Alternatives to Incarceration and
Care Coordination
May 12, 2015
CASES
Youth Programs
Adult Behavioral Health
Programs
Court Employment Project
Choices ATD
Manhattan START
Nathaniel ACT Team
Queens Justice Corps
Manhattan ACT Team
Justice Scholars
Manhattan CIRT
Civic Justice Corps
Participants Served (Projected)
Service
# of Clients
Adult Behavioral Health Programs
Nathaniel ACT Team
Manhattan ACT Team
Manhattan START
1415
80
75
1260
New Mental Health Programs
(Adult)
Nathaniel Clinic
New York County CIRT
Manhattan Link
900
400
100
400
TOTAL
2315
Diversion Logic Model
Stage 1
Stage 2
Stage 3
Improved
Mental Health
/Individual
Outcomes
Diversion
Identify and
Enroll People
in Target
Group
Linkage
Comprehensive/
Appropriate CommunityBased Services
Improved
Public Safety
Outcomes
Diversion Population
Arrested at disproportionately
higher rates
-Co-occurring Disorders
-Homelessness
Stay longer in jail and prison
Limited access to health care
5
CSG Justice Center
Low utilization of EBPs
High recidivism rates
More criminogenic risk factors
Addressing Access Challenges
•
“The Forensic Client”
“Need
Higher Level
of Care”








Bias
Distrust
Prejudice
Fear
Avoidance
Distress
Anger
Stereotypes
•
•
Reduced Access:
• Care
Coordination
• Housing
• Employment
• Treatment
• Other
services
Perception of
violence
Discrimination
Source: Surgeon General’s Report on Mental Health
Source: Surgeon General’s Report on Mental Health
(1999)
(1999)
Individuals with Mental Illness
– Misdemeanor Diversion at
First Court Appearance






38% Bipolar Disorder, 20% Depression, 19%
Schizophrenia
27 average prior convictions
43% previous prison sentence
12 months pre-enrollment arrests (3.6 ± 2.4)
12 months post-enrollment arrests (2.5 ± 3.0)
Face-to-face contacts (17.5 ± 22.0)
Women Legal History
Lifetime Average
Arrests
Lifetime Average
Misdemeanor
Convictions
Lifetime Average
Felony Convictions
21.1
17.9
2.0
Felony & Misdemeanor
Diversion after Jail Detention
and Receipt of MH Jail Services






Average age 42 years old (range 18-74)
Chronic Medical Conditions 66%
HIV+ 20%
Average number prior convictions 8.63
Prior felony convictions 56%
Instant offense drugs (75%)
Serious Mental Illness vs.
Behavioral Health
LSCMI Risk Score
Low Utilization of Community
Resources






38% connected to community
treatment at enrollment
40-52% homeless
20-40% no health insurance
95% Medicaid eligible
Universal Health Home eligibility
Low Health Home outreach success
and lower engagement rates
Diversion = Eligible Health
Home Members
NATHANIEL ACT
FELONY ALTERNATIVE TO
INCARCERATION
Felony Convictions
Assault
Criminal Sale Controlled Substance
Robbery
Burglary
Grand Larceny
Criminal Contempt
15
15
FACT Recipients
Co-Occurring Substance
Use
Homeless
Schizophrenia
High Use Psychiatric
Hospitals
Outpatient Commitment
High Use ER visits
16
Criminogenic Need Clinical Profiles
Variable
Low
Medium
High
Very High
Risk Total Score
7.67
14.67
23.82
31.28
Criminal History
.67
1.84
3.58
4.06
Antisocial
Associates
.17
1.07
1.84
3.11
Antisocial
Cognition
.22
.49
1.68
3.06
Antisocial
Personality
.44
.87
2.16
2.89
ACT ATI Psychiatric Hospitalization &
Emergency Room Utilization Visits
Criminogenic Needs Influence
Outcomes
MEDIUM
HIGH/
VERY
HIGH
TOTAL
15%
35%
50%
100%
0%
30%
52%
36%
RISK
GROUP
LOW
Nathaniel
Consumers
ReArrested in
2-Years
Care Management & Diversion






Short-term diversion/ATI programs will hand care over to the care
manager – quick engagement
When should hand-offs from diversion case manager to Health Home
care manager occur, at what stage of community integration
Can a care manager provide intensive services at point of transition
from incarceration with frequency and intensity of services to engage
the individual in community services – what are the ideal caseload
sizes for effective reentry
Long-term diversion/ATI programs will want to collaborate with the care
manager – insert care coordination into the diversion plan and share
work with the care manager, how can this collaboration work to reduce
duplication of services
Care manager will need to understand reintegration, engagement and
address risks for re-arrest to successfully work with diverted client
Diversion program plan and care plan = ONE PLAN
Thank You
Ann-Marie Louison
Co-Director Adult Behavioral Health Programs
CASES, NYC
[email protected]
www.cases.org