Mental Health Issues from Probation and Parole

1
Mental Health Issues from Probation and Parole

• Forensic Conference
• Thursday, December 4, 2008

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Mission Statement

• The Pennsylvania Board of Probation and Parole
  is committed to protecting the safety of the
  public, addressing the needs of crime victims,
  improving county adult probation and parole
  services and assisting in the fair administration
  of justice by ensuring the custody, control, and
  treatment of offenders under the jurisdiction of
  the Board.

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Legal Authority

• Pursuant to the Parole Act of 1941, the Board
  can
• Make parole decisions and supervise offenders
  with maximum sentence of two years or more
• Accept certain special probation cases by order
  of court
• Provide all probation services in certain
  counties
• Revoke parole of technical violators (TPVs) and
  convicted parole violators (CPVs)
• Interstate Compact for Adult Offender Supervision
  
• Board supervision of offenders referred to
  Pennsylvania from other states

4
Organization

• The Board has
• 9 Board Members, including Chairman
• 15 Hearing Examiners
• Institutional, Field and Administrative Staff
  1,081 employees
• 10 District Offices
• 15 District Sub-offices
• 26 Institutional Parole Offices
• Central Office Administration

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Overview of Parole Population
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Statistical Overview
7
Statistical Overview
Supervised Population by Original Jurisdiction
Parole Population 31,791 as of October 31,
2008
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The Decision Process by the Board of Probation
and Parole
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Discretionary Parole

• A system that allows for review of parole
  eligibility at an offenders minimum eligibility
  date
• Ensures protecting the public by releasing
  offenders that are prepared to return to the
  community
• Measures offenders risk by considering the
  seriousness of the offense and the likelihood to
  re-offend
• Examines offenders needs such as employment or
  treatment and addresses them
• 90 of all offenders will return to their
  communities

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Grant or Refuse Parole?

• Use of valid, research-based parole guidelines
• Predictive and Discretionary Factors
• Risk likelihood to reoffend, not dangerousness
• Criminogenic (crime producing) needs
• Four Domains Scored
• Violent vs. Nonviolent Offenders
• LSI-R Level of Risk
• Institutional Programming
• Institutional Behavior

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Grant or Refuse Parole?

• Factors Required by Law
• Nature of the offense
• Prior criminal history
• Employment potential
• Emotional stability
• History of family violence
• Adjustment to prison
• Program completions
• External Input
• Judge and prosecutor
• Input of victim or family
• Qualitative decisional improvements
• Recommendation of Superintendent or Warden

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Top Reasons to Refuse Parole

• Need to participate in or complete institutional
  programs
• Negative recommendation from DOC
• Factors in interview
• Institutional behavior
• Minimize/denial of offense(s)/lack of remorse

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Top Reasons to Parole

• Participation/completion of institutional
  programs
• Positive recommendation from DOC
• Acceptance of responsibility
• Institutional behavior
• Interview w/Hearing Examiner/Board Member

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Establishing Parole Conditions

• Based on Risk and Needs Assessment
• General Conditions Placed on every offender
• Report within 48 hours to district office Live
  at approved residence Report as instructed
  Comply with all federal, state and local laws No
  use of drugs or controlled substances No firearm
  possession
• Special Conditions Targeted to Specific
  Behavior
• No contact with victim Sex offender treatment
  Drug and Alcohol treatment Urinalysis testing
  No alcohol consumption Must support dependents
  Maintain employment

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Statistical Overview

• Overall Parole Rate as of FY 07-08 62
• Parole consideration 1,700 per month
• Parole Granted at Minimum
• Nonviolent 69
• Violent 59
• Parole Rates by Level of Risk
• High 56
• Medium 69
• Low 74

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Evidence Based Practices Crosswalk
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Assess Actuarial Risk/Need

• All parolees have applicable assessments
  completed while incarcerated
• All parolees are reassessed while on parole at
  6-month intervals
• Assessments are used by institutional staff to
  identify criminogenic needs of offenders prior to
  release

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Assess Actuarial Risk/Need

• Assessments are a part of the Parole guidelines
  to facilitate Board Member decision making
  through the identification of offenders level of
  risk and criminogenic needs
• District ensure progressive sanctioning practices
  based on offender risk and need

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Increase Intrinsic Motivation

• Agents and supervisors have been trained in
  motivational interviewing techniques
• Several agents are being trained to become
  motivational interviewing trainers for
  agency-wide rollout

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Target Interventions

• Risk Principle
• Parole decision and conditions complement each
  other and use the risk principle to direct
  treatment interventions to medium and high risk
  offenders

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Target Interventions

• Need Principle
• Parole developed Release Accountability Plan
  between agents and offenders target medium to
  high criminogenic needs and provide the basis for
  subsequent supervision planning

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Target Interventions

• Responsivity
• Agents have been trained to understand factors
  relating to responsivity that influence
  individual learning styles

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Target Interventions

• Dosage
• Transitional Coordinators concentrate
  supervision, assistance, treatment interventions,
  family support and problem solving with newly
  released offenders who are at a higher risk to
  recidivate

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Target Interventions

• Treatment
• Continuity of care planning is being implemented
  for all offenders with special emphasis on
  special needs offenders

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Skill Train(Cognitive Behavioral Treatment
Methods)

• Cognitive behavioral programming provided in the
  DOC for offenders is continued by the Board upon
  release in community settings
• Assessment, Sanctioning and Community Resource
  Agents are trained to deliver cognitive
  behavioral groups

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Increase Positive Reinforcement

• Agents are being trained on Risk Reduction
  Techniques on a district-wide basis
• Agents have been trained to understand the
  relationship between positive reinforcements and
  negative sanctions on a 4 to 1 ratio

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Engage Ongoing Support in Natural Communities

• Agents are actively involved with local criminal
  justice committees such as county CJABS, MH, AOD,
  Employment and Housing
• Districts conduct monthly Family Support Programs
  and Parole Education classes

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Measure Relevant Processes/Practices

• Statewide Performance Measures are tracked and
  reported on a monthly and annual basis

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From Incarceration to the Community

• Department of Corrections
• Preparation for release
• Treating criminogenic needs
• Effectiveness Principles of Effective
  Intervention
• Board
• Continuity of care for MH offenders (Release
  Accountability Checklist)
• Continuity of medications
• Secure adequate housing (ASCRAs)
• Links to community services and employment (TCs)
• Supportive supervision

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Transitional Coordinators

• Caseload Description
• Newly released offenders
• Paroled or Reparoled
• May differ to district to district depending on
  geography and type of case (SCI or County)
• Regional, District Directors and Supervisors will
  monitor
• Development and Implementation
• Special Populations (Hard to Place, MH, Sex
  Offenders, etc.)

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Transitional Coordinators

• Supervision Responsibilities
• Transitional Activities
• Parole/Home Plan Investigation
• Initial Supervision Package
• Special Condition Adherence (Initial/Modifications
  and Removal)
• Representative on Regional Reentry Committee
• Initial Programming (Release Checklist and
  Supervision Planning)
• Risk Principle to target criminogenic needs most
  predictive of recidivism (4 to 6)
• History of antisocial behavior
• Antisocial personality, cognitions and companions
• Family/Marital Issues, AOD, School, Work and
  Leisure
• Stabilize and Transfer to General Supervision

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Assessment, Sanctioning and Community Resource
Agent (ASCRA)

• Assessment
• Employing EBP
• Experts in Application of the Instrument(s)
• LSI-R, Static-99, etc (HIQ, TCU, CSS-M)
• Experts in Interpreting Results of Assessments
• Risk Principle
• Targeting Criminogenic Factors Most Predictive of
  Recidivism (4 to 6)
• Assist in Development of Supervision Plans

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ASCRA

• Sanctioning
• Employing EBP
• Violation Sanctioning Grid
• Alternatives to Incarceration
• Knowing Diversionary Assets
• Performance Measurement

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ASCRA

• Community Resource
• Develop additional community resources
• Close coordination with single county authority
• District Liaison/Public Relations
• Community Resource Directory
• Sex Offender Cases (treatment and invoicing)
• Tracking available community alternatives to
  incarceration

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ASCRA

• Group Facilitator
• Parole education/Orientation/Family parole
  education
• Employment/Vocational
• Staff Training
• Risk Reduction Techniques (University of
  Cincinnati)
• National Curriculum Training Institute/APPA
• Cognitive Based Life Skills and Anger Management
  Groups

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Reentry Goal

• To increase the successful completions of
  probation/parole by reducing recommitments among
  Pennsylvania offenders through a risk reduction
  philosophy

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Reentry Strategy

• To develop a system of case management by
• Establishing an agency wide system of individual
  risk reduction planning and case management from
  the time offenders enter the criminal justice
  system to the time they are discharge from parole
  supervision
• To increase stable, long term housing
  opportunities for offenders entering communities
  after periods of incarceration
• To increase the employment rate of offenders
  returning home

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Reentry Strategy

• To increase the percentage of offenders who gain
  employment after the first 30 days on supervision
  and who remain employed for a period of six
  months
• Enhance the network of faith based services
  accessed by offenders
• Assist offenders in addressing family issues such
  as child support, fatherhood, accessing domestic
  violence and/or family counseling
• Ensure that offenders who are high risk for drug
  or alcohol relapse as properly assessed as needed
  and have access to appropriate treatment options
  in the community.

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Reentry Supervision for MH

• To ensure continuity of care for mental health
  and other special needs
• Psychology evaluation
• Ongoing mental health treatment/ counseling
• Continuance of medication
• Joint mental health case management

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Parole Management

• Specialized Supervision Units
• Specialized caseloads for MH Offenders
• Parole Agents specially trained as Forensic
  Agents in all districts
• Philadelphia designated one unit (6 agents) to
  supervise MH population
• Balance Supervision with Case Management
• All districts work with County MH/MR
• Allentown District Cooperative Case Management
  with Lehigh County

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Supervision Assessment Instrument

• Level of Service Inventory-Revised (LSI-R)
• Since 2003
• Validated on PBPP Population
• Administered within first 45 days of supervision
• Re-administered annually
• Uses
• Determines initial field supervision level
• (Maximum, Medium or Minimum)
• Determines contact requirements based on
  supervision level
• Identifies treatment needs of offenders

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Supervision Level Requirements

• Enhanced
• 4 face-to-face offender contacts per month
• Maximum
• 6 monthly face-to-face offender contacts per
  three months
• Medium
• Three face-to-face offender contacts per three
  months
• Minimum
• One face-to-face offender contact per three
  months
• Special Circumstances
• One face-to-face offender contacts per six months

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Statistical Overview Successful Completions
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Managing Offenders with Mental Health Issues

• Reentry From Incarceration to the Community

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Parole Re-entry

• Formed steering committee November 2005 at SCI
  Waymart
• Focused on seriously mentally ill offenders and
  their community re-entry
• Included reps OMHSAS in Dept. of Corrections and
  Dept. of Public Welfare and Board of Probation
  and Parole

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Pilot Program

• Selected 16 offenders from 13 different counties
• Examined actual cases to make recommendations for
  improvement to the system for the very serious
  mentally ill offenders re-entering society

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Degree of Success/Challenges

• Were early successes at SCI-Waymart, but did not
  maintain at the level desired
• MH individuals have recently been paroled to
  state run hospitals (specifically Western
  Psychiatric and Clarke Summit)
• They have not been getting to their home
  community due to the unavailability of local bed
  space which was the case when the program began
• This is slowing the initiative down

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Degree of Success/Challenges

• The Enhanced Reentry Program, which was begun in
  2005 (Waymart) had more successes at that time
• The challenges now and in the future will be
  available bed space offered by the DOC, thus
  enabling individuals the opportunity to quickly
  tap into local county services
• In short no viable home plan or half way back
  placement, no up-start of county services that
  are required

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Board Focus on MH Challenges

• Many parole agents are specialized agents in
  dedicated units
• MH offenders sent to Community Corrections
  Centers work with Transitional Coordinator (TC)
  Agents to assist and facilitate the immediate
  needs of the client specifically, establishing
  their on-going medication supply

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Board Focus on MH Challenges

• These clients are maintained on a TCs caseload
  up to 90 days or until they have become
  stabilized enough for transfer to a general
  caseload often under a specialized agent

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Mental Health Statistics

• There are 8,878 inmates on the active MH roster
  in state prisons of which 1,200 are classified as
  PRT (Psych Review Team) active
• There are 10,712 current inmates that are
  inactive MH roster cases, which means that there
  was treatment in the past

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MH Field Initiatives

• Philadelphia District Office
• Mental Health Unit has 6 agents - trained as
  Crisis Intervention Specialists
• Free training offered through the Montgomery
  County Emergency Services (MCES)
• These agents, plus 1 ASCRA, regularly attend the
  City's Forensic Task Force Meetings, participate
  in "Enhanced Reentry" conference calls with PMHCC
• Continued pursuit of staff training by NAMI and
  those sponsored by MCES on Forensic Psychiatry,
  Criminalization of the Mentally, and Jail
  Diversion.

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MH Field Initiatives

• Allentown District Office
• This office has a specialized unit that focuses
  upon the Half-Way Back Offenders - Sex Offenders
  - and the MH/MR Offender
• They have 1 MH agent

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MH Field Initiatives

• Allentown District Office
• After a case is identified as a mental health
  case, is assigned to a specialized agent
• Verification as to six (6) months or more
  remaining until max date
• Review most recent psychological evaluation for
  diagnosis
• If diagnosis is Schizophrenia - Bi-Polar - Major
  Depression - Schizoaffective - Psychotic Disorder
  - Mental Retardation. .the case is then
  referred to the local county mental health
  authority

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MH Field Initiatives

• Allentown District Office
• In this instance, Lehigh County Mental Health
  would receive the case for further determination
  of eligibility and services
• If the county worker determines the case to be
  stabilized, the case is then supervised by an
  agent with a general caseload
• If intensive services are needed (determined by
  Individual Case Manager (ICM) then the case is
  assigned to the specialized agent who coordinates
  services with the ICM

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MH Field Initiatives

• Reading Sub Office
• 1 current agent, part of a specialized unit who
  is being sent to relevant trainings
• Agent is networking with county MH/MR Berks
  County
• Agent will also continue to learn and partner
  with the Allentown District's specialized agent,
  who has a Master's Degree with a focus in this
  area.
• This unit has been functioning for approximately
  2 years.

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MH Field Initiatives

• Pittsburgh District Office
• Currently in transition as a Special Needs Unit
  recently created
• Present MH agent just transferred out
• When replaced, the agent will cover Allegheny
  County
• Presently, county resources and Mercy
  Behavioral/Western Psychiatric are being used

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MH Field Initiatives

• Chester District Office
• 2 specialized agents, one for MH and 1 for sex
  offenders
• Norristown Sub Office
• 1 MH agent
• Erie District Office
• 1 MH agent
• Scranton District Office
• 1 MH agent
• Williamsport District Office
• 1 MH agent

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MH Field Initiatives

• Harrisburg District Office
• 1 MH agent
• Altoona District Office
• Currently do not have specialized agents in this
  area. Dedicated agents will not complete BTA
  until March 2009
• Mercer District Office
• This training is offered and given to all agents.
  Specialization not yet occurring

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Violator Management

• Parolees who cannot be safely and effectively
  managed in the community continue to be revoked
• Efforts to reduce our returns are succeeding
• FY 05/06 317 per month
• FY 06/07 271 per month
• FY 07/08 237 per month
• Average monthly reduction 80

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Statistical Overview 1-year Recidivism Rate
Reduction
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Systematic Management Approach to Mental Health
Offenders

• Study by Fred C. Osher, MD
• Pennsylvanias Responses to People with Mental
  Illness in Contact with the Criminal Justice
  System

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Major Findings

• Diversion programs increase
• Public safety
• Help persons with mental illness succeed in the
  community
• Save taxpayer dollars

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Policy Recommendations

• Front-End Establish a competitive grant program
• Respond to local diversity
• Require criminal justice/mental health
  collaboration
• Measure impact/set performance benchmarks
• Leverage existing state bodies to administer

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Policy Recommendations

• Back-End Improve outcomes for people with mental
  illnesses released from prison to the community
• Reduce disparity in length of incarceration and
  parole revocation rates for people with mental
  illnesses
• Provide intensive supervision, treatment and
  services
• Increase the number of specialized parole agents
  to reduce caseloads to 25 per agent
• Cross training and intermediate sanctions

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Policy Recommendations

• Back-End Improve outcomes for people with mental
  illnesses released from prison to the community
  (contd.)
• Expand Community Corrections Centers
• Ensure availability of specialized mental health
  case managers
• Increase access to EBPs
• Increase access to supported housing

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Board Initiative

• Based upon Oshers recommendations, the Board is
  working in conjunction with top officials with
  key agencies to begin a pilot program in the
  Allentown and Pittsburgh districts to address
  mental health issues in the reentry process
• Grant funding is being sought after to support
  this initiative

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Current Challenges

• Earlier pre-release continuity of care planning
  in which the counties are willing to commit to
  providing care
• Ensuring no interruption of availability of
  required psychotropic medications

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Current Challenges

• Establishing throughout the Commonwealth joint
  case management by the parole agent and county
  mental health case manager of MH offender clients
• Expand dual diagnosis residential and
  non-residential program availability
• Expand inpatient program availability for
  offenders to avoid otherwise unnecessary parole
  revocation