Los Angeles County
Alternatives to Incarceration
Work Group
Interim Report Goals

Ad Hoc Committee Recommendations:
Community Based System of Care
Justice System Reform
Community Engagement
Funding
Data & Research

May 21, 2019

 COMMUNITY BASED SYSTEM OF CARE (CBSOC)
Overview
The County’s current system of community-based alternatives to incarceration for people
living with mental health needs is not equipped to prevent their criminalization. Instead, there is
a revolving “system of care” that flows from crisis and hospitalization to homelessness and jailand sometimes death. Our system is difficult to navigate, exists in silos, and does not meet the
whole person needs of people with mental and behavioral health needs in our communities. The
current approach can often isolate people with harmful results, rather than helping them integrate
into our communities using systems that prioritize dignity, promote wellbeing, and provide
meaningful opportunities to be active community members of Los Angeles County.
The lack of community-based services and alternatives to incarceration in the County for people
with mental health needs has resulted in overburdened emergency rooms and jail towers full of
people suffering from varying mental health symptoms. The delivery of mental health services in
jail, and other carceral settings exacerbate mental health needs and often times subjects’ people
to additional trauma. The Federal Department of Justice (DOJ) acknowledges that people
confined to the county jails who have mental health needs were failed by other systems, and
these people would be safely and more effectively served in community-based settings at a lower
cost to the County.1
Currently, people with mental health needs are not provided with the holistic care that address all
the social determinants of health. We must invest in prioritizing access to health care services,
availability of resources to meet daily needs (e.g., safe housing and transportation), as well as
access to educational, economic, and employment opportunities with family and community
reintegration. An integrated, decentralized system of care that addresses mental health needs and
the social determinates of health will create social and physical environments that promote good
health for all community members which has been supported by public health experts across the
nation. The American Public Health Association “recommends the following actions by federal,
state, tribal, and local authorities: (1) eliminate policies and practices that facilitate
disproportionate violence against specific populations (including laws criminalizing these
populations), (2) institute robust law enforcement accountability measures, (3) increase
investment in promoting racial and economic equity to address social determinants of health, (4)
implement community-based alternatives to addressing harms and preventing trauma, and (5)
work with public health officials to comprehensively document law enforcement contact,
violence, and injuries”.2 Developing a system of care that is easily accessible, decentralized, and
has the capacity to serve thousands of people throughout the County can end the County’s
reliance on jails and law enforcement while ensuring that people with mental health needs are

1

U.S. Department of Justice, letter to Anthony Peck, Esq. Deputy County Counsel and Stephanie Jo Reagan, Esq. Principal
Deputy County Counsel for Los Angeles County, 04 Jun. 2014.
2

Ryan A. Crowley, BSJ, and Neil Kirschner, PhD, for the Health and Public Policy Committee of the American College of
Physicians. (2015). The Integration of Care for Mental Health, Substance Abuse, and Other Behavioral Health Conditions into
Primary Care: An American College of Physicians Position Paper. Annals of Internal Medicine.
https://www.integration.samhsa.gov/Integration_of_BH_into_primary_care_Annals_of_Internal_Medicine.pdf

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 thriving with dignity and living lives that are restored, not restricted, by ecosystems of care. Care
first, and jail only as a last resort.
Goals
Goal
1. Increase Access and
Remove Barriers to
Community Based
Services by addressing
the Social
Determinants of
Health

Description
Develop policies and expand programs that ensure that people
with mental health needs and substance use disorder, their loved
ones, and community members have multiple points of access to
the full continuum of services and that match the individual’s
current needs (from low to high levels of care) through a
combination of County-operated and not-for-profit communitybased organizations services throughout Los Angeles County
while creating alternatives to incarceration at every level of the
criminal justice system. This recommendation impacts intercept
zero (which enables people to access services before any contact
or involvement with the criminal justice system has occurred) and
intercept five (prevent recidivism). All services should be
implemented in a need-aligned and equitably-distributed manner.

2. Increase Access and
Remove Barriers to
Community Based
Services by addressing
the Social
Determinants of
Health

Remove barriers to accessing all necessary and complimentary
integrated not for profit community-based services related to
mental health needs, substance use disorder, and poor social
determinants of health while providing community members with
the necessary tools, support, and incentives to attend and
participate in services.

3. Expand the
Community Based
System of Care

Scale up effective culturally competent mental health and
substance use models that are community based that already exist
at critical intercepts with a priority on intercepts zero and five
that enables people to access services before any criminal justice
system involvement. Develop contracting policies and procedures
that make it less difficult for culturally competent nonprofit
community partners to become part of the funded integrated
system of care and invest in those relationships long term.
Develop capacity among local providers to compete for county
contracts and provide high quality services. Address the
distribution of resources by the geographic and racial impact of
services equitably.

4. Expand the
Community Based
System of Care

Remove barriers that prevent not for profit community-based
service providers from accessing county funding, contracting
opportunities, technical assistance, and incubation opportunities.

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 5. Coordinate
Community Based
Services

Create an Alternatives to Incarceration Coordination Initiative
within the county governance structure to oversee program
implementation and equitable distribution of resources. The
Initiative would create policies and procedures to connect all
county capacity building and services provision efforts. This
Initiative would create linkages in service provision for county
departments, non-profit community-based service providers and
the community at large so that mental health needs, substance use
disorder, and poor social determinants of health are supported and
treated through an integrated model.

6. Expand Community
Health Worker and
Peer Support Models
to Provide Holistic
Support

Will be further developed by Community Health Workers across
Los Angeles County.

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 JUSTICE SYSTEM REFORM (JSR)
Overview
The Los Angeles District Attorney has spearheaded many of LA County’s recent efforts to
provide treatment instead of incarceration for people with serious mental illness. The County
health agencies, community treatment providers and advocacy organizations, along with the
Superior Court, the Public Defender’s Office and Alternate Public Defender, the Probation
Department, the Los Angeles Sheriff’s Department, LAPD and other local law enforcement
agencies, have also been working hard to provide more appropriate responses to the increasing
numbers of people in our communities and on our streets who are experiencing mental disorders
and/or substance use disorders.
There is much more work to do to shift from a punitive criminal justice response to a public
health, trauma-informed approach to crisis. The goal is to prevent and reduce involvement with
the criminal justice system in the first place—the system least equipped to provide appropriate
care and treatment.
First, we must ensure that everyone, in every neighborhood in LA County, has access to effective
substance use treatment and mental health care—as described by the CBSOC recommendations
above. For those who do come into contact with the system, we must increase the opportunities
for diversion and alternatives to jail custody at every point—from law enforcement contact in the
field, to local police lockups, to the County Jail, and during every stage of the case process. We
must ensure that law enforcement officers have the tools they need to respond safely and
effectively; develop a system of effective and widescale pretrial release and services; fully
implement recent legislative reform greatly expanding pre-plea diversion for people with mental
health and/or substance use disorders, expand access to and the availability of effective diversion
programs at every courthouse in the County; and for those still in custody, improve reentry
practices and employ harm reduction strategies.
Goals
Goal
1. Improve Diversion
Opportunities within
the Court System

Description
Formally implement recent legislative opportunities for earlier
diversion away from the justice system for people with
behavioral health needs, from the booking stage throughout the
court process.

2. Reduce Pretrial
Detention and
Increase Services

Substantially and sustainably reduce pretrial incarceration of
people with clinical behavioral health needs while strengthening
public safety by instituting a presumption of release and using a
public health approach that links accused persons to services and
programs without additional justice system contact to reduce the
financial burden on the accused by upholding the presumption of
innocence.

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 The broader goal is to reduce the entire pretrial population in
comprehensive ways that recognize and address the
disproportionate impacts of race, socioeconomic status, and other
factors that contribute to pretrial detention.
3. Reduce and Improve
Interactions between
Law Enforcement and
People with Mental
Health Needs;
Increase Diversion
Opportunities and
Improve Training for
Law Enforcement

Scale up mental health and community-based response to
behavioral health crises to substantially reduce contact between
people with behavioral health needs who are in crisis and law
enforcement. When there is contact between people with
behavioral health needs who are in crisis and law enforcement,
ensure that law enforcement has the training and partnership with
behavioral health personnel to respond appropriately to each
situation and to divert many more people into community-based
treatment and services.

4. Increase and Improve
Access to Treatment
Services for CourtInvolved Clients

Expand and ensure easy access and timely linkage to treatment
services for clients involved in the court process to a broader
range of behavioral health programs and expand the diversity and
capacity of those programs. Create a flexible and integrative
service model across the Departments of Mental Health, Health
Services and Public Health, in order to provide the most
responsive system possible to client’s service and housing needs.
Streamline the referral process from arraignment to disposition,
and avail judges and attorneys of the general menu of options
available to qualifying clients requesting mental health, substance
use disorder, or co-occurring treatment services.

5. Improve Reentry
Practices

Improve pre-release and reentry practices to ensure that
individuals, including those with co-occurring mental health and
substance use disorders, can transition directly from jail into
appropriate community-based treatment and services.

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 COMMUNITY ENGAGEMENT
Overview
The Community Engagement Ad Hoc Committee has been tasked to plan a series of community
mapping and listening sessions in selected communities to hear, elevate, and empower
community members and gather information from community members and community
organizations about available and needed services, supports, and policies that promote
alternatives to incarceration. We seek to understand what services and supports prevent
incarceration and assist those re-entering their communities after incarceration. Where services
are currently offered, we are interested in understanding who is being served and who has limited
or no access to support. We recognize that community members need access to health, services,
good employment, affordable housing, and thriving communities and seek to understand
inequities in the distribution of resources and opportunities that promote well-being.
The Committee will organize workshops in seven communities that have been identified through
the Million Dollar Hoods and Advancement Project assessments as a sample of areas where there
are significant needs and gaps in resources available to prevent and address high rates of
incarceration. Workshops will be held in the following communities: South LA with a
connection to Compton, the Antelope Valley with a connection to Lancaster, East LA, Long
Beach, Pacoima, the San Gabriel Valley, and Pomona.
The ad hoc committee is focused on designing workshops that create a meaningful, intentional,
and respectful environment for individuals and families that have been directly and indirectly
impacted by incarceration to share information, identify challenges, and suggest opportunities for
efforts aimed at preventing incarceration and addressing the needs of people re-entering after
incarceration. Workshop participants also include key stakeholders such as service providers,
advocacy organizations, and county health departments. The workshops will focus on soliciting
and incorporating community feedback to shape recommendations for the final report and inform
the full implementation of the roadmap for years to come.
To design a workable, effective alternative system to incarceration, it is necessary to
meaningfully engage key stakeholders – primarily justice-impacted individuals and their
families, though also including service providers and advocacy entities – in highly-impacted
areas. This engagement will not function as a one-way, reporting-out process nor to simply
gather assent to solutions prepared by others. The ad hoc committee’s submission of findings
from the community workshops should not stand alone and apart in the final report but, rather, be
woven throughout the report – and directly inform (or reshape) interim recommendations drafted
by the other ad hoc committees in advance of the community engagement.

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 Goals
Goal
1. Engagement of
Currently Incarcerated
People

Description
Hold three workshops in the county and/or local jail system and 1
workshop in a juvenile hall to solicit feedback from individuals
that are currently incarcerated in LA County. Workshop attendees
should be able to participate without any risks; information
gathered at the workshop will be treated as confidential and will
be shared without attribution or identifying information.
Additionally, incarcerated individuals should be allowed to
provide information through anonymous surveys or postings that
will be managed by the Health Agency. The Office of Diversion
and Reentry, Department of Mental Health, the Sheriff’s
Department, and other partners should help plan for workshops to
be held between June and December. The outreach for
engagement of currently incarcerated people may also include
connecting to family members who currently have a loved one
incarcerated in Los Angeles County.

2. Advisory
Collaborative of
Impacted People

The creation of an advisory collaborative is necessary to ensure
there is continuous feedback and accountability to the prioritized
communities and LA County at large in the implementation of the
comprehensive roadmap. The advisory collaborative will
communicate community solutions to the ATI work group and
can serve to review recommendations and drafts of the final
report. The advisory collaborative can also interface with local
law enforcement to support the communication of community
needs and feedback after the workshops. Possible sources of
support for the Advisory Collaborative include the Whole Person
Care Re-entry Health Advisory Collaborative and the DPH Office
of Violence Prevention Community Council.

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 FUNDING
Overview
The Alternatives to Incarceration Funding Ad Hoc Committee was established to assess and
outline resources needed to implement recommendations by the Alternatives to Incarceration
Work Group to scale up ATI services in the County.
In advance of recommendations from other work groups, the Funding Ad Hoc Committee has
begun to draft an at-a-glance matrix of key funding streams that can potentially support the
scaling up of ATI efforts. When developed, this document will identify funding streams, eligible
uses, current county policy for utilization, and scale of funding available to the County. While
the ad hoc committee is not positioned to line item budget recommendations from each fund, the
matrix will help identify gaps and support the Board of Supervisors and Chief Executive Office
in identifying potential sources of funding for this work.
To support the ATI effort, the County should continue efforts to maximize resource availability
in order to meet the full scope of ATI recommendations, including advocacy at the state and
federal level.
The California Department of Health Care Services is beginning the process of identifying
changes to the scope and populations covered by Medi-Cal as part of its new Medicaid waiver
with the Federal Government that would take effect in 2021. The final waiver provisions will
significantly impact the scope of services funded under the program and shape available
resources for eligible individuals involved with the justice system.
Goals
Goal
1. Advocate for MediCal Coverage

Description
The County should advocate for changes that would expand
services and populations covered by Medi-Cal to support
integrated service delivery to system-involved individuals and
their families, which could provide a source of sustainable
funding to support ATI recommendations related to an integrated
system of care.

DATA & RESEARCH
Overview
The Data and Research Ad Hoc Committee committed to developing two jail population
overviews with an emphasis on racial disproportionality for the Interim Report: 1) will focus on
the population of people in jail who have severe clinical needs and 2) will include the total jail
population. This description will guide the ATI Work Group in their development of
frameworks, funding, and recommendations. The data that is currently available includes but is
not limited to the following: race, gender, age, charges, repeat bookings, geography (including
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 where the court case is, where the arrest was made, self-reported data about where individuals
live), homelessness (with limitations), mental health status, length of stay, number of pre-trial
individuals, SUD and co-occurring disorders, and serious medical needs. The committee also
developed a recommendation on data transparency. The Data and Research Ad Hoc Committee
is also compiling a comprehensive list of data needs to address for the final report that includes
requests from the other ATI committees.

Goal
1. Improve data
transparency

Description
Expand justice data transparency including access, analysis, and
metric design by those most impacted by the justice system.

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