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Veteran Treatment Courts
March 21, 2016 by CSOSA
DC Public Safety Radio
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See the radio program at http://media.csosa.gov/podcast/audio/2015/11/the-growth-of-veterans-treatment-courts/
Leonard Sipes: From the nation's capital, this is DC Public Safety. I'm your host, Leonard Sipes. Ladies and gentlemen, veterans treatment court is the topic for today. We have three extraordinary guests before our microphones. Aaron Arnold is the Director of Treatment Court programs at the Center for Court Innovation. Aaron oversees the Center's national training and technical assistance for drug courts. Greg Crawford is a Correctional Program Specialist at the Community Services Division at the National Institute of Corrections. Greg's experience prior to the National Institute of Corrections includes over fourteen years as a probation department person and a community based mental health agency expert. We have Ruby Qazilbash. Did I get that right or did I screw that up? Qazilbash.
Ruby Qazilbash: Qazilbash. Good enough.
Leonard Sipes: Ruby is the Associate Deputy Director for Justice Systems Policy at the Bureau of Justice Assistance within the US Department of Justice. She leads a team of policy staff in program and policy development aimed at improving safe local and tribal justice systems. To all three of you, welcome to DC Public Safety.
Greg Crawford: Thanks, Len.
Leonard Sipes: Veterans treatment court, it is exploding. It is growing like wildfire throughout the United States, so Greg, give me an overview of what veteran's treatment court is.
Greg Crawford: Basically what a veterans treatment court is, is a hybrid integration of drug court and mental health court that serves military veterans, and sometimes active duty personnel. The first veterans court was implemented in 2008 up in Buffalo, New York by Judge Robert Russell, and since then, there's been over three hundred implemented across this country.
Leonard Sipes: That's an amazing amount of growth. Aaron, to my knowledge, I can't think of another criminal justice program that has grown as much or as fast as veterans treatment courts.
Aaron Arnold: I'd have to agree with you. I mean drug courts have been around longer, and there are more of them, but they didn't grow quite as fast as we're seeing veterans treatment courts grow today.
Leonard Sipes: Ruby, the role of the Bureau of Justice Assistance within the US Department of Justice, you are the Associate Deputy Director for Justice Systems Policy. Obviously, you're here to support BJA's involvement in veterans treatment courts, correct?
Ruby Qazilbash: That's correct. BJ provides training, funding. In fact, we've set up almost two hundred veteran treatment court teams around the country, training soup to nuts, making sure that those team members understand what their roles and responsibilities are, that they come out of that training with a policy and procedures manual, and they're ready to go and open those doors to veterans. We, also, provide federal funding to the drug court programs, solicitation, and veteran treatment courts are eligible to come in for federal funding, federal grants to support the implementation of these courts around the country.
Leonard Sipes: I can't think of any other program where everybody's on board. Everybody's enthusiastic, everybody wants this to occur. The question is why? Why is it growing so fast? Why is everybody on board with this?
Aaron Arnold: I would say because they work, Len. First of all, veterans are not typically criminals prior to their military service, and some veterans have experienced things and done things that most of us can't imagine, and they come home, and sometimes they struggle. Sometimes they self-medicate with alcohol and drugs, and they, unfortunately, find themselves involved in the criminal justice system, and really what veterans treatment courts do is they're an opportunity to intervene in the lives of veterans before things escalate for them in the system. What they're doing, is they're restoring veterans' lives. They're reducing recidivism. They're enhancing public safety, and saving taxpayer dollars, so it's checking all the boxes.
Leonard Sipes: Is there an issue with veterans and a crime?
Aaron Arnold: Well, typically, like I said, veterans are not criminals prior to their service, and they're coming home and they're really struggling with post traumatic stress disorder, and traumatic brain injury, and it's taking them down a path, and I think that's why it's so critical for our system to intervene before they go down a deeper path.
Leonard Sipes: People so far are seemingly bullish about veterans treatment courts, and the question either goes out to Aaron or to Ruby. Most people seem to feel that they do better than the typical drug courts or the typical treatment courts, that veterans, given the chance, have an opportunity to rearrange their lives and straighten their lives out, but they need assistance. First of all, am I right with the perception that veterans treatment courts seem to have greater potential than other specialty treatment courts?
Ruby Qazilbash: There are obviously a proliferation of drug courts around the country. As Aaron said, that movement has been building and growing for the past twenty-five years, but, since then, we've, also, seen other specialty or problem solving courts address the special needs of individuals in our communities, including mental health courts, and then, of course, veterans treatment courts. I think that the issue is to find the diversion opportunity. You want to reduce incarceration and get people the help and the services that they need, so they can lead productive lives, crime free, to find the right intervention for them, and the project that we're talking about today we hope is going to lead us down that road.
Do they see equal or better outcomes as drug courts that we know of? I think more research, for sure, needs to be done, but outcomes are looking good so far.
Leonard Sipes: Everybody seems to be very encouraged about that. Everybody seems to be very encouraged in terms of the outcomes thus far. We've had 2.5 million men and women serve in our country since 9/11, and 1.5 million serving overseas. Veterans come home. They struggle with combat related issues. As Greg said a little while ago, PTSD, major depression, homelessness, suicide, and some are ending up with us, within the criminal justice system. This is not just a matter of good criminal justice policy. This has a moral issue attached to it as well, does it not, Greg?
Greg Crawford: I think so. Absolutely. Here's the deal, like you said, we had 2.5 million serve our country since 9/11, and really it's a volunteer service. These people are serving our country as volunteers, so the rest of us don't have to go overseas and fight our wars in Iraq and Afghanistan, or wherever they are, so absolutely, I think we have an obligation to try to help them.
Leonard Sipes: Where are we going with all of this? The Bureau of Justice Assistance in the US Department of Justice is providing funding for the expansion of drug court. We are talking about evaluating drug court. We are talking about creating specialized instruments for drug court. The National Institute of Corrections is coming out at a certain point with a white paper that describes what best practices in drug court.
Greg Crawford: Yeah. What we want to talk about here today is … The white paper actually served as a platform for all of NIC's veterans specific initiatives. We've, also, done a three hour live satellite broadcast on veterans treatments court, and, also, with that, I contacted Ruby over at BJA about a potential collaboration to develop a risk needs assessment tool that factors in trauma for justice involved veterans. As a former probation officer, back in the day I would get cases, and these veterans coming in from joint base Lewis McChord over in Pierce Country, Washington. They would be ordered to do domestic violence treatment, and nothing on the court order would touch their underlying issues of PTSD and TBI that I think are a major cause of them bleeding into the system, and that's why we partnered on this project, because we thought there needs to be some science behind what we're doing in these veterans treatment courts. I don't want to steal Aaron's thunder, but I'll let him talk a little bit about the project.
Leonard Sipes: Go ahead, Aaron.
Aaron Arnold: Thanks, Greg. Greg hit it on the head. We're trying to put some science behind what veterans treatment courts are doing, and I should just give a little context to say that in the drug court field, for a number of years now, courts have been eager to adopt evidence based risk need assessments, and all that means is to use a standardized set of questions that courts or probation departments will ask to offenders who are coming into the court system to try to identify what are their actual needs that we can help to address to reduce their risk of re-offending, and those tools exist. There are many of them that are being used in the drug court context. They have been proven over and over again in the research to help courts do a better job of getting people the appropriate kinds of supervision and treatment they need, and reduce their long term risk of re-offending.
What has not existed, up till now, is a specialized risk need tool designed specifically for the justice involved veterans population. That's what this project is intended to create. Here at the Center for Court Innovation … We're a nonprofit justice reform organization in New York City, and what we're doing is, with our in house research department, is to create the first evidence based risk need assessment tools for use in veterans treatment courts.
Leonard Sipes: It's important that whatever risk instrument that we come up with, that it really works with that particular population, whether it be juveniles, whether it be women, whether it be men, whether it be adults, whether it be pre-trial, whether it be supervision, adult supervision, whether it be … It doesn't matter. The whole idea is to create a risk instrument that is going to be germane to that particular population. What is unique, Aaron, about the veterans and in a risk instrument?
Aaron Arnold: That's exactly right. We've actually spent the last twelve months working, like I said, with our in house researchers, with our partner agencies around the country, like the National Association of Drug Court Professionals and Justice for Vets, other organizations who work in this field, as well as a hand picked committee of experts in the field, who are helping us to identify what are the specific unique factors that veterans bring to the justice system, and how can we reflect those in a new evidence based risk need tool. Some of those we've already talked about: the exposure to combat trauma and the resulting post traumatic stress disorder, traumatic brain injury, and other mental health issues that emerge from that, the substance abuse and other behavioral health factors that can emerge after folks return home. Making sure that all of those very specific needs are reflected in the instrument itself, so that courts have the tools they need to make sure that folks are getting the appropriate levels of supervision and treatment.
The tools are essentially done at this point. We're excited. After a year, we've drafted up the tools, and they're ready to be tested in the field.
Leonard Sipes: Ruby, this is exciting. You represent the Bureau of Justice Assistance from the US Department of Justice, and within the Obama Administration, what they have done through federal agencies and through funding to state, local, tribal agencies, is to expand the concept of alternatives to traditional ways of conducting criminal justice. This is exciting, because it's moving in a dozen different directions. We are basically reinventing the way that we operate the criminal justice system on a wide variety of platforms. The veterans treatment court is just one of them.
Ruby Qazilbash: Without a doubt. I think we know so much more about what contributes to criminal behavior, and what this project lends itself towards is furthering to narrow that, and to get the right people into the right program at the right time, and I think Aaron hit on it when he said that the intention for this risk and needs assessment is to figure out for the individual that you're presented with in that courtroom and that day.
With using an assessment tool that's accurate for that population and for that person's peers. What is their risk level, so that we can assign supervision accordingly. We don't want to over supervise. We don't want to under supervise. We want to get it right. For needs assessment, what kinds of potentially substance abuse treatment might that individual need, what kind of mental health counseling. What should that look like? What should the dosage be, so that we can give people what they need. The point here is to increase their functional outcomes, the way that they behave and act in society in a way that's beneficial to them and to the rest of us, and to reduce recidivism, thereby enhancing public safety for the community that those folks live in.
Leonard Sipes: The larger question is that it becomes a larger issue. Veterans treatment courts go hand in hand with regular treatment courts, go hand in hand with all sorts of opportunities and endeavors that the federal government, and state governments and local governments are trying to employ nowadays to operate the criminal justice system differently, to intervene in the lives of individuals earlier, to defer them or to keep them out of the mainstream criminal justice system, if at all humanly possible, to provide treatment services in prison, and on post release.
This is part of a larger effort, correct?
Ruby Qazilbash: Without a doubt. It is the move towards risk based decision making, while striking a balance between reducing unnecessary incarceration and maintaining or increasing public safety. That's the goal.
Leonard Sipes: Because every governor in every state has had a conversation with their state public safety secretaries or their directors of corrections, and basically said look, the correctional budget is now the second largest component of our state budget. We cannot continue to bring in the numbers of people that we have. It's impossible to sustain this level of funding, so we need alternatives. You can look at that from a cost effectiveness point of view. You have now both sides of the political aisle. It doesn't matter what side you're on. They are now supportive, because they want a bigger bang for tax paid dollars. They want more results.
This is all part of a unique and growing and interesting aspect to criminal justice administration. I've been in this system for forty-five years, and I have never seen what I'm seeing now in terms of that emphasis on programs, that emphasis on treatment, that emphasis on is there another way of handling this person besides simply throwing them in prison, so the veterans treatment court seems to be a natural outcome of that. It's the growth that astounds me for veterans treatment courts.
Aaron Arnold: Yeah. You talked about the numbers. Since the early 80s, we've seen nearly a four hundred percent increase in the US prison population, and I think the writing was on the wall. I think everybody's on board that alternatives are critical to turning this thing around for our country. We have basically one in thirty-five adults under some from of correctional supervision, whether it be prison, probation, parole, so something needed to be done. When this first court was implemented in 2008, we immediately started seeing results, and not only is it effective, it's a humane way to go about treating our veterans.
Leonard Sipes: We're more than halfway through the program, ladies and gentlemen. We're doing a show today on veterans treatment courts with the National Institute of Corrections, and with the Bureau of Justice Assistance, and with the Center for Court Innovation. Aaron Arnold is Director of Treatment Programs for the Center for Court Innovation, Greg Crawford, is a Correctional Programs Specialist at the Community Services Division of the National Institute of Corrections; and Ruby Qazilbash … I hope I'm not screwing that name up. Ruby is the Associate Deputy Director for Justice Systems Policy at the Bureau of Justice Assistance within the US Department of Justice.
Where do we see drug treatment courts going. Aaron, I'm going to start off with you. For the next ten years, if we've had this explosive growth, and since 2008, we have three hundred veterans treatment courts throughout the country. Where does that take us ten years from now?
Aaron Arnold: I think part of the trend is what we're discussing here today, is to make science based decisions. There's tons and tons of research from the last twenty-five years on drug treatment courts, and we can be very confident, at this point, that drug treatment courts, when implemented correctly, reduce the risk of re-offending, keep people in treatment longer, promote recovery, and all of the things that we're trying to accomplish in the justice system.
There is less research, as Ruby mentioned earlier, that's focused specifically on veterans treatment courts, so one area that we need to continue to push in the next decade is to bolster the amount of research that's specifically geared toward veterans treatment courts, verify, as we've done in the drug court world, that we're getting the results that we want to see, and create tools, like we're creating in this veterans treatment court enhancement initiative, to help these courts make decisions that are rooted in science and help to get the best long term outcomes for the justice involved veteran population.
Leonard Sipes: I would imagine somewhere along the line what we want is for every court system in the United States to have a veterans treatment court component to it, correct? I mean if we're expanding the reach of the criminal justice system into dozens of different specialty courts … Here in Washington, DC there are probably seven specialty courts dealing with domestic violence, dealing with child custody cases. This is something that we see, I would imagine, expanding to every court system in the United States. I would imagine if there's any particular group of individuals that people feel some sense of allegiance towards, it would be our veterans.
Aaron Arnold: I think you're right, and as you mentioned earlier, there seems to be very broad based support for these courts, even more so than some of the other specialized court models, and I think we've already established that part of the reason for that is a desire to help veterans who have volunteered, as Greg was saying earlier, and risked their own lives to protect all of us, so there's definitely plenty of reason that we want to see these courts spread, and, again, part of the reason for creating these specialized risk need tools and other tools to support these courts, is so that we can facilitate their spread in all kinds of state, and county, and local jurisdictions that want to create them.
Greg Crawford: Len, real quick. I just wanted to say that, building off what Aaron just talked about, NIC's vision for this, and I'm hoping BJA and CCI, I'm pretty confident to say that this is our vision, to have this risk needs assessment tool and protocol be the standard for the field. We're trying to, as we talked about, develop the science, and we want to make this available to the field, and think Ruby can talk about the funding opportunities that would support this tool.
Leonard Sipes: Ruby.
Ruby Qazilbash: Happy to. Every year, the Bureau of Justice Assistance releases a drug court program solicitation, and courts can come in for funding to implement brand new programs, to enhance existing programs, and that means ramping up your capacity and the types of services that are being provided, to ramp up the number, the percent of the arrestee population for whom this is a good option, has the option to go through a drug court or a veteran treatment court program.
I, also, just wanted to mention that for the past couple of years, the Bureau of Justice Assistance has seen a new appropriation, a line item to the tune of five million dollars that is aimed just for support for veteran treatment courts, so we're, also, seeing an increase in appropriations to be able to support these courts.
Leonard Sipes: Where are we going with this in terms of growth? Right now, we're talking about five million dollars from the Bureau of Justice Assistance. You agree with me, that we would like to see this in every jurisdiction in the United States, and an opportunity for every veteran to partake in these sort of programs?
Ruby Qazilbash: I think that is a noble goal. I think we've got thirty-three hundred counties around the country. We've got pretty close to that in the number of drugs courts, and I think you need to look at your population. If you have a sizable amount of veterans, then it makes sense to develop a track where you can attach these resources, and we should talk about some of the things that make veteran treatment courts different than drug courts.
Leonard Sipes: Please.
Ruby Qazilbash: Greg started out by saying these are hybrid drug and mental health courts. I think that is one potential difference. There are a lot of resources and partnership that come from the Department of Veteran Affairs, and access to benefits, and supports, and services through the VA that are attached to these courts in most jurisdictions. The idea, the mentor is new, and I think is not a part of most drug courts around the country, and I think a theme or a trend, and Aaron or Greg could talk more about this, but the people that choose and self-select to work in veterans treatment courts oftentimes are veterans themselves: judges, prosecutors, defense attorneys and others that support the services within that court, so there's a camaraderie, and there's a feeling as if we want to support our fellow veterans to heal, to recover, and to stay crime free.
Leonard Sipes: I have a friend of mine, who fought at the Battle of Iwo Jima during the Second World War. He's a veteran, and he's not being taken care of in terms of his medical needs, and I was assisting him in terms of trying to get him the attention that he was looking for, and I didn't have to search far. All the veterans' groups that I contacted and said, "Look, we've got a World War II ex-Marine who fought at the Battle of Iwo Jima and survived, and he needs help," and, boy, that help came rather quickly, so within the veterans community, there is support across the board for fellow veterans, is there not?
Aaron Arnold: Absolutely. What we're seeing when we go out into the field is, as Ruby mentioned, mentors. There's not a shortage of mentors out there. Veterans volunteer to help other veterans, and they live by the motto to leave no veteran behind. You go into the courtroom, and a veteran is immediately assigned a mentor, and the mentor will take him in the hallway and they'll start talking to them. They're not part of the veterans treatment court team. They're there to help them through the labyrinth of the criminal justice system.
A veterans treatment team will consist of a judge, a prosecutor, defense, probation, court coordinator, and critical to the success of these programs is the US Department of Veterans Affairs and the community treatment providers. Basically it's the court system, the VA, and the community treatment providers working together for a common goal, but the mentors are really as, Judge Russell called them, in our live broadcast, the secret sauce. They're the ones that really make this thing work. They fill in the gaps, get them a mattress, a bus ticket, help them overcome the obstacles, have a cup of coffee and just talk them through it, and that is very unique to these diversionary programs. That doesn't happen, as Ruby mentioned, in other courts.
Leonard Sipes: No. We have our own mentors here at the court services of the federal supervision agency, but there is not enough of them. That's the thing that I find really interesting about veterans treatment courts is that there always seems to be that league of veterans, who are willing to help this individual in trouble.
Aaron Arnold: Yeah. I've been out to several sites. I've been to a couple of national conferences, and without a doubt, everybody I've come across is not just collecting a paycheck.
Leonard Sipes: But theses are volunteers. This is what I'm talking about.
Aaron Arnold: I'm talking about both the people working in the courts, and, also, the volunteers. Volunteers are committed to helping other veterans.
Leonard Sipes: This is a mission. This is just not a criminal justice program. This is a mission. These are people who are wildly enthusiastic about veterans treatment courts. This is something that's growing rapidly. Fastest growing program I've seen, and different people that I've talked to about this concept, you can have an individual veteran before the bench, and find himself or herself with not just a mentor, but two, three, four, five mentors. That's exciting, and that's why I'm predicting that veterans treatment courts is going to continue to grow like wildfire, and continue to show good results, because of that treatment team, because of the volunteers who are willing to help that individual. Aaron.
Aaron Arnold: I agree with you. One of the things that we see at the Center for Court Innovation in the last twenty years, is a little bit of fatigue sometimes with the fact that, as you mentioned earlier, the creation of all these specialized court parts. There are people who wonder why do we need so many specialized court parts, and are we going to have a specialized court part for everything under the sun, but with these veterans courts, whatever you're feeling on that question, is with these veterans treatment courts, we see that having veterans together with other veterans, supported by mentors, supported by, as Ruby said, staff and judges who themselves oftentimes are mentors and have requested to be part of this team, it creates a special environment that gets better results, and, at the end of the day, I think it's hard to argue against a system that gets better results and treats people in a more thoughtful, humane manner, and gets them the support that they need.
Leonard Sipes: Judges seem to have a magical place within the criminal justice system. We, within the adult correctional system, can intervene in the lives of individuals all day long, but nothing seems to get the attention of the individual before the bench as a judge does, so a very involved judge seems to be the secret sauce in some ways, as to why specialty courts work. Anybody want to take a shot at that?
Ruby Qazilbash: That bears out in the research. I think some of the strongest research effects are seen in judicial interaction with a participant in that court program. It is the way that they interact, the eye contact that they make, the amount of time that they spend with that individual, remembering personal details about the individual's life, celebrating successes or milestones that they've been able to reach has borne out to be very impactful, and definitely have better outcomes for those folks.
Leonard Sipes: I would guess as well is that the reason why this is growing like wildfire, is that judges themselves seem to have that magic ability to bring the entire criminal justice system together for change in ways that others within the executive branch cannot. Judges have a way of producing these specialty courts or veterans treatment courts. Maybe it's because of the judges themselves that this is growing as quickly as it is.
Greg Crawford: That's exactly right. In fact, you said exactly what I was thinking, is that … You were asking earlier about where do we see the growth going. In many cases, it is the motivated judge at the local level, who is a veteran, or has family members who are veterans and has a special place in their heart for this kind of work. They're oftentimes the ones who are driving the creation of these programs and making them successful, rather than having a statewide administrative decision making process. These are oftentimes locally driven initiatives, because people care about serving their veterans.
Leonard Sipes: Ruby, we've got about a minute left.
Ruby Qazilbash: I was just going to add, I think this is an area that we can learn from drug courts. Drug courts began with a leader judge in that community or judicial district, that got a team together and used the power, the authority of the bench to be able to do that. When drug courts became institutionalized in communities, and that started to be a rotational judgeship, or you had people that didn't self-select into those positions, sometimes you lose some of that secret sauce, and so I think we need to learn from the drug court movement, and make sure that we're setting up veterans treatment courts in a way that they're sustainable.
Leonard Sipes: Ruby, you've got the final word. I find this to be a fascinating concept, an encouraging concept and I really want to thank Aaron Arnold, the Director of Treatment Programs at the Center of Court Innovation, Greg Crawford at the National Institute of Corrections, and Ruby Qazilbash, the Deputy Director for Justice Systems Policy at the Bureau of Justice Assistance. Ladies and gentlemen, this is DC Public Safety. We appreciate your comments. We even appreciate your criticisms, and we want everybody to have themselves a very, very pleasant day.
Filed Under: Audio Podcast, Drug Court, Drug Treatment, Education and Vocational Assistance, Employment, Mental Health, Parole and Probation, Reentry Tagged With: veteran treatment courts
Offenders and the Affordable Care Act-The Urban Institute
http://media.csosa.gov
Radio show at http://media.csosa.gov/podcast/audio/2014/07/offenders-affordable-care-act-urban-institute/
LEONARD SIPES: From the nation's capital this is DC Public Safety. I'm your host Leonard Sipes. Ladies and gentlemen, today's topic, Offenders and the Affordable Care Act, something of real importance to those of us in the criminal justice system and throughout the country. It's a real pleasure to have Kamala Mallik-Kane; she is a research associate, Justice Policy Center for the Urban Institute, www.urban.org, www.urban.org. Kamala Mallik-Kane, welcome to DC Public Safety.
KAMALA MALLIK-KANE: Hi, Len. I'm glad to be here.
LEONARD SIPES: Hi. This is exciting, because we have a new study that Urban is going to come out with next week talking about the Affordable Care Act and offenders, how many enroll, and what happens. Tell me about that.
KAMALA MALLIK-KANE: Sure. This is a study that is funded by the National Institute of Corrections, and we are very excited to be doing this work, because it gives us an important preview of what might be happening under the ACA as states are expanding their access to Medicaid. In our study we look at two states that were early adopters of Medicaid expansion. We're looking at what these states did before 2014, so that we can have some insights about what may happen as Medicaid expansion moves forward post-ACA.
LEONARD SIPES: Now, those of us in the criminal justice system, this is the Holy Grail, and I've seen that term "Holy Grail" used in a wide variety of articles. We have said for decades, those of us throughout the criminal justice system throughout the United States, that people in the criminal justice system, offenders, people on supervision, are not getting mental health treatment, they're not getting substance abuse treatment. I've seen surveys that put it at 10% or less within some state correctional systems. People on the outside, again, are not getting substance abuse treatment; they're not getting mental health treatment. We all see the potential of the Affordable Care Act as being something that's going to revolutionize the way that we deliver services. Is there a snowball's chance in Hades of that actually happening?
KAMALA MALLIK-KANE: I'm optimistic. I think there's a good chance of that happening. I think it'll take a while, but I think that this is definitely a step in the right direction. We know that so many people in the criminal justice system suffer from substance abuse problems, mental illness, and various chronic physical conditions, and we know that before the ACA, in most places, that they would be released from prison without health insurance. So what would happen is somebody comes into prison or jail, they get a certain level of treatment while they're in prison or jail, they get stabilized and they manage these conditions, then they get released without health insurance. And so within a couple of months they are no longer receiving treatment for these conditions and they can spiral out of control.
LEONARD SIPES: When I was with the Maryland Department of Public Safety for 14 years the staff there explained to me that mental health treatment was designed to do nothing more than stabilize their experience while in prison or while in jail, it had little to do with stabilizing that experience in the community. So that's what you're talking about in terms of in many cases getting access to mental health treatment in prisons or in jails. It's not designed for them to transfer to the community and for some sort of services to follow. It's purely to help them maintain their sanity in the correctional facility.
KAMALA MALLIK-KANE: Right. My understanding is that many prison and jail systems provide people with a small supply of what they like to call walking meds, and sometimes may set people up with a prescription to get a refill at a community-based pharmacy, but we all know if you don't show up at a pharmacy with insurance this going to cost you an outrageous amount of money.
LEONARD SIPES: Yes.
KAMALA MALLIK-KANE: And so having insurance is a key step for people to be able to get those medications in an affordable way.
LEONARD SIPES: Now, there is I think a dollar amount stipulation, that they have to earn less than a certain amount every year to be eligible for the Affordable Healthcare Act.
KAMALA MALLIK-KANE: Right. With the ACA that is 138% of the poverty level and to qualify for the subsidies for the ACA exchanges I think you can be up to 400% of poverty. And programs in the States vary with respect to what their income thresholds are, because Medicaid is a combined federal state program, and so the states have some discretion too in setting those limits.
LEONARD SIPES: I've seen figures like 16,000 dollars, 18,000 dollars, less than that, and I would imagine it does vary from state to state, because, as you said, it's a combined federal-state program.
KAMALA MALLIK-KANE: Right. That sounds about right to me. And certainly in the pre-ACA time period that we studied the thresholds for the two states that we looked at, Oregon and Connecticut, were quite different.
LEONARD SIPES: Again, and it'll be the last time I'll beat this point to death, is that we see, those of us in the criminal justice system are so excited about Urban, the fact that you're coming out with this report next week. I'd really urge everybody to go to the website at the Urban Institute, www.urban.org, www.urban.org, because this whole idea is, again, we in the system understand that they need treatment, we in the system understand that oftentimes the experience throughout the United States is that they're not getting treatment. We believe that if they got treatment they would do a lot better, recidivate less, cost taxpayers fewer dollars, cost victims of crime – there would be fewer victims of crime. We see this as a huge win for people in the criminal justice system and our ability to control cost.
KAMALA MALLIK-KANE: Right. I think there's a lot of research out there showing things like substance abuse treatment with aftercare being effective at engaging people in treatment after release and keeping their reoffending rates lower and similar things with mental health treatment. I think that what we tend to see in the justice system are pretty small-scale programs that are effective but serve a pretty small slice of the total population coming out. But we know there's such a lot of unmet need. And that's what makes the potential under the ACA very exciting is that insurance can be extended to a huge swath of individuals who are returning. As long as they meet the program eligibility requirements this is something that doesn't affect 1% or 2% of people coming out but the majority.
LEONARD SIPES: Okay. So we know that the, I would say the majority of people caught up in the criminal justice system have substance abuse history, certainly. I've seen self-reporting studies that say 55% self-report mental health issues in the past. I've seen studies that say; suggest that 16%, up to 16% of people have diagnosable histories of mental health problems. But physical health problems, if you throw all that in, I think we're talking about certainly the majority and probably more than that of people caught up in the criminal justice system.
KAMALA MALLIK-KANE: At Urban we did a study called Returning Home several years back that interviewed people as they were leaving prison and then followed up with them in the community at several times over the course of a year. And when we did interview them in prison we found that when you looked across the spectrum of the types of issues that someone could have it was eight in ten men had at least one chronic physical or mental or substance abuse condition, it was like nine in ten women. So it's really a huge swath of the population. Of course the severity of these conditions can vary, but in some of the, in some other data that I've seen I've seen numbers I think around something like 60% having conditions that require active treatment or management.
LEONARD SIPES: Okay. So they leave prison, they're typically uninsured, and their health deteriorates, right?
KAMALA MALLIK-KANE: Right.
LEONARD SIPES: Okay. And so the bottom line in all of this is, we in the criminal justice system care, but I'm not quite sure the average person out there sees this as that big of an issue, but it really is to them, is it not, in terms of holding down costs of correctional care, holding down re-victimizations?
KAMALA MALLIK-KANE: Sure. I think that the most obvious connection that you can make for an average layperson who's looking at this is to think about substance abuse and relapse. When someone is clean they are not stealing or victimizing people or doing other harmful things just for the purpose of being able to obtain more drugs. When somebody has relapsed they slide into those behaviors again. I'm not saying that everybody who's addicted does these things, but it's a common enough pattern that substance abuse is one of these key drivers of this revolving door phenomenon that we see in the justice system.
LEONARD SIPES: So we all agree that this could have a huge impact. I said I would not bring that topic back up again. What can be done on the part of the criminal justice system? I mean what we have to then, and I've seen in some articles where jails and prisons are actually creating staff to help the men enroll, that they're being very proactive in terms of getting as many people enrolled as possible, but this involves a lot of effort on the part of the criminal justice system in terms of discharge and release planning, treatment referrals, care coordination, so this, the criminal justice system should take an active role in terms of enrolling as many people as possible.
KAMALA MALLIK-KANE: Yeah. I agree with that. And I think that states and localities are doing a number of these various things. They're engaged in some level of release planning. They make treatment referrals for individuals. I think some of this is triaged so that you're putting more resources into the people that have greater needs. But Medicaid enrollment is something that is being implemented into release planning curricula or programming in criminal justice systems around the country.
LEONARD SIPES: Okay. The report that's coming out next week – is this, do we have specific findings in terms of how many enroll and what happens? Or what is the purpose of the study? It is it describing what it is that you're doing or will it have impact findings?
KAMALA MALLIK-KANE: Sure. So our study has two broad goals. One of them is to understand more about the enrollment process, how do you get inmates connected to Medicaid, what are some of the challenges that systems and individuals face, and what are the rates of enrollment when people have the opportunity to apply for Medicaid. So that's the first part of our study. The second part of our study is a little further down the road. We're looking at impacts post-release with regard to when people get enrolled in Medicaid, do they utilize Medicaid health services, and are there impacts post-release, one to two years later on employment and recidivism.
LEONARD SIPES: You and I were talking before we hit the record button is that I remember a national researcher, I'm sorry, a national reporter reporting for a national publication was trying to do an article that he was calling ObamaCare and Offenders or ObamaCare and Inmates, and he said he found a general reluctance on the part of those of us in the criminal justice system to talk about this, because we don't know what the impact will be, we don't have a clear understanding as to whether or not this will have a huge impact. What he was heard on an off the record basis from so many people was that just because you have health insurance doesn't mean you act on it, doesn't mean that you go out and get the mental healthcare that you need, doesn't mean that you go out and get the substance abuse care you need. You may use it to fund your physical infirmaries, but not necessarily mental health or substance abuse. So we really don't know what the impact is and we won't know until your research is completed, correct?
KAMALA MALLIK-KANE: That's right. I think that's a very valid point, just because you have insurance doesn't mean that overnight you change the way that you seek services or get care or take care of yourself. But having insurance I think is a necessary first step to being able to use preventative health services, to be able to use mental health treatment services and substance abuse treatment that's out in the community.
LEONARD SIPES: And this study that you all are doing is in Oregon in terms of the prison stage and a jail study in Connecticut.
KAMALA MALLIK-KANE: That's right.
LEONARD SIPES: And how – was it difficult to get them involved in this?
KAMALA MALLIK-KANE: Well, in Oregon what we did was we looked historically at an effort that the Department of Corrections had implemented. In Oregon before the ACA Oregon had a very interesting Medicaid program for what's called childless adults. Have you heard that phrase or should I talk through that?
LEONARD SIPES: That's fine.
KAMALA MALLIK-KANE: Okay. Just that historically Medicaid had been a program for children and parents and people with disabilities and people with some specific eligibility criteria in addition to being low income. And before the ACA Oregon had expanded its Medicaid program to be more broadly a low income adults program, but because of limited funds in the state what they did was to have a lottery process so that it would be fair who they could provide this to. And so they had been doing this lottery process from about 2008, and we looked at what was going on in the prisons in 2010 and 2011 with respect to signing up for this lottery process, and then if people were selected at random to apply for Medicaid, how many of them did apply given that opportunity.
LEONARD SIPES: We're more than halfway through the program. What we're talking about today, ladies and gentlemen, is offenders and the Affordable Care Act. At our microphones is Kamala Mallik-Kane; she is a research associate with the Justice Policy Center at the Urban Institute, www.urban.org, www.urban.org, coming out with a new study report next week talking about what they plan on looking at in terms of how many enroll in the Affordable Care Act and what happens afterwards, correct?
LEONARD SIPES: And that's exciting, because we in the system are really, really looking forward to these findings. Okay. Some of the challenges of getting and keeping inmates enrolled in Medicaid, now, again, you're talking jail, you're talking prison, you're not talking about necessarily community supervision, but some of the releases could be on community supervision at the same time, right?
LEONARD SIPES: Okay. Tell me about that.
KAMALA MALLIK-KANE: About community supervision in particular or –?
LEONARD SIPES: Well, federal, the federal and state Medicaid rules. You're not allowed to use Medicaid while incarcerated, a few states let you stay covered but suspend your benefits, so some of this gets technical in terms of the challenges of getting and keeping inmates enrolled in Medicaid.
KAMALA MALLIK-KANE: That's right. The timing really matters, timing it appropriately with release so that – the Medicaid rules don't permit people to be, to receive Medicaid benefits while they're incarcerated. And this is an old provision in the Medicaid program and one that's really intended to guard against Medicaid billings that are inappropriate.
LEONARD SIPES: Right.
KAMALA MALLIK-KANE: But what happens when –
LEONARD SIPES: So they get double billing because they're already getting healthcare within the prison setting.
KAMALA MALLIK-KANE: Right. And I think as a way of sort of ensuring that there's not a community provider that's billing for somebody –
KAMALA MALLIK-KANE: That's not out in the community.
KAMALA MALLIK-KANE: But I think the difficulty for people who are frequently in and out of the justice system is that the information technology systems that are out there aren't particularly good at keeping track of when people are in and out of jail. And so this is an issue that a lot of states are grappling with. I believe that there's funding through the ACA for Medicaid systems to upgrade their information technology systems for a whole lot of reasons. But places that are attuned to this issue of correctional populations and their need for Medicaid and the challenges of timing things correctly so that the Medicaid system is aware of when people are being released from prison so that they can have benefits when they're in the community is –
LEONARD SIPES: Okay. But this is specifically – we're not talking about necessarily medical care within a correctional facility. We're talking about giving them access to Medicaid so they can get treatment in the community.
KAMALA MALLIK-KANE: Right. Because in general inmates receive healthcare from the correctional system when they're in, and so Medicaid is not – the purpose of the Medicaid is to have continuity of care from the prison or jail setting to the community so that –
LEONARD SIPES: Okay.
KAMALA MALLIK-KANE: They can continue that care when they're in the community.
LEONARD SIPES: Well, that's an important distinction. But what if they don't get like say mental health treatment or substance abuse treatment while in prison, because the studies I've seen put that figure pretty low, at around 10% or lower, for most state systems. So what if you're getting a, what if you're getting mental health treatment or substance abuse treatment in prison, would Medicaid still provide funding for those particular programs while in prison?
KAMALA MALLIK-KANE: For mental or for substance abuse treatment in prison?
LEONARD SIPES: Uh huh.
KAMALA MALLIK-KANE: No. I don't believe Medicaid funds that.
LEONARD SIPES: Okay. All right, so we're talking about getting them enrolled and when they get out to the community and seeing what happens, and your study is looking specifically at one jail and one prison.
KAMALA MALLIK-KANE: We're looking at prisons in Oregon and we're looking at some jail facilities in Connecticut.
LEONARD SIPES: Okay. The level of interest, so we find folks in the criminal justice system are really interested in this, what about the offenders themselves?
KAMALA MALLIK-KANE: Right. In Oregon what we saw was that given the opportunity – so, again, let me just go back to what I was saying about –
LEONARD SIPES: Sure.
KAMALA MALLIK-KANE: The way you had to apply before the ACA in Oregon was you had to two stage process. The first stage was that you put your name what they called a reservation list, and so about half of the inmates who were leaving Oregon prisons at the time of our study put their names on that reservation list. Then the state did a random drawing and then based on who they invited at that point then people got mailed a Medicaid application and then they had 45 days to fill out the application, turn in their documentation, and then get it reviewed by the Medicaid agency. What we found that was very interesting in Oregon was that about 4 in 10 of the inmates that got invited turned in their application and this was identical to the level of participation in the general population in Oregon.
LEONARD SIPES: So 4 in 10, and that was indicative of the population across the board that was eligible, not necessarily for people caught up in the criminal justice system.
LEONARD SIPES: And, okay, findings on Medicaid impacts. So you're working on this data and you're collecting this data. Are you aware of anybody else out there in terms of your literature review who has looked at this issue previously?
KAMALA MALLIK-KANE: We've seen smaller studies from a couple of years back –
KAMALA MALLIK-KANE: Looking at specific subpopulations. So I know that there are studies of people who are seriously mentally ill and their rates of Medicaid enrolment and how that impacts arrest, for example.
LEONARD SIPES: Do we have any findings?
KAMALA MALLIK-KANE: I believe that they found a lower rate of rearrest among the people that were enrolled, but I don't remember too, too clearly to talk about it more than that.
LEONARD SIPES: Okay. But in essence, as long as they meet guidelines, as long as they meet the state Medicaid guidelines they're eligible, as long as they're under a certain – I know the percentage of gross poverty, whatever – it's even confusing to me. If they make, what I've seen commonly thrown out in newspaper throughout the country, if they make less than 16, 18,000 dollars, it depends upon it at state level, they're eligible. And so there's no question about eligibility. You've just got to be under that threshold.
KAMALA MALLIK-KANE: Right. And when we looked at the applicants in Oregon we found that when people got their applications into the Medicaid agency that about 8 in 10 of them qualified, and that was higher than in the general population, because there was more poverty –
KAMALA MALLIK-KANE: Among the people who were leaving prison.
LEONARD SIPES: So 8 in 10 are eligible. And so that gives us hope that those of us in the criminal justice system can find sources of funding for substance abuse treatment and mental health treatment.
KAMALA MALLIK-KANE: Right. This gives people a ticket to be able to –
KAMALA MALLIK-KANE: Access those services in the community.
LEONARD SIPES: So what is the sense between yourself or your peers at Urban in terms of what the impact could be down the road? I mean you're talking to people, again, specifically in Connecticut and Oregon, but you're probably talking to other people throughout the country. You were quoted in a rather extensive article, ObamaCare for Ex-Inmates: Is Health Insurance an Antidote to Crime?, and I think that was from the Christian Science Monitor, a very powerful article talking about how people around the country feel about the Affordable Care Act and what its potential could be. So what are your perceptions from talking to people?
KAMALA MALLIK-KANE: I think there's a sense of a lot of potential and a lot of work ahead of us. I think, yeah, I like to think of having the insurance card as being sort of a ticket that you need to enter, but you need to do a whole lot of other things in order to make the change happen. I think some of the challenges are getting people to use healthcare differently, and I think that involves education.
KAMALA MALLIK-KANE: One of the things in our Connecticut study was as they were doing enrollment there was an eligibility worker who talked with individuals about what kinds of services they could go out and get in the community. But another thing that we saw as we observed these recruitment sessions in Connecticut was that there was some confusion about the program, there was confusion about whether people had Medicaid or not. We had people in our sessions that we felt we had screened and thought them to be needing Medicaid who said, "No, no, I already have it. I don't need to stay here and I don't need to apply for this." So I think people knowing what their status is and knowing how their perception affects what they do out in the community, that's an important thing for us to figure out.
LEONARD SIPES: So there's an educational process on the part of the system. This is not going to be an easy process for those of us in the criminal justice system. It's going to take a lot of work to explain what the rules are, to figure out if they are eligible, to sign them up, to, and, again, try to encourage them to participate if they have funding. So it's a multi-step process between correctional facilities and community correction facilities and parole and probation agencies, so this is going to involve a lot of work.
KAMALA MALLIK-KANE: And I would add that also community based health organizations have to be a partner in these conversations, because I think some of the disconnect that we may see are that there are treatment providers that have been serving the criminal justice population that have not been previously Medicaid providers and they may need to do things about the way they run their organizations in order to be qualified Medicaid providers so that the insurance can actually be used to pay for services in those facilities.
LEONARD SIPES: I didn't even think about that. So not only must the criminal justice system gear up in terms of implementing this, the providers need to gear up to implement it.
KAMALA MALLIK-KANE: Right. There was a story in the New York Times recently about an old Medicaid rule about just which types of residential substance abuse treatment facilities they could reimburse or not. And so I think there needs to be that exchange between the provider network that's out there and the Medicaid structure to figure out whether these are going to be reimbursable services.
LEONARD SIPES: Why is that a question though? I thought it would be pretty much straightforward.
KAMALA MALLIK-KANE: I would've thought that too. But I think that these kinds of details, you have a population that's been receiving typically non-Medicaid services –
KAMALA MALLIK-KANE: That are now coming into the Medicaid world, and so I think these details haven't yet been worked out.
LEONARD SIPES: And we need to remind the audience that only half the states are involved in the Affordable Care Act provision, so half the people in the country listening to this are going to say, "Well, yes, this applies to me." but half it doesn't apply to the offenders within their states.
LEONARD SIPES: And so what's the final analysis? In the final minutes of the program, I mean we in the criminal justice system do have to gear up, correct? We probably have to add staff; we probably have to add training. A significant burden falls on us to be sure that people who are eligible enroll. But that's going to require a lot of effort and probably staffing and training on our part.
KAMALA MALLIK-KANE: Right, and a certain amount of coordination with the Medicaid agency. A lot of what we observed in our Connecticut Study and a lot of what was possible in the Connecticut Study was the result of a year's long collaboration between the Department of Corrections and their Department of Social Services to establish procedures and workarounds that would let the correctional population enroll.
LEONARD SIPES: Okay. And that's the other part of it is that we need to need to reach out to all the providers out there, because some who may be eligible to be providers may not want to take upon an offender based population. So we need to do a lot of work on our part to convince people who are the providers to get involved in this and to be sure that they are attuned to our needs and the needs of the people coming out.
KAMALA MALLIK-KANE: Yeah, absolutely.
LEONARD SIPES: And what else? What is the general sense to the public that they need to understand? You're talking to aides to mayors, aides to governors through this program. What do they need to understand?
KAMALA MALLIK-KANE: Sure. I think that this is a great opportunity, because I think for years we have all known that substance abuse and mental illness are problems that have been feeding this revolving door cycle that we've had in our justice system, and you've had people coming in with problems, the problems don't get resolved, and then they get released without any resources to deal with them. So I think that this is a great opportunity to begin addressing those problems that can slow down this revolving door of recidivism.
LEONARD SIPES: I couldn't agree with you more. Our guest today has been Kamala Mallik-Kane; she is a research associate, Justice Policy Center, the Urban Institute, www.urban.org, www.urban.org. Ladies and gentlemen, this is DC Public Safety. We appreciate your comments, we even appreciate your criticisms, and we want everybody to have themselves a very pleasant day.
Filed Under: Budget Issues, Corrections-Prisons, Drug Treatment, Mental Health, Reentry Tagged With: Affordable Care Act. offenders
Supervising and Treating Mentally Ill Offenders-DC Public Safety Radio
Welcome to "DC Public Safety" – Radio and television shows, blog and transcripts on crime, criminal offenders and the criminal justice system.
The portal site for "DC Public Safety" is http://media.csosa.gov.
Radio Program available at http://media.csosa.gov/podcast/audio/2013/03/supervising-and-treating-mentally-ill-offenders-dc-public-safety-radio/
[Audio Begins]
Len Sipes: From the nation's capital, this is DC Public Safety. I'm your host, Leonard Sipes. Ladies and gentleman, our show today is on the supervision and treatment of mental health offenders. We, within the Court Services and Offender Supervision Agency, we say that 37% of our offenders have had contact with mental health providers or claim a mental health issue. Reports from the Department of Justice several years ago, they suggest a self-report figure of over 50%. To discuss this emerging issue within the Court Services and Offender Supervision Agency and throughout the country, we have three guests today. We have Ubux Hussen, she is the Mental Health Program Administrator; a Community Supervision Officer – Supervisory Community Supervision Officer Marcia Davis; and Supervisory Community Supervision Officer Robert Evans. And to Ubux and Marcia and to Robert, welcome to DC Public Safety.
Female: Thank you, Leonard, for inviting us.
Female: Thank you.
Robert Evans: Thank you.
Len Sipes: All right. You know this is an extraordinarily important topic for us. It really is and it's an extraordinarily important topic for every court, every parole commission, every parole and probation agency throughout the United States. It really is an emerging issue because it seems to – it seems to me that the numbers increase – continuously increase. Every time I read a piece of national research or local research, they tell me that they're sort of astounded by the high numbers of people who have had contact with mental health providers and who claim to have a mental background. Like I said, there was a Department of Justice report that suggested that over 50% of the individuals who they interviewed caught up in the criminal justice system; they claimed to have a mental health problem or had contact with a mental health system in the past. So, Ubux, the first question is going to you. How many people out of the 15,000 individuals that we have on supervision on any given day, both parolees and probationers, how many are involved in our mental health unit?
Ubux Hussen: In our mental health unit, approximately 2068…
Len Sipes: That's a lot of people.
Ubux Hussen: It is a lot of people spread across six or seven mental health men and women's teams. The observation you made about the number of people – you know, back in the '70s and '80s, we did this deinstitutionalization from state mental health hospitals and a lot of those people have cycled through both state, federal, and local jails and prisons which really have become very innovative in mental health service delivery because of the need of the people under their care. So there are a lot more people who probably qualify than the 2068…
Len Sipes: Right.
Ubux Hussen: …who are currently assigned to our branch. So I'll stop there.
Len Sipes: Well, that is an important piece of context for people to understand that one time we had within this country a fairly extensive community-based and hospital-based mental health system. They went through a process of deinstitutionalization, I think, back in the 1970s and at one time, there were thousands of people caught up in community care and in terms of intuitional care, but they've taken down most of those institutions from various states and they did not support the community component. So, in essence, we've heard individuals suggest that the criminal justice system is now the de facto provider of mental health services to a lot of people caught up who are in the system who are mentally ill and that's shocking. You know, to me, it's shocking. Marcia, who gets to be on our mental health unit? Describe that kind of person.
Marcia Davis: Okay. So the individuals who come to supervision come to us by way of the United States Parole Commission after they have been placed on supervisory list of parole or through the DC Court System after being placed on probation.
Len Sipes: Uh huh.
Marcia Davis: And in most cases, they've been either court ordered or ordered by the USPC to either undergo a mental health assessment, participate in mental health treatment, or be supervised by the mental health unit.
Len Sipes: Okay. Now, so they come either from the courts or they come from the US Parole System.
Marcia Davis: Right.
Len Sipes: Can a community supervision officer– what most people throughout the country call parole and probation agents, can a community supervision officer here within Court Services and Offender Supervision Agency can they mandate that a person receive an evaluation? Robert?
Robert Evans: Well, not necessarily mandate but one thing that is important to know is that we kind of train our staff to be very observant. We train them to have a listening ear and also be observant of when someone is experiencing some sort of breakdown or issue. And so what they'll make – what they'll do is make a recommendation and they will make a referral. So they will refer to our mental health program administrator to review a situation, most likely try to get this person a mental health assessment so that we can kind of gauge what this person is going through. So anybody who has a mental health assessment and assessment basically says that they have a current issue they're dealing with, a mental health diagnosis, then we'll take another look at that to see if they qualify for our unit.
Len Sipes: Well, from the beginning of the show, I do want to establish two things: a) Because an individual has a mental health issue does not mean that they're going to be part of the criminal justice system and I want to make that abundantly clear.
Ubux Hussen: Correct.
Len Sipes: There are endless millions of people floating throughout the United States, throughout the world, who have mental health condition who never come into contact with the criminal justice system. However, if you are schizophrenic, if you have one of dozens of mental health diagnosis, if you are depressed in some ways that does correlate, however, with substance use that does correlate, however, with a contact with the criminal justice system. Did I phrase it correctly, Ubux?
Ubux Hussen: Absolutely. There also other environmental or psychosocial factors – poverty, low educational level, a fragile limited or non-existent family or social support network.
Ubux Hussen: In terms of poverty, access to health insurance whether you're able to get the medication that allows you to have stability in your life so that you're not engaging in criminal activity. So there's both the diagnosis and then there is what's called the ecology of the person's life.
Len Sipes: Okay.
Ubux Hussen: So who else is in your life and what else is in your life that serves as a prosocial stabilizing factor?
Len Sipes: But we have to establish as well in terms of a baseline for this discussion people on parole and probation supervision both within Washington DC and throughout the country. It applies equally across the board. They come often with substance abuse backgrounds.
Len Sipes: They come often with multiple contacts with the criminal justice system.
Len Sipes: They come often with tough upbringings, oftentimes single parent family, often time I've heard dozens and dozens and dozens of people caught up in the criminal justice system describe the fact that they raised themselves, that they were basically on their own, that they basically got up, fed themselves, and took themselves to school. Individuals caught up in the criminal justice system have dozens of disadvantages. Most of the female offenders that we have do things, number one, the large number have children so it's not just taking care of themselves as they come out of the prison system. Somehow someway they want to reunite with their children. My heavens, when you start stacking deck – when you start considering all the different things that an individual caught up in the criminal justice system has to deal with and you throw mental health issues on top of all those things, it becomes scary. It becomes what some people have claimed almost to be a school to prison pipeline because they're saying how do you overcome all those obstacles?
Robert Evans: Right.
Len Sipes: Anybody feel to comment from a mental health point of view?
Robert Evans: Yeah. I'm glad you've mentioned that because you know we – we throw the word mental health around and it's kind of – there's a stigma that comes along that word just mental health.
Robert Evans: And we need to be clear that everybody has mental health. If you have a brain, you know. So everybody has health that they're dealing with and you know, issues face us all. If you have death in the family, if you are struggling in life, so all these things that people have come along with, they deal with them differently.
Robert Evans: You know and how do they – how do they deal with it. And so, one thing that we have to mention is that – especially here in DC, there are services that people can get…
Robert Evans: …as a result of having "mental health issue" and so that can also add to why people are getting into this system – the mental health system because, for example, you have people that are in – who are locked up and once they realize that they can get special treatment for being in mental health now that they want to fake issues. So there's another, you know, a sort of layer of the whole mental thing that we should visit because it's more than just you know people have in "mental health issue." It's a huge sort of box that they can be opened up. You know, people can get SSI checks, people kind of once they get a diagnosis they kind of rely on at some time.
Len Sipes: Okay. So it's a fairly complex issue.
Robert Evans: It's very complex.
Len Sipes: All right. Let's start from the beginning then now that we've laid this groundwork. So a person either comes from the courts or comes from the parole commission with a mandate that we evaluate them for mental health services. What happens when we receive that piece of paper?
Marcia Davis: And then let me also add because we kind of touched on it a little bit but I want to add sometimes, like you said, people go to general supervision and while they're in general supervision, the CSO may notice that there's some things that may not be totally right with this person.
Marcia Davis: So they will refer them for an assessment and once they get assessed, they could be deemed appropriate for the mental health unit and be transferred over.
Len Sipes: Okay. Okay. What happens when that happens? Either through the CSO in general supervision or the parole commission or the courts? So somebody says I think this person has an issue, what happens?
Ubux Hussen: Usually, either through a supervisor or the actual CSO, I will receive an e-mail…
Ubux Hussen: …with an attached mental health assessment.
Ubux Hussen: That has to be current and not older than 12 months.
Ubux Hussen: We want the most current information about the person. That assessment is reviewed for whether the person has what mental health clinicians call a severe and persistent mental illness.
Ubux Hussen: And so that's your schizophrenias, that's your bipolar disorder, etcetera.
Len Sipes: Right. Right.
Ubux Hussen: We also, however, supervised other people who have developmental delays, who are mild to moderately what used to be called mentally retarded. We now have a – I'm noticing a trend as everybody is getting older, we have an older population of supervisees who have age-related cognitive deficits and so it is in just do they have a serious mental illness, it's what else is going on that might impede their successful supervision.
Len Sipes: Okay, fair enough. But we get an evaluation from the Federal Bureau of Prisons.
Ubux Hussen: Yup.
Len Sipes: We get an evaluation from a mental health clinic. Do we do our own evaluations?
Ubux Hussen: Yes, sometimes.
Len Sipes: Okay. So who does those evaluations?
Ubux Hussen: We have consultants that we contract with.
Ubux Hussen: One of the things in the DC area that's really hard to get is a psychological evaluation.
Ubux Hussen: And so the agency pays for those. If the information is conflicting, if it's inadequate, if somebody for example has experienced trauma to the head while they've been in the community and we just need more information, we will pay for those services for them to get this assessment.
Len Sipes: Okay. So CSOSA does their own evaluations when necessary.
Ubux Hussen: Yes, that's right.
Marcia Davis: And we also use the Department of Mental Health.
Ubux Hussen: Yes.
Marcia Davis: The DC Department of Mental Health Agency does assessments, too.
Len Sipes: Okay. So the person comes in, we diagnose them, we figure out on what level of deficiency they have and then they're placed in the mental health unit with well over 2000 people under supervision. Right?
Ubux Hussen: That's correct.
Len Sipes: Okay. So what happens at that point? So you get this person, not only does he have to make restitution, not only does he have to get a job, not only does he have to get his GED, not only does he have to get his plumbing certificate, not only does he have to obey all law…
Ubux Hussen: Right.
Len Sipes: …he now has to go through some sort of intervention in terms of his mental health problem and I'm assuming that that ranges in terms of the degree of severity of the mental health problem, right?
Robert Evans: Correct.
Len Sipes: Okay, talk to me about that.
Robert Evans: So, basically, the guy comes from my unit and he's assigned to community supervision officer to supervise him. Now, this supervision officer has been trained to make sure that this person is connected with the mental health services. They're going to make sure that they connect either for Core Service Agency. This person is going to be connected with a case manager or a therapist if necessary depending on the person's need. Once they go to that Core Service Agency, the agency would do an intake and they'll see what this person needs and so, now, this officer needs to follow up with the case manager or whoever they're connected with…
Robert Evans: …to be sure that they're following through with that.
Len Sipes: And that connection could be authorities from the District of Columbia. That connection could be with the Veterans Administration.
Len Sipes: That connection could be with lots of different agencies. So okay.
Marcia Davis: Correct. Private organization…
Len Sipes: Private organizations. It could be a private counselor. Now, but do all of them get the counseling they need? I mean, you know, all we hear are budget cuts, budget cuts, budget cuts and my guess is that not everybody is going to be getting counseling – not everybody is getting counseling, not everybody is going to get "therapy." My guess is that people on the high end of the spectrum with serious mental health issues such as bipolarism or schizophrenic – or being a schizophrenic, they will get it and the people at the lower end don't. Am I right or wrong?
Robert Evans: Well, you're right. You're right. In DC especially, you know, people are overwhelmed with clients. You know, the case mangers that we deal with have extremely high case loads so they're trying to do the best they can to make sure that they meet these individual's needs. Bu in most cases, the people that need the intensive service, what they'll do is get connected with what was called the ACT team, which is Assertive Community Treatment.
Marcia Davis: Assertive Community Treatment.
Robert Evans: So this ACT team is going to be assigned to this client who has a very severe issue.
Marcia Davis: A severe need.
Len Sipes: A severe need, right.
Robert Evans: And so what that would do is get this person more specialized treatment but even in those cases, it's very difficult. The difficulty that we face is we have to make sure that this person is following through with the recommendation but we can't hold their hand, we can't take them to treatment, we can't pick him up from their home and take them to the case manager so –
Len Sipes: But in many cases – and that I want to get to this right after the break – in many cases, we are the principal pro-social entity in that person's life which I find astounding…
Len Sipes: …in terms of doing previous radio programs about this topic.
Len Sipes: Ladies and gentleman, we're talking to Ubux Hussen. She is the Mental Health Program Administrator. We're talking to Marcia Davis and Robert Evans. They're both Supervisory Community Supervision Officers with my agency, Court Services and Offender Supervision Agency, here in Washington DC. We are a federal independent agency offering parole and probation services to the great city of Washington DC. Our website is www.csosa.gov, www.csosa.gov. Talking about the issue of mental health and how parole and probation agencies treat mental health problems and again getting back to the issue that I've brought up right before the break that for so many individuals under supervision, we are, in many cases, the sole stabilizing pro-social force in their life, coming into contact with them and asking them: a) Are you taking your medication?; b) Are you going to the counseling clinic but we have liaisons, we know whether or not they're complying with this counseling clinics; and c) To sit with that individual and we're not therapist…
Len Sipes: We're not therapists but we do talk with that individual and try to help that individual through the various crises of their lives, and d) often times when they find themselves in crisis, we're the first people that they turn to. So I talk to be all that.
Marcia Davis: Okay. So what we're seeing now with the co-service agencies is that collaborations work tremendously. In the female unit, we have a group of women with unique needs. When we look at the pathways to crime for our women, these are women who have a history of childhood victimization. They've been –
Len Sipes: Childhood sexual assault.
Marcia Davis: Right. They've also been sexually assaulted as adults. They have a history of trauma. They have serious chronic mental illnesses. They are homeless.
Len Sipes: Yes.
Marcia Davis: They have low education, low appointment.
Marcia Davis: They've been separated from their children. Their self-esteem is low.
Marcia Davis: But with this population, the collaborations between the different agencies, with CSOSA, with the Core Service Agency, with the treatment staff, with the faith-based mentoring staff. If we come together and we work as one, we can see how those collaborations work. Just yesterday, we had a case, a high-risk offender who has a serious mental illness. She is 7-1/5 months pregnant. She is using substances and we had a team, a multidisciplinary staff, and where we had her Core Service Agency case manager, we had our mental health administrator, Ms. Ubux, we had the CSO, we had the individual from our central intervention team who provides substance abuse treatment, and we had our mental health treatment specialist and together, we came up with a plan to help this individual. So we see as – if we work together it's so much better than each entity trying to do it alone in this –
Marcia Davis: It takes away from the offender's ability to play one agency against the next because working together we come up with one plan. We're all on one co-work and it just works out better for everyone involved.
Len Sipes: I do want to point out to our audience that we do have a variety of special emphases. Am I correct? Saying that am I grammatically correct in terms of three groups. Number one, we've reorganized around women offenders, we've reorganized around high-risks offenders and now, we're in the process of reorganizing around young adult offenders.
Len Sipes: And, we're finding mental health problems in all three groups.
Len Sipes: And with – especially with the high-risk offenders and especially the young adult offenders we're finding real problems in that group with both recidivism and mental health problems. We have to prioritize…
Len Sipes: …what it this we do to the highest risk offender. Correct?
Robert Evans: Yeah, absolutely. I wanted to also go back to your point because I think it's really important to really highlight that even in my serious case, her community supervision officer was the one that orchestrated all of that.
Marcia Davis: Yes, because –
Robert Evans: Because, you know, when the offender comes home, they're reporting to the CSO and the CSO is between them and the releasing authority and that's the freedom right there. So, now, it's up to that CSO will be the one that can try to connect…
Robert Evans: …with all these other people .
Robert Evans: And so, like you said, that community supervision officer is a lifeline…
Robert Evans: …in most cases.
Len Sipes: Well, I have talked to a wide variety of people in going on 10 years now with the core services and the federal supervision agency, they've been – women offenders, Marcia, you and I have talked and the people under supervision have talked and I've talked to more than just a couple who are on the mental health program and they basically say, you know, Mr. Sipes, if it wasn't for that CSO, again, community supervision officer, I don't know where I'd be.
Len Sipes: He's the one – she's the one who constantly says, are you taking your medication, show me your medications, show me that you have your prescription in hand, show me that you're not abusing this drug, are you going to counseling, or are you hooking up with your faith-based mentor, where are you on your life. And that provides a lifeline. Again, I'm making the same point twice but I do want to reemphasize it. The employees of this organization become sometimes the lifeline…
Len Sipes: …in the life of that individual and becomes the major difference as to whether or not that person succeeds or does not succeed.
Robert Evans: Right. And that's gonna be really heightened when you're talking about the young population because this is a population who's in a predicament and most likely because their family may not be there…
Robert Evans: …or they have turned their back on them.
Robert Evans: So, now, you have somebody who is playing that role in addition to authority but now we have the sort of kind of train you up, you know, and teach you to be an adult. You know, so that…
Len Sipes: It's cognitive behavioral therapy, restructuring how they think about things in life.
Robert Evans: It's all [indiscernible]
Len Sipes: Do we do group therapy with some individuals in the mental health unit?
Ubux Hussen: We do. There are – we have two types of groups. We have mental health intervention groups, for example, where Marcia is located. There is a trauma group that targets women and then we do what are called sanctions groups which is for technical violations of your supervision agreement.
Ubux Hussen: We're now restructuring ourselves because at the base of everything – what you were saying earlier about people raising themselves and so forth – is underlying trauma that hasn't been addressed.
Ubux Hussen: And so we're reconfiguring the group so that we're offering more treatment-oriented groups and fewer sanctions groups.
Len Sipes: You know, it's interesting, the average person listening to this program especially if they are familiar with their parole and probation agency and people are more than welcome to write me, leonardsipes@csosa.gov, leonard.sipes. Call me, send with a nasty letter, do what they will but what we're talking about is unrecognizable to them because: a) we have a ratio where we come in of community supervision officers, a lot of parole and probation agents and people under supervision of somewhere in about ballpark of 50:1. For mental health teams, it's less than that but we come into contact with individuals at higher levels of supervision at least four to eight times a month, two of those have to be community contacts and, at the same time, they have all the mental health contacts. Most parole and probation agents in this country, you know, at the highest levels, come into contact with that individual two times a month and when it comes to mental health services, they say go to your mental health clinic and report in. That's it. That's most jurisdictions' response to people with mental health problems. What we do here at CSOSA as cumbersome as it is at times and as frustrating is at times is generally leaps and bounce better than most parole and probation agencies. Now, am I right or wrong?
Robert Evans: You're absolutely correct and it's unacceptable if we see anything less.
Robert Evans: You know, because, you know, the bottom line is the consumer. We're thinking about the offender, you know. We say that but really we're looking at them like the customer and our job is to assist then through the process. We're trying to help them get the supervision so that they don't come back.
Len Sipes: Well, we're trying to protect public safety.
Robert Evans: Exactly.
Len Sipes: If we get them through supervision that means they're not out there committing crimes.
Len Sipes: It means they're not a burden to society.
Len Sipes: That means they're no longer tax burdens and they're tax payers.
Len Sipes: So a lot of people have a lot of investment in making sure that that person succeeds under supervision including us.
Robert Evans: Absolutely.
Ubux Hussen: Right. Not the least of which the one million children whose parents…
Ubux Hussen: …at various times are involved with criminal justice systems. So it's really in societies enlightened self-interest at some point, budgets are finite, and people have to come home and –
Len Sipes: I'm sorry. Finite and declining.
Ubux Hussen: Finite and declining and so people have to come home and we have to be able to, in terms of those of us charged with public safety, be creative in identifying the reasons for how you got involved in the criminal justice system.
Len Sipes: Okay. But you say creative and so many of us in the criminal justice system, people sitting all throughout the country, listening to this program going creative shamative [PH]. It takes money. It takes resources to do this and – and that's – that's where the rubber meets the road.
Robert Evans: I would say that's false. I would say that, you know, when we talk about being creative, we're talking about being evidence-based and what the evidence says is that you don't need money to show empathy.
Robert Evans: And so – and that is what our unit is all about. You know, we train people to be able to build a rapport. A big huge part that you were talking about is this person sitting in front of me has to build trust.
Robert Evans: So we're all about trying to make a connection with this person so that this person will respond to what we're trying to put in place for them to be successful.
Len Sipes: But this is a difficult population to supervise because I've did what you've done with your lifetime and they come out of the prison system in many cases and I do note that 65% of our people on our supervision are probationers, not coming out of the prison, but those who would come out of the prison have – what I say a chip on their shoulder the size of Montana.
Robert Evans: Big time.
Len Sipes: And you add mental health to that. You're breaking through that barrier and so to the point you can get them to point – that person to the point where you can help them is a monumentally difficult task. How you break through that barrier?
Robert Evans: You don't personalize it. The biggest thing that I've learned is to not to personalize it, you know. Just to give you a real life example, a young guy, you know, they – like you said, the chip on your shoulder, I'm seeing that more and more with the young population.
Len Sipes: Yep.
Robert Evans: He comes in. He's cussing out his officer. This officer called me. Mr. Evans needs you. He came to the cubicle. He's cussing me out.
Robert Evans: So he said he was done. I let him walk out. Ten minutes later, he came back.
Len Sipes: Uh-huh.
Robert Evans: And he had a different attitude. Now, a typical person may have taken it personal, may have said, you know, what? You walked out, we're done. But we have to not personalize that process and we have to realize that he is here, we've got a body to work with, and let's rock and roll.
Len Sipes: That is I think the only way it can be done in terms of breaking through. If we do not break through their lives as individuals, we might as well just give it up. We might as well just send them back to prison.
Marcia Davis: Now, when it comes –
Len Sipes: Go ahead, either one. We have one minute left.
Marcia Davis: When it comes to female unit, the females appreciate the programs that we have developed on the female unit that are geared and unique to addressing their needs. So they're participating in these programs and they're saying that, okay, finally, our needs are being addressed because, for so many years, their needs were never addressed and they haven't been able to address the issues that they need to address in order to stop the cycle. So just then seeing that we've taken the time to develop these programs that were develop for – specifically for females, they appreciate that and they see the direction and appreciate the direction at the agency is doing.
Len Sipes: And I am – never in my 42 years in the criminal justice system have I been as impressed with anything as impressed as I am with the women's unit and the fact that they come out with so many strikes against them but yet, at the same time, they succeed in greater numbers than I would ever expect and considering the efficiencies that they have to deal with. All of you, who deal with the female population, should be congratulated and all of you who deal with the mental health population should be congratulated. Ladies and gentleman, this is DC Public Safety. I am your host, Leonard Sipes. Our guests today have been Ubux Hussen, she is the Mental Health Program Administrator; Marcia Davis and Robert Evans, they're both Supervisory Community Supervision Officers. Ladies and gentleman, again, DC Public Safety. We appreciate your letters. We appreciate your e-mails. We appreciate your phone calls and all of the suggestions in terms of new shows, even criticisms, and we want everybody to have themselves a very, very pleasant day.
[Audio Ends]
Filed Under: Anger Management, Audio Podcast, Interviews with Staff, Mental Health, Parole and Probation, Reentry, What Works Tagged With: mental health, mentally ill, parole, Probation
Reinventing the Criminal Justice System-Justice Reinvestment-Urban Institute-DC Public Safety
Radio Program available at http://media.csosa.gov/podcast/audio/2013/01/reinventing-the-criminal-justice-system-justice-reinvestment-urban-institute-dc-public-safety/
Len Sipes: From the nation's capital, this is DC Public Safety. I'm your host, Leonard Sipes. Today's program, ladies and gentlemen, is Reinventing the Criminal Justice System, Justice Reinvestment; I think one of the more important topics that we're going to be discussing and one of the more complicated topics we are going to be discussing this year. Dr. Nancy La Vigne, Director of the Justice Policy Center for The Urban Institute is our guest today. – www.urban.org. We'll be making reference to that website throughout the program because, ladies and gentlemen, this is, again, an extraordinarily difficult concept to understand, complicated but unbelievably important to the future of the criminal justice system. I'll try to summarize it and then turn the entire program over to Nancy. Number one, states and locales all throughout the country are complaining of budget cuts, and it really has impacted the criminal justice system. And I'll read a passage, a quick passage from a publication, "What can county and city managers do reduce these costs without compromising public safety, they can engage in Justice Reinvestment. Justice Reinvestment can help prioritize local justice spending for those who pose the greatest risk to public safety while also informing which individuals would be better off in the community, where services and treatment are more readily available." And then bottom line, I'm thinking, about Justice Reinvestment are the savings. If there are savings, a portion of those savings go back to the states and local jurisdictions to even provide more programs. Nancy, am I somewhere in the ballpark of even beginning to describe what Justice Reinvestment is all about?
Nancy La Vigne: Yes, you are, and you did it quite succinctly, I will say. It's a multi-step process and so it does take some time to explain but perhaps we should start with a little bit of history. You did refer to the fact that the impetus behind a lot of states and localities getting on the Justice Reinvestment bandwagon is because of the budget shortfalls, and that's definitely accurate, but there were other issues as well. First of all, as I think we all know, a lot of those budget shortfalls are being fed by rising criminal justice costs. They may not be the entire – as a matter of fact they're a rather small, 8% to 10% of the total state budget in any given state but still we're talking about hundreds of millions of dollars so with states and localities thinking, "What can we do? How can we save money? How can we deal with these budget shortfalls," it's a natural inclination to look at the criminal justice system because those costs continue to rise because the populations have been rising historically. Now you may be aware of recent studies that show that state prison populations are on the decline but actually, as my colleague Jesse Jannetta recently blogged about, that's driven almost entirely by California.
Len Sipes: By the state of California, that's right, and those overall declines are not all that dramatic.
Nancy La Vigne: They're marginal, but states realize that this is an issue and they've been grappling with it for a while, and many have tried different efforts to control the growth of the prison population that have been maybe mildly successful but not sustained over time, and arguably it's because they haven't engaged in this Justice Reinvestment process which requires a couple of things to be place. First, you need to have all the people in the system, all the key stakeholders at the table and on board. If you only work one end of the system, it's just going to bulge out somewhere else kind of like squeezing a water balloon so you need everyone at the table. At the state level, it's critical that you have representation from both sides of the aisle, and you've got the support of the Governor and the House leadership, the Senate leadership, minority, majority, as well as the Head of the Department of Corrections, and parole and probation and so forth, and judges, prosecutors, everyone who drives the system. If you don't have them all on board, it's not going to work because either changes will be made and they'll be fought and they won't get through or they won't be sustained over time because you don't have this joint buy-in.
Len Sipes: You're as good as your weakest link.
Nancy La Vigne: Exactly. Exactly. Some of those weak links are quiet powerful, as you may know.
Len Sipes: Yes! Yes!
Nancy La Vigne: So there's that. It's having the right people at the table. And then it's guiding the decision-making process with hard empirical data, and that data is often supplied by the state or the locality but typically in the Justice Reinvestment model, it's analyzed by a technical assistance partner, funded by the Bureau of Justice Assistance, U.S. Department of Justice, Office of Justice Programs —
Len Sipes: Thank you.
Nancy La Vigne: — in partnership with the Pew Center on the states for the state-level initiative, they together have funded this initiative and supported four technical assistance providers, two that work with states, two that work with localities. I can share who those are if you wish.
Len Sipes: 17 states are doing this?
Nancy La Vigne: 17 states right now are engaged in this process. Some states early on have already engaged in the process and declared victory and moved on. A lot of people point to Texas as an example of that. They were the earliest adopter I can think of, and they were looking towards the future and had planned to spend billions of dollars on new prison construction —
Len Sipes: And did not.
Nancy La Vigne: — and did not. They chose not to.
Len Sipes: And the crime rates have basically gone down in Texas.
Nancy La Vigne: And they took some of the money they would have spent on prisons and funded treatment beds.
Len Sipes: And that is the heart and soul of Justice Reinvestment, is it not? – Using data, doing things differently. If there's cost-savings, those cost-savings are shared with the states and localities, and they buy more treatment options for people in the criminal option system.
Nancy La Vigne: That's the way it's been playing out, not only treatment options or programming. Sometimes it's to shore up supervision. In some states they've identified that the wrong people are being supervised and some people are not being supervised at all so, you know, folks who are maxing out and are exiting after often serving time for pretty serious crimes without any supervision, and of course with supervision comes support. It's not just about surveillance; it's about support and providing the necessary programs and services, so shifting who gets supervised, how long they get supervised. You know, some low-level offenders perhaps shouldn't be supervised at all or certainly shouldn't be supervised for the length of time that they are. That can save money. But also with those savings, putting it into implementation of graduated sanctions to prevent revocations and other best practices that are supported by evidence.
Len Sipes: One other person – I won't name this person – this is what he told me, not knowing it, but he said it with all the conviction in the world, that every governor in every state in the United States has had a discussion with his or her Correctional Administrator basically saying that costs have to be reduced. That was his proposition.
Nancy La Vigne: So do you know what I find really frustrating about that?
Len Sipes: Please.
Nancy La Vigne: The assumption that the head of the DOC has control over that population. I mean yes, they are housed within his or her domain or control but that suggests that they're the ones that drive the growth in the population, and what we've learned from the experiences in the states is that's not really the case.
Len Sipes: True.
Nancy La Vigne: Revocations, often technical revocations, are driving that growth.
Len Sipes: That's why everybody's got to be on board.
Nancy La Vigne: Sentencing decisions, sentencing low-level drug offenders, low-level property offenders to increasingly lengthy terms behind bars – that's not under the control of the head of the DoC. That's a decision that prosecutors and judges make.
Len Sipes: But after 42 years in the criminal justice system, we are stodgy. We are bureaucrats. We are round-peg in a round-hole kind of people. We're not used to people coming along and saying, "We're going to basically readjust/reinvent/change the way that you conduct business." The criminal justice system, when I joined when I was 18 as a cadet for the Maryland State Police, is basically 90% of the criminal justice system I see as I'm looking at the end of my career.
Nancy La Vigne: Yeah, and I agree with that. You are stodgy. However – however – when you look at this process, how it plays out in action, it's a wonder to witness. The Urban Institute is in a role as the oversight coordination and assessment entity for this project so we get to kind of go to all the states and localities and observe how this works, so the Counsel of State Governments, for example, they've been leading the charge on the state side. They literally embed people in a state and develop the relationships and share the data and engage in intensive policy conversations and work a tremendous amount of time behind the scenes, getting people on board, educating people, identifying folks that may be reticent to get on board, and finding ways to persuade them that it's not just in their best interests but in the best interests of the system. They are that neutral outside entity that can speak with authority based on extensive experience working in many states, and presenting the data that can just kind of dispel a lot of the anecdotes that you hear that nay-sayers often argue based on stories rather than fact. They can demonstrate how it is a system-wide problem not just owned by one player, and that can really nudge some stodgy people into action.
Len Sipes: Yeah. Yeah. Let's give some examples because I'm afraid some of our listeners possibly could be confused with the process. We are talking about in essence focusing our resources on those people who pose the greatest risk to public safety and doing "something else" with those people who do not necessarily pose a great risk to public safety.
Nancy La Vigne: Well, that is one of the many interventions that states have chosen to implement. Really, the interventions should be guided by the identified drivers of population growth so in some states it may be one driver and in some it might be another, and across the 17 states, the most common drivers are revocations, both probation and parole revocations, and a high, high percentage of them being technical.
Len Sipes: In your report, you cited one state with 50% as having histories of parole and probation revocations coming in through their prison system. I spent 14 years with the Maryland Department of Public Safety and Correctional Services. At one point for us it was 70%.
Nancy La Vigne: 70%.
Len Sipes: 70%, yes it was.
Nancy La Vigne: Well, I would call that low-hanging fruit. There's a lot that could be done there. So certainly with the revocation issue, the response to that is to look at what sanctions are in place, do people need to be returned to prison for technical violations, can you create graduated sanctions, can you create incentives for not engaging in technical violations, can you return people for shorter periods of time or return them to local jails rather than to state facilities. All of that saves a ton of money.
Len Sipes: And Project Hope basically said those short, meaningful interventions of a day or two days or three days were effective enough to dramatically reduce recidivism, dramatically reduce technical violations. It was wonderful across the board. So Project Hope is the epitome of an example as to the effectiveness of that approach.
Nancy La Vigne: That's exactly right, and several of the states who are grappling with high revocation rates did choose to implementation Hope models or Hope-like models. That's exactly right. But then there's other drivers, and I mentioned before, sentencing practices and the incarceration of low-level offenders. In Louisiana, for example, non-violent, non-sex offenses represented over 60% of prison admissions so, you know, what can we do with that population? Some may need to go, some may could be diverted, and also what's stunning to me is that there's also been a trend in many states of increased lengths of stay for these low-level, non-violent, property and drug offenders So that's another place where you could look to see making changes. Sentencing reform is tremendously challenging.
Len Sipes: It's a huge issue.
Nancy La Vigne: It's very challenging, so most states don't choose to go the sentencing reform route. They usually look at some kind of back-end way to – although some do pass statutes to change the thresholds by which people should be —
Len Sipes: The research on specialty courts has been very encouraging, diverting people out of the prosecution prison route and going into the specialty courts, and specialty courts have had good returns basically in terms of recidivism and cost-savings.
Nancy La Vigne: Um-hum, uum-hum. It's true, and then another common driver we observed across states is the issue of delays in parole processing or reductions in the parole grant rate, and these too are relatively simple changes, figuring out what's slowing things down and how can you speed them up, or how can you change or guide parole boards in a way that they're incentivized to make decisions to grant parole, perhaps supported by evidence, and the most obvious evidence would be a risk assessment that gives them more comfort in knowing who they should release. In other cases, the parole grants get stalled because people don't have a home plan. Well, that is an issue of resources often behind bars. If you don't have a case manager that can help line up a home plan then no one gets released, and then you have this backlog which is really unnecessary.
Len Sipes: And the interesting data in terms of parole is that those paroled have consistently much less of a rate of recidivism than those not paroled, so fewer people coming back to prison, once again, as long as they are released with conditions and those conditions are enforceable.
Nancy La Vigne: Exactly.
Len Sipes: So what else?
Nancy La Vigne: What else?
Len Sipes: It's very complicated.
Nancy La Vigne: Yes. Well, so what's complicated about it is how long it takes to explain why it's called Justice Reinvestment because up till now what we've discussed is data-driven, collaborative approaches to reducing the prison population and saving money through identifying the drivers and developing responses to the drivers. Where does this word "reinvestment" come in?
Nancy La Vigne: That comes in at the very, very end with the anticipated savings associated with making all these changes. Now this is very complicated because the savings might not be hard cold cash that you have in your hands and you can put elsewhere, as a matter of fact it's rarely that. A lot of the savings are projected savings that aren't realized until several years into the future however the process still encourages states to think about upfront reinvestment. So in looking at prison projections had they done nothing and then the projections associated with the changes that they plan to make, they can anticipate that, you know, five years down the road they're going to save however many millions of dollars – why not reinvest some of that upfront into programs, supervision, services that help support the entire system and reduce recidivism?
Len Sipes: So the reductions in terms of the cost outlays to the criminal justice system are actually reinvested to make the system even better, so it's a win-win situation across the board.
Nancy La Vigne: Um-hum.
Len Sipes: All right. Let me reintroduce you, and ladies and gentlemen, we're a little bit more than halfway through the program. We're talking about reinventing the criminal justice system – that's my title – Justice Reinvestment, Nancy La Vigne, Director of the Justice Policy Center, Urban Institute, www.urban.org – www.urban.org. Again, we reemphasize that this is a joint project of the Bureau of Justice Assistance, the Office of Justice Programs, U.S. Department of Justice, the Pew Center on the states and the – I'm sorry, the Centers for State Government, correct?
Nancy La Vigne: The Counsel of State Governments.
Len Sipes: The Counsel of State Governments, I'm sorry, my apologies, but this is a massive undertaking on the part of 17 states, a lot of different jurisdictions, with the understanding that people have been talking about reinventing the criminal justice system, doing "something different" with the criminal justice system for a multiple of reasons but budget, in my opinion, seems to be the principle driver behind all of this. People are more than welcome to disagree with my assessment but I do think it's budget that's pushing an awful lot of this, and this is exciting stuff because what it does is bring an awful lot of people in one room, data-driven, taking a look at an awful lot of data and saying, "What can we do to reduce the amount of people flowing through the criminal justice system without having an adverse impact on public safety and saving money and taking those savings and reinvesting those savings in terms of either more prosecutors, more parole and probation agents, more programs, more resources for the criminal justice system so they can do a better job to begin with so it can be data-driven in the future so we can continue this philosophy down the road, right?
Nancy La Vigne: That's right – data-driven and evidence-based.
Nancy La Vigne: Before we continue, I do want to acknowledge all of our partners in this initiative.
Len Sipes: Please. Please. Please.
Nancy La Vigne: We mentioned, of course, the Bureau of Office Assistance and the Pew Center on the States are the funding partners. The Counsel of State Governments and the Vera Institute of Justice have both been working with states, and the way that works is that the Counsel of State of Governments helps identify the drivers and the policy options, and gets states to the point where they pass legislation, and then Vera comes in and helps implement. And then at the local level, it's the Center for Effective Public Policy and the Crime and Justice Institute that are working with counties across the country.
Len Sipes: Oh, lots of different people, lots of jurisdictions involved in this.
Nancy La Vigne: Yeah, a lot of players, a lot of very, very seasoned criminal justice professionals, often former practitioners and/or data analysts that come into states and localities and, as I said before, really embed themselves in the system, develop the relationships and the trust, and really make things happen.
Len Sipes: This is, in my mind, the most significant story of the criminal justice system as we move into the 21st century and yet it gets zero coverage. There's nobody from the Boston Globe, there's nobody from the New York Times, there's nobody from the Washington Post, there's nobody looking at this systematically, and yet this, in my mind, is a fundamental change in terms of how we within the criminal justice system operate. Why is that? Is it just a bunch of policy wonks sitting with a bunch of budget-cutters and saying, "Hey, what's the best way we that can rearrange the deck chairs?" or is this really a substantive, hard-nosed examination of the fact that we can do this better without imposing so much of a fiscal burden on the states and counties and cities?
Nancy La Vigne: It's definitely the latter because it's not just budget-cutters and policy wonks. It's all the key players in the system that have a shared interest in doing things differently and getting more bang for their buck. I mean, the return on investment has been really poor. If you look at the increased expenditures on corrections across the country —
Len Sipes: Massive.
Nancy La Vigne: — massive, with no real discernible change in the recidivism rate.
Len Sipes: But isn't it interesting of how you take a look at conservative politicians – not to touch upon politics in any way, shape, or form – but conservative politicians are demanding that the criminal justice system prove its cost effectiveness, demanding that we get a bigger bang for our criminal justice dollar. I mean, I find that to be interesting.
Nancy La Vigne: This is why it's been so popular an initiative, it's because it garners support on both sides of the aisle. The left has always been more sympathetic to rehabilitation spending and perhaps diverting people from prison. The right has observed that this is not just a wise use of taxpayer dollars, and they do, they want to see a better return on the investment and that's what we're seeing. You know, we talked at the end of the first segment about the projected savings and how they get reinvested. Across the 17 states that are currently engaged in justice reinvestment, they're projecting between 9 and 438 million dollars in savings.
Len Sipes: That's amazing. Now is that per state or is that total?
Nancy La Vigne: An average of $163 million per state.
Len Sipes: An average of $163 million cost savings per state.
Nancy La Vigne: Yes. Um-hum. Yeah. It's huge!
Len Sipes: Who's getting the Nobel Prize for this?
Nancy La Vigne: I'd love to see it. Well, we have to see those savings, realized, right?
Len Sipes: Of course. Of course.
Nancy La Vigne: A lot of these are projections and we hope they're accurate but even if they're off by 50%, that's still a tremendous savings. Across all the states, in five years the projected savings is $2.12 billion.
Len Sipes: $2.12 billion.
Nancy La Vigne: And that speaks volumes, I think.
Len Sipes: Well, it does speak volumes if we can hold down the rate of recidivism, if we can ensure public safety, if we focus on those people who pose a clear and present danger to our well-being.
Nancy La Vigne: Well, the beauty of this model is that a lot of the policy responses to the drivers of growth embody those principles. Every single state that engages in Justice Reinvestment is refining their risk assessment tools and validating them, and using them to guide decisions on diversion, on supervision, on everything including on needs and who should great treatment, and everything in between; and that is evidence-based, and we know that that's tied to better outcomes in terms of recidivism rates.
Len Sipes: In essence what we're saying is that there's a certain portion of the population that comes into the criminal justice system, again, recognizing there's been an almost continuous 20-year decline in crime per the National Crime Survey in crimes reported to law enforcement agencies and through the FBI, there is still a certain portion of the population coming to the criminal justice system that is better served from a public safety point of view and from a recidivism point of view not to process them in the way that we did ten years ago.
Nancy La Vigne: Um-hum. I think that's right.
Len Sipes: And that's taking risks, and that's why a lot of the people at the local level, at the country level, are saying, "Well, why should we take those risks? Those risks have a way of blowing up in our face." I think that would be the greatest point of reluctance. Why change it? Why take that risk? Why not simply incarcerate that person for a year or six months instead of putting that person into drug court?
Nancy La Vigne: Well, because it's just not sustainable, that's why. There's just not enough room. There's not enough money to build more prisons and so if you don't make these hard decisions now, essentially you're not making strategic decisions about how to use that space most wisely. You want to free up that space for folks who are really a danger to society but if you don't make hard decisions about who needs to be in and who shouldn't be in, those decisions should be backed up by risk assessment tools, then you're actually engaging in really bad practice.
Len Sipes: And isn't California the poster child for this whole movement where the courts have ordered the release of tens of thousands of offenders from their prison system in California because of the fact that they could not fund properly their health care system? – And they've released massive numbers of offenders, and that's what we're trying to avoid.
Nancy La Vigne: Right. Exactly. When you said "poster child" I paused for a section. "No, no, don't hold up California as the example of Justice Reinvestment!"
Len Sipes: No, no, no, I'm not. I'm not.
Nancy La Vigne: No, this is what could happen to you if you don't engage, yes. Right. Absolutely.
Len Sipes: If you don't. Right. Right. Right. There are consequences for not managing your population better. There are consequences for not managing your dollars better.
Len Sipes: And states, I mean, and one state that you looked at in terms of one of our reports, 12% of their overall budget was the state correctional system. That's astounding!
Nancy La Vigne: That's right, I think that was Oregon.
Len Sipes: That's astounding, that 12% of the budget is Corrections. It raised from I think 4% to 12% in terms of the various states but you're talking about billions of billions of dollars, and if you can divert individuals from coming back into the criminal justice system, you are saving literally billions dollars in terms of future prison costs, building and operating those prisons. That doesn't have to happen if you manage your population carefully.
Nancy La Vigne: Couldn't have said it better myself.
Len Sipes: Okay, but we can, through a data-driven process, assure people that this is not going to have an adverse impact on their public safety.
Nancy La Vigne: Again, states, localities, are using risk-assessment tools – some, not all. The ones they are using are not always validated which means they're not always accurate. By using these tools, and using them in a way that can guide decision-making, I think that they should have confidence. I have confidence that this is no threat to public safety, in fact it' a wiser and more efficient use of scarce criminal justice resources.
Len Sipes: Right, and the alternative is billions, billions, billions more or the alternative is what's happening in California with tens of thousands of offenders court-ordered release so if we don't manage our resources carefully, if we don't make data-driven decisions, evidence-based decision, we're not serving the public.
Nancy La Vigne: That's right, and getting back to the concept of reinvestment, the ways in which states and localities are looking to reinvest a fraction of the savings is in evidence-based programs that are designed to reduce recidivism so you really are getting at recidivism reduction in two ways. You're getting at it through better use of risk and needs assessments and you're getting at it through enhanced programs to help people succeed on the outside.
Len Sipes: Um-hum, and that goes all the way from who do you prosecute to what programs do you provide at the end of it because the criminal justice system has done basically a terrible job in the opinion of many in terms of I think, what, 10%, 12% of people get substance abuse treatment while in prison. The numbers for mental health treatment are even smaller. The percentage getting mental health and substance abuse treatment on community supervision is also small, and that's come back to bite us.
Nancy La Vigne: Yeah.
Len Sipes: To a certain degree, that's not cost-effective.
Nancy La Vigne: Agreed.
Len Sipes: And the numbers need to drive that in terms of that larger policy discussion with hard-bitten criminal justice people like myself.
Nancy La Vigne: That's right. We've got to get you out of your stodgy ways, Len.
Len Sipes: I would love to do a bit of the fly-on-the-wall for so many of those meetings where people are saying, "Hey, if we don't do this, we just have the courts release lots of people, and we don't have the money to continue doing what we're doing."
Nancy La Vigne: Right.
Len Sipes: Yeah, it's a fascinating thing. I really applaud Urban, I really applaud all the partners, and I applaud the Department of Justice of really trying to take a really unique and different approach, and this is why I called the program Reinventing the Criminal Justice System through Justice-Free Investment. Ladies and gentlemen, this is DC Public Safety. Your guest today has been Nancy La Vigne, Director of the Justice Policy Center of the Urban Institute, www.urban.org – www.urban.org. And we thank everybody for their time and efforts in terms of all the input that you provide for the radio shows here at DC Public Safety. We appreciate your calls. We appreciate your letters. We appreciate your emails, and we want everybody to have themselves a very, very pleasant day.
Filed Under: Audio Podcast, Budget Issues, Corrections-Prisons, Courts, Drug Court, Drug Treatment, Education and Vocational Assistance, Employment, High Risk Drug Offenders, Interviews with Policy Makers, Mental Health, Parole and Probation, What Works Tagged With: Justice Reinvestment, Urban Institute
What Works in Offender Reentry-The Urban Institute-DC Public Safety Radio
November 20, 2012 by CSOSA
Welcome to "DC Public Safety" – Radio and television shows, blog and transcripts on crime, criminal offenders and the criminal justice system. We currently average 90,000 page views a month.
Radio Program available at http://media.csosa.gov/podcast/audio/2012/10/what-works-in-offender-reentry-the-urban-institute-dc-public-safety-radio/
Len Sipes: From the nation's capital this is DC Public Safety, I'm your host, Leonard Sipes. Back at our microphones is Nancy la Vigne, she is the Director of the Justice Policy Center for the Urban Institute. www.urban.org We're here today to talk about what works in reentry and the fact that there are now, for the first time, actual websites, databases, that really do summarize the state of the art in terms of research in a variety of areas, what we have is crimesolutions.gov from the Office of Justice Programs, which gives research on a wide variety of criminal justice topics, including reentry but now we have another website that's focusing specifically on reentry. It was launched by the Urban Institute and a Council of State Governments. The website is the "what works" clearinghouse for reentry. It's at www. nationalreentryresourcecenter.org/whatworks .Nancy La Vigne, welcome back to DC Public Safety.
Nancy La Vigne: Thanks, it's great to be here.
Len Sipes: Wonderful website. Is it in competition with crimesolutions.gov?
Nancy La Vigne: Not at all, in fact it's very complimentary and bear in mind, both websites are funded by the Office of Justice Programs.
Len Sipes: There you go.
Nancy La Vigne: So we worked very closely with the developers of Crime Solutions to talk about methodology and the ways in which the sites will be different and not duplicative and in fact, they're not, Crime Solutions, as you said, covers a wide array of crime and justice topics.
Len Sipes: Law enforcement, corrections, juvenile justice courts –
Nancy La Vigne: Right, right, exactly.
Len Sipes: You focus on reentry.
Nancy La Vigne: Yeah, we take more of a deep dive approach and whereas Crime Solutions only looks at what they're calling brand name programs, we're looking at all evaluations across a wide array of programs related to reentry. And as you know, reentry is a very broad topic in and of itself, so we're looking at a wide array of different types of reentry interventions and summarizing the research findings across those types. So: employment, mental health, housing, juvenile justice.
Len Sipes: Nancy, you've been around for quite some time. I mean, you are the Director of the one of the most prestigious research organizations in the country, if not the world. Why did it take us so long? I remember talking to the former Assistant Attorney General, Laurie Robinson, who said that we are going to do this, we are going to start summarizing the research, we're gonna start making it easy for practitioners. Why did it take us decades to do this?
Nancy La Vigne: Well, I think in the case of the reentry topic, it took a real awareness and sense of urgency by members of Congress to fully fund reentry in all its aspects and that came with the Second Chance Act. And the Second Chance Act funded the National Reentry Resource Center, which of course, is run by the Council of State Governments and when we partnered with the Council of State Governments, we knew that CSG, as they're called, was very well equipped to provide technical assistance and that we could provide some research value and the way we saw the best way to add value was to cull all the research on reentry and make it accessible to practitioners. So that's what we set out to do.
Len Sipes: I just want to state, for the record, that I think that it's been very frustrating for those of us in the practitioner community because we've been waiting decades for this and it's here. In terms of crimesolutions.gov and in terms of your website, I mean, it's taken a long time to make it easy for practitioners and policy makers to follow the research.
Nancy La Vigne: I think that's right and you know, when you look back, even a decade ago, there were two statements that were made as fact. One is: we don't know what works. And the other was: well, we might know what works but the "we that know it" are a bunch of academics that do nothing more than talk to each other and publish for each other.
Nancy La Vigne: I was of that second school of thought, which is that, you know, being an academic myself, I was aware of what was out there, I knew that there were evaluation studies that showed that certain types of reentry programs worked, but they were largely inaccessible. Sometimes inaccessible to me. You know, the methodology's extremely complicated, the way the studies are presented are really more to show off the methodology off and rather than to illustrate the findings and the implications of the findings for policy and practice.
Len Sipes: My heavens, that's a bias I've had for years. I'm glad you expressed it. Here's the example that I give to everybody else. I remember being the Director of Public Information for the Maryland Department of Public Safety and the Secretary of Public Safety comes in with a sour look on his face and he's got a document from the Department of Justice, and he plops it on my desk. And he goes, "Sipes, I want a one page summation." And then he goes to the doorway and turns around and points his finger at me and goes, "Now did you hear me? A one page summation. I don't care about the methodology, I don't care about the literature review, I don't have time to wade through this. I simply want to know, did this work, what are the policy implications and how we can implement it here. One page." And he reminds me, again, "One page." So simplicity is next to Godliness in terms of the transfer of information.
Nancy La Vigne: Yes, exactly. And you know, and one page is often, for a busy decision maker, too much. They want the bottom line, and that's what we need to give them.
Len Sipes: And I think that's what the both organizations, both websites do, is provide that summation. www.nationalreentryresourcecenter.org/whatworks So, did we cover the website enough or are there more points that you want to make before getting into what the research says?
Nancy La Vigne: Well, sure, no, I would like to talk a little bit about the website and the methodology because I don't want to overpromise on what this is.
Len Sipes: Please, okay.
Nancy La Vigne: And the reason I can't overpromise is because I think that the research community has largely failed us and I say that because of the work that we had to do to winnow through all the evaluative research out there to get this much, much smaller subset of studies that we felt met methodological rigor enough that we could include them. And so, just to give you a few statistics, we identified roughly 2500 individual publications –
Len Sipes: Oh my heavens! 2500?
Nancy La Vigne: That called themselves evaluations and were on various topics of reentry which is to you know, prepare people for release from prison or jail, and tracks reentry outcomes. So it doesn't just track infractions behind bars, for example. Of those, we screened out almost 1500 as irrelevant for a variety of purposes.
Nancy La Vigne: They weren't really serving a reentry population; they weren't really relevant outcomes for a reentry topic.
Len Sipes: Right, right.
Nancy La Vigne: Some other reasons, so we have around 1000 that were potentially relevant. Of those, only 276 met our standards for rigor.
Len Sipes: 15000 to 276?
Len Sipes: That's amazing.
Nancy La Vigne: Now, there's more that we're still in the process of reviewing, but I would say that for every, easily every 10 we review, eight get winnowed out because they're just not strong enough as studies.
Len Sipes: Okay, and without getting into a methodological review or discussion, it's just that, that the findings and the way that they went about getting their findings just wasn't strong enough to hold the confidence of their findings.
Nancy La Vigne: Right, but how do you know this if you're a practitioner trying to figure out what works?
Nancy La Vigne: You just go to you know, you find a study online, you find a series of studies, they say that they have positive outcomes and then they take it at face value, and why wouldn't they?
Len Sipes: Sure, of course.
Nancy La Vigne: So I feel like that's one way we're really adding tremendous value is to winnow through all of this supposed knowledge –
Len Sipes: Amazing.
Nancy La Vigne: Down to really what we can say with confidence, seems to be the findings. Now, not all of those studies, once you winnow them down, show that reentry interventions work.
Nancy La Vigne: Many are inconclusive and a lot of our findings suggest that more research is necessary.
Nancy La Vigne: But, so I want to be clear. It's a lot of work that boils down to you know really just, you know, tens of studies that end up on the website. The ones that you see will be relevant, will have met these methodological standards and you can have faith in that they're saying something meaningful. So I think that that's really important and I wanted to make sure that your audience understood both the value of the website but also the limitations because of the lack of good quality research that's out there.
Len Sipes: So the bottom line in terms of what's there, it can be trusted.
Nancy La Vigne: It can be trusted.
Len Sipes: Okay, the larger issue, I talked to a couple reporters a couple weeks ago, and we were talking about the state of research in terms of offender reentry and one of them said that, "You know Leonard; there are a lot of failed research programs out there." And I said, "Well, you know, there's a lot of hope and there's enough evidence, there's enough good evidence that we believe that we're moving in the right direction, that we believe that if you take a look at drug courts in particular and you take a look at GPS in particular, you take a look at substance abuse, if you take a look at preparation in prison, that, that you're getting fairly consistent, good findings that are methodologically correct, well done evaluations." So I think there's enough promise that leads us to believe that we can cut recidivism rates and I'm not saying 30% or 40% but at the moment, somewhere between 10 and 20%. But I point out that out of 700,000 people coming out of the prison system every year, if you cut that down from 15 to 20%, you're saving billions of dollars and you're saving victims from hundreds of thousands of victimizations.
Nancy La Vigne: That's right, and I would agree with you. There's certainly enough evidence out there to suggest that these programs are worth continuing to fund and support.
Len Sipes: But what do we say to practitioners when they go to your website, because they go to crimesolutions.gov, they go to your website and what it does seem to say is that promising, promising, promising, promising and you've got three or four at the top with the green indicators saying that they did reduce recidivism and you have some down at the bottom with the red – you have a color coded system, which makes it real easy, and some fairly prestigious evaluations didn't seem to have that much of an impact.
Nancy La Vigne: That's right.
Len Sipes: The Serious and Violent Offender research comes to mind. So the person takes a look at this and again, the word promising comes to mind.
Nancy La Vigne: Yeah, I mean I think that's right. And I think that much depends on the population and the nature of the intervention and the fidelity with which it was implemented, which was something that we're having a very difficult time assessing based on the studies. The studies rarely look at issues of the design and implementation of the program. So if you don't do that, and you say a program doesn't work, you don't know if it doesn't work because the concept was flawed, or because it wasn't implemented properly.
Nancy La Vigne: And so we're saying it doesn't work, which is really an unfair indictment on a concept that could be very theoretically sound and could work under better circumstances.
Len Sipes: So we're going to repeat what Joan Petersilia of Stanford said that what we do too much of at a National Institute of Justice conference, was that we overpromise and deliver too little in community corrections. That seems to be true to some degree, but people need to understand that this Rome was not built in a day. I mean, these are thousands of pieces of research, cumulatively speaking, seem to be saying that we're moving in the right direction. So for those out there who are saying, hey, we can dramatically cut recidivism, that doesn't seem to be supported by the literature but I'm talking about 30% and above. That's not supported by the literature.
Nancy La Vigne: No, it's not.
Len Sipes: And we shouldn't be, as advocates –
Nancy La Vigne: It's an unrealistic goal, and if we have goals like that, we're setting ourselves up for failure and that's just no way to go.
Len Sipes: And that was her point. I think her point was was that don't overpromise because there's a certain point where the States are going to be well funded again and then they're going to have to make a decision as to whether or not to continue to build more prisons and if we overpromise, we inevitably invite our own demise.
Nancy La Vigne: Well put.
Len Sipes: But I mean, that's serious stuff, but at the same time, you know, I travel throughout the country, I work with principally public affairs people, they're enthused about this. They're enthused. Most of the people representing parole and probation agencies, most of the people representing correctional agencies, I was doing some training for the National Institute of Corrections and had a chance to talk to directors of public affairs for various states who not only do mainstream prisons, but they also do parole and probation. They're very happy to be exploring opportunities of doing something else besides putting the person away for 20 years. They're not saying, you know, "Let's let'em out." They're not saying, "Let's not incarcerate them." But what they are saying is is that we certainly can really have an impact in terms of them coming back. So there's an enthusiasm and and optimism out there nevertheless.
Nancy La Vigne: Oh, I would say so, and it's interesting. You referenced how long I've been in the field. Thanks for showing off my age to your audience.
Len Sipes: I thought you were 25.
Nancy La Vigne: But you know, we've both been around for a while, and when you think about it, if you look back, even, you know, a decade or you know, 15 years ago, I would say the large majority of directors of departments of corrections across the country did not view it as their responsibility to do anything to prevent people from returning to their prisons.
Len Sipes: We were told, when I was with the Maryland Department of Public Safety, we had three correctional systems, we were told our mission was to constitutionally incarcerate. The parole and probation side of it, we were told that our mission was to enforce the provisions set by the courts and to enforce the provisions set by the Parole Commission. That was it. There was no mention of recidivism, there was no mention of best practice and there was no mention of intervention. None.
Nancy La Vigne: Yeah, we've come a very long way.
Len Sipes: Where the average correctional administrator wants to do these things, for a variety of different reasons. So the whole idea is to supply programs that are meaningful and evidence based within the correctional setting and to continue that when they come out.
Nancy La Vigne: Yep.
Len Sipes: And there is evidence that shows in some cases, you get some fairly decent reductions and I'm saying again, to be on the safe side, somewhere between 10 and 20%.
Nancy La Vigne: I think that's safe to say.
Len Sipes: I wanted to give the resource center, the address one more time. We're halfway through the program. www.nationalreentryresourcecenter.org www.nationalreentryresourcecenter.org My guest today is Nancy la Vigne. She's the Director of the Justice Policy Center of the Urban Institute, www.urban.org. www.urban.org, and I do also want to talk at the same time about the Crime Solutions data base, funded by the Office of Justice Programs of the US Department of Justice. They are at crimesolutions.gov, and again, Office of Justice programs supports this particular reentry resource center endeavor as well. Where do we go to from here in terms of the research? I mean, part of it is the frustration that the research hasn't been good enough, hasn't been rigorous enough and so the message needs to go out to the research community to do better?
Nancy La Vigne: Absolutely. And they need to be incentivized to do better and I'm not sure how to do that, because you know, as I said earlier, you know, researchers spend a lot of time publishing to communicate with each other and not with the world outside of academia. So I think that there is a share of academics out there that really care about making a difference and that we need to get to them and explain that you know, while you're publishing and trying to get tenure, also think about ways that you can do good work that's of a high quality, that also is accessible.
Len Sipes: That withstands scrutiny. That, that people can depend upon.
Len Sipes: But the practitioner community, unto themselves, I mean, the only thing that they want, is again, a la the Secretary of Public Safety who I used to work for, they just want it simple.
Nancy La Vigne: The bottom line, yeah.
Len Sipes: They just want the bottom line, they just want, you know, want to know the policy, they want to know the results and they wanna know what the policy states and they want to know if they can implement that policy within their jurisdictions, that's pretty much it.
Nancy La Vigne: Right. Yeah, now let me tell you a little bit more about how the website is set up. I mean, unfortunately, this is a radio show so we can't do a webinar and have visuals, but it's tiered in such a way that for those very busy decision makers, it is indeed just the bottom line. But then you can click down and get more and more information.
Nancy La Vigne: And so what it starts out is a description of each category of type of intervention. So under employment it might be a literacy program. Or a vocational training behind bars. And then it has a summary of the finding across all studies that address that intervention. So that's the bottom line, right?
Len Sipes: And it's a fairly quick description.
Nancy La Vigne: Yeah. But, if you click, it unscrolls a long, detailed, not as detailed as anything you'll see in a journal article, but detailed description of the population that participated in the program, the geographic location, the nature of the program, and all those other nuances that I think are really critical. Because you have the busy decision maker, right? And he or she just wants to know the bottom line, but ultimately, if they're going to use that bottom line to develop or alter a program, there's gonna be someone who is tasked with doing that, and that person is going to need to know these details so that they don't take, God forbid, the cookie cutter approach of just saying, "Okay, so we're gonna do vocational programming." Without thinking through who it works best with, why it works with this population, some of the details behind the program that might have made it more likely to achieve it's intended results –
Nancy La Vigne: Those types of details we felt, really had to be somewhere on the website and easily accessible, but the average viewer that goes there is not confronted with all that detail; they can chose to unveil it at their will.
Len Sipes: Do we have in this country any sense of training for the practitioner community that they understand everything that we, you and I just talked about? I mean, isn't the natural inclination to say that if they did substance abuse treatment, if they did mental health treatment and if they did job placement, it worked in Milwaukee, it reduced recidivism by 17%, so it will work Baltimore, so we're going to do the exact same thing. But it's not the exact same thing. It all depends upon the population, it all depends upon high risk, low risk, it all depends upon what you mean by treatment.
Len Sipes: I mean, and I think a lot of people in the practitioner community don't quite understand that it's not a cookie cutter approach; it depends upon your particular set of circumstances.
Nancy La Vigne: Right, I think that's right. And we try to communicate that in the website, but that's not our primary goal. However, bear in mind, this is just one part of the larger, National Reentry Resource Center website, which does I think, a very good job at that, where they talk about best practice and you know, how to tailor a program to your local jurisdictions and needs and population so there's a lot of complimentary guidance and information that should be used in concert with the stuff that's on the reentry website.
Len Sipes: And nationalreentryresourcecenter.org, people should go to there and explore the entire website –
Nancy La Vigne: Absolutely.
Len Sipes: As well as crimesolutions.gov. But the, in terms of reentry specifically, pretty much everything you need to know is at the National Reentry Resource Center.
Nancy La Vigne: I would say so.
Len Sipes: I mean in terms of guidance, in terms of what to do –
Nancy La Vigne: its one stop shopping.
Len Sipes: Right, right, right, because different people come to me and they say, "Oh, my Congressman–he's now interested in this reentry issue. Where do I go? What do I do?" And they search the internet and they come to one of my television shows or one of my radio shows and they think I know the answers and I don't. I say, go to the National Reentry Resource Center, go to OJP, go to NIJ.
Nancy La Vigne: Right. So the Resource Center has been up and running for what – five years, four years? Something like that.
Len Sipes: About.
Nancy La Vigne: So we, you and I, used to field those inquiries all the time. I still am to some extent, but I can't tell you how much more time I have in my life, now that people are referred to this website. It's got an added bonus of freeing me up to do more research.
Len Sipes: You don't have to go through the endless explanations. Before ending the show, I do want to talk about what, in your opinion, seems to be the principle findings and we haven't really talked about that. So we know about the website, we know about the National Reentry Resource Center, we know about the Office of Justice programs, we know about how you got to where you are in terms of going from 15000 studies to 276 studies, so people are sitting back and going, "Well, shut up Leonard, and tell 'em what works."
Nancy La Vigne: Well, you know, we did not set out to synthesize across all of the research that we presented. We present it by topical areas so that people can look and make their own decisions about what seems to work, based on different intervention categories. But I can say that just based on the content we have up right now, which is not fully up there, we have covered just a handful of the topics, housing and employment –
Len Sipes: A work in progress.
Nancy La Vigne: And so forth. . . There are some findings that perhaps won't surprise you at all. Chief among them is the importance of aftercare, or what's called the continuum of care. So across all the topics that we've explored all ready, the ones, the programs that seem to have an impact are surprise, surprise, the ones that start in an institutional setting –
Len Sipes: Right, within prison.
Nancy La Vigne: And continue out into the community and this I'm sure is a no-brainer for many in your audience but it's nice that sometimes research can confirm what we know to be true, so. . . that's a big one.
Len Sipes: Well, we have a captive audience, no pun intended, so there is an opportunity for them to get their GED, there is an opportunity for them to get their welding certificate, there is an opportunity to go to, I don't think there's a lot of drug treatment or mental health treatment within prison systems, so the research that I've looked at somewhere in the ballpark of 10 to 15% but there are groups in there. So they come out, whatever they get, they come out and it's supposed to continue seamlessly in the community.
Nancy La Vigne: That's right. We've also found rather mixed results on the topic of employment, even though I know in my heart that employment can work, we found it in our own research at the Urban Institute, but if you look across the studies that we felt met the threshold of rigor, we found very mixed results. Some, some work programs or employment readiness programs worked and others did not. Again, this gets back to the missing piece of data for us, which is how well were those programs implemented?
Nancy La Vigne: And we largely don't know that. So if I were to conjecture, I'd say that the ones that worked were implemented well, and those that didn't weren't, or were not focused on the right population who could best benefit from. . .
Len Sipes: A good history of research in terms of substance abuse, SAMHSA, has had decades to look at what works and how it should be implemented so what do we have in terms of the correctional literature?
Nancy La Vigne: We are still in the process of coding and assessing all the substance abuse studies so. . .
Len Sipes: Ah, okay.
Nancy La Vigne: Which is actually the largest body of research of any category that we have.
Len Sipes: Right, and it's been around for decades, but I mean, what we have now is again, promising. I mean, there does seem to be some fairly decent findings, because substance abuse research or programs do seem to be coupled with cognitive behavioral therapy and for the average person listening to this program, getting a person to rethink how they live their lives and how they make decisions, so those seem to be coupled, but most of the drug treatment that I've been exposed to was cookie cutter. It's not designed for that individual; it's designed for anybody with any drug history, with any drug of choice.
Nancy La Vigne: Yeah, there's often a mismatch on who gets access to the substance abuse treatment behind bars and in some of our own research we found that often it's just based on your crime of conviction. So if you're convicted of a drug related crime, you automatically go into some kind of substance abuse treatment program you know, regardless if you're a trafficker and you might be very successful as a trafficker because you don't engage in any substance use at all. So, I know that departments of corrections are a lot more savvy about that now but you know, even a decade ago we saw a lot of examples of that. So. . .
Len Sipes: Mental health is an issue that's just emerging. I saw a piece from the Bureau of Justice Statistics about five or six years ago talking about self reports and the self reports were somewhere in the 55% range of people who self reported a problem with substance, I mean, a mental health problem. I've seen more and more literature in terms of self reports and assessments that indicate that very large numbers of offenders have histories of substance, I'm sorry, mental health problems but treatment is far and few and in-between and it's really tough to deal with schizophrenia within a correctional setting. It's really tough to deal with depression within a correctional setting.
Nancy La Vigne: That's right, and disentangling studies that look at certain types of mental health treatment programs that are more about counseling and you know, clinical counseling, separate and apart from medication, is very difficult. It makes it very challenging for research studies, because you can't withhold that type of treatment so finding a good comparison group is very. . .
Len Sipes: No, you cannot do random assignment when it comes to health related issues.
Nancy La Vigne: Right, right, right.
Nancy La Vigne: Which is why we found so many or so few examples of rigorous studies in health – just physical health. We had none to include at all which is kind of disappointing, but in part, some of those end up in a larger category of what we're calling holistic reentry programs.
Nancy La Vigne: So it's very rare to only address physical issues in a study on reentry.
Len Sipes: And we're talking about holistic, it seems to be for, it seems to be substance abuse, it seems to be mental health, it seems to be job related, and it seems to be cognitive behavioral therapy, which is again, how to think your way through situations. Those seem to be the four key, core areas of the research that I read.
Len Sipes: And those, then the comprehensive programs are designed to deal with all four of those issues.
Nancy La Vigne: That's right, and if they're good, they'll bring in the family component you know, that's a favorite topic of mine.
Len Sipes: Yes it is a favorite topic and a very important topic at the same time. So in the final analysis, what we have is an understanding as to the key components. I mean, I think housing is certainly an extraordinarily important component and I read about different, you know, projects around the country that are providing housing, but in Washington DC, which is one of the United States and world's most expensive housing markets, we're not gonna be able to provide a lot of housing regardless to how much money we get. I mean, I would imagine a housing program in the middle of the country in a rural area, they can probably stretch their dollars, so that's, that's really problematic.
Nancy La Vigne: And that's right, and really there were very few studies on housing that met our criteria and they were entirely about halfway houses, so. . .
Len Sipes: Yes, right. So in the final analysis it seems those are the four key areas and that people can now have places, a place to go to that will be populated to a much larger degree than it is now, a place to go to in terms of offender reentry and to get all those research summations in one place.
Len Sipes: And for the future, you're going to be putting more and more and more in?
Nancy La Vigne: That's right, right now we have housing and employment and a few other topics and then we'll be adding substance abuse, cognitive behavioral therapy, sex offender treatment, some special populations topics, like juveniles and so forth.
Len Sipes: Nancy, I really appreciate you being here. Ladies and gentlemen, our guest today is Nancy La Vigne, Director of the Justice Policy Center for the Urban Institute – www.urban.org The National Reentry Resource Center, boy that's a mouthful. The National Reentry Resource Center, their website, in terms of what works, is exactly that – www.nationalreentryresourcecenter.org/whatworks and don't forget crimesolutions.gov. for all the criminal justice topics. Ladies and gentlemen, this is DC Public Safety. We really appreciate all the interaction, all the emails, all the comments, all the criticism and I want everybody to have themselves a very, very pleasant day.
Filed Under: Audio Podcast, Drug Treatment, Education and Vocational Assistance, Mental Health, Reentry, What Works Tagged With: Offender Reentry, Reentry, research, Urban Institute, what works
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