Assessing the Need in Pennsylvania Kirk Heilbrun Ed Mulvey Carol Schubert Katy Winckworth-Prejsnar 11/26/12

Funded By:  Pennsylvania Commission on Crime and Delinquency (PCCD)  Department of Public Welfare Office of Mental Health and Substance Abuse Services (OMHSAS)  Oversight by the Mental Health and Justice Advisory Committee of PCCD Collaboration between Drexel University and Western Psychiatric Institute and Clinic University of Pittsburgh Medical School

Center of Excellence Staff  Edward P. Mulvey, Ph.D., Co-Director Professor of Psychiatry, University of Pittsburgh School of Medicine  Kirk Heilbrun, Ph.D., Co-Director Professor and Head, Department of Psychology, Drexel University  Carol A. Shubert, M.P.H., Senior Consultant Research Program Administrator, Law and Psychiatry Program, Western Psychiatric Institute and Clinic  David DeMatteo, J.D., Ph.D., Senior Consultant Assistant Professor, Department of Psychology, Drexel University Co-Director, JD/PhD Program in Law and Psychology, Drexel University  Patricia A. Griffin, Ph.D., Senior Consultant Consultant for a variety of agencies and organizations including the CMHS National GAINS Center & TAPA Center for Jail Diversion, the Philadelphia Dept. of Behavioral Health, and the Montgomery Dept. of Behavioral Health  Amanda Cross, Ph.D, Senior Research Associate  Katy Winckworth-Prejsnar, Project Coordinator  Sarah Filone, M.A., Project Coordinator

The Problem  Many of the same people in multiple systems:  Mental health  Substance abuse  Criminal justice  Other social services  Expensive - high service users, people who cycle and recycle through the system SOLUTION: Cross-Systems Coordination

Pennsylvania Center of Excellence Goals & Tools  Diversion  Technical Assistance  Sequential Intercept Model  Cross Systems Mapping and Action Planning Workshops  Education  Presentations  Consultation  Website

Web-based Resource Center

Sequential Intercept Model as our Organizing Tool

Sequential Intercepts The Ultimate Intercept I. Law Enforcement/Emergency Services II. Post-Arrest: Initial Detention/Initial Hearings III. Post-Initial Hearings: Jail/Prison, Courts, Forensic Evaluations and Commitments IV. Re-Entry From Jails, State Prisons, & Forensic Hospitalization V. Community Corrections & Community Support Munetz & Griffin Psychiatric Services 57: 544–549, 2006

 Identifies  Existing local services and systems  Issues considered important to local stakeholders  Data  Diagnosis  Strengths to be built upon  Helps everyone see “big picture” & how they fit  Helps diverse groups from various systems understand where/how everything fits  Intercepts provide “manageable” venues and opportunities for systems interventions Useful Organizing Tool

Five Key Points of Interception 1. Law enforcement / Emergency services 2. Booking / Initial court hearings 3. Jails / Courts 4. Re-entry 5. Community corrections / Community support

Cross-Systems Mapping Workshops 13

Workshop Tasks 1. Nurture cross-system collaboration 2. Map the local system 3. Inventory current resources, gaps, and opportunities 4. Agree on priorities 5. Build an Action Plan

Washington County Cross Systems Map

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Final Report  Cross-systems picture  Available for wide distribution  Provided in PDF and Word formats  County-Specific Narrative for each intercept  Gaps and Opportunities  Action Plan  Support for future funding applications  Reference/resource materials included

Cross Systems Mapping Workshops What We’ve Learned About Pennsylvania

Common Gaps in Service  Intercept 1 Law enforcement agencies have limited time for training Law enforcement officers spend hours waiting with individuals at local hospital Lack of detoxification and sobering services  Intercept 2 Lack of pretrial services Problems with video arraignment equipment  Intercept 3 Many jail admissions requiring detoxification Lack of treatment staff Medical Assistance benefits terminated after admission  Intercept 4 Significant gaps in aftercare medication Limited continuity of care Limited re-entry efforts Few systematic efforts to reinstate or start MA and/or SS benefits  Intercept 5 Not enough housing

What We’ve Learned About PA  Many opportunities as well:  Support for Training at Intercept 1  Collaborative efforts among systems (CJABs, Problem Solving Courts, Forensic Treatment Teams)  Growing interest in Peer Support Services for forensic settings  Individuals dedicated to change

What We’ve Learned About PA  Most Common County Priorities  Training at Intercept One  Formalized detoxification procedure  Reduce strain on hospitals, jails, and law enforcement  Continuity of care from local jails to community  Aftercare Meds  Re-activation of benefits  Psychiatric Appointments  Housing  Information sharing across systems

23/27 identified SPR as a top priority 3 already has some type of SPR training in place

Specialized Police Response (SPR) Training :  Crisis Intervention Training (CIT)  Advanced CIT addressing veterans, military culture, and trauma topics  Mental Health First Aid (MHFA) -12 hour  MHFA – Public Safety 8 hour  Crisis Intervention Specialist (CIS) Police School  Family Training and Advocacy Center (FTAC) training

Specialized Police Response to People with Behavioral Health Problems in PA: A Survey of the Commonwealth A summary of results

Background  Survey developed by the COE regarding specialized police responses in PA Counties  Requested by Judge Zotolla and members of the Mental Health and Justice Advisory Committee (MHJAC)  Three groups targeted:  Law enforcement  County Office of Mental Health  Criminal Justice Advisory Board (CJAB)  Distributed with the assistance of PCCD and OMHSAS  Reflects views between December 2010-January 2011

What the survey covers  Respondent information  Activities taken to address responses to people with behavioral health challenges  Training provided in the area of behavioral health  Cross-system collaboration to address problems related to individuals with behavioral health challenges  Resources needed to better respond to people with behavioral health challenges  Opportunities for and barriers to change related to improving response to individuals with behavioral health challenges

Who Responded  Law Enforcement  84 responses  33 counties (1-9 responses per county)  Mental Health  31 responses  27 counties (1-3 responses per county)  CJAB  21 responses  16 counties (1-4 responses per county)

Responses: Training (received training on behavioral health issues) (provided training on behavioral health issues) (training provided to law enforcement on behavioral health issues) Percent of responses

Responses: Collaboration (Collaboration with non-law enforcement agencies) (Collaborate with law enforcement) Percent reporting collaboration

Responses: Needed Resources (to improve responses to people with behavioral health challenges)  In forced responses - over 80% in all 3 groups identified  Additional training on mental health issues  Crisis mental health services  In open-ended responses – all 3 groups identified  More training  Better access to crisis intervention services  Better system collaboration in the county

Responses: Barriers (to improving the response to people with behavioral health challenges) Law Enforcement Mental HealthCJAB Funding (49%) Funding (63%) Funding (88%) Manpower shortage/time (33%) Lack of cooperation/ understanding (37%) Manpower issue within police departments (31%) Access to training (21%) Housing (19%) Lack of time/ understanding (13%)

For more information Contact: Katy Winckworth-Prejsnar Research Coordinator