Veteran's Treatment Court Project

VETERAN’S TREATMENT COURT PROJECT Introduction

Purpose Provide a general overview Why What How

Background of the project My Background The National Center for Veteran Studies at the University of Utah (NCVS) Directed Research

Intended audience Assumptions Legal Community Judges, prosecution and defense attorneys Service Providers

How to use this course Chapters Format Video and PDF slideshow Design Purpose Crash course

JUST WHAT IS A DEPLOYMENT? One soldier’s perspective

Personal Deployment Experience Pre-mobilization (3 months) Short leave Camp Bucca (9 months) Mission Demobilization Reunion Reintegration

Topics Covered General overview of military structure Who makes up the military community The military justice system When does one become a “Veteran”

A general overview Military Structure

Military Structure Department of Defense United States Army (USA) United States Navy (USN) United States Marine Corp (USMC) United States Air Force (USAF) Department of Homeland Security United States Coast Guard (USCG)

Military Structure Army 1775 Active Duty: 522,388 Reserve: 202,000 National Guard: 352,000 Mission: “ The Army’s mission is to fight and win our Nation’s wars by providing prompt, sustained land dominance across the full range of military operations and spectrum of conflict in support of combatant commanders.” Sources: www.todaysmilitary.com & www.army.mil & http://open.dodlive.mil/data-gov/demographics/

Military Structure Navy Established: 1775 Active: 337,690 Reserve: 61,891 Mission: “The mission of the Navy is to maintain, train and equip combat-ready Naval forces capable of winning wars, deterring aggression and maintaining freedom of the seas.” Sources www.todaysmilitary.com & http://open.dodlive.mil/data-gov/demographics/ & www.navy.mil

Military Structure Marine Corps Established: 1775 Active: 184,000 Reserve: 42,602 Mission “ The Marine Corps shall be organized, trained, and equipped to provide fleet marine forces of combined arms, together with supporting air components, for service with the fleet in the seizure or defense of advanced naval bases and for the conduct of such land operations as may be essential to the prosecution of a naval campaign.” - 10 U.S.C. § 5063 Sources www.todaysmilitary.com & http://open.dodlive.mil/data-gov/demographics/

Military Structure Air Force Established Active: 352,000 Reserve: 109,622 Guard: 160,700 Mission: “The mission of the United States Air Force is to fly, fight and win ...in air, space and cyberspace.” Sources www.todaysmilitary.com & http://open.dodlive.mil/data-gov/demographics/ & www.af.mil

Military Structure Officer Rank Commissioned officer Warrant officer Enlisted Rank Lower enlisted Non-commissioned officer

Types of punishment – commander’s discretion Restriction of duties Detention/confinement Forfeiture of pay Reduction in rank Extra duties

Court Martial Offenses Sex Offenses Perjury and False Statements Assault and related offenses Escape and related offenses Homicide Desertion Disobedience Theft Offenses Robbery Fraud Offenses Conduct unbecoming an officer Alcohol and drug offenses

Military Discharge Administrative Honorable Meets or exceeds the requirements Full benefits General Some form of non-judicial content Under Other Than Honorable Conditions Significant departure from military conduct Lose most benefits Judicial Process Bad Conduct Punitive discharge Nearly all benefits lost Dishonorable Can only be given through a General Court Martial for serious offenses (i.e. murder, rape and desertion) Source: http://www.eielson.af.mil/news/story.asp?id=123117744

Overview Part I Recent Combat Deployments Part II Reactions to op-tempo Troop issues stemming from OEF/OIF

OEF/OIF Operational Tempo (op-tempo) Part 1: Recent Combat Deployments

Stressors from OEF/OIF Risk of death or injury Witness death of buddies Kill others in combat Constant fear of threat Prolonged separation Sexual Trauma More severe physical trauma TBI Prior traumatic event PTSD Substance Abuse Suicide Reunion/Reintegration issues Cause Possible Effect Sources: Mental Health Effects of Serving in Afghanistan and Iraq, available at http://www.ptsd.va.gov/public/pages/overview-mental-health-effects.asp & Returning From the War Zone: A guide for Military Personnel, PDF guide available at http://www.ptsd.va.gov/public/reintegration/guide-pdf/SMGuide.pdf

Common reactions Trouble sleeping, overly tired Stomach upset, trouble eating Headaches and sweating when thinking of the war Rapid heartbeat or breathing Existing health problems become worse Experiencing shock, being numb, unable to feel happy Bad dreams, nightmares Flashbacks or frequent unwanted memories Anger Feeling nervous, helpless or fearful Feeling guilty, self-blame, shame Feeling sad, rejected, or abandoned Agitated, easily upset, irritated, or annoyed Feeling hopeless about the future Common Physical Reactions Common Mental and Emotional Reactions Source: Returning From the War Zone: A guide for Military Personnel, PDF guide available at http://www.ptsd.va.gov/public/reintegration/guide-pdf/SMGuide.pdf

Common reactions, cont. Trouble concentrating Edgy, jumpy and easily startled Being on guard, always alert, concerned too much about safety and security Aggressive driving habits Avoiding people or places related to the trauma Too much drinking, smoking, or drug use Lack of exercise, poor diet, or health care Problems doing regular tasks at work or school Behavioral Reactions Behavioral Reactions Source: Returning From the War Zone: A guide for Military Personnel, PDF guide available at http://www.ptsd.va.gov/public/reintegration/guide-pdf/SMGuide.pdf

My Story I gave the briefings about reunion/reintegration Effects from above Slamming door at law school Felt strong and like I didn’t need help Hand to hand with brothers Honeymoon and then trouble Connecting with other vets

What about those that leave the military? 2002 – 2009 1 million troops left OEF/OIF 46% went to the VA for services 48% percent that went in for care have mental health problems (220,800 troops) Source: Mental Health Effects of Serving in Afghanistan and Iraq, available at http://www.ptsd.va.gov/public/pages/overview-mental-health-effects.asp

Why don’t vets reach out for help? Concern over being seen as weak Concern about being treated differently Concern that others would lose confidence in them Concerns about privacy They prefer to rely on family and friends They don't believe treatment is effective Concerns about side effects of treatments Problems with access, such as cost or location of treatment Source: Mental Health Effects of Serving in Afghanistan and Iraq, available at http://www.ptsd.va.gov/public/pages/overview-mental-health-effects.asp

What is PTSD “ Posttraumatic stress disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event.” Sources: What is PTSD?, National Center for PTSD, USDVA, available at http://www.ptsd.va.gov/public/pages/handouts-pdf/handout_What_is_PTSD.pdf & What is PTSD? from http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp

Likelihood of getting PTSD How intense the trauma was or how long it lasted If you lost someone you were close to or were hurt How close you were to the event How strong your reaction was How much you felt in control of events How much help and support you got after the event Sources: What is PTSD?, National Center for PTSD, USDVA, available at http://www.ptsd.va.gov/public/pages/handouts-pdf/handout_What_is_PTSD.pdf & What is PTSD? from http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp

Onset of PTSD Can be immediate Months Years 30% of individuals develop chronic symptoms Sources: What is PTSD?, National Center for PTSD, USDVA, available at http://www.ptsd.va.gov/public/pages/handouts-pdf/handout_What_is_PTSD.pdf & What is PTSD? from http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp

Symptoms of PTSD Reliving the event Avoiding situations that remind you of the event Feeling numb Feeling keyed up (also called hyperarousal) Sources: What is PTSD?, National Center for PTSD, USDVA, available at http://www.ptsd.va.gov/public/pages/handouts-pdf/handout_What_is_PTSD.pdf & What is PTSD? from http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp

Problems associated with PTSD Drinking or drug problems. Feelings of hopelessness, shame, or despair. Employment problems. Relationships problems including divorce and violence. Physical symptoms. Sources: What is PTSD?, National Center for PTSD, USDVA, available at http://www.ptsd.va.gov/public/pages/handouts-pdf/handout_What_is_PTSD.pdf & What is PTSD? from http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp

TRAUMATIC BRAIN INJURY All About TBI from Combat

What is TBI? “ Traumatic brain injury (TBI) occurs from a sudden blow or jolt to the head.” TBI is the injury, not the symptoms Similar to a concussion Mild, moderate or severe 80% of all TBIs are moderate and can have full recovery Source: Traumatic Brain Injury and PTSD available at http://www.ptsd.va.gov/public/ pages/traumatic_brain_injury_and_ptsd.asp .

Symptoms that follow a TBI Symptoms that follow TBI are known as post-concussion syndrome (PCS) Not all of the symptoms are present all the time Source: Traumatic Brain Injury and PTSD available at http://www.ptsd.va.gov/public/ pages/traumatic_brain_injury_and_ptsd.asp .

Symptoms Headache Feeling dizzy Being tired Trouble sleeping Vision problems Feeling bothered by noise and light Memory problems Trouble staying focused Poor judgment and acting without thinking Being slowed down Trouble putting thoughts into words Physical Cognitive (mental) Source: Traumatic Brain Injury and PTSD available at http://www.ptsd.va.gov/public/ pages/traumatic_brain_injury_and_ptsd.asp .

Symptoms, continued Depression Anger outbursts and quick to anger Anxiety (fear, worry, or feeling nervous) Personality changes Represent getting better Not to cause worry or concern Symptoms of TBI overlap symptoms of PTSD Both stem from trauma Emotional (feelings) Symptoms are normal Source: Traumatic Brain Injury and PTSD available at http://www.ptsd.va.gov/public/ pages/traumatic_brain_injury_and_ptsd.asp .

Coping with TBI Ease back into life Avoid alcohol and drugs Listen to the symptoms Symptoms are a normal part of getting better Involve family Source: Traumatic Brain Injury and PTSD available at http://www.ptsd.va.gov/public/ pages/traumatic_brain_injury_and_ptsd.asp .

TBIs from OIF/OEF Main causes of TBI in OIF/OEF vets: Blats, vehicle accidents, and gunshot wounds 22% of all OEF/OIF wounds are brain injuries 12% of all Vietnam wounds were brain injuries Veteran’s symptoms last longer than regular civilian injuries Often coupled with more than one problem: PTSD, chronic pain, substance abuse Source: Traumatic Brain Injury and PTSD available at http://www.ptsd.va.gov/public/ pages/traumatic_brain_injury_and_ptsd.asp .

What’s being done to mitigate? Source: Softening TBI Implications from IED Impacts available at http://www.youtube.com/watch?v=_AkoYAp9bts

WHAT DO THESE ISSUES CREATE IN CRIMINAL BEHAVIOR? Chapter III

The underlying reason behind the current project Source: KSL.com available at http://www.ksl.com/?nid=148&sid=12175791

PTSD v. other mental health Research looks at the increased rate of violence for those who have PTSD Limited research on those who are combat vets and not diagnosed with PTSD Difference between having a mental health issue and the expression of that issue Should this discussion be limited to just those who have PTSD? Those who are not seeking care Group with PTSD-like symptoms Battlemind – those skills that keep troops alive in combat need to be turned off when at home Information from PTSD should be applied to understanding combat veteran’s needs

How to turn off combat mindset…

Veteran’s, Invisible Wounds of War, and Co-occurring Disorders “ In a 2008 Rand Corporation report that has received much public attention, it was noted that since October 2001, almost 1.64 million U.S. troops have been deployed for Operation Iraqi Freedom (OIF; Iraq) and Operation Enduring Freedom (OEF; Afghanistan). 2 The report highlights the invisible wounds of war, relating to the psychological aftermath of these military initiatives. The two main invisible psychiatric and neurological areas of concern are posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI).” “ Data are also emerging about the importance of recognizing that the co-occurring conditions of substance abuse and mental health problems are often a major obstacle to full functioning of returning veterans. Male veterans aged 18 to 25 are more likely than older male veterans to have had co-occurring serious mental illness and a substance use disorder. 3 A study of approximately 300,000 soldiers who returned after deployment for OIF/OEF demonstrated elevated rates of mental health problems compared with soldiers returning from other conflicts. 4 In a study of soldiers who were surveyed after deployment and screened again, approximately 6 months later, 27 to 35 percent reported symptoms placing them at mental health risk, including symptoms of PTSD, depression, alcohol misuse, and suicidal ideation, as well as self-reported aggression. 5 Seal and colleagues 6 reported that among a group of OIF/OEF veterans seen at VA facilities, 27 percent had three or more mental health diagnoses, including depressive disorders, PTSD, and substance use disorders. Traumatic brain injury and posttraumatic stress disorder in veterans also commonly occur together and can be difficult to distinguish, 7 and both can be associated with co-occurring substance use disorders. ” “ Thus, there is a growing recognition of the clinical and research attention needed to gain a better understanding of the prevalence and phenomenology of mental health, neuropsychiatric, and substance use conditions among veterans.” Source: Veterans and the Justice System: The Next Forensic Frontier, Debra A. Pinals, MD available at http://www.jaapl.org/cgi/content/full/38/2/163

PTSD and criminal behavior “ At times the symptoms of PTSD may contribute to the likelihood that persons with the disorder will get in trouble with others or with the law. PTSD affects the way in which individuals perceive, process, and respond to people and situations (1). Trauma survivors with PTSD may be more prone to feeling threatened in many situations, even when the feeling of threat is not warranted. Some may act impulsively or go to extremes to protect themselves” Source: Criminal Behavior and PTSD: An Analysis available at http://www.ptsd.va.gov/professional/pages/criminal-behavior-ptsd.asp

Relationship between PTSD and Crime “ It is important to note that any relationship between PTSD and crime could be correlational rather than causative.” Source: Criminal Behavior and PTSD: An Analysis available at http://www.ptsd.va.gov/professional/pages/criminal-behavior-ptsd.asp

How PTSD affects functioning Cognition Flashbacks Perceived threats Beliefs about justice Heightened psychological arousal Anger and irritability Hypervigilance Exaggerated startle response Emotional reactions Psychological distress Heightened emotions Emotional numbing Source: Criminal Behavior and PTSD: An Analysis available at http://www.ptsd.va.gov/professional/pages/criminal-behavior-ptsd.asp

The way forward “ Symptoms of PTSD can sometimes lead to a lifestyle that is more likely to result in aggressive or criminal behavior. Individuals with PTSD are often plagued by memories of the trauma and are chronically anxious. Feeling the need to be always "on guard" can cause survivors to misinterpret benign situations as threatening and cause them to respond with self-protective behavior. Increased physiological arousal may result in impulsive behavior that is out of proportion to the perceived threat.” “ Further epidemiological research is needed to determine the complex relationship between PTSD and crime. Even with this much-needed research, the role that PTSD may play in criminal behavior should be carefully appraised on a case-by-case basis.” Source: Criminal Behavior and PTSD: An Analysis available at http://www.ptsd.va.gov/professional/pages/criminal-behavior-ptsd.asp

HOW MIGHT REHABILITATION BE THE BEST MODEL? Chapter IV

Social cost of an all volunteer military Burden shifting 1% percent of the population serves Cost of not handling the issue Fears about ticking time bomb Getting system in place Use federal funds where available VA resources

Theories of the justice system Forms of punishment Utilitarian (criminals calculate between punishment and pleasure) General deterrence – instills fear Specific deterrence – prevent future misconduct by the individual Rehabilitation Retributivism Because of the harm done to society, society may harm the individual Source: Joshua Dresler, Understanding Criminal Law, 3 rd Ed. LexisNexis, Chapter 2

Why rehabilitation? Society has a burden to do its part PTSD, TBI, substance abuse, domestic violence are treatable! Veterans who are caught up into the criminal justice system are often first time offenders First time offense may represent a veteran who should get help but is not reaching out. Solve the problem quickly and effectively using top-notch support programs Treat the issue before it becomes “malignant”

Realization from drug court model “ Drug courts work by recognizing that unless substance abuse ends, fines and jail time are unlikely to prevent future criminal activity. Consequently, drug courts, through frequent testing and court supervision, focus upon eliminating drug addiction as a long-term solution to crime.” Source: Utah Drug Courts available at http://www.utcourts.gov/drugcourts/

Non-judicial punishment in the military Used to bring about specific performance Timely correction Application by analogy rather than duplication

WHAT IS BEING DONE AT THE NATIONAL AND LOCAL LEVEL Chapter V

National Associations National Association of Drug Court Professionals (NADCP) Justice Center: The Council of State Governments

Federal involvement Veteran’s Administration (VA) Bureau of Justice Assistance (BJA)

Local involvement Federal Magistrate Judge Warner Judge John Baxter (Salt Lake City Justice Court) Salt Lake County District Attorney Sim Gill

Adult Drug Court Model “ A specially designed court calendar or docket, the purposes of which are to achieve a reduction in recidivism and substance abuse among nonviolent substance abusing offenders and to increase the offender’s likelihood of successful habilitation through early, continuous, and intense judicially supervised treatment, mandatory periodic drug testing, community supervision, and use of appropriate sanctions and other rehabilitation services (Bureau of Justice Assistance, 2005).” Source: http://www.nadcp.org/learn/what-are-drug-courts/models

Drug Courts vs. Traditional Courts Level of supervision Traditional: Court involvement generally does not take place unless a probation violation has been reported. Therefore, follow-ups for urinalyses may not be as frequent. Drug Courts: Throughout the duration of drug court, defendants attend required and regular treatment sessions and court appearances as well as undergo random urinalyses. Source: Utah Drug Courts available at http://www.utcourts.gov/drugcourts/

Drug Courts vs. Traditional Courts Reductions in Recidivism Traditional: According to the United States Department of Justice, 45 percent of defendants convicted of drug possession will commit a similar crime within the next several years. In fact, the more often a defendant is arrested for a drug offense, the more likely they are to commit an additional offense. Drug Courts: Drug court participants exhibit a lower recidivism rate ranging from five percent to 28 percent. The recidivism rate for drug court graduates is approximately four percent. Additionally, urinalysis reports for drug court participants are generally 90 percent negative. Source: Utah Drug Courts available at http://www.utcourts.gov/drugcourts/

Drug Courts vs. Traditional Courts Emphasis on Long Term Recovery Traditional: In many cases, drug addiction may not be the only problem faced by offenders. Poor reading skills, low levels of self-respect, and troubled family relationships are just a few of the issues offenders face outside of the courts. Traditional processes may refer offenders to treatment programs but follow up is not generally conducted. Drug Court: Drug courts often recommend that participants develop skills and connections that will allow them to survive following treatment. For example, some programs suggest that participants attain their GED or develop ties with community mentors. Many Utah drug courts also encourage alumni groups so that the recovery process will continue after treatment ends. Source: Utah Drug Courts available at http://www.utcourts.gov/drugcourts/

The 10 Key Components of Drug Courts Drug courts integrate alcohol and other drug treatment services with justice system case processing Using a nonadversarial approach, prosecution and defense counsel promote public safety while protecting participants’ due process rights Eligible participants are identified early and promptly placed in the drug court program Drug courts provide access to a continuum of alcohol, drug, and other related treatment and rehabilitation services Abstinence is monitored by frequent alcohol and other drug testing A coordinated strategy governs drug court responses to participants'’ compliance Ongoing judicial interaction with each drug court participant is essential Monitoring and evaluation measure the achievement of program goals and gauge effectiveness Continuing interdisciplinary education promotes effective drug court planning, implementation, and operations Forging partnerships among drug courts, public agencies, and community-based organizations generates local support and enhances drug court effectiveness Source: National Drug Court Institute available at http://www.ndci.org/publications/ten-key-componets

Facts about Drug Court Success Drug Courts Reduce Crime FACT: Nationwide, 75% of Drug Court graduates remain arrest-free at least two years after leaving the program. FACT: Rigorous studies examining long-term outcomes of individual Drug Courts have found that reductions in crime last at least 3 years and can endure for over 14 years. FACT: The most rigorous and conservative scientific “meta-analyses” have all concluded that Drug Courts significantly reduce crime as much as 35 percent more than other sentencing options. Drug Courts Save Money FACT: Nationwide, for every $1.00 invested in Drug Court, taxpayers save as much as $3.36 in avoided criminal justice costs alone. FACT: When considering other cost offsets such as savings from reduced victimization and healthcare service utilization, studies have shown benefits range up to $12 for every $1 invested. FACT: Drug Courts produce cost savings ranging from $4,000 to $12,000 per client. These cost savings reflect reduced prison costs, reduced revolving-door arrests and trials, and reduced victimization. FACT: In 2007, for every Federal dollar invested in Drug Court, $9.00 was leveraged in state funding. Source: NADCP, Drug Courts Work, available at http://nadcp.org/learn/drug-courts-work

Facts about Drug Court Success + Drug Courts Ensure Compliance FACT: Unless substance abusing/addicted offenders are regularly supervised by a judge and held accountable, 70% drop out of treatment prematurely. FACT: Drug Courts provide more comprehensive and closer supervision than other community-based supervision programs. FACT: Drug Courts are six times more likely to keep offenders in treatment long enough for them to get better. + Drug Courts Combat meth addiction FACT: For methamphetamine-addicted people, Drug Courts increase treatment program graduation rates by nearly 80%. FACT: When compared to eight other programs, Drug Courts quadrupled the length of abstinence from methamphetamine. FACT: Drug Courts reduce methamphetamine use by more than 50% compared to outpatient treatment alone. + Drug Courts Restore Families FACT: Parents in Family Drug Court are more likely to go to treatment and complete it. FACT: Children of Family Drug Court participants spend significantly less time in out-of-home placements such as foster care. FACT: Family re-unification rates are 50% higher for Family Drug Court participants. Source: NADCP, Drug Courts Work, available at http://nadcp.org/learn/drug-courts-work

Numbers There are more than 2,300 drug courts nationwide More than 120,000 people will receive services in one year. Source: NADCP, Types of Drug Courts, available at http://www.nadcp.org/learn/what-are-drug-courts/models

Definition of a Mental Health Court “ The Current Working Definition of a Mental Health Court is a court with a specialized docket for certain defendants with mental illnesses.9 These courts vary as to the types of charges and mental illness diagnoses accepted as well as the participants’ demographics and plea requirements, but they are united by the common themes of substituting a problem-solving model for traditional criminal court processing and an emphasis on linking defendants to effective treatment and supports. In general, mental health court participants are identified through mental health screening and assessments and voluntarily participate in a judicially supervised treatment plan developed jointly by a team of court staff and mental health professionals. Incentives reward adherence to the treatment plan or other court conditions; non-adherence may be sanctioned, and success or graduation is defined according to predetermined criteria.” Source: Mental Health Court Research Guide, available at: http://consensusproject.org/jc_publications/ mental-health-courts-a-guide-to-research-informed-policy-and-practice

Essential Elements of a Mental Health Court Planning and administration Target population Timely participation identification and linkage to services Terms of Participation Informed Choice Treatment supports and services Confidentiality Court team Monitoring adherence to court requirements Sustainability Source: Mental Health Court Research Guide, Appendix A, available at: http://consensusproject.org/jc_publications/ mental-health-courts-a-guide-to-research-informed-policy-and-practice

Success from mental health courts Recidivism Lower recidivism rates for those who participate in court supervised program over those who do not Higher chance of success for those who complete the program compared to those who do not Mental Health Outcomes Research indicates that these are more effective with getting people help rather than traditional criminal justice system Cost savings Lower recidivism means lower costs long term Source: Mental Health Court Research Guide, available at: http://consensusproject.org/jc_publications/ mental-health-courts-a-guide-to-research-informed-policy-and-practice

Training NADCP Online New York State Unified Court System http://e-learning.nycourts.gov/

SUPPORT SYSTEMS AT THE LOCAL LEVEL Chapter VI

Department of Veterans Affairs Streamlined clinics PTSD Screening www.va.gov

Local Law Enforcement Crisis Intervention Training http://www.nami.org

Anonymous help MilitaryOneSource.com

Education Institutions National Center for Veteran’s Studies University of Utah

Veteran’s Organizations VFW American Legion

Identification Self-Identification National Guard / Reserve Commands Community based

VETERAN’S COURT IN ACTION Chapter VIII

Which Model? Drug Court Model Mental Health Court Model Mixed model Veteran’s with substance abuse issues Veteran’s with PTSD or TBI needs

Identification & Interaction Most important step Problem with self-identification as a veteran “ Have you ever served in the military?” First interaction (LEO) Second interaction (detention) Third interaction (public defender) Fourth interaction (court)

Criteria Who is a veteran? Who qualifies for service “ If you are a veteran, you get in” Combat veteran Diagnosable issue All offenders or non-violent offenses only

Intake Judicial discretion Prosecutorial discretion Defense attorney’s recommendation

Supervision Court monitoring Frequent contact Reports from VA Taking care to not abuse VA’s primary responsibility (i.e. VA is not the enforcer)

Post-completion Documentation Inter-agency communication

Repeat offenses? What to do? May indicate a need to revise criteria for treatment May indicate failure to receive suppervision

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