Topic: Pretrial

The war on drugs has failed. More than 60 percent of people who are prosecuted for drug offenses reoffend. In Deschutes County, Oregon, our Clean Slate program provides a model for how communities can chart a better path.

Fifty-three percent of program participants have successfully completed the Clean Slate program, which requires not incurring a new arrest within one year. When compared to individuals that were eligible to enroll in the program but did not participate, only 38 percent were not cited for a new crime within 12 months. This impact is reflected again in that Deschutes County’s two-year recidivism rate hovers around 76 percent, but the two-year rate for Clean Slate participants is only 42 percent. Due to these successes, over 400 court appearances have been avoided and 253 people have been connected to much-needed medical care since the program’s inception in November 2017.

Front-end diversion efforts like Clean Slate—which occur before a court date, when a person has initial contact with law enforcement—can prevent overuse of jail and the negative consequences an arrest can have on a person’s life. We were able to develop the Clean Slate program and run the proof-of-concept pilot thanks to funding from the Safety and Justice Challenge Innovation Fund.

How the Program Works

When an officer interacts with a person on the street suspected of drug possession, rather than arrested them, they issue a citation to appear in court, and they give them a card with information about the Clean Slate program. Our office then calls that person and invites them to a Clean Slate orientation meeting which they can attend before their court date. At that meeting, the District Attorney or one of their deputies is there to welcome the person. After the welcome, the person has a confidential meeting with the public defenders, who also participate in the orientation process. After meeting with the District Attorney and the public defender, the individual meets with a substance use disorder professional who conducts an assessment. The person is then scheduled for an appointment with a primary care provider provider at one of the program’s participating federally qualified health centers. Once the patient shows up at that appointment, they are in the program and out of the criminal justice system.

Treating Substance Abuse Disorder in the Medical System, Not the Criminal Justice System

We have tried treating substance abuse disorder in the criminal justice system for the past 100 years, and we have failed miserably. It simply does not work. When someone is charged with possessing drugs, it is our belief that they either use recreationally or they are living with a substance use disorder and need the help of a medical professional.

The healthcare environment is very different from the criminal justice environment. Patients are free to talk openly and can communicate about what is going on with their lives. There are often underlying issues contributing to their substance abuse disorder. Sometimes it is a history of trauma or a mental health condition. There are also socioeconomic stressors that often play a role. Most people want to do better; they just do not know how to take the first step.

The leadership and providers at Mosaic Medical and La Pine Community Health Center were invaluable to this effort and worked intensely with us to develop the nuts and bolts of the program. They provide compassionate and competent care to our participants everyday.

Getting Law Enforcement on Board

Law enforcement officers have also been important partners. Many have embraced the program and encourage people suspected of possessing drugs to attend a Clean Slate orientation meeting.

Many officers on the street tell us they have come to have a better understanding of the people they interact with on a regular basis. They now realize that the people they are interacting with often have mental health issues, physical conditions, and trauma, which go together with drug addictions.

Handing a person a Clean Slate card and referring them to programs and resources can build a good working relationship between officers and the people they are citing. It shows the officer is not just there to throw a person into a jail cell but instead wants to see them succeed.

Humanizing People with Substance Abuse Disorder

People with a substance abuse disorder do not want or choose to have it. We are not giving them a break; we are giving them a chance to live the life they want to live.

By removing the criminal framework and demonstrating that there are healthcare providers here to help, we make it easier for people to stay employed and housed. Those are important ways for people to stay productive and engaged in society.

Our participants tell us they did not know programs like Clean Slate existed and that they did not think they had the resources to go through such a program. They feel like it is their opportunity to succeed and change their life. They also tell us that the medical staff they work with are helpful and kind, and that there is a lack of judgment which also helps them succeed.

One participant told us: “This program saved my life: I would have been dead by now. I reconnected with my family, have not been arrested, gained weight, got healthier, have fewer sick days at work. It is a miracle, and my whole life has changed.”

Lessons Learned

Police officers told us that the personal commitment of the prosecutor’s office to encourage them to refer to Clean Slate was important in securing their support. We also learned the importance of securing stakeholder support during the process of designing the program. And of course, we relied on data collection to validate the program’s success.

Jail detention has tremendous costs for the people in jail, their families, and their community. This program has reduced those costs and is a worthwhile investment in people’s futures.

We encourage other Safety and Justice Challenge jurisdictions to draw on the lessons from the Clean Slate Program to lower the use of jails and help people living with substance abuse disorder improve their lives.

The Clean Slate Program is also the subject of a case study by the Urban Institute which is available here. And you can watch a video about the program featuring participants and law enforcement, here.

We can learn a lot from the city of Long Beach in California about how best to keep people from falling through the cracks in our criminal justice systems. That’s the crux of an extensive new case study by the Urban Policy Institute on a Connection to Care (C2C) program focused on the city’s municipal jail.

John D. and Catherine T. MacArthur Foundation funded the initiative and the case study through its Safety and Justice Challenge.

The Safety and Justice Challenge seeks to reduce jail populations in communities around the country. Many participating cities and counties have jails that can hold thousands of people, but Long Beach’s municipal jail holds just 200 people who are often released in fewer than 72 hours before going to a county facility. They are in many cases people without housing who cycle in and out of the city’s jail and back onto the streets. They often struggle with behavioral health issues like substance abuse disorders and mental health diagnoses. And they are arrested for low-level crimes on a repeated basis.

Long Beach’s initiative is simple, yet, at the same time, quietly revolutionary. It doesn’t involve high-priced consultants or elaborate new care models. It is often as simple as getting people a taxi from the city jail in Long Beach to drug treatment or to a homeless shelter when they are released. Yet in some cases the C2C model pioneered in Long Beach has been sufficient to help people who have languished in the same destructive cycle for decades, getting them off the streets and into supportive services.

More than anything else, the program encourages people in the criminal justice system who have historically been operating in silos to talk to each other. It gets them to collaborate and work together in new, mutually beneficial ways.

In the case of this program, two of the biggest challenges to overcome were signing a contract with a taxi firm to provide rides, which took several months; and figuring out how to release people from the city jail to coincide with intake at the shelters and rehabilitation centers.

In other places, people are given a bus pass or a metro card when they are released from city jails. The idea is to get people on their way, and in many cases to get them to drug treatment or supportive housing. But some people do not follow through, instead falling through the cracks.

The C2C pilot was one element of a broader collaborative strategy developed by the City of Long Beach. The goal was to work more effectively with people who were repeatedly arrested, often because of a lack of housing. In 2015 the city developed the Public Safety Continuum, a collaboration between the Long Beach Police Department, the Long Beach Fire Department, and other municipal government partners including the city prosecutor’s office and Long Beach Department of Health and Human Services. Its research led to the city creating the Justice Lab at the start of 2018, to improve approaches for people who were cycling in and out of jails.

Foundational to the Justice Lab’s overarching strategy was the creation of the Multidisciplinary Team (MDT), which the Justice Lab manager oversees. It brings together city and county safety, social service, and behavioral health departments monthly to better coordinate the provision of mental health, substance abuse, and homelessness services for high-frequency users (HFUs) of the system.

The nine-month C2C pilot was a key strategy to enhance the city’s continuum of responses, and a way of addressing a critical gap in that continuum. Since 2015, Long Beach had been cultivating a range of responses to the needs of people coming into frequent contact with the city’s justice system, human services, and behavioral health systems. It based this effort on the Sequential Intercept Model, which helps jurisdictions systematically address how community-based responses can serve people with mental and substance use disorders involved in the justice system.

The foundational intervention for engaging HFUs at the jail intercept is the “clinician in jail” pilot program, which began in April 2018. The program embeds a mental health professional in the Long Beach City Jail to assist people incarcerated there and connect them to services to prevent additional jail bookings. The clinician is employed by the Guidance Center, a community-based mental health services provider. During the initial six-month pilot, the clinician met with 297 people and provided 214 referrals, primarily to mental health services (33 percent of referrals), substance abuse services (19 percent), and homelessness services (32 percent; Long Beach Justice Lab 2019).

The Long Beach Police Department, which operates the jail, committed to funding the clinician program during its second year. However, despite the good work the clinician did, the actual rate of connection to referred services upon release was disappointingly low because of challenges like the lack of transportation at the point of release. The C2C pilot was conceived to address this gap. And the results were impressive, even through COVID-19.

147 rides were provided in the program’s first ten months, primarily to emergency shelters and behavioral health treatment centers.

You can download and read the case study, Connection to Care in a Municipal Jail Setting, by clicking here. It includes client success stories and more detail on overcoming challenges.

The Multidisciplinary Team meetings provided a forum for strategic and client-level collaboration. Perhaps the greatest testament to the strength of the C2C collaboration was the partnership’s ability to reallocate resources and become more successful in engaging clients even as the city’s pandemic response disrupted the pilot’s jail-based components.

By replicating Long Beach’s step-by-step work, other jurisdictions can use data to understand their own challenges and develop the collaborative relationships and add priority system capacity to better meet them.