Harris County Mental Health Jail Diversion Program Harris County Sequential Intercept Model 12/31/2015 1
Harris County Mental Health Jail Diversion Program Sequential Intercept Model The Sequential Intercept Model was developed by Mark R. Munetz, M.D., and Patricia A. Griffin, Ph.D. The Sequential Intercept Model provides a conceptual framework for communities to organize targeted strategies for justiceinvolved individuals with serious mental health issues. These intercept points identify activities for system and service level change. 12/31/2015 2
Senate Bill 1185 Harris County has a long history of collaboration between the criminal justice system, law enforcement and behavioral health providers. These service components can be identified at the various sequential intercept points. Senate Bill 1185 will now have the opportunity to expand services and help reduce recidivism. http://legiscan.com/tx/bill/sb1185/2013 12/31/2015 3
Action for System-Level Change SYSTEM-LEVEL CHANGE is a change in culture, policies and procedures within organizations that enhance or streamline access to services as well as reduce or eliminate barriers.. 12/31/2015 4
Action for System-Level Change Examples of Action for System-Level Change for Senate Bill (1185) Make housing for persons who are homeless, with mental health issues & criminal justice involvement a priority; remove barriers that exclude persons formerly incarcerated from housing or services. Expand access to treatment; provide comprehensive, best practice, and evidence-based services; integrate treatment of mental health & substance use disorders. Expand supportive services to sustain recovery efforts, such as housing, education and training, employment, and peer advocacy. 12/31/2015 5
Service-Level Change SERVICE-LEVEL CHANGE is the prevention, diversion and treatment for justice-involved individuals with mental health issues & substance use issues. Services and supports are available at various intercept points. 12/31/2015 6
Harris County Criminal Justice Coordination Harris County Criminal Justice Coordinating Council is the focal point for efforts to improve the criminal justice system and seek reductions in the jail population. Harris County Office of Criminal Justice Coordination was created by Commissioners Court and is responsible for policy development, oversight and improvement initiatives for the criminal justice system. These entities interface with all of the various intercept points. URL: http://offthekuff.com/wp/?tag=harris-county-criminal-justice-coordinating-council 12/31/2015 7
Intercept 1 Law Enforcement 911: Train dispatchers to identify calls involving persons with mental health issues and refer to designated, trained respondents Police: Train officers to respond to calls where mental health issues may be a factor Documentation: Document police contacts with persons with mental health issues Emergency/Crisis Response: Provide policefriendly drop off at local hospital, crisis unit, or triage center Follow Up: Provide service linkages and follow-up services to individuals who are not hospitalized and those leaving the hospital Evaluation: Monitor and evaluate services through regular stakeholder meetings for continuous quality improvement 12/31/2015 8
Service-Level Change Intercept 1 - Action Step Law Enforcement Local Law Enforcement... Homeless Outreach Team (HOT) A Houston Police Department (HPD) and collaboration between The HARRIS CENTER Crisis Intervention Response Team (CIRT) A joint collaboration between HPD & The HARRIS CENTER, & Harris County Sheriff Office (HCSO) & The HARRIS CENTER Chronic Consumer Stabilization Initiative (CCSI) A joint collaboration between HPD & The HARRIS CENTER Harris County Sheriff Office (HCSO) Mental Health Task Force 12/31/2015 9
Service-Level Change Intercept 1 - Action Step 911: Trained dispatchers identify calls of persons with mental health issues & refer to law enforcement officers (HOT Team or CIRT). Clients can be taken to local hospital emergency room or taken to Houston City Jails or Harris County Jail (HCJ) based upon level of offense. 12/31/2015 10
Intercept 2 Initial Detention/Initial Court Hearings Screening: Screen for mental health issues at earliest opportunity; initiate process that identifies those eligible for diversion or needing treatment in jail; use validated, simple instrument or matching management information systems; screen at jail or at court by prosecution, defense, judge/court staff or service providers Pre-trial Diversion: Maximize opportunities for pretrial release and assist defendants with mental health issues in complying with conditions of pretrial diversion Service Linkage: Link to comprehensive services, including care coordination, access to medication, integrated dual disorder treatment (IDDT) as appropriate, prompt access to benefits, health care, and housing; IDDT is an essential evidence based practice (EBP) 12/31/2015 11
Service-Level Change Intercept 2 - Action Step Initial Detention/Initial Court Hearings 1. Arrest Screening: The screening process at Houston City Jails and Harris County Jail (HCJ) has a system that identifies defendants with mental illness at booking. The Houston City Jail staff, HCJ Deputies, HCJ medical personnel, & Court Services utilize the Justice Information Management System (JIMS) which flags for mental health history. If there is a history of mental health issues, appropriate staff is alerted. 12/31/2015 12
Service-Level Change Intercept 2 - Action Step Initial Detention/Initial Court Hearings First Court Appearance: A magistrate may see the defendant for probable cause hearing. First Court Appearance Service Linkage: Individuals who have a mental health diagnosis and receive a personal bond, are assigned a specialized Pre-Trial Officer for follow up. Initial Detention Service Linkage: Individuals who remain in jail are then referred for appropriate jail services including Senate Bill 1185 services. 12/31/2015 13
Service-Level Change Intercept 3 - Action Step Jails/Courts Specialty Courts Harris County Felony Mental Health Court (FMHC) Harris County Felony Drug Court - Success Through Addiction Recovery (STAR) Harris County Veterans Court (VC) Harris County Women Court - Survivors Acquiring Freedom and Empowerment (SAFE Court) Harris County Saving Ourselves By Education & Recovery (S.O.B.E.R) Court Program MHJDP receives referrals from all specialty courts 12/31/2015 14
Intercept 3 Jails / Courts Screening: Inform diversion opportunities and need for treatment in jail with screening information from Intercept 2 Court Coordination: Maximize potential for diversion in a mental health court or non-specialty court Service Linkage: Link to comprehensive services, including care coordination, access to medication, IDDT as appropriate, prompt access to benefits, health care, and housing Court Feedback: Monitor progress with scheduled appearances (typically directly by court); promote communication and information sharing between nonspecialty courts and service providers by establishing clear policies and procedures Jail-Based Services: Provide services consistent with community and public health standards, including appropriate psychiatric medications; coordinate care with community providers 12/31/2015 15
Service-Level Change Jails / Courts Intercept 3 - Action Step Dispositional Court Screenings, Jail Services, & Court Coordination. Screenings: Inform diversion opportunities and need for treatment in jail Jail Based Services: Provide psychiatric & medical services according to Jail Based Standards. Court Coordination: Criminal courts coordination for eligible & interested individuals. If interested they are referred to The HARRIS CENTER for screening & assessment. 12/31/2015 16
Service-Level Change Jails / Courts Intercept 3 - Action Step Dispositional Court Service Linkage: Specialty Courts role - linking & coordinating to MHJDP & other service providers. Monitor progress with scheduled appearances. Typically occurs in the specialty courts, & non-specialty courts if the judge makes this a stipulation of probation. 12/31/2015 17
Service-Level Change Jails / Courts Intercept 3 -Action Step District Attorney Office District Attorney Office (DA) Mental Health Division The Harris County District Attorney s Office Mental Health Division exists to handle any felony case in which the defendant has a mental health diagnosis or intellectual disability. Each prosecutor is specially trained to balance the interests of public safety, justice, victims rights and the humane treatment of these special individuals. The Division handles all cases in which the defense of insanity arises. This includes evaluating cases to ascertain if this defense is applicable, then trying the case if necessary, or drafting the necessary documents if the State agreed that a defendant meets the criteria to be acquitted not guilty by reason of insanity. 12/31/2015 18 http://app.dao.hctx.net/ouroffice/ouroffice.aspx
Service-Level Change Jails / Courts Intercept 3 - Action Step: Harris County Public Defenders Office Mental Health Division The Chief Public Defender works with The HARRIS CENTER and others to improve criminal defense, mental health treatment, and other services to indigent defendants. They provide trial counsel and support services to indigent clients who are acutely mentally ill or intellectually disabled and charged with a misdemeanor in the fifteen county criminal courts at law. Harris County Public Defender Special Resource Counsel The Harris County Public Defender s Mental Health Division provides representation to persons charged with misdemeanor offences who also have a mental illness. Attorneys in this Division are all mental health specialists, qualified by education, training and experience to assist this vulnerable population. Psychosocial services staff within the Division aide in locating and brokering post-release housing as well as mental health treatment. Attorneys from the Mental Health Division are appointed at the discretion of the court to represent Defendants. http://www.harriscountytx.gov/publicdefender/sitemap.aspx 12/31/2015 19
Intercept 4 - Reentry Assess clinical and social needs and public safety risks; boundary spanner position (e.g., discharge coordinator, transition planner) can coordinate institutional with community mental health and community supervision agencies Plan for treatment and services that address needs; GAINS Reentry Checklist (available from http://www.gainscenter.samhsa.gov/html/ resources/reentry.asp) documents treatment plan and communicates it to community providers and supervision agencies domains include prompt access to medication, mental health and health services, benefits, and housing Identify required community and correctional programs responsible for post-release services; best practices include reach-in engagement and specialized case management teams Coordinate transition plans to avoid gaps in care with communitybased services 12/31/2015 20
Service-Level Change Intercept 4 - Action Step Reentry Jail Reentry Includes: Harris County Sheriff Office (HCSO) Re-Entry Services - URL: http://www.hcsonews.com/redefining-rehab-innovative-jail-reentryprogram-revolutionary-inmates-criminal-justice-students-advocating-behalf/ Jail In-Reach Program - URL: usich.gov/issue/human-rights/jail-inreach MHJDP All Re-Entry Activities Include: Assess clinical and social needs Plan for treatment and services Identify for post-release services Coordinate with community-based services 12/31/2015 21
Intercept 5 Community Corrections Screening: Screen all individuals under community supervision for mental health issues and co-occurring substance use disorders; link to necessary services Maintain a Community of Care: Connect individuals to employment, including supportive employment; facilitate engagement in IDDT and supportive health services; link to housing; facilitate collaboration between community corrections and service providers; establish policies and procedures that promote communication and information sharing Implement a Supervision Strategy: Concentrate supervision immediately after release; adjust strategies as needs change; implement specialized caseloads and cross-systems training Graduated Responses & Modification of Conditions of Supervision: Ensure a range of options for community corrections officers to reinforce positive behavior and effectively address violations or noncompliance with conditions of release 12/31/2015 22
Service -Level Change Intercept 5 - Action Step Community Corrections Harris County Community Supervision Correction Department The Harris County Community Supervision and Corrections Department serves 22 district criminal courts and 15 county criminal courts at law with supervision and services for approximately 38,000 felony and misdemeanor offenders. Screening: Harris County Community Supervision Correction Department (HCCSCD) provides screening for people with mental health issues and substance abuse issues. Maintain a Community of Care: Connect individuals to employment, including supportive employment, facilitate engagement in supportive health services; link to housing; facilitate collaboration between Harris County Community Supervision Corrections Department & service providers (The HARRIS CENTER, HHH, & SEARCH) policies & procedures are in place that promote communication & information sharing. Implement a Supervision Strategy: HCCSCD concentrate supervision immediately after release; adjust strategies as needs change; implement specialized caseloads & cross-systems training. HCCSCD has 21 mental health specialized caseloads. Graduated Responses & Modification of Conditions of Supervision: Ensure a range of options for HCCSCD probation officers to reinforce positive behavior & effectively address violations or noncompliance with conditions of release. HCCSCD Dual Disorder Residential Program: This program is located at the HCCSCD Atascocita Facility. HCCSCD works in collaboration with service provider The HARRIS CENTER & HCCSCD specialized probation officers & The HARRIS CENTER clinical staff are co-located at the Atascocita Facility. The Dual Disorder Residential Program serves all types of offenders, males and females on separate compounds. HCCSCD & The HARRIS CENTER work together as one Team to develop a re-entry treatment plan for the probationer with mental health issues & substance abuse. HCCSCD makes referrals to MHJDP HCCSCD URL: www.harriscountytx.gov/cscd/ 12/31/2015 23
Intercept 5 Community Corrections The HARRIS CENTER New START Forensic Program: Available to patients whom the courts may require to participate in conjunction with their court-ordered court supervision. It is a community-based outpatient mental health program with services inclusive of referral and screening, crisis intervention, counseling, medication related services, intense skills training, court advocacy and continuity of care activities. The HARRIS CENTER Forensic Assertive Community Team (FACT): Provide outpatient mental health services to individuals who have had multiple psychiatric hospitalizations and/or involvement with the judicial system and have been non-responsive to traditional treatment approaches. To increase the individual s tenure in the community, psychiatric assessments, medication-related services, counseling, crisis intervention, skills training, family education and coordination and linkage services are provided. 12/31/2015 24