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Evaluating Specialty Court Programs: Adaptations and
Emerging PracticesOklahoma State Conference
Norman OKSeptember 3, 2015
STEPHEN S. GOSS, JUDGE, SUPERIOR COURTS OF GEORGIA
ALBANY , GEORGIAEMAIL: [email protected]
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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
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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
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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
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TRANSINSTITUTIONALIZATION
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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
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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
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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)
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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
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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
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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
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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)
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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
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New Business ?
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Or Old Business? “They have been here Mr.Mulder”( you deal with the same folks anyway)
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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
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JAILED WITH MH ISSUES Possible security issues: decompensated, combative with jailers Increased suicide risks Other poorly managed chronic medical issues (HIV,diabetes, hypertension)
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Jail: Treatment Disruption
Decompensated on entry Formulary only: side effects
Loss SSI Rx Gap: Leave jail until Dr. appt.
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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
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http://gainscenter.samhsa.gov/pdfs/integrating/GAINS_Sequential_Intercept.pdf
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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.
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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
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Intercept 1- Field/Police
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Crisis Intervention Training-CIT
Evidence Based Practice 2719 programs nationally in 45 states Developed by Memphis Police Department www.Cit.Memphis.edu
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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
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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
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Intercept 2- Diversion
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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
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Intercept 3- Courts
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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
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http://csgjusticecenter.org/mental-health/learning-sites
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Intercept 4- Re-Entry
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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
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CSG National Reentry Resource Centerhttp://csgjusticecenter.org/nrrc
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Intercept 5- Community Corrections
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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
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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
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Key Component # 3: Eligible participants are identified early Screenings Assessments- possibly ongoing once fog clears Criminogenic Risks/Needs
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http://www.ndci.org/sites/default/files/nadcp/C-O-FactSheet(list of assessments/screening tools)
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CRIMINOGENIC RISKS/NEEDS/RESPONSIVITY FRAMEWORK- BJA/CSG Publication
https://www.bja.gov/Publications/CSG_Behavioral_Framework
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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
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Judges’ Leadership Initiative/ Psychiatric Leadership Group
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QUESTIONS?DEFINITION OF “INSANITY”-
DOING THE SAME THING THE SAME WAY OVER AND OVER AGAIN EXPECTING A BETTER OUTCOME.