A Community-Based Youth Diversion Program as an Alternative to Incarceration, Illinois, 2017–2019

Abstract

The US justice system unfairly targets youths of color; systemic reform plus interventions to keep youths out of the justice system are needed. The Juvenile Justice Collaborative provided care coordination and wraparound services to adolescents in a diversion program from 2017 to 2019 in Cook County, Illinois. Youths showed increased strengths and decreased needs by program’s end. Youths who successfully completed the program showed reduced recidivism compared with nonprogram youths. Community-based alternatives to incarceration may decrease life disruption, promote positive health and social outcomes, and reduce further justice involvement. (Am J Public Health. 2022;112(9):1265–1268. https://doi.org/10.2105/AJPH.2022.306946)

Cook County, Illinois, youths are at substantial risk for involvement with the justice system: in 2015, the arrest rate was 37.9 per 1000 youths; the detention admission rate was 6.7 per 1000 youths. Statewide, Black youths account for 18% of the population but 59% of juvenile arrests and detentions. ¹ These differences do not reflect a predilection for criminal activity. Rather, they are the result of “the criminalization of Blackness and poverty, as reflected in the failed war on drugs, draconian sentencing laws, centralized power of prosecutors, a school-to-prison pipeline, and gutting of health and social systems.” ^2(pS5) Comprehensive reform is needed to address these factors, and Wennerstrom et al. also call for primary incarceration prevention, including diversion and community-based mental health services. ³

INTERVENTION AND IMPLEMENTATION

The Juvenile Justice Collaborative (JJC), formed in 2017, aimed to minimize further involvement of youths in the justice system and reduce racial disparities by facilitating access to services that meet adolescents’ developmental needs. Youths of color living in Chicago neighborhoods most affected by systemic racism received priority for referrals. JJC partners included a pediatric hospital, a centralized intake and referral home, and 10 community-based service providers.

Care coordinators conducted a home visit to complete consents and assessments to evaluate each youth’s and their family’s needs. Care coordinators, in collaboration with families, developed a family care plan to set goals related to the youth’s interests and needs that were identified through the Child and Adolescent Needs and Strengths assessment. Youths were referred to the appropriate community-based service provider or providers based on their desired goals, such as seeking adult or peer support through mentoring or engaging in recreational or workforce skills training. The top three services provided were mentoring (48%), mental health and substance use services (36%), and employment services (9%). Care coordination lasted an average of 95 days.

PLACE, TIME, AND PERSONS

We describe the JJC model and its outcomes from its first phase of implementation, 2017 through 2019. The JJC accepted referrals of eligible youths, aged 12 to 18 years, who were arrested for a felony or a violent misdemeanor in overpoliced communities of color. The Cook County State’s Attorney’s Office identified youths for diversion services and sent the cases to Juvenile Probation, which screened cases for JJC eligibility. If youths chose not to participate, they continued under informal supervision; referral to community services was at Juvenile Probation’s discretion.

The JJC received 556 referrals. Most participants were male (73%) and people of color (84% non-Hispanic Black and 15% Hispanic/Latino). Therefore, exploring differences based on gender and race and ethnicity was not warranted. The mean age was 15.36 years (SD = 1.41); the median age was 16.00 years. The most common charges were drug possession or dealing and battery. Most (376; 68%) completed an intake. Among the 180 who did not, 54% did not attend an intervention program, 28% had their justice system referral withdrawn, and 17% attended with ineligible offenses or new charges (Table 1).

TABLE 1—

Participant Characteristics: Cook County, IL, 2017–2019

Characteristic	No. (%), Median, or Mean ±SD
Year referred
2017	96 (17)
2018	209 (38)
2019	251 (45)
Gender
Female	149 (27)
Male	407 (73)
Race/ethnicity
Non-Hispanic Black	466 (84)
Hispanic/Latino	82 (15)
Non-Hispanic other	8 (1)
Age, y
Median	16
Mean	15.36 (1.41)
Charges
Possession/dealing drugs	134 (24)
Battery	129 (23)
Theft	47 (9)
Robbery	37 (7)
Possession of a stolen vehicle	26 (5)
Burglary	23 (4)
Assault	18 (3)
Weapons charges	9 (2)
Other	30 (5)
Multiple charges	51 (9)
Blank/missing	52 (9)
Intake completion
Completed intake	376 (68)
Did not complete intake	180 (32)
Failed to show for intake	98 (54)a
Referral withdrawn by juvenile justice system	51 (28)a
Ineligible to participate because of ineligible offenses or new charges	31 (17)a

Note. Population total was n = 556.

^a Percentages are given as a share of the group who did not complete an intake.

PURPOSE

Racial disparities in justice system involvement negatively affect the health of youths of color. Youths of color face increased surveillance in their communities, harsher discipline in schools, and a greater risk of a parent being incarcerated, leading to numerous adverse health outcomes, even without direct justice system involvement. ⁴ Punitive measures such as detention hinder positive development. Justice-involved youths have higher rates of psychiatric disorders than the general population ⁵ as well as lower use of well-child visits. ⁶ Therefore, a diversion program that prioritizes youths of color for referrals, while taking a strengths-based approach, is one strategy to align the justice system response with developmentally appropriate services for youths. ⁷

EVALUATION AND ADVERSE EFFECTS

Among the 376 youths who completed an intake, most (64%) successfully completed the program: 21% of youths were dismissed as unsuccessful, 12% were discharged as unserviceable (e.g., moving away, transferring to another program), 1% were ineligible to continue, and 2% were neutrally discharged with a new charge before being connected to services.

The Child and Adolescent Needs and Strengths assessment tool has 77 questions across several domains: childhood trauma, traumatic stress, risk behaviors, behavioral and emotional needs, life domain needs, caregiver needs, and strengths. ⁸ Paired pre–post assessments demonstrated that needs decreased from an average of 2.90 to 1.42, whereas strengths increased from 4.81 to 5.38, suggesting that youths who complete the program have increased strengths and reduced needs (paired means t tests; P < .001).

Recidivism, defined as any rereferral to court within one year of discharge, was also assessed. The care coordination agency and Juvenile Probation shared data directly; results were de-identified before being shared with us. Analysis was completed only for 2017 and 2018 because the one-year window was incomplete for many youths in 2019. Matches were found in the Juvenile Probation arrest database for 96% of youths. Although 18% of youths who successfully completed the program were rereferred to court, 55% of youths who were connected to services but not successful and 44% of youths who were referred but never connected to services were rereferred to court. Overall, 33% of JJC youths were rereferred to court. By comparison, 32% of youths were rearrested following diversion program involvement after their first arrest in 2016. ⁹ Youths who successfully completed the program had a significantly lower recidivism rate (χ²; P < .05), whereas the overall JJC recidivism rate did not significantly differ from the comparison group (P = .77; Table 2). The comparison group is imperfect because it included youths with lower-level offenses with a reduced propensity for recidivism. The quasiexperimental nature of the program means a true control group did not exist.

TABLE 2—

Rereferral to Court Rates by Discharge Category: Cook County, IL; 2017 and 2018 Cohorts

Discharge Category	Not Rereferred to Court, No. (%)	Rereferred to Court, No. (%)
Successful	117 (81.8)	26 (18.2)
Connected to services but not successful	19 (45.2)	23 (54.8)
Not connected to services	61 (56.0)	48 (44.0)
Total	197 (67.0)	97 (33.0)

Note. Population total was n = 197.

SUSTAINABILITY

Developing a long-term funding strategy remains challenging. Although services are provided to justice-involved youths, the justice system did not fund services. Shifting justice system funding for detention to alternative community-based services would be more cost effective and address systemic inequities associated with access to care for youths of color. JJC services cost an average of $4600 for 90 days of programming compared with nearly $47 000 for detention. ¹⁰ Furthermore, community-based alternatives result in lower recidivism, yielding long-term savings from reduced future reliance on detention and incarceration. ¹¹ Promising strategies in other states allow Medicaid billing for trauma and other prevention services without a mental health or substance use diagnosis. ¹²

PUBLIC HEALTH SIGNIFICANCE

The disproportionate targeting of youths of color by the justice system, leading to negative health outcomes, makes reducing their justice system involvement a public health issue. Findings from phase 1 of this diversion program are promising. Youths had increased strengths and decreased needs by the program’s end. Moreover, youths who successfully completed the program had a significantly lower recidivism rate. The care coordination model may also be scaled and evaluated with other populations, such as young adults aged 18 to 24 years.

The punitive nature of the carceral system exacerbates trauma and disrupts healthy adolescent development. However, providing youths with tailored services allows them to maintain connections and social support in communities while addressing basic needs and causes for their justice involvement. In turn, these may decrease life disruption, promote positive health and social outcomes, and reduce further youth justice involvement while we work to eliminate the racial and structural disparities in the current criminal justice system, which disproportionately affects people of color.