A Health Department Tackles Recidivism

More than two-thirds of jail inmates in Oklahoma County suffer from mental health or substance abuse issues. Those inmates are likely to cycle in and out of the criminal justice system, jeopardizing their housing, child care arrangements or jobs—destabilizing factors that can exacerbate their other problems, making recidivism more likely and more difficult to stop.

Health workers from the Oklahoma City-County Health Department are aiming to stop that cycle. Funded by a one-year grant from the Centers for Disease Control and Prevention, the department last month placed two community health workers—one male, one female—in the county’s drug court and jail to work with high-need inmates, establish long-term relationships and help to facilitate connections between community resources and people in need.

“If you’re in the criminal justice system for too long, you’re going to lose your job or your housing and then you’ll be in an even more unstable environment than you were before,” said Gary Cox, executive director of the Oklahoma City-County Health Department. “Basically what these workers do is mentor them, coach them, link them up with needed services in the community and help them navigate the system successfully. We’re trying to see if we can break that cycle of incarceration.”

The program works specifically with what Cox called “high-need” defendants—nonviolent offenders who frequent emergency rooms and have repeated contact with law enforcement—with extra focus on people who struggle with opioid addiction. Successfully intervening to keep those people out of the system, Cox said, will result in less stress on resources.

“Most of them are there because of mental health issues or substance abuse, so they don’t really need to be in the criminal justice system. They need to be in a place where they can get help,” he said. “After that, we have all these secondary missions—keeping them employed, getting them a safe place to live and keeping them together with their families.”

The county’s community health workers start their mornings in court, alongside a judge, the assistant district attorney and treatment providers. Together, they discuss the status of each program participant back in their communities.

“Have they had any missed or failed drug tests? Have they missed any treatment appointments? Are they checking in with their probation officer as required?” Cox said. “If there’s noncompliance or another issue, they discuss what the appropriate action might be. Many times the judge will require that the participants call one of our community health workers and check in daily.”

In addition to helping connect program participants with services—temporary housing, drug counseling, medical or dental care—the community health workers take on a peer role, working to establish a trusting, and productive, relationship.

“Participants feel more open to deal with our folks because there’s no threat of judgment or punishment like there might be with a probation officer or with law enforcement,” Cox said. “We’ve used community health workers in other model initiatives we’ve done here with great success. Although there are a lot of challenges, we’re confident it’s going to work here as well.”

The program’s success will be measured in tangible, data-driven outcomes, including recidivism rates, emergency room visits and run-ins with law enforcement. Ultimately, the health department would like to link disparate agencies together to allow for real-time sharing of data and records.

“That way, providers could see immediately where this person is, which would help them have the best chance of success of reintegrating into the community,” Cox said. “That’s a big goal, but it’s our goal.”

The $250,000 CDC grant funds two community health workers salaries for a period of one year, with some money also allocated to data projects. It’s too early for quantifiable results, though early assessments are promising.

“The community health workers gain their trust by offering to help in any way they can, and that results in participants being more engaged in the program and checking in to make sure they’re following the rules,” Cox said. “Case managers from the treatment centers have been really satisfied having the community health workers on the drug court team. We think it’s going to be successful.”

Health officials are hoping the CDC grant will be renewed, but the program will continue either way, Cox said.

“The community was really ready for this. Our leaders—the mayor, the county commissioners, the district attorney, the sheriff—they all knew there was a problem and were just looking for anyone who wanted to come to the table and help pull together efforts to help these people and make a difference,” he said. “We hope they will renew the grant, but if they won’t, we’ll just find a way to keep those folks down there.”