< Previous30 PERSPECTIVES VOLUME 44, NUMBER 2 Gagliardi, G. J., Lovell, D., Peterson, P. D., & Jemelka, R. (2004). Forecasting recidivism in mentally ill offenders released from prison. Law and Human Behavior, 28, 133-155. Glied, S., & Frank, R. G. (2014). Mental illness and violence: Lessons from the evidence. American Journal of Public Health, 104, e5-e6. Guastaferro, W. P., & Daigle, L. E. (2012). Linking noncompliant behaviors and programmatic responses: The use of graduated sanctions in a felony-level drug court. Journal of Drug Issues, 42, 396-419. Hartwell, S. (2004). Triple stigma: Persons with mental illness and substance abuse problems in the criminal justice system. Criminal Justice Policy Review, 15, 84-99. Joyal, C. C., Côté, G., Meloche, J., & Hodgins, S. (2011). Severe mental illness and aggressive behavior: on the importance of considering subgroups. International Journal of Forensic Mental Health, 10, 107-117. Junginger, J., Claypoole, K., Laygo, R., & Crisanti, A. 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Offenders with mental disorder have criminogenic needs, too: Toward recidivism reduction. Law and Human Behavior, 38, 212-224. Stier, A., & Hinshaw, S. P. (2007). Explicit and implicit stigma against individuals with mental illness. Australian Psychologist, 42, 106-117. Wolff, N., Epperson, M., Shi, J., Huening, J., Schumann, B. E., & Sullivan, I. R. (2014). Mental health specialized probation caseloads: Are they effective? International Journal of Law and Psychiatry, 37, 464-472. ABOUT THE AUTHOR JENNIFER ENO LOUDEN, Ph.D. is an Associate Professor with the Department of Psychology at The University of Texas at El Paso. She can be reached REBEKAH ADAIR is a doctoral student of legal psychology in the Department of Psychology at The University of Texas at El Paso. JENNIFER SKEEM, Ph.D. is a Professor in the School of Social Welfare at the University of California, Berkeley. 32 PERSPECTIVES VOLUME 44, NUMBER 2 SUPERVISING PEOPLE WITH MENTAL AND SUBSTANCE USE DISORDERS: DEVELOPING STRATEGIES UTILIZING THE SEQUENTIAL INTERCEPT MODEL BY MATTHEW ROBBINS33 AMERICAN PROBATION AND PAROLE ASSOCIATION People with mental illness enter the criminal justice system at greater frequency, penetrate deeper into it, and experience worse outcomes compared to people without mental illness. As a result, those with mental illness are overrepresented in the criminal justice system. In fact, 17% of people incarcerated in jails have been diagnosed with a serious mental illness, compared to 4% of the general population (Steadman, Osher, Robbins, Case, & Samuels, 2009); Substance Abuse and Mental Health Services Administration (SAMHSA), 2019). Another important consideration is that 72% of people with mental illness incarcerated in jails have a co-occurring substance use disorder (Abram & Teplin, 1991). Community corrections agencies are in a unique position to change outcomes for this population. Given that 69% of the approximately 6.6 million people involved in the criminal justice system are on community supervision (Kaeble & Cowhig, 2018), probation and parole providers play an important role in supervising people with mental and substance use disorders involved in the criminal justice system. (Policy Research Associates, 2018) The Sequential Intercept Model provides a conceptual framework for community- based strategic planning and collaboration between criminal justice and behavioral health systems to address concerns about criminalization and improve outcomes for people with mental and substance use disorders involved in the criminal justice system. Developed in the early 2000s by Mark Munetz and Patricia A. Griffin along with Henry J. Steadman, this model established a series of intercept points at which people with mental and substance use disorders can be identified, connected with treatment and other support services, prevented from penetrating deeper into the criminal justice system, and diverted out of the criminal justice system when appropriate (Munetz FIGURE 1: SEQUENTIAL INTERCEPT MODEL34 PERSPECTIVES VOLUME 44, NUMBER 2 & Griffin, 2006). The intercept points are: (Intercept 0) Community Services, (Intercept 1) Law Enforcement, (Intercept 2) Initial Detention and Initial Court Hearings, (Intercept 3) Jails and Courts, (Intercept 4) Reentry, and (Intercept 5) Community Corrections (Abreu, Parker, Noether, Steadman, & Case, 2017). SEQUENTIAL INTERCEPT MODEL IN ACTION Communities have been exploring ways to increase collaboration between criminal justice and behavioral health systems—spurred on in part by the need to address concerns about criminalization and to improve outcomes for people with mental and substance use disorders involved in the criminal justice system. It is worthwhile to consider how the Sequential Intercept Model can guide these efforts. The Sequential Intercept Model was first tested in 2002 in Summit County, Ohio, and in five counties in southeastern Pennsylvania (Griffin, Munetz, Bonfine, & Kemp, 2015). Following that, it was the subject of a National Institute of Mental Health Small Business Research study conducted by Policy Research Associates, Inc. (PRA) that formalized a strategic planning approach to the Sequential Intercept Model known as Sequential Intercept Mapping (formerly “cross system mapping”). To date, PRA has conducted Sequential Intercept Mapping (SIM) workshops in over 200 communities throughout the country. These facilitated and interactive workshops involve convening cross-system groups of key stakeholders to assess available resources, identify gaps in services, develop priorities for change, and engage in strategic planning. Community corrections agencies are essential participants in Sequential Intercept Mapping efforts and can also benefit greatly from the process. Although community corrections agencies operate primarily on the back end of the criminal justice system at Intercept 5, they have a critical role in promoting engagement in treatment, connecting people with services and supports, reducing recidivism, and maintaining public safety, all of which can support positive outcomes for people with mental and substance use disorders who are involved in the criminal justice system. Community Corrections agencies can also be integral partners in efforts at earlier intercepts as well. For example, many community corrections agencies play a role at Intercepts 2 and 3 (Initial Detention/Court Hearing and Jails/Courts), as they provide pretrial supervision as well as supervision for drug court and mental health court participants. Community corrections agencies are also frequently involved in reentry planning and transitioning people from jail or prison into the community at Intercept 4 (Reentry).35 AMERICAN PROBATION AND PAROLE ASSOCIATION In some cases, community corrections agencies have taken the lead in organizing Sequential Intercept Mapping efforts in their communities. The Napa County Probation Department in California organized and hosted a SIM workshop in 2018. The group of key stakeholders who attended used the SIM workshop to guide planning for the establishment of a 72-bed reentry resource center that would be managed by the probation department. The center was designed to assist individuals with mental and substance use disorders being released from jails and prisons with case management and access to housing, medications, treatment, and other support services. Napa County attendees also used the workshop to engage in strategic planning for expanding housing options in the community in response to a lack of housing. In addition, they worked to develop a more coordinated and structured approach to reentry planning, with linkage to community-based treatment providers and other support services. Finally, they successfully worked to address the county’s need to improve data and information sharing between agencies within the criminal justice and behavioral health systems. That same year the Marion County Probation Department in Indiana took the lead in organizing and hosting a SIM workshop. This SIM workshop was used to develop a process for enrolling people in benefits prior to their release from jail or prison in order to improve access to treatment and other supportive services in the community. It also resulted in an increase in the amount of medication provided to individuals at the time of release and the expansion of housing options in the community. Finally, through that workshop the probation department identified validated screening and assessment tools and established specialized caseloads for people with mental and substance use disorders. Also worth mentioning is a 2019 SIM workshop organized and hosted by the Probation Department in Yuma County, Arizona. Among the areas of focus were guidance in planning for an integrated health clinic within the probation department, Crisis Intervention Team training for probation officers, developing capacity within the probation department to schedule mental health and substance use treatment intake appointments, improving communication between case managers and probation officers, and implementing peer support during reentry. RESOLVING GAPS AT KEY INTERCEPT POINTS PRA recently completed an analysis of reports from SIM workshops that took place between 2015 and 2018, and the results revealed that groups of key stakeholders participating in the workshops frequently identified 36 PERSPECTIVES VOLUME 44, NUMBER 2 and developed strategies to address gaps in services at Intercepts 4 and 5 (Reentry and Community Corrections). The most prevalent gaps in services were discharge planning and reentry, access to housing, access to medications, staffing shortages, large caseloads, and transportation (Rogers, 2019). Discharge planning and reentry was the most frequently identified area with gaps in services. Some of the specific issues identified were limited time for discharge planning and lack of information about release dates, limited knowledge of the availability of reentry services and supports and how to access them, and lack of identification documents needed to access services and supports in the community. To address these gaps, workshop attendees established priorities that commonly included developing discharge planning and reentry guides, improving notification and coordination of discharge timing, implementing programs to assist with obtaining identification and benefits, and improving linkage to treatment and other supports in the community. Access to housing was the next most frequently identified area with service gaps. Some of the specific issues identified were a lack of immediate emergency and transitional housing, limited permanent housing options—particularly for people with mental and substance use disorders who have criminal justice histories—and the problem of people being unable to pay for housing on their own combined with a lack of funding for housing. The priorities established in response included developing immediate emergency housing and transitional housing, educating the public about homelessness, and developing strategies to expand the availability of safe and affordable housing both generally and for those with both mental and Priorities established in response included expanding medication availability in jails and prisons, providing medication at the time of discharge (and increasing the amount of such discharge medications provided), and ensuring access to medication sources for continuity of medications in the community.37 AMERICAN PROBATION AND PAROLE ASSOCIATION substance use disorders and criminal justice histories. Difficulty in getting access to medications was near the top of the problem list as well. Some of the specific issues identified were limited amounts of medications being provided at the time of discharge, need for continuity of medication following discharge, and difficulty obtaining medications in the community. Priorities established in response included expanding medication availability in jails and prisons, providing medication at the time of discharge (and increasing the amount of such discharge medications provided), and ensuring access to medication sources for continuity of medications in the community. Staffing shortages and large caseloads were reported as a challenge for many community corrections agencies. Some of the specific issues identified in the general category of staffing were high rates of staff turnover, staff shortages and large caseloads, and lack of training. As a result, priorities were often established that included efforts to improve staff retention. In addition, priority was given to designating dedicated officers with specialized caseloads of people with mental and substance use disorders that are typically smaller in size than traditional caseloads, to providing specialized training, and to ensuring access to the latest information about treatment providers and other support services available in the community. Last but not least were the reported gaps in services involving transportation, with needs particularly acute in rural areas and areas with little or no public transportation. Priorities established in response included expanding transportation options, providing assistance to pay for transportation, and expanding the use of technology to provide tele-behavioral health services. One combined approach that helps agencies cut down barriers and cross over to address multiple gaps in services has been establishing reentry resource centers. Many community corrections agencies have been involved in the establishment of reentry resource centers with co-located services to connect people with mental and substance use disorders with treatment and other support services in the community. Such centers can also assist clients in accessing identification, benefits, housing, and employment. SIM workshops assist with the identification of resources and the development of strategic plans to address all the previously mentioned gaps in services, as well as other gaps in services that exist at earlier intercepts, through collaboration between key stakeholders from criminal justice and behavioral health systems. 38 PERSPECTIVES VOLUME 44, NUMBER 2 REFERENCES Abram, K. M., & Teplin, L. A. (1991). Co- occurring disorders among mentally ill jail detainees. American Psychologist, 46, 1036-1045. Griffin, P. A., Munetz, M., Bonfine, N., & Kemp, K. (2015). Development of the sequential intercept model: The search for a conceptual model. In Griffin, P.A., Heilbrun, K., Mulvey, E. P., DeMatteo, D., & Schubert, C. A. (Eds.), The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp.21-39). New York: Oxford University Press. DOI: 10.1093/med:psych/9780199826759.001.0001 Kaeble, D., & Cowhig, M. (2018). Correctional populations in the United States, 2016. (NCJ 251211). Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Munetz, M. R., & Griffin, P. A. (2006). Use of the sequential intercept model as an approach to decriminalization of people with serious mental illness. Psychiatric Services, 57, 544-549. DOI: 10.1176/ps.2006.57.4.544 Rogers, S. (2019). Sequential Intercept Mapping Report Analysis. Unpublished Manuscript. Steadman, H. J., Osher, F. C., Robbins, P. C., Case, B., & Samuels, S. (2009). Prevalence of serious mental illness among jail inmates. Psychiatric Services, 60, 761-765. DOI: 10.1176/ ps.2009.60.6.761 Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved ABOUT THE AUTHOR MATTHEW ROBBINS is a Project Associate who has been employed at Policy Research Associates, Inc. (PRA) since 2012. In his current role he coordinates all of PRA’s the Sequential Intercept Mapping related work. He also assists with the operation of SAMHSA’s GAINS Center and provides behavioral health related technical assistance to the MacArthur Foundation’s Safety and Justice Challenge Network. He can be reached 39 AMERICAN PROBATION AND PAROLE ASSOCIATION Next >