Forensic services

 

About

The Colorado Department of Human Services, Office of Behavioral Health (OBH) provides evaluation, treatment and other services to the forensic population statewide. Forensic clients are individuals who are diagnosed with mental health disorders, involved in the criminal justice system, and are either currently incarcerated or living in the community. In order to best serve this population, OBH's Forensic Services team works across all settings, including the Mental Health Institutes, jails, and the community.

Mission → Vision → Values

Mission: Forensic Services employs data-driven research and evolving best practices to inform court decisions and public understanding of the assessment and treatment of individuals with mental health disorders involved in the criminal justice system.

Vision: Forensic Services will develop, implement, monitor and enhance high-quality programs in the least restrictive environment in collaboration with our stakeholders to support the mission of Colorado Courts.

Values: In Forensic Services, we strive to:

  • Consider all possibilities
  • Be curious
  • Support one another
  • Remain humble while seeking opportunities to evolve

For this may lead to innovation, growth and success.

Forensic Services Newsletter

Forensic Services Departments

Forensic Services consists of five departments: Court Services, Forensic Community Based Services (FCBS), Jail Based Evaluation and Restoration, Forensic Support Team, and Outpatient Restoration Services. These departments are responsible for coordinating, managing and responding to court orders for forensic evaluation and related forensic services statewide.

Org Chart

Forensic Services Org Chart Sept 2019

Court Services responds to court-ordered evaluations and provides opinions to the court, as mandated by state statute, regarding:

  • Competency to proceed,
  • Restoration to competency,
  • Sanity, and
  • Mental condition.

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The following charts outline each step of the Competency and Restoration processes:

Forensic Community Based Services (FCBS) is responsible for the case management of persons found Not Guilty by Reason of Insanity (NGRI) and who are transitioning from an inpatient hospital setting into a community-based outpatient setting. NGRI acquittees on Community Placement and Conditional Release have the opportunity for continued independence, recovery and community reintegration.

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The Jail-Based Evaluation and Restoration Program serves as the State's only program to provide jail-based competency restoration services for individuals who have been court ordered to receive an initial evaluation of competency to proceed or found incompetent to proceed and ordered to undergo competency restoration treatment.

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The Outpatient Restoration Program serves adults and juveniles in the criminal justice or juvenile justice system, who are found incompetent to proceed (ITP), providing education and case management services in or near their community. This program delivers competency restoration services in the least restrictive setting, increasing a person's ability to engage with local and social support while preventing personal losses such as employment, housing, income and freedom. Education services are at no cost to the individual and are provided by contracted educators throughout the State of Colorado.

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The Forensic Support Team (FST) serves as a centralized structure within OBH in order to assist forensic clients when competency restoration services have been ordered by the court. The team includes a Program Director, two Program Coordinators, and 15 Forensic Navigators to provide case management services to Pretrial Detainees. Forensic Navigators are placed throughout the state.

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For Court Executives

Actions related to Competency to Proceed (Senate Bill 19-223)

In May 2019, the Colorado General Assembly passed a number of bills to improve behavioral health services and resources across the state. This included Senate Bill 19-223, Actions Related to Competency Proceed, which directed the Colorado Department of Human Services to implement some new programs and practices. It includes changes to competency-related statutes to align with the Consent Decree and utilizes the court and state systems to contribute to the best outcomes for individuals in the competency process. All of these new teams, practices, and services aim to maximize Forensic Services' efforts in providing timely competency evaluations and restoration treatment services to pretrial detainees.

Admissions based on need:

This system will create new language that will appear in the initial competency evaluations that will work to screen each Pretrial Detainee to help make recommendations to the committing court as to the most clinically appropriate level of care to restore the individual to competency. This will help us ensure that patients are connected to the most appropriate care based on their individual needs. This includes new language and assessment criteria to assign patients a Tier 1 or Tier 2 status. The recently passed legislation requires that the Department implement a set of policies related to this requirement to achieve the following outcomes:

By July 2019, a tiered triage system that admits the most acute patients within 7 days after the Department receives the order and collateral materials. By July 2020, in-custody evaluations must be completed no later than 21 days after the Department receives the order and collateral materials. By July 2020, out-of-custody evaluations be completed within 42 days after the Department receives the order and collateral materials. By July 2020, offers for admission for inpatient evaluations must occur within 14 days after the Department receives the order and collateral materials. After the fourth 90-day court review of whether the defendant has been restored to competency, reviews occur every 63 days, and if the court determines that there is not a substantial probability that the defendant will be restored to competency in the foreseeable future, the case will be dismissed.

Launch date: 6/1/2019

Forensic Support Team:

This new team will serve as a centralized structure for stakeholders to immediately access detailed information about programs, clients, and settings. The Forensic Services Support Team consists of a Supervising Coordinator and 15 Forensic Navigators strategically placed throughout the state. The Forensic Navigators will interface with clients ordered to competency and restoration services, interface with courts, jails, mental health providers, and other agencies to assist with case coordination, and act as a central point of contact overseeing an individual's continuum of care from point of entry to point of exit.

Launch date: 8/15/2019

Fellowship Program

The Forensic Services Postdoctoral Fellowship in Forensic Psychology at CMHIP is a one-year program providing intensive training in forensic psychological assessment. It is one of only 20 programs recognized by the American Board of Forensic Psychology (ABFP) as meeting their criteria for waiver of the experience requirement to apply for board certification in forensic psychology.

Download the Forensic Services Postdoctoral Fellowship Program Announcement.

"Careers with Forensic Services"]Job vacancies within Forensic Services are announced on the State of Colorado Job Opportunities website. Applications are accepted only during the time period listed on the announcement. Review the job announcements and identify those that you may be qualified for and interested in. To apply for a specific job, follow the instructions in the announcement section titled "How to Apply." When applying for a state job, carefully follow the instructions. Submitting an application to the wrong location or not providing all the required materials may result in not being considered for the job.

Definitions

The following definitions are common terminology used within Forensic Services.

Definitions related to Sanity can be found in C.R.S. 16-8-101.5, C.R.S. 16-8-102.

  • Impaired mental condition - condition of mind caused by mental disease or defect that prevents the formation of a culpable mental state.
  • Insanity - a disease or defective mind that is incapable of distinguishing right from wrong at the time of a commission of an act. Disease or defective is not manifested by repeated antisocial behavior and is not attributable to voluntary ingestion of alcohol or other substances.
  • Mental disease/defect - severely abnormal mental condition that grossly impairs a person's perception and understanding of reality which is not attributable to voluntary ingestion of alcohol or other Substances.
  • Sanity evaluation - a court-ordered evaluation of a defendant who has entered a plea of not guilty by reason of insanity directed at determining the defendant's sanity or insanity at the time the act was committed.
  • Forensic psychologist - a licensed psychologist who is board certified in forensic psychology by the American board of professional psychology or who has completed a fellowship in forensic psychology.
  • Community placement - patients committed to Colorado Department of Human Services and Colorado Mental Health Institute at Pueblo that are treated on an outpatient basis.
  • Conditional release - a status granted to patients by the court that discharges patients from their commitment to CDHS on a conditional basis and is still subject to hospitalization.
  • Not Guilty by Reason of Insanity (NGRI) - a person who is so diseased or defective of mind at the time of the commission of the act as to be incapable of distinguishing right from wrong with respect to that act is not accountable.
  • Release examination - a court-ordered examination of a defendant to determine eligibility for release.
  • Release hearing - hearing determining whether a defendant previously committed to the Department of Human Services as a result of a not guilty by reason of insanity plea has become eligible for release.

Definitions related to Competency can be found in C.R.S. 16-8.5-101.

  • Competent to proceed - means that a defendant does not have a mental disability or developmental disability that prevents the defendant from having sufficient present ability to consult with the defendant's lawyer with a reasonable degree of rational understanding in order to assist in the defense, or prevents the defendant from having a rational and factual understanding of the criminal proceedings.
  • Incompetent to proceed - as a result of a mental disability or developmental disability, the defendant does not have sufficient present ability to consult with the defendant's lawyer with a reasonable degree of rational understanding, or, as a result of a mental disability or development disability, the defendant does not have a rational and factual understanding of the criminal proceedings.
  • Competency evaluation - court-ordered examinations of a defendant directed at determining a defendant's competency to proceed at a particular stage of the criminal proceeding that is performed by a competency evaluator and includes evaluations concerning restoration to competency. Can be completed before, during, or after a trial.
  • Competency evaluator - a licensed physician who is a psychiatrist or a licensed psychologist who is trained in forensic competency assessments Competency Hearing - a hearing to determine whether a defendant is competent to proceed.
  • Developmental disability - a disability that has manifested before the person reaches twenty-two years of age, which constitutes a substantial disability to the affected individual, and is attributable to mental retardation or other neurological conditions that impair general intellectual functioning or adaptive Behavior.
  • Mental disability - a substantial disorder of thought, mood, perception, or cognitive ability that results in a marked functional disability and significantly interferes with adaptive behavior. Mental disability does not include intoxication from alcohol or other substances, or any substance abuse impairment resulting from recent use or withdrawal, or any condition manifested only by antisocial behavior. However, substance abuse that results in long-term, substantial disorder of thought, mood, or cognitive ability may constitute a mental disability.
  • Restoration hearing - a hearing to determine whether a defendant who has previously been determined to be incompetent to proceed has become competent to proceed.​​​​​​

 

 Forensic Services Newsletter

January 2021

COVID-19 UPDATE ON ADMISSIONS AT CMHIP

Admissions to the Colorado Mental Health Institute at Pueblo (CMHIP) were at times temporarily suspended due to the surge in COVID-19 cases over the past couple of months. Admissions have resumed this week at CMHIP and will continue to evaluate admissions based on COVID-19 testing. 

We make these decisions in the best interest of our patients, many of whom belong to high-risk categories. We remain committed to serving Coloradans and review opportunities to resume admissions on a weekly basis.

As you know, many county jails have experienced COVID-19 outbreaks that have complicated our admissions process. Per Colorado Department of Public Health and Environment (CDPHE) guidance, we have instituted a cohort model where prospective patients are medically cleared, isolated and monitored for two weeks before joining the hospital community. 

We are hopeful that with renewed commitment to public health guidance--as well as anticipated vaccine distribution--we can safely admit patients. We continue to watch state COVID-19 data and will update you when we can restart admissions. 

Thank you for your cooperation during these difficult times.


COURT SERVICES

The Court Services Department is responsible for completing court-ordered evaluations, which include Sanity/Mental Conditions, Competency, and Incompetent to Proceed Evaluations along with other duties. Throughout the COVID-19 pandemic, Court Services continues to complete the evaluations with as little interruption as possible. 

When scheduling evaluations, Court Services takes into consideration all COVID-19 protocols specific to the jails or hospital settings. This includes ensuring an evaluator is available to complete the evaluations within the deadlines set by statute. Telehealth Video Conference Evaluations and WebEx Court Hearings have become increasingly frequent. This has pushed the evaluators to quickly learn new technology and adjust from their usual routine of completing evaluations in person.

In alignment with the CDC guidelines, Court Services has been taking all precautions to help keep the community safe. The majority of Court Services’ staff is working remotely and all meetings and En Bancs take place in a virtual setting with most processes being completed electronically. Chromebooks and cell phones have been supplied to rural areas where evaluators may not be able to easily travel to complete the evaluations.

Although there is a lot of uncertainty, COVID-19 has dictated how every branch affiliated with Court Services operates. Processes are constantly changing to accommodate clients. It is vital to have constant communication between the evaluators, administrative staff, court clerks, and attorneys in order to continue to serve our patients. This change has not been easy on anyone, but we are all in this together.


FORENSIC SUPPORT TEAM

In response to COVID-19, the Forensic Support Team (FST) is currently operating under Protocol 1, which restricts Navigators from entering jails for face-to-face contact. As a result, FST is reminded of the essential value for increased communication with jails, attorneys, courts and all other stakeholders. This includes working closely to obtain the most current information on

clients in jail ordered to inpatient competency restoration, clients who meet the criteria of Individual Special Circumstance (a situation that delayed the offer of admission of a pretrial detainee, where the circumstances are not within the control of the Department) clients in jail waiting for an initial competency evaluation. 

According to 16-8.5-105 (1)(d), when a forensic evaluator makes a recommendation for outpatient restoration for an in-custody client who has been found Incompetent to Proceed (ITP), the Forensic Support Team (FST) will submit a discharge plan to the court. Recently, the forensic evaluators have implemented updates to competency reports by making outpatient restoration recommendations for in-custody individuals. In response to these recommendations, the FST has seen an increase in requests for formal discharge plans.

In November 2020, the FST created a discharge plan template that Forensic Navigators will file with the court. On December 3, 2020, the Forensic Navigators were trained on discharge planning, the use of the discharge plan templates, and the new policy and process related to discharge plans. At a minimum, discharge plans will be filed 24 hours in advance of any and all scheduled court hearings pertaining to discharge planning. These plans will be filed in the same manner as FST court reports; in most districts they are available under the suppressed documents file in the Judicial’s case management system for filings (JPOD).

Unfortunately, movement from jails to restoration has also been largely impacted by COVID-19. FST serves as the primary point of contact in bridging the delays and gaps for clients who are waiting during any part of the competency process. The information FST is able to gather is significant in providing the clinical admission team the most updated information they need as they review and assess a client for placement along with keeping stakeholders informed of changes during this time. Finally, FST has also taken on reviewing potential inpatient clients who may be able to continue their restoration efforts in the community. With the collective efforts of CMHIP staff, FST has also been able to make referrals for pertinent services for clients as they enter back in the community. COVID-19 has impacted us all and we shall continue to persevere and overcome obstacles together.


FORENSIC COMMUNITY BASED SERVICES

Community living, holidays, COVID-19, oh my!

Forensic Community Based Services (FCBS) has been following all guidelines mandated by the State and local governments related to COVID-19. Since we cover several counties within Colorado, we have to be flexible while we still provide case management services. Our clients live in residential homes, assisted living, nursing homes, and other care facilities. Depending on the policy and rules of each facility, the team has been keeping contact by face-to-face sessions, telephone, email, and of course telehealth via Google Hangouts. 

Some of our clients have not left their facility since the beginning of the pandemic. This has been a major concern for the staff at FCBS. Our work has always been face-to-face and we definitely had to adjust. We continue to provide face-to-face contact when able; however, our services and care had to adjust for those we can’t have face-to-face contact with.

The holiday season is upon us and this does seem to be a time that our clients struggle. The team has been coming together to make sure that our clients are taken care of and have their mental health needs met. This may include extra phone calls or contact visits (when appropriate) and also for those not able to leave their homes, we have been helping provide grocery and personal need runs. FCBS staff will cover for each other and make sure that both the team and clients stay safe and healthy! 


JAIL BASED RESTORATION

COVID-19 has had a significant impact on all Jail Based Restoration programs, particularly to the admissions process, housing options for patients, programming, and staff coverage. All patients admitting to a Jail Based Restoration program must be screened for COVID-19 and provide the appropriate documentation prior to admission. Should an individual have recent exposure, test positive, or have concerning symptoms related to COVID-19 during screening, they will not be admitted into the programs. We implemented admission cohorts that occur approximately every two weeks and are only admitting into a limited number of designated units. Should there be exposure within a program, specific quarantine and testing processes will be followed for staff and patients. Intensive restoration education and mental health treatment continue to be provided in tandem with additional safety precautions and enhanced social distancing practices. Examples include select telehealth services, social distancing practices, and coordinated staff schedules.


OUTPATIENT RESTORATION

Although the introduction of COVID-19 has certainly had a tremendous impact on our world, its influence on the way in which outpatient restoration services are provided in Colorado has been markedly smaller. Early on in the pandemic, we encouraged our restoration educators to utilize various televideo platforms (such as Google Hangouts or Skype) to conduct restoration sessions, thereby allowing those court-ordered to outpatient restoration to participate in these services without the risk of being exposed to COVID-19. Our educators demonstrated tremendous flexibility by readily adapting to this change, learning the skills necessary to conduct virtual sessions and teaching clients how to navigate the new technology. Educators have continued to utilize televideo platforms in accordance with local public health orders and individual client needs. 

For clients without devices that could access televideo platforms, our educators were invited to purchase cell phones (at CDHS’ expense), to ensure that each client had access to the equipment necessary to participate in restoration. We have seen numerous providers take advantage of this offer over the past several months, allowing those who previously had no ability to remotely participate in services the opportunity to consistently do so. 

Additional resources for outpatient restoration clients have been made available through our recent partnership with Momentum, a Rocky Mountain Human Services’ program. Momentum has helped to provide a tremendous amount of financial support and case management assistance to clients who have struggled during this pandemic, helping to alleviate significant barriers to restoration.

Since the start of the pandemic in Colorado, Outpatient Restoration has received more than 450 adult and juvenile referrals for services. Of those, 100% have been assigned to one of our 55 outpatient restoration providers, resulting in no current delay for anyone court-ordered to outpatient restoration. This has been achieved through an increase in our community mental health centers’ capacity for this population, as well as our ever-growing network of private providers. Our educators have continued to provide high-quality educational and case management services in all of Colorado’s 64 counties while maintaining consistent service provision to vulnerable populations during a time when consistency has been hard to achieve.


DISCHARGE PLAN INFORMATION FROM THE FORENSIC SUPPORT TEAM

According to 16-8.5-105 (1)(d), when a forensic evaluator makes a recommendation for outpatient restoration for an in-custody client who has been found Incompetent to Proceed (ITP), the Forensic Support Team (FST) will submit a discharge plan to the court. Recently, the forensic evaluators have implemented updates to competency reports by making outpatient restoration recommendations for in-custody individuals. In response to these recommendations, the FST has seen an increase in requests for formal discharge plans.

In November 2020, the FST created a discharge plan template that Forensic Navigators will file with the court. On December 3, 2020, the Forensic Navigators were trained on discharge planning, the use of the discharge plan templates, and the new policy and process related to discharge plans. At a minimum, discharge plans will be filed 24 hours in advance of any and all scheduled court hearings pertaining to discharge planning. These plans will be filed in the same manner as FST court reports; in most districts they are available under the suppressed documents file in the Judicial’s case management system for filings (JPOD).

All Forensic Services comply with Health Insurance Portability and Accountability Act (HIPAA) provisions for the privacy and security of client Protected Health Information. Access the Behavioral Health Care Compliance Toolbox for related rules, regulations and resources.