SYSTEM UPDATE

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SYSTEM UPDATE

• Lessons from the Field
• Partnerships, Programs and Practical Alternatives
  for System Transformation

The Commonwealth Consortium Executive Leadership
Stakeholder Meeting Richmond, Virginia -- October
22, 2009
James S. Reinhard, M.D., D.F.A.P.A Commissioner De
partment of Behavioral Health and Developmental
Services
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What Is the Problem?

• Many of the same people in multiple systems
• Mental health
• Substance abuse
• Criminal justice
• Other social services
• Significantly overrepresented in the criminal
• justice system
• Expensive - high service users, people who cycle
  and recycle through the system
• SOLUTION Cross-Systems Coordination

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Mental Health and Criminal Justice Transformation
Goals

• Improve Public Safety, Reduce Inappropriate
  Contact With and Minimize Penetration Into The
  Criminal Justice System For Persons with Mental
  Illness
• Develop and support improved systems
  interoperability
• Replicate and support effective programs,
  practices and processes
• Enhance workforce awareness and training
• Improve access to services

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National PerspectiveCriminal Justice Population
Increases

• Source U.S. Department of Justice, Office of
  Justice Programs, Bureau of Justice Statistics
  Correctional Surveys (The Annual Probation
  Survey, National Prisoner Statistics, Survey of
  Jails, and The Annual Parole Survey) as presented
  at http//www.ojp.usdoj.gov/bjs/glance/corr2.htm.

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National PerspectiveScope of the Problem

• Over 14 million arrests each year, involving
• more than 9 million adults
• Over 1 million arrestees have serious mental
  illnesses
• 75 of those with serious mental illnesses have
  co-occurring substance use disorders
• The vast majority will be released to the
  community

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Virginia PerspectiveMore High Numbers

• Source Virginia General Assembly Senate Finance
  Public Safety Subcommittee Report, November, 2008

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Average Daily Population in Jails by Year
Department of Criminal Justice Services
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Average Daily Census in Psychiatric Hospitals by
Year
Department of Behavioral Health Developmental
Services
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Forensic Psychiatric Hospital Bed Utilization by
Year
Department of Behavioral Health Developmental
Services
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Cross Systems MappingBringing a Local Approach
to Scale

• Interagency Conference In May 2008, DBHDS and
  Department of Criminal Justice Services (DCJS)
  sponsored the Governors Conference for Mental
  Health and Criminal Justice Transformation. Patty
  Griffin, Ph.D., was a key note speaker during the
  conference and provided information about the
  Sequential Intercept Model and the Cross Systems
  Mapping process to the criminal justice and
  mental health stakeholders in attendance from
  across the state.

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Cross Systems MappingDescription and Goals

• A facilitated1.5 day community workshop bringing
  together local CJ/MH stakeholders to
• Understand and map their local CJ/MH interface
  utilizing the Sequential Intercept Model
• Identify local resources and gaps
• Enhance local relationships and improve capacity
  to create effective systems change
• Develop locality specific priorities and an
  Action Plan for Change

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Cross Systems MappingFocus

• Men and women with
• Serious mental illness, and often
• Co-occurring substance use disorders
• Involved in the criminal justice system

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Cross Systems MappingGoals

• Promote and support recovery
• Provide safety and quality of life for all
  community residents
• Keep people out of jail (when appropriate) and in
  treatment
• Provide constitutionally adequate treatment in
  jail
• Link to comprehensive, appropriate, and
  integrated community-based services
• Reduce penetration/length of involvement of
  individuals with mental illness in criminal
  justice system
• Reduce numbers of individuals with mental illness
  coming into contact with criminal justice system

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Cross Systems MappingVirginias Statewide
Initiative

• Interagency ( intra-agency) Facilitators
  Twenty-two people were selected and then trained
  by Policy Research Associates (Patty Griffin and
  Jackie Massaro) in August 2008 to be facilitators
  for Cross System Mapping in Virginia. The
  composition of the group
• 5 CSB staff
• 7 DBHDS state hospital forensic staff
• 3 DBHDS central office staff
• 5 Community Corrections staff
• 1 private residential provider staff
• 1 DCJS staff

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Cross Systems Mapping Agenda

• DAY 1
• Workshop Overview
• MH/CJ Challenges
• What Works! Strategies for Systems Coordination
  Collaboration
• Creating a Systems Map for Richmond
• Setting Priorities For Change

• DAY 2
• Day 1 Accomplishments
• Keys to Success in Richmond
• Action Planning
• Next Steps

Cross Systems Mapping
Taking Action For Change
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Cross Systems MappingStrategies for Success

• Share a vision and direction
• Use evidence-based and promising practice models
• Use money creatively
• Blended funding sources
• Using both existing and new resources
• Collect and use data

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Cross Systems MappingFoundation
Cross-Systems Mapping is an activity which
depicts contact/flow with the criminal justice
system

• The Sequential Intercept Model is a tool to
• Help transform fragmented systems
• Identify local resources, gaps and
• Help identify where to begin interventions

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The Sequential Intercept ModelFramework for
Change

• Law enforcement / Emergency services
• Booking / Initial court hearings
• Jails / Courts
• Re-entry from jails/prisons
• Community corrections / Community support

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The Sequential Intercept ModelFramework for
Change
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Sequential Intercept Model Patty Griffin, PhD
Mark Munetz, MD

• People move through criminal justice system in
  predictable ways
• Illustrates key points to intercept, to ensure
• Prompt access to treatment
• Opportunities for diversion
• Timely movement through criminal justice system
• Linkage to community resources

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Cross Systems MappingLessons and Outcomes

• Localities Served in FY10
• Hampton
• Charlottesville/Albemarle
• Suffolk
• Localities Scheduled in FY10
• 1. Fauquier
• 2. Lynchburg/Bedford/Campbell
• Culpepper
• Henrico
• Middle Peninsula
• Roanoke City/Roanoke County/Salem
• Rappahannock Area
• Chesterfield (XSM Update)

• Localities served in FY09
• 1. Prince William
• 2. Virginia Beach
• 3. Martinsville/Henry/Patrick
• 4. Richmond City
• 5. Newport News
• 6. Chesapeake
• 7. Williamsburg/James City County/York/Poquoso
  n
• Winchester/Clarke/Frederick/Page/Shenandoah/Warren
  
• 9. Petersburg/Dinwiddie

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Cross Systems MappingLessons and Outcomes

• 24 of Virginias 134 Cities and Counties
• large cities
• large suburban counties
• multi-jurisdictional urban/suburban and rural
  mixed communities
• 2.3M of Virginias 7.4M population live in
  jurisdictions that have received a XSM
• Over 350 stakeholders have participated in XSM
• 22 facilitators trained and leading workshops

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Cross Systems MappingLessons and Outcomes

• Most commonly identified priority areas
• Increase availability of community based services
  (12)
• Develop comprehensive pre-release tx
  plans/resource linkages (9)
• Develop CIT and drop off centers/increase
  pre-booking police options (9)
• Develop post-arrest/pre-trial programs with
  linkage to services (7)
• Support public/private partnerships, improve data
  collection and dissemination to support outcome
  measurement and advocacy (6)
• Develop inter-agency cross training,
  communication and collaboration (5)
• Improve MH/CJ communication protocols and
  information sharing (5)
• Increase pre and post-trial community corrections
  manpower(4)
• Increase/enhance jail based MH services (3)

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A Cross Systems Approach to Keep Virginia Moving
Forward
Collaborating Among State Leadership
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A Cross Systems Approach to Keep Virginia Moving
Forward

• Challenges to Collaboration
• Funding silos
• Limited resources create acompetitive and/or
  protective environment
• System cultures appear to have divergent goals
• Time constraints reduce opportunity to develop
  relationships and understand commonality of goals

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A Cross Systems Approach to Keep Virginia Moving
Forward
Benefits of Effective Collaboration

• ? Service retention
• ? Stability in the community
• Public Safety
• Cost Savings

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A Cross Systems Approach to Keep Virginia Moving
Forward
Developing an Action Plan for Targeted Priorities
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Thoughts on Identifying Priorities and Challenges

• Priority
• Improve data and information exchange among all
  CJ/MH partners
• Challenges and Actions to Consider
• Multiple non integrated data bases (LIDS, CMS,
  VCIN, CCS, NCIC, etc.)
• Need to determine what Virginia may already be
  undertaking
• Research potential impact on consumer
  privacy/choice
• Identify Federal and state legislative,
  regulatory and policy constraints/changes to
  facilitate data integration and information
  exchange
• Examine efforts in other states are doing to
  improve (TX)

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Thoughts on Identifying Priorities and Challenges

• Priority
• Identify current workforce education status and
  additional training needs
• Challenges and Actions to Consider
• Create a comprehensive workforce development plan
  to address CJ/MH training and cross-systems
  education
• Identify existing educational and training
  curricula and programs
• Define priority workforce training and education
  needs
• Prioritize target workforce for initial
  training/education

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Thoughts on Identifying Priorities and Challenges

• Priority
• Develop new strategies for blending and
  braiding resources
• Challenges and Actions to Consider
• Determine how to identify and leverage grant
  opportunities across agency/secretariat/private/no
  n-profit boundaries
• Identify impediments to moving funds more quickly
  and effectively from Federal and state funding
  streams to localities
• Recognize and overcome funding and thinking
  silos

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Thoughts on Identifying Priorities and Challenges

• Priority
• Identify additional considerations for improving
  services to specific populations, e.g., veterans,
  children, older adults
• Challenges and Actions to Consider
• Identifying, understanding and improving access
  to specialized resources, programs and processes

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Thoughts on Identifying Priorities and Challenges

• Priority
• Continue to identify and implement evidence
  based practices
• Challenges and Actions to Consider
• EBPs currently in place
• Efficacy of current EBPs
• Additional EBPs to consider
• Using promising practices

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Cross Systems MappingLessons and Outcomes

• Most commonly identified priority areas
• Increase availability of community based services
  (12)
• Develop comprehensive pre-release tx
  plans/resource linkages (9)
• Develop CIT and drop off centers/increase
  pre-booking police options (9)
• Develop post-arrest/pre-trial programs with
  linkage to services (7)
• Support public/private partnerships, improve data
  collection and dissemination to support outcome
  measurement and advocacy (6)
• Develop inter-agency cross training,
  communication and collaboration (5)
• Improve MH/CJ communication protocols and
  information sharing (5)
• Increase pre and post-trial community corrections
  manpower(4)
• Increase/enhance jail based MH services (3)