By Donna Rogers, Editor
Scott Tirocchi said that when Rhode Island District Court started a vet treatment program in 2011, it had a capacity of 25. As of last month the program’s capacity is about 80. That seems to be following the number of arrested vets coming into the state’s jail population: one year ago the number of justice-involved vets in the state was 150, this year that number is 250.
While there is no hard and fast number of vets seeking treatment, “they don’t appear to be reducing,” says Tirocchi, who is the administrator of the Veterans Treatment Court and deputy director of the Pretrial Services Unit.
The day we spoke President Obama had changed course and had just extended our country’s presence in Afghanistan, keeping 5,500 troops on the ground there into 2017. “We can’t expect it not to have repercussions,” he noted.
Of 320 million people in the U.S. less than 1% have served in the military. Yet, despite the relatively small percentage, there are currently 22.5 million living U.S. military veterans, and this number is expected to increase dramatically as military personnel return from Iraq and Afghanistan. In 2010 when Tirocchi was serving as a counselor in the jail system, he observed that a high portion of those inmates were first time offenders who had never been in trouble with the law.
Their behavior was not appropriate for civilian life. For example, they were driving at a high rate of speed, a kind of behavior needed in war zones, he explains, and they were commonly arrested for reckless driving or for disorderly conduct. They weren’t aware of the high-risk behavior they were exhibiting, he says.
Veterans had issues such as “TBI, PTSD and substance abuse,” he says, referring to traumatic brain injuries and post traumatic stress disorder. There was and is also significant alcohol dependence and abuse, as well as abuse of opinoids. This type of behavior is on par with veterans across the country, he says.
In fact, in 2008 when a judge in Buffalo, N.Y., began making these same observations and noticing an increase in the number of veterans appearing on his Drug Court and Mental Health Court dockets, the Honorable Robert Russell founded the first Veterans Treatment Court. It is a hybrid drug and mental health that treats the particular stressors that follow veterans home. As of June 2014 there were more than 200 of these veterans problem-solving courts in the U.S., according the National Institute of Justice.
Statistics on Vets
Studies bear out that returning vets have difficulties returning to civilian life. In fact, according to a National Academies study, a full 44 percent of returning service members from Iraq and Afghanistan have reported difficulties after they returned. Significant numbers of these deployed personnel have suffered traumatic brain injuries and many have shown symptoms of posttraumatic stress disorder, depression, and substance misuse or abuse. In the scientific literature, the estimates of the prevalence of those conditions among service members who served in these two conflicts range from 19.5 to 22.8 percent for mild TBI (commonly known as concussion), 4 to 20 percent for PTSD, 5 to 37 percent for depression, and 4.7 to 39 percent for problematic alcohol use.
These military and veteran personnel often have more than one health condition. The most common overlapping health disorders are PTSD, substance use disorders, depression, and symptoms attributed to mild TBI. In 2010, nearly 300 service members committed suicide, and about half of those suicides involved service members who had deployed to Iraq or Afghanistan.
Unlike physical wounds, these conditions affect mood, thoughts, and behavior and often remain invisible to other service members, family, and society. In addition, symptoms of these conditions, especially PTSD and depression, can have a delayed onset—appearing months after exposure to stress.
The Buffalo Court acknowledged those comorbid disorders within the veteran population and takes a multi-pronged approach to dealing with them. As such, it is a collaborative effort among law enforcement, the courts, the V.A. healthcare system and a mentoring program. Like other problem-solving courts, it attempts to rehabilitate participants using structured treatment programs rather than relying on punitive sentences. It is reported have excellent results: for those who have graduated the Buffalo program, the recidivism rate has plummeted, with only 5 percent returning to jail, according to a newspaper series on war veterans in The Ithaca Times in June 2015.
High Deployment Rates
Back in Rhode Island, Tirocchi points out they have faced an unusual phenomena in regard to the high numbers of deployments since 9/11. Possibly owing to many Rhode Islanders in the Army and Air National Guard, its 10,000 calls since 2001 from the Department of Defense represent the nation’s second highest deployment rate per capita.
When veterans began appearing in their court system, common problems they exhibited were sporadic feelings of isolation, having difficulty relating to those who have not served and future planning goals pertaining to finances, family, vocational and educational objectives. Along with PTSD and TBI, they were having trouble readjusting to the civilian world, and they had substance abuse issues mentioned above. Other unique issues the Court found in those returning from deployment, Tirocchi says, are that “many will not self-identify as veterans. They also have a lot of pride…but also a lot of shame.”
In response, in April 2011 District Court Chief Judge Jeanne LaFazia requested the Court establish the first Veteran Treatment Court (VTC) within the state of R.I. The RIVTC is designed to direct defendants who have served in the military into a Court program that integrates treatment plans and support with the judicial process. It offers offenders a treatment option, which is judicially supervised and designed to divert offenders away from incarceration by providing rehabilitative alternatives.
“It gave them a chance to press the pause button and recognize they needed the intervention,” explains Tirocchi, who is a veteran himself.
The Court is a pre-plea, pre-sentence diversion program that is on average 12 months in length. It serves the entire state: the Court is centrally located in Warwick, R.I., and cases are transferred from other counties such as Providence, Washington and Newport, when deemed appropriate.
Similar to those in the general jail population, some individuals have criminogenic risk and will require criminogenic interventions to address these needs. These risks might be a history of antisocial behavior, antisocial personality pattern, antisocial cognition, antisocial attitudes, family and/or marital discord, poor school and/or work performance, few leisure or recreation activities, substance abuse and PTSD.
Tirocchi explains that the former soldiers are identified as high risk (criminal)/high need (treatment) or high need/low risk and they treat each accordingly. He notes that his state’s court provides a multi-disciplined team that includes mental health and substance abuse, counselors, prosecutors, the judge, and ancillary organizations such as Americore, as well as the V.A. “We really do an assessment—both criminal and clinical in nature to determine the programming around them. We don’t do the same [treatment] for everyone but we tailor it to each individual’s need,” he says.
Veterans have their unique issues, he furthers. “Many are isolative. They have their own culture… Internally they wage their own little battles and keep to themselves,” Tirocchi says. At the same time he points out civilians in the reserves are being deployed; not just once but multiple deployments.
“We face this with treatment that is much more precise, tailored, cognitive behavioral therapy,” he says. “It is a holistic, veteran-centered approach.” And because the Pretrial Services Unit oversees the RIVTA, he continues, “we can ID them early, usually at arraignment.”
Treatment Models
RIVTC employs various treatment models. Among these are:
• TAMAR Education Model, a SAMHSA-approved trauma-specific intervention based on psychosocial educational empowerment principles. This model, which stands for Trauma, Addiction, Mental Health, and Recovery, was developed for women in correctional settings, and provides basic insights on trauma, its developmental effects on symptoms and current functioning. It is a 10-week intervention combining psycho-educational approaches with expressive therapies.
• Another is DBT, or Dialectical Behavior Therapy, a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized a standard psychological treatment for this population. It is an evidence-based model that assists in gaining common skills to address interpersonal skills, says Tirocchi.
• MRT, or Moral Reconation Therapy, is a cognitive-behavioral program that is ideal for this population because it address both substance abuse treatment and criminogenic needs. MRT addresses beliefs and reasoning. It is a systematic, step-by-step group counseling treatment approach for treatment-resistant clients. Tirocchi says he can’t speak enough about it because it offers treatment in a nontraditional manner. It has a homework component and perhaps most significantly “it hits upon values common to the veteran community—i.e., getting one’s own house in order, looking out for others, giving back.”
In January 2015 RIVTC initiated the MRT veteran-specific treatment component called Winning the Invisible War. “It is especially effective with this particular population,” he believes.
The Rhode Island Court also has another tool that is particularly effective—a strong mentoring program, says Tirocchi. In the program 19 veterans serve as mentors, representing all branches of the service. “They tend to open up a lot more than with non veterans,” he adds.
Since the beginning, we have had 170 folks graduate, Tirocchi says, and between 75 and 80 participants can be accommodated concurrently in the caseload. The court is one of a growing trend: according to Justice for Vets, a professional services division of the National Association of Drug Court Professionals, as of June 2014, 220 Veterans Treatment Courts across the U.S have already served 11,000 vets. As long as “our citizen soldiers” will be called upon, says Tirocchi, Veterans Courts will be challenged to help them readjust to civilian life with as much productivity and normalcy as possible.
Scott Tirocchi said that when Rhode Island District Court started a vet treatment program in 2011, it had a capacity of 25. As of last month the program’s capacity is about 80. That seems to be following the number of arrested vets coming into the state’s jail population: one year ago the number of justice-involved vets in the state was 150, this year that number is 250.
While there is no hard and fast number of vets seeking treatment, “they don’t appear to be reducing,” says Tirocchi, who is the administrator of the Veterans Treatment Court and deputy director of the Pretrial Services Unit.
The day we spoke President Obama had changed course and had just extended our country’s presence in Afghanistan, keeping 5,500 troops on the ground there into 2017. “We can’t expect it not to have repercussions,” he noted.
Of 320 million people in the U.S. less than 1% have served in the military. Yet, despite the relatively small percentage, there are currently 22.5 million living U.S. military veterans, and this number is expected to increase dramatically as military personnel return from Iraq and Afghanistan. In 2010 when Tirocchi was serving as a counselor in the jail system, he observed that a high portion of those inmates were first time offenders who had never been in trouble with the law.
Their behavior was not appropriate for civilian life. For example, they were driving at a high rate of speed, a kind of behavior needed in war zones, he explains, and they were commonly arrested for reckless driving or for disorderly conduct. They weren’t aware of the high-risk behavior they were exhibiting, he says.
Veterans had issues such as “TBI, PTSD and substance abuse,” he says, referring to traumatic brain injuries and post traumatic stress disorder. There was and is also significant alcohol dependence and abuse, as well as abuse of opinoids. This type of behavior is on par with veterans across the country, he says.
In fact, in 2008 when a judge in Buffalo, N.Y., began making these same observations and noticing an increase in the number of veterans appearing on his Drug Court and Mental Health Court dockets, the Honorable Robert Russell founded the first Veterans Treatment Court. It is a hybrid drug and mental health that treats the particular stressors that follow veterans home. As of June 2014 there were more than 200 of these veterans problem-solving courts in the U.S., according the National Institute of Justice.
Statistics on Vets
Studies bear out that returning vets have difficulties returning to civilian life. In fact, according to a National Academies study, a full 44 percent of returning service members from Iraq and Afghanistan have reported difficulties after they returned. Significant numbers of these deployed personnel have suffered traumatic brain injuries and many have shown symptoms of posttraumatic stress disorder, depression, and substance misuse or abuse. In the scientific literature, the estimates of the prevalence of those conditions among service members who served in these two conflicts range from 19.5 to 22.8 percent for mild TBI (commonly known as concussion), 4 to 20 percent for PTSD, 5 to 37 percent for depression, and 4.7 to 39 percent for problematic alcohol use.
These military and veteran personnel often have more than one health condition. The most common overlapping health disorders are PTSD, substance use disorders, depression, and symptoms attributed to mild TBI. In 2010, nearly 300 service members committed suicide, and about half of those suicides involved service members who had deployed to Iraq or Afghanistan.
Unlike physical wounds, these conditions affect mood, thoughts, and behavior and often remain invisible to other service members, family, and society. In addition, symptoms of these conditions, especially PTSD and depression, can have a delayed onset—appearing months after exposure to stress.
The Buffalo Court acknowledged those comorbid disorders within the veteran population and takes a multi-pronged approach to dealing with them. As such, it is a collaborative effort among law enforcement, the courts, the V.A. healthcare system and a mentoring program. Like other problem-solving courts, it attempts to rehabilitate participants using structured treatment programs rather than relying on punitive sentences. It is reported have excellent results: for those who have graduated the Buffalo program, the recidivism rate has plummeted, with only 5 percent returning to jail, according to a newspaper series on war veterans in The Ithaca Times in June 2015.
High Deployment Rates
Back in Rhode Island, Tirocchi points out they have faced an unusual phenomena in regard to the high numbers of deployments since 9/11. Possibly owing to many Rhode Islanders in the Army and Air National Guard, its 10,000 calls since 2001 from the Department of Defense represent the nation’s second highest deployment rate per capita.
When veterans began appearing in their court system, common problems they exhibited were sporadic feelings of isolation, having difficulty relating to those who have not served and future planning goals pertaining to finances, family, vocational and educational objectives. Along with PTSD and TBI, they were having trouble readjusting to the civilian world, and they had substance abuse issues mentioned above. Other unique issues the Court found in those returning from deployment, Tirocchi says, are that “many will not self-identify as veterans. They also have a lot of pride…but also a lot of shame.”
In response, in April 2011 District Court Chief Judge Jeanne LaFazia requested the Court establish the first Veteran Treatment Court (VTC) within the state of R.I. The RIVTC is designed to direct defendants who have served in the military into a Court program that integrates treatment plans and support with the judicial process. It offers offenders a treatment option, which is judicially supervised and designed to divert offenders away from incarceration by providing rehabilitative alternatives.
“It gave them a chance to press the pause button and recognize they needed the intervention,” explains Tirocchi, who is a veteran himself.
The Court is a pre-plea, pre-sentence diversion program that is on average 12 months in length. It serves the entire state: the Court is centrally located in Warwick, R.I., and cases are transferred from other counties such as Providence, Washington and Newport, when deemed appropriate.
Similar to those in the general jail population, some individuals have criminogenic risk and will require criminogenic interventions to address these needs. These risks might be a history of antisocial behavior, antisocial personality pattern, antisocial cognition, antisocial attitudes, family and/or marital discord, poor school and/or work performance, few leisure or recreation activities, substance abuse and PTSD.
Tirocchi explains that the former soldiers are identified as high risk (criminal)/high need (treatment) or high need/low risk and they treat each accordingly. He notes that his state’s court provides a multi-disciplined team that includes mental health and substance abuse, counselors, prosecutors, the judge, and ancillary organizations such as Americore, as well as the V.A. “We really do an assessment—both criminal and clinical in nature to determine the programming around them. We don’t do the same [treatment] for everyone but we tailor it to each individual’s need,” he says.
Veterans have their unique issues, he furthers. “Many are isolative. They have their own culture… Internally they wage their own little battles and keep to themselves,” Tirocchi says. At the same time he points out civilians in the reserves are being deployed; not just once but multiple deployments.
“We face this with treatment that is much more precise, tailored, cognitive behavioral therapy,” he says. “It is a holistic, veteran-centered approach.” And because the Pretrial Services Unit oversees the RIVTA, he continues, “we can ID them early, usually at arraignment.”
Treatment Models
RIVTC employs various treatment models. Among these are:
• TAMAR Education Model, a SAMHSA-approved trauma-specific intervention based on psychosocial educational empowerment principles. This model, which stands for Trauma, Addiction, Mental Health, and Recovery, was developed for women in correctional settings, and provides basic insights on trauma, its developmental effects on symptoms and current functioning. It is a 10-week intervention combining psycho-educational approaches with expressive therapies.
• Another is DBT, or Dialectical Behavior Therapy, a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized a standard psychological treatment for this population. It is an evidence-based model that assists in gaining common skills to address interpersonal skills, says Tirocchi.
• MRT, or Moral Reconation Therapy, is a cognitive-behavioral program that is ideal for this population because it address both substance abuse treatment and criminogenic needs. MRT addresses beliefs and reasoning. It is a systematic, step-by-step group counseling treatment approach for treatment-resistant clients. Tirocchi says he can’t speak enough about it because it offers treatment in a nontraditional manner. It has a homework component and perhaps most significantly “it hits upon values common to the veteran community—i.e., getting one’s own house in order, looking out for others, giving back.”
In January 2015 RIVTC initiated the MRT veteran-specific treatment component called Winning the Invisible War. “It is especially effective with this particular population,” he believes.
The Rhode Island Court also has another tool that is particularly effective—a strong mentoring program, says Tirocchi. In the program 19 veterans serve as mentors, representing all branches of the service. “They tend to open up a lot more than with non veterans,” he adds.
Since the beginning, we have had 170 folks graduate, Tirocchi says, and between 75 and 80 participants can be accommodated concurrently in the caseload. The court is one of a growing trend: according to Justice for Vets, a professional services division of the National Association of Drug Court Professionals, as of June 2014, 220 Veterans Treatment Courts across the U.S have already served 11,000 vets. As long as “our citizen soldiers” will be called upon, says Tirocchi, Veterans Courts will be challenged to help them readjust to civilian life with as much productivity and normalcy as possible.
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