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Patricia A. Griffin, PhD April 13, 2011
Using the Sequential Intercept Model To Target Early Intervention and Treatment
for Co-Occurring Disorders in the Justice System
• Funded by: – Pennsylvania Commission on Crime and Delinquency (PCCD)
– Department of Public Welfare Office of Mental Health and Substance Abuse Services (OMHSAS)
• Oversight by the Mental Health and JusDce Advisory CommiHee of PCCD
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Collaboration between Drexel University
& Western Psychiatric Institute and Clinic University of Pittsburgh Medical School
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Focus
Men and women with…
• Serious mental illness, and oMen • Co-‐occurring substance use disorders • Involved in the criminal jusDce system
The Problem
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• Many of the same people in mulDple systems:
– Mental health – Substance abuse – Criminal jusDce – Other social services
• Expensive -‐ high service users, people who cycle and recycle through the system
SOLUTION: Cross-Systems Collaboration and Coordination
Bureau of Justice Statistics 5
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SequenDal Intercept Model
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Com
mun
ity
Arrest C
ourt
s Jail
Prison
Community Supervision
Mental Health
Substance Abuse
Initial Hearings
Dan Abreu
VA
“Unsequential” Model
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8 8 Dan Abreu
Sequential Intercept Model
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A systematic approach to the criminalization problem
n There is no single solution to the problem we are calling “criminalization of people with mental illness” or over-representation n The problem must be attacked from multiple
levels n The “Sequential Filters” Model
n We conceptualized a series of filters. Each filter provides a point to “catch” an individual with mental illness. Over time, the filter rate should increase earlier in the sequence.
SequenBal Intercepts Best Clinical PracDces: The UlDmate Intercept
I. Law Enforcement/Emergency Services
II. Post-Arrest: Initial Detention/Initial Hearings
III. Post-Initial Hearings: Jail/Prison, Courts, Forensic Evaluations and Commitments
IV. Re-Entry From Jails, State Prisons, & Forensic Hospitalization
V. Community Corrections & Community Support
Munetz & Griffin Psychiatric Services 57: 544–549, 2006
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SequenDal Intercept Model Mark Munetz, MD and PaHy Griffin, PhD (2006)
• Envisions a series of points of intercepDon at which an intervenDon can be made to prevent individuals from entering or penetraDng deeper into the criminal jusDce system
• Using the model, a community can develop targeted strategies over Dme to increase diversion, reentry, and linkage to the community
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• SequenBal: People move through criminal jusDce system in predictable ways
• Intercept: Illustrates key points to “intercept” to ensure:
– Prompt access to treatment – OpportuniDes for diversion – Timely movement through criminal jusDce system – Linkage to community resources
SequenDal Intercept Model Mark Munetz, MD and PaHy Griffin, PhD (2006)
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CO
MM
UN
ITY
Intercept 1 Law enforcement
911
Law
Enf
orce
men
t Intercept 2 Initial detention / Initial court hearings
Initi
al D
eten
tion
Firs
t App
eara
nce
Cou
rt
Arrest
Intercept 3 Jails / Courts
Jail
Spec
ialty
Cou
rt
Dis
posi
tiona
l Cou
rt
Intercept 4 Reentry
Pris
on/
Ree
ntry
Ja
il
Re-
entr
y
Paro
le
CO
MM
UN
ITY
Intercept 5 Community corrections
Prob
atio
n
Violation
Violation
Sequential Intercept Model
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Five Key Points of IntercepDon
1. Law enforcement
2. IniDal detenDon / IniDal court hearings
3. Jails / Courts
4. Re-‐entry
5. Community correcDons
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The UlDmate Intercept
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• IdenDfies – ExisDng local services and systems – Issues considered important to local stakeholders
• Data • Diagnosis
– Strengths to be built upon • Helps everyone see “big picture” & how they fit
– Helps diverse groups from various systems understand where/how everything fits
– Intercepts provide “manageable” venues and opportuniDes for systems intervenDons
Useful Organizing Tool
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Community Corrections & Community
Support
Law Enforcement/Emergency
Services
Community Re-Entry
Booking/ Initial
Appearance
Jails, Courts
Access to Appropriate
Services
Munetz & Griffin, 2006
SequenDal Intercept Model: A Circular View
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Summary
• Seamless transiDon to community
• Moving away from criminal jusDce system, into services
• Strategic approach is necessary
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SequenDal Intercept Model as Basis for Cross-‐Systems Mapping
A tool to
• Help transform fragmented systems,
• IdenDfy local resources and gaps, and
• Help idenDfy where to begin intervenDons
Cross-Systems Mapping depicts local contact/flow with the criminal justice system
Cross-Systems Mapping Completed
Cross-Systems Mapping Scheduled
Key:
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Indiana County
Draft 3-11
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• Systemic reentry from jail to facilitate successful community reintegraBon
– Improved coordinaBon with current services across the conBnuum of care
• Data across intercepts
• Improved diversion at Intercept One
– Crisis IntervenBon Team (CIT)
– Increase training for Emergency Room doctors re community resources
• Access to Medical Assistance Benefits
• Expanded Housing
Indiana County PrioriDes
Franklin County Top 10 PrioriDes
• Housing • Improved InformaDon Sharing
– Data at front door of jail • Even when Missy is not there
• Earliest idenDficaDon and diversion – Increase diversion opportuniDes at police contact
– Develop expanded alternaDves to arrest
– Drop off points, non-‐hospital, and crisis beds
• Explore broad range of engagement strategies – Develop effecDve treatment and supports to help people recognize their mental illness
– Peer specialists from beginning to end
• Recruit and keep psychiatrists/psychiatric nurse pracDDoners
• Cross-‐system educaDon • Increase strategies to get benefits back
• Expand Pretrial Release and Jail Diversion Programs
• Develop more strategies to increase non-‐county funding sources for human services
• Increase transportaDon opDons
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BEHAVIORAL HEALTH AND JUSTICE INVOVLED POPULATIONS
Pamela S. Hyde, J.D. SAMHSA Administrator
NaBonal Leadership Forum on Behavioral Health/Criminal JusBces Services Washington, MD • April 5, 2011
BEHAVIORAL HEALTH àIMPACT ON AMERICA
è THE ECONOMY: Annually -‐ total esDmated societal cost of substance abuse in the U.S. is $510.8 billion
• Total economic costs of mental, emoDonal, and behavioral disorders among youth ~ $247 billion
è HEALTH CARE: By 2020, BH condiDons will surpass all physical diseases as a major cause of disability worldwide • Half of all lifeDme cases of M/SUDs begin by age 14 and three-‐fourths by
age 24
è CRIMINAL JUSTICE: >80 percent of State prisoners, 72 percent of Federal prisoners, and 82 percent of jail inmates meet criteria for having either mental health or substance use problems
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SAMHSA’S FOCUS
è People -‐ NOT money
è People’s lives -‐ NOT diseases
è SomeDmes focus so much on a disease/condiDon we forget people come to us with mulDple diseases/condiDons, mulDple social determinants, mulDple cultural aotudes
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Health Reform
DRIVERS OF CHANGE 36
SAMHSA à LEADING CHANGE
è Mission: To reduce the impact of substance abuse and mental illness on America’s communiDes
è Roles: • Leadership and Voice • Funding -‐ Service Capacity Development • InformaDon/CommunicaDons • RegulaDon and Standard seong • PracDce Improvement
è Leading Change – 8 Strategic IniBaBves
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HHS STRATEGIC PLANS à SAMHSA STRATEGIC INITIATIVES
è AIM: Improving the NaDon’s Behavioral Health 1 PrevenDon 2 Trauma and JusDce 3 Military Families 4 Recovery Support
è AIM: Transforming Health Care in America 5 Health Reform 6 Health InformaDon Technology
è AIM: Achieving Excellence in OperaDons 7 Data, Outcomes & Quality 8 Public Awareness & Support
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TRAUMA AND JUSTICE à CHALLENGES
è Substance abuse or dependence rates of prisoners >four Dmes general populaDon
è Youth in juvenile jusDce have high rates of M/SUDs
• Prevalence rates as high as 66 percent; 95 percent experiencing funcDonal impairment
è ~ Three-‐quarters+ of State, Federal, and jail inmates meet criteria for either MH or SU problems, contribuDng to higher correcDons costs
• >41 percent State prisoners, 28 percent Federal prisoners, and 48 percent jail inmates meet criteria for having both
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è On any given day, veterans account for nine of every 100 individuals in U.S. jails and prisons
è Among inmates w/MH problems, 13 percent of State prisoners and 17 percent jail inmates were homeless in year prior to incarceraDon
è ~46 percent of people who are homeless have a mental illness
è Providing housing for persons with MI who are homeless can decrease criminal jusDce involvement by 84 percent for prison days and 38 percent for jail days
è In 2009, nearly 76,000 veterans were homeless on a given night, ~ 136,000 veterans spent at least one night in a shelter
TRAUMA AND JUSTICE à CHALLENGES For Veterans & Housing
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SAMHSA STRATEGIC INITIATIVE TRAUMA AND JUSTICE – GOALS
è Public health approach to trauma è Trauma informed care and screening; trauma specific
service è ↓ impact of violence and trauma on children/youth è ↑ BH services for jusDce involved populaDons
• PrevenDon • Diversion from juvenile jusDce and adult criminal jusDce systems
è ↓ impact of disasters on BH of individuals, families, and communiDes
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è When done right, jail diversion works – those diverted: ● Use less alcohol and drugs (last 30 days)
• Any Alcohol Use: Baseline at 59 percent vs. 6 months at 28 percent
• Alcohol to IntoxicaDon: Baseline at 38 percent vs. 6 months at 13 percent
• Illegal Drug Use: Baseline at 58 percent vs. 6 months at 17 percent
● Have fewer arrests aMer diversion compared to 12 months before (2.3 vs. 1.1)
● Fewer jail days (52 vs. 35)
è CommuniDes want jail diversion programs: three of four jail diversion programs keep operaDng aMer Federal funding ends
TRAUMA & JUSTICE 42
è Common to all SAMHSA iniDaDves
• PrevenDon, early intervenDon, treatment, and recovery support services
• Shared vision (e.g. PPCs, Community Resilience and Recovery IniDaDve, SBIRT, Access to Recovery)
è Expand access to community-‐based BH services at all points of contact with jusDce system
è People served by drug courts and mental health courts tend to have mulDple issues which create mulDple challenges and opportuniDes
THE ROLE OF PROBLEM-‐SOLVING COURTS 43
HEALTH REFORM IMPACT OF AFFORDABLE CARE ACT
è More people will have insurance coverage
• ↑Demand for qualified and well-‐trained BH professionals
è Medicaid will play a bigger role in M/SUDs
è Focus on primary care & coordinaDon with specialty care
è Major emphasis on home & community-‐based services; less reliance on insDtuDonal care
è Theme: prevenDng diseases & promoDng wellness
è Focus on quality rather than quanDty of care
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In 2014: 32 MILLION MORE AMERICANS WILL BE COVERED
4-6 mil
6-‐10 Million with M/SUDs
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ACA & JUSTICE INVOLVED POPULATIONS
è Coverage expansion means individuals reentering communiDes from jails and prisons (generally have not had health coverage in past) will now have more opportunity for coverage
è CJ populaDon w/ comparaDvely high rates of M/SUDs = opportunity to coordinate new health coverage w/other efforts to ↑ successful transiDons
è Addressing BH needs can ↓ recidivism and ↓ expenditures in CJ system while ↑ public health and safety outcomes
è SAMHSA and partners in OJP will develop standards and improve coordinaDon around coverage expansions –
è Enrollment is the challenge
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For more informaDon
www.pacenterofexcellence.piH.edu
