Recovery-Oriented Systems of Care: 

Needs and Opportunities 

for Kentucky's Court System 

MARCH 2021 

PREPARED BY THE CRIME AND JUSTICE INSTITUTE 

CJI 

CRIME AND JUSTICE INSTITUTE 

A Division of Community Resources for Justice 

I am pleased to present “Recovery-Oriented Systems of Care: Needs and 

Opportunities for Kentucky’s Court System.” This comprehensive report 

by the Crime and Justice Institute examines how Kentucky courts are 

positioned to give individuals with substance use disorder access to the 

services and treatment they need. 

The move toward a recovery-oriented system of care is an important step 

in our response to the drug epidemic, which continues to pose significant 

challenges to Kentucky courts. The courts are in a unique position to 

positively impact those dealing with substance use disorder and we have a duty to embrace the 

most effective models that support lifelong recovery. 

In recent years, the Kentucky Court of Justice has been striving to improve its understanding 

of substance use disorder, evidence-based treatment and recovery supports, and the best 

court practices in handling drug-related cases. Here is a brief description of our journey toward 

reaching this goal.

RESTORE Initiative

Kentucky launched the RESTORE initiative in 2019 to give judges, circuit court clerks and court 

personnel best court practices to support the treatment of opioid use disorder and other 

substance use disorders. RESTORE stands for Responsive Education to Support Treatment 

in Opioid Recovery Efforts and is funded by the Kentucky Opioid Response Effort through a 

Substance Abuse and Mental Health Services Administration Grant. 

RESTORE has allowed the court system to provide a variety of evidence-based educational 

programs, coordinate changes in practice and reduce the stigma of substance use disorder. 

We have also been able to promote a family centered approach, facilitate access to effective 

treatment and unify efforts to counter the effects of the opioid crisis and future drug trends. 

This initiative has furthered my understanding of addiction and recovery and changed my 

perspective on how we should handle court-involved individuals with substance use disorder.

CJI Assessment of Treatment and Recovery Supports

In 2020, the Kentucky Administrative Office of the Courts received a grant from the State 

Justice Institute to assess the court system’s access to and use of mental health and substance 

use treatment and recovery supports within the community. The AOC used this funding to 

contract with the Crime and Justice Institute to conduct a qualitative assessment of strengths, 

Kentucky Courts Moving Toward a Recovery-Oriented System of Care

By John D. Minton Jr., Chief Justice of Kentucky

continued on next page

MESSAGE FROM THE CHIEF JUSTICE
opportunities and challenges that Kentucky judges, court personnel and stakeholders 

experience when trying to connect individuals to services. 

The project’s overarching goal was to explore our readiness to shift to a recovery-oriented 

system of care model. To that end, CJI facilitated focus groups with key stakeholders and 

developed and disseminated a survey for treatment providers. CJI also reviewed documents 

responsible for the system constructs related to substance use, including Supreme Court rules, 

statutes, policies, trainings, screening/assessment tools, outcome evaluations and annual 

reports. 

In March 2021, CJI completed its assessment and presented a final report titled “RecoveryOriented Systems of Care: Needs and Opportunities for Kentucky’s Court System.” The report 

provides an overview of the project, explains the ROSC model, and details CJI’s findings and 

recommendations.

Benefits of ROSC Model

Kentucky’s work with RESTORE and CJI has affirmed the importance of changing our approach 

to substance abuse cases. The court setting presents the opportunity to identify individuals 

with behavioral health conditions and connect them with needed services and supports. 

Acknowledging that the courts are a critical piece of Kentucky’s system of care has proven to be 

a powerful impetus for change.

The ROSC model recognizes that recovery is a unique process, rather than an end goal, and that 

responses must adapt to an individual’s evolving needs. Decision-making focuses on promoting 

recovery and encouraging access to a continuum of treatment services and recovery supports. 

This is no small task and will require intentional collaboration and communication among the 

court, community agencies, the individual in recovery and the individual’s family and peers. 

Next Steps to ROSC

Step One. Our first step is to convene an internal work group to establish a shared vision and 

define goals and values. We are fortunate to already have the RESTORE Leadership Team in 

place. This team of circuit, district and family court judges will guide our shift to a ROSC model. 

Step Two. We will then create a Justice System of Care Stakeholder Committee composed of 

judicial and administrative leaders within the KCOJ, leaders from the Cabinets for Justice and 

Public Safety and Health and Family Services, attorneys, adults with lived experiences and key 

stakeholders. This committee will foster communication and input, identify needed system 

improvements, propose any necessary statutory changes and institutionalize policy changes.

Although substance use and co-occurring disorders present significant challenges, individuals 

can and do recover. I appreciate the partners who have joined us in this important work. To 

inquire about Kentucky’s move to the ROSC model, please contact RESTORE@kycourts.net. 

continued from previous page
Crime and Justice Institute 1 

TABLE OF CONTENTS

Executive Summary..................................................................................................................................... 2

Background................................................................................................................................................. 5

Problem Statement................................................................................................................................. 5

Kentucky’s Desire to Move to a Recovery-Oriented System of Care Court Model.................................. 5

Recovery-Oriented Systems of Care........................................................................................................ 6

Methodology ............................................................................................................................................ 10

Findings..................................................................................................................................................... 12

Collaboration, Communication, Coordination....................................................................................... 12

Access & Availability.............................................................................................................................. 23

Funding ................................................................................................................................................. 28

Education .............................................................................................................................................. 29

Resource allocation and utilization ....................................................................................................... 30

Recommendations.................................................................................................................................... 32

Coordination within the court system................................................................................................... 32

Coordination at the state level between court and behavioral health systems.................................... 37

Coordination within local communities ................................................................................................ 43

Conclusion ................................................................................................................................................ 46

ABOUT THE CRIME AND JUSTICE INSTITUTE AT COMMUNITY RESOURCES FOR JUSTICE

The Crime and Justice Institute (CJI), a division of Community Resources for Justice, bridges the gap 

between research and practice with data-driven solutions that drive bold, transformative improvements 

in adult and youth justice systems. With a reputation built over many decades for innovative thinking, a 

client-centered approach, and impartial analysis, CJI assists agency leaders and practitioners in 

developing and implementing effective policies that achieve better outcomes and build stronger, safer 

communities. CJI works with local, state, tribal, and national justice organizations, providing nonpartisan 

policy analysis, implementation consulting, capacity-building assistance, and research services to 

advance evidence-based practices and create systems-level change. For more information, please visit: 

https://www.cjinstitute.org/. 
Crime and Justice Institute 2 

EXECUTIVE SUMMARY

In 2019, 61.2 million Americans had either a mental illness, substance use disorder, or both.

1 Many 

individuals with substance use and co-occurring disorders enter into the court system, prompting a need 

for courts to respond to behavioral health concerns. To improve responses to individuals affected by 

substance use and co-occurring disorders, Kentucky’s Court of Justice (KCOJ) is exploring a philosophical 

shift from a sanction-based, compliance court model to a Recovery-Oriented System of Care (ROSC)

court model. An ROSC court model would streamline service connections, provide opportunities to 

divert individuals to treatment, and maximize the use of natural supports and settings by partnering 

with community providers.

The Crime and Justice Institute (CJI) conducted a qualitative assessment of the opportunities and 

challenges that judges, other court personnel, prosecutors, and defense counsel experience when trying 

to connect defendants and sentenced individuals with services. The needs assessment focused on

perceived challenges to access and availability of behavioral health services as they relate to the tenets 

of the ROSC model for those involved in the court process in Kentucky as well as opportunities to 

connect individuals to evaluation and treatment. The needs assessment looked specifically at two 

populations: individuals involved in the adult justice system through Pretrial Services and Specialty 

Courts, and individuals involved in the civil court system through dependency, neglect, and abuse cases. 

Specialty Courts includes mental health courts, drug courts, and veterans’ courts. The following is a list 

of findings from the needs assessment and recommendations based on these findings that will allow the 

KCOJ to move towards becoming an ROSC court model through the work of the Administrative Office of 

the Courts (AOC).

FINDINGS

• There are challenges in coordinating care between courts and treatment providers and different

expectations about the roles of courts and treatment providers, making efficient and effective

service delivery difficult.

• Each direct service department within the AOC operates independent court programs and

collaborates on joint projects, but they have not yet established a shared definition, vision, and

approach to recovery. Differences in perspectives towards recovery result in different uses of

program conditions.

• The collaboration among the Cabinet for Health and Family Services’ (CHFS) Department of

Behavioral Health, Developmental and Intellectual Disabilities (DBHDID), and Department of

Community Based Services (DCBS), and the AOC has strengthened in the past six years. In family

1 SAMHSA-nsduh2019, accessed at: 

https://www.samhsa.gov/data/sites/default/files/reports/rpt29392/Assistant-Secretarynsduh2019_presentation/Assistant-Secretary-nsduh2019_presentation.pdf
Crime and Justice Institute 3 

law and juvenile cases, efforts to move towards a system of care for families can provide a 

roadmap to developing a similar approach within the adult court system.

• Certain courts, DBHDID, and DCBS are already implementing ROSC principles, including personcentered care, timely and equitable access to services, and use of natural supports.

• Treatment availability improved with Medicaid expansion and recent changes allowing service

provision via telehealth to be billable, but challenges persist, such as transportation, limited

provider office hours, stigma, and lack of resources to access telehealth services.

• Essential services to coordinate care for individuals involved in the court and behavioral health

systems do not have adequate funding, which has caused some communities to rely on shortterm grants to fill in gaps. Without a long-term sustainability plan, the care coordination services

will disappear when grant periods end.

• Courts and communities have increased their awareness of substance use and recovery but

would benefit from ongoing education to increase collaboration, awareness of communitybased resources, and appropriate advocacy for recovery-oriented responses to substance use

and mental health.

• Programs specifically designed to target people with substance use issues and connect them to

treatment are underutilized because of a perception among some system stakeholders that

diversion and deferred prosecution programs are too lenient. A lack of meaningful participant

incentives prevents some specialty courts from operating at full capacity.

RECOMMENDATIONS

• Convene an AOC Working Group to develop definitions, goals, values, and vision for a

Recovery-Oriented System of Care court model. It is critical to explore internal barriers to

serving individuals and families involved in multiple systems. Establishing a shared vision and

principles can help Kentucky prepare to develop achievable action steps with realistic

timeframes to transform its court system and increase consistency between different courts.

• Form a statewide Transformation Steering Committee to understand the gaps between the

current system and the vision and goals outlined by the AOC Working Group. The Steering

Committee, which should include a wide variety of stakeholders, can develop a conceptual

framework to implement a Recovery-Oriented Systems of Care court system. ROSCs require

multiple systems to align their policies and administrative and fiscal practices both internally and

with others, and the Steering Committee can identify and navigate potential barriers to

implementation.

• Identify key areas of the state in which to pilot local Recovery-Oriented System of Care

efforts. While the Transformation Steering Committee can help judicial circuits and districts

build statewide cross-agency relationships, local planning is needed to personalize each

community’s model. The Steering Committee can select local areas to pilot ROSC
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implementation. Selected communities should complete a capacity inventory and create 

resource maps and action plans to address identified gaps.
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BACKGROUND

PROBLEM STATEMENT

Over 20 million Americans over the age of 11 had a substance use disorder (SUD) in 2019, including 

alcohol use disorder, illicit drug use disorder, or both.2 Substance use disorders can contribute to 

significant academic, familial, and other life challenges; mask or aggravate mental health conditions; 

increase the risk of injury and exposure to violence; and lead to involvement with the child welfare and 

youth and adult justice systems. It is well known that justice-involved individuals have a higher 

prevalence of SUDs than the general population.

3 Programs such as drug court are a firm 

acknowledgment of the prevalence of SUDs in the justice system and provide an innovative attempt to 

integrate the mutually reinforcing goals of public safety and accountability with individuals’ recovery. 

Court involvement presents a unique opportunity to engage with individuals who have a substance use 

or co-occurring disorder and to promote long-term care and recovery. While substance use is primarily a 

behavioral health problem, the judiciary can play a critical role in addressing substance use and other 

behavioral health disorders by strengthening its approach to connecting individuals involved in the 

system with needed services. The justice and behavioral health systems have different policies, 

authority, and functions that can at times be in conflict, but have the potential to complement each 

other and work together toward outcomes that are beneficial for individuals. 

KENTUCKY’S DESIRE TO MOVE TO A RECOVERY-ORIENTED SYSTEM OF CARE COURT MODEL

Kentucky’s Court of Justice (KCOJ) recognizes the prevalence of substance use disorders among courtinvolved individuals and the opportunity that the court has to intervene and encourage treatment and 

recovery. The KCOJ’s vision for a Recovery-Oriented System of Care (ROSC) court model involves 

providing a holistic “no wrong door” approach to individuals with substance use or co-occurring 

disorders. Creating a holistic model would require the court system to operate under a shared approach 

to recovery, including clear definitions of roles and responsibilities and coordination. The KCOJ would 

like to see individuals involved in the court system assessed for behavioral health needs and connected 

to treatment services and recovery supports as early as possible regardless of their stage of court 

involvement. Its aim is to ensure that judges and court personnel at all points in the system have the 

knowledge and resources to refer an individual for assessment if they believe the individual would 

benefit from treatment at the earliest possible contact with the court system or upon identifying a 

potential substance use or mental health condition. The courts can serve as a central system to help 

2 Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health 

indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication 

No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, 

Substance Abuse and Mental Health Services Administration. Accessed at: 

https://www.samhsa.gov/data/report/2019-nsduh-annual-national-report 3 NIJ's Drugs and Crime Research: Arrestee Drug Abuse Monitoring Programs | National Institute of Justice 

(ojp.gov), accessed at: https://nij.ojp.gov/topics/articles/nijs-drugs-and-crime-research-arrestee-drug-abusemonitoring-programs#data
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court personnel identify whether individuals are touching multiple points within the legal system and

streamline their service approach. 

The KCOJ hopes to achieve the following goals by adopting an ROSC court model: 

• Ensure adequate screening is done to ensure individuals are referred for assessments;

• Examine the shift from a sanction-based, compliance court model to a Recovery-Oriented

System of Care court model to address substance use disorders (including co-occurring

disorders); 

• Leverage resources to achieve better outcomes for people with substance use and or mental

health disorders, including by expanding the services provided and matching services provided

with services individuals need;

• Consider the continuum of needs/recovery pathways to ensure staff understand how individuals

can navigate their recovery; and

• Work to enhance recovery capital by removing barriers and connecting individuals to services

available through other agencies, including childcare, housing, transportation, and employment

assistance.

RECOVERY-ORIENTED SYSTEMS OF CARE

Recovery-Oriented Systems of Care are “networks of organizations, agencies, and community members 

that coordinate a wide spectrum of services to prevent, intervene in, and treat substance use problems 

and disorders.”4

 

The Center for Substance Abuse Treatment (CSAT) within the Substance Abuse and Mental Health 

Services Administration (SAMHSA) prioritizes developing systems and services centered on recovery. In 

2005, CSAT held a National Summit on Recovery. During that Summit, a group of substance use and 

recovery leaders expressed a shared desire to break down barriers that exist in the current treatment 

model, which centered on the delivery of treatment services. To do this, the stakeholders who 

participated in the Summit proposed shifting to a community-based model, where services are available 

in communities that need them most, and family and peers are involved in the recovery process along 

with treatment professionals. 

The ideals of ROSC also reflect a shift from recovery as a goal to recovery as a process. At the 2005 

Summit, stakeholders created 12 guiding principles and 17 essential elements of ROSC. The principles 

and elements serve as a framework to create systems centered on the individuals in or moving toward 

recovery and provide services that are flexible to the evolving needs of individuals, families, and 

communities.

4 Sheedy C. K., and Whitter M., Guiding Principles and Elements of Recovery-Oriented Systems of Care: What Do 

We Know from the Research? HHS Publication No. (SMA) 09-4439. Rockville, MD: Center for Substance Abuse 

Treatment, Substance Abuse and Mental Health Services Administration, 2009. Guiding Principles and Elements of 

Recovery-Oriented Systems of Care: What do we know from the research? - August 2009 (naadac.org), accessed 

at: https://www.naadac.org/assets/2416/sheedyckwhitterm2009_guiding_principles_and_elements.pdf
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The 12 guiding principles are:

1. There are many pathways to recovery.

2. Recovery is self-directed and empowering.

3. Recovery involves a personal recognition of the need for change and transformation.

4. Recovery is holistic.

5. Recovery has cultural dimensions.

6. Recovery exists on a continuum of improved health and wellness.

7. Recovery emerges from hope and gratitude.

8. Recovery involves a process of healing and self-redefinition.

9. Recovery involves addressing discrimination and transcending shame and stigma.

10. Recovery is supported by peers and allies.

11. Recovery involves (re)joining and (re)building a life in the community.

12. Recovery is a reality.

The 17 essential elements are:

1. Person-centered – An ROSC uses language that puts the person experiencing substance use or 

mental health conditions first rather than their illness (e.g., “people experiencing substance use 

disorders” rather than “addicts”). An ROSC offers choice in treatment, recognizes individual 

potential, and is responsive to a person’s overall wellbeing rather than only their addiction.

2. Inclusive of family and other ally involvement – An ROSC encourages family and peer supports 

to play important roles in people’s recovery from mental illness or substance use disorders.

3. Individualized and comprehensive services across the lifespan – An ROSC encourages and 

supports individuality and focuses on the goals and needs of the person who is experiencing 

addiction throughout various stages of life and throughout the cycle of addiction. An ROSC 

recognizes there is no one treatment that is appropriate for everyone.

4. Systems anchored in the community – An ROSC increases the chances of successful and 

maintained recovery and wellness through strengthening support networks in the communities 

where people in recovery live.

5. Continuity of care – An ROSC ensures that individuals have appropriate services available to 

them at every step in the recovery journey.

6. Partnership-consultant relationships – An ROSC values collaboration, particularly between 

provider and client, over hierarchy.

7. Strength-based – An ROSC emphasizes the positives, strengths, and self-determination of the 

individuals involved in the system. 

8. Culturally responsive – An ROSC recognizes that various cultures may have different needs in 

the recovery process, and cultural customs may impact the effectiveness and outcomes of 

treatments.

9. Responsiveness to personal belief systems – An ROSC recognizes that individual beliefs may 

influence the treatment and recovery process.
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10. Commitment to peer recovery support services – An ROSC recognizes the value of lived 

experience and encourages peers to assist others in their recovery.

11. Inclusion of the voices and experiences of recovering individuals and their families – In an 

ROSC, all community stakeholders have something to contribute and should be part of the 

system’s design and implementation.

12. Integrated services – An ROSC provides treatment for individuals with substance use disorders 

as well as mental illness in an integrated way.

13. System-wide education and training – An ROSC ensures values and concepts associated with 

ROSCs are learned through the entire system.

14. Ongoing monitoring and outreach – In an ROSC, stakeholders assess treatment plans and 

services on an ongoing basis, and make changes as needed to ensure the plan and services 

continue to meet the person’s needs. ROSCs recognize that recovery is not a linear process.

15. Outcomes driven – An ROSC develops performance measures with all stakeholders and 

measures individual as well as community wellness.

16. Research-based – An ROSC places value on research already conducted and encourages 

additional research on relevant topics and treatment methods.

17. Adequately and flexibly financed – An ROSC permits all individuals to be able to pay for needed 

treatment along a continuum of services.5

Several states and communities have made or are making the transition to ROSC using the above guiding 

principles and essential elements. Ohio started its ROSC process by designing a stakeholder assessment 

tool to examine the extent to which state and local behavioral health systems were recovery-oriented 

and to identify opportunities to improve these systems.

6 Connecticut and Maine encouraged providers 

to collect input from individuals in recovery and their family members and to adjust their care and 

practices based on feedback received and self-assessment results.7 Michigan started its transformation 

process by convening community members such as people in recovery, family members, providers, and 

coordinating agencies to create a shared vision and implementation plan that emphasized that changes 

in attitudes and beliefs must go along with changes in practice and policy. The state formed a Steering 

Committee to lead the transformation, which incorporated the following in its vision: integrating 

strategies to prevent new substance use disorders, reducing harm from addiction, helping people 

 5 Sheedy C. K., and Whitter M., Guiding Principles and Elements of Recovery-Oriented Systems of Care: What Do 

We Know from the Research? HHS Publication No. (SMA) 09-4439. Rockville, MD: Center for Substance Abuse 

Treatment, Substance Abuse and Mental Health Services Administration, 2009. Guiding Principles and Elements of 

Recovery-Oriented Systems of Care: What do we know from the research? - August 2009 (naadac.org), accessed 

at: https://www.naadac.org/assets/2416/sheedyckwhitterm2009_guiding_principles_and_elements.pdf

6 Ohio ROSC Report 2019, accessed at: https://www.oacbha.org/docs/ROSC_State_Report.pdf 7 Practice Guidelines for Recovery-Oriented Care for Mental Health and Substance Use Conditions, Connecticut 

Department of Mental Health and Addiction Services (2008), accessed at: https://portal.ct.gov/-

/media/DMHAS/Recovery/practiceguidelines2pdf.pdf ; Mental Health Services: Practice Guidelines for Recovery 

Oriented Care (Maine, 2011), accessed at: 

https://www.maine.gov/dhhs/samhs/mentalhealth/wellness/recovery/documents/recovery-guidelines.pdf
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transition from brief to sustained recovery, promoting quality of life, and improving health and wellness 

for all.8

Kentucky appears to be the first state court system to move toward an ROSC. While examples of other 

state systems that have transitioned to ROSC are helpful to consider in moving towards an ROSC, there 

is no exact roadmap to follow to transform the state’s court system. However, Kentucky can learn from 

the steps that states like Ohio, Connecticut, Maine, and Michigan have taken in first understanding their 

own systems and identifying needs and opportunities. This report marks the beginning of that process 

and outlines recommendations for how Kentucky’s court system can start moving towards becoming a 

Recovery-Oriented System of Care.

 8 Michigan's ROSC Implementation Plan, accessed at: 

https://www.michigan.gov/documents/mdch/ROSC_Implementation_Plan_357360_7.pdf
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METHODOLOGY

SAMHSA recommends that agencies complete a needs assessment to develop an ROSC plan to inform 

stakeholders about the extent of substance use problems, gaps in services and support, and community 

and organizational strengths.9 To complete the needs assessment, CJI began by reviewing the following 

documents to identify steps Kentucky could take to move to an ROSC court system: 

• Relevant statutes and administrative rules for Pretrial Services, Specialty Courts, and Family 

Court

• Relevant Supreme Court rules

• Policy and procedure manuals

• Staff training and orientation materials

• Screening and eligibility assessment tools

• Program eligibility criteria

• Participant agreements

• Performance measures

• Program statistics and fact sheets

• Outcome evaluations

• Annual reports

Next, CJI spoke with the following stakeholders representing various geographic regions of the state, 

including rural, suburban, and urban areas, either one-on-one or through focus groups:

• Chief Justice of Kentucky’s Supreme Court (1)

• Circuit, District and Family Court Judges (13)

• AOC Leadership (3)

• Pretrial Services Managers (2)

• Specialty Court Managers (2)

• Pretrial Services Supervisors (4)

• Pretrial Officers (8)

• Specialty Court Supervisors (5)

• Specialty Court Case Specialists (6) 

• DBHDID Leadership (3)

• Community Mental Health Center and Treatment Program Directors (8)

• DCBS Regional Administrators and Family Services Office Supervisors (9)

• DCBS Social Workers (5)

• Probation and Parole Leadership (2)

• Prosecutors (3)

• Defense Attorneys (7)

 9 Recovery-Oriented Systems of Care (ROSC) Resource Guide, accessed at: 

https://www.samhsa.gov/sites/default/files/rosc_resource_guide_book.pdf
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• Law Enforcement (1) 

Finally, CJI created a survey that an additional seven treatment providers completed.

This report articulates the findings from the document review and discussions with stakeholders, and 

includes recommendations for the KCOJ.
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FINDINGS

COLLABORATION, COMMUNICATION, COORDINATION

FINDING 1

There are challenges in coordinating care between courts and treatment providers and different 

expectations about the roles of courts and treatment providers, making efficient and effective service 

delivery difficult. 

Together, Kentucky’s courts and behavioral health systems value the collaboration they experienced 

through recent grant opportunities funded through SAMHSA, such as the Kentucky Opioid Response 

Effort (KORE) and the Responsive Education to Support Treatment in Opioid Recovery Efforts (RESTORE) 

Initiative. However, stakeholders noted challenges involving care coordination, the expectations about 

the courts and treatment providers’ roles, collaboration, competition, and data sharing. 

Care Coordination

Treatment providers noted challenges with coordinating care for individuals, particularly those who do 

not have a designated case manager, social worker, or probation or parole officer. They also expressed 

that having individuals set up services independently in times of stress can be difficult and confusing.

Information sharing is a critical component of cross-system collaboration, and many courts and 

treatment providers lack a consistent communication structure. The communication structure is very 

different based on the type of program and geographic location. Smaller jurisdictions tend to have 

closer relationships and more frequent contact with providers than jurisdictions in larger urban areas.

Generally, Pretrial Officers give individuals a resource list and tell them to call providers to set up

appointments. When individuals initially reach out to service providers, they are frequently unclear 

about what the courts expect of their participation with the provider. Sometimes they are required to 

complete treatment, while other times they only have to complete an assessment to determine whether 

the provider recommends treatment participation. Due to caseload size and staffing, Pretrial Services 

lacks staff capacity to provide stronger links to services.

The Pretrial Assisted Reentry Treatment Services (PARTS) program is an exception; its coordinator 

communicates directly with service providers to connect individuals to services and provides ongoing 

case management to program participants.10 Another program that facilitates connections to services 

during the pretrial phase is the Department of Public Advocacy’s (DPA) Alternative Sentencing Worker 

(ASW) Program.11 Pretrial Officers who work closely with the social workers from this program have 

 10 Multiple stakeholders spoke highly of the PARTS Program’s ability to engage and support participants through 

ongoing case management.

11 Through a referral process, DPA attorneys and ASWs identify individuals who suffer from substance abuse 

and/or mental health disorders, offering alternative options to the court, in lieu of incarceration. More information 

at: Alternative Sentencing Workers - Department of Public Advocacy (ky.gov), accessed at: 

https://dpa.ky.gov/who_we_are/ASW/Pages/default.aspx
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found ASWs to be helpful in initiating care; however, not all Pretrial Officers are aware of or utilizing 

them as a resource and the ASWs cannot provide ongoing monitoring and support for individuals once a 

court approves the plan. To ensure continuity of care, it is important to connect people to ongoing case 

management in addition to treatment services.

Once Pretrial Officers refer individuals to services, they reported having infrequent contact with service 

providers. They receive participation verification at intake and discharge only. In the PARTS program, the 

coordinator maintains regular contact with 

treatment providers and notifies courts upon 

treatment program completion.

Specialty courts generally do not report 

concerns with care coordination, except in 

cases where providers are understaffed. 

Specialty courts outline communication and 

reporting expectations in Memorandums of 

Agreement with their contracted providers. 

Specialty court staff and treatment providers 

both participate on the treatment court team 

and problem solve care coordination issues as 

they arise during staffing. 

Family Courts primarily receive treatment 

information through DCBS social workers. DCBS staff receive monthly updates from providers and 

include treatment participation information in their reports to the court. DCBS staff articulated 

challenges with receiving information from some service providers. In many cases, individuals do not 

sign releases of information for DCBS to receive treatment information, and providers cannot share 

treatment information without a signed release due to HIPAA. In turn, DCBS cannot share treatment 

engagement and progress with the courts. Social workers also reported that even with a signed release, 

they do not always receive consistent treatment participation information, particularly from 

medications for opioid use disorder providers. Despite those challenges, DCBS staff reported having 

strong relationships and regular communication with Community Mental Health Centers (CMHCs).

Expectations about the roles of the courts and treatment providers

Throughout the state, courts and behavioral health providers have varied understanding of their roles 

and expectations of one another. Some courts view their role as screening and connecting individuals to 

resources and providing structure and accountability, but rely on treatment providers to determine the 

appropriate level of care and responses to individuals’ needs. Other courts recommend specific 

treatment responses for individuals with substance use and other behavioral health conditions before 

receiving input from providers. Treatment providers view the courts as a significant referral source and a 

screening and entry point, and prefer to recommend service plans based on the results of their clinical 

assessment of each person’s needs. The level of collaboration between systems correlates to the courts’ 

ROSC Elements in Action in Kentucky 

Integrated services: 

In Eastern Kentucky, Help End Addiction for 

Life (HEAL) was formed in 2018 by a local 

doctor, a hospital CEO, and a local 

treatment provider. Through HEAL, courts 

in Letcher county developed stronger 

connections to treatment providers, and 

they now have a Community Mental Health 

Center provide screening and assessments 

to individuals released directly from jail. 

HEAL focuses on prevention, education, 

treatment, and recovery. 
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relationships with specific providers and the level of trust between courts and programs in their 

communities. 

In some jurisdictions, courts ask providers to attend court to screen and assess individuals. Other courts 

ask treatment providers to be available to assess individuals presenting to court on an on-call basis. 

Although immediate assessment facilitates access to services for those in the court systems, many

providers cannot accommodate those requests without grant funding.

Courts and behavioral health providers recognize opportunities to increase understanding of each 

system to leverage their strengths. Judges expressed that they would like to learn more about available 

community-based case management services to ensure adequate referrals to services based within their 

communities for all individuals not engaged in specialty courts. This would allow them to effectively 

utilize community resources while reserving court-based case management capacity for high-risk/highneeds individuals through specialty courts. Behavioral health providers expressed an interest in learning 

how to become more involved in expediting entry into services for those involved in the court system. 

Stakeholders identified ways in which the courts communicate with other agencies, including providers, 

to strengthen relationships. Treatment providers found education sessions with judges about the use of 

drug testing to improve therapeutic responses have been productive. Both systems would benefit from 

educating one another about processes and approaches to recovery to improve coordination. Specialty 

court supervisors reported participating in boards such as the Agency for Substance Abuse Policy Board 

to develop relationships with providers within their communities.12 In some jurisdictions, DCBS 

supervisors meet quarterly with judges to identify areas for improvement, and staff expressed that 

those meetings are productive and improve communication between systems. 

Competition

The court system is a significant referral source for behavioral health treatment programs, and 

competition for referrals exists among some providers. Certain courts have close relationships with 

specific programs, while others do not. Access to long-term recovery support services for those who 

need them is not equitable throughout the state, and existing referral patterns do not always ensure 

that individuals are matched with the best treatment modality to meet their needs. 

In addition to concerns about referrals and access, stakeholders acknowledged that there are different 

perspectives within the provider community about best practices for treating substance use disorders. 

In a truly Recovery-Oriented System of Care, clinical behavioral health treatment is one of many 

pathways to recovery. ROSCs make space for a variety of services and place equal value in each pathway 

to recovery. However, the different pathways are not always equally accessible to consumers. 

Understanding the challenges with entry into different treatment and recovery services as well as how 

competition among providers impacts collaboration is important to building a robust system. ROSCs 

 12 KY Agency for Substance Abuse Policy - Office of Drug Control Policy, accessed at: 

https://odcp.ky.gov/About/Pages/History.aspx
Crime and Justice Institute 15

value both licensed and peer-led options for individuals seeking recovery, so exploring and navigating 

these differences in services and approaches to recovery will be crucial to creating a system where 

individuals seeking recovery have multiple options available to meet their needs. 

Data integration/information sharing

The behavioral health system has worked towards data integration with the courts for several years. 

DBHDID wants to track incarceration data and court case outcomes. DBHDID has made progress with 

the Department of Corrections and can track individuals after release to see if they went to the 

emergency room within a certain number of days. However, behavioral health cannot currently get

similar data to track outcomes from the courts due to confidentiality concerns. Although DBHDID can 

access court data, the data systems do not talk to each other, and the data are not integrated. 

Treatment providers indicated that the release of information, which the individual signs during intake,

determines the information they share with the court. Providers emphasized the importance of basing 

that information sharing on individual preferences. However, court staff suggested that individuals 

generally agree to share all information the court requests regardless of their personal comfort level due 

to the courts’ power. It is critical to consider the type and degree of treatment information providers 

share with the courts and how they use that information. Providers have an obligation to protect the

therapeutic alliance, which is an essential component of positive recovery outcomes. Therefore, courts 

and providers need to develop a clear understanding of the purpose of sharing treatment information.

FINDING 2

Each direct service department within the AOC operates independent court programs and 

collaborates on joint projects, but they have not yet established a shared definition, vision, and 

approach to recovery. Differences in perspectives towards recovery result in different uses of program 

conditions.

Approach to recovery and the roles of courts and service providers

The AOC oversees three distinct direct service departments: Pretrial, Family and Juvenile Services, and 

Specialty Courts. Generally, there is little cross-training or collaboration among AOC departments,

although all three are now providing training to new staff on racial disparities and are in the process of 

developing an SUD overview training for all new employees. Throughout the AOC, staff indicated that 

individuals, families, and staff are involved in multiple aspects of the court system (e.g., criminal, child 

welfare, civil). This highlights the need for a shared understanding of and approach to behavioral health. 

All three departments have trained staff, judges, and other justice stakeholders on substance use 

disorders, primarily through the RESTORE Initiative.13 Stakeholders spoke highly about the RESTORE 

summits and expressed interest in receiving more training on behavioral health topics. Staff from 

 13 RESTORE Summary Booklet, accessed at: https://operationunite.org/wp-content/uploads/2019/04/RESTOREpamphlet-4-11-19.pdf
Crime and Justice Institute 16

various departments within the AOC highlighted the importance of engaging in more collaboration to 

streamline obligations that individuals and families may have in different courts and systems.

Although there is consensus among stakeholders that substance use affects approximately 90 percent of 

cases throughout the court system, they shared different perspectives about substance use. The 

majority of stakeholders mentioned that relapse is part of recovery; however, they continually used 

language conveying the perspective that substance use is an acute condition that only treatment can 

address. This perspective is contrary to an ROSC, which views substance use as a chronic condition and 

recognizes that one can achieve recovery through many pathways, including treatment.14

Screening tools

Each direct service department within the AOC relies on a separate screening tool and process to 

identify individuals with substance use and mental health needs. Screening provides the foundation for 

identification and placement into treatment interventions, and research shows that the use of 

comprehensive screening and assessment for substance use and mental health conditions improves 

outcomes for individuals involved in the justice system.15 Without a shared approach to screening and 

referring individuals, the courts may miss opportunities to connect people to services. Information 

sharing barriers within the adult justice system also result in individuals having to answer similar 

questions multiple times. For example, jail staff initially screen individuals during booking, but they do 

not share that information with Pretrial Services staff.16 Some judges reported that the pretrial 

screening tool does not provide enough information about substance use and mental health to aid their 

decision making and suggested that jails share behavioral health information with Pretrial Services to 

inform the courts. They did not explain how they intended to use that information to make decisions 

about pretrial release or conditions, and there would likely need to be training and policy on this as the 

information could be used differently by different judges (e.g., used as a reason to detain or a reason to 

connect to community based services).

To identify individuals with potential substance use treatment needs, Pretrial Services checks the 

criminal history to see whether the individual has three or more alcohol or other substance abuse 

charges within the past five years.

17 Pretrial Services collects data on drug charges as part of the 

screening process but recognizes that those charges are not a valid indicator of substance use among 

individuals screened pretrial.18 In the interview, pretrial officers ask each defendant, “Do you feel that 

you have a substance abuse problem?”19 Stakeholders mentioned that individuals’ willingness to 

 14 Mental Health Services: Practice Guidelines for Recovery Oriented Care (Maine, 2011), accessed at: 

https://www.maine.gov/dhhs/samhs/mentalhealth/wellness/recovery/documents/recovery-guidelines.pdf 15 Screening and Assessment of Co-occurring Disorders in the Justice System (samhsa.gov), accessed at: 

https://store.samhsa.gov/sites/default/files/d7/priv/pep19-screen-codjs.pdf 16 Email received from Tara Blair, Executive Officer of Pretrial Services, received 9/15/20. 17 Pretrial Release Information Management Technical Guide 18 Email from Michael Thacker, Risk Assessment Coordinator for Pretrial Services, received 10/5/20 19 Pretrial Release Information Management Technical Guide
Crime and Justice Institute 17

respond to that question depends on how staff ask it and whether they communicate the purpose of 

collecting that information. Pretrial Services does not screen specifically for mental health conditions.20

Judges, prosecutors, and defense attorneys generally identify specialty court candidates and refer 

individuals for an eligibility assessment, which AOC staff complete.

21 The assessment results create a risk 

score, which helps the judge and specialty court team make an acceptance decision. The judge makes 

the final acceptance decision considering the current charges and convictions, past convictions, 

eligibility assessment results, victim information, willingness to participate, and other factors.22 The 

specialty court eligibility assessment process includes mental health as well as substance use 

information, and is extensive and includes some duplicative questions. Some of the information staff 

collect during the assessment is not needed to make program eligibility determinations as it is typically

used by clinicians for diagnostic and treatment planning purposes.

23

In Family Court, DCBS staff screen individuals for substance use and mental health treatment needs and 

refer them to treatment providers or assessment centers such as the Targeted Assessment Program 

(TAP) for clinical assessments. DCBS focuses on whether a parent or guardian’s substance use interferes 

with their ability to care for their children and whether a sober adult is available to step in and care for 

the children if a parent becomes impaired. The DCBS screening is brief, and in some Family Courts, 

service providers attend court to complete assessments with families in need of services. Stakeholders 

find this practice beneficial in linking families to treatment when they are interested in participating in 

services.

Use of Program Conditions

Courts vary in their use of program conditions and responses to violations of conditions, both within and 

among direct service departments. Pretrial Services Regional Supervisors consult with local judges to 

develop a written protocol to guide communication about program violations.24 The amount of 

discretion provided to Pretrial Services to respond to violations without court intervention varies 

considerably. If the pretrial screening indicates the presence of recent and relevant substance use 

disorder risk factors, courts may order release conditions such as drug testing, additional assessment, 

and treatment or recovery program participation based on assessment results.25

Stakeholders indicated that courts tailor release conditions to the individual or the current charge. Some 

judges order more conditions than others do for similarly situated cases. For example, some judges 

order individuals to obtain employment or work towards getting a General Equivalency Diploma (GED) 

 20 Pretrial Services is in the process of selecting a standardized screening tool. 21 The specialty court assessment process consists of the Addiction Severity Index Lite, the Ohio Risk Assessment 

System Pretrial Assessment Tool and the Ohio Risk Assessment System Community Supervision Tool, the Texas 

Christian University TCUDS-5 for substance use disorder identification, and the Mental Health Form III for a history 

of mental health issues, including history of suicidality and traumatic experiences. 22 Supreme Court Administrative Procedures 2016 23 Specialty Court Assessment, Version 1.0, September 23, 2019 24 Pretrial Services Administrative Policies (Amended 6/2018) 25 KRS 431.518 and Pretrial Training and Resource Guide
Crime and Justice Institute 18

to provide daily structure and help them become more financially stable, while other judges limit the 

conditions they impose because of transportation and financial barriers that impact compliance. In 

addition to differing views on pretrial release conditions, judges also expressed different views on the 

value of individuals meeting with pretrial officers, the use of Monitored Conditional Release (MCR), 

home incarceration, and electronic monitoring. Some judges rely on MCR, which can include home 

incarceration with a condition of release to attend treatment for individuals they do not feel 

comfortable releasing on their recognizance, to limit their movement while remaining in the community.

Other judges expressed that some treatment providers will not accept individuals on home incarceration 

and avoided its use to remove that barrier to accessing services.

Specialty court conditions also vary by program, particularly those related to employment and education 

requirements. Some courts require individuals to attend an employment search group each day they 

remain unemployed, and certain courts require participants to obtain a GED before graduating. Some

courts do not allow individuals to complete the program until they have paid all of their court costs, 

which keeps participants in the program long after they have finished all other requirements. Courts 

also do not employ a consistent approach to the use of medications for opioid use disorder (MOUD). 

Some judges expressed concerns about its use and potential for abuse and did not support individuals 

receiving MOUD, while others discussed its benefit in treating opioid use disorders. 

Family Court conditions vary across the state. Some courts defer to the needs identified by DCBS staff, 

while others use their own assessment of families’ needs and challenges to determine conditions. The 

court and DCBS determine what activities will be included in the case plan at the disposition hearing.

Families and supports play a role in shaping their case plan goals and activities to the extent they wish to 

participate. DCBS also makes recommendations based on collateral contacts with community partners, 

and the judge often orders individuals to comply with those recommendations. 

Drug Testing

Courts hold differing views on the purpose, utility, and role of drug testing people on pretrial release. To 

begin with, each type of court takes a different approach to ordering drug testing as a condition. In 

pretrial supervision circumstances, participants only need to complete drug testing when it is courtordered.26 In specialty court, each phase has a specific drug testing frequency to which all participants 

must adhere. Family Court orders most parents involved in dependency, neglect, and abuse cases to 

complete drug testing. Individuals on pretrial supervision and in Family Court are responsible for paying 

for drug testing costs, unless a court orders CHFS to pay for those involved in dependency, neglect, and 

abuse cases. Individuals in specialty courts do not have to pay for drug testing. Individuals pay for 

additional testing costs to challenge positive test results, with the exception of specialty court 

participants.

27 28 Some judges order drug testing as a condition while others avoid requiring individuals 

 26 Monitored Conditional Release Supervision Manual 27 Monitored Conditional Release Supervision Manual 28 In dependency, neglect, and abuse cases, individuals are required to pay for drug testing unless the judge 

explicitly orders the Cabinet for Health and Family Services to pay testing fees. At times, judges weigh drug test 

results more heavily than treatment engagement and participation in making decisions about visitation.
Crime and Justice Institute 19

to complete drug testing due to financial barriers. Overall, stakeholders identified drug testing as the 

condition with which participants struggle most. 

Since many treatment providers also drug test participants, not all courts order drug testing as a 

separate condition from treatment participation. In many courts, judges receive drug test results from 

the treatment providers. Pretrial staff indicated 

that allowing treatment providers to conduct 

the drug testing reduced individuals’ barriers to 

compliance with release conditions. 

Responses to positive drug tests also vary

throughout the court system. Some courts 

confer with treatment providers when deciding 

how to respond to positive drug test results, 

while others do not. Judges often want to see 

people back in court if they test positive. At 

times, judges use these contacts to arrange for 

the person to get to treatment, but in other 

cases, the judge orders individuals into custody 

for a violation of program conditions. In some 

courts, individuals receive a misdemeanor 

charge for testing positive while on pretrial 

release. When individuals test positive, some courts forward that information to the county attorney’s 

office to see whether they would like to file a motion to revoke the person’s bond.

Some judges and Pretrial Services staff indicated that many courts excuse the first drug test if the person 

informs staff that the result will be positive, and some courts allow a period for substance concentration

levels to decrease if the person opts to pay for the test to go to the lab for further analysis. Although 

courts generally give individuals an initial grace period, that rarely extends beyond the beginning of 

supervision. If an individual experiences a recurrence or returns to use after a period of sobriety, courts 

tend to view a positive test result as a failure and an indication of noncompliance regardless of any

incremental progress made in other areas. Specialty courts, however, understand that individuals may 

experience a recurrence or return to use and adjust participant progress through program phases 

accordingly. Participants must remain drug-free for a minimum of 180 days to complete specialty court. 

FINDING 3

The collaboration between the Cabinet for Health and Family Services’ DBHDID and DCBS, and the 

AOC has strengthened in the past six years. In family law and juvenile cases, efforts to move towards a 

system of care for families can provide a roadmap to developing a similar approach within the adult 

court system.

The courts and CHFS have navigated communication challenges by creating formal structures to support 

collaboration. 

ROSC Elements in Action in Kentucky 

Ongoing monitoring and outreach: 

The Pretrial Assisted Reentry Treatment 

Services (PARTS) program views drug 

testing while a person is involved in 

treatment as part of the therapeutic 

process rather than an indication of 

compliance with pretrial release conditions. 

Treatment professionals may make 

therapeutic adjustments to the person’s 

care plan in response to positive test 

results. However, the providers do not 

share drug test results with the court, and 

those results do not impact the person’s 

court case or status in the PARTS program. 
Crime and Justice Institute 20

Communication and structure

In 2014, Chief Justice Minton created a communication plan that includes quarterly meetings between

high-level representatives from KCOJ, the Cabinet for Health and Family Services, and the Justice and 

Public Safety Cabinet. The group focuses on working better together on issues affecting children and 

families in the courts. They discuss legislative changes but do not address issues related to criminal 

cases. The group also has subgroups, including a judicial engagement workgroup. Chief Justice Minton’s 

leadership has been critical to increasing judges’ awareness and education about substance use and 

mental health. Many stakeholders indicated his support for education offered through the RESTORE 

Summits was very influential in generating buy-in from the courts. Chief Justice Minton noted that 

Kentucky has some background in implementing systemic change to the court system at the statewide 

level through its experience with specialty courts, bail reform, and the Family Court model. He 

expressed that the experience gained from those prior efforts, combined with Kentucky’s desire to 

better address behavioral health conditions for those involved in the court system, prepare the state to 

take on the transition to an ROSC court model. 

The AOC, DBHDID, and DCBS all participate in the State Interagency Council for Services to Children and 

Transition-age Youth, a statutorily mandated group.29 Participation in the council created more formal 

connections between behavioral health and the court system on substance use and mental health; this 

group serves as a system of care entity. In addition to the state-level work, Regional Interagency 

Councils coordinate services locally to support families. Behavioral health leaders indicated that the 

collaboration between their system and Juvenile and Family Services is much farther along than 

collaboration within the adult system. The partnership between systems is evident through the 

prevention programs offered in Family Court that help families resolve issues either without getting 

involved in the courts or minimizing court system involvement while keeping families intact.

30

Frequent turnover in the Cabinet for Health and Family Services presents a challenge to sustaining 

improvements. Changes in vision and direction can easily derail prior efforts to improve systems, and 

collaboration requires strong relationships. Staff turnover also contributes to a lack of institutional 

knowledge and understanding of policies and processes within the court, behavioral health, and child 

welfare systems. It is important to establish communication structures and coordination at multiple 

levels within agencies to create the consistency needed to build trust and sustain change. The various 

coordination levels established between systems serving families can inform the adult criminal court 

system’s transition to an ROSC court model.

 29 Kentucky Cabinet for Health and Family Services, accessed at: http://dbhdid.ky.gov/dbh/siac.aspx 30 Prevention Services Description and Eligibility Criteria, accessed at: 

https://manuals.sp.chfs.ky.gov/Resources/Related%20Resources%20Library/Prevention%20Services%20Descriptio

n%20and%20Eligibility%20Criteria.pdf
Crime and Justice Institute 21

FINDING 4

Certain courts, DBHDID, and DCBS are already implementing ROSC principles, including personcentered care, timely and equitable access to services, and use of natural supports.

Although the courts and the Cabinet for Health and Family Services, including DBHDID and DCBS, have 

distinct roles and responsibilities, all systems embrace a shared understanding of the impact of 

substance use on individuals and families. Stakeholders expressed a need to better support individuals 

with substance use and other behavioral health conditions through swift and uncomplicated access to 

individualized services. 

Person-centered planning

In courts and treatment programs, individuals provide input into their case and treatment plans. There 

are varying degrees to which people involved with the courts can choose their goals. Still, case managers 

generally try to individualize plans to the extent possible. Case and treatment plans often include goals 

related to basic needs such as transportation, stable housing, and employment, which are all crucial 

components of their recovery capital.31 Goals include incremental action steps and evolve as each 

person progresses in the program. Treatment providers reported that they determine the individual’s

stage of change and adapt their engagement strategies to meet each person where they are.

32 Providers 

use motivational interviewing and the American Society of Addiction Medicine (ASAM) criteria to inform 

their treatment recommendations.33 CMHC Directors stated that they take a broad perspective on 

individuals’ success and measure progress towards recovery as developing a healthy mind, body, and 

spirit.

Exit and annual surveys

Some courts and treatment providers solicit feedback from participants to identify areas for 

improvement. Specialty courts conduct exit surveys with those participants who successfully complete 

the program. While this is important, the courts may be missing opportunities to understand gaps by not 

gathering information from individuals who do not complete it. Pretrial Services and Family Court do 

not have a consistent mechanism to collect recommendations for improvements from individuals, 

although staff informally ask them about their experiences. All licensed treatment facilities are required 

to provide a survey to anyone involved in treatment at the time of the annual survey, and the Kentucky 

Treatment Outcome Study reflects those survey results.

34 Some providers use information obtained 

through exit surveys to drive changes to their programming and services.

 31 2008Recovery:SystemsPerspective (ky.gov) Presentation from the Southeast Addiction Technology Transfer 

Center (ATTC) provided to Kentucky Department for Behavioral health, Developmental and Intellectual Disabilities, 

accessed at: 

http://dbhdid.ky.gov/dbh/documents/ksaods/2017/RecoveryOrientedSystemsofCare.pdf?t=23425306122018

32 Stages of Change, accessed at: https://tnchildren.org/wp-content/uploads/2014/11/Stages-of-Change.pdf 33 About the ASAM Criteria, accessed at: https://www.asam.org/asam-criteria/about 34 2020 KTOS Fact Sheet, accessed at: https://cdar.uky.edu/KTOS/KTOS_2020_Fact_Sheet.pdf
Crime and Justice Institute 22

Use of peer supports

The courts value services provided by peer 

supports—individuals with lived experience in 

recovery. Some courts have arranged with service 

providers to have a peer support specialist attend 

court to help individuals learn more about 

treatment and recovery support services. Courts 

have accomplished this without grant funding 

through relationship building and find peer 

supports beneficial to increasing engagement.

The Cabinet for Health and Family Services also 

incorporates peer support specialists for some 

eligible court cases. 

DBHDID also relies on peer support specialists to engage and provide recovery support to individuals 

involved in the behavioral health system. Peer supports facilitate connections to services through quick 

response teams that respond to overdoses. They also establish rapport with individuals in jails. Peer 

supports work at federally qualified health centers and connect people to primary care and syringe 

exchanges. Community Mental Health Centers frequently hire peer support specialists and employ 

individuals with lived experience in recovery in case manager and supervisor positions. Behavioral health 

leaders expressed an interest in hiring more peers with justice system experience, but indicated that 

barriers prevent some justice-involved and formerly justice-involved individuals from interacting with 

those with felony convictions. Some individuals bypassed this restriction by having their records 

expunged. DBHDID would like to see those opportunities expand. 

Community representation and advisory groups

Courts and treatment providers acknowledge the importance of partnering with community groups to 

improve responses to substance use. Hardin County’s drug court grew out of a local community 

grassroots effort, although the AOC currently oversees program operation.

Family Court judges and staff currently participate 

in specialized training based on a community 

strengths-based, holistic model that focuses on 

building community involvement and gaining a 

full understanding of available social services. 

Some specialty courts involve a community 

representative on their teams, such as the YMCA, 

Chamber of Commerce, or other similar entities,

to serve as an additional resource to programs. In 

addition to court-community partnerships, some 

ROSC Elements in Action in Kentucky

Commitment to peer recovery 

support services: 

In the Sobriety Treatment and Recovery 

Team (START) Program, parents who 

have navigated the child welfare system 

offer support to parents/guardians 

involved in dependency, neglect, and 

abuse cases. The courts consider their 

services invaluable.

ROSC Elements in Action in Kentucky

Culturally responsive:

One Family Court established Hardin 

County’s Minority Advisory Council to 

educate the courts on cultural issues to 

understand how culture affects parenting 

and increase the courts’ responsivity to 

families of different cultures.
Crime and Justice Institute 23

behavioral health providers partner with mutual aid groups to link individuals to long-term community 

supports.

ACCESS & AVAILABILITY

FINDING 5

Treatment availability improved with Medicaid expansion and recent changes allowing service 

provision via telehealth to be billable, but challenges persist, such as transportation, limited provider 

office hours, stigma, and lack of resources to access telehealth services.

Transportation

In rural areas of Kentucky, where there is an 

absence of public transit, many individuals

struggle to get to treatment, drug testing 

appointments, job sites, educational 

opportunities, or other appointments. 

Stakeholders identified transportation as the 

most significant barrier to individuals receiving 

services.35 Many individuals do not have access 

to a car, the financial resources to purchase a 

vehicle, or the ability to drive, often due to a 

suspended driver’s license. Although some 

transportation assistance is available through 

Medicaid, several hurdles and eligibility requirements make access to transportation difficult.36 37

Stakeholders in all roles shared that they felt the many court-related requirements combined with the 

lack of access to transportation set individuals up for failure. 

Scheduling and Employment

In addition to transportation barriers, individuals struggle to maintain employment and keep up with 

drug testing requirements while on pretrial release or while involved in other court programming. 

Stakeholders shared that in some areas of the state where drug testing is only available for limited hours 

each week, many individuals work later shifts so that they can make it to the allotted time for drug 

testing. Employment opportunities are already limited for those with prior records, so limiting the shifts 

people can work may further impact their employment prospects. Local employers who are willing to 

hire individuals who are actively on pretrial supervision or involved in a specialty court are aware of drug 

 35 In addition to posing a barrier to accessing services, access to transportation is an eligibility factor for some 

specialty courts. 36 Medical Transportation - Cabinet for Health and Family Services (ky.gov), accessed at: 

https://chfs.ky.gov/agencies/dms/dpo/bpb/Pages/transportation.aspx 

37 DOC secured funding to support transportation for individuals on probation in some areas of the state, and 

contracts services through Medicaid transportation brokers.

ROSC Elements in Action in Kentucky

Systems Anchored in the Community: 

Addiction Recovery Care (ARC), a local 

provider in Eastern Kentucky, transports 

individuals with substance use disorders 

directly from jail to treatment, which the 

courts find extremely helpful. This 

collaboration alleviates the barrier of lack 

of transportation for consumers.
Crime and Justice Institute 24

testing times and provide their employees flexibility to attend appointments. However, this is not the 

case for all court-involved individuals, and often random or scheduled drug testing can interfere with 

employment, education, or other opportunities for self-improvement. Pretrial supervisors highlighted 

the benefit of viewing drug testing as part of treatment rather than as a separate release condition. 

Treatment providers can still provide test results to the court if required, eliminating additional costs 

and time for participants and reducing duplication of services for those currently being tested through 

multiple entities.

38

Many court-involved individuals lack family support, making it challenging to prioritize treatment. Some 

areas of the state lack vital child care services, preventing some individuals with parental responsibilities 

from complying with various conditions. Many individuals also begin their court involvement 

unaccustomed to living with a structured schedule, and therefore struggle with attending court and 

other appointments. Keeping a highly structured schedule is especially difficult for individuals whose 

families have dealt with substance use and other behavioral health conditions for multiple generations. 

Since court programs require participants to juggle several competing priorities at once with limited 

support, courts have tried to assist individuals with meeting their court obligations such as providing 

text reminders notifying them about upcoming court dates. This approach has proven successful in 

other jurisdictions, including Hennepin County, Minnesota39, and Nebraska40.

Geographic variability

Like many states, Kentucky spans rural, urban, and suburban areas, and stakeholders have identified 

differential availability of services depending on geographic location. One service that is lacking in many 

rural areas is sober or recovery housing. People face long wait times for program admittance in rural 

areas, and not every county has a drug testing facility. These limitations present barriers to successful 

participation in programming for individuals who live in remote areas. Stakeholders from Pretrial

Services indicated they have struggled to find providers in Eastern Kentucky that take Medicare. Some 

programs offer services outside of regular business hours to accommodate those that work during the 

day, but this availability is largely dependent on grant funding in other areas. Certain areas of the state 

have minimal flexibility with drug testing times, which results in individuals having difficulties meeting 

their appointments for testing. Similarly, rural counties lack resources for treatment and struggle to add 

programming because they cannot justify expanding services without having a guaranteed population to 

participate in the service. To pay staff to run groups, they need a certain number of participants to 

justify the cost of providing those services. Rural areas also face challenges in providing treatment 

 38 Individuals can be tested through several agencies at the same time, such as treatment providers, probation and 

parole, pretrial services, specialty courts, and under a court order.

39 Hennepin County Court eReminders Project September 2019, accessed at: 

https://www.mncourts.gov/mncourtsgov/media/fourth_district/documents/Research/Hennepin-County-CourteReminders-Project-September-2019.pdf 40 Reducing Courts’ Failure to Appear Rate: A Procedural Approach (ncjrs.gov), accessed at: 

https://www.ncjrs.gov/pdffiles1/nij/grants/234370.pdf
Crime and Justice Institute 25

options that are responsive to individuals’ needs, such as gender-specific, LGBTQIA, and culturallyresponsive programs.

In addition to the availability of services varying throughout the state, programs have significant 

operational variation.41 For example, specialty courts may have different eligibility criteria depending on 

the jurisdiction. Stakeholders shared that differences in eligibility to participate in specialty courts and 

attend treatment exist based on risk score and criminal charge.

Capacity

A key component of understanding whether treatment services are accessible and available is a capacity 

assessment or resource mapping.42 Stakeholders held different views about the availability of treatment 

and recovery support resources in their area. Some noted a lack of services, while others, mainly court 

officials and providers, indicated that the lack of services is primarily a perception issue. Stakeholders 

reported that the wait for residential treatment is typically one to two weeks, depending on the 

program. While individuals face waiting periods for services, service providers try to ensure that 

individuals can meet multiple needs while attending treatment. Several communities have co-located 

physical health clinics so that individuals can move towards improving their quality of life in areas 

beyond behavioral health.

Insurance

Medicaid expansion became effective in Kentucky on January 1, 2014. Several stakeholders expressed 

that additional treatment options became available in the state after this. Between the fall of 2013 and 

July 2018, the state experienced an increase of 643,807 individuals covered by Medicaid or the Kentucky 

Children’s Health Insurance Program (CHIP) and a 62% reduction in its uninsured rate from 2013 to 

2017.43 The 1115 waiver is a part of Medicaid expansion and specifically targets people who are justiceinvolved, allowing Kentucky to improve substance use disorder treatment, including using evidencebased practices, increasing provider capacity, and improving care coordination and transitions between 

levels of care. Even with the increase in treatment centers and programs throughout the state, access 

and availability issues remain.

Although coverage has dramatically improved for Kentucky residents, stakeholders indicated that the 

average length of stay in treatment covered by insurance is inadequate to meet many individuals’ 

needs. Jail stays also impact individuals’ ability to receive treatment funding through Medicaid. The 

longer people are in jail, the less likely it is that insurance would deem them medically in need of 

treatment. Some judges expressed the importance of having individuals released from jail to treatment 

 41 Misdemeanor diversions are available in some but not all counties (about 30 of 120). To operate a misdemeanor 

diversion program, the county attorney and judge develop an agreement and submit local court rules to the 

Supreme Court for approval. Individuals do not plead guilty and the court dismisses the case if they successfully 

completed the terms of the diversion.

42 Asset Mapping, accessed at: https://healthpolicy.ucla.edu/programs/healthdata/trainings/Documents/tw_cba20.pdf

43 Kentucky and the ACA’s Medicaid expansion, accessed at: https://www.healthinsurance.org/kentucky-medicaid/
Crime and Justice Institute 26

as quickly as possible to remain eligible for treatment, and that jail can be a strategic access point if 

people gather information quickly and develop connections to services. Medicaid has strict approval 

guidelines and often does not accept findings of professionals and their recommendations, so 

individuals may be approved for outpatient services only, even though professionals are recommending

inpatient. To navigate Medicaid’s tier approval process, individuals may attend multiple treatment 

interventions before receiving coverage for the appropriate level of care. Other challenges present 

barriers to accessing services. In terms of home incarceration, stakeholders shared that some treatment 

programs will not accept individuals serving this kind of sentence. Although the Department of 

Corrections has contracted residential treatment beds, they are unavailable to individuals who are not 

on probation or parole. Certain treatment programs do not accept Medicare, while others only take 

Medicare recipients or private insurance, all of which pose a barrier to some individuals referred to 

treatment.

Financial

A substantial barrier to accessing treatment and recovery support services is financial. Individuals

struggle to pay for costs associated with their court involvement, such as court fees and some drug 

testing and treatment services. Kentucky does not have statewide guidance about drug testing for 

individuals involved in dependency, neglect, and abuse cases, so local protocols and practices set 

standards for the approach to drug testing. Pretrial Services’ list of approved drug testing providers

requires providers to offer a sliding fee scale; however, that financial obligation is still difficult for many 

individuals to meet. It is possible for legal representation to file a motion for the court to waive drug 

testing fees, but it is unclear how often this happens and what the standards or rules are. Although 

there are no guidelines for attorneys to help their clients reduce drug testing fees, courts in various 

jurisdictions found ways to reduce costs, such as using a sliding scale or waiving fees altogether 

prompted by verbal requests from counsel. Whether individuals have access to that relief varies 

considerably among courts. 

Individuals facing DUI charges typically have to pay for ignition interlock devices, which can pose a 

financial burden, even with the sliding scale fee system. Stakeholders shared that GPS monitoring is 

cost-prohibitive, and as a result, rarely used. Although specialty court participants do not have to pay for 

drug testing, they must afford transportation to attend all required appointments. Some treatment 

providers require individuals to pay for assessments and treatment sessions, and parents may have to 

pay for child care to attend appointments. Failure to meet these financial obligations can prevent 

individuals from completing all of their court requirements, which can make them appear noncompliant. 

In addition to paying for services or fees related to court involvement and substance use or mental 

health treatment, stakeholders expressed that some individuals do not wish to attend residential 

treatment because they cannot afford to be out of work while in treatment. In some cases, the 

individual with a substance use or mental health disorder is the primary breadwinner for their family, 

prompting them to leave residential treatment early or not attend at all.
Crime and Justice Institute 27

Stigma 

Another significant barrier to equitable access to treatment is cultural dynamics, resulting in contrasting

views of effective approaches to substance use and mental health across the state. Cultural influences 

impact justice stakeholders and community members. Stakeholders acknowledged that attitudes 

towards marijuana use have changed over time and that courts generally understand substance use as a 

behavioral health issue. However, at times they also framed substance use as a lifestyle and behavior 

choice rather than a chronic behavioral health 

condition. In addition to differences in 

perspectives about substance use, stakeholders 

also expressed varied views about particular 

types of treatment and the role of medication in 

treating opioid use disorders. Court officials and 

providers indicated that the perception of a lack 

of services might be related to community 

stigma towards individuals receiving behavioral 

health services. Community stigma may lead 

people not to take advantage of some of the 

resources available in their communities.

In addition to societal stigma, individuals face familial and internalized stigma, impacting their ability to 

work towards recovery. Stakeholders indicated that individuals often lack family support because they 

have burned bridges with family members due to ongoing issues related to substance use. The lack of 

support can affect individuals’ engagement in treatment if they feel hopeless. Stigma can also affect an 

individual’s employment opportunities, further affecting their ability to meet basic needs and 

preventing full or successful engagement with treatment. 

Telehealth 

Prior to the COVID-19 pandemic, Kentucky had many restrictions on delivering services through 

telehealth. The state lifted many of those restrictions to continue service provision while also keeping 

individuals, families, and communities safe during the COVID-19 pandemic, but stakeholders shared 

their fears that the restrictions will return. Treatment providers are advocating for telehealth remaining 

as an option for individuals who have difficulty attending groups and accessing services otherwise. The 

provision of services via telehealth during the COVID-19 pandemic has increased individuals’ ability to 

access services. However, there are many individuals, particularly in rural areas of the state, that lack 

the technology or service connection necessary to utilize services this way. Stakeholders pointed to 

churches and other community organizations that have helped individuals use Wi-Fi to participate in 

treatment and meetings, which has mitigated this barrier for some. 

ROSC Elements in Action in Kentucky

System-wide education and training: 

A community theater group in the 

southeastern part of Kentucky called 

Higher Ground, performed Needlework, a 

play that tackled issues such as harm 

reduction and needle exchange in ways 

that were accessible and educational for 

communities. 
Crime and Justice Institute 28

FUNDING

FINDING 6

Essential services to coordinate care for individuals involved in the court and behavioral health 

systems do not have adequate funding, which has caused some communities to rely on short-term 

grants to fill in gaps. Without a long-term sustainability plan, the care coordination services will 

disappear when grant periods end. 

Stakeholders identified many needed services that do not have a secure and stable funding source, 

including court-run and behavioral health programs. Courts struggle to fund certain Specialty Court 

programs without grants, and Pretrial Services lacks funding to expand its PARTS program. In some 

cases, services have a funding source but a low reimbursement rate relative to the value they provide, 

particularly peer supports. Behavioral health service providers mentioned several ways in which they 

rely on grants to provide after-hours services and some jail-based programs.

Non-reimbursable treatment and recovery support services 

Providing adequate and timely screening is a critical step towards identifying and responding to 

individuals with substance use and other behavioral health conditions. Both courts and treatment 

providers identified challenges with screening. Community Mental Health Centers cannot go into jails to 

assess individuals without grant funding, although they see the benefit of reaching people before they 

return to their communities. Multiple courts have set up informal networks to quickly assess and refer 

individuals to services, as judges generally feel that this practice eliminates barriers to accessing 

services. However, some providers cannot afford to place staff at courts since it is cost-prohibitive 

unless they receive a certain number of service referrals each day. Some of these efforts are grantfunded, while others are not. 

Care coordination is another significant component of a Recovery-Oriented System of Care. Treatment 

providers indicated that care coordination, particularly between physical and behavioral health, is not 

reimbursable. ROSCs aim to improve all aspects of health; physical, mental, and emotional health are all 

part of well-being. Court staff and treatment providers struggle to link individuals to all appropriate 

services while avoiding over conditioning. Pretrial Officers cannot provide the level of care coordination

needed due to high caseloads and a limited budget. 

Recovery-Oriented Systems of Care promote the use of natural supports. For many individuals involved 

in the court system, family members are a significant source of their recovery support. Treatment 

providers highlighted the value in providing education to help family members understand substance 

use and mental health and learn strategies to support their loved ones in recovery. However, they 

indicated that family engagement and education of family members is not reimbursable through

Medicaid, although family therapy is covered.

Behavioral health treatment providers, DCBS, and court staff all indicated that sharing information and 

attending meetings together strengthens their collaboration, but those interactions are not billable. 
Crime and Justice Institute 29

Treatment providers see the benefits of educating courts regularly about behavioral health but lack the 

capacity to provide these extra services without steady funding sources to support the work.

Grant-funded programs

Pre-arrest diversion to behavioral health services is one way that the justice system can respond to 

behavioral health needs while preventing individuals from court-involvement or incarceration. 

Currently, pre-arrest diversion opportunities are limited in Kentucky. Louisville Metro Police Department 

piloted a federal grant-funded Law Enforcement Assisted Diversion (LEAD) program that connected 

individuals with substance use disorders or mental health issues to treatment, but the program closed in 

2019 due to a lack of funding.44 Grant funding availability also affects Kentucky’s specialty courts. 

Several stakeholders mentioned court programs that no longer exist because grant periods ended, and 

others noted they were seeking grant funding to start new specialty courts. 

Federal grants support jail-based programs that some CMHCs provide. These programs include 

parenting classes, case management, and referrals to substance use services. When funding is available, 

treatment programs use grants to provide prevention programs such as educational programming about 

SUD treatment for families.

EDUCATION 

FINDING 7

Courts and communities have increased their awareness of substance use and recovery. They would 

benefit from ongoing education to increase collaboration, awareness of community-based resources, 

and appropriate advocacy for recovery-oriented responses to substance use and mental health. 

Stakeholders indicated that the courts and communities at large have become more aware of the 

prevalence of substance use and the need to provide services to individuals with behavioral health 

conditions. This awareness, in combination with opportunity and leadership, has led to positive changes 

in the courts and communities. One area where educational opportunities have influenced the courts’ 

responses is learning about the use of Medications for Opioid Use Disorder (MOUD) in treating opioid 

use disorders. In addition to that effort, the RESTORE Initiative provided the courts with much-needed 

information about substance use and recovery. Some judges indicated that the summits were the first 

time they fully understood their role in connecting individuals to services and their available options. 

However, long-standing beliefs are hard to change; stigma continues to impact communities’ and courts’ 

perceptions towards individuals with substance use and co-occurring disorders. Ongoing training is 

essential to ensure that systems understand and apply the complex values and concepts associated with 

 44 Louisville budget cuts force Centerstone's Living Room to close (courier-journal.com), accessed at: 

https://www.courier-journal.com/story/news/local/2019/06/27/louisville-budget-cuts-force-centerstone-livingroom-to-close/1576260001/
Crime and Justice Institute 30

Recovery-Oriented Systems of Care. While training and education alone are not sufficient for action and 

change to occur, they are a necessary component of systems transformation.

ROSCs involve multiple aspects of health and wellness. They are culturally responsive, integrated, and 

include the voices of individuals in recovery in planning, implementation, and evaluation. Many of these 

behavioral health concepts are new to the courts and represent a significant philosophical shift in 

perception of substance use and recovery. To aid systems in responding to substance use as a chronic 

behavioral health condition, stakeholders would benefit from education about evidence-based 

treatment approaches, ASAM criteria for determining appropriate levels of care, and the role of natural 

supports and mutual aid groups in supporting recovery. Increasing ongoing training between courts, 

DBHDID, and DCBS can increase capacity to accurately identify service needs during brief screenings and

allow multiple systems to establish communication and information sharing protocols.

Many stakeholders explained the influence of community attitudes towards substance use and mental 

health on court operations, particularly in areas where the community expects a punitive response 

towards substance-related charges from the courts. Elected officials may respond in a more punitive 

manner because of community demands. In smaller jurisdictions, justice stakeholders may interact with 

the same people multiple times due to the chronic nature of substance use and mental health disorders. 

This repeated engagement can influence beliefs that people can change and affect their ability to offer 

diversion or treatment opportunities. 

The behavioral health system has also recognized the impact of stigma on treatment engagement and 

has worked to reduce stigma in some communities. Since ROSCs are anchored in the community, 

collaborating with community groups and individuals to challenge stigma is an important step toward

increasing awareness and understanding about substance use and recovery. Greater community 

understanding can increase support for valuing a treatment response over incarceration for individuals 

impacted by substance use and other behavioral health conditions.

RESOURCE ALLOCATION AND UTILIZATION

FINDING 8

A perception among some system stakeholders that diversion and deferred prosecution programs are 

too lenient results in underutilization of programs specifically designed to target people with 

substance use issues and connect them to treatment. A lack of meaningful participant incentives 

prevents some specialty courts from operating at full capacity. 

Although Kentucky statutes created specific programs to respond to those charged with drug possession

and drug-related offenses, many areas of the state underutilize the programs. The way a community 

views behavioral health and the stigma attached to it impacts the extent to which prosecutors are 

willing to offer diversion and deferred prosecutions. Many consider these options too lenient and 

believe that victims would be upset with the outcome. Prosecutors tend to use pretrial diversion for 
Crime and Justice Institute 31

individuals with drug charges and other substance-use-related offenses due to the supervision provided 

and the monitoring period length; pretrial diversions can last up to five years. 

Discretion to defer prosecution for individuals, which allows them to avoid pleading guilty and have their 

charges dismissed upon successful completion, is up to the commonwealth attorney’s recommendation. 

Prosecutors do not feel that deferred prosecution cases are monitored as closely as diversion 

agreements, which probation and parole monitors. They expressed resistance to offering deferred 

prosecution in many areas of the state because of a lack of monitoring. Kentucky did not invest

resources to support case coordination or monitoring for deferred prosecution agreements. Fayette 

County, which has an active deferred prosecution program, incorporates recovery-oriented conditions. 

Despite their reservations about deferred prosecution and diversion, prosecutors are willing and 

interested in placing individuals in specialty court programs due to the structure and intensity of services

offered. However, many stakeholders reported low participant numbers and suggested that most 

people choose diversion given a choice between diversion and specialty courts. Before Medicaid 

expansion, specialty courts provided opportunities for treatment that were not otherwise available. 

However, now with diversion, individuals still have access to treatment services and avoid the strict 

program conditions in specialty courts. Individuals in jail often only hear from individuals who have not 

successfully completed specialty courts. As a result, they may only be aware of the programs’ negative 

aspects and decide not to participate. In addition to diversion being a less restrictive option than 

specialty courts, those who participate in diversion or simply plead guilty may also serve less time in jail 

than specialty courts in some cases. To ensure that specialty courts use their resources for maximum 

benefit, they may need to consider providing more incentives to increase participation. Although some 

participants who graduate from specialty courts can complete their probation terms early, this does not 

apply to all participants, and programs lack formal incentive structures for successful completion beyond 

graduation.
Crime and Justice Institute 32

RECOMMENDATIONS

Transitioning to a Recovery-Oriented System of Care court model will require coordinated efforts in 

three main areas: 

1) within Kentucky’s court system,

2) at the state level between the court system and CHFS, including DBHDID and DCBS, and 

3) within local communities. 

Each level of coordination requires a working group or committee to take responsibility for improving 

responses to individuals with substance use and other behavioral health conditions. Although these 

recommendations call for multiple groups, each focusing on different aspects of transitioning to an 

ROSC, these groups can simultaneously work on their specific priorities while also maintaining 

communication with the other groups. 

COORDINATION WITHIN THE COURT SYSTEM

RECOMMENDATION: CONVENE AN AOC WORKING GROUP TO DEVELOP DEFINITIONS, 

GOALS, VALUES, AND VISION OF A RECOVERY-ORIENTED SYSTEM OF CARE COURT MODEL

To effect system change, stakeholders need to ensure they are operating under a shared set of 

definitions, goals, values, and vision. ROSCs are principle and values-driven; building consensus around 

shared values is essential to system transformation.45 Developing a shared vision of the courts’ role in 

supporting those with behavioral health conditions will help cultivate relationships, build trust among 

key partners, and serve as a needed first step to inform stakeholders about the shift in response to 

these individuals.

46 It is essential to include judges in this effort because of their significant influence on 

how individuals move through the court system. 

The AOC working group should start by engaging in the following activities to transition to an ROSC:

• Identify key definitions for concepts like recovery, recovery management, and RecoveryOriented Systems of Care;

• Ensure adopted definitions are consistent with those used in the behavioral health system;47

 45 Sheedy C. K., and Whitter M., Guiding Principles and Elements of Recovery-Oriented Systems of Care: What Do 

We Know from the Research? HHS Publication No. (SMA) 09-4439. Rockville, MD: Center for Substance Abuse 

Treatment, Substance Abuse and Mental Health Services Administration, 2009. Guiding Principles and Elements of 

Recovery-Oriented Systems of Care: What do we know from the research? - August 2009 (naadac.org), accessed 

at: https://www.naadac.org/assets/2416/sheedyckwhitterm2009_guiding_principles_and_elements.pdf 46 Using person-first language of recovery already utilized in the behavioral health field also helps stakeholders 

understand behavioral health conditions, including substance use, as chronic conditions requiring ongoing support 

and management.

47 2008Recovery:SystemsPerspective (ky.gov) Presentation from the Southeast Addiction Technology Transfer 

Center (ATTC) provided to Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities, 

accessed at: 

http://dbhdid.ky.gov/dbh/documents/ksaods/2017/RecoveryOrientedSystemsofCare.pdf?t=23425306122018
Crime and Justice Institute 33

• Identify recovery-oriented values and principles for the court system to adopt; 

• Establish an initial vision and goals for an ROSC court system; and

• Identify funding sources to support the work.

Since the AOC consists of three distinct departments that administer statewide programs to support 

court operations, it is critical to explore internal barriers to serving individuals and families involved in 

multiple systems. Establishing a shared vision and principles can help Kentucky prepare to develop 

achievable action steps with realistic timeframes to transform its court system and increase consistency 

between different courts. Creating a shared vision and approach to substance use and co-occurring 

disorders will be particularly useful in jurisdictions where judges have multiple types of dockets, such as 

a criminal docket and a specialty court docket. 

The AOC working group should consider focusing on the following recommended activities to create a 

more holistic court model. 

RECOMMENDED ACTIVITIES FOR THE AOC WORKING GROUP

1. Streamline the screening process to identify individuals in need of services (including insurance 

and housing).

Individuals entering the court system are frequently overwhelmed by challenges. They may be in 

custody, face criminal charges or removal of their children, and have to navigate the complex court and 

behavioral health systems to comply with court requirements. They may be involved in court-related 

issues in multiple counties, and may be detoxing from substances or experiencing a crisis at the time of 

screening. An ROSC court system would provide a “no wrong door” approach to screen and refer 

individuals and families to services that address their complex needs and meet their court obligations. 

ROSCs seek to provide uncomplicated entry into services. To avoid individuals having to answer the 

same or similar questions multiple times while navigating systems, courts should investigate using a 

system-wide screening tool. The screening tool can determine who to refer for mental health and 

substance use assessments and facilitate connections to multiple service needs. Data systems should 

track referrals to inform staff whether an individual has already been recommended for or connected to 

resources by another part of the court system to streamline access to services. In addition to increasing 

efficiency, using the same screening tool throughout the system can ensure substance use information is 

collected consistently and simplify staff training on the purpose and role of screening.

Courts would also benefit from clarifying roles and responsibilities in responding to individuals with 

substance use and other behavioral health service needs. The courts’ role should be limited to

identifying individuals who would benefit from services, screening for substance use and other basic 

needs such as insurance, and making referrals for clinical assessments to be completed by providers in 

the community.
Crime and Justice Institute 34

2. Ensure that all courts expand eligibility to individuals who would benefit from treatment and 

recovery support services. 

Certain eligibility criteria, outlined through statute or program policies and procedures, may result in 

courts missing opportunities to engage and respond to individuals affected by substance use and/or 

mental health. For example, the majority of cases referred for pretrial diversion in Kentucky are drug 

possession charges, although stakeholders acknowledged the connection between substance use and 

other charges. Pretrial diversion is available to individuals charged with a Class D felony (and Class C 

felony with court approval) and those whose criminal, medical, or mental health record indicates a 

present need for or potential benefit from substance use disorder treatment. 48 However, some 

individuals would still benefit from treatment but may not have been previously flagged in one of these 

ways. Charges are not a reliable indicator of a substance use service need. In addition, individuals 

convicted of a felony within the ten years preceding the current charge, and those who have received 

pretrial diversion within five years, are ineligible to participate in pretrial diversion.49

The Pretrial Substance Abuse Program (PSAP), operated by the Department of Corrections, provides 

comprehensive services, including treatment, to individuals during incarceration. PSAP accepts 

individuals referred to the program under the pretrial diversion statutes, and those whose criminal 

record indicates a history of recent and relevant substance abuse.50 Some Pretrial Officers indicated that 

they check whether an individual has had three or more drug or alcohol charges within the past five 

years to screen for potential PSAP referrals, which may exclude potential participants who have a recent 

use history but do not have the criminal record that staff are looking for. It is important to note that 

people can return to substance use at any point and may benefit from treatment services while in 

custody, regardless of their recent criminal history.

Substance use is a chronic behavioral health condition, so programs may benefit from considering 

whether the courts and Department of Corrections could modify eligibility criteria to better serve 

individuals with substance use and other behavioral health treatment needs. Part of their consideration 

may be assessing the number of individuals deemed ineligible.

3. Create structure and accountability for diversion programs to increase consistency and access 

throughout the state.

In interviews, prosecutors reported underutilizing the deferred prosecution program due to concerns 

about a lack of monitoring and accountability. However, the deferred prosecution program offers 

significant benefits to participants working towards recovery. Participants in this program can avoid 

criminal charges and have their records sealed if they successfully complete the program.

51 This benefit 

 48 KRS 533.251, accessed at: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=20088 49 KRS 533.250, accessed at: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=44797 50 KRS 431.518, accessed at: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=18630 51 KRS 218A.14151, accessed at: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=40911
Crime and Justice Institute 35

is key, as avoiding conviction has been shown to significantly increase employment opportunities,

reduce barriers to obtaining housing, and increase the chances an individual can secure student loans.52

Tracking the extent to which various jurisdictions offer diversion opportunities can also help to increase 

their consistent use. Ensuring that individuals have equitable access and opportunity to participate in 

deferred prosecution and diversion requires a shared understanding of these programs’ use, benefits, 

and expectations. 

Stakeholders could take the following steps to increase the use of diversion programs:

• Clarify deferred prosecution and diversion eligibility to create consistency within the court 

system, and ensure individuals with similar charges and circumstances are provided the same 

opportunities; 

• Establish standard hearing and reporting guidelines for deferred prosecution cases, so 

prosecutors have more information about each person’s progress towards their goals; 

• Seek funding to support monitoring to address prosecutors’ concerns about a current lack of 

monitoring in the program; and

• Consider best practices for appropriate term lengths for pretrial diversion and deferred 

prosecution.

The National Association of Pretrial Services Agencies (NAPSA) recommends that programs establish 

time limits for participation in pretrial diversion programs, which should be no longer than needed to 

predict someone’s future law-abiding behavior.53 In one survey, pretrial diversion programs from across 

the country reported median lengths of six months for misdemeanor charges and twelve months for 

felony charges.54

4. Build capacity for judges and court staff to identify and respond to behavioral health needs.

Stakeholders expressed interest in building on training opportunities offered through the RESTORE 

Initiative about substance use and recovery. To further move towards creating an ROSC court model, 

courts should consider identifying and implementing ongoing training opportunities. 

Given the prevalence of trauma among people involved in the justice system, and particularly noting the 

connection between substance use and trauma, courts should consider implementing training on this 

topic, such as Trauma Training for Criminal Justice Professionals.55

 52 Welcome to the NICCC | National Inventory of Collateral Consequences of Criminal Conviction 

(nationalreentryresourcecenter.org), accessed at: https://niccc.nationalreentryresourcecenter.org/#about 53 DIVERSION INTERVENTION STANDARDS 2008.doc, accessed at:

https://netforumpro.com/public/temp/ClientImages/NAPSA/2bf61b50-6b7d-4292-8837-e6b48a1b2a7a.pdf 54 Pretrial Diversion in the 21st Century, accessed at: 

https://netforumpro.com/public/temp/ClientImages/NAPSA/18262ec2-a77b-410c-ad9b-c6e8f74ddd5b.pdf 55Trauma Training for Criminal Justice Professionals | SAMHSA, accessed at: https://www.samhsa.gov/gainscenter/trauma-training-criminal-justice-professionals
Crime and Justice Institute 36

Another topic that courts may want to explore is Motivational Interviewing (MI) training. MI is a 

technique frequently used by counselors and corrections professionals to help people with substance 

use and other behavioral health conditions enhance their readiness for change by exploring and 

resolving their ambivalence. Research has found that the practice of MI can increase treatment 

retention and motivation to change.56 Stakeholders who use MI also noted the approach encourages 

more honest responses to questions which helps providers assess an individual’s needs more accurately.

Thus, establishing a shared understanding of MI techniques could help the courts employ a more 

consistent approach to interacting with individuals with behavioral health conditions. 

Whichever curriculums the AOC Working Group selects, it may consider implementing the training(s) 

through a train-the-trainer model, which would allow the court system to build in-house expertise 

without relying on external providers. In this model, once a select group of judges participate in a trainthe-trainer, they can train other judges as well as court personnel.

5. Provide meaningful incentives to promote program participation.

Although Kentucky courts offer various programs for individuals impacted by substance use, not all 

programs are used consistently throughout the state. Several stakeholders indicated that their specialty 

court programs were not operating at capacity and attributed low participation rates to individuals 

pursuing other opportunities, such as pretrial diversion, instead of specialty court. Courts identified that 

specialty court programs have several built-in incentives, such as priority placement in treatment

programs and phase advancement. However, the programs are also rigorous, and individuals lacking 

financial resources and/or family support may struggle to comply with all program requirements.

In many cases, those who successfully complete specialty court while on probation do not have their 

probation terms shortened; they are usually placed on unsupervised probation for the remainder of 

their supervision terms. Those who complete pretrial diversion must return to court 60 days after 

graduation to have their records expunged. The courts should consider ways to incentivize participation 

through court rules or policies to allow automatic access to expungement so individuals can navigate 

housing and employment barriers more easily, and consider shortening probation terms for those who 

successfully complete programs while on community supervision. 

6. Develop structure and consistency for the use of court-ordered conditions.

To achieve equitable outcomes, Kentucky must create a shared structure to guide the use of conditions 

throughout the state, particularly drug testing. Research has not demonstrated a clear connection 

 56 McMurran, M. (2009). Motivational interviewing with offenders: A systematic review. Division of Psychiatry, 

Section of Forensic Mental Health, University of Nottingham, Nottingham UK. Legal and Criminological Psychology, 

83-100. Motivational interviewing with offenders: A systematic review, accessed at: 

http://23.29.59.141/assets/document-library/archive/library/forensics/ofo%20-

%20ebp%20motivational%20interviewing%20with%20offenders%202009.pdf 
Crime and Justice Institute 37

between drug testing programs and pretrial outcomes.57 Courts need to explore the potential 

inequitable impact of imposing costly pretrial conditions, including testing and electronic monitoring, on 

pretrial defendants.58 Currently, court expectations and use of conditions vary significantly, resulting in 

inequitable access or ability to complete requirements successfully across the state. 

Over-conditioning and failing to tailor conditions to individuals’ specific risks and needs can increase an 

individual’s risk of failure. Finding the balance between providing structure and consistency while also 

taking individuals’ circumstances into account is key to implementing an ROSC. The AOC Working Group 

would benefit from building consensus around the appropriate use of conditions through a recoveryoriented lens. 

It is also important to note that Recovery-Oriented Systems of Care do not view the absence of clinical 

symptoms or substance use as recovery; successful outcomes include a broad range of measures such as 

employment, social relationships, and community engagement.59 To reinforce prosocial behaviors, 

courts should also identify ways to reward incremental progress towards personalized goals. To aid this 

effort, courts would benefit from creating a shared structure to guide their decisions while allowing for 

individual risks, needs, and priorities to inform their approach to individuals.

COORDINATION AT THE STATE LEVEL BETWEEN COURT AND BEHAVIORAL HEALTH SYSTEMS

RECOMMENDATION: FORM A STATEWIDE TRANSFORMATION STEERING COMMITTEE TO 

UNDERSTAND THE GAPS BETWEEN THE CURRENT SYSTEM AND THE VISION AND GOALS 

OUTLINED BY THE AOC WORKING GROUP

Although each state has different needs, ROSCs generally require organization on two parallel tracks; 

developing the framework and vision at a state-level, and coordinating care at a local level.60 CJI 

recommends creating a statewide Transformation Steering Committee to fulfill the first of those tracks.

The AOC Working Group should identify key partners to include in this Steering Committee to shape 

Kentucky’s system transformation. Strong leadership is essential to drive organizational and systems 

change; individuals involved in the Steering Committee need to have the capacity to commit their 

 57 Research On the effectiveness of pretrial Support and Supervision services (unc.edu), accessed at: 

https://cjil.sog.unc.edu/wp-content/uploads/sites/19452/2020/05/Research-on-the-Effectiveness-of-PretrialSupport-Supervision-Services-5.28.2020.pdf 58 NAPSA Standards on Pretrial Release, 2020 Edition (1) (1).pdf, accessed at: 

https://drive.google.com/file/d/1edS2bltwfNROieGeu1A6qKIuTfzqop92/view

59 Recovery Standards for Behavioral Healthcare (williamwhitepapers.com), accessed at: 

http://www.williamwhitepapers.com/pr/ROSC%20Practice%20Guidelines%20CT%202006.pdf

60 Sheedy C. K., and Whitter M., Guiding Principles and Elements of Recovery-Oriented Systems of Care: What Do 

We Know from the Research? HHS Publication No. (SMA) 09-4439. Rockville, MD: Center for Substance Abuse 

Treatment, Substance Abuse and Mental Health Services Administration, 2009. Guiding Principles and Elements of 

Recovery-Oriented Systems of Care: What do we know from the research? - August 2009 (naadac.org), accessed 

at: https://www.naadac.org/assets/2416/sheedyckwhitterm2009_guiding_principles_and_elements.pdf
Crime and Justice Institute 38

organizations to the transformation effort. The statewide Transformation Steering Committee needs to 

include all relevant stakeholders, including, but not limited to:

• Judges;

• Court personnel;

• Department of Corrections/Probation and Parole;

• Prosecutors;

• Department of Public Advocacy;

• Law enforcement;

• Division of Community Based Services;

• Department for Behavioral Health, Developmental and Intellectual Disabilities;

• Treatment providers (public and private);

• Prevention and education programs; 

• Housing providers; 

• Employment services and local and statewide employers; and 

• Community members such as people in recovery and their family members.

The AOC Working Group can create the initial list of definitions, principles and values, and vision for an 

ROSC court system, but the Steering Committee should refine and finalize them. The Steering 

Committee should ensure that a variety of perspectives are included in developing the vision will

promote buy-in and collaboration among participants. A broad group can also ensure that recovery 

principles are reflected throughout the framework and help raise awareness and visibility of the 

transformation. The AOC should consider applying for technical assistance to help convene stakeholders 

and lead implementation efforts. A technical assistance provider can help with developing state and 

organization-level implementation plans and act as a neutral facilitator to support the consensusbuilding process.61 Technical assistance providers can also identify important members to include in the 

process and share lessons learned from other states.

After clarifying the vision, the next step towards operationalizing a Recovery-Oriented System of Care is 

to create a conceptual framework.62 63 64 65 Recovery-Oriented Systems of Care require multiple systems 

 61 Recovery-Oriented Systems of Care (ROSC) Resource Guide, September 2010 (samhsa.gov), accessed at: 

https://www.samhsa.gov/sites/default/files/rosc_resource_guide_book.pdf

62 expert-panel-05222012.pdf (samhsa.gov), accessed at: https://www.samhsa.gov/sites/default/files/expertpanel-05222012.pdf 63 Recovery-Core Values (ct.gov), accessed at: https://portal.ct.gov/DMHAS/Initiatives/Recovery/Recovery-CoreValues

64 A Recovery Revolution in Philadelphia (williamwhitepapers.com), accessed at: 

http://pop.williamwhitepapers.com/pr/2007ARecoveryRevolutioninPhiladelphia.pdf

65 Pennington County, South Dakota Behavioral Health Continuum of Care, accessed at: 

https://mylrc.sdlegislature.gov/api/Documents/122821.pdf#:~:text=PENNINGTON%20COUNTY,%20SOUTH%20DA

KOTA%20BEHAVIORAL%20HEALTH%20CONTINUUM%20OF,to%20develop%20a%20conceptual%20framework%20

and%20key
Crime and Justice Institute 39

to align their policy, administrative, and fiscal practices both internally and with others.66 Both court 

systems and behavioral health systems can be siloed, making it challenging to integrate substance use 

and mental health care. For example, DBHDID’s Division of Behavioral Health consists of four separate 

branches; each branch has its own programs, services, and potential funding sources.67 A conceptual 

framework will need to outline the necessary changes within and between systems to align policies and 

administrative and fiscal practices to promote recovery. Including a wide variety of stakeholders in this 

process will ensure the Steering Committee includes individuals with in-depth knowledge of the 

necessary areas to identify needed changes and ensure all partners develop complementary definitions 

and practices.

It is important to note that system change is a process, not an event, and it takes time. States take years 

to develop recovery-oriented outcome measures. For example, Connecticut started its ROSC journey in 

2000 with a policy statement from its behavioral health commissioner, and the state continues to refine 

its efforts.68 Michigan began its system transformation process by scheduling dialogue and visioning 

sessions to create a shared understanding of the goals of moving towards a Recovery-Oriented System 

of Care.69 Although each state approaches the process based on its own needs, building the foundation 

of shared language is critical to identifying a framework and implementation plan towards transitioning 

to an ROSC.

Organizations typically go through multiple stages when implementing new policies and practices:

1. First, organizations enter the exploration stage. They explore barriers and potential roadblocks 

and identify funding sources and other needed materials to support the new interventions or 

policies.

2. Next, organizations progress to the installation stage. They develop new policies, train staff to 

implement the approach, and develop performance measures to monitor progress. 

3. Third, organizations enter initial implementation, when they start using the new policies and 

practices and start monitoring quality and progress. 

4. Finally, organizations move to full implementation, in which the new policies and procedures 

become fully operational. During this time, organizations continue to monitor performance and 

make needed changes to ensure that the practices are sustainable. 

 66 Operationalizing_ROSC_SAMHSA_2012.pdf (oacbha.org), accessed at: 

https://www.oacbha.org/docs/Operationalizing_ROSC_SAMHSA_2012.pdf

67 Kentucky Cabinet for Health and Family Services, accessed at: https://dbhdid.ky.gov/dbh/default.aspx 68 Practice Guidelines for Recovery-Oriented Care for Mental Health and Substance Use Conditions, Connecticut 

Department of Mental Health and Addiction Services (2008), accessed at: https://portal.ct.gov/-

/media/DMHAS/Recovery/practiceguidelines2pdf.pdf 69 Interview with Deborah Hollis, Director, Office of Recovery Oriented Systems of Care, Michigan. White, W. 

(2014), accessed at: https://www.opioidlibrary.org/wpcontent/uploads/2019/08/2014_Deborah_Hollis_ROSC_in_Michigan2.pdf
Crime and Justice Institute 40

Implementation scientists generally say implementation of anything takes between two to four years 

from exploration to full implementation;70 however, transitioning to a Recovery-Oriented System of 

Care court model will take longer because multiple systems need to change. 

Organizations often create implementation plans to aid in the implementation process, identify key 

policy change areas, and designate parties responsible for carrying out the work. The Steering 

Committee should create a statewide conceptual framework to inform the implementation process and 

provide a solid starting point for agencies to identify and understand their roles and responsibilities to 

move towards building an ROSC court model. 

The Steering Committee should also consider focusing on the following recommended activities in this 

section to increase access to and availability of recovery services and supports. 

RECOMMENDED ACTIVITIES FOR THE STATEWIDE TRANSFORMATION STEERING COMMITTEE

1. Identify policy and practice changes required to improve access and availability of needed 

services.

As previously outlined, access and availability of services are limited or hindered in many areas 

throughout the court and behavioral health treatment systems. The Steering Committee can identify 

where the limits or hindrances are and develop policy and practice changes to overcome them. This 

work should include the following:

1. Track length of time between initial screening to engagement in services and work to reduce 

inequities in access.

2. Track why referrals are not admitted to behavioral health and court programs to help each 

program determine how to increase capacity. 

3. Find ways to solicit feedback from individuals involved in Pretrial Services, Specialty Courts, and 

Family Court to inform program modifications. 

4. Assess the use of Medications for Opioid Use Disorder (MOUD) and ensure all courts allow 

MOUD as an option.

Medicaid reimbursement is one specific area Kentucky could focus on to affect policy change. Courts 

would benefit from understanding Medicaid reimbursement to ensure a robust array of services and 

supports are available to those in the court system. The Steering Committee should conduct this 

research and investigate the possibilities of modifying Medicaid policies to provide the following 

services:

 70 Implementation Research: A Synthesis of the Literature, accessed at: 

https://www.activeimplementation.org/wp-content/uploads/2018/11/FixsenEtAl-ImplementationResearchASynthesisOfTheLliterature-2005.pdf
Crime and Justice Institute 41

• Continued use of telehealth 

• Medicaid transportation71

• Family education and engagement 

• Care coordination (physical/mental health)

• Dental services (particularly dentures)

2. Identify needed resources and work to secure funding to expand care coordination. 

Stakeholders shared that there are services and resources necessary to individuals’ success that are not 

reimbursable through Medicaid and therefore require other forms of funding. Coordinating care 

between physical and behavioral health systems is essential to ROSC’s goal of enhancing quality of life. 

Care coordination is an integral part of providing care, but it is often unfunded, leaving agencies to 

provide the services without adequate funding. The Steering Committee and localities piloting RecoveryOriented Systems of Care efforts should investigate alternative ways of funding these services so 

individuals have the best possible opportunity for recovery. The following are examples of steps that the 

Steering Committee could take toward increasing funding for necessary services:

1. Consider securing funding to provide participants with technology (such as smartphones or 

phone minutes) so they can attend groups and appointments electronically. 

2. Investigate ways to obtain additional funding for the Department of Public Advocacy’s 

Alternative Sentencing Workers to continue linking individuals to community resources.

3. Secure funding to collaborate with behavioral health on developing a peer support program for 

all types of courts, including identifying necessary policy changes, processes, and how Medicaid 

could pay for needed services.

4. Assist with the hand-off to resources. Ensure AOC and DCBS staff are aware of local resources, 

and designate a staff person at each office to be the main point of contact for community

providers. Create and update resource lists regularly and ensure Pretrial Officers know enough 

about available resources to connect individuals with a provider that meets their needs. 

5. Provide a liaison to service providers, so individuals who are referred by the courts but not 

connected to a specialty court case manager, probation and parole officer, or DCBS social 

worker have a point of contact within the courts to clarify referrals, expectations, and provide 

ongoing case management and support. 

6. Look for funding to expand the PARTS pilot program. Consider designating Pretrial Officers in 

multiple offices to act as the liaison between courts and treatment, and modify the program to 

meet individuals assessed for various levels of care, not just residential treatment.

 71 Human Services Transportation | KYTC, accessed at: 

https://transportation.ky.gov/TransportationDelivery/Pages/Human-Services-Transportation.aspx
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3. Increase use of peer supports with lived experience in the justice system.

Recovery-Oriented Systems of Care recognize the value of lived experience in assisting individuals in 

their recovery. While there are peer supports employed currently throughout the court and treatment 

systems in Kentucky, the state could increase the number of peer supports available and ways in which 

peer supports support individuals in their recovery. Stakeholders expressed that individuals who are 

incarcerated often only hear from others about the negative aspects of participating in specialty courts. 

Increasing the use of peer supports with lived experience in the justice system could allow potential 

participants to hear more success stories and increase trust in the court system. Developing trusting 

relationships with peer supports could increase participation as well as success rates.

The Steering Committee should examine peer support models and a process to identify the best place to 

house peer supports, whether in the DBHDID or the court system. There will likely be legal barriers to 

navigate to hire individuals with a history of incarceration. Stakeholders should identify those barriers 

and modify restrictions that would prevent them from interacting with other people incarcerated or 

charged with felonies. It may take time to certify peer supports with lived experience in the justice 

system. Change takes time; while there is an urgent need for change, it is important to spend time 

assessing and planning so that when the new policy or practice is implemented, it can be effective.

Policy Research Associates has created a resource that would be useful in implementing this 

recommendation. The resource, “Peer Support Roles Across the Sequential Intercept Model,” outlines 

ways in which peer supports can be utilized at every intercept in the criminal justice system, including 

prior to law enforcement interaction and post-incarceration.72 The resource also provides specific and 

concrete examples of how other localities across the United States have used peer supports.

4. Navigate barriers to identifying and collecting information about individuals and families involved 

in multiple aspects of the court and behavioral health systems.

Information sharing is critical to implementing an ROSC court model. Individuals and families frequently 

touch multiple aspects of court and behavioral health systems. Information sharing across behavioral 

health and justice systems is needed to reduce the number of incarcerated individuals with substance 

use and other behavioral health conditions. Having accurate and available information about each 

person’s health and treatment history can improve recovery outcomes; however, barriers currently exist 

to sharing that information.73 Programs use different data systems and often focus exclusively on the 

presenting case without identifying additional cases or service referral needs. Separate data systems 

present one barrier, but there are also privacy and consent concerns with sharing information. 

 72 Peer Support Roles Across the Sequential Intercept Model (prainc.com), accessed at: 

https://www.prainc.com/wp-content/uploads/2020/08/PeersAcrossSim_PRA-508.pdf 73 Point-of-service Information Sharing Between Criminal Justice and Behavioral Health Partners: Addressing 

Common Misconceptions - Policy Research Associates (prainc.com), accessed at: https://www.prainc.com/pointservice-information-sharing-criminal-justice-behavioral-health-partners-addressing-common-misconceptions/
Crime and Justice Institute 43

Although there are challenges to sharing information within and across systems, the benefits of doing so 

are significant. A working group that explored information sharing between justice and behavioral 

health systems noted that information sharing can increase the accessibility of information, reduce staff 

time and costs, and enable more effective continuity of care.74 The Steering Committee should identify 

the challenges with data integration and information sharing to ensure that data systems can and do 

talk to each other while complying with all legal requirements.

COORDINATION WITHIN LOCAL COMMUNITIES

RECOMMENDATION: IDENTIFY KEY AREAS OF THE STATE IN WHICH TO PILOT LOCAL 

RECOVERY-ORIENTED SYSTEM OF CARE EFFORTS

Statewide ROSC efforts often include two parallel tracks; a state-level transformation and oversight 

committee articulating a value-driven framework and a local action planning component.75 While the 

statewide Transformation Steering Committee can help judicial circuits and districts build statewide 

cross-agency relationships, local planning is needed to personalize the model for each community. 

ROSCs require coordination and trust-building between courts and criminal justice agencies, behavioral 

health treatment providers, community resource providers, and individuals in recovery and their family 

members. Trust-building requires participants to know one another and work towards a shared vision; 

thus, it often works better when localized. Certain courts have already developed close relationships 

with local treatment providers, and in some cases, recovery collaboratives.76 Those relationships can be 

leveraged to build support for transitioning to an ROSC. 

ROSCs work to complement the natural support that communities already provide. To effectively build 

upon those natural supports, Recovery-Oriented Systems of Care have to incorporate a local component 

to increase individuals’ connections to their communities and promote opportunities for long-term 

recovery.77

 74 Opportunities for Information Sharing to Enhance Health and Public Safety Outcomes (urban.org), accessed at: 

http://www.urban.org/sites/default/files/publication/23466/412788-Opportunities-for-Information-Sharing-toEnhance-Health-and-Public-Safety-Outcomes.PDF 75 Interview with Deborah Hollis, Director, Office of Recovery Oriented Systems of Care, Michigan. White, W. 

(2014), accessed at: https://www.opioidlibrary.org/wpcontent/uploads/2019/08/2014_Deborah_Hollis_ROSC_in_Michigan2.pdf

76 HEAL, accessed at: 

https://www.healky.org/?fbclid=IwAR3DtXNDBUigSA5FqthIPV61PpSjAmI_ShmSxqP5GyDHBdm76i-r6DQthig 77 Interview with Mark Witte, Planning Director of Network 180, and Kevin McLaughlin, Executive Director of 

Recovery Allies of West Michigan. White, W. L. (2014), accessed at: 

http://www.williamwhitepapers.com/pr/2014%20Mark%20Witte%20and%20Kevin%20McLaughlin.pdf
Crime and Justice Institute 44

Research shows that the use of community resources maximizes recovery outcomes. Individuals with 

strong community ties and support are more likely to sustain their recovery, so collaborating a system of 

care at a local level increases positive outcomes.78

The statewide Transformation Steering Committee should pilot a Recovery-Oriented System of Care 

court system in local communities by taking the following steps:

• Identify local champions for recovery efforts and start in judicial circuits or districts where courts 

are closely connected to treatment providers;

• Convene community stakeholders (including those who use services and their family members, 

service providers, community leaders, businesses, law enforcement, criminal justice partners, 

faith-based and veterans organizations, as well as other social, health, and human services 

partners);79 and

• Secure resources to support Sequential Intercept Mapping (SIM), a process to help communities 

identify resources and gaps in services to connect individuals with mental health and substance 

use disorders to services at various points throughout the criminal justice system.80

RECOMMENDED ACTIVITIES FOR LOCAL PILOT SITES

1. Engage in Sequential Intercept Mapping to identify intervention points, gaps in services, and 

available resources.

Once the statewide Steering Committee selects pilot sites and each site has convened stakeholders, 

they should consider starting with Sequential Intercept Mapping (SIM). Since Kentucky does not have 

many pre-arrest diversion programs, the state may benefit from exploring options to link and refer 

individuals to treatment at all contact points within the criminal justice system, including prevention 

services to keep people out of the justice system. 

The SIM process can help communities complete a capacity inventory and create a custom resource 

map and action plan to address identified gaps.81 Progressing through SIM can help clarify key action 

 78 Litt, M. D., Kadden, R. M., Kabela-Cormier, E., & Petry, N. (2007). Changing network support for drinking: Initial 

findings from the Network Support Project. Journal of Consulting and Clinical Psychology, 75(4), 542–

555. https://doi.org/10.1037/0022-006X.75.4.542, Accessed at: 

Litt_et_al_2007_Net_Supp_Initial_Findings_JCCP.pdf (d1wqtxts1xzle7.cloudfront.net)

79 ROSC In Ohio Recovery is Beautiful 2014.pdf, accessed at: 

http://www.williamwhitepapers.com/pr/ROSC%20In%20Ohio%20Recovery%20is%20Beautiful%202014.pdf 80 The Sequential Intercept Model (SIM) | SAMHSA, accessed at: https://www.samhsa.gov/criminal-juvenilejustice/sim-overview 81 Leading_Change_Guide_Final_4.27.20.pdf (ncsc.org), accessed at: 

https://www.ncsc.org/__data/assets/pdf_file/0024/36492/Leading_Change_Guide_Final_4.27.20.pdf
Crime and Justice Institute 45

steps to work towards a Recovery-Oriented System of Care.82 Each community will have distinct 

priorities based on its assets, needs, and priorities. In addition to identifying gaps and strengths in local 

communities, SIM can help identify what data should be collected to monitor the impact of the 

program. The process can also help tackle any associated privacy concerns to ensure that information is 

shared and complies with the Health Insurance Portability and Accountability Act (HIPAA), which can aid 

in transforming to an ROSC court model.83

2. Engage local recovery groups as part of the ROSC transformation process. 

ROSCs are consumer-driven, and local pilot sites should ensure that individuals in recovery and recovery 

groups are included in their design, implementation, and evaluation. In addition to helping with ROSC 

design, recovery groups can also help courts combat stigma towards those with behavioral health 

conditions. Stigma can impact individuals’ ability to meaningfully engage in services and develop strong 

ties to their communities, 84 so it is crucial that ROSCs address stigma to empower individuals in 

recovery and ensure that their communities can support them. Anti-stigma efforts can also educate 

broader communities on how stigma poses a barrier to individuals involved in the court system. The 

pilot sites should work to develop and support anti-stigma campaigns to increase the likelihood that 

individuals will avail themselves of available recovery support resources.85

 82 CreatingaRecovery-OrientedSystemofCareinFlorida-2017.pdf (flgov.com), accessed at: 

https://www.flgov.com/wp-content/uploads/childadvocacy/CreatingaRecovery-OrientedSystemofCareinFlorida2017.pdf

83 Data Collection Across the Sequential Intercept Model: Essential Measures, accessed at: 

https://store.samhsa.gov/sites/default/files/d7/priv/pep19-sim-data.pdf 84 Practice Guidelines for Recovery-Oriented Care for Mental Health and Substance Use Conditions, Connecticut 

Department of Mental Health and Addiction Services (2008), accessed at: https://portal.ct.gov/-

/media/DMHAS/Recovery/practiceguidelines2pdf.pdf

85 Anti-Stigma Toolkit: A Guide to Reducing Addiction-Related Stigma, accessed at: 

https://attcnetwork.org/sites/default/files/2019-04/Anti-Stigma%20Toolkit.pdf
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CONCLUSION

Kentucky’s Court of Justice recognizes that while substance use and co-occurring disorders present 

significant challenges for those involved in the court system, individuals can and do recover. The court

setting presents unique opportunities to identify and connect individuals with behavioral health 

conditions to needed services and supports. KCOJ is committed to improving responses to individuals 

affected by substance use and co-occurring disorders, and to that end is interested in transformation

from a sanction and compliance-focused court model to a Recovery-Oriented System of Care court 

model. Through intentional collaboration within the KCOJ, at the state-level between the courts and 

behavioral health systems, and within local communities, Kentucky’s court system can begin the process 

of moving towards this new model. 

Department of Family & Juvenile Services

Kentucky Administrative Office of the Courts

1001 Vandalay Drive • Frankfort, Kentucky 40601

502-573-2350 or 800-928-2350 

kycourts.gov

P-186, Printed With State Funds, July 2021