Montgomery County s Continuity of Care (COC) Court for Mentally Ill Probationers: Process Evaluation

Montgomery County s Continuity of Care (COC) Court for Mentally Ill Probationers: Process Evaluation Prepared by: Jeff Bouffard, PhD Liz Berger, MA Nicole Niebuhr Correctional Management Institute of Texas College of Criminal Justice Sam Houston State University 0

EXECUTIVE SUMMARY Researchers from Sam Houston State University s College of Criminal Justice conducted a process evaluation of the Continuity of Care (COC) program as part of a three-year contract to evaluate the COC and the Managed Assigned Counsel (MACMH) program for mentally ill, indigent defendants. From June 2012 when the COC began, until June 2013, 29 individuals were enrolled in the COC program. Of these, 15 were involved in the misdemeanor court and 14 participated in the felony-level COC court program. The program was successful in targeting appropriate types of offenders. Most of the participants in the COC program were repeat offenders. Specifically, 83.3% of the combined sample (felony and misdemeanor) had at least one prior arrest, with an average 3.0 prior arrests, and 3.7 prior criminal charges. The majority of COC participants (86.2%) were or had been also involved in the County s Managed Assigned Counsel (MACMH) program for mentally ill, indigent defendants. Most COC program participants had serious mental health diagnoses. In fact, 82.8% were diagnosed with either bipolar disorder, some type of schizophrenic disorder, major depression or some combination of these mental illnesses. To date, few felony-level offenders have successfully completed the program (1 of 14, or 7%; 83 days to disposition); however among misdemeanor participants, the completion rate was substantially higher (9 of 15 or 60%), with an average time in the program of 166 days. Among the combined sample of felony and misdemeanor offenders, 24.1% of participants reoffended during the evaluation follow-up time period. Specifically, 36% of felony level program participants, and about 13% of the misdemeanor COC participants were re-arrested at some point during a minimum of 6 months follow-up. Prior studies of the effectiveness of mental health courts have found 12-18 month recidivism rates as high as 43% for combined samples of misdemeanor and felony-level participants. o It is important to note that for much of this time the participants were also subject to probation supervision, so it is unclear if their recidivism rates would be higher once they complete their probation terms and are no longer being actively supervised. Additional efforts should be made to increase the number of offenders involved in this combined supervision/rehabilitation program; to solidify program procedures related to sanctions and rewards used to promote compliance; to aid offenders in reentering and remaining in the community, including retention in needed mental health services; and to prepare for coming state-level changes in the oversight of Specialty Courts in light of SB 462. 1

INTRODUCTION While mental health courts have not been subject to as much evaluation research as other problem-solving courts, especially drug courts, past research has suggested that they can be effective at reducing recidivism among mentally ill offenders. For instance, Moore & Hiday (2006) preformed a quasi-experimental study using 82 mental health court participants, relative to 183 participants in a treatment as usual comparison group. Despite not using a true randomized experimental design, the two groups were closely matched on variables such as age, race, gender, criminal history, jail time and severity of the current charge. Within the 12-month follow-up period after entry into the mental health court, 42.7% of those in the Mental Health Court group had been arrested for a new crime, while 70% of those in the traditional court group had been re-arrested. Similarly, McNiel & Binder (2007) preformed a quasi-experimental study using propensity score matching, to compare 170 Mental Health Court participants to a large group of 8,067 offenders who received treatment as usual. After an 18-month follow-up time period, 42% of the Mental Health Court participants had a new arrest, while in the treatment as usual group the probability of re-arrest was 57%. The current study does not include a comparison group; however, results from these past studies can be used to provide context for the recidivism rates documented among participants in Montgomery County s Continuity of Care (COC) mental health court program relative to other Mental Health Court programs around the country. The information presented in this process evaluation of the Montgomery County Continuity of Care (COC) Court for mentally ill probationers is based on several interviews conducted with COC stakeholders (judges, mental health caseload probation officers) in October 2013, as well as data collected from cases processed during the first year of COC operations (June 2012 - June 2013). Many programs undergo substantial refinement during their early months of operation and as such, evaluation efforts often capture data reflecting program processes that are being revised as the program is refined and establishes the most efficient processes. As such, the program description and outcomes should be interpreted cautiously as they result from the earliest stages of program implementation and ongoing revision/improvement. This process evaluation report includes information collected on cases processed through the first year and qualitative information obtained via direct observation and several interviews with COC staff. Interviews were conducted with both the felony and misdemeanor COC Court judges, as well as two probation officers and the probation supervisor for the Mental Health Caseload in Montgomery County. Information presented includes the background characteristics of these defendants, rate of successful program completion, and most predominantly a program description and process evaluation of both the probation and judicial components of the program. Individuals with a history of treatment for a mental illness that are charged with nonviolent crimes in Montgomery County are eligible for participation in the Continuity of Care docket and are managed by specialized probation officers who maintain a Mental Health probation caseload. Most (about 87%) of the COC participants also participate in the County s Managed Assigned Counsel program (MACMH) for mentally ill and indigent defendants and as such, these MACMH-involved offenders also receive services from the MACMH casework staff. 2

Program Overview The COC court program typically addresses non-violent, repeat offenders with mental health issues who appear to be candidates for community-based supervision and services in lieu of incarceration in the jail. If the individual is eligible and wishes to participate in the COC court program, it is usually part of a plea agreement to a term of probation, or in a few cases, as part of a deferred adjudication (which typically includes a pretrial bond as a condition of probation). All COC participants are part of the probation office s specialized Mental Health caseload, which includes two probation officers and a supervisor. Probation officers screen potential candidates for known mental health diagnoses or histories of mental health treatment. In addition, some cases have been identified by the Managing Attorney from the MACMH program, with those individuals then referred to the probation department for additional screening to determine if the case is eligible for the COC. Most commonly, COC program participants are referred to the program post-judgment, as a plea resulting in a sentence to probation, or as part of an agreement for deferred adjudication. During their participation in the COC, offenders are required to participate in appropriate mental health treatment, as a formal condition of probation. METHODS Much of the data related to COC Court participants was collected from county court records. For instance, information on defendant s date of arrest, release from jail, current offense, final case disposition and various demographic factors (age, race, ethnicity) was collected from various computerized court and jail database systems, with the assistance of several Sam Houston State University College of Criminal Justice graduate student research assistants (whose time incurred no cost to the County). These research assistants also collected criminal history and recidivism (any re-arrest post release from jail) data from the Department of Public Safety for all COC program participants. Finally, to supplement the quantitative information collected from these various computerized databases and the monthly tracking forms, SHSU researchers also developed a series of open-ended questions which were then distributed to the judges who oversee the misdemeanor and felony Continuity of Care dockets, as well as the MACMH Managing Attorney. A similar set of interview questions were also presented to the two probation officers and the probation supervisor of the Mental Health probation caseload. These interviews were administered in October 2013, after each group had several months experience interacting with the program so that they could report their impressions of how the court was operating. Additionally, researchers from SHSU collected qualitative information via direct observation of the staffing procedures and subsequent misdemeanor and felony court hearings for the Continuity of Care docket. 3

SAMPLE Defendant Sample: Overall Description During the first 12 months of COC program (June 2012 through June 2013), the Montgomery County Continuity of Care (COC) Court provided services for 29 mentally ill probationers. Evaluators from SHSU collected relevant information on this sample (n=29) which is presented in this evaluation report. The offenders in this sample are somewhat similar to those in the Managed Assigned Counsel (MAC) program, as 25 of the 29 defendants (86.2%) in the COC court are also participants in the MAC program. When considering mental health diagnoses for COC participants, there were four cases for whom the diagnosis was unknown, accounting for 13.8% of the sample. The largest group of individuals were diagnosed with some type of serious mental illness, 14 of whom (48.3%) were diagnosed as Bipolar, six (20.7%) who were diagnosed with Major Depression, three (10%) who were diagnosed with Schizophrenia, and one person (3.4%) that was diagnosed with Schizophrenia and Major Depression (i.e., Schizoaffective disorder). The average age of a COC defendant is 34.4 years old, and the sample is comprised of mostly White defendants (96.6%). Only one individual (3.4%) was identified as non-white. In terms of Hispanic ethnicity, 6.9% (n = 2) of the sample was identified as such. Almost twothirds of the COC defendants are male, comprising 62.1% of the sample. These characteristics are displayed below in Table 1. Table 1. Characteristics of the Continuity of Care (COC) Court Docket Variable Frequency Percentage Age (Mean) 34.4 -- MAC Participant 25 86.2% Male 18 62.1% White 28 96.6% Hispanic Ethnicity 2 6.9% Current Felony 14 48.3% Current Drug/Alcohol Offense 11 37.9% Current Violent Offense 8 27.6% Current Property Offense 7 24.1% 4

Information on current offense for the COC sample is also displayed above in Table 1. The breakdown between felony and misdemeanor level offenses was almost evenly split, with 14 individuals (48.3%) facing a felony level offense and 15 individuals facing a misdemeanor level offense. The largest group of individuals faced a current drug or alcohol offense (37.9%), totaling 11 people overall. Additionally, eight individuals (27.6%) were currently facing a violent offense (e.g., aggravated assault), while seven participants (24.1%) were facing a property offense. The breakdown of most serious charge by type is shown below in Table 2. Table 2. Highest Charged Offenses for Continuity of Care (COC) Defendants Charge Type Frequency Percentage Drugs/Alcohol Assault/Threats 7 7 24.1% 24.1% Theft/Burglary 6 20.7% DWI 2 6.9% Public Order/Trespass 3 10.3% Other 3 10.3% Traffic 1 3.4% The highest offenses charged for defendants in the sample covered a variety of categories. Drug and/or alcohol-related charges, as well as assault/threats were most common, with each of these categories comprising 24.1% of COC probationers. It was also common for defendants to have as their highest offense charged an offense related to theft/burglary (20.7% of the sample). DWI accounted for 2 cases (6.9%), while public order/trespassing, and other categories covered the highest offense charged for six people total, with three in each category (or 10.3% each). Finally, one person s (3.4%) highest offense charged was related to a traffic violation. The amount of time spent in jail following initial arrest was relatively short for most of the COC participants. About half (51.7%) of the COC probationers spent five or fewer days in jail (median number of days was 6). Most commonly, offenders spent only one day in jail, which was relevant for 31% of probationers (nine people). Approximately 20% spent between two and six days in jail (five people total), and one person (3.4%) spent no time in jail at all. Six people spent between one and three weeks in jail (20.4%), and the remaining eight people remained in jail for over one month. All participants resided in the community during the duration of the COC court program. About 59% of offenders who eventually participated in the COC program (17 of 29) had been released from jail prior to the disposition of their cases, under a pretrial bond. 5

Criminal History Information Criminal history information for the sample is displayed in Table 3. Although five offenders (about 17%) were in the COC program as a result of their first arrest, it is much more likely for individuals to be repeat offenders. In fact, 82.8% of the sample (24 people) possessed some sort of criminal history prior to their current arrest. Note that for the remainder of this section, percentages will relate to only those 24 COC probationers who had an officially recorded criminal history (at least one prior arrest). Table 3. Prior Offenses among Those with At Least One Prior Arrest (n=24) Percent of Sample Mean (Range) Total Prior Arrests -- 3.6 (1-12) Total Prior Charges -- 4.5 (1-15) Prior Felony Arrests 42% 1.1 (0-8) Prior Violent Arrests 21% 0.3 (0-5) Prior Property Arrests 50% 1.1 (0-5) Prior Drug/DWI Arrests 79% 1.5 (0-5) Of those 24 offenders with a criminal history, the average number of prior arrests was 3.6 each and the average number of prior charges was 4.5 per offender. Of those 24 with criminal histories, 42% had at least one prior felony level arrest, with an average of just over one felony arrest per person (1.1, range = 0 to 8 felony arrests). Only 21% of those with criminal histories had any prior arrests for violent crimes, while 50% of the 24 offenders with a prior arrest had at least one prior arrest for a property crime. By far the most common crime for which this sample had at least one prior arrest was Drug/DWI offenses (79% of these 24 offenders). Sample of Defendants in the Felony Court The total COC court sample was also divided into those who had a current felony or misdemeanor offense. These sub-groups were almost equal in terms of size, with 14 offenders in 6

the felony COC court and the remaining 15 participating in the misdemeanor level COC court programs. Of the 14 felony level COC participants, 11 (78.6%) were also MAC participants. Among the felony COC court participants, 71.4% had an official mental health diagnosis, including 50% diagnosed as Bipolar (n = 7) and 21.4% who were diagnosed with Major Depression (n = 3). Four felons in the COC court program did not have a specific diagnosis recorded; however, three of these were not participants in the MAC program. The typical felony-level COC participant is White (about 93%) and 39 years old. Only one individual (7.1%) was identified as non-white. In terms of Hispanic ethnicity, 14.3% (n=2) of the felony court group identified as such. About two-thirds (64.3%) of the felony COC group were males (9 of 14). Table 4. Characteristics of the Felony COC Court Defendants Variable Frequency Percentage Age (Median) 39 -- MAC Participant 11 78.6% Gender: Male 9 64.3% Race: White 13 92.9% Ethnicity: Hispanic 2 14.3% Current Drug/Alcohol Offense 5 35.7% Current Violent Offense 5 35.7% Current Property Offense 4 28.6% Information on the highest charged current offense for the felony-level COC court defendants is also displayed above in Table 4. The breakdown of offense type for felony COC defendants was fairly evenly distributed, with 35.7% in the drug/alcohol offense category, 35.7% in the violent offense category (e.g., aggravated assault), and 28.6% in the property offense category. The breakdown of most serious charge by type is shown below in Table 5. 7

Table 5. Highest Charged Offenses for Felony Defendants in the COC Court Charge Type Frequency Percentage Theft/Burglary 4 28.6% Assault/Threats 4 28.6% Drugs/Alcohol 3 21.4% Public Order/Trespass 1 7.1% Other 2 14.3% The highest charged offenses for defendants in this sample covered a variety of categories, including theft/burglary, assault/threats, drugs/alcohol, public order/trespass, and an other category. Both assault/threats and theft/burglary charges were the most common for the felony-level COC probationers (28.6% each). Drug or alcohol charges were the next most common offense type (21.4%). The other category included 14.3% of the felony level sample, while one (7.1%) felon s most serious charge fell within the public order/trespass category. Criminal History Information Criminal history information for the felony-level subgroup is displayed in Table 6. Although one felony-level COC offender (about 7.1%) was in the program as a result of his/her first arrest, it is much more likely for individuals to be repeat offenders. In fact, 92.9% of the felony subgroup (13 out of 14) possessed some sort of criminal history prior to their current arrest. Note that for the remainder of this section, percentages will relate to only those 13 felonylevel COC probationers who had an officially recorded criminal history (at least one prior arrest). 8

Table 6. Prior Offenses among Those with At Least One Prior Arrest (n=13) - COC Felony Court Percent of Sample Mean (Range) Total Prior Arrests -- 3.79 (1-12) Total Prior Charges -- 4.64 (1-15) Prior Drug/DWI Arrests 92.3% 1.64 (0-4) Prior Felony Arrests 46.2%.86 (0-5) Prior Property Arrests 46.2% 1.0 (0-5) Prior Violent Arrests 23.1%.29 (0-2) Of those 13 felony-level COC offenders with criminal histories, the average number of arrests was 3.79 each and the average number of prior charges was 4.64 per offender. Of those 13 with criminal histories, 46.2% had at least one prior felony level arrest, with an average of just under 1 felony arrest per person (.86, range = 0-5 felony arrests). Only 23.1% of those with criminal histories had any prior arrests for violent crimes (e.g., aggravated assault), while 46.2% of the 13 felony-level offenders with a prior arrest had at least one prior arrest for a property crime. By far the most common crime for which this subgroup had at least one prior arrest was Drug/DWI offenses (92.3% of these 13 offenders). Defendant Samples: Misdemeanor Court Among the 15 offenders participating in the misdemeanor level COC program, 93.3% were also MACMH participants (only one offender on this docket was not a part of the MACMH program). Almost all (14) individuals in the misdemeanor COC program had a recorded diagnosis of a serious mental illness, including seven (46.7%) diagnosed with Bipolar disorder, three (20%) diagnosed with Major Depression, three (20%) diagnosed with Schizophrenia, and one participant (6.7%) diagnosed with Schizoaffective disorder (Schizophrenic and Major Depressive symptoms). One case (the COC participant who was not also part of the MACMH program) did not have a mental health diagnosis recorded in COC files. All participants in the misdemeanor-level COC program were white (100%), with an average age of 30.7 years. 9

Approximately 60% of this sample were males. Information on each of these characteristics is displayed below in Table 7. Table 7. Characteristics of the COC Misdemeanor Court Defendants Variable Frequency Percentage Age (Median) 30.7 -- MAC Participant 14 93.3% Gender: Male 9 60.0% Race: White 15 100% Ethnicity: Hispanic 0 0.0% Current Drug/Alcohol Offense 6 40.0% Current Violent Offense 3 20.0% Current Property Offense 3 20.0% Information on current offense for the participants in the misdemeanor COC court is also displayed above in Table 7. Specifically, 40% of the offenders in this court group were facing a drug/alcohol-related offense, while 20% were facing a current violent offense (e.g., aggravated assault), and another 20% were facing a current property offense. Three individuals were facing offenses in other categories. The breakdown of most serious charge by type is shown below in Table 8. The highest offense charged for defendants in the misdemeanor COC court covered a variety of categories, including drugs/alcohol, DWI, assault/threats, theft/burglary, public order/trespass, and an other category. Drugs or alcohol charges were the most common offense type for misdemeanor-level COC probationers. Assault/threats charges were the next most common offense type (20%). Both DWI and theft/burglary and public order/trespass charges were the third most common offense type with 13.3% each. Finally, traffic and other categories were the least common offense types for the misdemeanor-level subgroup (6.7% each). 10

Table 8. Highest Charged Offenses for Misdemeanor Defendants in the COC Court Charge Type Frequency Percentage Drugs/Alcohol 4 26.7% DWI 2 13.3% Assault/Threats 3 20.0% Theft/Burglary 2 13.3% Public Order/Trespass Traffic 2 1 13.3% 6.7% Other 1 6.7% Criminal History Information Criminal history information for the misdemeanor-level subgroup is displayed in Table 9. Although four misdemeanor-level COC offenders (26.7%) were in the program as a result of their first arrest, it is much more likely for individuals to be repeat offenders. In fact, about threequarters (73.3%, 11 of 15) of the misdemeanor subgroup possessed some sort of criminal history prior to their current arrest. Note that for the remainder of this section, percentages will relate to only those 11 misdemeanor-level COC probationers who had an officially recorded criminal history (at least one prior arrest). Of those 11 misdemeanor-level COC offenders with criminal histories, the average number of prior arrests was 3.1 each and the average number of prior charges was 3.8 per offender. Of those 11 with criminal histories, 36.4% had at least one prior felony level arrest, with an average of just over one felony arrest per person (1.36, range = 0-8 felony arrests). Only 18% of those with criminal histories had any prior arrests for violent crimes (e.g., aggravated assault), while 54% had at least one prior arrest for a property crime. By far the most common crime for which this subgroup had at least one prior arrest was Drug/DWI offenses (63.6% of these 11 offenders). 11

Table 9. Prior Offenses among Those with At Least One Prior Arrest (n=11) COC Misdemeanor Court Percent of Sample Mean (Range) Total Prior Arrests -- 3.09 (1-11) Total Prior Charges -- 3.82 (1-15) Prior Drug/DWI Arrests 63.6% 1.18 (0-5) Prior Property Arrests 54.5% 1.09 (0-4) Prior Felony Arrests 36.4% 1.36 (0-8) Prior Violent Arrests 18.2%.18 (0-1) PROGRAM DESCRIPTION Overall Program Description The Continuity of Care (COC) Court program targets non-violent, sometimes repeat offenders with mental health issues who have been criminally charged, but appear to be candidates for a community-based treatment and supervision program. The program has several goals, including to help remove some low-risk offenders from the Montgomery County jail, while providing them with necessary levels of specialized probation supervision and providing these offenders with opportunities to participate in needed mental health services in the community. In essence the program is a modification from probation s pre-existing Mental Health Caseload, but also adds regular judicial contacts to assist in the monitoring of offender compliance. Unlike the Managed Assigned Counsel (MACMH) program however, individuals participating in the COC program are not required to be indigent as a condition of eligibility. The total staff of the COC court is made up of the two judges who oversee the misdemeanor and felony level COC dockets, two Montgomery County probation officers, and their supervisor. Casework staff from the MACMH, as well as the MACMH Managing Attorney contribute information to COC judges if the COC participants also happens to be a MACMH participant (about 87% of COC participants). Probation officers divide the COC workload by region of the participants residence within the county. Tri-County Services (the local mental 12

health authority) also plays a role in determining potential client s official diagnoses, as well as developing treatment plans; however Tri-County Services is not involved in the overall judicial or supervisory processes. The average length of time a participant would spend in the program can vary depending on individual conditions of probation, as most of the participants enter the program postjudgment. Typically, individuals spend at least six months following their conviction in the COC program; however, this can be extended at the discretion of the judge. The majority of individuals are on the probation mental health caseload and the COC judge will see the probationer in court on a monthly basis. Generally, the Court will supervise a probationer for over a year, but this may vary depending on the potential for incentives, such as early termination of probation and/or waivers of court appearances. In the future, the Court is hoping to expand to include participants pre-judgment as well as post-conviction, by imposing conditions of bond that would require them to comply with the COC Court program and satisfy other monthly conditions of bond. Should this happen, this would lengthen the time of participation in the court program. Stakeholders report that the amount of interaction between the client and various members of the COC court team varies by offender, and by type of charge. On average, a successful client will have monthly judicial contacts, unless doing particularly well, in which case the judge may waive a court appearance. There is required contact with probation at least one time a month; however, most clients report to their probation officers more frequently, on an as needed basis as issues arise. There is also regular contact between the client and his/her MAMCMH case workers, but this is fairly informal and can occur over the phone or email. The majority of interaction takes place between the clients and his/her treatment provider, but this varies based on the particular treatment program the individual participates in, as well. Individuals meet with treatment providers at a minimum of one time per month, but this can be as much as weekly or biweekly, depending on the situation. In other cases, the individual is simply required to complete the length of a particular program or class (e.g., 12 hours). If the client is unsuccessful (i.e. not compliant), the required frequency of contact with the above staff members (especially probation officers and judges) may be increased. If this occurs, conditions of probation must be formally amended to reflect the increased requirements. All compliance forms and other relevant information is exchanged between parties prior to court, at monthly group staffing meetings that are held with Mental Health Caseload probation staff and COC judges. The MACMH Managing Attorney may also be asked to provide information about participants if they are also engaged in that program. At this staffing meeting, all clients are discussed individually, giving probation officers, judges and MACMH staff the opportunity to catch up and verbally exchange information. All COC participants are required to pay probation supervision fees and fees for Tri- County services, but other fines and costs may vary based on conditions of the plea agreement. The judges may also choose to adjust or waive some fees, as a reward for compliance by defendants. Other behavioral demands include standard conditions of probation, which can sometimes be tailored to the individual participant s circumstances. Additionally, all COC Court participants who are on probation are required to go to Mental Health treatment, as compelled by probation conditions. The specific treatment program that a client is referred to varies on a case 13

by case basis and is largely dependent on a person s individual needs. Stakeholders were asked if they felt that these various program requirements require participants to stretch their ability to remain compliant (i.e., that they have to really work hard to be compliant). Stakeholders generally agreed with this statement regarding the program requirements. Program expectations are presented to their participants by the probation officers and case workers at the outset. The COC Court judges do not operate on an established, formal system of rewards and sanctions to support offender compliance with program conditions; however, there is the possibility of incentives or sanctions at the judge s discretion. If the offender is doing particularly well, the judge may decide to waive or reduce probation fees, community service hours, court appearances, or on the other hand, may choose to terminate an individual from the program for repeated non-compliance. Program sanctions are also individualized by the judge and stakeholders report that sanction use is relatively rare. Serious violations have been reportedly infrequent; however, probation officers may submit written recommendation to the judge to obtain an immediate consequence for any instance of non-compliance. Depending on the severity of the sanction (i.e., positive drug test), the judge makes the ultimate decision of whether to send the individual to jail, or pursue a motion to revoke probation. If the judge decides to pursue a serious penalty, this will take place immediately. Otherwise, less serious infractions (i.e., a missed payment) may be reviewed during court hearings by the probation officer and are dealt with in that setting. The judge always has the final say in these matters, but receives feedback from the attorney, probation officers, or other COC staff members. Although the COC Court operates fairly independently, it has been affected by other agencies in the community, particularly in the area of local mental health treatment capacity. For example, during the first 12 months of operation, there was a waiting list to receive treatment at Tri-County Services, due to a large influx of clients. As of January 2014, the need for this wait list has reportedly ceased, such that clients can now schedule initial appointments with Tri- County as soon as needed (though there may still be a delay before the appointment itself). COC stakeholders noted that treatment providers are an essential part of the operation of the COC Court because of their role in making treatment determinations and developing case plans. Stakeholders generally reported that they felt the COC itself has been beneficial in improving the process of getting participants into needed programs and services and in promoting cooperation from the District Attorney s Office to deal with mentally ill offenders pre-judgment. Coordination between agencies is performed largely by the probation supervisor who manages the mental health caseload. Stakeholders report that to date, there have been no major incidents involving public safety concerns by participants in the COC program. Probationary Procedures Most typically, the defendant enters the specialized Continuity of Care Mental Health Court docket on the basis of a plea agreement to probation (including a pretrial bond as a condition of probation) or deferred adjudication sentence. Probation staff has no discretion regarding the selection process, but after the individual s eligibility has been determined, the client will report to probation and be placed on the Mental Health Caseload. At this point attendance and participation in the Continuity of Care court hearings becomes a condition of probation, and these individuals become the responsibility of the probation office s Mental 14

Health Caseload. In accordance with COC procedures, standard conditions of probation apply along with monthly judicial monitoring, attendance at an appropriate treatment program and/or other services, and monthly check-ins between Tri-County and probation. Since many participants are also involved in the MACMH program, they will also maintain contact with the casework staff from the MACMH program. Once placed on the Mental Health probation caseload, the client has already been assessed by Tri-County and thus has been deemed eligible to participate. Paperwork regarding the mental health assessment is shared with the probation directly from Tri-County services. At their first meeting, the probation officer will initially talk with the client about his/her criminal and mental health history and will verbally convey all conditions of probation (including COC program conditions) and offender expectations in detail. At the meeting, the client will also receive paperwork outlining these conditions. When necessary, the case manager will be contacted with any relevant information. These meetings between the probation officer and the client occur at a minimum of once a month, but typically are carried out more frequently as deemed necessary. Additionally, Tri-County professionals will physically travel to the probation office one time per month, giving the client an opportunity to speak with both the treatment provider and the probation officer on the same day. At this meeting, the treatment provider and probation officer also have a chance to compare notes and discuss any concerns regarding the client s progress and rehabilitation. Other than this monthly interaction, probation is generally not present at treatment staff meetings and is not significantly involving in the treatment planning process. Clients of the Mental Health Court program are mainly the responsibility of the probation officers who handle the Mental Health Caseload because COC requirements are, in essence, a condition of probation. The COC participant s case worker and the judge are also integral in the monitoring of the defendant, but the probation officer has the most personal interaction. In a similar manner, the case worker is again pivotal for making referrals and is critical in overseeing the defendant s progress, but it is ultimately the probation officer s responsibility to supervise and ensure that the offender is upholding conditions of probation. The probation officer will also fill out monthly compliance forms, as consistent with standard procedure. Compliance reports are one form of written documentation used to evaluate offender progress and are fundamental for communicating information with caseworkers and the judge. Other formal communication procedures are practiced between probation and the treatment agency when paperwork is circulated upon a client s completion of a treatment program. Most often though, an individual s progress is determined informally on an anecdotal and individualized basis. The appropriate staff are always using personal judgment to ascertain how the client is doing based on the his/her behavior, insofar as regular attendance in substance abuse counseling, employment information, fulfillment of specialized conditions, active pursuance of community service requirements, and upkeep with all medications. All respective agencies have an open communication policy with probation to make sure the individual is meeting all expectations, but this contact is kept fairly informal. Probation may make written recommendations to the judge regarding specific clients, should serious violations occur. This individualized process is meant to be very specific and tailored to needs of every client in particular. The probation side of the Mental Health Court takes a mixed model approach 15

encompassing both rehabilitative and surveillance functions. It is much more individualized than a typical surveillance process (as compared to other probationers), but not surprisingly, some individuals need more monitoring than others. Often the approach is more rehabilitative in nature because staff are willing to do whatever they can to help probationers maintain compliance and succeed. The desire to maintain mental health stability is consistent, but the specific approach on a day-to-day basis varies depending on the offender s attitude, state of mind, and cooperation. Additionally, most of the offenders are also indigent and therefore are also assigned to the Managed Assigned Counsel (MACMH) program, but this is not true for all clients. There are other referrals to different forms of rehabilitation or self-help classes dependent on the individual s particular needs, which is fairly common because most clients have an array of problems. This requires some coordination with other agencies on behalf of the probation officer (and MACMH case workers when relevant). For those participants also in the MACMH program, caseworkers and probation officers will meet in person once a month before court where they can discuss any of these issues, but there is always open communication between court appearances whenever necessary. The court liaison officer is critical in transferring information specifically from the courtroom to the probation agency, while probation officers and case workers usually talk amongst themselves regarding potential referrals and other concerns. As of now, there is no operational management information system allowing for rapid retrieval and exchange of information, but there is a standing communication policy that currently works to everyone s satisfaction. Coordination with outside agencies is the fundamental responsibility of the probation supervisor, while probation officers simply act as brokers of services who offer assistance to clients on an individual level, making referrals when necessary. Most importantly, it is probation s role to monitor participants, determine conditions of probation, and work to create and sustain supervision plans for offender maintenance purposes. The probation officers handling the Mental Health Caseload were asked what they thought was the most helpful about the program and whether they had any recommendations for program improvements. None of them had any specific recommendations, but did claim that it was still a new program and that change is inevitable. Probation officers did perceive some benefits resulting from the program, which are included below: Incentives give probation officers feedback they need Potential sanctions from the judge help probation officer stress and frustration Forces the defendant to be accountable Judges are willing to work with clients, helping them stay on track Clients can communicate individually with the judge on a frequent basis Court & probation personnel provides numerous resources Allows the offender a chance to remain stable without incarceration Judicial Procedures Information in this section is based on observations of court hearings by SHSU researchers. As part of the COC Court conditions, a participant must appear in court once per month, where 16

s/he has the opportunity to speak with the judge individually and address any and all concerns. There is a staff meeting prior to court which includes the Mental Health probation officer and supervisor, the MACMH Managing Attorney, and any MACMH caseworkers working with individuals from the MACMH program. During these meetings all concerns are discussed by the program staff, so that everyone, especially the judge, is kept informed. During the actual court session, the probation officer and MACMH Managing Attorney will stand near the podium to provide the judge with the compliance report for each defendant as they are called up. The probation officer also provides additional input during court as necessary. The MACMH case workers sit in the audience and observe, participating in the court procedure as necessary or when spoken to by the judge. Once court is in session, the judge calls clients up one by one, in alphabetical order. Typically, the judge reviews the individual s progress in a fairly informal manner. This includes a simple conversation about how the individual is doing, a discussion of where the individual is in regards to completion of community service hours and other probation conditions, reinforcing the need for the defendant to keep up with all fees, and inquiring as to whether the individual is compliant with required mental health treatment and medications. Should there be any additional updates in between court appearances, this information may be informally communicated to the judge via email from various COC staff members. As mentioned previously, there is no specific protocol of punishments and rewards; judges have the discretion to impose an incentive or sanction when appropriate. Based on individual circumstances, the judges may decide to waive fees or court appearances if a defendant is in compliance. In the event of a violation, depending on the severity of the mental health condition and one s ability to adhere to requirements, a varying degree of sanctions can occur. These can range from simple admonishment to increased contact with the staff and/or court, and sometimes may include a period of jail incarceration, or complete termination from the program. From a judicial standpoint, the program s goals reflect both a focus on providing needed rehabilitation services and ensuring overall probation compliance through surveillance and frequent probation contacts, with these efforts combined to help stabilize the offender in the community. The main goal is rehabilitation, with the judge and other program staff working with offenders individually to help them be productive, gain employment and stable housing, and most importantly, remain compliant with treatment and medication regimens. Stakeholders reported that while the Montgomery County COC conforms closely to the original program model, there have been some concerns regarding identification of the target population and whether or not enough clients are being targeted. Most people enter the court as a plea to probation, excluding any pre-judgment cases which may otherwise be suitable targets for the combined supervision and treatment services offered by the program. Both misdemeanor and felony court judges handling the Continuity of Care docket were asked what they thought was the most helpful about the program and whether they had any recommendations for program improvements. Perceived benefits resulting from the mental health court program from a judicial standpoint were as follows: Reduction in jail costs Opportunity for the defendant to stabilize mentally, in the community 17

Opportunity to divert the defendant from the criminal justice system Deals with the root problem behind criminal behavior Increased awareness of mental health issues, particularly by members of the DA s office Court can provide numerous resources Participants have shown marked improvements in family relations during program duration On the other hand, the two judges involved in the COC court offered the following recommendations for improving the program: A Full circle team effort between prosecution, defense, court, caseworker, and probation officer Required monitoring for all mental health cases, not just those on the probation mental health caseload (i.e., include straight conviction cases, if feasible) Developing an established protocol for sanctions and rewards Developing the ability to ascertain who the MAC defendants are Incentives for completing the program after a reasonable period of time Anticipate impacts of implementation of statewide guidelines for specialty court s practices Generate more buy-ins for specialty courts from other players in the courthouse 18

RESULTS: PROGRAM OUTCOMES In this section, outcomes are presented which examine the impact of the Montgomery County Continuity of Care (COC) Court for mentally ill probationers. Being a community-based diversion program, all participants of the COC court were eventually released to the community regardless of charge type. Nonetheless, the sample is split into two groups to examine differences between felony and misdemeanor level defendants. This outcome description will include measures specifically related to the Montgomery county jail and courts, as well as information related to state-wide measures recidivism (i.e., DPS records). 1. Outcome Measures Related to the Jail Overall time spent in jail and the likelihood of release through a bond are presented as outcome measures related to the jail. The misdemeanor and felony courts were examined separately to properly assess outcomes of the COC program. Felony Defendants. There were 14 participants within Montgomery County s felony-level COC court during the study period. All had been released from jail prior to their participation in the program and 64.3% of these were released on a bond. The average amount of time served in jail from arrest to release was 57 days, however the range was from one day to 141 days. Misdemeanor Defendants. There were 15 participants within Montgomery County s misdemeanor-level COC court during the study period. Again, all participants had been released to the community prior to participating in the program, with 53.3% of these being released on a bond. Time spent in jail for this group ranged from zero days up to 34 days, with a mean of 6.6 days (much lower than the range for the felony group). 2. Outcome Measures Related to Courts In this section, Continuity of Care court participants will be examined separately by charge type (felony or misdemeanor). Outcome measures related to the courts include what type of disposition was received and the relative time (from arrest date) until that disposition was received. Felony Defendants. Among the 14 offenders in the COC court, eight cases (57.1%) were still participating in the program and had their cases pending at the time of data collection. Four individuals (28.6%) were terminated for various reasons. Among these four terminated cases, one was terminated immediately upon entry into the COC (zero days in the program). One was terminated approximately two months into the program (57 days). Two others who were terminated spent approximately three months (each 84 days) in the program before eventually being terminated. One individual (7.1%) from the felony group did successfully complete the program, after the expected six month time frame (program duration of 182 days total). Additionally, one individual (7.1% of the felony group) was referred to the mental health court but never was an 19

active participant (program duration of zero days). Overall, the mean program duration was 67.8 days with a range from 0 to 182 days. All participants eventually received a case disposition, but there was considerable variation in the timing of these dispositions. Among felony level COC court participants, the minimum number of days from arrest to case disposition was 8 with a maximum of 412 days. The average timeframe until disposition was about four months (134.6 days). Probation was the most common type of disposition, granted to six defendants (42.9%) in the COC felony level court. It was also common for a case to receive a deferred adjudication, which occurred for five individuals (35.7%). Two cases (14.3%) were eventually dismissed, and one defendant (7.1%) received a jail sentence. Among the four cases that were terminated from the felony-level COC program, two (50%) received probation dispositions, one (25%) served time in jail and one (25%) received a deferred adjudication. The mean number of days until disposition among these terminated cases was 85.7, with a range from 8 to 148 days. For the one felony-level case that successfully completed the program during the study period, the time to disposition was 83 days. For the defendant who was never technically enrolled in the COC, the case was eventually dismissed at 166 days, or approximately 5.5 months after the arrest date. Among the eight defendants in the felony-level COC with pending cases, four (50%) have received probation sentences, three (37.5%) have received a deferred sentence, and one (12.5%) had the case dismissed. Average days from arrest to disposition among these defendants still active in the felony-level COC ranged from 21 to 412 days, with a mean of 162 days. Misdemeanant Defendants. For those defendants participating in the misdemeanor-level COC program, five cases (33.4%) were still pending at the time of data collection. One defendant (6.7%) was terminated from the program after a program duration of 154 days. Over half (60%, n=9) of the misdemeanor participants did successfully complete the program, with a mean of 166 days and a range of 8 to 309 days. Once again, the time from arrest to disposition for the misdemeanor group was highly variable, but was generally much shorter than the time to disposition for the felony group. Among misdemeanor participants, the average number of days until disposition ranged from three days to 271 days, with a mean of 95 days. In contrast with the felony court, the timeframe until disposition was less than one year for all misdemeanants and the range of disposition times was smaller than among the felony COC participants. In sum, misdemeanor COC defendants appeared to receive their dispositions much more quickly than the felony-charged counterparts. However, the two groups were more similar when considering the percentage breakdown by disposition type. For COC misdemeanants, probation was the most common disposition type (40%, n = 6) of the misdemeanor group, with five cases (33.3%) receiving a deferred adjudication. In addition, one case (6.7%) was dismissed, and three defendants (20%) were sentenced to jail time already served. 20