Assess, Plan, Identify, Coordinate (APIC) participants are eligible adult offenders releasing to the communities of Anchorage, Juneau, Fairbanks, and Mat-Su from Department of Corrections (DOC) facilities. APIC provides re-entry planning and transitional services to mentally ill and mentally disabled incarcerated offenders to reduce recidivism and increase successful reentry into the community upon release.

The goal is to connect offenders with community-based services prior to release from DOC custody in an effort to reduce recidivism and increase successful reentry. All APIC referrals are released from custody with a transitional treatment plan. Treatment plans can range from very complex and involved to simple with limited options. The program strives to provide the best possible transitional treatment plan for all APIC participants.

We measure how much we are doing by tracking the number of beneficiaries served by APIC.

Background

The President’s New Freedom Commission on Mental Health Subcommittee on Criminal Justice (2004) reported that mental illness is common among individuals involved with the criminal justice system. The rate of serious mental illness is about three to four times that of the general population. Nationally, the subcommittee estimated that about 910,000 people with serious mental illness are incarcerated each year. About 93,000 individuals with mental illness are incarcerated on any given day. By contrast, there are only about 40,000 patients on a given day in state mental hospitals.

People with serious mental illnesses who are involved with the criminal justice system are typically poor, uninsured, members of minority groups, and often homeless. Approximately 70 to 90 percentof offenders with a serious mental illness also have a co-occurring substance abuse disorder. They cycle in and out of homeless shelters, hospitals, and jails, occasionally receiving mental health and/or substance abuse services, but often receiving no services at all. The majority has committed misdemeanor crimes.

A Trust-funded study by Hornby Zeller Associates (HZA) revealed similar findings in Alaska. On June 30, 2012, almost two-thirds of the offender population in Alaska Department of Corrections was identified as having a mental health, substance abuse or cognitive impairment problem.

Department of Corrections Assess, Plan, Identify, and Coordinate (APIC) Program

In 2007, the Alaska Department of Corrections, with funding from the Alaska Mental Health Trust Authority, initiated the APIC (Access, Plan, Identify, Coordinate) re-entry model for offenders with mental illness and co-occurring disorders. APIC is a national best practice re-entry strategy described in the President’s New Freedom Commission on Mental Health, Sub-committee on Criminal Justice, 2004.

APIC’s purpose is to reduce legal recidivism and increase successful re-entry into the community by providing funds fortransitional planning and community services for Trust beneficiaries through contracts with community behavioral health agencies. Services can begin up to 90 days before release and continue up to 60 days after release from ADOC custody.

Positive environmental factors that may be influencing program outcomes

• There is increased recognition that prisoner reentry and recidivism is not solely an ADOC problem; it is a community problem. This change in the prevailing culture resulted in increased collaboration between ADOC, community and other governmental partners, who are working together to improve mental health programming and services for individuals with co-occurring disorders.
• Continuity of psychotropic medications from jail to the community is critical for success and has significantly improved in large part due to the Division of Behavioral Health Individual Service Account (ISA) funds’ ability to pay for medications, and on a pre-approved basis, for APIC to pay for medications when ISA funds are not available.
• APIC links eligible participants with benefits and entitlements. Because inmates are not Medicaid eligible, APIC is a valuable funding source for community behavioral health providers to initiate services prior to release from jail.APIC funding pays for (non-Medicaid billable) treatment services up to 90 days before release and up to 60 days after release (or longer on a pre-approved basis).
• All of the APIC community behavioral health providers prioritize services to individuals releasing from Department of Corrections.
• Some agencies dedicate staff to complete applications for Social Security through SOAR (SSI/SSDI Outreach, Access, and Recovery), Adult Public Assistance and Medicaid, freeing APIC funds and promoting continued service delivery to participants.

Challenges in the environment that may influence program outcomes

• In comparison to national APIC projects, which focus on sentenced felony offenders, the Alaska APIC initiative works with sentenced and unsentenced felony and misdemeanor offenders. Misdemeanor offenders comprise approximately 70 to 80 percent of the DOC prison population. Prisoners are released by the court, through the legal system, which does not require consideration of the conditions they will face outside of incarceration. Consequently, program staff and providers are challenged by the fast pace of incarcerations and notifications of release.
• Workforce shortages impact the effectiveness and service delivery of the APIC program by community behavioral health providers.
• Many community providers are at capacity for responding to crisis situations, and services have been reduced or eliminated in an effort to manage high caseloads.
• DOC clients can be behaviorally complex, with a severe mental illness and/or an intellectual developmental disability (IDD). Obtaining an IDD waiver and services for this population is very challenging and lengthy process.
• Lack of transitional housing and assisted living facilities in communities outside of Anchorage result in offenders moving to Anchorage for services regardless of their home based community supports and engagement in APIC services.
• Lack of a statewide intergrated electronic health record database in the Alaska Department of Corrections.

Collecting data is a complex and evolving process

• Some of the APIC Trust performance measures require data that is not generated by DOC, but rather by the APIC contract providers. APIC staff does not have direct access to contract provider’s data management systems, such as Alaska Automated Information Management System (AKAIMS) or other community behavioral health provider databases. Data collected by APIC contract providers inherently contain various reporting interpretations and discrepancies, which results in program data not being as consistent, comprehensive, or accurate as desired.
• Data collection is challenging for APIC staff. Currently, data is collected by the program staff and entered into an Excel spreadsheet, which is manually analyzed for the Trust reports. In FY13, DOC Medical will began the process of designing an Electronic Health Record (EHR) with the plan to implement the electronic database in FY14. At the present time, the APIC program is not sufficiently included in the EHR. However, ADOC is working toward obtaining funding to include mental health institutional and release programs in the electronic database. One of the options for the EHR Mental Health component is the ability to interface with existing and developing programs such as the Division of Behavioral Health (DBH) ECourts and AKAIMS; the Alaska Court System Court View; and the Alaska Public Safety Information Network (APSIN). This option would require formal agreements with other departments, and program and interface challenges, plus, additional funding.
• APIC staff has been working above capacity. If an APIC component is included in EHR, it will be time consuming for staff to assist in developing, transitioning, and implementing the new program. To mitigate the increased workload, another APIC Mental Health Clinician position was funded by the Legislature for FY13 and it is hoped that a PCN will be approved to fill the position.

Alaska Coalition on Housing and Homelessness

Alaska Native Corporations

Alaska Native Justice Center

Alaska Native Tribal Health Consortium

Anchorage Police Department

Alaska Community Behavioral Health Providers

APIC Contract Community Behavioral Health Providers

• Anchorage Community Mental Health Services (ACMHS)
• The Arc of Anchorage (Arc)
• Assets, Inc. (Assets)
• Fairbanks Community Behavioral Health Center (FCBHC)
• Hope Community Resources, Inc. (Hope)
• Juneau Alliance for Mental Health, Inc. (JAMHI)
• Mat-Su Health Services (MSHS)

Social Security Administration

State of Alaska

• Alaska Court System
• Alaska Housing Finance Corporation
• Alaska Mental Health Trust Authority Advisory Boards
  • Advisory Board on Alcoholism and Drug Abuse
  • Alaska Mental Health Board
  • Governor’s Council on Disabilities and Special Education
  • Alaska Commission on Aging

• Department of Administration - Office of Public Advocacy
• Department of Corrections
• Department of Health and Social Service
• Department of Labor - Division of Vocational Rehabilitation
• Department of Law
• Legislature

Future Partners

Faith-based Organizations

Former offenders

Community Behavioral Health Providers in other areas statewide

The New Freedom Commission on Mental Health Subcommittee on Criminal Justice: Background Paper (2004) identified a range of effective interventions for offenders with mental illness

• Diversion programs to keep people with serious mental illnesses who do not need to be in the criminal justice system out of it.
• Institutional services to provide constitutionally adequate services in correctional facilities for people with serious mental illnesses who do need to be the criminal justice system because of the severity of the crime.
• Reentry transition programs to link people with serious mental illnesses to community-based services when they are discharged.

The APIC model addresses the third type of effective intervention: reentry transition programs. The Substance Abuse and Mental Health Services Administration (SAMHSA) GAINS¹ Center for Behavioral Health and Justice Transformation promotes the APIC model. Osher, Steadman, and Barr (2002) propose that there are four critical steps that if implemented are likely to improve the outcomes for persons with co-occurring disorders when transitioning from jail back to the community. The four steps of the model are:

• Assess the inmate’s clinical and social needs, and public safety risks
• Plan for the treatment and services required to address the inmate’s needs
• Identify required community and correctional programs responsible for post-release services
• Coordinate the transition plan to ensure implementation and avoid gaps in care with community-based services

¹GAINS is the acronym for gathering information, assessing what works, interpreting the facts, networking with key stakeholders, and stimulating change.

The Disability Justice focus area proposes to:

·Institutionalize and expand APIC services statewide (EB)

·Continue participation in Statewide Reentry Taskforce (LC/NC)