1. Alternatives to Incarceration and Care Coordination May 12, 2015

2. CASES Adult Behavioral Health Programs Manhattan ACT Team Nathaniel ACT Team Manhattan START Youth Programs Court Employment Project Civic Justice Corps Justice Scholars Queens Justice Corps Choices ATD Manhattan CIRT

3. 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

4. Diversion Logic Model Identify and Enroll People in Target Group LinkageComprehensive/ Appropriate Community- Based Services Improved Mental Health /Individual Outcomes Improved Public Safety Outcomes Stage 1Stage 2 Diversion Stage 3

5. Diversion Population 5 Arrested at disproportionately higher rates -Co-occurring Disorders -Homelessness Stay longer in jail and prison Limited access to health care Low utilization of EBPs High recidivism rates More criminogenic risk factors CSG Justice Center

6. Bias Distrust Prejudice Fear Avoidance Distress Anger Stereotypes Addressing Access Challenges Source: Surgeon General’s Report on Mental Health (1999) Reduced Access: Care Coordination Housing Employment Treatment Other services “The Forensic Client” “Need Higher Level of Care” Perception of violence Discrimination Source: Surgeon General’s Report on Mental Health (1999)

7. 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)

8. Women Legal History Lifetime Average Arrests 21.1 Lifetime Average Misdemeanor Convictions 17.9 Lifetime Average Felony Convictions 2.0

9. 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%)

10. Serious Mental Illness vs. Behavioral Health

11. LSCMI Risk Score

12. 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

13. Diversion = Eligible Health Home Members

14. NATHANIEL ACT FELONY ALTERNATIVE TO INCARCERATION

15. 15 Felony Convictions Assault Criminal Sale Controlled Substance Robbery Burglary Grand Larceny Criminal Contempt

16. FACT Recipients 16 Co-Occurring Substance Use Schizophrenia Outpatient Commitment HomelessHigh Use Psychiatric Hospitals High Use ER visits

17. Criminogenic Need Clinical Profiles VariableLowMediumHighVery High Risk Total Score7.6714.6723.8231.28 Criminal History.671.843.584.06 Antisocial Associates.171.071.843.11 Antisocial Cognition.22.491.683.06 Antisocial Personality.44.872.162.89

18. ACT ATI Psychiatric Hospitalization & Emergency Room Utilization Visits

19. Criminogenic Needs Influence Outcomes RISK GROUP LOWMEDIUM HIGH/ VERY HIGH TOTAL Nathaniel Consumers 15%35% 50%100% Re- Arrested in 2-Years 0%30%52%36%

20. 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

21. Thank You Ann-Marie Louison Co-Director Adult Behavioral Health Programs CASES, NYC alouison@cases.org www.cases.org