1. Veterans Treatment Courts American Judges Association 2012 Educational Conference-New Orleans Presented by Judge Robert Russell

2. Outline Who is a Veteran? Who is a Veteran? Who are they? Who are they? Justice-involved Veterans Justice-involved Veterans What is a Drug Court? What is a Drug Court? How is a Veterans Treatment Court different? How is a Veterans Treatment Court different? Why have a Veterans Treatment Court? Why have a Veterans Treatment Court?

3. Who is a Veteran? Prior or Current Service in the U.S. Armed Forces Army, Navy, Air Force, Marine Corps, or Coast Guard Army, Navy, Air Force, Marine Corps, or Coast Guard Active Duty, Reserves, National Guard Active Duty, Reserves, National Guard Anyone who has served regardless of discharge (VA) Anyone who has served regardless of discharge (VA)

4. Veterans: Who are they? 23.2 million Veterans in the United States 23.2 million Veterans in the United States 5.2 million have served from the Gulf War to present 5.2 million have served from the Gulf War to present 2 Million members of the armed forces have served in Iraq and Afghanistan since October 2001 2 Million members of the armed forces have served in Iraq and Afghanistan since October 2001 As of December 31, 2007, more than 800,000 veterans of these conflicts were eligible for VA healthcare As of December 31, 2007, more than 800,000 veterans of these conflicts were eligible for VA healthcare

5. Reserve and National Guard 254,000 Reservists and 332,000 National Guard members have deployed to OEF/OIF 254,000 Reservists and 332,000 National Guard members have deployed to OEF/OIF Increased stress on families, employment, and housing Increased stress on families, employment, and housing

6. Women Veterans 1.8 million of today's Veterans are women (7.5%) 1.8 million of today's Veterans are women (7.5%) 20% of all military personnel are represented by women 20% of all military personnel are represented by women 182,000 served in OEF/OIF 182,000 served in OEF/OIF 5% of the Veteran homeless population are women 5% of the Veteran homeless population are women 4 times more likely to become homeless than male veterans 4 times more likely to become homeless than male veterans

7. Homelessness Over 67,000 Veterans will be homeless tonight Over 67,000 Veterans will be homeless tonight Veterans 50% more likely to become homeless than non- Veterans Veterans 50% more likely to become homeless than non- Veterans 76% suffer from a substance abuse and/or mental health condition 76% suffer from a substance abuse and/or mental health condition Criminal involvement is single best predicator of future homelessness Criminal involvement is single best predicator of future homelessness

8. Unemployment As of Oct 2011, unemployment rate for Veterans was 11.5% who served since September 2001 As of Oct 2011, unemployment rate for Veterans was 11.5% who served since September 2001 Rate for 18-24 yr old Veterans was 21.9% Rate for 18-24 yr old Veterans was 21.9% Bureau of Labor Statistics

9. Suicide Veterans make-up 1% of the population, but 20% of suicides Veterans make-up 1% of the population, but 20% of suicides Women Veterans are 2-3 times more likely to commit suicide than non-Veteran women Women Veterans are 2-3 times more likely to commit suicide than non-Veteran women Suicides among active duty Army and Marines have increased following OEF/OIF Suicides among active duty Army and Marines have increased following OEF/OIF VA indicates 4 or 5 Veterans commit suicide each day VA indicates 4 or 5 Veterans commit suicide each day

10. Traumatic Brain Injury (TBI) Primary: Resulting from initial trauma Secondary: Resulting from Intracranial Pressure (ICP), hypoxia, hypotension. In 2010: 31,407 cases of TBI 11,800 troops injured in IED attack 28% of all military evacuated to Walter Reed AMC = TBI Rapid evac + treatment = 96% survival rate TBI is not only the result of combat

11. Post Traumatic Stress Disorder (PTSD) Exposure to traumatic event in which both of following present: (1) Person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. (2) Person’s response involved intense fear, helplessness, or horror.

12. How common is PTSD among Veterans? Vietnam – 15% men/8% women (31%/27% est. lifetime prevalence) Vietnam – 15% men/8% women (31%/27% est. lifetime prevalence) Desert Storm – 10% Desert Storm – 10% Operations Enduring Freedom & Iraqi Freedom (OEF/OIF) – 14% Operations Enduring Freedom & Iraqi Freedom (OEF/OIF) – 14% –Est. 300,000 suffering from PTSD or major depression (2010) Repeated deployments increase the likelihood of PTSD Repeated deployments increase the likelihood of PTSD

13. Combat Experience (OEF/OIF) 78%Received incoming artillery, rocket or mortar fire 78%Received incoming artillery, rocket or mortar fire 72%Knew someone seriously injured or killed 72%Knew someone seriously injured or killed 60%Saw dead bodies or human remains 60%Saw dead bodies or human remains 58%Received small arms fire 58%Received small arms fire 56%Had a member of their unit become a casualty 56%Had a member of their unit become a casualty 49%Saw dead or seriously injured Americans 49%Saw dead or seriously injured Americans 33%Handled or uncovered human remains 33%Handled or uncovered human remains

14. Military Sexual Trauma (MST) Both sexual harassment and sexual assault that occurs in military settings Both sexual harassment and sexual assault that occurs in military settings 60% of women with Military Sexual Trauma also suffered from PTSD 60% of women with Military Sexual Trauma also suffered from PTSD VA Screening, 2002-2008

15. Substance Abuse Among active duty service members: Heavy drinking (five or more drinks per occasion at least once a week) self-reported at 20%. Heavy drinking (five or more drinks per occasion at least once a week) self-reported at 20%. –Heavy drinking is higher among 18 to 34 age group than civilians. Prescription drug misuse doubled from 2005 to 2008 ( 5% in 2005 to 12% in 2008) Prescription drug misuse doubled from 2005 to 2008 ( 5% in 2005 to 12% in 2008) Dept of Defense Behavioral Health Survey - 2008

16. Justice-involved Veterans Less likely to be arrested or incarcerated Less likely to be arrested or incarcerated Average 10% of criminal justice population Average 10% of criminal justice population Approx 80% with Honorable/General discharge Approx 80% with Honorable/General discharge 57% violent offenders compared to 47% of non-Veterans 57% violent offenders compared to 47% of non-Veterans Reported longer sentences for all crime types. - On average, Veterans are expected to serve 22 months longer than non-veterans Reported longer sentences for all crime types. - On average, Veterans are expected to serve 22 months longer than non-veterans Bureau of Justice Statistics - 2004

17. Justice-involved Veterans 61% of Veterans in State prison meet the criteria for substance dependence or abuse (57% of Federal prison veterans) 61% of Veterans in State prison meet the criteria for substance dependence or abuse (57% of Federal prison veterans) 54% of Veterans in State prison met one of two criteria for a recent mental health problem 54% of Veterans in State prison met one of two criteria for a recent mental health problem Veterans in State prison (45%) and Federal prison (35%) reported symptoms of mental health disorders in the past 12 months Veterans in State prison (45%) and Federal prison (35%) reported symptoms of mental health disorders in the past 12 months Veterans are more likely to report recent history of mental health services Veterans are more likely to report recent history of mental health services Experienced physical abuse: 18% Experienced physical abuse: 18% Experienced sexual abuse: 7% Experienced sexual abuse: 7%

18. What is a Drug Court? Judicially-supervised docket that provides defendants/clients with intensive treatment and other services while holding them accountable to the court, society, their families and themselves Judicially-supervised docket that provides defendants/clients with intensive treatment and other services while holding them accountable to the court, society, their families and themselves

19. Judge, Prosecution, Defense, Probation, Law Enforcement, Treatment, using a non- adversarial, team approach Judge, Prosecution, Defense, Probation, Law Enforcement, Treatment, using a non- adversarial, team approach Regular court appearances Regular court appearances Frequent and random drug tests Frequent and random drug tests Immediately rewards positive behavior, sanctions negative Immediately rewards positive behavior, sanctions negative What is a Drug Court?

20. Drug Courts 1989 – 1 st Drug Court formed in Miami, FL 1989 – 1 st Drug Court formed in Miami, FL 2011 – 2,569 Drug Courts in the United States 2011 – 2,569 Drug Courts in the United States Drug Courts Work! Drug Courts Work! –Reduce crime –Lower costs –Ensure compliance

21. Reduce Crime 75% of Drug Court clients remain arrest-free at least 2 years after graduation. 75% of Drug Court clients remain arrest-free at least 2 years after graduation. Reductions in crime last at least 3 years and can endure for over 14 years. Reductions in crime last at least 3 years and can endure for over 14 years. Drug Courts reduce crime as much as 35% more than other sentencing options. Drug Courts reduce crime as much as 35% more than other sentencing options.

22. Save Money Up to $3.36 in criminal justice costs for every $1.00 invested. Up to $3.36 in criminal justice costs for every $1.00 invested. Up to $12 for every $1 invested, when including other cost offsets (i.e., reduced victimization and healthcare service utilization. Up to $12 for every $1 invested, when including other cost offsets (i.e., reduced victimization and healthcare service utilization. Between $4,000 to $12,000 in Annual costs per participant. Between $4,000 to $12,000 in Annual costs per participant.

23. Ensure Compliance Provide more comprehensive and closer supervision than other community-based supervision programs. Provide more comprehensive and closer supervision than other community-based supervision programs. 6 times more likely to keep offenders in treatment long enough for them to get better. 6 times more likely to keep offenders in treatment long enough for them to get better.

24. Veterans have challenges, but why have a separate treatment court for them?

25. Hybrid Drug and Mental Health Treatment Courts using the Drug Court Model. Principals of both Drug & Mental Health Courts Hybrid Drug and Mental Health Treatment Courts using the Drug Court Model. Principals of both Drug & Mental Health Courts Addition of U.S. Dept of Veterans Affairs representatives, state and local agencies, and volunteer Veteran mentors. Addition of U.S. Dept of Veterans Affairs representatives, state and local agencies, and volunteer Veteran mentors. Target those who have served in the U.S. Armed Forces. Target those who have served in the U.S. Armed Forces. Jan 08 – First opened in Buffalo, NY. Jan 08 – First opened in Buffalo, NY. May 11 – Approx 100 VTCs, many are being planned. May 11 – Approx 100 VTCs, many are being planned. Veterans Treatment Courts

26. Veteran-specific Benefits and Services U.S. Department of Veterans Affairs (VA) U.S. Department of Veterans Affairs (VA)  Veterans Health Administration (VHA)  Veterans Benefits Administration (VBA) Department of Housing and Urban Development (HUD) Department of Housing and Urban Development (HUD) Department of Labor (DOL) Department of Labor (DOL) State/County agencies State/County agencies Veteran Service Organizations Veteran Service Organizations Pro Bono Legal Assistance Pro Bono Legal Assistance

27. Veterans Affairs (VA) Medical Medical  Substance Abuse  Mental Health (to include PTSD) Homeless Services Homeless Services Employment and Vocational Training Employment and Vocational Training Education Education Pension and Disability Payments Pension and Disability Payments

28. Veterans Justice Outreach (VJO) Program Outreach, assessment, case management for justice-involved Veterans in local courts and jails Outreach, assessment, case management for justice-involved Veterans in local courts and jails Veteran identification Veteran identification Assistance in eligibility and enrollment Assistance in eligibility and enrollment Continued monitoring and consultation Continued monitoring and consultation Hand-off to VA and community service providers Hand-off to VA and community service providers

29. VTC Mentor/Peer Programs Volunteers with prior or current military service Volunteers with prior or current military service Help Veterans navigate the Court, VA, and treatment systems Help Veterans navigate the Court, VA, and treatment systems Assess “other needs” and help adjust to civilian life Assess “other needs” and help adjust to civilian life Help the Veteran and Veteran’s family receive the services they need to be productive members of society Help the Veteran and Veteran’s family receive the services they need to be productive members of society

30. Military Cultural Veterans are used to: Structure Structure Leadership Leadership Loyalty Loyalty Patriotism Patriotism Camaraderie Camaraderie Teamwork & Self-reliance Teamwork & Self-reliance

31. The 10 Key Components of Veteran’s Treatment Court

32. Veterans Treatment Courts have adopted with slight modifications the essential tenements of the Ten Key Components as described in the U.S. Department of Justice Publication entitled “Defining Drug Courts: The Ten Key Components”, (Jan. 1997).

33. Key Component # 1 Integrates alcohol, drug treatment, mental health treatment, medical services with justice system case processing

34. Key Component # 2 Using a non-adversarial approach, prosecution and defense promote public safety while protecting participants' due process rights

35. To facilitate the veterans’ progress in treatment, the prosecutor and defense counsel shed their traditional adversarial courtroom relationship and work together as a team.

36. Key Component # 3 Eligible participants are identified early and promptly placed

37. Early identification of veterans entering the criminal justice system is an integral part of the process for placement in the Veterans Treatment Court program. The trauma of arrest can be an opportunity for the veteran to address denial issues.

38. Key Component # 4 Access to a continuum of alcohol, drug, mental health and rehabilitation services

39. Participants in Veterans Treatment Court may have different levels of need in a wide variety of service domains. Issues such as PTSD, TBI, Domestic Violence and homelessness may need to be assessed and addressed. Mentors

40. Key Component # 5 Abstinence is monitored by frequent alcohol and drug testing

41. Court ordered drug testing Frequent Random Use of results Drug Testing

42. Key Component # 6 Coordinated strategy governs Court’s responses to participants' compliance

43. Incentives and Sanctions Coordinated strategy establishes protocols for rewarding progress as well as sanctioning non-compliance.

44. Key Component # 7 Ongoing judicial interaction with each Veteran is essential

45. Judge as leader of the team. Continuity of relationship between judge and veteran Relationship from acceptance in program throughout treatment and commencement and aftercare The message is “Someone in authority cares”

46. Key Component # 8 Monitoring and evaluation measure the achievement of program goals and gauge effectiveness

47. Program Monitoring Measures progress against goals Results are used to monitor progress Results are used to improve operations

48. Key Component # 9 Continuing interdisciplinary education promotes effective Court planning, implementation, and operations

49. All Veterans Treatment Court staff should be involved in interdisciplinary education and training. Shared interdisciplinary training creates common knowledge and understanding.

50. Key Component # 10 Forging partnerships among the Veterans Administration, public agencies, and community-based organizations generates local support and enhances Court effectiveness

51. Questions ?