REACH OUT

SECTION 1 – WHAT IS REACH OUT?

REACH OUT

Purpose: To properly address and treat substance use disorders and criminogenic factors in order to achieve pro-social change while reducing recidivism.

Goal: To identify those probationers currently incarcerated in need of residential substance abuse treatment, and to place these individuals into the appropriate level of care within the community.

History: Began in October 1999 with grant funding to pay for community treatment for probationers in jail. Revamped in November 2015; new collaboration implemented in March 2016.

REACH OUT COLLABORATION

Maricopa County Adult Probation Department -MCAPD

Mercy CareCorrectional Health Services - CHSMaricopa County Sheriff ’s Office - MCSOArizona Health Care Cost Containment System -

AHCCCSMaricopa County Superior Court

REACH OUT COLLABORATION CONT.

Keogh Health ConnectionCommunity Treatment Providers (Crossroads, CPLC-

Corazon, Lifewell, Native American Connections, NCADD, Casa de Amigas, Unhooked Recovery, Ebony House, Elba House, Destiny Sober Living, Calvary Healing Center, Valley Hospital)

Maricopa Integrated Health System’s RELINK programHealth Plans – Justice Liaisons (Banner-University Family

Care Plan, Care 1st Health Plan Arizona, Health Choice Arizona, Health Net Access, Magellan Complete Care of Arizona, Mercy Care, and United Healthcare Community Plan)

PROCESS Begins with a Judicial Order for assessment Referral sent to Reach Out inbox ReachOut@apd.maricopa.gov Criminal History is reviewed – looking specifically for warrants or holds RO Team send a listing “Hope List” to Keogh of those probationers to

be assessed for the upcoming week. Keogh researches AHCCCS status and sends this information back to

RO team. APD licensed therapist completes a clinical interview (in the jail) and

makes a professional level of care recommendation. APD licensed therapist completes paper AHCCCS application with the

probationer in the jail as needed. APD notifies CRU, CHS, MCSO, and Keogh of assessment results for

the week – Weekly Shared List

PROCESS CONTINUED

APD RO team coordinates with community treatment partners to secure placement.

Notification and referral is sent to Mercy Care for residential substance abuse placement.

The Mercy Care GMHSU and SMI Justice team reviews the referrals and adds this data to a tracker. (Amy Kraus, Norma Brasda, Andrew Woods)

The Mercy Care team determine notate current RBHA assignment, AHCCCS status, SMI status, Dual members and health plan.

The Mercy Care team share this tracker with the RO staff weekly The Mercy Care team notify the corresponding health plan of member

needs and placement. Keogh completes AHCCCS application utilizing online system.

PROCESS CONTINUED

Treatment facility contacts APD with the number of treatment available and dates of admission.

RO team create a Weekly Release Listing and share with appropriate partners. (Assigned TX providers, CHS, Keogh, RELINK, CRU, MCSO)

Purpose of Weekly Release Listing and impact

APD contacts the judicial officer and requests that an Order of Release be signed for identified intake date and to a specific provider.

Once signed, APD sends the signed Order of Release to MCSO.

MCSO reviews the order and criminal history to ensure that no outstanding warrants or holds exist – process release.

PROCESS CONTINUED

CHS determine if the probationers on the Weekly Release List will need medications, prescriptions, or medical devices upon release.

CHS work with the multiple jails to coordinate transportation of medications upon release.

APD RO staff meet with probationers at the Lower Buckeye Jail the day of release to sign paperwork.

At release, APD introduces the probationer to the treatment facility peer support and hand delivers all medications, paperwork, and personal belongings

The treatment facility peer support transports the probationer to the treatment facility from jail.

REACH OUT PROCESS FLOW CHART

SECTION 2 – COMMUNICATION & CHANGE

ARIZONA’S SHIFT TO INTEGRATIVE CARE New contracts awarded - Banner-University Family Care Plan, Care1st Health

Plan Arizona, Health Choice Arizona (Steward Health Choice Arizona), Health Net Access, Magellan Complete Care of Arizona, Mercy Care, and UnitedHealthcare Community Plan.

Required Memorandums of Understanding (MOUs) Contractor requirements:

Deliver services to adults in conformance with Section D, Paragraph 11, Behavioral Health Service Delivery, Nine Guiding Principles for Recovery-Oriented Adult Behavioral Health Services and Systems,Employ a phased-in implementation approach, as directed by AHCCCS:

Utilize the American Society of Addiction Medicine (ASAM) Criteria (Third Edition, 2013) in substance use disorder assessments, service planning, and level of care placement, and

Monitor fidelity of ASAM implementation, and,

Implement Supported Employment.

SECTION 3 – MERCY CARE

INDIVIDUALS ARE ELIGIBLE FOR GMH/SU SERVICES

• If the individual is enrolled in AHCCCS, Medicaid will be the funding source.

• If the individual has a problem with drugs and/or alcohol, Mercy Care receives funding from AHCCCS under the Federal Block Grant for the Prevention and Treatment of Substance Use (SABG).

SUBSTANCE ABUSE BLOCK GRANTPriority Populations for SABG:

• Pregnant females who use substances

• Intravenous drug users

• Substance using females with dependent children and their families, including women who are attempting to regain custody of their children; and

• As Funding is Available - all other clients with a substance use disorder, regardless of gender or route of use.

Persons must indicate active substance use within the previous 12-months to be eligible for SABG services.

SUBSTANCE ABUSE BLOCK GRANT ELIGIBLE SERVICES

• Services for individuals who do not qualify for Title-XIX eligibility

• Non-Medicaid reimbursable services identified by DBHS in the Covered Service Guide.

• The services are prioritized by population and are provided for as long as they are clinically indicated.

• SABG funds do not cover Level 1 Acute Hospital nor Medications (except methadone)

• Detox services only if provided in an Outpatient setting, a free-standing Level I sub-acute facility, or Rural Substance Abuse Transitional Center

MEDICATION ASSISTED TREATMENT PROVIDERS (MAT)

“The use of pharmacological medications, in combination with counseling and behavioral therapies, to

provide a 'whole patient' approach to the treatment of substance use disorders."

-Substance Abuse and Mental Health Services Administration (SAMHSA)

• Research indicates that a combination of medication and behavioral therapies can successfully treat substance use disorders, and for some people struggling with addiction, MAT can help sustain recovery.

OPIOID STATE TARGETED RESPONSE (STR)

On May 1, 2017, Arizona received an award notice for $24,343,406 over the course of two years to implement prevention and treatment activities for this targeted effort. AHCCCS, as the Single State Agency for Substance Abuse Treatment, will administer the grant and work with other state agencies, Regional Behavioral Health Authorities (RBHAs), and contractors.

SECTION 4 – PROVIDER PERSPECTIVE

• CPLC Corazon is a client centered, multicultural and bilingual treatment center for men. Corazon has been serving the community in delivering quality substance abuse and mental health services to individuals and their families since 1983. Over the years Corazon has developed into a multi-level service provision program for men 18 years and older.

• Partnership With Reach Out• Types of funding utilized

0

50

100

150

200

250

FY 16/17 FY 17/18

Corazon Men’s Residential Substance Abuse Treatment Program-Reach Out

Results

Total Clients Served Successful Completions of the Program

STORY OF CHANGE - BILLY

SECTION 5 - OUTCOMES

WHAT ARE WE MEASURING?

GenderRace / EthnicityAge Risk Level Program CompletionReasons for DischargeTreatment LengthProbation Status

PLACEMENT DATA

PRELIMINARY DATA In FY2018, Reach Out facilitated the early release from jail to

residential treatment for 926 probationers.

In FY2017, Reach Out facilitated the early release from jail to residential treatment for 615 probationers.

The majority of those released early to treatment were male (76%) and white (60%) with an average age of 35.

In addition to being high need as assessed by the ASAM (assessed as in need of residential treatment), this population is also a higher risk population based on the OST/FROST (general risk/needs assessment tools used by the MCAPD). 83% of this population assessed as medium-high or high risk. Illustrates that the population is both high risk and high need.

PRELIMINARY DATA CONT.

Treatment results were available for 524 individuals (85%) of the 615 individuals released early to treatment.

Of the 524 individuals with treatment outcomes, 316 (60.3%) successfully completed residential treatment.

For those that were not successful (n=207, 40%) the reasons for not completing treatment varied. 16% never really started treatment (either they left the day of intake or may have tested positive for drugs upon arrival at the facility), 33% were discharged by the provider for violations of program rules, and 51% left the program voluntarily.

PRELIMINARY DATA CONT.

PTR information was reviewed for the individuals who had a treatment result so only violation behavior that occurred after release to treatment is considered. Of the 524 individuals with treatment information, 370 (70.6%) had a PTR filed since their release.

For those with a PTR filed, the majority (n=235, 63.5%) were for technical violations only. The remainder had allegations of new criminal behavior.

Overall, when looking at how the 524 individuals with treatment outcomes are doing on probation, 36% of those released early to treatment have been revoked to DOC. However, we also looked specifically at the 316 who had successfully completed treatment. Of those 316 individuals, only 79 (25%) have been revoked to DOC. This is much better than those who were not successful, where 52.6% have been revoked to DOC.

DATA SUMMARY

We are getting probationers out of jail early and into treatment

The majority of those released are successfully completing treatment.

The majority of those released have been successful on probation with those who successfully complete doing better than those who do not.

These are significant outcomes given the population is both high risk and high needs.

QUESTIONS?

PRESENTER CONTACT INFORMATION

Shelley Curran – Director of Crisis, Cultural, Prevention, & Court Programs for Mercy Care currans2@mercycareaz.org

Erica Sims – MCAPD Reach Out Clinical Supervisor simse001@apd.maricopa.gov

Elisha Franklin – CPLC Corazon Program Director Elisha.Franklin@cplc.org