Improve Recovery Support for People in the Criminal Justice System

 

Introductory Paragraph

Many states are revising their drug penalties and focusing on prevention, treatment, and recovery to integrate evidenced-based practices for treatment and recovery. Implementation of evidenced-based practices allows criminal justice agencies and communities to work together to save lives and decrease costs associated with criminal justice system and healthcare system involvement. Upon returning to their communities, many individuals require mental and/or physical healthcare services. Community-based behavioral health systems have an essential role in serving individuals who are currently or formerly involved with the criminal justice system. These individuals are a part of every community and providing resources to a person with an SUD can help lead to a life in recovery, as opposed to a life in long-term incarceration.

Key Information

Community-based behavioral health providers play a key role in ensuring that every individual they serve has the treatment, support, skills, and opportunity for recovery and that they live productively with dignity and respect. People who simply need access to quality community-based care may be arrested instead. In many communities, people with behavioral health disorders cannot access adequate community-based services and find themselves channeled into the justice system. This may happen when a person is arrested for behaviors related to their untreated mental illness or when a law enforcement officer believes that a person could benefit from healthcare services that are provided in the jail. Arrest and even brief incarceration can destabilize an individual’s life in many ways, including housing, health care, employment, and disruptions in family life and social connections. Once in the criminal justice system, individuals with mental and substance use disorders stay in jails longer, have an increased risk for self-harm, and receive more frequent punitive responses to infractions. Due to funding and staffing limitations, many people with mental illnesses do not receive the services that they need, and their conditions often worsen inside jail settings. For individuals already receiving medications and treatment in the community, these services may be interrupted during incarceration, creating lapses in treatment and difficulties in resuming treatment upon reentry to the community. Without continuous coordinated care throughout and following incarceration, these individuals are at risk for re-incarceration. Programs to improve outcomes of those in recovery within the criminal justice system includes community-based diversion programs, drug/treatment courts, treatment while incarcerated, and re-entry resources and services. For more detailed information on re-entry, please see the SAFE wiki titled "Improve Reentry After Incarceration."

SAMHSA's 8 Principles

The Substance Abuse and Mental Health Services Administration (SAMHSA) identified eight principles to assist community-based behavioral health providers and criminal justice professionals to collaborate most effectively. These principles provide a strong foundation for understanding re-entry programs, evidence-based practices, the risk of recidivism, pre-arrest and diversion programs, and medication assisted therapy:

• Community providers are knowledgeable about the criminal justice system. This includes the sequence of events, terminology, and processes of the criminal justice system, as well as the practices of criminal justice professionals.
• Community providers collaborate with criminal justice professionals to improve public health, public safety, and individual behavioral health outcomes.
• Evidence-based and promising programs and practices in behavioral health treatment services are used to provide high quality clinical care for justice-involved individuals.
• Community providers understand and address criminogenic risk and need factors as part of a comprehensive treatment plan for justice-involved individuals.
• Integrated physical and behavioral health care is part of a comprehensive treatment plan for justice-involved individuals.
• Services and workplaces are trauma-informed to support the health and safety of both justice-involved individuals and community providers.
• Case management for justice-involved individuals incorporates treatment, social services, and social supports that address prior and current involvement with the criminal justice system and reduce the likelihood of recidivism .
• Community providers recognize and address issues that may contribute to disparities in both behavioral health care and the criminal justice system.

Medication-Assisted Treatment (MAT)

MAT can be utilized for drug-dependent individuals within the criminal justice populations. Currently, within the criminal justice system, MAT is used primarily for pregnant women to detoxify and is minimally used for reentry. There are ongoing studies surrounding MAT, as well as efforts to expand the use of MAT within the current correctional infrastructure. Efforts to expand MAT include training, education, reducing stigma, and increasing funding. Expansion of MAT within community correctional settings will also require increased collaboration with community providers in order to enhance the appropriate pharmacotherapy for individuals under community correction supervision. Concerns of correctional facilities surrounding MAT have included liability, staffing, regulation, and funding. More information can be found at the SAFE wiki article titled, "Expand the Use of MAT/MAR in Correctional Facilities."

Relevant Research

• This article documents the benefits of treatment for the incarcerated in terms of both increased recovery rates and decreased recidivism.

Impactful Federal, State, and Local Policies

SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration and will add additional resources.

Available Tools and Resources

SAFE Project:

• Pre-Arrest Diversion Guide is a SAFE Project downloadable resource intended for law enforcement agencies that provides background information, research, and case studies on the Pre-Arrest Diversion model as an alternative to arresting those with substance use disorders.
• Integrated-Forensic Peer Recovery Specialist (I-FPRS) Training. This SAFE Project program is a comprehensive set of curriculums designed for Peer Recovery Specialists, organizations, and groups working with justice-involved individuals who experience substance use disorders. This training equips participants to navigate the intersection of behavioral health and the criminal justice system.
• "SAFE Community Playbook" is a downloadable resource that provides a blueprint on how communities can convene a local coalition, conduct an assessment, and prioritize actions to address the addiction epidemic.
• Bridging Prevention and Recovery (BPR): A Community Approach to Systems Change. This SAFE Project program, offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects.
• See the wiki titled "Expand Access to MAT/MAR for Pregnant People" for more detailed information on the role of Medication Assisted Treatment (MAT) and Medication Assisted Recovery (MAR) for treating substance use disorders during and after pregnancy.

The Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP) website offers peer-to-peer learning opportunities, profiles of COSSUP sites across the nation, information on demonstration projects, and access to technical assistance.

The Opioid Response Network provides "Community Supervision and MOUD Toolkit," a free online learning series to help probation officers and treatment providers enhance client recovery during supervision.

The American Academy of Addiction Psychiatry Published "Cultivating Law and Medicine Partnerships to Support Justice-Involved Individuals With Substance Use Disorders – Digital Guide."

Promising Practices

Massachusetts -- Plymouth County Outreach (PCO) was developed through the Public Safety, Community Coalition, and the Faith Based Subcommittees of the Plymouth County Drug Abuse Task Force. Since its inception, PCO has fostered innovative law enforcement collaboration with faith-based coalitions, the District Attorney’s Office, The Sheriff’s Department, all 27 police departments, 5 major hospitals, the Division of Children and Families, recovery coaches, District Court Probation, and the Police Assisted Addiction and Recovery Initiative (PAARI). The two main aspects of the program are overdose follow-up and community drop-in centers. Within 12-24 hours of an overdose, an outreach team consisting of plainclothes officers, a licensed clinician, and/or a recovery coach will conduct a home visit of the overdose survivor. The intent of the outreach effort is to provide resources and support to those with substance use disorders and/or their families with the hope of getting people into treatment and connecting family/friends with existing resources in the county. Drop-in centers are held each week in various sites across Plymouth County. These centers host a growing number of health care providers who help with treatment options and train and distribute Narcan for free.

Massachusetts -- Arlington Opiate Outreach Initiative. This community-based strategy has two major components. First is the proactive outreach to known substance users. This involves a clinician at the police department reaching out to the known population of persons with substance use disorders to support them in developing a plan to ensure their survival, to provide access to services, and to facilitate the long-term process of recovery. The second component is the Arlington Community Training & Support (Arlington ACTS) which involves a series of community-based meetings. These are co-facilitated by the police department’s clinician and a community substance use intervention expert and are aimed at creating a supportive non-judgmental environment for substance users and their families.

North Carolina. The HOPE Initiative in Nashville was the first pre-arrest diversion program in North Carolina. Its purpose is to assist those individuals with substance use disorder find treatment options, get into treatment, and begin recovery. While other programs were centered on opioids, the HOPE Initiative was willing to accept any substance use disorder. Partnerships were established with the local district attorney’s office, the Eastpointe Local Management Entity, UNC Nash Hospital, Coastal Plain Hospital (Detox facility), Police Assisted Addiction and Recovery Initiative (PAARI), and many others. The program allows individuals to come to the Nashville Police Department to start their recovery process by turning over any drugs and/or paraphernalia without fear of charges. The first organization in the HOPE Initiative served 320 clients in 2 years. The program is funded through donations, grants, and fundraisers.

Virginia Recovery and Re-Entry Project. The VRR Project serves individuals with SUDs during incarceration and through the re-entry process, with a peer-to-peer approach to recovery. The McShin Foundation and SAMHSA’s Building Communities of Recovery Initiative funded two new recovery jail programs in Riverside Regional Jail and the Rappahannock-Shenandoah-Warrenton Regional Jail. Recovery support services are provided five days a week in RSW and three days a week in Riverside. In follow-up to participation in these VRR programs, residential recovery program scholarships were offered to twenty individuals. VRR uses a wide variety of resources to promote long-term recovery support networks and services.