Process Evaluation of the Los Angeles County Rapid Diversion Program: A Pretrial Mental Health Diversion Program

Background

In 2019, Los Angeles County, California, established the Rapid Diversion Program (RDP), a pretrial mental health diversion program. Initially supported by the MacArthur Foundation Safety and Justice Challenge, RDP serves individuals whose mental health diagnosis (which can include substance use disorders) played a role in the criminal charges that they are facing. The program began by diverting misdemeanor cases in a single courthouse and has since expanded to diverting both misdemeanor and felony cases in seven courthouses.

Methods

We conducted a process evaluation of RDP to assess how the program is being implemented, what the implementation process has looked like, who is being served by RDP and the barriers to serving a larger population, the early outcomes for RDP participants, and the strengths and areas for improvement for the program. To address the research questions, our methods included (1) a document review and courtroom observations; (2) qualitative interviews with implementation partners, including RDP supervisors and leadership, defense attorneys, prosecutors, service navigators, clinicians, and case managers; (3) qualitative interviews with RDP graduates; and (4) quantitative analysis of program data.

Findings

RDP has filled an important place in the continuum of options for people in Los Angeles County who have behavioral health concerns and are involved in the legal system. Prior to RDP, their options were focused more on post-plea programming or were targeted to people with more-serious clinical needs or higher-level criminal charges (e.g., the Office of Diversion and Reentry's jail diversion program). When RDP began, the goal was simple: reduce the inefficiencies in the traditional mental health diversion process. It accomplished this goal by embedding the diversion infrastructure within the court setting, focusing on individuals with minor behavioral health concerns and low-level charges, and finding ways to streamline the evaluation and linkage process. But while the goal was simple, accomplishing it has required time, funding, and the dedication of implementation partners—such as defense attorneys, prosecutors, judges, and clinicians—all with the support of the MacArthur Foundation's Safety and Justice Challenge.

RDP has grown substantially since it launched in 2019. It now exists in seven courthouses, which vary substantially in terms of demographics and the communities they serve, from the Airport Courthouse, serving much of the west side of Los Angeles County, to the Lancaster Courthouse, serving much of the northern portions of the county. After the program demonstrated its ability to successfully divert individuals with misdemeanor cases, it began to take on individuals with felony cases. The program has served a large volume of clients: Even just focusing on March 2022 to April 2024, more than 4,300 people have been clinically evaluated, with nearly two-thirds being approved, and more than 1,200 have been diverted. Our analysis suggests that at least 53 percent of individuals diverted go on to graduate from the program. And rates of recidivism are low among program graduates; among the 669 public defender clients who have graduated from the program since it began, 607 (91 percent) have not had a new case filed for an offense occurring after their graduation.

Although the program has grown substantially, it has faced challenges in implementation. These include

• concerns about relying on the brief evaluation and diversion report as the program expands to individuals with more-serious charges
• challenges linking certain clients to treatment, especially those with mental health diagnoses only or dual diagnoses, individuals with complex medical issues or physical disabilities, and undocumented individuals
• turnover and high caseloads among case managers, who are in a demanding role
• philosophical resistance among some partners within the county, which affects current sites and expansion efforts.

At the same time, the program has considerable strengths, including

• a rapid timeline (compared with traditional mental health diversion), which is possible because of the collaborative efforts of attorneys, clinical evaluators, service navigators, and case managers
• mutual respect between attorneys and clinicians
• the understanding that mental health and substance use disorder recovery is not a linear process
• the dedication and availability of case managers who are respected and trusted by clients
• the development of formal procedures, a memorandum of understanding, and standardized forms to support growth and expansion.

RDP graduates emphasized how this program gave them a new chance at life and supported their growth throughout their participation.

Recommendations

We developed several recommendations based on these findings. Some of these recommendations relate to the nature of RDP and factors within the program and its implementation partner organizations. Other recommendations are more related to the larger context in which the program operates, such as funding and availability of services.

Recommendations Related to RDP and Implementation Partners

We recommend the following actions related to RDP and implementation partners:

• Improve awareness of the program among implementation partners. This could include development of a one-pager program description and attorney trainings that come with participation incentives.
• Formalize program documentation. This could include development of a detailed program guide, including courthouse-related variations and the cases that may be reasonable for exception protocol requests.
• Revisit the exception protocol process. Much of the tension that arises between the defense and the prosecution relates to this process, and it may be worth considering whether the process could involve an expanded evaluation.
• Create more opportunities for formal contact between the defense and prosecution to build stronger relationships. More regular meetings or participation in cross-training can help build relationships and trust.
• Provide sufficient support for case managers. Case managers have a challenging job, and strategies to mitigate burnout could include reducing caseloads, sharing caseloads, and providing professional development opportunities.
• Collect and share data frequently with implementation partners. Transparency will help build trust among partners, and sharing data can be the basis for quality improvement initiatives.

Recommendations Related to the Larger Implementation Context

We recommend the following actions related to the larger implementation context:

• Provide additional funding to support dedicated staff roles within the program. Having a fully dedicated staff member at each courthouse could support implementation of the previous recommendations and ensure that responsibility for supporting implementation is distributed across more individuals.
• Fund dedicated treatment centers that can be used for RDP clients. More dedicated treatment beds could help to ensure that RDP clients obtain an initial treatment placement faster, allowing them to be out of custody and begin treatment sooner and facilitating the process of linkage to the next treatment.
• Improve collaboration and interagency partnership within the county. This includes improving the relationship between RDP and other agencies, such as the Office of Diversion and Reentry, and strengthening the role of the Los Angeles County Justice, Care and Opportunities Department in overseeing and supporting implementation.