Lucas County, Ohio
Urban/Rural Population: 95.3 percent/4.7 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 develop actions plans for developing and using integrated data systems that would aid 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 an array of connected efforts, Lucas County is developing a comprehensive system that can respond to the different needs of the justice-involved population. The county’s overarching goal is to create a fairer and more just criminal justice system, while simultaneously ensuring community safety. Toward that end, the county’s immediate objectives are to reduce recidivism and use jail and diversion options appropriately, especially for individuals with behavioral health needs.
The Lucas County Board of Commissioners plays an active role in efforts to reduce the jail population and forge collaboration between the justice and behavioral health systems. For example, Commissioner Carol Contrada serves as the treasurer for the Toledo-Lucas County Criminal Justice Coordinating Council (CJCC) and leads the county’s efforts in the Safety and Justice Challenge, and Commissioner Tina Skeldon-Wozniak convened a behavioral health working group to explore alternatives to jail for people with behavioral health needs. The county has decided to build a smaller jail to replace its current facility. To plan for a smaller jail population, the county is working to develop and expand the scope of services offered in the community. When the appropriate community-based services are in place to address the social and health conditions of individuals who frequently cycle through the jail system, diversion can be utilized more often as the appropriate response to people with behavioral health needs.
By attending the Design Institute, Lucas County identified two priorities that will help leaders build a system of diversion and advance their efforts on Data-Driven Justice (DDJ), a national initiative involving over 140 county, city and state governments working to reduce the frequent and repeat cycling of high utilizers—also called frequent utilizers—with mental illnesses, substance abuse disorders and chronic health conditions through jails, emergency rooms, homeless shelters and other crisis services. The county’s top priority is to engage stakeholders and develop the networks and partnerships that are foundational for bringing together the justice and behavioral health systems. The second priority the county identified is to do a “deep dive” into its systems and develop an understanding of how high utilizers interact with and use the various service and resource systems.
Using data to identify opportunities for new approaches to justice system operations is a central component of DDJ and Lucas County’s criminal justice reform efforts. Unique to Lucas County is the Northwest Ohio Regional Information System (NORIS). NORIS stores data from law enforcement, courts, probation and corrections, acting as a central repository for criminal justice information in not only Lucas County, but also from 21 other counties in Ohio and Michigan. An important feature in NORIS is the regional identifier, which is a unique identifier that links information about a person in the system across users and agencies. The CJCC oversees NORIS and the NORIS Advisory Council and NORIS User Group provide direction on projects and issues related to operations, procedures and technology. The system houses more than 100 million information records.
Making Progress by Leveraging Resources and Relationships
NORIS provides the technology for the county’s efforts to improve information sharing, better integrate the justice and behavioral health systems and implement new practices that will span across sectors and services. Currently, Crisis Intervention Team (CIT) officers with the Toledo Police Department can enter CIT-specific information into NORIS such as de-escalation techniques used and whether the person self-reported a history of mental illness and/or substance abuse. The county’s vision is to use NORIS to facilitate the sharing of information collected from hospitals and the homeless and 911 systems. The data would then be used to identify the individuals who repeatedly cycle through the jail and develop mechanisms to track their connections to services and identify the impact of services on reducing recidivism.
Ideally, the information system envisioned would also go beyond identifying a target population like high utilizers and be used more widely to identify where behavioral health and justice systems overlap. Some examples of the types of information system capabilities Lucas County is looking to develop include equipping law enforcement with access to some behavioral health information so that they arrive on scene ready with an appropriate response to individuals, providing law enforcement and the corrections systems with information to support diversion to treatment and mental health services instead of jail during the booking process and improving sentencing decisions by providing judges with mental health information in order to increase the use of treatment over jail.
By planning for cross-system information sharing, Lucas County is building a process to create and maintain information that will be critical for enhancing and improving the responses and services available to the county’s high utilizers. The county jail provides a daily data feed to the Lucas County Mental Health and Recovery Services Board (LCMHRSB) of all bookings and the 911 system automatically communicates data on law enforcement calls for service to NORIS. To expand information-sharing, the CJCC identified 20 individuals with the most frequent jail bookings to begin the process of understanding how these frequent utilizers interact with different systems and services. That list was shared with the 911 system, LCMHRSB and the Toledo Lucas County Homelessness Board to begin the process of identifying individuals who appear in all of these systems.
Holly Matthews, CJCC Executive Director, describes Lucas County’s strategy for implementing a system that can identify and respond to high utilizers as a “phased approach.” In the short-term, the county is developing the proof of concept and evidence demonstrating the value and impact of providing comprehensive services to high-need, high-cost individuals who appear in multiple systems.
Eventually the county would like to engage the hospitals in the area, with the hope that a partnership could reduce emergency room use and hospital admissions among high-utilizers. One of the largest hospitals in the county recently moved into the downtown area of Toledo from a suburban setting, giving it a firsthand look at homelessness and the needs of the frequent utilizer population. The move may be a window of opportunity for Lucas County to engage the hospital in this process because the homeless population has a direct impact on the hospital’s day-to-day business operations. Additionally, the CJCC is looking at engaging the Hospital Council of Northwest Ohio, which is a regional association that provides collaborative opportunities for its hospital and health care members and community partners to improve health and well-being among the region’s residents. The county believes that if hospital leadership is on board with identifying and diverting high utilizers, it may be easier to have discussions related to data-sharing and the Health Insurance Portability and Accountability Act (HIPAA).
Moving Forward and Advancing New Ideas
A priority for Lucas County is the development of a deflection center for people with behavioral health needs who might otherwise end up in the justice system. The county is currently seeking funding for completion of this center and hopes to open it in 2019, but already has in place a host of services to meet individuals’ various mental health needs. Resources include an urgent care center for psychiatric services and a crisis stabilization center. LCMHRSB funds the psychiatric urgent care center, which is open 10 hours a day, and center clinicians can prescribe medication to individuals when necessary. The county anticipates that engaging more people in treatment and services will decrease the use of jail when someone is in crisis and therefore help reduce the jail population overall.
The Opportunity Project is another program the county will be using to engage individuals in treatment. The Opportunity Project is a joint venture between the Public Defender’s Office, the court system, LCMHRSB, the CJCC and the Board of Commissioners to target pretrial felony defendants who are pre-arraignment or have been arraigned but have not returned to court for disposition. To better use the time between arraignment and disposition, which is usually 10 days, a social worker is paired with a public defender to identify the services individuals need and develop a plan for engaging them in those services. The public defender can then present the plan to the judge and proactively demonstrate that the defendant is committed to participating in treatment to address his or her behavioral health needs.
In order to coordinate work across the justice and behavioral health systems in Lucas County, the county created the Behavioral Health/Criminal Justice Coordinator position. The coordinator will be the point person for the county on its behavioral health and justice initiatives, including information sharing, the deflection center and the Opportunity Project. The position is a partnership between the CJCC and LCMHRSB and the coordinator will guide the planning, development, analysis and evaluation of cross-system activities to identify gaps and improve coordination across systems.
Participating in the Design Institute reinvigorated Lucas County’s efforts to develop a coordinated system that can divert high utilizers and other individuals with behavioral health needs from the jail. Coupled with the county’s existing information system and its new capacity to coordinate services and resources between the justice and behavioral health systems, the Design Institute gave momentum to efforts that have been years in the making.
NACo would like to thank Toledo-Lucas County Criminal Justice Coordinating Council Executive Director Holly Matthews for sharing information on the county’s efforts.
iU.S. Census Bureau. QuickFacts: Lucas County, Ohio. https://www.census.gov/quickfacts/fact/table/lucascountyohio/PST045216 (accessed February 13, 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