Behind Bars: Intervention and Promising Approaches Giving

Inmates a Second ChanceThe Opioid Crisis:

The Clinician's Role and Treatment Practices February 14, 2018

Dawn Noggle, PhD. Maricopa County Correctional Health Services

Criminal Justice Involved Individuals: Jail as an opportunity for intervention

The opportunity: A large population that is screened and accessible

– 7,900 individuals/month booked (95,000 2016)– 700 OUD/monthly on 7 day withdrawal protocol– MAT since 2014 for 4 facilities (seeking for 5th)– 24/7 health staff and ability to verify medications and

community OTP– Ability to identity pregnant females (often without Rx)

The challenge:

• Rapid release and short length of stay– 47% release in 24 hours or less– 76% released within 14 days

• High risk of overdose upon release from custody

• Introducing harm reduction effectively• Managing MAT in jail• Absolute necessity of community

connection for successful transition

Essential Continuity of Care

Methadone started for all individuals verified on OTP

Women, pregnancy, babies born, and OTP

2014 23624 677 12 49 0

2015 22659 683 18 59 0

2016 21667 735 10 89 3

Up to 10/31/2017 19714 631 4 83 4

Transgenerational Impact: Intervention as Prevention

.. Harm Reduction: Or as many chances as it takes

• Spring 2017 Haley Coles, Sonoran Prevention Works approached CHS regarding naloxone

• SPW helped educated staff on delivering patient education on naloxone use

• July 2017 CHS began distributing Narcan at release– Patients educated by RN’s at COWS assessments– LPN’s place Narcan nasal sprays in patient property

to have at release• 250-300 Narcan kits are being distributed monthly

Goal is 400-500 kits a month

Promising Approaches: Healing and addressing pain

• osaic

• Helping individuals put

• the pieces back together osaic

Promising Approaches: Healing and addressing pain

Evidence-based 7 week intensive treatment (SUD/moderate-high recidivism risk)

o Mindfulness Criminogenicso “New Freedom” Community

Partners/Transition Planningo “Parenting Inside Out” o “START NOW” o Trauma and Resilience (CPT model)

Reaching In and meaningful connection

• CMS as the model

• STR funded providers

– Building a model for in reach to optimize

offering people MAT, engaging them in

treatment

• Diversion and decriminalizing

The voice of experience; compassion that extends beyond “the bars”

• People with lived experience are our best front line– Peers and work in the jail

• Building models from standing witness and listening to people with the experience of using substances

Lessons in the nitty gritty: criminalization of mental illness and

homelessness

• Jail population: 25% claim homelessness– Social determinants MUST be addressed

• Criminalization of mental illness got us into this mess; are we destined to repeat?– Diversion not criminalization is imperative

• Harm reduction including needle exchange and safe injection sites are essential

• Transgenerational impact cannot be denied

SAMHSA GAINS: Sequential Intercept Mapping

Mosaic

Mosaic Video Clip

• http://santansun.com/2017/06/09/rehabilitative-programs-are-key-to-reducing-recidivism/

• https://www.youtube.com/watch?v=wjDB1sSQllE&feature=youtu.be

Questions and Contact:

Dawn Noggle, PhDMental Health Director or

Community and Justice Partners StrategistMaricopa County Correctional Health Services

D.noggle@mail.Maricopa.gov