20240129-113438-74

Analysis Area 1:?Facilitate a cross-system data match between DHHS and county jails to identify the overlapping population of people who have behavioral health challenges who move through local criminal justice systems and identify high utilizers of both systems. CSG Justice Center staff will conduct an in-depth descriptive analysis of the matched Medicaid claims data to provide information on trends in services accessed in the community by people incarcerated in each participating jail. CSG Justice Center staff will also analyze county jail data related to demographic information, booking and release information, screening and assessment information, medications, and programming and treatment information to understand the criminal justice and behavioral health characteristics of locally incarcerated populations.?
Background:?County and state officials report a high prevalence of people with behavioral health needs moving through local county department of corrections (jails) and state prisons, with an increasing reliance on using incarceration at the local level to address behavioral health challenges. In at least one of the state?s 10 county jails, a data match found a 76 percent overlap between the populations for both the county jail and the community mental health center.[i]?In another county, the majority of people held in jail reported using drugs on a regular basis;[ii]?another county estimated that about a quarter of its jail population had an opioid use problem.[iii]?Improving criminal justice and public health outcomes for people with behavioral health conditions who are high utilizers of the health and jail systems can impact public safety and state budgets.?
Update: In September, CSG Justice Center research staff connected with New Hampshire DOC data staff to learn more about their data formatting and to continue data scoping conversations. CSG Justice Center research staff also met jointly with New Hampshire DOC and New Hampshire DHHS data staff to start preliminary conversations about the Medicaid and state corrections data match. CSG Justice Center staff were notified by CSG Justice Center legal counsel that a new Data Use Agreement (DUA) is required for the project because the DUA in Phase 1 authorized the use of the jail data for the Medicaid match, while the DUA for phase 2 is for authorizing the use of the DOC data for the Medicaid match. A meeting to solidify details is scheduled for October 4, and CSG Justice Center staff are working to finalize the DUA. ?
CSG Justice Center staff met with the DOC commissioner and discussed expectations from the Governor?s Advisory Commission on Mental Illness and the Corrections System (Advisory Commission) for the next phase of work. The commissioner shared that they are expecting a few presentations on the data analysis, consisting of an initial findings presentation, a preliminary Medicaid and qualitative findings presentation, and a final presentation. During the meeting, CSG Justice Center staff also discussed the commissioner?s thoughts on standardizing validated mental health and substance use screenings in the jails and standardizing in-reach to the jails. The commissioner was supportive of these recommendations. Finally, CSG Justice Center staff finalized the focus of work for new data analysis and implementation technical assistance.
[i]?Meeting between The Council of State Governments Justice Center and Sullivan County, Department of Corrections on November 18, 2020.
[ii]?Merrimack County, ANNUAL REPORT For the year ending December 31, 2019 (Concord, NH: County of Merrimack, 2020). ?69% of inmates self-reported regular drug use.? Self-reported drug use statistics were not available for all counties.
[iii]?County of Co?s, Annual Report of Co?s County for the Year Ending December 31, 2019 (Lancaster, NH: County of Co?s, 2020). Information on substance use in jails was not available for all counties.
Analysis Area 2:?Conduct a qualitative assessment on the availability, quality, and data collection practices of jail-based mental health and substance use disorder programming and treatment. CSG Justice Center staff will conduct interviews and focus groups with superintendents, jail staff, and contracted behavioral health providers to provide information on the identification of people with behavioral health needs, services, programming, and options within jails for care coordination to support connections to community-based care. CSG Justice Center staff will review jail policies that guide the practice of identifying, tracking, and referring people with behavioral health conditions to services. This assessment will provide qualitative data on local trends in jail populations, behavioral health needs, and participation in jail-based treatment and services.
Background:?While less is immediately known about the nature and prevalence of behavioral health needs among people who are incarcerated in and frequently move through county jails, stakeholders have indicated, and preliminary data analyses show that people with behavioral health needs may also make up large proportions of local jail populations.?In Merrimack County, over two-thirds of people in jail in 2019 reported using drugs on a regular basis.[i]In Cheshire County, 84 percent of people in jail who received a mental health assessment in 2019 met the criteria for alcohol and/or drug abuse or dependence, and 64 percent had co-occurring mental illness and substance use disorders.[ii]?However, data collection systems are not consistent across county jails and often lack behavioral health indicators and metrics. Additionally, despite the reported prevalence of behavioral health needs, there are gaps in the availability and quality of jail-based behavioral health programming.?
Update: In September, CSG Justice Center staff communicated with the county jail Superintendents Affiliates president about the focus of work for the next round of data analysis and implementation assistance. At their upcoming meeting, the president will share the focus of work with the membership and discuss the benefits of supporting the project and signing the forthcoming LOI.
[i]?Merrimack County, ANNUAL REPORT For the year ending December 31, 2019 (Concord, NH: County of Merrimack, 2020). ?69% of inmates self-reported regular drug use.? Self-reported drug use statistics were not available for all counties.
[ii]?County of Cheshire, Report of the County Commissioners County Treasurer and Other Officers of Cheshire County New Hampshire for the Year Ending December 31, 2019 (Keene, NH: County of Cheshire, 2020). Of the 1,610 people booked in calendar year 2019, 280 received a mental health evaluation. Information on mental health in jails was not available for all counties.
Analysis Area 3:?Conduct a community-based behavioral health assessment with mental health center staff, substance use disorder treatment and recovery support service providers, housing and homeless service providers, and people with lived experiences. CSG Justice Center staff will identify and geographically map current behavioral health services, crisis response, and alternatives to incarceration programs to provide an overview of availability of services in each county. This assessment will inform stakeholders on the current gaps in behavioral health resources and care coordination with criminal justice systems.??
Background:?The behavioral health needs in New Hampshire are significant, but mental illness and substance use disorder (SUD) treatment and service providers are limited in their ability to meet these needs generally, let alone for people involved in the criminal justice system.?In 2017 and 2018, an estimated nine percent of adults in New Hampshire needed substance use treatment but did not receive it, the seventh-highest rate in the nation.[i]?This assessment will inform recommendations on how to address people who have frequent contact with county jails and behavioral health systems, including increasing diversion opportunities and access to services for people reentering communities from jails, such as mental illness and SUD treatment, affordable housing, and other effective community-based support services.
Update: In September, CSG Justice Center staff presented the data analysis and recommendations to the Committee to Study the Long-Term Effects of the NH Parole System. The committee was very interested in the behavioral health figures among the high utilizers, especially those with substance use disorder and mental health conditions. CSG Justice Center staff provided resources to the committee on strategies to decrease parole revocations due to behavioral health-related conditions. The committee plans to ask for more time in order to include the CSG Justice Center?s additional data analysis to inform their recommendations to the legislature.?

[i]?Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality, 2017-2018 NSDUH State Estimates of Substance Use and Mental Disorders (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2019). Percentages are annual averages for 2017 and 2018; rates for individual years were not available. Adults are people 18 years of age and older.
Analysis Area 4:?Connect with criminal justice stakeholders (law enforcement, judges, defense attorney, prosecuting attorneys, and community-based corrections) to examine the extent to which law enforcement, courts, and other criminal justice stakeholders have viable, evidence-informed community resources available for people in the criminal justice system who have behavioral health and housing needs, including access to effective crisis and treatment services. CSG Justice Center staff will also identify and geographically map current alternatives to incarceration programs to provide an overview of availability of options for criminal justice agencies in each county. This assessment will inform stakeholders on the current gaps in alternatives to the criminal justice system for people with behavioral health conditions.?
Background:?County officials report significant gaps in how the state is currently able to respond to and provide behavioral health services to people. Without more effective and available community-based services to respond to people with SUDs or mental illnesses or both, New Hampshire has increasingly relied on incarceration in jails or prison to address behavioral health challenges, which increases fiscal pressure on counties.?
Update:?In September, CSG Justice Center staff met with the Strafford County Attorney to provide him with a status update and learned about his new role with the Attorney General?s Office, where he will be working on policy. He shared he would still like to be an engaged stakeholder in his new role and believes he can be an asset to future work.
Research Monthly Status:?This month, Research staff collaborated via email, phone, and Zoom with the Department of Corrections to explore the data available within their system and met with Commissioner Hanks to discuss project updates. Additionally, Research staff met with partners at DOC and DHHS for a kickoff meeting where the data submission process, analysis plan, and timeline were discussed. On the administrative side, Research staff made progress on developing the DUAs essential for the project?s legal compliance around data sharing. Finally, Research staff continued working on shaping the analysis plan to guide our work once data is received.