Final Evaluation of LA DOOR: Proposition 47 Grant Program

Short abstract

The Los Angeles Diversion, Outreach, and Opportunities for Recovery program provides a comprehensive, health-focused, preventative approach that proactively engages individuals at elevated risk of returning to the Los Angeles City Attorney's Office on a new misdemeanor offense related to substance use, mental illness, or homelessness. In this article, the authors summarize their findings from an evaluation of Cohort 1 of the program.

Abstract

The Los Angeles Diversion, Outreach, and Opportunities for Recovery program (LA DOOR) was designed by the Los Angeles City Attorney's Office (LACA) to provide a comprehensive, health-focused, preventative approach that proactively engages individuals at elevated risk of returning to LACA on a new misdemeanor offense related to substance use, mental illness, or homelessness.

LA DOOR was funded through the grant program of Proposition 47. Programs funded through Proposition 47 are intended to serve individuals with a history of criminal justice involvement and mental health issues or substance use disorders and to offer mental health services, substance use disorder treatment, and diversion programs for justice-involved individuals. Grant-funded projects such as LA DOOR are required to be evaluated to understand how they are being implemented and whether they are achieving their intended outcomes. The formal evaluation of the program is being conducted by the RAND Corporation and its subcontractor, KH Consulting Group.

This final evaluation summarizes the authors’ findings from a process and outcome evaluation of Cohort 1 of LA DOOR, which provided services from July 2018 to March 2021. Interested stakeholders of this research include LACA, the California Board of State and Community Corrections, the City of Los Angeles, and other jurisdictions that provide supportive services to criminal justice populations or might be interested in implementing a similar program.

The Los Angeles Diversion, Outreach, and Opportunities for Recovery (LA DOOR) program employs a comprehensive, health-focused approach to addressing substance dependence that emphasizes field-based services, prebooking diversion, community engagement, and financial leveraging. LA DOOR is operated by the Los Angeles City Attorney's Office (LACA) and targets historically underresourced South Los Angeles populations with a history of mental health issues or substance use disorders (SUDs) who have previously been arrested, charged with, or convicted of a criminal offense. The three main goals of LA DOOR are to

• increase participants’ utilization of community-based support services

• reduce entry into the criminal justice system

• create sustainable community social safety nets in targeted locations.

LA DOOR receives funding through Proposition 47. Proposition 47, which passed in 2014, reduced simple drug possession from a felony or “wobbler” (i.e., an offense that can be charged as either a felony or a misdemeanor) to a misdemeanor and required misdemeanor sentencing for certain theft charges, including petty theft, receiving stolen property, and forging checks (Hunter et al., 2017). Enacting Proposition 47 resulted in decarceration savings that are redistributed to local communities in the form of grant funding administered by the California Board of State and Community Corrections. In addition to funding social services, all programs supported by Proposition 47 grant funds are required to be evaluated to understand how they are being implemented and whether they are achieving their intended outcomes.

LA DOOR captures Proposition 47's guiding principles through the implementation of three components:

• Mobile service outreach. Members of the Mobile Team deliver culturally competent, trauma-informed, harm-reductive, and peer-navigator-led social services. Mobile Team members are required to attend a series of trainings and workshops, including motivational interviewing and trauma-informed care. The Mobile Team responds to five “hot spot” locations in Los Angeles with a high density of misdemeanor drug arrests and homeless encampments for their outreach efforts. The consistency of conducting outreach at the same locations allows the team to build rapport and gain trust with participants and to provide field-based services and monitor progress for those enrolled in the program.

• Prebooking diversion. LA DOOR has a prebooking diversion pathway to treatment featuring a 24/7 hotline for use by law enforcement and social contact referrals. Through this pathway, law enforcement contacts LA DOOR to connect eligible people arrested on misdemeanor drug offenses with services. An LA DOOR peer navigator then responds to the police station and enrolls the arrestee in LA DOOR services in lieu of booking and prosecution.

• LA DOOR Advisory Committee (Advisory Committee). The Advisory Committee is designed to foster collaborative partnerships that inform and adapt interventions to address the collateral consequences of substance use and mental illness. The Advisory Committee consists of a range of stakeholders, including behavioral health experts, formerly justice-involved individuals, community-based organizations, law enforcement, academics, and defense representatives. The Advisory Committee meets regularly with LA DOOR partners to provide guidance and project accountability.

Individuals who enroll in LA DOOR have access to a range of services. These include

• mental health services

• SUD treatment

• health and wellness checks

• legal services

• housing services

• peer case management services.

Proposition 47 grantees are required to collect data and evaluate their programs. LACA selected the RAND Corporation and KH Consulting as their evaluators following a competitive request-for-proposal process. Subsequently, LACA contracted with Special Services for Groups’ Project 180 (P180) as the primary LA DOOR social service provider, as well as with West Angeles Community Development Corporation and its subcontractor Ms. Hazel's House to provide additional housing and case management support. The Los Angeles County Public Defender's Office is also a partner of LA DOOR but does not receive grant funding.

RAND and KH (the evaluation team) conducted a mixed-methods process and outcome evaluation of the first cohort of individuals served by LA DOOR. The evaluation covered the period of July 2018 to March 2021. This study builds on our Two-Year Preliminary Evaluation Report, submitted in August 2019, which described the observations from the initial program planning phase (February 2018 to July 2018) and initial findings from the program implementation through March 2019. The present study focuses on the implementation phase only (July 2018 to March 2021), integrating data discussed in the interim report with the additional data collection activities that took place over the last two years.

The process evaluation focused on the implementation of LA DOOR, including characteristics of participants served, types of services provided, and implementation-related challenges and solutions. It also assessed the effect of LA DOOR's goals. Process evaluation data were derived from quantitative data submitted by providers, site visits with each program partner, meetings with the service providers, and focus groups and interviews with program participants.

The outcome evaluation examined whether LA DOOR achieved expected short-term and intermediate outcomes. These include the following:

• Increase access to services (short term, from enrollment to exit).

• Improve housing situation of LA DOOR clients (short term, from enrollment to exit).

• Address legal barriers (short term, from enrollment to exit).

• Reduce substance use (short term, from enrollment to exit).

• Reduce symptoms of mental health problems (short term, from enrollment to exit).

• Reduce criminal justice involvement, including recidivism (intermediate, assessed following program enrollment).

During the interim reporting of Cohort 1, because of the lack of data capabilities, we were not able to measure any of these outcomes other than recidivism. However, as discussed in more detail in the next section, LACA updated their data collection tool, and program partners were able to collect data from clients at baseline and again at multiple time points throughout their engagement with the program.

Key Findings

Based on our results, we identified the following key findings.

LA DOOR Successfully Established Three Referral Sources and Has Exceeded Its Goals of Number of Enrolled Clients

LA DOOR enrolled 711 participants in case management. Initially, the prebooking diversion arm of LA DOOR took longer to implement than the mobile outreach arm. However, even after full implementation of prebooking diversion, levels of LA DOOR case management enrollment through prebooking diversion remained far lower than through mobile outreach because of the relatively few bookings for individuals on Proposition 47–eligible offenses, especially during COVID. Rather than bring arrestees back to the station for LA DOOR referral, law enforcement generally used a “cite and release” approach, meaning arrestees were released in the field before the referral could be made at the police station prior to booking. However, LA DOOR pivoted and implemented the social contact referral arm, which has become a successful referral source.

LA DOOR Is Achieving High Completion Rates

LA DOOR works with individuals at elevated risk of returning to the LACA office on a new misdemeanor offense related to substance use, mental illness, or homelessness who have extremely high needs and are often difficult to reach. A key success of this program is that currently 74 percent of individuals enrolled in LA DOOR case management have completed at least two months of engagement.

LA DOOR Clients Represent a Hard-to-Treat Population with High Needs

Sixty-five percent of LA DOOR clients report having co-occurring substance use problems and mental health issues. A majority of participants also expressed housing service needs (67 percent) and general service needs (58 percent). Many LA DOOR participants lack stable income sources. Both quantitative data and focus groups suggest that clients found SUD services and housing services to be among the most important LA DOOR services. Importantly, LA DOOR is providing and making the proper service linkages to address those needs. For instance, over 70 percent of participants access health services and housing services conditioned on need.

The Need for Housing Has Become More Prevalent, and LA DOOR Has Increased Capacity to Meet Those Needs

One of the most expressed needs of LA DOOR clients in the interim report was the need for housing (67 percent overall). We found that 25 percent of LA DOOR clients completed an application for Los Angeles County's Coordinated Entry System. Fourteen percent of clients were placed in transitional housing (LA DOOR funded or P180 partner). An additional 31 percent of clients were linked to temporary housing, permanent housing, or other services. The need for safe housing became even more prevalent in 2020, during the COVID pandemic. During interviews, LA DOOR clients continued to indicate that housing services are a top priority. Overall, 2020 focus group participants indicated that their transition from P180 outreach services into LA DOOR–funded housing was generally smooth and described LA DOOR as a “well-oiled machine.” This is an improvement in perception compared with 2018 feedback in the interim report that depicted a confusing and frustrating process for both LA DOOR clients and staff. Since 2018, LA DOOR–funded housing clients have moved to a new housing facility provided by Ms. Hazel's House, where male and female LA DOOR clients are colocated in different buildings on the same property. West Angeles Community Development Corporation provides a consistent and supportive case management presence and continues social services once participants are placed in LA DOOR housing. There have been benefits to this new housing arrangement. For example, clients indicated that they are happy with the LA DOOR–funded housing facility and staff. Staff indicated that the colocation provides service efficiency and opportunity for collaboration.

COVID Created Additional Barriers to Serving Clients

At the onset of the COVID-19 pandemic, program partners quickly adapted their communication to a virtual format and collaborated digitally to address the rapidly changing pandemic situation. The LA DOOR Mobile Team ceased providing outreach services for a mere two weeks, just long enough to train staff in appropriate precautions and to access personal protective equipment for all team members. Once this was achieved, the Mobile Team resumed outreach, adding meal service delivery and COVID-19 prevention and education to mobile outreach efforts. Although on-site group services at P180 stopped, clinical and case management services continued to be provided in person, with some visits handled over the phone or online. LA DOOR housing responded by ceasing new intakes and quarantining housed participants in place during the early days of the pandemic. LA DOOR housing partners at West Angeles Community Development Corporation and Ms. Hazel's House also developed quarantine rooms to allow new participants to come into housing while maintaining safety protocols to protect against infection in the housing sites. Additionally, a digital referral system to the Public Defender's Office was developed. All LA DOOR program partners swiftly took steps to put new safety protocols in place, educate staff and clients about COVID-19 hygiene and safety, and develop new logistical procedures for the protection of staff and clients. Despite an initial reduction in the provision of services, LA DOOR was able to continue serving clients with few instances of infection among staff or clients.

Participants Were Satisfied with Services

LA DOOR participants described the importance of the services provided and highlighted that the mobile outreach component was particularly important to engaging them in the program. In general, LA DOOR clients believe services to be effective, including assistance in obtaining IDs and accessing benefits, transportation services, and physical and behavioral health services. Participants noted that the program has allowed them to access services that may otherwise be difficult to obtain. Case managers were described as critical to engaging and retaining participants in the program. Clients perceive them as advocates, and interviews with the case managers highlighted their dedication to their roles. Moreover, interviews with staff members highlighted the ways that the program has continued to evolve to be responsive to client needs.

Progress Toward LA DOOR Goals

Goal 1: Increase Participants’ Utilization of Community-Based Services

LA DOOR providers have demonstrated their commitment to serving justice-involved individuals. They are exceeding their enrollment goals and began implementing the social contact referral arm to reach additional individuals. The LA DOOR team monitors the most prevalent needs and responds to those needs accordingly, including working with partner agencies to provide linkages when necessary. During this evaluation period, the LA DOOR team has clearly indicated that this goal is of the utmost importance; it has developed and implemented a program that targets a high-need population that historically has not been provided with the necessary resources, time, or attention.

Goal 2: Improve Outcomes, Including Reduced Recidivism

Overall, our analyses suggest that individuals enrolled in prebooking diversion are less likely to commit crimes compared with individuals who did not participate in LA DOOR. Among the 79 LA DOOR prebooking diversion participants enrolled in case management, 20.5 percent had a reconviction, including 11.5 percent who had a subsequent felony conviction and 14 percent who had a subsequent misdemeanor conviction as of April 1, 2021. Statistically, this was significantly lower than the comparison group, of whom 32 percent had a reconviction, including 23.2 percent who had a subsequent felony conviction and 20 percent who had a subsequent misdemeanor conviction as of April 1, 2021. In addition, preliminary analyses indicate promising results regarding SUD, housing, and physical health outcomes; however, at this time, conclusions cannot be made about the effect of these other measured outcomes.

Goal 3: Create Sustainable Community Social Safety Nets in Targeted Locations

A key goal of LA DOOR is to expand the availability and utilization of new community-based housing and social supports through housing services and capacity-building efforts. During Cohort 1, the LA DOOR team has worked to enhance partnerships with South Los Angeles's existing provider network. According to P180, the Mobile Team has developed provider partnerships to support LA DOOR, which includes 53 partner organizations that represent 15 substance use agencies, 12 health care agencies, 9 housing agencies, 1 employment/education agency, 1 legal organization, and 15 others (includes ER and urgent care needs, dental, vision, and Supplemental Security Income benefits). This has been key in providing linkages to much-needed services; in particular, 19 percent of individuals were linked to SUD services, 10 percent linked to medical detox/residential treatment, 15 percent linked to mental health services, 25 percent linked to health services (outside medical providers), 23 percent linked to temporary housing, and 3 percent linked to permanent housing.

Recommendations

Recommendation 1: Continue Serving Lower-Acuity Referrals

LA DOOR set a goal of increasing the number of lower-acuity referrals. With the guidance of the Advisory Committee, LACA staff provided trainings to relevant local agencies (e.g., residential drug treatment providers) and also brainstormed additional potential referral sources, such as the Probation Department and local community colleges. Continued discussions with partners are necessary.

Recommendation 2: Continue Working on Quality Data Collection

While the new data collection system is an improvement, we have determined that key information is missing, most importantly the follow-up data regarding substance use, mental health, housing, and recidivism. As Cohort 2 continues, the project team will meet to discuss the importance of data collection, challenges, and barriers of data collection, and how best to make sure that data are being collected in a rigorous way. Although this is a challenging population to get follow-up information from, improvements have been made.

Recommendation 3: Continue Working to Match Needs to Services

The top needs reported by clients concern substance use, housing, general service, mental health, and transportation. While clients who expressed those needs are accessing SUD, housing, and general service needs, only half of clients who expressed mental health, food and clothing, education or employment, health care, and legal assistance needs are accessing the appropriate services. Similar needs were also discussed during the focus groups with clients, especially the needs and challenges associated with housing, and participants described the way that the program has allowed them to access services that may otherwise be difficult to obtain. As pre-COVID policies and procedures begin to be reinstated, we anticipate differences in service needs and access. The LA DOOR team will use the information provided in this study to ensure that clients’ top needs are being matched with the services offered.

Recommendation 4: Focus on Employment Linkages

Fifty-one percent of participants expressed employment as a priority need. LA DOOR works with participants to address employment-related needs through linkage to organizations such as Homeboy Industries, Chrysalis, and Work Source Centers, although there is currently no structured employment component to the program. This is a key finding, especially since the clients were trying to find and secure employment during COVID. The Los Angeles City Attorney's Office and P180 worked to ensure there is a full-time employment specialist on staff and available to LA DOOR participants in Cohort 2.

Conclusion

LA DOOR is a program designed by LACA to provide a comprehensive, health-focused, preventative approach that proactively engages individuals at elevated risk of returning to LACA on a new misdemeanor offense related to substance use, mental illness, or homelessness. The findings from this evaluation demonstrate that the participants are satisfied with the services and that the program shows promise in achieving its goals. It is our hope that the evaluation of LA DOOR will contribute to the broader literature on the effectiveness of a comprehensive, health-focused, preventative approach that proactively engages individuals at elevated risk of returning to the criminal justice system.