IRETA works with courts to ensure that individuals on community supervision are receiving appropriate, high-quality care
Since 2011, IRETA has been a trainer and clinical consultant for the federal courts about substance use and mental health disorders. Why do federal courts need our help? Here’s the situation as described by the Federal Judicial Center’s podcast, Off Paper:
Chronic substance use and mental health disorders are common problems for individuals in the criminal justice system. Alone or together, and sometimes in conjunction with other risk factors, these disorders can drive behavior that results in violation of supervision conditions or even in new criminal conduct. To deal with these problems, probation and pretrial services offices in the nation’s 94 U.S. district courts maintain contracts with treatment providers. Sometimes these offices can also supplement contract services with community-based treatment.
But what does good treatment look like? How should treatment providers be evaluated? How can probation and pretrial services offices ensure that individuals on community supervision are receiving appropriate, high-quality care? What outcomes should be expected from treatment providers? And, finally, are there proven practices criminal justice professionals can use to improve treatment outcomes?
That’s a lot of unanswered questions. Despite the fact that the criminal justice system has been working with people affected by mental health and substance use disorders for many decades, there is still tremendous room for progress in the way that courts work with community services to support individuals with behavioral health needs.
For a look at how this can be done, we encourage you to listen to the most recent episode of the Off Paper podcast, which features an interview with our Executive Director, Peter F. Luongo, PhD. Below are some key points that the podcast covers.
Federal courts are sometimes faced with low service availability. This is tricky. Creative contracting and telehealth may help.
Federal courts contract with service providers who treat addiction and mental health disorders. In an urban area, a court may be able to choose between several (or even several dozen) providers to ensure that individuals under supervision are getting appropriate care.
But what about rural areas? In some cases, courts have just one treatment provider to choose from. In some cases, the contract with the federal court is what’s keeping the one provider in business. What, then, is a court to do to ensure a reasonable level of treatment quality?
Courts can use a bit of creativity to design contracts that facilitate performance improvement without being punitive. In fact, it’s not even necessary to provide a financial incentive for designated performance measures. Rather, a contract can include stipulations that court staff and treatment providers regularly review client-level data together, so that both parties understand the services that individuals are receiving, and how effective the services appear to be.
This may sound elementary, but it’s beyond the scope of many courts’ or treatment providers’ current practices.
“Agencies and purchasers often have no idea how they’re doing,” said Luongo. “Just having a transparent co-viewing of agreed-upon data can make a difference in improving performance.”
What data should courts and treatment programs jointly review? Initiation and engagement is one measure. For example, how often is an individual participating in three face-to-face appointments within the first 30 days of treatment? Another idea is to look at state-level TEDS data, which can provide a benchmark for average rates of treatment completion.
“I think there isn’t a program out there that doesn’t want to do a good job,” said Luongo. “Absent any other competition, you’re trying to use people’s professional ethics and their need to do well as the basis for incentivizing good performance.”
However, performance isn’t the only issue that confronts federal courts with low service availability: many individuals under supervision need specialty services that their local provider doesn’t offer. Telehealth can fill these gaps. Luongo encourages courts to investigate options in their area: are there primary care settings that currently use (or are willing to explore) telebehavioral health? Are there existing behavioral health providers who can supplement their services using telehealth technology? Telehealth is a growing trend, and for good reason.
Here are 5 questions that can help a federal court (or anyone, really) determine if addiction treatment is high quality.
Even when courts have the luxury of choosing between treatment providers, they don’t always know what they’re looking for. As many individuals and families who have sought behavioral health services can attest, it’s not easy to be an educated consumer when it comes to addiction or mental health treatment.
How does a court gauge which programs are doing a good job? Here are five questions that can guide decision-making.
1. Are they using evidence-based treatment? This should include behavioral practices like Motivational Interviewing, Contingency Management, and Cognitive-Behavioral Therapy, in addition to medications for addictions to opioids, alcohol, and tobacco.
2. Is the treatment tailored to the person? It’s all too common for an individual to be forced through every component of a program, rather than a program being designed for the client’s needs. For example, said Luongo, it’s not unusual for a person with an established career to be required to participate in vocational training. That’s not individually-tailored care.
3. Does the program adapt treatment as it moves along? If a client does not appear to be successful through the program’s treatment approach, the program should adjust treatment rather than discharging the client.
4. Is the duration of care sufficient? Individuals receive more benefits from treatment services if they are delivered over at least 90 days, rather than in short, episodic bursts. However, these 90 days of treatment do not need to be delivered in the same setting. Rather, a client can step down, for example, from residential to outpatient treatment. It’s important that these treatment services are connected and the client is moved smoothly between them over the course of at least 90 days.
5. Are they introducing people to self-care and recovery support? Individuals recover in their communities. Quality treatment programs will work to fit clients with self-care services that fit their individual needs.
Screening and assessment are two different things. Both are important.
Screening should be a universal practice within the criminal justice system. Every individual within the courts’ purview should be screened for a substance use and/or mental health disorder. When it comes to substance use, this screening practice is known as SBIRT, and it identifies at-risk substance use that may indicate a diagnosable substance use disorder.
A clinical assessment, on the other hand, provides a diagnosis and assigns an individual to an appropriate level of care. The most widely-used assessment process to determine a level of care placement is the ASAM Criteria, which considers the individual needs using six dimensions, including their recovery environment, readiness to change, and any co-occurring physical or behavioral health conditions.
Ideally, assessments should be conducted by an independent entity that is not connected with a treatment program.
To learn more about IRETA’s work with federal courts, read our case study, Improving the Quality of a Problem-Solving Court.