The JMHCP Grantee Meeting Effective Strategies for Working with Justice-‐Involved Veterans with Behavioral Health Needs
Dan Abreu SAMHSA National GAINS Center February 28, 2013 Washington DC
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Jus$ce Involved Veterans
Estimated number of military Veterans, 2007: Probation supervision:
399,300 Parole or supervised release: 75,000 Local jail custody: 72,600 State prison custody: 136,800 Federal prison custody: 19,300 Total, correctional supervision: 703,000 Arrests: 1,159,500 Source: U.S. Department of Justice – Bureau of Justice Statistics
NADCP Veterans Court Clearinghouse
www.nadcp.org
Jail Diversion and Trauma Recovery – Priority to Veterans 2008 Grantees 2009/2010 Grantees
Grantees
VT MA
IL
CO
OH
PA
NC NM
GA
TX FL
CT RI
Key Statewide Rollout Components
• Screening -‐ Veterans with trauma-‐related disorders • Trauma informed care (TIC) and trauma specific care: principles of safety, choice, client control, consumer involvement, trauma-‐specific treatment (train staff and clients) • Build community service competency trea$ng veterans and coordinate services between VA and non VA providers, maximizing par$cipant choice • Peer presence on Advisory Boards and services provision • Establish Leadership -‐ State and Local Advisory CommiPees • Support exis$ng programs • Sustainability
Diversion Pilot Intercept Points CT, IL, NM, RI, TX
CT, IL, FL, NC, NM, OH, PA, RI
CT, IL, CO, GA, MA, VT, FL, NC, OH, PA, RI
CT, IL, VT, NM, OH
JDTR Cross System Partnerships
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Client Level Data Collection Status and Preliminary data
Kristin Stainbrook, AHP Steve Sullivan, Cloudburst Consulting Group JDTR Annual Grantee Meeting / March 4, 2011 10
Military Status of Clients (n=780) Military Status
Separated from Military
87%
Service
Served in combat theater/zone Length of service (mean years)
57% 6 yrs
Tours of Duty (mean) Honorable/ General
2 92%
Retired/Discharged with severance/disability Separation 5 years or more
24% 60%
Discharge
Baseline Data (N=919)
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Military Era (N=919)* 85% (780) of JDTR Enrollees had served in the military 60 50
Afghanistan/Iraq (2002-Present)
40
Persian Gulf (1990-2001)
30 20
Post Vietnam (1975–1990)
10 0 Percent Era
Vietnam (1964-1975) *Current 1/15/13 12
Trauma History 100 90 80 70 60 50 40 30 20 10 0
95 73 63
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55
25
Any Lifetime Trauma under Ever Forcibly Trauma 18 Restrained
Trauma in Sexual past 12 mo Violence E ver
Baseline Data (N=919)
Physical Violence under 18
13
Military Trauma (gathered at 6 mo) n=450
Includes only the individuals who served in combat zone n=271 1/15/13
Military sexual assault Patrol areas with landmines/IEDs Seen someone injured/killed Shot at/received fire Seen, smelled, handled dead bodies
6% 85% 84% 82%
Attacked/Ambushed
73%
Shot or directed fire at enemy Cleared homes/blgs/bunkers
69% 57%
Provided Aid to seriously wounded
53%
Wounded/injured Felt responsible for death of someone
35%
Any Combat Trauma
74%
28%
97%
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Charge Level at Screening/Enrollment Point (1/15/13) Charge Level
Ini.al Screenings N= 4509
Court Decisions Program Enrollments N=718 N= 1105
Felony
34%
61%
45%
Misdemeanor
36%
32%
44%
Viola$on/Ticket
1%
1%
<1%
Technical Viola$on
2%
5%
3%
Unspecified/ Missing/No Formal 26%
1%
8%
Majority of CO cases are felonies (89% Felony, 2% Misdemean) CT majority are misdemeanor (58% Misdemean, 36% Felony) 15
Vet/Peer Involvement Definitions used at sites include: JDTR target population (vets with trauma and/or mental health histories and justice involvement) Any veteran Veteran status + other criteria (but not target pop.) Some include family members
Most definitions lead with veteran status and other
criteria are secondary
What You Should Know •Screening across systems •Trauma focused •Broad Clinical Criteria •Veteran Definition •Peer/Mentor Involvement •VA/Community based provider partners •Flexibility with Charges •DV, DUI, MV, Weapons •Minimize Collateral Sanctions •Choice
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Dan Abreu, SAMHSA National GAINS Center dabreu@prainc.com http://gainscenter.samhsa.gov Community Oriented Policing Services http://www.cops.usdoj.gov/ National Veterans Technical Assistance Center http://bbi.syr.edu/nvtac/ National Council of Community Behavioral Health www.thenationalcouncil.org/cs/veterans National Veterans Court Clearinghouse www.nadcp.org National Center for PTSD www.ptsd.va.gov
Sequential Intercept Model
Dan Abreu
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Intercept 1
Crisis Triage Units
Local Law Enforcement Jail Releases Other
COMMUNITY
Pre-booking Jail Diversion
Law enforcement / Emergency services - Transition Service Linkage: ICM/ACT EBP’s Peer Bridging Medical f/u Trauma Specific Services Jail linkage Other Assistance: Medication Access Benefits Housing Information Sharing
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CIT Officer Intervenes I do not even know how to begin to "Thank You" for your class/session "Improving Police Encounters with Returning Veterans" at the CIT Conference in Atlanta. I have been home just over a week and was already confronted by a Marine OIF with PTSD. !
Your video helped me interpret reckless driving and anger as possible PTSD symptoms ...It saved us from having to go hands on because I was able to reach out with the verbal skills I learned in your class and this situation did not escalate. In fact, because of that same video and that scenario where the VET had the handgun, I was able to ask the right question "do you have any weapons?". He looked me straight in the eye and began to weep and asked me to take the weapon for safekeeping until he felt he was ready to have it back. What a heart wrenching sight to have this honorable Marine hand over his weapon to me.
I gave him and his wife the Veteran Suicide phone number that I put in my contacts during your class/session. On Monday, I will contact the VA in my area and have them follow-‐up. THANK YOU with all my
Arrest
After arrest has been made.
Initial Hearings
Intercept 2 Initial detention / Initial court hearings
Initial Detention
Post–Booking Diversion Options
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Screening – An Evidenced Based Practice
Key Screening Partners Public Defenders/Defense Bar Pre-‐trial Services Jail Intake VJO’s
Specialty Courts? Other Court Programs
Jail-Based Diversion Programs
Intercept 3 Jails / Courts Courts
Jail
& Jail Mental Health Services 27
Specialty Courts Mental Health Courts Veterans Courts Drug Courts Other, eg DWI, DV
300 100 2,200
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Employment Housing Voting Driver’s License Student Loans TANF Food Stamps Multiple Fees/Fines
Prison
Intercept 4 Reentry
Jail Re-entry 30
http://www.va.gov/HOMELESS/docs/Reentry
Intercept 5
Probation
Violation
COMMUNITY
Violation
Parole
Community corrections / Community support
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Brownfield v United States
Mental Health Status: Changes between Baseline and 6-‐mo (n=47) Baseline %
Six Month %
Sig. Level
BASIS Full Scale-‐ Moderate to Extreme Difficulty
18%
15%
NS
Depression Subscale-‐ Moderate to Extreme Difficulty
33%
19%
.05
Emo.onal Lability Subscale-‐ Moderate to Extreme
62%
32%
.001
Psychosis Subscale – Moderate to Extreme
13%
6%
NS
Substance Abuse Subscale-‐ Moderate to Extreme
15%
9%
.05
PCL-‐ PTSD diagnosis criteria
70%
53%
.01 35
Number of Screening Events (2/15/11) State
Initial
Subsequent Court Enrollment Decision
CO
---
---
381
30
CT
105
---
61
65
IL
81
3
27
27
MA
33
---
27
20
TOTAL
219
3
496
142 36
Diversion Condi$on N=1105/608 Condition of Diversion Pending Missing Charges Dropped Deferred Sentencing Condition of Probation Deferred Prosecution Condition of Bail Other
# 377 120 93 154 183 51 67 60
% % 608 1105 34 11 8 14 17 5 6 5
15 25 30 8 11 10
Adult Correc$onal Popula$ons, 1980-‐2009
Bureau Of Justice Statistics
Going where no man or woman has gone before
Going where no man or woman has gone before
“Unsequential” Model Community Supervision Initial Hearings
Dan Abreu
Prison
Substance Abuse
Reentry
Mental Health
Jail
Courts
Community
Arrest
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Reentry Checklist Domains Mental health services
Psychotropic medications
Housing
Substance abuse services
Health care
Health care benefits
Income support/benefits
Food/clothing
Transportation
Other (often used for child care needs of women)
Veteran Mentors These volunteers are veterans who have served in Vietnam, Korea, Operation Desert
Shield, Operation Enduring Freedom, and Operation Iraqi Freedom. These men and women volunteer their time to work directly with the Veterans Treatment Court Participants. Mentors serve a variety of roles, including coach, facilitator, advisor, sponsor, and supporter.
GAINS Re-‐Entry Checklist Based on APIC Assist jails in re-‐entry
planning Quadruplicate – central record Inmates potential needs Steps taken gainscenter.samhsa.gov/html/
resources/reentry.asp
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NCCBH Serving Our Veterans Behavioral Health Cer$ficate Trains civilian behavioral health and primary care providers, Provides the latest clinical guidelines from the Department of
Defense. Demonstrates applicable knowledge and skills through real-‐life examples. Emphasizes cultural sensitivities to ensure clinical competency. Public/private partnership among the National Council for Community Behavioral Healthcare, the Department of Defense Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences, and Essential Learning www.thenationalcouncil.org/cs/veterans
Specialized Caseloads: Promising Prac$ce? Benefits Improves linkage to services Improves functioning Reduces risk of violation Mixed evidence on lowering re-‐arrest risk
AZ Safe Communities Act “Good time”; community gets savings
Integrating treatment & support with Probation
activities
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Incarcerated Veterans Transi$on Program & Homeless Veterans Reintegra$on Programs
Supported by the
Na.onal Veterans Technical Assistance Center Syracuse University
US DEPT OF LABOR VETERANS EMPLOYMENT AND TRAINING SERVICE
Legisla$on Pros and Cons
Legislation varies by:
Combat related trauma Discharge status Charge level Physical injury to victim DWI history Prior felony/violent crime/DV history Plea status Duration in program Recidivism
What you should know Pay attention to Identification and Screening What will you definition of “veteran” be? Do an environmental scan of other veterans programs Mentor/Peer component is essential Identify a trauma specific intervention Train partners on trauma informed care Domestic violence, DUI/motor vehicles and weapons are
special considerations.