The audit of the Community Diversion Program was initiated as part of the broader directive from the County Council to review alternatives to incarceration, access to treatment, and program services for special offender populations detained in the King County Correctional Facility (KCCF), and was included in the Auditor's Office 1993 work program. The "special populations" identified by the Council request were substance abusing, mentally ill, or developmentally disabled offenders.

The Community Diversion Program (CDP), also known as the Pre-Booking Diversion Project, was begun in July 1991 for offenders arrested by Seattle Police, and in early 1992 expanded to accept offenders referred from the KCCF and the Harborview Medical Center Emergency Room.

Funded primarily by King County with Criminal Justice Assistance Act (CJ) revenue, the CDP was operated by the Community Psychiatric Clinic, under contract to the King County Mental Health Division (MHD) and Division of Alcohol and Substance Abuse Services (DASAS). By 1993, 81% ($1.3 million) of the Diversion Program's $1.6 million in expenditures had been funded by King County, while the City of Seattle had contributed $300,000. Oversight of the Diversion Program was provided by an inter-agency Oversight Committee, chaired by the Associate Director of the Department of Adult Detention (DAD).

The CDP was staffed by 6 mental health and 4 chemical dependency outreach staff supervised by a program manager. Mentally ill and substance abusing offenders who did not meet the criteria for involuntary commitment, but who had been charged by Seattle Police with a non-violent crime (and met other program criteria) were to be delivered by the SPD to the diversion site. Diversion staff would then provide crisis stabilization assistance and serve as a "broker" to facilitate the offenders' connection to long-term mental health and chemical dependency services.

The budget justification for the 1991 CDP appropriation of $589,375 anticipated that 500 persons would be cited/detained by police in the downtown Seattle (West) precinct, and diverted from jail during the 7 month period from June through December (71 offenders per month).

The audit objective was to evaluate the efficiency and effectiveness of the Community Diversion Program (CDP) in meeting its service objectives for the client population of mentally ill or chemically dependent offenders. The audit was also to identify means to improve service delivery.

The general audit conclusion was that criminal justice funds had been used inefficiently to operate the CDP in 1991 through 1993, and that monitoring and evaluation of CDP expenditures and program outcomes had been inadequate. Although the number of mentally ill/chemically abusing offenders referred had increased since program inception in mid-1991, the volume of offenders served (24 per month) remained at less than half of program capacity (50-71 per month).

Moreover, the CDP was ineffective in providing long-term benefits to offenders referred to the program. During the two-year period from July 1991 through June 1993, the Diversion Program expended $1.3 million in CJ revenue to refer 23 (6%) offenders for enrollment into the mental health system and 60 (16%) offenders for chemical dependency treatment. Most of the 378 (181 or 48%) offenders referred to the CDP refused or otherwise did not receive services or were already clients in the mental health system (74 or 20%).

The Diversion Program was staffed by 10 employees. Staffing was designed to accommodate 71.4 offenders per month (or 7 new clients per staff person per month) beginning in 1991. All 71 offenders were to be referred from the downtown, or West, precinct. However, when only 24 offenders (4/month) were referred during 1991, the 1992 level of service objective was reduced to 20 clients per month, or 2 clients per staff person, with no corresponding reduction in staffing or budget. In addition, the program was expanded citywide to all 4 SPD precincts (and the KCCF) and mobile outreach was initiated. As a result, citywide SPD referrals increased to an average of 10 offenders per month in 1992 and 12 in 1993. (See pages 20 through 22 for the analysis of CDP capacity and objectives compared to referrals.)

SPD did not use the program to the degree anticipated. Some precincts made few to no referrals.

Moreover, an analysis of referrals by precinct indicated considerable variation among precincts, with the largest number of referrals originating from the North precinct to which the program site had relocated, rather than the downtown Seattle (West) precinct, and virtually no referrals from the South precinct. Jail referrals averaged 12 offenders per month during 1992 and 1993, resulting in a combined SPD/KCCF total of 24 referrals per month, which was the reduced goal, but less than half the staffed capacity of 50 to 71 offenders. In addition, the number of offenders screened and accepted by CDP staff was not accurately reported to the Oversight Committee or to City and County agencies. (See pages 25 through 28 for the analysis of police referrals by precinct.)

Attempts to increase SPD use of the program should be renewed, and it should be determined if any additional police referrals are likely.

The audit recommended that the CDP attempt to increase SPD referrals through a renewed officer familiarization program and a survey to determine if there are means to increase the usefulness of the program to officers, or if its potential benefits have been maximized.

Meaningful level of service objectives for the CDP should be set and the program’s budget and staffing should be adjusted accordingly.

The audit also recommended that the County establish meaningful level of service objectives for the number of offenders referred through the annual contract in 1994, and adjust budget and staffing levels to reflect actual program activity. Progress toward meeting referral objectives should be clearly and unambiguously reported to the City and County.

In 1992, as a result of the initially low number of direct SPD referrals, CDP staff assumed responsibility for follow-up on Seattle Police Incident Reports completed by officers following interactions with persons with symptoms of mental illness and mailed to the Community Psychiatric Clinic (CPC). Incident report referrals were reported as a major source of CDP clients, representing 43% of referrals in 1992. Yet follow-up on these reports resulted in very few linkages of mentally ill or chemically dependent offenders to long-term treatment services. No treatment outcome could be identified for approximately 70% of Incident Reports handled by CDP staff during 1992 and 1993. (See pages 35 to 36 for the analysis of incident report referral outcomes.)

CDP staff should be re-assigned to perform tasks which do not conflict with the CJ statute, and which directly further CDP objectives.

The CDP was never intended to provide a "paper" follow-up service. The transfer of this function from Crisis Intervention Services staff to the CDP was not authorized by the County’s funding contract, and was inconsistent with Criminal Justice Assistance Act limitations on supplanting pre-existing services funded from other sources. The audit, therefore, recommended that the CPC discontinue the practice of assigning follow-up on incident reports to CDP staff, who would be free to perform other tasks which directly further the objectives of the Diversion Program. (See page 34 to 35 for the discussion of the act's specific provisions.)

Finding 4. (II-4)  Short-term services provided were not adequately documented.

The database maintained by the CDP to track eligible clients was evaluated to determine the nature of both short-term crisis respite services and longer-term treatment outcomes. Data reported in the crisis services field did not provide sufficient information to determine which of several services may have been provided, or to document unmet needs. In fact, no crisis services information or only a catch-all phrase ("crisis stabilized") was entered for the majority (60%) of clients in 1993. (See pages 41 through 44 for the analysis of crisis response services reported.)

Key long-term program objectives of connecting mentally ill offenders with mental health and chemical dependency treatment services were not met for most CDP clients.

During the two years from July 1991 through June 1993 most offenders (40% to 48%) referred to the CDP were reported as having no treatment or referral connection due to refusing or not needing services, not being located by staff, etc. Twenty percent (20%) of CDP clients who did accept referrals were already enrolled in the mental health system and were re-referred to pre-existing case managers; 16% were reported to have been referred to Cedar Hills or other chemical dependency treatment programs, while 11% were referred to various social service programs. Only 6% of offenders were referred for new enrollment into the mental health system.

Jail referrals were more likely to result in new connections for treatment.

Overall the data indicated significantly fewer CDP offenders were connected with case management or treatment services which could "break the cycle of recidivism" than had been proposed in justifying the program's funding. Data analysis also indicated that jail referrals were more likely than SPD referrals to be a "productive" referral source for offenders’ entry into mental health or chemical dependency treatment. (See pages 45 through 52 for the analysis and discussion of treatment outcome data.)

CDP treatment outcomes should be accurately measured and reported.

The audit, therefore, recommended actions to accurately measure progress in meeting CDP program objectives such as assessing, revising, and validating the data fields used to track offenders, and defining useful data. Whether clients referred for new enrollment or previously enrolled in the system were in fact engaged, the time elapsed between referral and entry into programs or services, specific service and agency referrals (rather than general references), and offenders who recycle through the CDP should be tracked. The audit also recommended revising the CDP reporting format to show actual services provided compared to program objectives. (See pages 53 and 56 for specific recommendations.)

Finding 5. (II-5)  Although King County provided more than 80% of the $1.6 million spent through 1993, services were focused within Seattle boundaries.

From the CDP's inception in 1991 through 1993, King County provided more than 80% of the program's funding, with County appropriations totaling $1,519,330. The Seattle contribution remained constant at $100,000 per year, while the County increased its funding from $489,375 in 1991 to $525,662 in 1993.

Program eligibility criteria required that offenders be cited or detained by Seattle Police and their offense be under the jurisdiction of Seattle Municipal Court. Although the criteria as written did not exclude other (non-Seattle) King County residents, the program as operated resulted in a focus of services on Seattle residents. This service emphasis resulted from the program's location within the Community Psychiatric Clinic, the north central lead mental health agency. CPC's catchment area was roughly consistent with the Seattle City boundaries, and referral arrangements with other mental heath and social service providers were centered within the catchment area. For jail inmates, a non-Seattle residence was an exclusionary criteria, one reason cited by CDP staff for not accepting offender referrals.

Cost savings resulting from CDP services reported to the Seattle budget office were based on outdated assumptions and thus overstated program benefits.

Although services were primarily focused within Seattle boundaries, cost savings for Seattle attributed to the Diversion Program were based on outdated assumptions and therefore overstated. Proposals to broaden the base of clients accepted to include offenders (Seattle and non-Seattle residents) at arraignment by Seattle District Court and non-violent felony offenders had been discussed but not implemented at the completion of audit fieldwork. (See pages 67 through 69 for the discussion of methods for computing CDP cost savings.)

Assumptions used to compute cost-savings resulting from CDP services should be updated and specified. CDP program changes should be designed to better reflect city and county funding shares.

The audit recommended that cost savings attributed to the CDP be computed and reported based on updated and clearly stated assumptions. The audit also recommended the County reevaluate the cost-sharing arrangement with Seattle in conjunction with service focus and program eligibility to ensure equitable access to services for all eligible offenders. Future CDP program changes, such as expansion to Seattle District Court, inclusion of certain felony offenders, and staffing assignments should be designed to better reflect City and County funding contributions.

Finding 6. (II-6)  Criminal Justice funds to secure chemical dependency treatment services at Cedar Hills were not spent effectively in 1991 and 1992, and the Oversight Committee did not track costs, services, or outcomes for CDP clients placed in treatment.

CDP expenditures for Cedar Hills alcoholism and substance abuse treatment services to "dually diagnosed" clients did not reflect utilization rates, were not based on the provision of clearly specified services, and resulted in limited outcomes. Although a large proportion of CDP clients were expected to be in need of CHAT services, the number of bed-days used by CDP clients at Cedar Hills was far less than the number paid for in 1991 and 1992. While higher rates were charged for CDP clients placed in the dual diagnosis "track" compared with State funded clients, no written description of specialized services for CDP clients existed. In fact, there was no contract with CHAT to ensure accurate and equitable charging for Cedar Hills beds, effective provision and reporting of services, and efficient coordination by CDP and CHAT staff for client intake and aftercare. (See pages 75 to 79 for the discussion of specific costs and utilization rates.)

Fewer CDP clients completed treatment than other CHAT client groups.

Consequently, inconsistent methods were used to set the CHAT budget for services to CDP clients and to pay for those services, and CDP-funded beds were used for State clients without offsetting reductions in charges to the CDP. In addition, the low rate of program completion for CDP clients relative to other clients at Cedar Hills (46% for CDP clients compared to 58% to 89% for other groups in 1993) and inaccurate reporting of program days and outcomes (the primary measure of program success) were not recognized or addressed. (Treatment outcomes are discussed on pages 82 through 86.)

CDP clients in CHAT's dual diagnosis program should be closely monitored, a written basis for program services and costs should be established, and treatment outcomes for CDP clients reported and evaluated.

The audit recommended close monitoring of CDP clients placed in the dual diagnosis treatment program at Cedar Hills, and establishing a formal description of treatment services accompanied by a revised method (fee-for-service) of charging for service days through a written contract. The effectiveness of treatment services and program modifications which might increase completion rates and improve transition into aftercare or day treatment programs should also be reviewed. (See pages 89 to 92 for related recommendations.)