The Chicago Community Trust Grantee Success Profile: Justice and Health Initiative

(Chicago) –  Jails, courts, and prisons across the U.S. have been inundated for decades with people who have untreated health problems.

Rates of substance use disorders, mental illness, and other chronic health conditions are far higher among people in jail than they are among the general public. These health conditions, often co-occurring, contribute to chronic arrest and recidivism. Until the passage of the Affordable Care Act in 2010, for millions of men and women cycling in and out of jails, their first or only access to healthcare services very often occurred only when they were incarcerated.

In 2012, the Chicago Community Trust provided important early funding to TASC to work with Cook County partners to leverage the ACA to increase opportunities for healthcare access in the community. Since then, and thanks to continuing support from the Trust and an array of partners, an estimated 15,000 people have obtained coverage after having initiated their applications at the Cook County Jail.

The Trust recently reported on the success of this initiative in a feature entitled, Seizing a Health Care Opportunity: County Jail.

Excerpt:

Before the ACA, only 1 in 10 had coverage. A combination of circumstances suddenly made it feasible to try to raise that number to 9 in 10: a waiver that allowed Cook County to get a year’s head start on expanding Medicaid to include single adults; a willingness among all the disparate shareholders to work together; and TASC’s commitment to lead the planning group that formed the Justice and Health Initiative, or JHI.

And, critically, the Trust provided seed money, awarding a grant of $98,000 in 2012. It was the first of four grants, for a total of $392,200.

“The Trust deserves credit for being the first to invest in this,” says Pamela Rodriguez, president and CEO of TASC, which coordinates health services and advocates for people in the justice system.

The Trust-funded Justice and Health Initiative represents a crucial step toward broadly addressing the underlying issues—substance use and mental health disorders—that often bring people in contact with the justice system.

“Through these public-private partnerships, we can bring innovative policies and successful practices to scale, and ultimately we can reshape the landscape of justice and health in this country,” Rodriguez wrote last year.

“Brought to scale, this innovation is a game changer.”

Read the Chicago Community Trust’s feature story here.

Ciera Washington, TASC community application specialist, offering health insurance application assistance at the Cook County Jail.

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.”

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.”

2015 Urban Labs Innovation Challenge Winners: TASC, Cook County Sheriff’s Office, Heartland Alliance Earn Grant for Supportive Release Center

(Chicago) – The University of Chicago announced the winners of the Urban Labs 2015 Innovation Challenge grants on October 12, including a $1M grant to TASC, the Heartland Alliance, and the Cook County Sheriff’s Office to support people with mental illness as they are released from the Cook County Jail.

Timothy Knowles, the Pritzker Director of Urban Labs, and Chicago Mayor Rahm Emanuel made the announcement during a Chicago Ideas Week event, which included a panel discussion with WomenOnCall.org founder and President Margot Pritzker, Philadelphia Mayor Michael Nutter, and host Cheryl Corley of NPR.

The 2015 Urban Labs Innovation Challenge focused on the areas of health, poverty, and energy and the environment. Advisory committees comprising civic leaders, practitioners, funders, and academic experts selected the grant winners from a pool of more than 100 applicants.

The grant will enable the launch of a Supportive Release Center to help individuals with mental illness transition to services in their communities following their release from the Cook County Jail. It also will include rigorous evaluation—conducted by the Health Lab—to empirically examine outcomes and better inform practitioners and policymakers about its effectiveness, cost-efficiency, and potential scalability in the long run.

“We are honored to partner with the University of Chicago Urban Labs, Heartland Alliance, and the Cook County Sheriff’s Office to develop solutions to the issues faced by people with mental illness who are leaving the jail,” said TASC President Pam Rodriguez. “This will help us create a safe, supportive environment to facilitate access to care. The project also will be closely evaluated, using a random controlled research design, so that it has the potential to become an evidence-based practice that could be replicated nationwide.”

The Urban Labs’ collaborative approach recognizes that many long-term challenges in cities are related, and require unified responses. Public-private partnerships are central to the approach of the project, and in fact Blue Cross Blue Shield of Illinois already has made a $50,000 commitment toward the Supportive Release Center.

The Cook County Jail admits approximately 100,000 men and women annually. Among the average daily population of 9,000, 20 to 30 percent are estimated to have a mental illness.

The project builds upon other collaborative strategies to improve access to health care for people leaving the jail. These aligned and reinforcing efforts include the Justice and Health Initiative funded by The Chicago Community Trust, the Justice Advisory Council, and the Cook County Health and Hospitals System, as well as the planning and pilot project funded by the Michael Reese Health Trust, and the service network innovation collaborative funded by the Polk Bros. Foundation.

For additional coverage of the announcement, see articles in the Chicago Tribune, Chicago Inno, DNAChicago, UChicagoNews, and social media posts at #InnovationChallenge.

Why Systems Matter: Are They Helping or Hurting Communities?

The following column by TASC President Pamela Rodriguez appears in TASC’s Fall/Winter 2012 News & Views:

As a social work student at the University of Chicago 32 years ago, I learned that the way our society operates, and the means through which we create or deny opportunities to people, depends largely on our systems.

“Systems” is one of those bureaucratic terms used in grad school.  And yet, we must understand them as essential to the creation of a fair and just society, where all people have opportunities for education, health, and equal justice under the law.

Without clear oversight and analysis of trends and consequences, systems may grow to the point of over-reach. Drug policies in the U.S. have fertilized the growth of the criminal justice system for the past 30 years.

From mandatory minimum sentences to funding that favors incarceration over rehabilitation, our society pours more and more people into courtrooms, jails, and prisons in this country than any other country in the world.

These costly trends not only tear apart families and communities, but they break states’ budgets as well.  According to data from the National Association of State Budget Officers and reported by the Pew Center, states increased their collective spending on corrections by 315% between 1987 and 2007. Adjusted to 2007 dollars, state corrections costs rose 127% while spending on higher education increased only 21 percent in the same period.

These incarceration trends do not need to continue. We can change our systems.

What was true three decades ago—my lessons from grad school—was the notion that government was the sole keeper of our systems.  Today, there is greater attention on public-private partnerships, whether the topic is education, health care, or criminal justice. Exactly whether and how these partnerships will improve our public systems—and improve outcomes for the people at the heart of these systems—remains to be seen and is a debate for another day.  But what we know right now is that we cannot allow the profit interests of the private sector, nor the self-perpetuating nature of large public systems, to dictate the parameters of justice in our country.

When private interests involve profit, or when partners within the system seek unlimited growth, the notions of justice will tilt.

Justice is not about growth. It is not about profit. It is about ensuring the fair and appropriate dispensation of sanctions to carry out public safety.

TASC is engaged in a number of projects and initiatives to inform and improve sound systems.  For instance, we staffed the Disproportionate Justice Impact Study (DJIS) Commission, which pointed out racial and ethnic inequities in the application of state drug laws. As a follow-up to DJIS Commission recommendations, we staffed the Racial and Ethnic Impact Research Task Force, which focused on improved data collection methods to inform fair justice processes.

In partnership with the National Judicial College, we are leading the Justice Leaders Systems Change Initiative, through which we train jurisdictions across the country on science-based responses to addiction-driven crime. Through a grant from The Chicago Community Trust, and under the leadership of Judge Paul P. Biebel, Jr., we are facilitating a structured planning process to improve health care access for people under justice supervision in Cook County.

As we work to change and improve systems, we are guided by our core values. The principles of fairness and justice have not changed in my 32 years in social service, and they continue to guide us at TASC.

We care about fairness. We care about opportunity. And to our core, we care about the people affected by systems, and whether those systems are hurting or helping people and communities. With your support and partnership, we will continue to strive for community health and public safety achieved by means other than the over-expansion of correctional systems.  These are the lessons we live by.

To read TASC’s Fall/Winter 2012 News & Views, please click here.

Statewide Criminal Justice Association Names Director: Edna R. Lee Takes Helm of Justice Advocacy Group

(Chicago) – The Illinois Association for Criminal Justice (IACJ) has named Oak Park resident Edna R. Lee as its inaugural director. Founded in 2010, IACJ is a membership group of criminal justice researchers, advocates, and service providers in Illinois.

Ms. Lee comes to IACJ with more than 25 years of experience in leadership of community-based organizations and correctional programs, including managing offender reentry and employment services within the Crossroads and North Lawndale Adult Transition Centers (ATCs).

“As Illinois seeks answers to reduce prison overcrowding while maintaining public safety, IACJ’s role in positively impacting public policy decisions is more important than ever,” said Diane Williams, president of the Safer Foundation and president of IACJ. “Edna Lee brings a wealth of practical experience, knowledge, and political acumen that will help advance necessary criminal justice reforms in Illinois.”

Prior to joining IACJ, Lee led Positive Anti-Crime Thrust (PACT), which develops community-based programs to interact with police, courts, and corrections to reduce crime. During her career, Lee also has administered numerous programs that serve individuals involved in the Illinois Department of Corrections.

The mission of IACJ is to ensure quality, comprehensive and coordinated services for people with criminal histories. Through public advocacy and community capacity- building, IACJ promotes the use of proven practices to reduce recidivism and restore individuals to stability and productivity within their communities.

IACJ currently has 286 individual and organizational members across Illinois. The Association was founded by the Safer Foundation; Treatment Alternatives for Safe Communities (TASC, Inc.); Northern Illinois University Center for Governmental Studies; and University of Illinois at Chicago Jane Addams College of Social Work. The IACJ also would like to acknowledge the support of The Chicago Community Trust, which, for nearly 100 years, has connected the generosity of donors with community needs by making grants to organizations working to improve metropolitan Chicago.

For more information about the IACJ, please visit www.illinoiscriminaljustice.org.

Lawmakers Dennis Reboletti, Adam Brown, Mattie Hunter Open Way for Seized Drug Money to Help Fund Addiction Treatment

(Chicago, IL) – A bi-partisan group of Illinois state lawmakers this year opened the door to a possible new source of funding for addiction treatment agencies: money seized from drug dealers.

The legislation, House Bill 2048, was introduced by State Representative Dennis Reboletti (R-Addison) and sponsored by State Representative Adam Brown (R-Decatur) and State Senator Mattie Hunter (D-Chicago). It empowers local state’s attorneys with the discretion to make grants to Illinois treatment agencies and half-way houses from the monies and the sale proceeds of all other property forfeited and seized under state drug laws.

The bill, which won unanimous support from both legislative chambers, was signed by Governor Pat Quinn on August 4.

“As government budgets for substance abuse treatment continue to shrink, it is deeply encouraging that lawmakers can work together to develop creative solutions to address the need for treatment funding,” said Pamela Rodriguez, president of Treatment Alternatives for Safe Communities (TASC).

“The gap between the treatment need and availability is widening,” added Rodriguez. “I want to thank Representative Reboletti, Representative Brown, and Senator Hunter for their hard work and Governor Quinn for approving the new law, which is a step toward reducing that gap.”

The new public act is a direct outcome of recommendations made by the Illinois Disproportionate Justice Impact Study Commission, a statewide, bipartisan group established in 2008 to examine the impact of Illinois drug laws on racial and ethnic groups.

The Commission’s final report, released to the Illinois legislature in December 2010, recommended that local jurisdictions define a fixed portion, or criteria that would trigger the allocation of a portion, of existing drug asset forfeiture funds to support treatment and diversion programs in addition to enforcement and prosecution activities.

In addition to Brown and Reboletti, House sponsors included State Representatives Connie Howard (D), Jim Sacia (R), Chapin Rose (R), Esther Golar (D), Rita Mayfield (D), LaShawn Ford (D), Monique Davis (D), and Camille Lilly (D).

In addition to Hunter, Senate sponsors included State Senators Jacqueline Collins and Donne Trotter.

The new law takes effect on January 1, 2012.

TASC, Inc. has a 35-year history of promoting social justice and providing alternatives to incarceration in Illinois. TASC’s Racial Justice Initiative, including dissemination of the findings of the Illinois Disproportionate Justice Impact Study Commission, has received generous support from The Chicago Community Trust.