By Catherine R. Counts, P1 Contributor

The Camden Coalition of Healthcare Providers, known for its work focusing on high utilizers within the healthcare setting, teamed up with the Camden County Police Department for one of the most comprehensive evaluations of the crossover between high-utilizing patients and repeat offenders.

This collaboration, known as Camden ARISE (Administrative Records Integrated for Service Excellence), looked at arrest data and hospital claims data within Camden, New Jersey, from 2010 to 2014. It stemmed from the hypothesis that “there is a relationship between the factors that contribute to both negative public safety outcomes and negative public health outcomes.” A report summarizing the findings and lessons learned was recently published.

Findings from Camden ARISE

The authors of the report discovered some generalizable lessons from their work:

1. Pareto’s Principle applies to arrests.

The Camden Coalition previously gained notoriety for demonstrating Pareto’s Principle can be applied to healthcare; that a small number of patients make up a large portion of healthcare utilization. The ARISE data shows similar trends with arrests, 5% of those over 18 that were arrested made up 25% of all arrests.

2. There is a correlation between frequent hospital use and arrests.

During the five-year study period, two of every three arrestees made at least one trip to the emergency department, and nearly 55% of arrestees made five or more trips over that same period. Looking at the data from the perspective of the hospital, 32% of patients with six or more ED visits would be arrested during the same period.

Both entities focus their energy at the encounter level, whereas the individuals bouncing between the healthcare and criminal justice systems are living outside of the stability of those systems. This means that upon discharge or release, they are unable to sustain the status quo and relapse into one of the two systems.

3. Super-users of both systems share unique characteristics.

There were 226 individuals who fell into the top 5% for both emergency department visits and arrests over the five-year study period. Ninety-five percent of the nearly 3,700 arrests of these super-users were for nonviolent offences. The median number of ED visits during the five-year study period for this group was 25, and they were four times more likely to be admitted to the hospital than all arrestees.

The researchers realized these individuals fell into four distinct categories:

Nonviolent, medically complex drug offenders – Mostly young men, these individuals were often arrested for disorderly conduct or drug possession, but never for an act of violence. At least 50% had suffered at least one drug overdose and most had a history of behavioral health issues or a serious mental illness. Nonviolent offenders often arrested for petty crimes with complex behavioral health histories – These individuals were typically middle-aged men with a high prevalence of housing instability. While they frequented the emergency departments, they were the category least likely to require hospital admission. Assault victims who would go on to become the assailant – These women were typically under 40 and suffered from addiction and other mental health issues. They were the group most likely to be arrested for violent crime and rarely arrested for drug-related offences. While they may perpetrate violence, individuals within this category were often admitted to the hospital for assault-related injuries suggesting they were often victims as well. Young men arrested for a variety of drug-related offences including some proportion of violent crime arrests – They were the least likely to require hospitalization during the study period and less likely to suffer from mental illness or any form of substance abuse history.

Perhaps more important than realizing there are distinct sub-groups within super-utilizers was the assertation that no one-size-fits-all solution would work across all four categories. Caring for such a medically and socially complicated population must be done in a way that mirrors their complexity.

This is true of any community.

Memorable quotes about the Camden ARISE program

Here are five memorable quotes from the report:

“Cross-sector data offer a more holistic view of the challenges these individuals face, telling a different story than the one we typically hear – a story with far-reaching public policy implications.”

“To hospitals, the illness is the problem; to the criminal justice system, the crime is the problem. Both systems also typically operate in information silos.”

“Have we chosen a seemingly quick fix, where we repeatedly funnel people who need treatment into our jails and hospitals, over solutions that foster the long-term safety and well-being of communities?”

“Research and practice are now moving away from a sole focus on criminogenic risk to a growing emphasis on services and interventions tailored to an individual’s crime- producing risk factors and responsivity to treatment.”

“In the end, the most important finding from this study may be that there is enormous value in fostering collaborative data sharing among agencies.”

Key takeaway for criminal justice leaders

Cross-sector data sharing and integration is a logical next step to better understand the social determinants of health that arrestees face. Until silos around the healthcare and criminal justice systems are broken, it will be impossible to fully understand the driving forces behind individuals frequenting both systems.

About the Author Catherine R. Counts is a health services researcher with Seattle Medic One in the Department of Emergency Medicine at the University of Washington School of Medicine. She received both her PhD and MHA from Tulane University School of Public Health and Tropical Medicine.

Dr. Counts has research interests in domestic healthcare policy, quality, patient safety, organizational theory and culture, and prehospital emergency medicine. She is a member of the National Association of EMS Physicians and AcademyHealth. In her free time she trains Bruno, her USAR canine. Connect with her on Twitter, Facebook, or her website.

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