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The Center for Health Care The Center for Health Care ServicesServices

Therapeutic Jurisprudence Therapeutic Jurisprudence CollaborationCollaboration

Models in San Antonio, TexasModels in San Antonio, Texas

2010 State TAAP Conference2010 State TAAP Conference

Linda Tavel, MPA,LCDC,CARTLinda Tavel, MPA,LCDC,CARTMelanie Lane, LCSW,LCDC,AADCMelanie Lane, LCSW,LCDC,AADCGilbert Gonzales MA,LPC,LCDCGilbert Gonzales MA,LPC,LCDC

July 9, 2010July 9, 2010

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The Problem

3

CMAGScreeningLaw

Enforcement

MH NO

MH YES

Refer to Sherry (UHS Nurse)

RoutineEmergent

Urgent

MH

IOP Frio

CD

Release w/Referral – Bus

Pass

History

Unstable

MH/CD

Stable

24/7 CCC-CTUPresa – Business

Hrs.

Release W/Referral Bus Pass

IOP-Frio Release W/Referral

CD

MH

Detox Sobering

24/7CCC

Presa

CTU

? SP5Orig. OP

Unit

Jail Re-Entry

FACT

OP

CCC UHS-ER

UHS Nursing

Psych Eval

Agressive

Recommend ED

Find Bed

Private Hospital

ACCESS

ER CCC Jail

CD MH/CD MedicationUHS

Nursing

YES

NO

Bexar County Adult Detention

Center

Pre-Trial

UHS

PR Bond

CC12

Judge Carruthers -NGRI/IST

Eligibility

MH Court

Docket

NO

Yes

Jail Re-entry

Community

CCC

CTU

Fact

Access

Outpatient

Jail Re-Entry

CCC CTU

Mental Health Forensic Flow

a work in progress…Circa 2010,

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Origins of Therapeutic Origins of Therapeutic JurisprudenceJurisprudence

The creation of the term “Therapeutic The creation of the term “Therapeutic Jurisprudence” is attributed to Professor Jurisprudence” is attributed to Professor David Wexler, University of Arizona Law David Wexler, University of Arizona Law School in the late 1980’s and further School in the late 1980’s and further developed with a legal colleague Professor developed with a legal colleague Professor Bruce Winick in 1999 of Miami School of Law Bruce Winick in 1999 of Miami School of Law (Alaska Justice Forum,2009)(Alaska Justice Forum,2009)

Definition of “Therapeutic Justice”. “ the use of social Definition of “Therapeutic Justice”. “ the use of social science to study the extent to which legal rule or science to study the extent to which legal rule or practice promotes the psychological and physical practice promotes the psychological and physical well-being of the people it affects” well-being of the people it affects” (Honorable William Schma, 200).(Honorable William Schma, 200).

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What elements comprise a What elements comprise a Therapeutic Justice Model?Therapeutic Justice Model?

Emphasis on guiding individuals toward Emphasis on guiding individuals toward treatment.treatment.

Goal is to reduce recidivism while providing Goal is to reduce recidivism while providing treatment for individuals entering the legal treatment for individuals entering the legal system with mental illness, drug/alcohol system with mental illness, drug/alcohol addictions, family violence, and abuse issues.addictions, family violence, and abuse issues.

Courts partnering with social service Courts partnering with social service agencies to execute Therapeutic Justice agencies to execute Therapeutic Justice goals. goals.

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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 EnforcementDetention/Jail

CIT

Judicial/CourtsMagistrate, County, District

Mental HealthPublic and Private

Providers

Crisis Care CenterJail DiversionPsychiatric and Medical

ClearanceSpecialty Offender Services

CommunityDynamicCrisis Jail Diversion

Information Exchange

Pol

ice,

She

riff

Pro

batio

n, P

arol

e

Civil and CriminalT

reatment

Continuity of C

are

County City-wide

Emergency Services

Data exchange through• Community Collaborative• Crisis Care Center • CIT/DMOT• Jail and Juvenile Detention• Statewide CARE Match

System County City-wideEntry Points

System Level

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Adaptation of Therapeutic Adaptation of Therapeutic Jurisprudence in San Antonio, Jurisprudence in San Antonio,

TexasTexas Problem solving courts have been established in Problem solving courts have been established in

San Antonio, Bexar County, Texas since 2005.San Antonio, Bexar County, Texas since 2005. Specialty Courts in Bexar County;Specialty Courts in Bexar County;

Felony Drug CourtFelony Drug Court Misdemeanor Drug CourtMisdemeanor Drug Court

Family Drug CourtFamily Drug Court Dual Diagnosis Drug CourtDual Diagnosis Drug Court

Mental Health CourtMental Health Court Juvenile Drug CourtJuvenile Drug Court Veteran Drug CourtVeteran Drug Court

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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 BeginsTherapeutic Justice Begins

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The Building a Therapeutic Justice The Building a Therapeutic Justice Model in Bexar County,TexasModel in Bexar County,Texas

Collaborations between Bexar County Community Collaborations between Bexar County Community Supervision and Corrections and The Center for Health Care Supervision and Corrections and The Center for Health Care ServicesServices

The Center for Health Care Services’ Mental Health The Center for Health Care Services’ Mental Health Treatment and Substance Abuse Treatment Programs Treatment and Substance Abuse Treatment Programs began providing services within the County’s Residential began providing services within the County’s Residential Treatment Facilities 2004.Treatment Facilities 2004.

Other Community Providers joined the collaboration in Other Community Providers joined the collaboration in providing supportive social services; Region 20, SAISD, providing supportive social services; Region 20, SAISD, Oxford House Inc. , Goodwill Industries, Dullnig Health Oxford House Inc. , Goodwill Industries, Dullnig Health Clinic, University Health System, Christian Assistance Clinic, University Health System, Christian Assistance Ministries, San Antonio Alternative Housing, Our Casas Ministries, San Antonio Alternative Housing, Our Casas Housing Inc., Community AA/NA/CA groups providing Housing Inc., Community AA/NA/CA groups providing institutional meetings, and faith based organizations who institutional meetings, and faith based organizations who provided spirituality meetings.provided spirituality meetings.

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"Justice Reinvestment"April 1, 2009

Commerce, Justice, Science, and Related Agencies Appropriations Subcommittee

U.S. House of Representatives: Jerry Madden

“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).

“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).

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;;

1. 1. Between 1997 and 2006, an 18% increase in probation revocations despite a 3 percent decline in the probation population. 2. Reductions in funding for community-based substance abuse and mental health services , and by 2006, more than 2,000 individuals were awaiting placement in

such programs and facilities 3. 3. Fewer approvals for Parole for low risk individuals were granted (Madden,2009).

The Texas justice reinvestment strategy consisting of treatment alternatives to incarceration strategies resulted in an immediate savings of $210.5 million for fiscal years 2008 and 2009 (Madden,2009)

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

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Therapeutic Justice PartnershipsTherapeutic Justice Partnershipswith Bexar County Community with Bexar County Community

Supervision and Corrections Dept.Supervision and Corrections Dept. Two-100 Bed Substance Abuse Treatment Facilities (SATF-1 & SATF-2,

60 Bed Young Adult “boot camp” residential facility- Zero Tolerance)

One- 60 Bed Dual Diagnosis Unit (MH/SA) Mentally Ill Offender Facility Outpatient Substance Abuse Treatment Program (lH 10)

Dual Diagnosis Outpatient Substance Abuse Program (Palo Alto)

Drug Court Treatment Services, Dual Diagnosis Drug Court Treatment Services, Mental Health Court Services, and the upcoming commencement of Veteran Drug Court Services.

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The Center for Health Care ServicesThe Center for Health Care Services

The Restoration CenterThe Restoration Center Criminal Justice Substance AbuseCriminal Justice Substance Abuse

Treatment ProgramsTreatment Programs Co-Occurring Psychiatric and Co-Occurring Psychiatric and

Substance Abuse Disorders ServicesSubstance Abuse Disorders Services Pharmacology-Methadone Pharmacology-Methadone

Maintenance Maintenance

TreatmentTreatment Project CarinoProject Carino Centro De Vida-HIV OutreachCentro De Vida-HIV Outreach

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Therapeutic Jurisprudence Partnerships

with the Public Inebriate PopulationApril 16, 2008 – March 31, 2009

Cost CategoryCost Category City of City of San San AntonioAntonio

Bexar Bexar CountyCounty

Direct Cost Direct Cost AvoidanceAvoidance

Public Public Inebriates Inebriates Diverted from Diverted from Detention Detention FacilityFacility

$435,435.$435,435. $1,983,574.$1,983,574. $2,419,009$2,419,009..

Injured Prisoner Injured Prisoner Diverted from Diverted from UHS Emergency UHS Emergency RoomRoom

$528,000.$528,000. $1,267,200.$1,267,200. $1,795,200$1,795,200. .

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Therapeutic Justice ModelTherapeutic Justice Model

Treatment in lieu of incarceration renders a cost Treatment in lieu of incarceration renders a cost savings, impacting recidivismsavings, impacting recidivism

Cost of treatment is cheaper than incarceration and Cost of treatment is cheaper than incarceration and detentiondetention

Treatment aids defendants in achieving stability Treatment aids defendants in achieving stability and self sufficiency in the community to make and self sufficiency in the community to make restitution through paying fines, and compliance restitution through paying fines, and compliance with probation conditions.with probation conditions.

Defendants receive treatment and rehabilitation Defendants receive treatment and rehabilitation skills to become a functional member of societyskills to become a functional member of society

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The Problem Revolving Door The Problem Revolving Door SyndromeSyndrome

Arrest Jail

The Solution

The Restoration Center

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TheRestoration Center

OpenedApril 15, 2008

•

• Public Safety- Sobering Unit• Detoxification Facility• Community Court• Outpatient Substance Abuse Services

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Community Wide PartnershipCommunity Wide PartnershipBetweenBetween

The Center for Health Care ServicesThe Center for Health Care Services Bexar CountyBexar County The City of San AntonioThe City of San Antonio University Health SystemUniversity Health System Haven for HopeHaven for Hope The Judicial SystemsThe Judicial Systems Law EnforcementLaw Enforcement

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To establish a system of care for To establish a system of care for homeless, serial inebriates that homeless, serial inebriates that

includesincludes

• 24/7 Access to Substance Abuse Treatment 24/7 Access to Substance Abuse Treatment

• Safe affordable housingSafe affordable housing

• Medical CareMedical Care

• Psychiatric CarePsychiatric Care

• Vocational/Employment AssistanceVocational/Employment Assistance

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Substance Abuse System of Care

Partial/Day Hospital,Partial/Day Hospital,““Intensive” OutpatientIntensive” Outpatient

Outpatient TreatmentOutpatient Treatment

Urgent Care CenterUrgent Care Center“Front-Door”

•Substance Abuse Triage•Mental Health Jail

Diversion

Haven for HopeHaven for Hope•Homeless Housing Initiative

RecoveredRecovered ! !

Community PatientsCommunity Patients

XRelapse

Medical Detoxification Medical Detoxification

CHCS Detoxification CHCS Detoxification

Community PatientsCommunity Patients

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The Restoration Center Programs include:

Public Safety Unit (PSU) Injured Prisoner Medical Clearance &

Treatment

40 person sobering unit (4-6 hr stay)

Detoxification Unit – 27 beds - 3 to 5 day stay

Substance Abuse Intensive Outpatient Services

16 weeks- 6 days per week, 4 hrs per day counseling program

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Public Safety Sobering UnitPublic Safety Sobering Unit

Cost is High Cost Savings can be achieved

Public Inebriates are sobered Up In Jail

Can Now Be Sobered upIn a location where treatmentIs possible.

Experienced Peer Recovery Specialists provide Motivation to enter treatment

RNs monitor/evaluate 24/7

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• Funded by: Funded by: Texas Department of State Health Services, Texas Department of State Health Services, University Health System, and Hope Action University Health System, and Hope Action Care.Care.

• Provides Physician Medication Management Provides Physician Medication Management and and Substance Abuse Outpatient Treatment.Substance Abuse Outpatient Treatment.

• Licensed by the Commission of Licensed by the Commission of Accreditation for Accreditation for Rehabilitation Facilities (CARF).Rehabilitation Facilities (CARF).

Pharmacology-Methadone Pharmacology-Methadone Maintenance TreatmentMaintenance Treatment

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Project CariñoProject Cariño

• Provides intensive wrap-around support services for pregnant women who are opioid addicted.

• Provides medically managed Methadone Maintenance Treatment and Outpatient Substance Abuse Treatment • Funded for five-years by CSAT under the Targeted Expansion Program for Substance Abuse Treatment.

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Funded by the Texas Department of StateFunded by the Texas Department of State Health Services.Health Services.

Outreach to high risk Substance AbusersOutreach to high risk Substance Abusers

Provides information, referrals and Provides information, referrals and education on HIV and other communicable education on HIV and other communicable diseases, including hepatitis.diseases, including hepatitis.

Centro de Vida-HIV OutreachCentro de Vida-HIV Outreach

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CHCS Central Services SitesCHCS Central Services Sites

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Haven for HopeHaven for Hope

The Community Wide InitiativeThe Community Wide InitiativeHaven for Hope and CHCS Haven for Hope and CHCS

collaborationcollaborationGoal:

To increase the community capacity To increase the community capacity for mental health, substance abuse for mental health, substance abuse

and detoxification servicesand detoxification services

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The Center for Health Care Services

Leon Evans, President/CEOThe Center for Health Care Services

Mental Health Authoritywww.chcsbc.org

levans@chcsbc.org