Planning

1
Planning Implementing Effective Interventions

• Henry J. Steadman, Ph.D.
• July 16, 2009

Smart Responses in Tough Times Achieving Better
Outcomes for People with Mental Illnesses
Involved in the Criminal Justice System July
15-17, 2009
2
(No Transcript)
3
Prevalence of Current Substance Abuse Among Jail
Detainees with Severe Mental Disorders
Detainees with severe mental disorder plus either
alcohol or drug abuse/dependence
72
72
Adapted from Abram, K.M. and Teplin, L.A.
Co-Occurring Disorders Among Mentally Ill Jail
Detainees Implications for Public Policy.
American Psychologist, 46(10)1036-1045, 1991 and
Teplin, L.A. Personal Communication. Policy
Research Associates, Inc., 6/17/98
4
Trauma History Interview Data (n978)
5
Treatment-Resistant Clients
OR
Client-Resistant Services
6
Basic Goals

• Keep people out who do not need to be there

• Provide constitutionally adequate services when
  incarcerated

• Link people to services to keep them from
  coming back because of mental illness

7
Sequential Intercept Model
8
Sequential Intercept Model
Sequential - People move through the criminal
justice system in predictable ways

• Intercept - Examine this flow and look for ways
  to intercept persons with mental illness and
  often co-occurring disorders to ensure
• Prompt access to treatment
• Opportunities for diversion

9
Sequential Intercept Model
10

• Diversion avoiding or radically reducing jail
  time by using community-based treatment as an
  alternative.

11
Diversion

• Criminal Justice ? Not filing or dropping
  charges (ATI)
• Mental Health ? Not filing
• Condition of bail
• Deferred prosecution (stipulate to police
  report)
• Deferred sentencing
• Condition of probation

12
Publics Expectations
Reduce recidivism
Reduce violence
Diversion
Reduce jail days
Reduce costs
13
Diversion Logic Model
Stage 1
Stage 2
Stage 3
Improved Mental Health /Individual Outcomes
Identify and Enroll People in Target Group
Linkage
Comprehensive/ Appropriate Community-Based
Services
Improved Public Safety Outcomes
14
EBP Expert Panel Meetings

• Assertive Community Treatment
• Joseph Morrissey, Ph.D.
• Housing
• Caterina Roman, Ph.D.
• Supported Employment
• William Anthony, Ph.D.
• Illness Management
• Kim Mueser, Ph.D.
• Integrated Treatment
• Fred Osher, M.D.
• www.gainscenter.samhsa.gov

15
Key Expert Panel Conclusions

• Forensic ACT Teams (FACT) show promise for
  reducing recidivism, but Forensic Intensive Case
  Management (FICM) may be more appropriate for up
  to 80 of divertees
• IDDT will reduce CJ system involvement
• No single model of Supported Housing has emerged
  specific to justice-involved persons

16
Key Expert Panel Conclusions (2)

• Supported Employment is a well documented EBP
  with face validity for justice-involved persons,
  but is untested for them
• Illness Management and Recovery (IMR) has no
  demonstrated effectiveness on correctional
  outcomes
• Trauma specific interventions are a promising
  practice with small scale studies showing
  reduction in trauma symptoms, but no studies on
  re-arrest

17
Essential System of Case

• Phase I
• Forensic Intensive Case Management
• Supported Housing
• Accessible and appropriate medication
• Peer Support

National Leadership Forum on Behavioral
Health/Criminal Justice Services
18
Essential System of Case

• Phase II
• Integrated Dual Disorder Treatment
• Supported Employment
• FACT
• Cognitive Behavioral Interventions

National Leadership Forum on Behavioral
Health/Criminal Justice Services
19
Nathaniel Project (NYC) N53
20
Changes in Arrests and Jail Days
21
San Francisco Behavioral Health Court

• Samples
• 172 in Behavioral Health Court
• 8,067 jail inmates with mental disorder
• 1/14/2003 11/19/2004
• Results
• BHC At 18 months, 26 reduction in probability
  of any new charge
• BHC 55 reduction in probability of violent
  charge

Effectiveness of a Mental Health Court in
Reducing Criminal Recidivism and Violence. D.E.
McNiel R.L. Binder. Archives of General
Psychiatry 2007 (164)1-9.
22
Diversion Logic Model
Stage 1
Stage 2
Stage 3
Improved Mental Health /Individual Outcomes
Identify and Enroll People in Target Group
Linkage
Comprehensive/ Appropriate Community-Based
Services
Improved Public Safety Outcomes
23
Baseline Characteristics and Subsequent Arrest
24
Baseline Characteristics and Subsequent Jail Days
25
Arrest and Symptoms/Functioning
26
Monthly Jail Diversion Cost Scenarios