Treatment Alternatives to Prison A Health Impact Assessment HIA Research Scope February 2012

1. Treatment Alternatives to Prison A Health Impact AssessmentHIA Research Scope February 2012 Health Impact Assessment – a structured yet flexible research and engagement tool used to elevate the consideration of health outcomes in decision-making.

2. General Incarceration • recovery • substance addiction • injuries ALTERNATIVES • crime and violence • premature mortality Drug / alcohol courts • ability to manage mental health Mental health courts • chronic disease • family life Bail diversion / Day report programs • unemployment • infectious disease (HIV, Hep C, STI) Job placement programs • quality of life in communities • homelessness Community based SATS • mental health • economic impact • stress Community based MH services

3. Overarching Questions How would Treatment Instead of Prison (TIP) impact: • Number of slots for each intervention • Proportion of the general population incarcerated vs. in each alternative intervention • Number of people employed after each intervention • Number of people able to find housing after each intervention • Educational attainment for those in each intervention • Racial distribution of population in each intervention • Rates of infectious disease (STIs, hepatitis), chronic disease (hypertension, heart disease, respiratory disease), mental health issues (stress, depression, anxiety) among the targeted population and among the general population

4. Recovery Incarceration • neurological damage Δ recovery from substance addiction • access to drugs and drug tx services ALTERNATIVES • heart disease • case management • ability to manage mental health Drug / alcohol courts • respiratory harm Mental health courts • risk of infectious disease (HIV, Hep C, STI) • access to prescription tx & MH services Bail diversion / Day report programs • homelessness Job placement programs • access to a living situation • physical health conditions Community based SATS • mental health • access to medical ins/ tx for co-occurring issues Community based MH services • stress

5. Recovery: Primary Question Primary question: How would TIP impact substance abuse recovery and mental health management? Questions address each intervention, with statewide and per county counts

6. Recovery: Research Questions How would Treatment Instead of Prison impact: • Rates of substance abuse recovery and ability to manage mental health issues • Access to: substance abuse and mental health treatment services; affordable medical insurance; prescriptions; and active case management • Number of people who are homeless or otherwise do not have access to affordable housing • Number of people who overdose and/or commit suicide • Number of neurological disorders, STIs, and infectious disease in the targeted population

7. Crime and Safety • property/violent crime (for those in drug courts or job training programs) Incarceration • injury • levels of crime in the community ALTERNATIVES Δ solitary confinement/ punitive tx Drug / alcohol courts • recidivism Δ access to case management and rehab programming • death Mental health courts Δ access to prescription tx & drug/MH tx services Bail diversion / Day report programs Δ access to SATS • legal income • chronic disease Job placement programs • parole services • access to a living situation Community based SATS • access to jobs Community based MH services Δ prison reentry • stress • mental health • educational opportunities

8. Crime and Safety: Primary Question Primary question: How would TIP impact crime and safety levels? Questions address each intervention, with statewide and per county counts

9. Crime and Safety: Research Questions How would Treatment Instead of Prison impact: • Number of violent and property crimes committed? Injury and fatality from these crimes • Recidivism • Number of people receiving parole, per intervention, and the rate of recidivism in these population groups • Average time out of circulation to commit crimes in public, per type of crime

10. Family Incarceration • exposure to crime & violence • child injuries • individual living with family ALTERNATIVES • child mental health • dependent abuse/ neglect Drug / alcohol courts • parent mental health • bonding w/ parent Mental health courts • immune function • single parent families Bail diversion / Day report programs • children to foster care • Behavioral issues for children • peer bonding Job placement programs • educational outcomes for children • ability for custodial caregiver to hold job • extended family to care for dependents Community based SATS • youth involvement in justice system • financial effects of caring for others’ dependents Community based MH services • ability to afford food, medicine, clothes

11. Family: Primary Question Primary question: How would TIP impact children/dependents of individuals involved in these programs? Questions address each intervention, with statewide and per county counts.

12. Family: Research Questions (High Priority) How would Treatment Instead of Prison impact: • Number of children in foster care or living with a non-parent family member • Exposure to violence for children/dependents of individuals in each intervention • Educational attainment of children in these families • Abuse/neglect of children/dependents for parents in each intervention • Number of single parent families • Cost of caring for child/dependent for alternate caretaker and unemployment for alternate caretakers • Children/youth in these families involved in youth justice system

13. Community Incarceration • injury • violent and property crime ALTERNATIVES • premature Mortality • persons who commit crimes residing in community • wealth Drug / alcohol courts • chronic disease (obesity, nutrition, cardiovascular, asthma, other) • rates of unemployment Mental health courts • income levels • community-wide poverty Bail diversion / Day report programs • infectious disease • exposure to weather Job placement programs • parolees living in community • homelessness Community based SATS • mental health • social cohesion & support Community based MH services

14. Community: Primary Question Primary question: How would TIP impact the quality of life in communities where many are involved in the criminal justice system? Questions address each intervention, with statewide and per county counts.

15. Community: Research Questions (High Priority) How would Treatment Instead of Prison impact: • Community-level poverty, average household income, unemployment, and homelessness? • The number of those under supervision? • Community-level crime, fear of crime, and participation in the underground economy? • Levels of social cohesion and/or social support in each of these communities? • Level of substance abuse in each of these communities?

16. Economic • cost of interventions Incarceration • Government spending • cost benefits ALTERNATIVES • parole costs • homeless costs Drug & alcohol courts • Medical costs • Health Care costs • MH costs Mental health courts • case mgmt • ED use Bail diversion Day Report programs • Stress & Mental Health • Employment Job Placement Programs • Poverty • Premature mortality • Personal income • HH income Community Based SATS • Chronic disease • income tax revenue Community Based MH Services • Criminal Justice system employment • use of education system • Occupational Injuries

17. Economy: Primary Question Primary question: What is the economic impact of TIP? Research questions address each intervention, with statewide and per county counts

18. Economy: Research Questions How would Treatment Instead of Prison change: • Annual costs of incarceration and alternate treatments • Amount funded publicly and funded from other means for each intervention • Health care costs for prison health care, health care provided to target population outside of prison, substance abuse treatment services and mental health services costs for each intervention • Median household income and employment prospects for those participating in these intervention; Stress levels, mental health outcomes, and chronic disease associated with employment and low-income • Number of people employed in each intervention, their average salary and benefits • Income tax revenue from employees in each intervention

19. Economy: Research Questions (Medium Priority) How would Treatment Instead of Prison impact: • Case management and supervision costs of each intervention • Annual costs of construction vs. start-up for alternate treatments); Cost of operations/maintenance • Emergency room use and costs for people in each intervention • Costs of post-incarceration homelessness