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

Incarceration Drug & alcohol courts Mental health courts Job Placement Programs Community Based SATS Community Based MH Services ∆ Recovery rates ∆ Crime & Violence ∆ Economic impact ∆ infectious disease (HIV, Hep C, STI) ∆ premature mortality ∆ injuries ∆ mental health ∆ stress ∆ unemployment ∆ Quality of Life in Communities ∆ in Family life ∆ homelessness ALTERNATIVES General Bail diversion Day Report programs ∆ chronic disease ∆ ability to manage mental health ∆ addiction to substances

General Research Questions How would Treatment Instead of Prison (TIP) change: 1Number of slots for each intervention? 2The proportion of the general population incarcerated vs. in each alternative intervention? 3Number of people employed after each intervention? 4Number of people able to find housing after each intervention? 5Educational attainment for those in each intervention? 6Racial equity in each intervention? 7Rates 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

∆ Access to drugs and drug tx services ∆ Case management ∆ Access to medical ins/ tx for co-occurring issues Recovery from substance addiction ∆ risk of infectious disease (HIV, Hep C, STI) ∆ heart disease ∆ neurological damage ∆ respiratory harm ∆ mental health ∆ stress ∆ ability to manage mental health ∆ access to a living situation ∆ Access to prescription tx & MH services ∆ homelessness ∆ physical health conditions Recovery Incarceration Drug & alcohol courts Mental health courts Job Placement Programs Community Based SATS Community Based MH Services ALTERNATIVES Bail diversion Day Report programs

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 ∆ property/ violent crime (for those in drug courts or job training programs) ∆ Injury ∆ Death ∆ levels of crime in the community ∆ Recidivism Access to Case management and rehab programming Access to prescription tx & drug/MH tx services Access to SATS ∆ Educational opportunities ∆ Access to a living situation ∆ Access to jobs ∆ Legal Income ∆ Stress ∆ Chronic disease ∆ Mental health Solitary confinement/ punitive tx Reentry ∆ Parole services Incarceration Drug & alcohol courts Mental health courts Job Placement Programs Community Based SATS Community Based MH Services ALTERNATIVES Bail diversion Day Report programs

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: 1Number of violent & property crimes committed? Injury/fatality from these crimes? 2Recidivism? 3How many people receive parole, per intervention, and what is the rate of recidivism in these population groups? 4The average time out of circulation to commit crimes in public, per type of crime? 9

∆ educational outcomes for children ∆ exposure to crime & violence ∆ extended family to care for dependents ∆ Individual living with family ∆ Children to foster care ∆ ability for custodial caregiver to hold job ∆ child mental health ∆ financial effects of caring for others’ dependents ∆ dependent abuse/ neglect ∆ ability to afford food, medicine, clothes ∆ Behavioral issues for children ∆ parent mental health ∆ bonding w/ parent ∆ youth involvement in justice system ∆ child injuries ∆ peer bonding ∆ Immune system ∆ Single parent families Family Incarceration Drug & alcohol courts Mental health courts Job Placement Programs Community Based SATS Community Based MH Services ALTERNATIVES Bail diversion Day Report programs

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: 1Number of children in foster care or living w/ a non- parent family member? 2Exposure to violence for children/dependents of individuals in each intervention? 3Educational attainment of children in these families 4Abuse/neglect of children/dependents for parents in each intervention 5Number of single parent families 6Cost of caring for child/dependent for alternate caretaker and unemployment for alternate caretakers 7Children/youth in these families involved in youth justice system 12

∆ Premature Mortality ∆ persons who commit crimes residing in community ∆ violent and property crime ∆ income levels (same as poverty?) ∆ rates of unemployment ∆ infectious disease ∆ injury ∆ homelessness ∆ Chronic disease (obesity, nutrition, cardiovascular, asthma, other) ∆ community-wide poverty ∆ social cohesion & support ∆ exposure to weather ∆ wealth) ∆ parolees living in community ∆ Mental health Community Incarceration Drug & alcohol courts Mental health courts Job Placement Programs Community Based SATS Community Based MH Services ALTERNATIVES Bail diversion Day Report programs

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: 1Community-level poverty, average household income, unemployment, and homelessness? 2The number of those under supervision? 3Community-level crime, fear of crime, and participation in the underground economy? 4Levels of social cohesion and/or social support in each of these communities? 5Level of substance abuse in each of these communities? 15

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

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: 1The annual costs of incarceration and alternate treatments? 2Amount funded publicly and funded from other means for each intervention? 3Health 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? 4Median 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? 5The number of people employed in each intervention, their average salary & benefits? 6Income tax revenue from employees in each intervention? 18

Economy: (con’t) How would Treatment Instead of Prison change: 7Case management and supervision costs of each intervention? 8Annual costs of construction vs. start-up for alternate treatments)? Cost of operations/maintenance? 9Emergency room use and costs for people in each intervention? 10Costs of post-incarceration homelessness? 19