# Presentation: 042988

## Net Conference

**Net Conference**
**Evaluating Jail Diversion Outcomes: Making the Case for Jail Diversion**
**February 22, 2005**

## TAPA Center for Jail Diversion

**Funded by Substance Abuse and Mental Health Services Administration (SAMHSA) / Center for Mental Health Services (CMHS) since 2002**
**National resource and TA center**
**Coordinating center for 20 CMHS-funded jail diversion programs**
**Along with the ****GAINS Center for Evidence-Based Programs (EBP) in the Justice System****, comprises the National GAINS Center**

## Resources

- GAINS Center: _[http://](http://www.gainscenter.samhsa.gov/)__[www.gainscenter.samhsa.gov](http://www.gainscenter.samhsa.gov/)_
- Criminal Justice/ Mental Health Consensus Project: _[www.consensusproject.org](http://www.consensusproject.org/)_
- Bureau of Justice Assistance Mental Health Courts Grant Program briefs (available in May 2005) at: _[http://www.consensusproject.org/mhcourts/](http://www.consensusproject.org/mhcourts/)_)

## Presenters

**Henry J. Steadman, Ph.D.**
**Judge Steven Leifman**

## Jail Diversion Logic Model

## Diversion Program

**Community-Based Services**

- •

-  Police

- •

-  Court

- •

-  Jail

- •

-  MH

- •

-  SA

- •

-  Co-Occurring

- •

-  Housing

- •

-  Health

- •

-  Entitlements

- •

-  Employment

- Outpatient

- Residential

- Outpatient

- Residential

- Linkage

- (Case Management)

## Basic Research Questions

- What types of diversion work?
- For whom?
- Under what circumstances?

## “What did I buy?”

**“****What good did it do?”**

## Outcome Measures

**How many and who served?**
**What services delivered?**
**With what effects?**

## Outcome Measures

**How many and who served?**
**Number screened**
**Number eligible**
**Number accepted**
**Relevant characteristics of accepted and not accepted**
**Time between key decision points**

## Data

**Most programs do not count number considered for diversion eligibility**
**Compared to other jail detainees, divertees **
**	****are more likely to be:**
**Women**
**White**
**Older**

## Outcome Measures

**Got what services? (Before-After)**
**Case management**
**Medication appointments**
**Psychosocial rehabilitation**
**Housing**
**Residential substance abuse**
**Integrated services for co-occurring disorders**
**Supported employment/other vocational**
**Self-help groups**
**Etc.**

## Data from Where?

**Data from Where?**

**With what effects?  (Before-After)**
**Criminal Justice System**
**Mental Health System**
**Client**

**Outcome Measures**

**Outcome Measures**

## Outcome Measures

**Criminal Justice System **
**Arrests (# / rate)**
**All**
**Violent**
**Incarcerations (#)**
**New offenses**
**Technical violations**
**Jail days**

## Data

**Reduced jail days**
**Reduced rates of arrest**
**Similar percentage arrested**

## Data: Nathaniel Project (N=53)

|  | Prior Year | Current Year |
| --- | --- | --- |
| Number of Arrests | 101 | 7 |
| Misd. | 35 | 5 |
| Felonies | 66 | 2 |

## Data: SAMHSA KDA (6 sites)

|  | Diverted | Non-Diverted |
| --- | --- | --- |
| Community days | 303 | 245 |
| # Arrests | 1.03 | 1.20 |
| Arrests/mo. | .11 | .15 |
|  |  |  |

## Outcome Measures

**Mental Health System**
**Inpatient hospitalizations**
**ER evaluations/treatment**

## Data: SAMHSA KDA (6 sites)

|  | 
Diverted | 
Non-Diverted |
| --- | --- | --- |
| Hospitalization | 31.7% | 18.7% |
| ER | 31.3% | 23.9% |

|  |  |  |
| --- | --- | --- |
|  |  |  |

## Outcome Measures

**Client**
**Symptoms**
**Days homeless**
**Victimization**
**Service system satisfaction**
**Quality of life**

## Data: SAMHSA KDA (6 sites)

|  | Diverted | Non-Diverted |
| --- | --- | --- |
| Change in CSI (symptoms) | 8.21 | 7.19 |

## Data: SAMHSA KDA Cost Studies (Cowell et al, 2002)

|  | 
OR | 
AZ | 
NYC | 
Memphis |
| --- | --- | --- | --- | --- |
| Costs | Same | Same | -$6,260 | +$5,855 |
| Outcomes | Drug Use ↓ 80% | CSI       + 4.5 | Non-viol. Victimization ↓ 70% | CSI 
+ 2.4              |

## Case studies—a great complement!

## Key Evaluation Challenges and Some Solutions

_**Key Challenges**_
**Money set aside to do evaluation**
**Being too ambitious**
**Documenting treatment services actually received**
**Thinking about these things soon enough**
**Cost data**

_**Solutions**_
**1a. Approach local foundations**
**1b. Involve local college students**
**2a.  Less, done well = better**
**2b. Get pro bono evaluation help **
**3a. Doing #’s 1 & 2**
**3b.  Hard work**
**4a. Just do it **
**4b. Line up a prime local evaluation ally**
**5. Fairly sophisticated or not at all**

## Evaluating Jail Diversion Outcomes: Making the Case for Jail Diversion

**Eleventh Judicial Circuit of Florida****Criminal Mental Health Project**
**Judge Steve Leifman, Miami-Dade County  Associate Administrative Judge**

## Build It and They Will Come

## In the beginning . . .

## We had nothing

**We had nothing**
** ****No Research**
** ****No Data**
** ****No Staff**
** ****No Resources**

## The 2000 GAINS Summit

## The Summit: Initial Data Gathering

**The Summit: ****Initial Data Gathering**

**Miami-Dade highest % of mental illnesses of any urban community (9.1%)**
**800-1200 people with mental illnesses in jail (20%)**
**Recidivism of defendants with mental illnesses > 70% **
**Defendants with mental illnesses stay in jail 8 x longer at 7 x the cost **
**7 people with mental illnesses killed during a police encounter (now 13)**

## The Summit continued...

**Analyzed existing system – concluded it was embarrassingly dysfunctional**
**Produced GOALS – must develop a system that works for people with mental illnesses, not us**
**Produced Cooperative Agreement – everything in writing**
**Created the 11****th**** Judicial Circuit Criminal Mental Health Project **
**Motto “Diversion and Linkages to Comprehensive Care Makes Jail the Last Resort”**

## 11th Judicial Circuit’s Criminal Mental Health Project 

**Pre-Booking Diversion: **
**Crisis Intervention Team Policing (CIT)**
**Post-Booking Diversion**
**County Court Jail Diversion Program**
**Comprehensive Care Program**
**Assisted Living Facility (ALF) Quality of Care Program**
**Housing & Transition Program**
**Identification Card Program**

## 11th Judicial Circuit’s Criminal Mental Health Project continued

- Stakeholders/Partnerships
- Planned Computer Linkage System
- Research – FIU/Dr. Jim Rivers & In-house

## CRITICAL

## Why? 

**Why? **

**We had a project, but still:**
-  No Research
-  Little Data
-  Little Staff
-  No Resources

## Who?

**A Reputable Public Policy Researcher**
- You get along with
- You trust
- Adds credibility to the Project
- Ability to produce practical, useful data
- Ability to collaborate and write grants

## How?

**Interview, Interview, Interview**
- Go to different Universities/different departments
-  Review past projects
-  Check references/reputation

## Research/Data Needs

**  ****Apply for grants**
**  ****Educate policy makers**
**  ****Increase public funding**
**  ****Educate community**
**  ****Justify continued funding**
**  ****Justify system/policy changes**

## Required Research

**Jail mental health population survey**
**National, State and local data on mental illness**
**Costs of incarcerating people with mental illnesses**
**Costs of acute care**
**Recidivism studies**
**Costs of forensic hospitalization**
**Outcome data**

## Study of Mental Health Population at Miami-Dade Co. Jail

**Data on jail mental health population needed for grant application**
**With funding from the Health Foundation of S.F. and the Dept. of Children and Families, Dr. Rivers conducted first- ever study of the mental health population in Miami-Dade Co. Jail**
**Provided critical data about mental health population: demographics, charges, and number of arrests **

## Highest Utilizers Study

**Examined costs associated with mental health acute service delivery for the recidivists of the Miami-Dade County Jail Diversion Program**
**Highest utilizer defined as anyone who participated in the Jail Diversion Program more than one time within a calendar year**

## Methodology

**Identified a one-year time period (1/1/01- 1/1/02)**
**Identified the highest utilizers (recidivists) of the program for time period**
**Collected data elements for each high utilizer**

**Collaborated with multiple agencies to collect data elements**
**Calculated total costs for group of highest utilizers **
**Isolated costs for each service examined**

## Results

**1,955 Jail Days**
**830 Crisis Stabilization Days**
**14 court ordered psychological evaluations**
**138 Emergency Room & Inpatient Admissions**

**31 High Utilizers Identified**

| Miami-Dade County Corrections | $228,735.00 |
| --- | --- |
| FL Department of Children & Families | $185,455.20 |
| JMH/Public Health Trust | $124,081.02 |
| Administrative Office of the Courts | $2,050.00 |

-     _**AGENCY**_**	****           **_**COSTS**_

## Results

**GRAND TOTAL:  **_**$540,321.22**_

## Outcomes of Diversion Project

**Misdemeanor recidivism reduced 70% to 18%**
**Improved public safety**
**Reduced police injuries**
**Faster return to patrol**
**Saving Miami-Dade Co. $2.3 million annually**
**Saving lives – No deadly force by Miami Police Department – 2 yrs**
**De-criminalization of mental illness**

## Outcomes of Research

**SAMHSA Targeted Capacity Expansion Jail Diversion Grant**
**Funding for a Computer Linkage Program ($160,000)**
**Commitment from County to continue funding 2 court staff positions and absorb all grant staff positions**
**$22 million dollar Bond to build new County Forensic Facility**

## Outcomes of Research continued

**Miami-Dade County Grand Jury Report: “Mental Illness and the Criminal Justice System: A Recipe for Disaster/A Prescription for Improvement”**
**Proposed legislation for a $1 million dollar revolving fund pilot program to provide gap funding for individuals with mental illnesses accessing federal entitlements after incarceration**

## Packaging the Data

-  Follow the money/Determine gov’t interests
-  _County Govt’s_ have little idea how much $ is spent on Corrections Mental Health and Liability
-  The _States_ are keenly aware of the amount of $ being spent on Forensic State Hospitals and are looking for ways to reduce costs
-  The _Police_ have little idea on the number of mental health calls they handle
-  The _public _has no idea that more people with mental illnesses are in jail than hospitals

## Packaging the Data: Audiences

_***Everyone ***_
**Using data, put the issue in context **
**How the problem began **
**The extent of the problem **
**Who’s paying and who’s suffering**

## Packaging the Data: Audiences

_***The County/Law Enforcement***_
**Jail mental health population**
**Costs of incarceration**
**Liability costs **
**Recidivism rates **
**Savings from diversion**
**Outcome data**

## Packaging the Data: Audiences

_*** ***__***The State***_
**Forensic commitment costs vs. diversion costs **
**Recidivism rates**
**Highest Utilizer Study – Cost of doing nothing**
**Outcome data**

## The Messenger

**As a Judge, I invited non-traditional stakeholders to a MH Summit –              **_**Everyone**_** Attended**
**10 years earlier as an Asst. Public Defender, I did the same and **_**No One**_** Attended**
_***Other Viable Messengers***_
**Elected Officials**
**Police Chiefs**
**Sheriffs**

## FOR MORE INFORMATIONCONTACT:

- Judge Steve Leifman
_**sleifman@jud11.flcourts.org**_
- Alina Perez, M.A.
- Mental Health Project Coordinator
- _alperez@jud11.flcourts.org_
- Dr. Jim Rivers
- _riversj@fiu.edu _

**Questions?**
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