include a brief description of each.
Pre-Arrest Identification of MI/COD
Law Enforcement Responses
1. EXAMPLE: Mental health crisis identified on 911 call • Process for identifying whether a 911 call requires a response by the mobile crisis outreach team 2.
1. EXAMPLE: Crisis Intervention Training (CIT) • All law enforcement in the county are required to be trained in CIT
3.
3.
4.
4.
5.
5.
2.
Screening for MI, COD, and Risk at Booking
Jail Diversion Opportunities
1. EXAMPLE: The Brief Jail Mental Health Screen is administered to people at booking into jail • Everyone booked into jail receives the screen, with the results recorded electronically 2.
1. EXAMPLE: Crisis Center • Provides short-term mental health crisis stabilization in a secure unit
3.
3.
4.
4.
5.
5.
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2.
Key Outcome 2: Reduce their average length of stay in jail Instructions List the relevant policies, practices, evidence-based programs, and treatment options that currently exist in your system and include a brief description of each.
Screening for MI, COD, and Risk in Jail
Pretrial Release Decision Making
1. EXAMPLE: A pretrial risk assessment tool is
1. EXAMPLE: Pretrial risk information is made
administered • Everyone booked into jail receives the screen, with the results recorded electronically
available to inform the court regarding release at the first appearance • The information is electronically submitted to judge, prosecutor, and defense lawyer
2.
2.
3.
3.
4.
4.
5.
5. Pretrial Treatment Programs
Pretrial Community Supervision
1. EXAMPLE: Referral to treatment included in pretrial
1. EXAMPLE: Pretrial supervision ordered for people
release order • All who are screened and/or assessed as needing treatment receive an appointment for follow-up care upon release
•
2.
2.
3.
3.
4.
4.
5.
5.
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identified as moderate to high risk People assigned to pretrial supervision and identified as needing mental health services are connected to care
Key Outcome 3: Increase the percentage of people released from jail who are connected to treatment Instructions List the relevant policies, practices, evidence-based programs, and treatment options that currently exist in your system and include a brief description of each.
Assessments for MI and COD in Jail/Community
Mental Health and Substance Use Policies
1. EXAMPLE: People who screen positive for mental
1. EXAMPLE: Release of information policies are in
illness receive a full assessment • There is process in place for both in-jail and community-based assessments
•
2.
2.
3.
3.
4.
4.
5.
5.
place to allow for information sharing The sheriff’s office shares relevant information with the local behavioral health authority
Case Management/Supervision 1. EXAMPLE: A community supervision officer and behavioral health clinician provide collaborative case management • Roles and responsibilities are clearly defined to increase consistency in care and supervision expectations
Mental Health and Substance Use Treatment 1. EXAMPLE: The local behavioral health agency administers an in-reach program in the jail The local behavioral health agency provides jail-based services and ensures connection to care upon release
•
2.
2.
3.
3.
4.
4.
5.
5.
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Key Outcome 4: Reduce their recidivism rates Instructions List the relevant policies, practices, evidence-based programs, and treatment options that currently exist in your system and include a brief description of each.
Assessments for Risk in Jail/Community
Risk-Reduction Policies
1. EXAMPLE: A post-conviction risk and needs assessment tool is administered • Everyone assigned to community supervision receives a risk and needs assessment and a case management plan, which is developed based on risk and needs
1. EXAMPLE: The community supervision provider implements evidence-based practices that are proven to reduce recidivism • Interventions such as cognitive behavioral therapy (CBT) are in place to address criminal thinking
2.
2.
3.
3.
4.
4.
5.
5.
Community Supervision Focused on Risk Reduction 1. EXAMPLE: Community supervision follows the
Risk-Reduction Treatment
principles of Risk, Needs, and Responsivity • More intense supervision is provided to moderate- to high-risk people
1. EXAMPLE: Treatment plans follow the principles of Risk, Needs, and Responsivity • For people who are assessed as moderate to high risk and have mental health needs, treatment includes interventions based on CBT
2.
2.
3.
3.
4.
4.
5.
5.
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C. Addressing Gaps In the System Use the following four tables to identify the policies, practices, programs, and treatment options across all four key outcomes that do not currently exist in your system. Later in this guide, you will be asked to prioritize these responses, so this exercise can be used as a “wish list.” Refer to the previous charts in this exercise to identify gaps in services and practices.
Key Outcome 1: Reduce the number of people with mental illnesses and co-occurring disorders who are booked into jail Instructions List the relevant policies, practices, evidence-based programs, and treatment options that do not currently exist in your system but would improve your system’s outcomes, and include a brief description of each.
Pre-Arrest Identification of MI/COD
Law Enforcement Responses
1.
1.
2.
2.
3.
3.
4.
4.
5.
5. Screening for MI, COD, and Risk at Booking
Jail Diversion Opportunities
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
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Key Outcome 2: Reduce their average length of stay in jail Instructions List the relevant policies, practices, evidence-based programs, and treatment options that do not currently exist in your system but would improve your system’s outcomes, and include a brief description of each.
Screening for MI, COD, and Risk in Jail
Pretrial Release Decision Making
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
Pretrial Treatment Programs
Pretrial Community Supervision
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
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Key Outcome 3: Increase the percentage of people released from jail who are connected to treatment Instructions List the relevant policies, practices, evidence-based programs, and treatment options that do not currently exist in your system but would improve your system’s outcomes, and include a brief description of each.
Assessments for MI and COD in Jail/Community
Mental Health and Substance Use Policies
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
Case Management/Supervision
Mental Health and Substance Use Treatment
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
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Key Outcome 4: Reduce their recidivism rates Instructions List the relevant policies, practices, evidence-based programs, and treatment options that do not currently exist in your system but would improve your system’s outcomes, and include a brief description of each.
Assessments for Risk in Jail/Community
Risk-Reduction Policies
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
Community Supervision Focused on Risk Reduction
Risk-Reduction Treatment
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
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SECTION 5: DATA-DRIVEN FINDINGS The following exercises will help you understand whether your county is currently able to measure these key outcomes, and advise you on the types of data findings that will help your collaborative planning team understand whether your county is effectively reducing the prevalence of mental illnesses and co-occurring substance use disorders in its jail.
EXERCISE 6: MEASURING OUTCOMES Answer the following questions about data your county collects to measure progress toward achieving key outcomes. Outcomes Measures Reduce the number of people with MI/COD who are booked into jail
Is there a way to flag people identified through screening and assessment as having mental illnesses and co-occurring disorders in a searchable electronic database? Yes No
Reduce their average length of stay in jail Increase the percentage of people released from jail who are connected to treatment Reduce their recidivism rates
Does your county track lengths of stay for pretrial and sentenced populations? Yes No Does your county match every person booked into jail to the local behavioral health authority’s database to establish whether connections to care are being made? Yes No Does your county track recidivism, including technical violations and new offenses, for people at both the pretrial and post-conviction stages? Yes No Does your county assess criminogenic risk levels of people booked into jail and on community supervision? Yes No
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EXERCISE 7: COLLECTING DATA AND KEY FINDINGS A. Tracking Sub-measures of the Four Key Outcomes In addition to the broader measures addressed in Exercise 6, below is a list of sub-measures that counties should track to demonstrate progress toward achieving the four key outcomes—reducing the number of people with mental illnesses and co-occurring substance use disorders booked into jail, shortening their average length of stay in jail, increasing the percentage of people connected to treatment in the community, and lowering their recidivism rates. These sub-measures will provide more detailed data analysis to inform your key findings and determine where to target interventions. The chart below provides information on the sub-measures and general recommendations on which agencies would have this data, although this may vary by jurisdiction. Guidance has not been provided on the timeframe for collecting this data, as that may change based on a number of factors. Your TA provider can provide additional advice regarding the recommended timeframe for collecting this data. Please complete the rest of the chart to answer whether these sub-measures are being collected, and if so, what the data findings are. 1. Reduce the number of people with mental illnesses and co-occurring substance use disorders who are booked into jail Sub-measures How to Obtain Data Has data been collected? If so, Provide Data and Related by which agency? Findings Number of unique Request from 911 dispatch or individuals identified as having police departments behavioral health disorders who were diverted from jail by law enforcement Number of unique individuals Request from the jail and/or jail’s who screened positive for mental health provider potential behavioral health disorders at jail booking according to a validated mental health screen Number of people who were Request from the jail’s mental identified as having a mental health provider illness through a clinical assessment at the jail Comparison of the above data to bookings for general population, including demographic and criminogenic information (age, sex/gender, race/ethnicity, offense type/level, etc.)
Request from 911 and jail
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2. Reduce their average length of stay in jail Sub-measures How to Obtain Data Number of unique individuals screened as low, medium, and high for pretrial risk with a behavioral health disorder Average length of stay by release type (including pretrial population, post-sentencing population, surety bond release, federal holds, etc.) Comparison of the above data to bookings for the general population, including demographic and criminogenic information (age, sex/gender, race/ethnicity, offense type/level, etc.)
Has data been collected? If so, by which agency?
Provide Data and Related Findings
Only possible to obtain if pretrial risk information is collected, which may be through an agency outside of the jail Request from jail
Request from jail and agency that collects pretrial risk information
3. Increase the percentage of people connected to treatment in the community Sub-measures
How to Obtain Data
Percentage of people with behavioral health disorders connected to community-based services upon release (by release type) Percent of people with behavioral health disorders connected to community supervision/treatment programs (by release type) Comparison of the above data to bookings for the general population, including demographic and criminogenic information (age, sex/gender, race/ethnicity, offense type/level, etc.)
Request data from the jail and the community behavioral health provider to perform a data match (additional information may come from community supervision) Request data from the community supervision provider (i.e., probation)
Has data been collected? If so, by which agency?
Request from jail, community supervision provider, and community behavioral health provider
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Provide Data and Related Findings
4. Reduce their recidivism rates Sub-measures
How to Obtain Data
Percentage of failures to appear and/or re-arrest for people with behavioral health disorders released pre-adjudication, and re-arrest for post-jail sentenced population with behavioral health disorders
People identified with a mental illness, and their release dates should be matched to a request from the state criminal history repository. Most counties do not record FTA information in a way that can be extracted for data analyses. Request data from the community supervision provider
Percentage of technical violations and new criminal charges for sentenced population with behavioral health disorders who are assigned to community supervision Number of prior jail admissions for people identified with behavioral health disorders booked into jail—this will help identify the high-utilizer population Comparison of the above data to the general population
Has data been collected? If so, by which agency?
Provide Data and Related Findings
If the jail can’t calculate this variable, a longitudinal review of past bookings at the jail would be required
Request from criminal history repository, community supervision provider, and jail
B. Key Findings Now that you have identified the appropriate sub-measures of the four key outcomes, use this chart to identify the key findings that can be reported to your planning team and stakeholders in the community. Analysis Questions Indicate the prevalence of people with mental illnesses in your jail.
Answers/Data
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Is the average length of stay in jail for people with mental illnesses longer than people without mental illnesses? Please provide the data in your explanation.
What is the percentage of people identified with a mental illness in jail who are connected to care in the community?
What is the recidivism rate for people identified with a mental illness in jail and then released to the community?
Please describe any additional findings.
Please identify missing data that you would still like to collect.
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SECTION 6: STRATEGIC PLAN In this exercise, all of your collaborative work is now coming together in one master planning chart that includes the data you have gathered, policies, practices, and programs you currently have in place, as well as those that are on your “wish list” to fill identified gaps. The next step involves analysis and prioritization of interventions that will result in achieving the four key outcomes.
EXERCISE 8: PLANNING AND PRIORITIZING Complete the following chart with your planning team knowing this will take multiple meetings or need to be accomplished at a “planning retreat.” Each of the four sections of the chart addresses one of the four key outcomes. Once all four sections are completed, the planning team should identify prioritized responses for each outcome and develop consensus around an action plan that is data based, cost effective, and provides the most potential for reducing the prevalence of people with mental illnesses in your jail. Key Outcome 1. Reduce the number of people with mental illnesses and co-occurring substance use disorders who are booked into jail Current Policies, Practices, and Programs Key data (e.g., mental illness prevalence, recidivism)
List of effective policies, practices, and programs
Identified gaps in policies, practices, and programs
Planning for Implementation of Policies, Practices, and Programs Policies and evidencedbased responses to be implemented
Projected number of people to be served
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Projected cost/ funding source
List of evidencebased responses for implementation in order of highest priority
Timeline for implementation
Key Outcome 2. Reduce their average length of stay in jail Current Policies, Practices, and Programs Planning for Implementation of Policies, Practices, and Programs Key data (e.g., mental illness prevalence, recidivism)
List of effective policies, practices, and programs
Identified gaps in policies, practices, and programs
Policies and evidencedbased responses to be implemented
Projected number of people to be served
Projected cost/ funding source
List of evidencebased responses for implementation in order of highest priority
Timeline for implementation
Key Outcome 3. Increase the percentage of people released from jail who are connected to treatment Current Policies, Practices, and Programs Key data (e.g., mental illness prevalence, recidivism)
List of effective policies, practices, and programs
Identified gaps in policies, practices, and programs
Planning for Implementation of Policies, Practices, and Programs Policies and evidencedbased responses to be implemented
Projected number of people to be served
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Projected cost/ funding source
List of evidencebased responses for implementation in order of highest priority
Timeline for implementation
Key Outcome 4. Reduce their recidivism rates Current Policies, Practices, and Programs Key data (e.g., mental illness prevalence, recidivism)
List of effective policies, practices, and programs
Identified gaps in policies, practices, and programs
Planning for Implementation of Policies, Practices, and Programs Policies and evidencedbased responses to be implemented
Projected number of people to be served
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Projected cost/ funding source
List of evidencebased responses for implementation in order of highest priority
Timeline for implementation
SECTION 7: EVALUATION AND SUSTAINABILITY Once your planning is completed, the work of tracking progress and ongoing evaluation starts. Identifying the essential data and tracking the four key outcomes will provide your collaborative planning team with clear indicators of progress. As your planning segues to implementation, sustainability will become a focus. This section will help you ensure that your plan is implemented appropriately and can continue beyond the completion of this grant.
EXERCISE 9: TRACKING PROGRESS A. Using Data to Track Progress 1. Are data available to share on a consistent basis with key stakeholders? Answer:
2. How often will the four key outcomes be reported to or discussed with key stakeholders? Answer:
3. How will you communicate the four key outcomes to stakeholders? Answer:
B. Other Sustainability Strategies 1. Identify any policy (internal, local, state, federal) challenges that need to be addressed in order to achieve your program goals. Answer:
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C. Tracking Progress from Start to Finish Organized by the four key outcomes, this chart will help you keep track of what you had in place prior to this grant, what initiatives are currently underway as a result of your planning process, and what you would like to achieve moving forward.
1. Reduce the number of people with mental illnesses and co-occurring substance use disorders who are booked into jail Status of Program, Current Status Action Steps to By Whom (list the Timeline for Final Date Action Steps Practice, or Policy Take person or agency) Implementation Are To Be Prior to Project Completed
2. Reduce their average length of stay in jail Status of Program, Current Status Action Steps to Practice, or Policy Take Prior to Project
By Whom (list the person or agency)
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Timeline for Final Implementation
Date Action Steps Are To Be Completed
3. Increase the percentage of people connected to treatment in the community Status of Program, Current Status Action Steps to By Whom (list the Practice, or Policy Take person or agency) Prior to Project
Timeline for Final Implementation
Date Action Steps Are To Be Completed
4. Reduce their recidivism rates Status of Program, Current Status Practice, or Policy Prior to Project
Timeline for Final Implementation
Date Action Steps Are To Be Completed
Action Steps to Take
By Whom (list the person or agency)
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Appendix A Supporting Resources i. The Stepping Up Initiative Recognizing the critical role local and state officials play in supporting systems change, the National Association of Counties (NACo), the American Psychiatric Association Foundation, and The Council of State Governments Justice Center launched Stepping Up in May 2015. Stepping Up is a national initiative to reduce the number of people with mental illnesses in jails. More than 325 counties have passed a resolution to participate in the initiative. With support from public and private entities, the initiative builds on the many innovative and proven practices being implemented across the country. Stepping Up engages a diverse group of organizations with expertise on these issues, including those representing sheriffs, jail administrators, judges, community corrections professionals, treatment providers, people with mental illnesses and their families, mental health and substance use program directors, and others. The following resources available through Stepping Up can help local leaders develop a plan for reducing the prevalence of mental illnesses in jail: i.
Reducing the Number of People with Mental Illnesses in Jail: Six Questions County Leaders Need to Ask is the foundational document of Stepping Up that encourages counties to assess their existing efforts to reduce the number of people with mental illnesses in jail by considering the following questions: 1. 2. 3. 4. 5. 6.
Is our leadership committed? Do we conduct timely screening and assessments? Do we have baseline data? Do we conduct a comprehensive process analysis and inventory of services? Have we prioritized policy, practice, and funding improvements? Do we track progress?
ii. Stepping Up partners have developed an online Resources Toolkit. Below are resources that are currently available or will be developed in 2017: 1. 2. 3. 4. 5.
Monthly webinars and networking calls Educational workshops at NACo Conferences A Project Coordinator Handbook Guidance on measuring the number of people with mental illnesses in jail Companion tools for the Six Questions report with the latest research and case studies for county officials 6. Key Resources
ii. Criminogenic Risk and Behavioral Health Needs Framework With mounting research that demonstrates the value of science-based tools to predict a person’s likelihood of reoffending, criminal justice practitioners are increasingly using these tools to focus limited resources on the people who are most likely to reoffend. At the same time, mental health and substance use practitioners are trying to prioritize their scarce treatment resources for people with the most serious behavioral health needs. A person who screens positive for mental illness and/or substance use should be connected to appropriate treatment at the soonest opportunity; however, when that person is also assessed as being at a moderate to high risk of reoffending, connection to treatment is an even higher priority, along with interventions such as supervision and cognitive behavioral therapy to reduce the risk of recidivism. The framework depicted below 36
outlines a structure for state and local agencies to consider how information about risk of reoffending and substance use and mental health treatment needs can be considered in combination to prioritize interventions to have the greatest impact on recidivism. For more information, read Adults with Behavioral Health Needs under Correctional Supervision: A Shared Framework for Reducing Recidivism and Promoting Recovery.
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Appendix B
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