The literature regarding the effects of incarceration on individuals with intellectual and developmental disabilities (IDD) establishes a clear pattern of decreased health status and poor levels of appropriate healthcare across all domains. Individuals with IDD experience significant health disparities when compared to the wider community including misdiagnoses and diagnostic overshadowing. The population of individuals with IDD who are also forensically involved is at even greater risk of lower health status across all domains but particularly in the areas of poor mental health treatment, increased trauma, and increases in abuse and exploitation.
This paper outlines an innovative program implemented in Philadelphia to provide specialized supports coordination to individuals with IDD who are involved with the criminal justice system as an alternative to incarceration. The Special Offenders Supports Program is the only program in the city of Philadelphia that provides a specialized team of supports coordinators dedicated to supporting special offenders. It is also only one of four existing programs in the state of Pennsylvania. Temple University’s Institute on Disabilities conducted an evaluation of existing SOS programs in 2004. The evaluation references the Philadelphia program; however, because the program was in its infancy it was not part of the complete evaluation. In the 12 years that the Philadelphia program has been in existence there has not been a follow-up study or evaluation of the special offender programs in Pennsylvania or a substantive evaluation of the Philadelphia program. The program evaluation has demonstrated that the Philadelphia SOSP is now the largest program in PA, having started with 7 individuals and now serving over 180 special offenders, and redefining how to support this specialized population within the IDD population.
Background
With funding provided by the Pennsylvania Commission on Crime and Delinquency and in collaboration with the Lancaster County Mental Health/Mental Retardation Program, a project was initiated to assist individuals with intellectual and developmental disabilities who were also on parole and or probation. The Lancaster model, as it became known, was predicated upon the goal of providing individuals with IDD specialized service as an alternative to incarceration. The Lancaster model was built upon the ideal of a collaborative relationship between an intensive case manager and the parole or probation office. Both parties would work collaboratively to ensure a system of support was in place to meet the individual’s assessed needs and desired outcomes while simultaneously avoiding incarceration. Initial success led to expanded funding in 1985 for additional programs in Erie, Dauphin, Lehigh, Allegheny and Philadelphia Counties.
In 2004, the Temple University Institute on Disabilities conducted an evaluation of the existing special offender programs in Pennsylvania. At the time of the report there were five formal programs in existence in Erie, Dauphin, Lancaster, Lehigh, and Philadelphia counties. The evaluation conducted by Temple University comprised two steps: a focus group discussion with representatives of each program participating, and descriptive analysis of each program to collect baseline data. The goals of the evaluation were:
- Evaluate the selected programs;
- Assess how the criminal justice system and intellectual disabilities systems work together;
- Determine how the programs operate and potential expansion; and
- Generate recommendations for future special offenders programs.
Method
The Delphi technique is a method of obtaining group input for ideas and problem¬-solving that does not require face-to-face participation. It uses a series of carefully designed questionnaires interspersed with information summaries and feedback from preceding responses. Delphi is a method for structuring a group communication process so that the process is effective in allowing a group of individuals, as a whole, to deal with complex problems without physically assembling the contributors. Instead, information is exchanged via mail, fax or e¬ mail. This technique is designed to take advantage of participants' creativity as well as facilitating effects of group involvement and interaction.
PersonLink Program Specifics
The PersonLink Special Offenders Supports Program was established as a formal program organized within the PersonLink supports coordination organization in 2005. When the program started, there were 17 individuals and two supports coordinators. Currently the program has grown to support 150 offenders with 6 supports coordinators and one team manager. The literature has stated that female offenders represent less than 1% of total offenders with IDD. This is represented in the demographics of the PersonLink SOSP. Offenders enrolled in the program are supported in a variety of community setting including formalized community residential program and in the homes of relatives. In 2005, when the original evaluation of SOSP in Pennsylvania was conducted, the PersonLink program had an estimated budget of $138,000. The largest program at the time, in Lancaster county, had a budget of $250,000. Currently, the PersonLink Special Offenders Supports Program has increased its budget exponentially.
Analysis of the Findings
The Delphi technique was replicated for the purposes of this comparative evaluation and the responses from the staff of the PersonLink Program were compared to the responses from the staff in the 2005 evaluation. The questions asked on both the original and current program evaluation surveys sought to understand how the staff felt data should be collected and stored, and by what standards program effectiveness, objectives, and challenges should be assessed. The current evaluation found that PersonLink SOSP staff shared similar assessment of the original SOSP implementation. Both sets of respondents felt that the program should be assessed based on community awareness, recidivism, and the establishment of increased community supports specific to the forensic population of individuals with intellectual and developmental disabilities
Programmatic Outcomes
Developing and maintaining connection with the community of choice has been the hallmark of the IDD system since the 70s. Within the wider population, the literature has shown that the primary goal of rehabilitation and programs that offer alternatives to incarceration is integration into the community of their choice with viable options that support treatment and rehabilitation. What has been identified in the literature as a challenge to existing SOSPs is the availability of reliable assessment tools to identify the level of support an individual will need based on their cognitive limitation. The PersonLink program utilizes the supports intensity scale assessment tool. The utilization of the standardized assessment tool allows for individualized supports to be put in place.
Future Directions
The PersonLink Special Offender Supports Program has operated for more than 10 years and grown from supporting 17 individuals with 3 staff and $138,000 budget to over 150 individuals with 6 staff, a team manager, and operating budget of over $500,000. The results of evaluations done by both the Temple University Institute on Disabilities and the Pennsylvania Center for Excellence showed that while the SOSPs were necessary to protect the individuals with IDD there are significant challenges to programs in the form of lack of awareness of the programs’ benefits and formal operating agreements between key stakeholders. Additional concerns have been the limited availability of accurate recidivism rates due to inconsistent definitions used by existing programs. With this in mind, future directions include:
1. Develop memorandums of understanding with county IDD programs probation and parole offices, the Defender Association, and the forensic unit of the state mental hospital to streamline referrals to the PersonLink program.
2. Utilize the existing Public Health Management Corporation (PersonLink’s parent organization) database to capture specific data points relative to the special offenders program.
3. Develop a formal definition of recidivism to ensure that data collected across counties is reliably consistent.