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
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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 Officer, San Joaquin County, CA
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Learning Objec(ves • Determine the difference between criminogenic and non-‐criminogenic needs • Apply the risk-‐need-‐responsivity 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 risk-‐need-‐responsivity and behavioral health principles in their work
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Faye S. Taxman, Ph.D. Amy Murphy, MPP
C e n t e r f o r A d v a n c i n g C o r r e c 4 o n a l E x c e l l e n c e C r i m i n o l o g y , L a w a n d S o c i e t y G e o r g e M a s o n U n i v e r s i t y w w w . g m u a c e . o r g ] a x m a n @ g m u . e d u Council of State Governments Jus4ce Center | 4
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Acknowledgements • Bureau of Jus4ce Assistance • BJA: 2009-‐DG-‐BX-‐K026 • BJA: 2010-‐DG-‐BX-‐K026; 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
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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
?
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RNR Hierarchy of Dynamic Needs Criminogenic Needs
Destabilizers/Stabilizers
• Criminal Thinking • Substance Dependence
• • • • • •
• An(social Peers • Low Self-‐Control/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 Self-‐Control, 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.
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GED SUD Proba4on Officer
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 needs-‐-‐substance 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 job-‐seeking, etc.
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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
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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)
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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 15 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 • Co-‐morbid criminal thinking may be addressed through posi4ve reinforcers to shape decisions • Risk level and unmet criminogenic needs should drive who receives programming • Priori4ze high-‐need (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 16 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 17 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: Low-‐risk offender with cocaine dependence 18 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 • High-‐risk 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 19 Council of State Governments Jus4ce Center | 19
Myth: Non-Criminogenic Needs are Not Important • Fact: Non-‐Criminogenic 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 20 Council of State Governments Jus4ce Center | 20
Hierarchy of Dynamic Needs Criminogenic Needs
Destabilizers/Stabilizers
• Criminal Thinking • Substance Dependence
• • • • • •
• An(social Peers • Low Self-‐Control/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 21 Council of State Governments Jus4ce Center | 21
Program Groups • Six program groups based on specific target behaviors RISK Levels Needs Stabilizing Factors
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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 self-‐control.
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
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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
Self-‐Improvement & Self-‐Management (Abuse, MH)
Program Group D
Social and Interpersonal Skills
Program Group E
Life Skills
Program Group F
Punishment
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Step Up/Down Depending on Responsivity Factors Program Group A
Severe Substance Use Disorder
Program Group B
Criminal Thinking/Cogni4ve Restructuring
Program Group C
Self-‐Improvement & Self-‐Management (Abuse, MH)
Program Group D
Social and Interpersonal Skills
Program Group E Program Group F
Life Skills Punishment
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Intensify Dosage & Program Structure from Key Lifestyle Issues
Program Intensity
ü Anti-social Peers ü Social Support/Lack of Social Supports ü Housing Instability • Education Level • Employment Status • Mental Health • Financial Issues
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No Whack a Mole: Decision Rules Severe Substance Use Disorder? u Always Group A! Criminal Thinking? u Schemas, regardless of risk—Always Group B u Criminal Thinking (elevate), moderate to high risk, destabilizers—Group B Intensity Programming with….. u Housing Instability u Lack social supports (prosocial) u Criminal Schemas Council of State Governments Jus4ce Center | 27
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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 system-‐wide change
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Group A
Group B
Group C
Group D
Group E
Group F
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APD Estimated Responsivity Gap
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• Greatest unfulfilled needs are cogni4ve restructuring programs, mental health, co-‐occurring 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 32 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
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Probation Population Needs & Recidivism Rates (n=1000) 25% 20% 15% 10% 5% 0%
High Dosage
Moderate Dosage
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Responding to Risk and Needs How well do the programs adhere to EBPs?
How well does my system address risk-‐ needs of offenders?
What type of risk/needs does a par4cular Person need? Council of State Governments Jus4ce Center | 36
www.gmuace.org/tools
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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 Offenders with Co-‐ Occurring Substance use and Mental Health ProBlems-‐-‐Awarded 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.
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MISSION Criminal Justice Edition: Understanding the Criminal Justice Sequential Intercept Framework
Clinical Evaluation and Treatment of Substance Use
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Criminogenic Risk Factors: The Risk-‐Need-‐Responsivity 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) 40
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MISSION is TRAUMA INFORMED Adverse Childhood Events Data for Youth Referred to Massachusetts Juvenile Court Clinics •
Six Month Data 10/2/12-‐3/31/13 Findings: Median Score
CDC Study of General Popula(on
JCC Referred Youth
1
5
• (ACES data scores 1-‐10)
•
63% had scores of 4 or more (compared with 12.5% in the CDC sample) Short and long-‐term outcomes: health and social difficul4es
•
(Source: MassachuseJs Alliance of Juvenile Court Clinics data report 2013)
•
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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 42 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 community-‐based mental health system/Reduce recidivism treatment
Assessment Level (RNR) Match level of treatment to the Iden4fy criminogenic needs and level of risk to re-‐offend use these to inform treatment
Interven(on/Person Level (MISSION-‐CJ) Provide direct treatment Addi4onal focus on criminogenic services to address co-‐occurring needs and responsivity to reduce disorders with trauma-‐informed 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 iden4fied
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
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MISSION-‐CJ: 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
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MISSION-‐CJ Model Combining evidence-‐based services into a comprehensive system of care
Core Services Cri(cal Time Interven(on (CTI) Dual Recovery Therapy (DRT)
Risk-‐Need-‐ Responsivity (RNR)
Support Services Voca(onal and Educa(onal Support Trauma Informed Care
Peer Support
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Educa4onal and Voca4onal Support
Housing
Case Management and Peer Support
General Medical Care
Benefits
Mental Health Services
Substance Abuse Treatment
Criminal Jus4ce Council of State Governments Jus4ce Center | 46
MISSION Key Clinical/Social Outcomes
Increase community tenure
Reduce re-‐hospitaliza4ons
Improve psychiatric Increase the number and substance abuse of days employed and outcomes wages earned
-‐Smelson, et al. (2005). Preliminary outcomes from a community linkage interven4on for individuals with co-‐ occurring substance abuse and serious mental illness. Journal of Dual Diagnosis, 3(1), 47-‐59. -‐Smelson, et al, (2007). Six month outcomes from a booster case management program for individuals with a co-‐ occurring substance abuse and a persistent psychiatric disorder. European Journal of Psychiatry, 21, 143-‐152. -‐Smelson, et al, (2012). A Brief Treatment Engagement Interven4on for Individuals with Co-‐occurring Mental Illness and Substance Use Disorders: Results of a Randomized Clinical Trial. Community Mental Health Journal, 48(2), 127-‐132. -‐Smelson, et al, (2013). A Wraparound Treatment Engagement Interven4on for Homeless Veterans with Co-‐ occurring Disorders. Psychological Services, 10(2), 161-‐7.
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SAMPLE PRIOR MISSION PROJECTS Model Development (1999-‐2005) PI David Smelson Supported by VA OPCS/VISN 3 MIRECC
Components: Model Development, Pilot Tes4ng SeBng: Acute psychiatry/inpa4ent treatment program
Brief 2-‐month Interven(on (2005-‐2009) 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 (2004-‐2010) PI David Smelson Supported by SAMHSA
Components: CTI, DRT, Peer Support, and Voca4onal Support; Treatment Length: 12 months SeBng: Residen4al treatment program
MISSION-‐VET 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 Trauma-‐Informed 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 (2009-‐2011) PI Debra Pinals Supported by the Bureau of Jus4ce Assistance (BJA)
Components: Dual Recovery Therapy, Cri4cal Time Interven4on, and Voca4onal Support with trauma-‐sensi4ve contribu4ons; Treatment Length: 3 months pre-‐release and 6 months post-‐release Target PopulaHon: female offenders with co-‐occurring substance abuse and mental health disorders who commiJed a non-‐violent offense
MISSION Jail Diversion Project (2008-‐2013) PI Debra Pinals Supported by SAMHSA-‐CMHS.
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 HUD-‐VASH Randomized Controlled Trial (2011-‐2013) PI David Smelson Supported by VA Na4onal Center for Homeless Veterans
Components: In addi4on to standard HUD-‐VASH Case Management, for 6 months, par4cipa4ng Veterans will receive either MISSION-‐VET, Telephone Counseling or symptom monitoring via telephone; Treatment Length: 6 months SeBng: Formerly homeless, dually diagnosed Veterans who have received housing placements through HUD-‐VA Suppor4ve Housing Program
MISSION-‐Vet Implementa(on Study (2011-‐2014) 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 MISSION-‐Vet Interven4on within VA Homeless Services SeBng: Formerly homeless, dually diagnosed Veterans who have received housing placements through HUD-‐VA Suppor4ve Housing Program in Boston, MA, Washington D.C., and Denver, CO.
MASS-‐MISSION: Ending Chronic Homelessness in Central and Western MA(2011-‐2014) PI David Smelson Supported by SAMHSA-‐CABHI
Components: Housing Placement, CTI, DRT, Peer Support, Trauma-‐Informed 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 co-‐occurring disorders
MISSION IRAPS (2013-‐2015) PI Debra Pinals Supported by the DOJ Second Chance Act
Treatment Length: 3 months pre-‐release and 6 months post-‐release Target PopulaHon: medium-‐ and high-‐risk female and male offenders with co-‐occurring substance abuse and mental health disorders (may have commiJed a violent or non-‐violent offense) Council of aSnd tate Governments Center | 48 Components: Dual Recovery Therapy, Cri4cal Time Interven4on, Voca4onal Support wJus4ce ith trauma-‐sensi4ve
Adapting MISSION to Reentry Services Grant
Funding Source
Target Popula(on
Risk Level
MISSION-‐CREW (Community Reentry for Women) 2009-‐2011
DOJ/JMHCP Female 2009-‐MO-‐BX-‐0037 Offenders; CODs and Trauma
Non-‐violent
MISSION-‐RAPS (Reentry and Peer Support); 2011-‐2013
DOJ/SCA Female 2011-‐RW-‐BX-‐0010 Offenders
Medium and High Risk
MISSION-‐IRAPS DOJ/SCA Male & (Integrated Reentry and Peer 2013-‐RW-‐BX-‐0003 Female Support); 2013-‐2015 Offenders; CODs and Trauma
Medium and High Risk
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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
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MISSION IRAPS (M-‐IRAPS) FLOW CHART Iden(fy Eligible Inmates Rule out out-‐of-‐area 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
M-‐RAPS 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
M-‐RAPS Services Con4nues upon release and is ongoing for 4-‐5 months
6th Month Follow Up Assessment (Only for those consen4ng to Evalua4on)
M-‐RAPS Services Commence RSS* and PSS** meet with inmate in pre-‐release 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 follow-‐up data collec(on (Only for those consen4ng to Evalua4on) Up to a year and a half a]er follow-‐up assessment
*RSS = Re-‐entry Services Specialist or M-‐RAPS Clinical Case Manager **PSS = Peer Services Specialist or M-‐RAPS Peer Support Specialist
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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, problem-‐solving irresponsibility, help coping, problem-‐ 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 significant 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 co-‐occurring 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
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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
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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
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IRAPS, RAPS, and CREW Sample: Baseline • 62-‐75% have chronic medical problems which con4nue to interfere with life • 55-‐74% have been troubled by psychological or emo4onal problems in past 30 days • 45-‐80% repor4ng trauma4c symptoms and/or trauma exposure to par4cular events, o]en both recently and before age 18
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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)
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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%)
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Conclusions • Popula4on with complex need, but poten4ally improved outcomes • • • •
Criminogenic Psychosocial Trauma Drug Use
• Early recidivism data shows variable re-‐arrest but likely reduced reincarcera4on. Majority of par4cipants successfully complete 6 month post-‐release services. • Parole/Proba4on intensive surveillance because of program enrollment, possibly higher likelihood to violate. • MISSION-‐CJ holds promise • Helps behavioral health providers work more closely with criminal jus4ce en44es • Ongoing learning lessons con4nue
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TYGR Transi4on-‐age Youth Grounds for Recovery
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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 18-‐25 with co-‐ occuring disorders sentences to at least 120 days and a 3-‐5 year formal proba4on grant
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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)
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TYGR (Phase 2) • Intensive family based re-‐entry 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 9-‐12 month program dura4on
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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
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TYGR Treatment/Case Plan Collaboration
The dedicated TYGR Clinician and Proba4on Officer will conduct the assessments of the individual offender as a team -‐ STRONG Assessment -‐ Addic4on Severity Index -‐ 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 -‐ The targeted interven4ons may be different due to the difference in what the agencies are targe4ng (re-‐offend 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
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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
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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