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Making SOAR Workin Criminal Justice Systems
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Making SOAR Workin Criminal Justice Systems
Presented by:
SAMHSA SOAR Technical Assistance CenterPolicy Research Associates, Inc.
Under contract to:
Substance Abuse and Mental Health Services AdministrationU.S. Department of Health and Human Services
Welcome!
Dr. Pamela J. Fischer, Ph.D.
Social Science AnalystHomeless Programs Branch
Center for Mental Health ServicesSubstance Abuse and Mental Health Services
Administration
Webinar Instructions
Muting Recording availability Downloading documents Evaluation Question instructions
Agenda
Consider a “PILOT”
Dazara Ware, SAMHSA SOAR Technical Assistance Center, Policy Research Associates, Inc.
Oklahoma Mental Health Reentry
Bob Mann, Administrator of Mental Health Services Operations, Oklahoma Department of Corrections
Questions and Answers
SAMHSA SOAR TA Center
Consider a “PILOT”
Dazara Ware, MPC
SAMHSA SOAR Technical Assistance Center
Policy Research Associates, Inc.
Delmar, New York
SOAR TA Center Follow up SOAR and
Criminal Justice Webinar – 11/2012
Reentry Reality Correctional supervision in the US = 7 Million
Community corrections supervision = 5 Million
Annual release from federal and state prisons = 750,000
Serious mental illness = 125,000
Offenders diagnosed with a SMI that were homeless in the months before their incarceration = 20 percent
Rates may be even higher for those exiting the criminal justice system
Access to benefits can help to promote post release success
Proposal to promote recovery
Identify stakeholders and coordinator
Link to the community Optimism! Time
P
I
L
O
T
The Proposal Discuss prevalence of mental health needs within
the criminal justice setting Promote recovery and community re-entry
– Income– Healthcare– Access to housing
Provide information to decision making authorities within the agency about SOAR success– Buy-in– SOAR Overview tool
Park Center’s Facility In-Reach Program
Proposal initiated by Ashley Blum
Inception of Facility program: July 1, 2010
Total clients to date: 92 facility clients
Success rate: 100% (86 approved, 6 pending)
Average days from date of application to date of DDS decision: 39.7 days
Identify Stakeholders Identify stakeholders to form a
steering committee– Commissioners, Judges, Chief Jailers– Social workers, Counselors, Reentry
staff, Medical records staff– MH administrators, Psychologists,
Psychiatrists– Parole, Probation and Community
Reentry Project Directors
Identify a Coordinator
Starting an SSI/SSDI initiative as part of reentry planning requires a steering committee with a strong and effective coordinator– Serves as the liaison between case
managers and steering committee– Effective– Committed
Make the Link to the Community
Linking justice involved persons that may be eligible for benefits to community resources should be part of the continuity of care in the facility’s SOAR plan
Internal discussions about existing resources– What is already being done?
Eleventh Judicial Circuit Criminal Mental Health Project (CMHP)
Miami-Dade County, Florida Implemented to divert people with SMI
away from the criminal justice system into community-based treatment and services
Target population expanded to include individuals re-entering the community after completion of jail sentence
Approach with Optimism
Opportunities for success CAN happen!
Stories from around the country
SOAR Helps Reentry Efforts
Income
• Reducing state cost
• Promotes recovery
Health
care
• Healthier individual
• Promotes healthier communities
Access to
Housing
• From “ex-con” to paying customer
• Integration into community
This Process Takes Time Time to train and learn
– 2-day training– On-going support
Time to do– Not a “file it and forget it” approach– FTE dedicated to SOAR
Time to see results– 1 year to see results– 2 years for a fully functioning program
Time to track– SOAR OAT
Consider a PILOT site
Pilot sites provide a great opportunity to test your plan in a focused area– Test the plan– Address challenges– Make revisions– Use results as leverage
Fulton County, GA Jail Pilot Initiated in 2009 Proposal submitted to the Chief Jailer
and Social Workers at the Public Defender’s Office
SOAR Staff issued official jail ID’s that allowed for full and unaccompanied access to potential applicants
70% approval rate Used as leverage to gain the buy-in for
GDC initiative
It’s Really About People “Al” April 2009, Al was arrested on felony charges and lost his job Undiagnosed and untreated mental illness After 41 days in custody in the Miami-Dade County jail Connected to the Jail Diversion Program was able to coordinate a
successful transition plan to the community Received assistance with housing, treatment, and application for
Social Security benefits using the SOAR approach. In May 2010, Al successfully completed the Jail Diversion Program
and the felony charges were dismissed. Today, Al is a valuable member of the Jail Diversion Program staff
as a peer recovery coach.“If it wasn’t for this program, I don’t know where I would be now.”
Contact for Assistance
Dazara Ware
Senior Project Associate
SAMHSA SOAR TA Center
518-439-7415 *5260
Oklahoma Mental Health Reentry Program:
SOAR and Federal Benefit Implementation
Bob Mann, RN, LSWAdministrator of Mental Health Operations
Oklahoma Department of Corrections
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Why Do We Need a Mental Health Reentry Program?
Crucial Elements of a Correctional Mental Health Reentry System
Executive level buy-in Potential partners examine overlap in missions Recovery orientation and public safety awareness Coalition of empowered boundary spanners Focused on solutions- tear down silos Common vocabulary – framework for identification of
target population Shared conceptual framework- Sequential Intercept
Model & SSI/SSDI Outreach and Recovery (SOAR)
Partners in Collaboration Oklahoma Department of Mental Health and
Substance Abuse Services Social Security Administration Oklahoma Department of Rehabilitative Services:
Disability Determination Division (DDD) and Vocational Rehabilitation Division (Voc Rehab)
Oklahoma Department of Human Services Oklahoma Health Care Authority (Medicaid
agency)
ODMHSAS has taken ownership for the continuity of mental health services for those offenders with the highest level of mental health need.
Discharge managers, who are ODMHSAS employees, are boundary spanners with offices in DOC mental health units and serve as members of correctional mental health treatment teams.
The discharge managers serve as part of the ODOC institution mental health treatment team that creates and implements the individualized treatment plan, including reentry planning for offenders with serious mental illness.
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How is This Interagency Mental Health Reentry Program Unique?
“In-Reach” and Intensive Services Post Release- Modified Assertive Community Treatment (ACT)
Reentry Intensive Care Coordination Teams (RICCT) meet with offender a minimum of 90 days before projected release date from prison and work with offender in the community until offender has adjusted to life following incarceration.
An innovative, vital component of RICCT is inclusion of a Certified Peer Recovery Support Specialist on the team. These specialists have life-experience with mental illness and/or substance abuse and are trained to offer peer support.
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How is This Interagency Mental Health Reentry Program Unique?
Benefit Planning for Successful Reentry
Most of the target population for the MHRP are eligible for SSI/SSDI and Medicaid
Oklahoma is a 209 b Waiver State (one of eleven) to get disability determination from Social Security (for most individuals)
Affordable Care Act implementation- many states (including Oklahoma) chose to not expand- much ado about nothing?
SSI/SSDI crucial for recovery support (opens door to disability based housing, services)
Timeline for Benefit Planning Implementation in Oklahoma
2004 SAMHSA Mathematica Policy Research- (Establishing and Maintaining Medicaid Eligibility upon Release from Public Institutions)
2005- Oklahoma received support to implement the SSI-SSDI Outreach, Access, and Recovery (SOAR) program
2006- MH Reentry staff trained in SOAR and Medicaid 101
2006- Pre-release Agreements Signed with local SSA offices
SOAR Training (even for administrators!)
Timeline for Benefit Planning/ Implementation - Continued
2006-Now Ongoing meetings between DOC and DDS staff
2007 Mental Health Reentry Program begins 2008 Qualified Services Organization Agreement
signed between ODMHSAS and ODOC (information sharing agreement)
2009 Voc Rehab counselor begins to work with MHRP participants (performs vocational assessments/ evaluations & refers individual to Voc Rehab services in the community)
Benefit Planning Process The goal is for the individual to leave prison with their
Social Security benefits in place and have the Medicaid entitlement aligned so funding is in place for medical and mental health services following release from prison (pre-approval takes place in the facility- Certificate of Release documents “flips the on switch” in the community
The MHRP staff start the social security and Medicaid application process 120 days prior to an offender’s scheduled discharge
Model Program to Assist Offenders with Serious Mental Illness Obtain Federal Disability and Medicaid Benefits
6–9 months from release:
Identify target population
Screen for income, resource eligibility
Request consents
120 days from release:
Start SSI/SSDI application
60 days from release:
Start Medicaid application
45 days from release:
Submit Medicaid application
Monitor application status
Day of release:
Direct person to local SSA office
Fax certificate of release to local DHS officeSource: Mathematica Policy
Research, Inc.
Benefit Planning Process The MHRP staff get releases signed, set up
phone interviews, coordinate with ODOC Mental Health Services clinical staff who prepare the discharge summary
DDD staff flag cases, assign specific examiners and specific medical consultants
Community Based RICCT staff follows up with individual post release (Medicaid & SSA office visits
Benefit Planning Challenges Documenting functional ability in a correctional
setting: DOC clinical staff SOAR training, meetings with DDS staff medical consultants and specified examiners.
Lots of discussions about ‘apples and orange’ language differences in systems (e.g. in a mental health unit a job might be ‘keep the unit microwave clean)
Sharing not just clinical information- disciplinary reports are also helpful measures of functionality
Benefit Planning Challenges Getting medical records from ODOC to DDD can be
a very time consuming process.
– From 2006 through 2012 MHRP staff faxed, mailed and even hand carried ODOC mental health documentation to the local SSA and/or DDD office
– Documentation occasionally became lost, misfiled, etc and the process would slow down dramatically
– Additional information would be requested (which also slowed down the process)
Benefit Planning Challenges 2013 Electronic Information Exchange Agreement
between DDD and ODOC signed. Allows DDD staff direct access to ODOC Electronic Health Record.
Benefit Planning Challenges
Maintaining collaboration can be difficult
– Two years ago an increase in processing time was observed. A meeting with all of the staff involved (some old, some new) from all systems revealed that some processes has shifted
– Direct line numbers were again shared so staff can ‘speed dial’ their counterparts
SSI/SSDI Application Results Disability Determination Allowance
Rate Comparison
Oklahoma DOC Rate (Oct 2007- Aug 2008)
Oklahoma DOC Rate (Oct 2006- Sept 2007)
Oklahoma Average (Sept 2008)
National Average (Sept 2008)
89.9%
52.0%
39.7%
36.6%
Percent with Approved Disability Determination
Source: Oklahoma Department of Rehabilitative Services, Disabilities Determination Division.
MHRP offenders were over 4 times more likely to be enrolled in Medicaid at prison release than the baseline comparison group.
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Offenders Enrolled in Medicaid
Medicaid Enrollment at Release from Prison
Medicaid Enrollment within 90 Days of Release from Prison
0%
25%
50%
75%
6.3%
14.5%
28.4%
46.8%
Baseline Comparison RICCTS
Service engagement rates for MHRP offenders were over 5 times more than the baseline comparison group.
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Rate of Engagement Offenders Receiving 4 Services Within 44 Days of Release from DOC
Baseline Comparison RICCTS0%
25%
50%
75%
11.7%
63.6%
MHRP offenders showed 80% less inpatient admissions than the baseline comparison group.
($776,000 estimated savings from 2/07 to 10/09)
MHRP offenders received over 50% more outpatient services than the baseline comparison group.
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Inpatient, Outpatient & Pharmacy Services
Percent of Offenders Receiving Inpatient Services
Percent of Offenders Receiving Outpatient Services
Percent of Offenders Receiving Pharmacy Services
0%
25%
50%
75%
100%
8.7%
55.1%
35.7%
1.6%
83.8%
64.8%
Baseline Comparison RICCTS
Offenders Returning to Prison Within 36 Months
42.3%
25.2%
0%
25%
50%
Baseline Comparison RICCTS
Contact Information
Bob Mann, RN, LSWAdministrator of Mental Health Operations
Oklahoma Department of Corrections405.962.6137
Questions and Answers
Facilitated By:
SAMHSA SOAR Technical Assistance Center
Policy Research Associates, Inc.
For More Information on SOAR
Visit the SOAR website: www.prainc.com/soar
SAMHSA SOAR TA Center
Policy Research Associates, Inc.518-439-7415
www.facebook.com/soarworks
Twitter: @soarworks