Vera Institute of Justice, NYC Health + Hospitals Correctional Health Services' Enhanced Pre-Arraignment Screening Unit (EPASU) Demonstrates Potential for Improved Medical Care and Diversion Opportunities among Arrested Individuals
Comprehensive health screenings and more efficient processes at intake leads to quicker diagnoses and treatment; greater coordination within correctional and community health systems.
Sep 20, 2017
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 the 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 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 twelve-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, 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 screen 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.