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Primary Preven+on of Criminal Jus+ce Involvement
for People with SMI Michael A. Norko MD, MAR
NASMHPDAnnualMee.ngArlington,VAJuly30,2017
Public Health Concepts
• Ter$arypreven$onaimstoreducethenega.veimpactofestablishedcondi.onsbyrestoringfunc.onandreducingcondi.on-relatedcomplica.ons(e.g.,diabetesmanagement&strokerehabilita.onprograms)
• Secondarypreven$onaimstodiagnoseandtreatanexis.ngcondi.oninitsearlystagesbeforeitresultsinsignificantmorbidity(e.g.,dailyaspirintopreventfurtherheartaNack,Paptestsorotherscreening)
• Primarypreven$onaimstoavoidthedevelopmentofanadversecondi.on(e.g.,immuniza.ons,bikehelmets)
Sequen+al Intercept Model (Munetz & Griffin 2006)
MunetzMR,GriffinPA:Useofthesequen.alinterceptmodelasanapproachtodecriminaliza.onofpeoplewithseriousmentalillness.PsychiatricServices57:544-549,2006
Ter.aryPreven.on
JailDiversion
SpecialtyCourts
MentalHealthProba9on&Parole
Re-entryprograms
Ter.aryPreven.on
SecondaryPreven.onCrisisInterven9onTeam
Ter.aryPreven.on
SecondaryPreven.on
“BestClinicalPrac$ces–TheUl$mateIntercept” PrimaryPreven.on(aka“InterceptZero”-GAINSCenter)
Policy Research Associates (GAINS Center): Framework for Intercept Zero*
CrisisResponse• Cer.fiedCommunityBehavioralHealthClinics• CrisisCareTeams• CrisisResponseCenters• MobileCrisisTeams
PoliceStrategies• CrisisInterven.onTeams• HomelessOutreachTeams• SerialInebriatePrograms• SystemwideMentalAssessmentResponseTeams
hJps://www.prainc.com/wp-content/uploads/2016/11/Intercept-0-Infographic-2.pdf
Problems with Primary Preven+on • EveryweekindividualswithSMIarehospitalizedforcompetencyrestora.ononmisdemeanorchargesandlow/nobond• Bestclinicalprac.cesworkwhenclientsarecollabora.ngwithtreatmentandnotabusingsubstances• Evenwhenservicesareaccessible,availableandwell-delivered&coordinated,individualsgetarrestedfornuisancecrimes• Cliniciansandcourtsgetfrustrated• Arrestandcompetencyevalua.onsandrestora.onrelievethefrustra.on(temporarily)
• UsualMo.va.onalInterviewingisnotenoughformanyclients• Clinicalstaffarenotequippedtoprovideprimarypreven.on
• Whynot?Oeen,theyhavethewrongtoolbox
Problem with tradi+onal clinical responses*
• Bestprac.cesreducesymptoms,butmaynotdecreasecriminalrecidivism• ArrestforindividualswithSMIpredictedbysamecriminogenicfactorsasaverageadultcriminalpopula.on• an.socialpersonality,cogni.on,andassociates;family/marital;school/work;leisure/recrea.on
• SpecialCogni.veBehavioralprogramsdesignedforoffenderscanreducerecidivisminindividualswithSMI
*RoNerM,CarrWA:Reducingcriminalrecidivismforjus.ce-involvedpersonswithmentalillness:Risk/needs/responsivityandcogni.ve-behavioralinterven.ons.SAMSHA’sGainsCenterforBehavioralHealthandJus.ceTransforma.on,2013.hNps://www.prainc.com/wp-content/uploads/2016/02/ReduceCrimRecidRNR.pdf
Available Cogni+ve Behavioral Programs
• ThinkingforaChange(T4C)• MoralRecona.onTherapy(MRT)
• Interac.veJournaling• Reasoning&Rehabilita.on(R&R)• Op.ons• STARTNOW
Robert Trestman PhD, MD: START NOW Presenta+on to NASHMPD Forensic Division (2016)
• Anintegra.veskillstrainingmodelinformedbyanumberoftheore.calapproaches&models-• Primarilyacogni.vebehaviortherapy(CBT)model• Includesmo.va.onalinterviewingprinciples&prac.cestoenhancemo.va.onforchange• Infusedwithelementsofcogni.veneuro-rehabilita.on,inconsulta.onwithcorrec.onalneuro-cogni.veresearcher,D.Fishbein(Fishbeinetal.,2009).• Theoriesofcriminalbehavior,includingrelevantexamplesinpar.cipantworkbooks.
Fishbein,Diana,etal."Deficitsinbehavioralinhibi.onpredicttreatmentengagementinprisoninmates."Lawandhumanbehavior33.5(2009):419.
Overall Principles
• Reinforcepersonalresponsibilityforbehavior• Iden.fystrengths&buildonthem
• Appreciate&respectindividualdifferences,capabili.es,&limita.ons
• Lookformul.pleopportuni.estoteachtheconnec.onsbetweenthoughts,feelings,&behavior:
• “Yourfeelingsdon’tmakeyouactacertainway-youchoosehowyourespondtositua.ons.”
RobertTrestmanpptavailableathNp://www.nasmhpd.org/sites/default/
files/START%20NOW%20NASMHPD%20Forensic%20Division%20Presenta.on_Trestman.pdf
Structure & Design
• 32Skillstraininggroupsessions• twiceweekly,for16weeks(orcanbeprovidedweekly)• 75minutesinlength
• Poten.alforrollingadmissions
• Clinicaltools:• Par.cipantworkbook• Facilitatormanual• Checkliststobeusedforfidelitymonitoring&supervision
• Freelyavailable,publicdomainmaterials
Specifically for offenders with behavioral disorders • Concepts&languagearesimplifiedgivenpoten.alcogni.velimita.ons
• Numerousiconsincludedinthepar.cipantworkbook-especiallyusefulwithTBIorverballylimitedpar.cipants
• Illustra.veexamples&copingbehaviorsrelevanttocorrec.onalsitua.ons
• Facilitatormanualsupportsengagingdifficult-to-engagepar.cipants:shapingbyreinforcinganymovementtowardthedesiredbehavioralchange
Units
1. MyFounda.on:Star.ngwithMe(10sessions)• Focusesondevelopingincreasedself-control&abilitytocopewithstressors
2. MyEmo.ons:DealingwithUpsetFeelings(8sessions)• Recognizing,understanding,copingwithemo.ons
3. MyRela.onships:Connec.ngwithOthers(8sessions)• Focusesondevelopingposi.verela.onshipskills
4. MyFuture:Sesng&Mee.ngMyGoals(6sessions)• Preparingforaposi.vefuturebydevelopinghope,realis.cgoals,problemsolvingskills
MixedGenderGroupPar$cipantWorkbookFORENSICEDITIONUConnHealthSusanSampl,Ph.D.RobertL.Trestman,Ph.D.,M.D.JulieWright,Psy.D.WithCogni9veRehabilita9onEnhancementsbyDianaFishbein,Ph.D.RTIInterna.onal
VersionF1.0,July2016
Discussion
• Canwetrain/augmentclinicalstaffwithSTARTNOWandothercogni.vebehavioralapproachestocriminogenicneeds?
• Canweimplementtheseapproacheswithindividualsathighriskforjus.ceinvolvementorre-involvement?
• Whatstepscanwetaketoexplorethisop.onandassessresults?