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Treatment Alternatives to Prison A Health Impact Assessment Scope of research February 2012 Health Impact Assessment – a structured yet flexible research and engagement tool used to elevate the consideration of health outcomes in decision-making. 1 General Incarceration ∆ Recovery rates ∆ addiction to substances ∆ injuries ALTERNATIVES Drug & alcohol courts ∆ Crime & Violence Mental health courts ∆ ability to manage mental health mortality ∆ chronic disease Bail diversion Day Report programs ∆ in Family life Job Placement Programs ∆ Quality of Life in Communities ∆ unemployment ∆ infectious disease (HIV, Hep C, STI) ∆ homelessness Community Based SATS Community Based MH Services ∆ premature ∆ Economic impact ∆ stress ∆ mental health General Research Questions How would Treatment Instead of Prison (TIP) change: 1 Number of slots for each intervention? 2 The proportion of the general population incarcerated vs. in each alternative intervention? 3 Number of people employed after each intervention? 4 Number of people able to find housing after each intervention? 5 Educational attainment for those in each intervention? 6 Racial equity in each intervention? 7 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? 3 Recovery Incarceration ALTERNATIVES Recovery from substance addiction ∆ Access to drugs and drug tx services ∆ neurological damage ∆ heart disease Drug & alcohol courts ∆ ability to manage mental health ∆ Case management Mental health courts Bail diversion Day Report programs Job Placement Programs ∆ risk of infectious disease (HIV, Hep C, STI) ∆ Access to prescription tx & MH services ∆ homelessness ∆ access to a living situation ∆ physical health conditions Community Based SATS Community Based MH Services ∆ respiratory harm ∆ Access to medical ins/ tx for co-occurring issues ∆ mental health ∆ stress Recovery Main question: How would TIP impact SA recovery and MH management? Questions address each intervention, with statewide and per county counts 5 Recovery: Research Questions How would Treatment Instead of Prison change: 1. Rates of substance abuse recovery and ability to manage mental health issues? 2. Access to: substance abuse and mental health treatment services; affordable medical insurance; prescriptions; and active case management? 3. Number of people who from each intervention who are homeless or otherwise do not have access to affordable housing? 4. The number of people who overdose and commit suicide? 5. The number of neurological disorders, STIs, and infectious disease in the targeted population? 6 Crime and Safety Incarceration ∆ property/ violent crime (for those in drug courts or job training programs) ∆ Injury ∆ levels of crime in the community ALTERNATIVES Drug & alcohol courts Mental health courts Solitary confinement/ punitive tx ∆ Recidivism Access to Case management and rehab programming Bail diversion Day Report programs Access to prescription tx & drug/MH tx services Job Placement Programs Access to SATS ∆ Parole services ∆ Legal Income ∆ Chronic disease ∆ Stress ∆ Mental health ∆ Access to a living situation Community Based SATS Community Based MH Services ∆ Death ∆ Access to jobs Reentry ∆ Educational opportunities Crime and Safety Main question: How would TIP impact crime and safety levels? Questions address each intervention, with statewide and per county counts 8 Crime and Safety: Research Questions How would Treatment Instead of Prison change: 1 2 3 4 Number of violent & property crimes committed? Injury/fatality from these crimes? Recidivism? How many people receive parole, per intervention, and what is the rate of recidivism in these population groups? The average time out of circulation to commit crimes in public, per type of crime? 9 Family Incarceration ALTERNATIVES ∆ Individual living with family ∆ child injuries ∆ exposure to crime & violence ∆ child mental health ∆ dependent abuse/ neglect Drug & alcohol courts ∆ parent mental health ∆ bonding w/ parent Mental health courts Bail diversion Day Report programs ∆ Immune system ∆ Single parent families ∆ Children to foster care ∆ Behavioral issues for children ∆ peer bonding Job Placement Programs Community Based SATS Community Based MH Services ∆ extended family to care for dependents ∆ ability for custodial caregiver to hold job ∆ financial effects of caring for others’ dependents ∆ educational outcomes for children ∆ youth involvement in justice system ∆ ability to afford food, medicine, clothes Family Main question: How would TIP impact children/dependents of individuals involved in these programs? Questions address each intervention, with statewide and per county counts. 11 Family: Research Questions How would Treatment Instead of Prison change: 1 2 3 4 5 6 7 Number of children in foster care or living w/ a nonparent 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 12 Community Incarceration ∆ injury ∆ violent and property crime ALTERNATIVES Drug & alcohol courts ∆ persons who commit crimes residing in community ∆ wealth) ∆ rates of unemployment Mental health courts ∆ income levels (same as poverty?) ∆ community-wide poverty Bail diversion Day Report programs Job Placement Programs ∆ Premature Mortality ∆ exposure to weather ∆ parolees living in community ∆ Chronic disease (obesity, nutrition, cardiovascular, asthma, other) ∆ infectious disease ∆ homelessness Community Based SATS Community Based MH Services ∆ social cohesion & support ∆ Mental health Community Main 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. 14 Community: Research Questions In communities with high rates of incarceration, how would Treatment Instead of Prison change: 1 2 3 4 5 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? 15 Economic ∆ cost of interventions Incarceration ∆ Government spending ALTERNATIVES ∆ parole costs ∆ homeless costs Drug & alcohol courts Mental health courts ∆ cost benefits ∆ Medical costs ∆ MH costs ∆ Health Care costs ∆ case mgmt ∆ ED use Bail diversion Day Report programs ∆ Employment Job Placement Programs Community Based SATS Community Based MH Services ∆ Stress & Mental Health ∆ Poverty ∆ Personal income ∆Criminal Justice system employment ∆ Premature mortality ∆ HH income ∆ income tax revenue ∆ Chronic disease ∆ use of education system ∆ Occupational Injuries Economy Main question: What is the economic impact of TIP? Questions address each intervention, with statewide and per county counts 17 Economy: Research Questions How would Treatment Instead of Prison change: 1 2 3 4 5 6 The 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 interventions? Stress levels, mental health outcomes, and chronic disease associated with employment and low-income? The number of people employed in each intervention, their average salary & benefits? Income tax revenue from employees in each intervention? 18 Economy: (con’t) How would Treatment Instead of Prison change: 7 Case management and supervision costs of each intervention? 8 Annual costs of construction vs. start-up for alternate treatments)? Cost of operations/maintenance? 9 Emergency room use and costs for people in each intervention? 10 Costs of post-incarceration homelessness? 19