Veteran s Justice Outreach and Veteran s Treatment Courts. Richard J. Kulich, LCSW Veteran s Justice Outreach Coordinator Marion VA Medical Center

Transcription

1 Veteran s Justice Outreach and Veteran s Treatment Courts Richard J. Kulich, LCSW Veteran s Justice Outreach Coordinator Marion VA Medical Center

2 Veteran s Justice Outreach Program (VJO) The Department of Veterans Affairs (VA) has committed to preventing incarceration and reducing recidivism among Veterans through the development of the Veterans Justice Outreach (VJO) Program. VJO Initiative: The purpose of the VJO initiative is to avoid unnecessary criminalization of mental illness and extended incarceration among Veterans by ensuring that eligible Veterans in contact with the criminal justice system have access to Veterans Health Administration (VHA) mental health and substance services. Source: Department of Veterans Affairs, April 30, Under Secretary for Health s Information Letter

3 Veteran s Justice Outreach Program (VJO) Focus areas of the VJO Program: Courts and Attorneys Provide information and education about Veterans issues to include PTSD and TBI and services available. Develop and implement Veterans Courts. Law Enforcement Provide training to local law enforcement on Veterans issues and strategies to help work with Veterans. Jails Develop communication with jails to identify Veterans who are incarcerated and engage Veterans in available services upon their release.

4 Veteran s Justice Outreach Program (VJO) What VJO Can Do: Serve Veterans of all eras, Assess Veteran s health care needs, identify appropriate VA and non-va services, Refer and link Veteran to comprehensive health care services, With Veteran consent, communicate essentials (attendance, progress, treatment, testing, discharge plan) to courts and probation, Function as a court team member

5 Veteran s Justice Outreach Program (VJO) What VJO Can t Do: Perform forensic psychiatric/psychological evaluations for the court Accept custody Guarantee program acceptance Write lengthy court reports, complete diversion paperwork Advocate for legislation Serve VHA ineligible Veterans Decide criminal justice criteria for Veteran Court participation or decide who gains admission to specialty treatment court

6 Veteran s Justice Outreach Program (VJO) Important Considerations: VJO services are available to Veterans involved in the criminal justice system. Veterans involved in civil disputes, bankruptcy, divorce, etc. are not eligible for the VJO Program. A Veteran s legal status will not be a factor in determining eligibility for VA services and/or programs. The court cannot mandate the VA to provide care to justice-involved Veterans. However, the VA will provide appropriate services based on clinical need for eligible Veterans involved in the criminal justice system.

7 Most Recent BJS Statistics (2007 estimates) Justice Involvement U.S. Residents Veterans Veteran % Probation Supervision 4,293, , % Parole 824,400 75, % Local Jail Custody 780,600 72, % State Prison Custody 1,315, , % Federal Prison Custody 197,300 19, % Adults Arrested 12,078,000 1,159, %

8 The First Veteran s Treatment Court The First VTC was created by Judge Russell in Buffalo, New York, in Judge Russell presided over a drug treatment and mental health court, and had a participant who was also a Veteran, who appeared to be struggling with the program. Judge Russell s staff included two Veterans whom the judge had speak with the offender. They discovered that that Veteran preferred to be around other Vietnam Veterans, and he was subsequently connected with a Veteran s Group at the VA. After witnessing the positive impact that this had with the Veteran participant, Judge Russell created a separate treatment court for Veterans.

9 Veteran Treatment Courts throughout the United States. The parameters of a Veterans Treatment Court vary from court to court. Generally, a Veterans Treatment Court is a problem-solving court designed to serve Veterans who have been charged with a criminal offense, who are at high risk for re-offending, and who have significant mental health and/or substance use issues. Most Veterans Treatment Courts are essentially a hybrid drug and mental health treatment court.

10 10 Key Components of a Veteran s Treatment Court Key Component #1: Veterans Treatment Court integrate alcohol, drug treatment, and mental health services with justice system case processing Veterans Treatment Courts promotes sobriety, recovery and stability through a coordinated response to veteran s dependency on alcohol, drugs, and/or management of their mental illness. Realization of these goals requires a team approach. This approach includes the cooperation and collaboration of the traditional partners found in drug treatment courts and mental health treatment courts with the addition of the Veteran Administration Health Care Network, veterans and veterans family support organizations, and veteran volunteer mentors.

11 10 Key Components of a Veteran s Treatment Court Key Component #2: Using a non-adversarial approach, prosecution and defense counsel promote public safety while protecting participants' due process rights To facilitate the veterans progress in treatment, the prosecutor and defense counsel shed their traditional adversarial courtroom relationship and work together as a team. Once a veteran is accepted into the treatment court program, the team s focus is on the veteran s recovery and law-abiding behavior not on the merits of the pending case.

12 10 Key Components of a Veteran s Treatment Court Key Component #3: Eligible participants are identified early and promptly placed in the Veterans Treatment Court program Early identification of veterans entering the criminal justice system is an integral part of the process of placement in the Veterans Treatment Court program. Arrest can be a traumatic event in a person s life. It creates an immediate crisis and can compel recognition of inappropriate behavior into the open, making denial by the veteran for the need for treatment difficult.

13 10 Key Components of a Veteran s Treatment Court Key Component #4: Veterans Treatment Court provide access to a continuum of alcohol, drug, mental health and other related treatment and rehabilitation services While primarily concerned with criminal activity, AOD use, and mental illness, the Veterans Treatment Court team also consider co-occurring problems such as primary medical problems, transmittable diseases, homelessness; basic educational deficits, unemployment and poor job preparation; spouse and family troubles especially domestic violence and the ongoing effects of war time trauma.

14 10 Key Components of a Veteran s Treatment Court Key Component #5: Abstinence is monitored by frequent alcohol and other drug testing Frequent court-ordered AOD testing is essential. An accurate testing program is the most objective and efficient way to establish a framework for accountability and to gauge each participant s progress.

15 10 Key Components of a Veteran s Treatment Court Key Component #6: A coordinated strategy governs Veterans Treatment Court responses to participants' compliance A veteran s progress through the treatment court experience is measured by his or her compliance with the treatment regimen. Veterans Treatment Court reward cooperation as well as respond to noncompliance. Veterans Treatment Court establishes a coordinated strategy, including a continuum of graduated responses, to continuing drug use and other noncompliant behavior.

16 10 Key Components of a Veteran s Treatment Court Key Component #7: Ongoing judicial interaction with each Veteran is essential The judge is the leader of the Veterans Treatment Court team. This active, supervising relationship, maintained throughout treatment, increases the likelihood that a veteran will remain in treatment and improves the chances for sobriety and law-abiding behavior. Ongoing judicial supervision also communicates to veterans that someone in authority cares about them and is closely watching what they do.

17 10 Key Components of a Veteran s Treatment Court Key Component #8: Monitoring and evaluation measure the achievement of program goals and gauge effectiveness Management and monitoring systems provide timely and accurate information about program progress. Program monitoring provides oversight and periodic measurements of the program s performance against its stated goals and objectives. Information and conclusions developed from periodic monitoring reports, process evaluation activities, and longitudinal evaluation studies may be used to modify program

18 10 Key Components of a Veteran s Treatment Court Key Component #9: Continuing interdisciplinary education promotes effective Veterans Treatment Court planning, implementation, and operations All Veterans Treatment Court staff should be involved in education and training. Interdisciplinary education exposes criminal justice officials to veteran treatment issues, and Veteran Administration, veteran volunteer mentors, and treatment staff to criminal justice issues. It also develops shared understandings of the values, goals, and operating procedures of both the veteran administration, treatment and the justice system components.

19 10 Key Components of a Veteran s Treatment Court Key Component #10: Forging partnerships among Veterans Treatment Court, Veterans Administration, public agencies, and community-based organizations generates local support and enhances Veteran Treatment Court effectiveness Because of its unique position in the criminal justice system, Veterans Treatment Court is well suited to develop coalitions among private community-based organizations, public criminal justice agencies, the Veteran Administration, veterans and veterans families support organizations, and AOD and mental health treatment delivery systems. Forming such coalitions expands the continuum of services available to Veterans Treatment Court participants and informs the community about Veterans Treatment Court concepts. The Veterans Treatment Court fosters system wide involvement through its commitment to share responsibility and participation of program partners.

20 FACILITIES Marion, IL VA Medical Center Parent facility 55 hospital beds (currently 39 due to renovation), 60 bed Community Living Center, Primary Care Annex, Behavioral Medicine Annex, Administrative Annex, AmVets Building (under construction), Residential Rehabilitation Treatment Program Community Based Outpatient Clinics (CBOC s) Illinois Effingham, Mt. Vernon Indiana Evansville (largest CBOC), Vincennes Kentucky Paducah, Mayfield, Owensboro, Hanson

21 STAFF 30 Clinical Social Workers 16 Psychologists 15 Psychiatrists 15 Nurses 14 Administration 8 Interns 4 Nurse Practitioners 3 Addiction Therapists 3 Physicians Assistants 3 Clinical Nurse Specialists 2 LPNs 2 Psychology Technicians 2 Vocational Rehabilitation Specialists 1 Pharmacist

22 SERVICES AVAILABLE Substance Use Disorder Services (SUD) Outpatient Specialty Mental Health Post Traumatic Stress Disorder Clinic (PCT) Mental Health Intensive Case Management (MHICM) Compensated Work Therapy (CWT) Military Sexual Trauma Treatment (MST) Mental Health in Primary Care (MHPC)

23 SERVICES AVAILABLE Suicide Prevention Program Healthcare for Homeless Veterans Veterans Justice Outreach Peer Support Services Home Base Primary Care (HBPC) Residential Rehabilitation Treatment Program (RRTP) Psychosocial Rehabilitation and Recover Center (PRRC) Family Services

24 SERVICE REFERRALS Inpatient psychiatric treatment - Jefferson Barracks, St. Louis, MO Outpatient opioid substitution - Jefferson Barracks, St. Louis, MO Residential treatment for Post-Traumatic Stress Disorder - Topeka VA, Topeka, KS Residential treatment for dual-diagnoses at the Psychiatry and Addiction Recovery Treatment (PART) Program - Leavenworth VA, Leavenworth, KS Fee Basis referrals are made to community resources when appropriate

25 OVERALL MENTAL HEALTH CARE In FY2011, 1,338,482 Veterans received specialized mental health treatment from VA for a mental health problem; this number has risen each year. Example: 927,052 in FY2006. Mental health staff levels have increased, from 13,802 in FY2006 to more than 20,500 currently. Expanded access is available, with longer clinic hours, telemental heath capability to deliver services, and standards that mandate rapid access to mental health services.

26 OVERALL MENTAL HEALTH CARE VA has worked with the Department of Defense (DoD) to develop the VA/DoD Integrated Mental Health Strategy (IMHS); implementation for all 28 actions of the IMHS is now underway. The National Call Center for Homeless Veterans ( AID VET) was fully implemented March 1, The Call Center ensures that homeless Veterans or Veterans at-risk for homelessness have free, 24/7 access to trained counselors.

27 SUICIDE PREVENTION August 6, 2011, marked four years since the establishment of VA s Veterans Crisis Line, which has expanded to include a Chat Service and texting option for contacting the Crisis Line. The program continues to save lives and link Veterans with effective ongoing mental health services on a daily basis. As of February, 2012: Over 500,000 calls and over 46,000 chat connections Over 20,000 rescues of those in immediate suicidal crisis Over 15,000 callers directly linked to immediate care Over 85,000 callers provided referral to a VA Suicide Prevention Coordinator

28 PTSD TREATMENT In FY 2011, 476,515 Veterans received specialized mental health treatment for PTSD; this number has risen each year, for example from 271,976 in FY2006. State-of-the-art treatments are available for Veterans with PTSD: As of March 2012, over 4,200 VA mental health professionals have been trained to provide the most effective known therapies for PTSD, Prolonged Exposure and Cognitive Processing Therapy Medication treatments are offered and may be helpful for specific symptoms of PTSD The National Center for PTSD guides a national PTSD Mentoring program, which works with every specialty PTSD program across the country to improve care.

29 SUBSTANCE USE DISORDER TREATMENT In FY 2011, 160,223 Veterans received specialized treatment for substance use disorders; 43% increase from 112,217 in FY Developed and received approval for VHA s five year plan to support the 2011 National Strategy of the Office of National Drug Control Policy; received evaluation of Substance Use Disorder programs by General Accounting Office with no recommendations offered for improvement. Developed and disseminated clinical guidance to newly hired SUD-PTSD specialists at 139 facilities who are promoting integrated care for these cooccurring conditions.

30 General Eligibility for Care in VHA 30

31 WHO IS ELIGIBLE FOR VA HEALTH CARE BENEFITS? Served in the Active military and discharged or released under conditions other than dishonorable Former Reservists may be eligible if they served full-time and for operational or support (excludes training) purposes Former National Guard members may be eligible if they were mobilized by a Federal order 31

32 MINIMUM DUTY REQUIREMENTS Persons enlisting in the Armed Forces after 9/7/80 or who entered on active duty after 10/16/81 are not eligible for VHA benefits unless they completed: 24 months continuous active service, or the full period for which they were called or ordered to active duty 32

33 EXCLUDED FROM THE MINIMUM DUTY REQUIREMENTS Minimum active duty requirements do not apply to persons discharged or released from active duty for: Early out Hardship Disability that was incurred or aggravated in line of duty or Veterans with compensable service-connected disability 33

34 Eligibility for VHA Care as a Combat Veteran 34

35 COMBAT VETERAN (CV) AUTHORITY Title 38, U.S.C., Section 1710(e)(1)(D) gave authority to provide hospital, medical and nursing home care to Combat Veterans despite insufficient medical evidence to conclude that such condition is attributable to such service. Veterans who served on active duty in a theater of combat operations during a period of war after the Persian Gulf War or in combat against a hostile force during a period of hostilities after November 11, The National Defense Authorization Act of 2008 extended the period in which a combattheater Veteran may enroll for VA health care and services to five years post discharge/release date. (Please note that this includes Reserve and National Guard Personnel mobilized for Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) and Operation New Dawn (OND).) 35

36 CRITERIA FOR COMBAT VETERAN ELIGIBILITY Must first meet the definition of a Veteran for VA health care benefits. Combat-theater Veterans who are ineligible to enroll for VA care are referred to a Vet Center for readjustment counseling services, if appropriate, or to a community provider to obtain services at the Veteran's expense. If a health care emergency exists for an ineligible Veteran, treatment is provided under VA s humanitarian treatment authority. 36

37 KEY ASPECTS OF VHA MENTAL HEALTH CARE SERVICES Recovery Orientation Evidence-Based Practices and Treatments Continuum of Care Integration of Mental Health Services with Each Other and with Physical Health Care Services Role of Principal Mental Health Care Provider Maximal Access to Care Continuing Care Measurement-Based Outcome Indicators Automated Treatment Adjuncts (e.g. MyHealtheVet) 37

38 FREQUENCY OF VHA MENTAL HEALTH SCREENINGS At-risk drinking (annual) Post-traumatic stress disorder (every year for first five years and once every five years thereafter) Depression (annual) Suicide risk (if depression screen is positive) Military sexual trauma (once) Traumatic brain injury (once) 38

39 Operation Enduring Freedom (OEF) Operation Iraqi Freedom (OIF) Operation New Dawn (OND) Experiences

40 Understanding the Experience of OEF/OIF/OND

41 STATISTICS Approximately 2.2 million have deployed since ,250,663 OEF/OIF/OND Veterans have separated from service and are eligible for care 50% (625,385) of these have obtained VA health care since FY 2002 (cumulative total) Active Duty vs. Reserve/National Guard 53% (638,774) Former Active Duty Troops 47% (568,654) Reserve & National Guard

42 There s nothing normal about war. There s nothing normal about seeing people losing their limbs, seeing your best friend die. There s nothing normal about that, and that will never become normal Lt. Col. Paul Pasquina, MD from the movie "Fighting For Life" 42

43 TRAUMATIC EVENTS IN OEF/OIF/OND SERVICE MEMBERS Multi-casualty incidents (suicide bombers, IEDs (improvised explosive devices), ambushes) Seeing the aftermath of battle Handling human remains Friendly fire Witnessed or were involved in situations of excessive violence 43

44 TRAUMATIC EVENTS IN OEF/OIF/OND SERVICE MEMBERS Witnessing death/injury of close friend/favored leader Death/injury of women and children Feeling helpless to defend or counter-attack Being unable to protect/save another service member or leader Killing at close range Killing civilians and avoidable casualties or deaths 44

45 OEF/OIF/OND VETERANS AND VA As of the Fourth Quarter, FY 2010: 1,250,663 OEF/OIF/OND Veterans eligible for VA services 50% (625,384) have already sought VA care Their three most common health issues: Musculoskeletal Mental Health Symptoms, Signs and Ill-Defined Conditions 45

46 The most complex and dangerous conflicts, the most harrowing operations, and the most deadly wars, occur in the head. (Anthony Swafford, Jarhead from PBS video Operation Homecoming) 46

47 MENTAL HEALTH PROBLEMS IN OEF/OIF/OND VETERANS 38% of Soldiers and 31% of Marines report psychological symptoms. Among the National Guard, the figure rises to 49%. Further, psychological concerns are significantly higher among those with repeated deployments, a rapidly growing cohort. Psychological concerns among family members of deployed and returning OEF/OIF/OND Veterans are also an area of concern. Hundreds of thousands of children have experienced deployment of a parent. 47

48 MENTAL HEALTH ISSUES AMONG OEF/OIF/OND VETERANS Approximately half of OEF/OIF/OND Veterans have provisional mental health diagnoses. The most common of these are PTSD, affective disorders, neurotic disorders, and nondependent abuse of drugs or alcohol, and alcohol dependence. 48

49 BEYOND MENTAL HEALTH DIAGNOSIS Many problems faced by returning combat Veterans and their families are not so much clinical as they are functional: Work Stress/Unemployment Educational/Training Needs Housing Needs Financial and/or Legal Problems) Family Issues Lack of Social Support Estrangement Family Breakup Kids in trouble 49

50 COMMON THEMES & PRESENTING PROBLEMS IN OEF/OIF/OND VETERANS Marriage, relationship problems Financial hardships Endless questions from family and friends Guilt, shame, anger Feelings of isolation Nightmares, sleeplessness Lack of motivation Forgetfulness Anger Feeling irritable, anxious, feeling on edge 50

51 Resources National Veteran s Crisis Hotline: National Call Center for Homeless Veterans: Marion VA Medical Center s VJO Coordinator: ext Marion VA Medical Center s OEF/OIF/OND Program: ext

52 QUESTIONS? 52