Agencies in the state should develop policies to standardize and increase access to telehealth services for behavioral health treatment for those individuals on community supervision within the criminal justice system. This recommendation includes several propositions directed to multiple agencies to revise practice standards. These standards should address such topics as Competency of the Provider, Ethical Considerations in Standards of Care, Informed Consent, Diversity and Inclusivity Considerations, Confidentiality of Data & Information, Security & Transmission of Data & Information, Participant Guidelines and Criteria, and Telehealth Treatment Decision Making.

Amend §16-11-205, §16-11-209, §16-11-2?? (new section), §16-11.5-101, §16-11.5-102(1)(c), §16-11.5-105, §18-1.3-102, and any other required conforming revisions to statute to reflect contemporary best practice guidelines that serve people on probation and deferred sentences, especially those diagnosed and/or dealing with substance use disorders. Such practices provide corresponding systems that include a range of individualized and structured behavioral responses to substance use and other behaviors that violate typical conditions of probation. This recommendation specifically prioritizes modern methods of rehabilitative and reparative justice that align with the statutory purposes of probation (included in CCJJ Recommendation FY22-SR #01. Define the Purposes of Probation) rather than the finite and limited responses in current statute that reflect retributive, punitive, and deterrent-based justice methods.

[See the "Recommendation Text" for the Proposed Statutory Language.]

Fund public health interventions that strengthen community resources and expand alternatives to filing criminal charges against adults and youth with substance use issues who are at risk of justice involvement. By aspiring to a public health approach — which redirects adults and youth with substance abuse issues engaging in behaviors that can lead to incurring criminal charges from the justice system entirely — this recommendation shifts priorities in funding upstream, supporting the still inadequate system for care coordination and treatment. Recognizing that funding diversion programs that are post-arrest continues to inadvertently reinforce the justice system as the point of intervention for many adults and youth with substance use disorder treatment needs, notwithstanding potential for co-occurring mental health needs, true alternatives are still needed to avoid the justice system operating as a healthcare system of intervention and care.

 

To facilitate this approach, implement the following:

- Priority #1: Provide funding and improve access to coordinated treatment provider and care coordination systems so that adults, youth and families can access services, interventions, supports, and treatment modalities within their community, leading to a decrease in call volume for first responders and reliance on the justice system as a point of intervention and to improved community wellness.

- Priority #2: Continue to improve training and to enhance service provider collaboration with law enforcement including but not limited to expanding co-responder and law enforcement diversion programs and deflection models that also include the critical component of care coordination, treatment when and where necessary and community engagement. Without community supported and appropriately funded alternative case management and treatment options, first responders will continue to be left without options that match the complexity of needed care.  

- Priority #3: Continue to increase post-arrest diversion opportunities to create multiple "off-ramps" from criminal and juvenile justice system entanglement and prioritize programs using a harm-reduction approach to address the underlying needs of individuals, the community, and victims.

Implement and require participation by public safety and public health personnel in the Overdose Detection Mapping Application Program (ODMAP) in Colorado. The Washington/Baltimore High Intensity Drug Trafficking Area's ODMAP is an emergency medical service tracking and reporting system. To facilitate expeditious public health and law enforcement responses to save lives in Colorado, the following entities should be required to implement and participate in this program:

 

- The statewide ODMAP implementation will require coordination and leadership. The Dangerous Drugs Coordination Council (created in Recommendation FY20-OP #01) will be responsible for directing the implementation of ODMAP, including outreach to rural agencies, and facilitating statewide participation.

- Emergency Medical Services (EMS), Coroners, Law Enforcement & Emergency Departments (ERs)

 

[No Proposed Statutory Language was prepared for this statutory provision.]

This recommendation creates pilot options to provide quality care for individuals held in jail who have acute behavioral health needs that are beyond the ability of the jail to manage and who do not meet criteria for diversion with the goals to develop information and experience necessary to advance a state-wide solution. This recommendation proposes the following:

- A care transitions partnership between local and regional acute care hospitals and county jails that provides quality care for jailed individuals who have acute behavioral health needs that are beyond the ability of the jail to manage.

- The target patient population includes those who are not eligible for diversion programs due to the serious nature of the criminal charge and whose behavioral health needs surpass the capacity of the jail to manage with existing in-house medical and/or mental health service providers.

- This partnership allows for the transfer of jailed individuals to acute care facilities for provision of appropriate services and is modeled after, and expands upon, the existing partnerships and transfer protocols for individuals experiencing a medical crisis while being held in jail.

- To support the development of initial pilot sites and to allow for one-time building modifications or other required changes, it is anticipated that additional state funds will need to be allocated to pilot this solution in one rural region and one urban region.

This recommendation proposes the development of pilot programs for pre-file mental health diversion in judicial districts where the option or resources for the option may be lacking. The pilot will:

- Develop post-arrest, pre-file diversion programs specifically for individuals experiencing mental health disorders and who meet specific criteria and are determined able to benefit from diversion to treatment rather than being processed through the criminal justice system.

- Create pre-file mental health diversion programs that utilize a stakeholder-created, reviewed, and approved model [A proposed model may be found in Appendix A at the "Recommendation Text" link to the full recommendation.].

In addition, local officials should promote the utilization of Adult Pretrial Diversion Programs and funding as created by §18-1.3-101, C.R.S.

Position the Colorado Crisis Services System as the comprehensive response to behavioral health emergencies in all Colorado communities by making the following reforms: a) Strengthen and enhance existing crisis services and resources; b) Amend §27-60-103 to clarify the intent of the crisis system; c) Undertake conforming regulatory changes to crisis system contracting; and d) Commit resources to incentivize the development and expansion of the crisis services provider network.

Amend Title 27 of Colorado Revised Statutes (C.R.S), section 65-105, to remove jails and correctional facilities as a placement option for individuals on an M1 (emergency mental health) hold. Introduce language that allows intervening professionals to transport individuals to an outpatient facility for immediate evaluation for treatment based on evidence of need.

Request that the Department evaluate the feasibility of allowing defendants sentenced to prison with a relatively short sentence who need substance abuse treatment to serve their prison sentence in the county jail if the jail can provide the appropriate level of substance abuse treatment.  The Sheriff and the DOC would need to both agree to a defendant serving his/her prison sentence in jail. DOC would be responsible to pay for the cost of incarceration at the jail per diem set by the legislature.  

Encourage the General Assembly to provide funding to the DOC to develop or expand an intensive residential treatment program for inmates who have relatively short sentences who are assessed to need that level of treatment.

Allow for expansion of civil remedies (e.g. consumer protection and/or use of public health regulatory authority) as part of building more comprehensive drug policy. Areas related to this proposal include strategies to prevent and effectively intervene in prescription drug abuse/misuse and adopting medical models for detoxification programs.

If there are projected cost-savings from legislation reforming the Colorado Controlled Substances Act, the Drug Policy Task Force recommends that the General Assembly prioritize expanding access to trauma-informed treatment services for people with a substance abuse disorder to the extent that is appropriate and available.

Consolidate the Drug Offender Surcharge Cash Fund (to include the H.B.1352 general fund appropriation) and the Drug Treatment Fund (created in S.B.03-318) into a single fund (Correctional Treatment Cash Fund). In addition, consolidate the three oversight bodies into a single decision making body.

Support funding an enhanced per diem differential ($33.02) for community corrections programs that house sex offenders and that applies to specialized programming for Diversion, Transition, Condition of Probation and Condition of Parole clients.

Support funding for the Division of Parole in the Department of Corrections to negotiate an increase in the number of beds in Community Corrections agencies and programs to house condition of parole sex offenders for residential sex offender treatment.

Increase treatment resources at DOC.

The criminal justice committee of the state's Behavioral Health Transformation Council should meet with the appropriate stakeholders to develop a plan to (a) streamline and coordinate existing funding mechanisms related to offender treatment and (b) expand data collection and reporting.

Implement a standardized mental illness screening instrument as part of the presentence investigation or, if none was completed, at post-sentence probation intake.

The commission supports the efforts of the Department of Health Care Policy and Financing (HCPF) to prioritize early health care interventions and the alignment of resources to increase the efficiency of service delivery and patient access to services.

Consolidate and streamline funding for the Division of Behavioral Health.

Use the Commission's Evidence-based Practices Training Initiative (EPIC) as a vehicle to educate criminal justice professionals in effective behavioral health assessment and treatment.

The criminal justice committee of the Behavioral Health Transformation Council should discuss and identify potential strategies to expand access to Medicaid for community corrections clients.

Any fiscal savings realized through the implementation of effective reforms shall be reallocated for the purpose of developing and sustaining viable, evidence-based substance abuse treatment programs related to DUI and associated behavioral health problems.

The court shall order treatment from a Department of Human Services approved provider pursuant to an alcohol/drug evaluation. If treatment is commenced during a period of incarceration such treatment shall be credited toward the treatment required as a condition of probation.

Substance abuse treatment provided while incarcerated must be accepted by private sector providers during post-release treatment. This means that any treatment module completed or treatment level attained by the offender while incarcerated shall not be required to be repeated once released.*

Identify a working group to develop funding strategies.

Community-based treatment should be expedited for alcohol and drug-involved defendants.

As part of the contract award process, the Department of Corrections will give preference to private service vendors (for example, for treatment, drug tests, etc.) who provide extended hours of operation during the week and/or weekend hours. The Department of Corrections can waive this requirement for vendors in under-served areas of the state, or for those providers for whom this requirement would prevent the delivery of services.

Provide resources to evaluate the assessment practices and program delivery of community-based and institutional treatment providers.

The state should invest in community-based, evidence-based mental health and substance abuse treatment for all citizens to prevent the need for incarceration, and to provide such treatment as an alternative to incarceration where appropriate.

The General Assembly must substantially increase state funding for evidence-based and promising practices in substance abuse and mental health treatment.

The Commission supports the current work by the Interagency Committee on Adult and Juvenile Correctional Treatment and its study of the reliability and validity of the Standardized Offender Assessment-Revised (SOA-R).