Roger Allen LMHC Director of Inmate Services Jessica Burgess MSN, RN

1. Barnstable County Sheriff’s Office’sEducating Inmates on Medication Assisted Recovery_________________ Roger Allen LMHC Director of Inmate Services Jessica Burgess MSN, RN Assistant Director of Health Services

2. Barnstable County Correctional FacilityBourne, Massachusetts • Maximum capacity: 588 • Head count in May, 2013: 350-400 • Highest head count was upper 400’s • American Correctional Association Certified • Opened in October of 2004

3. Residential Substance Abuse Treatment Program (RSAT) • Therapeutic Community separate from general pop. • Six Month minimum requirement for participation • Structured curriculum based on Cognitive Behavioral Theory and Disease Model of Addiction • Military structure • Progressive phases of privileges • Inmates assessed as high risk comprise most of participants • Participants assessed initially by LSI-R:SV when entering the jail. Assessed by LSCMI when entering RSAT. • Peer leadership (Squad leaders and mentors)

4. Treatment for General Population • All units with sentenced inmates except segregation receive Substance Abuse Education and CBT skills with similar curriculum to RSAT • Job Readiness classes • Education classes • AA/NA • OUI Program • Re-Entry Services

5. Re-Entry Program Begins on Person’s Entry to Jail • Comprehensive Re-entry Needs Assessment completed at beginning of sentence. LSI-R:SV administered. High Risk individuals recommended for intense treatment • Individualized re-entry goals established based on Risk/Needs Assessment and/or co-occurring medical and mental health needs • Individualized transition plan updated 60 days prior to release or as needed • Transition plan implemented through strategic collaboration of key team players and providers on staff and in community • Bi-monthly Re-entry Team meeting at the jail with community providers and probation officers • Follow-up data collected to evaluate program effectiveness

6. Questions Regarding RSAT Program at Barnstable County Correctional Facility?

7. Indications for Pre-and Post-Release Substance-Abuse Treatment • Approximately 25% of new Intakes at BCCF require opioid detox • Approximately 35% of all inmates meet criteria for drug or alcohol dependence • Highest risk of death is in the first 2 weeks after release; i.e.; overdose • Recidivism is tightly linked to relapse • Expense of incarcerating non-violent offenders • Substance abuse is a causative factor for criminogenic behavior

8. Current Options for Opioid/Alcohol Addicted Individuals After Release • Relapse • Abstinence • Counseling • 12 Step Programs • Medication Assisted Treatment Opioids: *Methadone *Suboxone Opioids & Alcohol: *Vivitrol

9. Vivitrol(Extended-Release Naltexone) • An injectable form of the medication Naltrexone • Each dose lasts 30 days • For treatment of Alcohol and/or Opioid dependence • Reduces Cravings/Blocks positive effects of substances • Recommended abstinence from opioids for 7-10 days before administration • Non-Mood Altering/Non Addictive • Not controlled/No Street Value • No withdrawal

10. The Vivitrol Program is a Medication ASSISTED Treatment • The medication is only 1 aspect of treatment • The medication is intended to help prevent relapse while the addicted individual works to make lasting behavioral changes • Other treatments (counseling/meetings) are necessary for lasting recovery

11. VivitrolProgram Outline • Programs department presents information about Medication-Assisted Treatment to inmates in RSAT • Inmate requests treatment/information • Medical Director, Assistant Director, or Transitional Healthcare Coordinator meets one on one with inmate to determine if appropriate treatment for individual • Medical Clearance obtained by Medical Director

12. VivitrolProgram Outline(Cont.) • Motivation Assessment (involvement in available programs)performed • Risk Assessment (LS/CMI) performed • Two counseling sessions with Mental Health Staff • Oral Naltrexone trial for 3 days • Vivitroladministered 1 week prior to release • Mass Health Insurance initiated & follow-up treatment at community clinic scheduled prior to release

13. VivitrolProgramData Collection • Inmate self-reported and recorded data pre- and post- treatment compared • Validated assessment tool: LS/CMI • CORI reports run for 2 years after release • Inmate self-reports level of cravings to use substances before and after Vivitrol programtreatment • Release of Information signed by inmate to allow communication with follow-up treatment providers and personal contact. Allows for data collection of progress post-release

14. Data of Interest • Clean time history compared to current treatment • Compliance with appointments, counseling requirements, and monthly Vivitrol injections • Contributing to the work force? • Recidivism- Is treatment increasing time between incarcerations?

15. Preliminary Results • 37 Inmates treated since April 2012 • 20 remain in treatment in the community • 2 are no longer being treated with Vivitrol, but remain in recovery in the community • 59% of inmates treated remain in recovery • 31 of the 37 treated in the vivitrol program followed through with treatment at referral site in the community (Presented at first appointment) 84% • 4 of the inmates treated have been re-incarcerated 11%

16. Questions? Roger Allen LMHC Director of Inmate Services Barnstable County Sheriff’s Office rallen@bsheriff.net Jessica Burgess MSN, RN Assistant Director of Health Services Barnstable County Sheriff’s Office jburgess@bsheriff.net

17. Next PresentationDomestic Violence and RSAT June 19, 2013 2:00 – 3:00 p.m. EDT Although substance abuse is the universal common denominator among RSAT inmates, many share another common challenge, domestic violence (DV). Among RSAT populations are a high proportion of both domestic violence victims and perpetrators. In fact, some RSAT inmates’ substance abuse may have been the result of self-medication to deal with the stress of domestic violence. It also plays a major role in post-release recidivism. Studies indicate that after release, the second largest number of rearrests for RSAT graduates after substance abuse crimes is domestic violence. Presenter: Andrew Klein