developmental disability treatment courts: rethinking our approach to those who appear before us in...

DEVELOPMENTAL DEVELOPMENTAL DISABILITY TREATMENT DISABILITY TREATMENT

COURTS:COURTS:

Rethinking our Approach to Rethinking our Approach to those who appear before us in those who appear before us in

Drug CourtsDrug Courts

Traditional Drug CourtsTraditional Drug Courts

-Incorporate the Ten key Components-Incorporate the Ten key Components-Concentrate on Substance Abuse-Concentrate on Substance Abuse-Clear requirements apply to all-Clear requirements apply to all-One set of sanctions and incentives-One set of sanctions and incentives-One definition of success-One definition of success-Emphasis on accountability-Emphasis on accountability

Traditional Mental Health CourtsTraditional Mental Health Courts

-Incorporate Guiding Principles-Incorporate Guiding Principles

-Concentrate on Mental Illness and -Concentrate on Mental Illness and

may include Substance Abusemay include Substance Abuse

-Utilize existing treatment-Utilize existing treatment

-Lower the bar-Lower the bar

-Emphasis on Accountability to Treatment-Emphasis on Accountability to Treatment

The Developmentally Disabled are Routinely Excluded from Participating

in Drug Courts and Mental Health Courts and have very poor outcomes

in “Traditional Courts”

Why Are They Excluded

from Treatment Courts?

• They are misdiagnosed• They cannot understand or follow directions or keep up

with other clients• They are not provided appropriate treatment in the

community or are shuffled from silo to silo • They are “dropped” from treatment because they are not

compliant• They commit serious crimes and continue the behavior

Where Do We Go Wrong?

1. Those found by the Court to meet Definitions in Statutes as “Developmentally Disabled” are either placed in Diversion Programs or Competency Restoration Programs.

2. Those not meeting the strict definitions are ignored and left in the traditional court process without any attention to their special needs.

Our “Traditional Court System and Laws” Keep

Them Out of Drug Courts-• We commit them as incompetent • We commit them as gravely disabled• We commit them as dangerous because

of their disability • We divert them • We conserve them• And the majority are simply punished

Conclusions from Study of Eight States

• Competency statutes and rulings generally result in defendants standing trial despite their impairment

• Hospital Commitments for Treatment do not result in ongoing treatment

• The majority of the mentally incompetent receive no special treatment from the Courts

As to Those we Ignore and Leave in

the Traditional Court System?

Courts find them “too difficult” to work with, and unable to meet probation and other court “requirements”

We utilize state hospitals, jails and prisons to “fix” these offenders and, then, we keep sending them back.

We make every step and every decision an adversarial one, rather than problem solving, and treatment focused

We “decide” these offender’s lives, we do not help them get better.

Mentally Challenged Offenders spend 30% more

time in jails and prisons than other offenders convicted of

the same crimes AND RECEIVE INADEQUATE OR

NO TREATMENT WHILE INCARCERATED !

The Public Perception of these Clients Perpetuates

the Myth that Developmentally Disabled offenders are Dangerous and “Permanently” Flawed

Mental RetardationMental Retardation

It is not as Simple as we make it!

We Are Ignoring What Research and the Reality of

Today Teach Us:1.Beating up and warehousing the

mentally incompetent solves nothing.

2.Excluding them from a Drug Treatment Court opportunity is unacceptable.

3. We must look at clients today as having “multiple diagnosis”

MOST IMPORTANTLY –SINCE THE DEVELOPMENTALLY DISABLED

DO NOT DO WELL IN TRADITIONAL TRATMENT

COURTS, WE MUST BE OPEN TO CREATING A COURT AND

ENVIORNMENT THAT WORKS FOR ALL OF THEM!

If we are going to treat them,who are they?

5 Diagnosable Conditions Qualifying Offenders for State Treatment in

California• 1. Mental retardation• 2. Autism• 3. Severe epilepsy• 4. Cerebral Palsy• 5. Catchall Category: Handicapping conditions

found to be closely related to mental retardation or to require treatment similar to that for a mentally retarded individual, but that are not solely physical in nature, and may or may not include Traumatic Brain Injury

WHO ARE MOST LIKELY TO BE DENIED TREATMENT?

• Miss the cut-off line• Undocumented individuals• African-Americans who were not tested as kids because

it was illegal to give them IQ tests in many states, including California

• Individuals not identified as DD before the age of 18• Persons with no family to talk about adaptive deficits

before age 18 (often the homeless)• TBI after age 18• Individuals from out of state or having no social network

What Leads to Misdiagnosis

• These clients are often initially misdiagnosed as having “Behavioral Problems” and the behavior leads to school expulsion or dropout, entry into the Juvenile Court system, and subsequent adult arrests and incarcerations for inappropriate and illegal “behavior”

Behavior and Vulnerability that Leads to Arrests and Court

Involvement

• Inappropriate and illegal sexual behavior• Uncontrollable anger and physical violence• Destruction of property, vandalism and theft• Vulnerability to gang and anti-social

associations• Drug and alcohol abuse• Easily convinced by others to participate in

crime

What Treatment and Services Do they Need?

• Intense Case management• Job and vocational training• Crisis services• Supported living • Independent life skills training• Caregivers• Substance Abuse Treatment• Mental Health Treatment• Medical Treatment

How do their Co-Occurring Disorders Intersect?

Diagnostic Manual –Intellectual Disability, 2007:

• The prevalence of substance abuse has increased in recent years.

• Mental Illness is common in those who are Developmentally Disabled

• Many have medical conditions that are often undiagnosed.

Why doesn’t Drug Court work for these clients?

1.They need a different Team in and outside of the Courtroom

2. They need more individual attention

3. They require more discussion

4. Other clients treat them as “different”

Why Doesn’t Drug Court work for these Clients?

• Difficulty in ability to understand and apply information and follow directions (Judges expect defendants to understand and follow direction in Drug Court)

• Difficulty in ability to ignore irrelevant information (Judges are not patient with defendants who are fixed on what is important to them)

• Difficulty in ability to learn new information and ability to recall material (Judges expect defendants to “figure it out”)

• Existing sanctions schedules do not work

• If the client qualifies for services, the State rather than the counties are often responsible and provide that treatment through regional centers

• If the State does not provide treatment, existing treatment programs must be found and standards must be changed and specialized to serve the needs of this population

• Environmental and psychosocial issues must be addressed

How is the Team “different”

1. Substance Abuse Treatment that is meaningful for this population

2. Mental Health Treatment and medications

3. Medical Treatment to address multiple diagnosis such as seizure disorder

What Developmental Disability Treatment Does not Provide and the

Drug Court Must Provide:

A A ““NEW SYSTEMNEW SYSTEM”” for Providing for Providing Treatment to the Developmentally Treatment to the Developmentally Disabled Client Must be DevelopedDisabled Client Must be Developed• Mentally Disabled Client = Substance Mentally Disabled Client = Substance Abuse client = Medical patient Abuse client = Medical patient

• Multiple treatment needs must be met!Multiple treatment needs must be met!

• Treatment staff = Treatment staffTreatment staff = Treatment staff

What can a Judge do to reach better outcomes

for offenders with Developmental

Disabilities?

• The Judge must confront the “stigma”.

• The Judge must “engage” the offender.

• The Judge must build trust.

• The Judge must learn new techniques to communicate.

• The Team must be involved in the interaction!

We Must Change Our Expectations!!

• Lower the bar

• Individualize plans and expectations

• The “small steps” are the only ones that are important

• Find appropriate treatment and supervision, or modify existing treatment and supervision to

address the needs and permit “full participation” by the Developmentally Disabled Client