Archive for Humane Exposures

Study:Psychotropic Medication after Prison Release Linked to Less Violent Reoffending

Among released prisoners in Sweden, rates of violent reoffending were lower during periods when individuals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders, compared with periods in which they were not dispensed these medications, according to a study appearing in the November 1 issue of JAMA.

There were more than 10 million prisoners worldwide in 2015, with


approximately 2.2 million in the United States alone. Despite reported decreases in violence in many countries, reoffending rates remain high. From 2005 through 2010, more than one-third of released prisoners in the United States and the United Kingdom were reconvicted of a new crime within 2 years. Most programs to reduce reoffending focus on psychosocial interventions, but their effect sizes are weak to moderate.

As psychiatric and substance use disorders, which increase reoffending rates, are overrepresented among jail and prison populations, treatment with appropriate psychotropic medications offers an alternative strategy to reduce reoffending, although there is uncertainty about whether pharmacological treatments reduce reoffending risk.

Seena Fazel, M.D., of the University of Oxford, England, and colleagues examined the associations between major classes of psychotropic medications and violent reoffending. The study included all released prisoners in Sweden from July 2005 to December 2010, through linkage of population-based registers. Rates of violent reoffending during medicated periods (dispensed prescription of psychotropic medications [antipsychotics, antidepressants, psychostimulants, drugs used in addictive disorders, and antiepileptic drugs]) were compared with rates during nonmedicated periods. Prison-based psychological treatments were also included in the analysis.

The study included 22,275 released prisoners (average age, 38 years; 92 percent male). During follow-up (median, 4.6 years), 4,031 individuals (18 percent) had 5,653 violent reoffenses. The researchers found that three classes of psychotropic medications were associated with substantial reductions in violent reoffending: antipsychotics, a 42 percent reduction; psychostimulants, 38 percent; and drugs used in addictive disorders, a 52 percent reduction. In contrast, antidepressants and antiepileptics were not significantly associated with violent reoffending rates.

Analyses also demonstrated that completion of psychological treatmentstargeting general criminal attitudes and substance abuse was associated with reductions in violent reoffending. The associations with these psychological programs were not stronger than those for medications.

The study added:

These findings may have implications for risk management, because prison psychological programs need appropriate facilities, require sufficiently trained and supervised therapists, and are likely to be relatively expensive. Provision of medication after prison release needs evaluation as a possibly cost-effective crime reduction alternative. Because prisoners with psychiatric disorders benefit from both pharmacological and psychological treatments, research should investigate whether combining therapies improves outcomes.

“The absolute numbers of prisoners with psychiatric disorders are large worldwide, and most individuals who could benefit from psychotropic treatment do not receive it after prison release. The magnitudes of the associations reported in this study may warrant correctional services to review policies for released prisoners. Evidence-based provision of psychotropic medications to released prisoners may have the potential to make substantial improvements to public health and safety, particularly in countries that are undergoing decarceration [reducing the number of persons imprisoned or the rate of imprisonment].

© Humane Exposures / Susan Madden Lankford

Some States Now Realize Youth Prisons Don’t Work

About 50,000 youth are caught in a system that disproportionately imprisons African Americans and Latinos. Some teens, including Dequan Jackson, are kept behind bars not because they are a danger to society but because they cannot afford court fees. Others experience appalling treatment: just last month in Kentucky, staff allegedly stood idly by as a 16-year-old had a seizure and died in custody. Far too often, juvenile offenders are housed in facilities—like Wisconsin’s Lincoln Hills, which is under federal investigation for abuse—that could leave them worse off.

These stories are heartbreaking, but they need not be disheartening. Coupled with awareness of the problems should be awareness of the tremendous progress being made to change the way our juvenile justice system operates. Advocates across the country are hard at work to create more effective, humane alternatives that will help young offenders stay out of the criminal justice system as adults.

In response to calls for change, legislators and governors in states including Virginia, Kansas and Connecticut have committed to closing some of the worst youth prison facilities in their states, while reinvesting in community-based solutions that actually rehabilitate youth.

Photo by Susan Madden Lankford

Photo by Susan Madden Lankford

In Virginia, RISE for Youth advocacy group has earned bipartisan support in the state legislature to close massive, outdated youth prisons and reinvest the money saved into more effective community-based programs. Advocates are working to ensure the closure of other youth prison complexes and instead offer young Virginians a real shot at rehabilitation and a brighter future.

A similar effort is underway in Kansas, where Kansans United for Youth Justice helped ensure the passage of comprehensive reform legislation to reduce the use of incarceration and redirect funds to evidence- and community-based approaches. The Kansas Department of Corrections has also announced plans to close the Larned youth facility, one of the state’s two youth prisons.

Connecticut Governor Dannel Malloy has similarly pledged to close the state’s youth prison, and the advocacy group Connecticut Juvenile Justice Alliance is working to ensure that a plan is in place to offer community-based care and rehabilitation to young people moving forward. And following recent reports of sexual assault at the Lincoln Hills facility in Irma, Wisc., Youth Justice Milwaukee is working with allies to provide recommendations for bringing local youth home.

Mishi Faruqee, National Field Director of the Youth First Initiative says:

Youth prisons are an outdated approach to rehabilitation that too often includes physical and sexual abuse, neglect and isolation. These facilities tear young people away from the schools, families and faith communities where they can find the support and services they need for success. Instead of nurturing responsible citizens, youth prisons risk systemically traumatizing youth and leaving them less able to find employment, have healthy relationships, get an education and lead productive lives.

This system is not just failing our young people and their families; it’s also incredibly expensive for taxpayers. In Virginia, it costs $142,000 per year to incarcerate just one young person. And 75% of incarcerated young people end up back in the system within a few years, which exacerbates the human and economic costs. Meanwhile, Youth Advocate Programs which offer services in homes and community settings cost significantly less—about $27,000 a year—and allow youth to stay arrest-free throughout their participation.

States from coast to coast could see a major reduction in costs associated with the juvenile justice system if youth prisons—which eat up billions of dollars each year—were shuttered in favor of alternatives that rehabilitate youth while promoting public safety. Fortunately, some elected officials are beginning to understand this reality, and increased public pressure can help swell their ranks.

We have a real opportunity to build on the progress being made in these states in every jurisdiction across the country. We owe it to young people and their families to invest in community-based interventions that actually work. The models are there. It’s time to replicate and build on them to give young people access to services and supports that will keep us all safer. We can’t afford not to.

© Humane Exposures / Susan Madden Lankford

Seattle Sees How Mass. Alloted $50 Million to Cut Chronic Homelessness, with Some Success

Roger Valdez, Director of Smart Growth Seattle,

Photo by  Susan Madden Lankford

Photo by
Susan Madden Lankford

talked last week with Jeff Hayward, Chief of External Affairs of the United Way of Massachusetts Bay and Merrimack Valley about their Pay for Success Initiative. He says, “What Pay for Success does is identify the hardest to serve homeless people and leverage private and public dollars along with coordination to get as many as possible housed. The program just started about 18 months ago, but it sounds like it has promise. Here’s how it works.

Former Massachusetts governor, Deval Patrick, set aside $50 million in the state budget to back investment in a collaborative effort to reduce chronic homelessness. 

According to Hayward, there are 1590 people who, by the State’s count, fit the definition. A non-profit alliance was formed by the United Way, the Massachusetts Housing and Shelter Alliance and the Corporation for Supportive Housing called the Massachusetts Alliance for Supportive Housing (MASH) to implement the program and promised to reduce that number by half in exchange for $6 million dollars from the state, $1 million in donations, and $2.5 million in borrowed money. The rest of the funding for the program will come from $11 million in dedicated vouchers for people qualified for the program and $7 million in Medicaid funding for health services provided once people are housed. All together the program is budgeted at $27 million for the six years.


Using what Hayward calls a ‘tested intervention,’ the Community Support Program for People Experiencing Chronic Homelessness (CSPECH), an intensive case management approach to moving people who can’t seem to get off the streets into housing, these ‘high utilizers’ of emergency rooms and other publicly funded services are the most in need but also create the highest costs for local and state government. Moving them in to stable housing would not only solve a serious human problem but also allow more resources to be moved to other people struggling with homelessness.

Valdez explained:

The idea is to work with non-profit service providers who are already in contact with chronically homeless people and allow them to screen and qualify people for the program. Once a person is identified and screened they are moved into a low-threshold housing situation along with case management and health services. If the person stays housed for exactly one year, the program can access the $6 million in funding to help offset the costs of the program. Much of the funding comes from reprioritizing vouchers and Medicaid services ($11 million and $7 million respectively). So this isn’t actually new money, but a prioritization of those resources for the program and the goal of halving the number of chronically homeless. Hayward says they’ve already got over 300 people enrolled in the program.

The additional dollars incentivized the coordination and prioritization of those existing resources. The extra dollars were the spark that was needed to get the collaborative effort going.

Seattle and other jurisdictions ought to watch Massachusetts closely. Housing vouchers and Medicaid are tried and true sources of real money for housing and health. Putting them together is smart. Adding the promise of dollars to offset administrative and other costs for shifting those resources to chronically homeless people seems like an incentive to organizations who want to solve the problem but just don’t have the resources.

The huge opportunity in resolving stubborn homelessness is quantifying the costs to taxpayers and then investing private dollars to create savings. In Seattle, for example, the Downtown Emergency Service Center built a project called 1811 that created low threshold housing for homeless people who used the emergency room hundreds of nights each year. By giving these people a place to live with no requirements about drinking, the project has saved local government, and tax payers, millions of dollars.

If private investors could pay for the the capital costs of housing up front, then get paid back with this savings plus interest, then a serious and costly human problem could be substantially solved without having to tap into already scarce public resources. Using private capital for public benefit has already been used to great effect to produce lots of housing through the sale of Low Income Housing Tax Credits. But this is a costly system that doesn’t move fast enough. Pay for Success could address the chronic problems of homeless now and generate a return on the investment. It’s worth trying something new to address an old problem.

© Humane Exposures / Susan Madden Lankford


Female Inmate Release Impacts Spread of H.I.V./AIDS

According to “The Global Burden of HIV,  

Photo by Susan Madden Lankford

Photo by Susan Madden Lankford

Hepatitis, and Tuberculosis in Prisoners and Detainees”, a recent study on HIV and incarceration worldwide. mass incarceration, particularly the cycling of people in and out of jails and prisons, has contributed to the spread of not only HIV, but also viral hepatitis and tuberculosis.

The authors estimate that, of the approximately 10.2 million people incarcerated on any given day, 3.8 percent (or 389,000 people) are living with HIV. In the United States, prisons in Florida, Maryland and New York have higher rates of HIV prevalence than any country outside sub-Saharan Africa. At the same time, incarceration in the United States disproportionately impacts people of color, particularly African Americans.

Andrea Wirtz, Ph.D., one of the study’s co-authors and an assistant scientist at Johns Hopkins Bloomberg School of Public Health, is quick to clarify that it’s not that HIV transmission is rampant within U.S. jails and prisons. The availability of antiretroviral therapy in prison actually keeps the risk of transmission low behind bars. The risk arises once people are released and have difficulties continuing their medications. These interruptions mean they are no longer virally suppressed and thus are more at risk of transmission. “It’s right after release that there’s an increased risk of overdose and HIV transmission,” she explained.

Across the globe, over 30 million people are released from prison and return to their home communities each year. It’s the time just after release when the risk of HIV transmission increases. Even a short time behind bars means disruptions in treatment, causing viral loads to increase. Once people are released, their sexual partners or those with whom they inject drugs are at risk for HIV.

The racial disparities of arrest and incarceration — and the accompanying disruption in antiretroviral treatment — put black women in the U.S. at particular risk. Chris Beyrer, M.D., another of the study’s co-authors and a professor at Johns Hopkins University, noted that, despite having lower levels of individual sexual risk, African-American women are five times more likely to become HIV positive than Latina or white women. “So how do we understand that?” he asked a media delegation from Black AIDS Institute at the 2016 International AIDS Conference. One underlying driver is the mass incarceration of African-American men and the interruptions in treatment upon release, he said. “People are sometimes released with three days’ worth of antivirals [and told,] ‘Be sure to follow up and get your appointment’. How likely is that to happen?”

But not just post-prison sex increases women’s risk. Women in jails and prisons face a higher risk of infection than both their male counterparts and non-criminalized women. In most regions of the world, HIV prevalence is higher for women behind bars than their male counterparts.  The New York City Department of Health found that women incarcerated at Rikers Island, the second largest jail in the country, have a prevalence rate 14 times higher than the city’s general female population.

Nearly 12 percent of women in New York State prisons were living with HIV in 2010, a rate that is more than double that of their imprisoned male counterparts and far above the rate of the general public. The Correctional Association of New York noted that “experiences that lead women to be criminalized and incarcerated, including addiction, being prostituted, engaging in sex work, and experiencing domestic violence and trauma, put women at greater risk for contracting the virus.”

Jack Beck is the director of the Correctional Association’s Prison Visiting Project. Before that, as the senior supervising attorney at the Prisoners’ Rights Project of the Legal Aid Society, he was the lead attorney on a class-action lawsuit on behalf of state prisoners with HIV. That litigation led to the 2009 Department of Health Oversight of HIV/HCV Bill, requiring the NYS Department of Health to review HIV and hepatitis C care in state prisons each year. Initially, the Department found that nearly half of all people with HIV in New York State prisons had not been identified by prison staff, but Beck says that the numbers may now be lower.

New York’s state prison system does not have mandatory HIV testing, Beck explained. Though it offers HIV testing in each of its prisons:

it was the worried well who were getting tested. Those who already knew their status might decide against disclosing to prison medical staff, even if it meant going without their medications. You can’t keep secrets inside. If you’re put on a list of the people going to see the infectious disease doctor, then you’re letting people know that you’re HIV positive.

In prison environments, even today, people living with HIV often face stigma, ostracism and even violence, leading many to prefer foregoing needed treatment.

Outside of prisons, HIV infection is going down, including among injection drug users. “It’s an indication that harm reduction works,” Beck says, referring to the availability of sterile syringes and other services for drug users in New York. Furthermore, the number of people incarcerated solely for drug use has declined.

However, HIV care remains inconsistent throughout New York’s prison system. The Department of Health found that, of those identified, only 75% were receiving treatment. Furthermore, people in prison reported problems getting their medications and sometimes going without medications for up to four months.

Access to treatment frequently stops shortly after a person walks out the prison gates. In New York, which releases between 22,000 and 24,000 people each year, people are supposed to be given two weeks’ worth of medication, known as “walking meds.” Only a few prisons help people enroll in Medicaid before leaving prison; most, however, are left to navigate the process on their own upon release. In Maryland, the majority of the nearly 16,000 people released from jails or prisons between 2014 and 2016 walked out without medical coverage.

But follow-up care is crucial. In New York City, approximately 10,000 people are detained each day on Rikers Island. In 2011, 3.5 percent of those entering a New York City jail self-disclosed as being HIV-positive and another 1.1 percent tested positive through follow-up and care an opt-in HIV testing program. Unlike people in state or federal prisons, the majority of people in jails are awaiting trial or sentencing; a minority may be serving short (less than one year) sentences.

In New York City jails, people with HIV are offered transitional care services, including referrals to community-based care. From 2008 to 2011, the city’s Department of Health conducted follow-up interviews with people who utilized these transitional care services. Researchers found that, six months after their release from Rikers, a greater percentage were taking antiretroviral medications (92.6 percent up from 55.6 percent during the initial interview), were adhering to their medications (93 percent up from 81 percent) and had an undetectable viral load.

But not just access to HIV-related services made the difference, they also found a significant reduction in unstable housing and food insecurity. Noting that the nearly 200 people who were lost to follow-up interviews after release had reported some degree of housing and/or food insecurity, researchers pointed out.

Victoria Law, author of Resistance Behind Bars: The Struggles of Incarcerated Women, said:

Housing instability is a fundamental barrier to successful retention in care for most people since basic needs such as food and housing are typically prioritized over health care needs. In other words, medical care alone is not enough. Addressing all of a client’s most pressing needs, such as housing, substance abuse treatment, and mental health care needs as well as referrals to primary medical care, are core components of this approach.

After examining the impact of incarceration on HIV worldwide, Wirtz and her fellow researchers concluded that one obvious response would be to reduce the prison population:

Mass incarceration of people who inject drugs is a key driver of the ever-growing population of prisoners. Decriminalization of drug use, providing alternatives to incarceration and ensuring access to antiretroviral therapy and opioid agonist therapy behind bars are key to reducing the burden of infections in the world’s prison population — and the communities to which they return.


Michigan Inmates Get Job Training in Vocational Village

Few states have been more aggressive in

AP photo/Carl Osorio

AP photo/Carl Osorio

releasing inmates and diverting offenders than Michigan, where a decade ago, one out of every 200 people was in prison, and penal costs were beginning to crowd out basic government services. After easing parole policies, the state managed to cut its 51,000-plus prison population by about 18 percent. But costs kept surpassing $2 billion a year, in part because too many freed inmates came back after committing new crimes or violating parole or probation rules.

Now Michigan is trying to stop the boomerang effect with a new program that removes soon-to-be-released inmates from the general population and assigns them to an exclusive “vocational village” for job training. The idea is to send them out through the prison gates with marketable skills that lead to a stable job, the kind that will keep them out of trouble long term.

Corrections officials have also ramped up their marketing efforts — attending manufacturing expos to tout inmates’ credentials, coordinating with local workforce-development agencies and inviting business leaders behind prison walls to conduct job interviews.

State Corrections Director Heidi Washington said:

In the village, inmates have some protection and isolation from the pressures of the rest of the prison compound. They are up every day when they’re supposed to be, and they’re engaged in learning and perfecting their skill or their trade all day long.

The system marks a turnabout for a state where the get-tough approach has prevailed for years. But pressure has been growing to punish criminals without punishing taxpayers.

Although Michigan has tried vocational programs in the past, officials believe the opportunities for inmate employment are greater these days because the state’s skilled tradesmen are getting older or left during the Great Recession, and the workforce has tightened in an improving economy. A state website projects nearly 1,600 annual openings for truck drivers, more than 1,100 for machinists and almost 700 for industrial machinery mechanics. The economy that’s growing and there are 100,000 open jobs in the state.

Each year, Michigan releases 10,000 prisoners, but repeat offenders make up nearly 40 percent of those entering the system. That is despite a successful anti-recidivism initiative that was launched more than a decade ago but which was cut back in recent years to save money.

Too many programs “keep people busy but don’t really lead to marketable skills or certificates that would allow individuals to get employment on the outside,” said Lois Davis, a senior policy researcher for the Rand Corp. who studies prison education and job training programs. A 2013 Rand study found that prisoners receiving educational training were 43 percent less likely to reoffend than those who did not.

Jesse Torrez, 41, is among the prisoners who were admitted to vocational housing at the Richard A. Handlon Correctional Facility in Ionia, about 110 miles northwest of Detroit. There, the inmates receive full days of training in high-demand skills such as welding, machining and carpentry.

Torrez, who is imprisoned for unarmed robbery, served two previous prison terms. Each time after release, he said, he reverted to “drinking and drugging” when he could not find steady work. If he lied about his criminal record, the employer would inevitably find out and fire him.

“It was just real tough, due to my past, which I created and am totally accountable for,” said Torrez, a father of five who is hoping to be paroled in 2017 and is being trained in construction trades. He said he has a job waiting for him with a manufacturer.

The vocational push is being driven by Washington, the reform-minded corrections director who took over last year after 17 years at the agency. She revived an inactive automotive-repair program at the Ionia prison, created new plumbing and electrical schooling, and expanded welding and machining offerings. Days are designed to simulate a regular work schedule, not just a few hours of classes.

It is not enough to have the right technical skills, she said. Inmates “need to understand that an employer needs to rely on you — every day, all day. You need to be accountable to be a producer.”

The 225 inmates in the program comprise just a fraction of those paroled annually, but the governor and legislators recently committed more money to launch a second vocational village. Total prison education spending is up nearly $8 million, or 27 percent, from 2011.

Some executives are now open to employing ex-cons, saying it can be smart business.

“We see an untapped talent pool here,” said Mark Miller, president and CEO of Cascade Engineering Inc. in Grand Rapids, which makes automotive parts, trash carts, storage containers and other goods.

Cascade does not ask job applicants about their crimes until they have been extended an offer. Depending on the job, inmates can make between $11.60 to start and $15.15 an hour within a year.

Efforts are underway to lobby 30 other local employers to hire two ex-offenders each and monitor their progress.

Incarceration of Children, Especially Minorities, is Too Common

In the wake of a staggering mass incarceration problem that predicts one in three Black men will be involved in the criminal justice system at some point in his lifetime (in jail, on probation, paroled, or in a halfway house) politicians and civil society organizations frequently overlook


what the so called race to incarcerate means for women and children. That is, while it is true that the United States incarcerates more men than any other nation in the world—the same should be said for women. And children are caught in the spiral too.

Three years ago there were are about 2500 young offenders serving life

sentences without the possibility of parole in the world–all in the United States. Notwithstanding the fact that in 2012, the U.S. Supreme Court ruled that mandatory life sentences without the possibility for parole were unconstitutional for children, thousands remain locked up without the possibility of release. The United Nations issued a report urging reform and noting that incarcerating a youth for life amounts to cruelty and often leads to degrading and inhumane treatment, but the U.S. has failed to act.

Just a decade ago, it was still legal for states to kill children—even though we know that nearly 1 in 9 cases involving the death penalty will amount to a serious reversible error. As Bryan Stevenson recently asked, “imagine if we had that error rate with airplanes” that every ninth flight that took off would crash?”

This election provides a pivotal time to act on mass incarceration, but also the school to prison pipeline and children in the criminal justice system. The mass incarceration of our youth is virtually forgotten about.

One chilling example of backward criminal law policies that involve children is the incarceration of sex trafficked girls. Girls as young as ten and eleven are locked behind bars in the U.S. even though they are the victims who’ve suffered from devastating crimes—rape, sexual assault, sodomy and more.

Some states even have “John Schools” that allow their victimizers to attend what amounts to traffic school for sex offenders. The men who violate these girls go back home to their families, while the girls are locked behind bars. And too frequently children become the victims of sexual assault in our jails. One man recounts his story: the place he was sent to was a “dilapidated house of horrors.” Sometimes, the abuse is inflicted by guards.

Over the past two years, the Defense For Children International and the University of California Irvine Center of Biotechnology and Global Health Policy have taken up a joint initiative to study juvenile incarceration. This combined effort has already produced important research and more is to come. 

Michele Goodwin, Chancellor’s Professor at University of California, Irvine, says:

In our fifty state survey of juvenile detention, we observed racial disparities throughout the U.S. We also shine a light on female juvenile incarceration, a topic grossly overlooked and under examined in political discourse, and we examine how attitudes and practices at schools can be the gateway to incarceration or the school to prison pipeline. Indeed, the practices at far too many schools in the U.S. reflect the larger mass incarceration phenomenon.

In schools many disciplinary actions are discretionary, which sadly leaves room for subjectivity and sometimes bias. A Texas study revealed that when accounting for the same behaviors, African American kids were nearly three times more likely to receive an “out-of-school” suspension for their first offense. For Latino students, they were twice as likely as white students to be removed from school for their first offense. On the other hand, whites were more likely to receive in school suspensions. Researchers found that “seventy-five percent of the 133,719 African-American public school students (male and female) experienced involvement in the school disciplinary system.” The contrast is stark—less than 47 percent of white students experienced similar discipline.

Students with disabilities and students of color are disproportionately impacted by such practices according to the U.S. Department of Education. A study of school systems in Oregon revealed that students with special needs were four times more likely to be suspended than their counterparts.

Kicking kids out of school and locking them up for the rest of their lives does not make society safer. Indeed, we place our nation at risk of stereotyping, stigmatizing, and damaging future generations.

Goodwin continues:

Consider the case of Madisyn Moore, a six year old African American who was handcuffed and abandoned under a dark stairwell at her school, because a security mistook her candy for a stolen item. In defending his actions, the security guard said, “‘I’m teaching her a f — -g lesson. She took a piece of candy and I handcuffed her under the stairs.’” The guard was wrong and later fired; the little girl’s mother placed the special treat in her lunchbox.

In one case, elementary school students were arrested, handcuffed, and sent off to juvenile detention for not breaking up a fight off campus. In that case, arrest warrants were issued for African American kids ages 6-10 for an altercation they did not start nor participate in.

Yet, there are other troubling cases of arrests and handcuffing of little elementary school kids from Georgia where a six year old was detained because he was having a bad day—not because he brought a gun to school, harmed another child or teacher to Kentucky and even California where five year olds are just as vulnerable to having law enforcement arrest them without any call to the parents. In another case, a five year old diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) was cuffed at the hands and ankles with zip ties, charged with assaulting an officer, and hauled off to a psychiatric facility in the back of a squad car. The child’s parents were not called.

Teachers have tough jobs and school administrators too. However, resolving student conduct issues through law enforcement is rarely the right answer.

As our nation turns to consider the overwhelming policy and political impacts of adult mass incarceration and its toll on families and communities, it’s worth considering how the culture of fear, which is answered by jailing and punishment trickles down to children in disparate, cruel, and inhumane ways.

Hamilton, Ontario Leads Canada in Lowering Homelessness, Using “Housing First”

Hamilton, Ontario made the biggest dent

Canadian paramedics approach sculpture "Homeless Jesus"

Canadian paramedics approach sculpture “Homeless Jesus”

in Canada in reducing the number of people experiencing homelessness over one year, even as the housing and rental market’s frenzy has some advocates fretting about the city having enough affordable places to live. The number of so-called “chronically homeless” people who’ve been experiencing homelessness for six months or longer dropped 35 per cent between 2014 and 2015.
And the number of unique individuals/families accessing an emergency shelter was down 11 per cent, to about 2,800 people last year.

These are the most dramatic drops measured since the campaign began by any of the 33 communities across Canada enrolled in the 20,000 Homes campaign launched by the Canadian Alliance to End Homelessness, according to Tim Richter, president and CEO of the alliance.

“Achieving a 35 per cent reduction with little or no new resources tells you that they’re becoming very efficient,” Richter said. “What Hamilton’s doing is showing what works to reduce homelessness. It can certainly be looked at as a model for the rest of Ontario.”

The city’s success is in implementing a new approach to tackling homelessness, driven by changes to how federal funds are allocated. Funding to cities has changed in recent years, away from supporting shelter and other emergency and temporary services. The funding now pushes cities toward a treatment-focused approach, with an emphasis on stable housing first — before any of the other factors in someone’s homelessness can be addressed.

Locally, four contractors receive funding from the city, passing along federal money, to find those low-cost units for vulnerable clients and deliver the supports they need. Supports are tailored to the unique needs of each individual. The four contractors focus on single men, single women, youth and Aboriginal people. Already, a few hundred people have been housed this way since 2014.

The city is also attracting attention for being on the cutting edge of techniques to combat homelessness. Hamilton is one of three cities in the country to adopt an approach known as a “by-name list,” or a real-time, priority ranking of the people using services or experiencing homelessness who could be best served by a housing placement.

The by-name list is yet another step toward breaking down the barriers between non-profits and programs. In a previous era, someone who’d used a shelter run by one organization might be selected to graduate into that organization’s other programs. But the by-name list hopes to establish whether that placement is needed more by someone else, somewhere else in the city.

Amanda DiFalco, Hamilton’s homelessness services coordinator, said:

Historically, we’ve managed homelessness. But homelessness is in fact a solvable problem. It’s about using limited resources, prioritizing limited resources to the most vulnerable people. We’re thinking as a community not just as a service.

The city was selected to be a pilot community for the 20,000 Homes campaign in 2015. Since then, two “point-in-time” counts have served as a snapshot census, estimating how many people in Hamilton are homeless and what their needs are. The campaign wants to find permanent homes for 20,000 of the most vulnerable Canadians by July 1, 2018.

This year, 504 people were counted and surveyed one day in February, though the number of unique individuals using shelters throughout the year is closer to 3,000. In part, the new approaches have been motivated by a change in how homelessness programs are funded. In 2014, Hamilton’s federal funding for homelessness switched to a model that designates 65 cents out of every dollar of funding for “housing first” placements.

As of July 31, the city and its partners had found permanent housing-first placements for 68 people, about half of a targeted 138 people prioritized based on the findings of the census in February.

In housing first, people are evaluated based on medical conditions, mental health, length of time on the street or in shelters, and then they are prioritized for a housing placement with supports tailored to their needs provided by a social worker. Once a person is housed, the thinking (and research) goes, they can more effectively manage their health and lead a stable life.

Homelessness co-ordinator DiFalco said traditional homelessness programs lead to people finding permanent housing at a rate of just 33 per cent. But “housing first” programs have success rates of more like 80 per cent, she said. Hamilton’s initial housing first placements have led to 83 per cent of people remaining housed, two years later, DiFalco said earlier this year.

30,000 Prisoners Released from Philly Prisons Annually Without Medicare are About to Get Help

For 30,000 people released from Philadelphia

Photo by Susan Madden Lankford

Photo by Susan Madden Lankford

jails each year with five days’ medication and no medical coverage, getting benefits restored after incarceration can take weeks or even a few months – long enough for people to relapse.

Bruce Herdman, chief of medical operations at the jails, says:



Most people are not on medications, and are destabilized when they come in. We do a pretty good job tuning them up. But up until now, it’s been so frustrating, because we help people get healthy, and we send people out and they don’t have the resources to maintain their health.

That’s about to change though. A slew of new city- and state-level initiatives will preserve Medicaid benefits for people who have them, and sign up more of those who don’t – in particular, those leaving jail with serious mental illness and chronic disease. Together, advocates say, these efforts can decrease recidivism, save taxpayers money, and maybe even save lives.

Right now, three-quarters of all men and women arriving at Philadelphia jails are on drugs. About 28 percent have hypertension, diabetes, or significant seizure disorder. About a thousand each year will be treated for HIV. Fourteen percent have serious mental illness, and 40 percent will require psychotropic medication; Herdman notes the prison system is effectively the state’s largest psychiatric hospital.

But only about 8 percent, at last count, had health insurance – all of it Medicaid. Right now, that benefit is terminated in Pennsylvania when people are imprisoned; but, starting in November, it will instead be suspended for up to two years.

That’s important because applying for new coverage upon release takes time. “Eliminating the gap, that can be 45 or even 90 days, can make the difference in stabilizing people,” state Human Services Secretary Ted Dallas said.

It’s a fix more states are making. But it required a political and culture change – and, above all, technological upgrades.

“The biggest issue is you have these very large IT systems that determine eligibility, and getting changes to them, it’s not always an easy thing,” he said.

In the interim, a series of pilot programs at the Philadelphia Department of Prisons are focused on specific, high-need groups being released from jail.

One is targeting people with serious mental illness like schizophrenia, bipolar disorder, or major depression. They’re significantly more likely to be rearrested than other inmates, and they stay in jail an average of 25 days longer, according to the department’s statistics.

Through the pilot, people with serious mental illness can get Medicaid within two days of their release. And, they’re connected with a forensic peer specialist from the city Department of Behavioral Health and Intellectual Disability Services (DBHIDS) to help with everything from reconnecting with family to securing housing and benefits.

“If you’re not able to reconnect within the first 72 hours, it becomes more difficult,” said H. Jean Wright II, of DBHIDS. “This is a way of getting to a group of people who have historically fallen through the cracks.”

So far, he said, 45 people have gone through the program, with only four rearrests. Given that 38 percent of Philadelphia jail inmates are re-incarcerated within a year, that’s a remarkable success.

At the same time, Corizon, a contractor that provides health care in the jails, is running a separate pilot to connect people with chronic physical illnesses with Medicaid.

Herdman said:

These aren’t diseases that you cure, but you would reduce the number of times people get incarcerated. Say someone has a seizure disorder, and they are medicated when released and continue their medication. They can go to work without having their illness interfere. But if they don’t fill the prescription, maybe they have a seizure, they don’t show up for work, they lose their job and then go back to street crime.

The female jail population is especially needy, Herdman notes: 25 percent have serious mental illness, and 60 percent use psychotropic medication.

For everyone else leaving the jails – and there are thousands each month, leaving at all hours of the day and night – reentry services providers are cobbling together resources as best they can.

Soon maybe they won’t have to. Thanks to Medicaid expansion in Pennsylvania in 2015, almost everyone passing through Philadelphia jails is eligible for coverage. Herdman said efforts are underway to presume eligibility for all inmates and fill out applications for them as part of the discharge process.

But coverage alone isn’t enough, said Maureen Barden, who’s been working on the issue with the Pennsylvania Health Law Project and agencies around the state. It’s just the first step:

The handoff to services in the community is a tremendously important part, which is still to be implemented in most places. Getting people the [insurance] card is not going to be enough for most people to turn the tide and have them not return to jail. Connection to care as this movement goes forward will be recognized as an increasingly important thing.

Virginia Making Genuine Progress Toward Juvenile Justice

For years, Virginia has spent up to $150,000 per year on each youth confined in its juvenile correctional centers. Historically, we know the longer youth stay in these centers, the more likely they are to reoffend: 75 percent were being rearrested within three years of release. We have failed too many young people and their communities for too long. This is why the administration, including the staff at the Department of Juvenile Justice (DJJ), is dedicated to transforming the juvenile justice system. This transformation initiative will produce better outcomes for youth, for public safety and for Virginia taxpayers. 

During the 2016 legislative session, Gov. Terry McAuliffe and the General Assembly reached historic agreement in three critical areas. First, due to declining populations of youth in state custody, they agreed that DJJ could close one of two remaining oversized and aging juvenile correctional centers (JCCs) — Beaumont or Bon Air — both of which are located near Richmond. Second, they agreed that the state would reinvest the savings from downsizing into a statewide continuum of evidence-based services and alternative placements for juveniles. Third, to meet the needs of the many youth committed to state custody from the Hampton Roads area, they agreed on bond funding to construct a 64-bed, therapeutic JCC in Chesapeake and authorized planning funds to address the correctional needs for the rest of the state.
The legislature also established an interagency task force to make recommendations for optimal utilization of these new facilities, and directed the members to submit an interim report on its findings in order to receive planning money for the Chesapeake facility. The report was submitted this month and provides a road map for moving ahead with Chesapeake and designing facilities that are built for safety and rehabilitation, not just for securing youth.
The Chesapeake facility’s 64 beds make it 70 percent smaller than Beaumont Juvenile Correctional Center, which will close by the end of June 2017. The new facility will be located near families and service providers of committed youth from Hampton Roads, and will provide a setting that supports DJJ’s rehabilitative goals.
The department is also creating community-based alternatives to JCCs. At the beginning of 2014, DJJ had only large centers available for youth committed to state custody. As of today, DJJ has added eight residential programs in local juvenile detention centers across the state. The new placements are in smaller settings, and closer to most youths’ homes. These, along with other policy and administrative actions, allowed DJJ to safely reduce its JCC population by more than half since 2014, to just over 270 youth today.
Additionally, DJJ will contract with regional service coordinators who will lead development of a statewide continuum of evidence-based services and additional alternative placements to effectively serve youth in their communities. This new initiative is budgeted using funds derived from reinvestment as well as administrative and operational efficiencies within the department.

Brian Moran, Virginia’s secretary of public safety and homeland security, says:

Unfortunately, some still misunderstand the certain benefits of the transformation plan and misrepresent the results of our progress thus far. What’s true is that there is bipartisan support for each change described here and the significant changes DJJ is making. What’s true is that we are dramatically shrinking our old, adult-style correctional footprint, and moving toward modern, small rehabilitative facilities and alternative placements. And what’s true is that there are some youth and some situations that will require time in secure custody in order to keep communities safe and provide the services and setting that will most effectively address their complex needs.
“These bipartisan-supported changes not only will produce better rehabilitative results for youth throughout our juvenile justice system but also will provide safer communities and savings for our taxpayers. Once this transformation is complete, we project reductions in our facility footprint by at least two-thirds, and substantial annual investments in the statewide continuum of services.
I am extremely proud of our progress, the hard work of the DJJ staff and the bipartisan support we have enjoyed. To secure our early gains, it will be critical that we maintain unity of purpose. This is a precious opportunity to make Virginia a safer and better place for our communities and for our children. We must not waste it.

Poverty and Homelessness? Richer States Have Higher Homeless Rates

Evan Horowitz, The Boston Globe:

Rich states — not poor ones — have the largest homeless populations. Why? It’s all about housing costs.

Think about the recession. While it stoked unemployment and devastated family budgets, it really began with the collapse of the housing market, which drove prices down to a level that made basic shelter more affordable for all.

You can’t beat homelessness with economic growth. In fact, you can actually make things worse, boosting housing prices in a way that heightens problems for the most desperate families.

But there’s a second takeaway: Policy matters. Massachusetts is one of those rich states with high housing costs and an outsize homeless population. But the number of “unsheltered” homeless — people stuck on the street — is extremely low, among the very lowest in the country. And one big reason is that Massachusetts guarantees homeless families a “right to shelter.”

Rich states have more homeless people. It’s not an iron-clad rule, just a loose tendency, but it cuts sharply against the grain of economic expectation.

Photo by Susan Madden Langford

Photo by Susan Madden Langford


The District of Columbia is the tragic leader on this score, with a rate of homelessness six times the national average and the highest per capita incomes in the nation. Close behind are other relatively wealthy redoubts: Hawaii (53 homeless/10k), New York (45), Oregon (33), and Massachusetts (31). Meanwhile, the states with the smallest homeless populations are Mississippi (7) and Alabama (8), two of the poorest places in the country.

Even if you take a simpler measure — just comparing the poverty rates across all 50 states — there doesn’t seem to be any connection between the number of poor people and the number of homeless people. And if you’re still skeptical, remember that the national figures provide a kind of corroboration. Poverty rates leapt during the great recession, homelessness didn’t.

The one thing that really does seem connected to homelessness rates is the cost of housing.

Look back at the list of places with the highest homeless populations: D.C., New York, Hawaii, Oregon, Massachusetts. Those are five of the hottest housing markets in the country (and California, slightly down the list, is another high-priced, high-homelessness state). And at the bottom, Mississippi and Alabama are cheap places to live.

If this connection between homelessness and housing costs seems obvious, think for a second how strange it is that poverty isn’t part of this equation. After all, there’s no “absolute” sense in which costs are high; they can only be high relative to how much money people have. So why isn’t homelessness equally about out-of-reach costs and limited means?

What’s needed is a story of homelessness that involves housing costs, but not income. And there, the academic research provides some assistance.

You can think of homelessness as being caused by a confluence of three things:

1. a sudden life shock, like a health crisis or unexpected unemployment

2. a breakdown in social support, with too few friends and relatives willing to lend their couches or share their homes

3. a lack of alternative housing at the bottom end of the rental market

Put these together and you can start to see why homelessness and poverty might not be so strongly connected.

Imagine a middle-class family in a rich state. They’re doing fine until the breadwinner is hit by a health or career crises. Bills begin to mount, and they quickly find they can’t afford to pay their rent or cover their debts.

So they reach out for support, sleeping on friends’ couches or in spare bedrooms. But eventually this dries up. If there’s no affordable housing, they may end up in a shelter.

In this account, your place in the income ladder is secondary. For poor and middle-class people alike, a serious life shock can break your financial life and lead to temporary homelessness.

This is just a theory, which you may well find unconvincing. Even so, you can’t wave away the puzzle that lies behind it. Homelessness seems to be driven by factors other than poverty.

Rich states have one big advantage: more resources. Wealthier states may have higher housing costs and larger homeless populations, but they also have more resources to combat the problem. And that really can make a difference.

Massachusetts is a prime example. When the Department of Housing and Urban Development did its most recent count, back in January, it found that there were 31 homeless people for every 10,000 residents. But 30 of those 31 were sheltered. Even with all the shortcomings and indignities that come with living in a homeless shelter, that’s an incredible achievement.

Now, to be fair, January weather certainly played a role. In general, colder states have higher shelter rates than warmer states; only about a third of California’s homeless population was sheltered on that same January night.

Still, few states can match Massachusetts’ ability to provide shelter for the homeless. And one reason is that Massachusetts guarantees shelter access for families (though not for individuals). There are restrictions and hurdles that make this guarantee less than universal, but it has nonetheless helped Massachusetts become a leader when it comes to keeping people off the streets.

What’s more, the state continues to explore new ways to help the most desperate. An innovative public-private partnership has raised money to move more people into permanent housing. And in recognition of the role poor mental and physical health can play in chronic homelessness, the state is trying to use federally backed Medicaid dollars to advance this effort.

Economic growth can’t end homelessness. Maybe that’s good news.

There’s a bright side to this story. If homelessness and poverty aren’t strongly connected, then you don’t have to solve poverty in order to solve homelessness.

Instead, you can take a more direct path: providing shelter for those who need a temporary safety net and permanent housing for those who lack the health or capacity to right themselves.

Done right, this approach needn’t be that expensive, because we’re not talking about large numbers of people.

A relatively small infusion of new money might suffice to provide homeless individuals with the same guaranteed shelter access we already offer families.

And to battle chronic homelessness, research increasingly shows that the best solution is simply to provide permanent housing. That may sound like a costly proposition, but we’re actually talking about a pretty small population: several thousand chronically homeless individuals in Massachusetts, a few hundred of whom consistently lack shelter.

With needs at this scale, you can make real progress with pilot programs and public-private partnerships — the kinds of efforts Massachusetts is already pursuing.

And unlike so many government programs, which struggle for resources when the economy goes sour, these programs should be more predictable. After all, homelessness doesn’t seem to be shaped by economic cycles.