Michele Rosiere, MSW
Vice President of Programs
Competency Restoration Training
The SAMH team provides competency restoration training (CRT) to over 450 clients who have been found Incompetent to Proceed. This training is provided at the BRHPC office and in the community at residential programs including Henderson Headway, Chrysalis, Henderson CSU, Archways, House of Hope, STAR, and Order My Steps. The program also provides individual training to incarcerated individuals in the Main Jail, North Broward Bureau, Victor Conte Detention Center and Paul Rein Detention Center in Broward County. The competency curriculum is tailored to meet the needs of clients who have special needs as well as clients who are only in need of a fast track review of the legal process. Training is provided five days a week, with sessions at varying times of the day and evening to accommodate all schedules.
The program serves as a bridge that spans across the community, the jail, the forensic hospitals and the criminal justice system impacting the lives of a wide spectrum of individuals. Services include competency restoration, linkage to mental health services, peer support, housing placements, discharge planning, and linkage to public entitlements. The program promotes successful community re-integration of these individuals entrapped in the criminal justice system. It provides support and services to keep them psychiatrically and medically stable and provides engagement in meaningful activities. Team members have direct contact with individuals, have knowledge of the needed services and are able to link them to services.
The CRT program utilizes a 12-week curriculum provided to clients who are mandated into the program by Court order with the specific purpose of achieving competency restoration generally while released into the community on conditional release or while they are in Broward County jails. The curriculum includes an embedded emphasis on living successfully in the community while on conditional release and looking at their lives beyond the short-term of the competency classes. Peer specialists are an integral part of this process. They assist with the training sessions, provide individual support as needed and act as role models for the goal of recovery and resilience. As members of the SAMH team, they provide perspective on living with mental illness and advocacy for the people with whom we work to increase the team’s effectiveness in providing services. At the end of a training series, clients are re-evaluated to determine level of competency and risk factors.
Post-Arrest Diversion Program
The Post-Arrest Diversion Program at Broward Regional Health Planning Council, Inc., seeks to divert individuals with serious and persistent mental illness from the criminal justice system and into a structured, outpatient treatment protocol. Prerequisites to program eligibility include a history of non-violent, 3rd-degree felony charges, and a history of mental illness, specifically concerning serious, long-term mental illnesses. Determination of program eligibility is a collaborative effort between the State Attorney’s Office, the Public Defender’s Office, and the Mental Health Diversion Program by way of the referral process. Once the State concludes that the individual has met the legal criteria for The Program, an evaluation request is sent to The Program for this individual.
The defendant is then evaluated by The Program to determine whether the mental health criteria is satisfied; evaluations include The Program’s preferred interview and psychological assessment battery, which examines symptom validity, psychiatric symptoms, cognitive ability, and risk factors. Evaluations are conducted at the Broward Regional Health Planning Council, Inc., and supervised by The Program’s Licensed Psychologist. The evaluation process for each individual is conducted in approximately two hours. Results of the evaluation are scored and interpreted to form a comprehensive diversion report. Upon completion, the diversion report is submitted to the State Attorney’s Office with a diagnostic opinion and recommendation for program participation.
If a history of severe and persistent mental illness in corroborated by the report, the individual meets mental health criteria for the diversion program. Evaluation results indicate if the patient is able to comply with all therapeutic and legal aspects of the program for a duration of one year. During the first 6 months of The Program, clients are expected to attend weekly psycho-educational group therapy sessions, partake in individual insight-oriented psychotherapy, and receive medication management from a physician. Psycho-educational group therapy provided by the Diversion Program is Moral Reconation Therapy (MRT). MRT is an evidence-based, cognitive-behavioral approach for substance abuse treatment and criminal justice offenders. Clients are also provided with intensive case management, weekly individual therapy sessions, psychiatric services, and medication management, in addition to housing and vocational services. Individual therapy is also evidence-based and adheres to the basic principles of cognitive behavioral therapy, motivational enhancement, and intensive psychosocial support. During the second half of the program, clients are expected to continue with individual therapy, psychiatric services, and medication management, as needed; group therapy sessions and intensive case management are reduced from weekly to monthly services, case management is tapered to as needed on a case by case basis.
The diversion evaluation protocol consists of 3 phases; 1- initial assessment (indicates the presence of mental illness, 2-step-down (determines readiness to advance to phase 2 of a program), and 3-termination (determines readiness to discharge from the program and have felony charge dismissed by SAO. Upon discharge, the participants will be connected to community mental health providers to continue treatment in order to further stabilize your mental health condition. Each evaluation is meant to serve as a clinical marker of current concerns regarding cognitive ability, psychiatric symptoms, symptom validity, and risk factors.
Nova Southeastern Doctoral Students contribute by participating in clinical activates conducted at BRHPC.
State Hospital Case Management
The State Hospital Case Management team works to provide services and explores appropriate community residential options to individuals that are deemed not competent to proceed or not guilty reason of insanity and are ordered to treatment in secure forensic hospitals. The BRHPC State Hospital Case Management team coordinates care for Broward County clients in South Florida Evaluation and Treatment Center and South Florida State Hospital located in Miami-Dade County, Treasure Coast Forensic Treatment Center located in Martin County, North Florida Evaluation and Treatment Center in Gainesville, Northeast Florida State Hospital in MacClenny near Jacksonville and Florida State Hospital in Chattachooche in the Florida panhandle. Court Liaisons attend felony mental health court sessions.
The Substance Abuse and Mental Health (SAMH) program is contracted by Broward Behavioral Health Coalition to provide linkage, support, and advocacy to clients who have mental health or co-occurring disorders and are involved in the felony court system in Broward County. This involves being present in the felony mental health courts, visiting clients in the six state mental hospitals, providing linkage to case management agencies for all defendants who are found Incompetent to Proceed (ITP) to trial due to mental illness, and conducting training designed to restore these individuals to competency so they can proceed through the judicial process.
The BRHPC SAMH Team provides services in three main areas. The programs include Competency Restoration Training (CRT), Post-Arrest Diversion (PAD) and Forensic Hospital Case Management. In all these areas, we try to promote the idea that each individual can break the cycle of frequent recidivism in the jail during the competency restoration process and reoffending after being found competent. The SAMH Clinician is responsible for processing all referrals of clients who are found ITP in the Felony courts. First, the referrals are reviewed for completeness. Next, a clinical determination is made of the client’s suitability for services, based on their mental health and/or substance use disorders, general intellectual ability to comprehend competency restoration material and specific competency deficits. Clients are then linked with appropriate community agency for case management and medication services, as well as to enrollment in competency restoration services at BRHPC. Services are delivered in English, Spanish and Haitian Creole by BRHPC staff. Contracted interpreters are used with anyone who needs an interpreter including those who communicate using American Sign Language. Assistive Aids are also available for clients who are hard of hearing.
All services are delivered in an atmosphere of unconditional positive regard with a focus on resilience and recovery. While we have a variety of specific tasks within the Forensic Judicial System including Competency Restoration and linkage to the community, our overriding goal is to provide strengths-based, person centered, culturally and linguistically response, trauma informed services to all our clients. We have adapted our services to include Evidence Based Practices that support our clients’ movement toward recovery. These EBP’s include Motivational Interviewing, Comprehensive Continuous Integrated System of Care, Screening, Brief Intervention and Referral to Treatment (SBIRT) and Moral Reconation Therapy (MRT).
Hospital Liaisons coordinate care for Broward County clients in South Florida Evaluation and Treatment Center and South Florida State Hospital located in Miami-Dade County, Treasure Coast Forensic Treatment Center located in Martin County, North Florida Evaluation and Treatment Center in Gainesville, Northeast Florida State Hospital in MacClenny near Jacksonville and Florida State Hospital in Chattahoochee in the Florida panhandle.
SAMH Court Liaisons attend felony mental health court sessions four days a week. They are located in the courtroom of Judge Ari Porth. They are also available to assist in all other felony courtrooms where ITP clients’ cases are heard.
The SAMH team also includes Certified Peer Specialists who provide advocacy and support to all our clients. In an effort to train more Peer Specialists, the BRHPC Training Institute, a certified licensed training provider with the Florida Certification Board for Continuing Education
Units/Credits (CEU), offers training to promote the Florida Certification Board’s new professions, “Substance Abuse Peer Specialist” or “Recovery Support Specialist,” and “Adult Mental Health Recovery Peer Specialist.” The Institute’s mission is to assist consumers and family members through recovery and resiliency, while promoting employment for individuals and families with substance abuse recovery and mental health needs. The main objective is to assist consumers to obtain Certification and secure employment in mental health and substance abuse recovery settings.
The Peer Specialists aid clients in completing the Social Security Income/ Social Security Disability Insurance (SSI/SSDI) Outreach, Access, and Recovery (SOAR) application. The SOAR application is a form of benefit acquisition, as it will allow the client to be eligible for Social Security Income and Disability. The Peer Specialist also provides individual support and interim services while the client is waiting to be admitted to the Post-Arrest Diversion Program. Additionally, the Peer Specialist acts as a role model for the goal of recovery and resilience.