BEHAVIORAL HEALTH TRAINING SUMMIT SCA CO-‐OCCURRING DISORDERS AND JMHCP MENTAL HEALTH GRANTEES August 4, 2015
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Why we are here today?
FY14 Second Chance Act Reentry Program for Adults with Co-‐ Occurring Substance Abuse and Mental Disorders
FY 14 Jus4ce and Mental Health Collabora4on Program
1st Grantee Intensive Training Summit 2 Council of State Governments Jus4ce Center | 2
The Second Chance Act The Second Chance Act (SCA) was designed to improve outcomes for people returning to communi4es aXer incarcera4on. It authorizes federal grants to government agencies and nonprofit organiza4ons to provide support strategies and services to help reduce recidivism.
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What does the Second Chance Act fund? Training and technical assistance
Grant programs serving adults
Grant programs serving juveniles
Grant programs impac4ng statewide policy and prac4ce
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The Second Chance Act Grantees
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Justice and Mental Health Collaboration Program (JMHCP) The U.S. Department of Jus4ce’s Bureau of Jus4ce Assistance (BJA) funds the Jus4ce and Mental Health Collabora4on Program (JMHCP) grant, which support innova4ve cross-‐system collabora4on for individuals with mental disorders or co-‐occurring mental health and substance use disorders who come into contact with the jus4ce system.
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What does the JMHCP fund? Training and technical assistance
Grant programs serving adults
Grant programs serving juveniles
Grant programs impac4ng statewide policy and prac4ce
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The JMHCP Grantees
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SCA Grants at a Glance • Through SCA, BJA has awarded nearly $300 million in grants to more than 600 recipients in 49 states; over $1 billion in SCA grants have been requested. • There have been 68 Adult Co-‐occurring Disorder grantees • There have been 9 Juvenile Co-‐occurring Disorder grantees
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JMHCP Grants at a Glance • Through JMHCP BJA has awarded $57 million in grants to more than 300 recipients in 49 states and territories • Approximately 1/3 of these grants focus on jail diversion, treatment in correc4ons and reentry, and broad strategic planning for either adults or both adults and juveniles
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• Na4onal non-‐profit, non-‐par4san membership associa4on of state government officials
• Engages members of all three branches of state government
• Jus4ce Center provides prac4cal, nonpar4san advice informed by the best available evidence
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Summit Roadmap ü Integra4on of Behavioral Health and Criminogenic Risk Assessments Into Case Plans ü Understanding the Role of Trauma in Recovery and Recidivism ü Leveraging Resources to Support Sustainability ü Responding to People with Mental Illnesses at the Pretrial Stage Council of State Governments Jus4ce Center | 12
Summit Expectations Collabora4on drives success
• Collabora4on between behavioral health and criminal jus4ce partners drives success and promotes health ci4zens and communi4es.
Increase public safety through public health
• A healthier community is a safer community. Using evidence-‐based tools and programs impacts personal health and public safety.
EBP leads to funding
• Recognizing that EBP programs carried out to fidelity and measured with data lead to further funding opportuni4es
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How does this +e into Training and Technical Assistance?
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The Na+onal Reentry Resource Center • The NRRC is a project of the CSG Jus4ce Center and is supported by the Bureau of Jus4ce Assistance csgjus+cecenter.org/nrrc • NRRC staff have worked with over 600 SCA grantees • The NRRC provides individualized, intensive, and targeted technical assistance, training, and distance learning to support SCA grantees.
ü Please register for the monthly NRRC newsleker at: csgjus+cecenter.org/subscribe/ ü Please share this link with others in your networks that are interested in reentry!
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Welcome And enjoy the summit!
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BEHAVIORAL HEALTH TRAINING SUMMIT EFFECTIVE PROGRAMS TO ADDRESS BEHAVIORAL DISORDERS IN THE CRIMINAL JUSTICE SYSTEM Fred C. Osher, M.D. August 4, 2015 Council of State Governments Jus4ce Center | 18
Presentation Goals Provide An Overview of Mental and Substance Use Disorders in the Criminal Jus4ce System
Discuss Applica4on of Behavioral Health Framework
Highlight Key Issues for our Summit Conversa4ons
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Individuals Incarcerated for Drug Offenses: 1980 and 2010
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Substance Use Disorders in Criminal Justice Settings 60 54 %
Percent of Popula+on
50
47 %
53 % 44 %
40 30
Alcohol use disorder (Includes alcohol abuse and dependence) Drug use disorder (Includes drug abuse and dependence)
20 8 %
10 0
2 % Household
Jail
State Prison
Source: Compton et al., Am J Psychiatry, 2010. Council of State Governments Jus4ce Center | 21
SMI and Co-Occurring Substance Use Disorders (CODs) Prevalence of SMI and CODs in Jail Popula+ons General Popula+on
Jail Popula+on
95% 5%
83%
17% 72%
Serious Mental Illness No Serious Mental Illness
Serious Mental Illness No Serious Mental Illness
28 %
COD No COD
Sources: Kessler RC, Chiu WT, Demler O, Walters EE. “Prevalence, severity, and comorbidity of twelve-‐month DSM-‐IV disorders in the Na4onal Comorbidity Survey Replica4on” (NCS-‐R). Archives of General Psychiatry, 2005 Jun; 62 (6): 617-‐27; Henry Steadman, Fred C. Osher, Pamela C. Robbins, Brian Case, and Steven Samuels, “Prevalence of Serious Mental Illness Among Jail Inmates,” Psychiatric Services, 60 (2009): 761-‐65; Abram, K. M., Teplin, L. A. (1991). “Co-‐occurring disorders among mentally ill jail detainees,” American Psychologist, 46 (10), 1036–1045. Council of State Governments Jus4ce Center | 22
Not all Mental Illnesses are Alike Diagnosable mental disorders 16%
Serious mental disorders 5%
Severe mental disorders 2.5%
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Portion of Jail Group Meeting Criteria for Serious Mental Illness (SMI)
100% 90% 80%
43%
M Group, SMI
70%
M Group, Non-‐ SMI
60%
Non-‐M Group 79%
M Group 21%
50% 40% 30%
57%
20% 10% 0%
Source: The City of New York Department of Correc4on & New York City Department of Health and Mental Hygiene 2008 Department of Correc4on Admission Cohort with Length of Stay > 3 Days (First 2008 Admission) Council of State Governments Jus4ce Center | 24
Not all Substance Use Disorders are Alike
Mild
Severe
The Substance Abuse Con+nuum Council of State Governments Jus4ce Center | 25
CJ Risk Exists on a Continuum as well Rates of Failure Across LSI-R Categorization: Kansas Department of Corrections Assessment Tools Can Accurately Identify Offender Risk
48% 41%
33% 21%
Low 0-18
Moderate 19-24
Moderate / High 25-31
Very High 32+
Source: Holsinger, Alex. Inves4ga4ng the Predic4ve Validity of the Level of Service Inventory – Revised using a sample of releasees from the Kansas Department of Correc4ons Council of State Governments Jus4ce Center | 26
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A Framework for Prioritizing Target Population Low Criminogenic Risk
Medium to High Criminogenic Risk
(low)
(med/high)
Low Severity of Substance Abuse
Substance Dependence (med/high)
(low)
Low Severity of Mental Illness (low)
Serious Mental Illness
Serious Mental Illness
(med/high)
Low Severity of Mental Illness (low)
Group 1 I–L CR: low SA: low MI: low
Group 2 II – L CR: low SA: low MI: med/high
Group 3 III – L CR: low SA: med/high MI: low
Low Severity of Substance Abuse
Substance Dependence (med/high)
(low)
Serious Mental Illness
(med/high)
Low Severity of Mental Illness (low)
(med/high)
Low Severity of Mental Illness (low)
Group 4 IV – L CR: low SA: med/high MI: med/high
Group 5 I–H CR: med/high SA: low MI: low
Group 6 II – H CR: med/high SA: low MI: med/high
Group 7 III – H CR: med/high SA: med/high MI: low
Serious Mental Illness (med/high)
Group 8 IV – H CR: med/high SA: med/high MI: med/high
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The Goal: Universal Screening • All individuals presen4ng for treatment of a substance use disorder should be rou4nely screened for any co-‐occurring mental disorders. • All individuals presen4ng for treatment of a mental disorder should be screened rou4nely for any co-‐ occurring substance use disorders. • All individuals booked into jails should be screened for both mental and substance use disorders AND criminogenic risk Council of State Governments Jus4ce Center | 29
Assess Positive Screens • Gather key informa4on • Understand the client’s goals/ objec4ves • Determine readiness for change • Determine COD diagnoses • Iden4fy disabili4es, and strengths. • Determine Criminogenic Needs Council of State Governments Jus4ce Center | 30
Assessment for Criminogenic Risk
….. the goal of risk assessment is not simply to predict the likelihood of recidivism, but, ul:mately, to reduce the risk of recidivism. To do so, the informa:on derived during the risk assessment process must be used to guide risk management and rehabilita:on efforts. Desmarais et al, 2013
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Framework Implementation Challenges • Assessing risk and behavioral health needs soon aXer someone is charged with a crime • Packaging assessment results for decision-‐makers and sharing this informa4on appropriately • Using informa4on to inform services and supervision provided • Encouraging treatment providers and supervising agents to serve “high risk” popula4ons • Ensuring treatment system has capacity/skills to serve popula4ons they would not otherwise see as a priority popula4on Council of State Governments Jus4ce Center | 32
Two Critical Components
Target Popula+on
Comprehensive Effec+ve Community-‐based Services
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Collaboration between Criminal Justice & Behavioral Health: Sequential Intercept Model
Source: Munetz &Griffen (2005)
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Developing Effective Interventions for Each Subgroup
• It is assumed these responses will: • Incorporate EBPs and promising approaches • Be implemented with high fidelity to the model • Undergo ongoing tes4ng/evalua4on Council of State Governments Jus4ce Center | 35
Hypothesis for Justice Involved Persons with COD Interven=ons (at the program or provider level) that reduce substance use (licit and illicit), improve levels of func=oning in persons, and mi=gate criminogenic risks will reduce both the frequency of involvement with the jus=ce system and =me spent in jus=ce seHngs or under correc=onal supervision.
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COD Intervention Principles 1. Integrated Treatment 2. Individualized Treatment Planning 3. Employ Evidence Based Prac4ces 4. Longitudinal Perspec4ve 5. Asser4veness 6. Harm Reduc4on Strategies 7. Stable living situa4on 8. Cultural competency and consumer centeredness 9. Integrate Supervision and Treatment 10. Op4mism
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Integrated Treatment for Adults with Co-occurring SMI and SUD (NSDUH, 2008)
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Individualized Treatment Planning Non-‐addic+ve Psychiatric Disorders
B
A C
Substance Use Disorders
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Longitudinal Interventions Percent of Par+cipants in Stable Remission for High-‐fidelity ACT Programs (E:n=61) vs. Low-‐fidelity ACT Programs (G: n=26) (McHugo et al, 1999) 50 40 30 20 10
o. 36
m
o. 30
m
o. 24
m
o. m 18
12
m
o. 6
m
e in el as
o.
0
B
Percent in Remission
60
Assessment Point
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Employ Evidence Base Interventions Resource: A Checklist for Implementing EBP s for Justice-involved with Behavioral Health Disorders
hkp://gainscenter.samhsa.gov/cms-‐assets/documents/ 73659-‐994452.ebpchecklisvinal.pdf Council of State Governments Jus4ce Center | 41
Optimism • Belief in the capacity for change • Hope as an an4dote to despair • Peer supervision and training needed to bolster staff op4mism • Summit Par4cipants Council of State Governments Jus4ce Center | 42
Stepping Up: A Na4onal Ini4a4ve to Reduce the Number of People with Mental Illnesses in Jails
www.stepuptogether.org Council of State Governments Jus4ce Center | 43
Thanks And enjoy the summit!
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