I recently sat down with John Finn (and a cup of coffee) to discuss the intersection between Criminal Justice and Human Services and how we can facilitate positive transitions between the two.

First, a bit of background on this odd couple of Criminal Justice and Human Services:

It is undeniable that the human services and criminal justice systems are inherently different and that the two systems do not typically mix well together. They are based on fundamentally different principles, operate on very dissimilar ideologies and have rules and regulations that are often conflicting, stifling inter-agency communication. Also, both the criminal justice and human services systems are facing tremendous challenges with increasing demands and shrinking resources in an era of unprecedented regulation and intense oversight.

Transitions of care from incarceration to community living; from inmate to citizen; from being an offender to living a law abiding life — these are some of the most challenging transitions faced by anyone. Furthermore, when the person making this transition has an intellectual disability or a serious mental illness, the challenges are multiplied greatly.

 Over the course of the hour webcast John discussed the following:

 

About the Guest Speaker

John Finn received a Bachelor of Science Degree in special education and a Master of Science degree in Rehabilitation Counseling from Syracuse University. He has worked in several capacities in various human services settings including direct care, as a community residence manager, and program coordinator. For 32 years he served as the Director of Forensic Services for the New York State Office of Mental Retardation and Developmental Disabilities. In this capacity he oversaw the design, developmental, and operation of specialized secure, intensive treatment programs. For several years he was the Director of a free standing, secure, intensive residential treatment facility, certified as an ICF/MR. Mr. Finn retired from state service in 2010 and now serves as President of Forensic Specialists, offering full service consultations, expert evaluations, specialized training and systems transformation assistance for both the human services and criminal justice systems.

Part 1: Intro and Differentiation between the Missions of Corrections and Human Services

 

The reality is that jails and prisons are becoming the largest psychiatric ward. The GAIN center estimates that 1.1 million persons with serious mental illnesses are admitted annually to U.S. jails. Among this 72% also meet the criteria for co-occurring substance abuse disorders.

John highlighted that the seemingly distinct systems of Criminal Justice and Human Services have different principles and missions. However, he was quick to point out the reality is that they should have a shared common mission and responsibility for the individuals under their charge. When an individual has an intellectual or mental health disability within the criminal justice system, Criminal Justice and Human Services are not set up to coordinate effectively. But to accomplish the mission of transitioning an individual from incarceration to leading a meaningful life they must collaborate. Each system has expertise knowledge and resources that they need to bring to bear within a systems management approach to accomplish what should be a shared mission—that mission ultimately is for an individual to remain law abiding.


 

Part 2: Funding

 

John explained that funding is always a huge problem. On the Human Services side, they are moving to a managed services model where demand is growing while resources are shrinking. An individual coming out of incarceration has to compete for shrinking dollars with someone that has not committed a crime. An organization must decide if they will take resources away from one segment to serve a population that they may see as on the periphery of their responsibility.

On the criminal justice side, the recidivism rate is three times higher for mentally ill individuals than the general public. An individual with an intellectual disability or mental illness consumes a massive amount of resources if they are a repeat offender. If they do not have access to the support they need, they are doomed to a failed transition and a return to the criminal justice system


 

Part 3: Patient-centered Dynamic Risk Manageability – A Model that Works

 

Here, John discusses what kind of model will maximize coordination and collaboration between agencies. He states that once we accept that it is a shared responsibility, the question becomes how do we create a platform where the different agencies can relate to one another in a positive way? One model that has proved successful in achieving these goals is Person-centered dynamic risk manageability.

This model creates a structure that empowers both systems to work together to address the elements that are critical to achieving the goal of a successful transition for individual at the center of the model. It incorporates knowledge, data and evidence-based practices in the identification of risks, and creates a structure through which those risks will be mitigated for the individual. It includes elements that are important to the individual as well as elements that are important for the individual. John highlighted that this is an important distinction. The individual must be brought into the plan as a cooperative element. It will enhance cooperation on the part of the individual if they see things in the plan that are important to them. Through this plan, we create a dynamic balance, with the individual risks and needs on one side and services support and supervision on the other. The plan must be dynamic enough to adjust as the individual’s situation changes.


 

 

Part 4: A Deeper Dive into Patient-centered Dynamic Risk Manageability

 

John feels the following elements are critical in developing a successful plan: Quality Assessments—We need to break away from personal opinions and evaluate based on evidence-based data and facts. Assessments need to be individualized based on detailed review of case history, and the assessments need to provide a good understanding of dynamic risk.

There are several types of risk to consider. Static risk—the nature of the offense committed and related factors do not change over time and cannot be greatly influenced. Dynamic risk—the individual’s reaction to supervision, ongoing significant deviant arousal, the individual’s commitment to treatment, the presence of an emotional disability, a substance abuse issue—all of these factors lead to increased risk, but they can also be managed. The assessments need to include these elements of dynamic risk, as they are the factors that can be influenced.

Also to be identified: Treatment issues, level of structure needed, and restrictions needed in order to establish a safe platform to build the plan. There can be no growth or quality of life if we don’t have a safe circumstance

The next element is to include the individual in the process. They should be able to define what they consider a good life. It needs to go beyond avoidance of the crime in question and positively consider how they want to define a good life. If the individual proposes a high risk activity, dig to the core issue and then propose non-high-risk activities as a substitute.

The next element is the comprehensive plan. Once the risk is identified, provide the means and treatment to manage each risk. If you don’t look at treatment, then all you have is containment. You need a vehicle for an individual to materialize a different life.

The plans need to specify who is providing what service and when and under what circumstance. What data needs to be gathered? Progress needs to be evaluated against this data. There needs to be protocol on what to do if a specific thing happens. Coordination between systems is key here. Who do you call if something happens? Who will pick the individual up? Everyone must be trained in the plan.


 

 

Part 5: What is the Circle of Support and Accountability

 

In Human Services, the concept of the circle of support has existed for some time. The circle of accountability is also gaining traction, but John proposes that both of these circles need to surround an individual. The first step is to identify who holds important roles in the life of the individual. Their roles need to be defined. Both professional and family members need to be included—if the family members will provide a positive influence.

John drew a contrast here between normal treatment and treating an offender. When treating an offender there are no secrets and there must be full accountability in order to manage risk. Cognitive distortions that the offender feels justify their offense need to be identified and dealt with through the circle. The circle presents a powerful dynamic as it prevents the individual from telling a story to the case manager, and a different story to the parole officer, etc. The circle also enables the individual to feel that he or she is supported in their struggle—possibly for the first time in their life.


 

 

Part 6: Strategy and Details to Implementing the PDRM Model

 

Once the plan is developed, it is very important to get sign-off from all involved in both Human Services and Criminal Justice. There must be recognition that problems will occur and that responsibility is shared between both agencies. This includes an agreement that no one will deviate from the agreed strategy unless the circle of support has met and decided in favor of the change. The next step is to incorporate an individual’s resistance to these efforts, and how to deal with that resistance, as part of the plan. A transition must occur where the individual internalizes the responsibility for leading a law-abiding life.

All members of the circle must know where the individual sits in terms of progress and any emergent issues that arise that can impact the individual’s acute dynamic risk. The data gathered must be comprehensive enough to indicate increasing risk factors before an individual crosses a line and actually commits another offense.

It must be determined how will be data shared. An effective method is to share data electronically through a coordinated care platform. With disparate agencies and systems, data sharing can be difficult and proper integration is key. Without it, the individual will realize that they can provide conflicting information to difference agencies and get away with it.

The circle of accountability and support must meet frequently, especially at the beginning. Everyone must be committed to the meetings. If an event occurs, having the individual sit down with the circle is a powerful agent for change. Any issues must be discussed and resolved in the circle.

Increasing privileges, reductions in restrictions or supervision are based on corresponding reductions in dynamic risk. Reductions in dynamic risk will be based on primarily three factors: the absence of the negative target behavior, making treatment progress in areas relating to dynamic risk, demonstration of appropriate replacement behaviors associated with dynamic risk.


 

Part 7: The Role Information Management plays in Positive Transitions

Transparency with the individual is the only way to make sure that they are invested in the plan. They are more likely to accept accountability if there is a clear understanding of the rules involved. Data will also help identify the small issues and provide accountability before they become larger issues. The data will also provide accountability to the responsibilities of everyone participating within the circle

Part 8: Closing and Contact Info

 

Any questions can be submitted to www.cocentrix.com under the “Contact Us” page.

Part 9: Next Steps

 

In conclusion, John outlined a roadmap for next steps to be taken. He highlighted that there is no substitute for a commitment on the part of both agencies to deal with the lack of coordination. The executive level and a key person from each agency must come together with a commitment to making this work. Issues and roadblocks on both sides must be identified and responses to the roadblocks must be worked out. Each agency needs a champion to move this process forward.