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The Center for Health Care Services Therapeutic Jurisprudence Collaboration Models in San Antonio, Texas 2010 State TAAP Conference Linda Tavel, MPA,LCDC,CART Melanie Lane, LCSW,LCDC,AADC Gilbert Gonzales MA,LPC,LCDC July 9, 2010

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The Problem

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Mental Health Forensic Flow a work in progress… Circa 2010,

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Origins of Therapeutic Jurisprudence <ul><li>The creation of the term “Therapeutic Jurisprudence” is attributed to Professor David Wexler, University of Arizona Law School in the late 1980’s and further developed with a legal colleague Professor Bruce Winick in 1999 of Miami School of Law (Alaska Justice Forum,2009) </li></ul><ul><li>Definition of “Therapeutic Justice”. “ the use of social science to study the extent to which legal rule or practice promotes the psychological and physical well-being of the people it affects” (Honorable William Schma, 200). </li></ul>

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What elements comprise a Therapeutic Justice Model? <ul><li>Emphasis on guiding individuals toward treatment. </li></ul><ul><li>Goal is to reduce recidivism while providing treatment for individuals entering the legal system with mental illness, drug/alcohol addictions, family violence, and abuse issues. </li></ul><ul><li>Courts partnering with social service agencies to execute Therapeutic Justice goals. </li></ul>

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Therapeutic Justice Model: The Integration of Treatment and Justice “Therapeutic Justice is defined as a systemic approach which insures a collaborative partnership between the Courts, the Criminal Justice System and the Behavioral Health system while providing that the public safety net is able to provide for the most efficient and effective support for persons who are in crisis and or are experiencing psychiatric and substance abuse disorders.” Leon Evans, President and CEO, CHCS Bexar County Mental Health Authority

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Law Enforcement Detention/Jail CIT Judicial/Courts Magistrate, County, District Mental Health Public and Private Providers Crisis Care Center Jail Diversion Psychiatric and Medical Clearance Specialty Offender Services Community Dynamic Crisis Jail Diversion Information Exchange Police, Sheriff Probation, Parole Civil and Criminal Treatment Continuity of Care County City-wide Emergency Services <ul><li>Data exchange through </li></ul><ul><li>Community Collaborative </li></ul><ul><li>Crisis Care Center </li></ul><ul><li>CIT/DMOT </li></ul><ul><li>Jail and Juvenile Detention </li></ul><ul><li>Statewide CARE Match </li></ul>System County City-wide Entry Points System Level

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Adaptation of Therapeutic Jurisprudence in San Antonio, Texas <ul><li>Problem solving courts have been established in San Antonio, Bexar County, Texas since 2005. </li></ul><ul><li>Specialty Courts in Bexar County; </li></ul><ul><li>Felony Drug Court </li></ul><ul><li>Misdemeanor Drug Court </li></ul><ul><li>Family Drug Court </li></ul><ul><li>Dual Diagnosis Drug Court </li></ul><ul><li>Mental Health Court </li></ul><ul><li>Juvenile Drug Court </li></ul><ul><li>Veteran Drug Court </li></ul>

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Before the end of the 2007 legislative session the Texas Legislature enacted a package of criminal justice policies designed to prevent the predicted growth in the prison population and save $443 million. To improve success rates of people under supervision, A reinvestment of $241 million planned to expand the capacity of substance abuse and mental health community-based treatment and diversion programs, and enacted parole reforms to enhance the use of parole for low-risk offenders. Between 2006 and 2008, probation revocations to prison declined by 4% and parole revocations to prison plummeted by 25%. Madden, J. (2009, April 1).. “ Hearing on Justice Reinvestment”. Retrieved from website URL http:// search.aol.com/aol/search?s_it = topsearchbox.search&q =an+analysis+on+cost+savings+treatment+alternatives+to+incarceration+in+texas+2008 Therapeutic Justice Begins

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The Building a Therapeutic Justice Model in Bexar County,Texas Collaborations between Bexar County Community Supervision and Corrections and The Center for Health Care Services The Center for Health Care Services’ Mental Health Treatment and Substance Abuse Treatment Programs began providing services within the County’s Residential Treatment Facilities 2004. Other Community Providers joined the collaboration in providing supportive social services; Region 20, SAISD, Oxford House Inc. , Goodwill Industries, Dullnig Health Clinic, University Health System, Christian Assistance Ministries, San Antonio Alternative Housing, Our Casas Housing Inc., Community AA/NA/CA groups providing institutional meetings, and faith based organizations who provided spirituality meetings.

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&quot;Justice Reinvestment&quot; <ul><li>April 1, 2009 </li></ul><ul><li>Commerce, Justice, Science, and Related Agencies </li></ul><ul><li>Appropriations Subcommittee </li></ul><ul><li>U.S. House of Representatives: Jerry Madden </li></ul><ul><li>“ During the 1980s and 1990s, the Texas legislature enacted tough, new criminal laws which increased the incarceration rate in Texas becoming one of the largest prison systems in the nation”(Madden,2009). </li></ul><ul><li>“ Between 1985 and 2005, the state prison population grew by 300 percent. Texas spent $2.3 billion to add 108,000 prison beds”(Madden,2009). </li></ul><ul><li>In 2007 an analysis was requested of The Justice Center resulting in the identification of three key factors contributing to the growth in the Texas prison population ; </li></ul><ul><li>1. Between 1997 and 2006, an 18% increase in probation revocations </li></ul><ul><li>despite a 3 percent decline in the probation population. </li></ul><ul><li>2. Reductions in funding for community-based substance abuse and mental health </li></ul><ul><li>services , and by 2006, more than 2,000 individuals were awaiting placement in such </li></ul><ul><li>programs and facilities </li></ul><ul><li>3. Fewer approvals for Parole for low risk individuals were granted (Madden,2009). </li></ul><ul><li>The Texas justice reinvestment strategy consisting of treatment alternatives to </li></ul><ul><li>incarceration strategies resulted in an immediate savings of $210.5 million for </li></ul><ul><li>fiscal years 2008 and 2009 (Madden,2009) </li></ul><ul><li>Madden, J. (2009, April 1).. “ Hearing on Justice Reinvestment”. Retrieved from website URL http:// search.aol.com/aol/search?s_it = topsearchbox.search&q =an+analysis+on+cost+savings+treatment+alternatives+to+incarceration+in+texas+2008 </li></ul>

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Therapeutic Justice Partnerships with Bexar County Community Supervision and Corrections Dept. <ul><li>Two-100 Bed Substance Abuse Treatment Facilities (SATF-1 & </li></ul><ul><li>SATF-2, </li></ul><ul><li>60 Bed Young Adult “boot camp” residential facility- Zero </li></ul><ul><li>Tolerance) </li></ul><ul><li>One- 60 Bed Dual Diagnosis Unit (MH/SA) Mentally Ill Offender </li></ul><ul><li>Facility </li></ul><ul><li>Outpatient Substance Abuse Treatment Program (lH 10) </li></ul><ul><li>Dual Diagnosis Outpatient Substance Abuse Program (Palo Alto) </li></ul><ul><li>Drug Court Treatment Services, Dual Diagnosis Drug Court </li></ul><ul><li>Treatment Services, Mental Health Court Services, and the </li></ul><ul><li>upcoming commencement of Veteran Drug Court Services. </li></ul>

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The Center for Health Care Services <ul><li>The Restoration Center </li></ul><ul><li>Criminal Justice Substance Abuse </li></ul><ul><li>Treatment Programs </li></ul><ul><li>Co-Occurring Psychiatric and </li></ul><ul><li>Substance Abuse Disorders Services </li></ul><ul><li>Pharmacology-Methadone Maintenance </li></ul><ul><li>Treatment </li></ul><ul><li>Project Carino </li></ul><ul><li>Centro De Vida-HIV Outreach </li></ul>

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<ul><li>Therapeutic Jurisprudence Partnerships with the Public Inebriate Population </li></ul>April 16, 2008 – March 31, 2009 $1,795,200. $1,267,200. $528,000. Injured Prisoner Diverted from UHS Emergency Room $2,419,009. $1,983,574. $435,435. Public Inebriates Diverted from Detention Facility Direct Cost Avoidance Bexar County City of San Antonio Cost Category

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Therapeutic Justice Model <ul><li>Treatment in lieu of incarceration renders a cost savings, impacting recidivism </li></ul><ul><li>Cost of treatment is cheaper than incarceration and detention </li></ul><ul><li>Treatment aids defendants in achieving stability and self sufficiency in the community to make restitution through paying fines, and compliance with probation conditions. </li></ul><ul><li>Defendants receive treatment and rehabilitation skills to become a functional member of society </li></ul>

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<ul><li>The Problem Revolving Door Syndrome </li></ul>Arrest Jail The Solution The Restoration Center

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The Restoration Center Opened April 15, 2008 <ul><li>Public Safety- Sobering </li></ul><ul><li>Unit </li></ul><ul><li>Detoxification Facility </li></ul><ul><li>Community Court </li></ul><ul><li>Outpatient Substance </li></ul><ul><li>Abuse Services </li></ul>

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Community Wide Partnership Between <ul><li>The Center for Health Care Services </li></ul><ul><li>Bexar County </li></ul><ul><li>The City of San Antonio </li></ul><ul><li>University Health System </li></ul><ul><li>Haven for Hope </li></ul><ul><li>The Judicial Systems </li></ul><ul><li>Law Enforcement </li></ul>

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To establish a system of care for homeless, serial inebriates that includes <ul><li>24/7 Access to Substance Abuse Treatment </li></ul><ul><li>Safe affordable housing </li></ul><ul><li>Medical Care </li></ul><ul><li>Psychiatric Care </li></ul><ul><li>Vocational/Employment Assistance </li></ul>

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Substance Abuse System of Care Partial/Day Hospital, “ Intensive” Outpatient <ul><li>Urgent Care Center </li></ul><ul><li>“ Front-Door” </li></ul><ul><li>Substance Abuse Triage </li></ul><ul><li>Mental Health Jail Diversion </li></ul><ul><li>Haven for Hope </li></ul><ul><li>Homeless Housing </li></ul><ul><li>Initiative </li></ul>Community Patients Community Patients Outpatient Treatment Recovered ! X Relapse Medical Detoxification CHCS Detoxification

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The Restoration Center Programs include: <ul><li>Public Safety Unit (PSU) </li></ul><ul><li>Injured Prisoner Medical Clearance & Treatment </li></ul><ul><li>40 person sobering unit (4-6 hr stay) </li></ul><ul><li>Detoxification Unit – 27 beds - 3 to 5 day stay </li></ul><ul><li>Substance Abuse Intensive Outpatient Services </li></ul><ul><li>16 weeks- 6 days per week, 4 hrs per day </li></ul><ul><li>counseling program </li></ul>

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<ul><li>Public Safety Sobering Unit </li></ul>Cost is High Cost Savings can be achieved Public Inebriates are sobered Up In Jail Can Now Be Sobered up In a location where treatment Is possible. Experienced Peer Recovery Specialists provide Motivation to enter treatment RNs monitor/evaluate 24/7

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<ul><li>Funded by: </li></ul><ul><li>Texas Department of State Health Services, </li></ul><ul><li>University Health System, and Hope Action Care. </li></ul><ul><li>Provides Physician Medication Management and </li></ul><ul><li>Substance Abuse Outpatient Treatment. </li></ul><ul><li>Licensed by the Commission of Accreditation for </li></ul><ul><li>Rehabilitation Facilities (CARF). </li></ul>Pharmacology-Methadone Maintenance Treatment

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Project Cariño <ul><li>Provides intensive wrap-around support services for </li></ul><ul><li>pregnant women who are opioid addicted. </li></ul><ul><li>Provides medically managed Methadone Maintenance </li></ul><ul><li>Treatment and Outpatient Substance Abuse Treatment </li></ul><ul><li>Funded for five-years by CSAT under the Targeted </li></ul><ul><li>Expansion Program for Substance Abuse Treatment . </li></ul>

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<ul><li>Funded by the Texas Department of State </li></ul><ul><li>Health Services. </li></ul><ul><li>Outreach to high risk Substance Abusers </li></ul><ul><li>Provides information, referrals and </li></ul><ul><li>education on HIV and other communicable </li></ul><ul><li>diseases, including hepatitis. </li></ul>Centro de Vida-HIV Outreach

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CHCS Central Services Sites Crisis Center Restoration Center

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Haven for Hope <ul><li>To increase the community capacity for mental health, substance abuse and detoxification services </li></ul>The Community Wide Initiative Haven for Hope and CHCS collaboration Goal:

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The Center for Health Care Services Leon Evans, President/CEO The Center for Health Care Services Mental Health Authority www.chcsbc.org [email_address]