Now, we’re going to talk about specific opportunities for probation, and the biggest opportunity in probation is reduction in probation violations that are due to untreated substance use and psychiatric disorders.  We know that people who are continuing to use have both violations for new cases as well as many, many technical violations, and that has a big impact on how probation officers have to spend their time.  Many of those people wind up incarcerated as a result of repeated violation.

So, being able address what is, today, untreated substance abuse and psychiatric disorders can have a big impact for probation officers and probation departments.  It’ll be possible to gain these results across all probationers not just in smaller demonstration programs or specialty supervision units or specialty courts.  Then, for the specialty courts, specifically, they’ll certainly have better access to timely treatments.

A lot of specialty courts do their best to leverage existing resources.  They may have small amounts of grant dollars that pay for treatment. They may have the county dollars that they are able to use, but straightforward across the board access for everyone will make it much more manageable and hopefully much more timely manner to get into treatment.  There’s also an opportunity to focus on the high risk, high need probationers in the specialty court if everyone who’s on probation supervision is referred to treatment that specialty courts can be used to prioritize the people who need the more structured supervision, which we talked about earlier, Doug Marlow’s research.  This is a one way to apply it in this new environment starting in 2014.

A lot of the things that are needed to gain these results are similar to what’s needed in the jails, but’s a different twist because probation supervision provides different opportunities.  Timely enrollment in Medicaid and insurance is definitely very important.  A number of people who come into probation have spent time in jail.  So, if they get enrolled there, then that burden doesn’t shift to probation officers, but if probation officers can facilitate that timely enrollment, that’s great.  It could also be done by community substance abuse and mental health providers in partnership with probation departments.

Universal screening early in the criminal justice process will help determine who needs what because we know that the epidemiological information is all of this, substance abuse and mental health issues, are everywhere, but everyone has it in a different combination and in a different history.  So, everyone’s treatment plan is a little different.  So, universal screening could figure out what each person needs to expedite getting to everybody in a different way than we do today.

Certainly matching to appropriate services is very important.  There are people, the low risk, low need people you want to send to drug education programs and to early intervention programs, not necessarily to structured treatment services.  Intensive outpatient residential treatment are certainly for substance abuse side, which has very extensive needs.  The continuum on the mental health side, also will expand to [01:02:19].  I’m not as familiar with all the gradations along the way, but, certainly, it’s a high end community treatment services.  At the lower end, outpatient counseling that does a great deal of what it does in substance abuse treatment and everything in between.

So, there may be new modalities like an expansion of partial hospitalization.  That becomes available, and we’ll have to see how that plays out.  Certainly, the funding will come on board, and the providers need to get in planning the capacity, how much, how many, who, where, when.  Our suggestion is to do that planning in concert with the criminal justice system so that the providers are creating the capacity that the criminal justice system wants to use, and the criminal justice system will know which providers do what.  This whole system can be much more broad and robust and dynamic than is possible for it to be now.

It’s almost very important when you think about this kind of expanded act and expanded referral that we think about what universal reporting and sanctions process should look like.  We don’t want to generate an unmanageable burden for probation officers.  We don’t want to have a sanctions process that’s so aggressive that it actually results in more people violating and going to prison.  That’s the reverse of what we’re trying to make happen here.  So, we need to be really thoughtful about that, and the phrase for that in the criminal justice literature is net widening, when you set up a program and it’s intended consequence is that actually more people go to prison.  That’s widening of the net or more people are intensively involved in criminal justice supervision than you would expect.  So, we definitely want to avoid that.

Moving on to opportunities for parole.  There are, again, similarities and differences.  So, the opportunity in parole is to develop structured re-entry services for parolees who have had treatment inside correctional centers.  There’s many, many years of research that demonstrates that pre- and post-release treatment together have the greatest impact and subsequent reductions in recidivism.

There’s also the opportunity to reduce parole violations even for people who haven’t had treatment in an incarcerated setting to reduce violation due to untreated substance abuse and psychiatric disorders.  Increased access to treatment.  Increased ready-access to treatment as an alternative to re-incarceration when someone is about to be evaluated; is it a big deal for the criminal justice system?  Also, the expansion of routine access to treatment created that in a process of an interview, a parolee mentioned, “I used to have this problem.  I’m concerned about starting again/ I have started again.  I don’t want it to get worse.”

An easy access to the system in the community will make it much more viable for a parole officer to write that instead of waiting for the problem to get worse.  It may also make it easier for a parolee just to walk into treatment on their own, but I think we’re looking at a population that often needs a little encouragement.  So, this is helpful.

Also, there’s also a possibility of gaining these results across all parolees not just as earlier in the smaller demonstration programs or specialty supervision units.  The key is the creation of universal access to substance abuse and mental health services on release.

So, what’s needed for parole officers?  Again, timely enrollment in Medicaid and insurance.  We’re doing a planning process here in Illinois for connecting the criminal justice system and the substance abuse and alcohol treatment providers and Medicaid, which will be the big funder for our population in 2014 in planning how you would do this.  How can you facilitate timely enrollment prior to release from prison, prior to release from jail?  Looking at a number of technical options as well as how this would be staffed, workload expectations, and so forth, but I think we’re going to get there.  I think we’re going to see a good penetration of enrollment in an incarcerated setting.

As with probationers and people in jail, universal screening early in the justice process so you know who needs what.  Matching to appropriate services and expanding capacities and the same issues with avoiding net widening in the sanctions process and the reporting process.  The last thing we want to do is make this treatment expansion and significantly increase the number of people who are imprisoned or jailed as a result.

I’m going to take another pause here, and Monica, if you want to look if there’s any hands up.  The next section is going to be about the changes in the substance abuse and mental health treatment systems that are coming in health care reform and what the criminal justice system needs to know about that.



Alright.  If we do someone raise your hand.  Okay, Taz?



Hi.  I just had a question about a brief note about real jails and the correctional facilities and how they’re becoming the default settings for mental health and abuse health needs that are available in those communities. I was wondering if you meant that those are those only places where it’s available, or are there people who aren’t incarcerated who are actually attempting to access those?



That’s a really great question, and I’m glad you asked for clarification there.  What I meant was not that people are trying to get into jail to get services although once in a while you do hear an anecdotal story like that.  Really, it’s more than because there isn’t the capacity to provide treatment in the community for mental health and substance abuses, you got people with lots of untreated addictions. Their behavior gets them the attention of the criminal justice system, whether it’s because they’re arrested for possession or they’re arrested for a crime that they used to gain the resources to continue using or sometimes trespassing or disorderly conduct or a number of misdemeanor charges that people with serious mental health issues often brings them to the attention of the criminal justice system.

So, it’s certainly isn’t an intentional situation.  It’s just that the criminal justice system and the emergency room are two no decline systems, and that’s where the current situation is brought up.  Does that make sense?



Yeah.  It does.  Thank you.



Sure, no problem.


Okay, we have another question from Doug.



Yeah, hi.  I have two questions actually.  You put out a term there that I haven’t seen before.  Trauma-informed care in one category, if you could explain that.  Then, the next question would be where and how do private agencies fit into the overall scheme treatment providers?



When you say private agencies are you thinking about private non-profits or private for profits or a combination?



Abled capitalist.



Okay.  Let me take these questions one at a time, then.  In terms of trauma-informed care, that is a term that’s become more common in the substance abuse and mental health world in the last five to eight years I would say, and there’s some really good work being done on what this means in substance abuse treatment, what this means in mental health treatment, and what this means in the criminal justice setting.

So, the broadest notion of trauma-informed care is that, especially in any of those setting because the resource suggested is nearly universal, you assume that the people in front of you have had some significant issues, whether it’s domestic violence, being beaten up, sexual abuse in childhood.  There’s a long list of the kinds of things that create this response in the nervous system that suggests accelerated fight-or-flight response.

So, if you approach someone with a serious trauma history in a particular way and you get a very unexpected reaction from them, you know it’s active.  You know you need to deal with.  So, trauma-informed care practices, the research I’ve seen on this in criminal justice settings where they’ve done this systematically, they did a lot of this in Maryland in the prisons and the jails, has reduced the officer injuries.  It’s increased safety rates.  It’s had a lot of good effects for officers as well because we’re just a little bit more informed about who’s in front of us and how to handle them.

On the treatment side, how do you get out these issues in a way that’s appropriate for the setting?  So, you don’t want to push somebody into dealing with a level of their trauma history that they’re not ready for.  Yet, at the same time, you want to bring it to their awareness that they can start to integrate that into their thinking about why they’re using because, often, the heavier the use, the more likely use of opiates is a very high sign that there’s something going on because they’re using heavy pain killers.  It kills emotional pain or decreases emotional pain.



Right.  Okay.



Okay.  So, good.  So, there’s a lot of work out on this.  If you Google trauma-informed care, you’ll start to find that there’s some good models for treatment like [01:13:00].  There’s a bunch of stuff out there.

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