Making SOAR Work in Criminal Justice Systems Please stay on the line. AUDIO: Toll Free Number: Passcode: PIN: Provided in your registration confirmation (Contact if you can’t find your The webinar will begin shortly.

Making SOAR Work in Criminal Justice Systems Presented by: SAMHSA SOAR Technical Assistance Center Policy Research Associates, Inc. Under contract to: Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services

Welcome! Dr. Pamela J. Fischer, Ph.D. Social Science Analyst Homeless Programs Branch Center for Mental Health Services Substance Abuse and Mental Health Services Administration

Webinar Instructions Muting Recording availability Downloading documents Evaluation Question instructions

Agenda Consider a “PILOT” Dazara Ware, SAMHSA SOAR Technical Assistance Center, Policy Research Associates, Inc. Oklahoma Mental Health Reentry Bob Mann, Administrator of Mental Health Services Operations, Oklahoma Department of Corrections Questions and Answers SAMHSA SOAR TA Center

Consider a “PILOT” Dazara Ware, MPC SAMHSA SOAR Technical Assistance Center Policy Research Associates, Inc. Delmar, New York

SOAR TA Center Follow up SOAR and Criminal Justice Webinar – 11/2012

Reentry Reality Correctional supervision in the US = 7 Million Community corrections supervision = 5 Million Annual release from federal and state prisons = 750,000 Serious mental illness = 125,000 Offenders diagnosed with a SMI that were homeless in the months before their incarceration = 20 percent Rates may be even higher for those exiting the criminal justice system Access to benefits can help to promote post release success

Proposal to promote recovery Identify stakeholders and coordinator Link to the community Optimism! Time

The Proposal Discuss prevalence of mental health needs within the criminal justice setting Promote recovery and community re-entry –Income –Healthcare –Access to housing Provide information to decision making authorities within the agency about SOAR success –Buy-in –SOAR Overview tool

Park Center’s Facility In-Reach Program Proposal initiated by Ashley Blum Inception of Facility program: July 1, 2010 Total clients to date: 92 facility clients Success rate: 100% (86 approved, 6 pending) Average days from date of application to date of DDS decision: 39.7 days

Identify Stakeholders Identify stakeholders to form a steering committee –Commissioners, Judges, Chief Jailers –Social workers, Counselors, Reentry staff, Medical records staff –MH administrators, Psychologists, Psychiatrists –Parole, Probation and Community Reentry Project Directors

Identify a Coordinator Starting an SSI/SSDI initiative as part of reentry planning requires a steering committee with a strong and effective coordinator –Serves as the liaison between case managers and steering committee –Effective –Committed

Make the Link to the Community Linking justice involved persons that may be eligible for benefits to community resources should be part of the continuity of care in the facility’s SOAR plan Internal discussions about existing resources –What is already being done?

Eleventh Judicial Circuit Criminal Mental Health Project (CMHP) Miami-Dade County, Florida Implemented to divert people with SMI away from the criminal justice system into community-based treatment and services Target population expanded to include individuals re-entering the community after completion of jail sentence

Approach with Optimism Opportunities for success CAN happen! Stories from around the country

SOAR Helps Reentry Efforts Income Reducing state cost Promotes recovery Health care Healthier individual Promotes healthier communities Access to Housing From “ex-con” to paying customer Integration into community

This Process Takes Time Time to train and learn –2-day training –On-going support Time to do –Not a “file it and forget it” approach –FTE dedicated to SOAR Time to see results –1 year to see results –2 years for a fully functioning program Time to track –SOAR OAT

Consider a PILOT site Pilot sites provide a great opportunity to test your plan in a focused area –Test the plan –Address challenges –Make revisions –Use results as leverage

Fulton County, GA Jail Pilot Initiated in 2009 Proposal submitted to the Chief Jailer and Social Workers at the Public Defender’s Office SOAR Staff issued official jail ID’s that allowed for full and unaccompanied access to potential applicants 70% approval rate Used as leverage to gain the buy-in for GDC initiative

It’s Really About People “Al” April 2009, Al was arrested on felony charges and lost his job Undiagnosed and untreated mental illness After 41 days in custody in the Miami-Dade County jail Connected to the Jail Diversion Program was able to coordinate a successful transition plan to the community Received assistance with housing, treatment, and application for Social Security benefits using the SOAR approach. In May 2010, Al successfully completed the Jail Diversion Program and the felony charges were dismissed. Today, Al is a valuable member of the Jail Diversion Program staff as a peer recovery coach.“If it wasn’t for this program, I don’t know where I would be now.”

Contact for Assistance Dazara Ware Senior Project Associate SAMHSA SOAR TA Center *5260

Oklahoma Mental Health Reentry Program: SOAR and Federal Benefit Implementation Bob Mann, RN, LSW Administrator of Mental Health Operations Oklahoma Department of Corrections

24 Why Do We Need a Mental Health Reentry Program?

Crucial Elements of a Correctional Mental Health Reentry System Executive level buy-in Potential partners examine overlap in missions Recovery orientation and public safety awareness Coalition of empowered boundary spanners Focused on solutions- tear down silos Common vocabulary – framework for identification of target population Shared conceptual framework- Sequential Intercept Model & SSI/SSDI Outreach and Recovery (SOAR)

Partners in Collaboration Oklahoma Department of Mental Health and Substance Abuse Services Social Security Administration Oklahoma Department of Rehabilitative Services: Disability Determination Division (DDD) and Vocational Rehabilitation Division (Voc Rehab) Oklahoma Department of Human Services Oklahoma Health Care Authority (Medicaid agency)

ODMHSAS has taken ownership for the continuity of mental health services for those offenders with the highest level of mental health need. Discharge managers, who are ODMHSAS employees, are boundary spanners with offices in DOC mental health units and serve as members of correctional mental health treatment teams. The discharge managers serve as part of the ODOC institution mental health treatment team that creates and implements the individualized treatment plan, including reentry planning for offenders with serious mental illness. 27 How is This Interagency Mental Health Reentry Program Unique?

“In-Reach” and Intensive Services Post Release- Modified Assertive Community Treatment (ACT) Reentry Intensive Care Coordination Teams (RICCT) meet with offender a minimum of 90 days before projected release date from prison and work with offender in the community until offender has adjusted to life following incarceration. An innovative, vital component of RICCT is inclusion of a Certified Peer Recovery Support Specialist on the team. These specialists have life-experience with mental illness and/or substance abuse and are trained to offer peer support. 28 How is This Interagency Mental Health Reentry Program Unique?

Benefit Planning for Successful Reentry Most of the target population for the MHRP are eligible for SSI/SSDI and Medicaid Oklahoma is a 209 b Waiver State (one of eleven) to get disability determination from Social Security (for most individuals) Affordable Care Act implementation- many states (including Oklahoma) chose to not expand- much ado about nothing? SSI/SSDI crucial for recovery support (opens door to disability based housing, services)

Timeline for Benefit Planning Implementation in Oklahoma 2004 SAMHSA Mathematica Policy Research- (Establishing and Maintaining Medicaid Eligibility upon Release from Public Institutions) Oklahoma received support to implement the SSI-SSDI Outreach, Access, and Recovery (SOAR) program MH Reentry staff trained in SOAR and Medicaid Pre-release Agreements Signed with local SSA offices

SOAR Training (even for administrators!)

Timeline for Benefit Planning/ Implementation - Continued 2006-Now Ongoing meetings between DOC and DDS staff 2007 Mental Health Reentry Program begins 2008 Qualified Services Organization Agreement signed between ODMHSAS and ODOC (information sharing agreement) 2009 Voc Rehab counselor begins to work with MHRP participants (performs vocational assessments/ evaluations & refers individual to Voc Rehab services in the community)

Benefit Planning Process The goal is for the individual to leave prison with their Social Security benefits in place and have the Medicaid entitlement aligned so funding is in place for medical and mental health services following release from prison (pre-approval takes place in the facility- Certificate of Release documents “flips the on switch” in the community The MHRP staff start the social security and Medicaid application process 120 days prior to an offender’s scheduled discharge

Model Program to Assist Offenders with Serious Mental Illness Obtain Federal Disability and Medicaid Benefits 6–9 months from release: Identify target population Screen for income, resource eligibility Request consents 120 days from release: Start SSI/SSDI application 60 days from release: Start Medicaid application 45 days from release: Submit Medicaid application Monitor application status Day of release: Direct person to local SSA office Fax certificate of release to local DHS office Source: Mathematica Policy Research, Inc.

Benefit Planning Process The MHRP staff get releases signed, set up phone interviews, coordinate with ODOC Mental Health Services clinical staff who prepare the discharge summary DDD staff flag cases, assign specific examiners and specific medical consultants Community Based RICCT staff follows up with individual post release (Medicaid & SSA office visits

Benefit Planning Challenges Documenting functional ability in a correctional setting: DOC clinical staff SOAR training, meetings with DDS staff medical consultants and specified examiners. Lots of discussions about ‘apples and orange’ language differences in systems (e.g. in a mental health unit a job might be ‘keep the unit microwave clean) Sharing not just clinical information- disciplinary reports are also helpful measures of functionality

Benefit Planning Challenges Getting medical records from ODOC to DDD can be a very time consuming process. –From 2006 through 2012 MHRP staff faxed, mailed and even hand carried ODOC mental health documentation to the local SSA and/or DDD office –Documentation occasionally became lost, misfiled, etc and the process would slow down dramatically –Additional information would be requested (which also slowed down the process)

Benefit Planning Challenges 2013 Electronic Information Exchange Agreement between DDD and ODOC signed. Allows DDD staff direct access to ODOC Electronic Health Record.

Benefit Planning Challenges Maintaining collaboration can be difficult –Two years ago an increase in processing time was observed. A meeting with all of the staff involved (some old, some new) from all systems revealed that some processes has shifted –Direct line numbers were again shared so staff can ‘speed dial’ their counterparts

SSI/SSDI Application Results Disability Determination Allowance Rate Comparison Source: Oklahoma Department of Rehabilitative Services, Disabilities Determination Division.

MHRP offenders were over 4 times more likely to be enrolled in Medicaid at prison release than the baseline comparison group. 41 Offenders Enrolled in Medicaid

Service engagement rates for MHRP offenders were over 5 times more than the baseline comparison group. 42 Rate of Engagement Offenders Receiving 4 Services Within 44 Days of Release from DOC

MHRP offenders showed 80% less inpatient admissions than the baseline comparison group. ($776,000 estimated savings from 2/07 to 10/09) MHRP offenders received over 50% more outpatient services than the baseline comparison group. 43 Inpatient, Outpatient & Pharmacy Services

Offenders Returning to Prison Within 36 Months

Contact Information Bob Mann, RN, LSW Administrator of Mental Health Operations Oklahoma Department of Corrections

Questions and Answers Facilitated By: SAMHSA SOAR Technical Assistance Center Policy Research Associates, Inc.

For More Information on SOAR Visit the SOAR website: SAMHSA SOAR TA Center Policy Research Associates, Inc