CLINICAL HANDBOOK OF SCHIZOPHRENIA

528 VII. POLICY, LEGAL, AND SOCIAL ISSUESnew partners come on stage—judges, district attorneys, jail administrators, public defenders,and possibly probation officers. Postbooking diversion can occur at first arraignmentcourt; during pretrial detention in the jail; at adjudication by a regular or mentalhealth court; or following conviction and sentencing to prison, jail, or probation (communitysupervision). All of these options represent “backdoor” diversions, in that theperson already has been booked into the jail, and the effort shifts to reducing the lengthof time under criminal justice supervision. This is accomplished by negotiating with thecriminal justice partners to secure alternative sentencing, conditional release, or droppedcharges given the rationale that the person will enter into well-supervised mental healthtreatment. These arrangements are mandated or ordered by a criminal court or a specialtymental health court, with stipulations that create continuing obligations to thecourt for both the offender and the treatment provider. If probation is the intercept point,then probation officers become important partners in the postbooking diversion processas well.How Does Postbook Diversion Work?There are times when an informal or ad hoc approach might work for diverting a personwith severe mental illness from jail, but a formal, well-planned, programmatic approachis much more effective. The APIC model (Assess, Plan, Identify, and Coordinate) offers abest practice approach to managing the early release and reentry of jail detainees (Osher,Steadman, & Barr, 2003; see Table 50.1). This model provides guidance for mental healthand criminal justice partners, and proposes a set of critical elements that, if implemented,is likely to improve outcomes for persons with mental illness who are being released fromjail. The four stages of the APIC model are described below.AssessIn this initial stage, a detainee’s psychosocial, medical, and behavioral needs andstrengths are carefully evaluated. Information is compiled from law enforcement, court,corrections, correctional health, families, and community providers, with the goal of creatinga plan for transitioning the person to community care. Consistent with empowermentprinciples, efforts are made to engage the detainee in an assessment of his or herown needs. Also, logistical issues around access to and means to pay for communitybasedtreatment and services must be explored. It is self-defeating to refer a detainee to acommunity service that only takes insured persons, for example, without first checking tosee that the individual has Medicaid, Veterans Administration entitlements, or otherthird-party coverage.TABLE 50.1. The APIC Model for Postbook DiversionItemAssessPlanIdentifyCoordinateDescriptionAssess the inmate’s clinical and social needs, and public safety risks.Plan for the treatment and services required to address the inmate’s needs.Identify required community and correctional programs responsible for postreleaseservices.Coordinate the transition plan to ensure implementation and avoid gaps in care withcommunity-based services.Note. From Osher, Steadman, and Barr (2003). Copyright 2003 by Sage Publications, Inc. Reprinted by permission.