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Addressing AddictionBehind The WallsALEXIS DEAN,E X E C U T I V E D I R E C TO R O F M E D I C A I D A N D R E - E N T RYSTEPHANIE SPOOLSTRA,E X E C U T I V E D I R E C TO R O F A D D I C T I O N R E C O V E RYINDIANA DEPARTMENT OF CORRECTION

ObjectivesAttendees will learn How Indiana’s growing problem with addiction is changing the role of the Indiana Department ofCorrection.What best practices have been put into place by the IDOC to aid in community safety andincreased access to addiction recovery.About the collaborative role required between the community and the IDOC in addressing theaddiction epidemic

Substance Use and CrimeAlcohol 8,018 alcohol-related collisions in2014 153 fatalities in crashes attributableto alcohol in 2014 Arrest rates per 1,000 population(2012) Public Intoxication 2.3 (U.S.: 1.3) Liquor Law Violations 2.0 (U.S.: 1.2) DUI 3.6 (U.S.: 3.5)Cocaine/Opiate Arrests (2012) 1600 arrests for possession 1500 arrests for sale/manufactureMethamphetamine ISP seized 1452 meth labs in 2015Prescription Drugs (2012) 2500 arrests for possession 1000 arrests for sale/manufacture

Substance Use & CrimeApproximately 60% of individual arrested for any crime test positive for illegal drugs at arrest(nationally)Estimated that 80% of offenses leading to incarceration in the U.S. are related to drugs/alcohol Domestic ViolenceDriving While IntoxicatedProperty OffensesDrug OffensesPublic Order offenses

Substance Use & CrimeThe relationship between drugs and crime is complex The Chicken or the Egg?Three types if crimes related to drugs: Use-Related Crime Economic-Related Crime System-Related Crime

Substance Use & Incarceration53% of State and 45% of Federal prisoners75% of prisoners returning to prison68% of jail inmatesGeneral Public is 8.8% According to SAMHSA, “substance use disorders occur when the recurrent use of alcoholand/or drugs causes clinically and functionally significant impairment, such as healthproblems, disability, and failure to meet major responsibilities at work, school, or home.”

Drug Use in a Correctional SettingIDOC Facilities – YTD 2016 Completed 12,132 Urine Drug Screens Random and For Cause 572 (4.7%) were positive for at least one substance Tests include Amphetamines, Benzodiazepines, Cocaine, Opiates, PCP, Cannabis, Suboxone Most Common Positive: Suboxone (68.8%) Coming Soon: UDS for K2/Spice/Synthetic Cannabinoids

Drug Use in a Correctional SettingIndiana Parole Districts – YTD 2016 Completed 15,286 Urine Drug Screens 4,695 (30.7%) were positive for at least one substance Tests include Amphetamines, Benzodiazepines, Cocaine, Opiates, PCP, Cannabis, Suboxone Most common Positive: Cannabis (59.7%) In comparison, suboxone only accounted for 0.01 % (56) of all positives Amphetamines were second at 26.5% (1,246)

Whole-Person Rehabilitation at IDOC

Case ManagementBasic overview of Case Management within IDOC Stars with Day 1 Indiana Risk Assessment Program Referrals Ongoing Case Management Release Preparation Indiana Risk Assessment Pre-Release Programming Facility to Supervision handoff

Whole-Person Recovery at IDOCOverview of Programs within IDOC Program Inventory Program Fact Sheet Programs, Courses, Activities Programs Courses Activities Program Referral Domains Criminal HistoryCriminal LifestyleSchool and EmploymentFamily and Social SupportSubstance Abuse and Mental Health

From Punishment to RehabilitationEmotional Mental Health and Addiction TreatmentEnvironmental PREA ACA AccreditationIntellectual Educational Programming including TASC andCollege EducationPhysical New focus on preventative medicine andintegrated healthcare Health/Wellness ActivitiesOccupational DOL programsSpiritual Religious and volunteer servicesSocial Family Reintegration Programming Program CommunitiesFinancial Medicaid/HIP 2.0 Process Financial literacy

Medicaid/HIP 2.0HEA 1206 effective July 1, 2015 IDOC will apply for all releasing IDOC offenders prior to release IDOC acts as the Authorized Representative (AR) for all offenders An application for healthcare coverage is completed for every releasing offender within 60 days torelease Since July 1, 2015: 16,468 total apps completed on behalf of offenders Average: 1,176 apps/month Medicaid Processing Unit (MPU) Centralized unit responsible for: Application database by release date Oversight of Re-Entry Services mailroom Vital records database

Traditional Medicaid/PresumptiveEligibility Traditional Medicaid Physically and mentally disabled offenders are processed using a disability application for healthcarecoverage MPU represent the offender during the interview with DFR The offender is required to apply for Social Security Disability Once approved by the Medical Review Team, the offender is placed on Traditional Medicaid. Presumptive Eligibility Medicaid has been billed for 5.2M worth of medical expenses for DOC offenders Average of just over 400K/month. 674 HPE applications have been completed since July 1, 2015, resulting in an average “savings” ofabout 8,500/per application.

Offender Documents Medicaid processing requires the DOC to have vital records on file forreleasing offenders– Totals through January 2016-August 2016 Birth Certificates Received: 9,715 Social Security Cards Received: 4,482 BMV IDs Received: 4,500 A new Administrative Policy and Procedure was established to ensure fieldstaff are applying for vital documents Allows offenders to have their documents when they are released Active Memorandums of Understanding with Indiana BMV, Indiana Dept. ofHealth, and the Social Security Administration

IDOC Adult Addiction RecoveryServicesOUTPATIENT ARS3 Phases Psycho-Educational Guided Self Study Primary Treatment Group 48 hours 3-month credit time Relapse Prevention &Reintegration 24 hours 1-month credit timeTHERAPEUTIC COMMUNITYA specialized communityfocused on addiction recoveryOffenders with significantimpairment due to SUDMinimum of 8 months tocomplete5 phases of treatment Competency Based Addiction & Criminal Thinking 6-month credit time

Adult Outpatient Treatment Program –14 Facilities Chain O’Lakes Correctional Facility Branchville Correctional Facility Edinburgh Correctional Facility New Castle Correctional Facility Henryville Correctional Facility Miami Correctional Facility Indianapolis Re-Entry EducationalFacility Wabash Valley Correctional Facility Madison Correctional Facility South Bend Community Re-EntryCenter Heritage Trail Correctional Facility Westville Correctional Facility Putnamville Correctional Facility Indiana State Prison Indiana Women’s Prison Pendleton Correctional Facility

Adult Therapeutic Communities –10 ProgramsBranchville Correctional Facility 288 BedsCorrectional Industrial Facility(Pendleton) 248 BedsPlainfield Correctional Facility 224 BedsWestville Correctional Facility 640 BedsWestville Minimum Security 95 BedsMiami Correctional Facility 204 BedsPutnamville Correctional Facility 304 BedsMadison Correctional Facility 170 BedsRockville Correctional Facility 136 BedsStarke County Jail Pilot Program *** 48 Beds

WestvilleStarke PilotMiamiTherapeuticCommunities –Facility ille

Purposeful Incarceration Initiative Indiana Appellate Rule 7 (B) “The Court may revise a sentence authorized by statute if, after due consideration of the trial court'sdecision, the Court finds that the sentence is inappropriate in light of the nature of the offense andthe character of the offender.” Create/Foster relationships between TC and Judicial System Order must state “Court will consider a sentence modification upon completion of theTherapeutic Community” Improve community safety, re-entry outcomes, access to treatment

Relationship of TC & PITherapeuticCommunityCaseManagerReferralSelf ReferralPurposefulIncarceration OffendersARS StaffCustody StaffUnit Manager

Addiction Recovery Services – StarkeCounty PilotRegional Approach to TherapeuticCommunityKnox, IN(Starke County) Starke County, IN & 7 Surrounding Counties48 Total ResidentsPurposeful IncarcerationAccess to Special Programming The FarmCultural Presentations“Drug-Court-Like” Interaction with JudgeFamily Reintegration Officer/Program

Addiction Recovery Services – RSAT GrantGOAL: Improve programming as it prepares the offender for re-entry or re-integration back intothe communityTwo Major Components in 2016/2017: Implementation of “Integrating Dialectical Behavior Therapy with Twelve Step Facilitation” (DBT/TSF) Expansion of Recovery Coaching within IDOC

Parole Re-Entry LiaisonsLocated in all Indiana Parole DistrictsRole: To provide specialized re-entry support to those released onto parole who have significantmental health and addictions needs Targeted Case ManagementLinkage to Community Supports and TreatmentWork Collaboratively with Parole OfficerSupport with basic daily living skills

Re-Entry Vivitrol PilotTargets those re-entering onto Indiana Parole with and Opiate or Alcohol Addiction Voluntary Program Linked with Parole Re-Entry Liaison prior to release Medically evaluated for VivitrolPre-Release, Provided first Vivitrol Injection Linked to community provider for ongoing medication assisted treatment Ongoing community-based support by Parole Re-entry Liaison

The Future VisionIntegration with medical/mental health servicesUpfront accessStandardized addiction screeningImproved connection to the community AA/NA meetings Connection to treatment Recovery WorksRe-Entry SRR Grant Case Management Training Pre-Release Restructuring

Questions & Contact InformationAlexis [email protected] [email protected]