Berks County, Pa.
Urban/Rural Population: 76.3 percent/23.7 percentii
In September 2017, the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Association of Counties (NACo) and the Laura and John Arnold Foundation (LJAF) hosted the Data-Driven Justice and Behavioral Health Design Institute (Design Institute) in Rockville, Md. The Design Institute convened 13 teams committed to the Data-Driven Justice (DDJ) initiative. Teams were selected through a competitive process to work directly with expert faculty in facilitated sessions and workshops to create action plans for developing and using integrated data systems that would aid their jurisdictions in identifying high utilizers of jails and crisis services. This case study is part of a series highlighting counties that participated in the Design Institute.
Through the strategic plan of their Criminal Justice Advisory Board (CJAB), Berks County has prioritized addressing the needs of the justice-involved population with mental illnesses. Chief among CJAB’s goals are the development of a system-wide evidence-based approach to treatment and the implementation and improvement of technology initiatives that reduce recidivism and jail overcrowding.
To address the implementation of technology-related goals and initiatives, Berks County has involved its Information Systems (IS) department in its Data-Driven Justice (DDJ) efforts. While Berks County has an existing data warehouse that can track individuals’ interactions with justice and social service systems, strict state laws limit how mental health and drug abuse information can be shared, limiting how the county can use the data warehouse. These state laws go beyond the patient protections that are governed by the Health Insurance Portability and Accountability Act (HIPAA) and 42 CFR Part 2.
When the county attended the Design Institute it identified two priorities. The first priority was to gather the data necessary to understand the delivery and consumption of behavioral health, emergency and criminal justice services. The second was to identify the appropriate measures for determining the effectiveness or success of each service. In order to address these priorities, the county is creating a map of its data systems, including data elements that are stored within existing databases, developing a data governance strategy and identifying a technology solution that would allow data owners to share deidentified datasets with other stakeholders in order to identify high utilizers—also called frequent utilizers—with cross-system interactions. The priorities identified and action plan developed by the Berks County team at the Design Institute support the CJAB’s goals to use data and technology to better understand, design and implement effective and appropriate services for people with mental illnesses.
Making Progress by Leveraging Resources and Relationships
Berks County has made a concerted effort to develop relationships between county departments such as the Office of Mental Health and Developmental Disabilities (MHDD), IS, the jail and local police departments through the Berks County Chiefs of Police Association. Another way the county is working to achieve the goals described in the CJAB’s strategic plan is through its diversion program. Berks County started a diversion program in 2012 with the intent of reducing how long people with mental health conditions were in jail. Originally operating out of its pretrial services agency, the diversion program now operates as the Mental Health Forensic Diversion Program through the MHDD in partnership with Service Access and Management (SAM), a non-profit case management, crisis intervention and administrative services provider. The goal of the diversion program is to link people to the appropriate level of mental health and/or substance abuse treatment, case management, peer support and other community resources. Through its provider network, Berks County has more than 10 certified forensic peer specialists that support individuals through treatment and recovery by giving them an opportunity to learn from others who also have experience with the justice system.
The Mental Health Forensic Diversion Program depends on the Mental Health Forensic Diversion Specialist to create and maintain relationships with local law enforcement, the court system and other justice system officials. This relationship is critical for ensuring that the diversion specialist is called to intervene and divert individuals from jail and prevent further penetration into the system. The diversion specialist then works to develop a treatment plan for program participants. Since 2012, over 380 people have been diverted; only six percent of participants have been charged with a new crime.
Another asset for treatment and service coordination in Berks County is blended case management (BCM). BCM evolved out of case management and resource coordination practices that used to be regulated by the State of Pennsylvania and guided how mental health services were delivered to individuals. Previously, individuals moved between case workers as they improved and their treatment and service needs changed. Now, under BCM, a person stays with the same caseworker—and maintains their relationship—regardless of changes to their treatment level. SAM uses the BCM model with the justice-involved individuals it works with through its Forensic Targeted Case Management (FTCM) program, which started in 2016. The FTCM program assists individuals with reinstating health care benefits that may have been suspended while incarcerated, setting up psychiatric and outpatient therapy appointments and identifying and planning around goals. SAM offers specialized training to FTCM staff to equip them with tools and strategies for working with the justice-involved population.
A forensic coalition also exists within Berks County to facilitate ongoing education and collaboration among county human services staff, behavioral health professionals, doctors, law enforcement and other stakeholders from the community. The coalition offers a quarterly forum to discuss and identify opportunities to improve how the county responds to the needs of people with mental illnesses who are involved in the justice system and to strengthen existing efforts. MHDD provides law enforcement with trainings at least twice a year on topics related to behavioral health and resources available in the community.
Berks County is also building on the energy and action within the county to respond to the opioid epidemic. The county created an opioid coalition, which is co-chaired by Berks County Commissioner Kevin Barnhardt. In partnership with the Council on Chemical Abuse—a nonprofit that administers, manages and coordinates publicly funded alcohol and drug services on behalf of Berks County government—two local hospitals have a warm hand-off protocol for helping people who survive an opioid overdose access treatment and recovery services. The coalition has prioritized data as part of its effort to prevent overdose deaths and educate the community about addiction and the availability of services.
Moving Forward and Advancing New Ideas
Ultimately, Berks County wants to better understand how it uses its financial resources to provide behavioral health services and where the opportunities are to improve efficiency by expanding how data systems communicate. In preparing for the Design Institute, the county completed two cases studies on individuals who are known anecdotally to different county systems. The case study exercise offered a window into where coordination and communication can be improved, which has led to a greater need to understand the county’s data capabilities. This includes what and how data are collected, how they are represented in systems and what quality issues exist.
The county is also looking at who owns data that will help identify frequent utilizers and their service needs. For example, Berks County owns behavioral health Medicaid data through its role as a behavioral health managed care organization in Pennsylvania’s HealthChoices medical assistance program. Some of the data is collected by SAM as the Base Service Unit, which is defined by state law and facilitates and coordinates treatment from the initial intake to the conclusion of services. At the same time, the county acknowledges that because participation in treatment and services is voluntary, identifying individual high utilizers will require the use of comprehensive data from across the span of services and resources in the county. The county’s IS department is leading efforts to educate data owners throughout the county on the importance of data sharing, data quality and integration.
Moreover, the county wants to design a data-driven system that not only identifies high utilizers, but also can distinguish between levels of acuity and reveal individuals who need the most immediate attention and highest level of services. While program data can be revealing, a person’s engagement in services or a treatment plan does not mean that he or she has the severest of symptoms. Berks County would like an information system that could aggregate service consumption data and model how different groups of consumers cycle through services.
In preparation of designing a high-functioning data system, the county is working on enhancing its data governance strategy. As part of its strategy, the county is going through the process of ensuring that employees receive proper training and that the necessary documentation and data controls are in place. One way this is being achieved is through a HIPAA compliance exercise to better understand how data are collected, stored, accessed and used. The results of this exercise will then be used as foundation on which to manage data in ways that comply with state laws, which are stricter than HIPAA. To work through the compliance exercise, the county is using the same outside legal counsel that it has previously worked with on some of its health and human services contracts. The county would like to be able to electronically manage and track signed consent forms and releases of information across justice, health and human services departments.
Finally, Berks County is looking at opportunities to use and learn from geospatial data. After becoming familiar with the history of successes in Johnson County, Kan., which are rooted in the county’s Geographic Information Systems (GIS) department and its Automated Information Mapping System, Berks County is involving its GIS Office in its DDJ efforts. Geospatial data can help counties identify where a service need exists, adding a level of information that can aid decisions about what service to offer in the community. For example, service provider and emergency medical system data have geospatial components that could help Berks County discover the areas where frequent utilizers are likely to need services and then deploy resources accordingly.
By participating in the Design Institute, Berks County was able to develop an action plan that further guides its efforts to develop a data-driven system that provides treatment and other supportive services to individuals with mental illnesses and substance abuse disorders who are involved in the justice system. The Design Institute helped leaders identify opportunities to improve communication across systems and use its data more strategically, including refining and strengthening how the county delivers services for the best outcomes.
NACo would like to thank Mental Health and Developmental Disabilities Administrator Dr. Edward B. Michalik, Mental Health and Developmental Disabilities Deputy Administrator for Adults Mary Hennigh and Chief Information Officer Justin Loose for providing information on the county’s efforts.
iU.S. Census Bureau. Quick Facts: Berks County, Pa. https://www.census.gov/quickfacts/fact/table/berkscountypennsylvania/PST045216 (last visited Jan. 31, 2018).
iiU.S. Census Bureau. Urban and Rural Population by State Data, 2010. https://www.census.gov/geo/reference/ua/urban-rural-2010.html (accessed December 21, 2017).Standard