TASC, Inc. 2011

1. TASC, Inc. 2011

2. What is Pretrial Diversion? Alternative to prosecution/CJ dispositions Typical pretrial diversion mechanism: deferred prosecution Multiple Benefits Court System Community Offenders TASC, Inc. 2011

3. 2010 National Drug Control Strategy (Office of National Drug Control Policy) TASC, Inc. 2011

4. National Association of Pretrial Services Agencies (NAPSA) 2010 “Promising Practices in Pretrial Diversion”  Maricopa County TASC Diversion named a model program with: Operating Memorandum Of Understanding Tailored services and supervision In-house information systems configured to program specifications Established, validated clinical assessment tools Current program data maintained Independent program evaluation TASC, Inc. 2011

5. Maricopa County TASC Adult Deferred Prosecution Program (TASC Diversion) Longevity: self-sustaining program established in 1989 More than 26,000 successful completions Long term recidivism study validation TASC, Inc. 2011

6. TASC, Inc. 2011 Final rate of Survival VS Recidivism for four groups of Demand Reduction Participants(NIJ-ASU School of Justice Studies 56-72 Month Study) Group #of Cases % survival % for who recidivate TASC eligible, 1,618 45% 54% Did not enter, filed TASC ineligible, 1,389 48% 52% Filed TASC eligible, Failed program 514 57% 43% TASC eligible, Completed Program 1,096 78% 22%

7. TASC Diversion has 3 core elements fundamental to its success: Intensive Case Management Drug Testing Substance Abuse Treatment TASC, Inc. 2011

8. TASC, Inc. 2011

9. Marrya 1st SlideMarrya 1st Slide

10. Tasc, Inc 2011 Maricopa County/TASC Diversion Programs Participation Continuum Chart

11. TASC, Inc. 2011

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13. TASC, Inc. 2011 Diversion vs. Probation Diversion No Criminal Conviction $150 Intake Fee POM (90 days - 6 months) $150 TASC/$650 Drug Fund PODD (1 year minimum) $1285 TASC/$750 Drug Fund POND (1 year minimum) $1285 TASC / $1500 Drug Fund UA Testing Costs

14. TASC, Inc. 2011 Critical Components Leading to a Successful Pre-Trial Diversion Program Case Management Plays the role of support and rapport vs. enforcement role of probation officer Holds clients accountable for their behaviors and program responsibilities Assistance with community referrals (jobs, housing, intensive out-patient facilities, 12-step meetings) Treatment is more likely to end successfully when client’s have the fundamental support from a case manager

15. Critical Components Leading to a Successful Pre-Trial Diversion Program Case Management Drug Testing TASC, Inc. 2011

16. TASC, Inc. 2009

17. TASC, Inc. 2011 Critical Components Leading to a Successful Pre-Trial Diversion Program Case Management Drug Testing Treatment 80% of clients reported no prior treatment upon entering the TASC Diversion Program

18. TASC, Inc. 2011 Critical Components Leading to a Successful Pre-Trial Diversion Program Case Management Drug Testing Treatment 80% of clients reported no prior treatment upon entering the TASC Diversion Program Reporting

19. TASC, Inc. 2009

20. TASC, Inc. 2011 Critical Components Leading to a Successful Pre-Trial Diversion Program Case Management Drug Testing Treatment 80% of clients reported no prior treatment upon entering the TASC Diversion Program Reporting Accountability

21. TASC, Inc. 2009

22. TASC, Inc. 2011 Maricopa County TASC ADPPPre-Trial Diversion Benefits Community Based Early CJ Intervention Education and Prevention Treatment Accountability Court System Costs Reduces Recidivism Research and Evaluation

23. CLINICAL SERVICES PRESENTATION A Multisystemic Approach to Clinical Services

24. TASC Clinical Services TASC is licensed by the Arizona Department of Health Services, Office of Behavioral Health Licensing, as an outpatient behavioral health clinic for the following services: Substance Abuse Treatment and Education General Mental Health Treatment DUI Screenings and MVD Revocation Packets DUI Level I Treatment DUI Level II Education Misdemeanor Court Ordered Domestic Violence Treatment

25. Counseling Services TASC provides clinical services while working collaboratively with the following referring agencies: - US Federal Probation and Pretrial - Bureau of Prisons - Arizona Department of Corrections - Maricopa County Superior Court - Arizona Department of Motor Vehicles - Partnership for a Drug Free America - Various Unified School Districts , Municipal Courts, Employers, Social Service Agencies, Attorneys, etc.

26. Counseling Services Approximately 25 - 30% of all clients receiving clinical services are participating in the Diversion Program and self-pay for services. Approximately 25 - 30% of all clients receiving clinical services are privately referred and self-pay for services. Approximately 25 - 30% of all clients receiving clinical services are under some type of Federal Probation who are generally responsible for making co-pays for services. The remaining percentage of clients receive school-based, community-based, or correctional-based clinical services through contractual agreements.

27. Counseling Services TASC Clinical Services are - Evidence-Based - Provided with an Analytically-Oriented Treatment Modality (Cognitive Behavioral Therapy – CBT) - Directed by the involvement of all Systems and Treatment Team Members

28. Motivational Interviewing All assessments/evaluations are conducted using a Motivational Interviewing approach. Motivational Interviewing is a directive, client-centered counseling style for eliciting behavioral change by helping individuals to explore and resolve ambivalence. MI focuses on the client’s ability to develop a strong sense of self-efficacy. The clinician is directive in helping participants examine and resolve ambivalence. Readiness to change is not perceived, as a trait but rather a fluctuating product of interpersonal interaction. The therapeutic relationship is more like a collaborative partnership than one that rigidly demonstrates the expert/recipient roles.

29. Clinical Assessment Before an individual can begin counseling services, he/she must complete an assessment. The assessment can be for Domestic Violence (DV); Substance Abuse (SA); General Mental Health (MH); or both (SA/MH). The assessment is a comprehensive bio/psycho/social evaluation that is comprised of the following: Questionnaire (the Actual Assessment Form) SASSI-3 (Substance Abuse Subtle Screening Inventory) MAST (Michigan Alcohol Screening Test) Drug and Alcohol Service Level Determination Checklist Mini-Mental Status Exam (Mental Health only) Aggressive Behavior Inventory (Domestic Violence Only)

30. Clinical Assessment The questionnaire addresses issues regarding the following factors: - Identifying Information; - Chief Complaint (Who referred the client here and why?); - Presenting Problem (How does the client perceive the situation? Problematic?); - Social and Developmental History, inc. Education /Training, Work History; Social Network and Support, etc.; - Family History and Functioning; - History of Abuse, Domestic Violence, etc.; - Client Social Functioning, inc. Significant Relationships; - Legal Involvement History, inc. DUI, Drug-Related Charges, and other Significant Charges, such as Disorderly Conduct, Assault, etc.;

31. Clinical Assessment - Substance Abuse and Mental Health History; - Treatment History and Background; - Medical History; - Initial Impression, including Strengths and Barriers to Treatment; - Disposition (i.e., Results of SASSI-3, MAST, etc.); - Diagnostic Impression (Axis I – V); - Treatment Recommendations

32. Case Summary for Development of TX Goals Reasons for Referral Substance Use/Abuse/Dependence Referral to Court History of Positive UAs

33. Case Summary for Development of TX Goals Initial Goals/Desired Outcomes Participants may include: Client Clinician Case Manager AA/NA Sponsor Family Member

34. Case Summary for Development of TX Goals Client’s Goals for Treatment: Success in Program, as evidenced by Successful Completion Maintain Gainful Employment No New Court Referrals Improve Coping Mechanisms, as evidenced by abstaining from Using Substances Participate in Random Urinalysis Testing (UA)

35. Case Summary for Development of TX Goals Case Manager’s Goals for Treatment: Attend Treatment Services Participate in Random UA Testing Maintain Gainful Employment No New Court Referrals Abstain from Using Substances Compliance with Terms of Program.

36. Case Summary for Development of TX Goals Systemic Strengths Versus Systemic Weaknesses/Needs Areas include: Client Family Employer Peers Community

37. Case Summary for Development of TX Goals Systemic Strengths The Client is: Ambitious Motivated to Remain Clean and Sober - Motivated to Become an AA Sponsor Motivated to Adhere to the Terms of his Program Mechanically Inclined Gainfully Employed (on a Part-Time Basis) Enjoys Playing the Guitar Kind, Considerate, and Caring Charismatic

38. Case Summary for Development of TX Goals Systemic Strengths The Client’s Family is: Mother is very Supportive and Loving Family has Reliable Transportation for Client Family is Committed to the Client’s Success Client has Regular Contact with his Family (who Reside in Phoenix) Maternal Grandmother Resides with the Family Family Owns and Operates a Successful Painting Company

39. Case Summary for Development of TX Goals Systemic Weaknesses The Client has history of: Using Alcohol and Other Drugs, as evidenced by Multiple Charges of DUI, Possession/Paraphernalia, etc. Difficulty Maintaining Employment, due to Excessive Absences Reacting Impulsively Obtained Numerous Referrals to Court for Various Charges

40. Systemic Weaknesses The Peers: Lack of Employment (None are Working) Client Reports Peers Tend to have contact with the Criminal Justice System, as evidenced by Various Charges, etc. Client Reports the Majority of Peers are Actively Using Alcohol and Other Drugs Case Summary for Development of TX Goals

41. Fit Assessment Finding the “FIT” Fit Factors: Selected Based on: Observable Measureable Evidence that they Support or Sustain the Target Behavior

42. Fit Assessment Finding the “FIT” Target Behavior: Substance Use

43. Fit Assessment Finding the “FIT” Target Behavior: Substance Use Fit Factor: Low Coping Skills. Evidence: The client self-reportedly has a tendency to use alcohol and other drugs, when confronted w/ stressful/unpleasant situations, as opposed to using adaptive coping mechanisms. Information corroborated with the client’s Clinician, Case Manager, History of AOD related charges, and other team members.

44. Fit Assessment Finding the “FIT” Target Behavior: Substance Use Fit Factor: Lack of Prosocial Peers Evidence: The client self-reportedly has a group of friends who have histories of violent behavior (i.e., assault charges, etc.), as well as and also use AOD on a regular basis. Information corroborated with the client’s Clinician, Case Manager, History of AOD related charges, and other team members.

45. Fit Assessment Finding the “FIT” Target Behavior: Substance Use Fit Factor: Continued Use of Alcohol and Other Drugs Evidence: The client self-reportedly has a tendency to experience anxiety, particularly when confronted with stressful/unpleasant situations, which then results in using alcohol and other drugs, as evidenced by positive UAs, AOD related charges, etc. Information corroborated with the client’s Clinician, Case Manager, History of AOD related charges, and other team members.

46. Fit Assessment Finding the “FIT” Target Behavior: Substance Use Fit Factor: History of Familial Substance Abuse Evidence: The client self-reportedly was raised in a household where alcoholism and substance use was prevalent and therefore repeated exposure to this occurred throughout his childhood until the age of 15 when his father (diagnosed with a dependence disorder) was incarcerated. Information corroborated with the client’s Clinician, Case Manager, History of AOD related charges, and other team members.

47. Fit Assessment Finding the “FIT” Target Behavior: Substance Use Fit Factor: Maladaptive Cognitive Perceptions (MCP) Evidence: - Client self-reported that he is the “victim” of many situations, as he is “the one who the police always charge and hold responsible for the negative occurrences in his life”. Client reported that he is “unlucky”, which is why he has had AOD related arrests. Information corroborated with the client’s Clinician, Case Manager, History of AOD related charges, and other team members.

48. Relapse and Resulting Behavior - C was dropped off, by his friend at his ex-wife’s house (1:15 AM). The client reported that he had been out drinking with a groups of friends since 6 PM the evening before. Client also reported that he also snorted “one line of cocaine”. - C began to ring the doorbell and pound on the door because his ex-wife was not answering her cell phone. - C reported that he remembers becoming angry because she wouldn’t answer the door. As a result, C began pounding louder on the door and yelling. - The C’s ex-wife comes to the door and tells him that he needs to leave the premises or she will contact the police. Functional Behavioral Analysis (FBA)

49. Functional Behavioral Analysis (FBA) - The C reported that he became angry, as a result of his ex-wife threatening to call the police when he has already been in trouble with the police. He feels like his ex-wife is “f ing with him”. - The C reported that he began to kick the door. - As a result, the client’s ex-wife calls the police. - The police arrive and arrest the client for Disorderly Conduct.

50. Antecedents & Consequences Analysis Antecedents: - Evening before incident client began using AOD because he was reportedly feeling stressed about money and worried about potentially not being able to see his children, as he is currently going through a messy divorce. - The more the client uses AOD, the more agitated he becomes. - The client’s friend (identified, as a primary support by the client) uses AOD with the client all evening and then drops the client off at his ex-wife’s house.

51. Antecedents & Consequences Analysis Client’s Cognitions/Thoughts: - The client feels that is problems go away when he uses AOD. - The client was angry with his ex-wife and confronted her once his inhibitions were lowered and his judgment was impaired due to AOD use.

52. Antecedents & Consequences Analysis Consequences: - The client is arrested by police and charged with a charge of Disorderly Conduct. - The client violated his program, as he received another charge and was under the influence of AOD at the time of the arrest.

53. Case Summary Overarching/Primary Treatment Goals: - The client will adhere to the terms of program, as evidenced by client and Case Manager reports. - The client will abstain from AOD, as evidenced by urinalysis testing. - The client will not acquire any new referrals to court, as evidenced by Case Manager, client and court reports.

54. Annex Invitation We encourage everyone to take a tour of our facility if you are ever in the area. Our Corporate Clinical Office is located at 2302 North 7th Street, Suite B, Phoenix, Arizona 85006. We will show you how clients are processed, clinical protocols and procedures, as well as urinalysis testing requirements for clinical services. Simply give us a call and we’ll make sure a Supervisor is free to assist you.

55. TASC, Inc. 2011 The End