SOAR Webinar: SOAR A Reentry Tool for Individuals Involved in the Criminal Justice System

SOAR Webinar: SOAR A Reentry Tool for Individuals Involved in the Criminal Justice System

August 22, 2019 0 By Kailee Schamberger


– [Pam] Hello everyone
and welcome to the first webinar in our fiscal year
of 2019 webinar series, titled SOAR: A reentry tool
for individuals involved in the criminal justice system. The SOAR TA center is pleased
to bring you today’s webinar in partnership with the
SAMHSA GAINS Center. My name is Pam Heine,
senior project associate with the SOAR TA Center and I
will be your moderator today. Before we begin, just a few
housekeeping items to review. A disclaimer. This training is supported
by the Substance Abuse and Mental Health Services Administration and the US Department of Human Services. The contents of this
presentation do not necessarily reflect the views or
policies of SAMHSA or DHHS. The training should not
be considered substitute for individualized care
in treatment decisions. Just a few webinar instructions. As a reminder, your lines will be muted throughout the entire webinar. This webinar is being
recorded and will be available for download on the SOAR
website in about a week or so. You may download the presentation
slides or other materials now by going to the
top left of your screen and clicking file, save,
document, or visit the SOAR website at SOARworks.prainc.com,
click webinars, on the left side bar and
choose today’s topic. At the conclusion of the
webinar, you will immediately be redirected to a brief
evaluation, which we kindly ask you to complete and finally,
we will save all questions and comments until the
end of the presentation, at which time we will review
instructions for posing questions to panelists
via the Q and A function. A few learning objectives. It is our intention that
by the end of this webinar, you will learn about key
strategies and the best practices for introducing SOAR and engaging your criminal justice community. Today’s agenda, so to reach
those objectives, we will begin this afternoon with
presentations from Dazara Ware, who is a senior project
associate with the SOAR TA Center and Dan Abreu who is a
senior project associate with the GAINS Center, both here at Policy Research Associates. They have collaborated
extensively over the years with establishing SOAR
initiatives within the criminal justice systems around the country. You’ll then hear from Paul
Mulloy, who is the Director of Programs with the
Nashville Sheriff’s Office in Nashville, Tennessee and
Lolita Johnson, a LEAD SOAR Counselor with the Davidson
Country Sheriff’s Office in Nashville, Tennessee. They will share how they have implemented SOAR within their jail system. Next up, providing a SOAR Prison
Implementation perspective for the state of Oklahoma
are Donna Bond, who is the Coordinator of Mental Health
Reentry with the Oklahoma Department of Corrections
in Oklahoma City, and Marcus Ayers, the Manager
of Prison Based Reentry Services, also in Oklahoma
City, with the Oklahoma Department of Mental Health Services. And finally, we’ll have
plenty of time for Q and A, which are facilitated by the
SAMHSA SOAR TA Center staff. So providing today’s
welcome, we have Robert Grace who was our project officer at SAMHSA. Bobby, please provide your welcome. – [Robert] Yes, hi, thanks. I’d like to start by,
again, thanking all of you for joining us today. I’m Bobby Grace and on
behalf of the Substance Abuse and Mental Health Services
Administration, SAMHSA, and the Homeless Programs
Branch of the Center for Mental Health Services, I would
like to welcome you to this joint webinar with SAMHSA SOAR TA Center and SAMHSA GAINS Center
for behavior health and justice transformation. This webinar is titled SOAR:
A reentry tool for individuals involved in the criminal justice system. SOAR, which stands for SSI/SSDI
Outreach Access and Recovery helps states and communities
increase access to social security disability
benefits for eligible adults who are experiencing or
at risk of homelessness and have a serious mental
illness, medical impairment, and or a co-occurring
substance use disorder. Today’s webinar will feature
speakers who will share their best practices for
implementing SOAR in a county jail, state correctional system, and explore how SOAR implementation in
criminal justice settings can be a strong reentry tool to increasing housing stability and
promote post-release success. And now, I would like to turn
things back over to Pam Heine who will be moderating
today’s webinar, Pam. – [Pam] Thank you, Bobby. So now I will turn it over to Dazara Ware, who will kick things off. Dazara, please begin your presentation. – [Dazara] Awesome, thank
you Pam for that introduction and thanks to the guests attending
today and taking the time to participate in this webinar. We are super excited to have you here. As mentioned, this webinar
is entitled SOAR: a tool for reentry for individuals involved in the criminal justice system. It’s intended to explore
the intersection of criminal justice and behavioral
health and how the SOAR model can be used in effort to
address the challenges associated with reentry and
recovery for individuals involved in the criminal
justice system with serious mental illness, physical
disabilities, and or co-occurring substance abuse disorders. Our presenters will share
their work and their experience with SOAR implementation in
both jail and prison settings, but first, let’s cover some basics. So what is SOAR? So for those guests that have
experience with assisting others with disability
applications, please bear with me as I quickly review some of the key points for others that may not be as familiar. To start, SOAR stands for, as
Bobby, Robert Grace mentioned, SOAR stands for SSI/SSDI
Outreach, Access, and Recovery and it’s a model that’s
sponsored by SAMHSA in collaboration with the
Social Security Administration. It’s developed to assist
eligible individuals applying for the two
disability programs that are administered by the Social
Security Administration. SSI, which is supplemental
security income, and SSDI, which is social
security disability insurance. This model is specifically
designed to help states increase this access to
these benefit programs for eligible adults who
are experiencing or at risk of homelessness and have
a serious mental illness or other disabling condition. Yes, it’s in all 50
states and Washington D.C. However, it’s important to
note that although SOAR’s presence is marked nationwide,
there are many communities within each state that may
not have SOAR providers, well just yet. The SOAR TA Center is
working really hard to expand SOAR to the point where
every community everywhere will gain access to SOAR
providers in the future. So I mentioned the two disability
programs, SSI and SSDI, so let’s take a closer look. So each program has the same
criteria for determining disability based on medical evidence and functional abilities. Both programs utilize the
same application process and although they have
different application forms, they share one disability determination. Each program has an associated
health insurance program. The one on the left is the supplemental security income, or SSI. This is a needs based program
for individuals who are blind, disabled, or elderly
with low income or resources. The federal benefit rate
for this program is $750, which is a way of saying that’s
the maximum amount awarded with federal dollars that’s approved. And this program is accompanied
by Medicaid in most states and again, this is a needs
based program so resources are really heavily
investigated and looked at. In short, if the applicant
has resources and there is no need, they won’t be
eligible for that program. But on the other hand, or
should I say on the right side of the slide, is the social
security disability insurance, or SSDI, also for blind
or disabled individuals. But these individuals
are insured through their contributions to the
social security trust fund. So based on their work, the
amount of money they contributed into that trust fund while
working will yield the award amount if that person became
disabled and in most states, Medicare is associated
and generally provided under this program. Again, these are both
disability programs that require an applicant to meet SSA’s
definition of disability, defined as the inability to
engage in substantial gainful activity or work with a
monetary amount that looks like earnings of $1180 a month, as
of 2018, that have a medically determinable physical or mental
impairment that is lasted or is expected to last a
continuous period of 12 months or more or result in death. In addition to that
definition, I think it’s really important to point out that
there’s a myth that’s often heard with people that work
with individuals in criminal justice settings that have
been circulating around the country for years and years
and that is that if a person is incarcerated, they’re
automatically eligible for disability and that’s simply not true. Incarceration is viewed
as a living situation and not a disabling condition. However, people that are
incarcerated with serious mental illness experience functional
limitations that kind of prohibit them from working
at that level long before they become incarcerated and
in fact, for many individuals, interaction with police can
be linked to the symptoms associated with their diagnosis
that is tied to the behavior that ultimately led to arrest
and further involvement in criminal justice
system in the first place. So that’s why we’re doing this work. But what happens to benefits when people, or someone, becomes incarcerated, well, that depends on a
couple of things, time, how long they’ve been
incarcerated and also it depends on what benefit program they were awarded. So if someone was receiving
supplemental security income for individuals that
received this benefit, there’s no affect on their
benefit if they were incarcerated for less than a calendar month. However, benefits are
suspended if the person is incarcerated for one to 12
calender months and terminated when they’re incarcerated
for 12 months or more. Be mindful that these are calender months, which is different than 30 days. For example, if someone
became incarcerated today, October 24th, and
released on November 27th, that person has been incarcerated
for more than 30 days, but not the full calender
month of October or November and there should be no effect
on their benefit check. When benefits are terminated however, they must reapply with a new application. When receiving social
security disability insurance, those recipients are eligible
to continue receiving their benefits until they
are convicted and confined for more than 30 continuous days. Once released, the individual
can have benefits reinstated at the Social Security Office. They must, you know, arrive
at the office with discharge papers to show legitimate release. So as we continue to speak
about the SOAR model, it’s really important to have
those basic rules in mind and will help you plan the
course of action for discharge planners and reentry specialists
and others that prepare for an individual to be released. So now that we’ve covered
some of the basics, it’s with a very, very, very broad stroke, we will review what make SOAR so unique. We have our Super SOAR there
and says that SOAR trained caseworkers are the heroes. And that is definitely the case
and each of these components is expanded upon during our online course and through training. But in general, the SOAR model encourages a collaborative
process and facilitates communication among the
applicants, the case managers, social security, disability
determination services, community providers. It provides case managers
with the tools they need to assume a really central
role in gathering complete, targeted, and relevant information for Social Security and DDS. SOAR operates on the use of
some critical components, which is depicted in this
slide, one of which include acting as authorized
representative which is really key to allowing for two-way
communication between the Social Security office,
disability determinations, and the SOAR case manager. Collecting medical records, writing a medical summary
report, encouraging collaboration with treatment sources
to have that MSR signed, completing a quality review
to ensure that the information submitted is complete
and concise and stands up to the fidelity of the SOAR model. All of these things help
the disability determination process move more smoothly
and quickly by providing the assistance to Social
Security and DDS that’s needed. Another unique feature is
that SOAR seeks approval on the initial applications,
avoiding the need for appeals. And we tend to go above and
beyond by working to increase access to supportive services
and employment opportunities. There’s tons of support
available for SOAR providers. State and local leads kind
of spearhead and coordinate the implementation of the SOAR
initiative and these local leaders identify and engage
stakeholders to participate in starting committees
that kind of meet regularly to collaborate, report
on progress, troubleshoot any challenges, and basically
provide that continued support to SOAR case managers with
supplemental trainings and online core support. SOAR case managers are the kind of, they’re the crown jewel of the structure and work hard to provide
quality applications in order to yield the best results
for not only the individual but to demonstrate their
work in their efforts. All these are key players
and very valuable partners in the SOAR initiative, all
united to end homelessness and increase post-release
success for individuals with disabling conditions. And there’s more support. The SAMHSA SOAR TA Center will be with you every step of the way. Our website holds our
contact information for each of our liaisons that are
assigned to each state. We encourage strongly contact
and communication with us. Through our website you will
gain access to all the tools and resources that you
need to support you, including those
supplemental training tools and the online course access. Through continued support
and collaboration with state and local leads, SOAR
providers across the country continue to, well, they continue to soar. These are our national outcomes for 2018. Cumulatively, 50 states and
Washington DC have reported using the SOAR model to
assist over 71,705 people who are experiencing or
at risk of homelessness with disability applications. Again, this is the annual
report for last fiscal year, covering the date range of July 1st, 2017, to June 30th, of 2018. There is a 65% approval
rate on initial applications at 100 days to decision with
approximately 4,300 approvals. That’s a lot of lives that are changed. These outcomes can be compared
to the national average of 29% for all people
applying without assistance. Specific to our criminal justice outcomes, this report was generated
as of August 1st, 2018. It demonstrates or depicts
SOAR assisted applications that have been completed
for people that are living in correctional facilities. So as you can see, it’s
a 76% approval rate and average range of 79 days. And although these outcomes
are strong, our goal is to see more people that are currently
involved in criminal justice systems have access to SOAR services. Because we are confident that
the access to these benefits will really help promote
post-release success. The possibilities kind of
speak loudly and clearly. So SSI and SSDI, I’ve said
it about four times already, promotes post-release success. The income attached to this
benefit program really reduces state cost in a way that
we might not consider. The insurance that is
available creates healthier individuals that are more
likely to participate in treatment and thereby
creating healthier communities. But I want to emphasize the
income portion, because of it’s connection with housing,
making it a strong factor in post-release success and promoting the participation and treatment. It’s really hard to think
about treatment when you’re basic needs are not met
due to having no income and no idea where you’re
gonna lay your head at night. The use of SOAR to secure
funding to, that can promote funding, housing opportunities
and housing stability, that’s so desperately
needed upon post release, increases the treatment
participation and decreases the utilization of hospitals
and emergency rooms for care. Collaboration is the
cornerstone for SOAR success. Partnering with medical
records providers, community mental health providers,
sheltering agencies, housing partners,
hospitals, court systems, probation, parole, on and on. Why? Because partnerships and
collaborations are critical to any reentry program success. We share the same clientele
and often provide the same services to the exact same person. Avoiding the missed opportunities
to share our information could save valuable time
and resources and promote a true recovery model for a person, for the people that we serve. Working together to strategize
ways to share information and organize our effort
to assist this individual with the tools they need
upon release in order to reduce their likelihood of returning into the criminal justice system. Here are some facilities well
on their way to SOAR success. So since 2017, 12 agencies
have responded to the call and are working to implement
SOAR within their programs and their criminal justice programs. They have applied for and
received a technical assistance award which will be discussed
a little later in this webinar to strategize a plan
for SOAR implementation in their facilities. They understood the urgency
to connect with the people they serve with the resources
that they needed to promote successful community integration. They worked really hard through
the delays in implementation due to staff changes, leadership
changes, limited resources, workload demand, and are
using the outcomes as leverage to fund in conversations because the data can no longer be overlooked. The challenges faced by reentry
planners, case managers, court systems, and all those
other partners that are responsible for assisting
individuals comply with the conditions of release while
still looking for resources to meet basic needs such
as housing and treatment is exceptionally challenging when the individual has no income and no support and is unlikely
to maintain employment due to disabling conditions. So where do we start? First, start off by believing
that recovery is possible and approaching SOAR implementation from the solutions based perspective. Benefits acquisitions may
not solve every single issue, but it’s a start to
alleviate some of them. Then consider a pilot,
stick with the plan, and give yourself time to see the results. Identify the need, create
a proposal by discussing prevalent, the prevalence
of mental health needs within one facility or unit or pod. Mainly focusing on those
units that may house people with the most serious conditions. Do some research, calculate
how much it costs to house those folks with serious
mental illness in your agency and compare it to the reduction
of the cost if that person was in the community at
the earliest possible time. Then provide that information
to the decision makers and authority within your
agency to emphasize SOAR success and highlight that success that has been demonstrated around the country. Work with your SOAR TA
center, your liaison and we can help with the
communication with Social Security and DDS and encourage those
post-release, those pre-release agreements and, you know,
facilitate communication and collaboration so that there
could be a true initiative. Give yourself some time,
time to train, time to do, this is not like a fill
the form out and forget it kind of approach, it’s very hands-on. Give yourself time to see
results, one year to see some results, two years to see
a fully functioning program, and track your outcomes. Test the plan by creating a pilot site. Pilot sites provide a great
opportunity to test your plan in a focused kind of area. Address those challenges,
make those revisions, use those outcomes and results as leverage to continue talking to folks. Breathe, celebrate your success, learn from your mistakes, and repeat. This is a totally replicable
program that we hope to expand. So in conclusion of my
portion of this presentation, I know that we say that SOAR
is SSI/SSDI outreach, access, and recovery, but for the
purposes of this webinar today, I encourage you to think of
SOAR as SSI/SSDI opportunity to access resources to recovery. Thank you. – [Pam] And now I’ll
pass this presentation on to my colleague, Dan Abreu. Dan is a seasoned criminal
justice professional and a current senior project associate with the SAMHSA GAINS
Center in Delmar, New York. Dan. – [Dan] Thank you Daz. So as Daz provided an overview
that SOAR really is uniquely suited to address a lot of
the issues that are presented to the justice involved population. I’m gonna pick up from
there and talk specifically about to give you an overview
of some of the characteristics of justice involved
people with mental illness in the justice system. As a group, justice involved persons excuse me, while I, there we go. As a group, justice involved
persons are disadvantaged in many ways that result
in a higher prevalence of mental illness in the justice system. But also and not surprisingly
that result in inability to access healthcare and recovery support exiting the justice system. And SOAR can be a critical component to balance those inequities. If you look at the graphic on
the left side of your screen, there are almost two million
individuals incarcerated in the nation’s jails and prisons. For those of you who might not
know, the US has the highest incarceration rate in the world. There are an additional
four million people under probation or parole supervision. Looking at the graphic on
the right side of the screen, jails incarcerate pre-trial
individuals and individuals sentenced to one year or less. And prisons incarcerate
individuals in over one year. On any given day, there are
twice the number of individuals incarcerated in prisons than jails. However, and this is a staggering
number, there are almost 12 million people admitted yearly into jails
and often for lengths of stay of less than 30 days, which for
a person with mental illness is just long enough to disrupt
access to healthcare benefits housing, employment, and
other social supports. And this study from BJA
demonstrates the health care needs of justice involved individuals,
which is significant. What they found is that
there is increased prevalence of high blood pressure and diabetes. Three times the prevalence
of heart related illness. Four and a half times the
prevalence of infectious disease, including hepatitis, HIV, and TB. 10 times the prevalence of hepatitis. Over six times the
prevalence of tuberculosis and three and a half times
the prevalence of HIV. And looking at mental health
prevalence, the prevalence rate in the general population
of serious mental illness hovers around 4%. But in the justice system,
the rates of serious mental illness in jails is four times higher than the general population
and 75% of people in jails with serious mental illness
have a co-occurring disorder. Further challenge in providing
care to this population is the prevalence of trauma. This data’s derived from
individuals with mental illness who participate in one of 17 SAMHSA funded jail diversion programs. The trauma rates are, and as you see here, on the left, women identified
96% lifetime prevalence rate and men 89% lifetime
prevalence rate of trauma. The prevalence rates for
incarcerated justice involved individuals is the same for both genders. What surprised us a little
when we looked more closely at the data is the amount
of current prevalence that was identified by
people going through those jail diversion programs. And current trauma being
identified as having had a traumatic episode the
year prior to the arrest that brought them into the program. 74% of the women, 86% of
the men reported a traumatic incident the year prior to their arrest. What that means in terms of
people being released from jails and prisons is that very
often the first thing you’re dealing with is not so
much their treatment needs as it is safety needs. People are in unsafe relationships and living in unsafe environments. Parenthetically, you should
know that the rates for veterans the trauma rates for veterans
in another jail diversion program that focused on veterans were about the same as we see here. There’s a myth I think that trauma, for veterans, is solely related to combat. Not when you’re talking about
justice involved veterans. Veterans that went through
these jail diversion programs, less than 50% ever participated in any combat. But the data did show that 73%
of the veterans participating in the diversion programs had
73% had pre-military trauma. So again, addressing,
for the purposes of SOAR and for treatment planning,
documenting trauma is critical for these individuals. So other studies show that
people with serious mental illness are more likely to
be homeless, more likely to have co-occurring disorders,
use a greater variety of services at a higher cost,
and they’re more likely, when they’re in prison, to
have disciplinary problems, they’re more likely to be unemployed and have extensive
psychological impairment. And their length of
stay tends to be longer. Generally that’s due to
inability to make bail, which is further
compromised by homelessness. Because people with mental illness, this slide I’ll demonstrate
that people with mental illness are more likely to be
homeless and homelessness affects outcomes in the justice system. You can see the legend on
the right, street homeless in dark blue, shelter homeless light blue, non-homeless in black,
that at arraignment, street and shelter homeless
are two to three times less likely to be released at
their first court appearance and that they’re one and half
to three times more likely to complete their full sentence rather than being released early. So homelessness compounds
justice involvement. Now in developing your
programs, if you haven’t worked, oh I’m sorry. Again, some more information
about the nature of jails in developing your programs. Nationally, about three
quarters of people being held in jails really haven’t
been convicted of anything. They’re there on pre-trial
status, often because they’re poor and they can’t make bail. And of course in the case of
people with mental illness, because there’s a prejudice
towards keeping people in jail longer. When we look at New York
City, data from New York City, you’ll also find, and this
holds true across communities, that there is a group of high
utilizers, just as we have high utilizers in the healthcare
system, in the shelter systems, there are high
utilizers in the jail systems cycling around shelters,
jails, and emergency rooms. And this reveal of Riker’s
Island shows similar patterns. So they’ve identified 473
people over a five year period who had been admitted to
the jail over 18 times, mainly charged with low level charges and a significant percentage
with mental illness. And that these 473 people accounted for over 10,000 jail admissions. So again, when you’re thinking
about implementing SOAR, SOAR has had tremendous
success working with homeless populations and high utilizers
of services and people participating in housing
first initiatives. And these are exactly
the kinds of individuals that you’ll encounter and could benefit from a robust SOAR initiative. If you haven’t worked
in jails before, there’s developing the relationships
with the jail healthcare providers and the prison
healthcare providers is important. But they’re not the
same across the country. So there are some jails that
employ their healthcare staff, meaning that they’re
employees of the Department of Corrections or in
prisons or the sheriff’s department in the jails. There are other communities
that you’ll find where the county mental health department and the county health department
will come in to the jail and provide those services. There are other models
where the jail will contract with the national correctional
healthcare provider. These are providers that
specialize in providing custodial treatment across the country
and may not have any particular connection to the communities
that they are working in. And then the fourth model
would be where a jail contracts with a local provider
who might be a private or a public contractor. Of these three models,
probably the most challenging would be the national
correctional healthcare vendors that come in. Now, this isn’t like all
generalizations, some are better than others, but
generally these providers, the contract providers, will
do what they get paid to do and if there isn’t a discharge
planning piece to their contract, their main focus and
their mission is going to be on providing custodial care
and it will take a little bit more engagement and effort to enroll them and get them to participate
and spend their time to participate in SOAR initiative. So you should be aware of that. And that could occur in
either jails or prisons. Again, demonstrating the
importance of being able to access healthcare
and SOAR’s role in this, this study comes out of
the state of Washington where they followed 30,000
individuals released from Washington State prisons. And what they found over
a two year period is that 443 died during that
follow-up period, leading to a mortality rate three
and a half times that of the general population. Within the first two weeks,
the mortality rate was 13 times higher than the general population, with the primary cause of
death being drug overdose, heart disease, homicide, and suicide. So again, this dramatizes
the need to have access to care immediately upon release. Further emphasizing this
point, this slide depicts the risk of arrest as a
function of time spent in the community. The data demonstrates that
the highest risk of arrest is in the days and weeks
immediately after release. So you will note that those
charged with drug crimes have the highest risk of arrest,
two to three times higher in the immediate days after release. Again, highlighting the
need for health services upon reentry. So, having social security
benefits can address many of the inequities faced
by the justice involved persons with mental illness,
providing access to income, healthcare, and housing. In the work that Daz and
I and the SOAR Center have done over the years
assisting jails, prisons, and community partners in
development of SOAR programs, we’ve identified five areas
that need to be addressed in program development. Leadership, collaboration,
resources, whether or not there are competing initiatives that will interfere
with the implementation and then training. And I’m not gonna go into
these specifically now, rather as our next presenters
from Oklahoma and Tennessee are talking about their
programs, consider these five areas and how these programs
address these various issues. And we can address these
more specifically when we get to the question and answer part of the, of the presentation. So at this point, I’ll
turn the presentation over to Paul Mulloy, Director of
Programs for the Nashville Sheriff’s office and Lolita
Johnson, Lead SOAR Counselor from the Davidson County Sheriff’s office. – [Paul] First I want to
thank SAMHSA for allowing us to participate in this
webinar on the SOAR program. As many of you know, this
is a new initiative for us here in Nashville and we
hope to highlight some of successes that we’re
having and then also some of the challenges we’re
still working toward. In 2014, the mayor’s
office asked Sheriff Hall if he could plan, develop,
and implement a SOAR program within the jail system
and Sheriff Hall agreed and designated two full time staff persons to establish the SOAR
program in our facilities. Which we have four facilities here. And after a thorough training
through the SOAR process, these two individuals are
our assessors for all four of our facilities, along with
the case managers training on referring those that would
qualify for the SOAR program. We basically initiated in
2014 but probably didn’t get started really well until about 2016. This is a part of our
reentry effort as part of the transition from jail
to community initiative we started back in 2009. We see SOAR as an extension
of our reentry efforts. We provide all types of
programming, license, alcohol and drug treatment, battery
intervention programing, education, and SOAR is a key component to the mental health piece. It was just mentioned, the
collaboration of the health care inside the jail facilities,
we’ve been fairly lucky here, we do have contract health
care and part of that contract provides for a mental health
agency that is also located in the community so the
individuals providing the care inside the jail facilities
are also the ones that we are referring
back out to the community as well as others that
also provide SOAR access. This is a very innovative
program on our end. This is the initial part of
a program that we have not participated in before. We see it’s going really well,
along with the case managers and the SOAR counselors
were able to screen at least 350 or more people
to see who is eligible and apply those for benefits through the Social Security Administration. Lolita Johnson, I’ll
turn this over to her, she can go through some
of the mechanics of how we participate in SOAR, make
the referral, and then also apply the individual and
then I’ll come back and talk a little bit about some of
the tracking data we’ve been looking at for the last few years. Lolita, I’ll turn it over to you now. – [Lolita] Thank you Paul. So, again, my name is Lolita Johnson. I’m one of the Lead SOAR
Counselors here at the National Davidson County Sheriff’s Office. And I want to talk to you a little bit about our eligibility criteria. I know some people talk
about some of the barriers and this can kind of be a
barrier for us being that it is a jail and a lot of the
offenders that we work with do not stay in our facilities
longer than maybe a year and sometimes much shorter than that. But in our criteria, we have
individuals that are not currently in application
process or pending, which you all probably know. And also, they can not have,
they must have at least 120 days before being released from jail. We also only want people
with a severe persistent mental illness or have
experienced homelessness. And they have to be currently
working with our psychiatrist in the jail and taking medication there. So a lot of times we have a
lot of people that may apply or get a referral in with the
case manager that have not seen anyone, not doing anything,
so we have to kind of work with the case managers to,
you know, let them understand. And we have been fortunate
enough to be able to work with the case managers,
sit down with the staff, and let them know what we’re looking for. And we also are able to go
into the facility and talk to the offenders and let
them know kind of what we’re looking for so we’ve been
very fortunate with that. Another thing that’s been
cool with the criteria is that we also work
with mental health court here in Davidson county and
they make referrals as well so it’s not just the case managers. We can get referrals
from mental health court as well as the public
defenders office and a lot of outside agencies that may
have had someone that they were getting ready to work
with, they will also make referrals to us and that’s
been very helpful because we’re able to catch people that
may have been on the outside that were trying to get the
services but were not able to and then they were incarcerated. So we were able to help them,
so that was very helpful. Next, our technology piece. We thought this was important
because like Mr. Mulloy stated, we have been very
fortunate to have our mental health people inside the
facilities, so we have access to ERMA, which is the electronics records management assessment. And what this means is, me and
my co-worker, which I forgot to mention, her name is Angela
Clayborn, she’s actually not with us today, she’s in training. We have access to the medical
records, to the mental health records of
everyone in our facility. So we were able to get that
access so we can kind of see if they see the doctors, what’s
been going on, everything. So it makes it very easy for us. And we also get access to
the outside records they may have already come in that
the doctors have requested. So we have a lot of stuff already on hand that we don’t have to record
sometimes from the other agencies for the medical records. So that’s been very, very helpful. And this is also where we
keep our progress notes to document that we see the
person, we’re able to upload the records there, and
it’s been very helpful. Also the jail management
system, which is the sheriff’s office system, this is where
all our referrals are made. This is where we also put
the information to show we actually started
working with the offender all the way to the point of
the person being approved. And so we can keep a timeline
of when we started the process to when they were approved
and we can put in our system and keep a good track
record of how long it took as well as when the person is getting out of the facility as well. This is very helpful for
us, it’s our timeline I guess you could say. This part I’m gonna turn
it over to Mr. Mulloy and let him kind of talk about some of the statistics for you. – [Paul] What we’ve tried
to do the last few years is track the number of
individuals who have been approved for the SOAR program and
have benefits and released and of individuals that
we were tracking that met those criteria, there
was about 42 actually. And we looked at their
total number of arrests, which was really close to
about 500 arrests, 460 or so, and what we found is those
are very low level arrests, nuisance mainly charges, and
one year prior to the SOAR program being approved, on
average, the people were arrested three times,
on average, each year. And there’s a little misnomer I think. Sometimes in high risk
population, what we see when we track other programs, a
lot of people view recidivism as people never coming
back into the system. And unfortunately that’s
usually not the case. If a person has been involved
in the criminal justice system for several years, they’ve
built kind of a lifestyle that there’s a lot of
components that need to be fixed before they stay out of the system. And their potential to
come back to the system, unfortunately, is pretty high. Especially with SOAR population,
this is probably one of our most critical and highest
return groups that we deal with on a regular basis. But this gives you a little
bit of a feel for a one year prior to arrest before the
SOAR program was initiated. And then one year post initiated. And if you look, you got 94 of the individuals
that were approved, they were arrested about
94 times one year prior to the program and then after
release, that same number of individuals was
released, arrested 85 times. And a lot of times you’ll
look at that and say 85 is not much different than 94. But in actuality, they’ve
been arrested one or two less times the year after than
year prior to the SOAR program except your one
individual, he kind of blew the chart numbers off. But as you look at these
two charts, it’s obvious that some of them are doing really well. And they’re not reentering the system. And for the most part, these
individuals have been involved in the criminal justice
system for at least five to eight years. So the reduction is pretty
significant, especially for the ones who have
not returned in a year. When we were looking at
some of the training around why individuals come back
and how we can have a better impact on the ones who
come back into booking. So we did a couple things
that we really relative for what we needed to do. First, all the SOAR candidates that we’ve applied have been
approved by the Social Security Administration we put in our system. If they do come back to
jail, they’re flagged as a SOAR participant. So we can reengage those
individuals and find out what has happened and why
they’re back into the system. And one of the main reasons we see is the transportation issue. Our jails, a large portion
of our jails, are out probably about 10 miles
from downtown and the Social Security Administration
from that facility site is about 15 miles away. So what we’ve asked a lot of
the individuals that we’re reengaged who have come
back into the system is that they weren’t able to
get to the Social Security Administration to begin the benefits that they have been approved for. So for us, that was a
really good training piece and education that transportation
identification for the individuals who have already
been approved for benefits we needed to address and
that’s currently still an issue for us that we’re trying
to address currently. – [Lolita] I just want to add, Paul. Can I add, Paul? I wanted to show you one
of our success stories. We did have a gentleman
and it just kind of shows how our program works when
Paul talked about transition from jail to community. One thing we have been fortunate
with, not only do we have the relationship with
DDS and Social Security, but we also have been
fortunate enough to be able to get Social Security cards for offenders that, this population. So we had a gentleman that
actually went through the SOAR program but not only that,
he was able to get housing. We were able to get bus passes for him. We were able to get his
social security card and kind of get him into
everything and he has not been back to jail since he actually applied and everything’s been going really well. I actually was his case
manager on the outside, because, again, the
relationship with mental health cooperatives who we work with,
they kind of keep in contact and he’s doing really well. And you know, those are the successes that we really are proud of. And like Paul spoke about
earlier about the one guy that’s kind of off the charts,
you know, you’re always going to have a few that
come back, but the catch is that we do get flagged when
we see that and we’re able to try to connect with
that person to get them right back out and to see
what we can do to make sure that they don’t lose their
benefits and see what we can do to help them in any way possible. I mean, we do everything to
even making sure the discharge planner makes sure they have enough meds. Just everything, we try to
make sure we hit every avenue to, you know, get those
barriers out of the way the best we can. Just something I kind of
wanted to add in there because I think that’s important
to talk about the successes a lot of times we don’t get to hear those. Just wanted to add that. – [Paul] Let me just
follow up and close on that that for us, the major effort
for us here in Nashville is the transition from jail
to community and the SOAR program is a very good
fit for what we do here. When we apply someone for
benefits, we also look at all the other criminal
needs that they have. If they’re undereducated,
if they need housing, if they need transportation,
if they need a food box, or they need clothing, we
have a social network site called Base Camp that we
communicate internally with all of our community
partners on the outside and those other needs
are being met as well. So it doesn’t happen in a
vacuum, we really try to be as broad as we can when we’re
looking at all components of reentry and we think that’s
what success with not just the SOAR candidates but
also the other individuals that we deal with on the
other programming piece. At this time I want to
turn it over to Donna Bond and Marcus Ayers. – [Donna] Okay, thank you for inviting us to join in this webinar. First slide. In 2006, the initial planning
started for this collaborative program between the Oklahoma
Department of Mental Health and Substance Abuse Services and the Oklahoma
Department of Corrections. There were a few key
like-minded folks that were in administrative roles
with a common mission and that mission and goal
was first to decrease the recidivism rate for the inmates with the most serious mental illness. As you know, our state is like
every state, the seriously mentally ill are very
overrepresented in the prison and their recidivism rate. Since 2006, well, I want to say in 2006, the planning started and February
of 2007, services started with three integrated
services discharge managers in the prisons that have
the mental health unit and that have the most, the
highest number of inmates with serious mental illness. Next slide please. Since 2007, we’ve increased
the number of staff trained in SOAR training and
training with case management and just several different
evidence-based practices and assessments that we use in our program that we’ve built over the last 11 years. I want to say that since
we started in 2007, we’ve now worked with over
1000 inmates in Oklahoma. And also want to say
that our recidivism rate with this group since we
started, and we measure this in three year intervals, at last check, we were at 22% recidivism. We have cut it right in half on what, with the comparison group. So how we built and this
program is that we built and nurtured relationships with
several different agencies, like vocational rehab, all the
local Social Security offices the Department of
Developmental Disabilities, the Department of Human Services,
local housing authorities, HUD, which is the federal
housing authority. Basically anybody and
everybody that we can find that would join in with
us for this program and for our mission to
decrease the recidivism rate and to help get this population
approved and on public benefits so they would have a chance to stay in the community. Also, since we’ve started,
we’ve applied and been awarded four federal reentry grants
that have really helped go along with our state funded reentry. Our initial program was
possible through the funding of the Department of Mental
Health and Substance Abuse Services, that continued to
provide more than a million dollars per year out
of their general funds for our state funded program
and our community-based contract that people
transition to from prison to the community. The grant definitely helped
because we were able to expand and add a co-occurring population. So we were able to add a second
population and that their needs were a little bit different
but a lot of these folks also met criteria for disability
so when that was the case, we also made sure that those
applications were done as well. Next slide. Our goal is approval before release. And we want the approval
before release both for SSI or SSDI, if they
qualify, as well as Medicaid. We want to know that when the
people we are working with leave, that 30 days
after the day of release, they should be eligible
for that first check. And normally that goal is met. We start, we do our Medicaid
applications at 30 days pre-release and we have a
specific contact with DHS. We also have specific
contacts with our local Social Security offices, so when we
call, we are not just talking to anyone that answers, we
actually have a contact person for each local office. We have a contact person at the disability division office. We have the general manager
there has been great to work with us if we run
into any kind of issues. He’s always there to support and help us. Next slide please. I wanted to, can we go right
back to the previous slide really quickly, I’m sorry. I wanted to mention that when
we don’t have enough time to complete the entire
process before release, it can cause a lot of obstacles with housing, with just anything that has
to do with them sustaining themselves in the community,
even though we have programs with funds to help people in
our program when they first get out, if they don’t have
the preapproval for their benefits to start shortly after release or within that month or
maybe two at the most, that really puts a strain on
our team and on our program. So it’s very important that we have the right amount of time. And with Oklahoma, they
have built in new credits, earned credits, good conduct credits, and different things like
that within DOC and within Oklahoma to help move inmates
through the system faster which is definitely a good
thing but it just makes the need for us to plan critical. Next slide please. In establishing a SOAR process,
once the online application is done, we make sure
that everything’s accurate and that we have a complete
packet, we fax it to the local office and the most key
component to getting a quick approval and a quick turn
around is that we have a psych summary from the attending psychologist. When we have that to send
with the rest of our medical documentation and paperwork
on that day, we can get really quick turn around approval. That is key and we have
some wonderful psychologists in Oklahoma and Department
of Corrections that help us. In fact, when we have our
annual meetings with the Disability Determination
Division examiners and all the local SSA office
managers, and then all of our staff, our psychologists
always receive accolades in just how well they
do with their reports and how it really helps the examiners with being able to make a decision. We also have information
sharing agreements in place to where if examiners don’t
see something in that report or in the paperwork, they can
go in to our medical records and look for that extra information. We want to provide it for them
and so it makes the process much more time efficient for them. But if they do need something else, they can go into the records. We also have information
sharing agreements in place between the Department of Mental
Health and Substance Abuse Services and Department of Corrections. Our collaboration truly is
one of a kind in Oklahoma and I’ve never heard
of one exactly like it where the agencies work
so closely together and it’s just really been
the key to our success. Next slide. We just, to follow the
SOAR model, at the end, just allowing time to complete
and submit the application within the correct time frame. So planning, checking with
case managers, checking with your facilities records
department to make sure that the projected release date for an inmate is not going to change, that there aren’t credits
that may be extra are already worked into that date so
we know when they’re going to discharge, they don’t
have any surprises. We have learned some really
hard lessons with that. We’ve learned to plan and
call and check and double and triple check so that we are able to get this process done in time. I can say that we have
known of one approval that from the day of submission
into the local office from the call back with
approval as quick as seven days. Slide. Over the past 11 years,
our approval rate has kind of varied some, but
it is at 80% right now. I think the, for the general
population and the community, I think the approval rate is,
for a first time application, I was thinking 33, but it
might even be lower than that. I would have to double check on that. 80% is, I think, we’re really
proud to have that rate and we have not gone below that. Next slide. We got here in our program
and with the success that I’ve been talking about by having all of our reentry staff trained. We started with three
staff inside the prisons that are hired and employed
by the Department of Mental Health and Substance Abuse Services. We now have seven and eight with the boss, or with the supervisor. And mentoring is an important
part of the program. We have integrated
services discharge managers will go onsite and work with the new staff and then they’ll have the new
staff come and work with them. And I’ll just give you
an example of mentoring. I was one of the first three
discharge managers in 2007 and I was at the maximum
security prison in McCalister doing my very first application
after my SOAR training. I had a maximum security
seriously mentally ill inmate in a very small office along
with the general manager from the local social security office. She came to the facility, went
through the process to be, took down to have to go
through the metal detector, all of that to come in and go
through that first application with me, which that’s
something I never forgot, to have someone, you know,
that type of mentoring. So in turn, we’ve always provided
mentoring for one another and made sure that before
a person starts doing these applications on their
own that they are ready. And another really important step to success is that we’re
consistent with our process, that we’re consistent with
our timeline, we’re consistent in the way that we do our
paperwork, you know, the steps. We make sure that everybody
follows the same steps. An example is that we flag
each application to say that this is a prisoner pre-release case. It’s very important that that’s flagged. If not, it will just go into
general cases and no one will know that that’s actually
an inmate release case. So you know, that’s just one
example that this consistency that we are all doing
things in the same way and that the staff at the local housing and at the disability
determination division office know what to expect from us
and know that we’re all going to be doing things in a consistent way. And just, you know,
support one another and provide anything that they
need as far as new staff that come on and if we run
into anything that we can’t fix or that we don’t
know how to do ourselves, we have plenty of support
in the local offices and in the state office. So that’s been very helpful. Next slide. I want to ask Marcus if
he can think of anything that I didn’t say that
he feels important to say with our presentation. – [Marcus] I think maybe just
one thing that I would add is just highlighting how
important this process is in the state of Oklahoma. The population that those
seven staff work with in the Department of
Corrections are individuals with every range of mental
health functional and disability represented pretty much
in the general population and so in the state of Oklahoma,
sometimes the only chance that these individuals have
for treatment is to be a part of the Medicaid program and
we’re not an expansion state. And so being able to assist
these individuals with obtaining disability is really the
pathway to get them into sometimes nursing homes, into
residential care centers, medical or sensitive health
patients services as well. So these services that
we provide really make a humongous difference in
the lives of the individuals in the full range of what
they were talking about a minute ago in terms of
housing, treatment, income, those three, all factors. – [Donna] I think that
wraps up our presentation. – [Pam] Great, thank you
so much Donna and Marcus. Before we get to Q and A,
which is going to start in just a second, I wanted
Dazara Ware to talk about the slide that you’re
seeing now about SOAR and CJ Technical Assistance opportunity
that’s coming up shortly. Daz, you wanna talk about that for a sec? – [Dazara] Absolutely. So what you’re seeing on
the screen right now is our invitation that has
gone out on October 23rd kind of soliciting respondents
to an RSA that we’ve presented and this is just
a, not just a, but this is a great opportunity to have
the SOAR TA Center fully engaged in your effort to
implement SOAR in your facility. The technical assistance
opportunity provides planning and technical assistance,
which includes implementation meeting that’s onsite where
we could gather all the key stakeholders together to provide
a guided kind of discussion about how SOAR could
work in your facility, what areas need to be addressed,
and those sorts of things. An awardee will be provided
the opportunity to participate in the leadership academy,
which would help to provide you with the skills needed
to kind of understand how to build the infrastructure
within your facility. And then, once that case is kind of kind of solidified, we’ll go
ahead and part of that plan address those folks that
you’ve identified to complete the SOAR applications and
assist them with online course and how to track those outcomes. The application’s what you see right now. It has 10 components and
it’s, we ask that you submit the application in narrative
form, addressing each of the components in three and no more than five page applications. We’ll have a kick off call for
any questions that you have about applying on November
14th, so stay tuned for that announcement. And overall, the applications
are due on December 21st and announcements will
be made for at least six kind of awardees in January. So if you have any additional
questions, you can ask on this call or you are more
than welcome to reach out to any of us at the SOAR TA Center. – [Pam] Great, thanks Daz. – [Dazara] You’re welcome. – [Pam] So, we have some
really great questions that have come in and many
are related to how do I start a SOAR initiative,
how do I get started? What are the first steps? And we had a couple
questions that came in early in the presentation, like
I understand the statistics but what can SOAR do and
how do I start a SOAR implementation within our
criminal justice system? How can I get my SOAR local
program to reach out and integrate SOAR with the criminal
justice system community. So I wanted to first remind
that if you’re new to SOAR, or you’ve taken the SOAR
online course or you’re a SOAR local lead, I’ll just remind
you to go to the SOAR website, and again, find your state,
you’ll find your state lead. You’ll find your SOAR local
leads, but also your SOAR TA Center Liaison, who can give
you more detailed information about if there is any
criminal justice coordination within your locality, within your state. That’s a great place to start. And then they can loop in
Dazara Ware with the TA Center, who you just heard from,
about again, efforts that she can help with to again establish
some of the relationships similar to the presenters today
from Nashville and Oklahoma. So again, hopefully you’ll go
there to get more information. But again, you can type
in some of your questions in the Q and A box that
you see on the right hand side of your screen. If we don’t get to your
question today, we will be sure to get that to one of our
panelists and answer that offline. So don’t worry, we’ll make sure we get to some of your questions. Some are very specific to
clients you’re working with and again, those we want
to make sure we give you the most accurate information
so we may handle these offline as well to draw
in maybe more expertise from SSA, for example. So an overriding question, we
had a bunch of these questions again, and I’m gonna throw
this out to all the panelists. What messaging can you
share in terms of beginning? How does somebody start? What are the first steps
that a SOAR program may need to take to start even
thinking about integrating in your community? And I know Oklahoma’s been
doing this for a long time. So would you want to
start, Donna, with sharing? What would be the first step
to engage at the state level? – [Donna] Well, kind of
as I explained earlier, the planning started a year
or more before we actually started services and
some of the leadership persons or individuals
in leadership roles, collaborated on this and knew that getting public
benefits in place for this population was going to be critical. And I also know that when
we first started our reentry program that we were part
of the Mathematica study so I think that was also, I was not one of the key
planners of the program. I was one of the first staff
to work in one of the prisons to do the work but I was not
in on the initial planning. I was hired in 2007 to
actually start doing the work. I just know that we had
multi-agency collaboration and that I do know that
Mathematica was involved and that we were hired and were
all sent for SOAR training. – [Pam] Donna, it sounded like it started with training for you. Daz, would you like to chime in? – [Dazara] Yeah, sure, thanks Pam. So you know, I get a lot
of these questions from reentry specialists and case
managers that work in jails or prisons and really see
the need but not really know where to start the conversation. So we spent a lot of time
talking about statistics and the prevalence and the
importance of attaching individuals with serious mental illness that are incarcerated is quite clear. I encourage you to do,
you know, as we discussed when we talked about how
to start a SOAR initiative in CJ settings earlier
in the presentation. I encourage you to start
by gathering information. Gathering information
specific to the facility in the community that you work with. As we said, we talked
about collaborations, and we talked about how
important it is to build those communications and those
collaborations with the same kind of agencies that provide
services to the same folks that you provide services to. So as you are gathering
information about your facility, how many people are
currently incarcerated, how many people are currently
incarcerated that are receiving psychotropic medication? How many people of that
population have returned back to prison or jail? Attach the cost, each state
has a website specifically for prisons that will
tell you how much it costs to house an individual
that is incarcerated, how much it costs them. Put a number next, put a dollar
amount next to the number so that you can demonstrate
the potential amount of money that is spent to care for this individual. So it starts with preparing
and identifying the need but also being able to address
it more from the financial aspects of how SOAR can
work for the institution. You have two major kind of lines of communication or two kind of
areas that you must address when you’re talking about
implementing a new program. You have to speak to the
heartstrings of the people that are providing the
services because they do want to see things that work,
but you also have to speak to the purse strings of the
person that has the position of authority so that they
understand the importance of committing to a program so that they can see the best results. So it starts with gathering
information and I don’t want to take a whole bunch of
time, there’s a whole bunch of things that I want to
say, but it starts there. And then you prepare a proposal. You identify the need, you
identify how SOAR can help, and you talk to people. You talk to the chief jailer,
the chief social worker. You go to all of your reentry meetings. You talk to the chief social worker. You talk to, you know, the
public defenders office. Because, again, all of
these folks touch the life of the same person you’re
providing services for. So the more that you talk, the
more that you gain the buy in which makes your proposal even stronger. And then you use the
outcomes that have gained from everywhere else across the country. You contact someone
from the SOAR TA Center and say, you know, where can
I find statistics on or data about the amount of applications that you, that have been submitted
across the country and what are the outcomes? We’ll be happy to provide that for you. And in the meantime, in
part of your conversations not only with the community and within your agency internally,
you also want to talk with Social Security, but
if you’re not comfortable there, start just at the
beginning and getting all your information together. It’s not a process where
you want it to happen, so you wish it and then you mention it, and then you never mention it again ’cause they didn’t hear me. It’s something that you are
adamant about and consistent because you really know that
access to this kind of benefit really helps the people
that you’re serving. – [Pam] Great, thanks Daz. And I shared some of the
tools that the TA Center has and part of that are some
FAQs, which will include, I think, hopefully some answers
to some of the questions that we have here about getting started. Another question that popped
up is how do we establish a prerelease agreement,
how does that start? Or how do we find out if
our state or our locality has a prerelease agreement? Who would like to take that, Daz? – [Dazara] Yeah, sure. So that’s another conversation
that needs to happen with you reaching out to the
SOAR TA Center to find out if we have any information
about your state that you just didn’t know of. And then if there is no
prerelease agreement, that starts with
communication and conversation with the Social Security
field office in your area. And the SOAR TA Center
is a great resource. We could have contact information
that are already there and we can help join you
in those conversations. If there is no prerelease
agreement, we can work with you to help to establish one. – [Pam] Okay, great. Another question came in
about, this is a really great question, and it comes up a lot. It’s about working with individuals. Have you worked with individuals
who do not have a serious mental illness but have
a serious drug disorder? Or do individuals have to
suffer from both an SMI and a substance abuse disorder? And again, this question
hits on some misconceptions about working with individuals who, regardless of whether
there’s justice involved. Who would like to take that
question in terms of that? Because we know that an
individual can’t be found disabled if they only have a substance
use disorder diagnosis, right. They need to have at least,
you know, another medical condition or a mental health disorder. Does somebody want to
address that issue of folks, I know Dan touched on this,
individuals that do have a serious mental illness,
substance abuse disorder. – [Dan] Sure, Pam. Well, first of all, I wouldn’t
take the substance abuse disorder diagnosis at face value. Many of the individuals
that are coming into jails really haven’t had access
to healthcare and maybe through the emergency
system, they’re diagnosed as a substance use disorder,
but when you start to look, remember the prevalence
issues around medical, coexisting medical conditions,
trauma, undiagnosed depression, there’s a lot of
undiagnosed mental illness that you’ll see in the
population that might look like just substance use disorder. So I wouldn’t take this substance use disorder at face value. The other thing– – [Pam] Go ahead Dan. – [Dan] Yeah, and then
the other thing is that, to get a good history and
assessment so that you’re getting the past records from the community. And what you typically find
with a lot of individuals is that they’ll have multiple
diagnosis, which really is, so it becomes important to
get a good current psychiatric assessment that looks at the longitudinal health career of the folks. And remember that even
though there might be a lot of substance use disorder,
that with health conditions and mental illness can reach
the threshold of a disability. – [Pam] Thanks for sharing that Dan. I think that’s a really
great point to stress and to also review the SOAR
online course about this topic, which will give you some more guidance. So with that, we are out of time. You’ll see on the slide we
have Dazara Ware’s email, should you want to reach
out to her directly. Again, I just want to
thank all of the presenters for your presentations and on
behalf of the SOAR TA Center and the GAINS Center, we’d
like to, again, thank our presenters and everyone who joined today’s important webinar. Have a great rest of your day and thank a lot for joining us.