1. Council of State Governments Justice Center | 1 Jessica Nickel, President, Brimley Group; and Executive Director, Addiction Policy Forum Steve Allen, Senior Policy Advisor Council of State Governments Justice Center Fred Osher, M.D. Director of Health Systems and Services Policy Council of State Governments Justice Center Sarah Wurzburg, Grantee Technical Assistance Manager Council of State Governments Justice Center Mid Year Meetings, New York, NY Wednesday, February 24, 2016 Opiates: Everyone is Talking About Them; What are We doing About It?

2. Council of State Governments Justice Center | 2 Substance Use Work Across Justice Center: Justice Reinvestment, Intensive County Work, Grantee TA Overview Areas Where the Justice Center Can Advance the Field Overview of the National Landscape for Addressing the Opioid Crisis and Substance Use Disorders in Criminal Justice Settings Discussion: How does substance use issues affect your work?

3. Council of State Governments Justice Center | 3 Substance Use Work Across Justice Center: Justice Reinvestment, Intensive County Work, Grantee TA Areas Where the CSG Justice Center Can Advance the Field Overview of the National Landscape for Addressing the Opioid Crisis and Substance Use Disorders in Criminal Justice Settings Discussion: How does substance use issues affect your work?

4. Council of State Governments Justice Center | 4 OVERVIEW OF THE NATIONAL LANDSCAPE FOR ADDRESSING THE OPIOID CRISIS AND SUBSTANCE USE DISORDERS IN CRIMINAL JUSTICE SETTINGS

5. Council of State Governments Justice Center | 5 Substance Use Work Across the Justice Center: Justice Reinvestment, Intensive County Work, and Grantee TA Areas Where the CSG Justice Center Can Advance the Field Overview of the National Landscape for Addressing the Opioid Crisis and Substance Use Disorders in Criminal Justice Settings Discussion: How does substance use issues affect your work?

6. Council of State Governments Justice Center | 6 JUSTICE REINVESTMENT Substance Use Work Across the CSG Justice Center

7. Council of State Governments Justice Center | 7 Substance Use Disorder Treatment Justice Reinvestment Opportunities and Challenges

8. Council of State Governments Justice Center | 8 Past-Year Treatment for Alcohol or Other Drug Use and Perception of Treatment Need Age 12 or Older with Substance Dependence or Abuse

9. Council of State Governments Justice Center | 9 Troublesome alcohol and other drug use Little interest in treatment

10. Council of State Governments Justice Center | 10 SUD Issues Arising in JR Stakeholder Perspectives “It’s the main problem in the system right now” “If we could fix this, it would solve the biggest problem we face” “It’s a revolving door” “What we are doing doesn’t work” “We need more beds” “Housing, Housing, Housing…” “We can’t do it all (probation agents). We are not caseworkers” “We can’t get our people into treatment, even when there are programs” “It takes forever” to get someone into a program”

11. Council of State Governments Justice Center | 11 What’s going on in the theater?

12. Council of State Governments Justice Center | 12 JR Team Perspectives Lack of accountability – provider “black box” for stakeholders Little or no basic information on services Little or no outcome information Lack of coordination of interventions Drug courts as “the answer” “over-focus” on drugs (versus alcohol) Courts ordering level of care Lack of screening, assessment, risk assessment Gaps in the continuum of care, especially in more rural settings Poorly defined models of care

13. Council of State Governments Justice Center | 13 And… unfortunately too often the performance isn’t very good Providers not utilizing EBP’s Lack of qualified practitioners Lack of training Lack of integrated services with mental health

14. Council of State Governments Justice Center | 14 JR: What is our approach? Improve system “mapping” Encourage screening and assessment Encourage enrollment (Expansion states) Education – “Myth busting” and “what works” Divert general fund monies when health care funding will cover services Help states “bridge” systems – across agencies “Value-based incentives” Offering technical assistance to re-design contracts, design Medicaid strategies Work with higher education to create specialized practitioner development

15. Council of State Governments Justice Center | 15 Where are we coming up short? More “enhanced” services for people with complex behavioral health needs. More “Theaters” and more people in them. No lines to get in….

16. Council of State Governments Justice Center | 16 Where are we coming up short (cont)? Medicaid Expansion: Systems are still in transition – overwhelmed Very technical Providers and Practitioners Too few and long development tracks Information systems “chasing our tail” with systems information (population specific, extent of need, performance, gaps, etc

17. Council of State Governments Justice Center | 17 Opportunities in JR Co-occurring Most systems are still taking “baby steps” if it is even in the mix. Systems aren’t integrated. DWI/DUI We haven’t done much. Fits well with CJ/SUD. Too many systems take a “one size fits all” approach. Need risk assessment tool. Domestic Violence Too often ignored. Lack of good research. Couple with SUD interventions. Quality More “under the hood” work.

18. Council of State Governments Justice Center | 18 Opportunities in JR (cont) Information systems Develop? Nimble Flexible Modular Interoperable Performance Closer (more strategic?) connections with SCA projects and JR

19. Council of State Governments Justice Center | 19 Thank you!

20. Council of State Governments Justice Center | 20 INTENSIVE COUNTY WORK Substance Use Work Across the CSG Justice Center

21. Council of State Governments Justice Center | 21 GRANTEE TECHNICAL ASSISTANCE Substance Use Work Across the CSG Justice Center

22. Council of State Governments Justice Center | 22 Behavioral Health Technical Assistance Second Chance Act Reentry Program for Adults with Co-occurring Substance Abuse and Mental Disorders Risk assessment required Recidivism rate required Reentry focused Integrated treatment written into solicitation Justice and Mental Health Collaboration Program Some site address CODs Variety of sites: – Diversion Pre-trial and pre-booking – Mental health courts – Law enforcement – Juvenile – Reentry

23. Council of State Governments Justice Center | 23 Planning & Implementation Guides Section 1: Getting Started and Identifying Goals Section 2: Defining or Refining Your Target Population Section 3: Identifying Evidence-Based Services and Support Section 4: Effective Transition Planning and Post- Release Supports Section 5: Data Collection, Performance Measurement, and Program Evaluation Section 6: Sustainability Appendix A: Supporting Resources

24. Council of State Governments Justice Center | 24 TA Considerations Is there a specific drug or drugs that are prevalent in the jurisdiction? How has this affected their jail/prison population? If there is an opioid issue, what does detoxification look like in their jail/prison and the community? Do they screen/assess in jail or prison? What SUD treatment options are available on jail/prison? What are the community-based substance use disorder treatment options in the community? Are there programs that are able to address co-occurring substance use and mental disorders? Is there collaboration between community-based SUD providers and criminal justice staff? Do teams meet to discuss the person’s needs?

25. Council of State Governments Justice Center | 25 Substance Use Work Across Justice Center: Justice Reinvestment, Intensive County Work, Grantee TA Areas Where the CSG Justice Center Can Advance the Field Overview of the National Landscape for Addressing the Opioid Crisis and Substance Use Disorders in Criminal Justice Settings Discussion: How does substance use issues affect your work?

26. Council of State Governments Justice Center | 26 Areas Where the CSG Justice Center Can Advance the Field 1.Increase law enforcement officers ability identify individuals with substance use issues, and provide them with the resources to refer individuals to treatment. 2.Promote systems collaboration that builds relationships to enable appropriate referral to community-based substance use disorder treatment by criminal justice professionals (law enforcement, jail/prison staff, community corrections). 3.Expand measurement of people in the justice system who are referred to and engage in community-based substance use disorder services. 4.Enhance screening, assessment, and substance use disorder treatment services in corrections facilities. 5.Engage in and move the conversation forward on effective community supervision responses for people with substance use disorders.

27. Council of State Governments Justice Center | 27 Substance Use Work Across Justice Center: Justice Reinvestment, Intensive County Work, Grantee TA Areas Where the Justice Center Can Advance the Field Overview of the National Landscape for Addressing the Opioid Crisis and Substance Use Disorders in Criminal Justice Settings Discussion: How Does substance use issues affect your work?

28. Council of State Governments Justice Center | 28 HOW DOES SUBSTANCE USE ISSUES AFFECT YOUR WORK? Slide Title

29. Council of State Governments Justice Center | 29 Substance Use Work Across the Justice Center: Justice Reinvestment, Intensive County Work, and Grantee TA Overview Areas Where the CSG Justice Center Can Advance the Field Overview of the National Landscape for Addressing the Opioid Crisis and Substance Use Disorders in Criminal Justice Settings Discussion: How does substance use issues affect your work?

30. Council of State Governments Justice Center | 30 Thank You The presentation was developed by members of the Council of State Governments Justice Center staff. The statements made reflect the views of the authors, and should not be considered the official position of the Justice Center, the members of the Council of State Governments, or the funding agency supporting the work. Citations available for statistics presented in preceding slides available on CSG Justice Center web site. Join our distribution list to receive CSG Justice Center project updates! www.csgjusticecenter.org/subscribe For more information, contact Jessica Nickel (jnickel@csg.org), Steve Allen (sallen@csg.org), Fred Osher (fosher@csg.org) or Sarah Wurzburg (swurzburg@csg.org)jnickel@csg.orgsallen@csg.orgfosher@csg.orgswurzburg@csg.org