1. Evaluating Specialty Court Programs: Adaptations and Emerging Practices Oklahoma State Conference Norman OK September 3, 2015 STEPHEN S. GOSS, JUDGE, SUPERIOR COURTS OF GEORGIA ALBANY, GEORGIA EMAIL: JUDGESTEVEGOSS@BELLSOUTH.NETJUDGESTEVEGOSS@BELLSOUTH.NET

2. Presentation includes PowerPoints slides from: David A. D’Amora: Adults with Behavioral Health Needs under Correctional Supervision: A Shared Framework for Reducing Recidivism and Promoting Recovery Council of State Governments Justice Center

3. Key Components ( Drug Courts) Essential Elements ( MHC) HTTP://CSGJUSTICECENTER.ORG/COURTS/PUBLI CATIONS/IMPROVING-RESPONSES-TO-PEOPLE- WITH-MENTAL-ILLNESSES-THE-ESSENTIAL- ELEMENTS-OF-A-MENTAL-HEALTH-COURT/ HTTP:// WWW.NDCI.ORG/PUBLICATIONS/ MORE-PUBLICATIONS/TEN-KEY- COMPONENTS

4. Key Component # 4: Drug Courts provide access to a continuum of alcohol, drug and other related treatment and rehabilitation services Co-Occurring Disorders Population High Over-Representation in Criminal Justice System

5. TRANSINSTITUTIONALIZATION

6. Olmstead 527 U.S. 581 (1999) Under ADA Title II, states are required to provide community based MH treatment when recommended and if placement can be reasonably accommodated

7. DSM-IV Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Still will see in reports for some time as we transition to DSM-5 Multi-axial review

8. DSM-IV Axis I- clinical disorders; mental illness(i.e psychotic disorders-schizophrenia and mood disorders- bipolar disorder) and substance related disorders Axis II-personality disorders(i.e antisocial/obsessive compulsive) and developmental disability (MR) Axis III- general medical issues (diabetes; hypertension; HIV)

9. DSM-IV Axis IV- psychosocial and environmental factors(i.e. homelessness; death of spouse)(neither legal nor medical but impacts outcomes with criminal justice population) Axis V- Global Assessment of Functioning

10. DSM-5 Fifth Edition Combines first three Axes into one list; Contributing psychosocial and environmental factors can be coded with disorders; Separate measures of symptom severity and disability

11. DSM-5 Diagnostic Categories 1.Neurodevelopmental Disorders 2.Schizophrenia Spectrum and Other Psychotic Disorders 3.Bipolar and Related Disorders 4.Depressive Disorders 5.Anxiety Disorders 6.Obsessive-Compulsive and Related Disorders 7.Trauma- and Stressor-Related Disorders 8.Feeding and Eating Disorders 9.Substance-Related and Addictive Disorders 10.Disruptive, Impulse-Control, and Conduct Disorders 11.Neurocognitive Disorders 12.Personality Disorders

12. DEVELOPMENTAL DISABILITY INTELLECTUAL DISABILITY (Mental Retardation) DSM –IV – Axis II DSM-5- Neurocognitive disorders Typically three factors: (1) sub-average intellectual functioning (i.e. IQ testing); (2)Deficits in adaptive functioning (inability to learn basic skills and adapt to changes); (3)onset of deficits during developmental period ( before age 18)

13. Challenges with COD Population Diverse and complex problems-not all legal, not all medical No one clinical approach “fits all” Axis I M/H and S/A Personality disorders, learning disabilities and health issues impact treatment plans

14. New Business ?

15. Or Old Business? “They have been here Mr. Mulder” ( you deal with the same folks anyway)

16. JAILED WITH MENTAL HEALTH ISSUES Homeless Practically homeless-worn out welcome Housing, economic and lifestyle instability- lack of Rx regimen History of trauma: sexual, domestic violence

17. JAILED WITH MH ISSUES Possible security issues: decompensated, combative with jailers Increased suicide risks Other poorly managed chronic medical issues (HIV,diabetes, hypertension)

18. Jail: Treatment Disruption Decompensated on entry Formulary only: side effects Loss SSI Rx Gap: Leave jail until Dr. appt.

19. Sequential Intercepts Model Developed by Dr. Munetz and Dr. Griffin GAINS Center for Co-Occurring Disorders in the Criminal Justice System Policy Research Associates Inc. www.gainscenter.samhsa.gov

20. http://gainscenter.samhsa.gov/pdfs/integrating /GAINS_Sequential_Intercept.pdf

21. Key Component #6- Develop a coordinated strategy Community mapping- where are our challenges vs. resources? “Hon” meeting- they will come Where can you build allies? You become a pivot point in the community discussion.

22. Who to Call? (Who has “skin in the game”?) State Hospital Director for your area Local MH/Addictive Disease clinic director Local ER/medical community Local shelters that work with homeless population Sheriff/Jail Director Local Advocacy/NAMI

23. Intercept 1- Field/Police

24. Crisis Intervention Training- CIT Evidence Based Practice 2719 programs nationally in 45 states Developed by Memphis Police Department www.Cit.Memphis.edu

25. CIT Reduce use of force situations Reduce workers comp claims Raise awareness in law enforcement- it is what they deal with daily Change the culture in your jail

26. CIT Officers Most officers that go through the training feel it is very worthwhile Intercept 1- Not a lot of judge time required www.nami.org http://www.namioklahoma.org/ http://ok.gov/odmhsas

27. Intercept 2- Diversion

28. Jail Diversion http://gainscenter.samhsa.gov/topical_r esources/jail.asp Pre-booking vs. Post-booking Got to have a location Meet with community mental health director and local hospital administrator- EC issues/Crisis Unit

29. Intercept 3- Courts

30. Specialty Dockets/Courts Drug Courts: National Association of Drug Court Professionals(NADCP) www.nadcp.org Mental Health Courts: Council of State Governments (CSG) Justice Center www.csgjusticecenter.org

31. http://csgjusticecenter.org/mental- health/learning-sites

32. Intercept 4- Re-Entry

33. Re-Entry Programs A natural fit with a specialty docket Some of best outcomes because high utilizers of services 90-95% inmates return home at some point 4.9 million on probation/parole Do not wait for the next bad outcome

34. CSG National Reentry Resource Center http://csgjusticecenter.org/nrrc http://csgjusticecenter.org/nrrc

35. Intercept 5- Community Corrections

36. Probation/Parole Ready source of referrals Many of their revocations have roots in unresolved MH/SA issues A natural tie to intercepts 1, 3 & 4 Part of a multi-discipline approach

37. DEFINING A “WIN” Do not expect perfection-crisis frequency reduction is a win Episodic crisis events It is an illness –manage not cure Do not cherry pick- lawyer settling too many cases

38. Key Component # 3: Eligible participants are identified early Screenings Assessments- possibly ongoing once fog clears Criminogenic Risks/Needs

39. http://www.ndci.org/sites/default/files/nadc p/C-O-FactSheet http://www.ndci.org/sites/default/files/nadc p/C-O-FactSheet (list of assessments/screening tools)

41. CRIMINOGENIC RISKS/NEEDS/RESPONSIVITY FRAMEWORK- BJA/CSG Publication https://www.bja.gov/Publications/CSG_Behavioral _Frameworkhttps://www.bja.gov/Publications/CSG_Behavioral _Framework

42. Risk-Need-Responsivity Model as a Guide to Best Practices RISK PRINCIPLE: Match the intensity of individual’s intervention to their risk of reoffending NEEDS PRINCIPLE: Target criminogenic needs, such as antisocial behavior, substance abuse, antisocial attitudes, and criminogenic peers RESPONSIVITY PRINCIPLE: Tailor the intervention to the learning style, motivation, culture, demographics, and abilities of the offender. Address the issues that affect responsivity (e.g., mental illnesses) COUNCIL OF STATE GOVERNMENTS JUSTICE CENTER 42

55. Judges’ Leadership Initiative/ Psychiatric Leadership Group 55

56. QUESTIONS? DEFINITION OF “INSANITY”- DOING THE SAME THING THE SAME WAY OVER AND OVER AGAIN EXPECTING A BETTER OUTCOME.