NC TASC Effective Case Management for Improved Offender & System Outcomes September 30, 2004 Annapolis, Maryland

1. NC TASC Effective Case Management for Improved Offender & System OutcomesSeptember 30, 2004Annapolis, Maryland

2. Structured Sentencing Act • Truthful & consistent sentencing that projects resource needs • Established 3 forms of punishment • Established statutory continuum of sanctions • Eliminated discretionary parole • Established model for matching sentences & resources • SSA-related Expansions • Largest Expansion of probation resources in 60 year history - 900+ positions • Enhanced TASC Expansion - 1.8 mil established 13 new programs

3. Typeof PunishmentImposed Felonies In 1993, Average Sentence served - 16 Months Under SSA, Average Sentence served - 34 Months * SOURCE: NC Sentencing and Policy Advisory Commission ** SOURCE: 1993 Pre-Structured Sentencing Data

4. NC Problem Statement • Use of criminal justice & treatment resources • Complex clients: challenging behavioral health needs & serious consequences of failure • Recidivism & relapse are common • Unmanaged cases, uncharted outcomes • Service availability & effectiveness • Prison pop  offenders entering community in increasing numbers  multiple unsuccessful tx & prison admissions • Budget shortfalls & no expansions Need options to improve access to & retention in treatment, while preserving public safety

5. Evolving Solution Our Common Goal: Safely manage high-risk, high-need offenders in the community • Treatment System Needs: • Less reliance on institutions • Better resource utilization & management • Increased community capacity • Effective treatment, interventions & case management • Justice System Needs: • Effective & available care • Regular communication • Offender & treatment accountability

6. OFFENDER MANAGEMENT MODEL OMM ONE OFFENDER - ONE CASE PLAN - ONE TEAM DHHS DOC TASC DCC Balances Intervention Opportunities provided thru DMHDDSAS & Controlled Supervision provided thru DCC

7. NC Offender Management Model Target Population I Punishment, C Punishments at-risk for Revocation, Post-Releasees who completed a prison tx program Standard TASC Screening & Assessment Individual Case Planning by Probation & TASC Control, Care & Service Management Team staffings with shared decision-making between Probation & TASC

8. North Carolina Criminal Justice Planning Flow Chart Arrest Pre-Trial Hearing Pre-Sentence Hearing Trial/ Sentencing Div of Prisons/ Post-Release Div of Community Corrections Referred to Other Services NC Offender Management Model (OMM) Clinical Assessment CBI Employment Mental Health Services Individualized Case Plan Education/ Voc Training Transportation Substance Abuse Svcs Housing/Food/ Clothing Medical Services EXIT MODEL Continuous Case Management and Case Staffing Figure 1. NC Criminal Justice Flow Chart

9. NC Continuum of Sanctions, Supervision & Care Split Sentence Community Detention Drug Court Enhanced Intensive Intensive Residential Tx House Arrest Day Reporting Center Enhanced Traditional Probation Contempt of Court (all supervision & tx levels) Cost & Intensity Cost & Intensity Cost & Intensity Level 1 Care Management w/ Tx Level 6 & Aftercare Services • Intermediate • I Punishment • Post-Release • C Failures • Sex Offenders • Domestic Violence • High Risk/High Need DWIs No Tx Therapeutic Community Residential Tx Intensive Outpatient Tx Level 1, 2 or 3 Care Management w/ Tx Level 4 or 5 Level 1 or 2 Care Management w/ Tx Level 3 Level 1 Care Management w/ Tx Level 2 • Community • C Punishment • Unsupervised Failures • Low Risk/Low Need DWIs • PSIs & Targeting for Courts Outpatient Treatment Education & Urinalysis Traditional Probation Deferred Prosecution Treatment Matching Assessment Screening No Treatment TASC SANCTIONS TREATMENT SUPERVISION

11. Objectives of OMM • Seamless system of care for the provision of services to offenders, improving access to treatment for justice clients • Clarify roles & responsibilities in providing control & treatment, eliminating duplication • Target limited resources to the right clients: • Combine efforts to guarantee effective utilization of limited resources with a team approach & shared decision-making • Emphasize quality over quantity • Develop coordinated information systems • Ensure staff are trained to implement the OMM • Reduce rates of revocation for technical & drug violations, while increasing accountability & community safety • Increase efficiency & improve client outcomes

12. Philosophy & PrinciplesProcesses & Policies & ProtocolsPrograms Developing & Maintaining an Integrated Approach

13. ELEMENTS OF SUCCESSFUL COLLABORATION • Convergence of needs • Commitment - mutual respect, understanding & trust • Vision - shared mission; shared objectives & strategies • Willingness to re-think policies/procedures • Communication - communicate w/ & involve staff • Resources - commitment of financial & human • Regular meetings w/ diverse participation resulting in decisions (all key systems & the right people) • Clearly defined roles & responsibilities • Information & a common language • On-going oversight w/ regular feedback to an advisory group • Formal Service Agreements - protocols & MOUs • Formalized system for conflict resolution

14. CHALLENGES TO SUCCESSFUL COLLABORATION • Separate Systems with Seemingly Disparate Goals • Competitive Markets • Lack of/Limited Communication • Duplicative Services • Revolving Door Treatment & Correctional Systems • Inadequate Funding • Limited Number of Service Providers • Limited Service Capacity, including Limited Effective Services in practice • Restricted Availability of certain Levels of Care & over abundance of other Levels of Care • Limited Specialized Services • Insufficient Aftercare & Transition Services

15. The Bottom Line • What do you want? • What do your partners want? • Identify resources to be shared • Establish regular venues for communication & problem-solving

16. What is TASC? A program model & methodology that bridges two separate systems: justice & treatment. The justice system’s legal sanctions reflect community concerns for public safety, while treatment emphasizes therapeutic relationships as a means for changing behavior.

17. TASC Core Services • Screening & Clinical Assessment • Service Determination & Referral • Care Planning, Coordination & Management • Reporting to Justice System

18. Strategic Individualized Case Planning Other Services Treatment Referral Other Services Monitoring Reporting to Referral Source TASC Care Management Model Comprehensive Clinical Assessment

19. TASC Person-Centered Client Flow Client referred out No Services Needed Services Refused Non-TASC Services Needed TASC Care Management TASC Eligibility Determination Service Screening High-Risk High-Need Client Reporting, Monitoring Assessment Person Centered Planning Referral to Services Client Identification Low-Risk, Low-Need Client Referral to intervention Referral to other services TASC reporting

20. TASC Key Concepts • Facilitates communication between systems • Based on clinical & support needs, not only medical necessity • Develops & maintains linkages with a variety of community resources • Incorporates justice system language & goals • Balances control & treatment • Active relationships - client, probation, treatment, community services • Utilizes the influence of legal sanctions to engage & retain offenders in treatment • Positive outcome-oriented for clients, as well as treatment & justice systems

21. TASC Nationally • 1962 - Robinson v. California - addiction is an illness, not a crime • 1970s - Federal government develops model to interrupt drug-crime cycle - Treatment Alternatives to Street Crime • 1972 - first TASC program in Wilmington, Delaware • 2000 - Over 150 individual TASC programs in 32 states

22. National TASC Critical Elements 1) Process to coordinate justice, treatment & other systems 2) Procedures for providing information & cross-training to justice, treatment & other systems System Coordination Elements

23. Organizational Elements 3 & 4) Broad bases of support from justice & treatment systems, with institutionalized systems for effective communication 5) Organizational integrity 6) Policies & procedures for regular staff training 7) MIS with a program evaluation design

24. Operational Elements 8) Clearly defined client eligibility 9)Client-centered case management 10) Screening procedures to identify justice system candidates 11) Assessment & referral procedures 12) Policies & procedures for monitoring drug & alcohol use through testing 13) Competency with diverse populations

25. For more information about TASC nationally, visit the National TASC website at www.nationaltasc.org

26. In NC, TASC is administered by the Division of Mental Health, Developmental Disabilities & Substance Abuse Services, through private NPOs & public MH Centers. NC TASC effectively & efficiently links treatment & justice goals of reduced drug use & criminal activity through processes that increase treatment access, engagement & retention.

27. TASC in North Carolina • 1978 - First TASC Programs in NC • 1993 - 10 Programs in 20 Counties • 1994 - Enhanced TASC (SSA) • 1998 - 23 Programs in 43 Counties • 2002 - TASC services available in all 100 counties • 2003 - TASC Training Institute

28. Goal for NC TASC Equitable statewide access to a standard of TASC services in the most cost-effective, timely & organizationally efficient manner, consistent with the unified court & statewide probation systems

29. NC TASC Tasks • Developed standard clinical care management procedures (TASC SOP) w/ TASC staff • Improved current aggregate data collection & analysis • Developed financing plan, based on I Punishment offender pop • Proposed regional management structure & statewide expansion plan • Issued RFA

30. NC TASC Tasks • Developed performance measures: process & outcome • Awarded 4 grants for infrastructure development & expansion • Identified training needs & contracted for NC TASC Training Institute • Implemented NC-TOPPS/TASC CJM - Performance Measures project • Developing NTASC Critical Elements audit protocols • Developing statewide MIS

31. Expansion & Regionalized Management Unified Statewide TASC System Regional Coordinating Entity (RCE) TASC Services TASC Training Institute TASC Service Expansion

32. Implementing Statewide Offender Care Management • Committed, visionary leadership & identified key staff • Build support with community leaders, legislators & stakeholders • Design appropriate organizational structure & financing models • Financing plan for development, implementation & continuation

33. NC TASC Training Institute The mission of the TASC Training Institute is to improve the quality of services to the offender population through workforce development TASC Clinical Series TASC Continuing Education On-line training Drug Education Schools Staff Certification

34. How is this done? • 4 regional training coordinators & director review requests from the field to develop annual training plan • The Institute negotiates contracts with contractors to develop curricula, deliver TOTs, trainings, etc. • TASC Clinical Series is provided via TASC staff who’ve become TASC trainers

35. TASC Clinical Series 32 hours training for new staff: • Understanding TASC • Confidentiality • HIV/BRI/Infectious Disease (on-line) • Understanding Addiction • Criminal Justice • Clinical Skills - Care Planning & Management

36. TASC Continuing Education • American Society of Addiction Medicine • Motivational Interviewing & Enhancement • Mental Health Screening • Co-Occurring Disorders • Effective Interventions for TASC Clients • The TASC Journey…. An Agency’s Response to Person Centered Services

37. Training.nctasc.net • Provides on-line courses of didactic materials prior to clinical series • Research to Practice site • Continuous communication with users & Center’s staff

38. Drug Education School • Intervention for First-time Offenders • 15 Hours of Standard Education • One Time Opportunity for Expungement for persons under 21 years of age • Self Supporting $150.00 Fee • Statutory Authority: G.S. 90-96

39. Staff Certification Legislation to be introduced in 2005 legislative session to create Certified Criminal Justice Addictions Credential

40. TASC Training Institute FY04 • Delivered 4,199 hours of training to 315 TASC & 102 partner agency staff • Provided 100 stipends for the NTASC conference hosted in Raleigh, NC • Addt’l 2200+ hours were received thru NTASC Conference All hours provided at no addt’l cost to participant or participant’s employing agency

41. NC TASC Training Institute Web Site www.nctasc.net Register for Classes Read Important Announcements View Your Total Training Hours

42. TASC Quality Points • Statewide Availability for Equity • Regional Management for Economies of Scale • TASC Training Institute • TASC in MH Reform Legislation • MH Commission promulgated TASC Rules • NC TASC Standard Operating Procedures • National TASC Critical Elements • Local Memoranda of Agreement • TASC CJM Performance Measures • Funding contingent on DOC-DHHS MOU compliance

43. FY04 TASC Statistics • Offenders served: 9845 (53% increase from FY99) • 70% Less than 36 years old (43% less than 26) • 83% Not married • 55% Did not complete high school • 34% Unemployed at admit (24% in FY01) • Primary Substance Used •Marijuana 44% •Alcohol 28% •Cocaine 19% • Length of Stay •0-3 months 24% •4-6 months 35% •7-12 months 31% •More than 1 year 10%

44. TASC Costs & Benefits • $1.79 per TASC client per day • FY96-97 sample TASC client pop*: • 85.9% had at least one previous arrests (mean # 2.6) • 61.3% were NOT re-arrested within 2 years * NC Sentencing & Policy Advisory Commission - Submitted to the 2000 Session of the North Carolina General Assembly

45. DMHDDSAS Reorganization • Best Practice & Community Innovations • Local Management Entity Systems Performance • Justice System Innovations • Prevention & Early Intervention • Single State Agency for Substance Abuse • Office of Employee Assistance Programs • State Methadone Authority • Quality Management Community Policy Management Section MH, DD & SA public policy leadership & oversight collaboration w/ a wide base of customers, public & private partners

46. Justice Systems Innovations Team, Community Policy Management Section Policy re: adults & children with mental health, developmental disabilities & substance abuse problems involved in criminal & juvenile justice systems Multi-system coordination with state, county & local law enforcement, institutional & community corrections Best practices, promising approaches & innovations related to supports, services & treatments for individuals & improved systems performance

47. Justice Systems Innovations For Adults: • TASC develops & manages comprehensive protocols for offender management, according to DHHS-DOC MOU • Implementation of OMM, in partnership with DCC & other stakeholders • Implementation of “Going Home” initiative, according to DOC, DHHS, Department of Commerce & NC Community College System MOU • Treatment & case management for Drug Treatment Courts, in cooperation with AOC & DCC • Review & programming for DOC residential substance abuse programs & mental health services • Protocols for DWI • Drug Education School (GS90-96) diversion alternative • Jail-based & police partnership diversion programs

48. Justice Systems Innovations For Children and Families: Coordination with DJJDP for a continuum of services & care RWJF Resources for Recovery & Co-occurring Academy projects Evidence-based treatment in DJJDP Detention Centers & Youth Development Centers Evidence-based protocols utilized in MAJORS program for juvenile offenders with substance abuse disorders Evidence-based protocols for treatment & case management of individuals in juvenile courts, Youth & Family Treatment Court

49. MHDDSA Reform established... Adult Substance Abusing Criminal Justice Offender Target Population to ensure access to treatment for individuals with a SA diagnosis who present the greatest risk to public safety. Eligibility includes: • DSM criteria for a substance-related disorder; and • Services approved by a TASC care manager; and • Voluntary consent to participate; and • Status as an Intermediate Punishment offender, a Department of Correction releasee who has completed an in-prison treatment program, or a Community Punishment violator at-risk for revocation

50. COMMUNITY CORRECTIONS: SOFT ON CRIME? ABSOLUTELY NOT! The Strategy Must: • Balance the public’s expectation for protection, control & accountability with resources necessary to control & treat high-risk/high-need offenders • Strive for a balance between Control & Treatment based on offender risk & needs • Manage risks by supervisory control • Manage needs through treatment collaboration • Prioritize resources based on offender risk & needs • Build partnerships with law enforcement, treatment providers, schools, victims & the public