SYSTEM UPDATE

1. SYSTEM UPDATE Lessons from the Field: Partnerships, Programs and Practical Alternatives for System Transformation The Commonwealth Consortium Executive Leadership Stakeholder Meeting Richmond, Virginia -- October 22, 2009 James S. Reinhard, M.D., D.F.A.P.A Commissioner Department of Behavioral Health and Developmental Services

2. What Is the Problem? • Many of the same people in multiple systems: • Mental health • Substance abuse • Criminal justice • Other social services • Significantly overrepresented in the criminal justice system • Expensive - high service users, people who cycle and recycle through the system SOLUTION: Cross-Systems Coordination

3. Improve Public Safety, Reduce Inappropriate Contact With and Minimize Penetration Into The Criminal Justice System For Persons with Mental Illness Develop and support improved systems interoperability Replicate and support effective programs, practices and processes Enhance workforce awareness and training Improve access to services Mental Health and Criminal Justice Transformation Goals

4. National Perspective:Criminal Justice Population Increases Source: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics Correctional Surveys (The Annual Probation Survey, National Prisoner Statistics, Survey of Jails, and The Annual Parole Survey) as presented at http://www.ojp.usdoj.gov/bjs/glance/corr2.htm. 4

5. National Perspective:Scope of the Problem Over 14 million arrests each year, involving more than 9 million adults Over 1 million arrestees have serious mental illnesses 75% of those with serious mental illnesses have co-occurring substance use disorders The vast majority will be released to the community 5

6. Virginia Perspective:More High Numbers Source: Virginia General Assembly Senate Finance Public Safety Subcommittee Report, November, 2008 INDIVIDUALS UNDER CORRECTIONAL SUPERVISION (As of June 2008) State Probation and Parole DOC State Correctional Facilities District Offices (DOC) (33,500 State-Responsible (57,000 Offenders Under Offenders in Prison) Community Supervision) State-Responsible Offenders Housed in Jails (5,360*) * Includes the out-of- compliance backlog of 1,552 Local-Responsible Community Corrections and Pre-Trial Release Local and Regional Jails Programs (19,000 Offenders (20,400 Local-Responsible Under Community Supervision) Offenders in Jail) 6

7. Average Daily Population in Jails by Year Department of Criminal JusticeServices

8. Average Daily Census in Psychiatric Hospitals by Year Department of Behavioral Health & Developmental Services

9. Forensic Psychiatric Hospital Bed Utilization by Year Department of Behavioral Health & Developmental Services Page 9

10. Cross Systems Mapping:Bringing a Local Approach to Scale • Interagency Conference: In May 2008, DBHDS and Department of Criminal Justice Services (DCJS) sponsored the Governor’s Conference for Mental Health and Criminal Justice Transformation. Patty Griffin, Ph.D., was a key note speaker during the conference and provided information about the Sequential Intercept Model and the Cross Systems Mapping process to the criminal justice and mental health stakeholders in attendance from across the state.

11. Cross Systems Mapping:Description and Goals • A facilitated1.5 day community workshop bringing together local CJ/MH stakeholders to • Understand and ‘map’ their local CJ/MH interface utilizing the Sequential Intercept Model • Identify local resources and gaps • Enhance local relationships and improve capacity to create effective systems change • Develop locality specific priorities and an Action Plan for Change

12. Cross Systems Mapping:Focus Men and women with… Serious mental illness, and often Co-occurring substance use disorders Involved in the criminal justice system 12

13. Cross Systems Mapping:Goals Promote and support recovery Provide safety and quality of life for all community residents Keep people out of jail (when appropriate) and in treatment Provide constitutionally adequate treatment in jail Link to comprehensive, appropriate, and integrated community-based services Reduce penetration/length of involvement of individuals with mental illness in criminal justice system Reduce numbers of individuals with mental illness coming into contact with criminal justice system 13

14. Cross Systems Mapping:Virginia’s Statewide Initiative • Interagency (& intra-agency) Facilitators: Twenty-two people were selected and then trained by Policy Research Associates (Patty Griffin and Jackie Massaro) in August 2008 to be facilitators for Cross System Mapping in Virginia. The composition of the group: • 5 CSB staff • 7 DBHDS state hospital forensic staff • 3 DBHDS central office staff • 5 Community Corrections staff • 1 private residential provider staff • 1 DCJS staff

15. Cross Systems Mapping: Agenda DAY 1 Workshop Overview MH/CJ Challenges What Works! Strategies for Systems Coordination & Collaboration Creating a Systems Map for Richmond Setting Priorities For Change • DAY 2 • Day 1 Accomplishments • Keys to Success in Richmond • Action Planning • Next Steps Cross Systems Mapping Taking Action For Change 15

16. Cross Systems Mapping:Strategies for Success Share a vision and direction Use evidence-based and promising practice models Use money creatively Blended funding sources Using both existing and new resources Collect and use data 16

17. Cross Systems Mapping:Foundation The Sequential Intercept Model is a tool to: Help transform fragmented systems Identify local resources, gaps and Help identify where to begin interventions Cross-Systems Mapping is an activity which depicts contact/flow with the criminal justice system 17

18. The Sequential Intercept Model:Framework for Change • Law enforcement / Emergency services • Booking / Initial court hearings • Jails / Courts • Re-entry from jails/prisons • Community corrections / Community support

19. The Sequential Intercept Model:Framework for Change

20. Sequential Intercept ModelPatty Griffin, PhD & Mark Munetz, MD People move through criminal justice system in predictable ways Illustrates key points to “intercept,” to ensure: Prompt access to treatment Opportunities for diversion Timely movement through criminal justice system Linkage to community resources 20

21. Cross Systems Mapping:Lessons and Outcomes Localities served in FY09 1. Prince William 2. Virginia Beach 3. Martinsville/Henry/Patrick 4. Richmond City 5. Newport News 6. Chesapeake 7. Williamsburg/James City County/York/Poquoson • Winchester/Clarke/Frederick/Page/Shenandoah/Warren 9. Petersburg/Dinwiddie Localities Served in FY10 • Hampton • Charlottesville/Albemarle • Suffolk Localities Scheduled in FY10 1. Fauquier 2. Lynchburg/Bedford/Campbell • Culpepper • Henrico • Middle Peninsula • Roanoke City/Roanoke County/Salem • Rappahannock Area • Chesterfield (XSM Update)

22. Cross Systems Mapping:Lessons and Outcomes • 24 of Virginia’s 134 Cities and Counties • large cities • large suburban counties • multi-jurisdictional urban/suburban and rural mixed communities • 2.3M of Virginia’s 7.4M population live in jurisdictions that have received a XSM • Over 350 stakeholders have participated in XSM • 22 facilitators trained and leading workshops

23. Cross Systems Mapping:Lessons and Outcomes Most commonly identified priority areas • Increase availability of community based services (12) • Develop comprehensive pre-release tx plans/resource linkages (9) • Develop CIT and drop off centers/increase pre-booking police options (9) • Develop post-arrest/pre-trial programs with linkage to services (7) • Support public/private partnerships, improve data collection and dissemination to support outcome measurement and advocacy (6) • Develop inter-agency cross training, communication and collaboration (5) • Improve MH/CJ communication protocols and information sharing (5) • Increase pre and post-trial community corrections manpower(4) • Increase/enhance jail based MH services (3)

24. A Cross Systems Approach to Keep Virginia Moving Forward Collaborating Among State Leadership 24

25. Challenges to Collaboration Funding “silos” Limited resources create acompetitive and/or protective environment System “cultures” appear to have divergent goals Time constraints reduce opportunity to develop relationships and understand commonality of goals A Cross Systems Approach to Keep Virginia Moving Forward 25

26. A Cross Systems Approach to Keep Virginia Moving Forward  Service retention  Stability in the community Public Safety Cost Savings Benefits of Effective Collaboration 26

27. A Cross Systems Approach to Keep Virginia Moving Forward Developing an Action Plan for Targeted Priorities 27

28. Thoughts on Identifying Priorities and Challenges Priority: Improve data and information exchange among all CJ/MH partners Challenges and Actions to Consider: • Multiple non integrated data bases (LIDS, CMS, VCIN, CCS, NCIC, etc.) • Need to determine what Virginia may already be undertaking • Research potential impact on consumer privacy/choice • Identify Federal and state legislative, regulatory and policy constraints/changes to facilitate data integration and information exchange • Examine efforts in other states are doing to improve (TX)

29. Thoughts on Identifying Priorities and Challenges Priority: Identify current workforce education status and additional training needs Challenges and Actions to Consider: • Create a comprehensive workforce development plan to address CJ/MH training and cross-systems education • Identify existing educational and training curricula and programs • Define priority workforce training and education needs • Prioritize target workforce for initial training/education

30. Thoughts on Identifying Priorities and Challenges Priority: Develop new strategies for ‘blending and braiding’ resources Challenges and Actions to Consider: • Determine how to identify and leverage grant opportunities across agency/secretariat/private/non-profit boundaries • Identify impediments to moving funds more quickly and effectively from Federal and state funding streams to localities • Recognize and overcome funding and thinking ‘silos’

31. Thoughts on Identifying Priorities and Challenges Priority: Identify additional considerations for improving services to specific populations, e.g., veterans, children, older adults Challenges and Actions to Consider: • Identifying, understanding and improving access to specialized resources, programs and processes

32. Thoughts on Identifying Priorities and Challenges Priority: Continue to identify and implement evidence based practices Challenges and Actions to Consider: • EBPs currently in place • Efficacy of current EBPs • Additional EBPs to consider • Using promising practices

33. Cross Systems Mapping:Lessons and Outcomes Most commonly identified priority areas • Increase availability of community based services (12) • Develop comprehensive pre-release tx plans/resource linkages (9) • Develop CIT and drop off centers/increase pre-booking police options (9) • Develop post-arrest/pre-trial programs with linkage to services (7) • Support public/private partnerships, improve data collection and dissemination to support outcome measurement and advocacy (6) • Develop inter-agency cross training, communication and collaboration (5) • Improve MH/CJ communication protocols and information sharing (5) • Increase pre and post-trial community corrections manpower(4) • Increase/enhance jail based MH services (3)