Integrating Criminogenic Risk into Mental HealthCriminal Justice Dialogue

1
Integrating Criminogenic Risk into Mental
Health/Criminal Justice Dialogue

• Robert Kingman
• Director of Correctional Services, Kennebec
  County, Maine Comprehensive Jail Diversion
  Project (2008 JMHCP grantee)
• Lars Olsen
• Director of Treatment and Intervention Programs,
  Maine Department of Corrections (2008 JMHCP
  grantee)
• Dr. Fred Osher
• Director of Health Systems and Services Policy,
  Council of State Governments Justice Center
• Dr. Jennifer Skeem
• Associate Professor, University of California,
  Irvine

2
Overview

• Statement of the problem and research that can
  inform solutions
• The Maine Experience
• The Maine Experience The Mental Health
  Perspective

3
Statement of the problem and research that can
inform solutions
4
Burgeoning corrections population is now over 7.3
million
3.2 of all adults in the United States
Source Bureau of Justice Statistics (2008)
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Overrepresentation of Serious Mental
Illnesses General and Jail Populations
Steadman et al, 2009
6
Most have co-occurring substance abuse disorders
Source The National GAINS Center, 2004
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Most are supervised in the community
Sources Bureau of Justice Statistics (2007)
Skeem, Emke-Francis, et al. (2006)
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Many fail community supervision

• Vidal, Manchak, et al. (2009)
• Screened 2,934 probationers for mental illness
  13 screened in
• Followed for average of two years
• No more likely to be arrested
• But 1.38 times more likely to be revoked

See also Eno Louden Skeem, 2009 Porporino
Motiuk, 1995
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The perceived root of the problem

• People on the front lines every day believe too
  many people with mental illness become involved
  in the criminal justice system because the mental
  health system has somehow failed. They believe
  that if many of the people with mental illness
  received the services they needed, they would not
  end up under arrest, in jail, or facing charges
  in court

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Research suggests the root of the problem is more
complex

• Increased mental health services often do not
  translate into reduced recidivism, even for
  state of the art services
• Caslyn et al., 2005 Clark, Ricketts, McHugo,
  1999 Skeem Eno Louden, 2006 Steadman
  Naples, 2005
• Untreated mental illness is a criminogenic need
  for only a small proportion of offenders with
  serious mental illness
• Junginger et al. (2006), Peterson et al. (2009),
  Skeem, Manchak, Peterson (2009)
• Strongest criminogenic needs are shared by those
  with- and without- mental illness
• Bonta et al., (1998) Skeem et al. (2009)

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The Central Eight
Andrews (2006)
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Evidence-based corrections- Target recidivism

• Focus resources on high RISK cases
• Target criminogenic NEEDS like anger, substance
  abuse, antisocial attitudes, and criminogenic
  peers (Andrews et al., 1990)
• RESPONSIVITY - use cognitive behavioral
  techniques like relapse prevention (Pearson,
  Lipton, Cleland, Yee, 2002)
• Ensure implementation (Gendreau, Goggin, Smith,
  2001)

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Evidence-based mental health services - Target
symptoms functioning

• http//mentalhealth.samhsa.gov/cmhs/CommunitySuppo
  rt/toolkits/about.asp
• Assertive community treatment (ACT)
• Integrated dual diagnosis treatment
• Supported employment
• Illness management and recovery
• Family psycho-education
• http//consensusproject.org/updates/features/GAINS
  -EBP-factsheets
• Supported housing
• Trauma interventions

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High Increase emphasis on EBP for mental health
Integration of EBPs for mental health and
corrections
High Increase emphasis on EBP for corrections
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What to do
Screen and assess
Target criminogenic risk clinical needs with
EBPs

• Identify offenders with mental illnesses, using a
  validated tool like the K-6 or BJMHS
• http//www.hcp.med.harvard.edu/ncs/k6_scales.php
• http//gainscenter.samhsa.gov/HTML/resources/MHscr
  een.asp
• Or MAYSI, for youth http//www.maysiware.com/MAYSI
  2Research.htm
• Assess risk of recidivism, using a validated tool
  like the LS/CMI (includes youth version)

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What to do
Coordinate or Integrate
Above all

• Particularly for high risk, high need cases
• Buttarget RISK

• Avoid bad practices
• Low thresholds for revocation
• Threats
• Authoritarian relationships

Skeem, J., Manchak, S., Peterson, J. (2009).
Correctional policy for offenders with mental
illness Moving beyond the one-dimensional
approach to reduce recidivism. Under review
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Overview

• Statement of the problem and research that can
  inform solutions
• The Maine Experience
• The Maine Experience The Mental Health
  Perspective

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2. The Maine Experience
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2004 National Institute of Corrections Technical
Assistance Grant to Implement Effective
Correctional Management of Offenders in the
Community

• One of Two States Selected Nationwide
• Training on Evidence Based Practices,
  Organizational Development and Collaboration
• Ongoing Consultation

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2005 Legislative Commission to Improve
Sentencing, Supervision, Management and
Incarceration of Prisoners

• Development of Joint Plan of Action between
  Department of Corrections and Department of
  Health and Human Services
• Annual Mental Health and Criminal Justice Summit
• Assignment of Intensive Case Managers to all
  correctional facilities and community corrections
  regions
• Monthly Grand Rounds training
• Established MOU with DHHS, DOC and all jails

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2006 Legislative Corrections Alternatives
Advisory Committee

• Recommendation on Implementing Evidence Based
  Practices to Manage Offenders by Risk and Need
• Recommendation on Integrating Risk and Needs
  Assessments into Criminal Justice Processing
• Recommendation that Department of Corrections and
  Department of Health and Human Services Develop
  Strategies to Improve programming for Offender
  Population

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2006 Implemented Correctional Program Assessment
Inventory 2000

• Assessed programs providing services to
  corrections clients to determine fidelity to
  evidence based practices
• Programs developed performance improvement plans
• Programs assessed include
• Multi-Systemic Therapy
• Functional Family Therapy
• Day Reporting Programs
• Risk Reduction Programs
• Domestic Violence Programs
• Residential Substance Abuse Programs
• Residential Sex Offender Programs
• Drug Court
• Reentry Center
• Outpatient Sex Offender Programs
• Community Corrections Regions

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2007 Awarded Justice and Mental Health
Collaboration Program Grant

• Planning
• Develop common database and measurement tools
• Collect data
• Use GIS mapping to coordinate needs and resource
• Implementation
• Share data with criminal justice agencies,
  courts, providers and stakeholders
• Use GIS to manage resources
• Provide public awareness

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2009 Implementation of Criminal Justice and
Mental Health Advisory Committee

• Joint appointments by Commissioners of Department
  of Corrections and Department of health and Human
  Services
• Broad representation including mental health,
  corrections, substance abuse treatment, law
  enforcement, prosecution, pretrial services,
  victim services,
• Provide guidance and feedback to both departments
  on needs, interventions and services to people
  with mental health issues involved in the
  criminal justice system

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Lessons Learned

• Develop common vision
• Provide Evidence Based Practices and programs
• Maintain fidelity
• Define your intervention strategies and desired
  outcomes
• Develop atmosphere of mutual respect and trust
• Cross and co-train staff
• Reach an understanding of function and language

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Lessons Learned

• Co-locate staff whenever possible
• Provide leadership and accountability from the
  very top and all the way down
• Data needs to work for everybody
• Develop protocols for co-supervision of staff
• Understand the unique problems and challenges of
  systems that are at times in competition
• Must see the issues as shared responsibilities-no
  finger pointing

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Overview

• Statement of the problem and research that can
  inform solutions
• The Maine Experience
• The Maine Experience The Mental Health
  Perspective

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3. The Maine Experience The Mental Health
Perspective
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Brief History of Treatment Approaches

• Mental Health major mental illness(personality
  disorders not addressed/substance abuse is
  separate issue)
• Mental illness/substance abuse-which is
  primary?(personality disorders are
  problematic/trauma is a separate issue)
• Dual-diagnosis assessment and treatment(traumaco
  mplicating factor/criminogenic elementseparate
  issue)
• Co-occurring assessment and treatment(traumagend
  er responsive treatment/criminogenic issues a
  complicating factor)
• Criminogenic Co-occurrence Treatment(assessment
  and intervention with criminogenic factors for
  sustainable pro-social change)

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Screening and Assessment

• Admission to county jails
• -Brief Jail Mental Health Screen
• -UNCOPE
• -Intake screening for risk of harm to self
• -Follow-up with comprehensive risk assessment
• (as needed)
• Admission to Outpatient Mental Health and
  Substance Abuse Treatment Programs
• Depression Rating Scale
• Patient Health Questionaire(PHQ-9)
• TCU Screening Tools

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Traditional Assessment and Programming
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Assessment Shapes the Intervention

• Traditional Psycho-Social Approach
• Presenting Concern
• Current Mental Status
• Risk of Harm to Self/Others
• Family/Household Information
• Employment
• Social/Recreational History
• Developmental History
• Education/Military Service
• Medical Health/Medications
• Legal History
• Treatment History (mental health and substance
  abuse)
• Treatment Planning and Intervention

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Recidivistic Risk FactorsAndrews and Bonta,

• Criminal History
• Anti-social Attitudes
• Anti-social Associates
• Anti-social Behaviors
• Anti-social personality traits
• Substance Abuse
• Family/Relationship
• Recreation/Leisure

Big five
Central Eight
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Expand the View/Sharpen the Focus

• Shift psycho-social perspective to
• Include recidivistic risk factors
• Evaluate history of disengagement
• Understand value of criminal behavior
• as a coping skill(s)
• Train Clinicians
• Develop screening/evaluation tools to
• Identify inmates/clients for follow-up
• Utilize responses in treatment interventions

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Training Examples

• Developed for
• outpatient clinicians
• outreach/transition staff
• clinicians in correctional facilities
• correctional care workers

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Life Course Persistence and Desistence

• Anti-social behavior has developmental roots
• Early delinquency can predict adult crime
• Age desistance
• Weakened social bonding
• Adult social bonds
• Tri-effect variables
• Family process
• Child effect
• Contextual

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Social Bond Development
Social Bond
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Adaptive Anti-social Culture
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Pro-social change Key Assessment/Treatment
Planning Domains

• Tri-Effect Variables
• Individual Effects
• History of disengagement
• Emotional, cognitive and behavioral regulation
• Attitudes, perceptions and expectations
• Significant Other effects
• Abuse/neglect (past and current)
• Relationship skills
• Anti-social associates
• Community Effects
• Stigmatization
• Social rejection
• Anti-social inclusion

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Implications

• Shift from traditional pathology based to
  pro-social based interventions
• Common language of pro-social accountability and
  skill development
• Maximize resources through Stage of Change
  matched, research based treatment targets
• Connections of prevention, juvenile justice and
  adult criminogenic programming
• Policies and procedures that attend to
  perpetuating stigmatizing shame and exclusion

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Lessons Learned

• Change is gradual and challenging
• Utilization of transparent process enhances
• therapeutic relationship
• Expanded treatment team has potential to
• be more effective

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Thank you

• For further information conference
  presentations
• please visit
• www.consensusproject.org

This material was developed by presenters for the
July 2009 event Smart Responses in Tough Times
Achieving Better Outcomes for People with Mental
Illnesses Involved in the Criminal Justice
System. Presentations are not externally
reviewed for form or content and as such, the
statements within reflect the views of the
authors and should not be considered the official
position of the Bureau of Justice Assistance,
Justice Center, the members of the Council of
State Governments, or funding agencies supporting
the work.