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Improving Outcomes through Coordinated Health and Justice Systems
FFI Case Study: Minnehaha County, South Dakota

As a member of the Familiar Faces Initiative, Stepping Up and the Safety and Justice Challenge, Minnehaha County leverages multiple opportunities to develop strategies that meet the needs of familiar faces – high-needs residents with complex behavioral health conditions who frequently cycle through jails, homeless shelters, emergency departments and other crisis services. These strategies also reduce the county’s reliance on the county jail and emergency medical services.

Minnehaha County sits in the southeast corner of South Dakota and is home to the state’s largest city, Sioux Falls. The county supports familiar faces through a ‘whole person’ approach that seeks to address all the social determinants of health—including medical, behavioral and socioeconomic needs. This case study highlights Minnehaha County’s actions to address service gaps in the community and improve outcomes for familiar faces.

Alliance Reentry Program

Minnehaha County health and justice stakeholders found that their familiar faces in the jail system were being released with minimal to no support and often quickly returning to jail. In response, the Minnehaha County Department of Human Services (DHS) developed and continues to staff a jail reentry program, Alliance, which provides intensive case management for familiar faces that is available on a voluntary or referral basis. Alliance staff build rapport with their clients, determine their needs and connect them to employment, housing and other services. There is no time limit on participation and some individuals stabilize within a few months, while others remain lifelong clients.

Recognizing multiple systems at play, DHS Alliance staff developed the Coordinated Assessment Reentry Team (CART). CART is a multi-disciplinary team of county, jail, community medical and health centers and other service providers who work with Alliance staff to ensure treatment engagement. Alliance convenes CART weekly to identify potential clients and connect them to the appropriate providers in the community or in the jail. The provider determines the individual’s treatment and service needs, develops a plan and initiates services which include jail discharge planning to ensure engagement with treatment after release. Alliance tracks and shares client progress through the weekly CART meetings and staff follow up with clients as needed to ensure consistent engagement.

Safe Home

Minnehaha County provides long-term housing for chronically homeless familiar faces with alcohol addiction through a Housing First model. Project Safe Home is designed to provide long-term housing, case management and other supportive services to these community members.[v]

“Safe Home has enabled residents to live with dignity and respect as a person deserving of services.” – Kari Benz, Director, Department of Human Services, Minnehaha County, S.D.

Minnehaha County commissioners collaborated with former U.S. Sen. Tim Johnson (D-S.D.) on the initial grant to build Safe Home. First opened in 2011, Safe Home is a 33-unit building where residents pay a monthly rental fee and adhere to facility rules through a point system to remain in their housing unit. Minnehaha County spends approximately $30,000 in services for each homeless individual on an annual basis.[vi] Using that figure, Safe Home estimates saving taxpayers approximately $1 million annually in cost avoidance of county resources such as law enforcement, jails, ambulances and emergency departments.

Community Triage Center

Despite collaboration to support familiar faces, Minnehaha County had limited alternative response options to their jail. The county contracted with a local university to develop a baseline report investigating the need for and feasibility of establishing a community triage center (CTC). Based on the report findings, the county mobilized various stakeholders through policy and operations committees to develop a CTC conceptual plan.[i] The staffing and activities of the planning phase were supported by grants from the MacArthur Foundation’s Safety and Justice Challenge and the State of South Dakota.[ii] Local and national donors contributed to construction for the CTC. [iii] Minnehaha County Commissioner Dean Karsky, Sioux Falls Mayor Paul TenHaken and the Chief Executive Officers of each area hospital serve as the founding members of The Link, and the four entities have committed 100 percent of the operating funds through 2024.

The Minnehaha County CTC, ‘The Link,’ officially opened its doors in June 2021. The Link provides a voluntary, 24 hours a day, seven days a week option for community members experiencing a behavioral health emergency and also serves as an alternative to jail in appropriate cases. The Link is staffed by a care team of nurses, case managers, counselors and peer support specialists. From June to December 2021, Link staff supported residents with 2,332 triages with 20 percent of clients accepting referrals to other services. The Link and Alliance also formed a collaborative team specifically to provide coordination for familiar faces across the jail and The Link.

“I’m very thankful for this program, it’s helping save my life.”[iv] – Link Patient

Data Sharing

The Link, the two major hospitals, the county jail and DHS signed agreements to enable data sharing for coordination and tracking progress. Data from each entity is de-identified and pulled into a database. The Alliance team uses the database to review jail bookings and emergency department visits for familiar faces to track progress with the various local initiatives and programs.

In addition, the warden of the county jail granted DHS limited permissions to the jail software to see who is in jail, the charges and release dates. This enables the Alliance team to take quicker action in meeting clients at discharge, which ensures access to clients and service provision.

Advancing Next Steps

Minnehaha County received a third grant in 2021 from the MacArthur Foundation to focus on reducing racial and ethnic disparities in the county justice system, as well as enhancing data tracking across systems. The intent is to match individuals across county and city systems to identify familiar faces and measure utilization patterns to inform planning for future services. [vii]

NACo would like to thank Kari Benz, Director of the Department of Human Services, Minnehaha County, South Dakota and Erin Srstka, Director of the Center for Rural Health Improvement at the University of South Dakota, Sanford School of Medicine for sharing information on Minnehaha County. Ms. Benz can be reached at kbenz@minnehahacounty.org and Ms. Srstka can be reached at Erin.Srstka@usd.edu.

This case study was created with support from Arnold Ventures as part of the Familiar Faces Initiative, seeking better outcomes and lower incarceration rates for individuals who frequently cycle through jails, homeless shelters, emergency departments and other local crisis services.

[i] Minnehaha County Commission Office. Community Triage Center Project Reports: Community Triage Center Baseline Report. https://www.minnehahacounty.org/ctcp/reports/reports.php

[ii] Minnehaha County Commission Office. Community Triage Center Project. https://www.minnehahacounty.org/ctcp/ctcp.php.

[iii] Staff Writer. “With final donation, community triage center approaches opening.” Sioux Falls, 12 February, 2021, https://www.siouxfalls.business/with-final-donation-community-triage-center-approaches-opening/.

[iv] The Link 2021 Annual Report.

[v] Minnehaha County Department of Human Services. Safe Home. https://www.minnehahacounty.org/dept/hs/safe_home/safe_home.php.

[vi] Baumeister, Dave. As weather grows colder, Minnehaha County Safe Home gives local people permanent place to live. Garretson Gazette, 4 December 2019, https://www.garretsongazette.com/as-weather-grows-colder-minnehaha-county-safe-home-gives-local-people-permanent-place-to-live/.

[vii] Ferguson, Danielle. “Minnehaha County uses $700k grant to focus on racial, ethnic inequities in justice system.” Argus Leader, 16 March 2021, https://www.argusleader.com/story/news/2021/03/16/minnehaha-county-uses-700-k-grant-focus-racial-ethnic-inequities-justice-system/4715081001/.