Police Referral to Intensive Case Management Lessons Learned from LEAD (and other) Programs

1. Police Referral to Intensive Case ManagementLessons Learned from LEAD (and other) Programs LISA DAUGAARD Director, Public Defender Association; LEAD National Support Bureau TRACY GILLESPIE • LEAD Project Manager, Seattle • ANNE LARSEN • Outreach Services Coordinator, Olympia Police Department • KIM HENDRICKSON (moderator) • Project Manager, City of Poulsbo’s 4-city police co-response program 2019 CIT International Conference, Seattle, WA - August 27, 2019

2. Panel Goals Participants will be able to explain core elements of LEAD and similar programs Participants will be able to list ways intensive case management improves outcomes for individuals struggling with substance use and mental illness—and why it reduces recidivism. Participants will be able to explain how the harm reduction approach relates to LEAD and CIT.

3. Law Enforcement Assisted Diversion (LEAD): Paradigm Shift Lisa Daugaard LEAD National Support Bureau/Public Defender Association (Seattle) Judicial Symposium on Using the Law and Economics to Reform the Criminal Justice System Mason Judicial Education Program 12/11/2015 Law Enforcement Assisted Diversion (LEAD) CIT Conference LEAD King Co project management team Lisa Daugaard and Tracy Gillespie, Public Defender Association August 27, 2019 www.LEADBureau.org | info@LEADBureau.org

4. What is LEAD? • Law Enforcement Assisted Diversion (LEAD) • Community-based care & coordination for people whose criminal activity is due to behavioral health issues • Arrest diversion • Social contact referral • Law enforcement is the primary portal • In Seattle/King Co., expanded to include higher acuity mental health conditions in 2018-19

5. What is LEAD? • Case manager & participant agree on an individual intervention plan • Only requirements for participation: complete psychosocial intake & sign release of information • Key feature after program entry: comprehensive coordination of all “touches” with the LEAD participant, especially by prosecutors

6. Core Principles of LEAD • Harm reduction framework • abstinence is not required • Housing First • No one “fails” LEAD • Goal is reduced law violations related to behavioral health issues

7. Core Principles of LEAD • Operational partners make the choice that is empirically most likely to achieve behavior change • Continuous community engagement is essential politically and operationally

8. Information-Sharing Framework • Information is shared beyond care providers—required careful analysis under 42 CFR (ask for our memo!) • law enforcement and health care providers each share only what they can • care providers can share as needed and with good judgment pursuant to participant ROI • information shared could be publicly disclosed • sharing is voluntary by all & would halt if there were bad experiences

9. As distinct from CIT/crisis response: • explicit focus is criminal offenses where there is legitimate public expectation of enforcement • sometimes (Swift & Certain) also a legal obligation to enforce • stakeholders may perceive potential for legal or political blowback • possible defense issues with information-sharing arrangement • Law Enforcement: Police, Sheriff’s Office, County and City Prosecutors • Community: Public Safety Groups, Civil Rights Groups, Business Community • Political Officials: Mayor’s Office, County Executive, City & County Councils • Public Defense • Service Providers: Harm Reduction Providers

10. Relationship to Courts • Original diverted case does not go before a court -- but, most LEAD participants have other cases both pre & post program entry • Prosecutors reconcile those cases with the individual intervention plan; supporting that plan wherever possible & appropriate • Judges: continue cases, grant prosecutors’ release motions & consider LEAD information outside the context of a “compliance” framework

11. Outcomes • Independent evaluation by University of Washington research team funded by Arnold Foundation • Findings published in peer-reviewed journals 2017-2018 • Quasi-randomized control design showing causation • Ongoing evaluation planned

12. Outcomes

13. Recidivism Effects

14. Cost Savings • Program costs less than system-as-usual processing, with savings estimated conservatively • Costs can fall further • In Seattle, costs are now about $350/month per participant

15. What’s Missing? • Strong case management but missing key components to support health & healing: • Housing • Housing • Housing • Effective treatment modalities for stimulants

16. Replication: www.leadbureau.org

17. Replication • Primary barrier to LEAD implementation is funding • Jurisdictions that have implemented Medicaid expansion can leverage ACA dollars to pay for many LEAD services • e.g., chemical dependency treatment, mental health care, health and dental care

18. State & Federal Funding Developments • Federal CARA funding through BJA • NY state DSRIP funding for LEAD case management • State-level funding in WA, CA, CO, HI, NC, ME (general fund, substance abuse block grants)

19. Paradigm Shift • If fully implemented, LEAD allows communities to reserve police, prosecutors, and courts for where they are most needed • Facilitates the shift to using public health strategies for public health problems, including: • Trauma-informed engagement • Harm Reduction • Housing First • Sustained Relationships

20. Paradigm Shift • Recognizes the harm done by charging and/or convicting someone of a crime if that is not necessary or helpful in achieving behavior change • Katherine Beckett article in Harvard Law & Policy Review on “Harm Reduction Policing” & Reconciliation Impact on LEAD

21. LEAD Helps to Support Recovery Source: Hogg Foundation U of Texas at Austin

22. Contact Information LEAD King County project management team info@leadkingcounty.org Program Director Tara Moss: tara.moss@defender.org www.LEADBureau.org | info@LEADBureau.org

23. Familiar Faces Program Collaboration between OPD and CCS Bridges relationships and community knowledge Focused services Goal: a safe, healthy and vibrant City for every Olympia community member

24. Complex health and behavioral problems Frequent and persistent contact with OPD Walking Patrol Identified using composite information from OPD Walking Patrol and City Staff. 25+ of the most vulnerable individuals in Downtown Olympia who are most resistant to services and resources. Familiar Faces Participants

25. Current Demographics • GENDER IDENTIFICATION • 17 Clients Identify as Male • 10 Clients Identify as Female • CURRENTLY RESIDING • Drexel House (Shelter & Apartments) – 6 • Streets/Unsanctioned Encampments – 6 • Mitigation Site – 5 • Jail – 4 • Adult Family Home – 1 • Plum Street Village – 1 • Quixote Village – 1 • Sober House – 1 • Harmony House – 1 • Telecare Triage – 1 • AGE • Oldest Client: 66 • Youngest Client: 22 • “unofficial youngest client” 2 weeks old • COMMON CHARACTERISTICS • Criminal Justice Involvement • Chronic Medical Conditions • Mental Health Diagnosis • Substance Use Disorder

26. Kat F, Familiar Faces Client

27. 2018 & 2019 Recap 2018 December 24 clients 163 contacts 2019 January 18 clients 126 contacts 2019 February 17 clients 134 contacts 2019 March 23 clients 204 contacts 2019 April 26 clients 259 contacts 2019 May 26 clients 182 contacts * 2019 June 30 clients 200 contacts *only one Peer working

28. CCS Peers Melissa McKee & Keith Whiteman

29. Peer Navigators Share lived experience Provide non-judgmental and unconditional support to clients Utilize motivational interviewing skills Recognized as a Peer Specialist by DBHR or have the ability to obtain that status within 3 months.

30. Services Mental health and substance use disorder treatment integrated with primary health care and life skills development. Motivational interviewing Permanent supportive housing Assertive Outreach/Engagement Trauma-Informed Care Harm Reduction Integrated Care and Care Coordination Culturally Responsive Service

31. Project Personnel • Familiar Faces Team • OPD Walking Patrol (7) • OPD Outreach Services Coordinator • CCS Program Manager • CCS Peer Navigators (2) • Familiar Faces Partner Group • Mitigation Site Manager • Providence Mental Health Provider • OPD Jail Sergeant • Crisis Response Unit • Representative from local faith based organizations

32. Partnership & Collaboration • Social Service Providers • Community Care Center (Providence) • Interfaith Works • SeaMar • Behavioral Health Resources • Sidewalk • Telecare • Thurston Mason Behavioral Health Organization • Northwest Resources • Community Youth Services • Lacey Veteran’s Hub • Salvation Army • Union Gospel Mission • Additional Partners • TCOMM • Community Court • Office of Public Defense • Corrections • Prosecuting Attorney’s Office • Olympia Downtown Alliance • Intercity Transit

33. 2018-2019

34. 2018-2019 Successes • Partnership, collaboration, and COORDINATION between law enforcement, peer navigators, corrections, prosecution, defense, treatment centers, care providers, housing and more • Constant communication and “eyes on” Familiar Faces Clients with law enforcement, Crisis Response Unit, and City partners • Conversation without agenda

35. 2018-2019 Successes • Saying “YES” to non-traditional “services” or “resources” such as: • Laundry • Banking • Rides • Ice-Cream Cones • Walks • Dog training • Dog neutering • Dog sitting • Walmart trips • Haircuts • Delivering a baby • Driving to Spokane

36. 2018-2019 Successes Familiar Faces Peers are awarded a Chief’s Coin by Olympia Police Chief Ronnie Roberts!

37. 2018 – 2019 Lessons Learned Multiple referrals from outside of OPD Walking Patrol (DOC, Corrections, City programs, and Providence) Shortage of permanent supportive housing The “true” financial costs of supporting clients Lack of backend supports: detainment beds, recovery housing post treatment, and flexible and nimble providers The need for MORE Familiar Faces Peer Navigators!