Slide 1

**Discharge Policies**

**George Epp and Tracy D'Alanno**

**National Learning Meeting**

**October 7--8, 2004**

Slide 2

**PACE-Partnership for Active Community Engagement**

-   Boulder County Sheriff

-   Chief Judge of the 20th Judicial District

-   Boulder County Commissioners

-   Boulder County Probation

-   Boulder County Community Corrections

-   Boulder County Public Health Department

-   Mental Health Center of Boulder County, Inc

Funded by a Byrne grant from the Colorado Division of Criminal Justice
and match from participating agencies

Slide 3

**Presenting Problem**

-   The Boulder County Jail faced chronic crowding

-   Percentage of jail inmates with mental disorders grew from 17% in
    1996 to 31% in 1999

-   For over 10 years, the jail and the Mental Health Center have had an
    effective system to move the most seriously mentally ill from jail
    to mental health treatment facilities

-   This system did not address offenders with less serious illnesses
    who do not fit the legal requirements for involuntary treatment

Slide 4

**Development of Project**

-   With the leadership of Chief Judge Bailin and Sheriff Epp a
    subcommittee of the Criminal Justice Management Board was formed to
    better define the problem and propose solutions

-   Committee membership included:

    -   The chief judge and a county judge

    -   The sheriff, jail captain and other law enforcement agencies

    -   Probation and community corrections

    -   The district attorney and public defender

    -   The mental health center and the public health department

Slide 5

**Planning Process**

-   Review of the recommendations of the Colorado Legislature's Interim
    Committee on the mentally ill in the justice system

-   Further assessment of the data and problem with the help of a
    consultant from the National Institute of Corrections

-   Review of current research regarding effective interventions with
    offenders who have co-occurring mental illness and substance abuse

-   Discussion and consensus regarding a problem statement, a proposed
    solution, and a target population description

Slide 6

**Goal of PACE**

-   Provide an integrated treatment and diversion program that reduces
    jail use and increases sobriety, stability, and employment for the
    targeted population of mentally ill offenders, without increasing
    costs

Slide 7

**Current Treatment Knowledge**

-   New psychiatric medications with fewer side effects are successful
    with more people

-   Length of substance abuse treatment is critical, not whether
    treatment is voluntary or involuntary

-   Community-based, intensive treatment, and case management services
    are effective in helping adults with major mental illness recover

-   Progress towards recovery, abstinence, and employment is often
    incremental leading to shorter setbacks and longer periods of
    success

Slide 8

**Hypothesis**

-   We know that integrating mental health treatment and substance abuse
    treatment leads to better outcomes than if each is provided
    separately

-   If correctional supervision is integrated with treatment, outcomes
    should improve.

Slide 9

**Target Population**

-   Adult offenders with mental illness who have a history of
    incarceration

-   Many also will have substance abuse problems

-   Mental disorders will include those for which a medical intervention
    can improve outcome:

    -   schizophrenia, bipolar disorder, major depression, panic
        disorder, obsessive-compulsive disorder, and attention deficit
        disorder

-   Adults with major mental illness who are already in daily monitored
    treatment through the Mental Health Center will be excluded since
    they are already receiving effective treatment

Slide 10

**Critical Program Elements**

-   Continuing commitment of participating agencies, common goals, and a
    common vision of the program

-   Commitment of staff resources by key agencies as part of the grant
    match

-   An integrated, colocated multidisciplinary team including:

    -   Full-time probation officer

    -   Full-time clinical director

    -   Mental health/substance abuse therapist

    -   Part-time psychiatrist and psychiatric nurse practitioner

    -   Service assistant (case aide)

    -   Administrative support worker

    -   Life skills training onsite

Slide 11

**Colocated Multidisciplinary Team**

-   To improve client compliance and participation

-   To ensure tight communication between criminal justice and mental
    health/substance abuse treatment staff

-   To ensure that all service providers and the consumer have all of
    the necessary information to help the consumer and protect the
    community

-   To provide consistent interventions and structure

Slide 12

**Probation Integrated with Treatment**

-   Recovery model which fully includes each client in assessment,
    setting goals, and developing service plans

-   Regular reviews which include the client, appropriate, supportive
    persons, the district attorney, the defense attorney, and providers

-   Commitment to providing:

    -   Community safety

    -   Respect

    -   Empathy

    -   Hope

    -   Continuous treatment relationships

    -   A longitudinal perspective

Slide 13

**Treatment Services**

-   Daily support and recognition of strengths

-   Daily monitoring of psychiatric medications and Antabuse

-   Daily observation of mental status and sobriety, including sobriety
    testing

-   Service assistance to access basic needs

-   Help with finding and maintaining employment

-   Life skills training and practice

-   Integrated substance abuse and psychiatric treatment

-   On-site probation services

Slide 14

**Referrals/Admissions, July 2000--March 2003**

-   467 jail inmate were evaluated

-   182 were admitted to PACE

-   Clients admitted were 40% female, 60% male

Slide 15

**Client Characteristics**

-   The most frequent primary diagnoses are:

    -   Bipolar disorder

    -   Major depression

    -   Schizophrenia

-   The most frequent secondary diagnoses are:

    -   Personality disorders

    -   Over 98% of the clients have histories of substance abuse

    -   Anxiety disorders

Slide 16

**Client Characteristics at Entry**

-   LSI (Level of Supervision Inventory) scores of PACE averaged 27.9
    with a minimum score of 13 and a maximum score of 42. These scores
    indicate many PACE clients are prison bound

Slide 17

**Goal: Reduce Jail Use**

-   Offenders served, June 2000-March 2003: 182

-   Jail days served during the year prior to program entry : 10,767

-   Re-arrests: 34

-   Jail days after program entry: 759

-   Projected jail days saved: 10,008

Slide 18

**Average Jail Days Per Year Per Client, 2000--2003**

-   Before PACE entry: 56

-   After PACE entry: 3.4

-   Days avoided: 52.6

Slide 19

**Goal: Avoid Cost Increase Cost Avoidance 2000--2003**

-   10,008 jail days avoided @ \$61.50 per day = \$615,492

Slide 20

This slide is a description of increase in successful functioning. The
chart details client employment by percentage. Before the Partnership
for Active Community Engagement (PACE) program, 33% were employed, 52%
were unemployed, and 15% were receiving disability. After PACE 61% were
employed, 9% were unemployed, and 27% received disability.

Slide 21

**Goal: Community Benefit**

-   Increase in employment translates to a change from a negative to a
    positive in the community balance sheet

-   Instead of being supported by community resources, PACE clients
    become taxpaying supporters of the community

Slide 22

**Goal: Increased Sobriety**

-   98% of PACE clients had problems with substance abuse prior to
    program entry

-   66% of clients achieved and maintained sobriety

Slide 23

**Funding Sources**

-   Byrne Grant funding: \$149,450

-   Local Match: \$181,095

    -   Sheriff \$31,990

    -   Mental Health \$70,827

    -   Public Health \$17,216

    -   Probation \$48,561

    -   Community Corrections \$12,501

Slide 24

**New Criminal Cases for PACE Clients Accepted During 2000**

-   Total clients accepted in 2000: 36

-   Number rearrested on new charges as of June 2003: 4

-   Percent of re-arrests: 11%

-   Charges on re-arrests

    -   Theft: 2

    -   Walk-away from work release: 1

    -   Assault: 1

Slide 25

**Key Factors in the Success of PACE**

-   Multi-disciplinary team

    -   Integrated treatment and supervision

-   Co-located team

    -   Seasoned, well trained, creative staff

-   Caring and supportive treatment environment

-   Flexibility

-   Swift and sure consequences

-   Emphasis on continuity of treatment

-   Collaborative support from key leaders

Slide 26

**Challenges and Barriers**

-   Housing

-   Funding

-   Leadership

-   Paradigm shift

Slide 27

**For More Information**

-   **Sandy Rothman, Clinical Director**

    -   **Phone: 303-245-0894**

    -   **E-mail: srothman@mhcbc.org**

-   **George Epp**

    -   **Phone: 720-344-4609**

    -   **E-mail: george.epp@csoc.org**