Transcript Management of TASC Services in North Carolina

NC TASC
Effective Case
Management for
Improved Offender &
System Outcomes
September 30, 2004
Annapolis, Maryland
Structured Sentencing Act
Truthful & consistent sentencing that
projects resource needs
Established 3 forms of punishment
Established statutory continuum of sanctions
Eliminated discretionary parole
Established model for matching sentences &
resources
SSA-related Expansions
Largest Expansion of probation resources in
60 year history - 900+ positions
Enhanced TASC Expansion - 1.8 mil
established 13 new programs
Type of Punishment Imposed
Felonies
50%
45%
15%
10%
22%
26%
25%
20%
Old Law**
43%
28%
30%
35%
47%
40%
35%
Structured Sentencing*
In 1993, Average
Sentence served 16 Months
Under SSA, Average
Sentence served 34 Months
5%
0%
Active
Intermediate
Community
* SOURCE: NC Sentencing and Policy Advisory Commission
** SOURCE: 1993 Pre-Structured Sentencing Data
NC Problem Statement
• Use of criminal justice & treatment resources
• Complex clients: challenging behavioral health
needs & serious consequences of failure
• Recidivism & relapse are common
• Unmanaged cases, uncharted outcomes
• Service availability & effectiveness
• Prison pop  offenders entering community in
increasing numbers  multiple unsuccessful tx &
prison admissions
• Budget shortfalls & no expansions
Need options to improve access to & retention in
treatment, while preserving public safety
Evolving Solution
Our Common Goal: Safely manage high-risk,
high-need offenders in the community
– Treatment System Needs:
• Less reliance on institutions
• Better resource utilization & management
• Increased community capacity
• Effective treatment, interventions & case
management
– Justice System Needs:
• Effective & available care
• Regular communication
• Offender & treatment accountability
OFFENDER
MANAGEMENT
MODEL
ONE OFFENDER - ONE CASE PLAN - ONE TEAM
DOC
DCC
DHHS
TASC
Balances Intervention Opportunities provided thru
DMHDDSAS & Controlled Supervision provided thru DCC
NC Offender Management Model
Target Population
I Punishment, C Punishments at-risk for Revocation, PostReleasees who completed a prison tx program
Standard TASC Screening & Assessment
Individual Case Planning
by Probation & TASC
Control, Care & Service Management
Team staffings with shared decision-making between Probation & TASC
North Carolina Criminal Justice Planning Flow Chart
Arrest
Pre-Trial
Hearing
Pre-Sentence
Hearing
Trial/
Sentencing
Div of Community
Corrections
Referred to Other
Services
NC Offender
Management
Model (OMM)
Clinical Assessment
CBI
Employment
Transportation
Substance
Abuse Svcs
EXIT MODEL
Div of Prisons/
Post-Release
Individualized
Case Plan
Medical Services
Mental Health
Services
Education/
Voc Training
Housing/Food/
Clothing
Continuous Case Management and Case Staffing
Figure 1. NC Criminal Justice Flow Chart
NC Continuum of Sanctions, Supervision & Care
Split Sentence
Community
Detention
Drug Court
Enhanced Intensive
Intensive
Residential Tx
House Arrest
Day Reporting
Center
Enhanced
Traditional
Probation
Cost &
Intensity
Cost &
Intensity
Cost &
Intensity
Intermediate
No Tx
•I Punishment
•Post-Release
•C Failures
•Sex Offenders
Therapeutic
Community
Residential
Tx
•Domestic
Violence
•High Risk/High
Need DWIs
Intensive
Outpatient
Tx
Community
Outpatient Treatment
Traditional Probation
•C Punishment
Deferred Prosecution
•Unsupervised Failures
Education &
Urinalysis
Contempt of Court
(all supervision & tx levels)
•Low Risk/Low Need DWIs
•PSIs & Targeting for Courts
SANCTIONS
SUPERVISION
Level 1 Care
Management w/
Tx Level 6 &
Aftercare
Services
Level 1, 2 or 3
Care Management
w/ Tx Level 4 or 5
Level 1 or 2 Care
Management w/ Tx Level 3
Level 1 Care Management
w/ Tx Level 2
Treatment Matching
No Treatment
Assessment
Screening
TREATMENT
TASC
Memorandum of Understanding
between the
North Carolina Department of Health and Human Services
and the
North Carolina Department of Correction
This Memorandum of Understanding (MOU) and Appendices are entered by
and between the Department of Health and Human Services and the
Department of Correction for the purpose of developing a comprehensive
offender management model that ensures public safety while addressing
the needs of offenders. Currently, the Division of Community Corrections
(DCC), the Criminal Justice Partnership Program (CJPP) and the Treatment
Alternatives to Street Crime (TASC) Network are the primary resources
involved in community corrections. The Division of Alcoholism and
Chemical Dependency Programs (DACDP) and Division of Prisons (DOP)
impact community corrections through the release of offenders who have
received services while in custody. The purpose of a comprehensive
offender management model is to create a seamless system built on the
ideals of integrated service delivery and coordination of resources that
provide effective interventions for offenders.
With DCC, CJPP, and TASC available under the community corrections
umbrella and a structured link with DACDP and DOP for transitioning
offenders, the Offender Management Model (OMM), as described in the
Appendices, presents a systemic model for screening and assessing
offenders, matching them to the appropriate intervention(s) and managing
their case plans. Utilizing the principles of effective interventions, we can
reasonably assert that the OMM will be successful in modifying offender
behavior. The objectives of the OMM are:







To create a seamless system of care for the provision of services to
offenders;
To clarify roles in providing control and treatment;
To reduce the rate of revocation for technical and drug violations;
To combine efforts to guarantee the effective utilization of limited
resources and prevent duplication;
To provide cognitive behavioral interventions;
To develop an integrated information system; and
To ensure Probation, CJPP, DACDP, DOP and TASC staff are trained to
implement the OMM.
Objectives of OMM
 Seamless system of care for the provision of services to
offenders, improving access to treatment for justice clients
 Clarify roles & responsibilities in providing control & treatment,
eliminating duplication
 Target limited resources to the right clients:
 Combine efforts to guarantee effective utilization of limited resources
with a team approach & shared decision-making
 Emphasize quality over quantity
 Develop coordinated information systems
 Ensure staff are trained to implement the OMM
 Reduce rates of revocation for technical & drug violations, while
increasing accountability & community safety
 Increase efficiency & improve client outcomes
Developing & Maintaining an
Integrated Approach
Philosophy & Principles
Processes & Policies & Protocols
Programs
ELEMENTS OF SUCCESSFUL
COLLABORATION
•Convergence of needs
•Commitment - mutual respect, understanding & trust
•Vision - shared mission; shared objectives & strategies
•Willingness to re-think policies/procedures
•Communication - communicate w/ & involve staff
•Resources - commitment of financial & human
•Regular meetings w/ diverse participation resulting in
decisions (all key systems & the right people)
•Clearly defined roles & responsibilities
•Information & a common language
•On-going oversight w/ regular feedback to an advisory group
•Formal Service Agreements - protocols & MOUs
•Formalized system for conflict resolution
CHALLENGES TO SUCCESSFUL
COLLABORATION
• Separate Systems with Seemingly Disparate Goals
• Competitive Markets
• Lack of/Limited Communication
• Duplicative Services
• Revolving Door Treatment & Correctional Systems
• Inadequate Funding
• Limited Number of Service Providers
• Limited Service Capacity, including Limited Effective
Services in practice
• Restricted Availability of certain Levels of Care & over
abundance of other Levels of Care
• Limited Specialized Services
• Insufficient Aftercare & Transition Services
The Bottom Line
• What do you want?
• What do your partners want?
• Identify resources to be shared
• Establish regular venues for
communication & problemsolving
What is TASC?
A program model & methodology
that bridges two separate
systems: justice & treatment.
The justice system’s legal
sanctions reflect community
concerns for public safety, while
treatment emphasizes therapeutic
relationships as a means for
changing behavior.
TASC Core Services

Screening & Clinical
Assessment

Service Determination &
Referral

Care Planning, Coordination
& Management

Reporting to Justice System
TASC Care Management Model
Comprehensive Clinical Assessment
Strategic Individualized Case Planning
Other
Services
Treatment
Referral
Other
Services
Monitoring
Reporting to Referral Source
TASC Person-Centered
Client Flow
Client referred out
No Services Needed
Services Refused
Non-TASC Services Needed
TASC Care Management
Client
Identification
TASC
Eligibility Determination
Service Screening
Low-Risk, Low-Need Client
Referral to intervention
Referral to other services
TASC reporting
High-Risk
High-Need
Client
Assessment
Person
Centered
Planning
Referral to
Services
Reporting,
Monitoring
TASC Key Concepts
• Facilitates communication between systems
• Based on clinical & support needs, not only
medical necessity
• Develops & maintains linkages with a variety of
community resources
• Incorporates justice system language & goals
• Balances control & treatment
• Active relationships - client, probation,
treatment, community services
• Utilizes the influence of legal sanctions to
engage & retain offenders in treatment
• Positive outcome-oriented for clients, as well
as treatment & justice systems
TASC Nationally
• 1962 - Robinson v. California - addiction
is an illness, not a crime
• 1970s - Federal government develops
model to interrupt drug-crime cycle Treatment Alternatives to Street Crime
• 1972 - first TASC program in Wilmington,
Delaware
• 2000 - Over 150 individual TASC
programs in 32 states
National TASC Critical Elements
System Coordination
Elements
1) Process to coordinate justice,
treatment & other systems
2) Procedures for providing
information & cross-training to
justice, treatment & other systems
Organizational Elements
3 & 4) Broad bases of support from
justice & treatment systems, with
institutionalized systems for effective
communication
5) Organizational integrity
6) Policies & procedures for regular
staff training
7) MIS with a program evaluation design
Operational Elements
8) Clearly defined client eligibility
9) Client-centered case management
10) Screening procedures to identify
justice system candidates
11) Assessment & referral procedures
12) Policies & procedures for monitoring
drug & alcohol use through testing
13) Competency with diverse populations
For more
information
about TASC
nationally,
visit the
National TASC
website at
www.nationaltasc.org
In NC, TASC is administered by
the Division of Mental Health,
Developmental Disabilities &
Substance Abuse Services, through
private NPOs & public MH Centers.
NC TASC effectively & efficiently links
treatment & justice goals of reduced
drug use & criminal activity through
processes that increase treatment
access, engagement & retention.
TASC in North Carolina
 1978
- First TASC Programs in NC
 1993
- 10 Programs in 20 Counties
 1994
- Enhanced TASC (SSA)
 1998
- 23 Programs in 43 Counties
 2002
- TASC services available
in all 100 counties
 2003
- TASC Training Institute
Goal for NC TASC
Equitable statewide access
to a standard of TASC
services in the most costeffective, timely &
organizationally efficient
manner, consistent with the
unified court & statewide
probation systems
NC TASC Tasks
• Developed standard clinical care
management procedures
(TASC SOP) w/ TASC staff
• Improved current aggregate data
collection & analysis
• Developed financing plan, based on
I Punishment offender pop
• Proposed regional management
structure & statewide expansion plan
• Issued RFA
NC TASC Tasks
• Developed performance measures:
process & outcome
• Awarded 4 grants for infrastructure
development & expansion
• Identified training needs & contracted
for NC TASC Training Institute
• Implemented NC-TOPPS/TASC CJM Performance Measures project
• Developing NTASC Critical Elements
audit protocols
• Developing statewide MIS
Expansion & Regionalized
Management
Unified Statewide TASC System
TASC Services
Regional Coordinating Entity (RCE)
TASC Service Expansion
TASC Training Institute
Implementing Statewide
Offender Care Management
• Committed, visionary leadership &
identified key staff
• Build support with community leaders,
legislators & stakeholders
• Design appropriate organizational
structure & financing models
• Financing plan for development,
implementation & continuation
NC TASC Training Institute
The mission of the TASC Training
Institute is to improve the quality of
services to the offender population
through workforce development
•TASC Clinical Series
•TASC Continuing Education
•On-line training
•Drug Education Schools
•Staff Certification
How is this done?
• 4 regional training coordinators &
director review requests from the field
to develop annual training plan
• The Institute negotiates contracts with
contractors to develop curricula, deliver
TOTs, trainings, etc.
• TASC Clinical Series is provided via
TASC staff who’ve become TASC
trainers
TASC Clinical Series
32 hours training for new staff:
– Understanding TASC
– Confidentiality
– HIV/BRI/Infectious Disease (on-line)
– Understanding Addiction
– Criminal Justice
– Clinical Skills - Care Planning &
Management
TASC Continuing Education
• American Society of Addiction Medicine
• Motivational Interviewing & Enhancement
• Mental Health Screening
• Co-Occurring Disorders
• Effective Interventions for
TASC Clients
• The TASC Journey….
An Agency’s Response to Person
Centered Services
• Training.nctasc.net
• Provides on-line courses of
didactic materials prior to
clinical series
• Research to Practice site
• Continuous communication
with users & Center’s staff
Drug Education School
• Intervention for First-time Offenders
• 15 Hours of Standard Education
• One Time Opportunity for
Expungement for persons
under 21 years of age
• Self Supporting $150.00 Fee
• Statutory Authority: G.S. 90-96
Staff Certification
Legislation to be introduced in
2005 legislative session to create
Certified Criminal Justice
Addictions Credential
TASC Training Institute FY04
•Delivered 4,199 hours of training to
315 TASC & 102 partner agency staff
•Provided 100 stipends for the
NTASC conference hosted in
Raleigh, NC
•Addt’l 2200+ hours were received
thru NTASC Conference
All hours provided at no addt’l cost to participant or participant’s employing agency
NC TASC Training Institute Web Site
www.nctasc.net
Register for
Classes
Read Important
Announcements
View Your Total
Training Hours
TASC Quality Points
• Statewide Availability for Equity
• Regional Management for Economies of Scale
• TASC Training Institute
• TASC in MH Reform Legislation
• MH Commission promulgated TASC Rules
• NC TASC Standard Operating Procedures
• National TASC Critical Elements
• Local Memoranda of Agreement
• TASC CJM Performance Measures
• Funding contingent on DOC-DHHS MOU compliance
FY04 TASC Statistics
• Offenders served: 9845
(53% increase from FY99)
• 70% Less than 36 years old (43% less than 26)
• 83% Not married
• 55% Did not complete high school
• 34% Unemployed at admit (24% in FY01)
• Primary Substance Used
•Marijuana 44% •Alcohol 28% •Cocaine 19%
• Length of Stay
•0-3 months 24%
•7-12 months 31%
•4-6 months 35%
•More than 1 year 10%
TASC Costs & Benefits
• $1.79 per TASC client per day
• FY96-97 sample TASC client pop*:
– 85.9% had at least one previous
arrests (mean # 2.6)
– 61.3% were NOT re-arrested
within 2 years
* NC Sentencing & Policy Advisory Commission - Submitted to the
2000 Session of the North Carolina General Assembly
DMHDDSAS Reorganization
Community Policy Management Section
•MH, DD & SA public policy leadership & oversight
•collaboration w/ a wide base of customers, public
& private partners
•Single State Agency
for Substance Abuse
•Best Practice & Community
Innovations
•Office of Employee
Assistance Programs
•Local Management Entity
Systems Performance
•State Methadone
Authority
•Justice System Innovations
•Quality Management
•Prevention & Early
Intervention
Justice Systems Innovations Team,
Community Policy Management Section
•Policy re: adults & children with mental
health, developmental disabilities &
substance abuse problems involved in
criminal & juvenile justice systems
•Multi-system coordination with state, county
& local law enforcement, institutional &
community corrections
•Best practices, promising approaches &
innovations related to supports, services &
treatments for individuals & improved
systems performance
Justice Systems Innovations
For Adults:
 TASC develops & manages comprehensive protocols for
offender management, according to DHHS-DOC MOU
 Implementation of OMM, in partnership with DCC &
other stakeholders
 Implementation of “Going Home” initiative, according to
DOC, DHHS, Department of Commerce & NC
Community College System MOU
 Treatment & case management for Drug Treatment
Courts, in cooperation with AOC & DCC
 Review & programming for DOC residential substance
abuse programs & mental health services
 Protocols for DWI
 Drug Education School (GS90-96) diversion alternative
 Jail-based & police partnership diversion programs
Justice Systems Innovations
For Children and Families:
•Coordination with DJJDP for a continuum of services &
care
RWJF Resources for Recovery & Co-occurring
Academy projects
Evidence-based treatment in DJJDP Detention
Centers & Youth Development Centers
Evidence-based protocols utilized in MAJORS
program for juvenile offenders with substance abuse
disorders
Evidence-based protocols for treatment & case
management of individuals in juvenile courts, Youth &
Family Treatment Court
MHDDSA Reform established...
Adult Substance Abusing Criminal Justice Offender
Target Population to ensure access to treatment for
individuals with a SA diagnosis who present the
greatest risk to public safety.
Eligibility includes:
 DSM criteria for a substance-related disorder; and
 Services approved by a TASC care manager; and
 Voluntary consent to participate; and
 Status as an Intermediate Punishment offender, a
Department of Correction releasee who has completed
an in-prison treatment program, or a Community
Punishment violator at-risk for revocation
COMMUNITY CORRECTIONS: SOFT ON CRIME?
ABSOLUTELY NOT!
The Strategy Must:
Balance the public’s expectation for protection,
control & accountability with resources necessary to
control & treat high-risk/high-need offenders
Strive for a balance between Control & Treatment
based on offender risk & needs
•Manage risks by supervisory control
•Manage needs through treatment collaboration
Prioritize resources based on offender risk & needs
Build partnerships with law enforcement, treatment
providers, schools, victims & the public
Effectiveness & Efficiency of
ACTIVE
Community Corrections
 44% Recidivism
$63.00 Per Day
21% Population
INTERMEDIATE PUNISHMENTS
(Highest Risk Supervision)
Crime & Punishment
U.S. prison, parole population sets record
One in 32 Americans in jail or on
parole in 2003
The Associated Press
July 26, 2004
WASHINGTON - A record 6.9 million adults
were incarcerated or on probation or parole
last year, nearly 131,000 more than in 2002,
according to a Justice Department study.
Put another way, about 3.2 percent of the adult
U.S. population, or 1 in 32 adults, were
incarcerated or on probation or parole at the
end of last year.
 32% Recidivism
 $10.00 Per Day
 24% Population
COMMUNITY PUNISHMENTS
(Traditional Probation/Parole Supervision)
 24% Recidivism
 $2.00 Per Day
 42% Population
Why is Community Corrections Vital to
the Criminal Justice System?
 GOOD PUBLIC POLICY
 PUBLIC HEALTH
 PUBLIC SAFETY
 SOUND ECONOMICS
 THE RIGHT THING TO DO
Regardless of sentencing practices or laws,
less than 1% of all incarcerated offenders
will remain there for life.
Front end control & rational planning prior to
release are essential for the 99% that remain
in or return to our communities.
Why is TASC Care Management Vital to
Community Corrections & Treatment?
• Maintains clear roles & responsibilities
– Probation officers focus on supervision & tx
providers focus on client care
– TASC actively supports & integrates both,
providing a framework & structure for
managing CJ clients
• Engages clients at all points in CJ system
• Improves communication among systems
re: & with client
• Advocates for & assists client in
navigating multiple complex systems
• Appropriately manages client
confidentiality rules & law
• Broadens range of sanctions available to
CJ system & supports a system of
graduated sanctions
• Offers tx in lieu of or in combination with
punishment
• Provides added information to CJ
system
• Provides basis for judicial & correctional
decision-making
• Extends power of the court to
influence drug-using behaviors
• Reduces technical & drug violations
– improving probation recidivism rates &
positive impact on prison pop
• Improves treatment outreach & access
• Provides independent assessments &
makes appropriate referrals
• Improves treatment engagement
– orients clients to tx, reduces “no shows”,
increases tx staff productivity
• Improves treatment retention &
supports tx compliance
– improving tx outcomes
• Provides support & continuity during
CJ & tx transitions
• Facilitates access to addt’l services
• Compensates for service availability
• Utilizes resources more effectively
• Arranges goals & objectives of CJ, tx
& the client
TASC … a Task Indeed
Damn, why am I here, I know I’m not an addict,
Yeah, I smoke a little weed, but it’s just a small habit;
I’m not alcoholic, I drink to ease the pain,
So what I popped a few pills, snorted lines of cocaine;
Hell no I’m not addicted, I could stop if I want,
But I don’t right now, I’m having too much fun;
They say I have a disease, I only use because I choose,
Drugs are harmless, what’s wrong with a blunt and a few booze;
Yeah I stole from a few people, but they had enough to share,
I knew that it was wrong, but drugs helped me not to care;
I feel a lot more stable being clean now but I don’t like it much,
I keep thinking about the past things I’ve done and people I’ve
wrongly touched;
On the other hand, I’m relieved I can finally love again,
I can see much more clearly, I found who are my real friends;
I’ve regained trust from my family, they’re no longer ashamed,
Telling people I’ve changed, before they wouldn’t mention my name;
Matter of fact I like being drug free, I feel like I’m really alive,
And I owe all to God and Treatment Alternatives to Street Crime.
- Cumberland County, NC TASC Client