The large number of individuals with mental illness in the nation’s criminal justice system, and their risk of recidivism, is an ongoing public health challenge. Many communities are leveraging partnerships between public health, mental health, and law enforcement agencies to share data across sectors to prevent unnecessary hospitalizations and incarceration for those with complex health and social needs.
A recent All In webinar featured two communities that are integrating data from multiple sectors to improve health and public safety. Lori Carnahan, MA, Director of Behavioral Health at the DuPage County Health Department, discussed how the health department and the sheriff’s office are partnering to form post-crisis response teams that create effective linkages to care and lower recidivism for individuals with mental illness. Dawn Wiest, PhD, Director of Action Research and Evaluation at the Camden Coalition of Healthcare Providers, shared how they are integrating police department data with information from regional hospitals to identify strategic points of intervention that reduce hospital readmissions and arrests. Presenters outlined various approaches for effective cross-sector data sharing, which are summarized below.
1. Make the effort to better understand partners from other sectors
When DuPage County Health Department observed that their behavioral health service unit was frequently encountering individuals who had touchpoints with the criminal justice system, it was clear that a partnership between these two sectors could help individuals struggling with mental illness move forward on the path to recovery. The health department began a formal partnership with the DuPage County Sherriff’s Office to develop a post-crisis response team that would follow up with individuals after every mental health related 9-1-1 call.
Carnahan emphasized that conducting trainings so that each sector could get a deeper understanding of the other’s work was crucial to the program’s effectiveness. Mental health clinicians completed 40 hours of training with the sheriff’s office to understand their policies, protocols, and safety regulations. Likewise, the sheriff’s deputy spent 40 hours shadowing the health department’s crisis center to get a sense of the types of calls they were receiving and learn about their privacy procedures. Both entities also attended regular meetings to review the police and patient data and discuss what was working and what could be improved.
2. Map key stakeholders and resources in the community
To identify additional opportunities for cross-sector collaboration, the DuPage County Health Department held a sequential intercept mapping workshop. The health department convened 37 partners, including stakeholders from mental health, substance abuse, and criminal justice (police, sheriff’s office, jails), and consumers with lived experience. Participants looked at where and when individuals with mental illness have touch-points with the criminal justice system and how they navigate that system. After this exercise, the group came up with six priority areas to focus on that could help improve coordination between sectors. Carnahan reflected:
“We found that we offer a lot of different services across the continuum, but not everybody knew who did what and how things were done. So this was actually a wonderful opportunity for everybody to come together and realize while we are probably richer in resources than some other areas, we were still very siloed.”
3. Standardize data coding
One priority that rose to the top after the mapping exercise was the need to standardize the data that are collected across police departments in the 36 different municipalities in DuPage County. A wide variety of mental health codes were being used in police departments across the county, making it difficult to obtain an accurate view of which neighborhoods experience a higher volume of mental health related 9-1-1 calls and may be in need of more resources.
When individually tracking down the right staff members from each police department who were collecting mental health data proved to be a daunting task, the health department tried a different strategy. They utilized their relationship with the sheriff’s deputy, who was able to make a case for the importance of data standardization and send a survey to all the police departments to obtain all of the different codes. Based on the results, the health department developed recommendations to streamline all mental health calls to three codes: general mental health, suicide attempt, and completed suicide. These standardized codes will provide enough data to better understand where the need is and streamline referrals to the post-crisis response team.
4. Use cross-sector hotspotting to identify high-risk individuals
Patients with complex health and social needs often cycle through hospitals frequently yet have poor health outcomes. The Camden Coalition of Healthcare Providers uses an approach called “hotspotting” to identify high need, high-cost patients in Camden, NJ. The coalition built a data sharing partnership with the police department to find out if the primary drivers of high health care utilization were also driving frequent encounters with the criminal justice system. They integrated arrest data with hospital records to identify an overlap in population between the two sectors.
When the Camden Coalition analyzed data from this targeted population, they found a very high prevalence of housing instability, chronic medical conditions, substance-related disorders, and mental health challenges. Wiest noted:
“The integrated hospital and police data really tells the story of the importance of breaking down operational and data siloes because when we do so, we can see a more holistic view of the challenges faced by people who have complex needs that aren’t adequately met within the systems that are working in isolation, despite great intentions.”
5. Provide support to help individuals navigate complex systems
In response to the findings from integrated police and hospital data, the Camden Coalition launched a care management intervention called Camden RESET to help people with complex health and social needs re-enter the community after being incarcerated. Wiest emphasized the importance of having “navigators” who are there for participants each step of the way. Once someone is identified as eligible for Camden RESET, a navigator meets with them in jail to invite them to the program and works with them to develop a care plan based on their personal goals. They also accompany participants to court and other appointments to provide support while navigating the challenges that result from a fragmented system.
6. Be vigilant about building and managing stakeholder relationships
Wiest shared that while there are several technical obstacles that come with sharing data, building relationships is often just as arduous and fundamental to success. The Camden Coalition has built trusted relationships among many different sectors by being good stewards of local data and inviting as many community entities to participate in regular stakeholder meetings as possible. By the time the Camden Coalition started discussing a jail-based re-entry pilot program, the corrections department was already aware of their work after attending several stakeholder meetings. Once criminal justice stakeholders were exposed to the cross-sector hotspotting data, it was clear that both sectors had a shared interest in better serving individuals with complex needs that were cycling through jails and hospitals, which opened the doors for Camden RESET.
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