DEVELOPMENTAL DISABILITY TREATMENT COURTS: Rethinking our Approach to those who appear before us in Drug Courts

1. DEVELOPMENTAL DISABILITY TREATMENT COURTS:Rethinking our Approach to those who appear before us in Drug Courts

2. Traditional Drug Courts -Incorporate the Ten key Components -Concentrate on Substance Abuse -Clear requirements apply to all -One set of sanctions and incentives -One definition of success -Emphasis on accountability

3. Traditional Mental Health Courts -Incorporate Guiding Principles -Concentrate on Mental Illness and may include Substance Abuse -Utilize existing treatment -Lower the bar -Emphasis on Accountability to Treatment

4. The Developmentally Disabled are Routinely Excluded from Participating in Drug Courts and Mental Health Courts and have very poor outcomes in “Traditional Courts”

5. Why Are They Excluded from Treatment Courts? • They aremisdiagnosed • They cannot understand or follow directions or keep up with other clients • They are not provided appropriate treatment in the community or are shuffled from silo to silo • They are “dropped” from treatment because they are not compliant • They commit serious crimes and continue the behavior

6. Where Do We Go Wrong?

7. 1. Those found by the Court to meet Definitions in Statutes as “Developmentally Disabled” are either placed in Diversion Programs or Competency Restoration Programs.2. Those not meeting the strict definitions are ignored and left in the traditional court process without any attention to their special needs.

8. Our “Traditional Court System and Laws” Keep Them Out of Drug Courts- • We commit them as incompetent • We commit them as gravely disabled • We commit them as dangerous because of their disability • We divert them • We conserve them • And the majority are simply punished

9. Conclusions from Study of Eight States • Competency statutes and rulings generally result in defendants standing trial despite their impairment • Hospital Commitments for Treatment do not result in ongoing treatment • The majority of the mentally incompetent receive no special treatment from the Courts

10. As to Those we Ignore and Leave in the Traditional Court System?

11. Courts find them “too difficult” to work with, and unable to meet probation and other court “requirements”

12. We utilize state hospitals, jails and prisons to “fix” these offenders and, then, we keep sending them back. We make every step and every decision an adversarial one, rather than problem solving, and treatment focusedWe “decide” these offender’s lives, we do not help them get better.

13. Mentally Challenged Offenders spend 30% more time in jails and prisons than other offenders convicted of the same crimes AND RECEIVE INADEQUATE OR NO TREATMENT WHILE INCARCERATED !

14. The Public Perception of these Clients Perpetuates the Myth that Developmentally Disabled offenders are Dangerous and “Permanently” Flawed

15. Mental Retardation

16. It is not as Simple as we make it!

17. We Are Ignoring What Research and the Reality of Today Teach Us: • Beating up and warehousing the mentally incompetent solves nothing. • Excluding them from a Drug Treatment Court opportunity is unacceptable. • We must look at clients today as having “multiple diagnosis”

18. MOST IMPORTANTLY –SINCE THE DEVELOPMENTALLY DISABLED DO NOT DO WELL IN TRADITIONAL TRATMENT COURTS, WE MUST BE OPEN TO CREATING A COURT AND ENVIORNMENT THAT WORKS FOR ALL OF THEM!

19. If we are going to treat them,who are they?

20. 5 Diagnosable Conditions Qualifying Offenders for State Treatment in California • 1. Mental retardation • 2. Autism • 3. Severe epilepsy • 4. Cerebral Palsy • 5. Catchall Category: Handicapping conditions found to be closely related to mental retardation or to require treatment similar to that for a mentally retarded individual, but that are not solely physical in nature, and may or may not include Traumatic Brain Injury

21. WHO ARE MOST LIKELY TO BE DENIED TREATMENT? • Miss the cut-off line • Undocumented individuals • African-Americans who were not tested as kids because it was illegal to give them IQ tests in many states, including California • Individuals not identified as DD before the age of 18 • Persons with no family to talk about adaptive deficits before age 18 (often the homeless) • TBI after age 18 • Individuals from out of state or having no social network

22. What Leads to Misdiagnosis • These clients are often initially misdiagnosed as having “Behavioral Problems” and the behavior leads to school expulsion or dropout, entry into the Juvenile Court system, and subsequent adult arrests and incarcerations for inappropriate and illegal “behavior”

23. Behavior and Vulnerability that Leads to Arrests and Court Involvement • Inappropriate and illegal sexual behavior • Uncontrollable anger and physical violence • Destruction of property, vandalism and theft • Vulnerability to gang and anti-social associations • Drug and alcohol abuse • Easily convinced by others to participate in crime

24. What Treatment and Services Do they Need? • Intense Case management • Job and vocational training • Crisis services • Supported living • Independent life skills training • Caregivers • Substance Abuse Treatment • Mental Health Treatment • Medical Treatment

25. How do their Co-Occurring Disorders Intersect? Diagnostic Manual –Intellectual Disability, 2007: • The prevalence of substance abuse has increased in recent years. • Mental Illness is common in those who are Developmentally Disabled • Many have medical conditions that are often undiagnosed.

26. Why doesn’t Drug Court work for these clients? • 1.They need a different Team in and • outside of the Courtroom • 2. They need more individual attention • 3. They require more discussion • 4. Other clients treat them as “different”

27. Why Doesn’t Drug Court work for these Clients? • Difficulty in ability to understand and apply information and follow directions (Judges expect defendants to understand and follow direction in Drug Court) • Difficulty in ability to ignore irrelevant information (Judges are not patient with defendants who are fixed on what is important to them) • Difficulty in ability to learn new information and ability to recall material (Judges expect defendants to “figure it out”) • Existing sanctions schedules do not work

28. How is the Team “different” • If the client qualifies for services, the State rather than the counties are often responsible and provide that treatment through regional centers • If the State does not provide treatment, existing treatment programs must be found and standards must be changed and specialized to serve the needs of this population • Environmental and psychosocial issues must be addressed

29. What Developmental Disability Treatment Does not Provide and the Drug Court Must Provide: 1. Substance Abuse Treatment that is meaningful for this population 2. Mental Health Treatment and medications 3. Medical Treatment to address multiple diagnosis such as seizure disorder

30. A “NEW SYSTEM” for Providing Treatment to the Developmentally Disabled Client Must be Developed Mentally Disabled Client = Substance Abuse client = Medical patient Multiple treatment needs must be met! Treatment staff = Treatment staff

31. What can a Judge do to reach better outcomes for offenders with Developmental Disabilities?

32. The Judge must confront the “stigma”. • The Judge must “engage” the offender. • The Judge must build trust. • The Judge must learn new techniques to communicate. • The Team must be involved in the interaction!

33. We Must Change Our Expectations!! • Lower the bar • Individualize plans and expectations • The “small steps” are the only ones that are important • Find appropriate treatment and supervision, or modify existing treatment and supervision to address the needs and permit “full participation” by the Developmentally Disabled Client