Integrating Criminogenic Risk into Mental Health/Criminal Justice Dialogue

1. Integrating Criminogenic Risk into Mental Health/Criminal Justice Dialogue Robert Kingman Director of Correctional Services, Kennebec County, Maine Comprehensive Jail Diversion Project (2008 JMHCP grantee) Lars Olsen Director of Treatment and Intervention Programs, Maine Department of Corrections (2008 JMHCP grantee) Dr. Fred Osher Director of Health Systems and Services Policy, Council of State Governments Justice Center Dr. Jennifer Skeem Associate Professor, University of California, Irvine

2. Overview • Statement of the problem and research that can inform solutions • The Maine Experience • The Maine Experience: The Mental Health Perspective

3. Statement of the problem and research that can inform solutions

4. Burgeoning corrections population is now over 7.3 million 3.2% of all adults in the United States Source: Bureau of Justice Statistics (2008)

5. Overrepresentation of Serious Mental Illnesses: General and Jail Populations Steadman et al, 2009

6. Most have co-occurring substance abuse disorders Source: The National GAINS Center, 2004

7. Most are supervised in the community Sources: Bureau of Justice Statistics (2007); Skeem, Emke-Francis, et al. (2006)

8. Many “fail” community supervision • Vidal, Manchak, et al. (2009) • Screened 2,934 probationers for mental illness; 13% screened in • Followed for average of two years • No more likely to be arrested… • But 1.38 times more likely to be revoked See also: Eno Louden & Skeem, 2009; Porporino & Motiuk, 1995

9. The perceived root of the problem • “People on the front lines every day believe too many people with mental illness become involved in the criminal justice system because the mental health system has somehow failed. They believe that if many of the people with mental illness received the services they needed, they would not end up under arrest, in jail, or facing charges in court”

10. Research suggests the root of the problem is more complex • Increased mental health services often do not translate into reduced recidivism, even for “state of the art” services • Caslyn et al., 2005; Clark, Ricketts, & McHugo, 1999; Skeem & Eno Louden, 2006; Steadman & Naples, 2005 • Untreated mental illness is a criminogenic need for only a small proportion of offenders with serious mental illness • Junginger et al. (2006), Peterson et al. (2009), Skeem, Manchak, & Peterson (2009) • Strongest criminogenic needs are shared by those with- and without- mental illness • Bonta et al., (1998); Skeem et al. (2009)

11. The “Central Eight” Andrews (2006)

12. Evidence-based corrections- Target: recidivism • Focus resources on high RISK cases • Target criminogenic NEEDS like anger, substance abuse, antisocial attitudes, and criminogenic peers (Andrews et al., 1990) • RESPONSIVITY - use cognitive behavioral techniques like relapse prevention (Pearson, Lipton, Cleland, & Yee, 2002) • Ensure implementation (Gendreau, Goggin, & Smith, 2001)

13. Evidence-based mental health services - Target: symptoms & functioning • http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/about.asp • Assertive community treatment (ACT) • Integrated dual diagnosis treatment • Supported employment • Illness management and recovery • Family psycho-education • http://consensusproject.org/updates/features/GAINS-EBP-factsheets • Supported housing • Trauma interventions

14. High: Increase emphasis on EBP for mental health Integration of EBPs for mental health and corrections High: Increase emphasis on EBP for corrections

15. What to do… Screen and assess Target criminogenic risk & clinical needs with EBPs • Identify offenders with mental illnesses, using a validated tool like the K-6 or BJMHS • http://www.hcp.med.harvard.edu/ncs/k6_scales.php • http://gainscenter.samhsa.gov/HTML/resources/MHscreen.asp • Or MAYSI, for youth http://www.maysiware.com/MAYSI2Research.htm • Assess risk of recidivism, using a validated tool like the LS/CMI (includes youth version)

16. What to do… Coordinate or Integrate Above all • Particularly for high risk, high need cases • But…target RISK • Avoid bad practices • Low thresholds for revocation • Threats • Authoritarian relationships Skeem, J., Manchak, S., & Peterson, J. (2009). Correctional policy for offenders with mental illness: Moving beyond the one-dimensional approach to reduce recidivism. Under review

17. Overview • Statement of the problem and research that can inform solutions • The Maine Experience • The Maine Experience: The Mental Health Perspective

18. 2. The Maine Experience

19. 2004 National Institute of Corrections Technical Assistance Grant to Implement Effective Correctional Management of Offenders in the Community • One of Two States Selected Nationwide • Training on Evidence Based Practices, Organizational Development and Collaboration • Ongoing Consultation

20. 2005 Legislative Commission to Improve Sentencing, Supervision, Management and Incarceration of Prisoners • Development of Joint Plan of Action between Department of Corrections and Department of Health and Human Services • Annual Mental Health and Criminal Justice Summit • Assignment of Intensive Case Managers to all correctional facilities and community corrections regions • Monthly “Grand Rounds” training • Established MOU with DHHS, DOC and all jails

21. 2006 Legislative Corrections Alternatives Advisory Committee • Recommendation on Implementing Evidence Based Practices to Manage Offenders by Risk and Need • Recommendation on Integrating Risk and Needs Assessments into Criminal Justice Processing • Recommendation that Department of Corrections and Department of Health and Human Services Develop Strategies to Improve programming for Offender Population

22. 2006 Implemented Correctional Program Assessment Inventory 2000 • Assessed programs providing services to corrections clients to determine fidelity to evidence based practices • Programs developed performance improvement plans • Programs assessed include: • Multi-Systemic Therapy • Functional Family Therapy • Day Reporting Programs • Risk Reduction Programs • Domestic Violence Programs • Residential Substance Abuse Programs • Residential Sex Offender Programs • Drug Court • Reentry Center • Outpatient Sex Offender Programs • Community Corrections Regions

23. 2007 Awarded Justice and Mental Health Collaboration Program Grant • Planning • Develop common database and measurement tools • Collect data • Use GIS mapping to coordinate needs and resource • Implementation • Share data with criminal justice agencies, courts, providers and stakeholders • Use GIS to manage resources • Provide public awareness

24. 2009 Implementation of Criminal Justice and Mental Health Advisory Committee • Joint appointments by Commissioners of Department of Corrections and Department of health and Human Services • Broad representation including mental health, corrections, substance abuse treatment, law enforcement, prosecution, pretrial services, victim services, • Provide guidance and feedback to both departments on needs, interventions and services to people with mental health issues involved in the criminal justice system

25. Lessons Learned • Develop common vision • Provide Evidence Based Practices and programs • Maintain fidelity • Define your intervention strategies and desired outcomes • Develop atmosphere of mutual respect and trust • Cross and co-train staff • Reach an understanding of function and language

26. Lessons Learned • Co-locate staff whenever possible • Provide leadership and accountability from the very top and all the way down • Data needs to work for everybody • Develop protocols for co-supervision of staff • Understand the unique problems and challenges of systems that are at times in competition • Must see the issues as shared responsibilities-no finger pointing

27. Overview • Statement of the problem and research that can inform solutions • The Maine Experience • The Maine Experience: The Mental Health Perspective

28. 3. The Maine Experience: The Mental Health Perspective

29. Mental Health = major mental illness(personality disorders not addressed/substance abuse is separate issue) Mental illness/substance abuse-which is primary?(personality disorders are problematic/trauma is a separate issue) Dual-diagnosis assessment and treatment(trauma=complicating factor/criminogenic element=separate issue) Co-occurring assessment and treatment(trauma=gender responsive treatment/criminogenic issues = a complicating factor) Criminogenic Co-occurrence Treatment(assessment and intervention with criminogenic factors for sustainable pro-social change) Brief History of Treatment Approaches

30. Screening and Assessment • Admission to county jails -Brief Jail Mental Health Screen -UNCOPE -Intake screening for risk of harm to self -Follow-up with comprehensive risk assessment (as needed) • Admission to Outpatient Mental Health and Substance Abuse Treatment Programs • Depression Rating Scale • Patient Health Questionaire(PHQ-9) • TCU Screening Tools

31. Traditional Assessment and Programming

32. Assessment Shapes the Intervention Traditional Psycho-Social Approach • Presenting Concern • Current Mental Status • Risk of Harm to Self/Others • Family/Household Information • Employment • Social/Recreational History • Developmental History • Education/Military Service • Medical Health/Medications • Legal History • Treatment History (mental health and substance abuse) • Treatment Planning and Intervention

33. Recidivistic Risk FactorsAndrews and Bonta, • Criminal History • Anti-social Attitudes • Anti-social Associates • Anti-social Behaviors • Anti-social personality traits • Substance Abuse • Family/Relationship • Recreation/Leisure Big five Central Eight

34. Expand the View/Sharpen the Focus • Shift psycho-social perspective to: • Include recidivistic risk factors • Evaluate history of disengagement • Understand value of criminal behavior as a coping skill(s) • Train Clinicians • Develop screening/evaluation tools to: • Identify inmates/clients for follow-up • Utilize responses in treatment interventions

35. Training Examples • Developed for • outpatient clinicians • outreach/transition staff • clinicians in correctional facilities • correctional care workers

36. Life Course Persistence and Desistence • Anti-social behavior has developmental roots • Early delinquency can predict adult crime • Age desistance • Weakened social bonding • Adult social bonds • Tri-effect variables • Family process • Child effect • Contextual

37. Social Bond Development Social Bond

38. Adaptive Anti-social Culture

39. Pro-social change Key Assessment/Treatment Planning Domains Tri-Effect Variables • Individual Effects • History of disengagement • Emotional, cognitive and behavioral regulation • Attitudes, perceptions and expectations • Significant Other effects • Abuse/neglect (past and current) • Relationship skills • Anti-social associates • Community Effects • Stigmatization • Social rejection • Anti-social inclusion

40. Implications • Shift from traditional pathology based to pro-social based interventions • Common language of pro-social accountability and skill development • Maximize resources through Stage of Change matched, research based treatment targets • Connections of prevention, juvenile justice and adult criminogenic programming • Policies and procedures that attend to perpetuating stigmatizing shame and exclusion

41. Lessons Learned • Change is gradual and challenging • Utilization of ‘transparent’ process enhances therapeutic relationship • Expanded treatment team has potential to be more effective

42. 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.