The treatment readiness pilot serves as a pathway to access treatment and services; aims to reduce recidivism, hospitalization

January 25, 2023

The Multnomah County Department of Community Justice Mental Health Unit recently launched a pilot program aimed at improving access to treatment and other services for people involved in the justice system struggling with behavioral health issues.

The new program, called Treatment Readiness, focuses first on providing stability and then encouraging participants to become involved in treatment and services. At the same time, participants learn the skills that will help them succeed in accessing these services. The pilot program can serve up to 40 participants at a time – with parole and parole officers, case managers, community health specialists, among other county partners.

With limited capacity in Oregon for substance use and behavioral health resources, the County’s pilot program has the potential to serve not only as a pathway for people in the legal system to access community-based treatment and services, but also as a way to decrease the chances that they will have future involvement in the criminal justice system, use hospitals or experience unemployment.

The Multnomah County MHU Mental Health Unit provides supervision for people on probation, probation, and post-prison supervision who also struggle with behavioral health issues. The team works to preserve public safety while reducing recidivism and helping people avoid returning to clinical and therapeutic services.

John McVay, Community Justice Sworn Manager for the Mental Health Unit (MHU), noted that treatment readiness fills a need amid a statewide lack of treatment options for substance use, including care at the residential and treatment for substance use for people whose mental health needs are acute.

“We started the Treatment Preparation Program because in the Mental Health Unit we serve many people who could not start treatment because they were not ready for treatment or because treatment was not available. And one thing that we realized we needed was a way to stabilize people,” McVay said.

The Mental Health Unit can supervise up to 300 people at any one time, many of whom have long waiting times to access treatment. Ambivalence about entering and engaging with treatment is also not uncommon, McVay said. But Treatment Readiness—offered at Multnomah County parole and probation offices—provides a one-stop shop for basic needs, education, and training.

“What we try to do is focus on people’s basic needs like food, shelter, clothing, hygiene, etc.” said McVay. “Because without those things, it’s very difficult to do any kind of programming.”

“We are working to build as much of a single center as possible where we can meet or help people meet their needs in one place. So, for example, we have community health specialists who will drive people to appointments or drive people to resources.”

Participants can receive food, clothing and hygiene material, or simply a place to sleep. The treatment readiness team can help with tasks such as obtaining an ID or with more complex tasks such as helping the participant find housing. The program offers many other services and benefits, including skills training through individual and group activities and long-term case management. Showing participants that the program exists to address these needs helps them develop stable, trusting relationships with probation and parole officers, case managers, treatment providers, community health specialists, and others who are truly invested in their success. .

“A lot of it is about building relationships with people,” McVay said. “One thing we discovered in our outreach work through the Mental Health Unit was that having a stable relationship – or someone they could count on who would always be there to guide them through everything – is really important.”

Treatment Readiness strives to make participation as accessible as possible, waiving strict participation requirements. Participants are referred by the Mental Health Unit or the Multnomah County Mental Health Court.

“We develop goals with them and then work on them to achieve them and break them down into steps and skill development,” McVay said.

“But it’s also a low barrier program. For example, we have people who just want to sleep, and a lot of that is because they’re living homeless and it’s the only safe place they have to sleep. So we will start where people are and work to build skills and the things they need to be successful in programming.”

Juan Cornejo joined the Mental Health Unit as a probation and probation officer in 2021. His role requires ensuring that clients – sometimes more than 40 at any given time – follow supervisory conditions, but also help clients succeed in the community.

“Having something like this makes it a lot easier,” Cornejo said.

“It’s really going a step further and saying that we really want to help our community. We really want to make sure they have access to care, that we address their basic needs. As probation and probation officers, we are trained to provide specific skill sets for clients, but due to the sheer number of cases, it can be challenging to meet this.”

Cornejo described a client who recently had nowhere to go. He wasn’t running away or breaking the conditions of his supervision, but he wasn’t as engaged in the services as he could have been.

“The show has really allowed him to have a place to come every day, in my opinion, where he’s turning a corner. He is starting to share some goals where, for so long, he was unmotivated”, said Cornejo. “So the idea is that he says, ‘OK, I have a place where people will listen to me, where I can share some goals.’ He has been showing up every day. We are currently working on the housing.”

McVay mentioned another client who had very complex medical needs but refused medical attention and also had untreated mental health needs.

Treatment Readiness served as a touchpoint where doctors, the parole office and the correctional health team could come together and really collaborate on working with the client, McVay said.

“Because it was the only place he showed up regularly for his needs,” McVay said. “This is an important example of having a place with relatively low barriers where people can come for their needs.”

It’s an iterative process, McVay said. The program will be sculpted and shaped as it grows over time. For example, cooking and basic nutrition classes being considered for participants living alone in single bedroom units. Portland Street Medicine has also joined the list of providers offering guidance to participants.

“It might take some time,” McVay said, but “generally what we find is that we’ve managed to really get most people involved.”

The treatment readiness pilot serves as a pathway to access treatment and services; aims to reduce recidivism, hospitalization

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