2005-145-Minutes for Meeting February 07,2005 Recorded 2/28/2005DESCHUTES COUNTY OFFICIAL RECORDS C f 20(j5_'IJ5
NANCY BLANKENSHIP, COUNTY CLERK vy y
COMMISSIONERS' JOURNAL 0Z12812005 0137;15 PM
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DESCHUTES COUNTY CLERK
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Deschutes County Board of Commissioners
1130 NW Harriman St., Bend, OR 97701-1947
(541) 388-6570 - Fax (541) 388-4752 - www.deschutes.org
MINUTES OF MEETING
LOCAL PUBLIC SAFETY COORDINATING COUNCIL
MONDAY, FEBRUARY 7, 2005
Deschutes Services Center - Second Floor Conference Room - 1300 NW Wall St., Bend
Present were Judge Michael Sullivan and Judge Stephen Tiktin, Circuit Court
Judges; Dan Peddycord, Health Department; Michael Dugan, District Attorney;
Lt. Carl Rhodes, Oregon State Police; Scott Johnson and Susan Battles, Mental
Health; Mike Maier, County Administrator; Tom DeWolf, Commissioner; Becky
Wanless and Pat Tabor, Adult Parole and Probation Director; Bob Smit, KIDS
Center; Jacques DeKalb and Brendon Alexander, Defense Attorneys; and Jack
Blum and Denny Maloney, citizen members.
Also in attendance were Ruth Jenkin, Jail; Hillary Saraceno, Commission on
Children and Families; Andy Jordan, Bend Police Chief- Robert Burch, Sheriff's
Office; Les Stiles, Deschutes County Sheriff; Bob Warsaw, Oregon Youth
Authority; Toni Ryan, COBRA; and three other citizens. No representatives of the
media were present.
1. Call to Order and Introductions.
The meeting was called to order by Judge Michael Sullivan at 3:30 p.m., and
the attendees introduced themselves.
2. Approval of the January 10, 2005 Meeting Minutes.
Mike Dugan moved approval of the minutes, and Les Stiles seconded; there was
unanimous approval of the minutes as written.
Minutes of LPSCC Meeting Monday, February 7, 2005
Page 1 of 6 Pages
3. Discussion of Rural Domestic Violence and Child Victimization
Enforcement Grant.
Judge Sullivan explained that he had needed to confirm an application would be
submitted for this grant in order to save a spot in the process. (A copy of his
memo is attached as Exhibit A.) However, he learned that there would be some
problems with funding the grant in the future, and that administration was also
an issue; no one was willing or able to take on the project.
Becky Wanless added that the District Attorney's Office did not want to be the
grant holder, Parole and Probation didn't have the resources to administer it,
and COBRA (Central Oregon Battering and Rape Alliance) would have been
unable to handle it.
The Attorney General is drafting Administrative Rules regarding battering
issues, which may result in a mandate component for battering intervention.
Toni Ryan stated that in regard to domestic violence, there is no established
way to bring the entities together; and even though various groups are putting
forth efforts, there is no coordination of these efforts. Groundwork needs to be
in place so that when future grant opportunities arise, how the work is handled
and sustained will be known and established. She said she would like to revisit
this issue with LPSCC about once a quarter for the next year.
Judge Sullivan suggested that an update be provided in six months unless
another grant opportunity comes up. (This update will be scheduled for the
August meeting.) Commissioner DeWolf said that Judith Ure, the County's
grant writer, should be kept informed so she can watch for potential grants.
The consensus of the group was to rescind the application for the subject grant
at this time.
4. A Report on NACo Justice and Public Safety Steering Committee Retreat.
Commissioner DeWolf gave an overview of the information he obtained at the
retreat, which was also attended by Denny Maloney. (A copy of Commissioner
DeWolf's notes is attached as Exhibit B) He said this NACo committee is a
great resource for input on issues relating to mental health, public safety and
early childhood intervention.
Minutes of LPSCC Meeting Monday, February 7, 2005
Page 2 of 6 Pages
A brief discussion then took place, with the group touching on how other
entities handle their mental health case docket, the cost of incarceration versus
prevention, and the need for early childhood development dollars.
Commissioner DeWolf noted that there will be a one -day retreat held in Oregon
this fall, featuring some of the same speakers. Judge Sullivan and others asked
to be advised of the date and location as soon as possible so they can plan to
attend.
5. Discussion of the Parole and Probation Department's 2005-07 Biennial
Plan.
Becky Wanless explained that the majority of funding for her department is
from the Oregon Department of Corrections through intergovernmental
agreements. These agreement require certain things, including a biennial plan
with dollar amounts attached to the various items. (A copy of the Parole and
Probation basic budget for FY 2004-05 is attached for reference, as Exhibit C.)
She said that LPSCC will need to approve the biennial plan, which is due in
June or July. LPSCC members are asked to provide input on where certain
programs should be expanded or decreased.
Ms. Wanless then gave an overview of several problem areas. The State does
not provide funding for misdemeanor family violence and sex offender
caseloads. A variety of reports are required by statute, and there is not enough
staffing to handle this workload adequately. Funding for mental health
assessments is limited; it is typically done only when it has been court-ordered.
Offenders are often ordered to pay certain fees, but it is difficult to collect.
The transitional housing arrangement at the Work Center is working out well,
but interns are being added to expand supervision to twenty-four hours a day,
every day.
Ms. Wanless said she will be working on the biennial plan during the next few
months, and welcomes input from the members of LPSCC during this process.
Denny Maloney asked how LPSCC can help with the department's wish list;
Ms. Wanless replied she didn't know at this time, and probably won't know
where the funding cuts are until the state budget is complete.
This item will be addressed further at the June LPSCC meeting.
Minutes of LPSCC Meeting Monday, February 7, 2005
Page 3 of 6 Pages
6. Criminal Justice and Mental Health Items.
(A list of the issues to be addressed is attached as Exhibit D.)
Overview.
Sheriff Stiles explained that he and others wanted to address this issue from the
focus on the offender to the overall problem. He said that two years ago state
funding cuts were anticipated for handling mental ill offenders and non -
offenders. Oregon Partners in Crisis worked hard at the state level to address
this issue, but little money was made available.
It is now widely known that the use of methamphetamines has exceeded the
abuse of alcohol. The problem of mental illness related to meth use has greatly
increased. There is a lack of secured beds in the region, and the new Crisis
Resolution Center has indicated no strong commitment to provide secured beds,
either. The availability of these beds in the hospital emergency room is about
18 months out.
The typical mentality has been to lock these individuals up, but that is not the
answer. Unfortunately not much support to address this issue can be expected
from either the state or federal level.
Crisis Services at County Mental Health.
Scott Johnson and Pam McCollum provided an overview of the programs that
could help this situation. It is important to encourage prevention and treatment
to keep these individuals on track. This is not just a mental health issue; it
needs to be addressed by public safety entities and the courts as well.
Commissioner DeWolf suggested that a strict set of criteria be used to track
program outcomes; the results can then be used in a variety of ways.
A Family Perspective.
Pam and Bob Marble explained their personal experiences with the problem of
mental illness. Their son is dealing with mental illness issues that began soon
after his teens. It is felt that one out of every five families is faced with a
mental illness problem. When they moved to the area six years ago, their
doctor advised them to contact NAMI (National Alliance for the Mentally Ill).
Minutes of LPSCC Meeting Monday, February 7, 2005
Page 4 of 6 Pages
Since that time various programs have been established for families to deal with
mental health issues; however, the outreach is not as extensive as it should be.
After several very difficult years, including run-ins with law enforcement and
other problems, because of the support of local organizations, their son is now
handling his situation well and is functioning at a normal level.
Mr. and Mrs. Marble praised the hard work of Pat Tabor, Judge Tiktin, Rob
Burch and others who have helped them and their son through several difficult
years. They pointed out that many mentally ill persons do not have the benefit
of this type of support. With the proper help many mentally ill persons can turn
their lives around; they need lives filled with hope, not despair.
Ruth Jenkin stated that she sees all levels of mental illness in jail inmates, and
often their history is not known. Staffing for the incarcerated mentally ill
population is very intensive and expensive, and it is often hard to determine if
an individual is merely acting out or is truly affected by a mental illness.
Typically the mentally ill end up being in custody longer, and training for
deputies is limited.
She pointed out that maintaining mentally ill individuals in the jail also creates
liability issues for the County, and the average daily cost is more than double
the regular expense. It was agreed that it is important for all affected entities to
work together on this issue instead of moving these individuals around in the
system.
Due to limited time to address this topic, the discussion will be continued at the
next LPSCC meeting on Monday, March 7. Judge Sullivan asked that priorities
for action be apart of the discussion at that time.
7. Other Items.
The next meeting will be conducted on the usual date (first Monday of the
month) — Monday, March 7, 2005, at 3:30 p.m.
Being no further items brought before the group, the meeting adjourned at
5:05 p. m.
Minutes of LPSCC Meeting Monday, February 7, 2005
Page 5 of 6 Pages
Respectfully submitted,
Recording Secretary
Attachments
Exhibit A: Memo from Judge Sullivan regarding a Rural Domestic Violence and
Child Victimization Enforcement Grant 2005 (1 page)
Exhibit B: Justice and Public Safety Steering Committee Retreat Report (45 pages)
Exhibit C: Parole and Probation Budget, FY 2004-05 (1 page)
Exhibit D: Mental Health Issues Report (10 pages)
Exhibit E: Meeting Sign -in Sheet (1 page)
Minutes of LPSCC Meeting Monday, February 7, 2005
Page 6 of 6 Pages
TO: LPSCC
FROM: Michael Sullivan
RE: Rural Domestic Violence and Child Victimization Enforcement Grant 2005
DATE: January 20, 2005
The Office of Violence Against Women is soliciting applications for a 24 -month $500,000
grant due February 3, 2005. The deadline for intention to submit is January 21, 2005. I
know this is a short timeframe, but this grant was just brought to my attention. Because of
the merits associated with the grant and the deadline, as chair of LPSCC I've decided we
should submit our intention to apply for the grant this Friday. No one is bound by this
proposal and if necessary we can rescind our intent. We can have a discussion about the
project at the next LPSCC meeting. A tentative project proposal that meets the grant
statutory and priority areas and includes the entire chain of family/criminal justice system
and victim advocates is as follows:
• The project's fundamental and overriding goal is to implement and establish
cooperative efforts and projects between the family/criminal justices system and
victim advocates for the purpose of prioritizing victim's safety, while thoroughly
investigating and prosecuting incidents of domestic violence, dating violence and
child abuse.
• This grant will establish a project coordinator to specifically address the more
global concerns of victim safety, including oversight of a Safety and
Accountability Audit and the establishment of a domestic violence team. In
addition to thorough investigation, prosecution, and sanctions, the coordinator and
team will develop the necessary infrastructure and skills to better serve the
victims and families impacted by domestic violence and child abuse. It is the goal
of this program to reach a state where a single domestic violence case can be
tracked through each stage of the system and monitored for victim safety.
• Another goal of this project is to create public awareness campaigns to inform
victims of services, to educate the public and promote cultural change. Besides
general awareness activities, a targeted effort will be made to reach middle and
high school students through the Family Access Network. COBRA will expand
its model program to reach men - Men Against Domestic Abuse — whereby non-
violent men reach out to other men and boys to discourage the use of violence.
Addressing the impact of domestic violence on children will be through
COBRA's Program for Children Exposed to Violence and the KIDS Center. A
partnership with child welfare will provide an on-site domestic violence advocate
to meet with victims and collaborate with child welfare workers.
While we could accomplish more with many agencies' involvement, our moving ahead
does not mean that every agency needs to commit at this time. Jefferson County is in its
second Rural DV grant funding cycle and they report that their collaborations have
greatly improved. Our project proposal is an opportunity for us to serve our community
better.
Exhibit__
Page —I— of �_
/A
Justice & Public Safety Steering Committee Retreat
National Association of Counties
January 19-22, 2005
Report by Deschutes County Commissioner Tom DeWolf
Attached are twenty-three pages of notes from the most invigorating retreat I've
attended as a County Commissioner. The quality of presenters and resources at this
retreat were the highest I've ever experienced together at one time.
There were three areas of focus:
• The critical importance of Early Childhood intervention
• Diverting the non-violent mentally ill from jail
• Successful re-entry programs to reduce the revolving jail door for offenders
This may appear to be a lot of reading, but I encourage you to look at the table of
contents (next page) and then, at the very least, turn to your specific areas of interest. The
resources noted in these pages will prove to be very valuable to those involved in the
fields of early childhood, mental health and public safety in our community.
Exhibit
Page �_ of
Table of Contents:
3: What Works in Preventing Violence; Delbert Elliott, PhD
(violence, drugs and juvenile crime prevention)
4: Resources for Children & Families; Dennis Maloney
5: Lessons of Ghosts from the Nursery: Robin Karr -Morse
(cycle of violence that begins at birth; brain development)
7: Fight Crime, Invest in Kids: Meredith Wiley
(Nurse -Family Partnership; early brain development
9: Justice Department Re-entry initiative; Elizabeth Griffith, D.O.J.
10: "Invest in Children;" Michelle Katona, Cleveland, Ohio
11: Diverting non-violent mentally ill from jail;
• Marvin Southard, Mental Health Director, L.A. County, CA
• Sheriff Michael Corona, Orange County, CA
• Peter Lukevich, Washington Partners in Crisis, Seattle, WA
• Larry Spottsville, Juvenile Probation Director, Rapides Parish, Louisiana
15: Model Re-entry program; Robert Hunter, Hennepin County, MN
("Real Work and Real Pay")
16: Model Re-entry program; Christopher Fay, Eisenhower Foundation, Washington, DC
("The Delancey Street Replication Project")
17: "Assessment and Education;" Arthur Wallenstein, Montgomery County, Maryland
18: "The Cost Effectiveness of Re-entry;" Peter Greenwood, Ph.D.
21: "The Revolving Door for the Mentally Ill in the Justice System"
Evelyn Lundberg Stratton, Justice, Ohio Supreme Court, Columbus, Ohio
22: "The Nevada Re -Entry Initiative"
Jackie Crawford, Director, Department of Corrections; Nevada
24: Action Plan
Health Care Challenge
Additional Health Issues
Attachments Available Upon Request:
• "Selecting & Implementing Effective Prevention Programs"
o Del Elliott Power Point slides (83 slides; 83 pages)
"Invest in Children" (29 slides; 5 pages; reading glasses recommended)
"The Importance of Re -Entry" (36 slides; 36 pages)
2 - ----
Exhibit S
Page of 4
"What Works in Preventing Violence"
Delbert Elliott, Ph.D., Director of Center for the Study and Prevention of Violence
University of Colorado at Boulder
Note: See Attachment A (available upon request)
Dr. Elliott's primary focus is on violence, drugs and juvenile crime prevention.
Elliott's group has looked at over 600 programs and 80% of them have no credible
evaluation. This doesn't mean they don't work, just that we have no idea whether they
work or not. The majority of the remaining 20%, which have been evaluated, don't work.
There are some which are actually harmful and actually increase risk.
A relatively small number meet very high standards of scientific credibility and
they work. They reduce the onset of drugs, delinquency and violence by 50% or more.
When speaking about "best practices" (see Attachment A, page 17), Elliott points
out under `things that don't work' regarding Waivers into Adult Criminal Courts that
there are states in which 10 -year olds can be tried and sentenced as adults. There is often
racial bias. These kids are more likely to be victimized and less likely to receive
treatment. We know when they come out they are more likely to offend than if they'd
gone through a juvenile program. When talking about Boot Camps, he points out that
they have about the same recidivism as probation, which costs about one fourth as much
as boot camps.
When talking about the traditional DARE program, elementary school is simply
too early for kids to understand the concepts presented. The New Dare, which involves
7`"-9`" grade intervention, is working with proven practices. In `Gun Buy -Back'
programs, 2/3 of guns turned in aren't functional and most people still have one at home
that does work. There is no significant reduction in gun -related crimes as a result of this
program. Finally, scare tactics generally don't work.
On evidence for effectiveness of mental health strategies and approaches
(Attachment A, page 19), Elliott points out that in residential treatment services, Multi -
Systemic Treatment and Functional Family Treatment (which also often has positive
effect on younger siblings) are effective Family preservation programs that show
promise.
When implementing proven, effective programs, it is critical that they are actually
implemented properly. Use the whole "best practices" body of literature. Poorly
implemented programs will fail.
On page 31, RCT stands for Randomized Control Trial. On page 34, under
Effective Programs, Nurse Family Partnership program is focused on young, typically
teen, first -pregnancy mothers and is proven to work only with first pregnancies.
In terms of cost effectiveness, investment in effective programs will pay for
themselves. Look at the very high scientific, randomized -control trials and used Evidence
Based Programs. You can invest in these programs and know they will work if they are
implemented with fidelity.
Website: www.colorado.edu/cspv
Del Elliott Phone: (303) 492-1032
Exhibit
Page of
"Show Me the Money: Gaining new resources for Children and
Families during difficult financial times"
Dennis Maloney; project leader
Civic Justice Corporation, Bend, Oregon
Revenue/Programmatic Implementation Strategy
• Redeployment of Current Expenditures
• Purchasing power for children/private sector incentives (create a list for bidders
on requirements that they are child/family friendly, such as: allow parenting
training to be offered during lunch/break times; companies provide family health
screenings; referral service for families to needed family services)
• Ounce of prevention
• Base plus matching appropriations
• Earmarked fees/fines (proposed Westlund legislation to charge offenders is their
crime is committed in view of, or directly and negatively impacts children)
• Dedicated business fees (Oregon's Conservation Corps funded by amusement
machine/video arcade game proceeds)
• Community service (rather than picking up trash on the highways, which
accommodates the slobs who litter, implement programs like Deschutes County's
Habitat for Humanity/Juvenile partnership and elevate that work to really serve
the community; construction of Kids Center with help of offenders)
Combining Solid Research and Common Sense to build a comprehensive Community
Justice Continuum (early childhood development (0-5 years)
• Universal Home Visitation (Model: Nurse family partnerships)
• Effective Parenting (Model: Incredible Years)
• Enriched Childcare (Model: High Scope Perry Pre -School)
- -- -4
Exhibit
Page of
Revisiting the Lessons from Ghosts of the Nursery: Implications for
Local Government
Robin Karr -Morse, founding director of Oregon Children's Trust Fund and co-
author of Ghosts from the Nursery, Tracing the Roots of Violence; Portland, OR
Just three years ago, before 9/11, our nation wasn't concerned about terror from
abroad; we were worried about violence in our schools (Columbine, CO; Springfield,
OR). As we study the kids who act out violently, there are early markers of risk.
Even if we take all the typical factors (media violence, poverty, etc) we don't
understand why kids develop thoughts, plan and then take violent action. The U.S. has
the highest rate of incarceration (U.S. is 5% of world's population; we incarcerate 20% of
world's prisoners) on earth. Prisons and jails are the third highest employer in U.S.
behind General Motors and Wal-Mart. As of 2004, the number of people in U.S. prison is
one out of 37 adults. In the future, the following number of babies will end up in prison: 1
in 17 babies; 1 in 3 African American babies; 1 in 6 Hispanic babies.
From age zero to eighteen, the cost and intensity of treatment efforts to reverse
problems increases dramatically while the likelihood of preventing children's original
potential to be constructive citizens decreases dramatically. The cycle begins with babies.
Too often, mother's have bruises on their bodies, are depressed, are teenagers in
demeaning relationships. Too many babies are born hooked on the same substance the
mother has used to mask her pain. We wait until kids have developed their anger to a
point where they act out. We do too little, too late. It's expensive to allow kids to enter
school damaged and angry.
If we want to succeed with the little ones, we must start during the nine months in
the womb and focus on the first twenty-four months of life. Violence can begin in the
womb and be well rooted by preschool. Detached and enraged little brains comprehend
guns and television violence far differently than those with older, more developed brains.
It's not the finger that pulls the trigger, it's the brain. It's not the penis that rapes,
it's the brain. Premature birth, drugs during gestation, domestic violence all impact brain
growth. The brain is designed to require use from the child's world in order to develop.
Completion of the brain is dependent on stimulation from the environment; every taste,
sound, touch and other stimulation contributes to proper growth. Neglect and abuse are
reflected in lack of development of the brain. The younger the child, the more difficult it
is to control normal development of the brain.
Under -stimulation of the higher, cortical brain (rational thinking) or over-
stimulation of the lower brain (base brain; fundamental senses; fight or flight, etc) leads
to abnormal development. We are born with unfinished brains. We are born with 25% of
adult brain weight. At end of 24 months, our brains are 90% of adult weight.
Chimpanzees are born with 40% of its adult brain weight. Macaw monkeys are born with
50%.
The brain is use -dependent. When it comes to brain cells, use it or lose it. We
would not be surprised to come across a teenager who has never been exposed to music
that he can't play the piano. Why should be we surprised that kids who have been
exposed only to neglect, abuse, gunfire, or the like, don't respect the rights of others and
don't trust or respond to nurturing. Babies are at the key age for intensive care. Ignorance
Exhibit
Page 5 of
about emotional development permeates our society. Technology (DVD; video games;
computers) too often replaces simple nurturing.
The most important stimulation babies need is: touch. Nurturing touch increases
emotional connection and development of the cortical brain. Parts of the brain can be
under -built due to neglect or over -built due to abuse. Searing fear creates a specific
response as truly as nurturing love does in a different way. Following even one
frightening experience, fundamental responses will be developed. Repeated similar
experiences will create a trait within the child. Boys tend to act out. Girls tend to
withdraw. The experience is not stored as language, in the cortical brain. It is stored in
the limbic brain, the emotional center of the brain. Experience shapes brain tissue,
chemistry and organization. IQ, school performance and relationships are all affected.
This is not just a low -class, poverty issue. By saying it is, the rest of us can avoid
seeing it has anything to do with me. Violent behavior permeates every class of people,
sometimes more subtly than others. Karr -Morse and Wiley wrote Ghosts from the
Nurser to put the face of babies on the impact of violence. Education begins at zero.
Kids are the way they are because their parents are simply are, or are not, available to
them.
You cannot overestimate the huge, positive impact of having nurses involved with
young mothers. High quality daycare (Perry pre-school spawned Head Start 30 years ago)
is equally as important as elementary school. Enriched, nurturing, predictable, caring
development is the key.
The hand that rocks the cradle rules the world. All our children are at risk of
emotional problems. Apply the Pediatric Health Model to all our children (The Parenting
Institute). What makes a difference is applying the best of what we know to build healthy
kids rather than fixing broken ones. Parenting is the hardest job we'll ever have.
The book Silent Spring taught "poison at the front end, poison out the back end"
in regards to our environment. We have a similar problem on the human system. When
we neglect the problem, we contribute to the demise of ourselves.
www.minneapolisfed.org: the ABC's of early childhood development.
6
Exhibit
Page of
Meredith S. Wiley, NY State Director, "Fight Crime, Invest in Kids." Co -Author of
Ghosts from the Nursery; Albany, NY
"Fight Crime, Invest in Kids" is supported by Police, District Attorneys and
Sheriffs across the nation. Violent criminals need to be locked up. But this is only a part
of what needs to happen. We won't arrest and incarcerate our crime problem and solve it.
When eleven year olds join gangs, or sixteen year olds kill schoolmates or five year olds
act out, there's a reason.
"Trim Tab" is a term coined by Buckminster Fuller. It's a very small addition to a
rudder on a large battleship that drastically reduced the time it took to shift the direction
of a large ship. What used to take several people then needed only one person's flick of a
wrist. Trim Tabs are alterations that will exponentially improve outcomes with far less
effort. The early brain development is a prime opportunity for a trim tab.
Meredith has a grandson named Louis. He's nine. Her daughter had a normal
birth and a non -drug, natural birth. Within hours of birth his screams were gigantic. He
trembled and had trouble sleeping. He was highly sensitive to light and sound. He would
not cuddle. Caroline became desperate and felt like a failure as a mother. This was her
first baby. Robin Karr -Morse stepped in and helped Caroline. She helped Caroline build
her confidence and to help her see Louis as adventurous and high-spirited rather than
troubled. But something was amiss with this little guy. And Meredith and Robin were
writing Ghosts and new they were time-limited with the development of Louis' brain.
At three months, Caroline took Louis to a pediatrician and he recommended she
go to a psychiatrist. She got pissed and spent the next few months searching nationwide
for help. She was told far too often that the baby was too young to diagnose with
anything. There was simply an unavailability of resources.
After three more months, Caroline finally found someone less than ten miles from
her home. Louis was a month and a half behind (at six months of age) normal
development of movement, sitting and crawling. They began physical therapy and
symptoms began to abate. Six weeks later, he began sucking normally, establishing eye
contact and motor skills. But he was still behind at age ten months. An MRI showed a
brain hemorrhage from when he was born. The doctor pointed out that he would've
experienced massive headaches as a result. With continued therapy and knowledge, he
continued to improve. By age four, he passed his motor -coordination tests with flying
colors. Louis is now happy, outgoing, and playful and all the other well-documented
things people are who will succeed in school.
If he'd been left to grow out of his physical problems, he would never have
developed properly. Intervention was critical. Getting a diagnosis was extraordinarily
difficult. What would a less confident mother without the support system Caroline have
done? What would the results have been?
We simply don't pay close attention to babies the way we should. Babies don't
exist for us until they are potty -trained, can walk, talk, hit other kids and shoot guns. We
blame the mother. We hate the kid. We don't have a society that is interested in
overcoming our neglect of these babies.
Three percent of non -abused children are arrested for violent crime by age 18.
Five percent of abused children will be arrested for violent crime by age 18. There are 8
- -- - - ----'7---- --
Exhibit 6
Page % of 4
million prisoners worldwide; 2 million are in the United States. We have the highest
homicide rate in the world.
To say we don't know what to do is untrue. We have the evidence. We do know
what to do. The Nurse Family Partnership program has been studied. Four percent of
kids who received home visitation by nurses committed crimes by age fifteen. Nineteen
percent of kids who did not receive home visitation by nurses committed crimes by age
fifteen. In 1998, Rand determined that four dollars was saved for every dollar spent. The
brain's capacity for change is highest at age 0-3 when Head Start and Early Head Start
will have the most impact. Where we actually spend the money to change brains is all
later in K-12, Mental Health, Juvenile Justice, substance abuse treatment and so on.
In comparative costs, locking someone up in prison costs $35,000 per year. Foster
care costs $17,000 per year. Nurse Home Visitation program costs less than $4,000 per
year. We spend $80 Billion annually dealing with the fallout from the neglect of children
(mental health, juvenile, prisons, jails, treatment, etc). And there are other hidden costs
we don't think about. Child welfare programs are failing nationwide. Longer sentences
raise the already high cost of fighting crime. Between 1981 and 1992, the U.S. went from
spending $8.3 billion per year in prison costs to $50 billion. The New York Times and
Boston Herald have warned that al Qaeda is recruiting in our prisons and in gangs. Where
better to recruit angry, young men?
We've got to find a way to put the money up front.
www.fightcrime.org
- --- 8 — - ----
Exhibit 6
Page P, of
The Justice Department's Re-entry Initiative
A. Elizabeth Griffith, Associate Deputy Director for Policy
Bureau of Justice Assistance; U.S. Department of Justice
Ninety percent of people who go to prison will come back out into our
communities. They'll return disproportionately to neighborhoods that don't have the
resources to deal with them. Many have no close relationships with family. Lack of work
history, literacy, job qualifications, housing, health and mental health issues and drug
problems run strong in this population.
"Serious and Violent Offender Initiative" is designed to help. On a national basis,
DOJ is identifying the partners available to work with and support these efforts.
Departments of Labor and Health and Human Services help with funding. There are
training and technical assistance available. HUD and Veterans Affairs are partnering.
Vets represent 15% of population and 15% of criminal population as well. Social
Security Administration is at the table. They are working on the barriers, such as the
reinstatement of benefits to parolees.
They're looking at the concept of suspending, rather than eliminating benefits for
prisoners. This loss of benefits is a huge issue for counties. The Initiative focuses
primarily on prison issues.
Exhibit
Page S— of
Model Prevention Program
Michelle Katona, Director, "Invest in Children"
Cuyahoga County (Cleveland), Ohio
Michelle phone: (216) 698-2215
e-mail: cnmak(a�,www.cuyahoga.oh.us
Note: See Attachment B (available upon request)
Cleveland was recently named the poorest city in the U.S. The uniqueness of
"Invest in Children" is that it is universal, research -based, focused on home and
neighborhood, proactive and wellness -oriented and built on a public-private partnership
(including State of Ohio, Board of County Commissioners, local foundations and funders
and community-based organizations). Evaluation was required by the partnership and
included customer satisfaction, performance, quality, outputs/production (numbers
served) and outcomes (family behavior).
The primary goals are helping to create effective parents, healthy children and
quality child care, all the things Karr -Morse and Wiley spoke of during lunch. This
appears to be an incredibly far-reaching campaign with the best of goals.
They have a tax bond specifically for human services as a result of the success of
their work that is seen in the community.
Website: www.cuyaho ag counter
Exhibit Fj
Page 10 of 4
F2_
Diverting the non-violent mentally ill from jail and juvenile detention:
an intergovernmental challenge"
Marvin Southard, Director of Mental Health
Los Angeles County, California
LA County has a billion dollar budget and 3,000 MH employees. Their largest
MH facility is their jail, which is the largest MH facility in the nation. "Kobe Bryant
factor: you can always do better if you play as part of a team." No matter how good each
of the organizations is that works with mentally challenged people, they can't do it alone.
Find partners and work with them.
2034 Program in California: LA, Stanislaus & Kern counties partnered with state
of California and focused on homeless mentally ill and mentally ill in jail. They measured
outcomes: fewer days homeless; fewer days incarcerated; two other measurements.
Results were astounding. The program went from five million dollar pilot program to
fifty-five million dollar annual program in most counties in California.
Proposition 63 (to address issues of seriously mentally ill people) was approved in
November. It taxes people who make over one million dollars annually 1% (taxes 2nd
million and above). It will raise $700 million annually and will be accessed by all
counties in California. Focus is transformation of MH system so mentally ill are safe in
communities and communities are safe without having them in jail. It includes diversion
of juveniles from system.
There are three areas in the LA County plan:
• First is true diversion. Make sure that people with true MH issues are dealt with at
the court level, with judge and attorneys, to keep them out of jail and in programs
and services.
• Second area is prevention. One of the pre -cursors to mental health issues and
substance abuse is being witness to extreme violence. Witnessing trauma affects
the brain. MH interventions can help. They've found remarkable responses in
middle school youth.
• Third focus is on clear aftercare plan for folks to have housing and substance
abuse and MH treatments as they come out of jail. LA County is creating an
Aftercare Unit for this purpose. MH patients need partners as well.
MH treatment and substance abuse treatment are completely separate in LA
County. Without both, the patient will fail. Partnership is critical in order for people to
have better lives.
Over time, ongoing relationships that mentally ill people have with other people
have proven to be more important in the curative process of mental illness than drug
treatment programs.
11
Exhibit
Paget of45
Michael S. Carona, Sheriff
Orange County, California
Orange County has the 2nd largest Sheriff's county in California, and 5th largest in
U.S. They have the 14th largest jail in U.S. $5.5 million annual budget. Orange County is
the 31St largest economy in the world and 2nd or 3" most expensive housing in the U.S.
Proposition 63 is a windfall for people dealing with mentally ill offenders in
California. Jails are being turned into mental health hospitals. Nearly 2/3 of the boys and
3/4 of the girls in jail in the U.S. have at least one mental health issue. Nearly 70% of MH
inmates are dual diagnosed. 94% of mentally ill people in the nation's prison system
recidivated if there was no aftercare available to them.
The mentally ill have no voice. No one makes a case for them; no movie stars; no
nationally recognized champion. We in public service need to be that champion.
If mentally ill end up in jail, we need services available within the jail dedicated
to getting them resources. Proposition 63 was one of the answers. We then need an
aftercare system in place when they get out of jail. Orange County is working to create a
Mental Health court. When police, prosecutors, courts and counties work together,
solutions can be found for these people. Objective is to keep them out of jail and inside
systems of support and control so they are safe and community is safe.
12
Exhibit
Page _ of US
Peter M. Lukevich, Executive Director, Washington Partners in Crisis
Seattle, Washington
Jails: Asylums of the New Millennium
Washington Partners in Crisis is a coalition of sheriffs, police chiefs, judges,
prosecutors, defense lawyers, treatment providers and consumers who have a goal to do a
better job of treating the mentally ill in Washington. When this group gathers together
before legislators, things happen. In King County, 78% of GF budget is for law
enforcement. 80% of the 78% is spent on jails.
A group like this has not been part of the solution before. They now partner with
Sheriff Raul Ramirez, Commissioner Lisa Naito and others who are doing the same thing
in Oregon. They've seen a 90% reduction in recidivism with people who successfully
access a full range of treatments (only currently available in two counties in Washington).
They want to keep them out of jail, where they don't belong, except for seriously violent
offenders, and get them the services they need. The burden falls immediately to counties
to deal with these folks. It is in all our best interests
We must insist that Oregon no longer terminate inmates from Medicaid; just
suspend them so they aren't cut off when they get out. This is discrimination against
the most vulnerable people: mentally ill, low-income, homeless, minority, etc.
Find case managers who can access them before they leave jail so they are
immediately receiving aftercare upon release. One of the most effective front-end
solutions is to have officers properly trained in crisis intervention to recognize that an
offender may be mentally ill and off their medication rather than just another offender.
There are ways to keep people out of the system; they just need the support of these
partnerships.
The shortage of beds in the state hospital will lead to a shortage of beds in jails. It
takes a cop, a commissioner, a judge, a sheriff, a group like LPSCC to make a difference.
It takes you, who are reading this, now, to make a difference. It is no longer acceptable
that mentally ill offenders spend twice the time in jail that non -mentally ill offenders
committing the same offense.
Peter Lukevich e-mail: picnwapic.org
13
Exhibit
Page 1.5 of L A5
Larry Spottsville, Director, Juvenile Probation Department
Rapides Parish, Louisiana
Prevalence of mental disorders among children (juvenile justice system)
• 73% of children in national sample of public and private juvenile facilities
reported mental health problems during screenings. 57% reported previously
received MH treatment.
• In Maryland, 57% of youth have history of mental illness; 53% have at least one
current mental disorder diagnosis.
• In Virginia, 8-10% of youth in secure detention homes need immediate MH
treatment. 77% of youth meet diagnostic criteria for mental disorder.
• In Georgia, 61 % of youth admitted to detention centers had mental disorders,
including substance abuse disorders.
• 72% of youth in South Carolina Juvenile Justice facilities met full criteria for at
least one mental disorder diagnosis.
• In Toronto, 63% had two or more mental disorder with an additional 22% meeting
diagnostic criteria for one mental disorder.
Conclusions:
• Prevalence of mental disorders among youth in juvenile facilities ranges from
50% to 75% in multiple, well-designed studies.
• Nearly half of incarcerated girls meet criteria for PTSD and up to 19% of youth
may be suicidal.
• Children involved with juvenile justice system frequently have more than one co-
occurring mental and/or substance abuse disorder.
• Children involved with juvenile justice system have substantially higher rates of
mental disorder than children in the general population.
14
Exhibit_
Page \q___ of
Model County Re-entry Program
"Real Work and Real Pay"
Robert Hunter, Program Manager; Sentencing -to -Service Home Program
Hennepin County, Minnesota
In the 1990's, instead of probation or parole, certain individuals were going
through STS program. Upon successful completion, they were released from P&P. These
were typically low-risk, non-violent offenders and are with STS for several days of
community work service.
They expanded to include minimum -security prison inmates who would be with
STS longer-term and worked with the city of Minneapolis to rehab rundown houses for
low-cost housing. They worked with the Carpenter's Union to train and supervise inmate
workers. After hearing about Deschutes County's efforts, they partnered with Habitat for
Humanity and currently build thirty homes per year. Of the first six people they trained,
five graduated and four entered the carpentry trade permanently. They eventually grew to
four crews and one of them is all women from a women's minimum security prison.
Now when they interview to start another new crew of 6-7 inmates, they interview
40-50 men and a dozen women. When they first started, they had a hard time getting a
crew of seven; they ended up with six. Habitat now completely funds the women's crew.
They have a 75% placement rate in new employment once inmates complete their service
with STS. The word is out. STS is about the best thing going in construction training in
the Minneapolis area. There's a lot of pride among the inmates. Priority is serving non-
custodial fathers. They sign a contract to support their family when they get a job on the
outside. Some construction companies have stopped advertising and now rely on STS for
new workers.
In addition to Habitat, STS has begun working for developers in the Twin Cities.
They're bidding all the residential projects they can handle and the union supports their
work (as long as they stay away from commercial). They will be self-sustaining within
the next year. They've expanded to include juveniles in the program this year. They've
expanded to include training in machine shop work. No one has failed in this program. In
the construction program, they've trained two hundred participants. Fewer than ten have
recidivated with either parole violations or new felonies.
They originally thought the focus was on building homes. They learned they are
really rebuilding lives and that a finished home was a nice byproduct. Seventy-five
percent of their graduates are making a living in construction industry.
15
Exhibit g
Page 15 of y 5
"The Delancey Street Replication Project" (Milton Eisenhower Foundation)
Christopher Fay, Director
Washington, DC
Eisenhower Foundation's mission is to find model programs to reduce and
prevent crime. In the past year, they wanted to find a program to rehabilitate inmates.
Imagine a forty-five year old man who's on drugs for 20 years, started with petty
crimes and graduated to major crimes. He's fathered six children by three different
women. He did not graduate from high school. The only thing he can do well is commit
crimes. Next, imagine going to a fine restaurant in San Francisco that is run entirely by
ex -felons. Next door is a moving company operated for thirty years by ex -offenders
without one problem. There is a very successful Christmas tree lot. There are 400
workers. 399 are offenders.
Delancey projects are located in San Francisco, Los Angeles, Pueblo, New
Mexico, Greensboro, North Carolina, Brewster, New York. These are not replications.
Replications may not be exactly like the original five.
Delancy believes they can transform people. They do this without tax dollars.
They fund themselves through business income earned. These are businesses and they are
schools. Imagine a person going into Delancey Street who commits to staying for two
years. The average stay ends up being 3-4 years. Imagine that first man leaving Delancey
Street with at least three marketable skills, a high school diploma and perhaps a college
degree. He'll have worked driving trucks, cooking and so forth. He will have made
contact with the three mothers and all his children. Child support payments were
suspended due to the judicial system's belief in the Delancey program and then he
transitions into steady employment and responsibility. During the first six months of his
first job on the outside, half of his new salary from his new job goes back to Delancey
and half goes into savings. By the time he's ready to transition back out on his own. He
has money in the bank, a job, an education and has been mentored by tough ex -cons. He
talks and thinks differently. He has an improved relationship with his family.
Principle: each one, teach one. His first three months at Delancey, he learns to
clean the floor. Next, he learns a new skill from another ex -offender while he teaches a
new man at Delancey how to clean the floor. This program reverses the whole culture
that has been learned in prison. This man actually wants to succeed. He won't just make
some money; he'll make a living and impact his family and friends in very positive ways.
The Eisenhower Foundation believes this program must and can be replicated.
The program started in 1971 with seven offenders. Thirty four years later, they
have five facilities and a portfolio worth fifty million dollars and a huge success story.
They help both men and women. Eisenhower starts with the corrections community and
local business community and college on bringing resources to the table in order to
transform lives which need to be transformed for their sake, their family's sake and their
community's safety sake. They change lives and they change minds.
They face strong NIMBY concerns since they house a large group of ex -offenders
supervised by ex -offenders. They don't have outcome measurements, as they aren't
required to do so. Replication projects would be tested for typical outcomes by
Eisenhower. Anecdotally, it appears to make a significant difference in the lives of
offenders.
16
Exhibit
Page � of
"Assessment and Education"
Arthur Wallenstein, Director, Department of Corrections and Rehabilitation
Montgomery County, Maryland
Insist upon collaboration. Insist upon outcomes regarding re-entry of offenders.
To this date, Wallenstein knows of no study that shows why a ten year sentence is better
than an eight year or six year sentence. Safety in our communities requires that we know
how to succeed with these people. Which offenders need to be incarcerated and for how
long and what treatment programs will be most effective with them while they are
incarcerated and what is available to them upon release? If we knew what worked, we
wouldn't have the enormous challenges we face. High rates of recidivism and high cost
of system of dealing with untrained, mentally ill, uneducated and drug -addicted people
has led to the high interest in re-entry programs.
1.7 million mentally ill people are released from county jails in the U.S. annually.
People always talk about prisons, where average stay is 42 months. Jail stays may be 42
minutes (typical max is 12 months) and the number of inmates served is far more
significant than in prison.
G.W. Bush, in last year's State of the Union was the first sitting president to ever
mention prisons and re-entry in this context.
There is no reason in any jail in the U.S. that an education cannot be provided.
There is no reason GED programs can't be offered. It is cheap and it is easy. There is not
a jailer in this country that should be able to stand in front of an enlightened board of
county commissioners and claim otherwise. Total cost of education program in
Montgomery County, hiring state licensed teachers, often retired, is $254,000 per year.
There are Adult Education programs in most communities. This is a valid, non -mandated
service. They buy services for $20-25 per hour. They do not hire full time teachers. They
pay for hours worked and do not pay benefits (hence the focus on retirees). Volunteers
are recruited to help with remedial reading skills.
Support must come from the top and must include partnership with local
education system. Politically, the issues must be engaged. Ask why we cannot provide
this service. Reject the notion that security issues prevent the possibility. Get support
from the state. Ten million people will come out of county jails this year versus 600,000
from state prisons. It is time to diminish the "dead time" in jails and bring these programs
in.
17
Exhibit FD
Page of
The Cost Effectiveness of Re-entry
Peter Greenwood, Ph.D.
Founder of Rand's Criminal Justice Program
"I have a 91 -year old father who wasn't doing too well. He was in a rest home
after a bad spell in the hospital and he was going down hill. But he's a Red Sox fan. He's
doing great now."
"If the evidence is there, why aren't we doing it?"
First, we are a nation that wants fast solutions. Intervention and prevention are all
about the future. If we lock someone up, they're gone. Issue solved, many believe. But
we can't even pay our current bills. We're building up bills that our grandkids will be
paying. This is not a great time to be talking about long-term benefits of intervention and
prevention programs.
Second, we're not talking about building a bridge; you're talking about preventing
crime. Five years from now, you're going to have a bunch of people who would have
been victims and they don't know it. This is invisible.
Ten years ago, only the techies were making movies on computers. Now you're
kids are at home doing exactly this. You can buy a disc from the people who created the
technology and just do it. This is exactly what we're proposing in prevention and
intervention.
Prevention began before the Civil War. By 1994, the experts from National
Academy of Sciences concluded there wasn't a single program that worked consistently
to prevent violence. But in the past ten years, the world has changed. The research has
proven that certain things actually do work. The standard is, if you do one test you have
evidence that it works.
The Elmira Project first started in the 1970's. David Olds invented the nurse home
visitation program. He followed these kids for fifteen years. Through that long follow up,
it showed that it worked in preventing child abuse, but it also proved a bunch of
unexpected byproducts like fewer unwanted subsequent pregnancies, better prepared kids
going to school and so on.
How do we train other people to replicate what David Olds did? How do we weed
out the programs that don't work? How do you insure that we are building the most
effective models? Olds' program costs $7,000 per year. Other programs were doing much
the same thing for $25,000, but they certainly weren't four times as effective.
Functional Family Therapy takes four months and costs $2,500 per family. It
saves government seven times as much as is invested. It is very cost-effective and is
supposed to reduce recidivism by thirty percent.
In California, "three strikes your out" has resulted in lots of people receiving life
sentences. Studies have shown there are far more cost-effective solutions than locking
people up.
Cost Effectiveness Lesson: Pay for the program/training. There's an upfront cost
to get the benefit from the program. FFT training lasts four days. You know nothing
about it on Monday and on Friday you're seeing your first family. Most important is that
the program be implemented appropriately, according to the evidence based training.
FFT, Inc builds in quality assurance and fidelity to the design of the program.
18
Exhibit
Page T5V of 4—
FFT, MST and Treatment Foster Care are the three most cost-effective programs
currently being used regularly. They all provide $7-10 in savings to the local jurisdiction
(Treatment Foster Care ($10 saved for every $1 invested.), FFT ($7), MST ($6), Nurse
Home Visitation ($5)). You save money by avoiding government expenditures.
Once you've got the program, you follow the kids over time and study them for
several years. Compare these kids with kids who haven't been through the same
programs. Figure in a 30% reduction in recidivism and then measure the savings in
mental health, health, corrections, unemployment benefits, housing subsidies and other
areas. This information is visible. It's replicable. This is a very powerful instrument.
The Reentry Roundtable just published (January 2005) an 850 page report. It's
got every good idea that anyone thinks is great. It's a quagmire. You need a David Olds
to boil it down to the five or six things that are scientifically proved to work.
Where does the money come from? We have the money. We have enough money
to put every single at -risk and adjudicated kid through an effective program. But it's
being spent somewhere else.
Example: DARE doesn't work. It never worked. L.A. police and L.A. School
District partnered to create DARE in the 1970's. It grew like wildfire nationwide and got
an $800 million dollar federal earmark. They published studies that showed it worked,
but scientists said the studies weren't valid. When two separate, random, scientific
studies were done, they learned DARE made no difference. But so many powerful people
were committed that they could barely get the study published. Eventually, DARE
admitted that their program could be improved and Robert Wood Johnson Foundation is
funding the improvements.
One thing they learned was that fourth and fifth graders weren't typically old
enough to comprehend the DARE education. The new DARE program will focus on
seventh and eighth graders. They had to revamp the optimal age for the kids.
Two members defended DARE anecdotally as implemented in their own counties.
They claim it has worked well for them. The man who monitored the DARE earmark at
the Department of Justice pointed out a few problems with DARE included that they quit
training kids right at the age when the real threat began. Also, in far too many
jurisdictions, officers were using DARE as a way to increase overtime. It was very rigidly
designed and didn't allow enough flexibility to include other aspects that would have
helped it. The new DARE program is apparently going to be much -improved.
Scared Straight has been showed to not reduce proclivity toward criminal
behavior. David Huffman, Sheriff from North Carolina shows how and why Scared
Straight does work. Here's the crux of the challenge. All these programs have their
champions, whether the science shows that they work or not; or work less well than other
options.
And why do we keep doing things that aren't terribly effective (like electronic
monitoring; DARE; Scared Straight)? Because we like it; because it seems logical that it
should work; because we've been doing it this way; because we're invested in them.
But things are changing. And they'll continue to change. More people are
beginning to understand and accept the evidence. If we aren't going to give up on all the
programs that have been proven not to be effective, at least begin to move toward, or
implement aspects of, programs that are clearly proven to work (FFT, MST, etc).
19
Exhibit 15
Page�_ of
The optimal model for implementation of programs is that practices would all be
evidence based. All practices would be regularly assessed for outcomes. Proven programs
would be available to those who need them. With new, unproven programs, you'd
implement assessment tools from the outset so within a few years, you'd know if it
works. What keeps us from doing this? First, the key people need to truly understand this
work and it isn't that complicated. Peter has everything we need to know on two pages.
We can sort out what programs need to include in order to be considered evidence -based.
We don't have any evidence on re-entry yet. We will.
"I'm very positive about this meeting. You people get it! Ken Mayfield!
Republican! From Texas! (laughter) This group gets it!"
Check website for WSIPP (Washington State Institute on Public Policy)
20
Exhibit
Page ko of _
"The Revolving Door for the Mentally Ill in the Justice System"
The Honorable Evelyn Lundberg Stratton, Justice, Ohio Supreme Court
Columbus, Ohio
"You don't need money to start; just a strong will. You don't need a lot of
knowledge; just surround yourself with those who do."
Supreme Court Justice Evelyn Lundberg was born in Thailand to missionary
parents. She came to the United States when she turned eighteen and went to college. She
became a lawyer and then a judge and was appointed to the Supreme Court. She lives and
works in Columbus. She made it her own mission to change the way the mentally ill were
dealt with in the prison system in Ohio.
The key points for success include:
Collaboration: find committed partners in all related fields, including law
enforcement, mental health and so forth. Be sure to include judges. Have them
lead the effort. They carry key clout to assemble people and accomplish change.
Statistics: NACo publications have statistics that are very persuasive for decision
makers and funders ("Ending the Cycle of Recidivism"). Use your local
university to do studies and create accountability measures for programs.
Crisis Intervention Training (CIT): Introduce police and sheriff's deputies to
mental health professionals. They need to learn how to best deal with mentally ill
people. Jail diversion is where to start. This is critical, but you must have
alternatives to jail in place. CIT training is available in every county in Ohio for
cops, parole and probation officers, campus police and so forth.
Mental Health courts have been established in Ohio. They are voluntary for the
offender to be involved. The program lasts one to two years. They are extremely
effective. Their websites (www.sconet.state.oh.us/ACMIC;
www. specdocsgsconet.state. oh. us) have related articles. Mental Health courts are not
actually separate courts in Ohio, they are specialized dockets.
Ongoing training and education are available for cops, judges and other partners.
There is an annual conference in Ohio in May that combines CIT and MH courts. She
says it's open to anyone from any state.
She raised a variety of options to seek funding. Butler County is developing a
Mental Health Court manual. There are many people with personal wealth who have
mentally ill family members. The Corporation for Public Housing is an option. Land
Banking can turn county properties into housing for the mentally ill. Check to see if there
is a Central State Pharmacy in Oregon where counties can buy in bulk by tagging onto
the state contract to save money. Steal ideas from other counties and adopt them for
ourselves.
It's important to avoid the syndrome where you spend three years developing a
"white paper." Act! Make a difference. Use building blocks from others and build up
from there.
21
ExhibiA0f---L4s—
Page
"The Nevada Re-entry Initiative"
Jackie Crawford, Director, Nevada Department of Corrections
Carson City, Nevada
Note: See Attachment C (available upon request)
Ms. Crawford is introduced as one of the most progressive people in the U.S.
working in the area of re-entry. She requests that we spend a lot of money, because it
goes into her budget. Nevada is known for bars and bullets. Their prison population grew
dramatically during the 1990's. They soon learned they couldn't build themselves out of
their problem. Their budget is $440 million for the biennium with 2,600 employees.
6.9 million people were on probation, in jail, prison or on parole at year-end 2003.
3.2% of all U.S. adult residents (1 out of 32) are incarcerated. In 1980, parole failures
accounted for 17% of new admissions. In 1999, it was 35 %. By 2002, it was 41%. In
2004, there were more than 5,000 new admissions into Nevada prisons. 75% were for
new crimes. 25% for parole violations (69% of these were technical violations). This was
when the accreditation movement caught fire, because of the huge increase in lawsuits
that resulted from so many new admissions. 97% of inmates are coming back home some
day. Combined with recidivism rates, re-entry programs have become critical to
community safety.
Nevada Offender Characteristics
• 58% have no GED or high school diploma
• 45% function below 8th grade level
• 15% have some form of mental illness
• 72% have children (imagine what happens with these children...)
• 80-90% drug or alcohol problems (girls are beginning using meth as a diet aid to
stay thin; meth is huge problem)
• 65% have no job training or work skills
Public attitudes toward rehabilitation and punishment
• Policy makers consistently overestimate the public's punitive attitudes
• Citizens want criminals to be punished, but they also support rehabilitation as a
major purpose of corrections (California public opinion currently shows 82%
support prevention and 12% support the building of more prisons)
Correctional realities include the facts that offenders often have no social net and
no marketable skills. More prisoners are "maxing out" in their sentences. Longer
sentences mean fewer community connections. There is a lack of adequate housing and
treatment programs and there are many restrictions on public welfare assistance.
What we know is that treatment works. National studies have shown that effective
intervention can reduce recidivism by 30%. Prison does not have to be purely punitive to
have an appreciable impact on behavior. Benefits of treatment include decrease in prison
misconduct, prison violence, drug use and anti -social attitudes as well as an increase in
pro -social skills, positive behaviors and a safer environment for everyone. This is good
public safety policy.
22
Exhibit-5---
Page
xhibit _Page Q 9 of 45
Leadership must embrace re-entry in order for it to work. The attitude must come
from the top down. The goals of Nevada's "Going Home Prepared" Program are to
reduce recidivism, increase public safety and coordinate existing community resources.
They have an 80% success rate in the past year and a half since the GHP program has
been operational. The 20% who have failed have all failed due to technical violations.
There have been no new crimes committed by anyone who has completed the GHP
program.
Dana Serrata; re-entry coordinator (702) 879-3800; ext 295
E-mail: dserrataAdoc.nv.gov
23
Exhibit
Page of 4
Action Plan
Health Care challenge
Current situation is that offenders are cut off from health care by federal
government (Medicaid, housing benefits, SSI, SSDI, VA benefits) and the result is that
burden falls onto counties to pay full freight for the health care of inmates. The cost is not
the rates insurance companies pay or Medicaid pays; the cost is the full, retail cost. Then,
when they are released, they are not put back onto assistance, they are without medical
coverage. Many counties are required to report the names of all people who are arrested
and held in jail to Social Security and they receive a "bounty" as a reward. Many counties
rely on these funds to supplement their jail budgets while long-term the costs to the
counties end up being much higher due to the lost of benefits.
What should happen is that when someone is on federal medical (and other)
assistance, they should maintain their benefits after arrest until they are convicted of a
crime. Health benefits should continue until conviction.
Even after conviction counties are stuck with medical costs for inmates, but it is
not politically likely to have full benefits continue after conviction. It will be hard enough
to get changes just for those who lose benefits upon arrest only. One possibility is to get
legislation that will allow counties to pay a lower rate than full freight for inmates.
Additional health issues
Hepatitis B, AIDS, Tuberculosis and drug addiction are growing problems in the
U.S. due to prison conditions. Many people enter prison without disease and contract
them while in prison. Illegal drugs do not enter prisons via visitors. They have no direct
contact with the prisoners. The drugs can only be obtained by inmates via sworn law
enforcement officers. Think about the healthy, young man who enters prison for stealing
a car. Too often, he leaves prison a few years later diseased, drug -addicted, tattooed and
gang -affiliated.
24
Exhibit
Page Q of
A
A26 o YT THE NEW YORK TIMES EDITORIALS/LETTERS SATURDAY, JUNE Z
The Price of Prisons
Thirteen million Americans have been convict-
ed of felonies and spent time in prison — more than
the population of Greece. And they tend to return to
prison again and again. Of the 650,000 inmates who
will be released in 2004, two-thirds will be back
behind bars within few years. The cost of keeping so
many in jail — the operating expenses for state
prisons alone is around $30 billion a year — has
created bipartisan concern. Congress, which spent
so many years obsessed with how to look tough on
crime, is currently considering legislation that
would tackle two of the big factors behind the
revolving -door phenomenon: the huge number of
mentally ill people in prison, and the difficulty ex -
convicts have in carving out new lives in the law-
abiding world.
A bill known as the Second Chance Act, en-
dorsed by the White House and developed primarily
by Representative Rob Portman, Republican of
Ohio, and Representative Danny Davis, Democrat
of Illinois, would invest a modest x$112 million over
the next two years in drug treatment and mentoring
programs aimed at helping newly released felons
rejoin their communities. It would also do away
with a punitive federal law that denies college loans
to applicants with drug offenses, even if the offenses
resulted in no jail time and occurred in the distant
past.
The loan ban, which has been used to deny aid
to more than 140,000 students, would remain in
effect only for people who committed drug crimes
while actually receiving federal aid. Unfortunately,
the bill would not eliminate a similar rule that
excludes inmates from the federal Pell Grant pro-
gram.
The Second Chance Act calls for a task force to
review the obstacles that keep ex -felons pinned to
the margins of society. If this bill is passed, as it
deserves to be, the task force will find a wealth of
information in a recent study by the Legal Action
Center, a criminal justice policy group, which iden-
tifies laws in all 50 states that bar former convicts
from scores of professions that require state li-
censes.
While it is important to screen for prison
records when hiring teachers or day care workers,
It makes no sense to tell men and women who once
served time for breaking state drug laws that they
are barred for life from careers as barbers or
landscape architects. Some states even strip con-
victs of their driver's licenses.
The House is also considering a bill that recog-
nizes the role that mentally ill offenders play in the
recidivism problem. About one in six prison inmates
is mentally ill. A spate of recent studies describe
American prisons as mental institutions by default
— although they are institutions in which the dis-
turbed inmates get no treatment to speak of. Once
they complete their sentences, such inmates are
generally dumped onto the streets without medica-
tion or therapy, and rapidly end up back in jail.
The Mentally Ill Offender Treatment and
Crime Reduction Act, which was passed by the
Senate in 2003, calls for an investment of $100
million for inmates' mental health services, includ-
ing training for people who work in mental health
courts. These courts make sure that offenders with
mental problems comply with treatment regimens.
Opponents are already arguing that given the
government's enormous deficit, Congress should
reject any bills that involve new spending. But given
the soaring price of incarceration, and a prison
population that is growing, the most costly option is
to do nothing.
A.I. -b
Exhibit
Page2b of L45_
ARTHUR OCHS SULZBERGER JR., Publisher
BILL KELLER, Executive Editor
JILL ABRAMSON, Managing Editor
JOHN M. GEDDES, Managing Editor
Assistant Managing Editors
SOMA GOLDEN BEHR MICHAEL ORESKES
TOM BODKIN ALLAN M.SIEGAL
CRAIG RWHITNEY
GAII:COLLINS, Editorial Page Editor
ANDREW ROSENTHAL, Deputy Editorial Page Editor
Founded in 1851
ADOLPH S. OCHS, Publisher 1896-1935
SCOTT H. HEEKIN-CANEDY, President, General Manager
ARTHUR HAYS SULZBERGER. Publisher 1935-1961
JYLL F. HOLZMAN, Senior V.P., Advertising
ORVIL E. DRYFOOS. Publisher 1961.1963
MARC Z. KRAMER, Senior VP Circulation
ARTHUR OCHS SULZBERGER, Publisher 1963-1992
DENISE F. WARREN, Senior VP, Panning
LL4M J. CARLOS, VP., ChieFFinancal Officer
THOMAS P. LOMBARDO, VP., Production
ALYSE MYERS, VP., Marketing Services
JAY L SABIN, V.P., Labor Relations
DENNIS L STERN, V.P., Human Resources
MICHAEL G. WILLIAMS, V.P., Chieffnformation Officer
THOMAS K. CARLEY, President. News Services
The Price of Prisons
Thirteen million Americans have been convict-
ed of felonies and spent time in prison — more than
the population of Greece. And they tend to return to
prison again and again. Of the 650,000 inmates who
will be released in 2004, two-thirds will be back
behind bars within few years. The cost of keeping so
many in jail — the operating expenses for state
prisons alone is around $30 billion a year — has
created bipartisan concern. Congress, which spent
so many years obsessed with how to look tough on
crime, is currently considering legislation that
would tackle two of the big factors behind the
revolving -door phenomenon: the huge number of
mentally ill people in prison, and the difficulty ex -
convicts have in carving out new lives in the law-
abiding world.
A bill known as the Second Chance Act, en-
dorsed by the White House and developed primarily
by Representative Rob Portman, Republican of
Ohio, and Representative Danny Davis, Democrat
of Illinois, would invest a modest x$112 million over
the next two years in drug treatment and mentoring
programs aimed at helping newly released felons
rejoin their communities. It would also do away
with a punitive federal law that denies college loans
to applicants with drug offenses, even if the offenses
resulted in no jail time and occurred in the distant
past.
The loan ban, which has been used to deny aid
to more than 140,000 students, would remain in
effect only for people who committed drug crimes
while actually receiving federal aid. Unfortunately,
the bill would not eliminate a similar rule that
excludes inmates from the federal Pell Grant pro-
gram.
The Second Chance Act calls for a task force to
review the obstacles that keep ex -felons pinned to
the margins of society. If this bill is passed, as it
deserves to be, the task force will find a wealth of
information in a recent study by the Legal Action
Center, a criminal justice policy group, which iden-
tifies laws in all 50 states that bar former convicts
from scores of professions that require state li-
censes.
While it is important to screen for prison
records when hiring teachers or day care workers,
It makes no sense to tell men and women who once
served time for breaking state drug laws that they
are barred for life from careers as barbers or
landscape architects. Some states even strip con-
victs of their driver's licenses.
The House is also considering a bill that recog-
nizes the role that mentally ill offenders play in the
recidivism problem. About one in six prison inmates
is mentally ill. A spate of recent studies describe
American prisons as mental institutions by default
— although they are institutions in which the dis-
turbed inmates get no treatment to speak of. Once
they complete their sentences, such inmates are
generally dumped onto the streets without medica-
tion or therapy, and rapidly end up back in jail.
The Mentally Ill Offender Treatment and
Crime Reduction Act, which was passed by the
Senate in 2003, calls for an investment of $100
million for inmates' mental health services, includ-
ing training for people who work in mental health
courts. These courts make sure that offenders with
mental problems comply with treatment regimens.
Opponents are already arguing that given the
government's enormous deficit, Congress should
reject any bills that involve new spending. But given
the soaring price of incarceration, and a prison
population that is growing, the most costly option is
to do nothing.
A.I. -b
Exhibit
Page2b of L45_
PAGE B2 /SUNDAY, AUGUST 29, 2004 5tr
WESLEY PRUDEN, Editor in Chief
FRANCIS B. COOMBS JR., Managing Editor
TONY BLANKLEY, Editor of the Editorial Page
MARY LOU FORBES, Editor of Cornmentary
ARNAUD DE BORCHGRAVE, Editor at Large
TED AGRES, Deputy Managing Editor
JOSEPH W. SCOPIN GEOFFREY ETNYRE
KENNETH M. MgNTYRE MARIA STAINER
Assistant Managing Editors
DOUGLAS a M. JOO, President
;tonarimeo
KEITH COOPERRIDER, Chief Financial Officer RICHARD H. AMBERG JR., VR,General Manager
1.11 GEOFFREY TL EDWARDS, Vice President
America's Newspaper
A matter of public safety
oI
than 60U,000 inmates willbe re-
leased from prisons this year. And
present trends continue, within
three years nearly two-thirds of those pris-
oners will be re -arrested for committing a
felony or serious misdemeanor. The fiscal
burden on taxpayers is enormous: Accord-
ing to the federal Bureau of Justice Statis-
tics, expenditures on corrections increased
from $9 billion in 1982 to $44 billion in 1997.
That.says nothing about the costs of arrest,
prosecution, defense, health care or — most
importantly — the cost to the victims. It is
clearly in the public's best interest to ad-
dress the issue of recidivism.
Current attitudes toward prisoner re-
entry efforts are not always favorable. A
strong desire to see justice carried out
often means society wishes to lock a Crim-
inal up and throw away the key. But the
harsh reality is that most prisoners will be
released one day — and they will shop at the
same grocery stores, visit the same parks
and live right next door to us. A prison sys-
tem that has not prepared convicts for life
outside the strictly controlled regime of
prison life has not only failed them, but also
the public at large. As President Bush said
in his State of the Union address this year,
'America is the land of second chance, and
when the gates of the prison open, the path
ahead should lead to a better life"
Reps. Stephanie Tubbs Jones, Mark
Souder, Danny Davis and Rob Portman in-
troduced the Second Chance Act of 2004 in
late June, which addresses recidivism. The
heart of the bipartisan bill provides grants
to state and local governments to develop or
MICHAEL R. MAHR, Advertising Director
ARTHUR D. FARBER, Circulation Director
THOMAS P. McDEV1T>; Madmfing Director
DAVID N. COLEMAN, Production Director
SARA COOPERRIDER, Computer Services Director
STEVEN SWEET, Interna Director
JAMES BORER, Human Resources Director
RICHARD OBEN, Facilities Director
adopt procedures to ensure that criminals
are not released before they are ready. Some
prisons across the country have successful
faith -based and pre-release programs. One
such program, the InnerChange Freedom
Initiative, is a volunteer, values -based pro-
gram that operates in four states, including
Minnesota, and mentors and aids prisoners
on both sides of the gates.
The Second Chance legislation recog-
nizes that, too often, there is no bridge be-
tween the prison -based programs and life
on the other side. Among other things, it
calls for a national offender re-entry re-
source ' center and a federal interagency
task force, so that faith- and community-
based organizations can begin—or in some
instances, continue to work with — inmates
and governments. The bill also would re-
move the age limit of 60 years of age for
grandparents to receive support while car-
ing for the children of offenders and pro-
vides grants for mentoring organizations as
well as to state and local governments to es-
tablish post -release housing, such as group
homes. It also encourages collaboration
between correctional facilities and local
community colleges and technical schools,.
to enable prisoners to develop practical
skills to gain employment upon release. The
price tag is a little more than $100 million,
a relatively low-cost program when dis-
cussing the federal budget.
Second Chance provides hope for crim-
inals, but remains tough on crime. After
all, the bottom line is: When men and
women walk through the gates, will the
public be safer?
ovel-&
Exhibit g
Pageof t�
r•
F(
j
THE NEW FORK TIMES �DITO"11 051
;LETTERS FRIDAY, JANUARY 21, 2005 1 "
.1�1evv� 56at gles. tor`ACurbingRe.idiv sm
_
s State and federal lawmakers are finally" re I liz-
rearrested" within a" few years. These "people were
Ping that !controlling prison costs "means controlling '
: marginally "employable before they went to jail
fecidivism"— by helping newly released people es- .
nearly"half earned less than $600 a'moath. They are,
4 tat lish viable lives once tliey,,get out of Jai,, report
even iess empioyablg afterward, thanks to criminal
just out from a group of lOd policy makers, including
records. In ad`didda many.of them suffer fromil_ men-
elected "officials; ;established by the Council of State
talillnessesaat often go untreatedafter release.
Governments argues.that th'e country needs to re- :
invenx.its'corteetions s stem.;In the lace of a's s-
Y p y
" The social servaces necessary f6r successful re-
�" �'4"�
entry; are virtually noneii;te'trCi�n. most communi-
i tem that `locks people up and shoves them out the.
ties Th repoti'dffers; an"exhaustive prescrip=
:door when their' sentences are°fmishod, the rteport, '
tion for changing the 9tatus,quo: stojtes. will need to
,b the Re Eritr$ Po1ic. Gounvsipn�, "e=em
y y
-coax:I ispurate parts of their systefns. to. work to=
try"' services that reintegrate ex -offenders` into
gether. State officials will also, have to. re-educate,
their communities.
This line of thinking is long overdue. The United
voters, who have grown accustomed to a corrections
that begins and ends with merely locking
;States has 2.1 "million people behind bars on any giv-
+;en day -- nearly seven times the number three dec-
philosophy
people up for the;longest possible periodof time.
These policies will need to change, and quickly, if
jades ago. CoOrectiotis costs have risen accordingly
the states' aceto solve the recidivism problerri and
1:— from =about $9 billion a year two, decades ago "to
:more than $60 billion a year today— making correc- ;
develop programs that help former .inmates find
;:tions the second -fastest-growing expense in state "
homes, training, jobs and places in their communi-
budgets "after Medicaid. The portrait of the inmate_ .
+population offered in the report leaves no doubt as to
ties.: Until that happens, corrections costs will con -
tinue to soar, siphoning off billions of dollars- that
:why two' -thirds of -the. people who leave prison are
could be used for more constructive purposes.
Exhibit
Page F3 of 4_
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Exhibit
Page of --465—
o� Recidivism
• _ 1
Best Practices for DivertingMentally
Ill Individuals from County Jails
Letter from
NACo President lien Mayfield
Acknowledgements
What is Jail Diversion?
Presidential Initiative
About the Programs
Los Angeles County California
Clermont County Ohio
Butler County Ohio
Hamilton County Ohio
Miami—Davie County Florida
Program Central Themes
State and National Resources
Exhibit
Page;
JunC 2003
Dear Fellow County Official,
The nonviolent mentally ill should not be in county jails. I first realized this when I was a prosecutor in Dallas
County and came to understand fully how the justice system works. As a Dallas County Commissioner, I became
committed to changing the system that deposits the mentally ill in jail because there is no other place to put
them. For that reason, one of my initiatives as President of NACo focuses on encouraging counties to develop
programs to divert the non-violent mentally ill from jails.
A key objective of this initiative is to educate and train county officials and partners in the community about
the mentally ill, so that the mentally ill are identified and handled appropriately if and when they enter the crimi-
nal justice system.
According to the U.S. Department of Justice, of the 10 million admissions to jails each year, approximately 16
percent of the inmate population is mentally ill. This is a treatment and custodial problem for counties, both dur-
ing the jail term and in the person's reentry to the community.
Too often, the mentally ill tend to follow a revolving door, from detention to the streets and then back again.
The longer non-violent people with mental health problems are incarcerated, the more their condition will dete-
riorate—and then they may very well become a public safety risk.
Jail diversion programs can save counties money, provide better treatment for the mentally ill, and improve
public safety and the safety of the jail.
As part of the initiative, I made three site visits to learn about successful county programs.The programs
examined were in Los Angeles County, California; Hamilton, Butler and Clermont Counties, Ohio; and Miami -
Dade County, Florida. Accompanying me on these site visits were Commissioner Tony Bennett of Ramsey County,
Minnesota, and chair of the Justice and Public Safety Steering Committee and Commissioner Bill Kennedy of
Yellowstone County, Montana, and chair of the Health Steering Committee.
This report outlines the programs from these counties and how they were developed. It presents the key ele-
ments for starting a diversion program, describes the program operation, and demonstrates results of the cost
savings and improved services for the mentally ill.The report shows the level of commitment within the county
and the groups that must become involved for the program to succeed.
I encourage you to use this guide to develop yourjail diversion program or expand your program if you
already have one in place. One of the most important lessons that we learned is that none of the programs are
alike. Some of the elements are similar, but no program is identical with another.
A good program to divert the non-violent mentally ill from jail must fit the needs of its county. So, take the ele-
ments from these programs that work best for your county and develop a program. A successful program will
have a positive impact on your county and your citizens.
New legislation, the Mentally III Offender Treatment and Crime Reduction Act of 2003 has been introduced in
Congress to increase public safety and community health by facilitating collaboration among the criminal justice,
juvenile justice, mental health treatment, and substance abuse systems. The legislation will help divert individu-
als with mental illness away from the criminal and juvenile justice systems and treat them within the mental
health and substance abuse systems.
NACo was successful in getting language into the bill that will promote collaboration and partnership between
cities and counties and between states and local governments. I strongly support this legislation and urge you
to do so, too. k
Sincerely,
Kenneth A. Mayfield
NACo President
Commissioner, Dallas County,Texas
Exhibit
Page of
experiences,and rrisiglit�°� � '
3I1y grateful to the followirtg irdi,duals
Commissioner Tony Bennett, Ramsey County
Minnesota, Chair of NACo's Justice and Public Safety
Steering Committee
Commissioner Bill Kennedy, Yellowstone County
Montana, Chair of NACo's Health Steering Committee
Steve Szalay, Executive Director
California State Association of Counties
Elizabeth Howard
California State Association of Counties
Larry Long, Executive Director
County Commissioners Association of Ohio
John Leutz
County Commissioners Association of Ohio
Janice Bogner, Program Officer
The Health Foundation of Greater Cincinnati
IJohn Kies, Associate Director
Clermont County Mental Health & Recovery Board
John Staup, Executive Director
Butler County Mental Health Board
The Honorable Bob Proud
President, Clermont County Board of Commissioners
The Honorable Mary Walker
Clermont County Board of Commissioners
The Honorable John Dowlin
Hamilton County Board of Commissioners
The Honorable Courtney Combs
Butler County Board of Commissioners
The Honorable Charles Furmon
Butler County Board of Commissioners
The Honorable Michael Fox
President, Butler County Board of Commissioners
The Honorable W. Reed Madden
President, Greene County Board of Commissioners
The Honorable Dr. Barbara Carey -Shuler
Chair of the Miami -Dade Board of County
Commissioners
The Honorable Harvey Ruvin
Clerk of the Courts
Martha Guerrero, Legislative Analyst, Government The Honorable Katy Sorenson
Relations Department Vice Chair of the Miami -Dade Board of County
Los Angeles County Department of Mental Health Commissioners
Tom Joseph, Deputy Legislative Advocate The Honorable Natacha Seijas
Los Angeles County Miami -Dade Board of County Commissioners
The Honorable Steven Leifman, County Judge NACo would like to especially thank The Health
State of Florida 11 th Judicial Circuit Foundation of Greater Cincinnati for hosting a
dinner forum in honor of the NACo visit to the
The Honorable Yvonne Brathwaite Burke Southwestern Ohio counties.
Chair of the. L oc Ange!es,Co!nty_ Board of Super dsorc. ,
What is Jail Diversion?
The nation's local jails have increasingly become the
place of last resort for the mentally ill. Beginning in the
late 1950's and early 1960's, individuals with mental ill-
ness were released from state-run hospitals without
alternative placement. Many of these individuals sub-
sequently have committed repeat non-violent crimes,
resulting in incarceration, release from jail, and repeat
offense and arrest — a cycle of recidivism. By default, jails
in many communities have become the primary source
of care for the mentally ill, a function for which they are
neither equipped nor designed to handle. Moreover,
there are cases of individuals struggling with mental ill-
ness who intentionally break the law as a way to receive
treatment services. This cycle of recidivism is a clear
symptom of an unhealthy system.
In a landmark Bureau of Justice Statistics report by
Paula M. Ditton published 1999, Mental Health and
Treatment of Inmates and Probationers, it was estimated
that 16 percent of local jail populations are suffering
from mental illness. The study found that 70 percent of
the mentally ill population was comprised of non-vio-
lent offenders.
What county officials and the public should know
about the incarcerated, mentally ill population is not
just that these individuals will significantly benefit from
a system of comprehensive services, such as housing,
health, and human services, but also that such a strategy
would be less expensive and more effective in the long-
term. For a minor offender, community based mental
health care is far less expensive than maintaining the
individual in jail.
Moreover, implementing a community based social
services system is infinitely more.preferable to jail in
terms of humane care and treatment, and in addressing
the multiple issues facing this population. By keeping
the mentally ill within the health and human services
system, counties are better able to monitor their con-
dition, provide treatment, and dispense medication if
needed. And the public safety is better served.
Jail, on the other hand, has the opposite effect. It can
traumatize the mentally ill and result in worsened men-
tal health. For the county health department psychia-
trist, it often means working twice as hard to get indi-
viduals back to the better, though not entirely healthy,
condition they were in when they entered the jail. For
the sheriff, it often means assigning a deputy to carefully
monitor the individual in jail.
There is an additional, significant fiscal impact. In
many states, even a short stay in the county jail is
enough to disqualify a mentally ill person from such
entitlements as Social Security, Medicaid or Medicare.
Once an individual is released from jail, he or she is eli-
gible to receive such benefits, but it may take weeks or
months for the benefits to be restored.
In response to this cycle of recidivism, the mental
health, judicial, and law enforcement systems at the
county level have begun to work together to develop
solutions to this growing crisis. Some counties have
developed programs that demonstrate the benefit of
these systems working together to more effectively
respond to individuals with mental illness. These pro-
grams demonstrate interventions to divert people at
different stages in the criminal justice process, including
before arrest, after arrest, and after release from jail.
An ideal diversion program would include interven-
tions for mentally ill offenders at all stages of the crimi-
nal justice process. The first stage (or approach), often
referred to as the"crisis intervention team" approach,
diverts the individual at the scene of the disturbance by
training police officers to recognize signs of mental ill-
ness. Under this approach, the offender is transported
Exhibit
Page of
directly to a treatment or housing facility as an alterna-
tive to jail.
Another approach, called the "mental health court,"
diverts mentally ill individuals after they have been
arrested and charged with an offense. In this instance,
the court system has a program to allow for an alterna-
tive course of action. This action often involves having
the individual enter into treatment and case manage-
ment, while the court monitors the individual through
probation.
Sometimes a person will fall through the cracks and
not be diverted at either of the two stages described
above, ultimately leading them to jail. A "post -incarcer-
ation intervention approach"to transition individuals
from jail to community based treatment services helps
to ensure that they do not re -offend and re-enter the
criminal justice system.
Finally, a key component in sustaining the success of
a comprehensive diversion system is the availability of
a long-term, supervised residential housing program
for individuals with mental illness. This strategy has
been found to be very effective in preventing indi-
viduals from re-entering the criminal justice system;
however, it can be cost prohibitive. Nonetheless, with
the coordination, strategizing, and sharing of resources
between the criminal justice and mental health sys-
tems, counties have successfully implemented these
types of housing programs.
Presidential Initiative
NACo President Kenneth A. Mayfield has long rec-
ognized the serious problem of maintaining non-vio-
lent individuals with mentally illness in countyjails.
Therefore, Commissioner Mayfield made this issue a
focus of his presidency during 2002-2003. The human
and dollar cost of the increasing number of individuals
with mental illness being housed in the nation's jails is
a major problem for counties, Mayfield believes.
Commissioner Mayfield pursued this initiative to
raise awareness among county officials that there
are alternative strategies to treat non-violent offend-
ers with mental illness, and that these strategies can
be cost-effective. Diversion programs can improve
care for the mentally ill, reduce costs for counties, and
improve safety within the jails. Solutions exist and
counties can take the lead in being part of those solu-
tions. By encouraging the collaboration of mental
health and criminal justice systems, county officials can
initiate comprehensive programs to divert individuals
with mental illness from jail.
"One of my goals as NACo president was to look at
gathering support and getting counties involved in
making leadership decisions to divert the non-violent
mentally ill from our jails,"Mayfield said during a visit
to Los Angeles County.
More and more counties across the country have
begun to implement promising strategies in the
treatment and management of individuals with men-
tal illness in the jail system. During his presidency,
Commissioner Mayfield visited five such county mod-
els throughout the country to learn about the key ele-
ments that made for their jail diversion programs'suc-
cess. Mayfield, along with other NACo officials, toured
and studied these model programs. They found that
these programs reduced the fragmentation of services
for the mentally ill, demonstrated cost savings, and
could be replicated in counties nationwide.
Exhibit rj
Page L� of qff
About the Programs
"The matter remains that there are
too many Americans who have mental
challenges, and jails should not be the
answer,"
- Los Angeles County Sheriff Leroy Baca
Pre -arrest Diversion
■ Law Enforcement/Department of Mental
Health Clinician Teams (Mental Evaluation
Teams, MET)
This element of Los Angeles County's program
pairs law enforcement officers with mental health
clinicians to respond to 911 calls involving men-
tally ill citizens.Team members have been specially
trained to identify, evaluate, and locate appropriate
placement for the mentally ill citizen. Placements
can include shelters, medical facilities, or jail if nec-
essary. The Department of Mental Health has devel-
oped similar partnerships with the police depart-
ments of the cities of Los Angeles, Long Beach, and
Pasadena.
This cooperative project between law enforce-
ment and the mental health system began as one
MET team serving one section of the county. 20
MET teams now serve the county because of the
improved public safety and popularity among resi-
dents.
The main objective of the law enforcement -men-
tal health teams is to provide rapid, compassionate
response. To achieve this, teams provide interven-
tion, referral, or placement for mentally ill persons
while allowing field officers to focus on maintaining
public safety. The program prevents the unneces-
sary incarceration, and facilitates the hospitaliza-
tion when necessary, of these individuals. Another
objective is to return the sheriff's deputies back to
service in a timely manner. On average, it takes 3-4
hours to evaluate and transport the individual to
the appropriate facility. The average response time
to get officers back on scheduled duty is now 29
minutes.
One of the challenges of the MET program
has been establishing trust between the sheriff's
deputy officer and the mental health clinician.
Officers, used to having their partners be from law
enforcement, had to adjust to having civilian part-
ners. Building that trust was one of the barriers that
needed to be overcome for the teams to be effec-
tive.
When diverting a mentally ill person in need of
medical care, the team also determines if the per-
son has Medicaid or private insurance, enabling
the team to pinpoint the appropriate hospital that
would accept the person's medical benefit. If a
person requires hospitalization, the teams research
Exhibit
Page of 1-
the private insurance or verify Medicaid benefits and
then transport the person to either a county or pri-
vate hospital. According to the program's statistics, of
the individuals diverted, about one-third are placed
in county hospitals, another one-third are placed in
private hospitals, and the rest are transported to com-
munity providers.
County Leadership
The Los Angeles County Board of Supervisors played
a key role in establishing the law enforcement Mental
Evaluation Teams with the Sheriff's Department and
the City of Los Angeles, and in expanding that model
to other police departments throughout the county.
The ongoing leadership of the Board of Supervisors
has played a key role in the successful interagency
collaboration for the treatment of mentally III offend-
ers. The cornerstone of the county's jail diversion
initiative is the partnership among the Los Angeles
County Sheriff's Department, Probation Department,
Department of Mental Health, and the cities within
the county. This kind of cooperation and shared
vision among these departments has created sys-
temic change that is not only cost effective, but also
designed to improve the lives of the mentally ill in Los
Angeles County.
Results
In FY 2001-2002, the law enforcement -mental
health teams responded to 7,121 calls for interven-
tion. Of these, only 107 resulted in arrest. Given the
national recognition of this model, Sacramento County,
California, and Baltimore County, Maryland, have inves-
tigated initiating similar models.
Re-entry into the
Community/Housing
Strategies
■ Strategies:Village Integrated Service Agency,
Integrated Services for Homeless Mentally III
Offenders
This program is funded through special legislation,
Assembly Bill 34, established by the state of California
in 1999 to reduce homelessness and incarceration
among people with mental illness. The Village Agency
is one of several agencies contracted by Los Angeles
County to provide comprehensive care for the home-
less mentally ill.
This community-based program provides
treatment, housing assistance, linkages to health
care, employment and vocational services, advocacy
in the legal system, and assistance in applying for
public benefits to mentally ill individuals who are
homeless or at risk of incarceration. The program also
serves those who recently have been released or are
pending release from the criminal justice system. The
purpose of the program is to reduce incarcerations,
hospitalizations, and homelessness while moving
people into housing through an integrated
services approach. The program also provides crisis
intervention 24 hours per day, seven days per week.
Professional staff members work closely with jail
mental health services to link individuals in jail with
community agencies. Therefore, when individuals are
released from jail, they are already connected to ser-
vices.There are a total of 1,680 individuals enrolled in
the program.
Results
Comparing data for 720 participants 12 months prior
to their enrollment to the 12 months after enrollment
in the program demonstrated the following results:
77% increase in permanent housing
65% reduction in the number of incarcerations
80% decrease in the total number of days participants
were incarcerated
33% reduction in hospital admissions
250% increase in the number of participants employed
full-time
The success of the village integrated -services
approach has sparked much national interest. The
federal Substance Abuse and Mental Health Services
Agency is funding programs in counties across the
country to develop models based on the village
program.
Keys to Success
■ Outreach in the community and engaging the client
in treatment
■ Linkage of care from the jail to the community
■ Ongoing training, including training by the state on
developing partnerships with housing agencies
Exhibit
Page of 1�„ �5_
Post -arrest Diversion
The jail diversion project diverts individuals after
they are charged and brought into the Clermont
County Municipal Court system. There are three
Municipal Court Judges and a Magistrate who sen-
tence the majority of cases and make referrals to
the jail diversion program. Each of the judges plays
an integral role in the jail diversion program, and
all attended educational sessions on mental health
and substance abuse issues.
For the participants in the program, the primary
diagnoses were depressive disorder, bi-polar, and
generalized anxiety disorder. Driving under the
influence ranks as the most frequent charge for
individuals potentially served by this program; how-
ever, to qualify,a person must be diagnosed with a
qualifying mental illness. Often these individuals
suffer from both substance abuse and mental ill-
ness, called co-occurring disorders. Clermont's jail
diversion team consists of a specialized case man-
ager working with a dedicated intensive probation
officer whose background and understanding is
focused on persons with mental health problems.
Most clients participate in the intensive treatment
probationary period for 14 months.They must take
required medications and stay clean and sober
while in the program.
Results
From March 2000 to December 2002, a 34 -month
period, 252 non -duplicated individuals participated
in the program.These 252 individuals referred to jail
diversion had been sentenced to 37,629 jail days.
With jail diversion, 8,166 days were actually served
and 29,463 days were suspended.
At the county jail per diem rate of $57, the
sentenced days would have cost $2,144,853.
Considering the grant amounts and treatment
expenses, costs were $526,089 for the 34 -month
period, for a savings of $1,618,764. (Please note that
"As a Past President of the Ohio Community Corrections Association, I have seen
the benefits of jail diversion programs. It is important to recognize the mental health
issues that affect our community.These issues also affect our courts and corrections
systems. The jail diversion program supports these individuals in making restitution
and becoming more productive members of our community. Also, it frees up jail space
for more predatory offenders"
- Clermont County Commissioner Bob Proud
Exhibit
Page of
figure represents the maximum amount of savings to
the county. The offender may not have served all ini-
tially sentenced jail days.)
The recidivism rate during this period was 29, or
11.5% percent.
County Leadership
County officials are convinced programs such
as these can result in significant savings in county
resources and human capital. The Clermont County
Board of Commissioners believes in the success of the
project and has decided that the county will begin
covering the cost of a staff position to keep the pro-
gram running smoothly as one of the grant funding
sources ends. Beyond the cost savings, the Clermont
County jail is experiencing over crowding; therefore,
the Sheriff is also very supportive of efforts to divert
appropriate individuals to treatment in lieu of incar-
ceration. For the Sheriff, not only is the jail not the
best place to be treating these individuals, but liability
issues escalate when people with mental illness are
housed in the jail.
Keys to Success
■ Relationship and partnership between the courts,
law enforcement, and mental health treatment system
■ Examine existing models and design a program to
meet the needs of the local community
■ Set clear goals and objectives in planning stage
■ Collect data and measure the results
Exhibit
Page ,?)� of qW
Post -arrest Diversion
The SAMI Court is designed for individuals with
co-occurring mental illness and substance abuse
who have been charged with a felony in the Butler
County Court of Common Pleas.
Once a defendant qualifies, he or she must vol-
untarily enter a guilty plea and enter the SAMI
Court program as a condition of probation. The
caseload for SAMI Court program is 25 individuals;
it is a relatively small number because the program
deals with the most difficult cases in the commu-
nity. These individuals have moved from crisis to
crisis, ending up in emergency rooms, and repeat-
edly are arrested. All participants would have been
sentenced to prison, if not for the SAM[ Court treat-
ment option.
The program utilizes a specific treatment model
focusing on active treatment and relapse preven-
tion. The SAMI Court program treatment team
consists of representatives from probation, the
court, and the mental health and substance abuse
systems. This team of cross -system professionals
meets weekly to discuss the cases and treatment
planning. Every two weeks, SAMI Court partici-
pants are required to appear before the Court, and
the entire treatment team is present to review the
client's progress.
The probation officer monitors the client on a
regular basis, and the client is screened weekly for
drug use. The client also receives intensive case
management services consistently throughout
the program and can access assistance in obtain-
ing housing and enrollment in federal and state
benefit programs. A 24-hour crisis intervention
service is also available. The average length of stay
in the program is one year. After completion of the
program, individuals receive ongoing community-
based case management services.
Results
From July of 1999 through April of 2002, the
courts, probation, attorneys and social service agen-
cies referred over 400 individuals to the program.
From this group, 50 were found to meet all legal
and diagnostic criteria and were enrolled in the
program. Of the 50 clients admitted, 23 failed to
complete the treatment and were sentenced to
prison. As of May 2002, eight of the remaining 27
have graduated to community-based care and 19
are still active in SAMI Court treatment. Due to the
"difficult to treat" nature of this population, success
with a few clients is considered by Butler County to
be a positive outcome.
Exhibit
Page of
The following outcomes are based on data collected
on 30 clients who were in SAMI Court treatment for
any part of the one-year period from May 1, 2001,
through April 30, 2002.
■ Hospital costs were lowered by $177,000 for the 30
SAMI Court participants compared with costs for the
two years prior to admission.
■ Community treatment was less expensive than
prison. The cost to house and treat a mentally ill adult
in prison is approximately $80.10 per day, compared to
an average of $53.92 per day for SAMI Court services.
During this one-year study period, the cost of treat-
ment yielded a savings of $76,400.
■ By enrolling participants in Medicaid and Medicare
federal benefit programs, approximately 40% of SAMI
Court treatment costs are paid by the federal govern-
ment.
■ To date, none of the eight SAW Court graduates
have re -offended.
Post -arrest Diversion
■ Therapeutic Alternative Court (TAC)
Butler County launched a second mental health
court in January 2002 at the Fairfield Municipal Court,
building from the success of the SAMI Court. The City
of Fairfield within Butler County has a population of
approximately 42,000. The TAC program is a pretrial
diversion program for misdemeanor offenders who
have a qualifying mental illness. The understanding
behind the program is that these individuals most
likely committed a minor offense because of their
untreated mental illness, and court monitored treat-
ment would serve as the smarter alternative to jail.
Although the TAC program does not follow a specific
treatment model, the focus is on court oversight and
supervision, intensive case management, and system
coordination. The criteria and procedure for being
admitted to the TAC program are very similar to the
SAMI Court. A defendant must meet diagnostic crite-
ria, enter a guilty plea, and successfully comply with
program requirements.
1
Pre -arrest Diversion
Shortly after the TAC program began, mental health
staff met with the City of Fairfield Police Department
staff to discuss the goals of the TAC program and why
mental health training for officers would enhance
overall diversion efforts. The partnership that devel-
oped among the court, law enforcement, and mental
health community resulted in the creation of a crisis
intervention team approach. In October 2002, mental
health training for Fairfield police officers began as an
extension of the TAC program.
Results
From the period of July 1, 2002, through February
15, 2003, there have been 47 pre -arrest diversions with
none resulting in arrest. In addition to training officers
of the police department, mental health staff often
rides along with officers several times per month. TAC
mental health clinicians are also in communication
with the police department on an average of three or
more times per week.
Official evaluation of the TAC program is currently
underway.
Keys to Success
■ During project planning, define the roles of the
criminal justice and mental health system in program
implementation.
■ Consistent and frequent communication between
the criminal justice and mental health treatment staff.
■ Involving members of the mental health, probation,
and court systems in the decision-making process
regarding program participants'treatment planning.
Exhibit
PageLam. Q of
Post -arrest Diversion
Hamilton County's jail diversion project is
designed specifically for women with non-violent
misdemeanor or felony offenses who have been
diagnosed with co-occurring mental illness and
substance abuse disorders. The Court Clinic per-
forms a clinical assessment for each woman to
determine eligibility. A Judge or Probation Officer
can refer a woman once a diagnosis is made and
eligibility criteria have been met.
This program enables women to set personal
goals for the program and develop, with staff sup-
port, an individual treatment plan. Women must
participate in the core program for a minimum of
five weeks and up to three months. Step-down and
transition and aftercare services are available to
women for up to one year.
Hamilton County also opened its first Mental
Health Court, which operates out of the Hamilton
County Municipal Court, with funding support from
The Health Foundation of Greater Cincinnati and
the Hamilton County Community Mental Health
Board.The Court is designed to divert non-violent
misdemeanor offenders with a qualifying mental ill-
ness to community-based treatment.
County Leadership
The leadership and support of the Hamilton
County Board of Commissioners has been critical to
the creation and expansion of jail diversion efforts.
Results
From March 2001 to December 2002,4,203
women were screened for mental health and sub-
stance abuse disorders at the Hamilton County
Department of Pretrial Services. Three hundred
sixty-six women qualified for the next phase,
in- depth assessment, and a recommendation of
appropriate treatment was made to the court. Of
the 366 women assessed, 25 women were not
found to be in need of treatment services, and 119
entered the Alternative Interventions for Women
program. The remaining individuals were referred
to other community-based services.
Exhibit
Page of
3
Pre -arrest Diversion
There are Crisis Intervention Team (CIT) police
programs. Police officers volunteer to complete 40
hours of training to learn how to sensitively and
effectively interact with individuals in mental health
crisis. The County Mental Health Hospital Center,
Jackson Memorial Hospital, provides the training
at no cost. There are currently 10 police agencies
in Miami -Dade County offering the CIT program.
Once diverted, CIT officers transport the individual
to one of six community mental health center crisis
stabilization units (CSU's). These state -funded pub-
lic receiving facilities stabilize individuals and assist
them in accessing services. Once released, the
Court Mental Health Project staff tracks and ensures
that these individuals are linked with case -manage-
ment services.
Post -arrest Diversion
The post -arrest misdemeanor diversion occurs
through two courts that are not separate specialty
mental health courts, but function like specialty
courts. If an individual is determined to be in need
of mental health services, they are transported by
the Department of Corrections within 24-48 hours
of arrest to an appropriate CSU.
To enroll and maintain individuals in federal ben-
efit programs for better access to treatment, Miami -
Dade County has established a relationship with
the local Social Security office to expedite the pro-
cess of re-establishing or establishing federal ben-
efits for individuals. Under this system, it can take
as few as 24 hours to establish a person's benefits.
Housing
There are adult living facilities that provide long-
term supervised housing for people with mental ill-
nesses. The Court Mental Health Project refers 500
to 1,000 individuals per year to these adult living
facilities.
Collaboration
A group of stakeholders including State's attor-
neys, public defenders, state and county repre-
sentatives, family members of people with mental
illness, members of the judiciary, the Department
of Corrections, mental health providers, and repre-
sentatives from the 10 police agencies involved in
CIT meet on a monthly basis to discuss successes,
challenges, and needs of the entire jail diversion
program.
The State of Florida has been a key partner with
Miami -Dade County in their efforts to properly treat
Exhibit
Page of
people with mental illness. Both the county and the
state work together in a mutually beneficial way and
each contributes to the success of the project. The
state has provided funding for a staff person within
the court system to link diverted mentally ill individu-
als to case management services. The state has also
offered to help offset costs of treating undocumented
immigrants who cannot access benefits. The county
provides funding for an additional staff position in
the court and also has committed $6 million to build
a forensic facility, to expand crisis stabilization, and to
provide a transitional living program.
County Leadership
The Miami -Dade Board of County Commissioners
provides critical leadership for jail diversion efforts.
Not only is the Commission supportive of efforts to
find the best alternatives for treating individuals with
mental illness, they also are committed to ensure
that these efforts not only continue, but expand. The
County Board Chair plans to keep the issue of appro-
priate treatment of mentally ill individuals a top prior-
ity in Miami -Dade County.
Results
The City of Miami CIT police officers diverted 2,100
individuals to community based mental health centers
over a period of six months, resulting in fewer police
injuries, decreased recidivism, and substantial savings
to the county.
From 2000 to 2001, the Project has reduced the
recidivism rate for the mentally ill population from an
estimated 70 percent to 11 percent. The recidivism
rate rose slightly, to 18 percent, in 2002. According to
the Project's calculations, the overall reduced recidi-
vism rate saved Miami -Dade County $2.3 million in a
one year period.
In May 2003, Miami -Dade County was one of seven
communities across the country to be awarded a
federal grant from the Substance Abuse and Mental
Health Services Administration (SAMHSA) to expand
its jail diversion program. Additional expansions and
improvements to the Project are underway, including
enhancing evaluation through a partnership with a
local foundation and university, and creating a felony
diversion program.
Keys to Success
■ Partnership and cooperation among state, county,
and city agencies
■ Cooperative agreements with hospitals and other
mental health providers to build the continuum of
mental health care.
■ Having a coalition of key stakeholders meet regu-
larly as a group to strategize on how to continue lever-
aging local, state, and national resources. Approaching
potential funding sources as coalition with a shared
cause can increase chances of success.
■ Ongoing and frequent communication among the
key agencies involved in the jail diversion program
■ Leadership of the County Commission
Exhibit
Page of
Program Centrad Themes
County Leadership
In each of the sites visited, the County Board, County
Sheriff, and members of the judiciary played key roles
in launching jail diversion efforts. In many cases, the
support and leadership of elected and appointed
county officials created the political will for programs
to be developed. Additionally, county elected officials
can play a key role in financial!y sustaining programs
after grant funds or start-up funds expire.
Strategic Planning
As demonstrated by the visits, there are innovative
strategies for counties of all sizes. Counties certainly
should investigate and examine existing models for
jail diversion and decide what pieces/aspects will
work best for their community. What will work effec-
tively in one community may not in another. The best
approach often depends on the social needs of the
county, the problems particular to their region, and the
structure of local systems.
City/County
Collaboration
Another common theme was the division of labor
between municipal and county governments and the
need for collaboration. Counties have a major respon-
sibility for funding felony courts, operating jails and
detention centers, and providing for public health and
human services at the local level. Municipal govern-
ments have major responsibility for municipal police,
public housing and misdemeanant courts. It is essen-
tial that they plan and work together.
5
Mental Health/Criminal
,justice Collaboration
The need for collaboration between criminal justice
and health and human service agencies at the local
level in dealing with the mentally ill was another cen-
tral theme of the programs we visited. The ability of
these two systems to effectively work together and
share responsibility for treating this population played
a key role in the success of the programs.
State/Local
Partnerships
The sharing of responsibility between the state and
counties for the humane and appropriate treatment of
individuals with mental illness is essential. In each of
the local programs visited there was State support of
the programs. Whether through special legislation (LA
County), grants from State Mental Health Departments
(Ohio), or the state being open to and responding to
requests for assistance from the county (Miami -Dade),
the state and local governments need to work with
each other to put a final end to this crisis. Each has
much to gain by the improved public safety, reduced
costs, improved lives, and even lives saved.
Future Opportunities
Counties are inherently regional governments and
as such are often engaged in countywide and multi -
county solutions. (There are 2500 counties with popu-
lations of less than 50,000.) Progress in developing
new systems at the local level will depend on creating
new partnerships between state and county govern-
ments and strengthening relationships between city
and county governments.
Exhibit
Page 44 of
State and National Rescurces
■ Substance Abuse and Mental
Health Services Administration
(SAMHSA)
Center for Mental Health
Services (CMHS)
Phone: (301) 443-0001
Center for Substance Abuse
Treatment (CSAT)
Phone: (301) 443-5700
Room 12-105 Parklawn Building
5600 Fishers Lane
Rockville, MD 20857
Email: info@samhsa.gov
Web: www.samhsa.gov
■ U.S. Department of Justice
Office of Justice Programs
Bureau of Justice Assistance
950 Pennsylvania Avenue, NW
Washington, DC 20530-0001
Phone: (202) 616-6500
Email: AskBJA@ojp.usdoj.gov
Web: www.ojp.usdoj.gov/BJA/
■ The National GAINS Center
for People with Co -Occurring
Disorders in the Justice System
Policy Research Associates
345 Delaware Avenue
Delmar, NY 12054
Phone: (800) 311-4246
Email: gains@prainc.com
Web: www.gainsctr.com
■ National Resource Center on
Homelessness and Mental Illness
Policy Research Associates
345 Delaware Avenue
Delmar, NY 12054
Phone: (800) 444-7415
Email: me@prainc.com
Web: www.nrchmi.com
■ National Sheriffs' Association
1450 Duke Street
Alexandria,VA 22314-3490
Phone: (703) 836-7827
Web: www.sheriffs.org
■ National Association of
State Mental Health Program
Directors (NASMHPD)
Phone: (703) 739-9333
Web: www.nasmhpd.org
■ National Association of
County Behavioral Health
Directors (NACBHD)
1555 Connecticut Avenue NW
Suite 200
Washington, DC 20036
Phone: (202) 234-7543
Email: Lauren@nacbad.org
Web: www.nacbad.org
■ Bazelon Center for Mental
Health Law
1101 15th Street NW
Suite 1212
Washington, DC 20005-5002
Email: materials@bazelon.org
Web: www.bazelon.org
■ President's New Freedom
Commission on Mental Health
5600 Fishers Lane
Room 13C-26
Rockville, MD 20857
Phone: (866) 326-4563
Email:
staff@mentalhealthcommission.gov
Web:
www.mentalhealthcommission.gov
■ Police Executive Research
Forum (PERF)
1120 Connecticut Avenue NW
Suite 930
Washington, DC 20036
Phone: (202) 466-7820
Email: perf@policeforum.org
Web: www.policeforum.org
■ The Health Foundation of
Greater Cincinnati
Janice Bogner, Program Officer
3805 Edwards Road, Suite 500
Cincinnati, Ohio 45209-1948
Phone: (888) 310-4904 (Toll Free)
Email:
jbogner@healthfoundation.org
Web: www.healthfoundation.org
■ The Maryland Mental Health
and Hygiene Administration
Dr. Joan Gillece, PhD
Director of Special Needs
Populations
201 West Preston Street
Baltimore, MD 21201
Phone: (410) 724-3235
■ Florida Partners in Crisis
Advocating for Improved Mental
Health and Substance Abuse
Services in the State of Florida
100 Bush Boulevard
Sanford, FL 32773
Phone: (407) 665-6731
Web:
www.floridapartnersincrisis.org
■ Criminal Justice/Mental
Health Consensus Project
Council of State Governments
Phone: (212) 912-0128
Web: www.consensusproject.org
Exhibit
Page L - of 14W-
PAROLE AND PROBATION BUDGET
FY 04-05
Administration
1.0 FTE Director
2.0 FTE Supervisor
1.0 FTE Administrative Supervisor
Supervision
3.0 FTE generic caseloads (felony only)
1.0 FTE intensive supervision caseload (felony only)
1.0 FTE mental health caseload (felony and misdemeanor)
2.0 FTE family violence caseloads (felony and misdemeanor)
1.0 FTE limited risk caseload (felony only)
1.0 FTE low risk caseload (felony only)
2.0 FTE LaPine caseloads (some misdemeanor family violence and sex
offenders in addition to felons)
2.0 FTE Redmond caseloads (same as above)
3.0 FTE sex offender caseloads (felony and misdemeanor)
16.0 FTE parole and probation officers
Programs/Services
Presentence reports
Alcohol/drug testing
Community service referrals and tracking
Electronic monitoring
Transitional housing
Substance abuse treatment
Assistance for indigent sex offenders with cost of sex offender treatment
Lifeskills training
Administrative hearings (parole violations)
Day reporting
Wish list for FY 05-06
Purchase assessment services from mental health (approximately 4 hours per week)
Expanded substance abuse treatment
Assistance for indigent family violence offenders with cost of battering
intervention programs
2/4/05
Exhibit in
Page of �_
MENTAL HEALTH ISSUES
Local Public Safety Coordinating Council
February 7, 2005
Introduction—Les Stiles, Scott Johnson
Deferred Sentencing Program—Judge Tiktin, Susan Battles ATTACHMENT
A Family Perspective—The Marble Family
Jail Trends, Statistics and Services—Ruth Jenkin, Rob Burch ATTACHMENT
Parole & Probation Services and Needs—Becky Wanless, Pat Tabor ATTACHMENT
Other Recent Developments; Discussion
Other materials attached:
DCMH Bridge Grant Information
Sage View Information
Exhibit D
Page of 1 c�
Deschutes County Mental Health Deferred Sentencing Program
PROGRAM OBJECTIVES:
These are the identified objectives of the Mental Health Deferred Sentencing Program.
* Protect public safety.
* Reduce the frequency with which those suffering from mental disorders
encounter the criminal justice system.
* Decrease the inappropriate use of institutionalization for people with mental
illness.
*Improve the mental health and well-being of the defendants who come into
contact with the Deferred Sentencing Program (DSP);
*Develop greater links between the criminal justice system, mental health
and other social service agencies in order to better coordinate and enhance the
overall delivery of mental health and chemical dependency services;
* Expedite case planning and processing.
CRITERIA:
*Any non -person misdemeanor committed by a person who has a major mental illness (The DA
may consider other cases for inclusion in the program on a case-by-case basis)
*The individual is diagnosed with a severe and persistent mental illness (i.e. Schizophrenia,
Bi -polar Disorder, and/or Major Depression) and collateral sources indicate that there is
a history of a severe and persistent mental disorder.
* Potential participants in jail will be screened initially by the adult jail Mental Health
Specialist, with recommendations made to the district attorney, public defender and
the Court Liaison regarding whether they are appropriate for the program;
*The Court liaison will make recommendations to the district attorney and the public
defender, for potential participants in the community if they are brought to the attention
of the liaison and they meet the criteria to participate in the program.
*The participant's mental illness is treatable in a community setting;
*The person is legally competent and voluntarily consents to participation in the alternative
track;
*The individual has a stable local address.
REFERRAL FOR SCREENING:
*Those defendants lodged in the jail are eligible for a referral for screening.
*The arresting officer notes any abnormal behavior and documents. Information
regarding the subjects abnormal behavior is passed on to the jail deputies by the
arresting officer.
*If the arresting officer believes the individual might be appropriate for the DSP
program the arresting officer should mention this to the jail deputy and note it in the
police report.
*Referrals to the Court Liaison at the Deschutes County Mental Health and the jail
Mental Health Staff can be initiated by the Court, the District Attorney's office,
Community Corrections, County Jail staff, the Public Defender, the Mental Health
Department, Community Police, family members, or by the consumers themselves.
PROCESS:
After a defendant has been referred to the Mental Health Professional at the jail or the
Court Liaison the following will occur:
*The Mental Health Professional at the jail or the court liaison will determine whether the
individual is clinically appropriate for the Deferred Sentencing Program.
*The DA will determine whether the person is legally appropriate for the program.
*If the defendant is deemed appropriate for the program treatment recommendations are
prepared and submitted to the court, the DA and the PD.
*The individual will then go through the DSP court process.
Exhibit D
Page of
Deschutes County Sheriff's Office
COMPOSITE PROFILE OF A DESCHUTES COUNTY CITIZEN WITH THE CO-
OCCURING DISORDERS OF MENTAL ILLNESS AND DRUG ABUSE,
INVOLVED IN THE CRIMINAL JUSTICE SYSTEM
Identifying Information
a. Age: 28
b. Sex: M
c. Ethnicity: Caucasian
d. Education: 10th grade High School; participated in GED classes.
e. Employment: Unemployed; Disability Application in Process
II. Charges
a. Criminal Trespass
b. Menacing
c. Harassment
III. Diagnoses
a. Bipolar Disorder; with Psychotic Features
b. Amphetamine Abuse
c. Epidemiological data indicate the high prevalence of co morbidity for
substance abuse disorders and mental disorders in the general population'.
IV. Points of Identification / Intervention
a. Arresting Officer (CIT Crisis Intervention Training)*
b. Pre -Booking Mental Health Screening*
c. Post -Booking Intake Medical Screening
d. Jail Mental Health Appraisal
e. Court Arraignment Hearing (Possible Mental Health Court)**
V. Deschutes County Adult Jail Mental Health Services
a. Crisis Intervention
b. Medication Stabilization
c. Assessment and Referral to Mental Health and Chemical Dependency
Treatment Services
d. Counseling
e. Case Management
' U.S. Department of Health and Human Services; Substance Abuse and Mental Health Services
Administration (2002). Report to Congress on the Prevention and Treatment of Co -Occurring Substance
Abuse Disorders and Mental Disorders.
*possible pre -booking diversion
**possible post -booking diversion
Exhibit
Page of 10
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MENTAL HEALTH ISSUES
IMPACTING PAROLE AND PROBATION DEPARTMENT
Mentally ill offenders under supervision: 60
Percentage male 75%
Percentage female 25%
Average age 35
Diagnosis; from mild depression and anxiety to paranoid
schizophrenia
Needs; housing, medication, speedy access to psychiatric
care
P and P staff dedicated to supervision of mentally ill
offenders 1.00 FTE
Salary and benefits per FY
Subsidy dollars spent on mentally ill offenders
per FY
$ 5,000
Exhibit D
Page —I_ of -LQ_
Deschutes County Mental Health
Bridge Grant
MHS 20 funds continue to be utilized to support a Mental Health Specialist I (QMHA level
clinician), who provides services to adults with co-occurring disorders within the jail and the
community corrections system in Deschutes County. This position acts as a liaison between
DCMH, Parole and Probation, and the Jail, providing intensive case management services such
as:
• Setting clients up with the Self Sufficiency Program, the Seniors and Persons with
Disabilities Program, the Social Security Administration, Vocational Rehabilitation,
Central Oregon Regional Housing Authority and Central Oregon Community College.
• Assisting clients in connecting with psychiatric and medication management services.
• Working closely with the local hospitals, crisis staff, jail mental health staff, and Parole
and Probation to find the least restrictive option for the clients.
• Diverting from emergency hospitalization/incarceration through intensive case
management and outreach services.
• Working closely with clients who have been released from the state hospital (and have
ties with the correctional system) in order to give the client added support to reduce the
chance of decompensation. This includes some individuals released under the
jurisdiction of the PSRB (Psychiatric Security Review Board).
• Assisting clients coming out of prison in connecting with mental health and community
supports.
• Completing ASAM drug and alcohol assessments in the jail, and making appropriate
referrals to inpatient drug and alcohol treatment facilities.
• Working with many at -risk offenders and their families struggling with mental health
issues and addictions.
• Facilitating a weekly treatment group for individuals with co-occurring disorders.
• Working in combination with family court and Ready -Set -Go to help establish a
treatment plan for helping these clients regain custody of their children by helping them
follow through with recommended treatment/classes.
Deschutes County Mental Health and our partners believe implementation of the bridge position
has improved our services to individuals with co-occurring disorders who are involved with the
criminal justice system. Unfortunately, with the OHP cuts, state budget cuts, and county mental
health cuts, treatment options for this population continue to dwindle. Lack of prescription drug
coverage has made it very challenging to keep clients on their medications, and only the most
severely and persistently mentally ill are able to receive mental health services.
Exhibit
Page of to
Sage View is a 15 -bed acute psychiatric facility that will be initially licensed as a residential psychiatric
facility under the ORS. It is a free-standing facility on the campus of St. Charles Medical Center - Bend.
Sage View was constructed with donations from a variety of sources including a Community Development
Block Grant, Lottery Dollars through the Central Oregon Intergovernmental Council, Ford Family
Foundation, Jeld-Wen, Collins Foundation, Deschutes County Mental Health, St. Charles, National Alliance
of the Mentally Ill (Central Oregon Chapter), and many others. The facility has one loan from Deschutes
County that the hospital will repay. Sage View has also received a large operational grant for three years
from the Northwest Health Foundation.
Initially formed as a partnership with Deschutes County and the Central Oregon Regional Housing
Authority, Sage View is fully owned and operated by Cascade Healthcare Community, the parent company
of St. Charles Medical Center - Bend and St. Charles Medical Center - Redmond. Central Oregon is the last
region of the state to develop acute mental health resources. For years, citizens have traveled hundreds of
miles for care that can now be delivered safely in their own region.
Sage View utilizes the latest research and evidence -based practices including:
• Home -like environment with private rooms, each with a view of nature. The facility has a
classroom, day room, dining facilities and outdoor recreation area all within a secure environment
• 24-hour RN staff, Master's level clinicians, Bachelor's level technicians, Recreational Therapist and psychiatry
services
• 24-hour intake and admissions, including a secure area for police holds
Sage View will be a non-violent environment. Research shows that the utilization of seclusion and restraint
is not therapeutic, and contributes to the trauma experienced in these settings. Sage View has applied for
a variance from the State to open without a seclusion/restraint room. Caregivers and patients will agree to
behave within the bounds of this culture, and if a more secure environment is needed, accommodations are
available at St. Charles Medical Center - Bend.
Sage View serves as the central mental health resource for the region. The following additional services
have been developed, are in implementation, or are planned for the near future:
• Horizon House—a 14 unit transitional housing complex built by Central Oregon Regional Housing
Authority (CORHA) with federal HOME funds and grants from St. Charles and Deschutes County
located next door to Sage View
• Emma's Place—an 8 unit permanent housing complex built by CORHA and staffed by Deschutes
County Mental Health (DCMH) located in Bend
• Prairie House—an 8 unit permanent housing complex under construction by CORHA and staffed by
Crook County Mental Health located in Prineville
• Barbara's House—an 8 unit permanent housing complex under development by CORHA and staffed
by DCMH located in Redmond
• TBA—an 8 unit permanent housing complex under development by CORHA and staffed by
Jefferson County Mental Health located in Madras
St. Charles was also recently awarded a $450,000 federal Rural Utilities Service grant to fund and
implement a teleconferencing network throughout 25 rural mental health settings in Central and Eastern
Oregon, placing state-of-the-art units in each clinic, connected through a bridge at St. Charles, with the hub
at Sage View. We are in negotiation with OHSU to begin development of a rural telepsychiatry program to
service this much needed population.
It is the hope of St. Charles and the development team of Sage View that this model of care can be adopted
as the preferred resource for development in the future.
Exhibit
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Deschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
MEETING AGENDA
LOCAL PUBLIC SAFETY COORDINATING COUNCIL
3:30 P.M., MONDAY, FEBRUARY 7, 2005
Commissioners' Conference Room - Administration Building, Second Floor
1300 NW Wall St.., Bend
1. Call to Order & Introductions
2. Approval of January 10, 2005 Meeting Minutes
3. Discussion of Rural Domestic Violence & Child Victimization Enforcement
Grant - Judge Sullivan
4. Report on NACo Justice and Public Safety Steering Committee Retreat — Tom
De Wolf
5. Discussion of the Parole & Probation Department's 2005-07 Biennial Plan —
Becky Wanless
6. Criminal Justice and Mental Health Items
Overview — Les Stiles, Scott Johnson (5 minutes)
Crisis Services at County Mental Health — Pam McCollum (5 minutes)
A Family Perspective — the Marble Family (10 minutes)
Deferred Sentencing Program —Judge Tiktin, Susan Battles (10 minutes)
Jail Trends, Statistics and Services — Ruth Jenkin, Rob Burch (10 minutes)
Parole & Probation Services and Needs — Pat Tabor (5 minutes)
Other Recent Developments; Where Do We Go from Here? (15 minutes)
7. Other Business