Process Measures at the Interface of Criminal Justice and Behavioral Health—Set 4: Access Measures and Systematic Responsivity (Systems Level)
JMHCP Learning Community: Research and Evaluation
Insurance Enrollment Pe rc e nt o f individuals invo lve d in th e j u stic e syste m w h o a re e n ro l l e d in health i n s u ra n c e
insurance
Pe rc e nt o f individuals re le a s e d f ro m p r is o n o r j a il w h o a re e n ro l l e d i n h e a l t h i n s u ra n c e
The Affordable Care Act (ACA) extended Medicaid eligibility to all adults whose annual income is less than $16,2431
http://www.naco.org/sites/default/files/documents/QandAACA%20Inmate%20Healthcare-OCT2014%20(2).pdf
•
Up to 30% of individuals released from jails could enroll in Medicaid in states that expand the program2
•
In 2011, 80% of former inmates in Massachusetts were continuously enrolled in Medicaid during the first year after their release1
https://csgjusticecenter.org/wp-content/uploads/2013/12/ACA-Medicaid-Expansion-Policy-Brief.pdf 1 http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/6/11/linking-released-inmates-to-health-care 2 http://www.chcs.org/media/Medicaid_Expansion_and_Jails_Fact_Sheet_032714.pdf
Systemic Responsivity • Examine Characteristics of Different Probation Populations • Examine Patterns of Rearrest Among the Population • Examine Programs Used • Assess Responsivity of the System
What are Client Types by Risk Level? Homeless (n=665)
Mental Hlth (n=1615)
13%
6%
24%
8%
23%
40%
20%
DV Charge (n=59)
67%
61%
Youth (n=1088)
20%
Females (n=589)
17%
20%
30%
AB-109 (n=693)
7%
Gen. Pop. (n=4474)
6%
17%
15%
22%
31%
65%
12% 20%
Low
17%
44%
21%
27% 0%
7%
Moderate
20% 40%
41% 60%
Mod/High
80%
High
100%
Populations with High Rates of Rearrest and/or Reconviction Rearrest
Reconviction
Difference
Overall Sample Mean
42%
13%
29%
AB-109
65%
30%
36%
Homeless
62%
21%
41%
Mental Health Disorder
54%
17%
37%
0-2 Stabilizers
53%
18%
35%
Substance Dependence
50%
16%
34%
Black/AA
49%
25%
24%
Youth (Age 16-27)
41%
13%
28%
What are the Probationer Needs? Employment
72%
Education
32%
Family
69%
Financial
57%
Housing
57%
Crim. Peers
54%
Mental Health
36%
Drug Abuse
53%
Crim. Thinking
56%
Drug Dep.
20% 0%
20%
40%
60%
80%
100%
AB-109 Population Needs Employment
81%
Education
33%
Family
56%
Financial
60%
Housing
57%
Crim. Peers
70%
Mental Health
49%
Drug Abuse
63%
Crim. Thinking
57%
Drug Dep.
21% 0%
20%
40%
60%
80%
100%
Female Population Needs Employment
76%
Education
35%
Family
44%
Financial
44%
Housing
50%
Crim. Peers
49%
Mental Health
35%
Drug Abuse
58%
Crim. Thinking
54%
Drug Dep.
23% 0%
20%
40%
60%
80%
100%
Youthful Adult Population Needs Employment
74%
Education
39%
Family
44%
Financial
51%
Housing
43%
Crim. Peers
56%
Mental Health
45%
Drug Abuse
33%
Crim. Thinking
69%
Drug Dep.
10% 0%
20%
40%
60%
80%
100%
Homeless Population Needs Employment
85%
Education
Extend housing services to clients who are not homeless but do not have stable housing
68%
Family
60%
Financial
67%
Crim. Peers
67%
Mental Health
Need for integrated substance abuse/ housing programming
53%
Drug Abuse
71%
Crim. Thinking
51%
Drug Dep.
29% 0%
20%
40%
60%
80%
100%
DV Population Needs Employment
62%
Education
29%
Family
43%
Financial
46%
Housing
58%
Crim. Peers
45%
Mental Health
28%
Drug Abuse
41%
Crim. Thinking
63%
Drug Dep.
11% 0%
20%
40%
60%
80%
100%
Mental Health Population Needs Employment
88%
Education
46%
Family
57%
Financial
74%
Housing
69%
Crim. Peers
87%
Drug Abuse
66%
Crim. Thinking
64%
Drug Dep.
29% 0%
20%
40%
60%
80%
100%
Program Availability Current Distribution 8
6
Number of Programs
6
4
4
3
3 2
2
0 Sub. Dep. (A)
Crim Think (B)
Self-Improve (C)
Interpersonal Skills (D)
Life Skills (E)
Program Tool Scores by Domain
100%
80%
60%
47% 46% 44% 41% 41%
44%
40%
23% 20%
0%
Total
Risk
Need
Responsivity
Implementation
Dosage
Restrictiveness
ro gr am
40%
s b. D ep en d. (A ) Cr im Th in k (B Se ) l fIm pr ov e (C In ) te rp er so na l( D ) Li fe Sk ill s( E)
lP 60%
Su
Al
Program Tool Total Scores by Group
100%
80%
52% 52% 44% 43% 41% 39%
20%
0%
Domestic Violence Programs 100%
80%
60%
65%64% 60% 56% 54%55% 51% 44%
40%
20%
0%
Average
Manalive Men in Progress
PREP
John Hamel & Assoc
Pocovi
Startrac
SF Bay Counseling
WomanAlive
ADP Estimated Responsivity Rate
• Greatest unfulfilled needs are cognitive restructuring programs, mental health, cooccurring disorders, and substance abuse
Responsivity Rate for Females
• Higher rates of substance dependence than males; similar need for cognitive restructuring, mental health, co-occurring disorders programs • Limited gender-specific treatment available
Responsivity Rate for Young Adults
• APD clients age 18-27: lower rates of substance dependence; VERY high rates of criminal thinking, resulting in pronounced gap
Green Bar= Available Programming for General Population
Responsivity Rate in Cognitive Restructuring
Red Bar=Need for Programming among General Population
Domestic Violence
Mental Health
Homelessness
Young Adults
Female
AB109
0
10
20
30
40
50
60
70
Population Needs & Recidivism Rates Life Skills Interpersonal Self-Improvement Criminal Thinking Alcohol SUD 0%
Recidivism
5%
10%
15%
Moderate Dosage
20%
25%
30%
High Dosage
35%
Why do we need process measures? • Holds systems accountable – If you do not screen, you can assess or place with fidelity – If people do not have insurance, then the programming options are limited
• Some measures can be “warning signs” – Engagement predicts reduction in rearrest (Garnick, et al 2014) – Treatment Completion predicts reduction in recidivism (Wexler, et al 1998)
• Systems improvements can be earmarked!