1. Behavioral Health / Criminal Justice Collaboration in Beaver County, PA Re-entry Services Council of State Governments Site Visit: May 15, 2013 1

2. Agenda / Itinerary 2 TimeLocation Focus Area 9:00 - 9:15 AM BCRC Arrival and Introductions 9:15 - 10:00 AMPart 1: Overview of CJ/BH Initiatives & Reentry Efforts 10:00 - 10:45 AMPart 2: Process Mapping of Intercepts 4 and 5 10:45 – 11:00 AMBreak 11:00 - 11:45 AMFunding and Sustainability 11:45 - 12:45 PMLunch Roundtable with Community Based Service Partners 12:45 - 1:00 PMTravel to Jail 1:00 - 2:00 PM BC Jail Screening and Assessment 2:00 - 2:30 PMJail-Based Treatment, Educational and Supportive Services 2:30 - 2:45 PMWrap Up / Next Steps 2:45 - 3:30 PMTour of Jail

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4. 4 Semi-rural county located in the southwestern region of the state about 30 miles northwest of Pittsburgh. Diverse area with pockets of affluence, as well as very poor districts, urban, and rural areas, and varying economic resources. The approximate population of Beaver County is 180,000 – 23% of the population is under the age of 18. 5.0 % of that population lives in poverty. – 11% of the total population lives in poverty The average annual wage for Beaver County was stated at $25,254, as compared to the average annual wage for the Commonwealth of Pennsylvania of $30,081. The racial composition of Beaver County is predominantly Caucasian (92.5%), followed by African American (6%), and has not changed significantly in the past 20 years. Beaver County: Overview

5. 5 Commissioners: Tony Amadio, Chairman; Joe Spanik; Dennis Nichols Beaver County Behavioral Health: Gerard Mike, Administrator Services – Mental Health Administration – Mental Retardation Administration – Drug and Alcohol Single County Authority – HealthChoices Medicaid Managed Care Administration – Early Intervention Administration – Human Services Development Fund Administration – State, Federal and Private Foundation Grant Management – Direct Services: Outpatient Assessment Center and Case Management

6. Behavioral Health Criminal Justice Partners 6 County Departments – SIM Subcommittee Community partners – NHSETCBBBS – BCRCROOTS TRAILS – ACPOVRAliquippa Impact – AHCIBB BSBenefit Specialist – HPWHACBSPA

7. Beaver County System of Care 7 Criminal Justice is a key part of the Beaver County System of Care

8. System of Care Management Structure Stakeholder Group (Provider Representatives, Change Agent Representatives, Subcommittee Representatives, Consumers, Families, Natural Supports) Stakeholder Group (Provider Representatives, Change Agent Representatives, Subcommittee Representatives, Consumers, Families, Natural Supports) Beaver County: Board of Commissioners Beaver County Behavioral Health Residents of Beaver County Steering Committee (Providers, Change Agents, and Subcommittee Representatives) Steering Committee (Providers, Change Agents, and Subcommittee Representatives) BC-HOMES BC LAUNCH Housing BC-HOMES BC LAUNCH Housing SIM - Criminal Justice SIM - Criminal Justice BC SCORES Child Serving Systems BC SCORES Child Serving Systems Employment -Transformation Employment -Transformation Quality Improvement Leadership Committee (Project Director, Steering Committee Co-Chairs, and Sub-Committee Chairs) Leadership Committee (Project Director, Steering Committee Co-Chairs, and Sub-Committee Chairs) Change Agents Family, Youth and Peer Voice 8-12

9. Evolution of COD Programs in the Justice System in Beaver County WRAP 9

10. BCBH: Using Evidenced Based Practices 10 Motivational Interviewing - 2002 Comprehensive, Continuous, Integrated System of Care (CCISC) - 2007 Seeking Safety – 2007 Supported Employment - 2008 Supported Housing – 2009 Forensic Assertive Community Treatment (FACT) - 2009 Wellness Recovery Action Planning (WRAP) – 2009 Thinking for a Change - 2010

11. Publications and Presentations: National and State Arenas Publications – Corrections Today (2005 and 2011) – Behavior Science and the Law (2009) National GAIN Center (2008) NASMHD Research Institute Conference (2006) Forensic Rights Conference (2005, 2008, 2011) 11

12. Contracting Federal Grants Contractors are provided with a budgeted contractual limit – Contract fees can be a combination of Fee For Service – Units of service provided, or – Have begun to “experiment” with outcomes based payment terms on some grants Cost Reimbursement – Typically only for out of pocket expenses such as start-up and travel Contractors are provided a list of deliverables as part of the contract 12

13. Invoicing Federal Grants Grants are invoiced from providers on a fee-for-service basis – Rates similar to HealthChoices (HC) Rates are utilized Grants are only invoiced when HC does not cover the services, such as – Ineligible individuals – Service not covered under HC Contractors are also permitted to bill grants for items not covered under HC, including: – Planning, Meetings, Training, Data Collection State funds (County Base) are used for non-HC, non-grant services 13

14. BCBH: Current Grants 14 Grant NameTermFunderPurpose BC-LAUNCH 9/08 – 9/13 SAMHSATreatment of homeless with COD TIPS (kids) 4/10 – 6/13 DOJ/PCCDTransition to independent processes ChancesR 10/10 – 9/11 DOJ Assessment and re-entry services for individuals incarcerated with COD ChancesR (2011) 10/11 – 9/13 Expanding BBBS Mentoring 10/10 – 6/13 PCCD Mentoring Kids with caregivers in the forensic system Project Recovery 10/10 – 10/15 SAMHSA Prevention/housing/employment and develop infrastructure for communication of providers CJAB-SIM 1/12 – 6/13 DOJ/PCCD CJAB Strategic Plan, MHFA training, Screening in RBC REACH 10/12 – 9/14 DOJ Released offenders who have a co-occurring mental health and substance abuse disorder SIM 2 10/12 – 9/14 DOJMHFA, RBC screens, and IT consulting

15. Training Summary: 10/2011 – 5/2013 42 Training Programs – EBP’s Motivational Interviewing Seeking Safety Supported Employment – Behavioral Health – Peer/Consumer 183.5 Hours of Training More than 1500 Participants 5 MHFA Trainings 15

16. Key Data Systems: Support System-wide Evaluation / Quality Improvement Aim is: – To support and sustain a data-driven process – Collect and report on consistent measures across programs or services as opposed to utilizing data collected differently within programs or services – Develop benchmarks, compare results against targets, implement corrective action plans 16

17. Key Data Systems HealthChoices (BH Medicaid Managed Care) County Base Probation/Parole Jail Grant-Specific Data Consumer Satisfaction Data 17

18. Data Warehouse 18 Electronic Service Plan (eSP) System Provides Framework

19. FOCUS: Increase public safety and reduce recidivism by providing services and supports to Beaver County residents with a substance use disorder (SUD) or a co-occurring substance use and mental health disorder (COD) incarcerated in the Beaver County Jail. PURPOSE: Provide, both pre- and post-release, COD treatment educational/vocational services, peer support, family mentoring, and assistance with housing. Reentry: FOCUS and PURPOSE 19

20. Reentry Flow Chart 20 Reception Re-Entry Liaison administers the GAIN and intake form. TransitionRe-Entry Engagement Community Integration Re-Entry Liaison works with client in the jail.. TRAILS and ROOTS meet with clients in the jail to establish a sponsor relationship. BCRC begins working with client in the jail on vocational/educational services Client re- integrates into the community with housing, along with sponsor relationship, and continues to work on vocational/ educational skills, treatment and other supports. Access to treatment groups in the jail.

21. Summary of Reentry Services 21 Provided by NHS HealthChoices (MA) supplemental Jail-based – ChancesR – REACH – LAUNCH Community-based – ChancesR – LAUNCH – REACH – HC – Base # of positions Assessment – Transition Planning – Follow-up

22. Available Forensic-Based Services – Throughout Criminal Justice System Screening and Assessment – Jail, Courthouse and Community Co-occurring Disorder (COD) Treatment – Jail and Community Re-Entry Liaison Assertive Community Treatment Seeking Safety / Trauma-Informed Care Re-Entry Sponsor Coordinators Assistance for Youth with an Incarcerated Parent Housing / Outreach to the Homeless Vocational / Educational Services Peer Services 22

23. Sequential Intercept Model (SIM) Planning Collaboration between the Criminal Justice Advisory Board (CJAB) and Beaver County Behavioral Health (BCBH) Builds on the key relationships and history of collaboration established with previous projects. Goal is to enhance the integration of the criminal justice and behavioral health systems for adults and juveniles in Beaver County Services from ChancesR are integral to the overall integration of systems 23

24. 24 CJAB Representatives County Commissioners Administrative Criminal Court Judge Magisterial District Judge District Attorney Chief Public Defender Deputy District Court Administrator County and State Adult and Juvenile Probation Warden of the County Jail County Sheriff Local law enforcement 911 Center Community and Peer Representatives Victim’s Advocate Family members Community partners Peers Behavioral Health Representatives Behavioral Health Administrator Behavioral health providers Crisis providers The task force is a subcommittee of the Criminal Justice Advisory Board Members represent all major behavioral health and criminal justice partners ChancesR Partners are represented CJAB SIM Subcommittee

25. Sequential Intercept Model: Overview Criminal Justice System Behavioral Health System Sequential Intercept Model Community Services and Supports: crisis support, residential and vocational support, SPA, outpatient Intercept 1 Pre-arrest Diversion Law Enforcement / Emergency Services Intercept 2 Post-arrest Diversion Initial hearings / initial detention Intercept 3 Court/Jail Diversion Special jurisdiction courts Intercept 4 Re-entry from jail Transitional support back to community Intercept 5 Probation / Parole Community support services Criminal Justice System Diversion of appropriate non-violent juveniles and adults throughout CJ system BH System 25

26. Impact People with mental illness require specialized approaches during contact with police, a substantial amount of time is spent on these contacts. Existing Services Existing options for police are detention or 302. 302’s are very time intensive. Mobile crisis services Identified Needs Identification of people, who are involved with MH system, when police are dispatched Early assessment Alternatives instead of criminal justice system Short-term respite Potential Interventions Cross-training for Behavioral health and Criminal Justice Training specific for first responders (CIT for police, EMS, and 911) Explore expanding the 911 system for early identification Explore a temporary residential option as a diversion to incarceration Additional coordination with existing crisis services to increase utilization, improve interface with police, and increase diversions Intercept 1: Pre-arrest Diversion Law Enforcement / Emergency Services 26

27. Intercept 2: Post-arrest Diversion Initial Detention / Initial Court Hearings ImpactMany individuals with behavioral health needs have little or no resources & may be detained because they are unable to post bail and are not offered release on personal recognizance. An absence of supervised treatment/support alternatives for these offenders may lead to incarceration instead of more appropriate treatment. Existing Services Medical assessment and clearance by nurse Identified Needs Behavioral health evaluation and assessment earlier in CJ process Potential Interventions Behavioral health evaluation and assessment at booking and preliminary arraignment 27

28. Intercept 3: Jail / Court Diversion ImpactOpportunity for plea agreement and diversion to connect to appropriate community resources Existing Services MH assessment service at courthouse for adults and juveniles DUI assessment program Jail-based COD assessments and treatment (mental health and substance abuse) Additional jail-based services include anger management, parenting, and education classes Identified Needs Not all police and court staff are aware of existing in-house MH forensic programs at courthouse Potential Interventions Additional cross-training on existing on-site MH assessment services to increase awareness of existing diversion options 28

29. Intercept 4: Jail/Prison and Re-Entry ImpactConnecting with community services and supports prior to and upon release to reduce recidivism. Existing Services Jail-based assessments and treatment Re-entry Liaison Vocational supports Sponsor programs Identified Needs Increase awareness of existing programs Potential Interventions Additional cross-training on jail-based services and re-entry supports 29

30. Intercept 5: Probation, Parole, Community Support ImpactMaintaining individuals in community to reduce recidivism and providing linkage between probation/parole and Behavioral health services and supports. Existing Services Specialized probation officers Assertive Community Treatment Team that includes forensic specialty Re-entry Liaisons Vocational supports Identified Needs Probation/parole officers may not be aware of available Behavioral health services that can serve as a diversion to incarceration given a violation of probation/parole. Potential Interventions Training for probation/parole officers on existing crisis / respite services to provide alternatives to incarceration. Explore a temporary residential option as a diversion to incarceration. Cross-functional reentry teams that include criminal justice and behavioral health supports 30

31. Contact Information 31 Nancy Jaquette, LSW Compliance Officer Beaver County Behavioral Health 1040 Eighth Avenue Beaver Falls, PA 15010 Phone: 724-847-6225 njaquette@bcbh.org Alex Corkos, M.A., L.M.F.T. ChancesR Project Director Alex Corkos Counseling & Consulting, LLC 4160 Washington Road - Suite 212 McMurray, PA 15317 Phone: 412-567-3930 alexcorkos@gmail.com