Leading the Movement Toward Diversion as a First Response: Building Connections to Treatment at the Front End of the Justice System

Below is an excerpt from TASC’s semi-annual News & Views. The current issue includes articles on pre-arrest, prosecutorial, and jail release interventions for people who have substance use and mental health conditions.

(Chicago) — A recent criminal justice trend is gaining traction. It has potential not only to help curb the devastation that the opioid epidemic is causing in communities across the nation, but also to bring law enforcement, treatment providers, and communities together to solve common challenges that substance use and mental health disorders pose.

It’s known as pre-arrest diversion. Other terms include front-end diversion, deflection, and pre-booking diversion. Regardless of terminology, the goal is the same: to divert eligible individuals with substance use and mental health disorders to treatment before logging an arrest.

“We know from decades of research and experience that formal connections to treatment can improve access and outcomes,” said TASC President Pam Rodriguez. Lessons learned from prosecutorial diversion programs, court intervention programs, and reentry programs can, and should, be applied even earlier in the justice system.”

The first point of entry into the justice system—and thus the earliest opportunity for justice diversion—is law enforcement.

“For most people who are manifesting substance use and mental health disorders, there are better alternatives than arrest,” said Rodriguez. “Through our work with partners across the country, we hope to make it easier for law enforcement officers to connect people to treatment.”

Building Police-Treatment-Community Partnerships

According to the Centers for Disease Control and Prevention, from 2000 to 2015, nearly half a million people died from a drug overdose, and since then, mortality rates have climbed precipitously, with a record 64,000 people having lost their lives to overdose in 2016.

Often at the front line of these tragedies, local law enforcement agencies are seeking new ways to better serve and protect communities confronting the consequences of substance use disorders, especially as police frequently interact with individuals affected by addiction and/or overdose. Pre-booking or pre-arrest diversion strategies can help reduce drug use, promote public safety, and save lives.

In March, the Center for Health and Justice at TASC partnered with the Civil Citation Network to convene the first-ever national summit focused on pre-arrest diversion. Criminal justice, behavioral health, and public policy experts from across the country gathered at the headquarters of the International Association of Chiefs of Police (IACP) in Alexandria, Virginia, for two days of information sharing and planning.

From this meeting emerged the Police, Treatment and Community Collaborative (“PTAC Collaborative”), the first national effort to build a multi-disciplinary approach that ensures law enforcement, treatment professionals, and community members collaborate as equal partners to widen community behavioral health and social service options available through law enforcement diversion.

Working through the PTAC Collaborative, IACP and TASC have come together to promote alternative-to-arrest diversion programs for state, county, and local law enforcement agencies across the United States. This collaboration seeks to greatly improve the means, ease, and speed with which law enforcement can partner with substance use and mental health treatment providers so that police can help people access treatment.

Read more about TASC’s partnership with IACP and the PTAC Collaborative to advance pre-arrest diversion.

Save the date for the inaugural PTAC Collaborative conference March 4-7, 2018 in Ponte Vedra, Florida.

Browse additional stories in the current issue of TASC News & Views, including frameworks for pre-arrest diversion (p. 5), prosecutorial diversion in Illinois (p. 6), and the new Supportive Release Center in Cook County, Illinois, where TASC and partners provide intervention and service linkages at the critical point of release from jail (p. 7).

Also in this issue:

Advertisements

TASC, National Judicial College Offer Self-Study Courses on Addiction for Criminal Justice Practitioners

(Chicago) – In the face of a national opioid crisis, and recognizing that most people entering the justice system have recently used illicit drugs and/or have a substance use disorder, the Center for Health and Justice at TASC and the National Judicial College (NJC) have co-developed three new self-study courses to support justice leaders in implementing evidence-based responses to help stop cycles of drug use and crime.

These free, online courses provide timely information and practical solutions offered by top national researchers in addiction and criminal justice. They were created as a result of TASC’s and NJC’s collaborative work in leading the Justice Leaders Systems Change Initiative (JLSCI), which supports jurisdictions across the country in leveraging local resources to create and implement collaborative responses to substance use disorders.

The courses present several key topics requested by jurisdictions, including research on how the brain is affected by addiction, implications for evidence-based sentencing options, and information on medication-assisted treatment.

Available by clicking on the titles below and registering through the NJC website, these free courses include:

The Neuroscience of Addiction. This self-study course offers an introduction to the opiate epidemic, why individuals use drugs, and the long-term effects of addictive drugs on the brain. Designed for judges, probation staff, and other criminal justice system stakeholders, the course takes approximately two hours to complete, and is presented by NJC distinguished faculty member Timothy P. Condon, PhD, a preeminent expert in the neuroscience of addiction and its application to policy and practice.

Evidence-Based Sentencing for Drug Offenders. This self-study course addresses several aspects of sentencing and supervision of people with substance use disorders, including matching treatment and supervision to the individuals’ clinical needs and risks of reoffending. Providing tools, resources, and evidence-based approaches for judges, the course takes approximately two to four hours to complete, and is presented by NJC distinguished faculty member Roger Peters, PhD, a prolific author, researcher, and professor in the Department of Mental Health Law and Policy at the University of South Florida (USF).

Medication-Assisted Treatment. This self-study course addresses how medication-assisted therapies can be used to treat substance abuse disorders, including discussions on the opiate epidemic; the impact of addiction on the brain; relapse, overdose, and mortality rates; and how medication-assisted treatment can work. Designed for leaders and practitioners in criminal justice, the course takes approximately two to four hours to complete, and is presented by NJC distinguished faculty member Joshua D. Lee, MD, director of the NYU ABAM Fellowship in Addiction Medicine, and a clinician researcher focused on addiction pharmacotherapies.

Created by the Center for Health and Justice at TASC and the National Judicial College, the Justice Leaders Systems Change Initiative (JLSCI) helps local jurisdictions create and implement practical, collaborative responses to substance abuse and addiction among offenders and is funded by the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT), the National Institute on Drug Abuse (NIDA), the Bureau of Justice Assistance (BJA).

TASC, Partners Launch Supportive Release Center by Cook County Jail

(Chicago) – In collaboration with the University of Chicago Health Lab, the Cook County Sheriff’s Office, and Heartland Health Outreach, on July 26, 2017, Treatment Alternatives for Safe Communities (TASC) announced the launch of the Supportive Release Center (SRC), an innovative new program that provides short-term, critical services to people with high needs as they are released from the Cook County Jail.

SRC Ribbon Cutting

Supportive Release Center Ribbon Cutting, July 26, 2017. Left to right: Pamela F. Rodriguez, TASC; Dr. David Meltzer, University of Chicago Harris School of Public Policy; Cook County Sheriff Tom Dart; Dr. Daniel Diermeier, University of Chicago; Ed Stellon, Heartland Health Outreach; Dr. Harold Pollack, University of Chicago Urban Labs.

The SRC offers a brief overnight stay and linkages to community-based services for individuals who are struggling with mental illness, substance use disorders, or homelessness.

The facility, owned and administered by TASC, is located just blocks away from the Cook County Jail. It offers a “softer landing” for vulnerable persons who are being released from the jail, with the goal of reducing re-arrests, future incarceration, adverse health outcomes, and future incidents of homelessness.

SRC Exterior

 

SRC Interior with Staff

At the Cook County Jail—the largest single site jail in the United States—staff estimate that at least 30 percent of the daily population is living with some form of mental illness. An April 2016 survey study conducted by the UChicago Health Lab found that over 70 percent of respondents being released from Cook County Jail indicated some form of mental illness, substance use disorder, or other acute need, including feeling unsafe leaving the jail or an immediate need for medical care. More than one in three of those leaving the jail with indications of mental illness and substance use disorders were re-arrested within just five months of release. With approximately 70,000 individuals passing through the jail each year, the need to better serve individuals as they transition out of the jail has become a pressing public health concern.

“We know that people released from jail often don’t have a safe place to go, especially if they are facing addiction, mental illness, or homelessness,” said TASC President Pam Rodriguez. “The SRC represents a collective effort of partners in the nonprofit sector, academia, government—and supported by private donors—to create a better path to health and safety.”

The Cook County Sheriff’s Office provides assistance in assessing and recruiting people for the center as they are leaving the jail. Participation in the SRC is voluntary, and interested participants are transported to the SRC by TASC staff, where they receive light food, clothing, and access to showers. TASC staff at the SRC conduct needs assessments and facilitate linkages to services in the community, including substance use treatment, mental health services, supportive housing, job training programs, and legal aid resources.

Participants also have access to an advanced practice nurse (APN) on-site, to provide immediate medical care and any necessary prescription medications. For those individuals who are identified as being homeless, Heartland Alliance Health is offering longer-term, more intensive case management services. The University of Chicago Health Lab is evaluating the project.

SRC partners group

SRC partners gather to celebrate the center’s launch.

The SRC was the winner of the Health Lab’s 2015 Innovation Challenge, which sought to identify and evaluate the most promising solutions to pressing challenges in public health.

Along with the University of Chicago Health Lab, numerous foundations and donors have contributed to the development of the SRC, including: Blue Cross Blue Shield of Illinois, The Chicago Community Trust, Crown Family Philanthropies, Michael Reese Health Trust, Margot and Thomas Pritzker Family Foundation, Reynolds Family Foundation, The Siragusa Family Foundation, and SixDegrees.org.

SAMHSA Awards Funding to Cook County Drug Treatment Courts, including TASC Case Management

(Chicago) – TASC now plays a supporting role in all Cook County Drug Treatment Court programs, thanks to a new federal grant awarded to three suburban drug court programs.

The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the U.S. Department of Health and Human Services, awarded $324,811 to the Circuit Court of Cook County Drug Treatment Court programs in the Markham, Maywood, and Bridgeview courthouses. These programs follow the original such program operating in the Criminal Court Building at 26th Street and California Avenue in Chicago.

Defendants enter the drug courts voluntarily, and all participants have been charged with nonviolent offenses.

“For nonviolent defendants who are driven by drug addiction, the court exercises compassion in the pursuit of justice. Treatment, not punishment, is the best option to pursue,” Chief Judge Timothy C. Evans said.

“Many times, these individuals would rather receive a short-term jail sentence so that they can start using again upon release. Instead, we offer a long-term effective treatment plan that can help end their suffering and the suffering of their families and friends. This grant funding will allow us to enhance our existing services and help defendants find a future of sobriety.”

The three suburban courts will now work with case managers from TASC, who will provide clinical assessments of all defendants entering the drug courts. The case managers will determine what level of treatment is needed and whether it will require out-patient or in-patient services. The TASC case managers are also trained to help defendants enroll in Medicaid and also re-enroll as required every year. The coverage under Medicaid can pay for the drug court defendant’s treatment.

Read more.

Collateral Consequences of Convictions

(Chicago) – TASC submitted comments for the May 19 briefing of the U.S. Commission on Civil Rights on Collateral Consequences: The Crossroads of Punishment, Redemption, and the Effects on Communities.

The briefing focused on the barriers to successful community reentry for formerly incarcerated individuals. According to the Commission, “They may face numerous barriers to reentry, including denial of governmental assistance designed to assist with finding employment. These collateral consequences affect families of the formerly incarcerated in a multitude of ways. For decades, communities of color have been disproportionately represented in the rates of felony convictions, and therefore are hardest hit.”

These barriers are mirrored in Illinois, and are experienced by TASC clients, even decades after they have paid their debt to society and resumed a law-abiding life. Barred access to employment and housing opportunities also create added challenges for individuals who are also striving to overcome substance use and mental health disorders.

Below is a synopsis of TASC’s comments, offering observations from decades of experience working to support diversion to community-based behavioral health treatment for men and women involved in the justice system, as well as reentry support following release from incarceration:


[Barriers to reentry and disproportionate minority contact are among] the reasons that TASC actively pursues strategies and opportunities that reduce the number of people entering the justice system. We seek to divert people away at every intervention point, and we promote avenues to health and recovery in the community so individuals do not return to the system.

We worked with and drafted reports on behalf of the Illinois Disproportionate Justice Impact Study (DJIS) Commission and Illinois Racial and Ethnic Impact [REI] Research Task Force) to evaluate and address disparities in the justice system. We conducted several surveys of diversion programs across the country and in Illinois that prevent criminal convictions on record, offering observations and recommendations for improvement and expansion.

We seek ways to improve access to healthcare coverage for those who come in contact with the justice system. Recently we have collaborated with jurisdictions in exploring law enforcement diversion practices for drug-involved individuals, a need that has become even more visible and accentuated in the midst of the opioid crisis.

We recognize that there are many individuals in the justice system who are less likely to return to the system if they have access to behavioral health services, and we know that a criminal record acts as a barrier to recovery, restored citizenship, and community reintegration. Improving access to and connecting justice-involved populations to community-based services may help reduce the racial disparities that exist throughout the criminal justice system. It is good health policy. It is good justice policy. It is good public policy.

In our decades of work in these fields, we have made a number of observations about the state of safe, responsible criminal justice diversion that we hope will inform the Commission’s work.

  • The criminal justice system has become a de facto societal response to substance use and mental illness. Across the U.S., criminal justice systems are managing record numbers of people, with rates of substance use and mental health disorders that are much higher than those among the general public. More jurisdictions are focusing efforts to leverage resources toward management of these disorders in the community instead of the justice system, seeking to prevent taxpayer costs associated with incarceration and recidivism, as well as to support restored citizenship and second chances.
  • Numerous factors have led to broad-based calls for criminal justice reform. In recent years, a confluence of factors has created fertile ground for broad-based improvements to criminal justice policy and practice. These factors have included overburdened courts, crowded jails and prisons, strained government budgets, advances in the science of drug use intervention and recovery, shifting public attitudes about drug policy, awareness of the negative and residual impacts of justice involvement on families and communities, attention on the disparate burden of justice policies on racial/ethnic minority communities, and a preponderance of research on the effectiveness and cost efficiency of alternatives to incarceration.
  • Diversion policy should be focused on systems rather than programs. Modern justice policy is beginning to adopt public health strategies, focusing on broad-based, systemic intervention, and the application of the minimum but appropriate amount of supervision, sanctions, accountability, services, and resources to achieve the intended result.
  • Meaningful diversion can happen at any point before conviction. Initiatives can occur at points of contact with law enforcement, prosecutors and public defenders, pretrial services and probation, the judiciary, and even the jail. In cases where diversion before conviction isn’t an option, treatment-based alternatives to incarceration can prevent recidivism, taxpayer costs, and deleterious effects of confinement.
  • Evidence-based practices should inform decision-making. The most effective response to justice-involved individuals with substance use and mental health issues is a locally defined balance of supervision, accountability, and community treatment and support. What is deemed appropriate should be driven by the ever-expanding base of research and data regarding which intervention models best serve a given population at a given point of justice involvement. A risk-needs-responsivity (RNR) approach offers particular promise in this context. Considered a best practice for criminal justice populations, this approach assesses both the risk of recidivism as well as needs related to substance use, mental health, and other social and environmental conditions, and determines the appropriate type and dose of treatments and other services necessary to maximize justice and health outcomes.
  • Responses should be data-driven, which may mean changes in methods and resource allocation related to data collection. Justice, health, and community resources should be allocated to those programs that demonstrate the greatest capacity to reduce recidivism, protect public order and safety, promote public health, and promote equal and fair access to alternative options, while also mitigating the need for costly justice supervision. These determinations will be most successful if uniform data are collected and used—including measures related to the race/ethnicity of participants—and if programs take formal steps to develop standardized outcome measures (cost-, public safety-, and public health-based), and measure, analyze, monitor, and share results.
  • Arbitrary prohibitions on eligibility are counter-productive. Many jurisdictions still set limits on participation in diversion programs based on offense history or type, such as accepting only people with first-time or “low-level” offenses. Instead, jurisdictions can adopt strategies and interventions that focus on those individuals most likely to recidivate, and that consider factors other than just current charge and criminal history in determining an intervention plan (for example, through the use of individualized risk and needs assessments). The next generation of diversion programs should be able to determine and provide the appropriate level of services and justice supervision for each individual.
  • The field is continuing to evolve. The development of a common, shared language to discuss diversion and alternatives to incarceration is still in process. The need for clarity and specificity around the description of programs and models will be of increasing importance in the growing exchange of ideas, innovations, and best practices.

We are committed to continuing our work to connect people involved in or at risk for involvement in the justice system with community-based treatment and services for behavioral health conditions, to promote and support diversion and alternative options that prevent criminal convictions on record whenever appropriate and possible, and to advance policies and practices that reduce disproportionate minority contact with the justice system.

Governor Rauner Signs Bipartisan Criminal Justice Reform Legislation at TASC

(Chicago) – Illinois Governor Bruce Rauner, accompanied by bill co-sponsors State Senator Kwame Raoul (D-13) and State Rep. Jehan Gordon-Booth (D-92), signed bipartisan criminal justice reform legislation at TASC on March 10.

SB2872, also known as the Neighborhood Safety Act, increases trauma recovery support services for crime victims, strengthens judicial discretion to mandate individuals to probation and addiction treatment services in the community instead of prison, and expands opportunities for rehabilitative programming within Illinois prisons.

Watch a video of the March 10 bill signing here, including remarks from Governor Rauner; Senator Raoul; Representative Gordon-Booth; John Maki, executive director of the Illinois Criminal Justice Information Authority; Lisa D. Daniels, founder of the Darren B. Easterling Center for Restorative Justice; and Lenore Anderson, president of the Alliance for Safety and Justice.

The legislation advances recommendations of the Illinois State Commission on Criminal Justice and Sentencing Reform in its final report, including giving further discretion to judges regarding whether certain offenses may be appropriate for probation.

“By increasing access to rehabilitation services and alternatives to incarceration, this bill helps to support families, build communities, and reduce the number of people in prison and associated costs,” said TASC President Pam Rodriguez, a member of the Governor’s commission, which seeks to reduce Illinois’ prison population by 25 percent by 2025.

“TASC strongly supports these legislative reforms,” said Rodriguez. “We applaud the Governor, Senator Raoul, Representative Gordon-Booth, all the bill co-sponsors, and our community partners for their leadership in bringing about these important reforms.”

Governor Rauner signs SB2872 at TASC. Left to right: John Maki, Illinois Criminal Justice Information Authority; IL Senator Kwame Raoul; IL Representative Jehan Gordon-Booth; IL Governor Bruce Rauner; Lisa D. Daniels, Darren B. Easterling Center for Restorative Justice; Lenore Anderson, Alliance for Safety and Justice.

OP-ED: Revamping of Health Law Could Be Costly to Illinois

As Congress prepares to replace the Affordable Care Act, it is essential that the Medicaid expansion provision of the law be protected.

Any rollback of federal Medicaid coverage would be particularly harmful to Illinois, especially as our state grapples with budget deficits, an opioid epidemic, and an overburdened criminal justice system.

Under the ACA, Illinois was among the majority of states that expanded Medicaid, which provides federally-funded health insurance for low-income people. In a January letter to congressional leaders, the Rauner administration expressed concern about potential changes to Medicaid, pointing out that 3.2 million Illinoisans—almost one-quarter of the state’s population—are enrolled in coverage. 

Reducing Medicaid coverage would deprive Illinois of millions of dollars per year in federal support. As an example, in behavioral health services alone, the state would have to replace an estimated $80 million per year in federal Medicaid resources to pay for community-based substance use and mental health services that would support alternatives to incarceration and reentry initiatives.

Second, such changes would fly in the face of efforts to address the opioid epidemic that is devastating Illinois communities. Nineteen Illinois sheriffs, prosecutors, and police chiefs recently signed a letter to Congress urging action against any policy changes that would make it even harder for low-income individuals to access addiction and/or mental health treatment. Lack of treatment access impairs law enforcement’s ability to prevent overdose deaths and to make our communities safer.  

Finally, rolling back Medicaid coverage would hamstring Illinois’ successful bipartisan progress toward reforming the criminal justice system. Coverage for addiction and mental health services is essential to the state’s strategy for preventing crime, reducing recidivism, and avoiding the $41,000 per person annual average cost of incarceration for those whose non-violent offenses stem from untreated health conditions.

It is well recognized that there are aspects of the Affordable Care Act that must be overhauled. However, as changes are made, and to expound on what the Governor’s administration and criminal justice experts have written, it would be foolhardy and counter-productive if those changes include an attack on Medicaid coverage. Illinois can ill afford such a loss.

Pamela F. Rodriguez, President & CEO of TASC

TASC President Pam Rodriguez


Pamela F .Rodriguez is president and CEO of Treatment Alternatives for Safe Communities (TASC, Inc.) and a member of Governor Rauner’s Illinois State Commission on Criminal Justice and Sentencing Reform.