Change Project Success Stories Webinar March 8, 2013

1. Access to Treatment: Bringing NIATx to Corrections Project A project of the Council of State Governments Justice Center in partnership with the Center for Health Enhancement Systems Studies. Funded by the Bureau of Justice Assistance, Office of Justice Programs, U.S. Department of Justice Change Project Success Stories Webinar March 8, 2013

2. Agenda • Welcome • Presentations from Pilot Sites • Durham County, NC • State of Maryland • DeKalb County, GA • Discussion • Next Steps

3. Welcome Housekeeping Items Introductions Goals of Webinar Project Timeline

4. Presentations • Durham County, NC • Division of Community Corrections, District 14 North Carolina Department of Public Safety and Durham County Criminal Justice Resource Center (CJRC) • Coach: Neil Kaltenecker • State of Maryland • DeKalb County, GA

5. Durham County Criminal Justice Resource Center NIATx March 8, 2013 / Robin Heath

6. Durham County CJRC • County Government department that provides case management and substance abuse treatment for probationers referred by the Probation office as a condition of Probation or in response to a violation or non-compliance. • Substance abuse clients are ordered by Probation to TASC (Treatment Alternatives for Safer Communities) for an assessment who determines need and intensity of treatment. TASC refers to CJRC for treatment. • Partners: Probation/Parole and TASC CJRC TASC Probation

7. Changes Change 1: • Make Personal Telephone Reminder Calls night before CJRC Intake Appointment. • Aim: Reduce no show rate of 52%. Change 2: • Replace scheduled CJRC intakes with modified walk-in appointment schedule (clients given a date and time range the next week to walk-in). • Midway, limited # intake appointments to 4 a day and arrive by 4 PM (15 -30 minutes earlier than originally) • Aim: Reduce wait time between TASC Referral and CJRC Intake Date from minimum of 21 days to 7 days.

8. Changes Change 3: • Notify Probation Management weekly on Friday of Clients that did not show for TASC Substance Abuse Assessment to insure follow-up by Probation Officers with clients and Officers use new sanctions authorized by Justice Reinvestment. This was in addition to notifying individual Probation Officer within 48 hours when a client missed their TASC appointment. • Aim: Reduce no show rate 50% to 25%.

9. Results • 1. Personal Phone Calls: No change because 50%+ phone numbers were incorrect • 2. Walk-in Appointments • Reduced wait time for intake date from 21+ days to 7 days • 60% of clients admitted within 14 days of referral

10. Results 3. Weekly Notice to Probation • 6-10% decrease first 3 months

11. Next Steps • Personal Phone Calls: Abandon • Weekly Notice to Probation Management: Abandon, Probation and TASC to design a new change project to address no show rate • Walk in Appointments: Continue; Monitor for effect of changes that restricted the number of walk-ins, the walk in time period

12. Impact • Walk-in appointments rapidly engage clients in treatment • TASC Care Managers were able to tell client a date and time to show up • TASC is considering using walk-ins for Probation appointments • CJRC staff able to focus on clients who arrive for intake rather than waiting to see if client showed up • There needs to be continuous and regular communication and feedback between partners about the change project • The larger the change partner, the more difficult it is to institutionalize change

13. Presentations • Durham County, NC • State of Maryland • Department of Public Safety & Correctional Services and the Alcohol and Drug Abuse Administration • Coach: Jack Kemp • DeKalb County, GA

14. State of Maryland Pilot Site • Department of Public Safety & Correctional Services • Substance Abuse Treatment Service • Community Supervision • Alcohol & Drug Abuse Administration Target Population: • Inmates who have completed 6 months of Therapeutic Community Treatment • Now housed at Baltimore Pre-Release Center • Receiving RSAT Grant Aftercare Services

15. NIATx Aim • Increase Continuation Rates in Community Treatment • Inmates who have completed 6 months of Therapeutic Community Treatment behind the walls and involved in RSAT Aftercare Grant Programming at BPRU would be released, referred to a Re-Entry Community supervision agent and referred to community treatment and support groups. • Our goal was to make sure that it was always occurring after finding out that it hardly ever happened.

16. PDSA Change Cycles • Communication & Exchange of Information Project Improved communication and information exchange among correctional and vendor staff internally, and between correctional, community supervision, and community treatment providers • Case Manager will send out 30 day release list 1 week prior to PRT meeting • Aftercare Coordinator brings to PRT meeting discharge summaries and continuing care plans for all inmates on the 30 day PRT meeting list • Case Manager will attach a 2nd colored piece of paper to the release order of all RSAT Aftercare Grant inmates which states “This offender is a re-entry offender and has been assigned to agent (name)” • Community Supervision Deputy Director will ensure Aftercare Coordinators are added to the Tracking List that is managed by Community Supervision • Aftercare Coordinators will scan discharge summaries & continuing care plans to S Drive • Community Supervision Agents will gain access to the S Drive for aftercare documentation retrieval

17. PDSA Change Cycles • “Warm Hand Off” Project – In Progress Direct Handoff of Inmates involved in RSAT Aftercare Grant services to Community Treatment Provider Gaudenzia • Aftercare Coordinator develops & places spreadsheet on S drive for Community Supervision Agents to track Aftercare Support Group Attendance • Aftercare Coordinators to be added to BPRU Traffic distribution list • Aftercare Coordinator works with Community Provider to develop tracking spreadsheet of who makes it after being referred

18. Results • PEOPLE MET & TALKED TO EACH OTHER IN THE SAME ROOM!

19. Data Results • Currently still in process of analysis • Will be looking at 6 months prior to project and 6 months after project changes (over 600 inmates for each time period) • Specifically: • # of RSAT involved inmates seen at PRT meetings prior to release • # of RSAT involved inmates had their discharge summaries & aftercare plans “handed-off” at PRT meetings • # of RSAT involved inmates assigned to correct community supervision agent prior to release. • # of RSAT involved inmates referred to community treatment and support at Gaudenzia • # of RSAT involved inmates referred to Gaudenzia actually involved in community treatment and support groups

20. Next Steps • All changes were adopted except for one • One was initially abandoned. Currently revisiting and adapting • Change Team commitment to continue monthly meetings and work on refining process, uses NIATx principles despite Grant ending • DPSCS is currently involved in the development of new Re-Entry Policies and Procedures. It is our goal that the changes made at BPRU through this project could be expanded to all institutions and community treatment providers. • Also we were able to see specific “small” areas where the true principle foundations of NIATx could be applied such as waiting time to see agents at intake, etc and will be investigating the feasibility of those projects as well.

21. Lessons Learned • Changes made allowed us to: • Coordinate all the different agencies, departments, and staff members • Develop and strengthen working relationships and communication • Messages to future ORP’s: • Honest & open communication with all parties to tweak all the PDSA changes • Suggestions for applying NIATx to other large complex systems: • Executive Sponsor perhaps not the highest ranking official in the Agency in order to provide more support to Change Leader • Rapid Cycle Testing definitely works, just at a much slower pace

22. Presentations • Durham County, NC • State of Maryland • DeKalb County, GA • DeKalb County Sheriff’s Office and the DeKalb Community Service Board (Criminal Justice Programs/Court Services) • Coach: Mathew Roosa

23. DeKalb Community Service Board and DeKalb County Jail present NIATX CHANGE PROJECT TREATMENT ENGAGEMENT DeKalb County Jail DeKalb CSB Substance Abuse Treatment Facility DeKalb County Sheriff Thomas Brown DeKalb CSB CEO Gary Richey

24. Pilot Site for Bringing the NIATx to Corrections Project TEAM LEADERS DEKALB COUNTY SHERIFF’S OFFICE Melissa Manrow Special Projects Coordinator 4415 Memorial Drive Decatur, GA 30032 404.298.8183 www.dekalbsheriff.org DEKALB CSB CRIMINAL JUSTICE/COURT SERVICES Elizabeth Upshaw Program Director Nolan Henderson, START Manager 455 Winn Way Decatur, GA 30030 404.508.6445 www.dekcsb.org

25. START PROGRAMDEKALB COUNTY, GEORGIA Starting Treatment And Recovery Today (START) 90-day substance abuse treatment program within the jail Treatment plan and referral to outpatient services Capacity 32 male and 14 female Housing is located in an area of the jail identified specifically for custodial treatment Referral to the START program is selective and determined by the sentencing judge prior to clinical assessment DEKALB COMMUNITY SERVICE BOARD (DEKALB CSB) DeKalb CSB is a public nonprofit provider of community-based behavioral healthcare, offering a full range of mental health, substance abuse and developmental disabilities services to 10,000 clients annually. DEKALB COUNTY JAIL (DCJ) DCJ contains 1974 cells capable of holding 3,732 inmates in 940,000 square feet of space. The facility books and releases about 42,000 inmates per year.

26. PLAN: START PROGRAM AIM Plan Increase Aftercare 1st appointment Show Rate Increase Aftercare Treatment Retention Rate Targeted Follow up Re-engagement s for no show appointments

27. Need for Change:Low aftercare first appointment show rate Baseline 19 percentGoal to increase to 50 percent Intervention 1: START staff will provide an informative session to family members of START participants prior to release from jail Intervention 2: START staff will provide the first contact at outpatient appointment in order to insure familiarity, continuity of caregiver and increase show rate Intervention 3: START graduates maintaining aftercare will work with START staff as a peer recovery contact for future START participants DO: IMPLEMENTING THE CHANGE PLAN

28. STUDY: Aftercare Study

29. STUDY: SURVEY • After release from jail each graduate was contacted and asked to participate in a survey : • How did the following factors impact whether or not you kept your outpatient appointment? • Factor 1 - immediate appointment upon release • Factor 2 - family education program provided support/engagement • Factor 3 - START staff on site at intake appointment • (warm hand off)

30. ACT: PROMISING PRACTICES AND LESSONS LEARNED • ADOPT • START staff will continue to provide warm handoff at first outpatient appointment • Provide family members additional family sessions • Continue to identify funds to expand the program, hire additional staff and provide more services-To allow follow up re-engagement • Early Discharge Planning to incorporate The Risk-Need Responsivity Model and assessment tools presented by Dr. Fred Osher

31. ACT: PROMISING PRACTICES AND LESSONS LEARNED • ADAPT • Develop alternative language for legal system to replace the term “aftercare” in the court sentences • Develop additional surveys for continued feedback after jail release at 6 and 12 month intervals • Develop case management services that can be incorporated in core provider reimbursable • ABANDON • The assumption that ALL clients will be motivated to participate in continued care

32. Discussion Questions for pilot sites Experiences implementing NIATx model

33. Next Steps Final thoughts May 23rd meeting

34. Thank you! • Council of State Governments Justice Center • http://www.justicecenter.csg.org/ • Center for Health Enhancement Systems Studies • https://chess.wisc.edu/chess/home/home.aspx • Bureau of Justice Assistance • https://www.bja.gov/