P&P December 2016

from the field

By Louise Wasilewski

Case Management Coordination for High Utilizers

E ach year, 11,000 people cycle through our jails. About half of them have substance use challenges, and 2,000 suffer from serious mental illness. It costs our counties about $20 billion a year on jails, our courts $22 billion, with the cost to human services, workforce, and housing agencies added to that. The Washington State Institute for Public Policy (WSIPP) 1 has analyzed hundreds of programs to identify those that are both cost effective and likely to produce the desired outcomes. We know that case management of supportive services, combined with swift and certain sanc- tions, produces lower recidivism and improved public safety. We know how to make a dent in this problem, but it is still harder than it looks. When a person is released from jail, he or she often needs help finding housing and work, but if the counselors do not coordinate their efforts, we know what happens. Housing finds a place to live on one side of town, workforce finds a job on the other side, and then everyone wonders why that person is late for work. Most seriously, if an individual on psychiatric medica- tions is released from jail but cannot get continuity of care in the community, decompensation can occur, resulting in renewed engagement with law enforce- ment—so the cycle continues. There are many barriers to coordina- tion in addition to organizational silos. Informed consent and other privacy concerns prevent a caseworker in one organization from sharing information with a caseworker in another. HIPAA, 42 CFR Part 2, and state statutes form a tangled mess of regulations, so staff simply do not share even what they could, to avoid the risk of dismissal. Isn’t it crazy that privacy, something that is

supposed to protect us, is getting in the way of recovery? Of course, our criminal justice information systems (CJIS) are designed to safeguard data and CJIS requirements are stringent for staff, processes, and systems. Workforce, housing, education, and social services all have their own IT systems that usually don’t communicate to each other either, and have their own privacy rules. The question

is, how do we get criminal justice

agencies, whose first mission is to protect the public, and health and human service

for Information Sharing to Enhance Health and Public Safety Outcomes,” that provides a use case guide for com- munities wishing to improve reentry and care in the community . 3 This report identifies the challenges that must be overcome, including regula- tory and technology burdens. APHSA’s affiliate, IT Solutions Management for Human Services (ISM), is now in a dialogue with its peer organization in criminal justice, the Integrated Justice Information Solutions (IJIS) Institute, to establish a working relationship. IJIS members have been key contributors to the NIEM standards now being adopted

agencies, whose first mission is to help the individual, to work together and share information? There are resources that counties and states can use to build trust and systems to create the change we all need to see. The National Association of Counties, the American Psychiatric Association Foundation, and the Justice Center for the Council of State Governments teamed up last year to launch the Stepping Up Initiative. This provides a toolkit to help communities come together to address this pressing challenge. The toolkit focuses on people and processes . 2 The Criminal Justice and Health Collaboration Project produced an extensive report, “Opportunities

See Case Management on page 25

Photo illustration by Chris Campbell

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Policy&Practice December 2016