Presented by:

The Honorable Judge Marcia Hirsch

Crystal Stanton, M.A.

Maritza Karagiorgos, M.A.

The ECM Program is a Substance Abuse and Mental HealthServices Administration (SAMHSA) grant funded initiativethat uses the risk-needs- responsivity (RNR) model toincrease the success of treatment court participants bylinking a risk and needs assessment with treatmentplanning.

This program was established in 2015 when the New YorkState Unified Court System (UCS) collaborated with EAC’sTreatment Alternatives for Safer Communities (TASC)creating the Queens Treatment Court Enhanced CaseManagement Program (ECM).

The population of focus for the ECM project are participantsthat are found eligible for one of the five felony treatmentcourts in Queens County, New York:

Queens Treatment Court (QTC)

Queens Driving While Intoxicated (QDWI) Court

Queens Mental Health Court (QMHC)

Queens Veterans Treatment Court (QVTC)

Queens Drug Diversion Court (QDDC)

All five of these courts are presided over by one Judge, theHonorable Marcia Hirsch in the same court part on differentdays.

QTC- Participants are first time felony substance abusers.

QDWI- Participants are alcohol or substance abusers

charged with driving while intoxicated.

QMHC- Participants have co-occurring or mental health

disorders.

QVTC- Participants are veterans with substance abuse

disorders.

QDDC- Handles defendants with extensive criminal justice

histories and substance abuse disorders who apply for a

judicial hearing regarding diversion to drug court

The Queens treatment courts were initially designed to serve first

time felony offenders with substance abuse issues however in

April 2009, the New York State legislature passed legislation

reforming the state’s harsh drug sentencing laws commonly

referred to as Article 216. (http://criminaljustice.ny.gov/drug-law-

reform/documents/dlr-update-report-may-2014.pdf)

This expanded opportunities for treatment diversion for addicted

offenders by allowing judges to offer treatment alternatives

without approval of the district attorney.

These drug law reforms were intended to reduce unnecessary

confinement for eligible offenders who, historically, would have

been incarcerated. Specifically defendants charged with a felony

drug charge (except class A felonies) or other nonviolent charges.

In addition to the increase in people eligible for diversion,

the NYC Department of Health and Mental Hygiene

reported that from 2010 to 2012 heroin-involved deaths

increased 71% from 3.1 to 5.3 per 100,000.(http://www.nyc.gov/html/om/pdf/2013/edb_unintentional_drug_poisoning_ov

erdose_deaths.pdf)

When hearing these statistics the only question one can

ask is how can I help? How can the treatment courts help?

In accordance with the resolution of the Board of Directors

of the National Association of Drug Court Professionals

(NADCP) certain medically assisted treatments (M.A.T.) for

addiction- including antagonist medications such as

naltrexone, agonist medications such as methadone, and

partial agonist medications such as buprenorphine which

have been proven through rigorous scientific studies to

improve addicted offenders’ retention in counseling and

reduce illicit substance use, re-arrests, technical violations,

re-incarcerations, hepatitis C infections, and mortality.http://www.nadcp.org/sites/default/files/nadcp/NADCP%20Board%20Stateme

nt%20on%20MAT.pdf

In response to these issues an enhancement of services

was required to better serve our participants. The RNR

model is implemented to affect participant behavior change

and treatment success.

Application of the risk principle requires matching levels or

intensity of treatment with the risk levels of the offenders.

High-risk offenders require intensive interventions to

reduce recidivism, while low-risk offenders benefit most

from low intensity interventions or no intervention at all.

Most participants have many needs. However, certain

needs are directly linked to crime. Criminogenic needs

constitute dynamic risk factors or attributes of participants

that, when changed, influence the probability of recidivism.

The responsivity principle refers to the delivery of services

in a manner that is consistent with the ability and learning

style of a participant.

TASC Clinical Case Management including intensive communitycase management for participants identified as medium/highrisk of recidivism.

One-on-one and/or group sessions using Cognitive BehavioralInteractive Journaling to explicitly address criminological factorsand increase self-efficacy.

Identification of health needs and connections to Health HomeCare Coordination for participants with chronic medical disorders.

Individualized case management services for participantsaddicted to opioids who are in need of M.A.T.

Integration of peer support to

facilitate drug court participation

and maintenance of recovery.

In addition to the enhancements, and consistent with the

drug court model, participants will be placed in behavioral

health treatment programs that match identified needs, will

receive trauma-informed case management, receive drug

testing, monitoring and enforcement of sanctions and

implementation of rewards.

100% of participants are screened utilizing the CorrectionalOffender Management Profiling for Alternative Sanctions(COMPAS) validated risk and needs tool.

COMPAS is a computerized assessment tool used to identifyand assess criminogenic needs and risks and to supportdecisions regarding community placement, supervision,treatment and case management.

COMPAS is a 4th generation risk assessment instrumentwhich means it addresses a number of the issues witholder generation risk assessment tools, and moreover, arespecifically designed to be integrated into not only theprocess od risk management, but also the selection ofintervention modes and targets for treatment, as well as theassessment of rehabilitation progress.

COMPAS allows the development of risk and need typologies tofacilitate the goals of specific responsivity and to guide the“matching” of interventions to client needs in the context of theCOMPAS system.

The assessment yields a risk level allowing the program totarget medium-and high-risk offenders,

and measures risk across four

dimensions, while also providing

comprehensive assessment of

health, behavioral, educational,

vocational, family and other

needs and strengths.

Participants with medium and high risks for recidivism will

engage in cognitive behavioral interactive journaling to

address criminogenic thinking in addition to ongoing drug

court services and intensive case management.

Case management and peer specialists journal with the

participants which offers support and builds rapport.

All staff involved in the ECM project have been trained inTrauma Informed Care. The treatment court team receivedtraining from the National Center for Trauma Informed Care(NCTIC) to standardize the screening process and identifytrauma victims. In addition, the GAINS Center worked withTASC to develop and pilot the trauma informed casemanagement curriculum for court case managers ensuringthe ability for a manualized trauma-informed

approach to monitoring and case

management to increase compliance,

reduce misdiagnosis, and increase

better treatment matching.

All participants are screened for trauma utilizing the

following:

➢ Post-traumatic Stress Disorder Checklist-Civilian (PCL-C 5)

A 17-item self-report checklist of the 17 DSM-IV symptoms of PTSD,

administered in this project by interviewer/clinician

➢ Adverse Childhood Experience Survey (ACE)

This is a 10 item questionnaire that can be self-administered and has

English and Spanish versions. (www.acestudy.org)

➢ Trauma History Screen (THS)

A 13-item measure that asks about 11 events and one

general event and follow-up details for those acknowledged

➢ Participants with chronic medical conditions will be assessed by

the Care Coordinator using the FACT-GP/Health Home Functional

Assessment. The tools gather information about the participant’s

physical, social/family, emotional and functional well-being.

Those eligible are referred to a Medicaid Health Home for long-

term Care Coordination even post treatment court completion. A

Health Home is a care management service model

whereby all of an individual's caregivers

communicate with one another so

that all of a patient's needs are

addressed in a comprehensive manner.

Over the past decade, peer support has expanded and is

now recognized as an important element of a consumer’s

recovery process.

A peer provider is a person who uses his or her lived

experience of recovery from mental illness and/or

addiction, plus skills learned in formal training, to deliver

services in behavioral health settings to promote mind-body

recovery and resiliency.(http://www.integration.samhsa.gov/workforce/team-members/peer-providers)

The Many Roles of a Peer

• Instill Hope • Show Recovery is Possible

• Act as a Role Model • Share Experiences

• Help Change Attitudes • Help Change Behaviors

• Build Rapport • Help with Treatment

Engagement

All ECM Peers are trained in all

interventions and work closely with case

management staff to help implement

them.

Any Questions about the ECM Program?