Primary Preven+on of Criminal Jus+ce Involvement

for People with SMI Michael A. Norko MD, MAR

NASMHPDAnnualMee.ngArlington,VAJuly30,2017

Public Health Concepts

•  Ter$arypreven$onaimstoreducethenega.veimpactofestablishedcondi.onsbyrestoringfunc.onandreducingcondi.on-relatedcomplica.ons(e.g.,diabetesmanagement&strokerehabilita.onprograms)

•  Secondarypreven$onaimstodiagnoseandtreatanexis.ngcondi.oninitsearlystagesbeforeitresultsinsignificantmorbidity(e.g.,dailyaspirintopreventfurtherheartaNack,Paptestsorotherscreening)

• Primarypreven$onaimstoavoidthedevelopmentofanadversecondi.on(e.g.,immuniza.ons,bikehelmets)

Sequen+al Intercept Model (Munetz & Griffin 2006)

MunetzMR,GriffinPA:Useofthesequen.alinterceptmodelasanapproachtodecriminaliza.onofpeoplewithseriousmentalillness.PsychiatricServices57:544-549,2006

Ter.aryPreven.on

JailDiversion

SpecialtyCourts

MentalHealthProba9on&Parole

Re-entryprograms

Ter.aryPreven.on

SecondaryPreven.onCrisisInterven9onTeam

Ter.aryPreven.on

SecondaryPreven.on

“BestClinicalPrac$ces–TheUl$mateIntercept” PrimaryPreven.on(aka“InterceptZero”-GAINSCenter)

Policy Research Associates (GAINS Center): Framework for Intercept Zero*

CrisisResponse• Cer.fiedCommunityBehavioralHealthClinics• CrisisCareTeams• CrisisResponseCenters• MobileCrisisTeams

PoliceStrategies• CrisisInterven.onTeams• HomelessOutreachTeams•  SerialInebriatePrograms•  SystemwideMentalAssessmentResponseTeams

hJps://www.prainc.com/wp-content/uploads/2016/11/Intercept-0-Infographic-2.pdf

Problems with Primary Preven+on •  EveryweekindividualswithSMIarehospitalizedforcompetencyrestora.ononmisdemeanorchargesandlow/nobond• Bestclinicalprac.cesworkwhenclientsarecollabora.ngwithtreatmentandnotabusingsubstances•  Evenwhenservicesareaccessible,availableandwell-delivered&coordinated,individualsgetarrestedfornuisancecrimes•  Cliniciansandcourtsgetfrustrated•  Arrestandcompetencyevalua.onsandrestora.onrelievethefrustra.on(temporarily)

• UsualMo.va.onalInterviewingisnotenoughformanyclients• Clinicalstaffarenotequippedtoprovideprimarypreven.on

• Whynot?Oeen,theyhavethewrongtoolbox

Problem with tradi+onal clinical responses*

• Bestprac.cesreducesymptoms,butmaynotdecreasecriminalrecidivism• ArrestforindividualswithSMIpredictedbysamecriminogenicfactorsasaverageadultcriminalpopula.on•  an.socialpersonality,cogni.on,andassociates;family/marital;school/work;leisure/recrea.on

•  SpecialCogni.veBehavioralprogramsdesignedforoffenderscanreducerecidivisminindividualswithSMI

*RoNerM,CarrWA:Reducingcriminalrecidivismforjus.ce-involvedpersonswithmentalillness:Risk/needs/responsivityandcogni.ve-behavioralinterven.ons.SAMSHA’sGainsCenterforBehavioralHealthandJus.ceTransforma.on,2013.hNps://www.prainc.com/wp-content/uploads/2016/02/ReduceCrimRecidRNR.pdf

Available Cogni+ve Behavioral Programs

•  ThinkingforaChange(T4C)• MoralRecona.onTherapy(MRT)

•  Interac.veJournaling• Reasoning&Rehabilita.on(R&R)• Op.ons•  STARTNOW

Robert Trestman PhD, MD: START NOW Presenta+on to NASHMPD Forensic Division (2016)

• Anintegra.veskillstrainingmodelinformedbyanumberoftheore.calapproaches&models-•  Primarilyacogni.vebehaviortherapy(CBT)model•  Includesmo.va.onalinterviewingprinciples&prac.cestoenhancemo.va.onforchange•  Infusedwithelementsofcogni.veneuro-rehabilita.on,inconsulta.onwithcorrec.onalneuro-cogni.veresearcher,D.Fishbein(Fishbeinetal.,2009).•  Theoriesofcriminalbehavior,includingrelevantexamplesinpar.cipantworkbooks.

Fishbein,Diana,etal."Deficitsinbehavioralinhibi.onpredicttreatmentengagementinprisoninmates."Lawandhumanbehavior33.5(2009):419.

Overall Principles

•  Reinforcepersonalresponsibilityforbehavior•  Iden.fystrengths&buildonthem

•  Appreciate&respectindividualdifferences,capabili.es,&limita.ons

•  Lookformul.pleopportuni.estoteachtheconnec.onsbetweenthoughts,feelings,&behavior:

•  “Yourfeelingsdon’tmakeyouactacertainway-youchoosehowyourespondtositua.ons.”

RobertTrestmanpptavailableathNp://www.nasmhpd.org/sites/default/

files/START%20NOW%20NASMHPD%20Forensic%20Division%20Presenta.on_Trestman.pdf

Structure & Design

•  32Skillstraininggroupsessions•  twiceweekly,for16weeks(orcanbeprovidedweekly)•  75minutesinlength

• Poten.alforrollingadmissions

• Clinicaltools:•  Par.cipantworkbook•  Facilitatormanual•  Checkliststobeusedforfidelitymonitoring&supervision

•  Freelyavailable,publicdomainmaterials

Specifically for offenders with behavioral disorders • Concepts&languagearesimplifiedgivenpoten.alcogni.velimita.ons

• Numerousiconsincludedinthepar.cipantworkbook-especiallyusefulwithTBIorverballylimitedpar.cipants

•  Illustra.veexamples&copingbehaviorsrelevanttocorrec.onalsitua.ons

•  Facilitatormanualsupportsengagingdifficult-to-engagepar.cipants:shapingbyreinforcinganymovementtowardthedesiredbehavioralchange

Units

1.  MyFounda.on:Star.ngwithMe(10sessions)•  Focusesondevelopingincreasedself-control&abilitytocopewithstressors

2.  MyEmo.ons:DealingwithUpsetFeelings(8sessions)•  Recognizing,understanding,copingwithemo.ons

3.  MyRela.onships:Connec.ngwithOthers(8sessions)•  Focusesondevelopingposi.verela.onshipskills

4.  MyFuture:Sesng&Mee.ngMyGoals(6sessions)•  Preparingforaposi.vefuturebydevelopinghope,realis.cgoals,problemsolvingskills

MixedGenderGroupPar$cipantWorkbookFORENSICEDITIONUConnHealthSusanSampl,Ph.D.RobertL.Trestman,Ph.D.,M.D.JulieWright,Psy.D.WithCogni9veRehabilita9onEnhancementsbyDianaFishbein,Ph.D.RTIInterna.onal

VersionF1.0,July2016

Discussion

• Canwetrain/augmentclinicalstaffwithSTARTNOWandothercogni.vebehavioralapproachestocriminogenicneeds?

• Canweimplementtheseapproacheswithindividualsathighriskforjus.ceinvolvementorre-involvement?

• Whatstepscanwetaketoexplorethisop.onandassessresults?