Presenters:

Jennie M. Simpson, Ph.D.

George M. Owens

Kara Ahearn, LCSW

Melissa Zhiss, MA, LPA

March 28, 2019

3:00-4:30pm ET Hosted by SAMHSA’s GAINS Center

SAMHSA’s Eight Guiding Principles for Behavioral Health and Criminal Justice

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Welcome and Housekeeping

Melissa Neal, DrPHCriminal Justice Division

Policy Research Associates, Inc.

The views, opinions, and content expressed in this presentation do not necessarily reflect the views,

opinions, or policies of the Substance Abuse and Mental Health Services Administration (SAMHSA) or the U.S.

Department of Health and Human Services (HHS).

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Disclaimer

Welcome Melissa Neal, DrPHSenior Research Associate, Policy Research Associates, Inc.

Opening Remarks Larke Huang, Ph.D.Director, Office of Behavioral Health EquitySubstance Abuse and Mental Health Services Administration

Presentations Principles of Community-based Behavioral Health Services for Justice-involved IndividualsJennie M. Simpson, Ph.D.Senior Drug Policy Advisor, Bureau of Justice Assistance, U.S. Department of Justice

Principle 5: Integrated Physical and Behavioral Health Care as Part of a Comprehensive Treatment PlanGeorge M. OwensProgram Manager, Arizona Complete Health Kara Ahearn, LCSWChief Clinical Director, Community Health Associates

Principle 7: Case Management For Justice-involved Individuals Melissa Zhiss, MA, LPAJail Liaison-Forensic Evaluations Unit, Mecklenburg County Criminal Justice Services

Questions & Closing Remarks

Melissa Neal, DrPHSenior Research Associate, Policy Research Associates, Inc.

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Agenda

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Download the Publication

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Opening Remarks

Larke Huang, Ph.D.Director, Office of Behavioral Health Equity

Substance Abuse and Mental Health Services Administration

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Introducing Today’s Presenters: Jennie M. Simpson, Ph.D.

• Jennie is a Senior Drug Policy Advisor at the Bureau of Justice Assistance. In this role, she works on the policy initiatives and training and technical assistance activities for the Comprehensive Opioid Abuse Program.

• Prior to this position, she was the Senior Staff Lead for Criminal Justice at the Substance Abuse and Mental Health Services Administration, during which she led the development of the Principles of Community-Based Behavioral Health Services for Justice-Involved Individuals.

• A specialist in law enforcement diversion, Dr. Simpson has provided training and technical assistance to law enforcement agencies, consulted to law enforcement leadership on behavioral health and homelessness, and conducted research on behavioral health and law enforcement collaborations.

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Introducing Today’s Presenters: George M. Owens

• Program Manager II with Arizona Complete Health, working with Targeted

Investment since its inception.

• Currently working on three unique justice clinics utilizing integrated care in

Casa Grande, Tucson, and Yuma, Arizona.

• Diverse knowledge of probation and treatment, and committed to justice

and treatment working hand in hand.

• Experience working on Justice/Treatment Leadership initiatives throughout

the State of Arizona, both in Probation and with Arizona Complete Health.

Programs include: Defensive Tactics as a Lead, Evidence Based Practices, Kids

at Hope, Juvenile Detention Alternatives Initiative, and most recently,

Integrated Justice Clinics.

• Retired from the Juvenile Court in 2015, after serving over 21 years to the

court system. Worked in both adult and juvenile probation settings, from

treatment services to officer safety.

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Introducing Today’s Presenters: Kara Ahearn, LCSW

• Chief Clinical Administrator at Community Health Associates in Yuma, Arizona.

• Former Clinical Director for Children’s Services at Community Health Associates.

• Licensed Clinical Social Worker in Florida and Arizona with over 16 years’ experience working with young children, adolescents, and adults.

• 12 years professional experience in the Florida Panhandle in child welfare and juvenile justice.

• Experience working with a wide range of populations, focusing on substance use, mood disorders, relationship problems, trauma, abuse/neglect, adjustment, and behavioral concerns.

• Bachelor’s and master’s degrees in Social Work from Florida State University in Tallahassee, FL.

• Mental Health Jail (Diversion) Liaison, Mecklenburg County, North Carolina.

• Held a variety of positions with Mecklenburg County Area Mental Health and MeckLINK, including State Hospital Liaison; Housing (Grant) Coordinator; and Utilization Review.

• Trained and certified as a Law Enforcement Instructor in the state of North Carolina. Taught Mecklenburg County Sheriff and Charlotte-Mecklenburg Police Officers courses on mental health issues, such as suicide precautions, general mental health diagnoses and symptoms, verbal de-escalation skills, and involuntary commitment orders.

• Former Release Coordinator with the Mecklenburg County Sheriff’s Office in the Work Release and Restitution Center. In this position, built relationships with community organizations to enable justice-involved individuals with mental and substance use disorders to work instead of serving time.

• Over 18 years of mental health experience, including work with community mental health systems, inpatient psychiatric units, criminal justice systems, and with the homeless.

• Former Program Director of Kalamazoo County (Michigan) Substance Abuse Diversion Program (felony drug treatment court).

• Licensed Psychological Associate and a master’s level clinical psychologist.

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Introducing Today’s Presenters: Melissa Zhiss, MA, LPA

Principles of Community-based Behavioral Health Services for Justice-Involved

Individuals

Jennie M. Simpson, Ph.D.

Senior Drug Policy Advisor (IPA)

Bureau of Justice Assistance

U.S. Department of Department of Justice

Principles of Community-based Behavioral Health Services for Justice-involved Individuals: Building Bridges

• Why Principles?

Historically, focus on ensuring criminal justice professionals can appropriately respond to individuals with mental and substance use disorders

o Resources focused on training and tools for criminal justice professionals

Increased focus on the role of behavioral health providers in preventing and reducing justice involvement

o Significant gap in information, resources, and tools for providers on criminal justice and working with justice-involved individuals

Key Challenges

for Providers

• Partnerships

With law enforcement, pre-trial services,courts, and community corrections

Necessary for shared and new clients

• Knowledge of criminal justice system andconcepts

Who, what, when, where, why, and how?

• Effective and responsive treatment, recovery andsupport services for justice-involved individuals

Evidence-based treatment for justice-involvedindividuals with mental and substance usedisorders

Addressing criminogenic risk and needfactors: necessary part of effective treatment

Case management and support servicesspecific to justice-involvement

Working with Justice-

involved Individuals

• Added complexity in working withthe criminal justice system

• Additional skills for addressingcriminal justice involvement

• Stigma

Development of Principles

• Technical Experts panel

August 17, 2017

National experts, communitybehavioral health providers, criminaljustice professionals, professionalassociations, federal representatives

• Peer-review by experts in relevant fields

Across fields of psychiatry,psychology, social work, criminaljustice, criminology and medicine

• Public comment on the document

May 2018

PRINCIPLE 1

Community providers are knowledgeable about the criminal justice system. This includes the sequence of events, terminology, and processes of the criminal justice system, as well as the practices of criminal justice professionals.

PRINCIPLE 2

Community providers collaborate with criminal justice professionals to improve public health, public safety, and individual behavioral health outcomes.

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PRINCIPLE 3

Evidence-based and promising programs and practices in behavioral health treatment services are used to provide high quality clinical care for justice-involved individuals.

PRINCIPLE 4Community providers understand and address criminogenic risk and need factors as part of a comprehensive treatment plan for justice-involved individuals.

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PRINCIPLE 5

Integrated physical and behavioral health care is part of a comprehensive treatment plan for justice-involved individuals.

PRINCIPLE 6 Services and workplaces are trauma-informed to support the health and safety of both justice-involved individuals and community providers.

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PRINCIPLE 7

Case management for justice-involved individuals incorporates treatment, social services, and social supports that address prior and current involvement with the criminal justice system and reduce the likelihood of recidivism.

PRINCIPLE 8

Community providers recognize and address issues that may contribute to disparities in both behavioral health care and the criminal justice system.

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Principle 5: Integrated Physical and Behavioral Health Care as Part of a Comprehensive Treatment Plan

March 28, 2019

George M. Owens, Program Manager II

Arizona Complete Health

Kara Ahearn, Chief Clinical Director

Community Health Associates

• Integrated physical and behavioral health careis part of a comprehensive treatment plan forjustice-involved individuals.

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Principle 5: Overview

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Yuma, Arizona

• Yuma County Board of Supervisors• Yuma County Adult Probation• Arizona Department of Corrections - Parole• Community Health Associates - Treatment• Hope Inc./The Living Center Recovery (TLCR)- Peer Run

Organizations• State Medicaid - Arizona Health Care Cost Containment

System (AHCCCS)• Arizona Complete Health

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Collaborative Team

• 6,500 square feet– West Entrance is the Probation Department

– East Entrance is the Clinic

• Purposeful signage, using “recovery language”

• Inviting and comfortable space

• Family friendly

• Opened June 2018, over 500 clients to date

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Clinic Named Based Upon What We Do: “Connect”

• Onsite financial assessors – marketplace

• Medical facility with on-site family nurse practitioner

• Tele-Psych services with a doctor of nursing practice

• Behavioral health services

• Case management services

• Peer support services

• On-site pharmaceutical services

• Medication Assisted Treatment (MAT)

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Core Services

• Individuals released from jail

• Individuals released from prison

• Moderate-high to high risk to re-offend

• Utilize validated actuarial assessment

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Target Population

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Culture and Cross-training

Cross-training• Understanding role of others in the team

concept.• Training on assessment tools, treatment/case

plans, and shared goals.• Breaking down silos.• Developing relationships between treatment and

supervision.

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Justice Teams

• Case manager(s) are assigned to officer orspecific units.

• Adult Recovery Team meets with client,provides coordination of caseloads.

• Communication is improved and increasedbetween team.

• Coordinate release while in custody:– Prisons use data sharing to assess release and risk level.– Jails coordinate at the pre-sentencing level on all probation-eligible

plea agreements.

• Officer initiates release plan for individual to include any sentencinglimitations.

• Case manager or jail liaison will meet with individual to developrelease plan and share with team.

• Officer will ensure plan is compliant with any sentencingrequirements.

• Jail is notified and release is authorized.

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Referral Process

• Connection is made with individual before theyreconnect with people, places, and things.

• Individual needs to see hope.

• Peer support is critical to process.

• Peer support involves someone who hassuccessfully navigated to a better life.

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Connection

• Immediate/24 hours intake assessment

• Connect to peer support at intake, if not before

• Peer support assists with navigation.

• Viable services begin within 7 days.

• Adult Recovery Team meeting within 10 days

• Refine integrated care plan.

• 30 day ongoing team meetings

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Time Lines

• Developed with member with promotion ofnatural supports.

• Utilizes the risk assessment and addresses 3 (orfewer) criminogenic needs.

• Provides dosage-based service delivery (high risk200+ hours – moderate 100+ hours).

• Completed within 30 days with ongoing teamcollaboration.

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Integrated Care Plan

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Preliminary Data - 1

521

275

Total Number Members Count

Behavorial Health Members Integrated Members

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Preliminary Data - 2

47%

21%

9%7%

36%

18%

8% 8%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

1-7 DAYS 8-30 DAYS 31-60 DAYS 61 + DAYS

First Date Of Service From Behavioral Health (BH) Admit Date

1ST BH SERVICES FROM ADMIT DATE 1ST MEDICAL SERVICES FROM ADMIT DATE

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Percent Wellness Visit Of Total Integrated Members

275

103

Integrated Member's Wellness Visit

Total number Integrate members Total number members receive wellness visit

37%

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Show Rate for Scheduled Appointments

70% 70%

61% 60%57% 57%

60% 60%65%

46%

58% 58%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19

Show Rate

Behavorial Health Show Rate Medical Show Rate

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High-risk Registry

• The High-risk Registry has been created to identify, monitor, and intervene in the subset of

members who are at the highest risk of hospitalizations or deteriorating health.

• The High-risk Registry tracks the highest risk member whose long-term health outcomes can be

completely affected with proper interventions.

DLA-20: Daily Living Activities-20

OST: Offender Screening Tool

• Identifying high-risk members for High-risk Registry:

• High-risk members: DLA-20 Level of Care 4 and/or 5, OST-

high risk need and medical diagnosis of 1 of the 3: Diabetes,

STDs, or hypertension.

• Medium-high-risk members: DLA-20 Level of Care 3, OST-

medium high and medical diagnosis of 1 of the 3: diabetes,

STDs, or hypertension.

• Community Health Associates has a family nurse practitioner who is tracking the

identified high-risk members.

• Team concept: Case manager and parole officerhave the same caseload

• We and Us culture: Team can solve their ownproblems

• Expedited service delivery• Simplified communication channels• Person-centered• Whole health

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Summary

Principle 7: Case Management For Justice-involved Individuals

March 28, 2019

Melissa Zhiss, MA, LPA

Jail Liaison-Forensic Evaluations Unit

Mecklenburg County Criminal Justice Services

• Case management for justice-involved individualsincorporates treatment, socialservices, and social supportsthat address both prior andcurrent involvement with thecriminal justice system andreduce the likelihood ofrecidivism.

Principle 7: Overview

pc: pixabay

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The Differences

Individuals who are currently involved with

the criminal justice system or reentering

communities from jails and prisons often face

unique obstacles in finding housing,

employment, and coordinating health and behavioral health care.

pc: pixabay

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What Makes Them Unique?

• Income:

Employment (Full Time/Part Time)

o Criminal Record

o Lack of Training/Education/Support

o Addiction, Mental Health, Physical Health

Supplemental Security Income and Social SecurityDisability Insurance (SSI/SSDI)

o SSI suspended up to 1 year while in custody;Difficulty reinstating

o SSDI suspended until reported by individual theyare out of custody

o Applying for SSI/SSDI when released from custody

pc: pixabay

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SOAR—Criminal Justice

• SOAR: SSI/SSDI Outreach, Access, andRecovery

• For people who are experiencing or at risk ofhomelessness

• A model for assisting individuals to apply forSocial Security disability benefits

• Sponsored by SAMHSA in collaboration withthe Social Security Administration (SSA) since2005

• All 50 states currently participate

https://www.samhsa.gov/soar

Benefits & Supportive Services

•Medicaid/Medicare

•Food Stamps

•Women, Infants andChildren (WIC)

•Veterans Benefits

•Expungement Clinics

•Providers pc: pixabay

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• Shelters

• Transitional housing

• Coordinated entry

• Family/natural supports

• Specialized behavioralhealth (BH) housing(group homes)

• Landlords (affordablehousing)

• Boarding homes/rooms torent

• Assisted living facilities/family care homes (ifappropriate)

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pc: pixabay

Housing

Supports

•Clergy

•Family

•Friends/Neighbors

•Significant other

•Previous employer

•Professionals - YOU! pc: pixabay

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Join the GAINS Center’s listserv and receive our eNews!

http://bit.do/GAINSenews(Link is case sensitive)

Substance Abuse and Mental Health Services Administration

SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

www.samhsa.gov1-877-SAMHSA-7 (1-877-726-4727) ● 1-800-487-4889 (TDD)

GAINS Center for Behavioral Health and Justice Transformation

The GAINS Center focuses on expanding access to services for people with mental and/or substance use disorders who come into contact with the

justice system.

https://www.samhsa.gov/gains-center

1-800-311-424652

Thank You