Dr. James Davy: A Seamless Continuum of Mental Health and Addiction Treatment Services for Justice-Involved Individuals in New Jersey

By Dr. James Davy, Distinguished Practitioner in Residence, Rutgers SPAA
Research Funded by the New Jersey State Policy Lab

Disrupting a Fragmented System

The professional staff of the New Jersey Reentry Corporation and other public and nonprofit service providing agencies can attest to the problem of fragmented and uncoordinated service-delivery systems that inhibit efforts to meet the mental health and substance use needs of previously incarcerated individuals in New Jersey. Typically, many previously incarcerated individuals fall through the cracks, unable to access timely assessment, treatment, and recovery supports. From intake to reentry and beyond, too often these individuals encounter closed doors and dead ends. Such barriers render comprehensive solutions elusive, leading to poor outcomes including recidivism, homelessness, and premature mortality.

With support of the New Jersey State Policy Lab, and working in partnership with the New Jersey Reentry Corporation, founded by former Governor James E. McGreevey, the Rutgers University School of Public Affairs and Administration and its Center for Applied Appreciative Inquiry are embarking on Appreciative Inquiry (AI) driven process to “Develop a Policy Portfolio for a Seamless Continuum of Mental Health and Addiction Treatment Services for Justice-Involved Individuals in New Jersey.”

Through this joint project, the NJ Reentry Corporation and the Center for Applied Appreciative Inquiry aim to disrupt the deficits, gaps, and weaknesses of the current system by bringing together key multi-sector stakeholders to collaboratively design a policy portfolio that enables cohesive integration and continuity of screening, assessment, treatment, and recovery services. The vision is to co-create a seamless continuum of care capable of reaching people where they are, when they need it. Our plan is to engage relevant stakeholders in appreciative dialogue which is grounded in a deep-dive inquiry of the system’s strengths, collective imagination of practical solutions grounded in those identified strengths, innovation of workable and aligned policies and practices, and implementation driven by people with lived experience.

Appreciative Inquiry Inspired Policy Transformation

To accomplish our goal, we will use Appreciative Inquiry (AI), a positive dialogic process focused on the discovery of systemic strengths and using those strengths to co-design transformative solutions. AI provides a process for motivating transformative change by exploring the root causes of success, rather than diagnosing problems. Facilitated sessions will convene multi-sector stakeholders from state and county government, criminal justice, healthcare, social services, housing, community providers, advocates, and importantly, justice-involved individuals and families. Through storytelling, identifying shared values, and envisioning possibilities, stakeholders will gain a renewed appreciation for existing assets and bright spots upon which to build a new, transformed system of mental health and addiction treatment services for justice-involved citizens.

The Rutgers University Center for Applied Appreciative Inquiry will facilitate dialogue in a way that enables stakeholders to imagine how fragmented services can be woven into a coordinated continuum anchored in person-centered care. This uplifting, appreciative approach will provide the momentum needed by stakeholders to effectively and positively collaborate in strengthening current systems and in creating new ones.

Translating Aspirations into Inspirated Transformations

Guided by a common purpose, key stakeholders will translate high-level aspirations into concrete policies and programs. Workgroups will research evidence-based and emerging best-practice models from other jurisdictions to inspire innovative solutions tailored for New Jersey’s needs. While ideas will emerge from the facilitated process, it is envisioned that some potential areas of co-designed solutions might include but not be limited to:

• Early Intervention and Diversion, such as mobile crisis response teams to divert those with behavioral health crises away from arrest. Expansion of mental health and drug courts utilizing community-based treatment instead of incarceration.
• Care Coordination and Transition Support, such as cross-sector case management teams to coordinate services for discharge and post-release planning.
• Treatment and Recovery in Reentry, such as expanded Medicaid eligibility for justice-involved populations. Medicaid and grant funding for transitional housing, vocational training, and peer support. Embedding social workers and recovery coaches in community supervision. Removing barriers to support groups and spiritual community participation. Technical assistance and reimbursement incentives for treatment providers offering reentry programs.
• Workforce Development and Capacity Building, such as cross-sector training on cultural competence, trauma-informed approaches, and recovery principles. Loan forgiveness and scholarships to expand justice-involved peer support workforce. Enhanced reimbursement for team-based integrated care models and licensing and oversight policies that promote quality of care.

First Step – Conduct a SOAR Analysis

One of the first steps in the Appreciative Inquiry process is conducting a SOAR inquiry. Individuals who can influence the design and implementation of policies and those who may be affected by those policies will be invited to one of three SOAR forums to discuss systemic Strengths, Opportunities, Aspirations, and Results. The data from these forums will be analyzed and themed to identify transformational topics for discussion at an Appreciative Inquiry summit.

Next Step – An Appreciative Inquiry Summit

An Appreciative Inquiry Summit will bring stakeholders together to design the policy portfolio. Appreciative Inquiry Summits can range in size from 100 stakeholders to 1,000. It is anticipated that this summit will involve upwards of 350 key stakeholders. At the summit, participants will co-design a portfolio of policies and programs for transformational systemic change.

Ongoing Steps – Implementation

The most challenging work will occur post-summit during the implementation phase of the project. The proactive work of key stakeholders in promoting and advancing adoption and implementation of the policy solutions will follow the summit.  Innovative multi-sector working groups will form, including government leaders, agency officials, healthcare administrators, justice partners, frontline service providers, advocates, and importantly, individuals with lived experience. These working groups will be charged with the task of advocacy and implementation. These groups will finalize policy and program design details, identify needed resources, and develop communication and outreach strategies.

The Promise of Whole System Stakeholder Engagement

While certain policy aspirations were previously outlined, the beauty of the Appreciative Inquiry approach is that the whole system of stakeholders will define what policies, programs, and services will be needed to create the seamless continuum. The Center for Applied Appreciative Inquiry trusts that the process will yield workable and transformational solutions that make sense for the justice-involved community.

Conclusion

This promises to be a very engaging, dynamic, and fun process leading to policy change. If you are involved in the systems of care and supports for justice-involved individuals or you have lived experience in ‘the system’ and wish to be involved in the process of co-designing a Seamless Continuum of Mental Health and Addiction Treatment Services for Justice-Involved Individuals, then please send an email to James M. Davy, PhD, Director, Rutgers University Center for Applied Appreciative Inquiry at jdavy@newark.rutgers.edu.