Veterans Treatment Courts

American Judges Association 2012 Educational Conference-New Orleans

Presented by Judge Robert Russell

OutlineOutline

Who is a Veteran?Who is a Veteran? Who are they?Who are they? Justice-involved VeteransJustice-involved Veterans What is a Drug Court?What is a Drug Court? How is a Veterans Treatment Court How is a Veterans Treatment Court

different?different? Why have a Veterans Treatment Why have a Veterans Treatment

Court?Court?

Veterans: Who are they?Veterans: Who are they?

23.2 million Veterans in the 23.2 million Veterans in the United States United States

5.2 million have served from 5.2 million have served from the Gulf War to presentthe Gulf War to present

2 Million members of the 2 Million members of the armed forces have served in armed forces have served in Iraq and Afghanistan since Iraq and Afghanistan since October 2001October 2001

As of December 31, 2007, As of December 31, 2007, more than 800,000 veterans more than 800,000 veterans of these conflicts were of these conflicts were eligible for VA healthcareeligible for VA healthcare

Reserve and National GuardReserve and National Guard

254,000 Reservists 254,000 Reservists and 332,000 and 332,000 National Guard National Guard members have members have deployed to OEF/OIFdeployed to OEF/OIF

Increased stress on Increased stress on families, families, employment, and employment, and housinghousing

Women VeteransWomen Veterans 1.8 million of today's 1.8 million of today's

Veterans are women (7.5%)Veterans are women (7.5%) 20% of all military personnel 20% of all military personnel

are represented by womenare represented by women 182,000 served in OEF/OIF182,000 served in OEF/OIF 5% of the Veteran homeless 5% of the Veteran homeless

population are womenpopulation are women 4 times more likely to 4 times more likely to

become homeless than male become homeless than male veteransveterans

HomelessnessHomelessness

Over 67,000 Veterans Over 67,000 Veterans will be homeless tonightwill be homeless tonight

Veterans 50% more Veterans 50% more likely to become likely to become homeless than non-homeless than non-VeteransVeterans

76% suffer from a 76% suffer from a substance abuse and/or substance abuse and/or mental health conditionmental health condition

Criminal involvement is Criminal involvement is single best predicator of single best predicator of future homelessnessfuture homelessness

UnemploymentUnemployment

As of Oct 2011, As of Oct 2011, unemployment unemployment rate for Veterans rate for Veterans was 11.5% who was 11.5% who served since served since September 2001September 2001

Rate for 18-24 yr Rate for 18-24 yr old Veterans was old Veterans was 21.9%21.9%

Bureau of Labor Statistics

SuicideSuicide Veterans make-up 1% of the Veterans make-up 1% of the

population, but 20% of population, but 20% of suicidessuicides

Women Veterans are 2-3 Women Veterans are 2-3 times more likely to commit times more likely to commit suicide than non-Veteran suicide than non-Veteran womenwomen

Suicides among active duty Suicides among active duty Army and Marines have Army and Marines have increased following OEF/OIFincreased following OEF/OIF

VA indicates 4 or 5 Veterans VA indicates 4 or 5 Veterans commit suicide each daycommit suicide each day

Traumatic Brain Injury Traumatic Brain Injury (TBI)(TBI) Primary: Resulting from initial trauma Secondary: Resulting from Intracranial

Pressure (ICP), hypoxia, hypotension. In 2010: 31,407 cases of TBI 11,800 troops injured in IED attack 28% of all military evacuated to Walter Reed

AMC = TBI Rapid evac + treatment = 96% survival rate

TBI is not only the result of combat

Post Traumatic Stress Disorder Post Traumatic Stress Disorder (PTSD)(PTSD)

Exposure to traumatic event in which both of following present:

(1) Person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.

(2) Person’s response involved intense fear, helplessness, or horror.

How common is PTSD among How common is PTSD among Veterans?Veterans?

VietnamVietnam – 15% men/8% women – 15% men/8% women (31%/27% est. lifetime prevalence)(31%/27% est. lifetime prevalence)

Desert Storm Desert Storm – 10%– 10% Operations Enduring Freedom & Iraqi Operations Enduring Freedom & Iraqi

Freedom (OEF/OIF)Freedom (OEF/OIF) – 14% – 14% – Est. 300,000 suffering from PTSD or major Est. 300,000 suffering from PTSD or major

depression (2010)depression (2010) Repeated deployments Repeated deployments increaseincrease

the likelihood of PTSDthe likelihood of PTSD

Combat Experience Combat Experience (OEF/OIF)(OEF/OIF) 78%78% Received incoming artillery, rocket or Received incoming artillery, rocket or

mortar firemortar fire 72%72% Knew someone seriously injured or killedKnew someone seriously injured or killed 60%60% Saw dead bodies or human remainsSaw dead bodies or human remains 58%58% Received small arms fireReceived small arms fire 56%56% Had a member of their unit become a Had a member of their unit become a

casualtycasualty 49%49% Saw dead or seriously injured AmericansSaw dead or seriously injured Americans 33%33% Handled or uncovered human remainsHandled or uncovered human remains

Military Sexual TraumaMilitary Sexual Trauma(MST)(MST)

Both sexual Both sexual harassment and harassment and sexual assault that sexual assault that occurs in military occurs in military settingssettings

60% of women with 60% of women with Military Sexual Military Sexual Trauma also Trauma also suffered from PTSDsuffered from PTSD

VA Screening, 2002-2008

Substance AbuseSubstance Abuse

Among active duty service members:Among active duty service members:

Heavy drinking (five or more drinks per Heavy drinking (five or more drinks per occasion at least once a week) self-occasion at least once a week) self-reported at 20%. reported at 20%. – Heavy drinking is higher among 18 to 34 Heavy drinking is higher among 18 to 34

age group than civilians. age group than civilians.

Prescription drug misuse Prescription drug misuse doubleddoubled from from 2005 to 2008 ( 5% in 2005 to 12% in 2005 to 2008 ( 5% in 2005 to 12% in 2008)2008)

Dept of Defense Behavioral Health Survey - 2008

Justice-involved VeteransJustice-involved Veterans

Less likely to be arrested or incarcerated Less likely to be arrested or incarcerated Average 10% of criminal justice Average 10% of criminal justice

populationpopulation Approx 80% with Honorable/General Approx 80% with Honorable/General

dischargedischarge 57% violent offenders compared to 47% 57% violent offenders compared to 47%

of non-Veteransof non-Veterans Reported longer sentences for all crime Reported longer sentences for all crime

types. -types. -On average, Veterans are expected to serve On average, Veterans are expected to serve 22 months longer than non-veterans22 months longer than non-veteransBureau of Justice Statistics - 2004

Justice-involved Veterans

61% of Veterans in State prison meet the criteria 61% of Veterans in State prison meet the criteria for substance dependence or abuse (57% of for substance dependence or abuse (57% of Federal prison veterans) Federal prison veterans)

54% of Veterans in State prison met one of two 54% of Veterans in State prison met one of two criteria for a recent mental health problemcriteria for a recent mental health problem

Veterans in State prison (45%) and Federal prison Veterans in State prison (45%) and Federal prison (35%) reported symptoms of mental health (35%) reported symptoms of mental health disorders in the past 12 monthsdisorders in the past 12 months

Veterans are more likely to report recent history Veterans are more likely to report recent history of mental health servicesof mental health services

Experienced physical abuse: 18%Experienced physical abuse: 18% Experienced sexual abuse: 7%Experienced sexual abuse: 7%

What is a Drug Court?What is a Drug Court?

Judicially-supervised docket that Judicially-supervised docket that provides defendants/clients with provides defendants/clients with intensive treatment and other intensive treatment and other services while holding them services while holding them

accountable to the court, society, accountable to the court, society, their families and themselvestheir families and themselves

Judge, Prosecution, Defense, Probation, Judge, Prosecution, Defense, Probation, Law Enforcement, Treatment, using a Law Enforcement, Treatment, using a non-adversarial, team approachnon-adversarial, team approach

Regular court appearancesRegular court appearances Frequent and random drug tests Frequent and random drug tests Immediately rewards positive behavior, Immediately rewards positive behavior,

sanctions negativesanctions negative

What is a Drug Court?What is a Drug Court?

Drug CourtsDrug Courts

1989 – 11989 – 1stst Drug Court formed in Drug Court formed in Miami, FL Miami, FL

2011 – 2,569 Drug Courts in the 2011 – 2,569 Drug Courts in the United StatesUnited States

Drug Courts Work!Drug Courts Work!– Reduce crimeReduce crime– Lower costsLower costs– Ensure complianceEnsure compliance

Reduce CrimeReduce Crime

75% of Drug Court clients 75% of Drug Court clients remain arrest-free at least remain arrest-free at least 2 years after graduation.2 years after graduation.

Reductions in crime last at Reductions in crime last at least 3 years and can least 3 years and can endure for over 14 years.endure for over 14 years.

Drug Courts reduce crime Drug Courts reduce crime as much as 35% more than as much as 35% more than other sentencing options.other sentencing options.

Save MoneySave Money

Up to $3.36 in criminal justice costs for Up to $3.36 in criminal justice costs for every $1.00 invested.every $1.00 invested.

Up to $12 for every $1 invested, when Up to $12 for every $1 invested, when including other cost offsets (i.e., including other cost offsets (i.e., reduced victimization and healthcare reduced victimization and healthcare service utilization.service utilization.

Between $4,000 to $12,000 in Annual Between $4,000 to $12,000 in Annual costs per participant.costs per participant.

Ensure ComplianceEnsure Compliance

Provide more Provide more comprehensive and comprehensive and closer supervision than closer supervision than other community-based other community-based supervision programs.supervision programs.

6 times more likely to 6 times more likely to keep offenders in keep offenders in treatment long enough treatment long enough for them to get better.for them to get better.

Veterans have challenges, Veterans have challenges, but why have a separate but why have a separate

treatment court for them?treatment court for them?

Hybrid Drug and Mental Hybrid Drug and Mental Health Treatment Courts Health Treatment Courts using the Drug Court Model. using the Drug Court Model. Principals of both Drug & Principals of both Drug & Mental Health CourtsMental Health Courts

Addition of U.S. Dept of Addition of U.S. Dept of Veterans Affairs Veterans Affairs representatives, state and representatives, state and local agencies, and local agencies, and volunteer Veteran mentors.volunteer Veteran mentors.

Target those who have Target those who have served in the U.S. Armed served in the U.S. Armed Forces.Forces.

Jan 08 – First opened in Jan 08 – First opened in Buffalo, NY.Buffalo, NY.

May 11 – Approx 100 VTCs, May 11 – Approx 100 VTCs, many are being planned.many are being planned.

Veterans Treatment Veterans Treatment CourtsCourts

Veteran-specificVeteran-specificBenefits and ServicesBenefits and Services

U.S. Department of Veterans Affairs (VA)U.S. Department of Veterans Affairs (VA) Veterans Health Administration (VHA)Veterans Health Administration (VHA) Veterans Benefits Administration (VBA)Veterans Benefits Administration (VBA)

Department of Housing and Urban Department of Housing and Urban Development (HUD)Development (HUD)

Department of Labor (DOL)Department of Labor (DOL) State/County agenciesState/County agencies Veteran Service OrganizationsVeteran Service Organizations Pro Bono Legal AssistancePro Bono Legal Assistance

Veterans Affairs (VA) Veterans Affairs (VA)

MedicalMedical Substance Abuse Substance Abuse Mental Health (to include PTSD)Mental Health (to include PTSD)

Homeless ServicesHomeless Services Employment and Vocational Employment and Vocational

TrainingTraining EducationEducation Pension and Disability PaymentsPension and Disability Payments

Veterans JusticeVeterans JusticeOutreach (VJO) ProgramOutreach (VJO) Program Outreach, assessment, Outreach, assessment,

case management for case management for justice-involved justice-involved Veterans in local courts Veterans in local courts and jailsand jails Veteran identificationVeteran identification Assistance in eligibility Assistance in eligibility

and enrollmentand enrollment Continued monitoring Continued monitoring

and consultationand consultation Hand-off to VA and Hand-off to VA and

community service community service providersproviders

VTC Mentor/Peer VTC Mentor/Peer ProgramsPrograms Volunteers with prior or current military Volunteers with prior or current military

serviceservice Help Veterans navigate the Court, VA, and Help Veterans navigate the Court, VA, and

treatment systemstreatment systems Assess “other needs” and Assess “other needs” and

help adjust to civilian lifehelp adjust to civilian life Help the Veteran and Help the Veteran and

Veteran’s family receive Veteran’s family receive the services they need to the services they need to be productive members of societybe productive members of society

Military CulturalMilitary Cultural

Veterans are used to:Veterans are used to: StructureStructure LeadershipLeadership LoyaltyLoyalty PatriotismPatriotism CamaraderieCamaraderie Teamwork & Self-relianceTeamwork & Self-reliance

The 10 Key Components of Veteran’s Treatment Court

Veterans Treatment Courts have adopted with slight modifications the essential tenements of the Ten Key Components as described in the U.S. Department of Justice Publication entitled “Defining Drug Courts: The Ten Key Components”, (Jan. 1997).

Key Component # 1

Integrates alcohol, drug treatment,

mental health treatment, medical

services with justice system case

processing

Key Component # 2

Using a non-adversarial approach,

prosecution and defense promote

public safety while protecting

participants' due process rights

To facilitate the veterans’ progress in treatment, the prosecutor and defense counsel shed their traditional adversarial courtroom relationship and work together as a team.

Key Component # 3

Eligible participants are identified

early and promptly placed

Early identification of veterans entering the criminal justice system is an integral part of the process for placement in the Veterans Treatment Court program.

The trauma of arrest can be an opportunity for the veteran to address denial issues.

Key Component # 4

Access to a continuum of alcohol,

drug, mental health and

rehabilitation services

Participants in Veterans Treatment Court may have different levels of need in a wide variety of service domains.

Issues such as PTSD, TBI, Domestic Violence and homelessness may need to be assessed and addressed.

Mentors

Key Component # 5

Abstinence is monitored by frequent

alcohol and drug testing

Court ordered drug testing

Frequent

Random

Use of results

Drug Testing

Key Component # 6

Coordinated strategy governs Court’s

responses to participants' compliance

Incentives and Sanctions

Coordinated strategy establishes protocols for rewarding progress as well as sanctioning non-compliance.

Key Component # 7

Ongoing judicial interaction with each

Veteran is essential

Judge as leader of the team.

Continuity of relationship between judge and veteran

Relationship from acceptance in program throughout treatment and commencement and aftercare

The message is “Someone in authority cares”

Key Component # 8

Monitoring and evaluation measure the

achievement of program goals and

gauge effectiveness

Program Monitoring

Measures progress against goals

Results are used to monitor progress

Results are used to improve operations

Key Component # 9

Continuing interdisciplinary education

promotes effective Court planning,

implementation, and operations

All Veterans Treatment Court staff should be involved in interdisciplinary education and training.

Shared interdisciplinary training creates common knowledge and understanding.

Key Component # 10

Forging partnerships among the

Veterans Administration, public

agencies, and community-based

organizations generates local support

and enhances Court effectiveness

QuestionsQuestions??