1. Recovery Innovations in the Criminal Justice System: Paying for Outcomes

2. 1
North Dakota’s jail and prison populations are experiencing some of the largest rates of growth in the country
The North Dakota prison population had the FOURTH HIGHEST percent increase
in the country between 2005 and 2014
Change
in Prison
Populations
2005–2014
Stable Prison Population
Significant Growth in Jail Population
The North Dakota jail population had the
THIRD HIGHEST percent increase
in the country between 2006 and 2013
Change
in Jail
Populations
2006–2013*
Stable Jail Population
Significant Growth in Jail Population
*The 2006–2013 timeframe is the most recent data available for national data comparisons on jail populations.
Source: U.S. Department of Justice, Bureau of Justice Statistics (BJS) Census of Jails: Population Changes, 1999–2013 (Washington DC: BJA, 2015). Excludes the unified jail and prison systems in Alaska, Connecticut, Delaware, Rhode Island, Hawaii, and Vermont. BJS, “Correctional Statistical Analysis Tool (2005–2014),” retrieved on January 21, 2016, from

3. 2
The state’s correctional system is at capacity and is forecasted to grow significantly over the next decade
DOCR Historical and Projected One-Day Inmate Counts, 2005–2025
Current Prison Capacity
1,479 Beds
Actual Prison Population
+32%
Projected Growth
+75%
DOCR one-day inmate population snapshots for 2005–2007 are as of January 1 of each fiscal year. DOCR one-day inmate population snapshots for 2008–2015 and one-day inmate population projections for 2016–2025 are as of the last day of each fiscal year (June 30). Source: correspondence between CSG Justice Center and DOCR, 2015 and 2016.

4. Without action, public safety dollars will be consumed trying to keep up with growth rather than investing in crime and recidivism-reduction strategies 3
General Fund Corrections Appropriations (in millions), FY2007–2017
Corrections Spending Increase, FY07–09 to FY15–17
64%
The FY2009–11 state budget provided $64 million ($22.5 million from the General Fund) for construction and renovation at the North Dakota State Penitentiary.
DOCR also receives special funding allocations.
*Budgeted, not spent for 2016 and 2017.
Biennial budgets run on a two-year cycle. Budget information cited here is from July 1, 2003 to June 30, 2005 and the most recent running from July 1, 2013 to June 30, Source: DOCR, Biennial Report 2003–2005. (Bismarck: DOCR, 2005); DOCR, Biennial Report 2013–2015. Actual General Fund appropriations were $83,458,031 for 2005 and $178,475,785 for 2015.

5. A majority of judges have sentenced individuals to prison in order to connect them with mental health or alcohol and drug programming
Have you ever sentenced someone to prison in order to connect him/her with needed mental health, alcohol or drug addiction programming, or other treatment even when he/she is not considered high risk?
Judges noted that these sentences
are reserved for specific instances with extenuating circumstances, such as:
Inadequate services in the local area
Community-based drug or alcohol treatment programs have failed or been exhausted
Defendant has no ability to pay for treatment
YES
70% NO
30%
Source: 2014 CSG Justice Center North Dakota Judicial Survey

6. Probation and parole officers reported an acute need for substance use services in the community
NEED FOR TREATMENT
AVAILABILITY OF TREATMENT
Half of POs reported that 75% or more
of their clients needed substance use treatment
Unavailable
Available &
accessible
SUBSTANCE USE
Somewhat
unavailable
Somewhat
available
NEED FOR TREATMENT
AVAILABILITY OF TREATMENT
Half of POs reported that fewer than 50%
of their clients needed mental health treatment
Unavailable
Available &
accessible
MENTAL HEALTH
Somewhat
unavailable
Somewhat
available
Source: CSG Justice Center Probation and Parole Officer Survey

7. Reported Wait Time for Treatment Services
A majority of POs observed wait times of at least three weeks to access all forms of community treatment
Reported Wait Time for Treatment Services
74%
over
3 weeks
79%
over
3 weeks
82%
over
3 weeks
Source: CSG Justice Center Probation and Parole Officer Survey

9. JUSTICE-INVOLVED POPULATIONS:
Data sources indicated a very high prevalence of behavioral health issues in the state’s criminal justice systems for both adults and youth in North Dakota, which is consistent with national trends.

10. Behavioral Health System Analysis - Common Themes:
Judges are sentencing individuals with behavioral health conditions for low-level crimes to provide them access to treatment they would be unable to access in their communities.
Individuals with justice involvement experience multiple barriers to accessing services.
Community-based treatment providers are resistant to serving individuals with criminal justice histories.
The need for community-based services is high among the re-entry population.

11. Keys to Reforming North Dakota’s Behavioral Health System
Support the full Continuum of Care
Increase Community-Based Services
Prevent Criminal Justice Involvement for Individuals with a Behavioral Health Condition
DHS mission

13. In 2017, Senate Bill 2015 created a new community behavioral health program for people involved in the criminal justice system.
The bill established a $7M investment in behavioral health services for people in the criminal justice system to improve public safety and public health outcomes.

14. Shared Values: (Criminal Justice & Behavioral Health)
Best Practice
Assess Offender Risk and Need Levels using Actuarial Tools
Target Interventions
Provide Skills Training for Staff and Monitor their Delivery of Services
Data-Driven
Measure Relevant Practices and Processes
Person-Centered
Enhance Offender Motivation
Recovery-Oriented
Engage Ongoing Support in the Community
Transparent
Provide Measurement Feedback
Trauma-Informed
Trauma-Informed Care

16. Recidivism is reduced by attending to criminogenic risk and need.
Key Principles:
Recidivism is reduced by attending to criminogenic risk and need.
Recovery from substance use and mental health disorders is a process of change through which individuals improve their health and wellness, live a self- directed life, and strive to reach their full potential.

17. Individual Business Community
Provides care coordination – individualized care plan
Provides recovery support services
Connections to clinical support services like addiction or mental health counseling or treatment
Support private providers by providing another revenue source
Performance-based pay
Non-traditional behavioral health providers
Once providers exist, there will be infrastructure to expand services to individuals not in the criminal justice system
Providers can meet cultural and spiritual needs
Flexibility to address community specific needs
Community organizations working together to collaborate (fill services gaps) and avoid duplication
Rural areas can participate through existing non-traditional providers
State-local partnerships to address regional-specific needs

18. Behavioral Health Team
Department of Corrections and Rehabilitation
Admissions
Discharges
Corrections Best Practices
Department of Human Services
Contracts
Payments
Outcomes
BH Best Practices
Probation and Parole
Supervision
Drug/Alcohol Screens
Community Care Coordination Agency
Service Coordination
Connection to Resources
Recovery Support Services
Behavioral Health Team

22. Care Coordination
Professionals working closely with individuals and helping them get connected to supportive resources, while addressing problems that might prevent the person from being successful.

23. Care Coordination Care Coordinators
Match clients with agencies, professionals and peers that are a good fit for their specific needs
Provide a source of connection and emotional support to clients, outside of the criminal justice system
Provide ongoing assessment of needs and help establish recovery-oriented goals (care plan)
Provide clients with recovery services based on their individual needs
Collaborate with other clinical services and providers
Serve as a part of a care team
Creatively problem solve
Provide transportation or help establish transportation support

24. Recovery Support Services
Recovery services includes access to supportive housing, educational opportunities, meaningful employment, leisure activities, family and community social supports, spiritual support, and any other individualized needs the person needs to help them lead a healthy and fulfilling life.
Recovery Support Services

25. Specialists with similar first-hand, lived experience as the individuals they are serving. Peer Specialists use their experience to support others in their recovery.

28. Pay for Performance Model
Providers are paid a monthly base rate for each participant with the opportunity to receive performance pay if the participant meets at least 3 out of 4 monthly outcomes.

29. Outcome Monitoring Stable Housing Stable Employment
Is the person living in a residence that is supportive of their recovery?
Examples: Independent housing, living with supportive family/friend, halfway house, etc.
Stable Employment
Is the person actively seeking or participating in employment?
Examples: Retired, homemaker, receives SSDI, involved in education, attending behavioral health treatment

30. Criminal Justice Involvement
Outcome Monitoring
Recovery
Is the participant demonstrating effort to reduce their substance use or the harm associated with their use and/or improve their mental health functioning.
Criminal Justice Involvement
Did the participant avoid law enforcement involvement resulting in arrest, criminal charge, or probation violation resulting in initiation of revocation?

32. 18 Months of Implementation
What does the data tell us?

37. Risk Level of Referrals

41. Thank You
Questions?