Treatment Alternatives to Prison A Health Impact AssessmentHIA Research Scope February 2012 Health Impact Assessment – a structured yet flexible research and engagement tool used to elevate the consideration of health outcomes in decision-making.
General Incarceration • recovery • substance addiction • injuries ALTERNATIVES • crime and violence • premature mortality Drug / alcohol courts • ability to manage mental health Mental health courts • chronic disease • family life Bail diversion / Day report programs • unemployment • infectious disease (HIV, Hep C, STI) Job placement programs • quality of life in communities • homelessness Community based SATS • mental health • economic impact • stress Community based MH services
Overarching Questions How would Treatment Instead of Prison (TIP) impact: • Number of slots for each intervention • Proportion of the general population incarcerated vs. in each alternative intervention • Number of people employed after each intervention • Number of people able to find housing after each intervention • Educational attainment for those in each intervention • Racial distribution of population in each intervention • Rates of infectious disease (STIs, hepatitis), chronic disease (hypertension, heart disease, respiratory disease), mental health issues (stress, depression, anxiety) among the targeted population and among the general population
Recovery Incarceration • neurological damage Δ recovery from substance addiction • access to drugs and drug tx services ALTERNATIVES • heart disease • case management • ability to manage mental health Drug / alcohol courts • respiratory harm Mental health courts • risk of infectious disease (HIV, Hep C, STI) • access to prescription tx & MH services Bail diversion / Day report programs • homelessness Job placement programs • access to a living situation • physical health conditions Community based SATS • mental health • access to medical ins/ tx for co-occurring issues Community based MH services • stress
Recovery: Primary Question Primary question: How would TIP impact substance abuse recovery and mental health management? Questions address each intervention, with statewide and per county counts
Recovery: Research Questions How would Treatment Instead of Prison impact: • Rates of substance abuse recovery and ability to manage mental health issues • Access to: substance abuse and mental health treatment services; affordable medical insurance; prescriptions; and active case management • Number of people who are homeless or otherwise do not have access to affordable housing • Number of people who overdose and/or commit suicide • Number of neurological disorders, STIs, and infectious disease in the targeted population
Crime and Safety • property/violent crime (for those in drug courts or job training programs) Incarceration • injury • levels of crime in the community ALTERNATIVES Δ solitary confinement/ punitive tx Drug / alcohol courts • recidivism Δ access to case management and rehab programming • death Mental health courts Δ access to prescription tx & drug/MH tx services Bail diversion / Day report programs Δ access to SATS • legal income • chronic disease Job placement programs • parole services • access to a living situation Community based SATS • access to jobs Community based MH services Δ prison reentry • stress • mental health • educational opportunities
Crime and Safety: Primary Question Primary question: How would TIP impact crime and safety levels? Questions address each intervention, with statewide and per county counts
Crime and Safety: Research Questions How would Treatment Instead of Prison impact: • Number of violent and property crimes committed? Injury and fatality from these crimes • Recidivism • Number of people receiving parole, per intervention, and the rate of recidivism in these population groups • Average time out of circulation to commit crimes in public, per type of crime
Family Incarceration • exposure to crime & violence • child injuries • individual living with family ALTERNATIVES • child mental health • dependent abuse/ neglect Drug / alcohol courts • parent mental health • bonding w/ parent Mental health courts • immune function • single parent families Bail diversion / Day report programs • children to foster care • Behavioral issues for children • peer bonding Job placement programs • educational outcomes for children • ability for custodial caregiver to hold job • extended family to care for dependents Community based SATS • youth involvement in justice system • financial effects of caring for others’ dependents Community based MH services • ability to afford food, medicine, clothes
Family: Primary Question Primary question: How would TIP impact children/dependents of individuals involved in these programs? Questions address each intervention, with statewide and per county counts.
Family: Research Questions (High Priority) How would Treatment Instead of Prison impact: • Number of children in foster care or living with a non-parent family member • Exposure to violence for children/dependents of individuals in each intervention • Educational attainment of children in these families • Abuse/neglect of children/dependents for parents in each intervention • Number of single parent families • Cost of caring for child/dependent for alternate caretaker and unemployment for alternate caretakers • Children/youth in these families involved in youth justice system
Community Incarceration • injury • violent and property crime ALTERNATIVES • premature Mortality • persons who commit crimes residing in community • wealth Drug / alcohol courts • chronic disease (obesity, nutrition, cardiovascular, asthma, other) • rates of unemployment Mental health courts • income levels • community-wide poverty Bail diversion / Day report programs • infectious disease • exposure to weather Job placement programs • parolees living in community • homelessness Community based SATS • mental health • social cohesion & support Community based MH services
Community: Primary Question Primary question: How would TIP impact the quality of life in communities where many are involved in the criminal justice system? Questions address each intervention, with statewide and per county counts.
Community: Research Questions (High Priority) How would Treatment Instead of Prison impact: • Community-level poverty, average household income, unemployment, and homelessness? • The number of those under supervision? • Community-level crime, fear of crime, and participation in the underground economy? • Levels of social cohesion and/or social support in each of these communities? • Level of substance abuse in each of these communities?
Economic • cost of interventions Incarceration • Government spending • cost benefits ALTERNATIVES • parole costs • homeless costs Drug & alcohol courts • Medical costs • Health Care costs • MH costs Mental health courts • case mgmt • ED use Bail diversion Day Report programs • Stress & Mental Health • Employment Job Placement Programs • Poverty • Premature mortality • Personal income • HH income Community Based SATS • Chronic disease • income tax revenue Community Based MH Services • Criminal Justice system employment • use of education system • Occupational Injuries
Economy: Primary Question Primary question: What is the economic impact of TIP? Research questions address each intervention, with statewide and per county counts
Economy: Research Questions How would Treatment Instead of Prison change: • Annual costs of incarceration and alternate treatments • Amount funded publicly and funded from other means for each intervention • Health care costs for prison health care, health care provided to target population outside of prison, substance abuse treatment services and mental health services costs for each intervention • Median household income and employment prospects for those participating in these intervention; Stress levels, mental health outcomes, and chronic disease associated with employment and low-income • Number of people employed in each intervention, their average salary and benefits • Income tax revenue from employees in each intervention
Economy: Research Questions (Medium Priority) How would Treatment Instead of Prison impact: • Case management and supervision costs of each intervention • Annual costs of construction vs. start-up for alternate treatments); Cost of operations/maintenance • Emergency room use and costs for people in each intervention • Costs of post-incarceration homelessness