1. Plan elements Co-location of juvenile and adult facilities Change in number of adult and juvenile beds Services Diversion programs Racial disparities Visitation options Economic disparities Social support Incarceration/ crime Outcomes How do all these plan elements affect health outcomes related to incarceration and recidivism? 1

2. Services education Δ Employment Δ Self-esteem Δ Income Δ Chronic Disease Δ Influence on next generation Δ Incarceration mental health care Δ mental health Δ Recidivism substance abuse tx Δ Substance use restorative justice Δ Offender accountability Δ Victim perception of outcome Δ Community involvement Δ cmty sense of wellbeing/safety Δ cmty support for crime-fighting housing assistance Δ premature mortality Δ mental health See Incarceration slide Community- based services Services in jail / transition ctr Re-entry Services Δ homelessness health assessment Δ healthcare access Δ healthcare utilization 2 Δ offender empathy trauma-informed care/treatment Δ parenting Δ high school completion Δ job training

3. Research Questions – Services Pathway How does service provision affect incarceration (rates of incarceration, recidivism)? – Type of service (which services are most important) – Timing of service – Location of service (community, facility-based and / or re-entry) 3

4. Primary Prevention Δ Availability of mental health resources Δ Youth mentoring programs / opportunities Δ Chronic Disease Δ Violence / injury Δ Incarceration Δ attitudes of inclusion (gender, race, orientation) Δ Gender, race, orientation- based violence Δ Skill set for educational and employment success Δ Attitudes about education Δ Knowledge of / utilization of educational resources Δ Level of education Δ morbidity / mortality Δ mental health status See Incarceration slide Δ School involvement Δ early childhood interventions (i.e. home visiting, services for foster children) Δ Social / emotional support Δ Funding that Prioritizes Community-Based Services and Infrastructure Δ Youth drop- outs Δ Income Δ Chronic stress Δ Healthcare Costs Δ Substance abuse Δ Policy 4 Δ Healthy Community Infrastructure

5. Research Questions – Prevention Pathway Can primary prevention reduce the need for incarceration? Are primary prevention services more cost- effective than incarceration to ensure a safe and healthy community? 5

6. Diversion Diversion: Alternative treatment programs offered within criminal justice system Δ Racial disparity in incarceration rate Δ Incarceration Δ Sobriety Court Diversions Δ Drug Court Diversions Δ Domestic Violence Court Δ Mental Health Court Δ access to services Δ recidivism Δ Recovery Δ Family support See Incarceration slide See Services slide 6 Δ Community Support (CBO, faith-based) Δ Prosecutor’s Diversion Process Δ CMH Jail Diversion Program Δ Community Correction Diversion Program Δ Veteran's Court Green: have Blue: don’t have Purple: pilot

7. Research Questions – Diversion Pathway Are diversion services more cost-effective than incarceration? To what extent can diversion reduce the need for incarceration and still ensure a safe and healthy community? 7

8. Co-Location vs. Separate Co-locate facilities Δ Access to services Δ Youth perception of self as a criminal Δ Social stigma associated with youth incarceration Δ RecidivismΔ Incarceration/Crime Δ Employment Δ Income Δ Educational attainment 2 separate facilities See Services slide See Incarceration slide Δ Cost of construction and operation 8 Δ Program options for youth

9. Research Questions – Co-Location Juvenile / Adult Pathway How would co-location of adult and juvenile facilities impact youth? Would the benefits of co-locating the facilities outweigh the risks to youth (e.g. recidivism, mental health, stigma, educational attainment, income, etc.)? 9

10. Visitation Options “Contact” vs. “non- contact” visits Letters (ability of inmates to receive letters) Televised/Webcam visits Δ Ability of all visitors to have more frequent communications with inmates Δ Visits with physically disabled people Δ Visits with people who must travel long distances Δ Confidential communication with friends and relatives Δ Communication with those forbidden from visiting inmates Δ Confidential communication with healthcare providers Δ Opportunities for physical contact Δ Inmates bonding with young children Δ Secure attachments among youth Δ Inmate Stress Δ Quality of relationships as adult Δ Mental health status Δ Likelihood of adult and adolescent criminal behavior Δ Mental status among inmates Δ Violence among inmates/jail crime Δ Connection to support system Δ Recidivism Δ Incarceration rates/crime Δ Access to healthcare services Δ Health status See Incarceration Slide 10 Δ Inmate bonding with older children

11. Research Questions – Visitation Options Pathway How do limitations on types of communication for inmates affect re-entry success and future incarceration? Do benefits of limiting communication methods outweigh risks? Do different types of communication options have different effects on children? How does the physical design of visitation space impact visitors, especially children? 11

12. Number of jail beds available Decrease in juvenile detention beds/increase in juvenile treatment beds/increase in day treatment capacity; Create capacity to increase adult beds by 800 over the next 20 years Δ Racial disparity in incarceration rate Δ Incarceration Δ Pressure to fill beds Δ Ease of incarceration Δ Investment by service providers to provide services in jail vs. in community Δ Judicial choices See Incarceration slide Δ Police choices Δ D.A. choices Δ public defender choices Δ Cost of construction Δ Ability to locally house “straddle cell” inmates, inmates reentering from prison and parolees Δ in ability to provide services to reentering inmates See also Services and Visitation Options slides 12 See Racial Disparities slide

13. Research Questions – Number of Jail Beds Pathway What effect does adding capacity have on incarceration rates and expenses? What is the “right” number of juvenile and adult beds? 13

14. Racial Disparity in Incarceration Δ Male to female ratio in population Δ CPS contact in AA families Δ Income in AA community Δ Educational attainment among AA Δ Stress among AA Δ STI rates among AA Δ Infant mortality Δ Infertility among AA women Δ AA children in foster care Δ Violence against AA children Δ Chronic disease rates Δ Average life expectancy for AA Health and Social Impact of Racial Disparities in Incarceration Δ AA Sexual networks Δ Mental health status Δ ATOD use among AA Δ AA teen pregnancy rate 14 See Economic Disparities slide

15. Research Questions – Racial Disparity Pathway What effect does racial disparity in incarceration have on illness and life expectancy for African Americans? 15

16. Impact of Economic Disparities Economic Disparity Δ Ability of former inmates to obtain employment Δ Economic burden of the poor (jail fines, etc.) Δ Family income (spouses, children) Δ Ability to afford medical treatment Δ Income among the poor Δ Insurance coverage among formerly incarcerated and their dependents Δ Self-esteem Δ Ability to access higher education opportunities Δ Ability to afford transportation Δ Mental health status Δ Healthcare in utilization, prevention, and screening Δ Health Status 16

17. Research Questions – Economic Disparity Pathway What effect does economic disparity in incarceration have on illness and life expectancy for low income Muskegon residents? 17

18. Incarceration/Crime Δ Mental health risk factors affected by incarceration Δ Proximity to spouse Δ Societal stigma Δ Mental health status Δ Marital status Δ Employability Δ Access to income and housing support programs Δ Income Δ Stress levels Δ chronic disease Δ premature mortality Δ infectious disease Δ injuries 18 Δ Social support Δ Educational Attainment See Economic Disparities slide

19. Research Questions – Incarceration / Crime Pathway What effect does incarceration have on illness and life expectancy? What is the societal cost of the health impact of incarceration? 19