1.21: Military and Criminal

Introduction

Nationally, the Department of Veterans Affairs (VA) administers a myriad of complex health services at 152 VA Medical Center's. Some of these services are justice-related services and approaches that involve the cooperation and partnership of the Criminal Justice System (CJS) and law enforcement. These services are provided at VA Medical Center's to facilitate reentry, support and advocacy services for incarcerated Veterans in state, county jail, community corrections and those released but still involved in the CJS. This reflects a paradigm shift within the VA, Court Systems, corrections and law enforcement in targeting how Veteran offenders are identified, afforded treatment, reenter and adjust to society. VA's are continuing to develop re-entry initiatives, justice coordinators and increased role within the Veteran's Court trend. This work enhances and does not replace the duties of the CJS in the transition of veteran prisoners to a productive life in the community and ensuring that these veterans receive timely services from VA to ensure a successful transition back to the community. Post-release, the VA provides the necessary services for eligible Veterans, other than what was provided in the institution.

Impact

In 2008, a study by the RAND Corporation found that about 1/5, 300,000 of the more than 1.6 million U.S. troops, witnessed combat action and reported symptoms of Post Traumatic Stress Disorder (PTSD) and depression. Many of those veterans did not seek treatment for their problems, the study found. The ongoing OIF/OEF wars have yielded many veterans that return from war with incidences of substance abuse, partner relational domestic violence, PTSD, Traumatic Brain Injury (TBI), employment, depression, anxiety, suicide, suicidal ideations, redeployment and related issues.

Many veterans encounter the CJS post-deployment or post-discharge and need a treatment alternative vs. incarceration. Some Veterans will not be afforded an alternative, like diversion, based upon the severity of their crime (e.g. murder, sex offender, rape, arson, etc). Veterans in this country appear to be overrepresented when it comes to psycho-social problems like, substance abuse, driving under the influence (DUI), higher rates of unemployment, assaults, intimate partner violence (IPV), family conflicts, homelessness episodes, suicides, PTSD and other problems. Veterans as a group are not overrepresented in the corrections system, but may have special treatment needs (e.g. PTSD, TBI, etc) not provided by the institution. Tragically, some studies report that Veterans in general are twice as likely to commit suicide. Another study (Wortzel, 2009) also suggests that veterans in jail and prisons face an increased risk of suicide. Most Veterans have had more violent offenses, are usually first time offenders and honorably discharged (Noonan, 2004). Recent 2009 US Department of Labor (DOL) unemployment statistics revealed that veterans have a higher unemployment rate than non-veterans. The aggregate of their problems, studies and statistics profile the timeliness and the urgency of Veterans Treatment Courts, diversion programs and enhanced VA-CJS interface, as we face epidemic proportions. The magnitude of this population and their criminogenic needs has not been established. The most recent U.S. Department of Justice (DOJ) Bureau of Justice Statistics (BJS) Survey of Inmates in local jails (2002) data indicates that 9.3% of people incarcerated in jails are Veterans. The controlling offense for 70% of these Veterans was a non-violent crime, and 45% had served two or more state prison sentences. At minimum, 90,000 of the 9 million unique inmates annually released from U.S. jails are Veterans. A large majority, 82% are eligible for VA services, having been discharged either under honorable (65%) or general with honorable (17%) conditions. BJS reported in 2006 that 60% of all U.S. jail inmates had a mental health problem. As of 2005, only one in six jail inmates with a mental health diagnosis had received mental health treatment since incarceration. The 2002 BJS Jail Survey also found that 65 % had screened positive for either an alcohol or drug dependency problem. Twenty-nine % had been diagnosed with at least one of five psychiatric disorders (depressive, bipolar, psychotic, PTSD, or anxiety disorder). One in five (18%) Veterans were homeless in the year prior to the current incarceration. Statistics on the jail and prison inmate populations suggest significant health risk for Veterans released from jail. The war's unpopularity and the prospect of a draft have resulted in enlistment standards being relaxed over the past few years to allow recruitment of those with criminal records. Commonly referred to as the moral waiver process, the Army and Marines did provide waivers for eligible recruits for misdemeanors and some felony offenses. Most of these recruit became OEF or OIF Veterans. Military applicants with no criminal convictions, fines, or periods of restraint are morally eligible for enlistment. However, the voluntary disclosure, or recruiter discovery, of any form of police/criminal involvement by an applicant may require waiver of the moral disqualification. It's important to note here that federal law requires applicants to divulge all criminal history on recruiting applications, including expunged, sealed, or juvenile records. Additionally, in most states, such records are accessible to military investigators, regardless of what you have heard to the contrary. The process begins with an interview by the recruiter, asking the applicant about any records of arrest, charges, juvenile court adjudications, traffic violations, probation periods, dismissed or pending charges or convictions, including those which have been expunged or sealed. A confounding service variable that needs consideration is the Veteran not eligible for VA services and/or having an Other Than Honorable (OTH) or Bad Conduct Discharge (BCD). These Veterans are typically provided an application for military discharge upgrade and provided guidance and support with the process. Although rare, some Veterans with an OTH or BCD are eligible for VA services if they have a service connected disability. They can only be seen for their disability. Veterans with UHC, OTH and BCD discharges have had judicial and court offenses subject to the Uniform Code of Military Justice (UCMJ). The UCMJ provides four methods of disposing of cases involving servicemen's offenses: general, special, and summary courts-martial, and disciplinary punishment pursuant to Article 15 of the UCMJ. General courts-martial and special courts-martial, which may impose substantial penalties, resemble judicial proceedings, nearly always presided over by lawyer judges, with lawyer counsel for both sides. Historically, reports of World War II, Korean, Vietnam and post-Vietnam era Veterans with histories of civilian or military trauma and service-related injuries suggest an association between trauma and subsequent contact with the CJS. Thus, an association for some Veterans of the Persian Gulf War (PGW). For the majority of Veterans this appears a matter of choice and decision-making to break the law. PTSD symptoms can indirectly lead to criminal behavior (for example, domestic violence, substance abuse, prescription drug abuse, hyper-vigilance, road rage, etc.) or a traumatic incident to a specific crime. These justice-related services are more commonly provided by VA social workers through the following programs: Veterans Justice Outreach (VJO), Health Care for Reentry Veterans (HCRV) and Veterans Treatment Courts (VTC). First, the VJO is an initiative for homeless prevention and avoids the unnecessary criminalization of mental illness and extended incarceration among Veterans by ensuring that eligible justice-involved Veterans have timely access to VA mental health and substance abuse services when clinically indicated, and other VA services and benefits as appropriate. Each VA medical center has been asked to designate a facility-based Veterans' Justice Outreach Specialist, responsible for direct outreach, assessment, and case management for justice-involved Veterans in local courts and jails, and liaison with local justice system partners. VJO services include:

1. Outreach and pre-release assessments services for Veterans in county jails, probation and pre-trial diversion where applicable*.
2. Referrals and linkages to medical, psychiatric, and social services, including employment services upon release
3. Short term case management assistance upon release

*Note: There are DUI programs at the Philadelphia, PA; Northern Florida/Southern Georgia; Colorado VA's; Intimate Partner Violence (IPV) programs at the Tampa, FL, Indianapolis, IN and Buffalo VA's; Gambling Addiction program, Brecksville, OH.

Second, HCRV is designed to address the community re-entry needs of incarcerated Veterans. The goals are to prevent homelessness, reduce the impact of medical, psychiatric, and substance abuse problems upon community re-adjustment, and decrease the likelihood of re-incarceration for those leaving prison. HCRV services include:

1. Outreach and pre-release assessments services for Veterans in state and federal prison
2. Referrals and linkages to medical, psychiatric, and social services, including employment services upon release
3. Short term case management assistance upon release

The VA cannot provide medical services that are part of care to be provided by correctional institutions and only provide outreach and pre-release assessment. Also, the VA cannot provide medications while a Veteran is incarcerated.

Reentry Outreach and Diversion in the Greater Cincinnati Area

The Cincinnati approach is unique in that the Veteran is afforded reentry and diversion services. At the Cincinnati VA, the reentry is provided through the Incarcerated Veteran Outreach Program (IVOP) and the Domestic Relations Clinic (DRC) where the staff provides outreach, pre-release assessments to ensure comprehensive service delivery and/or community agencies, assists veteran with parole or probation officer, problem solving and advocating for veteran as appropriate. Also, the IVOP staff also disseminates the Ohio state incarcerated veteran guidebook to reentry staff and re-entering incarcerated veterans. Veterans need to be able to provide feedback about the content, outreach worker, overall usefulness, pre/post knowledge about veteran's benefits and general comments about their reentry needs. In Cincinnati, the IVOP had designed a survey tool for these purposes and obtained 143 responses from incarcerated veterans that afforded further insight into their needs as well as guidebook feedback.

Since 2003, the IVOP has encountered and captured data on the reentry needs of 399 Veterans (refer to tables 1 -4). Of the 399, the contacts were made in the following settings: 42% prison, 45% jail and 13% community corrections. The IVOP has taken the lead role in this collaboration with ODRC, Adult Parole Authority (APA), jails and CJS providers. In addition, the Cincinnati Volunteer of America (VOA) has a VA capital grant for 50 beds specific to veteran's reentry needs. VA and VOA have finalized a housing strategy option for homeless veteran sex offenders separate from the grant. The concept is that homeless veteran sex offenders admitted to the VA would be discharged to VOA under a contract for housing, transitional and sex offender treatment, as clinically indicated.

Objectives for Veteran Reentry & Diversion:

1. Provide seamless and collaborative pre-release planning, assessment and coordination of services.
2. Examine jailed veteran health characteristics, VA enrollment and episodes of homelessness.

Goals for Veteran Reentry & Diversion

1. Optimize their chances for successful community reintegration; reduce recidivism and incidences of homelessness.
2. Interact with agencies on a national, state and local level, working actively for change through social action and community education
3. Identify referral patterns, sources and build coalition support.
4. Improve incarcerated veteran satisfaction and overall functioning.
5. Provide basic to intensive case services and post-release follow-up.

The IVOP provides short-term case management services to assist offenders in acquiring the life skills needed to succeed in the community and become law-abiding citizens with the following three phases:

Phase 1-Pre-release Preparation: Veterans having 6 months or less remaining on their sentence are identified, assessed and prepared to reenter society. Services provided in this phase include outreach, assessment, enrollment, education, mental health and substance abuse treatment and job linkages. Phase 2-Post-Release: Working with veterans immediately following their release from correctional institutions. Services provided in this phase include, as appropriate, education, monitoring, mentoring, life-skills training, job-skills coordination, mental health and substance abuse treatment. Phase 3-Support: Connecting veterans with a network of VA, social services agencies and community-based organizations to provide ongoing services and relationships. Table 1: Demographics, Military Service and Housing Needs (n=399)

Demographics	Totals
Enrolled In VA System	47%
Mean Age Age Range Std Deviation	44.6 20-80 9.65
Gender Males Females	98% 2%
Race White Black Hispanic	54% 41% 4%
Education GED High School College Graduate Vocational	16% 61% 17% 1% 4%
Marital Status Married Divorced Separated Never Married Widowed	12% 48% 11% 25% 4%
Non Service Connected (NSC) Service Connected (SC) Injuries	88% 12%
Average Years in a Correctional Setting	5.16
Military Discharge Honorable General Honorable* Other than Honorable** Bad Conduct**	77% 13% 9% 1%
Era of Service Korean Vietnam Post-Vietnam Persian Gulf OEF/OIF	.5% 40% 35% 22% 2%
Branch of Service Army Navy Marines Air Force Coast Guard	55% 23% 16% 6% 1%
Combat Non-Combat	19% 81%
Homeless 1x Homeless >1x	74% 50%
SSD/SSI	12.7%
Jobless	57.4%

*UHC - Uniform Code of Military Justice, Judicial Article 15 offenses

**OTH and BCD - Court Marital offensTable 2: Medical Problems (n=399)

Problems	Totals
Medical	62%
Dental	56%
Eye	28%
High Blood Pressure	34%
Gastro	17%
Liver	12%
Diabetes	13%

Table 3: Substance Abuse and Mental Health Problems (n=399)

Problems	Totals
Alcohol Present	60%
Drug Present	55%
Psychiatric Meds	29%
Current Psychiatric	57%
PTSD from Combat	14%
Past Hospitalization for SA/MH	37%
Used VA in last 6 months?	26%
Depression	58%
Anxiety	54%
Hallucinations	13%
Understanding/Concentration	45%
Violent Behavior	18%
Suicide Thoughts	18%
Suicide Attempts	7%
DV Abuser Past	23%

Table 4 - Category of Offenses*

Offense	Number	Percentages
Violent	180	45%
Property	47	12%
Drug	87	22%
Public	50	13%
Parole/Probation	25	6%
Other	10	3%
Total	399

Categories of Offenses:

1. Violent Offense (example: murder, manslaughter, assault, sexual assault, including rape or child molestation, robbery or other violent offense).

2. Property Offense (example: burglary, breaking & entering, larceny, motor vehicle threat, fraud, stole property, arson, shoplifting, vandalism, other property offense) 3. Drug Offense (example: possession, trafficking, other drug offense) 4. Public Order Offense (example: weapons offense, prostitution, public intoxication, disorderly conduct, child support, DWI, other public order offense). 5. Probation/parole violation. 6. Other/unspecified.

Identification and Referral Process

Ohio is the 7th most populous state in the country, and Cincinnati is its 3rd largest city; the 53rd largest in the nation. To identify Veterans, inmates were asked during the jail intake process or during prerelease, if they are military veterans, and if “yes” in what branch of service they served. Some jails had already had a data field set to capture veteran information. Many do not have this data field established. This information is then fed communicated on a monthly basis to the IVOP Coordinator, Cincinnati VA Medical Center for efficient, effective and seamless services.

Consequently, the IVOP then verifies veteran status, facilitates enrollment for those eligible, assists with DD214 processing, military upgrades applications, Compensation & Pension (C&P) applications, the Ohio Incarcerated Veteran Guidebook, survey tool for the guidebook and the pre-release assessment. The assessment tool data was utilized to identify demographics, medical, mental health, substance abuse, domestic violence, housing, vocational and reentry needs.

Diversion Example

The author facilitated a Domestic Relations Clinic (DRC) at the VA in Cincinnati, OH, from 2002 - 2008. The DRC was a diversion focused and justice-related. The DRC is a 13-week domestic violence prevention program that was approved the Ohio Department of Rehabilitation and Corrections (ODRC) and Adult Parole Authority (APA) for reentry. The program targeted Veterans that had anger and domestic violence problems. Nearly 1,000 Veterans were screened for IPV in the DRC with an average score of 8.6 on a scale of 0 - 34 (mild, moderate severe), 389 were referred, 221 had successfully completed the program with an aggregated pre-test score of 9.63 to a post-test of 2.33.

Veterans that successfully completed (56.8%) the program were less likely to repeat (27.6%) the offense. This outcome partially represents what the Veterans Courts are striving for with all offenders. Hence, this type of program offers an aspect of the problems that are encountered and is a commensurate fit into the Veterans Court equation. Within the VA system, only Tampa, FL; Phoenix, AZ and Buffalo, NY are active. In addition, the Tacoma, WA Vet Center and Boston, MA are funded for the study of IPV and PTSD. Bay Bines, FL and Cincinnati, OH closed in 2009. This appears contra-indicated based upon the advent of VTCs. However, some VTC are exploring IPV programming as a component.

County Case Example

The Hamilton County Jail's Corrections Division operates all adult detention facilities in Hamilton County Ohio under the jurisdiction of the Sheriff's Office. With an average daily inmate population of 2000, and an estimated 55,000 admissions annually, the local jail system is ranked in the top 25 largest in the nation. The total system capacity is 1,240. A computerized Jail Management System assists staff and other criminal justice agencies in locating and maintaining accurate information on the inmate population Hamilton County's violent crimes rate was recorded as 114.9 per 100,000 and 529.8 per

100,000 for non-violent crimes. Across the country, too many veterans come home facing challenges the rest of us don't have to grapple with, like life-altering injuries, scars, both physical and psychological, medical issues, substance abuse, homeless, and some recycle in our local jails. In 2008, Hamilton County Pre-Trial Services, trend data conducted 07/23/08 reflected that: 99 veterans were jailed daily, which included, 5 that were active duty, and 9 who were medically discharged; _from January 1, 2008 through June 30, 2008, 1125 veterans went through our jails (out of 23,009 total cases), including 26 active duty, and 53 who had been medically discharged. 973 had been honorably discharged; of those 1125, 217 were identified with a mental health issue, 642 with substance abuse, and 205 with both. The cumulative aforementioned VA and county jailed veteran data may suggest that a veteran specific data may need further exploration. The point to emphasize is that veterans have specific penal treatment and post-release needs related to their military service. This is especially true for veterans with service connected (SC), such as PTSD, Mental Health, Medical, Traumatic Brain Injury (TBI), etc. There needs to more emphasis on identifying veterans at arrest, during their entrance into the penal system and linking this information to the VA or relevant system. In general, health care and re-entry of ex-offenders back into their communities has become a public health crisis. We must understand that reentry is a complex process for the person, family, environment and society. Everyone appears to be seeking the perfect model of reentry. A fragmented approach and half measures will not suffice. The effort must be sustained to succeed and parties need to get up off their apathies to make a difference, promote and be change agents. Reentry for veterans is a collective approach. This cannot be achieved in a vacuum or by a singular entity as it warrants a collaborative response. Reentry is a process that begins at incarceration and requires short, long and/or intensive follow-up; dependent upon a host of factors. Conceptually, reentry involves the use of programs targeted at promoting the effective reintegration of veteran offenders back to communities upon release from prison and jail. Reentry programming involves a comprehensive case management approach, is intended to assist offenders in acquiring the life skills needed to succeed and become law-abiding citizens.

Veterans Treatment Courts

Veteran's Treatment Courts (VTCs) are a growing therapeutic jurisprudence trend in the United States within the Criminal Justice System (CJS). These new judicial approaches are challenging the traditional roles of Judges, Courts, Jail corrections, County Sheriff's, State Police, Probation Officers, Police Chief's and Police Officers and the VA in affording unique collaborations, diversion alternatives and court sanctions. These Courts are a special docket within the Court system and target Veterans charged with non-violent felony offenses. They are similar to Mental Health, Drug and DUI Courts. All parties are collaborating in this effort to address the needs of military Veterans who turn to various crimes in the aftermath of military service. These Courts address the needs of all Veterans ready, willing and able to abide by the Court sanctions and make the necessary changes in their lives. The need for intervention, services and treatment related to their military service has drastically increased in the last several years, especially with the impact of the Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) wars amid a turbulent economy. The rationale is based on the combat Post-Traumatic Stress Disorder (PTSD), non-combat PTSD (military sexual trauma), economic hardships, substance abuse, domestic violence and readjustment. Most of these Veterans are law-abiding, but their problems contribute to criminal behavior among a substantial number of veterans.

In 2008, the first Veterans Court was started in Buffalo, NY by Judge Robert Russell. Since this court started, Veterans Courts have opened in Orange and Santa Clara counties in CA; Tulsa, OK; Rochester, NY; Anchorage, Alaska. Most jurisdictions are encountering 100 - 150 Veterans per month. New Courts are being considered in Phoenix, AZ, Edwardsville, IL; Colorado Springs, CO; Las Vegas, NV; Southern Oregon; Pittsburgh, Philadelphia, Scranton and Montgomery, PA. Their successes will lead to others being developed. The SERV Act would enhance and hopefully sustain these efforts to help spread Veterans Courts trend across the country. Generally, the key ingredients of these Veterans Court and Diversion programs are: 1) Local County Courts, Police, Pre-Trial, Jails and/or Magistrate Jurisdiction 2) A reliable mechanism to verify Veteran's Status. 3) Court liaison to interface with the VA 4) Development and Implementation through Partnership between Court system, Corrections, Police, VA and other advocate parties. 5) Treatment, mentoring, monitoring, advocacy and support. 6) Availability to all Veterans from all periods of service. In traditional courts, an offender is sentenced if found guilty. Alternative courts offer qualified participants an opportunity to participate in court-supervised, community-based treatment in lieu of typical criminal sanctions. Some studies on drug courts have shown a lower recidivism rate and cost savings than traditional court approaches. All parties in these courts (e.g. judges, prosecutors, law enforcement, probation officers, substance abuse, therapists, community, advocates, mentors and families) work together toward a holistic outcome that focuses on recovery and support rather than incarceration. Studies have shown that as many as half of the troops returning from OEF/OIF suffer PTSD and other disorders, and mental health is the second-most-treated ailment for returning Veterans in the VA system. However, some question the necessity of separate Veterans Courts, stigma of being a Veteran and the underlying theme of culpability in the Veteran's offense. Is there a connection between their service and crime? Are the establishments of Veterans Courts discriminatory and suggests that Veterans are more likely than non-Veterans to commit crimes. Veterans have generally committed non-violent offenses such as driving while intoxicated (DUI), drug possession, theft, domestic violence, assaults, etc. Veterans that agree to: stay clean and sober, urine screens, obtain mental health or addiction counseling, and so forth will get their lives back on track. Generally, court and VA staff meets with the Veterans routinely for case management and progress. Some court systems even assign a mentor or adviser to support the Veterans recovery and monitor progress. Once he/she complete the requirements, their charges are reduced, cases are dismissed and/or expunged. If they fail to comply, they risk facing their original criminal charges and could be sentenced to jail and/or prison time. To underscore, the transition from military to civilian life is challenging and Veterans cope in many different ways whether exposed to combat or not. Veterans often isolate, turn to substance abuse, domestic violence, assaults, etc. trying to cope with what they experienced in the military. However, not all Veterans get into trouble. The Court, VA and military systems seem overburdened, lack sufficient resources to meet the needs of those suffering from PTSD, readjustment and other psychological problems, which place Veterans at-risk for a host of problems. Like prior wars, current Veterans are also facing the growing stigma of war. Many Veterans may think getting help is weak, but the reality is that it takes the strength to ask for help. As indicated by the Veteran Court bench practice and diversion trends, Veterans are receiving a collective, holistic and multi-system chance to get their lives back in order. Hence, Veterans Courts and diversion programs are viable options that also warrant chances to survive and thrive.

Conclusions

The likelihood of receiving VA services increased as a result of the IVOP and DRC reentry and diversion services. Veterans received case management and service coordination for medical, psychiatric, substance abuse, PTSD, discharge upgrades, VA pensions and transitional housing. The majority of jailed veterans had one episode of homelessness prior to their incarceration. They reported medical, psychiatric, substance abuse, PTSD, domestic abuse and employability problems, but were less likely to be disabled. The numbers of incarcerated veterans are likely to increase, especially within the PGW and OEF/OIF populace. This is based upon expeditious discharge mustering, under-reporting of service related injuries, multiple & extended tours of duty, the advent of felony waivers to enter the military) and difficulty in adjusting to life and coping with life stressors. More VA/County Jail benchmark reentry models, diversion programs, Veterans Treatment Courts (VTC), appears warranted for our veterans, but will only succeed with the sustained juxtaposition of society, corrections and VA.

For supplemental information, please visit the: Veterans Treatment Court Clearinghouse at: www.nadcp.org/learn/veterans-...-clearinghouse Veterans Justice Outreach: www1.va.gov/HOMELESS/VJO.asp Health Care for Reentry Veterans: www1.va.gov/HOMELESS/Reentry.asp References Hal S. Wortzel, MD, Ingrid A. Binswanger, MD, MPH, C. Alan Anderson, MD, and Lawrence E. Adler, MD: Suicide Among Incarcerated Veterans, J Am Acad Psychiatry Law 37:82-91, 2009 ME Noonan: Veterans in state and federal prison, 2004. Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics Special Report, 2007. B Schaffer: Male Veteran Interpersonal Partner Violence (IPV) and Associated Problems, Journal of Aggression, Maltreatment, and Trauma (JAMT), Volume 19, No. 4, June 2010 B Schaffer, C. Seals: Jailed Rural Veterans: VA/County Jail & Sheriff Reentry Outreach Collaboration, Sheriff Magazine: 31-32, Fall 2008

About the author

Bradley Schaffer is the Coordinator, Veterans Justice Outreach (VJO) and Veterans Treatment Court (VTC) Liaison at VA Butler Healthcare. He has over 24 year's federal service and is a USMC Veteran. He has developed particular expertise with incarcerated veterans & reentry, diversion, domestic violence prevention and fatherhood programs for Veterans. He is a Licensed Master Social Worker (LMSW) and Board Certified Diplomat (BCD) in Clinical Social Work. He is an Adjunct Instructor, Thiel College, Department of Sociology as well as California University of Pennsylvania, Department of Social Work. For more information, contact him at [phone] and/or email: [e-mail]