Strengthening Partnerships between County Jails and Community-based Service Providers. Dan Martin Maureen McDonnell Dr. Fred Osher

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2 Strengthening Partnerships between County Jails and Community-based Service Providers Dan Martin Maureen McDonnell Dr. Fred Osher

3 Webinar Overview Background System Improvements: Medications Behavioral health standards MHFA Crisis interventions Relationship Building Effects of Medicaid Access pre- and post-jail

4 Fred C. Osher, M.D. Director, Health Systems and Services Policy Council of State Governments Justice Center

5 Reducing the Number of People with Mental Illnesses in County Jails

6 An Expanding Population under Correctional Supervision

7 Jail Population Declining Nationally Inmates confined in local jails at midyear and percent change in the jail population, NUMBER OF INMATES AT MIDYEAR 900, , , , , , , , ,000 ANNUAL PERCENT CHANGE YEAR Source: Bureau of Justice Statistics, Jail Inmates at Midyear 2013 Statistical Tables,

8 What About Persons with Behavioral Disorders? AVERAGE DAILY JAIL POPULATION (ADP) AND ADP WITH MENTAL HEALTH DIAGNOSIS 13,576 Total 11,94 8 Total NEW YORK CITY

9 Percent of Population Alcohol and Drug Use Disorders: Household vs. Jail vs. State Prison 8 % Source: Abrams & Teplin (2010)

10 Prevalence of Serious Mental Illness and Co- Occurring Disorders in Jail Populations GENERAL POPULATION JAIL POPULATION 95% 5% 83 17% 72% 28% % SERIOUS MENTAL ILLNESS NO SERIOUS MENTAL ILLNESS SERIOUS MENTAL ILLNESS NO SERIOUS MENTAL ILLNESS CO-OCCURRING SUBSTANCE USE DISORDER NO CO-OCCURRING SUBSTANCE USE DISORDER

11 The Problem: Overrepresentation of Persons with Behavioral Disorders Arrested at disproportionately higher rates Co-occurrence of SUD Homelessness Stay longer in jail and prison Limited access to health care High recidivism rates Low utilization of EBPs More criminogenic risk factors

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13 Stepping Up: A National Initiative to Reduce the Number of People with Mental Illnesses in Jails

14 The Stepping Up Initiative officially launched with a series of events in May 2015 May 5, Washington DC May 5, Johnson County, KS May 6, Miami-Dade County, FL May 7, Sacramento, CA

15 Thank you! Fred Osher, M.D. Director of Health Systems and Services Policy, CSG Justice Center The presentation was developed by members of the Council of State Governments Justice Center staff. The statements made reflect the views of the authors, and should not be considered the official position of the Justice Center, the members of the Council of State Governments, or the funding agency supporting the work.

16 Dan Martin, JD Director of Public Policy Mental Health Association of Maryland

17 CIT Overview Purpose Law enforcement-based intervention to assist and divert individuals in crisis Key Partners Local Law Enforcement Local Mental Health Authorities Crisis Programs Service Providers Emergency Departments

18 Origin of MHCJP House Bill 990 (2005) required DHMH, DPSCS and DHR to convene a workgroup of interested stakeholders to make recommendations on actions to break the cycle of rearrest and reincarceration for individuals with mental illness who become involved in the criminal justice system.

19 Who We Are The HB 990 workgroup has been formalized as the Maryland Mental Health and Criminal Justice Partnership (MHCJP) and includes over 40 active members representing: State agencies Local mental health authorities Local law enforcement Correctional administrators Advocates Mental health service providers Members of the judiciary

20 Progress Report Medication Upon Release Legislation enacted to ensure 30-day supply of medication upon release from state facilities and local detention centers Professional Training/Continuing Education Worked with Police and Correctional Training Commissions to establish behavioral health training standards and approve curricula; more than 1,100 public safety professionals trained in MHFA Personal Identification Cards Data sharing program between MVA and holding facilities; issuance of IDs upon release recognized as a priority throughout the system

21 Ongoing Initiatives Data Sharing DataLink program developed to allow the sharing of public mental health system data across systems, promoting the continuity of care for individuals with serious mental illness that interact with law enforcement MHCJP DataLink Subcommittee established to advise and assist in expanding the program throughout Maryland Crisis Intervention Teams Recent increased funding for and interest in CIT programs MHCJP CIT Subcommittee established to standardize and expand availability throughout Maryland

22 DataLink Overview Key Partners Department of Health and Mental Hygiene Department of Public Safety and Correctional Services Administrative Services Organization Local Mental Health Authorities Local Detention Centers Process DPSCS ValueOptions DPSCS and CSA

23 Subcommittee Progress and Efforts Outreach to local jurisdictions bring partners together Development of toolkit/materials to explain program and alleviate concerns Assist in implementation details and troubleshooting Report on progress 8 jurisdictions and state facilities; several more nearing implementation Collect and review aggregate data

24 Subcommittee Progress and Efforts Development of core standards/elements document Development of implementation milestones grid/questionnaire Series of regional relationship-building forums for law enforcement and mental health professionals Outreach to local jurisdictions bring partners together and assist in plan development Identify and overcome obstacles to implementation Draft legislation

25 For More Information Dan Martin Director of Public Policy Mental Health Association of Maryland (443) x208 Follow me on

26 Maureen McDonnell, MPH Director for Business and Health Care Strategy Development TASC

27 Building Care Paths from Jail to Community Medicaid Applications = Step 1 Broad Linkages to Care = Step 2

28 Around the Country Many large jails have enrollment projects: Chicago, LA, Louisville, Denver Building continuity of care will reduce recidivism Assistance available from: National Institute of Corrections Foundations TASC

29 The Promise of Health Care Reform Won t solve all challenges, but... Unique opportunity for significant change on a broad scale. Near universal coverage for low income adults. Address gaps in services. Eliminate long waiting lists. o Developing unified systems with single point of access to care improve outcomes, increase competitive position. Ending piecemeal approach to public funding.

30 Cook County Justice & Health Initiative August 2012 Planning process convened by the Honorable Paul P. Biebel, Jr., Presiding Judge of the Criminal Division The Justice and Health Initiative (JHI) Steering Committee includes leadership from: Cook County Sheriff s Office and justice agencies Cook County Health and Hospitals System Community substance abuse and mental health providers Community foundations Builds on Cook County s early expansion of Medicaid (2012). JHI was developed and led by TASC with Chicago Community Trust funding; other foundations joined.

31 Justice & Health Initiative Goals: 1. Determine how to facilitate applications for all eligible persons entering the justice system. 2. Develop infrastructure and processes that support universal linkage to medical, mental health, and substance abuse treatment. 3. Support expansion of care in the community that meets the needs of people under supervision. 4. Expand diversion from jail and prison to care in the community under appropriate supervision.

32 Jail Intake Application Assistance Process Partnership between Cook County Health & Hospitals System, Cook County Sheriff s Office and TASC Operational Goals: Maximize Applications & Use of Care Complete full application during intake: Fingerprint-based identifying information used to verify inmate identity. Applications are completed online using state Medicaid application websites and jail management system records. Process must fit in fast-paced secure environment: new detainees/day. Cannot impede security or medical flow. Each application takes approximately ten minutes. Encourage applicants to use care after release. Results: Over 20,000 Medicaid applications have been initiated to date (April 2013 March 2015).

33 Jail to Community Continuity of Care Planning Process: How to establish processes that link people with serious mental illness, severe substance use disorders and chronic medical conditions to needed care in the community, given jail release timeframes? Demonstration Project: Link 30 people /day with serious mental illness released to care in the community (local foundation funding). Expanded to Full Care Coordination Project through Cook County Health System contract. Partnership between Sheriff s Office, Cook County Health and Hospitals System, Cermak Mental Health Services/CCHHS and TASC NEW: Provider Learning Collaborative Build solid connections between jail release and community care Integrate transitional housing, mental health care, other needed supports Test projects for future investments Funded by Polk Bros. Foundation

34 Jail Diversion Bridgeport CT Corrections/courts/treatment provider working together Early results 14 people diverted from jail in first 6 weeks Funded by Public Welfare Foundation PWF looking for additional sites; TASC provides TA

35 Contact Information Maureen McDonnell Director for Business and Health Care Strategy Development

36 SAMHSA Resources SAMHSA s GAINS Center Provides technical assistance to the field and grantees. Supports the following grant programs: Behavioral Health Treatment Court Collaborative Mental Health Transformation Grant Early Diversion Adult Treatment Court Collaboratives Jail Diversion Trauma Recovery

37 SAMHSA Resources Behavioral Health and Justice Involved Populations Discusses the impact of behavioral health on the criminal justice system (e.g. changes in the field, impacts of health reform, the challenges related to trauma, etc.). SAMHSA s Efforts on Criminal and Juvenile Justice Issues Reviews SAMHSA s five areas of focus for justice-involve populations.

38 Questions

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