Minutes from the 2/4/05 Statewide Offender Re-Entry Initiative

Absent: Jeri Boisvert (DPS), Jody Pepinski (DOC), Amy Roberts (Education)

Guests: Cynthia Godin and Jeffrey Hunsberger (DHS), Pat Orud (DOC)

Introduction:

To put the discussion of best practices in mental health and chemical dependency in context, Pat Orud discussed the DOC perspective:  The DOC has transition services throughout the agency for sex offenders, behavior health and discharge planning for severe mental illness.  It has been shown that offenders with mental health and chemical dependency issues function poorly in society and have a higher rate of incarceration.  Research shows that services sometimes fall apart when they walk out the door; the more we can help them prepare for the challenges of the community and be ready with support services when they walk out the door, the more successful reentry is.  There have been recent shows and articles on the “criminalization” of mental health; 25% of offenders are on psychiatric medications, which is a higher rate than in the community-at- large.  To help reduce the risk of future criminal behavior, an initiative was begun several years ago that included hiring 3 discharge planners; in 4 years, this effort has demonstrated a substantial reduction in returns to facilities. Discharge planners: . Make appointments . Assist in obtaining housing . Generally work 20 – 40 hours, per client

MCORP Minutes 06/28/05 – Page 1 of 7  Because of the additional barriers in placing sex offenders, an additional 4 discharge planners have been requested.  Using this model, there is a continuity of care across systems of care

Chemical Dependency Best Practices – Jeffrey Hunsberger:

The first point made was that there isn’t a single treatment option that is appropriate for everybody. Jeffrey handed out the 13 Principles of Effective Treatment [Source: National Institute of Drug Abuse, NAIDA]. These constitute the best practices in chemical dependency treatment. Rather than discussing those in depth, time was spent discussing the issues facing chemical dependency treatment in Minnesota today. Points made were:  The chemical dependency/social security continuum could be closer if we could work more productively with counties; specifically: . All people who qualify on economic grounds, below the federal poverty level, get an assessment & referral; most offenders being released would qualify. . Reportedly, it’s been impossible to get an assessment before offenders are released; once they’re released, it’s hard to get them to do it because their disorder “convinces” them they don’t need to do anything about it. . When discussing possible solutions to the discontinuity of service problem, it was noted [by a participant] that in an effort to get people enrolled in treatment very quickly, discharge planners are qualified as Rule 25 assessors. . Counties don’t have to re-assess; some accept the discharge planners’ assessment. . Most offenders qualify for general assistance medical care, which makes them eligible for the Consolidated Chemical Dependency Treatment Fund (CCDTF); the CCDTF is managed by the state, but counties, who have the authority to authorize treatments payments from the CCDTF, are on the hook for 15%, although oftentimes they pay more. . CCDTF is a forecast item, an entitlement in the state budget, and is replenished as need arises. Fixed and limited county budgets may affect some counties’ ability to meet their residents’ treatment needs.  There are two new licensing rules: Rule 2960 for juvenile residential care and Rule 31, which is a treatment licensing rule for facilities providing non-residential CD programs for adolescents and all CD programs for adults. Programs licensed under these rules are able to access the CCDTF.  There is a need to identify the core information that should be included in treatment plans; there is a Rule 25 rewrite underway that will be based on 6 dimensions and will fit with the same continuous assessment requirement in the treatment rules. The characteristics identified in six dimensions outline the treatment plan basics and establish a baseline for current and possibly future treatments.  Generally, in the field of chemical dependency, they are seeing fewer readmits in the first year and 2/3 of those in treatment have been in treatment before.

Mental Health Best Practices – Cynthia Godin:

MCORP Minutes 06/28/05 – Page 2 of 7 In addition to handouts on the Evidence Based Practices for Mental Health Treatment Services, statutory definitions, and new community-based mental health services, Cynthia made the following points: Discharge planning occurs prior to the offender leaving the facility, with collaborative planning involving the offender, Corrections personnel, and in some cases, county social service case management. Offenders can begin the application process for county case management services, cash assistance, and health plan enrollment at this time. This planning assists the offender in transitioning to community-based county social service case management services which could include help in obtaining housing, job searches, and mental health services. DOC now has professionals able to do diagnostic assessments. Increased collaboration between DOC and DHS has been to increase the availability of DOC psychiatric records to the community-based mental health treatment provider, so that diagnostic assessments are not duplicated. Diagnostic assessments by a licensed mental health professional are used to determine healthcare eligibility for individuals with a mental illness disability. For the past two decades DHS has been moving toward the expansion of community- based mental health services for adults. Significant milestones have been reached over the past five years in the development of new community-based mental health services. County regional planning groups have been working with the Minnesota Department of Human Services over the past two years to decide which array of adult community- based services will best support consumers’ recovery. This past fall DHS carefully reviewed those plans and began to approve state funding for a variety of new services, proven to be effective in treating mental illness, which include the following to date: • 25 Assertive Community Treatment teams statewide, including 15 in the Twin Cities metropolitan area. These teams of professionals from multiple disciplines serve as “hospitals without walls,” offering intensive, round-the-clock supports to people with serious mental illness in their homes, at work and elsewhere in the community. Implementation of the ACT teams began in January 2005. • 34 Intensive Residential Treatment facilities, with up to 16 beds, including 15 in the Twin Cities metropolitan area. IRTs provide a more intense, step-down-from-hospital level of service than the Rule 36 residential facilities they replace. The first IRTs began operations in November 2004. • A statewide allocation to counties of 55 new Community Alternatives for Disabled Individuals slots. CADI dollars fund a comprehensive package of Medical Assistance services that can be used to provide care and support for people to live in their own home, instead of in a nursing home. The first of these slots will be approved for funding in July 2005 with others being approved and implemented during the course of this year. Sixteen-bed inpatient psychiatric hospitals in Alexandria, Brainerd, Fergus Falls, Monticello, Rochester, St. Cloud, St. Peter and Wadena. All of these facilities are expected to be up and running in 2006. 22 crisis service providers have joined the system since March 15, 2002 when these services became eligible for Medical Assistance funding. In addition, there are now a total of 15 hospitals across the state with contracts to provide extended inpatient care to adults who, in the past, were only served in the regional treatment centers. The total planned inpatient acute psychiatric capacity in the system will be similar to what exists today in the regional treatment center system.

MCORP Minutes 06/28/05 – Page 3 of 7 Development of the community-based services is naturally leading to the vacation of regional treatment centers, a development that is freeing up funding for these service improvements. These services are expected to make it possible to discontinue providing inpatient mental health services on the Brainerd, Fergus Falls, St. Peter and Willmar campuses over the next 12 to 18 months. Discontinuing property maintenance of the Brainerd, Fergus Falls and Willmar campuses alone will free up about $3 million for community-based adult mental health services. 81 Adult Rehabilitative Mental Health Services (ARMHS) providers have been certified with DHS since 2002. ARMHS services, for which many ex-offenders may be eligible, are mental health services which are rehabilitative and enable the recipient to develop and enhance psychiatric stability, social competencies, personal and emotional adjustment, and independent living and community skills, when these abilities are impaired by the symptoms of mental illness. Adult rehabilitative mental health services are also appropriate when provided to enable a recipient to retain stability and functioning, if the recipient would be at risk of significant functional decompensation or more restrictive service settings without these services. Adult rehabilitative mental health services instruct, assist, and support the recipient in areas such as: interpersonal communication skills, community resource utilization and integration skills, crisis assistance, relapse prevention skills, health care directives, budgeting and shopping skills, healthy lifestyle skills and practices, cooking and nutrition skills, transportation skills, medication education and monitoring, mental illness symptom management skills, household management skills, employment-related skills, and transition to community living services. Crisis Response Services available include mental health crisis assessment, mental health mobile crisis intervention services, and mental health crisis stabilization services.

An eligible recipient for ARMHS is an Medical Assistance eligible individual who is age 18 or older; is diagnosed with a medical condition, such as mental illness or traumatic brain injury, for which adult rehabilitative mental health services are needed; has substantial disability and functional impairment in three or more areas, so that self- sufficiency is markedly reduced; and has had a recent diagnostic assessment by a qualified professional that documents adult rehabilitative mental health services are medically necessary to address identified disability and functional impairments and individual recipient goals. Please note that this definition is more inclusive than the statutory definition of serious and persistent mental illness (SPMI) as described in the Comprehensive Mental Health Act.

People with traumatic brain injury (TBI) have access to ARMHS; this may be a good fit with released offenders, because many offenders have TBI. Many long-term homeless have TBI and may be released offenders. ARMHS has done a very good job working with Housing; one of the advantages is that the service can move with them. If they move, they don’t lose their support. Again this may be a good fit with offenders, because they often have scattered housing histories. Note: they are looking at clusters of housing.

MCORP Minutes 06/28/05 – Page 4 of 7 An Intensive Residential Treatment facility (IRTS), licensed by DHS, will be opening in fall 2005 in Hennepin County to provide intensive mental health services. It will be operated by a non-profit provider called Tasks Unlimited. When a court intends to commit an offender with a serious and persistent mental illness to the custody of the commissioner of corrections for imprisonment at a state correctional facility, either when initially pronouncing a sentence or when revoking an offender’s probation, the court, when consistent with public safety, may instead place the offender on probation or continue the offender’s probation and require as a condition of the probation that the offender successfully complete an appropriate supervised alternative living program having a mental health component. This first IRTS will have 6 beds. Questions raised: 1. If they receive benefits, will they have to contribute? Yes, a portion. 2. If they receive general assistance medical care, will they have to contribute? It’s likely that they may have to.

CD/MH in the Department of Corrections – Pat Orud:

Pat noted that the Tasks Unlimited facility was originally targeted for released offenders; because of community acceptance, the mission changed. It’s a resource that is also needed for those leaving prison.

Best practices for chemical dependency and the list of 6 assessment dimensions are being put in place in the DOC. An integrated, dual-disordered treatment is more effective; the chance of success is more restricted if treatment is provided separately.

Whether inside a facility or in the community, chemical dependency is a chronic, recurring problem requiring attention to varying degrees. Community treatment is not a duplication of services but rather a continuation of the treatment process. While no single treatment is effective for all individuals, offenders tend to respond better to cognitive behavioral therapy. Dual disorder offenders are generally higher functioning on the mental health side and can participate in groups. At intake, offenders are screened for mental health and chemical dependency. DOC uses the TCU screen developed for correctional populations. If there is a need for a more specific diagnosis, then a more comprehensive assessment (multiple sources at multiple times, longitudinal) is done. The DOC chemical dependency assessor is not licensed for assessments done by psychologists.

Expanding on the previous discussion regarding counties, Pat noted that the 87 Minnesota counties use assessment as a gate-keeping mechanism to manage budgets not just to assess treatment needs; because of limited resources, they use assessment to prioritize resources.

In response to a question regarding prescription refills for just-released offenders, Pat said offenders may be eligible for medical assistance before they are released; they just need to fill out the paperwork. As part of the mental health discharge plan, DOC can make sure that’s done. Offenders have a 30-day supply, plus a prescription for 30 days; this gives them adequate time to find community provider. Of course, this is dependent on the offender being proactive.

MCORP Minutes 06/28/05 – Page 5 of 7 Because Minnesota is a “diversion” state, we have the second lowest rate of incarceration and the lowest per capita prison cost. Following is a picture of a typical MN offender:

. By the time offenders are committed to the DOC, they have racked up a lot of time (people in jails have a shorter history of criminal behavior) . Offenders have a complex array of disorders . Offenders are a risk to public safety and have a demonstrated level of criminality . Offenders have a character structure that engages in criminal lifestyle; case management has to take into account the offender’s criminal value system . Offenders may have 9+ prior treatment attempts which may not be taken into account by a community chemical dependency treatment program that typically just addresses the symptoms . Offenders may have 3 – 5 mental health diagnoses . Offenders often have chronic medical issues (diabetes, liver) . Offenders have psychological problems . Offenders have lots of involvement with social services (or running from social services, as in the case of child support collection)

The trend toward integrated services will serve our population well; the first job of DOC is public safety. DOC is one of the largest treatment providers in the state; many of those identified with chemical dependency needs also have a mental health diagnosis. DOC has had administratively integrated services for the last few years under one administrative umbrella. A fully integrated clinical approach is the next goal. With public safety in mind, an integrated approach will help reduce criminal behavior by addressing the issues that are contributors to criminal behavior.

DOC has established services to be consistent with the community; they now have licensed chemical dependency and mental health professionals, adhere to community standards, and are consistent in language and practice. DOC rules are consistent with DHS and DOC services are consistent with the requirements in DHS Rule 31.

DOC intake has a comprehensive assessment approach for chemical dependency, mental health, medical, risk, and correctional needs. DOC does have limited funds, it not a pass-through like the CCTF; DOC must prioritize who will get the services. Even if it is recommend that an offender needs treatment, they may or may not get it; this is why another assessment is necessary upon release for referral to community care.

Twenty-five percent of those directed to CD treatment actually get a treatment offer. DOC treats 1400 – 1800 offenders a year; 4,000 need to be treated. One of the conditions of release is that offenders follow professional recommendations for mental health, medical and chemical dependency care.

Release violators often go back to chemical use; they get discouraged upon release and give up and go back to what they know. A comprehensive case plan is a big part of making release successful, i.e., a correctional case plan for effective case management.

There are not enough services in the community designed for the release population; once you get an idea for a program, you have to meet standards to get licensed and get an established rate system

MCORP Minutes 06/28/05 – Page 6 of 7 approved by the county. The criminogenic behavior of offenders makes it hard for community providers to get adequate funding to treat all the issues.

Note: Reggie brought up the linkage to veterans benefits and that these are often available to families of offenders while the offender is incarcerated.

Subcommittee Reports: (Slideshow summary attached)

. Population Profile – Chris Bray . System Map – Susan Allan . Assessment – Lynda Boudreau . Offender Programming – Jeff Shorba . Pre-Release Planning – Tim Lanz . Supervision – Ken Merz . Post Supervision – Dave Ellis

Miscellaneous: Meeting dates – Chris discussed options for the next two upcoming meetings. NIC has supported us with technical assistance, and we have asked that this continue for the next 6 months. . The next meeting is scheduled for July 14th; Paul Herman will facilitate . August 22nd is targeted for the next meeting to accommodate Gary Kempker (MO)

Criminal Justice Institute – The 40th Annual Criminal Justice Institute is scheduled for August 22 – 24, 2005 in Bloomington, MN.

Legislative committee meeting – There will be a legislative committee meeting scheduled for August 24th in the afternoon with Senators Ranum, Foley, and Smith.

Re-convene & report back to commissioners – It was agreed that MCORP would report back to the agency commissioners and the courts’ chief of administration in January 2006 on Steering Committee progress and an update on the strategic plan.

Website overview – Minutes, articles, reports, calendar items are on the MCORP website: http://www.forums.doc.state.mn.us/mcorp/default.aspx

Updating the Work Grid – After each meeting, an updated work grid will be posted on the website.

MCORP Minutes 06/28/05 – Page 7 of 7