Continuity of Care for the Justice- Involved: The Case for Bidirectional Data Exchange

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2 Continuity of Care for the Justice- Involved: The Case for Bidirectional Data Exchange Dina Passman, MPH, LCDR USPHS Public Health Advisor, Health Information Technology Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration National Forum on Criminal Justice Breckenridge, CO August 12, 2014

3 SAMHSA s Criminal Justice Efforts To better address the needs of persons with mental and substance use disorders in the criminal justice system. 3 3

4 CJ Behavioral Health is Public Health MH/SUDs CJI Public Health & Safety MH/SUDs and CJ involvement (CJI) are interlinked public health & safety issues. Addressing MH/SUDs can reduce CJI, simultaneously improving public health and safety while reducing related economic burdens. 4

5 Criminal Justice System continues to be the Largest Referral to Substance Abuse Treatment Other Health Care Provider, 6.4% Alcohol Drug Abuse Care Provider, 9.9% School (Educational), 1.2% Individual (inc. self-referral), 33.1% Employer/EAP, 0.5% Other Community Referral, 12.1% Court/ Criminal Justice Referral/DUI/ DWI, 36.9% Other recognized legal entity, or other Other DUI/DWI Prison, 2.4% Diversionary program, 2.5% Probation/ Parole State/Fed Court, Other Court Recognized Legal Entity 20.6% 10.8% 34.6% 29.2% SAMHSA Treatment Data Set (TEDS) Concatenated,

6 CJ Referrals Make a Difference in Treatment Completion According to SAMHSA TEDs data, CJ referral to treatment was consistently one of the strongest predictors of treatment completion or transfer to further treatment. Secondary statistical analysis of data from a clinical study found that individuals entering court ordered treatment were over 10Xs more likely to complete treatment compared to offenders who entered treatment voluntarily. SAMHSA, OAS, TEDS data (4/25/12); and Coviello, DM et al Does mandating offenders to treatment improve completion rates? J Substance Abuse Treatment. 44:

7 SAMHSA s Strategic Initiative - Health IT Goal: Widespread Implementation of HIT Systems that Support Quality Integrated Behavioral Health Care for All Americans Ensure that behavioral health provider networks fully participate in the adoption of Health IT Support the behavioral health aspects of HIT based on the standards and systems promoted by the Office of the National Coordinator for Health IT Support linkage with systems relevant to behavioral health that support prevention, treatment, wellness and recovery (Criminal justice, HUD, education, public health, recovery oriented systems of care, and other human services) 7

8 Importance of Criminal Justice Behavioral Health Information Sharing Identifying target population for intervention Providing better clinical care Risk assessment Assessing outcomes Program evaluation Coordinating services for re-entry Payment and billing 8

9 Current CJ HIT Efforts

10 Federal Interagency Reentry Council HIT Workgroup Part of the Health Access Subcommittee Co-Chairs SAMHSA & ONC Members HHS (ASPE, CMS, HRSA, NIH, ONC, SAMHSA), ONDCP, DOJ 10

11 Federal Interagency Reentry Council Objectives: To promote the adoption and meaningful use of HIT within the correctional health system To promote interoperability and effective information exchange within the correctional health system, as well as between the correctional health system and the community health system 11

12 Federal Interagency Reentry Council Current initiatives: Federal interagency materials (TPs, Myth Busters) Environmental scan of stakeholder activities CJ-Community Data Sharing Stakeholder Meeting 12

13 Challenges & Opportunities

14 Challenges Standards Privacy and security (42 CFR Part 2, HIPAA) Equipment and connectivity Meaningful Use 14

15 Myth 1 Myth: All disclosures require consent Fact: HIPAA does not require consent for disclosures or uses that are necessary to carry out treatment, payment, or health care operations However: 42 CFR Part 2 does require consent unless one of the limited exceptions apply 15

16 Myth 2 Myth: No one outside the health system can access protected health information Fact: HIPAA permits disclosures for : Public health activities Victim of abuse or neglect Judicial/Administrative proceedings Law enforcement Threats to health or safety Court-ordered examinations Correctional facilities Through business agreements 16

17 Myth 2 (Cont.) Myth: No one outside the health system can access protected health information Fact: 42 CFR Part 2 permits disclosures Public health research Child abuse reporting Crimes on premises or against staff Criminal justice system if treatment is made a condition of parole or release Or to other systems with patient consent or QSOA 17

18 Myth 3 Myth: Federal law prohibits staff from the same agency or organization from talking to each other Fact: Both HIPAA and 42 CFR Part 2 permit intraagency exchanges of information 18

19 Opportunities Current state of IT and HIT infrastructure Meaningful Use CMS EHR Incentive Program rule change Source: State of Florida Center for Drug-Free Living, Inc.,842 So.2d 177 (2003) at

20 Questions and Comments Contact: