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Better Coordination Brings Improved Discharge Planning for Those Incarcerated with Behavioral Health Needs

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Hannah Huntt & Flannery Peterson

National Council for Behavioral Health

Better Coordination Brings Improved Discharge Planning for Those Incarcerated with Behavioral Health Needs

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Improving the quality of life for justice-involved individuals living with mental illness and substance use disorders (SUD) can start with something as small as a simple conversation. Two organizations in Hennepin County, Minnesota — Hennepin County Community Services (HCCS) and RESOURCE Chemical and Mental Health — can attest to this strategy. As participants in the Health Justice Learning Collaborative (HJLC), an initiative of the National Council for Behavioral Health, HCCS and RESOURCE were able to focus on strengthening the relationship between their two organizations to enhance care coordination and discharge planning for those incarcerated in the Hennepin County jail.

Given that county jails often rely on behavioral health organizations to provide services to inmates, correctional facilities and behavioral health organizations can be instrumental in improving mental health and addictions services for justice-involved individuals.

Working together to succeed

As a part of the HJLC, HCCS’ Criminal Justice Behavioral Health Initiative partnered with RESOURCE to streamline care coordination and enhance access to services for justice-involved individuals. Over the course of nine months, both parties learned that investing time in their partnership was pivotal to improving care coordination.

While HCCS and RESOURCE enjoyed a strong partnership prior to participating in HJLC, as with most relationships, it was not without its challenges. “We were partners for a while, but I think one of our biggest challenges was to pace the process properly. We don’t want to rush in and say this is what we are going to do with no follow through or systems in place. But we also wanted to make changes,” Carrie Salsness, director of access and operations at RESOURCE explained.

With the help of goals developed through the HJLC, HCCS and RESOURCE were able to improve access to care. HCCS streamlined its screening and referral process to keep RESOURCE abreast of the behavioral health needs of justice-involved individuals. This process resulted in warm hand-offs and point-in-time assessments at RESOURCE upon release. Post-incarceration, HCCS will continue to monitor recidivism for individuals referred to RESOURCE. Simultaneously, RESOURCE will deliver a suite of services tailored to the client’s unique needs during and after incarceration.

HCCS and RESOURCE are optimistic about their partnership’s future. Cynthia Arkema-Oharra, associate of criminal justice behavioral health initiatives and chemical health of Hennepin County, says they will continue to “develop a standardized communication method for team members to ensure sustainability of communication and relationships, nurture the relationship through any potential turnover and begin to provide specialized programming.”

Takeaways from the field

Salsness and Arkema-Oharra offer the following advice to other justice and behavioral health partnerships developing around the country:

  • Don’t assume your organization knows about a program or agency you partner with. Take the time to become proficient in your knowledge of the other programs and agencies.
  • Establish a process for ongoing communication so all members are aware of any changes occurring within a system.
  • Accept that change is a process and take the necessary steps to achieve your goals while seeking staff input and gaining buy in.
  • Take the time to allow staff to build relationships for the ongoing partnership.

The National Council wants to offer a big thank you to Hennepin County Community Services and RESOURCE for their time and participation in the Health Justice Learning Collaborative.

©2018 National Council for Behavioral Health. All Rights Reserved.