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.

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.”