Jail-Based Competency Restoration

Project Description

The Harris County Jail houses over 250 inmates who are incompetent to stand trial or participate in the proceedings against them and are awaiting competency restoration services at the state hospital. Typically, inmates who are incompetent to stand trial are transferred to a state hospital for treatment. However, these facilities have been at capacity since the onset of the COVID-19 pandemic, resulting in wait times as long as 500 days before treatment is received. During this time, all proceedings against them are at a standstill—thereby contributing to both the criminal court backlog and the rising jail population—and their health often deteriorates under the stresses of incarceration. The Jail-Based Competency Restoration (JBCR) program, operated by the Harris Center for Mental Health and Intellectual Disabilities, provides mental health treatment to these inmates and combines individual and group therapy, co-occurring substance abuse services, trauma-informed care, peer support services, medication management and nursing services with a focus on individualized care, and factual and rational court education services, and has been tremendously successful. During FY 2022, the program had a competency restoration rate of 93%—more than double the average rate for other JBCR programs in Texas (40%), and its average length of stay—55 days—is a fraction of the wait time for a state hospital bed.

Commissioners Court approved an allocation of $645,609 for an ARPA-funded expansion of the Harris Center’s JBCR program, sponsored by the Harris County Sheriff’s Office. The program expansion, which includes pre- and post-units, increases program capacity 20 to 50 patients and aims to reduce the number of people in the Harris County Jail on the state hospital waitlist by providing behavioral health services to have speedier access to trials. The pre- and post-units provides limited services to inmates before they enter the program to reduce their length of stay once admitted to the program and also prevents restored patients from relapsing while their cases are pending, which would require another round of treatment before their case is resolved. The program plans to serve 200 to 245 patients annually.

PRIMARY PARTNERSHIPS

COMMUNITY ENGAGEMENT

The Harris Center’s outreach strategy for the Jail-Based Competency Restoration (JBCR) program incorporates the elements of education, collaboration, and transparency with community partners and vested parties. The JBCR program will provide continuing education for community partners in efforts to increase awareness and education about the process of competency restoration in Harris County. The program will collect and distribute data to the community partners on a regular basis to ensure transparency and encourage continued collaboration.

Community partners include, but are not limited to, the following:

  • Harris County Sheriff’s Office
  • Harris County District Attorney’s Office
  • Harris County Public Defender’s Office
  • Harris County District Clerk’s Office
  • Harris County Criminal Courts at Law and District Courts
  • Dunn Behavioral Sciences Center
  • UTHealth Harris County Psychiatric Center
  • Local defense attorneys

TARGET IMPACT

To evaluate the impact of expanding the Jail-Based Competency Restoration (JBCR) program which aims to restore competency to individuals awaiting restoration services on the State Hospital Waitlist, the following metrics will be analyzed:

  • Total number of people served in the JBCR Program
  • Total number of people served in the JBCR Program and restored to competency
  • Total number of people receiving Outpatient Competency Restoration (OCR) services
  • Total number of beds allocated for the JBCR Program
  • Average recidivism rate among individuals who successfully completed restoration services in the JBCR Program
  • Total number of disciplinary incidents among program participants
  • Average length of stay in the JBCR Program

WEBSITE LINK

USE OF EVIDENCE & PROGRAM EVALUATIONS

The Jail-Based Competency Restoration (JBCR) program will be evaluated through a combination of data tracking, analytics, and aggregate data compiled from stakeholder reports and participant survey responses. Program evaluation will occur continuously throughout the duration of the program, due to the nature of reporting standards. Data and metrics are due on a monthly, quarterly, biannual, and annual basis to various stakeholders. The Program Manager will self-monitor the JBCR Program at both the midpoint of the project (March 30th) and at the end of the fiscal year (August 31st).

The JBCR program uses a survey design to measure program participant satisfaction. Upon completion of the JBCR Program, the participant is provided with an exit survey inquiring about patient satisfaction in the following areas: quality of services provided, quality of service provided by medical staff, quality of service provided by clinical staff, and quality of service provided by peer support staff. Patients are also asked to respond to a series of statements regarding their treatment while in JBCR. Finally, there is an option for free response, where patients can express their opinion on the program using their own words. The data from the surveys is then analyzed and compiled into a final report, which will be submitted as part of the program evaluation.