SAMHSA/CSAT Justice Initiatives: Partnerships and Opportunities

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1 SAMHSA/CSAT Justice Initiatives: Partnerships and Opportunities H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Director Center for Substance Abuse Treatment Substance Abuse Mental Health Services Administration U.S. Department of Health & Human Services CAM Grantee Meeting National Harbor, MD January 12, 2010 President Barack Obama As a Nation, we must work together to provide access to effective services that reduce substance abuse and promote healthy living. August 31, 2009 Kathleen Sebelius Secretary U.S. Department of Health & Human Services At its very core, our work today is about improving lives and ensuring peace of mind. It s about getting the right care to the right person at the right time each and every time. October 4,

2 SAMHSA: Key Messages SAMHSA s Role in Improving the Nation s Health Pamela S. Hyde, J.D. Administrator, SAMHSA Behavioral health is essential to health Prevention works Treatment is effective People recover from mental and substance use disorders 5 Behavioral health services improve health status and reduce health care and other costs to society. SAMHSA is charged with effectively targeting substance abuse and mental health services to the people most in need and to translate research in these areas more effectively and more rapidly into the general health care system. Continued improvement in the delivery and financing of prevention, treatment and recovery support services provides a cost effective opportunity to advance and protect the Nation s health. SAMHSA has identified strategic initiatives to guide us as we address emerging national trends. 6 SAMHSA s Strategic Initiatives Trauma and Justice Initiative Prevention of Substance Abuse & Mental Illness Trauma and Justice Military Families Health Care Reform Recovery Support Health Information Technology, Electronic Health Records and Behavioral Health Data Quality and Outcomes Demonstrating Results Public Awareness and Support SAMHSA s strategic initiatives are continuing to evolve as we adjust to emerging trends. One of the goals of the Trauma and Justice Initiative is to address the needs of people with mental and substance use disorders and with histories of trauma within the criminal and juvenile justice systems. To achieve this goal, SAMHSA is partnering with ihthe Bureau of Justice Assistance and constituency groups to explore expanding beneficial health problem solving courts. SAMHSA is also collaborating with the Office of Justice Programs, National Institute on Drug Abuse and the National Judicial College to develop a strategy for implementing additional judicial training in issues of substance use, mental health disorders and trauma

3 The Challenge Past Month Alcohol Use 2009 In 2009, an estimated 22.5 million persons 8.9% of the population aged 12 or older were classified with substance abuse or dependence in the past year. Any Use: 51.9% (130 million) 3.9 million of them were dependent upon or abused both alcohol and illicit drugs. Binge Use: 23.7% (59 million) Only 4.3 million people aged 12 or older received treatment for a problem related to alcohol or illicit drugs in Heavy Use: 6.8% (17 million) Also, in 2009, adults aged 18 or older who were on parole or a supervised release from jail during the past year had higher rates of dependence on or abuse of a substance than their counterparts who were not on parole or supervised release (24.6% vs. 9%). Source: NSDUH Source: NSDUH 2009 (Current, Binge, and Heavy Use estimates are similar to those in 2008) 10 Past Month Use of Selected Illicit Drugs among Persons Aged 12 or Older: Methamphetamine Use among Females by Pregnancy Status Percent Using in Past Month 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% Source: NSDUH, 2009 Illicit Drugs Marijuana Psychotherapeutics Methamphetamine 8.3% 8.3% 8.7% 8.2% 7.9% 8.1% 8.0% 8.0% 62% 6.2% 62% 6.2% 6.6% 61% 6.1% 6.0% 60% 6.0% 61% 6.1% 5.8% 2.7% 2.7% 2.5% 2.7% 2.9% 2.8% 2.5% 2.8% 0.7% 0.7% 0.8% 0.7% 0.8% 0.5% 0.3% 0.5% Past Month Methamphetamine Use among Females Aged 15 to 44 by Pregnancy Status: 0.4% 0.4% 0.3% 0.3% 0.2% 0.2% 0.1% 0.1% 0.0% Source: NSDUH, % Pregnant % 0.3% 0.2% Not Pregnant 12 3

4 Concurrent Methamphetamine and Alcohol Use Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or older: 2009 In 2009, 119,000 individuals reported using methamphetamine with alcohol or within 2 hours of alcohol use more than double the number reporting concurrent usage in 2008 (46,000). The largest increase in concurrent meth and alcohol usage was reported by those 26 years old and older (29,000 in 2008 vs. 98,000 in 2009). Number of Individuals reporting first use of substance in past year Marijuana Pain Relievers Tranquilizers Ecstasy Inhalants Stimulants Cocaine LSD Sedatives Heroin Methamphetamine ,226 1, ,179 53% of past year initiates of methamphetamine use were female and 47% were male 2,361 Source: NSDUH Source: NSDUH ,000 1,500 2,000 2,500 Numbers in Thousands 14 Sources Where Methamphetamine Was Obtained for Nonmedical Use in Past Month Past Year Perceived Need for and Effort Made to Receive Specialty Treatment among Persons Aged 12 or Older Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use: 2009 Individuals Aged 12 or older: From Friend or Relative for Free 40.9% 49.7% Bought from Friend or Relative 29.2% 25.1% Took from Friend or Relative without Asking 4.0% 1.9% Bought from Drug Dealer or Other Stranger 21.2% 20.5% Bought on Internet 0.7% 0.9% 4.0% Some Other Way 1.8% 0% 10% 20% 30% 40% 50% 60% Felt They Needed Treatment and Did Not Make an Effort Did Not Feel (693,000) They Needed d 94.9% 9% 3.3% Treatment 1.8% ( 19.8 Million) Felt They Needed Treatment and Did Make an Effort (371,000) 20.9 Million Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use Source: NSDUH Source: NSDUH

5 Substance Misuse/Abuse: Impact on Children Methamphetamine Use: Effects on Children Over 8.3 million children (11.9%) lived with at least one parent who was dependent on or abused alcohol or an illicit drug during the past year. (NSDUH ) Approximately 60% of clients being served by active SAMHSA grants report having one or more children. A majority of the children are in the custody of the adult client at the time of intake. A substance dependent or abusing parent mother or father affects not only his or her health, but the well being of the children and other family members. 17 Aggressive behavior has been found in approximately 42% of pre school and school aged children raised in meth involved families even after the children had been removed to other environments. Children from meth involved environments also were found to act out more (having externalizing problems) than their peers in non meth involved homes. Pre schoolers were more vulnerable than older siblings to the negatives effects of a meth involved environment. Source: Asanbe, C PhD, Hall, C. EdS, & Bolden, C, EdS. (Summer 2008) The methamphetamine home: psychological impact on preschoolers in rural Tennessee. The Journal of Rural Health. Vol 24, No 3 18 Substance Abuse and Domestic Violence Methamphetamine Use among Those in the Criminal Justice System vs. Those Not 61% of domestic violence offenders also have substance abuse problems. (U.S. Dept. of Justice) Substance abuse and violence amplify denial and hopelessness among family members. Child neglect or abuse can result. Children exposed to violence can exhibit: Problems in school Increased violent behaviors Drug and alcohol use (especially among teens) Depression and suicidal thoughts (especially among middle and high school children) Source: CSAP s Prevention Pathways Online Course. 19 Individuals Aged 18 or Older: NOT on Probation On Probation NOT on Parole/Supervised Release Parole/Supervised Release Numbers in Thousands Source: NSDUH 2008 and

6 Criminal Justice System is the Largest Source of Referral to Treatment 2008 Referral from the Criminal Justice System as a Predictor of Treatment Completion School (Educational) 1% Other Health Care Provider, 6% Employer/EAP 1% Alcohol/ Drug Abuse Care Provider, 11% Other Community Referral 11% Individual (incl.selfreferral) 32% Court/Criminal i Justice Referral/DUI/D WI 38% DUI/DWI Diversionary Program, Other Probation/ Parole, Prison State/Fed Court, Other Court Recognized Legal Entity 8.3% 17.5% 44.9% 29.3% According to Treatment Episode Data Set data, across the four treatment types,* referral to treatment from the criminal justice system was consistently one of the strongest predictors of treatment completion or transfer to further treatment. Other predictors included: Being employed Use of alcohol as primary substance of abuse, and Being white, non Hispanic Source: SAMHSA Treatment Data Set (TEDS) Concatenated, * outpatient, intensive outpatient, short term residential (30 days or less), and long term residential (more than 30 days) Source: SAMHSA, OAS, TEDS data (2/26/09) 22 The Role of Problem Solving Courts Problem Solving Courts: Unifying Themes SAMHSA recognizes the positive impact problemsolving courts have on resolving the underlying chronic anti social behaviors of defendants. The most common type of problem solving court is the drug court, but other examples include: family drug treatment courts, mental health courts, domestic violence courts, homeless courts, teen courts, tobacco courts, and veteran courts. All of the types of problem solving courts have a set of unifying themes: A focus on underlying problems, rather than just the offense A focus on outcomes through the use of evidence based practices A proactive court system that may include ongoing judicial supervision, intermediate sanctions and rewards, case management and drug testing. 23 Source: Rempel, M. (2008, July 14) Problem-Solving Courts: The Latest Results [PowerPoint Presentation] Presented at the 2008 National Association of Court Management Annual Conference, Retrieved 5/16/10 from Courts%20-%20Rempel.ppt 24 6

7 The Success of Treatment Drug Courts CSAT s Criminal Justice Grant Programs According to national averages drug court retention rates exceed those for the general treatment population 60% one year retention for drug courts vs % one year retention for general treatment. (Condelli & DeLeon 1993, Lewis & Ross 1994, Belenko 1998) In a recent study, 48 of 55 drug courts reduced recidivism by an average of 26% over conventional case processing. (Wilson et al. 2006) A Washington state study found that drug courts saved the tax payer $3,892 per participant over conventional case processing. (Aos et al. 2001) CSAT s Criminal Justice Portfolio addresses the challenges of providing effective substance abuse treatment to criminal justice populations who are not in prison or jail. Programs focus on diversion and re entry for adolescents, teens, and adults with ihsubstance use and mental disorders. d Criminal Justice program grantees are tasked with providing a coordinated and comprehensive continuum of supervision, programs and services to help members of the target population become productive, responsible and law abiding citizens SAMHSA/CSAT Criminal Justice Programs Adult Treatment Drug Courts There are 98 active grants in CSAT s criminal justice portfolio: 64 Drug Court grants 10 Adult Criminal Justice Treatment grants 24 Offender Reentry Program grants 86 new Criminal Justice grants have been awarded for FY 2010 : 28 Joint SAMHSA/Bureau of Justice Assistance (BJA) Adult Drug Court 18 Offender Reentry Program 12 Children of Meth Family Court 17 SAMHSA Adult Treatment Drug Court 8 SAMHSA Juvenile Treatment Drug Court 3 SAMHSA/Department of Justice, OJJDP/Robert Wood Johnson Foundation Juvenile Treatment Drug Court 27 SAMHSA s Adult Treatment Drug Court program uses the problem solving court model to provide a more holistic approach to treatment and recovery. The program supports and shapes Adult Treatment Drug Courts, including Driving While Intoxicated (DWI)/Driving Under the Influence (DUI) Courts, Co Occurring Drug and Mental Health Courts, Veterans Courts, and Community Courts. The intent is to meet the clinical needs of clients and ensure clients are treated using evidence based practices consistent with the disease model and the problem solving model, rather than with the traditional court case processing model. 28 7

8 Treatment Drug Courts Outcomes Treatment Drug Courts Mental Health Outcomes The success of SAMHSA s currently active Treatment Drug Court grants is reflected in the outcomes data. Clients reporting At Intake 6 Month Follow up Difference No substance use 53.0% 85.2% 60.8% Being employed/in school 44.7% 60.5% 35.4% No arrests 76.6% 92.3% 20.6% Being Housed 38.8% 44.0% 13.4% Being socially connected 90.8% 95.8% 5.5% Clients reporting At Intake 6 Month Follow up Difference Depression 33.9% 25.3% 25.4% Anxiety 40.5% 31.9% 21.2% Hallucinations 3.6% 1.9% 47.2% Trouble understanding, concentrating or remembering 27.6% 20.7% 25.0% Trouble controlling violent 7.4% 4.5% 39.2% behavior Suicide attempts 0.7% 0.3% 57.1% Source: SAMHSA, SAIS, data collected through 10/06/10 29 Source: SAMHSA, SAIS, data collected through 10/06/10 30 SAMHSA Treatment Drug Court Clients Focus of Children Exposed to Methamphetamine Grants Approximately 12% of clients being served by SAMHSA s Treatment Drug Court grantees report using methamphetamine. 68% of them are under 35 years old. 52.2% of them are females. 70% of meth users in TDC programs report having children. To address the effect a meth involved family environment has on children, SAMHSA s Children Exposed to Methamphetamine (CAM) grants provide assistance to children of meth abused through the Drug Court program. Grants provide linkages between child care workers and available community based social services that focus on the trauma caused by substance abuse/meth use in the family and concurrent criminal justice involvement

9 Problem Solving Courts in SAMHSA s Criminal Justice Portfolio Because we recognize their effectiveness, SAMHSA is also making efforts to integrate the tools and services that are essential parts of problem solving courts, such as: Screening and assessment for co occurring disorders Voluntary HIV rapid testing, as appropriate Medically Assisted Treatment, such as buprenorphine, Naltrexone, and Methadone Treatment models such as Motivational Enhancement Therapy and Cognitive Behavioral Therapy Other SAMHSA Criminal Justice Programs SAMHSA s Offender Re entry Program: 24 grants awarded in FY 2009 expand and/or enhance substance abuse treatment and related recovery and reentry services to sentenced juvenile and adult offenders returning to the community from incarceration for criminal/juvenile offenses. Grantees are expected to form stakeholder partnerships that will plan, develop and provide a transition from incarceration to community based substance abuse treatment and related reentry services for the populations of focus Offender Reentry Grants Up to 23 new grants will be awarded for FY2010 expected announcement date is October. Up to 16 grants will be for juvenile offenders Up to 17 grants will be for adult offenders SAMHSA Partnership with Department of Justice (DOJ) SAMHSA and the U.S. Department of Justice Bureau of Justice Assistance (BJA) are currently working on a formal collaboration to coordinate the SAMHSA ORP grant related activities and BJA s Second Chance Act grant related activities. SAMHSA s ORP grantees will be expected to seek out and coordinate with any local federally funded offender reentry initiatives including Second Chance Act offender reentry programs, as appropriate

10 Other SAMHSA Criminal Justice Programs FY 2011 President s Budget Request Adult Criminal Justice Treatment (ACJT) ACJT programs address gaps in substance abuse treatment services for adults involved with the criminal justice system. Goals of the program are to expand or enhance the community s ability to provide a comprehensive, integrated, and community based response to a substance abuse treatment capacity problem. The program also helps to improve the quality and intensity of substance abuse treatment services for adults who are in some form of judicial or community justice/corrections program, such as probation, parole, or community corrections. SAMHSA is requesting $84.2 million a $16.6 million increase over the FY 2010 Appropriation level. $17.9 million will support new Drug Court grants, $4.8 $ million will support new Ex Offender Re entry Grants, and Approximately $4.6 million will support new Adult Criminal Justice Treatment Grants The Importance of Evidence Based Practices Evidence Based Practices in the Judicial System SAMHSA will continue to emphasize the importance of Evidence Based Practices (EBPs) in our Criminal Justice programs. EBPs provide scientifically validated evidence that the program is effectively meeting goals. They should identify desired outcomes for offenders and include a means for measuring progress. The implementation of evidence based practices results in an average decrease in crime of 10 20%, whereas programs that are not evidence based tend to see no decrease and even a slight increase in crime. Interventions that follow evidence based practices can achieve recidivism reductions of 30 percent. Source: Aos, S,etal, Evidence Based Public Policy Options to Reduce Future Prison Construction, Criminal Justice Costs, and Crime Rates (Olympia,WA:Washington State Institute for Public Policy, Oct.2006) As cited in Pew Center on the States, One in 31: The Long Reach of American Corrections (Washington, DC: The Pew Charitable Trusts, March 2009). 39 Evidence based programs should identify desired outcomes for offenders and include a means for measuring progress. The implementation of evidence based practices results in an average decrease in crime of 10 20%, whereas programs that are not evidence based tend to see no decrease and even a slight increase in crime. Interventions that follow evidence based practices can achieve recidivism reductions of 30 percent. Source: Aos, S,etal, Evidence Based Public Policy Options to Reduce Future Prison Construction, Criminal Justice Costs, and Crime Rates (Olympia,WA:Washington State Institute for Public Policy, Oct.2006) As cited in Pew Center on the States, One in 31: The Long Reach of American Corrections (Washington, DC: The Pew Charitable Trusts, March 2009)

11 Enhancing Adult Drug Court Services, Coordination, and Treatment Conclusion SAMHSA/CSAT and the U.S. Department of Justice, Office of Justice Programs (OJP), Bureau of Justice Assistance (BJA), have collaborated in creating a new joint opportunity: Enhancing Adult Drug Court Services, Coordination, and Treatment. Almost $76 million was awarded in FY 2010 through this joint initiative to enhance the court services, coordination, and substance abuse treatment capacity of adult and juvenile drug treatment courts. The program allows grantees to develop a comprehensive strategy for enhancing drug court capacity, with access to both criminal justice and substance abuse treatment funds through one application. The behavioral health needs of those within the criminal justice system and their families will continue to be a priority for SAMHSA through: The Trauma and Justice strategic initiative, The Criminal Justice Portfolio including grants to expand services to children affected by methamphetamine in families served by treatment drug courts, and Effective collaboration with other Federal entities (such as Department of Justice) to provide integrated, evidencebased programs. Thank you

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