Last month, the first-ever national deflection summit was held in Alexandria, Virginia, where experts from criminal justice, behavioral health and public policy convened to come up with strategies aimed at diverting, or deflecting, low-level drug offenders away from the justice system into treatment, before arrest. Also called prebooking diversion, deflection can help get people into treatment instead of incarceration. The two-day summit was sponsored by the International Association of Chiefs of Police (IACP).

Perhaps the best-known examples of “deflection” are the Police Assisted Addiction and Recovery Initiative (PAARI), which started in the Gloucester, Massachusetts, police department and now has many member police departments across the country, and Law Enforcement Assisted Diversion (LEAD), based in Seattle, Washington.

While law enforcement is eager to find treatment solutions instead of arrest and incarceration, the treatment field isn’t making it easy, said Jac A. Charlier, national director for justice initiatives at the Center for Health and Justice at TASC (Treatment Accountability for Safer Communities), which convened the meeting. “Police departments are willing to partner, but it’s behavioral health that has to get its act in gear,” Charlier told ADAW in an interview last week. “There are police departments all over that are ready to do this, but they don’t have a history of working together with behavioral health.” Charlier urged treatment providers to call him. “I will help you navigate the waters with the police,” he said.

One obvious barrier for treatment providers is funding. Police departments have direct government funding; treatment providers don’t. “In the United States, for the most part our community behavioral health system is nonexistent in terms of capacity,” said Charlier. Medicaid expansion has accounted for much of the increased access to treatment, but it’s still not enough, he said. “There are low rates of insurance, so therefore low access to treatment.” But the calls, when there are overdoses or other substance use–related problems, usually go to first responders, including police, he said. “We want to increase treatment access points through our first responders,” he said.

Charlier distinguishes deflection from diversion, which is a criminal justice term. He coined the term to make that distinction clear, and also to encompass the many terms used in the emerging field (Charlier, whose expertise is deflection, said there are nine terms, and noted that even PAARI and LEAD don’t use the same terminology). “Nothing is settled about this,” he said. “There are early adopters, there are experimenters, but I want to focus on deflection, which means moving away from the criminal justice system without ever having entered it.” Diversion often means entering, and then leaving, the criminal justice system. Deflection means using the criminal justice system as an access point to non-justice-related treatment. But that means making sure access is there.

“Behavioral health capacity is the holy grail of deflection and diversion,” said Charlier.

But as for funding, Charlier and his deflection colleagues have “no pretense to solving the problem,” he said. “We’re not going to crack that nut because it’s a federal issue.” But he sees little resistance from police on deflection. “The resistance is from behavioral health, not because they’re the bad guys, but because they have to worry about how they get paid,” he said.

The treatment view

C4 Recovery Solutions, an international not-for-profit focused on substance use, headed up the treatment side of the deflection meeting. “We tried to broaden people’s awareness that substance use is a multisystemic issue,” said Dee K. McGraw, director of education and event services for C4. At the West Coast Symposium on Addictive Disorders last summer, C4 convened a group focusing on first responders, she said. C4 senior advisor Lee Feldman took this to the next level, to address the problems of capacity.

“We’re looking at different kinds of financing, and models such as municipal bonds,” Feldman told ADAW. “There are also possible private-public funding mechanisms.” Key to the success of this, however, is community support. Just as a community is willing to pay taxes for a firehouse, it should be willing to support a treatment infrastructure, he said. “Communities have a need for treatment capacity, and it’s a community responsibility to create that capacity,” he said. “Some communities are looking at additions to the sales tax.”

In North Carolina, the cost of incarceration per person per year is $40,000, noted Feldman. In the Charlotte area, counties are discussing the idea of moving some money from corrections to treatment, in cases of diversion. C4 is hoping to research the effectiveness of such programs.

“So far, the research is anecdotal,” said Feldman. “One sheriff might mention that if he has to continue building jail capacity because of opioids, he’ll need several million dollars.” Instead, that money could go to treatment. “The economic justifications are there, and the need is there,” said Feldman. “What’s missing is the research on the actual mechanisms — how do you take the capital expenditure for a new jail and move it over to pay for treatment?” There may be a requirement for legislation, he said. “This is a local issue."

Deflection also means a shift in the way people think about funding treatment, said Feldman. “In the past, funding treatment meant funding an addict or an alcoholic,” he said. “Here we’re talking about funding community safety. The ‘ask’ is different, and it’s an ‘ask’ that has not been made before.” The community — hospitals who keep seeing repeat patients whose substance use disorders aren’t getting better, law enforcement and taxpayers — needs to figure out what it needs, and pay for it, he said. “It’s the community that needs to raise the war chest."

There was consensus at the conference that behavioral health needs to be brought into the law enforcement discussion on deflection, said Feldman. “But the problem is, they want to deflect people to treatment, and nobody is bothering to ask whether the behavioral health community can do it,” he said. “The behavioral health system isn’t even a system — it’s a bunch of independent actors, and getting it organized isn’t going to be easy.”

C4 is working to create a repository of information communities can use to jump-start deflection efforts, said McGraw. “We’ve been to law enforcement trainings, but they each have their own way to do it; they all have different names,” she said.

There were about 60 people at the invitation-only meeting in Alexandria, which is hoped to lead to a “think tank” on deflection, said McGraw. “We need to figure out what deflection means. Is it one chance at treatment and that’s it? You need assessment instruments. You need to train the police officers to make these determinations.”

Civil citations

The Civil Citation Network (CCN), based in Tallahassee, Florida, offers counseling, education and community service in lieu of arrest, enabling clients to avoid a record. The clients pay for it themselves — the same $350 they would be required to pay for their own court costs if they were arrested — explained Tom Olk, founder of the CCN. Using the GAIN to assess clients, the CCN decides whether they need treatment; less than 8 percent do. Only about 100 of the 1,200 people who went through the CCN since 2013 have needed actual treatment, he said. The CCN is publicly funded.

People who don’t need specialty treatment are treated by CCN counselors using CBT, MI and trauma-informed care, using the curriculum from The Change Companies. “They have at least three therapeutic sessions,” said Olk.

“What we’re trying to do is provide the officer on the street with another option,” said Gregory A. Frost, president of the CCN, which was the third convener of the deflection conference. “If you don’t have a way to deflect that person, you either arrest them or you let them go. Our option is prearrest deflection.” The completion rate since 2013 is 83 percent, said Frost. CCN clients are first-time offenders and are required to sign a contract and to remain substance-free. They are drug-tested.

“Let’s not wait until this person has been arrested five times before they get the help that they need,” said Frost. “Let’s get this person the very first time they have a contact with law enforcement. We intervene early on before they get to the point of sitting in jail for the 10th time, before they are overdosing.”

But the CCN program is “not a free ride,” said Olk. “If they continue to use while they’re in our program, they risk going into the criminal justice system.” If they complete the program, however, they will not have any record, he said.

The two main substances involved in the CCN program are alcohol and marijuana. First-time misdemeanor offenders have a 45 percent rearrest rate within three years, said Olk. But the rearrest rate for people who go through the CCN program is only 7 percent.

Alcohol offenses that end up in the CCN are typically for open container or disorderly conduct charges, said Olk. Anyone caught driving under the influence is arrested and not eligible for the program. The CCN also gets non-drug-related cases, such as people who are hunting at night. “They don’t want to arrest people for hunting at night — we get cases like that,” he said. “We still drug-test them.”

TASC’s Charlier said the summit will create a “voice and vision” for deflection and increased access to treatment for people involved with the justice system. Treatment providers can email him at JCharlier@tasc-il.org or call him at (312) 573-8302.

Bottom Line…

Police and sheriffs want to “deflect” people who need treatment from the criminal justice system, but treatment needs to be there to receive them.