Documenting Impact & Ensuring Sustainability Ann-Marie Louison CASES, Inc. NYC Washington, DC

1. Documenting Impact & Ensuring Sustainability Ann-Marie Louison CASES, Inc. NYC Washington, DC July 17, 2009

2. Overview • Nathaniel Project – a case study • Data, data, data • Adapting program in response to outcomes to achieve Sustainability

3. Nathaniel Project – case study Can I account for the use of the funds? January 2000 $100,000 City Council funding Serve 8 participants performance-based contract Is there any evidence/data to show that the program is effective? Does this program have enough clients for cost-effectiveness? 2000 funds to serve 8 participants 2002 53 consumers served in 2 year case management services How did CASES justify program continuation?

4. Nathaniel Project – case study • Can I account for the use of the funds? • Characteristics of the consumers Psychiatric diagnosis Co-occurring substance abuse Intake charge Baseline conviction history Health problems Homeless at intake Gender, race, age Baseline utilization history (hospital) 4

5. Nathaniel Project – case study • Data 101 • Educate private funders to increase support for the program • Justify continued funding • Increase support for program services • Define and refinetarget population Non-violent and violent felonies Primary diagnosis and co-occurring disorder Baseline service needs - housing 5

6. Nathaniel Project – case study • Can I account for the use of the funds? • Staffing • November 1999 one full-time social worker & part-time legal director • May 2000 two social workers and part- time legal director • December 2000 four masters level clinicians and part-time psychiatrist 6

7. Nathaniel Project – case study • Simple Data • Program participant characteristics • 88% of participants mentally ill and chemically addicted • 92% homeless at time of release from jail • 48% chronic health conditions • 78% not engaged in treatment at time of arrest • 50% violent instant offense 7

8. Nathaniel Project – case study • Simple Outcomes • Performance-based contract • Retention – 82% of participants retained in program at one year • 79% in permanent housing after one year in the program • Two participants out of 50 re-arrested on felony charges 8

9. Nathaniel Project – case study • Take Data on the Road • 2000 – 2003 City and State mental health officials • 2000 – 2003 City and State criminal justice officials • State budget office staff • City and State elected officials 9

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11. Nathaniel Project – case study Simple Recidivism data Participants in the Nathaniel Project demonstrated a dramatic decrease in arrests The number of arrests dropped from 101 (35 misdemeanor and 66 felony) arrests in the year prior to and including arrest on the charge that brought them into the program down to 7 (5 misdemeanor and 2 felony) arrests in the year since intake 11

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14. Nathaniel Project – case study Take Data on the Road Nathan Kline Institute for Psychiatric Research and the Center for Health and Public Service Research at the NYU Wagner Graduate School of Public Service Qualitative study was funded through an NIMH Center Grant (The Center for the Study of Issues in Public Mental Health) 14

15. Nathaniel Project – case study Take Data on the Road Nathan Kline Institute for Psychiatric Research and the Center for Health and Public Service Research at the NYU Wagner Graduate School of Public Service Qualitative study was funded through an NIMH Center Grant (The Center for the Study of Issues in Public Mental Health) 15

16. Nathaniel Project – case study Qualitative Study The Nathaniel Project: Manualizing the Committed Work of an Innovative Program and Monitoring that Program’s Transformation Overview The goals of this qualitative study are to describe the nature and characteristics of an innovative program that provides alternatives to incarceration for felony offenders with serious mental illness (the Nathaniel Project at the Center for Alternative Sentencing and Employment Services) and to then use this description of the key operating principles of the program as a baseline to track the program’s evolution over the next year as it transforms itself into an ACT Team 16

17. Nathaniel Project – case study • Take Data on the Road • 2002 Special Achievement Award from the American Psychiatric Association • 2002 American Probation and Parole Association’s President’s Award • 2002 Thomas M. Wernert Award for Innovation in Community Behavioral Healthcare 17

18. Overview • Role of Data in Decision Making • Minimum Level of Effort for Data • Data and Impact on Sustainability

19. Role of Data in Decision Making 19

20. Recidivism Outcomes Recidivism Results • 89 percent decrease in arrests between pre-intake arrest and post-release period • 2.2 average arrests before intake • 0.25 average post release arrests • 97 percent decline in convictions

21. Role of Data in Decision Making June 2003: CASES began to operate the licensed Nathaniel Assertive Community Treatment (ACT) program, two-year ATI with 68 treatment slots CASES responded to statewide RPF for ACT to sustain demonstration Nathaniel Project Received waivers to provide ACT to criminal justice involved population Certified by NYS Office of Mental Health as licensed provider of ACT services Enrolled by NYS Department of Health as Medicaid Provider 21

22. Role of Data in Decision Making Two-year contract NYC Office of the Criminal Justice Coordinator supports intake NYS Division of Probation and Correctional Alternatives (DPCA) supports court liaison services March 2009, supported employment enhancement funded competitive grant from DPCA New York City Council to support ACT transitional housing 22

23. Role of Data in Decision Making Blended funding: mental health, Medicaid, and criminal justice Nathaniel ACT Team operations are funded by Medicaid, NYS Office of Mental Health (OMH), NYS Division of Probation and Correctional Alternatives (DPCA), NYC Criminal Justice Coordinator, and NYC City Council 23

24. Minimum Level of Effort Target Population Administration Outcomes Presentation Identification of population characteristics Tracking of basic aggregate counts Flow chart of the process Documentation of efficiencies for key administrative junctures Agreement on some basic outcome measures at program start Attempt to measure these outcomes Define: Problem being addressed Program strategies How well were those strategies implemented How many people were served What were the outcomes

25. Data and Impact on Sustainability Eliminate Barriers to Care “ The greatest challenge the Nathaniel Project faces is locating appropriate treatment services in the community. This has been difficult, both because of a general lack of services in NYC and because of the resistance many providers demonstrate toward working with clients with criminal justice involvement and/or histories of violence.” (GAINS Program Brief, 2002) 25

26. Target Population Referral Sources 26

27. Minimum Level of Effort Administration Outcomes Presentation Target Population Felony offense ACT eligible Tracking of basic aggregate counts Flow chart of the process Documentation of efficiencies for key administrative junctures Agreement on some basic outcome measures at program start Attempt to measure these outcomes Define: Problem being addressed Program strategies How well were those strategies implemented How many people were served What were the outcomes Felony offense ACT eligible Incompetent after felony arrest 43 % Violence 61% Drugs 23% Property 9% Other 7% Intake Specialist conducting interviews in forensic hospital Psychiatric Hospitalization  Homelessness Psychiatric ER Visits Current employment Education activity Recidivism 27

28. What do the Researchers say? Violent and non-violent offenses • Federal study found no empirical evidence showing more negative outcomes when people with violent charges are diverted (Naples & Steadman, 2003) Assertive Community Treatment (ACT) • One of six evidence-based practices • Effective in decreasing hospitalization • Increases housing stability • Effective service model for clients involved in the criminal justice system • Not consistent in reducing arrests

29. Sustainability Nathaniel Assertive Community Treatment (ACT) Team June 2003 licensed by NYS Office of Mental Health Capacity to serve 68 participants in 2-year ATI program 2006, launched supported housing funded by NYSOMH 6 chronically homeless ACT Consumers participating in ATI services

30. Data and Impact on Sustainability Nathaniel ACT Data NYS Office of Mental Health Child and Adult Information Reporting System (CAIRS) Baseline and six-month follow-up data collection Program outcomes live on OMH website 30

31. You Need to Identify Sources of Data

32. Thank You This material was prepared for the conference by staff of the Council of State Governments Justice Center. Presentations are not externally reviewed for form or content and as such, the statements within reflect the views of the authors and should not be considered the official position of the Justice Center, the members of the Council of State Governments, or funding agencies supporting the work.