Sacramento County Community Corrections Partnership

Sacramento County Community Corrections Partnership AB 109 Mental Health & Substance Abuse Work Group Proposal Mental Health & Alcohol / Drug Service Gaps: County Jail Prison ( N3 ), Parole, and Flash Incarceration Inmate Services Post-Release Community Supervision (PRCS) Offender Services June 28, 2012 Contact : Mary Ann Bennett, Sacramento County Behavioral Health Services (916) 875-9904 Email: bennettma@saccounty.net

Sacramento County Community Corrections Partnership Public Safety Realignment Plan AB 109 Mental Health and Substance Abuse Work Group Proposal Table of Contents Page Executive Summary 1 Identification of Mental Health and Alcohol / Other Drug Service Gaps 3 AB 109 Mental Health Assessments, Referral and Service Trends 4 AB 109 Alcohol and Other Drug Assessments, Referral and Service Trends 10 Mental Health and AOD Recommended Services 13 Non-Violent and Non-Serious County Jail Prison ( N3 ), Pre- and Post Parole Revocation and Flash Incarceration Inmates 14 Post-Release Community Supervision PRCS Offenders 15 CCP Funding Allocation Requests and FY 2012 13 Budgets 21 Appendix A. Appendix B. Appendix C. Appendix D. AB 109 Mental Health and Substance Abuse Work Group Roster HALT/RSAT (Housing For Accountable Living Transitions / Residential Substance Abuse Treatment Program) Description Jail Inmate Reentry Services Discharge Planning Process AB 109 Inmate Reentry Services Program Requirements

Executive Summary AB 109 Mental Health and Substance Abuse Work Group Funding Allocation Recommendations In recognition of the need to expand mental health and substance abuse services for Realignment Act offenders, the Community Corrections Partnership (CCP) established an AB 109 Mental Health and Substance Abuse Work Group. The goal of the Work Group was to identify service gaps and make recommendations which could be submitted for funding in the FY 2012 13 Sacramento Public Safety Realignment Plan. Analysis of the AB 109 offender data showing service needs, current program availability and capacity points to several significant factors about the level of mental health and AOD needs among these new jail inmates and community supervised offender groups. Key Mental Health and AOD Characteristics Among New AB 109 Offender Caseloads About one in five Realignment inmates prescreened by RCCC Social Workers are reporting mental health-related concerns to Jail Intake personnel. The Sheriff has processed 989 AB 109 inmates through March 2012, and a total of 407 (41.2%) received mental health services (crisis counseling, clinical / case management, and medication support). In-custody inmates, particularly parole violators, are requiring mental health services at nearly double the levels traditionally experienced in local jail facilities. A total of 77 (38.9%) of Probation s ADRC offenders are receiving case management and treatment services for identified problems, while another 54 (8.4%) of the offenders being supervised in Intensive or Specialized Gang / Sex Offender caseloads also have received mental health counseling services. Among the 77 offenders provided services, about 28.6% are being seen on a regular basis. Approximately 10.4% of the active mental health offenders also have referrals to the Access Team because of a higher level of case and/or medication needs. Nearly 85.2% of the Realignment offenders processed through RCCC Intake are also reporting significant alcohol and other drug usage problems and are indicating their drinking or drug use has caused problems with friends and family or has interfered with their ability to maintain employment. Many have also participated in prior substance abuse counseling sessions. Nearly half (48.8%) of the active PRCS mental health offenders also have significant alcohol and other drug issues, (i.e., one out of three have used substances within the last six months, another 31.4% have used substances in the last year, with the remaining being current AOD users). Review of PRCS commitment offenses shows 60.4% or 99 offenders placed in the ADRC are returning from prison after serving a sentence for alcohol or other drug crimes. Nearly 40.5% (205) of the offenders assigned to other AB 109 Field Units also have prison commitments resulting from alcohol and other drug violations. 1

The Work Group has identified nine (9) programming and service gaps that should be considered for funding by the Community Corrections Partnership (CCP). The identified gaps include the following: List of Service Gaps For AB 109 Offender Populations Substance Abuse and Mental Health Program Needs County Jail Prison ( N3 ), Pre- and Post- Revocation, and Flash Incarceration Offenders (Main Jail and RCCC) Summary Description of Services CCP Funding Request 1. In-custody Drug & Alcohol Addiction Services $289,591 2. In-Custody Mental Health Out-Patient Clinician, Psychiatrist & Discharge Planning Services $539,950 3. In-custody Mental Health Treatment For Longer Term Inmates $110,000 4. In-custody Jail Inmate Community Reentry Services $535,820 TOTAL COST FOR ADDED SERVICES FOR IN-CUSTODY INMATES $1,475,361 AOD and Mental Health Service Needs Probation Department Post- Release Community Supervision (PRCS) Offenders Summary Description of Services CCP Funding Request 5. PRCS Substance Abuse Counselor $110,000 6. PRCS Mental Health Counselor $110,000 7. Cognitive Behavioral Substance Abuse Counseling $80,000 8. PRCS Eligibility Specialist $98,000 9. Psychotropic Medication Management & Monitoring $641,088* TOTAL COST $1,039,088 TOTAL FY 2012 13 FUNDING ALLOCATION REQUEST $2,514,449 * This is a critical need identified by the Work Group and would be available for both Sheriff s Department and Probation Department identified AB 109 offender groups. The proposed services will form the basic service structure the Sacramento Criminal Justice System should have in place for addressing alcohol / other drug and mental health problems associated with the AB 109 inmates and State Prison PRCS offenders. The funding will help the County jail system and Probation Department establish an integrated and expanded continuum of treatment programs. The programs will use evidence-based assessment principles combined with an expanded service capacity dedicated and directed to the new realignment in-custody inmates and offenders participating in the Adult Day Reporting Center (ADRC) high-risk, Intensive and Specialized Field Supervision Units. The resulting services include the creation and expansion of substance abuse and mental health treatment involving multi-disciplinary treatment professionals who will be able to provide expanded services to the AB 109 offender populations. The services will include assessments, mental health, medication management, alcohol / drug counseling, jobs / work preparation assistance, and the development of transitional community reentry discharge plans. The funding will support the implementation of new cognitive behavioral alcohol and drug counseling therapy and enhanced mental health interventions for the large number of AB 109 offenders who have these presenting problems. The reentry services proposed for RCCC will also include voucher funding for transitional short-term housing for ( N3 ) inmates release from jail, and funding that can be accessed to cover prescription cost for psychotropic medications and other monitoring expense for offenders requiring these types of medications. 2

AB 109 Mental Health & Substance Abuse Work Group Proposal 2012-13 Public Safety Realignment Plan Identification of Mental Health and Alcohol / Other Drug Service Gaps Assembly Bill (AB) 109 became law on October 1, 2011. The AB 109 legislation reassigns three groups of offenders previously handled through the State Prison and Parole System to California counties. The first group includes convicted offenders receiving sentences for new non-violent, non-serious, non-sex offender ( N3 ) crimes that will be served locally (one year or more). Offenders in this category will have no prior violent or serious convictions. The second group involves post-release offenders (up to three years) coming under Probation Department supervision for N3 crimes released from State Prison. Offenders in this category may have had prior convictions for violent or serious crimes. The third group includes State parole violators who are revoked to custody. With the exception of offenders sentenced to life with parole, this group will be revoked to local County Jail instead of State Prison. The California Department of Corrections and Rehabilitation (CDCR) estimates that in the initial first nine months of Realignment implementation (October 2011 to June 2012), the Sacramento County criminal justice system will receive approximately 396 new N3 offenders sentenced to local incarceration in the County Jail, 243 State parole revocations committed to the local jail and 1,003 Post-Release Community Supervision (PRCS) offenders receiving supervision provided through the Probation Department. Between July 2012 and September 2013, CDCR estimates the AB 109 Realignment will result in 613 additional new locally sentenced offenders, 982 new post-release probation assignments, and 567 State Parole revocations to County Jail. Based on these estimates from CDCR over the first two year implementation period, the Sacramento Probation Department is projected to receive a total of 1,985 Post-Release Community Supervision (PRCS) offenders (monthly average of 83). The Sheriff s Department is projected to receive 1,819 (monthly average of 76) N3 felony offenders sentenced to jail time or some combination of jail time and community supervision and parolee jail commitments. In the initial 2011 Public Safety Realignment Plan, developed and approved by the Sacramento County Community Corrections Partnership (CCP), limited funding was provided for mental health or alcohol / other drug service needs of this new jail inmate and offender populations. In recognizing the need for services in these two critical areas, the CCP established an AB 109 Mental Health and Substance Abuse Work Group to identify service gaps and make recommendations for a Behavioral Health Services Funding Proposal which could be submitted to the CCP for consideration as part of the second year FY 2012 13 Public Safety Realignment Plan for the Sacramento Criminal Justice System. (See Appendix A: AB 109 Mental Health and Substance Abuse Work Group Roster) The Work Group, with assistance from the Criminal Justice Research Foundation (CJRF), reviewed information that allowed the agencies to better understand the criminogenic risk and service needs associated with these offender populations. The discussions focused on identifying and developing a service delivery model which could be implemented with the CCP funding. Four basic planning steps and tasks were carried out that included (1) review of the Work Group goal and planning objectives; (2) collection and analysis of AB 109 offender data showing mental health and AOD service needs; (3) identification of the current level, availability and service capacity of local mental health and AOD providers; and (4) development of program / service recommendations. A kickoff meeting and orientation with the Mental Health and AOD Work Group initiated the discussions and planning work the participating agencies would be involved in. Background information and data showing the legislative intent of the new AB 109 Realignment Legislation was reviewed. The agencies also reviewed the primary objectives and scope of work set for the Proposal. The meeting also helped identify other significant programmatic operational issues and problem areas that were examined by the Work Group and consultant staff as part of the planning process leading to the CCP Proposal. 3

In order to fully understand the range of service gaps and related interventions, the agencies worked with the Sheriff s Department s RCCC jail mental health staff and Probation Department s new AB 109 Day Reporting Center intake personnel. Through these discussions, the Work Group was able to compile and summarize current information about the mental health and substance abuse service needs of the County Jail Prison ( N3 ), Parole, and Post-Release Community Supervision (PRCS) offenders being sentenced to County Jail in lieu of State Prison and parolees being transferred to the Probation Department. Both agencies are in the process of conducting evidence-based risk and service need assessments of these offenders and structuring in-custody reentry, community supervision interventions, and monitoring plans for both populations. The information analyzed by the Work Group included general demographic, criminal history characteristics, offender risk levels, and specific mental health and AOD service needs related to the population groups. The Work Group also reviewed the existing crisis, medication management, and other treatment services the two agencies are providing or plan to provide through their AB 109 funding. These discussions assisted in identifying other unmet requirements the Departments are experiencing in responding to these offenders mental health and AOD needs. These challenges were reviewed and factored into the Work Group s service recommendations. Intent and Purpose: AB 109 Mental Health and Substance Abuse Work Group The Sacramento Community Corrections Partnership (CCP) established the AB 109 Mental Health and Substance Abuse Work Group to specifically identify the program interventions, related services, and supporting budgets needed to implement mental health, alcohol and other drug programming for the County Jail System s Realignment custody inmates and offender populations supervised through the Probation Department. The CCP directed the Work Group to make recommendations for a Behavioral Health Services funding proposal which could be submitted to the CCP for consideration in the second year FY 2012 13 Sacramento County Safety Realignment Plan. The planning work focused on identifying and developing a service delivery model that responds to identified service gaps in these two critical areas. Consultant staff also met individually with each of the Work Group agencies to make a summary assessment of the level, type of services, and provider experience which could be redirected or augmented to begin addressing the mental health and substance abuse problems associated with the two AB 109 offender groups. Before the Work Group could begin considering program and service development proposals, this fundamental understanding about program capacities and/or gaps in services for offenders had to analyzed and reviewed. The intent of these discussions was to gain consensus about priority program needs, service levels, and potential public / provider organizations which should be considered in developing a recommended service delivery model and case management process for handling the mental health and AOD needs of the two large offender pools. Through this work, the participating agencies identified a range of program and service options which could be implemented in response to mental health and AOD service needs of the N3 and PRCS offender populations. Consultant staff also assisted in finalizing the working groups recommendations including identified provider organizations, implementation timelines, program components / interventions, and proposed budgets. The budget information included staffing, operational, and one-time cost estimates for recommended programs, service levels, and case management processes. AB 109 Mental Health Assessments, Referral and Service Trends As part of the Sheriff s Department s efforts to implement the Realignment legislation and expand jail inmate services for newly incarcerated County Jail Prison ( N3 ) and Parole Revocation offenders, RCCC 4

staff have developed and are implementing an 8-page pre-screening, multi-component assessment tool. The self-report instrument is designed to aid the facility s intake social workers and classification officers in identifying and referring sentenced inmates to cognitive behavioral, academic, personal development, counseling, work experience, career education and other in-custody health / psychiatric services. The questionnaire asks offenders if (a) they have mental health problems including prior diagnosis; (b) they ever received mental health, substance abuse or other counseling; (c) friends or family have complained about drinking, drug use or mental health concerns; (d) their problems have interfered with school or work, and (e) friends or family members have wanted the individual to be in treatment. As the following chart shows, 15.3% of the AB 109 inmates prescreened and housed at RCCC during the six months between October 2011 and March 2012 reported mental health-related concerns. These inmates were referred for further clinical assessment and jail psychiatric services provided through the University of California (UCD) Medical Center contract overseen by the jail s Correctional Health Services Unit. County Jail Prison Non-Violent and Non-Serious ("N3") AB 109 Offenders Incarcerated at RCCC Who Are Reporting Mental Health Issues 84.3% Reported No Mental Health Issues Reporting Period: October 2011 through March 2012 15.3% Self-Reported Mental Health Issues Analysis of the number of inmates and type of mental health services currently being provided to AB 109 custody inmates (County Jail Prison N3, Pre- and Post-Revocations, PRCS, and Flash Incarceration) detained in the Sacramento County jail system (Main Jail and RCCC) between October 1, 2011 and March 31, 2012 is highlighted in the table at the top of the next page. The data indicates, during the first six months of the Realignment implementation period, the Sheriff s Department has processed 989 AB 109 inmates. A total of 407 (41.2%) received mental health services (crisis counseling, clinical and case management services, and medication support). Nearly 294 or 72.2% of the inmates received out-patient mental health services while 66 (16.2%) were housed in the Main Jail s Psychiatric In-patient Unit. Another 47 inmates were assessed by psychiatric clinical staff, but refused or did not need services. Among the 407 inmates receiving jail mental health services, a total of 251 or 61.7% were prescribed psychotropic medications that are monitored and overseen by Jail Psychiatric Services clinicians. 5

AB 109 Inmates ( N3 ) Pre- and Post-Parole Revocations; PRCS and Flash Incarceration) Receiving Mental Health Services 10/1/11 3/31/12 Type of Mental Health Service Total Main Jail and RCCC AB 109 Inmate Population Only AB 109 Inmates Receiving Jail Mental Health Services 1. Inmates Not Receiving Any Mental Health Services 582 58.8% 2. Inmates Receiving Mental Health Services 407 41.2% Number Percent Number Percent Total 989 100.0% 3. Inmates Receiving In-patient Services 66 6.7% 66 16.2% 4. Inmates Receiving Out-patient Services 294 29.7% 294 72.2% 5. Inmates Assessed But Refused or Did Not Need Services 47 4.7% 47 11.5% Total 407 41.2% 407 100.0% 6. AB 109 Inmates Receiving Psychotropic Medications 251 25.4% 251 61.7% Utilizing the jail s AB 109 booking information showing offenders names and Xref numbers, Correctional Health Services management staff were able to cross-reference the inmate listings with their automated health care services and cost modeling database to identify the total direct and administrative jail mental health costs associated with AB 109 inmates between October 2011 and March 2012. The analysis of the information is shown in the following chart which provides a breakdown of jail mental health costs (percentage) associated with each AB 109 incarcerated offender group (County Jail Prison ( N3 ), Flash Incarceration and Pre- and Post-Revocation Inmates). Jail Mental Health Costs Associated With Each AB 109 Incarcerated Offender Group Total Jail Mental Health Cost for AB 109 Inmates: $569,959 29.5% Pre-Revocation Inmates (29.5%) 28.1% County Jail Prison Inmates ("N3") (28.1%) Post Revocation Inmates (41.9%) 41.9% Reporting Period: October 2011 through March 2012 0.6% Flash Incarceration Inmates 6

As the chart shows, a total of $569,959 of the Correctional Health Services budget has been spent for AB 109 inmate mental health services during the six month period. Approximately 71.4% of the costs has involved Pre- and Post-Parole Revocation offenders. County jail prison inmates ( N3 ) have accounted for 28.1% of the service costs, while Flash Incarceration inmates have accounted for less than 0.6% of the total expenditures. Another impact related to the shift of AB 109 Realignment offenders incarcerated in County jail facilities is reflected in changes in the overall percentage of the jail s average daily inmate population historically receiving mental health services. The UCD psychiatric clinicians working at the Main Jail and RCCC have estimated that about 18.0% of in-custody inmates receive assessments, crisis counseling, and/or psych medications in response to identified mental health problems. To date, the AB 109 populations are requiring these services at nearly double the levels (41.2%) traditionally experienced in our local adult detention facilities. Because more of the AB 109 inmates are needing mental health services, the impact on the jail s psychiatric services budget is significant. A comparative cost analysis for providing mental health services to AB 109 inmate populations and all other jail inmates included in the following table shows the difference in cost for delivering mental health services to both incarcerated offender groups. Additional Cost For Providing AB 109 Inmates ( N3, Pre- and Post-Parole Revocations, and Flash Incarceration) Mental Health Services 10/1/11 3/31/12 AB 109 Inmate Population All Other Jail Inmates Additional Cost For AB 109 Inmates Mental Health Services Cost $ Per Day Cost $ Per Day Cost $ Per Day 1. Care Planning & Documentation $139,463 $2.59 $1,136,387 $1.58 $54,426 $1.01 2. Psychiatric Clinical Services $334,191 $6.20 $2,373,928 $3.29 $156,811 $2.91 3. Psych Medications $96,305 $1.79 $502,820 $0.70 $58,737 $1.09 Total $569,959 $10.58 $4,013,135 $5.57 $269,974 $5.01 4. Inmate Custody Days 53,887 720,653 5. Ave. Daily Direct Cost $10.58 $5.57 6. Ave. Daily Administrative Overhead Cost $3.00 $3.00 Total $13.58 $8.57 $5.01 The data shows that the average daily inmate cost for AB 109 mental health services is $13.58 while all other jail daily inmate custody costs for similar services are averaging $8.57. Because of the higher service needs among AB 109 inmates over the six months between October 1, 2011 and March 31, 2012, the added $5.01daily rate required an additional $269,974 to cover these services. When this cost differential is extended to FY 2012 13, the jail system s total mental health expenditures related to AB 109 offenders is projected to increase by $539,948, bringing the total annual expenditures to $1.7 million. The Sacramento Probation Department is using AB 109 Public Safety Realignment Plan funding to implement a community supervision and intervention strategy which serves the Post-Release Community Supervision (PRCS) offender population created by the new legislation. The Department is utilizing three levels of community supervision and service delivery for the AB 109 Post-Release Community Supervision offender group. These include the (1) Adult Day Reporting Center, (2) Intensive Field Supervision Units, and (3) Specialized Gang and Sex Offender Units. Assignment and participation in these Probation Supervision Units is made by the AB 109 Intake Unit. 7

The Adult Day Reporting Center (ADRC) component creates a continuum of services and sanctions that respond to offender needs while providing high intensity tracking and control. The Program approach involves community-based organizations and Probation Officers who work together to couple service interventions and supervision. Program services are comprehensively structured, evidence-based, multipronged, and address different facets of an offender s presenting problems: behavioral self-control, substance abuse, educational and vocational needs, health and mental health, social services, family, and community support. Post-Release Community Supervision (PRCS) Offender Monthly Referral and Supervision Caseload Trends October 1, 2011 March 31, 2012 Total CDCR Pre-Release Packets Received by Probation Department: 1,378 Number Monthly Average Percent (%) PRCS Offenders Reporting and Processed by Probation AB 109 Intake Unit: 844 141 100.0% Community Supervision Caseload Assignment 1. High-Risk Intensive Field Supervision Units A & B 592 99 70.1% 2. Specialized Supervision Caseload (Sex & Gang 54 9 6.4% Offenders) Sub-Total 646 108 76.5% 3. Adult Day Reporting Center (ADRC) 198 33 23.4% Total AB 109 Offenders 844 141 100.0% Over the first six months of the Realignment legislation, a total of 844 PRCS offenders have reported and been processed by the Probation Department s AB 109 Intake officers. On the average, the Department has been processing and assigning supervision caseloads to 141 Post-Release Community Supervision (PRCS) offenders released monthly from State Prison. Each month, approximately 108 (76.5%) of the offenders are placed in either High-Risk Intensive Field Supervision Units A and B or in a Specialized Sex or Gang Offender Unit. An average of 33 offenders (23.4%) are assigned monthly to the Adult Day Reporting Center (ADRC) sites. Each Adult Day Reporting Center site has a full-time Mental Health Counselor who is responsible for (a) mental health screening and assessment; (b) counseling, and (c) case management services for the PRCS offenders supervised through the ADRC. Offenders who report mental health treatment history or symptoms to ADRC probation officers are referred for assessments. The Counselor will also provide individual counseling for offenders with mental disorders, in collaboration with the ADRC treatment plan devised by the Center s treatment team (Strategies for Change Counselors, Probation Officers, and SETA staff). The Mental Health Counselor will provide crisis interventions to stabilize individuals and provide group counseling focused on mental health recovery topics (ADD/HD, Bipolar disorder, and fathers support groups). The Counselor also works with ADRC team and outside service providers to develop and implement needed case management plans. The Counselor will monitor the treatment and progress of PRCS offenders who are already receiving mental health services in community settings. The Counselor may also provide brief counseling or case management interventions with these linked clients in order to support the effectiveness of the combination of outside mental health services and their ADRC treatment plan. 8

No mental health counseling staff is assigned or dedicated to work with PRCS offenders and Probation Officers who handle community supervision and monitoring activities through the PRCS High-Risk Intensive Field Supervision Units A and B or Specialized Sex and Gang caseloads. In interviews conducted with management staff and ADRC Mental Health Counselors, data was compiled which shows the number of active PRCS offenders who are being screened and provided services including case management and counseling. Similar information was collected from other interviews with unit management personnel, supervisors and Probation Officers assigned to the High-Risk and Specialized caseloads. Analysis of the information is summarized in the following table. Number of Post-Release Community Supervision (PRCS) Offenders With Mental Health Issues by Type of Supervision Caseload October 1, 2011 March 31, 2012 Type of PRCS Supervision Caseloads Probation Department Current Supervision Caseload Number of PRCS Offenders With Mental Health Problems Percent Number (%) High-Risk Intensive Field Supervision Units and Specialized Supervision Caseloads 646 54 8.4% Adult Day Reporting Center (ADRC) 198 77 38.9% Total AB 109 Offenders 844 131 15.5% A total of 77 (38.9%) of the 198 PRCS offenders supervised through the Adult Day Reporting Center sites have been screened by the program s Mental Health Counselors and are receiving case management and counseling services for identified problems. Approximately 54 (8.4%) of the PRCS offenders being supervised in the Intensive Field Supervision Units A and B or Specialized Gang and Sex Offender caseloads have also received mental health services. Overall, about 15.5% (131) of the 844 offenders processed through Probation s AB 109 Intake Unit and assigned to community supervision have received mental health clinical assessments, counseling services, and case management oversight. The Adult Day Reporting Center Mental Health Counselors are responsible for completing a mental health screening on all active ADRC offenders (average of 33 per month). Among the 77 offenders provided mental health services, 12 or 15.4% are being seen on a regular basis. A total of 22 (28.6%) have been diagnosed with serious mental health issues and/or are currently on medication or need medication monitoring. Approximately eight (10.4%) of the active mental health offenders also have referrals to the County s Mental Health Access Team for a higher level of case and/or medication needs. A total of ten PRCS offenders (13.0%) have been referred due to the severity of their needs exceeding what the onsite Mental Health Counselor could provide. A total of 37 (48.8%) of the 77 active PRCS mental health offenders also have significant alcohol and other drug issues. Thirteen (13) have used substances (37.1%) within the last six months, 11 have used substances in the last year (31.4%), and 11 are current AOD users (31.4%). Two of these offenders (2.6%) have been referred to the County s Alcohol and Drug System of Care Program for residential or detox services. 9

AB 109 Alcohol and Other Drug Assessments, Referral and Service Trends Alcohol and other drug abuse issues are common presenting problems among any incarcerated inmate population whether at the County or State level. The use of substances among the AB 109 jail inmate population and PRCS offenders transitioning from State Prison is extremely high in light of the commitment offenses or criminal history characteristics of these two offender groups. The self-report information, for example, taken from the Inmate Prescreening Questionnaire that RCCC s Intake Social Workers are using to identify and refer sentenced inmates to in-custody counseling programs, clearly shows the level of substance abuse that is occurring among these newly incarcerated offenders. As shown in the following Chart, 85.2% of the AB 109 inmates processed through the RCCC Intake Unit between October 2011 and March 2012 are reporting significant alcohol and other drug usage problems. Only about one out of every five inmates (14.8%) have reported no AOD problem areas. In response to a series of questions contained in the Prescreening Questionnaire, AB 109 inmates have indicated that their drinking or drug use has caused problems with friends or family or has interfered with their ability to maintain employment. A significant number have also participated in prior substance abuse counseling sessions. County Jail Prison Non-Violent and Non-Serious ("N3") AB 109 Offenders Incarcerated at RCCC Who Are Reporting Alcohol and Other Drug Abuse Problems 85.2% Report Alcohol and Other Drug Abuse Issues Source: Inmate Pre-Screening Questionnaire (Self-Report) October 2011 through March 2012 14.8% Have Reported No AOD Problem Areas As the average daily jail population (ADP) of County Jail Prison ( N3 ) of inmates continues to increase, it is important to point out that the alcohol and drug treatment services available and being offered at RCCC, prior to the Realignment legislation, is quite limited. The facility only provided one gender-specific female program for 45 participants and one counseling program for 55 males with identified AOD problems. The Project Renewed Families for women uses Choice Theory as a component for their substance abuse / family reunification program. The classes are three hours in length, two times per week for approximately 45 inmates. The HALT/RSAT program has been in existence since 2001. It serves male offenders housed together in minimum security at RCCC. HALT/RSAT is an intensive 3-6 month program. HALT/RSAT is an integrated program offering several components that address offenders substance abuse and criminogenic behaviors. Offenders are mandated to participate in 36 hours per week and nine hours optional accountability, education and counseling services. 10

Alcohol and other AOD classes are offered to HALT participants in three hour classes, once per week. The main goal and purpose is to educate inmates about the bio/psycho/social ramifications of addiction and chemical dependency. Change Counseling Services, a private organization, provides relapse prevention counseling and guidance to attendees. This program is also offered in the community. Strategies for Change, a non-profit community based organization, provides case management services for the participants utilizing Reentry Specialists. The Reentry Specialist facilitates group counseling for inmates transitioning back into the community. The Reentry Specialist offers aftercare services and assists the offender when released back to the community. The aftercare includes substance abuse and transitioning groups held at Strategies for Change locations in the community. Females: Males: Alcohol and Drug Treatment Services Being Offered Prior to Realignment legislation at RCCC Project Renewed Families: Partnered with Strategies for Change 115 female offenders served to date with eight being rearrested One-year program Pre- and post-release services that include (a) case management (2 Reentry Specialists), (b) substance abuse, (c) relapse prevention, (d) parenting, (e) cognitive behavior, and (f) family reunification HALT/RSAT (Substance Abuse Program, Began 2001): Partners include Elk Grove Unified and Strategies for Change 55 male participants daily 38 graduates in past year Three month program (Will be expanded to six month by July 23, 2012) Treatment components include (a) case management (1 Reentry Specialist), (b) substance abuse, (c) accountability, (d) Framework for Recovery (cognitive behavioral treatment), (e) relapse prevention (f) survivor impact, and (g) parenting Alcoholics Anonymous / Narcotics Anonymous (AA/NA): Inconsistent, once a week for male and female inmates A similar pattern of alcohol and other drug abuse issues are also common presenting problems for the Probation Department s Post-Release Community Supervision (PRCS) offenders transitioning to community supervision from State Prison facilities. The number of PRCS offenders with alcohol and other drug commitment offenses are highlighted in the following Table. As indicated, substance abuse violations represent the largest percentage (36.8%) of commitment offenses among the 844 PRCS cases initially processed through Probation s AB 109 Intake Unit. Approximately one out of every three of the offenders released from State Prison to community supervision were originally convicted and sentenced by local Courts for alcohol and other drug crimes. Correlation of the commitment offenses among these offenders by the type of caseload supervision assignment further shows 60.4% or 99 or the PRCS offenders placed in the Adult Day Reporting Center 11

(ADRC) have been convicted and are returning from prison after completing a sentence for alcohol and other drug offenses. Nearly 40.5% (205) of the PRCS offenders assigned to the AB 109 High-Risk Intensive Field Supervision Units A and B also have prison commitments resulting from alcohol and other drug violations. Only seven or 14.0% of the Specialized Gang and Sex Offender caseloads have commitments for these types of crimes. Number of Post-Release Community Supervision (PRCS) Offenders With Alcohol and Other Drug Commitment Offense By Type of Supervision Caseload October 1, 2011 March 31, 2012 Commitment Offense Category and Type of Supervision Number Percent (%) Commitment Offense Category: Property Crimes 257 30.5% Alcohol and Other Drug Violations 311 36.8% Other Offenses 276 32.7% Type of Supervision Assigned to PRCS Offenders Reporting to Probation: High-Risk Intensive Field Supervision Units: TOTAL 844 100.0% Alcohol and Other Drug Violations 205 40.5% Specialized Gang and Sex Offender Caseloads: Alcohol and Other Drug Violations 7 14.0% Adult Day Reporting Center (ADRC): 99 60.4% Alcohol and Other Drug Violations Total AB 109 Offenders With AOD Violations 311 100.0% Initial Realignment funding for the Adult Day Reporting Center (ADRC) has allowed the Probation Department to implement a dedicated Cognitive Behavioral Intervention Program to address the AOD needs of these PRCS offenders. The counseling utilizes the Barbara Armstrong Substance Misuse Programming principles. Substance Misuse is a cognitive behavioral intervention which targets substance abuse. This treatment need is identified through a SASSI assessment or other evidence based substance severity instrument. Other serious substance issues which may require residential treatment are also identified through these assessments. This is a 24 session course and covers process of successful change, assertion, selfmanagement, motivation, changing thoughts, inside/outside cues, lapses and relapses, and problem solving/goals. Group size is determined by the intervention provider and program need, but it is generally recommended groups do not exceed ten to twelve participants. Groups can be run multiple times a week depending on the intervention setting, but it is also not recommended the curricula be delivered with less than two sessions per week. The schedule for the Substance Misuse counseling for the ADRC South Area site is shown at the top of the following page. The schedule shows the day of the week for the male and female programming and duration of the daily counseling sessions. The total duration for each component is also highlighted. To date, ADRC staff have indicated this available programming is able to address the alcohol and other drug abuse needs and problems among these PRCS offenders. These services, however, have only been funded and directed to about one-fourth of the total PRCS offenders Probation is supervising in the community. No CCP funds have been allocated for similar AOD programming for the PRCS High-Risk 12

Intensive Field Supervision and Specialized caseloads. Substance Misuse Counseling Program Schedule For the ARDC South Area Site MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 9:30 10:00 SUBSTANCE SUBSTANCE MEN S BASICS MENS BASICS 10:30 MISUSE MISUSE 10:00 11:30 10:00 11:30 11:00 10:00 11:30 10:00 11:30 2 WEEKS 2 WEEKS 11:30 12 WEEKS 12 WEEKS 12:00 12:30 1:00 WOMEN S BASICS 1:00 2:30 2 WEEKS 1:30 2:00 2:30 3:00 LIFESTYLES 1:00 2:30 9 WEEKS WOMEN S BASICS 1:00 2:30 2 WEEKS LIFESTYLES 1:00 2:30 9 WEEKS Probation management staff and Supervisors overseeing the High-Risk Intensive Field Supervision and Gang / Sex Offender PRCS caseloads have indicated that approximately 225 (34.8%) of their PRCS caseloads include offenders who have a drug/alcohol related history/offense. Many have multiple DUI s and are chronic alcoholics. Other than Alcoholics Anonymous (AA), staff have limited access to resources for PRCS offenders who are in need of more intense alcohol abuse treatment. The only available referral source staff are accessing is the County s Alcohol and Drug System of Care for assessment, counseling, and AOD treatment referrals. In the first six months of Realignment, staff in these supervision units have referred 42 PRCS offenders for services. These referrals represent about 6.5% of the PRCS offenders Probation staff are supervising in these field units. Mental Health and AOD Recommended Services For AB 109 Offenders The work and research completed by the Mental Health and Substance Abuse Work Group has identified a number of programming and service gaps that should be considered for funding by the Community Corrections Partnership (CCP) as part of the AB 109 Public Safety Realignment Plan for FY 2012 13. Approval and implementation of the Work Group s recommendations will result in the development and implementation of a service delivery model that responds to the majority of the identified mental health and AOD programming needs associated with the County Jail Prison ( N3 ), Parole Revocation, and PRCS offender populations coming to the County s criminal justice system as a result of the Realignment legislation. The list of service gaps the CCP should consider for Realignment funding responds to several areas and identified needs in our criminal justice system including (a) drug and alcohol addiction services, (b) incustody out-patient mental health clinician, psychiatrist and discharge planning for the jail inmate population coming under the jurisdiction of the legislation, (c) mental health counseling for longer term offenders with mental health disorders, (d) related inmate community reentry services, and (e) psych medication management and support for both AB 109 jail inmates and PRCS offenders. For each offender group (County Jail Prison ( N3 ), Parole Revocation, and PRCS offenders), specific categorical service needs are shown in the following matrix which provides a summary description of the programming and service delivery activities which should occur. Existing AB 109 program capacity is also highlighted followed by an indication of the number of new AB 109 offenders to be served and a summary cost estimate for providing the proposed mental health or alcohol and other drug treatment services. For each proposed service, the Work Group is not recommending that the CCP funding 13

allocation be used for specific staffing positions, but rather for an existing contract augmentation or RFP process to select contract providers who have experienced and qualified personnel who can be assigned to RCCC or Probation Department to meet AB 109 offender service needs. List of Service Gaps For AB 109 County Jail Prison ( N3 ), Pre- and Post-Revocation and PRCS Offender Populations Substance Abuse and Mental Health Program Needs Non-Violent and Non-Serious County Jail Prison ( N3 ), Pre- and Post- Revocation, and Flash Incarceration Offenders (Main Jail and RCCC): Summary Description of Services Existing Service Capacity Additional Service Capacity Program Costs for Additional Service Capacity 1. In-custody Drug & Alcohol Addiction Services: RCCC has a need to expand existing substance abuse counseling services which would make dedicated services for a total of 200 AB 109 County Jail Prison ( N3 ) sentenced offenders. These services would be based on cognitive behavioral best practice that provides a framework for engaging substance abusers in treatment and helping them learn about issues critical to addiction and relapse, drug education and self-help group participation. The counseling would serve both male and female N3 populations. The expanded services would include assessment, case management, discharge planning and coordination with new reentry services programming being implemented at RCCC. 100 AB 109 custody Inmates 100 AB 109 custody Inmates Agency: Sheriff s Dept. FY: 2012-13 Estimated Cost: $289,591 Service Delivery: Contract service providers 2. In-Custody Mental Health Out-Patient Clinician, Psychiatrist & Discharge Planning: The Jail s Correctional Health Services Unit has a need to augment the Main Jail and RCCC mental health programming (crisis counseling, clinical services, and medication monitoring) to address the mental health needs of a projected average daily population of 895 long-term County Jail Prison N3, Pre- and Post-Revocation, and Flash Incarceration AB 109 inmates. The service augmentation would provide clinical psychiatric evaluations, crisis counseling, monitoring of medications, and case management for this new realignment population. The augmentation would allow the additional availability of a Psychiatrist at RCCC and implementation of discharge planning services for the longer term AB 109 County Jail Prison N3 sentenced Inmates. These services would involve the coordination of both internal and external mental health care services to insure optimal continuity of care for AB 109 offenders with complex mental health problems who are reentering the community. The discharge work would be coordinated with RCCC s new Inmate Reentry Program. The goal of the discharge activities would give transitioning offenders vital information regarding programs, medication prescriptions, and community support services and would help inmates acquire knowledge and skills in basic community entry requirements. 180 AB 109 custody Inmates 230 AB 109 custody Inmates Agency: Correctional Health Services FY: 2012-13 Estimated Cost: $539,950 Service Delivery: University of California (UCD) Medical Center Contract 14

Summary Description of Services Existing Service Capacity Additional Service Capacity Program Costs for Additional Service Capacity 3. In-Custody Mental Health Treatment For Longer Term Inmates: Agency: Sheriff s Dept. With the projected increase in sentenced AB 109 offenders who are serving up to two year sentences, instead of the average length of stay (ALS) of 125 days for convicted felons, RCCC needs to develop and implement ongoing supportive individual and group counseling services for extended stay AB 109 offenders with identified mental health disorders. (none) 50-75 AB 109 custody Inmates FY: 2012-13 Estimated Cost: $110,000 Service Delivery: Contract service provider 4. In-Custody Jail Inmate Community Reentry Services: RCCC is in the process of developing a Reentry Program directed to the AB 109 County Jail Prison N3 offender population. The Program is intended to facilitate access to support services (transitional housing, transportation, employment assistance, etc.), behavioral change interventions, and post-release services that will assist offenders in responding to education, training and employment needs. The Program will also provide case management oversight for N3 offenders diverted from jail to the Sheriff s Work Release Division. The Sheriff s Department is allocating its initial AB 109 inmate services allocation to begin the Reentry Program for 100 offenders transitioning back to the community. Additional funding is needed for another 100 offenders with similar service needs. The added funds would support personnel costs, housing voucher expense, and other identified operating expenses projected for FY 2012-13 total program costs. Funding is also needed to implement family counseling services for transitioning inmates. Approximately 60.0% of the Program budget would cover housing voucher costs for these additional offenders released from jail. 100 AB 109 custody Inmates 100 AB 109 custody Inmates Agency: Sheriff s Dept. FY: 2012-13 Estimated Cost: $535,820 Service Delivery: Contract service providers Total Estimated Cost For Added Services For In-Custody Inmates: $1,475,361 AOD and Mental Health Service Needs Probation Department Post-Release Community Supervision (PRCS) Offenders: Summary Description of Services Existing Service Capacity Additional Service Capacity Program Costs for Additional Service Capacity 5. PRCS Substance Abuse Counselor: Agency: Probation Dept. The Intensive and Specialized Supervision Caseloads currently supervising 646 PRCS offenders (76.0%) have a need for an assigned, experienced substance abuse counselor who can provide onsite drug and alcohol screening, assessment, referrals and feedback to assigned Probation Officers. (none) 50-75 PRCS Offenders FY: 2012-13 Estimated Cost: $110,000 Service Delivery: Contract service provider 15

Summary Description of Services Existing Service Capacity Additional Service Capacity Program Costs for Additional Service Capacity 6. PRCS Mental Health Counselor: The Intensive and Specialized Supervision PRCS Caseloads has a need for an assigned, experienced Mental Health Counselor who can provide onsite mental health screening, assessment, counseling, case management and referrals for identified PRCS offenders. The services provided would be similar to those provided the Adult Day Reporting Center (ADRC) AB 109 offender populations. (none)* 50-75 PRCS Offenders Agency: Probation Dept. FY: 2012-13 Estimated Cost: $110,000 Service Delivery: Contract service provider 7. Cognitive Behavioral Substance Abuse Counseling: The Intensive and Specialized Supervision PRCS caseloads have a need for dedicated continuing alcohol and other drug group counseling / treatment services that addresses lapses and relapse prevention, motivation, and problem-solving goals for these offenders. Strategies For Change provide contract AOD counseling sessions for the ADRC, but not the other AB 109 supervision caseloads. (none) 50-75 PRCS Offenders Agency: Probation Dept. FY: 2012-13 Estimated Cost: $80,000 Service Delivery: Contract service provider 8. PRCS Eligibility Specialist: Both the Adult Day Reporting Center (ADRC) and Intensive Supervision / Specialized PRCS caseloads have a need for assigned experienced staff who can work to link AB 109 offender population to services or supports including eligibility and enrollment into critical benefits that are available through existing funded programs (general assistance, SSI support, housing and other referrals). This support will reduce the logistics and eliminate poor outcomes associated with the current referral processes and face-to-face enrollment failures to appear or follow up with required documentation. (none) 150-200 PRCS Offenders Agency: Probation Dept. FY: 2012-13 Estimated Cost: $98,000 Service Delivery: Eligibility Specialist 9. Psychotropic Medication Management & Monitoring: Both the Adult Day Reporting Center (ADRC) and Intensive Supervision / PRCS caseloads as well as County Jail Prison N3 have a need for a formalized partnering process which will allow for a seamless continuation of offenders psychotropic prescription medications. The intent is to reduce the number of offenders failing probation or ending up in a crisis situation due to the lack of medication support issues. These services may include prescribing, administering, dispensing and monitoring of psychiatric medications. They may also include the evaluation of the need for initial / ongoing medications, ancillary lab costs, and instruction in how to use the medication, and alternatives to medication. This is a critical need identified by the Work Group and would be available for both Sheriff s Department and Probation Department identified AB 109 offender groups. (none) ADP of 72 ( N3 ) Inmates Exiting From Jail & PRCS Offenders Supervised By Probation FY: 2012-13 Estimated Cost: $641,088 ** Service Delivery: Contract service provider Total Estimated Cost: $1,039,088** *Currently, three (3) Sr. Mental Health Counselors are assigned to each ADRC site. One is AB 109 funded and the other two positions are funded through other Probation sources. 16