Cheshire County Treatment Court Presentation Highlights 2024

Cheshire County Treatment Court Semi- Annual Presentation to County Commissioners ALISON WELSH OCTOBER 16, 2024

Seamus Batdorf-Dwyer C.R.S.W CERTIFIED RECOVERY SUPPORT WORKER

The Four Domains of a CRSW Advocacy Recovery support workers relate to individuals as advocates, and advocate for person-centered recovery and wellness support services. Ethical responsibility Recovery support workers should recognize risk indicators that may affect an individual's welfare and safety. Mentoring and education Recovery support workers should serve as role models, and educate through shared experiences. Recovery/wellness support Recovery support workers should support the development of healthy behavior that is based on choice.

Qualifications Lived experience with substance use and multiple pathways of recovery Several years of sustained abstinence-based recovery from substance use disorder Attendance at three state treatment court conferences, three national treatment court conferences, two New England treatment court conferences, and two R.I.C.H (Recovery, Inclusion, Community, Harm Reductions.) Trainings The Art of Peer-Assisted Recovery Motivational Interviewing Ethics Co - Occurring Disorders Suicide Prevention AIDS, HIV, and Hepatitis C

Accomplishments Forty-six hundred hours on the job Over five hundred of which was direct contact with participants Attendance with participants at over one hundred self-help meetings Assist participants with acquiring stable housing Educated participants on multiple pathways of recovery Educated participants on recovery capital Assisted with transportation Facilitated periodic pro-social activities Provide relatable emotional support Broker local resources Advocate and promote self advocacy

Services Rendered Pro- Social Employment Services Working on Drivers License Coaching: General Service: Other Service: Vocational Service: Transportation Service: Housing Assist Service: Health/Medical Service: Educational Referrals Made Resources Recommended Meetings Attended 0 50 100 150 200 250

Graduations and Terminations since June 4, 2013 Medication Assisted Treatment Data Terminated 52 terminated Graduated 44 graduates 25 males 36 males 19females 16 females On MAT: 31 yes/13 no On MAT: 25 yes/26 no

Medication Assisted Treatment 2024 Participants 16 14 14 Number of Participants 12 10 8 6 4 4 3 2 1 0 0 Sublocade Suboxone Methadone Types of Medication Naltrexone Not on MAT

Mental Health Diagnoses of 2022 participants Unspecified Caffeine-related Stimulant Use Disorder, Stimulant use Disorder, Stimulant Disorder, Severe Posttraumatic Stress Disorder Opioid Use Disorder Major Depressive Disorder Generalized Anxiety Disorder Gambling Disorder Episodic Cannabis Use Disorder Borderline Personality Disorder Bipolar Disorder Attention Deficit/Hyperactive 0 2 4 6 8 10 12 14 16 Diagnosis

Mental Health Diagnoses of 2024 Participants Unspecified Depressive Disorder Unspecified Caffeine-related Unspecified Attention Deficit Unspecified Anxiety disorder Stimulant Use Disorder, Stimulant use Disorder, Stimulant Disorder, Severe Posttraumatic Stress Disorder Opioid Use Disorder Major Depressive Disorder Generalized Anxiety Disorder Gambling Disorder Episodic Cannabis Use Disorder Bipolar Disorder Attention Deficit/Hyperactive 0 2 4 6 Diagnosis 8 10 12 14 16 18 20

Cheshire County Treatment Current Curricula All aspects of treatment returned to in person for groups and individual sessions Seeking Safety Group (trauma) Moral Recognition Therapy (criminal thinking)- Thinking for Change Anger Management Matrix Gender Based Groups Individual Therapy Yoga on Thursdays now at Mudita Individual DBT when recommended EMDR -Eye Movement Desensitization and Reprocessing Case Management 1 to 2 times per week also increased Peer Support/Recovery Coach sessions Equine Therapy through Coopers Crossroads

Housing for CCTC Participants 2024 Types of Housing Apartment Unhoused Sober Living

Participant Incentives 2024 Number of Incentives 300 253 250 189 176 200 163 125 150 105 89100 100 27 25 23 21 19 50 16 14 12 12 12 11 8 7 7 5 5 4 3 3 1 1 1 1 0 0 Incentive type

Participant Sanctions and Therapeutic Interventions 2024 30 25 20 15 10 5 0 UAs must be done before Carry/Update/Review Added to docket to Check in with probation Meet with Case Manager Daily Meeting with Case Increase in Probation Weekly logs handed in Weekly logs handed in Weekly logs due by 8:00 Apply to Residential Breathalyzer/alco-sensor Therapeutic Intervention Daily Text or Phone Contact Double Colors Report Early Daily Logs Daily UAs Warrant Warrant Self-Help Assess for Level of Care Daily Check In w/ Judge Verbal Warning Meet w/ Case Manager Relapse Plan Study Hall Use Calendar Essay Jail Warning from Judge Warning from Judge Daily Check Ins Large Team Meeting Suspended 24 Hours Court Observation Behavior Chain Beverage log Increase Level of Care Meet w/ Clinician Verbal Warning Care & Concern Functional analysis Reduce Curfew Community Service Restart sober date

Incentives to Sanctions 2024 Total Incentives: 1438 Sanctions: 194 (e.g. Jail, Court Observation, Community Service) Therapeutic Interventions: 71 (e.g. Relapse Response Groups, Additional Treatment) Final Incentive to Sanction Ratio: 7.4:1 (Total Incentives)/(Sanctions) = Sanction Ratio above the recommended 4:1 ration recommended by best practice

Positive Drug Tests 2024 Oxycodone/Oxymorphone Naloxone Methadone Metabolite Gabapentin Ethyl Glucuronide (EtG) Benzodiazepines Amphetamine Heroin Morphine Codeine Cocaine 0 50 100 150 200 250 Number of Positives

Primary Drug of Choice Comparison Primary Drug of Choice 2022 Primary Drug of Choice 2024 1 3 3 2 1 2 12 16 Opioids Stimulant- Amphetamine Alcohol Stimulant- Cocaine Opioids Stimulant- Amphetamine Alcohol Stimulant- Cocaine

Demographics: Race Cheshire County Treatment Court 2024 Race Cheshire County House of Corrections 2023 9.00%1% 6.00% 85.00% 100% White White Latinx/Hispanic Black Other

Demographics: Age 9 8 7 6 5 4 3 2 1 0 18-22 23-27 28-32 33-37 38-42 43-47 48+ Age

Demographics: Gender and Phase Gender Phases By Gender 16 4.5 14 4 12 3.5 3 10 2.5 8 2 1.5 6 1 4 0.5 0 2 0 Males Females Males Females

Confirmed Overdose Rates for Cheshire County, NH Data Overdose deaths Cheshire county 2024 up to 9/11/24 Overdose Deaths Cheshire County 2024 Fentanyl, methamphetamine and cocaine 9 deaths in Cheshire County as of August, 2024, toxicology reports across the state still pending and Cheshire County has seen a recent spike in overdoses. Graph to be updated when end of year data is available. Fentanyl and cocaine Fentanyl and methamphetamine Fentanyl alone 0 20 40 60 80 100 Total Data provided by Susan Watkins, Chief Forensic Investigator, Office of Chief Medical Examiner Xylazine was detected in 26 overdose deaths and considered contributory to death in 2 cases. Carfentanil was detected in 3 overdose deaths and considered contributory to death in 2 cases.

Overdose Data for New Hampshire 2011 2012 2013 2013 2015 2016 2017 2018 2019 2020 2021 201 163 198 342 444 486 490 471 415 417 436 2022 2023 2024 487 431 183 (43 pdg as of 9/11/24)

Friends of Cheshire County Recovery Courts 2024 Donations made in 2024: 5 gift cards of $50 each to Hannaford s to supplement UNH Nutrition Class, fall 2024 Bikes, bike locks and helmets donated by Norm s Two presentations in collaboration with in conjunction with the Greater Monadnock Collaborate: Changing the Culture Around Mental Health: It s Way Past Time- Judge Nadeau, Judge Broderick and other speakers Donation of $2,000 by board member New members Kelly Griffin from Keene Housing and Sarah Tatro from Franklin Pierce Friends created a new grant application

Conclusion: Takeaways CCTC continues to follow Best Practices Increased graduation rates Seamus is now a CRSW-certified recovery support worker BJA grant ends in October 2025 Added Equine Therapy as an additional resource UNH Nutrition classes in October 2024 Great community resources and collaboration sent a few participants to free dental clinic Continuing with Pathway Home Program Southwestern classes Tenancy, Budgeting and Financial Literacy Narcan training by John Letendre from CMC We are working on becoming a trauma informed court hiring an expert in the field Brian Meyer Brand new judge Honorable Anne Edwards started October 8th Savings to tax payers. The cost of a year in CCHOC is approximately $68,080 and the cost of one year of treatment in Cheshire County Treatment Court $$16,338. A savings of $51,722 per individual..

CHESHIRE COUNTY TREATMENT COURT TEAM 2024 Missing from team picture: Joel Chidester, Gary Richard, Seamus Batdorf-Dwyer and Stacie LeClerc