Impacts of Felony Diversion on Health and Housing Outcomes in San Francisco

• In Event: Criminal Justice Interventions with Cross-Policy Impacts

Abstract

 In most jurisdictions, a small percentage of individuals frequently cycle through local criminal justice, social service, and physical and behavioral health agencies. For individuals with a mental illness or substance use disorder, incarceration can interrupt or prevent treatment and exacerbate health problems. Diversion from criminal prosecution is one tool to address the behavioral health needs of arrested individuals, decrease incarceration, and interrupt the cycle. Prior research, including our own (Augustine et al., 2022), demonstrates that diversion programs help participants avoid future interaction with the justice system. Yet the existing literature is silent on the effects of diversion on participants' health and well-being, whether their multiple, complex needs are being met, and whether such interventions close racial gaps in health outcomes. 

For more than 20 years, San Francisco’s Collaborative Courts have provided alternatives to criminal prosecution, with a focus on social service needs and equity. These programs provide eligible individuals with case management and programming in lieu of a criminal trial with the goal of addressing underlying issues that may have led to their alleged criminal behavior. Individuals who complete diversion programs have their charges reduced, dismissed, or removed from their record. Prior research found that referral to a diversion program leads to a decline in future convictions. The current study estimates the impact of a diversion referral on the domains of well-being that the programs are designed to affect, including health, mental health, substance use, and housing status. We will answer the following research questions:

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  What is the impact of referral to diversion on adverse health outcomes, such as emergency department visits, psychiatric emergency services, hospitalization, and mortality? 

  
  


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  What is the impact of referral to a diversion program on housing outcomes, including homelessness and stays in supportive or emergency housing?

  
  


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  Do the impacts on these outcomes vary by race and ethnicity?

  
  

To estimate the causal effect of referral to diversion on outcomes, we use an instrumental variable model leveraging the random assignment of felony cases to judges in San Francisco. We calculate a diversion referral rate for each judge not inclusive of the current case, and use the diversion referral rate as an instrument for referral to diversion. An individual has a higher likelihood of referral to a diversion program if their case is randomly assigned to a judge with a higher referral rate, than if it is assigned to a judge with a lower referral rate. Following the primary models, we conduct subgroup analyses by defendant demographic characteristics to discern whether there is variation in impacts for different groups.

This study uses an individual-level linkage of administrative records from the San Francisco District Attorney, San Francisco Sheriff, San Francisco Department of Public Health, San Francisco Department of Homelessness and Supportive Housing, and California Department of Public Health. The primary outcomes are: mortality, homelessness, connection to treatment, and adverse health outcomes. In addition to these primary outcomes, we report both the secondary outcomes that comprise the treatment and adverse outcomes on their own, in addition to several other secondary outcomes.

Authors

• Johanna Lacoe, University of California, Berkeley
  Presenting Author

• Stephen Paolillo, University of California, Davis
  Non-Presenting Co-Author

• Alissa Julia Skog, University of California, Berkeley
  Non-Presenting Co-Author

• Steven Raphael, University of California, Berkeley
  Non-Presenting Co-Author