Lessons Learned through The Health Foundation of Greater Cincinnati’s
Substance Use Disorder and Severe Mental
Illness in the Criminal Justice System Initiative
Jocelyn Fontaine, Ph.D., and Helen Ho
with Kaitlin Greer
March 2013
Copyright © 2013 by The Health Foundation of Greater Cincinnati.
All rights reserved.
To cite this work, please follow this format:
Health Foundation of Greater Cincinnati, The (2013). Lessons Learned through The
Health Foundation of Greater Cincinnati’s Substance Use Disorder and Severe Mental
Illness in the Criminal Justice System Initiative. Cincinnati, OH: Author.
Permission is granted to reproduce this publication provided that these reproductions are
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on page 4 for details.
2 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
Contents
About the authors, Foundation staff, about the Health Foundation 4
1.0. Introduction
5
1.1. Importance of the Initiative
5
1.2. Substance Use Disorder and Severe Mental Illness in the Criminal Justice System Initiative 5
1.3. The Urban Institute Study
6
2.0. Grantee Interviews 7
2.1. Methods
7
2.2. Findings
7
2.3. Summary
9
3.0. Grantee Outcomes 10
3.1. Methods
10
3.2. Activities Funded
10
3.3. Sustainability Findings
11
3.4. Grantee Outcomes
12
3.5. Summary 14
4.0. Lessons
15
4.1. Lessons for Criminal Justice and Behavioral Health Practitioners
15
4.2. Lessons for Criminal Justice Practitioners
16
4.3. Lessons for Behavioral Health Practitioners
17
4.4. Lessons for Policymakers, Public Administrators and Other Decisionmakers
18
4.5. Lessons for Researchers 19
4.6. Lessons for Funders
19
5.0. Conclusions
22
Endnotes22
Appendix: Data Limitations, Methods, and Results
23
A.1. Data Limitations
23
A.2. Methods
25
A.3. Findings—Recidivism, Mental Health, and Substance Use Outcomes
26
A.4. Findings— Cost Benefit Outcomes
32
THE HEALTH FOUNDATION OF GREATER CINCINNATI 3
About the authors
Jocelyn Fontaine, Ph.D., is a senior research associate in the Justice Policy Center of
the Urban Institute. Dr. Fontaine’s research portfolio is focused mostly on evaluating
innovative community-based crime reduction and reentry initiatives targeted to vulnerable populations. She is experienced in using both quantitative and qualitative research
methodologies to explore the impact of community-based initiatives on a range of
individual and community outcomes.
Helen Ho is a research assistant in the Justice Policy Center of the Urban Institute. Her
research focuses on criminal justice reforms, reentry programs, and racial disparities in
the criminal justice system.
Kaitlin Greer is an analyst in the Executive Office of the President (EOP). Before joining EOP, Ms. Greer was a research assistant in the Justice Policy Center of the Urban
Institute where she contributed to several criminal justice-related projects. Before
joining the Urban Institute, Ms. Greer was a policy intern at the Pennsylvania Prison
Society and the Vera Institute of Justice.
Foundation staff
Janice Bogner, Senior Program Officer, Severe Mental Illness
Jeff Williams, Director, Publications
Ann Barnum, Senior Program Officer, Substance Use Disorders
Patricia O’Connor, Vice President, Chief Operating Officer
About The Health Foundation of Greater Cincinnati
Since 1997, The Health Foundation of Greater Cincinnati has invested more than
$128 million to address health needs in 20 counties in Ohio, Kentucky and Indiana
that surround Cincinnati. Our mission is to improve the health of the people of the
Cincinnati region. Our vision is to be one of the healthiest regions in the country.
For more information about the Health Foundation and our grantmaking interests and
capacity building programs for nonprofits, please call us at 513-458-6600 or toll-free
at 888-310-4904, or visit our website at www.healthfoundation.org. Copies of this and
other Health Foundation publications can be downloaded at www.healthfoundation.
org/foundation-publications-and-reports.
4 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
1.0. Introduction
In the late 1990s, The Health Foundation of Greater Cincinnati began exploring
how to improve outcomes for people with
severe mental illnesses and substance use
disorders in the criminal justice system. It
commissioned a paper to better understand
the scope of the problem and where funding
could be most useful. With this information,
the Foundation began the Substance Use
Disorder and Severe Mental Illness in the
Criminal Justice System Initiative in 1999.
Through the Initiative, the Foundation has
invested more than $12 million in 99 grants
in the Greater Cincinnati area. The grants
cover a wide range of activities focused on
diversion and reentry for people with behavioral health issues in the criminal justice
system.1 Although the Initiative formally
ended in 2008, several grantees continue to
work on multi-year projects.
Beginning in November 2011, the Urban
Institute (UI) has been working with the
Foundation to disseminate the findings and
lessons learned from the Initiative, lessons
that are relevant for interested stakeholders within the Greater Cincinnati area and
beyond. Specifically, UI has gathered information from interviews and focus groups
with Health Foundation staff, grantees, and
criminal justice and behavioral health stakeholders in the Greater Cincinnati area, as
well as grantee reports. This report summarizes the findings and lessons learned from
the perspective of the UI researchers and
is intended for five audiences: behavioral
health practitioners, criminal justice practitioners, policymakers and public administrators, researchers, and funders.
This report aims to contribute to each
audience’s understanding of the Initiative
and the outcomes for the population served
by the Initiative’s grantees. The following
sections within the introduction outline the
importance of focusing on people with be-
havioral health issues in the criminal justice
system, a brief overview of the Initiative,
and the UI study. Next, a section describes
the findings from interviews with stakeholders. Program outcomes are discussed in a
subsequent section and the report ends with
specific findings and lessons learned for the
five audiences outlined.
1.1. Importance of the Initiative
As documented extensively in existing
research, people with behavioral health
issues are overrepresented in the juvenile
and adult criminal justice systems.2 And in
many cases, individuals’ behavioral health
conditions directly influence their participation in crime.3 Unfortunately, the criminal
justice system is ill-equipped to address the
needs of these people effectively.4 Behavioral health services provided in prisons and
jails are limited5 and many people would be
better and more effectively served by behavioral health diversion and reentry programs
in the community.6 As such, it is critical that
information detailing the opportunities for
alternative programs for individuals with
behavioral health disorders be available to
a wide array of stakeholders. Further, it is
equally important that information about
the successes and challenges of implementing and sustaining alternative programs are
disseminated widely—to contribute to the
field.
1.2. Substance Use Disorder and Severe Mental Illness in the Criminal
Justice System Initiative
Beginning in 1999, 99 grants were
funded by the Health Foundation under
the Initiative. The 99 grants funded activities across the Greater Cincinnati area,
including 20 counties in the states of Ohio,
Kentucky, and Indiana. Grantees applied
THE HEALTH FOUNDATION OF GREATER CINCINNATI 5
for funding by responding to a request for
proposals (RFP). The application process
was iterative; the Foundation would give
feedback to applicants throughout the
RFP process to strengthen applications.
As a condition of funding, the Foundation
required grantees to develop evaluation
plans that described how they would evaluate their processes and their participants’
outcomes. The Foundation also encouraged
grantees to describe how they would obtain
funding to sustain their programs when the
grant period ended.
Grantees funded by the Health Foundation through the Initiative varied widely.
Programs ranged from mental health courts
to crisis intervention teams to multisystemic therapy. Programs included services for both juveniles and adults and
focused on diverting people with behavioral
health disorders from incarceration (diversion) or serving them upon their release
from incarceration (reentry). In addition to
paying for the implementation of programs,
the Initiative included funding for program
planning and development activities, such as
paying for practitioners to attend research
conferences and funding multi-organization
collaborative bodies to evaluate behavioral
health needs in the local criminal justice
system. Some of these planning and development activities led to program implemen-
tation funding by the Health Foundation
under the Initiative. The grantees also varied widely, including a range of stakeholders
from departments of corrections and prosecutors, mental health and substance use
disorder treatment providers, to nonprofit
or faith-based agencies, such as churches.
1.3. The Urban Institute Study
To understand the overall findings and
distill the lessons learned from the Initiative, the Health Foundation tasked UI with
collecting and analyzing qualitative and
quantitative data from two primary sources.
First, we conducted interviews and focus
groups with former and current grantees. In
these conversations, we discussed grantees’
perspectives on the Initiative, the Foundation, and program implementation successes and challenges, and their experiences
with sustaining the program after the Initiative funding ended. Second, we received
administrative data collected about and by
the grantees, including the information that
the Health Foundation routinely collected
from the grantees during the course of their
program performance and the Foundation staff’s observations. Using these data,
we assessed the results of the Initiative to
understand what overall lessons could be
learned.
6 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
2.0. Grantee Interviews
To improve outcomes for the people in the
criminal justice system with behavioral health
disorders and reduce system cycling and the
associated costs, it is the perspective of the
Health Foundation that the criminal justice
and behavioral health systems must modify
their practices, policies, and procedures
to better serve this population. To assess
whether the Initiative achieved its goals, UI
conducted semi-structured interviews and
focus groups with grantees and other key
stakeholders throughout the Greater Cincinnati area. The grantee interviews were used
to document changes in local and state treatment of individuals with behavioral health
disorders. These discussions revealed difficult, but rewarding experiences with developing cross-system collaborations, effective
and sustained interventions, and meeting the
Health Foundation’s grant requirements.
2.1. Methods
UI conducted 20 semi-structured
telephone interviews and facilitated one focus
group with stakeholders involved in executing grants funded by the Health Foundation.
The interviews ranged from 30 to 60 minutes
in length. The focus group lasted 120 minutes. In total, UI spoke with 38 stakeholders,
representing 30 different grantees in addition
to four staff members at the Foundation who
designed and managed the Initiative. The
discussion themes that emerged from the
discussions fell into six categories:
• The Foundation’s planning-to-implementation grant structure
• Stakeholder support
• Interagency collaboration
• Data collection
• Sustainability
• Working with the Foundation
These main themes were those most consistently cited by grantees and stakeholders as
factors that contributed to the adoption (or
lack thereof) of effective strategies and interventions for the population under focus.
2.2. Findings
The role of the planning-to-implementation grant structure—There was consensus among stakeholders who worked on
planning and implementation grants that the
planning grants were very helpful in laying
the groundwork for the implementation
grants. Specifically, the planning grants provided the grantees with time and resources
to determine which program or design
to pursue and then to build support from
relevant stakeholders. One grantee credited
the planning process for establishing their
project because “everyone took ownership
of the project, because
they got invested in the
One grantee credited the
planning of it.” Planplanning process for esning grants also helped
tablishing the program as
“everyone took ownership
grantees identify and
of the project, because
address potential issues
they got invested in the
that may arise during
planning of it.”
implementation. One
negative comment that
did emerge regarding the grant structure was
that the planning grant perhaps inflated the
sense of stakeholder support and collaboration. Stakeholders had supported the abstract
ideas generated during the planning grant;
however, support waned as implementation
challenges arose. Regardless, the grantee
who encountered these issues noted that the
planning-to-implementation grant structure
was an effective one.
The role of stakeholder support—All of
the grantees discussed stakeholder support,
either as a positive indicator of program
adoption, a negative indicator, or both.
Stakeholder support was gained at different
stages of the grant process. In some cases,
stakeholders had existing support and a history of collaboration before they applied for
THE HEALTH FOUNDATION OF GREATER CINCINNATI 7
a planning or implementation grant. In other
cases, the collaborative group was brought
together specifically to apply for a grant. In
most cases, though, a small group of stakeholders applied for and were awarded a grant
and they had to gain additional stakeholder
support as the grants were implemented.
Stakeholder support took many forms. For
example, support was gathered in two grants
through prominent
stakeholders with
One grantee stated that
enough political clout
stakeholder support was
to recruit supportchallenging because “the
consensus to address the
ers. In another grant,
need was there, but how
there was a clear and
to do it wasn’t, mainly
agreed-upon need
because of resources.”
for services, such that
stakeholder support
was easy to gather. In addition to stakeholder
support, political support was important to
the success of grants, and in one grant, the
planning stakeholders anticipated a negative
political reaction to the program and made
changes that would gather more support.
Stakeholder support was also a challenge
for some grantees because of a lack of understanding of the program being implemented,
lack of patience with or interest in working
with the client population, and logistical difficulties in service delivery to clients in rural areas. One grantee stated that stakeholder support was challenging because “the consensus
to address the need was there, but how to do
it wasn’t, mainly because of resources.” Some
grantees were able to work through their
stakeholder support challenges by engaging
leaders with in-person meetings and by framing collaboration as a way to avoid duplicating
services. Two grantees that worked on grants
not sustained after Health Foundation funding ended cited lack of stakeholder support as
one of the reasons they were not sustained.
The role of interagency collaboration—
Interagency collaboration was also named as
either a challenge or a contributor to success
by almost all of the grantees interviewed.
As with stakeholder support, interagency
collaboration was formed at different times
during the grant. The mental health, drug,
and substance abuse/mental illness (SAMI)
courts, especially, emphasized the importance of having a long history of interagency
collaboration. For those without a history of
collaboration, the Health Foundation grant
provided an opportunity where “people met
each other who had never met each other—
the sheriff met providers, adult education
providers were able to network, and parole
talked with (clients’ support networks).” This
collaboration was not only useful during the
planning phases of grants, but in one case,
two service providers collaborated to deliver
services within a drug court program. Four
grantees mentioned that they used boundary
spanners or liaisons to help connect clients
with services and that these boundary spanners helped agencies work together to deliver
services. Another four grantees mentioned
that interagency collaboration was a minor challenge during
implementation of their
For those without a hisgrants, but those mentory of collaboration, the
tions were brief and did
Health Foundation grant
not come up as many
provided an opportunity
times as did stakeholder
where “people met each
other who had never met
support challenges.
each other—the sheriff
Lack of referrals, mismet providers, adult edutrust between agencation providers were able
cies, and confidentiality
to network, and parole
challenges when sharing
talked with (clients’ supclient information were
port networks).”
mentioned by interviewees as barriers to collaboration, as was an insular service-provider
community wary of ideas from outsiders.
The role of data collection—While all of
the grantees were required by the Health
Foundation to collect program and outcome
data during their implementation grant, not
all of the grantees maintained data collection
after the grants ended. The data required by
the Foundation and collected after the grants
8 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
have been used to leverage sustainability
funding and gather political support as well
as target services to the greatest number of
people. One grantee mentioned that mental health court data are being collected
and reported to county commissioners as a
contingency plan in case the need for additional funding arises. The grantee hopes that
should the need arise, the commissioners will
see a history of reported success and agree to
provide funding.
Efforts to sustain programs—As mentioned, the Health Foundation encouraged
grantees to develop sustainability plans as a
condition of funding. One grantee appreciated the sustainability plan requirement
because “if we hadn’t committed to that
at the beginning, we wouldn’t have done
the fundraising.” Many, but not all, of the
programs funded by the Foundation were
sustained after the financial support ended.
Sustainability funding came from many
different sources, which depended on the
type of program being funded (for example,
some mental health courts received funding
from local mental health boards in Ohio).
Funding types included local levies, a builtin payer source (such as Medicaid), private
foundation grants, fees collected from program participants, state departments of corrections funding and federal grants. While
all of the grantees dealt with sustainability
funding, only two mentioned non-monetary sustainability, such as continued regular
meetings of stakeholders involved in the
implementation of the grant. Even though
most grantees were
successful in finding
One grantee apprecisustainability funding
ated the sustainability plan
requirement because “if we
and support, a handhadn’t committed to that at
ful of the grantees
the beginning, we wouldn’t
indicated that their
have done the fundraising.”
programs had not
been sustained after
the funding ended. Barriers to sustainability
funding included the lack of federal grants,
lack of time to develop stakeholder support,
lack of stakeholder support for finding continuation funding, and state budget cuts.
Working with the Health Foundation—
Overall, the grantees found the Health Foundation to be flexible and supportive during
the planning process and during implementation, specifically when grantees needed help
to meet the Foundation’s data collection
requirements or to work through unforeseen
implementation challenges. One grantee
One grantee praised the
Health Foundation: “They
praised the Health
thought this was their
Foundation: “They
project, too. There was so
thought this was their
much support.”
project, too. There was
so much support.” In
addition, some grantees reported that the
Foundation helped gather stakeholder support and identify effective partners for grantees during the planning stages. One grantee
used the phrase “night and day” to describe
the positive experience of working with the
Foundation compared with other foundations and funders.
2.3. Summary
In summary, funding from the Health
Foundation led to changes in the behavioral
health and criminal justice systems involved
in the funded programs. The success of the
Initiative in leading to sustainability funding
is notable as are the grantees’ highlighting of
the critical role of collaboration and stakeholder support. It appears that much of the
stakeholder support and collaboration was
generated specifically through the Foundation’s planning grants, which led to more
successful implementation. While grantees did not often cite specific examples of
changed policies and practices, the funding
appears to have led to new and/or strengthened modes of contact between behavioral
health and criminal justice system stakeholders.
THE HEALTH FOUNDATION OF GREATER CINCINNATI 9
3.0. Grantee Outcomes
The logic of the Health Foundation’s
Initiative is that grantees’ outcomes were
intended to be broad, such that the programs were intended to have an impact on
criminal justice outcomes as well as behavioral health outcomes (mental health
and/or substance use disorders). The
synergies between different systems created
by grantees were also intended to be costbeneficial across these systems. As such,
the Foundation required grantees to report
their clients’ criminal justice involvement
and behavioral health assessments as well as
cost savings. Overall, grantees reported that
the majority of their clients had reduced
involvement with the criminal justice system, reduced mental health symptoms, and
reduced substance use. Those that reported
cost savings reported significant savings
from reduced criminal justice involvement.
3.1. Methods
Of the 99 grants funded, UI received reports and materials for 79 grants. After reviewing the data at length, we encountered
multiple challenges to conducting quantitative analyses for comparison purposes.
Grantees defined their outcomes in various
ways, used different outcome periods, used
a breadth of interventions with minimal
overlaps, did not report outcomes for all of
their participants, reported aggregate data
without individual-level data, and did not
use comparison groups. Most of these issues
emerged because grantees collected data
to generate and report on program benchmarks. Therefore, more systematic analyses
of outcomes across grantees could not be
conducted. The Appendix provides more
information on the data analysis methods
and limitations. The following section describes grantee characteristics and provides
an overview of some of the outcomes that
grantees reported. Then, we present a scan
of practice of the grantee’s most frequently
used program models to contextualize the
outcomes.
3.2. Activities Funded
Grantees were funded for a variety of
purposes: planning, research, technical assistance, operations support, and implementation. The distribution of funding purposes
is displayed in Table 1. The majority (52
percent) of grants were given to implement
a program. A large portion of grantees
received funding for planning and development activities, which included creating a
task force, hiring a project coordinator, and
developing a business plan. The remaining
grants were used for technical assistance,
operations support, and research. The activities funded under these grants included
sending organization representatives to
conferences, studying reentry outcomes for
those released from an Ohio prison, and
preparing for litigation to improve reentry
services. As echoed in the stakeholder interviews previously described, the Initiative’s
planning and technical assistance grants
facilitated the establishment or improvement of programs. Fifty-three percent of
the planning and technical assistance grants
evolved into an implemented program
funded by the Initiative.
Table 1:
Number of Grants by Grant Type
Grant Type
Count Percentage
Planning
27
34
Research
1
1
Technical Assistance
5
6
Operations Support
5
6
Implementation
41
52
Total
79
99*
* Numbers do not add to 100% because of rounding.
1 0 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
The grantees that received implementation grants employed a variety of treatment
models and approaches to interacting with
people with behavioral health issues in the
criminal justice system. Table 2 in Appendix A lists the treatment models and the
frequency of their use among the grantees.
The most common approach was creating a diversion court, although each of the
eight diversion courts funded had different
focuses or models. The next two most common models implemented were the Assertive Community Treatment (ACT)7 and
Crisis Intervention Teams (CIT)8, with five
and four grantees, respectively. Two grantees each used the Assessment, Planning,
Identifying, Coordinating (APIC) model9; a
boundary spanner, or someone who knows
both the criminal justice and behavioral
health systems and facilitates collaboration
between the systems; or drug treatment.
The rest of the models were used by only
one grantee each.
Notably, some grantees combined more
than one approach or model. For example,
one SAMI court used Integrated Dual
Disorders Treatment (IDDT) in addition to
its diversion strategy while another diversion court used ACT as its treatment model.
Other grantees did not employ a specific
model and provided standard services, such
as screening, treatment, and case management.
3.3. Sustainability Findings
Program sustainability was a major focus
of the Initiative. As part of the Initiative’s
requirements, grantees developed plans
to sustain their programs after the Health
Foundation’s funding ended. Throughout
the grant period, grantees reported on their
progress with fundraising, writing grant
proposals, and securing funding commitments from stakeholders. Grantees were
also asked to report whether they were able
to sustain their programs when they sub-
mitted their final reports or when Foundation program officers wrote their grant
close-out reports.
The vast majority of grantees sustained their programs—Likely because
of the Health Foundation’s emphasis on
sustainability from the outset of program
implementation, the vast majority of the
Initiative’s implementation projects were
sustained at the end of their grant periods.
Figure 1 displays the percentage of programs that were sustained. Of the 41 implementation projects, 37 had closed their
grant periods at the time of our analyses. Of
these 37, 33 (or 89 percent) sustained their
programs.
Figure 1: Percentage of Projects Sustained
after Health Foundation Funding Ended
Sustained
(33 projects)
89%
11%
Not
sustained
(4 projects)
Multiple factors contributed to the discontinuation of some programs—
Because only four grantees were not sustained, it was difficult to determine the
factors that promoted and hindered sustainability. One of the programs that was not
sustained had not developed a detailed funding plan. In its application, the grantee had
not identified specific funding avenues to
pursue while all of the other grantees did. At
the end of the grant period, the grantee still
had not identified potential funding sources
and could not continue its operations. The
other program that was not sustained experienced severe staff turnover. This led to a
costly process to maintain the certification
THE HEALTH FOUNDATION OF GREATER CINCINNATI 11
for its evidence-based treatment model,
which the program could not afford. One
grantee was initially sustained at the close of
its grant period, but it had to discontinue
its program because of state government
budget cuts.
Grantees relied on a variety of funding
sources for their programs—As for the
grantees that were sustained, they initially
planned to use a variety of funding sources
and ultimately were able to acquire funds
from many different sources. Grantees
mainly planned to receive funds from fees
for services; reallocations of the grantee’s
own budget; grants from foundations and
federal, state, or local governments; budget
reallocations from state or local government
agencies; and levy taxes.
Built-in payer sources—Billing revenue
from Medicaid, private insurance companies, or clients was a fairly reliable source of
continuation funding for grantees. Eight of
the 11 grantees that planned to use billing
revenue and specified their final funding
sources were able to rely on billing revenue
as part of their funding package. In addition, two grantees that had not planned to
use billing revenue were able to support
their programs with this method.
Grantee funds—Nine of the grantees
used their own funds to sustain the programs after their grant periods ended. These
grantees were mostly county-level mental
health and substance use disorder boards or
another type of government agency.
State and federal government agencies—Many grantees were sustained using
public funds that were not from their own
budgets, suggesting that activities funded
by the Initiative filled important service
gaps. Some of the grantees attributed this
to their ability to demonstrate success to
external public agencies. Five grantees were
sustained by state department funds, usually
from a behavioral health department or a
department of corrections. A state depart-
ment of jobs and family services also provided funding, notable since this department
is outside of the criminal justice, mental
health, and substance use disorder systems.
Thirteen grantees were sustained by
local funding sources, including probation
departments, county government mental
health and substance use disorder boards,
county commissioners, and local courts.
The availability of federal grant funds was
much more limited. Of the seven grantees
that planned to apply for federal grants,
only one received federal grant money.
Public levies—Public agencies planned to
use funds from a levy, which were thought
to be unreliable. Seven grantees, most of
which were mental health and/or substance
use disorder boards, planned to use levies.
Some levies were slated to be approved or
renewed by voters and the grantees were
not sure whether the levies would pass. Additionally, one grantee whose grant period
had not ended was able to use funds from a
levy that passed, but reported that there was
less tax revenue than expected because of
the economic recession.
3.4. Grantee Outcomes
More than three-quarters of implementation grantees reported outcomes for mental
health, substance use disorders, and criminal justice, where applicable (see Table 3
in Appendix A for reporting rates). The
majority of grantees reported very positive
outcomes for each of these three outcome
categories.
Mental health outcomes—Grantees used
a variety of methods to measure mental health outcomes. Most grantees used
scored instruments such as the BASIS-24,
the Youth Outcome Questionnaire, and the
Ohio Mental Health Consumer Outcomes
Instrument. Two CIT programs measured
whether mental health cases resulted in
referrals to mental health services. These
outcomes were reported for participants
1 2 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
who were active in the program at the time
of measurement or were discharged successfully. Grantees reported that between
33 and 100 percent of their clients had
improved mental health at some point after
admission to their programs. Most grantees
reported that more than 50 percent of the
clients showed improvement, though it is
not appropriate to compare results across
grantees because of differences in their
client populations. The two CIT grantees
reported that 72 percent and 93 percent
of cases were linked to treatment services.
Graph 1 displays the distribution of client
improvements across programs.
Few grantees reported on the magnitude
of their clients’ improvements. The grantees
that did report changes indicated improvements in mental health outcomes between 3
and 48 percent.
Graph 1: Improvements in Mental
Health or Referrals to Mental Health
Services
12
11
11
9
9
Graph 2: Reductions in Substance Use
10
8
7
6
5
4
3
2
2
1
0
9
9
0
0-25%
26%-50% 51%-75% 76%-100%
Percentage of Clients Reporting
Improvements or Receiving Referrals
Note: Five grantees reported only percentage improvements
in mental health assessment scores and were not included in
this chart. One grantee reported a range for its percentage of
clients who improved without noting the number of clients it
assessed. The median of the range (45.5%) was used as a
proxy for this grantee’s outcome.
Number of programs
Number of programs
10
Substance use disorders outcomes—
Most grantees measured substance use
using clients’ self-reports. Some grantees
used parole office and case manager reports and urine testing. All but six grantees
reported that more than 50 percent of
their clients had reduced substance use.
The outcomes were measured for participants active in the program at the time
or measurement or for those who were
successfully discharged. Graph 2 displays
the distribution of reduced substance use
across programs. Similar to the mental
health outcomes, it is not appropriate to
compare outcomes across grantees because
of differences in client populations and
their outcome definitions. For example,
some grantees used “being substancefree” as their definition of having reduced
substance use, a higher bar than those
reporting on substance use reductions.
The grantees that measured whether their
clients were substance-free reported that
between 27 and 88 percent of their clients
had no substance use by the end of their
programs.
9
8
7
6
5
5
4
3
2
1
0
1
0-25%
26%-50% 51%-75% 76%-100%
Percentage of Clients
Reporting Reductions
Note: One grantee reported only the percentage of
substance-free days clients experienced and was not
included in this chart.
THE HEALTH FOUNDATION OF GREATER CINCINNATI 13
Criminal justice outcomes—Grantees
used a variety of measures to assess clients’
involvement in the criminal justice system,
including charges, convictions, and incarcerations. They reported that between 50
and 100 percent of their clients had no new
involvements or reduced involvement with
the criminal justice system either during or
after their programs. All but two grantees
reported that 60 percent or more of their
clients had reduced involvement with the
criminal justice system. For the CIT and
Mobile Crisis Teams, between 93 and 99
15
percent of calls involving people with mental health issues were resolved at the scene
or resulted in a referral to a mental health
service provider instead of resulting in an
arrest. Graph 3 shows the distribution of
reduced criminal involvement across programs.
Cost savings—Of the 41 implementation grants, 17 reported cost analyses in
their evaluation documents. The reported
per month costs saved ranged from a loss of
$1,517 per client to a savings of $45,316
per client, with only one grantee reporting
an overall loss. Although the self-reported
cost analyses are encouraging, they should
be taken with caution. First, none of the
grantees compared its clients’ outcomes to
a comparison group; therefore, the cost effectiveness of the grantee programs relative
to no intervention, another intervention,
or business-as-usual services is unknown.
Second, some grantees did not subtract
treatment costs from their calculations,
inflating the program’s net benefits. Table
5 in Appendix A displays reported costs and
additional data limitations.
14
3.5. Summary
Graph 3: Reductions in
Criminal Justice Involvement
22
21
21
20
19
18
17
Number of programs
16
13
12
11
10
10
9
8
7
6
5
4
3
2
2
1
0
0
0-25%
In summary, it appears that the Initiative
has led to notable benefits among program
participants, who were served by an array
of treatment models, some of which were
based in evidence. As mentioned throughout this section, we cannot make definitive claims as to the benefit of the specific
programs or the overall Initiative in leading
to the outcomes observed for a variety of
reasons. Yet, from the self-reported outcomes provided by the grantees, the Initiative succeeded in helping individuals with
behavioral health disorders in the criminal
justice system achieve generally positive
health and criminal justice outcomes.
26%-50% 51%-75% 76%-100%
Percentage of Clients
Reporting Reductions
1 4 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
4.0. Lessons
Using the information gathered from
the stakeholders during the interviews and
focus groups, coupled with the grantee data
on outcomes, successes, and challenges
discussed in the data provided to UI, we
have generated some lessons learned from
the Initiative.
4.1. Lessons for Criminal Justice and
Behavioral Health Practitioners
Anticipate the difficulty involved in collecting and using data—Data from other
systems, such as criminal data and medical
data, can be difficult to obtain, especially
cost data. One grantee wanted to measure
the program’s effect on child services, but
could not access that department’s data.
Some of the data collection issues encountered by the grantees were resolved with
memoranda of understanding or information release protocols that allowed grantees
to access data from other systems. Grantees
also found it difficult and time-consuming
to follow up with clients to measure longterm outcomes, particularly those who
were no longer attached to the program.
Grantees should develop realistic plans for
working with data early in their program’s
implementation, especially with regard to
clients who do not complete programs or
cannot be reached for data collection.
While there are likely to be issues collecting data, data can be a powerful tool
in obtaining new funding and support—
Grantees reported that the outcomes they
tracked were helpful in persuading funders
and other stakeholders to support their
programs. This helped programs sustain
operations after funding from the Health
Foundation ended.
A slow economy presents challenges
and opportunities for new initiatives—
Not only was funding scarcer in the slower
economy, but collaborative support also
diminished. Nonprofit organizations and
businesses may be less willing to consider
new collaborations as they focus on their
own organizations’ issues. Yet, budget cuts
can provide the impetus for organizations
to find ways to be more efficient through
collaboration. Practitioners need to anticipate and adapt to the changing environment caused by the current economic
realities.
Collaborative efforts and learning opportunities build capacity for future initiatives—Even though some projects were
not sustained or implemented after funding from the Health Foundation expired,
grantees were able to make connections to
professionals in different systems and levels
of government that may lead to future collaborations. The grantees also gained the
experience of developing plans, navigatIn one grantee’s expeing federal funding
rience, “if you lay the
groundwork, you might
proposals, working
not get something at the
through implemenbeginning, but you might
tation issues, and
get something later.”
learning behavioral
health practices. This
new capacity will likely be useful for future
efforts focused on people with behavioral
health issues in the criminal justice system.
In one grantee’s experience, “if you lay the
groundwork, you might not get something
at the beginning, but you might get something later.”
Adaptations in implementation to
account for local context may be necessary—Health Foundation grantees included
both urban and rural communities, communities that face different challenges and
realities. In particular, programs in rural
communities reported issues with recruiting
and retaining qualified staff and providing
transportation for clients. These issues were
not as pronounced for grantees in more
THE HEALTH FOUNDATION OF GREATER CINCINNATI 15
urban settings. Meanwhile, rural communities found that communication and collaboration was facilitated by the smaller number
of relevant stakeholders in their jurisdiction
as compared with urban communities. Additionally, since some program models may
have been developed in urban areas, some
program adaptations may be necessary before being implemented in rural areas.
Legal leverage can be used to motivate
clients—One benefit of collaborating with
the criminal justice system is the use of legal
leverage to motivate clients to continue
with the program and to comply with treatment. However, behavioral health and criminal justice practitioners must discuss and
agree on appropriate sanctions for violating
the terms of a program.
Ongoing training is necessary to sustain
knowledge and practice—Ongoing professional development is critical to maintaining
model fidelity and best practices, especially
when there is staff turnover. Even without
significant staff turnover, staff may revert to
past techniques over time, particularly when
dealing with a difficult client or an intractable system issue.
Programs should think about finding
new funding sources early—Grantees
learned that verbal support from collaborators did not always translate into support,
financial or otherwise. Further, the slow
economy meant that grants and public
funding were cut, often unexpectedly.
Programs should anticipate and prepare
for staff turnover—The loss of key personnel among the grantees hampered their
ability to implement their programs and
increase services. Grantees should plan to
mitigate the problems stemming from staff
turnover. Helpful ways to deal with staff
turnover include ongoing documentation of
institutional knowledge, creating plans for
smaller staffs, and planning training opportunities for new staff.
In choosing models, service providers
should consider the costs of model fidelity, training, and certification—Although
practitioners may believe in the success of
certain models, they should consider very
practical barriers to model fidelity. For
example, a model that requires a great deal
of staff training, such as functional family
therapy or multi-systemic therapy, may be
very costly for programs that experience
staff turnover.
4.2. Lessons for Criminal Justice
Practitioners
A focus on behavioral health can inform
criminal justice work—Learning about
substance use disorder or mental health issues may help criminal justice practitioners
more effectively supervise their clients and
address the causes of offending or recidivism. For example, staff in a women’s unit
of a jail began providing trauma-informed
services because the training and technical
assistance that was funded by the Initiative
helped them better understand substance
use disorders and mental health issues.
Collaboration with behavioral health
practitioners can provide an opportunity
to teach them about the criminal justice
system—Although criminal justice and
behavioral health practitioners work with
some of the same clients, there is often a
lack of understanding between the two systems. Those in the behavioral health system
may create programs without fully understanding the nuances of the criminal justice
system. For example, one of the Health
Foundation’s grantees trained only dayshift police officers when night-shift officers
had the most contact with the program’s
potential clients. Thus, exposing behavioral
health practitioners to the criminal justice
system can better prepare them for future
collaborations.
Behavioral health practitioners can
provide knowledge of other community
services—It may be difficult for criminal
1 6 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
justice practitioners to know about all of
the services in the community to which
they can refer clients. Collaboration with
behavioral health practitioners can provide
a link to the array of service providers in the
community.
4.3. Lessons for Behavioral Health
Practitioners
Criminal justice practitioners have varying levels of understanding of behavioral
health issues—Some criminal justice practitioners may be fully aware of addiction and
treatment practices and the value of diverting offenders with substance use disorder
and mental health problems, while others
may not. One grantee reported that some
defendants would rather plead to serve
jail time than participate in programs,
Another grantee deand some attorneys
scribed success with
advised defendants
changing criminal justice
against participatpractitioners’ approach
ing in the program.
to the client population:
Discussions with
“We had to change the
attorneys and judges
language people used …
but that’s been satisfying.
could improve proNow police officers want
gram participation by
to help … instead of just
explaining the benearresting them.”
fits of participating in
behavioral health programs. Another grantee described success
with changing criminal justice practitioners’
approach to the client population: “We had
to change the language people used … but
that’s been satisfying. Now police officers
want to help … instead of just arresting
them.”
Emphasizing the importance of treating
behavioral health issues in one program
may spur action in other programs or
parts of the system—Exposure to the intersection of behavioral health and criminal
justice can spill over to other jurisdictions
and parts of the criminal justice system. In
Dearborn and Ohio counties, for example,
because of the new juvenile drug court
program, the traditional court counterpart
began requiring more drug screenings and
more intensive probationary supervision
because they could see the value in treating behavioral health issues. In Hamilton
County, after implementing Mobile Crisis
Teams (MCT) to assist police officers in
two districts, three other districts requested
MCT presence.
While engaging families of defendants
may be difficult, it can be rewarding—
Some grantees were able to engage clients’
families with great responses. For example,
parents in one program believed that the
parenting classes they received from the
grantee helped them regain control of their
children. Other programs could not involve
families in their services and sometimes
received resistance to family involvement.
One grantee learned that families with open
children services cases could be skeptical
of service providers, who they perceived as
outsiders. Another grantee reported that
some clients refused to allow the grantee to
contact their families.
Social Security and other benefits take
time to be approved—Although clients
may qualify for benefits, the approval
process may be long and arduous. One
program was able to apply for benefits two
weeks before a client’s release from prison,
but it still took two to 12 months for clients
to receive benefits. Thus, maintaining stable
lifestyles will be difficult for clients who do
not yet have the money to pay for housing
and other necessities.
Be aware of the extra burdens that
behavioral health and criminal justice collaborations place on criminal justice practitioners—Incorporating behavioral health
services into criminal justice processes may
present a burden on criminal justice professionals. For example, judges may not get
credit for cases on the mental health docket
to reduce their caseload on other dockets,
THE HEALTH FOUNDATION OF GREATER CINCINNATI 17
increasing their workload. Finding ways to
rework incentives or performance indicators
to reward collaboration may reduce reluctance on the part of criminal justice practitioners to incorporate behavioral health
programs.
Anticipate clients with co-occurring disorders—Some grantees that had planned to
treat either substance use or mental health
disorders found that their clients often had
both. Service providers should develop
treatment and funding plans to address
overlapping issues.
Program staff should create a presence
in criminal justice settings to improve referrals and linkages—Criminal justice practitioners and people in the criminal justice
system may not be aware of or understand
behavioral health programs. Making visits
to criminal justice settings, speaking with
front-line staff, and having program staff on
site will help engage criminal justice practitioners and inmates.
Programs should anticipate using funds
for wrap-around services—Grantees
observed that wrap-around services were
needed to stabilize clients. One grantee
explained, “We’re trying to fix cracks so the
clients don’t fall through them—there can’t
be gaps in the housing situation.” Leaving a
need, such as housOne grantee explained,
ing, unaddressed can
“We’re trying to fix cracks
interfere with behavso the clients don’t fall
ioral health service
through them.”
efficacy. Thus, programs should plan to
use funds for wrap-around services even if
those services are not explicitly part of their
models.
4.4. Lessons for Policymakers, Public Administrators, and Other Decisionmakers
For the criminal justice population with
behavioral health issues, collaboration
between systems is critical—Awareness of
and collaboration among the systems fosters
support for program operations and referrals. Health Foundation grantees reported
that in the beginning of the implementation process, the criminal justice and behavioral health systems had different goals
and languages for describing the problem
and solutions. There was also a lack of trust
across agencies. Thus, communication is
critical for continued collaboration and
understanding.
Use and support “boundary
spanners”—A boundary spanner is a person who knows and operates in both the
criminal justice and behavioral health systems and serves as a bridge between them.
These boundary spanners helped Health
Foundation grantees foster support and
collaboration in order to connect clients
with services more effectively. The resulting
cross-system learning and development of
relationships spurred other criminal justice
and behavioral health cooperative projects.
Change can be slow—Getting systems,
such as the substance use disorder, mental
health and criminal justice systems, to work
in new ways and collaboratively takes time.
These nuanced systems often speak in different languages, and operate with different
missions and goals. Changing the way these
systems work together
As one of the stakeholdcan be a slow process.
ers aptly said, “It’s not all
As one of the stakeor nothing. … Change is
holders aptly said, “It’s
slow, but it’s about headnot all or nothing. …
ing in the right direction.”
Change is slow, but
Decisionmakers who can
it’s about heading in
anticipate the pace of the
the right direction.”
process are critical.
Decisionmakers who
can anticipate the pace
of the process are critical.
Simple changes can make a big difference—Because of the Initiative, a local
jail changed its discharge hours from the
middle of the evening to standard working hours. Previously, the jail staff released
1 8 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
inmates at a time that was convenient for
the jail staff, not taking into account the
challenges this placed on case managers
who needed to pick up clients from the jail
and link them to services upon release. One
of the funded programs made this reality
apparent and the jail staff changed its discharge hours. There are other points of opportunity that are easily changed but could
have a substantial impact on the overall
effectiveness and efficiency of services.
Develop data-sharing agreements—As
many Health Foundation grantees discussed, there were challenges to gathering data to document outcomes that were
contained in other systems. Although datasharing agreements take time to produce,
given the multiplicity of issues facing the
clients, agreements across agencies are invaluable to documenting impacts. Without
them, programs run the risk of incorrectly
estimating the benefits of their programs.
Work together toward shared problems—By the nature of the population with
behavioral challenges and criminal justice
histories, systems that work together do far
better to serve this population than those
working alone.
4.5. Lessons for Researchers
Practitioners have time and resource
constraints, so make sure data collection
is worthwhile to them— Many practitioners’ priority is to deliver services to their
clients. They may not view data collection
as a resource-efficient endeavor. Thus, researchers should make sure the data collection process is designed in a way to benefit
practitioners. For example, the data collection and analysis process should be used to
help practitioners obtain new funding and
evaluate how to serve their clients better.
Researchers should work with practitioners early in the process to define specific
outcome measures and methods—Grantees had challenges defining their outcome
measurements, selecting appropriate time
intervals for data collection, reporting the
magnitude of changes, using comparison
groups, contacting clients who had left
their programs, obtaining data from other
agencies, and developing appropriate data
systems. Researchers can provide guidance
and help grantees develop data-collection
protocols before implementation begins.
4.6. Lessons for Funders
Grantees needed help with developing data-collection plans and research
designs—Grantees reported needing help
with developing realistic evaluation plans
with meaningful measures. Challenges
included reporting on the magnitude of
client outcomes, measuring outcomes at
set intervals, and using comparison groups.
Additionally, some grantees planned to
gather data that they later realized would
be too difficult to obtain. And even with
data, databases sometimes lacked the ability
to extract results. Funders must recognize
that the ability to track outcomes will vary
widely across behavioral health and criminal
justice practitioners for a variety of reasons.
Grantees appreciate the opportunity
to learn from each other—The Health
Foundation held meetings in which grantees came together to
discuss their experiOne grantee acknowlences, challenges, and
edged that practices could
solutions. One grantee
not be directly transferred
acknowledged that
from one place to anpractices could not
other, but said, “I’ll bring
it back and try to make it
be directly transferred
work here” and that the
from one place to
bringing multiple grantanother, but said, “I’ll
ees together was useful
bring it back and try
because “very few of us are
to make it work here”
as creative as 10 of us put
and that the bringing
together.”
together of multiple
grantees was useful
because “very few of us are as creative as 10
of us put together.” The grantee meetings
THE HEALTH FOUNDATION OF GREATER CINCINNATI 19
allowed stakeholders across counties and
systems to share best practices and discuss
pressing issues facing all of them.
Use trained evaluators—The Health
Foundation expressed a strong interest in
not using trained evaluators for its grantees.
Because of this, the data-collection process
and reported outcomes lacked consistency.
Trained evaluators could be internal to the
program, such as program analysts who
work closely with the program manager; or
external to the program, such as staff from
a local university that partners with the program. The validity and reliability of the data
collection methods are likely to be limited
if evaluation is done by program practitioners who are untrained or unknowledgeable
about data collection methods and their
various strengths and weaknesses. More
robust findings on the program’s impact
on participant outcomes would have been
possible if data-collection efforts within the
Initiative were more rigorous. Further, a
more rigorous assessment of the overall Initiative would have been possible with better
data-collection methods.
Understand the tension between being prescriptive and standardized versus
grantee-centric and flexible—The Health
Foundation staff worked with the grantees
to develop their own outcome measures and
data-collection processes to gather those
data. The logic was that more meaningful
information could be gathered from grantees if they were developing their own datacollection systems and outcomes. Further,
the Initiative grantees were a diverse group,
including public administrators, nonprofits
and community-based service providers, and
standardized outcomes would have likely
meant that some meaningful outcomes
would have been lost by using a standardized
protocol. This decision, however, severely
limits the Foundation’s ability to look across
programs and understand the impact of the
Initiative as a whole.
Consider requiring grantees to measure
model fidelity—Although model fidelity
is critical to determining effectiveness, few
grantees mentioned measuring fidelity in
their program reports. Measuring model
fidelity and quality assurance, particularly
for programs with a strong evidence base,
can help grantees and funders determine
whether outcomes can be attributed to a
particular model or to the implementation
process. Measures of program fidelity would
also aid in the assessment of the outcomes
across participants being served by similar
programs.
Be “hands-on”—The Health Foundation worked with grantees throughout the
grant process, from submitting and refining
their request for funding to developing and
refining their evaluation and sustainability
plans through to implementation. Given
the Foundation’s role on the projects and
the flexibility given to grantees to refine
their evaluation and
sustainability plans,
One grantee described
they engendered feelthe Foundation’s helpings of trust among
ful “hands-on” approach:
“Once we got our team
grantees who felt they
together, the Health Founcould rely on Foundadation explained to us that
tion staff members to
we weren’t ready. They
help them troublewere right. …”
shoot issues. One
grantee described
the Foundation’s helpful “hands-on” approach: “Once we got our team together,
the Health Foundation explained to us
that we weren’t ready. They were right. We
wanted to partner with a community mental
health provider, and they were at the table
but not really. … The Health Foundation
picked up on that.” A couple months later,
the grantee found a stronger partner and
was approved by the Foundation. Because
grantees felt that Foundation staff members
were approachable and flexible, the grantees
were more comfortable in setting realistic
service targets and goals.
2 0 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
Use planning grants—The use of planning grants by the Health Foundation
allowed grantees time to develop collaborative partnerships, develop communication
systems across partners, develop data-sharing tools and measurement plans, and set
more realistic service targets and goals before needing to actually serve clients. Without the planning grants, the need to serve
clients while developing the systems would
need to happen simultaneously. This is less
than ideal, given that criminal justice and
behavioral health practitioners are often not
engaged with each other or communicating
routinely. Planning grants are tremendously
useful in bringing diverse groups together
and allowing partnerships to develop.
Expect implementation issues—Even
with the use of planning grants, implementation issues are likely to arise. Issues external
to the actual program, such as cuts in Medicaid funding or staff turnover in a correctional facility, for example, are likely to have
an impact on any program services. Funders
should anticipate implementation issues
and be flexible in working with grantees to
troubleshoot these issues as they arise.
Do your homework—Since the Health
Foundation was previously not directly engaged in serving or funding services for the
criminal justice population, staff members
did a lot of upfront research, planning, and
training internally to understand the justice
system and the special needs of people involved in the criminal justice system before
launching the Initiative. These planning
activities likely led to them having a better understanding of where the Initiative
could make a meaningful impact within the
local Greater Cincinnati context. Given the
planning, the Foundation understood the
policy levers, what meaningful change could
happen within the Greater Cincinnati region, and which local players would be able
to work within and across the behavioral
health and criminal justice systems.
THE HEALTH FOUNDATION OF GREATER CINCINNATI 21
5.0. Conclusions
Overall, the Health Foundation can point
to an array of positive outcomes associated
with the Initiative. As evidenced in the literature, the Initiative was focused squarely
on an under- and unserved population and
can point to several benefits of program
participation for this population. Further,
the Initiative has generated lessons for
future behavioral health and criminal justice
programming as well as the different system
stakeholders who have the ability to foster
such programming. In highlighting these
lessons, we also shined a light on the ways
in which the Health Foundation and other
agencies like it might improve its processes
and outcomes and better serve the people
with mental health and substance use disorders in the criminal justice system.
Endnotes
1 See The Health Foundation of Greater Cincinnati. 2009. Substance Use Disorders and Severe Mental
Illnesses: Interim Grantmaking Report.
2 See Fazel, S. & N. Langstrom. 2009. Mental disorders among adolescents in juvenile detention and correctional facilities: A systematic review and metaregression analysis of 25 surveys. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 1010-1019; Steadman, H.J., F.C. Osher, P.C. Robbins, B. Case & S. Samuels. 2009. Prevalence of serious mental illness among jail inmates. Psychiatric
Services Sabol, W.J. & H. Couture. 2008. Prison Inmates at Midyear 2007. Washington, DC: Bureau
of Justice Statistics, U.S. Department of Justice; and Sabol, W.J. & T.D. Minton. 2008. Jail Inmates at
Midyear 2007. Washington, DC: Bureau of Justice Statistics, U.S. Department of Justice.
3 Silver, E., R.B. Felson & M. Vaneseltine. 2008. The relationship between mental health problems and
violence among criminal offenders. Criminal Justice and Behavior, 35, 405-426; and Bennett, T., K.
Holloway & D. Farrington. 2008. The statistical association between drug misuse and crime: A metaanalysis. Aggression and Violent Behavior, 13, 107-118.
4 Chandler, R.K., B.W. Fletcher & N.D. Valkow. Treating drug abuse and addiction in the criminal justice
system. Journal of the American Medical Association, 301, 183-190.
5 Golembeski, C. & R. Fullilove. 2005. Criminal (in)justice in the city and its associated health consequences. American Journal of Public Health, 95, 1701–1706.
6 Morrissey, J.P., J.A. Fagan & J.J. Cocozza. 2009. New models of collaboration between criminal justice
and mental health systems. American Journal of Psychiatry, 166, 1211-1214.
7 See Morrissey, J., & Meyer, P. (2008, August). Extending assertive community treatment to criminal
justice settings. Retrieved from http://gainscenter.samhsa.gov/pdfs/ebp/ExtendingAssertiveCommunity.pdf.
8 See National Alliance on Mental Illness’ CIT Resource Center http://www.nami.org/template.
cfm?section=cit2.
9 Osher, F., Steadman, H. J., & Barr, H. (2002, September). A best practice approach to community
re-entry from jails for inmates with co-occurring disorders: the APIC model. Retrieved from http://
gainscenter.samhsa.gov/pdfs/reentry/apic.pdf
2 2 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
Appendix: Data Limitations, Methods, and Results
Since the Initiative began, the Health
Foundation has been collecting outcome
measures from grantee programs on changes in mental health, substance use, criminal
justice involvement, and cost savings and
cost shifting. In addition, as a condition of
funding, each grantee developed a program
logic model, process and outcome evaluation plan, and final report. UI worked
with the Foundation to collect copies of all
available planning, process, and outcome
data for each program funded under the
Initiative to assess outcomes, including cost
outcomes. Our analysis of the outcome
data was intended to quantify and compare
key outcomes associated with Foundation
grants to answer the following research
questions:
• What are the outcomes associated with
the funded programs?
• What population characteristics or
combination of characteristics (e.g., age,
race and mental health status) are associated with program completion and
program success?
• Are there differences in outcomes associated with funded diversion programs
and reentry programs; substance abuse
and mental health programs?
• What is the relative efficacy of the
various mental health and substance
abuse programs and treatment strategies employed by Foundation-funded
programs?
A.1. Data Limitations
After reviewing the data at length, we encountered multiple challenges to conducting quantitative analyses for comparison
purposes. Each of these challenges limited
our ability to make strong, valid and reliable
conclusions about the overall impact of the
Initiative on participant outcomes.
• Grantees defined their outcomes in
various ways. Some grantees defined
recidivism as the number of new jail
days while others defined recidivism as
the number of rearrests. While grantees’
measures of recidivism and other outcomes were likely appropriate for their
respective programs, the variation across
outcomes limited our ability to compare
outcomes across programs.
• Grantees used different outcome periods. Some programs reported outcomes
of participants after the programs had
ended (e.g., six months following program completion), while some reported
outcomes when the participants completed the program (e.g., at discharge).
Others reported outcomes of participants while they were still active (e.g.,
three months after the start of their
participation in the program). Given
the different outcome periods, it would
not have been meaningful to compare
outcomes for participants with different
dosages of the programs.
• Grantees did not report outcomes for
all participants. Some grantees reported outcomes for only a portion of
their program participants, which likely
skewed their overall outcomes in an
unknown way. Further, it is likely that
the participants whose outcomes were
known by the grantee organizations
were those participants whose outcomes
were most favorable (i.e., they were still
attached to the program). Given the
limited reporting, we were left with a
less than full picture of the overall programs’ outcomes.
• Grantees reported aggregate data
without individual-level data on participants. In general, the grantees did
not provide enough information about
individual-level outcomes. Aggregate
information masks the variation across
THE HEALTH FOUNDATION OF GREATER CINCINNATI 23
relevant variables, such as a participant’s
age, gender and risk level, which may
explain why participant outcomes were
different from others. Without such
data, it would be inappropriate to compare programs because some grantees
may have worked with more high-need
or high-risk participants. Because of the
lack of data, we were also unable to determine which population characteristics
were associated with program success.
• Range of program interventions used
within the Initiative. By the nature of
the Initiative, grantees used a range of
intervention models. As shown in Table
2, some of the models funded by the
Initiative were employed by only one
grantee. Further, some grantees did not
serve very many participants, while others served several dozens. This made it
difficult to conclude whether one model
was more effective than another.
Table 2: Number of Implementation Grants by Model or Approach
Model
Diversion Courts
• ACT/MH Court (1) • DUI Court; Matrix Model (1) • SAMI Court (1)
• Drug Court (1)
• Mental Health Court (2)
• SAMI Court (IDDT) (2)
Assertive Community Treatment (ACT)
Crisis Intervention Team (CIT)
Assessment, Planning, Identifying, Coordinating (APIC)
Boundary Spanner
Drug Treatment
Assessment and aftercare treatment
Criminal Justice Resource Center
Functional Family Therapy
IDDT
IDDT/Maryland Community CJ Treatment Program
Jail Diversion Team
Matrix Model
Mobile Crisis Team
Multi-Systemic Therapy
Recovery Coach (Jail Diversion)
Reformers Unanimous
SAGE Model
Screening, case management, short-term therapy, crisis intervention
Screening, in-depth evaluations, intensive day treatment, community integration services
TAMAR
Teaching Family Model
Training and treatment
Transitional Housing
Total
2 4 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
Count
8
5
4
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
41
• Grantees did not use comparison
groups. Without an appropriate comparison group to use as a benchmark for
participants’ outcomes, our ability to
draw meaningful conclusions regarding
the programs’ impacts were not possible. We had no way of knowing whether
the outcomes reported were caused by
the grantees or if there was an unmeasured factor that accounted for changes
in participant outcomes.
In 2007, the Health Foundation began to
be more prescriptive about outcome measures, which appeared to improve outcome
consistency across the grantees. However,
many of the data challenges remained.
Even though we were limited in our ability to compare grantee outcomes reliably,
we nevertheless summarized outcomes and
lessons from grantee reports and documents
to give an overall picture of the successes
and lessons from the Initiative. This included reading several hundred documents
within the grantee reports to extract both
qualitative and quantitative information.
The following sections describe our methodology for conducting the analysis and our
findings.
A.2. Methods
Of the 99 grants funded, UI received
reports and materials for 79 grants. Of the
reports and materials provided, we used the
following documents to explore outcomes:
• Grantee proposal summaries and recommendations (GPS): The GPS documents described the grantee’s initial
request for funding, including its organization history, proposed action plan,
and an assessment of grantee’s capacity
and capabilities.
• Site visit reports: The Health Foundation staff members conducted periodic
site visits to each grantee and these
reports detailed the progress of the
grantee in achieving its goals at the time
of the site visit.
• Evaluation plan: Each grantee had an
evaluation plan that included its plans
to evaluate its implementation processes
and the outcomes of its programs.
• Annual reports: These reports detailed
the progress of the grantee in achieving its goals at the time of the annual
report. Some grantees were funded for
one year while others were funded for
several years.
• Final reports and close-out reports:
These reports included an overall narrative for each grant. These reports provided information on grantee outcomes,
barriers and facilitators to implementation, and whether grantees were sustained after the grant period ended.
The GPS was used as the primary document for creating a database to document
outcomes because every grantee had a GPS
in the files that were provided to UI. Not
all of the grantee files included the other
types of documents. Given that the GPS
was written before grantees began their
activities, we reviewed the other types of
documents for outcomes, while recognizing the limitations of these data for reporting outcomes as previously mentioned.
The documents were used to develop a
coding protocol and database to explore
the outcomes of the funded programs
systematically. Data were summarized into
the following 10 main categories, with the
possible information included within those
categories in parentheses:
• Grant purpose (planning, implementation, technical assistance, operations
support, or research purposes)
• Program type (reentry or diversion)
• Target population served (gender,
youth/juvenile, probationers/parolees,
children/families, mental health clients,
substance abuse clients)
• Treatment model (Assertive Community Treatment, mental health court, drug
THE HEALTH FOUNDATION OF GREATER CINCINNATI 25
court, etc.)
• Mental health outcomes (percentage of
clients reporting improvements in mental health symptoms, percentage reduction in symptom assessment scores, etc.)
• Substance use outcomes (percentage
of clients reporting reduced substance
use during the program, percentage of
clients reporting reduced substance use
after program completion, etc.)
• Recidivism outcomes (percentage of
clients with no new charges, percentage reduction in number of arrests after
admission, etc.)
• Sustainability (whether the program
continued after the grant period)
• Lessons (open-ended field)
• Cost-benefit outcomes (cost savings,
cost shifting)
As mentioned previously, grantees used
different definitions for mental health, substance abuse and recidivism outcomes and
different methods of data collection. Therefore, more systematic analyses of outcomes
across grantees could not be conducted
with the data. Instead, the proportion of
programs that reported a positive impact
of more than 50 percent was calculated for
each type of outcome: substance use, mental health, and recidivism. Where reported
by the grantees, cost-benefit calculations
were also summarized.
A.3. Findings—Recidivism, Mental
Health, and Substance Use Outcomes
The descriptive results discussed below
are exploratory due to the very limited
nature of the data that was provided to
the research team. The findings listed here
should not be overstated as positive or
negative effects of the various planning
processes and intervention programs used
by the grantees under the Initiative. Rather,
the compilation of grants reflects a modest
start at systematically planning and evaluat-
ing interventions for individuals involved in
the criminal justice system with behavioral
health issues.
Table 3:
Number of Grantees Reporting
Outcomes, by Outcome Type
Outcome
Type
N
Reported Percentage
Mental
Health
Substance
Use
Criminal
Justice
32
27
84%
28
25
89%
41
33
80%
Cost Benefit
41
17
41%
In the subsequent section, we describe
the implementation grantees and their
outcomes. As shown in Table 3, a majority
of grantees reported outcomes for mental
health, substance use, and criminal justice,
where applicable. All 41 implementation
grantees were supposed to measure criminal
justice outcomes and system cost savings
since the Initiative’s purpose was to reduce
involvement with the criminal justice system
by focusing on behavioral health issues,
thereby producing cost savings. To determine whether grantees should have reported substance use and/or mental health
outcomes, we examined the grantee’s treatment model or approach and determined
whether the model intended to address
substance use, mental health, or both. Most
grantees reported criminal justice outcomes
and far fewer grantees reported cost benefit outcomes. For the most part, grantees
reported positive outcomes. However,
because each grantee collected and defined
outcomes differently, their outcomes could
not be averaged. As shown in Table 4,
grantees measured mental health, substance
use, and criminal justice outcomes and their
results in various ways.
2 6 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
Table 4: Criminal Justice, Mental Health and Substance Use Disorder Outcomes by Grantee
Organization Model
Criminal Justice
Outcome
N
Mental Health
Outcome
N
Substance Use
Disorder Outcome
N
Hamilton
ACT
County
Community
Mental Health
Board
91% of clients were not
incarcerated during the
program
64
59% of clients reported
improvement in symptomsa, b
64
NA
NA
Greater
Cincinnati
Behavioral
Health
Services
ACT
79% of clients reduced
the number of jail days
serveda
14
75% of clients reported
improvement in symptoms one or more years
after admissionb
16
57% of clients had reduced substance usea,b
14
Forensic and ACT
Mental Health
Services, Inc
63% of clients had
no new charges after
program admission
through the end of the
grant period
16
19% reduction in
average Symptoms of
Distress Score on the
Ohio Mental Health
Consumer Outcomes
Instrument at one year
after admission
NR
NA
NA
Transitional
Living, Inc.
NR
NR
71% of clients had an
improved BASIS-24
score measured at various times
31
NA
NA
Scioto Paint
ACT/IDDT
Valley Mental
Health Center
NR
NR
3% increase in average
quality of life score six
months after admission
108
21% increase in number 110
of clients who abstained
from substance use six
months after admission
(increase from 38% to
46%)
Kentucky
APIC
Department
of Corrections
91% of clients did not
61
receive a new conviction
resulting in incarceration while participating
in the programd
52% of clients had an
improved BASIS-24
scorea
48
NR
13% reduction in average BASIS-24 scorea
NR
50% of clients were not
incarcerated 12 months
after releasec
NR
NR
NR
58% of clients remained 142
drug-free throughout
their period of post-release control or parole according to urine testing,
parole officer reports, and
case manager reports
Assessment
91% of clients did
and Aftercare not re-enter the Grant
Treatment
County Detention
Center during the 2007
fiscal year
35
23% reduction in average BASIS-24 score at
three months after
admission
NR
36% of the clients who
22
began receiving services
in the 2010 fiscal year
reported a reduction
in substance use in the
2010 fiscal year according
to client self-report during treatment sessions
ACT
Talbert House APIC
NorthKey
Community
Care
NR
Note: NR means not reported and NA means not applicable
a
b
Grantee did not specify when it measured this outcome. Grantee did not specify how this was defined.
c
Grantee reported that less than 50 percent of program completers were reincarcerated, but did not give a precise number.
d
25 percent of its clients (15 of 61) received a parole violation.
THE HEALTH FOUNDATION OF GREATER CINCINNATI 27
Organization Model
Criminal Justice
Outcome
N
Mental Health
Outcome
N
Substance Use
Disorder Outcome
N
Community
Boundary
Mental Health Spanner
Center, Inc.
84% of clients showed
“reduced involvement”b
in the criminal justice
systema
104 65% of clients had
74
improved mental health
assessment scores six
months after assessment
60% of clients reporting
a reduction of alcohol
or other drugs by six
months after assessment according to selfreports
74
Community
Behavioral
Health Horizon Services
94% of clients had no
new arrests during the
fiscal year of admission
170 NA
80% reduction in the
number of total days
of substance use for
all clients 30 days after
admission according to
drug screens and selfreports
72
Shawnee
CIT
Mental Health
Center
99% of encounters with
CIT did not result in
arrest
NR
NA
NA
Brown
CIT
County Community Board
of Alcohol,
Drug Addictions and
Mental Health
Services
93% of mental health
cases handled by the
sheriff’s office did not
result in arrest
260 93% of mental health
cases were linked to
community treatment
services
260
NA
NA
Mental Health CIT
Recovery Services of Warren & Clinton
Counties
NR
NR
NR
NA
NA
NorthKey
Community
Care
98% of encounters with
CIT did not result in
arrest
342 72% of mental health
342
cases resulted in a
referral to mental health
NR services
NA
NA
77
61% of clients reported 18
a reduction in substance
use 12 months after
release according to the
ADAS Clinical Outcomes
Measure
Chemical
Dependency
Boundary
Spanner
CIT
37% reduction in number of incarcerations in
the 12 months after contact with CIT compared
with 12 months before
contact
Central Clinic
Criminal justice resource
center
64% of clients had no
new arrest 12 months
after release from jail
NA
100% of clients showed 4
improved functioning in
the Ohio Mental Health
Consumer Outcomes
Instrumenta
NR
86% of clients reported 18
an improvement in
symptoms on the Ohio
Mental Health Consumer Outcomes Instrument
at one year after admission
Note: NR means not reported and NA means not applicable
a
Grantee did not specify when it measured this outcome.
b
Grantee did not specify how this was defined.
2 8 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
Criminal Justice
Outcome
N
Mental Health
Outcome
N
Substance Use
Disorder Outcome
N
Dearborn and Drug Court
Ohio Coun(juvenile)
ties Prosecutor's Office
NR
NR
NA
NA
NR
NR
Kentucky Department of
Corrections
Drug
Treatment
54% of clients had
not committed a new
offense or been incarcerated six months
after release from jail or
prison
174 NA
NA
88% of clients were sub- 145
stance-free six months
after discharge
Transitions,
Inc
Drug Treatment
75% of clients had no
new arrests six months
after completing program
145 NA
NA
100% of clients had a
reduction in substance
use during treatmentb
265
Clermont
DUI Court
County
(Matrix
Mental Health Model)
and Recovery
Board
88% of clients had no
new chargesa
195 NA
NA
90% of days with no
substance use during
treatment according to
self-reports
172
Lifespan
76% of clients did not
have involvement with
the juvenile court during the grant period
101 93% of clients showed
a positive change in
functioning as measured by the Youth
Outcome Questionnaire
at discharge
101
67% of clients had a
negative urinalysis at
FFT program completion
6
Clermont
IDDT
County
Mental Health
& Recovery
Board
NR
NR
56% of clients reported
an improved BASIS-24
score six months after
admission
9
100% of clients self-reported reduced substance use at discharge
1
Scioto Paint
IDDT/
Valley Mental Maryland
Health Center Community
Criminal
Justice
Treatment
92% of clients did not
return to “permanent
confinement”b within
one yeara
60
7% improvement in average score on the Ohio
Department of Mental
Health Quality of Life
Surveya
37
75% of clients with a
60
reduction in substance
use 12 months after
release compared to
pre-incarceration use
according to self-reports
Clermont
Jail Diversion
County
Team
Mental Health
& Recovery
Board
88% reduction in aver142 NR
age days of incarceration per person for three
years after the program
compared with three
years after the program
NR
NA
NA
Clermont
Matrix Model
County
Mental Health
and Recovery
Board
90% of clients had no
new convictions after
program admission during the grant period
NR
73% of clients had no
substance use 30 days
before discharge according to an SOQIC
Assessment
132
Organization Model
Functional
Family
Therapy
143 68% of clients had an
improved BASIS-24
score at discharge compared with admission
Note: NR means not reported and NA means not applicable
a
Grantee did not specify when it measured this outcome.
b
Grantee did not specify how this was defined. THE HEALTH FOUNDATION OF GREATER CINCINNATI 29
Organization Model
Criminal Justice
Outcome
N
Mental Health
Outcome
N
Substance Use
Disorder Outcome
N
NKU Research Mental
Foundation
Health Court
84% of clients were not
69
reincarcerated on new
charges while active with
the program during 2010
81% of clients had an
11
improved BASIS-24
score at six months after
admission
NA
NA
Butler County Mental
Treatment
Health Court
Alternative
Court Demonstration
90% of clients were not
reincarcerateda
NR
NR
NA
NA
Hamilton
Mental
County
Health Court
Community
(ACT)
Mental Health
Board
69% of clients had
26
decreased arrests and
convictions during one
year in the program
compared with one year
before admission
59% of clients reported 81
improvement in clinical
symptoms on the Ohio
Mental Health Consumer Outcomes Instrument
at six months or 12
months after admission
or upon discharge
NA
NA
Hamilton
Mobile Crisis
County
Team
Community
Mental Health
Board
96% of calls involving
355 NR
mentally ill individuals
resulted in transport of
the individual to the hospital rather than arrest.
NR
NA
NA
NR
31
Butler County Multisystemic 65% of clients did not
NR
Educational
Therapy
commit new juvenile ofService Center
fenses after admissiona
48% average reduction
in Child and Adolescent
Functional Attainment
Scale scorea
NR
NR
The Counseling Center
Recovery
Coach
71% of clients did not
“reoffend”b one year after completing program
71
NA
NA
56% of clients reported
88
reduced use during 2009
or 2010 according to drug
screens or self-report
Scioto County Reformers
Prosecuting
Unanimous
Attorneys'
Office
Five clients were not
incarcerated on new
charges or failure to
comply with probationa
NR
NA
NA
90% of clients with
reduced drug use in the
first or second year of
the program according
to self-reports
513f
Cincinnati
Union Bethel
SAGE Model
95% of clients did not
have a new prostitution
charge six or 12 months
after program completion
NR
77% of clients had an
improved BASIS-24 score
three months after program completion compared with admission
NR
94% of clients with a
reduction in number of
days of use per month
according to self-reporta
NR
Hamilton
County Court
of Common
Pleas
SAMI Court
100% of clients were not 30
charged, convicted, and
incarcerated of a new
offense while active in
the programe
76% of clients had an
improved BASIS-24
score at three or more
months after admission
25
73% of clients had a
“significant reduction”b
in use compared to use
prior to admission according to urine testing
and self-reportsa
19
Note: NR means not reported and NA means not applicable
a
Grantee did not specify when it measured this outcome.
b
Grantee did not specify how this was defined. e
One client of the 30 included in the measure was sentenced to prison for a probation violation that was not related to a new charge.
f
The grantee did not specify how many clients were included in this measure. It reported that 513 participants said they had no drug use, which
the grantee said was more than 90 percent of the total sample.
3 0 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
Organization Model
Community
Behavioral
Health Horizon Services
SAMI Court
Butler County SAMI Court
Alcohol and
(IDDT)
Drug Addiction Services
ADAS Board
Criminal Justice
Outcome
N
Mental Health
Outcome
N
Substance Use
Disorder Outcome
N
50% of clients had fewer 48
convictions 90 days after discharge compared
with 90 days before
admission
33% of clients had an
improved BASIS-24
score at discharge
48
35% of clients had a
reduced number of
positive drug screens
48
57% of clients were not
arrested or charged
with an offense during
involvement with the
court
80% of clients were not
hospitalized during
court involvement
NR
27% of clients did not
experience a relapse
NR
NR
Clermont
County
Mental Health
and Recovery
Board
Screening,
65% of clients did not
case manreoffend per year
agement,
short-term
therapy, crisis
intervention
185 20 to 71% of clients reNR
ported a 20% improvement on the Ohio Scales
each year of the grant
period.
NA
NA
Central Clinic
– Court Clinic
Screening,
in-depth
evaluations,
intensive day
treatment,
community
integration
services
87% of clients were not
convicted of new offensesa
16
Cincinnati
Union Bethel
TAMAR
94% of clients had
reduced the level of
symptom distressa
16
94% of clients reduced
substance abusea,b
16
81% of clients were not NR
convicted of a new criminal charge six months
after release from jail
67% of clients showed
a decrease in trauma
symptomsa,b
NR
84% of clients showed
a decrease in substance
usea,b
NR
Talbert House Teaching
Family
63% of clients who did
not have new adjudications 12 months after
discharge
76
69% of successfully
discharged clients demonstrated a reduction
in problem severity as
measured by the Ohio
Scales
53
76% of clients remained
substance-free 30 days
post-discharge from
treatment according to
self-reports
112
The Vision of
Hope Outreach Center
Training and
treatment
NR
NR
NA
NA
40% of clients were
substance-free upon
completion according
to urine testing
48
TAPP House/
TC, Inc
Transitional
Housing
NR
NR
NA
NA
0% of clients reduced
20
substance use up to
three months after intake compared with 30
days before intake. No
clients had substance
use 30 days before
intake and four reported
substance use at data
collection
Note: NR means not reported and NA means not applicable
a
Grantee did not specify when they measured this outcome.
b
Grantee did not specify how this was defined.
THE HEALTH FOUNDATION OF GREATER CINCINNATI 31
A.4. Findings—
Cost Benefit Outcomes
month costs saved ranged from a loss of
$1,517 per client to a savings of $45,316
per client, with only one grantee reporting
an overall loss. Although these cost findings are encouraging, they should be taken
with caution. None of the grantees compared participant outcomes to a comparison
group; therefore, the cost effectiveness of
the grantee programs relative to no intervention, another intervention, or businessas-usual services is unknown.
Of the 41 implementation grantees, 17
reported cost outcomes in their evaluation
documents. Table 5 shows the granteecalculated costs and benefits of their programs. Because each grantee measured
cost savings over different periods of time,
each cost savings figure was averaged over
its measurement period. The reported per
Table 5: System Savings Generated by Grantees
Savings
per
Client
Did not
subtract
program
costs
Savings
Reported
n
Transitional Living, ACT
Inc.
(-)$87,960
58
(-)$1,517 Cost of sentenced days
– (Cost of days served
+ Cost of services) over
the grant period of 42
months
NorthKey Community Care
CIT
$20,400
342
$60
Cost of three jail days
for each potential
charge per diverted
person over the grant
period of 39 months
NKU Research
Foundation
Mental
Health
Court
$88,389
85
$993
Costs of incarceration
saved by diversion a –
(Cost of jail days served
+ Cost to operate program) for 12 months
Cincinnati Union
Bethel
SAGE
Model
$484,185
402
$1,204
Costs of jail days not
serveda over 43 months
x
Shawnee Mental
Health Center, Inc.
CIT
$105,050
76
$1,382
Cost of jail days avoideda over the grant period
of 44 months
x
$76,400
30
$2,547
Cost of hospital days in
the year before admission + Costs of jail time
before admission + Costs
of prison days avoideda
– (Cost of hospital days
in year of treatment +
Cost of jail days during
program) over the grant
period of 24 months
x
Organization
Model
Method
Diversion Programs
Butler County
SAMI
Alcohol and Drug Court
Addiction Services (IDDT)
Board
a
Grantee did not define this figure.
3 2 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
x
Savings
Reported
n
Savings
per
Client
DUI Court
(Matrix
Model)
$623,105
242
$3,247
Cost of jail days suspended – (Cost of jail
days served + Costs
of treatment) over 36
months
Community
Behavioral Health
Horizon Services
Chemical
Dependency
Boundary
Spanner
$650,650
170
$3,827
Cost of the average percentage of days served
of sentence – (Cost of
days served for sanctions) over 24 months
Butler County
Educational
Service Center
Multisystemic
therapy
between
$5,045 and
$23,100 per
person
63
between Cost of 157 days of
$5,045
incarceration – (Cost of
and
157 days of service)
$23,100
Hamilton County
Court of Common
Pleas
SAMI
Court
$152,855
30
$5,095
Cost of prison days sentenced and not served
in the first year of service – (Cost of jail days
served for sanctions +
Costs of treatment) over
12 months
Clermont County
Mental Health &
Recovery Board
Jail Diversion Team
$1,400,000
142
$9,859
Cost of jail days suspended – (Costs of
treatment) over 24
months
Greater Cincinnati
Behavioral Health
Services
ACT
$340,883
14
$24,349
Cost of jail days avoideda + Cost of hospital
days avoided b for 18
months
Clermont County
Mental Health &
Recovery Board
Matrix
Model
$4,947,887
143
$34,601
Cost of sentenced jail
or prison days – (Cost
of jail or prison days
served + Costs of treatment) over 33 months
Clermont County
Mental Health &
Recovery Board
IDDT
$2,401,757
53
$45,316
Cost of jail days suspended – (Costs of jail
days served + Costs
of treatment) over 12
months
$27,491
35
$785
Cost of incarceration
days preventeda – (Cost
of days served + Cost
of treatment) over the
reporting period of 12
months
Organization
Model
Clermont County
Mental Health &
Recovery Board
Method
Did not
subtract
program
costs
x
x
Reentry Programs
NorthKey Community Care
Assessment and
aftercare
treatment
Grantee did not define this figure.
This calculation assumes that their clients would have been immediately reincarcerated for the remaining length
of the grant period after returning to the community.
a
b
THE HEALTH FOUNDATION OF GREATER CINCINNATI 33
n
Savings
per
Client
$2,690,404
159
$16,921
Cost of the number of
days not served after release from incarceration
during the grant period
– (Costs of treatment)
over 36 months
$2,675,322
380
$7,040
Cost of jail or prison
days prevented – (Costs
of sanction days served
+ Costs of treatment)
over 24 months
Organization
Model
Savings
Reported
Kentucky Department of Corrections
APIC
b
b
Method
Did not
subtract
program
costs
Diversion/Reentry Programs
Scioto County
Prosecuting Attorneys’ Office
Reformers
Unanimous
Program
This calculation assumes that its clients would have been immediately reincarcerated for the remaining length
of the grant period after returning to the community.
b
3 4 LESSONS LEARNED THROUGH THE CRIMINAL JUSTICE SYSTEM INITIATIVE
THE HEALTH FOUNDATION OF GREATER CINCINNATI 35
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