States and communities throughout the U.S. are making efforts to address the complex issue of devising accessible, effective and comprehensive systems of care for persons living with mental illness who become involved in the criminal justice system. Often the focus of these efforts is to implement “Jail Diversion” programs which will redirect persons with mental illness to evidence based community treatment alternatives designed to address symptoms associated with mental illness that may lead to problem behaviors which result in interaction with the justice system.

More recent evidence indicates that effective treatment of the symptoms of mental illness alone is not sufficient in preventing initial or repeat contact with the criminal justice system. Persons with serious mental illness are over-represented in the criminal justice system as a result of additional risk factors that often combine with untreated, symptomatic mental illness. These include trauma, environmental and social disadvantages, situational stressors, substance dependence and criminogenic risks. In order for the mental health system to serve as the “ultimate intercept,” treatment of these additional risk factors likely needs to be integrated within that system of care, or mental health services need to be strategically coordinated with a criminal justice system that provides effective interventions to address trauma, social disadvantages, stressors, and criminogenic risks.

The Criminal Justice Coordinating Center of Excellence (CJCCoE) promotes use of the Sequential Intercept Model to engage local stakeholders in discussion and planning surrounding effective practices, gaps in services, and barriers to cross-systems improvement related to serving persons with mental illness at all points of intercept in the criminal justice system. The CJCCoE also encourages collaboration and sharing within and among communities to improve awareness, knowledge, and access to helpful resources.

 

Best Practices in Schizophrenia Treatment Center

The Best Practices in Schizophrenia Treatment (BeST) Center at NEOMED in the Department of Psychiatry is dedicated to promoting recovery and improving the lives of as many people with schizophrenia as possible by accelerating the adoption of evidence-based and promising practices.  The BeST Center works with mental health consumers, family members, expert consultants, policy makers and mental health partners from Ohio.  The BeST Center offers training, consultation, evaluation, education and outreach activities to build the capacity of local systems to provide state-of-the-art care.

GENERAL INFORMATION

• What is AOT? *
• Treatment Advocacy Center: Implementation Information
• Implementing Assisted Outpatient Treatment: Essential Elements, Building Blocks and Tips for Maximizing Results*
• AOT Guide for Families*
• The Competency Restoration Crisis and the Potential Alternative of Assisted Outpatient Treatment*

 

Treatment Advocacy Center
703.294.6001
info@treatmentadvocacycenter.org

 

OHIO Specific GUIDANCE

Information, Materials and Tools

• Ohio AOT Implementation Manual*
• Ohio’s AOT Implementation Map*
• Ohio AOT Monitors Group Member List*
• Core Elements of an Effective AOT Program Checklist*
• Ohio AOT Judges’ Quick Reference Guide*
• Questions & Answers of Legal Questions, Regarding Data Entry and Outcomes Tracking via the Ohio Department of Mental Health and Addiction Services*
• Prosecutor’s Questions at Initial Hearing*
• NAMI Ohio’s Understanding of Ohio’s Court Ordered Outpatient Treatment Law*
• Crisis Intervention Team (CIT) and AOT: Working Together for the Betterment of the Community Slide Presentation*

 

For technical assistance within Ohio, please contact:
Betsy Johnson
614.519.3137
johnsonb@treatmentadvocacycenter.org

Ohio Data Collection

The first link below will take you to a replica of the Ohio AOT Data Collection Portal.  It is intended for Ohio’s AOT Monitors and others interested in tracking, data entry, and reporting on assisted outpatient commitment to acquaint themselves with the portal.  Once a county signs the Business Associate Agreement with the Ohio Department of Mental Health and Addiction Services, the county will be provided with a secure link.

• Ohio Data Collection Portal
• Ohio Data Entry Guide*
• Business Associate Agreement Template*

 

County Specific Information & Materials

• Butler County Probate Monitor Position Description*
• Butler County Local Rules of Practice – Special Provisions*
• Butler County Court Forms*
• Cuyahoga County Order to Convey Form*
• Richland County Judgement Entry Form*
• Richland County Participant Handbook*
• Summit County Compliance Summary Form*
• Summit County OPC Notification and Discharge Form*
• Summit County Court Forms and Sample Orders*
• Trumbull County OPC Provider Expectations*
• Trumbull County OPC Forms*
• Warren and Clinton Counties Probate Monitor Position Summary*

 

November 2017 Ohio’s Building the AOT Community: A Symposium for Beginners, Experts and Those in Between

• Symposium Program and Reference Materials*

 

Below are videos taken during the symposium to depict different components of an AOT program

• AOT Skit Act 1
• AOT Planning Committee Role Play
• AOT Hearing in Courtroom

One key component of a comprehensive mental health system of care is an effective and accessible crisis response system, a continuum of recovery-oriented services available 24/7 for individuals in all communities, of all ages.  Across the United States, communities are struggling to meet the needs of citizens in mental health crises through services designed to effectively triage, assess and refer individuals to the most appropriate and least restrictive level of care that will meet immediate and longer-term needs.  In Ohio, where Crisis Intervention Teams (CIT) are widespread, the gap in crisis services has become keenly apparent, with law enforcement officers in many communities struggling to identify alternatives to jail or often ill-equipped hospital emergency departments.

The Criminal Justice Coordinating Center of Excellence has completed Sequential Intercept Mapping (SIM) exercises in 28 Ohio Counties related to the adult mental health and justice systems.  Of the 27 counties where full SIM exercises, addressing all points of intercept along the justice system, were completed, 24 (89%) identified the crisis system as a critical gap and top priority to address, making it the number one priority across the state.

Download the Top Priority Graph*

International Summit on Urgent and Emergency Mental Health Care

On September 9-10, 2019, Crisis Now and International Initiative for Mental Health Leadership held a joint international summit on Urgent and Emergency Mental Health Care.  Various resources were highlighted during the summit, including the following resources.

Conference Slides

• What if…Access to Care was the Priority?  Lessons from the Southern Arizona Crisis System
• What if we could see the whole system? 
• Crisis Now: The Business Case
• Elements of Care Traffic Control
• Role of Law Enforcement 
• USA: 3-Digit Dialing Code Initiative for People in Mental Health or Suicidal Crisis
• National Three Digit Crisis Hotline 
• Crisis Across Countries – Panel Discussion 

 

Publications and Graphics

• 2016-2017 Policy Paper. Decriminalization of Mental Illness: Fixing a Broken System 
• Fair Justice for Persons with Mental Illness: Improving the Court’s Response 
• Leading Change: Improving the Court and Community’s Response to Mental Health and Co-Occurring Disorders
• Working Well Together: Evidence and tools to enable co-production in mental health commissioning 
• University of Birmingham: Investigating the contribution of the voluntary sector to mental health crisis care in England 

 

Conference Videos

• Care Traffic Control 
• The Evolution of the Recovery Response Center
• Second Crisis Now Global Summit 

Stepping Up Summit 2018: Resources for Implementing Stepping Up

The Third Annual Stepping Up Summit focused on resources to help counties find ways to deal with the challenges of reducing the numbers of people with mental illness in jails.  A featured topic of the summit was crisis centers and crisis continuum of care.  One feature presentation was provided by David Covington, LPC, MBA, Change is Underway: The Core Elements of Crisis Now are changing the way we treat mental health crises.

Download the presentation*

The Crisis Response Continuum Conference

Peg’s Foundation, The Ohio Department of Mental Health and Addiction Services, and Northeast Ohio Medical University sponsored a one-day conference in Columbus on March 21, 2018 for medical and mental health professionals, judges, attorneys and law enforcement who are on the frontline of care for those in a mental health crisis.  The goal of the course was to provide participants with an understanding of:

1. The mental health crisis continuum
2. The role of law enforcement, EMS and mobile crisis services
3. The difference in the roles of law enforcement and mental health mobile crisis teams
4. How a crisis response can traumatize or re-traumatize an individual
5. How an effective crisis response system is a critical component of a community’s suicide prevention efforts

 

Conference Materials

• Conference Description and Agenda*
• Crisis Conference Scrolling Slides*
• Dr. Mark Munetz’s Introduction Slides*
• Ohio Panel: The Role of First Responders Slides*

 

Ohio Resources Related to Crisis Services

• Athens County Crisis Admissions Work Group Program Brief*
• Delaware Police Department Multi-Agency Crisis Intervention Team Program Brief*
• Marysville Fire Division Community Paramedic Program Brief*

 

National Resources Related to Crisis Services

• Crisis Now: Transforming Services is Within Our Reach*, The National Action Alliance for Suicide Prevention created a report outlining recommendations for an effective crisis response continuum
• Crisis Now Excel Spreadsheet*, the spreadsheet is a guide for communities to complete a self-assessment on the current state of their crisis response continuum
• Crisis Now Scoring Tool Programmatic Guide, provides some direction on using the spreadsheet
• National Council Magazine: Crisis to Recovery*
• SAMHSA Crisis Services: Effectiveness, Cost-Effectiveness, and Funding Strategies*
• SAMHSA National Guidelines for Behavioral Health Crisis Care – Best Practice Toolkit: Knowledge Informing Transformation*  

Standard Authorization Form

The Ohio Department of Medicaid (ODM), in collaboration with the Ohio Attorney General’s Task Force on Criminal Justice and Mental Illness Policy and Legislative Subcommittee, and other stakeholders developed a standard authorization form with the goal of improving care coordination for patients, especially those with behavioral health needs who are justice involved.

Under Ohio Revised Code §3798.10, the form will cover the use and disclosure of Protected Health Information (PHI) in alignment with the Health Insurance Portability and Accountability Act (HIPAA) privacy of individually identifiable health information and the confidentially of substance use disorder patient records by a Part 2 program.  ODM has filed the Standard Authorization Rule with an effective date of January 3, 2019.  Ohio health care providers are not required to utilize the form but beginning February 2, 2019, providers will be required to accept the new form.

The Standard Authorization Form Fact Sheet includes links to a fillable Standard Authorization Form and instructions.  Questions about the form can be addressed to StandardAuthForm@medicaid.ohio.gov

National Glimpse

SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation also collects and disseminates information and provides consultation and technical assistance to help communities achieve integrated systems of mental health and substance abuse services for individuals in contact with the justice system. The Center’s primary focus is on expanding access to community based services for adults diagnosed with co-occurring mental illness and substance use disorders at all points of contact with the justice system. To support communities in these efforts, the Center released a web-based resource on jail diversion for serious mentally ill offenders: and in cooperation with the Council of State Governments a Checklist for Implementing Evidence-based Practices and Programs (EBP’s) for Justice Involved Adults with Behavioral Health Disorders.

The Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (AKA “health reform” law), signed into law by President Barack Obama in March 2010 may have a significant impact on how people involved in the criminal justice system can access public health insurance and services. This document addresses the implications of the law for justice-involved adults.

DiPietro, Barbara. Frequently Asked Questions: Implications of the Federal Legislation on Justice Involved Populations. New York Council of State Governments Justice Center 2011.