37
© 2018 The Council of State Governments Justice Center Behavioral Health Diversion Interventions Moving from On-Off Programs to a System-Wide Strategy June 1, 2018
© 2018 The Council of State Governments Justice Center
Behavioral Health Diversion Interventions
Moving from On-Off Programs to a System-Wide Strategy
June 1, 2018
Speakers
• Merrill Rotter, MD ASSOCIATE CLINICAL PROFESSOR OF PSYCHIATRY, ALBERT EINSTEIN COLLEGE OF MEDICINE
• Sarah Wurzburg, Deputy Program Director, Behavioral Health THE COUNCIL OF STATE GOVERNMENTS JUSTICE CENTER
2
Overview
• Challenges in the Field
• What is Diversion?
• Moving from One-Off Program to a Systems Strategy
3
4
National nonprofit, nonpartisan membership association of state government officials
Represents all three branches of state government
Provides practical advice informed by the best available evidence
4
Behavioral Health at the CSG Justice Center
Council of State Governments Justice Center | 5
Criminal Justice / Mental Health
Consensus Project
police chiefs | consumers | pretrial service
administrators | probation officials | state legislators |
substance abuse providers | state corrections directors |
judges | district attorneys | families | parole board
members | county executives | public defenders | crime
victims | state corrections directors | prosecutors | mental health
advocates | court administrators | mental health providers | researchers
| jail administrators | sheriffs | correctional mental health providers |
state mental health directors | victim advocates | parole officials
Criminal Justice/Mental Health
Learning Sites Program
Mission of the JPLI• The Judges’ and Psychiatrists’ Leadership Initiative (JPLI) aims to stimulate, support, and enhance
efforts by judges and psychiatrists to improve judicial, community, and systemic responses to people with behavioral health needs who are involved in the justice system.
6
Creating a community of judges and psychiatrists
Increasing the reach of trainings
Developing educational resources
Three Judges’ Guides
Subscribe to the JPLI Newsletter
Resources
7
https://csgjusticecenter.org/courts/judges-leadership-initiative/
Addressing a National Crisis of Too Many People with Mental Illnesses in Jails
An Unprecedented Response
More than 430 counties across 43 states, representing 40% of the U.S. population, have resolved to reduce the
number of people with mental illnesses in jails.
Council of State Governments Justice Center | 9
The Stepping Up Initiative’s Data-Driven Approach to Systems Change
1. Is your leadership committed?2. Do you have timely screening and assessment?3. Do you have baseline data?4. Have you conducted a comprehensive process analysis and
service inventory?5. Have you prioritized policy, practice, and funding?6. Do you track progress?
The number of people with SMI booked into jail
Reduce
1
ShortenThe average length of stay for people SMI in jails
2
IncreaseThe percentage of connection to care for people with SMI in jail
3
LowerRates of recidivism
4
Six Questions County Leaders Need to Ask
Strategies Should Focus on Four Key Measures
Council of State Governments Justice Center | 10
Framework for Police-Mental
Health Collaborations
Is our leadership committed to the police-mental health collaboration (PMHC)?
Are we following clear protocols to respond to people who have mental illnesses?
Are we providing staff with quality mental health and de-escalation training?
Do we have the resources and service connections for people who have mental illnesses?
Do we collect and analyze data?
Do we have a process for reviewing and improving performance?
Council of State Governments Justice Center | 11
Primary Practice-Level Challenges
• Targeting Interventions Based on BH Needs and Criminogenic Risk
• Assessing serious mental illnesses, substance use disorders, and criminogenic risk factors in courts and correctional facilities
• Targeting and tailoring appropriate services and supervision based on level of needs and risk
• Incorporating Assessment Information into Case Plans
• Utilizing the assessment information for BOTH behavioral health criminogenic risk in case plans
• Defining lead case planner at an agency and outlining case conferencing procedures
• Knowing When to Refer to Which Intervention
• Taking the assessment information to guide program referral such as cognitive behavioral intervention
Council of State Governments Justice Center | 12
Primary Systems-Level Challenges
• Quantification of Needs Using Data
• Systematic identification of people with behavioral health needs by courts and corrections, using validated tools and standard definitions of mental illness and SUDs
• Accurate data collection and reporting on prevalence, entries, length of stay, and connections to treatment
• Identifying System Improvements and Treatment Gaps Using Data
• Selecting strategies and designing programs based on projected impact on key outcome measures
• Specifying gaps in community-based services and treatment based on data on connections to care
Council of State Governments Justice Center | 13
Use of data to identify and prioritize systems improvements
14
Jurisdiction Metric Finding Action Taken
Bexar County, Texas
The number of people with mental illnesses in jail
County does not know how many people with mental illnesses are in the jail.
Bexar County established universal screening for mental illnesses.
New York City, New York
Length of stay
People with mental illnesses stayed in jail 112 days on average as compared to 61 days for those without mental illnesses.
New York City implemented early pretrial diversion options to move people with mental illnesses out of jail in a timely way.
Franklin County, Ohio
Connection to care post- release
More than one in three of people who had contact with the behavioral health care system in the year prior to their incarceration did not have contact with the behavioral health care system in the year following their release from jail.
The local Alcohol Drug And Mental Health (ADAMH) board establisheda jail liaison team to provide in-reach service to get follow-up appointments within two weeks of release.
Salt Lake County, Utah
Recidivism rate
One out of three people on pretrial supervision and one out of two people on county probation did not fulfill the requirements of their supervision.
Salt Lake County recommendations included establishing intensive supervision caseloads for people who are assessed as being moderate to high risk of reoffending and who are also assessed as having an SMI.
What does the term diversion mean to you?
Behavioral Health Diversion Terms
• Diversion
• Jail Diversion
• Deflection
• Early Intervention
What is Behavioral Health Diversion?
• Jail diversion is a community-based, collaborative criminal justice–mental health response for justice-involved people with mental illnesses where jail time is reduced or avoided, and the individual is linked to comprehensive and appropriate services.
– Judges’ Criminal Justice/Mental Health Leadership Initiative. (2010). Judges’ guide to mental health diversion: A reference for justice system practitioners. Delmar, NY: Policy Research Associates, CMHS National GAINS Center.
Behavioral Health Diversion Intervention• This term includes common name brand programs (like
LEAD) and local practices (e.g., court processes that lead to a diversion-related outcome). These programs and practices share the following diversion-related goals:
(1) connecting people who have behavioral health needs to treatment and support services, and
(2) reducing or eliminating jail time by exploring alternatives to traditional case processing.
18
Behavioral Health Diversion Strategy
• Diversion strategies that address systems enhancements
• Opportunities for diversion at multiple intercept points– Ability to divert eligible individuals at different points in the criminal
justice system
• For those not eligible for diversion providing providing reentry services that include connection to behavioral health services in the community
Discussion Questions
• Do you consider your specialty court diversion?
• Do you know about other diversion interventions in the court system?
• Is there a larger strategy across agencies in the criminal justice system for people with BH needs?
20
Challenges to Developing Continuum of Diversion Responses
• No clear “common” language standards for diversion related terminology
• Diversion programs and practices constantly evolving
• No clear strategies on how to build diversion opportunities throughout the criminal justice system
Key Questions• What is behavioral health diversion?
– Providing definition for diversion
• How is a system of diversion developed? – Key components needed for strategic development
• What are options for behavioral health diversion? – Describing common BH diversion interventions,
programs/practices
• How do you develop multiple diversion options for your systems?– Key components tailored for each subpart of system (law
enforcement, pretrial, courts, jails)
Overview
• Challenges in the Field
• What is Diversion?
• Moving from One-Off Program to a Systems Strategy
23
Agency-Specific Diversion Interventions
• Programs and practices that are designed to divert people at specific process-oriented phases (i.e., pre-arrest, pre/post-booking, and pre-trial) and implemented by the main agency that has the best opportunity and resources.
24
Continuum of BH Diversion Interventions
• A range of behavioral health diversion programs and practices that span a community’s criminal justice system—starting from first contact with law enforcement (arrest) through incarceration.
25
Behavioral Health Diversion Decision Points
Behavioral Health Diversion Options
Multiple Behavioral Health Diversion OptionsLaw Enforcement Considerations Pretrial Considerations Court Considerations Jail Considerations
Is our leadership committed to the police-mental health collaboration (PMHC)?
Are we following clear protocols to respond to people who have mental illnesses?
Are we providing staff with quality mental health and de-escalation training?
Do we have the resources and service connections for people who have mental illnesses?
Do we collect and analyze data?
Do we have a process for reviewing and improving performance?
Engage stakeholders
Identify target population
Conduct a comprehensive process analysis and inventory of services
Identify and leverage funding streams
Information sharing
Track progress
Engage stakeholders
Identify target population
Conduct a comprehensive process analysis and inventory of services
Identify and leverage funding streams
Information sharing
Track progress
Is our leadership committed?
Do we conduct timely screening and assessments?
Do we have baseline data?
Have we conducted a comprehensive process analysis and inventory of services?
Have we prioritized policy, practice, and funding improvements?
Do we track progress?
Specific questions are in development
Behavioral Health Diversion Continuum Components
• Engage stakeholders
• Identify target population
• Conduct a comprehensive process analysis and inventory of services
• Identify and leverage funding streams
• Information sharing
• Track progress
A Framework for Prioritizing Resources
30
Subgrouping B
High criminogenic risk/ some significant BH treatment needs
Prioritize for intensive supervision (in lieu of incarceration or as condition of release) coordinated with appropriate treatment and supports
Subgrouping A
Low criminogenic risk/ some significant BH treatment needs
Divert from criminal justice system without intensive community supervision if connected to appropriate treatment and supports
Collaborative Comprehensive Case Planning1. Interagency Collaboration and Information-Sharing
2. Staff Training
3. Screening and Assessment
4. Case Conference Procedures
5. Participant Engagement
6. Prioritized Needs and Goals
7. Responsivity
8. Legal Information
9. Participant Strengths
10. Gender Considerations
31
https://csgjusticecenter.org/nrrc/collaborative-comprehensive-case-plans/
Goal of BH Diversion Resources• Provide information on diversion • Agency-specific information on possible interventions
– Law enforcement– Courts– Pretrial – Jails
• Assist jurisdictions to develop, or modify, a continuum of diversion responses for people with behavioral health disorders in the criminal justice system – identification of BH issues, – alternatives to traditional case processing, – reduction or avoidance of jail time, and – linkage to comprehensive and appropriate community-based services.
Questions and Answers
33
learning.csgjusticecenter.org
Developing a Mental Health Court is a free multimedia curriculum for individuals and teams seeking to start, maintain, or just learn about mental health courts or other criminal justice/mental health collaborations.
Developing a Mental Health Court: An Interdisciplinary Curriculum
CSG
Ju
stic
e C
ente
r
https://csgjusticecenter.org/mental-health/learning-sites/
Criminal Justice/Mental Health Learning Sites
Contact Information Merrill Rotter, MD, Associate Clinical Professor of Psychiatry, Albert Einstein College of [email protected]
Sarah WurzburgDeputy Program Director, Behavioral Health The Council of State Governments Justice [email protected]
36
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 Council of State Governments Justice Center, the members of The Council of State Governments, or the funding agency supporting the work.
Join our distribution list to receive CSG Justice Center updates and announcements!
www.csgjusticecenter.org/subscribe
