There is an increasing recognition that mental health services provided in jail diversion programs need to be both gender responsive and trauma informed.  In 2002, the Department of Women’s Justice Services began the development of our integrated mental health program with the assistance of SAMSHA’s GAINS Center.  This assistance increased our ability to provide gender specific mental health services that would address the needs of women involved with the criminal justice system.  This consultation facilitated our continued efforts to provide mental health treatment to women in our 3 jail diversion programs, many of who have co-occurring disorders.  Additional assistance from the GAINS Center allowed us to visit several programs, and our staff’s attending Lisa Najavits’ training with her empirically validated curriculum “Seeking Safety”, also sponsored by the GAINS Center, and our integrated mental health program was officially launched.

There are many challenges to implementing a quality mental health program in a jail diversion program.  Lack of funding, system paradigm differences, and the women’s complex problems all were challenges that had to be addressed simultaneously.  While constrained by the criminal justice system, we wanted to promote the individual’s recovery from substances while recognizing that the high rates of Post Traumatic Stress Disorder and other serious mental illnesses impacted a woman’s ability to function and recover.  We established a partnership with Northwestern University’s Feinberg School of Medicine.  We had a series of planning meetings with Haymarket Center staff who provide the substance abuse services in all three of our programs.  These discussions yielded a collaborative perspective and a more integrated treatment program that is trauma informed.

Early on, we recognized the scarcity of resources required creative solutions.  We implemented our mental health services by partnering with several graduate programs in psychology in Chicago.  We became a practicum site for doctoral level clinical psychology students.  Through providing required instruction and weekly supervision to these students, we are able to provide quality services to the women while training the next generation of psychologists who will be better equipped to provide gender-specific mental health services to women.  We currently have 9 graduate students who commit to one year of services.  We accept both diagnostic students and therapy students.  The students provide 20 hours weekly of services and they are considered DWJS Staff.  They interact closely with the substance abuse counselors and a team approach is used for the individual women’s treatment planning.  This process results in a more complete identification of the woman’s treatment needs, both while in our program and upon her release.  We have weekly multi-disciplinary clinical staffings to ensure an integrated approach.  We strive to provide the same quality of services that are found in more traditional psychological settings.  All students, regardless of placement, are trained on the Structured Clinical Interview for Diagnosis (SCID), which is considered by the National Institute of Health (NIH) to be the “gold standard” instrument for clinical diagnosis.  In this manner, we correctly identify the mental health needs of the women and we are better able to provide appropriate trauma informed treatment and community linkages.  The diagnostic students are required to learn to administer and score psychological assessments, which are then utilized to identify the specific needs of individual women.  Therapy students provide short term, problem focused therapy, utilizing cognitive behavioral interventions.  The mental health staff is known as the Safety and Empowerment Team, since both concepts are part of our mental health treatment philosophy.

The mental health staff is formally trained on Najavits’ Seeking Safety curriculum, Covington’s Helping Women Recover and an anger management program.  These are provided both in individual and group format.  When women are released back into the community, we attempt to link them to mental health services and, with the woman’s consent, prepare a treatment summary to better provide a seamless continuity of services.  We make recommendations to the court regarding mental health concerns in an attempt to reflect the challenges that the women are addressing in our programs. 

In the late summer of 2006, DWJS began collaboration with Mt. Sinai Hospital for community mental health treatment.  The DWJS Mental Health Team or Haymarket staff identifies the women and the Mental Health Team conducts a full assessment.  The Mental Health Team prepares copies of the assessments, including the woman’s recent drug drops for Mt. Sinai Staff.  The women are transported by DWJS on Tuesdays.  A more in depth mental health diagnosis and pharmaceutical needs assessment is prepared by a Mt. Sinai psychiatrist.  Further weekly mental health counseling sessions are conducted by a Mt. Sinai Mental Health Professional.  Women also have access to Mt. Sinai health clinics and the pharmacy and laboratory.  Mt. Sinai staff prepares and shares all outcomes stemming from the weekly visits with the DWJS Mental Health Team thereby solidifying a true integrated systems approach.

As of December 2006, DWJS has referred 27 women to the Mt. Sinai case load.  We also have developed a linkage with Dwight Correctional Center, the penitentiary that processes all convicted women in Illinois.  Once discharged from DWJS to IDOC we provide Dwight’s mental health staff with information regarding the women’s level of functioning, risk factors and a summary of services provided.  The Department of Women’s Justice Services (DWJS) comprehensive mental health services include:

• Individual therapy
• Group therapy
• Anger management
• Psychological assessment
• Crisis intervention
• Medication referrals and medication compliance
• Triage to emergency services
• Linkages to community services
• DCFS treatment plan compliance

In 2004, the Department of Women’s Justice Services (DWJS) partnered with Northwestern University  and the Chicago Department of Public Health (CDPH) to provide integrated services for women with co-occurring disorders.  Using pilot data collected during the formative years of our program, Northwestern University was awarded a 2-year grant from the National Institute of Drug Abuse (NIDA) entitled “Providing Integrated Health Treatment for Women Drug Users”.  The grant represents a formal collaboration between DWJS, Northwestern University and the Chicago Department of Public Health.  Using an integrated model, the grant correctly identifies women with co-occurring disorders and provides them with either 4 full days of treatment for 4 weeks or treatment as usual.  Women who are released in the community are interviewed at 1, 3 and 6 month follow up. 

The integrated model of treatment offered by DWJS is yielding positive outcomes.  Specifically: 

• Reduction mental health symptoms
• Reduction in drug use
• Reduction in HIV risk behaviors

We are also examining the impact of this program on recidivism and have begun to follow the women receiving the DWJS Integrated Model at 3, 6, and 9 months in the community.  Preliminary results indicate that the women in the study have statistically significant reductions in depression, anxiety and trauma related symptoms.  By decreasing the severity and frequency of psychological symptoms and by providing the participants with specific coping skills to resist old patterns of behaviors associated with drug use, we expect these changes will interrupt the cycle of drug using, criminal behavior and re-incarceration.

Salina and her colleagues have found very high rates of PTSD, due to multiple traumas, in this population.  The high rate of PTSD in this population has profound implications for future programming and public policy.  We expect to apply these results to improve our ability to provide integrated services to women with multiple-occurring disorders. 

According to the Global Assessment of Functioning, (GAF) scale (Axis V), DWJS participants report a median score of 50.  The GAF is a numeric scale (0 through 100) used by mental health clinicians and doctors to rate the social, occupational and psychological functioning of adults.  A score of 50 indicates serious symptoms or any serious impairment in social or occupational functioning.

 Many of the women who have received the integrated model of treatment have reported that although they have participated in other drug treatment programs, this is the first time that they believe they can actually stay off drugs and make other changes consistent with healthy lifestyles. 

We continue to develop and expand our integrated mental health program.  By using core concepts of collaboration, gender responsiveness and empowerment, we are able to provide better substance abuse and mental health services, which are reflective of the complexities of the women’s lives.  By providing trauma informed services, we believe we are more likely to impact the women in a positive, empowered way. 

All indicators clearly define the DWJS Integrated Model of treatment as an effective working model.  This is no longer theory; it is evidenced based.

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