Task Force for the Continuing Study of the Treatment of Persons with
Mental Illness who are Involved in the Criminal Justice System
Thursday, June 19, 2008
10:00 a.m. to 12:30 p.m.
Hearing Room B
Legislative Services Building
MINUTES FOLLOW AGENDA
Call to Order
I. Introductions and Welcome
• Harriet Hall, Jefferson Center for Mental Health
• Jeanne Smith, Division of Criminal Justice
II. Approaches to Co-occurring Treatment for the Criminal Justice Population
• Marilyn Gaipa, LCSW, CAC III, Care Solutions, Inc.
III. Disproportionate Minority Contact Committee
• Anna Lopez, Colorado Department of Public Safety
IV. Subcommittee for Medication, Health Care and Public Benefits Update
V. Juvenile Justice Subcommittee Update
• Judge Karen Ashby
VI. Legislation Updates
VII. Task Force Legislative Issues for Upcoming Year
• Areas of Study
VIII. Other Updates
IX. What's Happening at Your Agency
X. Minutes Approval
M I N U T E S
Task Force for the Continuing Study of
Treatment of Persons with Mental Illness
Who are Involved in the Criminal Justice
June 19, 2008
10:00 a.m. – 12:30 p.m.
Call to Order -10:05
The Task Force for the Continuing Examination for the Treatment of Persons with Mental Illness who are Involved in the Criminal Justice System meeting was called to order at 10:05 a.m. by Harriet Hall, chair.
Introductions were made around the room. Task Force members and guests introduced themselves.
Co-Occurring Treatment for the Criminal Justice Population – Marilyn Gaipa,
LCSW, CAC III, Care Solutions, Inc.
Harriet introduced Marilyn Gaipa, an expert on co-occurring disorders and substance abuse treatment.
Marilyn has been working with
The numbers tell the story about co-occurring disorder and current statistics indicate:
· In a state prison survey, 24% of inmates reported a recent mental health problem)
· 75% of prisoners have had a diagnosable abuse or dependence disorder in their lifetime
· 72 to 87% of offenders with severe mental disorders have co-occurring substance use disorders
· 80% of probationers sentenced to participate in substance abuse treatment and as many as 50% of female offenders and juvenile detainees have co-occurring mental health and substance abuse disorders.
Marilyn noted that many of the statistics presented were from “Public Health Behind Bars: From Prisons to Communities”.
What do we know about co-occurring clients in the correctional system?
· Occurring in increasing numbers
· Do poorly in
ü Traditional treatment programs
ü Regular supervision caseloads
· High risk for
ü Premature dropout from treatment
Poor outcomes for this group of consumers are attributed to poor motivation, lack of engagement in treatment, sill deficits and behavioral problems. These poor outcomes have focused on things wrong with the client. A new approach has started to look at the fact that the poor outcomes instead result from:
· Absence of specialized treatment
· Cognitive impairment
· Motivation level
· Effects of mental disorders
Ineffective medication plan to address both mental health and
substance abuse. Marilyn noted that
the IDDT (Integrated Dual Disorders Treatment) program at
Motivational interviewing has become a best practices models for treating co-occurring disorders and has had a significant impact on treatment of individuals in the criminal justice system. There has recently been a greater understanding regarding the neurobiology of addiction. Marilyn recommended the HBO 13 session documentary series “Understanding Addiction” for training and understanding the neuroscience and neurobiology of addiction.
Treatment for the co-occurring criminal justice population
· Requires specialized services using an integrated approach
· Experiences demonstrated success with treatment programs
– built on evidence based approaches
– developed in community settings
Successful IDDT programs include the following service philosophies and strategies:
· Multidisciplinary Team that is integrated in service and care
· IDDT views all life activities as part of the recovery treatment process
· Stage Wise Interventions
– Engagement – Pre-Contemplation
– Persuasion – Contemplation/Preparation
– Active Treatment – Action
– Relapse Prevention – Maintenance
· Access to Comprehensive Services, meeting basic needs, especially housing
· Family/client Psychoeducation
· Time Unlimited Services
· Participation in Alcohol/Drug Self Help Groups – DRA/Double Trouble Assertive Outreach
· Pharmacological Treatment
· Motivational Interviewing
· Substance Abuse Counseling
· Interventions to Promote Health
· Group Treatment
Marilyn noted that the
Multidisciplinary Team is a strong and important component of treating
individuals with co-occurring disorders and it is imperative to have a team that
wants to work with and has passion for this population.
The individuals are not always easy to engage are not cheerful and happy
all of the time and have significant disorders.
It is also important that the team have a sense of optimism and hope for
these individuals. Marilyn reported
that the Multidisciplinary Team at
All life activities are a part of the recovery treatment process and engage a holistic approach to look at all pieces of an individuals life including; housing, medication, what they do for work and what they do for leisure activities.
The two main components of IDDT
and two components that have been successful and a driving force for successful
treatment of co-occurring disorders include Stage Wise Interventions and
Motivational Interviewing. Marilyn
noted that the use of motivational interviewing in the Criminal Justice System
is increasing. Marilyn noted that a
Marilyn noted that the most frequent request that the program receives relates to housing needs and is a major issue and concern. Motivational interviewing is used for all areas of treatment including substance abuse, medication compliance and mental health issues. Using motivational interviewing, clients are graded according to their stage of treatment. Based on the stage of treatment, appropriate goals, actions and maintenance are determined and adjusted when treatment plans are updated.
Included in the handout that was distributed to Task Force members was information regarding a Family Education Series. This series is an eight session community based education series with each session focused around recovery and addiction and the relationship that different choices have to recovery. For family members, the series provides and understanding of co-occurring disorders and offers hope and provides facts and approaches regarding the illness.
Marilyn noted that individuals
are not removed from the program because of non-compliance.
A study at
Participation in drug and alcohol groups is an important component of the program. Dual Recovery Anonymous (DRA) and Double Trouble are some available programs; however, there are not many groups and meeting available in the area.
Marilyn noted that Pharmacological Treatment is an important component of the program and thanked HCPF for allowing Medicaid to cover all anti-craving drugs. Positive results are being seen with aggressive pharmacological treatment and with the use of anti-craving medications.
Interventions to promote health include treating individuals holistically in their life activities and within their community with emphasis on health and wellness.
Three IDDT programs in place at
Prison co-occurring treatment program best practices key principles are much the same and include:
· Early interventions focused on
· Comprehensive approach that addresses
– mental illness
– substance abuse
– criminal thinking and behaviors
· Tailoring treatment through ongoing assessment of offender’s needs
· Continuity of treatment while in custody
Initially, it was believed that IDDT was not effective with anti-social disorders; however, when programming includes a focus around criminal thinking and behavior and uses Cognitive Behavioral Therapy (CBT) and Dialectic Behavioral Therapy (DBT), it is now shown to have a much greater rate of success.
Individuals are re-evaluated every 90 days and treatment plans and motivation is addressed. Clients within the program are becoming more responsible for their treatment plans and are encouraged to carry the treatment plan with them and keep track of goals and progress.
An addendum to the Prison CDT Programs slide was included in the handout to the Task Force members and includes structural and clinical modification to prison CDT programs. One of the clinical modifications includes decreasing the amount and intensity of confrontation and replacing it with supportive feedback and cognitive behavioral models. Some structural modifications include a highly structure treatment schedule and an extended duration of treatment. A lot of the modification is around reinforcement and around the criminal thinking and behavioral treatment.
Principles of jail based co-occurring treatment programs include:
· Focus on meeting immediate and basic needs
– stabilization of acute psychological symptoms
– detoxification from alcohol and drugs
– suicide screening, prevention & monitoring
– treatment of physical illness and injuries
– dental care
· Integrated Delivery of Mental Health and Substance Abuse Service
– isolated treatment unit away from general population
– cross trained treatment staff
– strong assessment skills
– use of engagement and motivational approaches
– stage specific treatment interventions
· Preparation for Release
– reentry and transition planning begin after screening & enrollment in jail services
– continually modified throughout jail stay
· Collaboration with Community Agencies to Enhance Continuity of Care
– continuation of benefits
– community providers come into jail setting to plan release
Marilyn noted that there are no best practices for Court Diversion Programs. Court Diversion Programs currently include:
· Pre booking
· Post booking
– Drug courts
– Mental health courts
– Specialized jail based case management
§ early identification of co-occurring disorder
§ court liaison
§ triage to community services
Common elements of post booking court diversion co-occurring service include:
· Identification of arrestees with co-occurring disorders
· Screening and assessment for mental health/substance abuse disorders
· Counseling & discharge planning
· Use of “boundary-spanning” staff (cross-training of individuals working in the environment)
· Referral to community services and/or monitoring following release
Marilyn reported that many of the statistics and information for the presentation was gathered from Public Health Behind Bars: From Prisons to Communities. Marilyn recommended this reference for additional information
Todd Helvig questioned the
average cost of participating in an IDDT within the community.
Marilyn noted that IDDT is very expensive and a lot of the cost is
based on community resources and what services are available.
Marilyn suggested reviewing Chapter 22 of the book used as a reference in
the presentation. Initial investment
early on is expensive and really encouraging looking five to 10 years out.
Other mental health centers are implementing IDDT.
Community Reach and
Marilyn recommended the following SAMHSA resource manual on co-occurring disorders “Substance Abuse Treatment for Persons with Co-Occurring Disorder A Treatment Improvement Protocol TIP 42”.
Jeaneene Miller noted that the presentation was very valuable. While the Task Force works directly with the Legislative Oversight Committee in communicating information, it may be beneficial to extend efforts in sharing information with the OSPB and JBC analysts. It is the tendency of the OSPB and JBC to fund programs based on caseload and services and when budget requests are made that are broad based the support isn’t that strong. Harriet suggested that one approach may be to pull information from the various presentations made to the Task Force and put together a special presentation for the analysts.
Minority Contact Committee – Anna Lopez, Colorado Department of Public Safety
Jeanne Smith noted that the
statutory charge for the Task Force for the coming year includes reviewing how
disproportionate minority confinement affects individuals with mental illness.
Jeanne introduced Anna Lopez with the Colorado Department of Public Safety who will provide an update to the Task Force on the Disproportionate Minority Contact Committee.
Anna staffs the Coalition for Minority Youth Equality whose charge is to look at the disproportionate minority contact with the juvenile justice system for minority youth. The Juvenile Justice Delinquency and Prevention Act requires states to look at the over-representation of minority youth in the juvenile justice system. It is required but in addition 20% of federal dollars for juvenile justice are tied to efforts to address disproportionate minority contact. This is sometimes an issue that is uncomfortable to address as it requires discussion about bias and race.
A handout was distributed to the Task Force which outlines disproportionate minority contact data. Disproportionate Minority Contact is defined as minority youth who are represented in the juvenile justice system at greater proportions than they are represented in the general population.
In reviewing the at-risk youth population for African American youth it is 5%; however, the percentage of African American youth in secure confinement is 19.3%. This is information that is reviewed to determine if there is disproportionate minority contact in certain systems and to what degree that represents.
Anna explained that the relative rate is determined by a comparison of the rate of specific minority youth in comparison to white youth entering a specific system. Anything above 1 is an over-representation of minority youth in a specific system.
Anna noted that in 2001 and 2002, data indicated high rates for African American and Hispanic youth in many of the systems including pre-adjudicated detention and DYC commitment and are areas where intervention strategies have been focused. Rates in these areas have decreased. Anna noted that a lot of focus has been placed on the pre-adjudicated stage because pre-adjudication is a big determinant on further entrance into the juvenile justice system. Therefore, focus on the pre-adjudication stage can have a larger impact on the confinement stage.
An area of current focus is the
high arrest rates for African American and Hispanic youth.
Additional data included in the handout is from the Division of Mental Health and was information presented by Bill Bane to the Juvenile Justice Subcommittee of the Task Force. The data was asked to answer the following questions:
1. How many minority youth with current or previous juvenile justice involvement were served in the public mental health system, and what were their primary diagnoses?
2. How many girls/young women with current or previous juvenile justice involvement were served in the public mental health system, and what were their primary diagnoses?
3. How many youth with co-occurring substance abuse and current or previous juvenile justice involvement were served in the public mental health system, and what were their primary diagnoses?
The number of youth ages 10 to 17.99 that were served by the mental health centers total 18,285. Of those served, 2,108 or 11.53% were minority youth. The total at-risk youth for all minorities totaled 32.1%. Therefore, the numbers indicated that there is an under-representation of minority youth being served in mental health centers. The Disproportionate Minority Contact Committee would then look at whether this under-representation is affecting the numbers of youth entering the juvenile justice system. Other systems that are reviewed include education, social services and child welfare. Anna noted that under-representation in other systems lead to over-representation in the juvenile justice system.
Included in the handout was data from the Division of Youth Corrections which is not separated by minority. While the data indicates that there has been a drop in the percentage of youth entering the DYC system that have high moderate to severe mental health needs, Debra Cady noted that this is not the case. In FY06-07 the CCAR was modified to outcome measure rather than an assessment tool. Debra noted that there has not been a change or dip and DYC is actively working on this issue. Information is available on the DYC website. Debra reported that at least 60% of the youth in DYC commitment have high moderate to severe mental health issues.
Also included in the handout are Intervention Strategies which include:
· Minority Family Advocacy Programs
· Community Coalitions
· Children in Crisis (CIC): Intervention Skills and Strategies for Law Enforcement Officers training
A list of references and resources as well as contact information for Anna Lopez was included in the handout.
Jeaneene Miller noted that the data is quite alarming and questioned if the system isn’t building a brick by brick path for some of the minority populations to land in the adult justice system. The Department of Corrections is taking a firm position at looking at ways to make impacts so that a lot of populations are not penetrating the system. Harriet noted that the difference between arrest rates and penetration farther into the system raises the question of what is happening to those youth.
Medication, Health Care and Public Benefits Update – Harriet Hall
Harriet reported that currently a Chair for the Subcommittee for Medication, Health Care and Public Benefits has not been appointed. Interested individuals should contact Harriet or Jeanne.
One of the areas of interest the
Subcommittee had started work on looking at indigent care related to the
community corrections system. There
is a broad variety of issues that could be taken on by the Subcommittee and it
may be a time for the committee to take a step back and set direction.
There has also been a strong interest in looking at SSI and matching SSI
benefit to the
Subcommittee Update – Harriet Hall
Harriet reported that Judge Ashby, due to work commitments, has resigned from the Task Force.
As outlined in the Task Force charge for the current year, the Juvenile Justice Subcommittee is looking at minority youth, girls and youth with co-occurring issues. To date, presentations have been made to the Subcommittee by the Division of Criminal Justice, Division of Mental Health, the Mental Health/Juvenile Justice Plan and the next presentation scheduled will be from the Division of Youth Corrections. A summary of the information presented to the Subcommittee will be provided to the Juvenile Justice Subcommittee.
Individuals interested in serving as chair of the Subcommittee should contact Harriet Hall or Jeanne Smith.
– Harriet Hall
Harriet reported that all five legislative bills brought forward by the Task Force passed and were signed by the Governor. The five legislative bills were:
· Senate Bill 08-006 “Concerning Suspension of Medicaid Benefits for Persons Confined Pursuant to a Court Order”
Senate Bill 08-007 “Concerning Assistance to Inmates Prior to
· Senate Bill 08-008 “Concerning the Addition of a Representative from the Department of Health Care Policy and Financing to the Task Force for the Continuing Examination of the Treatment of Persons with Mental Illness Who are Involved in the Criminal and Juvenile Justice Systems”
· House Bill 08-1016 “Concerning Juvenile Justice Procedures for Juveniles Who May Benefit From Mental Health Services”
· House Bill 08-1046 “Concerning Procedures to Facilitate the Provision of Public Benefits to Offenders Transitioning From the Criminal Justice System”
Harriet Hall noted that the
suspension bill has national significance and was a huge accomplishment for the
Task Force. Harriet Hall reported
that the keynote speaker at the national NAMI conference talked about the
Legislative Issues for Upcoming Year – Harriet Hall
The Task Force should begin working on legislation for the coming year and should have that legislation determined by the end of summer. If the Task Force agrees that it should continue meeting and its work is not completed, reauthorizing legislation should be brought forward in the upcoming legislative session. The reauthorizing legislation should include a study plan. Current legislation outlines a Task Force charge through 2009. Harriet Hall and Jeanne Smith will take the lead on this legislation and would like input from other Task Force members.
Jeaneene Miller questioned how the MICJS Task Force relates to the Behavioral Health Coordinating Council. Jeanne Smith reported that currently the Behavioral Health Coordinating Council is determining its charge and there is a sense that the charge from the Governor would be for the cabinets of the various agencies to come together and determine if business could be done differently. Rather than the Council developing new programs it would look at ways of managing funding from different sources that come into state agencies and are distributed to community groups. Initially, it is anticipated that the focus will be fairly narrow and may look at a small population as a pilot to determine if it could be funded in a more unified fashion and then look at taking it broader scale. Therefore, the changes would be financial rather than programmatic. The MICJS Task Force could serve in an advisory capacity to the Behavioral Health Coordinating Council.
There was also discussion of how the MICJS Task Force may fit with the Criminal and Juvenile Justice Commission. The fit could be in an advisory capacity, reauthorizing legislation could identify the Task Force as a separate entity or a subpart of the Commission, or reauthorizing legislation could layout a method for coordination between all three bodies (Behavioral Health Coordinating Council, Criminal and Juvenile Justice Commission and MICJS Task Force). Jeaneene Miller and Tom Raynes will work with Harriet Hall and Jeanne Smith to further discuss these issues.
Areas of Study
Harriet reported that the enabling legislation defines the 2009 Task Force charge as follows:
ON OR BEFORE JULY 1, 2009, THE FOLLOWING ISSUES:
(I) THE EARLY IDENTIFICATION, DIAGNOSIS, AND TREATMENT OF ADULTS AND JUVENILES WITH MENTAL ILLNESS WHO ARE INVOLVED IN THE CRIMINAL AND JUVENILE JUSTICE SYSTEMS;
(II) THE MODIFICATION OF THE CRIMINAL AND JUVENILE JUSTICE SYSTEMS TO MOST EFFECTIVELY SERVE ADULTS AND JUVENILES WITH MENTAL ILLNESS WHO ARE INVOLVED IN THESE SYSTEMS;
(III) THE IMPLEMENTATION OF APPROPRIATE DIAGNOSTIC TOOLS TO IDENTIFY PERSONS IN THE CRIMINAL AND JUVENILE JUSTICE SYSTEMS WITH MENTAL ILLNESS; AND
(IV) ANY OTHER ISSUES CONCERNING PERSONS WITH MENTAL ILLNESS WHO ARE INVOLVED IN THE STATE CRIMINAL AND JUVENILE JUSTICE SYSTEMS THAT ARISE DURING THE COURSE OF THE TASK FORCE STUDY.
Harriet Hall asked that Task Force members start identifying individuals and programs that should present to the Task Force in addressing this charge. The Authorizing Legislation is available on the Task Force website.
Tom Raynes recommended that the
Task Force consider appointment of Judge Elyn Straus of
Michael Ramirez noted that in regards to diagnostic tools, the schools are looking at finding universal screeners which can be given to all kids and would like to discuss this further with the Task Force.
Other Updates and
What’s Going on at Your Agency
Harriet Hall reported that there had been some concern regarding referrals and the number of individuals in the John Eachon Re-Entry Program (JERP) which came out of the work of the Task Force; however, the numbers of individuals in the program have increased and there may be close to a full program in the near future. Diane Pasini-Hill reported that the year one and two evaluation of the program is wrapping up and she would like to present the evaluation information to the Task Force at an upcoming meeting.
Michael Ramirez reported that the Department of Education has received a grant for the “Building Bridges” program. Information and an outline of the program was distributed to Task Force members. The grant is an 18 month grant and is a multi-tiered and multiple systems approach to look at behavioral health.
Jeanne Rohner noted that a triage presentation should be a future agenda item for the Task Force.
Melinda Cox with the Department of Child Welfare reported that the department is working with the OSPB and JBC in looking at services and looking at different programs to be funded statewide and looking at evidence based practices.
Elizabeth Hogan reported that
the Department of Corrections put together a very successful interagency
conference on improving institutional and correctional mental health care.
As a result of the conference,
Jeaneene Miller reported that the Department of Corrections received $1.8M for parole wraparound services which will serve 300 offenders. The eligible offenders can be on regular rather than the intensive level of parole. The individual eligible for the services will be required to have some form of mental health need. The program will also serve the entire needs of the individual including housing, employment and substance abuse treatment. An RFP is currently being developed.
Dr. Sandeep Wadhwa reported that the Department of Health Care Policy and Financing released a draft RFP for behavioral health services and expanded coverage to include substance abuse. The Department is continuing work with the Center for Medicaid Services (CMS) and Attorney Generals Office in defining inmate.
11:52 p.m. –
The Task Force for the Continuing Study of the Treatment of Persons with Mental Illness who are Involved in the Criminal Justice System was adjourned at 11:52 a.m.