CommStat 1/24/19
Everyday I grow stronger… Everyday there is a chance. -Anonymous
CommStat Principles: 1. Timely and accurate information and intelligence 2. Effective tactics and strategies 3. Rapid deployment of resources 4. Relentless follow-up and assessment *Adapted from NYPD’s CompStat
CommStat Ground Rules: • We will be addressing serious issues; we need to be tough-minded about them • Work collectively to develop creative, innovative solutions, do not focus on deficiencies • Ask direct, difficult questions, but do so respectfully • Provide candid, honest answers, do not be defensive • Make space for others to speak • If you don’t know the answer, it is okay to say “I don’t know” and provide a timeframe for when you can get the answer • Celebrate successes! • Critique ideas and debate issues, not people • Use evidence not opinions, challenge assumptions and inferences • Ask for and offer ideas and solutions • Don’t be afraid to fail • Be present, no distractions, ringers off. Use breaks for work.
Monthly Data Reports from our Partners Kayla Donohue, MPH
Accidental or Undetermined Opioid-Related Fatalities Among Chittenden County Residents, 2010-2017 30 28 25 21 20 20 17 17 16 16 15 13 13 13 12 11 10 12 10 9 10 8 10 8 8 5 4 5 3 5 5 4 1 3 3 0 0 1 0 2010 2011 2012 2013 2014 2015 2016 2017 All Opioids Rx Opioid (No Fentanyl) Heroin Fentanyl Source: VDH
Accidental or Undetermined Opioid-Related Fatalities Among Chittenden County Residents, 2018 * Indicating preliminary data, with 6 pending cases statewide 4 2 2 2 1 1 1 1 0 0 0 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov* Dec* Source: VDH
Source: SIREN, VDH
Source: SIREN, VDH
Source: Valcour
Monthly Surveillance of Opioid-Related Emergency Department Visits at UVMMC 30 25 23 20 16 15 15 11 11 10 10 9 11 8 7 7 8 5 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2018 2015-2017 Average 2015-2017 Min 2015-2017 Max Source: UVMMC
Individuals Enrolled, Admitted, and Waiting by Month at the Chittenden Clinic (Hub) 45 1020 40 1006 1010 35 33 30 1000 25 990 20 15 980 10 970 5 0 960 Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Waiting Admitted Census Data Source: Howard Center Chittenden Clinic
Number of Medicaid Beneficiaries Treated in Chittenden County Spokes, Sep 2013-Sep 2018 700 645 600 500 400 959 all payer patients 300 on MAT at spokes with 74 total prescribers as 200 of Nov. 2018 100 0 Sep-13 Dec-13 Jun-14 Sep-14 Dec-14 Jun-15 Sep-15 Dec-15 Jun-16 Sep-16 Dec-16 Jun-17 Sep-17 Dec-17 Jun-18 Sep-18 Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Source: http://www.healthvermont.gov/sites/default/files/documents/pdf/ADAP_OpioidUseDisorderTreatmentCensusandWaitList.pdf
Safe Recovery Services & Statistics General Safe Recovery Statistics • 5,113 members of the syringe exchange • Greater than 20,000 doses of Narcan given from December 2013 to December 2018 • 1,381 reported overdose reversals since December 2013 Safe Recovery by the numbers, fiscal year data 2018 • The syringe exchange was visited 6,926 times • 1,236 clients visited the exchange • 6,029 people accessed syringe supplies through secondary exchange • 303 new syringe exchange clients • Clients from every county in Vermont accessed our services • 872 clients were referred to treatment • 409,198 syringes were safely disposed of at Safe Recovery • 651,464 syringes were distributed at Safe Recovery
Safe Recovery Low Barrier Buprenorphine Program Data (October 22, 2018 – January 15, 2019) • Number Currently Receiving Prescription – 30 clients • Number Transitioned to Hub and Spoke – 16 clients • Chittenden Clinic – 2 client • Pine Street – 8 clients • CHCB – 5 clients • Appletree Bay - 1 • Incarcerated – 1 client • Declined/Unreachable – 2 clients
Police Data for Property Crime & Drug-Related Incidents Valcour Agencies in Chittenden County Nancy Stetson
Source: Valcour
Source: Valcour
Source: Valcour
Source: Valcour
Department of Corrections, December 2018 342 new intakes 1516 Average (Initial Healthcare 44 OUD Screening Daily Population Receiving Screening) 19 on 594 on 78 on 691 on MAT Naltrexone Suboxone Methadone 121 releases of 682 releases inmates on MAT 23 referrals to hubs (12/5/18-1/1/19) (12/5/18-1/1/19) 18% of inmates released were on MAT
http://annals.org/aim/fullarticle/2708164/next-stage-buprenorphine-care-opioid-use-disorder
Access to Medically Assisted Treatment in Federal Court Christina Nolan U.S. Attorney
Access While Under Release Conditions • Two forms of release for federal defendants: • Pretrial release conditions – the period between your initial appearance and your sentencing • Supervised release conditions – post-sentencing supervision, that is, period of supervision following your prison sentence (often mandatory minimum period of supervision) or period of supervision for those with non-incarcerative sentence • U.S. Probation Officers supervise defendants on release – certain officers do pretrial; certain do post-sentencing • Where offense involved drug use/addiction, conditions include drug rehab/treatment
Bureau of Prisons • Traditionally, Bureau of Prisons has not offer MAT to federal defendants • We do have Vermont Correctional Addictions Program (cognitive behavior therapy and motivational interviewing) – partnership with UVM and correctional facilities • First Step Act – appears to pave the way for MAT in BOP. • Requires BOP and U.S. Courts to submit reports to congressional committees regarding BOP capacity to provide MAT to prisoners and, including plans to expand access, then take steps to implement the plan
Pretrial Supervision • At your initial appearance, Court decides whether you should be detained as flight risk/danger to community or released on conditions • Probation officer conducts an thorough investigation to aid the court, prosecutor, and defense attorney in that decision, and makes a recommendation to all parties on release/detention. • Includes drug test and interview about drug use history • Can be on pretrial released with condition of drug treatment, which may include hub/spoke treatment; if already on MAT and it’s working, continues uninterrupted while on release. • Will be drug tested by US Probation to monitor compliance
Pretrial Supervision • Large share of our defendants are severe addicts • often detained pending (say 3 weeks) a proposed treatment plan (currently no MAT while detained) • Treatment plan typically includes residential stay at Valley Vista or Serenity House, followed by aftercare plan, which probation office oversees/monitors. Valley Vista will provide MAT. • If it’s working, MAT through clinic or spoke can continue while on pretrial release. • Strict compliance monitoring by USPO, including rigorous drug testing. Violation of release conditions can result in pretrial detention. • Pretrial supervision usually lasts 6 months – year, depending on case
Post-Sentencing Supervision (Supervised Release/Probation) • Those who finish the incarcerative term of their prison sentence or no prison time at sentencing go on supervised release or probation • Supervised release conditions give probation officer discretion to require drug treatment. • Treatment includes strict monitoring, including drug testing • As with pretrial supervision, defendants on supervised release can participate in MAT through hub/spokes, if it’s working • Supervised release for drug defendants typically a mandatory minimum of three years; sometimes more • Violations can result in return to prison
Federal Drug Courts • “Diversion” court in Rutland, run by Chief Judge Crawford • Those with addiction-motivated offenses plead guilty to felony, and enter program that lasts 12 months. • Bimonthly in-court meetings with Judge; Howard Center, defense counsel, federal prosecutor, US Probation Officer, and Judge work together to aid defendant with sobriety plan, employment, social services, housing, etc. • Carrots and sticks. Serious violations result in revocation of release and proceeding immediately to sentencing • Graduation from drug court will result in sentencing and a non- incarcerative sentence (just supervised release). Other possibilities include misdemeanor disposition or dismissal • Those in drug court may opt to avail themselves of MAT, if such treatment is working for them
Federal Drug Courts • Burlington re-entry court • Run by Magistrate Judge Conroy. • Same structure and stakeholders as diversion court, but this court aims to transition back to community addiction-driven defendants who have served jail time and are starting supervised release • Can be on MAT if it’s working for defendant • Incentive is reduction in term of supervised release • Serious violations result in revocation of release and return to prison
CRIMINAL JUSTICE OVERVIEW SARAH GEORGE – CHITTENDEN COUNTY STATE’S ATTORNEY BECKY PENBERTHY – VERMONT PRETRIAL OPERATIONS DIRECTOR STEPHEN VONSITAS – REGIONAL PROGRAM COORDINATOR – TREATMENT COURT
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