Supporting Criminal Justice Reforms and Treatment Access: National Initiatives

(Chicago) – The majority of people who enter the justice system have a substance use or mental health condition, or both. In many cases, deflection and diversion to appropriate services can happen at the very front end of the system, even before arrest.

TASC and its Center for Health and Justice (CHJ) are active in a number of national initiatives to advance knowledge, policy, and practice to divert eligible participants away from the justice system and into appropriate services in the community.

Comprehensive Addiction and Recovery Act

Passed by Congress and signed into law in 2016, the Comprehensive Addiction and Recovery Act (CARA) is groundbreaking legislation that, among its many provisions, supports justice diversion practices, medication-assisted treatment, and naloxone for first responders to help curb the opioid overdose epidemic. TASC played a leading role in the bill’s inclusion of the first-ever Congressional authorization of funding for pre-booking police deflection programs. TASC and CHJ are partnering with the Addiction Policy Forum to help advance these innovative practices.

MD Magazine Peer Exchange Video Series on Addiction and Treatment in the Justice System

TASC’s Jac Charlier and Phillip Barbour are featured in a 14-part video series entitled Medication-Assisted Treatment in Drug Abuse Cases: A Path to Success. The series is produced by MD Magazine, a portal that provides physicians with clinical news, information, and resources designed to help them provide better care to patients. In the series, Charlier, Barbour, and other experts discuss an array of issues around drug treatment and medication-assisted therapies in justice and reentry settings.

Data-Driven Justice Initiative

The Data-Driven Justice Initiative (DDJ) is a coalition of over 100 cities, counties, and states that have committed to employing data-driven strategies to divert individuals out of the justice system and into care, with a specific focus on the small percentage of people with substance use and/or mental health disorders who account for a disproportionate amount of health and justice resources. This groundbreaking effort is merging the fields of big data and criminal justice reform.

Working with the National Association of Counties, TASC is providing technical assistance to the State of Illinois and five small-to-medium counties outside of Illinois as they pursue their respective DDJ initiatives. TASC is helping these jurisdictions develop partnerships, identify core data sources, and plan for pilot programs to address local concerns.

Roll Call Videos for Law Enforcement

The Center for Health and Justice at TASC produced two videos to be used by local police departments during roll call to help law enforcement officers and leadership better understand the nature of addiction and improve community relations as a foundation for deflecting drug-involved individuals into treatment rather than arrest. This project was funded by the Office of National Drug Control Policy.

Following recent consulting work to help initiate Baltimore’s Stop, Triage, Educate, Engage, and Rehabilitate (STEER) program, Charlier recently was quoted in the Wall Street Journal regarding the value of law enforcement deflection initiatives. “The policing world, through deflection efforts, is understanding that access to treatment and follow-up to treatment is a legitimate approach to public safety,” he said.

Read more about TASC ‘s national work and other news here.

TASC’s Jac Charlier (far right) and Phillip Barbour (second from left) appear in MD Magazine Peer Exchange series.

TASC’s Jac Charlier (second from right) and Phillip Barbour
(second from left) in MD Magazine Peer Exchange series.

TASC Offers Roll Call Videos for Law Enforcement: The Science of Addiction, Building Partnership with Treatment

(Chicago) – The Center for Health and Justice at TASC has produced two short videos designed to support law enforcement in connecting addicted individuals to treatment in the community.

The videos can be viewed on the Center for Health and Justice website.

When people are addicted to drugs, their decision-making abilities are compromised. With information on how addiction affects the brain, and how to effectively partner with drug treatment organizations, many law enforcement agencies are working to reduce crime and improve community relations by diverting low-risk individuals to treatment rather than arrest them when their offenses are related to addiction.

Designed for showing during roll call or staff meetings, the videos cover two specific areas:

What Happens When a Brain is Addicted

  • Dr. Timothy Condon, former science advisor to the White House Office of National Drug Control Policy and past deputy director of the National Institute on Drug Abuse, discusses addiction as a disease of the brain and the challenge of managing it, similar to other chronic diseases such as diabetes and hypertension.

Building Partnerships with Addiction Treatment

  • Peter Palanca, executive vice president of TASC, discusses opportunities to build partnerships between law enforcement and drug treatment providers in the community. This video provides questions that law enforcement can ask providers during an initial meeting to learn about the services they provide.

For information on how to use these videos in your law enforcement setting, please contact Jac Charlier, director of consulting and training for the Center for Health and Justice at TASC.

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Funding for the production of the videos was provided through a grant awarded by the Office of National Drug Control Policy, Executive Office of the President. Points of view or opinions in the videos are those of the presenters and do not represent the official position or policies of the Executive Office of the President.

Fundamentals of Alternatives to Incarceration

(Chicago) – In the United States, the majority of people who come into the criminal justice system have a substance use problem, which is a treatable health condition. As a response to non-violent offenses related to drug use and addiction, there are many alternatives to incarceration that are more effective and less expensive than keeping people behind bars.

“Program models are not enough,” said TASC President Pam Rodriguez. “What’s much harder to sustain—but what’s necessary if we want to achieve real impact—are whole systems where justice partners and health services in the community work together by design.

“Too often,” she added, “the justice system is the first place where people have a chance to get drug treatment and other health services. Adequate health services must be available in the community far before people reach the point of incarceration.”

For cash-strained governments, overburdened justice systems, and communities and families suffering the consequences of addiction, alternative sanctions for non-violent, drug-related offenses make sense.

First, incarceration is costly. In Illinois, it costs an average of $38,000 to keep someone in prison for a year. A single day in the Cook County Jail costs an average of $143, and even more in the segment of the jail that detains people with serious mental illness.

To borrow a term from the medical field, incarceration is iatrogenic, meaning that in and of itself it is harmful. Incarceration usually leaves people worse off—in terms of recidivism risk, job and family disruption, financial destabilization, and more—than when they went in. Even three days in jail has deleterious consequences.

Furthermore, without intervene early on, there are costs and consequences of a criminal conviction that last far beyond the period of incarceration or probation. The American Bar Association keeps a record of these consequences in each state.

Like other chronic health conditions, substance use disorders are treatable. It is estimated that 23 million people in the United States once had an alcohol or drug problem and no longer do.

Among individuals with a drug problem who were sent to TASC’s court and probation services, there was a 71 percent reduction in arrests for drug and property crimes over a two-year period after program enrollment.

“We know that addiction is treatable,” said Rodriguez. “We know that incarceration is expensive and iatrogenic. We also know that there are effective alternatives to incarceration. For these reasons and more, it makes sense to divert eligible individuals with substance use problems out of the justice system and into treatment and recovery support services in the community.”

There are numerous evidence-based practices and policies for preventing and stopping cycles of drug use and crime. The National Institute on Drug Abuse, the Institute of Behavioral Research at Texas Christian University, and TASC’s Center for Health and Justice are among many entities that publish and promote what works.

“What we know from extensive research and experience is that interventions must be matched to individuals’ risks for reoffending and their clinical needs,” said Rodriguez. “Mismatched interventions—such as the wrong level of care or supervision—not only waste resources, but actually can have the opposite of the intended effect.”

Sept. 14-16, 2016: TASC and partners welcomed guests from international agencies for a three-day site visit focused on diversion initiatives, jail interventions, and sentencing alternatives in Cook and Lake counties. Left to right: Antonio Lomba, Organization of American States; Chritharth Palli, India judiciary; Melody M Heaps, MMH & Associates; Pamela F. Rodriguez, TASC; Charlotte Sisson, U.S. State Dept.; Richard Baum, White House Office of National Drug Control Policy

Sept. 14-16, 2016: TASC and partners welcomed guests from international agencies for a three-day site visit focused on diversion initiatives, jail interventions, and sentencing alternatives in Cook and Lake counties. Left to right: Antonio Lomba, Organization of American States; Chritharth Palli, India judiciary; Melody M. Heaps, MMH & Associates; Pam Rodriguez, TASC; Charlotte Sisson, U.S. State Dept.; Richard Baum, White House Office of National Drug Control Policy.

Public Support Grows for Criminal Justice Diversion Initiatives

(Chicago) – A recent poll of Illinois voters indicates strong support for criminal justice reform. More than two thirds (70 percent) agree that state prisons are overcrowded and require reform for people with non-violent offenses, and four in five (83 percent) support sending fewer individuals with low-risk, non-violent offenses to prison so that state funding can be used to keep people who have committed violent offenses incarcerated for their full sentences.

The number of people behind bars in the U.S. has grown more than 500 percent over the past four decades, and U.S. incarceration rate tops the charts. In line with public opinion, policymakers are reversing their appetite for tough-on-crime policies that have fueled record incarceration rates. In fact, criminal justice reform stands apart as one of the only issues on which individuals across political parties are unified in their support.

There also is a growing understanding of the extremely high rates of substance use and mental health disorders among people involved in the criminal justice system, and of the need to address these problems earlier in the lifespan as a critical part of criminal justice reforms, before medical and behavioral health problems become advanced, and before the often lifelong collateral consequences of a conviction block individuals’ efforts to reenter communities, lead productive lives, and avoid future criminal behavior, re-arrest, and re-incarceration.

In 2013, TASC’s Center for Health and Justice (CHJ) conducted a national survey of criminal justice diversion programs and practices, to explore the landscape of diversion at the front end of the system—by law enforcement, by prosecutors and pre-trial service agencies, and by courts. CHJ is currently conducting an Illinois survey to explore the use of diversion programs and practices at phases of justice system involvement prior to conviction and sentencing, with a special focus on those operated by prosecutors, and plans to release a report with findings and recommendations later this year.

Poll of Illinois voters shows overwhelming support for criminal justice reform. Source and image credit: U.S. Justice Action Network

Poll of Illinois voters shows overwhelming support for criminal justice reform. Source and image credit: U.S. Justice Action Network

Medicaid Expansion: Improving Access to Substance Use and Mental Health Treatment for Justice Populations

(Chicago) – April 2016 marks the third anniversary of Cook County’s groundbreaking jail-based Medicaid application project, through which people detained at the jail have received assistance in applying for health coverage. Some 15,000 detainees have gained Medicaid coverage since 2013, making Cook County’s initiative the nation’s largest and most ambitious projects of its kind to date.

Most of the 11 million admissions to local jails in the U.S. each year—646,000 are detained at any given time—represent people who have untreated medical and behavioral health issues, perpetuating cycles of arrest and incarceration. With health coverage, they have the means to access care in the community, which is far less expensive than corrections-based care and emergency rooms—the predominant healthcare options for uninsured people prior to Medicaid expansion.

What’s happening in Cook County is occurring in many counties and jurisdictions across the country, as local governments seek to reduce the cost burdens of corrections and emergency care, and ultimately improve public safety and public health.

Since Medicaid expansion came about as a result of the Affordable Care Act, TASC (Treatment Alternatives for Safe Communities) has been working with partners in Cook County and across the U.S. to bring aspects of this national public policy from concept to local implementation and results.

Early Adopters: Cook County and Medicaid Expansion

Before Medicaid expansion, nine out of 10 people entering jails lacked health insurance. At the same time, justice-involved populations have high rates of substance use disorders, mental health conditions, and chronic medical conditions requiring treatment during detention and immediately after release. For decades, large and small counties have struggled to meet these needs with very limited resources. The expansion of coverage to low-income adults provides new and welcome means to address this perennial challenge.

Cook County has been a national leader in implementing processes for Medicaid application assistance at the jail, having obtained a waiver in 2012 for early expansion of Medicaid. Transformation has come about through coordinated planning and collaboration between the Cook County Health and Hospitals System, the Cook County Sheriff’s Office, and TASC, aided by significant public and private support from the Cook County Justice Advisory Council, The Chicago Community Trust, the Michael Reese Health Trust, and the Polk Bros. Foundation.

A National Sea Change

TASC President Pam Rodriguez: We have "an unprecedented opportunity to shrink the oversized justice system."

TASC President Pam Rodriguez: We have “an unprecedented opportunity to shrink the oversized justice system.”

Building on the Cook County experience, the Center for Health and Justice at TASC works with counties and states to leverage available federal health care funding in order to create linkages to care, divert people from the justice system, and improve individual and community health. To these ends, and in partnership with the National Association of Counties, TASC provides national consulting, which also is supported by the Open Society Foundations and the Public Welfare Foundation.

Working in more than a dozen states, TASC has observed the following trends with regard to Medicaid expansion for justice populations:

  • The proportion of people entering large county jails with Medicaid coverage has increased from 10% to 40-60% since 2014;
  • Most jails in large urban counties are assisting some of their detainees in applying for coverage;
  • Jails vary as to where applications are taken. It is relatively rare to take applications at jail intake (as in Cook County). It is increasingly common for medical providers to assist with applications and for applications to be taken at release;
  • Jails in rural communities are less likely to have application processes in place, though there are notable examples of small and rural community jails taking Medicaid applications routinely; and
  • States such as New Mexico and Indiana have passed legislation that enables or requires state and county corrections to facilitate applications. These states are leading the way in building statewide infrastructure and processes that institutionalize access to coverage and care for people under justice supervision.

As coverage becomes more common, counties and states can build reentry systems and expand diversion from jail to services in the community. Elements of success in building these processes include:

  • Understanding the impact of coverage on people’s use of treatment for substance use disorders and psychiatric conditions after release and on subsequent arrests;
  • Building comprehensive systems that provide seamless bridges to care upon release from jail;
  • Expanding substance abuse and mental health capacity in the community to support safe reentry; and
  • Building jail diversion projects that take full advantage of these new health care services.

Ultimately, these systems changes are intended to bring about not only cost savings and the more efficient use of public resources, but a healthier society as well, where quality treatment and other health services are accessible in the community. “For decades now, jails have been inundated with people who have severe substance use and mental health conditions,” said TASC President Pam Rodriguez. “Medicaid expansion offers the means to change that. Together with our partners in the public and private sectors, we are leveraging an unprecedented opportunity to shrink the oversized justice system.”

Gov. Pat Quinn’s Illinois Budget: Close Some Illinois Prisons, Invest More Money in Illinois Community Care

(Chicago, IL) – Illinois Governor Pat Quinn laid out plans for Illinois’ FY’13 budget on Wednesday, calling for cost-cutting measures that decrease reliance on expensive Illinois prisons and other Illinois institutions while increasing the use of transitional services and community-based care.

The details of the Illinois budget will be discussed and debated in the Illinois General Assembly throughout the spring legislative session.  On principle, TASC and its Center for Health and Justice support the Governor’s commitment to provide community-based, individualized care to achieve budget savings for Illinois.

According to the Governor Quinn’s proposed Illinois budget, a number of state institutions will close, including two adult prisons, two juvenile justice centers, and six adult transition centers. “From both a fiscal standpoint and a social responsibility standpoint, it makes sense to close some Illinois prisons,” said TASC President Pamela Rodriguez. “It is critical to do so in a way that doesn’t exacerbate crowding in other Illinois prisons, and in a way that ensures responsible reentry when people are released.”

Illinois’ prison population stands at record-high of nearly 49,000, of whom approximately 70 percent are incarcerated for non-violent crimes. More than half meet the clinical criteria for alcohol or drug dependence.
 
“Especially when we’re talking about nonviolent offenders with substance use or mental health problems, it benefits both the systems and individuals to redirect people to appropriate interventions,” said Rodriguez.  “As an agency concerned with both public safety and public health, we support strategies that combine accountability with clinical interventions.”
 
TASC provides transition and clinical reentry services for individuals released from the Illinois Department of Corrections (IDOC). As part of IDOC’s designated team of community-based providers, TASC’s services are core to the success of IDOC’s Sheridan and Southwest Illinois reentry programs. A year after release, Sheridan releases had a 44% lower risk of returning to prison than those who did not receive treatment and TASC.
 
“The bottom line is that we’re talking about reducing costs while maintaining public safety,” said Rodriguez.  “Any plans to reduce Illinois prison populations must be accompanied by carefully planned transition services and evidence-based services in the community.”

Creating Institutional Change in the Criminal Justice System: White House Blog Post by Judge William Dressel

(Chicago, IL)  —  Judge William F. Dressel, president of the National Judicial College, discusses a collaborative effort for systems change in a new blog post for the White House Office of National Drug Control Policy.

The Judicial Leadership Systems Change Initiative was developed by the National Judicial College and TASC’s Center for Health and Justice, with support and participation from a number of researchers and federal entities, including the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT), the National Institute on Drug Abuse (NIDA), and the Bureau of Justice Assistance (BJA).

Please read Judge Dressel’s post to find out about this innovative effort to help jurisdictions use science-based, systemwide responses to interrupt cycles of drug-related offenses. The initiative is promoted as a model for institutional change in the 2011 White House National Drug Control Strategy.