Case Studies From Three States: Breaking Down Silos Between Health Care And Criminal Justice

Abstract

The jail-involved population-people with a history of arrest in the previous year-has high rates of illness, which leads to high costs for society. A significant percentage of jail-involved people are estimated to become newly eligible for coverage through the Affordable Care Act's expansion of Medicaid, including coverage of substance abuse treatment and mental health care. In this article we explore the need to break down the current policy silos between health care and criminal justice, to benefit both sectors and reduce unnecessary costs resulting from lack of coordination. To draw attention to the hidden costs of the current system, we review three case studies, from Washington State, Los Angeles County in California, and New York City. Each case study addresses different aspects of care needed by or provided to the jail-involved population, including mental health and substance abuse, emergency care, and coordination of care transitions. Ultimately, bending the cost curve for health care and criminal justice will require greater integration of the two systems.

Health Insurance Trends and Access to Behavioral Healthcare Among Justice-Involved Individuals—United States, 2008–2014

“…13 Roughly half of justice-involved individuals are expected to be eligible for health insurance through the Affordable Care Act (ACA), 10,14 and many believe insurance expansion offers an opportunity to improve access to substance abuse and mental health treatment for this population. 5,14,15 One recent report suggested that the ACA improved insurance rates among justice-involved individuals with SUD. 16 However, to date, no national reports have assessed insurance trends among the general justice-involved population following implementation of either the ACA's dependent coverage mandate, which expanded parental health insurance to children age 19-25, 17,18 or Medicaid expansion and Marketplace plans.…”

Learning Through Practice: The Design and Implementation of an Advanced Integrative Practicum for DrPH Students

“…After decades of public health–related entities working in separate silos, the landscape is evolving to take on a systems-wide approach that connects and coordinates public health–related services to care for and support entire populations (Bechelli et al, 2014; Public Health Foundation for the Performance Management National Excellence Collaborative, 2003). DrPH programs must adapt to this changing landscape and ensure that their graduates are prepared to serve as leaders in interdisciplinary settings (ASPPH, 2014).…”

More than the Affordable Care Act: Topics and Themes in Health Policy Research

“…Quantitative methods have a lot to offer, but the subfield has plenty of activity in qualitative research and mixed methods to address the complexity of the problems of interest. Health Affairs has published work using ethnographic analysis (e.g., Bhatia &Corburn, 2011), interviews andcontent analysis (e.g., Etchegaray et al, 2014), and regularly features case studies (e.g., Bechelli et al, 2014;Laurance et al, 2014;Lerner, Robertson, & Goldstein, 2015;Rosenbaum, Cartwright-Smith, Hirsh, & Mehler, 2012). The Milbank Quarterly has published studies using comparative (Sorenson & Drummond, 2014) and content analysis (Van der Wees et al, 2014), ethical (Rhodes & Miller, 2012) and critical interpretive analysis (Moat, Lavis, & Abelson, 2013), and has expanded its op-ed section to include additional informed commentary from leading health policy scholars.…”