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7. Specialty Populations

The RecoveryOhio Advisory Council and the RecoveryOhio State Team are committed to addressing the unique needs of all Ohioans. In preparation for this report, the RecoveryOhio Advisory Council spoke about two “specialty” populations: individuals involved in the criminal justice system and youths. The council recognizes that the two groups represent only a small percentage of the population of the state. Moving forward, both the RecoveryOhio Advisory Council and the RecoveryOhio State Team intend to continue their work serving all specialty populations, including older adults, veterans, and racial and ethnic minorities.

Ohio’s prisons and jails have become defacto treatment centers for those with severe and persistent mental health needs, substance use disorders, or both. Individuals involved in the criminal justice system have unique, complicating factors that could create barriers to long-term health and recovery.

The ability to get a job, build life skills, or have a safe place to stay can be challenging for anyone leaving criminal justice settings, but when these challenges are coupled with a mental illness, a substance use disorder, and/or other physical issues it may seem that recovery and wellness are impossible. Decades of addressing mental illness and addiction as a public safety crisis rather than a public health crisis resulted in escalated incarceration rates, which has been particularly devastating to racial and ethnic minorities who, as individuals, families, and communities, continue to live with the consequences.

The second specialty population of great concern to the RecoveryOhio Advisory Council is Ohio’s youth. Many of our youth are especially at risk for exposure to adverse childhood experiences (ACEs) 

that can result in problems that occur presently and may continue later into life, including depression, substance use disorders, school difficulties, chronic diseases, or even premature death, including death from suicide. These are complicated when parents and others close to the young person are struggling with mental illness or addiction, themselves. In this public health crisis, we must do what we can to prevent, intervene early, and address mental health conditions and substance use disorders so that every child in Ohio can have a fruitful, long life.

To address the needs of Ohio’s specialty populations, the RecoveryOhio Advisory Council is breaking down its recommendations into two categories: Individuals involved in the criminal justice system and youths.

Individuals Involved in the Criminal Justice System

The interface between the behavioral health and criminal justice systems is significant. The increased involvement of people with mental illness and/or substance use disorders in the criminal justice system is a serious problem. Treatment providers, law enforcement, courts, jails, and prisons have joined with consumers and family members in addressing this difficult situation. By connecting individuals with clinical treatment and/or pre-release care coordination services, they are more likely to get well and make positive life changes.

Local communities are encouraged to develop collaborative relationships between the behavioral health and criminal justice systems so that individuals with mental illness and/or alcohol and other drug addiction receive the care they need on a continuous basis. This, in turn, helps to reduce recidivism, improve public safety, and minimize the risk of harm to law enforcement and those with whom they come in contact.

Services available to those involved in local justice systems include funding for psychotropic medications, including medication-assisted treatment; administrative costs for case management services; and treatment and recovery services for court-involved individuals and their families. Collaboration among treatment and recovery support providers, ADAMH Boards, health departments, law enforcement, courts, jails, prisons, consumers, and family members contribute to public safety and promote recovery for the well- being of Ohioans.

Specialty Dockets
A specialized docket is a court that offers a therapeutically-oriented judicial approach and provides court supervision coordinated with appropriate treatment to individuals. Since the establishment of Ohio’s first drug court in 1995, the state has been established as a forerunner in the national specialized dockets movement. The spectrum of specialized dockets offered in Ohio is vast and diverse, including, but not limited to: adult and juvenile drug and mental health courts, family dependency treatment, veteran treatment, operating a vehicle under the influence (OVI), and substance abuse and mental illness (SAMI), juvenile treatment, human trafficking, re-entry, and domestic violence dockets. The jurisdictions of Ohio’s specialized dockets include court of common pleas, general, juvenile and domestic relations divisions, as well as municipal and county courts.

Specialized dockets that target high-risk, high-need addicted parents charged with abuse, neglect, and dependency of their minor children are shown to increase the number of children able to remain in their homes due to the involvement of child protective services who provide oversight and supervision that assists families in developing and maintaining a safe home environment. Additionally, there are increased rates of reunifying with their parents, children who were removed from their homes.

To address concerns about incarcerated individuals with mental health conditions and/or substance use disorders, the RecoveryOhio Advisory Council recommends:

55. Criminal Justice Reform

Anticipate the impact of criminal justice reforms on demand for treatment and recovery supports and the corresponding availability of these services. Ensure reforms are enacted without bias toward any specific drug so that individuals with any substance use disorder have an equal opportunity to access treatment and recovery support services in lieu of jail time. And, recognize the effects these changes will also have on other systems, such as child welfare.

56. Decreasing the Supply of Drugs

Continue to coordinate efforts between the Ohio Department of Public Safety and the Ohio Attorney General’s Office to work with law enforcement agencies to expand proven drug task force models that specifically target and disrupt the flow of money and drugs from cartels that target individuals struggling with substance use disorders.

57. Alternatives to Incarceration

Increase diversion opportunities through crisis stabilization or deflection centers to ensure that individuals in need of treatment get treatment instead of using jails as defacto holding centers.

58. Specialty Courts

Expand access to specialty courts for people and families with mental illness and addiction and increase the number of specialty dockets that embrace trauma-informed best practices and family-centered approaches.

59. Competency Restoration

Amend the in-patient competency restoration process to emphasize treatment and community access to services, especially for misdemeanor offenses. This will have the positive result of returning the use of in-patient hospital beds to those individuals in psychiatric crisis without criminal justice involvement and decrease wait time for admission. It will also help meet the long-term clinical and safety needs of individuals and communities.

60. Treatment While Incarcerated

Enhance continuity of care and introduce new treatment opportunities, including counseling, medication, and other supports, to individuals with mental health and substance use disorders who are incarcerated in community-based correctional facilities, jails, prisons, and halfway houses. The treatment would promote recovery, minimize disruption in care, reduce recidivism and promote wellness.

61. More Programs for Incarcerated Women

Expand programs that address the unique needs of women, particularly pregnant and mothers, who are increasingly being incarcerated in Ohio’s prison and community-based correction facilities.

62. Attention to Re-entry and Reintegration

Implement research-informed re-entry and reintegration strategies that help individuals exiting the criminal justice system to transition successfully back into the community. Disseminate best practices on strategies for promoting recovery from mental illness and addiction to treatment providers who focus on criminogenic behaviors and to re- entry professionals. Ensure consistent local implementation of Ohio Medicaid enrollment policies in all 88 counties for Ohioans in jails.

Youths

A recent report by the Ohio Council of Behavioral Health & Family Services Providers stated, “Today’s children are tomorrow’s parents, community leaders, workforce and the key to our state’s economic success.” 7 Recent studies have found that mental health and substance use disorders in children are quite common, and frequently go untreated or undertreated. A recent study found that between 17.8 and 19.9 percent of children between birth and age 17 have a mental health disorder and that only 53.4 percent of these children receive treatment, ranking Ohio 28th among all states.8 Despite this information, substance use and mental health screenings are not routinely used, putting the state’s youth population at risk for crisis and substance abuse later in life.
 
In 2018, more than 15,000 children were served through Ohio’s child welfare system in out-of-home care, with one-half of them placed due to parental substance use disorders, Ohio must build protective factors, programs, and services to protect and support healthy development of our children. For youths involved in foster care the trauma caused by these out-of-home placements, as well as the events that occurred leading to the placements, often results in feelings of fear and helplessness. These are normal responses to abnormal events, not signs of weakness and may lead to lifelong problems.
Children need to know that they’re safe and that people care and will help them through whatever events they have experienced. Caregivers, teachers, and service providers can be more effective in providing care and support if they are trauma- informed and sensitive to a child’s needs.

As children grow, mental, social, and emotional challenges are exacerbated during the transition from youth to adulthood. This can result in problems in multiple life domains, including housing, education, employment, quality of life, and life skills. Best practices for serving transition-age youths incorporate the principles of recovery, resiliency, and cultural competence. In addition, the care during these critical ages must be youth-guided and family- driven so that our children feel loved and supported and can lead healthy lives.

To address the gaps with the youth continuum of care, the RecoveryOhio Advisory Council recommends:

63. Looking at the Needs of Youths and Families

Convene a focus group, including state agencies, experts, families, and other parties, to review the needs of youths and families. Specifically, the group should prepare strategies to implement the Joint Legislative Committee on Multi-System Youth Recommendations (June, 2016). Particular attention should be given to:

  • Improving access to early intervention depression, substance use, and adverse experiences/trauma.
  • Promoting evidence-based, outcomes- focused treatment services.
  • Promoting treatment for kids in homes and communities while preventing out-of- home placements.
  • Exploring options to help kids assimilate back into homes and communities following out-of-home treatment.
  • Promote appropriate levels of care coordination and case management across systems for multisystem youths.
  • Providing access to a mental health professional in every school.

64. Focusing on Juvenile Justice

Continue, and improve upon, the RECLAIM program to ensure youths have access to treatment in lieu of incarceration. Review the transition process for youths to adult prison facilities to ensure that incarcerated young adults benefit from services and environments that are specific to their age and development level.

65. Examining Crisis Services

Ohio should evaluate the crisis service infrastructure to improve services and resources for youths and their families.

66. Concentrating on Foster Care and Child Welfare

Embrace best practices in cross-system collaboration among state entities — including the Ohio Department of Mental Health and Addiction Services, Ohio Department of Job and Family Services, the Supreme Court of Ohio, the Ohio Department of Medicaid, and the Ohio Department of Health — that will expand resources and technical assistance to local communities for families involved with the child welfare system and who are experiencing substance use, mental illness, and co-occurring disorders. Support efforts to meet the demand for foster care while reducing the need for foster care. Build resources to support foster care and kinship caregivers, such as grandparents, in meeting the needs of children with significant behavioral and emotional problems.

67. Providing a Full Continuum of Care for Ohio’s Children, Youths, and Young Adults

Review the continuum of services available to Ohio’s youths, young adults, and families to determine gaps and create strategies for timely access to appropriate care for Ohio’s youngest citizens and their parents.

68. Focusing on Organizations For Youths

Expand collaboration among organizations meeting the prevention, treatment, and recovery needs of Ohio’s young people and organizations serving youths, such as Boys & Girls Clubs, YMCAs and others. Support the growth of recovery high schools, collegiate recovery communities, and alternative peer groups for youths recovering from mental illness and substance use disorders.

69. Meeting the Respite and Support Needs of Families

Create a plan to meet the distinct needs of families of children and youths with severe emotional disorders and provide respite and support for these caregivers.

Other Specialty Populations

To address the needs of other specialty populations, the RecoveryOhio Advisory Council recommends:

70. Expanding Services for Seniors

Explore partnership opportunities among the Ohio Departments of Mental Health and Addiction Services, Aging, and Health that will expand support and services for senior citizens experiencing neglect and abuse. Expand prevention and education services to older adults at risk of mental illness and/or substance use disorders. Increase screening of older adults for mental illness and substance use disorders. Support grandparents who are providing kinship care to children who are not able to remain in their homes due to parental substance use disorder or mental illness.

71. More Treatment Options for People With Eating Disorders

Assure that a full continuum eating disorder treatment is available within the state.

72. Greater Support for First Responders

Support collaborative strategies that increase local support available to first responders related to secondary trauma. Build targeted efforts for suicide prevention among first responders.