Competency Restoration Programs

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The Mission of OCRP
OCRP strives to provide competency restoration services to adult defendants in the least restrictive setting,  assisting each participant in learning, to the best of his/her ability, about the court system, how to help in his/her defense, and to make rational decisions throughout the court process.

Additionally, OCRP strives to:

  • Protect the Defendant and the Public

  • Minimize Losses to the Individual and the Taxpayer

History
The Outpatient Competency Restoration Program (OCRP) officially began in 2008 when a change in the statutory language under WSS 971.14(5) was included in the 2007-2009 budget bill, Wisconsin Act 20, that allows defendants, once committed, to be treated for competency restoration on an outpatient basis if deemed appropriate by the Department of Health Services (DHS).  Behavioral Consultants, Inc. contracted with DHS to deliver OCR programming. 

Program Overview
This program offers a least restrictive and cost-effective alternative for defendants adjudicated Not Competent but Likely to Regain Competency and who do not appear to require the full structure, services, and security of an inpatient setting to complete remediation.  Clinical and case management staff assess the defendant for appropriateness in a two-step process.  If the defendant is determined to be clinically appropriate, Behavioral Specialists provide treatment to competency sessions and Case Managers address community-based needs in the home environment.  The defendant is evaluated by an examiner every three months while in the Program, and a written report about the defendant’s progress is given to the court at that time for consideration on making a determination of competency.

Outpatient vs Inpatient Options
According to the statutory language under WSS 971.14(5), once a defendant has been adjudicated incompetent and committed to the Department of Health Services (DHS), the placement for competency remediation(inpatient or outpatient) is fully under the purview of DHS.  In other words, the court cannot order a defendant’s admission into OCRP.  The placement decision is based on a formal assessment process conducted by OCRP staff.

Jail Based Option

There is also a jail based option, first rolled out in 2016, designed to reduce the time defendants spend in an MHI for competency restoration.  Historically, the OCRP has only provided restoration services to defendants in the community but a new Jail-based program (JBCR) was launched to provide those same services to defendants who are in county jails awaiting admission to an MHI.  The services are provided at no cost to the county jail system with the added benefit that inmates receive additional mental health monitoring and DHS will pay for psychotropic medications and medication oversite for this population of at-risk inmates.  The goal is to utilize this “down time” in the jail toward the defendant’s restoration thereby reducing the time they spend at the MHI.  A number of counties have signed contracts with DHS for these services.  Other counties interested in exploring this initiative are invited to contact DHS.  Visit the JBCR page for more information.

 

Benefits of the Outpatient Setting

  • Prevention of Individual Losses to the Defendant

    • Liberty

    • Social Security or other income

    • Housing

    • Employment

  • Decreased Life Disruption for the Defendant

    • Continuity of care with community service providers

    • Familiarity with environment

    • Regular access to support system

  • Benefits to the Public

    • Significant cost savings

 

The Role of ALL OCRP Staff

  • Treat every Program participant with dignity and respect

  • Strive to remain neutral regarding the charges for which a defendant has been brought to court

  • Refrain from offering any type of legal advice

  • Maintain strong boundaries and work within the boundaries of their respective functions

  • Abide by the ethical and legal guidelines of the respective profession

 

Optimal Participant

  • Refrains from AODA use/abuse

  • Presents no immediate danger to community or self

  • Has stable mental health

  • Has reliable transportation

  • Has stable housing

  • Is motivated with a good attitude

 

Referring

  • Defendants who may be appropriate for OCRP participation are typically first identified by the initial competency evaluator

  • Once adjudicated as Not Competent/Likely to become competent, the defendant’s information is forwarded to OCRP for assessment

  • If not identified by the WFU examiner, the court may still request an assessment by noting this request on the CR-206 under #9: Other referral to OCRP.

 

The Assessment Process

  • Following a successful file review, the defendant is scheduled for a clinical assessment with a licensed psychologist

  • Contrary to other examination practices, we encourage at least one member of the individual’s support system to be present for the assessment

  • Once the clinical Intake Assessment has been successfully completed and the defendant continues to present as a suitable candidate for OCRP, the defendant will be referred for an Environmental Assessment

  • This assessment involves an OCRP case manager or supervisor going to the defendant’s home for an interview to:

    • Ensure general safety and stability of the residence

    • Gather information on community providers and the defendant’s support system

    • Review Program expectations and rules related to their home and behavior outside of the remediation session

 

Acceptance

The Clinical Director reviews all assessment information as the process unfolds. Once a decision is reached by the Clinical Director as to appropriateness for OCRP, a letter, along with program rules, is sent to the judge, district attorney, and defense attorney. The defendant then is contacted by Program staff and treatment to competency commences.

 

Treatment
Because of the nature of the Program, the OCRP has the ability to utilize an individualized, multi-modal approach for competency remediation.  Each participant is assigned a Behavioral Specialist and Case Manager.  These individuals, together with supervisors and the Clinical Program Director, represent the core team.

  • Behavioral Specialist sessions are typically conducted two times per week for one hour per session and occur in a public locations

  • Case management sessions occur at least one time per week, generally in the home setting

 

How Long Does This Take?

The total amount of time someone will be in the Program can be up to 9 months (for a misdemeanor) or one year (for a felony). The participant will be seen by a doctor, and possibly the judge, every three months [per Wisconsin Statute 971.14(5)(b)]  to see if the person is ready to continue with the case.

 

Program Removal
OCRP works diligently to make appropriate placement decisions and support successful participation of defendants.  Changes can occur which may render the defendant no longer clinically appropriate for OCRP.

 

This can be for things like:

  • Missing appointments, elopement, absconding

  • Breaking the law

  • Using drugs or alcohol

  • Doing dangerous things

  • Not taking medications

  • Decline in clinical stability

  • Poor motivation or cooperation

 

Some issues that arise in competency remediation require immediate action with referral to the inpatient setting (e.g., episodes of violence, suicidality, new arrests).  For other problems that are identified, the OCRP core team will work to correct or manage the issue. This may include calls to the defense attorney with a request that the attorney provide counsel to the OCRP participant.  When these attempts to resolve issues fail, the individual is referred for inpatient transfer because OCRP can no longer reasonably ensure the safety of the defendant or of the community.  Should the defendant require discharge, both the court and the defendant will be informed by the Clinical Director via letter of the OCRP decision and the reason(s) for discharge. The letter will include a request that an arrest warrant and order of transport are issued in order for the defendant to be safely secured and transported to the one of the state mental health institutes for continued restoration treatment, per the original commitment order. The state mental health institutions are also notified of a removal decision so that they can be activated to assist with voluntary admission.

 

Where We Are
While OCRP has not served defendants in all counties of Wisconsin, we are willing to consider defendants for participation in the Program from any county; however, circumstances such as the location of the defendant’s residence, transportation issues, or level of need in a particular case may result in our inability to provide services for defendants who might otherwise be appropriate for the Program.  In such a circumstance, the defendant will be placed on the waiting list for admission to one of the state Mental Health Institutes and will be contacted by institutional staff to arrange for admission. A letter will then be sent to the court and the attorneys notifying them of this.

Connection to the Wisconsin Forensic Unit (WFU)
Since 2002 WFU has provided outpatient competency to stand trial evaluations of adult defendants throughout Wisconsin.  WFU also provides re-examinations of defendants committed to DHS and enrolled in OCRP.

Connection to the Department of Health Services (DHS)
The OCRP is contracted by the Wisconsin Department of Health Services to provide competency remediation, and as such, is accountable to them for performance and compliance requirements.

 
If you have a question, feel free to contact us any time at 414-271-5577 and ask for the OCRP Program Liaison.

757 N Broadway, Suite 500

Milwaukee, WI 53202

Tel: (414) 271 – 5577

821 W. State Street, Room 504

Milwaukee, WI 53233

Tel: (414) 278 – 4690