Presentation on theme: "The Sequential Intercept Model"— Presentation transcript:
1 The Sequential Intercept Model Leah Vail, MAForensic Program DirectorMeridian Behavioral Healthcare, Inc.PresenterJim Santangelo, CAPAlachua County Court ServicesClinical Programs ManagerCo-Presenter
2 A RequestPlease turn off your cell phones, Blackberrys, Beepers, I-phones, Pagers and gameboysOr place on silent mode
3 Training Agenda A. “Criminalization of the Mentally Ill” B. Model Basics-It’s history-It’s useB. Sequential Intercept PointsC. Alachua County Discussion
4 Impact of Consumers in the Criminal Justice System Current estimates suggest that as many as 700,000 adults entering jails each year have active symptoms of serious mental illness and three quarters of these individuals meet criteria for a co-occurring addictive disorder (GAINS, 2001)
5 General Involvement in the CJ System In 2005, over 7 million people were on probation, in jail or prison, or on parole at yearend – 3.2% of all U.S. adult residents or 1 in every 23 adults. (Bureau of Justice Statistics)In 2001, the U.S. incarceration rate of 690 per 100,000 overtook Russia (670/100,000) to lead the world. Then by 2005, the rate had risen to 726/100,000.
6 Mental Health Involvement in the CJ system People with a Mental Illness are charged, convicted, and sentenced than more severely than others accused of similar crimes (Hochstedler, 1987; NY State Office of Forensic Task Force, 1991)People with a Mental Illness spend 2 to 5 times longer in jail than those without MI (Criminal Justice/Consensus Project, 2003)
7 Alachua County JailAlachua County Jail: between 10 and 25% of the detainees received psychotropic meds ( CJMHSA Planning Group).
8 Alachua County JailAccording to Jail statistics, 36% of all detainees at first appearance had either an open or previous SA or MH case. Approximately 5% had an open case, 23% had previously received MH and/or SA services as an adult, and 9% had treatment as a child.
9 The Alachua County Story 1998 – County Committee begins to identify MH/SA as reasons for growing jail populationConsensus that treatment is importantPartnership solutions sought2000 – Mental Health Court established2003 – Crisis Intervention Team grant written– Felony Mental Health Court (Div V) established– Community Based Competency Restoration program established2005 – CIT classes started– In-jail to community competency restoration– County created Mental Illness Workgroup (“MIWg”) to identify needed services and develop strategic plan for effective jail diversion system.
10 The Alachua County Story 2006 – MIWg report leads to funding for enhancing existing competency restoration program and creating a “Forensic Specialist Team”2007 – Meridian Forensic Specialist Team started-County Commission created CJMHSAG Planning CommitteeOfficial County advisory Board charged with responding to grants and other funding opportunitiesResulted in award of 3-year $2million grant that is a county and state partnership.2008 – CJMHSAG awarded funding creating the Forensic Diversion Team.2010 – CJMHSAG awarded continued funding by merging the MIWg and CJMHSAG teams to create a comprehensive Forensic Team.
11 Public Safety Coordina-ting Council Courts (Judges & Staff) Partners since 1998Public Safety Coordina-ting CouncilMH/SA ProvidersLaw Enforce-mentCounty Govern-ment (Elected & Staff)State’s AttorneyCourts (Judges & Staff)Public Defender
12 Tools for Transformation: Alachua County’s Partners Court System, Judges, AdministrationOffice of Public Defender, Office of State Attorney, Regional CouncilAlachua County JailLaw EnforcementCourt ServicesMeridianV.A.SAMH/DCFState Hospitals – FSH, NEFSH, NFETCAgency for Persons with DisabilitiesFACT teamGulf Coast HomeAlachua/Gainesville Housing Authority
13 A systematic approach to the criminalization problem There is no single solution to the problem we are calling “criminalization of people with mental illness”Cecil’s Story
14 What is the Sequential Intercept Model? “Framework for thinking about how and where diversionary alternatives might best fit a community”Marc Cherna, Director ALLEGHENY County Dept. of Human Services, Pitt, Penn
15 Basics of the Sequential Intercept Model A conceptual framework for communities to use when considering the interface between the Criminal Justice and Mental Health systems.There are a series of points of inceptions at which an intervention can be made to prevent individuals from entering or falling deeper into the criminal justice system.
16 More Basics of the Sequential Intercept Model People with mental disorders should not “penetrate” the criminal justice system at a greater frequency than people in the same community without mental disorders.Ideally, most people will be intercepted at early points, with decreasing numbers at each subsequent point.
17 Final Basics of the Sequential Intercept Model The deeper that people enter into the system costs more time, money, and energy.And the harder it is to exit them from the system.Think of the model as a funnelHandout
18 Why is this model important? State of Florida made it central to the CJMHSA grantsSAMSHA Best Practice
19 Five Stages of the Model 1. Current Services (prevention) & Emergency/Police-Based Response2. Initial Hearings and Initial Detention3. Speciality Courts4. Re-Entry to the Community from Jails and State Hospitals5. Community Corrections and Community Support Services
20 1. Current Community Mental Health Services OutreachTreatment & MedicationCase ManagementHousingTransportationMeaningful Daily ActivitiesCrisis Services
21 Treatment & Medication Mental disorders are treatable.For most mental disorders, there is a range of treatmentsRehab Services/Case ManagementTherapyPharmacological1st generation medicationNewer medications
22 Consequences of a Lack of Treatment The consumer falling into a crisisMore VulnerableInvolvement with LEOCSU admissionCriminal Charges
23 Case ManagementIn general, the more specialized, the more intensive services are betterForensic Specialists (ave caseload of 35)Intensive Case Management (caseload of 10)FACT services (team approach, max 100 clients)Traditional Case Management (caseload of 30)VA - MHICM
24 Housing The importance of housing cannot be over stated IDEALLY, the community has a range of housing options, includingResidentialSRTAFPALFHousing vouchersHomeless Assistance Programs
25 Transportation Bus system/passes Are there bureaucratic barriers interfering with staff transporting consumers?Medical transportMedicaid transportation
27 Crisis Services Emergency screening services CSU or receiving centers How many beds does your community have?Public CSU vs. Private CSUHow easy is it to access these beds?Educating LEO re: the Baker ActInvoluntary Outpatient Commitment
28 If treatment is so effective, then why are so few people receiving it? Less than a third of adults with a diagnosable mental disorder and even smaller proportion of children receive any mental health services in a given year (Surgeon General report)StigmaFear of being hospitalizedCostOrganizational barriers - No accessNot having the timeThinking that they could handle it aloneThinking that no one could helpDenial –lack of insight into illnessSide EffectsSubstance Abuse
29 1. Emergency/Police-Based Response. “Law enforcement agencies have played an increasingly important role in the management of persons experiencing psychiatric crisis” Lamb et al (2002)7 to 10% of patrol officer encounters involve persons with mental disorders.Historically mental health and law enforcement have not worked closely together.
30 Emergency/Police-Based Response. The prototype of the specialized police officer approach is the Memphis Model Crisis Intervention Team (CIT), which is based on collaboration between law enforcement, the local community mental health system, and other key stakeholders.CIT has lower arrest rates, high utilization by patrol officers, rapid response time, and frequent referrals to treatment.
31 CIT in Florida CIT Mobile Crisis Team (Tampa,FL) Emergency/Police-Based Response a Rural and Multi-Jurisdictional Crisis Intervention TeamEnhanced mental health, crisis intervention, system awareness at the police academy
32 Emergency/Police-Based Response:Alachua CIT started March 2005Steering Committee contains representatives by GPD, ASO, UPD, DCF, Meridian, NFETC, Alachua County Crisis Center, VAThree classes per year*Alachua County Crisis Center, CAREs Team, Crisis Hotline, Therapy*Mental Health Training for 911 operators*Mental Health and BA Training for LEO
33 2. Initial Hearings and Initial Detention– Even when optimal mental health service systems and effective pre-arrest diversion programs are in place, some individuals with serious mental disorders will be arrested.On the basis of the nature of the crime, such individuals may be appropriate for diversion to treatment, as a condition of pre-trial release
34 Initial Hearings and Initial Detention– Post arrest diversion procedures may include having the court employ mental health workers to assess individuals after arrestMH workers advise the court about the possible presents of mental illness and options for assessment and treatment.Courts may develop collaboration with the public mental health system, which would provide staff & services
35 Initial Hearings and Initial Detention : Alachua Several points of initial contact at Booking In and First Appearance:Jail classificationJail Mental HealthCentralized Screening Team – Court ServicesFirst appearance staff – judges, attorneys
36 Initial Hearings and Initial Detention : Alachua Individual then are screened for services:MH CourtCourt Service Supervision, Day Reporting and TreatmentMeridian Forensic ServicesPotential Div V casesVeterans ServicesDrug Court
37 At SentencingWant the Judiciary to be informed at sentencing to make sure that the appropriate conditions are established
38 3. Specialty Courts–Incept 3 intervention that is receiving attention are the establishment of separate court programs specifically to address the needs of persons with mental illness.Special jurisdiction courts limit punishment and instead focus on problems solving strategies and linkage to community treatment to avoid further involvement in the criminal justice system.
39 Specialty Courts–The national GAINS center estimates that there are now 114 mental health courts for adults in the United States.Most are for misdemeanor defendants.
40 Court : National Best Practices Many Counties are starting to just develop misdemeanor courts1st such Court in the United States of America was in Broward county2nd such court in Florida was in Alachua County1st Felony Court in Florida was Alachua County
41 Court: Alachua (MH Court) The Alachua County Mental Health Court is a pre-adjudication diversion program, and the charges will be dismissed if the individual successfully completes the mental health court plan. This is a VOLUNTARY court. Court Services, Meridian, State Attorney, Public Defender work as a team.Alachua County and Columbia County2011 data on 204 participants indicated that:Average Jail Days was before Mental Health CourtAverage Jail Days was 2.4 after Mental Health Court
42 Court: Alachua (Div V Felony Forensic Court) Participants are individuals who have been found Not Guilty by Reason of Insanity, Incompetent to Proceed, and/or Probation with Mental Health conditions. This is a NON- VOLUNTARY court.Court Services, State Attorney, Public Defender, Regional Council, Probation and Meridian all work as a team.
43 4. Reentry/Reintegration Re-entry from Prison, Jail, and State HospitalThere is little continuity of care or communication between corrections and community mental health for mentally ill individuals who leave correctional settings.Public mental health systems may be unaware when their clients are incarcerated or released.
44 Reentry/Reintegration In addition, pressure is increasing on corrections and mental health systems to stop the cycle of recidivism frequently associated with people with severe mental illness who become involved in the criminal justice system.Assess-Plan-Identify-Coordinate – APIC Model
45 Reentry to the Community from jail and state hospital The APIC model for transitional planning from local jails breaks new ground with it’s focus on assessing, planning, identifying and coordinating transitional care.
46 The APIC Model: Assessing Assess the clinical and social needs, and public safety risks of the consumerCataloging the consumer’s psychosocial, medical, and behavioral needs and strengthsGathering information from LE, courts, corrections, CMH, & families to create a fully informed transition planIncorporating a cultural formulation in the transition planEngaging the consumer in assessing their own needsEnsuring the consumer has access to and means to pay for treatment and services
47 The APIC Model: Planning Plan for the treatment and services required to address the consumer’s needsAddressing the critical period immediately following release (1st hour,day, & week) as well as long term needsLearning from the consumer what has worked or not worked during past transitionsSeeking family inputAddressing housing needs
48 The APIC Model: Planning-2 Arranging an integrated treatment approach for the consumer with co-occurring disordersEnsuring that the consumer is on an optimal medication regimenEnsuring that they have sufficent medication to last until psychiatric appointmentConnect consumers with acute and chronic medical conditions with community medical providers
49 The APIC Model: Planning-3 Initiating benefit applications/reinstatements for eligible inmates for Medicaid, SSI/SSDI, Veterans, food stamps, and TANFEnsuring the consumer has…Adequate clothingTransportationFood
50 The APIC Model: Planning Almost all jail consumers with co-occurring mental illness and substance abuse disorders will leave correctional settings and return to the community. Inadequate transition planning puts people with co-occurring disorders who enter jail in a state of crisis back on the streets in the middle of the same crisis (Osher, Steadman, & Barr, 2002)
51 The APIC Model: Planning The outcomes of inadequate transition planning include the compromise of public safety, an increased incidence of psychiatric symptoms, relapse to substance abuse, hospitalization, suicide, homelessness, and re-arrest. (Osher, Steadman, & Barr, 2002)
52 The APIC Model: Planning Transition planning can only work if justice, mental health, and substance abuse systems have a capacity and a commitment to work together… The results will only be as good as the partnership in the community
53 The APIC Model:Identifying Identify required community and correctional programs responsible for post-release servicesNaming in the transition plan specific community referralsForwarding a complete discharge summary to the community providerEnsuring every consumer’s belongings are returned upon releaseEnsuring the consumer has a picture ID
54 The APIC Model:Identifying Ensuring that the treatment and supportive services match the consumer’s level of disability, motivation for change, and availability for community resources.Supporting conditions of release and community supervision that match the severity of the consumer’s criminal behaviorAddressing the community treatment provider’s role vis-à-vis other social service agencies, probation, and the courts
55 The APIC Model:Coordinating Coordinate the transition plan to ensure implementation and avoid gaps in careSupporting the staff in coordinating the timing and delivery of services and in helping the consumer span the jail-community boundary after releaseCase assignment must be made cooperatively by the consumer, jail, and community agency itself
56 The APIC Model:Coordinating Explicitly communicating to the consumer, family, releasing facility, and community treatment agency, the names and contact information of the person(s) who will responsible for care between the time of release and first follow-up appointmentConfirming the consumer knows details of the follow-up visitConfirming that they have adequate medicationGAINs Re-Entry Checklist
57 Community Re-entry: Alachua JAIL-Coordinated efforts are made to ensure an appropriate release plan, use A.P.I.C. model-GAINS Reentry Checklist, handout-SOAR application in jailPRISON-Limited discharge planning – usually a medication appointment with the local provider is made.-VA has Prison release programs
58 5. Community Corrections (and Community Support Services) – Consumers under continuing supervision in the community by the CJ system (usually probation) are another large group to consider.Failure to attend treatment appointments often results in revocation of probation and a return to jail.
59 MI individuals have trouble with probation or conditional release Person may never understand instructions or follow through because of symptomsPerson may be experiencing symptoms of psychosisOverwhelmed because of anxiety about the appointmentExperience paranoia & not trust enough to follow throughUnable to complete the terms of release – community service, fee’sZero tolerance probation standardsInconsistent sleep patterns due to side effects of medsUnable to plan how to get there
60 Community Corrections/Support: Alachua Interagency collaboration continues to be the key focus in Alachua County.Once per month a continuity of care meeting in held consisting of key stakeholders of the forensic population. This meeting provides agencies with a floor for planning, networking, implementation, service coordination, collaborative problem solving, referrals, and information sharing.
61 Community Corrections/Support: Alachua Department of Probation – dedicated probation officerCourt Services-Day Reporting-County Probation-Work Release-Electronic Monitoring-Court Service Contact and Treatment Supervision
62 Alachua Team Ongoing Support Meetings, leadership, & CooperationNeeded as boundary spannersInformation exchangeTimely information handoffsHIPPATraining. System training for LEO, PD, ASA, Jail, MH, Courts, & Court Services
63 Sequential Intercept Model + Community Vision A community that no longer needs jails and courts to serve as a provider of mental health and addictions treatmentPre-Booking Intercepts Crisis Intervention TeamsFully funded community based system of carePost Booking Intercepts Coordinated screening Forensic Specialists, Court ServicesCourt/Jail Intercepts In-jail specialized treatmentTherapeutic Courts (Misdemeanor, 916, Felony) Community/Jail-based Competency Restoration Services Forensic Services Court ServicesRe-Entry Intercepts Forensic Residential Treatment Forensic Specialist TeamCourt Services Peer SpecialistsPost-Release Intercepts Specialized Probation Specialized, Supported HousingNot availableIn placePartially in place
64 Working Together to Install Best Forensic Mental Health Practices Incentivize by funding, removing barriers, provide excellent resources to learn and growEncourage improvementRequire and regulateAssist local mental health systems to develop the capacity to identify and implement Best PracticesDevelop education and training materialsUtilize and share fidelity scales or other measures to evaluate implementationPromote cross system sharing
65 Alachua Diversion Statistics At the end of March, a total of 184 clients were actively participating in the program. Approximately 16% (28 of 184) received outreach/case management in the jail. Approximately 6% (12 of 184) received competency restoration services in the jail. Approximately 78% (144 of 184) of participants received treatment and/or case management services in the community, with a total of 26% (38 out of 144 people in the community) receiving treatment services, treatment groups and individual sessions.
66 Re-Cap A. Model Basics B. Sequential Intercept Points 1. (Current Services) + Emergency/Police-Based Response2. Pre/Post-arrests3. Specialty Courts4. Re-entry/Reintegration & the APIC model5. Community CorrectionsC. Alachua County Status & Recommendations