Evaluating Specialty Court Programs: Adaptations and Emerging Practices Oklahoma State Conference Norman OK September 3, 2015 STEPHEN S. GOSS, JUDGE, SUPERIOR.

Evaluating Specialty Court Programs: Adaptations and

Emerging PracticesOklahoma State Conference

Norman OKSeptember 3, 2015

STEPHEN S. GOSS, JUDGE, SUPERIOR COURTS OF GEORGIA

ALBANY , GEORGIAEMAIL: JUDGESTEVEGOSS@BELLSOUTH.NET

Presentation includes PowerPoints slides from:

David A. D’Amora: Adults with Behavioral Health Needs under Correctional Supervision: A Shared Framework for Reducing Recidivism and Promoting Recovery

Council of State Governments Justice Center

Key Components ( Drug Courts)Essential Elements ( MHC)HTTP://CSGJUSTICECENTER.ORG/COURTS/PUBLICATIONS/IMPROVING-RESPONSES-TO-PEOPLE-WITH-MENTAL-ILLNESSES-THE-ESSENTIAL-ELEMENTS-OF-A-MENTAL-HEALTH-COURT/

HTTP://WWW.NDCI.ORG/PUBLICATIONS/MORE-PUBLICATIONS/TEN-KEY-COMPONENTS

Key Component # 4: Drug Courts provide access to a continuum of alcohol, drug and other related treatment and rehabilitation services

Co-Occurring Disorders Population High Over-Representation in Criminal Justice System

TRANSINSTITUTIONALIZATION

Olmstead 527 U.S. 581 (1999)

Under ADA Title II, states are required to provide community based MH treatment when recommended and if placement can be reasonably accommodated

DSM-IVDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition

Still will see in reports for some time as we transition to DSM-5

Multi-axial review

DSM-IV

Axis I- clinical disorders; mental illness(i.e psychotic disorders-schizophrenia and mood disorders-bipolar disorder) and substance related disorders

Axis II-personality disorders(i.e antisocial/obsessive compulsive) and developmental disability (MR)

Axis III- general medical issues (diabetes; hypertension; HIV)

DSM-IV Axis IV- psychosocial and environmental factors(i.e. homelessness; death of spouse)(neither legal nor medical but impacts outcomes with criminal justice population)

Axis V- Global Assessment of Functioning

DSM-5Fifth EditionCombines first three

Axes into one list;

Contributing psychosocial and environmental factors can be coded with disorders;

Separate measures of symptom severity and disability

DSM-5 Diagnostic Categories

1. Neurodevelopmental Disorders2. Schizophrenia Spectrum and Other Psychotic Disorders3. Bipolar and Related Disorders4. Depressive Disorders5. Anxiety Disorders6. Obsessive-Compulsive and Related Disorders7. Trauma- and Stressor-Related Disorders8. Feeding and Eating Disorders 9. Substance-Related and Addictive Disorders10. Disruptive, Impulse-Control, and Conduct Disorders11. Neurocognitive Disorders12. Personality Disorders

DEVELOPMENTAL DISABILITYINTELLECTUAL DISABILITY(Mental Retardation)

DSM –IV – Axis II DSM-5- Neurocognitive disorders Typically three factors: (1) sub-average intellectual functioning (i.e. IQ testing); (2)Deficits in adaptive functioning (inability to learn basic skills and adapt to changes); (3)onset of deficits during developmental period ( before age 18)

Challenges with COD Population

Diverse and complex problems-not all legal, not all medical No one clinical approach “fits all” Axis I M/H and S/A Personality disorders, learning disabilities and health issues impact treatment plans

New Business ?

Or Old Business? “They have been here Mr.Mulder”( you deal with the same folks anyway)

JAILED WITH MENTAL HEALTH ISSUES

Homeless Practically homeless-worn out welcome Housing, economic and lifestyle instability- lack of Rx regimen

History of trauma: sexual, domestic violence

JAILED WITH MH ISSUES Possible security issues: decompensated, combative with jailers Increased suicide risks Other poorly managed chronic medical issues (HIV,diabetes, hypertension)

Jail: Treatment Disruption

Decompensated on entry Formulary only: side effects

Loss SSI Rx Gap: Leave jail until Dr. appt.

Sequential Intercepts Model

Developed by Dr. Munetz and Dr. Griffin GAINS Center for Co-Occurring Disorders in the Criminal Justice System

Policy Research Associates Inc.

www.gainscenter.samhsa.gov

http://gainscenter.samhsa.gov/pdfs/integrating/GAINS_Sequential_Intercept.pdf

Key Component #6- Develop a coordinated strategy

Community mapping- where are our challenges vs. resources?

“Hon” meeting- they will come Where can you build allies? You become a pivot point in the community discussion.

Who to Call?(Who has “skin in the game”?)

State Hospital Director for your area Local MH/Addictive Disease clinic director Local ER/medical community Local shelters that work with homeless population Sheriff/Jail Director Local Advocacy/NAMI

Intercept 1- Field/Police

Crisis Intervention Training-CIT

Evidence Based Practice 2719 programs nationally in 45 states Developed by Memphis Police Department www.Cit.Memphis.edu

CIT Reduce use of force situations Reduce workers comp claims Raise awareness in law enforcement- it is what they deal with daily Change the culture in your jail

CIT Officers Most officers that go through the training feel it is very worthwhile

Intercept 1- Not a lot of judge time requiredwww.nami.org

http://www.namioklahoma.org/

http://ok.gov/odmhsas

Intercept 2- Diversion

Jail Diversionhttp://gainscenter.samhsa.gov/topical_resources/jail.asp Pre-booking vs. Post-booking Got to have a location Meet with community mental health director and local hospital administrator- EC issues/Crisis Unit

Intercept 3- Courts

Specialty Dockets/Courts

Drug Courts: National Association of Drug Court Professionals(NADCP)

www.nadcp.org Mental Health Courts: Council of State Governments (CSG) Justice Center

www.csgjusticecenter.org

http://csgjusticecenter.org/mental-health/learning-sites

Intercept 4- Re-Entry

Re-Entry Programs A natural fit with a specialty docket Some of best outcomes because high utilizers of services 90-95% inmates return home at some point 4.9 million on probation/parole Do not wait for the next bad outcome

CSG National Reentry Resource Centerhttp://csgjusticecenter.org/nrrc

Intercept 5- Community Corrections

Probation/Parole Ready source of referrals Many of their revocations have roots in unresolved MH/SA issues A natural tie to intercepts 1, 3 & 4 Part of a multi-discipline approach

DEFINING A “WIN” Do not expect perfection-crisis frequency reduction is a win Episodic crisis events It is an illness –manage not cure Do not cherry pick- lawyer settling too many cases

Key Component # 3: Eligible participants are identified early Screenings Assessments- possibly ongoing once fog clears Criminogenic Risks/Needs

http://www.ndci.org/sites/default/files/nadcp/C-O-FactSheet(list of assessments/screening tools)

CRIMINOGENIC RISKS/NEEDS/RESPONSIVITY FRAMEWORK- BJA/CSG Publication

https://www.bja.gov/Publications/CSG_Behavioral_Framework

Risk-Need-Responsivity Model as a Guide to Best Practices

RISK PRINCIPLE: Match the intensity of individual’s intervention to their risk of reoffending

NEEDS PRINCIPLE: Target criminogenic needs, such as antisocial behavior, substance abuse, antisocial attitudes, and criminogenic peers

RESPONSIVITY PRINCIPLE: Tailor the intervention to the learning style, motivation, culture, demographics, and abilities of the offender. Address the issues that affect responsivity (e.g., mental illnesses)

COUNCIL OF STATE GOVERNMENTS JUSTICE CENTER 42

Judges’ Leadership Initiative/ Psychiatric Leadership Group

55

QUESTIONS?DEFINITION OF “INSANITY”-

DOING THE SAME THING THE SAME WAY OVER AND OVER AGAIN EXPECTING A BETTER OUTCOME.