Congratulations to 2016 Integrated Behavioral Health Interns

(Chicago) – Post-graduate interns with the Integrated Community Behavioral Health Training Consortium (ICBHTC) completed their capstone projects on May 3, having gained skills and knowledge in the treatment of substance use disorders, mental health, and TASC’s interface with the justice system.

ICBHTC is an innovative, multidisciplinary post-graduate internship program designed to develop health care leaders equipped to address the pressing primary and behavioral health needs and disparities of vulnerable, at-risk individuals and groups.

Now graduating its second class of interns, the program was initiated in 2013 through a collaboration of Chicago-area graduate programs, including Governors State University, the University of Illinois at Chicago’s School of Public Health, the Chicago School of Professional Psychology, the Illinois Area Health Education Centers, and TASC. The effort has been guided and supported by the Substance Abuse and Mental Health Services Administration’s Region 5, led by Captain Jeff Coady.

The program places student interns in criminal justice and community-based settings, and facilitates weekly multidisciplinary seminars. Student interns gain clinical, public health, and policy knowledge that offers an integrated experience reflective of the need for person-centered health care inclusive of substance use and mental health treatment and evolving health care delivery systems.

2016 ICBHTC Intern Class (left to right): Amanda Auerbach, Jessica Garner, Cassandra Simmons, Jennifer Chmura, Delilah Portalatin, Anthony Barlog. Not pictured: Rebecca Gonzalez.

2016 ICBHTC Intern Class (left to right): Amanda Auerbach, Jessica Garner, Cassandra Simmons, Jennifer Chmura, Delilah Portalatin, Anthony Barlog. Not pictured: Rebecca Gonzalez.

National Reentry Week Highlights Key Elements of Criminal Justice Reform

The U.S. Department of Justice has designated April 24-30 as National Reentry Week, highlighting efforts to support successful community reintegration for men and women who have been incarcerated.

Renewed community reentry strategies are part of a wave of criminal justice reforms across the country. These initiatives involve reversing decades-old policies and practices that not only have fueled record incarceration rates, but also have created substantial reentry barriers for people who have paid their debt to society. Such barriers include practices and policies that bar or inhibit people with offense records from accessing rehabilitative care, employment, and affordable housing.

The collateral consequences of a criminal conviction extend beyond the direct consequences issued by a sentencing court. These penalties and disadvantages are now well understood to contribute to stubborn recidivism rates. According to Department of Justice data, half of those released from state prisons returned within three years. Illinois’ recidivism rate mirrors the national trend, with 47 percent of individuals released from prison returning within that time frame.

Compounding the harms of collateral consequences are disproportionately high rates of substance use disorders among incarcerated individuals, and sparse treatment and recovery support within institutions and following incarceration. Research has identified problem substance use as a “criminogenic” need—a dynamic risk factor that can be changed—and it is increasingly recognized by reform efforts that seek to apply evidence-based approaches to reduce recidivism.

Reentry in Illinois

Faced with a prison population that increased by 650 percent since the 1970s and a system built to house 32,095 individuals with greater than ten thousand more than that currently behind bars, Illinois has undertaken efforts in recent years to reverse these trends.

In 2014, the Illinois state legislature convened a bi-cameral, bi-partisan Joint Criminal Justice Reform Committee to examine the current system, study the impact of current sentencing structure, and consider strategies for reform. In 2015, Governor Bruce Rauner issued Executive Order 15-14, creating the Illinois Criminal Justice and Sentencing Reform Commission, and tasking it with a goal of mapping out strategies to decrease the state prison population by 25 percent within 10 years. TASC President Pam Rodriguez is an appointed member of the Commission.

In its work to date, the Commission has affirmed that appropriate substance use treatment not only helps address the health and social problems among those involved in the justice system, but also decreases crime and recidivism:

“Building community capacity to address the criminogenic needs of offenders, such as behavioral health services, job training, and access to social services, is critical to reducing the prison population safely and sustaining the reduction over time.”

“Recommendation 12—Enhance rehabilitative programming in IDOC. Implement or expand evidence-based programming that targets criminogenic need, particularly cognitive behavioral therapy and substance abuse treatment. Prioritize access to programming to high-risk offenders. Evaluate those programs identified as promising and eliminate ineffective programs.”

Successful Reentry Models

Proven, evidence-based, and nationally recognized reentry models already exist in Illinois. The Sheridan and Southwestern prison drug treatment and reentry programs offer drug treatment services, both within the prison facility and in communities after release, and comprehensive reentry services, including TASC reentry case management and recovery support.

The programs have been rigorously evaluated. Individuals in the Sheridan prison reentry program have a 15 percent lower likelihood of return to prison within three years of release than comparable releasees who did not receive these services. Those successfully completing the program had even better recidivism outcomes, with a 44 percent lower likelihood of return to prison. The program operated at Southwestern Correctional Center has demonstrated comparable outcomes. A subsequent evaluation of the Sheridan program found that its recidivism benefits were still intact seven years after release.

Additionally, the programs were found to have generated combined annual savings of $5 million in reduced incarceration costs.

“There is substantial research on what works in reentry policies and practices,” says Rodriguez. “The more that our public systems, communities, and families understand and apply this knowledge, the more successful we can be together in reducing recidivism and restoring men and women to full citizenship in communities.”

Medicaid Expansion: Improving Access to Substance Use and Mental Health Treatment for Justice Populations

(Chicago) – April 2016 marks the third anniversary of Cook County’s groundbreaking jail-based Medicaid application project, through which people detained at the jail have received assistance in applying for health coverage. Some 15,000 detainees have gained Medicaid coverage since 2013, making Cook County’s initiative the nation’s largest and most ambitious projects of its kind to date.

Most of the 11 million people who cycle through the nation’s jails annually—646,000 are detained at any given time—have untreated medical and behavioral health issues, perpetuating cycles of arrest and incarceration. With health coverage, they have the means to access care in the community, which is far less expensive than corrections-based care and emergency rooms—the predominant healthcare options for uninsured people prior to Medicaid expansion.

What’s happening in Cook County is occurring in many counties and jurisdictions across the country, as local governments seek to reduce the cost burdens of corrections and emergency care, and ultimately improve public safety and public health.

Since Medicaid expansion came about as a result of the Affordable Care Act, TASC (Treatment Alternatives for Safe Communities) has been working with partners in Cook County and across the U.S. to bring aspects of this national public policy from concept to local implementation and results.

Early Adopters: Cook County and Medicaid Expansion

Before Medicaid expansion, nine out of 10 people entering jails lacked health insurance. At the same time, justice-involved populations have high rates of substance use disorders, mental health conditions, and chronic medical conditions requiring treatment during detention and immediately after release. For decades, large and small counties have struggled to meet these needs with very limited resources. The expansion of coverage to low-income adults provides new and welcome means to address this perennial challenge.

Cook County has been a national leader in implementing processes for Medicaid application assistance at the jail, having obtained a waiver in 2012 for early expansion of Medicaid. Transformation has come about through coordinated planning and collaboration between the Cook County Health and Hospitals System, the Cook County Sheriff’s Office, and TASC, aided by significant public and private support from the Cook County Justice Advisory Council, The Chicago Community Trust, the Michael Reese Health Trust, and the Polk Bros. Foundation.

A National Sea Change

TASC President Pam Rodriguez: We have "an unprecedented opportunity to shrink the oversized justice system."

TASC President Pam Rodriguez: We have “an unprecedented opportunity to shrink the oversized justice system.”

Building on the Cook County experience, the Center for Health and Justice at TASC works with counties and states to leverage available federal health care funding in order to create linkages to care, divert people from the justice system, and improve individual and community health. To these ends, and in partnership with the National Association of Counties, TASC provides national consulting, which also is supported by the Open Society Foundations and the Public Welfare Foundation.

Working in more than a dozen states, TASC has observed the following trends with regard to Medicaid expansion for justice populations:

  • The proportion of people entering large county jails with Medicaid coverage has increased from 10% to 40-60% since 2014;
  • Most jails in large urban counties are assisting some of their detainees in applying for coverage;
  • Jails vary as to where applications are taken. It is relatively rare to take applications at jail intake (as in Cook County). It is increasingly common for medical providers to assist with applications and for applications to be taken at release;
  • Jails in rural communities are less likely to have application processes in place, though there are notable examples of small and rural community jails taking Medicaid applications routinely; and
  • States such as New Mexico and Indiana have passed legislation that enables or requires state and county corrections to facilitate applications. These states are leading the way in building statewide infrastructure and processes that institutionalize access to coverage and care for people under justice supervision.

As coverage becomes more common, counties and states can build reentry systems and expand diversion from jail to services in the community. Elements of success in building these processes include:

  • Understanding the impact of coverage on people’s use of treatment for substance use disorders and psychiatric conditions after release and on subsequent arrests;
  • Building comprehensive systems that provide seamless bridges to care upon release from jail;
  • Expanding substance abuse and mental health capacity in the community to support safe reentry; and
  • Building jail diversion projects that take full advantage of these new health care services.

Ultimately, these systems changes are intended to bring about not only cost savings and the more efficient use of public resources, but a healthier society as well, where quality treatment and other health services are accessible in the community. “For decades now, jails have been inundated with people who have severe substance use and mental health conditions,” said TASC President Pam Rodriguez. “Medicaid expansion offers the means to change that. Together with our partners in the public and private sectors, we are leveraging an unprecedented opportunity to shrink the oversized justice system.”

U.S. Senate Passes Comprehensive Addiction and Recovery Act (CARA), Bipartisan Bill Moves to House of Representatives

On March 10, the U.S. Senate overwhelmingly approved the Comprehensive Addiction and Recovery Act (CARA). The legislation embodies a comprehensive response to addiction and the opioid crisis, earning the support of over 130 organizations—including TASC—in the fields of prevention, treatment, recovery, law enforcement, and state and local governments.

CARA garnered strong, bipartisan support in the Senate, passing on a vote of 94-1. Among the bill’s strong leaders and supporters were Senators Sheldon Whitehouse (D-RI), Rob Portman (R-OH), Amy Klobuchar (D-MN), and Kelly Ayotte (R-NH), as well as both Illinois Senators, Dick Durbin (D-IL) and Mark Kirk (R-IL).

More people died in 2014 from drug overdoses than in any previous year on record, according to the Centers for Disease Control and Prevention. The vast majority of people who need addiction treatment do not receive it. The Substance Abuse and Mental Health Services Administration estimates that only 2.6 million of the 22.5 million people across the country who needed help with a substance use disorder got it in 2014. The treatment gap also exists for people in prisons and jails, where an estimated 85 percent have been found to be substance-involved, but only 11 percent received any kind of treatment.

CARA’s key provisions include:

  • Expanding the availability of naloxone—an overdose antidote—to law enforcement and first responders to help save lives.
  • Expanding resources to identify and treat incarcerated individuals with addiction disorders promptly by collaborating with criminal justice stakeholders and by providing evidence­based treatment.
  • Launching an evidence-­based opioid and heroin treatment and intervention program to expand best practices throughout the country.
  • Launching a medication-assisted treatment and intervention demonstration program.

Appropriations to implement the bill were not included in the legislation.

For more information about CARA, visit here, and to ask your U.S. Representative to support the bill, click here.

 

TASC Public Policy Priorities

At local, state, and federal levels, TASC supports public policies that reduce incarceration and create healthier communities. Our policy priorities are to:

1. Shrink the justice system by diverting eligible people away from prosecution and incarceration and into community-based services, as soon as appropriate.

2. Create pathways for successful reentry after justice involvement, and reduce barriers that inhibit success.

3. Promote evidence-based strategies in substance use and mental health disorder prevention, treatment, and recovery.

4. Expand community capacity to treat mental health and substance use disorders, adapting to changing environments.

TASC President Pam Rodriguez serves on Governor Rauner’s Illinois State Commission on Criminal Justice and Sentencing Reform, and she has been honored by the White House for advancing system-wide justice interventions for people with substance use disorders. Rodriguez and TASC Founder Melody Heaps are featured in a White House video describing TASC as a model for reducing incarceration and increasing access to community-based healthcare and recovery.

For more information on TASC’s public policy activities, please visit our Center for Health and Justice.

Sheriff Tom Dart, Bill O’Donnell Receive TASC Leadership Awards; Access to Healthcare and Recovery Highlighted at Annual Event

(Chicago) – TASC held its 2015 Leadership Awards Luncheon on December 10, honoring Cook County Sheriff Tom Dart and entrepreneur Bill O’Donnell for their advocacy on behalf of people with mental health and substance use disorders.

“Sheriff Dart has called national attention to the injustice of using county jails to house people with mental health conditions,” said TASC President Pam Rodriguez in presenting TASC’s Justice Leadership Award. “He has supported Medicaid enrollment and other activities to ensure continuity of care for people detained at the Cook County Jail.”

To the applause of more than 300 guests at the Westin Michigan Avenue in Chicago, Dart reported that 12,000 people have successfully signed up for insurance at the jail via the Affordable Care Act (ACA). “People who never had insurance now have insurance,” he said. “It is absolutely amazing what this collective work has done.”

Since 2013, the Cook County Sheriff’s Office, working with TASC and the Cook County Health and Hospitals System, has enabled individuals detained at the jail to apply for health insurance. Prior to the expansion of Medicaid under the ACA, the vast majority of people entering U.S. jails lacked insurance, hindering their access to treatment for chronic substance use and mental health conditions that often contribute to rearrest.

The prevalence of these conditions in the justice system is not new, Dart observed. “These are issues that have been around for a while. And it’s with partnerships, working with TASC, that we’ve been able to make incredible change.”

TASC Public Voice Award Recipient Bill O’Donnell noted that he might well have gone to jail for his behavior while he was in the throes of addiction. Coming from a family driven to “achieve, achieve, achieve,” O’Donnell was a successful businessman who became addicted to alcohol and cocaine in the 1970s.

“It wasn’t until I got into treatment the second or third time… that I ever asked myself the question, ‘Why is it that I even need the marijuana, the booze, the coke, to change the way I felt?’” O’Donnell recalled. “Recovery and life and awareness is an inside job. You get can get help, you can get direction, you can get love, you can get guidance—but it’s an inside job.”

O’Donnell went on to found Sierra Tucson in 1983, an internationally-recognized treatment center that was among the first to involve family members in the recovery process.

TASC Executive Vice President Peter Palanca praised O’Donnell for his openness and high-profile voice for recovery. “Twenty-three million are in long-term recovery in this country and it’s still the most stigmatized illness,” said Palanca. “Bill was one of the first corporate leaders to speak openly about his addiction. He is a powerful voice for recovery.”

The value of helping one another was highlighted in two videos accompanying speakers’ remarks. Dart introduced a video depicting personal stories of people who now have health insurance thanks to enrollment efforts at the jail, and Rodriguez presented a video featuring participants in Winners’ Circles, which are peer-led recovery support groups for people who have been involved in the justice system.

TASC has been engaged in initiatives at the intersection of health and social justice since 1976, explained TASC Board Chair Cecil Curtwright. “I believe that our highest human calling is to help others—directly, if possible, and if not possible, to support those who do, with whatever means and talents available to us,” said Curtwright, who is the associate vice provost for academic and enrollment services at the University of Illinois at Chicago.

Among other dignitaries attending TASC’s event were previous honorees, including Gino DiVito, retired appellate court justice; Melody Heaps, TASC founder and president emeritus; and Toni Preckwinkle, president of the Cook County Board of Commissioners.

Chairing TASC’s 2015 event committee was John Zielinski, vice president and financial advisor at William Blair, who, along with other volunteers and generous donors, guided TASC’s most successful fundraising campaign to date. Zielinski extended special thanks to Blue Cross and Blue Shield of Illinois, the presenting sponsor of the event, along with numerous other generous sponsors and raffle prize donors.

“TASC is successful because we work together,” said Rodriguez. “Thanks to science and treatment parity, thanks to the Affordable Care Act and the efforts of TASC and our community partners, and especially thanks to all of you, more and more men and women are finding the treatment, the support, and the hope and tenacity needed to build and strengthen those delicate roots into lifetimes of recovery.”

TASC 2015 Leadership Awards Luncheon. Left to right: TASC Board Chair Cecil Curtwright, Justice Leadership Award Honoree Tom Dart, Public Voice Leadership Award Honoree Bill O'Donnell, TASC President Pam Rodriguez. Photo by Uk Studio.

TASC 2015 Leadership Awards Luncheon in Chicago. Left to right: TASC Board Chair Cecil Curtwright, Justice Leadership Honoree Tom Dart, Public Voice Leadership Honoree Bill O’Donnell, TASC President Pam Rodriguez.

Supporters filled the Westin Michigan Avenue ballroom for TASC's 2015 Leadership Awards Luncheon. Photo by Uk Studio.

Supporters filled the Westin Michigan Avenue ballroom for TASC’s 2015 Leadership Awards Luncheon. Photos by Uk Studio.

Parental Addiction Treatment Improves Child Welfare Outcomes: TASC President Pam Rodriguez at Capitol Hill Briefing

(Chicago) – TASC President Pam Rodriguez shared highlights of Illinois’ successful Recovery Coach program at a December 3 Capitol Hill briefing focused on issues and solutions in child welfare reform.

In partnership with the offices of U.S. Senator Rob Portman (R-OH) and Congressman Danny K. Davis (D-IL), Children and Family Futures hosted the briefing, entitled The Elephant in the Room: Access to Substance Abuse Treatment—A Cornerstone of Child Welfare Reform. With an audience encompassing Congressional staff, policymakers, and child welfare advocates, the briefing highlighted the role of substance use disorders in the child welfare system and what works to better serve affected children and their families.

Rodriguez presented lessons and outomes from Illinois’ Recovery Coach program, which addresses substance use disorders among parents whose children have been removed from custody due to substance-related maltreatment. The program began in 2000, funded through a Title IV-E waiver granted the Illinois Department of Children and Family Services (DCFS). TASC has provided services for the Recovery Coach program since its inception in Cook County in 2000, as well as in Madison and St. Clair counties since the program expanded in 2007.

Links between childhood maltreatment and delinquency. There is growing understanding of the connection between child maltreatment and later delinquency, and the crossover of children who are involved in both child welfare and juvenile justice systems. Young people involved in these systems face a host of complex challenges, which may include trauma, educational difficulties, mental health conditions, sexual abuse, and the instability of group homes or foster care placement.

TASC works with DCFS to help stabilize children in care and reduce young people’s likelihood of becoming involved in the justice system.

Intensive outreach and case management. Through the Recovery Coach program, TASC works with the parent, child welfare caseworker, and alcohol/drug treatment agency to remove barriers to treatment, engage the parent in treatment, provide outreach to re-engage the parent if necessary, and provide ongoing support to the parent and family through the duration of the child welfare case.

As Rodriguez explained in the briefing, the program draws on research pointing to the complex needs of parents involved in child welfare and justice systems. For example, a 2014 needs assessment report by the Center for Children and Family Futures for the Office of Juvenile Justice and Delinquency Prevention synthesized hundreds of Family Drug Court surveys, stakeholder interviews, and more than 2,500 technical assistance requests from all 50 states.

Among Family Drug Courts, services for parents were consistently identified as priorities. Systems must recognize and respond to complex and multiple needs arising from trauma, dual-diagnosis, and domestic violence; responses include engagement and retention strategies, recovery supports, and serving parents in medication-assisted treatment (MAT). The report also found that sustainability of funding and cross-system knowledge emerge as consistently-cited needs among jurisdictions and stakeholders.

Rodriguez noted that the Recovery Coach program’s success comes from not only the direct services to parents, but also the understanding of and attention to the cross-systems issues that influence outcomes. Further, the program provides a response to the opiate crisis that is affecting child welfare systems.

“With the rise in heroin use across the country, even more children are being removed from their homes and placed in foster care,” said Rodriguez. “By working with systems to address complex issues around addiction, programs like Recovery Coach and Family Drug Courts make it possible to safely return many affected children.”

Effectiveness and cost savings. A 2012 in-depth program evaluation by the University of Illinois at Urbana-Champaign showed that parents with a TASC recovery coach were more likely to access treatment, and children whose parents had recovery coaches were more likely to be safely reunified with their parents.

Furthermore, children whose parents had recovery coaches were significantly less likely to be associated with a subsequent juvenile arrest.

In addition, according to the March 2015 semi-annual progress report released by DCFS, the Recovery Coach program has generated more than $10 million in savings for the State of Illinois since the program began in 2000. These savings come from significantly higher rates of family reunification, resulting in fewer youth in the system, as well as quicker reunification, resulting in fewer days spent in foster care.

TASC is a statewide, independent case management and care coordination agency in Illinois, annually serving 27,000 individuals referred by criminal justice, juvenile justice, and child welfare systems.