SEQUENTIAL INTERCEPT MODEL MAPPING WORKSHOP REPORT:

WINONA COUNTY, MINNESOTA

Prepared by SAMHSA’s GAINS Center

Policy Research Associates, Inc.

March 2021

 

Background

The Sequential Intercept Model (SIM), developed by Mark R. Munetz, M.D. and Patricia A. Griffin, Ph.D.,1provides a conceptual framework for jurisdictions interested in exploring the intersection of behavioral health and criminal justice, assessing available resources, identifying gaps in services, and conducting strategic planning. These activities are best accomplished by a diverse cross-system group of stakeholders from the behavioral health and criminal justice systems including mental health and substance use treatment providers, law enforcement and other first responders, courts, jails, community corrections, social service agencies, housing providers, people with lived experience, family members, and many others.

SIM Mapping is a process that results in the development of a map that illustrates how people with mental and substance use disorders enter and move through the criminal justice system. Through the process, facilitators and participants identify opportunities for linkage to treatment and other support services, and for prevention of further penetration into the criminal justice system.

SIM Mapping has three primary objectives:

  1. The development of a comprehensive picture of how people with mental and substance use disorders enter and move through the criminal justice system along six distinct intercept points: (0) Community Services, (1) Law Enforcement (2) Initial Detention and Court Hearings, (3) Jails and Courts, (4) Reentry, and (5) Community Corrections.
  2. Identification of resources, gaps in services, and opportunities at each intercept for individuals in the target population.
  3. The development of priorities for change and strategic action plans.



1 Munetz, M., & Griffin, P. (2006). A systemic approach to the de-criminalization of people with serious mental illness: The Sequential Intercept Model. Psychiatric Services, 57, 544-549.

Introduction

Since 1995 SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation, which is operated by Policy Research Associates, has worked to expand access to services for adults with mental and substance use disorders who are involved or at risk for involvement in the criminal justice system. The GAINS Center is supported by SAMHSA to focus on five primary areas:

In November 2020, the GAINS Center released a national solicitation for applications from jurisdictions interested in SIM Mapping Workshops. The Winona County Criminal Justice Coordinating Council applied and was awarded a SIM Mapping Workshop.

On March 12, 2021, the GAINS Center met with a group of behavioral health and criminal justice system stakeholders from Winona County virtually. GAINS Center staff delivered a presentation on the SIM and facilitated discussions focused on identifying:

The discussions focused on all intercepts. The GAINS Center captured information about the resources, gaps in services, and opportunities, and reviewed them with participants at the conclusion of the meeting. Following the initial meeting the GAINS Center coordinated a voting process to prioritize the list of identified gaps in services.

On March 26, 2021, the GAINS Center met with the same group of stakeholders to review the results of the voting process and discuss the group’s priority areas. GAINS Center staff also facilitated the development of strategic action plans that outlined next steps for beginning to address the top priority areas.

The following report was developed based on information captured during these meetings as well as additional information obtained from stakeholders throughout the process.

Winona County: Sequential Intercept Model Map

View Interactive Map

Resources and Gaps at Each Intercept

The development of a SIM map is the centerpiece of this process. As part of the mapping process, the facilitators work with the participants to identify resources and gaps in services at each intercept. This is important since the behavioral health and criminal justice systems and services are ever changing, and the resources and gaps in services provide contextual information for understanding the SIM map. Moreover, this catalog can be used by planners to establish greater opportunities for improving public safety and public health outcomes for people with mental and substance use disorders by addressing the gaps in services and building on existing resources.

INTERCEPT 0/1

COMMUNITY SERVICES AND LAW ENFORCEMENT

INTERCEPT 0/1 RESOURCES

General

Engage Winona is a nonprofit organization focusing on convening, facilitation, network building, communication, and resource sharing.

Winona County Criminal Justice Coordinating Council (CJCC) coordinates systemic responses to justice problems with criminal justice stakeholders.

Live Well Winona is a community health hub dedicated to supporting healthy activities and lifestyles in the Winona region. Among other things, Livewell Winona coordinates the Pathways Community Hub and maintains an online directory for health and wellness community resources.

Winona Pathway Community Hub is a care coordination program which focuses on addressing social determinants of health and coordinating evidence-based solutions. The Hub coordinates the work of Community Connectors employed by different area health and social services providers, who work with clients to complete identified Pathways, such as mental health, housing, and food security.

Crisis Lines and Stabilization Facilities

Great Rivers 2-1-1 is the Tri-state Region’s helpline accessed by calling 2-1-1 or toll-free in Wisconsin, Minnesota, or Iowa at (800) 362-8255. The line is available 24 hours Monday through Friday 8 a.m. - 4 p.m..

Additionally, the helpline operates a chat (text) service accessed by texting your zip code to 898211.

Southeast Regional Crisis Center coming soon in Rochester, MN.

Mobile Crisis Services

Crisis Response of Southeastern Minnesota has a 24/7/365 crisis line for the county staffed by a regional provider that can refer to Hiawatha who can then connect with trained professionals locally who are contracted to provide crisis services. The line is accessed at 1-844-CRISIS2 or 1-844-274-7472.

Winona County Emergency Management (9-1-1) dispatchers will identify calls that involve a mental health or substance use crisis and dispatch law enforcement. Some 9-1-1 dispatchers have received Crisis Intervention Team (CIT) training and many attend one-day mental health trainings annually. Law enforcement responds to all calls to 9-1-1.

Law Enforcement, Fire and Emergency Medical Services

The Winona Police Department has a sergeant and three officers on duty during each shift.

Winona Sheriff’s Department: Operates and oversees the county jail and has a staff of 76 employees and over 50 volunteers. The Sheriff’s Department is responsible for coordinating with Winona County emergency management services and numerous other public safety and community programs.

Some Winona County officers have received Crisis Intervention Team (CIT) training. One officer is a CIT trainer. All officers attend one-day mental health trainings annually, which now incorporate some key components of the CIT training curriculum. The training covers mental health diagnosis, symptoms, de- escalation techniques, and peers that discuss lived experience.

Law enforcement officers uphold Good Samaritan Laws, encourage calls for drug overdose and Emergency Medical Service (EMS) carry and will administer Naloxone, an opioid antagonist, to rapidly reverse opioid overdose.

A Winona County Alternative Response Team (ART), a co-responder program, is currently under development. With the ART program, EMS, and Police respond to 9-1-1 calls together.

Hospitals and Crisis Stabilization

Winona Health Hospital A psychiatric provider was previously in-house, but now the hospital has a third- party arrangement. This psychiatric provider makes decisions about 72-hour holds. Participants report there is a lot of bed searching, many times resulting in having to board in the Emergency Room (ER). The hospital ER only has nine beds.

The hospital emergency department social worker performs an in initial screening in the ER to determine eligibility for Community Hub services. At this time, no follow-up is conducted by the hospital.

Detox and Withdrawal Management

The few detox programs in Winona are scheduled to close, but a variety of detox facilities located in Rochester, MN are still available. Rochester, MN is 45 miles out of Winona county.

Harm Reduction

Naloxone is available at local pharmacies. A prescription is not required, and it is provided at no cost for residents who have county health insurance.

Planned Humanity provides harm reduction services. The group is staffed mostly by volunteers and provides Naloxone and training. Planned Humanity also operates a syringe exchange program. The syringe program operates on Tuesdays from 5:00 p.m. – 7:00 p.m. and Saturdays from 7:00 p.m. – 11:00 p.m.

Winona County Alliance for Substance Abuse Prevention (ASAP) Operates a drug drop box is located outside the law enforcement center and another is located a Winona pharmacy. ASAP also provides drug disposal products.

Community-Based Treatment and Support Services

Winona Community Hub provides support and assistance and is available to eligible residents of the county. Eligibility criteria include food insecurity, minors in the household, underinsured, or experiencing homelessness. The type of assistance provided is based on individual needs but often includes direct linkage to community-based treatment providers and support services.

Family and Children’s Services provides outpatient mental health and substance use disorder treatment.

Common Ground has 20 bed men’s facility that provides residential substance use disorder treatment.

Peer Support Services

Hiawatha Valley Mental Health Center hosts Peer Support Network (PSN) “drop-in centers” where adults experiencing mental health issues can have a safe space to socialize and support one another.

Veterans Services

Winona County Veterans Services Office (CVSO) works with law enforcement to link individuals to services.

Housing

Hiawatha Bluffs Living (HBL) has fully furnished apartment(s) that are available to house adults with serious mental illness. HBL can house up to 20 individuals within the 10-county region of Southeastern Minnesota.

Common Ground has 2 sober living houses for individuals enrolled in intensive outpatient treatment.

A Hiawatha Valley Mental Health Center crisis worker connects individuals to housing and does follow- up.

Catholic Charities of Southern Minnesota operates a seasonal overnight shelter and a year-round day shelter in the City of Winona.

Before COVID-19 there were several 7 p.m. to 7 a.m. shelter beds for sleeping, daytime shelter as well, limited access to medications at shelters. There are two “warming” houses operating through COVID-19, the Bethany House and Dan Corcoran House. Both houses are faith based and operated by the Winona Catholic Worker organization. The houses operate from 4-7 p.m. Monday-Friday. Guests are provided dinner at 6 p.m. in addition to having the opportunity to shower, do laundry, and socialize with other guests.

*For comprehensive list of additional Winona, Co. housing resources contact Clayton Greisbach, Hiawatha Valley Mental Health Center

INTERCEPT 0/1 GAPS

Early Identification and Efficient Resource Connection

  • County needs to improve access to mental health and substance use treatment (treatment on- demand).
  • Implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) model in hospital emergency department.
  • “Warm handoffs” for direct linkage to treatment and support services and assistance with navigating behavioral health and criminal justice systems.
  • Development of a strategy for educating the community about available resources and/or the development of a local resource directory.
  • Development of a strategy for identifying “familiar faces” or “high utilizers” of behavioral health and criminal justice system, and coordination with new WRAP+ program and all involved agencies.

Facilities and System Infrastructure

  • There is no local crisis stabilization facility or detox/sobering center the nearest is an hour away.
  • County needs alternatives to the hospital emergency department (ED). Because of overuse of the ED there are long wait times for accessing hospital emergency department. The ED has a limited staff (1 social worker) and beds (9 total).
  • There is no longer a dedicated behavioral health unit at the hospital (DBM).
  • Access to emergency shelter beds (currently at capacity). Also access to gender-specific shelters.
  • Additional after-care recovery housing (currently there is a waiting list).

Personnel/Training/Programing

  • Need increased awareness and greater access to available peer support services.
  • Additional mental health and substance use training for law enforcement, and the involvement of people with lived experience in providing the training.
  • Expansion of co-responder program throughout the county (a co-responder program is currently being implemented within the City of Winona).

Medication Assisted Treatments (MATs)

  • There is no authorized MAT or Opioid Treatment Provider (OTP) in Winona county, however there is limited access to buprenorphine providers.
  • The county needs access to medications for Opioid Use Disorder (all three, particularly Methadone). Explore X-waivers for expanding provision of buprenorphine. The X waiver requirement under the Drug Addiction Treatment Act (DATA) of 2000 establishes licensing criteria of physicians eligible to treat OUD with buprenorphine.
  • Expanded access to Naloxone and training for community (locations and hours of operation, also training for community members on CPR and administering Naloxone).
  • Utilization of Overdose Detection Mapping Application Program (ODMAP).
  • Additional secure drug takeback locations and drug disposal products in the county (e.g., Deterra or DisposeRx).

INTERCEPT 2/3

INITIAL DETENTION/COURT HEARING AND JAILS/COURTS

INTERCEPT 2/3 RESOURCES

Initial Detention

Initial detention is in the Winona County jail.* To meet processing timeline of 90 days, the county contracts with Houston County jail, which holds an average of 15 inmates a day. Additionally, if there are medical conditions the inmate may be transferred to Olmsted County where there is access to Mayo Clinic.

The Winona County jail has 38 beds on the second floor and 43 on the first floor.

Due to COVID-19 the county is limiting new arrests, and new arrests need to be quarantined for 14 days before being sent to Houston County. There has been a reduction in arrests and subsequently on the number of inmates in the jail.

*The Winona County jail will cease to operate after September 30, 2021. The design and construction of a new 80-bed jail has been authorized by the Winona County Board.

Booking Procedure

Upon arrival at booking the arrestee is brought in through a secure door and a quick pat down is conducted by a staff member of the same gender. Then the handcuffs are removed and a more in-depth over the clothes pat down is conducted before beginning booking.

Arrestees are then fingerprinted, strip searched under authorization of sergeant on duty. Then the inmate can make a phone call and is briefed on where they can safely go in the jail.

The sergeant or staff may flag an individual for mental health or set them up to see a nurse if it seems needed. Even if the individual does not want to see MH, the jail staff will still email a request if they think it is needed.

During booking the staff will ask questions about substance use, but they currently do not use a formal questionnaire. New practices including formal screening will be implemented soon as part of the Winona County Re-Entry Assistance Program Plus (WRAP+). The staff do, however, conduct a risk assessment and a mental health screen (CMHS). A Suicide Screener is now performed (NIMH) at booking.

Jail staff receive annual mental health training from the mental health provider for the jail, specifically motivational interviewing and how to identify substance use issues. However, jail staff do not receive de-escalation training nor trauma training. Since January of 2021, WRAP+ has been providing monthly mental health trainings which have been well attended by jail staff.

Although the CMHS is given to all individuals arriving at the jail, additional mental health services are accessible by inmates through a referral process. Upon referral by jail staff, a licensed mental health professional will conduct assessments as needed. MH assessments include additional screenings and diagnostic instruments.

The jail contracts with Advance Correctional Healthcare. There is a medical provider (PA) that is available 24/7 by phone and will visit once a week for interviews and to prescribe prescriptions etc. There is one nurse for 16 hours on site, and one mental health staff (social worker) available 2 days a week on site and available by phone the rest of the time. The mental health provider prioritizes stabilization, provides supportive counseling, and obtains trauma history, if possible.

If a person presents intoxicated the jail staff can call the medication provider on call to get guidance. If needed they can take the person to the hospital for detox. The jail does have Narcan available.

Data

A range of data is being collected by different parties (booking, mental health, jail staff). Information being collected is not currently being shared or utilized outside of data requests or for grant reporting purposes. The WRAP+ program will improve the data collection, storage, and utilization process.

Medication Assisted Treatment

The jail does not have MATs for opioids. The procedure for incoming individuals exhibiting opioid withdrawal symptoms is to monitor for 12 hours or until the morning. If symptoms are severe, then the medical provider is contacted. The medical provider will review cases with prescriptions for MATs and has the discretion to approve or deny. However, the jail cannot not provide MATs, a family member must bring it in. Generally, if the medication has the potential for addiction, the provider is hesitant to approve it.

Individuals in jail are at increased risk of losing their medical benefits (Medicaid). If the individual spends more than a few days in jail, benefits are usually suspended and the process for reinstating them is challenging. One goal with the WRAP+ is to establish a community connector program which will also provide access and support for accessing or continuing health insurance, so medication can be continued.

Arraignment/First Appearance

Depending on release status, a bail evaluation may not be performed prior to court appearance (persons on probation holds only do not received bail evaluations). Additionally, those that are immediately released are given a court date and therefore do not see a judge within 36 hours. Those who remain in custody are held until first appearance or arraignment. The booking list is sent to the court, social services, public defenders, prosecutors, and others and describes who has been arrested and is in custody.

An attorney (Winona County Public Defender) is available to new arrestees Monday through Friday and will contact the individuals on the list prior to first appearance, unless the individual explicitly says they don’t want a public defender. Arrestees must complete a four-page application to obtain a public defender. Jail staff provide the application to arrestees and the jail intake worker can assist with completion of the form.

At the arraignment, the judge will decide whether to release the individual on their own recognizance with conditions or some amount of bail or both. Whether released or held in custody, a subsequent hearing will be scheduled.

There is a slightly different process on the weekend. The jail contacts a prosecutor and a Riverside district judge to review weekend detentions to have bail set within 48 hours (preferably 36).

Pre-trial Bail Evaluations

Law enforcement sends the Office of the Winona County Attorney (prosecutor) the police reports. If there is not enough evidence to support a charge, the prosecutor will direct that the individual be released. On other cases, the prosecutor will file a complaint based on the evidence in the police report. Depending on the complexity of the case this could take some time and is sometimes not done prior to the first appearance. The prosecutor does not conduct a separate bail evaluation. Prior to COVID-19 the number of bail evaluations a day averaged at 8, currently is closer to three.

The bail evaluation is in-depth. The agent reviews mental health and substance abuse histories, checks the law enforcement management system for emotional behavior calls, works with case managers and others to verify information provided by the inmate, and looks at criminal history and prior court appearance patterns.

Both the prosecutor and the public defender use the bail evaluation in their arguments during first appearance. Based on these arguments, the judge will determine whether the person is released, with or without bail.

Diversion Programs

Winona County has a Misdemeanor Diversion Program as an alternative to traditional court prosecution. In contrast, for felony level charges there is no formal diversion program or process; however, the court may consider releasing an individual to treatment if the issue is raised. Due to funding obstacles, there have been short-term attempts to create diversion programs under different grants obtained by the Criminal Justice Coordinating Council (CJCC). Under the these grants the treatment court was created along with an effort to fund additional positions for intake workers.

Treatment Court

Individuals are eligible for the treatment court for felony level, nonviolent offenses if they are a resident of Winona County and meet criteria on substance abuse/chemical dependency assessments. The treatment court does accept dual diagnosis. An estimated 90% of treatment court participants have a mental health disorder as well as a moderate to severe substance abuse disorder. The Office of the Winona County Attorney does the screening for every felony charged to see if they qualify. Not everyone agrees to participate if they do qualify. It may take up to 2 months to get into Treatment

Court, so many give up and just serve their time. The Department of Corrections does the supervision for Treatment Court.

The treatment court has a capacity of 20 participants and has averaged 12-15. The treatment court program is a minimum of 13 months, but participants, on average, complete in 18 to 20 months.

Winona County has a Veteran’s Court as well. The Veteran’s court launched in 2019. It serves the 3rd Judicial District. The Veteran’s Affairs - Health Administration has a Veteran’s Justice Outreach specialist assigned to this veteran’s court.

Jail Programming

There is very little programming in the jail due to space. The jail is very old and does not have enough space for classes, etc. The jail has had people from a temporary agency come in to talk about employment. The jail has also had GED classes, CPR classes, Bible Study and AA/NA. The jail plans to expand programming once the new jail is built.

INTERCEPT 2/3 GAPS

Screening and Access to Mental Health Services

  • Currently there is no formal substance use screening at booking apart from the CMHS. However, a substance use screener (TCUDS-V) will be instituted as part of WRAP+. The mental health screen will be changed from the CMHS to the Brief Jail Mental Health Screen. The ORAS-CSST risk screen will continue under WRAP+.
  • There is a Suicide Screening (NIMH) as well as a brief MH screen (CMHS) currently given at booking. Minimal opportunity to provide access to MH treatment for individuals due to delayed identification and short stays. Most stays are less than 90 days, many that come in are released within 7-10 days.

Facilities

  • Little to no programming or recreation space in the jail. (New jail will provide space, but is a year out)
  • No resources or effective responding to Nicotine withdrawal for new inmates.
  • Current jail does not hold maximum security prisoners.
  • No standard data collection, storing, or utilization procedure.<
  • Minimal sharing of mental health and substance use information among key stakeholders who interact with inmates.
  • No MAT provider in Winona County.

Training and Staff Support/Resources

  • Most officer training (de-escalation, crisis intervention, Motivational Interviewing (MI)) is online and not always helpful, participant stated most training is on the job-learning directly from the inmates. There is no training related to trauma.
  • Jail staff need a plan for screening to occur at booking or before initial appearance. However, the plan must be flexible, because there are often issues with obtaining effective/accurate screening for incoming arrestees. They are usually upset and can be unwilling or unable to complete the screening during booking.
  • Not enough licensed mental health or medical providers on site, specifically there is no Psychiatrist on staff.
  • Pre-COVID there was some concern regarding meeting the 36-hour rule with bail evaluations and complaints. This was due to lack of staff and high caseloads.
  • No pre-trial services program. There is a lack of funding to support such a program.
  • Lack of in-reach by community providers
  • Lack of the use of Peer Specialists with programming or in-reach.

Policy

  • It can take up to 2 months to get approved to participate in Treatment Court. Many offenders give up on the process and just serve their time.
  • Individuals are at risk of losing federal and state benefits for health care when arrested. Minimal use of SOAR (Social Security Outreach Access and Recovery) program.

INTERCEPT 4/5

REENTRY AND COMMUNITY CORRECTIONS

INTERCEPT 4/5 RESOURCES

General

Minnesota Department of Corrections (MDOC) Felony Unit, Court House Unit. Most of the prisons have psychiatric units or access to them. Post-COVID19 telehealth is being used for jail in reach.

Reentry

The Care Prerelease planning program is being replaced by WRAP+ which is not fully up and running yet; they are currently halfway through a 9-month planning process. The target date to be fully functional is the end of June 2021. WRAP+ will consist of 3 components.

  1. Reentry with Community Corrections
  2. Embedded Jail Social Worker
  3. Cross-Training

With WRAP+ the reentry component will include screening, qualification, connection to the community health worker and then setting the individual up MH/SUD resources. WRAP+ will feature an enhanced enrollment. Previously, ‘time spent in jail’ was the criteria, but has been expanded to serve a larger population. Now justice-involved can mean probation, a call for MH crisis, a child protection case, someone who has spent time in jail, etc.

Under the WRAP+ plan a social worker (one position) will be embedded in the jail and will consult with anybody in the jail and help integrate that person back into the community by assisting with connections to other needed resources. The social worker will work with a community health worker who will be employed by Hiawatha Valley Mental Health Center and will follow the community hub process which involves intake that looks at social determinants of health (housing, education, access to medical care, etc.) and then identify pathways that need to be addressed to assure that needs are addressed, and the person is connected with services.

The community worker/connector is meant to walk people through the services, not just to provide referrals and then stop. They can get people to go to intake and walk with them through the process and bridge that gap.

Probation/Parole

Winona County has 10 probation officers. Specialized caseloads include sex offender (SO) that has about 45 cases, but this is not just for Winona county. Traditional or medium level risk caseload is about 75 cases, and the low-level felony caseload covers 3 counties and is about 300 clients.

Typically, officers are cross trained and trained in mental health, motivational interviewing, assessment tools, etc. Sex Offender officers received additional specific training for this population.

When probation wants to offer housing options to their clients, they have a few different avenues they have used as far as funding goes. They will sometimes tap into short-term housing but maybe only for a week. The Dept of Corrections (DOC) has had grant money in the past, but it is used up fast. If they can work with a local landlord to house their clients there is an arrangement to be established that the landlord can be given funding through that grant.

Community Supports

Detox

A detox center is in Rochester which is 40 mins away. Winona does have sober housing for men and women. The women’s housing was not used as much as the men’s, so now its co-ed- and has been around for 1.5-2 years. There is also a halfway house for chemical dependency treatment run by Common Ground, which has been around for 4-5 years now.

A Winona County financial worker helps re-entering inmates with public assistance benefits, Medicaid, medical assistance benefits, and she will continue to do that even with community connector.

Housing

Homelessness- Churches have resources. There used to be a group called Poverty Roundtable and now Winona Interfaith Council that circulates emails when someone needs certain things. This is for all people, not just justice-involved individuals.

Treatment court has support from Pleasant Valley Church, which has provided funding for treatment court participants for services they need, housing related sometimes. Similarly a community run non- profit organization, identified as Friends of the Drug Court, houses a special fund for the treatment court.

Southeastern Minnesota Center for Independent Living (SEMCIL) teaches independent living skills for anyone who identifies as having a disability. They can provide educate about three different types of housing: private, landlord, and income-based living. They can help people apply for housing, get their driver’s license, fill out documentation etc.

There is a seasonal shelter run by Catholic Charities as well as a year-round day center.

Peers

The Hiawatha Valley Peer Support Program started 12 years ago and was in a previous location until 3 years ago. They are now a part of the main office space in Hiawatha Mental Health, so they are under the same roof as psychiatry and other services. The primary purpose of peer support network is to establish a place where individuals, not just Hiawatha clients, but anyone with genuine interest with a need for support/resources could come together in a very informal drop-in basis. They started out with part time and have always utilized college student interns and volunteers and then eventually peer support specialists became available, so they were able to hire at least one peer specialist to participate in the programming. They were eventually able to evolve with group opportunities to support groups and offer groups that focus on specific topics such as MH. These were offered daily from 9 a.m. to 8 p.m. along with drop ins but they closed a year ago due to COVID but hope to be able to reopen soon. They have been doing virtual groups Tues and Thurs on Microsoft Teams. Tuesday is educational group and utilizes interns and Thursday there is a professor from Winona State who does a lunch group. They are very informal, not mandatory.

Veterans

Veterans Services Office is located within a block of the jail. Pre-COVID a veteran’s services officer would go into the jail but not currently.

The jail used to ask, “Are you a veteran?” but there were some people that did not identify with that term because they thought it meant combat, so they have rephrased their question to make sure they are identifying everyone who is eligible for veterans’ services.

INTERCEPT 4/5 GAPS

Continuity of Care/Information Sharing

  • Medication continuation – need assistance for individuals that are incarcerated with maintaining their current medication regime.
  • Benefits- Individuals that enter the jail receive 10-day notice of benefit discontinuation. Depending on when in the month the individual enters jail, there is a big variance as far as how much time the individual has before their benefits are cut off.
  • Case plans are often a duplicative effort by jail and probation. There is an opportunity for collaboration and alignment between stakeholders.
  • Information sharing – siloes within the system/opportunity for more communication amongst stakeholders. It can be traumatizing for individuals to repeat their stories over and over to access benefits.
  • Communication gap with probation participants. They do not always do their part to follow up when they are supposed to or make themselves accessible (no voicemail set up)
  • Probation sometimes receives inaccurate or missing info about sentencing or conditions from the court.
  • Clients do not always receive clear communication regarding their conditions of release, or do not become aware of their conditions of release until they meet with probation.

Peer Support/Reentry Programs

  • There are no formal partnerships with peers in probation.
  • Lack of awareness regarding available resources. There is an opportunity to increase information sharing and to maintain a current list of county resources.
  • Lack of shelter/housing options – shelter is seasonal (winter only), there is a need for transitional housing.
  • Homeless individuals may remain in jail because of the requirement of a verifiable address when leaving the jail.
  • There is a lack of social support for folks coming out of jail system-what to do with their time and how to engage them in a meaningful way to keep them focused on constructive healthy distractions. One major issue that has been long standing is how to accommodate individuals with significant legal history into residential programming.

Strategic Action Plans

Priority Area 1: Reduce use of ED as crisis stabilization/sobering detox facility
  Objective Action Steps Who When
1. Create an in-county 24/7 Crisis stabilization facility or detox/sobering center. (Nearest is in Rochester, a 45-60-minute drive, but it is often full/red status. Transportation is an issue. Look into using existing jail facility (once new jail is opened). Potential barrier: meeting code/ADA compliance, costs Eric Mueller/ Ron, County Board, Karin Sonneman  
    Identify sites or existing community resources that could be used as sobering center/ stabilizing beds (potential to open up DBM beds for those that do not meet criteria) Mike Fahey, FCC-Jenny Yahnke, Karen Sanness  
    Identify credentialing criteria depending on the intended type of facility (voluntary/involuntary, justice involvement)    
    Need to develop a shared definition of the facility/model?    
2. Develop data collection and sharing procedure to better understand the needed supports (number of beds and other resources, who needs the support, what is the size of the problem) Reinstate the data collection committee Kalene Engel-CJCC, Karin Sonneman, (Steve Buswell?) Start by April 7 at next CJCC meeting
2. Develop data collection and sharing procedure to better understand the needed supports (number of beds and other resources, who needs the support, what is the size of the problem) Identify funding needs and options based on data. (leveraging COVID relief funding) Kalene Engel-CJCC, Karin Sonneman, (Steve Buswell?) Start by April 7 at next CJCC meeting
2. Develop data collection and sharing procedure to better understand the needed supports (number of beds and other resources, who needs the support, what is the size of the problem) Specify population to be served in crisis stabilization facility Kalene Engel-CJCC, Karin Sonneman, (Steve Buswell?) Start by April 7 at next CJCC meeting
    Examine the impact of COVID related to current need and what it may be post COVID    
3. Account for liability and legal concerns with information sharing (HIPAA) as well as Law Enforcement/ Criminal Justice involvement in crisis response Review available SAMHSA webinars on information sharing strategies    
3.   Review other models of addressing information sharing barriers (MOUs between agencies, Advanced Psychiatric Directives)    
3.   Review other qualified service agreements available on SAMHSA website    

Priority Area 2:

Continuity of Care: Creating direct linkage (“warm handoffs”) to treatment and support services, and assistance with navigating behavioral health and criminal justice systems.

  Objective Action Steps Who When
1. Spread awareness of current resources among collaborative group → capacity to bring awareness to the community at large. Establish shared language among collaborative (conduct department presentations that highlight those involved in the process). *Monthly mental health trainings (WRAP+) Chris Meyer, Christy Ferrington, Brian Voerding April-May after survey report released<
1. Spread awareness of current resources among collaborative group → capacity to bring awareness to the community at large. Invite professional organizations to the table (HHS Directors, Association of MN Counties, and Minnesota Intercounty Association) Local Advisory Meeting (soon to resume) → Mike Fahey  
1. Spread awareness of current resources among collaborative group capacity to bring awareness to the community at large. Look to other counties/states to find models for addressing similar challenges Kristen Christensen  
2. Creating peer support services (some in place, but on hold due to COVID). Also, Community Connectors. * Take an inventory of what is currently available in Winona for any peer related resource available.

 

Conduct peer/recovery support specialist trainings (expensive and regulated by state) and support more peer support programing at the “Warming Center” (recruitment of peers) Jenny Yahnke, Judy Gilow, Karen Sanness July
2. Creating peer support services (some in place, but on hold due to COVID). Also, Community Connectors. * Take an inventory of what is currently available in Winona for any peer related resource available. Identify process for connecting peers to individual through email/chat/text (crisis networking/Hiawatha Health)    
2. Creating peer support services (some in place, but on hold due to COVID) Also, Community Connectors * Take an inventory of what is currently available in Winona for any peer related resource available. Provide law enforcement with contacts for community connectors so they are not in the role of case manager (education on WRAP plans and increased use of the ‘Alert’ system) Mike Fahey  
2. Creating peer support services (some in place, but on hold due to COVID). Also, Community Connectors. * Take an inventory of what is currently available in Winona for any peer related resource available. Look into getting local university/college to become a peer training institute    
3. Increase utilization of Outpatient crisis stabilization at first contact Loop in with other efforts to increase awareness about community resources Clayton Griesbach  
3. Increase utilization of Outpatient crisis stabilization at first contact Include in program spotlight presentations    
3. Increase utilization of Outpatient crisis stabilization at first contact Marketing and public awareness/understanding about mental health    

 

Quick Fixes

While most priorities identified during a Sequential Intercept Model mapping workshop require significant planning and resources to implement, quick fixes are priorities that can be implemented with only minimal investment of time and little, if any, financial investment. Yet quick fixes can have a significant impact on the trajectories of people with mental and substance disorders in the justice system.

Recommendations

Resources

Competence Evaluation and Restoration

Crisis Care, Crisis Response, and Law Enforcement

Brain Injury

Housing

Information Sharing/Data Analysis and Matching

Patient Records.

Jail Inmate Information/Services

Medication-Assisted Treatment (MAT)/Opioids/Substance Use

Mental Health First Aid

Peer Support/Peer Specialists

  • Policy Research Associates. (2020). Peer Support Roles Across the Sequential Intercept Model.
  • Department of Behavioral Health and Intellectual disability Services. Peer Support Toolkit.
  • University of Colorado Anschutz Medical Campus, Behavioral Health and Wellness Program (2015). DIMENSIONS: Peer Support Program Toolkit.
  • Local Program Examples:
    • People USA. Rose Houses are short-term crisis respites that are home-like alternatives to hospital psychiatric ERs and inpatient units. They are 100% operated by peers.
    • Mental Health Association of Nebraska. Keya House is a four-bedroom house for adults with mental health and/or substance use issues, staffed with Peer Specialists.
    • Mental Health Association of Nebraska. Honu Home is a peer-operated respite for individuals coming out of prison or on parole or state probation.
    • MHA NE/Lincoln Police Department REAL Referral Program. The REAL referral program works closely with law enforcement officials, community corrections officers and other local human service providers to offer diversion from higher levels of care and to provide a recovery model form of community support with the help of trained Peer Specialists.

Pretrial/Arraignment Diversion

Procedural Justice

Racial Equity and Disparities

Reentry

Screening and Assessment

Sequential Intercept Model

SSI/SSDI Outreach, Access, and Recovery (SOAR)

Increasing efforts to enroll justice-involved persons with behavioral disorders in the Supplement Security Income and the Social Security Disability Insurance programs can be accomplished through utilization of SSI/SSDI Outreach, Access, and Recovery (SOAR) trained staff. Enrollment in SSI/SSDI not only provides automatic Medicaid or Medicare in many states, but also provides monthly income sufficient to access housing programs.

Telehealth

Transition-Aged Youth

Trauma and Trauma-Informed Care

Veterans

Appendices

INDEX

Appendix 1: SIM Mapping Workshop Participant List

Appendix 2: Priority Voting Results

APPENDIX 1: PARTICIPANT LIST

Associates in Mental Health & Addiction Services Certified Nurse Practitioner Lauria Robert info@winonamentalhealth.com
Common Ground CEO Schmitz Mattea mattea@commongroundmn.org
Common Ground Outpatient Counselor Buckmaster Aimee aimee@commongroundmn.org
Common Ground Residential Counselor Burk Michael mike@commongroundmn.org
Engage Winona Executive Director Voerding Brian brian@engagewinona.org
Family and Children's Center Counselor Yahnke Jennifer jyahnke@fccnetwork.org
Family Service Rochester FARR Case Manager Gerke Marissa mgerke@familyservicerochester.org
Family Service Rochester Supervisor - FARR Burton Stephanie burton.stephanie@co.olmsted.mn.us
First Congregational Church Rev. Bartz Danielle pastordanielle@winonaucc.org
Goodview Police Dept Police Chief Roloff Lonnie lroloff@goodviewmn.org
Hiawatha Valley Mental Health Center Adult Community Based Programs Supervisor Ferrington Christy christyf@hvmhc.org
Hiawatha Valley Mental Health Center ARMHS/CRU Worker Griesbach Clayton claytong@hvmhc.org
Hiawatha Valley Mental Health Center ARMHS/CRU Worker Kruse Tanya tanyak@hvmhc.org
Hiawatha Valley Mental Health Center Children's Therapeutic Services Director Poepping Sally sallyp@hvmhc.org
Hiawatha Valley Mental Health Center Executive Director Sievers Erik eriks@hvmhc.org
Hiawatha Valley Mental Health Center Peer Support Program Director Fahey Mike mikef@hvmhc.org
Inclusa   Kranz Andy andy.kranz@inclusa.org
SEMCIL Independent Living Skills Worker Madsen Laura lauram@semcil.org
St. Charles Police Dept Police Officer Pelaez Jose jpelaez@stcharlesmn.org
Winona Community HUB HUB Manager Lorenz Heather heather.lorenz@livewellwinona.org
Winona County Health & Human Services Adult Mental Health Social Worker Loken Tessa tloken@co.winona.mn.us
Winona County Health & Human Services Financial Worker Christenson Kristin kchristensen@co.winona.mn.us
Winona County Health & Human Services Supervisor-Adult Mental Health Bunkowski Karen kbunkowski@co.winona.mn.us
Winona County Vertern's Services Office Veteran Services Officer Obieglo Jerry jobieglo@co.winona.mn.us
Winona Health Emergency Room Social Worker Wessels Hannah hwessels@winonahealth.org
Winona Police Department Deputy Chief Engrav Eric eengrav@co.winona.mn.us
Winona Police Department Police Officer Heiden Tyler theiden@co.winona.mn.us
Winona Police Department Police Officer Mueller Eric emueller@co.winona.mn.us
Winona Police Department Police Officer Sobotta Anita dlanning@co.winona.mn.us
Winona State University Professor (Social Work) Charles Ruth rcharles@winona.edu
Winona Volunteer Services Client Services Coordinator Peterson Kay kayp@winonavs.org
  Community Member Polus Zarna zarnapolus@gmail.com
  Community Member Straight Richard carrie_mckee@yahoo.com
  Peer Recovery Specialist Sublett Kathy isubmitsublett@yahoo.com
Acumen Counseling Mental Health Clinic Cratchy Don don@acumencs.com
Advocacy Center of Winona Director Hegge Crystal crystal@advocacywinona.org
Counseling Associates Substance Abuse Provider Vue-Brabant Choua cvue13163@gmail.com
Empower CTC Mental Health Clinic Olson Mary mary@empowerctc.com
Family and Children's Center   Roessler Darci droesler@fccnetwork.org
First Congregational Church Rev. Bartz Danielle pastordanielle@winonaucc.org
Goodview Police Department Police Officer Volkman Travis travisv@goodviewmn.com
Grace Place Director Burton Carla carla@graceplaceinc.org
Hiawatha Valley Mental Health Center Mental Health Clinic Dieck Jen jend@hvmhc.org
Lewiston Police Dept Police Chief Yeiter Scott chief@lewistonmn.org
Project FINE Executive Director Said Fatima fatimas@projectfine.org
Winona County Health & Human Services Financial Supervisor Morris Naomi nmorris@co.winona.mn.us
Winona County Sheriff's Office Chief Deputy Mueller Jeff jeff.mueller@co.winona.mn.us
Winona State University Director of Diversity & Inclusion Locust Jonathan jonathan.locust@winona.edu
    Mueller-Freitag Katie ktmae@risup.net
3rd Dt. Public Defender's Office Managing Public Defender Kuehn Michael michael.kuehn@pubdef.state.mn.us
Third Judicial District Court Administrator Brandt Becky becky.brandt@courts.state.mn.us
Third Judicial District District Court Judge Buytendorp Nancy nancy.buytendorp@courts.state.mn.us
Treatment Court of Winona County Treatment Court Coordinator Hyter Carin chyter@co.winona.mn.us
Winona County Attorney's Office County Attorney Sonneman Karin ksonneman@co.winona.mn.us
Winona County Board of Commissioners County Commissioner Kovecsi Marie mkovecsi@co.winona.mn.us
Winona County Board of Commissioners County Commissioner Meyer Chris cmeyer@co.winona.mn.us
Winona County CJCC Executive Director Engel Kalene kalene@engellawoffice.com
Winona County Sheriff's Office Jail Intake Worker Chandler Trish tchandler@co.winona.mn.us
Winona County Sheriff's Office Programs/Training Director Glithero David dglithero@co.winona.mn.us
Winona County Sheriff's Office Shift Commander/Transport Fruth Dave dfruth@co.winona.mn.us
Winona State University Assistant Professor/Field Director (Social Work) Vande Berg Anne avandeberg@winona.edu
  Community Member Gilow Judy jgilow@hotmail.com
  Community Member Green Justin jgreen466@live.com
Court Administration Court Clerk Rosecke Kerry kerry.rosecke@courts.state.mn.us
Third Judicial District District Court Judge Leahy Mary mary.c.Leahy@courts.state.mn.us
Catholic Charities of Southern MN Director of Housing Rivenburg Audrey arivenburg@ccsomn.org
JustUs Service Grant Evaluator Weber Tom webertom@justusservice.com
MN Dept of Corrections District Supervisor Patterson Rená rena.patterson@state.mn.us
MN Dept of Corrections Probation Officer Moe Bill bmoe@co.winona.mn.us
SEMCIL Independent Living Skills Worker Sixty Amy amys@semcil.org
Winona County Health & Human Services Director Sanness Karen ksanness@co.winona.mn.us
Winona County Sheriff's Office Jail Administrator Buswell Steve sbuswell@co.winona.mn.us
Winona Health Community Connector Tullius Rheba rtullius@winonahealth.org
  Community Member Soderberg Linda llsod.lindalee@gmail.com
Advanced Correctional Healthcare Jail Social Worker Warnke Daryl darrell.warnke@gmail.com
City of Winona Community Development Specialist Larson Nick nlarson@ci.winona.mn.us
Common Ground Care Coordinator-Recovery Housing Revord Maddie recoveryhouse@commongroundmn.org
SEMMCHRA Executive Director Beranek Buffy bberanek@semmchra.org
Winona County Sheriff's Office Sheriff Ganrude Ron rganrude@co.winona.mn.us
Winona County Sheriff's Office Transport Officer Centeno Pablo pcenteno@co.winona.mn.us
Winona Housing Association Pringle   Dave rentfrompringle@gmail.com

Appendix II: VOTING RESULTS

Answer Choices Responses    
Immediate access to mental health and substance use treatment (treatment on-demand) "warm handoffs" for direct linkage to treatment and support services. and assistance with navigating behavioral health and criminal justice systems. 55.81% 24  
Crisis stabilization facility or detox/sobering center (in-county). Nearest is 45-60 minute drive. 55.81% 24  
24/7 Access to emergency shelter beds (currently at capacity). Also access to year-round and gender-specific shelters. Additional after-care sober/recovery housing (currently there is a waiting list). Also, individuals who are experiencing homelessness may be held in jail until there is a verifiable address. 39.53% 17  
Alternatives to the hospital emergency department. Long wait times (up to three hours) for accessing hospital emergency department. Limited staff (1 social worker) and beds (9 total). Also. there is no longer a dedicated behavioral health unit at the hospital (DBM). Considering Implementation of Screening, Brief Intervention. and Referral to Treatment (SBIRT) model in hospital emergency department. 25.58% 11  
Formal mental health and substance use screening during jail booking process. Development of strategy for quickly identifying individuals with mental and substance use disorders in the jad and connecting them with treatment and support services. 20.93% 9  
Development of a strategy for educating the community about available resources and/or the development of a local resource directory. 16.28% 7  
Communication and collaboration between jail staff, courts. and probation around case management and treatment planning. Clients don't always receive clear communication regarding their conditions of release, or don't become aware of their conditions of release until they meet with probation. Probation sometimes receives inaccurate or messing information about conditions of release from the court. 16.28% 7  
Additional mental health, substance use, and diversity/inclusion training for law enforcement and jail staff, and the involvement of people with lived experience in providing the training. 13.95% 6  
Medication continuity for individuals booking into the jail and being released from the jail. 13.95% 6  
Access to peer support services and daytime recovery support groups. Reopening peer support drop-in center. Peer Support to assist individuals who are on probation. 11.63% 5  
Limited medical and mental health treatment providers in the jail. As well as lack of physical space for programming. 9.3% 4  
No pretrial services program. No organized post-adjudication diversion program/procedure. 6.98% 3  
Data and information sharing between system stakeholders. Development of a strategy for identifying “familiar faces” or “high utilizers” of behavioral health and criminal justice system, and coordination with new WRAP+ program and all involved agencies. 6.98% 3  
Access to medications for Opioid Use Disorder (all three, particularly Methadone). X-waivers for expanding provision of buprenorphine. No Opioid Treatment Program in-county. Expanded substance use prevention harm reduction efforts. Expanded access to Naloxone and related training for community (locations and hours of operation. Naloxone at shelter locations. Additional secure drug takeback locations and drug disposal products in the county (e.g.. Deterra or DisposeRx). Additional syringe exchange locations. Utilization of Overdose Detection Mapping Application Program (ODMAP). 4.65% 2  
Expansion of co-responder program throughout the county (a co-responder program is currently being implemented within the City of Winona). 2.33% 1  
Total Responses: 43      

ACKNOWLEDGEMENTS

This report was prepared by Chanda Funcell, Arnold Remington, and Michele Saunders of Policy Research Associates, Inc., which operates the Substance Abuse and Mental Health Services Administration’s (SAMHSA) GAINS Center for Behavioral Health and Justice Transformation. SAMHSA’s GAINS Center wishes to thank the Winona County Criminal Justice Coordinating Council for organizing this effort, as well as all the local stakeholders who participated.

RECOMMENDED CITATION

SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation. (2021). Sequential intercept model mapping report for Winona County, Minnesota. Delmar, NY: Policy Research Associates.

Agenda: Sequential Intercept Model Mapping Workshop

Agenda (Part I)

9:00 a.m. - 9:30 a.m. Registration and Networking

9:30 a.m. - 9:40 a.m. Welcome and Opening Remarks

9:40 a.m. - 10:00 a.m. Introductions

10:00 a.m. - 10:30 a.m. Sequential Intercept Model Presentation

10:30 a.m. - 10:45 a.m. Break

10:45 a.m. - 12:30 p.m. Concurrent Focus Groups

12:30 p.m. - 1:30 p.m. Lunch

1:30 p.m. - 2:45 p.m. Concurrent Focus Groups - Continued

2:45 p.m. - 3:00 p.m. Break

3:00 p.m. - 3:55 p.m. Facilitation Discussion of Priority Areas and Voting

3:55 p.m. - 4:00 p.m. Closing and Next Steps

Agenda (Part II)

9:00 a.m. - 9:15 a.m.

9:15 a.m. - 9:30 a.m.

9:45 a.m. - 10:15 a.m.

10:15 a.m. - 10:20 a.m.

10:20 a.m. - 10:30 a.m.

10:30 a.m. - 11:45 p.m.

11:45 p.m. - 1:00 p.m.

1:00 p.m. Closing and Next Steps