New Developments in Supported Employment San Francisco Behavioral Health Court

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1 New Developments in Supported Employment San Francisco Behavioral Health Court NADCP National Conference May 27, 2014 Lisa Lightman Kathleen Connolly Lacey, LCSW Gregory Jarasitis, MOT, OTR/L

2 Goals of Presentation What is Behavioral Health Court? What is Supported Employment? How do I create a Supported Employment program? Case examples & new developments

3 Behavioral Health Court: Who Are We? BHC was created in 2002 to address unprecedented influx of mentally ill defendants in the jails Collaboration between Community Mental Health, Jail Psychiatric Services, the Court, District Attorney, Public Defender, Adult Probation, Sheriff s Department Program started without federal, state or local funding

4 Program Goals Behavioral Health Court: What Do We Do? Connect criminal defendants with serious mental illness to community based mental health treatment Find appropriate dispositions to the criminal charges that consider the mental illness, seriousness of the offense and impact on the victim Increase public safety and reduction in recidivism Combine clinical expertise and court supervision

5 Behavioral Health Court: Who Do We Serve? Primarily homeless Disproportionately persons of color High end users of community mental health services, Psychiatric Emergency Services In and out of the criminal justice system Incarcerated at time of entry into program All clients enter into the program voluntarily

6 The Population of BHC active clients 80% facing felony charges Approximately 70% male, 30% female 66%+ diagnosed with schizophrenia 90%+ diagnosed with a co-occurring disorder

7 Jail Reentry Services as a Link to the Community Core Principles Continuum of Care Bring existing providers into the jail to meet with their clients Ensure continuity of care by linking patients to new or existing treatment providers in the community Collaborate with the court to develop mental health dispositions and coordinate inmate s release

8 Jail Reentry and BHC Client accepted into BHC and treatment planning begins Treatment plan is in place and client is transitioned to community Client is out of custody and Case Manager becomes a liaison to the Court Case Manager serves as a Boundary Spanner

9 Focus on Community Treatment

10 CWCMF FACT DESIGN Multidisciplinary Team Masters Level Clinical Case Managers Psychiatrists Nurses Occupational Therapists Employment Specialists Peer Advocates Probation Officers Low Caseload 1:17 Services 7 days per week/24 hrs per day Criminal Justice-oriented Advocacy Individual Therapy Medication Management Group Therapy Family Therapy Crisis Intervention Case Management Brokerage Social Activities Supported Employment Assistance with housing, entitlements, payee services

11 FORENSIC CHECK-IN (Women and Men) HEARING VOICES ANGER MANAGMENT STRESS MANAGEMENT HARM REDUCTION WOMEN WELLNESS DBT SKILLS TRAINING YOUNG ADULTS CLOZARIL ART COOKING SUPPORTED EMPLOYMENT LGBT SUPPORT DUAL DIAGNOSIS AFRICAN AMERICAN MEN GROOMING CURRENT EVENTS DUAL DIAGNOSI S CITYWIDE GROUP PROGRAM MOVIE HEARING VOICES STRESS MANAGEMENT HARM REDUCTION WOMEN WELLNESS DBT SKILLS TRAINING YOUNG ADULTS CLOZARIL SEEKING SAFETY ART COOKING WOMEN S HEALTH LGBT SUPPORT WRITIN G ILLNESS MGMT RECOVERY AFRICAN AMERICAN MEN GROOMING CURRENT EVENTS DUAL DIAGNOSI S CITYWIDE GROUP PROGRAM MOVIE

12 Integrated Dual Diagnosis Treatment A necessity not an option Services offered by the Citywide treatment team in one setting since BHC emphasizes both disorders in treatment planning and approach. SF s Community Behavioral Health Services has implemented Integration of services throughout the system

13 From Medical Model to Recovery Model Four Stages of Recovery: Hope, Empowerment, Self-Responsibility and Meaningful Roles Client Choice Quality of Life Community Focus Whatever It Takes: Any Door is the Right Door Community reintegration is a treatment goal and a requirement in order to graduate from BHC

14 Supported Employment Definition competitive work in integrated work settings consistent with the strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individuals with the most significant disabilities for whom competitive employment has not traditionally occurred; or for whom competitive employment has been interrupted or intermittent as a result of a significant disability Rehabilitation Act Amendments of 1998: Title IV of the Workforce Investment Act of 1998, Pub Law , 112 Stat 936

15 Supported Employment Principles Rapid job search Integrated mental health and employment services No exclusion criteria Consumer preference in the job search Focus is on competitive employment Individualized and ongoing job supports Pays at least minimum wage Aimed at people with the most severe disabilities Integrated work settings

16 Research Supports the Model Meta-analysis of 15 randomized controlled trials, found two-thirds of participants in Supported Employment obtained competitive employment - - more than twice the comparison group in traditional vocational programs and triple the earnings. Extensive Research: Bond, Drake, Becker

17 The Model is Endorsed American Psychiatric Association Substance Abuse Mental Health Services Administration (SAMHSA) National Alliance on Mental Illness (NAMI) GAINS Center for Behavioral Health and Justice Transformation (2013)

18 Build a Supported Employment Program Diversify Funding Department of Rehabilitation, City and County Mental Health, DOJ grants, Private grants Network Join Reentry Councils, Community Meetings, Mayor s Committees Have a Specialization Justice involved individuals with mental health issues

19 HERO Program Housing and Employment Recovery Outcomes Combines Supported Employment services with six months of transitional housing to: Decrease recidivism End homelessness Promote recovery through competitive employment

20 HERO Program Referred by case manager Screened by employment team Housing Contract and Employment Milestones signed by participant, case manager and employment specialist Housing secured Release from custody Active job and housing search Court monitoring for progress towards goals

21 Case Example Job Development is Key!

22 Case Example Employer Incentives

23 Case Example Rapid Job Search & Ongoing Support

24 Case Example Working through ambivalence Take a team approach

25 Case Example Success after Sanctions

26 The Essential System of Care Forensic Intensive Case Management Supported Housing Peer Support Accessible and Appropriate Medication Integrated Dual Diagnosis Treatment Supported Employment Forensic Assertive Community Treatment (FACT) Cognitive Behavioral Interventions Targeted to Risk Factors

27 Outcomes Decrease in recidivism by 39% and a decrease in re-arrest for violence of 54% for graduates. (Effectiveness of a Mental Health Court for Reducing Criminal Recidivism and Violence, American Journal of Psychiatry September 2007, Dale McNiel, Ph.D. and Renee Binder, M.D.) In the third year post-bhc entry, savings accrued from both criminal justice and mental health outcomes for an annual savings of more than $2.7 million. (Findings from Examining Program Costs and Outcomes of San Francisco s Behavioral Health Court, Arley Lindberg, May 2009.) MacArthur multi site study results support the findings of SF study. (The Effect of Mental Health Courts on Arrest and Jail Days, Archives of General Psychiatry, October 2010, Henry Steadman, Ph.D. et al.)

28 Contact Information Lisa Lightman Director of Collaborative Courts San Francisco Superior Court Kathleen Connolly Lacey, Director Citywide Case Management Forensics Program Gregory Jarasitis, Director Citywide Employment Program

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