Transcript WI HIA on Alternatives to Prison

Treatment Alternatives to Prison
A Health Impact Assessment
Scope of research
February 2012
Health Impact Assessment – a structured yet flexible
research and engagement tool used to elevate the
consideration of health outcomes in decision-making.
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General
Incarceration
∆ Recovery rates
∆ addiction to
substances
∆ injuries
ALTERNATIVES
Drug & alcohol
courts
∆ Crime & Violence
Mental health
courts
∆ ability to
manage mental
health
mortality
∆ chronic
disease
Bail diversion
Day Report
programs
∆ in Family life
Job Placement
Programs
∆ Quality of Life in
Communities
∆ unemployment
∆ infectious
disease (HIV,
Hep C, STI)
∆ homelessness
Community
Based SATS
Community
Based MH
Services
∆ premature
∆ Economic impact
∆ stress
∆ mental
health
General Research Questions
How would Treatment Instead of Prison (TIP) change:
1 Number of slots for each intervention?
2 The proportion of the general population incarcerated vs.
in each alternative intervention?
3 Number of people employed after each intervention?
4 Number of people able to find housing after each
intervention?
5 Educational attainment for those in each intervention?
6 Racial equity in each intervention?
7 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?
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Recovery
Incarceration
ALTERNATIVES
Recovery from
substance
addiction
∆ Access to
drugs and drug
tx services
∆ neurological
damage
∆ heart disease
Drug & alcohol
courts
∆ ability to
manage mental
health
∆ Case
management
Mental health
courts
Bail diversion
Day Report
programs
Job Placement
Programs
∆ risk of
infectious
disease (HIV,
Hep C, STI)
∆ Access to
prescription tx &
MH services
∆
homelessness
∆ access to a
living situation
∆ physical
health
conditions
Community
Based SATS
Community
Based MH
Services
∆ respiratory
harm
∆ Access to
medical ins/ tx
for co-occurring
issues
∆ mental
health
∆ stress
Recovery
Main question:
How would TIP impact SA recovery and MH
management?
Questions address each intervention, with statewide
and per county counts
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Recovery: Research Questions
How would Treatment Instead of Prison change:
1. Rates of substance abuse recovery and ability to manage
mental health issues?
2. Access to: substance abuse and mental health treatment
services; affordable medical insurance; prescriptions; and
active case management?
3. Number of people who from each intervention who are
homeless or otherwise do not have access to affordable
housing?
4. The number of people who overdose and commit
suicide?
5. The number of neurological disorders, STIs, and
infectious disease in the targeted population?
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Crime and Safety
Incarceration
∆ property/ violent
crime (for those in
drug courts or job
training programs)
∆ Injury
∆ levels of
crime in the
community
ALTERNATIVES
Drug & alcohol
courts
Mental health
courts
Solitary
confinement/
punitive tx
∆ Recidivism
Access to Case
management and
rehab programming
Bail diversion
Day Report
programs
Access to
prescription tx &
drug/MH tx services
Job Placement
Programs
Access to SATS
∆ Parole services
∆ Legal Income
∆ Chronic
disease
∆ Stress
∆ Mental
health
∆ Access to a living
situation
Community
Based SATS
Community
Based MH
Services
∆ Death
∆ Access to jobs
Reentry
∆ Educational
opportunities
Crime and Safety
Main question:
How would TIP impact crime and
safety levels?
Questions address each intervention, with statewide
and per county counts
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Crime and Safety: Research Questions
How would Treatment Instead of Prison change:
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2
3
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Number of violent & property crimes committed?
Injury/fatality from these crimes?
Recidivism?
How many people receive parole, per intervention, and what
is the rate of recidivism in these population groups?
The average time out of circulation to commit crimes in
public, per type of crime?
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Family
Incarceration
ALTERNATIVES
∆ Individual
living with
family
∆ child injuries
∆ exposure to
crime & violence
∆ child mental
health
∆ dependent
abuse/ neglect
Drug & alcohol
courts
∆ parent mental
health
∆ bonding w/
parent
Mental health
courts
Bail diversion
Day Report
programs
∆ Immune system
∆ Single parent
families
∆ Children to
foster care
∆ Behavioral issues
for children
∆ peer bonding
Job Placement
Programs
Community
Based SATS
Community
Based MH
Services
∆ extended
family to care
for dependents
∆ ability for
custodial caregiver
to hold job
∆ financial effects
of caring for
others’
dependents
∆ educational
outcomes for
children
∆ youth
involvement in
justice system
∆ ability to afford
food, medicine,
clothes
Family
Main question:
How would TIP impact
children/dependents of individuals
involved in these programs?
Questions address each intervention, with statewide
and per county counts.
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Family: Research Questions
How would Treatment Instead of Prison change:
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2
3
4
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Number of children in foster care or living w/ a nonparent 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
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Community
Incarceration
∆ injury
∆ violent and
property crime
ALTERNATIVES
Drug & alcohol
courts
∆ persons who
commit crimes
residing in
community
∆ wealth)
∆ rates of
unemployment
Mental health
courts
∆ income levels
(same as
poverty?)
∆ community-wide
poverty
Bail diversion
Day Report
programs
Job Placement
Programs
∆ Premature
Mortality
∆ exposure to
weather
∆ parolees
living in
community
∆ Chronic disease
(obesity, nutrition,
cardiovascular,
asthma, other)
∆ infectious
disease
∆ homelessness
Community
Based SATS
Community
Based MH
Services
∆ social cohesion
& support
∆ Mental health
Community
Main 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.
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Community: Research Questions
In communities with high rates of incarceration, how would
Treatment Instead of Prison change:
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2
3
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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?
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Economic
∆ cost of
interventions
Incarceration
∆ Government
spending
ALTERNATIVES
∆ parole costs
∆ homeless costs
Drug & alcohol
courts
Mental health
courts
∆ cost benefits
∆ Medical costs
∆ MH costs
∆ Health Care
costs
∆ case mgmt
∆ ED use
Bail diversion
Day Report
programs
∆ Employment
Job Placement
Programs
Community
Based SATS
Community
Based MH
Services
∆ Stress & Mental
Health
∆ Poverty
∆ Personal
income
∆Criminal Justice
system
employment
∆ Premature
mortality
∆ HH income
∆ income tax
revenue
∆ Chronic disease
∆ use of education
system
∆ Occupational
Injuries
Economy
Main question:
What is the economic impact of TIP?
Questions address each intervention, with statewide
and per county counts
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Economy: Research Questions
How would Treatment Instead of Prison change:
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2
3
4
5
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The 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 interventions? Stress levels,
mental health outcomes, and chronic disease associated with
employment and low-income?
The number of people employed in each intervention, their
average salary & benefits?
Income tax revenue from employees in each intervention?
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Economy: (con’t)
How would Treatment Instead of Prison change:
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Case management and supervision costs of each
intervention?
8 Annual costs of construction vs. start-up for alternate
treatments)? Cost of operations/maintenance?
9 Emergency room use and costs for people in each
intervention?
10 Costs of post-incarceration homelessness?
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