The VJO Specialist in Veterans Treatment Courts: The Glue Holding - - PowerPoint PPT Presentation

VETERANS HEALTH ADMINISTRATION

The VJO Specialist in Veterans Treatment Courts: The Glue Holding VTCs Together

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BJA Drug Court Technical Assistance Project at American University November 9th, 2016

VETERANS HEALTH ADMINISTRATION

The VJO Specialist in Veterans Treatment Courts: The Glue Holding VTCs Together

Justice Evelyn Lundberg Stratton (ret.), Ohio Supreme Court

• Ms. Mary Gillette, LISW-S, Veterans Justice Outreach Coordinator, Chalmers P. Wylie

VA Ambulatory Care Center, Ohio Judge John Zottola, Allegheny County, Pennsylvania, Court of Common Pleas

VETERANS HEALTH ADMINISTRATION

VJO Mission

To reduce and prevent criminal justice recidivism and homelessness among veterans by linking justice-involved veterans with appropriate supports and services.

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VETERANS HEALTH ADMINISTRATION

Five Strategic Goals

• 1. Increase the identification of justice-involved veterans (JIVs) and promote their

engagement with VA.

• 2. Build VJO capacity to serve JIVs through a comprehensive workforce development

program that attracts and retains high-quality staff, supports their professional development efforts, and supports succession planning.

• 3. Match JIVs with the medical, psychiatric, vocational, and social services that will

improve health and optimize successful community integration and safety.

• 4. Optimize community integration for JIVs by removing attitudinal barriers through

improving stakeholder understanding of the population.

• 5. Develop systems for program evaluation and dissemination of

knowledge on JIVs.

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VETERANS HEALTH ADMINISTRATION

What is a JIV?

A veteran who is:

• 1. Arrested by local law enforcement who can be appropriately diverted from

arrest into treatment;

• 2. Incarcerated in a local jail, and who either has a pending trial or is serving a

sentence after a conviction; or

• 3. Involved in adjudication or monitoring by a court.

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Source: U.S. Government Accountability Office. (2016, April). Veterans Justice Outreach Program: VA Could Improve Management by Establishing Performance Measures and Fully Assessing Risks. (Publication No. GAO-16-393). Page 9.

VETERANS HEALTH ADMINISTRATION

Background

• In 2012, 22 million veterans in the US

– About 9.3% are incarcerated (50,000 veterans) – This is a decrease of 25% since 2004

• Veterans incarcerated at a lower rate than non-

veterans

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VETERANS HEALTH ADMINISTRATION

History of Veterans and Incarceration

Increase in incarceration after each war

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Names of Wounds of War Civil War Soldier’s Heart WWI Shell Shock WWII Combat Fatigue Present PTSD or PTS

VETERANS HEALTH ADMINISTRATION

Where JIVs served

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VETERANS HEALTH ADMINISTRATION

Veterans in Jails - Statistics

• Types of crimes – 70% are non-

violent – Public Order Offenses: 33% – Drug Offenses: 22% – Property Offenses: 16% – Probation Violations: 12%

• 25% have been in prison two or

more times

• 95% male
• 52% between ages 18 and 44
• Many older Vietnam vet era
• 40% little or sporadic work in last

three years

• 33% retired or disabled
• 73% had served during a military

intervention (within geographic proximity of a military conflict)

• 40% homeless or unstable

housing – More Vietnam veterans are homeless – Recent veterans entering homelessness at a faster rate

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VETERANS HEALTH ADMINISTRATION

Housing Situation

• f JIVs

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VETERANS HEALTH ADMINISTRATION

Health Issues in Veterans

• 69% have substance use disorders
• 68% have serious mental health issues
• Rand Estimate: 300,000 have major depressive disorders

(such as Post-Traumatic Stress Disorder)

• Rand Estimate: 320,000 have some form of Traumatic Brain

Injury

• 60% have serious medical problems

– 5x higher rates for AIDS – 9x higher rates for Hepatitis C – 4x higher rates for Tuberculosis – Higher prevalence rates for asthma

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VETERANS HEALTH ADMINISTRATION

Eligibility Criteria – Discharge Status

• 82% eligible for VA Healthcare services
• 65% have honorable discharge
• 17% general under honorable discharge
• Those with dishonorable discharge but can prove mental

health or PTSD, TBI causes can upgrade bad paper but difficult

• Discharge for homosexuality being upgraded
• While many have significant risk factors, most are eligible

for VA services but have never accessed them

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VETERANS HEALTH ADMINISTRATION

History and Purpose of Treatment Courts Development of Veterans Treatment Court Concept

463 VTCs as on June 3, 2016 – only 65 existed in 2010 Veterans served by VJOs in a VTC rose from 1,900 in 2012 to 3,900 in 2015

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VETERANS HEALTH ADMINISTRATION

Evolution of Concept and Meeting to form VJOs Program

• Purpose and extent of VJO outreach
• Participation in training for VJOs
• Operational in 2009
• Funding made available in 2010 for every VA facility (167 medical

centers)

• Originally one per facility, now increased to 261 total in 2015

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VETERANS HEALTH ADMINISTRATION

Progress of VJO Services

By 2015: 46,500 veterans served 72% increase in veterans served between 2012 and 2015

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VETERANS HEALTH ADMINISTRATION

Number of Veterans Served

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VETERANS HEALTH ADMINISTRATION

Challenges

• GAO Report suggests performance and risk assessment

measures

• Challenges posed by diversity of service areas

– Rural versus urban – Large population versus small – Jail versus VTC duties

• VTC involvement more extensive and longer term, 12-24

months, versus brief jail contacts

• Time spent helping to set up a VTC

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VETERANS HEALTH ADMINISTRATION

Challenges

• Different priorities of VA hospital facilities both in duties
• f VJOs and in allocating treatment resources
• Increase in usage of Veterans Reentry Search Service

identifying many more veterans after arrest

• Increase in usage outstripping capacity
• Incarcerated veterans at higher risk of homelessness
• Handbook for policies and procedures still in progress
• No current anticipated increase in funding

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VETERANS HEALTH ADMINISTRATION

Resource and Treatment Challenges

• Residential treatment facilities are limited and often full
• Limited housing options for sex offender

– However, VA making strong push and great strides to end homelessness among veterans generally

• Limited transportation options for veterans to get to

treatment or court hearings, especially if driver’s license has been revoked

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VETERANS HEALTH ADMINISTRATION

MISSION

• To partner with the criminal justice system to identify

Veterans who would benefit from treatment as an alternative to incarceration. VJO will ensure access to exceptional care, tailored to individual needs, for justice-involved Veterans by linking each Veteran to a VA and community services that will prevent homelessness, improve social and clinical outcomes, facilitate recovery and end Veterans’ cyclical contact with the criminal justice system.

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VETERANS HEALTH ADMINISTRATION

VISION

• Every justice-involved Veteran will have access to the health

care and other benefits necessary to pursue and realize a full, meaningful life as a self-reliant, positively contributing member of the community.

• Source: Department of Veterans Affairs, 2009

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VETERANS HEALTH ADMINISTRATION

Risk Factors that increase likelihood of a JIV

• Homelessness
• Mental Illness
• Substance Abuse/Use
• Chronic Health Issues
• Trauma
• Head Injuries
• Multiple Life Stressors
• Lack of Supports

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VETERANS HEALTH ADMINISTRATION

Service/Treatment Delivery Emphasis

• Homelessness prevention
• Medical care (including TBI)
• Mental health (including Posttraumatic Stress

Disorder) and addiction

• Cognitive risk (and personality characteristics)
• Psychosocial Needs

Housing, financial/employment, interpersonal, social

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VETERANS HEALTH ADMINISTRATION

Scope and Demand –Direct VJO Duties

• Liaison with law enforcement
• Jail outreach
• Linkage with and coverage of treatment courts (and other courts)
• Catchment area POC –justice involved Veterans
• Support of ancillary needs of justice involved Veterans
• (e.g. child support, legal, financial stability and benefits)
• Documentation and clinical record keeping
• Data tracking, monitoring, and reporting
• Program planning/development, coordination, and promotion
• Linkage development –internal VA, justice partners, community providers

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VETERANS HEALTH ADMINISTRATION

VJOs and JIVs

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VETERANS HEALTH ADMINISTRATION

Other VJO Duties (examples)

• Homeless Program Coverage
• Mental Health Assessments
• Program Screening
• Committee Participation
• Accreditation Preparation

* Hybrid Justice Specialists

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VETERANS HEALTH ADMINISTRATION

What VJOs are not . . .

• Specialty Care Coordinators
• Homeless or Mental Health Case Managers
• Forensic Evaluators
• Mentor Coordinators
• Residential Programs Admission Coordinators
• Enrollment Clerks/Benefit Specialists
• Hospital Director/Policy Maker

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VETERANS HEALTH ADMINISTRATION

General VJO Approach

• Internal VA and External Community/Justice Partnership (CIT)
• Veterans Re-entry Search Service (VRSS)
• Tele-Justice via Telehealth
• Coordination and Planning
• Education to Community and Families of Veterans
• Supportive Services for Veterans and Families (SSVF)

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VETERANS HEALTH ADMINISTRATION

General VJO Strategies

• Program planning and prioritization
• Planning in conjunction with community processes
• POC and utilization of other structures
• Solutions when facing capacity
• Program promotion/Public relations and media

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VETERANS HEALTH ADMINISTRATION

Veteran Treatment Courts

• Collaboration between Courts and VA
• Program criteria and admission criteria established by the

Court

• Certified verses No Certification
• Hybrid Treatment Courts

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VETERANS HEALTH ADMINISTRATION

Veterans Justice Outreach Specialist and Role with VTC

• Treatment Team Member
• Educator of Veteran Culture
• VA System Educator
• Service and Benefits Facilitator
• Data Collaborator

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VETERANS HEALTH ADMINISTRATION

The advantages of a Veteran Specific Docket Substantially reduces the costs to the community

• Incarcerating
• high medical/medication costs
• mental health and substance abuse counseling and

treatment

• burdens to the shelter system
• other financial resources.

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VETERANS HEALTH ADMINISTRATION

Administrative

• Referral process to VJO
• Each VA medical center has a VJO Specialist who serves as a

liaison between VA and the local criminal justice system. Contact information for each Specialist is available at: http://www.va.gov/HOMELESS/VJO.asp#contacts

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VETERANS HEALTH ADMINISTRATION

Important Considerations

• Veterans involved in civil disputes, bankruptcy, divorce,
• etc. are not eligible for the VJO Program
• Non-VA programming available to address legal needs

(Operation Legal Help Ohio , Grassbaugh Project, Legal Aid)

• A Veteran’s legal status will not be a factor in determining

eligibility for VA services and/or programs

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VETERANS HEALTH ADMINISTRATION

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TOP DOWN MODEL

• Allegheny County – 2009: PA Supreme Court & Director of Veterans

Integrated Service Network (VISN) created a statewide task force to address veterans’ issues and veterans’ courts.

• Initial team understanding and creation of MOU w/VA to recognize and

enforce an equal partner team approach to VTC.

• VA and VBA involvement in planning and VJO involvement from

inception of VTC.

• Currently two VJOs on the team; duration of service is 6 and 4 years

respectively.

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• Heavy VJO emphasis on attending court hearings, service plan creation

and implementation, jail visits and involvement. Fully engaged team member actively participating in bi-weekly staffings, quarterly planning meetings and day-to-day service to veterans (medical, psychiatric, housing, employment and reintegration issues).

• VJO is an active participant in VTC email tree to, on a short-term notice,

address issues for a veteran in crisis, need or simply looking for a listening ear.

• Through active engagement of court & VA w/VJO as point, we have

forged an equal and satisfying partnership w/VA to benefit our veterans.

TOP DOWN MODEL

VETERANS HEALTH ADMINISTRATION

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VJO AND VA INTERACTION WITH THE COURTS

• VJO as an active, participating and advocating member of VTC team.
• Adding a second VJO to support a large urban VTC as well as less populated

and rural counties to increase support and services (as will be noted later an increase in VJOs assigned to regions is recommended as each veteran and their circumstances are unique and there is a concern of support services burnout.)

• Providing and supporting the use of MAT, Medical Assisted Treatment, for

appropriate veterans in VTC. Since 2011, the VA has provided, at no cost, Vivitrol injections to veterans. As of this date, 16 veterans have participated with generally favorable results. (Sufficient sampling to support a preliminary study of effectiveness of MAT.)

VETERANS HEALTH ADMINISTRATION

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• The VA purchase and presentation to VTC of TAD-EM bracelets so that

veterans with alcohol issues can be released from incarceration earlier with electronic monitoring and begin treatment as opposed to sitting in jail.

• The printing of informational posters that have been placed in strategic

areas where a justice-involved veteran can obtain VJO assistance. (Poster reads “Are you in trouble with the law? Have you served in the military? If so, contact your VJO at this number…”

• The printing of resource cards with the names of local agencies that can

assist an in-crisis, in-need veteran. Cards were distributed to law enforcement, minor judiciary, social-service agencies and courts.

VJO AND VA INTERACTION WITH THE COURTS

VETERANS HEALTH ADMINISTRATION

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• Providing the VTC with challenge coins which are presented to each veteran

at the completion of their time in the court as a recognition of achievement.

• Since the first graduation, consistent, enthusiastic and meaningful

attendance at VTC graduation ceremonies

• Involvement in diversion at magisterial level as well as Common Pleas.
• Assessment of VJO by team members, calling into place great

achievements and suggested improvement.

VJO AND VA INTERACTION WITH THE COURTS

VETERANS HEALTH ADMINISTRATION

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ASSESSMENT BY PROSECUTION

ACHIEVEMENTS

• VJOs provide outreach, assessment and case management to at-risk

veterans in the criminal justice system.

• Ensure eligible veterans are referred to VTC but also receive VA

services.

• Ensure veteran is connected to appropriate housing and employment

services as needed as well as a treatment service plan and providers. The plan may include medical, psychiatric, drug and alcohol treatment.

• Report to court regarding compliance progress of veteran in staffing

and reinforcement hearings.

VETERANS HEALTH ADMINISTRATION

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ASSESSMENT BY PROSECUTION

SUGGESTED IMPROVEMENT

• As a result, and knowing that each veteran is

unique, the position of the VJO is very time- consuming and emotionally intensive and consideration should be given to increasing the number of VJOs in each jurisdiction.

VETERANS HEALTH ADMINISTRATION

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ASSESSMENT BY DEFENSE PARTNER

Allegheny County VTC is supported by Duquesne University Law School Veterans’ Court clinic as its defense partner. PA Supreme Court certified law students supervised by a practicing attorney represent the majority of veterans in VTC.

ACHIEVEMENTS

• VJO role provides timely identification and access for veterans to VTC. In addition, VJO

role includes outreach and collaboration with attorneys, law enforcement, probation departments, jails, social services and court systems in Allegheny County and surrounding counties that have VTC.

• The effective collaboration between Duquesne University and VA/VJO and VTC to

provide timely and effective access to VA and community mental health and substance abuse services when clinically indicated and other services and benefits as appropriate.

• VJO assisted in “hearing voices” training.
• Collaboration with VJO to engage the veterans at an earlier stage in the criminal justice
• system. The current VTC model is a post plea court. The earlier engagement at the

minor judiciary level will probably prevent further penetration into the criminal justice system and engage the veteran in treatment with the VA at an earlier stage which reaps enormous benefits in the long run to the veteran, his family and society.

VETERANS HEALTH ADMINISTRATION

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ASSESSMENT BY DEFENSE PARTNER

SUGGESTED IMPROVEMENT

• Increase the number of VJOs to support the

current and anticipated veteran justice involvement in the short run and decrease recidivism in the long run.

VETERANS HEALTH ADMINISTRATION

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ASSESSMENT BY PROBATION

Allegheny County has three probation officers who participate in staffings, compliance hearings, and an email tree. Of the three, one is a fully dedicated P.O. who undertakes coordination duties.

ACHIEVEMENTS

• VJO as an advocate and primary caseworker for the justice-involved veteran.

The VJO constructs a service plan so that everyone understands the expectations of the veteran and the court.

• VJO acts as an additional set of eyes for probation communicating all pertinent

information to probation thereby creating a strong supervision partnership.

• VJO identifies and refers for vetting in Veterans’ Court referral meetings those

veterans currently on probation in other courts who would be appropriate for VTC.

• VJO regularly reports to probation and ultimately to court instances
• f non-compliance with service plans that may lead to sanctions for

the veteran.

VETERANS HEALTH ADMINISTRATION

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ASSESSMENT BY PROBATION

SUGGESTED IMPROVEMENTS

• Making sure that with each VJO that there is a common understanding of

the expectations of their role and its interaction with probation.

• Assuring that VJOs understand that when they are responsible for multiple

jurisdictions, that practices and procedures can vary and to make sure they have a working knowledge of the differences.

• Increase the number of VJOs to prevent supervision burnout.

VETERANS HEALTH ADMINISTRATION

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ASSESSMENT BY HUMAN SERVICES

Allegheny County VTC practice is that no eligible veteran should be left behind so that if an otherwise VTC-eligible veteran is ineligible for VA services, that our Department of Human Services will provide services and treatment.

• VJO provided technical assistance to Human Services when they are

unfamiliar with a VA program or service.

• Coordinated county projects with VJO/VA to assist all veterans within or

without VTC.

• Provided the use of a central recovery center on a temporary basis for

veterans who would otherwise be homeless or in jail.

• VJO, Human Services and local non-profit veteran agencies meet with

Veterans’ Housing Developers to develop housing strategies.

• The extensive and effective use of the cross-agency created email tree

to deal with veterans in crisis who require immediate attention.

VETERANS HEALTH ADMINISTRATION

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ASSESSMENT BY VJO

Allegheny County and 8 surrounding counties are the responsibility of the VJOs.

ACHIEVEMENTS

• Created in 2009 after President Obama appointed Sec. Shineski over the Department of

Veterans Affairs.

• Discovered criminal justice system created and perpetuates homeless among our

Veteran population.

• The VJO’s role is to conduct outreach, educate community agencies, courts and jails
• n justice-involved Veterans in their community.
• Outreach includes the education of local law enforcement in identifying justice-involved

Veterans providing resources should they encounter a Veteran in distress.

• VJOs assist in creating and coordinating Veterans Courts and the care among Veterans

accepted into a VTC.

• VJOs in Allegheny County are also in the magistrate courts assisting Veterans with low-

level offenses, summaries, and accepting referrals for Veterans Court on more serious charges. VJO reports to Magistrate Court, Court of Common Pleas and federal courts on Veterans that are justice-involved.

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• Education and outreach are the primary roles of VJOs. This

education and outreach allow the community to be informed and assist in creating future courts and assisting more Veterans that are justice-involved. VJO typically is involved in CIT (Crisis Intervention Team) in various counties as well as attending different Bar Association, Law School functions, and conventions, conferences and Community Justice Advisory Boards.

ASSESSMENT BY VJO

ACHIEVEMENTS

VETERANS HEALTH ADMINISTRATION

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ASSESSMENT BY VJO

SUGGESTED IMPROVEMENTS

• Dedicated Formal Arraignment for Veterans or capturing more Veterans at

the magistrate level to engage in care

• Dedicated jail pod for justice-involved Veterans
• More funding for transportation as that is lacking
• Accept more cases that may not otherwise meet protocol
• Veterans without a mental health diagnosis but have issues with

substance abuse, employment, housing as those are all treatable issues within the VA programs.

VETERANS HEALTH ADMINISTRATION

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ASSESSMENT BY MENTOR

Work hand-in-hand with VJO to identify and provide services to veterans that are not provided, or are provided on a limited basis by the VA.

• VJOs have an in-depth understanding of the needs of each

veteran within the courts. This keen awareness of the veterans’ circumstances and background enables appropriate matching of veterans with mentors and appropriate matching

• f services within the community.

VETERANS HEALTH ADMINISTRATION

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POTENTIAL IMPROVEMENT

Beyond the VJO Level

• VA should permit veterans that have not been successful in

VA treatment programs to receive alternative treatments by civilian providers that specialize in treatment of veterans/first responders (i.e. Warriors Heart in San Antonio, equine therapy, hyperbaric chamber, etc.). If VA were willing to authorize alternative treatments, I would work with VJOs to identify alternative treatment programs and coordinate those services for veterans.

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November 17, 2016

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VETERANS HEALTH ADMINISTRATION

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BJA Drug Court Technical Assistance Project Justice Programs Office School of Public Affairs, American University 4400 Massachusetts Avenue, NW Washington D.C. 20016-8159 Email: justice@american.edu Website: www.american.edu/spa/jpo Telephone: (202) 885-2875 Facebook: facebook.com/aujpo Twitter:@AU_JPO

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