Co-Occurring Disorders and Military Justice
Integrating Services for Justice-Involved Veterans with Co-Occurring Disorders
Effective services for justice-involved veterans with co-occurring disorders requires an integrated, coordinated approach. Three activities that promote the development of effective services include:
Partnerships designed to coordinate and leverage available resources promote the development of effective services for justice-involved veterans with co-occurring disorders. Consider partnering with key stakeholders such as representatives from:
- Criminal justice: Local judges and magistrates, law enforcement officials, jail administrators, probation officers, and victim advocates
- Behavioral health: Local behavioral health authorities, community-based behavioral health providers, and consumer-operated organizations
- Veterans services: U.S. Department of Veterans Affairs representatives, Vet Center representatives, veterans service organizations, military families organizations, and veterans peer-based services
One of the goals of the partnership may be to complement or enhance existing services rather than duplicate efforts.
Leadership is essential for achieving the partnership's vision. Often two people representing different systems co-chair the partnership. It is important to have people who are change agents that can bring people to the table, leverage resources, and who understand the systems represented at the table.
Judges can be effective at motivating agencies to see the shared responsibilities they have for improving outcomes for people with co-occurring disorders in the justice system. The chair from a behavioral health agency needs to be an equally strong leader who understands the intricacies and politics of collaboration and service delivery.
Develop a vision. Forming a partnership begins with reaching agreement on the desired outcomes and goals. The scope may be broad or narrow, but at some point all of the stakeholders will need to arrive at an agreement. The first meetings of the group may not advance a specific agenda, but all stakeholders need a chance to be heard and to have an opportunity to develop an understanding on the cultural differences between systems and agencies.
The goals of the partnership may be broad enough to encourage agreement from all stakeholders, but narrower programmatic goals are required to guide activities. The narrow goals may be to:
- Improve continuity of care for veterans across criminal justice, behavioral health, and the U.S. Department of Veterans Affairs
- Implement a specialized police response for veterans with mental and substance use disorders
Once the stakeholders have settled on the vision and goals for the partnership, a practical next step is to develop a strategic plan for achieving the stated goals. This process involves:
- Identification of action items
- Delegating responsibility to individuals or subgroups of stakeholders
- Managing the overall progress
As part of the planning process, stakeholders may want to establish information sharing protocols, establish formal agreements, and provide cross-training opportunities.
Creating specialty programs. Few partnerships have the resources at hand to implement a specialized police response, specialty court, or reentry program. To estimate the resources required to implement a program, the partnership may need to consider the impact of enrollment criteria on the pool of potential participants. As resources are obtained for a program, the partnership may want to formalize responsibilities through an agreement.
Developing enrollment criteria. Estimating the need for a program involves developing enrollment criteria (demographic, clinical, and criminal justice) and determining how many people will be eligible to enroll. It is important to define who will be enrolled in order to estimate service needs and capacities. Clinical enrollment criteria may be restricted by service providers' diagnostic priority populations. For criminal justice criteria, some programs target specific charges or are restricted from handling certain charges because of pre-existing policies. Sex offenses, driving while under the influence, and domestic violence are some examples of charges where there is generally little flexibility in case processing.
Using jail intake data and screening data, for example, partnerships can estimate the number of people who could participate in the program at any given time. The characteristics of new intake can be compared against the proposed enrollment criteria to understand the program's exclusivity when taking into account the charge and clinical criteria. Quite often the initial criteria set for enrollment result in too few individuals being eligible for the program.
During this process it may also be helpful to assess how difficult it will be to find individuals to participate in the program. Methods to improve the identification process include improving criminal justice agencies' screening and assessment procedures, increasing referral sources, and adding intercept points.
Create formal agreements. Memoranda of understanding are formal agreements between agencies that can facilitate service delivery through cooperative efforts. A memorandum of understanding or interagency agreement is a way to formalize the responsibilities of each stakeholder in a partnership. The elements of a memorandum of understanding include:
- Statement of goals of the agreement
- Overall responsibilities
- Responsibilities for each partner
- Time lines
- Communication procedures
- Contacts for each agency
An alternative to a memorandum of understanding is a resolution of principles. In a resolution the partners sign off to a set of principles for the program. The benefit of such a resolution is that the heads of agencies are not always the signatories. The downside is that a resolution does not have the legal weight as a memorandum of understanding.
Engaging peers early and sustaining their involvement in co-occurring criminal justice initiatives is essential. Peers play a key role in education stakeholders and the community about their experiences and in providing resources such as recovery oriented services and emerging practices in peer support. Their lived experience puts them in unique positions to define problems and identify key solutions. Roles and responsibilities of peers vary across initiatives and include:
- Participating on local and statewide planning/ advisory groups
- Chairing or co-chairing local and statewide planning/ advisory groups
- Part of the research and evaluation team
- Dedicated staff members: Certified Peer Specialists, Veteran Outreach Specialists, Veteran Service Clinicians, Peer Supervisors
- Volunteers: Peer Specialists and Mentors
Recruiting peers as integral partners in the development of policies, procedures and services for justice-involved veterans with co-occurring disorders is relatively new. It is critical that peer advisors also are veterans who have lived experience with mental illness, substance abuse and justice involvement. Some peers may be affiliated with the United States Department of Veterans Affairs, veterans self help groups and organizations, local, statewide and national consumer operated programs, while others may not be affiliated with these organizations but may be interested in becoming involved in criminal justice initiatives.
Leveling the playing field. Veterans with histories of criminal justice involvement, mental illness and substance abuse who are involved with criminal justice initiatives may be faced with a number of challenges in becoming full partners. For example veterans with lived experience may face barriers relating to:
- Financial disparities: Compensation, payment advances, and reimbursement
- Eligibility and assess: Both real and implied limitations; and
- Experiential differences and preparedness: Readiness to participate, resources to prepare participants and support of their involvement
When forming a partnership with peers, it is critical that projects consider potential obstacles and identify key action steps to eliminate them to ensure the involvement of individuals with lived experience in advisory positions.
Key action steps that may be taken to identify, mitigate and eliminate potential barriers include:
- Reviewing and modifying policies and practices regarding prepaying, cash advances, and reimbursements. It is essential that all partners are aware of these policies and practices. In some instants, states have subcontracted with consumer-operated programs to provide cash advances for expenses incurred by partners.
- Develop strategies to identify and address restrictions that may be placed on peers with criminal justice involvement as a condition to their community supervision. Some suggestions include engaging community corrections leaders as stakeholders, learning about peer support programs that can help individuals navigate the criminal justice system, and assuring participants that their disclosures are confidential.
Preparing all stakeholders for their involvement. Provide formal orientations/trainings for each member including: an introduction to all key players, a review of task responsibilities, a review of policies and practices, goals of the meetings and opportunities to debrief following each meeting. It is also important to recognize volunteers' contributions. Recognition includes but is not limited to publicly thanking the individual for their work, and/or providing them written acknowledgements for their work.
Resources and Links
Leveling the Playing Field: Practical Strategies for Increasing Veterans' Involvement in Diversion and Reentry Programs
The barriers to veterans' participation in diversion and reentry programs as advisors and practitioners are often invisible to agencies. This brief provides agencies with strategies to reduce those barriers.
Using Organizational Change Strategies to Guide Peer Support Technician implementation in the Veterans Administration