Guidelines for the Successful 

Transition of People with Behavioral 

Health Disorders from Jail and Prison

Alex M. Blandford, MPH, CHES

Fred Osher, MD

Council of State Governments Justice Center

SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation

The Council of State Governments Justice Center

[Assess Plan Identify Coordinate]
Guidelines for the Successful 

Transition of People with Behavioral 

Health Disorders from Jail and Prison

Alex M. Blandford, MPH, CHES

Fred Osher, MD

Council of State Governments Justice Center

SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation

Council of State Governments Justice Center

November 2013
This work was conducted by SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation 

(GAINS Center), operated by Policy Research Associates, Inc., in collaboration with the Council of State 

Governments Justice Center (CSG Justice Center), and was authored by Alex M. Blandford, MPH, CHES, 

and Fred C. Osher, MD. Support for this work came from U.S. Department of Health and Human Services’ 

Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health 

Services (CMHS) and the Department of Justice’s (DOJ) Bureau of Justice Assistance (BJA). The material 

contained in this publication does not necessarily represent the position of the U.S. Department of Health 

and Human Services or the U.S. Department of Justice. 

The suggested citation for this resource is Blandford, Alex M. and Fred C. Osher. Guidelines for the 

Successful Transition of Individuals with Behavioral Health Disorders from Jail and Prison. Delmar, NY: 

SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation, 2013. 

About SAMHSA’s GAINS Center: Since 1995, SAMHSA’s GAINS Center has been operated by Policy 

Research Associates, Inc. in Delmar, NY. The GAINS Center’s primary focus is on expanding access 

to community based services for adults diagnosed with co-occurring mental illness and substance 

use disorders at all points of contact with the justice system. The Center emphasizes the provision of 

consultation and technical assistance to help communities achieve integrated systems of mental health 

and substance abuse services for individuals in contact with the justice system.

345 Delaware Avenue

Delmar, NY 12054

http://gainscenter.samhsa.gov/

About the CSG Justice Center: The Council of State Governments Justice Center is a national nonprofit 

organization that serves policymakers at the local, state, and federal levels from all branches of 

government. It provides practical, nonpartisan advice and consensus-driven strategies—informed by 

available evidence—to increase public safety and strengthen communities. 

100 Wall Street, 20th Floor

New York, NY 10005

www.csgjusticecenter.org
iii

Acknowledgments.....................................................................................................................v

Introduction.............................................................................................................................. 1

Table 1: Estimated Proportion of Adults with Mental Health, Substance Use, and Co-occurring

 Disorders in U.S. Population and under Correctional Control and Supervision .......................................... 1

Building Effective Partnerships Through a Shared Vision ........................................................2

Implications for Successful Transition and Reentry.................................................................. 5

Figure 1: Summary of Guidelines................................................................................................................. 6

Assess — Guidelines 1 & 2 ......................................................................................................9

Table 2. “Central Eight” Risk Factors That Place a Person at Risk for Future Criminal Behavior...10

Plan — Guidelines 3 & 4 .........................................................................................................13

Identify — Guidelines 5 & 6 ....................................................................................................17

Coordinate — Guidelines 7–10...............................................................................................21

Conclusion...............................................................................................................................27

Appendix A. Evidence-Based Practices and Programs for Individuals

with Behavioral Health Needs in the Criminal Justice System...........................................29

Appendix B. Information Sharing in the Criminal Justice-Behavioral Health Context:

HIPAA and 42 CFR...................................................................................................................31

Endnotes ..................................................................................................................................33

Contents

v

SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation (GAINS) in partnership with 

The Council of State Governments Justice Center (Justice Center) produced this technical assistance 

resource with support from the U.S. Department of Health and Human Services’ Substance Abuse 

and Mental Health Services Administration (SAMHSA) and the U.S. Department of Justice’s Bureau of 

Justice Assistance (BJA). The project staff thanks the leaders of these agencies for their commitment to 

addressing the overrepresentation of people with behavioral health disorders in jails, prisons, and under 

probation and parole supervision. Special thanks to Danica Binkley, BJA; Dr. Larke Huang, SAMHSA; Dr. 

David Morrissette, SAMHSA; Ruby Qazilbash, BJA; and Kenneth Robertson, SAMHSA.

Agencies collaborating on this project included the National Association of State Mental Health Program 

Directors, the National Association of State Alcohol and Drug Abuse Directors, Association of State 

Correctional Administrators, and the American Probation and Parole Association.

In addition, project staff gratefully acknowledge the contributions of the group of practitioners who provided 

invaluable ideas and feedback on earlier drafts. Special thanks go to Steven Allen, Executive Director, 

Mental Health And Substance Abuse Treatment Services, DHS Direct Care at the State of Minnesota; 

Marianne Cripps, Peer/Case Manager at the 31st Judicial Drug Court in Tennessee; Laverne Miller, 

Senior Project Associate, SAMHSA's GAINS Center; and Dr. Merrill Rotter, Associate Clinical Professor 

Of Psychiatry at the Albert Einstein College Of Medicine.

Acknowledgments

1

Progress has been made in recent years to reduce the number of individuals with behavioral health2 

disorders (mental and/or substance use disorders) who are incarcerated and to expand interventions that 

address the many factors that lead to their involvement in the criminal justice system. However, these 

individuals continue to be overrepresented in criminal justice settings. High arrest and recidivism rates still 

act as barriers to the recovery paths of these individuals, create stress for their families, and adversely affect 

public safety and government spending. As reflected in Table 1, research confirms that many individuals 

under correctional supervision have mental or substance use disorders, or both. 

General 

Public

State 

Prisons Jails Probation and Parole

Serious Mental Disorders 5.4%4 16%5 17%6 7–9%7

Substance Use Disorders (Alcohol and Drugs) 

— Abuse and/or Dependence 16%8 53%9 68%10 35–40%11 

A Co-occurring Substance Use Disorder When 

Serious Mental Disorder Is Diagnosed 12 25%13 59%14 72%15 49%16

A Co-occurring Serious Mental Disorder When 

Substance Use disorder Is Diagnosed 17 14.4%18 59.7%19 33.3%20 21% 21

Table 1. Estimated Proportion of Adults with Mental Health, Substance Use, and Co-occurring Disorders in 

U.S. Population and under Correctional Control and Supervision3

Despite the significant number of individuals with behavioral disorders in the criminal justice system, 2010 

marked the first time in nearly 40 years that the number of state prisoners in the United States declined.22 

To achieve better outcomes, policymakers and researchers agree that a shift away from a reliance on 

incarceration to an emphasis on expanding capacity to supervise and treat individuals in the community 

is necessary. This shift has focused attention on the importance of cross-system approaches to providing 

effective criminal justice and behavioral health treatment interventions with the dual goals of reducing 

recidivism and promoting recovery. A critical component of cross-system work occurs at the transition from 

jail or prison to the community. Reentry into the community is a vulnerable time, marked by difficulties 

adjusting, increased drug use and a 12-fold increased risk of death in the first two weeks after release.23 

Effective transition planning and implementation can minimize the risk of these hazards, enhance public 

safety by increasing the possibility that individuals will participate in and complete supervision and treatment 

requirements, and improve individual outcomes. 

Introduction

Transition planning can only work if justice, mental health, and substance 

abuse systems have a capacity and a commitment to work together.1
2

Building Effective Partnerships Through a Shared Vision

While there is overlap in the populations they serve, there is little consensus among behavioral health 

care, corrections, and community corrections administrators and providers on who should be prioritized 

for treatment, what services they should receive, and how those interventions should be coordinated with 

supervision conditions. Too often, corrections and community corrections administrators hear that “those 

aren’t my people” from behavioral health care administrators and providers. Just as often, the behavioral 

healthcare community feels that it is asked to assume a public safety role that is not in sync with its primary 

mission. Misunderstandings about each system’s capacity, abilities, and roles—as well as appropriate types 

of referrals—have contributed to the overrepresentation of behavioral health disorders in the criminal justice 

system. Renewed emphasis on efficiency and results within the criminal justice and behavioral health systems 

has increased the focus on effective and quality interventions designed with key outcomes in mind. 

To help professionals in the corrections and behavioral health systems take a coordinated approach to reducing 

recidivism and advancing recovery, Adults with Behavioral Health Needs Under Correctional Supervision: A 

Shared Framework for Reducing Recidivism and Promoting Recovery (Behavioral Health Framework) was 

Health Care Reform and Opportunities for Expanded Access to 

Behavioral Health Services

Over the past five years, the United States has seen the passage of several laws making major changes 

to our health care system, including the:

 2008 passage of the Mental Health Parity and Addiction Equity Act (MHPAEA);

 2009 passage of the Health Information Technology for Clinical and Economic Health (HITECH) 

Act; and 

 2010 passage of the Patient Protection and Affordable Care Act (ACA). 

Taken together, these health care reforms will require more comprehensive health care coverage, 

especially for mental health and substance abuse services; expand health care coverage to millions 

of Americans; and promote quality of care and care coordination through the electronic exchange of 

health information. Implementation of these laws is just now gaining full steam, and the implications for 

individuals under correctional and community-based supervision are yet to be realized. 

As many as 90 percent of individuals involved in the criminal justice system are uninsured, but expanded 

eligibility under the ACA will greatly reduce these numbers. Starting on January 1, 2014, many in the 

criminal justice-involved population are expected to be eligible for coverage in either Medicaid or a 

federally subsidized health plan offered in the Marketplace. Importantly, protections on coverage required 

by the ACA and the MHPAEA will ensure that all plans offer comprehensive coverage of “essential 

health benefits,” including coverage of mental health and substance abuse services at parity, i.e., on a 

basis that is no more restrictive than coverage for medical/surgical coverage. In addition, payment and 

delivery reforms authorized by the ACA and the improved ability of health care providers to record and 

share health information electronically resulting from the HITECH Act will work in concert to promote 

care coordination and quality.

These health system changes represent an opportunity to improve access to comprehensive health 

care services, improve continuity of care between incarceration and reentry, and reduce state and local 

expenditures for individuals involved with the criminal justice system. To help realize this potential, 

systems should support applications and enrollment at all points in the justice system, including during 

incarceration. Stakeholders should also commit to the use of comprehensive, coordinated primary and 

behavioral health care, which studies have shown can reduce recidivism and build recovery.
3

Prioritizing Enrollment to Facilitate Transition

To ensure successful transition planning, states and counties must address the need for 

timely access to benefits.

Health insurance coverage and Social Security benefits are key to successful transition planning so 

that individuals can access required services in a reliable and timely manner. Whether health insurance 

coverage is accessed through Medicaid or a subsidized plan offered through Health Insurance 

Marketplace, it is critical for ensuring access to essential treatment services (psychiatric treatment, 

health care, medications, etc.) upon reentry to the community. 

For individuals with serious disabilities, Supplemental Security Income (SSI) and Social Security 

Disability Insurance (SSDI) provide a monthly income benefit, which can be used for housing. In most 

states, qualification for SSI or SSDI also entitles an individual to enroll in Medicaid or Medicare, ensuring 

access to both income supports and healthcare coverage. While the application process for SSI/SSDI 

is lengthy and can be time consuming, this comprehensive benefit can help to meet the full range of an 

individual’s basic needs and has been shown to be instrumental in facilitating successful reentry.

It is in everyone’s best interest for jails and prisons to develop community partnerships to ensure timely 

access to benefits upon release. Four key areas must be addressed to ensure timely access to benefits:

 Develop MOUs or Letters of Agreement with county social services agencies and the Social 

Security Administration.

 These documents clarify procedures for submission of benefit applications, response time for 

determinations, and enrollment procedures.

 Some states have passed Medicaid suspension statutes that require that Medicaid can be 

reactivated upon release from custody.

 Social Security Outreach, Access and Recovery (SOAR) is an approach focused on facilitating 

the submission of SSI/SSDI applications through training that results in approval rates of 70–

90 percent. This training has been successfully implemented in jails and prisons. Each state 

has a SOAR team lead and training transition staff may be available. For further information: 

http://www.prainc.com/SOAR.

 Screen for benefits.

 Screening for Veterans benefits, Medicaid, and Social Security benefits at point of intake will 

enable prompt processing of appropriate benefit applications.

 Designate resources to assist with preparation, submission, and follow-up of benefit applications.

 Transition planning is resource intensive and staff resources must be identified to initiate 

applications, liaise with benefit agencies, and communicate with providers. Resources can be 

jail or prison based, or community based, and are provided through in-reach by community 

staff, or shared between institution staff and community staff.

 Develop jail/prison and community partnerships to assist with transition. 

 Sharing of information, timely access to treatment, collaborative transition planning, and postrelease follow-up on benefits applications submitted prior to release are some of the activities 

that require coordination and shared responsibility. Often communities have reentry-specific 

task forces to address system barriers to transition planning. 

* In states that will not participate in ACA Medicaid expansion and where Medicaid benefits are restricted to people with 

disabilities and custodial parents, state/local or other funding may be required to obtain essential services for people 

who require mental health treatment but are not considered disabled. 
4

developed.24 The Behavioral Health Framework provides a structure to identify subgroups within the larger 

group of individuals involved in the criminal justice system based on their identified behavioral health and 

criminogenic needs (factors associated with committing future crimes; see Table 2 on page 10). In doing 

so, the Behavioral Health Framework is a helpful tool to prioritize resources and allocate those resources 

to the most effective interventions for each subgroup. The Behavioral Health Framework was funded by the 

National Institute of Corrections (NIC), the Bureau of Justice Assistance (BJA), and the U.S. Department 

of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA), 

and supported by the Association of State Correctional Administrators (ASCA), the American Probation 

and Parole Association (APPA), the National Association of State Mental Health Program Directors 

(NASMHPD), and the National Association of State Alcohol and Drug Abuse Directors (NASADAD). 

The cross-system strategies promoted by the Behavioral Health Framework are designed to 

1. advance collaboration and communication by developing a shared language associated with risk of 

criminal activity and public health needs and setting common priorities between criminal justice and 

behavioral health systems for individuals with treatment needs who are likely to commit future crimes;

2. ensure that scarce resources are used efficiently by promoting the use of validated assessment 

tools to gauge individuals’ criminogenic risk and behavioral health needs, identify the right people for 

appropriate interventions, and align and develop capacity to meet those needs;

The Risk-Need-Responsivity (RNR) Model

The underlying principles of the RNR model are:

Risk Principle: Match the intensity of individuals’ treatment to their level of risk for reoffending.

Research shows that prioritizing supervision resources for individuals at moderate or high 

criminogenic risk can lead to a significant reduction in recidivism among this group. Conversely, 

intensive supervision interventions alone for individuals who are at a low risk of recidivism will 

do little to actually change the individuals’ likelihood of committing future criminal acts, and may 

even be harmful. High-intensity supervision for low-risk people is an ineffective use of resources 

to reduce reoffending. All persons with significant behavioral health needs should have access to 

comprehensive and effective services.

Need Principle: Target criminogenic needs—those dynamic factors that contribute to the 

likelihood of reoffending.

The need principle states that individuals have criminogenic and noncriminogenic needs and that 

treatment and case planning should prioritize the core criminogenic needs that can be changed 

through treatment, supervision, or other services and supports. Research indicates that the 

greater the number of criminogenic needs addressed through interventions, the greater impact the 

interventions will have on the likelihood of recidivism. 

Responsivity Principle: Address individuals’ barriers to learning in the design of treatment 

interventions.

The responsivity principle highlights the importance of reducing barriers to learning by addressing 

learning styles, reading abilities, cognitive impairments, and motivation when designing supervision 

and service strategies. Accordingly, the presence of a mental disorder may need to be addressed to 

accommodate individuals’ level of processing so they can learn from service providers and comply 

with the conditions of their supervision or release.

Excerpt from Adults with Behavioral Health Needs Under Correctional Supervision: A Shared Framework for Reducing 

Recidivism and Promoting Recovery
5

3. promote effective practices by matching individuals’ risk and needs to programs and practices 

associated with research-based, positive outcomes and refocusing transition and other reentry efforts 

for individuals leaving prisons and jails, or who are on probation or parole, to equip them with the 

necessary skills and competencies; and 

4. improve continuity of care and community integration through development of policies and practices 

to share information across systems.

Implications for Successful Transition and Reentry

To effect successful transition and reentry, behavioral health, corrections, and community corrections 

agencies should partner on state and local levels to develop cross-system approaches based on the 

principles of the Behavioral Health Framework. Tools such as the APIC model25 can help jurisdictions 

improve outcomes for people with substance use and mental disorders who are released from jail and 

prison. Developed by corrections and behavioral health experts to guide evidence-based transition 

planning, APIC stands for: 

 Assess the individual’s clinical and social needs, and public safety risks;

 Plan for the treatment and services required to address the individual’s needs (while in custody and 

upon reentry);

 Identify required community and correctional programs responsible for post-release services; and

 Coordinate the transition plan to ensure implementation and avoid gaps in care with communitybased services.

To actualize the principles set forth by the Behavioral Health Framework, the APIC model, and evidencebased practices (EBPs), the following guidelines were developed (see the Guidelines-at-a-Glance chart on 

pages 6 and 7, and detail in subsequent pages). They are intended to promote the behavioral health and 

criminal justice partnerships necessary to successfully identify which people need services, what services 

they need, and how to match these needs upon transition to community-based treatment and supervision. 

These guidelines build upon the APIC approach and its emphasis on “building lasting bridges” between 

behavioral health and criminal justice systems to achieve “coordinated and continual health care for clients 

in both systems.” Through applying these principles, state and local policymakers and behavioral health 

and criminal justice practitioners can promote the development of effective transition and reentry practices 

for individuals with behavioral health disorders who are involved in the criminal justice system. While the 

guidelines are intended to apply across the continuum of the criminal justice system, the authors recognize 

that there are differences between the provision of behavioral health services inside correctional facilities 

and in the community; missions may differ and the comprehensiveness and access to services may vary.

The guidelines rest on two key assumptions. First, each guideline depends on meaningful collaboration 

among leadership and staff in the criminal justice and behavioral health systems. Although achieving the 

requisite level of collaboration is often challenging—particularly when faced with long-standing systemic or 

cultural barriers—successful partnerships and a shared commitment to reducing recidivism and advancing 

recovery are needed to carry out the guidelines. Second, to address problems raised by the large number 

of people with behavioral health disorders in the criminal justice system, agents of change and staff 

must work together across the criminal justice continuum to develop a comprehensive community- and 

system-wide strategy. Adopting policies and implementing practices associated with these guidelines can 

seem impossibly complex, especially for agencies and departments facing shrinking budgets, increased 

demands for accountability, and scarce resources. Also, the process is not simple and may take years—

requiring leadership and staff in both systems to remain flexible, patient, and optimistic as they build upon 

shared goals.
6

Assess the individual’s clinical and social needs and public safety 

risks

Guideline 1:

Conduct universal screening as early in the booking/intake process as feasible and throughout 

the criminal justice continuum to detect substance use disorders, mental disorders, cooccurring substance use and mental disorders, and criminogenic risk.

 Valid and reliable screening instruments for the target population should be used.

Guideline 2:

For individuals with positive screens, follow up with comprehensive assessments to guide 

appropriate program placement and service delivery. The assessment process should involve 

obtaining information on

 basic demographics and pathways to criminal involvement;

 clinical needs (e.g., identification of probable or identified diagnoses, severity of associated 

impairments, and motivation for change);

 strengths and protective factors (e.g., family and community support);

 social and community support needs (e.g., housing, education, employment, and transportation); 

and

 public safety risks and needs, including changeable (dynamic) and unchangeable (static) risk 

factors, or behaviors and attitudes that research indicates are relating to criminal behavior.

Plan for the treatment and services required to address the 

individual’s needs (while in custody and upon reentry)

Guideline 3:

Develop Individualized treatment and service plans using information obtained from the risk 

and needs screening and assessment process.

 Determine the appropriate level of treatment and intensity of supervision, when applicable, for 

individuals with behavioral health needs. 

 Identify and target individuals’ multiple criminogenic needs in order to have the most impact 

on recidivism.

 Address the aspects of individuals’ disorders that affect function to promote effectiveness of 

interventions.

 Develop strategies for integrating appropriate recovery support services into service delivery 

models.

 Acknowledge dosage of treatment as an important factor in recidivism reduction, requiring 

the proper planning and identification of what, where, and how intensive services provided to 

individuals will be.





Guidelines at-a-Glance
7

Guideline 4: 

Develop collaborative responses between behavioral health and criminal justice that 

match individuals’ levels of risk and behavioral health need with the appropriate levels of 

supervision and treatment. 

Identify required community and correctional programs responsible 

for post-release services 

Guideline 5: 

Anticipate that the periods following release (the first hours, days, and weeks) are critical 

and identify appropriate interventions as part of transition planning practices for individuals 

with mental and co-occurring substance use disorders leaving correctional settings.

Guideline 6: 

Develop policies and practices that facilitate continuity of care through the implementation 

of strategies that promote direct linkages (i.e., warm hand-offs) for post-release treatment 

and supervision agencies.

Coordinate the transition plan to ensure implementation and avoid 

gaps in care with community-based services 

Guideline 7: 

Support adherence to treatment plans and supervision conditions through coordinated 

strategies.

 Provide a system of incentives and graduated sanctions to promote participation in treatment; 

maintain a “firm but fair” relationship style; and employ problem-solving strategies to encourage 

compliance, promote public safety, and improve treatment outcomes. 

 Establish clear protocols and understanding across systems on handling behaviors that 

constitute technical violations of community supervision conditions.

Guideline 8:

Develop mechanisms to share information from assessments and treatment programs 

across different points in the criminal justice system to advance cross-system goals.

Guideline 9:

Encourage and support cross training to facilitate collaboration between workforces and 

agencies working with people with mental and co-occurring substance use disorders who 

are involved in the criminal justice system.

Guideline 10:

Collect and analyze data to

 evaluate program performance; 

 identify gaps in performance; and

 plan for long-term sustainability.





9

Assess—Guidelines 1 & 2

Rationale 

To identify individuals’ needs that affect their likelihood of achieving positive criminal justice and other 

recovery outcomes, providers and criminal justice agencies should develop a comprehensive approach 

to screen and assess for criminogenic risk (the likelihood individuals will commit additional crimes or 

violate conditions of release); behavioral health needs; medical needs; and other factors such as housing, 

employment, and trauma that may have an impact on their ability to respond to treatment. All of the 

information obtained can then be used to identify individuals who need services, determine what services 

are needed (both during incarceration and upon release), and help match these needs upon transition to 

community-based treatment and, if applicable, supervision.

Major Risk/Need Factors Associated with Committing Future Crimes

Researchers have identified the “central eight” risk factors (see Table 2, page 10) that place a person at 

risk for future criminal behavior and have found the first “big four” should be effectively addressed before 

a focus on the remaining factors will show positive outcomes. 

Behavioral health care providers have historically assessed and provided services to address the bottom 

four risk factors. The top four—those involving antisocial attitudes and behaviors—have not typically been 

perceived as part of their mission. Understanding criminogenic risk, however, is an important part of 

identifying and responding to dangerousness and violence, so assessing individuals’ risk and needs is 

essential to creating safe service environments.

On the other hand, criminal justice staff have traditionally assessed for and provided services to address 

the top four risk factors, and are increasingly identifying the bottom four as treatment priorities.

Implications for Cross-system Planning and Practice

The screening and assessment process within jail and prison settings to determine risk and behavioral 

health needs should be coordinated between corrections and community staff to avoid parallel efforts and 

maximize benefits of scarce treatment resources. Better coordination can help minimize the duplicative or 

inconsistent efforts that often occur within institutions between various program and non-program staff and 

between institutional and community-based providers. A clearly agreed upon screening and assessment 

process is critical to understanding the nature and severity of an individual’s behavioral health need. 

While screening is the first step in the process, it is not sufficient because it only determines whether or 

not further assessment is warranted and not what kind of problem the person might have or how serious it 

might be. Follow-up assessment is necessary to ensure the right care is provided. Mutually agreed upon 

policies and procedures should detail the steps in the screening and assessment process and the role 

and responsibilities of each agency. In addition, to comply with the risk principle, agencies should ensure 

that assessment tools accurately predict risk of recidivism and that the information from the tool is used to 

determine the appropriate services, supervision, and supports for each individual. While some agencies 

may already identify all of the dimensions of risk as part of their screening and assessment process, it is 

possible for those who do not to build upon existing procedures without creating an entirely new process.

Assess the individual's clinical and social needs and public safety issues.

Assess
10

Table adapted from Andrews, D. A., James Bonta, and Robert D. Hoge. (1990). Classification for effective 

rehabilitation: Rediscovering psychology, Criminal Justice and Behavior. 17(1): 19-52.

Guideline 1

Conduct universal screening as early in the booking/intake process as feasible and throughout 

the criminal justice continuum to detect substance use disorders, mental disorders, co-occurring 

substance use and mental disorders, and criminogenic risk.

 Valid and reliable screening instruments for the target population should be used.26 

Practice Tips for Behavioral Health

 It is not appropriate for community behavioral health providers to use formal screens for 

criminogenic risk on all clients; obtain information about an individual’s criminal history during the 

routine psychosocial evaluation process, which triggers screening and assessment as indicated for 

criminogenic risk. 

 Many criminogenic risk tools include questions that screen for mental and substance use disorders, 

but do not provide full assessment of need. Integrate a standardized clinical assessment into the 

process for those whom the screen indicates it is warranted. 

Practice Tips for Criminal Justice

 Obtain access to criminal histories and sufficient data to identify static risk factors.

 Use a validated risk instrument to identify how likely an individual is to reoffend.

 Ensure that screening for mental disorders, substance use disorders, and co-occurring mental and 

substance use disorders is conducted not only at intake, but also periodically thereafter. 

Risk Factor Description

Antisocial 

Behavior

Early and continuing involvement in a number and variety of antisocial 

acts in a variety of settings

Antisocial 

Personality Pattern Adventurous, pleasure-seeking, weak self-control, restlessly aggressive

Antisocial 

Cognition

Attitudes, values, beliefs, and rationalizations supportive of crime; 

displays of anger, resentment, and defiance; and negative attitudes 

toward the law and justice systems

Antisocial 

Associates

Close association with criminals and relative isolation from law-abiding 

individuals; positive and immediate reinforcement for criminal behavior

Family and/or 

Marital

Poor relationship quality with little mutual caring or respect; poor 

nurturance and caring for children; and few expectations that family 

members will avoid criminal behavior

School and/or 

Work

Poor interpersonal relationships within school or work setting; low levels 

of performance and satisfaction in school and/or work

Leisure and/or 

Recreation

Low levels of involvement and satisfaction in non-criminal leisure 

pursuits

Substance Abuse Abuse of alcohol and/or other drugs (tobacco excluded)

Table 2. “Central Eight” Risk Factors That Place a Person at Risk for Future Criminal Behavior

Assess
11

Joint Practice Tips

 Due to the high rates of co-occurring mental and substance use disorders in criminal justice settings, 

screen upon detection of one disorder (i.e., either a mental disorder or substance use disorder) for 

the other type of disorder if that screening is already not conducted as part of the routine intake 

process. 

 Train staff on the correct administration and scoring of the instruments.27

Guideline 2

For individuals with positive screens, follow up with comprehensive assessments28 to guide 

appropriate program placement and service delivery. The assessment process should involve 

obtaining information on

 basic demographics and pathways to criminal involvement;

 clinical needs (e.g., identification of probable or identified diagnoses, severity of associated 

impairments, and motivation for change);

 strengths and protective factors (e.g., family and community support);

 social and community support needs (e.g., housing, education, employment, and transportation); 

and

 public safety risks and needs, including changeable (dynamic) and unchangeable (static) risk factors, 

or behaviors and attitudes that research indicates are relating to criminal behavior.

Practice Tips for Behavioral Health:

 Determine the extent to which a clinical assessment was conducted for the individual while 

incarcerated—an important step for community-based providers to guide their own assessment 

process prior to or upon release.

 While conducting an assessment is an important part of engaging an individual in care, to the extent 

possible, share information between institution and community staff. (For additional detail see 

guideline # 8 on information sharing). 

Practice Tips for Criminal Justice:

 For jail:

 For individuals in jail, the time for assessment is dependent on the time that the individual 

spends in jail. Develop and implement “fast track” strategies for individuals spending less than 

72 hours in custody, and recurrently conduct assessments informed by continual observation 

and consultation for longer stay individuals. 

 For prison: 

 Conduct full assessments to determine individuals’ risk levels and develop treatment plans 

while they are incarcerated to better prepare them for post-release transition.

Assess

13

Rationale

It is important to match individuals’ risk and needs to programs and practices associated with researchbased, positive outcomes while they are in jail or prison and in the community. Professionals in the 

criminal justice and behavioral health systems should use information regarding individuals’ risk levels and 

mental health and/or substance use treatment needs to target the right people for the most appropriate 

interventions—those most likely to benefit from coordinated treatment and supervision strategies, and 

those who can do well with fewer interventions. It is important to combine thoughtful consideration of 

the actuarial score obtained through assessment with clinical judgment to guide the development of 

supervision strategies and case management plans. The intensity of interventions should be proportionate 

to the assessed risk levels. Using RNR principles helps refocus reentry efforts for individuals leaving jails 

and prisons, or who are on probation and parole, to equip them with the necessary skills and competencies 

to live as law abiding and healthy members of communities and families, while progressing towards their 

recovery.

Implications for Cross-system Planning and Practice 

Agencies should assess the extent to which they incorporate RNR practices into their supervision and 

service delivery, and identify areas where they can make changes to strengthen their approach. Evaluating 

the extent to which RNR approaches are incorporated into service planning and delivery can help agencies 

plan and develop different responses based on individuals’ risk and need levels. A focus on implementing 

RNR may require an analysis of how the agencies are engaging clients with lower levels of motivation to 

change and participate in treatment services. Shifting programmatic focus from prioritizing services and 

treatment for people who volunteer or demonstrate a willingness to participate in services to those who 

may be less motivated or willing to participate is an important aspect of effective RNR practice. 

Guideline 3

Develop individualized treatment and service plans using information obtained from the risk and 

needs screening and assessment process. 

 Determine the appropriate level of treatment and intensity of supervision, when applicable, for 

individuals with behavioral health needs.

 Identify and target individuals’ multiple criminogenic needs in order to have the most impact on 

recidivism.

 Address the aspects of individuals’ disorders that affect function to promote effectiveness of 

interventions.

 Develop strategies for integrating appropriate recovery support services into service delivery models.

Plan — Guidelines 3 & 4

Plan for the treatment and services required to address the individual’s needs 

(while in custody and upon reentry)

Plan
14

 Acknowledge dosage of treatment as an important factor in recidivism reduction, requiring the proper 

planning and identification of what, where, and how intensive services provided to individuals will 

be.29, 30

Practice Tips for Behavioral Health

 Integrate information about criminogenic needs that is collected as part of the criminogenic risk 

assessment into individuals’ treatment plans. 

 When working with those under community supervision, make certain to address basic practical 

concerns and needs within treatment plans — housing, food, clothing, transportation, and childcare; 

optimal medication regimens; integrated treatment for individuals with co-occurring mental and 

substance use disorders; and benefits applications/reinstatements for Supplemental Security Income 

(SSI), Social Security Disability Insurance (SSDI), Medicaid, and other entitlements.

 Implement training approaches and policies to motivate and incentivize the ‘harder to engage’ clients 

in programming during incarceration.

Practice Tips for Criminal Justice 

 Develop case plans using this information to address risk and inform decisions regarding appropriate 

behavioral health treatment services while the individual is in jail or prison, in accordance with length 

of time in the institution.

 Use risk and need assessment results, and information from any programming individuals participated 

in while incarcerated, to formulate plans to transition them to continuing services in the community 

once they are released from jail or prison.

 Share information about services received while incarcerated with community supervision staff to 

incorporate into supervision strategies and conditions of release.

 Begin the application and enrollment process for people in jail and prison who are eligible for income 

supports and benefits. 

Joint Practice Tips:

 Identify and target individuals’ multiple criminogenic needs in order to have the most impact on 

recidivism. Research indicates that targeting as many needs as possible, as opposed to just one or 

two, has more impact on recidivism.31 

 For providers working to provide services in jail or prison settings, prioritize individuals with high to 

moderate risk and behavioral health needs and refrain from only selecting voluntary clients.

 Determine the roles for criminal justice staff and behavioral health providers based on a person’s risk 

and need profile. 

 Align dosage of treatment with current research.32 

 The greater the risk for recidivism, the greater the need for significant hours of treatment. 

 In addition to treatment intensity, the treatment duration should be long enough to allow for 

learning practice and behavioral change. 

Guideline 4

Develop collaborative responses between behavioral health and criminal justice that match 

individuals’ levels of risk and behavioral health needs with the appropriate levels of supervision 

and treatment.

Plan
15

Joint Practice Tips:

 The degree of collaboration required will vary based on individuals’ levels of risk and needs:

 Individuals with high criminogenic risk and high behavioral health needs may require 

specialized, targeted, and integrated interventions and intensive supervision.33 While in jail or 

prison, they may require special programming, including enrollment in interventions targeting 

criminogenic risk and need (e.g., cognitive behavioral therapy (CBT)). On probation or on their 

return to the community, the relatively limited treatment options (including CBT) and housing 

funds controlled by corrections systems (e.g., transitional housing) should be prioritized for 

this population to reduce their chances for recidivism. These individuals will require intensive 

community supervision, which can be used in lieu of incarceration or as a condition of release 

from jail or prison. 

 Example: frequent check-ins with community supervision agent, including curfew 

checks and drug testing, and access to integrated treatment options with multiple 

group and individual treatment sessions per week and ongoing pharmacotherapy.

 Individuals with high criminogenic risk and without significant behavioral health disorders

will likely need intensive monitoring and supervision, and minimal to no formalized treatment 

intervention. While in jail or prison, they should be prioritized for enrollment in interventions 

targeting criminogenic needs, such as those that address antisocial attitudes and thinking; 

lower prioritization is appropriate for behavioral health treatment resources. On their return to 

the community, they may participate in community-based programming that provides cognitive 

restructuring and skill building to address criminogenic needs. Corrections staff should make 

referrals to community service providers on reentry to address targeted low-level mental health/

substance use treatment needs. 

 Example: frequent check-ins with community supervision officer and visits to 

outpatient treatment clinic to assess and address symptoms associated with 

mental disorders. 

 Individuals with low criminogenic risk and high behavioral health needs will likely require 

less intensive supervision, monitoring, and access to integrated treatment interventions. While 

in jail and prison, they must be provided health care for acute and chronic health conditions 

and linked with appropriate community service providers upon release to ensure continuity of 

treatment. Outside the corrections facility, the level of care and types of treatment provided will 

conform to existing eligibility criteria and payment sources. Probation officers can spend less 

time with these individuals and promote case management and services over revocations for 

technical violations and/or behavioral health-related issues.

 Example: monthly supervision meetings, attendance at mutual support groups, 

and linkages with peer support programs may be appropriate.

 Individuals with low criminogenic risk and without significant behavioral health disorders 

will likely require low levels of supervision and minimal to no formalized treatment intervention. 

When possible, they should be separated from high-risk populations in correctional facility 

programming and/or when under community supervision programming. Referrals to behavioral 

health providers should take place as the need arises to meet targeted treatment needs. 

 Example: less frequent face-to-face contact with the community corrections officer 

and access to integrated treatment options with individual and group interventions, 

pharmacotherapy, and participation in independent self-help groups. 

Plan

17

Rationale

Individuals with mental and/or substance use disorders in jails and prisons or in the community have 

multifaceted needs and require specialized, comprehensive, and coordinated treatment and supervision 

interventions. Behavioral health professionals often express concern that criminal justice agencies refer 

types of individuals for which service providers have developed few effective interventions (such as those 

for individuals who have personality disorders), and have expectations that treatment alone is sufficient 

to change their criminal behavior. At the same time, criminal justice professionals are frustrated by the 

lack of community-based treatment services and alternatives to incarceration and the revolving door 

nature of this population. Deep budget cuts to all systems have led to staff reductions and a diminished 

capacity to offer services. In this context, limited resources are most wisely spent on interventions that—if 

properly implemented—have demonstrated positive outcomes for these clients as well as for the system. 

In addition, clients with behavioral health disorders have the best outcomes when mental health and 

substance use systems use evidence-based practices that include effective strategies to address the 

criminogenic needs of their clients with criminal histories to promote recovery goals. Many treatment 

providers already address certain criminogenic needs (e.g., substance use, lack of employment) of 

clients with criminal histories through evidence-based treatment components they routinely offer. Still, 

interventions addressing other criminogenic needs (e.g., antisocial thinking) should be added to have the 

greatest impact on public safety and recovery. A correctional institution or community corrections agency 

that has well-designed programs in place—including substance use treatment, mental health services, 

educational and vocational programs, cognitive behavioral skills programs, special needs services, and 

balanced supervision strategies—still needs to target the right individuals to improve the likelihood of 

success.

Implications for Cross-system Planning and Practice

It is important that agencies, departments, and organizations work together across systems, prompting 

the need for cross-system leadership to meet and establish partnerships. This collaboration should extend 

beyond informal handshakes and instead involve more formalized mechanisms to ensure that it lasts 

beyond leadership changes and staff turnover. Memoranda of understanding or other policy and procedure 

agreements can be useful tools to articulate different phases and aspects of a jurisdiction’s transition 

process. These agreements can also help agencies reach consensus about the roles and responsibilities 

of each agency and key staff in the transition process. Defining “who does what, when, and how” is a 

critical planning component and essential cornerstone of effective cross-system partnerships. 

One initial step agencies can take is to inventory the services that are provided prior to release and what is 

available in the community post-release. Conducting this activity early on will provide a helpful framework 

to guide discussions about gaps in resources that may exist in the community and how they can be 

addressed as part of the transition planning process. Differences across communities, particularly between 

urban and rural communities, will exist with regard to the availability and accessibility of quality care and 

services to address the needs of people with behavioral health needs; rural communities face a number of 

challenges and barriers to implementing EBPs—such as workforce issues and lack of transportation—that 

threaten the quality of care for behavioral health disorders.34 

Identify required community and correctional programs responsible for

post-release services

Identify—Guidelines 5 & 6

Identify
18

Guideline 5

Anticipate that the periods following release (the first hours, days, and weeks) are critical and identify 

appropriate interventions as part of transition planning practices for individuals with mental and cooccurring substance use disorders leaving correctional settings.

Practice Tips for Behavioral Health:

 Prior to release,

 develop specific plans to map out the time period immediately following release, including 

needed supports and resources such as housing, transportation, identification of likely 

interaction with family and peers, and scheduled appointments with supervision agents and 

community provider(s); and

 identify and access treatment resources for military veterans to ensure that they are connected 

to specialized service for which they are entitled. 

 When appropriate, include family members in transition planning and help prepare them for a family 

member’s release and possible return to the residence.

 Consider involving peer support and recovery specialists (trained peer specialists with personal 

“lived” experience with mental disorders and involvement in the criminal justice system) in transition 

planning as they can play a role in motivating an individual to engage in care; linking an individual to 

essential services, including housing, educational and vocational opportunities; and directly providing 

a wide array of recovery support services.35 

Practice Tips for Criminal Justice:

 Prior to release, establish or secure

 appointments for necessary and appropriate services and supports (e.g., behavioral health, 

medical care);

 a housing plan;

 a supply of medication to last two to four weeks or until his/her appointment for service; 

 a state approved identification card (for Medicaid and other purposes); and

 adequate clothing.

 When appropriate, identify family members who can assist in transition planning.

 Remove certain barriers (e.g., housing individuals closer to their communities and reducing 

the cost of phone calls) or offer programming specifically designed to strengthen positive 

relationships.36

 Establish procedures to ensure access, such as

 expediting the process to reduce wait time to see individuals;

 extending hours for visits; and

 streamlining the search process upon entering jail (to extent possible while ensuring safety)

 Train community providers on facility security policies and procedures to facilitate adherence to them 

and expedite entry.

 Consider developing specialized caseloads to help ensure that individuals with particular needs, 

such as behavioral health-related issues, can be given the attention they need by a community 

supervision officer with experience and expertise in those areas.37

Identify
19

Joint Practice Tip:

 Jointly establish a process to submit applications to reinstate or enroll individuals in Medicaid, SSI/

SSDI, and other benefits at least several months in advance of release. Community providers can 

pick up on the application process so that assistance is available once the individual is released.

 Develop protocols on access to jail or prison for community providers to conduct in-reach to initiate 

the engagement process (preferably through in-person contact) so that a connection is made with 

the community-based agency accepting responsibility for treatment and care.

 Work towards a model for the reentry of individuals with mental disorders consistent with principles 

of Critical Time Intervention (CTI)—an intensive, time-limited case management model that uses 

three phases to support transitions from institutional settings into community settings. CTI combines 

several evidence-based tools, including cognitive behavioral therapy, illness management, supported 

housing, integrated dual disorder treatment, and motivational enhancement. The intervention suits 

the transitional nature of the reentry process, the complexity of service and treatment needs, and the 

demand for individualized services.38

Guideline 6

Develop policies and practices that facilitate continuity of care through the implementation of 

strategies that promote direct linkages (i.e., warm hand-offs) for post-release treatment and 

supervision agencies.

Practice Tips for Behavioral Health:

 If no pre-release access is available, identify whether there is a pre-release/reentry coordinator or 

other staff person whose role it is to develop transition or reentry plans to coordinate release plans 

and access to post-release services. 

 Behavioral health professionals can be trained along with criminal justice professionals to assess 

and respond to individuals’ criminogenic risk, or at a minimum understand its role in recidivism 

reduction to successfully address criminogenic needs as part of treatment.

 Use an integrated approach consistent with effective practice to provide services that address 

individuals’ behavioral health and criminogenic needs, and targets those needs that are most 

likely leading to criminal justice involvement (e.g., cognitive behavioral treatment, or CBT, 

targeted to criminogenic risks, such as Reasoning and Rehabilitation and Thinking for a 

Change).39

 Use EBPs associated with serving clients who are involved in the criminal justice system to maximize 

recovery and recidivism outcomes (see Appendix A).40, 41, 42, 43 

 Although not correlated with recidivism reduction, trauma-informed and trauma-specific 

strategies and interventions have been adapted and implemented for use with individuals 

with behavioral health disorders involved in the criminal justice system who have experienced 

trauma to enhance coping skills and support recovery.44

Practice Tips for Criminal Justice:

 Identify an array of services that address criminogenic needs, including treatment options available 

in the community, provided either through community corrections agencies or through partnerships 

with behavioral health and other community-based organizations, to facilitate direct referrals of 

people upon release from prison or jail. 

 Recognize that the types of services that benefit individuals most are based on level of risk and 

need. 

Identify
20

 Communicate the expectation to contracted providers that they provide specialized and effective 

community-based services, directly or through referral.

 Use referrals to CBT programs that may be led by providers or specialized probation or parole 

staff to address anti-social risks in addition to other criminogenic needs like family, education, 

and employment (e.g., Motivational Interviewing ).45

 Prior to release, gather information provided by jail and prison staff to determine what funding may 

be available to fund services for the individual.

 Does the individual meet Medicaid eligibility criteria, either based on disability or income as 

defined in the ACA (if a Medicaid expansion state)?

 Is the individual eligible for SSI or SSDI benefits based on a disability?

 Is the individual eligible for any other publicly funded treatment services (such as the Ryan 

White Care Act)?46

Joint Practice Tips

Identify collaborative strategies (particularly those that are reimbursable) to engage individuals prior to 

and following release to enhance continuity of care. Ideally, interventions should begin in jail or prison and 

continue with a community-based provider following an individual’s release, and include:

 Using case management so that an individual has a single case manager before and after release

 Use of “boundary spanners” (e.g., an employee of the local mental health authority who works 

in a jail mental health unit) to oversee transition planning process

 Involving certified peer specialists in process to provide support and mentoring services

 Using technology to 

 connect individuals in jails and prisons with community-based organizations and support 

networks, including family members, prior to release (e.g., through video conferencing); and

 provide mental health treatment through telemedicine following release, particularly in rural 

areas.

Identify
21

Rationale

Individuals with mental, substance use, or co-occurring mental and substance use disorders on probation 

or returning from prisons and jails to the community often have complex problems. The reality is that 

public health care professionals already serve them — a significant number of individuals who receive 

services through the publicly funded mental health and substance use systems are involved in the criminal 

justice system. As such, corrections and behavioral health care systems have considerable overlap in the 

populations they serve, so building truly collaborative responses to address the needs of these individuals 

is certainly warranted. Although these systems vary among jurisdictions in terms of how their work is 

financed, how providers and staff are regulated, and how services are evaluated, there are opportunities 

to work collaboratively and determine how existing resources can be used more efficiently. For example, 

criminal justice and behavioral health care professionals can jointly determine how scarce treatment slots 

and intensive supervision services should be allocated to have the greatest impact. It is important that they 

also develop mechanisms to support this collaboration and communication, such as ways to share data 

and information.

Implications for Cross-system Planning and Practice 

The planning and development of policies and procedures regarding the transition process should include 

discussion and identification of essential information agencies should collect regarding how systems 

share information about clients, supervision and treatment outcomes, and the treatment referral process. 

Coordination strategies can be bolstered by: (1) gaining endorsement of leadership within the criminal 

justice, substance use, and mental health systems; and (2) establishing goals to link the systems that 

are specific and attainable. In addition, cross-system coordination efforts should include the adoption of 

a unifying goal that encompasses the needs of both the behavioral health treatment and criminal justice 

systems. The goals of each system should also be identified to clarify and resolve any differences that may 

exist among group members. Ideally, the goals should be accompanied by objectives and a work plan that 

will help identify roles and responsibilities within the group.

Coordinate the transition plan to ensure implementation and avoid gaps in 

care with community-based services

Coordinate—Guidelines 7–10

Coordinate
22

Guideline 7

Support adherence to treatment plans and supervision conditions through coordinated strategies.

 Provide a system of incentives and graduated sanctions to promote participation in treatment; 

maintain a “firm but fair” relationship style; and employ problem-solving strategies to encourage 

compliance, promote public safety, and improve treatment outcomes. 

 Establish clear protocols and understanding across systems on handling behaviors that constitute 

technical violations of community supervision conditions.

Practice Tips for Behavioral Health:

 Include supervision agents as part of the treatment team to strengthen cross-system approaches.

 Convene regular meetings with supervision agents as necessary to discuss client progress in 

meeting treatment and supervision goals as a useful mechanism to coordinate service delivery and 

messaging regarding expectations for clients.

 In community correction settings, work in “case staffings” to modify treatment plans, monitor 

adherence of the terms of release, and make changes to the conditions when appropriate.

 Train staff how to handle the “treater-turned-monitor dilemma” in which they may be tempted to 

engage in so-called “benevolent coercion” and use return to jail or prison as a threat to get individuals 

to comply with treatment.

 Train behavioral health providers to use Motivational Interviewing and other approaches to enhance 

individuals’ engagement in treatment. 

Practice Tips for Criminal Justice:

 Share release dates from prison or jail, to the extent possible, with provider agencies to strengthen 

their ability to provide a direct and immediate link to post-release continuing care. 

 Participate in regular joint meetings with treatment staff to discuss treatment and supervision 

progress.

 For jail and prison:

 Train corrections staff to use Motivational Interviewing and other engagement approaches to 

encourage individuals to participate in treatment in the community. 

 For community corrections:

 Include expectations regarding participation in and completion of treatment in supervision plans 

to emphasize its importance.

 Ensure that staff communicate to the individuals that they have sustained access to these 

treatments and other supports when supervision ends.

 Train community corrections staff to utilize Motivational Interviewing and other approaches to 

encourage individuals to participate and engage in treatment while under supervision. 

 Avoid sanctions that separate individuals from essential treatment and services. 

Joint Practice Tip:

 Determine if any evidence-based collaborative interventions are appropriate, such as: 

 Specialized community supervision caseloads47

Coordinate
23

 Forensic Assertive Community Treatment (FACT)48

 Forensic Intensive Case Management (FICM)49

Guideline 8

Develop mechanisms to share information from assessments and treatment programs across 

different points in the criminal justice system to advance cross-system goals.

Practice Tips for Behavioral Health:

 Develop an information sharing protocol with criminal justice to clearly establish what information will 

be shared and under what circumstances.

 Whenever possible, have individuals sign releases to allow for sharing of appropriate information 

related to their criminogenic risks, needs, and treatment progress.

Practice Tips for Criminal Justice:

 Provide behavioral health providers with appropriate access to information relating to a person’s 

criminal history and pre-sentence report.

 When services are provided prior to release, develop an approach to ensure that information can 

flow to community-based providers.

Joint Practice Tips:

 Establish mechanisms for sharing information, such as screening and assessment information, which 

comply with all legal privacy and confidentiality mandates and promote efficiency (see Appendix B 

for more information on HIPAA and 42 CFR).50 In order to facilitate the transition from jail and prison 

to the community, mechanisms should focus in particular on sharing information between jail/prison 

and community providers prior to release and, for people under supervision, between probation/

parole and community providers. Information-sharing tools and strategies could include

 developing interagency guidelines (e.g., memorandum of understanding, or MOU) among 

agencies that have contact with individuals so information can be shared;

 obtaining permission from the individual to release his/her health information by getting an 

authorization or consent form; and

 employing manual processes or management information systems (e.g., shared database) to 

support cross-system information sharing.

Guideline 9

Encourage and support cross training to facilitate collaboration between workforces and agencies 

working with people with mental and co-occurring substance use disorders who are involved in 

the criminal justice system.

Practice Tips for Behavioral Health:

 Train all staff to be more informed about fundamental practices in the criminal justice system, such 

as understanding

 the varied pathways that individuals with mental and co-occurring substance use disorders may 

take into the criminal justice system;

 relevant terms of conditions of supervision, how and when and to whom to report violations of 

supervision conditions, their roles and responsibilities when warrants are issued, and how to 

convey information during court hearings; and

Coordinate
24

 how to use problem-solving strategies in response to noncompliance.

Practice Tips for Criminal Justice:

 Train all staff to be more informed about fundamental practices in community behavioral health, such 

as understanding

 the signs and symptoms, and basic terminology of mental and co-occurring substance use 

disorders;

 how mental disorders and co-occurring disorders impact psychosocial functioning and are 

associated with diverse service needs such as housing, social services and supports, and 

vocational skills;

 the principles of effective treatment and programming for mental disorders and co-occurring 

substance use disorders and setting realistic expectations for recovery;

 the methods to improve interactions with individuals with mental and co-occurring substance 

use disorders (e.g., minimizing the use of jargon, making eye contact, using the principles of 

Motivational Interviewing); and

 how to use problem-solving strategies, RNR principles, and graduated sanctions in response 

to noncompliance.

Joint Practice Tip

 Recognize and acknowledge that criminal justice and behavioral health systems have traditionally 

different missions. While cross-training is necessary, it is not sufficient for reconciling these differences 

and achieved shared goals and outcomes. Structural supports, policies, agency leadership are 

crucial for training to be absorbed and implemented. 

 Ensure that staff understand the “culture of incarceration” so as to engage and support individuals 

under correctional supervision, both while incarcerated and in the community. Sensitizing Providers 

to the Effects of Correctional Incarceration on Treatment and Risk Management (SPECTRM) is one 

model to improve interactions with individuals who are involved in the criminal justice system.51 

 Staff from each system should serve as boundary spanners to actively coordinate treatments and 

services with supervision.

Guideline 10

Collect and analyze data to

 evaluate program performance;

 identify gaps in performance; and

 plan for long-term sustainability.

Practice Tips for Behavioral Health:

 Collect data elements related to criminal justice involvement like violations and arrests to help 

measure the impact of treatment on the criminal justice system. 

 Consider using a strong independent evaluation approach to help agencies collect, analyze, and use 

data to improve program performance. Universities are often used as unaffiliated partners with the 

state or local agency. 

Coordinate
25

Practice Tips for Criminal Justice:

 Use performance measures to help agencies improve access to and quality of treatment. 

 Collect data elements to measure the number of successful referrals to community-based mental 

health and substance abuse treatment or reduced revocations among probation or parole officers to 

help assess impact.

Joint Practice Tips:

 Where possible, include program evaluators in the initial planning and design processes to ensure 

that cross-systems work can be evaluated for effectiveness and to determine long-term sustainability.

 Establish a system of quality assurance at each respective agency/provider in order to denote 

strengths and weaknesses of newly implemented cross-system approach. 

 Create user-friendly reports to educate staff on how to use the data to inform and improve their work.

 Provide ongoing training and professional development to provide support to staff whose roles and 

assessment processes may have been altered.

 Incentivize positive staff performance to create and acknowledge agents of change.

Coordinate

27

Although the overrepresentation of people with behavioral health disorders in criminal justice settings 

persists, recent research suggests that with appropriate evidence-based interventions, treatment 

providers can have a significant impact on recovery and recidivism. These guidelines are intended to assist 

behavioral health and corrections and community corrections administrators in their ability to develop 

effective transition plans and to drive cross-system reentry approaches between behavioral health and 

criminal justice agencies. The guidelines can be used as a tool within behavioral health agencies on 

the state and local levels to ensure that community-based approaches respond to the multi-dimensional 

needs of clients who are involved in the criminal justice system and the agencies that supervise them. 

While each guideline is important and necessary, ultimately it is collaboration between the behavioral 

health and criminal justice systems that will ensure available resources are used efficiently and effectively 

to improve outcomes for individuals, and to make our communities safer. 

Conclusion

Ultimately it is collaboration between the behavioral health and criminal justice 

systems that will ensure available resources are used efficiently and effectively 

to improve outcomes for individuals, and to make our communities safer.

29

Evidence-Based Practice or Program† Mental Health 

(MH) Treatment

Substance 

Abuse (SA) 

Treatment

Co-occurring 

MH and SA 

Treatment

Forensic Assertive Community Treatment 

(FACT)

ACT-like programs that have been adapted 

for people involved in the criminal justice 

system and focus on preventing arrest 

and incarceration; ACT involves treatment 

coordinated by a multidisciplinary team 

with high staff-to-client ratios that assumes 

around-the-clock responsibility for clients’ 

case management and treatment needs

+ +

Illness Management and Recovery (IMR)

An approach that involves teaching clients 

skills and techniques to minimize the 

interference of psychiatric symptoms in 

their daily lives

+

Integrated Mental Health and Substance 

Abuse Services 

Treatment and service provision to support 

recovery from co-occurring mental and 

substance use disorder through a single 

agency or entity

+ + +

Supported Employment

An EBP for people with severe 

developmental, mental, and physical 

disabilities that matches them with and 

trains them for jobs where their specific 

skills and abilities make them valuable 

assets to employers

+

Psychopharmacology

Treatment that uses one or more 

medications (e.g., antidepressants) to 

reduce depression, psychosis, or anxiety 

by acting on the chemistry of the brain

+ +

Appendix A

 Evidence-Based Practices and Programs for Individuals with 

Behavioral Health Needs in the Criminal Justice System*

* Please note that the following list is not exhaustive. 

† These EBPs may be used across multiple domains, and an “X” in a particular column indicates that a significant research base exists for the application of 

that EBP in that particular domain. However, the EBP may also be used in the other listed domains when appropriate.
30

Evidence-Based Practice or Program

Mental 

Health (MH) 

Treatment

Substance 

Abuse (SA) 

Treatment

Co-occurring 

MH and SA 

Treatment

Supported Housing

A system of professional and/or peer 

supports that allows a person with 

mental illness to live independently in the 

community; Supports may include regular 

staff contact and the availability of crisis 

services and other services to prevent 

relapse, such as those focusing on mental 

health, substance abuse, and employment

+

Cognitive-behavioral Therapy (CBT) 

Targeting Criminogenic Needs

CBT interventions (e.g., Thinking for a 

Change or Reasoning and Rehabilitation) 

that are designed to address 

criminogenic needs and may focus on 

anger management, problem solving, 

and assuming personal responsibility for 

behavior 

+ +

Motivational Enhancement Therapies 

(e.g., Motivational Interviewing)

A consumer-centered, directive method 

for enhancing intrinsic motivation to 

change by exploring and resolving 

ambivalence

+

Contingency Management (CM) 

Interventions

The objective of CM interventions is 

to reinforce a client’s commitment to 

abstinence and to reduce his/her drug 

use using positive (e.g., vouchers) and 

negative (e.g., increased supervision) 

reinforcers in response to desired and 

undesired behaviors

+

Modified Therapeutic Community (MTC)

MTCs alter the traditional TC approach 

in response to the psychiatric 

symptoms, cognitive impairments, and 

other impairments commonly found 

among individuals with co-occurring 

disorders. These modified programs 

typically have (1) increased flexibility, 

(2) decreased intensity, and (3) greater 

individualization. 

+
31

APPENDIX B

Information Sharing in the Criminal Justice-Behavioral Health 

Context: HIPAA and 42 CFR

Health Information Portability and Accountability Act

HIPAA, together with regulations promulgated by the U.S. Department of Health and Human Services 

(HHS), establish federal standards for the privacy and security of Personal Health Information (PHI), 

including mental health information. HIPAA’s restrictions on sharing health information are often 

misunderstood, which has resulted in practitioners’ misapplying the law to be far more restrictive than 

the actual regulatory language requires. Practitioners should keep in mind the original intent of the 

legislation, which was to facilitate insurance coverage through the development of an information system 

for electronic health records that ensured appropriate privacy and IT security. 42 CFR Part 2

42 CFR Part 2

42 CFR Part 2 is the part of the Code of Federal Regulations under the Public Health chapter that deals 

with the confidentiality of alcohol concerns abuse patient records. These regulations apply to all “programs” 

that are “federally assisted.”52

Jails and Prisons

The information-sharing issues concerning medical and behavioral health that involve correctional staff 

who must administer a range of services in prisons and jails cause particular confusion. These laws were 

not designed or intended to impede the provision of necessary health services. Correctional facilities can 

be central locations for information collection and sharing: families and community treatment providers 

may be eager to share health information about those in custody; medical or corrections staff seek to 

identify individuals with behavioral health issues as quickly as possible and stabilize them; and successful 

reentry planners require the coordinated transfer of health information from treatment providers in the 

facility to those in the community. Incarcerated individuals generally have fewer protections for individual 

information privacy than individuals “outside the walls.”

Correctional institutions are generally not “covered entities” under HIPAA unless they declare themselves 

as such. Clinical staff who work for a correctional facility meet the definition of “health provider” under 

HIPAA, whether employed directly by the correctional facility or under contract. If a correctional facility 

contracts for healthcare services, the provider of those services will determine independently whether 

it is a covered entity (and in most cases will consider itself such). Many correctional facilities, as well as 

state departments of corrections, define themselves as covered entities. HIPAA permits PHI to be made 

available to a correctional or other custodial facility for several purposes, including, generally, providing 

healthcare and protecting the health and safety of inmates, officers, or other employees of the correctional 

institution, or people involved in transporting incarcerated individuals, or other activities necessary for the 

maintenance of safety, security, and good order or the institution. This provision in HIPAA permits very 

broad disclosure of PHI without the person’s authorization. As always, state law should be consulted to 

determine whether it is more protective of individual privacy.
32

Once a person is discharged from the facility, HIPAA rules apply to the sharing of a person’s health 

information. However, in some circumstances, HIPAA permits sharing information without authorization/

consent, although state law may not. For example, if a correctional facility is asked to provide health 

information to another covered entity, such as a psychiatrist, about an individual who has been released 

from custody, HIPAA does not require the person’s permission for the disclosure because it is for the 

allowable purpose of care, including aftercare. However, state law may require the person’s permission in 

such situations.

Because 42 CFR Part 2 does not contain provisions specifically addressing correctional institutions, the 

general rules about consent will apply.

Community Corrections

With an increased emphasis on finding alternatives to incarceration for individuals with mental health and 

substance abuse disorders, PHI becomes a part of the work of all community corrections officers, not just 

those with specialized caseloads.54

Federal laws limit what information probation and parole officers can receive in monitoring compliance 

with treatment conditions that are part of the person’s supervision. For the supervising officer to receive 

PHI, the person must have given permission under either authorization sections of HIPAA or the consent 

provisions in 42 CFR Part 2. Alternatively, the court can order that the person must waive confidentiality 

as a condition of probation, or the court can issue an order directing disclosure consistent with the terms 

of HIPAA and/or 42 CFR Part 2 if protected health or substance abuse treatment information is requested. 

HIPPA and 42 CFR Part 2 do not limit what community correctional officers can disclose. For example, if 

an individual discloses PHI to his probation officer, that officer may share or redisclose that information 

without being affected because the probation officer is not a covered entity or “program.” The probation 

officer may, however, be subject to state law prohibitions on redisclosure. 

*adapted from Petrila, John, and Hallie Fader-Towe. Information Sharing in Criminal Justice-Mental Health 

Collaborations: Working with HIPAA and Other Privacy Laws. New York, NY: Council of State Governments 

Justice Center, 2010. 
33

1. Osher, F., Steadman, H. B., and Barr, H. A best practice approach to community re-entry from jails 

for inmates with co-occurring disorders: The APIC model. Delmar, NY: The National GAINS Center, 2002.

http://gainscenter.samhsa.gov/pdfs/reentry/apic.pdf

2. The term “behavioral health” in this document refers to a state of mental/emotional being and/

or choices and actions that affect wellness. Behavioral health problems include substance abuse or 

misuse, alcohol and drug addiction, serious psychological distress, suicide, and mental and substance 

use disorders. This includes a range of problems from unhealthy stress to diagnosable and treatable 

diseases like serious mental illnesses and substance use disorders, which are often chronic in nature but 

that people can and do recover from. The term is also used to describe the service systems encompassing 

the promotion of emotional health, the prevention of mental and substance use disorders, substance use, 

and related problems, treatments, and services for mental and substance use disorders, and recovery 

support. Source: http://store.samhsa.gov/shin/content/SMA11-4629/01-FullDocument.pdf 

3. The numbers used in this table are estimates that come from a variety of sources. The studies cited 

are from different years, use different methodologies and definitions, and combine different data sets. The 

table is intended to give the reader a general sense of the prevalence rates of behavioral disorders in 

corrections populations and is not intended to be the definitive epidemiologic dataset. 

4. Kessler, R. C., Nelson, C. B. McGonagle, K. A., Edlund, M. J., Frank, R. G., and Leaf, P. J. (1996). 

The epidemiology of co-occurring addictive and mental disorders: Implications for prevention and service 

utilization. American Journal of Orthopsychiatry, 66(1): 17–31.

5. Ditton, P. M. (1999). Mental health and treatment of inmates and probationers. Washington, DC: 

U.S. Department of Justice, Office of Justice Programs. http://www.bjs.gov/content/pub/pdf/mhtip.

pdf; see also Metzner, J. L. (1997). An introduction to correctional psychiatry: Part I. Journal of the 

American Academy of Psychiatry and the Law, 25(3): 375–381. (Based on a review of pertinent studies, 

Metzner estimates that from 8–19 percent of incarcerated offenders in the United States have a psychiatric 

disorder that results in functional disability, and another 15–20 percent will need some form of psychiatric 

intervention.) 

6. Steadman, H. J., Osher, F. C. Robbins, P. C., Case, B., and Samuels, S. (2009). Prevalence of serious 

mental illness among jail inmates. Psychiatric Services, 60(6): 761–765. http://ps.psychiatryonline.

org/article.aspx?articleid=100482 

7. Feucht, T. E., and Gfroerer, J. (2011). Mental and substance use disorders among adult men on 

probation or parole: Some success against a persistent challenge. Rockville, MD: U.S. Department of 

Health and Human Services, Substance Abuse and Mental Health Services Administration. http://www.

samhsa.gov/data/2k11/MentalDisorders/MentalDisorders.pdf 

8. Ibid.

9. Mumola , C. J., and Karberg, J. C. (2004). Drug use and dependence, state and federal prisoners. 

Washington, DC: U.S. Department of Justice, Office of Justice Programs. http://www.bjs.gov/content/

pub/pdf/dudsfp04.pdf 

Endnotes
34

10. Karberg, J. C., and James, D. J. (2005.) Substance dependence, abuse, and treatment of jail 

inmates, 2002. Washington, DC: U.S. Department of Justice, Office of Justice Programs, http://www.

csdp.org/research/sdatji02.pdf 

11. Ibid. 7. (The 35–40 percent range represents both a probation and parole population. According 

to Feucht and Gfroerer in this SAMHSA and NIJ report, combined data from 2006–2009 reveal that 35 

percent of parolees and 40 percent of probationers had “illicit drug or alcohol dependence or abuse in the 

past year.”) 

12. Note that of those adults with serious mental disorders, the percentages in this row reflect how 

many also have co-occurring substance use disorders.

13. Substance Abuse and Mental Health Services Administration. (2009). Results from the 2008 

National Survey on Drug Use and Health: National findings. Rockville, MD: Substance Abuse and Mental 

Health Services Administration, Office of Applied Studies, (Among adults ages 18 or older with SMI, 25.2 

percent [2.5 million] were dependent on or abused illicit drugs or alcohol.) 

14. Ditton, P. M. (1999). Mental health and treatment of inmates and probationers. Washington, DC: 

U.S. Department of Justice, Office of Justice Programs. http://www.bjs.gov/content/pub/pdf/mhtip.

pdf

15. Adapted from Abram, K. M., and Teplin, L. A. (1991). Co-occurring disorders among mentally ill jail 

detainees. Implications for public policy. American Psychologist, 46(10): 1036–1045. http://psycnet.apa.

org/journals/amp/46/10/1036/ 

16. Ibid. 14.

17. Note that of those adults with substance use disorders, the percentages in this row reflect how 

many also have co-occurring mental disorders.

18. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services 

Administration. Results from the 2011 National Survey on Drug Use and Health: Summary of national 

findings and detailed tables. Accessed November 6, 2013. http://www.samhsa.gov/data/NSDUH/201

1SummNatFindDetTables/ 

19. Baillargeon, J., Penn, J.V., Knight, K., Harzke, A. J., Baillargeon, G., and Becker, E. A. (2010). 

Risk of reincarceration among prisoners with co-occurring severe mental illness and substance use 

disorders. Administration and policy in mental health, 37(4): 367-374. http://www.ncbi.nlm.nih.gov/

pubmed/19847638 (The authors used a cohort from Texas; the findings may not be representative 

across other states.)

20. Wilson, A. B., Draine, J. Hadley, T., Metraux, S., and Evans, A. (2011). Examining the impact of 

mental illness and substance use on recidivism in a county jail. International Journal of Law and Psychiatry, 

34(4): 264-268. http://www.ncbi.nlm.nih.gov/pubmed/21839518 

21. Ibid. 7.

22. Pew Center on the States. Prison count 2010: State population declines for the first time in 38 

years. Philadelphia: Pew Charitable Trusts, 2010. http://www.pewtrusts.org/our_work_report_detail.

aspx?id=57797 

23. Binswanger, I. A, Stern, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., and Koepsell, 

T. D. (2007). Release from prison—a high risk of death for former inmates. The New England Journal of 

Medicine, 356(2): 157–165. http://www.ncbi.nlm.nih.gov/pubmed/17215533

24. Osher, F. C., D’Amora, D. A., Plotkin, M., Jarrett, N., and Eggleston, A. (2012). Adults with behavioral 

health needs under correctional supervision: A shared framework for reducing recidivism and promoting 

recovery. New York: Council of State Governments Justice Center. http://csgjusticecenter.org/wpcontent/uploads/2013/05/9-24-12_Behavioral-Health-Framework-final.pdf

25. Ibid. 1.
35

26. For examples of screening tools for mental disorders and substance use disorders, please see: 

Peters, R. H., Bartoi, M. G., and Sherman, P. B. (2008). Screening and assessment of co-occurring 

disorders in the justice System. Delmar, NY: CMHS National GAINS Center, http://gainscenter.samhsa.

gov/pdfs/disorders/ScreeningAndAssessment.pdf 

27. Ibid. 

28. Ibid. 26.

29. Bourgon, G., and Armstrong B. (2006). Transferring the principles of effective treatment into a “real 

world” setting. Criminal justice and Behavior, 32(1): 3-25. http://cjb.sagepub.com/content/32/1/3.

abstract

30. “[...] practitioners and policymakers should resist the urge to translate these findings into concrete, 

narrowly defined standards for dosage. It is unlikely that there is a one-size-fits-all protocol for dosage, 

even for high-risk offenders. The evidence we currently have merely provides the field with evidencebased parameters or guidelines for making decisions about optimal dosage ranges for offender groups 

in the aggregate.” For more information, please see Sperber, K. G., Latessa, E. J. and Makarios, M. D. 

(2013). Establishing a risk-dosage research agenda: Implications for policy and practice. Justice Research 

and Policy, 15 (1): 123-141. 

31. Gendreau, P., French, S. A., and Taylor, A. (2002). What Works (What doesn’t Work) Revised 2002. 

Invited Submission to the International Community Corrections Association Monograph Series Project. 

32. Ibid. 29.

33. Prins, S. J., and Draper, Laura. Improving outcomes for people with mental illnesses under 

community corrections supervision. New York: Council of State Governments Justice Center. (2009). 

http://csgjusticecenter.org/wp-content/uploads/2012/12/Community-Corrections-ResearchGuide.pdf 

34. For more information on how rural communities have adapted EBPs given barriers they face, 

please see: Office of Rural Health Policy, Health Resources and Services Administration. Rural behavioral 

health programs and promising practices. (2011). Washington, DC: U.S. Department of Health and Human 

Services, http://www.hrsa.gov/ruralhealth/pdf/ruralbehavioralmanual05312011.pdf

35. Davidson, L., and Rowe, M. Peer Support within criminal justice Settings: The role of forensic 

peer specialists. (2008). Delmar, NY: CMHS National GAINS Center. http://gainscenter.samhsa.gov/

peer_resources/pdfs/Davidson_Rowe_Peersupport.pdf

36. Naser, R. L., and Visher, C. A. (2006). Family members’ experiences with incarceration and reentry. 

Western Criminology Review, 7(2) : 20-31.

37. For more information on specialized caseloads, please see: Prins, S. J., and Osher, F. C. (2009). 

Improving responses to people with mental illnesses: The essential elements of specialized probation 

initiatives. New York: Council of State Governments Justice Center, http://bit.ly/10MKuoe

38. For more information on CTI, please see: Draine, J., and Herman, D. B. Critical Time Intervention 

for reentry from prison for persons with mental illness. (2007). Psychiatric Services, 58(12) : 1577-1581. 

http://ps.psychiatryonline.org/data/Journals/PSS/3829/07ps1577.pdf

39. For more information on CBT targeted to criminogenic risks, please see: U.S. Department of 

Justice, National Institute of Corrections. (2007). Cognitive-behavioral treatment: A review and discussion 

for corrections professionals, by Milkman, H., and Wanberg, K. Washington, D.C.: U.S. Department of 

Justice, National Institute of Corrections, http://static.nicic.gov/Library/021657.pdf 

40. For more information, please see: Blandford, A. M., and Osher, F. C. (2012). A checklist for 

implementing evidence-based practices and programs for justice-involved adults with behavioral health 

disorders. Delmar, NY: SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation, http://

ainscenter.samhsa.gov/cms-assets/documents/73659-994452.ebpchecklistfinal.pdf 

41. Scott, W. (2008). Effective clinical practices in treating clients in the criminal justice system. 

Washington, DC: U.S. Department of Justice, National Institute of Corrections, 
36

42. For more information, please see: SAMHSA’s GAINS Center for Behavioral Health and Justice 

Transformation. Evidence-based practices (EBPs). Accessed November 6, 2013. http://gainscenter.

samhsa.gov/topical_resources/ebps.asp

43. Friedmann, P. D., Taxman, F. S., and Henderson, C. E. (2007). Evidence-based treatment practices 

for drug-involved adults in the criminal justice system. Journal of Substance Abuse Treatment, 32(3): 267-

277.

44. For more information on trauma-specific interventions for justice-involved individuals, please see: 

http://gainscenter.samhsa.gov/pdfs/ebp/TraumaSpecificInterventions.pdf 

45. For more information on Motivational Interviewing, please see: U.S. Department of Health and 

Human Services, Substance Abuse and Mental Health Services Administration. Training: Motivational 

interviewing. Accessed November 6, 2013. http://www.samhsa.gov/co-occurring/topics/training/

motivational.aspx 

46. For more information on the Ryan White HIV/AIDS programs funded through the Ryan White 

Care Act, please see: U.S. Department of Health and Human Services, Health Resources and Services 

Administration. HIV/AIDS programs: Technical assistance. Accessed November 6, 2013. http://hab.

hrsa.gov

47. For more information on specialized community supervision caseloads and other approaches, 

please see Prins, S. J., and Osher, F. C. (2009). Improving responses to people with mental illnesses: The 

essential elements of specialized probation initiatives. New York: Council of State Governments Justice 

Center. http://bit.ly/10MKuoe.

48. For more information on FACT, please see: Lamberti, J. S., Weisman R., and Faden D. I. 

(2004). Forensic assertive community treatment: Preventing incarceration of adults with severe mental 

illness. Psychiatric Services, (55):1285-1293. http://bit.ly/16gXquL; and Cusak, K. J., Morrissey, J. P., 

Cuddeback, G. S., Prins, A., and Williams D. M. (2010). Criminal justice involvement, behavioral health 

service use, and costs of forensic assertive community treatment: A randomized trial. Community Mental 

Health Journal, 46:356-363. http://1.usa.gov/1d4BIeR

49. For more information on FICM, please see: Morrissey, J. P., Myers, P. S., and Cuddeback, G. S. 

(2007). Extending assertive community treatment to criminal justice settings: Origins, current evidence, 

and future directions. Community Mental Health Journal, 43: 527-544. 

50. For more information on information sharing in criminal justice-behavioral health collaborations, 

please see: Petrila, J., and Fader-Towe, H. (2010). Information sharing in criminal justice-mental health 

collaborations: Working with HIPAA and other privacy laws. New York: Council of State Governments 

Justice Center. Accessed November 6, 2013. https://www.bja.gov/Publications/CSG_CJMH_Info_

Sharing.pdf

51. For more information on SPECTRM, please see: SAMHSA’s GAINS Center for Behavioral Health 

and Justice Transformation. (2007). Sensitizing providers to the effects of incarceration on treatment 

and risk management (SPECTRM): Expanding the mental health workforce response to justice-involved 

persons with mental illness. Delmar, NY: GAINS Center. http://gainscenter.samhsa.gov/pdfs/reentry/

Spectrum.pdf 

52. For definitions of "programs" and "federally assisted," please see pages 29-30 in Petrila, J., and 

Fader-Towe, H. Information sharing in criminal justice-mental health collaborations: Working with HIPAA 

and other privacy laws. New York, NY: Council of State Governments Justice Center, 2010. Accessed 

November 6, 2013. https://www.bja.gov/Publications/CSG_CJMH_Info_Sharing.pdf

53. For more information to assist corrections entities with establishing privacy policies and practices 

for sharing and receiving protected health information (PHI), please see: Association of State Correctional 

Administrators, American Probation and Parole Association, and Global Justice Information Sharing 

Initiative. Corrections and reentry: Protected health information privacy policy template for information 

sharing (forthcoming).