Criminal Justice and Behavioral Health Linkages Grant Overview

1. Promoting Wellness and Recovery John R. Kasich, Governor Tracy J. Plouck, Director Criminal Justice and Behavioral Health LinkagesGrant Overview Tracy Plouck, Director

2. CJ/BHOverview • A significant percentage of individuals incarcerated in jails have diagnosable mental illness and/or substance abuse disorder. • Many of these individuals repeatedly shift between the criminal justice and the behavioral health system and experience poor outcomes. • The ability of jails to treat inmates with behavioral health disorders is limited.

3. CJ/BH Needs Identified • Divert appropriate individuals from the legal system and into behavioral health services • Identify and treat inmates with behavioral health problems while incarcerated • Promptly link them to behavioral health services upon release to improve both health and legal outcomes for these individuals

4. CJ/BH Objectives • Reduce state and local correction costs • Reduce recidivism • Promote public safety • Promote behavioral health treatment • Support local partnerships • Increase/develop community capacity

5. CJ/BH Funding • $1.5 million for FY14 and $1.5million for FY15 • 12 projects were funded in FY14 • 17 projects were funded in FY15 • Serving 24 counties in FY14 and 30 counties in FY15

7. Preble County TASC andTreatment Services Treatment Accountability for Safer Communities

8. Preble County TASC and Treatment Services Justice System TASC Treatment What is TASC? TASC is an Model Program that provides an objective and effective bridge between the justice system and the treatment community. TASC reduces criminal recidivism and promotes public safety by linking clients to community based treatment services

9. Preble County TASC and Treatment Services TASC is certified by the Ohio Department of Mental Health and Addiction Services and provides the following services: Assessment Case Management Referral Urinalysis Testing Requirements to successfully complete our program Client must successfully complete an approved treatment program Remain drug-free for a minimum of 60 days Maintain stable housing Obtain legal employment and/or obtain a GED or enroll in further education Have no further court/legal involvement Clients who violate their Case Management Plan of Care receive sanctions and could be placed on Jeopardy Status.

10. Preble County TASC and Treatment Services At 10 months Goal: Abstinence Clients will remain engaged in the program as evidenced by client attending weekly treatment sessions 95% Clients will verbalize relapse triggers and behavior changes needed for abstinence as evidenced by client participation in counseling sessions 95% Clients will be abstinent at completion of treatment as evidenced by negative urine screens for a minimum of 60 consecutive days 100%

11. Preble County TASC and Treatment Services At 10 months Goal: No New Arrests Clients will remain engaged in treatment as evidenced by client enrolling in and attending first treatment session 95% Clients will comply with all court hearings as evidenced by client engaging in productive case management activities 95% Clients will incur no new arrests at completion of treatment as evidenced by arrests reports from police and community control officers 100%

12. Preble County TASC and Treatment Services All clients in the program were actively using at the time of Intake. Regular and random urinalysis testing have been conducted on all clients. To date, 334 urines have been collected, with only 26% (88) coming back as positive for illegal substances. 100% have shown a reduction in illegal substance use.

13. Preble County TASC and Treatment Services Linkage to Services Clients have been linked to the following services through participation in the TASC program: 22 - Drug & Alcohol Treatment 15 - Mental Health Services 1 - Community Action Partnership 3 - Medical Services 3 - Transportation Assistance 1 - Help Me Grow 1 - Strengthening Families Classes 1 - Housing Assistance 1 - Employment Placement Services 1 – Food Bank 12 - Job & Family Services (Medicaid enrollment)

14. Lucas County Community Innovations Project

15. Lucas County Community Innovations The project connects inmates to needed mental health services upon release from jail by providing: in-reach services focusing on engagement, and the development of a pre-release plan brief case management support (up to 60 days) until a connection (“warm hand-off”) is made with a community mental health center and other needed services i.e. DMV, Social Security, etc.

16. The Need… Almost one-quarter (23%) of the jail’s bookings in Lucas County was from 6% (993 individuals)of the offenders Cross system analysis revealed that 698 individuals had been enrolled in the MHRSB system at some point, of those, 664 individuals received at least one billable service Only 221 of the 664 individuals had received mental health services between July 1, 2012 to present The remaining two thirds of these individuals have not engaged in mental health services

17. Collaborative Partners Treatment Accountability for Safer Communities of Northwest Ohio (TASC) Lucas County Corrections Center (LCCC) Mental Health and Recovery Services Board Sheriff’s Office

18. Outcomes, Clients Served, etc Increase the number of individuals with severe mental illness referred to treatment upon release -Target: 50% of clients recommended for treatment will successfully connect with a treatment provider Decrease number of rearrests within six months of release -Target: Of the individuals who engaged in treatment, 60% will not be rearrested (too early to determine) Number of Clients Served -Since July, 2014, 26 inmates identified, 5 have been successfully linked to community mental health services, 11 have been sentenced or gave false contact information upon release, and 10 continue to be located in the jail awaiting court date

19. Lessons Learned Some projects take longer than others to implement In spite of good faith efforts some individuals do not want to engage in behavioral health services Staff turn-over greatly impacts project implementation Need for Continuous Quality Improvement

20. Criminal Justice and Behavioral Health Linkages Grant:Summit County Ashley N. Stead, LSW- Summit Psychological Associates, Inc. 205 E. Crosier St. Akron, Oh 44308 astead@summit-psychological.com

21. Summit County Grant Specifics Goal: • To increase efficacy of referral from jail release to connection with a community provider and to reduce relapse of symptoms within 30 days of release through use of a “long-acting” injectable. (i.e. Invega-Sustenna, Vivitrol) Target Population: • Inmates with diagnoses of opiate dependence and psychosis.

22. Approach (Developed by The National GAINS Center, SAMHSA & The U.S. Department of Justice)

23. Vision and Mission • Vision Statement: The Reentry Program strives to assist clients with severe mental illness and substance abuse issues to successfully re-enter society, maintain sobriety and mental health stability, and reduce their rates of recidivism by collaborating with local community providers to coordinate treatment services upon the clients release from the Summit County Jail. • Mission Statement: The Reentry Program will facilitate continuity of mental health care and substance abuse services for clients leaving the Summit County Jail by assessing the client’s needs, collaborating with community providers to coordinate treatment linkages, assisting with Medicaid applications, and monitoring client’s follow-up services with treatment providers. This model will promote client stability and self-sufficiency within the community, thus reducing rates of relapse and recidivism.

24. The Basic Needs of Reentry

25. Outcomes 172- Total number of inmates seen by reentry 7%- Re-incarcerated within 30 days of release 12%- Re-incarcerated within 30-60 days 8%- Re-incarcerated within 60-90 days 27%- Re-incarcerated <90 Days 1- Vivitrol Injection 5- Invega clients

26. Barriers • Unpredictable release dates • Timing of injections • Issues with providers accepting Vivitrol clients in the community • Inability to schedule client community appointments • Clients transferred to ODRC or other treatment facilities • Electronic Medical Records • Compatibility issues with community providers • Jail Protocol • Limited in-reach • Finding ways to integrate re-entry into current jail procedures

27. What’s Next? • Vivitrol Outpatient Clinic & Recovery Club & Café • Case Management services offered at Summit Psychological • Glenwood Jail program expansion • Collaborations with: • Drug Court & opiate specific PO’s • Medicaid • Housing Resources • Food & Clothing Resources • Reentry Case Plan Transition Meetings • Full Reentry Center

28. References Osher F, Steadman H, Barr H. A best practice approach to community re-entry from jails for inmates with co-occurring disorders: the APIC model. National GAINS Center for People with Co-occurring Disorders in the Justice System, Delmar, NY; 2002. Available from : http://gainscenter.samhsa.gov/pdfs/reentry/apic.pdf Mellow J, Mukamal D, LoBuglio S, Solomon A, Osborne J. The Jail Administrator’s Toolkit for Reentry. Washington, DC: Urban Institute Justice policy Center; 2008. Available from : http://www.jjay.cuny.edu/Jail_Admin_Toolkit.pdf

29. Supported by a grant from OHIO Mental Health and Addiction Services, Criminal Justice and Behavioral Health Linkages An Outpatient Competency Restoration Program for Criminal Court Defendants Jenny O’Donnell, Psy.D, and Kim Rosenzweig, Psy.D. Forensic Services, Forensic and Mental Health, Inc.

30. Least Restrictive Setting; • Cost of Inpatient Bed Days; • Long Wait Lists for State Hospital Restoration Beds • Delay is not therapeutic; • Delays court proceedings • ID clients going to SMI facilities; • Disruption of Client-connected community based services; • Effective Intervention for: • Psycho-Legal Education • Anxiety management • Communication Skills Why Outpatient Competency Restoration?

31. Researched what is out there • Florida, Washington • Ohio – • Created a Referral Process • Created a Psycho-educational Intervention Protocol • Educated the courts and boards about the availability and cost benefit analysis. Creation of a Program

32. Workbook • Incorporated videos • Multi-media gets and holds attention • Homework • Repetition, Repetition, Repetition • Environment Psycho-educational Intervention

33. What is Competency? What is incompetency? Being competent means that you are able to do something. • A competent mechanic can fix your car • A competent chef can cook a great meal Being incompetent means that you are not able to do something. • Someone may be incompetent at cooking • Or may be incompetent at gardening Start Where They Are

34. Legal Definition of competency Legal Definition of INCOMPETENCY ORC 2945.371 “Whether the defendant is capable of understanding the nature and objective of the proceedings against the defendant or of assisting in the defendant's defense.” Simply put, it means that you understand what goes on in court and can help your legal team with your defense. ORC 2945.37 “…because of the defendant's present mental condition, the defendant is incapable of understanding the nature and objective of the proceedings…or of assisting in the defendant's defense…” This means that the Judge thinks that right now you can’t understand what’s going on well enough to help your lawyer and defend yourself.

35. Dr. Jenny O’Donnell, Director of Forensic Services, St. Aloysius We’d be happy to discuss this with you further. ODonnell.Consulting@gmail.com 513-869-4014