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Co-occurring disorders

“This white paper presents a shared framework for reducing recidivism and behavioral health problems among individuals under correctional control or supervision—that is, for individuals in correctional facilities or who are on probation or parole. The paper is written for policymakers, administrators, and practitioners committed to making the most effective use of scarce resources to improve outcomes for individuals with behavioral health problems who are involved in the corrections system. It is meant to provide a common structure for corrections and treatment system professionals to begin building truly collaborative responses to their overlapping service population. These responses include both behind-the-bars and community-based interventions. This framework is designed to achieve each system’s goals and ultimately to help millions of individuals rebuild their lives while on probation or after leaving prison or jail” (p. viii). Three parts follow an introduction regarding the need for a framework intended for coordinating services across systems: current responses to individuals with mental health and substance use disorders and corrections involvement—mental health treatment, substance abuse treatment, mental health and substance use appearing together, corrections—custody, control, and supervision, screening and assessment, the relationship between behavioral health needs and criminogenic risk/need—assembling the parts, and closing thoughts on RNR (risk-need-responsivity); the framework—strong foundations, criminogenic risk and behavior health needs, application to resource allocation and individual case responses, and goal for the framework’s use; and operationalizing the framework and next steps.

Adults with Behavioral Health Needs Under Correctional Supervision: A Shared Framework for Reducing Recidivism and Promoting Recovery Cover

People with co-occurring mental illnesses and substance use disorders—also known simply as co-occurring disorders—have complex needs that require integrated responses across jails and behavioral health systems. However, staff often do not know how many people with co-occurring disorders reside in the jail or do not know how to respond when they recognize the symptoms. This brief outlines how jail administrators and staff can improve their responses to this population by implementing practices that focus on identification and provision of services: conducting standard screening and assessment for both, linking people to services through collaborative comprehensive case management, and assessing effectiveness through regular performance measurement tactics.

The use of the Mental Health Pretrial Release Program (MHPTR) by the Orange County Jail, in order to identify those individuals with mental illness who can be safely supervised in the community prior to their trials, is discussed. Seven sections comprising this case study are: introduction; summary of initiatives; first steps -- 1999-2004; beyond the Central Receiving Center -- 2004-2006; assessing the impact of new initiatives; looking ahead -- challenges; and dimensions of collaboration. Successful completion of the MHPTR program results in a 17% reduction in costs over 18 months.

Increasing Collaboration Cover

The opportunity for diverting offenders with mental illness and substance abuse disorders from the criminal justice system when they have their first appearance in a municipal court is explained. Sections of this publication include: introduction; Sequential Intercept Model (SIM); municipal courts—definition and caseloads; municipal courts as a venue for diversion of people with mental and substance use disorders; challenges to the use of municipal courts for diversion—case volume, time constraints and lack of leverage, and the mature of municipal courts; what the essential elements for effective diversion are—identification and screening, court-based clinician as the boundary spanner-linkage component, recovery-based engagement strategies, and proportional response; a municipal court achieving effective diversion—Seattle Municipal Mental Health Court; a municipal court achieving effective diversion—Midtown Community Court in New York City; a municipal court achieving effective diversion—Misdemeanor Arraignment Diversion Project in New York City; and summary. "Municipal courts that implement these four essential elements—Identification and Screening, Court-Based Clinician, Recovery-Based Engagement, and Proportional Response—are in the position to minimize the criminal justice system involvement and reduce unnecessary incarceration of people with mental illness and co-occurring substance use disorders as well as facilitate engagement or re-engagement in mental health and substance use disorder services" (p. 12).

Municipal Courts: An Effective Tool for Diverting People with Mental and Substance Use Disorders from the Criminal Justice System cover

"This monograph examines a wide range of evidence-based practices for screening and assessment of people in the justice system who have co-occurring mental and substance use disorders (CODs). Use of evidence-based approaches for screening and assessment is likely to result in more accurate matching of offenders to treatment services and more effective treatment and supervision outcomes … Key systemic and clinical challenges are discussed, as well as state-of-the art approaches for conducting screening and assessment. The monograph also reviews a range of selected instruments for screening, assessment, and diagnosis of CODs in justice settings and provides a critical analysis of advantages, concerns, and practical implementation issues (e.g., cost, availability, training needs) for each instrument" (p. 1). Two parts follow an executive summary. Part I-- Key Issues in Screening and Assessment of Co-occurring Disorders in the Justice System: prevalence and significance of co-occurring disorders in the justice system; defining co-occurring disorders; importance of screening and assessment; opportunities for screening and assessment; defining screening and assessment; developing a comprehensive screening and assessment approach; key information to address in screening and assessment for co-occurring disorders; enhancing the accuracy of information in screening and assessment; and special clinical issues. Part II—Instruments for Screening and Assessing Co-occurring disorders: key issues in selection; comparing screening instruments; recommended instruments for assessment and diagnosis of co-occurring disorders—screening instruments for substance use, screening instruments for mental disorders, screening instruments for co-occurring mental and substance abuse disorders, screening and assessment instruments for suicide risk, screening and diagnostic instruments for trauma and post-traumatic stress disorder (PTSD), screening instruments for motivation and readiness for treatment, assessment instruments for substance use and treatment matching approaches, assessment instruments for mental disorders, and assessment and diagnostic instruments for co-occurring mental and substance use disorders.

Screening and Assessment of Co-occurring Disorders in the Justice System Cover

“One of the biggest challenges for drug courts is effectively working with participants with co-occurring disorders. By definition, persons with the dual diagnosis of both substance use disorders and mental illnesses have co-occurring disorders … every adult drug court can achieve positive outcomes for persons with co-occurring disorders—if the court is committed to doing so. With some creativity and thoughtful planning, most persons with co-occurring disorders can successfully participate in drug courts” (p. 1). This publication explains very clearly how to ensure this by utilizing six critical steps. Topics covered include: three treatment court models; the need for flexibility; overlapping populations; step 1—know who your participants are and what they need by using the quadrant model, screening, and assessment; step 2—adapt your court structure; step 3--expand your treatment options; step 4--target your case management and community supervision; step 5—expand mechanisms for collaboration; and step 6—educate your team.

The use of systemic criminal justice planning by Hamilton County (OH) to improve services and programming for women offenders is reviewed. This bulletin is comprised of the following sections: introduction; the systemic planning process; members of the Intermediate Sanctions for Women Offenders Policy Team; steps in the collaborative systemic planning process (chart); how decision mapping works; sample findings and results; the Alternative Interventions for Women (AIW) Treatment Program; and lessons learned. AIW graduates have a 13% new criminal conviction rate and a 6% probation violation resulting in jail time rate.

Systemic Criminal Justice Planning: Improving Responses to Women Offenders in Hamilton County, Ohio Cover
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