Criminal Justice Services Research Articles

Heterogeneity in Algorithm-Assisted Decision-Making: A Case Study in Child Abuse Hotline Screening

Algorithmic risk assessment tools are now commonplace in public sector domains such as criminal justice and human services. These tools are intended to aid decision makers in systematically using rich and complex data captured in administrative systems. In this study we investigate sources of heterogeneity in the alignment between worker decisions and algorithmic risk scores in the context of a real world child abuse hotline screening use case. Specifically, we focus on heterogeneity related to worker experience. We find that senior workers are far more likely to screen in referrals for investigation, even after we control for the observed algorithmic risk score and other case characteristics. We also observe that the decisions of less-experienced workers are more closely aligned with algorithmic risk scores than those of senior workers who had decision-making experience prior to the tool being introduced. While screening decisions vary across child race, we do not find evidence of racial differences in the relationship between worker experience and screening decisions. Our findings indicate that it is important for agencies and system designers to consider ways of preserving institutional knowledge when introducing algorithms into high employee turnover settings such as child welfare call screening.

Utilisation and costs of mental health-related service use among adolescents.

The high level of care needs for adolescents with mental health conditions represents a challenge to the public sector, especially in low and middle-income countries. We estimated the costs to the public purse of health, education, criminal justice and social care service use associated with psychiatric conditions among adolescents in Brazil; and examined whether the trajectory of psychopathology and its impact on daily life, and parental stigma towards mental illness, was associated with service utilisation and costs. Data on reported service use among adolescents from a prospective community cohort (n = 1,400) were combined with Brazilian unit costs. Logistic regression and generalised linear models were used to examine factors associated with service use and associated costs, respectively. Twenty-two percent of those who presented with a psychiatric disorder used some type of service for their mental health in the previous twelve months. Higher odds of service use were associated with having a diagnosed mental disorder (either incident, [OR = 2.49, 95%CI = 1.44-4.30, p = 0.001], remittent [OR = 2.16, 95%CI = 1.27-3.69, p = 0.005] or persistent [OR = 3.01, 95%CI = 1.69-5.36, p<0.001]), higher impact of symptoms on adolescent's life (OR = 1.32, 95%CI = 1.19-1.47, p<0.001) and lower parental stigma toward mental illness (OR = 1.12, 95%CI = 1.05-1.20, p = 0.001). Average annual cost of service use was 527.14 USD (s.d. = 908.10). Higher cost was associated with higher disorder impact (β = 0.25, 95%CI = 0.12-0.39, p<0.001), lower parental stigma (β = 0.12, 95%CI = 0.02-0.23, p = 0.020) and white ethnicity (β = 0.55, 95%CI = 0.04-1.07, p = 0.036). The impact of mental health problems on adolescents' daily lives and parental stigmatising attitudes toward mental illness were the main predictors of both service use and costs.

The use of linked administrative data to explore the impact of formal social care services involvement in childhood on education and offending outcomes.

Young people who are care experienced are overrepresented in the criminal justice system and in general have worse outcomes in education than their non-looked after peers (DfE &amp; Hinds, 2019; Prison Reform Trust, 2017). Recent evidence has reported that children who have a social worker (classified as child in need or those with a child protection plan), but who do not enter the care system, can have worse outcomes in education than those children who are looked after (DfE, 2019b). There remains little research evidence about the extent to which children with a social worker become involved with criminal justice services or how the age, duration and nature of formal social care service involvement may impact on education and offending outcomes. Researchers have been challenged by the lack of a sufficiently sized quantitative data, that crossed social care, education and offending domains. In work funded by ADR-UK, the present research project uses the newly linked DfE-MoJ administrative dataset to explore how different forms of formal social care services involvement impacts on education and criminal justice outcomes. Multi-level models will explore the role of formal child social care services amongst other multi-systemic risk and protective factors for education and offending. The presentation of his work will include preliminary statistics and insights into the challenges and potential further use of the linked dataset for researchers.

Non-Indigenous privilege in health, justice and social services preceding first episode psychosis: A population-based cohort study.

There is evidence of disparities between non-Indigenous and Indigenous incidence of psychotic disorders. Despite these disparities being a clear signpost of the impact of structural racism, there remains a lack of evidence to target institutional factors. We aimed to investigate non-Indigenous and Indigenous differences in government service use prior to first episode diagnosis as a means of identifying points of intervention to improve institutional responses. We used a previously established national New Zealand cohort of 2385 13 to 25-year-old youth diagnosed with psychosis between 2009 and 2012 and a linked database of individual-level multiple government agency administration data, to investigate the differences in health, education, employment, child protection and criminal-justice service use between non-Indigenous (60%) and Indigenous youth (40%) in the year preceding first episode diagnosis. Further comparisons were made with the general population. A high rate of health service contact did not differ between non-Indigenous and Indigenous youth (adjusted rate ratio 1.0, 95% confidence interval [0.9, 1.1]). Non-Indigenous youth had higher rates of educational enrolment (adjusted rate ratio 1.2, 95% confidence interval [1.1, 1.3]) and employment (adjusted rate ratio 1.2, 95% confidence interval [1.1, 1.3]) and were 40% less likely to have contact with child protection services (adjusted rate ratio 0.6, 95% confidence interval [0.5, 0.8]) and the criminal-justice system (adjusted rate ratio 0.6, 95% confidence interval [0.5, 0.7]). Both first episode cohorts had a higher risk of criminal justice contact compared to the general population, but the difference was greater for non-Indigenous youth (risk ratio 3.0, 95% confidence interval [2.7, 3.4] vs risk ratio 2.0, 95% confidence interval [1.8, 2.2]), explained by the lower background risk. The results indicate non-Indigenous privilege in multiple sectors prior to first episode diagnosis. Indigenous-based social disparities prior to first episode psychosis are likely to cause further inequities in recovery and will require a response of health, education, employment, justice and political systems.

Premature mortality in people affected by co-occurring homelessness, justice involvement, opioid dependence, and psychosis: a retrospective cohort study using linked administrative data

SummaryBackgroundHomelessness, opioid dependence, justice involvement, and psychosis are each associated with an increased risk of poor health and commonly co-occur in the same individuals. Most existing studies of mortality associated with this co-occurrence rely on active follow-up methods prone to selection and retention bias, and focus on a limited set of specific exposures rather than taking a population-based approach. To address these limitations, we did a retrospective cohort study using linked administrative data.MethodsIn this retrospective cohort study, we linked a population register of adults resident in Glasgow, UK, to administrative datasets from homelessness and criminal justice services; community pharmacies; and a clinical psychosis registry with data from April 1, 2010 to March 31, 2014. Linkage to death registrations from April 1, 2014 to March 31, 2019 provided follow-up data on premature mortality (age <75 years) from all causes, non-communicable diseases, and causes considered potentially avoidable through health-care or public health intervention. We estimated hazard ratios (HR) using Poisson regression, adjusting for age, gender, socioeconomic deprivation, and calendar time.FindingsOf 536 653 cohort members, 11 484 (2·1%) died during follow-up. All-cause premature mortality was significantly higher among people with multiple exposures than among people with single exposures, and among people with any exposure than among people with none (eg, homelessness plus other exposures vs no exposures: HR 8·4 [95% CI 7·3–9·5]; homelessness alone vs no exposures: HR 2·2 [1·9–2·5]). Avoidable premature mortality was highest among those with multiple exposures (eg, imprisonment plus other exposures vs no exposures: HR 10·5 [9·1–12·3]; imprisonment alone vs no exposures: HR 3·8 [3·0–4·8]). Premature mortality from non-communicable disease was higher among those with any exposures than among those with none, despite accounting for a lower proportion of deaths in the exposed group; although in some cases there was little difference between estimates for single versus multiple exposures.InterpretationThe co-occurrence of at least two of homelessness, opioid dependence, justice involvement, or psychosis is associated with very high rates of premature mortality, particularly from avoidable causes of death, including non-communicable disease. Responding to these findings demands wide-ranging efforts across health-care provision, public health, and social policy. Future work should examine the timing and sequencing of exposures to better understand the causal pathways underlying excess mortality.FundingChief Scientist Office, Medical Research Council, NHS Research Scotland.

Working With Survivors of Human Trafficking: Results From a Needs Assessment in a Midwestern State, 2019.

While the needs of human trafficking survivors have been documented in the academic discourse, the saliency of such needs is understudied. This study aimed to reveal the critical needs of service provision for human trafficking survivors in a Midwestern state as perceived by multidisciplinary service providers. Targeting health care, social service, law enforcement, public health, and other service providers involved in anti-human trafficking service delivery, we disseminated a survey using purposive and snowball sampling. Drawing from survey responses collected in 2019 from 107 service providers working with 422 survivors of human trafficking in the previous 12 months in a Midwestern state, we examined the saliency of needs from the perspective of service providers in the health care, criminal justice, and social service sectors. Respondents indicated on a Likert scale (1-5) the level of need for 37 social, health care, and legal services in their communities. The top-indicated needs statewide were mental health care, shelter/housing, peer mentorship programs, legal services, transportation, and provider training in juvenile courts, schools, law enforcement, and health care settings on human trafficking. The results suggest the need for statewide responses, such as legal assistance networks, telemental health options, and enhanced training collaborations between interpersonal violence and anti-human trafficking service providers. The study findings are generalizable beyond the study site in 3 ways that can guide strategic action: (1) they provide a framework for state-level analysis and strategic planning that parallels the results; (2) they show that regional variation is possible and should be accounted for in state-level study design, analysis, and strategic planning; and (3) the implications for housing assistance, legal assistance, mental health/substance use disorder-related health care, and training are scalable.

Mental health, perceived consensus of coparenting, and physical health among incarcerated fathers and their nonincarcerated, romantic partners.

Incarcerated fathers and their coparenting partners experience serious challenges to their health and well-being, beyond the general population. The interdependent nature of romantic involvement and coparenting a child suggests that self-reported mental health and the perceived consensus of the coparenting relationship may predict the physical health of not only the individual, but their partner. We use Actor-Partner Interdependence Modeling (APIM) for 483 romantically involved coparents from the Multisite Family study on Incarceration, Parenting, and Partnering to explore this link. Each dyad consists of an incarcerated male and a nonincarcerated female. Results indicate a significant link between mental and physical health for each dyad member (actor effects). Additionally, a partner effect links perceived consensus of coparenting from men to women, indicating that women whose partners reported a higher perceived consensus of coparenting also reported better physical health. Implications for marriage and family therapy, criminal justice, health, and human services policy are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Immediate Needs and Systemic Solutions: Harnessing a Collective Crisis Response by Regional Philanthropy Alongside Systemic Change

On March 13, 2020, the Community Foundation for Greater Buffalo invited the John R. Oishei Foundation, the Health Foundation for Western & Central New York, and United Way of Buffalo & Erie County to convene all funders in western New York to respond collectively to the impending COVID-19 crisis. Funding was raised swiftly and, using a racial equity lens, more than $14.2 million was granted in 18 months to more than 400 nonprofits of all sizes serving on the front lines in eight counties. While emergency funding was the first priority for the collective group of more than 60 foundations, the magnitude of the response found the participants answering an important question in May 2020: How do we use this moment and this unprecedented collaboration to innovate and strengthen the region’s ability to face the future? We quickly launched proactive systems-change initiatives to address public policy and develop a robust regional food system. To surface additional collaborative solutions, we issued a “request for ideas” to seek out visionary concepts from nonprofit leaders that were collaborative, included multiple sectors, and addressed persistent challenges by centering race and lived experience. After an overwhelming response, grants were awarded to develop concepts in housing and homelessness, health equity, education, arts and culture, substance use disorders, criminal justice, digital literacy, and refugee services. This transformational work continues with implementation funding for the majority of the plans, which were selected with community input.

A Pilot Study of Service Utilisation Pathways of Patients With Distinct Psychotic and Antisocial Typologies

AimsThere is a developing body of research that suggests that there may be distinct categories of patients that can explain the relationship between psychosis and antisocial behaviours. Specifically, three pathways of offending, antisocial behaviour and psychosis have been described and there is an evolving empirical evidence base to suggest that these pathways are aetiologically distinct. Firstly, there is a pathway for early-start offenders, which have been identified as those with psychosis preceded by Conduct Disorder (SZ + CD). Secondly, a group that start to display antisocial behaviours in parallel to the onset of psychosis (SZ-AS). The third group involves those with a long history of a psychotic disorder and no history of antisocial behaviours, who will present to services following a first conviction for non-violent or violent crime (SZ). The authors hypothesise that each typology will utilise services differently throughout the clinical trajectory. This pilot study aimed to (i) examine the concurrent validity of the antisocial behaviour and psychosis typologies, and (ii) examine differences in the service utilisation patterns of patients between these groups.MethodsThe sample consisted of adult male patients admitted to low and medium secure forensic hospitals within the Northwest of England. A total of 90 patients were used.A categorisation checklist was developed, and the typology of patients determined from data collected from electronic health records. Data were collected on patient demographics, psychiatric diagnosis, aetiological factors, and service utilisation. Two researchers reviewed the data and determined the typology. Statistical analysis aimed to assess the difference in aetiological variables between the typologies and examine the relationship with how each typology utilised services.ResultsThis study provided further evidence of distinguishing characteristics emphasising typology heterogeneity.The CD-SZ group were more likely to have utilised mental health services &lt;18 years (70%, p = 0.062), and to have used services preceding a diagnosis of psychosis (60%, p = 0.011). Following the onset of a psychotic disorder, the AS-SZ and SZ groups had a higher proportion that used general adult psychiatry services (p = 0.031), with CD-SZ coming in to contact with forensic psychiatry services and criminal justice services earlier and more frequently.ConclusionThis study demonstrates that each typology has a different clinical trajectory through mental health services. This provides further empirical evidence towards different clinical typologies and trajectories of individuals with psychosis and anti-social behaviour. Understanding more about how these typologies utilise services will enable clinicians to introduce interventions help develop effective management plans that address the distinct characteristics of each typology of offender with psychosis.

State of Hate in Greater Buffalo

In a time of increased hate, understanding hate in the immediate world that surrounds us has become essential to engaging with greater society. This report discusses hate and inter-community relations in the Buffalo-Niagara region of Western New York, one of the most segregated metros in the nation and the second most densely populated area in New York State. Data from the New York State Division of Criminal Justice Services (DCJS), Federal Bureau of Investigation (FBI) Uniform Crime Reporting (UCR) Program, and Anti-Defamation League (ADL) indicate that hate and hate crimes, specifically antisemitic hate crimes, maintain a pervasive presence in Buffalo-Niagara. To address antisemitism, Buffalo-Niagara’s Jewish community has successfully come together with the help of community organizations. Their model of addressing hate can be applied more generally across the region. Interviews with 18 community members and leaders were conducted to gather insights into intra-community realities and inter-community relations of living in Buffalo-Niagara. These insights reflect lacking measures for anti-hate action within communities and, in many cases, non-existent relationships between communities. This report thus seeks to serve as a resource for community members to identify allies across Buffalo-Niagara that seek to develop inter-community relationships and address hate in all its forms. Knowledge of reporting mechanisms and organizations across Buffalo-Niagara will enable the region’s communities to find allyship among one another, promote mutual respect, facilitate cultural understanding, and unearth common ground that will undercut and contribute to driving out hate. Lists and maps of these organizations have been generated and included below using information collected through interviews as well as online listings. The report closes with final takeaways to keep in mind moving forward.

Crisis Work Embedded in a Global Crisis: The Early Phase Impact of COVID-19 on Survivors of Intimate Partner Violence and Service Provisions.

COVID-19, as a global pandemic, was a public health inflection point for individuals affected by intimate partner violence (IPV) and those who provide IPV services. Public health guidelines that were intended to reduce risk of exposure to the virus impacted vulnerability factors for IPV survivors and associated systems of services. We aimed to (1) explore the effect of COVID-19 on survivors of IPV; (2) assess the effect of COVID-19 on IPV-related service provisions and service providers; and (3) explore challenges and opportunities in the wake of COVID-19 on broader IPV services and advocacy. Method: Twelve directors of IPV shelter, criminal justice, and other advocacy services within a diverse, Midwestern metropolitan area were recruited to participate in in-depth, semi-structured interviews in June–August 2020. Interviews were transcribed verbatim and analyzed using Dedoose. Data were coded and analyzed through thematic analysis. Results: Four major themes, contextualized by COVID-19 and racial injustice, emerged from the data analysis: (1) IPV-related trends; (2) impact on IPV survivors, services, and agency morale; (3) inter-agency collaborations; and (4) future opportunities for innovative service delivery. Gaps and opportunities for developing culturally congruent, trauma-informed services were identified. Conclusion: Findings suggest that responsive and accessible IPV resources and associated advocacy services can make the difference between life and death for survivors.

Promoting Mental Health and Criminal Justice Collaboration Through System-Level Partnerships.

Recent high-profile deaths of unarmed individuals in police custody have raised concerns about the role of police officers in responding to people who are experiencing mental health crises. Of further concern, people with serious mental illness are highly over-represented throughout the entire criminal justice system including within jail, prison and community corrections populations. It is widely accepted that promoting mental health and criminal justice collaboration is a key to addressing these concerns. Promoting effective collaboration is challenging, however, due to fundamental differences in cultures and methods that exist between mental health and criminal justice service providers. To promote effective collaboration between service providers, a conceptual framework was recently published that divides the collaborative process into separate steps and outlines respective responsibilities at each step. Yet optimal collaboration between mental health and criminal justice service providers requires the support of their respective supervisors and agency heads. This paper extends previous work at the service provider level by applying the conceptual framework to promote effective collaboration at the systems level (i.e., between agencies). Barriers to inter-agency collaboration are discussed, and strategies for facilitating collaboration at each step of the collaborative process are presented.

Profiles of individuals with cannabis-related disorders

Background: Profiles of individuals with cannabis-related disorders (CRD) in specialized addiction treatment centers serving high-need patients have not been identified. This longitudinal study developed a typology for 9,836 individuals with CRD attending Quebec (Canada) addiction treatment centers in 2012–2013. Methods: Data on sociodemographic, clinical and service use variables were extracted from several databases for the years 1996–1997 to 2014–2015. Individual profiles were produced using Latent Class Analysis and compared predicting health outcomes on emergency department (ED) use, hospitalizations and suicidal behaviors for 2015–2016. Results: Six profiles were identified: 1-Older individuals, many living in couples and working, with moderate health problems, receiving intensive general practitioner (GP) care and high continuity of physician care; 2-Older individuals with chronic CRD, multiple social and health problems, and low health service use (chronic CRD referred to experiencing CRD for several years; social problems related to homelessness, unemployment, having criminal records or living alone); 3-Students with few social and health problems, and low health service use; 4-Young adults, many working, with few health problems, least health service use and continuity of physician care; 5-Youth, many working but some criminal offenders, with 1 or 2 years of CRD, few health problems and high addiction treatment center use; and 6-Older individuals with chronic CRD and multiple social and health problems, high health service use and continuity of physician care. Profiles 6 and 2 had the worst health outcomes. Conclusions: For Profiles 2 to 5, outreach and motivational services should be prioritized, integrated health and criminal justice services for profile 5 and, for Profiles 2 and 6, assertive community treatments. Screening, brief intervention and referrals to addiction treatment centers may also be encouraged for individuals with CRD, particularly those in Profile 2. This cohort had high social and health needs relative to services received, suggesting continued need for care.

Determinants of Poor Health among Workers in Criminal Justice, Community and Social Services, and Healthcare: Adverse Childhood Experiences, Workplace Trauma Exposure, and Gender Differences

Determinants of Poor Health among Workers in Criminal Justice, Community and Social Services, and Healthcare: Adverse Childhood Experiences, Workplace Trauma Exposure, and Gender Differences

Determinants of Poor Health among Workers in Criminal Justice, Community and Social Services, and Healthcare: Adverse Childhood Experiences, Workplace Trauma Exposure, and Gender Differences

Adverse childhood experiences and workplace trauma exposure are associated with poor health. However, their differential impacts by gender are difficult to assess in studies of organizations with gender imbalances (e.g., law enforcement officers are more likely men whereas social workers are more likely women). Using a community-based participatory research framework, this study examines trauma exposure, mental and physical health, and substance use in an occupationally diverse sample (n = 391). Trauma exposure was high and associated with poor health. Even though women experienced more adversity, they were often more resilient than men. Implications for trauma-informed workplaces are discussed.

Parent abuse by dependent adult children living in the family home: a gap in the service?

ABSTRACT Research is beginning to examine the abuse of parents by their children but has tended to focus on adolescent-to-parent abuse where the child is aged between 10–17 years, or elder abuse where the victim is of post-retirement age. This article examines an under-recognized form of family violence that involves the abuse of parents by their dependent adult-aged children living in the family home. This article draws on data from an evaluation of a police-social services response to family violence in Australia, as well as de-identified case files involving child respondents aged 18-years-and-over to examine the nature of this type of family violence and the service responses to such cases. The data suggest that parent abuse by dependent adult children is a unique issue that currently lacks research and specialized responses within the family violence service system. We consider the changing dynamic of family structures and how this might impact parent abuse by dependent adult children living in the family home. We also discuss the potential effectiveness of varying criminal justice and social service responses and propose that a tailored response which acknowledges the complexity and dynamics of family relations involving dependent adult children is required.

This is how it Feels: Activating Lived Experience in the Penal Voluntary Sector

Abstract Increasing calls for ‘nothing about us without us’ envision marginalized people as valuable and necessary contributors to policies and practices affecting them. In this paper, we examine what this type of inclusion feels like for criminalized people who share their lived experiences in penal voluntary sector organizations. Focus groups conducted in England and Scotland illustrated how this work was experienced as both safe, inclusionary and rewarding and exclusionary, shame-provoking and precarious. We highlight how these tensions of ‘user involvement’ impact criminalized individuals and compound wider inequalities within this sector. The individual, emotional and structural implications of activating lived experience, therefore, require careful consideration. We consider how the penal voluntary sector might more meaningfully and supportively engage criminalized individuals in service design and delivery. These considerations are significant for broader criminal justice and social service provision seeking to meaningfully involve those with lived experience.

Street gangs and coercive control: The gendered exploitation of young women and girls in county lines

This article explores young women and girls’ participation in gangs and ‘county lines’ drug sales. Qualitative interviews and focus groups with criminal justice and social service professionals found that women and girls in gangs often are judged according to androcentric, stereotypical norms that deny gender-specific risks of exploitation. Gangs capitalise on the relative ‘invisibility’ of young women to advance their economic interests in county lines and stay below police radar. The research shows gangs maintain control over women and girls in both physical and digital spaces via a combination of threatened and actual (sexual) violence and a form of economic abuse known as debt bondage – tactics readily documented in the field of domestic abuse. This article argues that coercive control offers a new way of understanding and responding to these gendered experiences of gang life, with important implications for policy and practice.

A retrospective records study of patterns in mental health and criminal justice service use by people found not criminally responsible on account of mental disorder.

While the presence or absence of previous healthcare and criminal justice system (CJS) contacts in the histories of mentally ill offenders has been well-studied, the frequency of these contacts and when they occur in the period leading up to an index criminal event has received less research attention. To explore patterns of healthcare and CJS use in the year prior to a criminal act leading to a Not Criminally Responsible on Account of Mental Disorder (NCRMD) finding in Canada. In this 3-year retrospective records study, the case files of all patients newly admitted to the British Columbia forensic psychiatric system after a finding of NCRMD between 1st July 2012 and 31st July 2015 were reviewed. Data were extracted on healthcare and CJS use for the 12months before the act leading to the NCRMD finding. Time-based descriptive statistics and two-step cluster analysis were used to investigate service use patterns. Among 94 eligible patients, only four had no service contacts in the year leading up to the index event, leaving 90 in the cohort for further analysis. On average, these 90 patients had seven contacts with health or criminal justice services in the year prior to the index offence. Cluster analysis revealed a high healthcare pathway group who had had many healthcare and few CJS contacts; a limited service user group who had had few contacts of any kind and a heavy service user group who had had a high volume of contacts with both types of service providers. The different patterns of patient contact prior to the index event imply that each practitioner-type has distinct and temporally relevant opportunities to provide preventative interventions to their patients or user groups.

Evaluation of a Police-Mental Health Co-response Team Relative to Traditional Police Response in Indianapolis.

Criminal justice and emergency medical service (EMS) outcomes were compared for individuals experiencing a behavioral health crisis who received a response from a co-response team (CRT) or a usual response from the police after a 911 call. A prospective, quasi-experimental design was used to examine outcomes of a CRT pilot tested in Indianapolis (August-December 2017). Weighted multivariable models examined effects of study condition (CRT group, N=313; usual-response group, N=315) on immediate booking, emergency detention, and subsequent jail bookings and EMS encounters. Sensitivity of outcomes to follow-up by a behavioral health unit (BHU) was also examined. Individuals in the CRT group were less likely than those in the usual-police-response group to be arrested immediately following the 911 incident (odds ratio [OR]=0.48, 95% confidence interval [CI]=0.25-0.92) and were more likely to experience any EMS encounter at 6- and 12-month follow-up (OR range=1.71-1.85, p≤0.015 for all). Response type was not associated with jail bookings at 6 or 12 months. Follow-up BHU services did not reduce bookings or EMS encounters. CRT recipients with BHU follow-up were more likely than those without BHU follow-up to have a subsequent EMS contact (OR range=2.35-3.12, p≤0.001 for all). These findings differed by racial group. CRT responses may reduce short-term incarceration risk but not long-term EMS demand or risk of justice involvement. Future research should consider the extent to which CRT and follow-up services improve engagement with stabilizing treatment services, which may reduce the likelihood of future crises.