# Presentation: 395401

## Discharge Policies

- George Epp and Tracy D’Alanno
- National Learning Meeting
- October 7–8, 2004

## 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

## 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

## 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

## 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

## 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

## 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

## 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.

## 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

## 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

## 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

## 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

## 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

## Referrals/AdmissionsJuly 2000–March 2003

- 467 jail inmate were evaluated
- 182 were admitted to PACE
- Clients admitted were 40% female, 60% male

## 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

## 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

## 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

## Average Jail Days Per Year Per Client, 2000–2003

- Before PACE entry: 56
- After PACE entry: 3.4
- Days avoided: 52.6

## Goal: Avoid Cost IncreaseCost Avoidance 2000–2003

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

## Goal: Increase Successful Functioning

| Client employment | Before Pace | After PACE |
| --- | --- | --- |
| Employed | 33% | 61% |
| Unemployed | 52% | 9% |
| Receiving Disability | 15% | 27% |

## 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

## Goal: Increased Sobriety

- 98% of PACE clients had problems with substance abuse prior to program entry
- 66% of clients achieved and maintained sobriety

## 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

## 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

## 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

## Challenges and Barriers

- Housing
- Funding
- Leadership
- Paradigm shift

## 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