Comprehensive health screenings and more efficient processes at intake leads to quicker diagnoses and treatment; greater coordination within correctional and community health systems. 

New York, NY— The Vera Institute of Justice (Vera) and NYC Health + Hospitals’ Division of Correctional Health Services (CHS) today announced findings from their 2015-2016 pilot program The Enhanced Pre-Arraignment Screening Unit (EPASU), demonstrating increased capacity to deliver medical care to people moving through the arrest-to-arraignment process, coordinate health services across correctional and community settings, and bolster diversion efforts for people with behavioral health needs. The pilot and study, The Enhanced Pre-Arraignment Screening Unit (EPASU): Improving Health Services and Diversion Opportunities in Manhattan Central Booking, were made possible in part through the support of the Jacob and Valeria Langeloth Foundation.

“The results of the pilot program are clear: more adequate medical screening is necessary to address health disparities across the justice system and reduce the overrepresentation of people with physical and behavioral health needs in our city’s jails,” said Jim Parsons, research director and vice president at Vera. “We know that alternatives to incarceration work—they remove burdens from an encumbered criminal justice system while also providing opportunity and better outcomes for individuals, families and whole communities. The EPASU provides a model that can be expanded to provide a smarter and more just process for New Yorkers.”

“This pilot program is among the innovative strategies outlined in Mayor de Blasio’s Task Force on Behavioral Health and the Criminal Justice System Action Plan, spearheaded by the Mayor’s Office of Criminal Justice, to increase diversion opportunities for people with substance abuse and mental health disorders, and reduce over-incarceration,” said Leah Pope, acting director of Vera’s Substance Use and Mental Health program. “We know that our courts and correctional agencies serve as default health care providers for underserved and uninsured New Yorkers who enter the criminal justice system, and we also know that jail is no place to address or solve these problems. Creating a more efficient system, and getting people the kind of health and support services they need, not only increases positive long-term health outcomes, it decreases the chances that these individuals will return to the criminal justice system.”

“The EPASU demonstrates that quality medical care in the correctional setting can begin before an individual even arrives in jail,” said Dr. Patsy Yang, senior vice president of Health + Hospitals for Correctional Health Services. “Gaining this critical medical and behavioral health information prior to arraignment further improves our ability to support diversion to alternatives to incarceration and expedite patients who do come to jail with urgent health concerns.”

In 2014, the Mayor’s Office of Criminal Justice’s Task Force published the Action Plan to provide a roadmap for decreasing the number of people with behavioral health issues in the criminal justice system. The plan, which is part of a 4-year, $130 million investment, will develop initiatives to reduce unnecessary arrests and incarceration. 

Elizabeth Glazer, director of the Mayor's Office of Criminal Justice said, “We are grateful to Vera and the NYC Health + Hospitals’ Division of Correctional Health Services for their leadership in providing the grounded research that helps the city and its partners to link individuals with services that can reduce justice involvement and improve health and wellbeing. We look forward to learning from the study released today and to use its findings to further reduce our jail population.”

The Pilot

Prior to being arraigned, a person charged with a crime in New York City must go through a medical screening at one of four central booking facilities in New York City to determine a defendant’s health status and provide care if needed. This is a critical juncture in the adjudication process and opportune for prevention, intervention, and diversion. The EPASU was developed over a 12-month planning process and implemented in the Manhattan Central Booking facility in May 2015. Vera and CHS conducted a process evaluation of the pilot from May 2015 through October 2016. As of November 2016, the EPASU offers its services around the clock in Manhattan Central Booking. The EPASU pilot was operational eight hours a day, five days a week. Since moving to coverage 24 hours a day, seven days a week, CHS has conducted over 35,000 screenings—referring approximately 25 percent for a more in-depth health encounter, and likely avoiding an unnecessary hospital run.

The EPASU program model included replacing the utilization of emergency medical technicians (EMTs)—who performed assessments to identify emergent medical needs—with a team comprised of a patient care associate, a nurse practitioner, and a licensed social worker. 

Additionally, the EPASU implemented a web-based health screening tool allowing the team to ask a wider range of questions, and garner more information to detect physical and behavioral health needs. This data sharing technology, along with access to public health databases, allowed health practitioners to build health histories in real time, at the point of service, and provide better care for patients.

The expanded capacity also reduced hundreds of hours of hospital emergency room visits among arrested people and accompanying police officers. Sixty-one percent of police officers who were involved with the pilot program said they were “very satisfied” with the program’s ability to avoid police-escorted trips to hospitals, which monopolizes police resources on a day-to-day basis. An estimated 601 trips from central booking to an emergency room were avoided during the pilot period.

Moreover, the EPASU social worker, who served as diversion liaison, screened individuals for behavioral health issues and prepared clinical summaries used to identify candidates for diversion to community-based programs in lieu of jail. The diversion liaison was a new component of the EPASU model, as this role didn’t exist in the FDNY model. Over the course of both the pilot and the expansion, CHS has shared nearly 2,000 clinical summaries with legal defense groups to assist in their clients’ advocacy.

More than half of public defenders reported that the clinical summaries were useful in post-arraignment stages, while more than a quarter found them useful at arraignments. Electronic screening tools were considered pivotal for successfully advocating for bail, diversion, or dismissal, while helping to ensure that arrested individuals were connected to appropriate supports.

Key data findings from the study of the pilot period include:

• EPASU clinicians saw 10,796 patients in the study period, an average of 149 patients each week.
• People passing through Manhattan’s central booking experience significant physical health needs; 7 percent of people screened reported having asthma, 4 percent reported having heart problems, and 1,532 patients (14 percent of those screened) reported having been in the hospital or emergency room in the week prior to arrest.
• EPASU screening data revealed high frequencies of self-reported substance use and mental health needs among patients; 4 percent of people reported having been prescribed psychiatric medication in the past three months and nearly 9 percent reported daily alcohol use.

The assessment of the pilot program included a mixed-method approach that combined quantitative and qualitative strategies, drawing on analyses of administrative data, in-depth interviews, surveys, and focus groups with key stakeholders.

About The Vera Institute of Justice

The Vera Institute of Justice is a justice reform change agent. Vera produces ideas, analysis, and research that inspire change in the systems people rely upon for safety and justice, and works in close partnership with government and civic leaders to implement it. Vera is currently pursuing core priorities of ending the misuse of jails, transforming conditions of confinement, and ensuring that justice systems more effectively serve America’s increasingly diverse communities.

For more information, visit www.vera.org.

To read this report, visit http://www.vera.org/Manhattan-EPASU-pilot-evaluation  

About the Authors

David Cloud is a senior program associate in Vera’s Substance Use and Mental Health Program. His work broadly focuses on the implications of mass incarceration for community health disparities and the role of public health systems in advancing justice reform. Currently, he is leading Vera’s partnership with NYC Health + Hospitals on the development and evaluation of a pilot to bolster medical treatments, healthcare triage, and jail diversion in Manhattan Central Booking. Prior to coming to Vera, David worked at the Center for Court Innovation researching constitutional and ethical issues arising in adult mental health courts. He has a JD from Villanova Law School, an MPH from Columbia University, and is completing a PhD in Behavioral Sciences and Health Education at Emory University.

Anne Siegler is director of surveillance and epidemiology in the Division of Correctional Health Services at NYC Health + Hospitals. Anne has worked in AIDS services for 13 years, and harm reduction specifically for eight years. She has direct experience serving individuals with substance use histories and HIV, as well as providing technical assistance to AIDS service providers. She served as harm reduction coordinator and evaluator in the Bureau of Alcohol, Drug Use, Prevention, Care, and Treatment at the NYC Department of Health and Mental Hygiene (DOHMH), overseeing all syringe exchange and overdose prevention activities, developing evaluation plans, and overseeing the evaluation of substance use services.

Michelle Martelle is the senior associate director of health information and insurance in the Division of Correctional Health Services at NYC Health + Hospitals. In this role she heads efforts to extend Medicaid coverage to individuals in NYC jails and ensure continuity of care between jail and community settings. Michelle has led a variety of projects bridging health care between community and criminal justice settings including the design and implementation of the Enhanced Pre-Arraignment Screening Unit in Manhattan Central Booking as well as the implementation of electronic health information exchange in NYC jails. Prior to joining Correctional Health Services, she worked with the Primary Care Information Project at the NYC Health Department, where she helped community health centers use electronic health records to improve quality and manage patient populations. She has an MPH from New York University and a BA in Business Administration from the University of Vermont.

Leah Pope is an anthropologist who joined Vera in 2016 as a senior research associate in the Substance Use and Mental Health Program, and currently serves as its acting director. Leah brings with her extensive experience in qualitative and mixed methods research in the fields of public mental health and criminal and juvenile justice. Her current work at Vera includes developing a policy brief on how criminal justice systems are thinking about and responding to the opiate epidemic, and implementing and evaluating a sentinel events review process at Rikers Island jail aimed at reducing incidents of suicide and self-harm. Prior to joining Vera, Leah was a research scientist at the Nathan Kline Institute for Psychiatric Research where she worked on a process and outcome evaluation of Parachute NYC, a citywide approach to providing a “soft landing” for people experiencing a psychiatric crisis.

Jim Parsons is the vice president and research director for Vera, responsible for shaping Vera’s research agenda and working closely with practitioners, government officials, and partner institutions to implement research findings. Jim joined Vera in March 2003. He previously served as both the director of the Substance Use and Mental Health Program and research director of the International Program. His work has included studies measuring the overlap of mental illness and incarceration in New York City and Washington, DC; the provision of jail-to-community reentry services in New York City and Los Angeles; an evaluation of the implementation and impacts of drug law reforms in New York City; and an ongoing study of the challenges that people with serious mental health disorders face accessing effective legal defense representation.

About NYC Health + Hospitals’ Division of Correctional Health Services (CHS)

With over 60,000 admissions per year and an average daily population of 9,400 in 12 jails citywide—nine of which are located on Rikers Island—the NYC jail system is among the largest in the nation. Correctional Health Services (CHS) is a Division of NYC Health + Hospitals, the nation’s largest and oldest public health care delivery system. CHS provides medical and behavioral health care, dental care, social work services, discharge planning and re-entry services 24-hours a day, 7-days a week in the city’s jails. As a national leader in the delivery of health care to the justice-involved population, CHS has successfully implemented a number of initiatives, including leveraging the resources of NYC Health + Hospitals to improve the quality of and access to care before, during, and after incarceration. CHS is an essential partner in the city’s efforts to create new avenues for diversion, reduce recidivism and decrease the overall jail population. It is a smart, nimble multidisciplinary team of 1,500 professionals committed to human rights, social justice, and accessible quality health services for patients while they are in the city’s care and as they re-enter the community.

The Jacob and Valeria Langeloth Foundation

The Pre-Arraignment Screening Unit initiative and Vera’s process evaluation were supported by the Jacob and Valeria Langeloth Foundation (Project #2693). The foundation’s grant-making program is centered on the concepts of health and well-being. The foundation’s purpose is to promote and support effective and creative programs, practices, and policies related to healing from illness, accident, physical, social, or emotional trauma, and to extend the availability of programs that promote healing to underserved populations.