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Planning & Implementing Effective Interventions

Planning & Implementing Effective Interventions. Henry J. Steadman, Ph.D. July 16, 2009. Smart Responses in Tough Times: Achieving Better Outcomes for People with Mental Illnesses Involved in the Criminal Justice System July 15-17, 2009.

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Planning & Implementing Effective Interventions

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  1. Planning & Implementing Effective Interventions Henry J. Steadman, Ph.D. July 16, 2009 Smart Responses in Tough Times: Achieving Better Outcomes for People with Mental Illnesses Involved in the Criminal Justice System July 15-17, 2009

  2. Prevalence of Current Substance Abuse Among Jail Detainees with Severe Mental Disorders Detainees with severe mental disorder plus either alcohol or drug abuse/dependence = 72% = 72% Adapted from: Abram, K.M. and Teplin, L.A. “Co-Occurring Disorders Among Mentally Ill Jail Detainees: Implications for Public Policy.” American Psychologist, 46(10):1036-1045, 1991 and Teplin, L.A. “Personal Communication.” Policy Research Associates, Inc., 6/17/98

  3. Trauma History Interview Data (n=978)

  4. “Treatment-Resistant” Clients OR “Client-Resistant” Services

  5. Basic Goals • Keep people out who do not need to be there • Provide constitutionally adequate services when incarcerated • Link people to services to keep them from coming back because of mental illness

  6. Sequential Intercept Model

  7. Sequential Intercept Model Sequential - People move through the criminal justice system in predictable ways • Intercept - Examine this flow and look for ways to intercept persons with mental illness and often co-occurring disorders to ensure: • Prompt access to treatment • Opportunities for diversion

  8. Sequential Intercept Model

  9. Diversion = avoiding or radically reducing jail time by using community-based treatment as an alternative.

  10. “Diversion” Criminal Justice → Not filing or dropping charges (ATI) Mental Health → Not filing Condition of bail Deferred prosecution (stipulate to police report) Deferred sentencing Condition of probation

  11. Public’s Expectations Reduce recidivism Reduce violence Diversion Reduce jail days Reduce costs

  12. Diversion Logic Model Stage 1 Stage 2 Stage 3 Improved Mental Health /Individual Outcomes Identify and Enroll People in Target Group Linkage Comprehensive/ Appropriate Community-Based Services Improved Public Safety Outcomes

  13. EBP Expert Panel Meetings Assertive Community Treatment Joseph Morrissey, Ph.D. Housing Caterina Roman, Ph.D. Supported Employment William Anthony, Ph.D. Illness Management Kim Mueser, Ph.D. Integrated Treatment Fred Osher, M.D. www.gainscenter.samhsa.gov

  14. Key Expert Panel Conclusions • Forensic ACT Teams (FACT) show promise for reducing recidivism, but Forensic Intensive Case Management (FICM) may be more appropriate for up to 80% of divertees • IDDT will reduce CJ system involvement • No single model of Supported Housing has emerged specific to justice-involved persons

  15. Key Expert Panel Conclusions (2) • Supported Employment is a well documented EBP with face validity for justice-involved persons, but is untested for them • Illness Management and Recovery (IMR) has no demonstrated effectiveness on correctional outcomes • Trauma specific interventions are a promising practice with small scale studies showing reduction in trauma symptoms, but no studies on re-arrest

  16. Essential System of Case* Phase I • Forensic Intensive Case Management • Supported Housing • Accessible and appropriate medication • Peer Support *National Leadership Forum on Behavioral Health/Criminal Justice Services

  17. Essential System of Case* Phase II • Integrated Dual Disorder Treatment • Supported Employment • FACT • Cognitive Behavioral Interventions *National Leadership Forum on Behavioral Health/Criminal Justice Services

  18. Nathaniel Project (NYC) N=53

  19. Changes in Arrests and Jail Days

  20. San Francisco Behavioral Health Court* Samples: • 172 in Behavioral Health Court • 8,067 jail inmates with mental disorder • 1/14/2003 – 11/19/2004 Results: • BHC = At 18 months, 26% reduction in probability of any new charge • BHC = 55% reduction in probability of violent charge * “Effectiveness of a Mental Health Court in Reducing Criminal Recidivism and Violence.” D.E. McNiel & R.L. Binder. Archives of General Psychiatry: 2007 (164):1-9.

  21. Diversion Logic Model Stage 1 Stage 2 Stage 3 Improved Mental Health /Individual Outcomes Identify and Enroll People in Target Group Linkage Comprehensive/ Appropriate Community-Based Services Improved Public Safety Outcomes

  22. Baseline Characteristics and Subsequent Arrest

  23. Baseline Characteristics and Subsequent Jail Days

  24. Arrest and Symptoms/Functioning

  25. Monthly Jail Diversion Cost Scenarios

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