Enhancing Health Outcomes for Justice-Involved People in South King County

Grantee: Peer Washington
Timeframe: July 2023 – June 2024 | Amount: $198,764.64

Healthcare Disparity: Behavioral health needs have not just continued to rise across King County but have accelerated. Public Health Seattle & King County (PHSKC)’s 2022 Overdose Death Report noted a 20% increase in overdose deaths from 2019 to 2020, followed by a 39% jump from 2020 to 2021. Rates of deaths in South King County cities such as SeaTac/Tukwila and Auburn, second only to numbers from downtown Seattle, hit 67 per 100,000 people in 2021, with the incidence rate doubling over just two years.

Marginalized populations, including individuals who are BIPOC and/or LGBTQ+, have long been disproportionately impacted by behavioral health issues and the disparity is growing. For example, according to the PHSKC 2022 report, the incidence of fatal overdose for non-Hispanic Black individuals went from 0.4 times greater than that of non-Hispanic Whites in 2013-2019 to 2.5 times greater in 2021. Even prior to the pandemic, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported rates of behavioral health challenges among the LGBTQ community were 3 to 4 times those of the general population. A 2021 report from the Kaiser Family Foundation found 3/4 of people identifying as LGBTQ polled said the pandemic had negatively impacted their mental health, compared to half of their heterosexual peers, with twice as many in the former group saying the impact was major.

Poverty is also increasingly concentrated in south county communities. The 2021/2022 King County Community Health Needs Assessment notes SDoH concerns in South King County communities that include higher rates of unemployment and food insecurity, and lower levels of educational attainment and access to health insurance compared to the county as a whole. Rates of frequent mental distress peaked at 17.9% for adults in the South King County communities of Federal Way and Auburn, well above average countywide rates.

The justice system is a major point of intersection, where individuals living in poverty, who are BIPOC, LGBTQ+ or from other marginalized communities, and those who have behavioral health challenges are all disproportionately represented. According to the National Alliance on Mental Health (NAMI), Black people are 3.5-5 times more likely to be incarcerated. They also report data from the Bureau of Justice that as many as 50% of individuals in jails have been told by a mental health professional that they have a mental illness. Similarly, data in the 2019 National Survey on Drug Use and Health found LGBTQ individuals were 2.25 times more likely to have been arrested over the previous 12 months and 3 times more likely to be incarcerated. Lesbian and bisexual women are a disturbing 4 times more likely to be arrested than their straight peers. Over the last several years there has been a growing recognition that jails and prisons, along with the broader law enforcement and justice systems, are contributing to systematically perpetuating devastating health and wellness impacts for marginalized populations and communities.

Use of Funds to Address Disparity: In 2018, Peer Washington was approached by King County’s Drug Diversion Court (KCDDC) to replicate Peer WA’s peer recovery services model for their justice-involved population. In 2020, Peer Washington was able to bring Peer WA’s peer services model to South King County, opening a new location in Kent to help fill the major gap in community-based peer services in the region. Peer Kent, with its full range of peer support services, also took on the management of Peer WA’s KCDDC partnership peer services program in alignment with its focus on serving justice-involved individuals as a priority population. Peer WA’s KCDDC collaboration, embedding peer services within a county-level drug diversion court, has proven highly successful. Yet despite the project’s documented outcomes (see question #5 “Project Outcomes”), no South King County jurisdiction—neither municipal nor district court levels—had moved to implement the model.

An opportunity for change was also opened by the February 2021 ruling by Washington State’s Supreme Court in State v. Blake that declared the state’s main simple drug possession statute to be unconstitutional and void. Following that decision, Washington’s legislature passed ESB 5476 which among other things, requires that the first two times an individual is stopped for drug possession they must be offered diversion rather than being arrested. On the third through fifth times an individual is stopped for drug possession, they may be arrested, but prosecutors have enhanced leeway whether to charge the individual or divert to community services and supports. This created a window of opportunity to rethink and reshape the intersection of multiple systems—law enforcement, criminal justice, behavioral health, community-based SDoH services—with the potential to have truly significant health and wellness impacts for historically marginalized populations.

Recognizing this opportunity for change, in 2021, Federal Way Municipal Court Judge David Larson approached Peer Washington about partnering in a pilot project. Judge Larson subsequently obtained a grant from the state’s Criminal Justice Treatment Account (CJTA) to integrate Peer Services Specialists (PSSs) into key intercept points (i.e., contact points individuals have with the justice system beginning in the community and spanning throughout diversion, arrest, charge, hearings, court proceedings, jail, reentry, etc.) in the justice system. In January 2022, Peer Washington signed a formal agreement with the Federal Way and Des Moines Municipal Courts, launching the South King County Municipal Court Peer Integration Project (SKCMCPIP). The project expanded to include a third municipal court system (Renton) later in the year with HealthierHere Innovations grant funding.

Today, the SCKMCPIP includes a team of 3 full-time PSSs and 1 Program Manager who provide services to justice-involved individuals engaged with the Federal Way, Des Moines, and Renton Municipal Courts and SCORE jail. The embedded PSSs complete the following activities:

• Invite individuals who have come into contact with the court system to access peer support services;
• Conduct an assessment of individual needs, including needs for behavioral health treatment, recovery supports, or other SDoH services or resources;
• Provide direct onsite peer support services such as emotional support and resource referral;
• Link individuals with Peer Kent’s full continuum of peer support services; and
• Provide onsite referrals and/or warm hand-offs for individuals to appropriate behavioral health treatment providers and other SDoH services and resource providers.

Peer WA’s formal partners for the SCKMCPIP are the three court systems with which Peer WA has signed agreements in place. Peer WA has also developed a strong relationship with SCORE Jail, including being added to their list of entities that detainees can call for no charge and being approved to come meet in-person with detainees. Peer WA works extensively with a broad range of treatment, health, and SDoH providers across and beyond South King County. Just a sampling of entities that Peer WA partner with regularly on behalf of SKCMCPIP participants include Evergreen Treatment Center, Valley Cities, Fusion (transitional housing for families), Recovery Place Seattle, Triumph Treatment Services (located in Yakima), Asian Counseling and Referral Service, Ideal Options, and the MATCH opiate assessment program.

Involvement of Population: As a peer-based entity, Peer Washington follows a “nothing about us without us” approach in all Peer WA’s programs and services. Peer WA is continually inviting input and feedback from Peer WA’s members including through informal conversations, by people expressing their preferences and showing us what works and what does not work by how, when, and what they opt to participate in, and by providing various opportunities for people to step into volunteer roles so they can directly help shape services. Peer WA’s programs and services continually evolve based on Peer WA’s members’ changing interests, needs, and challenges.

Learning from project participants and from Peer WA’s justice system partners has been a major focus of the first year of the SKCMCPIP. There has been a steep learning curve during the pilot. Project PSSs are daily in conversation with participants, learning from them about their needs and challenges, as well as about their strengths and resilience. The PSSs bring that information back to the weekly team meeting and use it to inform both the types of services and the way in which they are delivered. Based on this impact, the team has evolved how it works over the year. Peer WA plan to continue this approach to soliciting and employing participant input. In addition, people who first engage through this project are invited to become Peer Kent members where they will have additional avenues to provide input and help shape programs and services.

ABOUT OUR GRANTEE

Peer Washington

Peer WA’s mission is to cultivate powerful, healthy lives by providing peer emotional support and development services to those impacted by addiction, mental health issues, and/or HIV/AIDS.