Tampa Veterans Post- Booking Jail Diversion/Trauma Recovery Program Non-Specialty Court Diversion Peer Support Intervention

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1 Tampa Veterans Post- Booking Jail Diversion/Trauma Recovery Program Non-Specialty Court Diversion Peer Support Intervention Department of Children and Families Northside Mental Health Center James A Haley VA Medical Center USF/FMHI

2 . 2

3 Overview Context for Program Development Program Description Process/Outcome Data Lessons Learned

4 James Haley Veterans Hospital (500 yards from NMHC) 4

5 Pre-grant Perception of VA Access 5

6 Post-grant Perception of VA Access 6

7 Context for Program Development Shared Initiatives DVA initiative to establish dedicated Veterans Justice Outreach staff (VJO) at every VA medical center. State DCF received SAMHSA Jail Diversion/Trauma Recovery priority to veterans grant. State level transformation activities Promote EBP for Trauma Informed Care Develop a Veterans Peer Specialist Certification, Establish two pilot sites for veteran related diversion and trauma recovery programs JDTR Program JDTR IDENTIFY, DIVERT, LINK, TREAT 7

8 Front End JDTR Intercepts

9 JDTR Local Program The Two Sided Diversion Coin FRONT END -Diversion OUT of jail Where?- Initial Appearance, Arraignment and Dispositional (intercepts II/III) Who? Justice involved Veterans with Hx of Military or Civilian Trauma (No Traffic/Felony Possession/ Crimes with Violence on case by case basis When/How Identified: 1) First appearance court screening; 2) Dispositional Court referral from VJO, PD, Self 3) Vet status verified by VA (by VJO or VA staff) BACK-END- Diversion INTO Appropriate Program Flexible Terms/Services based on need and infrequently based on a legal condition (usually VOP court) Program staff are all veterans LCSW (1 FTE), CM FTE), Peer Specialists ( FTE) Direct Service Program Component 1) Peer Support (up to one year) 2)Case Management (up to 6 months) 3) Seeking Safety or other T.R. Program (1 yr)

10 Screening/Eligibility Veteran, Clinical, Legal Status Veteran Who qualifies as a veteran? Must have rapid access to veteran status and service eligibility status; Who (VAMC, VBA?) What database? Secure to VA Social Work for verification, same day/<24 hour The earlier veteran status is determined the better Disposition decisions may be same day for low level charges so eligibility/services/plan needs to be completed with a barebones assessment/plan Clinical -Trauma Screen 4 Item PTSD/2 Item Depression/Event Hx Legal -Judicial Decision Critical Partners for Intercept II/III: Judge, Public Defender and State Attorney, Someone to handle eligibility, VJO, and willing providers Non-specialty court diversion over multiple intercepts requires extensive marketing and relationship building with each division; very inefficient. 11

11 Back End You re Screened & Eligible, Now what? Services not typically court ordered Service Component Month after Diversion Peer Support Available to all participants Case Management Can receive if Level of Care criteria meet Not Available Group Trauma Recovery Individual Trauma Recovery Available at NMHC or other Provider

12 Back End Services Initial Engagement and Addressing Immediate Needs CM and Peer Support. Assertive/relentless engagement/support as bridge to chosen services with emphasis on linking to VA benefits/services Peer Specialist Non-VA trauma recovery group tx (Seeking Safety) Veteran Clinician and peer specialist. 13

13 Peers Support as a Critical Service Component Why use peers? Similarity to persons serves may enhance rapport and engagement (hx Vets, homeless, jobless,sa, needing tx). Modeling/feedback of adaptive coping/problem solving that runs counter to coping/attitude learned in military, perception/attitude toward help seeking. More cost effective to use peers for needed non-reimbursable services than other more costly disciplines. Barriers to using peers? HR resistance secondary to CJ/Employment Hx. Lack of 3 rd party payment for services Peer Training 40 hours peer specialist training; Florida Peer Network, FCB Motivational Interviewing Seeking Safety 14 14

14 Who we are serving? 49% some college 90% Post Vietnam era 51% Post Vietnam but no Persian Gulf or later 31% Persian Gulf/OEF/OIF 41% combat or theatre zone 29% unemployed, looking for work 27% unemployed, disabled 17% homeless 27% someone else s house, apt, room etc. 15% Arrest prior to age 18

15 Process/Outcome Data Numbers Served (since 8/10) Vets Screened/Referred 304 Legal and Clinically Eligible 182 *Enrolled 69 Not enrolled (declined or failed initial contact w/in 14 days of screening) 113 RE-ARREST RATES (up to year after enrollment) Enrolled 15/69 (23%) Not Enrolled 46/113 (40%)

16 Process/Outcome Data by Intercept Intercept II (little legal leverage) Screened = Eligible = Enrolled = Intercept III (more legal leverage) Active/Completed =38 22/48 (45%) 14/21 (66%) Lost/Incomplete= 29 26/48 (54%) 7/21 (33%) Rearrested = 15 12/48 (25%) 3/21 (12%) Much fewer cases from Division but generally more likely to participate and more likely to be successful (recidivism and retention).

17 JDTR Pathways/Re-Arrest Rates 18

18 Re-arrest Rates Selection Bias in group assignment Program participation not random but voluntary -participants may differ from decliners in some important dimension (motivation, readiness for change, willingness to have close contact with a treatment agency, etc). JDTR does not directly address any Big 8 risk factors yet may indirectly reduce risk for re-arrest by linkage to substance use services, providing alternative activities, close support and facilitating pro-social thinking and friends. Criminogenic Needs Big Eight (1. Hx criminal bx, 2. Pro-criminal attitudes, values, beliefs; 3. antisocial personality/temperment; 4. antisocial peers; 5. family or marital problems; 6. school or work problems; 7. lack of pro-social leisure/recreational activities; 8. substance abuse) LSI-R-SV data for enrollees. Not early starters Two of more adult convictions Some criminal friends Alcohol/Drug problems 19

19 Preliminary Clinical Outcomes Baseline-6 months, N=13, USF/FMHI 20

20 Preliminary Clinical Outcomes Baseline-6 months, N=13, USF/FMHI 5- Extreme Diff. 4- Quite a bit of Diff 3. Moderate Diff 2. A little Diff 1. No Difficulty 21

21 Preliminary Clinical Outcomes Baseline-6 months, N=13, USF/FMHI 22

22 Who is successful? Low Demand program suited for persons with lower criminogenic risk/need No substance dependence or, if present, is linked to appropriate SA level of care (e.g., ADATP, New Beginnings etc) Not early starters and not ASPD or antisocial thinking. Clear criminalized mental illness 23

23 Lessons Learned Recommendations Screening is labor intensive (15-20% of all staff time). All jails should inquire about veteran status Veteran status should be identified as early as possible during a Vets encounter with the criminal justice system Non specialty docket is inefficient Staff within the VA is critical in determining eligibility and linking to VA services. (VA Justice Outreach Clinician; VBA, VA Affairs Liaison) Veterans Justice Outreach staff in all VA Medical Centers VA/Contracting with community providers? Traditional providers of community behavioral health services should pay close attention to criminogenic risk/needs in order to match interventions with risk. Tiered Services increased court leverage/intensity with increased risk Peers services may be both effective and cost effective change agents. Advocate for reimbursable peer services under Medicaid Convert positions to peer specialist and use outreach cost center. 24

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