[NYAPRS Enews] PT: Albany DSRIP Initiative Also Focuses on Avoidable Drug-related Reincarcerations

[Harvey Rosenthal]

NYAPRS Note: NY's Medicaid Redesign program seeks to prevent avoidable inpatient readmissions with the use of enhanced care management and other community services. And it's also beginning efforts to prevent avoidable incarcerations for low level crimes associated with non-violent level crimes committed by people with substance use related disorders, in this case via the efforts of the Albany area's DSRIP initiative that is operated by Albany Medical Center.

On Low-Level Crime, Albany Swaps Arrests For Treatment
By Addy Baird Politico   May 23, 2016

Last month, security at an Albany store caught a man in his forties trying to shoplift a blender and other kitchen appliances valued at almost $300. He had been arrested 30 times before, starting in the late '90s - 28 of them for misdemeanors, mostly shoplifting electronics to resell to support a $500-a-day heroin habit.

But when police arrived, the man wasn't arrested. Instead, he was enrolled in a methadone program, with Medicaid funds. Within a week and a half, he had begun treatment.

"If we had done nothing but arrest him that day, he would have gone down to court, a judge would've released him, and he would've been right back to exactly where he was, trying to get some kind of money to get the drugs that he needs because of his illness," said Albany Police Chief Brendan Cox. "Instead, they were able to work with him."

The man had avoided heading back into the criminal justice system he'd cycled through so many times before because of a new Albany diversion program, funded in part by Medicaid, that aims to find new support systems for nonviolent, low-level offenders caught in the criminal justice system.

The Law Enforcement Assisted Diversion program, developed in Seattle and begun in Albany on April 1, is unique among diversion programs. While most rely on judges to divert people from the criminal justice system after they've been arrested, the LEAD program lets police officers divert them before arresting them, and sends them instead to case managers.

A 2015 independent evaluation by researchers at the University of Washington found participants in Seattle's program, in place since 2011, were 58 percent less likely to be rearrested after being diverted. Albany is only the third city nationwide to implement the program, after Seattle and Sante Fe, New Mexico. Albany police and the program's project managers say it's their best option for serving repeat offenders.

"The system for these lower-level offenses and people that are driven by mental illness or poverty issues - those aren't being addressed in the criminal justice system," said Cox. "They aren't being addressed at all."

When he first joined the department in 1994, amid its struggles against crack cocaine, Cox says he truly felt that arresting drug users was getting them help. It wasn't until he joined the department's child and family services unit in 2000 that he began to rethink whether the criminal justice system was capable of addressing issues of mental health and substance abuse.

Instead, many people simply cycled in and out of courtrooms, jails and the emergency rooms that, for many eligible for LEAD, served as their primary care providers.

Those visits, said Gabriel Sayegh, one of LEAD's project managers in Albany, can cost "emergency rooms tremendous amounts of money, of our tax dollars, and they take up a lot of time of law enforcement."

An ER visit due to opioid overdose costs, on average, about $3,640, but those costs can soar to almost $30,000 if a patient is admitted to the hospital after the overdose, a 2014 study found. In 2001, a study from the Washington State Institute for Public Policy found that police costs for a drug or property crime were $1,890 per arrest, with a subsequent $1,670 in court costs.

The LEAD program can save Albany money simply by avoiding those arrests and court appearances entirely, and by reducing the likelihood of repeat ER visits by people like the shoplifter who would be better served by meaningful substance-abuse treatment. But at its heart, the program aims to find new support systems for the people it diverts from the system.

"The system of mass incarceration and the war on drugs, as systems, have been utilized to address a whole range of things related to poverty and behavioral health and addiction," said Sayegh. "It stands to reason that we need to utilize other systems to address those needs - [like] the expansion of health care."

Before Cox took its helm last year, the Albany Police Department had tried several other diversion programs, without success. It decided to try LEAD after seeing a presentation by the team that had implemented Seattle's program, and with it gave all its police officers implicit-bias and harm-reduction training, which Cox felt were key to understanding the aims of the program.

"It was clear that the community wanted this," he said of the program. "It was really an easy decision for us."

What makes Albany's program unique is that it is funded in part by Medicaid, using money awarded to Albany Medical Center under the Delivery System Reform Incentive Program (DSRIP), the state's main Medicaid reform mechanism, which seeks to develop new ways to reduce avoidable hospitalizations.

"It was a no-brainer for us," said George Clifford, the executive director of Albany Medical Center's Center for Health Systems Transformation. He said the hospital had hoped to use DSRIP funding to work with community groups to improve care after it saw how many people "fall between the cracks because of how care is coordinated."

The hospital has invested $30,000 into funding the program on a trial basis for about three months - "but that's renewable," he said, and the hospital will reinvest if the program succeeds and meets its DSRIP goals. The LEAD program has also gotten more than $210,000 in planning and development funding from the New York State Health Foundation and the Touhey Family Foundation.

With six diversions already, the program's team and case managers are thinking about how to maintain funding, as DSRIP will eventually end and private investments aren't sustainable in the long term. Providers are already thinking about the program's future, including fundraising options and the potential to enroll eligible LEAD participants in Medicaid.

"There's a likelihood that a significant number of people we serve would be eligible for Medicaid," said Keith Brown, the executive director of Catholic Charities Care Coordination Services, which provides LEAD's case managers.

Cox is optimistic about the program's long-term viability, and its ability to reshape how his youthful department - nearly a third of its officers have less than three years on the job - engages with communities they police.

"We actually have a chance to have this be the way they think for the rest of their careers," Cox said. "We can really change the culture."

http://www.capitalnewyork.com/article/albany/2016/05/8599790/low-level-crime-albany-swaps-arrests-treatment
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