Name of Innovative Program:
The Eleventh Judicial Criminal Mental Health Project
The South Florida Behavioral Health Network
Name of Innovative Program Lead:
Cindy A. Schwartz, MS, MBA
E-mail Address of Innovative Program Lead:
The Eleventh Judicial Circuit Criminal Mental Health Program (CMHP) - Entitlement Unit in Miami, Florida, developed an innovative plan to transition individuals identified with serious mental illnesses and co-occurring substance use disorders from the jail to the community. The majority of individuals served were indigent and not receiving entitlement benefits upon re-entry to the community from jail. As a result, many did not have the necessary resources to access adequate housing, treatment, or support services in the community. Program participants who are eligible to apply for Social Security benefits are now provided with assistance utilizing a best practice model referred to as SOAR (SSI/SSDI, Outreach, Access and Recovery). This approach was originally developed as a federal technical assistance initiative to expedite access to social security benefits for individuals with mental illnesses who were homeless. The immediate gains of obtaining SSI and/or SSDI are clear: it provides a steady income and health care coverage which enables individuals to access basic needs including housing, food, medical care, and psychiatric treatment. The project has helped to maximize limited funding as well as reduce recidivism to the criminal justice system, prevents homelessness, and is an essential element in the process of recovery.
Creativity and Innovation:
Stakeholders in the criminal justice and behavioral health communities consistently identify lack of access to entitlement benefits and Medicaid as among the most significant and persistent barriers to successful community re-integration and recovery for individuals who experience serious mental illnesses and co-occurring substance use disorders. Medicaid eligibility that results from approval of SSI will help agencies to expand their capacity to serve people with the most complex needs. Agencies may recoup reimbursement for treatment and services incurred prior to SSI approval. Medicaid will pay for 90 days of retroactive bills once an individual is approved. This provides an incentive for treatment providers to ensure access to the necessary treatment and services upon community re-entry. It also serves to reduce the stigma of these individuals with mental illnesses that are involved in the criminal justice system and craft them into “more attractive paying customers”.
Leadership is essential to the success of the CMHP- Entitlement Unit and depends upon cross-system collaboration. In order to achieve successful outcomes, communication and training with community partners is a continuous process. Strong relationships have been developed with local representatives from the Social Security Administration and the Division of Disability Determination as well as stakeholders in the criminal justice and behavioral health system. The CMHP-Entitlement unit has been recognized by the SOAR Technical Assistance Center funded by SAMHSA as a best practice (January 2013) for Increasing Access to SSI/SSDI upon Exiting Criminal Justice Settings. The Florida Department of Children and Families, also recognizes the program as a model of excellence for SOAR, and refers other communities for information on implementation and training. Program staffs are SOAR trainers that have promoted this approach as a tool in recovery and serve as experts to the entire community.
Miami-Dade County was awarded funding from the State of Florida to develop the Entitlement Unit July, 2011. The program has demonstrated outstanding success and has expanded its target population to include individuals identified with severe mental illnesses and co-occurring disorders referred by the Public Defender and State Attorney Office as well as referrals from residential treatment facilities that serve forensic clients. It is estimated that this initiative leverages the equivalent of more than $33,500 annually in state funded treatment and support services for each individual served. To date, access to more than $5.9 million annually in state funded equivalent services have been secured for the 177 individuals approved for benefits. Due to this tremendous success, the program will be sustained by the South Florida Behavioral Health Network, the local managing entity for state funded mental health and substance abuse programs upon the completion of the grant, February 2014.
The CMHP- Entitlement Unit employs three full time entitlement specialists that have exclusive responsibility for assisting individuals with applying for benefits. Before the implementation of the program, case managers were charged with this task and the time spent completing applications directly competed with time available to assist program participants with linkages to treatment and support services. Entitlement Specialists must be able to engage and assess applicants as well as serve as boundary spanners across multiple systems. Each entitlement specialist is provided with the standardized SOAR training that was developed by the SOAR Technical Assistance Center, funded by SAMHSA. The training provides the necessary information for compiling a successful application. They also receive ongoing supervision including quality review. In addition, there are two part-time peer specialists that provide support and assist with accessing community services. The unit can be successfully duplicated and adapted by other communities across the country.
Program data indicates 94% approval rate within 28 days. Individuals served under this program are more than two and a half times more likely to be approved in just one tenth the time, compared to traditional approaches for applying for entitlement benefits which on average result in approval rates of just 37% within 9 to 12 months. Furthermore, while waiting for benefits to be approved individuals served by this program require as little as one-sixth as much state funded assistance for forensic and incidental services as compared to individuals applying for benefits in the traditional manner. This has generated significant savings and maximized the use of state funds. It has also allowed more individuals re-entering the community from the criminal justice system to receive services that support recovery and decrease the likelihood of recidivism, while ensuring access to long-term economic resources that support community integration and recovery.