Implementation and Outcome Evaluation of LA DOOR: A Proposition 47-Funded Program in Los Angeles—Cohort 2 Final Evaluation Report

The Los Angeles Diversion, Outreach, and Opportunities for Recovery (LA DOOR) program is 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.

Through Proposition 47 (the Safe Neighborhoods and Schools Act), the California Board of State and Community Corrections (BSCC) provided initial funding in 2017 to develop LA DOOR. In 2019, BSCC provided a second round of funding from Proposition 47 to a second cohort of select jurisdictions to either expand existing services or propose new programs. Programs funded through Proposition 47 are intended (1) to serve individuals with a history of criminal justice involvement and mental health issues or substance use disorder (SUD) and (2) to offer mental health services, SUD treatment, and diversion programs for justice-involved individuals (California Board of State and Community Corrections, 2016).

In January 2020, LA DOOR received additional funds for Cohort 2 to enhance and expand the LA DOOR model from South Los Angeles into Central Los Angeles, furthering the program's efforts to address existing service gaps, reduce recidivism, and prioritize public health solutions to addiction and mental illness. This second cohort serves five hotspots in South and Central Los Angeles. Hotspot locations are areas identified by LACA as having persistent open-air drug use and a high density of individuals struggling with substance use, mental health, or co-occurring disorders. LA DOOR deploys a multidisciplinary social service team to five hotspot locations (a different one each weekday) to proactively engage individuals with a broad array of social services. The three main goals of LA DOOR are to

• increase clients' utilization of community-based support services
• remove clients' legal barriers
• reduce recidivism through preventative services and prebooking diversion.

Individuals who enroll in LA DOOR have access to a variety of services, including

• mental health services
• SUD treatment
• health and wellness checks
• legal services
• housing services
• peer case management services.

Over the course of the project, Proposition 47 grantees are required to collect data and evaluate their programs. As with Cohort 1, LACA selected the RAND Corporation and KH Consulting as its evaluators. As part of the evaluation efforts, grantees submit a final evaluation report to assess progress toward the goals and objectives of their programs. During Cohort 2, LACA has continued its partnership with Special Service for Groups' (SSG's) Project 180 as the primary LA DOOR social service provider, as well as with West Angeles Community Development Corporation (WACDC) and its subcontractor, L.A. Global Care, to provide additional housing and case management support.

This final evaluation report for Cohort 2 documents the program evaluation results, focusing on the time frame from January 2020 to February 2023.¹ The goal of this evaluation is to better understand how the LA DOOR program was implemented and to examine the effect of the program on various outcomes. This study describes an overview of the program, evaluation methods, the logic model that guided the evaluation, findings from stakeholder interviews and client focus groups, and analysis of program data. Qualitative interviews and focus groups revealed key strengths and challenges of the program and focused on specific challenges of operating during the coronavirus disease 2019 (COVID-19) pandemic. Analyses of quantitative data describe the population of clients who are receiving LA DOOR services, the needs of that population, and the services provided. Together, these findings shed light on opportunities for future program implementation and evaluation.

Methods

Quantitative Methods

• Service Now (SNow) data analysis. In designing LA DOOR, LACA committed the project and its partners to robust and detailed data collection. SNow is a relational database platform commonly used by government entities within the City of Los Angeles. LACA, in partnership with the City of Los Angeles's Information Technology Agency, built the Health Insurance Portability and Accountability Act (HIPAA)-compliant SNow database to track caseloads among social service partners and track social service access for program clients. The SNow database follows social service engagement within several categories: general needs, case management, substance use services, mental health care, physical health care, employment services, housing services, and legal services. In addition to the SNow database, data on intensive outpatient program (IOP) visits, criminal justice history, public defender interaction, and recidivism were used. Included in this evaluation are eligible LA DOOR clients from January 1, 2020, through February 15, 2023.² The final sample of individuals included 1,102 clients.
• LA DOOR client feedback survey. Between September 1 and October 12, 2022, the research team and LA DOOR partners distributed the client feedback survey (in person and by email) to current and past clients to collect quantitative feedback on the perceived effectiveness and importance of LA DOOR services.³

Qualitative Methods

• LA DOOR client focus groups. Between October 18 and 25, 2022, the research team conducted five in-person focus groups and one virtual focus group with LA DOOR clients to gather qualitative input and feedback regarding the clients' LA DOOR experiences. Each focus group was between 45 and 60 minutes in length and covered a variety of topics, such as motivation for participating in LA DOOR; client experiences with LA DOOR programs, services, and staff; and challenges and suggestions for improvement.
• LA DOOR partner interviews. In October 2022, researchers held a total of six in-person and virtual interviews with LA DOOR partner staff involved with LA DOOR Cohort 2 clients. Interviewees were asked for their perspective on (1) different aspects of LA DOOR; (2) implementation barriers and facilitators; and (3) implementation components and implementation processes, including service planning and decisionmaking, service selection, development and maintenance of partnerships, communication among partners, and program-monitoring efforts.
• Participant observation. During the multi-day visit to LA DOOR, researchers observed LA DOOR activities as participant observers, which included observing both an intake session at Project 180 and case management sessions at both Project 180 and WACDC and a ride-along with the LA DOOR mobile team to a hotspot location.

Key Findings

The following are the key findings in this Cohort 2 final report:

• LA DOOR enrolled 1,102 individuals, which makes the program well positioned to meet the anticipated total caseload of 750 clients during the grant cycle.
• In 59 percent of cases, LA DOOR accomplished its goal of working with each client for at least two months after enrollment. Clients who were active in program services for two months are considered as having completed the LA DOOR program, though they can continue to participate in the program after that time.
• LA DOOR clients represent a hard-to-treat population with important psychosocial needs: 62 percent of clients had SUD and co-occurring mental health conditions (most commonly noted as depressive disorders, bipolar and related disorders, schizophrenia and other psychotic disorders, and trauma or stress-related disorders). In addition, many LA DOOR clients lack stable housing and income sources.
• LA DOOR clients reported that housing continues to be a significant need; both quantitative data and focus groups suggest that clients found housing services to be among the most important LA DOOR services. In addition, clients expressed concerns about the difficulty of navigating the bureaucratic processes associated with being linked to transitional and permanent housing, unsanitary and unsafe shelter conditions, and long wait times for Section 8 housing.
• LA DOOR project staff and partners discussed the many challenges related to service access and availability during the COVID-19 pandemic: heavy caseloads, lack of LA DOOR–funded training, decreased COVID-19–related services, cumbersome bureaucratic processes, and increased medical needs (primarily because of fentanyl use).
• LA DOOR partners maintain program fidelity, and LA DOOR clients continue to express gratitude for and high satisfaction with LA DOOR and the services it provides.

This final Cohort 2 report provides LA DOOR partners the opportunity to reflect on the implementation of the project and to learn more about the clients who are being served and the services that are being provided.