Transcript OKLAHOMA COLLABORATIVE MENTAL HEALTH REENTRY …

Making SOAR Work
in Criminal Justice Systems
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Making SOAR Work
in Criminal Justice Systems
Presented by:
SAMHSA SOAR Technical Assistance Center
Policy Research Associates, Inc.
Under contract to:
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
Welcome!
Dr. Pamela J. Fischer, Ph.D.
Social Science Analyst
Homeless Programs Branch
Center for Mental Health Services
Substance Abuse and Mental Health Services
Administration
Webinar Instructions
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Muting
Recording availability
Downloading documents
Evaluation
Question instructions
Agenda
Consider a “PILOT”
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Dazara Ware, SAMHSA SOAR Technical
Assistance Center, Policy Research Associates, Inc.
Oklahoma Mental Health Reentry
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Bob Mann, Administrator of Mental Health Services
Operations, Oklahoma Department of Corrections
Questions and Answers
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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
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SOAR and
Criminal Justice
Webinar –
11/2012
Reentry Reality
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Correctional supervision in the US = 7 Million
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Community corrections supervision = 5 Million
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Annual release from federal and state prisons = 750,000
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Serious mental illness = 125,000
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Offenders diagnosed with a SMI that were homeless in
the months before their incarceration = 20 percent
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Rates may be even higher for those exiting the criminal
justice system
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Access to benefits can help to promote post release
success
 Proposal
to promote
recovery
 Identify
stakeholders
and coordinator
 Link
to the community
 Optimism!
 Time
The Proposal
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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
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Proposal initiated by Ashley Blum
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Inception of Facility program: July 1, 2010
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Total clients to date: 92 facility clients
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Success rate: 100% (86 approved, 6
pending)
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Average days from date of application to
date of DDS decision: 39.7 days
Identify Stakeholders
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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
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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
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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)
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Miami-Dade County, Florida
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Implemented to divert people with SMI
away from the criminal justice system
into community-based treatment and
services
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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
Access
to
Housing
• Healthier
individual
• Promotes
healthier
communities
• From “ex-con”
to paying
customer
• Integration into
community
This Process Takes Time
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Time to train and learn
– 2-day training
– On-going support
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Time to do
– Not a “file it and forget it” approach
– FTE dedicated to SOAR
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Time to see results
– 1 year to see results
– 2 years for a fully functioning program
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Time to track
– SOAR OAT
Consider a PILOT site
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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
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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
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“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
[email protected]
518-439-7415 *5260
Oklahoma Mental Health Reentry
Program:
SOAR and Federal Benefit
Implementation
Bob Mann, RN, LSW
Administrator of Mental Health Operations
Oklahoma Department of Corrections
Why Do We Need a Mental
Health Reentry Program?
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Crucial Elements of a Correctional
Mental Health Reentry System
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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
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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)
How is This Interagency Mental
Health Reentry Program Unique?
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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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Benefit Planning for
Successful Reentry
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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
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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
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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
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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
120 days
from release:
6–9 months
from release:
Identify target
population
Screen for
income, resource
eligibility
Start SSI/SSDI
application
60 days
from release:
Start Medicaid
application
Day of release:
Direct person to
local SSA office
Request consents
45 days from release:
Source: Mathematica Policy
Research, Inc.
Monitor
application
status
Submit Medicaid
application
Fax certificate
of release to local
DHS office
Benefit Planning Process
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The MHRP staff get releases signed, set up
phone interviews, coordinate with ODOC
Mental Health Services clinical staff who
prepare the discharge summary
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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
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Benefit Planning Challenges
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Documenting functional ability in a correctional
setting: DOC clinical staff SOAR training, meetings
with DDS staff medical consultants and specified
examiners.
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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)
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Sharing not just clinical information- disciplinary
reports are also helpful measures of functionality
Benefit Planning Challenges
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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
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2013 Electronic Information Exchange Agreement
between DDD and ODOC signed. Allows DDD staff direct
access to ODOC Electronic Health Record.
Benefit Planning Challenges
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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
Percent with Approved Disability Determination
Oklahoma DOC
Rate (Oct 2007-…
89.9%
Oklahoma DOC
Rate (Oct 2006-…
Oklahoma Average
(Sept 2008)
National Average
(Sept 2008)
52.0%
39.7%
36.6%
Source: Oklahoma Department of Rehabilitative Services, Disabilities Determination Division.
Offenders Enrolled in Medicaid
MHRP offenders were over 4 times more likely to be enrolled in Medicaid
at prison release than the baseline comparison group.
75%
Baseline Comparison
RICCTS
46.8%
50%
28.4%
25%
14.5%
6.3%
0%
Medicaid Enrollment at Release
from Prison
Medicaid Enrollment within 90 Days
of Release from Prison
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Rate of Engagement
Offenders Receiving 4 Services Within 44 Days of Release from DOC
Service engagement rates for MHRP offenders were over 5 times more than the
baseline comparison group.
75%
63.6%
50%
25%
11.7%
0%
Baseline Comparison
RICCTS
4
Inpatient, Outpatient &
Pharmacy Services
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.
100%
Baseline Comparison
RICCTS
83.8%
75%
64.8%
55.1%
50%
35.7%
25%
8.7%
1.6%
0%
Percent of Offenders Receiving Percent of Offenders Receiving Percent of Offenders Receiving
Inpatient Services
Outpatient Services
Pharmacy Services
4
Offenders Returning to Prison
Within 36 Months
50%
42.3%
25.2%
25%
0%
Baseline Comparison
RICCTS
Contact Information
Bob Mann, RN, LSW
Administrator of Mental Health Operations
Oklahoma Department of Corrections
405.962.6137
[email protected]
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
[email protected]
www.facebook.com/soarworks
Twitter: @soarworks