The Sequential Intercept ModelThe Sequential Intercept Model

Leah Vail, MALeah Vail, MAForensic Program Director Forensic Program Director

Meridian Behavioral Healthcare, Inc.Meridian Behavioral Healthcare, Inc.

PresenterPresenter

Jim Santangelo, CAPJim Santangelo, CAP

Alachua County Court ServicesAlachua County Court Services

Clinical Programs ManagerClinical Programs Manager

Co-PresenterCo-Presenter

A RequestA Request

Please turn off your Please turn off your cell phones, cell phones, Blackberrys, Beepers, Blackberrys, Beepers, I-phones, Pagers and I-phones, Pagers and gameboysgameboys

Or place on silent Or place on silent modemode

Training AgendaTraining Agenda

A. “Criminalization of the Mentally Ill”A. “Criminalization of the Mentally Ill” B. Model BasicsB. Model Basics

-It’s history-It’s history-It’s use-It’s use

B. Sequential Intercept PointsB. Sequential Intercept Points C. Alachua County DiscussionC. Alachua County Discussion

Impact of Consumers in the Impact of Consumers in the Criminal Justice SystemCriminal Justice System

Current estimates suggest Current estimates suggest that as many as 700,000 that as many as 700,000 adults entering jails each adults entering jails each year have active year have active symptoms of serious symptoms of serious mental illness and three mental illness and three quarters of these quarters of these individuals meet criteria individuals meet criteria for a co-occurring for a co-occurring addictive disorder addictive disorder (GAINS, 2001)(GAINS, 2001)

General Involvement in the CJ General Involvement in the CJ SystemSystem

In 2005, over 7 million people were on probation, In 2005, over 7 million people were on probation, in jail or prison, or on parole at yearend – 3.2% of in jail or prison, or on parole at yearend – 3.2% of all U.S. adult residents or 1 in every 23 adults. all U.S. adult residents or 1 in every 23 adults. (Bureau of Justice Statistics)(Bureau of Justice Statistics)

In 2001, the U.S. incarceration rate of 690 per In 2001, the U.S. incarceration rate of 690 per 100,000 overtook Russia (670/100,000) to lead the 100,000 overtook Russia (670/100,000) to lead the world. Then by 2005, the rate had risen to world. Then by 2005, the rate had risen to 726/100,000.726/100,000.

Mental Health Involvement in the Mental Health Involvement in the CJ systemCJ system

People with a Mental Illness are charged, People with a Mental Illness are charged, convicted, and sentenced than more convicted, and sentenced than more severely than others accused of similar severely than others accused of similar crimes (Hochstedler, 1987; NY State Office crimes (Hochstedler, 1987; NY State Office of Forensic Task Force, 1991)of Forensic Task Force, 1991)

People with a Mental Illness spend 2 to 5 People with a Mental Illness spend 2 to 5 times longer in jail than those without MI times longer in jail than those without MI (Criminal Justice/Consensus Project, 2003)(Criminal Justice/Consensus Project, 2003)

Alachua County JailAlachua County Jail

Alachua County Jail: between 10 and 25% Alachua County Jail: between 10 and 25% of the detainees received psychotropic meds of the detainees received psychotropic meds (2008-2009 CJMHSA Planning Group). (2008-2009 CJMHSA Planning Group).

Alachua County JailAlachua County Jail

According to Jail statistics, 36% of all According to Jail statistics, 36% of all detainees at first appearance had either an detainees at first appearance had either an open or previous SA or MH case. open or previous SA or MH case. Approximately 5% had an open case, 23% Approximately 5% had an open case, 23% had previously received MH and/or SA had previously received MH and/or SA services as an adult, and 9% had treatment services as an adult, and 9% had treatment as a child. as a child.

The Alachua County StoryThe Alachua County Story 1998 – County Committee begins to identify MH/SA as reasons for 1998 – County Committee begins to identify MH/SA as reasons for

growing jail populationgrowing jail population– Consensus that treatment is importantConsensus that treatment is important– Partnership solutions soughtPartnership solutions sought

2000 – Mental Health Court established2000 – Mental Health Court established 2003 – Crisis Intervention Team grant written2003 – Crisis Intervention Team grant written

– – Felony Mental Health Court (Div V) establishedFelony Mental Health Court (Div V) established– – Community Based Competency Restoration program Community Based Competency Restoration program

establishedestablished 2005 – CIT classes started2005 – CIT classes started – – In-jail to community competency restorationIn-jail to community competency restoration

– – County created Mental Illness Workgroup (“MIWg”) to County created Mental Illness Workgroup (“MIWg”) to identify needed services and develop strategic plan identify needed services and develop strategic plan

for effective for effective jail diversion system.jail diversion system.

The Alachua County StoryThe Alachua County Story

2006 – MIWg report leads to funding for enhancing existing 2006 – MIWg report leads to funding for enhancing existing competency restoration program and creating a “Forensic Specialist competency restoration program and creating a “Forensic Specialist Team”Team”

2007 – Meridian Forensic Specialist Team started2007 – Meridian Forensic Specialist Team started-County Commission created CJMHSAG Planning -County Commission created CJMHSAG Planning

CommitteeCommittee– Official County advisory Board charged with responding to grants Official County advisory Board charged with responding to grants

and other funding opportunitiesand other funding opportunities– Resulted in award of 3-year $2million grant that is a county and Resulted in award of 3-year $2million grant that is a county and

state partnership.state partnership. 2008 – CJMHSAG awarded funding creating the Forensic Diversion 2008 – CJMHSAG awarded funding creating the Forensic Diversion

Team.Team. 2010 – CJMHSAG awarded continued funding by merging the MIWg 2010 – CJMHSAG awarded continued funding by merging the MIWg

and CJMHSAG teams to create a comprehensive Forensic Team.and CJMHSAG teams to create a comprehensive Forensic Team.

Partners since 1998 Partners since 1998

Tools for Transformation: Tools for Transformation: Alachua County’s Partners Alachua County’s Partners

Court System, Judges, AdministrationCourt System, Judges, Administration Office of Public Defender, Office of State Attorney, Regional CouncilOffice of Public Defender, Office of State Attorney, Regional Council Alachua County JailAlachua County Jail Law EnforcementLaw Enforcement Court ServicesCourt Services MeridianMeridian V.A.V.A. SAMH/DCFSAMH/DCF State Hospitals – FSH, NEFSH, NFETCState Hospitals – FSH, NEFSH, NFETC Agency for Persons with DisabilitiesAgency for Persons with Disabilities FACT teamFACT team Gulf Coast HomeGulf Coast Home Alachua/Gainesville Housing AuthorityAlachua/Gainesville Housing Authority

A systematic approach to the A systematic approach to the criminalization problem criminalization problem

There is no single solution to the problem we There is no single solution to the problem we are calling “criminalization of people with are calling “criminalization of people with mental illness”mental illness”

Cecil’s StoryCecil’s Story

What is the Sequential Intercept What is the Sequential Intercept Model?Model?

““Framework for Framework for thinking about how thinking about how and where and where diversionary diversionary alternatives might best alternatives might best fit a community”fit a community”– Marc Cherna, Director Marc Cherna, Director

ALLEGHENY County ALLEGHENY County Dept. of Human Dept. of Human Services, Pitt, PennServices, Pitt, Penn

Basics of the Sequential Intercept Basics of the Sequential Intercept ModelModel

A conceptual framework for communities A conceptual framework for communities to use when considering the interface to use when considering the interface between the Criminal Justice and Mental between the Criminal Justice and Mental Health systems. Health systems.

There are a series of points of inceptions at There are a series of points of inceptions at which an intervention can be made to which an intervention can be made to prevent individuals from entering or falling prevent individuals from entering or falling deeper into the criminal justice system. deeper into the criminal justice system.

More Basics of the Sequential More Basics of the Sequential Intercept ModelIntercept Model

People with mental disorders should not People with mental disorders should not “penetrate” the criminal justice system at a “penetrate” the criminal justice system at a greater frequency than people in the same greater frequency than people in the same community without mental disorders. community without mental disorders.

Ideally, most people will be intercepted at Ideally, most people will be intercepted at early points, with decreasing numbers at early points, with decreasing numbers at each subsequent point.each subsequent point.

Final Basics of the Sequential Final Basics of the Sequential Intercept ModelIntercept Model

The deeper that people enter into the system The deeper that people enter into the system costs more time, money, and energy.costs more time, money, and energy.

And the harder it is to exit them from the And the harder it is to exit them from the system.system.

Think of the model as a funnelThink of the model as a funnel HandoutHandout

Why is this model important?Why is this model important?

State of Florida made State of Florida made it central to the it central to the CJMHSA grantsCJMHSA grants

SAMSHA Best SAMSHA Best PracticePractice

Five Stages of the ModelFive Stages of the Model

1. Current Services (prevention) & 1. Current Services (prevention) & Emergency/Police-Based ResponseEmergency/Police-Based Response

2. Initial Hearings and Initial Detention2. Initial Hearings and Initial Detention 3. Speciality Courts3. Speciality Courts 4. Re-Entry to the Community from Jails 4. Re-Entry to the Community from Jails

and State Hospitalsand State Hospitals 5. Community Corrections and Community 5. Community Corrections and Community

Support ServicesSupport Services

1. Current Community Mental 1. Current Community Mental Health ServicesHealth Services

OutreachOutreach Treatment & MedicationTreatment & Medication Case ManagementCase Management HousingHousing TransportationTransportation Meaningful Daily ActivitiesMeaningful Daily Activities Crisis ServicesCrisis Services

Treatment & MedicationTreatment & Medication

Mental disorders are treatable.Mental disorders are treatable. For most mental disorders, there is a range For most mental disorders, there is a range

of treatmentsof treatments Rehab Services/Case ManagementRehab Services/Case Management TherapyTherapy PharmacologicalPharmacological

– 11stst generation medication generation medication– Newer medicationsNewer medications

Consequences of a Lack of Consequences of a Lack of TreatmentTreatment

The consumer falling The consumer falling into a crisisinto a crisis

More VulnerableMore Vulnerable Involvement with Involvement with

LEOLEO CSU admissionCSU admission Criminal ChargesCriminal Charges

Case ManagementCase Management

In general, the more specialized, the more In general, the more specialized, the more intensive services are betterintensive services are better

Forensic Specialists (ave caseload of 35)Forensic Specialists (ave caseload of 35) Intensive Case Management (caseload of 10)Intensive Case Management (caseload of 10) FACT services (team approach, max 100 clients)FACT services (team approach, max 100 clients) Traditional Case Management (caseload of 30)Traditional Case Management (caseload of 30) VA - MHICMVA - MHICM

HousingHousing

The importance of housing cannot be over statedThe importance of housing cannot be over stated IDEALLY, the community has a range of housing IDEALLY, the community has a range of housing

options, includingoptions, including– ResidentialResidential

– SRTSRT

– AFPAFP

– ALFALF

– Housing vouchersHousing vouchers

– Homeless Assistance ProgramsHomeless Assistance Programs

TransportationTransportation

Bus system/passesBus system/passes Are there bureaucratic Are there bureaucratic

barriers interfering barriers interfering with staff transporting with staff transporting consumers?consumers?

Medical transportMedical transport Medicaid Medicaid

transportationtransportation

Meaningful Daily ActivitiesMeaningful Daily Activities

Employment or vocational programEmployment or vocational program Psychosocial RehabPsychosocial Rehab EducationEducation VolunteeringVolunteering ClubhouseClubhouse Peer activitiesPeer activities Drop-in CenterDrop-in Center Partial hospitalizationPartial hospitalization

Crisis ServicesCrisis Services

Emergency screening servicesEmergency screening services CSU or receiving centersCSU or receiving centers

– How many beds does your community have?How many beds does your community have? Public CSU vs. Private CSUPublic CSU vs. Private CSU

– How easy is it to access these beds?How easy is it to access these beds? Educating LEO re: the Baker ActEducating LEO re: the Baker Act Involuntary Outpatient CommitmentInvoluntary Outpatient Commitment

If treatment is so effective, then why If treatment is so effective, then why are so few people receiving it?are so few people receiving it?

Less than a third of adults with a diagnosable mental Less than a third of adults with a diagnosable mental disorder and even smaller proportion of children disorder and even smaller proportion of children receive any mental health services in a given year receive any mental health services in a given year (Surgeon General report)(Surgeon General report)

StigmaStigma Fear of being hospitalized Fear of being hospitalized CostCost Organizational barriers - No accessOrganizational barriers - No access Not having the timeNot having the time Thinking that they could handle it aloneThinking that they could handle it alone Thinking that no one could helpThinking that no one could help Denial –lack of insight into illnessDenial –lack of insight into illness Side EffectsSide Effects Substance AbuseSubstance Abuse

1. 1. Emergency/Police-Based Emergency/Police-Based ResponseResponse..

““Law enforcement agencies have played an Law enforcement agencies have played an increasingly important role in the management of increasingly important role in the management of persons experiencing psychiatric crisis” Lamb et persons experiencing psychiatric crisis” Lamb et al (2002)al (2002)

7 to 10% of patrol officer encounters involve 7 to 10% of patrol officer encounters involve persons with mental disorders.persons with mental disorders.

Historically mental health and law enforcement Historically mental health and law enforcement have not worked closely together.have not worked closely together.

Emergency/Police-Based Emergency/Police-Based ResponseResponse..

The prototype of the specialized police The prototype of the specialized police officer approach is the Memphis Model officer approach is the Memphis Model Crisis Intervention Team (CIT), which is Crisis Intervention Team (CIT), which is based on collaboration between law based on collaboration between law enforcement, the local community mental enforcement, the local community mental health system, and other key stakeholders.health system, and other key stakeholders.

CIT has lower arrest rates, high utilization CIT has lower arrest rates, high utilization by patrol officers, rapid response time, and by patrol officers, rapid response time, and frequent referrals to treatment.frequent referrals to treatment.

CIT in FloridaCIT in Florida

CITCIT Mobile Crisis Team (Tampa,FL)Mobile Crisis Team (Tampa,FL) Emergency/Police-Based Response a Rural Emergency/Police-Based Response a Rural

and Multi-Jurisdictional Crisis Intervention and Multi-Jurisdictional Crisis Intervention TeamTeam

Enhanced mental health, crisis intervention, Enhanced mental health, crisis intervention, system awareness at the police academysystem awareness at the police academy

Emergency/Police-Based Emergency/Police-Based ResponseResponse:Alachua:Alachua

CIT started March 2005CIT started March 2005– Steering Committee contains representatives by GPD, Steering Committee contains representatives by GPD,

ASO, UPD, DCF, Meridian, NFETC, Alachua County ASO, UPD, DCF, Meridian, NFETC, Alachua County Crisis Center, VACrisis Center, VA

– Three classes per yearThree classes per year

*Alachua County Crisis Center, CAREs Team, Crisis *Alachua County Crisis Center, CAREs Team, Crisis Hotline, TherapyHotline, Therapy

*Mental Health Training for 911 operators*Mental Health Training for 911 operators

*Mental Health and BA Training for LEO *Mental Health and BA Training for LEO

2. Initial Hearings and Initial 2. Initial Hearings and Initial Detention– Detention–

Even when optimal mental health service systems Even when optimal mental health service systems and effective pre-arrest diversion programs are in and effective pre-arrest diversion programs are in place, some individuals with serious mental place, some individuals with serious mental disorders will be arrested. disorders will be arrested.

On the basis of the nature of the crime, such On the basis of the nature of the crime, such individuals may be appropriate for diversion to individuals may be appropriate for diversion to treatment, as a condition of pre-trial releasetreatment, as a condition of pre-trial release

Initial Hearings and Initial Initial Hearings and Initial Detention–Detention–

Post arrest diversion procedures may include Post arrest diversion procedures may include having the court employ mental health workers to having the court employ mental health workers to assess individuals after arrestassess individuals after arrest

MH workers advise the court about the possible MH workers advise the court about the possible presents of mental illness and options for presents of mental illness and options for assessment and treatment.assessment and treatment.

Courts may develop collaboration with the public Courts may develop collaboration with the public mental health system, which would provide staff mental health system, which would provide staff & services& services

Initial Hearings and Initial Initial Hearings and Initial DetentionDetention : : AlachuaAlachua

Several points of initial contact at Booking In and Several points of initial contact at Booking In and First Appearance:First Appearance:

- Jail classification Jail classification - Jail Mental Health Jail Mental Health - Centralized Screening Team – Court ServicesCentralized Screening Team – Court Services- First appearance staff – judges, attorneysFirst appearance staff – judges, attorneys

Initial Hearings and Initial Initial Hearings and Initial DetentionDetention : : AlachuaAlachua

Individual then are screened for services:Individual then are screened for services:- MH CourtMH Court- Court Service Supervision, Day Reporting and Court Service Supervision, Day Reporting and

TreatmentTreatment- Meridian Forensic ServicesMeridian Forensic Services- Potential Div V casesPotential Div V cases- Veterans ServicesVeterans Services- Drug CourtDrug Court

At SentencingAt Sentencing

Want the Judiciary to Want the Judiciary to be informed at be informed at sentencing to make sentencing to make sure that the sure that the appropriate conditions appropriate conditions are establishedare established

3. Specialty Courts–3. Specialty Courts–

Incept 3 intervention that is receiving Incept 3 intervention that is receiving attention are the establishment of separate attention are the establishment of separate court programs specifically to address the court programs specifically to address the needs of persons with mental illness.needs of persons with mental illness.

Special jurisdiction courts limit punishment Special jurisdiction courts limit punishment and instead focus on problems solving and instead focus on problems solving strategies and linkage to community strategies and linkage to community treatment to avoid further involvement in treatment to avoid further involvement in the criminal justice system.the criminal justice system.

Specialty Courts–Specialty Courts–

The national GAINS center estimates that The national GAINS center estimates that there are now 114 mental health courts for there are now 114 mental health courts for adults in the United States.adults in the United States.

Most are for misdemeanor defendants.Most are for misdemeanor defendants.

Court Court : National Best Practices: National Best Practices

Many Counties are starting to just develop Many Counties are starting to just develop misdemeanor courtsmisdemeanor courts

11stst such Court in the United States of such Court in the United States of America was in Broward countyAmerica was in Broward county

22ndnd such court in Florida was in Alachua such court in Florida was in Alachua CountyCounty

11stst Felony Court in Florida was Alachua Felony Court in Florida was Alachua CountyCounty

Court: Alachua (MH Court)Court: Alachua (MH Court)

The Alachua County Mental Health Court is a pre-The Alachua County Mental Health Court is a pre-adjudication diversion program, and the charges will be adjudication diversion program, and the charges will be dismissed if the individual successfully completes the dismissed if the individual successfully completes the mental health court plan. This is a VOLUNTARY court. mental health court plan. This is a VOLUNTARY court. Court Services, Meridian, State Attorney, Public Defender Court Services, Meridian, State Attorney, Public Defender work as a team.work as a team.

Alachua County and Columbia CountyAlachua County and Columbia County 2011 data on 204 participants indicated that:2011 data on 204 participants indicated that: Average Jail Days was 39.05 before Mental Health CourtAverage Jail Days was 39.05 before Mental Health Court Average Jail Days was 2.4 after Mental Health CourtAverage Jail Days was 2.4 after Mental Health Court

Court: Alachua (Div V Felony Court: Alachua (Div V Felony Forensic Court)Forensic Court)

Participants are individuals who have been found Not Participants are individuals who have been found Not Guilty by Reason of Insanity, Incompetent to Proceed, Guilty by Reason of Insanity, Incompetent to Proceed, and/or Probation with Mental Health conditions. This is a and/or Probation with Mental Health conditions. This is a NON- VOLUNTARY court.NON- VOLUNTARY court.

Court Services, State Attorney, Public Defender, Regional Court Services, State Attorney, Public Defender, Regional Council, Probation and Meridian all work as a team.Council, Probation and Meridian all work as a team.

4. Reentry/Reintegration4. Reentry/Reintegration

Re-entry from Prison, Jail, and State HospitalRe-entry from Prison, Jail, and State Hospital There is little continuity of care or communication There is little continuity of care or communication

between corrections and community mental health between corrections and community mental health for mentally ill individuals who leave correctional for mentally ill individuals who leave correctional settings.settings.

Public mental health systems may be unaware Public mental health systems may be unaware when their clients are incarcerated or released.when their clients are incarcerated or released.

Reentry/ReintegrationReentry/Reintegration

In addition, pressure is increasing on In addition, pressure is increasing on corrections and mental health systems to corrections and mental health systems to stop the cycle of recidivism frequently stop the cycle of recidivism frequently associated with people with severe mental associated with people with severe mental illness who become involved in the criminal illness who become involved in the criminal justice system.justice system.

AAssess-ssess-PPlan-lan-IIdentify-dentify-CCoordinate – APIC oordinate – APIC ModelModel

Reentry to the Community Reentry to the Community from jail and state hospital from jail and state hospital

The APIC model for transitional planning The APIC model for transitional planning from local jails breaks new ground with it’s from local jails breaks new ground with it’s focus on assessing, planning, identifying focus on assessing, planning, identifying and coordinating transitional care.and coordinating transitional care.

The APIC Model: AssessingThe APIC Model: Assessing

Assess the clinical and social needs, and public Assess the clinical and social needs, and public safety risks of the consumersafety risks of the consumer

Cataloging the consumer’s psychosocial, medical, and Cataloging the consumer’s psychosocial, medical, and behavioral needs and strengthsbehavioral needs and strengths

Gathering information from LE, courts, corrections, CMH, Gathering information from LE, courts, corrections, CMH, & families to create a fully informed transition plan& families to create a fully informed transition plan

Incorporating a cultural formulation in the transition planIncorporating a cultural formulation in the transition plan Engaging the consumer in assessing their own needsEngaging the consumer in assessing their own needs Ensuring the consumer has access to and means to pay for Ensuring the consumer has access to and means to pay for

treatment and servicestreatment and services

The APIC Model: PlanningThe APIC Model: Planning

Plan for the treatment and services required to Plan for the treatment and services required to address the consumer’s needsaddress the consumer’s needs

Addressing the critical period immediately Addressing the critical period immediately following release (1following release (1stst hour,day, & week) as well as hour,day, & week) as well as long term needslong term needs

Learning from the consumer what has worked or Learning from the consumer what has worked or not worked during past transitionsnot worked during past transitions

Seeking family inputSeeking family input Addressing housing needsAddressing housing needs

The APIC Model: Planning-2The APIC Model: Planning-2

Arranging an integrated treatment approach for the Arranging an integrated treatment approach for the consumer with co-occurring disordersconsumer with co-occurring disorders

Ensuring that the consumer is on an optimal Ensuring that the consumer is on an optimal medication regimenmedication regimen

Ensuring that they have sufficent medication to Ensuring that they have sufficent medication to last until psychiatric appointmentlast until psychiatric appointment

Connect consumers with acute and chronic Connect consumers with acute and chronic medical conditions with community medical medical conditions with community medical providersproviders

The APIC Model: Planning-3The APIC Model: Planning-3

Initiating benefit applications/reinstatements for Initiating benefit applications/reinstatements for eligible inmates for Medicaid, SSI/SSDI, eligible inmates for Medicaid, SSI/SSDI, Veterans, food stamps, and TANFVeterans, food stamps, and TANF

Ensuring the consumer has…Ensuring the consumer has… Adequate clothingAdequate clothing Transportation Transportation FoodFood

The APIC Model: PlanningThe APIC Model: Planning

Almost all jail consumers with co-occurring Almost all jail consumers with co-occurring mental illness and substance abuse mental illness and substance abuse disorders will leave correctional settings disorders will leave correctional settings and return to the community. Inadequate and return to the community. Inadequate transition planning puts people with co-transition planning puts people with co-occurring disorders who enter jail in a state occurring disorders who enter jail in a state of crisis back on the streets in the middle of of crisis back on the streets in the middle of the same crisis (Osher, Steadman, & Barr, the same crisis (Osher, Steadman, & Barr, 2002)2002)

The APIC Model: PlanningThe APIC Model: Planning

The outcomes of inadequate transition The outcomes of inadequate transition planning include the compromise of public planning include the compromise of public safety, an increased incidence of psychiatric safety, an increased incidence of psychiatric symptoms, relapse to substance abuse, symptoms, relapse to substance abuse, hospitalization, suicide, homelessness, and hospitalization, suicide, homelessness, and re-arrest. (Osher, Steadman, & Barr, 2002)re-arrest. (Osher, Steadman, & Barr, 2002)

The APIC Model: PlanningThe APIC Model: Planning

Transition planning Transition planning can only work if can only work if justice, mental health, justice, mental health, and substance abuse and substance abuse systems have a systems have a capacity and a capacity and a commitment to work commitment to work together… The results together… The results will only be as good as will only be as good as the partnership in the the partnership in the communitycommunity

The APIC Model:IdentifyingThe APIC Model:Identifying

Identify required community and correctional Identify required community and correctional programs responsible for post-release servicesprograms responsible for post-release services

Naming in the transition plan specific community Naming in the transition plan specific community referrals referrals

Forwarding a complete discharge summary to the Forwarding a complete discharge summary to the community providercommunity provider

Ensuring every consumer’s belongings are Ensuring every consumer’s belongings are returned upon releasereturned upon release

Ensuring the consumer has a picture IDEnsuring the consumer has a picture ID

The APIC Model:IdentifyingThe APIC Model:Identifying

Ensuring that the treatment and supportive Ensuring that the treatment and supportive services match the consumer’s level of disability, services match the consumer’s level of disability, motivation for change, and availability for motivation for change, and availability for community resources.community resources.

Supporting conditions of release and community Supporting conditions of release and community supervision that match the severity of the supervision that match the severity of the consumer’s criminal behaviorconsumer’s criminal behavior

Addressing the community treatment provider’s Addressing the community treatment provider’s role vis-à-vis other social service agencies, role vis-à-vis other social service agencies, probation, and the courtsprobation, and the courts

The APIC Model:CoordinatingThe APIC Model:Coordinating

Coordinate the transition plan to ensure Coordinate the transition plan to ensure implementation and avoid gaps in careimplementation and avoid gaps in care

Supporting the staff in coordinating the Supporting the staff in coordinating the timing and delivery of services and in timing and delivery of services and in helping the consumer span the jail-helping the consumer span the jail-community boundary after releasecommunity boundary after release

Case assignment must be made Case assignment must be made cooperatively by the consumer, jail, and cooperatively by the consumer, jail, and community agency itselfcommunity agency itself

The APIC Model:CoordinatingThe APIC Model:Coordinating

Explicitly communicating to the consumer, Explicitly communicating to the consumer, family, releasing facility, and community family, releasing facility, and community treatment agency, the names and contact treatment agency, the names and contact information of the person(s) who will responsible information of the person(s) who will responsible for care between the time of release and first for care between the time of release and first follow-up appointmentfollow-up appointment

Confirming the consumer knows details of the Confirming the consumer knows details of the follow-up visitfollow-up visit

Confirming that they have adequate medicationConfirming that they have adequate medication GAINs Re-Entry ChecklistGAINs Re-Entry Checklist

Community Re-entry: AlachuaCommunity Re-entry: Alachua

JAILJAIL-Coordinated efforts are made to ensure an appropriate -Coordinated efforts are made to ensure an appropriate

release plan, use A.P.I.C. modelrelease plan, use A.P.I.C. model-GAINS Reentry Checklist, handout-GAINS Reentry Checklist, handout-SOAR application in jail-SOAR application in jailPRISONPRISON-Limited discharge planning – usually a medication -Limited discharge planning – usually a medication

appointment with the local provider is made.appointment with the local provider is made.-VA has Prison release programs-VA has Prison release programs

5. Community Corrections 5. Community Corrections (and Community Support Services)(and Community Support Services) – – Consumers under continuing supervision in Consumers under continuing supervision in

the community by the CJ system (usually the community by the CJ system (usually probation) are another large group to probation) are another large group to consider.consider.

Failure to attend treatment appointments Failure to attend treatment appointments often results in revocation of probation and often results in revocation of probation and a return to jail.a return to jail.

MI individuals have trouble with MI individuals have trouble with probation or conditional releaseprobation or conditional release

Person may never understand instructions or follow Person may never understand instructions or follow through because of symptomsthrough because of symptoms– Person may be experiencing symptoms of psychosisPerson may be experiencing symptoms of psychosis– Overwhelmed because of anxiety about the appointmentOverwhelmed because of anxiety about the appointment– Experience paranoia & not trust enough to follow Experience paranoia & not trust enough to follow

throughthrough– Unable to complete the terms of release – community Unable to complete the terms of release – community

service, fee’sservice, fee’s– Zero tolerance probation standardsZero tolerance probation standards– Inconsistent sleep patterns due to side effects of medsInconsistent sleep patterns due to side effects of meds– Unable to plan how to get thereUnable to plan how to get there

Community Corrections/Support: Community Corrections/Support: AlachuaAlachua

Interagency collaboration continues to Interagency collaboration continues to be the key focus in Alachua County. be the key focus in Alachua County.

Once per month a continuity of care Once per month a continuity of care meeting in held consisting of key meeting in held consisting of key stakeholders of the forensic population. stakeholders of the forensic population. This meeting provides agencies with a floor This meeting provides agencies with a floor for planning, networking, implementation, for planning, networking, implementation, service coordination, collaborative problem service coordination, collaborative problem solving, referrals, and information sharing.solving, referrals, and information sharing.

Community Corrections/Support: Community Corrections/Support: AlachuaAlachua

Department of Probation – dedicated probation officerDepartment of Probation – dedicated probation officer Court Services Court Services

-Day Reporting-Day Reporting

-County Probation -County Probation

-Work Release-Work Release

-Electronic Monitoring-Electronic Monitoring

-Court Service Contact and Treatment Supervision-Court Service Contact and Treatment Supervision

Alachua Team Ongoing SupportAlachua Team Ongoing Support

Meetings, leadership, & Meetings, leadership, & CooperationCooperation– Needed as boundary Needed as boundary

spannersspanners

Information exchangeInformation exchange– Timely information Timely information

handoffshandoffs

– HIPPAHIPPA

Training. System training Training. System training for LEO, PD, ASA, Jail, for LEO, PD, ASA, Jail, MH, Courts, & Court MH, Courts, & Court ServicesServices

Sequential Intercept Model + Community VisionSequential Intercept Model + Community Vision

Not available In placePartially in place

Working Together to Install Best Working Together to Install Best Forensic Mental Health Practices Forensic Mental Health Practices Incentivize by funding, removing barriers, provide excellent resources Incentivize by funding, removing barriers, provide excellent resources

to learn and growto learn and grow Encourage improvementEncourage improvement Require and regulateRequire and regulate Assist local mental health systems to develop the capacity to identify Assist local mental health systems to develop the capacity to identify

and implement Best Practicesand implement Best Practices Develop education and training materialsDevelop education and training materials Utilize and share fidelity scales or other measures to evaluate Utilize and share fidelity scales or other measures to evaluate

implementationimplementation Promote cross system sharingPromote cross system sharing

Alachua Diversion StatisticsAlachua Diversion Statistics

At the end of March, a total of 184 clients were actively At the end of March, a total of 184 clients were actively participating in the program. Approximately 16% (28 participating in the program. Approximately 16% (28 of 184) received outreach/case management in the jail. of 184) received outreach/case management in the jail. Approximately 6% (12 of 184) received competency Approximately 6% (12 of 184) received competency restoration services in the jail. Approximately 78% restoration services in the jail. Approximately 78% (144 of 184) of participants received treatment and/or (144 of 184) of participants received treatment and/or case management services in the community, with a total case management services in the community, with a total of 26% (38 out of 144 people in the community) of 26% (38 out of 144 people in the community) receiving treatment services, treatment groups and receiving treatment services, treatment groups and individual sessions. individual sessions.

Re-CapRe-Cap

A. Model BasicsA. Model Basics B. Sequential Intercept PointsB. Sequential Intercept Points

– 1. (Current Services) + Emergency/Police-1. (Current Services) + Emergency/Police-Based ResponseBased Response

– 2. Pre/Post-arrests2. Pre/Post-arrests– 3. Specialty Courts3. Specialty Courts– 4. Re-entry/Reintegration & the APIC model4. Re-entry/Reintegration & the APIC model– 5. Community Corrections 5. Community Corrections C. Alachua County Status & RecommendationsC. Alachua County Status & Recommendations

StatusStatus

HandoutHandout Idea’s?Idea’s? Recommendations?Recommendations? Comments?Comments? Questions?Questions?

Thank YouThank You

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