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Supporting Clients Who Have Been Justice-Involved
Presentation Q&A
Presentation Q&A
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Video Transcription
So, while we wait for other questions to come in from listeners, I wanted to kick off with one for Dr. Pinals. I guess I'm wondering for, say, a clinician in a public sector setting who may not have so much experience in working in this area, who might have a client who's coming in who has recently interfaced with the criminal justice system, I'm wondering what your thoughts are on what are ways that a clinician might broach what's going on in the criminal, what's happened around the contact, and then what are ways of putting that in the context of a patient's ongoing care? How can this be raised in a way that might... You had mentioned that there are ways of framing this in terms of recovery or a patient's own goals. What are good ways of raising that with a patient, and then what are things that a clinician should be careful about in terms of how that issue is raised and put in that broader clinical context? Yeah. That's a great question, and I think people are often afraid to ask these questions or reluctant because they don't know how to ask them, so I really appreciate the question. When we're trained to do a full biopsychosocial history, usually we say, have you ever been arrested? That may be the most that people ask, but really what we should be saying is not only that, but what was that experience like for you? What happened? Again, are you under any supervision right now? What happened with that arrest? Were you charged? Did you go to court? Did you spend some time in jail or in prison, and where did you spend some time? I just recently was doing an interview with a patient who, in the context of the interview, I was rounding on our inpatient unit at University of Michigan and the patient referenced a local correctional facility. Now, it happened, obviously, I knew more about that correctional facility than the resident I was working with, and I was able to ask some questions, but I think just general questions, even if you don't know, that curiosity, so what is that facility? I haven't heard of that facility, and then trying to understand, well, how long were you there for? Were you able to get your medicines? I think one of the things that's important is to understand, too, where patient's goals are, because if you have a patient with SMI who's very frequently in jail, that may be the best they know, so trying to understand what their experience is, and if that's something they're trying to avoid in the future, then trying to understand what makes it difficult for them to avoid that, like what's their perspective on what keeps happening that the police keep showing up, for example, and really trying to get at it from that angle, but your patients are always, our patients are like encyclopedias, because they understand their experience better than anyone, so I always, if I don't know something, and I just ask, what does that mean, so you're on probation, what does that mean, like do you have to show up somewhere, or do you have a court appearance, do you like your probation officer, is that somebody I can call, you know, those are the kinds of questions I would be asking, to try and do that intentional collaboration. Great, thanks so much, really, you know, really helpful. We do have a couple of other questions, so one attendee is saying, for someone who's been in, someone with SMI who's been in the criminal justice system for a long period of time, how can we help them connect to a social network? We know that, you know, socialization is very important for recovery, and for someone who is, you know, doesn't have that, because they've been perhaps in prison or in jail, how would you think about that issue of social network, and how to help the patient build or rebuild that? Yeah, that's a really important question, I really appreciate that. It is very difficult for every human coming out of the prison system to rebuild a positive social network, and that is something that, in the re-entry conversation, from the inside to the outside, that's part of the dialogue of, like, what is that connection going to look like? And there's a whole host of activities that are going on, about, for people with lived experience in the correctional system, and in the peer community for people with SMI, and in the recovery coach community for people with SUD, there are groups of peers that also have criminal justice experience. In some states, they refer to them as forensic peers, but they don't necessarily have to be forensically labeled. But there are ways to work with the public mental health system, for example, to identify, there's classes people can take to be peer support workers with their criminal justice experience, and so that is one way to connect, is through, you know, the professional peer network. And then there are many sort of grassroots peer networks that people can connect to. So, it could be contacting, you know, the local jail or the local prison that would potentially know where formerly incarcerated people kind of congregate to give each other peer support. You know, I was involved in one jurisdiction where they had something called the Offender Alumni Association. That wasn't specific to people with SMI, but people with SMI would have been welcome there. And so there's ways through the peer, you know, the SMI peer community, the recovery coach community, and then just the general offender community, or what they call returning citizens. That's often the phrase that's used for people that have come out of correctional systems, returning citizens. And you could Google something, probably there's websites in your local community about those types of peer groups that people could go to. And one of the things we do with our treatment planning, as we're doing this intentional coordination to try and help people that are justice-involved, is we, our case managers, will sometimes help work with the individuals to identify those types of groups, and as part of their kind of pro-social activity for the week, as we're trying to address more pro-social contexts, and positive peer influences, we'll have them, you know, go for an hour to a, whatever might be happening, a picnic or a gathering type of thing, so that they can engage in that, in that network. Yeah, that's great. That's really helpful. How, how commonly do you find that, that say, peer organizations are kind of open to, and have experience in working with, with forensic populations, or does that tend to be, do those, is that more likely to be a separate organization? Yeah, so, and, you know, forensics means different things to different people. In some places, forensics means people who are incompetent to stand trial, or not guilty by reason of insanity, not just people with SMI. Most people with SMI who are in the criminal justice system are not people in the forensic system. That's a, that's sort of a, that's a different variable. That's a, probably a cohort within the larger cohort, and so there can, depending again on the community, there can be different groups for each that gets established. Great. Thank you. You know, we have, we have some, a couple of other comments and questions. Someone is asking about wellness projects in corrections, and how to establish a program to, for a wellness project. I guess that, maybe that would be, well, it says, I'm looking for funding and informational support for a wellness project in corrections. I'm looking for suggestions around that. So, I don't have exact ideas about funding, although, well, I guess I would say there's local foundations that are, that are interested sometimes in, in developing initiatives. I got involved with something at the University of Michigan. I learned that there was something called the Creative Arts Program, or the Creative Arts Project, the Prisoner Creative Arts Project, PCAP, and it's an amazing program that helps go into various prisons and does, they do creative arts. They help prisoners with paintings and other types of creative, they do drama and different kinds of presentations, and I volunteered at one point with that group and was part of a reentry group. And, you know, so there's ways that perhaps there are things going on in your local academic environment. You know, the sociology programs, the arts programs that may already be tapping into this population. There's a literacy program that's used in various places, for example, where incarcerated mothers can read books to their children and record the stories, and then the recording can go to the kids out in the community so the children can hear their mother's voice, which is a really cool initiative. Again, not totally focused on SMI, but people with SMI can participate. And so I would say look to your local foundations and look, which, you know, right now there's a big interest in sort of thinking about this criminal justice population and trying to have people be more served in the community than not. So there may be opportunities there with your local community, and there may be things already happening with your local universities.
Video Summary
In this video excerpt, Dr. Pinals answers questions about working with clients who have recently interfaced with the criminal justice system in a public sector setting. She emphasizes the importance of asking about the client's experiences with the criminal justice system and their goals, and suggests framing the conversation in terms of recovery and patient-centered care. Dr. Pinals also discusses the challenges of rebuilding a social network for individuals who have been in the criminal justice system and suggests connecting them with peer support groups and community programs. In terms of funding and support for wellness projects in corrections, she suggests seeking local foundations and academic institutions that may already be involved in initiatives related to the criminal justice population. No credits are provided in the video.
Keywords
Dr. Pinals
criminal justice system
patient-centered care
peer support groups
wellness projects
Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
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