Lessons Learned: Innovative Approaches to Mental Health Courts and Related ServicesGenerating Hope i

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Lessons Learned Innovative Approaches to Mental
Health Courts and Related Services/Generating
Hope in Times of Scarce ResourcesVA and
Reentry/Justice Involved VeteransJim McGuire,
PhD, LCSWJune 4, 2009
Patient Care Services D e p a r t m e n t of
V e t e r a n s A f f a i r s .. A
Continuum of Care

• Office of Mental Health Services

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VA who arent we?

• State DVA
• County Veteran Service Offices
• Veteran Service Organizations
• U.S. Military Medical Services
• Walter Reed Army Medical Center

Patient Care Services Department of Veterans
Affairs A Continuum of Care
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VA who are we?

• U.S. VA VBA, VHA, NCA
• FY 2008 38B budget 27B medical services
  3B MH/SA
• 2008 5.8M veterans (1/5)
• 42 eligible OEF/OIF veterans used VA care
  (40,000/945,000 thru 9/08)
• VHA Nationally
• gt150 hospitals gt1,100 CBOCs
• Residential treatment/transitional housing beds
• MHRRTP gt8,000 beds, gt180 programs
• 10,000 Grant and Per Diem VA-funded community
  residential care beds
• FY 2008 10,000 HUD permanent housing vouchers
  FY 2009 10,000 more HUD vouchers

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Services U.S. VA

• Benefits pensions, education and training, home
  loan guaranty, life insurance
• Health
• Physical health prevention, medical and
  specialty, mental health (medication, inhalers,
  etc.)
• Mental health the reality and promise of the
  uniform package medication, inpatient,
  outpatient, evidence-based treatments supported
  employment, consumer/peer supports homeless
  prevention/housing services
• Cemetery burial and memorial benefits

Patient Care Services Department of Veterans
Affairs A Continuum of Care
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VHA how good are we?

• Business Week (2006) Best Medical Care in the
  U.S.
• Quality of care
• 348 indicators targeting 26 conditions
• Chronic disease care VA 72 vs. private care 59
• Preventive care 64 vs. 44
• Clinical practice guidelines adherence 84
• Access to care
• 2008 target 96 primary care appointments within
  30 days of patients date
• Patient satisfaction 2006 American Customer
  Satisfaction Index (ASCI) Survey (National
  Quality Research Center, University of Michigan)
  
• Inpatient care 84/100 (10 pts. higher than
  private-sector health care industry)
• Outpatient 82/100 (8 pts. higher than
  private-sector health care industry)
• Harvards Innovations in American Government
  Award (2006) VAs Computerized Record Systems
  (CPRS)

Patient Care Services Department of Veterans
Affairs A Continuum of Care
Asch etal. 2004.
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Reentry needs

• Personal identification documents (IDs) for
  benefits, employment, and housing
• Stable housing
• Vocational, education training and work
  experience
• Medical, psychiatric, and substance abuse
  treatment
• Determination and negotiation of fines,
  restitution, child support, benefits overpayments
• Compliance with parole/probation conditions and
  relationship with parole/probation office
• Recidivism risk behavior and attitude avoidance
• Family re-integration

Patient Care Services Department of Veterans
Affairs A Continuum of Care
Reentry Policy Council, 2005
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The justice continuum
Source Policy Research Associates, Delmar, NY.
Patient Care Services Department of Veterans
Affairs A Continuum of Care
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How Is HCRV Doing?
HCRV Specialists are seeing veterans in 451 state
and federal prisons, 37 of all US Prisons
7,216 incarcerated veterans have received reentry
assessment and linkage services since HCRV began
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Why health care?
Urban Institute having any type of health
condition physical, mental, or substance
abusewas associated with either engaging in
more criminal activity or having a higher
likelihood of reincarceration.
Patient Care Services Department of Veterans
Affairs A Continuum of Care
Malik-Kane and Visher, 2008
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Medical problems Veterans in U.S. jails (BJS,
2002)
34 have 2 or more serious/chronic health
problems Federal veterans 37 have 2 or more
serious/chronic health problems
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Psychiatric/Substance Use Disorders Veterans in
U.S. jails (BJS, 2002)
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Other characteristics of Veterans in jail (BJS,
2002)

• 9.3
• Average age 42
• Trauma
• Combat 20
• Positive for physical/sexual abuse 21
• Either 36
• Homeless year prior to arrest 18
• Arrested for nonviolent crime 70

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PTSD
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PTSD and Criminal Behavior
Source Claudia Baker and Cessie Alfonso,
National Center for PTSD Fact Sheet PTSD and
Criminal Behavior
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JUSTICE OUTREACH UNIFORM MENTAL HEALTH SERVICES
IN VA MEDICAL CENTERS AND CLINICSVHA HANDBOOK
1160.01

• 20. INCARCERATED VETERANS
• VA is committed to the principle that when
  eligible veterans non-violent offenses are
  products of mental illness, veterans and their
  communities are often better served by mental
  health treatment than incarceration. Police
  encounters and pre-trial court proceedings are
  often-missed opportunities to connect eligible
  veterans with VA mental health services as a
  negotiated alternative to incarceration or other
  criminal sanctions. Each VA medical center is
  strongly encouraged to appoint and maintain an
  individual whois responsible for Working with
  community agencies in providing training to law
  enforcement personnel.Working either alone or as
  part of a team of community and justice system
  partners to develop and provide to the court a
  plan of community-based alternatives to
  incarceration.

Patient Care Services Department of Veterans
Affairs A Continuum of Care
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Diversion Logic Model
Patient Care Services Department of Veterans
Affairs A Continuum of Care
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Reentry EBT

• Outreach MI
• Residential
• SPECTRM Building Changes
• MRT RR T4C
• Seeking Safety TREM/MTREM
• FACT/FICM

Patient Care Services Department of Veterans
Affairs A Continuum of Care
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EBT - VJO

• Motivational Interviewing
• Moral Reconation Therapy
• Seeking Safety

Patient Care Services Department of Veterans
Affairs A Continuum of Care
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Opportunities

• Profound effects on veterans
• Profound effects on communities
• Prevention for chronic disease population
• Outreach and enrollment as veteran population
  declines
• VA tangible, real, accessible, and constructive
  community partner

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References

• Andrews, D. (1995). The psychology of criminal
  conduct and effective treatment. In J.McGuire
  (Ed.), What Works Reducing Reoffending ( New
  York John Wiley and Sons.
• Asch, S. M., McGlynn, E. A., Hogan, M. M.,
  Hayward, R. A., Shekelle, P., Rubenstein, L. et
  al. (2004). Comparison of quality of care for
  patients in the Veterans Health Administration
  and patients in a national sample. Annals of
  Internal Medicine, 141, 938-945.
• Claudia Baker and Cessie Alfonso, National Center
  for PTSD Fact Sheet PTSD and Criminal Behavior
  http//www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/f
  s_legal.html?printable-templatefactsheet
• Clemmer, D. (1940). The prison community. Boston
  Christopher Publishing House.
• Jacobson, M. 2005. Downsizing Prisons How to
  Reduce Crime and End Mass Incarceration. New
  York University Press New York.
• Mallik-Kane, K. Visher, C. A. (2008). Health
  and prisoner reentry How physical, mental, and
  substance abuse conditions shape the process of
  reintegration Washington, D.C.
• Mumola, C. J. (2000). Veterans in prison or jail
  (Rep. No. NCJ 178888). Washington, D.C. U.S.
  Department of Justice Office of Justice Programs.
• Noonan, M. E. Mumola, C. J. (2007). Veterans in
  State and Federal Prison, 2004 (Rep. No. NCJ
  217199). Washington, D.C. U.S. Department of
  Justice Office of Justice Programs.
• ReEntry Policy Council (2005). Report of the
  Re-Entry Policy Council Charting the safe and
  successful return of prisoners to the community
  New York, New York Council of State Governments.
• Walters, G. D. (1995). The Psychological
  Inventory of Criminal Thinking Styles Part 1.
  Reliability and preliminary validity. Criminal
  Justice and Behavior, 22, 307-325.

Patient Care Services Department of Veterans
Affairs A Continuum of Care