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JMHCP Data Learning Sites

JMHCP Data Learning Sites. Kevin Baldwin Robert Butkiewicz Jeannie Von Stultz Nancy Wolff Moderator: Rebecca Rose. Smart Responses in Tough Times: Achieving Better Outcomes for People with Mental Illnesses Involved in the Criminal Justice System July 15-17, 2009.

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JMHCP Data Learning Sites

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  1. JMHCP Data Learning Sites Kevin Baldwin Robert Butkiewicz Jeannie Von Stultz Nancy Wolff Moderator: Rebecca Rose Smart Responses in Tough Times: Achieving Better Outcomes for People with Mental Illnesses Involved in the Criminal Justice System July 15-17, 2009

  2. Evaluation and Enhancement of the Dougherty County (GA) Mental Health CourtKevin Baldwin, Ph.D.Applied Research Services, Inc.Georgia

  3. Three Objectives • Perform a comprehensive outcome evaluation of the Dougherty County Mental Health/Substance Abuse Court (DMHC) • Utilize the NIATx model to improve the efficiency and processes of substance abuse and mental health services at the community mental health agency • Develop an Internet-based data management and reporting tool for mental health courts

  4. The Dougherty County MHC • The DMHC was established in 2002 by Presiding Judge Stephen Goss • Located in SW Georgia, the DMHC is in an area designated by HHS as a Health Professional Shortage Area • Approximately 160 mentally ill and/or substance abusing clients have participated • The DMHC has been designated as one of five MHC learning sites nationwide

  5. Objective #1 • The outcome evaluation is a follow-up to a preliminary, paper-based outcome evaluation done by court staff that showed initially promising results • We are looking at typical outcome variables – attempting to answer the question as to what happened to participants subsequent to their participation in the DMHC • The goal is to provide the court with the information needed to describe, improve, and sustain itself

  6. Objective #2 • NIATx (formerly known as the Network for the Improvement of Addiction Treatment) helps behavioral health providers improve access to and retention in treatment. This is accomplished by helping treatment providers use process improvement methods to achieve the four main goals of NIATx, as follows: 1. Reduce waiting times 2. Reduce no-shows 3. Increase admissions 4. Increase continuation in treatment

  7. Objective #2, Continued From www.NIATx.net: • NIATx members have realized the following significant improvements: - 34 percent reduction in waiting times - 33 percent reduction in no-shows - 21 percent increase in admissions - 22 percent increase in treatment continuation • Since its inception, NIATx has worked with nearly 1000 treatment agencies to help them improve access to and retention in treatment • Utilizes rapid cycle testing and the Plan, Do, Study, Act (PDSA) method of process change

  8. Objective #3 • As a multi-agency, physically-distributed collaborative, the DMHC presently has no centralized or readily available means of recording, storing, retrieving, and reporting on court process and outcome data • A secure, Internet-based data management and reporting system would provide staff and key stakeholders real-time access to and reporting of court data

  9. Contact Information Kevin Baldwin, Ph.D. Applied Research Services, Inc. 663 Ethel Street, NW Atlanta, GA 30318 404-881-1120, ex. 104 kbaldwin@ars-corp.com

  10. Kalamazoo Mental Health Recovery Court Robert Butkiewicz KCMHSAS Michigan

  11. Program Introduction • Established Oct 17, 2009 • Misdemeanor court: diversion track and probation track • Participants must qualify for case management services • 40 + participants • Recovery focused • Staffed by mental health clinicians and peer staff

  12. Gathering Data – Lessons Learned • Hospital, Crisis, Specialized Residential • Information Source • KCMHSAS records (+) • Medicare, Medicaid, Privately Insured (-) • County and State of occurrence (-) • Consent Forms • Use hospital releases for ER and Psychiatric

  13. Gathering Data – Lessons Learned • Treatment Data • Outpatient • Substance Abuse • Primary Care

  14. Shaping Protocol with Data • Problem: Quickly inundated with referrals • High demand for service by the Criminal Justice system • Difficult program to advertise • Avoiding Stigma • Defining Recovery • Eligibility criteria was broad and complex

  15. Eligibility Form • Criminal History: Jail recidivism, nature of charges, frequency and severity of legal offences. • Diversion: Is the referral eligible for diversion? • System Services: Is the referral an individual that has been deemed as a person with high utilization of system services such as inpatient hospitalizations, Crisis residential, Specialized residential care (AFC), Emergency room visits? • Diagnosis: Is the individual diagnosed with a Severe and Persistent mental Illness and does he receive or meet Case management criteria? • Quality of Life: Will the individual benefit from MHRC as the charge and or fees might be expunged upon completion of the voluntary MHRC program. Will the participant benefit from MHRC as his/her general social quality of life will improve (housing, referral to services, employment, education, etc.?) • Recovery: At what stage in the recovery process is the participant both in the Substance abuse area and Mental Health (insight into the need for TX, his illness). • Fourth Quadrant: Does the participant have a history of accessing a high level intensity services in the Mental Health and SA system? Does the participant have high rate of jail recidivism or repeated legal difficulties?

  16. Case Example: (John Doe) • Only arrest: trespassing, 1 day in jail, eligible for diversion • Lives in Adult Foster Care home, case managed, no hospitalizations in past 5 years • 30 year old diagnosed with Schizophrenia, Paranoid type • Attends a club house, limited family support • Usually Medication compliant, Substance free since 22 • Not fourth quadrant

  17. Case Example: (Jane Doe) (not married to John) • Arrest for Operating while Intoxicated • Local prosecutor exception for diversion • Homeless, 3 children at risk for removal • Diagnosis: Mood Dis NOS, Alcohol Abuse, BPD • Recent psychiatric hospitalization, just entered DBT services with case management component • Action stage of substance abuse, action stage of mental health recovery, initial sobriety • Potential 4 quadrant

  18. Contact Information Robert Butkiewicz RButkiewicz@kazoocmh.org

  19. Crossroads:Girls’ Mental Health CourtJeannie Von Stultz, Ph.D.Director of Mental Health ServicesBexar County Juvenile ProbationTexas

  20. Girls’ Mental Health Court • Target Population • Females • 10-14 years of age • History of Trauma • Previous Deferred Prosecution • Mental Health Court Model • Community Involvement

  21. Girls’ Mental Health Court • Unique Elements of Juvenile MH Court • Involves parents/guardians • Reports child abuse – coordinates with CPS • Works with schools • Identifies and responds to developmental and learning issues

  22. Girls’ Mental Health Court • Program Components • Automatic Referral • Standardized Assessment • Intensive In-Home Services • Focus on Transition to Community Agencies

  23. Girls’ Mental Health Court • Program Partners • 386th District Court • District Attorney’s Office • 2 Defense Attorneys • Treatment Provider • Educational Support • Psychological Assessment • Mental Health Authority • Specialized Probation Officer • Uniform Data Collection

  24. Contact Information Jeannie Von Stultz, Ph.D. Director of Mental Health Services Bexar County Juvenile Probation 301 E Mitchell San Antonio, TX 78210 (210)335-7515 (210)335-1822 (fax)

  25. Integrated Trauma and Behavioral Health Treatment and Reentry Readiness Intervention for Incarcerated Women Nancy Wolff, Ph.D.Rutgers University New Jersey

  26. Integrated Intervention • Seeking Safety (14 weeks) • Focus on trauma/PTSDand substance use problems • Cognitive-behavioral therapy • Psycho-educational principles • Community 101 (14 weeks) • Focus on life and instrumental skill building • Interactive learning approach • Psycho-educational principles

  27. Study Design

  28. Study Methods • Eligible Population • 24 -12 months to release • PTSD/sub-threshold PTSD • Substance use problem • Mental disorder • Non-violent offense • Sample Size • 100 female subjects • Outcome Measures • Health, mental health, trauma • Treatment engagement • Housing, employment • Criminal justice

  29. Informed Consent • All research involving humans as subjects requires Institutional Review Board (IRB) approval, regardless of funding source. • All research involving prisoners as human subjects requires IRB approval and must comply with Subpart C of Title 45, which provides additional protections for prisoners involved as human subjects in research.

  30. Key Definitions • Research (defined by 45 CFR 46.102(d)) “a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge” • Human Subject • Living individual involved in research and • Data on that individual are being collected • through intervention or interaction with the individual or • that is identifiable private information.

  31. Definition of “Prisoner” According to 45 CFR 46.303, a “prisoner” is defined as: “any individual confined or detained in a penal institution. The term is intended to include individuals sentenced to an institution under a criminal or civil statute, individuals detainedin other facilities by virtue of statutes or commitment procedures which provide alternatives to criminal prosecution or incarceration in a penal institution, and individual detained pending arraignment, trial, or sentencing.”

  32. Human Subjects Approval Requirements • Human Subjects • University IRB approval • Agency Research Committee or IRB approval • Prisoners as Human Subjects • University IRB approval • Agency Research Committee or IRB approval • Office of Human Research Protections approval

  33. Informed Consent Human subjects must be: • Competent • Free to choose (i.e., no coercion) • Informed of • Purpose • Risks/Benefits • Alternatives • Right to refuse • Duty to inform

  34. Confidentiality • Duty to Inform • Harm to self or others • Plans to escape • Engaged in drug use/trafficking • Protection against Subpoena • Certificate of Confidentiality (NIH) • Certificate of Privacy (NIJ)

  35. Contact Information Nancy Wolff, Ph.D. nwolff@ifh.rutgers.edu

  36. 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.

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