Barnstable County Sheriff’s Office’s Educating Inmates on Medication Assisted Recovery _________________ Roger Allen LMHC Director of Inmate Services Jessica Burgess MSN, RN Assistant Director of Health Services

Barnstable County Correctional Facility Bourne, Massachusetts  Maximum capacity: 588  Head count in May, 2013:  Highest head count was upper 400’s  American Correctional Association Certified  Opened in October of 2004

Residential Substance Abuse Treatment Program (RSAT)  Therapeutic Community separate from general pop.  Six Month minimum requirement for participation  Structured curriculum based on Cognitive Behavioral Theory and Disease Model of Addiction  Military structure  Progressive phases of privileges  Inmates assessed as high risk comprise most of participants  Participants assessed initially by LSI-R:SV when entering the jail. Assessed by LSCMI when entering RSAT.  Peer leadership (Squad leaders and mentors)

Treatment for General Population o All units with sentenced inmates except segregation receive Substance Abuse Education and CBT skills with similar curriculum to RSAT o Job Readiness classes o Education classes o AA/NA o OUI Program o Re-Entry Services

Re-Entry Program Begins on Person’s Entry to Jail  Comprehensive Re-entry Needs Assessment completed at beginning of sentence. LSI-R:SV administered. High Risk individuals recommended for intense treatment  Individualized re-entry goals established based on Risk/Needs Assessment and/or co-occurring medical and mental health needs  Individualized transition plan updated 60 days prior to release or as needed  Transition plan implemented through strategic collaboration of key team players and providers on staff and in community  Bi-monthly Re-entry Team meeting at the jail with community providers and probation officers  Follow-up data collected to evaluate program effectiveness

Questions Regarding RSAT Program at Barnstable County Correctional Facility?

Indications for Pre- and Post-Release Substance-Abuse Treatment  Approximately 25% of new Intakes at BCCF require opioid detox  Approximately 35% of all inmates meet criteria for drug or alcohol dependence  Highest risk of death is in the first 2 weeks after release; i.e.; overdose  Recidivism is tightly linked to relapse  Expense of incarcerating non-violent offenders  Substance abuse is a causative factor for criminogenic behavior

Current Options for Opioid/Alcohol Addicted Individuals After Release  Relapse  Abstinence  Counseling  12 Step Programs  Medication Assisted Treatment Opioids: *Methadone *Suboxone Opioids & Alcohol: *Vivitrol

Vivitrol (Extended-Release Naltexone)  An injectable form of the medication Naltrexone  Each dose lasts 30 days  For treatment of Alcohol and/or Opioid dependence  Reduces Cravings/Blocks positive effects of substances  Recommended abstinence from opioids for 7-10 days before administration  Non-Mood Altering/Non Addictive  Not controlled/No Street Value  No withdrawal

The Vivitrol Program is a Medication ASSISTED Treatment  The medication is only 1 aspect of treatment  The medication is intended to help prevent relapse while the addicted individual works to make lasting behavioral changes  Other treatments (counseling/meetings) are necessary for lasting recovery

Vivitrol Program Outline  Programs department presents information about Medication- Assisted Treatment to inmates in RSAT  Inmate requests treatment/information  Medical Director, Assistant Director, or Transitional Healthcare Coordinator meets one on one with inmate to determine if appropriate treatment for individual  Medical Clearance obtained by Medical Director

Vivitrol Program Outline(Cont.)  Motivation Assessment (involvement in available programs)performed  Risk Assessment (LS/CMI) performed  Two counseling sessions with Mental Health Staff  Oral Naltrexone trial for 3 days  Vivitrol administered 1 week prior to release  Mass Health Insurance initiated & follow-up treatment at community clinic scheduled prior to release

Vivitrol Program Data Collection  Inmate self-reported and recorded data pre- and post- treatment compared  Validated assessment tool: LS/CMI  CORI reports run for 2 years after release  Inmate self-reports level of cravings to use substances before and after Vivitrol program treatment  Release of Information signed by inmate to allow communication with follow-up treatment providers and personal contact. Allows for data collection of progress post-release

Data of Interest  Clean time history compared to current treatment  Compliance with appointments, counseling requirements, and monthly Vivitrol injections  Contributing to the work force?  Recidivism- Is treatment increasing time between incarcerations?

Preliminary Results  37 Inmates treated since April 2012  20 remain in treatment in the community  2 are no longer being treated with Vivitrol, but remain in recovery in the community  59% of inmates treated remain in recovery  31 of the 37 treated in the vivitrol program followed through with treatment at referral site in the community (Presented at first appointment) 84%  4 of the inmates treated have been re-incarcerated 11%

Questions? Roger Allen LMHC Director of Inmate Services Barnstable County Sheriff’s Office Jessica Burgess MSN, RN Assistant Director of Health Services Barnstable County Sheriff’s Office

Next Presentation Domestic Violence and RSAT June 19, :00 – 3:00 p.m. EDT Although substance abuse is the universal common denominator among RSAT inmates, many share another common challenge, domestic violence (DV). Among RSAT populations are a high proportion of both domestic violence victims and perpetrators. In fact, some RSAT inmates’ substance abuse may have been the result of self-medication to deal with the stress of domestic violence. It also plays a major role in post-release recidivism. Studies indicate that after release, the second largest number of rearrests for RSAT graduates after substance abuse crimes is domestic violence. Presenter: Andrew Klein