People Incorporated’s project, Integrated Transition: Community-Based Behavioral Health Support for Jail Inmates (Integrated Transition), will target 350-500 (up to 75 in year 1 and 425 in year 2) mentally ill and chemically dependent individuals incarcerated in Hennepin, Ramsey, Anoka, Dakota, and Washington county jails using a best practices approach to transition planning tailored to inmates with behavioral health needs and co-occurring disorders.
Individuals in jails and prisons have been identified by the National Council of Behavioral Health as a high-need population experiencing significant behavioral health care disparities, including mental health challenges (64%), chemical dependency disorders (53%), and co-occurring disorders (49%). Despite the fact that the U.S. correctional system has become the largest provider of mental health services for most communities, jails are under-equipped to meet inmates’ behavioral health needs, leading to reduced public safety, increased incidence of symptoms, substance abuse relapse, higher emergency services usage, homelessness, and increased rates of recidivism. Community-based agencies like People Incorporated are well-equipped to fill the gap in behavioral health care, but funding reimbursement restrictions limit our ability to establish financially sustainable provider relationships with correctional facilities.
Funding for the CCBHC expansion grant will allow People Incorporated to implement activities ranging from initial assessment to integrated release planning. As a certified CCHBC, People Incorporated will spend the majority of year one of the grant period, in partnership with key stakeholders in the criminal justice and correctional systems, conducting analysis of barriers, recruiting key staff and service facilitators, developing and delivering curriculum to educate correctional facility staff in action protocols for identifying and responding to behavioral health needs among inmates, as well as developing mechanisms for communicating identified indicators of behavioral health challenges to correctional health care providers and Integrated Transition team members. In year two, with our care team and processes in place, we will deliver the following services to jail inmates: 1) early screening, assessment, and diagnosis; 2) patient-centered treatment planning); 3) case management and integrated care coordination; and 4) integrated care navigation, referrals, and individualized transition planning to connect inmates to community resources and social support opportunities.
The goal of the Integrated Transition project is to improve behavioral health outcomes for justice-involved individuals in our community. Objectives for the proposed 2-year funding period include establishing 2-3 MOUs with corrections facilities; providing needs and acuity assessments and integrated transition planning services to at least 350 inmates; engaging 150 inmates in wellness planning and other rehabilitative services; and initiating 6- and 12-month follow-up assessments of at least 80% of the initial cohort participants to begin gauging project efficacy.