The House Select Committee on Opioids & Substance Abuse met on August 7 to take up interim charges on the impact of substance abuse and substance use disorders on Texans who are involved in the adult or juvenile criminal justice system and/or the Child Protective Services system as well as on specialty courts in Texas. Repeated audio and video blackout interrupted portions of the livestream for this hearing and were present in the archive; disruptions persisted throughout the hearing, portions with significant disruption are indicated below.

This report is intended to give you an overview and highlight of the discussions on the various topics the committee took up. It is not a verbatim transcript of the hearing, but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

 

Opening Comments

  • Chair Price – Final hearing tomorrow on all public testimony

 

Examine the impact of substance abuse and substance use disorders on Texans who are involved in the adult or juvenile criminal justice system and/or the Child Protective Services system. Identify barriers to treatment and the availability of treatment in various areas of the state. Recommend solutions to improve state and local policy, including alternatives to justice system involvement, and ways to increase access to effective treatment and recovery options.

 

Hank Whitman, Texas Department of Family & Protective Services

  • Link to DFPS Presentation
  • @10:00-10:20 AM, repeated interruptions and video/sound blackouts
  • Substance abuse disorders in a child’s caregiver can have a dramatic impact on a child’s development, potentially fatal consequences

 

Kristene Blackstone, Department of Family and Protective Services

  • There are barriers to treatment for caregiver substance abuse, lack of providers, lack of beds, waitlists, etc.
  • DFPS tries to allow children to remain in the home when caregiver is receiving treatment when available and safe, but can be difficult to arrange care for children during this period
  • Outpatient treatment is generally provided through HHSC providers
  • Chair Price – Do our statistics for individuals receiving treatment represent a steady number year over year, has it increased?
    • We have seen removals of children go up this year, can be associated with substance use
    • Serving families in homes has decreased some
  • Chair Price – Why is that?
    • No complete analysis currently, might be able to compare more readily after end of fiscal year
  • @10:24 AM, repeated interruptions and video/sound blackouts
  • White – Regarding marijuana usage, you have statistics for children dying due to use?
    • Whitman, DFPS – That’s Correct
  • White – Have other states drawn down on data on how legalization is affecting their child welfare system?
    • Putting an infant into the equation creates risk
  • White – Obviously when you legalize something you lower cost, etc., could contribute to problems
  • Alvarado – You indicated marijuana is one of the leading indicators
    • We’re seeing marijuana involvement in fatalities, particularly in unsafe sleep; improper infant positions, co-sleeping, etc.
  • Member – I’m thinking there are other factors, like alcohol or other substances
    • We do test for other substances, we see methamphetamine more than marijuana
  • Murr – In the regions are you able to identify regions where substance abuse is higher?
    • Not exactly, have heard of prevalent substances from caseworkers
    • Blackstone, DFPS – I do think this is a gap in our data collection
  • Murr – If we’re not able to identify zip code, etc., we need to correct this
  • Minjarez – What about areas where there are no facilities for testing?
    • We do use swabs, hair strand testing, drive individuals, etc.
    • Have been a few cases of finger nail testing as well

 

Camille Cain, Texas Juvenile Justice Department

  • Most of the children committed have been stabilized in the community by Probation Departments, works through 166 probation chiefs in TX
  • Variety of “service deserts,” Lubbock or Amarillo children may be driven 6 or more hours to find a bed, very burdensome to find space & pay for it
  • 42% of children came from homes where at least one parent had a substance abuse problem, substantially increases chances of child becoming substance dependent
  • Also have a high rate of behavioral health issues, dealing with many co-occurring disorders

 

Lori Robinson, Texas Juvenile Justice Department

  • Best treatment option is comprehensive services, need appropriate personnel training, particularly in interventions and assessments
  • Nevarez – What do you need regarding assessments? Looking for specifics on how to prevent children from becoming those we are treating
    • There are many different assessments, would like to speak with colleagues before making specific recommendations
  • Nevarez – Would like to have specifics for the legislature, would appreciate any input as we get closer to session
    • King – We suffer from the same issues as everyone else, there is a general lack of people entering into this industry and a similar lack of training among them
    • Looking at issues internally to see how we can increase mental health staff
  • Chair Price – We will be preparing our recommendations, report due by Nov. 1, important to make us aware of any info we should consider & include
  • @10:55 am, repeated interruptions and video/sound blackouts
  • White – Asks after reasons for children beginning to use substances
    • Robinson – Trauma can happen over multiple generations, base is children observing parents use substances, but can be more complicated and worse
  • White – No one talks about these issues in regards to full legalization
  • White – How many children have acute mental health needs?
    • Very small number, maybe 20 children
  • White – So you would say those 20 youth need to be held in other settings, not necessarily Giddings; why can’t we get the 20 beds or rooms?
    • Meeting with HHSC staff later in the week, conversation on where and how this should be are just beginning
    • There are experts and resources we would like to utilize
  • White – Will there be more discussion next session, or are these available now? Would like to move process forward now if resources are available
    • When I called and asked for a bed recently they were very responsive
    • Right now we are concerned about kids in active crisis, in the future we would like to identify these children earlier
  • White – Do we have a cost per bed?
    • Intensive mental health care beds are very expensive

 

Lisa Ramirez, Health and Human Services Commission

  • Link to HHSC Presentation
  • HHSC has launched several response initiatives: MAT, pregnancy services, etc.
  • Works with Texas Commission on Jail Standards, including for physician consult, medication delivery, case management, OD prevention education, etc.
  • Services are available statewide and funded as of the 84th Session, varies by county which jails take part in these initiatives
  • Also run recovery support & re-entry programs to assist transition out of jail, incl. connection to MAT, etc.; released inmates are particularly vulnerable
  • Chair Price – Is TTOR funding geographically limited?
    • No, can be spent anywhere
    • First Responders Comprehensive Recovery and Prevention Act funds are limited to Bexar county
    • MHMR Tarrant County also has a specific award
    • TTOR covers services statewide
  • Chair Price – Do you provide funding outside of GR appropriation for MAT, is MAT available through Medicaid?
    • MAT is covered by Medicaid, Substance Abuse Block Grant also covers MAT for indigent individuals, there is GR for maternal MAT
  • Chair Price – Regarding the Medicaid funding portion, Suboxone is on the PDL, have heard from HHSC that it would be preferable to have open access or more drugs on the PDL? Is this correct, is this something we should consider?
    • There are 3 FDA approved medications, Methadone, Suboxone, Naltrexone & all 3 are available for MAT
  • Chair Price – I think I’ve seen this around, would like more information on this aspect & would like HHSC to provide more information
    • Are you speaking to Methadone, Naltrexone, etc.?
  • Chair Price – Not concerned about one drug over another, but we should have as many tools as possible available & not just Suboxone; Maybe we should have open access, possibly even for blood disorders and other areas
    • All these medications are covered, but there are new formulations for some; can consult with Medicaid partners to provide a more detailed response
  • Also running pre-arrest diversion programs
  • MAT combines counseling, treatment, and medications – 3 agents approved & use is associated with lowered opioid usage and lowered criminal justice costs overall, $1 invested in addiction treatment can realize $4-$7 savings in the criminal justice arena
  • Released population is particularly vulnerable to opioid overdose, MAT can help reduce risk of death
  • Chair Price – When HHSC helps fund these initiatives, how long do these last?
    • MAT is highly individualized, 3 approved medications are different & individuals respond differently; studies show there are improved patient outcomes year over year
  • Chair Price – So there is no standard timeline policy?
    • No, all national health guideline organizations discourage placing timelines on MAT, often compared to insulin for diabetes
  • Population of pre-trail detainees is several times larger than jail population, short timeline until release means these individuals are much harder to reach with prevention and intervention
  • Recommend increasing accessing to MAT and other services for these individuals to increase public health outcomes and decrease overall public health costs
  • MAT has proven to prevent multiple treatment episodes & allows individuals to remain in the community
  • In terms of priority population admissions, federal level incl. pregnant women, individuals who inject drugs; HHSC created an additional criteria for individuals involved in DFPS & those at risk for opioid overdose
  • Services and eligibility were expanded for pregnant and post-partum women to those individuals with children under the age of 6, further expanded to targeted response for those with opioid issues
  • Services incl. distribution of materials, intensive case management, home visitation, etc.; Targeted outreach in 2018 has reached >4k women, screenings reached similar numbers
  • Also during the 83rd, HHSC developed programs to educate fathers and expecting fathers involved with DFPS
  • HHSC has additional collaboratives with DFPS, incl. Parental Substance Abuse & Child Welfare Workgroup

 

Bill Gravell, Williamson County, Precinct 3 Justice of the Peace

  • Number of opioids and death inquests have increased year over year, concerned on when this will impact and reach courts
  • Often asks juveniles about substance use, see use of alcohol, marijuana, oxy, fentanyl, etc.
  • Over the last 3 years, opioid treatment for juveniles at Bluebonnet Trails OSAR has increased from 0% to ~6%, opioid epidemic continues to grow
  • Number 1 use for juveniles used to be marijuana, followed by alcohol, and then sedatives; expects opioids to overtake other substances
  • OSAR has been very helpful for treatment
  • Have been running training programs for staff, will be running training for the OD kit recently delivered
  • Sheffield – For adolescents, sedative use is at 12%, which sedative?
    • Not sure, but will get this to you
  • Sheffield – 98% of kids did not re-offend after treatment? How long have you been following these children?
    • Yes, we have been following for 5 years
  • Roberts – Seeing very similar use increases in my district, much of this due to ease of access
  • Roberts – Have you seen an increase in deaths related to opioid use
    • In short, yes, have seen an uptick, but we do not have anywhere to report this data; current reporting system does not have options for opioid deaths or toxicology results
  • Chair Price – Our data is only as good as our system tracks it
  • Roberts – Seems to be a common theme, is the same true for methamphetamine regarding deaths and ability to track?
    • Methamphetamine or opioids may not be the direct cause, but certainly showing up more in the toxicology reports
    • Methamphetamine use appears higher than opioid use

 

Katie Olse, Texas Alliance of Child and Family Services

  • Many unknowns in opioid use, particularly in long-term effect on CPS system
  • Substance use in a significant factor in child protection cases, data between states does not always relates; removals, etc. are increasing
  • Increase in removal is not related to abuse or physical neglect, but due to negligent supervision & incl. substance abuse
  • Clear link between early exposure to substance use and later substance dependency, also correlation between treatment and later outcomes
  • Need to build up therapeutic foster care capacity, many states struggling with increasing capacity for higher needs children
  • A lot of opportunity for coordination between court system, STAR Health, etc.; Current data does not allow for a nuanced response
  • Should encourage local innovation and partnerships, also collaboration between systems
  • Need to aggressively build service capacity, need to continue to fund
  • Chair Price – This is the Title IV(E) funding?
    • Yes, still need to build out capacity to meet demand

 

Carey Green, Texas Department of Criminal Justice

  • About 40% of felony placements and 50% of misdemeanors are directly linked to controlled substance or DWI
  • Within continuum of care, community treatment can provide services for specialized caseloads, also have residential programs available to care for specific offenders
  • Also contract residential service providers that may not qualify for traditional services
  • Community corrections facilities operated by Adult Probations Departments have ~2,500 beds across the state
  • As you move into intensive residential treatment, critical to have aftercare services for community transition the longer the individual is in residential treatment
  • Describes array of community & residential services available for individuals with substance abuse disorders
  • White – What are the recidivism rates, etc. for this population compared to state jail?
    • Don’t have this information currently, but can get it to you
  • White – And your metrics are?
    • We evaluated programs based on adherence to evidence-based practices, began with residential facilities; closed 7 facilities
    • In our populations we see a success rate of 60%-70% in our populations, we see roughly a 13% recidivism rate
  • White – Do you do anything with pre-trial diversion? Heard that the state does not fund this
    • Pre-trail diversion has taken off during the last 6 to 8 years; within the past 10 years, pre-trail diversion population has doubled
    • Last Session, the legislature provided grant funding for pre-trail diversions at ~$6 million, though not all pre-trail diversion in the state is funded
    • TDCJ received funding and distributes to the probation departments
  • White – Looking at pre-trail diversion metrics, have heard that diversion has been working well
  • White – Do you have metrics on your programs, 62% state jail recidivism versus probation 13% recidivism seems like a large gap
    • Just began funding these programs, so no data as of yet
    • 73% of pre-trail diversions are specifically linked to SWI or controlled substances, will be tracking this moving forward

 

Doug Smith, Texas Criminal Justice Coalition

  • For MAT and other services, generally individuals will encounter a waiting list unless they are part of the federal priority populations
  • Waitlists also obscure the amount of need, waitlists do not report on the amount of attrition coming off of the waitlist due to length of timeline
  • Serious and violent crime over last 5-10 years is falling, cases going up are all drug related
  • Presents statistics on increased recidivism linked to justice system involvement, should encourage diversions and present justice system involvement
  • Most courts do not have grants & capacity to handle the drug offense population
  • @12:21 pm, repeated interruptions and video/sound blackouts
  • Transportation for arrest and pre-trial diversion is crucial, community driven and collaborative solutions with TDCJ, HHSC, local communities, etc., could help build out capacity; state could recoup expenses through jail cost decreases
  • Should look into solutions for children of offenders

 

Elizabeth Henneke, Lone Star Justice Alliance

  • DA-driven programs can be incredibly helpful and supportive
  • In some instances, services are only available through jails, should not be focusing on these programs & should focus on community-based care
  • Survivors of crime need to be engaged, need to have a positive reinforcement treatment program
  • Need to measure processes and practices
  • Should pay particular attention to emerging adults & recidivism in this population
  • Texas should consider an innovation fund, which would serve to replicate best local practices

 

Brock Thomas, Harris County Judge

  • Presides over substance abuse & mental health dockets in Harris County
  • RIC Docket created in 2016 was a collaborative effort, focused on community supervision and pre-trial diversion, includes drug possession cases
  • Flows into outpatient treatment in communities, referrals to specialty courts, secure facilities, etc.
  • Information is given to offenders on MAT, but Harris County does not require MAT; decision is left to individual
  • Have seen significant results due to specialty dockets, have increased number of individuals in diversions and alternatives, but need to increase access to timely diversion
  • Docket system has collected most of the drug use cases, and thus most of the opioid cases
  • Alvarado – Other counties may not be in a position to replicate Harris County, but certainly something to strive for
  • White – Some have stated they need more leverage to get people through these types of dockets, including extending jail stays; how do we get others to see this as the best alternative?
    • Not here to suggest this is the only method, but it is effective; need to focus on the incentives involved in the process, shorter timelines, expungements, etc.
  • White – Asks after sensational stories about people in community care or those diverted
    • There are successes or failures, important to have individualized approaches
    • Hennecky, Lone Star Alliance – Fees are a huge incentive for these diversion programs, there is a general consensus that probation is too expensive
  • White – Is there anyone coaching or counseling individuals on the different options?
    • Defense attorneys are required to counsel these individuals, but long-term consequences might not be the focus

 

The Committee recessed from 1:00 PM until 3:50 PM

 

Identify the specialty courts in Texas that specialize in substance use disorders. Determine the effectiveness of these courts and consider solutions to increase the number of courts in Texas.

 

Riley Webb, Governor’s Criminal Justice Division

  • Specialty courts provide court-supervised probation and mandatory treatment as an alternative to sentencing
  • After successful completion, offender is able to petition court for order of nondisclosure of criminal history
  • Specialty courts must be authorized by Governor’s Criminal Justice Division
  • Focused on non-adversarial process for high risk and high need offenders, additional accountability is useful to reduce recidivism; rewards and incentives are built in to support successful completion
  • Court models incl. diversion prior to plea, & programs after adjudication
  • Chair Price – If it is pre-adjudication, what is the legal status of the individual on successful completion
    • The individual would not have gone to trail and would be prior to plea
  • Chair Price – Is there a prevalence of one over the other
    • Majority are post-adjudication due to high risk high need population
  • 7 types: drug courts, sexually exploited persons courts, mental health courts, veteran courts, family drug courts, public safety employee courts, & juvenile drug courts
  • Treatments in drug courts are tailored to an individual’s risk and need, case management, incentives/sanctions, mandated appearances, etc., play into positive outcomes
  • Risk and need are determined by risk of engaging in future criminal behavior & need is determined based on impairments or behavioral health issues
  • Target is high or moderate risk individuals, trying to prioritize intensive services
  • Chair Price – Who makes this determination in the process?
    • Discussion between judge, prosecutor, and defense attorney; multi-disciplinary team
  • Texas Risk Assessment System Tool is used to assess risk
  • Highlights successful drug court aspects, regular meetings, relationship with judge, drug testing, continuum of care involvement, support of social services, etc.
  • Murr – Regarding the different specialty courts, how do you think these courts would apply in rural portions of the state? And we don’t have specialty courts in rural areas?
    • Provided a map of specialty courts
  • 176 registered specialty courts, 71 funded on some level by Governor’s Division
  • White – Who usually reaches out to you for specialty court approval & how often does your office reach out to counties to try and establish a program?
    • Vast majority is those reaching out to us, grant solicitations are done through open request for applications
  • Murr – Do you see any efforts to transport individuals to locations where specialty courts are available? Has this been contemplated
    • I think this has happened, but unsure where
    • We have an appropriation of $2.1 million with add-ons from discretionary funds, but unsure how it breaks down
  • Murr – Have you considered this as one of the aspects of a grant, where a court gets extra funding in exchange for establishing a catchment area
    • In application reviews we give attention to those near or in rural areas
  • Chair Price – You’re obviously not trying to dissuade applications, looking at something like 3 dozen courts that must be funded at local level?
    • Yes, authorized to leverage fees for certain misdemeanors, authorized to retain 60% of fee
  • Chair Price – So if you don’t fall into CJD or GR funded, are the others funded by counties?
    • Could be funded by other sources, but depends on county being awarded the grants
  • Chair Price – Do you have recommendations to increasing number of courts?
    • Would encourage local jurisdictions to look at local method of finance, also look to non-grant courts to see method of finance
  • General framework shows promising results, presents statistics on court graduation rates, ~70% average

 

Ruben Reyes, Lubbock & Crosby County Drug Court Judge

  • Cost of imprisonment is very high, especially for juvenile offenders, drug courts were developed out of need for an alternative
  • High risk individuals are high risk because they are in high need of recovery services, specifically targeting these population and targeting addiction leads to lower occurrence of crimes
  • Drug courts have been successful and have spread worldwide
  • Drug courts take a variety of forms, each locality can have programs tailored to its circumstances, e.g. diversionary, post-adjudication programs, etc.
  • Crucial to have long-running communication between individual and judges, have detailed data to show 3 minutes per meeting, relationship is supported by drug testing, etc. to provide standards to the program
  • Working on solutions to expand programs, telemedicine is being explored in Lubbock & Crosby Counties
  • Common need is data for policy-making, etc.
  • Need to encourage expansion, but need to adequately control the expansion; early expansion led to development of improper and poorly-run courts; ombudsman program could be useful to influence development of courts
  • Certification could also work to ensure we have good programs, should extend beyond registration & need to consider how to monitor
  • Need to update Judge code of standards as well, policies do not reflect practice

 

Julie Turnbull, Dallas County Attorney’s Office, Texas Association of Drug Court Professionals

  • Shares experience being a prosecutor during the early days of drug courts, was initially very skeptical of the program
  • Current Dallas County program has seen great outcomes, program has expanded to 15 specialty courts
  • Texas specialty courts benefit due to the involvement of a strong association, main benefit is seen in training for court personnel; conference is held yearly to promote training
  • Texas association is asking for a statewide data system that would track court metrics in the same way
  • Murr – Have you seen instances where residents of other counties participate in your system
    • Reyes – Yes, major problem is jurisdiction; judge may not be able to sanction with jail sentences, etc. given jurisdiction issues
    • Statute could be altered to allow for easier transition, model provisions exist for veterans courts
  • Murr – Don’t you also need permission of the prosecutor from the originating county?
    • This would be a diversionary program and is a different model
  • Murr – I guess I’m looking at it from the standpoint of someone getting arrested & the local prosecutor recognizing that a neighboring court program could fit this individual
    • In this situation, we need the prosecutor’s green light, still have jurisdictional issue in post-adjudication model
    • Turnbull – Always at capacity in Dallas County, have not had any neighboring transfers; national trainings do have many different concepts for rural courts
  • Chair Price – Perspectives are very helpful to the Committee

 

David Slayton, Texas Judicial Council

  • There are an increasing number of misdemeanor drug possession cases filed, data collected by TJC does look at marijuana, but groups other drugs together
  • Drug possession is largely the only type increasing, other types are declining
  • CPS cases have increased by 25%, many related to removals due to substance abuse, projecting another 4% increase this fiscal year
  • Provides info on breakdown of specialty courts across state by type, drug courts are the most common variety
  • Polled Texas judges on incidence of opioid related cases, provides info on results; Dallas area and North felt opioids were a major problem, likewise Laredo to Bexar, over 75% of judges saw it as a moderate or major problem
  • Other types of drugs are more prevalent than opioids, alcohol is still the most common issue, 38% ranked methamphetamine as #1
  • Most drug cases were seen as the individual was arrested
  • Biggest needs are education and training, information on resources available, funding, etc.
  • Many judges reported a need for MAT
  • National committee recommends statewide opioid taskforce, Judicial Council should collect relevant case level data to promote timely response
  • Chair Price – If you made data more homogenous or uniform, what would this cost?
    • Depends on how detailed this is, some courts have sophisticated systems with ready information, some keep records by hand
    • Looking at case management system from Governor’s School Safety Program as model
  • Murr – We easily have data on marijuana and methamphetamine as they are set out separately, but nothing requires greater details on substance in question; data concerns will be coupled with looking at current criminal laws
    • One of the challenges with data currently is the categorization of data, specifics are not readily available as requirements are more to send data wholesale to the sate
    • One of the recommendations is to break out data at the court level and have case level data collected by them
  • White – Are people using drugs more than they used to? How does it relate to violent crimes decreasing? Are more violent offenders pleaing out on drug offenses?
    • No information to explain this as it is very odd, more violent crimes are down across the state by significant numbers
  • White – With family courts, I think juvenile probation staff understand value of keeping all issues collected, but would like to talk further
  • Judicial Council also recommended more oversight over the specialty courts
  • Council expects resolutions completed in September and statutory language will be completed at the same time
  • Governor’s Office has been very supportive of specialty courts in Texas, but many courts are nervous that specialty court funding is endangered due to emergency needs; legislature could ensure funding is more secure and explore new funding sources
  • Murr – Do you have any ideas for service in rural areas?
    • One of the large things we look it is telemedicine/telepsychology, 85th Session means telepsychiatry will be in every jail anyways
    • Veterans court statute allowing transfer for cases from county to county could also be a useful model; allows transfer to be done with agreement of both courts
    • Could also look to establish regional specialty courts, statutes allow for this currently