1. Barnstable County Sheriff’s Office’s Educating Inmates on Medication Assisted Recovery _________________ Roger Allen LMHC Director of Inmate Services Jessica Burgess MSN, RN Assistant Director of Health Services

2. Barnstable County Correctional Facility Bourne, Massachusetts  Maximum capacity: 588  Head count in May, 2013: 350-400  Highest head count was upper 400’s  American Correctional Association Certified  Opened in October of 2004

3. Residential Substance Abuse Treatment Program (RSAT)  Therapeutic Community separate from general pop.  Six Month minimum requirement for participation  Structured curriculum based on Cognitive Behavioral Theory and Disease Model of Addiction  Military structure  Progressive phases of privileges  Inmates assessed as high risk comprise most of participants  Participants assessed initially by LSI-R:SV when entering the jail. Assessed by LSCMI when entering RSAT.  Peer leadership (Squad leaders and mentors)

4. Treatment for General Population o All units with sentenced inmates except segregation receive Substance Abuse Education and CBT skills with similar curriculum to RSAT o Job Readiness classes o Education classes o AA/NA o OUI Program o Re-Entry Services

5. Re-Entry Program Begins on Person’s Entry to Jail  Comprehensive Re-entry Needs Assessment completed at beginning of sentence. LSI-R:SV administered. High Risk individuals recommended for intense treatment  Individualized re-entry goals established based on Risk/Needs Assessment and/or co-occurring medical and mental health needs  Individualized transition plan updated 60 days prior to release or as needed  Transition plan implemented through strategic collaboration of key team players and providers on staff and in community  Bi-monthly Re-entry Team meeting at the jail with community providers and probation officers  Follow-up data collected to evaluate program effectiveness

6. Questions Regarding RSAT Program at Barnstable County Correctional Facility?

7. Indications for Pre- and Post-Release Substance-Abuse Treatment  Approximately 25% of new Intakes at BCCF require opioid detox  Approximately 35% of all inmates meet criteria for drug or alcohol dependence  Highest risk of death is in the first 2 weeks after release; i.e.; overdose  Recidivism is tightly linked to relapse  Expense of incarcerating non-violent offenders  Substance abuse is a causative factor for criminogenic behavior

8. Current Options for Opioid/Alcohol Addicted Individuals After Release  Relapse  Abstinence  Counseling  12 Step Programs  Medication Assisted Treatment Opioids: *Methadone *Suboxone Opioids & Alcohol: *Vivitrol

9. Vivitrol (Extended-Release Naltexone)  An injectable form of the medication Naltrexone  Each dose lasts 30 days  For treatment of Alcohol and/or Opioid dependence  Reduces Cravings/Blocks positive effects of substances  Recommended abstinence from opioids for 7-10 days before administration  Non-Mood Altering/Non Addictive  Not controlled/No Street Value  No withdrawal

10. The Vivitrol Program is a Medication ASSISTED Treatment  The medication is only 1 aspect of treatment  The medication is intended to help prevent relapse while the addicted individual works to make lasting behavioral changes  Other treatments (counseling/meetings) are necessary for lasting recovery

11. Vivitrol Program Outline  Programs department presents information about Medication- Assisted Treatment to inmates in RSAT  Inmate requests treatment/information  Medical Director, Assistant Director, or Transitional Healthcare Coordinator meets one on one with inmate to determine if appropriate treatment for individual  Medical Clearance obtained by Medical Director

12. Vivitrol Program Outline(Cont.)  Motivation Assessment (involvement in available programs)performed  Risk Assessment (LS/CMI) performed  Two counseling sessions with Mental Health Staff  Oral Naltrexone trial for 3 days  Vivitrol administered 1 week prior to release  Mass Health Insurance initiated & follow-up treatment at community clinic scheduled prior to release

13. Vivitrol Program Data Collection  Inmate self-reported and recorded data pre- and post- treatment compared  Validated assessment tool: LS/CMI  CORI reports run for 2 years after release  Inmate self-reports level of cravings to use substances before and after Vivitrol program treatment  Release of Information signed by inmate to allow communication with follow-up treatment providers and personal contact. Allows for data collection of progress post-release

14. Data of Interest  Clean time history compared to current treatment  Compliance with appointments, counseling requirements, and monthly Vivitrol injections  Contributing to the work force?  Recidivism- Is treatment increasing time between incarcerations?

15. Preliminary Results  37 Inmates treated since April 2012  20 remain in treatment in the community  2 are no longer being treated with Vivitrol, but remain in recovery in the community  59% of inmates treated remain in recovery  31 of the 37 treated in the vivitrol program followed through with treatment at referral site in the community (Presented at first appointment) 84%  4 of the inmates treated have been re-incarcerated 11%

16. Questions? Roger Allen LMHC Director of Inmate Services Barnstable County Sheriff’s Office rallen@bsheriff.net Jessica Burgess MSN, RN Assistant Director of Health Services Barnstable County Sheriff’s Office jburgess@bsheriff.net

17. Next Presentation Domestic Violence and RSAT June 19, 2013 2:00 – 3:00 p.m. EDT Although substance abuse is the universal common denominator among RSAT inmates, many share another common challenge, domestic violence (DV). Among RSAT populations are a high proportion of both domestic violence victims and perpetrators. In fact, some RSAT inmates’ substance abuse may have been the result of self-medication to deal with the stress of domestic violence. It also plays a major role in post-release recidivism. Studies indicate that after release, the second largest number of rearrests for RSAT graduates after substance abuse crimes is domestic violence. Presenter: Andrew Klein